References
Resilience and burnout of healthcare workers during the early COVID-19 pandemic

Abstract
Introduction:
The COVID-19 pandemic has led to significantly more healthcare workers (HCWs) experiencing burnout than previously. This burnout is strongly associated with low resilience. Addressing organisational stresses and the introduction of resilience training will help to reduce the proportion of HCWs experiencing this phenomenon.
Aims:
The aim of this study was to assess the impact of the biopsychosocial changes and challenges associated with the COVID-19 pandemic on the healthcare workforce, exploring, specifically, the impact on and relationship between HCWs' resilience and burnout.
Methods:
An electronic opt-in survey was distributed to HCWs through hospital and professional association communications emails and websites, as well as social media. The survey consisted of demographic questions, the Oldenburg Burnout Inventory to assess burnout, Brief Resilience Scale to assess general resilience, and 10-item Connor-Davidson Resilience Scale to assess resilience during the pandemic. Univariate and multivariate analysis was undertaken to examine the relationship between these factors.
Results:
A total of 1370 HCWs completed the questionnaire, with 802 (58.5%) having burnout, 348 (25.4%) having low general resilience and 390 (28.5%) having low COVID resilience. Burnout was significantly associated with being public sector workers, low general resilience and low COVID resilience. Resilience training was found to be protective for burnout.
Conclusion:
The introduction of resilience training in the workplace is a fundamental tool that will significantly benefit HCWs when working under challenging conditions.
The COVID-19 pandemic presented one of the greatest challenges faced by already stretched healthcare services world-wide. Healthcare workers (HCWs) had to adapt to unfamiliar roles and environments with new schedules and pressures, while constantly needing to rapidly upskill themselves in order to provide clinical care in an area where the scientific knowledge was and still is, constantly evolving (Gavin et al, 2020; Wu et al, 2020). Added to this, they were contending with the biopsychosocial consequences of the COVID-19 pandemic in the form of social distancing, lockdown or quarantine (Gavin et al, 2020; Wu et al, 2020).
The additional stress of a pandemic has the potential to detrimentally impact the health of HCWs, as was associated with the 2003 SARS pandemic (Maunder, 2004; Marjanovic, 2007; Lancee et al, 2008). Burnout is a debilitating condition, which is predictive of long-term sickness (Peterson et al, 2011) and individuals leaving the profession (Rudman et al, 2014) and has an impact on quality of patient care (Kohnavard et al, 2015; Khodaveisi et al, 2017; Turner et al, 2017), with high burnout levels often being linked with compassion fatigue (Green and Walkey, 1988; Bakker et al, 2004; McKinley et al, 2020).
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