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BMJ Open
BMJ Open
bmjopen
bmjopen
BMJ Open
2044-6055
BMJ Publishing Group BMA House, Tavistock Square, London, WC1H 9JR

39182929
10.1136/bmjopen-2024-084522
bmjopen-2024-084522
Original Research
Occupational and Environmental Medicine
1716
1506
Relationship between burnout and occupational fatigue exhaustion and recovery among orthopaedic nurses in Tabriz, Iran: a cross-sectional survey
Moosavian Hiaq Seyyed Sadegh 1moosavianseyedsadegh@gmail.com

http://orcid.org/0000-0002-0497-211X
Jabbarzadeh Tabrizi Faranak 1jabbarzadehf@tbzmed.ac.ir

Parvan Kobra 1ParvanK@tbzmed.ac.ir

Sarbakhsh Parvin 2p.sarbakhsh@gmail.com

Dickens Geoffrey 3GEOFFREY.DICKENS@NORTHUMBRIA.AC.UK

1 Tabriz University of Medical Sciences Faculty of Nursing and Midwifery, Tabriz, Iran (the Islamic Republic of)
2 Health and Environment Research center, Tabriz university of Medical science, Tabriz, Iran
3 Nursing Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
DrFaranakJabbarzadeh Tabrizi; jabbarzadehf@tbzmed.ac.ir
None declared.

2024
24 8 2024
14 8 e08452221 1 2024
26 7 2024
Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Abstract

Objective

To examine the relationship between burnout and occupational fatigue exhaustion and recovery among orthopaedic nurses in Tabriz, Iran.

Design

Descriptive, cross-sectional survey and correlational analysis.

Setting

Two hospitals associated with Tabriz University of Medical Sciences, Iran, from August to September 2022.

Participants

92 bedside nurses in orthopaedic wards, each with >1 year of clinical experience.

Outcome measures

Burnout was assessed using the Copenhagen Burnout Inventory, and occupational fatigue exhaustion/recovery was measured with the Occupational Fatigue Exhaustion/Recovery Scale. Pearson’s correlation, independent t-test, one-way analysis of variance and multivariable linear regression analyses determined statistical significance.

Results

The mean burnout score was 63.65 (±15.88) out of 100 and the recovery rate was 35.43 (±15.60) out of 100. There were significant correlations between total burnout and each of the exhaustion recovery dimensions: chronic fatigue (r=0.70), acute fatigue (r=0.65) and intershift recovery (r=0.56). Nurses exceeding 44 weekly work hours reported higher burnout (66.52±14.77, p=0.005) than those working fewer hours (56.25±16.12, p=0.005). Rotational shift status was associated with increased burnout (64.97±15.32) compared with fixed shifts (55.54±17.42, p=0.04). Chronic fatigue (B=0.39, 95% CI 0.21, 0.57; t=4.29, p<0.001) and intershift recovery (B=−0.241, 95% CI −0.46, −0.02; t=−2.16, p=0.035) were significant predictors of burnout.

Conclusions

Burnout is a critical concern among orthopaedic nurses and is significantly linked to occupational fatigue/recovery. Addressing chronic fatigue and enhancing intershift energy recovery could mitigate burnout risk. Therefore, optimising work conditions and schedules and developing tailored recovery protocols are vital to safeguarding orthopaedic nurses’ well-being.

burnout
fatigue
nurses
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pmcSTRENGTHS AND LIMITATIONS OF THIS STUDY

This study explores the link between job burnout and fatigue recovery in orthopaedic nurses, providing fresh insights into key factors.

The sample size surpassed the predetermined target, enhancing the statistical robustness of the study.

The use of a regression model provided a predictive analysis of burnout risk among orthopaedic nurses based on study variables.

The study’s cross-sectional design limits the ability to establish causality in the relationships identified.

The research was confined to orthopaedic nurses from two major medical centres in Tabriz, which may limit generalisability of the results to other regions or settings.

