Skip to main content
NCBI home page
PLOS One logoLink to PLOS One
. 2024 Mar 14;19(3):e0300040. doi: 10.1371/journal.pone.0300040

Exploring antecedents and outcomes of burnout among emergency department staff using the job demands-resources model: A scoping review protocol

Luhuan Yang 1, Yunhong Lei 2, Dongmei Chu 1, Jiawei Jiang 1, Zifeng Li 3, Yanhua Tang 1, Abd Rahman Anita 1,*
Editor: Jasna Karacic Zanetti4
PMCID: PMC10939206  PMID: 38483916

Abstract

Introduction

High levels of burnout are prevalent among Emergency Department staff due to chronic exposure to job stress. There is a lack of knowledge about anteceding factors and outcomes of burnout in this population.

Aims

To provide a comprehensive overview of burnout and identify its workplace antecedents and outcomes among Emergency Department staff.

Methods

The scoping study will follow the methodology outlined by the Joanna Briggs Institute. PubMed, Scopus, Web of Science, APA PsycInfo, and CINAHL databases will be searched using predefined strategies. Two reviewers will screen the title, abstract and full text separately based on the eligibility criteria. Data will be charted, coded, and narratively synthesized based on the job demands–resources model.

Conclusion

The results will provide insights into the underlying work-related factors contributing to burnout and its implications for individuals, healthcare organizations, and patient care.

Introduction

Globally, healthcare workers in emergency departments (EDs) are experiencing increasing physical and emotional challenges [1,2]. Factors contributing to this stress include complex patient loads, long shifts, a broad range of diseases, insufficient human resources, fast-paced work, unpredictable working conditions, and heavy rescuing and managing tasks [3–5]. These working conditions, known as job stressors, significantly impact the staff. In turn, the individual responses of workers to these stressors, termed job strain, are of critical concern. Many studies indicate that cumulative strain can lead to "burnout" characterized by emotional exhaustion, depersonalization, and reduced professional efficacy [6–8]. Currently, ED healthcare workers are struggling to cope with an ever-escalating burnout syndrome, with recent studies showing alarmingly high prevalence rates [9]. While burnout rates in residents of different specialties lie between 18% and 80%, the rates among emergency healthcare workers range from 32% to 60% [10]. A systematic review of 17 studies revealed that, on average, approximately 26% of emergency nurses suffer from burnout [11]. Additionally, research focusing on ED physicians in Canada has shown that 46% experience medium-to-high levels of burnout [12]. Furthermore, a sample of Spanish healthcare workers in the ED exhibited burnout prevalence rates of 57% [13]. Moreover, the emergence of the COVID-19 pandemic has further exacerbated the issue, making the syndrome of burnout even more prevalent and visible within these healthcare settings [14].

Burnout can lead to a variety of negative outcomes, such as health problems, conflict within the workplace, poor coping skills, and substance dependence [15,16]. In healthcare environments, when employees experience burnout, it often leads to higher turnover rates, increased absenteeism, poor job performance, and a general decline in morale[17]. Additionally, when healthcare workers experience burnout, it tends to affect the level of care they provide, leading to a decreased sense of patient safety and an increased likelihood of medical errors [18–20]. The potential adverse outcomes of burnout have generated widespread interest and emphasized the importance of understanding burnout in ED healthcare workers.

Existing models for occupational stress offer valuable frameworks for elaborating burnout by identifying common workplace antecedents and outcomes. Among these, the Job Demands-Resources (JD-R) model, proposed by Bakker and Demerouti, stands out for its comprehensive approach [21]. This model is widely recognized as the most prevalent job stress model, effectively explaining occupational stress and its impact on employee health and organizational outcomes. The JD-R model assumes that despite the diversity of work environments across various organizations, each occupation generates distinct job stressors that can be categorized as job demands and resources.

