Original Paper

Journal of Research in Nursing

16(5) 468–479
Existential fulfilment, ! The Author(s) 2010
Reprints and permissions:

workload and work sagepub.co.uk/journalsPermissions.nav

DOI: 10.1177/1744987110383353

engagement among nurses jrn.sagepub.com

Marinka Tomic
Graduate student, Free University of Amsterdam, The Netherlands

Elvira Tomic
Economist, Port of Rotterdam Authority, The Netherlands

Abstract
In contrast to workload, existential fulfilment and work engagement are positive dimensions of
personal functioning in organisations. Research on positive dimensions fits into the context of
positive psychology. Existential fulfilment, workload and engagement have not yet been
investigated among nurses.
The relationships between existential fulfilment, workload and engagement, as well as the
contribution of the first two concepts to engagement, are examined. In a cross-sectional
survey, a random sample was drawn (N ¼ 278) from a hospital population of nurses. Of this
sample, 169 participants completed a questionnaire that included demographic, existential
fulfilment, workload and engagement items. The response was 61%. Two dimensions of
existential fulfilment, self-acceptance and self-actualisation, and the three engagement
dimensions were positively correlated. Self-transcendence was associated with one engagement
dimension, i.e. dedication. Self-actualisation explained a substantial percentage of variance in all
three dimensions of engagement. Workload was negatively associated with engagement: the
higher the workload scores, the lower the vigour and dedication scores. Workload explained a
substantial percentage of variance in vigour and dedication. Self-actualisation and workload are
important engagement determinants. The implications of the study are discussed.

Keywords
existential fulfilment, nurses, self-acceptance, self-actualisation, self-transcendence, work
engagement, workload

Corresponding author:
Marinka Tomic, Free University of Amsterdam, De Boelelaan 1081c, Amsterdam 1081 HV, The Netherlands
Email: marinka.tomic@gmail.com

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

Tomic and Tomic 469

Introduction
Much psychological research focused on unhealthiness and being indisposed (Schaufeli and
Bakker, 2001). Since the beginning of this century, however, researchers have shown an
increasing interest in positive aspects of personal functioning in organisations (Schaufeli
and Bakker, 2007). This turn is likely due to a new movement called positive psychology,
‘the scientific study of positive experiences and positive individual traits, and the institutions
that facilitate their development’ (Duckworth et al., 2005: 629). In the current study the
relationships between existential fulfilment, workload and engagement, as well as the
contribution of the first two concepts to engagement, are examined.

Existential fulfilment
In addition to work engagement, existential fulfilment is an important factor in the current
study. Existential fulfilment refers to a way of life that is full of meaning and purpose and
reveals an existential psychological approach to life (Längle et al., 2003). The first notion
related to existential fulfilment is self-acceptance. Self-actualisation is the second notion
connected to existential fulfilment. The third concept connected with existential fulfilment
is self-transcendence (Loonstra et al., 2007).
To obtain a fulfilled existence, humans must overcome the psychological conflicts
evoked by these boundaries. One who accepts the self accepts his or her potentialities
and intrinsic limitations. One who actualises the self explores and develops his or her
possibilities and potentialities for the sake of personal growth in understanding and
abilities. One who transcends the self recognises the otherness of the reality beyond the
self, searches for respectful relationships with this reality, derives life-meaning from these
relationships, feels responsible for them, feels part of a larger whole, distinguishes interests
that surpass self-interests, and is able to see the self in perspective of the outer reality
(Loonstra et al. 2007; Tomic and Tomic, 2008). Self-transcendence is considered by Frankl
(2004) to be the essence of human existence. This spiritual ability enables the individual to
make intentional contacts with the world beyond the self, which provides ultimate meaning
to life.
In fulfilling these existential tasks, people find life-meaning and a fulfilled existence. The
notions of self-acceptance, self-actualisation and self-transcendence can be interpreted as
basic attitudes in pursuing existential fulfilment and overcoming the psychological
conflicts caused by human limitedness. The inability to achieve existential goals may lead
to burnout (Pines and Aronson, 1988), whereas the achievement of these goals may result in
work engagement (Schaufeli and Bakker, 2001).
The interest in the relationship between existential fulfilment and work engagement
ensues from the view of healthy psychological functioning that has been developed by
existential and humanistic psychology.
Since self-transcendence is considered to be the essence of human existence (Frankl,
2004), it is not surprising that some research has been done to understand the
relationships between self-transcendence and well-being among nurses. Kilpatrick (2002)
found positive correlations between self-transcendence, spiritual perspective and well-
being among female nursing students. The author suggests that self-transcendence may
increase with development.
Self-transcendence and its influence on nurses’ practice have been investigated by
McGee (2004). Her study revealed that self-transcendence is a major healing mechanism

