Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

43

ABSTRACT

Objective Previous research has suggested that organisational

change can contribute to stress-related outcomes forworkers Burnout one such stress-related outcomehas been conceptualised as a multidimensional constructconsisting of emotional exhaustion depersonalisationand reduced personal accomplishment Many healthcare organisations have undergone substantialorganisational change over the last decade Thepurpose of this study was to assess levels of burnout in nurses and to ascertain if there were individual or work characteristics that were associated with this syndrome

Design Randomised survey methodology

Setting Registered nurses (Division 1) in Victoria who were

ANF members

Subjects A random sample of 574 Victorian ANF nurse

members

Main outcome measures The assessment of levels of burnout in Victorian

ANF nurse members and the identification ofindividual or work characteristics that may beassociated with it

Results Victorian ANF nurse members exhibited lower

depersonalisation and higher personal accomplishmentcompared to medical and overall normative dataIncreasing age and fewer working hours wereassociated with lower levels of emotional exhaustionand depersonalisation Working overtime was positively

associated with emotional exhaustion however furtheranalyses demonstrated that those who workedovertime voluntarily did not differ from workers notworking overtime However feeling pressuredexpected to work overtime was positively associatedwith emotional exhaustion and depersonalisation

Conclusion Victorian ANF nurse members were not

experiencing high levels of burnout However thestudy highlighted the need for health caremanagement to recognise the importance of workingreasonable hours and in particular to understand thepotential detrimental effect that having to workpressured or unexpected overtime has on staff

INTRODUCTION

Workplace stress has been well documented as a substantial issue for workers and also for the organisations for whom they work

(eg Dewe et al 2000) Researchers have typically focusedon a range of workplace constructs important amongwhich is burnout Burnout is commonly conceptualised as a multidimensional syndrome consisting of threecomponents emotional exhaustion depersonalisationand reduced personal accomplishment (Maslach 1993)Emotional exhaustion arises lsquoas emotional resources are depleted workers feel they are no longer able to giveof themselves at a psychological levelrsquo (Maslach et al1996 p4) Depersonalisation occurs when workersdevelop lsquonegative cynical attitudes and feelings aboutonersquos clients (Maslach et al 1996 p4) Reduced personalaccomplishment lsquorefers to the tendency to evaluateoneself negatively particularly in regard to onersquos workwith clientsrsquo (Maslach et al 1996 p4) Previous researchhas associated both individual (eg age Huebner 1994and gender van Horn et al 1997) and work characteristics(eg hours worked Evers et al 2001) with levels of burnout

Kent Patrick BAppSc (Chiro) GradDipPsychStudiesBAppSc(Hons) PhD School of Social Sciences andHumanities Charles Sturt University Wagga Wagga NewSouth Wales Australia

kpatrickcsueduau

Judy F Lavery BA (Hons) PhD School of Psychology DeakinUniversity Waterfront Campus Victoria Australia

Accepted for publication November 2006

BURNOUT IN NURSING

Key Words burnout nurses age years of experience overtime

44Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

There has been much research on burnout in nursespresumably because of the intense nature of their contactwith patients or clients (Demerouti et al 2000) A reviewof burnout found that 17 of published studies usednurses as their sample group (Schaufeli and Enzmann1998) Individual studies conducted in different groups ofnurses show variation in levels of burnout For exampleemotional exhaustion appears comparatively high in somestudies (eg Stordeur et al 2001) and low in others (eg Kilfedder et al 2001)

Other studies have described lower depersonalisation(eg Kilfedder et al 2001) or lower personalaccomplishment in nurses (eg Hayter 1999) Thevariations highlight the importance of investigatingindividual groups to determine their level of burnoutbecause generalisations are not always possible due todifferences in the job or workplace This is particularly soif employees have been through difficult work changessuch as organisational reform

Prior to this study being conducted hospitals inAustralia had undergone substantial organisationalchange Reform of hospital environments has previouslybeen found to negatively impact on nurses in particular(Spence-Laschinger et al 2001) as it results inrestructuring (Burke and Greenglass 2001 Sochalski et al1999) mergers (Idel et al 2003) and inadequateworkforce numbers (Aiken et al 2001) Similarlyrestructuring has been found to be associated withemotional distress (Idel et al 2003) role stress (Swansonand Power 2001) and work-family conflict (Burke andGreenglass 2001)

Consequently because the changes above have thepotential to impact negatively on nursesrsquo experiences theywere perceived to be an ideal group for further study inrelation to burnout In addition to investigating individualcharacteristics (eg age years of experience) that are ofteninvestigated in burnout research work characteristics that were relatively specific to the nursing profession at this time (eg where nursing qualification was gainedthat is hospital training or university based education)and overtime were also included in the study It wasthought prudent to investigate overtime in this samplesince with the reported increased workloads anddecreased staff numbers it was likely that overtime maybe an issue for nurses

The two major aims of the study were (1) to comparelevels of burnout in Victorian nurses against normativedata and (2) to assess the associations between selectedindividual and work characteristics and burnout

METHOD

ProcedureQuestionnaire packages were mailed to 2000

prospective participants who were registered nurses(Division 1) in Victoria by Australian Nursing Federation

Victorian Branch staff (VIC ANF) Registered nurseshave completed as a minimum a three-year nursingqualification resulting in being able to practice as aregistered nurse There were 574 usable questionnairesavailable indicating a response rate of 293

QuestionnaireBurnout Burnout was assessed using the Maslach

Burnout Inventory (Maslach et al 1996) The inventorycontains 22 items that assess the three components ofburnout Each item lists a work-related feeling andrespondents indicate how often they felt that way abouttheir job on a 7-point Likert scale Emotional exhaustionwas measured using nine items (eg lsquoI feel like Irsquom at theend of my ropersquo) depersonalisation was measured usingfive items (eg lsquoI feel I treat some patients as if they wereimpersonal objectsrsquo) and personal accomplishment wasmeasured using eight items (eg lsquoI feel Irsquom positivelyinfluencing other peoplersquos lives through my workrsquo)Response options for the items were 0 lsquoneverrsquo through to6 lsquoevery dayrsquo Responses are added to form a score foreach subscale thus giving each participant three scoresfor the three components of burnout

Demographics The demographics that were recordedincluded age years worked as a nurse and place ofprimary nursing qualification Respondents were alsoasked questions about their main nursing job includingthe average number of hours worked in the past fourweeks and whether they usually worked overtime and ifso whether it was voluntary or pressuredexpected paidor unpaid

RESULTSTable 1 displays the means standard deviations and

ranges for respondentrsquos age years working as a nurse andhours worked per week The sample is representative ofthe nursing profession in terms of age and number ofhours worked per week because previous research hasreported that the average age of registered nurses inAustralia is 432 years and they work an average of 331hours per week (AIHW 2006)

Table 1 Means and Standard Deviations for Age Years Working as a Nurse Years Working in Current Main JobHours Worked Per Week and Number of Days Taken in SickLeave in the Past Four Weeks

Variable (n) Mean SD

Age(years) 570 4394 961

Yearsworking asa nurse

571 2294 1024

Hoursworkedper week

545 3217 1064

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

45

Table 2 displays the frequency distribution for genderemployment status location of main nursing job worksetting where primary nursing qualification was obtainedand overtime characteristics

These figures are similar to those described in previousresearch (AIHW 2006) showing that 914 of registerednurses are female 883 worked in a clinical nursingrole 624 in an acute hospital setting with 662employed in the public sector Of the respondents to thestudy 782 worked in a clinical nursing role and 613worked in an acute hospital setting

COMPARATIVE RESULTSBurnout in the sample of nurses was compared

with the available normative data to investigate if any significant differences existed Table 3 presents the mean and standard deviation for emotional exhaustiondepersonalisation and personal accomplishmentAdditionally the table contains the normative data formedical workers and for the overall comparative sample

obtained from the manual of the Maslach BurnoutInventory (Maslach et al 1996)

The scores for nurses were not significantly differenton emotional exhaustion from both normative groups(medical sample t (570) = 073 pgt005 overall sample t(570) = 178 pgt005) However their scores weresignificantly different compared to both normative groupson depersonalisation (medical sample t (570) = 588plt005 overall sample t (570) = 1307 plt005) andpersonal accomplishment (medical sample t (570) = 358plt005 overall sample t (570) = 1035 plt005)Examination of the means indicated that the nursesexperienced lower depersonalisation and higher personalaccomplishment (lower burnout overall) than both thenormative sample groups

