Canadian Journal of Occupational

Therapy http://cjo.sagepub.com/

Experiences of Burnout and Coping Strategies Utilized by Occupational Therapists

Sangeeta Gupta, Margo L Paterson, Rosemary M. Lysaght and Claudia M. von Zweck
Canadian Journal of Occupational Therapy 2012 79: 86
DOI: 10.2182/cjot.2012.79.2.4

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Experiences of burnout and coping strategies utilized by
occupational therapists
Sangeeta Gupta, Margo L. Paterson, Rosemary M. Lysaght, Claudia M. von Zweck

Key words Abstract

Emotional exhaustion
Health care provider
Background. Work-related stress and burnout have been found to lead to job
Occupational therapy dissatisfaction, low-organizational commitment, absenteeism, and high turnover.
Stress management Purpose. The purpose of this study was to examine the burnout experiences
Stress mediators of occupational therapists practicing in Ontario and to describe the practice
implications and coping strategies employed. Methods. Data for this mixed
methods study were collected using the Maslach Burnout Inventory-General
Mots clés Survey, Areas of Worklife Survey, focus groups, and interviews in the hermeneutics
Épuisement émotionnel
Ergothérapie tradition. Findings. High levels of emotional exhaustion were reported by 34.8% of
Fournisseur de soins participants, high levels of cynicism by 43.5%, and low professional efficacy by 24.6%.
Gestion du stress Practice issues included excessive demands on time, conflict, and lack of autonomy
Médiateurs de stress and respect. Coping strategies included spending time with family and maintaining
professional/personal balance, control of work responsibilities, maintaining a sense
Sangeeta Gupta, MSc., OT Reg. (Ont.), of humor, and self-awareness/self-monitoring. Implications. This study contributes
is Staff Occupational Therapist, Adult to understanding the practice challenges for occupational therapists, factors that
Outpatient Psychiatry, Hotel Dieu contribute to therapist burnout, and strategies employed to maintain competent
Hospital, 166 Brock Street, Kingston, practice.
ON, K7L 5G2. At the time of this study
Sangeeta Gupta was a Masters student
in the School of Rehabilitation Therapy,
Queen’s University, Kingston, ON.
Abrégé
Description. On a découvert que le stress associé au travail et le surmenage
Tel: (613) 544-3400, ext. 2592.
entraînaient une insatisfaction face à l’emploi, un faible engagement organisationnel,
E-mail: guptas@hdh.kari.net
de l’absentéisme et un roulement de personnel élevé. But. Le but de cette étude
était d’examiner les expériences de surmenage vécues par des ergothérapeutes
Margo L. Paterson, PhD, OT Reg.
exerçant en Ontario et de décrire les conséquences pour la pratique et les stratégies
(Ont.), is Professor, Queen’s University,
d’adaptation employées. Méthodologie. Les données de cette méthodologie
School of Rehabilitation Therapy,
mixte ont été recueillies à l’aide du Maslach Burnout Inventory-General Survey, du
Occupational Therapy Program, 31
Areas of Worklife Survey, de groupes de discussion et d’entrevues réalisées selon la
George Street, Kingston, ON, K7L 3N6,
tradition herméneutique. Résultats. 34,8 % des participants ont indiqué des degrés
and Director, Office of Interprofessional
élevés d’épuisement émotionnel, 43,5 % avaient des degrés élevés de cynisme et
Education and Practice. Tel: (613) 533-3370.
24,6 % avaient une faible efficacité professionnelle. Les problèmes liés à la pratique
E-mail: margo.paterson@queensu.ca
étaient les suivants : demandes excessives par rapport au temps disponible, conflits,
manque d’autonomie et de respect. Les stratégies d’adaptation étaient : passer du
Rosemary M. Lysaght, PhD, OT Reg.
temps avec la famille et maintenir un équilibre entre la vie professionnelle et la vie
(Ont.), is Associate Professor, Queen’s
personnelle, le contrôle des responsabilités au travail, conserver son sens de l’humour
University, School of Rehabilitation
et la conscience de soi/l’auto-surveillance. Conséquences. Cette étude permet
Therapy, Occupational Therapy
de mieux comprendre les défis de la pratique des ergothérapeutes, les facteurs qui
Program, 31 George Street,
contribuent au surmenage de l’ergothérapeute et les stratégies employées pour
Kingston, ON, K7L 3N6.
continuer d’exercer de manière compétente.
Tel: (613) 533-2134.
E-mail: lysaght@queensu.ca

Claudia M. von Zweck, PhD, OT Reg.

