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S EM 8 3 229 14 363 Shieh Chich Jen TX PDF
S EM 8 3 229 14 363 Shieh Chich Jen TX PDF
ABSTRACT Medical staff is forced to leave the work as they bear distinct stress and burnout from workload. When
the amount of work is not reduced but increased from resigning employees, such a ferocious circle would eventually
reduce medical quality. Taking the medical staff in Kaohsiung Chang Gung Memorial Hospital as the research sample,
total 500 copies of questionnaires were randomly distributed. Having deducted invalid and incomplete ones, 327
copies are valid, with the effective retrieval rate 65%. The research results show 1.significantly positive effects of
Workload on Burnout, 2.remarkably positive effects of Burnout on Turnover Intention, 3.notably positive effects of
Workload on Turnover Intention, and 4.mediating effects of Burnout on the correlations between Workload and
Turnover Intention. Based on the conclusions, some suggestions are proposed in this study, expecting to assist in the
problems of high turnover rate of medical staff and the reducing medical quality caused by workload.
logical costs on task practice to achieve the re- self/herself with emotional shrink. Shafiezadeh
quirements. Ippolito et al. (2010) proposed that (2011) further defined Burnout as physical, emo-
workload was basically over-workload resulted tional, and psychological exhaustion, which ap-
from work requirements exceeding human peared on physical exhaustion and long-term
boundary, which is an individual had to practice fatigue, sense of helpless and not developing,
a lot amount of work and complete it in certain and negative concepts and attitudes toward
period, or lengthy working time causing the body work, life, or other people (Kane 2010). Lau (2010)
or spirit not being able to bear the load. Ksenia considered that burnout was the emotional ex-
(2012) regarded Workload as the workload in haustion caused by long-term and continuous
the working environment exceeding personal stress, which could be easily generated by ex-
capabilities and further resulting in threats and cessive demands. Letvak (2010) pointed out the
the reactions of nervousness, anxiety, frustra- problem of Burnout in various developed coun-
tion, pressing, or annoyance. Such reactions tries and defined it as human resource person-
would change the physical and mental condi- nel and emotional labor workers losing the ac-
tions of a normal person as well as the behav- tivities because of stress in the workplace and
iors. Marina (2012) considered Workload origi- generating Emotional Exhaustion. Natallia (2010)
nating from role overload that, in the competi- defined Burnout as burning out and pointed out
tive environment, personal work was extended the meaning of Burnout as completely physical
from single items to multiple duties, and the risk and mental exhaustion causing a person, who
of over-workload resulted in low emotion of excessively pursued unreal work objectives, not
employees, delaying work, low team atmosphere, being able to or unwilling to re-try a work
and not obeying rules to further affect the orga- (Stephen 2011). This study refers to Maslach
nizational performance and the employee’s cen- Burnout Inventory (MBI) proposed by Maslach
tripetal force. Shafiezadeh (2011) also pointed and Jackson in 1981, who regarded Burnout as
out the effects of Workload on the relations be- the symptoms of Emotional Exhaustion and cyn-
tween work input and output. Chen (2001) di- icism occurring on workers who engaged in con-
vided Workload into qualitative workload as an tacting with people and divided it into three di-
employee perceived the ability being insufficient mensions (Wu et al. 2012; Runcan et al. 2012).
for completing the work and quantitative work- (1) Emotional Exhaustion, originating from ex-
load as excessive amount of work. The common hausted feeling, emotionally over-expansion,
multiple subjective workload assessment tech- and emotion as resources being exhausted that
nique is utilized for this study. The subjective resulted in the loss of energy and incapability of
workload assessment technique (SWAT), devel- dealing with stress. (2) Depersonalization, refer-
oped by United States Air Force (Virtanen et al. ring to separating oneself from others, present-
2012), contained three dimensions. 1. Time Load. ing cold emotion, and showing negative reac-
When a person perceived large stress from the tions to others’ attitudes, for example, treating
work frequency, such a speed (frequency) could the served subject with improper attitudes, los-
be slowed down or madly urgent. 2. Spirit In- ing rationality and being irritable; such negative
vestment. A person had to work hard (mentally intention would transfer, change, develop, or ac-
and physically) with physical activities to cumulate as time went on. (3) Diminished Person-
achieve the preset performance. 3. Mental Stress, al Accomplishment, indicating inefficient and in-
referring to the investment in mental or percep- appropriate feelings, negative self-evaluation, and
tual activities at work, for example, thinking, de- the lack of achievement in the interpersonal rela-
cision-making, calculation, memory, attention, tionship, which could be explained as discour-
and search. agement, low morale, shrink, reducing productiv-
ity or potential, or incapable of adaptation.
