Burnout Among Physical Therapists

Transcription

1 urnout Among Physicl Therpists NEIL D. SCHUSTER, DAVID L. NELSON, nd CAROLYN QUISLING urnout results in decrese in job performnce becuse of excessive workrelted stress. This study ssessed the presence of burnout mong physicl therpists nd determined if potentil orgniztionl nd personl cuses of burnout could predict symptoms of burnout. One hundred nd sixty therpists surveyed ntionwide met the estblished criteri for inclusion in the study; 4 (53%) stted tht they were currently experiencing feelings of burnout. Subjects were sked to respond to the frequency of their symptoms of burnout nd the relevncy of the list of potentil cuses. A stndrd multiple regression eqution ws completed on ech of the five dependent vribles (symptoms) predicted by the eight potentil cuses of burnout, four of which were orgniztionl in nture nd four of which were personl in nture. our out of the five symptoms of burnout were significntly predicted by different potentil cuses. urnout experienced by physicl therpists cn hve detrimentl effect on ptients, therpists, nd the fcilities in which they re employed. Key Words: Occuptionl stress, Orgniztion nd dministrtion, Physicl therpy. In the workplce, short-term coping mechnisms re used to reduce stress temporrily, but over long periods of time, these cn dversely ffect the worker. 1 The normlity or bnormlity of rections to stress depends on the coping mechnisms the person develops. 2 One coping mechnism tht cn result in long-term dverse rections is clled burnout. urnout occurs when people hve reched stte of physicl nd mentl exhustion leding to loss of energy, drwing wy from their jobs, grdul loss of productivity, nd decrese in cring bout their jobs. 3 urnout hs mny definitions. Webster's dictionry defines it s verb mening "to fil, wer out, or become exhusted by mking excessive demnds on energy, strength, or resources." 4 Others hve defined burnout s "pinful debilitting response to work pressures." 5 In the helth professions, Wolfe defined burnout s the experience of emotionl nd physicl exhustion together with strong feelings of frustrtion nd filure. 6 The individul demonstrtes negtive ttitudes by loss of concern for the ptient nd withdrwl from work. Mttingly stted tht people who re suffering from burnout might feel overwhelmed by the sitution nd unble to cope with it Such people my begin to question wht they re doing nd whether they re ble to perform up to the employer's expecttions. Reed described burntout workers who Mr. Schuster is Assistnt Professor of Physicl Therpy, University of New Englnd, iddeford, ME (USA). This study is bsed, in prt, on Mr. Schuster's thesis completed in prtil fulfillment of the Mster of Science Degree t Srgent College of Allied Helth Professions, oston University, oston, MA. Dr. Nelson is Assistnt Professor of Occuptionl Therpy, Srgent College of Allied Helth Professions, oston University, oston, MA Ms. Quisling is Assistnt Professor of Occuptionl Therpy, Srgent College of Allied Helth Professions, oston University. This study ws funded, in prt, by grnt from the Dudley Allen Srgent Reserch und. This rticle ws submitted June 22, 193; ws with the uthors for revision three weeks; nd ws ccepted November 2, 193. showed poor cceptnce of coworkers who did not strive to chieve the best for their clients. The literture suggests tht burnout might be exhibited in mny wys: incresed bsenteeism, physicl ilments, nd rpid turnover in stff. All these fctors cn ffect the efficient opertion of n institution. If burnout is llowed to continue, it cn result in dngerous sitution for the worker nd those worked with. 9 Members of mny professions experience burnout. Discussing burnout in techers, Reed stted tht lthough burnout is not new in teching, the frequency of techer burnout is incresing. The Ntionl Eduction Assocition reported tht greter numbers of techers re leving their creers erlier. In child-cre socil workers, burnout is lso very prevlent. As Mttingly reported in n rticle on stress nd burnout in child-cre workers, mny qulified workers leve the field or lose their effectiveness becuse of job-relted physicl nd emotionl stress. 7 urnout cn cuse the cse workers to feel indequte for the jobs tht confront them, nd they my not shre their feelings of indequcies with their coworkers until long period hs pssed. 7 In ddition to techers nd child-cre workers, helth-cre professionls lso experience burnout to n incresing degree. 