Introduction

Burnout is an occupational phenomenon that has negative psychological effects such as anxiety and depression,1 2 as well as physical effects, which may increase the risk of cardiovascular diseases, type 2 diabetes and all-cause mortality.2 The WHO recently recognised burnout as a serious health issue in the International Classification of Diseases, 11th Revision.3 Burnout is defined by Maslach and Jackson as a psychological syndrome that includes emotional exhaustion, depersonalisation and reduced personal accomplishment.4

A review study in 2020 found that the average prevalence of burnout symptoms among nurses worldwide is 11.23%.3 There is considerable variation in the findings of studies on burnout in hospital nurses in Iran.57 For example, one study found that nurses in psychiatry wards had higher levels of emotional exhaustion and depersonalisation than nurses in other wards,5 while a second revealed that nurses in the emergency department were more stressed and burned out.8 These findings suggest that burnout in hospital nurses may partly depend on the context and work setting and indicate that more studies are needed to explore this issue.5

Studies have explored the factors that are associated with burnout among nurses in various settings. For instance, burnout in trauma nurses was linked to having a mental health diagnosis and working with adult populations,9 while in gastroenterology nurses it was related to increased workload and more night shifts.10 Other factors such as leadership style,11 organisational challenge, workplace culture and extra hours12 were also associated with burnout. Considering the range of factors influencing burnout across various nursing specialties, further research is needed to examine these dynamics within the broader context of nursing work environments.5

Occupational fatigue, a multifaceted syndrome resulting from high work demands and inadequate recovery,13 is particularly relevant to orthopaedic nursing due to the demanding nature of the work.14 Fatigue consists of both acute and chronic elements.15 Acute fatigue is a normal response to intense mental and/or physical work, emotional stress, insufficient recovery or temporary illness.16 While acute fatigue drains the energy necessary for daily life beyond work, curtailing the joy of leisure pursuits, it is subject to the rejuvenating powers of rest, sleep and a balanced regimen of diet and exercise.17 Chronic fatigue, on the other hand, is a complex and persistent combination of mental, physical and emotional fatigue that does not improve with rest.18 One theory suggests that chronic fatigue can develop from acute fatigue if workers do not have enough energy recovery between periods of working. Based on this, Winwood et al19 have defined occupational fatigue exhaustion recovery as the combination of work-related acute fatigue, and the fatigue caused by the lack of energy recovery between shifts. A distinctive aspect of Winwood et al’s19 definition of occupational fatigue exhaustion recovery, and the associated measurement scale formulated in accordance with this definition, is the emphasis on evaluating the contribution of between-shift recovery.20

Orthopaedic nursing, characterised by the care of patients with chronic conditions requiring long-term management,8 presents unique challenges21 that may predispose nurses to higher levels of burnout.22 The physicality of assisting patients with mobility coupled with the emotional toll of managing chronic pain distinguishes orthopaedic nursing from other specialties.14 Yet, to date, there have been few studies on job burnout in nurses working in the orthopaedic department. Further, while some studies indicate that these nurses have a high rate of burnout,2 22 more knowledge is required regarding the factors that potentially contribute to burnout.23 This study aims to fill this gap by examining the relationship between job burnout and occupational fatigue recovery among orthopaedic nurses. By investigating the interplay between burnout and recovery from work-related fatigue, the study seeks to inform the development of targeted interventions to mitigate burnout and enhance the resilience of orthopaedic nurses, ultimately contributing to improved patient care and nurse retention in this essential specialty.

Methods

Study design

This was a cross-sectional survey study with a descriptive correlational analysis.

Setting and participants

The study was conducted in Tabriz, the capital city of the East Azerbaijan province in northwest Iran. The Tabriz University of Medical Sciences encompasses orthopaedic centres in two hospitals. The first is a specialised orthopaedic hospital with multiple wards that caters to a substantial number of orthopaedic patients and functions as a referral centre. The second is an orthopaedic ward located within one of the largest hospitals in the city. These two hospitals were selected as the study settings.

The participants were bedside nurses who worked in the orthopaedic wards and had direct contact with patients. The inclusion criteria were having an associate’s, bachelor’s or master’s degree in nursing, at least 1 year of clinical work experience in the study setting, and working in either a rotating or a fixed shift pattern with direct patient contact. The total population of orthopaedic nurses available during the study period was 128, all of whom were invited to participate in the study. Of those invited, 15 nurses declined to participate and 20 were excluded based on the inclusion criteria after the initial assessment. Further, one nurse was excluded due to non-response to more than 40% of the questionnaire items. Consequently, data provided by 92 nurses were included in the final analyses.