Individual and work characteristics and burnout Pearson correlations were used to investigate

the association between emotional exhaustiondepersonalisation and personal accomplishment withindividual and work characteristics (see table 4) Age was negatively associated with emotional exhaustion (r = -008 plt005) and depersonalisation (r = -023plt005) indicating that as nursesrsquo age increased theirlevels of these two burnout components decreasedSimilarly nursesrsquo experience was negatively associatedwith depersonalisation (r = -020 plt005) The number ofhours worked as a nurse was positively associated withemotional exhaustion (r = 024 plt005) anddepersonalization (r = 010 plt005) Therefore as thenumber of work hours increased nurses were more likelyto experience emotional exhaustion and depersonalisation

Table 3 Means and Standard Deviations for Emotional ExhaustionDepersonalisation and Personal Accomplishment for ANFMembers with Comparative Data from Normative Samples

Variables (n) Mean SD t-test

EmotionalexhaustionANF members

571 2184 1140

Normative(medical) 1104 2219 953 t(570) = 073

pgt005

Overall normativesample 11067 2099 1075 t(570) = 178

pgt005

DepersonalisationANF members 571 581 534

Normative(medical) 1104 712 522 t(570) = 588

plt005

Overall normativesample 11067 873 589 t(570) = 1307

plt005

PersonalaccomplishmentANF members

571 3756 688

Normative(medical) 1104 3653 734 t(570) = 358

plt005

Overall normativesample 11067 3458 711 t(570) = 1035

plt005

Table 2 Frequency Distributions for Gender Employment StatusLocation of Main Nursing Job Work Setting Primary NursingQualification and Overtime Characteristics

Variable Percentage (n)

GenderFemale 9441 (541)

Male 559 (32)

Employment Status

Full Time 3427 (196)

Permanent Part-time 5734 (328)

Casual 839 (48)

Location of MainNursing Job

City 2915 (165)

Suburban 4046 (229)

Rural 3039 (172)

Work Setting

Public 6834 (382)

Private 2952 (165)

Both public and private 215 (12)

Primary NursingQualification

Hospital 7086 (406)

CollegeUniversity 2321 (133)

Both 593 (34)

OvertimePerformed at Work

Yes 6860 (391)

No 3140 (179)

Overtime Voluntaryor PressuredExpected

Voluntary 4590 (123)

PressuredExpected 5410 (145)

Overtime Paid or Unpaid

Paid 3838 (114)

Unpaid 6162 (183)

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

46

Note plt005 plt001

Key EE = Emotional exhaustion DEP = Depersonalisation PA = Personalaccomplishment Years = years worked as a nurse Hours = hours worked as anurse per week HospUni = where primary nursing qualification was gained (code0 = Hospital 1 = University) OT = Perform OT while at work in main nursing job(code 0 = No 1 = Yes) OT Voluntary = if the usual OT was voluntary orpressuredexpected (code 0 = Voluntary 1 = PressuredExpected) OT Paid = ifthe usual overtime was paid or unpaid (code 0 = Paid 1 = Unpaid)

Nurses who had gained their primary nursingqualification at a university or college tended to havehigher emotional exhaustion (r = 009 plt005) anddepersonalisation (r = 016 plt005) than hospital trainednurses Working overtime was associated with higheremotional exhaustion (r = 021 plt005) which waspartially explained because those nurses who workedovertime also worked more hours (t (543) = 468 plt005overtime M = 3355 hours SD = 1050 no overtime M =2911 SD = 992) A two-step hierarchical multipleregression using emotional exhaustion as the dependentvariable was used to analyse whether the effect of workingovertime occurred over and above the effect of hoursworked The regression was significant (F (2539) = 2518plt005 adjusted R2 = 008) and demonstrated thatworking overtime was significantly associated with higheremotional exhaustion (sbquo = 018 plt005) after allowing forhours of nursing work in step one of the hierarchicalmultiple regression Being pressured or expected to workovertime (rather than voluntarily) was associated withhigher emotional exhaustion (r = 041 plt005) anddepersonalisation (r = 022 plt005) and working unpaidovertime was associated with higher emotional exhaustion(r = 013 plt005)

DISCUSSIONThe first aim of the study was to compare the burnout

levels of Victorian nurses to normative data in order toassess whether they differed significantly The second aimof the study was to analyse the relationship betweenindividual and work characteristics and burnout

Comparative results The current sample of nurses had similar levels of

emotional exhaustion to the overall normative and medicalfigures (Maslach et al 1996) However respondents hadsignificantly lower depersonalisation and higher personalaccomplishment than both the normative and medicalsamples Additionally 893 of respondents reportedbeing satisfied (33 dissatisfied) with choosing nursing asa career choice This result would seem an extremelypositive one given that many of the respondents in thecurrent study would have been exposed to some type oforganisational change prior to the study being conductedPerhaps the lower rate of depersonalisation and higherpersonal accomplishment relates to the low averagenumber of hours worked by the nurses many of whomworked part-time and as such are likely to lead morebalanced lives than full-time employees Unfortunately the employment status of the normative samples is not available Another possible reason for the differences is that the normative figures are based on mainly American data and therefore there is the possibility of a cultural effect

Individual and work characteristics and burnout Age and the number of years in practice were strongly

positively associated (r = 089 plt001) indicating thatolder nurses are also likely to be more experienced Bothage and years working as a nurse were significantlynegatively associated with depersonalisation while only age was significantly associated with emotionalexhaustion Despite the non-significant result betweenyears of nursing and emotional exhaustion the result wasbordering significance and given the high correlationbetween age and years of working as a nurse they will beconsidered together This result indicated that older moreexperienced nurses experienced lower burnout on thesetwo components a finding that is consistent with previousresearch reporting that younger age is associated withhigher levels of burnout (Schaufeli and Enzmann 1998)

The significant association between increasing age andlower levels of emotional exhaustion and depersonalisationhas been consistently reported (Schaufeli and Enzmann1998) however the strength of association with emotionalexhaustion was weaker than previously reported in somestudies (eg Huebner 1994) The most likely explanationfor higher levels of emotional exhaustion anddepersonalisation in younger workers is that professionaleducation can not always equip new graduates with thenecessary skills to adequately deal with every problemsituation in the workplace Consequently new graduatesare continually experiencing stress as they struggle to find the necessary resources to deal with every newworkplace challenge

The gulf between skills provided by training and thoserequired in reality is particularly evident with interpersonalskills (Pines and Aronson 1988) which are so important inorder to effectively communicate with colleagues andclients This uncertainty with some work characteristics is

Table 4 Summary of Correlations between Age Years of Work Hours Worked per Week Burnout (Emotional Exhaustion Depersonalisation and PersonalAccomplishment) and Overtime

VariableEmotionalexhaustion

EE

DepersonalisationDEP

Personalaccomplishment

PA

DEP 056

PA -029 -038

Age -008 -023 004

Years -007 -020 004

Hours 024 010 008

HospUni 009 016 -001

OT 021 -001 008

OTvoluntary 041 022 -004

OT paid 013 -003 004

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

47

likely to influence the level of stress experienced by nurses(Buunk and Schaufeli 1993) Less experienced nurses arelikely to experience emotional exhaustion due to theemotional demands of new and unexpected worksituations Depersonalisation occurs in order to distancethemselves from this emotionally draining work (Leiter1993) Older nurses are likely to have previouslyexperienced most work scenarios thereby understandingand managing problematic or ambiguous work situationswith greater confidence and certainty The influence ofageyears of experience also partially explains why being ahospital trained nurse was significantly associated withlower emotional exhaustion and depersonalisation(compared to their universitycollege trained colleagues)While it would be tempting to suggest thatuniversitycollege nursing training is an influencing factorin this result it is more likely that because hospital nursingeducation was phased out over ten years ago hospitalnurses were an older cohort than collegeuniversity trainednurses A t-test confirmed this assumption (t (533) = 2101plt005) with hospital trained nurses being significantlyolder (M = 4770 SD = 724 universitycollege M = 3254 SD = 699)

