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Job burnout among critical care nurses

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Title:
Job burnout among critical care nurses
Creator:
Stechmiller, Joyce K., 1947-
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English
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xi, 177 leaves : ill. ; 28 cm.

Subjects

Subjects / Keywords:
Burnout ( jstor )
Critical care ( jstor )
Exhaustion ( jstor )
Job satisfaction ( jstor )
Job stress ( jstor )
Modeling ( jstor )
Nurses ( jstor )
Nursing ( jstor )
Psychological stress ( jstor )
Psychometrics ( jstor )
Burn out (Psychology) ( fast )
Dissertations, Academic -- Foundations of Education -- UF
Foundations of Education thesis Ph. D
Intensive care nursing -- Psychological aspects ( fast )
Nurses -- Job stress ( fast )
Florida ( fast )
Genre:
bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1990.
Bibliography:
Includes bibliographical references (leaves 168-176).
Additional Physical Form:
Also available online.
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
by Joyce K. Stechmiller.

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University of Florida
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University of Florida
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Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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24229079 ( OCLC )

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JOB Bl'.YOl'T A1iT!,( CRITICAL CARE NURSES


By


JOYCE K. STECHMILLER




































A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY



UNIVERSITY OF FLORIDA


1990

























Copyright 1990

by

Joyce Kolbek Stechmiller
















ACKNOWLEPCGEME- iTS

I wish to express my deepest love and appreciation to my husband,

Bruce, and my children, Stephanie and Christopher, for their support,

understanding and constant love. Also to my mother and father and

Kate Stechmiller I extend my thanks for their moral support and

encouragement.

I would also like to thank the faculty of the University of Florida,

with special thanks to Dr. Hannelore Wass, chairman of my supervisory

committee, and supervisory committee members, Drs. Linda Crocker, Robert

Ziller, and Barry Guinagh, who contributed greatly to the completion of

the dissertation. Special appreciation goes to Dr. Hussein Yurandi for

his assistance with the statistical analyses.

My special thanks go to Donna Hall and Dan O'Brien, who were always

there when I needed them, and to my research assistants, without whom

these data could not have been collected. I also wish to express

gratitude to a special group of friends, MTG, INC., and to my students

for their support and encouragement when I needed them.

This research was supported by a Post-Baccalaureate Faculty

Fellowship from the Department of Health and Human Services. I am

grateful to the governmental agency for easing the burden of doctoral

education.
















TABLE OF CONTENTS


Page

ACKNOWLEDGEMENTS . . . . . . . . . . . . iii

LIST OF TABLES . . . . . . . . ........ vii

LIST OF FIGURES . . . . . . . . . . . . ix

ABSTRACT . . . . . . . . . . . . . . x

CHAPTERS

I INTRODUCTION . . . . . . . . . . . 1

Background of the Problem . . . . . . . . 1
Statement of the Problem . . . .. . . . . 3
Purpose of the Study . . . . . . . . . 5
Significance of the Study . . . . . . . 10
Limitations . . . e o . . . . . . . 12
Assumptions .. .o. .o .a .* * a o a o o * & o 13

II REVIEW OF THE LITERATURE ................. 14

Derivation of the Concept Burnout . .. . . . . 14
Definitions of Burnout . . . . . . . . 15
Stages in Development of Burnout . . . . . . 18
Causes of Burnout . . . . . . . . 19
Conceptual Models of Burnout . . . . . .. 21
Burnout of Nurses . . . . . . . . 24
Personal Characteristics . . . . . . .. 25
Demographics . . . . . . . . * 25
Personal Stressors . . . . . . . .. 26
Personality Characteristics . . . . . .. 26
Social Support . . . . . . . . . .. 27
Coping Behavior . . . . . . . . .. 29
Organizational Characteristics . . . . . .. 30
Work stress . . .... o *...... . . . * 30
Work Environment . .. .. a. .... . . .... 30
Job Satisfaction . . . . . . . . . 32
Theoretical Framework . . . . . . . .. 34

III METHODOLOGY . . . . . . . . . . 39

Sample of Respondents . . . . . . . . . 39
Study Design and Procedures . . . . . . . . 43










Page


Instrumentation . . * o
Demographic Questionaire . . .* . . .
Daily Hassles Scale . . . *.. . . .
Psychometric Properties of Daily Hassles Scale .
Job Diagnostic Survey (JDS) . . . . ...
Psychometric Properties of JDS . . . .
Psychological Hardiness Test . . .. . .
Psychometric Properties of Psychological Hardiness


Test . . . . . o .
Maslach Burnout Instrument (MBI) .
Psychometric Properties of MBI .
Commitment and Workload . ...
Statistical Analysis . . . .


* 9 9 9 9
* 9 9 9
* 9 9 9 9
* 9 9 9
* 9 9 9


IV STUDY FINDINGS . . . . . . . ......


Full Model and Statistical Analysis .
Exogenous Variables . . . .
Endogenous Variables . . . .
Question 1 . . . . . ..
Question 2 . . . . ...
Question 3 . . . ...
Question 4 . .. . . ...
Question 5 * 9 e e o .....
Reduced Model and Path Analysis . ..
Contributions to Situational Stress .
Contributions of Perceived Job Stress
Contributions to Job Satisfaction .


Contributions to Burnout-Emotional Exh
Goodness-of-Fit . . . . ...


0 0 0 0 0P






9austion .
9 9 9 9 9 9


V DISCUSSION, INTERPRETATIONS, CONCLUSIONS AND
FECClt1F'" DATIONS . . .... . . ..

Overview . . . . . . . .
Causes of Burnout . . . . ..
Causes of Job Dissatisfaction .*... ..
Comparison of Job Dissatisfaction and Burnout
Causes of Job Stress . 9 . . ..
Limitations and Recommendations . .. ..
Conclusions . . . . . e .


APPENDICES


A INVITATION AND CONSENT FOR PARTICIPATION FROM
CRITICAL CARE NURSES . . . . . . .


9 0 9 9 9 9


B PROCEDURES FOR ADMINISTRATION ...............

C DEMOGRAPHIC SHELT AND WORK SURVEY . . . . . . .

D DAILY HASSLES SCALE DIRECTIONS AND SAMPLE ITEMS . . .

E JOB DIAGNOSTIC SURVEY DIRECTIONS AND SAMPLE ITEMS . ..


. 0 0 0 0









Page

F WORKLOAD Al-,M STAFF SIZE . . . . . . . . 132

G HARDINESS TEST DIRECTIONS AND SAMPLE ITES . . . . 134

H COMIIT'Et.T TO CAREER . . . . . . . . . 136

I MASLACH BURNOUT INVFNT'lTRY DIRECTIONS AND SAMPLE ITEMS . 138

J MEAS, STALDAPRD DEVIATIONS AND CORRELATIONAL ANALYSIS . 140

K MULTIPLE REGRESSION OF THE FULL MODEL . . . . .. 158

REFERENCES . . . . . . . . .. . . . 168

BIOGRAPHICAL SKETCH . . . . . . . . . . . . 177
















LIST OF TABLES


Table Page

1-1 Variables Found to be Significantly
Related to Burnout . * . o ... . 6

3-1 Characteristics of Critical Care Staff Nurses:
Sex, Age, and Education (N = 300) . . . . . . 41

3-2 Duration as Staff Nurse in Critical
Care (N'= 300) . . . . . . . . . . 42
3-3 Years of Experience as a Critical Care Staff
Nurse at the Present Institution . . . . . 44

3-4 Work Hours Per Week (N = 300) . . . . . . . 45

3-5 Psychometric Properties of Variables: Ability
and Time . . . . . . . 9 * * * 47

3-6 Psychometric Properties of Variables: Daily
Hassles Scale . . . .. . . 0 . . 51

3-7 Job Diagnostic Survey Subscales, Related
Variables and Sample Items . . . . . . . 53

3-8 Psychometric Properties of Variables: Job
Diagnostic Survey . . . . . . * * * 57

3-9 Psychometric Properties of Variables: Commitment
and Workload . . . . . . . . . 68

3-10 Instrumentation: Personal, Organizational
Variables, Situation Conducive to Stress,
Job Stress, Burnout, Job Satisfaction, and
Internal Work Motivation . . . . . . . 69

4-1 Multiple Regression of Degree Situation
Conducive to Stress on the Variables Within
Each Block of Characteristics . . . . . . 78

4-2 Multiple Regression of Job Stress on the
Variables Within Each Block of
Characteristics and Situation Conducive
to Stress * . e e e * . * * a o 80

4-3 Multiple Regression of Job Satisfaction on the
Variables Within Each Block of Characteristics,
Job Stress and Situation Conducive to Stress . . .. 82









Table


Multiple Regression of Internal Job Motivation
on the Variables Within Each Block of
Characteristics, Job Stress and Situation
Conducive to Stress . . . . .* * * *..


Multiple Regression of Burnout-Emotional
Exhaustion on the Variables Within Each Block
of Characteristics, Job Satisfaction, Internal
Job Motivation, Job Stress and Situation
Conducive to Stress . . . . .

Magnitudes of Direct and Indirect Effects on
Degree Situation Conducive to Stress, Level
of Perceived Job Stress, General Job
Satisfaction and Burnout . * o . .

Intercorrelations of Exogenous Variables in
the Path Analytic Model of Burnout Among
Critical Care Nurses . o . . . .


* * * 86





* * 88



* * 98


viii


Page





84
















LIST OF FIGURES


Figure Page

1-1 A Perceptual-Feedback Stress Paradigm . . . . 4

1-2 Full Model of Burnout . . . . . . . . 7

4-1 Reduced Model of Burnout . . . . . . . 93
















Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy


JOB BL_'.1i''I AMONG CRITICAL CARE NURSES

By

Joyce K. Stechmiller

December, 1990

Chairperson: Hannelore Wass
Major Department: Foundations of Education

This study was designed to test a path-analytical model of the

theoretical conceptualization of burnout for critical care nurses. Three

hundred critical care nurses in Florida were administered a demographic

questionnaire and Work Survey Instrument, Daily Hassles Instrument,

Psychological Hardiness Test, Job Diagnostic Inventory, and the Maslach

Burnout Inventory. Personal, organizational, situational stress, job

stress, job satisfaction, and burnout variables were examined.

Family demands, health difficulties and a low psychological

hardiness and a high degree of skill variety and a dissatisfaction with

job security are linked to situational stress, contributing 70 percent of

explained variance. This situational stress is causally linked to

perceived job stress along with the direct effects of family demands,

health difficulties, dissatisfaction with nursing supervision, pay, and

job security. These variables account for 71 percent of explained

variance in job stress. Job stress directly affects job satisfaction.










In addition, job dissatisfaction is also directly affected by high job

expectations, meaninglessness of work, low knowledge of work results,

health, high task identity, a high frequency of dealing with others on

the job, dissatisfaction with opportunities for advancement, pay,

supervision, and satisfaction with job security. Together these account

for 62 percent of the variance in general job dissatisfaction. This

situation will then lead to burnout-emotional exhaustion. Burnout-

emotional exhaustion is directly affected by job dissatisfaction, as well

as low commitment to the career, health difficulties, low psychological

hardiness, high workload, a high degree of dealing with others on the

job, and dissatisfaction with job security; however, only 38 percent of

the variance in burnout-emotional exhaustion was explained by these

variables.

The study results provide a better understanding of the factors

relevant to the development of burnout. This research indicates that

there is a causal progression of situational stress, job stress, job

dissatisfaction resulting in burnout.
















CHAPTER I
INTRODUCTION

Background of the Problem

The empirical study of job stress in the helping professional,

frequently termed "burnout" (Freudenberger, 1974; Maslach, 1976; Maslach

& Jackson, 1986), has provided valuable information and insight into this

phenomenon over the last 15 years. Freudenberger (1974) first described

burnout as a state of physical and emotional depletion resulting from

conditions at work. Maslach (1976) claimed that "burned out"

professionals "lose all emotional feelings for the persons they work with

and come to treat them in detached or even dehumanized ways" (p. 16).

Freudenberger and Richelson (1980) later described burnout as a "sense of

fatigue or frustration brought about by devotion to a cause, a way of

life, or relationship that failed to produce the expected reward"

(p. 13). Edelwich and Brodsky (1980) further defined it as a

"progressive loss of idealism, energy, purpose, and concern as a result

of conditions of work" (p. 14), and Pines, Aronson, and Kafry (1981)

added that it is "characterized by physical depletion, by feelings of

helplessness and hopelessness, by emotional drain, and by the development

of negative self-concepts and negative attitudes toward work, life, and

other people. . It is a sense of distress, discontent, and failure in

the quest for ideals" (p. 15). Thus, although the concept of burnout has

been defined in many ways, there is general consensus that the symptoms

include attitudinal, emotional, and physical components (Freudenberger,

1974; Maslach, 1976; Maslach & Jackson, 1986).









Various researchers (Berkeley Planning Association, 1977; Maslach &

Jackson, 1981; Perlman & Hartman, 1982) have conceptualized burnout as a

syndrome of emotional exhaustion that proceeds to depersonalization, and

results in reduced personal accomplishment that may occur with persons

who work with others in some manner. The term "emotional exhaustion"

describes the first stage of burnout, which includes feelings of being

emotionally drained and overextended by one's exposure to other people.

When emotional resources are over-used, one feels unable to give of

oneself to others. The second stage of burnout is depersonalization,

which includes an "unfeeling and callous response toward people, often

the recipient of one's service of care" (Maslach, 1982b, p. 30). This

negative attitude may be manifested in rude, inappropriate, or

insensitive behavior toward clients, as well as withdrawal from them.

Reduced personal accomplishment is the third stage of burnout, which is

characterized as a decline in one's sense of competence and perception oJ

successful achievement in one's work with people resulting in feelings ol

inadequacy, failure, loss of self-esteem, and even depression (Maslach,

1987).

V Recently, a number of researchers have posited transactional models

of burnout to aid understanding of its etiology (Cherniss, 1980a;

Chiriboga & Bailey, 1986; Cooper, 1986; Courage & Williams, 1987; Cox &

Mackay, 1981; Fletcher & Payne, 1980; Golembiewski et al., 1986;

Harrison, 1983). According to Handy (1988), the major theme of

transactional models is that stress and burnout result from the

transaction between individual worker needs, personal resources, and the

demands, constraints, limitations, and/or facilitators within the work

environment. Key to this conceptualization is the emphasis on the










individual worker's subjective perception of stressors as opposed to

conditions that actually exist in the work setting (Golembiewski et al.,

1986; Leiter & Maslach, 1988; Maslach & Jackson, 1986).

Perlman and Hartman (1982) have proposed a transactional model (see

Figure 1-1) of burnout that is of particular interest because of its

breadth and because it includes groups of personal-psychological and

organizational-work variables that have been empirically studied

individually, or in combination, since 1977.

Statement of the Problem

In their model, Perlman and Hartman (1982) represented burnout as a

function of personal characteristics, organizational-work

characteristics, and stages of stress including the degree to which a

situation is conducive to stress, perception of organizational job

stress, and outcomes of the stress such as job satisfaction and

psychological response. Although this conceptualization of burnout

seems to be fairly comprehensive in terms of variables included, there

are limitations with respect to the posited relationship among the

components of the Perlman and Hartman (1982) model. One problem is that

this model is not totally consistent with empirical findings reported in

the literature. For example, according to the literature, job

satisfaction has a direct relationship to pay, dealing with others at

work, opportunity for advancement, and economic market conditions

(Jayaratne & Chess, 1983; Oldham, Hackman, & Pearce, 1976; Paredes,

1982), but from Figure 1-1 it would appear that burnout has a direct

relationship to pay, support from others, and economic market conditions

and that job stress has a relationship with opportunity for advancement.

Also, Perlman and Hartman (1982) seemed to suggest that burnout precedes

job satisfaction, but other formulations of burnout would equate it with

what Perlman and Hartman (1982) defined as coping. Another limitation is












that Perlman and Hartman (1982) conceptualized each variable as affecting

only the next continuous variable in the model. They did not allow for

the possibility of some variables having direct or indirect causal

relationships to more than one outcome variable. From their discussion

of the burnout model, it seems likely that Perlman and Hartman (14,)

were unaware of how systems of linear regression equations can be

specified using path analysis (or causal modeling) to test a theoretical

model. Such an empirical test of a transactional model of burnout seemed

to call for obtaining measures on a fairly wide array of personal and

organizational variables entering them into multiple regression and path

analysis to permit the assessment of both direct and indirect effects of

independent variables on outcome variables.

Purpose of the Study

The purpose of this study was to collect data to develop and refine

a theoretical model of burnout for critical care nurses using variables

identified from research literature. The first stage of the study

involved an extensive literature review to identify variables that had

been studied by others in relationship to burnout. Table 1-I contains i

summary of variables that were identified in the literature review for

this study that are posited to have a meaningful relationship in the

process that leads to job burnout. As will be indicated in Chapters II

and III, multiple indicators have been used to operationalize the

variables labelled as Personal Work Needs and Work Group Norms in

Table 1-1.

The second stage of the study required depicting the relationships

among the variables in a path diagram. The path diagram in Figure 1-2

graphically displays the pattern of hypothesized relationships among a










Table 1-1

Variables Reported to be Significantly Related to Burnout


Predictor Predictor
Personal Organizational Outcome
Variables Variables Variables


Ability

Time

Family demands

Job expectations

Personal work
needs

Physical health

Commitment to
career

Psychological
hardiness


Workload

Expected role
performance and
role ambiguity

Work group norms

Dealing with
colleagues

Opportunity for
advancement

Pay

Support from
others

Organizational
climate and
economic/market
conditions


Situation conducive
to stress

Level of perceived
job stress

Job satisfaction

Internal job
motivation


Burnout


Supervision





































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set of personal exogenous variables, a set of organizational exogenous

variables, and a series of endogenous outcome variables. An exogenous

variable is defined as a variable that has variability due to causes

outside the model, when the analysis of the cause of an exogenous

variable is not under consideration in the model (Asher, 1976). It is

not the purpose of a path analysis to explain the variability of an

exogenous variable or its relations with other exogenous variables.

An endogenous variable is a variable that has variance contributed

to it by exogenous or other endogenous variables in the model (Asher,

1976). The endogenous variables under study in the path analytical model

include the degree to which a situation is conducive to stress, job

stress, job satisfaction, internal work motivation, and burnout.

Unidirectional arrows or paths have been drawn from the exogenous causes

to the endogenous effects. The causal flow in the burnout model under

study is recursive or unidirectional. Some endogenous variables are

treated as dependent variables in one set of analyses and independent

variables in relation to other variables. For example, the degree to

which a situation is conducive to stress is a dependent variable for one

set of variables and an independent variable for job stress. To simplify

the visual presentation, the personal and organizational variables have

been grouped in boxes, and arrows have been drawn from the boxes to

represent direct effects of each exogenous variable in the boxes in the

left column on the respective endogenous variables. Typically curved

arrows are used to indicate correlations among exogenous variables. In

Figure 1-2, these curved arrows were not shown to allow the model to be

depicted more clearly.









The third stage of the study was to answer the following questions

using multiple regression analyses:

1. Is there a significant relationship between the situational

stress variable and (a) the weighted linear combination of a set of

personal variables and (b) a set of organizational variables? Which

variables in the model contribute significantly to the variance in

situational stress?

2. Is there a significant relationship between job stress and the

combination of (a) situational stress and (b) the preceding exogenous

variables? Which variables in the model contribute significantly to the

variance in job stress?

3. Is there a significant relationship between job satisfaction and

the combination of (a) job stress, (b) situational stress, and (c) the

preceding exogenous variables? Which variables in the model contribute

significantly to the variance in job satisfaction?

4. Is there a significant relationship between internal job

motivation and the combination of (a) job stress, (b) situational stress,

and (c) the preceding exogenous variables? Which variables in the model

contribute significantly to the variance in internal job motivation?

5. Is there a significant relationship between burnout-emotional

exhaustion and the combination of (a) job satisfaction, (b) internal job

motivation, (c) job stress, (d) situational stress, and (d) the preceding

exogenous variables? Which variables in the model contribute

significantly to the variance in burnout-emotional exhaustion?

The final stage of the study was to refine the purposed model on the

basis of the empirical results obtained from stage three in an









exploratory fashion. Each of the independent variables that made a

significant contribution to the variance in one or more dependent

variables was considered a candidate for inclusion in a reduced model of

burnout. Path analysis was used to estimate the direct and indirect

effects of exogenous variables on endogenous outcome variables in a

reduced model of burnout. Results of the analyses of the full model and

a suggested reduced model will be presented in Chapter IV.

Significance of the Study

This study has practical value for the critical care staff nurses

themselves, the patients cared for by the critical care nurses, the

institutions in which the critical care nurses work, and the educational

preparation of nurses taught by nursing faculty. Maslach (1982) stated

that the burnout syndrome stems from a social interaction between helpers

and helpees, when in certain circumstances, helpers become unduly

involved emotionally with the recipients, overextend themselves, and

demonstrate emotional exhaustion. Nurses, as well as teachers, are

helping professionals and share the burdens and frustrations in the

helping relationship. Maslach (1982) described the progression of

burnout from emotional exhaustion to depersonalization in which helpers

decreased contact with clients and showed a callous, detached, and

dehumanizing response towards helpees. He proposed that clients

receiving care from helping professionals in the stage of

depersonalization do not receive adequate care because of ineffective

interpersonal helping relationships. Because nursing activities require

frequent contact with patients in an effective interpersonal









relationship, patients cared for by nurses in the stage of emotional

exhaustion or depersonalization may suffer from pathological detachment

on the part of the nurse. Critical care nurses who avoid their patients

and families lose opportunities essential for timely and potentially

useful interventions. This results in an unfortunate physiological loss

to the patient and a psychological loss to the patient, family, and

nurses and other members of the health team.

Burnout is costly as well to the institutions in which the helping

professionals work because of poor performance, job dissatisfaction,

absenteeism, job turnover, and illness of workers, all of which have been

related to this phenomenon. Knowledge about the causes of burnout and

the organizational work variables that critical care nurses perceive as

contributing to burnout could allow nursing administrators to identify

strengths and weaknesses in the hospital organization in reference to

prevention, recognition, and management of burnout. Such information

might give insight into the control of burnout. A variety of strategies

by those concerned with professional development and nursing management

could be employed to help alleviate nursing burnout, including redesign

of jobs, changing organizational policies, establishing flexible

schedules and support services, improving training for staff, and

designing explicit programs for more decisionmaking, emotional support,

and recognition.

Knowledge of results of this study could assist nursing educators in

curricular development. By recognizing burnout as a legitimate problem

with specific causes, greater efforts may be made to deal effectively

with it in academic institutions.

Clinical nursing faculty are also in an excellent position to teach

students how to cope with a stressful job as well as how to make the job

less stressful, but they are hampered by a lack of information about









sources of emotional stress on the job and the risk of burnout in many

nursing baccalaureate programs. It is important for nurse educators to

understand the causes of burnout among helping professionals. Students

should have more accurate information about the work they are undertaking

before they actually start. If this were accomplished, they might have

fewer surprises that destroy their professional ideals or lead them to

leave the profession. The consequences of attrition and turnover may be

greatly reduced by providing realistic job expectations. Prior knowledge

about the causes of burnout may enable nurses to recognize it in its

early stages, whether in themselves or in others. Greater awareness of

the risk of burnout can lead nurses to be better prepared for it in

advance. They can anticipate causes of emotional stress before they

occur and develop definite plans to deal with them. The results of this

study will allow them to have a clearer understanding of the personal and

organizational variables that may enable them to be successful at their

work.

Limitations

The following limitations of the study must be taken into

consideration when interpreting the findings:

1. The range of the study was limited to a geographical region

within the state of Florida that included Melbourne, Orlando,

Jacksonville, Ocala, Tallahassee, and Gainesville.

2. The sample was limited to a cross-section of critical care

nurses who work in critical care settings, including Medical and Surgical

Intensive Care Units.

3. The sample may be biased because individuals in advanced stages

of burnout may have been so apathetic that they did not participate in

the study.









4. Several of the constructs were measured by self-report

questionnaires that included items containing content of a sensitive

nature; some respondents may have reported inaccurately due to their

inability or unwillingness to recognize symptoms in themselves.

5. In this study, only the first stage of burnout (i.e. emotional

exhaustion) was examined.

6. Variables examined were limited to those that could be logically

viewed as representing constructs in Perlman and Hartman's (1982)

conceptual model of burnout.

Assumptions

There are three assumptions upon which the present study is

grounded:

1. Burnout in a biopsycho-social concept related to personal,

psychological, and organizational variables as a result of a stress

response.

2. The strength of relationship between burnout and these

contributing factors can be estimated through application of a linear

model.

3. The independent variables in the model are all those

contributing importantly to burnout.
















CHAPTER II
REVIEW OF THE LITERATURE

Derivation of the Concept Burnout

The concept "burnout" originated from stress research. There are

many publications reviewing varied definitions of the concept of stress

(Antonovsky, 1979; Cannon, 1932; Lazarus, 1966; Mason, 1975; Selye, 1956;

Selye, 1974; Sharit & Salvendry, 1982; Vachon, 1987). In an early

definition, Cannon (1932) reflected upon the physiological aspect of

stress and related it to society and job organizations. Selye (1956)

broadened the physiological concept of stress even further.

Selye's (1956) work was based upon earlier research of Cannon that

included homeostasis adaptations. His identification of body hormones in

the "fight or flight" mechanism for maintenance of homeostasis focused on

protective maneuvers in physical, social, or chemical situations that

elicited a physiological response. He defined stress as "the

non-specific response of the body to any demand made upon it" (Selye,

1974, p. 141) and stressors as any stimuli that cause physiological

adaptation. If stress results in positive effects, it is identified as

eustress; stress associated with negative results is distress.

Furthermore, he classified physiological adaptation to stress into three

stages--alarm, resistance, and exhaustion--and referred to this process

as the general adaptation syndrome. The alarm phase consists of

neurohormonal mechanisms that prepare the body for defense against an

adaptation caused by stressors. The second phase, the resistance phase,









consists of adaptive mechanisms that are instituted to destroy the

stressor and restore homeostasis. Exhaustion, which occurs if the body's

adaptive resources are depleted, is irreversible and results in death.

Once the stressor is perceived as a genuine stressor, the condition is

recognized as stress and the general adaptation syndrome.

The concept of coping as human adaptation to stress has been studied

by many psychologists. French, Rodgers, and Cobb (1974) proposed a model

for adaptation to stress that considers the interaction of

characteristics of the individual and environment. A cognitive appraisal

analysis of psychological stress has been addressed by Lazarus (1977),

who defined coping as problem solving attempts to deal with threatening

conditions. Coping, in this approach, depends on how individuals

appraise their encounters with the environment with regard to the

potential of those encounters as threatening, harmful, or challenging.

Burnout has been identified as a syndrome resulting from a negative

response to occupational stress. Researchers in a variety of

specialities, including educational psychology, clinical and social

psychology, psychiatry, sociology, cultural anthropology, nursing,

occupational medicine, and personnel management have provided an

important volume of literature which constitutes the background for the

present study. The following review of literature is concentrated on

job-related personal, psychological, and organizational factors that for,

the basis for burnout.

Definitions of Burnout

Freudenberger (1974) first used the term "burnout" to describe an

unfavorable response among helping professionals working in psychiatric









settings. He observed a pattern of behaviors and attitudes that he also

experienced. He identified a helping professional experiencing burnout

as one who becomes exhausted from excessive demands on strength, energy,

or resources or who is worn out. Freudenberger and Richelson (1980)

later described burnout as a "sense of fatigue or frustration brought

about by devotion to a cause, way of life, or relationship that failed to

produce the expected reward" (p. 13). At the First National Conference

on Burnout, Maslach (1982b) presented the following definitions of

burnout that were reported in the literature:

A syndrome of emotional exhaustion, depersonalization, and reduced
personal accomplishment that can occur among individuals who do
people-work of some kind.

A progressive loss of idealism, energy, and purpose experienced by
people in the helping professions as a result of the conditions of
their work.

A state of physical, emotional, and mental exhaustion marked by
physical depletion and chronic fatigue, feelings of helplessness and
hopelessness, and the development of a negative self-concept and
negative attitudes toward work, life, and other people.

A syndrome of inappropriate attitudes toward clients and self, often
associated with uncomfortable physical and emotional symptoms.

A state of exhaustion, irritability, and fatigue that markedly
decreases the worker's effectiveness and capability.

To deplete oneself. To exhaust one's physical and mental resources.
To wear oneself out by excessively striving to reach some
unrealistic expectations imposed by oneself or by the values of
society.

To wear oneself out doing what one does to do so. An inability to
cope adequately with the stresses of work or personal life.

A malaise of the spirit. A loss of wellbeing. An inability to
mobilize interests and capabilities.









To become debilitated, weakened, because of extreme demands on one's
physical and/or mental energy.

An accumulation of intense negative feelings that is so debilitating
that a person withdraws from the situation in which those feelings
are generated.

A pervasive mood of anxiety giving way to depression and despair.

A process in which a professional's attitudes and behavior change in
negative ways in response to job stress.

An inadequate coping mechanism used consistently by an individual to
reduce stress.

A condition produced by working too hard for too long in a
high-pressure environment.

A debilitating psychological condition resulting from work-related
frustrations, which results in lower employee productivity and
morals. (pp. 30-31)

Maslach (1982b) analyzed the problem of defining burnout and

concluded that some definitions are broad, others narrow; some include

emotional and physical behaviors, others include psychological and

cognitive terms. In addition, some describe a process while others

present a process; some relate causes while others relate consequences.

One commonality in the definitions is that the burnout syndrome presents

a psychological process affecting individual attitudes, motives,

feelings, and expectations. The individual perceives the syndrome as

unfavorable, dealing with distress, problems, malaise, and/or negative

outcomes. Furthermore, Maslach pointed out that there is agreement on

the component of exhaustion as a loss of energy and debilitation,

physiologically and psychologically, a loss of trust and apathy, with

loss of feeling, concern, and spirit. Another component includes a

disparaging response to others, with depersonalization, inappropriate









attitudes toward clients, loss of ideals, and irritability. A third

component is characterized by unfavorable responses toward oneself and

one's personal achievements, with depression, withdrawal, low morale,

lowered production, and a decrease in effective coping.

Stages in Development of Burnout

Maslach (1982a) described a progression of stages in burnout leading

from emotional exhaustion to depersonalization and finally ending with

decreased personal accomplishment. Helping professionals who have

emotional exhaustion feel drained, used up, and repleted without

resources. As a protective mechanism, some helping professionals acquire

a cold indifference to others' needs, become detached to close

relationships, and acquire a callous disregard for the feelings of

others. The occurrence of this dehumanizing attitude heralds in the

second component of the burnout syndrome, depersonalization, which

consists of the expression of poor opinions about clients, actively

disliking them, expecting the worst from them, ignoring their requests,

and giving inappropriate help and care. The third aspect of the burnout

syndrome is decreased personal accomplishment, which consists of helping

professionals developing a sense of inadequacy in dealing with their

clients. The helping professional may even develop a poor self-esteem

and perceive of himself as a failure. As a result, depression,

absenteeism, poor job performance, and changing jobs may occur.

Similar developmental models have been suggested by other

researchers. For example, Edelwich and Brodsky (1980) designed a

four-phase developmental process: (a) enthusiasm with high energy, high

hopes, and unrealistic job expectations; (b) stagnation, in which the job

is no longer perceived as the central force of a worker's life;









(c) frustration, in which a worker directs personal confidence and value

of the job; and (d) apathy, a defense mechanism against job frustration

necessary for survival. Similarly, Veninger and Spradley (1981)

presented a developmental process that consisted of five stages: (a)

honeymoon, (b) fuel shortage, (c) chronic symptoms, (d) crisis, and (e)

hitting the wall.

Costello and Zalkind (1963) and Daley (1979) posited stages of

burnout specifically for the nursing profession using the framework of

Selye's general adaptation syndrome. The first stage is an alarm stage,

characterized by an emergency mobilization of the body's defense

maneuvers used to maintain successful performance or to prevent an

internal conflict leading to frustration. The second stage is the

resistance stage, in which there are continued attempts to manage the

stress. If stress management is not achieved, exhaustion occurs. Shubin

(1978) described nurses as high-risk victims for burnout and delineated

the stages as beginning with physical fatigue and emotional drain,

followed by dehumanization of patients and guilt for not caring any

longer, and finally disgust for oneself and others.

Causes of Burnout

Freudenberger (1975), Freudenberger and Richelson (1980), and Pines,

Aronson, and Kafry (1981) have contended that personal variables

including psychological stress are the major precipitating cause of

burnout. Freudenberger (1974) studied ego analysis and believed that a

committed and over-dedicated personality type was susceptible to burnout.

He and Richelson (1980) also suggested another personality trait that

included a restricted social life with all meaning and gratification









achieved from the job. Edelwich and Brodsky (1980) discovered an

association of burnout with the young, enthusiastic, overcommitted

helping professionals. Other specific psychological factors associated

with burnout in the care provider include competence, intolerance in

confronting obstacles, lack of self-confidence, nonassertiveness in

dealing with people (Gann, 1979), lack of psychological hardiness (Keane,

Ducrete, & Adler, 1985; McCranie, Lambert, & Lambert, 1987), life events

(Chiriboga & Bailey, 1986), ineffective coping skills, and inadequate

social support (Chiriboga & Bailey, 1986; Cronin-Stubbs & Rooks, 1985;

Numerof & Abrams, 1984).

Evidence to date suggests that not all individuals are equally at

risk to develop burnout (Cherniss, 1980a-b). Cherniss stated that

organizational factors that include availability of resources and power

of the helping professional to apply them, autonomy, the stimulation and

challenge of the job, the rewards at work, and the degree of structural

support all share in the occurrence of burnout. Role conflict, role

overload, lower socioeconomic status, and job dissatisfaction (Oldham,

Hackman, & Pearce, 1976) also appear to promote burnout (Kahn, 1978).

Burnout has also been related with a greater number of hours spent in

direct patient contact (Lewiston, Conley, & Blessey-Moore, 1981; Maslach

& Jackson, 1982), more difficult client problems (Meadow, 1981; Pines &

Maslach, 1978), caseload (Berkeley Planning Associates, 1977;

Freudenberger & Richelson, 1980; Larson, Gilbertson, & Powell, 1978;

Maslach & Jackson, 1984a-b; Maslach & Pines, 1977; Perlman & Hartman,

1982; Solomon, 1979), a low degree of peer support (Burk et al., 1984;

Jackson, Schwab, & Schuler, 1986; Leiter & Maslach, 1986; Maslach &

Jackson, 1982), a low degree of commitment to the organization (Leiter &









Maslach, 1988), and organizational components of leadership,

communication, supervision and responsibility. Leiter and Maslach (1988)

and Gains and Jermier (1983) indicated that dealing with co-workers

was identified as the strongest source of job stress and burnout.

Burnout has also been linked to social and physical isolation in the work

setting (Larson, Gilbertson, & Powell, 1978). Maslach and her colleagues

(Maslach & Jackson, 1981a; Maslach & Pines, 1977) indicated that the

basis 6f burnout is interpersonal contact that includes intense

commitment and personal care when helping others, especially those with

severe problems.

Conceptual Models of Burnout

Our understanding of the burnout syndrome has grown over the last

15 years. No longer are conceptual models restricted to intrapsychic

factors. There is considerable acceptance that burnout is not a simple,

unidimensional syndrome with easily identified causes. Rather, it is

considered a complex problem, generic to intrapsychic, interpersonal,

social, occupational, and organizational components.

Fischer (1983) posited a psychoanalytic model of burnout in which

workers are driven to maintain a high self-esteem by working even harder

despite unrealistic expectations. These workers "idealize their work"

and relate to a "compensatory illusion of grandiosity." He also stated

that workers who are exhausted may be inappropriately identified as

burned out and use the label of burnout as an "excuse for poor

performance and as a justification for both easier working conditions and

higher pay" (p. 41). Fischer added to the knowledge of the function of

the intrapsychic factors of burnout and focused on the importance of

self-esteem as a mediator variable in the burnout process.









Harrison (1983), Farber (1983), and Heifetz and Bersoni (1983)

conceptualized burnout as a process resulting when helping professionals

do not receive positive and/or accurate feedback from their work

environment regarding their performance efforts. Harrison (1983) viewed

burnout as inversely related to the helping professionals' perceptions of

competence. The likelihood of the helping professional feeling good

about his/her work performance may be affected by lack of institutional

support, excessive workload, and inadequate professional skills.

Furthermore, he stated that if success is rarely experienced by the

helping professional and if failure is usually experienced as a result of

his or her job performance, burnout is likely. Farber (1983)

conceptualized work related stresses and burnout as due to feelings of

"inconsequentiality" by the helping professional. Like learned

helplessness, Farber hypothesized that burnout results when helping

professionals perceive that their efforts do not matter, and, as a

result, their efforts cease. The concept of cybernetics was used by

Heifetz and Bersoni (1983) in their model to describe the phenomenon of

burnout. The helping professional's perception of growth in themselves

and their recipients of care is strongest when goals are realized. In

order to be successful in realizing goals, requirements in the cybernetic

process must be identified: identification of the task, clearly defined

goals, short-term progress reports, and plans for modification of one's

goals. According to Heifetz and Bersoni (1983), burnout occurs when

one's pursuit of goals is interrupted because there is an absence of one

or more of the requirements in the cybernetic process.

Some authors have attempted to describe the burnout syndrome using a

job deficit model which proposes that burnout is due to the absence of









job motivations rather than the occurrence of job stressors. Jayaratne

and Chess (1983) reported that role conflict, excessive workload, and

role ambiguity are not significant predictors of burnout in social work.

They identified job challenge, financial rewards, and promotions as the

strongest predictors of burnout and job satisfaction. Eisenstat and

Felner (1983) isolated the variables of job motivations and job stressors

and reported that while job stressors are related to emotional

exhaustion, job enrichers, including autonomy, task significance, and

skill variety are related to job motivation in helping professionals.

Cherniss and Krantz (1983) also focused on the relationship between

burnout and lack of job motivation. Specific variables in their

conceptualization included long hours and the absence of meaning in work.

In addition, Fibkins (1983) and lanni and Reuss-Ianni (1983) emphasized

that the crucial deficit variable in the burnout model is lack of

organizational support. According to Fibkins, burnout in teachers occurs

when the school organization is not responsive to the complex, intensive

nature of teachers' work. lanni and Reuss-Ianni (1983) suggested that

individual and social factors may contribute to work stress; however,

burnout is more likely to be caused by a deficit within the

organizational structure.

Several other authors have advanced the stress model, incorporating

essential elements of modern stress theory and drawing on past research

(Beehr & Neuman, 1978; Chiriboga & Bailey, 1986; House & Wells, 1978;

Matteson & Ivanovich, 1979; Perlman & Hartman, 1982). In the stress

model, antecedent conditions such as sociodemographic characteristics,

are seen as laying the ground work for stress that results in conditions

such as burnout. Sociostructural conditions in the workplace constitute









a second element that helps shape the stress context. Specific stressful

work situations and chronic strain are seen as a third level of

predictor. Social support and coping strategies in turn are seen as

additional predictors that may act as mediators between the stress

context and stress response. Finally, burnout is viewed as the stress

response. An outcome of a maladaptive stress response is low

productivity; other sequelae include absenteeism, job dissatisfaction,

and excessive job turnover. Although exploratory testing of the stress

model of burnout has been accomplished, further comprehensive analysis is

needed with larger samples.

Burnout of Nurses

Consistent with recent findings in other professions (Chiriboga &

Bailey, 1986; Jenkins & Ostchega, 1986; Stone, Jebsen, Walk and Belsham,

1984), nurses who experienced more frequent work-related stress reported

greater burnout. Critical care nursing is one profession where the

burnout phenomenon has been acknowledged because a high rate of patient

mortality, severely ill patients who are emotionally consuming,

inadequate staffing and resources, and a difficult work load are

encountered. According to the literature, critical care nurses are at

risk for burnout when the patient presents with clinical problems in

which the complexity and acuity are beyond the resources of the nurse

(Bailey, Steffan, & Grout, 1980; Bartz & Maloney, 1986; Chiriboga &

Bailey, 1986; Claus & Bailey, 1980; Gray-Toft & Anderson, 1981a-b;

Hinshaw & Atwood, 1984; Kelly & Cross, 1985; Maloney, 1982; McCranie,

Lambert, & Lambert, 1987; Numerof & Abrams, 1984; Stone, Jebsen, Walk, &

Belsham, 1984; Vachon, 1987). In one study, commissioned by the American

Association of Critical-Care Nurses, a national panel of experts









identified both nursing stress and nursing burnout as being among the top

ten research priorities facing the profession (Lewandowski & Kositsky,

1983).

Studies were examined related to potential factors contributing to

burnout of nurses. The review was limited only to studies using the

Maslach Burnout Inventory as a criterion measure. In this review, the

studies have been grouped according to findings related to personal

characteristics of the nurse, including demographics (age, marital and

family status, length of employment, income, and education), personal

stressors, personality characteristics, social support, coping behavior

and organizational characteristics including work stress, the work

environment (worker involvement, type of unit, type of hospital,

involvement in decision making), job enhancement (skill variety and new

approaches, autonomy, clarity, physical comfort, work pressure), and job

satisfaction.

Personal Characteristics

Demographics

Demographic variables that have been associated with burnout in

nurses include age, marital and family status, length of employment,

income, and education. Younger nurses are more susceptible to burnout

than their older counterparts (Chiriboga & Bailey, 1986; Dames, 1983)

However, Bartz and Maloney (1986) found a positive association of burnout

with younger intensive care nurses.

Single care providers tend to be at greater risk for burnout than

married care providers (Dames, 1983; Kimmel, 1983). In addition, junior

nurses without the support of a marital partner are indicated as

vulnerable to burnout (Chiriboga, 1986).









Although Pomales (1982) found a negative correlation between

burnout, income, and number of people living at home, Dames (1983) and

Pomales (1982) agreed that income was inversely associated with burnout.

Grutchfield (1982) found no significant difference among nurses'

education in baccalaureate, diploma, or associate degree programs, but

Keane et al. (1985) and Stone et al. (1984) found that nurses with

baccalaureate degrees evidenced somewhat higher levels of burnout than

those with three-year diplomas. Although less education has been

associated with the occurrence of burnout in nurses (Grutchfield, 1982)

less education with fewer years of work experience tends to make the

nurse more vulnerable to burnout (Chiriboga & Bailey, 1986; Stone et al.,

1984). In addition, a negative correlation has been found between

burnout and a desire to remain in the field of nursing (Dames, 1983).

Personal Stressors

As indicated by the findings of Daubney (1980), Otto (1980),

Chiriboga and Bailey (1986), and Stone et al. (1984) personal stressors

may also be pertinent in the burnout process. In these studies,

undesirable personal life change events and personal stress directly

related to burnout. In addition, perception of a good quality of life

five years ago was found to be inversely related to burnout (Dames,

1983).

Personality Characteristics

Grutchfield (1982) studied the relationship between personality

variables measured by the Edwards Preference Schedule, demographic

variables, and the syndrome of burnout among nurses. Her findings

suggested that burnout emotional exhaustion was associated with the









following personality variables: nurturance, abasement, achievement, and

succorance. In addition these variables were found to be negatively

correlated with a dimension of burnout-personal accomplishment.

Dames (1983) explored the relationship between selected personality

characteristics, demographics, and burnout, using the Spielberger Trait

Anxiety Index, the Gough Adjective Checklist, and the Maslach Burnout

Inventory. The personality traits of intraception and nurturance had

negative correlations with burnout; abasement, aggression and anxiety had

positive correlations with burnout. Autonomy had no significant

relationship with burnout. Pomales (1982) reported an inverse

relationship between self-concept and burnout.

Keane et al. (1985) and McCranie et al. (1987) explored the

relationship of psychological hardiness, demographics, and burnout using

the Hardiness Test (Kobasa et al., 1984). They presented data supporting

the hypothesis that hardiness may be an important personality variable

based resistance resource for preventing burnout among hospital nurses.

They compared samples of staff registered nurses working in intensive

care units and non-intensive care units of a large metropolitan hospital.

Burnout consistently was negatively correlated with psychological

hardiness. This finding supports hardiness as a generalized resistance

resource for nurses working in diverse patient care settings.

Social Support

Effective social support systems are consistently recommended as a

means of coping with job-related stress and preventing burnout. In 1982,

Kimmel reported that nurses who perceived greater emotional support than.









demands at home did not experience different levels of burnout than

nurses who experienced greater household demands than emotional support

at home.

