Abstract : A study is reported of the variations in organizational commitment and job satisfaction, as related to subsequent turnover in a sample of recently-employed psychiatric technician trainees. A longitudinal study was made across a 10 1/2 month period, with attitude measures collected at four points in time. For this sample, job satisfaction measures appeared better able to differentiate future stayers from leavers in the earliest phase of the study. With the passage of time, organizational commitment measures proved to be a better predictor of turnover, and job satisfaction failed to predict turnover. The findings are discussed in the light of other related studies, and possible explanations are examined. (Modified author abstract)

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Organizational Commitment, Job Satisfaction and Turnover Among Psychiatric Technicians. Technical Report No. 16.

Burnout, viewed as the exhaustion of physical or emotional strength as a result of prolonged stress or frustration, was added to the mental health lexicon in the 1970s, and has been detected in a wide variety of health care providers. A study of 600 American workers indicated that burnout resulted in lowered production, and increases in absenteeism, health care costs, and personnel turnover. Many employees are vulnerable, particularly as the American job scene changes through industrial downsizing, corporate buyouts and mergers, and lengthened work time. Burnout produces both physical and behavioural changes, in some instances leading to chemical abuse. The health professionals at risk include physicians, nurses, social workers, dentists, care providers in oncology and AIDS-patient care personnel, emergency service staff members, mental health workers, and speech and language pathologists, among others. Early identification of this emotional slippage is needed to prevent the depersonalization of the provider-patient relationship. Prevention and treatment are essentially parallel efforts, including greater job control by the individual worker, group meetings, better up-and-down communication, more recognition of individual worth, job redesign, flexible work hours, full orientation to job requirements, available employee assistance programmes, and adjuvant activity. Burnout is a health care professional's occupational disease which must be recognized early and treated.

Burnout as a clinical entity—its importance in health care workers

Causal modeling was used to explore the processes by which individual characteristics, job satisfaction, and intention to quit explain turnover among nursing personnel in 29 Department of Veterans Affairs (VA) long-term psychiatric settings. The sample consisted of 1,106 registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides. We conceptualized turnover as a multistage process linking social and experiential orientations, attitudes toward the job, the decision to quit, and the behavior of actually quitting. Intention to quit was the strongest direct predictor of turnover. Professional growth opportunities and workload were important indirect predictors of turnover. Dissatisfaction with work hazards and relationships with coworkers were both indirect and direct predictors of turnover. Attitudes towards the job varied by nursing group. LPNs and aides were less satisfied than RNs with autonomy and work hazards. RNs were more dissatisfied with workload. We conclude that strategies to promote retention need to address aspects of jobs tailored to specific nursing groups.

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A causal model of voluntary turnover among nursing personnel in long-term psychiatric settings

As the industrial world has transformed toward a service economy, a particular interest has developed in mental health problems at the workplace. The risk for burnout is significantly increased in certain occupations, notably for health care workers. Beyond the effects of an extensive workload, many working hours, or long night shifts, the medical field has specific stressors. Physicians work in emotionally demanding environments with patients, families, or other medical staff. They must make quick decisions while faced with a quite frequent information overload. All of these stressors have to be weighed against a rapidly changing organizational context within medicine. Today, economics objectives have priority over medical values in health care. In principal, mental health workers should experience similar work stressors and the same contextual factors as health professionals from other medical disciplines. However, several studies have identified stressors that are unique to the psychiatric profession. These challenges range from the stigma of this profession, to particularly demanding relationships with patients and difficult interactions with other mental health professionals as part of multidisciplinary teams to personal threats from violent patients. Other sources of stress are a lack of positive feedback, low pay, and a poor work environment. Finally, patient suicide is a major stressor, upon which a majority of mental health workers report post-traumatic stress symptoms.

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Stress, burnout, and job dissatisfaction in mental health workers.

Background: Research into stress among psychiatrists has attempted to identify
stressors, which can lead to physical illness and psychological distress.
Aims: The aim of the study was systematically to review the current evidence for
the effectiveness of stress management interventions for those working in the
psychiatric profession.
Method: A systematic review of the current literature was conducted into stress
and stress management within the profession of psychiatry.
Results: Twenty-three international studies were included in the psychiatry
section of the review. Psychiatrists report a range of stressors in their work,
including stress associated with their work and personal stresses. One personal
stress, which psychiatrists ﬁnd very difﬁcult to cope with is patient suicide. Coping
strategies include support from colleagues and outside interests. No studies
evaluated the use of stress-management interventions for psychiatrists.
Conclusions: Psychiatry is a stressful profession. Psychiatrists identiﬁed several
stressors in their professional and personal lives.

Stress, burnout, coping and stress management in psychiatrists: findings from a systematic review.

Although state mental hospitals face a critical shortage of psychiatric manpower, there have been no studies of how psychiatrists view their roles and responsibilities within the public mental health system. in this study, a modification ofthe proportionate scaling method developed by Holmes and Rahe is used to measure and rank the stress-producing potential of 60 items identifled by psychiatrists at Saint Elizabeths Hospital in Washington, D. C., as sources of stress. Results of the analysis show that most of the events rated as highly stressful fall into the category of administrative and organizational shortcomings.

Occupational Stress in a Public Mental Hospital: The Psychiatrist's View

Models were developed to predict the tenure status of 106 psychiatric nursing assistants at 3, 6, and 12 months after beginning employment at a large public psychiatric inpatient facility. The attrition rate of this sample was 40% which was consistent with trends reported in the literature. The predictive power of four groups of variables--personal, training, ward related, and organizational--was shown to change over time. Personal and training variables were significant early determinants of tenure, while ward and organizational factors gained more importance during the course of the year. Certain factors that appear important in reducing turnover of nursing assistants are discussed, with recommendations for program changes.

Frederick C. Depp

Papers

Occupational Stress in a Public Mental Hospital: The Psychiatrist's View

Predicting tenure decisions of psychiatric nursing assistants: individual and work-related factors.