Factors contributing to burnout among nurses at a district hospital in Namibia: A qualitative perspective of nurses (2024)

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J Nurs Manag. 2022 Oct; 30(7): 2982–2991.

Published online 2022 Jun 1. doi:10.1111/jonm.13693

PMCID: PMC10083902

PMID: 35593041

Daniel Opotamutale Ashipala, RN, BNSc, MNSc, Senior Lecturer¹ and Tuyenikelao Muudikange Nghole, RN, Chief Health Programme Administrator¹

Author information Article notes Copyright and License information PMC Disclaimer

Associated Data

Data Availability Statement

Abstract

Aim

The aim of this study was to explore and describe the factors that contribute to burnout among nurses.

Background

Burnout remains one of the major occupational health problems, posing risks to human health globally. In Namibia, there has been growing public criticism of nurses, stating that they are rude or act in a manner that does not show professionalism towards their clients. Reasons for such unprofessional behaviour could be linked to negative attitudes on the part of nurses towards their clients, resulting from burnout syndrome.

Method

A qualitative, exploratory, descriptive and contextual research design was followed as the basis for conducting the study. Using a purposive sampling technique, a sample of 20 nurses was selected from a population of 69 nurses employed in this setting. This sample size was determined by the saturation of data as reflected in repeating themes. Data were collected using individual semi‐structured interviews and were analysed using qualitative thematic analysis.

Results

The following three themes emerged: understanding the concept of burnout, factors leading to burnout and creating a conducive environment as a corrective measure to address burnout and to advance nurses.

Conclusions

Burnout is indeed real and affects nurses' performance negatively. Burnout has a negative impact on the well‐being of nurses both physically and emotionally, which has the potential to compromise staff performance, productivity and the quality of patient care. Burnout among nurses is linked to many stressors such as poor staff management, inadequate resources, lack of support and lack of wellness programmes in the workplace.

Implications for Nursing Management

Strengthening communication between frontline health workers and management by engaging and involving them more in decision making in matters that concern them is anticipated to address poor staff management, enhance staff performance and improve the quality of patient care. Staff wellness programmes in the workplace are believed to be a good coping mechanism to address work‐related pressure and tensions, and they are believed to resolve some work‐related stress that may result in increased staff productivity.

Keywords: burnout, contributing factors, management, nurses, staff productivity, thematic analysis

1. BACKGROUND

Burnout remains a major occupational health problem, posing risks to human health globally. Nursing is a stressful profession that deals with human aspects of health and illness and can ultimately lead to job dissatisfaction and burnout. The profession is not only physically demanding as it deals with human health and functions but also necessitates the use of mental energy and leads to mental exhaustion when one is continuously exposed to stressful events and situations. This mental exhaustion is what partly defines burnout (Lambert et al.,²⁰¹⁸; Moukarzel et al.,²⁰¹⁹). Burnout is a condition of emotional exhaustion, depersonalization and low personal accomplishment that can occur among individuals who work with people in some capacity (Zhang,²⁰¹⁸). The emotional exhaustion component is characterized by loss of emotional resources and energy, lack of enthusiasm, frustration, tension and fatigue. The depersonalization component represents the interpersonal relationships that lead to a negative interaction, and the sense of low personal accomplishment refers to feelings of incompetence (Karthik et al.,²⁰¹⁹). Generally speaking, burnout can occur as a result of the presence of job demands like work overload, prolonged working hours, nurse–patient ratio imbalance, role conflict, lack of fairness, conflict in values and job resources such as a lack of social support from colleagues or management, lack of feedback, and poor participation in decision making (Ren et al.,²⁰²⁰). Burnout represents a high cost to workers and their institutions and appears to be more common in developing than in developed countries (Shanafelt et al.,²⁰²⁰). The World Health Organization (WHO) recently declared burnout as an “occupational phenomenon” in the International Classification of Disease 11th revision (ICD‐11), recognizing burnout as a serious health issue worldwide (Woo et al.,²⁰²⁰). Other evidence also suggests that burnout in nurses is high across specialties and countries (Ling,²⁰¹⁹). Globally, the overall prevalence of burnout among nurses is 11.23%, but significant differences have been noted between geographical regions and specialties. The sub‐Saharan African region had the highest burnout symptom prevalence rate, whereas Europe and Central Asia region had the lowest (Woo et al.,²⁰²⁰). A systematic review conducted in sub‐Saharan Africa showed that the prevalence of burnout among nurses was 33% (Owuor et al.,²⁰²⁰). Some of the consequences of job burnout are absenteeism, low morale or personal deterioration, stress, anxiety, psychosomatic complaints, sleep disturbances and poor organizational commitment (Torun & Cavusoglu,²⁰¹⁸). Burnout not only affects physical and mental abilities but also affects the individual's health (Fradelos et al.,²⁰¹⁹). Therefore, the identification and prevention of burnout play an important role in improving the quality of services provided (Bakker & Costa,²⁰²¹).

