Chapter 4 and 5

Chapter Four

Introduction
The purpose of this study has been to examine the impact of burnout on social care workers. To do so, this study has been guided by the following research questions and hypothesis.
RQ1- To what extent are new social workers satisfied with their current career roles?
H₀1 –Social workers are satisfied with career advancement and have job satisfaction
RQ 2 –What aspects of their job are new social workers least satisfied??
Ho2 – Based on social workers low self-efficacy ratings, there is no statistically significant difference between social workers burnout, occupational stress and intent to leave an acute care setting.
RQ3 – What is the overall impact of self-efficacy on the social workers Job satisfaction and Occupational Stress?
Ho2- High self-efficacy increases job satisfaction and reduces occupation stress among social workers

This chapter seeks to provide information on the data collected, a comprehensive statical of the data and finally, a summary of the results would be provided.
Personal themes
Individual history of mistreatment
Studies have examined the magnitude of traumatic experiences for social workers as a response to fears that these professionals’ abuse records could result in traumatic symptoms, dissociative symptoms, vicarious traumatization, and emotional exhaustion due to consistent exposure to a traumatic substance (Michalopoulos & Aparicio, 2012). Five study in the present study analysis point to a link between past experiences of ill-treatment and emotional exhaustion to high levels of job dissatisfaction (Nelson-Gardell & Harris, 2003; Bride et al., 2007; Cunningham, 2003; Michalopoulos & Aparicio, 2012; Lee et al., 2018). Gil & Weinberg (2015) highlights that a social worker’s past trauma experiences as a child raise the chance of secondary traumatic stress (STS). The findings agree with earlier research that has identified childhood traumatic experiences as a significant possible cause of STS (Nelson-Gardell and Harris, 2003; Caringi et al., 2008). Undoubtbly, there is need for more research to determine whether a traumatic past increase or decreases resilience. According to Michalopoulos & Aparicio (2012), the wide range of recorded prevalence estimates of mistreatment pasts among people in “empathic careers” (7.1% to 83%) indicates distinction in sampling, material, descriptions, layout strategies, and random variation. Moreover, the literature reveals the importance of maltreatment pasts as a potential motivating factor to join empathic careers and recommends that organizational strategy be implemented to nurture pliability in these workers.
Child welfare education and groundwork
Westbrook et al., (2006) in their study highlights that an involvement in financed social work training programs results in greater retention and job satisfaction among employees. Title IV is a US government-backed approach aimed at attracting and retaining trainees in social welfare workers. The framework pays trainees some allowance in exchange for a dedication to staying on the job for a predetermined period after certification as a social service professional (Westbrook et al., 2006). Ellett & Leighninger (2006) studied 369 respondents and found that an IV-E apprenticeship or employment history in social care welfare prior to starting the job is an obvious factor for retention. Ellett (2009) describe the creation and early enforcement of an Employee Selection Programme (ESP) for children’s wellbeing and emphasizes the value of ESP in enhancing the worker recruitment procedure.
Employees have a professional obligation to take part in Continuous Professional Development (CPD), not only for governance and ethical purposes but also for the advancement of skills and information and the maintenance of professionalism (Koskimaki et al., 2021). Cho & Song (2017) in his research analyzes that transmission of factors of learning and the effect of aggregate information exchange endorse the need for development and training programs as part of a comprehensive employee retention initiative. Moreover, Turcotte & Pouliot (2006) in a study notes that after a coaching program is implemented, a significant sample of 945 professionals felt extra proficient, had gained extra skills, and had transformed some behaviors with families.
Coping Strategies
Various studies have been conducted on how to deal with job demands within the social care setting. For this study, we reviewed eight studies dealing with coping strategies and job satisfaction (Shepherd & Newell, 2020; Collins, 2015; Barck-Holst et al., 2021; Bakker & de Vries, 2021; Tesi, 2021; Vyvey et al., 2014; McFadded et al., 2015; Travis et al., 2016). Tesi (2021) in a study highlights that social service employees use various coping mechanisms to gain job contentment, job retention, self-actualization, and significance and purpose in their job. These techniques entail i) using investigatory and people skills, (ii) incorporating risks and challenges, (iii) seeking direction and significance, (iv) anticipating the unusual, (v) maintaining sensible expectations, (vi) attaining confidence and competence, (vii) obtaining assistance from others and oversight, (viii) sustaining an essential work-life balance, (ix) debriefing from traumatic encounters, and (x) acquiring new skills.
Collins (2015) investigated how social service professionals handled occupational stress. The study’s results revealed that respondents believe they use effective coping mechanisms such as problem-solving and cognitive therapy more than they convey feelings and emotional support. Issue evasion, self-criticism, and social isolation were all utilized frequently than these approaches. The results reveal that coping mechanisms differ depending on the magnitude of emotional exhaustion encountered. The research results indicate that employees ought to employ active coping mechanisms, such as feeling-centered coping techniques and peer support, to cure job stress.
Shepherd & Newell (2020) studied 75 child wellbeing employees to assess burnout, compassion satisfaction (CS), and STS. According to the research results, one of the major pillars of workers’ retention is their satisfaction from assisting people. Surprisingly, the leading recorded coping techniques included “discussing with a spouse or colleague,” “workouts,” and “eating out – e.g., at a restaurant” (Shepherd & Newell, 2020). This research backs up Shepherd & Newell (2020) outcomes that active coping reduces the likelihood of emotional exhaustion.
Over the last few years, research efforts have been dedicated on understanding the impact of coping strategies on burnout among social workers. Boamah et al. (2017), conducted a research to ascertain social workers’ occupational wellbeing in their work environment, and established that coping strategies has a negative correlation to the level of commitment, perceived control, and emotional exhaustion. In another study, Alshbali, (2018) established that depersonalization factor is negatively related to burnout and personal accomplishment among the participants who participated in the study. The method of coping strategies employed by different people is negatively related to higher levels of burnout and personal accomplishment and lower levels of emotional exhaustion and depersonalization (Borges, et al. 2017). In three studies reviewed, it was established that using passive avoidant coping strategies and emotional coping strategies were found to be unsuccessful in handling stress, primarily when they used the methods alone without incorporating other methods of stress coping (Liu et al, 2018, Chuan-cheng. 2011, Davis et al. 2008). Participants that used active problem-focused coping were found to have reported lower levels of emotional exhaustion in their workplace and their profession.
