Self-endangering: A qualitative study on psychological mechanisms underlying nurses' burnout in long-term care

To develop a more specific understanding of psychological mechanisms in the development of burnout in long-term care as a basis for potential new intervention strategies aiming at improving nurses' mental health.

Two qualitative studies with thematic analysis were conducted. In Study 1, we conducted eight group interviews with 110 nurses from May-July 2019 in the context of workshops at eight nursing homes in Germany. In Study 2, we supplemented these with semi-structured interviews with 14 executives at German nursing homes in December 2019.

The thematic analysis in Study 1 identified three main themes: causes of challenges, employees' opportunities for change, and organisational opportunities for change. Thematic analysis in Study 2 identified three main themes: job motives, reasons for filling in for others, and employee self-care. Further, our results show that the need to stand in for colleagues, in particular, is one of the greatest challenges for geriatric caregivers. In dealing with these challenges we found that self-endangering behaviour-a diminished ability to say no when asked to fill in or to do work overtime-was an important antecedent of nurses' burnout. Further, high levels of altruistic motivation and identification with the team or organisation were associated with self-endangering behaviour in the presence of adverse working conditions. Low levels of self-worth are a further risk factor for self-endangering.

Our findings are at odds with some core tenets of classic models of job demands and burnout that construe motivation and identification as resources. Our results show the need of a holistic intervention program in nursing including individual coaching, team-based interventions and organisational development processes. Employees themselves should be sensitized to this issue and supported in the long term, and politicians should create structures that do not encourage this behaviour any further.