Background & Rationale: Burnout is a well-known phenomenon in healthcare and has been a hot topic in the literature for over 20 years. Current research on burnout in nursing has looked at this phenomenon among new graduate and experienced nurses. However, despite the unique characteristics and stressors of working in psychiatry, few studies have examined burnout in the psychiatry/mental health field, and work to date has focused on psychiatrists. Research is needed about psychiatric registered nurses, as their working environment has unique stressors that differentiate the psychiatric registered nurse’s role from that of other specialty areas. These stressors often include challenging situations such as suicidality or aggression, requiring intense one-on-one interactions with patients which can lead to emotional exhaustion. The proposed study will therefore address an important gap in knowledge about job burnout among psychiatric nurses.
Theoretical model: This research will test a theoretical model embedded within the Job Demands-Resources model. Specifically, the effects of structural empowerment (a job resource) on job burnout and subsequent perceptions of patient care quality among psychiatric nurses will be tested. Structural empowerment refers to workplace conditions that give employees the power to accomplish their work effectively. It has been consistently identified as an essential characteristic of a healthy nursing work environment and has been linked with lower levels of burnout and higher quality of patient care. It is logical to expect that psychiatric nurses who perceive their work environments to be structurally empowering experience lower levels of burnout because they have adequate resources to meet the demands of their work. Consequently, structural empowerment will also enable psychiatric nurses to deliver high quality of care to their patients. Finally, burnout is also hypothesized to mediate the effect of structural empowerment on patient care quality, such that high levels of structural empowerment lead to lower burnout, which in turn have a reduced negative effect on patient care quality.
Methods:
Study Design: After obtaining REB approval (September 2018) a cross-sectional mail survey will be conducted.
Sample: Approximately 400 registered nurses currently work in psychiatry/mental health in New Brunswick. To optimize response rates, all potential participants identified by the provincial nursing regulatory body (NANB) using their registry database will be included in the study. To be eligible for the study , registered nurses must be currently registered to work in New Brunswick, have self-identified as working in psychiatry/mental health, be working in a direct patient care role, and have given NANB permission to be contacted about opportunities to participate in research.
Measures: Demographic questions and validated self-report questionnaires will be used to measure the key study variables. Structural empowerment will be assessed using the Conditions for Work Effectiveness Questionnaire-II. Burnout will be measured using the Maslach Burnout Inventory – General Survey. Perceived quality of care will be measured using….
Data Collection: A survey package with a letter of information, survey, and addressed, stamped return envelope will be mailed to the home address of potential participants. As recommended by Dillman et al. to improve survey response rates, a reminder letter will be sent out to non-responders 4 weeks after the initial survey, followed by a second survey package 4 weeks after that.
Statistical Analysis: Once data collection has been completed (January, 2019), the validity and reliability of the study questionnaires will be examined using confirmatory factor analysis in Mplus and Cronbach’s alpha in SPSS. Descriptive statistics and linear regression analysis using the PROCESS macro will be used to test the hypothesized mediation model in SPSS.
Anticipated results: The results will show whether the proposed relationships in the hypothesized model are significant, and if so, to what degree.
Anticipated implications: This study will contribute to nursing research and practice in several ways. First, it will fill an important gap in our knowledge about structural empowerment, burnout, and quality of care among psychiatric registered nurses. Second, this research will add to the evidence base that formal nurse leaders in psychiatry settings can use to inform their leadership and management practices to create healthy, structurally empowering work environments, mitigate job burnout, and support high quality care. Lastly, this research will provide a foundation for further research, such as longitudinal and/or national/international studies, investigating the impact of work environment factors on psychiatric registered nurse and patient outcomes.