PREVALENCE OF OCCUPATIONAL BURNOUT: A CROSS-SECTION ANALYSIS ACROSS HOSPITAL NURSING PROFESSIONALS

Key words: nursing staff, burnout professional, predisposing factor, syndrome, sociodemographic factors, work-related factors

Ключові слова: медсестринський персонал, професійне вигорання, фактор схильності, синдром, соціально-демографічні фактори, фактори, пов’язані з роботою

Abstract

This study aims to investigate the prevalence of occupational burnout among nursing professionals at Shkodra Regional Hospital and identify factors contributing to it. Specifically, the objectives include measuring the burnout rate within this population and analysing demographic and occupational factors that affect burnout levels. This cross-sectional, observational and analytical study used a semi-standardised questionnaire distributed to healthcare professionals over 7 months (Sep­tember 2024 – March 2025) at the Shkodra Regional Hospital, Albania. The Excel file obtained from Microsoft software underwent statistical processing in SPSS version 26.0 software. The Maslach Burnout Inventory test was subjected to an evaluation of its reliability and consistency with the Cronbach alpha test. The alpha value was found to be 0.79. The level of significance adopted was p<0.05. The mean age among 131 nurses was 35.35±10.37, with a minimum to maximum age of 18-64 years old. Almost 38.2% of the participants belong to the 26-35 age group, which is considered to be a relatively young demographic one. Burnout prevalence turned to be relatively high – 68.9% for 95% CI (59.4-75.3), where 22.3% exhibited high levels of emotional exhaustion, 45.4% of cases high depersonalisation and low personal accomplishment domen in 92.3%. The phenomenon of depersonalization, in combination with two other areas, is worthy of consideration, with a p-value was found to be less than 0.05. It is noteworthy that the majority of these workers, 62.6%, are engaged in shift work with a frequency of 6-10 days per month. Burnout syndrome presented a correlation with sociodemographic factors (marital status, and monthly income) as well as some of the work-related factors (shift work system, weekly working hours, days on shift, work experience, etc). The findings of this study give us a relatively high prevalence of burnout syndrome among the participants (68.9%). We recommend rapid intervention with different policies or strategies that should improve the reduction of burnout among nursing staff. In order to facilitate recovery, it is essential to address burnout, recognise signs of excessive physical fatigue, seek support from colleagues and therapists, set boundaries, and prioritise self-care.

Реферат

Поширеність професійного вигорання: перехресний аналіз серед фахівців з догляду за хворими в лікарнях. Белішa (Готі) С., Зекя І., Петрі О., Браті (Кіка) Б., Фреску Е., Алі Е., Края Дж., Коя Дж., Абазай Е. Це дослідження має на меті дослідити поширеність професійного вигорання серед медсестер у Шкодерській регіональній лікарні та визначити фактори, що сприяють цьому. Зокрема, цілі включають вимірювання рівня вигорання серед цієї групи населення та аналіз демографічних та професійних факторів, що впливають на рівень вигорання. У цьому перехресному, обсерваційному та аналітичному дослідженні ви­корис­товувалася напівстандартизована анкета, розповсюджена серед медичних працівників протягом 7 місяців (вересень 2024 р. – березень 2025 р.) у Шкодерській регіональній лікарні, Албанія. Файл Excel, отриманий з програмного забезпечення Microsoft, пройшов статистичну обробку в програмному забезпеченні SPSS вер­сії 26.0. Тест Маслаха на вигорання був оцінений щодо його надійності та узгодженості з альфа-тестом Кронбаха. Значення альфа становило 0,79. Прийнятий рівень значущості становив p<0,05. Серед 131 медсестри середній вік становив 35,35±10,37 року, з мінімальним та максимальним віком 18-64 роки. Майже 38,2% учас­ників належать до вікової групи 26-35 років, яка вважається відносно молодою демографічною групою. Поширеність вигорання виявилася відносно високою і становила 68,9% для 95% ДІ (59,4-75,3), де 22,3% де­монстрували високий рівень емоційного виснаження, 45,4% випадків – високий рівень деперсоналізації та низь­кий рівень особистих досягнень у 92,3%. Феномен деперсоналізації в поєднанні з двома іншими областями заслуговує на увагу, при цьому значення p менше 0,05. Варто зазначити, що більшість цих працівників, 62,6%, працюють позмінно з частотою 6-10 днів на місяць. Синдром вигорання корелював із соціально-демографічними факторами (сімейний стан та щомісячний дохід), а також деякими факторами, пов'язаними з роботою (система позмінної роботи, тижневий робочий час, кількість днів у зміні, досвід роботи тощо). Результати цього дослідження свідчать про відносно високу поширеність синдрому вигорання серед учасників (68,9%). Ми рекомендуємо швидке втручання з використанням різних політик або стратегій, які повинні знизити вигорання серед медсестер. Для сприяння одужанню важливо боротися з вигоранням, розпізнавати ознаки надмірної фізичної втоми, звертатися за підтримкою до колег і терапевтів, встановлювати межі та надавати пріоритет турботі про себе.

