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The purpose of this abstract is to report on the findings of a study that was investigating collaboration of nurses and doctors in selected health facilities in Country X. The abstract is focused on findings on risk factors for burnout among nurses and doctors.
Methods:
The setting for the study was three hospitals at varying levels of the complexity of care; and the design was a cross-sectional descriptive qualitative approach. The population was doctors and nurses working in the public sector and sampling was purposive. The study’s inclusion crireria were fluency in Englich and practice of at least six months in Country X. Twenty doctors and 19 nurses were interviewed face-to-face with the aid of an interview guide.
Results:
The sample had 22 females and 18 males and had age range of 27-54 years and in-country work experience ranging from one to 30 years.
Risk factors for burnout
Risk factors for burnout were identified as follows:
1. Lack of the right tools for doing the work.
The tools for doing the work include staffing, equipment, supplies such as medications, and infrastrucrure as uch intensive care unit and operating theatre space. The respondents observed that it was not only frustrating but that it was also risky that they could not meet people’s needs at a time when the society’s expectations and entitlements had increased.
1.1 Staffing:
Respondents reported shortage of both nurses and doctors. A common theme was that there were two or three nurses to 50 patients. Nurses were therefore finding it difficult to meet patient needs and often had to focus their attention on most acutely ill patients. The doctors were also short-staffed with the most serious situation being for specialists and other senior medical personnel. Doctors found the workload unbearable and the strain was more felt by junior doctors who had to be everywhere and who frequently could not respond to nurses’ call when there were patients to be attended to in different wards. There was also shortage of auxiliary personnel, particularly those who could run errands between the ward and depatment such as operating therate, laboratory and X-ray; therefore it was uncommon that nurses and doctors would be the ones running those errands. Several doctors reported that they had no social life because they were always at work. It was reported that some nurses were using ‘sick leave’ as one strategy for coping with the high work load.
1.2 Non-human resources:
A chronic shortage of commodities such medications, fulid and blood giving sets and other stuff such as hand towels and laryngoscopes was reported. One of the frustrating things about medications was that patients who can afford to buy medications from their pockets were not allowed to do that. Laboratory resources were also inadequate and one could not do all the tests that she/he would like to do. Other non-human resources that were needed in some health facilities were extra operating room space, intensive care unit and children’s intensive care unit. The shortage of medications and other resources was even more challenging fornewly qualified doctors because they did not get an opportunity to put theirr expertise in operation but consistently had to provide sub-standard care.
- 2. Poor Work Ethic
Doctors were concerned about the work ethic that they observed especially among the young generation of nurses and to some extent among doctors; whereas nurses reported the poor work ethic among the young generation of nurses and among doctors. There was a general ‘go slow attitude toward work that often resulted in delay in giving patients appropriate treatment and therefore compromized patient outcome. Doctors reported that nurses were unprofessional when interacting with them. At all levels and at all departments, people were said to be dragging their feet. The problem was compounded by a culture of the work environment in which everyone was his/her own boss, where nobody could reprimand any person and where no one could own responsibility and accountability when there were gaps in work performance.
- 3. Perceived Management Inefficiency
Respondents reported frustration with the way the health system was operating and its failure to bring the prevailing situation to order. Areas of frustrations included poor conditionds of service, centralized power and decision making, laxity in taking appropriate action against non-performers, lack of objectivity in treating local and foreign doctors, and unclear job descriptions for nurses and doctors.
3.1 Conditions of service:
Both nurses and doctors were concerned about low pay and slow career progression for nurses. Nurses themselves were feeling unappreciated by colleagues such as doctors, the community, and nurse managers. Even though nurses were working under serious constraints such as high workloads, management recognized their presence only when they had done something wrong and their mistakes tended to be exeggerated. They indicated that there was no way other colleagues could respect or appreciate nurses when nursing management was treating them like trash. Doctors also reported frustrations with heavy workloads, low pay, and lack of appreciation by management.
3.2 Centralized Power and Decision Making
Participants observed that managers at hospital level were not empowered to discipline employees. Every incident of staff misconduct had to be reported to the ministry with the result that it was taking too long for any action on the matter. Patient care was therefore suffering because nobody could discipline workers on the ground.
3.3 Laxity in taking appropriate action against non-performers
Doctors were frustrated that nurses were not assisting them in their work. Many times doctors’ orders were not instituted because nurses failed to communicate when, say, the medication was out-of-stock or they could not read the doctor's hand writing. They observed that the fact that nurses were not taken seriously could be one contrbutory factor to their ‘I don’t care’ attitude toward work. Nothing was being done to address the situation whereas it was clear that the exclusion of nurses from the ‘scarce skill’ category was one of the main areas of discontent.
3.4 Lack of Objectivity in Treating Local and Foreign Doctors
Local doctors reported that they were lowly remunerated and that the system was rewarding foreign doctors better. The system was content with importing specialist doctor and was not making any effort to develop local doctors into specialist; despite the fact that many wanted to specialize. On appointment, foreign doctors were given temporary housing whereas local doctors were nort. They reported that the best paid medical positions were in foreigner-staffed institutions that were in the country.
On the other hand, foreign doctors complained of the xenophobia that existed in the system; the xenophobia was felt right from immigration offices to the ministry, through the office of hospital superintendents, and to the patient’s bed side. They reported that local doctors were reluctant to consider ideas from foreign doctors and that it was difficult for them to change anything in the system. They observed that local doctors could afford to refuse to take up posting to rural areas whereas should a foreign doctor do that, he/she risked having his/her job terminated.
3.5 Unclear Job Descriptions for Nurses and Doctors
Doctor expressed concern about unclear job descriptions for nurses and doctors; and this mainly stemmed from nurses refusing to do some tasks, arguing that those tasks were not covered in their job description. Insertion of intravenous cannula was a frequent bone of contention because doctors could not understand why a nurse would call a doctor for a cannula instead of inserting it her/himself.
- Attitudes and Beliefs of the Clientele
Although some families of patients were appreciative of the services provided by nurses and doctors, generally, the clientele was reported to be unappreciative. Some patients and family members believed that they could dictate the terms of treatment to doctors or that a doctor must be able to solve all their problems. Health literacy of the clientele also appeared to have an influence in how health providers and families/patients appreciated the services. A doctor reported that some patient believed in a pill and could not appreciate non-medicinal advice such as diet. A nurse reported that some patients would keep on bringing the same problem whereas they were not prepared to take advice they were given; this was reported to put one in a dilemma of whether to continue providing the same advice or to let the patient know that it was counterproductive.
Conclusion:
Nurses and doctors working in Country X have a number of challenges that have a potential to expose then to burnout. It is important that such factors in the working environment are given attention in order improve job satisfaction and job retention. Further research that will quantify burnout among doctors and nurses is needed.