NDT Advance Access originally published online on November 20, 2007
Nephrology Dialysis Transplantation 2008 23(2):775-776; doi:10.1093/ndt/gfm737
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Differences in burnout between Northern and Southern Italian dialysis health-care providers
E-mail: br.diiorio{at}libero.it
Sir,
I have read with interest the excellent paper by Klersy et al., examining burnout in dialysis health care providers [1]. Although several studies have shown that 25–30% of health-care professionals develop burnout symptoms as a consequence of their clinical activities, little data are currently available on burnout rates in dialysis health-care workers.
Klersy et al. [1] compared burnout levels in 344 nurses and physicians working in dialysis units in Northern Italy, and investigated the relationship between burnout and quality of life in their cross-sectional observational study. They concluded that ‘nurses and physicians working in dialysis units had burnout and quality of life scores comparable to those of their reference populations. Particularly, nurses appeared more burned-out on the emotional exhaustion scale than physicians, probably due to the different intensity and duration of the patient–health care provider relationship. In addition, working condition and personal situation were also associated to burnout.’
Burnout is a syndrome characterized by the three main components of emotional exhaustion, by lack of empathy with patients and colleagues and by diminished personal accomplishment, all of which lead to decreased effectiveness at work [1].
We performed a study in which we analysed burnout in health-care workers from Southern Italian dialysis units. Our study was conducted in 298 subjects, comprising 72 doctors (D) (24.2%) and 226 nurses (N) (75.8%), working in 58 dialysis units in Southern Italy [2]. We sent questionnaires examining personal data as well as six basic work-related areas, to several Italian dialysis centres. Items included in the questionnaire were:
- Personal data
- Work environment (seven items)
- Work instrumental (six items)
- Environment (six items)
- Knowledge of objectives (four items)
- Care quality (five items)
- Motivations to work (six items)
Our health-care workers were guaranteed complete anonymity to avoid any bias in their responses and to ensure that participants answered on the basis of their actual convictions. The questionnaire was set out according to a five-point scale, in which a score of 1 emphasized an entirely negative judgment and 5 was entirely positive. In addition to the overall analysis, we assessed answers from single dialysis units. Results were also analysed according to professional category. The questionnaire was modelled for the Laboratory Medicine Service, verified by the Italian Society of VRQ and adapted for dialysis units [3].
The median age of participants was 50 years for D and 37 years for N (P < 0.001); median time on the job was of 10.22 years for D and 6.18 years for N (P < 0.001). Male were 61% for D and 38% for N. The data showed that 39% of D and 27% of N were very critical with respect to the analysed items. We found that a greater percentage of N than D were negative about environmental climate, the objectives and the quality of services. The female N gave more negative responses across all items than male N. For D, there were no differences according to gender. Workers’ age showed a linear inverse correlation with score, while the number of years on the job was not related to score.
Our results agree with the conclusion of Klersy et al. [1]. In agreement with their findings, our population of dialysis workers was able to maintain higher levels of empathy with their patients and more satisfying feelings of personal accomplishment; both these factors are determinant features of good patient–physician and patient–nurse relationships. Our data also agree with the conclusion of Arikan et al. [4], indicating that dialysis nurses have less work stress and burnout and higher work satisfaction scores than nurses from intensive care units and ward nurses.
Because there are more profit dialysis units in Southern than in Northern Italy [5], we analysed our scores to compare profit and non-profit dialysis units, and were surprised to find that profit-dialysis health-care workers gave lower scores than non-profit-dialysis workers (Figure 1). In fact, profit-dialysis workers gave significantly lower scores for work environment (WE), work instrumental (WI) and environment (En) compared to non-profit workers. Figure 1 also shows that the ratio of percent scores from non-profit over profit-dialysis units for WE, WI and CE was higher (3.9, 3.4 and 4.9 times, respectively; Figure 1), whereas the capacity of quality assistance and improved professional interactions in their work places were similar.
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In conclusion, burnout in health-care professionals represents a dangerous form of work failure because work stress and burnout appear to exert significant influences in patients and their families.
Conflict of interest statement. None declared.
SOC Nefrologia, ASL AV/2,
PO "A Landolfi",
Solofra (AV), Italy
Notes
See http://ndtplus.oxfordjournals.org/
References
- Klersy C, Callegari A, Martinelli V, et al. Burnout in health care providers of dialysis service in Northern Italy. A multicentre study. Nephrol Dial Transplant (2007) 22:2283–2290.
[Abstract/Free Full Text] - Di Iorio B, Bellizzi V, Lopez T, et al. Analysis of satisfaction of human resource to quality ameliorate in dialysis units. An Italian experience (in Italian). Qual Assur (2001) 12:39–50.
- Di Iorio B, Visconti L, Cuccinilello E, et al. The satisfaction of the dialysis staff: validation of a questionnaire. Meeting Book, 11 European Meeting on Cardionephrology, Avril 7-9, 2005: Assissi. Cardionephrology 9, ed. Biosa 2005, 269–271.
- Arikan F, Koksal CD, Gokce C. Work-related stress, burnout and job satisfaction of dialysis nurses in association with perceived relations with professional contacts. Dial Transplant (2007) 36:182–190.[CrossRef][Web of Science]
- Alloatti S, Quarello F, Salomone M, et al. Census 2004 of the Italian renal and dialysis units (in Italian). G Ital Nefrol (2007) 24:45–30.
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