{"paper_id":"327c135d-e41b-4459-ab91-9054dd66b1fd","body_text":"An exploration of burnout among hospital first-line... | F1000Research <!-- --> <!-- --> <!-- This is commented out to fix display problems on mobile devices. We may use it again once we implement a responsive design that supports native device resolutions. --> \"use strict\";function _typeof(t){return(_typeof=\"function\"==typeof Symbol&&\"symbol\"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&\"function\"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?\"symbol\":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement(\"iframe\");r.style.cssText=\"display:none\",r.name=\"__tcfapiLocator\",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&\"boolean\"==typeof n[3]&&(e=n[3],\"function\"==typeof n[2]&&n[2](\"set\",!0)):\"ping\"===n[0]?\"function\"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:\"stub\"}):o.push(n)},n.addEventListener(\"message\",(function(t){var e=\"string\"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n=\"object\"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,\"*\")}),n.parameter)}),!1))};\"undefined\"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:[\"bam.nr-data.net\"]}}; ;NREUM.loader_config={accountID:\"438030\",trustKey:\"438030\",agentID:\"772317073\",licenseKey:\"97f8f67f26\",applicationID:\"772317073\"} ;NREUM.info={beacon:\"bam.nr-data.net\",errorBeacon:\"bam.nr-data.net\",licenseKey:\"97f8f67f26\",applicationID:\"772317073\",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{\"use strict\";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error(\"All info objects require an agent identifier!\");if(!a[e])throw new Error(\"Info for \".concat(e,\" was never set\"));return a[e]}function c(e,t){if(!e)throw new Error(\"All info objects require an agent identifier!\");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],\"info\")}var u=r(7056);const d=()=>{const e={blockSelector:\"[data-nr-block]\",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:\"*\",maskAllInputs:!0,get blockClass(){return\"nr-block\"},get ignoreClass(){return\"nr-ignore\"},get maskTextClass(){return\"nr-mask\"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=\",\".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error(\"All configuration objects require an agent identifier!\");if(!f[e])throw new Error(\"Configuration for \".concat(e,\" was never set\"));return f[e]}function h(e,t){if(!e)throw new Error(\"All configuration objects require an agent identifier!\");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],\"config\")}function g(e,t){if(!e)throw new Error(\"All configuration objects require an agent identifier!\");var r=l(e);if(r){for(var n=t.split(\".\"),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||\"object\"!=typeof e)return(0,n.Z)(\"Setting a Configurable requires an object as input\");if(!t||\"object\"!=typeof t)return(0,n.Z)(\"Setting a Configurable requires a model to set its initial properties\");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{\"object\"==typeof e[a]&&\"object\"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)(\"An error occurred while setting a property of a Configurable\",e)}return r}catch(e){(0,n.Z)(\"An error occured while setting a Configurable\",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n=\"1.236.0\",i=\"PROD\",o=\"CDN\"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n=\"undefined\"!=typeof window&&!!window.document,i=\"undefined\"!=typeof WorkerGlobalScope&&(\"undefined\"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||\"undefined\"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:\"undefined\"!=typeof WorkerGlobalScope&&(\"undefined\"!=typeof self&&self instanceof WorkerGlobalScope&&self||\"undefined\"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=\"\"+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&\"undefined\"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\\s](\\d+\\.\\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:\"\",ee:void 0};class o{constructor(e){try{if(\"object\"!=typeof e)return(0,n.Z)(\"shared context requires an object as input\");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)(\"An error occured while setting SharedContext\",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:\"\",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:\"feature\";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s=\"nr@context\";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&\"object\"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;f<d;f++)s[f].apply(a,r);var l=T()[c[e]];return l&&l.push([p,e,r,a]),a}}function b(e,t){n[e]=w(e).concat(t)}function y(e,t){var r=n[e];if(r)for(var i=0;i {r.d(t,{E:()=>n,p:()=>i});var n=r(2177).ee.get(\"handle\");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o=\"feature\"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener(\"test\",null,e),n._A.removeEventListener(\"test\",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i=\"xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx\";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split(\"\").map((e=>\"x\"===e?o(t,++r).toString(16):\"y\"===e?(3&o()|8).toString(16):e)).join(\"\")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n=\"NRBA\",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||\"\").indexOf(\"data:\"))return{protocol:\"data\"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement(\"a\"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split(\"://\");!o.port&&a[1]&&(o.port=a[1].split(\"/\")[0].split(\"@\").pop().split(\":\")[1]),o.port&&\"0\"!==o.port||(o.port=\"https\"===a[0]?\"443\":\"80\"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],\"/\"!==o.pathname.charAt(0)&&(o.pathname=\"/\"+o.pathname);var s=!t.protocol||\":\"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),\"/\"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){\"function\"==typeof console.warn&&(console.warn(\"New Relic: \".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&\"object\"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)(\"feat-\"+t,[],void 0,e,r):(0,i.p)(\"block-\"+t,[],void 0,e,r),(0,i.p)(\"rumresp-\"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)(\"feat-\"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)(\"rumresp-\"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if(\"object\"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit(\"internal-error\",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return\"undefined\"==typeof document||\"complete\"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)(\"load\",e,t)}function a(e){if(i())return e();(0,n.iz)(\"DOMContentLoaded\",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:\"bam.nr-data.net\",errorBeacon:\"bam.nr-data.net\"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)(\"visibilitychange\",(function(){if(t)return void(\"hidden\"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i=\"nr@original\";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n=\"\");var a,s,c,u=\"-\"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,\"fetch\",y),t.on(y+\"end\",(function(e,r){var n=this;if(r){var i=r.headers.get(\"content-length\");null!==i&&(n.rxSize=i),t.emit(y+\"done\",[null,r],n)}else t.emit(y+\"done\",[e],n)})),t}const O={},j=[\"pushState\",\"replaceState\"];function S(e){const t=function(e){return(e||n.ee).get(\"history\")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,\"-\")),t}var P=r(3239);const C={},R=[\"appendChild\",\"insertBefore\",\"replaceChild\"];function I(e){const t=function(e){return(e||n.ee).get(\"jsonp\")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\\.([^.]+)/,a=/^(\\w+)(\\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,\"dom-\"),t.on(\"dom-start\",(function(e){!function(e){if(!e||\"string\"!=typeof e.nodeName||\"script\"!==e.nodeName.toLowerCase())return;if(\"function\"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if(\"function\"!=typeof u.parent[u.key])return;var d={};function f(){t.emit(\"jsonp-end\",[],d),e.removeEventListener(\"load\",f,(0,P.m$)(!1)),e.removeEventListener(\"error\",l,(0,P.m$)(!1))}function l(){t.emit(\"jsonp-error\",[],d),t.emit(\"jsonp-end\",[],d),e.removeEventListener(\"load\",f,(0,P.m$)(!1)),e.removeEventListener(\"error\",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],\"cb-\",d),e.addEventListener(\"load\",f,(0,P.m$)(!1)),e.addEventListener(\"error\",l,(0,P.m$)(!1)),t.emit(\"new-jsonp\",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get(\"mutation\")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,\"fn-\")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get(\"promise\")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,\"executor-\",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,\"name\",{value:\"Promise\"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),[\"all\",\"race\"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a(\"all\"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit(\"propagate\",[null,!i],o,!1,!1),i=i||!e}}}})),[\"resolve\",\"reject\"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit(\"propagate\",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,[\"onreadystatechange\"],\"fn-\",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit(\"xhr-resolved\",[],e)),i.inPlace(e,f,\"fn-\",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,\"-xhr-\",E),r.on(\"send-xhr-start\",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on(\"open-xhr-start\",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on(\"fn-end\",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i=\"nr@seenError\"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i=\"sm\",o=\"cm\",a=\"storeSupportabilityMetrics\",s=\"storeEventMetrics\"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i=\"firstbyte\",o=\"domcontent\",a=\"windowload\"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i=\"bstResource\",o=\"resource\",a=\"-start\",s=\"-end\",c=\"fn\"+a,u=\"fn\"+s,d=\"pushState\"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=[\"click\",\"submit\",\"keypress\",\"keydown\",\"keyup\",\"change\"],a=999,s=\"fn-start\",c=\"fn-end\",u=\"cb-start\",d=\"api-ixn-\",f=\"remaining\",l=\"interaction\",h=\"spaNode\",g=\"jsonpNode\",p=\"fetch-start\",m=\"fetch-done\",v=\"fetch-body-\",b=\"jsonp-end\",y=n.Yu.ST,w=\"-start\",x=\"-end\",A=\"-body\",E=\"cb\"+x,T=\"jsTime\",_=\"fetch\"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();[\"setErrorHandler\",\"finished\",\"addToTrace\",\"inlineHit\",\"addRelease\",\"addPageAction\",\"setCurrentRouteName\",\"setPageViewName\",\"setCustomAttribute\",\"interaction\",\"noticeError\",\"setUserId\"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,\"api\");const h={};var g=a.ee.get(e),p=g.get(\"tracer\"),m=\"api-\",v=m+\"ixn-\";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?\"session\":void 0)(t,r)}function y(){}[\"setErrorHandler\",\"finished\",\"addToTrace\",\"inlineHit\",\"addRelease\"].forEach((e=>h[e]=x(m,e,!0,\"api\"))),h.addPageAction=x(m,\"addPageAction\",!0,n.D.pageAction),h.setCurrentRouteName=x(m,\"routeName\",!0,n.D.spa),h.setPageViewName=function(t,r){if(\"string\"==typeof t)return\"/\"!==t.charAt(0)&&(t=\"/\"+t),(0,i.OP)(e).customTransaction=(r||\"http://custom.transaction\")+t,x(m,\"setPageViewName\",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if(\"string\"==typeof e){if([\"string\",\"number\"].includes(typeof t)||null===t)return b(e,t,\"setCustomAttribute\",r);(0,f.Z)(\"Failed to execute setCustomAttribute.\\nNon-null value must be a string or number type, but a type of was provided.\"))}else(0,f.Z)(\"Failed to execute setCustomAttribute.\\nName must be a string type, but a type of was provided.\"))},h.setUserId=function(e){if(\"string\"==typeof e||null===e)return b(\"enduser.id\",e,\"setUserId\",!0);(0,f.Z)(\"Failed to execute setUserId.\\nNon-null value must be a string type, but a type of was provided.\"))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a=\"function\"==typeof t;return(0,o.p)(v+\"tracer\",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?\"\":\"no-\")+\"fn-start\",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit(\"fn-err\",[arguments,this,\"string\"==typeof e?new Error(e):e],r),e}finally{p.emit(\"fn-end\",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,[\"API/\"+t+\"/called\"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,\"api\")})).catch((()=>(0,f.Z)(\"Downloading runtime APIs failed...