Paredes (1982) studied the effects of social support and

psychological resources on the relationship between burnout and job

dissatisfaction. The findings showed a significant negative relationship

between supervision and co-worker support and burnout. Supervisor

support was more significant in burnout reduction than co-worker or off-

the-job support. Nurses who reported high levels of perceived

psychological support appeared to benefit most from social support in

terms of burnout reduction and job satisfaction.

Kanner, Kafry, and Pines (1981) and Pines, Aronson, and Kafry (1981)

found that on-the-job and off-the-job social support were negatively

related to burnout. Constable and Russell (1986) measured supervisor

support and found that this variable was a major predictor of burnout.

However, there was a significant association only with the emotional

exhaustion dimension of burnout. These results indicate that high levels

of support from supervisors can directly decrease feelings of emotional

exhaustion and, therefore, affect the potential for burnout among nurses.

In addition, their findings indicated significant moderating effects of

supervisor support on the relationship between job enhancement and

emotional exhaustion.

Finally, Chiriboga and Bailey (1986) reported that nurses who relied

more on their supervisor for support proved more likely to report

burnout. Additionally, reliance on co-worker support also correlated








with burnout. The correlations between inadequate psychological support

and higher burnout are consistent with the findings of Edelwich and

Brodsky (1983), Freudenberger and Richelson (1980), and Pines, Aronson,

and Kafry (1981).

Coping Behavior

Another important variable in the study of burnout is coping

behaviors used to reduce job stress. Kimmel (1982) measured coping with

the Ways of Coping Scale by Lazarus as well as role conflict, role

ambiguity, household support, demographic characteristics and burnout.

His sample included head nurses, supervisors, staff nurses, licensed

practical nurses, and nurses aids from a metropolitan hospital in New

York. He reported that coping variables were the best predictors of

burnout. Chiriboga and Bailey (1986) also measured coping with the Ways

of Coping Scale, and burnout. Their results indicated that the nurses

most vulnerable for burnout are younger and unmarried, work in critical

care units, have less involvement in work conditions, experience more

work hassles and distractions in the work place, and are more reliant or

nursing supervisor for support. In addition, these nurses used

anticipated coping which was significantly associated with burnout.

However, because only one variable out of nine measures of coping

strategies contributed significantly to burnout in their study, they

concluded that coping variables were not the best predictors of burnout.

In contrast, Stone et al. (1984) found that nurses endorsing a higher

number of effective coping skills suffer less burnout.









Organizational Characteristics

The organization variables include workstress, the work environment,

job enhancement and job satisfaction.

Work stress

Work stress has been identified as another contributing factor of

burnout. It has been consistently reported that (Chiriboga & Bailey,

1986; Jenkins & Ostehya, 1986) nurses who experienced more frequent

work-related stress reported greater burnout. According to Chiriboga and

Bailey (1986), the work stress variables were second only to work

environment measures in their degree of contribution to the explained

variance in burnout. Work hassles and work distractions were the

significant contributors. The more hassled the nurses felt, the more

likely they were to feel burned out. It is important to point out that

these are not the big stressful events; they are the smaller day-to-day

hassles that can exert a cumulative effect. The distraction variable

focused on trivial things: interruptions in the nurse's work, due to

physicians, nursing staff, or visitors. Nurses who reported more hassles

also reported more burnout. Their findings suggest that distracting and

annoying day-to-day stress in the hospital work environment exerted the

major stress on nurses, and that may lead to burnout.

Work Environment

Work environment variables including worker involvement, type of

unit, type of hospital, amount of patient contact and job enhancement

(variety of tasks and new approaches, autonomy, clarity, physical comfort

and work pressure) are strongly associated with burnout. Worker









involvement was the most important variable and explained the greatest

proportion of variance in burnout suggesting that when staff nurses feel

a low involvement in work, they are most at risk of burnout (Chiriboga &

Bailey, 1986). Burnout has been shown to be related to the type of unit.

There is evidence that units that provide fewer demands on the nurse may

potentiate a condition leading to Burnout (Chiriboga & Bailey, 1986). In

addition, nurses who work in the private hospital are more likely than

nurses employed by a district hospital to report burnout (Chiriboga &

Bailey, 1986).

Researchers have found that more hours worked and more hours of

direct patient contact increased the risk of burnout (Dames, 1983; Des,

1981). In addition, they also stated that the more hours working with

patients with grave prognoses, the higher the burnout scores.

The results offered by Constable and Russell (1986) suggested that

job enhancement was significantly correlated with burnout. This finding

indicates that nurses are more susceptible to burnout when working in

environments where there is a lack of variety and new approaches, there

is a lack of encouragement to be self-sufficient, rules and policies are

not clearly communicated, tasks are not clearly understood, and the work

environment is not considered comfortable and attractive. In addition,

work pressure was also positively associated with burnout-emotional

exhaustion. Critical care nurses experiencing burnout perceive the

critical care environment with little support and the events within the

unit as a threat. Consequently, the critical care nurse expects the

worst (Stone et al., 1984).









Job Satisfaction

The study of job satisfaction has evolved since the early 1900s.

The earlier work was done by Taylor (1911) who determined that job

satisfaction was associated with the amount of pay earned. This research

began during the industrial revolution when workers were equated to

machinery and efficiency was the expectation (Slavitt, Stamps, Piedmont,

& Haase, 1978).

In the 1930s a humanistic-sociological approach to job satisfaction

emerged. Work satisfaction was established as an oversatisfaction with

life (Hoppock, 1935). A cross-sectional study of industrial workers with

similar abilities, interests and job preparation revealed that an

employee's adaptability to the situation, the employee's socioeconomic

group identification, ability to relate to others, and the nature of the

work were associated with work satisfaction. The psychological basis for

job satisfaction was established by the Hawthorne studies (Mayo, 1945).

These studies found that group interaction was the major determinant of

job satisfaction (Slavitt et al., 1978).

One theory that is widely used today in studying job satisfaction is

the motivation-hygiene theory (Herzberg, 1968). Motivators was the term

Herzberg used to identify job satisfiers because they were effective in

contributing to the individual functioning at a higher level and resulted

in job satisfaction. Examples of motivators include responsibility,

advancement and recognition. Hygiene factors was the term used to

identify lower level needs because if not met, they added to

dissatisfaction but when met did not contribute to satisfaction.









Examples of hygiene factors include salary, supervision, policy, and

working conditions.

The theoretical conceptualization of job satisfaction by Herzberg

has been studied extensively among nurses (Hinshaw & Atwood, 1984, 1987;

Slavitt, Stamps, Piedmont, & Haase, 1978). Hinshaw and Atwood (1987)

reviewed the job satisfaction literature and identified 19 significant

factors relating to job satisfaction which were divided into two

categories: personal and work-related characteristics. Personal

characteristics included age, gender, intelligence, educational level,

experience as a nurse, tenure and position in the hierarchy. Work

related characteristics included the specialty area, nursing care

delivery model, supervision, tasks, outcomes and pay. These researchers

concluded that although these variables have been identified as

significantly associated with job satisfaction, the relative impact of

the personal and organizational variables acting directly and indirectly

with job satisfaction has not been determined.

The more relevant theory of job satisfaction related to this study

is the person-environment fit model of occupational stress (French,

Rodgers, & Cobb, 1974). This theoretical approach relates occupational

stress to job satisfaction. As a result of the interaction between the

person holding a job and the environment in which he or she is employed

with good person-environment fit, the job provides the necessary needs of

the individual (salary, fringe benefits, social involvement, opportunity

to achieve, and a sense of self worth). On the other hand, if the job is

too strenuous or too demanding, job stress and burnout may result. Job









satisfaction is described as the result of a good person-environment fit

(Vachon, 1987).

There are only two studies to date linking job dissatisfaction and

burnout for nurses. Job dissatisfaction accounted for the largest

variance in burnout in a dissertation study conducted by Parades (1982).

Younger age, low psychological resources, shorter length of time on the

hospital unit and less social support also contributed to the total

variance. In addition, nurses experiencing burnout are found to be

dissatisfied with their jobs because there are limited opportunities for

personal growth on the job (Stone et al., 1984).

Theoretical Framework

The burnout model proposed by the researcher is an adaptation of

the burnout model offered by Perlman and Hartman (1982) which integrates

many theoretical models. It evolved from Selye's (1974) identification

of stimuli and stressors, the definition of stress as the general

adaptation syndrome, as the theory that too much stress may lead to

maladaptation. The model is further grounded in a framework proposed by

House and Wells (1978), Beehr and Neuman (1978) and Matteson and

Ivancevich (1979).

Perlman and Hartman (1982) posited a transactional model of burnout

and this appears to be the trend in recent years (Cherniss, 1980a;

Chiroboga & Bailey, 1986; Cooper, 1986; Courage & Williams, 1987; Cox &

McKay, 1981; Fletcher & Payne, 1980; Golembiewski et al., 1986; Harrison,

1983). The major theme of the transactional model relates to the

conceptualization of stress and burnout as the result of a transaction









between individual worker needs and resources and the demands,

constraints, limitations, and/or facilities within the work environment.

Their model is broad and allows an examination of personal and

organizational-work variables which have been studied individually or in

combination in the burnout literature from 1977 to the present. In this

model personal, as well as organizational-work variables that are

subjectively perceived, are conceptualized.

Using Selye's (1974) definition of stress as "The nonspecific

response of the body to any demand made upon it" (p. 41), Perlman and

Hartman (1982) built a theoretical model of psycho-social organizational

mediated adaptation congruent with Selye's initial work. The Perlman and

Hartman (1982) model incorporated three major symptom categories of

stress that are reflected by the three dimensions of burnout:

(a) physiological (focusing on physical symptoms and perceptions of

reduced personal accomplishment); (b) affective cognitive (focusing on

attitudes and feelings and emotional exhaustion); and (c) behavioral

(focusing on symptoms or behavior related to depersonalized care of the

recipient of care). The model, which has a cognitive and perceptual

focus, consists of a linear progression of four stages of stress which

include the degree to which the situation is conducive to stress, the

perception of job stress, response to stress, and outcome of stress.

Groupings of significant personal variables and organizational variables

are related to each stage. In the first stage of stress the degree the

situation is conducive to stress is a function of personal variables of

ability, time, family demands, and job expectations and organizational









variables of workload, expected role performance and role ambiguity. The

combination of the variables age and education are theorized by Perlman

and Hartman (1982) to represent the variable ability. The combination of

the variables marital status and life events is theorized by Perlman and

Hartman (1982) to represent the variable family demands. The variable

job expectation is theoretically viewed by Perlman and Hartman (1982) to

represent perception of growth for helping professionals. In the second

stage of stress the level of perceived job stress is a function of

personal variables of personal work needs, and personality and

organizational variables of supervision, work group norms, opportunity

for advancement and dealing with colleagues at work. In the third stage

of stress the response to stress is a function of physiological,

affective and cognitive responses manifested as burnout. This stage is

related to personal variables including commitment to career, and health

and organizational variables that include pay, support from peers,

supervision, and organizational climate and the economic and market

condition. In the fourth stage, burnout is related to work outcomes

including job satisfaction and psychological response.

The model includes a complete representation of transactional

processes including personal characteristics, organizational

characteristics, the degree to which a situation is likely to be

stressful, perception of organizational job stress, and response to job

stress in understanding the etiology of burnout. Although the

conceptualization of burnout offered by Perlman and Hartman (1982) is

fairly comprehensive there are limitations with respect to the

operationalization of two variables labelled personal work needs and work

group norms. Multiple indicators need to be used to operationalize these









variables that are identified in the literature review for this study

that have a meaningful relationship in the process that leads to job

dissatisfaction and burnout. For example, according to the literature,

meaningfulness of work, responsibility for work outcomes and knowledge of

work outcomes have a direct relationship to job satisfaction (Herzberg,

1968; Hinshaw & Atwood, 1984, 1987; Oldham, Hackman, & Pearce, 1976).

Because job dissatisfaction has been linked to burnout, use of these

multiple indicators of personal work needs seems warranted. In addition,

according to the literature, autonomy, skill variety, task significance,

and task identity have a direct relationship to the process of job

satisfaction and job burnout (Cherniss, 1980a-b; Heifitz & Bersoni,

1983). Use of these variables to operationalize work group norms has

theoretical support and is justified.

Another problem is that the model conceptualized by Perlman and

Hartman (1982) has structural limitations of its components. Each

variable affects only the next continuous variable in the model. They

did not allow for the freedom of some variables having direct and

indirect causal relationships to more than one outcome variable. For

example, according to the literature, job satisfaction has a direct

relationship to pay, dealing with others at work, opportunity for

advancement, and economic market conditions (Jayaratne & Chess, 1983;

Oldham, Hackman, Pearce, 1976; Paredes, 1988) but from Figure 1-1 it

would appear that burnout has a direct relationship to pay, support from

others, and economic market conditions and that job stress has a

relationship with opportunity for advancement. In addition, Perlman and

Hartman (1982) seemed to suggest that burnout precedes job satisfaction,

but other theoretizations of burnout would equate it with what Perlman









and Hartman defined as maladaptation, manifested as an observable form of

ineffective coping.

A more logical approach is the expansion of the model offered by

Perlman and Hartman (1982) to a path-analytical model that will allow for

the analysis of direct and indirect effects of personal and

organizational variables simultaneously across stages. There is a need

to attend to a more comprehensive causal model of stress and burnout that

includes personal and organizational variables as well as stages of

stress, job satisfaction, and psychological response in understanding the

etiology of burnout.
















CHAPTER III
MEET1I''DOLOGY

This study was designed to collect data and to test a path analytical

model of the theoretical conceptualization of burnout for critical care

nurses. The model of interest was an expansion of the model offered by

Perlman and Hartman (1982) that allowed analysis of direct and indirect

effects of exogenous and endogenous variables using path analysis. Five

research study questions were used to guide this study in an exploratory

examination of the full model of burnout.

This chapter is divided into four section. In the first section,

the sample of respondents is described. The study design and procedures

used to collect the data are included in the second section of the

chapter. The instrumentation is described in the third section. The

fourth section includes a description of the statistical analysis of the

five research questions used to guide the study in examining the model.

Sample of Respondents

Selection of research participants. Permission to conduct the stud.

was first obtained through the Institutional Review Board of the

University Health Center. Following approval, a convenience sample of

hospitals was selected. Eligible hospitals (N = 14) were identified fru:

the 1985 Hospital Data Report published by the North Central Florida

Health Planning Council. Permission to conduct the study was then

obtained through the Nursing Research Committees of hospitals located in

North Eastern, North Central and Southern regions of the state of









the state of Florida. Administrators of five of the selected hospitals

declined to participate due to the perceived threatening tone of the Job

Diagnostic Survey Questionnaire and the burnout questionnaire. The final

sample consisted of nine hospitals which are licensed for between 250 and

450 beds, and are located in Northeastern, Northwestern, North central,

and Southern regions of Florida. All staff nurses employed in the nine

hospitals who fit the criteria of working on a critical care unit and

having worked full time for at least three months were invited to

participate in the study. During the months of September-November, 1989,

the burnout test battery was presented to the nurses by the author during

a scheduled staff meeting (Appendix A). Consent for participation was

then procured from the critical care nurse employed in these settings

(Appendix B).

A total of 375 female critical care registered staff nurses were

given a package of materials with a cover letter requesting their

participation. A total of 330 nurses agreed to participate by returning

complete questionnaires (86%). Thirty questionnaires were not fully

completed and were excluded from the data analysis. Three hundred

questionnaires were usable for data analysis.

The demographic characteristics of the critical care staff nurses

(age, marital status, sex, and education) are presented in Table 3-1.

These data revealed that all the critical care nurses in the sample were

female and that 75% of the nurses were between the ages of 20 and 39 with

32% under the age of thirty. The majority of the staff nurses held an

associate degree (50%) in nursing (ADN) and 10% were diploma graduates.

Only 34% were baccalaureate graduates in nursing.

The duration of experience as a staff nurse in critical care is

presented in Table 3-2. The duration ranged from 3 months to 30 years









Table 3-1

Characteristics of Critical Care Staff Nurses:
Sex, Age, and Education (N = 300)


Characteristics Number Percent



Sex:

Female 300 100.0

Marital Status:

Single 71 23.7

Married 188 62.7

Separated 6 2.0

Divorced 35 11.7

Total 300 100.1

Age:

20 29 96 32.0

30 39 129 43.0

40 49 60 20.0

50 59 14 4.7

60 or over I 0.3

Total 300 100.0

Education:

ADN 149 50.0

BSN 102 34.0

Diploma 31 10.3

Some graduate work 18 6.0

Total 300 100.3









Table 3-2

Duration as Staff Nurse in Critical Care (N = 300)


Number of years Number Percent Cumulative %



Duration as staff nurse
in critical care:

3 6 months 60 20 20

7 months 1 year 49 16.3 36.3

13 18 months 11 3.7 40.0

19 months 2 years 2 .7 40.7

2 3 years 15 5.0 45.7

3 4 years 25 8.3 54.0

4 5 years 9 3.0 57.0

5 7 years 34 11.7 68.7

7 10 years 31 10.0 78.7

10 15 years 43 14.3 93.0

15 20 years 14 4.7 97.7

20 25 years 5 1.6 99.3

25 years + 2 .7 100.0

Total 300 100.0 100.0









with a mean of 6.86 years and a standard deviation of 5.53 years. Over

45% had 3 years or less of work experience as a staff nurse in critical

care, and 46% had more than 4 years of experience.

Additional demographic information included the duration of

experience as a staff nurse in critical care at the present institution

and the number of hours working per week. The number of years of

experience as a staff nurse in critical care at the present institution

ranged from 1 month to 25 years with a mean of 4.75 years and a standard

deviation of 4.19 years. Over 67% had 5 years or less of work experience

in critical care staff nursing at the present institution and 8% had more

than 10 years of experience at the present institution (see Table 3-3).

The number of hours working per week ranged from 36 hours to 72 hours

with a mean of 38.16 hours and a standard deviation of 7.95 hours. It

was revealed that over 16% had 42 hours or more per week working time

(Table 3-4).

Study Design and Procedures

The design structure for the path analysis methodology was

correlational, involving selection of a number of psychometric

instruments to operationalize each of the variables specified in the

theoretical framework and administration of these instruments to all

subjects in the study. Subjects were asked to complete five

questionnaires, including the demographic sheet, and Work Survey

Instrument, the Daily Hassles Scale, the Job Diagnostic Survey, the

Hardiness Scale, and the Burnout Inventory. Each nurse self-administered

the burnout test battery during an off-work, scheduled, thirty-minute

period. The test battery included a set of standardized instructions for

each of the measures. All subjects were guaranteed anonymity.









Table 3-3

Years of Experience as a Critical Care Staff Nurse at the
Present Institution




Number of years Number Percent



6 months or less 16 5.3

7 months 1 year 29 9.7

13 months 2 years 60 20.0

2 5 years 97 32.3

5 10 years 74 24.7

10 15 years 16 5.3

15 20 years 7 2.3

20 25 years 1 .3

Total 300 100.0









Table 3-4

Work Hours Per Week (N = 300)


Number of hours Number Percent



40 hours 249 83.0

41 42 hours 3 1.0

43 44 hours 5 1.7

45 48 hours 28 9.4

49 50 hours 8 2.6

51 60 hours 5 1.6

61 70 hours 2 .7

Total 300 100.0









Instrumentation

A demographic questionnaire and work survey devised by the

researcher and four widely used standardized instruments including The

Daily Hassles Scale, Job Diagnostic Survey (JDS), Psychological Hardiness

Test, and Maslach Burnout Instrument were used in this study in order to

assess individual critical care nurses' perceptions of personal and

organizational variables in the work environment, levels of stress

including a situation conducive to stress, perceived job stress, and

burnout and outcomes of the stress response including job satisfaction

and internal job motivation.

Demographic Questionnaire

Description. A six-item questionnaire was constructed in order to

assess personal characteristics of the critical care nurses. The

personal characteristics assessed were age, sex, marital status,

education, duration as a staff nurse in critical care, duration as a

staff nurses in critical care at the present institution, and the number

of working hours per week in critical care nursing. Appendix C contains

this instrument.

Use in this study. The personal variables, ability and time

(tenure), were measured with items from the demographic questionnaire

(Appendix C). The measurement of ability consisted of the sum of the

duration of time as a staff nurse in critical care in months and the sum

of the duration of formal education in nursing months. The measurement

of tenure consisted of the numerical value of duration in months as a

staff nurse in critical care and the duration in months as a staff nurse

at their present institution. The means and standard deviation for the

sample used in the present study are presented in Table 3-5.









Table 3-5

Psychometric Properties of Variables: Ability and Time



Standard
Variable Number Mean deviation



Ability 300 117.82 68.858

Time 300 139.33 103.192









Daily Hassles Scale

Description. The measurement of psychological stress through the

use of the Hassles Scale theoretically approaches the role of cognitive

appraisal in the stress and coping process (Lazarus & Folkman, 1989). In

this approach, coping depends on how individuals appraise their everyday

encounters with the environment with regard to the extent to which those

encounters are perceived as threatening, harmful, or challenging.

Everyday encounters are called hassles and are measured in the Hassles

Scale. The Hassles Scale consists of 117 items used to measure the

frequency and severity of a person's transactions with the environment

that are considered by the individual to be stressful events; e.g., "How

much of a hassle was this for you . overloaded with family

responsibilities?" The scale takes approximately 10 minutes to complete.

The response format is a four-point scale, ranging from "none" or not

applicable to "extremely severe." The Daily Hassles Scale yields two

scores: frequency, which is the number of hassles endorsed by the person

without regard to severity and severity, which is the average severity

rating of all items that have been identified. Eight factor-based

subscales scores are also possible. They include future security, time

pressures, work, household responsibilities, health, inner concerns,

financial responsibilities, and neighborhood/environmental.

Psychometric Properties Of Daily Hassles Scale

Reliability. Kanner et al. (1981) reported a test retest

reliability coefficient of .79 on a sample of 432 college students and a

sample of 448 adults aged 20-60. There is no information available on

the internal consistency of the scale.









Validity. In reference to construct validity, an important

relationship has been explored between hassles and life events scores and

the treatment of both as indicators of psychological stress. Kanner et

al. (1981) provide the strongest evidence for construct validity of the

Daily Hassles Scale in order to explain psychological symptoms and

symptoms of somatic illness and emotional distress. His group found that

the hassles scores were strongly related to both affective distress and

psychological symptoms (.34). The Hopkins Symptom Checklist (HSC1)

(Derogotis et al., 1974) correlated between .5 and .6 with the Daily

Hassles Scale. Delongis et al. (1988) correlated hassles and somatic

health status as dependent variables and found that daily hassles

explained more variance than did life events.

Lazarus and Folkman (1989) performed a factor analysis of the Daily

Hassles Scale, using the principal factor method with oblique rotation

and generated eight factors: future security, time pressure, work,

household responsibilities, health, inner concerns, financial

responsibility, and neighborhood and environmental concern.

Use in the study. The personal variables family demands, health,

the situational stress and job stress variables were measured with the

Daily Hassles Scale on the basis that the scale contained factors that

corresponded to the variables used in this study. Family demands were

measured with the Daily Hassles Scale, items 1-4, 7-15, 19-23, 29, 35-3M,

43, 45, 55, 58-59, 61-64, 70, 71, 73-76, 78-79, 82, 87, 90, 92-93,

103-108, and 110-112 that corresponded to three factors: household

responsibilities, financial responsibility and neighborhood and

environmental concern (Lazarus & Folkman, 1989).









Health was measured with the Daily Hassles Scale, items 16-18, 48,

49, 50, 53, 54, 56, 77, 91, and 98 that corresponded to the health factor

(Lazarus & Folkman, 1989).

The degree to which the situation was conducive to stress was

measured with items 5, 6, 24-26, 39-42, 44, 46-47, 51-52, 57, 60, b7-69,

85, 88-89, 94-97, 99-101, 109, 113-117, of the Hassles Scale that

corresponded to the three factors inner concerns, future security, and

time pressure (Lazarus & Folkman, 1989).

The level of perceived job stress was measured with items 27-28,

30-34, 65, 66, 72, 80-84, 86, and 102 pertaining to work hassles of the

Hassles Scale (Lazarus & Folkman, 1989).

Critical care nursing faculty, critical care graduate nursing

students, and two top nursing management members of two critical care

intensive care units of a regional hospital were asked to rate and

evaluate this scale for use in this study. On the basis of the

reliability and validity data available, use of the Daily Hassles Scale

as a measure of family and life demands, health, situation conducive to

stress, and work stress seemed justified. The means, standard deviations

and coefficient alpha estimates for the variables for the sample used in

the present study are presented in Table 3-6. Appendix D contains

instrument directions and sample items.

Job Diagnostic Survey (JDS)

Description. The JDS is composed of 83 items used to diagnose

existing jobs to determine if and how they might be redesigned to affect

employee motivation and performance and to evaluate the effects of job

changes on employers. The measure is based on a theory of how a job

affects worker motivation and provides measures of objective job

dimensions, individual psychological states related to these dimensions,









Table 3-6

Psychometric Properties of Variables: Daily Hassles Scale




Standard
Variable Number Mean deviation Alpha



Family demands 300 .751 .408 .701

Health 300 .501 .396 .699

Situational stress 300 .717 .387 .703

Job stress 300 .659 .427 .714









affective reactions of employees to the work setting and the job, and the

need of the individual for growth. The scale is appropriate for grades 8

and over. The subjects respond to a seven-point response scale used

throughout the instrument.

The JDS yields scores on 18 subscales. All 18 of these subscales

were used as measures of variables in the present study. Table 3-7

relates JDS subscales to variables and gives sample items. The JDS

provides measures of the five core work dimensions which include skill

variety, task identity, task significance, autonomy and feedback from the

job itself. Two additional measures are included for two supplementary

dimensions which include feedback from agents and dealing with others.

They are defined as follow:

Skill variety is the degree to which a job requires a variety of

different activities in carrying out the work, which involve the use

of a number of different skills and talents of the employee.

Task identity is the degree to which the job requires completion of

a "whole" and identifiable piece of work--i.e., doing a job from

beginning to end and with a visible outcome.

Task significance is the degree to which the job has a substantial

impact on the lives or work of other people--whether in the

immediate organization or on the external environment.

Autonomy is the degree to which the job provides substantial

freedom, independence, and discretion of the employee in scheduling

the work and in determining the procedures to be used in carrying it

out.

Feedback from the job itself is the degree to which carrying out the

work activities required by the job results in the employee










Table 3-7

Job Diagnostic Survey Subscales, Related Variables and
Sample Items


Variable in
Subscale this study Sample Item


Total growth
need strength







Meaningfulness
of work


Responsibility
for work
outcomes


Knowledge of
work results


Feedback from
the job itself


Job expectations








Personal work needs


Expected performance
and role ambiguity


Feedback from
agents on the job


Skill variety


Work group norms


Task identity


"Indicate the degree to
which you would care to
have this characteristic
present in your job; e.g.,
opportunities for personal
growth and development in
my job."

"Most of the things I have
to do on this job seem
useless or trivial to me."

"I feel a very high degree
of personal responsibility
for the work I do on this
job."

"Most people on this job
have trouble figuring out
whether they are doing a
good or a bad job."

"Just doing the work
required by the job
provides may choices for me
to figure out how well I am
doing."

"Supervisors often let me
know how well they think I
am performing on the job."

"The job requires one to
use a number of complex or
high-level skills."

"The job provides me the
chance to completely finish
the pieces of work 1
begin."










Table 3-7--continued


Variable in
Subscale this study Sample Item


Task significance


Autonomy


Dealings with
others at work


Supervision
satisfaction


Satisfaction with
work growth and
advancement

Pay satisfaction


Satisfaction with
peers and
co-workers

Satisfaction with
job security


General job
satisfaction


Internal job
motivation


Work group norm


Work group norm


Dealing with
colleagues


Supervision



Opportunity for
advancement


Support from others
at work


Organizational climate
and the economic-
market condition

Job satisfaction



Psychological response
to job stress


"The job is one where a lot
of the other people can be
affected by how well the
work gets done."

"The job gives me
considerable opportunity
for independence and
freedom in how I do the
work."

"The job requires a lot of
cooperative work with other
people."

"The amount of support and
guidance I receive from my
supervisor.

"The amount of personal
growth and development I
get in doing my job."

"The amount of pay and
fringe benefits I receive.

"The chance to get to knuw
other people on the job."


"How secure things look tn r
me in the future in this
organization."

"I am generally satisfied
with the kind of work I dG
in this job."

"Most people in this job
feel a great sense of
personal satisfaction when
they do the job well."









obtaining direct and clear information about the effectiveness of

his or her performance.

Feedback from agents is the degree to which the employee receives

clear information about his or her performance from supervisors or

from coworkers.

Dealing with others is the degree to which the job requires the

employee to work closely with people in carrying out the work

activities.

The JDS also measures three psychological states that are associated

with the core job dimensions. These include experienced meaningfulness

of the work, experienced responsibility for work outcomes and knowledge

of work results. They are defined as follow:

Experienced meaningfulness of the work. The degree to which the

employee experiences the job as one which is generally meaningful,

valuable, and worthwhile.

Experienced responsibility for work outcomes. The degree to which

the employee feels personally accountable and responsible for the

results of the work he or she does.

Knowledge of results. The degree to which the employee knows and

understands, on a continuous basis, how effectively he or she is

performing the job.

Personal, affective reactions or feelings a person obtains from

performing the job include general satisfaction, internal job motivation,

and specific satisfactions (job security, pay and other compensations),

social satisfaction with peers and coworkers, supervision and opportunity

for personal growth and development on the job. They are defined as

follow:









General satisfaction. An overall measure of the degree to which the

employee is satisfied and happy with the job.

Internal job motivation. The degree to which the employee is self

motivated to perform effectively on the job--i.e., the employee

experiences positive internal feelings when working effectively on

the job, and negative internal feelings when doing poorly.

Specific satisfaction. A number of short scales which provide

separate measures of satisfaction with:

(a) Job security

(b) Pay and other compensation

(c) Peers and coworkers ("social" satisfaction)

(d) Supervision

(e) Opportunities for personal growth and development on the job

("growth" satisfaction)

Finally, the JDS measures the strength of the individual's desire to

obtain growth satisfactions from his or her work. This measure is called

the growth need strength index and is viewed as an individual

characteristic which is predicted to influence how well a worker will

react to a job with a high motivating potential (Hackman & Oldham,

1978).

Psychometric Properties of JDS

Reliability. Internal consistency reliabilities for the eighteen

subscales are reported as generally satisfactory with a range from a high

of .88 to a low of .56. The term scale is used to refer to the summary

score obtained for each variable measured by the JDS. On the basis of

these results the reliability estimates are satisfactory. The

psychometric properties of the variables on this sample are presented in

Table 3-8.










Table 3-8

Psychometric Properties of Variables: Job Diagnostic Survey





Standard
Variable Number Mean deviation Alpha



Job expectations 300 4.103 2.446 .714
(Total growth
strength need)

Meaningfulness of 300 5.750 .844 .669
work

Responsibility for 300 5.750 .653 .680
work outcomes

Knowledge of work 300 5.000 .946 .679
results

Expected role 300 4.668 .898 .670
performance and
role ambiguity
(Feedback from the
job itself and
feedback from
agents on the
job)

Skill variety 300 5.916 .818 .675

Task Identity 300 4.212 1.112 .691

Task 300 6.152 .772 .684
significance

Autonomy 300 5.090 .905 .689

Supervision 300 4.950 1.270 .677

Dealing with others 300 6.116 .707 .700
at work

Opportunity for 300 5.459 .893 .661
advancement


300 3.903


Pay satisfaction


1.608 .693









Table 3-8--continued


Standard
Variable Number Mean deviation Alpha



Social support at 300 5.639 .766 .673
work

Job security 300 5.207 1.224 .695
satisfaction

Job satisfaction 300 4.949 1.110 .675

Internal job 300 5.874 .640 .680
motivation









Validity. Convergent validity was demonstrated by Hackman and

Oldham (1978). Assessments of the specified jobs on the job dimensions

were made by the employers who worked on those jobs as well as by the

supervisors and the researchers. The ratings of each group were averaged

for each job, and then correlations were computed. The median of the

correlations between employees and supervisors is .51; between employers

and observers is .63; and between supervisors and observers is .46. In

general, the ratings of the three groups converge moderately well.

The validity of the JDS has been demonstrated further by data that

confirm hypotheses about the relationship of certain job characteristics

and experienced burnout. Hackman and Oldham (1974) found scores on the

JDS and the Maslach Burnout Inventory (MBI) were closely correlated. In

particular, high scores on the job dimension "feedback from the job

itself" were associated with low scores on emotional exhaustion and

depersonalization, and were high scores on personal accomplishment of the

burnout inventory (Maslach & Jackson, 1986). Another job dimension,

"dealing with others," was found to be weakly correlated with emotional

exhaustion. A third job dimension, "task significance," was highly

positively correlated with personal accomplishment.

Additional validation of the JDS is provided by data that confirm

hypothetical relationships between the JDS measure of "growth

satisfaction" and burnout. Scores on the JDS measure on "growth

satisfaction" were negatively correlated with emotional exhaustion and

depersonalization and positively correlated with personal accomplishment.

In addition, employees scoring low on the JDS subscale of "experienced

meaningfulness of the work" scored higher on depersonalization and lower

on personal accomplishment. With respect to coworkers, employees scoring








low on the JDS subscale of peer and coworker satisfaction' scored high

on emotional exhaustion and depersonalization, and low on personal

accomplishment.

Further evidence of the validity of the JDS has been obtained by

distinguishing its subscales by off diagonal median correlations which

provide an indication of discriminant validity of the items. The range

is from .12 to .28. In addition, distinguishing the JDS job satisfaction

subscale from measures of other psychological constructs including

burnout has been supported. Job satisfaction had a moderate negative

correlation with both emotional exhaustion (-.23) and depersonalization

(-.22), as well as slightly positive correlation with personal

accomplishment (.17).

Finally, a preliminary study has been performed in which factor

analysis was used to determine if the JDS measures a multidimensional

construct. The results of these studies are not enough to eliminate the

conceptualization of a multidimensional construct of job characteristics

measured by the JDS. Additional research is required to determine this

issue. Despite the high intercorrelations among the subscales, Hackman

and Oldham (1978) suggest that separate subscale interpretations are

probably warranted but should be made cautiously.

On the basis of the reliability and validity data available, use of

the JDS as a measure of personal and organizational variables seemed

justified.

Use in this study. The personal variables including job

expectations, and personal work needs and organizational variables,

including expected performance and role ambiguity, work group norms,

dealing with colleagues, supervision, opportunity for advancement, pay,









support from others, organizational climate and the economic-market

condition, general job satisfaction and psychological response to burnout

(internal work motivation) were measured with the JDS on the basis that

the scale contained measures that closely resembled the variables used in

this study. In addition, critical care nursing faculty, critical care

graduate nursing students, and two top nursing management members of two

critical care intensive care units of a regional hospital were asked to

rate and evaluate this scale for use in this study. On the basis of

their judgement, and the decision of this researcher, use of the JDS as a

measure of the personal and organizational variables seemed justified.

Appendix E contains instrument directions and sample items.

Psychological Hardiness Test

Description. Hardiness is defined as a learned ability to cope with

a wide variety of stressful situations in such a way that the stresses

are transformed to a positive outlook, or negative stresses, that cannot

be realistically transformed, are met with a plan to eliminate them.

Another way of describing "hardiness" is transformational coping which is

a learned process. The amount of hardiness one has acts as a buffer to

keep stress from changing into strain, and strain from changing into

illness. A sample item of the Psychological Hardiness Test includes, "I

often wake up eager to take up my life where it left off the day before."

The measurement of hardiness consists of 50 rating-scale items developed

by Kobasa, Maddi, Donner, Merrick, and White (1984). The 50 items were

derived from a factor analysis of six existing personality scales which

have been used to measure commitment, control, and challenge dimensions

of hardiness. The Hardiness Test was standardized on a population of 223

women and 1511 men who for the most part were professionals--business

executives, lawyers, white collar professional.









The hardiness scores is computed by transforming raw subscale scores

into standard scores and adding across the three subjscales to produce a

total score for each subject. Commitment is defined as the ability to

commit to the task or project or relationship. Control is defined as the

realistic knowledge and use of the amount of control or lack of control

that one has in this and other situations. Challenge is defined as the

use of both commitment and control in order to see events, relationships,

problems and opportunities as challenges rather than as trouble.

Psychometric Properties of Psychological Hardiness Test

Reliability. As to reliability, the internal consistency estimates

based on 10,000 subjects over the past four years from all walks of life

and a multitude of circumstances has yielded a coefficient alpha of .92

for total hardiness score a mean of 74.02 and a standard deviation of

9.60. Stability appears to be about .960 over a period of two weeks.

The internal consistency estimate for this sample was .89 with a mean

score of 69.31 and a S.D. of 11.01.

Validity. The validity of the hardiness test has been demonstrated

by data that confirm hypotheses about the relationship of hardiness to

burnout. Keane et al. (1985) reported that nurses who exhibited less

psychological hardiness reported more burnout. In addition, they

reported that perceived job stress and hardiness were significant

additive predictions of burnout. Hardiness appeared to have beneficial

effects on decreasing burnout.

Kobasa et al. (1982) related commitment and coping in stress

resistance among lawyers and identified that increases in strain are

significantly determined by personality characteristics of alienation

(vs. commitment). In another study, Kobasa (1979) reported discriminant

function analysis with the prediction that high stress/low illness

executives show by comparison with high stress/high illness executives,









more hardiness, that is, have a stronger commitment to self, an attitude

of vigor toward their environment, a sense of meaningfulness, and an

internal locus of control.

This evidence suggests that on the basis of the reliability

estimates and validity data available, the total hardiness scores

provides a measure of general psychological hardiness. However, there is

less empirical support for the interpretation of separate subscale scores

of control, commitment, and challenge.

Uses in this study. The personal variable personality was measured

with the Hardiness Test on the basis that this scale would determine if

hardiness or transfunctional coping acts as a buffer to keep situations

conducive to stress from changing into job stress, and job stress from

changing into burnout among critical care nurses. In addition, critical

care nursing faculty, critical care graduate students and two top nursing

management members of two critical care intensive care units of a

regional hospital were asked to rate and evaluate this scale for use in

this study. On the basis of their judgement and the discretion of this

researcher, use of the Hardiness Test is a measure of the personal

variable of personality seemed justified. Appendix G contains

instrument directions and sample items.

Maslach Burnout Instrument (MBI)

Description. Burnout, according to Maslach and Jackson (1986), is a

syndrome of emotional exhaustion, depersonalization, and reduced personal

accomplishment, which often affects helping professionals (e.g.,

teachers, nurses and therapists). A major aspect of the burnout syndrome

is increased feelings of emotional exhaustion; as emotional reserves are

depleted, helping professionals feel that they are no longer able to give

of themselves at a psychological level. In addition, the development of

depersonalization--i.e., negative, cynical attitudes and feelings about









one's own clients occurs. A third aspect of the burnout syndrome is

reduced personal accomplishment, which refers to the tendency to evaluate

oneself negatively, especially with regard to one's work with patients.

Helping professionals may feel unhappy about themselves and dissatisfied

with their accomplishments on the job. The MBI is designed to measure

the three components of burnout. Each aspect is measured by a separate

subscale. The Emotional Exhaustion subscale assesses feelings of being

emotional, over extended, and exhausted by one's work. The

Depersonalization subscale measures an unfeeling and impersonal response

towards recipients of one's service, care, treatment, or instruction.

The Personal Accomplishment subscale assesses feelings of competence and

successful achievement in one's work with people. Each scale further

includes an expression of frequency using a six-point response format.

The MBI consists of a total of 22 items.

Psychometric Properties of MBI

Reliability. Reliability coefficients of internal consistency

ranged from .71 to .90. Test retest reliability (2-4 weeks apart) ranged

from .82 to .53. Standard errors of measurement ranged from 3.16 to

4.99. Reliability estimates, therefore, appear sufficient. The internal

consistency of the emotional exhaustion subscale on the sample in this

study was .72.

Validity. Convergent validity was determined in a variety of ways.

First, behavioral ratings made by an acquaintance of the individual such

as a coworker or a spouse were correlated with MBI scores. The validity

of the job is demonstrated further in studies confirming hypotheses about

the relationships between various job characteristics and experienced

burnout. In one study, it was predicted that the greater number of

clients one must care for, the higher the burnout scores on the MBI

(Maslach & Pines, 1977; Maslach & Jackson, 1982, 1984a-b).










The JDS and the MBI scores were correlated in research performed by

Pines and Kafry (1978). High scores on the job dimension, feedback from

the job itself, were correlated with low scores on depersonalization and

emotional exhaustion and high scores on personal accomplishment. The

dimension, "dealing with others," relates to the degree to which a job

requires the employee to work closely with people in carrying out the job

activities. High scores on this job dimension were weakly correlated

with emotional exhaustion. Task significance, a third dimension,

assesses the degree to which the job has an impact on the lives of other

people. High scores on this dimension were positively correlated with

personal accomplishment.

Further validation of the MBI has been provided by data that

confirms hypotheses related to experienced burnout and various outcomes

or personal reactions. In a study of nurses, and social service and

mental health workers scores on the JDS measure of "growth satisfaction"

were negatively correlated with depersonalization and emotional

exhaustion and positively correlated with personal accomplishment. Low

scores on the JDS subscale of "experienced meaningfulness of the work"

scored higher on depersonalization and lower on personal accomplishment.

In addition, low scores on the JDS subscale of "knowledge of results"

were correlated with high scores on emotional exhaustion and

depersonalization and with low scores on personal accomplishment.

Support for the hypotheses predicting that burnout would be related

to the desire to leave one's job was supported by Maslach and Jackson

(1979, 1982, 1984a-b). In addition, the impairment of one's

relationships with people in general, both on and off the job was highly

correlated with emotional exhaustion. Low scores on the JDS subscale









peer and coworker satisfaction correlated with high scores on emotional

exhaustion and depersonalization, and low on personal accomplishment.

Additional studies have linked burnout to outcomes of stress

including increased use of alcohol, drugs, and insomnia. Individuals

scoring high on emotional exhaustion were also rated as having problems

with insomnia. Police officers in one study were more likely to describe

having a drink to cope with stress if they had high scores on emotional

exhaust-ion. If they scored low on personal accomplishment they were

likely to report using tranquilizers.

Finally, further research determining the discriminant validity of

the MBI has been performed in order to distinguish burnout from measures

of other psychological constructs that might be assumed to be confounded

with burnout. Scores from the general satisfaction subscale measured by

the JDS and scores of the MBI has a moderate negative correlation, -.23

(emotional exhaustion); -.22 depersonalizationn as well as slightly

positive correlations with personal accomplishment (.17). Low

correlations between burnout subscale scores and other measures of job

satisfaction have been reported in other studies as well.

The MBI appears to be the best scale available in measuring burnout.

It is a well constructed instrument and the validity and reliability data

are sufficient to provide meaning and stability of the construct.

Use in this study. The variable burnout-emotional exhaustion was

measured with the Maslach Burnout Inventory on the basis that burnout was

defined as a syndrome with three dimensions: emotional exhaustion,

depersonalization, and personal accomplishment and this measure is

consistent with that definition. In addition, the use of the Maslach

Burnout Inventory permits some comparability between studies among

helping professionals including nurses because it is widely used.









The cognitive, affective and physiologic response of stress,

referred to as burnout, was measured with the Maslach Burnout Inventory

(Maslach & Jackson, 1986). A sample item of the Maslach Burnout

Inventory for Emotional Exhaustion includes, "I feel emotionally drained

from my work." Appendix I contains instrument directions and sample

items.

Commitment and Workload

Description. Commitment to career was measured with one five point

Likert item (Appendix F). Workload was measured with two five point

Likert items (Appendix F).

Psychometric properties. Psychometric properties of these variables

are presented in Table 3-9.

Use in this study. The personal variable commitment to career and

the organizational variable workload were measured with three items that

were designed by the researcher to closely resemble the variables used in

this study among critical care nurses. Critical care nursing faculty,

critical care graduate nursing students, and two top nursing management

members of two critical care intensive care units of a regional hospital

were asked to rate and evaluate these three items for use in this study.

On the basis of their evaluation and the discretion of the researcher

these items were used to measure commitment to career and workload.

Table 3-10 presents a summary of the instrumentation of personal,

organizational variables, and situation conducive to stress, job stress,

burnout-emotional exhaustion, job satisfaction and internal work

motivation variables used in the study.