II. Burnout
III. Turnover Intention
Dyrbye et al. (2011) regarded Burnout as a
development process in which an employee Turnover Intention refers to individual atti-
would be frustrated and emotionally changeable tudes and intention, during to retain and actual-
to indirectly result in interpersonal conflict when ly to leave, to voluntarily leave the work and
encountering work stress and then protect him- look for another one, in which reducing job sat-
WORKLOAD ON BURNOUT AND TURNOVER INTENTION 231
isfaction and positive prediction of turnover causing threats. Such reactions changed the
behavior are the factors (Chen et al. 2010). Guest normal physical and mental conditions of a per-
et al. (2011) mentioned that turnover rate would son, changed the behaviors, and burnt out the
reduce when the employees reduced the turn- person. Deepak (2013) considered that the risk
over intention; therefore, turnover intention and of over-workload resulted in low emotion of an
turnover behavior were dependent concepts. employee, delaying work, low team atmosphere,
Kaori (2011) also pointed out the occurrence of and unwilling to obey rules which further affect-
turnover behavior when an employee tended to ed the organizational performance and the em-
leave the working organization. Lee and OK ployee’s centripetal force. The following hypoth-
(2012) proposed that turnover was the behavior esis is therefore proposed in this study.
when an employee left the work after deliberate-
ly considering the work being not affirmed for a H1: Workload Presents Significantly
period of time. Malik et al. (2011) generally de- Positive Effects on Burnout
fined turnover concept as labor movement,
which contained three dimensions of (1)region- Lesage et al. (2013) revealed that an employ-
al movement, showing an employee transferring ee would appear various reactions when the
from one region to another, (2)occupational work demands were excessive; Burnout was one
movement, referring to an individual transfer- of special reactions, which could result in Turn-
ring form an occupation to another, and (3)in- over Intention. Manzano and Ayala (2012) re-
dustrial movement, presenting an individual garded Turnover Intention as the shrink of an
transferring from one industry to another. Fur- individual encountering excessive stress at work
thermore, Peng et al. (2011) pointed out the nar- or dissatisfying with the work. Ksenia (2012)
row definition of labor movement as an organi- found out the significant correlations between
zation member flowing outwards. Shanafelt et Burnout and Turnover Intention as well as re-
al. (2011) mentioned that the withdrawal behav- markable effects of Burnout on Turnover Inten-
ior of nurses was considered to leave current tion. Pinar (2010) also proved the positive corre-
working sector, then the current hospital, and lations and positive effects of Burnout on Turn-
finally nursing industry. Accordingly, the with- over Intention, which is an employee with high-
drawal behavior was a gradual process. Since er Burnout would show higher Turnover Inten-
talents are the key capital in an organization, tion. Shanafelt et al. (2012) concluded the nota-
researchers often do the research from multiple bly positive correlations between Burnout and
dimensions, expecting to understand the rea- Turnover Intention. Shreffler et al. (2011) indi-
son of Turnover Intention (Simon et al. 2008). cated the significantly positive effects of Burn-
Consequently, this study refers to Heydarian out on Turnover Intention with the mediating
and Abhar’s (2011) concept of Turnover Inten- effects of Emotional Exhaustion, Dehumaniza-
tion, which is defined as the overall attitude and tion, and Diminished Personal Accomplishment.
behavior measurement of an employee deciding The following hypothesis is further proposed in
to voluntarily leave the work. this study.
However, excessive Workload could harm the cy) could be slowed down or madly ur-
health and result in negative emotion that the gent.
generation of Burnout would influence Turn- 2. Spirit Investment: One has to work hard
over Intention (Deepak 2013). As a consequence, (mentally and physically) to invest in
the following hypotheses are proposed in this physical activities for achieving the pre-
study. set performance.
3. Mental Stress: referring to mental or per-
H3: Workload Shows Notably Positive Effects ceptual activities invested in a work, such
on Turnover Intention as thinking, decision-making, calculation,
memory, attention, and search.