Job demands encompass various physical, psychological, social, and organizational dimensions, requiring sustained psychological and physical effort or skills [22]. Increased levels of demand are predictors of burnout and are linked to low engagement and increased turnover [23]. Job resources are those aspects of a job that facilitate the individual’s ability to achieve job goals, promote personal growth and reduce job demands [22,24]. The fundamental premise of the JD-R model is that, regardless of the specific job or occupation, job stress appears in the context of increased demands of particular jobs and constraints on specific job resources, which in turn impacts psychological well-being and organizational outcomes.

To the best of our knowledge, several reviews in the past decade have described the prevalence and determinants of burnout among ED staff, but have not investigated individual and organizational outcomes in detail. A systematic review by Jef Adriaenssens et al. assessed the prevalence of burnout in emergency nurses and identified specific (individual and work-related) determinants of burnout in this population [25]. However, only quantitative studies published between 1989 and 2014 were included. Two systematic reviews [20,26] summarized studies on burnout among ED physicians, focusing mainly on the burnout rate. There is a lack of knowledge about anteceding factors in this population. This research aims to provide a comprehensive overview of burnout and its antecedents and outcomes among ED staff. It will shed light on these professionals’ burnout challenges and underscore the urgency of addressing this issue. The study can also offer healthcare organizations vital information for crafting targeted interventions and fostering supportive work environments, thus improving healthcare workers’ work conditions and quality of life in the EDs.

Review objectives

This paper will aim to address three research objectives. Firstly, it seeks to systematically delineate past research endeavors in the domain, offering a comprehensive overview of burnout among healthcare personnel in the ED. Secondly, it aims to deepen our comprehension of the pre-existing conceptual framework that delves into potential antecedents and outcomes of burnout among ED healthcare workers. Lastly, the review strives to identify novel research gaps within the evidentiary foundation, mainly focusing on the scarcely investigated aspects of burnout among ED staff, encompassing both work-related antecedents and outcomes.

Materials and methods

Design

The scoping review will use the Joanna Briggs Institute (JBI) scoping review methodological framework [27,28]. This protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR checklist) [29] (S1 Appendix) and the Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P checklist) [30] (S2 Appendix). Additionally, the protocol was duly recorded and registered on the Open Science Framework (https://osf.io/ vfm63).

Review questions

(a)What is the current research landscape related to burnout among healthcare personnel in the ED?

(b)How do different studies conceptualize and define the relationships between burnout, its work-related precursors, and subsequent outcomes within this specific occupational setting?

(c)Which antecedents and outcomes of burnout have received limited attention in the existing literature, necessitating further investigation?

Identification of relevant studies

The PCC (Population/Concept/Context) framework was used to define retrieval strategy-related items. PubMed, Scopus, Web of Science, APA PsycInfo, and CINAHL databases will be searched. The search tactic combines Medical Subject Headings (MeSH) terms with keywords for healthcare workers, burnout, and emergency department (see Table 1 for the Pubmed search strategy).

Table 1. Full search string for the database “Pubmed”.

Pubmed Search Strategy
1. Population Subject Headings “Health Personnel”[Mesh]
("Health Care Provider*"[Title/Abstract] OR "Healthcare Provider*"[Title/Abstract] OR "Healthcare Worker*"[Title/Abstract] OR "Health Care Professional*"[Title/Abstract] ORHCWs[Title/Abstract] OR HCPs[Title/Abstract] OR "medical profession"[Title/Abstract] OR "medical worker*"[Title/Abstract] OR "medical staff" "health profession*"[Title/Abstract] OR "healthcare personnel"[Title/Abstract] OR "medical personnel"[Title/Abstract] OR "clinical staff"[Title/Abstract] OR paramedic*[Title/Abstract] OR doctor*[Title/Abstract] OR physician*[Title/Abstract] OR surgeon*[Title/Abstract] OR nurs*[Title/Abstract] OR technician*[Title/Abstract]) OR clinician[Title/Abstract])OR ((provider*[Title/Abstract] OR profession*[Title/Abstract] OR staff[Title/Abstract] OR workforce[Title/Abstract] OR practitioners[Title/Abstract] OR personnel[Title/Abstract] OR worker*[Title/Abstract]) AND (health[Title/Abstract]))
2. Concept AND
Subject Headings "Burnout, Psychological"[Mesh]
Keywords Burnout[Title/Abstract] OR Burn-out[Title/Abstract] or “Burn out”[Title/Abstract]
AND
3. Context Subject Headings "Emergency Service, Hospital"[Mesh]
Keywords “Emergency”[Title/Abstract] or “ER”[Title/Abstract] or “ED”[Title/Abstract]
Open in a new tab

