Burnout in Hospital-based Nursing and Medical Personnel and Trainees: A Mixed Methods Approach
Conditions: Stress, Burnout
Sponsor: University of Limerick

 
 
 
Burnout and Resilience in Hospital-based Nursing and Medical 
Personnel and Trainees (RESIST)  
 
EHSREC2024_06_02 
 
 
CONTENTS: 
 
Study Protocol 
 
Rationale 
 
Objective 
 
Methodology 
 
Qualitative component  
 
References  
Appendix A: Volunteer Information Sheet  
Appendix B: Research Privacy Notice  
Appendix C: Interview Schedule 
Appendix D: Recruitment Flyer 
Appendix E: Survey Instrument 
Broad Survey Design 
 
Survey  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
STUDY PROTOCOL 
 
Rationale 
Resilience of healthcare professionals in hospital settings is challenged. Healthcare professionals 
and those in training to become one are experiencing symptoms of burnout as never before. Within 
healthcare, job commitment is at stake leading to staff shortages which place further stress on the 
healthcare system, creating a vicious circle of healthcare personnel leaving the job and even more staff 
shortages [1, 2]. A severe negative impact on the healthcare system is on the horizon with a shortfall of 
15 million health care workers worldwide in 2030 [3]. Although healthcare professionals take pride in 
taking care of their patients, their own mental stretch and physical capacity is not unlimited; especially 
when much less attention is put towards the care of professionals themselves [4]. The Covid-19 
pandemic has exacerbated the problems of the healthcare workforce shortfall by impacting the 
emotional wellbeing of health and care professionals in the frontline. An estimated 60% now expresses 
symptoms of burnout, with 30-50% of nurses and 13-21% of physicians in the hospital contemplating to 
leave the workplace [2, 5]. This is especially problematic considering the current historically low influx of 
new healthcare professionals. “Our health systems are struggling to retain and attract the next generation 
of health workers”, according to Dr. Hans Kluge, WHO regional Director for Europe. It is important to act 
now, as compressed wellbeing in healthcare professionals impacts the health and care system overall. 
Although the pandemic is a factor of bias levelling up burnout percentages to unparalleled 
numbers, it has been much more a catalysing than a triggering factor. Pre-Covid literature showed that 
already 20-40% of physicians and nurses in hospitals experienced severe burnout symptoms [2]. People 
working in the surgical domain in various capacities are particularly at risk, although they seem to 
ignore/suppress alarming signals associated with burnout [2]. It is obvious that the pandemic has not 
only further overburdened the health and care workforce, but it also exposed the fragilities of the current 
health system in Europe [1]. As we recover from the pandemic, we need increased investments in 
multiple areas using the best science, tools and technologies available [6].  

 
 
The KEEPCARING project thus strives towards better resilience of our healthcare professionals 
and aspiring ones through structural and multidimensional organisational support of individuals and 
teams. Within KEEPCARING’s Work Package 2 (WP2), RESIST (Burnout and Resilience in Hospital-based 
Nursing and Medical Personnel and Trainees), an observational research component, builds an 
evidence-based framework of stress and resilience of healthcare professionals.  
 
Objective 
The primary objective of this study is to identify the risk and protective factors of resilience among 
healthcare professionals and how job demands, resources, support, and leadership styles affect 
resilience and burnout. The secondary objective is to identify individual and organizational level factors 
that are associated with resilience in Gen-Z among current healthcare workers, and how they relate to 
their health and well-being. This objective is implemented through the qualitative component of the 
study.  
 
Methodology 
This will be an observational cross-sectional design whereby psychosocial risk and protective 
factors associated with resilience and burnout in healthcare professionals will be assessed. Our intent 
here is to bring together different strengths in quantitative and qualitative approaches to develop a better 
understanding of burnout and resilience.  
Appropriate assessment of psychological phenomena of burnout, leadership styles, job demands 
and resources, including resilience for our survey instrument will be measured through well-validated 
psychometric indices. A literature search was performed and several relevant scales for each construct 
were identified, published articles using and employing the scale were also reviewed and those meeting 
criteria of validity, acceptability and brevity were presented to the wider WP2 group for consideration. WP 
members included multiple social scientists with expertise in psychometrics and theoretical application 
and measurement and relevant stakeholder groups who brought insight into practical applications of the 

 
 
survey to the hospital setting. Scales were deemed suitable if they met all of the above criteria, and in 
cases where multiple language versions and shorter item scales were available this also shaped 
selection.  
A key criterion of the non-social science stakeholder group as well as from our initial piloting was 
the survey had to be between 10-12 minutes in duration. This is also consistent with good survey design 
practice. Below are the key psychometric scales included in the RESIST survey. 
Resilience: This will be captured by the 8-item Short Resilience Survey (SRS) developed for measuring 
resilience in healthcare setting [7]. It has two subscales of decompression (e.g., “I can enjoy my personal 
time without focusing on work matters”) and activation (e.g. “I care for all patients/clients equally even 
when it is difficult.” An examples of Decompression items include “can enjoy my personal time without 
focusing on work matters” and Activation “I care for all patients/clients equally even when it is difficult.” 
These measures exist independent of employee engagement, indicating an empirical distinction between 
the two concepts.  Response categories on the items were Strongly Disagree, Disagree, Neutral, Agree, 
Strongly Agree, and Not Applicable (1 =Strongly Disagree, 5 = Strongly Agree), with total resilience score 
ranging from 8 to 40 with higher scores indicating higher resilience. 
 
Burnout: This will be captured by the shorter version of the Burnout Assessment Tool (BAT), a 12-item 
scale [8]. The scale’s deductive approach is based on the principle that the BAT should be in line with the 
theoretical description of burnout, as provided by Schaufeli and Taris [15]. They followed Edward 
Thorndike (1874-1949), a psychological fatigue researcher, who maintained that the basic principle of 
fatigue is “both the inability and the unwillingness to spend effort”, which is reflected by its energetic and 
motivational component of BAT, respectively. The 12-item BAT scale consists of items of four core 
symptoms of exhaustion, mental distance, emotional impairment and cognitive impairment [9]. The 
following scoring categories are used: 1 "never", 2 "rarely", 3 "sometimes", 4 "often", and 5 "always". This 
means that the value of the average scale scores varies from 1 to 5. By adding the scores on all BAT items 
and dividing the sum by 12, the total score is obtained, which also ranges between 1 and 5 [9]. 

