Burnout, Professional Commitment And Turnover Intention Among Nurses During COVID-19 Pandemic: A Cross-Sectional Study In The Second Year Of The Pandemic In Turkey

Öz

Aim: The aim of the research is to determine the relationship between burnout, commitment to the profession, and intention to leave work among nurses at the end of the second year of the COVID-19 pandemic. Method: This research employed a descriptive and correlational design. It was conducted in a pandemic hospital between April and May 2022 with a sample of 241 nurses. Data were collected using a Questionnaire Form, the Maslach Burnout Inventory (MBI), the Nursing Professional Commitment Scale (NPCS), and the Turnover Intention Scale (TIS). Descriptive statistics were used to analyze the nurses' demographic characteristics and their scores on the scales. Relationships between the MBI, the Nursing Professional Commitment Scale, and the Turnover Intention Scale were examined using Spearman’s correlation test, with statistical significance set at p < 0.05. Results: A very weak negative and statistically significant correlation was found between the total scores of the NPCS and the TIS. There was a weak negative and statistically insignificant correlation between the total scores of the MBI and the NPCS. Additionally, a very weak positive and statistically insignificant correlation was found between the total scores of the MBI and the TIS. Conclusion: It was concluded that as professional commitment increases, turnover intention decreases, and as burnout decreases, professional commitment increases and turnover intention decreases. It is recommended that nursing management develop practical solutions to identify and mitigate the risk factors negatively affecting burnout, turnover intention, and professional commitment in nurses, especially those on the front lines of the COVID-19 pandemic.

Anahtar Kelimeler

• profession commitment
• turnover intention
• COVID-19
• nurse
• burnout

COVID-19 Pandemi Sürecinde Hemşirelerde Tükenmişlik, İşe Bağlılık ve İşten Ayrılma Niyeti: Türkiye'de Pandeminin İkinci Yılında Kesitsel Bir Çalışma

Öz

Amaç: Araştırmanın amacı, COVID-19 pandemisinin ikinci yılı sonunda hemşirelerde tükenmişlik, mesleğe bağlılık ve işten ayrılma niyeti düzeyleri ile tükenmişlik, mesleğe bağlılık ve işten ayrılma niyeti arasındaki ilişkinin belirlenmesidir. Yöntem: Araştırma tanımlayıcı ve ilişki arayıcı tiptedir. Araştırma Nisan-Mayıs 2022 tarihleri arasında bir pandemi hastanesinde yapılmıştır. Örneklemi 241 hemşire oluşturmuştur. Veriler Anket Formu, Maslach Tükenmişlik Ölçeği (MTÖ), Hemşirelikte Mesleğe Bağlılık Ölçeği (HMBÖ) ve İşten Ayrılma Niyeti Ölçeği (İANÖ) ile toplanmıştır. Hemşirelerin tanıtıcı özelliklerinin ve ölçeklerden elde edilen puanların analizinde tanımlayıcı istatistikler kullanılmıştır. MTÖ, HMBÖ ve İANÖ arasındaki ilişki spearman korelasyon testi ile, anlamlılık p<0,05 düzeyinde değerlendirilmiştir. Bulgular: HMBÖ toplam puanı ile İANÖ toplam puanı arasında negatif yönlü çok zayıf düzeyde istatistiksel olarak anlamlı MTÖ ile HMBÖ toplam puanı arasında negatif yönlü zayıf düzeyde istatistiksel olarak anlamlı olmayan, MTÖ ile İANÖ toplam puanı arasında pozitif yönlü çok zayıf düzeyde istatistiksel olarak anlamlı olmayan bir ilişki belirlenmiştir. Sonuç: Araştırmada işe bağlılık artıkça işten ayrılma niyetinin azaldığı, tükenmişlik azaldıkça işe bağlılığın arttığı, tükenmişlik azaldıkça işten ayrılma niyetinin azaldığı sonucuna ulaşılmıştır. COVID-19 pandemisinde ön saflarda yer alan hemşireler üzerinde halen devam eden tükenmişlik ile işten ayrılma niyetlerine neden olan risk faktörlerinin ve mesleğe bağlılığı etkileyen faktörlerin belirlenip bu faktörlerin kötü etkilerini azaltmak için hemşirelik hizmetleri yönetimlerinin uygulanabilir çözümler geliştirmeleri önerilebilir.