Nurses experience high levels of burnout because of a high workload, and because nurses are always in contact with sick patients, they are easily exposed, infection that can cause work‐related health problems (Gil‐Monte et al.,²⁰²⁰). Burnout levels range between 10% and 70% among nurses, and burnout has become a common issue among health care workers, which can affect the quality of care provided to patients (Lyndon,²⁰¹⁸). Some of the factors that lead to burnout in the nursing profession include work‐related stress that is caused by high job demands, overtime work, shortage of staff and lack of resources (Khamisa et al.,²⁰¹⁹).

2. THE AIM OF THE STUDY

The aim of the study was to explore and describe factors that contribute to burnout among nurses.

3. METHODS

3.1. Research design

A qualitative, exploratory, descriptive and contextual research design was followed asthe basis for conducting the study. The ultimate point of departure for researchers to use qualitative study for this research was because it allowed descriptions and provided an in‐depth understanding of human experiences from the stance of research participants (Brink et al.,²⁰¹⁸). The descriptive design was appropriate because it allowed researchers to describe the phenomenon (Polit & Beck,²⁰¹⁷), which was the factors contribution to burnout among nurses at the selected district hospital. The use of an explorative design was aimed at exploring key issues to gain greater insight into the factor's contribution to burnout among nurses, therefore building a new understanding (Maree,²⁰¹⁸). One of the features of qualitative research is that it is naturalistic and context based, so it is centred around natural settings where interactions occur (Maree,²⁰¹⁸). This is because a phenomenon experienced in the research population is unique to their context, and therefore, the factors contribution to burnout among nurses was understood from the context of burnout among nurses at a specific district hospital, which makes this research a contextual design.

3.2. Population, sample and setting

Population in this study composed of nurses working at Gobabis District Hospital in Omaheke region. According to the records of Gobabis Hospital staff compliment of 2020, there were 69 nurses (both enrolled and registered nurses) in Gobabis Hospital. In this study, purposive sampling technique was used to select participants in this study. Purposive sampling allows the researcher to select participants who possess certain traits or qualities (Polit & Beck,²⁰¹⁷). The inclusion criteria in this study were as follows: (1) a registered or enrolled nurse working at Gobabis hospital for at least more than 1 year, (2) willing to participate by signing an informed consent and (3) available at the time of data collection. The study was conducted at Gobabis Hospital, which is situated in the town of Gobabis in the Omaheke region. Gobabis lies about 200 km west of Windhoek, and the hospital has a 172‐bed capacity and 69 nurses serving a population 86,709, which translates to a nurse–patient ratio of 1:1,257. During the day shift, two to three nurses work one shift on average, while during the night shift, only one enrolled nurse is on duty per shift in each department except for the maternity ward where three nurses (two enrolled and one registered nurse) work on each shift. If a nurse fails to turn up for any reason, the next available nurse will be called for overtime, or the one on duty will extend their shift for at least 6 h or more. This extreme heavy workload has the potential to cause unproductivity and burnout on the part of nurses. Additionally, the efficiency and effectiveness in the implementation of activities are likely to be poor, and quality of service delivery is compromised. The Namibian health care sector includes specialized medical care, primary health care and the private sector (Ministry of Health and Social Services,²⁰²⁰).