The sample size required to detect a correlation equal to 0.3 between burnout and fatigue,24 based on the following sample size formula to determine whether the correlation coefficient differs from zero,25 taking into account 95% confidence and 80% power, was 85.

α=two-tailed; threshold probability for rejecting the null hypothesis; type I error rate.

β=probability of failing to reject the null hypothesis under the alternative hypothesis; type II error rate.

r=the expected correlation coefficient.

Standard normal deviate for α: Zα=1.96.

Standard normal deviate for β: Zβ=0.84.

C=0.5×ln⁡[(1+r1−r)]=0.309

N=[(Zα+Zβ)/C]2+3=85

The data for this study were collected by the first author, who was not employed in any of the study settings, from August to September 2022. The study objectives were explained and questionnaires distributed to nurses during their shifts. Nurses were asked to complete them at their convenience, such as during breaks or at their preferred time.

Measures

The data collection instruments consisted of three parts: a demographic and work questionnaire, the Copenhagen Burnout Inventory (CBI)26 and the Occupational Fatigue Exhaustion/Recovery Scale (OFER).27

Demographic questionnaire

The demographic questionnaire included items on age, sex, marital status, education level, employment type, experience (total in this hospital and in the orthopaedic ward), shift pattern, dominant shift, amount of overtime worked, number of patients supervised per shift and antidepressant use (see table 1 for details).

Table 1 Demographic characteristics of study participants working in the orthopaedic department of Tabriz medical education centres in 2022

Demographic information	Category	Frequency	%	
Age	21–25	12	13.64	
26–30	23	26.14	
31–35	16	18.18	
36–40	13	14.77	
41–45	16	18.18	
46–50	7	7.95	
51–55	1	1.14	
Gender	Male	19	21.35	
Female	70	78.65	
Marital status	Married	56	62.22	
Others (single, divorced, etc)	34	37.78	
Education	Associate	3	3.49	
Bachelor	77	89.53	
Master	6	6.98	
Type of employment	Permanent	57	64.77	
Temporary to permanent	6	6.82	
Contractual	2	2.27	
Conscription law’s conscript	16	18.18	
Others	7	7.95	
Experience (years)	1–5	25	27.78	
6–10	22	24.44	
11–15	21	23.33	
16–20	15	16.67	
21–25	7	7.78	
Experience in the hospital (years)	1–5	35	38.46	
6–10	19	20.88	
11–15	21	23.08	
16–20	13	14.29	
21–25	3	3.30	
Experience in the orthopaedic ward (years)	1–5	55	60.44	
6–10	24	26.37	
11–15	10	10.99	
16–20	2	2.20	
Type of shifts	Fixed	14	15.38	
Rotational	77	84.62	
Dominant shift	Morning	17	18.68	
Evening	9	9.89	
Night	27	29.67	
Others	38	41.76	
Work hours in a week	Less than 44 hours	24	28.92	
44 hours	2	2.41	
More than 44 hours	57	68.67	
Number of overtime shifts in a month	No overtime shift	8	10.00	
1–5	35	43.75	
6–10	34	42.50	
More than 10	3	3.75	
Number of under-care patients in each shift	1–5	2	2.41	
6–9	9	10.84	
10–15	52	62.65	
16–20	15	18.07	
More than 20	5	6.02	
History of antidepressant use	Yes	11	12.09	
No	80	87.91	

