Background
Healthcare professionals in long-term care facilities have faced excessive workloads and a heavy emotional burden while caring for frail residents during the 2019 coronavirus disease (COVID-19) pandemic [
1,
2]. They have had to continuously adjust work practices and care routines while coping with limited time, resources, and protective equipment [
3,
4]. At the same time, they have been burdened with serious concerns about residents’ loneliness due to social isolation and distancing measures implemented during the pandemic [
5‐
7], and have needed to provide intensified psychosocial support to frail residents [
3,
4]. Working under these highly stressful circumstances has jeopardized the work-related well-being of these healthcare professionals, who reported burnout symptoms during the COVID-19 pandemic [
2,
3,
8].
Burned-out healthcare professionals are emotionally exhausted at work, which undermines their ability to deliver high-quality care [
9]. Healthcare professionals working in long-term care facilities have expressed the fear of committing more errors due to exhaustion and burnout during the pandemic [
10,
11]. Particularly high burnout levels have been reported by professionals working in environments characterized by heavy job demands and inadequate job resources [
8,
12‐
16]. Job demands are stressful work characteristics that require physical, cognitive, and/or emotional effort (e.g., workloads), and job resources are energizing work characteristics that foster professional growth (e.g., supervisor support). Job demands in long-term care settings were especially high during the COVID-19 pandemic because workloads were heavy and increased exposure to residents’ death and suffering was emotionally burdensome. Job resources were mixed: healthcare professionals in these settings reported strong collegial support, but inadequate support from supervisors [
17‐
19]. However, these findings are drawn from qualitative and cross-sectional studies, and research has not yet provided longitudinal insight into healthcare professionals’ perceptions of actual changes in job demands and resources during the pandemic.
The Job Demands and Resources (JD-R) model postulates two ways in which job demands and resources jointly shape work-related well-being: the
health impairment process and the
motivational process [
20]. The health impairment process occurs when excessive job demands increase stress and health issues, ultimately resulting in burnout [
21]. The motivational process occurs when abundant job resources stimulate professionals’ achievement of work goals and help to reduce job demands, thereby decreasing burnout [
20]. It also promotes work-related well-being by stimulating professionals’ work engagement, characterized by energy, dedication, and concentration [
22,
23]. Burnout and work engagement have been studied widely and taken to reflect poor and optimal work-related well-being, respectively; burnout is predicted by excessive job demands and insufficient job resources, and work engagement is predicted primarily by abundant job resources [
24].
Most research on the predictive value of job demands and resources was conducted before the COVID-19 pandemic [
24,
25]. In line with the JD-R model, it has shown that job demands and resources predicting burnout and work engagement vary across contexts and settings [
26]. For the long-term care setting, a lack of longitudinal evidence limits insight into the predictive value of job demands and resources for work-related well-being during the COVID-19 pandemic that would allow facilities to optimize conditions to promote such well-being in a pandemic context.
In addition, as the COVID-19 pandemic has involved a continuous flow of infection waves that has forced healthcare professionals to frequently adapt to changing care routines and work practices, marked shifts in job demands and resources likely occurred [
4]. Such changes, however, have not been confirmed or characterized, and their associations with changes in healthcare professionals’ burnout or work engagement remain unknown. In the current study, we therefore first addressed the following research question: how did healthcare professionals’ perceptions of job demands and resources change during periods of low and high COVID-19 infection rates in long-term care facilities in 2021? Second, we aimed to answer the research question: how are changes in healthcare professionals’ perceptions of job demands and resources associated with changes in burnout and work engagement?
Results
In total, 876 professionals participated in the T1 survey (response rate, 14.3%); 173 of these respondents completed a follow-up web-based survey at T2 (retention rate, 19.7%). At least one value for a variable of interest at one timepoint was missing for 44 (25.4%) respondents. Table
1 provides an overview of the sample characteristics at T1 after multiple imputation, showing 88.3% female healthcare professionals and average age of 49.7 years.
Table 1
Sample characteristics at baseline (n = 173); means and percentages
Work-related burnout | 2.4 | (0.6) |
Patient-related burnout | 2.0 | (0.6) |
Work engagement | 4.7 | (1.0) |
Age | 49.7 | (12.3) |
Years of experience | 16.6 | (13.3) |
Female | 88.3 |
Job type | |
Nursing staff | 56.0 |
(Para)medical staff | 18.6 |
Support staff | 25.5 |
Educational attainment | |
Lower secondary or less | 15.1 |
Higher secondary or lower tertiary | 56.4 |
Higher tertiary | 28.5 |
The respondents reported significantly greater workloads at T2 than at T1 (Δmean = 0.122,
p < 0.01, see Table
2). No significant difference in the other job demands (emotional demands and administrative burden) was observed (Table
2). We also found no evidence that job resources changed between T1 and T2.