The number of hours worked per week as a nurse wassignificantly associated with emotional exhaustion anddepersonalisation indicating that working longer hours wasassociated with higher levels of these two burnoutcomponents Previous researchers have suggested that thenumber of hours worked as being weakly associated withemotional exhaustion (Evers et al 2001) findings that areconsistent with those of the current study The averagenumber of hours worked for nurses in this study was 3217hours (SD = 1064) indicating a lower average than atypical full-time week and may partially explain why the hours worked per week was a weak contributor toemotional exhaustion and depersonalisation There is someindication that the association between the number of hoursworked and adverse consequences is non-linear with onlyexcessive work hours resulting in problems for workers(Sparks et al 1997)

Overall working overtime was associated with higherlevels of emotional exhaustion however the largestcontributor to this effect were those workers who werepressured or expected to do the overtime Examination ofthe means demonstrates that those workers who reportedvoluntarily working overtime (M = 1859 SD = 1062) didnot experience higher emotional exhaustion than thoseworkers who did not work any overtime (M = 1825 SD =1060) This result suggests that it is not working overtimeper se that is the problem the issue is when nurses losecontrol over their work patterns and they feel pressured toadd the extra work demands onto their existing load

Conversely for some nurses working overtime may be apositive experience because of extra income When aworker has voluntarily worked overtime it would also belikely that their homefamily commitments would beorganised in advance thereby removing potentialhomework conflict The reality of the hospital system

often means that nurses will be unexpectedly required towork overtime occasionally (and may indeed want to dothis) The current result highlights that there may be a costfor this extra work commitment if workers feel pressuredto engage in overtime work that is unexplained andunexpected This is not surprising given that much of thistype of work may be unexpected and therefore verydisruptive to homefamily life Attempting to juggle lifeand family commitments with regular work patterns islikely to be difficult enough let alone when pressured orunexpected overtime is required to be worked thus addingto the existing worker demands

A limitation of the current study was the low responserate which potentially limits the generalisability of thefindings Furthermore it is possible that this study wassubject to what Schaufeli and Enzman (1998) call thelsquohealthy worker effectrsquo (p74) because more healthyworkers are investigated because those who are extremelyaffected may not be working This situation is likely toresult in an underestimation of the incidence of burnout(Schaufeli and Enzmann 1998)

CONCLUSIONPositively the current study demonstrates that Victorian

nurses are not experiencing high levels of burnout and thevast majority was satisfied with their career choice Thestudy has also highlighted the importance of workingmanageable hours and that increasing years of nursingexperience is likely to be beneficial for the workerAdditionally working pressured or unexpected overtimewas associated with increased levels of emotionalexhaustion and depersonalisation indicating the need formanagement to be mindful of this situation occurringparticularly if foreshadowed nurse shortages continue

REFERENCESAiken LH Clarke SP Sloane DM Sochalski JA Busse R Clarke HGiovannetti P Hunt J Rafferty AM and Shamian J 2001 Nurses reportson hospital care in five countries Health Affairs 20(3)43-53

Australian Institute of Health and Welfare (AIHW) 2006 Nursing andmidwifery labour force 2004 AIHW CatNo HWL 38 Canberra AustraliaAustralian Institute of Health and Welfare (National Health Labour ForceSeries No37)

Burke RJ and Greenglass ER 2001 Hospital restructuring stressors work-family concerns and psychological well-being among nursing staff CommunityWork and Family 4(1)49-62

Buunk BP and Schaufeli WB 1993 Burnout A perspective from socialcomparison theory In W Schaufeli C Maslach and C Marek (eds)Professional burnout recent developments in theory and research (pp53-66)Washington DC Taylor and Francis

Demerouti E Bakker AB Nachreiner F and Schaufeli W B 2000 A modelof burnout and life satisfaction amongst nurses Journal of Advanced Nursing32(2)454-464

Dewe P Leiter M and Cox T (eds) 2000 Coping health and organisationsNew York Taylor and Francis

Evers W Tomic W and Brouwers A 2001 Effects of aggressive behaviorand perceived self-efficacy on burnout among staff of homes for the elderlyIssues in Mental Health Nursing 22(4)439-454

Hayter M 1999 Burnout and AIDS care-related factors in HIV communityclinical nurse specialists in the north of England Journal of Advanced Nursing29(4)984-993

44Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

There has been much research on burnout in nursespresumably because of the intense nature of their contactwith patients or clients (Demerouti et al 2000) A reviewof burnout found that 17 of published studies usednurses as their sample group (Schaufeli and Enzmann1998) Individual studies conducted in different groups ofnurses show variation in levels of burnout For exampleemotional exhaustion appears comparatively high in somestudies (eg Stordeur et al 2001) and low in others (eg Kilfedder et al 2001)

Other studies have described lower depersonalisation(eg Kilfedder et al 2001) or lower personalaccomplishment in nurses (eg Hayter 1999) Thevariations highlight the importance of investigatingindividual groups to determine their level of burnoutbecause generalisations are not always possible due todifferences in the job or workplace This is particularly soif employees have been through difficult work changessuch as organisational reform

Prior to this study being conducted hospitals inAustralia had undergone substantial organisationalchange Reform of hospital environments has previouslybeen found to negatively impact on nurses in particular(Spence-Laschinger et al 2001) as it results inrestructuring (Burke and Greenglass 2001 Sochalski et al1999) mergers (Idel et al 2003) and inadequateworkforce numbers (Aiken et al 2001) Similarlyrestructuring has been found to be associated withemotional distress (Idel et al 2003) role stress (Swansonand Power 2001) and work-family conflict (Burke andGreenglass 2001)

Consequently because the changes above have thepotential to impact negatively on nursesrsquo experiences theywere perceived to be an ideal group for further study inrelation to burnout In addition to investigating individualcharacteristics (eg age years of experience) that are ofteninvestigated in burnout research work characteristics that were relatively specific to the nursing profession at this time (eg where nursing qualification was gainedthat is hospital training or university based education)and overtime were also included in the study It wasthought prudent to investigate overtime in this samplesince with the reported increased workloads anddecreased staff numbers it was likely that overtime maybe an issue for nurses

The two major aims of the study were (1) to comparelevels of burnout in Victorian nurses against normativedata and (2) to assess the associations between selectedindividual and work characteristics and burnout

METHOD

ProcedureQuestionnaire packages were mailed to 2000

prospective participants who were registered nurses(Division 1) in Victoria by Australian Nursing Federation

Victorian Branch staff (VIC ANF) Registered nurseshave completed as a minimum a three-year nursingqualification resulting in being able to practice as aregistered nurse There were 574 usable questionnairesavailable indicating a response rate of 293

QuestionnaireBurnout Burnout was assessed using the Maslach

Burnout Inventory (Maslach et al 1996) The inventorycontains 22 items that assess the three components ofburnout Each item lists a work-related feeling andrespondents indicate how often they felt that way abouttheir job on a 7-point Likert scale Emotional exhaustionwas measured using nine items (eg lsquoI feel like Irsquom at theend of my ropersquo) depersonalisation was measured usingfive items (eg lsquoI feel I treat some patients as if they wereimpersonal objectsrsquo) and personal accomplishment wasmeasured using eight items (eg lsquoI feel Irsquom positivelyinfluencing other peoplersquos lives through my workrsquo)Response options for the items were 0 lsquoneverrsquo through to6 lsquoevery dayrsquo Responses are added to form a score foreach subscale thus giving each participant three scoresfor the three components of burnout

Demographics The demographics that were recordedincluded age years worked as a nurse and place ofprimary nursing qualification Respondents were alsoasked questions about their main nursing job includingthe average number of hours worked in the past fourweeks and whether they usually worked overtime and ifso whether it was voluntary or pressuredexpected paidor unpaid

RESULTSTable 1 displays the means standard deviations and

ranges for respondentrsquos age years working as a nurse andhours worked per week The sample is representative ofthe nursing profession in terms of age and number ofhours worked per week because previous research hasreported that the average age of registered nurses inAustralia is 432 years and they work an average of 331hours per week (AIHW 2006)

Table 1 Means and Standard Deviations for Age Years Working as a Nurse Years Working in Current Main JobHours Worked Per Week and Number of Days Taken in SickLeave in the Past Four Weeks

