Relationship between job burnout and presenteeism in anesthesia nurses: mediating effect of psychological capital

Presenteeism has become an important global public health problem, which not only affects the physical and mental health of employees, but also has a negative impact on the operating efficiency and quality of the entire organization. In the medical field, as an important part of the medical team, nurses are significantly more likely to suffer from presenteeism than other occupations, and their presenteeism is particularly worthy of attention [1, 2]. This phenomenon has a direct correlation and urgency with the core goal of the National Nursing Development Plan (2021–2025) formulated by the Chinese health department, which is to improve the quality and level of nursing services [3]. This plan focuses on improving the quality and level of nursing service, strengthening the construction of the nurse team, optimizing the management and operation system of the efficiency of nursing resource allocation, so as to achieve the goal of high-quality development of nursing service.

Previous studies have shown that presences are affected by multiple factors, including personal characteristics (age, gender, marital status, and physical and mental state) and working conditions (department characteristics, organizational climate, work system, scheduling, and burden) [4]. Among them, psychological capital of nurses was negatively correlated with presenteeism [5], while job burnout was significantly positively correlated with it, that is, the degree of job burnout was deepened, and the rate of presenteeism was increased [6]. Although the relationship between job burnout and presenteeism has been confirmed, and the influence of psychological capital cannot be ignored, few studies have used psychological capital and job burnout as variables to explore their relationship with presenteeism, especially the potential mediating role of psychological capital between the two, which needs to be further explored.

Presenteeism is a condition in which employees continue to work even though their health productivity is impaired or because they are unable to focus on other things. Performance is a kind of duty, duty in office is not the phenomenon [7]. It is worth noting that compared with the explicit loss caused by the direct absence due to illness, the harm of recessive absence is more profound and widespread. Studies have shown [8, 9] that it not only directly leads to the decline of nursing quality, increases the risk of nursing errors and adverse events, and endangers the safety of patients, but also reduces the work efficiency of nurses, and reduces the happiness and sense of accomplishment that nurses can experience. In view of the particularity of nursing work, such as high intensity, resource strain, irregular work and rest, nurses are more likely to become a high incidence group of presences [1]. A multi-country study [10] of presenteeism found that it is common in nursing work (about 49%), and anesthesia nurses work much longer with anesthesiologists in a closed environment than other nurses, and are required to be ready to participate in the emergency treatment of patients at any time, which leads to high occupational exposure risk and psychological stress, threatening their physical and mental health [11]. This hinders the overall high-quality development of the nursing team. Therefore, it is still necessary to explore the factors that promote the occurrence of recessive absence of anesthesia nurses, so as to provide theoretical basis for nursing managers to adopt efficient strategies to prevent recessive absence.

Job burnout usually comes from individuals who are prone to feel defeat, fatigue, and pressure accumulation under the continuous action of external environmental adverse factors. When these negative feelings are not effectively relieved in time, it will lead to the exhaustion of physical and mental state [12]. It includes three dimensions: emotional exhaustion, depersonalization and low personal accomplishment. Studies show that emotional exhaustion in job burnout has a significant positive effect on presenteeism [13]. With the accumulation of negative emotions, work efficiency decreases significantly, and presenteeism occurs frequently [14].

The purpose of this study was to explore the relationship between job burnout and presenteeism in anesthesia nurses, and to explore the mediating role of psychological capital. The finding that job burnout had a positive impact on presenteeism was consistent with previous studies [6]. This empirical study also found that psychological capital mediates between job burnout and presenteeism, suggesting that psychological capital may play a protective role in alleviating the negative effect of job burnout on presenteeism. These findings have important implications for the well-being and productivity of anesthesia nurses, and measures need to be taken to improve psychological capital and reduce job burnout in this population.