3.3. Data collection

In this study, the data were collected by the researcher using semi‐structured individual interviews with all categories of nurses who met the study criteria (N = 20). Data were collected in November 2020 at Gobabis District Hospital across different departments, namely, outpatients/casualty, paediatric and maternity, as well as the male and female wards and high care. After initial contact with the nurses selected according to the sampling criteria for this research, informed consent was obtained to tape record the interviews. The date, time and place of the interview were duly confirmed. Interviews were conducted by the researcher in a quiet place, and the participants were made comfortable. The interview session lasted for approximately 40–45 min, making use of an interview guide. During the interview, the researcher took fields notes and used follow‐up questions to probe for a more detailed exploration. Interviews were conducted until data saturation was reached. In this study, data saturation was reached at the 20th participant. These immediate impressions provided valuable context for data analysis. Prior to data analysis, the field notes were combined with the transcribed interviews to give insight into the situation during the interview. Additionally, individual interviews were tape recorded with the permission of the participants. The main question posed during the interviews included the following:

What are the factors contributing to burnout among nurses at Gobabis District State Hospital in Namibia?
What recommendations can be made to the district hospital management team to address burnout among nurses at Gobabis Hospital?

3.4. Data analysis

In the study, the researcher listened to the audio recordings of all the interviews several times before transferring the audio file to text. The content analysis has been used to analyse the narrative data and, according to Daniel(²⁰¹⁸), started with coding, a process that involves reading the data, breaking them down into subparts, and giving labels to that part of the text. Text labelling served as a path for the researcher to identify common data similarities and differences in text format. Where similarities existed, they were grouped and coded as the same theme, from a broader too narrower perspective, before drawing conclusions.

3.5. Rigour

The trustworthiness of the entire study was assessed using the criteria proposed by Lincoln and Guba(¹⁹⁸⁵), namely, criteria relating to the credibility, transferability, dependability and confirmability of the study.

Credibility was achieved through prolonged engagement, with the researcher spending a month in the clinical setting in which the research was conducted. Both individual interviews and field notes were used as methods of data collection. In addition, member checking was done with the researchers constantly checking their findings with the participants and comparing them with the literature control. Transferability was achieved through dense description that included a comprehensive description of the methods, including illustrative direct quotes of participants. Dependability was achieved in this study as an audit trail was kept and is available on enquiry. The transferability of this study was achieved by means of a confirmability audit done by an independent expert researcher.

3.6. Ethical considerations

The Committee of Research Ethics of the School of Nursing approved this study prior to data collection. The ethical clearance reference number is SoNREC No 87/202 (Decision Date: 17.12.2020, Reference No: 87/2020) and Ministry of Health and Social Services institutional and review board (Decision Date: 22.01.2021, Reference No 17/3/3TMN). Throughout the study, the researchers' conduct was guided by the following ethical principles: beneficence, non‐malfeasance, confidentiality, privacy, anonymity, justice, informed consent and autonomy. The participants signed to indicate informed consent prior to data collection, and data were accessible only to the two researchers involved in the study. The participants were assured of privacy, anonymity and confidentiality, as well as their right to terminate their participation in the study at any point without having to explain themselves or receiving penalties for doing so.

4. RESULTS

4.1. Demographics of the nurses

Participants in this study included 20 nurses in total from Gobabis Hospital, of which 10 were registered nurses and 10 were enrolled nurses. The pilot study included two participants from Epako Clinic of which one is a nurse manager. Participants' ages ranged between 25 and 56 years. Their years of work experience ranged from 1 year and 6 months to 29 years. The were 15 females and five males. Table1 summarizes the demographic data of the participants.