Measurement of burnout

The CBI was developed and validated by Kristensen et al.26 This scale comprises 19 items across three domains (personal burnout: 6 items; work burnout: 7 items; and client-related burnout: 6 items). Personal burnout is a measure of general fatigue and exhaustion, while work and client burnout dimensions relate to engagement within the work setting and with clients. The items are rated on 5-point Likert scales. For personal burnout, this ranges from ‘always’ (100), ‘often’ (75), ‘sometimes’ (50), ‘rarely’ (25) and ‘never’ (0). In the dimension of work-related burnout, the first three items are rated ‘very intense’, ‘intense’, ‘somewhat’, ‘little’ and ‘very little’, and the remaining four items are rated ‘always’, ‘often’, ‘sometimes’, ‘rarely’ and ‘never’. In the dimension of client-related burnout, the first four items are rated ‘very intense’, ‘intense’, ‘somewhat’, ‘little’ and ‘very little’, and the final two items are rated ‘always’, ‘often’, ‘sometimes’, ‘rarely’ and ‘never’. The scores of each dimension are calculated separately as a mean per item score (range 0–100) and presented alongside a mean per item total score (range 0–100). The mean per item burnout score in each dimension is interpreted as follows: low (0–25), average (25.01–50), high (50.01–75) and very high: (75.01–100). In a study in Iran, the internal reliability (α) of the questionnaire among nurses was reported at 0.7.28 In the current study, the internal reliability (α) was found at 0.92, indicating a high level of reliability among the items and suggesting that the questionnaire items are consistently measuring the same construct.

Occupational Fatigue Exhaustion/Recovery Scale

This tool was designed by Winwood et al.27 In the current study, the Persian version of the scale, validated by Javadpour et al,29 was used. The scale has been used in different occupational populations, and good internal reliability (α=0.8–0.85) has been reported. Since this tool measures both chronic and acute fatigue, it appears to be one of the most suitable tools for measuring occupational fatigue.29 The tool has three subscales (OFER-CF (chronic fatigue): five items; OFER-AF (acute fatigue): five items; OFER-IR (intershift recovery): five items). Each item is measured on a 7-point Likert scale (from 0=strongly disagree to 6=strongly agree). Positive and negative statements are scored across all three dimensions, with relevant items being reverse-scored. Consequently, the total possible score for each dimension ranges from 0 to 30. To facilitate comparison, scores for each dimension are normalised on a scale from 0 to 100. As a result, the scores of each dimension range from 0 to 100, with higher scores indicating more intensity of that dimension.29

Statistical analyses

The data analysis was conducted using SPSS V.20 software. The normality of the quantitative variables was assessed first, using the Kolmogorov-Smirnov test, skewness and kurtosis coefficients, and graphical methods. Normally distributed quantitative data were summarised with mean and SD, and non-normally distributed quantitative data were summarised with median and IQR. Categorical data were presented with frequency and percentage. Coefficients ranging from ±0.50 to 0.69 indicate a moderate positive/negative correlation, coefficients from ±0.70 to 0.89 suggest a high correlation and those above ±0.90 denote a very high correlation.30 Associations between burnout and categorical demographic variables were assessed with the independent t-test and one-way analysis of variance. Multivariable linear regression analysis was used to identify independent predictors of burnout based on the demographic variables and dimensions of OFER. All statistical analyses were conducted at a significance level of p=0.05.

Consent to participate

The purpose of the study was explained to the participants and written informed consent was obtained.

Patient and public involvement

None.

Results

Demographic characteristics of the participants

The total eligible population was 108 and 92 nurses completed the survey, with a response rate of 85%. Majority of the participants were aged 26–30. Women comprised 78.7% of the sample. More than half of the sample (62.2%) were married (table 1).

Burnout and occupational fatigue exhaustion and recovery scores

The mean per item total burnout score was 63.65±15.88 out of 100 and the recovery rate of nurses from fatigue exhaustion between shifts was low at 35.43±15.60 out of 100 (table 2).

Table 2 Mean and SD of the per-item scores on CBI and OFER

Variable	Mean	SD	
CBI	
 Personal burnout	67.43	17.76	
 Work-related burnout	67.51	19.78	
 Client-related burnout	53.85	19.25	
 Total burnout	63.65	15.88	
OFER	
 Chronic fatigue	63.47	21.38	
 Acute fatigue	70.39	17.75	
 Intershift recovery	35.43	15.60	
CBICopenhagen Burnout InventoryOFEROccupational Fatigue Exhaustion/Recovery Scale

Relationship between total burnout and all occupational fatigue exhaustion/recovery dimensions

There were significant positive correlations between mean per item total burnout score and each occupational fatigue exhaustion recovery dimension (p<0.001); mostly these indicated moderate correlations. Correlations between mean per item total burnout and OFER-CF, OFER-AF and OFER-IR were 0.70, 0.65 and 0.56, respectively (table 3).

