International Medical University, School of Health Sciences, Bukit Jalil, Kuala Lumpur, Malaysia
*Corresponding Author’s Email: yeebitlian5448@gmail.com
4.07 respectively. Conclusion: There is moderate to high level of job dissatisfaction and burnout reported by the registered nurses. The findings of this study will provide significant findings to the nursing administrative in addressing the expectation and needs of their registered nurses.
Keywords: Job Satisfaction; Burnout; Nurse
Burnout syndrome is part of occupational health problem that can include both emotional and physical burnout (Maslach & Jsckosn, 1981; Tosun & Ulusoy, 2017; Halcomb, Smyth & McInnes, 2018). Study by Cetinkaya et al., (2017) claimed that the prevalence can be varied. Nursing is one of the human service professions and is specifically vital in the medical and mental health care delivery. Many scholars highlighted that nursing profession is by nature highly vulnerable to burnout syndromes (Khamisah et al., 2015; Polat & Terzi, 2018; Tavakoli et al., 2018). Main risk factors for the burnout were reported such as heavy workload and non- compliance among persons (Alameddine et al., 2017; Centikaya et al., 2017; Raju et al., 2021). Therefore, it is a common problem among health care professionals, especially those at the frontline of care such as nursing staff (Doulougeri, Georganta & Montgomery, 2016).
Meanwhile, job satisfaction is the extent to which a person like the job and have a positive or negative attitude toward their jobs (Doulougeri, Georganta & Montgomery, 2016; Polat & Terzi, 2018). Job abandonment and frequent job change can be seen as an indication of job burnout (Kabir et al., 2016; Ismail & Yee, 2020). In health care setting, improvement of quality of care and patient outcomes have been positively linked to the higher levels of job satisfaction among nurses (Doulougeri, Georganta & Montgomery, 2016; Centikaya et al., 2017; Tavakoli et al., 2018), thus it is crucial to maintain good level of job satisfaction among the nurses. Few studies reported that negative job burnout is linked with job satisfaction, where higher job burnout are experienced by the nurses, the lower the job satisfaction they had toward their job (Khamisa et al., 2015; Polat & Terzi, 2018; Tavakoli et al., 2018).
Burnout directly affects the health outcomes as characterized by exhaustion, fatigue, somatization and social withdrawal (Khamisa et al., 2015; Larasati & Aryanto, 2019) leading to nurses being dissatisfied with coping their job routines and negatively influence patient care. Thus, considering the grave impact on health care service particularly involving patient care and outcomes as well as staff attrition. It is imperative to explore a better understanding of the existing relationships between job satisfaction and burnouts to nurses.
A stressful profession, such as nursing, that deals with the numerous human demands of health and disease (Panhwar et al., 2019; Mahoney et al., 2020). Consequently, the stressful nature can ultimately lead to work dissatisfaction, burn-out (Kabir et al., 2016) and its effect on their quality of life (Aytekin, Yilmaz & Kuguogly, 2014). Nurses have been found among health care professionals to be most prone to burnout (Kapucu et al., 2009; Doulougeri, Georganta & Montgomery, 2016; Vidotti et al., 2018). Job satisfaction and burn-out are important issues as they affect turnover rates, retention of staff and ultimately the quality of patient care (Kapucu et al., 2009; Khamisa et al., 2015; Mahoney et al., 2020).
Relationship between job satisfaction and burnout advocated comprehensive plan to reduce burnout among the nurses (Khamisa et al., 2015; Panhwar et al., 2019) in order to increase job satisfaction and the quality of healthcare services. Nurses experiencing burnout issue may be harmful as an exhausted person has a tendency to develop health issues and psychological damage (Kapucu et al., 2009; Polat & Terzi, 2018; Larasati & Aryanto, 2019). Nurses who experienced dissatisfaction in the workplace may have disrupted physical, mental and social well-being (Kabir et al., 2016; Tavakoli et al., 2018; Mahoney et al., 2020).
In the current setting, a private hospital was selected. It was found that the increased in the susceptibility to job dissatisfaction and burnout among nurses are often associated to several job-related issues such as the work overload, unclear job descriptions, staff issues, shift overtime, poor salary package, unfair shift work allocation and lack of opportunities for promotion. Therefore, this study is essential to identify the job satisfaction and burnout among state registered nurses in the selected private hospital in Kajang, Malaysia.