(Ont.), OT(C), is Executive Director, Citation: Gupta, S., Paterson, M. L., Lysaght, R. M., & von Zweck, C. M. (2012). Experi-
Canadian Association of Occupational ences of burnout and coping strategies utilized by occupational therapists. Canadian
Therapists, CTTC Building, Suite 3400, Journal of Occupational Therapy, 79, 86-95. doi: 10.2182/cjot.2012.79.2.4
1125 Colonel By Drive, Ottawa, ON,
Submitted: 26 April, 2011; Final acceptance: 23 October, 2011.
K1S 5R1. Tel: (613) 523-2268, ext. 224.
E-mail: cvonzweck@caot.ca No funding was received for this study.

86 Revue canadienne d’ergothérapie avril 2012 79(2)

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© CAOT PUBLICATIONS ACE
 Gupta et al.

B
urnout and job satisfaction in occupational therapy have convenience sampling. A recruitment letter was included in a
been the subject of a variety of international research monthly e-newsletter sent to OSOT members with a link to an
efforts, both quantitative and qualitative, over the past 30 online survey.
years. This body of work reveals that work-related stress leads to Once participants had completed the survey, they were
job dissatisfaction, low-organizational commitment, absentee- directed to a Queen’s University secure website to enter their
ism, and high turnover; it affects the interpersonal functioning names in a draw for a prize and to indicate their interest in
of teams and colleagues with increased conflict, substandard participating in a focus group or interview. All the individuals
patient care, attrition, problems at home, and physical and who answered in the affirmative were contacted.
mental health problems (Bailey, 1990a, 1990b; Balogun, Titi-
loye, Balogun, Oyeyemi, & Katz, 2002; Brown & Pranger, 1992; Data Collection
Davis & Bordieri, 1988; Laminman, 2007; Moore, Cruickshank, Quantitative data were collected through an online ques-
& Haas, 2006a, 2006b; Painter, Akroyd, Elliot, & Adams, 2003; tionnaire. The first section requested demographic informa-
Rees & Smith, 1991; Rogers & Dodson, 1988). tion such as their work setting, their level of education, and
To address burnout, occupational therapy studies recom- years of experience. Section 2 of the survey was comprised of
mend stress management interventions, including balancing the Maslach Burnout Inventory–General Survey (MBI-GS)
workload, focusing on client relationships, promoting role (Schaufeli, Leiter, Maslach, & Jackson, 1996), a widely used
definition, supervision and training (Bassett & Lloyd, 2001), burnout measure, and the Areas of Worklife Survey (AWS)
discussion with colleagues, sharing responsibilities with the (Leiter & Maslach, 2000). The researcher received clearance
interdisciplinary team, maintaining boundaries between from Psychometrics Canada to use the MBI-GS (a Class “B”
work and home, leisure activities (Brice, 2001), and changing assessment tool). The researcher also received permission
practice specialty (Bailey, 1990a, 1990b; Richardson & Rugg, from the Centre for Organizational Research and Develop-
2006a, 2006b). ment, Acadia University, to use these measures in exchange
Wilkins (2007) analyzed the data from the 2003 Canadian for providing anonymous data on both measures and demo-
Community Health Survey (CCHS), which surveyed nearly graphic information. Section 3 of the survey presented a list
one in three employed Canadians (approx 5.1 million). This of behaviours or cognitive strategies for prioritization by
study reported that 47% of occupational therapists found most the respondents on a scale from 1 (not at all important) to 7
days at work “quite” stressful to “extremely” stressful. Occu- (extremely important) regarding importance for functioning
pational therapists were ranked as the seventh most stressed effectively and maintaining a positive attitude towards work.
health care providers behind nurses, medical lab technicians, Qualitative data were gathered using hermeneutics
and specialist and family physicians. methodology through semi-structured interviews and focus
The purpose of this study was to expand existing knowl- groups. Focus groups and interviews (with those therapists
edge about the levels of stress that occupational therapists who could not make the focus group times due to other con-
practicing in Ontario experience in their day-to-day work straints) were conducted by teleconference due to geographic
lives and the coping strategies they utilize to prevent burnout. constraints and recorded and transcribed. The purpose of
This study sought to answer the following research questions: the interviews was to explore the lived experiences of par-
(1) What are the levels of burnout experienced by practicing ticipants relative to burnout and to build an understanding of
occupational therapists in Ontario? (2) What practice issues how Ontario therapists cope, successfully and unsuccessfully,
do occupational therapists face in their work lives? and (3) with contemporary practice demands. This information was
What coping strategies do occupational therapists utilize to intended to complement the findings of the survey by adding
maintain their practices? rich, thick descriptions.

