Latent profile analysis and  burnout study of Work addiction among clinical nurses

doi:10.21203/rs.3.rs-3978119/v1

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Latent profile analysis and burnout study of Work addiction among clinical nurses

https://doi.org/10.21203/rs.3.rs-3978119/v1

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Background: Work addiction in clinical nurses is associated with burnout.However, the classification of work addiction in this group remains unclear. The purpose of this study was to clarify the subtypes of work addiction in Chinese clinical nurses, explore the factors influencing the subtypes, and explore the relationship between job burnout and work addiction to provide a reference for improving the work addiction of nurses.

Methods: From July to October 2023, 524 clinical nurses from five tertiary general hospitals in Shaanxi Province were selected for a cross-sectional survey. They filled out questionnaires online through the questionnaire star, which included the General Information Questionnaire, the Burnout Scale, and the Work Addiction Scale. Data analysis included latent feature analysis, analysis of variance, chi-square test, binary logistic regression,and hierarchical regression analysis.

Results: Two potential traits were identified - low-grade work addiction(grade 1) and high work addiction (grade 3), representing 67.9% and 32.1%of the total number of nurses surveyed, respectively. Nurses' job titles and emotional exhaustion had an impact on the potential categories of work addiction in clinical nurses (P<0.05). Burnout is a significant predictor of work addiction and can independently explain the 18.70%difference in work addiction in clinical nurses.

Conclusion: There are different classification characteristics of work addiction in clinical nurses in China. More than half of clinical nurses have low levels of burnout, and work addiction is an essential predictor of nurses' burnout. Hospital administrators should actively focus on nurses with high work addiction to help them reduce burnout.

latent category analysis

nurses

burnout

work addiction

correlation

With the rapid development and continuous innovation in the medical and health field, hospitals and patients have put forward higher requirements for nursing staff. However, in the past three years, the pandemic has increased the shortage of nurses, increased workload, increased patient numbers, and a surge in doctor-patient conflicts, which have had a severe impact on nurses' physical and mental health [1, 2]. Burnout is defined as a response to chronic negative emotions and interpersonal stressors at work, with three main dimensions: emotional exhaustion, personality disintegration, and reduced self-fulfillment [3]. Burnout is a widespread phenomenon in healthcare: more than 70 percent of intensive care unit nurses and nearly 50 percent of nurses have experienced burnout in previous studies[4]. In addition, in 2019, Woo et al. conducted a systematic review of the occupational prevalence of nurses worldwide and found that nurses worldwide had burnout symptoms, with a prevalence of 11.23% and 14.36% among intensive care unit nurses [5].Nurses are more likely to experience burnout when they are in work environments where they are not respected and recognized for their work, interpersonal relationships with other colleagues and supervisors are mishandled, and there is insufficient support from family and society.as well as the need to cope with incomprehensible patients and their families [6, 7]. Burnout can have a severe impact on individual health and organizations, and nurses' burnout not only affects their physical and mental health, causing symptoms such as endocrine disorders depression, and anxiety, but these symptoms can lead to poor concentration, low-quality nursing, and nursing errors, and ultimately reduce patient satisfaction with nursing [8]. As a result, burnout has become an essential issue in the healthcare industry and has attracted the attention of multidisciplinary researchers in public health, hospital administration, and nursing management in recent years [9].Studies have shown that there is a positive correlation between work addiction and burnout; that is, the higher the level of work addiction, the higher the burnout [10]. Work addiction refers to the excessive amount of time spent preoccupied with work at work, beyond the usual norm, and predicts the onset of burnout by negatively impacting an individual's social development and physical and mental health [11–12]. A study of work addiction in a group of sports trainers found that those with a higher risk of work addiction reported higher levels of burnout [13]. Workaholics account for 24% of healthcare workers, which is higher than the prevalence rate among other professions. Studies have found that the more work addiction doctors experience at work, the more likely it is to burnout, and nurses with a high degree of work addiction usually have higher levels of burnout and secondary traumatic stress, which also affects their quality of professional life, so it is more necessary to pay attention to, understand, and prevent work addiction among healthcare workers [15, 16]. The relationship between work addiction and job burnout can be explained by the work demand-resource model, Which hypothesizes that excessive work demands can lead to stress-related adverse outcomes, such as burnout [17]. Moderate work addiction can stimulate people's vitality and potential and can make people create fun at work, which can have a positive emotional impact and further improve people's job satisfaction, while excessive addiction can cause damage to the physical and mental health of healthcare workers, aggravate fatigue at work, and ultimately lead to burnout [18–20].Latent profiling is a statistical method used to identify populations with different individual attributes and has been widely used in psychological and humanities research [21]. This approach can help us better understand emotions. In recent years, latent profiling has been commonly used in the fields of nursing, management, and psychology. Nonetheless there is currently no potential profiling of work addiction in clinical nurses.There are fewer studies on the relationship between burnout and work addiction in clinical nurses. Therefore, the purpose of our study was to investigate the relationship between nurses' burnout and their work addiction through the study of the relationship between nurses' burnout and work addiction in five tertiary hospitals in Shaanxi Province, China,and to provide a reference for further optimizing the management of nursing and improving the quality of nursing.