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

470 Journal of Research in Nursing 16(5)

for nurses who have experienced difficult and traumatic personal incidences. This study
underlined the role of self-transcendence in healing the nurse and in enriching the practice
of nursing.
Hunnibell (2006) and Hunnibell et al. (2008) examined the relationship between self-
transcendence and burnout (the opposite of work engagement) in hospice and oncology
nurses. Their studies showed a significant relationship between self-transcendence and all
three dimensions of burnout for both hospice and oncology nurses, i.e. as self-transcendence
increases, burnout symptoms decrease. Self-transcendence may be considered as a resource
for nurses and may protect them against burnout.
Research conducted by Palmer et al. (2010) showed that the higher nurses’ scores on self-
transcendence the more energy they had towards their work and the higher their scores on
work engagement dimensions, i.e. dedication and absorption. Palmer et al. (2010) revealed
that the ability of nurses to self-transcend and thus derive positive meaning from patient-
caring experiences fostered work engagement. Research indicates consistent evidence of the
importance of self-transcendence on the well-being of nurses.

Workload
Workload is the perceived pressure due to the amount of work and task heaviness.
Employees experience a heavy workload when they are not able to meet the task
requirements decreed by the employer. Perceived workload is a dynamic concept. It is
related to the individual work situation and the subjective perception of the employee.
Workload indicates the degree to which the job is taxing in terms of mental effort,
complexity of work and speed of work (De Jonge et al., 1995; Van Veldhoven and
Broersen, 1999). Workload seems to be related to health. Research suggests that those
with higher workloads report more health problems (Tummers et al., 2000).

Work engagement
Work engagement is defined as ‘ . . . a positive, fulfilling, work-related state of mind
characterised by vigour, dedication, and absorption’ (Schaufeli et al., 2002: 74). In the
context of positive psychology, which focuses on health and well-being, the concept of
work engagement is considered to be one of the positive dimensions. According to
Schaufeli and Bakker (2001), it refers to a positive, affective-cognitive state of supreme
satisfaction. The concept has three components. Vigour is characterised by high levels of
energy and mental flexibility while working, the willingness to invest effort in one’s work,
and perseverance in the face of difficulties. Dedication refers to a commitment to work and is
characterised by a sense of significance. Dedication is a useful and meaningful experience,
inspiring and challenging; it evokes feelings of pride and enthusiasm. Absorption, the final
dimension of engagement, refers to the full concentration on and deep engrossment in one’s
work. It has been established that vigour and dedication are the main characteristics of
engaged behaviour (Llorens et al., 2007).
Employees who display a high level of engagement work particularly hard and diligently
because they enjoy their work, and not because of a strong, compelling inner motivation
alone (Schaufeli and Bakker, 2007). When they experience fatigue, such individuals describe
the feeling as quite pleasant because of its association with positive achievements rather than
failures (Schaufeli and Salanova, 2008).

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

Tomic and Tomic 471

The outcomes of work engagement primarily include positive attitudes towards work and
the organisation, such as job satisfaction, commitment to the organisation and a lack of desire
to turnover (Demerouti et al., 2001; Schaufeli and Bakker, 2004). Likewise, engagement leads
to positive organisational behaviour, such as displaying personal initiative, a strong
motivation to learn (Sonnentag, 2003) and proactive conduct (Salanova et al., 2003).
When employees are engaged with their work, there is congruence between the employees’
priorities and the organisations’ goals. There are indications that the degree of work
engagement is positively associated with job performance (Schaufeli and Bakker, 2007).
Schaufeli and Salanova (2007) conclude that engaged individuals have a well-developed
ability to adequately respond to change, quickly adapt to a new environment and easily
switch from one activity to another. Engaged employees continue to seek new challenges in
their work and perform at a high-quality level, resulting in positive feedback from both
managers and clients. Work engagement is contagious and thus is transferable from one
person to another (Schaufeli and Salanova, 2007). Finally, there are indications that work
engagement is positively related to health, i.e. fewer depressed, stress-related and
psychosomatic symptoms were found (Demerouti et al., 2001; Schaufeli et al., 2004).
There are indications that work engagement has many advantages for both employees
and employers. However, the level of work engagement varies for each profession.
To date, little research has been conducted on work engagement among nurses (Schaufeli
and Bakker, 2004; Simpson, 2009).
The above-mentioned authors have formed the basis for theories about the relationships
between workload, the dimensions of existential fulfilment and work engagement.