Statistical Analysis

The five research questions listed in Chapter I (pg. 9) were used to

guide this study in examination of the full model of burnout-emotional









Table 3-9

Psychometric Properties of Variables: Commitment and Workload





Standard
Variable Number Mean deviation Alpha



Commitment 300 3.537 1.357 NE

Workload 300 4.097 .8038 NE


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exhaustion, that included ten personal variables, twelve organizational

variables, the degree to which the situation is conducive to stress, job

stress, job satisfaction, and internal work motivation. Multiple

regression analyses were used to answer the study questions. In a post

hoc analysis, each independent variable that made a significant

contribution to the variance explained in one or more dependent variables

was included in a path analysis. Path analysis, as described by Pedhazur

(1982), was used to estimate the magnitudes of the direct and indirect

effects of these selected variables on perceived levels of stress,

general job satisfaction, and burnout-emotional exhaustion,

respectively.
















CHAPTER TV
STUDY FINDINGS

This study was designed to collect data and to test a path-

analytical model of the theoretical conceptualization of burnout for

critical care nurses. The model of interest tested was an expansion of

the model offered by Perlman and Hartman (1982). Five research questions

were used to guide this study in the examination of the full model of

burnout including personal and organizational variables and situation

conducive to stress, job stress, job satisfaction and internal work

motivation. Each of the independent variables that made a significant

contribution to the variance explained in the dependent variables was

included in the path analysis.

This section is divided into two sections. The first section

describes the statistical analysis of the full model. This section

includes the mean, standard deviation, and zero-order correlation

coefficient between each of the variables included in the study and the

results of regression analyses used to address the five research

questions posed in Chapter I. The second section includes a presentation

of the findings related to estimation of the direct and indirect effects

of the exogenous and endogenous variables obtained from applying path

analysis to a more parsimonious version of the model.

Full Model and Statistical Analysis

Appendix J contains the means, standard deviations, and zero-order

coefficients of correlation between the endogenous variables consisting









of the situation conducive to stress, job stress, job satisfaction,

internal job motivation, and burnout-emotional exhaustion and each of the

exogenous variables in the study. As shown in Appendix J, many of the

variables were found to be significantly associated with the endogenous

measures and indicated promise for explaining and predicting burnout in

terms of the model shown in Figure 1-2 (pg. 7).

Exogenous Variables

Personal characteristics. Personal variables consisted of ability,

time, family demands, job expectations, personal work needs including

meaningfulness of work, responsibility for work outcomes, and knowledge

of work results, health, commitment to career, and personality. Among

the personal characteristics assessed family demands, knowledge of work

results, and health were all significantly associated with the situation

conducive to stress. With the exception of ability, time, and job

expectations, the personal characteristics were all significantly related

to job stress, and burnout-emotional exhaustion. Job expectations was

inversely related to internal job motivation. Personal characteristics

including meaningfulness of work, responsibility for work outcomes,

knowledge of work results and commitment to career were all significantly

associated with job satisfaction and internal job motivation. In

addition, while job expectation was significantly related to job

satisfaction, family demands was significantly associated with internal

job motivation. The personality variable was measured with three

psychological hardiness characteristics of commitment, challenge and

control with the total hardiness score. With the exception of job

satisfaction, the total psychological hardiness score was significantly

associated with the variables situation conducive to stress, job stress,

burnout-emotional exhaustion, and internal job motivation.









Organizational work characteristics. Organizational work variables

consisted of workload (workload and staff size), expected role

performance and role ambiguity, work group norms (skill variety, task

identity, task significance, autonomy), dealing with colleagues (dealing

with others at work), supervision, opportunity for advancement, pay,

support from others at work (social support satisfaction), organizational

climate and the economic-market condition (job security) measured with

the Job Diagnostic Survey.

As shown in Appendix J, the zero-order coefficient of correlation

between all the endogenous variables and expected role performance and

role ambiguity, supervision, opportunity for advancement and support from

peers at work were significant. Skill variety was significantly related

to all endogenous measures except situation conducive to stress and

burnout-emotional exhaustion. Task identity was significantly associated

with all the endogenous measures. The correlation of task significance

was significantly related to job satisfaction and internal job

motivation. Autonomy was significantly related to the situation

conducive to stress, job stress, and internal work motivation. Dealing

with others at work was significantly associated with all the dependent

variables. With the exception of the situation conducive to stress, and

internal work motivation, pay was significantly associated with the

endogenous measures. Job security was significantly related inversely to

burnout-emotional exhaustion, and positively related to job

satisfaction.

Endogenous Variables

Endogenous variables consisted of situation conducive to stress, job

stress, job satisfaction, internal job motivation, and burnout-emotional

exhaustion.









As shown in Appendix J, situation conducive to stress was

significantly related to all the endogenous measures while job stress was

significantly correlated with all the endogenous measures. Burnout-

emotional exhaustion was significantly related to job satisfaction. Job

satisfaction was significantly related to internal job motivation.

Question I

Question 1 addressed the significance of the relationship between

situational stress and the weighted linear combination of (a) a set of

personal variables and (b) a set of organizational variables. In

addition, this question also addressed which of the variables in the

model contributed significantly to the variance in situational stress.

Multiple regression analysis yielded an R2 of .72, (F = 31.948;

df = 22, 277; p = .0001), indicating that 72% of the variance on the

situation conducive to stress variable was explained by the variables in

the regression model. Regression results in Table 4-1 show that the

personal variables family demands, health difficulties, and psychological

hardiness, and the organizational work variables, skill variety and job

security, were significant predictors of the situation conducive to

stress.

Personal variables that did not relate significantly to situational

stress were ability, time, job expectations, meaningfulness of work,

responsibility for work outcomes, knowledge of work results, and

commitment to career. Organizational variables that did not relate

significantly to situational stress were workload, expected role

performance and role ambiguity, task identity, task significance,

autonomy, supervision, dealing with others, opportunity for advancement,

pay, and support from peers at work. (See Table K-I in Appendix K for

results of the multiple regression for all variables.)



















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Question 2

Question 2 addressed the significant relationship between job stress

and the combination of (a) situation conducive to stress and (b) the

preceding exogenous variables (ten personal variables and twelve

organizational variables). In addition, this question also addressed

which of the variables in the model contributed significantly to the

variance in job stress.

Multiple regression analyses yielded an R2 of .74, (F = 33.222;

df = 23, 276; p = .0001), indicating that 74% of the variance in job

stress was explained by the variables in the regression model.

Regression results in Table 4-2 show that the personal variables

including time (tenure), family demands, and health difficulties, the

organizational variables including workload, pay, supervision and job

security and the stress variable, situation conducive to stress were

significant predictors of job stress.

Personal variables that did not relate significantly to job stress

were ability, job expectations, meaningfulness of work, responsibility

for work outcomes, knowledge of work results, commitment to career and

psychological hardiness. Organizational variables that did not relate

significantly to job stress were expected role performance and role

ambiguity, skill variety, task identity, task significance, autonomy,

dealing with others, opportunity for advancement, and support from peers

at work. (See Table K-2 in Appendix K for results of the multiple

regression for all variables.)

Question 3

Question 3 addressed the significant relationship between job

satisfaction and the combination of (a) job stress, (b) situational












































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stress, and (c) the preceding exogenous variables (10 personal variables

and 12 organizational variables). In addition, this question also

addressed which of the variables in the model contributed significantly

to the variance in job satisfaction.

Multiple regression analysis yielded an R2 of .64, (F = 20.413;

df = 24, 275; p = .0001), indicating that 64% of the variance in job

satisfaction was explained by the variables in the regression model.

Regression results in Table 4-3 show that the personal variables

including job expectations, meaningfulness of work, knowledge of work

results, health difficulties and organizational variables including task

identity, supervision, dealing with others, opportunity for advancement,

pay and job security and the stress variable, job stress, were

significant predictors of job satisfaction.

Personal variables that did not relate significantly to job

satisfaction were ability, time, family demands, responsibility for work

outcomes, commitment to career, and psychological hardiness.

Organizational variables that did not relate significantly to job

satisfaction were workload, expected role performance and role ambiguity,

skill variety, task significance, autonomy, and support from peers at

work. The stress variable degree situation conducive to stress did not

relate significantly to job satisfaction. (See Table K-3 in Appendix K

for results of the multiple regression for all variables.)

Question 4

Question 4 addressed the significant relationship between internal

job motivation and the combination of (a) job stress, (b) situation

conducive to stress, and (c) the preceding exogenous variables. In

addition, this question also addressed which of the variables in the















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model contributed significantly to the variance in internal job

motivation.

Multiple regression analysis yielded an R2 of .54, (F = 13.552;

df = 24, 275; p = .0001), indicating that 54% of the variance of internal

job motivation was explained by the variables in the regression model.

Regression results in Table 4-4 show that the personal variables

including family demands, meaningfulness of work, responsibility for work

outcomes, commitment to career and health difficulties and organizational

work variables including autonomy, dealing with others, support from

peers at work and the stress variable situation conducive to stress were

significant predictors of internal work motivation.

Personal variables that did not relate significantly to internal job

motivation were ability, time, job expectation, knowledge of work

results, and psychological hardiness.

Organizational variables that did not relate significantly to

internal job motivation were workload, expected role performance and role

ambiguity, skill variety, task identity, task significance, supervision,

opportunity for advancement, pay, and job security. The stress variable

that did not relate significantly to internal job motivation was job

stress. (See Table K-4 in Appendix K for results of the multiple

regression for all variables.)

Question 5

Question 5 addressed the significant relationship between burnout-

emotional exhaustion and the combination of (a) job satisfaction,

(b) internal work motivation, (c) job stress, (d) situation conducive to

stress, and (d) the preceding exogenous variables. In addition, this

question also addressed which of the variables in the model contributed

significantly to the variance in burnout-emotional exhaustion.







84








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Multiple regression analysis yielded an R2 of .41, (F = 7.394;

df = 26, 273; p = .0001), indicating that 41% of the variance in

burnout-emotional exhaustion was explained by the variables in the

regression model. Regression results in Table 4-5 show the personal

variables that were significant predictors of burnout-emotional

exhaustion. Specifically, these were health difficulties, commitment to

career, and psychological hardiness. The significant organizational work

variables included workload, dealing with others, and job security and

the job stress outcome/variable job satisfaction.

Personal variables that did not relate significantly to burnout-

emotional exhaustion were ability, time, family demands, job

expectations, meaningfulness of work, responsibility for work outcomes,

and knowledge of work results. Organizational variables that did not

relate significantly to burnout-emotional exhaustion were expected role

performance and role ambiguity, skill variety, task identity, task

significance, autonomy, supervision, opportunity for advancement, pay,

and support from peers at work. The job stress outcome variable that di:

not relate significantly to burnout-emotional exhaustion was internal juo

motivation. The stress variables that did not relate significantly to

burnout-emotional exhaustion were job stress and the degree the situation

was conducive to stress. (See Table K-5 in Appendix K for results of the

multiple regression for all variables.)

In combination, these study questions have provided a test of the

full model of burnout. A major problem in testing the full model was

that the large number of variables found to be significantly associated















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with burnout made parsimonious and interpretable statements of

relationship difficult. To proceed with this exploratory analysis it

seemed desirable to reduce the total number of variables by eliminating

those variables that were not significantly related to the next

endogenous variable on the path in the model. A fairly liberal alpha

level of .10 was chosen for variable inclusion in the path analysis to

guard against "over-trimming" of the model in this early stage of theory

building.

Reduced Model and Path Analysis

Contributions to Situational Stress

Table 4-6 contains the estimates of the direct effects of the

exogenous personal variables, and organizational exogenous variables on

the situation conducive to stress. An NE in the Direct Effects column of

Table 4-6 indicates that the path coefficient was not significantly

greater than .00 in the full-model analyses. An NE in the Indirect

Effects column indicates that the effect could not be estimated because

(a) one of the coefficients along the path had not been significantly

greater than .00 in the full model, and thus the path was omitted in the

reduced model, or (b) there was no indirect path between the particular

independent and dependent variable in the full model show in Figure 1-2.

As evidenced in Table 4-6, family demands had the strongest effect (.637)

on situation conducive to stress; skill variety had the weakest effect

(.062) on situation conducive to stress. This set of variables in the

reduced model explained 70% of variance of the situation conducive to

stress, as compared to 72% of variance that had been explained in the

full model.









Table 4-6

Magnitudes of Direct and Indirect Effects on Situation
Conducive to Stress, Level of Perceived Job Stress,
General Job Satisfaction and Burnout


Effect



Variables Direct Indirect Total


Family demands

Health difficult

Psychological hai

Skill variety

Job security


Degree situation


to stress

Time

Family demands

Health difficulties

Psychological hardiness

Workload

Skill variety

Supervision

Pay

Job security


On Degree Situation Conducive to Stress

.637 NE

.es .201 NE

rdiness -.091 NE

.062 NE

-.095 NE

On Level of Perceived Job Stress

conducive .370 NE


-.034

.332

.127

NE

.042

NE

-.183

-.073

-.095


NE

.236

.074

-.034

NE

.023

NE

NE

-.035


.637

.201

-.091

.062

-.095



.370


-.034

.568

.201

-.034

.042

.023

-.183

-.073

-.130









Table 4-6--continued


Effect




Variables Direct Indirect Total


On

Degree situation conducive
to stress

Level of perceived
job stress

Family demands

Job expectations

Meaningfulness for work

Knowledge of work
results

Health difficulties

Psychological hardiness

Skill variety

Task identity

Supervision

Dealing with others

Opportunity for
advancement

Pay

Job security


General Job

NE


-.106


NE

-.115

.290

.100


.193

NE

NE

.096

.237

-.216

.196


.170

-.099


On Burnout-Emotional

General job satisfaction -.334

Level of perceived job NE
stress


Satisfaction

-.039


NE


-.060

NE

NE

NE


-.021

.004

-.002

NE

.019

NE

NE


-.008

.014

Exhaustion

NE

.035


-.039


-.106


-.060

-.115

.290

.100


.172

.004

-.002

.096

.256

-.216

.196


.162

-.085



-.334

.035




Full Text
60
low on the JDS subscale of "peer and coworker satisfaction" scored high
on emotional exhaustion and depersonalization, and low on personal
accomplishment
Further evidence of the validity of the JDS has been obtained by
distinguishing its subscales by off diagonal median correlations which
provide an indication of discriminant validity of the items. The range
is from .12 to .28. In addition, distinguishing the JDS job satisfaction
subscale from measures of other psychological constructs including
burnout has been supported. Job satisfaction had a moderate negative
correlation with both emotional exhaustion (-.23) and depersonalization
(-.22), as well as slightly positive correlation with personal
accomplishment (.17).
Finally, a preliminary study has been performed in which factor
analysis was used to determine if the JDS measures a multidimensional
construct. The results of these studies are not enough to eliminate the
conceptualization of a multidimensional construct of job characteristics
measured by the JDS. Additional research is required to determine this
issue. Despite the high intercorrelations among the subscales, Hackman
and Oldham (1978) suggest that separate subscale interpretations are
probably warranted but should be made cautiously.
On the basis of the reliability and validity data available, use of
the JDS as a measure of personal and organizational variables seemed
justified.
Use in this study. The personal variables including job
expectations, and personal work needs and organizational variables,
including expected performance and role ambiguity, work group norms,
dealing with colleagues, supervision, opportunity for advancement, pay,


APPENDIX D
DAILY HASSLES SCALE DIRECTIONS AND SAMPLE ITEMS


38
and Hartman defined as maladaptation, manifested as an observable form of
ineffective coping.
A more logical approach is the expansion of the model offered by
Perlman and Hartman (1982) to a path-analytical model that will allow for
the analysis of direct and indirect effects of personal and
organizational variables simultaneously across stages. There is a need
to attend to a more comprehensive causal model of stress and burnout that
includes personal and organizational variables as well as stages of
stress, job satisfaction, and psychological response in understanding the
etiology of burnout


19
(c) frustration, in which a worker directs personal confidence and value
of the job; and (d) apathy, a defense mechanism against job frustration
necessary for survival. Similarly, Veninger and Spradley (1981)
presented a developmental process that consisted of five stages: (a)
honeymoon, (b) fuel shortage, (c) chronic symptoms, (d) crisis, and (e)
hitting the wall.
Costello and Zalkind (1963) and Daley (1979) posited stages of
burnout specifically for the nursing profession using the framework of
Selye's general adaptation syndrome. The first stage is an alarm stage,
characterized by an emergency mobilization of the bodys defense
maneuvers used to maintain successful performance or to prevent an
internal conflict leading to frustration. The second stage is the
resistance stage, in which there are continued attempts to manage the
stress. If stress management is not achieved, exhaustion occurs. Shubin
(1978) described nurses as high-risk victims for burnout and delineated
the stages as beginning with physical fatigue and emotional drain,
followed by dehumanization of patients and guilt for not caring any
longer, and finally disgust for oneself and others.
Causes of Burnout
Freudenberger (1975), Freudenberger and Richelson (1980), and Pines,
Aronson, and Kafry (1981) have contended that personal variables
including psychological stress are the major precipitating cause of
burnout. Freudenberger (1974) studied ego analysis-and believed that a
committed and over-dedicated personality type was susceptible to burnout.
He and Richelson (1980) also suggested another personality trait that
included a restricted social life with all meaning and gratification


22 23
3.
Family
-0.07025
0.18420
demands
0.2251
0.0014
4.
Job
0.00604
0.01799
expectations
0.9170
0.7563
5.
Meaningfulness
0.62118
0.13692
of work
0.0001
0.0177
6.
Responsibility
0.42258
0.15160
for work
0.0001
0.0085
outcomes
7.
Knowledge
0.49151
0.07963
of work
0.0001
0.1689
results
8.
Commitment
0.34157
0.19244
to career
0.0001
0.0008
9.
Health
-0.00010
0.19242
0.9986
0.0008
10.
Commitment
0.24965
-0.04495
0.0001
0.4380
11.
Control
0.14915
-0.20199
0.0097
0.0004
12.
Challenge
-0.02901
-0.16482
0.6167
0.0042
13.
Hardiness
0.14993
-0.14952
total
0.0093
0.0095
24
0.10283
0.0754
0.00706
0.9030
0.49499
0.0001
0.39189
0.0001
0.39284
0.0001
0.16894
0.0033
0.08028
0.1655
0.20026
0.0005
0.23077
0.0001
0.04208
0.4678
0.18385
0.0014
25
1
0.06616
0.81395
0.2533
0.0001
-0.00288
-0.04134
0.9604
0.4756
0.16275
-0.10069
0.0047
0.0817
0.11925
-0.05379
0.0390
0.3532
0.12898
-0.35257
0.0255
0.0001
0.06890
-0.05534
0.2341
0.3395
0.08997
0.69301
0.1200
0.0001
0.17431
-0.42812
0.0024
0.0001
0.08383
-0.44038
0.1475
0.0001
0.11111
-0.32482
0.0546
0.0001
0.14084
-0.45140
0.0146
0.0001
2
3
0.76131
0.15583
0.0001
0.0068
-0.09135
-0.04884
0.1143
0.3992
-0.20731
-0.27614
0.0003
0.0001
-0.14046
-0.13571
0.0149
0.0187
-0.41107
-0.26021
0.0001
0.0001
-0.12110
-0.38037
0.0360
0.0001
0.66394
0.19172
0.0001
0.0008
-0.39456
-0.17995
0.0001
0.0018
-0.42526
-0.08835
0.0001
0.1268
-0.25455
-0.12991
0.0001
0.0244
-0.40838
1
o

0.0001
0.0087
151


106
mobility increasingly difficult for the staff nurse. "Burned out" staff
nurses, particularly those with 4-5 years of good experience in critical
care, may find few, if any, opportunities to rise in their profession.
Thus, they may feel "stuck in their job and resentful about having to
remain in their present job. Their sense of frustration may grow, and
feelings of burnout increase.
Maslach and Jackson (1981) analyzed separately the three components
of burnout among helping professionals including nurses with the Job
Diagnostic Survey. Although significant relationships were found between
feedback from the job itself and burnout-emotional exhaustion, feedback
from supervisors or from coworkers and burnout-emotional exhaustion,
skill variety and burnout-emotional exhaustion; and satisfaction with
opportunities for advancement and burnout-emotional exhaustion, the
findings reported by Maslach and Jackson (1981) were not replicated in
this present study among critical care nurses.
Causes of Job Dissatisfaction
The findings from this study indicate that job stress, as well as
job expectations, experienced meaninglessness of work, health
difficulties, degree of task identity, dissatisfaction with nursing
supervision, dealing with others on the job, dissatisfaction with
opportunities for advancement, dissatisfaction with pay, and satisfaction
with job security have direct effects on job dissatisfaction. A major
conclusion from these study findings is that job satisfaction of critical
care nurses is a function of personal and organizational variables and
job stress. This conclusion is strengthened by the fact that earlier
research supports these findings (French, Rodgers, & Cobb, 1974; Nord,
1977; Vachon, 1987)


BIOGRAPHICAL SKETCH
Joyce Kolbek Stechmiller was born in Passaic, New Jersey, on
September 5, 1947. She graduated from Clara Maass School of Nursing in
May, 1968, with a diploma in nursing. After graduation, she began work
as a staff nurse in the Recovery Room and Surgical Intensive Care Unit of
Johns Hopkins Hospital, Baltimore, Maryland, and entered the
baccalaureate nursing program at the University of Maryland in Baltimore.
In May, 1972, she graduated with a baccalaureate degree in nursing. From
1972 to 1975, she served as nurse researcher at the Johns Hopkins
Hospital. During that time she also completed a master's degree in
medical-surgical clinical specialist nursing from the University of
Maryland.
In 1975, she began employment at Boston City Hospital and Boston
State College as a cardiovascular clinical nurse specialist and
instructor of baccalaureate nursing students. In 1977, she moved to
Gainesville, Florida, and joined the nursing faculty at the University of
Florida. Over the past thirteen years she has held several positions as
a nursing instructor. She entered in the doctoral program in the College
of Education at the University of Florida in January, 1985.
177


43
with a mean of 6.86 years and a standard deviation of 5.53 years. Over
45% had 3 years or less of work experience as a staff nurse in critical
care, and 46% had more than 4 years of experience.
Additional demographic information included the duration of
experience as a staff nurse in critical care at the present institution
and the number of hours working per week. The number of years of
experience as a staff nurse in critical care at the present institution
ranged from 1 month to 25 years with a mean of 4.75 years and a standard
deviation of 4.19 years. Over 67% had 5 years or less of work experience
in critical care staff nursing at the present institution and 8% had more
than 10 years of experience at the present institution (see Table 3-3).
The number of hours working per week ranged from 36 hours to 72 hours
with a mean of 38.16 hours and a standard deviation of 7.95 hours. It
was revealed that over 16% had 42 hours or more per week working time
(Table 3-4).
Study Design and Procedures
The design structure for the path analysis methodology was
correlational, involving selection of a number of psychometric
instruments to operationalize each of the variables specified in the
theoretical framework and administration of these instruments to all
subjects in the study. Subjects were asked to complete five
questionnaires, including the demographic sheet, and Work Survey
Instrument, the Daily Hassles Scale, the Job Diagnostic Survey, the
Hardiness Scale, and the Burnout Inventory. Each nurse self-administered
the burnout test battery during an off-work, scheduled, thirty-minute
period. The test battery included a set of standardized instructions for
each of the measures. All subjects were guaranteed anonymity.


In addition, job dissatisfaction is also directly affected by high job
expectations, meaninglessness of work, low knowledge of work results,
health, high task identity, a high frequency of dealing with others on
the job, dissatisfaction with opportunities for advancement, pay,
supervision, and satisfaction with job security. Together these account
for 62 percent of the variance in general job dissatisfaction. This
situation will then lead to burnout-emotional exhaustion. Burnout-
emotional exhaustion is directly affected by job dissatisfaction, as well
as low commitment to the career, health difficulties, low psychological
hardiness, high workload, a high degree of dealing with others on the
job, and dissatisfaction with job security; however, only 38 percent of
the variance in burnout-emotional exhaustion was explained by these
variables.
The study results provide a better understanding of the factors
relevant to the development of burnout. This research indicates that
there is a causal progression of situational stress, job stress, job
dissatisfaction resulting in burnout.
xi


22
Harrison (1983), Farber (1983), and Heifetz and Bersoni (1983)
conceptualized burnout as a process resulting when helping professionals
do not receive positive and/or accurate feedback from their work
environment regarding their performance efforts. Harrison (1983) viewed
burnout as inversely related to the helping professionals' perceptions of
competence. The likelihood of the helping professional feeling good
about his/her work performance may be affected by lack of institutional
support, excessive workload, and inadequate professional skills.
Furthermore, he stated that if success is rarely experienced by the
helping professional and if failure is usually experienced as a result of
his or her job performance, burnout is likely. Farber (1983)
conceptualized work related stresses and burnout as due to feelings of
"inconsequentiality" by the helping professional. Like learned
helplessness, Farber hypothesized that burnout results when helping
professionals perceive that their efforts do not matter, and, as a
result, their efforts cease. The concept of cybernetics was used by
Heifetz and Bersoni (1983) in their model to describe the phenomenon of
burnout. The helping professional's perception of growth in themselves
and their recipients of care is strongest when goals are realized. In
order to be successful in realizing goals, requirements in the cybernetic
process must be identified: identification of the task, clearly defined
goals, short-term progress reports, and plans for modification of one's
goals. According to Heifetz and Bersoni (1983), burnout occurs when
one's pursuit of goals is interrupted because there is an absence of one
or more of the requirements in the cybernetic process.
Some authors have attempted to describe the burnout syndrome using a
job deficit model which proposes that burnout is due to the absence of


22
23
14.
Work load
0.02965
-0.05337
0.6090
0.3569
15.
Expected performance
0.53004
0.25969
and role ambiguity
0.0001
0.0001
16.
Skill variety
0.47944
-0.05032
0.0001
0.3851
17.
Task identity
0.33051
0.09381
0.0001
0.1049
18.
Task significance
0.28231
-0.00832
0.0001
0.8859
19.
Autonomy
0.31435
0.04237
0.0001
0.4647
20.
Supervision
0.57896
0.22139
0.0001
0.0001
21.
Dealing with others
0.16522
-0.27601
0.0041
0.0001
22.
Opportunity for
1.00000
0.38627
advancement
0.0
0.0001
23.
Pay
0.38627
1 .00000
0.0001
0.0
24
25
1
2
3
0.01727
0.02996
0.03375
0.08432
0.08921
0.7657
0.6053
0.5604
0.1451
0.1231
0.42608
0.21757
-0.12381
-0.22682
-0.17307
0.0001
0.0001
0.0321
0.0001
0.0026
0.37565
0.01248
-0.05410
-0.17543
-0.05484
0.0001
0.8295
0.3504
0.0023
0.3438
0.25229
-0.00899
-0.14440
-0.17573
-0.17137
0.0001
0.8768
0.0123
0.0023
0.0029
0.24434
0.11940
-0.02476
-0.04053
0.03275
0.0001
0.0388
0.6693
0.4843
0.5721
0.21759
0.24168
-0.14673
-0.21225
-0.04334
0.0001
0.0001
0.0001
0.0002
0.4543
0.55193
0.26150
-0.22595
-0.34672
-0.26352
0.0001
0.0001
0.0001
0.0001
0.0001
0.22115
-0.00462
-0.27039
-0.31755
0.12158
0.0001
0.9365
0.0001
0.0001
0.0353
0.66214
0.31387
-0.11658
-0.23151
-0.32576
0.0001
0.0001
0.0436
0.0001
0.0001
0.12324
0.35290
0.10762
0.12311
-0.21749
0.0329
0.0001
0.0627
0.0330
0.0001
152


110
38 percent of the total variance is explained by the personal and
organizational variables and situation conducive to stress and job
satisfaction for burnout-emotional exhaustion. It appears that the model
employed fits the concept of job satisfaction better than it fits the
concept of burnout-emotional exhaustion. By implication then, although
some of the personal and organizational variables are predictive of job
dissatisfaction and burnout-emotional exhaustion, some significant
variables related to burnout-emotional exhaustion appear to have been
omitted from the model. Determination of the missing variables linked to
burnout-emotional exhaustion is necessary for future empirical research.
Comparison of Job Dissatisfaction and Burnout
Earlier research by Jayaratne and Chess (1983) on job satisfaction
and burnout in social work suggests that these two concepts are discrete
entities. The variables, challenge of the job, promotional opportunity,
and financial rewards, were found to be the best predictors of job
satisfaction and promotions was the only predictor of burnout-emotional
exhaustion according to their study results. In other words, only
promotional opportunity was a common predictor of job satisfaction and
burnout-emotional exhaustion. In addition, workload, which has been
related to burnout in prior literature, did not appear to be an important
predictor of burnout and job satisfaction for their sample of social
workers. Although earlier research (Jayaratne & Chess, 1983) supported
the individuality of the concepts job satisfaction and burnout, the
findings from this research are not as straightforward in defining two
distinct concepts. This study suggests that health difficulties, dealing


Table 3-4
Work Hours Per Week (N = 300)
Number of hours
Number Percent
40 hours
249
83.0
41 42
hours
3
1.0
43 44
hours
5
1.7
45 48
hours
28
9.4
49 50
hours
8
2.6
51 60
hours
5
1.6
61-70
hours
2
.7
Total
300
100.0


21
Maslach, 1988), and organizational components of leadership,
communication, supervision and responsibility. Leiter and Maslach (1988)
and Gains and Jermier (1983) indicated that dealing with co-workers
was identified as the strongest source of job stress and burnout.
Burnout has also been linked to social and physical isolation in the work
setting (Larson, Gilbertson, & Powell, 1978). Maslach and her colleagues
(Maslach & Jackson, 1981a; Maslach & Pines, 1977) indicated that the
basis of burnout is interpersonal contact that includes intense
commitment and personal care when helping others, especially those with
severe problems.
Conceptual Models of Burnout
Our understanding of the burnout syndrome has grown over the last
15 years. No longer are conceptual models restricted to intrapsychic
factors. There is considerable acceptance that burnout is not a simple,
unidimensional syndrome with easily identified causes. Rather, it is
considered a complex problem, generic to intrapsychic, interpersonal,
social, occupational, and organizational components.
Fischer (1983) posited a psychoanalytic model of burnout in which
workers are driven to maintain a high self-esteem by working even harder
despite unrealistic expectations. These workers "idealize their work"
and relate to a "compensatory illusion of grandiosity." He also stated
that workers who are exhausted may be inappropriately identified as
burned out and use the label of burnout as an "excuse for poor
performance and as a justification for both easier working conditions and
higher pay (p. 41). Fischer added to the knowledge of the function of
the intrapsychic factors of burnout and focused on the importance of
self-esteem as a mediator variable in the burnout process.


APPENDIX E
JOB DIAGNOSTIC SURVEY DIRECTIONS AND SAMPLE ITEMS


46
Instrumentation
A demographic questionnaire and work survey devised by the
researcher and four widely used standardized instruments including The
Daily Hassles Scale, Job Diagnostic Survey (JDS), Psychological Hardiness
Test, and Maslach Burnout Instrument were used in this study in order to
assess individual critical care nurses' perceptions of personal and
organizational variables in the work environment, levels of stress
including a situation conducive to stress, perceived job stress, and
burnout and outcomes of the stress response including job satisfaction
and internal job motivation.
Demographic Questionnaire
Description. A six-item questionnaire was constructed in order to
assess personal characteristics of the critical care nurses. The
personal characteristics assessed were age, sex, marital status,
education, duration as a staff nurse in critical care, duration as a
staff nurses in critical care at the present institution, and the number
of working hours per week in critical care nursing. Appendix C contains
this instrument.
Use in this study. The personal variables, ability and time
(tenure), were measured with items from the demographic questionnaire
(Appendix C). The measurement of ability consisted of the sum of the
duration of time as a staff nurse in critical care in months and the sum
of the duration of formal education in nursing months. The measurement
of tenure consisted of the numerical value of duration in months as a
staff nurse in critical care and the duration in months as a staff nurse
at their present institution. The means and standard deviation for the
sample used in the present study are presented in Table 3-5.


Table K-4continued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
.2759
5.065
.0001*
Opportunity for advancement
.0243
.313
.7545
Pay
-.101
-.194
.8465
Support from peers at work
.1819
3.041
.0026*
Job security
-.0758
-1.542
.1243
Stress variables
Job stress
-.0068
-.086
.9314
Degree situation conducive to stress
.2509
3.058
.0024*
R2 = .5419 (F = 13.552
P
0001)


August 7, 1989
Dear Critical Care Nurse:
Your assistance with a research study would be greatly appreciated.
Your institution has been chosen as an important and significant provider
of Critical Care Nursing in the State of Florida. I am conducting a
study on career stress as it affects critical care nurses. Please
complete the attached questionnaires which examine some of the components
and symptoms of job stress. Do not leave any parts unanswered but rather
answer all the questions in the best possible way that you see fit. Be
assured, of course, that all responses will remain completely anonymous,
and no individual or institution will be identified in the report. I am
undertaking the study as part of my doctoral program at the University of
Florida.
I will share a summary of the findings with all Nursing Departments
that participate. Since the issue has so much professional importance, I
sincerely hope that you will be able to assist in the study. You will
agree, I am sure, that the issue is an important one and I would be happy
to share a summary of the total study with you.
No harm is incurred from participation in the study. Participants
may withdraw at any time.
Thank-you.
Joyce Stechmiller, R.N., CCRN, MSN
Project Director,
Adult Critical Care Nursing
I consent to complete the questionnaire battery.
120


117
correlations among large sets of variables or tested a single regression
model for predicting job burnout or job satisfaction.
Conclusions
In conclusion, this study has provided an exploratory analysis of
the progression of stress within the individual and within the work
setting to job dissatisfaction and burnout-emotional exhaustion. As
such, it provides an important first step in developing a comprehensive
causal model of burnout. First, these study results have clarified
relationships among personal variables, including commitment to the
career, health difficulties and a psychological hardiness; organizational
variables including workload, the degree of dealing with others at work
and the degree of satisfaction with job security; and burnout-emotional
exhaustion. Second, they have provided a framework for explaining the
variance of personal and organization-work variables among critical care
nurses in relation to the the degree that a situation is conducive to
stress, perceived job stress, job satisfaction, and burnout-emotional
exhaustion. Third, these results provide a perspective on the
relationship between burnout-emotional exhaustion and job satisfaction
in regard to the direct effects of personal and organizational variables.
Finally, the study results provide insight needed for a more precise
delineation of what is pertinent to the development of burnout-emotional
exhaustion. This research indicates that there is a progression of
burnout that includes situational stress, job stress, job
dissatisfaction, and burnout-emotional exhaustion. The research reported
here furthers this process, and provides important direction for future


114
difficulties, as well as by organizational variables, such as
supervision, pay and job security are perceived as stressful aspects of
the job among critical care nurses studied. Information about personal
stressors and organizational characteristics is necessary to understand
the critical care staff nurse's reaction to the job. The fact that the
pattern of personal stressors and organizational characteristics were
somewhat similar for job stress and job satisfaction suggests that the
process that links job stress to job satisfaction may be a fundamental
process. However, it is also interesting to identify that the pattern of
personal and organizational variables were somewhat dissimilar for job
stress and burnout-emotional exhaustion. Further study is indicated to
explore the relationship between these two concepts.
Limitations and Recommendations
This research provides an initial test of a comprehensive model for
explaning the contributions of personal and organizational variables to
burnout-emotional exhaustion among critical care nurses. The results of
this study suggest a good fit of personal and organization variables to
the burnout model among critical care nurses. Nevertheless, it cannot be
concluded that the model reflects the true causal process. It is
recommended that this model be considered as formative or exploratory
rather than definitive for six reasons:
First, the study focused only on critical care nurses. Further
research will be necessary on other organizational and cultural settings
and among other helping professional employees before these findings can
be generalized to greater numbers of helping professionals. Second, a


20
achieved from the job. Edelwich and Brodsky (1980) discovered an
association of burnout with the young, enthusiastic, overcommitted
helping professionals. Other specific psychological factors associated
with burnout in the care provider include competence, intolerance in
confronting obstacles, lack of self-confidence, nonassertiveness in
dealing with people (Gann, 1979), lack of psychological hardiness (Keane,
Ducrete, & Adler, 1985; McCranie, Lambert, & Lambert, 1987), life events
(Chiriboga & Bailey, 1986), ineffective coping skills, and inadequate
social support (Chiriboga & Bailey, 1986; Cronin-Stubbs & Rooks, 1985;
Numerof & Abrams, 1984).
Evidence to date suggests that not all individuals are equally at
risk to develop burnout (Cherniss, 1980a-b). Cherniss stated that
organizational factors that include availability of resources and power
of the helping professional to apply them, autonomy, the stimulation and
challenge of the job, the rewards at work, and the degree of structural
support all share in the occurrence of burnout. Role conflict, role
overload, lower socioeconomic status, and job dissatisfaction (Oldham,
Hackman, & Pearce, 1976) also appear to promote burnout (Kahn, 1978).
Burnout has also been related with a greater number of hours spent in
direct patient contact (Lewiston, Conley, & Blessey-Moore, 1981; Maslach
& Jackson, 1982), more difficult client problems (Meadow, 1981; Pines &
Maslach, 1978), caseload (Berkeley Planning Associates, 1977;
Freudenberger & Richelson, 1980; Larson, Gilbertson, & Powell, 1978;
Maslach & Jackson, 1984a-b; Maslach & Pines, 1977; Perlman & Hartman,
1982; Solomon, 1979), a low degree of peer support (Burk et al., 1984;
Jackson, Schwab, & Schuler, 1986; Leiter & Maslach, 1986; Maslach &
Jackson, 1982), a low degree of commitment to the organization (Leiter &


87
with burnout made parsimonious and interpretable statements of
relationship difficult. To proceed with this exploratory analysis it
seemed desirable to reduce the total number of variables by eliminating
those variables that were not significantly related to the next
endogenous variable on the path in the model. A fairly liberal alpha
level of .10 was chosen for variable inclusion in the path analysis to
guard against "over-trimming" of the model in this early stage of theory
building.
Reduced Model and Path Analysis
Contributions to Situational Stress
Table 4-6 contains the estimates of the direct effects of the
exogenous personal variables, and organizational exogenous variables on
the situation conducive to stress. An NE in the Direct Effects column of
Table 4-6 indicates that the path coefficient was not significantly
greater than .00 in the full-model analyses. An NE in the Indirect
Effects column indicates that the effect could not be estimated because
(a) one of the coefficients along the path had not been significantly
greater than .00 in the full model, and thus the path was omitted in the
reduced model, or (b) there was no indirect path between the particular
independent and dependent variable in the full model show in Figure 1-2.
As evidenced in Table 4-6, family demands had the strongest effect (.637)
on situation conducive to stress; skill variety had the weakest effect
(.062) on situation conducive to stress. This set of variables in the
reduced model explained 70% of variance of the situation conducive to
stress, as compared to 72% of variance that had been explained in the
full model


118
study of how personal and organization variables, stressors and job
dissatisfaction contribute to burnout-emotional exhaustion in the helping
professions


88
Table 4-6
Magnitudes of Direct and Indirect Effects on Situation
Conducive to Stress, Level of Perceived Job Stress,
General Job Satisfaction and Burnout
Effect
Variables
Direct Indirect Total
On Degree Situation Conducive to Stress
Family demands
.637
NE
.637
Health difficulties
.201
NE
.201
Psychological hardiness
-.091
NE
-.091
Skill variety
.062
NE
.062
Job security
-.095
NE
-.095
On Level
of Perceived
Job Stress
Degree situation conducive
to stress
.370
NE
.370
Time
-.034
NE
-.034
Family demands
.332
.236
.568
Health difficulties
.127
.074
.201
Psychological hardiness
NE
-.034
-.034
Workload
.042
NE
.042
Skill variety
NE
.023
.023
Supervision
-.183
NE
-.183
Pay
-.073
NE
-.073
Job security
-.095
-.035
-.130


HOMAN SERVICES SURVEY
How Often:
0
1
2
3
4
5
6
Never
A few times
a year or
less
Once a
month
or less
A few
times a
month
Once
a week
A few
times
a week
Every
day
How Often (0-6) Statements
! I feel emotionally drained from my work.
2. I feel used up at the end of the workday.
3. I feel fatigued when I get up in the morning
and have to face another day on the job.
4. I can easily understand how my recipients
feel about things.
138


Figure 1-2
Full Model of
Burnout


101
of burnout and job satisfaction has been reported in previous studies of
helping professionals (Hackman & Oldham, 1978; Jayaratne & Chess, 1983)
including nurses (Paredes, 1982; Stone et al., 1984) this finding
replicated for critical care nurses, is consistent with previous
empirical results. For example, a study conducted by Paredes (1982) has
shown that job dissatisfaction accounted for the largest proportion of
variance in burnout for nurses. In addition, based on findings by
Hackman and Oldham (1974) scores on the Job Diagnostic Survey on job
satisfaction were negatively correlated with burnout-emotional
exhaustion for helping professions. The implication drawn from the
findings of this study is that burnout-emotional exhaustion is caused by
a growing dissatisfaction with the job among critical care nurses. In
other words, burnout-emotional exhaustion is an outcome of job
dissatisfaction.
Still another major finding in the present study is that personal
variables (i.e., psychological hardiness, health difficulties, and
organizational commitment) and organizational variables (i.e., dealing
with others at work, workload, and dissatisfaction with job security)
have important direct relationships to burnout-emotional exhaustion.
Kobasa et al. (1979, 1982) defined a hardy individual as one who has
control over situations, seeks a challenge and remains fully committed to
the situation. Kobasa et al. (1982) found that personality-based
hardiness functions prospectively as a resistance resource in decreasing
stressful life events. Persons low in hardiness find themselves and the
environment meaningless and threatening. They are frightened by change,
have little tolerance of ambiguity and see themselves as incapable.
Keane et al. (1985) and McCranie et al. (1987) explored the relationship
of psychological hardiness, demographics, and burnout among nurses using


24
a second element that helps shape the stress context. Specific stressful
work situations and chronic strain are seen as a third level of
predictor. Social support and coping strategies in turn are seen as
additional predictors that may act as mediators between the stress
context and stress response. Finally, burnout is viewed as the stress
response. An outcome of a maladaptive stress response is low
productivity; other sequelae include absenteeism, job dissatisfaction,
and excessive job turnover. Although exploratory testing of the stress
model of burnout has been accomplished, further comprehensive analysis is
needed with larger samples.
Burnout of Nurses
Consistent with recent findings in other professions (Chiriboga &
Bailey, 1986; Jenkins & Ostchega, 1986; Stone, Jebsen, Walk and Belsham,
1984), nurses who experienced more frequent work-related stress reported
greater burnout. Critical care nursing is one profession where the
burnout phenomenon has been acknowledged because a high rate of patient
mortality, severely ill patients who are emotionally consuming,
inadequate staffing and resources, and a difficult work load are
encountered. According to the literature, critical care nurses are at
risk for burnout when the patient presents with clinical problems in
which the complexity and acuity are beyond the resources of the nurse
(Bailey, Steffan, & Grout, 1980; Bartz & Maloney, 1986; Chiriboga &
Bailey, 1986; Claus & Bailey, 1980; Gray-Toft & Anderson, 1981a-b;
Hinshaw & Atwood, 1984; Kelly & Cross, 1985; Maloney, 1982; McCranie,
Lambert, & Lambert, 1987; Numerof & Abrams, 1984; Stone, Jebsen, Walk, &
Belsham, 1984; Vachon, 1987). In one study, commissioned by the American
Association of Critical-Care Nurses, a national panel of experts


4
5
24.
Support from peers
-0.26452
0.23659
from work
0.0001
0.0001
25.
Job security
-0.02339
0.14211
0.6866
0.0137
1.
Degree situation conducive
0.21501
-0.10521
to stress
0.0002
0.0688
2.
Level of perceived
0.25697
-0.11292
job stress
0.0001
0.0507
3.
Emotional exhaustion
0.60744
-0.29516
0.0001
0.0001
4.
Depersonalization
1.00000
-0.35664
0.0
0.0001
5.
Personal accomplishment
-0.35664
1.00000
0.0001
0.0
6.
Job satisfaction
-0.29000
0.16063
0.0001
0.0053
7.
Internal job
-0.18169
0.17793
motivation
0.0016
0.0020
6
7
0.42478
0.44875
0.0001
0.0001
0.17348
0.03122
0.0026
0.5902
0.01077
-0.13188
0.8526
0.0223
0.11343
-0.26063
0.0497
0.0001
0.42493
-0.04243
0.0001
0.4641
0.29000
-0.18169
0.0001
0.0016
0.16063
0.17793
0.0053
0.0020
1.00000
0.14002
0.0
0.0152
0.14002
1.00000
0.0152
0.0
156