Table 3 Correlation between burnout dimensions and occupational fatigue exhaustion/recovery dimensions

	Burnout dimensions	
Personal burnout	Work-related burnout	Client-related burnout	Total burnout	
Occupational fatigue exhaustion/recovery dimensions	
 Chronic fatigue	r=0.59, p<0.001*	r=0.66, p<0.001*	r=0.46, p<0.001*	r=0.70, p<0.001*	
 Acute fatigue	r=0.56, p<0.001*	r=0.65, p<0.001*	r=0.37, p<0.001*	r=0.65, p<0.001*	
 Intershift recovery	r=−0.51, p<0.001*	r=−0.53, p<0.001*	r=−0.37, p<0.001*	r=−0.56, p<0.001*	
* p≤0.05.

Relationship between burnout and demographic variables

Bivariate analysis revealed a significant relationship between working hours per week and job burnout using the independent t-test. Burnout score in nurses with more than 44 work hours per week was 66.52 (SD=14.77) compared with 56.25 (SD=16.12) in nurses working less than 45 work hours per week (p=0.005).

Also, the t-test indicated a significant relationship between type of shifts and job burnout (p=0.04). Burnout score was higher in those working rotational shift patterns (mean score=64.97, SD=15.32) than in those working fixed shifts (mean score=55.54, SD=17.42).

No significant relationships were detected between job burnout and gender, marital status, education, type of employment, years of experience, work history in the hospital, years of experience in the orthopaedic ward, dominant shift, number of overtime shifts in a month or history of antidepressant use using Spearman’s correlation coefficient, t-test and analysis of variance test (p>0.05). There was a significant relationship between age and burnout (p=0.050) (table 4).

Table 4 Association between burnout score and demographic variables

Variable	Category	Mean	SD	P value	
Age	21–25	70.17	13.99	0.050*	
26–30	70.42	11.81	
31–35	57.97	15.19	
36–40	58.19	19.94	
41–45	60.57	16.18	
46–55	66.94	14.58	
Gender	Female	64.44	16.02	0.320	
Male	60.31	15.71	
Marital status	Married	61.79	17.23	0.145	
Others	66.85	13.13	
Education	Associate	59.21	19.38	0.514	
Bachelor	64.65	15.72	
Master	57.67	17.91	
Type of employment	Permanent	63.28	16.09	0.640	
Temporary to permanent	63.37	15.48	
Contractual	53.28	23.26	
Conscription law’s conscript	68.50	10.67	
Others	61.27	21.72	
Experience (years)	1–5	68.29	11.12	0.220	
6–10	58.28	19.71	
11–15	61.53	16.03	
16–20	60.83	17.41	
21–25	60.76	16.60	
Experience in the hospital (years)	≤5	65.59	14.77	0.659	
6–10	63.05	17.42	
11–15	60.83	16.44	
≥16	60.64	17.72	
Experience in orthopaedic ward (years)	≤5	62.44	15.34	0.449	
6–10	67.39	16.67	
≥11	61.63	19.46	
Work hours in a week	≤44	56.25	16.12	0.005*	
>44	66.52	14.77	
Type of shifts	Fixed	55.54	17.42	0.041*	
Rotational	64.97	15.32	
Dominant shift	Morning	62.92	12.05	0.722	
Evening	64.03	14.39	
Night	60.91	16.74	
Others	65.52	17.41	
Number of overtime shifts in a month	No overtime shift	65.22	9.70	0.749	
1–5	61.97	16.13	
6–10	60.77	17.73	
≥11	70.17	0.75	
History of antidepressant use	Yes	70.22	13.20	0.138	
No	62.60	16.12	
* pP ≤0.05.

Predicting job burnout based on demographic variables and dimensions of occupational fatigue/exhaustion recovery

According to the results of the multivariable linear regression model, the overall regression was statistically significant (R2=0.568, F(df)=7.03 (15), p<0.001). It was found that OFER-CF (B=0.39, 95% CI 0.21, 0.57; t=4.29, p<0.001) and OFER-IR (B=−0.241, 95% CI −0.46, −0.02; t=−2.16, p=0.035) were significant predictors of burnout among orthopaedic nurses (table 5).

