**1. Background**

The concepts of quality of work life (QWL) and job satisfaction are interrelated, when attempting to define a good work environment or a good and healthy life. Sirgy et al. [1] state that QWL relates to job satisfaction in the sense that job satisfaction is one of many outcomes of QWL. Job satisfaction is crucial because it influences job performance, customer satisfaction, employment retention, employee absenteeism, and organizational commitment [2]. Moreover, QWL does not only affect job satisfaction but also satisfaction in other life domains, such as family life, leisure life, social life, and financial life. In fact, women working from home during the COVID-19 lockdown experienced a set of negative effects from working remotely, namely the invasion of privacy, family time, the occurrence of distractions while working resulting in failures, and the increasing interference of work in private life [3]. Therefore, the focus of QWL goes beyond job satisfaction. It involves the effect of the workplace on satisfaction with the job; satisfaction in non-work life domains; and satisfaction with overall life, personal happiness, and subjective well-being [1].

Work occupies one's thoughts, determining decisions and thus contributing to one's social identity [4]. Such subjective and behavioral components of the QWL, namely supervisors' support, a good work environment, and collaborative support from co-workers, as well as the feeling of being respected professionally and personally, have an important influence on forming an employee's individual desire to contribute to the organization's productivity. This is also supported by the statement that QWL is associated with job

**Citation:** Pereira, D.; Leitão, J.; Ramos, L. Burnout and Quality of Work Life among Municipal Workers: Do Motivating and Economic Factors Play a Mediating Role? *Int. J. Environ. Res. Public Health* **2022**, *19*, 13035. https://doi.org/10.3390/ ijerph192013035

Academic Editor: Paul B. Tchounwou

Received: 30 August 2022 Accepted: 9 October 2022 Published: 11 October 2022

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

139

satisfaction, motivation, productivity, health, job security, safety, and well-being, embracing four main axes: a safe work environment, occupational healthcare, appropriate working time, and an appropriate salary [5,6].

With the increasing workloads of the past decades, plus the COVID-19 pandemic, the number of employees experiencing psychological problems related to occupational stress has increased rapidly, raising costs in terms of absenteeism and loss of productivity and also increasing healthcare consumption and raising public health issues in the long term [7]. Conversely, not only at the employees' level, but also at the level of SME owners, who faced, during the COVID-19 crisis, high stress, mostly derived from the shortage of personnel, financial constraints, liquidities, repeated closures, and reopenings, as well as great difficulty in adapting to such a changing environment [8].

Added to the above, occupational stress and self-reported sleep quality are also strongly associated with both QWL and work ability, highlighting the urgent need for the screening and handling of these health issues [9]. Occupational stress leads to organizational burnout, whose effects were formerly analyzed as moderators of the relationship between employees' QWL and their perceptions of their contribution to the organization's productivity by integrating the QWL factors into the trichotomy of (de)motivators of productivity in the workplace [10]. Our previous findings suggest that QWL hygiene factors (e.g., safe work environment and occupational healthcare) have an important influence on productivity, and burnout de-motivator factors (that is, low effectiveness, cynicism, and emotional exhaustion) significantly moderate the relationship between QWL and the contribution to productivity.

The COVID-19 pandemic—which has been (and will continue to be) a key issue throughout and beyond the 2020s—had an effect on individual–organizational relations and consequently, on organizational performance [11]. This took a toll not only on frontline workers (physicians, nurses, and hospital workers) but also on other public servants, such as municipal workers, not studied so far, who were affected by the changing the location of their work, tasks, the demands at work, and the demands they face outside work, endangering the balance between professional and personal life [12,13].

Furthermore, the financial insecurity and financial stress that already interfered with work [14] increased unexpectedly as COVID-19 aggravated these concerns. Due to the COVID-19 pandemic, employees are generally more aware of financial security. According to Kulikowski and Sedlak (2020), studies on work engagement and job performance have shown that employees ranked financial security as a factor of the highest significance [15]. These concerns could trigger stress, impacting employees' health and leading to mental illnesses such as post-traumatic stress disorder (PTSD) [13] but also high rates of tension, anger, anxiety, depressed mood, mental fatigue, and sleep disturbances. Such problems, usually referred to overall as distress, are often classified as neurasthenia, adjustment disorders, or burnout [7,16]. Focusing on younger, unmarried female healthcare workers with low monthly incomes who were studied in Jordan during the pandemic, they revealed high anxiety symptoms, which were exacerbated one year after the beginning of COVID-19, particularly for the physicians, with intense schedules, and those who were infected [17]. This situation is intensified in the public healthcare system, during pandemics, as it is characterized by a scarcity of resources and reduced accountability, thus increasing the lack of trustworthiness in the health system [18]. Strategies to improve healthcare systems' efficiency, physicians' motivation, management routines, patient flows, and information are a need during extreme crises, such as COVID-19. These strategies were implemented in a nodal-designated COVID-19 center in Qatar and proved to be effective, lowering mortality and increasing efficacy, capabilities, and patient satisfaction [19].