Ethical Consideration: Ethical approval from the IMU Joint-Committee on Research and Ethic, International Medical University was obtained to conduct the study. Permission for the data collection was obtained from the selected hospital management. Participants’ written consent were obtained prior to the study. This project has been approved at the 199th IMU Joint-Committee on Research and Ethics on 18th June 2020 (BN I/2020(PR-25).
Instrument: A self- administered questionnaires using 5 points Likert scale was used in this study. The questionnaire was adapted from Maslach & Jackson (1981). It consisted of three sections. Section A: sociodemographic data which include gender, age, education qualification in nursing, working experience as a nurse, job position at designated department and marital status. Section B: to measure the extent of burnout experience by the nurses. There was a total of 22 items in the instrument divided into three dimensions, namely emotional exhaustion (9 items), depersonalization (5 items) and personal accomplishment (8 items). Respondents’ feedback to each of the item were measured using a 5 points Likert-scale (1- strongly disagree to 5- strongly agree). Section C integrated the instrument to measure the level of job satisfaction among the nurses with 20 items. The respondents were required to express the extent of their satisfaction in their job using a 5 points Likert-scale (1- strongly dissatisfied to 5- strongly satisfied).
Most of the respondents had a diploma (n = 146, 87.4%), followed by bachelor’s degree holder which represent 20 respondents (12.0%) and only 1 respondent (0.6%) having master certificate. In terms of working experience, there are 77 respondents (46.1%) having experience of their job for 5 to 10 years, while 67 respondents (40.1%) have less than 5 years of working experience and only 23 respondents (13.8%) about 11 to 15 years of working experience. For the job position among registered nurses, there are 106 respondents (63.5%) working as a nurse, 53 respondents (31.7%) worked as a nurse instructor and only eight respondents (4.8%) were nurse specialist. Based on marital status, there are 71 of respondents (42.5%) still single, 92 of respondents (55.1%) are married and only four of respondents (2.4%) are divorced.
Table 1: Sociodemographic Data (n=167)
Characteristic | Frequency (N) | Percentage (%) |
Gender Male Female | 13 154 | 7.8 92.2 |
Age 21-30 years 31-40 years 41-50 years 51-60 years | 98 42 21 6 | 58.7 25.1 12.6 3.6 |
Education Level Diploma Bachelor’s degree Master | 146 20 1 | 87.4 12.0 0.6 |
Working Experience < 5 years 5-10 years 11-15 years | 67 77 23 | 40.1 46.1 13.8 |
Position Nurses Nurse Specialist Nurse Instructor | 106 53 8 | 63.5 31.7 4.8 |
Marital Status Single Married Divorced | 71 92 4 | 42.5 55.1 2.4 |
Level of Variables: The aims of the analysis are understanding the job satisfaction level and burnout level among registered nurses. This part of analysis is used to achieve the objective one of this study. To get a summary of the data, analysis is conducted to describe the general situation of job satisfaction and burnout among registered nurses from their perspective. The mean and standard deviation (SD) are explained briefly for each item of the job satisfaction and burnout among registered nurses. The mean and standard deviation (SD) are determined to examine the sample characteristics in this study. Othman & Ishak (2011) recommended the mean categorised into four sections as tabulated in Table 2.
