Introduction
The article, “Predictors of burnout in nurses working in inpatient rooms at a public hospital in Indonesia,” was written by Yumi Yestiana, Tri Kurniati, and Abdul Aziz Alimul Hidayat. After reviewing several studies, they identified burnout as a psychological problem arising from physical and emotional fatigue (Yestiana et al., 2019). Most of the work they reviewed had similar findings on the relationship with workload factor, but none demonstrated any link between burnout and work shift scheduling policy, competencies of nurses, and other factors.
Their research, therefore, tested the association between exhaustion and shift policy, workload, competency, age, gender, education, marital situations, and tenure independent variables. The study focused on nurses operating and managing in-patient rooms of Tangerang Regency hospital in Banten Indonesia. Who served in the facility for more than one year; were not in any leadership roles; were not on leave at the time, and were willing to participate.
Research Design and Methodology
A cross-sectional research method was employed in this study, where 133 nurses were selected as participants using a stratified random sampling technique. The researchers set the significance level of accepting the findings at 5% (0.05). Data gathering involved the application of a questionnaire with separate questions on burnout, shift policy, workload, and competency. Exhaustion was measured by “the Maslach Burnout Inventory scale,” employing 7 queries on psychological fatigue, 6 on self-disconnection, and 8 testing on decreased achievement. The policy queries included the potency, efficiency, adequacy, fairness, receptiveness, and precision of shift arrangements (Yestiana et al., 2019).
The work-load parameter was tested using daily log questions which nurses answered based on their schedule and the type of nursing tasks they do. While assessment of competency questions was measured on a Likert system of 1 = very unsuitable, 2 = unsuitable, 3 = appropriate, 4 = very appropriate. Internal consistency for all sets of data items for each variable was assessed using Cronbach’s alpha, with each having a different scale. Burnout, policy shift, workload, and competency all had Cronbach’s alpha of 0.97, 0.83, 0.95, and 0.91 respectively (Goforth, 2015). A stepwise multiple linear regression was run to assess the parameters that remarkably predicted burnout.
Discussing Results
The shifting policy was confirmed by 54.1% as appropriate; the mean workload for participants was 80.42% ± 049, and most participants (64.7%) had the appropriate level of competency. Additionally, the mean burnout measure for all respondents was 17.48 ± 0.50. Regression analysis confirmed that only two independent variables significantly predicted burnout in nurses. Workload and policy shift schedules of medics explained an 87.2% variation in burnout respectively (Yestiana et al., 2019). The possibility of medics experiencing burnout was 0.499 times higher if shift policy was not managed properly. While for workload, the likelihood of nurses encountering exhaustion was 0.494 greater if not managed well.
Evaluation
The research, design, methods, and approach adopted for this study were very scientific in many aspects. The sample size was large enough to represent nurses operating in the in-patient room of the clinic. The criteria used by the researchers to select the respondents were also very well elaborated, stating who among the nursing target population qualified to be participants in the study. However, it was not clear from the sample size determination, what was the total number of caregivers employed in the in-patient room, against the 133 respondents selected. There was also no mention of the proportions of males and females working in the ward.
The omission of these two factors makes it hard to know whether the sample size was representative in terms of the total population of the target group, and also whether it avoided gender biases. Again it is not clear why the researchers selected mostly young nurses below 31 years as respondents. It should have been better to have a clear explanation of nurses’ composition in terms of age in this inpatient room. The absence of clarity on the number of nurses in the room, their gender by numbers, and their ages makes it hard to determine the representativeness of the sample.
Validity of the Study
Whereas the study tested the consistency of the questions for variables, validity tests were inadequate. The construct validity was elaborated through several reviews of similar studies done before this one, which revealed similarities in findings with this study. However, this article fell short in demonstrating how content, face, and criterion validities were tested before the data collection process. For example, criterion validity is measured through the judgment of experts on how well the measurement instruments reflect the idea the study intends to examine (Cherry, 2021). There was no mention anywhere in the research methodology, of how criterion evaluation was carried out.
Content validity, on the other hand, evaluates whether the test represents all the aspects of the study variables. It also requires proper scrutiny and judgment of experts in the subject area, to ascertain whether measurement instruments defined content. Further, both content and face validity require some aspect of piloting before final research is conducted. There was no mention of how piloting of the instruments was done and what the results were. The researchers could have used experts to review their study instruments, as well as performed a pilot test study to help them gauge the design and make modifications.
Views on Conclusions
The concluding paragraphs capture the intentions of the authors when they designed this study. The findings revealed that the amount of work and shift schedules independent variables determined burnout of caregivers employed in the in-patient rooms of the health facility, while competency, age, gender, training, tenure, and marital situations did not. This exactly confirmed the reason for which this study was planned. The existence of fatigue among nurses shows the magnitude of challenges they go through to give attention to patients, without considering how too much work and irregular shifts in schedules can do to their well-being.
Finally, the study recommends that the nurses’ leadership must put in place proper mechanisms to manage their workload and shift policy, which resonate with what researchers aimed to achieve. Knowing exactly what causes fatigue in nurses, leads to finding a balance between their work and health. Thus, management of medics’ workload and shift policy help in reducing burnout, so that they are healthy all the time, for their effective and efficient work output. Specifically, the researchers stressed the need to have a well-defined nurse’s shift policy and a specific number of activities, which considers what they can manage physically and mentally without overstretching themselves.
Clinical Application
Registered Nurses Association Ontario’s best practice guidelines on burnout list the risk factors contributing to fatigue as on-call hours, mandatory overtime, working while sick, inadequate rest between shifts, and rotating shifts within the week of work. The factors mostly necessitating burnout are increased workload, working short-staffed, patient expectations, high levels of patient acuity, and emergency with staffing (RNAO, 2017). Further, the findings about these practices showed that 80% of the nurses felt fatigued after work ‘almost always’ to ‘all the time; and 55% of them were exhausted after working almost all the time without resting.
Another 50% of participants said they missed their shifts because of burnout; while 25.6% of the respondents were thinking of leaving their jobs due to exhaustion. The senior management must foster workload and shift policy that enhances a healthy working environment contributing to an effective and better outcome for nurses. These best practices and guidelines supported by their findings, conform to the results of this article that too much workload and policy shift schedules increase fatigue in nurses. This calls for an urgent review of standard workload and uniform shift policy taking into account the health of the nurses.
References
Cherry, K. (2021). Why Validity Is Important in Psychological Tests. Talent Library. Web.
Goforth, C. (2015). Using and Interpreting Cronbach’s Alpha. University of Virginia Library. Web.
Registered Nurses Association Ontario. (2017). Developing and Sustaining Safe, Effective Staffing and Workload Practices. Web.
Yestiana, Y., et al. (2019). Predictors of Burnout in Nurses Working in Inpatient Rooms at a Public Hospital in Indonesia. Pan African Medical Journal. Web.