Methods Measures and Administration for

This study utilized a mixed-methods approach, specifically, Quantitative Data Collection
a concurrent embedded strategy, in which the quantitative Maslach and Leiter (1997) recommend using the MBI-GS and
and qualitative data were collected simultaneously (Creswell AWS surveys together to assess the degree of match-mismatch
& Plano-Clark, 2007). Mixed methodologies have several between each person and his or her employer. The MBI-GS
strengths, such as the ability to generate and test theory, to measures the three core dimensions of a person’s experience
confirm findings, and to obtain greater breadth and depth on a with work: exhaustion–energy; cynicism–involvement; and
research topic (Johnson & Onwuegbuzie, 2004). Ethical clear- inefficacy–accomplishment. The MBI-GS is a 16-item ques-
ance for this study was received from the Queen’s University tionnaire that maintains a consistent factor structure across a
Health Sciences Research Ethics Board on August 16, 2009. variety of occupations (Bakker, Demerouti, & Schaufeli, 2002).
This test was normed on 5,259 respondents from Canada,
Participants Holland, and Finland. The scale items are rated on a 7-point
Participants in this study were occupational therapists who frequency scale. Individuals experiencing burnout score high
were members of the Ontario Society of Occupational Thera- on emotional exhaustion and cynicism and low on personal
pists (OSOT) and who had access to a computer to partici- accomplishment. Conversely, individuals with low scores on
pate in the online survey. Volunteers were recruited through emotional exhaustion and cynicism and high scores on per-

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Gupta et al.

sonal accomplishment experience many aspects of engage- ences at work regarding being able to or unable to cope with
ment with work. the demands) through grasping its parts (specific examples of
The AWS (Leiter & Maslach, 2000) contains 29 items that not being able to cope with demands gathered from the focus
produce six subscales on workload, control, reward, commu- groups and interviews), and “comprehending the meaning of
nity, fairness, and values. Agreement with statements such as the parts divining the whole” (Crotty, 1998, p. 92).
“I have enough time to do what’s important in my job” (work-
load) is measured on a 5-point Likert-type scale. The scale Integration of the Two Datasets
has a consistent factor structure and shows high correlations Creswell and Plano Clark (2007) recommend comparison of
with the three burnout dimensions measured by MBI-GS the data through a matrix or discussion for concurrent analy-
(Leiter & Maslach, 2004). This standardized assessment tool sis. In this study, the researcher chose to merge the quantitative
was normed on approximately 17,000 participants worldwide, and qualitative data in the form of a graphic to help paint an
including over 4,000 participants from Canada. This survey is enhanced picture of the practice issues faced by occupational
often used with MBI-GS to help organizations identify areas therapists practicing in Ontario and the coping strategies they
that need change to enhance engagement with work. The currently utilize to sustain practice.
AWS along with MBI-GS was chosen to measure the degree of
match or mismatch between the participants and their work in
addition to determining the levels of burnout. Findings
Demographics
Data Analysis The survey invitation was sent to approximately 2,587 occupa-
The quantitative data statistical analysis was carried out using tional therapists. Of the 76 respondents, 63 submitted a com-
SPSS 17.0. To determine whether parametric tests could be pleted survey. Survey respondent characteristics are shown in
used, kurtosis and skewness statistics were calculated to ensure Table 1. The average age of the respondents was 40.21 years and
that the data were normally distributed. The kurtosis statistic ranged from 26 to 67 years. The respondents had practiced for
varied from -1.453 to 1.488 except for being positively skewed an average of 14.72 years with a range of 6 months to 44 years.
for three of the coping strategies chosen overwhelmingly by Nineteen of the respondents (27.5%) worked part time (less
the sample as very important to maintaining their practice. than 35 hrs per week), 27 worked full time (39.1%) (between
The skewness statistic varied from -1.512 to .987 except for 35 and 40 hours per week), and 11 (15.9%) worked over 40
being positively skewed on one individual question about pro- hours per week. Four of the respondents (6.3%) held two jobs.
fessional efficacy chosen overwhelmingly by the sample in the Fifty-four (85.7%) respondents indicated that they were direct
measure for burnout. These numbers indicate that the data service providers, 4 (6.3%) were administrators, 3 (4.8%) were
were normally distributed, and the decision was made to carry consultants, and 2 (3.2%) were in other positions. The sam-
out parametric testing. Data analysis included analyses of vari- ple was compared proportionally to a Canadian Institute for
ance (ANOVA), stepwise regression analyses, and descriptive Health Information (CIHI, 2010) report describing registered
statistical analyses. occupational therapists in Canada and was representative of the
A hermeneutics-based approach was used for the quali- population of occupational therapists practicing in Ontario.
tative data analysis to gain understanding of the meanings Fifteen individuals gave permission for the researcher to
occupational therapists ascribe to stressful situations they contact them for focus group participation. Six of these individ-
encounter at work and how they cope with those situations.
Hermeneutics is situated in the interpretive paradigm and Table 1
seeks to study everyday experiences to further knowledge General Characteristics of Survey Respondents
through describing, illuminating, theorizing, or seeking mean-
ing (Higgs, 2001). A hermeneutics approach assumes that peo- N %
ple interpret and engage in processes to understand what is
important and real to them to create their own construction Gender
of reality (Koch, 1996). The researcher’s own experience as a Men 5 7.9
practicing occupational therapist also helped inform the study Women 58 92.1
as this represents a “past horizon” of the study. Marital status
Knowledge was constructed by repeated readings of the Single 10 15.9
text, which led to construction of meaning between the text Married/Permanent relationship 48 76.2
and the researcher (Koch, 1999). Gadamer (1975) outlined Separated/Divorced 5 7.9
the essential constructs in hermeneutics as metaphor, includ- Occupational therapy education
ing the hermeneutic circle, dialogue, and fusion of horizons. Diploma 3 4.8
The hermeneutic circle refers to a procedure in which the Bachelor’s degree 39 61.9
researcher reads and re-reads an entire manuscript to gain Master’s degree 21 33.3
understanding of the phenomenon as a whole (hermeneutic Workplace
circle) and its individual parts (Bontekoe, 1996). Utilizing the Community 35 56.5
hermeneutic circle, the researcher attempted to understand General hospital 19 30.6
the whole (the meaning participants ascribed to their experi- Long-term care 8 12.9