5 urnout mong nurses hs been ddressed in n bundnce of literture. Typicl problems such s low slries, poor hours, inflexible schedules, nd low prestige hve ll been cited s possibly influencing burnout in nurses. 10 Studying burnout mong occuptionl therpists, Quisling developed "burnout inventory" relting dministrtive, orgniztionl, nd personl chrcteristics to perceived level of burnout. 4 The study smple included 42 occuptionl therpists residing in the northestern United Sttes. The results showed tht burnout symptoms re interrelted, nd tht s the level of burnout increses, so does the frequency of symptoms reported. urnout ws present in the mjority of occuptionl therpists smpled nd ws most frequently ssocited with "decresed self-worth, morle chnges, loss of mening, nd thoughts of job chnge." 4 Volume 64/Number 3, Mrch

2 Although forml study hs not been done in physicl therpy settings, burnout my lso be n occuptionl hzrd in this profession. In n rticle on burnout in physicl therpy, Wolfe stted tht burnout must be considered becuse this syndrome cn ffect the therpist, the cre of the ptient, nd the institution in which the ptients re cred for. 6 urnout in physicl therpy my be the result of similr problems found in other professionl groups. Therpists my come to lck the feeling of ccomplishment when ptients do not chieve stted gols. When these gols re not met, therpists might feel s though they hve filed. Other fctors in physicl therpy burnout, s reported by Wolfe, re relted to the work sitution, including fctors such s low slries, rigid dministrtion, low prestige, nd the types of ptient seen most frequently. 6 Therpists my lso spek unkindly of ptient, become condescending, or overintellectulize sitution. 7 TALE 1 Predictors of Negtive Attitudes Towrd Others in the Workplce R = 0.76 R 2 = 0.5 Adjusted R 2 = 0.53 SE = 0.50 p < b The questions investigted in this study re the following: 1. How prevlent is burnout mong physicl therpists? 2. If burnout is present, wht symptoms do physicl therpists identify s indictors of their excessive stress? 3. If burnout is present, re there specific job-relted stress fctors tht predict burnout symptoms? 4. If burnout is present, cn physicl therpists identify how their ctions contribute to their own burnout? METHOD Subjects We surveyed ntionwide smple of 250 ctive members of the Americn Physicl Therpy Assocition. The nmes were generted from the APTA computerized miling list; the computer ws progrmmed to select every "nth" nme to chieve the smple size of 250. An initil miling with cover letter of consent ws sent to ll 250 subjects, nd subsequent miling ws completed three weeks lter to the nonrespondents. Ech questionnire ws coded by number. Questionnire The questionnire hd two prts. The first begn by surveying demogrphic dt (ge, yers s physicl therpist, longest time spent t the sme job, type of employment, nd primry function t tht job). The following criteri hd been estblished in dvnce for inclusion in the dt nlysis: fulltime employment with t lest 30 percent of time involved in direct ptient cre. The APTA members meeting the employment criteri were then sked if they currently experienced burnout bsed on the following definition: the temporry or permnent experiencing of physicl nd mentl exhustion plus notble diminished motivtion nd productivity s result of excessive commitments of energy, resources, nd strength. Our smple size ws determined by nticipting the number of those who would report burnout nd who would meet the employment criteri bsed in prt on the APTA ctive member profile completed in A high subjectto-predictor vrible rtio ws necessry to llow for pproprite sttisticl clcultions. If subjects did not meet these criteri, they were thnked for their prticiption nd urged to return their otherwise uncompleted questionnires. Those who reported burnout were requested to complete the second prt of the questionnire. The second prt of the instrument consisted of 52 items. Ech item surveyed the frequency with which the therpist experienced specified events, ttitudes, feelings, or thoughts on 5-prt Likert scle (lmost lwys, very often, often, occsionlly, nd rrely). The 52 items were broken down into three min ctegories: potentil symptoms of burnout (5), potentil orgniztionl nd professionl cuses of burnout (4), nd potentil personl cuses of burnout (4) (Tbs. 1-5). The items selected for the three min ctegories were determined through three fctor nlyses completed on the questionnire devised by Quisling in Ech fctor nlysis provided informtion on which items loded together nd which items were independent of ech other. To provide uniformity cross the 13 fctors generted, we