H4: Burnout Appears Mediating Effects on the
Correlations between Workload and Turnover (2) Burnout
Intention
Based on Virtanen et al. (2012), Burnout is
V. Conceptual Framework divided into three dimensions.
1. Emotional Exhaustion, originating from
Summing up the above literatures, the con- exhausted feelings, emotionally excessive expan-
ceptual framework (Fig. 1) is developed in this sion, and emotion being exhausted as resources
study to discuss the correlations among Work- which result in the loss of energy that one be-
load, Burnout, and Turnover Intention. comes weak towards the source of stress.
2. Depersonalization, separating oneself from
RESEARCH DIMENSION AND others to present cold emotion and to transfer
APPROACH DESIGN others’ attitudes towards negative reactions.
3. Diminished Personal Accomplishment, re-
Definition of Research Definition ferring to inefficient and improper feelings, neg-
ative self-evaluation, and lack of achievement in
(1) Workload the interpersonal relationship.
Spirit Turnover
Depersonal- Intention
Investment ization
Mental Personal
Stress Accomplish
voluntarily leave the work. Turnover Intention achieved 81.437%. With Factor Analysis, Burn-
therefore is used as the singe variable for this out was extracted three factors of Emotional Ex-
study. haustion (eigenvalue=2.762, α=0.84), Deperson-
alization (eigenvalue=2.138, α=0.88), and Person-
Research Participant al Accomplishment (eigenvalue=1.896, α=0.85).
The accumulative covariance explained reached
Kaohsiung Chang Gung Memorial Hospital 79.581%. With Factor Analysis, the accumula-
was established on the first of January. It cur- tive covariance explained of Workload (eigen-
rently opens 2,720 beds for the public and has value=2.517, α=0.80) achieved 86.732%.
more than 5,300 employees. The daily average
outpatients reach 6,700 person-times and the Correlation Analysis of Workload and
emergency 350 person-times. It is one of Chang Burnout
Kung Medical Foundations as well as an excel-
lent medical center evaluated by Ministry of Multiple Regression Analysis was applied
Health and Welfare. There are 73 specialties and to testing the hypothesis and theoretical frame-
sub-specialties in the hospital, which present work. The first regressive equation, Table 1, re-
the tasks of service, instruction, and research. vealed the significant standard (F=19.436,
To practice patient-centered healthcare, the hos- p<0.001) that Workload presented significant
pital stresses on interdisciplinary, construct user- effects on Emotional Exhaustion, where Time
friendly and secure environments to maintain Load, Spirit Investment, and Mental Stress in
the patient rights, and innovate the medical skills Workload showed remarkably positive effects
through consensus and management to promote on Emotional Exhaustion in Burnout, with the
the excellent healthcare quality. The medical staff significance (β=1.836, p<0.05; β=2.153, p<0.001;
in Kaohsiung Chang Gung Memorial Hospital β=2.344, p<0.001).
is, therefore, sampled for the questionnaire sur- The second regressive equation, Table 1,
vey. Total 500 copies of questionnaires are ran-
showed the significant standard (F=31.755,
domly distributed. Having deducted invalid and
p<0.001) that Workload appeared notable effects
incomplete ones, 327 valid copies are collected,
with the effective retrieval rate 65%. on Depersonalization, where Time Load, Spirit
Investment, and Mental Stress in Workload pre-
DISCUSSION sented remarkably positive effects on Deperson-
alization in Burnout with the significance
Factor Analysis of Workload (β=2.075, p<0.01; β=2.241, p<0.001; β=2.183,
p<0.001).
With Factor Analysis, Workload was extract- The third regressive equation, Table 1, re-
ed three factors of Time Load (eigenvalue=3.144, vealed the significant standard (F=42.382,
α=0.83), Spirit Investment (eigenvalue=2.751, p<0.001) that Workload showed notable effects
α=0.82), and Mental Stress (eigenvalue=2.216, on Personal Accomplishment, where Time Load,
α=0.86). The accumulative covariance explained Spirit Investment, and Mental Stress in Work-
Table 1: Regression analysis of workload and burnout
Note: * stands
234 YANG XIAOMING, BEN-JIANG MA, CHUNCHIH LISA CHAN
Independent variable↓
Workload â ñ â ñ
Time load 2.153 ** 0.000
Spirit investment 2.342 ** 0.000
Mental stress 2.573 ** 0.000
Burnout
Emotional exhaustion 2.362 ** 0.000
Depersonalization 2.471 ** 0.000
Personal accomplishment 2.615 ** 0.000
F 26.523 37.621
P 0.000 *** 0.000 ***
R2 0.341 0.392
Adjusted R2 0.031 0.037
Note: * stands for p<0.05, **
for p<0.01, ***
for p<0.001.
