Nurses' burnout and associated risk factors during the COVID‐19 pandemic: A systematic review and meta‐analysis

  1. Petros Galanis
  2. Irene Vraka
  3. Despoina Fragkou
  4. Angeliki Bilali
  5. Daphne Kaitelidou

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Abstract

Aims

To examine the nurses' burnout and associated risk factors during the COVID‐19 pandemic.

Design

We followed the Cochrane criteria and the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines for this systematic review and meta‐analysis.

Data Sources

PubMed, Scopus, ProQuest, Cochrane COVID‐19 registry, CINAHL and pre‐print services (medRχiv and PsyArXiv) were searched from January 1 to November 15, 2020 and we removed duplicates.

Review Methods

We applied a random effect model to estimate pooled effects since the heterogeneity between results was very high.

Results

Sixteen studies, including 18,935 nurses met the inclusion criteria. The overall prevalence of emotional exhaustion was 34.1%, of depersonalization was 12.6% and of lack of personal accomplishment was 15.2%. The main risk factors that increased nurses' burnout were the following: younger age, decreased social support, low family and colleagues readiness to cope with COVID‐19 outbreak, increased perceived threat of Covid‐19, longer working time in quarantine areas, working in a high‐risk environment, working in hospitals with inadequate and insufficient material and human resources, increased workload and lower level of specialized training regarding COVID‐19.

Conclusion

Nurses experience high levels of burnout during the COVID‐19 pandemic, while several sociodemographic, social and occupational factors affect this burnout.

Impact

We found that burnout among nurses is a crucial issue during the COVID‐19 pandemic. There is an urgent need to prepare nurses to cope better with COVID‐19 pandemic. Identification of risk factors for burnout could be a significant weapon giving nurses and health care systems the ability to response in a better way against the following COVID‐19 waves in the near future.

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  1. Version published to 10.1111/jan.14839
  2. ScreenIT

    SciScore for 10.1101/2020.11.24.20237750: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    PubMed, Scopus, ProQuest and pre-print services (medRχiv and PsyArXiv) were searched from January 1, 2020 to November 15, 2020 and we removed duplicates.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Search in Pubmed, medRχiv and PsyArXiv included title/abstract, while in Scopus and ProQuest included title/abstract/keywords.
    ProQuest
    suggested: (ProQuest, RRID:SCR_006093)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Probably, younger nurses are more vulnerable when facing difficult situations such as patients suffer and die from COVID-19 especially in cases where HCWs cannot offer the standard health care due to sources limitations. According to our review, decreased social support is associated with increased nurses’ burnout during COVID-19 pandemic. Psychological support that HCWs receive during and after a pandemic can significantly influence their feelings and emotions handling in a better way the negative effects of such a devastated event62,63. Also, we found that longer working time in quarantine increases nurses’ burnout. This result is confirmed by studies with nurses that work in quarantine areas during epidemics where loneliness has been recognized as a major stressor64,65. Loneliness is magnified in cases that nurses have to separate from their families and stay at designated hospitals as has happened in Wuhan, China40. Especially family and social support is an essential weapon for nurses to confront the psychological distress that experience during epidemic outbreaks66. A systematic review found that lack of social support is an important risk factor for the development of psychological issues in HCWs during disasters67. Support from families, friends, colleagues, and health care organizations gives nurses the opportunity to control effectively and avoid negative feelings and emotions decreasing the risk of burnout syndrome. In particular, several studies show that a strong...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.11.24.20237750v1 on medRxiv