Burnout and patient safety in operating room nurses during the COVID-19 pandemic: A cross-sectional study

Fabio Ferraiuolo

doi:10.26550/2209-1092.1345

Authors

Fabio Ferraiuolo AST Ascoli Piceno https://orcid.org/0000-0003-2203-8715

DOI:

https://doi.org/10.26550/2209-1092.1345

Keywords:

burnout, operating room, perioperative nurses, patient safety, COVID-19

Abstract

Introduction: The COVID-19 pandemic has profoundly impacted healthcare systemsglobally, placing operating room (OR) nurses under considerable strain and exposing them to elevated levels of psychological distress.

Aim: This study aimed to investigate the prevalence of burnout syndrome (BoS) among Italian OR nurses during the pandemic and examine its association with perceived job performance and patient safety.

Methods: A cross-sectional study was conducted between October and November 2020 involving members of the Italian Association of Nurses in Operating Teams (Associazione Italiana Coordinatori Infermieristici or AICO). Data were collected via an anonymous online questionnaire, which included the Maslach burnout inventory and items assessing clinical errors and self-perceived job performance.

Results: Of the 238 nurses invited, 233 completed the survey (97.9% response rate). High levels of emotional exhaustion were reported by 39.9 per cent of participants, moderate to high depersonalisation by 56.7 per cent and low personal accomplishment by 38.6 per cent. Additionally, 29.2 per cent reported having encountered risk and/or made a mistake in the past year, while 38.2 per cent reported a decline in their job performance. Both outcomes were significantly associated with higher levels of BoS (p < 0.01). Contributing factors included workplace disorganisation, negative team climate and workload intensity, particularly in general and neurosurgical settings.

Conclusion: These findings highlight the need for early identification of BoS and the implementation of targeted organisational strategies to support perioperative nurses. Addressing burnout is essential to safeguard staff wellbeing and maintain patient safety – both during public health crises and in everyday surgical care.

References

1. Alderwick H, Dunn P, Dixon J. England’s health policy response to COVID-19 [Internet]. BMJ. 2020[cited 2025 Jul 12];369:m1937. DOI: 10.1136/bmj.m1937

2. Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I et al. Implications for COVID-19: A systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic [Internet]. Int J Nurs Stud. 2020[cited 2025 Jul 12];111:103637. DOI: 10.1016/j.ijnurstu.2020.103637

3. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study [Internet]. EClinicalMedicine. 2020[cited 2025 Jul 12];24:100424. DOI: 10.1016/j.eclinm.2020.100424

4. European Centre for Disease Prevention and Control (ecdc). COVID-19 situation update worldwide [Internet]. Solna: ecdc; 2020[cited 2025 Jul 12]. Formerly available from: www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases

5. Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis [Internet]. J Adv Nurs. 2021[cited 2025 Jul 12];77(8):3286–302. DOI: 10.1111/jan.14839

6. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis [Internet]. Brain Behav Immun. 2020[cited 2025 Jul 12];88:901–7. DOI: 10.1016/j.bbi.2020.05.026

7. Lucchini A, Iozzo P, Bambi S. Nursing workload in the COVID-19 era: A case report from an intensive care unit [Internet]. Intensive Crit Care Nurs. 2020[cited 2025 Jul 12];61:102929. DOI: 10.1016/j.iccn.2020.102929

8. De Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz SA, Ellis L et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: Implications for supporting psychological wellbeing [Internet]. BMC Public Health. 2021[cited 2025 Jul 12];21(1):104. DOI: 10.1186/s12889-020-10070-3

9. Maslach C, Jackson SE. The measurement of experienced burnout [Internet]. J Occup Behav. 1981[cited 2025 Jul 12];2(2):99–113. DOI: 10.1002/job.4030020205

10. World Health Organization (WHO). Burn-out an ‘occupational phenomenon’: International classification of diseases [Internet]. Geneva: WHO; 2019[cited 2025 Jul 12]. Available from: www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

11. Dall’Ora C, Ball J, Recio-Saucedo A, Griffiths P. Burnout in nursing: A theoretical review [Internet]. Hum Resour Health. 2020[cited 2025 Jul 12];18(1):41. DOI: 10.1186/s12960-020-00469-9

12. García CL, Abreu LC, Ramos JLS, Castro CFD, Smiderle FRN, Santos JAD et al. Influence of burnout on patient safety: Systematic review and meta-analysis [Internet]. Medicina (Kaunas). 2019[cited 2025 Jul 12];55(9):553. DOI: 10.3390/medicina55090553

13. García GM, Calvo JCA. The threat of COVID‐19 and its influence on nursing staff burnout [Internet]. J Adv Nurs. 2021[cited 2025 Jul 12];77(2):832–44. DOI: 10.1111/jan.14642

14. Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing, burnout, and patient safety: A systematic review [Internet]. PLoS One. 2016[cited 2025 Jul 12];11(7):e0159015. DOI: 10.1371/journal.pone.0159015

15. Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, Chew-Graham C et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis [Internet]. JAMA Intern Med. 2018[cited 2025 Jul 12];178(10):1317–31. DOI: 10.1001/jamainternmed.2018.3713

16. Tawfik DS, Profit J, Morgenthaler TI, Satele DV, Sinsky CA, Dyrbye LN et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors [Internet]. Mayo Clin Proc. 2018[cited 2025 Jul 12];93(11):1571–80. DOI: 10.1016/j.mayocp.2018.05.014

17. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry [Internet]. World Psychiatry. 2016[cited 2025 Jul 12];15(2):103–11. DOI: 10.1002/wps.20311

18. Poghosyan L, Clarke SP, Finlayson M, Aiken LH. Nurse burnout and quality of care: Cross-national investigation in six countries [Internet]. Res Nurs Health. 2010[cited 2025 Jul 12];33(4):288–98. DOI: 10.1002/nur.20383

19. Shanafelt TD, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic [Internet]. JAMA. 2020[cited 2025 Jul 12];323(21):2133–34. DOI: 10.1001/jama.2020.5893

20. Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare workers [Internet]. Cochrane Database Syst Rev. 2015[cited 2025 Dec 21];(4). DOI: 10.1002/14651858.CD002892. pub5

21. West CP, Dyrbye LN, Satele DV, Sloan JA, Shanafelt TD. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment [Internet]. J Gen Intern Med. 2012[cited 2025 Jul 12];27(11):1445–52. DOI: 10.1007/s11606-012-2012-7

22. Cohen C, Pignata S, Bezazc E, Tie M, Childs J. Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review [Internet]. BMJ Open. 2023[cited 2025 Jul 12];13(6):e071203. DOI: 10.1136/bmjopen-2022-071203