This study will cover all primary quantitative and qualitative mixed-methods studies that meet the eligibility criteria for the scoping review. Inclusion criteria include original, peer-reviewed articles in English, available in full-text, utilizing both quantitative and qualitative methods, that focus on workplace antecedents and outcomes of burnout among ED staff, from inception to August 19, 2023. Book chapters, conference abstracts, editorials, commentaries, reviews, grey literature, and dissertations/theses will be excluded. Additionally, studies focusing on pediatric and pre-hospital emergencies will also be excluded.

Data selection

Upon retrieval, all identified citations will be compiled and uploaded to Covidence (https://www.covidence.org/), a robust software solution for managing data screening and extraction in systematic reviews. Using the Covidence platform, two reviewers will independently carry out study selection, encompassing title and abstract screening, as well as full-text screening. Any uncertainty or discrepancies between the reviewers will be addressed through team deliberations. This process will follow the PRISMA diagram (See Fig 1).

Fig 1. Flow chart of study selection.

Fig 1

Open in a new tab

Data extraction

The data extraction template will record information from the included papers. The template will consist of items related to the author, publication year, journal, study objectives, setting, study design, samples, assessment of burnout among ED staff, and factors and outcomes. The framework will be adapted and refined as necessary. One reviewer will accomplish data extraction independently for all studies. Two more reviewers will then independently review the extracted data. In case of discrepancies or inconsistencies in interpretation between reviewers, a third reviewer will resolve these issues.

Reporting the findings

The data will be descriptively analyzed using the completed extraction tool to map the available evidence. The key information will be systematically sorted and categorized to comprehensively summarize the evidence on burnout among healthcare workers in the ED. The acquired data will be visually represented through figures, charts, and tables. The report will describe the results concerning the research questions of the scoping review. Additionally, gaps in the literature will be identified, and potential implications for future research will be highlighted.

Discussion and conclusion

The high prevalence of burnout among ED staff is a significant concern driven by chronic exposure to job stress in their demanding work environment. This scoping review protocol outlines the methodology for exploring the workplace antecedents and outcomes of burnout among ED staff using the JD-R model. By analyzing how different studies define and conceptualize these relationships, this study represents a significant step towards identifying patterns, trends, and gaps in the existing literature, paving the way for a more holistic understanding of burnout within this population.

The implications of this review extend far beyond academic discourse. Healthcare professionals and researchers will gain a deeper insight into the nuances of burnout and its impacts. The identified gaps in antecedents and outcomes of burnout underscore the urgent need for strategic changes among healthcare policymakers and administrators. Targeted interventions are urgently needed to reduce specific job demands while enhancing job resources to reduce burnout among ED staff and create a healthier, more resilient, and more effective ED workforce.

Supporting information

S1 Appendix. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

(PDF)

pone.0300040.s001.pdf (534.6KB, pdf)
S2 Appendix. Recommended items to address in a systematic review protocol*.

(PDF)

pone.0300040.s002.pdf (280.5KB, pdf)

Data Availability

No datasets were generated or analysed during the current study. Deidentified research data will be made publicly available when the study is completed and published.

Funding Statement

The author(s) received no specific funding for this work.