Anahtar Kelimeler

• COVID-19
• hemşire
• tükenmişlik
• mesleğe bağlılık
• işten ayrılma niyeti

Destekleyen Kurum

YOK

Etik Beyan

Araştırmaya Nevşehir Hacı Bektaş Veli Üniversitesi Girişimsel Olmayan Etik Kurulu Başkanlığından 2022.03.13 karar numaralı etik kurul onayı alındıktan sonra başlanmıştır.

Teşekkür

Yazar araştırmaya katılan tüm hemşirelere araştırmaya katılımlarından dolayı teşekkür eder.

Kaynakça

1. 1 Akalın, B., & Modanlıoğlu, A. (2021). Covid-19 sürecinde yoğun bakımda çalışan sağlık profesyonellerinin duygu-durum ve tükenmişlik düzeylerinin değerlendirilmesi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 12(2), 346-352. https://doi.org/10.31067/acusaglik.850978
2. 2 Arpacıoğlu, S., Baltalı, Z., & Ünübol, B. (2021). COVID-19 pandemisinde sağlık çalışanlarında tükenmişlik, Covid korkusu, depresyon, mesleki doyum düzeyleri ve ilişkili faktörler. Cukurova Medical Journal, 46(1), 88-100. https://doi.org/10.17826/cumj.785609
3. 3 Bae, S. H., Mark, B., & Fried, B. (2010). Impact of nursing unit turnover on patient outcomes in hospitals. Journal of Nursing Scholarship, 42(1), 40-49. https://doi.org/10.1111/j.1547-5069.2009.01319.x
4. 4 Benligiray, S., & Sönmez, Y. D. D. H. (2011). Hemşirelerin mesleki bağlılıkları ile diğer bağlılık formları arasındaki ilişki: Örgüte bağlılık, işe bağlılık ve aileye bağlılık. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 18(1), 28-40.
5. 5 Bruyneel, A., Bouckaert, N., de Noordhout, C. M., Detollenaere, J., Kohn, L., Pirson, M., ... & Van den Heede, K. (2023). Association of burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic. International journal of nursing studies, 137, 104385. https://doi.org/10.1016/j.ijnurstu.2022.104385
6. 6 Bruyneel, A., Smith, P., Tack, J., & Pirson, M. (2021). Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium. Intensive and Critical Care Nursing, 65, 103059. https://doi.org/10.1016/j.iccn.2021.103059
7. 7 Chang, H. Y., Huang, T. L., Lee, I. C., Shyu, Y. I. L., Wong, M. K., Lun‐Hui, H., ... & Teng, C. I. (2021). Impact of professional commitment on professional capability improvement and care quality dimensions: A multi‐wave study. Journal of Clinical Nursing, 30(9-10), 1285-1294. https://doi.org/10.1111/jocn.15672
8. 8 Chiang, Y. C., Lee, H. C., Chu, T. L., Han, C. Y., & Hsiao, Y. C. (2016). The impact of nurses' spiritual health on their attitudes toward spiritual care, professional commitment, and caring. Nursing outlook, 64(3), 215-224. https://doi.org/10.1016/j.outlo ok.2015.11.012