Burnout has not been characterised as a medical diagnostic category; instead it has been recognised as a psychological syndrome. The term “burnout” was first coined in the 1970s in the USA by Freu­denberger, 1974 [1] and Maslach, 1976 [2]. However, the most precise definition was subsequently pro­vided by Maslach and Jackson, 1981 [3], who speci­fied it as “a syndrome of emotional exhaustion, deper­sonalisation and reduced personal accomplishment that can occur among individuals who do “people-work” of some kind”.

Despite its psychological underpinnings, in the long term, it exerts a direct and detrimental effect on the individual's health [4, 5]. The World Health Organisation (WHO) defines “Burnout” as “an occu­pational phenomenon resulting from the failure to manage prolonged exposure to chronic stressors in the workplace effectively” [6].

This term has been utilised within the occupa­tional medicine area. The manifestation of burnout syndrome is observed to vary in its presentation across diverse professional contexts. The con­sequences of professional burnout have been obser­ved to encompass a wide spectrum of effects, inclu­ding individual health concerns and organisational issues. As posited by Belisha et al., 2025, burnout has been identified as a pervasive problem among medi­cal personnel, particularly those engaged in nursing and general practice [7]. The syndrome has been documented to manifest through three main symp­toms: emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment.

These symptoms are predominantly experienced by the majority of nursing staff [8]. The predominant cause of burnout is identified as emotional ex­haustion. The condition is characterised by a persis­tent state of fatigue, insomnia, and overwhelming stress [9]. As proposed by Petersen et al., 2023, nurses who experience emotional exhaustion frequently en­counter emotional and burnout severity [10], which can impede their capacity to cope effectively with the demands of their professional duties [10,11]. In a further study by Lwiza & Lugazia, 2022, the preva­lence of burnout among healthcare professionals in developed countries was estimated to range from 40% to 55% [12]. Moreover, a report by the World Eco­nomic Forum on the prevalence of burnout in different populations resulted in the following figures for specific countries [13]: The data indicates that 57% of the cases are in the UK, 50% in the US, 37% in Spain, and 30% in Germany and France, respectively [13,14].

The following essay will provide a com­prehensive overview of the relevant literature on the subject. In the context of the national present, the prevalence of bur­nout among medical personnel, with a particular emphasis on nursing staff, remains under-researched. The extant literature on the subject is limited to a handful of recent publications [7,8,15]. This study aims to investigate the pre­valence of occupational bur­nout among nursing professionals at Shkodra Regional Hospital and identify factors contributing to it. Spe­cifically, the objectives include measuring the burnout rate within this population and analysing demographic and occupational factors that affect burnout levels.

MATERIALS AND METHODS OF RESEARCH

This cross-sectional, observational and analytical study was conducted over a 7-month period (Sep­tember 2024 – March 2025) at the Shkodra Regional Hospital using a semi-standardized questionnaire dis­tributed to healthcare professionals (nurses and midwi­fery staff). In this study, it was initially determined that only nursing staff would be included, with the ex­clusion of any medical or auxiliary staff. The inclusion criteria are as follows: the study is open to registered nursing staff working full-time in the hospital setting. Additionally, the study is open to any staff, irrespective of gender, aged between 23 and 65 years, and with a minimum of six months' expe­rience in nursing prac­tice. Staff members who are willing to participate in the study and provide consent will be eligible to take part. The exclusion criteria are as follows: the target demographic group for this study comprises nursing students, interns, and nur­sing staff with less than six months of experience in nursing practice. The sample calculation was con­ducted utilising Me­dicalcul soft­ware, which is an online resource that specialises in numerical compu­tations within the medical field. The anticipated response rate was  estimated to be in excess of 50% of the total nursing population.

The calculation demonstrated that a minimum of 162 participants were required to complete the online questionnaire, ensuring a confidence level of 95% and a true value within a margin of error of ±5% of the measured value. The questionnaire was uploaded to Microsoft Office software, after which the link was disseminated to all nurses via the WhatsApp website, Messenger, Facebook, and personal e-mails. At the commencement of each month for a period of appro­xi­mately three months, a reminder was dispatched to the participants to complete the questionnaire. Regis­tered nurses who completed the questionnaires also com­pleted and signed the consent forms. In conclu­sion, the data  from 130 nurses, who had completed all the  questions as requested by the working group,  were analysed.

