DOCUMENT RESUME ED 278 908 CG 019 687 AUTHOR Hare, Jan; And Others TITLE Predictors of Burnout in Professional and Paraprofessional Nurses Working in Hospitals and Nursing Homes. PUB DATE Mar 87 NOTE 24p.; Paper presented at the Annual Meeting of the American Sociaty on Aging (33rd, Salt Lake City, UT, March 13-17, 1987). Title listed on p.1 of document as "Predictors of Burnout in Nurses." PUB TYPE Reports - Research/Technical (143) -- Speeches/Conference Papers (150) EDRS PRICE MF01 Plus Postage. PC Not Available from EDRS. DESCRIPTORS *Burnout; Coping; *Interpersonal Relationship; *Nurses; *Personality Traits; Predictor Variables; *Stress Variables; *Work Environment ABSTRACT Burnout is a phenomenon in which the cumulative effects of a stressful work environment gradually overwhelm the defenses of staff members, causing them to psychologically withdraw. To understand-the experience of professional and paraprofessional nurses suffering from burnout requires a close examination of the environments in which they function. A study was conducted to examine interpersonal (professional exposure to patients with poor prognoses for survival, work relationships, informal support), intrapersonal (coping strategies, fear of death, comfort working with patients with poor prognoses for survival), and situational (personal and work demographics) factors expected to contribute to the six dimensions of burnout among nursing staff who worked in acute care and long-term health care facilities. Professional and paraprofessional nurses (N=312) completed the Work Relationships Index of the Work Environment Scale and other measures assessing informal support; coping strategies; fear of death; and comfort working with, and professional exposure to, patients with poor prognoses. Burnout was measured by the Maslach Burnout Inventory. Findings revealed that Work Relationships, Tension-Releasing, and Instrumental Problem-Focused Coping were the most powerful predictors of burnout. Nursing burnout appeared to be both an organizational and a personal problem. Recommendations for practice are considered. (Appended are an extensive reference list and two tables dealing with the six dimensions of burnout and the other variables assessed.) ********************************************************************** * Reproductions supplied by EDRS are the best that can be made * * from the original document. * ***********************************************************************
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DOCUMENT RESUME
ED 278 908 CG 019 687
AUTHOR Hare, Jan; And OthersTITLE Predictors of Burnout in Professional and
Paraprofessional Nurses Working in Hospitals andNursing Homes.
PUB DATE Mar 87NOTE 24p.; Paper presented at the Annual Meeting of the
American Sociaty on Aging (33rd, Salt Lake City, UT,March 13-17, 1987). Title listed on p.1 of documentas "Predictors of Burnout in Nurses."
PUB TYPE Reports - Research/Technical (143) --Speeches/Conference Papers (150)
EDRS PRICE MF01 Plus Postage. PC Not Available from EDRS.DESCRIPTORS *Burnout; Coping; *Interpersonal Relationship;
ABSTRACTBurnout is a phenomenon in which the cumulative
effects of a stressful work environment gradually overwhelm thedefenses of staff members, causing them to psychologically withdraw.To understand-the experience of professional and paraprofessionalnurses suffering from burnout requires a close examination of theenvironments in which they function. A study was conducted to examineinterpersonal (professional exposure to patients with poor prognosesfor survival, work relationships, informal support), intrapersonal(coping strategies, fear of death, comfort working with patients withpoor prognoses for survival), and situational (personal and workdemographics) factors expected to contribute to the six dimensions ofburnout among nursing staff who worked in acute care and long-termhealth care facilities. Professional and paraprofessional nurses(N=312) completed the Work Relationships Index of the WorkEnvironment Scale and other measures assessing informal support;coping strategies; fear of death; and comfort working with, andprofessional exposure to, patients with poor prognoses. Burnout wasmeasured by the Maslach Burnout Inventory. Findings revealed thatWork Relationships, Tension-Releasing, and InstrumentalProblem-Focused Coping were the most powerful predictors of burnout.Nursing burnout appeared to be both an organizational and a personalproblem. Recommendations for practice are considered. (Appended arean extensive reference list and two tables dealing with the sixdimensions of burnout and the other variables assessed.)
