Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic.
Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic.
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DOI：
10.1186/s12913-023-10270-8
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发表时间：
2023-11-27
影响因子：
2.8
通讯作者：
Stockdale, Susan E.
中科院分区：
文献类型：
--
作者：
Apaydin, Eric A.;Rose, Danielle E.;Mcclean, Michael R.;Mohr, David C.;Yano, Elizabeth M.;Shekelle, Paul G.;Nelson, Karin M.;Guo, Rong;Yoo, Caroline K.;Stockdale, Susan E.
新冠肺炎大流行涉及到所有医护人员(包括初级保健人员)工作条件的迅速变化。组织对大流行的反应，包括转向虚拟护理，人员配备的变化，以及重新分配到与检测相关的工作，可能已经将更多的负担转移到这些卫生工作者身上，增加了他们的职业倦怠和离职意图，尽管他们参与了他们的组织。我们的目标是(1)检查2017-2020年间退伍军人初级保健人员的职业倦怠和离职意向的变化(在大流行之前和期间)，以及(2)分析个人保护因素和组织背景如何在大流行的最初几个月影响退伍军人初级保健人员的职业倦怠和离职意愿。我们分析了2020年139个医疗系统中19894名初级保健工作者的个人和医疗系统级别的数据。我们将个人层面的职业倦怠和离职意图之间的潜在关系建模为结果，以及个人层面的员工敬业度、对工作量、领导力和工作组的看法。在医疗保健系统层面，我们评估了前一年的职业倦怠水平和离职意向、新冠肺炎负担(测试和死亡次数)以及虚拟护理使用的程度作为潜在的决定因素。我们使用Logistic回归进行了多变量分析，标准误差按医疗保健系统分组，控制了个人水平的人口统计数据和医疗保健系统的复杂性。2020年，37%的初级保健工作者报告了职业倦怠，31%的人报告了离职意向。高敬业度员工的职业倦怠程度较低(OR = 为0.57；95%CI为0.52~0.63)，离职倾向较低(OR = 为0.62；95%CI为0.57~0.68)。大流行前医疗系统层面的倦怠是个人层面大流行倦怠的主要预测因子(p = 0.014)。合理的工作量、值得信赖的领导和强大的工作团队也与较低的职业倦怠和离职意向有关(p <； 0.05)。新冠肺炎负担、虚拟护理使用和上一年营业额与这两种结果均无关联。在大流行期间，员工敬业度与初级保健人员职业倦怠和离职意向的可能性较低相关，这表明在压力时期，员工敬业度可能具有保护作用。新冠肺炎的负担和虚拟护理的使用与这两种结果都没有关联。未来的研究应该侧重于了解敬业度和职业倦怠之间的关系，并改善初级保健的幸福感。
The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017–2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic. We analyzed individual- and healthcare system-level data from 19,894 primary care HCWs in 139 healthcare systems in 2020. We modeled potential relationships between individual-level burnout and turnover intent as outcomes, and individual-level employee engagement, perceptions of workload, leadership, and workgroups. At healthcare system-level, we assessed prior-year levels of burnout and turnover intent, COVID-19 burden (number of tests and deaths), and the extent of virtual care use as potential determinants. We conducted multivariable analyses using logistic regression with standard errors clustered by healthcare system controlled for individual-level demographics and healthcare system complexity. In 2020, 37% of primary care HCWs reported burnout, and 31% reported turnover intent. Highly engaged employees were less burned out (OR = 0.57; 95% CI 0.52–0.63) and had lower turnover intent (OR = 0.62; 95% CI 0.57–0.68). Pre-pandemic healthcare system-level burnout was a major predictor of individual-level pandemic burnout (p = 0.014). Perceptions of reasonable workload, trustworthy leadership, and strong workgroups were also related to lower burnout and turnover intent (p < 0.05 for all). COVID-19 burden, virtual care use, and prior year turnover were not associated with either outcome. Employee engagement was associated with a lower likelihood of primary care HCW burnout and turnover intent during the pandemic, suggesting it may have a protective effect during stressful times. COVID-19 burden and virtual care use were not related to either outcome. Future research should focus on understanding the relationship between engagement and burnout and improving well-being in primary care.
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影响因子：
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