\")))}return[\"actionText\",\"setName\",\"setAttribute\",\"save\",\"ignore\",\"onEnd\",\"getContext\",\"end\",\"get\"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){\"string\"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,[\"API/noticeError/called\"],void 0,n.D.metrics,g),(0,o.p)(\"err\",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,\"api\"),(0,h.Qy)(e,A,\"exposed\"),(0,h.EZ)(\"activatedFeatures\",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:\"ajax\",jserrors:\"jserrors\",metrics:\"metrics\",pageAction:\"page_action\",pageViewEvent:\"page_view_event\",pageViewTiming:\"page_view_timing\",sessionReplay:\"session_replay\",sessionTrace:\"session_trace\",spa:\"spa\"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:\"page_action-aggregate\",147:\"metrics-aggregate\",242:\"session-manager\",317:\"jserrors-aggregate\",348:\"page_view_timing-aggregate\",412:\"lazy-feature-loader\",439:\"async-api\",538:\"recorder\",590:\"session_replay-aggregate\",675:\"compressor\",733:\"session_trace-aggregate\",786:\"page_view_event-aggregate\",873:\"spa-aggregate\",898:\"ajax-aggregate\"}[e]||e)+\".\"+{78:\"ac76d497\",147:\"3dc53903\",148:\"1a20d5fe\",242:\"2a64278a\",317:\"49e41428\",348:\"bd6de33a\",412:\"2f55ce66\",439:\"30bd804e\",538:\"1b18459f\",590:\"cf0efb30\",675:\"ae9f91a8\",733:\"83105561\",786:\"06482edd\",860:\"03a8b7a5\",873:\"e6b09d52\",898:\"998ef92b\"}[e]+\"-1.236.0.min.js\"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t=\"NRBA:\",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName(\"script\"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:\"timeout\",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{\"undefined\"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:\"Module\"}),Object.defineProperty(e,\"__esModule\",{value:!0})},i.j=364,i.p=\"https://js-agent.newrelic.com/\",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&(\"load\"===r.type?\"missing\":r.type),a=r&&r.target&&r.target.src;s.message=\"Loading chunk \"+t+\" failed.\\n(\"+o+\": \"+a+\")\",s.name=\"ChunkLoadError\",s.type=o,s.request=a,n[1](s)}}),\"chunk-\"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,\"\".concat(e,\".enabled\"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,\"privacy.cookies_enabled\");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)(\"A problem occurred when starting up session manager. This page will not start or extend any session.\",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,\"aggregate\");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)(\"Downloading and initializing \".concat(this.featureName,\" failed...\"),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,\"session_trace.enabled\")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),(\"undefined\"==typeof PerformanceNavigationTiming||c.Tt)&&\"undefined\"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)(\"timing\",[\"load\",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if(\"count\"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r=\"\",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean(\"hidden\"===document.visibilityState),(0,N.N)((()=>(0,s.p)(\"docHidden\",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)(\"pagehide\",(()=>(0,s.p)(\"winPagehide\",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem(\"__nr_flags\").split(\",\"),console&&\"function\"==typeof console.log&&(L.console=!0,-1!==R.indexOf(\"dev\")&&(L.dev=!0),-1!==R.indexOf(\"nr_dev\")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on(\"internal-error\",(function(e){z(e.stack)})),L.dev&&H.ee.on(\"fn-err\",(function(e,t,r){z(r.stack)})),L.dev&&(z(\"NR AGENT IN DEVELOPMENT MODE\"),z(\"flags: \"+(0,b.D)(L,(function(e,t){return e})).join(\", \")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on(\"fn-start\",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on(\"fn-err\",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)(\"err\",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on(\"fn-end\",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on(\"internal-error\",(function(t){(0,s.p)(\"ierr\",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener(\"unhandledrejection\",(t=>{const r=function(e){let t=\"Unhandled Promise Rejection: \";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)(\"err\",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){\"function\"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)(\"err\",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)(\"ierr\",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||\"Uncaught error with no additional information\",this.sourceURL=t,this.line=r}let U=1;const q=\"nr@id\";function G(e){const t=typeof e;return!e||\"object\"!==t&&\"function\"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if(\"string\"==typeof e&&e.length)return e.length;if(\"object\"==typeof e){if(\"undefined\"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if(\"undefined\"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!(\"undefined\"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||\"\").toString()||null,i=(r.agentID||\"\").toString()||null,o=(r.trustKey||\"\").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return\"00-\"+t+\"-\"+e+\"-01\"}generateTraceContextStateHeader(e,t,r,n,i){return i+\"@nr=0-1-\"+r+\"-\"+n+\"-\"+e+\"----\"+t}generateTraceHeader(e,t,r,n,i,o){if(!(\"function\"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:\"Browser\",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,\"distributed_tracing\")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener(\"load\",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener(\"progress\",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader(\"X-NewRelic-ID\",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader(\"newrelic\",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader(\"traceparent\",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader(\"tracestate\",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{\"abort\"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),(\"load\"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||\"function\"!=typeof t.onload)&&\"function\"==typeof o.end)&&o.end(t)}catch(e){try{n.emit(\"internal-error\",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set(\"newrelic\",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set(\"traceparent\",t.traceContextParentHeader),t.traceContextStateHeader&&e.set(\"tracestate\",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;\"string\"==typeof i?r=i:\"object\"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&\"object\"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(\"\"+(i&&i instanceof Y&&i.method||n.method||\"GET\")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,\"string\"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i(\"xhr\",[this.params,o,this.startTime,this.endTime,\"fetch\"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||\"agent\")),this.start()):(0,l.Z)(\"Failed to initial the agent. Could not determine the runtime environment.\")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t=\"features\";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)(\"\".concat(t.featureName,\" is enabled but one or more dependent features has been disabled (\").concat((0,D.P)(n),\"). This may cause unintended consequences or missing data...\")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)(\"Failed to initialize all enabled instrument classes (agent aborted) -\",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)(\"bst\",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)(\"bstHist\",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get(\"tracer\"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get(\"events\"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit(\"newURL\",[\"\"+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,\"xhr-resolved\"],this.featureName),f.buffer([ve],this.featureName),u.buffer([\"setTimeout\"+le,\"clearTimeout\"+fe,ve],this.featureName),d.buffer([ve,\"new-xhr\",\"send-xhr\"+fe],this.featureName),l.buffer([me+fe,me+\"-done\",me+he+fe,me+he+le],this.featureName),h.buffer([\"newURL\"],this.featureName),g.buffer([ve],this.featureName),s.buffer([\"propagate\",be,ge,\"executor-err\",\"resolve\"+fe],this.featureName),o.buffer([ve,\"no-\"+ve],this.featureName),a.buffer([\"new-jsonp\",\"cb-start\",\"jsonp-error\",\"jsonp-end\"],this.featureName),y(l,me+fe),y(l,me+\"-done\"),y(a,\"new-jsonp\"),y(a,\"jsonp-end\"),y(a,\"cb-start\"),h.on(\"pushState-end\",m),h.on(\"replaceState-end\",m),window.addEventListener(\"hashchange\",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener(\"load\",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener(\"popstate\",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:\"spa\"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is \"complete\" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event \"completion\" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', \"PixelInitialized\", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { \"@context\": \"https://schema.org\", \"@type\": \"ScholarlyArticle\", \"mainEntityOfPage\": { \"@type\": \"WebPage\", \"@id\": \"https://f1000research.com/articles/13-602\" }, \"headline\": \"An exploration of burnout among hospital first-line managers in Indonesia during the COVID-19 pandemic\", \"datePublished\": \"2024-06-07T15:12:37\", \"dateModified\": \"2024-06-07T15:12:37\", \"author\": [ { \"@type\": \"Person\", \"name\": \"Sri Nining\" }, { \"@type\": \"Person\", \"name\": \"Rr. Tutik Sri Hariyati\" }, { \"@type\": \"Person\", \"name\": \"Tuti Nuraini\" }, { \"@type\": \"Person\", \"name\": \"Prayetni Prayetni\" }, { \"@type\": \"Person\", \"name\": \"Tuti Afriani\" }, { \"@type\": \"Person\", \"name\": \"Elisabet Herlyani Bota Koten\" }, { \"@type\": \"Person\", \"name\": \"Siti Hardiyanti\" }, { \"@type\": \"Person\", \"name\": \"Azwar Azwar\" }, { \"@type\": \"Person\", \"name\": \"Yuvensius Pili\" }, { \"@type\": \"Person\", \"name\": \"Aria Wahyuni\" }, { \"@type\": \"Person\", \"name\": \"Suherman Suherman\" }, { \"@type\": \"Person\", \"name\": \"Yelmi Reni Putri\" }, { \"@type\": \"Person\", \"name\": \"Ropika Ningsih\" }, { \"@type\": \"Person\", \"name\": \"Asriadi Asriadi\" }, { \"@type\": \"Person\", \"name\": \"Lusianus Demon Kehi\" }, { \"@type\": \"Person\", \"name\": \"Yuliana Yuliana\" } ], \"publisher\": { \"@type\": \"Organization\", \"name\": \"F1000Research\", \"logo\": { \"@type\": \"ImageObject\", \"url\": \"https://f1000research.com/img/AMP/F1000Research_image.png\", \"height\": 480, \"width\": 60 } }, \"image\": { \"@type\": \"ImageObject\", \"url\": \"https://f1000research.com/img/AMP/F1000Research_image.png\", \"height\": 1200, \"width\": 150 }, \"description\": \" Background High work pressure and complex problems during the COVID-19 pandemic caused nursing staff, including first-line managers, experienced burnout. Objective This study aims to explore burnout experienced of first-line managers during the COVID-19 pandemic. Methods This qualitative descriptive study used thematic analysis. Twelve first-line managers were selected using purposive sampling from two government hospitals, designated as COVID-19 referral centres in Jakarta and Depok, Indonesia. Data were collected through semi-structured online face-to-face interviews using ZOOM meeting video with a guideline interview. Results Exploration of first-line manager&rsquo;s burnout revealed three themes: 1) unpreparedness, 2) impact on wellbeing, and 3) resilience. Conclusion The first-line managers experienced burnout during the pandemic due to obstacles in implementing management roles and functions accompanied. Their burnout was caused by the unpreparedness of both the hospital management and the community. Their burnout has an impact on their emotional and physical well-being. By this time, the first-line manager&rsquo;s resilience was formed because they used adaptive coping mechanisms and had a good support system. The experience during COVID-19 should be a lesson learned to strengthen the healthcare system in the future. Risk management mitigation must be systematically and routinely performed. \" } { \"@context\": \"http://schema.org\", \"@type\": \"BreadcrumbList\", \"itemListElement\": [ { \"@type\": \"ListItem\", \"position\": \"1\", \"item\": { \"@id\": \"https://f1000research.com/\", \"name\": \"Home\" } }, { \"@type\": \"ListItem\", \"position\": \"2\", \"item\": { \"@id\": \"https://f1000research.com/browse/articles\", \"name\": \"Browse\" } }, { \"@type\": \"ListItem\", \"position\": \"3\", \"item\": { \"@id\": \"https://f1000research.com/articles/13-602\", \"name\": \"An exploration of burnout among hospital first-line managers in Indonesia...