Table 2
Changes in job demands and job resources (n = 173)
Job demands | | | | | | |
Workload | 3.306 | (0.738) | 3.429 | (0.824) | 0.122** | (0.046) |
Emotional demands | 3.080 | (0.6451 | 3.039 | (0.595) | − 0.040 | (0.040) |
Administrative burden | 3.087 | (0.770) | 3.139 | (0.772) | 0.055 | (0.043) |
Job resources | | | | | | |
Supervisor support | 3.414 | (0.799) | 3.368 | (0.815) | − 0.046 | (0.058) |
Collegial support | 4.027 | (0.715) | 3.951 | (0.677) | − 0.076 | (0.054) |
Autonomy | 3.749 | (0.630) | 3.762 | (0.619) | 0.013 | (0.047) |
The regression model showed that within-person increases in workload (
b = 0.227,
p < 0.01) emotional demands (
b = 0.267,
p < 0.001), and administrative burden (
b = 0.223,
p < 0.01) were associated with significant increases in work-related burnout (Table
3). Increases in collegial support (
b = − 0.114,
p < 0.05) and autonomy (
b = − 0.115,
p < 0.05) were associated with declines in work-related burnout. No significant association of changes in supervisor support and work-related burnout was observed (Table
3).
Table 3
Results of fixed-effects regression analyses predicting work-related well-being changes
Job demands | | | | | | |
Workload | 0.227** | (0.074) | 0.215* | (0.089) | − 0.344* | (0.147) |
Emotional demands | 0.276*** | (0.071) | 0.171* | (0.073) | 0.060 | (0.142) |
Administrative burden | 0.223** | (0.072) | 0.160† | (0.091) | − 0.008 | (0.140) |
Job resources | | | | | | |
Supervisor support | − 0.061 | (0.058) | − 0.024 | (0.063) | 0.038 | (0.123) |
Collegial support | − 0.114* | (0.054) | − 0.046 | (0.069) | 0.286* | (0.130) |
Autonomy | − 0.115* | (0.054) | − 0.026 | (0.071) | 0.244† | (0.124) |
Time period | | | | | | |
T1 (Feb.–May 2021) | Ref | | Ref | | Ref | |
T2 (Nov.–Dec. 2021) | − 0.001 | (0.033) | 0.020 | (0.039) | − 0.008 | (0.074) |
Number of observations | 346 | | 346 | | 346 | |
Number of persons | 173 | | 173 | | 173 | |
Increases in workload (
b = 0.215,
p < 0.05) and emotional demands (
b = 0.171,
p < 0.05) were associated with elevated patient-related burnout. We found no significant association between changes in administrative burdens or job resources and changes in patient-related burnout (Table
3). Increases in workload were associated with declines in work engagement (
b = − 0.344,
p < 0.05) and increases in collegial support were associated with increased work engagement (
b = 0.286,
p < 0.05). No significant association of a change in work engagement with other job demand or resource was observed (Table
3).
The analysis of the complete cases subsample yielded results consistent with those of the main analysis. Specifically, respondents’ workloads increased from T1 to T2 (ΔMean = 0.149,
p < 0.01, Additional file
1: Table SA) and seven of nine associations that were significant in the main analysis were also significant in the subsample (Additional file
1: Table SB). The remaining two associations (of autonomy with work-related burnout and workload with patient-related burnout) were similar in direction and magnitude, but only marginally significant (
p < 0.1). Some estimated effects were also significant in the subsample. Specifically, the effect of administrative burden increased significantly and that of collegial support decreased significantly between T1 and T2. Moreover, the association between changes in autonomy and those in work engagement was similar in direction and magnitude to that observed in the main analysis, but significant in the subsample.
Conclusions
This longitudinal study showed that healthcare professionals in long-term care settings in the Netherlands experienced increased workloads as COVID-19 infection rates surged between early and late 2021. This increase, and some professionals’ perceived decline in collegial support, resulted in increased burnout and decreased work engagement. These findings emphasize the urgency of reducing workloads and promoting collegial support to protect healthcare professionals’ work-related well-being in a pandemic context, especially during periods with high infection rates.
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