Variable (n) Mean SD

Age(years) 570 4394 961

Yearsworking asa nurse

571 2294 1024

Hoursworkedper week

545 3217 1064

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

45

Table 2 displays the frequency distribution for genderemployment status location of main nursing job worksetting where primary nursing qualification was obtainedand overtime characteristics

These figures are similar to those described in previousresearch (AIHW 2006) showing that 914 of registerednurses are female 883 worked in a clinical nursingrole 624 in an acute hospital setting with 662employed in the public sector Of the respondents to thestudy 782 worked in a clinical nursing role and 613worked in an acute hospital setting

COMPARATIVE RESULTSBurnout in the sample of nurses was compared

with the available normative data to investigate if any significant differences existed Table 3 presents the mean and standard deviation for emotional exhaustiondepersonalisation and personal accomplishmentAdditionally the table contains the normative data formedical workers and for the overall comparative sample

obtained from the manual of the Maslach BurnoutInventory (Maslach et al 1996)

The scores for nurses were not significantly differenton emotional exhaustion from both normative groups(medical sample t (570) = 073 pgt005 overall sample t(570) = 178 pgt005) However their scores weresignificantly different compared to both normative groupson depersonalisation (medical sample t (570) = 588plt005 overall sample t (570) = 1307 plt005) andpersonal accomplishment (medical sample t (570) = 358plt005 overall sample t (570) = 1035 plt005)Examination of the means indicated that the nursesexperienced lower depersonalisation and higher personalaccomplishment (lower burnout overall) than both thenormative sample groups

Individual and work characteristics and burnout Pearson correlations were used to investigate

the association between emotional exhaustiondepersonalisation and personal accomplishment withindividual and work characteristics (see table 4) Age was negatively associated with emotional exhaustion (r = -008 plt005) and depersonalisation (r = -023plt005) indicating that as nursesrsquo age increased theirlevels of these two burnout components decreasedSimilarly nursesrsquo experience was negatively associatedwith depersonalisation (r = -020 plt005) The number ofhours worked as a nurse was positively associated withemotional exhaustion (r = 024 plt005) anddepersonalization (r = 010 plt005) Therefore as thenumber of work hours increased nurses were more likelyto experience emotional exhaustion and depersonalisation

Table 3 Means and Standard Deviations for Emotional ExhaustionDepersonalisation and Personal Accomplishment for ANFMembers with Comparative Data from Normative Samples

Variables (n) Mean SD t-test

EmotionalexhaustionANF members

571 2184 1140

Normative(medical) 1104 2219 953 t(570) = 073

pgt005

Overall normativesample 11067 2099 1075 t(570) = 178

pgt005

DepersonalisationANF members 571 581 534

Normative(medical) 1104 712 522 t(570) = 588

plt005

Overall normativesample 11067 873 589 t(570) = 1307

plt005

PersonalaccomplishmentANF members

571 3756 688

Normative(medical) 1104 3653 734 t(570) = 358

plt005

Overall normativesample 11067 3458 711 t(570) = 1035

plt005

Table 2 Frequency Distributions for Gender Employment StatusLocation of Main Nursing Job Work Setting Primary NursingQualification and Overtime Characteristics

Variable Percentage (n)

GenderFemale 9441 (541)

Male 559 (32)

Employment Status

Full Time 3427 (196)

Permanent Part-time 5734 (328)

Casual 839 (48)

Location of MainNursing Job

City 2915 (165)

Suburban 4046 (229)

Rural 3039 (172)

Work Setting

Public 6834 (382)

Private 2952 (165)

Both public and private 215 (12)

Primary NursingQualification

Hospital 7086 (406)

CollegeUniversity 2321 (133)

Both 593 (34)

OvertimePerformed at Work

Yes 6860 (391)

No 3140 (179)

Overtime Voluntaryor PressuredExpected

Voluntary 4590 (123)

PressuredExpected 5410 (145)

Overtime Paid or Unpaid

Paid 3838 (114)

Unpaid 6162 (183)

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

46

Note plt005 plt001

Key EE = Emotional exhaustion DEP = Depersonalisation PA = Personalaccomplishment Years = years worked as a nurse Hours = hours worked as anurse per week HospUni = where primary nursing qualification was gained (code0 = Hospital 1 = University) OT = Perform OT while at work in main nursing job(code 0 = No 1 = Yes) OT Voluntary = if the usual OT was voluntary orpressuredexpected (code 0 = Voluntary 1 = PressuredExpected) OT Paid = ifthe usual overtime was paid or unpaid (code 0 = Paid 1 = Unpaid)

Nurses who had gained their primary nursingqualification at a university or college tended to havehigher emotional exhaustion (r = 009 plt005) anddepersonalisation (r = 016 plt005) than hospital trainednurses Working overtime was associated with higheremotional exhaustion (r = 021 plt005) which waspartially explained because those nurses who workedovertime also worked more hours (t (543) = 468 plt005overtime M = 3355 hours SD = 1050 no overtime M =2911 SD = 992) A two-step hierarchical multipleregression using emotional exhaustion as the dependentvariable was used to analyse whether the effect of workingovertime occurred over and above the effect of hoursworked The regression was significant (F (2539) = 2518plt005 adjusted R2 = 008) and demonstrated thatworking overtime was significantly associated with higheremotional exhaustion (sbquo = 018 plt005) after allowing forhours of nursing work in step one of the hierarchicalmultiple regression Being pressured or expected to workovertime (rather than voluntarily) was associated withhigher emotional exhaustion (r = 041 plt005) anddepersonalisation (r = 022 plt005) and working unpaidovertime was associated with higher emotional exhaustion(r = 013 plt005)

DISCUSSIONThe first aim of the study was to compare the burnout

levels of Victorian nurses to normative data in order toassess whether they differed significantly The second aimof the study was to analyse the relationship betweenindividual and work characteristics and burnout

Comparative results The current sample of nurses had similar levels of

emotional exhaustion to the overall normative and medicalfigures (Maslach et al 1996) However respondents hadsignificantly lower depersonalisation and higher personalaccomplishment than both the normative and medicalsamples Additionally 893 of respondents reportedbeing satisfied (33 dissatisfied) with choosing nursing asa career choice This result would seem an extremelypositive one given that many of the respondents in thecurrent study would have been exposed to some type oforganisational change prior to the study being conductedPerhaps the lower rate of depersonalisation and higherpersonal accomplishment relates to the low averagenumber of hours worked by the nurses many of whomworked part-time and as such are likely to lead morebalanced lives than full-time employees Unfortunately the employment status of the normative samples is not available Another possible reason for the differences is that the normative figures are based on mainly American data and therefore there is the possibility of a cultural effect

Individual and work characteristics and burnout Age and the number of years in practice were strongly

positively associated (r = 089 plt001) indicating thatolder nurses are also likely to be more experienced Bothage and years working as a nurse were significantlynegatively associated with depersonalisation while only age was significantly associated with emotionalexhaustion Despite the non-significant result betweenyears of nursing and emotional exhaustion the result wasbordering significance and given the high correlationbetween age and years of working as a nurse they will beconsidered together This result indicated that older moreexperienced nurses experienced lower burnout on thesetwo components a finding that is consistent with previousresearch reporting that younger age is associated withhigher levels of burnout (Schaufeli and Enzmann 1998)

The significant association between increasing age andlower levels of emotional exhaustion and depersonalisationhas been consistently reported (Schaufeli and Enzmann1998) however the strength of association with emotionalexhaustion was weaker than previously reported in somestudies (eg Huebner 1994) The most likely explanationfor higher levels of emotional exhaustion anddepersonalisation in younger workers is that professionaleducation can not always equip new graduates with thenecessary skills to adequately deal with every problemsituation in the workplace Consequently new graduatesare continually experiencing stress as they struggle to find the necessary resources to deal with every newworkplace challenge

The gulf between skills provided by training and thoserequired in reality is particularly evident with interpersonalskills (Pines and Aronson 1988) which are so important inorder to effectively communicate with colleagues andclients This uncertainty with some work characteristics is

Table 4 Summary of Correlations between Age Years of Work Hours Worked per Week Burnout (Emotional Exhaustion Depersonalisation and PersonalAccomplishment) and Overtime