In most of the studies reviewed, it was found that avoidant behavior and emotional exhaustion, and depersonalization had lower levels of personal accomplishment among the participants in the studies. Further, most studies established that avoidant behaviors after going through traumatic events are not the best option if a long-term strategy is needed to cope with stress by social workers and social workers. In another study, Vigra et al, (2020), noted that people who had feelings of mastery for mediation between occupational stressors in social workers and higher levels of depersonalization led to lower depersonalization levels at the end.
Job Satisfaction and Burnout
While social service providers face high levels of exhaustion and turnover, job satisfaction plays an important role in ensuring reduced burnout among the social workers. Four papers were examined as being pertinent to the issue of satisfaction of jobs and discontent. Shiva Kumar et al. (2017) conducted a systematic review of six studies that looked at aspects of work performance and psychological distress among child protection workers. Despite the fact that 47 percent of individuals were pleased with their occupations, the mean for emotional exhaustion ratings were high. This research were directed by a range of study objectives, which may clarify why a connection between job satisfaction (JS) and emotional exhaustion (EE) was not documented frequently. Many studies had scientific design problems, such as the use of measures that were not validated and JS was measured in most of them by a specific comment. Other studies contradict Shiva Kumar’s et al. (2017) assertion that high EE and JS can coexist. Keller (2017), for instance, focused on 455 subjects in a long-term quantitative investigation. The primary aim of the study was to look into the impact of JS on workers’ need to stay in this industry. The outcomes reveal that boosting JS isn’t the solitary element that matters when it comes to retaining employees. In the same way, McFadden et al. (2017) according to a research of 550 Title IV MSW children’s services students, those with impaired learning emotional intensities ought to be less susceptible to fatigue and capable to make difficult social work judgments, which are required in this career. These professionals are also better at incorporating insights from their own and others’ emotions into their toil.
Organizational themes
Organizational and Professional Commitment
Staff retention is influenced by organizational characteristics such as worker dedication to the field, low rates of employee fatigue, high perception of self for continuing work engagement, salary, and incentives. Employing longitudinal methodologies, Schweitzer et al. (2016) discovered that one of the peak predictor of whether students stayed over their Title IV remuneration requirement was organizational loyalty. Mosadeghrad et al. (2017) also utilized a cross-sectional survey to explore why individuals choose to work in emotionally exhaustive workplaces. According to the study, employees who build a bond with their superiors and accept jobs because they believe in the agency’s objective are more pleased and less likely to leave, according to the findings.
Chang (2017) investigated attrition indicators among social workers. This study included 141 ‘leavers’ and 382 ‘still in post’ participants. The findings discriminate between having the intention to depart and actually leaving. It was discovered that employees’ sentiments of their working environments are more closely linked to the intent to leave than job leaving. In order to enhance worker retention, these researches show that workers must first feel dedicated to the agency, have built a connection to their supervisors, and have a favorable impression of working practices.
Organizational culture and climate
Organizational climate has been studied as a aspect in worker turnover and affects employee burnout. Accordingly, job satisfaction is linked to transformational leadership, level of confidence between coworkers, and sufficient resources. Furthermore, organizational environment has been demonstrated to be leading the predictor of promising effects for children, as well as customer satisfaction and user results. Dickinson & Claiborne (2019) in a research drew on quantitative data from child welfare workers (310). According to the findings, workers’ favorable perceptions of collaboration lowered their reported desire to quit, but workers’ burnout raised their reported intent to quit.
According Abdulrahim et al. (2020) a passive protective organization structure impacts negative influence on employees in their early careers but not on those in their late careers, or late phases of their careers. This shows that, over period, there has been a decrease in sensitivity to passively self-protective structural culture. Support and organizational culture have just a minor impact on retention among child welfare employees at various phases of their careers. Mosadeghrad et al. (2017) conducted a comparative study concentrating on the examination of barriers to retaining rookie clinicians in three countries: Australia, Sweden, and. England, The lack of line performance management, along with team experience and a lack of peer support, worsens the problem for beginners, according to this study.
Following the completion of an evaluation of an intervention targeted at addressing the organizational reasons of turnover in the public child welfare system. Griffiths et al. (2020) looked at the intention to depart and the intention to turnover. The findings back up the use of Design Teams as an organizational transformation technique for retaining child welfare workers. Organizational and individual benefits were discovered in the study, including a significant decrease in the desire to quit and an enhancement in organizational engagement and turnover intentions. According to qualitative data, supporting agencies were led by capable leaders with professional features and structural conditions that, among other things, subsidized to the long-term survival of DTs. However, such organizational circumstances were most likely the motivating factor behind its engagement in the first place.
Workload
A large number of studies have identified workload as a significant stressor in child protection employment. High workloads and low incomes have been shown to have a negative impact on workers’ self-esteem. Wainwright, (2019) discovered that such situations imply to employees that they are not valued by their company in a large-scale quantitative survey. Furthermore, employees see such working conditions as indicating that their company is unconcerned about their well-being, resulting in absence of organizational obligation and high turnover proportions. In a research, Messenger (2018) discovered that front-line employees and their managers are compelled to work 50-60 hours a week, and in some circumstances, 70 hours a week. When Tham & Meagher (2018) compared the perceptions of child welfare workers to those of social workers in general, he discovered that, while child welfare workers rated some aspects of their jobs positively, their work was unusually demanding, especially when compared to other social workers…
Support from peers and management
Several studies have indicated that social support and monitoring help employees stay on the job. Fatigue and turnover can be mitigated by supervisor and coworker support, according to research on the subject. Muneeb & Ahmad, (2020) used longitudinal methodologies to confirm that colleagues and supervisors have a critical impact in employee retention. Active coping techniques and social supports, according to Flovik et al. (2019) guard against fatigue. Stayers were more connected to their superiors and provided more assistance. According to Kachi et al., (2020), a trusting atmosphere with supervisors may give a steady and buffering impact to protect employees from job-related stresses. According to studies, supervisor and colleague assistance can help reduce burnout and turnover. Olaniyan et al. (2020) performed a twenty-five research study and found that child welfare supervisors must be aware of their essential role in supporting employees in coping with secondary upset.
The issue of “undesirable exits” is highlighted in an experimental attrition study, which included 151 child welfare workers. The findings show that supervisor practice support can reduce a employee’s chance of leaving by a substantial and incremental amount. Olaniyan et al. (2020) discovered that higher levels of JS were linked to higher levels of contentment with monitoring, working circumstances, the availability of being a manager and financial resources.