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 Gupta et al.

Table 2
Characteristics of Focus Group/Interview Participants

ID Age (Yrs) Highest level Years of practice Current practice setting Work status
of education Full time (FT)
Part time (PT)
Nonpracticing (NP)

1 31 BScOT 7.5 Adult outpatient rehab (Acquired FT

brain injury & cerebral palsy)
2 34 MSc (Rehab science) 8.0 Community (Adults 65+) FT
3 41 BScOT 19.0 Children’s rehab centre FT
4 40 MScOT 17.5 Private practice PT
5 67 BScOT 43.0 Private practice (Adults) NP
6 34 MScOT 4.5 Inpatient pediatric rehab & complex FT
continuing care (0–18 yrs)
7 53 BScOT 33.0 Private practice NP

uals declined participation, citing work and family reasons. Of groupings, with a slightly higher number of respondents scor-
the remaining nine individuals, two could not participate due ing in the high levels of burnout (see Table 4).
to scheduling and work conflicts. Three individuals participated A stepwise regression analysis was conducted to ascer-
in one focus group (ID 3–5) and two participated in a second tain which areas of worklife predicted emotional exhaustion in
focus group (ID 1 and 2). Two individuals participated in indi- this study. The results showed that workload is the only vari-
vidual interviews (ID 6 and 7). Participation in the study may able predictive of emotional exhaustion. Workload predicted
have been affected by an influenza (H1N1) outbreak in Ontario 29.9% of the variance in the exhaustion trait. All six AWS vari-
at that time. All the participants were female (see Table 2). ables together predicted 35.3% of the variance in emotional
exhaustion for the sample. Details of the analysis are presented
Quantitative Results in Table 5.
Because workload emerged as a predictor of emotional
Burnout. The overall results for the MBI-GS show that exhaustion in this study, it was examined in further detail. A
occupational therapists in this sample fell in the average range one-way ANOVA was conducted to determine the variance on
of burnout for emotional exhaustion and professional effi- the responses to individual questions on workload in the AWS
cacy dimensions (see Table 3). They scored in the high range for occupational therapists reporting low, average, or high lev-
of burnout in the cynicism dimension. Dividing the sample els of emotional exhaustion. The results revealed significant
into the three categories of burnout (low, average, and high) differences between groups on four of the workload questions,
revealed that the respondent scores spanned all three sub- as outlined in Table 6.
Table 3 Coping strategies. Descriptive statistics were computed
Overall Statistics of Subscale Scores on the Maslach Burnout to identify those strategies that participants rated as most
Inventory-General Survey important for functioning well at work. Table 7 presents the
mean ratings for each coping strategy on a scale ranging from
Normative Ranking of Item 1 (not at all important) to 7 (extremely important). Four of the
MBI-GS M SD Low Average High strategies were rated 6 or higher, which would indicate that the
subscales

Exhaustion 2.81 1.26 < 2.00 2.01 - 3.19 > 3.20 Table 5
Cynicism 2.23 1.40 < 1.00 1.01 - 2.19 > 2.20 Summary of Regression Analysis of AWS Predicting Burnout
Professional 4.39 0.90 > 5.00 4.01 - 4.99 < 4.00
efficacy Variable ba SE bb βc t R2 d ∆R2 e

