Job-Related Conditions Explain Emotional Exhaustion in Dialysis Social Workers

Background and Purpose: Dialysis social workers are central to the provision and management of psychosocial services to patients with kidney disease and members of their support system. In accordance with a Medicare mandate, a Master’s level social worker is required in every U.S. dialysis center because of the many psychosocial barriers to optimal dialysis outcomes. For example, social workers assist patients with issues such as coping with treatment regimens, pain management, end-of-life concerns, social role adjustment, and vocational rehabilitation. Studies indicate that high dialysis social worker caseloads are associated with lower patient satisfaction, less successful patient rehabilitation outcomes, and a decreased ability to provide clinical social work interventions. In addition, research has demonstrated that job demands and limited workplace resources are directly associated with a social worker’s ability to manage key professional responsibilities. This study examined the degree to which individual characteristics, employer characteristics, and job-related conditions were associated with experiencing emotional exhaustion.

Methods: A cross-sectional online survey was administered to measure social workers’ caseloads, job-related resources, professional roles, work conditions, and emotional exhaustion. The survey contained 58, multicomponent questions and took 20 minutes to complete. Surveys were distributed between June 6 and July 31, 2017 using the nationally based Council of Nephrology Social Worker listserv. A sample of 613 full-time (≥32 hrs/wk) social workers was obtained from all 50 states and two U.S. territories. The majority of respondents identified as female (92%) and White (81%), with a mean age of 46(12) years and 9(8) years of nephrology-specific practice experience. Data were analyzed using hierarchical multiple regression. The main outcome variable was measured using the Job-related Emotional Exhaustion Scale. The study complied with ethical standards for research with human subjects.

Results: The hierarchical multiple regression showed that individual characteristics such as gender and job tenure (Block 1) were not significantly associated with emotional exhaustion [Adj. R²=0, F(2, 610)=0.15, p=0.86]. We then added employer characteristics such as locality and profit/nonprofit status (Block 2) into our model. Findings showed these characteristics were not significant predictors of emotional exhaustion [Adj. R²=0, F(6, 606)=0.90, p=0.49]. At Block 3, we introduced the job-related conditions into our model. The full model accounted for 28.3% [Adj. R²=0.26, F(16, 596)=14.70, p<.001] of the variation in the emotional exhaustion score. Our statistical findings suggested that working overtime (β=1.97, p<.01); having a clerical assistant (β=-1.42, p<.05); having enough time to provide psychosocial services to patients (β=-4.37, p<.001); the likelihood of experiencing reprisal from management (β=-0.34, p<.001), an increase in caseload (β=1.97, p<.01); and an increase in job tasks (β=1.68, p<.05) were all significant predictors of job-related emotional exhaustion.

Conclusion and Implications: This study represents an important national effort to identity key job conditions and constraints associated with experiencing emotional exhaustion, which is a component of burnout. The findings provide empirical evidence that can be used by social workers to leverage resources that support their work and professional roles so that they can improve working conditions in dialysis clinics, provide much needed services to their clients, and improve health outcomes.