TABLE 1

Characteristics of the participants

Characteristic		Total
Age	18–28 years	7
	29–39 years	3
	40–50 years	8
	Above the age of 50	2
Gender	Male	5
Gender	Female	15
Marital status	Single	14
Marital status	Married	6
Working experience	1–10 years	5
	10–20 years	12
	20–30 years	3
Rank	Nurse managers	6
	Registered nurses	9
	Enrolled nurses	5

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4.2. Presentation of findings

The three themes that emanated from the data (as indicated in Table2) are as follows: understanding the concept of burnout; factors leading to burnout; and creating a conducive environment as a corrective measure to address burnout. Table2 summarizes the study results that are presented in the form of themes, subthemes, codes and participants' comments.

TABLE 2

Summary of findings

Themes	Subthemes
Understanding the concept of burnout	Staff under pressure
	Equipment insufficient
	Influx of patients
	Self‐identity undermined
Factors leading to burnout	Overwhelming number of patients
	Placement of patients
	Lack of necessities aggravating
	Poor management and communication
	Training unstandardised
	Budgeting controlled on national level
	Shifting responsibilities
	Domestic circ*mstances
Creating a conducive environment as a corrective measure to address burnout	Employment of more staff
	Improving management
	Much‐needed increase in funding.
	Procurement of items beforehand
	Saving lives

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4.3. Theme 1: Understanding the concept of burnout

This theme is a description of the way the participants understood the concept of burnout based on their working experience. All participants seemed to have a basic understanding of the concept and how it is linked to their work environment. The descriptions given are based both on personal experience and participants' understanding of the concept of burnout in general.

4.3.1. Staff under pressure

Participants described burnout as working under pressure in a high workload environment on a daily basis. Participants stated that they work under pressure in district hospitals because of the high nurse–patient ratio, resulting in high patient load.

Most nurses have high workload as they work alone in their wards due to staff shortage. (P1, 25 years, male)

Patient–nurse ratio, in Gobabis, or Omaheke is unequal. A patient and staff ratio, one staff is catering for 30–40 patients per day at casualty. (P3, 45 years, female)

4.3.2. Equipment insufficient

During the interview, one participant ascribed burnout to insufficient equipment in the hospital setup, adding that the lack of equipment put pressure on nurses, driving them to stress and burnout.

Equipment for nurses to do their work is not enough and it is shared at least between four wards like paediatrics, male, female and high care.

(P5, 26 years, male)

4.3.3. Influx of patients

The study results show that patients who receive services at Gobabis Hospital exceed the expected number on a daily basis. The participants believed that the high influx of patients in the hospital leads to overcrowding, causing emotional exhaustion for nurses because they must deal with a large number of patients when they are few on duty.

Burnout could be that fact that nurse is overworked or overloaded that they end up working out of their scope of practice. (P2, 30 years, female)

4.3.4. Self‐identity undermined

Participants understood how their minds and bodies function. They can identify when their bodies and minds are exhausted. They feel that sometimes supervisors do not take the time to listen to them when they report to them and when they are exhausted, overloaded and stressed out. In addition, nurses are not always involved in decisions that concern their working arrangements.

I understand burnout as physical and emotional exhaustion that involves sense of loss of accomplishment and identity. (P4, 34 years, female)

When someone is emotionally, physically or mentally tired. Contributes to a prolonged state of stress. (P8, 50 years, female)

4.4. Theme 2: Factors leading to burnout

This theme describes how participants understood the factors leading to burnout. The subthemes that emerged from the discussions with participants include the overwhelming number of patients, the placement of patients and the lack of equipment.