Procedures

Before the official distribution of the questionnaire, we set the questionnaire star, including the filling time, which should not be less than5 minutes, to ensure the quality of the study. After obtaining the consent of the leaders of each hospital department, the purpose and significance of the study were explained to the participants before collecting the data so as to obtain their understanding and help. At the same time, there searchers gave tiny dolls as a reward, and after the questionnaire was collected, the quality of the questionnaire was checked by two researchers, and some questionnaires answered at random were eliminated. When entering data from valid questionnaires, a two-person check method is also used to ensure the accuracy of the data. Our research is in line with the ethical standards set out in the Declaration of Helsinki (approved by the Ethics Committee of the Second Affiliated Hospital of the Air Force Medical University. Participants have all given informed consent prior to participating in the investigation. We fill in the information anonymously to ensure the privacy of the participant's information.

Participants

The study was based on the Declaration of Helsinki and the guidelines of the Second Affiliated Hospital of the Air Force Medical University. The study subjects were clinical nurses recruited from five tertiary hospitals in Shaanxi Province. All nurses voluntarily joined the study after understanding the purpose and significance of this study. They can withdraw from the study in the middle of the study for any reason and fillout the questionnaire anonymously. The inclusion criteria were clinical nurses. Exclusion criteria were patients who had recently experienced a significant life event and patients who were unwilling to participate in the investigation. A total of 546 clinical nurses participated in the survey between July and October 2023. The questionnaire filled in by the 20subjects who were collected had a significant regularity and was regarded as an invalid questionnaire for elimination. The final sample consisted of 526 clinical nurses (68 males and 456 females) aged 21-56years (33.54 + 7.11) from five tertiary hospitals in Shaanxi Province.

Measures

Sociodemographic questionnaire

Data on demographic variables (i.e., gender, age, years of service,education level, monthly income, and employment style) were collected through self-report questionnaires.

The burnout scale MBI-GS (MBI-General Survey) was used [22].The scale is applicable to Chinese cultural contexts and is now widely used in China with good reliability and validity among Chinese [23, 24]. The scale includes three dimensions (emotional exhaustion, depersonalization, and personal fulfillment reduction) and 15 items, and the questionnaire items are scored on a 7-level scale, ranging from "never" ~ to "every day" on a scale of 0–6.Higher scores indicate higher levels of burnout. The scale had a Cronbach's coefficient of 0.875 in this study.

Work addiction

The Chinese version of the Work Addiction Scale compiled by Robinson[25] in 1989 and translated by Chinese scholar Guo Li et al. [26] was used to measure the subject's work addiction tendency. The Work Addiction Scale, which includes 22 items in 5 dimensions, is employed. Using the four-level Likert scoring method, 1 ~ 4 points are assigned from "not right at al" ~ "always correct" with a total score of 22 ~ 88 points, 22 ~ 49points for normal, 50 ~ 58 points for moderate, and 59 ~ 88 points for height. Higher scores indicate a higher propensity for work addiction. The Cronbach's coefficient of the scale is 0.918.

