1. Introduction
Researchers’ interest in occupational burnout results primarily from the dangerous and extensive consequences of this phenomenon. Its health-related, mental and social effects affect not only the employees themselves, but also their work and family environment [
1,
2].
An important contribution is that of Freudenberger, who in his article used the words Staff Burnout to denote the exhaustion of an individual caused by the overload of tasks assigned to their social and physical work. Thus, the researcher introduced the term “burnout” to scientific vocabulary, defining it as “a drop in an employee’s energy, emerging as a result of being overburdened by the problems of others” [
3].
A slightly different, multidimensional definition of occupational burnout was provided by Ch. Maslach, who described it as “a psychological syndrome of emotional exhaustion, depersonalization and a lowered sense of personal accomplishment that can be observed in people working with others in a certain specific manner” [
4]. After research carried out on psychiatrists, social care staff and prison service staff, Ch. Maslach and S. Jackson described burnout as a long-term reaction to chronic interpersonal and emotional stressors appearing in people working in close contact with others [
5].
This definition accentuates that burnout syndrome is largely related to the work of people whose jobs involve care for others, such as medical staff. The operating theater is a very special space in the hospital structure. It is a hermetic room which can be accessed solely by its staff and patients scheduled for an operation at a given time [
6,
7]. The staff of the hospital operating theatre can be divided into two basic groups. The first, group one, is its regular staff, including operating room nurses and nurse anesthesiologists, anesthesiologists, and medical support staff. The second is temporary staff, including surgeons, trainees, students, as well as participants of various training or specialty courses [
8]. Work in an operating theater requires, above all, a team effort of many people. Staff members must not only have high professional qualifications and keep broadening their knowledge concerning progress in medicine, but also possess the knowledge and skills in the area of the operation of highly specialized medical devices and equipment [
9].
The burdens resulting from such work may be both mental and physical. The mental burdens result mainly from responsibility for the patient’s health and life. This is amplified by the necessity to simultaneously cooperate with a team of surgeons and anesthesiologists. Particularly burdening is providing assistance in operations on patients with multiorgan injuries, organ transplantations, and in the case of the patient’s death during surgery [
10]. The physical burdens include assisting in operations lasting for many hours, the related enforced body position, the lifting and transporting of patients, carrying sets of surgical tools, the specific microclimate of the operating room, and the noise of the equipment [
11]. These burdens are also connected to contact with anesthetic agents, exposure to X-ray and laser radiation, as well as magnetic fields and high voltage electricity. Additionally, the chemicals used for disinfection, gloves, talc, and other substances used for the fixation of preparations have an irritating effect on the skin. Direct contact with infectious materials (blood, body fluids, human waste, bone shavings) is related to a high risk of infection. Work in operating theaters is therefore challenging and requires good health, physical fitness, and resistance to stress. A well-organized and well-equipped operating theater, qualified medical staff, good cooperation in the team, a friendly atmosphere, as well as observation of procedures and standards lower the risk of physical and mental overload, resulting in nurses and doctors working in operating theaters being less susceptible to stress and, in consequence, to occupational burnout [
12].
There is a lot of research and reports on burnout among medical professionals, but few about operating theaters (nurses and doctors). The aim of the study was to analyze the level of occupational burnout among nurses and doctors in operating theaters.
4. Discussion
Occupational burnout syndrome has been described in relevant literature for more than 40 years. Since 1970, more than 5500 studies and books devoted to the topic have been published, and the number is increasing on an annual basis [
16]. This shows how important this phenomenon is [
17]. Numerous studies demonstrate that burnout is more often experienced by representatives of professions which deal with the provision of social services, require close, direct work with others and personal involvement in interpersonal relations, which are often connected with the provision of support to people, and in which social skills are a fundamental work tool [
18]. This is confirmed in Molina-Praena’s research, in which 31% of nurses were diagnosed with emotional exhaustion, 24% with high depersonalization, and 38% with low personal accomplishment [
19], and in Ramuszewicz’s study, in which 32% of the operating room nurses involved described themselves as experiencing occupational burnout, and almost half of them (42%) felt stressed [
20].
These findings have also been partially confirmed in our own research, which showed that a statistically significantly higher degree of occupational burnout was experienced by operating room nurses than by surgeons and orthopedists. Among persons working in operating theaters, occupational burnout is not often selected as a topic of studies. Most often, the studies are conducted on people performing specific tasks related to their own specialty in the operating theater. Wojciechowska et al. focused on operating room nurses. They demonstrated that nurses employed in the operating theaters are much more exposed to the risk of occupational burnout syndrome. At the same time, they recorded a certain relationship between the work setting and the degree of occupational burnout [
21].
Norwegians adopted another research attitude to the phenomenon of occupational burnout—they performed their study on doctors and nurses working in operating theaters and surgical wards in 15 national hospitals. There were 2601 participants in this study (2050 nurses and 551 doctors). In their results, they specified the elements giving employees satisfaction and simultaneously preventing occupational burnout. Among the doctors, it was mainly cooperation and a dominating position. For the nurses, it was the atmosphere in the team based on partnership, including recognition of their rights as equal with the doctors’ rights. These studies have shown the importance of good cooperation between doctors and nurses in order to prevent burnout and lead to an improvement in quality and hence patient safety [
22].
