COVID 19 BURNOUT AMONG HEALTH CARE WORKERS 2 COVID-19 BURNOUT AMONG HEALTHCARE
COVID 19 BURNOUT AMONG HEALTH CARE WORKERS 2
COVID-19 BURNOUT AMONG HEALTHCARE WORKERS 9
COVID 19 BURNOUT AMONG HEALTH CARE WORKERS 2
COVID-19 BURNOUT AMONG HEALTHCARE WORKERS 14
jCOVID-19 BURNOUT AMONG HEALTHCARE WORKERS
COVID-19 BURNOUT AMONG HEALTHCARE WORKERS
by
xxxxx
Doctoral Research Project – Case Study
Submitted in Partial Fulfillment
Of the Requirements for the Degree of
Doctor of Strategic xxxxxx
xxxxxx, xxxxxx of Business
July 2024
Abstract
The level of burnout among healthcare workers is an alarming problem affecting the healthcare sector. Burnout is a condition that impairs healthcare workers mentally, emotionally, and physically. The rise in the number of healthcare workers who experienced burnout during and after the pandemic attracted significant attention to the leadership in healthcare. The proposed research explored the impact of leadership on burnout levels among healthcare workers during the COVID-19 pandemic. A mixed method research was conducted using interviews for the qualitative approach and surveys for the quantitative method, which consisted of twenty participants. The study indicated that at least 80% of the participants agreed that poor leadership causes burnout. Also, 90% of the participants agreed that nurses were more vulnerable to burnout than other healthcare workers. The results indicated that the participants received a lack of support from leaders through a lack of emotional bonding with employees, and poor communication was a major cause of burnout. The participants noted that poor work environment, long hours, increased workload, and role confusion are additional causes of burnout among healthcare workers. The research found that measures such as providing employee empowerment in the form of training, rewards, and bonuses and hiring more healthcare workers are recommended solutions to the issue of burnout in healthcare. These solutions, if implemented effectively, have the potential to bring about a positive change in the healthcare sector, reducing the risk of burnout and improving the well-being of healthcare workers. The study has significant implications for leadership in the healthcare sector because it prompts leaders to play an active role in guiding the healthcare workers and urges leaders to implement practices that empower and support healthcare workers emotionally and mentally to prevent burnout.
Keywords: COVID-19, burnout, leadership, healthcare, rewards, communication
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Table of Contents
List of Figures 12
Section 1 Foundation of the Study 13
Background of the Problem 16
How the Research Questions Relate to the Study Purpose 20
Nature of the Study 23
Discussion of Research Paradigms 24
Positivism 24
Post-Positivism 24
Constructivism 25
Pragmatism 25
Researcher’s Selected Paradigm 25
Discussion of Design 26
Fixed Design Using Quantitative Methods 26
Flexible Design Using Qualitative Methods 26
Mixed Methods Design using Quantitative and Qualitative Methods 27
The Appropriateness of the Flexible Design in the Project and the Rationale 28
Discussion of Method 30
Narrative 30
Phenomenology 30
Grounded Theory 31
Ethnography 32
Case Study 32
Discussion of the Appropriateness of the Best Method 32
Discussion of Triangulation 33
Summary of the nature of study 35
Research Framework 36
Figure 1. Research Framework Diagram 37
Concepts 37
Burnout Within Health Professionals 38
Shortages in Healthcare Professionals in Relation to COVID-19 39
Leadership Within the Organization 39
Effective Leadership 40
Theories 40
Job Demands–Resources Theory (JD-R) 41
Maslach’s Theory 43
Conservation of Resources Theory 44
Actors 45
Health Care Providers 45
Healthcare Managers/Administrators 46
Patient / Consumer 46
Constructs 47
The Role of Stakeholders in Dealing with Healthcare Professional Burnout 47
Creation of a Conducive Working Environment for the Employees 48
Relationship Between Concepts, Theories, Actors, and Constructs 50
Conclusion of Constructs 51
Summary of the Research Framework 52
Definition of Terms 53
Assumptions, Limitations, and Delimitations 53
Limitations 55
Significance of the Study 57
Reduction of Gaps in Literature 57
Implications for Biblical Integration 59
Benefit and Relationship to Leadership Practice 60
Summary of Significance of the Study 61
Review of the Professional and Academic Literature 62
Overview 62
Leadership Practices and Employee Engagement 64
Figure 2. Employee Engagement Diagram 67
The Problem 71
The Role of Leadership 73
Burnout among Health Care Professionals 78
Shortages in Healthcare Professionals in Relation to COVID-19 81
Leadership within the Organization 81
Effective Leadership 82
Theories 83
Job Demands–Resources Theory (JD-R) 83
Maslach’s Theory 83
Conservation of Resources Theory 84
Health care professional 84
Healthcare managers/ Administrators 85
Patient / Consumer 85
Constructs 85
The Role of Stakeholders in Dealing with Healthcare Professional Burnout 87
Creating a Conducive Working Environment for the Employees 88
Related Studies 88
Anticipated and Discovered Themes 91
Literature Review Summary 95
Summary and Transition 97
Section 2: Methodology 100
Overview of Section 2 100
Introduction 100
Purpose Statement 101
Role of the Researcher 102
Research Methodology 106
Introduction 106
The rationale behind the Selected Research Design 106
Triangulation 108
Summary of the Research Methodology 109
Participants 110
Population and Sampling 111
Population 112
Sampling 112
Summary of Participants, Population, and Sampling 116
Data Collection Plan 117
Instruments 119
Interview guides 119
Surveys 120
Archive data 121
Data organization 122
Summary of Data Collection 122
Data analysis 123
Qualitative analysis 124
Analysis of Triangulation 125
Summary of Data Analysis 126
Reliability and Validity 126
Reliability 126
Validity 128
Bracketing 131
Summary of Reliability and Validity 131
Overall Summary of Section 2 and Transition 132
Conclusion 133
Section 3: Presentation of Findings 134
Overview of the Study 134
Presentation of the Findings 135
Overview of Themes Discovered 136
Discussion of Themes 137
Theme 1: Overwhelmed 137
Specific Finding 1: Feeling overwhelmed 138
Specific Finding 2: Stress 139
Specific Finding 3: Unmotivated 139
Specific Finding 4: Exhaustion 140
Summary of Theme 1 141
Theme 2: Poor Work Environment 142
Specific Finding 1: Long work hours 142
Specific Finding 2: Increased workload 143
Specific Finding 3: Role confusion due to lack of policy 145
Summary of Theme 146
Theme 3: Lack of Support 146
Specific Finding 1: Lack of Emotional Support 146
Specific Finding 2: Communication 147
Summary of Theme 148
Theme 4: Employee Empowerment 148
Specific Finding 1: Training 148
Specific Finding 2: Rewards and Recognition 149
Specific Finding 3: Hiring more workers 150
Summary of Theme 150
Relationship of Findings 150
Relationship of Findings to Research Questions 151
Relationship of Findings to Research Framework 160
1. Concepts 160
2. Theories 164
3. Actors 169
4. Constructs 171
Relationship of Findings to Anticipated Themes 173
Unanticipated Themes 175
Relationship of Findings with the Problem 177
Relationship of Findings with Literature 179
1. Similarities 179
2. Differences 182
Summary of Findings 182
Application to Professional Practice 183
Improving General Leadership Practice 184
Potential Implementation Strategies 187
Recommendations for Further Study 190
Reflections 192
Biblical Perspective 193
Summary Of Section 3 195
References 200
Appendices 225
Appendix A: Interview Guide 225
Appendix B: Survey Guide 227
COVID-19 BURNOUT AMONG HEALTHCARE WORKERS 12
List of Figures
Figure 1. Research Framework Diagram…………………………………………………… 32
Figure 2. Employee Engagement Diagram………………………………………………….62
Section 1 Foundation of the Study
The study focused on understanding how the COVID-19 pandemic affected healthcare workers. It investigated the burnout experienced by healthcare providers since the inception of the COVID-19 pandemic. Additionally, the study examined the contributory role of leadership in shaping healthcare workers’ exposure to professional burnout. Leaders remained an effective support system in the healthcare domain due to the strategic quality interventional measures they integrated (Sultana et al., 2020). Therefore, the study evaluated how leaders exposed healthcare workers to professional burnout during the COVID-19 pandemic. The primary objective was to enable leaders to comprehend how to improve the working environment to ensure care providers could deliver quality services in today’s setting and the future. Specifically, the inquiry determined if Southeastern United States healthcare leaders failed to adopt proper COVID-19 response measures, causing burnout among healthcare workers. It also investigated the appropriate response measures.
Section one of the study begins with a background of the problem that provides crucial details that introduce burnout as a challenge affecting healthcare workers. The section is followed by a problem statement that details why the issue of burnout is crucial to healthcare delivery and its impact on the general public as well as healthcare workers, making a case as to why the study into burnout among healthcare workers is crucial. The problem statement is followed by a listing of the research questions guiding the study and a discussion of why and how each research question addresses a specific aspect of the problem and the study’s purpose. The subsequent section was a discussion of the nature of the study where a detailed explanation of the research paradigms, research design, and methods applied in the study is provided. This section provides information on how the researcher structured the study and validated each choice made. The nature of the study section is also summarized using a visual illustration that aligns the nature of the study with
elements such as the crucial actors in the study, the concepts guiding the research, theories, and the constructs applied. Definitions of terms were also included to ensure all crucial terms and phrases were discussed to enhance the flow and understandability of the study throughout the research. The subsequent section discussed the study’s assumptions, limitations, and delimitations, followed by a detailed explanation of the significance of the study, a comprehensive review of literature, both professional and academic, and a description of anticipated themes, appendices, and references.
Section two of the research explained how the researcher gathered and analyzed data, introducing the study. The section begins with a restatement of the purpose statement and the role of the researcher in the study. The section then proceeds with a discussion of the research methodology, which details the data collection methods and participants included in the study. The research was conducted to understand healthcare workers’ struggles, especially during and after the COVID-19 pandemic. The study adopted a variable case study design based on qualitative inquiry regarding methods (Kumar, 2018). The flexibility of the case study design allowed the researcher to adjust the research methods based on the situation and target new participants if the selected ones were unavailable. The major participants of the study included healthcare providers in different roles and functions and leaders, with the research sampling 20 participants. The section also includes a detailed description of the characteristics used to determine the eligibility of the participants, which included working as a healthcare worker, being a leader in the healthcare sector, and having at least five years of experience. The study also used interviews as the data collection method, clearly defined in the section, and explained why the interviews were chosen. The section then proceeds with a detailed explanation of the data analysis methods used and how
the reliability and validity of the research were achieved. In addition to the interviews, the participants were also required to respond to an online questionnaire with 17 questions relating to the research questions, which aimed at enhancing the validity of the research, acting as a part of triangulation for the study.
In section 3, the study’s findings clearly describe what the researcher gained and collected from the participants. In addition to the anticipated themes of the need for resources, the importance of employee management, and the acknowledgment of the role played by leaders in effective employee management, additional themes were discovered. The researcher identified four more themes: feeling overwhelmed as a standard definition and sign of burnout, poor work environments as contributors to burnout, lack of support from leaders as a causative factor, and employee empowerment as the primary strategy for eradicating burnout.
The discovered themes provide significant insight into the relationship between leadership and the prevalence of burnout among healthcare workers. The study found that 100% of the participants had a similar definition of burnout, and 80% shared symptoms they used to recognize the issues in their peers that generally align with the theme of feeling overwhelmed, including stress, exhaustion, and feeling unmotivated. Also, 50% of the participants affirmed the impact of poor work environment on their vulnerability to burnout. The participants identified various aspects they used to define a poor work environment, including being required to work long hours, being overworked through increased workload and policies and practices such as wearing protective equipment and overly cleaning equipment and hands, and role confusion due to poor policy implementation. Also, more than 80% of the participants agreed that they needed more support from the leaders, while 90% provided varying forms of employee empowerment strategies as their recommendation
for solving the issue of burnout. The study’s findings support the hypothesis that poor leadership practices led to increased burnout among healthcare workers. Additionally, the study affirms that the issue is solvable if the leaders take an active approach towards early identification of burnout vulnerability, which can be achieved through proper policy implementation, effective communication with healthcare workers, hiring more workers, and employee empowerment through non-monetary and monetary approaches.
Background of the Problem
Professional burnout among leaders based in the healthcare industry has become a prevalent problem since the COVID-19 pandemic (Jalili et al., 2021). As Jalili et al. (2021) believe, healthcare workers have become increasingly prone to burnout due to the care and attention they provide to their patients. With the rising number of patients in dire need of services, healthcare professionals have become increasingly exposed to exhaustion. The
absence of strategic frameworks has denied these professionals the opportunity to advance their health and well-being when caring for patients (Khasne et al., 2020). Research shows that healthcare professionals have continued to blame their leaders due to inadequate preparedness to handle the COVID-19 menace (Khasne et al., 2020). The COVID-19 pandemic has exposed healthcare workers to different mental strains emerging from the continued care provision. Additional research shows that burnout among healthcare staff members continues to attract attention due to the leaders’ inability to address arising issues (Lasalvia et al., 2021). Due to the COVID-19 pandemic, there are significant gaps in leadership, responses, and strategies that continue to place healthcare providers at risk of physical and emotional problems.
Burnout is a primary occupational issue in the care sector, with leaders playing a vital role and responsibility in managing this problem (Sultana et al., 2020). Sultana et al. (2020) argued that leaders should use quality interventional measures to ensure healthcare providers
achieve a stable emotional, physical, and mental status. Due to the rising concern over the health and welfare of healthcare providers, institutional leaders must adopt quality policies and strategies to prevent burnout. Lack of effective participation at the top leadership level has threatened the healthcare system. Sultana et al. (2020) stressed that misunderstandings and work-related strains are common challenges likely to emerge with a lack of adequate leadership participation, leading to increased burnout among healthcare providers. The well-being of COVID-19 patients relies on the health status the care providers provide. Therefore, leaders must remain committed to creating strategic frameworks that reduce professional burnout.
Problem Statement
The general problem was healthcare leaders’ failure to develop a strategic framework in the wake of the COVID-19 pandemic, which resulted in increased burnout among healthcare professionals. According to Jalili et al. (2021), these burnouts occurred because leaders failed to develop a strategic framework, and there was an increased level of professional burnout among healthcare workers caring for COVID-19 patients. In a recent study, Khasne et al. (2020) found that many healthcare professionals blamed their leaders for a lack of preparedness to deal with COVID-19, resulting in mental strain for the caregivers. A similar study by Lasalvia et al. (2021) revealed that burnout among healthcare staff members during the pandemic was an issue of concern. Still, leaders had not done enough to mitigate the adverse implications. Sultana et al. (2020) supported this issue by stating that burnout was a major occupational problem among healthcare providers and
leaders had a critical role in developing intervention measures. This article addressed the specific problem of the potential failure of senior healthcare leaders within the South-Eastern United States to establish adequate response and preparedness to deal with COVID-19, which could result in increased burnout among healthcare professionals.
Purpose Statement
This flexible single case study aimed to understand the inability of healthcare leaders in the Southeast United States area to create and implement potential response measures for addressing professional burnout emerging from the COVID-19 pandemic. The researcher selected healthcare workers and leaders to offer their perspectives on healthcare management and the administration’s impact on staff burnout during the pandemic. The targeted population relayed viable information that answered the research questions. The research focused on two major concepts: professional burnout and leadership. First, the study investigated the increasing emotional and physical exhaustion among healthcare providers with COVID-19 infections (Cotel et al., 2021).
Second, in examining leadership contribution, the research assessed leaders creating the environment to address the burnout constructs. The results obtained from this research supplemented existing studies focusing on leadership strategies likely to develop a potential working environment for care providers during healthcare pandemics. This research informed leaders on the courses of action they could take to advance the health and well-being of healthcare professionals amidst the harsh realities of the COVID-19 pandemic. In the future, these leaders could potentially improve the handling of burnout based on the successful implementation of the approaches obtained from this research.
Research Questions
Given the burnout rate of healthcare providers due to the COVID-19 pandemic, these research questions aimed to provide leadership skills and interventions to reduce burnout in the healthcare profession (Sultana et al., 2020). Leadership learned first-hand knowledge
that could bring understanding to the problem and improve the burnout rate (Zang et al., 2018). The study combined open- and close-ended questions to achieve comprehensive research. Zhang, Liao, and Srivastava (2018) explained that combining available- and close-ended questions was highly beneficial to research because it reduced the chances of participants being bored during the study and dropping out, which is attributed to feature elicitation that minimizes dialogue length. However, the most critical questions to the research were the open-ended questions because they were more comprehensive (Allen et al., 2017). As Allen (2017) explained, open-ended questions in research designs such as surveys and interviews allowed participants to express themselves using views that may be unprecedented, extreme, or unknown to the researcher. The research questions sought to
draw information on the perspectives and opinions of various health workers who had experienced or were familiar with burnout. The research questions gathered sufficient factual data on the recommendations and solutions provided by the participants during the professional interaction with the interviewers (Khasne et al., 2020). The following are the main questions to be used in the research:
RQ1: How is professional burnout prevalent in healthcare among the nursing staff?
RQ1a: Why have nurses deemed the most affected medical staff by professional
burnout during the COVID-19 pandemic?
RQ1b: Why is professional burnout prevalent among nurses during the COVID-19 pandemic?
RQ2: What are the leadership failures in addressing professional burnout in healthcare organizations?
RQ2a: How do leadership failures affect the response toward professional burnout?
RQ2b: How have leaders failed to address professional burnout among healthcare workers?
RQ3: What proposals could address professional burnout among healthcare workers?
RQ4: How do healthcare management and administration affect staff burnout at hospitals in the wake of COVID-19?
How the Research Questions Relate to the Study Purpose
RQ1: How does the professional burnout problem occur in the healthcare setting and more so during COVID-19?
RQ1. Arguably, the COVID-19 pandemic had an unprecedented impact on the medical community (Essex et al., 2021). In this research question, the researcher investigates
whether COVID-19 poses a risk of professional burnout to the medical team. The researcher focuses on the nursing workforce because it covers most of the medical community. This research question obtains evidence to show why nurses are the most affected by professional burnout during COVID-19. Therefore, this will help develop evidence-based solutions.
RQ1a: Why have nurses deemed the most affected medical staff by professional burnout during the COVID-19 pandemic?
RQ1a. The researcher examined why COVID-19 leads to professional burnout among nurses. The question highlights why nurses are the most affected professionals in the
COVID-19 pandemic (Lasalvia et al., 2021). Nurses are the frontline medical workers who cater to the overwhelming number of patients due to the rapid spread of the disease and
hospitalization (Lasalvia et al., 2021). Therefore, they are deemed the most affected medical staff by professional burnout.
RQ1b: Why is professional burnout prevalent among nurses during the COVID-19 pandemic?
RQ1b.This question investigated how COVID-19 contributes to professional burnout within the nurse population. The research question addressed why professional burnout was prevalent among nurses during COVID-19 (Cotel et al., 2021).
RQ2: What impact do healthcare organizational policies have on the health and welfare of healthcare providers, primarily during the pandemic?
RQ2. Lack of effective leadership is a possible issue hindering efforts to combat professional burnout facing the COVID-19 pandemic (Cotel et al., 2021). This research question examines leadership’s possible failures in dealing with professional burnout.
Therefore, this helps determine how to combat leadership’s possible failures limiting healthcare professionals from burnout.
RQ2a: How do leadership failures affect the response toward professional burnout?
RQ2a: helped identify effective leadership qualities and aspects that will help minimize professional burnout. Practical leadership qualities may include strategic planning and advocating for nurses’ rights (Zhang et al., 2018). Thus, this will help reduce professional burnout.
RQ2b: How have leaders failed to address professional burnout among healthcare workers?
RQ2b helped determine leadership actions and behaviors contributing to healthcare staff burnout. Choosing which activities are beneficial is a vital aspect for leaders. Selecting the best steps is imperative to chart the best action to decrease burnout within the healthcare field (Zhang et al., 2018). Determining leadership
actions and behaviors can help change healthcare provider strategies and reduce burnout (Jalili et al., 2021).
RQ3: What proposals could address professional burnout among healthcare workers?
RQ3. The researcher examined options that leaders could use to address healthcare professional burnout amid the COVID-19 pandemic. Thus, the study identified the evidence-based interventions, such as working in shifts to avoid working extra time, that the medical community, policymakers, and health administrators could implement to overcome the challenge of professional burnout during the COVID-19 pandemic (Lasalvia et al., 2021). Evidence-based interventions are the most suitable solutions because experiments and scientific studies have proven them (Allen et al., 2017). In addition, investigating the leadership strategies to deal with the COVID-19 pandemic is fundamental
to implement reasonable measures to reduce burnout among healthcare workers (Allen et al., 2017).
RQ4: How do healthcare management and administration affect staff burnout at hospitals in the wake of COVID-19?
RQ4.The researcher sought to analyze the healthcare administration’s role and competencies in addressing professional burnout. Sufficient leadership qualities are necessary to address the COVID-19 pandemic (Cotel et al., 2021). Practical leadership qualities help leaders make sound decisions concerning any change in health care (Cotel et al., 2021). Therefore, the administration initiates change and communicates the strategies for addressing the challenge and steps to address professional burnout (Cotel et al., 2021).
The questions examined different aspects concerning addressing professional burnout due to COVID-19 among healthcare workers. The answers to these questions will provide
insights on strategies used in addressing professional burnout. The questions are highly relevant due to the increased healthcare sector issues arising from the high burnout among
healthcare workers. The research questions will deliver the opinions and tribulations that healthcare workers have endured to encourage burnout during the pandemic.
The questions presented the objectives of the research. They provided different ideas about the research concept. Stakeholders could use the ideas from the insights they potentially revealed in the healthcare sector to develop strategies for addressing professional burnout (Khasne et al., 2020). The questions addressed leadership attributes, qualities, plans, actions, and behaviors that promoted professional burnout. The questions also covered these leadership aspects that could potentially assist in solving the problem. The research potentially helped the United States set standards and solutions to solve the patient safety and practitioner efficacy risks that the healthcare industry had experienced since the
pandemic due to burnout. The research offered solutions to help the leaders reflect on the most successful approaches to preventing healthcare burnout. The culmination of all four research questions and the four sub-questions helped provide options for possible ways to decrease healthcare burnout within Sentara Internal Medicine, Norfolk, Virginia.
Nature of the Study
The study focused on understanding the status of COVID-19 burnout among healthcare workers and the leader’s role in handling the problem. The study called for a single and flexible research design process. The researcher could gain insights into participants’ emotions, opinions, and behavior with a positivist perspective. The triangulation process allowed the investigator to achieve credibility and validity.
Discussion of Research Paradigms
Positivism
The positive research paradigm targets a single objective reality that an investigator focuses on exploring (Park et al., 2020). The assessment is based on observation and
reasoning (Park et al., 2020). This paradigm assumes that a tangible reality exists among variables (Park et al., 2020). The positivism model entails the act of being sure about something. In research, science is based on observable facts. Thus, the positivism research paradigm views the knowledge generation process as a quantifiable process. Understanding the relationship between research parameters focuses on observation and reasoning. This relationship can be understood, identified, and measured to reveal the causal framework. Therefore, this paradigm focuses on the accurate and objective interpretation of data to establish a particular set of knowledge. The positive research paradigm is very different from positivism because it uses principles and assumptions to guide any potential scientific discoveries. By understanding these assumptions, one can know more about the findings that
could be used to identify research gaps and generate sound evidence. It also helps support scientific studies.
Post-Positivism
The post-positivism model is derived from the positivism paradigm and incorporates a better examination of the issues occurring in the real-world setting (Panhwar et al., 2017). It values methodological pluralism, which applies research methods that align with the research question (Panhwar et al., 2017). It integrates both positivism and empirical analysis methods to understand the social concept at hand better. This paradigm may offer a flexible model that allows researchers to incorporate multiple ways of answering a particular research question. Post-positivism was created from positivism to generate a more encompassing way of
examining real-world problems (Kankan, 2019). This understanding does not negate or refute positivism but suggests something subsequentially exists and is worth considering (Kankan, 2019).
Constructivism
The constructivist research paradigm is based on experience and in-depth reflection on these experiences (Mogashoa, 2014). This method is primarily based on learning to construct the meaning of a particular element. People generate knowledge by interacting with their experiences and ideas (Mogashoa, 2014). This research paradigm portrays that each person constructs a meaning depending on their experiences and assessment. The constructivism model believes humans acquire knowledge through experiences and interpret the insights obtained.
Pragmatism
The pragmatism paradigm is based on the use of “what works” rather than what is deemed “true” or “real” (Frey, 2018). Researchers ensure that they view a problem in its
broadest context after identification. Pragmatism portrays its experience-based and action-oriented perspective. The paradigm addresses an issue based on how people experience it. For
instance, if people view the sea as beautiful, the setting is gorgeous. The consideration of this statement is based on truth.
Researcher’s Selected Paradigm
The researcher selected the positivism paradigm to assess the impact of the COVID-19 pandemic on burnout among healthcare workers. This paradigm enabled the researcher to integrate a suitable social, philosophical model that applied to the issue of burnout among healthcare workers. This paradigm aligns closely with observation and reasoning strategies to develop an interpretation based on objectivity (Park et al., 2020). Research showed that the
positivist approach supported an objective method of viewing elements (Park et al., 2020). Understanding the burnout problem among these professionals was based on objective rather than subjective analysis. Thus, the positivist model was appropriate for the study because it
depended on observation and reasoning instead of my understanding of this crucial issue. It positioned the researcher in a better place to establish suitable and strategic recommendations capable of handling this menace across the healthcare setting.
Discussion of Design
Fixed Design Using Quantitative Methods
The fixed design model entails using permanent elements in the data collection process that are part of the research proposal (Kumaar, 2018). While relying on quantitative research tools, the investigator executes the research process. Some methods incorporated in the fixed design include experimental, quasi-experimental, and nonexperimental (Kumar, 2018). This design does not apply to the research because the data collected will be quantitative. However, the potential data derived in this research will be in qualitative form. It uses fixed data collection tools, so one cannot amend the data in the collection phase, which is often used in quantitative research (Doyle et al., 2009). The fixed design method is often used in quantitative research, which helps ensure that the data collected is unbiased and cannot be tampered with (Doyle et al., 2009). This also means that it will help provide the most accurate conclusion for the research party.
Flexible Design Using Qualitative Methods
A flexible research design allows the researcher to adjust the process during the research (Kumar, 2018). One of the critical benefits of relying on this method is that it facilitates the investigator with a viable opportunity to enhance the research validity (Kumar, 2018). As Kumar (2018) notes, a flexible design is vital to improving research outcomes. The
researcher can capture appropriate data and information depending on the situation. For instance, if the participants targeted for the study are unreachable due to work-related circumstances, the researcher can focus on a more flexible data collection method. Focusing
on a more flexible study saves time and massive resources due to diminished limitations (Kumar, 2018). It also makes it possible for the researchers to investigate many other factors that could prove helpful to the research. The flexible study is more efficient with technology since one can source participants worldwide, making the data collected more conclusive. The flexible research design approach improves study validity and other relevant research-based outcomes. Researchers can utilize flexible design methods, including narrative, phenomenology, grounded theory, case study, and ethnography (Kumar, 2018).
Mixed Methods Design using Quantitative and Qualitative Methods
The mixed research design focuses on a combination of fixed and flexible methods. It ensures that these two approaches integrate. This design is especially relevant in answering research questions that cannot be addressed while relying on a singular tactic (Doyle et al.,
2009). The mixed-methods design paves the way for the investigator to apply various methods they deem relevant to the study. The researcher can focus on convergent, explanatory, sequential, and exploratory transformative mixed design methods. A mixed research design is one of the most functional research designs. This is because it expands the scope of research, such as no single method can (Doyle et al., 2009). It involves a process that provides observations and statistical analysis, which helps ensure the research is more comprehensive. A mixed design also offers more in terms of exploration rather than just focusing on analysis (Doyle et al., 2009). This makes sure that the data used in the
research is more than comprehensive, which offers subtle solutions to a problem that may seem too big to solve initially.
The Appropriateness of the Flexible Design in the Project and the Rationale
The study used a single and flexible case study design focused on the qualitative method. The single study aspect aided in capturing data from a specific group of interest (Kumar, 2018). Capturing information from a single group was advantageous because it narrowed down the scope of data that needed to be analyzed (Kumar, 2018). This, in turn, ensured that the data was thoroughly analyzed. Capturing information from a small group also ensured that the participants were diverse and represented the diverse groups found on the ground (Kumar, 2018). This meant that their information authentically represented what happened in real life. The flexible design was crucial for applying and building an appropriate theory targeting a unique case (Kumar, 2018). In this case, the researcher targeted a group of healthcare providers and leaders to share their ideas and thoughts on the issue of professional burnout amidst the COVID-19 pandemic. By targeting a single interest group, the investigator could better understand the research question and derive a quality conclusion.
The flexible design suited the study because it allowed the investigator to gather a wide range of information obtained from the facts relayed by the participants through observing their behavior (Doyle et al., 2009). For example, the subjects provided verbal details when asked about their leaders’ participation in creating a conducive working environment during the COVID-19 pandemic and the burnout experienced. Also, the researcher could rely on verbal cues to draw quality information (Doyle et al., 2009). The flexible design also allowed the researcher to capture information depending on the situation (Doyle et al., 2009). It suited both the researcher and the participants. For instance, if the
investigator felt that the method used did not fit the context, one could change it to ensure that the results were more valid (Doyle et al., 2009). Also, it ensured that the subjects had the right
to withhold information that they might find inappropriate. For example, if an interview did not allow the researcher to obtain the desired information, an observation could suit the process better as it captured facts. A flexible design enhances a study’s validity (Doyle et al., 2009). As Kumar (2018) highlighted, adjusting a research design helped the researcher obtain relevant data and information for the study. A flexible design was essential to avoiding inappropriate conclusions based on inadequate information (Kumar, 2018). The fixed and mixed methods would not have been ideal for the study to collect information on attitudes and perceptions (Kumar, 2018). The flexible design was more about adapting to changing participant views, primarily when the study was conducted relatively quickly (Kumar, 2018). The design enabled the navigation of the changes while still capturing and integrating them into the study.
The study used the qualitative method to gather and analyze the acquired information. The qualitative method examined the experiences and perspectives that the subjects had toward the identified topic of study, known as ethnography (Al-Busaidi, 2008).
The study’s relevance was drawn from the fact that the study required direct interaction with healthcare workers. It was crucial to identify their factual and qualitative perspectives on the impact of leadership on their performance and, thus, burnout levels.. Thus, the qualitative design was useful as it supported information collection focusing on emotions, attitudes, and associated behavior (Al-Busaidi, 2008). The qualitative design was the right research design because it did not need numerical statistics to conclude since the research was based on emotions and attitudes, which are not quantitative (Al-Busaidi, 2008).
This research called for a qualitative research method as it accelerated accessing valuable information.
Discussion of Method
The study incorporated the flexible design approach and focused on the narrative, phenomenology, grounded theory, case study, and ethnography methods (Naideo, 2012). The researcher can use any of these methods depending on the context and desired results.
Narrative
The narrative methodology entails inquiries directed at human experience narratives or inquiries that yield data in the narrative form (Butina, 2015). The stories relayed from the subjects through their experiences develop into raw data. The researcher can rely on secondary data obtained from observations and interviews during the study. Notably, written or spoken information provided by the subjects during the actual research process becomes a
key source of quality information and data. The narrative methodology aligns with the researcher’s key, which focuses on acquiring raw data from participants’ experiences in the actual setting and through secondary narratives (Butina, 2015). The narrative method and the researcher’s key are cross-examined to reveal any outliers.
Phenomenology
Phenomenology is based on people’s experiences with a particular phenomenon depending on how it manifests (Williams, 2021). It uncovers “what experiences are like” (Williams 2021, p.366). Using an individual’s experience, an investigator can understand the concept at hand. For example, a researcher can study a group of people with first-hand knowledge of a particular area of interest or who have experienced an event. One’s individual experience may expose one to the manifestation of the problem in the actual world
setting. This approach suits the study because the researcher can access viable participants to share their experiences and obtain necessary information (Williams, 2021). If the information
collected from the participants is similar, it can help the individual develop a common theme, as will be proven by the data collected. If there are differing opinions, this can also be used to develop a theme since it shows a common discrepancy regarding the research topic.
Grounded Theory
Grounded Theory involves data collection and analysis (Konecki, 2018). Once the data is collected for research and analyzed, it is labeled grounded theory because the theories are supported by the data (Konecki, 2018). The grounded theory framework focuses on theory development (Pulla, 2016). Researchers can use it to explain how the study participants would handle the issue or any similar potential problem in the future. It also allows the researcher to modify or alter a theory when comparing existing and relevant data. Researchers systematically collect and analyze data to formulate appropriate theories (Pulla, 2016). The central aim of the grounded theory model is to establish social relationships and behaviors. The theory also provides the researcher with the benefit of being able to begin the study without a preconceived notion of what they will find. The grounded theory is based on the researcher’s ability to develop a theory from the research results (Pulla, 2016). The theory obtained will be reliable since it is based on previous supportive research. The obtained findings become the theory that helps the researcher develop a viable conclusion. The grounded theory method can be integrated into the study to further future research on the findings of the impact of the pandemic and the leadership role in exposing healthcare providers to professional burnout.
Ethnography
Ethnography aims at learning about the culture of a particular setting (Naidoo, 2012). Researchers engage participant observational processes across the field to learn more about
culture and learn about beliefs, social interactions, and behaviors (Naidoo, 2012). The outcomes inform investigators about interactions and relationships in a specific environment.
Ethnography methods aim to develop an analytical interpretation of cultures (Naidoo, 2012). The researcher gains new insights based on the in-depth understanding of a specific culture during the long span of the study.
Case Study
A case study method is a process that relies on real-life context. It is a comprehensive account of an individual case and its analysis (Starman, 2013). Researchers investigate a person, group of people, or events to examine the boundary between the phenomenon and the context (Starman, 2013). The case study method will assess the impact of the COVID-19 pandemic on professional burnout in the healthcare sector and the role that leaders have
played in addressing the challenge. The investigator will access viable information highlighting a link between the issue and its context by targeting a group of care providers and leaders as the case study.
