Professional Documents
Culture Documents
DOI 10.1007/s10597-014-9818-4
BRIEF COMMUNICATION
Received: 10 January 2014 / Accepted: 10 December 2014 / Published online: 24 December 2014
Springer Science+Business Media New York 2014
Introduction
Burnout is far more common among healthcare workers
than among other professional groups (Iglesias et al. 2010;
Spence Laschinger et al. 2009). Nurse burnout leads to
predicted turnovers that result in manpower shortages and
crucial staffing issues. In Taiwan, with nearly 40 % of the
nations nurses not practicing, 89 % of hospitals surveyed
reported that it was difficult to recruit nurses (Lu 2013).
Jourdain and Chenevert (2010) have noted that burnout
within the nursing profession is an especially important
factor when there is a shortage of nurses.
Nurse burnout has been investigated since the 1970s in
Western countries. However, only two studies have
investigated nurse burnout in Taiwan. Hsieh et al. (2004)
explored the relationships between characteristics, coping
strategies, and burnout among 147 psychiatric nurses.
However, both studies of Taiwanese nurses used limited
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Methods
A secondary data analysis was conducted to investigate the
predictors of burnout among nurses in Taiwan. The data
were obtained from the NURSE-Outcomes study, a
nationwide survey of nurse workload and patient outcomes
in Taiwan conducted from 2008 to 2010.
Description of the NURSE-Outcomes Database
The NURSE-Outcomes study collected data using a proportional stratified random sample of the 483 hospitals in
Taiwan. Thirty-five hospitals participated, including four
medical centers, nine regional hospitals, and 22 district
hospitals accredited by the Taiwan Joint Commission. The
hospitals were stratified by geographic location as north or
south. Of the 1,896 nurses invited to provide data, 1,846
completed questionnaires.
Measurements
Data from five instruments completed during the NURSEOutcomes were obtained. The Maslach Burnout Inventory
Human Service Survey (MBIHSS)Chinese version is a
20-item scale measuring burnout and was tested by Lee et al.
(2013) on Taiwanese nurses. The 7-point Likert scale rates
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Methods
A secondary data analysis was conducted to investigate the
predictors of burnout among nurses in Taiwan. The data
were obtained from the NURSE-Outcomes study, a
nationwide survey of nurse workload and patient outcomes
in Taiwan conducted from 2008 to 2010.
Description of the NURSE-Outcomes Database
The NURSE-Outcomes study collected data using a proportional stratified random sample of the 483 hospitals in
Taiwan. Thirty-five hospitals participated, including four
medical centers, nine regional hospitals, and 22 district
hospitals accredited by the Taiwan Joint Commission. The
hospitals were stratified by geographic location as north or
south. Of the 1,896 nurses invited to provide data, 1,846
completed questionnaires.
Measurements
Data from five instruments completed during the NURSEOutcomes were obtained. The Maslach Burnout Inventory
Human Service Survey (MBIHSS)Chinese version is a
20-item scale measuring burnout and was tested by Lee et al.
(2013) on Taiwanese nurses. The 7-point Likert scale rates
735
Results
98 % (n = 1,814) of the 1,846 nurses were female, and
74 % (n = 1,372) were unmarried. The mean subject age
was 29 years (SD 5.26). There was nearly equal representation from northern and southern Taiwan. Half of the
subjects (n = 938, 50.8 %) practiced in medical units.
Nurses who worked in regional or district hospitals
(p \ 0.001) and in northern Taiwan (p = 0.002) reported
lower levels of personal accomplishment. There were no
significant differences in the burnout subscales with respect
to the area of practice or gender. The nurses who were not
married had higher scores on the three burnout subscales,
indicating they experienced higher levels of burnout.
Except for age and NWI-R score, there were significant
correlations among all variables (p \ 0.001). Physical/
psychological symptoms were the highest correlate of
emotional exhaustion (r = 0.48); work engagement was
the highest correlate of personal accomplishment and
depersonalization (r = -0.615, r = -0.326, respectively).