Compassion Fatigue, CS and STS
Five studies empathy fatigue/satisfaction and how it affects employees. Those who are directly affected by traumatic events are not the only ones who are affected. Secondary Traumatic stress (STS) largely affects people who have regular interaction with traumatized people. Such individuals may be subjected to long-term emotional distress as a result of the trauma (Shiva Kumar et al., 2017). Given their amount of interaction with vulnerable individuals, numerous studies have revealed that social workers suffer from more emotional anguish than the broad public, and many have suffering points larger than those conveyed by normal mental health customers.
NCTSN (2011) piloted a study on STS in order to better understand its impact on 102 workers concerned with child safety. They were also interested in learning more about the risk and Factors that Contribute to the Development of STS. Extenuating variables included prior personal background of operative ordeal, (ii) reacting style, (iii) organizational features, and (IV) the employee’s own sense of pressure. Although there are numerous moderating factors to consider, this study appears to back up earlier results that CF is present in the child protection field.
Do the values and philosophy of social work make it intrinsically stressful?
Pines & Kafry (1978) hypothesized that social service providers are a relatively cohesive mass emotionally and that their sensitivity to their client’s concerns makes them particularly prone to work stress. Individuals susceptible to depression pick social work instead of another profession; Brown et al. (2019) hypothesized that they do so as they want to overcome their issues by assisting others. It has been proposed that the desire to be of service to others is a key motivation for several social workers in choosing their career path, and this desire can quickly grow into an excessive amount of engagement with clients, thus leading to stress (Waterman, 2002; Acker, 1999).
The connections that social workers have with their patients are at the heart of their profession. However, even when social workers are working with clientele who make requests or have standards that are insane or unacceptable, there is the possibility of inner strife. All through training, a great deal of emphasis is put upon the relationship between the service provider and the client (Brown et al., 2019). After being trained to be impartial, social workers may struggle to accept that the personality traits and inclinations of clientele make meaningful service responses nearly impossible (Brown et al. 2019). Consequently, they may be able to endure and take accountability or organization accountability in the event of a failure.
As a result of the contradictions, statuses, activities, and contextual factors that social workers face, there is a popular notion that social work is a high-stress profession (Brown et al., 2019; Kim & Stoner, 2008). Growing attention has been placed on constructive results and efficiency in the healthcare system while diminishing attention has been placed on the person’s value in the process. In maintaining rapport grounded on social work ethics, social service providers are likely to experience tensions (Waterman, 2002). According to Indregard et al. (2018), social workers are subjected to ever-increasing demands because the complications they handle reflect changes in society and the growing pressure of daily life.
A dispute may exist between social work ideologies (for instance, social justice and activism, clientele empowerment, and self-determination), as well as anticipated roles (for instance, client activism) (Kim & Stoner, 2008; Waterman, 2002; Brown et al., 2019; Indregard et al., 2018; Balloch et al., 1998). Miller et al., (2017) observed that social work professionals conducting Mental Health Act evaluations were confronted with these issues. Social workers struggled with the tension between their role as client advocates and representatives of their desires and obligation to ensure clients’ safety and other people around them.
Social workers and administrators have been described as experiencing conflicting values, which is a cause of stress (Waterman, 2002). As a result, social workers’ ethical principles are sometimes not economically viable in healthcare settings, which is especially apparent in social work. In a physician-dominated governing system, social service providers possess less influence or authority. For instance, discharge planning is a perfect illustration of obligation minus decision-making authority (Scanlan & Still, 2019; Waterman, 2002); the needs of hospital administrators regularly necessitate service users being released before they are physically and emotionally prepared to leave. The task of social service professionals is centered on solving problems, and it frequently entails making difficult decisions between unfulfilling options (Brown et al., 2019).
Independence and status as causes of social work strain
According to Kim & Stoner (2008), social service professionals seem to have little authority over the people they serve, the type and duration of their interactions with patients, the scope of professional operations they would be asked to perform, and the importance placed on their job by everyone else. Some people, according to Kim & Stoner (2008), misunderstand social service as simply being lovely or carrying out basic logic tasks anybody can perform on their own. There have been suggestions that there is absence of clarity regarding the duties and responsibilities of social workers, as well as how to convey efficacy (Brown et al., 2019). The perceptions of others (which includes co-workers and the public in general) about social work have been noted in several publications (Winter et al., 2019; Ngai et al., 2009; Collings & Murray, 1996) and social service providers have expressed concern about it. It has been suggested that this has led to hurdles to the credibility and validity of social work, according to Indregard et al. (2018).
Miller et al. (2017) carried out research in which they discovered that social workers in psychological health mentioned feeling frustrated since their position was misinterpreted. Their skillset is seldom sufficiently understood nor adequately appreciated by other healthcare professionals. Furthermore, Scanlan & Still (2019) discovered that social workers have contradictory anticipations, that most other colleagues do not fathom the social worker’s part, and do not recognize what they could achieve. Fantus et al. (2017) discovered that distress was caused by various factors, including role dispute, discord about practice, and a lack of appreciation. The level of occupational stress suffered by social workers is increased as a result of role conflict (Miller et al., 2017).
Social service providers are particularly vulnerable to the shifts in social laws and policies that marked much of the West in recent years. Brown et al. (2019) asserts that changes in the United Kingdom, such as the new focus on economic planning rather than expert knowledge, have harmed social workers’ performance. Among the repercussions of trends in social administration, according to Balloch (1998), are depreciation of skills, reductions in supervision and support, and a lack of professional chances for those who choose to stay in social work instead of pursuing a career in management. It has been proposed that social workers have deficiency of funds and recruitment necessary to carry out the task expected of them and current regulation is placing added duties on their shoulders while giving them less autonomy and control (Brown et al., 2019; Indregard et al., 2018). Social workers are confronted with a dispute between the pressure put on them as workers and their desire for some degree of professional independence (Brown et al., 2019).
