Occupational exhaustion and depersonalization

How do you perceive your work?" This question was asked of nurses in the cantons of Neuchâtel and Jura in November 2020, in the midst of the second Corona wave. The Neuchâtel/Jura section of the Swiss Nursing Association (SBK) wanted to conduct an observational study to find out how nurses perceive their profession and how demanding and exhausting it is.

The Maslach Burnout Inventory (MBI) was used for the survey, which was administered to the nurses via professional and social networks during two weeks. After data collection, the different underlying scores were calculated and a distinction was made between feelings of professional exhaustion, depersonalization and self-actualization.

The staff suffers

During the second wave of corona, covid cases in Switzerland seemed to increase exponentially, with an average of 500 new cases per day on October 7, 2020, which had increased to an average of 8600 cases per day by November 7. On November 1, the press informed about the saturation of the health system in the canton of Neuchâtel. In western Switzerland, nursing homes were particularly affected. Members of the SBC of the Canton of Jura approached the Section and told of their suffering at work. "I recently graduated, but I am already in the phase of incipient burnout; I handed in my resignation to my supervisor, who refused to accept it," recounts a young female nurse. Several professionals describe a considerable overload in the work environment, an incipient exhaustion and the fear that this situation could last longer. They also question certain decisions. "I don't understand why the weekly meetings were abolished without asking the people concerned and without considering the possibility of videoconferencing," criticizes one nurse. "The function of a nurse requires that you consult with each other, work together, exchange information with colleagues, especially in this pandemic period," says another.

Insufficient capacities

The greatest concern is capacity in intensive care units - to the detriment of nursing homes, which seem to be almost forgotten as a result. However, it is not only a matter of protecting the residents, but also the caregivers. The health crisis occurred in an environment that was already considered difficult by caregivers. In 2019, the SBC urged that nurses be supported in terms of their working conditions, emphasizing staffing levels in particular. Support, they said, should enable nurses to stay in the profession longer (46 % leave the profession prematurely). In this context, the Neuchâtel/Jura section considered it appropriate to give weight to nurses' perceptions by seeking answers to the following questions: how do nurses perceive their professional situation during this particular period? Is it possible to measure the risk for professional exhaustion? What about the ability of the care network to mobilize and provide information about this type of problem?

Working conditions and extreme commitment

Quality of life at work is defined as follows: "The conditions under which employees carry out their work and their possibility to express themselves on the content of these conditions and to influence them determine the perception of the quality of life at work resulting from these conditions." (Haute autorité de santé, France) The relationship between quality of life at work and quality of care no longer needs to be specifically mentioned; the international literature on the subject clearly demonstrates this relationship. Teamwork and collaboration, training, workload or the interdependence between the above parameters, as well as the staff and the possibility to act in accordance with its values: These are all factors that have an impact on work perceived as "good" (Clot, Y.2010). The nursing staff is considered to be at risk because of the extreme commitment they show. However, the exercise of the nursing profession is unthinkable without the dimension of this marked commitment, which is a cornerstone in nursing, as pointed out by Clémence Dallaire, professor of nursing science at the University of Laval (2008). However, this commitment can develop in the wrong direction if the gap between the idea of the profession and the reality becomes too great.

Factors that can lead to exhaustion

In the current situation, professional representatives are paying increased attention to suffering at work. An evaluation of the risk of burnout is strongly recommended by the State Secretariat for Economic Affairs (SECO), both in terms of the associated consequences in the personal sphere and for the company itself. The professional exhaustion is due to a relationship with a work considered difficult, stressful and (or) tiring, specifies the American psychologist Christina Maslach (2006), specialized in the topic of stress at work. It is a physical, emotional and psychological state of exhaustion resulting from the great expectations, associated with a chronic stress at work. There are six factors that promote the occurrence of exhaustion (Leiter, M. & Maslach, C., 2008):

• Work overload
• the feeling of having no control
• lack of recognition
• Crumbling away of the sense of community
• Feeling of injustice and lack of recognition
• Conflict of values and incongruence with values

Maslach's questionnaire was selected to survey nurses' perceptions of their job exhaustion. The test is often used, it has certain limitations (Langevin, V. et al., 2012), which were taken into account. The questions are formulated in the form of statements that make visible subjective elements related to professional practice.

Proven risk of burnout

The observational study revealed an alarming result: 77 % (all categories combined) rate self-actualization at work as weak. In other words, out of 361 people surveyed in November 2020, 254 are at risk of burnout. Given the persistence of the health crisis, increasing contagions peaking in December, constant hospital overload, and the emergence of variants that pushed the health care system to the brink, nurses' health is unlikely to have improved. The data collected are valuable in terms of preventive measures to be expanded or introduced to prevent caregiver dropout and even more pronounced weakening of the health care system.

There is an urgent need for action

It is important to mention that there is no relation between being mentally and physically exhausted on the one hand and being fully committed to one's work on the other. This is at the same time an indication of the resilience of the nurses, which seems to be innate or even God-given. However, one must ask oneself how high the risk is that bad feelings become chronic. It is therefore very important to maintain and value the commitment of nurses, while identifying and addressing the vulnerabilities of the profession. With this goal in mind, the SBC Ne/Ju Section, in accordance with SBC principles, has drafted the following recommendations:

• the nurses should have the opportunity to ask the question about exhaustion, time should be reserved for this on the occasion of the annual staff meetings, so that the nurses' perception is recorded and they have the opportunity to put forward ideas for improving the situation;
• the exchange in the clinical area should be promoted;
• the priorities of the individual departments should be redefined, subordinate tasks should no longer have to be carried out so that there is time to complete the essential work;
• an atmosphere of trust and support should be created;
• professional staff specialized in supporting caregivers should be available;
• the competences of the nursing staff are to be reformulated.

The Section has made it its business to listen carefully to its members. It is extremely important for them to follow the further development of the data in order to be able to keep an open ear for the needs of the practice. The section is therefore planning a new edition of the survey, taking into account developments in the nursing environment, in order to consolidate the role of the SBK as a contact and mouthpiece for the entire profession.

Sources:

• Anne Bramaud du Boucheron, master's degree in clinical nursing sciences and certified nursing specialist
• Marilyn Leuenberger, MScSI, Nursing Specialist at CHUV Lausanne
• Christine Perrin, nurse at the Centre neuchâtelois de psychiatrie, board member of the SBK section Ne/Ju
• Anne Guyot, nurse and secretary general of the SBK section Ne/Ju