selected four items for ech fctor. Within ech fctor, items were selected for inclusion on the bsis of how strongly they loded on the fctor (with minimum commonlity of.40) nd on the bsis of their independence from other fctors. This second prt of the questionnire ws intended to determine how well the potentil cuses of burnout could predict the five potentil symptoms of burnout. Dt Anlysis A stndrd multiple regression eqution generted by the Sttisticl Pckge for the Socil Sciences (SP) 12 ws completed on ech of the five dependent vribles (symptoms of burnout) s predicted by the eight potentil cuses of burnout. This sttisticl procedure ssessed the predictive vlue of ech potentil cuse of burnout fter the predictive vlues of the other seven potentil cuses of burnout hd been tken into ccount. Next, for ech dependent vrible (symptom of burnout), n overll regression eqution ws computed tht indicted whether ll eight potentil cuses combined predicted the vrible. p < PHYSICAL THERAPY

3 RESEARCH RESULTS Subjects One hundred ninety-six (7%) of the questionnires were returned. One hundred-sixty (2%) of the respondents met the estblished criteri for employment. Of the subjects in the specified criteri group, 4 (53%) subjects felt tht they were currently experiencing symptoms of burnout nd completed the reminder of the questionnire. The men ge of those experiencing burnout ws 32 yers, with stndrd devition of 7.7 nd rnge from 23 yers to 5 yers of ge; 65 percent were women nd 35 percent were men. The men ge of those in the employment criteri group but not experiencing burnout (n = 76) ws 33 yers, with stndrd devition of.7 nd rnge of 23 yers to 5 yers of ge; 62 percent were women nd 3 percent were men. The most frequent self-ctegoriztions of the burnout group were s follows: they hd been physicl therpists for five yers to nine yers (n = 29), they hd spent five or more yers t one job (n = 33), nd they were currently working in direct ptient cre treting 10 or more ptients dy (n = 55). As with the burnout group, the nonburnout group who met the other criteri for inclusion most frequently hd been physicl therpists for five yers to nine yers (n = 31), spent five or more yers t one job (n = 33), nd were involved in direct ptient-cre treting 10 or more ptients dy (n = 43). The primry type of fcility where the burnout group worked ws n cute-cre generl hospitl (n = 41). Twentytwo of the nonburnout criteri group worked in cute-cre generl hospitls, 22 worked in privte prctice, nd 21 worked in ll the other settings combined. Chi-squre nlysis indictes tht these proportions re significntly different from the proportions of the burnout group (χ 2 =.3, = 2, P <.05). Reltionship of Symptoms to Cuse TALE 2 Predictors of Physicl/Psychologicl Rections R = 0.66 R 2 = 0.44 Adjusted R 2 = 0.37 SE = 0.59 p < dependent vrible even fter ll the other vribles were considered (Tb. 4). When ll of the potentil cuses of burnout in the multiple regression eqution were combined, the eight vribles were significnt predictors of this dependent vrible. Avoidnce responses. No significnt indictors were found for voidnce response either by combining ll eight potentil cuses of burnout or on n individul bsis fter ll the other vribles were considered (Tb. 5) Negtive ttitudes towrd others in the workplce. Lck of professionl shring nd nd lck of fith in supervisors were significnt predictors of this dependent vrible even fter ll the other vribles were considered (Tb. 1). A unique inverse reltionship ws found in the vrible of overwork. In other words, lck of overwork predicted burnout. When ll of the potentil cuses of burnout in the multiple regression eqution were combined, the eight vribles were significnt predictors of this dependent vrible. Physicl nd psychologicl rections. On n individul bsis, there were no individul significnt predictors of burnout fter ll the other vribles were considered (Tb. 2). When ll the potentil cuses of burnout in the multiple regression eqution were combined, the eight independent vribles were significnt predictors of this dependent vrible. Disstisfction with the workplce. nd low self-esteem were significnt predictors of this dependent vrible even fter ll the other vribles were considered (Tb. 3). When ll of the potentil cuses of burnout in the multiple regression eqution were combined, the eight vribles were significnt predictors of this dependent vrible. Redirection of interests wy from the workplce. The fctor of excessive demnds ws significnt predictor of this TALE 3 Predictors of Disstisfction with the Workplce R = 0. R 2 = 0.47 Adjusted R 2 = 0.41 SE = 0.64 p < b 7.73 Volume 64/Number 3, Mrch