In order to assess the determinants of excessive burnout severity, data were collected on a range of sociodemographic variables including, but not limi­ted to, age, sex, residence, marital status, number of family members, educational level and family income. In addition, information was collected on the charac­teristics and work experiences of the nursing staff in order to provide a comprehensive overview of the subject matter. The second questionnaire is the stan­dardized Maslach Burnout Inventory (MBI), which was developed and validated by Maslach & Jackson in 1981 [3]. This questionnaire is regarded by many researchers as the gold standard for measuring and assessing burnout in different professions [16, 17, 18, 19]. Its high reliability and validity are well-docu­mented. The MBI is comprised of three distinct sections. The initial section concerns Emotional Ex­haustion (EE), whereby individuals present with symp­toms of fatigue in the workplace, chronic fatigue, sleep disturbances, and physical ailments. The second section is dedicated to Depersonalisation (DP), which can be defined as a form of "dehu­manisation" that manifests in interpersonal rela­tionships. The third section of the questionnaire is entitled Personal Ac­complishment (PA). In this section, individuals expe­rience a diminution in PA, frequently receiving a nega­tive appraisal and per­ceiving an inability to progress a situation. A high score in the first two sections and a low score in the last section may be indicative of burnout. It is imperative to note that all questions in this ques­tionnaire are formulated as statements per­taining to personal sentiments or dispositions.

The frequency scale is labelled on each point, starting from 1 to 7, with 1=Never; 2=Few times a year; 3=Once a month; 4=Few times a month; 5=Once a week; 6=Few times a week; 7=Everyday. Following the adaptation of the questionnaire into Albanian, the translated version was evaluated by three specialists in the field. The evaluation was then conducted in a pilot study phase. Following the pilot phase and the implementation of minor linguistic mo­di­fications, the MBI test was subjected to an eva­luation of its reliability and consistency with the Cron­bach alpha test. The alpha value was found to be 0.79.

The initial step in commencing the work for this study was to apply to the ethics committee at the University of Medicine, Tirana, for approval. Firstly, all documentation related to the purpose of the study, the methodology to be employed, the expected results and the involvement of health workers was prepared. Subsequently, the do­cumentation was submitted to the University of Medicine’s Ethics Committee in Tirana for the purpose of obtaining approval and authorisation for the study. Following the received ethical approval from the relevant committee, the investigators proceeded to present themselves to the hospital directorate at which the study was to be conducted. The individuals responsible for authori­sing and facilitating the execution of this study by the medical personnel have taken measures to ensure that the highest standards of research integrity have been adhered to. The working group convened a prelimi­nary meeting with the employees, during which the purpose and objectives of the study were com­municated to each participant. It was emphasised that participation in the study was voluntary and that employees were at liberty to withdraw from the study at any time. It was explained to each participant that no incentives or gifts would be offered. Each par­ticipant was assured of the main­tenance and storage of the data, with confidentiality guaranteed for any data provided by them. The survey was completed within a time frame of over 30 minutes.

The Excel file obtained from Microsoft software underwent statistical processing in IBM Statistics software SPSS, version 26.0 Issue, DT449052. The data were presented as frequency and percentage, as well as mean and standard deviation (SD). The statistical analysis was conducted using a combi­nation of student t-test, linear correlation, and linear regression analysis. In the context of categorical data, the statistical analysis employed was the chi-squared test. The level of significance adopted was p<0.05.

RESULTS AND DISCUSSION

In the context of this cross-sectional and des­criptive study, it is important to reiterate the exclu­sionary criteria previously outlined in the methodo­logy section. Specifically, the study focused exclu­sively on nursing and midwifery staff, with the former constituting 83.2% of the sample and the latter making up 16.8%. As illustrated in Table 1, the descriptive socio-demographic data of 131 medical personnel participants is presented, with a mean age of 35.35±10.37, a minimum age of 18 years, and a maximum of 64 years. The data indicates that almost 38.2% of the participants belong to the 26-35 age group, which is considered to be a relatively young demographic. The majority of the subjects are female, accounting for 71.8% of the total, and approximately 74.8% of the participants reside in urban areas. It is important to note that 28.2% of the participants in this study reside with family members, including spouses, children, and parents.

Furthermore, 27.5% of the participants live solely with parents, and it is noteworthy that the majority of these families consist of four to six members (58.2%). With respect to familial income, the majority of respondents (48.9%) reported a family income ran­ging from 60,001 to 100,000 lek (Table 1).