85
Multiple regression analysis yielded an of 41, (F = 7.394;
df = 26, 273; p = .0001), indicating that 41% of the variance in
burnout-emotional exhaustion was explained by the variables in the
regression model. Regression results in Table 4-5 show the personal
variables that were significant predictors of burnout-emotional
exhaustion. Specifically, these were health difficulties, commitment to
career, and psychological hardiness. The significant organizational work
variables included workload, dealing with others, and job security and
the job stress outcome/variable job satisfaction.
Personal variables that did not relate significantly to burnout-
emotional exhaustion were ability, time, family demands, job
expectations, meaningfulness of work, responsibility for work outcomes,
and knowledge of work results. Organizational variables that did not
relate significantly to burnout-emotional exhaustion were expected role
performance and role ambiguity, skill variety, task identity, task
significance, autonomy, supervision, opportunity for advancement, pay,
and support from peers at work. The job stress outcome variable that did
not relate significantly to burnout-emotional exhaustion was internal job
motivation. The stress variables that did not relate significantly to
burnout-emotional exhaustion were job stress and the degree the situation
was conducive to stress. (See Table K-5 in Appendix K for results of the
multiple regression for all variables.)
In combination, these study questions have provided a test of the
full model of burnout. A major problem in testing the full model was
that the large number of variables found to be significantly associated


65
The JDS and the MBI scores were correlated in research performed by
Pines and Kafry (1978). High scores on the job dimension, feedback from
the job itself, were correlated with low scores on depersonalization and
emotional exhaustion and high scores on personal accomplishment. The
dimension, "dealing with others," relates to the degree to which a job
requires the employee to work closely with people in carrying out the job
activities. High scores on this job dimension were weakly correlated
with emotional exhaustion. Task significance, a third dimension,
assesses the degree to which the job has an impact on the lives of other
people. High scores on this dimension were positively correlated with
personal accomplishment.
Further validation of the MBI has been provided by data that
confirms hypotheses related to experienced burnout and various outcomes
or personal reactions. In a study of nurses, and social service and
mental health workers scores on the JDS measure of "growth satisfaction"
were negatively correlated with depersonalization and emotional
exhaustion and positively correlated with personal accomplishment. Low
scores on the JDS subscale of "experienced meaningfulness of the work"
scored higher on depersonalization and lower on personal accomplishment.
In addition, low scores on the JDS subscale of "knowledge of results"
were correlated with high scores on emotional exhaustion and
depersonalization and with low scores on personal accomplishment.
Support for the hypotheses predicting that burnout would be related
to the desire to leave one's job was supported by Maslach and Jackson
(1979, 1982, 1984a-b). In addition, the impairment of one's
relationships with people in general, both on and off the job was highly
correlated with emotional exhaustion. Low scores on the JDS subscale


JOB BURNOUT AMONG CRITICAL CARE NURSES
By
JOYCE K. STECHMILLER
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA


Table K-2
Multiple Regression of Job Stress on the Variables Within Each Block of
Characteristics and Situation Conducive to Stress
Standard
Block
Variable
coefficient
t-value
p value
Personal
Ability
.1136
1.589
.1133
characteristics
Time
-.1307
-1.824
.0693*
Family demands
.3274
5.339
.0001*
Job expectations
-.0461
-1.402
.1620
Meaningfulness of work
-.0700
-1.534
.1262
Responsibility for work outcomes
-.0280
-.747
.4555
Knowledge of work results
-.0175
-.381
.7033
Health
.1296
2.587
.0102*
Commitment to career
-.0484
-1.402
.1621
Psychological hardiness
.0396
.984
.3262
Organizational work
Workload
.0572
1.733
.0842*
characteristics
Expected role performance and role ambiguity
-.0140
-.322
.7476
Skill variety
-.0162
-.371
.7111
Task identity
.0028
.081
.9352
Task significance
.0526
1.475
.1413
Autonomy
-.0408
-1.111
.2676
Supervision
-.1072
-2.360
.0190*


4 5
3.
Family
0.13154
-0.05722
demands
0.0227
0.3233
4.
Job
-0.06600
0.10051
expectations
0.2545
0.0822
5.
Meaningfulness
-0.23036
0.29973
of work
0.0001
0.0001
6.
Responsibility
-0.20045
0.22412
for work
0.0005
0.0001
outcomes
7.
Knowledge
-0.24799
0.13941
of work
0.0001
0.0157
results
8.
Commitment
-0.40679
0.37453
to career
0.0001
0.0001
9.
Health
0.20693
-0.06283
0.0003
0.2780
10.
Commitment
-0.24562
0.27449
0.0001
0.0001
11.
Control
-0.14992
0.19684
0.0093
0.0006
12.
Challenge
-0.10385
0.12087
0.0725
0.0364
13.
Hardiness
-0.19284
0.22809
total
0.0008
0.0001
6
7
0.09754
0.0917
-0.21928
0.0001
0.12487
0.0306
-0.08091
0.1622
0.58331
0.0001
0.44186
0.0001
0.35615
0.0001
0.44901
0.0001
0.39106
0.0001
0.36868
0.0001
0.26396
0.0001
0.24874
0.0001
0.16092
0.0052
-0.21551
0.0002
0.04748
0.4125
0.33436
0.0001
0.02519
0.6639
0.32512
0.0001
0.17020
0.0031
0.11933
0.0389
0.04652
0.4220
0.30067
0.0001
Ln
4>


LIST OF TABLES
Table Page
1-1 Variables Found to be Significantly
Related to Burnout 6
3-1 Characteristics of Critical Care Staff Nurses:
Sex, Age, and Education (N = 300) 41
3-2 Duration as Staff Nurse in Critical
Care (N~= 300) 42
3-3 Years of Experience as a Critical Care Staff
Nurse at the Present Institution 44
3-4 Work Hours Per Week (N = 300) 45
3-5 Psychometric Properties of Variables: Ability
and Time 47
3-6 Psychometric Properties of Variables: Daily
Hassles Scale 51
3-7 Job Diagnostic Survey Subscales, Related
Variables and Sample Items ............... 53
3-8 Psychometric Properties of Variables: Job
Diagnostic Survey 57
3-9 Psychometric Properties of Variables: Commitment
and Workload ....... ......... 68
3-10 Instrumentation: Personal, Organizational
Variables, Situation Conducive to Stress,
Job Stress, Burnout, Job Satisfaction, and
Internal Work Motivation 69
4-1 Multiple Regression of Degree Situation
Conducive to Stress on the Variables Within
Each Block of Characteristics 78
4-2 Multiple Regression of Job Stress on the
Variables Within Each Block of
Characteristics and Situation Conducive
to Stress 80
4-3 Multiple Regression of Job Satisfaction on the
Variables Within Each Block of Characteristics,
Job Stress and Situation Conducive to Stress ...... 82
vii


Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
JOB BURNOUT AMONG CRITICAL CARE NURSES
By
Joyce K. Stechmiller
December, 1990
Chairperson: Hannelore Wass
Major Department: Foundations of Education
This study was designed to test a path-analytical model of the
theoretical conceptualization of burnout for critical care nurses. Three
hundred critical care nurses in Florida were administered a demographic
questionnaire and Work Survey Instrument, Daily Hassles Instrument,
Psychological Hardiness Test, Job Diagnostic Inventory, and the Maslach
Burnout Inventory. Personal, organizational, situational stress, job
stress, job satisfaction, and burnout variables were examined.
Family demands, health difficulties and a low psychological
hardiness and a high degree of skill variety and a dissatisfaction with
job security are linked to situational stress, contributing 70 percent of
explained variance. This situational stress is causally linked to
perceived job stress along with the direct effects of family demands,
health difficulties, dissatisfaction with nursing supervision, pay, and
job security. These variables account for 71 percent of explained
variance in job stress. Job stress directly affects job satisfaction.
x


59
Validity Convergent validity was demonstrated by Hackman and
Oldham (1978). Assessments of the specified jobs on the job dimensions
were made by the employers who worked on those jobs as well as by the
supervisors and the researchers. The ratings of each group were averaged
for each job, and then correlations were computed. The median of the
correlations between employees and supervisors is .51; between employers
and observers is .63; and between supervisors and observers is .46. In
general, the ratings of the three groups converge moderately well.
The validity of the JDS has been demonstrated further by data that
confirm hypotheses about the relationship of certain job characteristics
and experienced burnout. Hackman and Oldham (1974) found scores on the
JDS and the Maslach Burnout Inventory (MBI) were closely correlated. In
particular, high scores on the job dimension "feedback from the job
itself" were associated with low scores on emotional exhaustion and
depersonalization, and were high scores on personal accomplishment of the
burnout inventory (Maslach & Jackson, 1986). Another job dimension,
"dealing with others," was found to be weakly correlated with emotional
exhaustion. A third job dimension, "task significance," was highly
positively correlated with personal accomplishment.
Additional validation of the JDS is provided by data that confirm
hypothetical relationships between the JDS measure of "growth
satisfaction" and burnout. Scores on the JDS measure on "growth
satisfaction" were negatively correlated with emotional exhaustion and
depersonalization and positively correlated with personal accomplishment.
In addition, employees scoring low on the JDS subscale of "experienced
meaningfulness of the work" scored higher on depersonalization and lower
on personal accomplishment. With respect to coworkers, employees scoring


97
situation conducive to stress. The second page of Figure 4-2 (pg. 94)
shows paths to the endogenous variable level of perceived job stress.
The third page of Figure 4-1 (pg. 95) shows paths to the endogenous
variable general job satisfaction. The last page of Figure 4-1 (pg. 96)
shows paths to the endogenous variable burnout-emotional exhaustion. No
indirect paths with effects less than .05 have been included in this
diagram, as suggested by Land (1969). The correlation between exogenous
variables is conventionally illustrated by a curve line with arrow heads
at both ends indicating that a relationship between exogenous variables
were not analyzed in the model. For the purpose of clarity,
correlational arrows have not been drawn in Figure 4-1 due to the large
number of exogenous variables included in the model. The correlations
between the exogenous variables included in the model are shown in
Table 4-7


CHAPTER V
DISCUSSION, INTERPRETATIONS, CONCLUSIONS AND RECOMMENDATIONS
Overview
This study was designed to collect data and to test a
path-analytical model of the theoretical conceptualization of burnout for
critical care nurses. The model of interest tested was an expansion of
the model offered by Perlman and Hartman (1982). The sample consisted of
300 female, critical care staff nurses who had worked for at least three
months in a medical, surgical or cardiac intensive care unit at a
tertiary, regional or community hospital in Northeastern, Northwestern,
Northcentral, and Southern regions of the State of Florida. The analysis
included estimation of magnitudes of direct and indirect effects of
exogenous and endogenous variables using path analysis. The overall
conclusion derived from the analyses was that a modified model of
burnout, containing most of the major elements posited by Perlman and
Hartman provided a good fit to the data obtained from this sample.
Specifically, the path analysis of burnout indicated that family J
demands, health difficulties, psychological hardiness, skill variety, and
dissatisfaction with job security are causally linked to a situational
stress variable for nurses in critical care settings. Together these
variables explained 70% of the variance in situational stress. This
situational stress variable is in turn linked to perceived job stress,
which is also directly affected by family demands and health
difficulties, as well as by dissatisfaction with nursing supervision,
99


3
individual worker's subjective perception of stressors as opposed to
conditions that actually exist in the work setting (Golembiewski et al.,
1986; Leiter & Maslach, 1988; Maslach & Jackson, 1986).
Perlman and Hartman (1982) have proposed a transactional model (see
Figure 1-1) of burnout that is of particular interest because of its
breadth and because it includes groups of personal-psychological and
organizational-work variables that have been empirically studied
individually, or in combination, since 1977.
Statement of the Problem
In their model, Perlman and Hartman (1982) represented burnout as a
function of personal characteristics, organizational-work
characteristics, and stages of stress including the degree to which a
situation is conducive to stress, perception of organizational job
stress, and outcomes of the stress such as job satisfaction and
psychological response. Although this conceptualization of burnout
seems to be fairly comprehensive in terms of variables included, there
are limitations with respect to the posited relationship among the
components of the Perlman and Hartman (1982) model. One problem is that
this model is not totally consistent with empirical findings reported in
the literature. For example, according to the literature, job
satisfaction has a direct relationship to pay, dealing with others at
work, opportunity for advancement, and economic market conditions
(Jayaratne & Chess, 1983; Oldham, Hackman, & Pearce, 1976; Paredes,
1982), but from Figure 1-1 it would appear that burnout has a direct
relationship to pay, support from others, and economic market conditions
and that job stress has a relationship with opportunity for advancement.
Also, Perlman and Hartman (1982) seemed to suggest that burnout precedes
job satisfaction, but other formulations of burnout would equate it with
what Perlman and Hartman (1982) defined as coping. Another limitation is


Table K-3
Multiple Regression of Job Satisfaction on the Variables Within Each Block of
Characteristics, Job Stress and Situation Conducive to Stress
Standard
Block
Variable
coefficient
t-value
p value
Personal
Abi lity
-.0059
-.070
.9442
characteristics
Time
.0151
.180
.8575
Family demands
.1332
1.773
.0773*
Job expectations
-.1078
-2.801
.0055*
Meaningfulness of work
.2885
5.398
.0001*
Responsibility for work outcomes
.0420
.960
.3381
Knowledge of work results
.1061
1.978
.0489*
Health
.1598
2.702
.0073*
Commitment to career
.0639
1.582
.1147
Psychological hardiness
-.0394
-.837
.4034
Organizational work
Workload
-.0308
-.794
.4281
characteristics
Expected role performance and role ambiguity
.0179
.353
.7242
Skill variety
-.0334
-.656
.5124
Task identity
.0996
2.449
.0150*
Task significance
-.0207
-.648
.5173
Autonomy
-.0543
-1.266
.2065
Supervision
.2192
4.080
.0001*
162


Table 3-10continued
Variables in this study
Supervision
Opportunity for advancement
Pay
Support from others at work
Organizational climate and economic
market condition (job security)
Degree situation conducive
to stress
Perceived job stress
Burnout:
Instrument
Items
JDS
Section 4 (5, 8, 14)
JDS
Section 4 (3, 6, 10, 13)
JDS
Section 4 (2, 9)
JDS
Section 4 (4, 7, 12)
JDS
Section 4 (1, 11)
Dai ly
Hass!es
Scale
5, 6, 24-26, 39-42, 44, 46-47,
51-52, 57, 60, 67-69, 85, 88-89,
94-97, 99-101, 109, 113-117
Daily
Hassles
Scale
27-28, 30-34, 65-66, 72, 80-84,
86, 102
Emotional exhaustion
Maslach Burnout Inventory
4, 5, 7, 9-12, 15, 17-19, 21-22


32
Job Satisfaction
The study of job satisfaction has evolved since the early 1900s.
The earlier work was done by Taylor (1911) who determined that job
satisfaction was associated with the amount of pay earned. This research
began during the industrial revolution when workers were equated to
machinery and efficiency was the expectation (Slavitt, Stamps, Piedmont,
& Haase, 1978).
In the 1930s a humanistic-sociological approach to job satisfaction
emerged. Work satisfaction was established as an oversatisfaction with
life (Hoppock, 1935). A cross-sectional study of industrial workers with
similar abilities, interests and job preparation revealed that an
employee's adaptability to the situation, the employee's socioeconomic
group identification, ability to relate to others, and the nature of the
work were associated with work satisfaction. The psychological basis for
job satisfaction was established by the Hawthorne studies (Mayo, 1945).
These studies found that group interaction was the major determinant of
job satisfaction (Slavitt et al., 1978).
One theory that is widely used today in studying job satisfaction is
the motivation-hygiene theory (Herzberg, 1968). Motivators was the term
Herzberg used to identify job satisfiers because they were effective in
contributing to the individual functioning at a higher level and resulted
in job satisfaction. Examples of motivators include responsibility,
advancement and recognition. Hygiene factors was the term used to
identify lower level needs because if not met, they added to
dissatisfaction but when met did not contribute to satisfaction.


REFERENCES
Antonovsky, A. (1979). Health, stress, and coping. San Franciso:
Jossey-Bass.
Asher, H. B. (1976). Causal modeling. Beverly Hills: Sage.
Bailey, J. T., Steffan, J. M., & Grout, J. W. (1980). The Stress Audit
Identifying the stressors of ICU nursing. Journal of Nursing
Education, 19, 15-25.
Bartz, C., & Maloney, J. P. (1986). Burnout among intensive care
nurses. Research Nursing Health, 9_, 147-153.
Beehr, T. A., & Newman, J. E. (1978). Job stress, employee health and
organizational effectiveness: A facet analysis, model, and literature
review. Personal Psychology, 31, 665-699.
Berkeley Planning Associates. (1977). Evaluation of child abuse and
neglect demonstration project. 1974-1977 (Volume IX). Berkeley, CA:
Author.
Burke, R. J., Shearer, J., & Deszca, G. (1984). Burnout among men and
women in police work: An examination of the Cherniss Model. Journal
of Health and Human Resources Administration, 7_, 162-188.
Cannon, W. B. (1932). Stresses and strains of homeostasis. American
Journal of Medicine, 189, 1-14.
Cherniss, C. (1980a). Professional burnout in human service
organizations. New York: Praeger.
Cherniss, C. (1980b). Staff burnout: Job stress in human services.
Beverly Hills, CA: Sage.
Cherniss, C., & Krantz, J. (1983). The ideological community as an
antidote to burnout in the human services. In B. Farber (Ed.), Stress
and burnout in the human service professions (pp. 142-154). New York:
Pergamon Press.
Chiriboga, D. A., & Bailey, J. (1986). Stress and burnout among
critical care and medical surgical nurses: A comparative study.
Critical Care Quarterly, 9_(3), 84-92.
Claus, R., & Bailey, J. (1980). Living with stress and promoting
well-being. St. Louis: C. V. Mosby.
168


2
Various researchers (Berkeley Planning Association, 1977; Maslach &
Jackson, 1981; Perlman & Hartman, 1982) have conceptualized burnout as a
syndrome of emotional exhaustion that proceeds to depersonalization, and
results in reduced personal accomplishment that may occur with persons
who work with others in some manner. The term "emotional exhaustion"
describes the first stage of burnout, which includes feelings of being
emotionally drained and overextended by one's exposure to other people.
When emotional resources are over-used, one feels unable to give of
oneself to others. The second stage of burnout is depersonalization,
which includes an "unfeeling and callous response toward people, often
the recipient of one's service of care" (Maslach, 1982b, p. 30). This
negative attitude may be manifested in rude, inappropriate, or
insensitive behavior toward clients, as well as withdrawal from them.
Reduced personal accomplishment is the third stage of burnout, which is
characterized as a decline in one's sense of competence and perception of
successful achievement in one's work with people resulting in feelings of
inadequacy, failure, loss of self-esteem, and even depression (Maslach,
1987).
Recently, a number of researchers have posited transactional models
of burnout to aid understanding of its etiology (Cherniss, 1980a;
Chiriboga & Bailey, 1986; Cooper, 1986; Courage & Williams, 1987; Cox &
Mackay, 1981; Fletcher & Payne, 1980; Golembiewski et al., 1986;
Harrison, 1983). According to Handy (1988), the major theme of
transactional models is that stress and burnout result from the
transaction between individual worker needs, personal resources, and the
demands, constraints, limitations, and/or facilitators within the work
environment. Key to this conceptualization is the emphasis on the


APPENDIX H
COMMITMENT TO CAREER


37
variables that are identified in the literature review for this study
that have a meaningful relationship in the process that leads to job
dissatisfaction and burnout. For example, according to the literature,
meaningfulness of work, responsibility for work outcomes and knowledge of
work outcomes have a direct relationship to job satisfaction (Herzberg,
1968; Hinshaw & Atwood, 1984, 1987; Oldham, Hackman, & Pearce, 1976).
Because job dissatisfaction has been linked to burnout, use of these
multiple indicators of personal work needs seems warranted. In addition,
according to the literature, autonomy, skill variety, task significance,
and task identity have a direct relationship to the process of job
satisfaction and job burnout (Cherniss, 1980a-b; Heifitz & Bersoni,
1983). Use of these variables to operationalize work group norms has
theoretical support and is justified.
Another problem is that the model conceptualized by Perlman and
Hartman (1982) has structural limitations of its components. Each
variable affects only the next continguous variable in the model. They
did not allow for the freedom of some variables having direct and
indirect causal relationships to more than one outcome variable. For
example, according to the literature, job satisfaction has a direct
relationship to pay, dealing with others at work, opportunity for
advancement, and economic market conditions (Jayaratne & Chess, 1983;
Oldham, Hackman, Pearce, 1976; Paredes, 1988) but from Figure 1-1 it
would appear that burnout has a direct relationship to pay, support from
others, and economic market conditions and that job stress has a
relationship with opportunity for advancement. In addition, Perlman and
Hartman (1982) seemed to suggest that burnout precedes job satisfaction,
but other theoretizations of burnout would equate it with what Perlman


58
Table 3-8continued
Standard
Variable
Number
Mean
deviation
Alpha
Social support at
work.
300
5.639
.766
.673
Job security
satisfaction
300
5.207
1.224
.695
Job satisfaction
300
4.949
1.110
.675
Internal job
300
5.874
.640
.680
motivation


42
Table 3-2
Duration as Staff Nurse in Critical Care (N = 300)
Number of years
Number
Percent
Cumulative %
Duration as staff nurse
in critical care:
3-6 months
60
20
20
7 months 1 year
49
16.3
36.3
13 18 months
11
3.7
40.0
19 months 2 years
2
.7
40.7
2-3 years
15
5.0
45.7
3-4 years
25
8.3
54.0
4-5 years
9
3.0
57.0
5-7 years
34
11.7
68.7
7-10 years
31
10.0
78.7
10 15 years
43
14.3
93.0
15-20 years
14
4.7
97.7
20 25 years
5
1.6
99.3
25 years +
2
.7
100.0
Total
300
100.0
100.0


112
section measuring inner and future concerns of stress and the section
measuring job stress, respectively. Inner and future concerns of stress
are characterized as troubling thoughts about the future, concern about
the meaning of life, trouble relaxing, concerns with inner conflicts,
concerns about getting ahead and concerns about life in general. These
stressors arise in any situation where individuals are confronted with
demands outside the work place that threaten to overwhelm their
capabilities and resources. Job stress is characterized by stressors in
the work environment including difficulty getting along with coworkers,
dislike of work, problems with employees, unchallenging work, job
dissatisfactions, and hassles from the boss or supervisor. These job
stressors happen at the work place and threaten to overwhelm the
employee's capabilities and resources.
Another stressor that also had a major direct effect on job stress
was family demands which was also measured with The Daily Hassles Scale.
Family demand stressors are characterized as household responsibilities,
home financial responsibilities, and stress within the immediate home
environment and the neighborhood.
The personal variable, health difficulties, is another stressor that
had a modest direct effect on job stress. Health difficulties are
characterized by physical manifestations of stress and include difficulty
with sleeping and appetite, and a variety of somatic complaints as was
measured with The Daily Hassles Scale. These results are interesting
because they suggest that job stress is a function of both organizational
stressors and personal variables.


96
Family Demands
Job Expectation
Degree Situation
Conducive to
Stress
Meaningfulness
for Work
Knowledge of
Work Results
Committment to
Career
Health Difficulties
Psychological
Hardiness
Work Load
Skill Variety
Task Identity
Supervision
Dealing with Others
Opportunity for
Advancement
-.276
.178
Level of
-.114
Perceived
Job Stress
General
Job
Satisfaction
R2 ..384
Burnout
Emotional
Exhaustion
.785 e
Figure 4-1continued


ACKNOWLEDGEMENTS
I wish to express my deepest love and appreciation to my husband,
Bruce, and my children, Stephanie and Christopher, for their support,
understanding and constant love. Also to my mother and father and
Kate Stechmiller I extend my thanks for their moral support and
encouragement.
I would also like to thank the faculty of the University of Florida,
with special thanks to Dr. Hannelore Wass, chairman of my supervisory
committee, and supervisory committee members, Drs. Linda Crocker, Robert
Ziller, and Barry Guinagh, who contributed greatly to the completion of
the dissertation. Special appreciation goes to Dr. Hussein Yurandi for
his assistance with the statistical analyses.
My special thanks go to Donna Hall and Dan O'Brien, who were always
there when I needed them, and to my research assistants, without whom
these data could not have been collected. I also wish to express
gratitude to a special group of friends, MTG, INC., and to my students
for their support and encouragement when I needed them.
This research was supported by a Post-Baccalaureate Faculty
Fellowship from the Department of Health and Human Services. I am
grateful to the governmental agency for easing the burden of doctoral
education.
iii


8 9
2.
Time
-0.16250
-0.04861
0.0048
0.4015
3.
Family
-0.02536
0.74082
demands
0.6617
0.0001
4.
Job
0.07881
-0.08136
expectations
0.1734
0.1598
5.
Meaningfulness
0.22048
0.02629
of work
0.0001
0.6501
6 .
Responsibility
0.17508
-0.02759
for work
0.0023
0.6341
outcomes
7.
Knowledge
0.19506
-0.26371
of work
0.0007
0.0001
results
8.
Commitment
1.00000
-0.06209
to career
0.0
0.2838
9.
Health
-0.06209
1.00000
0.2838
0.0
10.
Commitment
0.20192
-0.33921
0.0004
0.0001
11.
Cont rol
0.11436
-0.38642
0.0478
0.0001
12.
Challenge
-0.05578
-0.30706
0.3356
0.0001
10
11
-0.03446
0.00628
0.5522
0.9138
-0.40811
-0.45914
0.0001
0.0001
0.04871
0.06427
0.4006
0.2671
0.23368
0.18148
0.0001
0.0016
0.13445
0.07645
0.0198
0.1861
0.37583
0.38735
0.0001
0.0001
0.20192
0.11436
0.0004
0.0478
0.33921
-0.38642
0.0001
0.0001
1.00000
0.83720
0.0
0.0001
0.83720
1.00000
0.0001
0.0
0.64671
0.54134
0.0001
0.0001
12
13
-0.01391
-0.01657
0.8104
0.7750
-0.31056
-0.44539
0.0001
0.0001
0.07315
0.06874
0.2064
0.2352
0.02813
0.17449
0.6274
0.0024
0.04129
0.09830
0.4762
0.0892
0.18416
0.36287
0.0014
0.0001
-0.05578
0.10812
0.3356
0.0614
-0.30706
-0.388831
0.0001
0.0001
0.64671
0.94504
0.0001
0.0001
0.54134
0.90361
0.0001
0.0001
1.00000
0.80507
0.0
0.0001
14
0.13526
0.0191
0.02611
0.6524
0.05193
0.3701
0.07693
0.1839
0.00234
0.9678
0.12709
0.0277
0.06417
0.2678
0.06135
0.2895
0.12879
0.0257
0.12660
0.0283
0.09576
0.0978
145


48
Daily Hassles Scale
Description. The measurement of psychological stress through the
use of the Hassles Scale theoretically approaches the role of cognitive
appraisal in the stress and coping process (Lazarus & Folkman, 1989). In
this approach, coping depends on how individuals appraise their everyday
encounters with the environment with regard to the extent to which those
encounters are perceived as threatening, harmful, or challenging.
Everyday encounters are called hassles and are measured in the Hassles
Scale. The Hassles Scale consists of 117 items used to measure the
frequency and severity of a person's transactions with the environment
that are considered by the individual to be stressful events; e.g., "How
much of a hassle was this for you ... overloaded with family
responsibilities?" The scale takes approximately 10 minutes to complete.
The response format is a four-point scale, ranging from "none" or not
applicable to "extremely severe." The Daily Hassles Scale yields two
scores: frequency, which is the number of hassles endorsed by the person
without regard to severity and severity, which is the average severity
rating of all items that have been identified. Eight factor-based
subscales scores are also possible. They include future security, time
pressures, work, household responsibilities, health, inner concerns,
financial responsibilities, and neighborhood/environmental.
Psychometric Properties Of Daily Hassles Scale
Reliability. Kanner et al. (1981) reported a test retest
reliability coefficient of .79 on a sample of 432 college students and a
sample of 448 adults aged 20-60. There is no information available on
the internal consistency of the scale.


13
4. Several of the constructs were measured by self-report
questionnaires that included items containing content of a sensitive
nature; some respondents may have reported inaccurately due to their
inability or unwillingness to recognize symptoms in themselves.
5. In this study, only the first stage of burnout (i.e. emotional
exhaustion) was examined.
6. Variables examined were limited to those that could be logically
viewed as representing constructs in Perlman and Hartman's (1982)
conceptual model of burnout.
Assumptions
There are three assumptions upon which the present study is
grounded:
1. Burnout in a biopsycho-social concept related to personal,
psychological, and organizational variables as a result of a stress
response.
2. The strength of relationship between burnout and these
contributing factors can be estimated through application of a linear
model.
3. The independent variables in the model are all those
contributing importantly to burnout.


40
the state of Florida. Administrators of five of the selected hospitals
declined to participate due to the perceived threatening tone of the Job
Diagnostic Survey Questionnaire and the burnout questionnaire. The final
sample consisted of nine hospitals which are licensed for between 250 and
450 beds, and are located in Northeastern, Northwestern, North central,
and Southern regions of Florida. All staff nurses employed in the nine
hospitals who fit the criteria of working on a critical care unit and
having"worked full time for at least three months were invited to
participate in the study. During the months of September-November, 1989,
the burnout test battery was presented to the nurses by the author during
a scheduled staff meeting (Appendix A). Consent for participation was
then procured from the critical care nurse employed in these settings
(Appendix B).
A total of 375 female critical care registered staff nurses were
given a package of materials with a cover letter requesting their
participation. A total of 330 nurses agreed to participate by returning
complete questionnaires (86%). Thirty questionnaires were not fully
completed and were excluded from the data analysis. Three hundred
questionnaires were usable for data analysis.
The demographic characteristics of the critical care staff nurses
(age, marital status, sex, and education) are presented in Table 3-1.
These data revealed that all the critical care nurses in the sample were
female and that 75% of the nurses were between the ages of 20 and 39 with
32% under the age of thirty. The majority of the staff nurses held an
associate degree (50%) in nursing (ADN) and 10% were diploma graduates.
Only 34% were baccalaureate graduates in nursing.
The duration of experience as a staff nurse in critical care is
presented in Table 3-2. The duration ranged from 3 months to 30 years


90
Table 4-6continued
Effect
Variables
Direct
Indirect
Family demands
NE
.099
Job expectations
NE
.038
Meaningfulness of work
NE
-.097
Knowledge of work
results
NE
-.033
Commitment to career
-.276
NE
Health difficulties
.178
-.032
Psychological hardiness
-.114
-.012
Workload
.103
NE
Skill variety
NE
.009
Task identity
NE
.032
Supervision
NE
-.086
Dealing with others
.235
.072
Opportunity for
advancement
NE
-.065
Pay
NE
-.054
Job security
-.088
.017
Total
.099
.038
-.097
-.033
-.276
.146
-.126
.103
.009
.032
-.086
.307
-.065
-.054
-.071


35
between individual worker needs and resources and the demands,
constraints, limitations, and/or facilities within the work environment.
Their model is broad and allows an examination of personal and
organizational-work variables which have been studied individually or in
combination in the burnout literature from 1977 to the present. In this
model personal, as well as organizational-work variables that are
subjectively perceived, are conceptualized.
Using Selye's (1974) definition of stress as "The nonspecific
response of the body to any demand made upon it (p. 41), Perlman and
Hartman (1982) built a theoretical model of psycho-social organizational
mediated adaptation congruent with Selye's initial work. The Perlman and
Hartman (1982) model incorporated three major symptom categories of
stress that are reflected by the three dimensions of burnout:
(a) physiological (focusing on physical symptoms and perceptions of
reduced personal accomplishment); (b) affective cognitive (focusing on
attitudes and feelings and emotional exhaustion); and (c) behavioral
(focusing on symptoms or behavior related to depersonalized care of the
recipient of care). The model, which has a cognitive and perceptual
focus, consists of a linear progression of four stages of stress which
include the degree to which the situation is conducive to stress, the
perception of job stress, response to stress, and outcome of stress.
Groupings of significant personal variables and organizational variables
are related to each stage. In the first stage of stress the degree the
situation is conducive to stress is a function of personal variables of
ability, time, family demands, and job expectations and organizational


Table 4-7
Intercorrelatlons of Exogenous Variables of the Path Analytic Model of Burnout
Among Critical Care Nurses
1 2 3 4 5 6 7
1.
Family demands

-.074
-.057
-.32
-.025
.74
-.45
2.
Job expectations
-.099
.144
.079
-.80
.069
3.
Meaningfulness of work
.495
.22
.026
.174
4.
Knowledge of work results
.195
-.263
.362
5.
Commitment to career
.062
.108
6.
Health
.388
7.
Psychological hardiness
8.
Workload
.026
.051
.077
.127
.064
.061
.133
9.
skill variety
-.107
.087
.451
.367
.227
-.117
.247
10.
Task identity
-.142
.020
.0234
.341
.099
-.099
.060
11.
Supervision
-.150
.027
.378
.480
.187
-.163
.205
12.
Dealing with others
-.340
.010
.167
.336
.057
-.334
.431
13.
Opportunity for advancement
-.070
.006
.621
.491
.342
-.0001
.150
14.
Pay
.184
.018
.136
.080
.192
.192
-.150
15.
Job security
.066
-.003
.163
.129
.069
.090
.141


113
The organizational variables that had a minimal influence on job
stress among critical care nurses include dissatisfaction with
supervision, pay, and job insecurity. These findings are unique to this
study and warrant further investigation.
The present study contributes additional information to the
similarities of job stress and job satisfaction. The evidence suggests
that job stress and job dissatisfaction relate similarly to the same
personal variable health difficulty and organizational variables
including dissatisfaction with supervision and pay. This pattern is
unique to this study and suggests that job stress and job satisfaction
may not be completely distinct concepts but possess some commonality of
causal dimensions.
Although the evidence suggests that job stress and burnout relate
similarly to the health difficulties and dissatisfaction with job
security, family demands, dissatisfaction with supervision, and pay are
the prime determinants in job stress. By contrast, low commitment to
career, low psychological hardiness, and high degree of dealing with
others on the job appear to take the major role in the linkage to
burnout-emotional exhaustion. This suggest that although job stress and
burnout-emotional exhaustion may possess some commonality there are also
distinct causal linkages between personal and organizational variables
and these two concepts among critical care nurses.
The theoretical implication of these study findings is that job
stress is a complex phenomenon. It is affected by personal stressors,
such as family demands, the situation conducive to stress, and health


15
16
3.
Family
-0.09146
-0.10797
demands
0.1139
0.0618
4.
Job
-0.02005
0.08719
expectations
0.7294
0.1319
5.
Meaningfulness
0.40521
0.45108
of work
0.0001
0.0001
6.
Responslbl11ty
0.31916
0.28964
for work
0.0001
0.0001
outcomes
7.
Knowledge
0.51095
0.36740
of work
results
0.0001
0.0001
8.
Commitment
0.22779
0.22688
to career
0.0001
0.0001
9.
Health
-0.06812
-0.11724
0.2395
0.0424
10.
Commitment
0.17439
0.27856
0.0024
0.0001
11.
Control
0.17708
0.24555
0.0021
0.0001
12.
Chailenge
-0.03522
0.11787
0.5434
0.0413
13.
Hardiness
0.12715
0.24712
total
0.0277
0.0001
17
18
19
20
21
0.14232
-0.00814
-0.14242
-0.15037
-0.33998
0.0136
0.8884
0.0135
0.0091
0.0001
0.01999
0.01280
-0.00310
0.02687
0.00958
0.7302
0.8253
0.9574
0.6430
0.8688
0.23370
0.29239
0.23224
0.37790
0.16711
0.0001
0.0001
0.0001
0.0001
0.0037
0.17042
0.26893
0.09614
0.23261
0.17281
0.0031
0.0001
0.0965
0.0001
0.0027
0.34135
0.17996
0.23209
0.47950
0.33611
0.0001
0.0018
0.0001
0.0001
0.0001
0.09863
0.08461
0.13026
0.18700
0.05654
0.0881
0.1437
0.0240
0.0011
0.3290
0.09859
0.02514
-0.07517
-0.16294
-0.33432
0.0883
0.6645
0.1942
0.0047
0.0001
0.08800
0.19829
0.32919
0.23633
0.41848
0.1283
0.0006
0.0001
0.0001
0.0001
0.11603
0.20471
0.31840
0.26897
0.44756
0.0446
0.0004
0.0001
0.0001
0.0001
0.05988
0.06101
0.20498
0.01639
0.26982
0.3013
0.2922
0.0004
0.7775
0.0001
0.06018
0.17953
0.32455
0.20459
0.43176
0.2988
0.0018
0.0001
0.0004
0.0001
148


108
performing on the job. Unique to this study is the finding that a low
level of knowledge of work results had a minimal direct causal linkage to
job dissatisfaction. Further study of this relationship seems
indicated.
The finding that health difficulties have a direct causal
relationship to job satisfaction is unique to this study. It suggests
that health difficulties have a causal link to job satisfaction. This
finding, however, is not surprising because the health difficulties
variable, which is a measure of physical symptoms of stress in this
present study, has consistently provided a direct effect on all the
sequences of stress in this model including the situation conducive to
stress, job stress, and burnout-emotional exhaustion. Health
difficulties is considered as a stressor in the burnout model and
contributes to burnout-emotional exhaustion through its direct and
indirect effects on job satisfaction. It is important to point out that
the variable health difficulties also had direct effects on the other
stages of stress and burnout-emotional exhaustion.
According to the research by Hinshaw and Atwood (1984) and Jayaratne
and Chess (1983), organizational work-related characteristics, including
work task identity, supervision, and pay, were significant factors
relating to job satisfaction. Their findings, in conjunction with the
significance of interpersonal group interactions and ability to relate to
others and its relation to job satisfaction indicated by Slavitt et al.
(1987), support the direct linkages of task identity, supervision, pay
and the degree of dealing with others, to job satisfaction found in the


Table 3-10continued
Variables in this study Instrument Items
Commitment to career
Work Survey
3
Health
Daily Hassles Scale
1
oc
OC'
50,
53-54, 56,
77,
91 98
Psychological hardiness
Hardiness Test
1-50
Organizational variables:
Workload
Work Survey
1, 2
Expected performance and
JDS
Section
1
(6,
7)
role ambiguity
Section
2
(4,
7, 10, 12)
Work group norms:
Skill variety
JDS
Section
1
(4),
Section 2
(1, 5)
Task identity
JDS
Section
1
(3),
Section 2
(3, 11)
Task significance
JDS
Section
1
(5),
Section 2
(8, 14)
Autonomy
JDS
Section
1
(2),
Section 2
(9, 13)
Dealing with colleagues
JDS
Section
1
(1),
Section 2
(2, 6)


62
The hardiness scores is computed by transforming raw subscale scores
into standard scores and adding across the three subjscales to produce a
total score for each subject. Commitment is defined as the ability to
commit to the task or project or relationship. Control is defined as the
realistic knowledge and use of the amount of control or lack of control
that one has in this and other situations. Challenge is defined as the
use of both commitment and control in order to see events, relationships,
problems and opportunities as challenges rather than as trouble.
Psychometric Properties of Psychological Hardiness Test
Reliability. As to reliability, the internal consistency estimates
based on 10,000 subjects over the past four years from all walks of life
and a multitude of circumstances has yielded a coefficient alpha of .92
for total hardiness score a mean of 74.02 and a standard deviation of
9.60. Stability appears to be about .960 over a period of two weeks.
The internal consistency estimate for this sample was .89 with a mean
score of 69.31 and a S.D. of 11.01.
Validity. The validity of the hardiness test has been demonstrated
by data that confirm hypotheses about the relationship of hardiness to
burnout. Keane et al. (1985) reported that nurses who exhibited less
psychological hardiness reported more burnout. In addition, they
reported that perceived job stress and hardiness were significant
additive predictions of burnout. Hardiness appeared to have beneficial
effects on decreasing burnout.
Kobasa et al. (1982) related commitment and coping in stress
resistance among lawyers and identified that increases in strain are
significantly determined by personality characteristics of alienation
(vs. commitment). In another study, Kobasa (1979) reported discriminant
function analysis with the prediction that high stress/low illness
executives show by comparison with high stress/high illness executives,


Table J-l
Descriptive Statistics for Exogenous Variables
Standard
Variable N Mean deviation
Ability
Time (tenure)
Family demands
Job expectations
Meaningfulness of work
Responsibility for work outcomes
Knowledge of work results
Commitment to career
Health difficulties
Hardiness total
Workload
Expected role performance
Skill variety
Task identity
Task significance
Autonomy
Supervision
Dealing with others
Opportunity for advancement
Pay satisfaction
Social support
Job security
300
117.82
68.858
300
139.327
103.192
300
.751
.408
300
4.104
2.446
300
5.752
.844
300
5.751
.653
300
4.999
.946
300
3.537
1.357
300
.501
.396
300
69.310
11.01
300
4.973
.804
300
4.668
.898
300
5.916
.818
300
4.212
1.112
300
6.152
.777
300
5.909
.905
300
4.950
1.27
300
6.116
.787
300
5.459
.893
300
3.903
1.608
300
5.639
.766
300
5.207
1.224
140


34
satisfaction is described as the result of a good person-environment fit
(Vachon, 1987).
There are only two studies to date linking job dissatisfaction and
burnout for nurses. Job dissatisfaction accounted for the largest
variance in burnout in a dissertation study conducted by Parades (1982).
Younger age, low psychological resources, shorter length of time on the
hospital unit and less social support also contributed to the total
variance. In addition, nurses experiencing burnout are found to be
dissatisfied with their jobs because there are limited opportunities for
personal growth on the job (Stone et al., 1984).
Theoretical Framework
The burnout model proposed by the researcher is an adaptation of
the burnout model offered by Perlman and Hartman (1982) which integrates
many theoretical models. It evolved from Selye's (1974) identification
of stimuli and stressors, the definition of stress as the general
adaptation syndrome, as the theory that too much stress may lead to
maladaptation. The model is further grounded in a framework proposed by
House and Wells (1978), Beehr and Neuman (1978) and Matteson and
Ivancevich (1979).
Perlman and Hartman (1982) posited a transactional model of burnout
and this appears to be the trend in recent years (Cherniss, 1980a;
Chiroboga & Bailey, 1986; Cooper, 1986; Courage & Williams, 1987; Cox &
McKay, 1981; Fletcher & Payne, 1980; Golembiewski et al., 1986; Harrison,
1983). The major theme of the transactional model relates to the
conceptualization of stress and burnout as the result of a transaction


15
16
24.
Support from peers
0.42608
0.37565
from work
0.0001
0.0001
25.
Job security
0.21757
0.01248
0.0001
0.8295
1.
Degree situation conducive
-0.12381
-0.05410
to stress
0.0321
0.3504
2.
Level of perceived
-0.22682
-0.17543
job stress
0.0001
0.0023
3.
Emotional exhaustion
-0.17370
-0.05484
0.0026
0.3438
4.
Depersonalization
-0.23838
-0.16599
0.0001
0.0039
5.
Personal accomplishment
0.19468
0.21697
0.0007
0.0002
6.
Job satisfaction
0.44621
0.19744
0.0001
0.0006
7.
Internal job
0.32593
0.45934
motivation
0.0001
0.0001
22
23
1.
Ability
-0.03958
-0.05374
0.4946
0.3537
2.
Time
-0.01288
-0.05205
0.8242
0.3690
17
18
19
20
0.25229
0.24434
0.21759
0.55193
0.0001
0.0001
0.0001
0.0001
0.00899
0.11940
0.24168
0.26150
0.8768
0.0388
0.0001
0.0001
0.14440
-0.02476
-0.14673
-0.22595
0.0123
0.6693
0.0109
0.0001
0.17573
-0.04053
-0.21225
-0.34672
0.0023
0.4843
0.0002
0.0001
0.17137
0.03275
-0.04334
-0.26352
0.0029
0.5721
0.04545
0.0001
0.26164
-0.02330
-0.06851
-0.23005
0.0001
0.6877
0.2368
0.0001
0.04282
0.15769
0.11612
0.16426
0.4599
0.0062
0.0445
0.0043
0.33171
0.12266
0.07119
0.51866
0.0001
0.0337
0.2189
0.0001
0.15772
0.28710
0.36801
0.27062
0.0062
0.0001
0.0001
0.0001
24
25
1
2
0.05616
-0.14232
0.01130
0.00089
0.3323
0.0136
0.8455
0.9878
0.04306
-0.12126
-0.03829
-0.06446
0.4574
0.0358
0.5088
0.2657
21
0.22115
0.0001
-0.00462
0.9365
-0.27039
0.0001
-0.31755
0.0001
0.12158
0.0353
-0.04192
0.4695
0.01032
0.8588
-0.13660
0.0179
0.50730
0.0001
3
0.06884
0.2345
0.02616
0.6517
150


75
of the situation conducive to stress, job stress, job satisfaction,
internal job motivation, and burnout-emotional exhaustion and each of the
exogenous variables in the study. As shown in Appendix J, many of the
variables were found to be significantly associated with the endogenous
measures and indicated promise for explaining and predicting burnout in
terms of the model shown in Figure 1-2 (pg. 7).
Exogenous Variables
Personal characteristics. Personal variables consisted of ability,
time, family demands, job expectations, personal work needs including
meaningfulness of work, responsibility for work outcomes, and knowledge
of work results, health, commitment to career, and personality. Among
the personal characteristics assessed family demands, knowledge of work
results, and health were all significantly associated with the situation
conducive to stress. With the exception of ability, time, and job
expectations, the personal characteristics were all significantly related
to job stress, and burnout-emotional exhaustion. Job expectations was
inversely related to internal job motivation. Personal characteristics
including meaningfulness of work, responsibility for work outcomes,
knowledge of work results and commitment to career were all significant 1y
associated with job satisfaction and internal job motivation. In
addition, while job expectation was significantly related to job
satisfaction, family demands was significantly associated with internal
job motivation. The personality variable was measured with three
psychological hardiness characteristics of commitment, challenge and
control with the total hardiness score. With the exception of job
satisfaction, the total psychological hardiness score was significantly
associated with the variables situation conducive to stress, job stress,
burnout-emotional exhaustion, and internal job motivation.