Discussion of the Appropriateness of the Best Method
The case study was the best method to understand how the COVID-19 pandemic exposed healthcare providers to professional burnout and how leaders handled the situation (Starman, 2013). The researcher could study the participants during a set time or location to unravel the challenges experienced and how leaders effectively dealt with the problem (Starman, 2013). For instance, through this approach, the investigator could study nurses handling patients on the ground and establish viable conclusions.
Therefore, its ability to analyze the population in a real-life context made it an ideal method. It also made it easier to focus the study on a specific area, making the results even more viable due to the specificity.
It was also essential to ensure that the information presented in the study was valid. This could be done through a process called respondent validation (Starman, 2013). It involved retesting the initial results with the respondents to ensure they would respond similarly. This helped make sure that the researcher could overcome any personal bias.
Discussion of Triangulation
Triangulation entailed combining different research methods and approaches to enhance credibility and validity (Campbell et al., 2020). Researchers used multiple methods to study a phenomenon of interest (Campbell et al., 2020). This process eliminated potential biases often witnessed when relying on a single research method. The focused study entailed questionnaires, focus group discussions, and interviews to gather information. The information obtained from each of these methods enhanced credibility and validity.
The research methods used in this study included questionnaires, interviews, and focus group discussions. The first method used was a questionnaire to gather information from a group of healthcare providers. This questionnaire allowed participants to express their opinions about how the pandemic affected their work environment. The researcher could create a questionnaire that allowed participants to express their views on topics. The participants answered questions like had they been affected by the pandemic and how it had affected their work environment. The researcher also could ask what kind of support system would make them feel better about handling the threat posed by pandemics. The participants were given time to respond to the questionnaire.
The second method used was focus groups. The main objective of this method was to obtain reliable information about participants’ perceptions of the pandemic in their organization (Campbell et al., 2020). It also allowed participants to express their opinions regarding handling the problem if they were leaders or managers in their
organizations (Campbell et al., 2020). The researcher could hold discussions with a group of healthcare providers and leaders and engage them in conversations on how they would handle the threat posed by pandemics if they were leaders or managers (Campbell et al., 2020). The participants in focus groups needed a context to ensure they gave more realistic opinions.
Each theory established an analytical approach toward the emergence of professional burnout (Pulla, 2016). The researcher developed a better conclusion using each of the insights obtained from these theoretical models. Approaches that came into play included the job resource demand theory, Maslach’s model, and the conservation of resources theory. They allowed the researcher to connect the burnout challenge with various circumstances and conditions in the workplace. For instance, the job resource demand theory evaluated how the extensively demanding environment built burnout (Pulla, 2016). When healthcare
providers operate in a complex and challenging setting, they were bound to experience physical, emotional, and psychological problems (Shreffler et al., 2020). This exposed them to professional burnout, affecting their ability and capacity to handle their duties. On the other hand, Maslach’s theory evaluated emotional exhaustion based on high workload (Dall’Ora et al., 2020). These theories developed vital thematic elements that the researcher could use to achieve a better outcome (Dall’Ora et al., 2020). For example, these theories revealed the presence of emotional exhaustion, a key prerequisite factor for professional burnout. Overall, methodological triangulation was used as it yielded a wide range of data and information, supporting effective analysis. The researcher targeted the use of interviews,
questionnaires, and focus group discussions to collect vital information. These different methodologies ensured broader access to important ideas that helped make informed and excellent decisions (Noble & Heale, 2019). They may have revealed that healthcare providers were exposed to emotional, psychological, and physical exhaustion based on the
hectic working environment and other associated factors. Considering that each methodology and source provided unique insights, the investigator was better positioned to make a strategic generalization and conclusion. Overall, the selected methodology ensured that the researcher had a vast range of data and information essential in determining the extent to which healthcare providers may have been exposed to professional burnout during the COVID-19 pandemic era. Using triangulation guaranteed access to quality data and information (Noble & Heale, 2019). This enhanced the credibility and validity of the research outcomes. The audience was likelier to trust and believe in the established research outcomes based on the triangulation approach. Therefore, it became a vital perspective of concern when dealing with an issue such as professional burnout among healthcare professionals.
Summary of the nature of the study
This single case study addressed the issues of professional burnout among healthcare providers during the COVID-19 pandemic. The focus was on selected care providers and leaders in the healthcare setting. A positivist research paradigm enabled the researcher to base the process on an objective approach rather than a subjective one to interpret the situation. Also, a flexible design was crucial to ensure the researcher could adjust methods and techniques if needed. The case study approach was highly integrated with this case study, enabling the investigator to study the subjects in a real-life context. Questionnaires and interviews acted as imperative data collection strategies supporting triangulation. The
use of various qualitative methods, as described, benefited the researcher. They were able to collect the most accurate data possible and come up with research that was conclusive and very informative.
Research Framework
The research was guided by elements that helped the researchers focus and narrow their inquiry into burnout among healthcare workers. The study applied concepts, theories, actors, and constructs to help structure and govern the research. Thus, the study used a combination of organizational, psychological, and social frameworks to research how leadership in medical institutions affected healthcare workers’ performance amidst the challenges of COVID-19. The metrics considered were the healthcare personnel’s (HCP) working hours during the COVID-19 pandemic, the doctor-patient ratio, and the welfare provided. The psychological factors caused by COVID-19 might have been responsible for healthcare workers’ burnout. The research questions sought to address professional burnout among nurses and understand if nurses were the most affected by burnout during the COVID-19 pandemic. Other research questions sought to understand how leadership burnout affected burnout and the proposals to arrest the burnout among healthcare workers.
The following figure, Figure 1, is a visual representation of the relationship between these elements within the framework:
Figure 1. Research Framework Diagram
Concepts
Leadership is integral to ensuring any organization’s smooth running (Cotel et al., 2021). In a healthcare setup, leadership is crucial in facilitating quality services. In the past few years, the efficiency and effectiveness of leadership within the healthcare settings
have been put under severe test by the outbreak of COVID-19. The pandemic has exposed the gaps in leadership quality needed to run healthcare facilities (Sharifi et al., 2021). As a result
of inefficiency in leadership within the healthcare sector, cases of healthcare professionals experiencing burnout have drastically increased (Sharifi et al., 2021). Effective and efficient leadership is essential, ensuring various issues, such as professional burnout, do not affect the quality of healthcare services rendered to the patients (Anthony-McMann et al., 2017).
Burnout Within Health Professionals
The presence of effective and efficient leadership within the organization caters to the psychological welfare of its human resources (Sharifi et al., 2021). COVID-19 has caused chaos and confusion within the healthcare environment. For instance, the high number of patient deaths within the hospital has led to healthcare providers experiencing shock and trauma. This massive loss of patients and healthcare professionals has led to fatigue and burnout in healthcare providers (Sharifi et al., 2021).
Comprehending the severity of healthcare professional burnout and its cause is vital in developing a supportive environment for healthcare professionals and their well-being, effectiveness, and efficacy within the healthcare workforce. Cotel et al. (2021) demonstrate that 50% of medical professionals have experienced exhaustion due to the COVID-19 pandemic in one instance. As shown in Figure 1, the concept is linked to the psychological and organizational framework because it seeks to explain the psychology behind more than half of healthcare workers experiencing burnout. The impacts of COVID-19 on the psychological state of healthcare employees are clear. Just like the pandemic led to psychological trauma due to the loss of jobs and loved ones, school closures, and movement
restrictions, it equally had a daunting experience for the nurses who were the frontline soldiers to combat its spread (Sharifi et al., 2021). Moreover, they cared for their families, while others had to stay in the hospitals due to movement restrictions (Sharifi et al., 2021).
The long working hours, the high patient-nurse ratio, and the ever-increasing patient count caused burnout in the nurses (Sharifi et al., 2021).
Shortages in Healthcare Professionals in Relation to COVID-19
The outbreak of COVID-19 has exposed the acute shortage of healthcare providers within the healthcare systems (Dall’Ora et al., 2020). The exponential increase in the number of individuals seeking healthcare services due to the pandemic has stretched to limit the abilities of the available professionals. The influence of COVID-19 on healthcare safety cannot be underestimated. The burnout experienced by healthcare providers is of national concern (Dall’Ora et al., 2020). The emergence of COVID-19 did not stop other diseases from occurring, while the doctor-patient ratio remained the same (Dall’Ora et al., 2020). As a result, the long working shift and lack of proper support leadership infrastructure have led to healthcare professionals experiencing burnout while providing healthcare services.
Leadership Within the Organization
After the pandemic, healthcare organizations lost income due to canceling non-emergency and specialty treatments (Dall’Ora et al., 2020). Therefore, the healthcare sector has been strained beyond the limit, and the government’s relief has not been enough to address the impending more significant challenge. The loss of revenue and the overwhelming hospital capacities made the management of the healthcare facilities difficult. The healthcare administrators were thus overwhelmed with balancing life and work (Dall’Ora et al., 2020). Therefore, the leadership attributes were short of the transactional qualities needed for success in the healthcare sector. Some of the vital aspects to be deliberated, including the role
of supervisors of healthcare institutions in causative to the cause of healthcare professionals’ burnout (Dall’Ora et al., 2020). Notably, crucial resource allocation issues within the healthcare environment and shift patterns are essential in mediating burnout. Developing a clear insight into the influence COVID-19 has on healthcare professional burnout can inspire positive human resource management (Cotel et al., 2021). Thus, the leadership within healthcare facilities is mandated to create a conducive working environment.
However, employee engagement is essential to fully effect the necessary changes and help doctors overcome the challenges of the pandemic (Cotel et al., 2021). Healthcare administrators and senior managers must devise measures that reward the nurses and clinical officers appropriately to motivate them and help them overcome burnout (Cotel et al., 2021).
Effective Leadership
Employee engagement will be based on participative institutional practices that embrace the current organizational design trends toward effective leadership (Anthony-Mcmann et al., 2017). The techniques needed to address the concept of employee relations and job satisfaction through incentive programs motivate employees to work and improve their welfare while in the workplace (Anthony-Mcmann et al., 2017). Leaders are responsible for creating a conducive working environment that encourages employee engagement. Leaders can adopt numerous strategies and programs to ensure employees are conversant with their roles, reducing burnout cases (Cotel et al., 2021).
Theories
Theories are extensively beneficial in understanding how professional burnout affects and impacts care providers. They offer a set of principles that allow the audience to cultivate
a better relationship between these aspects and the core issue at hand. They encompass an in-depth and valuable relationship of variables leading to the problem. Primarily during the COVID-19 pandemic, when healthcare providers have experienced advanced professional burnout, using theories provides a greater understanding and view of the perspectives that led to the situation (Jalili et al., 2021). One of these theories is the job-demands resource, which analyzes the hectic and demanding environment evident during the pandemic. Care providers developed burnout due to handling numerous roles and responsibilities (Konlan et al., 2022). Maslach’s theory covers emotional exhaustion emerging from a similar working environment. Lastly, Maslach’s theory covers the emotional drain from the high workload evidenced during the pandemic.
These significant theories target the prevailing work setting detailing the pandemic (Konecki, 2018). The issue of emotional, psychological, and physical exhaustion relates to leadership capacity (Konecki, 2018). The researcher observed transactional and transformational leadership and the possible inefficiency of leaders in guiding healthcare organizations. The theory portion of the research framework is established on variables that may impact the possible responses of the sample population (Russell, 2014). As Russell (2014) further supports, a high perception of transformational leadership reduces burnout levels, especially among high-risk professionals such as the police and healthcare workers. The research sought to utilize healthcare workers’ attitudes and perceptions to understand further burnout among healthcare workers, supported by theories and specific research questions.
Job Demands–Resources Theory (JD-R)
This theory posits that the working environment can expose care providers to professional burnout. Healthcare professionals who work in a hectic and demanding setting
become extensively prone to burnout. These elements include workloads, emotional demands, and understaffing (Broetje et al., 2020). They become highly dissatisfied and demotivated in their work. The primary foundation behind burnout is the increased job demands in the
workplace. For example, during the COVID-19 pandemic, hospitals and other care centers experienced a surge in service demand. Care providers were handling numerous roles and responsibilities that left them overburdened. This created emotional, physical, and psychological challenges, especially in institutions that failed to capture the needs and well-being of these service providers (Broetje et al., 2020). This theory argues that the workload on an employee affects their stress levels (Cotel et al., 2021). Notably, when the work demands increase, stress levels increase simultaneously, leading to work burnout (Cotel et al., 2021). COVID-19 increased the tasks of healthcare people as the infections spread faster in all nations. The increased demand for healthcare services strained healthcare workers beyond the limit (Cotel et al., 2021). The healthcare workers had to handle more workload, work for long hours, lack enough sleep, suffer poor nutrition, and experience the mental trauma of experiencing patients suffering and dying due to the virus increase (Morgantini et al., 2020).
However, research shows that self-regulation will likely ease burnout in the healthcare sector (Bakker & de Vries, 2021). This means that care providers should regulate themselves to avoid burnout. This research counters the argument that high job demand leaves healthcare providers exposed to job strain and emerging burnout. Overall, this theory is used to evaluate data to inform the research on the impacts that an environment based on high demand for care services can have on professional burnout, primarily when leaders fail to integrate strategic actions. It allows institutional leaders to assess the status of the working environment to supplement the demand and supply of care services when dealing with a hectic setting.
Maslach’s Theory
Maslach’s theory focuses on the challenging environment in which care providers work, especially during pandemics (Dall’Ora et al., 2020). They operate in a complex and hectic setting that leaves them nursing emotional exhaustion. This theory applies where demanding working conditions expose care providers to emotional tribulations. They often face anxiety and stress, considering they are left to handle numerous critical roles and responsibilities (Teo et al., 2021). However, this does not mean that job demands and resource availability are the only aspects that leave care providers prone to the menace. Personal characteristics also act as a critical factor that shapes the outcome, as identified by McCormack et al. (2018). This means that contrary to the imagination that institutional leaders are to blame for burnout, healthcare providers can better manage their emotions and feelings to accelerate the fight against burnout.
The theory entails emotional exhaustion and a partial sense of personal accomplishment associated with their duties and responsibilities (Poghosyan et al., 2009). Burnout undermines the care and attention services provided to patients. Maslach’s theory has developed a framework capable of predicting the likelihood of burnout within the organization’s human resources (Dall’Ora et al., 2020). The framework is the Maslach Burnout Inventory (MBI) (Dall’Ora et al., 2020). According to the framework, some key components contributing to burnout are extreme assignment, negative coexistence with the community, lack of motivation, and lack of resource control (Morgantini et al., 2020). The management of resources will help to employ more healthcare personnel, purchase PPEs, pay for the workers’ allowances, and provide accommodation, childcare, and transport to ease the occupational stressors that lead to burnout in the workplace (Morgantini
et al., 2020). Maslach’s theory connects how using resources could help reduce burnout in the research framework (Dall’Ora et al., 2020).
This theory helps healthcare institutional leaders realize that the foundation behind reduced burnout lies in the strategic allocation of resources. This can handle most of the gaps that leave care providers with nursing burnout. For instance, a significant allocation of resources can facilitate employee mental welfare, providing quality personal protective equipment and workforce allowances. Advancing each of these areas can limit this menace. For example, during the COVID-19 pandemic, healthcare workers faced enormous and hectic tasks due to the surge in patients needing care and attention services. If their organizations could employ more staff, this may limit burnout.
Conservation of Resources Theory
The theory provides the necessary parameters to enhance the well-being of healthcare workers, including vitality, the working environment conditions, and the profession’s tools (Prapanjaroensin et al., 2017). According to the theory, the absence of the four above parameters leads to burnout among healthcare professionals. In line with the WHO (World Health Organization), the discussions of this theory define burnout as the lack of energy or fatigue, pessimism in the workplace, or leaving one’s profession (Morgantini et al., 2020). Therefore, the actor’s intervention to burnout must seek intervention mechanisms that guarantee energy, satisfaction at work, and a healthy organizational culture. This revolves around collecting a significant resource base to pave the way for viable healthcare systems and structures. Research indicates that poorly resourced health systems are a critical challenge in reducing burnout (Alvaro et al., 2010). If healthcare establishments fail to assemble vital and substantial resources, they will likely expose their care professionals to
burnout. This portrays the need for leaders to invest in a crucial resource base to supplement emerging needs when operating in a hectic and demanding environment.
This theory was used to analyze stress factors, how those stress factors relate to healthcare workers’ burnout and the most efficient methods of addressing burnout.
This theory will guide interventions to decrease possible burnout and future research examining the relationship between healthcare worker’s burnout and patient safety (Cocker & Joss., 2016). This theory captures the need for healthcare leaders to amass and allocate resources to establish a conducive working environment. A significant allocation of resources in various healthcare centers may pave the way for reduced burnout. This is because institutional leaders can address most issues that expose care providers to this problem. For example, they can employ more staff members to accelerate service delivery. This ensures greater flexibility and enables service providers to establish a work-life balance. Overall, this major theoretical approach enables healthcare leaders to address burnout during the pandemic.
Actors
Various personnel influence the activities in a healthcare system and define the fluidity of operations in providing care (Morgantini et al., 2020). Fundamentally, the segmentation of these actors in terms of their role in a healthcare facility determines the suitability of care provision. Therefore, the care team was segmented into various units facilitating the healthcare facility’s operations.
Health Care Providers
The healthcare professional was the core component under study. The study’s primary purpose was to determine how the pandemic had led to burnout in healthcare facilities. Burnout became a global health concern for nurses, physicians, and clinicians caused by
stress in the workplace that was not appropriately managed (Sharifi et al., 2021). Burnout manifests in three forms: fatigue or energy loss, pessimism about the job or mental distraction from work, and reduced professional effectiveness (Sharifi et al., 2021). Generally, the symptoms of burnout included increased absenteeism, attempts to leave the profession, drug abuse, and low self-esteem. Since the emergence of COVID-19, the health care professionals, particularly those working in the emergency departments, have faced many occupational stressors, including the hours worked, prolonged wearing of masks, lack of sleep, poor nutrition, dehydration, and heat generated by extra clothes, and increasing workload (Sharifi et al., 2021). These stressors worsened the burnout crisis in the healthcare sector because of the already demanding work schedules before the pandemic struck (Sharifi et al., 2021).
Healthcare Managers/Administrators
This actor played an essential role within the healthcare environment. Some healthcare leaders’ responsibilities included employing and assigning duties and ensuring healthcare workers had access to resources and protective gear. Figure 1 linked these actors to the organizational and psychological framework, allowing the investigation of how each actor influenced the psychological well-being of healthcare practitioners.
Patient / Consumer
The patient’s welfare was at the center of the healthcare service providers. However, this welfare was adversely affected when the quality of health and safety of the service provider was constrained by burnout (Sharifi et al., 2021). As a result of nurses experiencing burnout, careless mistakes were likely to occur, negatively impacting patients’ well-being. Moreover, the constant death, the suffering, and the need to sympathize with customers whose patients were admitted also became causes of burnout for the nurses (Sharifi et al., 2021). The COVID-19 agony undoubtedly caused mental health problems for the public,
the patients, the nurses, and other healthcare personnel (HCP). The research played an integral role in demonstrating the roles patients could play in facilitating the solving of the problem of caregiver burnout.
Constructs
Constructs are essential in facilitating critical understanding regarding issues affecting the topic under research. The constructs refer to the connection between leadership and healthcare professionals and the effort of healthcare administrators to contain burnout. Containing and controlling burnout among healthcare professionals was a challenging exercise requiring the pooling resources and skills from all the profession’s stakeholders (Sharifi et al., 2021).
The Role of Stakeholders in Dealing with Healthcare Professional Burnout
The role of stakeholders exists as one of the imperative constructs in the professional burnout challenge. Numerous parties are affected by the different decisions established in the healthcare domain. This has been a significant area of concern, as Wu et al. (2019) highlight that little attention is directed toward multiple stakeholders involved in healthcare matters. Organizational leaders should always integrate and observe the needs and interests of all stakeholders (Ali et al., 2021). In this case, the project focusing on addressing professional burnout through effective leadership means that leaders should evaluate and meet the expectations of all stakeholders. These entail both the internal and external parties. For example, patients and care providers are internal stakeholders impacted by this initiative, while the community is a critical external party.
Patients and medical supervisors are crucial stakeholders within the healthcare sector. These groups of stakeholders have an integral role in addressing the issues of professional
burnout. For instance, patients directly interact with healthcare providers and can tell the healthcare professionals’ burnout level. However, for the patients to be able to
report cases of professional burnout, several aspects are needed. One of the key aspects is how patients can realize and report incidences of burnout of healthcare professionals within the organization while still maintaining the professionalism of nurses (Morgantini et al., 2020). If patients realize the care the provider is offering inadequate services, they can always report this to the proper authorities. This paves the way for leaders to take immediate and quality actions. However, this does not mean that leaders should wait for such happenings to take action. They should evaluate the working environment and establish if it suits the needs and welfare of their team of professionals. This will ensure leaders take the best steps to avoid exposing their healthcare workers to burnout. For example, during the pandemic, healthcare workers faced various mental issues like stress, depression, and anxiety (Ghassemi, 2021). This was connected to the events and images they observed in their line of duty. This called for leaders to invest in mental training and awareness programs. Understanding their mental health risks should have accelerated them into establishing this strategic action (Ghassemi, 2021). This means that organizational leaders remain pivotal in making the work setting quality and conducive for everyone. This construct considers all stakeholders’ unique needs, interests, and expectations while observing them (Kelly et al., 2020).
Creation of a Conducive Working Environment for the Employees
Creating a conducive working environment for healthcare service providers is one of the most effective approaches to dealing with professional burnout (Morgantini et al., 2020). The healthcare environment changes rapidly, and strategic steps are needed to build a quality working environment. For example, when the pandemic occurred, most hospitals and care
centers experienced numerous patients needing admission and other critical services. Workers were left handling multiple roles that exposed them to burnout. This portrayed a lack of
adjustments for these care providers to balance their work and personal lives. They became heavily exposed to physical, emotional, and psychological challenges. Amidst the hectic environment was the lack of access to crucial equipment for handling patients. As Jalili et al. (2021) note, leaders failed in their mandate of making the working environment better for all healthcare workers. Immediately, care leaders realized that the COVID-19 pandemic had taken a toll on their organization; they would have liaised to create proactive measures. In case burnout advanced, they would have implemented these guidelines to safeguard their team members from developing burnout.
The leadership role during the crisis was a critical factor in containing the spread of the disease and ensuring the healthcare workers’ welfare (Morgantini et al., 2020). The healthcare leadership during the pandemic played an essential part in deploying the healthcare personnel and providing home care for the nurses and physicians, arranging transport services, accommodation, and social welfare (Morgantini et al., 2020). Healthcare administrators played an essential role in managing the workforce by recruiting non-specialized clinicians to assist in the hospitals’ wards while saving the most qualified doctors from the frontline and restricting them to emergency and intensive care units during the pandemic (Morgantini et al., 2020).
As indicated in Figure 1, the constructs were linked to the relationship between the organizational and social frameworks that will help identify the social impact of various strategies as part of a solution to burnout.
Relationship Between Concepts, Theories, Actors, and Constructs
The primary goal was to assess burnout challenges experienced by healthcare workers during the COVID-19 pandemic. Using relevant concepts, theories, actors, and constructs, the researcher established a viable explanation for the exposure to burnout among healthcare professionals when the world was struggling with the COVID-19 pandemic. These four components are interrelated to produce the desired outcome.
The major concepts included understanding the leadership role, the burnout among healthcare professionals, and the shortage of care providers. These crucial concepts enabled the audience to understand the cause and status of the burnout problem among these professionals. For example, the acute shortage of healthcare providers has exposed the current workforce to job strains that created burnout (Dall’Ora et al., 2020). This was because they were stretched beyond their limits.
The theories applicable in this situation included the Job Demands-resource (JD-R), Maslach’s, and the Conservation of Resources theories. The JD-R theory focuses on the increasing stress levels among healthcare professionals due to increased workloads (Morgantini et al., 2020). Maslach’s theory highlighted that burnout occurs due to extreme workloads, lack of motivation, and the absence of resource control (Morgantini et al., 2020). Lastly, the Conservation of Resources Theory revealed that the inability to consider the well-being of healthcare workers and create a quality working environment exposed these professionals to burnout (Prapanjaroensin et al., 2017).
The primary actors in this case included the healthcare workers and the leaders. Burnout directly affected providers with limited care and attention services to consumers and patients. The other vital actor was the healthcare managers or administrators responsible for addressing burnout among these professionals.
The addressed construct was the leadership approach that determined the effective handling of these vital issues. During the COVID-19 pandemic, the hospital needed talented leaders to manage the panic, provide medical workers with resources, and ensure enough employees to address the crisis (Brooms, 2020). Despite the prevailing crisis, leaders also needed to ensure that healthcare professionals got adequate time to relax and re-energize. However, healthcare leaders may have responded inappropriately to the crisis, causing burnout among healthcare workers (Brooms, 2020). The leadership strategies developed and implemented by the hospital leaders determined if the burnout challenge was adequately addressed (Al-Busaidi., 2008).
Conclusion of Constructs
This single case study aimed to understand the factors, particularly leadership strategies, that impacted COVID-19 burnout among healthcare workers. It was understood that leadership style impacted production and organizational culture (Allen, 2019). The effectiveness of leadership had to be assessed to determine plans for continuous improvement (Brooms, 2020).
The emergence of COVID-19 added to the growing concern about burnout among health professionals. WHO defined burnout as a crisis that needed addressing for an effective healthcare system and the realization of quality care (Allen, 2019). However, the emergence of the pandemic prolonged the nurses’ working hours and exposed them directly to the virus. Healthcare workers had to wear PPEs for long hours, lacked sleep, suffered poor nutrition, and the sympathy of comforting patients in the wards and the death of patients caused mental health trauma and increased burnout (Allen, 2019). The role of the healthcare leadership and the healthcare administrators in reducing burnout during the pandemic encouraged the healthcare personnel to continue in the fight against the pandemic. Organizational leadership,
transactional leadership and employee engagement were paramount. Providing childcare, accommodation, and transport reduced the healthcare workers’ pressures on work-life balance (Di Trani, 2021). The healthcare administrators were also critical in recruiting unspecialized clinicians and increasing bed capacity to reduce the work pressures on the most qualified human resources in the hospitals (Allen, 2019). The owners provided the necessary allowances, purchased the essential PPEs, and paid healthcare allowances. The government intervention in relief to healthcare institutions also helped increase bed capacity, PPEs, and other facilities (Denning et al., 2021). All these constructs effectively addressed the burnout issue among healthcare personnel. Patients’ contributions were also significant because they were the end consumers of the services. The patients could notice when the efficiency and efficacy of services, which must reflect the standard quality care and excellence, were not met. They thus helped to notify the relevant authorities of burnout.
Summary of the Research Framework
The research framework developed a visualization of the role of leaders to healthcare workers during everyday work environments and irregular work schedules, which had been the case since the outbreak of COVID-19. This research framework sought to effectively characterize each player and element of the healthcare sector by outlining how COVID-19 had evidenced the dependency of health workers on their leaders. This framework allowed the researchers to identify solutions to the high burnout levels, including all parties linked to the healthcare workers and practitioners. The role of the leaders’ psychological, social, and organizational frameworks helped outline the response to burnout during the pandemic.
Definition of Terms
Burnout: Burnout is a state of emotional, mental, and often physical exhaustion brought on by prolonged or repeated stress. (De Hert, 2020).
Occupational Challenge: An event that undermines a person’s ability to perform their duties or occurs due to their engagement within a particular occupational role (Lasalvia et al., 2021).
Proactive Actions: Anticipating events before they occur and being prepared and ready for the incident if it were to happen (Covin & Miller, 2014). Critical strategic postures for companies to thrive in fast-changing and competitive market environments (Covin & Miller, 2014).
Strategic Framework: A well-established plan or any other course of action focused on addressing a challenge or making a crucial investment (Marciano et al., 2020).
Assumptions, Limitations, and Delimitations
The study had assumptions, limitations, and delimitations that needed to be addressed. Maintaining reliability and validity in the study was fundamental to ensuring that data was solid and reproducible and that the findings were correct (Jalili et al., 2021). An instrument’s integrity and quality could be assured only if its validity and dependability could be shown. A study’s validity might factor in selecting which questionnaire to employ and assist researchers in guaranteeing that they were asking about areas of relevance that were genuinely being measured (Mohajan, 2018). The extent to which a study evaluated what it promised to measure was seen as an indicator of the validity of the data collected by it. The research identified leadership, nursing activities, and anonymity (Jalili et al., 2021). Identifying the stated factors and accounting for them enabled the
validation of the research and improved its reliability. This research dealt with time constraints and unwillingness to provide information. The investigator had to identify strategies to overcome the limitations. Overcoming the study constraints improved outcomes’ validity and reliability. Last in this section was delimitation; the part accounted for how the research overcame limitations (Mohajan, 2018). The study had to mitigate the adverse effects of limitations to ensure a valid and reliable conclusion.
Assumptions
Assumptions were deemed accurate but not tested or verified by the researcher (Jalili et al., 2021). They were based on reasons or logic and assisted the researcher in establishing a viable research process capable of answering the highlighted questions and verifying the hypotheses (Jalili et al., 2021). Assumptions validated the research process and formed the foundation behind the developed research problems. The study focused on assessing the impact of professional burnout among healthcare providers during the COVID-19 pandemic.
One of the assumptions made was that the burnout experienced by care providers emerged from the leadership’s inability to initiate viable institutional changes to protect and safeguard them amidst the demanding and unsafe working environment (Jalili et al., 2021). The researcher examined all potential antecedents, including leadership strategies and other possible causes linked to leadership capacity, to create a conducive working environment for healthcare providers during the pandemic through a strategic framework (Jalili et al., 2021).
Another assumption was that nurses were the most affected healthcare personnel during the pandemic (Jalili et al., 2021). They were always on the frontline to offer vital care and attention services to patients exposed to the virus. This meant that they were increasingly exposed to professional burnout. This was a critical assumption that the researcher focused on
reducing the impact of burnout on healthcare professionals. Understanding their mental health and risk factors for burnout helped formulate strategic actions (Ghassemi, 2021). The investigator targeted many nurses to participate in the research. The insights obtained from this assessment allowed the investigator to establish if nurses were exposed to professional burnout.
The final assumption was anonymity. Selected participants for the interview collection method were anonymous, and the responses were kept confidential to ensure they felt comfortable sharing their experiences (Surmiak, 2018). Participants selected for the interview collection had their responses remain anonymous. This portion was smaller and generated based on the initial response from the survey, and it was cross-referenced with the demographics to check for commonalities (Surmiak, 2018).
Limitations
Limitations influenced the research process and the interpretation of the findings, and they were out of the researcher’s control (Theofanidis & Fountouki, 2018). However, adequate risk management measures could limit these limitations. One of the limitations of this study was the reluctance to provide viable information due to fear associated with the exposure of this information into the public domain. However, the researcher promised to abide by anonymity and confidentiality (Dougherty, 2021). This motivated the participants to provide crucial information, mainly focusing on the leadership’s inability to improve the working environment. The researcher maintained communication with the healthcare representative to ensure they emphasized the confidentiality and anonymity of the research.
The other major limitation was time. The researcher was constrained by time to collect a lot of information from many potential participants. Addressing this challenge
called for a flexible research design that allowed the investigator to quickly collect significant data and information (Mohajan, 2018). It allowed the researcher to process and collect crucial information supporting the desired outcomes. In this case, the investigator focused on a single-study approach.
Delimitations
This study was conducted within one Hampton Roads organization using a minimum sample size of 20 participants. The hospital employed over 50,000 employees. The researcher focused on doctors, nurses, and medical assistants, viewed as the most common and active healthcare workers.
The research focused on managing time and resources to effectively assess the burnout levels among healthcare workers. The research applied a single case study to gather quality data to assess the topic. A single case study effectively focused on the given topic by sampling a smaller but more inclusive part of the population using the available data on a given population (Mohajan, 2018). The focus on conducting a single case study arose from the need to provide inclusive and applicable research on healthcare workers. The dominant difficulty with the topic was that it was impossible to sample each worker’s burnout levels or their opinions on the sources of burnout. A single study approach managed data on a given population based on the interactions from a smaller group that portrayed common characteristics with the collective population. Also, focusing on healthcare workers forced the researcher to focus only on a selected part of the population as a time management strategy. The specific group of workers was chosen for exposure to different conditions and factors influencing healthcare workers, making their experiences more applicable to the research.
Significance of the Study
Healthcare professional burnout has emerged as a crucial problem in the industry, especially during the COVID-19 pandemic (Jalili et al., 2021). Healthcare workers have been exposed to mental, psychological, and physical harm due to the enormous tasks they are expected to handle during the pandemic (Jalili et al., 2021). For example, nurses were increasingly burdened with the alarming number of individuals contracting the virus and being taken to various healthcare institutions. Healthcare professionals are handling an increased number of patients than usual. Institutional leaders have failed in their mandate to protect and safeguard the health and well-being of care providers (Jalili et al., 2021). Jalili et al. (2021) believe that leaders have been unable to develop strategic frameworks, thus exposing healthcare workers to professional burnout. This problem lies with the leaders expected to establish robust and strategic interventional measures to address the issue. For example, leaders can create flexible working schedules, introduce wellness programs, and ensure that these professionals have the needed safety equipment when handling patients. Thus, the rationale behind the research is to enable healthcare administrators and other decision-makers to gain insights focusing on the actions they can implement to limit burnout (Jalili et al., 2021). It may establish proactive measures that these leaders can incorporate when faced with similar pandemics in the future. Overall, the research exposes healthcare leaders to suitable interventional measures they can develop and implement to save healthcare providers from professional burnout currently and in the future (Jalili et al., 2021).
Reduction of Gaps in Literature
Even though leaders have a central role in reducing professional burnout among healthcare personnel and have failed in this area, there is limited research focusing on their approaches, the effect of leadership, or actions that have or could be taken. The researcher
attempted to fill this gap in research by asking questions specific to COVID-19 burnout among healthcare workers related to their perception of the role, actions, and leadership behaviors regarding the COVID-19 pandemic. More research was conducted through this study to assess leaders as frontline stakeholders handling and managing the burnout challenge. With the experiences witnessed during the COVID-19 pandemic, investigators focused on the leadership role and its impact on addressing professional burnout among healthcare workers (Lasalvia et al., 2021). As research indicates, healthcare administrators have failed in their mandate to address burnout (Lasalvia et al., 2021). Their limited attention to care providers’ physical, psychological, and emotional health had created a significant challenge in boosting overall health and well-being. Sharifi et al. (2020) argue that leaders were expected to use excellent interventions to provide these service providers with stable emotional, physical, and mental status. Leaders have a central role to play in addressing burnout. Therefore, more research explored the phenomena.