4 TALE 4 Predictors of Redirection of Interests Awy from the Workplce R = 0.55 R 2 = 0.30 Adjusted R 2 = SE = 0.54 p <.05. b p <.01. DISCUION Incidence nd Demogrphics of urnout b Of the subjects meeting the employment criteri, over onehlf (53%) identified themselves s experiencing current feelings of burnout. This lrge response demonstrtes tht burnout is problem tht hs importnt implictions within the physicl therpy profession. The subjects feeling burnout were similr to those not feeling burnout in terms of ge, experience, nd number of ptients treted dy, but they were not similr in terms of type of workplce. A greter number of the nonburnout group were working in privte prctice. We concluded tht the type of fcility in which person works my ffect the potentil for experiencing symptoms of burnout. Predicting the Cuse of urnout In this study, different symptoms of burnout tended to be predicted by different potentil cuses of burnout. Some symptoms were only predicted by combintion of potentil cuses; other symptoms hd highly significnt individul indictors; nd other symptoms were predicted both by the combintion of potentil cuses nd by individul fctors. As Cherniss stted, burnout is not relted to one potentil cuse but cn be ttributed to vriety of sources contributing to vriety of symptoms. 13 The symptom of negtive ttitudes towrd others in the workplce is strongly predicted by lck of professionl shring nd nd lck of fith in one's supervisors. According to Scully, nurses re lso fced with lck of professionl shring nd lck of fith in the orgniztion's ledership. 14 Scully suggested tht nurses often must direct their energies towrd stisfying physicins' needs rther thn striving to chieve the best for their ptients nd tht these fctors often result in negtive ttitudes mong nurses. orsyth nd Cmdy stte tht pproprite nd discussion sessions mong supervisors nd nurses llows nurses to feel s though they hve voice in importnt mtters within the fcility. 15 Like nurses, physicl therpists must be ble to shre thoughts nd concerns with peers. Mechnisms should exist for therpists to seek suggestions from coworkers in unusul ptient tretment situtions. To mintin professionl ttitude mong the stff bout their jobs, fcility must estblish good system. The inverse reltionship found between overwork nd negtive ttitudes towrd others in the workplce indictes the possibility tht feelings of frustrtion cn result when therpist's bilities re not fully used. If therpists re not fully involved in their jobs, they my begin to get frustrted with others. 16 TALE 5 Predictors of Avoidnce Responses R = 0.43 R 2 = 0.1 Adjusted R 2 = SE = In predicting physicl nd psychologicl rections to burnout, we found tht the combined potentil cuses of burnout do significntly predict this symptom. As Ptrick discussed in relting burnout to helth-cre workers, number of interrelted resons my cuse someone to rect physiclly or psychologiclly to excessive stress. 17 Psychosomtic nd psychologicl dysfunctions becuse of excessive stress re probbly cused by n interction of different fctors nd not by specific type of stressor. Therpists with these symptoms of burnout might be urged to consider how severl different orgniztionl nd personl sources of stress re creting their problems. In ssessing the symptom of disstisfction with the workplce, the significnt individul predictors of this symptom were low self-esteem nd orgniztionl dysfunctions. As Wolfe stted in discussing burnout in physicl therpy, primry fctor of burnout ppers to be n inbility of the therpists to feel successful with their ptients. 6 A number of problems cn result in the ptient not meeting estblished gols. Therpists with low self-esteem my ssume tht the 302 PHYSICAL THERAPY

5 RESEARCH lck of ptient progress is result of their own deficiencies rther thn result of other fctors. 6 In ddition to low selfesteem mong therpists, orgniztionl dysfunctions tend to increse the likelihood of disstisfction with the workplce. As roski reported, the demnds from the hospitl dministrtion nd the personl desires of the helth-cre professionls my differ. 1 This difference cretes high stress sitution tht needs to be responded to before burnout symptoms occur. It is importnt to be wre of the potentil res within the dministrtive frmework of the fcility tht my frustrte therpists. Administrtive stff should ensure tht therpists re wre of the rtionle of policies within the fcility. In ssessing the symptom of redirection of interests wy from the workplce, we found tht excessive demnds significntly predict this symptom. Mttingly discussed burnout relted to child-cre socil work nd rgued tht the excessive mount of work plced on socil workers cn be highly stress producing. 