Natl. J. Physiol. Pharm. Pharmacol. (2025), Vol. 15(1): 102-106

Original Research

10.5455/NJPPP.2025.v15.i1.18

Prevalence of occupational burnout among nurses in tertiary care hospital, Trichy

Pradeepa Senthil¹, P. Jenifer^2*, Rajaseharan Divya³, M. Gousalya4, M.S. Gowtham⁴, G. Hari⁴ Hari Prakash⁴ and Gowtham Ganesh⁴

¹Department of Community Medicine, Srinivasan Medical College and Hospital, Dhanalakshmi Srinivasan University, Samayapuram, India

²Institutional Research Board, Trichy SRM Medical College, Hospital and Research Centre, Tiruchirapalli, India

³Department of Community Medicine, Trichy SRM Medical College, Hospital and Research Centre, Tiruchirapalli, India

⁴CRRI, Trichy SRM Medical College, Hospital and Research Centre, Tiruchirapalli, India

*Corresponding Author: P. Jenifer. Institutional Research Board, Trichy SRM Medical College, Hospital and Research Centre, Tiruchirapalli, India. Email: jenijude63 [at] gmail.com

Submitted: 20/09/2024 Accepted: 05/12/2024 Published: 31/01/2025

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ABSTRACT

Introduction: Burnout is a serious process of impairment in the workers’ quality of life, which can lead to serious damage of physical and mental health.

Objectives: To identify the prevalence of burnout among nursing professionals.

Methods: This cross-sectional study was conducted among 100 nurses at Trichy SRM Medical College between August and October 2020 using random sampling. Data were collected via a structured questionnaire with three sections: socio-demographic details (e.g., age and marital status), factors contributing to burnout (e.g., work hours, job satisfaction, anxiety, and years of experience), and burnout levels measured using the Maslach Burnout Inventory (MBI). The MBI, a validated 22-item tool, assesses emotional exhaustion (7 items), depersonalization (7 items), and personal accomplishment (8 items).

Burnout was classified based on MBI scores:

• Emotional Exhaustion: Low (≤17), moderate (18–29), and high (≥30).
• Depersonalization: Low (≤5), moderate (6–11), and high (≥12).
• Personal accomplishment: High (≤33), moderate (34–39), and low (≥40).

Inclusion criteria were nurses working at the hospital, with nonconsenting individuals excluded. Ethical clearance was obtained, and data were analyzed using descriptive statistics such as mean and frequency distribution.

Results: Low-level burnout was seen in personal achievement; moderate-level burnout was seen in emotional exhaustion and high-level burnout was seen in depersonalization.

Conclusion: Research indicates a significant prevalence of burnout among nurses, highlighting the need for measures to enhance their mental well-being and workplace environment.

Keywords: Nurses, Burnout, Occupation.

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Introduction

Burnout is a condition characterized by three key dimensions: emotional exhaustion, depersonalization, and diminished professional efficacy (Khanna and Khanna, 2013). According to the World Health Organization classification under ICD-11, burnout arises from chronic work-related stress that has been ineffectively managed, manifesting as an occupational syndrome. While not classified as a mental disorder, prolonged burnout can lead to significant mental and physical health impairments (Bagaajav et al., 2011). Among healthcare workers, nurses are particularly vulnerable to burnout due to their high-intensity roles, frequent patient interactions, and responsibilities for patient well-being. Stressors, such as patient mortality, heavy workloads, interpersonal conflicts, and night shifts, are especially prevalent in nursing, making it one of the most stressful professions globally.

However, despite the recognized vulnerability of nurses to burnout, there is a notable gap in the literature that critically evaluates the current situation of Indian nurses (Baishya et al., 2014). While numerous international studies have explored burnout among healthcare workers (Lasebikan and Lasebikan, 2012; Lin et al., 2009; Thorsen et al., 2011; Mohammadpoorasl et al., 2012), their findings may not fully capture the unique challenges faced by nurses in India. For example, studies in Europe emphasize the role of organizational culture, systemic workload management, and legal protections, which often differ from the Indian context due to disparities in resources, infrastructure, and patient-to-nurse ratios. According to the International Council of Nurses, Indian nurses typically manage more than four times the recommended patient load per shift, contributing to chronic stress and job dissatisfaction.

In the Indian context, data on burnout are fragmented and limited in scope. Research is often confined to small sample sizes and lacks the depth needed to generalize findings across diverse healthcare settings. A study conducted in a tertiary hospital in India revealed that over 90% of nurses reported moderate to high levels of emotional exhaustion, but the study did not explore contributing factors such as socioeconomic conditions, systemic issues like understaffing, or regional disparities in healthcare access. Additionally, the interplay of cultural expectations, gender roles, and the stigma surrounding mental health further compounds the issue for Indian nurses, which is rarely addressed in existing studies.