VariableEmotionalexhaustion

EE

DepersonalisationDEP

Personalaccomplishment

PA

DEP 056

PA -029 -038

Age -008 -023 004

Years -007 -020 004

Hours 024 010 008

HospUni 009 016 -001

OT 021 -001 008

OTvoluntary 041 022 -004

OT paid 013 -003 004

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

47

likely to influence the level of stress experienced by nurses(Buunk and Schaufeli 1993) Less experienced nurses arelikely to experience emotional exhaustion due to theemotional demands of new and unexpected worksituations Depersonalisation occurs in order to distancethemselves from this emotionally draining work (Leiter1993) Older nurses are likely to have previouslyexperienced most work scenarios thereby understandingand managing problematic or ambiguous work situationswith greater confidence and certainty The influence ofageyears of experience also partially explains why being ahospital trained nurse was significantly associated withlower emotional exhaustion and depersonalisation(compared to their universitycollege trained colleagues)While it would be tempting to suggest thatuniversitycollege nursing training is an influencing factorin this result it is more likely that because hospital nursingeducation was phased out over ten years ago hospitalnurses were an older cohort than collegeuniversity trainednurses A t-test confirmed this assumption (t (533) = 2101plt005) with hospital trained nurses being significantlyolder (M = 4770 SD = 724 universitycollege M = 3254 SD = 699)

The number of hours worked per week as a nurse wassignificantly associated with emotional exhaustion anddepersonalisation indicating that working longer hours wasassociated with higher levels of these two burnoutcomponents Previous researchers have suggested that thenumber of hours worked as being weakly associated withemotional exhaustion (Evers et al 2001) findings that areconsistent with those of the current study The averagenumber of hours worked for nurses in this study was 3217hours (SD = 1064) indicating a lower average than atypical full-time week and may partially explain why the hours worked per week was a weak contributor toemotional exhaustion and depersonalisation There is someindication that the association between the number of hoursworked and adverse consequences is non-linear with onlyexcessive work hours resulting in problems for workers(Sparks et al 1997)

Overall working overtime was associated with higherlevels of emotional exhaustion however the largestcontributor to this effect were those workers who werepressured or expected to do the overtime Examination ofthe means demonstrates that those workers who reportedvoluntarily working overtime (M = 1859 SD = 1062) didnot experience higher emotional exhaustion than thoseworkers who did not work any overtime (M = 1825 SD =1060) This result suggests that it is not working overtimeper se that is the problem the issue is when nurses losecontrol over their work patterns and they feel pressured toadd the extra work demands onto their existing load

Conversely for some nurses working overtime may be apositive experience because of extra income When aworker has voluntarily worked overtime it would also belikely that their homefamily commitments would beorganised in advance thereby removing potentialhomework conflict The reality of the hospital system

often means that nurses will be unexpectedly required towork overtime occasionally (and may indeed want to dothis) The current result highlights that there may be a costfor this extra work commitment if workers feel pressuredto engage in overtime work that is unexplained andunexpected This is not surprising given that much of thistype of work may be unexpected and therefore verydisruptive to homefamily life Attempting to juggle lifeand family commitments with regular work patterns islikely to be difficult enough let alone when pressured orunexpected overtime is required to be worked thus addingto the existing worker demands

A limitation of the current study was the low responserate which potentially limits the generalisability of thefindings Furthermore it is possible that this study wassubject to what Schaufeli and Enzman (1998) call thelsquohealthy worker effectrsquo (p74) because more healthyworkers are investigated because those who are extremelyaffected may not be working This situation is likely toresult in an underestimation of the incidence of burnout(Schaufeli and Enzmann 1998)

CONCLUSIONPositively the current study demonstrates that Victorian

nurses are not experiencing high levels of burnout and thevast majority was satisfied with their career choice Thestudy has also highlighted the importance of workingmanageable hours and that increasing years of nursingexperience is likely to be beneficial for the workerAdditionally working pressured or unexpected overtimewas associated with increased levels of emotionalexhaustion and depersonalisation indicating the need formanagement to be mindful of this situation occurringparticularly if foreshadowed nurse shortages continue

REFERENCESAiken LH Clarke SP Sloane DM Sochalski JA Busse R Clarke HGiovannetti P Hunt J Rafferty AM and Shamian J 2001 Nurses reportson hospital care in five countries Health Affairs 20(3)43-53

Australian Institute of Health and Welfare (AIHW) 2006 Nursing andmidwifery labour force 2004 AIHW CatNo HWL 38 Canberra AustraliaAustralian Institute of Health and Welfare (National Health Labour ForceSeries No37)

Burke RJ and Greenglass ER 2001 Hospital restructuring stressors work-family concerns and psychological well-being among nursing staff CommunityWork and Family 4(1)49-62

Buunk BP and Schaufeli WB 1993 Burnout A perspective from socialcomparison theory In W Schaufeli C Maslach and C Marek (eds)Professional burnout recent developments in theory and research (pp53-66)Washington DC Taylor and Francis

Demerouti E Bakker AB Nachreiner F and Schaufeli W B 2000 A modelof burnout and life satisfaction amongst nurses Journal of Advanced Nursing32(2)454-464

Dewe P Leiter M and Cox T (eds) 2000 Coping health and organisationsNew York Taylor and Francis

Evers W Tomic W and Brouwers A 2001 Effects of aggressive behaviorand perceived self-efficacy on burnout among staff of homes for the elderlyIssues in Mental Health Nursing 22(4)439-454

Hayter M 1999 Burnout and AIDS care-related factors in HIV communityclinical nurse specialists in the north of England Journal of Advanced Nursing29(4)984-993

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

45

Table 2 displays the frequency distribution for genderemployment status location of main nursing job worksetting where primary nursing qualification was obtainedand overtime characteristics

These figures are similar to those described in previousresearch (AIHW 2006) showing that 914 of registerednurses are female 883 worked in a clinical nursingrole 624 in an acute hospital setting with 662employed in the public sector Of the respondents to thestudy 782 worked in a clinical nursing role and 613worked in an acute hospital setting

COMPARATIVE RESULTSBurnout in the sample of nurses was compared

with the available normative data to investigate if any significant differences existed Table 3 presents the mean and standard deviation for emotional exhaustiondepersonalisation and personal accomplishmentAdditionally the table contains the normative data formedical workers and for the overall comparative sample

obtained from the manual of the Maslach BurnoutInventory (Maslach et al 1996)

The scores for nurses were not significantly differenton emotional exhaustion from both normative groups(medical sample t (570) = 073 pgt005 overall sample t(570) = 178 pgt005) However their scores weresignificantly different compared to both normative groupson depersonalisation (medical sample t (570) = 588plt005 overall sample t (570) = 1307 plt005) andpersonal accomplishment (medical sample t (570) = 358plt005 overall sample t (570) = 1035 plt005)Examination of the means indicated that the nursesexperienced lower depersonalisation and higher personalaccomplishment (lower burnout overall) than both thenormative sample groups

Individual and work characteristics and burnout Pearson correlations were used to investigate

the association between emotional exhaustiondepersonalisation and personal accomplishment withindividual and work characteristics (see table 4) Age was negatively associated with emotional exhaustion (r = -008 plt005) and depersonalisation (r = -023plt005) indicating that as nursesrsquo age increased theirlevels of these two burnout components decreasedSimilarly nursesrsquo experience was negatively associatedwith depersonalisation (r = -020 plt005) The number ofhours worked as a nurse was positively associated withemotional exhaustion (r = 024 plt005) anddepersonalization (r = 010 plt005) Therefore as thenumber of work hours increased nurses were more likelyto experience emotional exhaustion and depersonalisation

Table 3 Means and Standard Deviations for Emotional ExhaustionDepersonalisation and Personal Accomplishment for ANFMembers with Comparative Data from Normative Samples

Variables (n) Mean SD t-test

EmotionalexhaustionANF members

571 2184 1140

Normative(medical) 1104 2219 953 t(570) = 073

pgt005

Overall normativesample 11067 2099 1075 t(570) = 178

pgt005

DepersonalisationANF members 571 581 534

Normative(medical) 1104 712 522 t(570) = 588

plt005

Overall normativesample 11067 873 589 t(570) = 1307

plt005

PersonalaccomplishmentANF members

571 3756 688

Normative(medical) 1104 3653 734 t(570) = 358

plt005

Overall normativesample 11067 3458 711 t(570) = 1035

plt005

Table 2 Frequency Distributions for Gender Employment StatusLocation of Main Nursing Job Work Setting Primary NursingQualification and Overtime Characteristics