4.4.1. Overwhelming number of patients

In this study, participants revealed that the Omaheke staff establishment (including that of Gobabis Hospital) has not been revised or reviewed since 2003. Although the Omaheke regional population has increased annually, participants said that the number of nurses remained the same. In this context, participants stated the following:

Other region was given additional staff after 2003 but Omaheke was excluded, that was around 2009. It is always being disadvantaged because it has one district and one region. (P4, 34 years, female)

Maybe they only look at the population and not at activities nurses are doing. (P6, 32 years, female)

While you balance your ward, all of a sudden you hear one of your staff is booked off. While you are maybe supposed to be five on duty, you will find that you are only two. In addition, workload becomes more for two people that are at work. (P9, 56 years, male)

4.4.2. Placement of patients

Participants in this study indicated that the inpatient admissions are beyond the hospital capacity. In relation to their experiences, they narrated how patients are admitted to wards where all the beds are already occupied, which they say results in patients sleeping on mattresses. One of the participants remarked as follows in this regard:

Some patients require special care but due to lack of admission beds they end up being nursed from different departments. (P4, 34 years, female)

4.4.3. Lack of necessities (equipment, stationery and supplies)

The study revealed that a shortage of materials and equipment is one of the major forces driving nurses in Gobabis Hospital to burnout. Participants identified a lack of equipment and supplies such as beds, linen, oxygen face masks, thermometers and blood pressure machines, among others, as a factor contributing to burnout among nurses. This is evident from one of the participants who narrated the following:

Nurses buy equipment such as blood pressure machines, thermometers, batteries, light bulbs and take work equipment for servicing using their own money. (P9, 56 years, male)

4.4.4. Poor management and communication

The study found that there is poor communication between the nurses and hospital management, which contributes to stress and burnout. Participants stated that hospital management lacks an open‐door policy that would allow for consultation and staff involvement in decision making. Study participants shared their experience of not being involved in decision making on critical issues that directly concern them. One participant had the following to say in this regard:

The management is not good, and the matron is not attending to the staff problems or if he/she cannot really understand what nurses are going through at ward level can be painful to the staff members. The management may not have that good experience of how to run the things. (P7, 38 years, male)

4.4.5. Training unstandardized

Participants acknowledged the need for continuous professional development for every nursing professional. The interviews revealed that nurses in Gobabis Hospital are not equally exposed to training opportunities despite working with the same programmes. Participants believed that nurses should be given equal chances to attend training. Participants mentioned that only some individuals are nominated for training while others must learn in the process of doing. In addition, those who received formal training do not give feedback to others.

Lack of in‐service training, e.g., Ministry programmes to be done by some individuals that are taken to run the programmes and those people when they are conducting workshops and in‐service training, they do not come and train others. One person cannot run the programme alone. He should train one or two people to help reduce the workload on you. (P11, 40 years, female)

4.4.6. Budgeting controlled at national level

The study results show that although the Omaheke region budgets for its needs, including those of the hospital, participants felt that management has little influence in controlling spending. They say the budget is controlled from national level with the region being allocated portions of money to spend on different votes on a monthly basis, but the monthly allocation is not done in consultation with the region. Accordingly, although the region may have planned to spend money on a certain activity, the amount allocated for that month may not be sufficient.

The budgeting is done but the budget is controlled from national level because they are the one putting money on regional votes on monthly bases and the money, they release monthly is not enough for what is supposed to be paid. (P14, 44 years, female)

When you order from the district to the region you will be told there are no funds to procure the needed equipment and it is really frustrating, staff are forced to buy equipment. (P10, 29 years, male)

4.4.7. Shifting responsibilities

Participants stated during the interviews that registered nurses are forced to supervise others and oversee their respective departments simply because there are no senior nurse positions within the hospital structure. There is only one senior registered (nurse manager) who oversees the entire hospital, something that participants feel forces the hospital to delegate registered nurses to take up administrative and supervisory duties, even supervising those of the same rank, besides their primary duties of patient care.