5 Mny dedicted child-cre socil workers leve their profession or become less effective in their jobs becuse of the intensity of the stress. 7 Ptrick stted tht helth-cre workers tend to focus their interests on other res if the demnds of sitution crete excessive stress. 17 In ssessing the symptom of voidnce responses, we found no significnt predictors of this fctor either in combintion or individully. This finding suggests tht therpists void the work sitution for other resons besides those tht cn be relted to burnout. Perhps, in fct, voidnce responses, which hve been conceptulized in this study s symptom of burnout, re, in fct, coping mechnisms tht tend to counter potentil cuses of burnout. Similrities nd Limittions The potentil cuses nd symptoms of burnout re similr within the vrious helth professions (physicl therpy, occuptionl therpy, nd nursing). All three professions report symptoms of disstisfction with the workplce, negtive ttitudes towrd others in the workplce, nd physicl nd psychologicl rections. Shubin 19 discussed number of these fctors s relted to nursing, nd Quisling 4 determined these fctors to be significnt in her survey of occuptionl therpists. urnout is not, therefore, unique to one profession. ecuse the nture of burnout is similr cross professions, common strtegy for eliminting or decresing burnout might be pplied. urther reserch using control situtions might identify the similrities nd differences in burnout between professions. urther reserch might lso investigte the effects of different intervention progrms designed to decrese burnout. In ssessing burnout in physicl therpy, this study my hve limittions becuse the subjects were ll members of the APTA. Not ll physicl therpists re members, nd the therpists involved in the APTA my not be entirely representtive of ll physicl therpists. or exmple, non-apta members my experience burnout in even higher numbers thn APTA members. Another potentil limittion of this study is its relince on multiple regression methodology, technique (s used in this study) tht is descriptive (predictive) rther thn experimentl (cusl). Multiple regression, s used in this study, cnnot identify cusl reltionships mong vribles. Multiple regression identifies ssocitive reltionships mong vribles, nd the predictions mde depend on theoreticl interprettions of wht the vribles men. In this study, the items mking up the eight predictor vribles were drwn from the theoreticl literture suggesting tht these fctors could predict burnout. CONCLUSION ifty-three percent of the surveyed therpists reported burnout; this problem needs to be ddressed within physicl therpy. Administrtors nd employees of fcility who cn identify the reltionship of burnout symptoms to cuses cn recognize potentil hzrds before they become insoluble problems. Intervention progrms should be estblished in high-stress situtions to ssist in lleviting the problem of burnout. If employees cn be educted to the potentil hzrds of burnout, the dnger of burnout cn be minimized. Along with educting employees, institution dministrtors must relize the importnce of designing pproprite methods of burnout intervention, such s exercise progrms, discussion groups, nd reevluting vction nd personl dy schedules. If burnout is llowed to exist in physicl therpist, detrimentl effects on the ptient, the therpist, nd the fcility in which the therpist is employed my result. REERENCES 1. ell J: Stressful life events nd coping methods in mentl illness nd wellness behviors. Nurs Res 26: , Sylvester R: Stress. The Instructor 6:72-7, Mslch C, Pines A: The burnout syndrome in the dy cre setting. 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New York, NY, McGrw-Hill Inc Cherniss C: Stff urnout: Job Stress in the Humn Services. everly Hills, CA, Sge Publictions, Scully R: Stress in the nurse. Am J Nurs 0: , orsyth DM, Cmdy NJ: Preventing nd lleviting stff burnout through group. Journl of Psychosocil Nursing nd Mentl Helth Services 19:35-3, Hrkson DG, Unterreiner AS, Sheprd K: ctors relted to job turnover in physicl therpy. Phys Ther 62: , Ptrick PS: Helth Cre Worker urnout, Wht It Is, Wht To Do About It. Chicgo, IL, Inquiry ooks, Publisher, roski DC: The job stisfction of llied helth professionls. J Allied Helth 7:21-27, Shubin S: urnout: The professionl hzrd you fce in nursing. Nursing 7 :22-27,197 Volume 64/Number 3, Mrch