Globally, studies emphasize systemic interventions such as supportive leadership and psychological counseling to mitigate burnout (Chakraborty et al., 2012). For instance, research in the United States shows that implementing mindfulness-based stress reduction programs reduced burnout among nurses by 40%. However, comparable data and interventions in India are either unavailable or underreported. Furthermore, international studies often focus on high-income settings, making their findings less applicable to resource-constrained environments like many Indian hospitals (O’Mahony, 2011).

This study seeks to bridge this gap by providing an in-depth evaluation of burnout among nurses in a tertiary care center in India. It aims to uncover the unique factors contributing to burnout within this context, supported by robust data and literature, and propose evidence-based strategies for improving mental health among Indian nurses. Addressing these gaps is essential not only for enhancing nurse well-being but also for ensuring the quality of patient care in an overburdened healthcare system.

The main causes of burnout are largely the same, the factors leading to burnout vary across Europe in terms of their impact on healthcare workers’ lives (Sipos et al., 2024).

Objectives

1. To examine the prevalence of occupational burnout in nursing professionals.

2. To investigate the factors that may affect burnout levels among nurses.

3. To evaluate the extent of burnout within the nursing workforce.

Fig. 1. Burnout. Out of the staff nurses interviewed with the questionnaire, only 10% agreed to none of the symptoms of burnout; 50% reported that they had lost empathy due to work stress, 22% reported that they had lost interest in their work due to lack of personal achievement, and 18% reported that they were emotionally drained.

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Methodology

This cross-sectional study was carried out among nurses at Trichy SRM Medical College between August and October 2020. A random sampling method was used to select 100 nurses for the study. A predesigned, structured questionnaire with three sections was explained and distributed to the participants. The first section focused on socio-demographic details such as age, gender, education level, marital status, and number of children. The second section explored factors contributing to burnout, including meal skipping, work hours, night shifts, job satisfaction, anxiety, depression, availability of nursing staff, and years of experience. The third section aimed to measure burnout levels using a burnout self-assessment tool.

The questionnaires were personally explained to participants. Literature review highlighted the importance of using standardized tools to assess burnout levels and the factors influencing burnout in healthcare workers (Table 1). The Maslach Burnout Inventory (MBI) is widely regarded as the most reliable tool for evaluating burnout in healthcare professionals. The burnout self-test (MBI) is divided into three categories, featuring 22 items that are rated on a scale ranging from “never” to “every day.”

• Section A: Emotional exhaustion (7 items).
• Section B: Depersonalization (7 items).
• Section C: Personal accomplishment (8 items).

Selection criteria

Inclusion criteria: Nurses working at Trichy SRM Medical College Hospital & Research Centre.

Exclusion criteria: Those who did not give consent and were not willing to participate in the study.

Scoring

Emotional exhaustion: This dimension reflects physical and mental fatigue at the thought of work, chronic tiredness, difficulty sleeping, and physical ailments. According to the MBI and many authors, emotional exhaustion is considered the core aspect of burnout. Unlike depression, these symptoms tend to subside when not at work.

Fig. 2. Level of burnout (emotional exhaustion, depersonalization, and personal achievement) (N=90). Emotional exhaustion: The emotional exhaustion bar chart shows that 40% of nurses experience a high level of burnout and 30% of nurses experience a moderate level of burnout, while 20% of nurses show a low level burnout. In depersonalization, among 90 nurses, 53% of nurses show a high level of burnout, 0.20% of nurses experience a moderate level of burnout, and 22% of nurses show a low level burnout. Personal achievement: 38% of nurses do not lack personal achievement, 30% of nurses score a high level of lack of personal achievement, and 22% show a moderate level of burnout in personal achievement.

• Score of 17 or lower: Low burnout.
• Score between 18 and 29: Moderate burnout.
• Score above 30: High burnout.

Depersonalization: This aspect involves a sense of detachment or “dehumanization” in professional relationships. It often manifests as cynicism, negative attitudes toward patients or coworkers, guilt, avoidance of social interactions, and withdrawal. Empathy toward others is suppressed.

Table 1. Factors influencing burnout.

• Score of 5 or less: Low burnout.
• Score between 6 and 11: Moderate burnout.
• Score of 12 or more: High burnout.

Personal accomplishment: A reduced sense of personal achievement occurs when individuals perceive themselves as ineffective or incapable of improving situations. This leads to feelings of failure and a lack of motivation, contributing to self-doubt. It typically results from prolonged exposure to emotional exhaustion and depersonalization.

• Score of 33 or less: High burnout.
• Score between 34 and 39: Moderate burnout.
• Score of 40 or higher: Low burnout.

A high score in emotional exhaustion and depersonalization, coupled with a low score in personal accomplishment, may suggest burnout.

Ethical approval: This study received clearance from the Institutional Ethics Committee.

Statistical analysis

Data obtained was analyzed using descriptive statistical analysis such as mean and frequency distribution.