References

  • 1.Elder E, Johnston ANB, Wallis M, Greenslade JH, Crilly J. Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study. International Emergency Nursing. 2019;45:17–24. doi: 10.1016/j.ienj.2019.03.006 [DOI] [PubMed] [Google Scholar]
  • 2.Judy AL, Andrea JC, Peter AC, Johannes US, Matthew WC, John JM. Systematic review of trends in emergency department attendances: an Australian perspective. Emergency Medicine Journal. 2011;28(5):373. doi: 10.1136/emj.2010.099226 [DOI] [PubMed] [Google Scholar]
  • 3.Watson AG, McCoy JV, Mathew J, Gundersen DA, Eisenstein RM. Impact of physician workload on burnout in the emergency department. Psychol Health Med. 2019;24(4):414–28. Epub 2018/10/30. doi: 10.1080/13548506.2018.1539236 . [DOI] [PubMed] [Google Scholar]
  • 4.Bragard I, Dupuis G, Fleet R. Quality of work life, burnout, and stress in emergency department physicians: a qualitative review. Eur J Emerg Med. 2015;22(4):227–34. Epub 2014/08/06. doi: 10.1097/MEJ.0000000000000194 . [DOI] [PubMed] [Google Scholar]
  • 5.Boyle A, Beniuk K, Higginson I, Atkinson P. Emergency department crowding: time for interventions and policy evaluations. Emerg Med Int. 2012;2012:838610. Epub 2012/03/29. doi: 10.1155/2012/838610 ; PubMed Central PMCID: PMC3290817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Dunne PJ, Lynch J, Prihodova L, O’Leary C, Ghoreyshi A, Basdeo SA, et al. Burnout in the emergency department: Randomized controlled trial of an attention-based training program. J Integr Med. 2019;17(3):173–80. Epub 2019/04/09. doi: 10.1016/j.joim.2019.03.009 . [DOI] [PubMed] [Google Scholar]
  • 7.Malik H, Annabi CA. The impact of mindfulness practice on physician burnout: A scoping review. Front Psychol. 2022;13:956651. Epub 2022/10/08. doi: 10.3389/fpsyg.2022.956651 ; PubMed Central PMCID: PMC9530040. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Basu S, Qayyum H, Mason S. Occupational stress in the ED: a systematic literature review. Emerg Med J. 2017;34(7):441–7. Epub 2016/10/13. doi: 10.1136/emermed-2016-205827 . [DOI] [PubMed] [Google Scholar]
  • 9.Howlett M, Doody K, Murray J, LeBlanc-Duchin D, Fraser J, Atkinson PR. Burnout in emergency department healthcare professionals is associated with coping style: a cross-sectional survey. Emerg Med J. 2015;32(9):722–7. Epub 2015/01/22. doi: 10.1136/emermed-2014-203750 . [DOI] [PubMed] [Google Scholar]
  • 10.Alanazy ARM, Alruwaili A. The Global Prevalence and Associated Factors of Burnout among Emergency Department Healthcare Workers and the Impact of the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Healthcare [Internet]. 2023. 2023/08/07; 11(15):[2220 p.]. Available from: doi: 10.3390/healthcare11152220 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Adriaenssens J, De Gucht V, Maes S. Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research. International Journal of Nursing Studies. 2015;52(2):649–61. doi: 10.1016/j.ijnurstu.2014.11.004 [DOI] [PubMed] [Google Scholar]
  • 12.Lloyd S, Streiner D, Shannon S. Burnout, depression, life and job satisfaction among Canadian emergency physicians. J Emerg Med. 1994;12(4):559–65. Epub 1994/07/01. doi: 10.1016/0736-4679(94)90360-3 . [DOI] [PubMed] [Google Scholar]
  • 13.Rodríguez-Rey R, Palacios A, Alonso-Tapia J, Pérez E, Álvarez E, Coca A, et al. Burnout and posttraumatic stress in paediatric critical care personnel: Prediction from resilience and coping styles. Australian Critical Care. 2019;32(1):46–53. doi: 10.1016/j.aucc.2018.02.003 [DOI] [PubMed] [Google Scholar]
