Campus Scenes: University of Western Ontario London, Ontario, Canada

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Campus Scenes University of Western
OntarioLondon, Ontario, Canada
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PREDICTORS OF NURSE MANAGER BURNOUT A
TIME-LAGGED ANALYSIS
Heather K. Spence Laschinger, RN, PhD Professor
and Associate Director Nursing Research School of
Nursing, Faculty of Health Sciences The
University of Western Ontario, London, Ontario,
Canada Email - hkl_at_uwo.ca Joan Finegan,
PhD Professor, Department of Psychology University
of Western Ontario, London, Ontario,
Canada 2008 NIOSH Work, Stress and Health
Conference Funded by Social Sciences
Humanities Research Council of Canada
Extramural Grants Program 410-99-0377
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Background and Rationale for Study

• A loss of 6617 (2.8) nurse manager positions
  across Canada over a decade of restructuring
  (CIHI, 2001, 2002)
• Led to increased span of control and
  responsibility for remaining managers
• Resultant stress for managers threatens their
  physical and emotional well being as well as
  organizational functioning (Lindholm et al, 2003)
• Reduced availability to staff also threatens
  staff nurse job satisfaction, organizational
  commitment and retention (McNeese-Smith et al,
  1997)
• Working conditions shown to influence quality of
  patient care (Aiken et al, 2002)

School of Nursing The University of Western
Ontario
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Purpose

• To examine the influence of effort-reward
  imbalance, a situational variable, and core
  self-evaluation, a dispositional variable, on
  nurse managers burnout levels over a 1-year
  period.

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Model Tested in the Study
Effort Extrinsic Rewards
Self-Esteem Locus of Control General
Self-Efficacy Emotional Stability
Controlling for Time 1 EE
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Burnout..a syndrome in which a previously
committed, helping professional gradually
disengages from full participation in a job in
response to excessive job-related stressors.
(Maslach, 1981)

• Burnout consists of 3 components
• Emotional exhaustion
• Depersonalization/Cynicism
• Personal accomplishment/Efficacy
• Burnout in nurse mangers linked to
• Decreased self efficacy or competence (Gordon,
  1994)
• Decreased job satisfaction and increased physical
  health symptoms (Jamal Baba, 2000)

School of Nursing The University of Western
Ontario
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Burnout

• Burnout is a result of
• too little time
• too few resources
• lack of control over the work situation
• performing tasks that conflict with employee
  values and beliefs
• a breakdown in social work factors
• (Maslach Leiter, 1997)

School of Nursing The University of Western
Ontario
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Effort-Reward Imbalance (Siegrist, 1996)

• The extent to which employees feel their efforts
  at work exceed rewards provided

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The Effort-Reward Imbalance Model (Siegrist, 1996)
rewards
demands pressures responsibilities
salary support treatment
efforts
Siegrist, J. (1996). Adverse health effects of
high effort / low reward conditions. Journal of
Occupational Health Psychology 1(1)27-41.
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Core Self-Evaluation (CSE)

• broad personal dispositional variable that
  describes an individuals evaluation of
  themselves and their self worth, that has been
  shown to be an important predictor of how
  employees interpret events in their work lives.
• 4 Dimensions
• Self Esteem overall value that people place on
  themselves
• General Self-efficacy refers to ones view of
  their ability to cope, perform, and achieve
  success
• Locus of Control the belief that one can control
  a broad set of factors experienced in life
• Emotional Stability the tendency to be confident
  and secure

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Core Self-Evaluation (CSE)

• CSE related to
• Job satisfaction in various work settings (Judge
  Bono, 2001 Judge, Bono Locke, 2000)
• Job performance
• Lower job stress and strain
• LMX quality, empowerment and job satisfaction of
  nurse managers (Laschinger, Purdy, Almost,
  2007)
• Individuals with high CSE seek out more complex
  jobs

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Methods

• Design Longitudinal Non-experimental
  Predictive Design
• Sample 600 staff nurses randomly selected
  from provincial registry
• Surveyed at 2 points in time (1998 and
  2001).
• Data Collection Mail survey using Dillman
  approach
• Return rate Time 1 - 73
• Time 2 - 58
• Staff nurses N
  192 (final T1-T2 matched sample)

School of Nursing The University of Western
Ontario
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Instrumentation

