Burnout in residential aged care managers: a scoping review

Figures & data

Table 1. Search concepts and terms used in initial search.

Concept	Key words
Aged Care	“aged care” OR “nursing home” OR “RACF” OR “residential aged care” OR “residential aged”
Burnout	Burnout OR stress OR fatigue OR exhaustion OR moral distress OR resilience
Manager	Manager* OR Leader* OR Supervisor* OR “Health Service Manager*”

Figure 1. PRISMA DIAGRAM – flowchart for article selection.

Table 2. Characteristics of articles included in the literature review.

Author and year (country)	Title of article	Aim and method of study	Findings	Relevance to Burnout in Aged Care managers
Hagerman, Skytt, Wadensten, Högberg, & Engström (2016) Sweden	A longitudinal study of working life among first-line managers in the care of older adults	Aim: This study looked at the relationship between employees and their manager working in the care of older adults and whether the number of employees and structural conditions influenced a manager’s stress and performance. Method: A longitudinal and correlational design.	Managers with smaller numbers of employees felt they had higher levels of structural empowerment. Access to structural empowerment led to psychological empowerment resulting in lower levels of self-rated stress and higher levels of self-rated performance. This study highlighted, the need to limit the number of employees a manager oversees. Managers also need access to opportunity, information, support and resources for the benefit of both the manager and their employees.	Responsibilities: Managers with ≤30 employees perceived greater levels of structural empowerment and more resources than with ≥31 employees.
Hower, Pfaff, & Pförtner (2021) Germany	Is time a healer? Course of demands during the COVID-19 pandemic in long-term care: a repeated cross-sectional survey in Germany	Aim: This study looked at the general and COVID-19 pandemic specific burdens from a manager’s perspective. Method: A cross-sectional online survey of managers.	The study found that the general demands relating to staffing and work organisation increased between the first and second survey. Concerns related to COVID-19 infections increased pandemic specific burdens.	Reaction: While looking at the usual contributors to burnout, additional and unexpected factors, such as a pandemic placed additional burdens on managers, such as staff shortages, the intensity and density of work and regulatory compliance.
Iaconi, Duan, Tate, Penconek, Cummings, Norton, & Estabrooks (2022) Canada	Nursing Home Managers’ High Risk of Burnout	Aim: This study looked at the characteristics of nursing home managers to develop strategies to improve a manager’s quality of work life. Method: A cross-sectional analysis of self-reported questionnaire data from managers of Nursing homes.	The study found that approximately half of the respondent’s self-reported moderate to high levels of emotional exhaustion and cynicism indicating their risk for burnout. Based on the results, it was expected that burnout amongst managers would be much higher post COVID-19 pandemic than pre-pandemic. Potential contributing factors to these feelings include work overload, lack of time and support, and managing conflict amongst team members. The authors suggested strategies to remedy this potential issue, which included creating a culture of recognition and supporting positive work environments.	Reaction: It was anticipated that there will be higher numbers of managers experiencing burnout post the pandemic due to high levels of emotional exhaustion and cynicism, despite reports of high professional efficacy and job satisfaction. The reason burnout was anticipated was due to the predicted increased workload due to COVID-19. Responsibilities: Aged care managers needing to work more overtime and an increase in workload and feeling that there was a lack of support and time to complete tasks
Jeon, Simpson, Chenoweth, Cunich, & Kendig (2013) Australia	The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial	Aim: This paper discusses the design of a cluster randomised control trial to determine the effectiveness of an aged care clinical leadership program on the workforce, the work environment and the quality of services provided in aged care.	The study was published at the point of data collection; therefore, no results were provided in this paper. Three primary hypotheses were proposed for the trial: “H1 – the intervention sites will report an enhanced work environment for staff. H2 – improved care quality and safety for care recipients. H3 – reduced staff turnover rates” (14).	Responsibilities: Positive outcomes were expected for staff and residents through the provision of education and training in leadership skills for managers.
Kristiansen, Westeren, Obstfelder, & Lotherington (2016) Norway	Coping with increased managerial tasks: tensions and dilemmas in nursing leadership	Aim: This paper took a qualitative look at how increased managerial tasks due to Public Health reforms have affected nursing leadership in nursing homes.	With an increase in managerial tasks, it was found that nursing leadership was weakened. Three themes were identified. These were: leading nursing care from a distance lack of support and increased responsibility increased demands for efficiency and increased documentation requirements. The increase in managerial tasks in addition to the usual core functions have placed additional burdens onto nurses and managers with the potential outcomes of increased frustration, absenteeism and turnover.	Regulation: Increased managerial tasks created by public health reforms have resulted in increased responsibilities. Daily tasks were being governed by quality standards which created additional workloads.

Hagerman, H., Skytt, B., Wadensten, B., Högberg, H., & Engström, M. (2016). A longitudinal study of working life among first-line managers in the care of older adults. Applied Nursing Research, 32, 7–13. https://doi.org/10.1016/j.apnr.2016.03.003

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Hower, K., Pfaff, H., & Pförtner, T. (2021). Is time a healer? Course of demands during the COVID-19 pandemic in long-term care: A repeated cross-sectional survey in Germany. Journal of Public Health, 43(3), e435–e437. https://doi.org/10.1093/pubmed/fdab144

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Iaconi, A., Duan, Y., Tate, K., Penconek, T., Cummings, G., Norton, P., & Estabrooks, C. (2022). Nursing home managers’ high risk of burnout. Journal of the American Medical Directors Association, 23(1), 173–175. https://doi.org/10.1016/j.jamda.2021.08.045

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Jeon, Y., Simpson, J., Chenoweth, L., Cunich, M., & Kendig, H. (2013). The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: Design of a cluster randomised controlled trial. BioMed Central, 8(1), 1–10. https://doi.org/10.1186/1748-5908-8-126

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Kristiansen, M., Westeren, K., Obstfelder, A., & Lotherington, A. (2016). Coping with increased managerial tasks: Tensions and dilemmas in nursing leadership. Journal of Research in Nursing, 21(7), 492–502. https://doi.org/10.1177/1744987116668940

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