Emotional exhaustion and workarounds in acute care: cross sectional tests of a theoretical framework

Int J Nurs Stud. 2012 Aug;49(8):969-77. doi: 10.1016/j.ijnurstu.2012.02.011. Epub 2012 Mar 3.


Background: As health care organizations strive to improve their work processes, attention is being paid to workarounds in the clinical setting. Some research has found a link between burnout and workarounds. Other research shows that the clinical work environment can influence burnout levels in clinical workers, particularly emotional exhaustion.

Objective: Underpinned by Conservation of Resources theory, we examined a conceptual model linking the work environment with workarounds in acute care nurses and other clinicians, and hypothesized that burnout, specifically emotional exhaustion, would mediate these relationships.

Study design and setting: A cross sectional survey study was conducted in a large tertiary hospital in North America.

Participants: All clinical care providers in the hospital's medical units were invited to participate. The response rate was 45%, with nurses comprising 85% of respondents.

Method: Questionnaires were mailed to employee homes using a two-wave methodology.

Results: Hypotheses were examined using structural equation modeling. Time pressure was positively related to exhaustion, and autonomy was negatively related. Exhaustion was positively related to workarounds, and mediated the time pressure and autonomy to workarounds relationships. Contrary to expectations, the physical environment was directly and negatively related to workarounds.

Conclusion: Our findings suggest that the work environment may influence more than individual clinician well-being and exhaustion, it also may influence workaround behaviors that could lead to harm for patients and/or the organization. More attention should be paid to the mechanisms that influence workarounds.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Burnout, Professional*
  • Cross-Sectional Studies
  • Efficiency, Organizational*
  • Environment Design
  • Health Facility Environment*
  • Humans
  • Nursing Staff, Hospital / organization & administration*
  • Nursing Staff, Hospital / psychology
  • Patient Safety*
  • Patient-Centered Care
  • Professional Autonomy
  • Quality Improvement
  • United States