Table 5 Predicting job burnout based on demographic variables and dimensions of occupational fatigue/exhaustion recovery by multivariable linear regression model

Variable	Category	B	t	95% CI	P value	
Lower bound	Upper bound	
Intercept	32.63	2.368	5.005	60.249	0.021*	
Gender	Female	−2.62	−0.748	−9.656	4.410	0.458	
Male	Reference category	
Marital status	Others	5.34	1.489	−1.851	12.530	0.142	
Married	Reference category	
Type of shifts	Rotational	2.32	0.543	−6.267	10.918	0.590	
Fixed	Reference category	
Dominant shift	Morning	2.73	0.711	−4.979	10.447	0.480	
Evening	1.71	0.338	−8.460	11.884	0.737	
Night	−1.46	−0.433	−8.221	5.303	0.667	
Others	Reference category	
History of antidepressant use	Yes	−1.84	−0.411	−10.832	7.143	0.682	
No	Reference category	
Age		−0.018	−0.717	−0.070	0.033	0.476	
Number of children		0.045	0.022	−4.078	4.169	0.983	
Experience		−0.016	−0.057	−0.589	0.556	0.955	
Work hours in a week		−0.054	−0.417	−0.312	0.205	0.679	
Number of overtime shifts in a month		0.872	1.725	−0.142	1.886	0.090	
Chronic fatigue (OFER-CF)		0.389	4.291	0.207	0.570	<0.001**	
Acute fatigue (OFER-AF)		0.164	1.487	−0.057	0.384	0.143	
Intershift recovery (OFER-IR)		−0.241	−2.163	−0.464	−0.018	0.035*	
*p<.05

**p<.01

OFER-AFOccupational Fatigue Exhaustion Recovery Scale-acute fatigue OFER-CFOccupational Fatigue Exhaustion Recovery Scale-chronic fatigueOFER-IROccupational Fatigue Exhaustion Recovery Scale-Intershift recovery

Discussion

The purpose of our study was to investigate the relationship between burnout and recovery from occupational fatigue among orthopaedic nurses. We first established baseline total and dimensional levels of burnout before assessing their association with occupational fatigue recovery. The mean total burnout score among orthopaedic nurses was in the ‘high’ range, a finding in line with global studies concerning orthopaedic nurses22 23 and a trend that has not been previously examined within this subgroup in Iran. The level of burnout reported in other nursing subgroups in Iranian studies has varied widely, potentially due to the use of different assessment tools and the heterogeneous subgroups studied.

Having determined burnout levels, we then assessed fatigue, finding both acute and chronic fatigue to be high, with a notably low recovery rate between shifts. Orthopaedic nurses face unique challenges and responsibilities and suboptimal working conditions which may exacerbate fatigue.14 Our results align with global data,14 suggesting that the nature of the work on orthopaedic wards contributes to inadequate intershift recovery.

A pivotal aspect of our research was to discern the connection between recovery from excessive occupational fatigue and burnout. There were moderate positive correlations between all subscales of occupational fatigue exhaustion recovery, acute and chronic fatigue, and intershift recovery and burnout. Similarly, a study of nursing staff in in Greece found a strong positive correlation between burnout and fatigue.31 In another study on emergency nurses, compassion fatigue directly and inversely affected burnout too.32 According to a 2018 meta-analysis study on compassion satisfaction, compassion fatigue and burnout in nursing, there is a strong positive correlation between compassion fatigue and burnout.33

Demographic and other factors were also scrutinised for their potential influence on burnout. Our study highlights the detrimental effects of prolonged work hours (>44 per week) and rotating shift patterns, corroborating previous research that associates night shifts with burnout34 and an Italian study linking shift numbers and workload with burnout levels.23 These insights suggest a need for systemic changes to reduce burnout, emphasising the importance of work environment and schedule flexibility for nurses’ well-being. Given the significant relationship between burnout and intershift recovery in this study, this finding is relevant to orthopaedic nurses who are at high risk and in need of recovery strategies. Oerlemans and Bakker35 have emphasised the importance of non-work activities in promoting recovery among employees at risk of burnout,35 indicating a significant gap in current recovery protocols for nurses.36

Further analysis revealed age as a factor in burnout, particularly among nurses aged 21–30, reflecting the unique pressures faced by those in early career stages. While some studies have reported no association between age and burnout,37 others have suggested that younger individuals are more susceptible, making age a strong demographic predictor of this condition.38 39 This suggests a potential need for targeted support strategies aimed specifically at younger nurses to mitigate the risk of burnout.