 
 
Work-related Stress: The Health and Safety Executive Stress Indicator Tool (SIT) is a 35-item 
questionnaire to assess exposure to seven common psychosocial factors involved in the genesis of work-
related stress. The seven common psychosocial factors or the seven-factor model consists of demands, 
control, managerial and peer support, role clarity, relationships, and change processes [16]. Recent work 
conducted in the UK has provided evidence that the SIT may be reduced to a 25-item questionnaire (the 
SIT-25) showing the same seven-factor model and criterion-related validity of the SIT [17]. It includes five-
point Likert scales ranging from ‘Never’ to ‘Always’ and ‘Strongly agree’ to ‘Strongly disagree’. This the 25-
item SIT will be used to measure work-related stress among healthcare professionals in hospital settings.  
  
Leadership styles: According to some theoretical considerations and recent research, leaders with a 
toxic leadership style usually display deviant personality traits (psychopathic, Machiavelism, 
narcissistic), impacting on the mental health and wellbeing of the workforce [10]. However, there is a lack 
of research focused on the identification and characterization of toxic leadership styles in health care 
leaders, as well as its impact on the mental health of the workforce. Developing a compassionate 
motivation (i.e., sensitivity to the suffering of the self and others, allied with the wisdom, strength, and 
commitment to prevent and/or alleviate that suffering) is considered an accurate strategy and a 
fundamental therapeutic goal for the rehabilitation of individuals with several psychopathological 
symptoms/disorders (e.g., anxiety, stress, burnout, and deviant personality traits) and for the 
establishment of healthy relationships with friends, family, and coworkers [11.12]. It has been 
documented not only that leaders scoring high in dark triad traits [18] may have direct repercussions on 
employees' well-being [19], but also indirectly, through the adoption of a toxic, abusive, and demeaning 
leadership style [20, 21]. Thus, our interest in studying both variables: the dark triad and the toxic 
leadership described by Schmidt [13]. Thus, it is crucial to assess (toxic) leadership styles and toxic 
deviant traits in leaders within the KEEPCARING project using validated assessment tools, which is the 
case of the 15-item Toxic Leadership Scale [13] and the 12-item Dirty-Dozen scale [14], respectively.   
The Dirty Dozen (DD) [14] is a brief 12-item questionnaire that aims to measures the "Dark Triad". The 
Dark Triad [18] can be defined as a constellation of three overlapping, although distinct, constructs: 

 
 
Machiavellianism (i.e., a manipulative and cold interpersonal style), Psychopathy (i.e., a callous, 
unemphatic and impulsive style), and Narcissism (i.e., A grandiose and dominant style). The 12-item 
scale aims to reflex and assess these three constructs [14]. Items are scored using a 5-point Likert-type 
scale ranging from 1 (Totally Disagree) to 5 (Totally Agree). Higher total scores indicate higher levels of 
Dark Triad traits. The other-report version of the scale will be used in the present study to assess 
employees’ perception of their direct leader’s Dark Triad traits.  
The Toxic Leadership Scale (TLS) is a 15/30-item instrument that aims to measure the five toxic leadership 
dimensions: Abusive Supervision (i.e., the demonstration of hostile verbal and nonverbal behaviours), 
Authoritarian Leadership (i.e., an absolute control over his/her subordinates and all decision making), 
Narcissism (i.e., a grandiose and self-centred style”), Self-promotion (i.e., a presentation of the self as a 
smart and capable person), and Unpredictability [13]. The 15/30 item scale, TLS, aims to measure these 
five dimensions on a 6-point Likert-type scale ranging from 1 (Strongly Disagree) to 6 (Strongly Agree). 
Higher total scores indicate higher levels of toxic leadership style. The TLS will be used in the present 
study to assess employees’ perception of their direct leader’s toxic leadership traits. 
 
Qualitative Component 
In the qualitative online interview study, the experiences of aspiring health care professionals (Gen Z) and 
current healthcare professionals in relation to resilience in the healthcare setting will be captured 
through semi-structured interviews. The interviews will be conducted focusing on participants' 
understanding of resilience, current experiences of coping under pressure, needs to be able to bounce 
back from workplace adversity and/or for better group resilience. Resourced data generated will provide 
contextual information on resilience in the healthcare professionals and how best to develop it in these 
settings. Interview transcripts will be transferred and analysed using inductive reflexive thematic 
analysis. The interview schedule for the semi-structured interviews is on the appendix below (Appendix 
C). 
 
 

 
 