Variable Percentage (n)

GenderFemale 9441 (541)

Male 559 (32)

Employment Status

Full Time 3427 (196)

Permanent Part-time 5734 (328)

Casual 839 (48)

Location of MainNursing Job

City 2915 (165)

Suburban 4046 (229)

Rural 3039 (172)

Work Setting

Public 6834 (382)

Private 2952 (165)

Both public and private 215 (12)

Primary NursingQualification

Hospital 7086 (406)

CollegeUniversity 2321 (133)

Both 593 (34)

OvertimePerformed at Work

Yes 6860 (391)

No 3140 (179)

Overtime Voluntaryor PressuredExpected

Voluntary 4590 (123)

PressuredExpected 5410 (145)

Overtime Paid or Unpaid

Paid 3838 (114)

Unpaid 6162 (183)

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

46

Note plt005 plt001

Key EE = Emotional exhaustion DEP = Depersonalisation PA = Personalaccomplishment Years = years worked as a nurse Hours = hours worked as anurse per week HospUni = where primary nursing qualification was gained (code0 = Hospital 1 = University) OT = Perform OT while at work in main nursing job(code 0 = No 1 = Yes) OT Voluntary = if the usual OT was voluntary orpressuredexpected (code 0 = Voluntary 1 = PressuredExpected) OT Paid = ifthe usual overtime was paid or unpaid (code 0 = Paid 1 = Unpaid)

Nurses who had gained their primary nursingqualification at a university or college tended to havehigher emotional exhaustion (r = 009 plt005) anddepersonalisation (r = 016 plt005) than hospital trainednurses Working overtime was associated with higheremotional exhaustion (r = 021 plt005) which waspartially explained because those nurses who workedovertime also worked more hours (t (543) = 468 plt005overtime M = 3355 hours SD = 1050 no overtime M =2911 SD = 992) A two-step hierarchical multipleregression using emotional exhaustion as the dependentvariable was used to analyse whether the effect of workingovertime occurred over and above the effect of hoursworked The regression was significant (F (2539) = 2518plt005 adjusted R2 = 008) and demonstrated thatworking overtime was significantly associated with higheremotional exhaustion (sbquo = 018 plt005) after allowing forhours of nursing work in step one of the hierarchicalmultiple regression Being pressured or expected to workovertime (rather than voluntarily) was associated withhigher emotional exhaustion (r = 041 plt005) anddepersonalisation (r = 022 plt005) and working unpaidovertime was associated with higher emotional exhaustion(r = 013 plt005)

DISCUSSIONThe first aim of the study was to compare the burnout

levels of Victorian nurses to normative data in order toassess whether they differed significantly The second aimof the study was to analyse the relationship betweenindividual and work characteristics and burnout

Comparative results The current sample of nurses had similar levels of

emotional exhaustion to the overall normative and medicalfigures (Maslach et al 1996) However respondents hadsignificantly lower depersonalisation and higher personalaccomplishment than both the normative and medicalsamples Additionally 893 of respondents reportedbeing satisfied (33 dissatisfied) with choosing nursing asa career choice This result would seem an extremelypositive one given that many of the respondents in thecurrent study would have been exposed to some type oforganisational change prior to the study being conductedPerhaps the lower rate of depersonalisation and higherpersonal accomplishment relates to the low averagenumber of hours worked by the nurses many of whomworked part-time and as such are likely to lead morebalanced lives than full-time employees Unfortunately the employment status of the normative samples is not available Another possible reason for the differences is that the normative figures are based on mainly American data and therefore there is the possibility of a cultural effect

Individual and work characteristics and burnout Age and the number of years in practice were strongly

positively associated (r = 089 plt001) indicating thatolder nurses are also likely to be more experienced Bothage and years working as a nurse were significantlynegatively associated with depersonalisation while only age was significantly associated with emotionalexhaustion Despite the non-significant result betweenyears of nursing and emotional exhaustion the result wasbordering significance and given the high correlationbetween age and years of working as a nurse they will beconsidered together This result indicated that older moreexperienced nurses experienced lower burnout on thesetwo components a finding that is consistent with previousresearch reporting that younger age is associated withhigher levels of burnout (Schaufeli and Enzmann 1998)

The significant association between increasing age andlower levels of emotional exhaustion and depersonalisationhas been consistently reported (Schaufeli and Enzmann1998) however the strength of association with emotionalexhaustion was weaker than previously reported in somestudies (eg Huebner 1994) The most likely explanationfor higher levels of emotional exhaustion anddepersonalisation in younger workers is that professionaleducation can not always equip new graduates with thenecessary skills to adequately deal with every problemsituation in the workplace Consequently new graduatesare continually experiencing stress as they struggle to find the necessary resources to deal with every newworkplace challenge

The gulf between skills provided by training and thoserequired in reality is particularly evident with interpersonalskills (Pines and Aronson 1988) which are so important inorder to effectively communicate with colleagues andclients This uncertainty with some work characteristics is

Table 4 Summary of Correlations between Age Years of Work Hours Worked per Week Burnout (Emotional Exhaustion Depersonalisation and PersonalAccomplishment) and Overtime

VariableEmotionalexhaustion

EE

DepersonalisationDEP

Personalaccomplishment

PA

DEP 056

PA -029 -038

Age -008 -023 004

Years -007 -020 004

Hours 024 010 008

HospUni 009 016 -001

OT 021 -001 008

OTvoluntary 041 022 -004

OT paid 013 -003 004

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

47

likely to influence the level of stress experienced by nurses(Buunk and Schaufeli 1993) Less experienced nurses arelikely to experience emotional exhaustion due to theemotional demands of new and unexpected worksituations Depersonalisation occurs in order to distancethemselves from this emotionally draining work (Leiter1993) Older nurses are likely to have previouslyexperienced most work scenarios thereby understandingand managing problematic or ambiguous work situationswith greater confidence and certainty The influence ofageyears of experience also partially explains why being ahospital trained nurse was significantly associated withlower emotional exhaustion and depersonalisation(compared to their universitycollege trained colleagues)While it would be tempting to suggest thatuniversitycollege nursing training is an influencing factorin this result it is more likely that because hospital nursingeducation was phased out over ten years ago hospitalnurses were an older cohort than collegeuniversity trainednurses A t-test confirmed this assumption (t (533) = 2101plt005) with hospital trained nurses being significantlyolder (M = 4770 SD = 724 universitycollege M = 3254 SD = 699)

The number of hours worked per week as a nurse wassignificantly associated with emotional exhaustion anddepersonalisation indicating that working longer hours wasassociated with higher levels of these two burnoutcomponents Previous researchers have suggested that thenumber of hours worked as being weakly associated withemotional exhaustion (Evers et al 2001) findings that areconsistent with those of the current study The averagenumber of hours worked for nurses in this study was 3217hours (SD = 1064) indicating a lower average than atypical full-time week and may partially explain why the hours worked per week was a weak contributor toemotional exhaustion and depersonalisation There is someindication that the association between the number of hoursworked and adverse consequences is non-linear with onlyexcessive work hours resulting in problems for workers(Sparks et al 1997)

Overall working overtime was associated with higherlevels of emotional exhaustion however the largestcontributor to this effect were those workers who werepressured or expected to do the overtime Examination ofthe means demonstrates that those workers who reportedvoluntarily working overtime (M = 1859 SD = 1062) didnot experience higher emotional exhaustion than thoseworkers who did not work any overtime (M = 1825 SD =1060) This result suggests that it is not working overtimeper se that is the problem the issue is when nurses losecontrol over their work patterns and they feel pressured toadd the extra work demands onto their existing load