Constant 6.47 0.79 - 8.16 - -

Workload -0.85* 0.20 -0.49 -4.23 .546 .299
Table 4 Control -0.11 0.22 -0.08 -0.51 .559 .313
Prevalence of Burnout in the Sample (n = 63) Rewards -0.07 0.23 -0.04 -0.29 .569 .324
Community -0.19 0.18 -0.14 -1.08 .579 .335
Level of burnout Fairness 0.30 0.26 0.19 1.15 .584 .341
Burnout traits Low n (%) Average n (%) High n (%)
Values -0.27 0.26 -0.17 -1.02 .595 .353
Emotional exhaustion 22 (31.9%) 17 (24.6%) 24 (34.8%) a
b = regression coefficient. bSE b = standard error in b. cβ = standardized value of regression
Cynicism 16 (23.2%) 17 (24.6%) 30 (43.5%) coefficient. dR2 = variance in correlation. eΔR2 = change in R.
Professional efficacy 17 (24.6%) 27 (39.1%) 19 (27.5%) *p < 0.01.

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Gupta et al.

Table 6
Summary of ANOVA for Differences in Scores on Workload for Occupational Therapists With Low, Average, or High Levels of
Exhaustion

Workload Sum of squares df Mean Square F

After work I come home too tired to do the Between groups 21.35 2 10.67 14.46*
things I like to do. Within groups 44.30 60 0.74
Total 65.65 62

I have so much work to do on my job that it Between groups 21.36 2 10.68 9.22*
takes me away from my personal interests. Within groups 69.53 60 1.16
Total 90.89 62

I have enough time to do what is important Between groups 8.31 2 4.15 4.0**
to me on my job. Within groups 62.30 60 1.04
Total 70.60 62

I leave my work behind when I go home at Between groups 9.90 2 4.94 3.55**
the end of the workday. Within groups 83.67 60 1.39
Total 93.56 62

*p < 0.01. **p < 0.05.

respondents viewed these as essential in maintaining a positive Table 8

attitude and helping to build a sustainable career. Coping Strategies: Quantitative Findings
One-way ANOVAs were conducted to determine if there
was a difference in the reported use of coping strategies based Rating
a
on levels of emotional exhaustion (see Table 8). The results Coping strategies M SD b
revealed that occupational therapists with a high degree of
emotional exhaustion reported significantly lower use of the Spend time with spouse/partner/family 6.63 0.60
coping strategies “maintain self-awareness, monitoring” (F[2, Maintain balance between professional and
personal lives 6.14 0.80
60] = 5.34, p = 0.007), “maintain sense of control over work
Maintain sense of control over work
responsibilities” (F[2, 60] = 3.95, p = 0.002), and “maintain
responsibilities 6.06 0.74
sense of humor” (F[2, 60] = 4.21, p = 0.020) than those with
Maintain sense of humor 6.00 0.88
low and average exhaustion. Similarly, one-way ANOVAs were Take regular vacations 5.73 1.38
conducted to determine the differences in use of coping strat- Have the autonomy to vary work responsibilities 5.63 1.07
egies with respect to level of cynicism. No significant differ- Feel like an equal member of the
ences between the individuals reporting low, average, and high multidisciplinary team 5.63 1.24
levels of cynicism were found. Examination of differences in Engage in physical activities 5.60 1.19
Spend time with friends 5.57 1.01
Table 7
Engage in hobbies 5.57 1.21
Common Themes and Sub-themes for Day-to-day Practice
Try to maintain therapeutic relationship with
Issues clients 5.56 1.01
Maintain professional identity/values 5.51 0.93
Demands on time
Maintain self-awareness/self-monitoring 5.48 1.01
1. Burgeoning workload
Discuss work frustrations/Seek support from
2. Unrealistic demands
colleagues 5.43 1.04
3. Juggling clinical and nonclinical duties
Remain active in professional development 5.22 1.07
Conflict Reflect on satisfying experiences of work 5.17 1.12
1. Mismatch in values with the organization Perceive client’s problems as interesting 5.10 1.12
2. Lack of health care resources Seek case consultation 5.02 1.04
Define my role on the team 4.76 1.13
Lack of respect Communicate with my managers 4.68 1.42
1. Need to provide constant justification Discuss work frustrations with spouse/
2. Lowered morale over bureaucratic delays partner/family 4.63 1.45
Maintain regular contact with referral networks 4.19 1.40
Lack of autonomy Turn to spiritual beliefs/activities 3.92 1.69
1. Unable to customize practice Change practice specialty 3.05 1.50
2. Policies and procedures of the workplace
3. Coordinating care a
M = mean. bSD = standard deviation.

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 Gupta et al.