Table 2: Test of Reliability (n = 167)
Scale | Interpretation |
1.00 – 2.00 | Low |
2.01 – 3.00 | Medium Low |
3.01 – 4.00 | Medium High |
4.01 – 5.00 | High |
Table 3: Level of Job Satisfaction among Registered Nurses (n = 167)
Level of Job Satisfaction among Registered Nurses | Mean (M) | Standard Deviation (SD) |
Being able to keep busy all the times | 4.50 | 0.569 |
The chance to work alone with the jobs | 3.81 | 1.197 |
The chance to do different thing from time to time | 3.43 | 1.604 |
The chances to be "somebody" in the community | 3.40 | 1.362 |
The way my boss handles his/her workers | 4.31 | 0.797 |
The competence of my supervisor in making decisions | 4.35 | 0.736 |
Being able to do things that don't go against my conscience | 3.72 | 1.421 |
The way my job provides for steady employment | 4.31 | 0.709 |
The chance to do things for other people | 4.22 | 0.662 |
The chance to tell people what to do | 3.69 | 1.212 |
The chance to do something that makes use of my abilities | 4.35 | 0.612 |
The way company policies are put into practice | 4.29 | 0.688 |
My pay and the amount of work I do | 4.17 | 0.655 |
The chances for advancement on this job | 3.97 | 0.817 |
The freedom to use my own judgment | 4.21 | 0.710 |
The chance to try my own methods of doing the job | 4.08 | 0.829 |
The working conditions | 4.08 | 0.784 |
The way my co-workers get along with each other | 4.00 | 0.988 |
The praise I get for doing a good job | 4.18 | 0.824 |
The feeling of accomplishment I get from the job | 4.08 | 1.041 |
Total | 4.06 | 0.911 |
*Note: Scores ranged from 1 (strongly disagree) to 5 (strongly)
4.00 to 4.50 and standard deviation from 0.569 to 0.864. While 13 items are at medium high level with mean from 3.62 to 3.99 and standard deviation from 0.744 to 1.105. Overall, the burnout level among registered nurses is at high level since mean is 4.07 and standard deviation is 0.801.
Table 4: Level of Burnout among Registered Nurses (n= 167)
Level of Burnout among Registered Nurses | Mean (M) | Standard Deviation (SD) |
I feel emotionally drained from my work | 3.62 | 0.923 |
I feel used up at the end of the workday | 3.80 | 0.941 |
I feel fatigued when I get up in the morning and have to face another day on the job | 3.75 | 0.930 |
Working with people all day is really a strain for me | 3.96 | 0.787 |
I feel burned out from my work | 3.91 | 0.805 |
I feel frustrated by my job | 3.87 | 0.991 |
I feel I’m working too hard on my job | 3.99 | 0.788 |
Working with people directly puts too much stress on me | 4.02 | 0.744 |
I feel like I’m at the end of my rope | 3.99 | 0.791 |
The chance to tell people what to do | 3.98 | 0.788 |
I feel I treat some recipients as if they were impersonal objects | 3.99 | 0.836 |
I’ve become more callous toward people since I took this job | 3.93 | 0.815 |
I worry that this job is hardening me emotionally | 4.00 | 0.864 |
I don’t really care what happens to some patients. | 3.89 | 0.934 |
I feel patients blame me for some of their problems | 4.05 | 0.838 |
I can easily understand how my patients feel about things | 4.26 | 0.678 |
I can deal very effectively with the problems of my patients | 4.22 | 0.748 |
I feel I’m positively influencing other people’s lives through my work | 4.45 | 0.708 |
I feel very energetic | 3.73 | 1.015 |
The feeling of accomplishment I get from the job | 4.48 | 0.798 |
I can easily create a relaxed atmosphere with my recipients | 4.41 | 0.678 |
I feel exhilarated after working closely with my patients | 4.53 | 0.599 |
I have accomplished many worthwhile things in this job | 4.43 | 0.645 |
In my work, I deal with emotional problems very calmly | 4.50 | 0.569 |
Total | 4.07 | 0.801 |
*Note: Scores ranged from 1 (strongly disagree) to 5 (strongly agree)
Relationship of Job Satisfaction Based on Demographic Respondents: There are six demographic items that included gender, age, education level, working experience, job position and marital status. We used independent t-test and one-way ANOVA test for this purpose.
Table 5: The Relationship of Job Satisfaction and Gender (n = 167)
Gender | N | Mean (M) | Standard Deviation (SD) | T | P-value |
Male | 13 | 4.18 | 0.641 | 0.774 | 0.440 |
Female | 154 | 4.05 | 0.598 |
Result from Table 5 revealed the relationship between job satisfaction and gender among registered nurses. The p-value is greater than significant level (p = 0.440 > α = 0.05). When the p-value >0.05 is consider as not significant. Therefore, there is no relationship between job satisfaction and gender among registered nurses at the chosen private hospital in Kajang.