\" } } ] } Home Browse An exploration of burnout among hospital first-line managers in Indonesia... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Nining S, Hariyati RTS, Nuraini T et al. An exploration of burnout among hospital first-line managers in Indonesia during the COVID-19 pandemic [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :602 ( https://doi.org/10.12688/f1000research.146209.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article An exploration of burnout among hospital first-line managers in Indonesia during the COVID-19 pandemic [version 1; peer review: 1 approved with reservations] Sri Nining https://orcid.org/0000-0001-5613-1227 1,2 , Rr. Tutik Sri Hariyati 3 , Tuti Nuraini 3 , [...] Prayetni Prayetni 4 , Tuti Afriani 3 , Elisabet Herlyani Bota Koten https://orcid.org/0000-0003-4241-8432 5 , Siti Hardiyanti https://orcid.org/0009-0001-4905-1306 6 , Azwar Azwar 6 , Yuvensius Pili https://orcid.org/0009-0009-9069-0837 6,7 , Aria Wahyuni 6,8 , Suherman Suherman 6 , Yelmi Reni Putri https://orcid.org/0000-0002-9417-9931 6,9 , Ropika Ningsih https://orcid.org/0000-0002-7089-9432 6,8 , Asriadi Asriadi https://orcid.org/0000-0002-0877-0988 6,10 , Lusianus Demon Kehi 6 , Yuliana Yuliana 11 Sri Nining https://orcid.org/0000-0001-5613-1227 1,2 , Rr. Tutik Sri Hariyati 3 , [...] Tuti Nuraini 3 , Prayetni Prayetni 4 , Tuti Afriani 3 , Elisabet Herlyani Bota Koten https://orcid.org/0000-0003-4241-8432 5 , Siti Hardiyanti https://orcid.org/0009-0001-4905-1306 6 , Azwar Azwar 6 , Yuvensius Pili https://orcid.org/0009-0009-9069-0837 6,7 , Aria Wahyuni 6,8 , Suherman Suherman 6 , Yelmi Reni Putri https://orcid.org/0000-0002-9417-9931 6,9 , Ropika Ningsih https://orcid.org/0000-0002-7089-9432 6,8 , Asriadi Asriadi https://orcid.org/0000-0002-0877-0988 6,10 , Lusianus Demon Kehi 6 , Yuliana Yuliana 11 PUBLISHED 07 Jun 2024 Author details Author details 1 Nursing, Universitas Kristen Krida Wacana, Central Jakarta, Indonesia 2 Nursing Committee, Woman and Child Bunda Jakarta, Central Jakarta, Jakarta, 10350, Indonesia 3 Department of Basic Science and Fundamental Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia 4 Nursing, Poltekkes Kemenkes Jakarta III, Bekasi, West Java, 17415, Indonesia 5 Nursing, Bundamedik Healthcare System, Central Jakarta, Jakarta, 10350, Indonesia 6 Faculty of Nursing, Universitas Indonesia, Depok, West Java, 16424, Indonesia 7 Nursing, Aeramo General Hospital Nagekeo, East Nusa Tenggara, East Nusa Tenggara, 86472, Indonesia 8 Faculty of Nursing, Universitas Muhammadiyah Sumatera Barat, Padang, West Sumatra, 25172, Indonesia 9 Faculty of Nursing, Fort de Kock University, Bukittinggi, West Sumatra, 26129, Indonesia 10 Nursing, Universitas Mega Buana Palopo, Palopo, South Sulawesi, 91912, Indonesia 11 Nursing Corporate, Eka Hospital, Bumi Serpong Damai, Indonesia Sri Nining Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Rr. Tutik Sri Hariyati Roles: Conceptualization, Formal Analysis, Supervision Tuti Nuraini Roles: Conceptualization, Supervision, Validation Prayetni Prayetni Roles: Conceptualization, Supervision, Validation Tuti Afriani Roles: Writing – Original Draft Preparation Elisabet Herlyani Bota Koten Roles: Data Curation, Methodology, Project Administration Siti Hardiyanti Roles: Funding Acquisition, Resources, Validation Azwar Azwar Roles: Funding Acquisition, Investigation, Project Administration Yuvensius Pili Roles: Data Curation, Methodology, Software Aria Wahyuni Roles: Data Curation, Funding Acquisition Suherman Suherman Roles: Data Curation, Funding Acquisition, Resources Yelmi Reni Putri Roles: Funding Acquisition, Visualization Ropika Ningsih Roles: Funding Acquisition, Software Asriadi Asriadi Roles: Funding Acquisition, Investigation Lusianus Demon Kehi Roles: Funding Acquisition, Project Administration Yuliana Yuliana Roles: Writing – Original Draft Preparation OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background High work pressure and complex problems during the COVID-19 pandemic caused nursing staff, including first-line managers, experienced burnout. Objective This study aims to explore burnout experienced of first-line managers during the COVID-19 pandemic. Methods This qualitative descriptive study used thematic analysis. Twelve first-line managers were selected using purposive sampling from two government hospitals, designated as COVID-19 referral centres in Jakarta and Depok, Indonesia. Data were collected through semi-structured online face-to-face interviews using ZOOM meeting video with a guideline interview. Results Exploration of first-line manager’s burnout revealed three themes: 1) unpreparedness, 2) impact on wellbeing, and 3) resilience. Conclusion The first-line managers experienced burnout during the pandemic due to obstacles in implementing management roles and functions accompanied. Their burnout was caused by the unpreparedness of both the hospital management and the community. Their burnout has an impact on their emotional and physical well-being. By this time, the first-line manager’s resilience was formed because they used adaptive coping mechanisms and had a good support system. The experience during COVID-19 should be a lesson learned to strengthen the healthcare system in the future. Risk management mitigation must be systematically and routinely performed. READ ALL READ LESS Keywords Pandemic, COVID-19, Burnout, First-line manager, Nursing Corresponding Author(s) Sri Nining ( [email protected] ) Close Corresponding author: Sri Nining Competing interests: No competing interests were disclosed. Grant information: This study was supported by Lembaga Pengelola Dana Pendidikan (LPDP), awarded to all the authors, except the supervisors. We confirm that the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Nining S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Nining S, Hariyati RTS, Nuraini T et al. An exploration of burnout among hospital first-line managers in Indonesia during the COVID-19 pandemic [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :602 ( https://doi.org/10.12688/f1000research.146209.1 ) First published: 07 Jun 2024, 13 :602 ( https://doi.org/10.12688/f1000research.146209.1 ) Latest published: 07 Jun 2024, 13 :602 ( https://doi.org/10.12688/f1000research.146209.1 ) Background The COVID-19 pandemic remains the focus of current global problems, especially in the world of health. Nurses, the largest fleet in handling COVID-19 (57% of all caregivers), experience significant professional, social, and psychological challenges with unique and unprecedented conditions ( Duncan, 2020 ; Poortaghi et al., 2021 ; Rothan & Byrareddy, 2020 ; WHO, 2020 ). The burnout experienced by nurses before the pandemic increased as psychological pressure increased during the pandemic. The March-April 2021 survey found that 53% of health workers experienced at least two of the four symptoms of mental health disorders, namely PTSD (post-traumatic syndrome disorder) , anxiety, distress, and despair, even when taking the initiative to commit suicide ( Bryant-Genevier et al., 2021 ). In Indonesia, a study found that 52.5% of nurses experienced high burnout ( Marpaung et al., 2020 ) . The nursing profession is vulnerable to mental problems because their work is related to the continuation of human life ( Wang et al., 2020 ) ( Havaei et al., 2021 ). Nurses, including first-line managers, have experienced high demands and complex problems during the COVID-19 pandemic caused nurse, including first-line managers, experienced burnout . The burnout experienced by executives and nurse managers is different. Managers’ burnout is due to their duties and responsibilities in managing the organization, nurses’ burnout is due to their duties as care providers to patients ( Kelly et al., 2019 ; Johnson et al., 2020 ; Remegio et al., 2021 ). Several studies have shown that burnout is felt not only by clinical nurses, but also by nursing managers. Research conducted by White (2021) and Raso (2021) proved that as a result of the pandemic, 83% of nursing managers experienced mental stress, which increased due to the pandemic. In a crisis such as the current one, managers must dynamically use situational management and flexibility. Despite their problems, nursing managers with a strong presence in the field are good role models for the remaining staff ( Poortaghi et al., 2021 ; Rosa et al., 2020 ; Yau et al., 2021 ). There are many ways to handle burnout , but choosing the right strategy must be adapted to individual needs. According to Dall'Ora, Ball, Reinius, and Griffiths (2020) , burnout management strategies can vary based on the symptoms they cause or can be adjusted to the organization's ability to carry out management. To date, research exploring nurse managers' experiences in dealing with the pandemic is still rare. A study of nurse managers conducted by White (2021) revealed that nurse managers experienced burnout during the pandemic. Handling burnout in first-line managers requires a deep understanding of the phenomenon in the first-line manager. Therefore, research is needed to explore the symptoms of burnout in nurse managers so that appropriate interventions can be provided. Based on this phenomenon, researchers are interested in exploring burnout among first-line manager s during the COVID-19 pandemic in hospitals that are COVID-19 referral centers. Methods Study design This qualitative study uses a phenomenological approach to understand the burnout experienced by first-line managers during the COVID-19 pandemic. Table 1. Categories and themes derived from data analysis. Theme Sub Theme Unpreparedness Hospital management unpreparedness: a. Staffing b. Equipment c. Regulation Community unpreparedness Impacts on well-being Emotional well-being Physical well-being Resilience Adaptive coping mechanisms Support system Setting and participants The participants were selected from two government hospitals, designated as COVID-19 referral centres, situated near the initial emergence location of COVID-19 in Indonesia: Hospital X in Jakarta and Hospital Y in Depok. They were selected using a purposive sampling method with the following inclusion criteria: 1) the first-line manager who is the sole manager in a particular unit or room, 2) the first-line manager from a room where nursing staff or rooms are used in handling COVID-19, and 3) the first line manager who has held the position of first-line manager for more than three months during the pandemic period. Temporary first-line managers were excluded from this study. Participant selection was initiated with recommendations from hospital management through the key informant. The researcher, guided by the key informant, introduced themselves to potential participants based on predefined inclusion criteria. None of the patients who were asked to participate in this study refused. Research ethics This study was approved by the Ethics Committee of the Faculty of Nursing, Universitas Indonesia, as evidenced by the Certificate of Passing Ethical Review Number Ket-258/UN2.F12.D1.2.1/PPM.00.02/2021 on 5 th November 2021. In the study, participants voluntarily signed informed consent forms before participating. Researchers explained the procedures, objectives, benefits, risks of harm, rights, and obligations of the participants through a research explanation sheet. Participants were assured of their right to withdraw without penalty, and confidentiality measures were outlined to protect their identity and data. Informed signed consent was obtained from all participants prior to their involvement in the study. Participants were provided with a detailed explanation of the study objectives, procedures involved, potential risks, and benefits. They were assured of their voluntary participation and informed of their right to withdraw from the study at any time without penalty. The consent form outlined the confidentiality measures in place to protect their identity and data. Participants were encouraged to ask questions and seek clarification before providing consent. Data collection Data interviews were conducted from July to December 2021 by the first author as the interviewer with the support from two experts as supervisors. The interviewer is a nursing master's student that focus on the burnout during her academic study and she has an experience