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BURNOUT SITUATIONS IN VARIOUS PROFESSIONS: A
BIBLIOGRAPHIC STUDY
PUSHPA KUMARI
Doctoral Research Scholar, GITAM School of Business, GITAM Deemed to be University, Visakhapatnam,
Andhra Pradesh, India. Email: pushpa043005422@gmail.com
Dr. RADHA RAGHURAMAPATRUNI
M.A Economics., M.B.A Int.Bus., PGDFT., Ph.D
Chairperson: BOS- Department of International Business, GITAM Associate Professor- Economics &
International Business GITAM Institute of Management, GITAM (Deemed to be University), Visakhapatnam,
Andhra Pradesh. Email: radharaghuramapatruni@gmail.com, dr.radhapatnaik@gmail.com, rraghura@gitam.edu
Abstract
Burnout has emerged as a severe occupational phenomenon amongst an active working section of people who are
subjected to prolonged work-related stress. Several types of research studies were done on this area from different
dimensions to determine the causes and situations in which it occurs. Several of them suggest potential changes
that employees and employers can use at their workplaces to achieve a sense of work-life balance and optimize
their performance at the workplace. This bibliographic research reviews some eminent work done in the area in
the year 2022. The topic and the study period are taken up owing to the opening up of all professions post the
COVID-19 pandemic. It was found that burnout occurs not just in working professionals but also in certain areas
like academics and even among the jobless. Several preventive strategies exist and are discussed for use by support
professionals such as human resources, psychologists, and others.
Keywords: Wellbeing, Moral Distress, Critical Care, Professional Performance, Job Burnout
INTRODUCTION
Burnout is a work-related syndrome resulting from the continuous subjection of an individual
to stress levels (chronic exhaustion), disruptive thoughts, depersonalization (Gatea et al., 2022),
chronic emotional exhaustion, interpersonal stressors, physical fatigue, cynicism, and negative
attitude toward work, and cognitive weariness. It is technically classified as a distinct
"occupational phenomenon" rather than a medical condition. Medical practitioners burnout has
become a global phenomenon (Shen et al., 2022), and that urgent action must be taken to
protect patients, physicians, and the health system (Weigl, 2022). The phenomenon exists
outside the medical profession too. Perhaps the most attention-seeking incident related to
burnout in recent times is the announcement of Jacinda Arden, who announced her resignation
from her post as the Prime Minister of New Zealand after having served the post for a tenure
of five and a half years. She cited burnout and said even politicians are human and give all they
can for as long as they can, and then it is time (to give up and reign) (Craymer, 2023).
Burnout is more prevalent in helping and supporting professionals who are exposed to
workloads and work stress – such as healthcare professionals, including physicians, dentists
(Radwan & Morsy, 2022), nurses (Zhang et al., 2022), midwives (Hadžibajramović et al.,
2022), critical care professionals (Kuriyama et al., 2022), medical residents (Dominguez-
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Espinosa et al., 2022) as well as from other work profiles such as policemen, firefighters (Dias
et al., 2022), correctional staff (Liu et al., 2022), flight attendants (Hu et al., 2023), volunteers,
amongst others (Khammissa et al., 2022). For example, health Care Workers (HCWs) risked
physical and psychological safety during the COVID-19 pandemic (Shechter & Norful, 2022).
The increased workload situation, as a result, has increased burnout levels (Parandeh et al.,
2022) for many. The immediate impact is decreased satisfaction, cynicism towards the
professional community, and work-life integration (Shanafelt et al., 2022). Of course, this is
not the same across all medical professionals. For example, an American Urologists
Association census showed that urologists did not feel COVID-19-related burnout though the
burnout levels in 2021 have increased by 14% compared to those in 2016 (Harris et al., 2023).
Similarly, natural disasters such as hurricanes and earthquakes with high levels and casualties
increase burnout because emergency plans do not consider social-emotional recovery factors
(Cannon et al., 2022). Not just workload but home confinement led to parents' burnout during
COVID-19, mainly when dealing with children with autism spectrum disorder (Kaba et al.,
2022).
Several studies on nurses during the first wave and second waves were conducted. For example,
one study on Italian nurses showed significantly high levels of emotional exhaustion during
the first wave and depersonalization levels during the second wave. On the other hand, no
significant differences were registered in the personal accomplishment sub-dimension between
the two waves of the pandemic (p = 0.108) and all the three burnout sub-dimensions by
referring to gender and work experience, too (Vitale, 2022).