There are no vacancies for senior positions in staff establishment at ward level. It is difficult to decide that this one should be the supervisor to others while they are both grade 8. (P13, 27 years, female)

There are no department managers. You are put to work your normal hours which is 8–5, 7–7, am or pm. And at time you are off during the week and when you come back you find things not done, drugs are not recorded but if there is a unit manager, that person actually from Monday to Friday can do supervision and staff management to improve staff adherence to work and services provision. (P16, 51 years, female)

4.4.8. Domestic circ*mstances

During the interviews for this study, the participants admitted exposure to social stresses relating to relationships, family relations and alcohol and drug abuse. Such exposure affects nurses negatively and also has an effect on the colleagues they work with. Accordingly, social factors affect the performance of the individual nurses. Participants believed that at times nursing supervisors were not doing enough to find out what nurses are going through outside the workplace.

Social issues whereby their social interaction outside work setting, which the management may not know what the person is going through being at home or at areas they associate, and they may come with stress to work. This creates stress for the next person that they are working together with and duplicate the work burden. (P12, 41 years, female)

Lack of leisure time such as sport clubs where nurses can share their challenges and relax their minds. Lack of praising of departments. (P15, 52 years, female)

4.5. Theme 3: Creating a conducive environment as a corrective measure to address burnout

This theme investigated the recommendations participants would like to make to Gobabis Hospital, the Ministry of Health and individual staff members to reduce burnout among Gobabis Hospital nursing staff and help individuals experiencing burnout to respond better. Participants had an opportunity to give their recommendations and propose strategies to address and reduce burnout in their workplace.

4.5.1. Employment of more staff

Study participants recommended the recruitment of more staff at both operational and supervisory level to reduce workloads by increasing manpower in the system. Furthermore, they urged the management to revise the current regional staff establishment, thus creating new nurse positions at the departmental and supervisory levels.

The hospital management especially the matron to increase staff capacity at ward level to relieve the burden. (P18, 31 years, female)

Employment of more staff to reduce staff patient ratio from 30 to 15, which a nurse can see productively per day. (P20, 55 years, female)

4.5.2. Improving management

The study participants recommended that nurse managers should be more flexible, sensitive and understanding with their subordinates when they open up to them for support. Participants further recommended that management open their doors to staff members and engage them more in discussions to hear their opinions and involve them in decision making.

Yeah, one of the things I would like to add is the engagement between management and the nurses. Because if our management engage our nurses and try to find out how comfortable they are in the setting where they are. (P19, 38 years, female)

4.5.3. Much‐needed increase in funding

The study participants recommended that additional funding be provided for the training of staff to increase capacity building and improve standard practices across departments. An increase in budget is recommended for buying equipment and stationery and increasing staff recruitment.

Increasing the number of nurses and training. (P17, 40 years, female)

Avail more funds for in‐services training for nurses. (P3, 28 years, male)

4.5.4. Procurement of items beforehand

The study participants recommended that funding be increased to enable the directorate to purchase much‐needed equipment, stationery and supplies. They further recommended that equipment be procured in advance and enough stock kept on hand, and not to start the procurement process the day nurses place their orders with the storeroom and items are not in stock.

Procure more items beforehand not to wait until you are left with one item or only order when there is a complaint. (P7, 52 years, female)

Admin should ensure that needed equipment should be made available. (P1, 37 years, male)

Discuss equipment shortage with other managers in the meeting. (P10, 53 years, male)

4.5.5. Saving lives

Among other things, participants recommended that all nurses be given an equal opportunity to attend and receive training in different programmes within the health system. Participants further advocated for the availability of basic lifesaving medication in the hospital, ambulances to transport emergencies from one point of care to another, lifesaving equipment and skilful human personnel.