Table 9
Summary of ANOVA for Differences in Use of Coping Strategies Between Occupational Therapists With Low, Average, and High
Levels of Exhaustion

Coping Strategy Sum of Squares df Mean Square F

Maintain self-awareness/monitoring Between groups 9.62 2 4.81 5.34*

Within groups 54.09 60 0.90
Total 63.71 62

Maintain sense of control over work responsibilities Between groups 3.93 2 1.96 3.95*
Within groups 29.82 60 0.50
Total 33.75 62

Maintain sense of humor Between groups 5.90 2 2.95 4.21**

Within groups 42.10 60 0.70
Total 48.00 62

Discuss work frustrations with spouse/partner/family Between groups 13.33 2 6.67 3.41**
Within groups 117.27 60 1.95
Total 130.60 62

*p < 0.01. **p < 0.05.

use of coping strategies with respect to levels of professional hadn’t seen, having to prescribe equipment or make recom-
efficacy revealed that individuals with high levels of profes- mendations with which they didn’t agree, as threats to their
sional efficacy reported more frequent use of “keeping in touch professional integrity. Participants spoke of feeling fatigued
with referral networks” (F [2, 60] = 6.045, p = .004). when providing care to chronic care patients for whom the
probabilities of making gains were limited. They also spoke of
Qualitative Findings lack of health care resources, which had led to long wait times
for services for their clients. One participant, who provides
Practice issues. Focus groups and interviews revealed services in the community, characterized it as supervisors’ or
commonalities and differences regarding factors that affect managers’ insufficient knowledge of the scope of occupational
day-to-day practice. Overall, four major themes emerged (see therapy practice:
Table 9 for a summary of the themes and subthemes). [It is] just a general lack of knowledge of occupational
Demands on time. Participants spoke of their burgeon- therapy generally by those that are managing people, not
ing workload as the main practice issue they struggle with on necessarily those in our profession or co-professionals,
a daily basis. They described challenges of carrying a waitlist, but those that come in with no professional background
working overtime, feeling the pressure to discharge, and feel- at all that are telling you that you should be doing this,
ing overwhelmed at times with the amount of work. Partici- this, this, and this; it just doesn’t seem viable at all.
pants mentioned several times balancing competing priorities Again, I guess there’s a conflict of values and that sort of
such as clinical and nonclinical duties, urgent versus chronic stuff, where they come in and they feel that you’ve done
care cases, as well as work-life balance. Citing major sources enough, they discharge the client even though you’re not
of stress, they spoke of unrealistic demands made of them by ready, the client’s not ready, this general lack of knowl-
managers, clients, or families of clients; pressure to discharge edge of what we do and why we do it. (ID 5)
clients into community programs; as well as requests to work
Lack of respect. Participants indicated the need to pro-
outside their scope of practice.
vide constant justification for their decisions or fees charged,
One participant spoke of feeling frustrated with the con-
and losing morale due to bureaucratic delays. A participant
stant time constraints that kept her from doing her job the way
spoke of not feeling respected as a member of the multidisci-
she would like to.
plinary team and having to justify the need to keep a case open
I really like the variety in my job that way, and so, at
because some of the occupational therapy interventions were
times, the[re] are certainly some of the things I celebrate
not complete.
in my job, but at other times they [the variety] certainly
Typical OT I guess; I am going to do what the clients want
provide the biggest challenges, trying to figure out what
me to do and if it’s something [that] is really important
would be most helpful in the limited amount of time that
to them, then I am going to really try and make it work.
I have to give. (ID 3)
I am not going to let their case be closed on short notice
Conflict. Participants spoke of a mismatch between their because the nurse doesn’t see, or the family doc hasn’t
professional values and the demands of employers. They iden- just tried the new medication, so, well, we’re just going to
tified scenarios, such as lack of adequate orientation when close the file. . . . I think it comes down to respect, hon-
providing coverage, being asked to sign off on clients they estly. I don’t think it would matter whether I was OT or

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Gupta et al.