  • 14.Karacic J, Bursztajn HJ, Arvanitakis M. Who Cares What the Doctor Feels: The Responsibility of Health Politics for Burnout in the Pandemic. Healthcare (Basel). 2021;9(11). Epub 2021/11/28. doi: 10.3390/healthcare9111550 ; PubMed Central PMCID: PMC8620824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Wijeratne C, Johnco C, Draper B, Earl JK. Older Physicians’ Reporting of Psychological Distress, Alcohol Use, Burnout and Workplace Stressors. The American Journal of Geriatric Psychiatry. 2021;29(5):478–87. doi: 10.1016/j.jagp.2020.09.010 [DOI] [PubMed] [Google Scholar]
  • 16.Mercado M, Wachter K, Schuster RC, Mathis CM, Johnson E, Davis OI, et al. A cross-sectional analysis of factors associated with stress, burnout and turnover intention among healthcare workers during the COVID-19 pandemic in the United States. Health Soc Care Community. 2022;30(5):e2690–e701. Epub 2022/01/18. doi: 10.1111/hsc.13712 . [DOI] [PubMed] [Google Scholar]
  • 17.Campbell DA, Jr., Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery. 2001;130(4):696–702; discussion -5. Epub 2001/10/17. doi: 10.1067/msy.2001.116676 . [DOI] [PubMed] [Google Scholar]
  • 18.Barden CB, Specht MC, McCarter MD, Daly JM, Fahey TJ, 3rd. Effects of limited work hours on surgical training. J Am Coll Surg. 2002;195(4):531–8. Epub 2002/10/12. doi: 10.1016/s1072-7515(02)01242-5 . [DOI] [PubMed] [Google Scholar]
  • 19.Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44(7):1017–22. Epub 1997/04/01. doi: 10.1016/s0277-9536(96)00227-4 . [DOI] [PubMed] [Google Scholar]
  • 20.Arora M, Asha S, Chinnappa J, Diwan AD. Review article: burnout in emergency medicine physicians. Emerg Med Australas. 2013;25(6):491–5. Epub 2013/10/15. doi: 10.1111/1742-6723.12135 . [DOI] [PubMed] [Google Scholar]
  • 21.Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. Journal of Applied Psychology. 2001;86(3):499–512. doi: 10.1037/0021-9010.86.3.499 [DOI] [PubMed] [Google Scholar]
  • 22.Bakker AB, Demerouti E, de Boer E, Shaufeli WB. Job demands and job resources as predictors of absence duration and frequency. Journal of Vocational Behavior. 2003;62(2):341–56. doi: 10.1016/S0001-8791(02)00030-1 [DOI] [Google Scholar]
  • 23.McVicar A. Scoping the common antecedents of job stress and job satisfaction for nurses (2000–2013) using the job demands-resources model of stress. J Nurs Manag. 2016;24(2):E112–36. Epub 2015/07/16. doi: 10.1111/jonm.12326 . [DOI] [PubMed] [Google Scholar]
  • 24.Hu Q, Schaufeli WB, Taris TW. The Job Demands–Resources model: An analysis of additive and joint effects of demands and resources. Journal of Vocational Behavior. 2011;79(1):181–90. doi: 10.1016/j.jvb.2010.12.009 [DOI] [Google Scholar]
  • 25.Adriaenssens J, De Gucht V, Maes S. Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research. Int J Nurs Stud. 2015;52(2):649–61. Epub 2014/12/04. doi: 10.1016/j.ijnurstu.2014.11.004 . [DOI] [PubMed] [Google Scholar]
  • 26.Zhang Q, Mu MC, He Y, Cai ZL, Li ZC. Burnout in emergency medicine physicians: A meta-analysis and systematic review. Medicine (Baltimore). 2020;99(32):e21462. Epub 2020/08/10. doi: 10.1097/MD.0000000000021462 ; PubMed Central PMCID: PMC7593073. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Implement. 2021;19(1):3–10. Epub 2021/02/12. doi: 10.1097/XEB.0000000000000277 . [DOI] [PubMed] [Google Scholar]
  • 28.Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis: JBI; 2020. [cited 2023 August 30]. Available from: 10.46658/JBIMES-20-12. [DOI] [Google Scholar]
  • 29.Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–73. Epub 2018/09/05. doi: 10.7326/M18-0850 . [DOI] [PubMed] [Google Scholar]
  • 30.Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ: British Medical Journal. 2015;349:g7647. doi: 10.1136/bmj.g7647 [DOI] [PubMed] [Google Scholar]