It results from our own research that only some sociodemographic factors are related to the participants’ occupational burnout. One of them is gender. Women suffered from a higher level of occupational burnout than men. This conclusion was presented in studies by researchers from Belgium, Germany, USA, and Canada [
7].
During the subsequent stage of our research, it was demonstrated that the occupational burnout rate was statistically significantly higher in participants with a bachelor’s degree in nursing than in graduates of six-year studies in medicine. This confirms the higher occupational burnout rate in operating room nurses than in surgeons and orthopedists. Hallsten et al. indicated an impact of higher education on the level of occupational burnout and established that higher education is most often related to greater responsibility, and sometimes also a greater scope of duties. However, it cannot be considered a predictor of occupational burnout [
23].
Other researchers demonstrated a difference of the level of occupational burnout depending on one’s medical qualifications, indicating that among five medical professions, the highest level of occupational burnout was experienced by nurses (66%), with physician’s assistants (61.8%), doctors (38.6%), administrative staff (36.1%), and medical technicians (31.9%) affected less [
24]. Among the studied sociodemographic factors, the respondents’ age, place of residence, marital status, number of years worked, and shift work had no impact on the level of occupational burnout. The first three factors do not play a significant role in the majority of studies by other authors, although some studies indicate a statistically significant relationship. Examples include research by Włodarczyk et al., who performed research on nurses working in operating theaters. The authors showed that among the demographic factors, place of residence and gender play a significant role. One’s residence in a city and the male gender were related to a lower degree of the absence of involvement. Residence in a city was also related to an expected lower rate of exhaustion [
2].
The authors stressed that what seemed significant here was the distance between one’s place of work and one’s place of residence: the greater this was, the higher the dissatisfaction and the faster the exhaustion. Our own research did not demonstrate such a relationship, although the participants lived in places situated at various distances from their place of work. Similar results were generated in the case of marital status—no relationship was discovered between the variables. However, other researchers have confirmed such a relationship in their studies—they demonstrated that non-married individuals were exposed to a higher risk of the absence of involvement in their work than married people, with a greater risk of exhaustion in divorced participants than in married ones [
25,
26]. These results seem to be consistent with the theory on social support from one’s family as a resource protecting against the negative consequences of stress at work.
Our own research did not show a relationship between the respondents’ age and the number of years worked and burnout. There are studies, however, showing that these variables have an impact on the level of occupational burnout. For example, Hatch et al. demonstrated that nurses with a higher number of years worked display a greater level of occupational burnout [
27].
Areas to be analyzed include shift work, which, according to the generated results, had no statistically significant impact on the respondents’ level of occupational burnout. Researchers demonstrated a negative impact of shift work on the level of occupational burnout from the point of view of there being an excessive burden on the balance between the quality of one’s personal and professional life as early as in 2013 [
28]. Many researchers consider shift work and, above all, its rhythm prolonged to 12 h, a factor facilitating the development of occupational burnout syndrome, and even as a stressor [
29]. Other researchers showed that nurses working on a full-time basis report a higher level of occupational burnout than nurses working a on a part-time basis [
30]. This is also confirmed by research devoted to flexible working time, which clearly demonstrated that the possibility to control one’s working time allows a decrease in occupational burnout [
31,
32].
The results generated in the group of nurses and doctors of operating theaters under this study allow to conclude that people who were more burdened with work displayed a higher level of occupational burnout. Overburdening with occupational work may result both from the excessive responsibility related to work in the operating theater, but also from undertaking too many working hours. Studies by other authors show that a high level of responsibility of employees of hospital operating theaters is related to the risk of medical errors and has an impact on the level of occupational burnout [
33].
Emotional burnout is marked by specific symptoms, including helplessness, lack of energy, weakness, fatigue, irritability, and proneness to conflicts [
34]. Our research showed a significant prediction of the level of emotional exhaustion through selected predictors (workload and values). Some studies show that emotional exhaustion is strongly related to pressure at work, which is very high in the staff of operating theaters [
10]. The staff of operating theaters is regularly exposed to many factors causing stress at work (shortages of staff and equipment, the necessity to supervise employees having less experience), which calls for more effort to be able to cope with the daily professional challenges. In consequence, they gradually develop the sense of weakening and occupational burnout [
35].
Depersonalization is most often manifested in the treatment of others as objects, cynicism, indifference, routine, treatment of the patient as yet another case, a change of care into supervision, and avoidance of contact with patients and their families [
36]. Our research shows that depersonalization concerns employees of operating theaters to a medium degree. When lowered, the third dimension of occupational burnout, referred to as personal accomplishment, leads to self-perception as an ineffective and incompetent individual, the sense of absence of achievements and successes, as well as the loss of the sense of work. It also manifests itself in the worsening of health, increased absence from work, negative emotions, and conflicts. In consequence, the quality of services provided by medical staff is lowered [
37].
An analysis of our research demonstrated that the correlation between areas of work life and the level of professional satisfaction was moderate. Similar results were obtained in studies conducted on nurses in Spain and Germany [
38,
39], where nurses indicated the absence of balance between their workload and rewards, e.g., absence of promotion (absence of the sense of personal accomplishment) as one of the main factors leading to occupational burnout.