Table 10 lot of competing priorities. . . . There is some really frus-

Common Themes and Sub-themes for Coping Strategies trating stuff, like purchasing. It can take us up to three
months to order a box of CDs that we need for our group.
Boundaries It can take multiple e-mails back and forth and reiter-
1. Maintain work-home boundary ating of orders and tracking down of misplaced orders
2. Negotiating workload /Other commitments that were sent back. I guess it’s a function of a big orga-
nization. They gain efficiency in that they only need one
Workplace /Home community
1. Supportive family/friends
purchasing department for six hospitals, but then they
2. Supportive colleagues lose efficiency in that it doesn’t actually work that well
and people spend a lot more time trying to just get it to
Monitoring self/Maintaining self-awareness go (ID 1).
1. Time management strategies
Coping strategies. Coping methods to help sustain par-
2. Goal setting
3. Pacing self ticipants in the workplace included setting boundaries and
4. Physical self-care balancing needs of home and work, utilizing time manage-
ment strategies to maximize productivity, seeking support
Focus on satisfying aspects of work from formal and informal social networks, setting goals and
1. Seeing clients improve priorities, physical self-care, and turning down tasks. Par-
2. Participating in program development ticipants focused on satisfying aspects of work, such as see-
ing clients improve, contributing to program development,
not; I think just some people just don’t respect an alter- mentoring others, and professional development activities as
native point of view. They are comfortable with the tried things that sustain them. A summary is presented in Table 10.
and true and the traditional, what’s worked for the past Some participants spoke of negotiating their workload as
20 years and how they have worked for the past 20 years, an important part of their coping strategy skills set.
and they don’t want to change. (ID 2) I think people really will give you as much as you can
Lack of autonomy. Participants spoke of a lack of auton- take. . . . I think it’s up to each of us to figure out what
omy in their ability to customize their practice, regardless of our limits are and then try to defend them a little bit
whether they practice in large amalgamated organizations, in and try to communicate that to other people and also
the community, or privately. Participants spoke of working in try to communicate it to ourselves, so that we’re not
large organizations where they experienced competing priori- feeling really guilty about how much we can’t do. Ulti-
ties and felt frustrated by some of the recent moves to amal- mately none of us is going to solve the problem. Most
gamate smaller hospitals into large health care centres. of our clients have chronic health conditions; they will
Relations within administration aren’t always easy, and always have their needs. . . . Taking on the task of making
especially in a big organization where I think there is a it all better is insurmountable and its only going to make

Figure 1: Model of balance between practice issues and coping strategies.

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 Gupta et al.

us unhappy, but if we can just bite off a little piece and of the variance in the efficacy trait, and all six AWS factors
do our best with that and then take on another realistic together predict 23.5% of the variance. The occupational ther-
time-limited goal and do our best with that, that is sus- apists in this study, who reported feeling highly effective at
tainable I think in a career. (ID 1) work, stated that their work is noticed and appreciated by oth-
ers. This is in keeping with the findings reported by Lasalvia et
Integrated Results al. (2009) and Laminman (2007).
The mixed methods analysis provided a greater depth of Qualitative findings of this study shed light on the prac-
understanding of practice issues related to burnout, worker tice issues that occupational therapists encounter in their day-
burnout, and engagement. The model in Figure 1 is a synthesis to-day practice. The issue of demands on one’s time, feeling
of findings in this study and depicts the workplace demands conflicted due to a mismatch between the person and the
placed on occupational therapists on the left side along with values of the organization, lack of health care resources, not
the coping strategies they utilize to sustain their practice on feeling respected, and lack of autonomy to customize practice
the right side. The model further depicts that when practice were themes that emerged. These are similar to the findings
issues become overwhelming for the individual, it might tip reported by Bailey (1990a, 1990b), Brown and Pranger (1992),
them into burnout. Davis and Bordieri (1988), Laminman (2007), and Moore et al.
(2006a, 2006b).
This study provides insights into coping strategies
Discussion that occupational therapists deem important in preventing
The MBI-GS is recognized as the leading burnout measure burnout and fostering resilience in the face of ongoing work
and generates information on three dimensions: emotional demands. Of the four most endorsed strategies, two were
exhaustion, cynicism and professional efficacy. The levels of externally focused and, therefore, more behavioural in nature
burnout found in this study were in keeping with the find- (i.e., “spend time with spouse/partner/family” and “maintain
ings reported by Brown and Pranger (1992) in their survey balance between professional and personal lives”), and the
of 89 psychiatric occupational therapy personnel working in other two were internally focused and therefore cognitive in
Ontario, although the higher reported levels of cynicism may nature (i.e., “maintain sense of control over work responsibili-
be reflective of increased stress in the health care system when ties” and “maintain sense of humor”).
compared to the 1990s. The results added a fifth coping strategy of “maintain
The levels of emotional exhaustion in this study were self-awareness/self-monitoring” through periodically “review-
slightly lower than those reported by Balogun et al. (2002), ing time management strategies,” “setting goals to accomplish
Painter et al. (2003), and Lloyd and King (2004). These dif- tasks,” “pacing self by taking breaks during the work day,”
ferences may be due to the work environments in the two and “enhance physical self care” through regular program of
countries (Canada and Australia) or perhaps due to unique- exercise, reducing caffeine, and engaging in relaxation pro-
ness of working in mental health environments. Mental health grams. These findings are in keeping with those reported by
personnel as a group have been studied more due to their ten- Brice (2001), Kramen-Kahn and Hansen (1998), Painter et al.
dency to report higher levels of burnout than the other groups (1998), Rupert and Kent (2007), and Stevanovic and Rupert
(Edwards & Burnard, 2003). The levels of burnout in this study (2004).
were lower than the levels of burnout reported by Gingras, de This study revealed that occupational therapists with
Jonge and Purdy (2010) and Martinusen, Borgen and Rich- a high degree of emotional exhaustion reported lower use
ardson (2011) in their surveys of dieticians in Ontario, Can- of the coping strategies “maintain self-awareness, monitor-
ada, and Norwegian physiotherapists, respectively. It should ing,” “maintain sense of control over work responsibilities,”
be noted that all of these studies used the Maslach Burnout “maintain sense of humor,” and “discuss work frustration with
Inventory-Human Services Survey (Maslach & Jackson, 1996) spouse/partner/family.” Individuals reporting high levels of
to measure burnout rather than MBI-GS. professional efficacy reported more frequent use of “keeping in
Another goal of this study was to determine which areas touch with referral networks” as compared to those reporting
of worklife contribute to burnout; this was done with the low levels of professional efficacy. These are unique findings of
administration of the AWS and data collection through focus this study not reported elsewhere in the published literature.
group and individual interviews. The quantitative findings Lasalvia et al. (2009) endorse the use of individually
were consistent with the reported direct relationship between oriented approaches, such as coping strategies to help profes-
unmanageable workload and exhaustion (Cho, Laschinger, & sionals alleviate their sense of exhaustion. They caution that
Wong, 2006; Lasalvia et al., 2009; Laschinger & Wong, 2006; individual strategies can be relatively ineffective in the work-
Leiter, Gascon, & Martinez-Jarreta, 2010; Leiter & Maslach, place as professionals have much less control over the stressors
2009; Timms, Graham, & Cottrell, 2007). It is interesting that than they do in the private domains of their lives. This study
none of the variables from the AWS made a statistically sig- endorses stress management interventions previously identi-
nificant contribution to predicting cynicism. It is possible that fied in the occupational therapy literature, such as balancing
other factors not measured by this study contributed to feel- workload (Bassett & Lloyd, 2001), discussion with colleagues,
ings of cynicism and need to be investigated further. sharing responsibilities of clients with members of the inter-
A direct relationship was found between rewards and disciplinary team, maintaining boundaries between work and
high levels of professional efficacy. Rewards predict 15.5% home, and engaging in leisure activities (Brice, 2001). Previous