9. 9 Christianson, J., Johnson, N., Nelson, A., & Singh, M. (2022). Work-related burnout, compassion fatigue, and nurse intention to leave the profession during COVID-19. Nurse Leader. In Press. https://doi.org/10.1016/j.mnl.2022.06.007
10. 10 Çelik, S. Ş., Gülten, K. O. Ç., Özbaş, A. A., Bulut, H. Ü., Karahan, A., Aydın, F. Ç., ... & Çelik, B. (2021). Uluslararası hemşireler yılında covid-19 pandemisi: Türk hemşireler derneği çalışmaları. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 6(1), 23-27.
11. 11 Çetinkaya, A., Özmen, D., & Temel, A. B. (2015). Hemşirelikte Mesleğe Bağlılık Ölçeği’nin geçerlik ve güvenirlik çalışması. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 8(2), 54-60.
12. 12 Daily Sabah (2020).Turkey remains firm, calm as first coronavirus case confirmed. Erişim adresi: https://www.dailysabah.com/turkey/turkey-remains-firm-calm-asfirst-coronavirus-case-confirmed/news
13. 13 Derin, N., Ilkim, N. Ş., & Yayan, H. (2017). Hemşirelerde mesleki bağlılığın mesleki prestijle açıklanması. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 4(3), 24-37.
14. 14 Dönmez, S., & Karakuş, E. (2019). Yeni mezun olan hemşirelerin mesleğe bağlılıklarının incelenmesi. Kocaeli Tıp Dergisi, 8(1), 146-152.
15. 15 Duran, S., Celik, I., Ertugrul, B., Ok, S., & Albayrak, S. (2021). Factors affecting nurses' professional commitment during the COVID‐19 pandemic: a cross‐sectional study. Journal of Nursing Management, 29(7), 1906-1915. https://doi.org/10.1111/jonm.13327
16. 16 Ergin, C. (1992, 22 Eylül). Doktor ve hemşirelerde tükenmişlik ve Maslach tükenmişlik ölçeğinin uyarlanması. (Kongre kitabı, s. 143-154). 7. Ulusal Psikoloji Kongresi, Ankara.
17. 17 Falatah, R. (2021). The impact of the coronavirus disease (COVID-19) pandemic on nurses’ turnover intention: an integrative review. Nursing Reports, 11(4), 787-810. https://doi.org/10.3390/nursrep11040075
18. 18 Fronda, D. C., & Labrague, L. J. (2022). Turnover intention and coronaphobia among frontline nurses during the second surge of COVID‐19: The mediating role of social support and coping skills. Journal of Nursing Management, 30(3), 612-621. https://doi.org/10.1111/jonm.13542
19. 19 Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses' burnout and associated risk factors during the COVID‐19 pandemic: A systematic review and meta‐analysis. Journal of advanced nursing, 77(8), 3286-3302. https://doi.org/10.1111/jan.14839
20. 20 Giusti, E. M., Pedroli, E., D'Aniello, G. E., Stramba Badiale, C., Pietrabissa, G., Manna, C., ... & Molinari, E. (2020). The psychological impact of the COVID-19 outbreak on health professionals: a cross-sectional study. Frontiers in psychology, 11, 1684. https://doi.org/10.3389/fpsyg.2020.01684
21. 21 Goldfarb, N., Grinstein‐Cohen, O., Shamian, J., Schwartz, D., Zilber, R., Hazan‐Hazoref, R., ... & Cohen, O. (2021). Nurses’ perceptions of the role of health organisations in building professional commitment: Insights from an Israeli cross‐sectional study during the COVID‐19 pandemic. Journal of nursing management, 29(5), 1102-1110. https://doi.org/10.1111/jonm.13248.
22. 22 Gümüşsoy, S., & Kıratlı, D. (2022). Burnout status, occupational satisfaction, and intention to leave the profession of nurses during the COVID-19 pandemic period; The Case of Turkey. Health Care for Women International, 1-18. https://doi.org/10.1080/07399332.2022.2134392
23. 23 Griffeth, R. W., Hom, P. W., & Gaertner, S. (2000). A meta-analysis of antecedents and correlates of employee turnover: Update, moderator tests, and research implications for the next millennium. Journal of management, 26(3), 463-488. https://doi.org/10.1177/014920630002600
24. 24 Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2021). Nursing shortage. StatPearls Publishing. Erişim adresi: https://www. ncbi.nlm.nih.gov/books/NBK493175/.
25. 25 Haydari, S. M., Kocaman, G., & Tokat, M. A. (2016). Farklı kuşaklardaki hemşirelerin işten ve meslekten ayrılma niyetleri ile örgütsel ve mesleki bağlılıklarının incelenmesi. Sağlık ve Hemşirelik Yönetimi Dergisi, 3(3), 119-131. https://doi.org/10.5222/ SHYD.2016.119
26. 26 Hayes, L. J., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., ... & Stone, P. W. (2006). Nurse turnover: a literature review. International journal of nursing studies, 43(2), 237-263. https://doi.org/10.1016/j.ijnurstu.2005.02.007
