Polish infection control nurses’ burnout in the context of cooperation of different hospital professionals during COVID-19 pandemic

Polish ICNs participating in this study just after the wave of infections related to the COVID pandemic, declared an average high level of burnout in the area of EE − 31, a low level in the area of DP – 5, and a low sense of PA − 24. In the study by Nowacka et al., the average EE score was 22.9, and the average PA score was 27.63. A value closer to the one found in our study was recorded in the area of DP: 6 points [ 7 ]. In the study by Szczerbińska et al. [8], the average values in the EE and PA areas were slightly lower than in the study by Nowacka et al., i.e. 18.82 and 26.68, respectively. This means that, according to the results of our study, ICNs presented a higher level of burnout compared to the cited research on a group of Polish nurses working in various types of departments [7 ], as well as compared to other groups of employees during the COVID-19 pandemic [ 8]. Lower EE scores than in our group of ICNs were also recorded by other authors: during the COVID-19 pandemic among ICU specialists – 18 [9], and before pandemic among trauma nurses − 23.8 [10] and among Chinese nurses − 23.95 [11]. At the same time, all cited authors also found higher indicators in the PA area, equaling 35, 35.31 and 32.46, respectively, while the DP indicators were closer to our results, i.e. 8, 6.72 and 6.63 [9‐11].

Lee et al. in a survey among 203 Korean ICNs indicate that work in the conditions of the COVID-19 pandemic, which involves greater effort and stress, significantly correlates with a higher level of burnout in this professional group and with higher turnover [12]. However, in Polish conditions, it turned out that the level of burnout during the COVID-19 pandemic was lower among doctors and nurses working directly with patients infected with the SARS-CoV-2 virus [8, 13] than among ICNs in our study. Therefore, it seems that the professional burnout of Polish ICNs is related to the work environment and difficulties in cooperation with various groups of hospital employees, including nurses and ward doctors. These difficulties were declared by ICNs both during and before the COVID-19 pandemic [1]. In a pre-pandemic questionnaire, only 31.6% of 253 nursing students concluded that ICNs enjoy due respect among the hospital staff. In fact, most of the staff perceive their work as a nuisance [14]. Our study showed a significant positive correlation between the level of difficulty in cooperation with doctors and the level of EE and decreased sense of PA. Zielińska- Więczkowska and Buśka showed that, according to 60% of the surveyed nurses, the factor disturbing proper cooperation at work is the stress felt by the nurse, the “main source of which (.) are doctors” [15]. Similar observations were also made by Puto et al. in a survey among nurses working in hospitals during the COVID-19 pandemic [13]. These authors noted lower EE values (on average 21.32 among nurses working with patients with COVID-19 and 21.81 working with patients without infection), higher DP (12.18 and 12.90, respectively) and lower PA values (18.99 and 18.88), but confirmed the correlation of these parameters with the characteristics of the work environment, i.e. lack of ability to make independent decisions and problems in relationships with colleagues. This problem is not restricted to Polish nurses and hospitals. Quesada-Paga et al. in a systemic review with meta-analysis found several studies with similar conclusions [16].

As mentioned above, in our study the median values of EE and PA were higher than in the cited studies among nurses working in wards and among doctors, both before and during the pandemic. Malinowska-Lipień et al. in a study among 1,509 nurses working in surgical and non-surgical departments of Polish hospitals, assessed the intention to stop working in the hospital depending on a number of factors and conditions, including the level of burnout [17]. The results of this study have indicated that occupational burnout is significantly higher among nurses expressing an intention to leave their jobs compared to those who did not declare such intentions, and the average burnout score in the three areas examined is:: EE, DP and PA: 32.01, 12.55 i 25.02 [17]. The median values for EE and PA in our study were close to the values correlating with nurses’ willingness to change jobs in the Malinowska-Lipień study.

These values were doubtlessly influenced during the pandemic by the higher workload and the additional challenges, as indicated by other authors examining this issue among ICPs, who should necessitate participation in ongoing training and readiness [18].

Of utmost importance in this case is the position in the hierarchy and the perception of the work of infection control nurses in Polish hospitals, related to the organizational culture. Polish hospitals are characterized by high power distance, masculine culture and a tendency towards centralized decision-making [19, 20]. In modern organizations, including hospitals, matching mutual requirements and expectations (including doctor-nurse relations) takes place on the basis of negotiation and agreement on individual counseling [21], and not by way of orders or decisions resulting from the organizational hierarchy. Inadequate organization’s culture may lead to burnout.

Our study did not find high rates of the depersonalization parameter, which reflects callous, impersonal treatment of others and decreased sensitivity. This parameter would be a more sensitive indicator of burnout in working with patients, which in the case of ICNs has a very limited significance. However, Tarcan et al. claimed EE to be the best indicator of burnout, comparing to DP [22].

The limitation of our study may be the lack of including any personal features of respondents, such as marital status, having children, religion, lifestyle, which may interfere with burnout. We included only some basic characteristic of respondents connected with workplace.