Recovery experience and burnout in cancer workers in Queensland

Abstract

Purpose

Two key recovery experiences mediating the relationship between work demands and well-being are psychological detachment and relaxation over leisure time. The process of recovery from work-related stress plays an important role in maintaining well-being, but is poorly understood in cancer workers. The aim of this exploratory study was to examine the relationships of burnout, psychological well-being and work engagement with the recovery experiences of psychological detachment and relaxation in oncology staff.

Methods

A cross sectional survey of 573 cancer workers in Queensland was conducted (response rate 56%). Oncology nurses (n = 211) represented the largest professional group. Staff completed surveys containing demographics and psychosocial questionnaires measuring burnout, psychological distress, work engagement and recovery experience. Multiple regression analyses were performed to identify explanatory variables which were independently associated with Recovery Experience Score (RES).

Results

There was a negative association between the RES and burnout (p = 0.002) as well as psychological distress (p < 0.0001), but not work engagement. Age >25 years was negatively correlated with RES as was having a post graduate qualification, being married or divorced, having carer commitments. Participating in strenuous exercise was associated with high recovery (p = 0.015).

Conclusions

The two recovery experiences of psychological detachment and relaxation had a strong negative association to burnout and psychological well-being, but not work engagement. Further research needs to be undertaken to better understand if improving recovery experience reduces burnout and improves the well-being of cancer workers.

Introduction

Cancer workers are exposed to a variety of work-related stressors including dealing with a clinical caseload that is emotionally taxing. It is well recognised that this may contribute to burnout and the literature suggests that approximately one third of cancer workers exhibit symptoms of burnout, core features of which are emotional exhaustion and disengagement (Girgis et al., 2009, Poulsen et al., 2011, Shanafelt et al., 2006). Burnout and work stress are negatively correlated with employees' health and well being and are positively associated with high desire to leave the organisation (Coffeng et al., 2012).

According to the Conservation of Resources Theory (Hobfoll et al., 2003), recovery is seen as a process to restore resources such as self-esteem or vigour that may be depleted in unfavourable work environments. Theoretically, workers with high daily recovery feel less fatigue and greater readiness to face new demands than those workers with poor recovery.

The concept of recovery evolved from the effort-recuperation model (Meijiman and Mulder, 1998) and is considered to be the need to recuperate and wind down after the effort invested in work-related activity. Recovery refers to the process during which the individual's functioning returns to the pre-stressor level (Sonnentag and Natter, 2004). When fatigue builds up, there is a sense of urgency to take a break and this is described as the need for recovery (Sonnentag and Zijlstra, 2006). This is an emotional state characterized by reluctance to continue the present demands. High needs for recovery are associated with burnout and are considered to be an important precursor for developing health problems (Sluiter et al., 1999).

The Job Demands-Resources (JD-R) model (Bakker and Demerouti, 2007) explains how low resource availability within a demanding work environment contributes to high recovery needs (Sonnentag and Zijlstra, 2006) Recovery experience is an important mediator between demand-resource imbalance and wellbeing. It has been postulated that insufficient recovery contributes to poor well-being and health problems (Geurts and Sonnentag, 2006).

Physical activity after work has been shown to be an important factor in recovery (Rook and Zijlstra, 2006) as well as improving levels of subjective well being (Poulsen et al., 2012). Relaxation is another factor which contributes to the recovery process by diverting attention away from work and reversing the negative consequences of work-related stress (Hahn et al., 2011b). Having insufficient time for relaxation increases the need for recovery which in turn leads to emotional exhaustion and sleep disturbance (Sonnentag and Fritz, 2007).

Daily recovery has been viewed as internal (i.e. happening at work) or external (i.e. occurring after work). Internal recovery may occur as a short break during work hours e.g. a coffee break with colleagues. External recovery before or after work, during weekends and holidays refers to engaging in replenishing activities that help rebalance suboptimal systems and return stress-related reactions to pre-stressor levels before the next working period commences e.g. a visit to the gym (Geurts and Sonnentag, 2006). When the demands of the job increase, there is an increase in the need for recovery.

Recovery experiences have been classified as psychological detachment, relaxation, mastery experiences and control over leisure time (Sonnentag and Fritz, 2007). Psychological detachment is defined as the sense of being away from work both physically and mentally. People who disconnect from work in the evening and do not engage in perseverative ruminating about past stressors or anticipation of future stressors, are more likely to experience positive mood and less fatigue on the following day (Sonnentag and Bayer, 2005). Psychological distancing is an important buffer that protects workers' well-being and promotes work engagement (Sonnentag et al., 2010). Relaxation may involve activities such as listening to music or going for a jog. Mastery experiences involve taking on a new challenge outside of work such as learning a new language or learning a new skill. Mastery and control over leisure time have been shown to be negatively associated with emotional exhaustion and positively associated with life satisfaction (Sonnentag and Fritz, 2007).

The purpose of this paper was to explore the relationship between perceived recovery experience, burnout, psychological well-being and work engagement. It was postulated that cancer workers who were burnt out were less likely to engage in activities that would lead to recovery while engaged workers were more likely to participate in recovery experiences. Possible explanatory factors associated with recovery experiences were analysed.