Factors contributing to Burnout among Nurses in Vaiola Hospital, the Kingdom of Tonga: A Qualitative Study.

Introduction and Aim
Burnout has recently been added to the International Classification of Diseases, 11th Revision as an occupational phenomenon, but it has been researched for the past 45 years. Burnout is characterized by emotional exhaustion, adverse detachment from patients and colleagues, and a lack of confidence in being able to do one’s job. Burnout develops when there is a prolonged mismatch between an employee and one or more of the following: having too much work without adequate resources, not having enough autonomy in how to do one’s job, inadequate pay, poor promotion mechanisms or low recognition of the value of one’s work, having no sense of belonging to a group of colleagues, unfair processes whereby some individuals are more advantaged than others. The aim of this qualitative study is to investigate the factors contributing to burnout among nurses in Vaiola Hospital: the Kingdom of Tonga.
Methodology.
The qualitative study was used to gather information using in-depth interview conducted amongst 25 Registered Nurses (RN) in the main hospital in Tongatapu, Vaiola Hospital. The data were collected through semi-structured open-ended questionnaires and were audio-recorded. The data were analyzed using thematic analysis process. The ethic approval was obtained from the College Health Research Ethics Committee (CHREC) in Fiji National University and from the Research Ethics Committee in Tongatapu Ministry of Health (MOH).
Results.
The study comprised of 25 participants, which include 23 Registered Nurses (RN), 1 Midwife (MW) and 1 Sister Graduate (SG) with majority of the respondents (44%) were over 10 years of experience. From the respondents, more than half of the respondents (84%) were female and the rest (16%) were male. The themes identified in the study were categorized into broad themes and sub-themes. Five broad themes and fourteen sub themes were identified. These included theme 1) Workload. Sub themes included lack of available physical resources, shortage of staff and working longer shift length. Theme 2) Lack of control. Sub themes included insufficient authority. Theme
13
3) Insufficient Reward. Sub themes included lack of financial rewards, lack of social rewards and lack of intrinsic rewards. Theme 4) Lack of community. Sub themes included poor teamwork, interpersonal conflict and lack of positive social interactions. Theme 5) Absence of Fairness. Sub themes included inequity in workload and pay, inappropriate handling of promotions and evaluations, and lack of leadership and management skills among nurse managers. Proposed strategies to resolved burnout among nurses in Vaiola hospital included two broad themes. Theme 1) Improve Leadership Skills and Theme 2) Improve Management Skills among nurse managers.
Conclusion
The nurses in Vaiola hospital have sound knowledge about the burnout and have identified key factors that contributed to burnout, its effects on them and the recommended interventions and measures to improve this problem. The findings can also be helpful to key people in the Ministry of Health such as the managers at the decision making level or policy makers to improve nursing workforce in the future. Further research is needed to determine the in-depth effects of burnout on nurses at the maritime hospitals and other healthcare professionals and the intervention to address it more effectively.