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Results

Out of the staff nurses interviewed with the questionnaire, only 10% agreed to none of the symptoms of burnout; 50% reported that they had lost empathy due to work stress, 22% reported that they had lost interest in their work due to lack of personal achievement, and 18% reported that they were emotionally drained (Fig. 1). Thus, the prevalence of burnout is very high. The factors influencing burnout were analyzed next and four factors brought significant results as follows: 57.1% of nurses have job satisfaction, which was a major factor contributing toward burnout; 97.3% of the nurses agreed the shortage of nursing personnel, thereby increasing workload and eventually leading to burnout. Surprisingly, only 28.6% reported that frequent night duties resulted in increased stress. Nurses with more than 5 years of experience reportedly experience only low levels of burnout, whereas nurses with less than 5 years of experience report high levels of burnout in a short time.

The level of burnout found through the burnout self-test described as the emotional exhaustion bar chart shows that 40% of nurses experience a high level of burnout, 30% of nurses experience a moderate level of burnout, and 20% nurses show a low level burnout. In depersonalization, among 90 nurses (48%) show a high level of burnout, 0.20% of nurses experience a moderate level of burnout, and 22% of nurses show a low-level burnout (Fig. 2). Surprisingly, 38% of nurses have personal achievement, while 30% of nurses score a high level of lack of personal achievement and 22% of them show a moderate level of burnout in personal achievement (Bühler and Land, 2003).

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Limitations

Since the study was conducted solely among staff nurses in a tertiary care teaching hospital, the results cannot be generalized due to the limited sample size.

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Discussion

The study on the prevalence of occupational burnout among nurses in a tertiary care hospital in Trichy reveals a concerning trend, with a significant portion of the nursing staff experiencing burnout symptoms. The findings indicate that only 10% of the nurses surveyed did not report any symptoms of burnout, suggesting that occupational stress is a widespread issue within this hospital.

The data highlight that 50% of the nurses reported a loss of empathy due to work-related stress, reflecting the emotional toll that constant patient care and high workloads can impose. This loss of empathy, a key component of depersonalization, can lead to a diminished quality of care, as nurses become less emotionally engaged with their patients.

Furthermore, 22% of the nurses indicated that they had lost interest in their work due to a lack of personal achievement. This is particularly troubling as it suggests that a significant number of nurses feel undervalued and unfulfilled in their roles, which can exacerbate feelings of burnout and lead to decreased job satisfaction and performance.

Emotional exhaustion, another core element of burnout, was reported by 18% of the nurses, indicating that nearly one in five nurses felt drained by their work. This exhaustion not only affects their ability to perform their duties but also their overall well-being.

The study also identified several key factors that contribute to burnout among nurses in this hospital. One of the most significant findings was that 97.3% of the nurses attributed their burnout to the shortage of nursing personnel, which increased their workload and stress levels. This shortage likely leads to overburdened staff, longer hours, and a heightened sense of pressure, all of which contribute to burnout.

Interestingly, while frequent night duties are often associated with increased stress, only 28.6% of the nurses reported that night shifts significantly contributed to their burnout. This suggests that while night duties may be a stressor, they are not the primary cause of burnout for most nurses in this setting (Jodas and Haddad, 2009; Das et al., 2015a,b, 2016).

Job satisfaction also emerged as a critical factor, with 57.1% of the nurses linking it to their experience of burnout. Low job satisfaction, driven by factors such as lack of support, recognition, and opportunities for advancement, can significantly undermine a nurse’s resilience against burnout.

Moreover, the study found that nurses with less than 5 years of experience were more susceptible to high levels of burnout, while those with more than 5 years of experience reported lower levels of burnout. This suggests that newer nurses may struggle more with the demands of the job, possibly due to a lack of coping mechanisms and professional support, while more experienced nurses might have developed better strategies to manage stress.

The study utilized a burnout self-test to measure levels of emotional exhaustion, depersonalization, and personal achievement among the nurses. The results showed that 40% of nurses experienced high levels of burnout in emotional exhaustion, 30% experienced moderate levels, and 20% reported low levels. This indicates that a substantial portion of the nursing staff is severely impacted by their work environment.

In terms of depersonalization, 48% of the nurses showed high levels of burnout, reflecting a significant emotional detachment from their work. This detachment can be detrimental not only to patient care but also to the nurses’ mental health and job satisfaction.

Regarding personal achievement, 38% of the nurses reported feeling a lack of achievement, with 30% experiencing high levels of burnout in this area. This suggests that many nurses do not feel recognized or rewarded for their hard work, which can lead to disengagement and reduced motivation (McAuliffe et al., 2009).

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Conclusion

The high prevalence of burnout among nurses in this tertiary care hospital underscores the urgent need for interventions to address the factors contributing to this issue. Strategies, such as improving staffing levels, enhancing job satisfaction through recognition and professional development opportunities, and providing support for less experienced nurses, could help mitigate burnout and improve both nurse well-being and patient care outcomes.

These findings should prompt hospital management to prioritize addressing burnout, recognizing that the well-being of nurses is critical to the overall functioning and effectiveness of the healthcare system. Future research could focus on evaluating the impact of specific interventions on reducing burnout and exploring the long-term benefits of such measures on nurse retention and patient care quality.

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