as nurse during covid for two months. The depth of data exploration increased as the interviewer, unaffiliated with any specific hospital, had greater freedom to delve into participants' burnout experiences. The research team had been done in qualitative research methodology training to support this study. We used a guideline interview approach, utilizing semi-structured interviews with open-ended questions. The interviewer and interview guidelines were tested by interviewing four department heads from different institution with the study. The results of each test were recorded and reviewed with the supervisors. The research proceeded upon receiving supervisor approval to continue the interviews. Each interview was conducted individually, lasting 60-90 minutes, with participants having the flexibility to request breaks or reschedule subsequent interviews as needed. Meetings were conducted using the ZOOM platform to enable face-to-face virtual interaction from participants' homes and workplaces, as requested, thereby ensuring compliance with social distancing guidelines. During the interviews, participants were alone to allow them greater freedom in expressing themselves. There was no repetition of interviews in this study. We reached data saturation with the 12th participant as there was no more new information, thus, no other participants were recruited. Data analysis All the interview sessions were recorded and transcribed. We used field notes to record participants' expressions during the interview. Transcribed data were returned to participants for confirmation and clarification before the next data processing. Furthermore, the researcher's reflections are also documented during the analysis process to ensure accuracy and honesty in data interpretation. We analyzed all the data using inductive thematic analysis, which consisted of six stages: recognizing and transcribing data, coding data, compiling themes, reviewing themes that have been prepared, naming and defining themes, and reporting results reports ( Braun et al., 2019 ). The analysis process used NVivo 12 Plus. The results study were shared with participants and checked by them. Two experts supervised this research, and its validity was tested through a thesis examination with two experts as examiners and nursing master's students as opponents. This process ensured that the research was high-quality and reliable. Results Twelve first-line managers from two hospitals participated in this study. In general, participants were aged 32-54 years, female and male, with work experience as a nurse of 11-35 years and experience as a first-line manager of 4 months-7 years. All participants were married. The educational level of the participants was D3 and they had a bachelor's degree in nursing. However, in the interviews, it was discovered that several participants were currently studying for a bachelor's degree in nursing and a master's degree in nursing. There were variations in work units; there were participants who were first-line managers working at the Emergency Room, Children's inpatients, adult inpatients, NICU-PICU, and HCU-ICU; some were specifically for COVID-19, and some were not specifically for COVID-19. During the pandemic, both hospitals implemented a first-line manager rotation system. However, in this study, several participants were never rotated to the COVID-19 treatment section, so the variation was that they had been in the COVID-19 room and never been in the COVID-19 room. The thematic analysis of the collected data revealed three themes: 1) unpreparedness, 2) Impacts on well-being and 3) resilience. These three themes reveal the critical meaning of first-line managers’ experience of burnout experiences ( Table 1 ). Unpreparedness All participants expressed that the main difficulty they experienced was related to COVID-19 and their unpreparedness to face the pandemic. Unpreparedness in meeting COVID-19 needs refers to ability and self-preparation, both by hospital management and the community. Participants stated that the unpreparedness observed at the level of hospital management was unpreparedness for personnel, equipment, and regulations. In contrast, unpreparedness on the part of the community was unpreparedness for changes in care, which caused the community to complain, and unpreparedness in knowledge caused negative reaction to the health worker such as discrimination and rejection from the community due to fear and suspicion of infection. 1) Hospital management unpreparedness a. Staffing Hospital management's unpreparedness for the rapidly increasing and significant service demands has caused the participants to experience burnout. The first-line managers had to provide sufficient nursing resources quickly, while the available ones were limited. The utilization of volunteer workers posed a challenge as they needed more readiness for immediate use. There are many patients, but, honestly, we don't have many nurses. (P1) Plus, the nurses … or nurses who have to serve are not all trained as ICU nurses. That’s why, we need emergency training to introduce them to what a ventilator is, what an ICU room is, and what we are like, how to work in the ICU, which is done on a cito basis. (P5) b. Equipment Participants expressed a lack of preparedness for equipment, insufficient quantity during high demand, and complicated and ever-changing rules for tool usage. Shortages of beds, oxygen, computers, and personal protective equipment have been reported as obstacles. Well, yes, what we want is that when the patient's condition is critical, we want oxygen to be available, we want this to be available … often… that is because several times the facilities are not there (P4) There are many rules, such as if we have finished preparing the room, we have to report and adjust by considering various possibilities. However, if the supervisor disagrees, it means we have to change it again, change it again, and that also takes time, you know… (P1) c. Regulation The participants reported that due to a lack of preparedness in handling COVID-19, governments and hospitals were unprepared for service standards during the pandemic, restrictions on leave and additional duties for first-line managers, including vaccination. These regulations became obstacles because they often changed, and several policies disrupted the first-line managers’ duties. Policies that can change quickly regarding to the pandemic, looking at the situation and developments of Covid (P11) Besides that, in Covid, the first line manager is also charged as a vaccinator, like that! (P3) 2) Community unpreparedness Community unpreparedness was reported in association with changes in service patterns that caused the community or clients to complain. Society's reaction to the changes during the COVID-19 pandemic has led to negative stigma surrounding individuals who have contracted the virus, frontline workers, and marginalized communities. The stigma involves isolation and discriminatory behavior towards certain individuals or groups due to fear and suspicion of infection. These complaints and stigmas were stressors for the first-line managers. The reaction comes from the unclear information about how to face the pandemic. Moreover, patients who complain, want to be visited by their families. Furthermore, patients who die … what is the name of the body? May not be brought into the room (P3) Because they knew I was a nurse, they initially made a distance between me and my family… I felt that society excluded us as a family (P12) Impacts on well-being The participants expressed several impacts of COVID-19 on their psychological and physical well-being. According to them, the impact of COVID-19 was both psychological, such as negative emotions and physical, and disrupted health during the pandemic. 1) Emotional well-being The first-line managers expressed the emotions they experienced during COVID-19, such as disappointment, annoyance, fatigue, anger, sadness, stress, and fear. Researchers noted that female participants expressed their emotions more expressively, such as clenching their fists when angry or annoyed and teary-eyed when expressing sadness. However, for men, their emotional expressions were calmer, and they did not show any distinctive facial or physical expressions. That time, I wanted to take break soon, but because the Covid [infection rate] was high, we [could do so only] when we could take time off. We could not apply for leave, so we had to endure the tiredness for the sake of service, and yeah! The tiredness should be endured throughout the service. Psychologically, we want to [be] angry. We have to endure whatever we want; no matter what, we still have to endure it, right? Yes, even though our hearts are annoyed. (P8) I had, eh… Without realizing it, I said some rather harsh words, but there were still ethics in my words. However, after that, I apologized to my nurses. They already knew and understood that I was angry (P2) At first, when I was given the assignment in the unit with many rooms and beds, I cried; I cried because there was so much to do and so much to adjust. Finally, behind my back, I cried. I cried, honestly, because my head was dizzy with the many tasks and rules (P1) 2) Physical well-being The COVID-19 pandemic has resulted in burnout, which, in turn, has disrupted the physical well-being of all individuals involved. The negative impact on physical well-being found in all participants was changes in sleep patterns, eating patterns, and health problems. Nevertheless, it cannot be helped, as the first-line manager in charge, I have to make sure our friends are safe first, then me. Such as eating time, for example, I prefer my friends to eat first, then me after them. It is like that word. They are full first, and then we will be full later. Even though I was hungry. (P8) … it just so happens that I have hypertension… I have hypertension, during the pandemic, my blood pressure was constantly high about 130 (P1) That time, I got COVID, my body was starting to feel feverish. In the morning, I checked. I am positive, Like that. Yes, maybe my fatigue is also a factor. (P3) Yes, I have been confirmed. Finally, it got sick, yes sick (P6) Resilience Researchers found that, over time, first-line managers’ resilience was formed against burnout due to COVID-19. The resilience of first-line managers helped them use adaptive coping mechanisms and a good support system. 1) Adaptive coping mechanisms The research found that all participants could use adaptive coping mechanisms when facing the role of first-line managers during the COVID-19 pandemic. The coping mechanisms used by the participants were acceptance, solitude, sharing, distraction, and spirituality. The coping mechanisms of spirituality and acceptance were the most frequently found among participants. I want to refuse, I want to refuse, honestly, I refuse… it would be better for me to be a staff member in a regular room… I was so dizzy then I told my friends that I wanted to resign, I wanted to ask to be transferred…, but my friends kept looking for support to motivate me to stay in my position (P1) Making a new program with the latest room conditions is a challenge for me (P11) In June, literature and references related to nursing services for COVID-19 began to appear. So we also have learn more. We also have to find much literature and the latest references related to nursing outcomes of COVID-19 patients (P12) Thank God. In the beginning, I was stressed, but thanks God, by the time, the stress became less and gone (P3) To get refreshed, sometimes, when I was bored, I listen to spiritual music to collect my strength (P10) I switched my focus. I was taught by a close friend to read books, and I watched Korean dramas (P1) 2) Support system This study found that participants' resilience stemmed from strong support systems both within and outside the workplace such as work support, emotional support, and material support. Work-related support is provided by the government, hospital executives, co-workers, and donors. The work support is related to the support that enables the first line manager to address the issues in the room to provide optimal service, such as providing human resources, establishing new regulations, providing PPE, and various other assistance. Support outside of work is received from the community or neighbours, friends outside of work, and family where almost their support is more in emotional support, and sometimes food assistance. As for superiors, they are supportive, ma'am. Thank God, the nursing department at the hospital,is always there when there is a problem, immediately discuss it and find a solution (P9) They supported me. They said “come on, sir… Keep fighting!”