References 
1. Hodkinson, A., et al., Associations of physician burnout with career engagement and quality of patient care: 
systematic review and meta-analysis. bmj, 2022. 378. 
2. Maunder, R., et al., Burnout in hospital-based healthcare workers during COVID-19. Science Briefs of the 
Ontario COVID-19 Science Advisory Table, 2021. 2(46): p. 1-24. 
3. Organization, W.H. Global Strategy on Human Resources for Health: Workforce 2030: Reporting at 
Seventy-fifth World Health Assembly. 2022; Available from: https://www.who.int/news/item/02-06-2022-
globalstrategy-on-human-resources-for-health--workforce-2030. 
4. van Leeuwen, E.H., et al., Burn‐out and employability rates are impacted by the level of job autonomy and 
workload among Dutch gastroenterologists. United European Gastroenterology Journal, 2022. 10(3): p. 296- 
307. 
5. Van Roekel,H., et al., Healthcare workers who work with COVID-19 patients are more physically exhausted 
and have more sleep problems. Frontiers in psychology, 2021.11: p. 625626. Kluge, H.H.P. Statement – 
Supporting and investing in our health workers is a win for all of us. 2023 [cited 2023 11-04-2023]; Available 
from: https://www.who.int/europe/news/item/22-03-2023-statement---supporting-and-investing-in-our-
healthworkers-is-a-win-for-all-of-us. 
6. Kluge, H.H.P. Statement – Supporting and investing in our health workers is a win for all of us. 2023 [cited 
2023 11-04-2023]; Available from: https://www.who.int/europe/news/item/22-03-2023-statement---supporting-
and-investing-in-our-healthworkers-is-a-win-for-all-of-us. 
7. Morgan, K. H., Libby, N. E., Weaver, A. K., & Cai, C. (2019). Development of an early warning resilience 
survey for healthcare organizations. Heliyon, 5(10). 
8. Redelinghuys, K., & Morgan, B. (2023). Psychometric properties of the Burnout Assessment Tool across 
four countries. BMC Public Health, 23(1), 824. 
9. Schaufeli, W., & De Witte, H. (2023). Burnout Assessment Tool (BAT) A fresh look at burnout. 
In International Handbook of Behavioral Health Assessment (pp. 1-24). Cham: Springer International 
Publishing. 
10. LeBreton, J. M., Shiverdecker, L. K., & Grimaldi, E. M. (2018). The dark triad and workplace 
behavior. Annual Review of Organizational Psychology and Organizational Behavior, 5(1), 387-414. 
11. Gilbert, P., & Simos, G. (Eds.). (2022). Compassion focused therapy: Clinical practice and applications. 
Routledge. 
12. Ribeiro da Silva, D., Rijo, D., Brazão, N., Paulo, M., Miguel, R., Castilho, P., ... & Salekin, R. T. (2021). 

 
 
The efficacy of the PSYCHOPATHY. COMP program in reducing psychopathic traits: A controlled trial with 
male detained youth. Journal of Consulting and Clinical Psychology, 89(6), 499. 
13. Schmidt, A. A. (2008). Development and validation of the toxic leadership scale. University of Maryland, 
College Park. 
14. Jonason, P. K., & Webster, G. D. (2010). The dirty dozen: a concise measure of the dark 
triad. Psychological assessment, 22(2), 420. 
15. Schaufeli, W. B., & Taris, T. W. (2005). The conceptualization and measurement of burnout: Common 
ground and worlds apart. Work & stress, 19(3), 256-262. 
16. Brookes, K., Limbert, C., Deacy, C., O’reilly, A., Scott, S., & Thirlaway, K. (2013). Systematic review: 
work-related stress and the HSE management standards. Occupational medicine, 63(7), 463-472. 
17. Balducci, C., Romeo, L., Brondino, M., Lazzarini, G., Benedetti, F., Toderi, S., ... & Pasini, M. (2015). The 
validity of the short UK health and safety executive stress indicator tool for the assessment of the 
psychosocial work environment in Italy. European Journal of Psychological Assessment. 
18. Paulhus, D. L., & Williams, K. M. (2002). The dark triad of personality: Narcissism, Machiavellianism, and 
psychopathy. Journal of research in personality, 36(6), 556-563.  
19. Tokarev, A., Phillips, A. R., Hughes, D. J., & Irwing, P. (2017). Leader dark traits, workplace bullying, and 
employee depression: Exploring mediation and the role of the dark core. Journal of abnormal psychology, 
126(7), 911.  
20. Mathieu, C., & Babiak, P. (2016). Corporate psychopathy and abusive supervision: Their influence on 
employees' job satisfaction and turnover intentions. Personality and Individual Differences, 91, 102-106.  
21. Fritzon, K., Brooks, N., & Croom, S. (2019). Corporate psychopathy: Investigating destructive 
personalities in the workplace. Springer Nature. 
 
 
 
 
 
 
 

 
 
Appendix A: Volunteer Information Sheet 
 
  
 
   EHSREC No: 2024_06_02 
 
DETAILED VOLUNTEER INFORMATION SHEET 
 
Dear Volunteer,  
We are carrying out a study on the experiences of hospital-based doctors and nurses across the EU. This 
information sheet will tell you what the study is about.  
What is the study about? 
As part of an EU funded KEEPCARING project (101137244) the study aims to find out what are the current 
risks and levels of burnout among hospital-based doctors and nurses in the EU and how do factors like 
work setting, leadership and resilience influence it, and what the health services can do about it.   
KEEPCARING Project 
This survey is part of a larger research project, KEEPCARING, funded by the EU (grant no. 101137244). 
The KEEPCARING project aims to address the stress and burnout among healthcare professionals in the 
European Union. Healthcare professionals, especially those working in hospital settings, face 
extraordinary levels of stress and pressure. The COVID-19 pandemic further intensified these stressors, 
revealing systemic vulnerabilities in healthcare systems across Europe. While some interventions to 
improve wellbeing and resilience exist, there is still a significant gap in understanding what combination 
of solutions works best, especially in high-stress, surgical environments.  
The KEEPCARING project was initiated with the goal of fundamentally improving the well-being of 
healthcare professionals across the European Union. The project seeks to co-create a comprehensive 
solution package specifically designed to reduce stress and enhance resilience in healthcare workers at 
every level—individuals, teams, and organizations. This study is the first stage of the project, which 
includes finding the levels of burnout, what factors hinder and support it, such as work environment, 
leadership, and resilience. Further details about KEEPCARING can be found here. 
What are the benefits of participating in the survey? 
We hope that you will benefit as a participant by having a space to share your knowledge and 
experience and have your voice heard. 
However, in particular, the findings of the study will help raise awareness of the levels of burnout among 
hospital-based doctors and nurses working at the coalface. A snapshot of the findings will be made 
available to your relevant associations/organisations so they can also raise awareness of these burnout 
levels. 
Other potential benefits include. 

 
 
● Contributing to development of best management and intervention practices to manage burnout 
in hospital nursing and medical staff. 
● New empirical research that will drive innovation on addressing burnout in hospital-based 
doctors and nurses.  
What are the risks? 
You might decide that you do not want to answer a question. If this happens, you do not have to answer 
any question you do not wish to. If you get upset and need support, we will be happy to signpost you to 
support services. 
As with all research surveys/interactions, there are data protection and privacy risks. The survey is 
administered through a University of Limerick approved Qualtrics account. Please note, your IP address 
may be collected once you complete the survey, but this will be deleted when we transfer the data from 
Qualtrics for analysis. The University has invested in commercial Microsoft accounts which have the 
highest level of security, and if you ticked the box for the interview part this will also be done on MS 
Teams and is also secure. All the Universities’ policies and procedures for IT security and data 
protection will be followed. 
 