Table 6: The Relationship of Job Satisfaction and Age, Educational Level, Working Experience, Job Position and Marital Status (n = 167)
Model | Sum Squares | Df | Mean Square | F | P-value |
Age | |||||
Between Groups | 3.695 | 3 | 1.232 | 3.578 | 0.015 |
Within Groups | 56.109 | 163 | 0.344 | ||
Total | 59.805 | 166 | |||
Educational Level | |||||
Between Groups | 1.258 | 2 | 0.629 | 1.762 | 0.175 |
Within Groups | 58.547 | 164 | 0.357 | ||
Total | 59.805 | 166 | |||
Working Experience | |||||
Between Groups | 0.737 | 2 | 0.369 | 1.023 | 0.362 |
Within Groups | 59.067 | 164 | 0.360 | ||
Total | 59.805 | 166 | |||
Job Position | |||||
Between Groups | 0.287 | 2 | 0.143 | 0.395 | 0.674 |
Within Groups | 59.518 | 164 | 0.363 | ||
Total | 59.805 | 166 | |||
Marital Status | |||||
Between Groups | 1.249 | 2 | 0.624 | 1.749 | 0.177 |
Within Groups | 58.556 | 164 | 0.357 | ||
Total | 59.805 | 166 | |||
Results from Table 6 reveals the relationship between job satisfaction and age, educational level, working experience, job position and marital status among registered nurses. The p-value >< 0.05 is consider as significant. For age factor, the p-value is less than significant level (p =
0.015 < α = 0.05). Therefore, there is a relationship between job satisfaction and age among registered nurses. For education level, working experience, job position factors, and marital status, the p-values are greater than significant level with educational level (p = 0.175 > α = 0.05), working experience (p = 0.362 > α = 0.05), job position factors (p = 0.674 > α = 0.05), and marital status (p = 0.177 > α = 0.05). Therefore, there is no relationship between job satisfaction and education level, working experience, job position factors, and marital status among registered nurses at the private hospital in Kajang.
Relationship of Burnout Based on Demographic Respondents: Result from Table 7 showed the relationship between burnout and gender among registered nurses. The p-value is greater than significant level (p = 0.170 > α = 0.05). When the p-value > 0.05 is consider as not significant. Therefore, there is no relationship between burnout and gender among registered nurses at the selected private hospital in Kajang.
Table 7: The Relationship of Burnout and Gender (n = 167)
Gender | N | Mean (M) | Standard Deviation (SD) | t | P-value |
Male | 13 | 4.09 | 0.345 | 0.170 | 0.865 |
Female | 154 | 4.07 | 0.438 |
Results from Table 8 reported the relationship between job satisfaction and age, educational level, working experience, job position and marital status among registered nurses. The p-value < 0.05 is consider as significant. For working experience factor, the p-value is less than significant level (p = 0.046 < α = 0.05). Therefore, there is a relationship between burnout and working experience among registered nurses. For age, education level, job position factors, and marital status, the p-values are greater than significant level with age (p = 0.724 > α = 0.05), education level (p = 0.215> α = 0.05), job position (p = 0.887 > α = 0.05), and marital status (p= 0.484 > α = 0.05). Therefore, there is no relationship between burnout and age, education level, job position factors, and marital status among registered nurses at the private hospital in Kajang.
Table 8: The Relationship of Burnout and Age, Educational Level, Working Experience, Job Position and Marital Status (n = 167)
Model | Sum Squares | Df | Mean Square | F | P-value |
Age | |||||
Between Groups | 0.248 | 3 | 0.083 | 0.441 | 0.724 |
Within Groups | 30.562 | 163 | 0.187 | ||
Total | 30.810 | 166 | |||
Educational Level | |||||
Between Groups | 0.572 | 2 | 0.286 | 1.552 | 0.215 |
Within Groups | 30.237 | 164 | 0.184 | ||
Total | 30.810 | 166 | |||
Working Experience | |||||
Between Groups | 1.134 | 2 | 0.567 | 3.134 | 0.046 |
Within Groups | 29.676 | 164 | 0.181 | ||
Total | 30.810 | 166 | |||
Job Position | |||||
Between Groups | 0.045 | 2 | 0.022 | 0.120 | 0.887 |
Within Groups | 30.765 | 164 | 0.188 | ||
Total | 30.810 | 166 | |||
Marital Status | |||||
Between Groups | 0.272 | 2 | 0.136 | 0.729 | 0.484 |
Within Groups | 30.538 | 164 | 0.186 | ||
Total | 30.810 | 166 | |||
Relationship of Job Satisfaction and Burnout Among Registered Nurses According to Demographic Items: The finding revealed that only the job satisfaction has statistically significant relationship with age. The finding showed that the different in age will affected in the job satisfaction among registered nurses at the private hospital in Kajang. While the other demographic items such as gender, education level, working experience, job position and marital status are not related or affected on the job satisfaction among the registered nurses. In addition, the findings also reported that the burnout has statistically significant relationship on working experience. Our findings proved that the different in working experience will affect the burnout level among registered nurses at the selected private hospital. Burnout among the registered nurses at the private hospital in Kajang is not affected by the other demographic factors such as gender, age, education level, job position and marital status. It has been found that job satisfaction and burnout are important factors (Khamisa et al., 2015; Polat & Terzi, 2018; Panhwar et al., 2019) to retain the staff. Therefore, in the context of nursing service, managers and leaders of any hospital should be more committed to improving employee satisfaction (Khamisa et al., 2015; Panhwar et al., 2019).