127
SEVERITY
How much of a None or
hassle was Did Not Somewhat Moderately Extremely
this for you? Occur Severe Severe Severe
1.Misplacing or
or losing things ....0 1 2 3
2. Troublesome
neighbors ........0 1 2 3
3. Social
obligations 0 1 2 3
4. Inconsiderate
smokers 0 1 2 3
5.Troubling thoughts
about your future ....0 1 2 3
6.Thoughts
about death 0 1 2 3
7 Health of a
family member ......0 1 2 3
8. Not enough
money for
clothes ....0 1 2 3
9. Not enough
money for
housing 0 1 2 3
10.Concerns about
owing money ..0 1 2 3


CHAPTER III
METHODOLOGY
This study was designed to collect data and to test a path analytical
model of the theoretical conceptualization of burnout for critical care
nurses. The model of interest was an expansion of the model offered by
Perlman and Hartman (1982) that allowed analysis of direct and indirect
effects of exogenous and endogenous variables using path analysis. Five
research study questions were used to guide this study in an exploratory
examination of the full model of burnout.
This chapter is divided into four section. In the first section,
the sample of respondents is described. The study design and procedures
used to collect the data are included in the second section of the
chapter. The instrumentation is described in the third section. The
fourth section includes a description of the statistical analysis of the
five research questions used to guide the study in examining the model.
Sample of Respondents
Selection of research participants. Permission to conduct the study
was first obtained through the Institutional Review Board of the
University Health Center. Following approval, a convenience sample of
hospitals was selected. Eligible hospitals (N = 14) were identified from
the 1985 Hospital Data Report published by the North Central Florida
Health Planning Council. Permission to conduct the study was then
obtained through the Nursing Research Committees of hospitals located in
North Eastern, North Central and Southern regions of the state of
39


APPENDIX A
INVITATION AND CONSENT FOR PARTICIPATION FROM
CRITICAL CARE NURSES


9
The third stage of the study was to answer the following questions
using multiple regression analyses:
1. Is there a significant relationship between the situational
stress variable and (a) the weighted linear combination of a set of
personal variables and (b) a set of organizational variables? Which
variables in the model contribute significantly to the variance in
situational stress?
2. Is there a significant relationship between job stress and the
combination of (a) situational stress and (b) the preceding exogenous
variables? Which variables in the model contribute significantly to the
variance in job stress?
3. Is there a significant relationship between job satisfaction and
the combination of (a) job stress, (b) situational stress, and (c) the
preceding exogenous variables? Which variables in the model contribute
significantly to the variance in job satisfaction?
4. Is there a significant relationship between internal job
motivation and the combination of (a) job stress, (b) situational stress,
and (c) the preceding exogenous variables? Which variables in the model
contribute significantly to the variance in internal job motivation?
5. Is there a significant relationship between burnout-emotional
exhaustion and the combination of (a) job satisfaction, (b) internal job
motivation, (c) job stress, (d) situational stress, and (d) the preceding
exogenous variables? Which variables in the model contribute
significantly to the variance in burnout-emotional exhaustion?
The final stage of the study was to refine the purposed model on the
basis of the empirical results obtained from stage three in an


16
settings. He observed a pattern of behaviors and attitudes that he also
experienced. He identified a helping professional experiencing burnout
as one who becomes exhausted from excessive demands on strength, energy,
or resources or who is worn out. Freudenberger and Richelson (1980)
later described burnout as a "sense of fatigue or frustration brought
about by devotion to a cause, way of life, or relationship that failed to
produce the expected reward" (p. 13). At the First National Conference
on Burnout, Maslach (1982b) presented the following definitions of
burnout that were reported in the literature:
A syndrome of emotional exhaustion, depersonalization, and reduced
personal accomplishment that can occur among individuals who do
people-work of some kind.
A progressive loss of idealism, energy, and purpose experienced by
people in the helping professions as a result of the conditions of
their work.
A state of physical, emotional, and mental exhaustion marked by
physical depletion and chronic fatigue, feelings of helplessness and
hopelessness, and the development of a negative self-concept and
negative attitudes toward work, life, and other people.
A syndrome of inappropriate attitudes toward clients and self, often
associated with uncomfortable physical and emotional symptoms.
A state of exhaustion, irritability, and fatigue that markedly
decreases the worker's effectiveness and capability.
To deplete oneself. To exhaust one's physical and mental resources.
To wear oneself out by excessively striving to reach some
unrealistic expectations imposed by oneself or by the values of
society.
To wear oneself out doing what one does to do so. An inability to
cope adequately with the stresses of work or personal life.
A malaise of the spirit. A loss of wellbeing. An inability to
mobilize interests and capabilities.



103
consequently were ineffective in preventing burnout. This is a
speculation because coping was not examined directly in this study.
Kimmel (1982) measured coping with the Ways of Coping Scale (Lazarus &
Folkman, 1989) as well as through assessment of role conflict, role
ambiguity, household support, and burnout. His sample consisted of
nurses from a metropolitan hospital. He reported that coping variables
were the best predictors of burnout. Further research to examine how
health difficulties and coping mechanisms affect burnout might be
fruitful for other helping professions.
The findings from this study also suggest that burnout-emotional
exhaustion can result from a low commitment to the career and a high
degree of dealing with others (colleagues) at work. Dealing with others
(colleagues) was measured in this present study as the degree to which
the job requires the nurse to work closely with other people in carrying
out the work activities including other organizational members. These
findings expand upon earlier research by Gaines and Jermier (1983), Dames
(1983), and Leiter and Maslach (1988) and support the theoretical
conceptualization offered by Perlman and Hartman (1982). Furthermore,
Leiter and Maslach (1988) cited interactions with coworkers as the most
important source of burnout in the work setting and, similarly, the
present study findings demonstrate a moderate effect (pc = .235),
supporting the importance of the interpersonal aspect with others at work
as a source of burnout-emotional exhaustion.
There are important implications to these findings. Colleagues on
the job include supervisors, other nurses, doctors and administrators who


12
sources of emotional stress on the job and the risk of burnout in many
nursing baccalaureate programs. It is important for nurse educators to
understand the causes of burnout among helping professionals. Students
should have more accurate information about the work they are undertaking
before they actually start. If this were accomplished, they might have
fewer surprises that destroy their professional ideals or lead them to
leave the profession. The consequences of attrition and turnover may be
greatly reduced by providing realistic job expectations. Prior knowledge
about the causes of burnout may enable nurses to recognize it in its
early stages, whether in themselves or in others. Greater awareness of
the risk of burnout can lead nurses to be better prepared for it in
advance. They can anticipate causes of emotional stress before they
occur and develop definite plans to deal with them. The results of this
study will allow them to have a clearer understanding of the personal and
organizational variables that may enable them to be successful at their
work.
Limitations
The following limitations of the study must be taken into
consideration when interpreting the findings:
1. The range of the study was limited to a geographical region
within the state of Florida that included Melbourne, Orlando,
Jacksonville, Ocala, Tallahassee, and Gainesville.
2. The sample was limited to a cross-section of critical care
nurses who work in critical care settings, including Medical and Surgical
Intensive Care Units.
3. The sample may be biased because individuals in advanced stages
of burnout may have been so apathetic that they did not participate in
the study.


79
Question 2
Question 2 addressed the significant relationship between job stress
and the combination of (a) situation conducive to stress and (b) the
preceding exogenous variables (ten personal variables and twelve
organizational variables). In addition, this question also addressed
which of the variables in the model contributed significantly to the
variance in job stress.
Multiple regression analyses yielded an of .74, (F = 33.222;
df = 23, 276; p = .0001), indicating that 74% of the variance in job
stress was explained by the variables in the regression model.
Regression results in Table 4-2 show that the personal variables
including time (tenure), family demands, and health difficulties, the
organizational variables including workload, pay, supervision and job
security and the stress variable, situation conducive to stress were
significant predictors of job stress.
Personal variables that did not relate significantly to job stress
were ability, job expectations, meaningfulness of work, responsibility
for work outcomes, knowledge of work results, commitment to career and
psychological hardiness. Organizational variables that did not relate
significantly to job stress were expected role performance and role
ambiguity, skill variety, task identity, task significance, autonomy,
dealing with others, opportunity for advancement, and support from peers
at work. (See Table K-2 in Appendix K for results of the multiple
regression for all variables.)
Question 3
Question 3 addressed the significant relationship between job
satisfaction and the combination of (a) job stress, (b) situational


Table K-3continued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
-.1717
-3.559
.0004*
Opportunity for advancement
.2125
3.086
.0022*
Pay
.1392
2.976
.0032*
Support from peers at work
-.0237
-.447
.6550
Job security
-.0848
-1.948
.0525*
Stress variables
Job stress
-.1404
-2.000
.0465*
Degree situation conducive to stress
-.0569
-.782
.4346
R2 = .6405 (F = 20.413, p
0001)


176
Taylor, F. (1911). Principles of scientific management. New York:
Harper and Brothers.
Vachon, M. (1987). Occupational stress in the care of the critically
ill, the dying, and the bereaved. New York: Hemisphere.
Veninga, R. L., & Spradley, J. P. (1981). The work/stress connection.
Boston: Little, Brown.
Young, V. C. (1987). Hassles, uplifts, and life events as predictors of
health. Doctoral dissertation, University of California, Berkeley.


130
SECTION ONE
This part of the questionnaire asks you to
describe your job, as objectively as you can.
Please do not use this part of the questionnaire to show how much
like or dislike your job. Questions about that will come later.
Instead, try to make your descriptions as accurate and as
objective as you possibly can.
A sample question is given below.
A. To what extent does your job require you to work with mechanical
equipment ?
1 2
3
4
5 -
6 7
Very little; the
Moderately
Very much; the job
job requires almost
requires almost
no contact with
constant work with
mechanical equip
ment of any kind
mechanical equipment
You are to circle the
number
which is the most
accurate description of
your job.
If, for example, your job requires you to work
with mechanical equipment a good deal of the time
but also requires some paperwork you might circle
the number six, as was done in the example above.
If you do not understand these instructions, please ask for assistance.
If you do understand them, turn the page and begin.


170
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Press.
Fimian, M. J. (1984). Organizational variables related to stress and
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Mentally Retarded, 19, 201-209.
Fischer, H. J. (1983). A psychoanalytic view of burnout. In B. Farber
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30, 159-165.
Freudenberger, H. F. (1975). The staff burn-out syndrome in alternative
institutions. Psychotherapy: Theory, Research and Practice, 12(1),
73-82.
Freudenberger, H. F., & Richelson, G. (1980). Burnout: The higher cost
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Otto, N. R. (1980). Professional burnout: Definition, characteristics,
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67
The cognitive, affective and physiologic response of stress,
referred to as burnout, was measured with the Maslach Burnout Inventory
(Maslach & Jackson, 1986). A sample item of the Maslach Burnout
Inventory for Emotional Exhaustion includes, "I feel emotionally drained
from my work." Appendix I contains instrument directions and sample
items.
Commitment and Workload
Description. Commitment to career was measured with one five point
Likert item (Appendix F). Workload was measured with two five point
Likert items (Appendix F).
Psychometric properties. Psychometric properties of these variables
are presented in Table 3-9.
Use in this study. The personal variable commitment to career and
the organizational variable workload were measured with three items that
were designed by the researcher to closely resemble the variables used in
this study among critical care nurses. Critical care nursing faculty,
critical care graduate nursing students, and two top nursing management
members of two critical care intensive care units of a regional hospital
were asked to rate and evaluate these three items for use in this study.
On the basis of their evaluation and the discretion of the researcher
these items were used to measure commitment to career and workload.
Table 3-10 presents a summary of the instrumentation of personal,
organizational variables, and situation conducive to stress, job stress,
burnout-emotional exhaustion, job satisfaction and internal work
motivation variables used in the study.
Statistical Analysis
The five research questions listed in Chapter I (pg. 9) were used to
guide this study in examination of the full model of burnout-emotional


Table Page
4-4 Multiple Regression of Internal Job Motivation
on the Variables Within Each Block of
Characteristics, Job Stress and Situation
Conducive to Stress 84
4-5 Multiple Regression of Burnout-Emotional
Exhaustion on the Variables Within Each Block
of Characteristics, Job Satisfaction, Internal
Job Motivation, Job Stress and Situation
Conducive to Stress .................. 86
4-6 Magnitudes of Direct and Indirect Effects on
Degree Situation Conducive to Stress, Level
of Perceived Job Stress, General Job
Satisfaction and Burnout 88
4-7 Intercorrelations of Exogenous Variables in
the Path Analytic Model of Burnout Among
Critical Care Nurses 98
viii


CHAPTER IV
STUDY FINDINGS
This study was designed to collect data and to test a path-
analytical model of the theoretical conceptualization of burnout for
critical care nurses. The model of interest tested was an expansion of
the model offered by Perlman and Hartman (1982). Five research questions
were used to guide this study in the examination of the full model of
burnout including personal and organizational variables and situation
conducive to stress, job stress, job satisfaction and internal work
motivation. Each of the independent variables that made a significant
contribution to the variance explained in the dependent variables was
included in the path analysis.
This section is divided into two sections. The first section
describes the statistical analysis of the full model. This section
includes the mean, standard deviation, and zero-order correlation
coefficient between each of the variables included in the study and the
results of regression analyses used to address the five research
questions posed in Chapter I. The second section includes a presentation
of the findings related to estimation of the direct and indirect effects
of the exogenous and endogenous variables obtained from applying path
analysis to a more parsimonious version of the model.
Full Model and Statistical Analysis
Appendix J contains the means, standard deviations, and zero-order
coefficients of correlation between the endogenous variables consisting
74


APPENDIX G
HARDINESS TEST DIRECTIONS AND SAMPLE ITEMS


1
2
23.
Pay
-0.05374
-0.05205
0.3537
0.3690
24.
Support from peers
0.05616
0.04306
from work
0.3323
0.4574
23.
Job security
-0.14232
-0.12126
0.0136
0.0358
1.
Degree situation conducive
0.01130
-0.03829
to stress
0.8455
0.5088
2.
Level of perceived
0.00089
-0.06446
job stress
0.9878
0.2657
3.
Emotional exhaustion
0.06884
0.02616
0.2345
0.6517
4.
Depersonalization
-0.02813
-0.05497
0.6275
0.3427
5.
Personal accomplishment
-0.00901
0.00635
0.8765
0.9128
6.
Job satisfaction
0.06026
0.06385
0.2982
0.2703
7.
Internal job
0.06270
0.05951
motivation
0.2790
0.3042
8
9
1.
Ability
-0.15944
-0.01813
0.0056
0.7545
3
4
5
6
7
0.18420
0.01799
0.13692
0.15160
0.07963
0.0014
0.7563
0.0117
0.0085
0.1689
0.1283
-0.00706
0.49499
0.39189
0.39284
0.0754
0.9030
0.0001
0.0001
0.0001
0.06616
-0.00288
0.16275
0.11925
0.12898
0.2533
0.9604
0.0047
0.0390
0.0255
0.81395
-0.04134
-0.10069
-0.05379
-0.35257
0.0001
0.4756
0.0817
0.3532
0.0001
0.76131
-0.09135
-0.20731
-0.14046
-0.41107
0.0001
0.1143
0.0003
0.0149
0.0001
0.15583
-0.04884
-0.27614
-0.13571
-0.26021
0.0068
0.3992
0.0001
0.0187
0.0001
0.13154
-0.06600
-0.23036
-0.20045
-0.24799
0.0227
0.2545
0.0001
0.0005
0.0001
0.05722
0.10051
0.29973
0.22412
0.13941
0.3233
0.0822
0.0001
0.0001
0.0157
0.09754
-0.12487
0.58331
0.35615
0.39106
0.0917
0.0306
0.0001
0.0001
0.0001
0.21928
-0.08091
0.44186
0.44901
0.36868
0.0001
0.1622
0.0001
0.0001
0.0001
10
11
12
13
14
0.04229
0.00491
-0.02431
-0.02379
-0.09834
0.4656
0.9325
0.6750
0.6815
0.0891
144


11
relationship, patients cared for by nurses in the stage of emotional
exhaustion or depersonalization may suffer from pathological detachment
on the part of the nurse. Critical care nurses who avoid their patients
and families lose opportunities essential for timely and potentially
useful interventions. This results in an unfortunate physiological loss
to the patient and a psychological loss to the patient, family, and
nurses and other members of the health team.
Burnout is costly as well to the institutions in which the helping
professionals work because of poor performance, job dissatisfaction,
absenteeism, job turnover, and illness of workers, all of which have been
related to this phenomenon. Knowledge about the causes of burnout and
the organizational work variables that critical care nurses perceive as
contributing to burnout could allow nursing administrators to identify
strengths and weaknesses in the hospital organization in reference to
prevention, recognition, and management of burnout. Such information
might give insight into the control of burnout. A variety of strategies
by those concerned with professional development and nursing management
could be employed to help alleviate nursing burnout, including redesign
of jobs, changing organizational policies, establishing flexible
schedules and support services, improving training for staff, and
designing explicit programs for more decisionmaking, emotional support,
and recognition.
Knowledge of results of this study could assist nursing educators in
curricular development. By recognizing burnout as a legitimate problem
with specific causes, greater efforts may be made to deal effectively
with it in academic institutions.
Clinical nursing faculty are also in an excellent position to teach
students how to cope with a stressful job as well as how to make the job
less stressful, but they are hampered by a lack of information about


25
identified both nursing stress and nursing burnout as being among the top
ten research priorities facing the profession (Lewandowski & Kositsky,
1983).
Studies were examined related to potential factors contributing to
burnout of nurses. The review was limited only to studies using the
Maslach Burnout Inventory as a criterion measure. In this review, the
studies have been grouped according to findings related to personal
characteristics of the nurse, including demographics (age, marital and
family status, length of employment, income, and education), personal
stressors, personality characteristics, social support, coping behavior
and organizational characteristics including work stress, the work
environment (worker involvement, type of unit, type of hospital,
involvement in decision making), job enhancement (skill variety and new
approaches, autonomy, clarity, physical comfort, work pressure), and job
satisfaction.
Personal Characteristics
Demographics
Demographic variables that have been associated with burnout in
nurses include age, marital and family status, length of employment,
income, and education. Younger nurses are more susceptible to burnout
than their older counterparts (Chiriboga & Bailey, 1986; Dames, 1983)
However, Bartz and Maloney (1986) found a positive association of burnout
with younger intensive care nurses.
Single care providers tend to be at greater risk for burnout than
married care providers (Dames, 1983; Kimmel, 1983). In addition, junior
nurses without the support of a marital partner are indicated as
vulnerable to burnout (Chiriboga, 1986).


95
Family Demands
Figure 4-1continued


141
Table J-2
Descriptive Statistics for Endogenous Variables
Standard
Variable
N
Mean
deviation
Situation conducive to stress
300
.717
.387
Job stress
300
.659
.427
Emotional exhaustion
300
2.589
1.070
Depersonalization
300
1.543
1.150
Personal accomplishment
300
3.442
.832
Job satisfaction
. 300
4.949
1.110
Internal work motivation
300
5.874
.640


23
job motivations rather than the occurrence of job stressors. Jayaratne
and Chess (1983) reported that role conflict, excessive workload, and
role ambiguity are not significant predictors of burnout in social work.
They identified job challenge, financial rewards, and promotions as the
strongest predictors of burnout and job satisfaction. Eisenstat and
Felner (1983) isolated the variables of job motivations and job stressors
and reported that while job stressors are related to emotional
exhaustion, job enrichers, including autonomy, task significance, and
skill variety are related to job motivation in helping professionals.
Cherniss and Krantz (1983) also focused on the relationship between
burnout and lack of job motivation. Specific variables in their
conceptualization included long hours and the absence of meaning in work.
In addition, Fibkins (1983) and Ianni and Reuss-Ianni (1983) emphasized
that the crucial deficit variable in the burnout model is lack of
organizational support. According to Fibkins, burnout in teachers occurs
when the school organization is not responsive to the complex, intensive
nature of teachers' work. Ianni and Reuss-Ianni (1983) suggested that
individual and social factors may contribute to work stress; however,
burnout is more likely to be caused by a deficit within the
organizational structure.
Several other authors have advanced the stress model, incorporating
essential elements of modern stress theory and drawing on past research
(Beehr & Neuman, 1978; Chiriboga & Bailey, 1986; House & Wells, 1978;
Matteson & Ivanovich, 1979; Perlman & Hartman, 1982). In the stress
model, antecedent conditions such as sociodemographic characteristics,
are seen as laying the ground work for stress that results in conditions
such as burnout. Sociostructural conditions in the workplace constitute


Page
Instrumentation 46
Demographic Questionaire 46
Daily Hassles Scale .... .......... 48
Psychometric Properties of Daily Hassles Scale 48
Job Diagnostic Survey (JDS) ..... 50
Psychometric Properties of JDS 56
Psychological Hardiness Test 61
Psychometric Properties of Psychological Hardiness
Test 62
Maslach Burnout Instrument (MBI) ... 63
Psychometric Properties of MBI 64
Commitment and Workload 67
Statistical Analysis .......... 67
IV STUDY FINDINGS 74
Full Model and Statistical Analysis 74
Exogenous Variables ....... 75
Endogenous Variables .. ........ 76
Question 1
Question 2 79
Question 3 79
Question 4 81
Question 5 83
Reduced Model and Path Analysis ....... 87
Contributions to Situational Stress ........... 87
Contributions of Perceived Job Stress ..... 91
Contributions to Job Satisfaction 91
Contributions to Burnout-Emotional Exhaustion 92
Goodness-of-Fit ...... 92
V DISCUSSION, INTERPRETATIONS, CONCLUSIONS AND
RECOMMENDATIONS 99
Overview 99
Causes of Burnout 100
Causes of Job Dissatisfaction .............. 106
Comparison of Job Dissatisfaction and Burnout ...... 110
Causes of Job Stress Ill
Limitations and Recommendations 114
Conclusions 117
APPENDICES
A INVITATION AND CONSENT FOR PARTICIPATION FROM
CRITICAL CARE NURSES 120
B PROCEDURES FOR ADMINISTRATION 122
C DEMOGRAPHIC SHEET AND WORK SURVEY 124
D DAILY HASSLES SCALE DIRECTIONS AND SAMPLE ITEMS 126
E JOB DIAGNOSTIC SURVEY DIRECTIONS AND SAMPLE ITEMS 129
v


94
Family Demands
Job Expectation
Meaningfulness
for Work
Knowledge of
Work Results
Committment to
Career
Health Difficulties
Psychological
Hardiness
Work Load
Skill Variety
Task Identity
Supervision
Dealing with Others
Opportunity for
Advancement
Pay
Job Security
Figure 4-1continued


17
To become debilitated, weakened, because of extreme demands on one's
physical and/or mental energy.
An accumulation of intense negative feelings that is so debilitating
that a person withdraws from the situation in which those feelings
are generated.
A pervasive mood of anxiety giving way to depression and despair.
A process in which a professional's attitudes and behavior change in
negative ways in response to job stress.
An inadequate coping mechanism used consistently by an individual to
reduce stress.
A condition produced by working too hard for too long in a
high-pressure environment.
A debilitating psychological condition resulting from work-related
frustrations, which results in lower employee productivity and
morals, (pp. 30-31)
Maslach (1982b) analyzed the problem of defining burnout and
concluded that some definitions are broad, others narrow; some include
emotional and physical behaviors, others include psychological and
cognitive terms. In addition, some describe a process while others
present a process; some relate causes while others relate consequences.
One commonality in the definitions is that the burnout syndrome presents
a psychological process affecting individual attitudes, motives,
feelings, and expectations. The individual perceives the syndrome as
unfavorable, dealing with distress, problems, malaise, and/or negative
outcomes. Furthermore, Maslach pointed out that there is agreement on
the component of exhaustion as a loss of energy and debilitation,
physiologically and psychologically, a loss of trust and apathy, with
loss of feeling, concern, and spirit. Another component includes a
disparaging response to others, with depersonalization, inappropriate
A


54
Table 3-7continued
Subscale
Variable in
this study
Sample Item
Task significance
Work group norm
"The job is one where a lot
of the other people can be
affected by how well the
work gets done."
Autonomy
Work group norm
"The job gives me
considerable opportunity
for independence and
freedom in how I do the
work."
Dealings with
others at work
Dealing with
colleagues
"The job requires a lot of
cooperative work with other
people."
Supervision
satisfaction
Supervision
"The amount of support and
guidance I receive from my
supervisor.
Satisfaction with
work growth and
advancement
Opportunity for
advancement
"The amount of personal
growth and development I
get in doing my job."
Pay satisfaction
Pay
"The amount of pay and
fringe benefits I receive.
Satisfaction with
peers and
co-workers
Support from others
at work
"The chance to get to know
other people on the job."
Satisfaction with
job security
Organizational climate
and the economic-
market condition
"How secure things look for
me in the future in this
organization."
General job
satisfaction
Job satisfaction
1 am generally satisfied
with the kind of work I do
in this job."
Internal job
motivation
Psychological response
to job stress
"Most people in this job
feel a great sense of
personal satisfaction when
they do the job well."


104
are significant individuals that the critical care nurse has to deal with
in the job setting. The results from this study indicate that the
critical care nurse needs emotional energy and resources to relate and
deal with them because these colleague relationships can be even more
stressful than anticipated and contribute to burnout-emotional
exhaustion. Another implication is that if the critical care nurse must
frequently deal with others at work, it is important that she relate
positively to her nursing and medical peers, seeking opportunities for
comfort, advice, praise and support from this essential group because
this may assist in warding off emotional strain and exhaustion that is
likely to occur. In conclusion, these findings suggest that contact with
people at work may be a major source of frustration, distress, or
conflict among critical care nurses. In addition, with the presence of a
low commitment to continue work, the negative experience of dealing with
others, and job dissatisfaction then burnout-emotional exhaustion is
likely to be perceived among critical care nurses.
The results of this study also indicate that workload is linked to
burnout-emotional exhaustion among critical care nurses and provides
support to findings by other researchers. For example, burnout has been
correlated with a greater percentage of time in direct care of clients
(Lewiston, Conley & Blessing-Moore, 1981; Maslach & Jackson, 1982), more
difficult client problems (Meadow, 1981; Pines & Maslach, 1978), and
caseload (Maslach & Jackson, 1984a-b). Similarly, nursing researchers
have found that the more hours worked and more hours of direct patient
contact, the increased risk of burnout (Dames, 1983; Des, 1981). These
researchers also stated that the more hours working with patients with
grave prognoses, the higher the burnout scores. The direct relationship


PROCEDURES FOR ADMINISTRATION
The researcher and/or a graduate assistant, will meet with the
critical care staff nurses at an already scheduled staff meeting and the
study will be placed on the staff meeting agenda. The researcher and/or
the graduate assistant will invite the critical care staff nurses to
participate in the study following a brief description of the
dissertation. The questionnaires will be handed out to those staff
nurses who are interested in participating. The participants will be
instructed to complete the questionnaires on their own time away from the
work setting. The staff nurses will be requested to place the completed
questionnaires in an enclosed sealed envelope and return the envelop to a
designated box in the unit nursing lounge within one week.
All subjects will be guaranteed anonymity. A graduate assistant and
the nurse researcher will pick up the questionnaires on a daily basis
until all the questionnaires are returned.
122


Table K-4
Multiple Regression of Internal Job Motivation on the Variables Within Each Block of
Characteristics, Job Stress and Situation Conducive to Stress
Standard
Block
Variable
coefficient
t-value
p value
Personal
Abi lity
.0654
.691
.4900
characteristics
Time
-.0484
-.510
.6104
Family demands
-.1442
-1.701
.0901*
Job expectations
-.0706
-1.624
.1055
Meaningfulness of work
.1325
2.196
.0290**
Responsibility for work outcomes
.2068
4.188
.0001*
Knowledge of work results
.0200
.330
.7414
Health
-.1262
-1.890
.0599*
Commitment to career
.1168
2.560
.0110*
Psychological hardiness
.0420
.7 90
.4299
Organizational work
Workload
-.0696
-1.590
.1130
characteristics
Expected role performance and role ambiguity
.0134
.234
.8148
Skill variety
.0254
.441
.6593
Task identity
-.0186
-.406
.6853
Task significance
.0326
.691
.4900
Autonomy
.1713
3.538
.0005*
Supervision
-.0387
-.639
.5236


LIST OF FIGURES
Figure Page
1-1 A Perceptual-Feedback Stress Paradigm 4
1-2 Full Model of Burnout . 7
4-1 Reduced Model of Burnout 93
lx


91
Contributions to Perceived Job Stress
Table 4-6 presents the estimates of direct and indirect effects
among the exogenous personal and organizational variables and the stress
variable situation conducive to stress. Estimates of indirect effects
were calculated as the product of the path coefficients of variables
connected by arrows that lay on the path between the variables of
interest. For example, the indirect effect of family demands on
perceived job stress was (.637) X (.370) = .236. This reflects the
effect of family demands, acting through the situational stress variable,
on the nurses' perceived job stress. Family demands also have a direct
effect on perceived job stress, represented by the path coefficient of
.332. The personal exogenous variable family demands had the strongest
effect (.568) on level of perceived job stress; the organizational
exogenous variable skill variety had the weakest effect (.023) on
perceived job stress. This set of variables in the reduced model
explained 71% of variance in job stress, as compared to 74% of the
variance explained with the full model.
Contributions to Job Satisfaction
Table 4-6 also contains the estimates of the direct and indirect
effects of the exogenous personal variables and organizational variables
and the stress variable job stress on general job satisfaction. The
personal exogenous variable meaningfulness of work had the strongest
effect on general job satisfaction; the organizational exogenous variable
skill variety had the weakest total effect on general job satisfaction.
This set of variables in the reduced model explained 62% of variance of
general job satisfaction, as compared to 64% of the variance explained in
the full model


8
9
13.
Hardiness
0.10812
-0.38831
total
0.0614
0.0001
14.
Work load
0.06417
0.06135
0.2678
0.2895
15.
Expected performance
0.22779
-0.06812
and role ambiguity
0.0001
0.2395
16.
Skill variety
0.22688
-0.11724
0.0001
0.0424
17.
Task Identity
0.09863
-0.09859
0.0881
0.0883
18.
Task significance
0.08461
0.02514
0.1437
0.6645
19.
Autonomy
0.13026
-0.07517
0.0240
0.1942
20.
Supervision
0.18700
-0.16249
0.0011
0.0047
21.
Dealing with others
0.05654
-0.33432
0.3290
0.0001
22.
Opportunity for
0.34157
-0.00010
advancement
0.0001
0.9986
23.
Pay
0.19244
0.19242
0.0008
0.0008
10
11
12
13
14
0.94504
0.90361
0.80507
1.00000
0.13293
0.0001
0.0001
0.0001
0.0
0.0213
0.12879
0.12660
0.09576
0.13293
1.00000
0.0257
0.0283
0.0978
0.0213
0.0
0.17439
0.17708
-0.03522
0.12715
0.01900
0.0024
0.0021
0.5434
0.0277
0.7431
0.27856
0.24555
0.11787
0.24712
0.09924
0.0001
0.0001
0.0413
0.0001
0.0862
0.08800
0.11603
-0.05988
0.06018
0.02458
0.1283
0.0446
0.3013
0.2988
0.6715
0.19829
0.20471
0.06101
0.17953
0.07399
0.0006
0.0004
0.2922
0.0018
0.2013
0.32919
0.31840
0.20498
0.32455
0.07571
0.0001
0.0001
0.0004
0.0001
0.1909
0.23633
0.26897
0.01639
0.20459
-0.09043
0.0001
0.0001
0.7775
0.0004
0.1181
0.41848
0.44756
0.26982
0.43176
-0.01484
0.0001
0.0001
0.0001
0.0001
0.7980
0.24965
0.14915
-0.02901
0.14993
0.02965
0.0001
0.0097
0.6167
0.0093
0.6090
0.04495
-0.20199
-0.16482
-0.14952
-0.05337
0.4380
0.0004
0.0042
0.0095
0.3569
146


Table 4-4
Multiple Regression of Internal Job Motivation on the Variables Within Each Block of
Characteristics, Job Stress and Situation Conducive to Stress
Block
Variable
Standard
coefficient
t-value
p value
Personal
Family demands
-.1442
-1.701
.0901
characteristics
Meaningfulness of work
.1325
2.196
.0290
Responsibility for work outcomes
.2168
4.185
.0001
Commitment to career
.1168
2.560
.0110
Health
-.1262
-1.890
.0599
Organizational work
Autonomy
.1713
3.538
.0005
characteristics
Dealing with others
.2759
5.065
.0001
Support from peers at work
.1819
3.041
.0026
Stress variables
Situation conducive to stress
.2509
3.058
.0024
R2 = .5419 (F = 13.552; df = 24, 275; p
0001)


63
more hardiness, that is, have a stronger commitment to self, an attitude
of vigor toward their environment, a sense of meaningfulness, and an
internal locus of control.
This evidence suggests that on the basis of the reliability
estimates and validity data available, the total hardiness scores
provides a measure of general psychological hardiness. However, there is
less empirical support for the interpretation of separate subscale scores
of control, commitment, and challenge.
Uses in this study. The personal variable personality was measured
with the Hardiness Test on the basis that this scale would determine if
hardiness or transfunctional coping acts as a buffer to keep situations
conducive to stress from changing into job stress, and job stress from
changing into burnout among critical.care nurses. In addition, critical
care nursing faculty, critical care graduate students and two top nursing
management members of two critical care intensive care units of a
regional hospital were asked to rate and evaluate this scale for use in
this study. On the basis of their judgement and the discretion of this
researcher, use of the Hardiness Test is a measure of the personal
variable of personality seemed justified. Appendix G contains
instrument directions and sample items.
Maslach Burnout Instrument (MBI)
Description. Burnout, according to Maslach and Jackson (1986), is a
syndrome of emotional exhaustion, depersonalization, and reduced personal
accomplishment, which often affects helping professionals (e.g. ,
teachers, nurses and therapists). A major aspect of the burnout syndrome
is increased feelings of emotional exhaustion; as emotional reserves are
depleted, helping professionals feel that they are no longer able to give
of themselves at a psychological level. In addition, the development of
depersonalizationi.e., negative, cynical attitudes and feelings about


8
9
24.
Support from peers
0.16894
-0.08028
from work
0.0033
0.1655
25.
Job security
0.06890
0.08977
0.2341
0.1200
1.
Degree situation conducive
-0.05534
0.69301
to stress
0.3395
0.0001
2.
Level of perceived
-0.12110
0.66394
job stress
0.0360
0.0001
3.
Emotional exhaustion
-0.38037
0.19172
0.0001
0.0008
4.
Depersonalization
-0.40679
0.20693
0.0001
0.0003
5.
Personal accomplishment
0.37453
-0.06283
0.0001
0.2780
6.
Job satisfaction
0.026396
0.16092
0.0001
0.0052
7.
Internal job
0.24874
-0.21551
motivation
0.0001
0.0002
15
16
1.
Abi li ty
0.07320
0.02823
0.2061
0.6262
2.
Time
0.07991
0.03579
0.1674
0.5368
10
11
12
13
14
0.20026
0.23077
0.04208
0.18385
0.01727
0.0005
0.0001
0.4678
0.0014
0.7657
0.17431
0.08383
0.11111
0.14084
0.02996
0.0024
0.1475
0.0546
0.0146
0.6053
0.42812
-0.44038
-0.32482
-0.45140
0.03375
0.0001
0.0001
0.0001
0.0001
0.5604
0.39456
-0.42526
-0.25455
-0.40838
0.08432
0.0001
0.0001
0.0001
0.0001
0.1451
0.17995
-0.08835
-0.12991
-0.15115
0.08921
0.0018
0.1268
0.0244
0.0087
0.1231
0.24562
-0.14992
-0.10385
-0.19284
0.11796
0.0001
0.0093
0.0725
0.0008
0.0412
0.27449
0.19684
0.12087
0.22809
0.04027
0.0001
0.0006
0.0364
0.0001
0.4872
0.04748
-0.02519
-0.17020
-0.04652
-0.03165
0.4125
0.6639
0.0031
0.4220
0.5851
0.33436
0.32512
0.11933
0.30067
-0.03119
0.0001
0.0001
0.0389
0.0001
0.5905
17
18
19
20
21
0.07467
0.01217
0.00145
0.08011
0.01566
0.1971
0.8337
0.9800
0.1664
0.7871
0.07281
0.03710
0.04832
0.09683
0.04398
0.2085
0.5221
0.4044
0.0941
0.4479
4>


10
exploratory fashion. Each of the independent variables that made a
significant contribution to the variance in one or more dependent
variables was considered a candidate for inclusion in a reduced model of
burnout. Path analysis was used to estimate the direct and indirect
effects of exogenous variables on endogenous outcome variables in a
reduced model of burnout. Results of the analyses of the full model and
a suggested reduced model will be presented in Chapter IV.
Significance of the Study
This study has practical value for the critical care staff nurses
themselves, the patients cared for by the critical care nurses, the
institutions in which the critical care nurses work, and the educational
preparation of nurses taught by nursing faculty. Maslach (1982) stated
that the burnout syndrome stems from a social interaction between helpers
and helpees, when in certain circumstances, helpers become unduly
involved emotionally with the recipients, overextend themselves, and
demonstrate emotional exhaustion. Nurses, as well as teachers, are
helping professionals and share the burdens and frustrations in the
helping relationship. Maslach (1982) described the progression of
burnout from emotional exhaustion to depersonalization in which helpers
decreased contact with clients and showed a callous, detached, and
dehumanizing response towards helpees. He proposed that clients
receiving care from helping professionals in the stage of
depersonalization do not receive adequate care because of ineffective
interpersonal helping relationships. Because nursing activities require
frequent contact with patients in an effective interpersonal


Table 3-10
Instrumentation: Personal, Organizational Variables. Situation Conducive to Stress,
Job Stress, Burnout, Job Satisfaction, and Internal Work Motivation
Variables in this study
Instrument
Items
Personal
Ability
Demographic questionnaire
3, 4, 5
Time (tenure)
Demographic questionnaire
4, 5
Family demands
Daily Hassles Scale
1-4, 7-15, 19-23, 29,
45, 55, 58-59, 61-64,
73-76, 78-79, 82, 87,
103-108, and 110-112
35-38, 43
70-71 ,
90, 92-93
Job expectations
JDS
Section 6 (2-3, 6, 8,
Section 7 (1-12)
10, 11)
Personal work needs
Meaningfulness of work
JDS
Section 3 (4, 7), Section 6 (6)
Responsibility for work outcomes JDS
Section 3(1,8, 12,
Section 5 (4, 7)
15)
Knowledge of work results
JDS
Section 3 (5, 11)
Section 5 (5, 10)


Table 4-3
Multiple Regression of Job Satisfaction on the Variables Within Each Block of
Characteristics, Job Stress and Situation Conducive to Stress
Block
Variable
Standard
coefficient
t-value
p value
Personal
Job expectations
-.1078
-2.801
.0055
characteristics
Meaningfulness of work
.2885
5.398
.0001
Knowledge of work results
.1061
1.978
.0489
Health
.1598
2.702
.0073
Organizational work
Task identity
.0996
2.449
.0150
characteristics
Supervision
.2192
4.080
.0001
Dealing with others
.1717
-3.559
.0004
Opportunity for advancement
.2125
3.086
.0022
Pay
.1392
2.976
.0032
Job security
-.0848
-1.948
.0525
Stress variables
Job stress
-.1404
-2.000
.0465
R2 = .6405 (F = 20.413; df = 24, 275; p
0001)


WORKLOAD AND STAFF SIZE
Circle the response that best describes your typical work day as a
critical care staff nurse:
1. The workload that I must deal with as a critical care staff nurse
is:
Satisfactory Unsatisfactory
1 2 3 4 5
2. The current staff size that is employed in the critical care unit of
which I am employed is:
Adequate Inadequate
1 2 3
4
5
132


6
Table 1-1
Variables Reported to be Significantly Related to Burnout
Predictor
Personal
Variables
Predictor
Organizational Outcome
Variables Variables
Ability
Workload
Situation conducive
to stress
Time
Expected role
performance and
Level of perceived
Family demands
role ambiguity
job stress
Job expectations
Work group norms
Job satisfaction
Personal work
Dealing with
Internal job
needs
colleagues
motivation
Physical health
Commitment to
Opportunity for
advancement
Burnout
career
Pay
Psychological
Support from
hardiness
others
Organizational
climate and
economic/market
conditions
Supervision


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AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
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55
obtaining direct and clear information about the effectiveness of
his or her performance.
Feedback from agents is the degree to which the employee receives
clear information about his or her performance from supervisors or
from coworkers.
Dealing with others is the degree to which the job requires the
employee to work closely with people in carrying out the work
activities.
The JDS also measures three psychological states that are associated
with the core job dimensions. These include experienced meaningfulness
of the work, experienced responsibility for work outcomes and knowledge
of work results. They are defined as follow:
Experienced meaningfulness of the work. The degree to which the
employee experiences the job as one which is generally meaningful,
valuable, and worthwhile.
Experienced responsibility for work outcomes. The degree to which
the employee feels personally accountable and responsible for the
results of the work he or she does.
Knowledge of results. The degree to which the employee knows and
understands, on a continuous basis, how effectively he or she is
performing the job.
Personal, affective reactions or feelings a person obtains from
performing the job include general satisfaction, internal job motivation,
and specific satisfactions (job security, pay and other compensations),
social satisfaction with peers and coworkers, supervision and opportunity
for personal growth and development on the job. They are defined as
follow:


102
the Hardiness Test (Kobasa, 1987). They reported that burnout
consistently was negatively correlated with psychological hardiness.
Their finding supports the view that hardiness constitutes as a
generalized resistance resource for nurses working in intensive care
settings. The findings and conclusions from this present study about the
direct effects of psychological hardiness on burnout among critical care
nurses confirm and expand upon earlier findings and substantiate the
theoretical formulation offered by Perlman and Hartman (1982) that the
personal characteristic personality has an impact on the process of
burnout.
The finding of a direct effect of health difficulties on burnout-
emotional exhaustion was also interesting, but not surprising,
considering the theoretical framework by Perlman and Hartman (1982) in
which they suggested that helping professionals' health may directly
affect the response to stress that includes burnout. In addition,
Maslach and Jackson (1981) reported that psychosomatic illness and use of
tranquilizers were significantly related to burnout-emotional exhaustion.
Health difficulties measured in this study are characterized by physical
manifestations of stress and include somatic complaints, difficulty
sleeping, eating difficulties, and drug and alcohol abuse. What is
interesting about these findings is that the reported health symptoms of
stress and their direct effect on burnout-emotional exhaustion was
significant in a relatively young group of female critical care nurses.
A possible explanation for the direct linkage of health difficulties to
burnout-emotional exhaustion is that perhaps the coping strategies used
by the critical care nurses studied were not sufficiently developed and


Page
F WORKLOAD AND STAFF SIZE 132
G HARDINESS TEST DIRECTIONS AND SAMPLE ITEMS '. 134
H COMMITMENT TO CAREER 136
I MASLACH BURNOUT INVENTORY DIRECTIONS AND SAMPLE ITEMS ... 138
J MEANS, STANDARD DEVIATIONS AND CORRELATIONAL ANALYSIS ... 140
K MULTIPLE REGRESSION OF THE FULL MODEL 158
REFERENCES 168
BIOGRAPHICAL SKETCH 177
vi


Although Pernales (1982) found a negative correlation between
burnout, income, and number of people living at home, Dames (1983) and
Pomales (1982) agreed that income was inversely associated with burnout
Grutchfield (1982) found no significant difference among nurses'
education in baccalaureate, diploma, or associate degree programs, but
Keane et al. (1985) and Stone et al. (1984) found that nurses with
baccalaureate degrees evidenced somewhat higher levels of burnout than
those with three-year diplomas. Although less education has been
associated with the occurrence of burnout in nurses (Grutchfield, 1982)
less education with fewer years of work experience tends to make the
nurse more vulnerable to burnout (Chiriboga & Bailey, 1986; Stone et al
1984). In addition, a negative correlation has been found between
burnout and a desire to remain in the field of nursing (Dames, 1983).
Personal Stressors
As indicated by the findings of Daubney (1980), Otto (1980),
Chiriboga and Bailey (1986), and Stone et al. (1984) personal stressors
may also be pertinent in the burnout process. In these studies,
undesirable personal life change events and personal stress directly
related to burnout. In addition, perception of a good quality of life
five years ago was found to be inversely related to burnout (Dames,
1983).
Personality Characteristics
Grutchfield (1982) studied the relationship between personality
variables measured by the Edwards Preference Schedule, demographic
variables, and the syndrome of burnout among nurses. Her findings
suggested that burnout emotional exhaustion was associated with the


PERSONAL VARIABLES
ORGANIZATIONAL VARIABI£S
Figure 1-1
A Perceptual-Feedback Stress Paradigm
Adapted from Perlman and Hartman (1982).