Also, more research should focus on nurses’ exposure to professional burnout (Sharifi et al., 2020). They form a large part of the healthcare workforce. Nurses oversee patients’ health and overall well-being by spending a large amount of their working time managing their recovery and progress. Healthcare providers interacted with patients. For example, a nurse visits patients to monitor their progress and overall status. This can expose them to burnout, especially if they fail to receive adequate support from top leadership. Thus, there was a need to advance research focusing on leadership strategies that may influence burnout, laying the foundation for quality leadership tactics that healthcare administrators develop to protect and safeguard the health and welfare of the largest workforce in the industry.
Implications for Biblical Integration
Integrating the issue of professional burnout with biblical perspectives will likely target outcomes (Cook, 2020). Addressing this burnout among healthcare providers calls for alignment with biblical teachings and values, ensuring that the stakeholders targeted to handle and manage this problem live up to their mandate and expectations. In this case, leaders ensure they advance their responsibility toward healthcare professionals by observing the environment and introducing approaches that limit the emergence of burnout. As the Bible states, “A prudent person foresees danger and takes precautions while the simpleton goes blindly on and suffers the consequences” (Proverbs 27:12, New International Version). There is a call for healthcare leaders to identify gaps and dangers associated with professional burnout and introduce viable ways of reducing their emergence. This will protect healthcare providers. For example, decreasing burnout will portray a healthcare establishment as a principal service provider that delivers quality outcomes. This biblical quote urges leaders to be attentive to issues that could expose care providers to burnout and take immediate and appropriate actions. There is an improved commitment to healthcare providers’ health and overall well-being in a highly demanding working environment, attributed to an increased surge in COVID-19 virus cases.
Research into the impact of leadership on burnout among healthcare practitioners can be effectively understood by analyzing the issue from a biblical perspective. The biblical perspective is critical because it yields a fruitful analysis of various elements to understand that God has revealed everything to us in spirit (Badley et al., 2011, 1 Corinthians 2:10).
The research was conducted from a biblical perspective through various research elements. Guided by the biblical perspective of research, the study was initiated through effective planning. According to the Bible, God urges us to “Commit to the Lord whatever
you do, and he will establish your plans” (Proverbs 16:9, New International Version). This evidences that the biblical research perspective demands that researchers initiate every type of study through proper planning. The Biblical perspective of research affirms that appropriate planning enhanced the applicability and relevance of the research by ensuring that the investigation was guided by reason and yields benefits to those involved. Secondly, the research was conducted to meet security standards. The Bible affirms, “The prudent see danger and take refuge, but the simple keep going and pay the penalty.” (Proverbs 22:3, New International Version). Using a biblical perspective in research allows the understanding that security threats in research are more than physical concerns. This will enable the researchers to be careful not to infringe on the participant’s privacy and emotional balance with the understanding that the security of the physical, mental, and emotional state is vital in promoting the accuracy and reliability of the research.
Benefits and Relationship to Leadership Practice
The research focused on addressing COVID-19 burnout among healthcare workers, potentially laying the foundation for effective leadership strategies to boost the health and welfare of all service providers (Dalla’Ora et al., 2020). The research provided valuable insights that healthcare leaders could integrate and implement to create a conducive working environment for healthcare providers during the pandemic. Leaders benefited from a wide range of potential ideas likely to reduce professional burnout among service providers. The research also helped in handling future pandemics that could generate similar outcomes. It positioned healthcare leaders in a better place to develop proactive actions seeking to protect healthcare workers from mental, physical, and psychological exhaustion amidst the
demanding working environment (Dalla’Ora et al., 2020). Excessive workload and lack of relevant resources were central issues that exposed care providers to burnout (Dalla’Ora et
al., 2020). Depending on the problems exposing care providers to burnout and the status of the working environment, leaders introduced and initiated significant measures to diminish the associated issues.
The principal focus of the research was to raise a call for healthcare administrators and other leaders to focus on building strategic frameworks capable of addressing issues that
generate professional burnout among care providers (Khasne et al., 2020). Research indicated that leaders had failed to adopt these frameworks, making care providers prone to increased
burnout (Khasne et al., 2020). This left the healthcare personnel unable to offer vital services due to reduced motivation and job satisfaction (Khasne et al., 2020). For instance, during the pandemic, most care providers terminated their services with various providers because they feared for their safety and lacked optimal job motivation. It was the responsibility of the leaders to create a potential working environment that allowed care providers to carry out their jobs satisfactorily (Khasne et al., 2020). Thus, the research created awareness of imperative leadership strategies likely to reduce professional burnout among healthcare personnel during the COVID-19 pandemic and in the future. Overall, the central focus was creating leadership awareness of the strategic approaches they could invest in to limit burnout during the pandemic and related conditions (Lasalvia et al., 2021). The solution to reduced burnout in the healthcare domain lies with the leaders (Lasalvia et al., 2021). As the key decision-makers, they had a crucial responsibility to initiate robust interventional measures that created a safe, secure, and flexible working environment for these team members during the pandemic (Lasalvia et al., 2021).
Summary of Significance of the Study
The central aim of the study was to assess strategies leaders could utilize to reduce professional burnout among healthcare providers, especially during the pandemic (Lasalvia et. al., 2021). Most issues leading to burnout among healthcare workers are connected to the leadership role (Lasalvia et al., 2021). For example, the leadership role was linked to increased workloads, lack of viable support systems, and limited access to personal protective equipment. These factors generated burnout, challenging care providers’ capacity and ability to offer essential services (Lasalvia et al., 2021). For instance, when nurses were exhausted
from handling many patients, they were likely to produce bad outcomes. Burnout remained a primary occupational challenge that leaders had failed to address through strategic frameworks and associated plans (Lasalvia et al., 2021). This study sought answers on the impact of leadership and specific practices that might offer relief from burnout. Integrating a biblical perspective ensured that all healthcare stakeholders engaged in behaviors and actions that fulfilled everyone’s needs, interests, and expectations, as recommended in the Bible.
Review of the Professional and Academic Literature
Overview
The review focused on the role of leaders in handling professional burnout among care providers, especially during the COVID-19 pandemic and future occurrences. The primary aim was to evaluate how leaders could use their positions to introduce strategic actions that limited exposure to professional burnout. Research has shown that leaders have failed to initiate strategies and effective interventions to address and prevent burnout in the workplace (Jalili et al., 2021). This continued to expose care providers to this problem. The analysis delved into existing leadership gaps that paved the way for massive burnout among healthcare providers during the pandemic. This generated viable recommendations that
healthcare institutional leaders should have developed policies to prevent their workforce from developing burnout.
Leadership is a critical aspect of the healthcare system (Jalili et al., 2021). Proper leadership ensures quality service delivery because of a motivated and enthusiastic workforce
(Jalili et al., 2021). However, despite most healthcare institutions having great leaders, various issues might have undermined the efforts of these leaders to achieve the best patient outcomes (Khasne et al., 2020). For instance, healthcare institutions should always be prepared to handle emergencies. Leaders were at the forefront, leading their followers to attain results even in challenging situations (Khasne et al., 2020). However, few were
prepared to handle pandemics as massive as COVID-19 that ravaged the world (Khasne et al., 2020). The pandemic exposed the challenges facing healthcare institutions globally (Khasne et al., 2020). The COVID-19 pandemic had affected various institutions because most medical facilities did not have a preparation model for their healthcare workers that would have ensured a flawless transition into emergency care for COVID-19 victims (Khasne et al., 2020). The leaders should have led the team through change and made goals public. Burnout continued to be a significant challenge due to the leaders’ lack of effective strategies in addressing issues that exposed healthcare workers to professional burnout (Lasalvia et al., 2021). The lack of strategic leadership in healthcare facilities has hindered effective interventions addressing professional burnout among health professionals (Jalili et al., 2021).
This research explored possible leadership failure in addressing professional burnout. Leadership gaps in healthcare organizations were to blame for the growing professional burnout among healthcare professionals (McPherson et al., 2022). Seemingly, many healthcare leaders might have lost touch with the realities facing medical professionals. Many health administrators did not respond to emerging COVID-19 risks. Many healthcare workers
were forced to work under strenuous and unsafe conditions during the pandemic. However, burnout was not new among healthcare providers (Mcpherson et al., 2022). Before the pandemic, most healthcare professionals, especially nurses, worked 12-hour shifts contrary to the 8 hours dictated by labor laws. Despite working excessively long hours, medical professionals were unpaid and underappreciated (Mcpherson et al., 2022). As a result, this demoralized medical professionals, attracting burnout. As COVID-19 infections rose, some medical professionals worked 14-16 hours daily, accelerating professional burnout (Lasalvia et al., 2021). The enormous professional burnout within the medical community called for leadership changes (Lasalvia et al., 2021). Leaders in the healthcare sector should have been
sensitive to employees’ needs by adopting a supportive leadership strategy (Lasalvia et al., 2021).
Leadership Practices and Employee Engagement
Leadership is deemed a critical factor that generates exposure to professional burnout among healthcare providers (McPherson et al., 2022). McPherson et al. (2022) find that the lack of objectivity in decision-making leads to the overall feeling of powerlessness among care providers. This entails the absence of transparency and openness as far as decision-making is concerned. It portrays that leaders may have failed their task as institutional decision-makers. Further research indicates that nursing leaders have been unable to improve the working environment, thus exposing the workforce to professional burnout (Mudallal et al., 2017). This has caused an enormous gap in making the working environment safe and favorable for all the team workers. For instance, if care providers work longer hours, they tend to develop burnout. This hinders their ability and capacity to deliver the projected results.
Nurses have been primarily exposed to burnout due to the hectic nature of their work setting (Kelly & Hearld, 2020). Statistics reveal that 50% of healthcare providers report high-stress levels due to high case workloads (Kelly & Hearld, 2020). This indicates that leadership has failed to introduce strategies to improve the working environment amidst demanding schedules. Thus, this calls for leaders to submit quality decisions to avoid
exposing care providers to professional burnout. Daily job demands, longer working hours, and high workloads have exposed care providers to this menace (Bosak et al., 2021). This highlights the lack of effective leadership styles across various healthcare centers. For example, by introducing effective organizational policies, leaders can open the opportunity to address the existing cases of professional burnout among healthcare providers.
Policies have a significant relationship with the performance of healthcare workers because they allow leaders to create the desired work environment (Sultan et al., 2020). A
report indicates that 35% to 54% of healthcare workers experience burnout because none of the six goals provided by the National Academy of Medicine offer proper staffing ratios to the medical facilities to establish practitioner wellness (Vuong, 2020). According to research, a good approach to reducing employee burnout is providing stress management interventions, offering social support, and engaging the workers in decisions (Gabriel & Aguinis, 2021). As a result, this enables the employees to design and craft their work environment and introduce high-quality performance management strategies.
Employee engagement refers to the team’s ability and willingness to invest or use their effort to accomplish organizational objectives (Shahid, 2019). Without staff engagement, an organization is likely to demoralize the people. Hence, this shows why staff engagement is a critical motivation and success factor in the workplace. The engagement concept emphasizes
flexibility and continuous improvement. Empowerment is also at the heart of employee engagement (Shahid, 2019). Thus, this shows why it is essential to invest in staff engagement.
Employee engagement inspires employees, but lacking it creates a disconnect between leaders and workers (Sultan et al., 2020). The staff engagement framework establishes a structured approach demonstrating how senior executives should engage with the staff and outlines how to achieve objectives. As an employer, it is critical to engage with the staff members at different levels using various communication and consultation methods. The main reason for this aspect is to determine how to reward and recognize performance or achievement (Wicherts et al., 2016). Engaged people take ownership of their duties, are clear on their responsibilities, and determine how they will fit into the broader organization; they feel empowered, motivated, and enjoy being part of the organization (Democracy et al.). Staff engagement also ignites staff loyalty and helps an organization maximize success. Thus, this shows why maximizing staff engagement should be a priority.
Organizations can implement a host of staff engagement practices. One way to maximize staff engagement is to ensure that the team members are actively involved in communication and decision-making matters within the workplace (Wicherts et al., 2016). Another effective way of staff engagement is to ensure appropriate communication (Shahid, 2019). Employees also need to be well-informed about relevant matters of the organization. The following figure illustrates the employee engagement model, showing the relationship between different processes that affect staff engagement. Managers must utilize processes to promote staff engagement at different organizational levels.
Figure 2. Employee Engagement Diagram
Employee Engagement Diagram
(Wicherts et al., 2016)
Leadership dynamics is a fundamental factor in resolving burnout issues experienced by healthcare workers during and post-COVID-19 season (Al-Malki et al., 2018). During the COVID-19 season, the factor that caused the progress of burnout was poor human resource management at the leadership level (Al-Malki et al., 2018). Poor structures that caused the healthcare workers to be subjected to long working hours created the burnout factor, which substantially reduced the overall scope of the burnout factor towards the operations of the personnel (Amanullah et al., 2020). The increment of the workload to the workers because of the surge for the patients who needed critical attention for the progress of enhancing the
operation’s sustainability became the overall dynamic that lacked objectivity in managing the situation for the specific needs of the issues raised through the
platform (Amanullah et al., 2020). Therefore, it became the springboard for realizing the stress function of the healthcare workers in providing services to the patients. The leadership could ensure that outsourcing for healthcare workers is incorporated into the strategies for managing the situation. Countries with high numbers of healthcare workers could supply the American health department with the requisite numbers, which would have mitigated the demand for healthcare services (Amanullah et al., 2020). This is a function of the leadership model incorporated at the executive level to determine the progressive solution to the specific answer to issues for creating sustainability.
The development of a sustainable schedule for managing the working hours for the workers and incorporating a model of instituting dynamics of relaxation may be a way to reduce stress for healthcare workers (Lee et al., 2018). Despite being professionals, they have human nature in them, thus making them susceptible to stress function (Lee et al., 2018). From this scope, it becomes critical that creating a powerful solution to the scheduling model helps to sustain the time for relaxation for healthcare workers. Integrating this management scope helps instill resilience in the employees’ workmanship and solve the sustainability of the focus (Lasalvia et al., 2021). The failure to integrate this model of creating focus causes the dynamic function for solving the progressive impact of the workers to be compromised on the account that they are obligated to work according to the requirements of the conditional provisions of the management. Therefore, it is integral in establishing a condition for improving the dynamics of solving the worker’s issues. Introducing the dynamics of providing nap time for healthcare workers is a fundamental approach to managing their healthcare capacity and ensuring they successfully help promote the operation’s
sustainability. The failure to incorporate this operation model helps bolster effective dynamics in resolving the substantial solution to the workers’ tiredness issues (Amanullah et al., 2020). Introducing the approach of nap time would effectively cause the sustainability of resolving the substantial provisions for managing the sustainable dynamics in ensuring that progression of optimal health is attained.
Adopting different leadership styles that are progressive according to the situation’s issues helps solve the problem issues of burnout among healthcare providers (Eliyana et al., 2019). From this progress, it becomes instrumental in balancing the sustainability of the progress (Eliyana et al., 2019). Increasing these operation dynamics becomes the critical dimension that would help resolve the unique needs promoted by creating improvement in the unique issues that are advanced into incorporating sustainability. For instance, incorporating the transformational leadership model would help to progress the dimension of caring for the potential realization of the specific needs of the workers (Lasalvia et al., 2021). Accordingly, transformational leadership focuses on the special interests of the employees. In this scope, the leadership would help create sustainability in the progress, essentially solving the specific focus of creating sustainability in the operation. Therefore, it
is beneficial to ensure that progress is made in realizing sustainability as a function for improving the quality of life that is advanced for workers who do not have an alternative to the negative impact of the healthcare service demand.
Similarly, the democratic leadership approach is instrumental in the sustainability of the burnout effect that engulfed healthcare workers during the pandemic (Eliyana et al., 2019). From this scope, sustainability is enhanced in developing progressive sustainability of progress (Eliyana et al., 2019). Creating these provisions is integral to resolving the essential dynamics of the problem (Eliyana et al., 2019). Therefore, it is critical to advance an
approach developed through the advancement of sustainable improvement toward resolving the issues that the workers experience. This brings the aspect of key theories that
can support healthcare leaders in reducing burnout in the workplace. These include transformation and servant leadership.
Healthcare institutional leaders should integrate transformative leadership to address the alarming cases of professional burnout among care providers (Liu et al., 2019). Research shows that transformational leadership can reduce the risk of burnout due to the promotion of workforce psychological empowerment (Liu et al., 2019). This entails leaders making crucial decisions that boost their employees’ physical and mental status. For example, when leaders stimulate their relationships with their followers, it improves job satisfaction, motivation, and performance. This means that workers will develop in-depth satisfaction irrespective of the state of their working environment. Also, leaders can offer social support amidst the emotional strain healthcare providers experience in the workplace (Liu et al., 2019). This ensures workers develop improved mental status while managing their duties and responsibilities. Further research indicates that transformational leaders can reduce burnout by making an organization’s mission attractive and salient (Bosak et al., 2021). This
focuses on a social-oriented mission. Leaders ensure that they develop an attractive and supportive mission to enable workers to deliver to the expectations while working in a safe and comfortable environment (Boamah, 2022). Boamah (2022) also reveals that transformational leadership strongly impacts workplace culture and job satisfaction and has an inverse direct outcome on burnout. This shows leaders can introduce a quality working environment that boosts motivation and satisfaction irrespective of the challenges experienced. It lays the foundation for reduced exposure to burnout.
Servant leadership is another strategic model capable of supporting leaders in the fight against burnout in the healthcare domain (Ma et al., 2021). Ma et al. (2021) reveal that the COVID-19 pandemic has exposed care providers to burnout, with leaders being called to
ensure that they integrate servant leadership strategies to alleviate this menace. This entails focusing on the health and well-being of the workforce. For instance, leaders ensure that they build quality working conditions to protect their employees from being prone to burnout.
Imran (2019) also argues that servant leaders can reduce workforce stress, which can lead to burnout. Their sole objective remains to be committed to serving workers. Thus, they use their positions to initiate decisions and actions that limit the emergence of burnout among care providers.
The Problem
The general problem is healthcare leaders’ failure to develop strategic frameworks in the wake of the COVID-19 pandemic, which has resulted in increased burnout among healthcare professionals. According to Jalili et al. (2021), because the leaders failed to develop a strategic framework, there is an increased professional burnout among healthcare workers caring for COVID-19 patients. In a recent study, Khasne et al. (2020) found that many healthcare professionals blamed their leaders for a lack of preparedness to deal with
COVID-19 resulted in mental strain for the caregivers. Therefore, leadership failure is a top cause of professional burnout among healthcare providers.
A similar study by Lasalvia et al. (2021) revealed that burnout among healthcare staff members during the pandemic was an issue of concern. Still, leaders had not done enough to mitigate the adverse implications. Sultana et al. (2020) supports this issue by stating that burnout is a major occupational problem among healthcare providers, and leaders are critical in developing intervention measures. The specific problem to be addressed is evaluating the
senior healthcare leaders within the south-eastern United States to effectively develop adequate responses to COVID-19, which could potentially increase burnout among healthcare professionals.
Research has revealed that professional burnout does not arise from the vacuum and that leaders play a vital role in creating a conducive environment that protects workers from exposure to burnout (Cotel et al., 2021). Lack of effective leadership abilities and capabilities leaves care providers prone to the menace. Professional burnout occurs due to the hectic and demanding status of the healthcare domain, especially during the pandemic. Care providers exposed to burnout depict symptoms such as anger, irritation, loss of productivity, anxiety, and emotional distress (Sultana et al., 2021). These are crucial issues likely to undermine the productivity of healthcare providers when their services are primarily needed. The failure of leaders to develop strategic change approaches to diminish exposure to burnout continues to accelerate the situation. Cotel et al. (2021) reveal that healthcare institutional leaders should spot signs and create opportunities that pave the way for reduced burnout. If they are in a position to detect gaps that lead to increased cases of burnout, they can develop essential solutions that limit the emergence of this menace. According to available research, curing professional burnout is better and easier than preventing burnout (Cotel et al., 2021).
Purposeful and regular one-on-one meetings are critical anti-burnout strategies that leaders in the healthcare sector must embrace (Cotel et al., 2021). In addition, leaders are obligated to monitor the workload and support the professional interests of the team members. Leaders are forced to intervene if burnout arises. For example, leaders are forced to act if they identify behavior change or the rise of unbecoming behavior in the workplace.
Burnout of healthcare workers is a critical problem that derails the performance level that the employees provide (Liu et al., 2019). The scope of burnout is caused by high
demand for the services when the time and the high number of patients caused the creation of the stress function (Liu et al., 2019). Therefore, it became substantial that realizing the sustainable approach to developing situational dynamics is created by resolving the issues
created to resolve the problem (Liu et al., 2019). The stakeholders in managing the burnout effect on healthcare workers are responsible for enabling the solution to the progressive management of the problem (Liu et al., 2019). Progressively, resolving the issue of burnout is beneficial for allowing the solution to provide healthcare services.
Concepts
The Role of Leadership
The pandemic has increased emotional and physical exhaustion among healthcare professionals due to the increased COVID-19 infection rates globally (Cotel et al., 2021). However, professional burnout is not a new phenomenon. Professional burnout has remained a significant issue across healthcare institutions for many years. However, it is COVID-19 that reawakened the study interest in professional burnout across academic and research circles (Cotel et al., 2021). Current research has investigated the interrelationship between professional leadership and professional burnout. Researchers agree that leadership weaknesses or gaps were ineffective or poor responses to the COVID-19 pandemic (WHO,
2020, September 17). Therefore, this presented a classic and reliable finding on the leadership implications of professional leadership. Effective intervention toward professional burnout will likely address issues that may undermine burnout concerns. There is a close link between professional leadership and burnout in healthcare. Papathanasiou et al. (2014) note that leadership is at the center of burnout, which healthcare professionals experience. This means that leadership capacity determines the status of occupational burnout portrayed in the care setting. A call for leaders to invest in a tactical leadership approach such as the path goal
leadership strategy will pave the way for reduced burnout (Papathanasiou et al., 2014). Further research indicates that reducing burnout requires organizational leaders to integrate crucial and advanced leadership strategies (McPherson et al., 2022). This means that
leaders play a pivotal role in addressing the emergence of occupational burnout and should always live up to expectations. They should adjust the working environment during the pandemic to accelerate the health and well-being of care providers. For example, alleviating burnout can focus on recruiting adequate staff and creating flexible schedules (Shah et al., 2021). This shows that reducing the risk of burnout lies in the domain of leadership.
Afulani et al. (2021) believe that low perceived preparedness to respond to the COVID-19 pandemic exposed care providers to professional burnout. When the situation emerged, leaders failed to take prompt and quality actions to protect their workers from developing stress amidst the demanding environment. This exposed them to burnout since they worked in a hectic work setting. Kniffin et al. (2021) also highlight that leaders have remained a major support system since the pandemic. With the organizational setting experiencing massive changes, leaders needed to adjust operations and strategies to protect their workers from occupational burnout. Kloutsinotis et al. (2022) also argue that the leadership approaches adopted by top-level leaders determined the milestones that healthcare providers experienced in the workplace.
Researchers across diverse studies have shown how the COVID-19 pandemic may have led to burnout concerns (Kloutsinotis et al., 2022). First, the COVID-19 infectious rate spike strained the inadequate healthcare workers in many organizations (WHO, 2020). An abrupt rise in the infectious rate left many healthcare facilities and leaders ill-prepared for the surging demand for medical services. Apart from the shortage of healthcare
Workers, including many health professionals, especially nurses and clinicians, worked longer hours.
Second, working long hours and lack of resting time overwhelmed the healthcare workers, leading to physical and mental exhaustion (WHO, 2020). According to Afulani et al. (2021), exposure to longer working hours and staffing are some of the gaps that led to increased exposure to occupational burnout during the COVID-19 pandemic. This signifies the institutional leaders’ lack of adequate and strategic actions to make the environment better and more conducive for these team members. Rising professional burnout was also evident from the symptoms exhibited by different healthcare workers. In addition, the harsh working environment led to professional burnout. Furthermore, the COVID-19 pandemic increased the safety and healthcare risks because of the high infection rate of the SARS-CoV-2 virus (WHO, 2020). Therefore, this shows how the leadership failed to create a positive working environment to address staff psychological and physical safety.
Leadership is integral to ensuring any organization’s smooth running (Cotel et al., 2021). Great leadership pervades different organizational levels to ensure the smooth functioning of an organization. Great leaders support their staff’s welfare by addressing psychosocial and physical needs. According to research, there are various ways leaders support their team members. One way is to set realistic expectations and avoid
overwhelming the staff with duties. Overwhelmed employees are unlikely to perform quality work, leading to service deterioration and eroding patient satisfaction.
Another way is to provide a career-life balance (Cotel et al., 2021). Many leaders in the healthcare field do not acknowledge how career-life balance is important for job satisfaction and quality work (WHO, 2020). Through work-life balance, employees can
achieve their emotional and social needs, including interacting with their loved ones and having time to rest (Sharifi et al., 2021). An excellent way to promote work-life balance is to hire sufficient healthcare staff to prevent employees from being overwhelmed with duties (Cotel et al., 2021). The lack of adequate protective equipment discouraged many healthcare employees from joining the workplace (WHO, 2020). Therefore, this may indicate that healthcare workers left were overwhelmed with medical duties, leading to pandemic concerns.
The COVID-19 pandemic exposed the gaps in the leadership quality needed to run healthcare facilities (Sharifi et al., 2021). Ineffective response and ill-preparedness to deal with the COVID-19 aftermath and implications exhibited the leadership’s failure to respond effectually to the pandemic (Sharifi et al., 2021). Leadership comes under the test during the unprecedented crisis. Undoubtedly, the COVID-19 pandemic was a major event that exposed leadership gaps that must be addressed (WHO, 2020). Poor leadership demonstrated by the healthcare administrators and top government officials reflected the leadership weaknesses that the government must address to safeguard and promote the staff’s welfare, including responding to burnout before, during, and after a crisis (WHO, 2020). An effective response to staff welfare, including addressing burnout, is critical for improving efficiency and reducing costs (Sharifi et al., 2021). During the COVID-19 pandemic, leadership inefficiency within the health sector was largely to blame for poor professional burnout (Sharifi et al., 2021). In the first place, leaders were ineffective in identifying professional burnout.
Effective leaders could have quickly identified professional burnout if they cared about the professional burnout that comes with disruptive trends, such as emergency cases (WHO, 2020). In addition, effective leaders ensure that various issues, such as professional burnout, do not affect the quality of healthcare services rendered to patients (Anthony-
McMann et al., 2017). Therefore, the COVID-19 pandemic was a prime testimony to show leadership weaknesses among professional managers.
Various concepts are instrumental in resolving burnout factors faced by healthcare workers (Blake et al., 2020). Positive interaction is the primary model that effectively solves burnout (Blake et al., 2020). Improving the social relationships among workers is instrumental in creating the right environment for managing the social needs that are provided for resolving the issue of burnout (Blake et al., 2020). Therefore, the environment must be developed to ensure the creation of interaction. Chatting among healthcare workers is an approach that could successfully help resolve the burnout problem’s negative impact (Raudenská et al., 2020). Creating these problems helps to ensure that the sustainability of the problem is determined. From this scope, it becomes instrumental in ensuring that progress in development is created. Establishing these dynamics is instrumental in developing the sustainability of the problem experienced by these workers
(Raudenská et al., 2020). Complimenting one another within the working space is a crucial approach for ensuring that healthcare workers can resolve the issue of burnout (Raudenská et al., 2020).
Incorporating yoga sessions by the workers is an instrumental concept for managing burnout (Raudenská et al., 2020). Yoga sessions are controlled through meditation (Raudenská et al., 2020). The workers engaged in the meditation time, becoming the progressive masters of the environment around them. This is the beneficial factor that helps
reduce the causative factors to the stress progress that the members of the workers feel in advancing their services (Raudenská et al., 2020). Creating these dynamic provisions helps to resolve the issue of the progressive improvement to the quality of the services promoted in creating sustainability of operations (Raudenská et al., 2020). The encouragement of the
Workers engaging in meditation during their relaxation time while in the workplace is instrumental in ensuring that the stress factor that creates the burnout effect is controlled (Di Trani et al., 2021). This progressive factor helps make the sustainable dynamic
of resolving the improvisation of critical progress. These dynamic factors help determine the progressive improvement in the quality of the work created for the employees.
Providing resting days for healthcare workers is a progressive approach to managing specific needs (Di Trani et al., 2021). In this dynamic, it becomes instrumental in creating a
progressive improvement to the problem of the effective dynamic. Resolving these factors is instrumental in creating a substantive solution to the issues in establishing the operation’s sustainability (Di Trani et al., 2021). These are the critical dynamics that help resolve the sustainability of the management function. Affirmatively, incorporating days for resting, especially during a time of high demand for workers’ services, is instrumental in managing the burnout problem that is instrumental to derailing the successful management problem (Di Trani et al., 2021). Failure to incorporate sustainable dynamics to resolve the progress of the problem becomes the dynamic factor in creating sustainability of the problem (Cleveland Clinic, 2022). These integral dynamics are instrumental in resolving the issues provided through negative provisions to determine the specific improvement of the problem (Cleveland Clinic, 2022). Therefore, including resting days is an instrumental dimension for resolving the oppressive impact towards creating a substantial solution to the problem’s improvement (Cleveland Clinic, 2022).
Burnout among Health Care Professionals
Effective leadership within the organization caters to the psychological welfare of its human resources (Sharifi et al., 2021). The massive loss of patients and healthcare professionals has led to fatigue and burnout in healthcare workers (Sharifi et al., 2021). Cotel
et al. (2021) demonstrate that 50% of medical professionals have experienced exhaustion due to the COVID-19 pandemic (2021). It means that half of the medical professionals are burned out.
According to available health reports, medical workers are on the frontline fighting COVID-19, increasing their infection vulnerability (Denning et al., 2021). Data has also shown that health workers and their families are among the most vulnerable population groups to physical and mental health during this pandemic (Denning et al., 2021). In addition,
data across different countries reveals that COVID-19 infection rates are significantly greater within the medical community than in the general population. Although health workers represent 2- 3% of the world population, they represent 14% of the COVID-
19 infection cases (WHO, 2020, September 17). In some nations, especially the underdeveloped ones, the infection rate is over 35% (WHO, 2020). Because of the high prevalence of COVID-19 within the medical community, thousands of healthcare workers have succumbed to this pandemic. Healthcare workers are far more vulnerable to COVID-19 infections than the general populace. However, there is limited data on whether infections among healthcare workers happen in community settings or within the workplace.
Besides the physical and biological risks, the COVID-19 pandemic has exposed healthcare workers to extraordinary stress levels (Essex & Weldon, 2021). Research has shown that many medical workers live in fear because of their exposure to extraordinary psychological stress levels and a highly demanding workplace. In addition, medical workers
constantly fear stigmatization because of the social stigmatization and isolation from their loved ones (Morgantini et al., 2020). Although COVID-19 accelerated psychological health risk, it is not the primary cause. A recent study has found that nearly 25% of healthcare workers experienced depression and anxiety before the pandemic (Essex & Weldon, 2021). In
addition, the studies revealed that 33% of medical professionals suffered from sleeping disorders during the pandemic (Morgantini et al., 2020). Reports by World Health
Organizations exposed an alarming rise in physical isolation, discrimination, and verbal harassment at the height of COVID-19 (Morgantini et al., 2020).
In 2020, the World Health Organization called on governments and healthcare administrators to prioritize staff wellness by maintaining a safe working environment and addressing emerging safety threats to healthcare workers (WHO, 2020). This portrayed a
central concern for the health and well-being of the healthcare providers. As the infectious rate surged, the World Health Organization, through its director-general, Tedros Adhanon Ghebreyesus, continued emphasizing the unmatched role that healthcare workers play in maintaining public safety and health (WHO, 2020). For example, healthcare leaders were required to introduce mental resilience programs to help care providers overcome the psychological and mental turmoil experienced in the line of duty (Ferreira & Gomes., 2021). This would enable healthcare professionals to provide critical services to the affected persons and simultaneously escape exposure to occupational burnout. Ma et al. (2021) also believe that mental resilience can reduce the emergence of professional burnout in the workplace. This calls on leaders to ensure that they introduce and implement actions that diminish the likelihood of burnout. Therefore, this implied that it is important to recognize and address the staff’s welfare and needs, including burnout issues.
This also showed that the WHO understood healthcare professionals’ unique role in addressing the pandemic (WHO, 2020). Recent studies have highlighted how managing healthcare workers’ wellness is critical to a properly functioning healthcare system and societal wellness (WHO, 2020). During the pandemic, the WHO released a circular with protocols exposing how to protect the welfare of healthcare workers.
Shortages in Healthcare Professionals in Relation to COVID-19
The outbreak of COVID-19 has exposed the acute shortage of healthcare providers within the healthcare system (Dall’Ora et al., 2020). The influence of COVID-19 on the safety of healthcare providers cannot be underestimated; hence, the burnout experienced by healthcare providers is of national concern, which has caused massive shortages within the healthcare system (Dall’Ora et al., 2020). Many healthcare facilities face a high attrition rate because of low job satisfaction, leading to staff shortages. Attrition is the failure to hire
new staff after the incumbent employees leave the workplace (Morgantini et al., 2020). As a result, this reduces the size of employees to meet organizational needs.
In addition, this forces employers to allocate more duties to employees to cover tasks previously performed by exiting employees (Ali et al., 2021). A decline in job satisfaction during COVID-19 was also a major factor in job turnover and attrition. Many healthcare employees left after COVID-19 because the working environment became increasingly riskier (Russell, 2014). Moreover, many healthcare providers have lost interest in the jobs they are passionate about, encouraging them to leave their workplaces and look for alternative employment (Essex & Weldon, 2021). As major players in the fight against the pandemic, healthcare workers were at the highest risk of contracting the COVID-19 infection. Hence, this encouraged many healthcare workers to resign.