OBJECTIVES OF THE STUDY
The key objective of this research activity is to understand the concept of burnout, its
prevalence in various professions, and its features and characteristics from the perspectives of
recent academic research work.
SIGNIFICANCE OF THE STUDY
The research is significant considering the increasing levels of burnout both in medical and
non-medical professionals, particularly after COVID-19-led lockdowns. The research work
done so far in the area paves the way to understanding the extent of the problem. In addition,
it can highlight the human resource teams in better planning work and ensure an optimal and
productive workforce at the institution.
LITERATURE STUDY
There are no standardized and internationally accepted diagnostic criteria for burnout. A wide
variation amongst the studies was observed regarding methodology, data presentation, criteria
of burnout assessment (burnout definition), and setting baseline criteria for cut-off points
(Sultan & Sultan, 2022). However, specific tools such as Copenhagen Burnout Inventory (C-
CBI), Shirom Melamed Burnout Questionnaire, Maslach Burnout Inventory (MBI), and
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Burnout Assessment Tool (BAT) are observed to be widely used for measuring burnout
(Hadžibajramović et al., 2022). There is no consistency in findings within the limited set of
tools available. Most of the studies used MBI, which is the closest in terms of measurement
methods defined by the World Health Organization (WHO). Of course, it is inconsistent with
other prevalence estimates to a vast extent (ranging from 2.8% to 85.7%) (McCammon et al.,
2022). Most researchers who studied the topic followed meta-analysis or systematic review
methods, while few followed narrative reviews in explaining the impending situation. Some
researchers used mixed methods (such as cluster analysis and quantitative analysis) (Bardhoshi
et al., 2022). Some studies used a combination of the Brief Symptom Rating Scale, six common
physical symptoms, and daytime dysfunction (a subscale of the Athens Insomnia Scale) (Hu et
al., 2023). Most studies that studied burnout and cognitive functions are cross-sectional, with
a few others being longitudinal studies (Renaud & Lacroix, 2023).
Some rare studies did a dairy analysis to study employees' immediate and dynamic responses
to stressors in various domains. Burnouts make individuals more sensitive to stressors, thereby
accelerating already-created damage. As a result, employees will have to put in more than
regular efforts to overcome the stressors, bringing burnout to normalcy (Fleuren et al., 2023).
Certain employers, such as in the armed forces, can use these research findings to determine
how personal negative news (stressors) be passed to their personnel during fieldwork.
RESEARCH GAP
While much research on the topic has already been done so far, the current research work
attempts to summarize the work that happened in the areas of burnout in the year 2022.
RESEARCH METHODOLOGY
The study uses bibliographic analysis of the research work done by various researchers in the
area of burnout. It follows the PRISMA method and Systematic Literature Review (SLR)
literature review method. The structure of the bibliographic analysis is shown in Figure 1. The
research databases for this study are Scopus, Science Direct, Google Scholar, and Semantic
Scholar. Only published research work in the year 2022 (including those that got spilled and
published in early January 2023) are considered for this review.
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Figure 1: Literature Review using PRISMA Method & SLR
DISCUSSION
Features and Characteristics of Burnout Situation
Burnout comes in three phases: emotional exhaustion (EE), depersonalization (DP), and
professional achievement dissatisfaction (PA). EE had a significant negative correlation with
the supervisor's support. Self-efficacy, hope, optimism, and resilience had a significant negative
correlation with DP and a significant positive correlation with PA. (Bafei et al., 2023).
Some close similarities to a burnout situation include a feeling of overwhelming emotional
exhaustion, cynicism, detachment from the job, defined as depersonalization, and a sense of
ineffectiveness and little personal accomplishment. Burnouts lead to impairments in memory,
attention, and executive functions. The degree of impairment varies over time (Renaud &
Lacroix, 2023). Physician burnout is associated with poor function and sustainability of
healthcare organizations. There are direct and indirect consequences.
1. Direct consequences: It leads to a poor professional engagement, unprofessional
behavior, thoughts of dropping out, leads to career disengagement and reduced
commitment, increased turnover, and even absenteeism and depression (Elliott et al.,
2023; Han et al., 2019)
2. Indirect consequences: It reduces the quality of patient care and suboptimal performance
(Alshreem et al., 2022).
