Review Reports - Burnout Levels in Italian Nurses during the First and the Second Wave in the COVID-19 Outbreak: A Pilot Cohort-Data Comparison

Round 1

Reviewer 1 Report

This was a straightforward study with a specific aim to compare burnout levels in Italian nurses during the first and the second waves of the Covid-19 pandemic utilizing two main factors: gender and years of work experience via convenience sampling methods.

Here are some comments to be addressed:

Introduction:

· The first two paragraphs seem redundant, and no need to focus on the number of cases or deaths as it has been documented in the literature.

· Please consider reorganizing the introduction to reflect specific themes which are easy to follow. For example, current findings à associated factors à risk of burnout on healthcare outcomes, etc.

· Please provide a specific definition of frontline nurses (ICU R.Ns, ED R.Ns, R.Ns working in isolation).

Methods:

· Please define the source of data: multicenter or specific site, tertiary or primary care settings, single city or different cities. For now, it shows an online voluntary survey was distributed, and data was gathered. Any other sociodemographic data were obtained or excluded.

· Please also clarify if the data collected reflected the start of the second wave in Italy. As of now it shows data collected in September might not be during the start of the wave, which started towards the end of September 2020.

Results:

· It lacks classical Table 1, where important sociodemographic data are missing. Those data are extremely important to a burnout study. Those variables include income, workload and shift work, and social status.

Discussion:

· Arguments and data interpretation seem adequate. However, a few lengthy sentences should be paraphrased for more clarity (for example, 228-234).

Conclusion:

· It does not reflect the actual findings of this study and looks pretty general and nonspecific.

References:

· Please reference more studies of similar context and culture, such as:

o Stocchetti N, Segre G, Zanier ER, Zanetti M, Campi R, Scarpellini F, Clavenna A, Bonati M. Burnout in Intensive Care Unit Workers during the Second Wave of the COVID-19 Pandemic: A Single Center Cross-Sectional Italian Study. Int J Environ Res Public Health. 2021 Jun 5;18(11):6102. doi: 10.3390/ijerph18116102. PMID: 34198849; PMCID: PMC8201217

Final remarks:

Please consider adding this is a pilot study in the title.

Author Response

Rebuttal letter

Burnout levels in Italian nurses during the First and the Second Wave in the Covid-19 outbreak: a pilot cohort-data comparison.

We thank the Referee for the valuables comments.

Reviewer 1

Here are some comments to be addressed:

R1: Introduction:

The first two paragraphs seem redundant, and no need to focus on the number of cases or deaths as it has been documented in the literature.
Please consider reorganizing the introduction to reflect specific themes which are easy to follow. For example, current findings à associated factors à risk of burnout on healthcare outcomes, etc.
Please provide a specific definition of frontline nurses (ICU R.Ns, ED R.Ns, R.Ns working in isolation).

A1: The Author revised the Introduction section according to the reviewer’s comments.

R2: Methods:

Please define the source of data: multicenter or specific site, tertiary or primary care settings, single city or different cities. For now, it shows an online voluntary survey was distributed, and data was gathered. Any other sociodemographic data were obtained or excluded.
Please also clarify if the data collected reflected the start of the second wave in Italy. As of now it shows data collected in September might not be during the start of the wave, which started towards the end of September 2020.

A2: The Author revised the Methodology section according to the given suggestions.

R3: Results:

It lacks classical Table 1, where important sociodemographic data are missing. Those data are extremely important to a burnout study. Those variables include income, workload and shift work, and social status.

A3: Unfortunately, data collected concerned only gender and work experience for both the two waves. Although, this aspect was added in the study limitations.

R4: Discussion:

Arguments and data interpretation seem adequate. However, a few lengthy sentences should be paraphrased for more clarity (for example, 228-234).

A4: Sentences were shortened.

R5: Conclusion:

It does not reflect the actual findings of this study and looks pretty general and nonspecific.

A5: The conclusion section was revised.

R6: References:

Please reference more studies of similar context and culture, such as:

A6: Reference was added.

R7: Final remarks:

Please consider adding this is a pilot study in the title.

A7: The title was revised.

Changes and modifications have been marked in red color in the text to speed up reviewing.

I hope that the revised version of our manuscript, now, is ready for acceptance.

Sincerely yours,

Elsa Vitale

Bari, 9.11.2022

Author Response File: Author Response.docx

Reviewer 2 Report

The article deals with the levels of burnout among nurses. Being also interested in this topic and doing interventions for nurses, I really happy to read your paper. I have no particular concern about the topic, the literature, or the method you used. The article is clear and the structure makes it easy to understand the very aspects of your study. Good job. However, I am wondering about the use of "sex" rather than "gender"? Why did you do that? Also, Have you asked your participants if they self-identified with a specific orientation? It has been almost 4-5 years that the practice of including other options for gender in surveys is quite mandatory. Can you add information about it? Also, what is the rationale behind the decision to split the years of work experience? You just split them between minor and major than 20. You should explain why. You reported the Cronbach alpha of BOS considering all the dimensions together but then you used them separately. Please report the Cronbach alpha of each subdimension. Finally, perhaps you may find interesting suggestions that might include in your text from the recent publication by Toscano, Tommasi & Giusino, 2022 (see below).

Toscano, F., Tommasi, F., & Giusino, D. (2022). Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors. International Journal of Environmental Research and Public Health, 19(19), 12914.

Author Response

Rebuttal letter

Burnout levels in Italian nurses during the First and the Second Wave in the Covid-19 outbreak: a pilot cohort-data comparison.

We thank the Referee for the valuables comments.

Reviewer 2

Author

The use of “Sex” was changed with “Gender”.

The work experience variable was classified into: until 5 years, 6-10 years, 11-15 years, 16-20 years, 21-25 years, 26-30 years and over 31 years.

Cronbach alpha of BOS considering all the three dimensions, as also reporting by the cited literature.

The reference suggested was also added in the manuscript.

Changes and modifications have been marked in red color in the text to speed up reviewing.

I hope that the revised version of our manuscript, now, is ready for acceptance.

Sincerely yours,

Elsa Vitale

Bari, 9.11.2022

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Thanks for addressing most of the comments. However, first, two comments were not addressed:

The first two paragraphs seem redundant, and no need to focus on the number of cases or deaths as it has already been documented in the literature.
Please consider reorganizing the introduction to reflect specific themes which are easy to follow. For example, current findings, associated factors, risk of burnout on healthcare outcomes, etc.

Additionally, please remove "multicenter" from methods section line 84 as data collection was via social media platforms.

Author Response

I thank the Referee for the valuables comments.

Reviewer 1

Thanks for addressing most of the comments. However, first, two comments were not addressed:

R1: The first two paragraphs seem redundant, and no need to focus on the number of cases or deaths as it has already been documented in the literature.

Please consider reorganizing the introduction to reflect specific themes which are easy to follow. For example, current findings, associated factors, risk of burnout on healthcare outcomes, etc.

A1: The first paragraph was re-organized according to the Reviewer’s comment an also references were consequentially re-organized, too.

R2: Additionally, please remove "multicenter" from methods section line 84 as data collection was via social media platforms.

A2: Line 84 was adjusted according to the reviewer’s suggestion.

Changes and modifications have been marked in red color in the text to speed up reviewing.

I hope that the revised version of our manuscript, now, is ready for acceptance.

Sincerely yours,

Elsa Vitale

Bari, 21.11.2022

Author Response File: Author Response.docx