As a result of the implementation of healthcare reforms, the organizational structure of social work is receiving more and more attention as a potential basis of occupational distress (Fantus et al., 2017; Scanlan & Still, 2019). Because of the significant economic burden associated with stress caused by organizational factors, several firms are concerned about the issue of stress (Bradley & Sutherland, 1995). According to the findings of Cushman et al. (1995), participants established a list of stress factors related to the organization of employment. Among them were funding cuts, a scarcity of staff, high rates of turnover among employees, a lack of connections with other job divisions, the mentalities of other healthcare workers, and operating in a rigid setting. An added managerial barrier is the demand to release patients faster than is necessary, the insufficient time for counseling or psychological backing, and an absence of collaboration from hospital employees (Scanlan & Still, 2019). During their research, Collings and Murray (1996) discovered that some of the most significant predictors of stress were the pressure associated with setting and meeting work goals.
Individuals are typically allocated and required to perform specific tasks in their place of employment. It is the workers’ expectations and other participants of the specific role that impact how well the workers deem and perform the task (Egan & Kadushin, 1995). Winter et al. (2019) discovered that children’s services administrators were experiencing expert role disputes as well as institutional goal disputes in their research. The respondents described major occurrences of role conflict, to the point that others had disputing interests in their roles in the group. According to Jessen (2010), it is unclear why social service professionals in a particular setting or task perceive themselves to be under greater stress or more susceptible to pressure than social workers in other environments.
An inquiry into job stressors among skilled and support staff in a social care team in England was carried out by Bradley and Sutherland (1995). The study comprised 63 social workers (with an 85% success rate) and 74 home helpers (79% success rate). According to this research, the primary stressors for social service employees were comparable to those described by Collings and Murray (1996). Increased stress levels were reported by social workers as a result of the organization’s structure and atmosphere, especially concerning the difficulties of operating in a low-morale environment (Bradley & Sutherland, 1995).
Every employee is vulnerable to the stress linked to role conflict as organizations start changing the previously well-established practices replacing them with more complicated and interlocking duties. Following the findings of the research steered by Balloch et al. (1998), it was discovered that role conflict is a significant source of frustration for social service professionals. They discovered that the commonly cited sources of stress included being subjected to competing objectives, performing tasks beyond the job description, inability to perform tasks in the job description, and absence of clarity about what is anticipated. In the event of confusion about the bounds of the employee and other people’s expectations, it is referred to as role conflict. According to research, stress resulting from undefined objectives and goals can eventually result in job discontentment, a loss of self-esteem, a decreased concept of self-confidence, a demotivation to work, and the inclination to resign (Newcomb, 2021). Gomes-Garcia et al. (2020) discovered that absence of job specificity is a predictor of burnout and high turnover, irrespective of the nature of the work environment in which it occurs. In their opinion, having a clear job description could be a preventative component in exhaustion.
Stress outcomes – burnout, job contentment, morbidity, and employee turnover
In their research of field social service professionals in the United Kingdom, Thompson et al. (1996) discovered increased levels of emotive pain; 74 percent of that polled reported borderline or compulsive anxiousness. Ngai et al. (2009) discovered that 37 percent of participants were defined as ‘caseloads,’ that is, they characterized signs that would have been categorized as minor psychological distress when studying work stress among social workers in Northern Ireland. Caughey (1996) discovered that 72 percent of the 36 participants in a later study who worked at a district social services office showed signs of psychological distress as tested by the GHQ28. Winter et al. (2019) discovered that 55 percent of the model suffered stress in research on the psychological pressure endured by social service providers; anxiety levels continued to increase as perceived expectations rose. In a research on the impacts of work stress and exhaustion on family relationships, social workers with severe exhaustion were more vulnerable to stress, anxiety, and irritability, as well as reduced satisfaction in their marriages (O’Connor et al., 2018). Beer et al. (2021) investigated anxiety sources, coping mechanisms, and anxiety results in three categories of social service professionals: adult physical dysfunction, adult psychological health, and child health. They discovered that the level of psychological stress was significantly higher than normal for any other career category. When assessed against normative groups and employees in different fields, the research found that all social workers had higher work-related stress and personality depression levels.
Similarly, Bradley and Sutherland (1995) discovered that home helpers and social workers had higher illness rates than the normative population; corporal fatigue (51%) and psychological fatigue (51%) were among the social work stress indicators (38 percent). Therefore, the mental health measure discovered that home helpers and social service professionals recorded lower mental wellness compared to other careers.
Balloch et al. (1998) researched five separate English local governments to investigate the link between dissatisfaction, satisfaction levels, and distress among social service workers. Interviews with a group of 1276 people were conducted. The sample’s mean GHQ scores were significantly higher than in earlier studies, with supervisors outscoring the staff. Employees who felt role conflict scored higher on GHQ compared to those confident concerning their professions. A while back, it was discovered that a substantial percentage of social work instructors had borderline depression and anxiety (Collins & Parry-Jones, 2000).
Job satisfaction is especially important because a person is more likely to apply for or remain in a positive work environment and ignore or quit an unsatisfactory job. The significance of job fulfilment is demonstrated by its continued relationship with turnover and absenteeism (Martin & Schinke, 1998; Lewis & King, 2019; Beer et al., 2020). O’Connor et al. (2018) studied fatigue in 144 local mental fitness workforce, 60 children’s welfare employees, and 84 home support employees. They discovered that the amounts of burnout observed by child welfare employees and local mental health wellness employees did not portray significant variations. De-personalisation was lesser among family services employees. 40 percent of those polled believed they were likely to change shift jobs.
Maslach et al. (1996) forecasted that exhaustion would be associated with a wish to quit one’s occupation in earlier studies. Ngai et al. (2009) discovered that 73% of participants had imagined abandoning social service at a certain moment, with half of those considering leaving in the previous year. Several other surveys have found that many social workers plan to quit their professions totally or quit their present positions (Lewis & King, 2019; Beer et al., 2020).
Ngai et al. (2009) used the Maslach Burnout Inventory (MBI) to research job stress among 176 field social service employees in Ireland. According to the findings of this research, 47 percent of social workers were in the medium activity exhaustion group in contexts of intensity and frequency of the psychological distress subscales, and 42 percent belonged to the intense exhaustion group on the de-personalization subscales. Social workers score highly on the scale that evaluates fatigue as a result of perceptions of self-inadequacy. All participants belonged to the high fatigue group for intensity (98%) and frequency (100%). Then, it is clear that the primary symptom of fatigue in the social service dataset was thoughts of personal achievement. Ngai et al. (2009) proposed that feelings of failure to achieve career goals are more probable in career paths that attract those with notions that are not realized in exercise. Findings like these demonstrate a high level of dissatisfaction with daily social work practice.