Leadership within the Organization
The healthcare organization has lost income due to non-emergency and specialty treatment cancellations due to leadership decisions (Dall’Ora et al., 2020). During the height of the pandemic, many leaders shifted attention towards efforts to control SARs-CoV2 infections. However, these leaders overlooked the management of other health conditions, including mental health disorders, obesity, hypertension, cancers, and other illnesses.
Effective leaders balanced COVID-19 interventions and those for other medical conditions. Importantly, striking this balance is instrumental in ensuring that resources (human capital and materials) are not overstretched in one area. Some of the vital aspects to be deliberated include the role of supervisors of healthcare institutions in causative to the cause of healthcare professionals’ burnout (Dall’Ora et al., 2020). Developing a clear insight into the influence COVID-19 has on healthcare professionals’ burnout can positively inspire positive human resource management (Cotel et al., 2021). Employee engagement is essential to fully effect the necessary changes and help the doctors overcome the pandemic’s challenges.
Effective Leadership
The techniques needed to address the concept of employee relations and job satisfaction through incentive programs motivate employees to work and improve their welfare while in the workplace (Anthony-Mcmann et al., 2017). To successfully engage in employee engagement, leaders can adopt numerous strategies and programs to ensure employees are conversant with their roles, reducing burnout cases (Cotel et al., 2021). Under the WHO Charter, the government should invest in health staff wellness, including adding risk allowances and protecting workers from physical and biological hazards. The WHO Charter also establishes safety and health protocols to advance safety measures and
procedures (Sultana et al., 2020). Leadership is instrumental in employee engagement as it facilitates a continuous communication chain regarding the issues that lead to burnout in healthcare workers (Sultana et al., 2020). Without leaders’ attention to healthcare, staff leads to misunderstanding and work-related strain, resulting in burnout (Cotel et al., 2021).
Theories
Job Demands–Resources Theory (JD-R)
Job Demands- Resource Theory argues that the workload on an employee affects their stress levels (Cotel et al., 2021). According to job demands-resource theory, stress levels are directly proportionate to job demands and burnout (Cotel et al., 2021). Conversely, the positive effects of job burnout are inversely correlational. Therefore, it means that positive elements of a job address the job dissatisfaction issue. This finding indicates that leaders should invest heavily in promoting job satisfaction (Dall’Ora et al., 2020). Failure to invest in job satisfaction will bring severe issues to an organization, including eroding the satisfaction rate (Dall’Ora et al., 2020). When a leader increases job positives and lessens job demands,
the staff will experience little stress. Hence, this will improve motivation and staff engagement levels. This indicates why the research emphasizes maximum job experience and satisfaction in the workplace.
Maslach’s Theory
Maslach’s theory connects how using resources could help reduce burnout in the research framework (Morgantini et al., 2020). Maslach proposed a framework for predicting the occurrence of burnout. The framework is called the Maslach Burnout Inventory (MBI) (Dall’Ora et al., 2020). According to the framework, some of the critical components that contribute to burnout are as follows: extreme assignment, negative co-existence with the community, lack of motivation, and lack of resource control (Morgantini et al., 2020). Hence,
leaders should address the factors contributing to professional burnout among healthcare providers.
Conservation of Resources Theory
The Conservation of Resource Theory provides the necessary parameters to enhance healthcare workers’ well-being, including vitality, working environment conditions, and the profession’s tools (Prapanjaroensin et al., 2017). The Conservation of Resource Theory proposes three significant resources for healthcare workers: energy, conditions of work objects that workers interact with, and one’s characteristics (Prapanjaroensin et al.,
2017). In line with the WHO (World Health Organization), the discussion of the
Conservation Resource Theory defines burnout as the lack of energy or fatigue, pessimism in the workplace, or leaving one’s profession (Morgantini et al., 2020). Undeniably, the conservation of resources theory has provided an effective framework to expose the elements of burnout.
Actors
Health care professional
The healthcare professional is the main subject of this study. They need to identify how their work affects their mental health to seek help to prevent burnout (Lasalvia et al., 2021).
Burnout is a global health concern for nurses, physicians, and clinicians. It is caused by stress in the workplace and is not appropriately managed (Sharifi et al., 2021). Burnout manifests in three forms: fatigue or energy loss, pessimism about the job or mental distraction from work, and reduced professional effectiveness (Sharifi et al., 2021). Hence, leaders should be able to recognize these major symptoms or signs of professional burnout, and effective identification of these symptoms allows a leader to address burnout.
Healthcare managers/ Administrators
Healthcare administrators and managers hire and assign duties to the rest of the team members. They also make available resources healthcare workers require, like protective gear (Sultana et al., 2020). Healthcare administrators and managers are top decision-makers responsible for formulating an organization’s strategic intent and direction in healthcare facilities. In addition, healthcare managers and administrators serve as liaisons and spokespersons (Russell, 2014). As liaisons, these leaders build networks and enter into agreements with the strategic partners on the organization’s behalf. This shows why health managers and administrators are critical shareholders.
Patient / Consumer
Patient welfare is adversely affected when the service provider’s quality of health and safety is constrained by burnout (Sharifi et al., 2021). The patient is negatively affected when the health and safety of the healthcare worker are not guaranteed (Dall’Ora et al., 2020).
Nurse burnout may increase the risk of medical error, negatively impacting patient health (Lasalvia et al., 2021). Constant death, suffering, and the need to sympathize with customers who have admitted patients also cause burnout in healthcare providers (Sharifi et al., 2021). At the COVID-19 peak, the surge in deaths traumatized many healthcare workers, increasing their burnout. Therefore, this shows that efforts to improve patient experience correlate with reducing professional burnout.
Constructs
The scope of managing the sustainability of operations is embedded in developing sustainability, thus impacting the lack of oppressive improvement to the quality of life for healthcare workers (Blake et al., 2020). From this dimension, the quality of the healthcare workers’ work is a testament that burnout is developed (Blake et al., 2020). Sustainability is
thus instrumental in realizing the effectiveness of managing the problem. Creating an effective dynamic that promotes creating an effective solution to the problem helps develop the critical solution to the specific progress created in promoting the sustainable solution to the specific issues that are advanced through the problem being created. The failure to incorporate the model helps increase a negative dynamic of the scope of work that is incorporated through a solution to the problem (Eliyana et al., 2019). These are the instrumental factors that help resolve the issues encouraged by healthcare workers. The overall development of the safety provisions helps create a sustainable condition that is promoted to enhance progressive solutions.
Developing sustainable burnout management through establishing an effective reward system for healthcare workers is an instrumental construct for resolving the burnout effect (Schunk et al., 2020). Developing sustainable operations helps create an effective
environment that is a substantial resolution in creating a resounding impact in helping promote sustainable impact (Schunk et al., 2020). Therefore, it is ideal to realize effective
progression of the solution to the burnout factors the workers experience as they advance their mandate. The failure to incorporate a sustainable approach would thus create a negative impact for promoting improved operation as a dynamic progression of the problems. Paying employees fairly is an approach that would help create the right environment to ensure productivity sustainability. Thus, it is ideal to incorporate a system that focuses on the financial affairs of the workers since they dictate the serial burnout effect, mainly because of the lack of meaning as advanced through the poor payment provisions (Eliyana et al., 2019). These sustainable provisions would resoundingly help create progress that is enhanced in creating the right solution to the problem (Schunk et al., 2020). These are the essential provisions that help resolve the specific issues to promote critical impact
towards the resolution of the problem. Accordingly, it has been instrumental in realizing progress by enabling the sustainability of reward dynamics, which would provide the requisite motivation for curtailing the burnout effect.
Adopting physical development through exercising is a progressive model that is instrumental in realizing the sustainability of the progress for managing the burnout effect (Shanukat et al., 2020). According to Shaukat et al. (2020), burnout is a factor promoted by including negative health practices. Regular exercise helps enhance physical relaxation and reduce the chances of developing burnout (Shaukat et al., 2020). Progressively, it becomes instrumental for enhancing improvement towards creating sustainable progress in creating the improvement towards the promotion of the progressive realization of the problem (Shaukat et al., 2020); (Verbeek et al., 2019). These are the instrumental provision that helps manage the burnout effect as realized by the high
demand for the provision of services within an environment with high stress caused by the feeling that possible life-threatening infections may arise (Verbeek et al., 2019).
Integration of stress management is a fundamental factor in providing the resounding dynamics for resolving the negative impact of burnout (Verbeek et al., 2020). Accordingly, integration of the specific dynamics into solving the specific improvement to the quality of life becomes the instrumental factor that helps resolve the specific solutions attached through the provisions provided in the advancement of burnout control (Shreffler et al., 2020); (Verbeek et al., 2019). Thus, it is instrumental in ensuring that the progressive improvement of the quality of the working environment as a factor for promoting sustainability becomes an instrumental determinant for resolving burnout issues.
The Role of Stakeholders in Dealing with Healthcare Professional Burnout
The researcher has determined if the lack of a proper COVID-19 preventive
framework was the primary contributor to burnout experienced by healthcare providers during the pandemic (Jalili et al., 2021; Khasne et al., 2020). Determining if healthcare leaders understand the meaning of a practical structure necessary to mitigate COVID-19 without causing burnout among staff members is necessary. The researcher sought to establish whether a proper COVID-19 preventive framework is the primary contributor to healthcare providers’ burnout. In this case, they experienced burnout during the pandemic (Jalili et al., 2021). The research has determined if healthcare leaders understand the meaning of the practical structure necessary to mitigate COVID-19 without causing burnout.
Creating a Conducive Working Environment for the Employees
Creating a conducive working environment for healthcare service providers is one of the most effective approaches to professional burnout (Morgantini et al., 2020). Healthcare
leaders can implement a reliable framework to ensure staff members are sufficient to cater to the rising number of positive cases (Sultana et al., 2020). The healthcare leaders played an essential role in managing the workforce by recruiting non-specialized clinicians to assist in the hospitals while saving the most qualified healthcare workers from the frontline and restricting them to emergency and intensive care units during the pandemic.
Related Studies
The acute shortage of healthcare providers has exposed the current workforce to strains that have created burnout (Dall’Ora et al., 2020). Professional burnout remains a central challenge during the COVID-19 pandemic (Lasalvia et al., 2021). Healthcare workers are constantly emotionally and physically exhausted due to the alarming number of patients they handle during the pandemic (Anthony‐McMann et al., 2017). As the work demand increases across all hospital settings due to the high number of emerging infections, healthcare providers are likely to become worn out (Cotel et al., 2021). Identifying issues
such as excessive workload, limited rewards and recognition, and the lack of control of healthcare resources might allow healthcare leaders to address burnout (Dall’Ora et al., 2020). Resource shortage has affected the provision of suitable rewards, appropriate resources for care delivery, and the employment of more care providers (Anthony‐McMann et al., 2017).
Professional stressors such as lack of PPEs (Personal Protective Equipment), inadequate compensation, and extreme assignments have increased burnout among these professionals (Morgantini et al., 2020). Facilitating healthcare providers with the right resources and systems is a prerequisite for reducing professional burnout (Prapanjaroensin et al., 2017). Healthcare providers face mental strains from the lack of preparedness amidst the COVID-19 pandemic (Khasne et al., 2020). Leaders have failed to integrate and implement quality preparedness approaches to boost workforce well-being during the pandemic.
Leaders should examine factors that generate burnout and find effective handling to protect nurses against burnout (Anthony‐McMann et al., 2017). As Lasalvia et al. (2021) revealed, healthcare professionals act as the primary targets in this case, with leaders expected to safeguard their physical, emotional, and psychological well-being. Patients risk failing to achieve the projected outcomes when healthcare providers are exposed to burnout (Lasalvia et al., 2021). For example, care providers experiencing burnout will likely cause medical errors that negatively impact patients’ health and welfare.
Overall, leaders’ inability to develop a robust and effective COVID-19 preventive framework is a primary barrier to the fight against professional burnout among healthcare providers (Jalili et al., 2021). Leaders are paramount in creating an excellent working environment that limits exhaustion among care providers. A strategy like adequate staffing
will ensure that care providers can sufficiently care for the patients amidst the rising number of positive cases.
Several studies related to burnout management have been realized from the literature review. Human resource management is the fundamental study advanced in promoting sustainable development progress. According to Tewari et al. (2019), it ensures progress in resolving employee issues. The instrumental factor becomes the underlying factor in determining the problems that the employees experience. Incorporating sustainable employee management would thus help provide a progressive solution to the problems attached to realizing sustainable progress (Tewari et al., 2019). Accordingly, the integral function is promoted in helping the coping mechanism in times of need, as evidenced by the COVID-19 situation that caused even retirees to resume their duties to help combat the pandemic.
Resource management is another related study that the platform has revealed. Accordingly, the utility of the factor is instrumental in creating overall progress as the ideal provision for creating sustainable improvement in developing sustainability. Thus, it is instrumental in ensuring that progress is enhanced in resolving the specific focus for managing the progressive resolution to the specific focus of enabling resounding progress to include the specific focus (Wen et al., 2019). Therefore, this is a crucial factor in improving progress. Furthermore, understanding the sustainable ways of managing the supportive resources in advancing the quality of services is critical to developing realistic dynamics that enhance the operation’s sustainability (Amanullah et al., 2020). Thus, the realization of the progressive improvement to the sustainability of creating improved provision helps resolve the issues of governance as the main factor that helps provide the sustainable solution to the issue of enhancing the sustainability of the progress.
The public healthcare management study is another fundamental study. Accordingly, enhancing sustainability is a progressive factor that is instrumental in improving the quality of the healthcare services offered to the public (Wen, Ho et al., 2019). The provision of quality services depends on the quality of life provided by the scope of creating sustainability. Thus, ensuring that the right progress is enhanced in resolving the overall progress to create resounding pandemic management is critical. Thus, public healthcare management’s function would help create sustainable service delivery as the optimal provision in developing progress (Eliyana et al., 2019). Thus, it is instrumental in ensuring that progress is provided to create substantial solutions to the specific details for resolving the specific problems.
Anticipated and Discovered Themes
Most employees will recommend and emphasize the need to better understand leaders’ role in protecting and safeguarding healthcare workers from professional burnout, especially during the COVID-19 pandemic and others likely to emerge (Khasne et al., 2020). Improved leadership participation will reduce misunderstanding and other work-related strains that leave crucial gaps or burnout (Sultana et al., 2020). Healthcare workers may present the unexpected increase in the number of individuals with COVID-19 infections as a source of burnout because of increased pressure (Cotel et al., 2021). The shift in work descriptions and cultures after the pandemic has introduced uncertainty and new practices that pressure healthcare workers (Jalili et al., 2021). A flexible working schedule will reduce associated burdens that make providers prone to burnout (Cotel et al., 2021). Therefore, this
shows why healthcare providers should focus on developing a flexible team schedule.
Employees might claim that increased appreciation through incentives such as rewards and bonuses might reduce their burnout levels (Anthony-Mcmann et al., 2017). Healthcare providers might report a failure by their administrators by claiming that the leaders should have evaluated the situation to develop proactive solutions when exposed to adverse conditions such as professional burnout (Khasne et al., 2020; Sultana et al., 2020). The employees might generally confirm that burnout is not a new concept by stating it has been prevalent before COVID-19 because of a lack of viable measures to mitigate this problem and its adverse outcomes (Lasalvia et al., 2021). Improved leadership participation
will reduce misunderstanding and other work-related strains that leave crucial gaps or burnout.
Research has demonstrated various effective leadership practices to address burnout among healthcare workers (Sultana et al., 2020). Implementing safety precautions and infection control measures within the healthcare system is critical to improving employees’ physical and psychosocial health. Healthcare leaders can achieve safety within the workplace by offering adequate PPE supplies, and the PPEs should also be of great quality. In addition, adequate training of the medical workers on using PPEs and other safety precautions is essential. Adequate environmental services, including proper hygiene, sanitation, disinfection, and ventilation within the healthcare facility, are critical to maintaining population health. Moreover, vaccination of the medical staff to reduce their vulnerability to COVID-19 infection is also critical in improving staff safety (Cook, 2020).
It is essential to establish policies that will prevent medical staff from overworking. In the policy, the leaders should ensure that the working schedules have realistic and fair
working hours, allow for breaks, and reduce administrative healthcare burden (Ghassemi, 2021). The policy should also provide medical allowances and adequate insurance coverage for the growing risks in the healthcare-related environment (Ghassemi, 2021). Access to mental health in the medical community constitutes another major player in protecting population health. Sufficient access to social support and mental wellness for medical workers is crucial (Ali et al., 2021). Therefore, this will limit medical employees from experiencing professional burnout, which is endemic in the COVID-19 environment.
Adequate protection of healthcare workers from violence can also address professional burnout. Anti-violence programs must be implemented according to relevant policies and laws (Ghassemi, 2021). In addition, leaders should cultivate zero tolerance for
workplace violence. Reviewing labor legislation and introducing specific laws to limit workplace violence is also critical (Cook, 2020). Moreover, leaders should establish helplines
to allow healthcare workers to report incidents of violence in the workplace and support a confidential reporting framework.
Healthcare workers also have a major obligation to establish safety protocols and policies. Establishing linkages between occupational safety and health to address violence is essential. Leaders must also work towards integrating and incorporating requirements to promote workers’ safety programs. Moreover, leaders should establish patient safety reporting and learning structures or systems.
Developing and executing national healthcare programs for occupational safety that are consistent with national health and safety protocols is also vital. Healthcare leaders should review and upgrade national regulations or laws for occupational safety and health hazards. In
addition, leaders must develop guidelines or codes of practice to promote occupational safety and health among the leaders (Cook, 2020). Leaders must also promote intersectoral and
interprofessional collaboration to ensure maximum safety accomplishment (Ali et al., 2021). Intersectoral and interprofessional safety management focuses on maximizing diversity and inclusion.
From the literature review, a critically anticipated theme revolved around employee management (Tewari et al., 2019). The dimension of creating impressive solutions to the problems faced by the employees in advancing their duties was an instrumental factor that required the utmost improvement to ensure that the resulting victory was realized. Creating a substantial solution to the problem of burnout became the critical determinant of employee management. Another integral theme anticipated revolved around crisis management (Tewari
et al., 2019). In this scope, the focus is on the specific provisions. This provisional process would help resolve the critical need to create overall progress. Thus, it is instrumental in
focusing on developing the ideal progress in sustainable improvement of ways to resolve problems once they occur.
The discovered themes may revolve around burnout management. The utility of meditation as a powerful tool for ensuring that sustainability is controlled became a critical factor in developing progress. Thus, the development of these factors became the ideal resolution that got the specification for improving progress (Tewari et al., 2019). These are the integral dynamics that help solve the respective dynamics to enhance the necessary improvement in managing stress as a causative function to the problem of the solution. Thus, it is instrumental in focusing on creating sustainable progress in developing effective solutions for the advancement of sustainable stress management.
The practical intervention to resolve the specific issues developed when managing stress among the target population was the application of different and suitable theories (Shaukat et al., 2020). Creating these models became the essential operation to help resolve
the specific objectivity (Shaukat et al., 2020). Thus, sustainability improvement became the resounding factor that caused the creation of the critical improvement factor to be the ideal determinant in realizing adequate progress. For instance, the effort-recovery model has introduced the theme of managing the recovery process to promote progress in critically managing the solution. Accordingly, this operation model became the ideal process that helped create the progressive improvement toward managing the operation dynamics (Shaukat et al., 2020); (Liu et al., 2019). These are the integral factors that help maintain the progressive improvement in the quality of resolving the specific issues connected to the burnout problem.
Acquisition of the requisite human resources in the healthcare department may be a fundamental theme introduced by the problem. These dynamics are improved by recruiting foreign healthcare workers to mitigate the deficit created within the healthcare platform (Blake et al., 2020). This progressive model is instrumental in managing the specific objective of resolving the problem’s issues. Accordingly, realizing the beneficial progress offered by the specific determination of the ideal progress became critical. These substantial provisions helped create a resounding improvement in the problems. These are the integral factors that are beneficial in creating a sustainable improvement to the quality of work as progress through promoting the resounding impact as a factor for enhancing improvement of service delivery (Blake et al., 2020); (Amanullah et al., 2020). These are the instrumental themes that have been realized in the study.
Literature Review Summary
This literature review provided a specific focus on the perceptions and experiences of healthcare providers that could possibly provide more insight into which leadership could improve
burnout. Burnout remained a significant difficulty due to leaders’ lack of effective ways to deal with issues predisposing healthcare personnel to professional burnout (Lasalvia et al., 2021). Hence, this required leadership to address burnout concerns among healthcare workers because it ensured that professionals were engaged (Sultan et al., 2020). Creating successful leadership strategies helped address factors that contributed to miscommunication and work pressures and was critical to addressing burnout issues (Sultan et al., 2020). Therefore, this suggested the significance of building effective leadership practices to address the challenges above facing health workers.
Burnouts were common among healthcare professionals. Influential leaders implemented burnout intervention strategies (Sultan et al., 2020). Healthcare providers needed to plan ahead of time to deal with and manage the COVID-19 outbreak (Khasne et al., 2020). To avoid burnout, leaders should have implemented initiatives that guaranteed healthcare providers were well-versed and informed about COVID-19 mitigation strategies (Sultan et al., 2020). Healthcare executives should have been aware of their responsibilities to improve their chances of avoiding workplace burnout. (Khasne et al., 2020). Leaders should have established adequate personnel levels to ensure caregivers were not overburdened by their tasks (Sultana et al., 2020). Leaders should have invested in quality leadership styles, including employee engagement and transactional leadership (Sultan et al., 2020). The primary aim was to ensure that administrators and other leaders committed their time and efforts to develop measures limiting exposure to professional burnout in the workplace (Sultan et al., 2020; Anthony-McMann et al., 2017). The absence of effective strategies to provide healthcare services contributed to the high burnout rates among nurses during the COVID-19 pandemic (Lasalvia et al., 2021). Healthcare workers blamed hospital leadership for the inadequate preparedness measures that subsequently led to high burnout
levels in healthcare workers (Khasne et al., 2020). Burnout among healthcare workers was a crucial issue; leaders had to ensure that it did not affect the quality of services patients received.
Among the most significant factors affecting employee performance was the work environment. Conducive work environments were the most effective solutions to burnout concerns in healthcare settings (Morgantini et al., 2020). Recruiting a sufficient workforce during the pandemic created a conducive healthcare working environment (Sultana et al., 2020; Morgantini et al., 2020). Workforce shortage contributed to burnout in healthcare professionals (Dall’Ora et al., 2020). Administrators should have enhanced leadership participation to ensure leaders understand employee burnout and work strains (Sultana et al., 2020). Physical and mental exhaustion arose from the influx of patients during the COVID-19 pandemic.
Summary and Transition
The topic “COVID-19 burnout among healthcare workers” was an area many investigators had delved into recently. The research outcomes added to the current literature and supported other investigators undertaking similar studies. The central focus was on how leaders had exposed healthcare providers to professional burnout, especially during the pandemic (Khasne et al., 2020). The results were intended to offer leaders valuable insights focused on the strategic actions they could develop to reduce burnout. For example, developing flexible schedules and offering mental and psychological support services were potential recommendations the research investigated. Leaders could take the research results to protect healthcare workers from burnout. Section one consisted of the purpose statement, research questions, research paradigm, research design, research framework, research assumptions, limitations, delimitations, summaries, appendices, and academic references.
The purpose statement section highlighted the reasons behind the study. Also, it provided information regarding what the research intended to achieve (Bonache & Festing, 2020). In this case, the study aimed to account for healthcare provider burnout and mitigation measures during the COVID-19 pandemic. The research questions were a crucial part of the research because they identified specific queries related to the study. The research had to provide questions that guaranteed focus from the beginning to the end (Gaya & Smith, 2016). Research questions enabled researchers to remain grounded in the study topic. The Research Paradigm was the part of the study that provided information concerning beliefs and agreements from the scientific field. The section indicated the agreed strategies for exploring and understanding scientific topics (Gustafsson, 2017). The study did not utilize any research formulas and theories; but the ones ratified by the scientific community. The research design was part of the study that provided strategies to incorporate all undertaking elements. It integrated all sections of the research into a comprehensible and logical unit. The research design explained data collection (Gaya & Smith, 2016). Also, the section accounted for the measurement and data analysis. It ensured that the researcher answered the research question or problem comprehensively. The research framework was vital because it highlighted and explained the relationships involving concepts, theories, and constructs (Gustafsson, 2017). Therefore, the study framework gave an overview of the right direction toward answering or solving the research problem. It guided scholars to focus on the objectives from the beginning to the end of the study. The research assumptions section accounted for the assumed factors within the research. Researchers had to identify the assumptions because they could affect the outcomes adversely (Gustafsson, J. (2017). Mitigating the unwanted outcomes of assumption was crucial. Limitations included
constraints related to the undertaking, and it could be time, resources, and lack of participants (Gaya & Smith, 2016). It was imperative to identify the limitations to plan how to overcome them.
Delimitations entailed the strategies to eliminate identified research limitations. Researchers had to ensure the limitations did not interfere with outcome validity and reliability (Gaya et al., E. E. (2016). In this way, the conclusion could be valid. The summary section summarized explored concepts and offered an overview of the literature outline. The summary made it easier for readers to understand the entire project (Butina, M. (2015). The summary should be comprehensive. Appendices and academic references were valuable in this research study. These were key perspectives that should be accommodated in the first section to prepare the readers for what they should expect to appear in section two.
The second part of this study entailed different segments such as research methodology, data collection, and measurement that established an effective link with the first section to develop a solid picture of the overall research process and its projected goals and objectives. The researcher established the methodology for undertaking the research and provided supporting details surrounding the selected methods. An overview of the targeted population, sampling process, and sample size was provided. This segment paid in-depth attention to the data collection methods whose aim was to gather data and information. A rationale behind the target group selection was also included. For example, if the researcher highlighted questionnaires and interviews as the central data collection methods, one had to portray the reasons behind selecting them over others. Following the data collection part was a descriptive analysis stage that concentrated on interpreting the obtained information. This led to generalizations, recommendations, and conclusions.
Section 2: The Project
Overview of Section 2
Section two focused on the research methodology, the targeted population, sampling methods, the data collection process, analysis, recommendations, and conclusions.
In the methodology part, the investigator determined the integral research methods used. This included surveys, interviews, observations, or experiments. The rationale behind each selection was provided: the targeted population, desired and selected sample size, sampling procedure, and rationale. One primary approach defining this segment was the data collection process. The researcher collected valuable data and helpful information. A well-established plan of useful data tools, the collection strategy, and data organization was highlighted in this part. The investigator provided supporting information on the reliance on the selected data collection methods and their role in providing integrity and reliability. After collecting data, an analysis procedure followed, in which the researcher used vital tools and techniques to analyze the obtained data and information. A recommendation and conclusion followed to highlight to the audience the outcomes achieved and how they supported the research questions. The researcher also provided details focusing on the reliability and validity of the research project and supporting information. The research’s generalizations, recommendations, and conclusions highlighted if leaders were responsible for protecting healthcare workers against burnout. This information added to existing literature relevant to this domain.
Introduction
The research’s central focus was assessing healthcare workers’ exposure to burnout during the pandemic. These professionals are crucial in advancing healthcare
outcomes and establishing improved health and overall well-being. The research exerted possible efforts to examine how different stakeholders can help address these burnouts, especially when the industry is experiencing numerous issues from the pandemic. The key area of focus was how leaders can improve their skills and abilities to limit the development of burnout among healthcare providers. This flexible single case study assessed aspects that expose healthcare providers to professional burnout in the southeastern United States.
The researcher reached out to a segment of care providers and leaders to gather ideas and insights on the exposure to professional burnout during the pandemic. The researcher used the study’s outcome to recommend best practices that leaders can adapt and implement to protect their workforce from current and future burnout. The results built the foundation for reduced professional burnout among care providers, especially during pandemics.
Purpose Statement
This flexible single case study aimed to understand the inability of healthcare leaders in the Southeastern United States area to create and implement potential response measures for addressing professional burnout emerging from the COVID-19 pandemic. The researcher will select healthcare workers and leaders to offer their perspectives on healthcare management and the administration’s impact on staff burnout during the pandemic. The targeted population will relay viable information that will answer
the research questions. The research will focus on two major concepts: professional burnout and leadership. First, the study will investigate the increasing emotional and physical exhaustion among healthcare providers during COVID-19 infections (Cotel et al., 2021). Second, in examining leadership contribution, the research will assess leaders creating the environment to address the burnout constructs. The results obtained from this
research will supplement existing studies focusing on leadership strategies likely to develop a potential working environment for care providers during healthcare pandemics. This research will inform leaders on the courses of action they can take to advance the health and well-being of healthcare professionals amidst the harsh realities of the COVID-19 pandemic.
Role of the Researcher
The researcher remains a crucial part of the successful outcomes of this study. First, the researcher collected information from the participants to better understand the situation. The role of the researcher is to ensure that the participants gathered for the study match the needs of the research. The researcher is also responsible for selecting the most appropriate research methods and approaches that match the study’s needs. One of the critical approaches that the investigator will need to pay attention to is collecting vital information on participants’ thoughts, feelings, and emotions because burnout is not a physical element readily seen (Salvaggioni et al., 2017). Salvagioni et al. (2017) emphasize this element of burnout by describing it as a syndrome that affects individuals’ well-being and health, making it a personal problem. The researcher will aim to understand how healthcare providers and leaders feel about the issue of burnout during the pandemic. This will expose the researcher to numerous themes, primarily those connected to the role of leaders in addressing burnout. The researcher will retrieve viable information that
answers the key research questions through interview sessions, questionnaires, and focus group discussions. In line with the research processes’ ethical values and perspectives, the investigator will observe confidentiality, privacy, autonomy, and zero potential harm (Yip et al., 2016). This will boost the chances of obtaining valuable information that supports quality generalizations and conclusions. For instance, the assurance of privacy and
confidentiality, which is also a significant role of the researcher, will ensure that the targeted participants can offer helpful information in the research. They are more likely to agree to participate and relay quality information when confidentiality, privacy, and zero exposure to harm are guaranteed. The investigator must abide by ethics and integrity to obtain the desired outcomes.
One of the main roles that the researcher will need to achieve is an excellent bond with all the participants. This will entail building positive relationships, which will allow greater openness. Building trust between researchers and participants translates to successful research outcomes (Guillemin et al., 2018). This portrays the need for researchers to create a
valuable rapport with all the targeted respondents. Since leaders may be deemed the central factor behind the increased exposure to professional burnout, a connection is essential to ensure that leaders and care providers do not withhold information. There is a dire need for the researcher to focus on appropriate tools that enhance the data collection process (Fischer, 2009). This will accelerate the chances of obtaining valuable data and information that supports effective analysis of the study topic. The researcher will achieve the desired milestones through the selected data collection tools. Besides selecting viable tools, the investigator must address the bracketing perspective to reach the research outcomes.
The researcher understands that bracketing can affect the established outcomes and will remain committed to addressing it (Noble, 2019). Refraining from personal judgment is
one integrated approach the investigator will adopt to avoid personal bias (Gustafsson, 2017). The dominant approach used to bracket is interviewing with an outsider, where biases and preconceptions will be discussed. The fundamental rationale behind bracketing is to ensure that a research outcome has zero presumption and bias that can influence the interpretation process (Fischer, 2009). The interviews with outsiders will raise awareness of the researcher’s
perceptions by introducing a platform where alternative views can be discussed and openly identified. The overall goal of conducting bracketing interviews is to provide researchers with clarity, especially in emotionally charged studies that may apply or be compromised by personal experiences (Tufford & Newman, 2010). The outsider to be included in the bracketing interview will be identified from a selection of retired medical practitioners. The outsider will be different from the existing participants in that the retired medical practitioners will have retired from the medical field in the past five years, making them unique in assessing, affirming, and restructuring the researcher’s existing assumptions about burnout in practitioners. Bracketing is an opportunity for the researcher to lower their disruptive impact on research through assumptions, achieved by exploring and putting aside their pre-existing knowledge to develop a non-judgmental view of the research topic (Sorsa et al., 2015). The outsider will be sourced online through a survey targeting retired practitioners. A major focus will be identifying a female outsider who will provide diversity in understanding the practitioner’s culture and experiences. The outsider profile provides the researcher with an understanding of the lives of the practitioners at work, which will help generate an understanding of the experiences of practitioners before the COVID-19 outbreak. The outsider will provide comparability and insight into the added vulnerability to burnout that COVID-19 introduced to practitioners. Writing a journal is a second approach that the researcher will apply as part of bracketing. According to Weatherford and Maitra (2019), writing a journal allows a researcher to reflect on the research process by observing how elements such as personal judgments, opinions, and narrative approaches influence their interaction with the participants and research in general. The journal will be initiated before the research questions are identified, including perceptions and questions that the researcher holds about the topic of burnout. Overall, the researcher will incorporate and document the
presence of any preconceived notions because they might sometimes be unavoidable. The central focus is to help the audience develop a baseline understanding of the final research outcomes associated with the project (Weller et al.,2018). Journaling is a crucial bracketing method that draws its efficiency from the fact that it is a process-guided
approach that records changes as the research continues. Journaling will allow the researcher to record assumptions and identify how they are changed through interactions within the research.
Summary of the Role of the Researcher
The role of the researcher is to delve into how institutional leadership may have exposed care providers to professional burnout during the pandemic. Leaders play a vital role in creating and implementing strategic changes encompassing the needs and interests of their workforces (Weller et al., 2018). During the COVID-19 pandemic, leaders may have lagged in their mandate and thus exposed care providers to burnout. The researcher’s role is to investigate employees’ physical, psychosocial, and mental stability to identify their vulnerability to burnout (Rahman., 2016). The role of the researcher is to form non-biased bonds with the research participants to ensure that the population being investigated is comfortable enough to share information (Fischer, 2009). Additionally, the researcher reduces bias in the study, which is achieved through processes that ensure the researcher’s
perceptions do not interfere with the analysis. The researcher must also engage in bracketing to reduce the biases in the research, which will be achieved through bracketing interviews and journaling (Rahman, 2016). The researcher’s roles are vital to the research because they give the right momentum to the rest of the study and influence the research outcome.
Research Methodology
Introduction
A single and flexible research-based study was used to evaluate the exposure of healthcare providers to burnout during the pandemic. The researcher targeted crucial methods that offer more comprehensive access to relevant data and information. The key approaches the researcher will focus on are interviews, questionnaires, and focus group
discussions. Secondary data sources were used to enhance triangulation. Combining these methods will offer comprehensive access to quality data and information.