. Then, there was also a program to share videos, and there was also a one-day activity that we shared our struggles with the management group (P3) We get rewards from the government. We also received a humanitarian heroes appreciation certificate from the nursing organisation, including from DPD PPNI for fellow nurses who handle COVID-19 services in the front line. Then, we also get a reward for SKP (Professional Credit Unit). For the SKP, they make it easier for us to renew our STR. (P12) Discussion This study found that first-line managers experienced burnout while performing their roles and functions during the COVID-19 pandemic. According to Maslach and Leiter's theory, the symptoms of burnout consist of 3 dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment ( Dall’Ora et al., 2020 ). The unpreparedness of various parties, especially hospital management and the community, to face the pandemic was the primary stressor for first-line manager burnout. Burnout impacted the psychological and physical well-being of participants. This shows that the dimensions of burnout are fulfilled by first-line managers, except for a decrease in self-achievement due to the resilience of the first line managers. The COVID-19 pandemic has become a very complicated issue for first-line managers because of their lack of experience in dealing with this issue. Even though pandemics have occurred previously, COVID-19 has been different because the virus spreads quickly and can be deadly( Rosa et al., 2020 ). Hospitals face a high demand for providing services immediately. The first-line managers had to ensure that the service ran while prioritizing patients and staff safety ( Middleton et al., 2021 ; Yau et al., 2021 ). Staffing and equipment constraints were the most significant obstacles in the early stage of the pandemic, which were experienced not only by the participants but also by various nursing institutions ( González-Gil et al., 2021 ; Liu et al., 2020 ). The unpreparedness for various resources obstructs work performance and motivation ( Batubara et al., 2020 ). If the work demands cannot be met immediately, it will cause first-line managers to experience burnout due to problems that still need to be resolved, even lingering beyond the workplace into their personal lives. This means that emotions and fatigue are felt throughout the day. The experience with the COVID-19 pandemic shows that hospitals must be able to mitigate disease disasters. Law No. 17 of 2023 mandates that dealing with disease outbreaks be the responsibility of health services ( Presiden RI, 2023 ). As part of risk management, the pandemic mitigation program must be implemented with a planned, budgeted, monitored, and reported program on an ongoing, systematic, logical, and measurable basis ( Kementerian Kesehatan, 2022 ). Pandemic mitigation simulations should be carried out periodically, similar to other emergency code simulations, such as the blue and red codes. The public's reaction during the observed early phase of the pandemic shows unpreparedness. Adverse reactions show this unpreparedness; it could even be said to be excessive, with the stigma spreading. This unpreparedness associated with a lack of information about how to deal with COVID-19, coupled with mass media reports about the deaths of many people and restrictions in public areas, which makes conditions even more tense ( Ramaci et al., 2020 ). The first-line managers experienced the impact of the community's reaction. First-line managers received the most complaints from patients and families because of restrictions on access to meet patients and various restrictions in the hospital area. The public stigma against health workers in close contact with COVID-19 causes first-line managers to experience unpleasant reactions. This condition made them anxious about interacting with the environment outside the hospital. Psychological pressure occurs not only at the workplace but also from the outside workplace ( Bryant-Genevier et al., 2021 ). This study found that the burnout of first-line managers impacted emotional well-being, such as anger, annoyance, disappointment, sadness, stress, tiredness, and fear. This was related to emotional exhaustion in the burnout dimension. This happens because the stress felt by participants is higher than their burnout. The same findings were also found among medical workers in Minnesota, where burnout was only the tip of the iceberg of the deep stress felt by the participants ( Britt et al., 2017 ). The first-line manager tries to carry out their interpersonal, decisional, and informational roles to the maximum, but circumstances such as unsupportive policies and limited resources make carrying out the part of the first-line manager a source of stress ( Navinés et al., 2021 ; Wihardja et al., 2019 ; Yau et al., 2021 ). It was also found that women had more forms of emotional expression than men, and were more expressive, such as crying and various bodily expressions. This statement supports previous research that states that burnout is higher in women than in men, especially in women who are married and have children ( Acosta-Ramos et al., 2021 ; Gupta et al., 2021 ; Lai et al., 2020 ; Rusca Putra & Setyowati, 2019 ; X. Zhang et al., 2021 ). Acosta-Ramos et al. (2021) and Rusca and Setyowati (2019) stated that women's vulnerability to burnout is related to their social lives and work outside the hospital, especially as housewives. Women's burnout is related to their positions as mothers and wives(L. Zhang et al., 2020 ). First-line manager burnout also has an impact on the physical condition . Some participants complained of a lack of sleep, body fat, and hypertension, and some even ended up being infected with COVID-19 due to fatigue. Research conducted by Gupta et al. (2021) stated that burnout can stimulate the autonomic nervous system (ANS), which modulates the physiological stress response; therefore, stress can cause changes in a person's physical health status and even cause cardiovascular disease. This condition is also associated with perceived sleep disorders, in which stress can cause sleep difficulties ( Wang et al., 2020 ). This study was conducted after approximately two years, with two waves of the COVID-19 pandemic in Indonesia. The results show that the participants had good resilience in facing COVID-19. All participants were able to use adaptive coping mechanisms when facing pandemics. Coping strategies include acceptance, sharing, solitude, diversion, and spirituality. The coping strategies most frequently used by participants were acceptance and spirituality. These two strategies were used by participants even before the pandemic, but these strategies have become very honed due to the pandemic. The reception coping developed by the first-line manager was related to adapting the first-line manager to the need for more information on handling services for COVID-19 patients. Spirituality coping is related to religion; one adheres to the first-line manager. The findings support previous research stating that nurses' abilities are usually exposed to burnout conditions , they are used to develop several adaptive coping strategies to deal with various unpleasant situations ( Shiu et al., 2021 ). This study found that while carrying out their duties as the first-line manager during the COVID-19 pandemic, the first-line managers received a lot of support such as work support, emotional support, and material support from inside and outside the workplace. Support from outside the workplace comes from friends, donors, and family, both immediate and extended. This support can be blessings or permission, understanding, prayers, food, being listened to, and not being forgotten. Participants received work support from the same first line manager, nurse staff, supervisor, and doctor. The support provided to first-line managers in the workplace includes assistance in problem-solving, emotional encouragement, and material aid such as incentives and food. Several participants have mentioned that solidarity arises in their workplace because of the shared feelings of destiny and resilience in confronting the same adversary, namely, the COVID-19 pandemic. From this study, we can learn that managers need to improve and maintain this work climate because the work cohesion that has been built will increase job satisfaction and also has an effect on nurses' burnout ( Penconek et al., 2021 ; Rusca Putra et al., 2021 ). The attitude of hospital management, including first-line managers, in handling the pandemic reflects a transformational leadership style. Several studies have recommended that managers needed to prevent burnout should embody a transformational leadership approach ( Kodama & Fukahori, 2017 ; Wei et al., 2020 ). The first-line manager came down to support and help to solve problem in their ward or unit. The supervisors of the participants have been giving out rewards, both material and psychological, although some people complained about the timing of getting the rewards. It's important to pay attention to rewards from the hospital management because they make nurses happier with their job, which can help reduce their burnout ( Putra et al., 2021 ). The hospital management where this study was conducted has implemented a strategy to address staff burnout by using rotation and sharing one positive thing. Sharing positive things helps people focus more on the good, so unpleasant experiences can be avoided. Thus, management strategies are the easiest, do not require high costs, and can be used quickly ( Nining et al., 2021 ; Tawfik et al., 2019 ). Preregistered data analysis Our study was not preregistered with any independent registry. We did not have a pre-established data analysis plan. As a result, all analyses presented in this manuscript were exploratory in nature. Data availability Underlying data Figshare: First Line Manager Burnout, https://doi.org/10.6084/m9.figshare.25423270.v7 ( Nining, 2024 ).nggu This project contains the following underlying data : 1. Nvivo Result: This document contains the results of NVIVO application analysis on participant statements regarding sub-themes and themes. 2. Theme categorisation: This document contains a table of selected meaningful words or sentences from each participant, which are subsequently categorized into themes and sub-themes. 3. Participants characteristic: details demographic data of all participant that used in this study. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). We are unable to share the transcript files and recordings due to an agreement with the participants, as stipulated and agreed upon in the informed consent and research explanation, to permanently delete all transcript files and recordings after the study was conducted. These measures are implemented to uphold the integrity and confidentiality of the data, in accordance with research ethics standards. This is especially crucial as the participant statements contain sensitive content. The Methods section contains detailed information to allow replication of the study. Any queries about the methodology should be directed to the corresponding author. Extended data Figshare: First Line Manager Burnout, https://doi.org/10.6084/m9.figshare.25423270.v7 ( Nining, 2024 ). This project contains the following extended data: 1. research explanation for participants: the information provided to the participants about the purpose, procedures, benefits, risks, and their rights in the study. This includes details on how their data will be used and protected, as well as how they can ask questions or withdraw from the study if needed. 2. informed consent: the voluntary agreement participants give after being fully informed about the details of the research/study procedures in the research explanation for participants. 3. interview guidelines: a guideline interview approach, utilizing semi-structured interviews with open-ended questions, allowing for in-depth understanding of participants' experiences during COVID-19. 4. COREQ checklist: used to assist authors in ensuring that the reports include sufficient and relevant information about research methodology, data analysis, and findings. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgments We thank Lembaga Pengelola Dana Pendidikan (LPDP) Indonesia for the scholarship funding provided during our academic studies that also help us to do this research. References Acosta-Ramos S, Ramirez-Martinez FR, Reveles Manriquez IJ, et al. : Burnout Syndrome and Association with Work Stress in Nursing Staff in Public Hospital of The Northern Border of Mexico. Arch. Psychiatr. Nurs. 2021; 35 (6): 571–576. PubMed Abstract | Publisher Full Text Batubara K, Syam B, Wahyuni SE: Job Demands–Resources Model Affects the Performance of Associate Nurses in Hospital. Jurnal Keperawatan Indonesia. 2020; 23 (2): 111–118. Publisher Full Text Braun V, Clarke V, Hayfield N, et al. :Thematic Analysis. In Handbook of Research Methods in Health Social Sciences. Springer Singapore . 2019; 843–860. Publisher Full Text Britt HR, Koranne R, Rockwood T: Statewide Improvement Approach to Clinician Burnout: Findings from the Baseline Year. Burn. Res. 2017; 7 (November): 29–35. Publisher Full Text Bryant-Genevier J, Rao CY, Lopes-Cardozo B, et al. : Symptoms of depression, anxiety, post-traumatic stress disorder, and suicidal ideation among state, tribal, local, and territorial public health workers during the COVID-19 pandemic — United States, March–April 2021. MMWR Morb. Mortal Wkly. Rep. 2021; 70 (26): 947–952. PubMed Abstract | Publisher Full Text | Free Full Text Dall’Ora C, Ball J, Reinius M, et al. : Burnout in nursing: A theoretical review. Hum. Resour. Health. 2020; 18 (1): 41. PubMed Abstract | Publisher Full Text | Free Full Text Duncan D: What the COVID-19 pandemic tells us about the need to develop resilience in the nursing workforce. Nurs. Manag. 2020; 27 (3): 22–27. PubMed Abstract | Publisher Full Text González-Gil MT, González-Blázquez C, Parro-Moreno AI, et al. : Nurses’ Perceptions and Demands Regarding COVID-19 Care Delivery in Critical Care Units and Hospital Emergency Services. Intensive Crit. Care Nurs. 2021; 62 (xxxx): 102966. PubMed Abstract | Publisher Full Text | Free Full Text Gupta MD, Jha MK, Bansal A, et al. : COVID 19-Related Burnout among Healthcare Workers in India and ECG Based Predictive Machine Learning Model: Insights from the BRUCEE- Li study. Indian Heart J. 2021; 73 (6): 674–681. PubMed Abstract | Publisher Full Text | Free Full Text Havaei F, Ma A, Staempfli S, et al. : Nurses’ workplace conditions impacting their mental health during Covid-19: a cross-sectional survey study. Healthcare. 2021; 9 (1): 1–14. PubMed Abstract | Publisher Full Text | Free Full Text Johnson LE, Nichols KJ, Sakhitab JA, et al. : Stress and Burnout in Nurse Leaders. Winona State University; 2020. Kelly LA, Lefton C, Fischer SA: Nurse leader burnout, satisfaction, and work-life balance. JONA. J. Nurs. Adm. 2019; 49 (9): 404–410. PubMed Abstract | Publisher Full Text Kementrian Kesehatan: STANDAR AKREDITASIRUMAH SAKIT KEMENTERIAN KESEHATAN RI TAHUN 2022. Kementerian Kesehatan RI Indonesia; 2022. Kodama Y, Fukahori H: Nurse managers’ attributes to promote change in their wards: a qualitative study. Nurs. Open. 2017; 4 (4): 209–217. PubMed Abstract | Publisher Full Text | Free Full Text Lai J, Ma S, Wang Y, et al. : Factors Associated with Mental Health Outcomes among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw. Open. 2020; 3 (3): e203976. PubMed Abstract | Publisher Full Text | Free Full Text Liu Y, Wang H, Chen J, et al. : Emergency Management of Nursing Human Resources and Supplies to Respond to Coronavirus Disease 2019 Epidemic. International Journal of Nursing Sciences. 2020; 7 (2): 135–138. PubMed Abstract | Publisher Full Text | Free Full Text Marpaung FV, Wiroko EP, Wicaksana S, et al. : Pengaruh iklim organisasi terhadap burnout pada perawat Rumah Sakit di Lebak dalam masa COVID-19. Journal of Behavior and Mental Health. 2020; 1 (2): 46–54. Publisher Full Text Middleton R, Loveday C, Hobbs C, et al. : The COVID-19 Pandemic – A focus on Nurse Managers’ Mental Health, Coping Behaviours and Organisational Commitment. Collegian. 2021; 28 (6): 703–708. PubMed Abstract | Publisher Full Text | Free Full Text Navinés R, Olivé V, Fonseca F, et al. : Work Stress and Resident Burnout, Before and During the COVID-19 Pandemia: An up-date. Medicina Clínica (English Edition). 2021; 157 (3): 130–140. PubMed Abstract | Publisher Full Text | Free Full Text Nining S: First Line Manager Burnout. Figshared. 2024. Publisher Full Text Nining S, Hariyati TS Rr., Rahman LOA, et al. : Psikoterapi Pemberdayaan: Berbagi Tiga Hal Baik untuk Mengatasi Burnout Perawat di Era COVID-19. Jurnal of Telenursing. 2021; 3 (2): 687–698. Publisher Full Text Penconek T, Tate K, Bernardes A, et al. : Determinants of nurse manager job satisfaction: A systematic review. Int. J. Nurs. Stud. 2021; 118 : 103906. PubMed Abstract | Publisher Full Text Poortaghi S, Shahmari M, Ghobadi A: Exploring Nursing Managers’ Perceptions of Nursing Workforce Management during the Outbreak of COVID-19: a Content Analysis Study. BMC Nurs. 2021; 20 (1): 10–27. PubMed Abstract | Publisher Full Text | Free Full Text Presiden RI: Undang-Undang RI Nomor 17 Tahun 2023 tentang Kesehatan. Presiden Republik Indonesia; 2023. Putra KR, Sutadi H, Setyowati S, et al. : The Impact of Nurse Manager Caring Behaviors and Work Environment on Burnout Syndrome among Nurses. Kontakt. 2021; 23 (2): 90–96. Publisher Full Text Ramaci T, Barattucci M, Ledda C, et al. : Social stigma during COVID-19 and its impact on HCWs outcomes. Sustainability (Switzerland). 2020; 12 (9). Publisher Full Text Raso R.:Nurse leader wellness: What’s changed in 3 years? Results of the second Nursing Management Wellness Survey. Nurs. Manag .2021; 52 (2). Publisher Full Text Remegio W, Rivera RR, Griffin MQ, et al. : The professional quality of life and work engagement of nurse leaders. Nurse Lead. 2021; 19 (1): 95–100. PubMed Abstract | Publisher Full Text | Free Full Text Rosa WE, Schlak AE, Rushton CH: A Blueprint for Leadership during COVID-19. Nurs. Manag. 2020; 51 (8): 28–34. PubMed Abstract | Publisher Full Text | Free Full Text Rothan HA, Byrareddy SN: The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J. Autoimmun. 2020; 109 : 102433. PubMed Abstract | Publisher Full Text | Free Full Text Rusca Putra K, Setyowati: Prevalence of Burnout Syndrome among Nurses in General Hospitals in Provincial East Java: Cross-Sectional Study. Enferm. Clin. 2019; 29 : 362–366. Publisher Full Text Rusca Putra K, Sutadi H, Setyowati S, et al. : The Effect of Caring Work Environment Model on Nurses’ Burnout in General Hospitals. International Journal of Public Health Science (IJPHS). 2021; 10 (3): 537. Publisher Full Text Shiu C, Chen W-T, Hung C-C, et al. : COVID-19 Stigma Associates with Burnout among Healthcare Providers: Evidence from Taiwanese Physicians and Nurses. J. Formos. Med. Assoc. 2021; 121 (xxxx): 1384–1391. PubMed Abstract | Publisher Full Text | Free Full Text Tawfik DS, Scheid A, Profit J, et al. : Evidence relating health care provider burnout and quality of care. Ann. Intern. Med. 2019; 171 (8): 555–567. PubMed Abstract | Publisher Full Text | Free Full Text Wang X, Jiang X, Huang Q, et al. : Risk Factors of SARS-CoV-2 Infection in Healthcare Workers: A Retrospective study of A Nosocomial Outbreak. Sleep Medicine: X. 2020; 2 (1): 100028. PubMed Abstract | Publisher Full Text | Free Full Text Wei H, King A, Jiang Y, et al. : The impact of nurse leadership styles on nurse burnout:: a systematic literature review. Nurse Lead. 2020; 18 (5): 439–450. Publisher Full Text White J. H.: A Phenomenological Study of Nurse Managers' and Assistant Nurse Managers' Experiences during the COVID-19 Pandemic in the United States. J. Nurs. Manag .2021; 29 (6). Publisher Full Text WHO, W. H. O: State Of World’ S Nursing 2020.2020. Wihardja H, Hariyati TS Rr., Gayatri D: Analysis of factors related to the mental workload of nurses during interaction through nursing care in the intensive care unit. Enferm. Clin. 2019; 29 : 262–269. Publisher Full Text Yau B, Vijh R, Prairie J, et al. : Lived Experiences of Frontline Workers and Leaders during Covid-19 Outbreaks in Long-term Care: A Qualitative Study. Am. J. Infect. Control. 2021; 49 : 978–984. PubMed Abstract | Publisher Full Text | Free Full Text Zhang L, Jin T, Jiang H: The Mediating Role of Career Calling in the Relationship Between Family-Supportive Supervisor Behaviors and Turnover Intention Among Public Hospital Nurses in China. Asian Nurs. Res. 2020; 14 (5): 306–311. PubMed Abstract | Publisher Full Text Zhang X, Jiang X, Ni P, et al. : Association between Resilience and Burnout of Front-Line Nurses at The Peak of the COVID-19 Pandemic: Positive and Negative Affect as Mediators in Wuhan. Int. J. Ment. Health Nurs. 2021; 30 (4): 939–954. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 07 Jun 2024 ADD YOUR COMMENT Comment Author details Author details 1 Nursing, Universitas Kristen Krida Wacana, Central Jakarta, Indonesia 2 Nursing Committee, Woman and Child Bunda Jakarta, Central Jakarta, Jakarta, 10350, Indonesia 3 Department of Basic Science and Fundamental Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia 4 Nursing, Poltekkes Kemenkes Jakarta III, Bekasi, West Java, 17415, Indonesia 5 Nursing, Bundamedik Healthcare System, Central Jakarta, Jakarta, 10350, Indonesia 6 Faculty of Nursing, Universitas Indonesia, Depok, West Java, 16424, Indonesia 7 Nursing, Aeramo General Hospital Nagekeo, East Nusa Tenggara, East Nusa Tenggara, 86472, Indonesia 8 Faculty of Nursing, Universitas Muhammadiyah Sumatera Barat, Padang, West Sumatra, 25172, Indonesia 9 Faculty of Nursing, Fort de Kock University, Bukittinggi, West Sumatra, 26129, Indonesia 10 Nursing, Universitas Mega Buana Palopo, Palopo, South Sulawesi, 91912, Indonesia 11 Nursing Corporate, Eka Hospital, Bumi Serpong Damai, Indonesia Sri Nining Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Rr. Tutik Sri Hariyati Roles: Conceptualization, Formal Analysis, Supervision Tuti Nuraini Roles: Conceptualization, Supervision, Validation Prayetni Prayetni Roles: Conceptualization, Supervision, Validation Tuti Afriani Roles: Writing – Original Draft Preparation Elisabet Herlyani Bota Koten Roles: Data Curation, Methodology, Project Administration Siti Hardiyanti Roles: Funding Acquisition, Resources, Validation Azwar Azwar Roles: Funding Acquisition, Investigation, Project Administration Yuvensius Pili Roles: Data Curation, Methodology, Software Aria Wahyuni Roles: Data Curation, Funding Acquisition Suherman Suherman Roles: Data Curation, Funding Acquisition, Resources Yelmi Reni Putri Roles: Funding Acquisition, Visualization Ropika Ningsih Roles: Funding Acquisition, Software Asriadi Asriadi Roles: Funding Acquisition, Investigation Lusianus Demon Kehi Roles: Funding Acquisition, Project Administration Yuliana Yuliana Roles: Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information This study was supported by Lembaga Pengelola Dana Pendidikan (LPDP), awarded to all the authors, except the supervisors. We confirm that the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 07 Jun 2024, 13:602 https://doi.org/10.12688/f1000research.146209.1 Copyright © 2024 Nining S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Nining S, Hariyati RTS, Nuraini T et al. An exploration of burnout among hospital first-line managers in Indonesia during the COVID-19 pandemic [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :602 ( https://doi.org/10.12688/f1000research.146209.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 07 Jun 2024 Views 0 Cite How to cite this report: Rosyad YS. Reviewer Report For: An exploration of burnout among hospital first-line managers in Indonesia during the COVID-19 pandemic [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :602 ( https://doi.org/10.5256/f1000research.160266.r400295 ) The direct URL for this report is: https://f1000research.com/articles/13-602/v1#referee-response-400295 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Sep 2025 Yafi Sabila Rosyad , Mental health nursing, Putrajaya, Malaysia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.160266.r400295 1. Title and Abstract Comment: The title is clear enough, but the abstract needs to be enriched to provide a more comprehensive and engaging overview. Recommendations: Abstract: Needs to ... Continue reading READ ALL 1. Title and Abstract Comment: The title is clear enough, but the abstract needs to be enriched to provide a more comprehensive and engaging overview. Recommendations: Abstract: Needs to highlight the unique contribution of this study more prominently. Briefly explain why burnout in first-line managers differs from clinical nurses and why this exploration is important. Include more specific key findings from each theme (e.g., the most prominent types of unpreparedness, specific emotional/physical impacts, and the most frequently used adaptive coping mechanisms). Clarify the practical implications of these findings in the conclusion section of the abstract. 