• Malasch Burnout Inventory (Schaufeli, et al.,
  1996)
• Effort-Reward Imbalance (Siegrist, et al.,
  2004).
• Core Self Evaluation Scale (Judge, et al., 2005)

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Data Analysis Methods

• Structural equation modeling (SEM) techniques
  (Arbuckle, 1997)
• Primary aim is to model co-variances, which
  entails proposing a set of relations and
  evaluating their consistency with the relations
  actually observed in an existing data set
  (Bollen, 1989)
• Approach permits modeling a set of relations
  among constructs, simultaneous estimation of all
  hypothesized paths, and estimation of indirect or
  mediating effects
• Used Hoyle and Panters (1995) recommendations
  and selected the following fit indices
• Chi-square (Joreskog Sorbom, 1989)
• Comparative Fit Index (CFI) (Bentler, 1989)
• Incremental Fit Index (IFI) (Bollen, 1989)
• Root Mean Square Error of Approximation (RMSEA)
  (Browne Cudeck, 1989)

School of Nursing The University of Western
Ontario
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Means and Standard Deviations of Major Study
Variables
Scale
Mean Standard Score Chronbach

Deviation Range Alpha

Malasch Burnout Inventory (MBI-GS)
EE Time 1
3.14 1.15 0-6
.91 EE Time 2
3.38 1.39 0-6
.90 Core Self-evaluation
5.12 .85 1-7
.81 Imbalance (Efforts/Rewards)
0.69 0.3
0.03-2.00 10 Imbalance ( distressed)
10
 
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Key Findings Descriptive Statistics

• Nurse managers experiencing high levels of
  burnout (emotional exhaustion) - gt 3.0 on a scale
  ranging 0-6
• ERI levels overall low (.69) but 10 were at risk
  for negative health outcomes using Siegrists
  norms
• Core self-evaluations were high

School of Nursing The University of Western
Ontario
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Results

• Empirical support for hypothesized relationships
  between personal (CSE) and situational (ERI)
  predictors of burnout
• ERI a significant mediator between burnout at T1
  and burnout one year later

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Key Findings Multiple Regression

• ERI and CSE (controlling for Time 1 EE)
  explained
• 17 of the variance in burnout one year later

Effort-Reward Imbalance
MM ?-.33
Time 2 Emotional Exhaustion
Core self-evaluation
MM ?-.13
Time 1 Emotional Exhaustion
plt.05
School of Nursing The University of Western
Ontario
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Conclusions

• Results of this study suggest that both
  situational and personal resources contribute to
  burnout among nurses
• ERI was a stronger predictor than CSE
• Situational factors amenable to management
  initiatives
• Management must also consider the role of
  personal dispositions in employees interpretation
  of organizational events and conditions

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Strategies for Healthy Workplaces

• Most burnout interventions are individual
  specific, that is, treatment focused, not
  prevention focused. Few interventions based on
  changing structural sources of burnout (Nelson,
  Quick Simmons, 2001)
• Areas of Work Life theory provides theory-driven
  structural approaches to preventing burnout.
• Work environment is made up of six areas of
  worklife workload, control, rewards, community,
  fairness and values. (Malasch, 1997)
• Suggested that work engagement/burnout is a
  consequence of the degree of fit (or mismatch)
  between employees and work environments

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Six Areas of Worklife and Engagement/Burnout

• Maslach and Leiter (1997) identify six areas of
  worklife considered precursors of employee
  engagement/burnout .
• Suggest that work engagement/burnout is a
  consequence of the degree of fit (or mismatch)
  between employees and work environments.
• Work environment is made up of six areas of
  worklife workload, control, rewards, community,
  fairness and values.

School of Nursing The University of Western
Ontario
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Workload-the work demands of an employee given a
specified amount of time and resources.
Workload
Control-related to involvement in decision-making
and exercising autonomy.
Control
Rewards-recognition for work contributions (e.g.
monetary, social or intrinsic).
Rewards
Community-related to the quality of social
interactions in the workplace.
Community
Fairness-trust and respect demonstrated by the
organization in relation to decision-making
processes.
Fairness
Values-congruence between organizational
priorities and values of the employee.
Values
School of Nursing The University of Western
Ontario
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Thank you!
Email hkl_at_uwo.ca