Ensure the availability of all medications and equipment for staff to easily carry out their activities. (P5, 39 years, female)

Sometimes you do not know how to treat your client to save their live, Avail a doctor and ambulance at the clinic. (P16, 47 years, male)

5. DISCUSSION

The study described the way the participants understood the concept of burnout based on their working experience. The study has shown the participants' understanding of burnout as being in line with that of Pieters and Matheus(²⁰²⁰), who in their definition explain that burnout is a result of being exposed to unpleasant stressful work environments for a long period of time. Similarly, WHO(²⁰¹⁹) further define burnout syndrome as occurring as a result of chronic stress at work and is characterized by emotional exhaustion, depersonalization and low professional accomplishment. This agrees with the findings of this study in which participants highlighted that burnout can occur when nurses work outside their scope of practice, which according to participants leads to physical tiredness, prolonged stress, poor concentration and poor productivity (Pieters & Matheus,²⁰²⁰).

Importantly, high workload, high patient inflow, limited resources and staff absenteeism formed part of the concept of burnout in this study. Self‐confidence is an important component that every nurse logically should have in dealing with incivility from supervisors and it is also important for building and maintaining teamwork to deliver effective and quality patient care. If management does not acknowledge the concerns of frontline workers, patient care may be compromised (Denning et al.,²⁰²¹).

During the interviews, various factors that lead to burnout among nurses were identified based on the participants' experiences. The study found that an unconducive environment, a high workload (high patient–nurse ratio) and the lack of needed equipment are among the factors contributing to burnout in nurses at Gobabis Hospital. These results are similar to those of a study conducted by Holdren et al.(²⁰¹⁸), which showed that poor working environments and an increased nurse–patient ratio have contributed significantly to burnout syndrome in hospital nurses. Similarly, a study done in South Africa by Roomaney et al.(²⁰¹⁸), among a nursing population, concluded that burnout was associated with high workload and lack of support. This is further supported by a Namibian study done by Pieters and Matheus(²⁰²⁰), who found anxiety, insomnia, workload and social dysfunction to be predictors of emotional exhaustion.

Participants narrated how frustrating it is for them to work without the necessary resources to meet their expectations. Medical equipment is very important in diagnosis and progress monitoring and some is used for patient treatment. Therefore, the absence of needed equipment leads to poor patient care, hampering service delivery and in turn frustrating health care workers. This is supported by Thakur(²⁰²⁰), who, in his study, found that medical supply shortages were significantly associated with emotional exhaustion and depersonalization.

Lack of communication may result in the poor coordination of services within a health system O'Daniel and Rosenstein(²⁰⁰⁸). Poor communication between frontline nurses and management is found to be one of the factors contributing to burnout. In addition, poor staff engagement is another identified factor alongside task shifting without capability assessment and proper training to ensure skills development (WHO,²⁰¹⁹). A study done on paediatric nurses has shown that a lack of real meaningful guidance regarding work‐related activities can lead to frustration and ultimately burnout (Bilal & Ahmed,²⁰¹⁸). Study participants also indicated that nurses are rotated between different departments on a monthly basis without the supervisor doing one‐on‐one assessments to find out how confident they are to work in their new environment. This causes stress as some nurses' lack skills in certain areas, such as rendering emergency care to a patient in casualty. Staff members feel left out and not part of the system when they are not consulted on the decisions that concern their work, resulting in them losing interest and contributing to unnecessary absenteeism. However, this was disputed in a study conducted by Meinia(²⁰²¹), which found that job rotation inspires nurses to achieve higher performance, allowing continuous growth at work, extended knowledge and skill, and increasing clinic patient care‐taking quality (Meinia,²⁰²¹).

