A new approach to stress of conscience's dimensionality: Hindrance and violation stressors and their role in experiencing burnout and turnover intentions in healthcare

Abstract

Aims: To identify a valid, longitudinally invariant factor model for stress of conscience and to investigate how stress of conscience dimensions associate with burnout and turnover intentions. Background: There has been a lack of consensus about the number and content of stress of conscience dimensions, and a lack of longitudinal studies on its development and outcomes. Design: A longitudinal, person-centred survey study using the STROBE checklist. Methods: Healthcare personnel (n = 306) rated their stress of conscience in 2019 and 2021. Longitudinal latent profile analysis was used to identify different subgroups based on the employees' experiences. These subgroups were then compared in terms of burnout and organisational/professional turnover. Results: Five subgroups were identified, where participants experienced: (1) hindrance-related stress (14%), (2) violation-related stress (2%), (3) both stress dimensions increasing over time (13%), (4) both high yet decreasing over time (7%), and (5) stable levels of low stress (64%). When both hindrance- and violated-related stress were high, it was a significant risk for burnout and turnover. Shortened, 6-item, two-dimensional scale for stress of conscience was found to be reliable, valid, and longitudinally invariant. Conclusion: On its own, hindrance-related stress (e.g. lowering one's aspirations for high-quality work) is less detrimental to well-being than when it is combined with violation-related stress (e.g. being forced to do something that feels wrong). Implications for the Profession Patient Care: To prevent burnout and staff turnover in healthcare, different risk factors for stress of conscience need to be identified and addressed. Public Contribution: Data were collected among public sector healthcare workers. Relevance to Clinical Practice: If healthcare workers are forced to ignore their personal values at work, it poses a significant risk for their well-being and retention.