Table 3-5
Psychometric Properties of Variables: Ability and Time
Variable
Standard
Number Mean deviation
Ability
300 117.82 68.858
Time
300
139.33
103.192


81
stress, and (c) the preceding exogenous variables (10 personal variables
and 12 organizational variables). In addition, this question also
addressed which of the variables in the model contributed significantly
to the variance in job satisfaction.
Multiple regression analysis yielded an of .64, (F = 20.413;
df = 24, 275; p = .0001), indicating that 64% of the variance in job
satisfaction was explained by the variables in the regression model.
Regression results in Table 4-3 show that the personal variables
including job expectations, meaningfulness of work, knowledge of work
results, health difficulties and organizational variables including task
identity, supervision, dealing with others, opportunity for advancement,
pay and job security and the stress variable, job stress, were
significant predictors of job satisfaction.
Personal variables that did not relate significantly to job
satisfaction were ability, time, family demands, responsibility for work
outcomes, commitment to career, and psychological hardiness.
Organizational variables that did not relate significantly to job
satisfaction were workload, expected role performance and role ambiguity,
skill variety, task significance, autonomy, and support from peers at
work. The stress variable degree situation conducive to stress did not
relate significantly to job satisfaction. (See Table K-3 in Appendix K
for results of the multiple regression for all variables.)
Question 4
Question 4 addressed the significant relationship between internal
job motivation and the combination of (a) job stress, (b) situation
conducive to stress, and (c) the preceding exogenous variables. In
addition, this question also addressed which of the variables in the


36
variables of workload, expected role performance and role ambiguity. The
combination of the variables age and education are theorized by Perlman
and Hartman (1982) to represent the variable ability. The combination of
the variables marital status and life events is theorized by Perlman and
Hartman (1982) to represent the variable family demands. The variable
job expectation is theoretically viewed by Perlman and Hartman (1982) to
represent perception of growth for helping professionals. In the second
stage of stress the level of perceived job stress is a function of
personal variables of personal work needs, and personality and
organizational variables of supervision, work group norms, opportunity
for advancement and dealing with colleagues at work. In the third stage
of stress the response to stress is a function of physiological,
affective and cognitive responses manifested as burnout. This stage is
related to personal variables including commitment to career, and health
and organizational variables that include pay, support from peers,
supervision, and organizational climate and the economic and market
condition. In the fourth stage, burnout is related to work outcomes
including job satisfaction and psychological response.
The model includes a complete representation of transactional
processes including personal characteristics, organizational
characteristics, the degree to which a situation is likely to be
stressful, perception of organizational job stress, and response to job
stress in understanding the etiology of burnout. Although the
conceptualization of burnout offered by Perlman and Hartman (1982) is
fairly comprehensive there are limitations with respect to the
operationalization of two variables labelled personal work needs and work
group norms. Multiple indicators need to be used to operationalize these


5
that Perlman and Hartman (1982) conceptualized each variable as affecting
only the next continguous variable in the model. They did not allow for
the possibility of some variables having direct or indirect causal
relationships to more than one outcome variable. From their discussion
of the burnout model, it seems likely that Perlman and Hartman (1982)
were unaware of how systems of linear regression equations can be
specified using path analysis (or causal modeling) to test a theoretical
model. Such an empirical test of a transactional model of burnout seemed
to call for obtaining measures on a fairly wide array of personal and
organizational variables entering them into multiple regression and path
analysis to permit the assessment of both direct and indirect effects of
independent variables on outcome variables.
Purpose of the Study
The purpose of this study was to collect data to develop and refine
a theoretical model of burnout for critical care nurses using variables
identified from research literature. The first stage of the study
involved an extensive literature review to identify variables that had
been studied by others in relationship to burnout. Table 1-1 contains a
summary of variables that were identified in the literature review for
this study that are posited to have a meaningful relationship in the
process that leads to job burnout. As will be indicated in Chapters II
and III, multiple indicators have been used to operationalize the
variables labelled as Personal Work Needs and Work Group Norms in
Table 1-1.
The second stage of the study required depicting the relationships
among the variables in a path diagram. The path diagram in Figure 1-2
graphically displays the pattern of hypothesized relationships among a


83
model contributed significantly to the variance in internal job
motivation.
Multiple regression analysis yielded an r2 of .54, (F = 13.552;
df = 24, 275; p = .0001), indicating that 54% of the variance of internal
job motivation was explained by the variables in the regression model.
Regression results in Table 4-4 show that the personal variables
including family demands, meaningfulness of work, responsibility for work
outcomes, commitment to career and health difficulties and organizational
work variables including autonomy, dealing with others, support from
peers at work and the stress variable situation conducive to stress were
significant predictors of internal work motivation.
Personal variables that did not relate significantly to internal job
motivation were ability, time, job expectation, knowledge of work
results, and psychological hardiness.
Organizational variables that did not relate significantly to
internal job motivation were workload, expected role performance and role
ambiguity, skill variety, task identity, task significance, supervision,
opportunity for advancement, pay, and job security. The stress variable
that did not relate significantly to internal job motivation was job
stress. (See Table K-4 in Appendix K for results of the multiple
regression for all variables.)
Question 5
Question 5 addressed the significant relationship between burnout-
emotional exhaustion and the combination of (a) job satisfaction,
(b) internal work motivation, (c) job stress, (d) situation conducive to
stress, and (d) the preceding exogenous variables. In addition, this
question also addressed which of the variables in the model contributed
significantly to the variance in burnout-emotional exhaustion.


89
Table 4-6continued
Effect
Variables Direct Indirect Total
On General Job Satisfaction
Degree situation conducive
to stress
NE
-.039
-.039
Level of perceived
job stress
-.106
NE
-.106
Family demands
NE
-.060
-.060
Job expectations
-.115
NE
-.115
Meaningfulness for work
.290
NE
.290
Knowledge of work
results
.100
NE
.100
Health difficulties
.193
-.021
.172
Psychological hardiness
NE
.004
.004
Skill variety
NE
-.002
-.002
Task identity
.096
NE
.096
Supervision
.237
.019
.256
Dealing with others
-.216
NE
-.216
Opportunity for
advancement
.196
NE
.196
Pay
.170
-.008
.162
Job security
-.099
.014
-.085
On Burnout-Emotional
Exhaustion
General job satisfaction
-.334
NE
-.334
Level of perceived job
stress
NE
.035
.035


Table K-lcontinued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
.049
L .148
.2520
Opportunity for advancement
-.008
-0.135
.8925
Pay
.0006
.015
.9880
Support from peers at work
-.017
-.357
.7216
Job security
-.070
-1.843
.0664*
R2 = .717 (f = 31.948, p = .0001)
159


66
peer and coworker satisfaction correlated with high scores on emotional
exhaustion and depersonalization, and low on personal accomplishment.
Additional studies have linked burnout to outcomes of stress
including increased use of alcohol, drugs, and insomnia. Individuals
scoring high on emotional exhaustion were also rated as having problems
with insomnia. Police officers in one study were more likely to describe
having a drink to cope with stress if they had high scores on emotional
exhaust-ion. If they scored low on personal accomplishment they were
likely to report using tranquilizers.
Finally, further research determining the discriminant validity of
the MBI has been performed in order to distinguish burnout from measures
of other psychological constructs that might be assumed to be confounded
with burnout. Scores from the general satisfaction subscale measured by
the JDS and scores of the MBI has a moderate negative correlation, -.23
(emotional exhaustion); -.22 (depersonalization as well as slightly
positive correlations with personal accomplishment (.17). Low
correlations between burnout subscale scores and other measures of job
satisfaction have been reported in other studies as well.
The MBI appears to be the best scale available in measuring burnout.
It is a well constructed instrument and the validity and reliability data
are sufficient to provide meaning and stability of the construct.
Use in this study. The variable burnout-emotional exhaustion was
measured with the Maslach Burnout Inventory on the basis that burnout was
defined as a syndrome with three dimensions: emotional exhaustion,
depersonalization, and personal accomplishment and this measure is
consistent with that definition. In addition, the use of the Maslach
Burnout Inventory permits some comparability between studies among
helping professionals including nurses because it is widely used.


109
present study of critical care nurses. Further study of the structural
arrangement of these variables is indicated among other helping
professions.
In this present study, the organizational variable, satisfaction
with the opportunity for advancement, was measured as the degree to which
the nurse is satisfied with the opportunity for personal growth and
development in the job. The findings indicate a direct causal link
between satisfaction with the opportunity for advancement and job
satisfaction. This finding is not surprising because promotional
opportunity has been identified as a common predictor of job satisfaction
in other studies (Jayaratne & Chess, 1983). The structural relationship
suggested by this study has support from the literature and makes
theoretical sense.
In this present study, the organizational characteristic, job
security, was measured as the amount of perceived job security. Its
direct inverse effect on job satisfaction is confusing and difficult to
interpret. Low job security causing job satisfaction is an
uninterpretable finding. In reviewing the zero order correlational
table, although the correlational coefficient between the variables job
security and job satisfaction is positive (.17), following path analysis
the path coefficient converted to a low negative value (-.099). This may
simply have been a function of sampling error.
One feature that clearly stands out is that whereas 62 percent of
the total variance is explained by the personal and organizational
variables and job stress in the determination of job satisfaction, only


64
one's own clients occurs. A third aspect of the burnout syndrome is
reduced personal accomplishment, which refers to the tendency to evaluate
oneself negatively, especially with regard to one's work with patients.
Helping professionals may feel unhappy about themselves and dissatisfied
with their accomplishments on the job. The MBI is designed to measure
the three components of burnout. Each aspect is measured by a separate
subscale. The Emotional Exhaustion subscale assesses feelings of being
emotional, over extended, and exhausted by one's work. The
Depersonalization subscale measures an unfeeling and impersonal response
towards recipients of one's service, care, treatment, or instruction.
The Personal Accomplishment subscale assesses feelings of competence and
successful achievement in one's work with people. Each scale further
includes an expression of frequency using a six-point response format.
The MBI consists of a total of 22 items.
Psychometric Properties of MBI
Reliability. Reliability coefficients of internal consistency
ranged from .71 to .90. Test retest reliability (2-4 weeks apart) ranged
from .82 to .53. Standard errors of measurement ranged from 3.16 to
4.99. Reliability estimates, therefore, appear sufficient. The internal
consistency of the emotional exhaustion subscale on the sample in this
study was .72.
Validity. Convergent validity was determined in a variety of ways.
First, behavioral ratings made by an acquaintance of the individual such
as a coworker or a spouse were correlated with MBI scores. The validity
of the job is demonstrated further in studies confirming hypotheses about
the relationships between various job characteristics and experienced
burnout. In one study, it was predicted that the greater number of
clients one must care for, the higher the burnout scores on the MBI
(Maslach & Pines, 1977; Maslach & Jackson, 1982, 1984a-b).


68
Table 3-9
Psychometric Properties of Variables; Commitment and Workload
Variable
Number
Mean
Standard
deviation
Alpha
Commitment
300
3.537
1.357
NE
Workload
300
4.097
.8038
NE
NE = Not estimated


61
support from others, organizational climate and the economic-market
condition, general job satisfaction and psychological response to burnout
(internal work motivation) were measured with the JDS on the basis that
the scale contained measures that closely resembled the variables used in
this study. In addition, critical care nursing faculty, critical care
graduate nursing students, and two top nursing managment members of two
critical care intensive care units of a regional hospital were asked to
rate and evaluate this scale for use in this study. On the basis of
their judgement, and the decision of this researcher, use of the JDS as a
measure of the personal and organizational variables seemed justified.
Appendix E contains instrument directions and sample items.
Psychological Hardiness Test
Description. Hardiness is defined as a learned ability to cope with
a wide variety of stressful situations in such a way that the stresses
are transformed to a positive outlook, or negative stresses, that cannot
be realistically transformed, are met with a plan to eliminate them.
Another way of describing "hardiness" is transformational coping which is
a learned process. The amount of hardiness one has acts as a buffer to
keep stress from changing into strain, and strain from changing into
illness. A sample item of the Psychological Hardiness Test includes, "I
often wake up eager to take up my life where it left off the day before."
The measurement of hardiness consists of 50 rating-scale items developed
by Kobasa, Maddi, Donner, Merrick, and White (1984). The 50 items were
derived from a factor analysis of six existing personality scales which
have been used to measure commitment, control, and challenge dimensions
of hardiness. The Hardiness Test was standardized on a population of 223
women and 1511 men who for the most part were professionalsbusiness
executives, lawyers, white collar professional.


Table K-5continued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
.1858
2.835
.0049*
Opportunity for advancement
-.0257
-.286
.7754
Pay
-.0046
-.075
.9400
Support from peers at work
-.0756
-1.094
.2749
Job security
-.1101
-2.183
.0299
Job stress outcomes
Job satisfaction
-.3125
3.995
.0001*
Internal job motivation
.0841
1.214
.2258
Stress variables
Job stress
.0328
.362
.7180
Degree situation conducive to stress
.1209
1.275
.2033
R2 = .4132 (F = 7.394
P
0001)


173
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115
test of the model using data based on self-report measures collected at a
single point in time makes it difficult to identify the causal
relationships between personal variables and organizational variables,
situation conducive to stress, job stress, job satisfaction and
burnout-emotional exhaustion. Such cross-sectional data make it
difficult to determine the effects of stressors and moderators in the
model. A more definitive determination of both causal effects and
moderating effects would require that further studies employ longitudinal
designs. Third, the identification and refined measurement of critical
personal and organization variables that might increase the explanatory
power of the burnout model should be an ongoing attempt balanced with
efforts to achieve parsimony of the explanation of burnout. In addition,
as evidenced in the results of the burnout model among critical care
nurses additional variables need to be identified and included in the
model because the indicated that the variables in the model account
for only 38 percent of the variance in burnout-emotional exhaustion. For
example, individual coping techniques, actual work performance and
turnover intentions might be other candidates for incorporation into the
model of burnout. Furthermore, subgrouping differences among the
critical care nurses sampled within the nine hospitals studied may be
great and reflect idosyncracies within organizational systems. For
example, the findings might reflect a very different kind of worker
burnout related to nursing administration burnout, i.e., a burned out
system. Fourth, an assumption of path analytical techniques is that
there is no measurement error. Although established instruments were


52
affective reactions of employees to the work setting and the job, and the
need of the individual for growth. The scale is appropriate for grades 8
and over. The subjects respond to a seven-point response scale used
throughout the instrument.
The JDS yields scores on 18 subscales. All 18 of these subscales
were used as measures of variables in the present study. Table 3-7
relates JDS subscales to variables and gives sample items. The JDS
provides measures of the five core work dimensions which include skill
variety, task identity, task significance, autonomy and feedback from the
job itself. Two additional measures are included for two supplementary
dimensions which include feedback from agents and dealing with others.
They are defined as follow:
Skill variety is the degree to which a job requires a variety of
different activities in carrying out the work, which involve the use
of a number of different skills and talents of the employee.
Task identity is the degree to which the job requires completion of
a "whole" and identifiable piece of worki.e., doing a job from
beginning to end and with a visible outcome.
Task significance is the degree to which the job has a substantial
impact on the lives or work of other peoplewhether in the
immediate organization or on the external environment.
Autonomy is the degree to which the job provides substantial
freedom, independence, and discretion of the employee in scheduling
the work and in determining the procedures to be used in carrying it
out.
Feedback from the job itself is the degree to which carrying out the
work activities required by the job results in the employee


76
Organizational work characteristics. Organizational work variables
consisted of workload (workload and staff size), expected role
performance and role ambiguity, work group norms (skill variety, task
identity, task significance, autonomy), dealing with colleagues (dealing
with others at work), supervision, opportunity for advancement, pay,
support from others at work (social support satisfaction), organizational
climate and the economic-market condition (job security) measured with
the Job Diagnostic Survey.
As shown in Appendix J, the zero-order coefficient of correlation
between all the endogenous variables and expected role performance and
role ambiguity, supervision, opportunity for advancement and support from
peers at work were significant. Skill variety was significantly related
to all endogenous measures except situation conducive to stress and
burnout-emotional exhaustion. Task identity was significantly associated
with all the endogenous measures. The correlation of task significance
was significantly related to job satisfaction and internal job
motivation. Autonomy was significantly related to the situation
conducive to stress, job stress, and internal work motivation. Dealing
with others at work was significantly associated with all the dependent
variables. With the exception of the situation conducive to stress, and
internal work motivation, pay was significantly associated with the
endogenous measures. Job security was significantly related inversely to
burnout-emotional exhaustion, and positively related to job
satisfaction.
Endogenous Variables
Endogenous variables consisted of situation conducive to stress, job
stress, job satisfaction, internal job motivation, and burnout-emotional
exhaustion


DEMOGRAPHIC SHEET AND WORK SURVEY
1.Age (check one):
Under 20 40-49
20-29 50-59
30-39 60 or over
2. Marital status (circle one):
1 = single
3 = separated
3. Education (check one):
ADN
Some graduate work
2 = married
4 = divorced
BSN
Diploma
4. How long have you worked as a staff nurse in critical care?
Number of months and/or years
5. How long have you worked as a staff nurse at this institution?
Number of months and/or years
6. How many hours do you work on the average per week in the ICU?
Hours per week
124


CHAPTER II
REVIEW OF THE LITERATURE
Derivation of the Concept Burnout
The concept "burnout originated from stress research. There are
many publications reviewing varied definitions of the concept of stress
(Antonovsky, 1979; Cannon, 1932; Lazarus, 1966; Mason, 1975; Selye, 1956;
Selye, 1974; Sharit & Salvendry, 1982; Vachon, 1987). In an early
definition, Cannon (1932) reflected upon the physiological aspect of
stress and related it to society and job organizations. Selye (1956)
broadened the physiological concept of stress even further.
Selye's (1956) work was based upon earlier research of Cannon that
included homeostasis adaptations. His identification of body hormones in
the "fight or flight" mechanism for maintenance of homeostasis focused on
protective maneuvers in physical, social, or chemical situations that
elicited a physiological response. He defined stress as "the
non-specific response of the body to any demand made upon it" (Selye,
1974, p. 141) and stressors as any stimuli that cause physiological
adaptation. If stress results in positive effects, it is identified as
eustress; stress associated with negative results is distress.
Furthermore, he classified physiological adaptation to stress into three
stagesalarm, resistance, and exhaustionand referred to this process
as the general adaptation syndrome. The alarm phase consists of
neurohormonal mechanisms that prepare the body for defense against an
adaptation caused by stressors. The second phase, the resistance phase,
14


8
set of personal exogenous variables, a set of organizational exogenous
variables, and a series of endogenous outcome variables. An exogenous
variable is defined as a variable that has variability due to causes
outside the model, when the analysis of the cause of an exogenous
variable is not under consideration in the model (Asher, 1976). It is
not the purpose of a path analysis to explain the variability of an
exogenous variable or its relations with other exogenous variables.
An endogenous variable is a variable that has variance contributed
to it by exogenous or other endogenous variables in the model (Asher,
1976). The endogenous variables under study in the path analytical model
include the degree to which a situation is conducive to stress, job
stress, job satisfaction, internal work motivation, and burnout.
Unidirectional arrows or paths have been drawn from the exogenous causes
to the endogenous effects. The causal flow in the burnout model under
study is recursive or unidirectional. Some endogenous variables are
treated as dependent variables in one set of analyses and independent
variables in relation to other variables. For example, the degree to
which a situation is conducive to stress is a dependent variable for one
set of variables and an independent variable for job stress. To simplify
the visual presentation, the personal and organizational variables have
been grouped in boxes, and arrows have been drawn from the boxes to
represent direct effects of each exogenous variable in the boxes in the
left column on the respective endogenous variables. Typically curved
arrows are used to indicate correlations among exogenous variables. In
Figure 1-2, these curved arrows were not shown to allow the model to be
depicted more clearly


57
Table 3-8
Psychometric Properties of Variables: Job Diagnostic Survey
Standard
Variable
Number
Mean
deviation
Alpha
Job expectations
(Total growth
strength need)
300
4.103
2.446
.714
Meaningfulness of
work
300
5.750
.844
.669
Responsibility for
work outcomes
300
5.750
.653
.680
Knowledge of work
results
300
5.000
.946
.679
Expected role
performance and
role ambiguity
(Feedback from the
job itself and
feedback from
agents on the
job)
300
4.668
.898
.670
Skill variety
300
5.916
.818
.675
Task Identity
300
4.212
1.112
.691
Task
significance
300
6.152
.772
.684
Autonomy
300
5.090
.905
.689
Supervision
300
4.950
1.270
.677
Dealing with others
at work
300
6.116
.707
.700
Opportunity for
advancement
300
5.459
.893
.661
Pay satisfaction
300
3.903
1.608
.693


APPENDIX C
DEMOGRAPHIC SHEET AND WORK SURVEY


41
Table 3-1
Characteristics of Critical Care Staff Nurses:
Sex, Age, and Education (N = 300)
Characteristics
Number
Percent
Sex:
Female
300
100.0
Marital Status:
Single
71
23.7
Married
188
62.7
Separated
6
2.0
Divorced
35
11.7
Total
300
100.1
Age:
20 29
96
32.0
30 39
129
43.0
40 49
60
20.0
50 59
14
4.7
60 or over
1
0.3
Total
300
100.0
Education:
ADN
149
50.0
BSN
102
34.0
Diploma
31
10.3
Some graduate work.
18
6.0
Total
300
100.3


Table 3-3
Years of Experience as a Critical Care Staff Nurse at the
Present Institution
Number of years
Number
Percent
6 months or less
16
5.3
7 months 1 year
29
9.7
13 months 2 years
60
20.0
2-5 years
97
32.3
5-10 years
74
24.7
10 15 years
16
5.3
15 20 years
7
2.3
20 25 years
1
.3
Total
300
100.0


53
Table 3-7
Job Diagnostic Survey Subscales, Related Variables and
Sample Items
Variable in
Subscale this study
Sample Item
Total growth Job expectations
need strength
Meaningfulness Personal work needs
of work
"Indicate the degree to
which you would care to
have this characteristic
present in your job; e.g.,
opportunities for personal
growth and development in
my job."
"Most of the things I have
to do on this job seem
useless or trivial to me."
Responsibility
for work
outcomes
Knowledge of
work results
Feedback from Expected performance
the job itself and role ambiguity
Feedback from
agents on the job
Skill variety Work group norms
Task identity
"I feel a very high degree
of personal responsibility
for the work I do on this
job.
"Most people on this job
have trouble figuring out
whether they are doing a
good or a bad job."
"Just doing the work
required by the job
provides may choices for me
to figure out how well I am
doing.
"Supervisors often let me
know how well they think I
am performing on the job."
"The job requires one to
use a number of complex or
high-level skills."
"The job provides me the
chance to completely finish
the pieces of work I
begin."


APPENDIX F
WORKLOAD AND STAFF SIZE


169
Constable, S., & Russell, A. (1986, Spring). The effect of social
support and the work environment upon burnout among nurses. Journal of
Human Stress, 4_, 20-26
Cooper, C. (1986). Job distress: Recent research and the emerging role
of the clinical occupational psychologist. Bulletin of the British
Psychological Society, 39, 325-331.
Costello, T. W., & Zalkind, S. S. (Eds.). (1963). Psychology in
administration: A research orientation. Englewood Cliffs, NJ:
Prentice-Hal1.
Courage, M. & Williams, D. (1987). An approach to the study of burnout
in professional care providers in human service organizations. Journal
of Social Service Research, 10( 1), 7-22.
Cox, T., & Mackay, C. (1981). A transactional approach to occupational
stress. In E. Corlett & J. Richardson (Eds.), Stress, work design and
productivity (pp. 127-141. Chicago: Wiley.
Cronin-Stubbs, D., & Rooks, C. A. (1985). The stress, social support
and burnout of critical care nurses. The Results of Research, 14,
31-39.
Daley, M. R. (1979). Burnout: Smoldering problem in protective
services. Social Work, 24(5), 375-379.
Dames, K. A. (1983). Relationship of burnout to personality and
demographic traits in nurses (Doctoral dissertation, City University of
New York). Dissertation Abstracts International, 44, 1588B.
Daubney, J. H. (1980). Stress and styles of coping with newborn death
among nurses in a neonatal intensive care unit (Doctoral dissertation,
University of Akron). Dissertation Abstracts International, 41,
1088B.
Delongis, A., Folkman, S., & Lazarus, R. S. (1988). The impact of daily
stress on mood: Psychological and social resources as mediators.
Journal of Personality and Social Psychology, 54, 486-495.
Derogotis, L. R., Lipman, R. S., Eickels, K., Uhlenhuth, E. H., &
Covi, L. (1974). The Hopkins Symptoms Checklist (HSC1): A
self-report symptom inventory. Behavioral Science, 19, 1-15.
Des, E. B. (1981). Contributing factors to burnout in the nursing
environment. Dissertation Abstracts International, 42, 1393 B.
(University Microfilm, No. AA D811352)
Edelwich, J., & Brodsky, A. (1980). Burnout: Stages of disillusionment
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Eisenstat, R. A., & Felner, R. D. (1983). Organizational mediators of
the quality of care: Job stressors and motivators in human service
settings. In B. Farber (Ed.), Stress and burnout in the human service
professions (pp. 142-154). New York: Pergamon Press.


49
Validity In reference to construct validity, an important
relationship has been explored between hassles and life events scores and
the treatment of both as indicators of psychological stress. Kanner et
al. (1981) provide the strongest evidence for construct validity of the
Daily Hassles Scale in order to explain psychological symptoms and
symptoms of somatic illness and emotional distress. His group found that
the hassles scores were strongly related to both affective distress and
psychological symptoms (.34). The Hopkins Symptom Checklist (HSC1)
(Derogotis et al., 1974) correlated between .5 and .6 with the Daily
Hassles Scale. Delongis et al. (1988) correlated hassles and somatic
health status as dependent variables and found that daily hassles
explained more variance than did life events.
Lazarus and Folkman (1989) performed a factor analysis of the Daily
Hassles Scale, using the principal factor method with oblique rotation
and generated eight factors: future security, time pressure, work,
household responsibilities, health, inner concerns, financial
responsibility, and neighborhood and environmental concern.
Use in the study. The personal variables family demands, health,
the situational stress and job stress variables were measured with the
Daily Hassles Scale on the basis that the scale contained factors that
corresponded to the variables used in this study. Family demands were
measured with the Daily Hassles Scale, items 1-4, 7-15, 19-23, 29, 35-38,
43, 45, 55, 58-59, 61-64, 70, 71, 73-76, 78-79, 82, 87, 90, 92-93,
103-108, and 110-112 that corresponded to three factors: household
responsibilities, financial responsibility and neighborhood and
environmental concern (Lazarus & Folkman, 1989).


Table K-2continued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
.0105
.254
.8000
Opportunity for advancement
.0109
.185
.8532
Pay
.101
2.549
.0114*
Support from peers at work
-.0545
-1.203
.2 299
Job security
-.0990
-2.685
.0077*
Stress variable
Situation conducive to stress
.3652
6.262
.0001*
R2 = .735 (F = 33.222
P
0001)


50
Health was measured with the Daily Hassles Scale, items 16-18, 48,
49, 50, 53, 54, 56, 77, 91, and 98 that corresponded to the health factor
(Lazarus & Folkman, 1989).
The degree to which the situation was conducive to stress was
measured with items 5, 6, 24-26, 39-42, 44, 46-47, 51-52, 57, 60, 67-69,
85, 88-89, 94-97, 99-101, 109, 113-117, of the Hassles Scale that
corresponded to the three factors inner concerns, future security, and
time pressure (Lazarus & Folkman, 1989).
The level of perceived job stress was measured with items 27-28,
30-34, 65, 66, 72, 80-84, 86, and 102 pertaining to work hassles of the
Hassles Scale (Lazarus & Folkman, 1989).
Critical care nursing faculty, critical care graduate nursing
students, and two top nursing management members of two critical care
intensive care units of a regional hospital were asked to rate and
evaluate this scale for use in this study. On the basis of the
reliability and validity data available, use of the Daily Hassles Scale
as a measure of family and life demands, health, situation conducive to
stress, and work stress seemed justified. The means, standard deviations
and coefficient alpha estimates for the variables for the sample used in
the present study are presented in Table 3-6. Appendix D contains
instrument directions and sample items.
Job Diagnostic Survey (JDS)
Description. The JDS is composed of 83 items used to diagnose
existing jobs to determine if and how they might be redesigned to affect
employee motivation and performance and to evaluate the effects of job
changes on employers. The measure is based on a theory of how a job
affects worker motivation and provides measures of objective job
dimensions, individual psychological states related to these dimensions,


158
Table K-l
Multiple Regression of Degree Situation Conducive to Stress on the
Variables Within Each Block of Characteristics
Block
Variable
Standard
coefficient
t-value
p value
Personal
Ability
074
1 .010
.3132
characteristics
Time
r^
O

1
-1.454
.1471
Family demands
.621
12.180
.0001*
Job expectations
.033
0.974
.3308
Meaningfulness of work
-.038
-0.803
.4225
Responsibility for work outcomes
.030
.774
.4393
Knowledge of work results
-.074
-1.573
.1168
Health
.206
4.118
.0001*
Commitment to career
1

o
H
v£>
-0.532
.5950
Psychological hardiness
-.086
-2.087
.0378*
Organizational work
Workload
.013
.389
.6978
characteristics
Expected role performance and role ambiguity
.0 24
.531
.5959
Skill variety
.102
2.281
.0233*
Task identity
-.011
-0.296
.7675
Task significance
-.025
-.694
.4884
Autonomy
-.008
-.207
.8358
Supervision
-.036
-.762
.4496


174
Maslach, C., & Jackson, S. E. (1982). Burnout in health professions: A
social psychological analysis. In G. Sonders & J. Sals (Eds.), Social
psychology of health and illness (pp. 38-54). Hillsdale, NJ:
Erlbaum.
Maslach, C., & Jackson, S. E. (1984a). Burnout in organizational
settings. Applied Social Psychology Annual, 135-153.
Maslach, C., & Jackson, S. E. (1984b). Patterns of burnout among a
national sample of public contact workers. Journal of Health and Human
Resources Administration, 7_, 189-212.
Maslach, C., & Jackson, S. E. (1986). Maslach Burnout Inventory manual.
Palo Alto, CA: Consulting Psychologists Press.
Maslach, C., & Pines, A. (1977). The burn-out syndrome in the day care
setting. Child Care Quarterly, j6, 100-113.
Mason, J. W. (1975). A historical view of the stress field: Part 1.
Journal of Human Stress, _1_(2), 22-36.
Matteson, M. T., & Ivancevich, J. M. (1979). Organizational stressors
and heart disease: A research model. Academy of Management Review, 4,
347-357.
Mayo, E. (1945). The social problems of an industrial civilization.
Cambridge, MA: Harvard University Press.
McCranie, E. W., Lambert, V. A, & Lambert, E. F. (1987). Work stress,
hardiness and burnout among hospital staff nurses. Nursing Research,
36(6), 374-378.
Meadow, K. P. (1981). Burnout in professionals working with deaf
children. American Annals of the Deaf, 126( 1) 13-20.
Nancevich, J. M., & Matteson, M. T. (1980). Stress and work: A
managerial perspective. Glenview, IL: Scott, Foresman.
Nowack, K. M., & Hanson, A. L. (1983). The relationship between stress,
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employees respond positively to enriched work. Journal of Applied
Psychology, 61(4), 395-403.


31
involvement was the most important variable and explained the greatest
proportion of variance in burnout suggesting that when staff nurses feel
a low involvement in work, they are most at risk of burnout (Chiriboga &
Bailey, 1986). Burnout has been shown to be related to the type of unit.
There is evidence that units that provide fewer demands on the nurse may
potentiate a condition leading to Burnout (Chiriboga & Bailey, 1986). In
addition, nurses who work in the private hospital are more likely than
nurses employed by a district hospital to report burnout (Chiriboga &
Bailey, 1986).
Researchers have found that more hours worked and more hours of
direct patient contact increased the risk of burnout (Dames, 1983; Des,
1981). In addition, they also stated that the more hours working with
patients with grave prognoses, the higher the burnout scores.
The results offered by Constable and Russell (1986) suggested that
job enhancement was significantly correlated with burnout. This finding
indicates that nurses are more susceptible to burnout when working in
environments where there is a lack of variety and new approaches, there
is a lack of encouragement to be self-sufficient, rules and policies are
not clearly communicated, tasks are not clearly understood, and the work
environment is not considered comfortable and attractive. In addition,
work pressure was also positively associated with burnout-emotional
exhaustion. Critical care nurses experiencing burnout perceive the
critical care environment with little support and the events within the
unit as a threat. Consequently, the critical care nurse expects the
worst (Stone et al., 1984).


APPENDIX K
MULTIPLE REGRESSION OF THE FULL MODEL


171
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occupational stress and burnout research. Human Relations, 41(5),
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professions (pp. 46-62). New York: Pergamon.
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and satisfaction: Models, measures and management. In H. H. Werley &
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Hinshaw, A., Smeltzer, C., & Atwood, J. (1987). Innovative retention
strategies for nursing staff. Journal of Nursing Administration,
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comparison of organizational stress and burnout among teachers and
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the burnout phenomenon. Journal of Applied Psychology, 71(4),
630-640.


51
Table 3-6
Psychometric Properties of Variables: Dally Hassles Scale
Variable
Number
Mean
Standard
deviation
Alpha
Family demands
300
.751
.408
.701
Health
300
.501
.396
.699
Situational stress
300
.717
.387
.703
Job stress
300
.659
.427
.714


22
23
24.
Support from peers
0.66214
0.12324
from work
0.0001
0.0329
25.
Job security
0.31387
0.35290
0.0001
0.0001
1.
Degree situation conducive
-0.11658
0.10762
to stress
0.0436
0.0627
2.
Level of perceived
-0.23151
0.12311
job stress
0.0001
0.0330
3.
Emotional exhaustion
-0.32576
-0.21749
0.0001
0.0001
4.
Depersonalization
-0.332330
-0.12746
0.0001
0.0273
5.
Personal accomplishment
0.24659
0.10522
0.0001
0.0688
6.
Job satisfaction
0.61746
0.40161
0.0001
0.0001
7.
Internal job
0.42007
-0.03840
motivation
0.0001
0.5076
4
5
1.
Ability
-0.02813
-0.00901
0.6275
0.8765
2.
Time
-0.05497
0.00635
0.3427
0.9128
24
25
1.00000
0.22085
0.0
0.0001
0.22085
1.00000
0.0001
0.0
0.14462
-0.04682
0.0122
0.4191
0.26936
-0.10396
0.0001
0.0722
0.22639
-0.16897
0.0001
0.0033
0.26452
-0.02339
0.0001
0.6866
0.23659
0.14211
0.0001
0.0137
0.42478
0.17348
0.0001
0.0026
0.44875
0.03122
0.0001
0.5902
6
7
0.06026
0.06270
0.2982
0.2790
0.06385
0.05951
0.2703
0.3042
1
2
-0.14462
-0.26936
0.0122
0.0001
-0.04682
-0.10396
0.4191
0.0722
1.00000
0.78169
0.0
0.0001
0.78169
1.00000
0.0001
0.0
0.26221
0.28319
0.0001
0.0001
0.21501
0.25697
0.0002
0.0001
-0.10521
-0.11292
0.0688
0.0507
-0.01077
-0.11343
0.8526
0.0497
-0.13188
-0.26063
0.0223
0.0001
3
-0.22639
0.0001
-0.16897
0.0033
0.26221
0.0001
0.28319
0.0001
1.00000
0.0
0.60774
0.0001
-0.29516
0.0001
-0.42493
0.0001
-0.04243
0.4641
153


APPENDIX B
PROCEDURES FOR ADMINISTRATION


Table J-3
Correlation Analysis for Exogenous and Endogenous Variables
1
2
3
1.
Ability
1.00000
0.89440
0.04366
0.0
0.0001
0.4512
2.
Time
0.89440
1.00000
0.01008
0.0
0.0
0.8620
3.
Family
0.04366
0.01008
1.00000
demands
0.4512
0.8620
0.0
4.
Job
-0.02178
0.01052
-0.07389
expectations
0.7072
0.8560
0.2019
5.
Meaningfulness
0.10422
0.09824
-0.05672
of work
0.0715
0.0894
0.3276
6.
Responsibility for work
0.07600
0.07119
-0.04572
outcomes
0.1893
0.2189
0.4301
7.
Knowledge of work
0.03750
0.07315
-0.32342
results
0.5176
0.2064
0.0001
8.
Commitment
-0.15944
-0.16250
-0.02536
to career
0.0056
0.0048
0.6617
9.
Health
-0.018913
-0.04861
0.74082
0.7545
0.4015
0.0001
10.
Commitment
-0.04229
-0.03446
-0.40811
0.4656
0.5522
0.0001
11.
Control
0.00491
0.00628
-0.45914
0.9325
0.9138
0.0001
4
5
6
7
-0.02178
0.10422
0.07600
0.03750
0.7072
0.0715
0.1893
0.5176
0.01052
0.09824
0.07119
0.07315
0.8560
0.0894
0.2189
0.2064
-0.07389
-0.05672
-0.04572
-0.32342
0.2019
0.3276
0.4301
0.0001
1.00000
-0.09955
-0.09524
0.14481
0.0
0.0852
0.0997
0.0120
-0.99559
1 .00000
0.46875
0.49537
0.0852
0.0
0.0001
0.0001
-0.09524
0.46875
1.00000
0.33132
0.0997
0.0001
0.0
0.0001
0.14481
0.49537
0.33132
1.00000
0.0120
0.0001
0.0001
0.0
0.07881
0.22048
0.17508
0.19506
0.1734
0.0001
0.0965
0.0007
-0.08136
0.02629
-0.02759
-0.2b371
0.1598
0.6501
0.6341
0.0001
0.04871
0.23368
0.13445
0.37583
0.4006
0.0001
0.0198
0.0001
0.06427
0.18148
0.07654
0.38735
0.2671
0.0016
0.1861
0.0001
o
ro


CHAPTER I
INTRODUCTION
Background of the Problem
The empirical study of job stress in the helping professional,
frequently termed "burnout" (Freudenberger, 1974; Maslach, 1976; Maslach
& Jackson, 1986), has provided valuable information and insight into this
phenomenon over the last 15 years. Freudenberger (1974) first described
burnout as a state of physical and emotional depletion resulting from
conditions at work. Maslach (1976) claimed that "burned out"
professionals "lose all emotional feelings for the persons they work with
and come to treat them in detached or even dehumanized ways (p. 16).
Freudenberger and Richelson (1980) later described burnout as a "sense of
fatigue or frustration brought about by devotion to a cause, a way of
life, or relationship that failed to produce the expected reward"
(p. 13). Edelwich and Brodsky (1980) further defined it as a
"progressive loss of idealism, energy, purpose, and concern as a result
of conditions of work" (p. 14), and Pines, Aronson, and Kafry (1981)
added that it is "characterized by physical depletion, by feelings of
helplessness and hopelessness, by emotional drain, and by the development
of negative self-concepts and negative attitudes toward work, life, and
other people. ... It is a sense of distress, discontent, and failure in
the quest for ideals" (p. 15). Thus, although the concept of burnout has
been defined in many ways, there is general consensus that the symptoms
include attitudinal, emotional, and physical components (Freudenberger,
1974; Maslach, 1976; Maslach & Jackson, 1986).
1


27
following personality variables: nurturance, abasement, achievement, and
succorance. In addition these variables were found to be negatively
correlated with a dimension of burnout-personal accomplishment.
Dames (1983) explored the relationship between selected personality
characteristics, demographics, and burnout, using the Spielberger Trait
Anxiety Index, the Gough Adjective Checklist, and the Maslach Burnout
Inventory. The personality traits of intraception and nurturance had
negative correlations with burnout; abasement, aggression and anxiety had
positive correlations with burnout. Autonomy had no significant
relationship with burnout. Pomales (1982) reported an inverse
relationship between self-concept and burnout.
Keane et al. (1985) and McCranie et al. (1987) explored the
relationship of psychological hardiness, demographics, and burnout using
the Hardiness Test (Kobasa et al., 1984). They presented data supporting
the hypothesis that hardiness may be an important personality variable
based resistance resource for preventing burnout among hospital nurses.
They compared samples of staff registered nurses working in intensive
care units and non-intensive care units of a large metropolitan hospital.
Burnout consistently was negatively correlated with psychological
hardiness. This finding supports hardiness as a generalized resistance
resource for nurses working in diverse patient care settings.
Social Support
Effective social support systems are consistently recommended as a
means of coping with job-related stress and preventing burnout. In 1982,
Kimmel reported that nurses who perceived greater emotional support than-


JOB BURNOUT AMONG CRITICAL CARE NURSES
By
JOYCE K. STECHMILLER
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA

Copyright 1990
by
Joyce Kolbek Stechmiller

ACKNOWLEDGEMENTS
I wish to express my deepest love and appreciation to my husband,
Bruce, and my children, Stephanie and Christopher, for their support,
understanding and constant love. Also to my mother and father and
Kate Stechmiller I extend my thanks for their moral support and
encouragement.
I would also like to thank the faculty of the University of Florida,
with special thanks to Dr. Hannelore Wass, chairman of my supervisory
committee, and supervisory committee members, Drs. Linda Crocker, Robert
Ziller, and Barry Guinagh, who contributed greatly to the completion of
the dissertation. Special appreciation goes to Dr. Hussein Yurandi for
his assistance with the statistical analyses.
My special thanks go to Donna Hall and Dan O'Brien, who were always
there when I needed them, and to my research assistants, without whom
these data could not have been collected. I also wish to express
gratitude to a special group of friends, MTG, INC., and to my students
for their support and encouragement when I needed them.
This research was supported by a Post-Baccalaureate Faculty
Fellowship from the Department of Health and Human Services. I am
grateful to the governmental agency for easing the burden of doctoral
education.
iii

TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS iii
LIST OF TABLES vii
LIST OF FIGURES ix
ABSTRACT x
CHAPTERS
I INTRODUCTION 1
Background of the Problem ......... ... 1
Statement of the Problem .......... 3
Purpose of the Study ............. 5
Significance of the Study 10
Limitations 12
Assumptions ........................ 13
II REVIEW OF THE LITERATURE 14
Derivation of the Concept Burnout ............. 14
Definitions of Burnout 15
Stages in Development of Burnout 18
Causes of Burnout ............. 19
Conceptual Models of Burnout ............... 21
Burnout of Nurses ............... 24
Personal Characteristics 25
Demographics .... ........ 25
Personal Stressors 26
Personality Characteristics ........ 26
Social Support 27
Coping Behavior ... ..... 29
Organizational Characteristics 30
Work stress 30
Work Environment ............ 30
Job Satisfaction ......... 32
Theoretical Framework ........ 34
III METHODOLOGY 39
Sample of Respondents 39
Study Design and Procedures ................ 43
iv