The Rationale Behind the Selected Research Design
The research will focus on a single case and flexible research design. The researcher will pay attention to a qualitative approach, which will assist the researcher in collecting data by focusing on perceptions and attitudes (Rahman, 2016). Rahman (2016) explains that qualitative research is advantageous because it allows the researcher to interact directly with the population and gather personal perceptions and experiences encompassing experiences, perceptions, personal views, and emotions. These advantages guided the selection of qualitative research for the study because investigating burnout requires a more personal approach and factual data. A single case study will be essential in this research. Single case studies are a viable research design because they offer researchers holistic and context-specific accounts of the research questions and theory-building and testing (Gustafsson, 2017). The issue of burnout and the COVID-19 pandemic can take a broader scope. However, the researcher’s primary target is to assess how institutional leadership exposes healthcare providers to professional burnout. Also, this will ensure that the researcher collects data from a limited scope, thus simplifying the interpretation and analytical processes. A flexible system will allow the researcher to adopt the best tactic which offers optimal
benefits. Roser and Kazmer (2000) explain that flexible research design is highly advantageous because it provides an explorative window in research where the theory is not well-established while placing the researcher as the data gatherer to provide room for the researcher to intervene during data collection. The combination of flexible research design and single case study method is effective for the proposed research
because these approaches deliver factual data while allowing the researcher to build on the theory as the study progresses.
Single case studies can be designed to have strong internal validity for assessing causal relationships between interventions and results (Rahman, 2016). A single advantage of the case study exists at a more practical rather than a theoretical level (Rahman, 2016). The suitability of the single case study is evident in the topic selected for the research. The topic encompasses one of the crucial issues of concern in healthcare. It can be extensive due to the numerous burnout challenges experienced by various care providers. This calls for the researcher to narrow the study and focus on a single approach that provides easy and smooth research operations. A single case study facilitates this because it involves repeating measures and manipulating independent variables to provide context-specific and rich research (Lobo et al., 2017). This may guarantee that the researcher can collect significant data on how care providers are exposed to burnout and how leaders may be able to accelerate the situation. The primary objective remains a commitment to deriving strategic research outcomes. The results may offer insights to assist future leaders. Overall,
the researcher will rely on a single, flexible case study to accelerate the likelihood of achieving the projected goals and objectives.
Triangulation
The researcher will rely on triangulation to boost the validity of the research on the issue of burnout among healthcare workers. Triangulation is the process through which numerous data-gathering sources, methods, and theories are used to investigate a given research question, which plays the role of helping a researcher improve the validity and credibility of the acquired findings (Noble et al., 2019). In this case, the researcher will apply two types of triangulations: methodological and theoretical. The dominant triangulation
method in the proposed research is methodological triangulation. Heesen et al., (2016) describe methodological triangulation as a process where the researcher collects crucial
information from multiple methods of gathering data. This entails collecting information using questionnaires, interviews, and focus group discussions. The researcher will use each of these approaches with the set of selected participants to ensure that different forms of factual data are collected, including the intensity of emotions and frequency of how a certain perception or opinion is shared. The healthcare workers and institutional leaders from the Southeastern United States area will offer vital details, enabling the researcher to establish crucial generalizations. The information provided through questionnaires, interviews, and focus group discussions will boost the analysis, allowing comparison to arrive at critical conclusions.
The investigator may frame strategic research questions as part of methodological triangulation, which will be the focal point behind the targeted analytical approach. The selected questions will be simple to prevent the study from delving into issues that do not support the research process and intended outcomes. The selected team of healthcare providers and leaders participating in the research will be expected to offer important information helpful in answering the research questions. As highlighted, the researcher will
use interviews, surveys, and focus group discussions. The answers from the interview sessions will be cross-examined against those collected from the other sources to evaluate occurring themes. One of the aspects that the research will need to pay attention to is using open-ended interview questions. Open-ended questions are important because they allow research participants to answer questions according to personal preferences, which may include lists, stories, and deep thoughts, resulting in more detailed data collection (Weller et al., 2018). This means the researcher will have a crucial chance to collect essential details
about the issue. Also, the researcher should consider well-established questions when using questionnaires and focus group discussions. Combining these data collection approaches helps to achieve the triangulation milestone.
Secondly, theoretical triangulation will be an additional method that the researcher will apply to cement the study’s credibility. Flick (2019) explains that theoretical triangulation encompasses using different theories to expand on the research questions by framing the research questions from different frameworks. The research may combine different theories to investigate the concept of burnout among healthcare workers, ensuring all elements contributing to the problem are effectively considered. Examples of theoretical frameworks applicable to the research include Maslach’s theory, Job demands-resources theory, and conservation of resources theory. Theory triangulation will achieve triangulation by approaching burnout from different lenses, including the role that the availability of resources plays in the development of burnout.
Summary of the Research Methodology
The researcher will invest in the qualitative approach, which integrates a flexible single case study. Also, questionnaires, interviews, and focus group discussions will be used to expand the data collection processes and deliver the triangulation perspective. Relying on
triangulation will provide the researcher with a viable chance of establishing accurate generalizations and conclusions. More comprehensive access to numerous data sources and information supports the case study’s validity, reliability, and outcome. The primary data collection and theme development will continue from interviews. For example, by supplementing questionnaires with interviews, focus group discussions, and secondary sources, the investigator will obtain highly informative information, enhancing the generalization and conclusion processes. Through triangulation, the researcher will collect a
broad range of information that can improve the analytical process and enable one to answer research questions and justify the established hypothesis.
Participants
The eligible persons of the case study included healthcare workers and institutional leaders selected from various healthcare institutions in the Southeastern United States region. These are vital segments of workers in healthcare capable of generating quality information about professional burnout. The healthcare workers were expected to provide honest and accurate feedback on present working conditions and the challenges experienced when handling patients. For example, if nurses and other care providers revealed that they had been experiencing physical and emotional exhaustion due to the high number of patients reporting to their care centers, the researcher was expected to relate their status to hectic and demanding working conditions. Thus, the most important aspect was to ensure that nurses and other healthcare providers selected for the study were offered valuable and credible information without fear, as their anonymity and confidentiality were highly observed.
Organizational leaders provided information that allowed the investigator to understand better the current situation being experienced by nursing professionals. Notably, leaders were expected to offer quality information on the leadership tactics adopted during
the pandemic and the outcomes experienced. Their leadership roles and interventions during this era helped shape individual workforce outcomes during the pandemic period and, thus, were influential in answering the research questions. Research indicates that leaders develop strategic quality interventions in the healthcare sector (Sultana et al., 2020). This made leaders a key area of focus for the study since professional burnout during the pandemic is closely associated with the status of the present working environment. Leaders make decisions that determine the nature of the work setting. Thus, their participation is essential for the researcher to evaluate their contribution to care providers’ burnout exposure. All the participants were selected based on the informed consent approach.
Population and Sampling
The study population entailed the larger group the researcher targets for an assessment, which must correspond to the entire set of subjects whose characteristics are vital to the investigating team (Martinez-Mesa et al., 2016). The researcher applied distinct characteristics to identify potential samples and obtain subjects from the larger group. The sample group was narrowed down to fit the specific elements targeted in the study. The imperative goal was to ensure that the study outcomes were reliable. This remains a primary target for this qualitative-based study since the results cannot be generalized. This framework assisted the investigator in developing key recommendations and conclusions.
Since the study uses a qualitative approach, the researcher aimed at achieving reliability instead of generalizing the outcomes to the larger population. This was based on the idea that qualitative studies are subjective, and the ideas and insights provided by the selected participants may not represent the views and opinions of other people. The fact that the study relied on human sense and subjectivity meant that a limited sample size would not generalize the large population (Leung, 2015). Thus, the core goal of the study was to
achieve reliability where the obtained findings would be deemed consistent when similar methods are used under the same circumstances by other researchers seeking to replicate the study. Thus, the researcher ensured the study would generate similar outcomes in a different setting. This enhanced the study outcomes due to the higher reliability of the study’s processes. The researcher establishes an appropriate sampling process to ensure one obtains vital results.
Population
In this case, the population used in the study was healthcare providers and institutional leaders who relayed valuable information focusing on professional burnout during the pandemic. Leaders were vital to the research because they compared opinions towards burnout and leadership practices. Nurses were a major priority concerning the healthcare workers included in the study. Based on increased workloads, Kowalczuk et al. (2020) reveal that nurses are among the most vulnerable groups. This made nurses an important group the researcher needed to investigate with the study’s goal of generating insights and understanding into the issue of burnout in healthcare. However, the researcher also included other healthcare workers dealing with COVID-19 patients.
Sampling
Considering that the study focuses on a qualitative approach, the investigator can utilize convenience, purposeful, and snowballing. However, the central methods that were used were purposeful and snowballing. Research shows that purposeful and snowballing are important sampling methods that researchers can integrate when dealing with qualitative studies because they allow the researcher to target participants who can provide ideal and reliable information (Naderifar et al., 2017). Professional burnout is a sensitive issue that requires the researcher to target and select specific persons capable of proving the targeted
information they provide through personal experiences. Mixing these two methods increased the chance of obtaining an adequate sample size for the study.
Selecting the right participants is a major area of focus in every study (Etikan et al., 2016). Convenience sampling entails selecting a sample based on its accessibility, availability, and willingness to participate (Etikan et al., 2016). However, samples selected using this strategy might not deliver viable outcomes. Research has shown that this method is not purposeful nor strategic, seeing that the method might result in a less diverse sample because the participants gained is either the easiest to reach or the closest (Etikan et al., 2016). This shows that convenience sampling is not ideal for most studies as it denies the investigator the chance to obtain quality feedback because it is a non-probability method of acquiring participants.
The research also applied the snowballing strategy, which entails gathering recommendations from the best people who can participate in the research (Parker et al., 2020). According to Parker et al., (2020), snowballing is a non-probability sampling method where acquired participants are encouraged to recruit others based on their familiarity, network, and acquaintances. Snowballing can somewhat acquire a reliable sample because
recruiters can knowingly recruit individuals that fit a given description (Naderifar et al., 2017). This approach was mainly beneficial as it enabled the investigator to obtain a substantial sample group that fit into the category of healthcare workers who had been active during the pandemic. The same case applies to those at the top leadership level, where the investigator could target one of the leaders and use the subject to target and incorporate others who could deliver quality information. Overall, this mechanism allowed the researcher to target care providers with burnout and ask the professional to recommend others. Snowballing reduced the time and cost of accessing potential study participants for
the research. However, the sampling method is prone to bias, and subjects tend to feel as if their privacy and confidential status have been affected when others recommend them for the study.
Purposeful sampling was an additional method used by researchers seeking reliable participants (Palinkas et al., 2015). It enhanced the likelihood of obtaining samples with rich information about the topic under scrutiny because purposeful traits in the larger population aligned with the study’s objectives were used to find participants. This was an advantage for the researcher as these samples provided quality data and information that were useful in the study. The purposeful sampling method allows the researcher to obtain information linked to the phenomenon of interest (Palinkas et al., 2015). However, time inefficiency was the dominant concern when using the method because it required a purposeful selection of characteristics, which was highly time-consuming.
Various characteristics were used to identify the research sample. The primary characteristics were working as a healthcare worker and being a leader in the healthcare system. Being a member of the healthcare departments, such as emergency and primary care was also a main characteristic used to narrow down the sample population. This characteristic was important because certain departments in healthcare have been noted to be more vulnerable to burnout (Toscano et al., 2022). For example, nurses working in the intensive care unit and the emergency departments are more prone to burnout than other professionals (Toscano et al., 2022). This is based on the numerous and hectic tasks these nurses manage when handling patients in these segments. Their responsibilities include caring for people in critical condition who need care and attention services.
Age was also a vital characteristic of the sampling because age was identified as a crucial risk factor for burnout among healthcare workers (Jiang et al., 2021). Research
indicates that young nurses are more likely to develop occupational burnout than their counterparts (Jiang et al., 2021). The length of time practitioners offered services also played a crucial role in selecting a sample of participants. This research showed that nurses were operating in highly demanding segments, and those newly recruited risk experiencing occupational burnout. Therefore, the research also concentrated on those assigned to demanding areas and those less tenured. The latter offered a key opportunity to evaluate how newly employed and less experienced care providers are exposed to professional burnout.
To select a sample population based on the aforementioned characteristics, the researcher was required to meet specific requirements by the IRB process. The researcher first had to obtain approval from the IRB to ensure that the study abided by ethical considerations to protect the participants. In the IRB process and approval, the researcher must observe the scope and timeline and be familiar with human participant research training knowledge (Liberale & Kovach, 2017). This process laid the foundation for well-undertaken research based on respect and value for human lives. After
all the approvals were provided, and the researcher moved ahead and initiated the study by obtaining the requisite participants.
The sample size for the research was 20 participants. This is a strategic number of subjects that can provide the required feedback and were attainable using purposeful and snowballing sampling strategies. The sample size in this qualitative study approach relied on the saturation level (Saunders et al., 2018). The saturation concept explains why the researcher can use the minimum and maximum sample sizes. It is a key methodological approach that has gained relevance and acceptance among researchers (Saunders et al., 2018). It works on the idea that based on the data collected from the small sample size
where a pattern is easily identified, further details and analysis are unnecessary (Saunders et al., 2018). This means the researcher can rely on already collected data to make viable conclusions, and any further emerging data and information have no impact on the outcomes. The researcher utilized this strategy to ensure the realization of the desired outcome of diversity and reliability of the data obtained from participants. The sample size was maintained at 20 because it was manageable for the qualitative research method employed in the study. As research has shown, qualitative studies encompass a small number of participants based on the depth of the case-oriented analysis (Vasileiou et al., 2018). The snowballing tactic used to obtain the sample size ensured that the researcher identified subjects that could provide rich-textured information, ensuring that using 20 participants allowed the investigator to obtain quality feedback without time wastage and strain on resources. This ensured that the study outcomes were valid and highly reliable.
Summary of Participants, Population, and Sampling
Overall, the participants in the study were a selected team of healthcare providers and organizational leaders based in the Southeastern United States area. Care providers can
highlight key experiences that portray exposure to professional burnout. A study by Mudallal et al., (2017) showed that nurses experience emotional exhaustion, reduced
motivation, and limited work efficiency due to higher levels of burnout, becoming less motivated and satisfied with their duties primarily because their leaders fail to take quality
actions to safeguard their health and well-being. Leaders must introduce and implement strategic guidelines and practices that reduce burnout (Sultana et al., 2020). The purposeful sampling process was used to select an appropriate sample because it facilitates access to subjects with rich information (Palinkas et al., 2015). Also, the snowballing method was applied to substantiate the number of participants needed for the study (Naderifar et al.,
2017). Convenience sampling also ensured that the selection of participants was guided and aligned with the research objectives. In each of these methods, the process started with the investigator identifying specific traits and characteristics required in individuals who can provide quality information and expanding it progressively to obtain a strategic group of participants. The research used twenty participants who were a combination of healthcare workers and leaders in healthcare. Also, the researcher obtained all the necessary approvals from different institutions.
Data Collection
The section will address the plan for data collection to provide details on how mixed method design was achieved for the study. The section will justify the data collection methods to explain how all data collected effectively advanced the research. The section will
predominantly use a qualitative research design articulated through interviews, questionnaires administered to a well-crafted sample population, and archive data. Tenny et al., (2022) explain that a qualitative research method is preferred for its extensive data collection by providing acumen and a deeper understanding of real-life issues. Interviews were selected for their interactive nature of gathering data, the focus groups to provide the chance to test narratives, and the questionnaires for quantifiable insight into the prevalence of certain perceptions, experiences, and opinions on various concepts.
Data collection plan
The researcher first administered online questionnaires to evaluate the research problem on burnout levels among healthcare workers during COVID-19. Online questionnaires focused on gathering factual data from diverse experiences, opinions, and attitudes relayed by numerous individuals accessible online, which makes data collection faster, more flexible, and more diverse (Dewaele, 2018). The final questionnaire questions
were used to request interview and focus group participants for additional data collection. Data from the online surveys was collected and transferred into a digital spreadsheet for easier analysis and the generation of patterns, aligning the study with the quantitative data collection method. The findings from the survey were used to select participants for other research steps based on whether the participants confirmed previously or currently suffering from burnout, their length of experience, and their area of specialization in healthcare.
The researcher proceeded to conduct physical interviews, which were semi-structured interviews. A major aspect of the mixed-method design of data collection was using qualitative methods to collect data, which was achieved through interviews.
The qualitative research method was selected because the study required insight from actual experiences to answer the research questions. Research indicates that qualitative methods are more suited for research into real-life phenomena because the method generates the opportunity to gather actual emotions, opinions, experiences, perceptions, and attitudes toward problems (Aspers & Corte, 2019). The study required interactions with healthcare providers and leaders to gain data on actual experiences, personal attitudes, and opinions, making qualitative methods reliable for data collection. A semi-structured interview was achieved by using a pre-determined set of questions alongside the flexibility of the interviewer asking questions as they arose when the interviews were being conducted (Ahlin, 2019). Thus, the researcher developed a portfolio of questions to be used in the questionnaires and in the comparable interviews. The sample population included in the interviewing will be smaller for a more focused assessment. All interviews will be conducted while being recorded for audio recordings and later transcribed to facilitate data storage on a digital spreadsheet.
Instruments
Interview guides
The interview guides facilitated the objectivity of the research process and data collection for each interview conducted. Roberts (2020) outlines that the interview guide provides standards of conduct that add structure to the interviewing while also providing
transparency to the participants by providing details on the methods to be applied. The interview guide presented the research questions in a simplified format to ensure all parties
involved in the research understood their roles, which made it easy for the study to have time-efficient studies while also offering the participants clear questions. Appendix A
indicates the interview guide that was applied in the research on the influence of COVID-19 on the prevalence of burnout among healthcare workers.
As indicated in Appendix A, the first part of the interview was the introductory section to set the environment. Lambley (2020) explains that the interviewing process for research into social problems becomes more effective through small talk, which
can be achieved through simple questions unrelated to the research to help participants become more comfortable and willing to share genuine information during the research. The small talk for the research was articulated through questions that also gathered background information on the participants. The four subsequent sections were based on the four research questions generated for the study. Part two of the interview was founded on RQ1 (How is professional burnout prevalent in healthcare among the nursing staff?). This section focused on gathering data on the perceptions and opinions on the rate of prevalence of burnout among healthcare workers. The section also asked participants to specify their perceived prevalence rate of burnout among healthcare professionals. The section also asked the participants to identify why they believe nurses are generally more affected by burnout.
The section also included questions on why the participants think nurses became more vulnerable after the onset of the pandemic.
The third part of the interview focused on RQ2 (What are the possible leadership failures in addressing professional burnout in healthcare organizations?). The questions in this part elicited genuine answers on the perceived role of leadership in managing
healthcare workers and organizations. The section included questions on the participants’ opinions regarding how leadership may have failed to address the issue of burnout in
healthcare facilities. The section also included questions on how leaders may have directly encouraged burnout among workers. The fourth section of the interview was based on
RQ3 (What proposals could address professional burnout among healthcare workers?). The section encouraged the participants to provide answers on the solutions that they believed could help reduce the rate of burnout among healthcare professionals.
The fifth section was based on RQ4 (How do healthcare management and administration affect staff burnout at hospitals in the wake of COVID-19?). The section drew out distinct opinions on solutions to burnout based on experiences and attitudes toward
burnout among nurses. The sixth and final section of the interview helped close the interactions between the researcher and the participant. The section included questions that elicited off-script answers solely based on final statements and thoughts from participants’ participation in the interview.
Surveys
The survey, in this case, were administered online. The general structure of the survey mimicked the questions used on the interviewees, meaning the survey was founded on the four research questions generated for the research. The survey included 17 questions, which were a distinct reflection of the questions expected in the interviews. Questions 1-5
was acted as warm-up questions to provide background information on the participant. Questions 6-9 reflected RQ1 because they will elicit answers to questions on the prevalence of burnout among nurses before and during the COVID-19 pandemic. Questions 10-12 focused on RQ2 and RQ4, which explored the role of leadership, management, and administration in encouraging high levels of burnout among healthcare workers. Questions 13 and 14 were based on RQ3, asking participants about solutions they think can help reduce burnout levels in healthcare. Questions 15, 16, and 17 were the closing questions that asked the participants if they were willing to participate in a focus group and interview for other data collection methods being used in the study.
Archive data
The research will also incorporate archive data to provide assertions and comparability to the collected data. Archival data is essential to research because it introduces additional data to guarantee the comprehensiveness of the study, which facilitates the comparability of data to ensure a more conclusive understanding of a research problem
(Turiano, 2014). The archive data used in the research was generated from the Centers for Disease Control and Prevention, a federal organization responsible for evaluating the state of public records in the United States. The CDC regularly evaluates healthcare workers to determine their stability in handling the public’s healthcare needs. Recently, the CDC conducted in-depth statistical research into the mental state of healthcare workers, revealing that up to 79% of practitioners in healthcare have reported burnout, with 64% of the reports being from women (CDC, 2022). The archival data focused on the RQ1 that analyzes and compares the prevalence of burnout among nurses compared to other professionals in healthcare.
Data organization
Data organization in the research relied on the use of digital spreadsheets. The data collected was entered into a digital spreadsheet for manual analysis and interpretation. Being qualitative research, the data was manually evaluated and interpreted to generate patterns and categories that help in coding the data. The data coding was facilitated by the researcher formulating coding schemes before the interviewing process. Coding was essential to every research because the process establishes new and unchartered concepts by encouraging the researcher to explore and break down the data obtained. Data organization was also facilitated by recording all the interactive research methods included in the study, namely the interviews and focus groups. The recordings were also transcribed and coded according to the formulated coding schemes. Another measure that the researcher applied to maximize data organization was note-taking during the interviews, which embodied the observation element of physical interviews. According to De Villiers et al. (2021), interviews are a flexible data collection method that allows researchers to interact with participants who are required to provide information from their perceptions and experiences, which allows the researcher to identify cues in the tone of voice, body language, and facial expressions. These attributes made it essential for the researcher to develop notes during interviews, which were interpreted and categorized according to the codes generated. The data organization process was vital to the research because it added to the structure of the study. The organization made it easier to recognize and identify patterns within the participants, which provided insight into the intensity of the study.
Summary of data collection
Summatively, the data collection was founded on a mixed-method research design that applied qualitative and quantitative data collection methods using interviews and
surveys. The primary rule when collecting data in the study was to maintain the anonymity of the participants, including in the interviews where participant names and identities were not noted in the data organization step. The four primary research questions will be the foundation for the survey and the interview questions. Archival data was also a vital element of the research, where existing data from research conducted by the CDC on healthcare workers was retrieved and compared to the data collected. All data gathered was entered into a digital spreadsheet generated by the researcher, stored, and protected in a hard drive for ease of accessibility and easy data organization.
Data analysis
The section will include details on the analysis and organization of the data gathered from the qualitative research methods employed in the single case study. The prime role of data analysis in qualitative research is to ensure that the data collected is coded to identify patterns and themes that can further be linked to the research problem (Lester et al., 2020).
However, the researcher must stringently organize the analyzed data coherently and clearly for data analysis to be effective. Data analysis in research has evolved with the rise of technology that has introduced additional ways of evaluating data. Data analysis has long been done manually, but introducing technologies such as artificial intelligence has facilitated a more structured approach to data evaluation. O’Kane et al., (2019) outline that
using technology-aided data analysis is advantageous to research because it reduces the time spent analyzing data using machine learning to develop coded patterns and categories and faster data exploration through text searches. However, the use of software-assisted analysis has been criticized for its efficiency. Based on the intricate nature of the social problem of burnout among healthcare workers paired with the small size of the sample population, the researcher applied manual data analysis to increase the accuracy of data analysis.
Qualitative analysis in the research focused on categorizing the data into patterns and themes developed from the facts presented in the form of opinions and perceptions by the participants (Sutton & Austin, 2015). The deductive analysis was applied to the
research to confirm or annul codes and themes generated before the initiation of data collection. The study also applied triangulation to compare data collected from qualitative research methods. A methodological approach to triangulation allowed the researcher to generate a deeper insight into the research problem of burnout among healthcare professionals.
Qualitative analysis
Qualitative analysis allows the researcher to understand the factual data collected from participants as it relates to research questions and problems. Coding through data analysis in qualitative research brings life to the research problem by fleshing out codes, themes, and patterns from the participants’ experiences to generate a story and image of the real-life experiences in real-life (Williams & Moser, 2019). There are two dominant methods of qualitative data analysis, namely deductive and inductive data analysis, that vary in terms of how they code the data. Mihas (2019) explains that deductive research is founded on testing an existing theory, while inductive analysis evaluates data to generate a new theory.
Deductive research was the main data analysis used in the study because it would be effective in coding the data to identify patterns and themes that would be compared to existing information and theories on burnout.
A thematic analysis method was further applied to support the deductive analysis approach. According to Kiger and Varpio (2020), a thematic analysis is more effective for qualitative research that will use codes to analyze collected data to generate themes based on the codes without the need for pre-existing perceptions from the data. Thematic analysis is
highly flexible and interactive because it encourages the use of manual evaluations of data to identify common themes and meanings to data. The researcher focused on generating themes based on the factual data collected, making manual analysis more effective. However, manual analysis is highly contested for its efficacy in delivering effective data
analysis. Zwanenburg (2019) identifies that manual data analysis is vulnerable to bias because the data analyst may be encouraged to code the data based on preconceptions that
make them only recognize concepts familiar to them. The thematic analytical model was used to examine the various concepts and ideas emerging from the participant’s feedback.
The central goal of the data analysis was to ensure the researcher could derive essential themes relating to the topic. Thus, the investigator paid significant attention to the thematic analysis to establish core patterns and emerging themes with the help of assigned codes. The researcher, being the primary coder, facilitated the generation of more themes based on their understanding of human behavior and communication, which was easily experienced and noted through the interviews.
Analysis of triangulation
Triangulation is a crucial step in research that encourages the evaluation of the validity of data collected by verifying data from multiple sources (Farquhar et al., 2020). The dominant goal of triangulation in the research was to evaluate the data to ensure biases were not present in the research. The case study’s research question not only guided the data collection but also directed the elimination of bias through the triangulation process. The research methods applied to the research also made the triangulation process easier because they generated diverse data.
For the case study, methodological triangulation was applied to ensure the diversity of data. Methodological triangulation entails using multiple data collection methods to study a
given research topic or phenomenon to reduce the deficiencies for increased validity (Thurmond, 2001). Triangulation through methodological triangulation was achieved through a survey that provided numerical data on the prevalence of burnout among healthcare professionals. A quantitative survey provided statistical findings, which as a different type of data from that obtained through the qualitative research methods applied in the research. This encouraged comparability of data for triangulation where facts and
numerical findings from the target population may triangulate the data by confirming the validity of the qualitative data.
Summary of data analysis
The research applied quality data analysis procedures to ensure the data is well-coded. Using coding, the researcher can objectively represent the data gathered. This study will use deductive and thematic coding, which was initiated by identifying predetermined codes that would be used to analyze the data. The literature review will create an initial coding scheme, but when new themes surface, the coding strategy may change. As a mandatory step for every process in the case study, the researcher will employ the methodological approach to undertake triangulation to support this study’s qualitative aspect.
Reliability and Validity
The following section will outline the steps that the researcher applied to establish the reliability and validity of the research. It will also discuss how the researcher will achieve validity by focusing on the trustworthiness and comparability of the data.
Reliability
Reliability in research refers to the ability of different research methods applied in research to generate the same results upon multiple applications consistently (McDonald et
al., 2019). Utilizing multiple research methods will enact the parallel form of reliability. A parallel-form reliability assessment entails using the same sample passed through similar methodology tests (Yadav, 2021). The three methods in the study are guided by the goal of providing comprehensive and descriptive data, namely, interviews, surveys, and focus groups. The interviews will entail accessing more personalized data due to the interactive platform interviews offer a researcher. The focus group will allow participants to explore and compare their opinions, perspectives, and views towards burnout among healthcare workers through discussions to be observed and recorded by the researcher. The surveys, however, will provide data that can be numerically tabulated to compare the data gathered from other research methods. The surveys will provide a thematic summary of the patterns and prevalence of various answers toward the hypotheses on the role of leadership in burnout levels among healthcare workers.
The interviews and focus groups will be recorded to produce visual and audio records for transcription that will be stored on a spreadsheet. The surveys will be translated into spreadsheets to compare themes and commonalities. For security, the data will be stored electronically for easy access to the researcher. Trustworthiness is a major concept associated with reliability. Unless the study process and the findings are trustworthy, they may fail to deliver the targeted reliability outcomes. The trustworthiness perspective entails credibility, transferability, dependability, and conformability. Credibility delves into how the results represent reality. A study by Stahl and King (2020) finds that credibility asks how congruent the research findings align with reality. It ensures that the outcomes can be applied to deal with the issues under scrutiny. One valuable way of achieving credibility is through triangulation, where the researcher targets numerous data sources and cross-examines correlating ideas and insights (Stahl & King, 2020). These sources reveal
identifiable patterns that can be used to develop a valuable conclusion. The results should also be transferable in the sense that the results can be achieved when the study is done in other contexts. Notably, the study outcomes should be dependable, an aspect that is achieved through rigorous data collection approaches. Irrespective of the changes made during the study process, there should be an assurance that the findings are actual. Lastly, confirmability ensures that the study outcomes are credible and trustworthy. The researcher should develop the conclusion based on the feedback obtained from the participants rather than on one’s bias. Overall, the trustworthiness status attributed to the study and the acquired findings enhances reliability. The key rationale behind achieving reliability is ensuring that the results warrant the attention of various stakeholders targeted by the issue.
Validity
Validity in qualitative research determines whether the study’s results represent actual findings that can be generated from similar participants outside the sample population (Rose & Johnson, 2020). Trustworthiness will be the guiding factor used to determine the study’s validity. The validity of the research on burnout levels among healthcare practitioners will be initiated by the researcher being mandated not to exclude any data during the data collection, recording, transcription, and coding. This step will advance the transferability of data used to determine validity. Also, the validity of the case study will be affirmed by applying extensive and interactive research methods. For the proposed study, credibility is asserted by focusing on interactive approaches such as interviews, focus groups, and surveys that encourage the generation of truthful data from facts, experiences, and opinions held by the participants. Bias in the coding and analysis will be eradicated through the use of multiple methods of data collection. Using multiple data collection methods will expose the researcher to underlying themes that could easily be sidelined or missed if one source was
used. A second approach to reducing bias in the coding process is to employ a reliable coding method. Exploratory and interactive coding are the two commonly used coding methods, and they have varying approaches to ensuring the data analysis is reliable, accurate, and valid.
Data saturation comes in handy when focusing on the validity element. The researcher will use the minimum and maximum range of participants to collect valuable data and information. The researcher will gather valuable feedback from the selected sample until one obtains the desired outcome. This will help reduce redundancies in the data collection process. The selected maximum sample size may provide similar deals, which portrays the need for the researcher to sample each individual and stop the process upon
realizing that the feedback is similar to what one already has. A study by Saunders et al. (2018) reveals that saturation is attained when the investigator repeatedly hears similar comments. At this point, the researcher terminates the data collection and analyzes the already acquired data. In this case, the researcher will assess each subject to acquire important details about the study topic. Along the way, this professional will look for
similarities between the ideas gathered from the participants. If commonalities exist, the researcher will analyze the already acquired data and information to examine emerging themes. This means that the information provided by the remaining subjects will not alter the outcomes in any way.
Also, triangulation enhances study validity since the researcher will have a set of information to derive quality outcomes. As Farquhar et al. (2020) state, data is examined from multiple sources to arrive at the best conclusion and decision possible. The investigator can assess similarities and differences across these multiple sources, paving the way for a valid outcome.
Member checking lays the foundation for a study’s trustworthiness and validity. The researcher will use the study participants to enhance the validity (Candela, 2019). The feedback forms and other documents acquired will be returned to the participants for accuracy purposes. Here, the subjects will provide information about their feedback’s accuracy status. For example, if a participant reveals that the information provided resonates with their experiences, the researcher will realize that the study outcomes will be valid and trustworthy. Lastly, follow-up interviews will help provide the desired outcome. The researcher will send all participants a memo about the follow-up interview. This is necessary to prepare the participants for a review that seeks to validate the information provided in the main data collection process. Considering the selected number was manageable, all participants will be involved in this session. Thus, the researcher can spend the minimum time possible on this task since the study uses a minimum of 30 and a maximum of 50 participants. During this session, the researcher will seek further clarification of the ideas mentioned during the data collection process. This relates to the thematic concepts incorporated in the interviews and the questionnaire forms. Also, the
researcher will seek to obtain new insights. For instance, the subjects can expose the researcher to their experiences related to the topic. This can help evaluate if the feedback is factual and correct, as mentioned during the primary interview sessions. Therefore, the researcher will engage all the study participants in the follow-up review and focus on validating feedback that has already been provided while gathering new information. These interviews will allow new insights to emerge and shape a better result. For example, some participants may provide new and advanced ideas that the researcher can use to establish a more robust argument and conclusion.
Bracketing
Bracketing in research aims to eradicate the deleterious impact of personal opinions and preconceptions a researcher holds in research that introduces biases (Dörfler et al., 2020). A researcher’s preconceptions interfere with every activity within the study, including data collection, recording, analysis, and the study findings. Bracketing as a strategy to
reduce bias will be achieved using bracketing interviews. Thomas (2020) defines bracketing interviews as a process requiring the researcher to list out their initial attitudes, opinions, experiences, attitudes, and assumptions toward research problems to inculcate humility and sensibility in the research. Bracketing will be conducted through an unstructured interview by the researcher, the researcher will be required to provide their opinions and perspectives towards the research topic. The unstructured bracketing interview will allow the researcher to explore issues and personal subjectivities as they arise because a set of predetermined questions will not guide the interviewer. The questions to be included in the bracketing interview will revolve around COVID-19, burnout, and the role of leaders in healthcare professionals. The researcher will be free to reflect on and critically assess their assumptions and personal perceptions to identify how they affect the research process.