What if I do not want to take part? 
Participation in this study is completely voluntary and you can choose whether or not to take part. You 
can stop your involvement in the survey at any time simply by exiting the survey. 
 
What happens to the information? 
Please note, that while we do not collect direct identifiers about you, if you provide your email address 
we will be able to link your answers with your email address. Be assured however, that all the 
information that is collected will be kept private including your email address and stored securely and 
safely on the researchers’ University of Limerick's One Drive. All our devices are encrypted, and also 
protected with a password, anti-virus software and VPN.  
For future studies using non-invasive biomarkers such as heart rate variability and breathing rate, we 
aim to link your survey responses to this data, and your email address will be deleted after research 
partner responsible for this part of the project, Universidade NOVA de Lisbia, contacts you. In case of 
the interview study, your email address will be deleted after we contact you in relation to that study.  
All email addresses will be deleted after 36 months. The data that is gathered in the study will be kept 
for seven years. After this time, it will be destroyed. We have also included a link to our Research Privacy 
Notice which has more information as to what happens to your information. 
 
Who else is taking part? 
Doctors and nurses, as well as trainee doctors and nurses aged 18 or over from several EU countries 
including Ireland, Germany, Denmark and the Netherlands. 
 
What if something goes wrong? 
It is unlikely that something will go wrong during the survey. Possible scenarios: poor connection or loss 
of internet connection. 
 
What happens at the end of the study? 
At the end of the study the information will be used to present results, including in academic forums 

 
 
such as journal articles and conferences. The researcher has agreed a plan to communicate the results 
to any of the support organisations that sent out the study information including providing a copy to any 
pre-print article. A copy of the written research paper will be freely available through the UL repository, 
and the link to this will be published on social media including your support organisations. 
 
Anonymised data from data collection will be made available to used by in academic papers, 
conference presentations and posters, and other academic forums. This may also be used in other 
communications to share the results such as blog posts, newsletter articles. No names or any 
participant identifiers, or third parties names will appear in any of the results or communication 
materials. 
 
As mentioned above, this study is part of a wider EU-funded project KEEPCARING (see partners below) 
on burnout in healthcare workers in EU countries, therefore, after being anonymised, the data collected 
will be shared with the other data controllers - partners of the project (Universidade NOVA de Lisboa, 
Portugal,  University of Coimbra, Portugal, Copenhagen University Hospital, Rigshospitalet, Denmark, 
and Universitätsklinikum Hamburg-Eppendorf, Germany. 
We are also subject to the policies and procedures of University of Limerick (UL) and the EU 
Commission. As an institution, UL and EU commission are committed to Open Science. This means 
that anonymised data sets (such as anonymous survey data sets) may be made available to other 
researchers following a strict set of guidance criteria.  
 
What if I have more questions or do not understand something? 
If you have any questions about the study, you may contact stephen.gallagher@ul.ie. 
It is important that you feel that all your questions have been answered at any stage during the research 
process. 
 
How do I take part? 
You can take part by following the link to the survey here or using the QR code to access it.  
Contact information of Project Investigators: 
Principal Investigator 
Prof. Stephen Gallagher, Dept of Psychology. University of Limerick, Tel (061) 234899   
Email: Stephen.Gallagher@ul.ie 
 
Co-Investigator 
Dr. Trina Tamrakar, Department of Psychology. University of Limerick, 
Email: Trina.Tamrakar@ul.ie 
Thank you for taking the time to read this. We would be grateful if you would consider participating in 
this study. 
 
This research study has received Ethics approval from the Education and Health Sciences 
Research Ethics Committee [2024_06_02]. 
If you have any concerns about this study and wish to contact someone independent, you may 
contact: 
Chair Education and Health Sciences Research Ethics Committee 
EHS Faculty Office 
University of Limerick, Tel (061) 234101 

 
 
 
Appendix B: Research Privacy Notice 
 
RESEARCH PRIVACY NOTICE 
 
Introduction 
This Research Privacy Notice governs the use and storage of your personal data by the University of Limerick (the 
“University”). The processing of this data is carried out in accordance with the General Data Protection Regulation (GDPR) 
/ Data Protection Acts 1988-2018 (“Data Protection Law”) and in accordance with this Research Privacy Notice. 
Any personal data which you provide to the University as part of this research project will be treated with the highest 
standards of security and confidentiality, in accordance with Irish and European Data Protection Law. This Notice sets out 
details of the information that we collect, how we process it and who we share it with. It also explains your rights under 
data protection law in relation to our processing of your data. 
1. 
     Title and Purpose of the research project                    . 
1. 
Title     : Burnout in hospital-based healthcare nursing and medical personnel  
 
This research project is part of a larger research project, KEEPCARING, funded by the EU (grant no. 101137244, 
“the Project”). The KEEPCARING project aims to address the stress and burnout among healthcare professionals 
in the European Union. You can find the project’s partner here. 
Over the last several years burnout, i.e., emotional, physical and mental exhaustion has increased in healthcare 
workers globally including Ireland. This was made worse by COVID-19 pandemic where healthcare workers faced 
the brunt of the fallout of this while working at the coalface. This increase in burnout has resulted in poor mental 
and physical health, higher levels of fatigue, lower job satisfaction, as well as having a negative impact job 
recruitment and retention making a chronic situation even worse. This study aims to examine, via a survey, levels 
of burnout among hospital-based nursing and medical personal in several EU countries (starting with Ireland, 
Denmark, Germany and Netherlands) and to explore the determinants of this from an individual, social, 
management and systems level.  
A sub-aim will be to give an option (tick box yes or no answer) to healthcare workers if they wanted to take part 
in future studies on burnout (e.g. have a one-to-one interview with us to elaborate on these experiences or if 
they wanted to or to wear a vest that monitors heart rates similar to a fit bit, i.e. non-invasively and unobtrusively 
without impacting your day-to-day work lives.) 
The aim of this project is to understand levels of burnout in healthcare workers in the EU, and the factors that 
may be important in increasing or mitigating its risk. At the end of the research process, recommendations for 
good practice will be developed to raise better awareness of burnout in nursing and medical personnel and shape 
better work practices to alleviate the negative effects of burnout.  
 