Data analysis

Statistical analysis was performed using SPSS 27.0 statistical software and Mplus 8.3. Descriptive statistical analysis was used for general data of nurses, categorical variables were described by frequency and percentage, and mean and standard deviation were used for continuous data. Chi-square test and analysis of variance were used to screen for statistically significant influencing factors. According to log likelihood (LL), Akaike information criteria (AIC), Bayesian information criteria (BIC), sample-adjusted BIC (BIC), The average information index (entropy), the likelihood ratio test based on LMR and the Bootstrap likelihood ratio test (BLRT) judged that the smaller the AIC, BIC, and BIC, the > Entropy0.8, LMR and BLRT reached significantly as the best fit, and the optimal model was determined. Based on the results of latent category classification, the test was used for comparison between groups. Through the comprehensive evaluation of the above indicators, the best-fitting model was selected, and the burnout of Chinese clinical nurses was divided into different categories. Binary logistic regression analysis was used to explore the influencing factors of work addiction, and hierarchical regression analysis was used to explore the effect of occupational burnout on work addiction, and P < 0.05 indicated that the difference was statistically significant.

Participant characteristics

A total of 524 clinical nurses were collected in this study. 87% of the nurses were women,13.0% were women, 69.60% were married, 82.60% of the nurses had a bachelor's degree or above, 6.20% of the nurses had senior titles, and 52.6% of the nurses had worked for ten years or more.In addition, 7.0% of nurses earn less than 4,000 yuan per month.

Common method deviation

The data in this study were measured as questionnaire self-report, and there may be common methodological biases. Therefore, the Harmanone-factor assay was used for testing. All scale items were subjected to exploratory factor analysis. The results showed that the variation explained by the first common factor was 30.94%, which did not exceed40% of the total variation explanation, indicating that the common method deviation in the study was not serious.

Analysis of latent characteristics and characteristics of burnout in clinical nurses

The best-fitting LPA is a two-class model. Regarding the interpretability of the model, we decided to keep two classes of models because they have the lowest AIC, BIC, and BIC. The LMR est and BLRT showed that the model was statistically significant (P < 0.05).According to the charts for classes 2 and 3 of the LPA model, the two classes of nurses exhibited similar patterns in three dimensions. Category 1 nurses scored high in 2performance types, which we named the high addiction group, which accounted for 32.10% of the total; Nurses in category 2 scored low among the two categories of nurses, and we named this group of nurses (67.10%of the total) as the low addiction group. The latent characteristic analysis model and fitting index are shown in Table 1, and the potential outline of the work addiction dimension is shown in Fig. 1. From the attribution probabilities of the two latent categories (Table 2), it can be concluded that the probability of each profile belonging to this category is95.8%~96.6%, respectively, indicating that the model of the two latent profiles is credible. Based on the above analysis, the selection of two profiles was the optimal classification result for work addiction in clinical nurses.

Table 1

Model fit indexes of latent profile analysis (N = 524)
Model	AIC	BIC	aBIC	Entropy	LMRT	BLRT	Category probability
1	24446.433	24633.939	24494.272	—	—	—	—
2	22890.158	23175.678	22963.003	0.874	<0.001	<0.001	0.689/0.311
3	22266.160	22649.694	22364.012	0.901	0.1652	<0.001	0.114/0.628/0.258
4	22043.997	22525.545	22166.856	0.881	0.386	<0.001	0.017/0.218/0.559/0.206

AIC Akike intomafo critero: BiC Baresian inormation criterion: ABic, same-sze adiusted Baresian iniormaton criterio: LM, -Mendel-Rubin ikehood ratio test: VIMR Vuong-Lo-Mendell-Rubin likelihood ratio test; BLRT, Bootstrapped likelihood ratio test.