Nurses
Examining specific groups that may be expected to have higher levels of work engagement is
highly recommended (Schaufeli and Bakker, 2001). Nurses are assumed to be particularly
engaged in their nursing work. The importance of further research on work engagement in
this profession is strongly emphasised (Schaufeli et al., 2001; Simpson, 2009). For example, it
is interesting to determine why some nurses burn out while other nurses, working under the
same conditions, continue to work in a highly engaged manner.
In their professional capacity, nurses provide care to patients. Due to the high physical
and mental demands of their profession, they run a high risk of health symptoms and
burnout (De Jonge et al., 1995). The job of a nurse is deemed to be quite stressful as it
requires prolonged and odd work hours and irregular work shifts. Among other things,
nurses experience a high level of physical load in dealing with seriously ill and dying
patients. The physical workload, particularly handling and lifting patients, often requires
close contact with people in need of medical and emotional support (Brulin et al., 1998).
In the Netherlands, the incidence of sick leave in health care is 30%, and one-fourth of the
sick days are due to common mental disorders (Roelen et al., 2009). In recent years, the
demands on nursing staff have increased, resulting from, for instance, labour shortage,
reorganisations and mergers, shorter patient hospital stays and aging (De Jonge and
Hamers, 2000).
It is important to expand upon the theory of work engagement through research on
potential predictor variables. Existential fulfilment may contribute to the theory of work
engagement among nurses. An adequate theory is of practical value and a prerequisite for
developing effective interventions that enhance engagement among these professionals.

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

472 Journal of Research in Nursing 16(5)

The above discussion provides sufficient grounds for further investigation among nurses.
In order to design effective, targeted interventions that promote work engagement among
nurses, research on the relationships between existential fulfilment, workload and work
engagement is necessary. Promoting and maintaining work engagement may result in
employees working with pleasure and enthusiasm, as well as the prevention of (health)
problems, sickness absence and turnover. Further research is also of practical importance,
as knowledge about healthy functioning may provide clues for a proactive human resource
policy aimed at sustainable optimal functioning. This could be of benefit to the quality of
nursing care.
The purpose of the present study was to examine to what extent existential fulfilment,
workload and work engagement occur among nurses, and the relationships between
existential fulfilment and workload on the one hand, and work engagement on the other.
We hope that this research will contribute to theory in the field of existential fulfilment and
workload in relation to work engagement. The study is the first to explore existential
fulfilment, workload and work engagement among nurses.

Method
Participants
The participants were nurses from a general hospital. In total, there were 557 nurses working
in the hospital. For the record, all nurses were female. From the population, a random
sample of 278 nurses was drawn. All nurses were eligible for the study. In total, 169
questionnaires were returned, resulting in a response rate of 61%. This response rate is
very good for survey research not only according to Babbie (1995) and Van Horn and
Green (2009), but also according to the findings of Asch et al. (1997) on research in
medical settings.
Of the 169 respondents who completed the questionnaire, the average age was 41
(SD ¼ 12.3), ranging from 21 to 64 years old. According to the Human Resources
Department, the average age of nurses in this hospital was also 41. Therefore, the sample
was representative for the age of the nurse population in this hospital.
Another demographic was years in nursing. Average years in nursing was 10.75
(SD ¼ 9.24). Average years in nursing of the hospital population was 10.09 (SD ¼ 8.97).
There is no difference between the sample mean and the population mean [t(724) ¼ 0.832,
p > 0.05]. Respondents worked in the following medical areas: surgery, obstetrics and
gynaecology, internal medicine, cardiology, day care nursing, orthopaedic surgery,
paediatrics, nephrology, pulmonology, oncology, neurology and dermatology.

Measurements
Existential fulfilment. Existential fulfilment, composed of the three dimensions of self-
acceptance, self-actualisation and self-transcendence, was measured by means of the
existential fulfilment scale (EFS) (Loonstra et al., 2007). The EFS consists of 15 items
(five items for each dimension) measured on a five-point Likert scale, ranging from 0
(‘not at all’ relevant to me) to 4 (‘fully’ relevant to me). The five items on self-acceptance
refer to the urge to prove oneself to others, rejection of the self, inner uncertainty and
psychological reliance (e.g., ‘Often I do things more because I have to than because
I want to’). The self-actualisation items deal with intrinsic motivation, the passion of

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

Tomic and Tomic 473

one’s own ideals, and feeling free to calmly pursue one’s goals (e.g., ‘I remain motivated to
go on, even when things are going against me’). The self-transcendence items focus on feeling
part of a larger, meaningful totality, conceiving a sense of life that transcends personal
interests and being convinced that life is good for something. The maximum score per
dimension is 20. In a study of 812 students, the factorial structure of the EFS showed an
acceptable fit (Loonstra et al., 2007). The internal consistency coefficients are 0.79, 0.76 and
0.82, respectively.