Work engagement was the variable most strongly correlated with the total burnout score among variables related
to nurse self-awareness (r = -0.633).
The significant categorical and continuous variables were
included in the linear regression model to predict total
burnout and the subscales of emotional exhaustion, personal
accomplishment, and depersonalization. The explained
variances were 54, 35, 39, and 18 %, respectively. Work
engagement explained the greatest variance in the total
burnout score; personal accomplishment, depersonalization,
and physical/psychological symptoms explained the most
variance in emotional exhaustion.
Statistical Analyses
Discussion
Descriptive statistics were used to describe subject characteristics. Differences were examined using t tests or
analysis of variance (ANOVA). Pearson correlations were
used to examine the association among continuous data. To
investigate the relationship between all significant
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Conclusions
Personal characteristics can be used to predict nurse burnout
among Taiwanese nurses. Younger nurses with compromised physical/psychological symptoms are at risk of emotional exhaustion. Work engagement is a strong predictor of
a sense of personal accomplishment. Strategies are needed to
improve physical/psychological symptoms and work
engagement among nurses in Taiwan to avoid burnout.
Acknowledgments This study was funded by the Department of
Health, Executive Yuan, R. O. C. (TAIWAN) (DOH099-TD-M-11397025).
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References
Aiken, L. H., & Patrician, P. A. (2000). Measuring organizational
traits of hospitals: The revised nursing work index. Nursing
Research, 49(3), 146153. doi:10.1097/00006199-20000500000006.
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J.
H. (2002). Hospital nurse staffing and patient mortality, nurse
burnout, and job dissatisfaction. Journal of the American
Medical Association, 288(16), 19871993. doi:10.1001/jama.
288.16.1987.
Cho, S. H., June, K. J., Kim, Y. M., Cho, Y. A., Yoo, C. S., Yun, S.
C., & Sung, Y. H. (2009). Nurse staffing, quality of nursing care
and nurse job outcomes in intensive care units. Journal of
Clinical Nursing, 18(12), 17291737. doi:10.1111/j.1365-2702.
2008.02721.x.
Demerouti, E., Mostert, K., & Bakker, A. B. (2010). Burnout & work
engagement: A thorough investigation of the independence of
both constructs. Journal of Occupational Health Psychology,
15(3), 209222. doi:10.1037/a0019408.
Gonzalez-Roma, V., Schaufeli, W. B., Bakker, A. B., & Loret, S.
(2006). Burnout & work engagement: Independent factors or
opposite poles? Journal of Vocational Behavior, 68(1), 165174.
doi:10.1016/j.jvb.2005.01.003.
Hanrahan, N. P., Aiken, L. H., McClaine, L., & Hanlon, A. L. (2010).
Relationship between psychiatric nurse work environments &
nurse burnout in acute care general hospitals. Issues in Mental
Health Nursing, 31(3), 198207. doi:10.3109/0161284090
3200068.
Hsieh, C. J., Hsieh, H. Y., Chen, P. H., Hsiao, Y. L., & Lee, S. (2004).
The relationship between hardiness, coping strategies & burnout
in psychiatric nurses. The Journal of Nursing, 51(3), 2433.
Hsu, H. Y., Chen, S. H., Yu, H. Y., & Lou, J. H. (2010). Job stress,
achievement motivation & occupational burnout among male
nurses. Journal of Advanced Nursing, 66(7), 15921601. doi:10.
1111/j.1365-2648.2010.05323.x.
Iglesias, M. E. L., Vallejo, R. B., & Fuentes, P. S. (2010). The
relationship between experiential avoidance & burnout syndrome in critical care nurses: A cross-sectional questionnaire
survey. International Journal of Nursing Studies, 47(1), 3037.
doi:10.1016/j.ijnurstu.2009.06.014.