27. 27 Hu, D., Kong, Y., Li, W., Han, Q., Zhang, X., Zhu, L. X., ... & Zhu, J. (2020). Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine, 24, 100424. https://doi.org/10.1016/j.eclinm.2020.100424
28. 28 Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., … & Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506. http://doi.org/10.1016/S0140-6736(20)30183-5
29. 29 International Council of Nurses (ICN) Nursing the World to Health - ICN announces theme for International Nurses Day 2020. (2020). Erişim adresi: https://www.icn.ch/news/nursing-world-health-icn-announces-theme-internationalnurses-day-2020
30. 30 International Council of Nurses. (2021). The global nursing shortage and nurse retention. Erişim adresi: https://www.icn.ch/system/files/2021-07/ICN%20Policy%20Brief_ Nurse%20Shortage%20and%20Retention.pdf
31. 31 Jalili, M., Niroomand, M., Hadavand, F., Zeinali, K., & Fotouhi, A. (2021). Burnout among healthcare professionals during COVID-19 pandemic: a cross-sectional study. International archives of occupational and environmental health, 94(6), 1345-1352. https://doi.org/10.1007/s00420-021-01695-x
32. 32 Jo, S., Kurt, S., Bennett, J. A., Mayer, K., Pituch, K. A., Simpson, V., ... & Reifsnider, E. (2021). Nurses' resilience in the face of coronavirus (COVID‐19): An international view. Nursing & Health Sciences, 23(3), 646-657. https://doi.org/10.1111/nhs.12863
33. 33 Khattak, S. R., Saeed, I., Rehman, S. U., & Fayaz, M. (2021). Impact of fear of COVID-19 pandemic on the mental health of nurses in Pakistan. Journal of Loss and Trauma, 26(5), 421-435. https://doi.org/10.1080/15325024.2020.1814580
34. 34 Kantorski, L. P., Oliveira, M. M. D., Alves, P. F., Treichel, C. A. D. S., Wünsch, C. G., Santos, L. H. D., & Pinheiro, G. E. W. (2022). Intention to leave nursing during the COVID-19 pandemic. Revista Latino-Americana de Enfermagem, 30. https://doi.org/10.1590/1518-8345.5815.3549
35. 35 Karem, M. A., Mahmood, Y. N., Jameel, A. S., & Ahmad, A. R. (2019). The effect of job satisfaction and organizational commitment on nurses’ performance. Journal of Humanities and Social Sciences Reviews. 7(6),2395-6518. https://doi.org/10.18510/hssr.2019.7658
36. 36 Khasne, R. W., Dhakulkar, B. S., Mahajan, H. C., & Kulkarni, A. P. (2020). Burnout among healthcare workers during COVID-19 pandemic in India: results of a questionnaire-based survey. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 24(8), 664-671. https://doi.org/10.5005/jp-journals-10071-23518
37. 37 Kim, Y. J., Lee, S. Y., & Cho, J. H. (2020). A study on the job retention intention of nurses based on social support in the COVID-19 situation. Sustainability, 12(18), 7276. https://doi.org/10.3390/su12187276
38. 38 Labrague, L. J., & de Los Santos, J. A. A. (2021). Fear of Covid‐19, psychological distress, work satisfaction and turnover intention among frontline nurses. Journal of nursing management, 29(3), 395-403. https://doi.org/10.1111/ jonm.13168
39. 39 Lachman, R., & Aranya, N. (1986). Job attitudes and turnover intentions among professionals in different work settings. Organization Studies, 7(3), 279-293. https://doi.org/10.1177/0170840686007003
40. 40 Lavoie‐Tremblay, M., Gélinas, C., Aubé, T., Tchouaket, E., Tremblay, D., Gagnon, M. P., & Côté, J. (2022). Influence of caring for COVID‐19 patients on nurse's turnover, work satisfaction and quality of care. Journal of nursing management, 30(1), 33-43. https://doi.org/10.1111/jonm.13462
41. 41 Li, Y., Fan, R., Lu, Y., Li, H., Liu, X., Kong, G., ... & Wang, J. (2023). Prevalence of psychological symptoms and associated risk factors among nurses in 30 provinces during the COVID-19 pandemic in China. The Lancet Regional Health-Western Pacific, 30, 100618. https://doi.org/10.1016/j.lanwpc.2022.100618
42. 42 Li, H., Shi, Y., Li, Y., Xing, Z., Wang, S., Ying, J., Zhang, M., & Sun, J. (2018). Relationship between nurse psychological empowerment and job satisfaction: A systematic review and meta-analysis. Journal of Advanced Nursing, 74(6), 1264–1277. https://doi.org/10.1111/jan.13549.
43. 43 Litam, S. D. A., & Balkin, R. S. (2021). Moral injury in health-care workers during COVID-19 pandemic. Traumatology, 27(1), 14. https://doi.org/10.1037/trm0000290