2.  
Research Ethics Committee 
2.1 
Ethical approval was granted by EHS Research Committee on [date to be added]. The research ethics approval 
number is [to be added]. 
3. 
Identity of the Data Controller(s) 
3.1 
The Data Controller 
● University of Limerick, Plassey, Limerick. 
4. 
Identity and Contact Details of the Data Protection Officer of the Data Controller(s)/ 
4.1 
You can contact the University of Limerick’s Data Protection Officer at dataprotection@ul.ie or by writing to Data 
Protection Officer, Room A1-073, University of Limerick, Limerick.   
5.  
The Identity of the Principal Investigator  
5.1 
The Principal Investigator for this Research Project is Stephen Gallagher, Associate Professor in Psychology at the 
University of Limerick.  
6. 
How we will use your personal data 
6.1 
The University must process personal data in order to undertake research relating to this project. 

 
 
 
For this study, we are running an online survey and an interview study about burnout in healthcare workers 
groups. The research is using personal data to understand what the determinants and experiences of burnout 
in hospital-based nursing and medical personnel are. The survey is the main part of the study and it is 
completed without collecting directly identifiable information. We just use your IP address while you are 
completing the survey but we will not save this IP address, therefore once you have completed the survey we 
cannot identify you anymore. If you provide an email address because you choose to be contacted for the 
interview, we will be able to link your survey with your email address. 
In addition, if you wish, you can also participate in future studies using non-invasive biomarkers such as heart 
rate, heart rate variability and breathing rate. In this case you will receive further information before starting 
the investigation. 
 
 
6.2 
Personal data collected and used for this survey is, for example: gender, age, work role and speciality, and 
ethnicity (aggregated for statistical information); some health-related personal data such as level of stress in 
the workplace.  
 
7. 
Lawful Basis for University Processing Personal Data  
7.1 
Data Protection Law requires that the University must have a valid legal reason to process and use your personal 
data. This is often called a ‘lawful basis’. GDPR requires us to be explicit with you about the lawful basis upon 
which we rely in order to process information about you. 
7.2 
The University is carrying out this research in the public interest and for scientific, historical or statistical 
purposes. In doing so, we are relying on Article 6(1)(e) of the GDPR. Where we are processing special category 
or sensitive personal data, we are relying on Article 9(2)(j) of GDPR. As required under Data Protection Law, we 
have appropriate safeguards in place in order to protect your personal data; these are set out in the next section.  
8. 
Protecting Your Personal Data 
8.1 
We have the following measures in place to help ensure we keep your personal data safe: 
- 
All researchers at the University must adhere to University policies and procedures that tell our staff and 
students how to collect and use your information safely;  
- 
Training is made available to all researchers to ensure our staff and students understand the importance of 
data protection and how to protect your personal data;  
- 
The University has security arrangements and technical measures in place that ensure your information is 
stored safely and securely; 
- 
All research projects involving personal data are reviewed and approved by a research ethics committee in 
line with University policies and procedures;  
- 
Where a research project may involve a high risk, we first carry out a data protection  impact assessment to 
assess risks and ensure adequate safeguards are in place; 
Further, our research partners at the Universidade NOVA de Lisboa, Portugal, University of Coimbra, Portugal, 
Copenhagen University Hospital, Rigshospitalet, Denmark, and Universitätsklinikum Hamburg-Eppendorf, 
Germany are joint data controllers abiding by these same regulations.  
 
9. 
Sharing Your Personal Data with Third Parties 
9.1 
The University and KeepCaring Partners will not disclose your personal identifying information to third parties. 
We will share anonymous data with the partners of the Project for achieving the purposes of this Project. We may share 
anonymous and aggregated data with third parties for scientific research purposes.  
10.  
Transfer of personal data to Other Countries Outside the EEA 
We store the data in the EU. However, we rely on our suppliers Microsoft and Qualtrics which can have access 
to the data form outside the EU for the provision of some services. In this case, the transfer occurs in accordance 
with the safeguards set out in Chapter V of the GDPR (adequacy decision or, in the absence, on the basis of the 
Standard Contractual Clauses adopted by the EU Commission). If you wish to know more about these transfers 
please contact our DPO at Personal Data collected, dataprotection@ul.ie 
11. 
How Long Will We Keep Your Data  

 
 
11.1      Email addresses are stored for 36 months starting from the end of the survey. All research data will be kept for 
7 years from the end of the survey. 
12. 
Your Rights 
12.1  
You have the right to request that we: 
● provide you with information as to whether we process your data and details relating to our processing, and 
with a copy of your personal data; 
● rectify any inaccurate data we might have about your without undue delay; 
● complete any incomplete information about you; 
● under certain circumstances, erase your Personal Data without undue delay; 
● under certain circumstances, be restricted from processing your data; 
● Furnish you with the Personal Data which you provided us within a structured, commonly used and machine-
readable format when the processing is based on the consent or on the contract. 
 
