The subject of burnout in a form of emotional exhaustion has become imperative in health organizations because of the emerging trends in employment and its related problems. It is been ascertained that unhealthy practice environment such as increased workloads, absurd nurse-patient ratios, and scarce human and material resources is a major threat in the well‐being of professionals especially in the incidence of emotional exhaustion among nursing workforce (1, 2, 3, 4) and any organisational culture that does not support its personnel has burnout costs (4). Emotional exhaustion, which is one of the pillars of ‘Burnout Syndrome’ is defined as syndrome characterized by losing enthusiasm for work (5, 6, 7, 8) and it is conceptualised as a response to a discrepancy between job-related strains and resources that is presented through feelings of emotional fatigue (9). Additionally, emotional exhaustion presents as a chronic manifestation of somatic and emotional depletion that results from extreme workload and/or personal strains and incessant tension from job (10). It is understood to develops from defects in the structural and psychological make-ups in an organisation (11, 12) and the study of this phenomenon in other jurisdictions among nurses have produced distinctive outcomes that need a critical look.
Among health workers, the nursing workforce is mostly found to report constantly complex intensity of emotional exhaustion. The frequency ranges between 37% and 89% among nurses in Sub-Saharan Africa (SSA). It is, however, common among Intensive Care Units (ICUs) nurses and those who provide reproductive health services. The resultant consequences are low staff productivity and dissatisfaction of care provided by health caregivers (13, 14). Within the context of a hospital setting, nurses in various units are duty bound to provide care to patients in settings associated with complex care and impending death. They also face death and grief situations on daily basis, and are at risk of becoming more susceptible to psychological repercussions and stress, frequently occasioning in emotional exhaustion (15, 16). Emotional exhaustion of nurses has been identified to increased work-related infections, increased medication error, high incidence of patients’ fall, poor nurse-physician relations, low personal accomplishment of the nurse, job dissatisfaction and increased turnover intention (17, 18). Burnout at workplace gives rise to chronic adverse emotions such as anger, anxiety or depression, mental exhaustion, apprehension, low enthusiasm, and absenteeism which certainly endangers not only the nurses own health, but also their patients (19, 20).
In low-middle-income countries (LMICs), where nurses undertake their task in unfavourable practice environment (uncomfortable postures, extreme noise intensities, and congested work area), there is moderate to higher dimensions of burnout in the form of emotional exhaustion (21). This obviously make the responsibility of giving care to patient extra demanding. The interactions between professional’s emotional exhaustion and practice environment cannot be underestimated; as workplace which boast of quality leadership and nurses’ involvement in decision-making presents with low levels of exhaustion (22, 23). Greater autonomy for nurses in respect of adequate staffing and resources and positive nurse-physician relation has also been found to improve this phenomenon; and thus reflects on nurses’ job satisfaction and the enhanced quality of care to clients (24, 25, 26).
With World Health Organization (WHO) report on nursing workforce stating that more nurses are required in attaining satisfactory nurse-patient ratio especially in LMICs (27); measures are needed to reduce emotional exhaustion among nurses. Potential widening of the disproportion of nurse-patient ratio places huge workload that build continuous psychosomatic stress on nurses in a form fatigue and emotional exhaustion. In extreme cases, emotional exhaustion results in work-family conflict for the nurse (28, 29).
In SSA, organisational factors (demands from job, control over work, social support, and interpersonal relationships, and change over the role of staff) considerably impact on staff’s emotional exhaustion. Most nurses have increased chances of exhaustion relative to other health care providers (30, 31). An unsafe nurse-to-patient ratio in most health care facilities in Ghana result in increased levels of stress among health staff (32). As reported in Switzerland 1:59, Canada 1:106 and United Kingdom 1:118, there is better efficiency in relation to the nurse-patient ratio in high-resource countries. There is a comparatively lower nurse-patient ratio in countries in SSA, with perhaps the exception of South Africa with one nurse to 192 patients and a few other countries. Sudan (1:833), Gambia (1:1111), Rwanda (1:1250) and Mali (1:1667) have reported a very low nurse-patient ratio, and Senegal (0.3) and Mozambique (0.4) are even more frightening. While there has been significant improvement in the nurse-patient ratios in Ghana from 1:1,251 in 2012 to 1:542 in 2016, and currently 4.2:1000, much is still needed to increase the nursing workforce in Ghana. The key implication is that most countries in SSA is not capable attain the WHO’s recommendation of nurse-patient ratio of 1:300 and further increase episodes of emotional exhaustion and deceased quality of care to patients (33, 34, 35).
Complains of inadequate recognition from clients and their relations and the community usually serve as the main cause of nurses’ emotional exhaustion. Additionally, some health care practitioners also experience emotional exhaustion in a form of despair when their patients relapse or their condition deteriorate despite the amount of time and quality of care provided to them (36). Importantly, challenges of role ambiguity of nurses who are upgraded without adequate training on their new roles usually cause an upsurge in job burdens. Such situations increase the amount of work by nurses; and inadequate human and material resources to perform these roles result in emotional exhaustion (37). Burnout compromises nursing care, thus delay in the recuperating time of patients and avoidable deaths; and also affect nurses’ loyalty to an organisation thereby increasing turnover intentions (38).
Emotional exhaustion among nurses in Ghana has not been given considerable attention, as most studies are directed towards other work-related risks with emphasis placed primarily on healthcare professionals in general. Besides, in circumstances where emotional exhaustion has been studied, it is generally restricted to a few categories of nurses; therefore, the trends among the broad segment of nursing staff cannot be evaluated. Additionally, in order to ameliorate the hazards caused by emotional exhaustion, and its compounding effects on job satisfaction, quality nursing care delivery and turnover intention, it would be appropriate for nurse researchers to devote more attention to undertaking studies that will holistically assess this concept. The study therefore, aimed at assessing rate of emotional exhaustion, determining the factors that accounts for it and also ascertaining the coping strategies used to overcome it among Ghanaian nurses.