The second section of the questionnaire, which was drafted by the working group, concerns itself with the issue of employment data and the working hours that respondents perform on a daily basis at the Shkodra Regional Hospital. As anticipated, the vast majority of the participants, approximately 97.7%, are engaged in full-time employment at this institution, with a mere 2.3% engaged in part-time or temporary contractual arrangements.

With regard to the work experience of the medical staff (nurses and midwives), it is evident that a signi­ficant proportion of the sample, constituting 33.6% of the total, have length of service from one and five years of experience. However, it is noteworthy that the majority of these workers, 62.6%, are engaged in shift work, while only 37.4% adhere to a standard 8-hour workday. In this study, approximately 50% of the participants (49.6%) reported working on the second shift, with a frequency of 6-10 days per month. Meanwhile, 47.3% of the participants indi­cated that they worked on the third shift, with a frequency of 6-10 times per month.

Furthermore, it was observed that approximately one-third of the participants (29.8%) had been working in shifts for 1-5 years. A mere 9.2% of nurses and midwives have been working in shifts for less than one year, while 6.9% have been working in shifts for more than 20 years (Table 2).

The following figure presents the levels of burnout experienced by nursing staff for each of the MBI test areas. In the context of the "Emotional Exhaustion" area, 22.3% of the nursing staff exhibited high levels of burnout, while 57.7% demonstrated moderate sym­ptoms. Notably, only 20% of the participants exhibited low levels of burnout. In the case of the “Deperso­nalisation” area, 45.4% of cases resulted in high levels of burnout, while 54.6% resulted in mode­rate levels. There were no cases of low burnout. With regard to the “Personal Accomplishment” area, 3.1% of subjects have been identified as experiencing high levels of burnout, 4.6% are exhibiting moderate sym­ptoms, and 92.3% demonstrate low levels of burnout (Fig.).

The following table illustrates the correlation statistics of the scores collected for the three MBI areas. As demonstrated in Table 3, a positive cor­relation between emotional exhaustion and deper­sonalisation is evident. Furthermore, DP has been found to correlate with both EM and PA, no­netheless, a negative correlation is evident in the latter case. The phenomenon of depersonalization, in conjunction with two other areas, is worthy of consideration. In all cases, the p-value was found to be less than 0.05 (Table 3).

In the subsequent table, we have presented the correlations between risk factors and the extent of burnout, according to each area. As is apparent from the data, a significant relationship (positive/negative) is observed between one, two or three domens and several factors, including marital status, family monthly income, employment status, profession, work system, hours of work based on the work system, and the number of times the third shift is worked. The issue of staff shortages, necessitating the replacement of other personnel, is one that is frequently encountered. The question of being over­loaded at work is also one that is pertinent. The purpose of this study is to ascertain the level of job satisfaction experienced by respondents. The present study seeks to ascertain whether respondents are satisfied with the conditions of their working environment. What is the nature of your relationship with your colleagues? The final question pertains to the question of whether the individual in question has the support of their superiors in their professional endeavours. In all cases, the p-value was found to be less than 0.05 (Table 4).

Burnout, a syndrome that has the potential to affect healthcare systems on a global scale, has been referred to as the "disease of the 21st century" [7]. The issue of excessive burnout severity in our country has not been the focus of significant research interest, resulting in a paucity of analysis and examination of the predisposing factors that contribute to it. The present study examines the prevalence of the afo­rementioned syndrome and its correlation with socio-demographic and professional variables that contri­bute to the condition among healthcare personnel (nursing). The prevalence of burnout among 131 nurses was found to be relatively high at 68.9%, with a 95% confidence interval of [59.4 to 75.3]. The mean value of the EE area was found to be 24.59 for 95% CI [19 to 30], while the participants with the highest EE resulted in 22.3%. The mean value of DP resulted in 13.04 for 95% CI [8-16], where 45.4% of the participants appear to have high DP. The mean value for the PA area was found to be 53%, with a 95% confidence interval of [48.5 to 56]. This indi­cates a prevalence of low PA, with 92.3% of the participants demonstrating this level of physical activity. This value is relatively high, as demonstrated by a study conducted by Heinen et al., which assessed the prevalence of burnout in 10 European countries. This prevalence was on an average of 28% of nursing staff, where the lowest prevalence was observed in employees in the Netherlands with 10% and the highest in employees in England with 42% [20]. Conversely, the prevalence observed in this study was lower than that reported by Mathkour et al., who found a prevalence rate of burnout among healthcare workers in 73.3% of participants [21]. A substantial body of research has identified various sociode­mographic factors [e.g., gender, marital status] and work-related factors [e.g., weekly work hours, monthly night shifts, years of experience, sleep quality, depressive symptoms, anxiety symptoms] as significant contributors to the development of high burnout [22, 23, 24]. In relation to factors such as gender, research indicates that women are more likely to experience physical fatigue syndrome than men [25]. The present study found no significant rela­tionship, which is consistent with the findings of another study [12]. The impact of marital relation­ships and family stability on individual lives has been demonstrated to be a positive one.