2. Introduction Comment: The introduction provides a good context regarding burnout in nurses in general, but the transition to burnout in first-line managers needs to be strengthened. Recommendations: Research Gap: While it is mentioned that research on nurse managers is still rare, this section could be stronger by citing more specific studies on nurse manager burnout in the context of pandemics or similar crises, and then highlighting what remains unknown or underexplored in depth. Study Significance: Emphasize why understanding burnout in first-line managers is crucial, not only for their well-being but also for the operational effectiveness of hospitals and the quality of patient care. First-line managers act as a bridge between management and staff, so their burnout has a domino effect. 3. Methods Comment: The methods section is quite detailed, but some aspects require clarification and stronger justification to meet rigorous qualitative standards. Recommendations: Study Design: Elaborate on why a phenomenological approach was chosen. What is the essence of the burnout experience that this study aims to capture? How does phenomenology help achieve this objective? Setting and Participants: Specify the type of hospital (e.g., type A/B government hospital) and its capacity if relevant, to provide richer context. Justify the inclusion criteria of \"the first-line manager who is the sole manager in a particular unit or room\" and \"more than three months during the pandemic period.\" Why are these criteria important for a phenomenological study? Describe the purposive sampling process in more detail. How were key informants identified? How did the researchers ensure diversity of experience among participants (e.g., from different units, with varying levels of burnout if possible)? State the number of participants interviewed before data saturation was reached (e.g., \"data saturation was reached with the 10th participant, but two additional participants were interviewed for confirmation\"). Data Collection: Provide examples of the semi-structured interview guide questions in an appendix or within the text if possible, to demonstrate the depth of exploration. Further explain the role of \"two experts as supervisors\" during data collection. Were they involved in the interview process or only provided input on the interview guide? How did the researchers establish rapport with participants via the ZOOM platform? How were \"researcher reflections\" documented and used in the analysis? This is crucial for demonstrating reflexivity in qualitative research. Data Analysis: Describe the inductive thematic analysis process by Braun and Clarke (2019) in more detail. For example, how was the data initially coded? How were these codes grouped into potential themes? How were these themes reviewed and defined? How were the validity and reliability of the qualitative data ensured? Besides expert supervision and member checking, was there data or researcher triangulation? The use of NVivo 12 Plus is mentioned, but explain how this software supported the thematic analysis process, not just as a transcription tool. 4. Results Comment: The results section presents three main themes with relevant sub-themes. However, the narrative and participant quotes need to be integrated more effectively to support the findings. Recommendations: Integration of Narrative and Quotes: Ensure that each sub-theme is supported by strong and representative participant quotes. Explain the context behind these quotes. Depth of Findings: Unpreparedness: Provide concrete examples of \"rapidly changing regulations\" or \"policies that disrupted first-line managers' duties.\" How did these changes specifically affect them? Impacts on Well-being: Further elaborate on how negative emotions (disappointment, annoyance, fatigue, anger, sadness, stress, and fear) manifested in their daily work. How did physical impacts (changes in sleep/eating patterns, hypertension, COVID-19 infection) affect their performance and personal lives? Resilience: Provide specific examples of how adaptive coping mechanisms (acceptance, solitude, sharing, distraction, and spirituality) were applied. How did support systems (from colleagues, superiors, family, community) concretely help them? Table 1: Is very helpful, but ensure consistency between the table and the narrative text. 5. Discussion Comment: The discussion connects the findings with Maslach and Leiter's burnout theory and existing literature. However, a deeper and more critical analysis is needed. Recommendations: Theoretical Linkage: Explicitly explain how each theme (unpreparedness, impact on well-being, resilience) relates to the dimensions of burnout (emotional exhaustion, depersonalization, reduced personal accomplishment). The authors state that the dimension of reduced personal accomplishment was not met due to the resilience of first-line managers; this is a crucial point that needs further discussion. How did this resilience prevent a decrease in personal accomplishment? Comparison and Contrast with Literature: When comparing findings with other studies, explain why there are similarities or differences. For example, why is burnout higher in women? Are there cultural or social factors in Indonesia that reinforce this finding? Discuss the implications of the finding that first-line managers experienced burnout but demonstrated strong resilience. What does this mean for future interventions? Practical and Policy Implications: Strengthen the recommendations for disease disaster mitigation and pandemic simulations. How can hospitals effectively implement these? Further discuss the role of transformational leadership. Provide concrete examples of how first-line managers can apply this leadership style to reduce staff burnout. How can rewards and recognition from hospital management be optimized to increase job satisfaction and reduce burnout? Elaborate on the rotation strategy and \"sharing one positive thing.\" How can these be integrated into daily management practices? 6. Conclusion Comment: The conclusion summarizes the main findings but could be strengthened with a more impactful statement. Recommendations: Present a more concise and powerful conclusion, highlighting the study's main contributions to the understanding of burnout in first-line managers. Include clear recommendations for future research, e.g., quantitative studies to measure burnout prevalence or intervention studies to test the effectiveness of mitigation strategies. 7. References Comment: The reference list is quite comprehensive. Recommendations: Ensure all references cited in the text are present in the reference list, and vice versa. Check the reference format according to the journal's specified style. 8. Technical Aspects and Language Comment: There are several grammatical and writing errors that need to be corrected to improve clarity and professionalism. Recommendations: Thorough Proofreading: Conduct a meticulous proofreading to identify and correct grammatical errors, spelling mistakes, and punctuation issues. Terminology Consistency: Ensure consistent use of terms throughout the manuscript (e.g., \"first-line manager\" vs. \"nurse manager\"). Sentence Clarity: Some sentences are quite long and convoluted; consider breaking them down into shorter, clearer sentences. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Mental health, nursing, public health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rosyad YS. Reviewer Report For: An exploration of burnout among hospital first-line managers in Indonesia during the COVID-19 pandemic [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :602 ( https://doi.org/10.5256/f1000research.160266.r400295 ) The direct URL for this report is: https://f1000research.com/articles/13-602/v1#referee-response-400295 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 07 Jun 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 07 Jun 24 read Yafi Sabila Rosyad , Mental health nursing, Putrajaya, Malaysia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Rosyad Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Sep 2025 | for Version 1 Yafi Sabila Rosyad , Mental health nursing, Putrajaya, Malaysia 0 Views copyright © 2025 Rosyad Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. Title and Abstract Comment: The title is clear enough, but the abstract needs to be enriched to provide a more comprehensive and engaging overview. Recommendations: Abstract: Needs to highlight the unique contribution of this study more prominently. Briefly explain why burnout in first-line managers differs from clinical nurses and why this exploration is important. Include more specific key findings from each theme (e.g., the most prominent types of unpreparedness, specific emotional/physical impacts, and the most frequently used adaptive coping mechanisms). Clarify the practical implications of these findings in the conclusion section of the abstract. 2. Introduction Comment: The introduction provides a good context regarding burnout in nurses in general, but the transition to burnout in first-line managers needs to be strengthened. Recommendations: Research Gap: While it is mentioned that research on nurse managers is still rare, this section could be stronger by citing more specific studies on nurse manager burnout in the context of pandemics or similar crises, and then highlighting what remains unknown or underexplored in depth. Study Significance: Emphasize why understanding burnout in first-line managers is crucial, not only for their well-being but also for the operational effectiveness of hospitals and the quality of patient care. First-line managers act as a bridge between management and staff, so their burnout has a domino effect. 3. Methods Comment: The methods section is quite detailed, but some aspects require clarification and stronger justification to meet rigorous qualitative standards. Recommendations: Study Design: Elaborate on why a phenomenological approach was chosen. What is the essence of the burnout experience that this study aims to capture? How does phenomenology help achieve this objective? Setting and Participants: Specify the type of hospital (e.g., type A/B government hospital) and its capacity if relevant, to provide richer context. Justify the inclusion criteria of \"the first-line manager who is the sole manager in a particular unit or room\" and \"more than three months during the pandemic period.\" Why are these criteria important for a phenomenological study? Describe the purposive sampling process in more detail. How were key informants identified? How did the researchers ensure diversity of experience among participants (e.g., from different units, with varying levels of burnout if possible)? State the number of participants interviewed before data saturation was reached (e.g., \"data saturation was reached with the 10th participant, but two additional participants were interviewed for confirmation\"). Data Collection: Provide examples of the semi-structured interview guide questions in an appendix or within the text if possible, to demonstrate the depth of exploration. Further explain the role of \"two experts as supervisors\" during data collection. Were they involved in the interview process or only provided input on the interview guide? How did the researchers establish rapport with participants via the ZOOM platform? How were \"researcher reflections\" documented and used in the analysis? This is crucial for demonstrating reflexivity in qualitative research. Data Analysis: Describe the inductive thematic analysis process by Braun and Clarke (2019) in more detail. For example, how was the data initially coded? How were these codes grouped into potential themes? How were these themes reviewed and defined? How were the validity and reliability of the qualitative data ensured? Besides expert supervision and member checking, was there data or researcher triangulation? The use of NVivo 12 Plus is mentioned, but explain how this software supported the thematic analysis process, not just as a transcription tool. 4. Results Comment: The results section presents three main themes with relevant sub-themes. However, the narrative and participant quotes need to be integrated more effectively to support the findings. Recommendations: Integration of Narrative and Quotes: Ensure that each sub-theme is supported by strong and representative participant quotes. Explain the context behind these quotes. Depth of Findings: Unpreparedness: Provide concrete examples of \"rapidly changing regulations\" or \"policies that disrupted first-line managers' duties.