Researchers feel that the root cause of burnout was the dysfunctional workplace environment
and poor clinical environments. Sometimes, this is because of increased workload and work
intensity because of insufficient medical staff. Hence healthcare organizations are
recommended to spend more to mitigate physician burnout across specialties, particularly in
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emergency medicine and for physicians in training or residency (Hodkinson et al., 2022). In
addition, education level, health condition, and monthly income influenced burnout factors.
Mindfulness-based interventions (Couser et al., 2022), personalized music intervention
(Matthew et al., 2022), and physical activities such as sports practice (for about 3 hours per
week) (Melguizo-Ibáñez et al., 2022) reduce emotional exhaustion and then improve their
wellbeing. In addition, studies showed that physical activities protect employees from adverse
outcomes but reverse the cardiovascular risk (Atad & Toker, 2023).
A stronger overcoming adversity identity is associated with interpersonal, intrapersonal, and
intellectual character enrichment. This character enrichment, in turn, is negatively related to
Burnout (Beetz, 2022). The intensity is different in different countries (Khammissa et al., 2022)
and between different grades of professionals. For example, palliative nurses have higher
burnout than general nurses (Zhang et al., 2022). Age and the size of the hospital/unit are found
to be significantly associated with burnout and the quality of life of pediatric nurses (Khatatbeh
et al., 2022). Similarly, high differences in burnout exist depending on specialty and sub-
specialty (Nugent et al., 2022).
Research on midwives found that burnout in them is dynamic and affects individual midwives
differently, depending on individual coping abilities and demographic and contextual factors.
It was found that self-awareness and basic self-care skills go a long way. Midwives with a high
level of commitment can reduce burnout at an individual level (Doherty & O'Brien, 2022).
The quantum of time spent at the workplace has an impact on the burnout levels of the
employee. For example, hospice nurses treating terminally ill patients might suffer from more
work-related stressors than other nurses because of their exposure to suffering, death, and grief.
Those nurses working for more than 8 hours per day and caring for more than ten patients the
previous month are found to be more vulnerable (Shi et al., 2023). The research highlights the
need to make the employees for the right time and not overstretch them.
As many as 77.7% of ICU nurses experienced workplace violence, male and staff nurses and
nurses with lower professional titles and shorter working years have greater odds of
experiencing this violence (T. Wang et al., 2022). In addition, nurses experiencing workplace
violence had 2.13 and 2.25 times higher odds of reporting post-traumatic stress disorder
(PTSD) and burnout than those without (J. Wang et al., 2022). Controlling burnout, bullying,
and workplace bullying, improving the work environment of nurses, and increasing job
satisfaction can reduce depression (Chowdhury et al., 2022).
Reasons for Burnout situation
Taiwanese medical professionals felt sleeplessness, lack of exercise, and stress due to one's
workload were all found to be risk factors for an increase in personal burnout levels. In addition,
being a nursing staff member at a younger age, sleeplessness, and lack of exercise were risk
factors for increased work-related burnout levels (Chu et al., 2022).
Person-career misfit (as seen in salespeople, for example) is a form of role stress and has
burnout implications (Tanner et al., 2022). This has severe implications and highlights the role
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of professional services in the Human Resource Department in finding the right candidate for
the right job to avoid potential misfits at the workplace. This can save a lot of time, effort, and
productivity regarding resource management in an organization.
While much of the research on the topic was a job in the context of work-related pressures,
some exciting research explored the possibility of a lack of a job (unemployment) as a reason
leading to stress. Exhaustion, Disengagement, Effectiveness in job search, and Disillusion are
the four dimensions from the perspective of psychosocial effects of job search (Nonnis et al.,
2023).
Employer perspectives
Keeping an eye on the health conditions of their employees is essential for employers because
it will eventually affect employer performance and their life satisfaction and, thereby,
organizational productivity. How employees treat and behave with customers will be linked to
their stress levels. For example, stressed employees will not have the patience to respond to
employees politely, thereby impacting customer satisfaction levels. Safety and accuracy of data
reporting will be more important in workplaces where critical levels are to be maintained.
Therefore, employers must educate their employees on burnout by using proper work
management practices and ensuring they do not fall into the situation (Khodadoost et al., 2023).