Conversely, an unstable relationship has been shown to engender stress, which can in turn com­promise work performance and quality of life [26, 27]. This, in turn, has the potential to increase the risk of burnout syndrome. The findings of this study revealed no significant relationship between burnout and marital status, a finding that aligns with the results of a previous study [26, 27]. A number of studies have indicated that the combination of factors, including extended working hours, shift work sys­tems, protracted work hours, work experience, rela­tionships with colleagues and superiors, fre­quently contributes to elevated levels of stress among em­ployees, who often report a high degree of burnout [24-28]. In the majority of cases, these employees are potentially vulnerable groups susceptible to excessive fatigue.

The findings of the present study are consistent with those of previous studies, for some of the variables such as marital status, family monthly in­come, profession, work systems, weekly hours at work, working time days/hours, etc. For each of these variables, a strong correlation was identified between one, two or three areas of the MBI questionnaire, with a p value less than 0.05%. It is imperative to acknow­ledge the limitations of this study when interpreting the findings. Firstly, the number of nursing staff included was minimal. Secondly, the study focuses exclusively on nursing staff, excluding all other medical personnel. This methodological decision is pivotal in enabling a meaningful comparison between the two groups. Thirdly, the decision was taken to utilise the method of data collection through self-reported questionnaires. However, the reliability of this method of completion is questionable, given the observed discrepancy between cases that refer to depersonalisation and those that demonstrate low per­sonal achievement in their work. This discrepancy may introduce a degree of bias into the responses. Not­withstanding the aforementioned limitations, the study successfully achieved its objectives and con­stitutes a valuable resource as it is the inaugural study to inves­tigate the prevalence of burnout syn­drome and its asso­ciated factors among healthcare workers in Shkoder.

CONCLUSION

1. This study has determined a relatively high prevalence rate (68.9%) of burnout syndrome within the surveyed population. A significant proportion of the nursing staff exhibited elevated levels of burnout in the Depersonalisation area, with 45.4% demon­strating high Emotional Exhaustion and 24.59% exhibiting low Personal Accomplishment.

2. The present study identified several factors that were found to be significantly associated with bur­nout syndrome. These factors included sociodemo­graphic factors, such as marital status and monthly income, as well as work-related factors, including shift work system, weekly working hours, days on shift, and work experience.

3. In order to facilitate recovery, it is essential to address burnout, recognise signs of excessive phy­sical fatigue, seek support from colleagues and thera­pists, set boundaries, and prioritise self-care.

4. In view of the high prevalence of burnout, it is re­commended that prompt intervention be made with various policies or strategies that should lead to a re­duction in the incidence of burnout among nursing staff.

5. Achieving an equilibrium between opportu­nities and work performance is a crucial factor in effective stress management, which will reduce burnout and enhancement of quality of life among healthcare workers. In addition to this, a superior standard of patient care is provided.

Contributors:

Belisha (Hoti) S. – conceptualization, methodo­lo­gy, investigation, project administration, writing – review & editing;

Zekja I. – project administration, supervision, me­thodology, writing – review & editing;

Petri O. – methodology, investigation, data cura­tion, writing – original draft, formal analysis;

Brati (Kika) B. – methodology, formal analysis, in­vestigation, data curation, writing – original draft;

Fresku E. – data curation, formal analysis, super­vision, writing – original draft;

Ali E. – supervision, methodology, investigation, writing – review & editing;

Kraja J. – methodology, investigation, formal analysis, writing – review & editing;

Koja Gj. – investigation, formal analysis, wri­ting – original draft;

Abazaj E. – conceptualization, methodology, in­vestigation, project administration, data curation, formal analysis, supervision, writing – original draft; writing – review & editing.

Acknowledgements

It is imperative to express our profound gratitude to all those members of staff whose invaluable contri­butions were instrumental in the design, imple­men­tation and completion of this study. Secondly, gra­titude is extended to all nursing staff of Rajonal Hospital of Shkodra, who participated in this study, responding promptly to the invitation and completing the form in an expeditious manner.

Funding. This research received no external funding.

Conflict of interests. The authors declare no conflict of interest.

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