Perceived workload. These items were measured on a six-point scale using a ‘strongly
disagree’ to ‘strongly agree’ response format. An example of an item is: ‘Work will be left
to me that should have been finished’. The items are partly based on the findings of Van
Veldhoven and Broersen (1999). The maximum score is 42. The internal consistency
coefficient is 0.74. High scores on this scale indicate more perceived workload.

Work engagement. Work engagement was measured with the Utrecht work engagement
scale (UWES) (Schaufeli and Bakker, 2001). The UWES has been found to be a reliable and
valid self-report questionnaire (Schaufeli et al., 2006). There are three subscales with five
items each: vigour, dedication and absorption. Participants responded on a seven-point
Likert scale, ranging from 0 (never) to 6 (always, daily), with a maximum score per
subscale of 30. Examples of items are: ‘At work I bubble over with energy’ (vigour),
‘Work inspires me’ (dedication) and ‘I am totally absorbed in my work’ (absorption).
High scores on these scales indicate greater work engagement (vigour, dedication and
absorption). The internal consistency coefficients are 0.84, 0.86 and 0.72, respectively.

Procedure
We mailed the questionnaires to nurses’ homes. The survey addressed topics in the following
order: existential fulfilment scale, perceived workload scale, work engagement and
demographic characteristics (age and years of work experience). The accompanying cover
letter stated that the purpose of the study was to better understand nurses’ feelings of
existential fulfilment, workload and well-being. The letter also explained that
participation in the survey was completely voluntary and that answers to the survey
questions would be kept in the strictest confidence. The researchers guaranteed that the
responses remain anonymous and that the responses could not be linked to identifying
information. The current study could not lead to the identification of individuals.
No individual could be singled out for their responses. Specific hypotheses were not
revealed. After the survey was mailed to all participants, one reminder was sent by mail
14 days later. We also posted a reminder on the hospital’s intranet. In addition, in order to
raise the response rate, we followed suggestions from Fox et al. (1988) and Green et al.
(1997): prenotification by letter, university sponsorship of the survey, the provision of
postage-free envelopes, the mailing of questionnaires directly to the respondents, the
provision of contact information (to be used at any time if necessary), a fairly brief
questionnaire and postcard follow-up.
A signed, informed consent form was obtained from each participant before data
collection. The Dutch ethics committee for medical research did not require approval for
this study as it did not involve any patients or vulnerable groups, nor focus directly on
health-related issues of the nurses.

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

474 Journal of Research in Nursing 16(5)

Results
Table 1 shows the mean scores, standard deviations, internal consistency and correlation
coefficients of the study variables. The table shows that the internal consistencies of all
variables were 0.70 or higher, which are sufficient values according to Nunnally and
Bernstein’s criterion (1994) and the British Psychological Society Steering Committee on
Test Standards (1995).
The majority of the correlation coefficients were significant. Self-acceptance correlated
positively with workload, while self-actualisation was negatively correlated with workload.
Workload was negatively associated with two dimensions of work engagement, namely
vigour and dedication.
A hierarchical regression analysis was carried out in order to examine the extent to which
the dimensions of work engagement could be explained by the independent variables of
existential fulfilment and workload. To this end, the regression analysis was carried out
three times, once for each of the dimensions: vigour, dedication and absorption (see
Table 2). With each work engagement dimension as a dependent variable, the control
variable age was first added to the regression equation (step 1), followed by the

Table 1. Means, standard deviations and correlations between variables and internal consistency
coefficients (on diagonal), N ¼ 169

Variables M SD 1 2 3 4 5 6 7

1 Age 41.00 12.28

2 Workload 18.86 5.50 0.02 (0.74)
3 Vigour 21.04 4.97 0.12 0.32** (0.84)
4 Dedication 23.63 4.56 0.09 0.26** 0.68** (0.86)
5 Absorption 20.46 4.64 0.18* 0.04 0.66** 0.65** (0.72)
6 Acceptance 14.93 3.59 0.11 0.39** 0.35** 0.28** 0.13 (0.79)
7 Actualisation 12.22 3.02 0.02 0.22** 0.43** 0.38** 0.37** 0.34** (0.76)
8 Transcendence 11.76 4.93 0.07 0.10 0.09 0.16* 0.12 0.09 0.52** (0.82)

*p < 0.05; **p < 0.01.