Summary of reliability and validity
The research will enact reliability using the parallel-form reliability evaluation that relies on different methods of gathering data for triangulation to determine whether the same population will generate similar themes. The research will achieve reliability by using interviews, focus groups, and surveys. Validity in the research will be achieved through the focus on trustworthiness and credibility, which will prompt the researcher to use comprehensive research methods while recording all details collected from the methods
without the biased omission of data. The survey will provide thematic summaries that can be compared to the data gathered from other research methods.
Overall Summary of Section 2 and Transition
The researcher’s job is to investigate if institutional leadership exposed healthcare workers to burnout during the pandemic. The researcher’s job is to look into an employee’s
mental, emotional, and physical health to determine whether or not they experienced burnout and the role that leadership played in the development of burnout. Furthermore, the researcher lessens bias in the study using procedures that guarantee their perspectives will not influence the analysis. A qualitative research design will serve as the foundation for data gathering. The researcher will support the study’s adaptable design using various data-gathering techniques. The fundamental guideline for data collection is to keep participants anonymous, including during interviews when names and identities will not be recorded throughout the data organization stage. Interviews and focus groups will be recorded so they may be later transcribed and entered into online spreadsheets. The researcher will create a computerized spreadsheet with all the collected data, which will then be inputted and safely kept on a hard drive for easy access. The research will use high-quality data analysis techniques to verify that the data is correctly coded. The researcher can give an unbiased representation of the data collected by applying coding. Deductive coding will be used in this investigation. An initial coding scheme will be made due to the literature review; however, the coding scheme may alter when new topics emerge.
The researcher will use the methodological approach to carry out triangulation as a required step for each phase in the case study to support this study’s qualitative aspect. Bracketing will be achieved through a bracketing interview, which will be an unstructured
interview where the researcher will be prompted to answer various questions. This will help the researcher identify preconceptions, attitudes, and assumptions that affect actual victims
of burnout. The bracketing interview conducted with the researcher will provide a reflection on possible ways the researcher may influence the case study, which brings awareness to any possible biases. In order to test if the same population would provide comparable
themes, the research will use parallel-form reliability evaluation, which depends on the utilization of several data collection techniques. The use of surveys, focus groups, and interviews will provide reliability in the study. The focus on reliability and credibility will encourage the researcher to employ thorough research methods and to document all the information obtained from those methods without intentionally omitting any information. This will help ensure the validity of the research.
Conclusion
Professional burnout is a key challenge that healthcare providers experience. Especially during the COVID-19 pandemic, these professionals were heavily exposed to burnout. They handled a surge of patients, among other increased duties that affected them
physically, emotionally, and psychologically. This led to the emergence of burnout, which often hampers service delivery since the care providers are less interested and motivated to handle their responsibilities due to the inadequate status of the working environment. This problem is often associated with inadequate leadership and the lack of resilient healthcare systems that can withstand the shocks of pandemics. The investigator relies on interviews, surveys, and archive data to acquire valuable information about the topic. The outcomes indicated the need for strategic leadership changes such as rapid information dissemination, team motivation, and massive resource pooling to pave the way for increased access to tools and equipment such as PPEs and oxygen facilities. These outcomes act as strategic
recommendations that the healthcare industry should make to develop a strong and resilient healthcare domain that can withstand pressures brought about by pandemics. For example, if
healthcare organizational leaders can provide motivational elements for workers during pandemics, this can lessen such a problem. Even though employees will experience increased responsibilities, they will still be motivated to handle increased patients, among other core
duties. Also, pooling more resources would ensure an adequate supply of healthcare essentials and thus allow care providers to accomplish their duties efficiently. The central solution to the burnout problem lies with the healthcare leadership. The government, healthcare leaders, and other primary stakeholders should formulate and implement strategic policies and associated frameworks to help strengthen the industry. This helps cultivate a robust and resilient system that can withstand pressure.
Section 3: Presentation of Findings
Overview of the Study
The study aimed to explore how healthcare workers were affected by the COVID-19 pandemic. The main concepts guiding the study included the issue of burnout among healthcare workers, shortages of medical workers, and the quality of leadership in the healthcare sector. The research also applied theories such as the Job Demands–Resources Theory, Maslach’s Theory, and Conservation of Resources Theory, which guided the data inquiry and analysis. The research applied a mixed-method design, which was achieved using semi-structured interviews to gather factual data and through surveys to collect quantitative data. The interviews and surveys were administered to twenty participants. Data was analyzed using the qualitative method of thematic coding, which resulted in various themes used to answer the research questions guiding the study. Twenty participants from the larger diverse sample of healthcare providers in different roles were interviewed for the study. Triangulation
The study was achieved through a survey administered to twenty respondents, which advanced the reliability and validity of the data. The themes emerging from the data included
being overwhelmed as a defining factor for burnout, the poor work environment for healthcare workers, the lack of support from leaders, and the need for employee empowerment.
Presentation of the Findings
The following section will discuss the findings identified from the data collection and data analysis conducted for the study. The findings will be presented in the form of themes that were identified from the data collected. The themes were identified after coding the data,
which was achieved through deductive coding for mixed-method research. Dawadi et al. (2021) describe mixed-method research as a study that combines quantitative and qualitative data, a research approach that increases the validity and comprehensiveness of the findings. The comprehensive mixed-method design warrants an equally exhaustive approach, such as deductive coding. As Bingham (2021) explains, deductive coding is the most preferred approach for analyzing qualitative data because it offers a top-down evaluation using pre-determined data codes grounded on the main ideas of the research question. The initial data codes were developed from an extensive literature review, marking the first step of the coding process. The researcher then proceeded to identify themes and organize them for effective presentation in the study. The results of the quantitative and qualitative analysis of the research conducted for triangulation will be contained in terms of themes that will answer the research question about the relationship between the prevalence of burnout among healthcare workers and the COVID-19 pandemic. The discussion will also incorporate vital research areas to provide a more elaborate discussion. The discussion will include quotes and
content from the interviews and surveys, which add to the validity of the research findings. The research framework, literature review, and research questions will provide
insight into the themes’ relationships and relevance. The section will conclude with an insightful summary of the themes discussed.
The study used 20 participants purposefully selected from the larger population of healthcare workers and administrative leaders. The participants were sourced from the southeastern United States area with a focus on gathering a diverse set of participants guided by diversity in age, area of practice, and duration of service in healthcare. The key focus when selecting healthcare workers in the study was based on the departmental area, the practitioner’s age, and the length of time the individuals have served in healthcare. Shea et al.
(2022) emphasize that the diversity of the research participants is essential to improving the quality of findings because diversity reduces perception barriers. Interviews were administered to the 20 participants to gather adequate data to develop the relationship between burnout in healthcare professionals and COVID-19. The researcher also used a survey/questionnaire as a triangulation method to increase the validity of the data gathered from the interviews. Using the interview and survey data, paired with an attentive use of deductive coding, the researcher developed themes that provide insight into COVID-19 and burnout among healthcare workers.
Overview of Themes Discovered
The data analysis in the study identified four major themes that provide an understanding of the relationship between COVID-19 and burnout in the healthcare system: overwhelmed, poor work environment, lack of support, and empowerment. The themes cover various areas in the research questions, including the burnout symptoms, causes of burnout, and appropriate strategy recommendations for solving burnout. From the interviews and
surveys, 90% of participants agreed that leaders were responsible for the high burnout rates among healthcare workers. A similarity among all participants in the interviews and survey
was the belief that nurses are more vulnerable to burnout than other healthcare workers. Also, all participants in both the interviews and surveys agreed that the burnout problem is solvable if the right measures are implemented.
More than 95% of the participants in the survey believed that susceptibility to burnout was higher in healthcare workers than in other professions. In comparison, an additional 90% of participants, based on the interview results, agreed that the type of role played by healthcare workers impacted their vulnerability to burnout. Most participants in the interviews agreed that an individual’s experience level determined their vulnerability to burnout, with 30% of the participants in the survey disagreeing that burnout was related to one’s experience level. The participants also recorded that they believed leadership and management were responsible for the high burnout among healthcare workers before and during the pandemic, with only 10% of the survey’s participants disagreeing on the impact of leadership on the prevalence of burnout.
Discussion of Themes
Theme 1: Overwhelmed
A recurring sign of burnout in healthcare workers and other professions is feeling overwhelmed (Mascaro et al., 2021). Research indicates that most individuals recognized to suffer from burnout were triggered into the condition by feeling overwhelmed by various aspects of their job (Mascaro et al., 2021). In the healthcare system, the symptoms are also recorded among healthcare workers. Prentice et al. (2022) outline that medical healthcare workers realize they are suffering from burnout once they start feeling overwhelmed constantly, resulting from a sense of tiredness and having too much to handle as healthcare
workers. The theme of feeling overwhelmed as a sign of burnout was recorded in the study’s interviews and survey results. From the interviews, over 90% of participants confirmed having witnessed some of their fellow healthcare workers suffering from burnout, which they recognized by observing that their colleagues were feeling overwhelmed. The theme elaborates on the answers to question 6 of the survey, where 80% of respondents strongly agreed that terms such as exhausted, demotivation, non-energetic, and unwilling to engage with duties are defining identifying factors of burnout in healthcare workers.
Specific Finding 1: Feeling overwhelmed
The term overwhelmed was frequently repeated among participants during the interviews, indicating signs that fellow healthcare workers were suffering from burnout. Roughly 20% of the participants chose to use the term “overwhelmed” as the sign they noticed in their colleagues suffering from burnout, where P4, P10, P12, P18, and P13 mentioned that they noticed their workmates seemed overwhelmed when at work. These participants mentioned that they noticed that everyone around their healthcare facility seemed to suffer from burnout because of the theme of being overwhelmed, as evidenced by Participant 4 stating, “Overwhelmed, not wanting to go to work, work vs. life” as the signs they noticed in colleagues they believed were suffering from burnout. One participant (P6) stated that “Everyone was overwhelmed.” In contrast, another participant (P12) stated, “One is that the work is so overwhelming, so my, you know, choosing between your job and your yeah life balance.” These responses indicate that a sense of being overwhelmed triggered burnout, making it easy for colleagues to recognize the impact of the changes caused by the COVID-19 pandemic on healthcare workers.
Specific Finding 2: Stress
Feeling overwhelmed is a significant indication of burnout, translating to significant stress at work (Queen & Harding, 2020). In the interviews, the participants were asked to share signs of burnout they noticed in their colleagues, with stress being a recurring element cited by multiple participants. More than 40% of the interview participants mentioned stress as an indication of their colleagues suffering from burnout. P2, P3, P4, P7, P17, P 18, P20, and P15 recognized that their fellow healthcare workers seemed overwhelmed, translating to burnout because their colleagues seemed stressed about their work. P15 mentioned that “Many of my nurse colleagues suffer from burnout. I noticed that nurses began to be more stressed out at work. There was more conflict among the nurses and other healthcare workers, too. They were feeling burnt out.” P2 also offers similar remarks in the interviews, stating, “Lack of motivation, calling out on a regular, stressed attitude” as indications of stress. Participant 3 also offered a similar response, stating, “stressed, lack of motivation, calling out on a regular, attitude” as factors they noticed in burnout colleagues. From these interview responses, stress is a significant indication of healthcare practitioners feeling overwhelmed, which confirms stress to be a major sign of burnout in healthcare.
Specific Finding 3: Unmotivated
As a sign of feeling overwhelmed, healthcare workers may feel unmotivated by their workload, which indicates that the individual suffers from burnout (Baumgartner et al., 2022). More than 30% of the survey’s participants recorded a lack of motivation as a symptom they recognized in their fellow healthcare workers, including P5, P3, P20, P10, P2, and P13. In the interview, P13 mentioned that “some people just are overwhelmed, and just not motivated really to do their job,” which indicates that their colleagues were feeling overwhelmed by their work environment. Other mentions of motivation as an indication of
burnout in the interview included “Lack of motivation” by P3, “not motivated” by P10, and “unmotivated” by P5. The lack of motivation was seen as a significant barrier to productivity and performance, as is the consequence of burnout in healthcare workers.
Specific Finding 4: Exhaustion
Exhaustion was also a feeling linked to feeling overwhelmed, highlighted as a common symptom of burnout among healthcare workers (Schaufeli, 2021). In the interviews, the findings also highlighted the term exhausted as an indicator of burnout based on responses to question 1 in part Two of the interview. Participants P8 and P9 mentioned exhaustion as a major indication that their colleagues were facing burnout. P8 stated
“attitude, calling out a lot, frustrated, exhausted” as indicators of burnout among their colleagues. P9 cited “exhaustion, calling out, sickly” as the factors they noticed in their fellow healthcare workers suffering from burnout. P2 stated, “Lack of motivation, calling out on a regular, stressed, attitude” and P 3 offered “stressed, lack of motivation, calling out on a regular, attitude” as factors they noticed in burnout colleagues. These interview responses majorly aligned with the theme of being overwhelmed because experiencing exhaustion means an individual is tired from being in their work environment and delivering services to their clients and patients. This also aligns with the survey’s findings of over 80% of participants strongly agreeing with question 6, which presents exhaustion as a descriptive factor of burnout among healthcare workers. The results of the interviews indicate that the participants also used the term tired to confirm exhaustion as an indicator of burnout among healthcare workers. In the interview, Participant 11 stated “Yes, I’ve noticed a lot of nurses suffering from burnout first of all they’re tired they seem to be overworked um they just like always frustrated.” This shows that healthcare workers suffering from burnout always seemed exhausted in their work environment.
More than 40% of participants linked the increase in workload due to protocol changes as a reason for exhaustion, which affected their comfort at work during the pandemic. P5, P7, P3. A good example of the mention of exhaustion in the interviews is P3
stating that “Disinfecting everything you touch. Wearing mask 12-14 hours a day” was a major factor that affected the healthcare workers because it affected their normal work duties. The response offered paints the image that the workers were feeling exhausted by the new protocols of having to disinfect things, which made them feel overwhelmed, preluding to the fact that the change increased their vulnerability to burnout. P5 states that “more precautions were added on our plate,” painting the picture that the precautionary protocols introduced by
policies and leaders added to the workload of healthcare workers, which overwhelmed them. The finding also correlates with the answers given to question 6 of the survey with 80% of participants strongly agreeing that burnout is characterized by elements such as feeling unmotivated, exhausted, non-energetic, and being unwilling to perform daily duties as a healthcare worker. The survey and interviews affirm that the lack of motivation in healthcare workers is a significant indication of burnout that leaders can look out for when seeking to eradicate the problem in healthcare.
Summary of Theme 1
The theme of feeling overwhelmed as an indication of burnout among healthcare workers was recorded in various forms. All participants recorded witnessing their colleagues suffering from burnout, with more than 90% mentioning different aspects of feeling overwhelmed as the sign was noticed. From the survey, 80% of participants brought out the theme of being overwhelmed by colleagues by defining it as noticing that their colleagues were stressed, unmotivated, and exhausted. These aspects indicate being overwhelmed, a
feeling that triggers burnout because the healthcare workers are unable to enjoy their jobs and are struggling to fulfill their duties to patients.
Theme 2: Poor Work Environment
The data analysis also deduced the theme of poor work environment as a cause of burnout among medical healthcare workers. There are both physical and emotional indications of a poor work environment that causes burnout among healthcare workers. Abraham et al. (2021) recognize that a poor work environment predicts clinical burnout among healthcare workers because such environments, marked by lowered autonomy in decision-making, multiple job duties, and minimal support from administrators, affect healthcare workers’ mental and emotional well-being. Multiple job responsibilities are among
the physical signs that the work environment is unhealthy and unsuitable for practice because it gives healthcare workers a heavy workload they cannot manage effectively. Žutautienė et al. (2020) use the Job Content and Copenhagen Burnout Inventory Questionnaires (JCQ) occupational stress dimensions to identify psychosocial work environment factors that indicate a poor environment, revealing that job control, coworker support, supervisory support, job demand, and job insecurity as crucial elements in the workplace that trigger burnout. These factors provide the factors that affect healthcare workers mentally, resulting in burnout. These elements were frequently identified in the data collected, pointing to poor work environments as a significant challenge that healthcare workers face, resulting in burnout.
Specific Finding 1: Long work hours
Participants recognized that the healthcare workers suffered burnout during COVID-19 due to working in a poor work environment based on unhealthy work hours during the pandemic. Longer work hours were relayed as a significant indicator of the work
environment that healthcare workers faced during the pandemic. More than 50% of participants, including P2, P3, P5, P8, P9, P16, P17, P18, P19, and P11, identified working
long hours as a problem that caused burnout among healthcare workers because it caused more stress and resulted in less free time. P11 stated, “I think I feel that the nurses work long hours and it kind of made them more susceptible to burnout before the pandemic because of their long work hours and short breaks.” This response indicates a poor work environment because long work hours indicate that the health and well-being of healthcare workers were being compromised by working longer than usual during the pandemic. P2 frequently mentioned long work hours as a reason nurses are vulnerable to burnout before and during the pandemic, stating “Due to the long working hours” as a causative factor. P17 presented
long work hours as part of poor work environments that caused burnout among healthcare workers during COVID-19, stating that “Nurses worked longer hours, sleep deprived,” indicating that the healthcare workers were facing unhealthy psychosocial work environments that affected their practice. P16 further supports the theme of poor work environment by stating that “They were working harder, longer, and even when they felt ill,” indicating that the work environment changed negatively during the pandemic.
Specific Finding 2: Increased workload
Dealing with more patients is also a dimension indicating a poor work environment because it translates to increased job demand and workload, which is a major problem leading to burnout because increased workloads mean workers will fail to balance their well-being and job responsibilities (Zhou et al., 2020). 50% of the participants in the survey mentioned handling more patients as a cause of burnout among healthcare workers before the pandemic and during the COVID-19 outbreak. More specifically, P1, P2, P3, P4, P8, P9, P20, P12, P15, and P14 recognized workload as some of the main reasons nurses and other
healthcare workers struggle with burnout. P4 highlighted that healthcare workers were affected by a poor work environment by stating that “they do more, more hands-on” and that
they had to “do more day-to-day activities,” indicating that the healthcare workers had more workload in the form of dealing with more patients that translated to more daily tasks. P3 also shared the impact of a poor work environment due to work overload as a trigger to burnout by stating that “the number of patients they see in a day” was a major problem that caused burnout among healthcare workers.
Another finding from the interviews and surveys highlighting work overload as a problem is the recognition that nurses were more vulnerable to burnout for being the first point of contact, which meant that they saw more patients with varying severities of illness.
This finding was provided by P7 who cited “first point of contact after checking in” as a major reason why nurses were more vulnerable. Nurses being the first point of contact correlates to an increase in workload during the pandemic because nurses are required to have more in-depth relationships with the patients than other practitioners, which prompts nurses to work in different environments to ensure care is more accessible (Sundler et al., 2023). This finding correlates with the survey’s findings from questions 10 and 11 identify a heightened vulnerability to burnout among nurses compared to other healthcare workers. According to survey question 10, 85% of participants strongly agreed while 15% agreed that nurses were more susceptible to burnout before the pandemic. Responses to question 11 reveal that 80% of respondents strongly agreed and 10% agreed that nurses made up the highest number of professionals in healthcare suffering from burnout during COVID-19. These answers validate the finding that the nurses were more vulnerable to burnout because they were the first point of contact, which meant they interacted with more patients and dealt with both severe and mild cases, which led to a poor work environment that did not facilitate
a good work pattern. These findings support the theme that the work environment increases vulnerability to burnout because nurses being at a higher risk means that their job description,
which entails handling more patients and responsibilities than other workers, affects their well-being as healthcare workers.
Specific Finding 3: Role confusion due to lack of policy
Role confusion arising from a lack of clear policies was also found to be a major challenge among healthcare workers, and this can be identified with the theme of poor work environment. As Schmidt et al. (2014) explain, role confusion and ambiguity is a problem that leads to role conflict among workers due to employees being unable to perform their responsibilities satisfactorily and comfortably, which results in an increase in depression
among workers. This was a problem highlighted by various interview responses that indicated the healthcare workers did not receive support from their institutions, highlighting a lack of insight into the problem and their roles during the pandemic. A major indication of role confusion was the healthcare workers confirming they did not know anything about COVID, which affected their capacity to deliver care. P2 stated that “Nurses were working longer hours with no knowledge of COVID-19” This further correlate to their observation that “there were no policies and procedures in place when COVID-19 first surfaced”. P3 also highlighted the leaders’ failure to support workers through clear role definitions through policies by stating “I don’t feel policies were in place when COVID first started. No one was aware of what to do, or what was going on during the first couple of months of the outbreak”. This highlights that healthcare workers became more vulnerable to burnout because of the emotional pressure and confusion caused by the lack of support through clarity that leaders were meant to provide.
Summary of Theme
Poor work environment in the healthcare system as a cause of burnout was a recurring theme recorded in the data collected for the study. Poor work environment was found to be a
major problem that caused the increase in burnout levels among healthcare workers because it caused challenges such as increased workload, working longer hours, and role confusion due to lack of policies. These were problems that caused emotional and physical unsoundness among healthcare workers, resulting in unmanageable fatigue and stress that culminated into healthcare burnout.
Theme 3: Lack of Support
Support is a vital theme developed from the findings that are a recommended strategy for eradicating burnout among medical workers. Support from the leader, which can
be achieved through emotional relationships and development, is important because it makes the employees feel acknowledged and empowered (Dirani et al., 2020). According to the study’s findings, more than 80% of the participants would appreciate various support from leaders as a solution to burnout. The need for support from leaders aligns with the survey findings based on answers to question 15, which asked respondents if they believe leaders can address burnout in their institutions, where 40% of participants strongly agreed, and 50% agreed that leaders must play an active role in solving the problem.
Specific Finding 1: Lack of Emotional Support
Lack of emotional support from leaders and administrators also resulted in a poor work environment for healthcare workers. Yang and Hayes (2020) explain that the lack of support from colleagues and supervisors is a major cause of burnout among medical care healthcare workers because it increases the risk of experiencing emotional exhaustion and depersonalization. Approximately 60% of participants agreed that the lack of support was a
factor causing the increase in burnout among healthcare workers. 90% of the respondents strongly agree that management and leadership contributed to the increased burnout levels among healthcare workers. P2, P3, P18, P19, and P20 mentioned lack of support as a factor
causing nurses to be more susceptible to burnout. P2 stated, “They are only worried about the budgets. They don’t truly focus on workers.” The survey findings were also consistent with the findings on the role played by leadership in the development of burnout among healthcare workers. P20 demonstrated this lack of support with the statement, “I don’t think leadership has done much” when asked about leaders’ contributions and also cited “lack of support” as a factor that made nurses more vulnerable to burnout. Similarly, P18 stated “lack of support from the administration” as one of the factors that led to higher burnout levels among nurses during the pandemic. Out of the 20 respondents to the survey, 14 participants
(P2, P3, P5, P6, P7, P9, P11, P12, P14, P15, P17, P18, P19, and P20) strongly agreed with question 5, stating that healthcare workers developed burnout because of how they were treated and managed by their leaders. Only one participant (P10) disagreed with the survey question, and only one (P1) strongly disagreed. This is a major indication of the perceived lack of support from leaders, translating to healthcare workers lacking the requisite sources of motivation and guidance, leading to increased vulnerability to burnout among healthcare providers.
Specific Finding 2: Communication
More than 60% of the participants highlighted that leaders needed to support their teams through constant and structured communication. The respondents highlighted the importance of communication by mentioning the lack of communication as a major factor contributing to healthcare professionals developing burnout. When asked what the participants would do if they were leaders, P17 stated, “I would hold weekly meetings to
address concerns,” highlighting a focus on communication as a solution to burnout. P9 also states, “I would listen to my team and come up with reasonable solutions,” which adds to the importance of communication by presenting the importance of two-way communication
where leaders would support their employees by listening to them. This theme is a crucial finding because it shows that healthcare workers desire communication with their leaders, and they need leaders to share information and allow them to share their grievances as healthcare workers. This shows that communication makes healthcare professionals feel supported, resulting in a positive mindset that allows the healthcare workers to overcome burnout.
Summary of Theme
Lack of support from leaders and administration is also a major cause of burnout among healthcare workers. The theme highlights that the lack of support manifested in the form of inadequate emotional reinforcement because the leaders were more worried about profits. The lack of communication was also cited as an indication of poor support from leaders that affected the relay of information and other areas of the work environment, leading to burnout.
Theme 4: Employee Empowerment
Specific Finding 1: Training
Training was also a recurring theme identified from the data about the solutions recommended for preventing burnout among healthcare workers. Anwar and Abdullah (2021) explain that training is pivotal to enhancing organizational and individual employee performance because it equips individuals with skills and new knowledge that makes them feel empowered. More than 90% of participants confirmed the importance of support in solving healthcare burnout by highlighting different ways for leaders to extend their support.
P5 confirms the importance of training with the response, ” going out as a team, team building exercises,” when asked to provide probable solutions to burnout. Other participants provided a different approach to training by emphasizing the need for healthcare workers to
receive stress management training. For example, P4 states that they would “cater to departments on what’s needed for staff to relieve stress. Find a solution that works” to prevent burnout. This response highlights a needed form of empowerment that targets the emotional well-being of healthcare workers and can only be achieved through training programs that equip employees with stress-management strategies. This highlights that leaders need to ensure that their workers receive training on coping mechanisms that they can use to relieve
job stress, making them empowered enough to handle high job demands and achieve an ideal work-life balance.
Specific Finding 2: Rewards and Recognition
Recognition and rewards were also provided as a solution to burnout levels among healthcare workers because it would make employees feel empowered. As Renger et al., (2020) describe, recognition is a viable solution to burnout among employees because it appeals to the intrinsic motivations among workers by establishing a sense of respect and high self-esteem. More than 50% of the participants highlighted rewards and recognition as solutions to eradicating burnout during the interviews. Recognition was mainly identified through terms such as “appreciated” and “being noticed”. Rewards were highlighted through terms such as “bonuses” and “higher pay”. P5 confirms the importance of rewards and recognition with the response, “awards and being noticed”. P2 stated, “8-hour workdays instead of 12–14-hour days, mental health days, training on self-care, bonuses, higher pay” when asked to provide solutions to burnout among healthcare workers. P3 also provided,
“Bonuses, fewer hours, higher pay, being noticed, appreciated, adequate training,” among the major solutions that can be applied to solve burnout levels.
Specific Finding 3: Hiring more workers
Hiring more workers is also seen as a way that leaders can support healthcare workers because it provides employees with the opportunity to manage their work hours and participate in activities that increase work-life balance (Willard-Grace et al., 2019). Leaders are responsible for human resource management, including ensuring a reasonable patient-healthcare-worker ratio. The findings gathered from the study revealed that more than 40% of the participants, including P1, P2, P4, P7, and P19, recommended hiring more healthcare workers to ensure the healthcare system had enough healthcare workers to meet any rise in
job demand and future unforeseen uncertainties similar to COVID-19. P19 stated “improve nurse to patient ratio” as a way of emphasizing the need for more healthcare workers.
Summary of theme
Employee empowerment is important to ensuring healthcare professionals are free from burnout because it provides emotional and personal development that equips workers in the face of unorthodox work conditions such as the COVID-19 pandemic. According to the theme, leaders are responsible for issuing support through effective communication, training, rewards, and recognition, and hiring more workers to ensure that healthcare workers can handle their occupations.
Relationship of Findings
The section will include a detailed description of the relationship between the findings and crucial areas of the research. The research will first discuss the relationship between the findings and the research question. An elaboration of how the findings relate to the research framework employed in the study will follow. Also, the subsequent sub-section will discuss
how the findings relate to anticipated themes for the study. In this sub-section, the researcher will focus on the differences in themes, unanticipated themes developed from the data
collected, and missing themes. The section will conclude with a detailed discussion of the relationship between the findings and the literature. The researcher will include a discussion of the similarities and differences between the themes and findings of the literature.
Relationship of Findings to Research Questions
The study was governed by four research questions that sought to elaborate on the prevalence of burnout among healthcare workers during the COVID-19 pandemic. The main purpose of the four research questions was to bring out the healthcare workers’ perceptions of burnout and leadership. The research questions also purposed to reveal the perception of
burnout among healthcare workers who had experienced or were familiar with the concept. An additional role of the research questions was to gather data on the recommendations provided by healthcare workers for reducing vulnerability to burnout among healthcare workers.
RQ1: How is professional burnout prevalent in healthcare among the nursing staff?
RQ1a: Why have nurses deemed the most affected medical staff by professional burnout during the COVID-19 pandemic?
According to the findings, nurses were more vulnerable to clinical burnout because of changes to their work environment, which were characterized by longer work hours, heavier workloads, and seeing more patients. Nurses and other medical professionals were vulnerable to burnout because they faced longer work hours, which affected their well-being as healthcare workers. More than 50% of participants reported longer working hours as a problem affecting medical healthcare workers, especially nurses, during the pandemic, stating that healthcare workers were required to stretch their work schedules to meet the high
demand due to the unfamiliar virus outbreak. P11 confirmed, “I think I feel that the nurses work long hours and kind of made them more susceptible to burnout before the pandemic
because of their long work hours and short breaks.” The participants mentioned long work hours were a problem because healthcare workers were forced to work longer than usual, sometimes without breaks and under sleep deprivation. P17’s response in the interviews particularly supports this finding because the participant stated that “Nurses worked longer hours, sleep deprived.” This response to the research questions is linked to the theme “poor work environment,” which describes various factors in healthcare institutions that cause burnout levels among healthcare workers, with the increased workload being a cause of stress, exhaustion, and a sense of being overwhelmed.
Also, more than 60% of participants from the interviews mentioned seeing more patients than before the pandemic as a problem that caused increased vulnerability to burnout among nurses and other medical professionals. The increase in the number of patients was recorded as increased patient scheduling, which resulted in significant work pressure on healthcare workers because there were numerous patients to be seen. P8 highlights this in the response “Having to deal with numerous patients. Dealing with patient attitudes” as a reason for burnout among healthcare workers. P3 also highlighted that “the number of patients they see in a day” was a major problem that caused burnout among healthcare workers.
This made it impossible for healthcare workers to clear the scheduled patients, making them feel overwhelmed, and triggering burnout. These findings relate to the question because they indicate that nurses faced significant challenges in meeting patient needs during the pandemic, which lowered their physical and emotional well-being during the pandemic.
According to the findings, healthcare workers were also more vulnerable to burnout during the pandemic because the outbreak increased their workload by introducing new
safety protocols. Roughly 40% of the healthcare workers mentioned the safety and precautionary measures introduced during the pandemic as a major factor that affected the
healthcare workers’ wellbeing. For example, P5 complained that “more precautions were added on our plate.” This brings out the relationship between the research questions and the theme of poor work environment. Most participants complained that the protocol of having to wash everything they touched was a major problem that affected the healthcare workers by increasing their workload because it was an additional overbearing duty they needed to accomplish to reduce their risk of infection and infecting other patients. Other complaints included needing a mask throughout the day and wearing Personal protective equipment (PPE), which they termed tedious and emotionally alarming. P3 summarizes this relationship
with the interview response stating that “Disinfecting everything you touch. Wearing mask 12-14 hours a day”. These findings also relate to the theme “overwhelmed” that highlighted stress and exhaustion due to work overload as major indications of burnout among healthcare workers.
RQ1b: Why is professional burnout prevalent among nurses during the COVID-19 pandemic?
The nurses were most affected by burnout during the COVID-19 pandemic because they were the first contact, which made them vulnerable to significant emotional and physical pressure. The findings identified that the nurses were more exposed to pressure and workload during the pandemic because of the nature of their job, which demands the patients to go through nurses who provide first assistance. This highlights a relationship with the theme of “poor work environment”. P7 effectively sheds light on this relationship between the theme and research questions with the interview response that nurses being the “first point of contact after checking in” is a major reason why nurses were more vulnerable.
RQ2: What are the leadership failures in addressing professional burnout in healthcare organizations?
RQ2a: How do leadership failures affect the response toward professional burnout?
The findings from the research answer this question by showing that leadership failures affect response to professional burnout due to their lack of focus on workers. More than 80% of participants stated that they did not think the leaders contributed in any way towards helping healthcare workers, which is a major problem indicating that leadership needed to protect workers and address burnout. Also, the findings indicate a need for more focus on healthcare workers because more than 60% of participants stated that the leadership had failed to support the healthcare workers, leading to the high prevalence of burnout that
was also unchecked because of such failures. This relates to the theme of “Lack of support” that identified the leaders’ failure to provide emotional support and effective communication as causative factors that led to higher burnout levels. P4 highlights this lack of emotional support that manifested as ignorance from leaders by stating, “They didn’t listen, no follow through.” P2 also highlighted the lack of emotional support, stating that “They are only worried about the budgets. They don’t truly focus on workers.” These responses link the theme of lack of support from leaders as a major failure of the healthcare leadership that significantly influences healthcare workers. This makes the lack of help and support given to healthcare workers an integral flaw in the healthcare system’s leadership.
RQ2b: How have leaders failed to address professional burnout among healthcare workers?
According to the findings, leaders have failed to address professional burnout among healthcare workers because they need to provide healthy working conditions to lower the prevalence of burnout. A major area of concern deducted from the findings was the leaders’
tendency to overwork the healthcare workers. Over 50% of the participants stated that the leaders had failed the healthcare workers by scheduling more patients, which was a problem
for healthcare workers because dealing with more patients exerted significant pressure on them. P1 stated that “most providers will put patients on schedule to be seen” as leadership contributed to burnout among healthcare workers. This highlights a relationship with the theme “poor work environment” because the scheduling meant that the number of patients attended increased tremendously per healthcare worker, increasing the workload for the employees. Another finding relating to the research question is the issue of leaders not providing support to their healthcare workers, which was identified as a major cause for burnout during and before the pandemic. More than 60% of the participants in the interviews
identified lack of support from leaders as a major failure by the leaders that contributed to increased burnout levels. P3, P18, P19, and P20 mentioned lack of support in their responses when asked about contributing factors to burnout. P3 stated that leaders “seem to focus more on customer satisfaction than protecting their workers from burnout”. P2 also stated “They are only worried about the budgets. They don’t truly focus on workers.” P19 and P20 also stated “lack of support” as one of the factors they believe caused higher burnout rates in nurses. These findings align with the theme of lack of support that identified the lack of emotional and physical support and poor communication from leaders as major leadership failures that cause increased burnout among healthcare workers.
RQ3: What proposals could address professional burnout among healthcare workers?