Jourdain, G., & Chenevert, D. (2010). Job demands-resources,
burnout and intention to leave the nursing profession: A
questionnaire survey. International Journal of Nursing Studies,
47(6), 709722. doi:10.1016/j.ijnurstu.2009.11.007.
Kanai-Pak, M., Aiken, L. H., Sloane, D. M., & Poghosyan, L. (2008).
Poor work environments & nurse inexperience are associated
with burnout, job dissatisfaction & quality deficits in Japanese
hospitals. Journal of Clinical Nursing, 17(24), 33243329.
doi:10.1111/j.1365-2702.2008.02639.x.
Klersy, C., Callegari, A., Martinelli, V., Vizzardi, V., Navino, C.,
Malberti, F., Tarchini, R., Montagna, G., Guastoni, C., Bellazzi,
R., Rampino, T., David, S., Barbieri, C., Dal Canton, A., Politi,
P. Working Group on Burnout, & Dialysis. (2007). Burnout in
health care providers of dialysis service in Northern ItalyA
multicentre study. Nephrology Dialysis Transplantation, 22,
22832290. doi:10.1093/ndt/gfm111.
Korkeila, J. A., Toyry, S., Kumpulainen, K., Toivola, J., Rasanen, K.,
& Kalimo, R. (2003). Burnout & self-perceived health among
Finnish psychiatrists & child psychiatrists: A national survey.
737
study. Journal of Organizational Behavior, 25(3), 293315.
doi:10.1002/job.248.
Schaufeli, W. B., Salanova, M., Gonzalez-Roma, V., Bakker, A. B., &
Alez-rom, V. G. (2002). The measurement of engagement &
burnout: A two-sample confirmatory factor analytic approach.
Journal of Happiness Studies, 3(1), 7192. doi:10.1023/A:
1015630930326.
Schaufeli, W. B., Bakker, A. B., & Salanova, M. (2006). The
measurement of work engagement with a short questionnaire: A
cross-national study. Educational and Psychological Measurement, 66(4), 701716. doi:10.1177/0013164405282471.
Spence Laschinger, H. K., & Leiter, M. P. (2006). The impact of
nursing work environments on patient safety outcomes: The
mediating role of burnout engagement. Journal of Nursing
Administration, 36(5), 259267.
Spence Laschinger, H. K., Leiter, M., Day, A., & Gilin, D. (2009).
Workplace empowerment, incivility, & burnout: Impact on staff
nurse recruitment & retention outcomes. Journal of Nursing
Management, 17(3), 302311. doi:10.1111/j.1365-2834.2009.
00999.x.
Taylor, B., & Barling, J. (2004). Identifying sources & effects of carer
fatigue & burnout for mental health nurses: A qualitative
approach. International Journal of Mental Health Nursing,
13(2), 117125. doi:10.1111/j.1445-8330.2004.imntaylorb.doc.x.
Van der Doef, M., Mbazzi, F. B., & Verhoeven, C. (2012). Job
conditions, job satisfaction, somatic complaints & burnout
among East African nurses. Journal of Clinical Nursing, 21,
17631775. doi:10.1111/j.1365-2702.2011.03995.x.
Wang, L., Kang, Y. H., & Wu, D. (2010). A review of research &
strategies for burnout among Chinese nurses. British Journal of
Nursing, 19(13), 844850.
Weng, H. C., Hung, C. M., Liu, Y. T., Cheng, Y. J., Yen, C. Y.,
Chang, C. C., & Huang, C. K. (2011). Associations between
emotional intelligence & doctor burnout, job satisfaction &
patient satisfaction. Medical Education, 45, 835842. doi:10.
1111/j.1365-2923.2011.03985.x.
Whitmer, M., Hurst, S., & Prins, M. (2009). Intergenerational views
of hardiness in critical care nurses. Dimensions of Critical Care
Nursing, 28(5), 214220. doi:10.1097/DCC.0b013e3181ac4b82.
Wu, M. L. (2009). SPSS & the application and analysis of statistics.
Taipei: Wu-Nan Book Inc.
123