Table 2. Hierarchical regression results for three work engagement dimensions (N ¼ 169)

Vigour Dedication Absorption

2 2
Predictor  R  R  R2

Age 0.09 0.01 0.07 0.01 0.16* 0.03*

Workload 0.20** 0.11** 0.15* 0.07** 0.03 0.00
Acceptance 0.14 0.05 0.11 0.03* 0.01 0.01
Actualisation 0.42** 0.10** 0.30** 0.08** 0.43** 0.13**
Transcendence 0.16* 0.02* 0.01 0.00 0.09 0.01
Multiple R 0.54 0.43 0.42
R2 Total 0.29 0.19 0.18
Overall regression F-test 12.34** 7.02** 6.60**

*p < 0.05; **p < 0.01.

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

Tomic and Tomic 475

independent variables workload (step 2), self-acceptance (step 3), self-actualisation (step 4)
and self-transcendence (step 5), according to Aiken and West (1991) and Tabachnick and
Fidell (2001).
On the basis of the hierarchical regression analysis, the following results are reported. The
table shows the best predictors of vigour, dedication and absorption. Firstly, there was a
significant positive correlation between age and absorption. Age explained 3% of the
variance in absorption ( ¼ .16, p < 0.05). The absorption score increased with age. There
was a negative significant correlation between workload and vigour ( ¼ 0.20, p < 0.01)
and dedication ( ¼ 0.15, p < 0.01). Workload explained 11% of the variance in vigour and
7% of the variance in dedication. We concluded that the higher the score on workload, the
lower the scores on vigour and dedication.
The correlations between the dimensions of existential fulfilment and work engagement
were as follows. There appeared to be a significant positive correlation between self-
actualisation and the three dimensions of work engagement: vigour ( ¼ 0.42, p < 0.01),
dedication ( ¼ 0.30, p < 0.01) and absorption ( ¼ 0.43, p < 0.01). The explained variance
was 10%, 8% and 13%, respectively. The higher the score on self-actualisation, the higher
the scores obtained on work engagement. Self-transcendence correlated significantly but
negatively with one dimension of work engagement, namely vigour ( ¼ 0.16, p < 0.05),
and explained 2% of the variance. The higher the score on transcendence, the lower the
score on vigour. These results demonstrate that self-actualisation had a positive and
significant correlation with all dimensions of work engagement. Self-transcendence,
however, was significantly negatively associated with one dimension of work engagement,
i.e. vigour. There was no correlation between self-acceptance and the dimensions of work
engagement.

Discussion
The purpose of the current study was to examine the relationships between existential
fulfilment, workload and work engagement among nurses. In addition, the extent to
which the first two independent variables influence work engagement was investigated.
To the best of our knowledge, there is no published empirical data on the relationships
between these concepts. Therefore, a comparison with results of previously conducted
studies is hardly feasible. In the Loonstra et al. (2009) study, similar concepts were
examined, i.e. the relationship between existential fulfilment and burnout (the opposite of
work engagement) among secondary education teachers.
A positive relationship between existential fulfilment and work engagement was
confirmed for the dimension of self-actualisation. The results show that self-actualisation
explained a substantial percentage of variance in all three dimensions of work engagement.
On the other hand, self-acceptance and self-transcendence hardly explained variance in work
engagement dimensions. With regard to self-transcendence, this is consistent with the results
reported by Loonstra et al. (2009).
Workload explained a substantial proportion of variance in vigour and dedication.
A higher workload level experienced by nurses resulted in lower scores on vigour and
dedication. This finding is consistent with Van Rhenen’s (2008) study, in which he advises
that people concentrate on work pleasure because enthusiastic staff members are a positive
contribution to an organisation.