Furthermore, employees' mental health has a positive relationship with job performance, although this same relationship is mediated by innovative behavior and work engagement, which are also positively associated with job performance [20].

Knowledge on the influencers of QWL has remained relatively limited. In order to forecast and make possible an anticipated action on the part of responsible managers, it is essential to assess hypothetical unexplored effects associated with other mediating factors of the core relationship between burnout and QWL [21].

Set against this background, a relevant research question arises concerning the need to advance the still limited knowledge about other types of motivating and economic mediators affecting municipal workers' QWL, especially in terms of disorders associated with burnout, in the context of the COVID-19 pandemic. An effective response to the COVID-19 pandemic required effective administration, which in turn depended on the effort and capacity of millions of public sector workers from the front line to central administration. Added to the above, for many public servants, COVID-19 has fundamentally changed not only where and how they work but also the increasing demands of their jobs and day-to-day life [12].

#### **2. Burnout during COVID-19 for Public Servants**

When the World Health Organization (WHO) declared the outbreak of a new coronavirus disease (COVID-19) and then characterized it as a pandemic, all working people were affected. Not only because of their (or their relatives') health, but also due to the implications for the workplace. Here, we can identify three main groups of people who could be affected by burnout, namely: (a) people who kept their jobs and continued to work in the same location, (b) people who kept their jobs but started to work from home, and (c) people who lost their jobs.

The term "burnout" was first used by Freudenberger (1974), who described his own experience as "a combination of feelings, exhaustion and fatigue, a lingering cold, headache and gastrointestinal disturbances, sleeplessness and shortness of breath" [22]. The discussion on burnout has grown since then, being continuously updated in terms of symptoms but also in terms of consequences, not only for the employee, but also for the employer.

The multidimensional theory of burnout [23–25] defines burnout as being grounded in three core components: (i) emotional exhaustion, as the individual stress dimension of burnout, refers to energy depletion or the draining of emotional resources; (ii) depersonalization, which represents the interpersonal dimension, refers to the development of negative, cynical attitudes towards the recipients of one's service or care; and (iii) reduced or lack of personal accomplishment, which refers to a decline in one's feeling of competence and successful achievement in one's career; this is the self-evaluation dimension of burnout. Furthermore, burnout is characterized by: (a) loss of enthusiasm for work; (b) psychological exhaustion; (c) indolence, and the appearance of negative attitudes and behaviors towards patients and the organization; and (d) the appearance, in some cases, of feelings of guilt [26].

Globally, burnout entails a state of physical, emotional, and mental exhaustion resulting from a long period of involvement in highly emotional demanding work situations [27]. Burnout is a psychological syndrome of exhaustion, cynicism, and inefficacy in the workplace. It is also considered to be an individual stress experience embedded in a context of complex social relationships, involving a person's perception of both the self and others on the job [28,29], associated with limited resources, low abilities, and low energies and interest in long-term work [30]. This condition involves emotional exhaustion, depersonalization, and a lack of personal accomplishment. Burnout can arise through stress disorders triggered by stress on the job and is also often defined as an emotional-exhaustion experience by employees [15,31]. Theoretical frameworks such as the JD-R model claim that high, unfavorable job demands are consistently related to burnout [32–36]. Moreover, the combination of those high demands with low job resources can lead to some kind of long-lasting burnout and employee disengagement.

As a phenomenon that is context-specific, it is worthwhile to try to deepen the stillscarce knowledge about the impact of pandemic circumstances on occupational health, insofar as it has influenced working conditions, involvement, QWL, and burnout levels, bearing in mind the limited knowledge about the situation for public servants, including municipal workers. According to Meyer et al. (2021, p. 1) [37], " ( ... ) the COVID-19 pandemic poses new challenges for employees' psychological health that go beyond previous findings in the area of demands and resources (e.g., [35,38]).