Our regression model, incorporating demographic variables and dimensions of occupational fatigue recovery, identified chronic fatigue and intershift recovery as significant predictors of burnout. This is consistent with the job demands-resources model, which posits that job demands can lead to burnout when resources for coping are insufficient.40 Our findings underscore the importance of intershift recovery as a critical resource that potentially mitigates the impact of chronic fatigue. This has potentially profound implications, suggesting that institutions should implement structured recovery protocols and provide resources to support mental and physical recuperation, thereby decreasing the risk of burnout in orthopaedic nurses. Potential strategies include more flexible scheduling, access to mental health support and promoting a healthy work–life balance.

Strengths and limitations

This study, drawing from a sample of two major orthopaedic hospitals affiliated with the Tabriz University of Medical Sciences, offers valuable insights into burnout in high-referral medical centres. The university includes two orthopaedic centres: the first, a specialised hospital with multiple wards serving a substantial patient population as a referral centre; the second, an orthopaedic ward within one of the city’s largest hospitals dedicated to orthopaedic care. While the findings are enlightening, caution is advised when generalising these results to other regions or populations due to potential cultural, social and other differences.

The study’s reliance on self-reported measures, while common in burnout research, may introduce recall bias and social desirability effects. However, the study’s strengths are notable. The study had a relatively high response rate. Validated instruments were employed to assess burnout and fatigue, ensuring measurement reliability, and a robust sample size based on a priori sample size calculation provided statistical power to the findings. Additionally, the study addresses the under-researched area of burnout among orthopaedic nurses, who face high risks of burnout due to demanding work conditions.

A key strength of this study is the use of a regression model, which provided a predictive analysis of burnout risk among orthopaedic nurses based on study variables. This analytical tool has allowed for a more nuanced understanding of the predictors of burnout, offering valuable insights for nursing managers to consider in their efforts to mitigate these risks.

Conclusions

The present study aimed to evaluate the burnout level correlation with fatigue exhaustion recovery. This study revealed that burnout is a prevalent and serious issue among orthopaedic nurses and that it is influenced by occupational fatigue exhaustion recovery. We observed a substantial moderate correlation between job burnout and all facets of occupational fatigue exhaustion recovery, suggesting that increases in both acute and chronic fatigue, coupled with insufficient recovery time between shifts, may contribute to heightened burnout levels. Moreover, working hours exceeding 44 per week and rotating shifts were identified as notable factors influencing burnout. Our regression model pinpointed chronic fatigue and intershift recovery as crucial predictors of risk of burnout. Our findings imply that orthopaedic nurses need more support and interventions to prevent burnout and enhance their energy recovery between work shifts. We suggest that further studies are necessary to investigate the causes of burnout among orthopaedic nurses in various contexts and settings and that subsequent research should concentrate on developing a recovery protocol for orthopaedic nurses to implement between shifts.

Acknowledgements

This study was derived from an MSc thesis in medical-surgical nursing authorised by the Tabriz University of Medical Sciences. We greatly appreciate the cooperation of the Office of Research and Technology of the Tabriz University of Medical Sciences and all the nurses and teaching hospitals (Emam Reza, Shohada).

Data availability statement

Data are available upon reasonable request.

Review Process File
24 8 2024

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

prepub: Prepublication history for this paper is available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2024-084522).

Patient consent for publication: Not required.

Ethics approval: Ethical approval for this study was obtained from the Ethics Committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1401.148). The study followed accepted ethical standards, as outlined in the Declaration of Helsinki. Participation in the study was voluntary and all participants provided written informed consent. All methods were performed in accordance with relevant guidelines and regulations.

Provenance and peer review: Not commissioned; externally peer reviewed.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
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