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

476 Journal of Research in Nursing 16(5)

A higher degree of perceived workload may result in decreased vigour and energy,
including mental resilience and perseverance. Dedication, a particularly strong work
involvement, diminishes, and the question is to what extent nurses experience their work
as meaningful and inspiring. It is likely that nurses with a higher perceived workload will not
be fully concentrated and deeply engrossed in their work (absorption).
Several limitations may have influenced the results of the current study. Firstly, our study
was limited by its cross-sectional design. Some reservations must be expressed in terms of the
direction of causation. The relationships shown do not reveal the causal direction. The
results indicate that self-actualisation influences work engagement, but one can also
imagine influences moving in the opposite direction: a low level of work engagement leads
to diminished self-actualisation. When a nurse is subjected to strict demands from her
superiors and the work environment does not offer opportunities for personal
development and growth, self-actualisation may be diminished.
Secondly, the direction of causation requires further investigation. Future longitudinal
studies are needed to evaluate the possibility of causal relationships between existential
fulfilment, workload and work engagement. Likewise, by applying a longitudinal design,
the possible common method bias can be reduced (Doty and Glick, 1998, Podsakoff et al.,
2003).
Thirdly, in addition to longitudinal studies, it is recommended that causal relationships be
investigated using experimental designs to test the psychological impact of interventions.
One possible intervention is the existential fulfilment approach outlined by Längle (2004).
It may be worthwhile making this approach suitable for nurses. In a training setting, one
explores the importance of meaning and its impact on work engagement. Firstly, an
overview of a meaningful life is provided, which helps localise the requirements for
attaining meaning and reveal practical steps for its attainment. Secondly, a deeper look at
the structure of our existence from the theoretical perspective of existential fulfilment is
necessary. Thirdly, the practical elements for a fulfilling life are shown through the
training approach. These steps are intended to illuminate the possibilities for growth in
one’s own existential fulfilment and to provide skills to manage the question of meaning
both personally and professionally. This approach highlights the basic structure of a
fulfilling existence.
Fourthly, the measurements in our study were based on self-reports. Consequently, we do
not know the extent to which these self-reports accurately reflect existential fulfilment,
perceived workload and work engagement. Naturally, the results of the present study for
the association between existential fulfilment, workload and work engagement should be
interpreted with caution, but there are no indications that these findings solely reflect biased
respondent reporting. Combining self-report data with data obtained in a more objective
manner is recommended for further research so that powerful statistical techniques can be
applied for hypothesis testing. The findings of the present survey could be used to generate
hypotheses for future research.
Fifthly, the sample size was relatively small. However, the response rate of 61% has been
found to be quite high for research among nurses (Asch et al., 1997). Moreover, the sample
was representative concerning ages of the population of nurses working in the participating
hospital.
Sixthly, since our study did not take into account geographical spread or the various
working environments of nurses (general hospitals, university hospitals, private clinics), we
must be cautious when generalising the results of our study to all nurses in the country.

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

Tomic and Tomic 477

Although our study was limited to one profession (nurses), it is possible that the results could
also be applied to other professions, for instance teachers, police officers and politicians.
Despite its limitations, our study has several important strengths. Firstly, the study
employed measures with known psychometric properties, allowing for the comparison of
findings across studies. Secondly, we applied an appropriate multivariate data-analytic
strategy, i.e. hierarchical regression. Thirdly, we adopted a theoretical framework that
may help to organise research findings across investigations. This theoretical research will
also be of use in developing interventions for nurses. Fourthly, the observed association
between existential fulfilment dimensions, workload and work engagement were not only
statistically significant, but also interesting and large enough to suggest that the findings
might be meaningful.
Despite the limitations, the current study contributed to the knowledge of the nursing
profession with regard to existential fulfilment and workload in relation to work
engagement. However, speculations about the practical relevance of the study are
premature. More studies are needed in this area.
Because the aim of the present study was to generate empirical knowledge about positive
behaviours in organisations, we may conclude that this study fits into the research context of
positive psychology. Existential fulfilment, in part, and workload appear to be determinants
of work engagement. In order to maintain and promote work engagement and the high
performance of employees, organisations should provide sufficient challenging work
(Bakker, 2009). According to Laschinger et al. (2006), engaged professional nurses are
critical to preserving the quality of health care.

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-
profit sectors.

Conflict of interest statement

None declared.

Acknowledgement
We gratefully acknowledge the constructive criticism of the anonymous reviewers; their suggestions
improved the manuscript.

References
Aiken LS and West SG (1991) Multiple Regression: Testing and
Interpreting Interactions. Newbury Park, CA: Sage.
Asch DA, Jedrziewski MK and Christakis NA (1997)
Response rates to mail surveys published in medical journals.
Journal of Clinical Epidemiology 50(10): 1129–1136.
Babbie E (1995) The Practice of Social Research, 7th edn.
Belmont, CA: Wadsworth Publishing Company.
Bakker AB (2009) Bevlogen van beroep. Rotterdam: Erasmus
Universiteit. Oratie. [Profession Engaged. Rotterdam:
Erasmus University. Inaugural lecture.].
British Psychological Society Steering Committee on Test
Standards (1995) Psychological testing: A User’s Guide.
Leicester: British Psychological Society.
Brulin C, Gerdle B, Granlund B, Höög J, Knutson A and
Sundelin G (1998) Physical and psychosocial work-related
risk factors associated with musculoskeletal symptoms
among home care personnel. Scandinavian Journal of Caring
Sciences 12: 104–110.
De Jonge J, Boumans N, Langdeweerd AB and Nijhuis F
(1995) Werkkenmerken en Werkbeleving [Work