\" How did these changes specifically affect them? Impacts on Well-being: Further elaborate on how negative emotions (disappointment, annoyance, fatigue, anger, sadness, stress, and fear) manifested in their daily work. How did physical impacts (changes in sleep/eating patterns, hypertension, COVID-19 infection) affect their performance and personal lives? Resilience: Provide specific examples of how adaptive coping mechanisms (acceptance, solitude, sharing, distraction, and spirituality) were applied. How did support systems (from colleagues, superiors, family, community) concretely help them? Table 1: Is very helpful, but ensure consistency between the table and the narrative text. 5. Discussion Comment: The discussion connects the findings with Maslach and Leiter's burnout theory and existing literature. However, a deeper and more critical analysis is needed. Recommendations: Theoretical Linkage: Explicitly explain how each theme (unpreparedness, impact on well-being, resilience) relates to the dimensions of burnout (emotional exhaustion, depersonalization, reduced personal accomplishment). The authors state that the dimension of reduced personal accomplishment was not met due to the resilience of first-line managers; this is a crucial point that needs further discussion. How did this resilience prevent a decrease in personal accomplishment? Comparison and Contrast with Literature: When comparing findings with other studies, explain why there are similarities or differences. For example, why is burnout higher in women? Are there cultural or social factors in Indonesia that reinforce this finding? Discuss the implications of the finding that first-line managers experienced burnout but demonstrated strong resilience. What does this mean for future interventions? Practical and Policy Implications: Strengthen the recommendations for disease disaster mitigation and pandemic simulations. How can hospitals effectively implement these? Further discuss the role of transformational leadership. Provide concrete examples of how first-line managers can apply this leadership style to reduce staff burnout. How can rewards and recognition from hospital management be optimized to increase job satisfaction and reduce burnout? Elaborate on the rotation strategy and \"sharing one positive thing.\" How can these be integrated into daily management practices? 6. Conclusion Comment: The conclusion summarizes the main findings but could be strengthened with a more impactful statement. Recommendations: Present a more concise and powerful conclusion, highlighting the study's main contributions to the understanding of burnout in first-line managers. Include clear recommendations for future research, e.g., quantitative studies to measure burnout prevalence or intervention studies to test the effectiveness of mitigation strategies. 7. References Comment: The reference list is quite comprehensive. Recommendations: Ensure all references cited in the text are present in the reference list, and vice versa. Check the reference format according to the journal's specified style. 8. Technical Aspects and Language Comment: There are several grammatical and writing errors that need to be corrected to improve clarity and professionalism. Recommendations: Thorough Proofreading: Conduct a meticulous proofreading to identify and correct grammatical errors, spelling mistakes, and punctuation issues. Terminology Consistency: Ensure consistent use of terms throughout the manuscript (e.g., \"first-line manager\" vs. \"nurse manager\"). Sentence Clarity: Some sentences are quite long and convoluted; consider breaking them down into shorter, clearer sentences. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Mental health, nursing, public health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Rosyad YS. Peer Review Report For: An exploration of burnout among hospital first-line managers in Indonesia during the COVID-19 pandemic [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :602 ( https://doi.org/10.5256/f1000research.160266.r400295) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-602/v1#referee-response-400295 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = \"An exploration of burnout among hospital...\".replace(\"'\", ''); var linkedInUrl = \"http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/13-602/v1\" + \"&title=\" + encodeURIComponent(lTitle) + \"&summary=\" + encodeURIComponent('Read the article by '); var deliciousUrl = \"https://del.icio.us/post?url=https://f1000research.com/articles/13-602/v1&title=\" + encodeURIComponent(lTitle); var redditUrl = \"http://reddit.com/submit?url=https://f1000research.com/articles/13-602/v1\" + \"&title=\" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Nining S et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : \"facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com\", services_expanded : \"facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com\", services_custom : [ { name: \"LinkedIn\", url: linkedInUrl, icon:\"/img/icon/at_linkedin.svg\" }, { name: \"Mendeley\", url: \"http://www.mendeley.com/import/?url=https://f1000research.com/articles/13-602/v1/mendeley\", icon:\"/img/icon/at_mendeley.svg\" }, { name: \"Reddit\", url: redditUrl, icon:\"/img/icon/at_reddit.svg\" }, ] }; var addthis_share = { url: \"https://f1000research.com/articles/13-602\", templates : { twitter : \"An exploration of burnout among hospital first-line managers.... Nining S et al., published by \" + \"@F1000Research\" + \", https://f1000research.com/articles/13-602/v1\" } }; if (typeof(addthis) != \"undefined\"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(\".f1r-shares-twitter\").attr(\"href\", \"https://twitter.com/intent/tweet?text=\" + addthis_share.templates.twitter); $(\".f1r-shares-facebook\").attr(\"href\", \"https://www.facebook.com/sharer/sharer.php?u=\" + addthis_share.url); $(\".f1r-shares-linkedin\").attr(\"href\", addthis_config.services_custom[0].url); $(\".f1r-shares-reddit\").attr(\"href\", addthis_config.services_custom[2].url); $(\".f1r-shares-mendelay\").attr(\"href\", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(\".addthis_button_expanded\").each(function(){ var count = $(this).text(); if (count !== \"\" && count != \"0\") $(this).removeClass(\"is-hidden\"); else $(this).addClass(\"is-hidden\"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get(\"/articles/acj/146209/160266\") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay(\"articles\", \"article\", \"160266\"); $(document).ready(function() { $( \"#frame1\" ).on('load', function() { var mydiv = $(this).contents().find(\"div\"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(\".interactive-living-figure-label .icon-more-info\"), titleLivingFigure = tooltipLivingFigure.attr(\"title\"); tooltipLivingFigure.simpletip({ fixed: true, position: [\"-115\", \"30\"], baseClass: 'small-tooltip', content:titleLivingFigure + \" \" }); tooltipLivingFigure.removeAttr(\"title\"); $(\"body\").on(\"click\", \".cite-living-figure\", function(e) { e.preventDefault(); var ref = $(this).attr(\"data-ref\"); $(this).closest(\".living-figure-list-container\").find(\"#\" + ref).fadeIn(200); }); $(\"body\").on(\"click\", \".close-cite-living-figure\", function(e) { e.preventDefault(); $(this).closest(\".popup-window-wrapper\").fadeOut(200); }); $(document).on(\"mouseup\", function(e) { var metricsContainer = $(\".article-metrics-popover-wrapper\"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(\".article-metrics-close-button\").click(); } }); var articleId = $('#articleId').val(); if($(\"#main-article-count-box\").attachArticleMetrics) { $(\"#main-article-count-box\").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(\".new_figshare_widget\"); if (figshareWidget.length > 0) { window.figshare.load(\"f1000\", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr(\"figshare_articleId\") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { \"313348\": 0, \"313349\": 0, \"313347\": 0, \"313356\": 0, \"313357\": 0, \"313358\": 0, \"313352\": 0, \"313353\": 0, \"313354\": 0, \"313355\": 0, \"293399\": 0, \"293404\": 0, \"293405\": 0, \"293406\": 0, \"293407\": 0, \"293400\": 0, \"293401\": 0, \"293402\": 0, \"293403\": 0, \"293408\": 0, \"299060\": 0, \"348469\": 0, \"357173\": 0, \"299061\": 0, \"348468\": 0, \"299062\": 0, \"348471\": 0, \"357175\": 0, \"299063\": 0, \"357174\": 0, \"299057\": 0, \"299058\": 0, \"348467\": 0, \"299059\": 0, \"348466\": 0, \"339519\": 0, \"299064\": 0, \"348473\": 0, \"299065\": 0, \"348472\": 0, \"357176\": 0, \"299066\": 0, \"316740\": 0, \"316741\": 0, \"316742\": 0, \"316743\": 0, \"339521\": 0, \"339520\": 0, \"339523\": 0, \"339522\": 0, \"316748\": 0, \"288588\": 0, \"316749\": 0, \"288590\": 0, \"288591\": 0, \"316744\": 0, \"316745\": 0, \"316746\": 0, \"316747\": 0, \"288596\": 0, \"288597\": 0, \"309077\": 0, \"288598\": 0, \"309078\": 0, \"309079\": 0, \"288592\": 0, \"288593\": 0, \"288594\": 0, \"288595\": 0, \"327004\": 0, \"455006\": 0, \"309084\": 0, \"327005\": 0, \"455007\": 0, \"309085\": 0, \"327006\": 0, \"455004\": 0, \"309086\": 0, \"455005\": 0, \"455002\": 0, \"309080\": 0, \"455003\": 0, \"309081\": 0, \"309082\": 0, \"455001\": 0, \"309083\": 0, \"455010\": 0, \"455008\": 0, \"455009\": 0, \"321396\": 0, \"321397\": 0, \"321394\": 0, \"321395\": 0, \"406654\": 0, \"406651\": 0, \"406649\": 0, \"406661\": 0, \"406659\": 0, \"406656\": 0, \"406666\": 0, \"406667\": 0, \"406664\": 0, \"406665\": 0, \"305052\": 0, \"305053\": 0, \"305054\": 0, \"305055\": 0, \"305048\": 0, \"305049\": 0, \"305050\": 0, \"305051\": 0, \"400295\": 14, \"305056\": 0, \"305057\": 0, }; $(\".referee-response-container,.js-referee-report\").each(function(index, el) { var reportId = $(el).attr(\"data-reportid\"), reportCount = reportIds[reportId] || 0; $(el).find(\".comments-count-container,.js-referee-report-views\").html(reportCount); }); var uuidInput = $(\"#article_uuid\"), oldUUId = uuidInput.val(), newUUId = \"920a155e-49a1-433a-ab3a-0f392e4745cd\"; uuidInput.val(newUUId); $(\"a[href*='article_uuid=']\").each(function(index, el) { var newHref = $(el).attr(\"href\").replace(oldUUId, newUUId); $(el).attr(\"href\", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: \"f1000research\", displayName: \"F1000Research\", hostName: \"f1000research.com\", id: \"1\", editorialEmail: \"research@f1000.com\", infoEmail: \"info@f1000.com\", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(\".cookie-warning\").is(\":visible\")) { $(\".sticky\").css(\"margin-bottom\", \"35px\"); $(\".devices\").addClass(\"devices-and-cookie-warning\"); } $(\".cookie-warning .close-button\").click(function (e) { $(\".devices\").removeClass(\"devices-and-cookie-warning\"); $(\".sticky\").css(\"margin-bottom\", \"0\"); }); $(\"#tweeter-feed .tweet-message\").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(\".partner\").on(\"mouseenter mouseleave\", function() { $(this).find(\".gray-scale, .colour\").toggleClass(\"is-hidden\"); }); }); <!-- Sign in --> Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $(\"a[id=googleSignInButton]\").click(function(event){ event.preventDefault(); $(\"input[id=oAuthSystem]\").val(\"GOOGLE\"); $(\"form[id=oAuthForm]\").submit(); }); $(\"a[id=facebookSignInButton]\").click(function(event){ event.preventDefault(); $(\"input[id=oAuthSystem]\").val(\"FACEBOOK\"); $(\"form[id=oAuthForm]\").submit(); }); $(\"a[id=orcidSignInButton]\").click(function(event){ event.preventDefault(); $(\"input[id=oAuthSystem]\").val(\"ORCID\"); $(\"form[id=oAuthForm]\").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($(\"#sign-in-form-gfb-popup\")); $(\".target-field\").each(function () { var uris = $(this).val().split(\"/\"); if (uris.pop() === \"login\") { $(this).val(uris.toString().replace(\",\",\"/\")); } }); });","source_license":"CC-BY-4.0","license_restricted":false}