Boundary Violations and Burnout Among Healthcare Workers

female nurses burnt out

Many employees struggle with burnout, which is characterized by feeling emotionally exhausted, detached from work, and incompetent. Healthcare workers (HCWs) are one group of employees who generally experience high levels of burnout, and the pandemic has only intensified this. 

One factor that may contribute to burnout is boundary violations. Boundary violations occur when people perceive that their desired boundary between their work life and non-work life has been breached. For example, being required to take a work-related phone call while on vacation could be considered a boundary violation, because in that instance work is interfering with non-work life.

BURNOUT AND BOUNDARY VIOLATIONS AMONG HEALTHCARE WORKERS

Researchers (Rapp, Hughey, & Kreiner, 2021) conducted interviews with HCWs during the COVID-19 pandemic in order to understand how the pandemic may have influenced how workers managed their work and non-work boundaries, and how this contributed to burnout. From their interviews, the researchers noted that burnout has increased among HCWs during the pandemic, and they identified three different types of boundary violations that contributed to burnout—physical, knowledge, and temporal boundary violations. 

Physical boundary violations are caused by either physical objects or physical distance. One physical boundary violation created by the pandemic among HCWs was the risk and fear of physically contracting COVID-19 or spreading it to others due to their proximity to the virus at work.

Knowledge boundary violations occur when there are disconnects between a worker’s knowledge base and the knowledge base of another person or group. An examples of a knowledge violation that HCWs experienced is feeling misunderstood by others regarding the nature of their work during the pandemic. 

Temporal boundary violations occur when aspects of one domain (e.g., work) infringe upon time in another domain (e.g., home) at unwanted times. An example of a temporal boundary violation that HCWs experienced during the pandemic was the inability to “leave work at work,” because hearing about the pandemic was inescapable.

INTRUSION VERSUS DISTANCING 

Further, each boundary violation could also be categorized as either an intrusion event or a distancing event. Intrusion events occur when a boundary violation results in unwanted integration between work and non-work domains, such as one’s health being threatened by contamination of COVID-19 as a result of going to work each day. Distancing events occur when a boundary violation results in unwanted separation between work and non-work domains, such as being required to eat lunch alone instead of being able to socialize with coworkers. 

Intrusion events were often associated with increased job-related demands and resulted in greater emotional exhaustion. Distancing events were often associated with decreased job-related resources that helped employees cope with work demands, and resulted in greater feelings of detachment and cynicism.

BOUNDARY WORK TACTICS

In order to combat the effects of these boundary violations, many workers utilized boundary work tactics. An example of a boundary work tactic that HCWs used in response to physical boundary violations is creating routines or rituals to minimize the potential for contracting COVID-19. An example of a boundary work tactic that HCWs used in response to knowledge boundary violations is educating others on the reality of the pandemic. An example of a boundary work tactic that HCWs used in response to temporal boundary violations is refraining from doing anything work-related at home.

PRACTICAL APPLICATIONS FOR ORGANIZATIONS

Overall, this study demonstrates how the COVID-19 pandemic influenced burnout via HCWs’ experiences with boundary violations. Additionally, the study shows how HCWs can use boundary work tactics to combat these boundary violations in order to reduce or avoid burnout.

The researchers suggest that healthcare and other organizations ought to be aware of how external events like a pandemic can lead to boundary violations among employees. This awareness will allow organizations to have empathy and take relevant, individualized action in order to help employees cope with these added stressors, such as by changing restrictive policies or introducing monetary benefits.

Rapp, D. J., Hughey, J. M., & Kreiner, G. E. (2021). Boundary work as a buffer against burnout: Evidence from healthcare workers during the COVID-19 pandemic. Journal of Applied Psychology, 106(8), 1169-1187.