You also have the right to object to the processing of your personal data.      
12.2 
Requests for any of the above should be addressed by email to the Principal Investigator at 
Stephen.gallagher@ul.ie and the Data Protection Officer at dataprotection@ul.ie. Your request will be processed 
within 30 days of receipt. Please note, however, it may not be possible to facilitate all requests, for example, 
where the University is required by law to collect and process certain personal data including that personal 
information that is required of any research participant. 
12.3 
It is your responsibility to let the Principal Investigator know if your contact details change. 
13.  
Queries, Contacts, Right of Complaint 
13.1 
Further information on Data Protection at the University of Limerick may be viewed at www.ul.ie/dataprotection. 
You can contact the Data Protection Officer at dataprotection@ul.ie or by writing to Data Protection Officer, 
Room A1-073, University of Limerick, Limerick. 
13.2 
You have a right to lodge a complaint with the Office of the Data Protection Commissioner (Supervisory 
Authority). While we recommend that you raise any concerns or queries with us first at the following email 
address stephen.gallagher@ul.ie, you may contact that Office at info@dataprotection.ie or by writing to the Data 
Protection Commission, 21 Fitzwilliam Square South, Dublin 2, D02 RD28. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
Appendix C: Interview Schedule 
 
SEMI-STRUCTURED INTERVIEW SCHEDULE  
(Add-on to the Quantitative Study) 
Thank you for agreeing to participate on this one-on-one interview. We are grateful that you have volunteered in the survey to 
come and talk to us a bit more about your experience and views of burnout in the workplace. During this conversation I will 
ask specific questions to guide our discussion.  
 
This conversation will be recorded so that we have an accurate record of your thoughts. As outlined in the information sheet, 
the recording and your transcript will be kept completely confidential. Only the research team will have access to the 
recording and transcript, and it will be anonymised. The recording will be destroyed as soon as the transcript is verified and 
analysed by the research team. I’m going to start recording now. 
 
This conversation is voluntary. Speak as openly as you feel comfortable. You may also skip any questions you wish during our 
conversation. There are no right or wrong answers, we just want to gather your views and experiences. 
 
Logistics 
• 
The conversation will last about a half hour. 
• 
If you lose your connection, you can log back in using the link you already joined with.  
• 
If possible, please put your mobile phone on silent mode and ensure you are in a quiet place to participate. 
 
Before we begin, do you have any questions? 
Are you ready to begin? 
 
Questions 
 
1. In your opinion, what does it mean for a healthcare worker to be experiencing ‘burnout’?  
a. How would you describe it? 
 
2. Have you experienced burnout in the workplace? 
a. If yes, what was that like for you? 
b. If no, can you tell me what you think has prevented burnout/ what supports you in the workplace? 
 
3. Is there anything in particular in your work environment that causes stress/burnout? 
a. Are there aspects of your role or your supervisor’s role that contribute to it? 
  
4. Do you feel supported by your manager/supervisor/the organisation in managing burnout and stress in the 
workplace?  
a.  Why? Or why not? 
 
5. What do you think is needed to address/prevent burnout among healthcare staff? 
a. In an ideal world, what would you like to see done? 
 
6. Do you see yourself working in your current role over the next year/ longer term? 
a. Why?  
 
7. Is there anything else that you think is relevant for us to know about stress and burnout in your workplace? 
 
Thank you for taking part in this research study. 
If possible, can you share the survey with your colleagues? 
Provide assurances about confidentiality. 
 
 

 
 
 
Appendix D: Social Media/Email Recruitment Flyer 
 
 
 
 
 
 
 
 
 

 
 
Appendix E: Survey Instrument  
 
Broad Survey Design 
 
 
 
 
 
 
 
 
 
 
 
 
Tick box - 
option of 
participating 
in further 
studies  
Burnout 
measure  
End 
Jobs 
stressors  
Leadership 
styles  
Information & 
Consent 
Demographics 
& Work 
characteristics  
Resilience  

 
 
 
 
EHSREC No: 2024_06_02 
 
  
 
VOLUNTEER INFORMATION SHEET 
Burnout in hospital-based doctors and nurses 
 
As part of an EU funded KEEPCARING project (101137244) this study aims to find out what the 
current risks and levels of burnout are among hospital-based doctors and nurses in the EU, and 
what the health services can do about it. 
 
Why should I participate? 
Your input will help us find if and how factors like work setting, leadership and resilience strategies 
influence burnout. Participation in this study is completely voluntary and anonymous. By 
completing the survey, you indicate your consent to use your responses for the stated research 
purposes. You can stop your involvement at any time simply by exiting the online survey. The 
survey will take approximately 12 minutes. 
 
At the end of the survey, you will be given the option to be invited for future studies if you are 
working in (or training for) one of the surgical specialties. More information about this will be 
provided at the end of the survey and at this link here. This is optional, and for us to reach you, we 
will ask for your email address. Your email will be used by us only to invite you to take part in the 
studies you have indicated interest in, and then it will be deleted. Your responses will be coded to 
protect your anonymity. Under no circumstances will your responses be shared to your employer. 
 
What happens to the information? 
Detailed information on the project and how your anonymised data will be used is available here. 
Our Research Privacy Notice has further details on what happens to your information. 
If you have any questions on the study, please contact us: 
Principal Investigator 
Prof. Stephen Gallagher, Dept of Psychology. University of Limerick, Tel (061) 234899 
Email: Stephen.Gallagher@ul.ie 

 
 
Co-Investigators 
Dr. Trina Tamrakar, Department of Psychology, University of Limerick, 
Email: Trina.Tamrakar@ul.ie 
Thank you for taking the time to read this. We would be grateful if you’d consider participating in 
this study. 
 
This research study has received Ethics approval from the Education and Health Sciences 
Research Ethics Committee [2024_06_02]. If you have any concerns about this study and wish to 
contact someone independent: 
Chair Education and Health Sciences Research Ethics Committee 
EHS Faculty Office 
University of Limerick 
Tel (061) 234101 
 
To continue, please confirm that you are over 18 years of age 
 Yes, I am over 18 
 
 
Do you consent to take part in this survey? 
 Yes 
 No 
 
 
Confidentiality Notice 
 
Please note that while all the information collected on this form is 
completely anonymous, should you provide your email address for us to 
invite you for future studies (optional), we will have this information. Your 
email address will ONLY be used for this purpose and then deleted. 
 