In their study, Kowalczuk et al.(²⁰²⁰) mentioned that the absence of nurses for health reasons results in an additional workload for their colleagues remaining in the workplace, adding that staff shortages mean that nurses replace absent workers, resulting in excessive workloads or additional on‐call time. Kowalczuk et al.(²⁰²⁰) further state that sometimes they (the colleagues remaining in the workplace) stay in the hospital and fill the shortage of staff on the next shift immediately after working one duty shift. They do this either out of an inner sense of responsibility that does not allow them to leave patients unattended, or they use it as an opportunity to gain extra remuneration. Additional duties naturally contribute to an increase in the workload, which, in turn, has an effect on burnout and thus creates a cyclical self‐perpetuating mechanism.

6. LIMITATIONS

This study only explored the experiences of Gobabis Hospital nurses of burnout syndrome based on their real‐life experiences while working at Gobabis Hospital. This means that the findings cannot be generalized to other hospitals within Namibia and globally. Furthermore, the geographical location of the research site may pose different challenges that are unique to the region.

7. CONCLUSION

In conclusion, excess workload results in stress that leads to burnout among nurses. Burnout among nurses is linked to many stressors such as poor staff management, inadequate resources, lack of support and lack of recreational facilities. Burnout has a negative impact on nurses' well‐being, both physically and emotionally, which is likely to compromise performance, productivity and the quality of patient care. Additional duties naturally contribute to an increase in the workload, which in turn has an effect on burnout and thus creates a cyclical self‐perpetuating mechanism. Further research exploring specific strategies for managing stress and improving job satisfaction may reduce the impact of burnout on the general health of nurses, while also minimizing absenteeism and turnover. This could be achieved through evidence‐based policies aimed at creating better work environments, in which nurses feel more secure and have adequate resources to successfully perform their jobs, hence improving their health outcomes as well as those of their patients.

8. IMPLICATIONS FOR NURSING MANAGEMENT

Strengthening communication between frontline health workers and management by engaging and involving them more in decision making in matters that concern them is anticipated to address poor staff management, enhance staff performance and improve the quality of patient care. Staff wellness programmes in the workplace are believed to be a good coping mechanism for work‐related pressure and tensions, resolving some work‐related stress and, thus, resulting in increased staff productivity.

CONFLICT OF INTEREST

None.

ETHICS STATEMENT

The Committee of Research Ethics of University of Namibia ethical clearance reference No SoNREC No 87/202 (Decision Date: 17.12.2020, Reference No: 87/2020) and Ministry of Health and Social Services (Decision Date: 22.01.2021, Reference No 17/3/3TMN). Throughout the study, the researchers' conduct was guided by the following ethical principles: beneficence, non‐malfeasance, confidentiality, privacy, anonymity, justice, informed consent and autonomy. The participants signed to indicate informed consent prior to data collection and data were accessible only to the two researchers involved in the study. The participants were assured of privacy, anonymity and confidentiality, as well as their right to terminate their participation in the study at any point without having to explain themselves or receiving penalties for doing so.

AUTHORS CONTRIBUTIONS

Study conception and design: Daniel Opotamutale Ashipala and Tuyenikelao Muudikange Nghole. Data collection: Tuyenikelao Muudikange Nghole. Data analysis and interpretation: Tuyenikelao Muudikange Nghole and Daniel Opotamutale Ashipala. Drafting of the article: Daniel Opotamutale Ashipala. Supervision: Daniel Opotamutale Ashipala. Validation: Daniel Opotamutale Ashipala. Writing – review & editing: Daniel Opotamutale Ashipala. All authors have read and approved the manuscript.

ACKNOWLEDGEMENTS

We acknowledge the cooperation of the participants for giving up their time to participate in this study.

Notes

Ashipala, D. O., & Nghole, T. M. (2022). Factors contributing to burnout among nurses at a district hospital in Namibia: A qualitative perspective of nurses. Journal of Nursing Management, 30(7), 2982–2991. 10.1111/jonm.13693 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

[Correction added on 13 June 2022, after first online publication: the ORCID IDs of authors Daniel Opotamutale Ashipala and Tuyenikelao Muudikange Nghole have been added to this version.]

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author, DOA, upon reasonable request.

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