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015

478
characteristics and work experience]. Tijdschrift voor
Verpleegkundigen [Journal for Nurses] 6: 186–189.
De Jonge J and Hamers JPH (2000) Inspanningen en
beloningen in het werk van verplegenden en verzorgenden
[Efforts and rewards in the work of nurses and carers].
Verpleegkunde 15: 64–73.
Demerouti E, Bakker AB, de Jonge J, Janssen PPM and
Schaufeli WB (2001) Burnout and engagement at work as a
function of demands and control. Scandinavian Journal for
Work and Environmental Health 27: 279–286.
Doty DH and Glick WH (1998) Common methods bias: Does
common methods variance really bias results? Organizational
Research Methods 1: 374–406.
Duckworth AL, Steen TA and Seligman MEP (2005) Positive
psychology in clinical practice. Annual Review of Clinical
Psychology 1: 629–651.
Fox RJ, Crask MR and Jonghoon K (1988) Mail survey
response rate. A meta-analysis of selected techniques for
inducing response. Public Opinion Quarterly 52: 467–491.
Frankl VE (2004) Man’s Search for Meaning. An Introduction
to Logotherapy. London: Random House/Rider.
Green KA, Boser JA and Hutchinson SR (1997) Effects of
population type on mail survey response rates and on the
efficacy of response enhancers. Paper presented at the annual
meeting of the American Educational Research Association,
Chicago, IL, March (ERIC Document Reproduction Service
No. ED 410252).
Hunnibell LS (2006) Self-transcendence and the three aspects
of burnout syndrome in hospice and oncology nurses.
Unpublished doctoral dissertation, Case Western Reserve
University, Cleveland, OH.
Hunnibell LS, Reed P, Quinn Griffin M and Fitzpatrick J
(2008) Self-transcendence and burnout in hospice and
oncology nurses. Journal of Hospice and Palliative Nursing
10: 172–179.
Kilpatrick J (2002) Spiritual perspective, self-transcendence,
and spiritual well-being in female nursing students and
female nursing faculty. Unpublished doctoral dissertation,
Widener University.
Längle A (2004) The search for meaning in life and the
existential fundamental motivations. Existential Analysis
16(1): 2–14.
Längle A, Orgler C and Kundi M (2003) The existence scale.
A new approach to assess the ability to find personal
meaning in life and to reach existential fulfillment. European
Psychotherapy 4: 135–151.
Laschinger H, Wong C and Greco P (2006) The impact of
staff nurse empowerment on person-job fit and work
engagement/burnout. Nursing Administration Quarterly 30:
358–367.
Llorens S, Schaufeli WB, Bakker AB and Salanova M (2007)
Does a positive gain spiral of resources, efficacy beliefs and
engagement exist? Computers in Human Behavior 23:
825–841.
Loonstra B, Brouwers A and Tomic W (2007)
Conceptualization, construction and validation of the
existential fulfillment scale. European Psychotherapy 7: 5–18.
Loonstra B, Brouwers A and Tomic W (2009) Feelings of
existential fulfillment and burnout among secondary school
teachers. Teaching and Teacher Education 25: 752–757.
McGee E (2004) I’m better for having known you: An
exploration of self-transcendence in nurses. Unpublished
doctoral dissertation, Boston College.
Nunnally JC and Bernstein IH (1994) Psychometric Theory,
3rd edn. New York: McGraw-Hill.
Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015
Journal of Research in Nursing 16(5)
Palmer B, Quinn Griffin M, Reed P and Fitzpatrick J (2010)
Self-transcendence and work engagement in acute care staff
registered nurses. Critical Care Nursing Quarterly 33:
138–147.
Pines AM and Aronson E (1988) Career Burnout: Causes and
Cures. New York: The Free Press.
Podsakoff PM, MacKenzie SB, Lee JY and Podsakoff NP
(2003) Common method biases in behavioral research: A
critical review of the literature and recommended remedies.
Journal of Applied Psychology 88: 879–903.
Roelen CAM, Koopmans PC, Hoedeman R, Bültmann U,
Groothoff JW and Van der Klink JJL (2009) Trends in the
incidence of sickness absence due to common mental
disorders between 2001 and 2007 in the Netherlands. The
European Journal of Public Health 19: 625–630.
Salanova M, Llorens S, Cifre E, Martı́nez I and Schaufeli WB
(2003) Perceived collective efficacy, subjective well-being and
task performance among electronic work groups: An
experimental study. Small Group Research 34: 43–73.
Schaufeli WB and Bakker AB (2001) Werk en welbevinden.
Naar een positieve benadering in de arbeids- en
gezondheidspsychologie [Towards a positive approach in
work and organizational psychology]. Gedrag en Organisatie
14: 229–253.
Schaufeli WB and Bakker AB (2004) Bevlogenheid: Een begrip
gemeten [Work engagement: A concept measured]. Gedrag en
Organisatie 17: 89–112.
Schaufeli WB and Bakker AB (eds) (2007) De psychologie van
arbeid en gezondheid. Tweede druk [Psychology of Work and
Health], 2nd edn. Houten: Bohn, Stafleu en Van Loghum.
Schaufeli WB, Bakker AB and Salanova M (2006) The
measurement of work engagement with a short
questionnaire. A cross-national study. Educational and
Psychological Measurement 66: 701–716.
Schaufeli WB and Salanova M (2007) Work engagement: An
emerging psychological concept and its implications for
organizations. In: Gilliland SW, Steiner DD and Skarlicke
DP (eds) Research in Social Issues in Management: Managing
Social and Ethical Issues in Organizations. Greenwich:
Information Age Publishers, 135–177.
Schaufeli WB and Salanova M (2008) Enhancing work
engagement through the management of human resources.
In: Näswall K, Sverke M and Hellgren J (eds) The Individual
in the Changing Working Life. Cambridge: Cambridge
University Press, 380–404.
Schaufeli WB, Salanova M, González-Romá V and Bakker AB
(2002) The measurement of engagement and burnout: A two
sample confirmatory factor analytic approach. Journal of
Happiness Studies 3: 71–92.
Simpson MR (2009) Predictors of work engagement among
medical-surgical registered nurses. Western Journal of
Nursing Research 31: 44–65.
Sonnentag S (2003) Recovery, work engagement, and
proactive behaviour: A new look at the interface between
non-work and work. Journal of Applied Psychology 88:
518–528.
Tabachnick BG and Fidell LS (2001) Using Multivariate
Statistics, 4th edn. Boston, MA: Allyn and Bacon.
Tomic W and Tomic E (2008) Existential fulfillment and
burnout among principals and teachers. Journal of Beliefs
and Values 29: 11–27.
Tummers GER, Landeweerd JA and Van Merode GG (2000)
Organisatieaspecten, ervaren werkkenmerken en
werkreacties in de verpleging [Organizational aspects,
perceived work characteristics and work reactions in
nursing]. Verpleegkunde 15: 132–141.
Tomic and Tomic 479