According to Owen et al., (2018), management of the private hospital can ensure the job satisfaction of employees by providing the nursing staff with an opportunity to participate in the policy development process. The internal governance can be developed based on the needs and concerns of staff with the help of this process.
Study has suggested that workplace burnout has a negative correlation with job satisfaction. As mentioned by Vidotti et al., (2018), the satisfaction of employees can be increased by reducing the burnout within the workplace. In order to prevent burnout, the managers need to be vigilant about risk factors. Burnout within the workplace is created by risk factors such as dysfunction of workplace dynamics, work-life misbalance, extreme pressure and lack of social support (Owen et al., 2018). It is the sheer responsibility of the managers to ensure that these risk factors are not affecting the nursing staff. In order to do that, managers can conduct a monthly or quarterly survey to understand the issues and concerns of nursing staff.
Our findings provided a clear implication for nursing practices and research. As articulated by Tosun & Ulusoy (2017), nurses are essential for educating emerging students who are interested in this field. It helps to detect, refer, intervene and create strategies for the people who are focused on creating cognitive impairment. It is essential for the nurses to suggest to the patients and their family members to lead a better life. As stated by Mahoney et al., (2020), nurse managers are considered as the key to create and harness a positive workplace environment. Development of a positive workplace environment is essential for meeting the needs of the staff and retains an organization (Kabir et al., 2016; Larasati & Aryanto, 2019). Therefore, it is important for the nurse managers of the private hospital to look into the needs and expectations of the nurses. The study has illustrated that there is a significant relationship between the demographic variables such as pay scale, work environment and others. Hence, it is the responsibility of the managers and leaders of the selected private hospitals to meet the needs and expectations of nurses.
As a conclusion, it can be derived that the top management must address to the needs and expectations of their nurses and focus on aspects for improving the burnout level and further enhance the job satisfaction. It is essential for retaining the nursing staff and enhancing their performance. Based on the performance of the nurses, the quality of service delivery in the hospitals can be improved.
The study only covers job satisfaction and burnout among registered nurses at the selected private hospital. Thus, the finding of this study cannot be generalised to other hospital.
The authors declare that they have not known competing financial or personal conflict of interest.
To Group Chief Nursing Officer and Chief Nursing Office (CNO), the researchers express a profound appreciation for authorizing them to conduct this study at the private hospital. This study was supported by International Medical University research grant, BN I-2020 (PR-25).
Alameddine, M., Baroud, M., Kharroubi, S., Hamadeh, R., Ammar, W., Shoaib, H., & Khodr, H. (2017). Investigating the job satisfaction of healthcare providers at primary healthcare centres in Lebanon: A national cross‐sectional study.
Health & social care in the community, 25(6), 1805-1816. https://doi.org/10.1111/hsc.12454Aytekin, A., Kuguoglu, S., & Yilmaz, F. (2014). Burnout levels in neonatal intensive care nurses and its effects on their quality of life. Australian Journal of Advanced Nursing, 31(2), 39-47.
Cetinkaya, F., Akbulut, Z, Dur, N., Eryalcin, O., & Korkmaz, M. (2017). Analysis of Job Satisfaction and Burnout Level of Nurses in Different Generations. International Journal of Caring Sciences, 10(3), 1507-1513.