Employers should incorporate a mechanism in which adverse outcomes at the workplace can
be reported (Jarrar et al., 2023). This can give a lead about what changes to the workplace to
make it look less stressful, more organized, and more enjoyable. Ergonomic professionals can
be engaged to make the workplace a comfortable, relaxing, and conducive atmosphere. The
human resources division can study the working patterns of its employees and periodically
make suggestions to the employees' managers before a burnout situation arises. HR
professionals can help employees in conflicts at work or when the employees are dissatisfied
with work-life balance (Harris et al., 2023). In some cases, simulation training based on critical
situations exposure appeared to be showing positive and rapid effects on stress, anxiety, and
burnout, as per research conducted on a sample of anesthesia and critical care staff (Couarraze
et al., 2023). Small, subtle changes can bring profound improvement in the organizational work
culture and mitigate burnout (Smith et al., 2023).
Burnout in Enterprises
Job Demands-Resources (JD-R) theory is popular in studies related to occupational motivation
and stress. The theory focuses on reducing adverse outcomes (such as burnout) and improving
positive outcomes. For example, on average, entrepreneurs show less job burnout than
employed individuals; solo entrepreneurs, in particular, exhibit the lowest risk among all
entrepreneurs (Obschonka et al., 2023).
There has been a steep rise in digital enterprises after the COVID-19 pandemic. However, some
of these entrepreneurs could become prone to burnout syndrome owing to role and business
model (Silva & Abreu, 2022).
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Burnout in Educational Institutions
Teachers with persistent turnover intentions had an increased risk of becoming alienated from
the professional community and developing Burnout (Räsänen et al., 2022). Studies showed
that school principals are given immediate ongoing feedback that allows them to monitor
critical constructs such as job demands and sources of stress compared to those who do not get
the feedback (Marsh et al., 2022).
Implicit measures tested using Implicit Association Test and Relational Responding Task done
on teachers teaching in ethnic schools found that implicit attitudes predicted teachers' burnout.
It was further found that explicit prejudice was low and did not predict burnout. The researchers
highlighted the need to investigate how exactly the implicit aspects lead to the development of
burnout among teachers (Costa et al., 2023).
Burnout in Sports
School burnout levels of non-athlete students are higher than those of athlete students. There
is no significant relationship between athletes and self-regulation. The school burnout levels of
athlete students who work out for 1-4 months and 9-12 months during the year are higher than
those who work out for 5-8 months. On the other hand, female students' self-regulation levels
are higher than males. The self-regulation and school burnout levels of the participants did not
show a significant difference depending on their age (Yıldırım & Koçak, 2022). A systematic
review of the literature showed athlete burnout to be associated with increases in adverse
mental health outcomes and declines in positive mental health outcomes. However, research
evidence for an association between athlete burnout and physical health outcomes was mixed
(Glandorf, 2021).
Academic workload predicted burnout, and burnout, in turn, predicted various adverse
outcomes. This highlights the need for sports educators to keep a close eye on the healthcare
of their athletic students and recommends that their academic peers make appropriate load-
related adjustments so that the students do not suffer burnout (Elliott et al., 2023).
Prevention of Burnout
According to research, developing extraversion, agreeableness, and conscientiousness should
be part of medical students and residents' burnout prevention and treatment plans (S. Wang et
al., 2022). Social support reduces burnout and improves resilience, as was seen in the case of
palliative nurses in Chinese (Zhang et al., 2022). Fair and supportive leadership was found
against burnout in policemen (Sørengaard & Langvik, 2022). Various burnout researchers
recommend providing areas for recreational activities, a food court with healthy food options,
providing psychologists/counselors for physicians in each department, and wellness activities
that can be beneficial in the future (Singh et al., 2022). Human Resource Professionals should
suggest a good work-life balance for their employees so that burnout situations can be
prevented.
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CONCLUSION
The core objective of this research work is to provide an organized synthesis of the current
state of academic research on professionals from various fields. While a lot of research work
is already done this year, the scope of the present research is confined to the year 2022 to get a
comprehensive view of the post-COVID-19 pandemic era. Observing the works done by the
researchers, the core areas of study within the concept of burnout are emotional exhaustion
(EE), depersonalization (DP), and professional achievement dissatisfaction (PA). Survey and
cross-sectional studies done by several researchers mostly categorized their works on these
dimensions. The studies have recommendations for all stakeholders, including the subjects
(professionals or patients), administration (such as management at offices and workplaces),
and support professionals (human resource professionals at workplaces, counselors,
psychologists, and psychiatrists, amongst others). There are profound changes that are to be
made at the workplace, and the style of working by the subjects and the administration has to
make changes to the workspace to be less stressful to avoid burnout situations.
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