Violence at the Workplace: Health Outcomes and Burnout Among Nursing Personnel

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Violence at the Workplace Health Outcomes and
Burnout Among Nursing Personnel

• Findings from the Safe at Work Study
• Johns Hopkins University Schools of Nursing
  Public Health JH Hospital
• Lareina La Flair, MPH Jill Messing, PhD, MSW
  Jacquelyn Campbell, PhD RN, FAAN Joan Kub, PhD,
  RN Sheila Fitzgerald PhD, RN, Jacqueline Agnew,
  PhD, RN Barbara Fowler, PhD Richelle Bolyard,
  Callie Vincent

Funded by The National Institute for Occupational
Safety and Health (R01 OH007953-01A2)
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Background

• Adverse health effects from psychological,
  physical, and sexual abuse by an intimate partner
  (IPA) have been well-documented
• IPA survivors and the workplace
• Source of support or source of additional stress
  and a place of victimization?
• Workplace violence (WPV) implicated in adverse
  occupational outcomes increased burnout,
  absenteeism, job dissatisfaction decreased
  productivity.
• This research explores risk factors for burnout,
  a precursor to job instability, among victims of
  both IPA and WPV

(Aiken et al., 2002 Campbell, 2002 Vahey et
al., 2004)
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Methods

• Self report questionnaire
• Online and confidential www.jhmisafework.org
• Follow-up at 6, 12 18 months after baseline
  (T1, T2, T3)
• Case Control Design
• Survivors of WPV compared with random sample of
  nursing personnel who did not experience WPV
• Multivariate linear regression
• Predictive models of patient, work, and personal
  burnout at 6-month follow-up

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Participants and Sampling

• Eligibility 4410 nursing personnel
• Recruited from 3 Baltimore, MD area hospitals
• Employed for at least 4 weeks prior to enrollment
• Nurses and nursing personnel
• Baseline Sample N2193 (49.7 recruitment)
• Case Control Design
• Cases 652 (those experiencing WPV)
• Controls 1038
• T1 Sample (6 months post-baseline) N1690
• Final T1 Sample N1348 (80 Retention)
• Sample for this presentation (Baseline and T1)
• N 1025

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Measures

• Burnout Copenhagen Burnout Inventory (CBI)
• State of prolonged physical and psychological
  exhaustion
• 3 Domains
• Patient Burnout related to work with patients
• Work-related Burnout related to work in general
• Personal Burnout physical and emotional
  exhaustion
• Response Categories
• Always, Often, Sometimes, Seldom, Never/almost
  never
• Total score (1-100) item average

(Kristensen, T.S. et al., 2005)
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Measures (contd)

• Workplace Violence
• Physical violence
• Psychological violence
• Intimate Partner Abuse
• Sexual abuse
• Physical abuse
• Emotional abuse
• Work characteristics
• Shift type
• Supervisor/Coworker Support Karasek
• Health Status
• Mental Health CESD-10
• Physical Health SF8 (PCS8)

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Baseline Demographics

• Table 1. Socio-demographic information at baseline

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Burnout

• Table 2. Distribution of Burnout by Type at
  Follow-up

• Burnout scales are scored 1-100 (100 most
  severe)

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Workplace Violence (WPV)

• Threats or experiences of physical or
  psychological workplace violence (WPV) in the
  last 12 months
• Of those participants who experience WPV (N630),
  what types of violence do they experience?
• Psychological 222 (35.2)
• Physical 213 (33.8)
• Both 195 (31)

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Intimate Partner Abuse (IPA)

• Definition sexual abuse, physical abuse,
  emotional abuse or hit by an IP in the last 12
  months prior to baseline survey

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Multivariate Linear Regression

• Outcome of Burnout at
• 6-month Follow-up

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Bivariate Analyses
Type of Burnout at 6 Month-Follow-up Predicted by
Baseline Violence
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Multivariate Regression

• Predictive models of patient, work, personal,
  total burnout score
• Baseline predictors outcome at 6 months
• Main effects violence, mental and physical
  health status, work variables,
  socio-demographic variables
• Hospital variable to account for clustering
• Methodology
• Backward selection GLM
• Removal of insignificant variables (p lt0.05)
• Adjusted R2

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Final Model Patient Burnout
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Final Model Work Burnout
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Final Model Personal Burnout
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Final Model Total Burnout
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Summary

• Past-year physical WPV was a significant
  predictor of all 4 types of burnout, with its
  strongest effect on patient burnout
• Past-year psychological WPV, income, supervisor
  support, and monthly mandatory overtime were
  significantly associated with work burnout only
• Past-year IPA appeared to predict personal
  burnout, but relationship became insignificant
  after other variables were added to model

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Summary (contd)

• Depressive symptoms were significantly associated
  with all four types of burnout
• Being a nurse (in contrast to nursing personnel)
  was significantly predictive of all four measures
  of burnout
• Baseline coworker support was a significant and
  strong protective factor against all types of
  burnout, as well as total burnout, at 6 month
  follow-up.

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Implications for Mental Health

• Nursing personnel who experience physical or
  psychological WPV are at risk for emotional
  distress in the form of burnout with regard to
  their work with patients, personal exhaustion,
  and job burnout and frustration.
• Interventions?
• strengthening workplace climate
• improving staffing
• recognizing and addressing staff depressive
  symptoms
• developing effective workplace policy to reduce
  both physical and psychological WPV

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Strengths Limitations

• Generalizability Employed, well educated sample
• Not longitudinal from childhood
• Methodological challenges Missing data, response
  bias, information bias (correlated measurement
  error)

• Multiples measures of violence
• Prospective study design
• Past-year measures Minimization of recall bias
• Online, confidential survey
• 80 retention at first 6 month follow-up

• Limitations

• Strengths

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Acknowledgements

• Johns Hopkins University Bloomberg School of
  Public Health, Department of Mental Health
• Johns Hopkins School of Nursing
• Safe at Work Study Research Team
  (PI Dr. Jacquelyn Campbell)
• Safe at Work Study Participants