Page
Instrumentation 46
Demographic Questionaire 46
Daily Hassles Scale .... .......... 48
Psychometric Properties of Daily Hassles Scale 48
Job Diagnostic Survey (JDS) ..... 50
Psychometric Properties of JDS 56
Psychological Hardiness Test 61
Psychometric Properties of Psychological Hardiness
Test 62
Maslach Burnout Instrument (MBI) ... 63
Psychometric Properties of MBI 64
Commitment and Workload 67
Statistical Analysis .......... 67
IV STUDY FINDINGS 74
Full Model and Statistical Analysis 74
Exogenous Variables ....... 75
Endogenous Variables .. ........ 76
Question 1
Question 2 79
Question 3 79
Question 4 81
Question 5 83
Reduced Model and Path Analysis ....... 87
Contributions to Situational Stress ........... 87
Contributions of Perceived Job Stress ..... 91
Contributions to Job Satisfaction 91
Contributions to Burnout-Emotional Exhaustion 92
Goodness-of-Fit ...... 92
V DISCUSSION, INTERPRETATIONS, CONCLUSIONS AND
RECOMMENDATIONS 99
Overview 99
Causes of Burnout 100
Causes of Job Dissatisfaction .............. 106
Comparison of Job Dissatisfaction and Burnout ...... 110
Causes of Job Stress Ill
Limitations and Recommendations 114
Conclusions 117
APPENDICES
A INVITATION AND CONSENT FOR PARTICIPATION FROM
CRITICAL CARE NURSES 120
B PROCEDURES FOR ADMINISTRATION 122
C DEMOGRAPHIC SHEET AND WORK SURVEY 124
D DAILY HASSLES SCALE DIRECTIONS AND SAMPLE ITEMS 126
E JOB DIAGNOSTIC SURVEY DIRECTIONS AND SAMPLE ITEMS 129
v

Page
F WORKLOAD AND STAFF SIZE 132
G HARDINESS TEST DIRECTIONS AND SAMPLE ITEMS '. 134
H COMMITMENT TO CAREER 136
I MASLACH BURNOUT INVENTORY DIRECTIONS AND SAMPLE ITEMS ... 138
J MEANS, STANDARD DEVIATIONS AND CORRELATIONAL ANALYSIS ... 140
K MULTIPLE REGRESSION OF THE FULL MODEL 158
REFERENCES 168
BIOGRAPHICAL SKETCH 177
vi

LIST OF TABLES
Table Page
1-1 Variables Found to be Significantly
Related to Burnout 6
3-1 Characteristics of Critical Care Staff Nurses:
Sex, Age, and Education (N = 300) 41
3-2 Duration as Staff Nurse in Critical
Care (N~= 300) 42
3-3 Years of Experience as a Critical Care Staff
Nurse at the Present Institution 44
3-4 Work Hours Per Week (N = 300) 45
3-5 Psychometric Properties of Variables: Ability
and Time 47
3-6 Psychometric Properties of Variables: Daily
Hassles Scale 51
3-7 Job Diagnostic Survey Subscales, Related
Variables and Sample Items ............... 53
3-8 Psychometric Properties of Variables: Job
Diagnostic Survey 57
3-9 Psychometric Properties of Variables: Commitment
and Workload ....... ......... 68
3-10 Instrumentation: Personal, Organizational
Variables, Situation Conducive to Stress,
Job Stress, Burnout, Job Satisfaction, and
Internal Work Motivation 69
4-1 Multiple Regression of Degree Situation
Conducive to Stress on the Variables Within
Each Block of Characteristics 78
4-2 Multiple Regression of Job Stress on the
Variables Within Each Block of
Characteristics and Situation Conducive
to Stress 80
4-3 Multiple Regression of Job Satisfaction on the
Variables Within Each Block of Characteristics,
Job Stress and Situation Conducive to Stress ...... 82
vii

Table Page
4-4 Multiple Regression of Internal Job Motivation
on the Variables Within Each Block of
Characteristics, Job Stress and Situation
Conducive to Stress 84
4-5 Multiple Regression of Burnout-Emotional
Exhaustion on the Variables Within Each Block
of Characteristics, Job Satisfaction, Internal
Job Motivation, Job Stress and Situation
Conducive to Stress .................. 86
4-6 Magnitudes of Direct and Indirect Effects on
Degree Situation Conducive to Stress, Level
of Perceived Job Stress, General Job
Satisfaction and Burnout 88
4-7 Intercorrelations of Exogenous Variables in
the Path Analytic Model of Burnout Among
Critical Care Nurses 98
viii

LIST OF FIGURES
Figure Page
1-1 A Perceptual-Feedback Stress Paradigm 4
1-2 Full Model of Burnout . 7
4-1 Reduced Model of Burnout 93
lx

Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
JOB BURNOUT AMONG CRITICAL CARE NURSES
By
Joyce K. Stechmiller
December, 1990
Chairperson: Hannelore Wass
Major Department: Foundations of Education
This study was designed to test a path-analytical model of the
theoretical conceptualization of burnout for critical care nurses. Three
hundred critical care nurses in Florida were administered a demographic
questionnaire and Work Survey Instrument, Daily Hassles Instrument,
Psychological Hardiness Test, Job Diagnostic Inventory, and the Maslach
Burnout Inventory. Personal, organizational, situational stress, job
stress, job satisfaction, and burnout variables were examined.
Family demands, health difficulties and a low psychological
hardiness and a high degree of skill variety and a dissatisfaction with
job security are linked to situational stress, contributing 70 percent of
explained variance. This situational stress is causally linked to
perceived job stress along with the direct effects of family demands,
health difficulties, dissatisfaction with nursing supervision, pay, and
job security. These variables account for 71 percent of explained
variance in job stress. Job stress directly affects job satisfaction.
x

In addition, job dissatisfaction is also directly affected by high job
expectations, meaninglessness of work, low knowledge of work results,
health, high task identity, a high frequency of dealing with others on
the job, dissatisfaction with opportunities for advancement, pay,
supervision, and satisfaction with job security. Together these account
for 62 percent of the variance in general job dissatisfaction. This
situation will then lead to burnout-emotional exhaustion. Burnout-
emotional exhaustion is directly affected by job dissatisfaction, as well
as low commitment to the career, health difficulties, low psychological
hardiness, high workload, a high degree of dealing with others on the
job, and dissatisfaction with job security; however, only 38 percent of
the variance in burnout-emotional exhaustion was explained by these
variables.
The study results provide a better understanding of the factors
relevant to the development of burnout. This research indicates that
there is a causal progression of situational stress, job stress, job
dissatisfaction resulting in burnout.
xi

CHAPTER I
INTRODUCTION
Background of the Problem
The empirical study of job stress in the helping professional,
frequently termed "burnout" (Freudenberger, 1974; Maslach, 1976; Maslach
& Jackson, 1986), has provided valuable information and insight into this
phenomenon over the last 15 years. Freudenberger (1974) first described
burnout as a state of physical and emotional depletion resulting from
conditions at work. Maslach (1976) claimed that "burned out"
professionals "lose all emotional feelings for the persons they work with
and come to treat them in detached or even dehumanized ways (p. 16).
Freudenberger and Richelson (1980) later described burnout as a "sense of
fatigue or frustration brought about by devotion to a cause, a way of
life, or relationship that failed to produce the expected reward"
(p. 13). Edelwich and Brodsky (1980) further defined it as a
"progressive loss of idealism, energy, purpose, and concern as a result
of conditions of work" (p. 14), and Pines, Aronson, and Kafry (1981)
added that it is "characterized by physical depletion, by feelings of
helplessness and hopelessness, by emotional drain, and by the development
of negative self-concepts and negative attitudes toward work, life, and
other people. ... It is a sense of distress, discontent, and failure in
the quest for ideals" (p. 15). Thus, although the concept of burnout has
been defined in many ways, there is general consensus that the symptoms
include attitudinal, emotional, and physical components (Freudenberger,
1974; Maslach, 1976; Maslach & Jackson, 1986).
1

2
Various researchers (Berkeley Planning Association, 1977; Maslach &
Jackson, 1981; Perlman & Hartman, 1982) have conceptualized burnout as a
syndrome of emotional exhaustion that proceeds to depersonalization, and
results in reduced personal accomplishment that may occur with persons
who work with others in some manner. The term "emotional exhaustion"
describes the first stage of burnout, which includes feelings of being
emotionally drained and overextended by one's exposure to other people.
When emotional resources are over-used, one feels unable to give of
oneself to others. The second stage of burnout is depersonalization,
which includes an "unfeeling and callous response toward people, often
the recipient of one's service of care" (Maslach, 1982b, p. 30). This
negative attitude may be manifested in rude, inappropriate, or
insensitive behavior toward clients, as well as withdrawal from them.
Reduced personal accomplishment is the third stage of burnout, which is
characterized as a decline in one's sense of competence and perception of
successful achievement in one's work with people resulting in feelings of
inadequacy, failure, loss of self-esteem, and even depression (Maslach,
1987).
Recently, a number of researchers have posited transactional models
of burnout to aid understanding of its etiology (Cherniss, 1980a;
Chiriboga & Bailey, 1986; Cooper, 1986; Courage & Williams, 1987; Cox &
Mackay, 1981; Fletcher & Payne, 1980; Golembiewski et al., 1986;
Harrison, 1983). According to Handy (1988), the major theme of
transactional models is that stress and burnout result from the
transaction between individual worker needs, personal resources, and the
demands, constraints, limitations, and/or facilitators within the work
environment. Key to this conceptualization is the emphasis on the

3
individual worker's subjective perception of stressors as opposed to
conditions that actually exist in the work setting (Golembiewski et al.,
1986; Leiter & Maslach, 1988; Maslach & Jackson, 1986).
Perlman and Hartman (1982) have proposed a transactional model (see
Figure 1-1) of burnout that is of particular interest because of its
breadth and because it includes groups of personal-psychological and
organizational-work variables that have been empirically studied
individually, or in combination, since 1977.
Statement of the Problem
In their model, Perlman and Hartman (1982) represented burnout as a
function of personal characteristics, organizational-work
characteristics, and stages of stress including the degree to which a
situation is conducive to stress, perception of organizational job
stress, and outcomes of the stress such as job satisfaction and
psychological response. Although this conceptualization of burnout
seems to be fairly comprehensive in terms of variables included, there
are limitations with respect to the posited relationship among the
components of the Perlman and Hartman (1982) model. One problem is that
this model is not totally consistent with empirical findings reported in
the literature. For example, according to the literature, job
satisfaction has a direct relationship to pay, dealing with others at
work, opportunity for advancement, and economic market conditions
(Jayaratne & Chess, 1983; Oldham, Hackman, & Pearce, 1976; Paredes,
1982), but from Figure 1-1 it would appear that burnout has a direct
relationship to pay, support from others, and economic market conditions
and that job stress has a relationship with opportunity for advancement.
Also, Perlman and Hartman (1982) seemed to suggest that burnout precedes
job satisfaction, but other formulations of burnout would equate it with
what Perlman and Hartman (1982) defined as coping. Another limitation is

PERSONAL VARIABLES
ORGANIZATIONAL VARIABI£S
Figure 1-1
A Perceptual-Feedback Stress Paradigm
Adapted from Perlman and Hartman (1982).

5
that Perlman and Hartman (1982) conceptualized each variable as affecting
only the next continguous variable in the model. They did not allow for
the possibility of some variables having direct or indirect causal
relationships to more than one outcome variable. From their discussion
of the burnout model, it seems likely that Perlman and Hartman (1982)
were unaware of how systems of linear regression equations can be
specified using path analysis (or causal modeling) to test a theoretical
model. Such an empirical test of a transactional model of burnout seemed
to call for obtaining measures on a fairly wide array of personal and
organizational variables entering them into multiple regression and path
analysis to permit the assessment of both direct and indirect effects of
independent variables on outcome variables.
Purpose of the Study
The purpose of this study was to collect data to develop and refine
a theoretical model of burnout for critical care nurses using variables
identified from research literature. The first stage of the study
involved an extensive literature review to identify variables that had
been studied by others in relationship to burnout. Table 1-1 contains a
summary of variables that were identified in the literature review for
this study that are posited to have a meaningful relationship in the
process that leads to job burnout. As will be indicated in Chapters II
and III, multiple indicators have been used to operationalize the
variables labelled as Personal Work Needs and Work Group Norms in
Table 1-1.
The second stage of the study required depicting the relationships
among the variables in a path diagram. The path diagram in Figure 1-2
graphically displays the pattern of hypothesized relationships among a

6
Table 1-1
Variables Reported to be Significantly Related to Burnout
Predictor
Personal
Variables
Predictor
Organizational Outcome
Variables Variables
Ability
Workload
Situation conducive
to stress
Time
Expected role
performance and
Level of perceived
Family demands
role ambiguity
job stress
Job expectations
Work group norms
Job satisfaction
Personal work
Dealing with
Internal job
needs
colleagues
motivation
Physical health
Commitment to
Opportunity for
advancement
Burnout
career
Pay
Psychological
Support from
hardiness
others
Organizational
climate and
economic/market
conditions
Supervision

Figure 1-2
Full Model of
Burnout

8
set of personal exogenous variables, a set of organizational exogenous
variables, and a series of endogenous outcome variables. An exogenous
variable is defined as a variable that has variability due to causes
outside the model, when the analysis of the cause of an exogenous
variable is not under consideration in the model (Asher, 1976). It is
not the purpose of a path analysis to explain the variability of an
exogenous variable or its relations with other exogenous variables.
An endogenous variable is a variable that has variance contributed
to it by exogenous or other endogenous variables in the model (Asher,
1976). The endogenous variables under study in the path analytical model
include the degree to which a situation is conducive to stress, job
stress, job satisfaction, internal work motivation, and burnout.
Unidirectional arrows or paths have been drawn from the exogenous causes
to the endogenous effects. The causal flow in the burnout model under
study is recursive or unidirectional. Some endogenous variables are
treated as dependent variables in one set of analyses and independent
variables in relation to other variables. For example, the degree to
which a situation is conducive to stress is a dependent variable for one
set of variables and an independent variable for job stress. To simplify
the visual presentation, the personal and organizational variables have
been grouped in boxes, and arrows have been drawn from the boxes to
represent direct effects of each exogenous variable in the boxes in the
left column on the respective endogenous variables. Typically curved
arrows are used to indicate correlations among exogenous variables. In
Figure 1-2, these curved arrows were not shown to allow the model to be
depicted more clearly

9
The third stage of the study was to answer the following questions
using multiple regression analyses:
1. Is there a significant relationship between the situational
stress variable and (a) the weighted linear combination of a set of
personal variables and (b) a set of organizational variables? Which
variables in the model contribute significantly to the variance in
situational stress?
2. Is there a significant relationship between job stress and the
combination of (a) situational stress and (b) the preceding exogenous
variables? Which variables in the model contribute significantly to the
variance in job stress?
3. Is there a significant relationship between job satisfaction and
the combination of (a) job stress, (b) situational stress, and (c) the
preceding exogenous variables? Which variables in the model contribute
significantly to the variance in job satisfaction?
4. Is there a significant relationship between internal job
motivation and the combination of (a) job stress, (b) situational stress,
and (c) the preceding exogenous variables? Which variables in the model
contribute significantly to the variance in internal job motivation?
5. Is there a significant relationship between burnout-emotional
exhaustion and the combination of (a) job satisfaction, (b) internal job
motivation, (c) job stress, (d) situational stress, and (d) the preceding
exogenous variables? Which variables in the model contribute
significantly to the variance in burnout-emotional exhaustion?
The final stage of the study was to refine the purposed model on the
basis of the empirical results obtained from stage three in an

10
exploratory fashion. Each of the independent variables that made a
significant contribution to the variance in one or more dependent
variables was considered a candidate for inclusion in a reduced model of
burnout. Path analysis was used to estimate the direct and indirect
effects of exogenous variables on endogenous outcome variables in a
reduced model of burnout. Results of the analyses of the full model and
a suggested reduced model will be presented in Chapter IV.
Significance of the Study
This study has practical value for the critical care staff nurses
themselves, the patients cared for by the critical care nurses, the
institutions in which the critical care nurses work, and the educational
preparation of nurses taught by nursing faculty. Maslach (1982) stated
that the burnout syndrome stems from a social interaction between helpers
and helpees, when in certain circumstances, helpers become unduly
involved emotionally with the recipients, overextend themselves, and
demonstrate emotional exhaustion. Nurses, as well as teachers, are
helping professionals and share the burdens and frustrations in the
helping relationship. Maslach (1982) described the progression of
burnout from emotional exhaustion to depersonalization in which helpers
decreased contact with clients and showed a callous, detached, and
dehumanizing response towards helpees. He proposed that clients
receiving care from helping professionals in the stage of
depersonalization do not receive adequate care because of ineffective
interpersonal helping relationships. Because nursing activities require
frequent contact with patients in an effective interpersonal

11
relationship, patients cared for by nurses in the stage of emotional
exhaustion or depersonalization may suffer from pathological detachment
on the part of the nurse. Critical care nurses who avoid their patients
and families lose opportunities essential for timely and potentially
useful interventions. This results in an unfortunate physiological loss
to the patient and a psychological loss to the patient, family, and
nurses and other members of the health team.
Burnout is costly as well to the institutions in which the helping
professionals work because of poor performance, job dissatisfaction,
absenteeism, job turnover, and illness of workers, all of which have been
related to this phenomenon. Knowledge about the causes of burnout and
the organizational work variables that critical care nurses perceive as
contributing to burnout could allow nursing administrators to identify
strengths and weaknesses in the hospital organization in reference to
prevention, recognition, and management of burnout. Such information
might give insight into the control of burnout. A variety of strategies
by those concerned with professional development and nursing management
could be employed to help alleviate nursing burnout, including redesign
of jobs, changing organizational policies, establishing flexible
schedules and support services, improving training for staff, and
designing explicit programs for more decisionmaking, emotional support,
and recognition.
Knowledge of results of this study could assist nursing educators in
curricular development. By recognizing burnout as a legitimate problem
with specific causes, greater efforts may be made to deal effectively
with it in academic institutions.
Clinical nursing faculty are also in an excellent position to teach
students how to cope with a stressful job as well as how to make the job
less stressful, but they are hampered by a lack of information about

12
sources of emotional stress on the job and the risk of burnout in many
nursing baccalaureate programs. It is important for nurse educators to
understand the causes of burnout among helping professionals. Students
should have more accurate information about the work they are undertaking
before they actually start. If this were accomplished, they might have
fewer surprises that destroy their professional ideals or lead them to
leave the profession. The consequences of attrition and turnover may be
greatly reduced by providing realistic job expectations. Prior knowledge
about the causes of burnout may enable nurses to recognize it in its
early stages, whether in themselves or in others. Greater awareness of
the risk of burnout can lead nurses to be better prepared for it in
advance. They can anticipate causes of emotional stress before they
occur and develop definite plans to deal with them. The results of this
study will allow them to have a clearer understanding of the personal and
organizational variables that may enable them to be successful at their
work.
Limitations
The following limitations of the study must be taken into
consideration when interpreting the findings:
1. The range of the study was limited to a geographical region
within the state of Florida that included Melbourne, Orlando,
Jacksonville, Ocala, Tallahassee, and Gainesville.
2. The sample was limited to a cross-section of critical care
nurses who work in critical care settings, including Medical and Surgical
Intensive Care Units.
3. The sample may be biased because individuals in advanced stages
of burnout may have been so apathetic that they did not participate in
the study.

13
4. Several of the constructs were measured by self-report
questionnaires that included items containing content of a sensitive
nature; some respondents may have reported inaccurately due to their
inability or unwillingness to recognize symptoms in themselves.
5. In this study, only the first stage of burnout (i.e. emotional
exhaustion) was examined.
6. Variables examined were limited to those that could be logically
viewed as representing constructs in Perlman and Hartman's (1982)
conceptual model of burnout.
Assumptions
There are three assumptions upon which the present study is
grounded:
1. Burnout in a biopsycho-social concept related to personal,
psychological, and organizational variables as a result of a stress
response.
2. The strength of relationship between burnout and these
contributing factors can be estimated through application of a linear
model.
3. The independent variables in the model are all those
contributing importantly to burnout.

CHAPTER II
REVIEW OF THE LITERATURE
Derivation of the Concept Burnout
The concept "burnout originated from stress research. There are
many publications reviewing varied definitions of the concept of stress
(Antonovsky, 1979; Cannon, 1932; Lazarus, 1966; Mason, 1975; Selye, 1956;
Selye, 1974; Sharit & Salvendry, 1982; Vachon, 1987). In an early
definition, Cannon (1932) reflected upon the physiological aspect of
stress and related it to society and job organizations. Selye (1956)
broadened the physiological concept of stress even further.
Selye's (1956) work was based upon earlier research of Cannon that
included homeostasis adaptations. His identification of body hormones in
the "fight or flight" mechanism for maintenance of homeostasis focused on
protective maneuvers in physical, social, or chemical situations that
elicited a physiological response. He defined stress as "the
non-specific response of the body to any demand made upon it" (Selye,
1974, p. 141) and stressors as any stimuli that cause physiological
adaptation. If stress results in positive effects, it is identified as
eustress; stress associated with negative results is distress.
Furthermore, he classified physiological adaptation to stress into three
stagesalarm, resistance, and exhaustionand referred to this process
as the general adaptation syndrome. The alarm phase consists of
neurohormonal mechanisms that prepare the body for defense against an
adaptation caused by stressors. The second phase, the resistance phase,
14

15
consists of adaptive mechanisms that are instituted to destroy the
stressor and restore homeostasis. Exhaustion, which occurs if the body's
adaptive resources are depleted, is irreversible and results in death.
Once the stressor is perceived as a genuine stressor, the condition is
recognized as stress and the general adaptation syndrome.
The concept of coping as human adaptation to stress has been studied
by many psychologists. French, Rodgers, and Cobb (1974) proposed a model
for adaptation to stress that considers the interaction of
characteristics of the individual and environment. A cognitive appraisal
analysis of psychological stress has been addressed by Lazarus (1977),
who defined coping as problem solving attempts to deal with threatening
conditions. Coping, in this approach, depends on how individuals
appraise their encounters with the environment with regard to the
potential of those encounters as threatening, harmful, or challenging.
Burnout has been identified as a syndrome resulting from a negative
response to occupational stress. Researchers in a variety of
specialities, including educational psychology, clinical and social
psychology, psychiatry, sociology, cultural anthropology, nursing,
occupational medicine, and personnel management have provided an
important volume of literature which constitutes the background for the
present study. The following review of literature is concentrated on
job-related personal, psychological, and organizational factors that form
the basis for burnout.
Definitions of Burnout
Freudenberger (1974) first used the term "burnout" to describe an
unfavorable response among helping professionals working in psychiatric

16
settings. He observed a pattern of behaviors and attitudes that he also
experienced. He identified a helping professional experiencing burnout
as one who becomes exhausted from excessive demands on strength, energy,
or resources or who is worn out. Freudenberger and Richelson (1980)
later described burnout as a "sense of fatigue or frustration brought
about by devotion to a cause, way of life, or relationship that failed to
produce the expected reward" (p. 13). At the First National Conference
on Burnout, Maslach (1982b) presented the following definitions of
burnout that were reported in the literature:
A syndrome of emotional exhaustion, depersonalization, and reduced
personal accomplishment that can occur among individuals who do
people-work of some kind.
A progressive loss of idealism, energy, and purpose experienced by
people in the helping professions as a result of the conditions of
their work.
A state of physical, emotional, and mental exhaustion marked by
physical depletion and chronic fatigue, feelings of helplessness and
hopelessness, and the development of a negative self-concept and
negative attitudes toward work, life, and other people.
A syndrome of inappropriate attitudes toward clients and self, often
associated with uncomfortable physical and emotional symptoms.
A state of exhaustion, irritability, and fatigue that markedly
decreases the worker's effectiveness and capability.
To deplete oneself. To exhaust one's physical and mental resources.
To wear oneself out by excessively striving to reach some
unrealistic expectations imposed by oneself or by the values of
society.
To wear oneself out doing what one does to do so. An inability to
cope adequately with the stresses of work or personal life.
A malaise of the spirit. A loss of wellbeing. An inability to
mobilize interests and capabilities.


17
To become debilitated, weakened, because of extreme demands on one's
physical and/or mental energy.
An accumulation of intense negative feelings that is so debilitating
that a person withdraws from the situation in which those feelings
are generated.
A pervasive mood of anxiety giving way to depression and despair.
A process in which a professional's attitudes and behavior change in
negative ways in response to job stress.
An inadequate coping mechanism used consistently by an individual to
reduce stress.
A condition produced by working too hard for too long in a
high-pressure environment.
A debilitating psychological condition resulting from work-related
frustrations, which results in lower employee productivity and
morals, (pp. 30-31)
Maslach (1982b) analyzed the problem of defining burnout and
concluded that some definitions are broad, others narrow; some include
emotional and physical behaviors, others include psychological and
cognitive terms. In addition, some describe a process while others
present a process; some relate causes while others relate consequences.
One commonality in the definitions is that the burnout syndrome presents
a psychological process affecting individual attitudes, motives,
feelings, and expectations. The individual perceives the syndrome as
unfavorable, dealing with distress, problems, malaise, and/or negative
outcomes. Furthermore, Maslach pointed out that there is agreement on
the component of exhaustion as a loss of energy and debilitation,
physiologically and psychologically, a loss of trust and apathy, with
loss of feeling, concern, and spirit. Another component includes a
disparaging response to others, with depersonalization, inappropriate
A

18
attitudes toward clients, loss of ideals, and irritability. A third
component is characterized by unfavorable responses toward oneself and
ones personal achievements, with depression, withdrawal, low morale,
lowered production, and a decrease in effective coping.
Stages in Development of Burnout
Maslach (1982a) described a progression of stages in burnout leading
from emotional exhaustion to depersonalization and finally ending with
decreased personal accomplishment. Helping professionals who have
emotional exhaustion feel drained, used up, and repleted without
resources. As a protective mechanism, some helping professionals acquire
a cold indifference to others needs, become detached to close
relationships, and acquire a callous disregard for the feelings of
others. The occurrence of this dehumanizing attitude heralds in the
second component of the burnout syndrome, depersonalization, which
consists of the expression of poor opinions about clients, actively
disliking them, expecting the worst from them, ignoring their requests,
and giving inappropriate help and care. The third aspect of the burnout
syndrome is decreased personal accomplishment, which consists of helping
professionals developing a sense of inadequacy in dealing with their
clients. The helping professional may even develop a poor self-esteem
and perceive of himself as a failure. As a result, depression,
absenteeism, poor job performance, and changing jobs may occur.
Similar developmental models have been suggested by other
researchers. For example, Edelwich and Brodsky (1980) designed a
four-phase developmental process: (a) enthusiasm with high energy, high
hopes, and unrealistic job expectations; (b) stagnation, in which the job
is no longer perceived as the central force of a worker's life;

19
(c) frustration, in which a worker directs personal confidence and value
of the job; and (d) apathy, a defense mechanism against job frustration
necessary for survival. Similarly, Veninger and Spradley (1981)
presented a developmental process that consisted of five stages: (a)
honeymoon, (b) fuel shortage, (c) chronic symptoms, (d) crisis, and (e)
hitting the wall.
Costello and Zalkind (1963) and Daley (1979) posited stages of
burnout specifically for the nursing profession using the framework of
Selye's general adaptation syndrome. The first stage is an alarm stage,
characterized by an emergency mobilization of the bodys defense
maneuvers used to maintain successful performance or to prevent an
internal conflict leading to frustration. The second stage is the
resistance stage, in which there are continued attempts to manage the
stress. If stress management is not achieved, exhaustion occurs. Shubin
(1978) described nurses as high-risk victims for burnout and delineated
the stages as beginning with physical fatigue and emotional drain,
followed by dehumanization of patients and guilt for not caring any
longer, and finally disgust for oneself and others.
Causes of Burnout
Freudenberger (1975), Freudenberger and Richelson (1980), and Pines,
Aronson, and Kafry (1981) have contended that personal variables
including psychological stress are the major precipitating cause of
burnout. Freudenberger (1974) studied ego analysis-and believed that a
committed and over-dedicated personality type was susceptible to burnout.
He and Richelson (1980) also suggested another personality trait that
included a restricted social life with all meaning and gratification

20
achieved from the job. Edelwich and Brodsky (1980) discovered an
association of burnout with the young, enthusiastic, overcommitted
helping professionals. Other specific psychological factors associated
with burnout in the care provider include competence, intolerance in
confronting obstacles, lack of self-confidence, nonassertiveness in
dealing with people (Gann, 1979), lack of psychological hardiness (Keane,
Ducrete, & Adler, 1985; McCranie, Lambert, & Lambert, 1987), life events
(Chiriboga & Bailey, 1986), ineffective coping skills, and inadequate
social support (Chiriboga & Bailey, 1986; Cronin-Stubbs & Rooks, 1985;
Numerof & Abrams, 1984).
Evidence to date suggests that not all individuals are equally at
risk to develop burnout (Cherniss, 1980a-b). Cherniss stated that
organizational factors that include availability of resources and power
of the helping professional to apply them, autonomy, the stimulation and
challenge of the job, the rewards at work, and the degree of structural
support all share in the occurrence of burnout. Role conflict, role
overload, lower socioeconomic status, and job dissatisfaction (Oldham,
Hackman, & Pearce, 1976) also appear to promote burnout (Kahn, 1978).
Burnout has also been related with a greater number of hours spent in
direct patient contact (Lewiston, Conley, & Blessey-Moore, 1981; Maslach
& Jackson, 1982), more difficult client problems (Meadow, 1981; Pines &
Maslach, 1978), caseload (Berkeley Planning Associates, 1977;
Freudenberger & Richelson, 1980; Larson, Gilbertson, & Powell, 1978;
Maslach & Jackson, 1984a-b; Maslach & Pines, 1977; Perlman & Hartman,
1982; Solomon, 1979), a low degree of peer support (Burk et al., 1984;
Jackson, Schwab, & Schuler, 1986; Leiter & Maslach, 1986; Maslach &
Jackson, 1982), a low degree of commitment to the organization (Leiter &

21
Maslach, 1988), and organizational components of leadership,
communication, supervision and responsibility. Leiter and Maslach (1988)
and Gains and Jermier (1983) indicated that dealing with co-workers
was identified as the strongest source of job stress and burnout.
Burnout has also been linked to social and physical isolation in the work
setting (Larson, Gilbertson, & Powell, 1978). Maslach and her colleagues
(Maslach & Jackson, 1981a; Maslach & Pines, 1977) indicated that the
basis of burnout is interpersonal contact that includes intense
commitment and personal care when helping others, especially those with
severe problems.
Conceptual Models of Burnout
Our understanding of the burnout syndrome has grown over the last
15 years. No longer are conceptual models restricted to intrapsychic
factors. There is considerable acceptance that burnout is not a simple,
unidimensional syndrome with easily identified causes. Rather, it is
considered a complex problem, generic to intrapsychic, interpersonal,
social, occupational, and organizational components.
Fischer (1983) posited a psychoanalytic model of burnout in which
workers are driven to maintain a high self-esteem by working even harder
despite unrealistic expectations. These workers "idealize their work"
and relate to a "compensatory illusion of grandiosity." He also stated
that workers who are exhausted may be inappropriately identified as
burned out and use the label of burnout as an "excuse for poor
performance and as a justification for both easier working conditions and
higher pay (p. 41). Fischer added to the knowledge of the function of
the intrapsychic factors of burnout and focused on the importance of
self-esteem as a mediator variable in the burnout process.

22
Harrison (1983), Farber (1983), and Heifetz and Bersoni (1983)
conceptualized burnout as a process resulting when helping professionals
do not receive positive and/or accurate feedback from their work
environment regarding their performance efforts. Harrison (1983) viewed
burnout as inversely related to the helping professionals' perceptions of
competence. The likelihood of the helping professional feeling good
about his/her work performance may be affected by lack of institutional
support, excessive workload, and inadequate professional skills.
Furthermore, he stated that if success is rarely experienced by the
helping professional and if failure is usually experienced as a result of
his or her job performance, burnout is likely. Farber (1983)
conceptualized work related stresses and burnout as due to feelings of
"inconsequentiality" by the helping professional. Like learned
helplessness, Farber hypothesized that burnout results when helping
professionals perceive that their efforts do not matter, and, as a
result, their efforts cease. The concept of cybernetics was used by
Heifetz and Bersoni (1983) in their model to describe the phenomenon of
burnout. The helping professional's perception of growth in themselves
and their recipients of care is strongest when goals are realized. In
order to be successful in realizing goals, requirements in the cybernetic
process must be identified: identification of the task, clearly defined
goals, short-term progress reports, and plans for modification of one's
goals. According to Heifetz and Bersoni (1983), burnout occurs when
one's pursuit of goals is interrupted because there is an absence of one
or more of the requirements in the cybernetic process.
Some authors have attempted to describe the burnout syndrome using a
job deficit model which proposes that burnout is due to the absence of

23
job motivations rather than the occurrence of job stressors. Jayaratne
and Chess (1983) reported that role conflict, excessive workload, and
role ambiguity are not significant predictors of burnout in social work.
They identified job challenge, financial rewards, and promotions as the
strongest predictors of burnout and job satisfaction. Eisenstat and
Felner (1983) isolated the variables of job motivations and job stressors
and reported that while job stressors are related to emotional
exhaustion, job enrichers, including autonomy, task significance, and
skill variety are related to job motivation in helping professionals.
Cherniss and Krantz (1983) also focused on the relationship between
burnout and lack of job motivation. Specific variables in their
conceptualization included long hours and the absence of meaning in work.
In addition, Fibkins (1983) and Ianni and Reuss-Ianni (1983) emphasized
that the crucial deficit variable in the burnout model is lack of
organizational support. According to Fibkins, burnout in teachers occurs
when the school organization is not responsive to the complex, intensive
nature of teachers' work. Ianni and Reuss-Ianni (1983) suggested that
individual and social factors may contribute to work stress; however,
burnout is more likely to be caused by a deficit within the
organizational structure.
Several other authors have advanced the stress model, incorporating
essential elements of modern stress theory and drawing on past research
(Beehr & Neuman, 1978; Chiriboga & Bailey, 1986; House & Wells, 1978;
Matteson & Ivanovich, 1979; Perlman & Hartman, 1982). In the stress
model, antecedent conditions such as sociodemographic characteristics,
are seen as laying the ground work for stress that results in conditions
such as burnout. Sociostructural conditions in the workplace constitute

24
a second element that helps shape the stress context. Specific stressful
work situations and chronic strain are seen as a third level of
predictor. Social support and coping strategies in turn are seen as
additional predictors that may act as mediators between the stress
context and stress response. Finally, burnout is viewed as the stress
response. An outcome of a maladaptive stress response is low
productivity; other sequelae include absenteeism, job dissatisfaction,
and excessive job turnover. Although exploratory testing of the stress
model of burnout has been accomplished, further comprehensive analysis is
needed with larger samples.
Burnout of Nurses
Consistent with recent findings in other professions (Chiriboga &
Bailey, 1986; Jenkins & Ostchega, 1986; Stone, Jebsen, Walk and Belsham,
1984), nurses who experienced more frequent work-related stress reported
greater burnout. Critical care nursing is one profession where the
burnout phenomenon has been acknowledged because a high rate of patient
mortality, severely ill patients who are emotionally consuming,
inadequate staffing and resources, and a difficult work load are
encountered. According to the literature, critical care nurses are at
risk for burnout when the patient presents with clinical problems in
which the complexity and acuity are beyond the resources of the nurse
(Bailey, Steffan, & Grout, 1980; Bartz & Maloney, 1986; Chiriboga &
Bailey, 1986; Claus & Bailey, 1980; Gray-Toft & Anderson, 1981a-b;
Hinshaw & Atwood, 1984; Kelly & Cross, 1985; Maloney, 1982; McCranie,
Lambert, & Lambert, 1987; Numerof & Abrams, 1984; Stone, Jebsen, Walk, &
Belsham, 1984; Vachon, 1987). In one study, commissioned by the American
Association of Critical-Care Nurses, a national panel of experts

25
identified both nursing stress and nursing burnout as being among the top
ten research priorities facing the profession (Lewandowski & Kositsky,
1983).
Studies were examined related to potential factors contributing to
burnout of nurses. The review was limited only to studies using the
Maslach Burnout Inventory as a criterion measure. In this review, the
studies have been grouped according to findings related to personal
characteristics of the nurse, including demographics (age, marital and
family status, length of employment, income, and education), personal
stressors, personality characteristics, social support, coping behavior
and organizational characteristics including work stress, the work
environment (worker involvement, type of unit, type of hospital,
involvement in decision making), job enhancement (skill variety and new
approaches, autonomy, clarity, physical comfort, work pressure), and job
satisfaction.
Personal Characteristics
Demographics
Demographic variables that have been associated with burnout in
nurses include age, marital and family status, length of employment,
income, and education. Younger nurses are more susceptible to burnout
than their older counterparts (Chiriboga & Bailey, 1986; Dames, 1983)
However, Bartz and Maloney (1986) found a positive association of burnout
with younger intensive care nurses.
Single care providers tend to be at greater risk for burnout than
married care providers (Dames, 1983; Kimmel, 1983). In addition, junior
nurses without the support of a marital partner are indicated as
vulnerable to burnout (Chiriboga, 1986).

Although Pernales (1982) found a negative correlation between
burnout, income, and number of people living at home, Dames (1983) and
Pomales (1982) agreed that income was inversely associated with burnout
Grutchfield (1982) found no significant difference among nurses'
education in baccalaureate, diploma, or associate degree programs, but
Keane et al. (1985) and Stone et al. (1984) found that nurses with
baccalaureate degrees evidenced somewhat higher levels of burnout than
those with three-year diplomas. Although less education has been
associated with the occurrence of burnout in nurses (Grutchfield, 1982)
less education with fewer years of work experience tends to make the
nurse more vulnerable to burnout (Chiriboga & Bailey, 1986; Stone et al
1984). In addition, a negative correlation has been found between
burnout and a desire to remain in the field of nursing (Dames, 1983).
Personal Stressors
As indicated by the findings of Daubney (1980), Otto (1980),
Chiriboga and Bailey (1986), and Stone et al. (1984) personal stressors
may also be pertinent in the burnout process. In these studies,
undesirable personal life change events and personal stress directly
related to burnout. In addition, perception of a good quality of life
five years ago was found to be inversely related to burnout (Dames,
1983).
Personality Characteristics
Grutchfield (1982) studied the relationship between personality
variables measured by the Edwards Preference Schedule, demographic
variables, and the syndrome of burnout among nurses. Her findings
suggested that burnout emotional exhaustion was associated with the

27
following personality variables: nurturance, abasement, achievement, and
succorance. In addition these variables were found to be negatively
correlated with a dimension of burnout-personal accomplishment.
Dames (1983) explored the relationship between selected personality
characteristics, demographics, and burnout, using the Spielberger Trait
Anxiety Index, the Gough Adjective Checklist, and the Maslach Burnout
Inventory. The personality traits of intraception and nurturance had
negative correlations with burnout; abasement, aggression and anxiety had
positive correlations with burnout. Autonomy had no significant
relationship with burnout. Pomales (1982) reported an inverse
relationship between self-concept and burnout.
Keane et al. (1985) and McCranie et al. (1987) explored the
relationship of psychological hardiness, demographics, and burnout using
the Hardiness Test (Kobasa et al., 1984). They presented data supporting
the hypothesis that hardiness may be an important personality variable
based resistance resource for preventing burnout among hospital nurses.
They compared samples of staff registered nurses working in intensive
care units and non-intensive care units of a large metropolitan hospital.
Burnout consistently was negatively correlated with psychological
hardiness. This finding supports hardiness as a generalized resistance
resource for nurses working in diverse patient care settings.
Social Support
Effective social support systems are consistently recommended as a
means of coping with job-related stress and preventing burnout. In 1982,
Kimmel reported that nurses who perceived greater emotional support than-

28
demands at home did not experience different levels of burnout than
nurses who experienced greater household demands than emotional support
at home.
Paredes (1982) studied the effects of social support and
psychological resources on the relationship between burnout and job
dissatisfaction. The findings showed a significant negative relationship
between supervision and co-worker support and burnout. Supervisor
support was more significant in burnout reduction than co-worker or off-
the-job support. Nurses who reported high levels of perceived
psychological support appeared to benefit most from social support in
terms of burnout reduction and job satisfaction.
Kanner, Kafry, and Pines (1981) and Pines, Aronson, and Kafry (1981)
found that on-the-job and off-the-job social support were negatively
related to burnout. Constable and Russell (1986) measured supervisor
support and found that this variable was a major predictor of burnout.
However, there was a significant association only with the emotional
exhaustion dimension of burnout. These results indicate that high levels
of support from supervisors can directly decrease feelings of emotional
exhaustion and, therefore, affect the potential for burnout among nurses.
In addition, their findings indicated significant moderating effects of
supervisor support on the relationship between job enhancement and
emotional exhaustion.
Finally, Chiriboga and Bailey (1986) reported that nurses who relied
more on their supervisor for support proved more likely to report
burnout. Additionally, reliance on co-worker support also correlated

29
with burnout. The correlations between inadequate psychological support
and higher burnout are consistent with the findings of Edelwich and
Brodsky (1983), Freudenberger and Richelson (1980), and Pines, Aronson,
and Kafry (1981).
Coping Behavior
Another important variable in the study of burnout is coping
behaviors used to reduce job stress. Kimmel (1982) measured coping with
the Ways of Coping Scale by Lazarus as well as role conflict, role
ambiguity, household support, demographic characteristics and burnout.
His sample included head nurses, supervisors, staff nurses, licensed
practical nurses, and nurses aids from a metropolitan hospital in New
York. He reported that coping variables were the best predictors of
burnout. Chiriboga and Bailey (1986) also measured coping with the Ways
of Coping Scale, and burnout. Their results indicated that the nurses
most vulnerable for burnout are younger and unmarried, work in critical
care units, have less involvement in work conditions, experience more
work hassles and distractions in the work place, and are more reliant on
nursing supervisor for support. In addition, these nurses used
anticipated coping which was significantly associated with burnout.
However, because only one variable out of nine measures of coping
strategies contributed significantly to burnout in their study, they
concluded that coping variables were not the best predictors of burnout.
In contrast, Stone et al. (1984) found that nurses endorsing a higher
number of effective coping skills suffer less burnout.

30
Organizational Characteristics
The organization variables include workstress, the work environment,
job enhancement and job satisfaction.
Work stress
Work stress has been identified as another contributing factor of
burnout. It has been consistently reported that (Chiriboga & Bailey,
1986; Jenkins & Ostehya, 1986) nurses who experienced more frequent
work-related stress reported greater burnout. According to Chiriboga and
Bailey (1986), the work stress variables were second only to work
environment measures in their degree of contribution to the explained
variance in burnout. Work hassles and work distractions were the
significant contributors. The more hassled the nurses felt, the more
likely they were to feel burned out. It is important to point out that
these are not the big stressful events; they are the smaller day-to-day
hassles that can exert a cumulative effect. The distraction variable
focused on trivial things: interruptions in the nurse's work, due to
physicians, nursing staff, or visitors. Nurses who reported more hassles
also reported more burnout. Their findings suggest that distracting and
annoying day-to-day stress in the hospital work environment exerted the
major stress on nurses, and that may lead to burnout.
Work Environment
Work environment variables including worker involvement, type of
unit, type of hospital, amount of patient contact and job enhancement
(variety of tasks and new approaches, autonomy, clarity, physical comfort
and work pressure) are strongly associated with burnout. Worker
A

31
involvement was the most important variable and explained the greatest
proportion of variance in burnout suggesting that when staff nurses feel
a low involvement in work, they are most at risk of burnout (Chiriboga &
Bailey, 1986). Burnout has been shown to be related to the type of unit.
There is evidence that units that provide fewer demands on the nurse may
potentiate a condition leading to Burnout (Chiriboga & Bailey, 1986). In
addition, nurses who work in the private hospital are more likely than
nurses employed by a district hospital to report burnout (Chiriboga &
Bailey, 1986).
Researchers have found that more hours worked and more hours of
direct patient contact increased the risk of burnout (Dames, 1983; Des,
1981). In addition, they also stated that the more hours working with
patients with grave prognoses, the higher the burnout scores.
The results offered by Constable and Russell (1986) suggested that
job enhancement was significantly correlated with burnout. This finding
indicates that nurses are more susceptible to burnout when working in
environments where there is a lack of variety and new approaches, there
is a lack of encouragement to be self-sufficient, rules and policies are
not clearly communicated, tasks are not clearly understood, and the work
environment is not considered comfortable and attractive. In addition,
work pressure was also positively associated with burnout-emotional
exhaustion. Critical care nurses experiencing burnout perceive the
critical care environment with little support and the events within the
unit as a threat. Consequently, the critical care nurse expects the
worst (Stone et al., 1984).