Decision Letter 0

Jasna Karacic Zanetti

14 Nov 2023

PONE-D-23-25522Exploring Antecedents and Outcomes of Burnout among Emergency Department Staff Using the Job Demands-Resources Model: Scoping Review ProtocolPLOS ONE

Dear Dr. Anita,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Dec 29 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Jasna Karacic Zanetti

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

- https://doi.org/10.1111/1742-6723.12135

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

3. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ

4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear Authors,

We appreciate the manuscript you submitted. After a thorough evaluation by our esteemed reviewers, we are delighted to inform you that your manuscript requires only minor revisions.

The reviewers found your work to be promising, and with the suggested revisions, we believe it will significantly enhance the overall quality and impact of the publication.

Information regarding burnout could be found in articile Who Cares What the Doctor Feels: The Responsibility of Health Politics for Burnout in the Pandemic

link

https://www.mdpi.com/2227-9032/9/11/1550

Kindly review and evaluate the requested work to determine whether they are relevant and should be cited.

Once you have completed the revisions, please submit the revised version of your manuscript through our online submission system. Include both a clean version and a tracked changes version to aid our review process.

We eagerly anticipate the enhanced version of your manuscript and your continued collaboration with our journal.

Should you have any questions or require any clarification during the revision process, please do not hesitate to contact us.

Sincerely,

REVIEWER COMMENT TO BE ADRESSED:

The manuscript appears to be well structured, overall. A suggested minor edit is to offer a concise overview of the anticipated benefits and implications of the scoping review in the Introduction section. Explain how the review's outcomes could affect healthcare organizations or practitioners. This background can assist readers grasp the significance of your findings.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

********** 

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

********** 

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

********** 

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

********** 

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

********** 

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript appears to be well structured, overall. A suggested minor edit is to offer a concise overview of the anticipated benefits and implications of the scoping review in the Introduction section. Explain how the review's outcomes could affect healthcare organizations or practitioners. This background can assist readers grasp the significance of your findings.

Reviewer #2: Introduction and Rationale: The introduction clearly states the high prevalence of burnout among ED staff due to chronic job stress. However, it would benefit from more specific data or statistics to emphasize the magnitude of the problem. Also, it would be useful to briefly mention why the Job Demands-Resources (JD-R) model is chosen for this study.

Methodology: The methodology section is thorough, explaining the use of the Joanna Briggs Institute methodology and the PRISMA-ScR checklist. However, it would be beneficial to include more detailed information on the criteria for selecting studies (e.g., year range, type of studies included).

********** 

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2024 Mar 14;19(3):e0300040. doi: 10.1371/journal.pone.0300040.r002

Author response to Decision Letter 0

2 Dec 2023

On behalf of the co-authors, we express our gratitude for the opportunity to revise our manuscript. We sincerely appreciate your insightful comments and suggestions on our manuscript titled "Exploring antecedents and outcomes of burnout among emergency department staff using the Job Demands-Resources model: A scoping review protocol" (No.: PONE-D-23-25522 ). We have thoroughly reviewed and diligently revised our manuscript following the reviewers' comments. The reviewer's comments are below in italicized font, and specific concerns have been numbered. Notably, our responses are in normal font, while additions to the manuscript are highlighted in green text. Moreover, all changes/additions to the latest manuscript use Microsoft Word's Track changes method. Below is a point-by-point response to the Editor and Reviewers' comments and concerns.

Responses to the comments of the Editor:

Comment 1: Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

Response: Thank you for your reminder. We have thoroughly reviewed and revised the manuscript style and file names in accordance with the journal's style requirements.

Comment 2: We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:- https://doi.org/10.1111/1742-6723.12135. In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section.

Response: In response to these concerns, we have carefully rephrased the duplicated text and cited all sources involved(Lines 58~64).

Comment 3: PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager.

Response: In compliance with this requirement, I have updated my information and linked my ORCID iD with the Editorial Manager system for our submission.