Conversely for some nurses working overtime may be apositive experience because of extra income When aworker has voluntarily worked overtime it would also belikely that their homefamily commitments would beorganised in advance thereby removing potentialhomework conflict The reality of the hospital system

often means that nurses will be unexpectedly required towork overtime occasionally (and may indeed want to dothis) The current result highlights that there may be a costfor this extra work commitment if workers feel pressuredto engage in overtime work that is unexplained andunexpected This is not surprising given that much of thistype of work may be unexpected and therefore verydisruptive to homefamily life Attempting to juggle lifeand family commitments with regular work patterns islikely to be difficult enough let alone when pressured orunexpected overtime is required to be worked thus addingto the existing worker demands

A limitation of the current study was the low responserate which potentially limits the generalisability of thefindings Furthermore it is possible that this study wassubject to what Schaufeli and Enzman (1998) call thelsquohealthy worker effectrsquo (p74) because more healthyworkers are investigated because those who are extremelyaffected may not be working This situation is likely toresult in an underestimation of the incidence of burnout(Schaufeli and Enzmann 1998)

CONCLUSIONPositively the current study demonstrates that Victorian

nurses are not experiencing high levels of burnout and thevast majority was satisfied with their career choice Thestudy has also highlighted the importance of workingmanageable hours and that increasing years of nursingexperience is likely to be beneficial for the workerAdditionally working pressured or unexpected overtimewas associated with increased levels of emotionalexhaustion and depersonalisation indicating the need formanagement to be mindful of this situation occurringparticularly if foreshadowed nurse shortages continue

REFERENCESAiken LH Clarke SP Sloane DM Sochalski JA Busse R Clarke HGiovannetti P Hunt J Rafferty AM and Shamian J 2001 Nurses reportson hospital care in five countries Health Affairs 20(3)43-53

Australian Institute of Health and Welfare (AIHW) 2006 Nursing andmidwifery labour force 2004 AIHW CatNo HWL 38 Canberra AustraliaAustralian Institute of Health and Welfare (National Health Labour ForceSeries No37)

Burke RJ and Greenglass ER 2001 Hospital restructuring stressors work-family concerns and psychological well-being among nursing staff CommunityWork and Family 4(1)49-62

Buunk BP and Schaufeli WB 1993 Burnout A perspective from socialcomparison theory In W Schaufeli C Maslach and C Marek (eds)Professional burnout recent developments in theory and research (pp53-66)Washington DC Taylor and Francis

Demerouti E Bakker AB Nachreiner F and Schaufeli W B 2000 A modelof burnout and life satisfaction amongst nurses Journal of Advanced Nursing32(2)454-464

Dewe P Leiter M and Cox T (eds) 2000 Coping health and organisationsNew York Taylor and Francis

Evers W Tomic W and Brouwers A 2001 Effects of aggressive behaviorand perceived self-efficacy on burnout among staff of homes for the elderlyIssues in Mental Health Nursing 22(4)439-454

Hayter M 1999 Burnout and AIDS care-related factors in HIV communityclinical nurse specialists in the north of England Journal of Advanced Nursing29(4)984-993

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

46

Note plt005 plt001

Key EE = Emotional exhaustion DEP = Depersonalisation PA = Personalaccomplishment Years = years worked as a nurse Hours = hours worked as anurse per week HospUni = where primary nursing qualification was gained (code0 = Hospital 1 = University) OT = Perform OT while at work in main nursing job(code 0 = No 1 = Yes) OT Voluntary = if the usual OT was voluntary orpressuredexpected (code 0 = Voluntary 1 = PressuredExpected) OT Paid = ifthe usual overtime was paid or unpaid (code 0 = Paid 1 = Unpaid)

Nurses who had gained their primary nursingqualification at a university or college tended to havehigher emotional exhaustion (r = 009 plt005) anddepersonalisation (r = 016 plt005) than hospital trainednurses Working overtime was associated with higheremotional exhaustion (r = 021 plt005) which waspartially explained because those nurses who workedovertime also worked more hours (t (543) = 468 plt005overtime M = 3355 hours SD = 1050 no overtime M =2911 SD = 992) A two-step hierarchical multipleregression using emotional exhaustion as the dependentvariable was used to analyse whether the effect of workingovertime occurred over and above the effect of hoursworked The regression was significant (F (2539) = 2518plt005 adjusted R2 = 008) and demonstrated thatworking overtime was significantly associated with higheremotional exhaustion (sbquo = 018 plt005) after allowing forhours of nursing work in step one of the hierarchicalmultiple regression Being pressured or expected to workovertime (rather than voluntarily) was associated withhigher emotional exhaustion (r = 041 plt005) anddepersonalisation (r = 022 plt005) and working unpaidovertime was associated with higher emotional exhaustion(r = 013 plt005)

DISCUSSIONThe first aim of the study was to compare the burnout

levels of Victorian nurses to normative data in order toassess whether they differed significantly The second aimof the study was to analyse the relationship betweenindividual and work characteristics and burnout

Comparative results The current sample of nurses had similar levels of

emotional exhaustion to the overall normative and medicalfigures (Maslach et al 1996) However respondents hadsignificantly lower depersonalisation and higher personalaccomplishment than both the normative and medicalsamples Additionally 893 of respondents reportedbeing satisfied (33 dissatisfied) with choosing nursing asa career choice This result would seem an extremelypositive one given that many of the respondents in thecurrent study would have been exposed to some type oforganisational change prior to the study being conductedPerhaps the lower rate of depersonalisation and higherpersonal accomplishment relates to the low averagenumber of hours worked by the nurses many of whomworked part-time and as such are likely to lead morebalanced lives than full-time employees Unfortunately the employment status of the normative samples is not available Another possible reason for the differences is that the normative figures are based on mainly American data and therefore there is the possibility of a cultural effect

Individual and work characteristics and burnout Age and the number of years in practice were strongly

positively associated (r = 089 plt001) indicating thatolder nurses are also likely to be more experienced Bothage and years working as a nurse were significantlynegatively associated with depersonalisation while only age was significantly associated with emotionalexhaustion Despite the non-significant result betweenyears of nursing and emotional exhaustion the result wasbordering significance and given the high correlationbetween age and years of working as a nurse they will beconsidered together This result indicated that older moreexperienced nurses experienced lower burnout on thesetwo components a finding that is consistent with previousresearch reporting that younger age is associated withhigher levels of burnout (Schaufeli and Enzmann 1998)

The significant association between increasing age andlower levels of emotional exhaustion and depersonalisationhas been consistently reported (Schaufeli and Enzmann1998) however the strength of association with emotionalexhaustion was weaker than previously reported in somestudies (eg Huebner 1994) The most likely explanationfor higher levels of emotional exhaustion anddepersonalisation in younger workers is that professionaleducation can not always equip new graduates with thenecessary skills to adequately deal with every problemsituation in the workplace Consequently new graduatesare continually experiencing stress as they struggle to find the necessary resources to deal with every newworkplace challenge

The gulf between skills provided by training and thoserequired in reality is particularly evident with interpersonalskills (Pines and Aronson 1988) which are so important inorder to effectively communicate with colleagues andclients This uncertainty with some work characteristics is

Table 4 Summary of Correlations between Age Years of Work Hours Worked per Week Burnout (Emotional Exhaustion Depersonalisation and PersonalAccomplishment) and Overtime

VariableEmotionalexhaustion

EE

DepersonalisationDEP

Personalaccomplishment

PA

DEP 056

PA -029 -038

Age -008 -023 004

Years -007 -020 004

Hours 024 010 008

HospUni 009 016 -001

OT 021 -001 008

OTvoluntary 041 022 -004

OT paid 013 -003 004

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

47

likely to influence the level of stress experienced by nurses(Buunk and Schaufeli 1993) Less experienced nurses arelikely to experience emotional exhaustion due to theemotional demands of new and unexpected worksituations Depersonalisation occurs in order to distancethemselves from this emotionally draining work (Leiter1993) Older nurses are likely to have previouslyexperienced most work scenarios thereby understandingand managing problematic or ambiguous work situationswith greater confidence and certainty The influence ofageyears of experience also partially explains why being ahospital trained nurse was significantly associated withlower emotional exhaustion and depersonalisation(compared to their universitycollege trained colleagues)While it would be tempting to suggest thatuniversitycollege nursing training is an influencing factorin this result it is more likely that because hospital nursingeducation was phased out over ten years ago hospitalnurses were an older cohort than collegeuniversity trainednurses A t-test confirmed this assumption (t (533) = 2101plt005) with hospital trained nurses being significantlyolder (M = 4770 SD = 724 universitycollege M = 3254 SD = 699)