In the present study, the total score of SPS was 18.96 (SD = 4.96), which was higher than the score in the study by Ren [32]. This difference may be attributed to the broad sample of our study, including a more diverse group of anesthesia nurses, who work in hospitals with high levels of daily work intensity and stress. This high-intensity work environment is likely to lead to a high rate of presences, which in turn affects the performance of presences. In 2018, the National Health Commission of the People’s Republic of China issued the Notice on the issuance of Opinions on strengthening and improving anesthesia medical services [33]. The introduction of the document has made the development of anesthesia nursing in China onto a new stage, and anesthesia nurses have become the right hand of anesthesiologists. Due to the particularity of the work in the department of anesthesiology, such as heavy work intensity, heavy responsibility, and complex interpersonal relationship, anesthesia nurses are more prone to recessive absence [34, 35]. In recent years, the work pressure of anesthesia nurses has increased, and the problem of presenteeism has become increasingly prominent. Hospitals and nursing managers should attach great importance to it. To address this, healthcare institutions could establish comprehensive wellness programs that include physical and mental health screenings, counseling services, and fitness activities. These programs can help nurses identify and manage their health issues, thereby reducing presenteeism and improving overall job performance.

In terms of psychological capital, the score was 93.31 (SD = 14.33). Consistent with the results of previous studies [36‐38], this indicates that the psychological capital of anesthesia nurses is in a good state, which may be due to their relatively simple and orderly working environment, and under the professional guidance of anesthesiologists, they can actively and efficiently devote themselves to nursing work, so as to promote their positive and stable psychological state. The results of this study show that the score of self-efficacy dimension is the highest. The analysis showed that the subjects were mainly anesthesia nurses in from class iii grade A general hospitals. They have stronger skills, higher education, greater confidence, and exhibit higher self-efficacy [39]. The scores of other dimensions (hope, resilience and optimism) were at the same level, which indicated that nurses in anesthesia had a relatively positive attitude towards working status and future development, and had a relatively strong resilience to setbacks and pressures. Perhaps because nurse anesthesiologists play a crucial role during surgery and are responsible for ensuring the patient’s vital signs are stable, this professional nature makes their job more challenging and important [40]. At the same time, there is a close relationship between national policy and psychological capital of anesthesia nurses [33]. The relevant policies issued by China can significantly boost anesthesia nurses’ psychological capital through reasonable HR allocation, career paths, mental health focus, and job satisfaction improvements [41]. Therefore, nursing managers and medical institutions should improve the psychological capital of nurses by providing learning and training opportunities, paying attention to the training of anesthesia specialist nurses, creating a positive working environment, and providing mental health support.

The total score of MBI of anesthesia nurses in this study was 56.35 (SD = 17.67), had a higher level of job burnout than those in the previous study [42, 43]. The reason may be that anesthesia nurses work in the closed operating room, the equipment is noisy, and they have to deal with emergencies such as the mutation of vital signs of patients. High-pressure work is easy to cause physical and mental fatigue. With medical technology advancing, anesthesia knowledge and skills are continually updated, requiring nurses to continuously learn for complex clinical situations [44, 45]. This increases workload and academic pressure, tests adaptability, and raises the risk of burnout. This study showed that the low score of emotional exhaustion dimension may be attributed to a safe, comfortable work environment, adequate protection, and support, easing nurse pressure and emotional resource consumption [46]. Nearly half (43.8%) of the nurse anesthetists showed moderate to high depersonalization, which showed that they kept a certain distance from their surroundings at work, tended to be indifferent, and were more inclined to process operations rather than enthusiasm when performing tasks. A minority (18.5%) had a high level of personal fulfillment, which revealed a general trend in the nursing workforce, that is, the majority of members may tend to negative self-evaluation and have a certain degree of skepticism about the meaning and value of their work. Therefore, it is recommended that nursing managers reduce the workload of nurses, improve job satisfaction, and promote a healthy work-life balance. This may include providing adequate staffing, offering flexible work arrangements, and encouraging teamwork. Meanwhile, it is necessary to deepen the awareness of the importance of anesthesia nurses’ occupation and significantly improve their respect for their occupation through active publicity and education activities.