Van Horn PS and Green KE (2009) Survey response rates and
survey administration in counseling and clinical psychology.
Educational and Psychological Measurement 69(3): 389–403.
Van Rhenen W (2008) From Stress to engagement.
Unpublished doctoral dissertation, Universiteit van
Amsterdam, Amsterdam, Academisch proefschrift.
Van Veldhoven M and Broersen JPJ (1999) Psychosociale
arbeidsbelasting en werkstress in Nederland. Een verkenning
gebaseerd op gegevens verzameld door arbodiensten met de
Vragenlijst Beleving en Beoordeling van de Arbeid (VBBA)
in de periode 1995 t/m 1998 [Psychosocial Work Load and
Work Stress in the Netherlands. An Investigation Based on
Data Gathered by Health and Safety Executive during the
Period 1995 until 1998 with the Work Experience and
Evaluation Questionnaire]. Amsterdam: Stichting
Kwaliteitsbevordering Bedrijfsgezondheidszorg [Foundation
for Quality Promotion in Organizational Healthcare].

Marinka Tomic is a graduate student in political science at the Free University of

Amsterdam. Her research interests include positive psychological factors relating to
vocational professions. She is now conducting research on fulfilment and work
engagement among city council members. Email: marinka.tomic@gmail.com

Elvira Tomic received her graduate degree in economics from the Free University of
Amsterdam. Her research interests encompass issues relating to economic psychology and
investment management. She has published, among other things, research about existential
fulfilment and burnout among principals and teachers. Recently, she joined the Port of
Rotterdam Authority. Email: elvira.tomic@gmail.com

Downloaded from jrn.sagepub.com at UNIV OF MONTANA on April 5, 2015