The spread of COVID-19, followed by swift responses by companies and governments, created many new challenges that have brought about profound changes and affected the normal health routines and lifestyles of people of all ages, restricting outdoor or physical activity, increasing sedentary time, and consequently, disrupting sleep [39]. Nevertheless, the same authors outline that the isolation of workers at home had mixed effects on adult health behaviors in China, stressing that those workers focused more on their eating quality and patterns, which had a positive influence on their quality of life. The biggest change for most workers was the remote work experience. Prior to COVID-19, most workers had little remote working experience, nor were they or their organizations prepared to adopt this practice. Now, the unprecedented pandemic has required millions of people across the world to become remote workers, inadvertently leading to a de facto global experiment on remote working [40,41]. According to a study by Moretti et al. (2001) of the home-working population, home workers perceived themselves to be less productive compared to their office working period and less satisfied due to isolation [42].

In this respect, COVID-19 highlights employees' and employers' vulnerability. As many businesses around the world will be restructured or disappear due to the pandemic, workers will be retrained or laid off and the economic, social–psychological, and health costs of these actions are likely to be immense. Indeed, the impacts of the pandemic affect some groups of workers more than others, for example, based on their age, race and ethnicity, gender, or personality [41]. These impacts were affirmed by Wang et al. (2021), who stated that, as schools in China shut down during the COVID-19 outbreak, working parents faced a challenge in balancing work and family roles and time, creating higher levels of exhaustion, depression, and burnout [40].

Blake at al. (2020) conducted a survey of frontline/healthcare workers to understand the psychological impacts on employees and how these translated into negative consequences for organizations [43]. They found that the extreme pressure experienced by workers during the COVID-19 pandemic might increase their risk of burnout, which has adverse outcomes, not only for their individual well-being, but also for patient care and for the healthcare system. In addition, fear of exposure to COVID-19 or even due to the scarcity of personal protective equipment (PPE), allocation of resources, accountability, and the efficient management of patient flows, as well as a lack of or a reduction in training on practical skills to deal with emergency situations and critical care, can put even more pressure on frontline/health professionals [18,44]. There is also the fear of taking the disease home or even being responsible for bringing it to the workplace, infecting other patients. All this combined with the normal challenges of supporting a family, changes in workload and schedules, and facing new or unknown clinical situations may substantially increase levels of anxiety, emotional strain, and physical exhaustion.

At the coalface of the pandemic, healthcare workers and public service providers have jobs and occupations that have proven to be associated with increased mental health problems during pandemic crises and high personal and work-related burnout [13].

A survey applied to Portuguese healthcare workers during the COVID-19 pandemic, wherein frontline working positions were associated with higher levels of stress and depression, showed a significant association with increased burnout levels. In this survey, higher levels of satisfaction with life and resilience were highly associated with lower levels of burnout [45]. This is also supported in the research developed by Hofmam and Hubie (2020), wherein surveys conducted among frontline workers from two health units in Cascavel-PR (Brazil) identified that all participants obtained higher than expected burnout scores, emotional exhaustion, and a feeling of low professional achievement [46].

Pandemics bring new ways of performing jobs in several sectors of activity, including among public servants not directly working in health-related areas, as happens with municipal workers. The institutionalization of remote working and the rapid, sometimes reckless, digitalization by companies and public organizations has increased the frequency of workers' burnout with consequences for families' personal life and budget [47].

During the COVID-19 pandemic, municipal workers working in sectors closer to citizens were forced to work remotely, which has caused unique supervisory demands for human resources managers [12], as well as exacerbated burnout caused by self-isolation policies, which can increase social isolation and relationship difficulties [48].

Other public sector activities and their workers, for instance, those connected with education, were also put under pressure by the effects of pandemics. Marelli et al. (2021) showed a high percentage of both students and university administration staff workers denoting symptoms of depression or anxiety [49], and Evanoff et al. (2020) pointed out the important prevalence of stress, anxiety, depression, work exhaustion, burnout, and worsened well-being among university employees [50]. Another study on insomnia among employees in occupations critical to the functioning of society (e.g., health, education, welfare, and emergency services) during the COVID-19 pandemic also found that employees reported higher levels of insomnia symptoms compared to normative data collected before the pandemic [51]. These findings only highlight the associations of health and well-being with additional personal and work factors beyond the COVID-19 pandemic, without addressing the role played by motivating and economic mediators of the relationship between burnout and QWL.

A study of social workers in the United States during the COVID-19 pandemic, showed a high level of PTSD and burnout symptoms among the participants enrolled in frontline jobs dealing directly with the risk of contagion [52]. Bapuji et al. (2020) stated that organizational and societal inequalities feed into each other, giving rise to concerns that growing inequality after COVID-19 will also contribute to a downward spiral of negative trends in the workplace in the form of decreased work centrality and increased burnout, absenteeism, deviant behaviors, bullying, and higher job rotation [53].
