MPH 598 Week 4 Burnout Evidence Brief Example

Burnout Evidence Brief: Do Long Night Shifts Raise Burnout Risk for Hospital Clinicians, and Do Schedule Changes Help? What Four Studies Say to a Respiratory Therapy Manager

Student Name

Chamberlain University

MPH 598: Student Success and Self-Care

Instructor Name

Month Day, Year

Burnout Evidence Brief: Do Long Night Shifts Raise Burnout Risk for Hospital Clinicians, and Do Schedule Changes Help? What Four Studies Say to a Respiratory Therapy Manager

The Question and Why It Is Asked

This brief asks a narrow question: are long and rotating night shifts associated with burnout among hospital clinicians, and is there evidence that changes to how work is organized reduce burnout? It is written for my manager in the respiratory therapy department of a regional hospital, because next week I will ask for a fixed night schedule for the rest of my term, and the request will be stronger if it rests on evidence rather than on my preference. Four studies carry the brief. Each is introduced with who was studied, because a finding about one group does not automatically apply to another.

Evidence on the Problem

Nurses on 12-hour shifts. Dall'Ora et al. (2015) surveyed 31,627 registered nurses working on general medical and surgical units in a dozen European countries. Set against colleagues on shifts of eight hours or less, nurses whose shifts lasted twelve hours or longer showed higher odds of high emotional exhaustion (adjusted odds ratio 1.26), depersonalization (1.21) and low personal accomplishment (1.39), and higher odds of intending to leave their job because of dissatisfaction (1.29). The exposure was shift length as reported by nurses, and because everything was measured at one time point, the study shows association rather than cause; nurses who chose long shifts may differ from those who did not.

Public health workers in a prolonged response. Stone et al. (2021) surveyed U.S. public health workers during the COVID-19 response in 2020 and found that 66.2% reported burnout, with higher prevalence among those with more years of experience. The population and the exposure, a sustained emergency, differ from mine, but the study shows that long periods of extended hours affect workers outside bedside care too.

Evidence on the Response

Physicians in intervention studies. West et al. (2016) pooled 15 randomized trials and 37 cohort studies of interventions to reduce burnout among physicians. Overall burnout fell from 54% to 44% across the studies. Both individual approaches, such as mindfulness and stress management training, and structural approaches, such as changes to schedules and workload, were associated with improvement.

Physicians in controlled trials. Panagioti et al. (2017) pooled 20 comparisons from 19 controlled studies of physicians and found small reductions in burnout overall. Interventions directed at the organization, such as changes to schedules, teamwork or workload, were associated with larger effects than those directed only at individual physicians.

Table 1

Four Studies on Burnout and Its Reduction

Note. Note. Summaries from the published abstracts and results of each study.

The Transfer Sentence

None of these studies was done with respiratory therapists. Respiratory therapists in my hospital work the same 12-hour shift pattern as the nurses in Dall'Ora et al. (2015), share the same units and handover practices and face the same night work, so the association between long shifts and burnout is likely to apply to us, though the strength may differ. The intervention evidence comes from physicians, whose work and autonomy differ more from ours; it supports the general point that changing how work is organized can reduce burnout, but not a specific size of effect for a therapy department.

What This Means for the Request

My request is not to work fewer hours but to work the same three nights each week for five weeks instead of rotating. The evidence does not test fixed versus rotating nights directly, and I will not claim it does. What it supports is narrower: long shifts carry a burnout risk, and changes to how schedules are organized are among the approaches associated with reduced burnout. A fixed pattern reduces the strain of switching between day and night sleep, which is a plausible part of that risk, and it costs the department nothing in hours.

Why an Employer Reads This

Burnout matters to an employer because it is linked to intention to leave. In the nurse survey, those on 12-hour shifts were more likely to report intending to leave their job (Dall'Ora et al., 2015), and replacing a respiratory therapist costs the department recruiting time, orientation and overtime while the post is empty. A small schedule accommodation that helps a staff member through a demanding term is cheaper than a vacancy. It is also a modest test of the organization-directed approach the evidence favors; if it works for one therapist, the department could consider offering fixed patterns to others who want them.

Limits of This Brief

The brief draws on four studies, chosen for relevance rather than through a systematic search. Two are cross-sectional and cannot show cause. The intervention evidence concerns physicians. And none of the studies addresses graduate students who work full time, a group whose combination of strains may differ again.

How the Studies Were Chosen

The four studies were chosen to answer the two halves of the question. For the problem, I searched for studies of shift length and burnout among hospital clinicians and chose the largest, the European nurse survey, because its population works the same 12-hour pattern as respiratory therapists. I added the public health workforce survey because I am training to work in public health, where extended hours during emergencies are common. For the response, I chose the two most cited meta-analyses of burnout interventions, both in physicians, because no comparable reviews exist for respiratory therapists. I did not include studies of medical students or of interventions delivered outside health care, because their populations differ too much from the reader's staff. A fuller brief would search for studies of allied health professionals directly, and I would expect to find fewer and smaller studies than for nurses and physicians, which is itself worth telling the manager.

References

Dall'Ora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, L. H. (2015). Association of 12 h shifts and nurses' job satisfaction, burnout and intention to leave: Findings from a cross-sectional study of 12 European countries. BMJ Open, 5(9), e008331. https://doi.org/10.1136/bmjopen-2015-008331

Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., Dawson, S., van Marwijk, H., Geraghty, K., & Esmail, A. (2017). Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Internal Medicine, 177(2), 195-205. https://doi.org/10.1001/jamainternmed.2016.7674

Stone, K. W., Kintziger, K. W., Jagger, M. A., & Horney, J. A. (2021). Public health workforce burnout in the COVID-19 response in the U.S. International Journal of Environmental Research and Public Health, 18(8), 4369. https://doi.org/10.3390/ijerph18084369

West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet, 388(10057), 2272-2281. https://doi.org/10.1016/S0140-6736(16)31279-X