Table 2

Clinical Nurse Work Addiction Attribution Probability of 2 Potential Profiles (%)
Potential section category	The probability of belonging to the potential category
Potential section category	C1	C2
C1	96.6	3.4
C2	4.2	95.8

Characteristics of work addiction in different categories of clinical nurses

Characteristics of work addiction in different categories of clinical nurses Univariate analysis showed that there were no significant differences in gender, age, marriage, and monthly income between the two groups (P > 0.05). There were significant differences in educational attainment and hiring style (P < 0.001), burnout (P < 0.001), emotional exhaustion,depersonalization, and reduced sense of accomplishment (all P < 0.001).See Table 3

Table 3

The differences in the work addiction types of in clinical nurse demography and job burnout
Variable	Respondents	Low addiction	High addiction	χ2/F	P
Gender
Male	68 (12.98%)	42 (61.76%)	26(38.24%)	1.853	0.206
Female	456 (87.02%)	319 (69.96%)	137 (30.04%)
Age
< 30	167 (31.87%)	120(71.86%)	47 (28.14%)	1.006	0.605
30–50	351 (66.98%)	237(67.52%)	114(32.48%)
> 50	6 (1.15%)	4 (66.67%)	2 (33.33%)
How to hire
Personnel Agency	119 (22.71%)	86 (72.27%)	33 (27.73%)	59.506	< 0.001
Contract	384 (73.29%)	257 (66.93%)	127 (33.07%)
system	21(4.00%)	18 (85.71%)	3 (14.29%)
Education background
Junior college or below	188 (82.07%)	50 (26.60%)	138 (73.40%)	244.762	< 0.001
Undergraduate or above	336 (17.93%)	311 (92.56%)	25 (7.44%)
Marital status
Married	365 (69.66%)	246 (67.40%)	119 (32.60%)	1.279	0.548
Unmarried	154 (29.39%)	111 (72.08%)	43 (27.92%)
Widowed or separated	5(0.95%)	4 (80%)	1 (20%)
Monthly income per capita(yuan)
< 4,000	213 (40.65%)	143(67.14%)	70(32.86%)	1.861	0.394
4,000–8,000	274 (52.29%)	189 (68.98%)	85 (31.02%)
> 8,000	37 (7.06%)	29(78.38%)	8(21.629%)
job title
junior	251(47.90%)	173(68.92%)	78 (31.08%)	3.592	0.166
intermediate	240 (45.80%)	170 (70.83%)	70 (29.17%)
Senior	33(6.30%)	18 (54.55%)	15 (45.45%)
Burnout Emotional exhaustion Depersonalization A reduced sense of accomplishment	51.12 ± 13.50 17.38 ± 6.46 11.80 ± 5.52 27.52 ± 7.80	48.35 ± 11.73 15.70-±5.45 10.72 ± 4.78 26.91 ± 7.80	57.27 ± 15.12 21.10 ± 6.99 14.20 ± 6.28 28.88 ± 7.69	53.952 91.840 48.608 7.196	< 0.001 < 0.001 < 0.001 0.008

Binary logistic regression of potential profiles of work addiction in clinical nurses

Binary Logistic regression analysis was performed with the meaningful variables in the univariate analysis as the independent variables and the potential profile of work addiction as the dependent variables (low addiction group = 1 and high addiction group = 2).Among the independent variables, the employment method is set as a dummy variable with reference to "establishment," and the rest of the independent variables are brought in with the original value. The results showed that there was a positive correlation between emotional exhaustion and work addiction (OR = 0.874.P < 0.001) as shown in Table 4.

Table 4

Binary logistic regression of potential profiles of work addiction in clinical nurses
Variable	B	SE	Waldχ²	P	OR 值(95%CI)
How to hire(take system as reference)
Contract	−0.176	0.267	0.433	0.510	0.839(0.497 ~ 1.416)
Personnel Agency	1.167	0.733	2.532	0.112	3.212(0.763 ~ 13.514)
Education background(take as Undergraduate or above as reference)
Junior college or below	0.047	0.296	0.025	0.874	1.048(0.587 ~ 1.871)
Burnout
Depersonalization	−0.126	0.111	1.284	0.257	0.881(0.708 ~ 1.097)
Emotional exhaustion	−0.134	0.017	62.539	< 0.001	0.874(0.846 ~ 0.904)
A reduced sense of accomplishment	0.025	0.014	3.012	0.083	1.025(0.997 ~ 1.054)

Stratified regression analysis of work addiction in clinical nurses

Table 5 shows the results of a hierarchical regression analysis with work addiction as the dependent variable. The results showed that the job title entered the regression equation of work addiction in clinical nurses (F = 11.899, R2 = 0.022, P < < 0.001). Burnout is an important predictor of work addiction in nurses, and it can independently explain 18.70% of the variation in work addiction (AR2 = 0.187.P < 0.001).