Although all information provided by you will be coded to anonymise, 
please be careful not to include any personally identifiable information 
about yourself or any other person when responding to the questions. You 
can save or leave the online survey at any time. Your responses will be 
saved for up to 7 days for you to resume, unless you delete the cookies on 

 
 
your browser. If you do not continue within the 7 days, your data will 
automatically be deleted. 
Section 1: Demographics 
Demographic Details 
These questions help us understand more about personal circumstances 
when investigating stress and resilience. 
What is your age? (Please put numbers only, for e.g. 36) 
 
 
What gender do you identify as? 
 Female 
 Male 
I use another term, please specify: 
 Prefer not to say 
 
 
What is your relationship status? 
 Single, living alone 
 Single, living with others 
 Cohabiting with a partner 
 Married or in a registered civil partnership 
 Widowed 
 Separated 
 Prefer not to say 
 
 
How would you best describe your cultural and ethnic background? 
(Categories extracted from a research publication on 'Ethnic and cultural diversity in Europe: validating measures of ethnic and cultural 
background.' DOI: 1369183X.2018.1550150) 
 European 

 
 
 Sub-Saharan African 
 North African/Middle Eastern/Central Asian 
 South and South-East Asian 
 East Asian 
 Latin American 
 Caribbean 
 North American and Australasian 
Mixed ethnicity, please specify: 
Other, please specify: 
Prefer not to say 
 
 
Do you have children you are a primary caregiver for? 
 Yes 
 No 
 
 
If yes, how many children do you currently care for at home? 
(Please answer only in numbers, eg. 3) 
 
 
What country do you work in? 
 
 
What is your current profession? 
 Medical, qualified 
 Medical, in training (student) 
 Nursing, qualified 
 Nursing, in training (student) 
Other medical professional, please specify: 

 
 
Do you work in one of the surgical pathways in the hospital? (Surgical 
pathways include not only surgical disciplines but also associated 
specialties like anaesthesiology, gynaecology, ENT, ophthalmology etc.) 
 Yes 
 No 
 
 
As a doctor, what is your current clinical role? 
 Non-consultant Doctor (Intern / Senior House Officer / Registrar / Specialist 
Registrar) 
 Consultant / Senior Consultant / Fellow 
 Clinical Director / Chief Consultant 
 Chief of Staff 
 Other 
 Prefer not to say 
 
 
As a doctor, do you have a current academic/teaching role? Please choose 
the one most applicable: 
 Teacher (to students, nurses, doctors) 
 Researcher (actively researching yourself) 
 Assistant Professor 
 Associate Professor 
 Full Professor 
 Prefer not to say 
 Not applicable 
 
 
As a nurse, what is your current clinical role? 
 Registered Nurse 
 Specialized Nurse 
 Nurse Practitioner 
 Clinical Nurse Specialist 

 
 
 Nurse Manager/ Head Nurse / Chief Nurse 
 Other 
Prefer not to say 
 
 
As a nurse, do you have a current academic/teaching role? Please choose 
the one most applicable: 
 Teacher (to students, nurses, doctors) 
 Researcher (actively researching yourself) 
 Assistant Professor 
 Associate Professor 
 Full Nursing Professor 
 Prefer not to say 
 Not applicable 
 
 
As a doctor, what is your main specialty? 
 
 
As a nurse, what specialty/ward do you primarily work in? 
 
 
In your medical training, where are you at? 
 
 
In your nursing training, where are you at? 
 
 
How long have you been in your current role/job? 
 Less than 1 year 
 1-2 years 

 
 
 3-5 years 
 6-10 years 
 11-15 years 
 16-20 years 
 More than 20 years 
Prefer not to say 
 
On average, how many hours a week do you work? 
 
 
How many days a month do you usually work at night, on average? 
 
 
On average, how many days a month are you on call? 
 
 
How long is your longest uninterrupted shift? (Please put number of hours 
only, for example, if it's 24 hours, please write 24.) 
 
 
In an average week, what percentage (%) of the total hours you work is 
spent on administrative tasks? (Please respond only in numbers, for eg. 
25) 
 
 
To what extent do you agree with this statement: 
‘Administrative tasks obstruct me from delivering quality patient care.' 
 Strongly disagree 
 Disagree 
 Neither agree nor disagree 
 Agree 
Strongly agree 

 
 
 
 
What percentage (%) of time are you unable to provide complete patient 
care to the standard that you would like? 
(For any reason.) Please respond in numbers only, for eg. if it's 15% of the time, please write 15 
 
 
 
If there is an inability to provide complete patient care to the standard you 
would like, how bothersome or stressful would that be to you? 
 Extremely 
 Very 
 Moderately 
 Slightly 
 Not at all 
 
 
On a score from 0 to 10, at the moment, I would rate my stress level at: 
(Please move the arrow) 
 
 
 
Section 2: Psychometric Scales 
 
For the next set of questions, please read each statement and then 
decide how frequently you may experience these at work. 
 
Please select the most appropriate response. 
 
Never 
Sometimes 
Regularly 
Often 
Always 
At work, I feel 
mentally exhausted 
 
 
 
 

 
 
Never 
Sometimes 
Regularly 
Often 
Always 
 
After a day at work, 
I find it hard to 
recover my energy 
 
 
 
 
At work, I feel 
physically 
exhausted 
 
 
 
 
I struggle to find any 
enthusiasm for my 
work 
 
 
 
 
Never 
Sometimes 
Regularly 
Often 
Always 
I feel a strong 
aversion towards 
my job 
 
 
 
 
I’m cynical about 
what my work 
means to others 
 
 
 
 
At work, I have 
trouble staying 
focused 
 
 
 
 
When I’m working, I 
have trouble 
concentrating 
 
 
 
 
Never 
Sometimes 
Regularly 
Often 
Always 
I make mistakes in 
my work because I 
have my mind on 
other things 
 
 
 
 
At work, I feel 
unable to control my 
emotions 
 
 
 
 
I do not recognize 
myself in the way I 
react emotionally at 
work 
 
 
 
 
At work I may 
overreact 
unintentionally 
 
 
 
 
 
It is recognised that working conditions affect worker well-being. 
Your responses to the questions below will help us determine current 

 
 
 
 
working conditions. 
 
It is important that your responses reflect your work in the last six 
months. 
 