Beer et al. (2020) compared the perceived job fulfillment, exhaustion, and turnover among a nationally representative sample of social service professionals in Norway and the United States. The Norwegians recorded higher burnout levels, discontentment with their professions, and intention to quit than the Americans. Norwegians recorded higher distress linked to role dispute, value conflict, job challenge, and monetary gains, while Americans recorded lower distress linked to workload and promotion. The challenge of the profession, according to Beer et al. (2020), is the main determinant of all emotional exhaustion.
Martin and Schinke (1998) studied levels of fatigue and job contentment in mental wellness professionals. The MSQ, the MBI, and the SBSHP survey 200 children/family and psychiatric employees from seven social service organizations in the New York City environs. 57 percent of psychiatric employees and 71% of children/family employees recorded being reasonably or severely exhausted. It was deduced that the utter lack of particular essential job aspects, such as promotions and bonus payments, is linked to employee burnout.
Prosser et al. (1999) collected data in England to investigate mental health providers’ mental well-being, exhaustion, and job contentment. When contrasted to in-patient employees, they discovered that being stationed in the society was linked to higher GHQ12 ratings. According to the MBI, being a social worker was linked to increased strain, low job contentment, and higher psychological burnout. Acker (1999) discovered a link between participation and psychological distress. He deduced that dealing with clients who have serious mental illness harms social workers.
Shielding factors: Management and squad support
Different types of social assistance help defend against exhaustion (Hombrados-Mendieta, & Cosano-Rivas, 2013), and several social service scholars have studied the impacts of psychological backing on mitigating the effects of profession distress (Thomas et al., 2014; Beer et al., 2020; Coady et al., 1990; Siebert, 2006). Siebert (2006) discovered that social assistance served as a buffer and moderator between job discontentment and burnout.
Monitoring is a significant type of social worker assistance, and social service providers frequently go to their managers for help with circumstances and developing skills (Brown et al., 2019; French et al., 2018; Collings & Murray, 1996). Beer et al. (2020) evaluated the possibility of backing and advice to mitigate the effects of profession distress. They discovered that emotive help from managers and colleagues is linked to low emotional exhaustion, job strain, and mental wellness issues. According to Eslayed et al. (2021) an absence of job assistance, especially administrative assistance, is linked to emotional exhaustion.
Coady et al. (1990) discovered no tangible link between burnout and de-personalization subscale ratings and social workers’ perceptions of teamwork. Social workers who viewed the squad as supportive, on the other hand, scored higher on the metric of personal achievement, implying a lower burnout risk. Coady et al. (1990) discovered no link between felt supervisory assistance and social workers’ ratings on burnout or personal achievement scales when they investigated purported managerial assistance. On the de-personalization scale, nevertheless, there was a massive distinction in stats. According to the research results, social workers who deem their manager helpful are less likely to burn out. Collings and Murray (1996) discovered that one component of oversight indicative of high-stress levels considered that one’s monitoring was predominantly aimed at safeguarding managers.
Caseload did not correlate with fatigue, but it had a significant impact when the mediating role of assistance was taken into consideration, according to Thomas et al. (2014). A work overload increased exhaustion, but only when the support network was weak. The percentage of patients handled in a normal day, the time-a-day invested in centered care, and the proportion of involvements were the caseload elements most applicable to emotional exhaustion.
Burnout and job satisfaction
All of the studies reviewed used cross-sectional design. Majority of the studies employed the use of questionnaires; with a sample population of about 100-1000 and the response rate ranging from 50% to 100% in the studies. The research majorly looked into care units, with most of the participants being from emergency units to help in the research.
Out of the 17 studies reviewed under this theme, 15 of them used the Maslach Inventory to look into the level of emotional exhaustion that the participants were undergoing during their work; it also looked at the level of depersonalization and lack of personal accomplishment of the participants of the study (Smetactova et al, 2019). Twelve out of the 17 studies reviewed in the study used the MBI for human services (MBI-HSS) and the MBI-GS scale of assessment. MBI-GS is a scale developed from the MBI-HSS instrument to help measure levels of burnout in members from the non-contractual professions. MBI-HSS is an instrument that majors in measuring levels of burnout on people from different professions that are usually in direct contact with clients, such as social work and social work (Rvalier et al, 2021). MBI-HSS and MBI-HSS are used to measure the same concept in different groups, and both the scales are made from theoretical considerations (Duan et al, 2019).
The MBI-HSS cut-off scores for the participants working in mental health facilities and those from the social work profession were tabulated. In all of the studies reviewed, results were used to make conclusive remarks on the study topic and answer research questions developed in the study. From the analysis, seven of the total reviewed studies showed that the respondents of the studies exceeded the standard limit set in the studies for burnout measures (Brown et al, 2019). Five of the studies reported a high level of burnout and exhaustion among workers and participants, the levels of burnout among the participants of the studies ranged from 15% to 67%, high level of depersonalization is another factor largely reported in the studies, with rates of depersonalization ranging from 10% to 60% and 16% to 42% levels of low personal accomplishment (Gori & Topino, 2020, Duan et al, 2019). Soto-Rubio et al, (2020) reported a 40% rate of burnout from the study participants, with a different scale being used in the study different from the conventional MBI-HSS instrument used in most of the studies used to study burnout among professionals. In another study, Kim, Yee & Lee, (2019) found 11.7 % of their participants reporting 11.7% percent of their respondents recording a higher sense of accomplishment for emotional exhaustion while 17% of their respondents performed above the required level of cut-off points required for depersonalization level among the participants, 17% of the respondents in the study reported to be exceeding the cut-off points required from the MBI-HSS scale for personal accomplishment from their profession (Baldschun et al, 2019). In another study, the levels of burnout among the respondents were found to be 22% for participants working in social work (Liu et al, 2019). In comparison, those working in the social work profession reported a 19% level of burnout among the participants.
Different values were acquired for the mean and deviation in the studies that were reviewed in the research. Ledikwe et al, (2018) used the MBI-HSS scale of evaluation and reported the lowest mean values for their participants. From the studies, the mean and standard deviations of the studies on emotional exhaustion, depersonalization, and personal accomplishment were acquired from the study and used to answer and address the study’s research objectives.