The findings relate to the research questions on proposals for addressing professional burnout because the healthcare workers offered numerous recommendations for solving the problem. According to the data and findings, more than 60% of healthcare workers recommend training as a suitable solution to reducing burnout among healthcare workers.
This relates to the theme “employee empowerment” which covers strategies that leaders could implement to help healthcare workers overcome burnout. Training is a viable solution to burnout because it gives healthcare workers confidence and security in coping mechanisms to help them manage their work and job stress more efficiently (Sapeta et al., 2021). P5 recommended “going out as a team, team building exercises.” P2 also offers a unique take on the importance of training in eradicating burnout by recommending “train the staff, encourage self-care…training on self-care” as strategies leaders can adopt to reduce burnout levels. P20 furthers the narrative of training as a proposal for tackling burnout through responses such as “stress management classes” as preventative and strategic changes in healthcare and “train leaders”. These responses highlight that training should cater to both
healthcare workers and their leaders to ensure a long-term impact on the healthcare system, as supported by the theme of employee empowerment. The findings gained from the data answer the research by providing a viable solution that can be adopted across institutions and applied to various healthcare professionals.
Hiring more workers in the healthcare system was also a finding deduced from the data relating to the research question. According to the findings, more than 40% of the participants believed that hiring more healthcare professionals was a major solution to burnout because it eradicates major factors triggering burnout in healthcare workers. Hiring more healthcare professionals is a recommendation that eradicates burnout vulnerability because it provides the human resources needed to handle more patients, thus reducing the need for healthcare workers to work long hours and without rest (Willard-Grace et al., 2019). The findings assert the theme “poor work environment” that highlights increased workload due to seeing more patients as a reason for increased burnout among healthcare providers, indicating a poor healthcare worker-to-patient ratio that must be addressed. This also
highlights a relationship with the theme of employee empowerment because hiring more workers empowers the task force by providing flexible work hours that allow them to seek
activities outside work for a higher work-life balance. Hiring more healthcare workers will also reduce the need to schedule patients, making it easy to establish flexible work hours characterized by a balanced patient-healthcareworker ratio. P2 highlights this need by stating, “Hire more workers, 48-hour work week”. P1 also recommends having “more employees per team,” while P7 provides “more recruiting” as solutions to burnout that highlight the need to hire more workers.
The findings also identified providing rewards as a proposed solution to burnout among healthcare workers. Rewards are linked to increased motivation and job satisfaction
among employees, making employees more willing to enhance their performance (De Simone et al., 2021). Over 70% of participants provided monetary rewards as the proposed way of rewarding the workers. Some participants recommended bonuses, which would serve to show the healthcare workers that their service, especially when they work overtime, is recognized and appreciated. Others suggested paid time off as a solution to the high burnout levels among healthcare providers. The suggestion to have paid time off is meant to eradicate burnout by ensuring healthcare workers can take time off to rest and enhance their work-life balance, offering them time to reconnect with themselves and relieve emotional stress from their work.
RQ4: How do healthcare management and administration affect hospital staff burnout after COVID-19?
Generally, the findings revealed that the healthcare management and administration significantly failed healthcare professionals because of inadequate support to help them during COVID-19. All participants agreed that the leadership had inadequate support to
protect the healthcare workers, with more than 40% citing the lack of policies and programs that would help the workers. An additional 30% stated significant confusion was caused by
the leadership’s failure to understand the unforeseen pandemic. This highlights a relationship with the theme “Poor work environment” that highlights role confusion due to the lack of proper policies as a major characteristic of the poor work environment that healthcare workers were under during the pandemic. P3 highlights this finding with the response “I don’t feel policies were in place when COVID first started. No one was aware of what to do, or what was going on during the first couple of months of the outbreak”. The participants complained that the lack of directionality in healthcare management and administration also resulted in poor management of patients. More than 50% of the participants confirmed that
the administration lacked organization by stating that the leaders scheduled patients. Participant 1 stated that poor scheduling habits would result in over 26 patients needing to be seen by a practitioner in a day. This was a healthcare leadership failure that resulted in exhaustion, feeling overwhelmed, and emotional fatigue among healthcare workers during the pandemic.
The research’s findings revealed significant flaws and failures in the management and administration that resulted in staff burnout during COVID. A major impact of healthcare management on clinical burnout was the observation that leaders denied healthcare professionals time off. More than 50% of the participants highlighted that healthcare workers were forced to work long hours without rest or time off, which was a problem because it exerted significant pressure on them. The lack of time off resulted in significant job stress and pressure that made healthcare workers feel exhausted and overwhelmed, triggering burnout in many healthcare workers.
According to the findings, healthcare management also affected the burnout levels by not providing adequate equipment and supplies to the healthcare workers. More than 40% of the participants recognized the lack of equipment as a problem for healthcare workers
because it hindered their capacity to meet their daily patient responsibilities during the pandemic. P2 mentioned “nurses were working longer hours without adequate supplies” as a contributing factor to higher burnout levels among nurses. P2 also highlighted “not making sure workers have adequate equipment to perform the job” as a way that leadership and management contributed to burnout among healthcare workers during the pandemic. P3 also highlights this problem by stating “not having adequate equipment to take care of themselves while working with COVID-19 patients” as a reason why nurses were more vulnerable to burnout. These responses highlight a significant failure by leadership and management in
healthcare to ensure healthcare workers had the requisite equipment and an adequate amount to ensure the protection of the workers and easy delivery of care. The lack of equipment also affected the healthcare professionals mentally because they felt overburdened, and other healthcare workers lacked the confidence to deliver medical assistance. This also ties to the themes of poor work environment, which indicates the leadership’s failure to equip the hospitals to prevent work overload and confusion. The management’s failure to ensure that the healthcare professionals had the right and adequate equipment to deal with the rising number of patients was also a problem, seeing that COVID-19 was a new problem for healthcare workers. The combination of the foreignness of the COVID-19 virus and the lack of equipment translated to job stress for healthcare workers, which overwhelmed most healthcare workers.
Relationship of Findings to Research Framework
The following section will discuss the research frameworks utilized in the study and identify their relationship with the findings developed from the data analysis. The researcher will thoroughly summarize the concepts, constructs, theories, constructs, and actors that comprise the research framework. Their summaries were followed by a discussion of how the
research’s findings relate to each element of the research framework. The researcher aims to expand on the findings and literature to identify the relationship between leadership and the high level of burnout during the COVID-19 pandemic.
1. Concepts
Four research concepts guided the research and expounded on the relationships between leadership, burnout, and the COVID-19 pandemic. The first concept states that burnout is an important concept in healthcare that affects healthcare workers with high severity and is caused by a lack of a healthy environment, resulting in poor well-being of the
medical professionals. The second concept states that there is a shortage of medical healthcare workers in the healthcare field that is affecting the ability of existing professionals to function efficiently, resulting in job stress that leads to burnout. The third concept highlights that the poor quality of leadership in healthcare can be attributed to the financial strain caused by the outbreak, resulting in poor work environments for workers that led to burnout. The fourth concept outlines that effective leadership characterized by participative practices and incentivizing programs is needed to eradicate burnout among healthcare providers.
Burnout has severe repercussions within the healthcare profession caused by a poor work environment.
Based on the findings, 45% of participants strongly agreed, and 55% agreed that burnout is a core concept in the healthcare sector. Therefore, 100% of the participants
approved that burnout is a significant concept affecting medical healthcare workers, which makes it pivotal to direct attention and resources toward understanding the concept. Also, all participants confirmed that certain factors in the healthcare system make the healthcare workers vulnerable to burnout, with 100% confirming that they had seen a colleague struggle.
This relates to the theme “overwhelmed,” which provides various factors that can help recognize burnout among employees. To support the theme, participants gave responses with common terms that highlighted characteristics such as feeling overwhelmed, exhaustion, being unmotivated, and exhaustion as signs of burnout. Responses such as “Overwhelmed, not wanting to go to work, work vs. life” by P4 and “Lack of motivation, calling out on a regular, stressed, attitude” by P2 highlight the relationship between the theme and the concept. P15 also highlights this theme as it relates to the concept with the statement, “Many of my nurse colleagues suffer from burnout. I noticed that nurses began to be more stressed
out at work. There was also more conflict among the nurses and other healthcare workers.” The findings indicate that burnout affects the healthcare sector and needs immediate attention. The findings also prove promising for solving the issue of burnout because recognizing the causes of burnout and easily identifying colleagues struggling with the issue means that healthcare workers with burnout can readily be set aside and receive the requisite help needed to restore their well-being.
There is a shortage of healthcare workers, causing immense work overload and job stress on the existing task force.
The study’s participants confirmed that there is a major problem in the healthcare system resulting from a shortage of workers. More than 40% of the participants highlighted hiring more workers as a major solution to the issue of burnout. This finding links the concept with the theme of employee empowerment that offers solutions to tackling and
preventing burnout among healthcare workers. P19 stated, “improve nurse to the patient ratio,” P9 cited “hire more employees,” and P7 recommended “more recruiting” when asked about solutions to burnout during the interviews. Also, more than 80% of the participants noted that seeing many patients was a major problem that resulted in burnout during the
pandemic. This indicates that the existing healthcare workers have noticed that they are experiencing work overload because the task force is small compared to the daily patient needs. This relates to the theme “Poor Work Environment” that emphasizes increased workload due to seeing more patients as a sign of poor healthcare worker-to-patient ratio. Responses such as “they do more, more hands-on” by P4 highlight that each healthcare worker was handling more work than needed, which a lack of enough healthcare workers can cause. This indicates a shortage of professionals that could be called in to alleviate the increase in patients during and after the pandemic. As Schlak et al. (2022) outline, a shortage
of healthcare workers is detrimental to patients, communities, and healthcare professionals because the scarcity of physicians’ results in poor work environments that make existing healthcare workers dissatisfied with their jobs, which results in poor service delivery and more severe issues such as absenteeism, among healthcare workers. The findings recognize the concept of physician shortage based on the participant’s accounts of the impact of a high patient-to-practitioner ratio on both the patients and healthcare providers. This relationship between the findings and concept shows that the healthcare system needs an overhaul to determine the current patient-to healthcare worker ratio for the employment of a sufficient number of new physicians to meet the gap.
Poor quality of leadership in healthcare is caused by the financial strain caused by the unforeseen circumstances of the COVID-19 pandemic.
The concept outlines that the pandemic caused significant financial strain on medical institutions. The facilities constantly lost income and profits due to the sidelining of non-emergency treatment channels to cater to infected individuals (Dall’Ora et al., 2020). The findings relate to the concept because participants highlight that the management seemed confused and ineffective during the pandemic. This relates to the theme of a poor work
environment that highlights role confusion due to a lack of policies as a major cause of burnout during the pandemic. This is highlighted by responses such as “I don’t feel policies were in place when COVID first started. No one was aware of what to do, or what was going on during the first couple of months of the outbreak” by P3. All participants agreed that the leadership was ineffective in protecting the healthcare workers from burnout. Also, roughly 30% of participants cited a lack of enough equipment as a failure by the healthcare management that triggered burnout among healthcare workers. Additionally, more than 80% of the participants during the interviews highlighted the lack of support as a major leadership
failure. This relates to the “Lack of Support” theme, which highlights how leaders failed to provide emotional help and proper communication to the healthcare workers. P4 highlights this with the response, “They don’t listen, no follow through,” when asked about leadership failures. These findings relate to the research concept by confirming that the management and leadership in healthcare may be affected by external factors such as financial constraints.
Effective leadership through participative practices and incentives is needed to reduce burnout among healthcare workers.
According to the findings, the concept of the importance of effective leadership is confirmed by the sentiments shared by the participants. 100% of the participants agreed that
effective management and administration were necessary. This relates to the themes of a Poor Work environment that revealed the leadership’s failure to balance work hours and patient numbers, communicate roles, and establish proper policies, leading to complaints about the leadership among participants. P3’s response that “it all starts with leadership. If you don’t have a great leader, or a leader that cares about the staff, you will have high turnover rates and staff that suffer from burnout more than others” effectively highlights the concept by showing the importance of effective leadership. More than 20% of participants stated that
effective leadership is essential because a good leader is the head of the institution and, thus, a role model, which means having strong leadership will result in a strong team. For example, P5 stated, “The managers’ energy can change things. It would make their employees want to work and be there.” Also, the participants recommended the establishment of strong leaders who are willing to listen to their workers and have good communication skills. These findings relate to the research concept to reveal the importance of ensuring that healthcare leadership is robust enough to guarantee a strong task force automatically.
2. Theories
Three theories were crucial to the study’s articulation: Job Demand-Resource theory, Maslach’s theory, and conservation of resources theory. The job demand-resource theory provides a model that links burnout to job demand and resource availability. Maslach’s theory has also been associated with burnout because it allows for various stages that detail the development of the problem in healthcare workers. The conservation of resources theory has also gained popularity as a stress theory that links the loss of resources to burnout among healthcare workers.
Job Demand-Resource theory about findings
The job demand-resources theory posits that the work environment has a strong correlation to the well-being of employees (Schaufeli & Taris, 2013). The theory links the work environment experienced by healthcare workers during the pandemic to the high burnout levels experienced. Overall, this theory strongly relates to the theme of a poor work environment that depicts the challenges healthcare workers experienced in their work environments that made them vulnerable to burnout. The theme highlights work overload as a significant characteristic of the poor work environment during COVID-19. As Tummers and
Bakker (2021) explains that the jobs demand-resource theory outlines that the quality of the work environment, measurable by the job’s demand and the resources available to an employee, activates different reactions in employees. The theory relates to the findings because the data showed how the job demand and the resources available to healthcare workers triggered worker vulnerability. According to the findings, the job demand for healthcare workers increased during the pandemic. The job demand-resources theory dictates that a high job demand makes employees feel pessimistic about their value in their occupation and uncertain about their ability to perform their duties (Bakker & Demerouti, 2017). Over 50% of the participants stated that healthcare workers were vulnerable to burnout because they worked long hours, affecting their well-being. P17 stated, “Nurses worked longer hours, sleep deprived,” which visualizes the high work demand that healthcare workers faced during COVID-19.
The theory also relates to the findings that healthcare providers were vulnerable to burnout during the pandemic because they managed more patients. 50% of respondents described that the number of patients healthcare workers saw in a day increased during the pandemic, which triggered burnout because more patients meant increased workload and,
thus, job stress. This also relates to the “Poor Work Environment” theme, which highlights issues such as increased workload and longer work hours, which relate to the job demand-resources theory. P3 stated “the number of patients they see in a day,” which indicates that the workload was due to an increase in the patients they attended to daily. This relates to the job demand-resource theory because it shows that the increase in job demands during the pandemic affected healthcare workers emotionally and mentally, increasing burnout levels among medical professionals. The participants’ revelation that the healthcare workers were also affected by the lack of resources during the pandemic revealed an additional relationship
between the concept and the findings. P3 stated that “not having adequate equipment to take care of themselves while working with COVID-19 patients” was a major problem that made nurses more vulnerable to burnout. This is an example of a low resource highlighted by the theory. According to the job demand-resources theory, lacking resources affects employees by lowering their motivation and energy and disrupting their work engagement (Bakker et al., 2023). The findings also relate to the concept because the participants revealed that the healthcare workers lacked the requisite resources to protect their mental state. Participants highlighted that the healthcare workers did not receive support from their administration and
that the leaders were also confused about what to do during the outbreak. The relationship between the findings and the job demand-resources theory highlights that there needs to be a balance between the job demand and the resources provided to healthcare workers to achieve optimal mental and emotional well-being and avoid burnout.
Maslach’s theory
As Dall’Ora et al. (2020) explain, Maslach’s theory posits that burnout is a problem that is more of a personal experience rather than a problem linked to external resources. The theory is essential to understanding burnout because it places the employee at the center of
burnout a responsibility to protect themselves from burnout. McCormack et al. (2018) explain that burnout can be attributed to an employee’s characteristics and traits determining an individual’s ability to cope with stress. The findings relate to this theory by highlighting the importance of workers establishing a proper work-life balance. This is evident in some participants who emphasize that workers need time off and proper schedules that allow them to explore other activities to manage stress better, seeing that working longer hours was regularly cited as a problem. For example. P11 cited, “I think, I feel that the nurses work long hours, and it made them more susceptible to burnout before the pandemic because of their long work hours and short breaks.” P17 also stated, “Nurses worked longer hours, sleep deprived,” indicating that the healthcare workers were neglecting their needs and activities, driving them into the onset of the stress stage identified by Maslach’s theory concerning burnout. The theory relates to the theme “overwhelmed,” where various indicators of burnout among healthcare workers are identified. When asked about the signs they noticed in their colleagues that indicated burnout, 20% used the term “overwhelmed,” 40% used “stress,” more than 30% cited a lack of motivation, and more than 30% stated “exhaustion.” For example, P15 stated, “Many of my nurse colleagues suffer from burnout. I noticed that nurses began to be more stressed out at work,” highlighting the issue of stress. P8 stated, “attitude, calling out a lot, frustrated, exhausted,” highlighting the aspect of emotional and physical exhaustion and stress. Emotional and physical exhaustion is represented in responses such as “lack of motivation” by P3, “not motivated” by P10, and “unmotivated” by P5. This relates to Maslach’s theory, which identifies emotional exhaustion and stress as a burnout stage. The varying prevalence and frequency of the factors during the interviews indicate that the victims of burnout had unique manifestations of burnout, which affirms Maslach’s theory that
burnout is a personal experience that occurs in various stages that culminate into emotional and physical exhaustion.
Conservation of resources theory
The conservation of resources theory relates to the findings because it presents the availability of resources as a crucial element that determines the development of burnout. As Prapanjaroensin et al. (2017) explain, the theory identifies three elements needed to enhance the well-being of medical healthcare workers, including the work environment, the vitality of the workers, and the resources or tools used in the occupation. The theme of poor work
environment strongly correlates to the theory because the theme highlights issues such as long work hours, work overload, and role confusion as factors that contribute to burnout. These characteristics of poor work environments were caused by a lack of certain resources in the work environment, including adequate healthcare workers, requisite equipment, and policies to protect the workers. For example, P2 revealed that “nurses were working longer hours without adequate supplies,” contributing to higher burnout levels among nurses, indicating a poor workplace due to inadequate supplies. P2 also responded similarly, “not making sure workers have adequate equipment to perform the job.” P3
also highlights the issue of poor work environment by stating “not having adequate equipment to take care of themselves while working with COVID-19 patients” as a reason why nurses were more vulnerable to burnout. The absence of these factors results in burnout because it impairs the ability of healthcare workers to avoid burnout, offering a model for preventing burnout. The research findings relate to the theory because they also identify resources as a crucial trigger to burnout. More than 50% complained that the healthcare workers did not have the right and adequate resources to promote a functional work environment during the pandemic. For example, P17 stated “workplace setting” as a reason
for increased burnout vulnerability. Also, P8 states that “not having adequate equipment and gear during the pandemic” is a management failure that has increased burnout. Also, the participants complained that there were no policies that supported functionality and directionality in the management of patients. The lack of policies was highlighted by responses such as “there were no policies and procedures in place when COVID-19 first surfaced” from P2 and “I don’t feel policies were in place when COVID first started. No one was aware of what to do, or what was going on during the first couple of months of the outbreak” by P3. These are crucial resources meant to equip healthcare workers to effectively
manage the rise in job demand, making it easy for healthcare workers to develop burnout because they felt overwhelmed, stressed, and unmotivated during the pandemic.
3. Actors
The study involved three main actors: healthcare professionals, healthcare leaders, and patients. The following section evaluates how the study’s findings relate to the actors regarding burnout.
Health care professional
Healthcare professionals were the primary actors affected by the study. According to Sharifi et al. (2021), burnout is a problem occurring globally and in different healthcare professionals worldwide. Participant responses show that 80% of participants highlighted that nurses were more vulnerable to burnout than other medical healthcare workers, indicating that certain professionals in healthcare are at a higher risk based on their job descriptions. For example, P2 highlighted that “Nurses were working longer hours with no knowledge of COVID-19.” P17 also stated, “Nurses worked longer hours, sleep deprived.” The actor relates to the findings because they show that the healthcare system needs stable and rigid
programs and initiatives that recognize the heightened vulnerability to burnout in healthcare more than any other occupation and implement proper solutions.
Patients
Patients are affected by burnout because the problem reduces a healthcare worker’s efficacy and quality of services because of the emotional and mental disruption (Sharifi et al., 2021). The actor relates to the findings because the participants regularly highlighted the consequences of burnout on patients. More than 60% of the participants highlighted that healthcare providers would be less engaged, call out, schedule patients, and even be absent from work. P3’s response summarizes this finding, where the participant stated, “stressed, lack of motivation, calling out on a regular and attitude,” which indicates burnout factors. P8 also stated, “attitude, calling out a lot, frustrated, exhausted,” confirming that patients were affected. Also, patients’ vulnerability and importance to the research is highlighted by P1’s response, stating, “most providers will put patients on schedule to be seen at the last minute.” This affects the patients by reducing their ability to be seen and access quality services, exposing them to risks such as infections and even death. This actor relates to the theme of
employee empowerment where hiring more healthcare workers is provided as a solution to burnout and a way of balancing the healthcare worker-to-patient ratio, which marks patients as key players in these efforts.
Leaders/Administrators
According to Sultana et al. (2020), leaders are crucial players in healthcare because they are responsible for human resource management and allocating the requisite resources needed for care delivery. The findings relate to this actor because 100% of participants confirmed that leadership failure led to burnout among healthcare workers during COVID-19. For example, P2 highlights this failure by stating, “They are only worried about the budgets.
They don’t truly focus on workers.” P18 also mentioned a “lack of support from the administration” as a major leadership failure that led to burnout. This relates to the theme of employee empowerment, which emphasizes that leaders must receive training to equip them with the skills and knowledge to manage employees and work environments effectively. Some failures identified in the findings include a lack of policies, not listening to nurses, poor scheduling of patients, denying workers time off, and not providing equipment. This also relates to the theme of a poor work environment that emphasized longer work hours, increased workload, and role confusion due to the absence of supportive policies as factors that caused higher burnout levels. This relationship highlights that leaders need to
play a more active role in identifying and solving the healthcare system gaps that may impact healthcare workers’ well-being.
4. Constructs
The constructs employed in the research purpose are to elaborate on the relationship between the prevalence of burnout and leadership in healthcare. Two constructs were used in the study: the role of stakeholders in dealing with burnout and the need to create a conducive
environment. The following section elaborates on how these constructs relate to the findings.
The Role of Stakeholders in Dealing with Healthcare Professional Burnout
The stakeholders in healthcare have a role to play in preventing burnout. Organizational leaders are the main stakeholders in healthcare because they are responsible for managing the systems governing care delivery, including managing employees. The construct relates to the findings because the data gathered revealed two crucial stakeholders that need to be considered and involved in efforts toward eradicating burnout. The findings identified leaders as essential stakeholders, with 50% of the participants advocating for
leaders to provide more support. Responses such as “lack of support” from P20 and “lack of support from the administration” by P18 as factors causing burnout highlight the importance of leaders as critical stakeholders in the healthcare sector. P5 also highlights the importance of leaders as stakeholders by stating, “the energy of the managers can definitely change things. It would make their employees want to work and be there.” P8 also asserts leaders as crucial stakeholders by stating, “if you have a great leader, you will have great staff to follow.” Another critical stakeholder identified in the findings is the healthcare workers, with 10% of participants highlighting that healthcare workers needed to find courage and take responsibility for their wellbeing. This relationship between the findings and the construct reveals the importance of collaboration between leaders and healthcare workers in implementing solutions targeting burnout. This relates to the theme of employee empowerment, which provides solutions such as training, rewards, and recognition, as well as hiring more employees to reduce burnout. These solutions can only be implemented with the input and approval of the stakeholders responsible for healthcare institutions’ decision-making and financial management.
Creation of a Conducive Working Environment for the Employees
A conducive environment is crucial to eradicating burnout because it provides the motivation and job satisfaction needed to make healthcare workers less overwhelmed and stressed at work (Morgantini et al., 2020). This construct relates to the study’s findings because more than 60% of the participants revealed that they worked in unhealthy environments characterized by flaws such as lacking support, long hours, poor patient scheduling, and lack of equipment. For example, P2 stated, “Nurses were working longer hours without adequate supplies,” highlighting the lack of equipment. Also, P14 highlights the issue of patient scheduling and seeing more patients by stating, “they’ll put them on the
schedule to be seen, and they may already have 26 or more patients on their schedule, but they add more, and it causes burnout.” These problems highlight that the environment needs to be considered to ensure that programs and incentives improve healthcare access resources for service delivery.
Relationship of Findings to Anticipated Themes
In research, anticipated themes are regarded as the repeated characteristics that appear throughout the study, which can be used to make reliable conclusions on a given problem. The following section explores the relationship between the findings and the anticipated themes to identify whether the participants relayed information aligning with the expected
themes. The section will also include a discussion of themes that emerged during the data analysis that had not been foreseen, as well as any missed themes that were not identified by the findings.
Leadership Participation and Support Towards Solving Burnout
Leadership participation and support as a crucial strategy for solving burnout was anticipated in the research. The study anticipated that healthcare workers would recommend
leaders playing a participative role and supporting the healthcare workers as a viable solution to burnout. Yang and Hayes (2020) explain that physical and emotional support is crucial to preventing burnout because it ensures that the employees do not experience emotional exhaustion that can lead to depersonalization that triggers burnout. P5’s response highlights the importance of leaders supporting employees by stating, “the energy of the managers can definitely change things. It would make their employees want to work and be there.” Support from leaders as a remedy for preventing burnout was an anticipated theme. The researcher expected that the participants would want their leaders to be more active and interact with the workers to identify their needs. This theme was recurring in the findings because the
participants complained about the lack of support from their leaders, which made nurses more vulnerable to burnout. Responses such as “lack of support” from P20 and “lack of support from administration” P18 highlight this complaint. Similarly, more than 50% of the participants had provided leaders’ support as a solution they believed would work to reduce burnout among healthcare workers. Providing the needed support is important to physicians because it will establish a work environment steered by transformational leadership where the leader is dedicated to improving employee motivation and job satisfaction (De Simone et al., 2021). This relationship between the findings and the anticipated theme reveals that leaders in healthcare need to improve their leadership presence.
The research also anticipated the theme of providing flexible work schedules to reduce burnout. The research expected that participants would recommend flexible work schedules because such schedules encourage a healthy work-life balance. Flexible work schedules as a solution to burnout were also recommended by more than 40% of the participants, who stated that the healthcare workers needed more time out of work rather than
working long hours. P3 highlights the importance of flexible work hours in the response “Bonuses, fewer hours, higher pay, being noticed, appreciated, adequate training” when asked to provide solutions to burnout. P17 also highlights this finding in the statement, “flexible work hours, clarify roles, manageable workloads, bonuses, paid time off” as some solutions to burnout. Gabriel and Aguinis (2022) explain that flexible workers are essential to reducing susceptibility to burnout because they provide employees with the time to invest in non-job-related activities and areas of their lives that support their mental and emotional well-being. This correlation between the anticipated theme and findings reveals a shared sentiment among healthcare professionals that highlights their desire for work-life balance by
having time to explore personal activities. This relationship highlights the importance of leaders avoiding overwork among healthcare workers.
The research’s findings also aligned with the anticipated theme of recognition being a recommended solution to burnout. Koo et al. (2020) explain that recognition through emotional and material rewards plays a major role in eradicating burnout among workers. It enhances their emotional well-being by increasing motivation to work and job commitment and improves job satisfaction. Recognition was an anticipated theme because the researcher expected that the research would reveal that healthcare workers crave the attention of their leaders and would appreciate the support. The findings revealed this theme based on how participants recommended rewards such as paid time off, promotions, and bonuses as preferred modes of recognition. For example, P2 stated, “8-hour workdays instead of 12–14-hour days, mental health days, training on self-care, bonuses, higher pay.” P3 also mentioned, “Bonuses, fewer hours, higher pay, being noticed, appreciated, adequate training.” Responses include “awards and being noticed” by P5 and “being noticed, appreciated, and adequate training.” P3 also highlights the importance of recognition and appreciation. The relationship
between the findings and the anticipated theme reveals that healthcare workers desire to be acknowledged for their value and enhance their commitment to serving patients, even amidst unprecedented circumstances such as those experienced during the pandemic.
Unanticipated Themes
A major unanticipated theme identified from the findings is that the safety precautions used during the pandemic, including the safety gear, significantly impacted healthcare workers. Some participants explained that they were disturbed by preventive measures such as wearing a mask every time, wearing PPEs, and having to disinfect everything they touched. Over 40% of the participants attributed their weariness, which impacted their
comfort level at work during the pandemic, to the increased effort brought on by protocol adjustments. For example, P3 stated, “Disinfecting everything you touch. Wearing mask 12-14 hours a day”. The complaints stemmed from the increased workload and the emotional fear created by the precautions. Participants complained that the safety precautions, especially having to disinfect everything, were additional responsibilities they needed to meet despite having a significant workload from working long hours and helping more patients than usual. P5 highlights this complaint by stating, “More precautions were added on our plate.” This relates to the theme of a poor work environment where increased workload was
recorded as a cause of higher burnout levels among healthcare workers. Also, the participants complained that the safety precautions affected the medical healthcare workers mentally because it made them feel pressured about the severity of the virus. For example, P17 stated, “I don’t think they helped much. It made the healthcare workers stressed out more with the new P.P.E.” when questioned about the effectiveness of the policies and procedures set up during the pandemic. This was an unanticipated theme, seeing that the research did not expect
that the healthcare workers would fault the precautionary practices meant to protect them during the uncertainties and risks in the wake of COVID-19.
The recommendation of an anti-violence program to combat burnout was a missing theme in the research. The theme was initially anticipated because the recommended program would protect healthcare workers. Leaders should prioritize zero tolerance for workplace violence. This relates to the finding that 20% of participants highlighted that increased conflicts and attitudes were a sign of burnout among colleagues. P15 highlights this issue: “Many of my nurse colleagues suffer from burnout.” I noticed that nurses began to be more stressed out at work. There was more conflict among the nurses and other healthcare workers, too. They were feeling burnt out.” This correlates with the theme of Employee Empowerment
where recommendations for training to ensure the employees have proper interpersonal skills are instilled. It is also necessary to review labor policy and enact specific policies to combat workplace violence (Cook, 2020). The theme advocated that leaders should develop helplines for medical professionals to report violence and promote a confidential reporting structure. However, the theme was missed because the research participants did not identify violence as a major area of concern that could lead to burnout.
Relationship of Findings with the Problem
The problem statement guiding the research is “the failure of the healthcare leaders within the Southeastern United States to develop a strategic framework in the wake of the COVID-19 pandemic resulted in increased burnout among healthcare professions”. According to the findings, the problem statement accurately describes the state of healthcare workers within the Southeastern United States during the pandemic. The findings revealed that the leadership in the healthcare system significantly contributed to the increase in burnout among healthcare workers during the pandemic. A major complaint from the
respondents was that the leaders did not do enough to support a conducive work environment for the healthcare workers. This is seen in responses such as “I don’t think leadership has done much” by P20. This relates to the theme of lack of support where participants complained of not receiving emotional support and adequate communication from their leaders. It also correlates with the theme of poor work environment where leaders’ inefficiencies manifested in long work hours, increased workload, and role confusion among healthcare workers. This is seen in responses such as “They are only worried about the budgets. They don’t truly focus on workers” from P2 highlighting misbalanced priorities by the leaders. A major area of concern identified by the findings is the leadership’s lack of
direction. 100% of the respondents explained that they did not think the leaders did anything to protect the healthcare workers against burnout during the pandemic.
Further findings based on the responses obtained in the data collection paint a better picture of all the areas in which leaders had failed. The lack of policies to support a healthy work environment was a recurring issue identified in the findings, which also relates to the theme of a poor work environment. P3 stated, “I feel that it led to the burnout of healthcare workers. I don’t feel that policies were in place when COVID-19 first started. No one knew
what to do or what was happening during the first couple of months of the outbreak.” This relates to the problem statement because it shows that healthcare leaders failed to implement reliable policies that would have offered guidance to healthcare workers. This failure resulted in the healthcare workers developing uncertainty about how to handle the outbreak, which resulted in medical workers feeling overwhelmed and stressed, triggering burnout.
Another indication of leadership failure identified by the findings is the lack of a quality work system during the pandemic, which also relates to the theme of a poor work environment. P4 attributed the lack of a working system to the leader’s obsession with the
bottom dollar, which means that the leaders were oblivious to the woes faced by the healthcare professions in the wake of COVID-19. The findings revealed that P4 complained that “they didn’t listen, no follow through,” while P17 stated, “I think they are more worried about the income coming in and the patients.” P2 also highlights this by stating, “Lack of motivation, calling out on a regular, stressed, and attitude” as indications of burnout. Participant 3 also stated, “stressed, lack of motivation, calling out on a regular and attitude.” These findings address the problem because they highlight the areas of weakness that the leadership within the southeastern United States faced, leading to their workers’ developing burnout. The findings also relate to the problem because they emphasize that leadership is a
crucial element in healthcare that determines the quality of services. After all, leadership directly impacts healthcare providers.
Relationship of Findings with Literature
The extensive literature evaluation helped to establish the link between the existing knowledge and the findings. The study’s findings revealed several similarities with the literature and many discrepancies. The similarities and differences will be discussed in the following section.