Never 
Seldom 
Sometimes 
Often 
Always 
I am subject to 
personal 
harassment in the 
form of unkind 
words or behaviour 
 
 
 
 
I have unachievable 
deadlines 
 
 
 
 
If work gets difficult, 
my colleagues will 
help me 
 
 
 
 
I am given 
supportive feedback 
on the work I do 
 
 
 
 
I have a say in my 
own work speed 
 
 
 
 
Never 
Seldom 
Sometimes 
Often 
Always 
I am clear what my 
duties and 
responsibilities are 
 
 
 
 
I have to neglect 
some tasks 
because I have too 
much to do 
 
 
 
 
I am clear about the 
goals and 
objectives for my 
department 
 
 
 
 
I have a choice in 
deciding how I do 
my work 
 
 
 
 
I understand how 
my work fits into the 
overall aim of the 
organisation 
 
 
 
 
Never 
Seldom 
Sometimes 
Often 
Always 

 
 
 
 
Never 
Seldom 
Sometimes 
Often 
Always 
 
 
Your responses should reflect your work in the last six months. 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
I get help and support I 
need from colleagues 
 
 
 
 
I have some say over 
the way I work 
 
 
 
 
I have sufficient 
opportunities to question 
managers about change 
at work 
 
 
 
 
I receive the respect at 
work I deserve from my 
colleagues 
 
 
 
 
Staff are always 
consulted about change 
at work 
 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
I can talk to my line 
manager about 
something that has 
upset or annoyed me 
about work 
 
 
 
 
I am pressured to 
work long hours 
I have a choice in 
deciding what I do 
at work 
I am subject to 
bullying at work 
I have unrealistic 
time pressures 
I can rely on my line 
manager to help me 
out with a work 
problem 

 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
 
 
 
 
 
 
 
 
For the next set of questions, please read each statement and then 
decide how much each applies to you in the past month. 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
I can enjoy my 
personal time 
without focusing on 
work matters 
 
 
 
 
I am able to 
disconnect from 
work 
communications 
during my free time 
(emails/phone etc.) 
 
 
 
 
I rarely lose sleep 
over work issues 
 
 
 
 
I am able to free my 
mind from work 
when I am away 
from it 
 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
I see every 
patient/client as an 
individual person 
with specific needs 
 
 
 
 
My colleagues are 
willing to listen to my 
work-related problems 
When changes are 
made at work, I am clear 
how they will work out in 
practice 
I am supported through 
emotionally demanding 
work 
My line manager 
encourages me at work 

 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
 
 
 
 
 
 
 
 
Please indicate your level of agreement (or disagreement) with each 
of the following statements based on your supervisor right now. 
Please take a moment to think about it.. 
 
My current supervisor... 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
Tends to manipulate 
others to get their 
way 
 
 
 
 
Has used deceit or 
lied to get their way 
 
 
 
 
Has used flattery to 
get their way 
 
 
 
 
Tends to exploit 
others towards their 
own end 
 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
Tends to lack 
remorse 
 
 
 
 
Tends to be 
unconcerned with 
the morality of my 
actions 
 
 
 
 
Tends to be callous 
or insensitive 
 
 
 
 
Tends to be cynical 
 
 
 
 
I care for all 
patients/clients 
equally even when 
it is difficult 
My work is 
meaningful 
The work I do 
makes a real 
difference 

 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
Tends to want 
others to admire 
them 
 
 
 
 
Tends to want 
others to pay 
attention to them 
 
 
 
 
Tends to seek 
prestige or status 
 
 
 
 
Tends to expect 
special favours from 
others 
 
 
 
 
 
Please indicate your level of agreement (or disagreement) with each 
of the following statements based on your supervisor right now. 
 
My current supervisor... 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
Drastically changes 
their demeanour 
when their 
supervisor is 
present 
 
 
 
 
Will only offer 
assistance to 
people who can 
help him/her get 
ahead 
 
 
 
 
Accepts credit for 
successes that do 
not belong to 
him/her 
 
 
 
 
Holds employees 
responsible for 
things outside their 
job descriptions 
 
 
 
 

 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
 
Publicly belittles 
employees 
 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
Reminds 
employees of their 
past mistakes and 
failures 
 
 
 
 
Allows their current 
mood to define the 
climate of the 
workplace 
 
 
 
 
Expresses anger at 
employees for 
unknown reasons 
 
 
 
 
Varies in their 
degree of 
approachability 
 
 
 
 
Has a sense of 
personal entitlement 
 
 
 
 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly 
agree 
Thinks that he/she 
is more capable 
than others 
 
 
 
 
Believes that he/she 
is an extraordinary 
person 
 
 
 
 
Controls how 
employees 
complete their tasks 
 
 
 
 
Does not permit 
employees to 
approach goals in 
new ways 
 
 
 
 
Determines all 
decisions in the unit 
whether they are 
important or not 
 
 
 
 

 
 
 
 
Final 
 
Please rate how satisfied you are with your current work position/role 
 Very satisfied 
 Satisfied 
 Neutral 
 Dissatisfied 
 Very dissatisfied 
 
 
Please rate how often you think about quitting you current profession 
 Never 
 Rarely 
 Sometimes 
 Often 
 Always 
 
 
We have further studies within this project, please click which ones 
you'd like to be approached for: 
 
Yes 
A) One-to-one interview study 
B) Future studies using non-invasive biomarkers such as 
heart rate, heart rate variablity and breathing rate. (Only 
if you work at one of our study sites: UAMC Amsterdam, 
Rigshospitalet Copenhagen or UKE Hamburg) 
C) Any other studies 
 
Please provide your email address if you clicked yes for any option above: 
 
 
 
 
Last Page 

 
 
 
 
Please click next to submit your response. 
 
Below are some organizations that provide support: 
 
Samaritans 
Samaritans services are available 24 hours a day, for confidential, non- 
judgmental support. 
Freephone 116 123, any time 
jo@samaritans.ie 
samaritans.ie 
 
Practitioner Health 
Confidential support and help for doctors, dentists and pharmacists. 
Phone 085 760 1274 
confidential@practitionerhealth.ie 
practitionerhealth.ie 
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