Burnout Self-TestMaslach Burnout Inventory (MBI)
Second Round of Data Collection
Name (Will be kept confidential )
*
First Name
Last Name
Badge number (Will be kept confidential)
*
Gender
*
Male
Female
N/A
Age
*
25-30
30-40
40-50
More than 50
Nationality
*
Marital Status
*
Single
Married
Divorced
Separated
Widow
Other
Do you have Children ?
*
Yes
No
Living With
*
Familiy
Friend
Alone
Other
Area of working
*
Clinic 720
Chemotherapy Suit
Day Care unit
Radiation Oncology Clinic
Other
How many years have you been working in oncology department?
*
1-5 year
6-10 years
11-15years
16-20 years
Morethan 20 years
For nursess who work on outpatient clinics, Number of Clinics per week?
1 Clinic
2 Clinics
3 Clinics
4 Clinics
Other
For nursess who work on inpatient wards, what is the avarage number Ofshifts /week ?
1
2
3
4
Other
For nursess who work on inpatient wards, what is the the ratio of patient/ nurse , one nurse to how many patients ?
1
2
3
4
Other
Estimated time you spend in EMR (BestCare) documentation Hours / week:
2-4 Hours / Week
4-6 Hours / week
6-10 Hours/ Week
More than 10 Hours / week
Do you think you have job related burnout
*
Yes
No
I don't Know
What is the main reason thats your causing burnout?
what do you suggest to reduce burnout among physicians?
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Section A
I feel emotionally drained by mywork.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Working with people all day long requires a great deal of effort.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I feel like my work is breaking me down.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I feel frustrated by my work.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I feel I work too hard at my job.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
It stresses me too much to work indirect contact with people.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I feel like I’m at the end of my rope.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
Total score – SECTION A
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Section B
I feel I look after certainpatients/clients impersonally, as ifthey are objects.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I feel tired when I get up in themorning and have to face anotherday at work.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I have the impression that mypatients/clients make me responsiblefor some of their problems.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I am at the end of my patience atthe end of my work day.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I really don’t care about whathappens to some of mypatients/clients.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I have become more insensitive topeople since I’ve been working.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I’m afraid that this job is making me uncaring.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
Total score – SECTION B
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Section C
I accomplish many worthwhile things in this job.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I feel full of energy.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I am easily able to understand whatmy patients/clients feel.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I look after my patients’/clients’problems very effectively.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
In my work, I handle emotionalproblems very calmly.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
Through my work, I feel that I have a positive influence on people.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I am easily able to create a relaxedatmosphere with my patients/clients.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
I feel refreshed when I have been close to my patients/clients at work.
*
Never
A Few Times per Year
Once a Month
A Few Times per Month
Once a Week
A Few Times per Week
Every Day
Total score – SECTION C
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Perception after the first intervention
Did you notice a decrease in the clinic workload?
*
Yes
No
Did you notice a decrease in the number of walk-in patients in the clinic?
*
Yes
No
Did you attend the psychological wellbeing session offered by the department last week?
*
Yes
No
Did that session help you to resuce your job related stress?
*
Yes
No
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