The influence of personal dispositional factors and organizational resources on workplace violence, burnout, and health outcomes in new graduate nurses: A cross-sectional study

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Abstract

Background

The alarmingly high rate of illness-related absenteeism among nurses and recent reports of workplace violence and burnout are problematic for both the current workforce shortage and the recruitment and retention of new nurses.

Objectives

To test a model derived from Leiter and Maslach's (2004) Six Areas of Worklife Model linking workplace factors (six areas of worklife, experiences of bullying and burnout) and a personal dispositional factor (psychological capital) to new graduates mental and physical health in their first year of practice.

Methods

A cross-sectional survey design was utilized to survey 165 Ontario nurses with one year or less experience in nursing. Participants completed measures of nurses’ work environment quality, psychological capital, bullying exposure, burnout, and physical and mental health. Structural equation modelling was used to test the hypothesized model.

Results

The fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ2 = 27.75, df = 12, CFI = .97, IFI = .97, RMSEA = .09), however an additional direct path from psychological capital to emotional exhaustion substantially improved the model fit (χ2 = 17.94, df = 11, CFI = .99, IFI = .99, RMSEA = .06). Increased psychological capital positively influenced nurses’ perceived person-job fit, which in turn was negatively related to bullying exposure and emotional exhaustion, and ultimately influenced their physical and mental health.

Conclusions

The findings suggest that psychological capital and perceived person-job fit are key variables in new graduate nurses’ worklife, which may contribute to decreased nurses’ burnout and increased physical and mental well-being. The results support an expanded conceptualization of the Areas of Worklife Model.

Introduction

In 2005 the illness-related absenteeism rate for nurses was 58% higher than that of the overall Canadian labour force (Canadian Institute for Health Information [CIHI], 2007). This absenteeism translated to a total work-time loss of 340,000 h each week, the equivalent of 9754 full-time nursing jobs (CIHI, 2007). Given the current nursing shortage worldwide and the aging of the nursing workforce, the recruitment and retention of new nurses has become a high priority. However new graduate nurses’ experiences of their transitions into the workforce has been described as a ‘reality shock’ (Kramer, 1974), or a ‘transition shock’ (Boychuk Duchscher, 2009) as a result of unsupportive work environments. These conditions could lead to a significant attrition of new nurses and threaten the stability of the nursing workforce.

Supportive supervisor and co-worker relationships have been found to be particularly important to new graduate nurses’ job satisfaction, work stress, turnover intentions and burnout (Casey et al., 2004, Halfer and Graf, 2006, Roberts et al., 2004). Thus, one would expect that hospitals would be striving to provide supportive work environments to help compensate for new graduates’ uneasy transition into the workforce. However, 33% of new graduate nurses report exposure to bullying behaviours weekly or daily (Laschinger et al., 2010). Workplace bullying and workplace incivility have been linked to detrimental organizational outcomes including increased emotional exhaustion and decreased organizational commitment (Laschinger et al., 2010, Smith et al., 2010). Furthermore, burnout has been associated with negative physical and emotional health (Schaufeli and Buunk, 2003). Clearly, if new graduate nurses find themselves in stressful, unsupportive work environments, not only their successful transition to the workplace is threatened, but also their health and subsequent retention. While numerous studies in the general nursing population have linked poor physical and mental health to work environment quality, burnout, and nonsupportive working relationships (Lambert et al., 2004, Laschinger et al., 2004, Lee and Brotheridge, 2006), the well-being of new graduate nurses has received little attention to date.

Personal resources such as high self-esteem and self-efficacy have been found to be protective factors for mental health (Boey, 1999) and to influence work engagement and burnout (Xanthopoulou et al., 2007). However, few studies have included both personal and workplace influences on employee health. Therefore, the purpose of this study was to test a model derived from Leiter and Maslach's (2004) Six Areas of Worklife Model linking workplace factors (six areas of worklife, experiences of bullying and burnout) and a personal dispositional factor (psychological capital) to new graduates mental and physical health.

We expand Leiter and Maslach's (2004) original Six Areas of Worklife Model to include a personal dispositional factor, psychological capital, to propose a comprehensive model of new nurses’ workplace health. Maslach and Leiter (1997) describe six areas of worklife that have been consistently shown to be organizational antecedents of work engagement and burnout across a wide variety of studies: manageable workload, control, reward, community, fairness, and values. They argue that when an employee experiences high levels on some or all of these areas it reflects a high person-job match and thus they are more likely to be engaged in their work and less burned out. Manageable workload refers to the time and resources allocated to meet job demands, control is the degree of role clarity and governance over how people do their job, reward reflects the relationship between effort and recognition, community refers to the quality of social relationships in the organization, fairness relates to the level of justice and managerial support in the organization, and finally values represents the congruence between the ideals and beliefs of the employee and the organization. According to Maslach and Leiter (1997) these components are all interrelated, and improvement on any one factor may lead to improvement in others, making these worklife factors ideal target variables for workplace interventions.

Section snippets

Areas of worklife

Leiter and Maslach (2004) found that the six areas of worklife were significantly related to the three components of burnout, most strongly to emotional exhaustion and cynicism. A causal model revealed that manageable workload and control played important roles in predicting burnout – manageable workload having a strong direct effect on emotional exhaustion and control influencing burnout factors indirectly through reward, community, fairness and value congruence. In a study of Canadian new

Design and sample

We tested the model using data from a larger study of new graduate nurse worklife well-being. In the larger study, a census of all registered nurses practicing in Ontario with less than two years of experience was drawn from the College of Nurses of Ontario's participant registry. Of the 907 surveys sent out, 365 (40.2%) met study inclusion criteria. A modified version of the Total Design Method (Dillman, 2000) was used as a technique for increasing survey response rates. Nurses received a

Descriptive statistics and correlations

The full demographic profile for the final sample is presented in Table 1. Participants were predominantly female (93.2%), working on medical–surgical units (51.9%). The average age was 28 years old, with ten months experience in nursing, nine months in their organization and eight months on their current unit, working full-time (57.4%). Although the majority (53.1%) intend to stay in their current position less than three years, approximately 80% intend to stay active as a nurse for more than

Discussion and implications for management

The results support a model that highlights the role of both personal and organizational factors that influence newly graduated nurses’ mental and physical health. As well, they add to Leiter and Maslach's process model by identifying the additional role of personal resources as an important influence in employees’ fit with their work, as well as the role played by workplace bullying as an intervening mechanism in the development of burnout. Psychological capital, a personal resource,

Limitations

The cross-sectional nature of the study design precludes our ability to make statements of cause and effect regarding our findings (Pedhazur and Schmelkin, 1991), therefore the results must be interpreted with caution. Furthermore, since the same individual completed all measures common method variance is also a concern, although Spector (2006) has argued that this issue may be overstated, especially when well established validated questionnaires are used. A longitudinal study is recommended to

Conclusion

In conclusion, the results of this study demonstrated the importance of both personal and situational factors that influence new graduate nurses’ health and well-being, many of which are permeable to change. Thus, the onus is on nursing management to ensure that conditions in nursing work environments are welcoming and supportive of new graduate nurses, not only to prevent burnout and poor health, but also to ensure that new nurses want to remain in the profession, thereby sustaining the

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