Doulougeri, K., Georganta, K., & Montgomery, A. (2016). “Diagnosing” burnout among healthcare professionals: Can we find consensus?, Cogent Medicine, 3(1), 1-10.https://doi.org/10.1080/2331205X.2016.1237605
Halcomb, E., Smyth, E., & McInnes, S. (2018). Job satisfaction and career intentions of registered nurses in primary health care: an integrative review. BMC Family Practice, 19(1), 1-14.https://doi.org/10.1186/s12875-018-0819-1
Ismail, N.H., & Yee, B.L. (2020). Nurses’ Intention to Leave Their Employment In A Private Hospital: A Descriptive Analysis. International Journal of Advances in Science Engineering and Technology, 8(1), 2321 –8991.
Kapucu, S., Akkuş, Y., Akdemir N., & Karacan Y. (2009). The burnout and exhaustion levels of nurses working in haemodialysis units. Journal of Renal Care, 35(3), 134-140.https://doi,org/10.1111/j.1755-6686.2009.00108.x
Kabir, M.J., Heidari, A., Etemad, K., Gashti, A.B., Jafari, N., Honarvar, M.R., Ariaee, M., & Lotfi, M. (2016). Job Burnout, Job Satisfaction, and Related Factors among Health Care Workers in Golestan Province, Iran. Electronic Physician, 8(9), 2924-2930.https://doi.org/10.19082/2924
Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work related stress, burnout, job satisfaction and general health of nurses. International Journal of Environmental Research and Public Health, 12(1), 652-666.https://doi,org/10.3390/ijerph120100652
Larasati, A., & Aryanto, D. B. (2020, January). Job-Hopping and the Determinant Factors. In 5th ASEAN Conference on Psychology, Counselling, and Humanities (ACPCH 2019) (pp. 54-56). Atlantis Press. https://www.atlantis-press.com/proceedings/acpch-19/125932598. https://dx.doi.org/10.2991/assehr.k.200120.011
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99-113.https://doi.org/10.1002/job.4030020205
Mahoney, C.B., Lea, J., Schumann, P. L., & Jillson, I.A. (2020). Turnover, Burnout, and Job Satisfaction of Certified Registered Nurse Anesthetists in the United States: Role of Job Characteristics and Personality. AANA Journal, 80(1), 39-48.
Othman, N. H., & Ishak, S. (2011). Kecenderungan terhadap pemilihan kerjaya keusahawanan mengikut persepsi peserta skim usahawan siswa. Sains Humanika, 56(1), 47-63.https://doi.org/10.11113/jt.v56.59
Owen, D. C., Boswell, C., Opton, L., Franco, L., & Meriwether, C. (2018). Engagement, empowerment, and job satisfaction before implementing an academic model of shared governance. Applied Nursing Research, 41, 29-35.https://doi.org/10.1016/j.apnr.2018.02.001
Panhwar, G.A., Jokhio, P.B., Wagan, H., & Channar, H.B. (2019). Workload as a Cause of Occupational Stress Among Registered Staff Nurses. Annals Abbasi Shaheed Hospital & Karachi Medical & Dental College, 24(3), 265-270.
Polat, S., &Terzi, B. (2018). Identification of the burnout and job satisfaction levels of the beginner nurses who were in the process of orientation. International Journal of Medical Research & Health Sciences, 7(12), 156-163.
Raju, A. V., Emmanual, A., Shaji, D., Faizal, M.R., & Aranha, P.R. (2021). Burnout among nurses at a tertiary care hospital of South India. Indian Journal of Health Sciences and Biomedical Research KLEU, 14(1), 80-83. https://doi.org/10.4103/kleuhsj.kleuhsj_154_20
Tavakoli, N., Shaker Seyed, H., Soltani, S., Abbasi, M., Amini, M., Tahmasebi, A., & Kasnavieh Seyed, M. (2018). Job Burnout, Stress, and Satisfaction among Emergency Nursing Staff after Health System Transformation Plan in Iran. Emergency, 6(1), e41-47.
Tosun, N., & Ulusoy, H. (2017). The Relationship of Organizational Commitment, Job Satisfaction and Burnout on Physicians and Nurses? Journal of Economics and Management, 28(2), 90-111.https://doi.org/10.22367/jem.2017.28.06
Vidotti, V., Ribeiro, R.P., Galdino, M.J.Q., & Martins, J.T. (2018). Burnout Syndrome and shift work among the nursing staff. Rev. Latino-Am. Enfermagem, 26, e3022-3031.https://doi.org/10.1590/1518-8345.2550.3022