*********************************************************************** Reproductions supplied by EDRS are the best that can be made ** from the original document. *
Predictors of Burnout in Professional and Paraprofessional NursesWorking in Hospitals and Nursing Homes
(Predictors of Burnout in Nurses)
Jan Hare, Ph.D.Assistant ProfessorUniversity of Wisconsin-StoutHuman Development, Family Livingand Community Educational ServicesMenomonie, Wisconsin 54751Phone: 715-232-1463
Clara C. Pratt, Ph.D.Associate Professor
David Andrews, Ph.D.Assistant Professor
Oregon State UniversityHuman Development and Family StudiesCorvallis, Oregon 97331Phone: 503-75,-4765
U.S. DEPAITTMENT OF EDUCATIONOffice oI Educational Research and ImprovementEDUC TIONAL RESOURCES INFORMATION
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ABSTRACT
Burnout is a phenomenon in which the cumulative effects of a stressful work
environment gradually overwhelm .he defenses of staff members, forcing them to
psychologically withdraw. To understand the experience of professional and
paraprofessional nurses suffering from burnout requires a close examination of
the environments in which they function. This study examined interpersonal,
intrapersonal and eituational factors expected to contribute to the six
dimensions of burnout among nursing staff who worked in acute care and
long-term care health rlctlities. The sample included 312 professional and
paraprofessional liurses. The following research question was explored using a
series of stepwise multiple regression analyses: Of the following variables
INTERPERSONAL [professional exposure to patients with poor prognosis for
survival, work relationships, informal support.], INTRAPERSONAL [coping
strategies, fear of death, comfort working with patients with poor prognosis
for survival], AND SITUATIONAL [personal and work demographics], which are the
significant predictors of the six dimensions of burnout in professional and
paraprofessional nurses? Findings revealed that Work Relationships and
Tension-Releasing and Instrumental Problem-focused Coping were the most
powerful predictors of burnout. Based upon this, it was concluded that nursing
burnout is both an organizational and a personal problem. Recommendations for
practice are presented.
1
Predictors of Burnout in Nurses
Burnout is an adaptation to the progressive loss of idealism, energy,
and purpose experienced by people working in the human services (Price and
Murphy, 1984). According to Price and Murphy (1984), the typical burnout
victim begins work full of idealism and a sene of mission; however, the
difficult realities of the work situation lead to gradual disillusionment,
resignation, and loss of spirit. Maslach (1982) describes burnout as a
syndrome of emotional exhaustion, depersonalization and reduced sense of
personal accomplishment that frequently occurs among individuals who work in
the human services and in educational institutions. Storlie (1979) paints a
vivid picture of burnout as it occurs in the nurse:
"burnout [13] a highly personal happening insidethe nurse--the literal collapse of the humanspirit. It would be more useful and certainlymore compassionate to ask what goes on in aprofessional nurbe that transforms caring intoapathy, involvement into distance, openness intoself-protection, and trust into suspicion."
(Storlie, 1979, p. 2108)
In addition to descriptive papers on nursing burnout (Storlie, 1979;
Maslasch, 1979), recent empirical investigations have begun to describe this
syndrome and to examine possible factors contributing to burnout among nurses
(Tones, 1981; Jackson and Maslash, 1982; Yasko, 1983; West, Horan and Games,
1984; Keane, 1985). Drawing upon these works and the larger literature on
work stress and burnout, several potential predictors of nursing burnout can be
identified, including situational, interpersonal and intrapersonal factors.
Among the situational factors are demographic variables such as age, marital
status, and education (Cherniss, 1980) and work shift (Parasuraman, Drake and
Zammuto, 1982). Given the differences in patient care responsibilities and
resources experienced by professional versus paraprofessional nurses (e.g.,
4
2
certified nursing assistants) and in acute care versus long-term care
facilities, the occupational role and work setting may also be identified as
situational factors which potentially ihc" burnout.
In addition to situational vc several interpersonal and
intrapersonal variables have been identifi n descriptive models of job
stress as potential contributors to burnout t. rniss, 1980; Maslasch, 1982).
Some research has confirmed that social support received from the work peers
(DuxburY, et.al, 1984) and family and friends ;Constable, 1983; Cronin-Stubbs
and Rooks, 1985) reduce staff vulnerabili y to burnout. Intrapersonal
characteristics related to burnout include personal coping strategies.
Specifically, higher levels of burnout have been reported among professionals
who utilized withdrawal coping strategies and lower levels among those who used
social coping strategies, such as talking about work ztress and getting advice
(Maslasch and Jackson, 1982). Fear of death, discomfort with dying patients,
and exposure to dying patients have also been discussed as potential
contributors to burnout (Pruyser, 1984). Two empirical studies have
investigated the last one of these possible relationships. One study confirmed
that amount of exposure to dying patients was associated with higher levels of
burnout (Dames, 1983) while the other found no relationship (Yasko, 1983)
between exposure and burnout.
Building upon and expanding these earlier descriptive and empirical
works, this current study examined the relationship of interpersonal,
intrapersonal and situational (demographic) factors to burnout among
professional and paraprofessional nurses who worked in acute care and long-term
care facilities.
5
3
Procedure.
Directors of Nursing Services in ten facilities (three acute care
hospitals and seven nursing homes) were contacted and given a thorough
description of the study. Consent for participation in the research study was
given by all of the facilities; however, each administrator was unwilling to
release names and addresses of the nursing staff. Therefore, random sampling
was not possible. Surveys were distributed to nursing employees by the
Directors of Nursing Services. With the exception of one facility which
attached surveys to all nurses' timecards, all others placed a stack of surveys
in the nurses' report rooms with a flyer announcing the study and requesting
the participation of registered nurses, licensed practical nurses, and
certified nursing assistants. Data were collected for a period of six weeks.