To achieve the purpose of the study and meet the research objectives of the studies, reversed sampling was used to ensure that data is generated using the means and the standard deviations (Molina et al, 2021). The data acquired from the studies through reverse sampling were assumed to be evenly and generally distributed across all the demographics. The analysis was developed to cut off scores for all the factors studies in the research used to determine the number of workers with high levels of emotional exhaustion, personal accomplishment, and depersonalization rates among the participants. Based on the data acquired from the studies using the reversed method sampling, it was found that 25.9% of the respondents in most of the studies reported high levels of emotional exhaustion. In comparison, 35% of the participants reported having high levels of depersonalization, and lastly, 27% of the participants reported having high levels of personal accomplishment (Lichner et al, 2018). Based on the assumption that emotional exhaustion is one of the most significant contributors of burnout among many social workers and social workers in the industry, it was noted that 26% of the respondents from the studies selected from the studies suffered from burnout.
Determinants for burnout in emergency social workers
The studies reviewed used various factors to determine the level of burnout among critical care workers. Based on these, the determinants were divided into two categories to help look into the rates of burnout prevalence among the study participants. The determinants were divided into two categories: individual factors and job-related factors based on an overview of burnout done by Csesznek & Simon (2019).For the two categories of the determinants, a brief introduction on the determinant category is given, followed by a brief description and then the category’s results from the selected studies that look at burnout among emergency social workers.
Individual factors
In a few studies, age was determined to be a significant determiner on the prevelance of burnout among social workers. In a study by Ginoux et al, (2019) higher age was related to higher levels of personal accomplishment. Walsh et al. (2018) found an inverse relationship between age and emotional exhaustion or depersonalization. Walsh et al. (2018) established that higher seniority was related to a lower level of emotional exhaustion among the social workers, which resulted in higher levels of burnout among the members. McFadden (2020) found a strong relationship between age, seniority, and burnout levels in social workers. Some of the studies reviewed in this study found that women had a higher risk of having lower levels of burnout among the social work and social work field members. Other studies found that men had higher rates of burnout due to the amount of work they do in the field (Gomez-Garcia et al, 2020, Walsh et al, 2018). In contrast, other studies found no significant difference in the prevalence rates of burnout among emergency workers. In most of the studies, it was noted that a higher level of education among the social workers and the social workers increased the risk of burnout among the participants; however, the links to this demographic factor remain unclear and are still sketchy.
Personality characteristics
In most of the literature reviewed in the study, the personality traits of a social worker such as neuroticism, extraversion, agreeableness, conscientiousness, and openness, were found to be linked with higher forms of burnout among the social workers. The results of most studies showed that a low level of hardness that is a lower level of participation in daily activities among social workers and a lower sense of control over events, and fewer acceptance rates to change in the issues in the workplace were related to a higher level of exhaustion among the participants that took part in the study (Geisler et al, 2019). The study also noted that personality characteristics were not recognized as more significant determinants of burnout among the participants. People recognized as being hardy in the study were noted to be viewing events in their work environment as more meaningful, which resulted in people having higher levels of commitment to their work than those not hardy in their work. The study from the results and the data obtained from the review of the studies showed a strong negative correlation between the level of commitment in social workers and the perceived control, job challenge, and emotional exhaustion (Uchmanowicz et al, 2019). The personal accomplishment was found from the studies to be positively related to commitment, control, and challenge. Other determinants reviewed were flexibility, stubbornness, judgmental behaviors, and the difficulty in adaptation to the place of work.
Job attitudes
Another factor discussed in the study as a determinant of burnout among social workers is their attitudes towards their jobs. Several studies showed that different expectations that people have in different populations were highly related to different levels of burnout among social workers. Higher levels of expectations set out by different workers in their profession led to a higher level of occupational efforts put by the participants (Merdiaty & Adrin, 2020). Thus, it results in an increase in the levels of emotional exhaustion in the social work profession. The results from this aspect are not uniform, but most of the studies show consistency.
Work-related factors
Exposure to traumatic events
Social workers are in a field that is in constant contact with events that often seem traumatic to them, such as incidences of death, severe injuries, suicide, aggression, and suffering often leads to the development of post-traumatic stress disorders among the professionals
(Cam, 2021). In one of the studies reviewed in this study, it was established that healthcare workers who had exposure to traumatic events in their line of duty within the previous five months reported an increase in the level of emotional exhaustion, while the rates of personal accomplishment were reported to be lower than professionals in the social work field that had not encountered traumatic events in the previous five months (Merdiaty & Aldrin, 2020). Merdiaty & Aldrin, (2020) noted that 70% of the social workers that had reported to have encountered traumatic events in their lives had not been able to get the time to recover from the encounter. In a study by Alexander (2020), it was noted that there was a link between the number of traumatic events and post-traumatic stress symptoms, emotional exhaustion, and depersonalization. In another study, Olivera et al. (2019) noted that there was a link between the number of exposures a social worker gets and emotional exhaustion. Due to the nature of their work, social workers are often exposed to violence from clients, such as insults and threats, which leads to a higher level of emotional exhaustion and depersonalization.
Job characteristics
In the Job Demand Control Support Model developed in the 1990s by Karasek and Theorell (1990), three dimensions of occupational stress by professionals is discussed and analyzed. The three dimensions developed include job demand, which is seen as a burden by most professionals, job control, and social support. These dimensions are predictors of occupational stress among professionals. Norling & Chopik (2020) define job demand as the psychological work involved in a profession. Its relation to time pressure, conflict, and the quantitative work in the profession make up the job demand specifications. Job control refers to the amount of freedom that a worker possesses in their professional life to control what they can do and what they do. This dimension was subdivided into two parts that are skill discretion and decision authority. Skill description has been defined as the range of skills and the level of competence with which a worker needs to complete tasks that are needed in their profession. This is related to the opportunities a worker can have in the future and the ability of a person to get new skills and expand their capacity at work with skills which often leads to promotion in the work environment. Decision authority, also known as autonomy, is the amount of freedom a person can have in their work environment to choose and plan their tasks. It is related to the participation and involvement of a person towards their job. The third dimension included in the Job Demand Control Support Model is social support; it is defined as the amount of psychological and instrumental help and supports a worker can rely on (Zongpu et al, 2021). The social support from the model can be grouped into two categories social support provided by colleagues and social support provided by the supervisor in the work environment. In studies done previously, there have been links between the JDCSM dimensions and burnout among professionals. In all the studies, burnout was seen as an adaptation failure resulting from the long-term lack of balance between the demands of the job and the available resources and provided to the workers.