The results of correlation analysis showed a positive correlation between burnout and presenteeism in anesthesia nurses, supporting previous studies [47]. With the deepening of anesthesia job burnout, the negative emotions encountered by anesthesia nurses in the work are more and more significant, which leads to the decline of work efficiency and the decline of nursing quality, and then catalyzes the breeding of recessive absence [14]. It’s noteworthy that, despite limited exploration in past literature, psychological capital significantly impacts anesthesia nurses’ preseneeism. High-level psychological capital nurses exhibit greater work enthusiasm, commitment, stress resilience, and effective challenge handling [48]. This positive attitude boosts nurses’ health, strengthens professional identity, reduces burnout-related inaction, and controls recessive absence rate. By establishing a positive organizational culture, providing personalized psychological support, reasonably arranging workload, and strengthening communication and feedback, managers can effectively improve the level of psychological capital of anesthesia nurses, reduce the risk of recessive absence, so as to improve work efficiency and service quality.

The results of this study showed that job burnout and psychological capital were independent predictors of presenteeism. The results of path analysis showed that the indirect effect of job burnout of anesthesia nurses on preseneeism through psychological capital was 0.279, and the total effect size was 0.579, accounting for nearly half of the total effect (48.18%). This clearly reveals that job burnout is not only directly related to the phenomenon of recessive absence of nurses, but also indirectly through the mediating effect of psychological capital. This finding provides a clearer direction for hospital administrators to develop management strategies to alleviate nurses’ job burnout. Job burnout, a major haze in the field of nursing well-being, is often accompanied by mental health problems such as anxiety and depression [49]. To mitigate the impact of this phenomenon on the nursing team, health care institutions should focus on enhancing the psychological capital of nurses. As the core psychological factors, psychological capital is constructed from self-efficacy, hope, resilience and optimism [25]. Individuals with high levels of psychological capital exhibit a range of positive traits: confidence in the face of work challenges, pursuit of goals with hope, flexibility in adapting strategies to change, resilience in the face of adversity, and optimism in looking to the future [50]. Psychological capital acts as a mediator between burnout and presenteeism, influencing their relationship through complex processes. The mechanism can be summarized as: (1) Perception regulation: facing burnout triggers like workload or lack of achievement, hope, and optimism adjust how nurses see these negatives. By staying positive, nurses can lighten the burnout load and mitigate presenteeism [51]. (2) Self-efficacy boost: self-confidence and coping skills, bolstered by psychological capital, empower nurses to face burnout with proactive strategies-seeking help, altering work habits, or exploring new career paths. These strategies ease burnout and diminish presenteeism risks [52]. (3) Resilience fortification: resilience, a psychological capital element, fosters grit in adversity. It sharpens nurses’ ability to bounce back from burnout, rejuvenating work passion and steering clear of recessive presenteeism [53].

By constructing a rigorous structural equation model, this study further verified the importance and validity of psychological capital as a mediating variable. Especially in the medical field, when nurses face a similar degree of job burnout, individuals with high psychological capital can quickly adjust their self-state and effectively reduce the phenomenon of presences, highlighting their unique value in maintaining occupational health and improving work efficiency.

In summary, this study reveals links between burnout, psychological capital, and presenteeism, guiding future research. For anesthesia nurses, alleviating burnout and boosting psychological capital are crucial for individual well-being and efficient team building. Managers can tailor strategies to enhance team structure and occupational well-being, improving medical service quality.

This study had several limitations. Firstly, since the vast majority of female participants (92.3%) in this study, the conclusions may not be fully applicable to male anesthesia nurses. More men should be included in future studies. Second, due to the use of non-random/non-probability sampling and the limited sample area, caution should be used when generalizing the findings to the whole country. Future studies with larger scale and random sampling are recommended. Finally, the cross-sectional design limits inference of causality. In particular, the specific impact of job burnout on presenteeism has not been in-depth. In the future, longitudinal research can be conducted to further explore and put forward effective strategies to reduce job burnout and improve the psychological capital of anesthesia nurses.

This study found that there was a direct positive correlation between job burnout and presences of anesthesia nurses, and psychological capital mediated the positive effect of job burnout on presences to a certain extent. The significant mediating effect emphasizes the importance of psychological capital as a positive psychological state for anesthesia nurses to cope with work stress and maintain work enthusiasm and efficiency, because it improves nurses’ psychological resilience and reduces the recessive absence caused by job dissatisfaction or excessive pressure.