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Gupta et al.

findings regarding the need for role definition for occupational burnout and engagement. The area of work engagement is an
therapy (Bassett & Lloyd, 2001; Davis & Bordieri, 1987; Moore emerging field (Leiter & Maslach, 2004), and it would be help-
et al., 2006a, 2006b) and changing practice specialty (Bailey, ful to learn about the factors that help occupational therapists
1990a, 1990b; Richardson & Rugg, 2006a, 2006b) were not feel energized, involved, and effective at work.
rated as highly by the study participants. These are interesting
findings and need to be investigated further.
Key Messages
• Burnout amongst occupational therapists is a com-
Limitations plex issue, central features of which are unmanage-
The present study had several limitations. One was the small able workload, lack of autonomy, lack of respect, and
number of participants. Participant views may, therefore, not conflict in the values of therapists and their employers.
present a full picture of the experience of burnout, day-to-day • Use of coping strategies, such as maintaining work-
practice issues, and coping strategies utilized by occupational home boundaries, staying in touch with colleagues
therapists in Ontario. Nonrespondents may have been over- and friends, maintaining self-awareness, and focusing
whelmed by work demands or too burnt out to respond to a on satisfying aspects of the job can help ameliorate job
general notice in an electronic newsletter. Nonrespondents stress.
may also include those who do not feel that they have burnout, • Clinicians, educators, administrators, and policy mak-
and therefore may not have identified with the subject matter. ers need to take note so that they can create health care
Recruitment of members of OSOT through individual e-mail environments that promote worker engagement and
invitations, mailed surveys, or both, may have yielded a higher resiliency.
return rate.
Second, a cause-and-effect conclusion cannot be drawn
from the findings reported in this study as this was a corre- Acknowledgements
lational study. In addition, it is likely that other contextual The authors would like to thank the occupational therapists
variables not considered in this study may significantly con- who took time out of their busy schedules to participate in this
tribute to burnout. There are regional variations in the deliv- study. This research was conducted in partial fulfillment of
ery of health care within Canada, and differences exist in work Sangeeta Gupta’s degree of Master of Science, at Queen’s Uni-
environments and demands placed on the practicing thera- versity, Kingston, Ontario.
pists. Therefore, it would be useful to replicate this study in
other provinces or on a national level. It might also be useful
to compare the burnout levels between occupational therapists
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