The studies reviewed showed that the variables in the JCDS model were related in one way or another to different higher levels of burnout among students. Psychological demands are linked with a higher rate of burnout among social workers in their working environment. Work pressure from the supervisors or even from the work goals has been a significant predictor of emotional exhaustion among social workers. Another predictor inferred by most studies is the psychological demands; psychological demands is predictive of high levels of emotional exhaustion (Kupcewicz & Jozwik (2020). Excessive workload results in increased levels of emotional exhaustion and increased levels of depersonalization among the social workers; personal accomplishment was found not to affect personal accomplishment (Humphries, et al. 2014). Another study reported an inverse relationship between the job demand and the general levels of burnout; the study noted that with the increase in the number of job demands, there is a decrease in burnout among members.
The lack of support that social workers get from their supervisors can be linked to increased emotional exhaustion among members. In contrast, the lack of support from coworkers has been found to insignificantly increase emotional exhaustion (Wood et al, 2019). In other studies, however, there exists a correlation between the lack of support from colleagues and an increase in emotional exhaustion and depersonalization. Another factor related to an increase in emotional exhaustion is the interpersonal conflicts between the members of the same team or colleagues resulting in higher levels of burnout between the members of the same team (Acquadro & Begoti, 2020). Higher levels of support from family members resulted in a decrease in the levels of burnout among the members, it resulted in an increased level of accomplishment among the social workers.
Factors related to the organization such as job environment, organizational characteristics, and the resources that a company has affect the levels of accomplishment and level of burnout among the members. Most of the social workers from the studies reviewed described their work environment as unfavorable, and a more significant percentage was unhappy with their environment. Several organizational factors were identified from the review of the studies as being determinants of the level of burnout among social workers.
Communication has been identified as one of the most significant contributors to higher levels of burnout among social workers. Aydigmus & Serce, (2020) notes that collaboration between the social workers in their working environment results in a decrease in emotional exhaustion among the workers while there was a decrease in depersonalization. Interpersonal conflicts among the social workers in their working environment resulted in increased exhaustion among the social workers. The quality of communication between members of the same environment links to the levels of burnout among workers. Poor communication in the work environment hurts the levels of burnout among the social workers and results in higher levels of emotional exhaustion and depersonalization. Understaffing of workers among the health environments increased the levels of burnout among the members as the workload increased (Sarabi et al, 2020). The allocation of night shifts to social workers resulted in a decrease in the feeling of accomplishment among the social workers. Lack of or reduced material resources for the social workers increased the levels of emotional exhaustion. The study showed that an increase in innovative methods results in a decrease in emotional exhaustion. The lack of quality assurance initiatives in health institutions was an indicator of higher levels of burnout among the social workers.

Chapter Five
Introduction
For this study, systematic review survey was carried out to evaluate the connection between burnout, work satisfaction and the intention to remain among critical care workers and the relation between job satisfaction and burnout among social care workers (preoperative, intraoperative, and immediate postoperative). To achieve the goal of the research, there are specific tools that the investigation was used to answer the research aim and attempt to fill the gap within the literature. To address the research problem, the study did review qualitative and quantitative studies that have been researched and determined to fit the required criteria for selection (Higgins et al, 2011). The articles and publications chosen that will be chosen will have to focus solely on burnout in the context of acute-care.
Key findings
Burnout studies have been examined in social care research in the past 25 years.All of the studies reviewed used cross-sectional design. Majority of the studies employed the use of questionnaires; with a sample population of about 100-1000 and the response rate ranging from 50% to 100% in the studies. The research majorly looked into care units, with most of the participants being from emergency units to help in the research The weighted average of those who exceeded the burnout limit was 26% for emotional fatigue, 35% for depersonalisation and 27% for loss of personal performance. These results worry and need the attention of all parties. The wide variety of research chosen may be explained partly by the small samples used in many studies. However, prior studies by different social work organizations shown substantial cross-border heterogeneity in MBI scores. North American social workers have been tired more emotionally than their Dutch colleagues (Borges et al. 2019). Irish, Greek, Italian, Polish, Dutch and British social workers have also been severely affected by their emotional fatigue and depersonalization (Steinheiser,2018). Numerous interpretations are possible for this result. First of all, the professional status and function of carers across the globe is quite different (Davis et al. 2008).
These include changes in working pace, level of independence of profession, control time and multidisciplinary collaboration and communication. In addition, welfare responses differ across cultures and nations. Therefore, Woo et al. (2020) cautioned against comparisons of burnout rates across borders. Moreover, Nowakowska-Domagala, et al. (2015) have shown substantial variations in the loading and interaction of MBIs between nations. Variances in MBI perception and scoring may have led to variations in the aggregate score on burnout aspects across countries (Adriaenssens et al., 2015). All of these difficulties highlight significant methodological limitations in intercultural research. As Samaranayake & Seneviratne (2012) emphasizes, even the translation of an instrument like the MBI does not ensure the results are similar. Other reasons of distortion of tools include features of the healthcare system, professional language competence, the importance of health professionals in various nations and the quality of the professional research infrastructure. The use of three distinct tools may further confound comparisons of the study’s burnout scores (MBI-HSS, MBI-GS and ProQOL R-IV).
The sample size requirements for inclusion in this review were established at 25 percent. However, many of the studies included in this assessment had small samples that may affect the findings. Differences in the makeup of the study samples may also affect the findings. It should be noted that study samples with the greatest or lowest proportion of female social workers showed the two highest and lowest rates of emotional fatigue and personalisation. Because of the shortage of potential responders, at the conferences two writers collected their data (Önder & Basim, 2008). This may cause harm (safety of the workplace), since participants in congresses are less likely to be burnout. Finally, because Ohura et al. (2017) used an instrument distinct from the usual MBI-HSS tool, it is impossible to compare its prevalence with that of another research. The average number of HR social workers is however high and needs the attention of the healthcare authorities and policy-makers, because burnout is directly associated with job satisfaction (Boamah, 2017), social work health (Amponsah-Tawiah, Annor & Arthur, 2016) as well as with social work turnover (Kelly, Gee & Butler, 2021) and patient safety (Salyers et al., 2015) and care quality (Humphries et al, 2014). Burning was also reported to be prevalent in non-ER social work disciplines. In general, social workers, 42% were (Salyers et al., 2015), 33% were Critical Care (ICU) social workers (Ponceet et al., 2007), 31% were CHN social workers (Montgomery et al., 2011), 40% were hospital social workers (Koy, 2015) and 59% were social workers in mental health (Adriaenssens et al., 2015).