The number of hours worked per week as a nurse wassignificantly associated with emotional exhaustion anddepersonalisation indicating that working longer hours wasassociated with higher levels of these two burnoutcomponents Previous researchers have suggested that thenumber of hours worked as being weakly associated withemotional exhaustion (Evers et al 2001) findings that areconsistent with those of the current study The averagenumber of hours worked for nurses in this study was 3217hours (SD = 1064) indicating a lower average than atypical full-time week and may partially explain why the hours worked per week was a weak contributor toemotional exhaustion and depersonalisation There is someindication that the association between the number of hoursworked and adverse consequences is non-linear with onlyexcessive work hours resulting in problems for workers(Sparks et al 1997)

Overall working overtime was associated with higherlevels of emotional exhaustion however the largestcontributor to this effect were those workers who werepressured or expected to do the overtime Examination ofthe means demonstrates that those workers who reportedvoluntarily working overtime (M = 1859 SD = 1062) didnot experience higher emotional exhaustion than thoseworkers who did not work any overtime (M = 1825 SD =1060) This result suggests that it is not working overtimeper se that is the problem the issue is when nurses losecontrol over their work patterns and they feel pressured toadd the extra work demands onto their existing load

Conversely for some nurses working overtime may be apositive experience because of extra income When aworker has voluntarily worked overtime it would also belikely that their homefamily commitments would beorganised in advance thereby removing potentialhomework conflict The reality of the hospital system

often means that nurses will be unexpectedly required towork overtime occasionally (and may indeed want to dothis) The current result highlights that there may be a costfor this extra work commitment if workers feel pressuredto engage in overtime work that is unexplained andunexpected This is not surprising given that much of thistype of work may be unexpected and therefore verydisruptive to homefamily life Attempting to juggle lifeand family commitments with regular work patterns islikely to be difficult enough let alone when pressured orunexpected overtime is required to be worked thus addingto the existing worker demands

A limitation of the current study was the low responserate which potentially limits the generalisability of thefindings Furthermore it is possible that this study wassubject to what Schaufeli and Enzman (1998) call thelsquohealthy worker effectrsquo (p74) because more healthyworkers are investigated because those who are extremelyaffected may not be working This situation is likely toresult in an underestimation of the incidence of burnout(Schaufeli and Enzmann 1998)

CONCLUSIONPositively the current study demonstrates that Victorian

nurses are not experiencing high levels of burnout and thevast majority was satisfied with their career choice Thestudy has also highlighted the importance of workingmanageable hours and that increasing years of nursingexperience is likely to be beneficial for the workerAdditionally working pressured or unexpected overtimewas associated with increased levels of emotionalexhaustion and depersonalisation indicating the need formanagement to be mindful of this situation occurringparticularly if foreshadowed nurse shortages continue

REFERENCESAiken LH Clarke SP Sloane DM Sochalski JA Busse R Clarke HGiovannetti P Hunt J Rafferty AM and Shamian J 2001 Nurses reportson hospital care in five countries Health Affairs 20(3)43-53

Australian Institute of Health and Welfare (AIHW) 2006 Nursing andmidwifery labour force 2004 AIHW CatNo HWL 38 Canberra AustraliaAustralian Institute of Health and Welfare (National Health Labour ForceSeries No37)

Burke RJ and Greenglass ER 2001 Hospital restructuring stressors work-family concerns and psychological well-being among nursing staff CommunityWork and Family 4(1)49-62

Buunk BP and Schaufeli WB 1993 Burnout A perspective from socialcomparison theory In W Schaufeli C Maslach and C Marek (eds)Professional burnout recent developments in theory and research (pp53-66)Washington DC Taylor and Francis

Demerouti E Bakker AB Nachreiner F and Schaufeli W B 2000 A modelof burnout and life satisfaction amongst nurses Journal of Advanced Nursing32(2)454-464

Dewe P Leiter M and Cox T (eds) 2000 Coping health and organisationsNew York Taylor and Francis

Evers W Tomic W and Brouwers A 2001 Effects of aggressive behaviorand perceived self-efficacy on burnout among staff of homes for the elderlyIssues in Mental Health Nursing 22(4)439-454

Hayter M 1999 Burnout and AIDS care-related factors in HIV communityclinical nurse specialists in the north of England Journal of Advanced Nursing29(4)984-993

Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

SCHOLARLY PAPER

47

likely to influence the level of stress experienced by nurses(Buunk and Schaufeli 1993) Less experienced nurses arelikely to experience emotional exhaustion due to theemotional demands of new and unexpected worksituations Depersonalisation occurs in order to distancethemselves from this emotionally draining work (Leiter1993) Older nurses are likely to have previouslyexperienced most work scenarios thereby understandingand managing problematic or ambiguous work situationswith greater confidence and certainty The influence ofageyears of experience also partially explains why being ahospital trained nurse was significantly associated withlower emotional exhaustion and depersonalisation(compared to their universitycollege trained colleagues)While it would be tempting to suggest thatuniversitycollege nursing training is an influencing factorin this result it is more likely that because hospital nursingeducation was phased out over ten years ago hospitalnurses were an older cohort than collegeuniversity trainednurses A t-test confirmed this assumption (t (533) = 2101plt005) with hospital trained nurses being significantlyolder (M = 4770 SD = 724 universitycollege M = 3254 SD = 699)

The number of hours worked per week as a nurse wassignificantly associated with emotional exhaustion anddepersonalisation indicating that working longer hours wasassociated with higher levels of these two burnoutcomponents Previous researchers have suggested that thenumber of hours worked as being weakly associated withemotional exhaustion (Evers et al 2001) findings that areconsistent with those of the current study The averagenumber of hours worked for nurses in this study was 3217hours (SD = 1064) indicating a lower average than atypical full-time week and may partially explain why the hours worked per week was a weak contributor toemotional exhaustion and depersonalisation There is someindication that the association between the number of hoursworked and adverse consequences is non-linear with onlyexcessive work hours resulting in problems for workers(Sparks et al 1997)

Overall working overtime was associated with higherlevels of emotional exhaustion however the largestcontributor to this effect were those workers who werepressured or expected to do the overtime Examination ofthe means demonstrates that those workers who reportedvoluntarily working overtime (M = 1859 SD = 1062) didnot experience higher emotional exhaustion than thoseworkers who did not work any overtime (M = 1825 SD =1060) This result suggests that it is not working overtimeper se that is the problem the issue is when nurses losecontrol over their work patterns and they feel pressured toadd the extra work demands onto their existing load

Conversely for some nurses working overtime may be apositive experience because of extra income When aworker has voluntarily worked overtime it would also belikely that their homefamily commitments would beorganised in advance thereby removing potentialhomework conflict The reality of the hospital system

often means that nurses will be unexpectedly required towork overtime occasionally (and may indeed want to dothis) The current result highlights that there may be a costfor this extra work commitment if workers feel pressuredto engage in overtime work that is unexplained andunexpected This is not surprising given that much of thistype of work may be unexpected and therefore verydisruptive to homefamily life Attempting to juggle lifeand family commitments with regular work patterns islikely to be difficult enough let alone when pressured orunexpected overtime is required to be worked thus addingto the existing worker demands

A limitation of the current study was the low responserate which potentially limits the generalisability of thefindings Furthermore it is possible that this study wassubject to what Schaufeli and Enzman (1998) call thelsquohealthy worker effectrsquo (p74) because more healthyworkers are investigated because those who are extremelyaffected may not be working This situation is likely toresult in an underestimation of the incidence of burnout(Schaufeli and Enzmann 1998)

CONCLUSIONPositively the current study demonstrates that Victorian

nurses are not experiencing high levels of burnout and thevast majority was satisfied with their career choice Thestudy has also highlighted the importance of workingmanageable hours and that increasing years of nursingexperience is likely to be beneficial for the workerAdditionally working pressured or unexpected overtimewas associated with increased levels of emotionalexhaustion and depersonalisation indicating the need formanagement to be mindful of this situation occurringparticularly if foreshadowed nurse shortages continue

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Australian Journal of Advanced Nursing 2007 Volume 24 Number 3

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