Comment 4: Please review your reference list to ensure that it is complete and correct.

Response: Thank you for your reminder. We have examined each citation in our manuscript to ensure the reference list is complete and correct.

Responses to additional Editor comments:

Comment: Information regarding burnout could be found in articile Who Cares What the Doctor Feels: The Responsibility of Health Politics for Burnout in the Pandemic. Kindly review and evaluate the requested work to determine whether they are relevant and should be cited. Once you have completed the revisions, please submit the revised version of your manuscript through our online submission system. Include both a clean version and a tracked changes version to aid our review process.

Response: Thank you for your valuable feedback and for providing the reference. We have carefully reviewed the article to assess its relevance to our work and cited this article in our revised manuscript, ensuring that it supports our findings(Lines 55~57).

As instructed, we are submitting a clean version and a tracked changes version of our revised manuscript through the online submission system.

Responses to the comments of Reviewer #1:

Comment: The manuscript appears to be well structured, overall. A suggested minor edit is to offer a concise overview of the anticipated benefits and implications of the scoping review in the Introduction section. Explain how the review's outcomes could affect healthcare organizations or practitioners. This background can assist readers grasp the significance of your findings.

Response: Thank you for your suggestion. We've revised the Introduction to include a concise overview of our scoping review's anticipated benefits and implications (Lines 92~98).

Responses to the comments of Reviewer #2:

Comment 1: Introduction and Rationale: The Introduction clearly states the high prevalence of burnout among ED staff due to chronic job stress. However, it would benefit from more specific data or statistics to emphasize the magnitude of the problem. Also, it would be useful to briefly mention why the Job Demands-Resources (JD-R) model is chosen for this study.

Response: Thank you for your insightful feedback. We have supplemented the Introduction with additional specific data and statistics to highlight the prevalence of burnout among ED staff (Lines 49~55).

We've also briefly explained why the Job Demands-Resources (JD-R) model is particularly relevant and suitable for this study (Lines 68~72).

Comment 2: Methodology: The methodology section is thorough, explaining the use of the Joanna Briggs Institute methodology and the PRISMA-ScR checklist. However, it would be beneficial to include more detailed information on the criteria for selecting studies (e.g., year range, type of studies included).

Response: Thank you for your kind reminder. As suggested, we have updated the methodology section to include more detailed information on our study selection criteria. Specifically, we have clarified that the included study types are original articles employing quantitative and qualitative research methods. We have also defined the year range of the studies from inception to August 19, 2023(Lines 134~136).

Attachment

Submitted filename: Response to Reviewers.docx

pone.0300040.s003.docx (19.6KB, docx)

Decision Letter 1

Jasna Karacic Zanetti

21 Feb 2024

Exploring Antecedents and Outcomes of Burnout among Emergency Department Staff Using the Job Demands-Resources Model: A Scoping Review Protocol

PONE-D-23-25522R1

Dear dr 

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

PLOS ONE

Additional Editor Comments (optional):

Dear authors,

I am pleased to inform you that, following revision, your manuscript titled "Exploring Antecedents and Outcomes of Burnout among Emergency Department Staff Using the Job Demands-Resources Model: A Scoping Review Protocol" has been accepted for publication in PLOS ONE.

Reviewers' comments:

Acceptance letter

Jasna Karacic Zanetti

5 Mar 2024

PONE-D-23-25522R1

PLOS ONE

Dear Dr. Anita,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Jasna Karacic Zanetti

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Appendix. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

    (PDF)

    pone.0300040.s001.pdf (534.6KB, pdf)
    S2 Appendix. Recommended items to address in a systematic review protocol*.

    (PDF)

    pone.0300040.s002.pdf (280.5KB, pdf)
    Attachment

    Submitted filename: Response to Reviewers.docx

    pone.0300040.s003.docx (19.6KB, docx)

    Data Availability Statement

    No datasets were generated or analysed during the current study. Deidentified research data will be made publicly available when the study is completed and published.

    Articles from PLOS ONE are provided here courtesy of PLOS

    RESOURCES