Many studies stress the need for a healthy individual to avoid burnout (Ray et al. 2013; Portoghese et al. 2014). This implies that a wide range of job and human factors must be taken into consideration. However, most of the research studies on occupational stress and burnout among ER social workers in this study lack a theoretical foundation. Most study evaluates just one type of stressors and outcomes, which from the ER viewpoint do not take into consideration the stressor. Moreover, multiple measures have frequently been employed to evaluate a single concept. The fact that research, instruments and findings are not uniformly analyzed creates meta-regression issue, making a meaningful statistical summary impossible. Seventeen of the 17 studies also used cross-sectional design. All of them unfortunately because (1) only a small portion of variances can be explained; (2) the relationship between determinants cannot be adequately examined; (3) it is impossible to compare results of research studies on the same concept; (4) it is not possible to draw causal links between determinants and results. A preferred method to take a longitudinal information processing design that represents the long-term effects of individual evaluations and the management of job stress (Kelly, Gee & Butler, 2021)).
In view of the previously mentioned methodological strengths and limitations, the results by Borges et al.(2019) and Kelly, Gee and Butler (2021) provide the most convincing evidence regarding burnout and its predictors among ER social workers. These studies indicate that the characteristics of JDCS in emergency social workers are significant burnout predictors. Borges et al. (2019) and Kelly, Gee and Butler (2021) showed the (long-term) detrimental impact of repeated exposures to stressful circumstances on burnout in ER social workers. Four of the 17 studies indicate that good communication, interdiscipline and a team spirit are essential for avoiding burnout (Woo et al. 2020; Önder & Basim, 2008; Ray et al. 2013 and Boamah et al. 2017). These aspects should be taken into consideration in future research.
Interpretation of the Results
There are many ways to interpret the results of this study. This study gives some confirmation and some different findings in contrast to the current literature given in Chapter 2 that it contributes to the body of knowledge about the work satisfaction, burnout and intention to leave.
Differences and similarities with the existing knowledge
Employment satisfaction and exhaustion are statistically significant factors for leaving the social work. Moreover, satisfaction ratings for both critical and non-critical social workers show that they are either not pleased or dissatisfied. My findings are similar those of Kelly, Gee & Butler (2021), who show that social workers working in critical care are less pleased with their job and less satisfied with their compassion. My study has revealed that the infirmaries had a very high degree of burnout and at least a medium intention of leaving their current job. My findings corroborated those from Salyers et al (2015), which also showed a lower demand for the crucial workplace in health care. As Humphries et al. (2014) have previously shown, the working environment influences the degree to which registered social workers plan to leave. My findings separate the participants from the working environment and may demonstrate that Humphries et al’s study has a favorable relationship to the desire to quit. My investigation, however, showed no results in comparison with their research according to degree level, marital status or demography. Salyers et al (2015) provided an overview of burnout levels among registered carers operating with non-critical caregivers. The findings of my research show that the critical care environment has a high burnout. However, my study revealed no higher burnout for critical care social workers than those who are not working in a critical care setting compared to studies carried out by Mooney et al. The work of Adriaensse, De Gucht & Maes (2015) and Steinheiser (2018), which may enhance the motivation to quit social work, is also supported by my study.
The findings of my research confirmed Kelly, Gee & Butler (2021), who underlined many aspects of the human condition, but one was that individuals have basic wants and met these requirements. As regards the social work profession, it is essential for social workers to be satisfied with their work environment. Steinheiser (2018) has hypothesized that stress, sorrow and loss contribute to failure to meet needs. Likewise, my study shows that stress and complaints may arise if a social worker’s expecations are not met.
Study limitations
This study has significant weaknesses. First, my study was limited to only use of secondary research. Consequently, the results of this research cannot be generalized to social workers working in other institutions or areas. The time window to conduct research was an unforeseen limitation of this study. Chuan-cheng (2011) describes the weariness of the survey as being exposed to too many surveys that lead to lack of readiness to respond.
Recommendations
The study questions I used were a valid method of determining a satisfactory job, exhaustion and the desire, albeit with some limitations, to quit the caregivers. This research may be applied easily to other acute care institutions abroad. The results of the survey may be collected to identify the best and worst locations for job satisfaction, burnout and intent to do so, and could be used for the purpose of improving work happiness and reducing burnout. While the research focused on health care, burnout and intent not only impact social work, it was able to readily identify people who have greater burnout levels and plan to move to the same institution for other professions in an acute care facility.
In addition, although not significant in my studies, demographics could lead to further research opportunities with respect to work satisfaction, burnout and intentions for caregivers. As CCUs are more specialized than non-CCUs, it is logical to believe the work relationship of persons working in these units is closer than those not in a CCU and thus less intentive. Further study is needed to determine why social workers quit the area of acute care. The results of my research give a deeper insight into this phenomenon and can eventually lead to further research.
Implications
My study was clearly limited and had numerous limits, but the potential for positive social change is enormous for those working in the participating institution and for the facility in its whole. Research has shown that the social work community studied suffers from a high burnout rate, which may lead to an increased desire to quit. This should act as an opportunity for further discussions between leaders and employees as to how a happy work environment might appear, and how it could help to prevent burnout and eventually lead to lower rates. In addition, the partnering hospital may maintain this pool of skilled social workers to help patients in its geographical region.
Conclusion
Care is a vocation in which skilled people are always needed. There has been a grave lack of social work practitioners and the US association of social work colleges is continuing to worsen this gap (Wu et al. 2011). Unfortunately, many social workers presently working in the profession are gone, and many more are gone before they retire. A recent research has shown that social workers under acute care suffer significant burnout regardless of their specialization and are considering leaving their present position or profession altogether. This should include people considering the profession of social work and those working at bedside and caring for the loved one of others. More significantly, everyone who may be involved in any event that may cause them to attend the hospital should also be extremely worried. Probably the primary job in the area of health care is career work and the occupation has to find a method to make the workplace more enjoyable, less stressful and encourage other healthcare workers. Until the social work staff depart, new social workers will need to be replaced, but social work research will definitely have to ask the key issues so that social workers one day do not have to go to the social work staff. The lives of many more may shortly rely on it.

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