(F=26.523, (p<0.001). According to Model 2, the performance. Avoiding the negative effects
effects of Workload and Burnout on Turnover caused by Burnout by reducing Workload has
Intention were taken into account to discuss become the core of management in a medical
the mediating effects of Burnout. It was discov- sector.
ered that β of Time Load remarkably dropped
from 2.153 (p<0.001) down to 1.927 (p<0.05), re- RECOMMENDATIONS
vealing that Burnout would reduce the direct
effects of Time Load on Turnover Intention; β Aiming at the research results among Work-
of Spirit Investment notably dropped from 2.342 load, Burnout, and Turnover Intention of medi-
(p<.001) down to 2.133 (p<0.001), showing that cal staff, the following suggestions are proposed
Burnout would reduce the direct effects of Spirit in this study.
Investment on Turnover Intention; and, β of 1. Formulating favorable working norms. The
Mental Stress remarkably dropped from 2.573 research results show the notably positive
(p<0.001) down to 2.374 (p<0.001), presenting effects of Workload on Burnout that hospi-
that Burnout would reduce the direct effects of tal managers are suggested to formulate fa-
Mental Stress on Turnover Intention. From the vorable shift time, maintain regular working
research results, Burnout appeared partial me- hours and day off, and increase the time to
diating effects on the correlations between adjust the work and rest so as to reduce
Workload and Turnover Intention that H4 was Workload resulted from shift work and Burn-
supported. out. Establishing favorable communication
channels to timely release stress. The re-
CONCLUSION search results revealed the significantly pos-
itive effects of Burnout on Turnover Inten-
Accordingly, Workload presents obvious tion. Hospital managers, therefore, are sug-
effects on Burnout and Turnover Intention, that gested to realize and pay attention to the
is medical staff with higher Workload and Burn- physical and mental conditions of each med-
out would show higher Turnover Intention, and ical staff for timely listening and concerns
the ones with higher Workload would appear and to build favorable two-way communica-
higher Burnout. Apparently, Burnout is gener- tion channels for patients, patients’ relatives,
ated when Workload gets worse, while over- supervisors, subordinates, and colleagues at
Workload is the work requirements exceeding work as well as family and friends in the life
the boundary of medical staff, that is medical for the mutual understanding and empathy.
staff could not bear the load physically or spiri- 2. Increasing nursing manpower. The research
tually when excessive amount of work needs to results present the significantly positive ef-
be completed in certain period or the working fects of Workload on Turnover Intention.
time is too long. The medical staff would first Medical sectors therefore are suggested to
perceive Emotional Exhaustion and then Deper- increase the quantity of medical labor, en-
sonalization, which is to keep the distance with hance student intention and interests in in-
the working subjects in order to release Emo- vesting in medical departments or schools,
tional Exhaustion; and, the accumulation of the and promote the cooperative education with
two would cause the perception of the work los- medical departments so as to release the di-
ing meanings so that the medical staff is lack of lemma of human resource shortage by stu-
achievement and further increases Turnover dents’ internship. Medical resources in hos-
Intention. pitals are expected to make up the vacancy
In the process of serving patients, medical in order to reduce and release Workload and
staff has to create the working atmosphere con- fatigue of medical staff so as to decrease
forming to the requirements of the sector as well Turnover Intention.
as to satisfy the patients’ objectives. The medi-
cal staff, therefore, has to constrain the inner ACKNOWLEDGEMENTS
perception which appears conflict between the
true perception and the requirement of the med- This research work is supported by National
ical sector. In this case, the medical staff would Natural Science Foundation of China (Grant
present Burnout to seriously affect the work 70921001,71372061)
236 YANG XIAOMING, BEN-JIANG MA, CHUNCHIH LISA CHAN
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Stephen Wanless 2011. Improving training and education a precondition of supervisor’s benevolent leader-
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Virtanen M, Stansfeld SA, Fuhrer R, Ferrie JE, Kivima- istic personality and perceived organizational sup-
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