44. 44 Manzano García, G., & Ayala Calvo, J. C. (2021). The threat of COVID‐19 and its influence on nursing staff burnout. Journal of Advanced Nursing, 77(2), 832-844. https://doi.org/10.1111/jan.14642
45. 45 Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., Schwab, R. L., & Inventory, M. B. (1996). Consulting Psychologists Press: Palo Alto. CA, USA.
46. 46 Orrù, G., Marzetti, F., Conversano, C., Vagheggini, G., Miccoli, M., Ciacchini, R., ... & Gemignani, A. (2021). Secondary traumatic stress and burnout in healthcare workers during COVID-19 outbreak. International journal of environmental research and public health, 18(1), 337. https://doi.org/10.1101/2020.09.13.20186692
47. 47 Özlük, B., & Bıkmaz, Z. (2021). The experiences of nurses diagnosed with COVID‐19 in Turkey: A qualitative study. Nursing & Health Sciences, 23(4), 916-924. https://doi.org/10.1111/nhs.12881
48. 48 Özkan Şat, S., Akbaş, P., & Yaman Sözbir, Ş. (2021). Nurses' exposure to violence and their professional commitment during the COVID‐19 pandemic. Journal of clinical nursing, 30(13-14), 2036-2047. https://doi.org/10.1111/jocn.15760
49. 49 Raso, R., Fitzpatrick, J. J., & Masick, K. (2021). Nurses' intent to leave their position and the profession during the COVID-19 pandemic. JONA: The Journal of Nursing Administration, 51(10), 488-494. https://doi.org/10.1097/NNA.0000000000001052
50. 50 Ruiz‐Fernández, M. D., Ramos‐Pichardo, J. D., Ibáñez‐Masero, O., Cabrera‐Troya, J., Carmona‐Rega, M. I., & Ortega‐Galán, Á. M. (2020). Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID‐19 health crisis in Spain. Journal of clinical nursing, 29(21-22), 4321-4330. https://doi.org/10.1111/jocn.15469
51. 51 Sampaio, F., Sequeira, C., & Teixeira, L. (2021). Impact of COVID-19 outbreak on nurses’ mental health: A prospective cohort study. Environmental research, 194, 110620. https://doi.org/10.1097/JOM. 0000000000001987
52. 52 Sayılan, A. A., Kulakac, N., & Uzun, S. (2021). Burnout levels and sleep quality of COVID-19 heroes. Perspectives in Psychiatric Care, 57(3), 1231–1236. https://doi.org/10.1 111/ppc.12678
53. 53 Tett, R. P., & Meyer, J. P. (1993). Job satisfaction, organizational commitment, turnover intention, and turnover: path analyses based on meta‐analytic findings. Personnel psychology, 46(2), 259-293. https://doi.org/10.1111/j.1744-6570.1993.tb00874.x
54. 54 Turgut, H., Soran, S., & Ateş, M. F. (2017). Örgütsel özdeşleşme işten ayrılma niyeti ilişkisinde psikolojik dayanıklılığın aracı rolü. Uluslararası İktisadi ve İdari İncelemeler Dergisi, 16, 577-592.
55. 55 Ulupınar, F., & Erden, Y. (2022). Intention to leave among nurses during the COVID‐19 outbreak: A rapid systematic review and Meta‐Analysis. Journal of Clinical Nursing, 00:1-11. https://doi.org/10.1111/jocn.16588
56. 56 Uysal, A., & Karakurt, P. D. (2020). The Effect of nurses’ profession commitment situation to tendency of making medical error. Turkish Journal of Family Medicine and Primary Care, 14(3), 349-361. https://doi.org/10.21763/tjfmpc.646889
57. 57 Waldman, J. D., Kelly, F., Arora, S., & Smith, H. L. (2010). The shocking cost of turnover in health care. Health care management review, 35(3), 206-211. https://doi.org/10.1097/HMR.0b013e3181e3940e
58. 58 Wang, Z., Harold, K. G., Tong, Y., Wen, J., Sui, M., Liu, H., ... & Liu, G. (2022). Moral injury in Chinese health professionals during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 14(2), 250. https://doi.org/10.1037/tra0001026
59. 59 Warshawsky, N., Rayens, M. K., Stefaniak, K., & Rahman, R. (2013). The effect of nurse manager turnover on patient fall and pressure ulcer rates. Journal of Nursing Management, 21(5), 725-732. https://doi.org/10.1111/jonm.12101
60. 60 Varghese, A., George, G., Kondaguli, S. V., Naser, A. Y., Khakha, D. C., & Chatterji, R. (2021). Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis. Journal of global health, 11, 05009. https://doi.org/10.7189/jogh.11.05009
61. 61 Yılmaz, M. Ç., & Uysal, N. (2021). Klinisyen hemşirelerde covıd-19 korkusu ve mesleğe bağlılık düzeyinin belirlenmesi. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 4(3), 316-325. https://doi.org/10.38108/ouhcd.886634
62. 62 Yılmaz, S., & Düşükcan, M. Covıd-19 pandemi sürecinde hemşirelerde tükenmişlik ve kaygının yaşam kalitesi üzerine etkisi. Hacettepe Sağlık İdaresi Dergisi, 25(4), 741-760