Table 5

Hierarchical regression analysis of job burnout on the work addiction of clinical nurses
Variable
	b	SB	b'	t	P		b	SB	b'	t	P
Constant	46.679	1.407		33.183	< 0.001		36.569	1.719		21.269	< 0.001
job title 2.486 0.721 0.149 3.450 <0.001 2.017 0.654 0.121 3.086 0.002
Burnout
Emotional exhaustion						0.538		0.078	0.445	6.860	< 0.001
Depersonalization						-0.024		0.092	-0.017	-0.266	0.791
A reduced sense of accomplishment						0.019		0.035	0.021	0.539	0.590
F			11.899***						34.422***
R2			0.022						0.210
AdjustedR² ∆R²			0.020						0.204 0.187***

M1, Model 1; M2, Model 2.

* * * P ≤ 0.001。

The main findings of this study are as follows. a There are differences in the status of nurses' work addiction in clinical work. We found that 67.90%of the nurses were in a state of low addiction, and 32.1% of nurses were in a state of high addiction, indicating that the state of clinical nursing work addiction is not very serious. b Nurses' job titles, emotional exhaustion.and reduced sense of accomplishment had an impact on the potential categories of work addiction in clinical nurses (P < 0.05) Our study shows that nurses with burnout tend to have higher levels of work addiction, and it is an important predictor of nurse work addiction and can independently explain 20% of the burnout variant

Clinical nurse work addiction is heterogeneous

In this study, we found significant heterogeneity in work addiction among clinical nurses in the sample. We refer to them as the low work addiction group (category 1), and the high work addiction group (category 2)respectively, and their respective groups account for 32.10% and 67.90%of the total, and the vast majority of nurses are in a state of low work addiction. The reasons for this are as follows: In recent years, China has been advocating high-quality nursing services, and clinical nurses not only have to complete busy work tasks but also rack their brains to think about how to innovate to provide better care for patients, and the pressure of work roles has increased, forcing nurses to put more energy into their work, leading to nurse work addiction [27, 28]. In a 2018 survey of nurses in Poland, Kunecka D found that Polish nurses have a high riskof work addiction and that 6% of nurses will be affected by Workaholism.and 40% of nurses may develop workaholism [29], and our study found that 39.5% of nurses have no work addiction, and the majority of nurses with low addiction to work addiction are more serious. Work-addictive states can lead to negative work-related events, which in turn lead to a decline in the quality of care [30]. Therefore, nursing managers can talk more with nurses by holding symposiums, be good at discovering nurses with work addiction tendencies and provide positive guidance, create a good working atmosphere for them, reduce their workload, and maintain their work addiction level in a good state, so as to ensure the physical and mental health of nurses, promote the stable development of the nursing team, and then provide better nursing services for patients.

Potential cross-sectional influencing factors of work addiction in clinical nurses