1. Similarities
The definitions of burnout in the literature and findings were significantly similar, which relate to the theme of “overwhelmed,” where factors such as stress, feeling overwhelmed, lack of motivation, and exhaustion that signal burnout in healthcare workers were identified. The literature presented various keywords that were used to define burnout. A simple scholarly definition of burnout is the constant feeling of exhaustion and loss of motivation after prolonged exposure to stress (Demerouti et al., 2021). This simple definition highlights the severity of burnout in employees. P8 affirms this definition with the response,
“attitude, calling out a lot, frustrated, exhausted” as indicators of burnout among their colleagues. P9 also confirms the similarity with the response “exhaustion, calling out, sickly” as the factors they noticed in their fellow healthcare workers suffering from burnout. Additional literature focused on defining burnout in terms of dimensions that translate into symptoms of burnout when seeking to identify practitioner vulnerability. Maslach and Leiter (2016) explain that three dimensions characterize burnout: low energy or exhaustion, increased mental withdrawal from one’s job or harboring negativism toward one’s occupation, and lowered professional productivity. The findings also offer a similar definition of burnout in the participants’ responses on how they identified burnout in their colleagues. 80% of the
participants strongly agreed, while the remaining 20% agreed with the definitions of burnout in the research, which included characteristics such as feeling unmotivated, wanting a promotion, demotivation, and being unhappy at work. For example, P4 stated, “Overwhelmed, not wanting to go to work, work vs. life.” P15 also defines burnout with the response, “Many of my nurse colleagues suffer from burnout. I noticed that nurses began to be more stressed out at work. There was more conflict among the nurses and other healthcare workers, too. They were feeling burnt out.” These characteristics align with the definition
established in the literature. Similarly, the participants highlighted frustration, lack of motivation, stress, low energy/sickness, not being engaged, attitude/conflict, quitting, and absenteeism as the signs they observed in colleagues suffering from burnout. For example, P2 mentioned, “Lack of motivation, calling out on a regular, stressed and attitude.” The similarity between the literature and the findings on the definition and characteristics of burnout reveals that the concept is widely recognized as a problem across the healthcare system, meaning that solutions and programs, once implemented, will also be extensively well-received.
There was also a distinct similarity between the literature and the findings in defining effective leadership and its role in preventing burnout in healthcare workers. The literature heavily expounded on effective leadership as implementing practices and programs that create a conducive work environment (Madanchian et al., 2017). This relates to the theme of employee empowerment, where solutions such as training, rewards, and recognition are identified as practices that leaders can adopt to solve burnout. According to the literature, effective leaders have a close relationship with their employees established by the leader’s innate concern for the team’s long-term development, resulting in the use of skills to motivate team members (Madanchian et al., 2017). The findings offer a similar input to the literature
because the participants highlighted that 100% believed leadership was crucial to eradicating burnout in medical workers. P5’s response highlights the importance of leaders in eradicating burnout by stating, “the energy of the managers can definitely change things. It would make their employees want to work and be there.” Also, the findings revealed that the participants believed that improving healthcare leadership would result in solid teams capable of meeting job demands in the future. This relates to the theme of Lack of Support where communication is highlighted as a major requirement for ensuring teams are fully
supported. P8 highlights this by stating, “If you have a great leader, you will have great staff to follow.”
The literature also focused on the impact of physician shortage on burnout levels in healthcare. As Barton et al. (2022) explain, the Association of American Medical Colleges (AAMC) had predicted that the healthcare system would struggle with a physician shortage, revealing that there would be a shortage of up to 48,000 primary care healthcare workers and more than 77,000 specialty physicians by 2034. The rise of burnout among healthcare workers during COVID-19 reveals that the healthcare system was affected by the predicted
worker shortages. The findings offered a similar conclusion because the participants highlighted insufficient healthcare workers during the outbreak. More than 50% of the participants revealed that there were too many patients during the outbreak. P3 highlights this by stating that “the number of patients they see in a day” is a major problem that causes burnout among healthcare workers. P8 also highlights this by stating, “Having to deal with numerous patients. Dealing with patient attitudes.”
In comparison, more than 40% recommended hiring more healthcare workers to reduce burnout among healthcare workers. P19 stated, “improve nurse to patient ratio” to reduce burnout among healthcare workers. P9 also responded similarly by saying, “Hire more
workers.” These findings offer a correlation between the physician-patient ratio during the pandemic, revealing that the existing medical healthcare workers during the wake of COVID-19 were insufficient to offset the rise in patient needs. Also, the findings indicate that the number of healthcare workers was inadequate in offering enough staffing to secure the flexibility of healthcare workers taking time off to relax or sleep.
2. Differences
A significant difference between the literature and the findings is that the data collected did not directly recognize the impact of financial constraints on leadership during the pandemic. The literature stated that financial constraints due to hospitals experiencing loss of income were a significant challenge to management and healthcare administration, preventing leaders from being fully efficient (Kaye et al., 2021). For example, P2 stated, “They are only worried about the budgets. They don’t truly focus on workers,” revealing major budgeting and profiting issues in the healthcare sector during the pandemic. This was not present in the findings because the participants focused on the leaders’ failure to support
the workers as a major problem. Participants complained that the leaders did not listen, hardly offered support, and did not offer proper training. 14 out of the 20 survey participants strongly agreed that lack of leadership support led to burnout, confirmed by responses such as ‘“lack of support” “by P20. These problems indicate that participants did not identify financial strain as a viable excuse for the leader’s failure to do anything substantial to protect the workers from burnout. Their presence as leaders made the healthcare workers feel appreciated, reducing their chances of developing burnout.
Summary of Findings
The purpose of the research was to identify the relationship between leadership and the high burnout levels among healthcare workers during the COVID-19 pandemic. The
study’s findings were highly informative about the problem of burnout among healthcare workers. A significant finding from the study is that there appears to be a standard definition among study participants of burnout in the healthcare sector characterized by factors such as lack of motivation, low energy, stress, and lack of engagement. The study also found that healthcare workers complained about the safety protocols implemented. An additional
finding was the observation that leaders had failed the healthcare workers during the pandemic by failing to provide policies that created a conducive work environment and by not providing adequate resources needed for service delivery. The study also found that major recommendations provided by the participants for solving burnout included training, hiring more workers, leaders communicating with the workers, providing support to the healthcare workers, and ensuring they listened to the workers. A major conclusion from the research is that solving burnout should be a collective effort between leaders and healthcare workers. Also, the research encourages the conclusion that supportive leadership
should be prioritized in healthcare to ensure leaders play an active role in identifying the needs of healthcare workers and implementing guided solutions.
Application to Professional Practice
The study’s findings significantly impact professional practice in the healthcare sector because they reveal a relationship between leadership and the well-being of healthcare providers. The prevalence of burnout among healthcare workers is alarming due to the significant impact the condition has on healthcare providers’ well-being and mental stability, which is evident in the characteristics of burnout offered by the participants, including feeling overwhelmed, unmotivated, and stressed, among others. The themes identified from the research attract significant attention to various aspects of healthcare that need to be addressed to lower the high burnout rate. The main target for applying the research’s findings is the
leadership practices and principles applied in healthcare to protect healthcare providers’ physical, emotional, and mental well-being.
Improving General Leadership Practice
The study’s results significantly impact general leadership practice by shedding light on the need for leaders to actively support their teams of healthcare workers, highlighting the
importance of adopting the transformational leadership style. Cheung and Wong (2011) define transformational leadership as an approach to leadership founded on the principle of providing team members with the support, guidance, and motivation needed to accomplish their roles, which, in return, creates an environment where team members support each other and have enhanced creativity. Based on the interview results, up to 80% of the participants presented the lack of leadership support as a significant factor causing burnout. Additionally, 60% of the participants recommended support from leaders as a solution to burnout and a change they would implement as leaders. This sheds light on the need for improved support
systems from leaders. The highlighted importance of support from leaders demands an improvement in the leadership style that leaders in the healthcare sector apply. Applying transformational leadership among healthcare leaders is warranted based on the findings as it best aligns with the highlighted need for leaders’ support, which is evidenced by 40% of the survey participants strongly agreeing and 50% agreeing that leaders must play an active role in solving the problem of burnout. The interview response,” the leader should be a role model and listen to their employees” by P18, also sheds light on the need for transformational leadership that takes an interactive approach to management. Transformational leadership will address the lack of support and poor work environment through leaders actively supporting employees. The study’s findings, through the identified themes of lack of support, poor work environment, and employee empowerment, indicate
the need for healthcare leaders to embrace a transformational leadership style. The theme of lack of support as a causative factor for burnout indicates that employees need engaged leaders who actively listen and communicate. The theme of poor work environment indicates sub-themes such as work overload, working long hours, and inadequate policies that stem from poor leadership, which suggests a need for applying the concept of
supportive leaders in transformational leadership. The findings thus influence leadership because the identified importance of a transformational leadership style may create a culture of leaders building relationships with healthcare workers, providing the needed support to ensure the medical workers have a supportive environment and emotional protection.
The study also improves leadership in healthcare by advocating for leaders to strengthen their policy development and implementation, which will, in return, improve the work environment enjoyed by healthcare workers. The study highlighted that up to 50% of the participants complained of healthcare providers working long hours, 50% presented
handling many patients as an issue, 40% complained of increased workload, and multiple participants highlighted role confusion as a problem leading to high burnout. This is affirmed through interview responses from various participants, such as P18, who provided “long non-flexible work hours” as a reason for burnout susceptibility among nurses and also cited “unmanageable workloads and “non-flexible work hours” as reasons for increased burnout during COVID-19. P1 also highlights the impact of increased workload through interview responses such as “too many patients” and “more patients now than before COVID” as reasons for high burnout rates. These issues indicate a significant failure by the leadership to ensure role clarity and quality job descriptions that protect healthcare workers. Zhang et al. (2020) and Agarwal et al. (2020) present the distinct role of policymakers and clinical managers as leaders in healthcare to ensure that policies advocate for hiring more workers,
flexible work schedules, and enhanced monetary benefits and wages. The study advocates for better policies that target protecting healthcare workers from any vulnerabilities that may lead to burnout, which can only be achieved if leaders improve their role as policymakers.
The results of the study also improve leadership by emphasizing the need for training programs as a way for leaders to actualize their role in ensuring employee development.
Hofmeyer et al. (2020) outline that leaders are responsible for fostering employee well-being, which can be articulated through training programs where employees can learn strategies for supporting physical and mental wellness, which will establish job satisfaction and compassion between leaders and workers based on the relationship building through training programs. Interview responses such as “team building exercises” from P5 and “being noticed, appreciated, adequate training” from P3 effectively emphasize the study’s recommendation for training. The study supports the implementation of training programs across the healthcare sector because such programs will allow leaders and healthcare
workers to interact with each other, learn about each other, and establish relationships founded on supporting each other. This is emphasized by P5’s statement that “the energy of the managers can change things. It would make their employees want to work and be there,” highlighting the importance of ensuring leaders are well-trained to offer the right energy through practical management skills. Training programs are also a way for leaders to ensure that healthcare workers are fulfilled in their careers because they are an avenue for learning emerging trends and technologies in the healthcare sector (Elsafty & Oraby, 2022). The study also advocates for leaders to improve their handling of employees through training programs that ensure the workers learn coping strategies to help them achieve a proper work-life balance and manage work stress more effectively, which is guaranteed to reduce burnout.
Potential Implementation Strategies
Leaders must leverage the study’s findings through proper implementation strategies to facilitate successful organizational change. Maximizing communication between leaders and healthcare workers is one of the potential implementation strategies that leaders can apply to take advantage of the study’s findings. This is highlighted by up to 60% of the interview participants, who highlighted that they would implement stronger communication to solve burnout as leaders in the healthcare sector. For example, P17 stated, “I would hold weekly meetings to address concerns,” presenting regular communication between leaders and healthcare workers as a crucial solution. According to Alwi et al. (2020), communication is essential for implementing change. It ensures employees successfully share and embrace the vision and goals, that the organization has a standard view of the implementation, and that employees understand their duties. The importance is highlighted by the study’s findings that 14 participants (P2, P3, P5, P6, P7, P9, P11, P12, P14, P15, P17, P18, P19, and P20) strongly agreed with the statement in the survey’s Question 5 that burnout among healthcare workers was caused by the way their leaders treated and managed them. Communication will lessen stakeholder resistance to change by informing them of the need for a collaborative approach to solving the issue of burnout, demonstrating a desire to invest in strengthening administration in the healthcare sector (Privitera, 2018). This highlights that communication may establish a reliable relationship between the leaders and healthcare workers.
Implementing feedback systems is another potential technique leaders can utilize to use the study’s findings. Errida and Lofti (2021) assert that implementing change is delicate since leaders’ roles fluctuate throughout the process. Therefore, getting employee feedback is essential to guarantee that leaders know how staff members respond to the change. To ensure
that the study’s recommendations are implemented effectively, healthcare leaders must implement a feedback mechanism that ensures confidentiality. The study’s findings reveal this based on responses such as “I would listen to my team and come up with reasonable solutions,” from P9 as a response to the question on what they would do to eradicate burnout as leaders, highlighting the need for two-way communication where leaders also listen to the
employees. Wei (2022) conducted a study investigating the most appropriate model for establishing professionalism in healthcare, which highlighted providing constructive feedback as pivotal to establishing a caring culture that combats burnout. Feedback will provide an avenue for leads to understand the impact of the changes recommended by the study on the well-being of healthcare workers and gather data on the alterations suggested by the workers. This will guarantee maximization of the study’s findings because the leaders will use the feedback systems as a source of quality data on the impact of the study’s solutions on the healthcare sector.
Training the leaders on effective leadership strategies is also a potential implementation strategy that can be applied to leverage the study’s findings. Leadership training is a popular strategy for enhancing the quality of leadership in an organization because proper training instills knowledge and skills in leaders that allow them to be effective communicators, build quality relationships, strengthen their decision-making, and improve how they handle organizational problems successfully (An et al., 2022). Leadership training
should be an implementation strategy considered by leaders so they can leverage the study’s findings. The training was a sub-theme identified from the study’s findings under the larger theme of employee empowerment, evidenced by interview responses such as “going out as a team, team building exercises” by P5. These findings highlight a need for both leaders and healthcare workers to undergo development through training exercises that grow their skills.
Major concerns relayed by the study’s themes and sub-themes include the lack of support from leaders, failed communication, and poor work environment management, which the study presents as causative factors for increased burnout. The lack of support was recorded by up to 80% of the interview participants, failed communication by 60% of participants, and poor work environment by 50% of the respondents. Practical leadership training instills skills
and techniques for adequately managing employees, including showing consideration, giving proper feedback, and handling others compassionately (Kelly & Hearld, 2020). This highlights that well-trained leaders may help the healthcare system achieve the theme of employee empowerment and tackle the issues of poor leadership, which is identified in the research theme of lack of support.
Summary
The study has a significant potential impact on the professional healthcare providers in the healthcare system. The study’s potential impact is on leadership practices in the
healthcare sector. The study advocates for leadership improvement because it sheds light on the importance of improved policy development and implementation as a solution to burnout. The study asserts that policies on work flexibility, monetary benefits, and quality of work environment require advocacy by leaders, which prompts leadership to play an active role in the policy-making process in healthcare. Improvement in the support leaders extend to healthcare workers is also a potential impact of the study on professional practice, which advocates for leaders to establish close relationships with workers and communicate effectively with teams. The study also has the potential impact on improving professional practice by suggesting training programs for healthcare workers as a way for leaders to articulate their responsibility of fostering employee empowerment. Potential implementation strategies that will ensure the study’s findings are leveraged for the benefit of healthcare
workers and leaders include training programs for leaders, intentional communication of the vision of change, and implementing a feedback system for data collection on the state of the healthcare workers.
Recommendations for Further Study
The research has identified various areas that need further research to effectively understand the relationship between burnout and leadership and identify potential solutions. A major recommendation is to conduct further research into the issue of the shortage of healthcare workers in the healthcare sector. The study’s results indicate that up to 40% of the study’s participants highlighted the need to hire more workers, which raises concerns about the possibility of a shortage of healthcare workers. However, further research should address the shortage of workers using three distinct approaches: as an issue caused by the decrease of graduating medical professionals, as a result of high employee turnover due to job dissatisfaction, and as a problem caused by the unwillingness of leaders to employ more
workers. The World Health Organization sheds light on the issue of shortages in the workforce based on its estimation that the world will experience a shortfall of up to 10 million healthcare workers by 2030 (WHO, 2019). This highlights a significant potential barrier to solving the issue of burnout among healthcare workers because the estimated worker shortage may affect the success of solutions recommended by the study. Further research into the shortage of workers will indicate areas that need to be improved to ensure recommendations such as hiring more workers to address burnout are effective. Further study into the causes of the shortage of healthcare workers will explore whether the current state of healthcare leadership is affecting enrollment and the willingness of graduates to work in healthcare.
Additionally, future research into the issue of employee silence on the prevalence of burnout is needed to identify whether the silence contributes to burnout prevalence. The study determined that healthcare workers lack an avenue for reporting their work issues while highlighting the disconnect between leaders and medical workers, as evidenced by the lack of
support from leaders, which was identified by 60% of participants as a factor causing burnout in healthcare workers. Montgomery and Lainidi (2022) explain that employee silence stems from the lack of psychological safety at work and a culture of performance protection by the leaders, which hinders the solution of self-care recommended for healthcare workers to balance work stress and life. The issue of employee silence should be an area for future research because it is seen as a problem that affects the reported cases of burnout. Employee silence is also a hindrance to early recognition of burnout in healthcare workers, which requires further research to identify factors that encourage employee silence. Additional research will explore leaders’ role in the severity of burnout among healthcare workers.
Future research should also investigate how control over the practice environment influences the prevalence of burnout. The study’s results indicated a disconnect between healthcare workers and the leaders, which resulted in medical workers’ inability to control how they provided services during the pandemic. Mete et al. (2020) emphasize the impact of perceived control over the practice as a causative factor of burnout, with control over practice being reduced in environments with poor leadership behavior while participative leadership encourages job satisfaction. The study’s observation that some healthcare personnel complained about administrators scheduling patients and depriving them of time off during the epidemic highlighted their lack of control over practice. This suggests an underlying need to investigate the possible influence of giving healthcare professionals autonomy over their work setting on minimizing their sensitivity to burnout. Control over practice is meant to
provide healthcare workers with significant flexibility, including deciding when they are available for work, the number of patients they see daily, and the quality of medical providers’ decisions.
Reflections
The research has provided the opportunity to reflect on various healthcare and professional development aspects. The study highlighted significant problems in how healthcare practitioners are treated in the healthcare sector. The research also revealed that most practitioners must implement strategies that protect them from burnout. However, the study also emphasizes the need for improvement by healthcare leaders and medical providers to ensure a comprehensive approach toward eradicating burnout. The study’s findings encourage reflection on areas for personal growth as an employee based on the results highlighting the role of practitioners in enhancing their wellness. The research also presents the need for constant professional growth as a self-care approach for reducing the risk of burnout. The need for personal and professional growth highlighted by the study aligns with the biblical concept of good leadership and servitude as leaders.
Personal & Professional Growth
Conducting the research has encouraged both personal and professional growth. The study encouraged reflection on personal growth regarding the quality of my relationships. This comes from recognizing the impact of relationships on vulnerability to burnout and seeing that quality relationships offer the support needed to enhance emotional and mental well-being. Relationships provide the social support required by employees in stressful work environments because the sources of support will identify a person’s pre-burnout state early while also eradicating the feeling of isolation that encourages burnout (Velando‐Soriano et al., 2019). This relationship between the support gained from quality relationships and the risk of
burnout instilled a motivation to establish quality relationships to ensure social support and enhance work-life balance.
The study also encouraged reflection on professional and personal growth by highlighting the need for improving conflict management. The study revealed that an increase in conflict in the workplace and practitioners showing negative attitudes towards each other indicated burnout factors, highlighting the need for medical workers to learn better strategies for conflict management. Gabriel and Aguinis (2022) explain the need for conflict management skills by revealing that employees in emotionally draining jobs are at a higher risk of conflict if they are poor at crisis management because such jobs lead to emotional exhaustion, which reduces their motivation to handle crises professionally. The study encouraged reflection on conflict management skills because the ability to manage crisis internally prevents outbursts that may lead to more extraordinary dilemmas with leaders and fellow workers, increasing burnout races. After significant reflection, learning conflict
management is seen as a way to reduce one’s vulnerability to burnout and as a strategy for preventing others from burnout by encouraging proper crisis management, which collectively leads to higher job satisfaction and emotional well-being among workers.
Biblical Perspective
The study also aligns with various biblical perspectives that align with the Christian worldview. The study defined burnout as mental and emotional exhaustion that results in decreased motivation and negativity. 20% of the interview participants used the term “overwhelmed” to describe their colleagues experiencing burnout, as exemplified by the response “Everyone was overwhelmed” from P6. 30% of the interview’s respondents mentioned being “unmotivated” as an indicative factor, as highlighted by P13’s statement that healthcare workers were “just not motivated really to do their job.” 40% of interview
participants also mentioned stress as a descriptive factor for burnout, which is confirmed by statements such as P15’s “Many of my nurse colleagues suffer from burnout. I noticed that
nurses began to be more stressed out at work.” These factors align with biblical perspectives on burnout, such as Moses’s case. Moses is a major figure who suffered from burnout, seeing that he experienced mental exhaustion and an intense feeling of being overwhelmed that prompted him to request death after asking God, “I am not able to bear all these people alone because it is too heavy for me. And if thou deal thus with me, kill me, I pray thee, out of hand, if I have found favour in thy sight; and let me not see my wretchedness.” (King James Version, 1611, Numbers 11:14-15). This highlights a connection between the theme of feeling overwhelmed in the study that recognized stress, lack of motivation, and exhaustion as characteristics of burnout, which are all recognized in Moses’s case.
Also, the study’s recommendation for training to teach healthcare workers self-care and coping strategies aligns with the biblical perspective that rest is essential for professionals. Elijah’s experiences as a prophet reveal the importance of rest and self-care after he met his breaking point after journeying in the wilderness for a whole day, which was an exhaustive task that led him to ask God to die (King James Version, 1611, 1 Kings 19:5-7). According to the Bible, “an angel touched him, and said unto him, Arise and eat. And he looked, and behold, there was a cake baking on the coals and a cruse of water at his head. And he did eat and drink and laid him down again. And the angel of the LORD came again the second time, and touched him, and said, Arise and eat; because the journey is too great for thee” (King James Version, 1611, 1 Kings 19:5-7). This aligns with the study’s findings that self-care and finding a work-life balance are essential to preventing burnout. This is affirmed by the angel recommending rest and eating, which Elijah had neglected as he pursued his
God-given journey in the wilderness. The response from P17 that “Nurses worked longer hours, sleep deprived,” highlights that healthcare workers neglected essential elements of
self-care such as rest and sleep. Also, P11 stated, “I think I feel that the nurses work long hours, and it kind of made them more susceptible to burnout before the pandemic because of their long work hours and short breaks.” These responses and findings indicate that healthcare workers and Elijah neglected self-care and overworked themselves, leaving them feeling overwhelmed and exhausted.
The study’s recommendation on the need for leaders to protect their employees from burnout by intentionally establishing a supportive work environment aligns with the biblical perspective on servanthood in leadership. Jesus showed his support for servanthood as part of good leadership when he washed his disciples’ feet (King James Version, 1611, John 13: 12-15). The Bible states, “So after he had washed their feet, and had taken his garments, and was
set down again, he said unto them, Know ye what I have done to you? Ye call me Master and Lord: and ye say well; for so I am. If I then, your Lord and Master, have washed your feet; ye also ought to wash one another’s feet. For I have given you an example, that ye should do as I have done to you “(King James Version, 1611; John 13: 12-15). These verses support the Christian view that leaders should seek to support their teams as a way for leaders to lead by example, which is seen in how Jesus urged the disciples to showcase the same level of support and humility towards each other. The study recommends similar actions by leaders by affirming that healthcare workers need better support from leaders through role clarity, effective policies, adequate resources, and proper communication.
Summary of Section 3
Finding a link between high levels of burnout among healthcare workers during the COVID-19 pandemic and leadership was the aim of the study. The study’s conclusions provided valuable insight into the issue of burnout among healthcare employees. One of the study’s key conclusions is that burnout is commonly defined in the healthcare industry as a c
combination of poor energy, stress, disengagement, and lack of desire. The survey also discovered that complaints regarding the safety procedures in place came from healthcare professionals. The remark that leaders had failed healthcare professionals during the pandemic by not implementing policies that promoted a positive work environment and by not allocating the funds required to provide services was another finding. The study also discovered that the participants’ top suggestions for addressing burnout included recruiting more staff, fostering communication between leaders and employees, offering support to healthcare professionals, and ensuring leaders pay attention to their employees. A critical finding from the study is that leaders and healthcare professionals should work together to find solutions to burnout. Additionally, the data supports the notion that supportive leadership has to be given top priority in the healthcare industry to guarantee that leaders actively participate in recognizing the requirements of healthcare professionals and putting recommended solutions into practice.
The study has encouraged significant reflection on the need for personal and professional development as the primary strategy for eradicating burnout among healthcare workers and other professionals. A substantial area of professional growth as a scholar is improved skills in conducting research based on the recognition of the professionalism and privacy standards that researchers need to uphold in every study. The researcher has undergone immense professional growth as a scholar concerning research documentation,
made possible by the constructive feedback and support offered by professors and supervisors. The researcher experienced tremendous growth from this study.
The researcher has improved in sharing and documenting areas of development, learning conflict management, and establishing quality relationships to reduce one’s risk of burnout. Learning conflict management benefits the person and their workmates by ensuring that crises are adequately handled, reducing vulnerability to burnout arising from emotional stress and exhaustion at the workplace. Establishing quality relationships is also essential for personal and professional growth because it ensures a person has quality support systems they
can rely on for emotional and mental support for coping with stress. Also, reflecting on the study’s findings highlights that the research’s conclusions align with various biblical perspectives. The definition of burnout as a sense of exhaustion and feeling unmotivated is presented by the case of Moses requesting to die after feeling overwhelmed by handling the Israelites (King James Version, 1611, Numbers 11:14-15). The need for self-care, rest, and work-life balance is also emphasized by Elijah’s case of feeling overwhelmed, which prompted an angel to make him sleep and eat (King James Version, 1611, 1 Kings 19:5-7). Also, the importance of leaders catering to the needs of employees and offering their support is highlighted by the servanthood displayed by Jesus when he washed his disciples’ feet (King James Version, 1611, John 3:12-15).
Summary and Study Conclusions
The purpose of the case study was to investigate leadership’s impact on healthcare workers’ vulnerability to burnout. The study was guided by the goal of providing adequate recommendations for change that can be used to improve the experiences and performance of the healthcare sector by actively reducing the vulnerability to burnout among healthcare
workers. The focus of the study was the healthcare workers and leaders in the southeastern United States, which was established from the recognition of a research gap on the impact of
leadership practices on the notable increase in burnout among healthcare workers during and after the COVID-19 pandemic.
The research applied a flexible research design, which was achieved through methods such as interviews for qualitative data collection. Additionally, the researcher administered surveys to the participants for data triangulation. A total of 20 participants were included in the study who participated in the physical interviews that were recorded and transcribed for data analysis. Overall, all anticipated themes for the study were affirmed by the findings where four themes emerged; feeling overwhelmed being a common factor used to describe and identify burnout, having a poor work environment as a causative factor for burnout, lack of support from leaders as a source of burnout vulnerability, and employee empowerment as the suitable solution to eradicating burnout.
90% of respondents to the survey and interviews said that the high rates of burnout among healthcare professionals were the fault of the leaders. More than 95% of survey participants stated that burnout was more common among healthcare professionals than it was among persons in other professions. Conversely, the results of the interviews revealed that 90% of the participants believed that their vulnerability to burnout was influenced by the type of job that healthcare professionals undertook. Compared to the majority of interviewees, thirty percent of survey participants disagreed that experience level had any influence on a person’s vulnerability to burnout. The participants also stated that they believed leadership and management were to blame for the high levels of burnout among healthcare workers prior to and during the pandemic, with just 10% disagreeing on the impact of leadership on burnout rates.
The findings, paired with the exhaustive literature review conducted by the researcher, indicate room for change among leadership in the healthcare sector. The research
The research addressed the gap in the impact of leadership during the pandemic, revealing that leaders need to take an active approach to dealing with healthcare workers. The study supports changes to leadership styles, communication, and support levels issued by leaders to ensure healthcare workers feel empowered and in a conducive work environment as a strategy to reduce burnout.
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Appendices
Appendix A: Interview Guide
Interview Questions
Part One – Warm-Up Questions
How long have you worked in healthcare?
What is your role in healthcare?
Part Two – Prevalence of Burnout in Healthcare among Nurses
Can you attest to some of your nurse colleagues suffering from burnout?
If yes, what indicating factors did you notice?
Why do you think nurses were more susceptible to burnout before the pandemic?
Do you think nurses were more affected and vulnerable to burnout during the COVID-19 pandemic?
Part Three: Leadership Failures
How have the leadership policies and procedures in place impacted healthcare providers and especially during the COVID-19 outbreak?
How do you think leadership has contributed to the responses towards professional burnout among healthcare workers?
Do you believe that leaders should adjust their systems and structures to advance workforce health statuses amidst pandemics?
Part Five: Management and Administration
What do you believe are the policies and practices that seem to expose care providers to professional burnout?
Do you agree that the leadership level has a key role in shaping the working environment and ensure employees deliver optimal results?
What are the strategic changes that can be made to salvage the situation currently and prevent such outcomes in the future?
Part Five: Proposed Solutions
Do you think the problem of burnout among healthcare workers is solvable?
What solutions do you think should be applied to help reduce burnout among healthcare workers?
Part Six: Wrap-up Questions
If you were a leader in healthcare, what would you do differently?
If you were given another chance at life, would you still work in healthcare?
Do you think your hospital’s administration and leadership are doing enough to protect its workers from burnout?
Appendix B: Survey Guide
I believe that Working in a healthcare setting directly correlates with professional burnout.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe that one’s profession in the healthcare sector has a relationship to professional burnout.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe that healthcare workers are impacted by professional burnout due to their level of experience.
Strongly Agree
Agree
Disagree
Strongly Disagree
On a scale of 1to 10, how strongly would you agree or disagree with the following statement: I believe that burnout is a core concept in the healthcare domain.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe that the health and well-being of nursing professionals lies on how well they are treated and managed by the top-leadership level.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe that these elements fit your description of burnout.
Feeling unmotivated, exhausted, non-energetic, and unwilling to perform your duties as a healthcare worker.
Wanting a promotion so bad
Being unhappy at work
An overall feeling of demotivation when handling daily routines.
Strongly Agree
Agree
Disagree
Strongly Disagree
How vulnerable do you think you are to burnout?
Extremely
Very Much
Slightly
Not at all
I believe that nurses and other care providers are responsible for developing burnout, considering that most people would argue that these should develop shock absorbers that allow them to adjust accordingly.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe that care providers have been exposed to professional burnout during the pandemic, please note that you can look at this from your own perspective.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe that nurses are more liable to burnout as compared to other professions in the healthcare industry.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe that nurses were most affected by higher burnout levels during the COVID-19 pandemic.
Strongly Agree
Agree
Disagree
Strongly Disagree
On a scale of 1 to 10, how responsible do you believe leadership is for the high rates of burnout among healthcare workers?
Extremely
Very Much
Moderately
Slightly
Not at all
I believe that management and administration contributed to burnout among healthcare professionals after the outbreak COVID-19 pandemic.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe burnout among healthcare workers is solvable.
Strongly Agree
Agree
Disagree
Strongly Disagree
I believe that leaders can address the burnout menace across their institutions.
Strongly Agree
Agree
Disagree
Strongly Disagree
October 25, 2023
Anita Whitehurst
Richard Roof
Re: IRB Exemption – IRB-FY23-24-359 COVID 19 Burnout Among Health Care Workers
Dear Anita Whitehurst, Richard Roof,
The Liberty University Institutional Review Board (IRB) has reviewed your application in accordance with the Office for Human Research Protections (OHRP) and Food and Drug Administration (FDA) regulations and finds your study to be exempt from further IRB review. This means you may begin your research with the data safeguarding methods mentioned in your approved application, and no further IRB oversight is required.
Your study falls under the following exemption category, which identifies specific situations in which human participants research is exempt from the policy set forth in 45 CFR 46:104(d):
Category 2.(iii). Research that only includes interactions involving educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures, or observation of public behavior (including visual or auditory recording) if at least one of the following criteria is met:
The information obtained is recorded by the investigator in such a manner that the identity of the human subjects can readily be ascertained, directly or through identifiers linked to the subjects, and an IRB conducts a limited IRB review to make the determination required by §46.111(a)(7).
For a PDF of your exemption letter, click on your study number in the My Studies card on your Cayuse dashboard.
Next, click the Submissions bar beside the Study Details bar on the Study details page. Finally, click Initial under Submission Type and choose the Letters tab toward the bottom of the Submission Details page. Your information sheet and final versions of your study documents can also be found on the same page under the Attachments tab.
Please note that this exemption only applies to your current research application, and any modifications to your protocol must be reported to the Liberty University IRB for verification of continued exemption status. You may report these changes by completing a modification submission through your Cayuse IRB account.
If you have any questions about this exemption or need assistance in determining whether possible modifications to your protocol would change your exemption status, please email us at irb@liberty.edu.
Sincerely,
G. Michele Baker, PhD, CIP
Administrative Chair
Research Ethics Office
July 13, 2023
Mr. Clayton Deese
Sentara Intemal Medicine
7401 Granby Street Norfolk, VA 23505
Dear Mr. Deese,
As a graduate student in the Business department at Liberty University, I am conducting research as part of the requirements for a Doctor of Strategic Leadership degree. The title of my research project is Covid-lQ Bumout among Health Care Workers, and the purpose of my research is to understand the inability of healthcare leaders in the Southeastern United States area to create and implement potential response measures for addressing professional burnout emerging from the COVID-19 pandemic.
I am writing to request your permission to contact members of your staff to invite them to participate in my research study. Participants will be asked to complete the attached survey/contact me to schedule an interview. Participants will be presented with informed consent information prior to participating. Taking part in this study is completely voluntary, and participants are welcome to discontinue participation at any time.
Thank you for considering my request. If you choose to grant permission, please respond by email to awhitehurst6@liberty.edu. A permission letter document is attached for your convenience.
Anita Whitehurst
Researcher
Sentara•
July 25, 2023
Clayton Deese
Office Manager
Sentara Internal Medicine
7401 Granby Street
Norfolk, Virginia 23505
Dear Amta Whitehurst:
After a careful review of your research proposal entitled Covid-19 Burnout among Health Care Workers, I have decided to grant you permission to access our membership list/contact our faculty,’staffothers and invite them to participate in your study.
Check the following boxes, as applicable:
( ) I will provide our membership list to Anita Whitehurst, and Anita Whitehurst may use the list to contact our members to invite them to participate in her research study.
(X ) I grant permission for Anita Whitehurst to contact the healthcare workers at this facility to invite them to participate in her research study.
( ) I will not: provide potential participant information to Anita Whitehurst but we agree to provide her study information to the healthcare workers on her behalf.
( ) I am requesting a copy of the results upon study completion and/or publication.
Office Manager
Sentara Internal Medicine