“Trying to put out fires with kitchen sink water”: Understanding burnout among providers and staff at Ryan White HIV Clinics in the Southeastern United States Público
Groff, Nicole (Fall 2021)
Abstract
Burnout, described as an extended response to chronic workplace stress, can have many downstream effects on healthcare systems, contributing to less productivity, increased turnover, lower patient satisfaction, and increased cost for health systems. Providers and staff who work at HIV clinics funded by the federal Ryan White program may be particularly prone to burnout due to the challenges that many of their patients face, such as homelessness, stigma, and histories of trauma—while often working with staffing shortages and funding changes. Studies on burnout among HIV providers and staff are limited and outdated and this study helps to address this gap. The purpose of this study is to gain a deeper understanding of the factors which may contribute to and alleviate stress and burnout, the role of patient trauma in provider and staff burnout, and existing strategies and suggestions to improve well-being at Ryan White Clinics (RWCs) across the Southeastern United States. This qualitative study is part of a larger mixed-methods study and includes twenty in-depth interviews with providers, staff, and administrators who work at RWCs in the Southeastern United States. Factors contributing to burnout included poor leadership, negative work environments, workload, and insufficient resources for patients, while factors which alleviated burnout included both formal and informal team support mechanisms, feeling supported, and years of experience. There was variation in the impact of patient trauma on providers and staff. Positively, providers often found the work rewarding to see patients make improvements, despite having experienced trauma. Negatively, many providers mentioned that hearing patients’ traumas could lead to burnout. Existing strategies included employee assistance programs, social and self-care activities, team meetings, and effective leadership, with many participants focusing on the effectiveness of the latter three. Suggestions included increased monitoring of well-being, increased team building, social activities, and trainings on patient trauma, burnout, and ways to manage well-being. This study provides opportunities for researchers and administrators in HIV care to better understand how to prevent burnout among providers and staff. Recommendations include normalizing dialogue on burnout and well-being, encouraging more effective leadership strategies, promoting team cohesion, and implementing trauma-informed care trainings.
Table of Contents
CHAPTER ONE: INTRODUCTION.. 1
CHAPTER TWO: LITERATURE REVIEW... 5
Burnout: Definition and Prevalence among Healthcare Professionals. 5
Impacts of Burnout 7
Factors Associated with Burnout 12
Ryan White HIV Primary Care Clinics. 17
Addressing Burnout: Trauma-Informed Care. 20
CHAPTER THREE: MANUSCRIPT.. 28
ABSTRACT.. 28
INTRODUCTION.. 28
METHODS. 32
Study Overview.. 32
Study Setting. 33
Participant eligibility and identification. 33
Participant Recruitment 34
Data collection. 34
Data Management 35
Data analysis. 36
Ethics. 36
RESULTS. 37
Participant Characteristics. 37
Table 1. 38
Factors related to stress and/or burnout 39
Positive and negative impacts of working with patients who have experienced trauma. 47
Existing strategies utilized by clinics to support well-being. 56
Suggestions to further promote well-being. 75
“[Burnout is an issue at the clinic], but it’s not for me”. 81
DISCUSSION.. 83
Recommendations. 91
REFERENCES. 94
APPENDICES. 99
In-depth interview guide for Staff/ Providers. 99
In-depth interview guide for Administrators. 107
Codebook. 116
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