Our study used latent profile analysis to divide nurses' work addictions into two groups: low addiction group (category 1) and high addiction group (category 2). Although the number of patients in category two accounts for 39.10%, it is this type of nurse who needs our attention the most. In recent years, nurses' work addiction has become more and more serious, and previous studies have shown that the average score of work addiction among female nurses is higher than that of male nurses, which may be due to the fact that female nurses not only have to take on heavy tasks at work, but also shoulder family tasks, and are unable to better balance work and family, coupled with the impact of female childbirth on work, female nurses often need to work harder, and the work and family pressure is greater than that of male nurses, and the work addiction is more serious [31, 32]. Our results show that nurses with different job titles have different levels of work addiction, and nurses with senior professional titles are more likely to have a high degree of work addiction,which is a bad work phenomenon that will reduce the quality of life and professional effectiveness of nurses [33]. A study showed that the vast majority of nurses with senior professional titles are promoted with a college degree, but with the improvement of hospital requirements nurses with senior professional titles also need to have scientific research achievements, which is more difficult for them, so they tend to spend a lot of time on this, and at the same time, the tasks they undertake at work are more cumbersome and complex, which leads to excessive and continuous work at work [34–36]. Factors influencing nurse work addiction include a number of factors, such as socio-environmental factors, and individual-related factors, such as work environment and personal traits [37, 38]. In our study, we explored the clinical work addiction of nurses from the three dimensions of burnout, which is shown in Table 5, and the results show that nurses' depersonalization and reduced sense of accomplishment are also influencing factors of work addiction. Emotionally exhausted, defined as a state in which the patients not emotionally overwhelmed for a long time, is like an emotionless machine that lacks emotional care and concern for the patient and is simply busy with daily tasks and forced to immerse herself in the work

The predictive effect of burnout on work addiction in patients

Burnout is an unhealthy occupational phenomenon, which is known as chronic sub-health state at work, which is mainly manifested by the severe and persistent state of stress caused by work stress at work, and the work does not achieve the expected results [40, 41]. Studies have shown that individuals with higher levels of burnout also have higher levels of work addiction [43, 44]. Work addiction is manifested as an increase in workload, and forced work may lead to a series of physical and mental consequences for nurses, mainly manifested as physical and mental problems such as exhaustion, anxiety, depression, and irritability,which can easily lead to burnout [45, 46]. Improve nurses' job satisfaction and reduce burnout [46, 47]. Nurses can guide themselves to adjust their mindset and rationally arrange their work and family tasks to achieve work-life balance, which is conducive to preventing and reducing the level of nurses' work addiction[48]. Studies have shown that meditative awareness training can improve workaholic symptoms, increase job satisfaction, reduce working hours, and reduce psychological distress[49]. Therefore, clinical nurses can be trained in meditative awareness to prevent and alleviate their psychological problems caused by work addiction, such as anxiety and depression, by improving their working conditions and organizational structure, thereby improving their job satisfaction [50].

Our study explored the characteristics of work addiction and its association with burnout among clinical nurses in five tertiary hospitals in Shaanxi Province. According to the latent trait analysis, we divided their sense of security into a low addiction group (level 1) and a high addiction group (level 2), accounting for 67.90 and 3210% of the total number of nurses surveyed,respectively. Factors that predict clinical nurse job addiction include nurse title and burnout. Burnout was an important predictor of work addiction and could independently explain the 18.70%change in work addiction in nurses. These predictors are of great significance for reducing the work addiction of clinical nurses, and hospital administrators should pay attention to them.

There are some limitations to our study. First of all, our research team only conducted a questionnaire survey on clinical nurses from five tertiary hospitals in one province in their field of familiarity but did not survey all Chinese clinical nurses. Second, our study was conducted in the form of an online questionnaire star, and the results of the study may be subjective. Third, we only preliminarily explored the relationship between burnout and work addiction and did not combine the groups of burnout to explore. In future research, we will further explore the relationship between burnout and work addiction by combining the different types of burnout.

Funding

This study was supported by the Shaanxi Provincial Military Nursing Innovation and Cultivation Project (2021HL041).

Author Contribution

Xh-L, Xx-L, and YY wrote the text of the manuscript. Lt-Z, Lj-G, and XJ distributed questionnaires. YJ and FL were involved in writing and revising the article. My-H participated in the analysis and processing of the data. All authors contributed to the writing of the article and approved the submitted version.

Acknowledgements

Thanks to the Military Medicine Program in Shaanxi Province and the nursing staff who participated in this study. We would also like to thank members of our research team for contacting hospitals to distribute questionnaires.

Data availability statement

The datasets used and analysed during the current study are available from the corresponding author(XueJiang) on reasonable request.

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No competing interests reported.

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Latent profile analysis and burnout study of Work addiction among clinical nurses

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