Flyers reminding staff to complete the questionnaire were posted on all nursing
units in each facility one week, two weeks and three weeks after the first
distribution of surveys. Respondents returned surveys directly to the
researcher in a self-addressed, stamped envelope.
Measures.
Research on the role of social support in nursing burnout suggests
that lack of support at work or from family and friends enhances staff's
vulnerability to burnout (Constable, 1983; Duxbury, et al, 1984; Cronin-Stubbs
and Rooks 1985). Therefore, both work support and informal support were
selected as important variables to be examined. Work Support was assessed with
The Work Relationships Index (W)U) of the Work Environment Scale (Moos, 1981).
The WRI assesses 1) peer cohesion, 2) supervisor support, and 3) work
involvement. The WRI has 27 true/false items and high internal consistency
(Cronbach's alpha equaling .88, Moos, 1981). Empirical evidence from numerous
sources supports the construct validity of the WRT as a measure of social
support (Billings and Moos, 1981).
Informal Support was measured by one item, ("How satisfied are you
with the support that you receive from friends and relatives?"). Responses
ranged from 1="not at all satisfied" to 5="very satisfied." According to
Gottlieb (1983), satisfactKon is the most important vatiable in assessing the
strength of an informal support system.
Coping Strategies were conceptualized as the cognitive and behavioral
efforts to manage specific job-related demands hich are perceived as
stressful. Maslach and Jackson (1982) noted that high degrees of burnout in a
variety of professions ha're been associated with withdrawal coping strategies,
such as getting away from people, while low degrees of burnout have been
associated with social coping strategies, such as talking with others about the
jc,b or getting advice. This variable was measured by the Jaloweic Coping Scale
(Jaloweic, Murphy, and Powers, 1984), a 40 item, Likert-type scale that has
been factor analyzed into four distinct coping strategies: 1) instrumental or
Jones, J. (1981). Attitudinal correlates of employee theft of drugs and
hospital supplies among nursing personnel. Nursing Research, 30, 349-351.
Kaplan, B., Cassel, J. & Gore, S. (1977). Social support and health. Medical
Care, 15, 47-58.
Kastenbaum, R. (1967). Multiple perspectives on a geriatric "Death Valley."
Community Mental Health Journal, 3, 21-29.
Keane, A., Ducette, J., Adler, D. (1984). Stress in ICU and non-ICU nurses.
Nursing Research, 34, 231-236.
20
Lazarus, R. & Folkman, S. (1984). Stress, appraisal and coping. New York:
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Maslach, C. & Jackson, S. (1981). Mn.slach Burnout Inventory Manual. Palo
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Maslach, C. (1982). Burnout: The cost of caring. Englewood Cliffs, N.J.:
Prentice-Hall.
18
Maslach, C. & Jackson, S. (1982). Burnout in health professions: A social
psychological analysis. In G. Sanders & J. Suls (Eds.), Social psychology
of health and illness. Hillsdale, NJ. Lawrence Erlbaum.
Moos, R. (1981). Work Environment Scale Manual. Palo Alto: Consulting
Psychologists Press.
Parasuraman, S., Drake, B., and Zammuto, R. (1982). The effect of nursing care
modaleties and shift assignments on nurses' work experiences and job
attitudes.
Price, D., and Murphy, P. (1984). Staff burnout in the perspective of grief
theory. Death Education, 8, 47-58.
Pruyser, P. (1984). Existential impact of professional exposure to life-
threatening or terminal illness. Bulletin of the Menninger Clinic, 48,
357-367.
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19
Quint, J. (1973). The nurses and the dying patient. New York: MacMillan Co.
Rando, T. (1984). Grief, dying and death: Clinical interventions for
caregivers, Champaign, IL: Research Press Company.
Storlie, F. (1979). Burnout: The elaboration of a concept. American Journal
of Nursing, 79, 2108-2111, p. 2108.
Strauss, A. (1968). The Intensive Care Unit: Its characteristics apd social
relationships. Nursing Clinics of North America, 3, 7-15.
West, D. Horan, J., & Games, P. (1984). Component analysis of occupational
stress inoculation applied to registered nurses in an acute care hospital
setting. Journal of Counseling Psychology, 31, 209-218.
Yasko, J. (1981). Variables which predict burnout experienced by oncology
clinical nurse specialists. Cancer Nursing, 6, 109-116.
"42
Table 1
Means, Standard Deviations, and Possible Ranges of Six DimensionsBurnout, Work Relationsips, Informal Support, Fear of Death, Comfowith Patients, Coping Strategies.(n=312)