32
Job Satisfaction
The study of job satisfaction has evolved since the early 1900s.
The earlier work was done by Taylor (1911) who determined that job
satisfaction was associated with the amount of pay earned. This research
began during the industrial revolution when workers were equated to
machinery and efficiency was the expectation (Slavitt, Stamps, Piedmont,
& Haase, 1978).
In the 1930s a humanistic-sociological approach to job satisfaction
emerged. Work satisfaction was established as an oversatisfaction with
life (Hoppock, 1935). A cross-sectional study of industrial workers with
similar abilities, interests and job preparation revealed that an
employee's adaptability to the situation, the employee's socioeconomic
group identification, ability to relate to others, and the nature of the
work were associated with work satisfaction. The psychological basis for
job satisfaction was established by the Hawthorne studies (Mayo, 1945).
These studies found that group interaction was the major determinant of
job satisfaction (Slavitt et al., 1978).
One theory that is widely used today in studying job satisfaction is
the motivation-hygiene theory (Herzberg, 1968). Motivators was the term
Herzberg used to identify job satisfiers because they were effective in
contributing to the individual functioning at a higher level and resulted
in job satisfaction. Examples of motivators include responsibility,
advancement and recognition. Hygiene factors was the term used to
identify lower level needs because if not met, they added to
dissatisfaction but when met did not contribute to satisfaction.

33
Examples of hygiene factors include salary, supervision, policy, and
working conditions.
The theoretical conceptualization of job satisfaction by Herzberg
has been studied extensively among nurses (Hinshaw & Atwood, 1984, 1987;
Slavitt, Stamps, Piedmont, & Haase, 1978). Hinshaw and Atwood (1987)
reviewed the job satisfaction literature and identified 19 significant
factors relating to job satisfaction which were divided into two
categories: personal and work-related characteristics. Personal
characteristics included age, gender, intelligence, educational level,
experience as a nurse, tenure and position in the hierarchy. Work
related characteristics included the specialty area, nursing care
delivery model, supervision, tasks, outcomes and pay. These researchers
concluded that although these variables have been identified as
significantly associated with job satisfaction, the relative impact of
the personal and organizational variables acting directly and indirectly
with job satisfaction has not been determined.
The more relevant theory of job satisfaction related to this study
is the person-environment fit model of occupational stress (French,
Rodgers, & Cobb, 1974). This theoretical approach relates occupational
stress to job satisfaction. As a result of the interaction between the
person holding a job and the environment in which he or she is employed
with good person-environment fit, the job provides the necessary needs of
the individual (salary, fringe benefits, social involvement, opportunity
to achieve, and a sense of self worth). On the other hand, if the job is
too strenuous or too demanding, job stress and burnout may result. Job

34
satisfaction is described as the result of a good person-environment fit
(Vachon, 1987).
There are only two studies to date linking job dissatisfaction and
burnout for nurses. Job dissatisfaction accounted for the largest
variance in burnout in a dissertation study conducted by Parades (1982).
Younger age, low psychological resources, shorter length of time on the
hospital unit and less social support also contributed to the total
variance. In addition, nurses experiencing burnout are found to be
dissatisfied with their jobs because there are limited opportunities for
personal growth on the job (Stone et al., 1984).
Theoretical Framework
The burnout model proposed by the researcher is an adaptation of
the burnout model offered by Perlman and Hartman (1982) which integrates
many theoretical models. It evolved from Selye's (1974) identification
of stimuli and stressors, the definition of stress as the general
adaptation syndrome, as the theory that too much stress may lead to
maladaptation. The model is further grounded in a framework proposed by
House and Wells (1978), Beehr and Neuman (1978) and Matteson and
Ivancevich (1979).
Perlman and Hartman (1982) posited a transactional model of burnout
and this appears to be the trend in recent years (Cherniss, 1980a;
Chiroboga & Bailey, 1986; Cooper, 1986; Courage & Williams, 1987; Cox &
McKay, 1981; Fletcher & Payne, 1980; Golembiewski et al., 1986; Harrison,
1983). The major theme of the transactional model relates to the
conceptualization of stress and burnout as the result of a transaction

35
between individual worker needs and resources and the demands,
constraints, limitations, and/or facilities within the work environment.
Their model is broad and allows an examination of personal and
organizational-work variables which have been studied individually or in
combination in the burnout literature from 1977 to the present. In this
model personal, as well as organizational-work variables that are
subjectively perceived, are conceptualized.
Using Selye's (1974) definition of stress as "The nonspecific
response of the body to any demand made upon it (p. 41), Perlman and
Hartman (1982) built a theoretical model of psycho-social organizational
mediated adaptation congruent with Selye's initial work. The Perlman and
Hartman (1982) model incorporated three major symptom categories of
stress that are reflected by the three dimensions of burnout:
(a) physiological (focusing on physical symptoms and perceptions of
reduced personal accomplishment); (b) affective cognitive (focusing on
attitudes and feelings and emotional exhaustion); and (c) behavioral
(focusing on symptoms or behavior related to depersonalized care of the
recipient of care). The model, which has a cognitive and perceptual
focus, consists of a linear progression of four stages of stress which
include the degree to which the situation is conducive to stress, the
perception of job stress, response to stress, and outcome of stress.
Groupings of significant personal variables and organizational variables
are related to each stage. In the first stage of stress the degree the
situation is conducive to stress is a function of personal variables of
ability, time, family demands, and job expectations and organizational

36
variables of workload, expected role performance and role ambiguity. The
combination of the variables age and education are theorized by Perlman
and Hartman (1982) to represent the variable ability. The combination of
the variables marital status and life events is theorized by Perlman and
Hartman (1982) to represent the variable family demands. The variable
job expectation is theoretically viewed by Perlman and Hartman (1982) to
represent perception of growth for helping professionals. In the second
stage of stress the level of perceived job stress is a function of
personal variables of personal work needs, and personality and
organizational variables of supervision, work group norms, opportunity
for advancement and dealing with colleagues at work. In the third stage
of stress the response to stress is a function of physiological,
affective and cognitive responses manifested as burnout. This stage is
related to personal variables including commitment to career, and health
and organizational variables that include pay, support from peers,
supervision, and organizational climate and the economic and market
condition. In the fourth stage, burnout is related to work outcomes
including job satisfaction and psychological response.
The model includes a complete representation of transactional
processes including personal characteristics, organizational
characteristics, the degree to which a situation is likely to be
stressful, perception of organizational job stress, and response to job
stress in understanding the etiology of burnout. Although the
conceptualization of burnout offered by Perlman and Hartman (1982) is
fairly comprehensive there are limitations with respect to the
operationalization of two variables labelled personal work needs and work
group norms. Multiple indicators need to be used to operationalize these

37
variables that are identified in the literature review for this study
that have a meaningful relationship in the process that leads to job
dissatisfaction and burnout. For example, according to the literature,
meaningfulness of work, responsibility for work outcomes and knowledge of
work outcomes have a direct relationship to job satisfaction (Herzberg,
1968; Hinshaw & Atwood, 1984, 1987; Oldham, Hackman, & Pearce, 1976).
Because job dissatisfaction has been linked to burnout, use of these
multiple indicators of personal work needs seems warranted. In addition,
according to the literature, autonomy, skill variety, task significance,
and task identity have a direct relationship to the process of job
satisfaction and job burnout (Cherniss, 1980a-b; Heifitz & Bersoni,
1983). Use of these variables to operationalize work group norms has
theoretical support and is justified.
Another problem is that the model conceptualized by Perlman and
Hartman (1982) has structural limitations of its components. Each
variable affects only the next continguous variable in the model. They
did not allow for the freedom of some variables having direct and
indirect causal relationships to more than one outcome variable. For
example, according to the literature, job satisfaction has a direct
relationship to pay, dealing with others at work, opportunity for
advancement, and economic market conditions (Jayaratne & Chess, 1983;
Oldham, Hackman, Pearce, 1976; Paredes, 1988) but from Figure 1-1 it
would appear that burnout has a direct relationship to pay, support from
others, and economic market conditions and that job stress has a
relationship with opportunity for advancement. In addition, Perlman and
Hartman (1982) seemed to suggest that burnout precedes job satisfaction,
but other theoretizations of burnout would equate it with what Perlman

38
and Hartman defined as maladaptation, manifested as an observable form of
ineffective coping.
A more logical approach is the expansion of the model offered by
Perlman and Hartman (1982) to a path-analytical model that will allow for
the analysis of direct and indirect effects of personal and
organizational variables simultaneously across stages. There is a need
to attend to a more comprehensive causal model of stress and burnout that
includes personal and organizational variables as well as stages of
stress, job satisfaction, and psychological response in understanding the
etiology of burnout

CHAPTER III
METHODOLOGY
This study was designed to collect data and to test a path analytical
model of the theoretical conceptualization of burnout for critical care
nurses. The model of interest was an expansion of the model offered by
Perlman and Hartman (1982) that allowed analysis of direct and indirect
effects of exogenous and endogenous variables using path analysis. Five
research study questions were used to guide this study in an exploratory
examination of the full model of burnout.
This chapter is divided into four section. In the first section,
the sample of respondents is described. The study design and procedures
used to collect the data are included in the second section of the
chapter. The instrumentation is described in the third section. The
fourth section includes a description of the statistical analysis of the
five research questions used to guide the study in examining the model.
Sample of Respondents
Selection of research participants. Permission to conduct the study
was first obtained through the Institutional Review Board of the
University Health Center. Following approval, a convenience sample of
hospitals was selected. Eligible hospitals (N = 14) were identified from
the 1985 Hospital Data Report published by the North Central Florida
Health Planning Council. Permission to conduct the study was then
obtained through the Nursing Research Committees of hospitals located in
North Eastern, North Central and Southern regions of the state of
39

40
the state of Florida. Administrators of five of the selected hospitals
declined to participate due to the perceived threatening tone of the Job
Diagnostic Survey Questionnaire and the burnout questionnaire. The final
sample consisted of nine hospitals which are licensed for between 250 and
450 beds, and are located in Northeastern, Northwestern, North central,
and Southern regions of Florida. All staff nurses employed in the nine
hospitals who fit the criteria of working on a critical care unit and
having"worked full time for at least three months were invited to
participate in the study. During the months of September-November, 1989,
the burnout test battery was presented to the nurses by the author during
a scheduled staff meeting (Appendix A). Consent for participation was
then procured from the critical care nurse employed in these settings
(Appendix B).
A total of 375 female critical care registered staff nurses were
given a package of materials with a cover letter requesting their
participation. A total of 330 nurses agreed to participate by returning
complete questionnaires (86%). Thirty questionnaires were not fully
completed and were excluded from the data analysis. Three hundred
questionnaires were usable for data analysis.
The demographic characteristics of the critical care staff nurses
(age, marital status, sex, and education) are presented in Table 3-1.
These data revealed that all the critical care nurses in the sample were
female and that 75% of the nurses were between the ages of 20 and 39 with
32% under the age of thirty. The majority of the staff nurses held an
associate degree (50%) in nursing (ADN) and 10% were diploma graduates.
Only 34% were baccalaureate graduates in nursing.
The duration of experience as a staff nurse in critical care is
presented in Table 3-2. The duration ranged from 3 months to 30 years

41
Table 3-1
Characteristics of Critical Care Staff Nurses:
Sex, Age, and Education (N = 300)
Characteristics
Number
Percent
Sex:
Female
300
100.0
Marital Status:
Single
71
23.7
Married
188
62.7
Separated
6
2.0
Divorced
35
11.7
Total
300
100.1
Age:
20 29
96
32.0
30 39
129
43.0
40 49
60
20.0
50 59
14
4.7
60 or over
1
0.3
Total
300
100.0
Education:
ADN
149
50.0
BSN
102
34.0
Diploma
31
10.3
Some graduate work.
18
6.0
Total
300
100.3

42
Table 3-2
Duration as Staff Nurse in Critical Care (N = 300)
Number of years
Number
Percent
Cumulative %
Duration as staff nurse
in critical care:
3-6 months
60
20
20
7 months 1 year
49
16.3
36.3
13 18 months
11
3.7
40.0
19 months 2 years
2
.7
40.7
2-3 years
15
5.0
45.7
3-4 years
25
8.3
54.0
4-5 years
9
3.0
57.0
5-7 years
34
11.7
68.7
7-10 years
31
10.0
78.7
10 15 years
43
14.3
93.0
15-20 years
14
4.7
97.7
20 25 years
5
1.6
99.3
25 years +
2
.7
100.0
Total
300
100.0
100.0

43
with a mean of 6.86 years and a standard deviation of 5.53 years. Over
45% had 3 years or less of work experience as a staff nurse in critical
care, and 46% had more than 4 years of experience.
Additional demographic information included the duration of
experience as a staff nurse in critical care at the present institution
and the number of hours working per week. The number of years of
experience as a staff nurse in critical care at the present institution
ranged from 1 month to 25 years with a mean of 4.75 years and a standard
deviation of 4.19 years. Over 67% had 5 years or less of work experience
in critical care staff nursing at the present institution and 8% had more
than 10 years of experience at the present institution (see Table 3-3).
The number of hours working per week ranged from 36 hours to 72 hours
with a mean of 38.16 hours and a standard deviation of 7.95 hours. It
was revealed that over 16% had 42 hours or more per week working time
(Table 3-4).
Study Design and Procedures
The design structure for the path analysis methodology was
correlational, involving selection of a number of psychometric
instruments to operationalize each of the variables specified in the
theoretical framework and administration of these instruments to all
subjects in the study. Subjects were asked to complete five
questionnaires, including the demographic sheet, and Work Survey
Instrument, the Daily Hassles Scale, the Job Diagnostic Survey, the
Hardiness Scale, and the Burnout Inventory. Each nurse self-administered
the burnout test battery during an off-work, scheduled, thirty-minute
period. The test battery included a set of standardized instructions for
each of the measures. All subjects were guaranteed anonymity.

Table 3-3
Years of Experience as a Critical Care Staff Nurse at the
Present Institution
Number of years
Number
Percent
6 months or less
16
5.3
7 months 1 year
29
9.7
13 months 2 years
60
20.0
2-5 years
97
32.3
5-10 years
74
24.7
10 15 years
16
5.3
15 20 years
7
2.3
20 25 years
1
.3
Total
300
100.0

Table 3-4
Work Hours Per Week (N = 300)
Number of hours
Number Percent
40 hours
249
83.0
41 42
hours
3
1.0
43 44
hours
5
1.7
45 48
hours
28
9.4
49 50
hours
8
2.6
51 60
hours
5
1.6
61-70
hours
2
.7
Total
300
100.0

46
Instrumentation
A demographic questionnaire and work survey devised by the
researcher and four widely used standardized instruments including The
Daily Hassles Scale, Job Diagnostic Survey (JDS), Psychological Hardiness
Test, and Maslach Burnout Instrument were used in this study in order to
assess individual critical care nurses' perceptions of personal and
organizational variables in the work environment, levels of stress
including a situation conducive to stress, perceived job stress, and
burnout and outcomes of the stress response including job satisfaction
and internal job motivation.
Demographic Questionnaire
Description. A six-item questionnaire was constructed in order to
assess personal characteristics of the critical care nurses. The
personal characteristics assessed were age, sex, marital status,
education, duration as a staff nurse in critical care, duration as a
staff nurses in critical care at the present institution, and the number
of working hours per week in critical care nursing. Appendix C contains
this instrument.
Use in this study. The personal variables, ability and time
(tenure), were measured with items from the demographic questionnaire
(Appendix C). The measurement of ability consisted of the sum of the
duration of time as a staff nurse in critical care in months and the sum
of the duration of formal education in nursing months. The measurement
of tenure consisted of the numerical value of duration in months as a
staff nurse in critical care and the duration in months as a staff nurse
at their present institution. The means and standard deviation for the
sample used in the present study are presented in Table 3-5.

Table 3-5
Psychometric Properties of Variables: Ability and Time
Variable
Standard
Number Mean deviation
Ability
300 117.82 68.858
Time
300
139.33
103.192

48
Daily Hassles Scale
Description. The measurement of psychological stress through the
use of the Hassles Scale theoretically approaches the role of cognitive
appraisal in the stress and coping process (Lazarus & Folkman, 1989). In
this approach, coping depends on how individuals appraise their everyday
encounters with the environment with regard to the extent to which those
encounters are perceived as threatening, harmful, or challenging.
Everyday encounters are called hassles and are measured in the Hassles
Scale. The Hassles Scale consists of 117 items used to measure the
frequency and severity of a person's transactions with the environment
that are considered by the individual to be stressful events; e.g., "How
much of a hassle was this for you ... overloaded with family
responsibilities?" The scale takes approximately 10 minutes to complete.
The response format is a four-point scale, ranging from "none" or not
applicable to "extremely severe." The Daily Hassles Scale yields two
scores: frequency, which is the number of hassles endorsed by the person
without regard to severity and severity, which is the average severity
rating of all items that have been identified. Eight factor-based
subscales scores are also possible. They include future security, time
pressures, work, household responsibilities, health, inner concerns,
financial responsibilities, and neighborhood/environmental.
Psychometric Properties Of Daily Hassles Scale
Reliability. Kanner et al. (1981) reported a test retest
reliability coefficient of .79 on a sample of 432 college students and a
sample of 448 adults aged 20-60. There is no information available on
the internal consistency of the scale.

49
Validity In reference to construct validity, an important
relationship has been explored between hassles and life events scores and
the treatment of both as indicators of psychological stress. Kanner et
al. (1981) provide the strongest evidence for construct validity of the
Daily Hassles Scale in order to explain psychological symptoms and
symptoms of somatic illness and emotional distress. His group found that
the hassles scores were strongly related to both affective distress and
psychological symptoms (.34). The Hopkins Symptom Checklist (HSC1)
(Derogotis et al., 1974) correlated between .5 and .6 with the Daily
Hassles Scale. Delongis et al. (1988) correlated hassles and somatic
health status as dependent variables and found that daily hassles
explained more variance than did life events.
Lazarus and Folkman (1989) performed a factor analysis of the Daily
Hassles Scale, using the principal factor method with oblique rotation
and generated eight factors: future security, time pressure, work,
household responsibilities, health, inner concerns, financial
responsibility, and neighborhood and environmental concern.
Use in the study. The personal variables family demands, health,
the situational stress and job stress variables were measured with the
Daily Hassles Scale on the basis that the scale contained factors that
corresponded to the variables used in this study. Family demands were
measured with the Daily Hassles Scale, items 1-4, 7-15, 19-23, 29, 35-38,
43, 45, 55, 58-59, 61-64, 70, 71, 73-76, 78-79, 82, 87, 90, 92-93,
103-108, and 110-112 that corresponded to three factors: household
responsibilities, financial responsibility and neighborhood and
environmental concern (Lazarus & Folkman, 1989).

50
Health was measured with the Daily Hassles Scale, items 16-18, 48,
49, 50, 53, 54, 56, 77, 91, and 98 that corresponded to the health factor
(Lazarus & Folkman, 1989).
The degree to which the situation was conducive to stress was
measured with items 5, 6, 24-26, 39-42, 44, 46-47, 51-52, 57, 60, 67-69,
85, 88-89, 94-97, 99-101, 109, 113-117, of the Hassles Scale that
corresponded to the three factors inner concerns, future security, and
time pressure (Lazarus & Folkman, 1989).
The level of perceived job stress was measured with items 27-28,
30-34, 65, 66, 72, 80-84, 86, and 102 pertaining to work hassles of the
Hassles Scale (Lazarus & Folkman, 1989).
Critical care nursing faculty, critical care graduate nursing
students, and two top nursing management members of two critical care
intensive care units of a regional hospital were asked to rate and
evaluate this scale for use in this study. On the basis of the
reliability and validity data available, use of the Daily Hassles Scale
as a measure of family and life demands, health, situation conducive to
stress, and work stress seemed justified. The means, standard deviations
and coefficient alpha estimates for the variables for the sample used in
the present study are presented in Table 3-6. Appendix D contains
instrument directions and sample items.
Job Diagnostic Survey (JDS)
Description. The JDS is composed of 83 items used to diagnose
existing jobs to determine if and how they might be redesigned to affect
employee motivation and performance and to evaluate the effects of job
changes on employers. The measure is based on a theory of how a job
affects worker motivation and provides measures of objective job
dimensions, individual psychological states related to these dimensions,

51
Table 3-6
Psychometric Properties of Variables: Dally Hassles Scale
Variable
Number
Mean
Standard
deviation
Alpha
Family demands
300
.751
.408
.701
Health
300
.501
.396
.699
Situational stress
300
.717
.387
.703
Job stress
300
.659
.427
.714

52
affective reactions of employees to the work setting and the job, and the
need of the individual for growth. The scale is appropriate for grades 8
and over. The subjects respond to a seven-point response scale used
throughout the instrument.
The JDS yields scores on 18 subscales. All 18 of these subscales
were used as measures of variables in the present study. Table 3-7
relates JDS subscales to variables and gives sample items. The JDS
provides measures of the five core work dimensions which include skill
variety, task identity, task significance, autonomy and feedback from the
job itself. Two additional measures are included for two supplementary
dimensions which include feedback from agents and dealing with others.
They are defined as follow:
Skill variety is the degree to which a job requires a variety of
different activities in carrying out the work, which involve the use
of a number of different skills and talents of the employee.
Task identity is the degree to which the job requires completion of
a "whole" and identifiable piece of worki.e., doing a job from
beginning to end and with a visible outcome.
Task significance is the degree to which the job has a substantial
impact on the lives or work of other peoplewhether in the
immediate organization or on the external environment.
Autonomy is the degree to which the job provides substantial
freedom, independence, and discretion of the employee in scheduling
the work and in determining the procedures to be used in carrying it
out.
Feedback from the job itself is the degree to which carrying out the
work activities required by the job results in the employee

53
Table 3-7
Job Diagnostic Survey Subscales, Related Variables and
Sample Items
Variable in
Subscale this study
Sample Item
Total growth Job expectations
need strength
Meaningfulness Personal work needs
of work
"Indicate the degree to
which you would care to
have this characteristic
present in your job; e.g.,
opportunities for personal
growth and development in
my job."
"Most of the things I have
to do on this job seem
useless or trivial to me."
Responsibility
for work
outcomes
Knowledge of
work results
Feedback from Expected performance
the job itself and role ambiguity
Feedback from
agents on the job
Skill variety Work group norms
Task identity
"I feel a very high degree
of personal responsibility
for the work I do on this
job.
"Most people on this job
have trouble figuring out
whether they are doing a
good or a bad job."
"Just doing the work
required by the job
provides may choices for me
to figure out how well I am
doing.
"Supervisors often let me
know how well they think I
am performing on the job."
"The job requires one to
use a number of complex or
high-level skills."
"The job provides me the
chance to completely finish
the pieces of work I
begin."

54
Table 3-7continued
Subscale
Variable in
this study
Sample Item
Task significance
Work group norm
"The job is one where a lot
of the other people can be
affected by how well the
work gets done."
Autonomy
Work group norm
"The job gives me
considerable opportunity
for independence and
freedom in how I do the
work."
Dealings with
others at work
Dealing with
colleagues
"The job requires a lot of
cooperative work with other
people."
Supervision
satisfaction
Supervision
"The amount of support and
guidance I receive from my
supervisor.
Satisfaction with
work growth and
advancement
Opportunity for
advancement
"The amount of personal
growth and development I
get in doing my job."
Pay satisfaction
Pay
"The amount of pay and
fringe benefits I receive.
Satisfaction with
peers and
co-workers
Support from others
at work
"The chance to get to know
other people on the job."
Satisfaction with
job security
Organizational climate
and the economic-
market condition
"How secure things look for
me in the future in this
organization."
General job
satisfaction
Job satisfaction
1 am generally satisfied
with the kind of work I do
in this job."
Internal job
motivation
Psychological response
to job stress
"Most people in this job
feel a great sense of
personal satisfaction when
they do the job well."

55
obtaining direct and clear information about the effectiveness of
his or her performance.
Feedback from agents is the degree to which the employee receives
clear information about his or her performance from supervisors or
from coworkers.
Dealing with others is the degree to which the job requires the
employee to work closely with people in carrying out the work
activities.
The JDS also measures three psychological states that are associated
with the core job dimensions. These include experienced meaningfulness
of the work, experienced responsibility for work outcomes and knowledge
of work results. They are defined as follow:
Experienced meaningfulness of the work. The degree to which the
employee experiences the job as one which is generally meaningful,
valuable, and worthwhile.
Experienced responsibility for work outcomes. The degree to which
the employee feels personally accountable and responsible for the
results of the work he or she does.
Knowledge of results. The degree to which the employee knows and
understands, on a continuous basis, how effectively he or she is
performing the job.
Personal, affective reactions or feelings a person obtains from
performing the job include general satisfaction, internal job motivation,
and specific satisfactions (job security, pay and other compensations),
social satisfaction with peers and coworkers, supervision and opportunity
for personal growth and development on the job. They are defined as
follow:

56
General satisfaction. An overall measure of the degree to which the
employee is satisfied and happy with the job.
Internal job motivation. The degree to which the employee is self
motivated to perform effectively on the jobi.e., the employee
experiences positive internal feelings when working effectively on
the job, and negative internal feelings when doing poorly.
Specific satisfaction. A number of short scales which provide
separate measures of satisfaction with:
(a) Job security
(b) Pay and other compensation
(c) Peers and coworkers ("social" satisfaction)
(d) Supervision
(e) Opportunities for personal growth and development on the job
("growth" satisfaction)
Finally, the JDS measures the strength of the individual's desire to
obtain growth satisfactions from his or her work. This measure is called
the growth need strength index and is viewed as an individual
characteristic which is predicted to influence how well a worker will
react to a job with a high motivating potential (Hackman & Oldham,
1978).
Psychometric Properties of JDS
Reliability. Internal consistency reliabilities for the eighteen
subscales are reported as generally satisfactory with a range from a high
of .88 to a low of .56. The term scale is used to refer to the summary
score obtained for each variable measured by the JDS. On the basis of
these results the reliability estimates are satisfactory. The
psychometric properties of the variables on this sample are presented in
Table 3-8

57
Table 3-8
Psychometric Properties of Variables: Job Diagnostic Survey
Standard
Variable
Number
Mean
deviation
Alpha
Job expectations
(Total growth
strength need)
300
4.103
2.446
.714
Meaningfulness of
work
300
5.750
.844
.669
Responsibility for
work outcomes
300
5.750
.653
.680
Knowledge of work
results
300
5.000
.946
.679
Expected role
performance and
role ambiguity
(Feedback from the
job itself and
feedback from
agents on the
job)
300
4.668
.898
.670
Skill variety
300
5.916
.818
.675
Task Identity
300
4.212
1.112
.691
Task
significance
300
6.152
.772
.684
Autonomy
300
5.090
.905
.689
Supervision
300
4.950
1.270
.677
Dealing with others
at work
300
6.116
.707
.700
Opportunity for
advancement
300
5.459
.893
.661
Pay satisfaction
300
3.903
1.608
.693

58
Table 3-8continued
Standard
Variable
Number
Mean
deviation
Alpha
Social support at
work.
300
5.639
.766
.673
Job security
satisfaction
300
5.207
1.224
.695
Job satisfaction
300
4.949
1.110
.675
Internal job
300
5.874
.640
.680
motivation

59
Validity Convergent validity was demonstrated by Hackman and
Oldham (1978). Assessments of the specified jobs on the job dimensions
were made by the employers who worked on those jobs as well as by the
supervisors and the researchers. The ratings of each group were averaged
for each job, and then correlations were computed. The median of the
correlations between employees and supervisors is .51; between employers
and observers is .63; and between supervisors and observers is .46. In
general, the ratings of the three groups converge moderately well.
The validity of the JDS has been demonstrated further by data that
confirm hypotheses about the relationship of certain job characteristics
and experienced burnout. Hackman and Oldham (1974) found scores on the
JDS and the Maslach Burnout Inventory (MBI) were closely correlated. In
particular, high scores on the job dimension "feedback from the job
itself" were associated with low scores on emotional exhaustion and
depersonalization, and were high scores on personal accomplishment of the
burnout inventory (Maslach & Jackson, 1986). Another job dimension,
"dealing with others," was found to be weakly correlated with emotional
exhaustion. A third job dimension, "task significance," was highly
positively correlated with personal accomplishment.
Additional validation of the JDS is provided by data that confirm
hypothetical relationships between the JDS measure of "growth
satisfaction" and burnout. Scores on the JDS measure on "growth
satisfaction" were negatively correlated with emotional exhaustion and
depersonalization and positively correlated with personal accomplishment.
In addition, employees scoring low on the JDS subscale of "experienced
meaningfulness of the work" scored higher on depersonalization and lower
on personal accomplishment. With respect to coworkers, employees scoring

60
low on the JDS subscale of "peer and coworker satisfaction" scored high
on emotional exhaustion and depersonalization, and low on personal
accomplishment
Further evidence of the validity of the JDS has been obtained by
distinguishing its subscales by off diagonal median correlations which
provide an indication of discriminant validity of the items. The range
is from .12 to .28. In addition, distinguishing the JDS job satisfaction
subscale from measures of other psychological constructs including
burnout has been supported. Job satisfaction had a moderate negative
correlation with both emotional exhaustion (-.23) and depersonalization
(-.22), as well as slightly positive correlation with personal
accomplishment (.17).
Finally, a preliminary study has been performed in which factor
analysis was used to determine if the JDS measures a multidimensional
construct. The results of these studies are not enough to eliminate the
conceptualization of a multidimensional construct of job characteristics
measured by the JDS. Additional research is required to determine this
issue. Despite the high intercorrelations among the subscales, Hackman
and Oldham (1978) suggest that separate subscale interpretations are
probably warranted but should be made cautiously.
On the basis of the reliability and validity data available, use of
the JDS as a measure of personal and organizational variables seemed
justified.
Use in this study. The personal variables including job
expectations, and personal work needs and organizational variables,
including expected performance and role ambiguity, work group norms,
dealing with colleagues, supervision, opportunity for advancement, pay,

61
support from others, organizational climate and the economic-market
condition, general job satisfaction and psychological response to burnout
(internal work motivation) were measured with the JDS on the basis that
the scale contained measures that closely resembled the variables used in
this study. In addition, critical care nursing faculty, critical care
graduate nursing students, and two top nursing managment members of two
critical care intensive care units of a regional hospital were asked to
rate and evaluate this scale for use in this study. On the basis of
their judgement, and the decision of this researcher, use of the JDS as a
measure of the personal and organizational variables seemed justified.
Appendix E contains instrument directions and sample items.
Psychological Hardiness Test
Description. Hardiness is defined as a learned ability to cope with
a wide variety of stressful situations in such a way that the stresses
are transformed to a positive outlook, or negative stresses, that cannot
be realistically transformed, are met with a plan to eliminate them.
Another way of describing "hardiness" is transformational coping which is
a learned process. The amount of hardiness one has acts as a buffer to
keep stress from changing into strain, and strain from changing into
illness. A sample item of the Psychological Hardiness Test includes, "I
often wake up eager to take up my life where it left off the day before."
The measurement of hardiness consists of 50 rating-scale items developed
by Kobasa, Maddi, Donner, Merrick, and White (1984). The 50 items were
derived from a factor analysis of six existing personality scales which
have been used to measure commitment, control, and challenge dimensions
of hardiness. The Hardiness Test was standardized on a population of 223
women and 1511 men who for the most part were professionalsbusiness
executives, lawyers, white collar professional.

62
The hardiness scores is computed by transforming raw subscale scores
into standard scores and adding across the three subjscales to produce a
total score for each subject. Commitment is defined as the ability to
commit to the task or project or relationship. Control is defined as the
realistic knowledge and use of the amount of control or lack of control
that one has in this and other situations. Challenge is defined as the
use of both commitment and control in order to see events, relationships,
problems and opportunities as challenges rather than as trouble.
Psychometric Properties of Psychological Hardiness Test
Reliability. As to reliability, the internal consistency estimates
based on 10,000 subjects over the past four years from all walks of life
and a multitude of circumstances has yielded a coefficient alpha of .92
for total hardiness score a mean of 74.02 and a standard deviation of
9.60. Stability appears to be about .960 over a period of two weeks.
The internal consistency estimate for this sample was .89 with a mean
score of 69.31 and a S.D. of 11.01.
Validity. The validity of the hardiness test has been demonstrated
by data that confirm hypotheses about the relationship of hardiness to
burnout. Keane et al. (1985) reported that nurses who exhibited less
psychological hardiness reported more burnout. In addition, they
reported that perceived job stress and hardiness were significant
additive predictions of burnout. Hardiness appeared to have beneficial
effects on decreasing burnout.
Kobasa et al. (1982) related commitment and coping in stress
resistance among lawyers and identified that increases in strain are
significantly determined by personality characteristics of alienation
(vs. commitment). In another study, Kobasa (1979) reported discriminant
function analysis with the prediction that high stress/low illness
executives show by comparison with high stress/high illness executives,

63
more hardiness, that is, have a stronger commitment to self, an attitude
of vigor toward their environment, a sense of meaningfulness, and an
internal locus of control.
This evidence suggests that on the basis of the reliability
estimates and validity data available, the total hardiness scores
provides a measure of general psychological hardiness. However, there is
less empirical support for the interpretation of separate subscale scores
of control, commitment, and challenge.
Uses in this study. The personal variable personality was measured
with the Hardiness Test on the basis that this scale would determine if
hardiness or transfunctional coping acts as a buffer to keep situations
conducive to stress from changing into job stress, and job stress from
changing into burnout among critical.care nurses. In addition, critical
care nursing faculty, critical care graduate students and two top nursing
management members of two critical care intensive care units of a
regional hospital were asked to rate and evaluate this scale for use in
this study. On the basis of their judgement and the discretion of this
researcher, use of the Hardiness Test is a measure of the personal
variable of personality seemed justified. Appendix G contains
instrument directions and sample items.
Maslach Burnout Instrument (MBI)
Description. Burnout, according to Maslach and Jackson (1986), is a
syndrome of emotional exhaustion, depersonalization, and reduced personal
accomplishment, which often affects helping professionals (e.g. ,
teachers, nurses and therapists). A major aspect of the burnout syndrome
is increased feelings of emotional exhaustion; as emotional reserves are
depleted, helping professionals feel that they are no longer able to give
of themselves at a psychological level. In addition, the development of
depersonalizationi.e., negative, cynical attitudes and feelings about

64
one's own clients occurs. A third aspect of the burnout syndrome is
reduced personal accomplishment, which refers to the tendency to evaluate
oneself negatively, especially with regard to one's work with patients.
Helping professionals may feel unhappy about themselves and dissatisfied
with their accomplishments on the job. The MBI is designed to measure
the three components of burnout. Each aspect is measured by a separate
subscale. The Emotional Exhaustion subscale assesses feelings of being
emotional, over extended, and exhausted by one's work. The
Depersonalization subscale measures an unfeeling and impersonal response
towards recipients of one's service, care, treatment, or instruction.
The Personal Accomplishment subscale assesses feelings of competence and
successful achievement in one's work with people. Each scale further
includes an expression of frequency using a six-point response format.
The MBI consists of a total of 22 items.
Psychometric Properties of MBI
Reliability. Reliability coefficients of internal consistency
ranged from .71 to .90. Test retest reliability (2-4 weeks apart) ranged
from .82 to .53. Standard errors of measurement ranged from 3.16 to
4.99. Reliability estimates, therefore, appear sufficient. The internal
consistency of the emotional exhaustion subscale on the sample in this
study was .72.
Validity. Convergent validity was determined in a variety of ways.
First, behavioral ratings made by an acquaintance of the individual such
as a coworker or a spouse were correlated with MBI scores. The validity
of the job is demonstrated further in studies confirming hypotheses about
the relationships between various job characteristics and experienced
burnout. In one study, it was predicted that the greater number of
clients one must care for, the higher the burnout scores on the MBI
(Maslach & Pines, 1977; Maslach & Jackson, 1982, 1984a-b).

65
The JDS and the MBI scores were correlated in research performed by
Pines and Kafry (1978). High scores on the job dimension, feedback from
the job itself, were correlated with low scores on depersonalization and
emotional exhaustion and high scores on personal accomplishment. The
dimension, "dealing with others," relates to the degree to which a job
requires the employee to work closely with people in carrying out the job
activities. High scores on this job dimension were weakly correlated
with emotional exhaustion. Task significance, a third dimension,
assesses the degree to which the job has an impact on the lives of other
people. High scores on this dimension were positively correlated with
personal accomplishment.
Further validation of the MBI has been provided by data that
confirms hypotheses related to experienced burnout and various outcomes
or personal reactions. In a study of nurses, and social service and
mental health workers scores on the JDS measure of "growth satisfaction"
were negatively correlated with depersonalization and emotional
exhaustion and positively correlated with personal accomplishment. Low
scores on the JDS subscale of "experienced meaningfulness of the work"
scored higher on depersonalization and lower on personal accomplishment.
In addition, low scores on the JDS subscale of "knowledge of results"
were correlated with high scores on emotional exhaustion and
depersonalization and with low scores on personal accomplishment.
Support for the hypotheses predicting that burnout would be related
to the desire to leave one's job was supported by Maslach and Jackson
(1979, 1982, 1984a-b). In addition, the impairment of one's
relationships with people in general, both on and off the job was highly
correlated with emotional exhaustion. Low scores on the JDS subscale

66
peer and coworker satisfaction correlated with high scores on emotional
exhaustion and depersonalization, and low on personal accomplishment.
Additional studies have linked burnout to outcomes of stress
including increased use of alcohol, drugs, and insomnia. Individuals
scoring high on emotional exhaustion were also rated as having problems
with insomnia. Police officers in one study were more likely to describe
having a drink to cope with stress if they had high scores on emotional
exhaust-ion. If they scored low on personal accomplishment they were
likely to report using tranquilizers.
Finally, further research determining the discriminant validity of
the MBI has been performed in order to distinguish burnout from measures
of other psychological constructs that might be assumed to be confounded
with burnout. Scores from the general satisfaction subscale measured by
the JDS and scores of the MBI has a moderate negative correlation, -.23
(emotional exhaustion); -.22 (depersonalization as well as slightly
positive correlations with personal accomplishment (.17). Low
correlations between burnout subscale scores and other measures of job
satisfaction have been reported in other studies as well.
The MBI appears to be the best scale available in measuring burnout.
It is a well constructed instrument and the validity and reliability data
are sufficient to provide meaning and stability of the construct.
Use in this study. The variable burnout-emotional exhaustion was
measured with the Maslach Burnout Inventory on the basis that burnout was
defined as a syndrome with three dimensions: emotional exhaustion,
depersonalization, and personal accomplishment and this measure is
consistent with that definition. In addition, the use of the Maslach
Burnout Inventory permits some comparability between studies among
helping professionals including nurses because it is widely used.

67
The cognitive, affective and physiologic response of stress,
referred to as burnout, was measured with the Maslach Burnout Inventory
(Maslach & Jackson, 1986). A sample item of the Maslach Burnout
Inventory for Emotional Exhaustion includes, "I feel emotionally drained
from my work." Appendix I contains instrument directions and sample
items.
Commitment and Workload
Description. Commitment to career was measured with one five point
Likert item (Appendix F). Workload was measured with two five point
Likert items (Appendix F).
Psychometric properties. Psychometric properties of these variables
are presented in Table 3-9.
Use in this study. The personal variable commitment to career and
the organizational variable workload were measured with three items that
were designed by the researcher to closely resemble the variables used in
this study among critical care nurses. Critical care nursing faculty,
critical care graduate nursing students, and two top nursing management
members of two critical care intensive care units of a regional hospital
were asked to rate and evaluate these three items for use in this study.
On the basis of their evaluation and the discretion of the researcher
these items were used to measure commitment to career and workload.
Table 3-10 presents a summary of the instrumentation of personal,
organizational variables, and situation conducive to stress, job stress,
burnout-emotional exhaustion, job satisfaction and internal work
motivation variables used in the study.
Statistical Analysis
The five research questions listed in Chapter I (pg. 9) were used to
guide this study in examination of the full model of burnout-emotional

68
Table 3-9
Psychometric Properties of Variables; Commitment and Workload
Variable
Number
Mean
Standard
deviation
Alpha
Commitment
300
3.537
1.357
NE
Workload
300
4.097
.8038
NE
NE = Not estimated

Table 3-10
Instrumentation: Personal, Organizational Variables. Situation Conducive to Stress,
Job Stress, Burnout, Job Satisfaction, and Internal Work Motivation
Variables in this study
Instrument
Items
Personal
Ability
Demographic questionnaire
3, 4, 5
Time (tenure)
Demographic questionnaire
4, 5
Family demands
Daily Hassles Scale
1-4, 7-15, 19-23, 29,
45, 55, 58-59, 61-64,
73-76, 78-79, 82, 87,
103-108, and 110-112
35-38, 43
70-71 ,
90, 92-93
Job expectations
JDS
Section 6 (2-3, 6, 8,
Section 7 (1-12)
10, 11)
Personal work needs
Meaningfulness of work
JDS
Section 3 (4, 7), Section 6 (6)
Responsibility for work outcomes JDS
Section 3(1,8, 12,
Section 5 (4, 7)
15)
Knowledge of work results
JDS
Section 3 (5, 11)
Section 5 (5, 10)

Table 3-10continued
Variables in this study Instrument Items
Commitment to career
Work Survey
3
Health
Daily Hassles Scale
1
oc
OC'
50,
53-54, 56,
77,
91 98
Psychological hardiness
Hardiness Test
1-50
Organizational variables:
Workload
Work Survey
1, 2
Expected performance and
JDS
Section
1
(6,
7)
role ambiguity
Section
2
(4,
7, 10, 12)
Work group norms:
Skill variety
JDS
Section
1
(4),
Section 2
(1, 5)
Task identity
JDS
Section
1
(3),
Section 2
(3, 11)
Task significance
JDS
Section
1
(5),
Section 2
(8, 14)
Autonomy
JDS
Section
1
(2),
Section 2
(9, 13)
Dealing with colleagues
JDS
Section
1
(1),
Section 2
(2, 6)

Table 3-10continued
Variables in this study
Supervision
Opportunity for advancement
Pay
Support from others at work
Organizational climate and economic
market condition (job security)
Degree situation conducive
to stress
Perceived job stress
Burnout:
Instrument
Items
JDS
Section 4 (5, 8, 14)
JDS
Section 4 (3, 6, 10, 13)
JDS
Section 4 (2, 9)
JDS
Section 4 (4, 7, 12)
JDS
Section 4 (1, 11)
Dai ly
Hass!es
Scale
5, 6, 24-26, 39-42, 44, 46-47,
51-52, 57, 60, 67-69, 85, 88-89,
94-97, 99-101, 109, 113-117
Daily
Hassles
Scale
27-28, 30-34, 65-66, 72, 80-84,
86, 102
Emotional exhaustion
Maslach Burnout Inventory
4, 5, 7, 9-12, 15, 17-19, 21-22

Table 3-10continued
Variables in this study
Instrument
Items
General job satisfaction
JDS
Section
3
(3,
9,
13)
Section
5
(2,
8)
Psychological response-
JDS
Section
3
(2,
6,
10, 14)
internal job motivation
Section
5
(1,
9)

73
exhaustion, that included ten personal variables, twelve organizational
variables, the degree to which the situation is conducive to stress, job
stress, job satisfaction, and internal work motivation. Multiple
regression analyses were used to answer the study questions. In a post
hoc analysis, each independent variable that made a significant
contribution to the variance explained in one or more dependent variables
was included in a path analysis. Path analysis, as described by Pedhazur
(1982), was used to estimate the magnitudes of the direct and indirect
effects of these selected variables on perceived levels of stress,
general job satisfaction, and burnout-emotional exhaustion,
respectively

CHAPTER IV
STUDY FINDINGS
This study was designed to collect data and to test a path-
analytical model of the theoretical conceptualization of burnout for
critical care nurses. The model of interest tested was an expansion of
the model offered by Perlman and Hartman (1982). Five research questions
were used to guide this study in the examination of the full model of
burnout including personal and organizational variables and situation
conducive to stress, job stress, job satisfaction and internal work
motivation. Each of the independent variables that made a significant
contribution to the variance explained in the dependent variables was
included in the path analysis.
This section is divided into two sections. The first section
describes the statistical analysis of the full model. This section
includes the mean, standard deviation, and zero-order correlation
coefficient between each of the variables included in the study and the
results of regression analyses used to address the five research
questions posed in Chapter I. The second section includes a presentation
of the findings related to estimation of the direct and indirect effects
of the exogenous and endogenous variables obtained from applying path
analysis to a more parsimonious version of the model.
Full Model and Statistical Analysis
Appendix J contains the means, standard deviations, and zero-order
coefficients of correlation between the endogenous variables consisting
74

75
of the situation conducive to stress, job stress, job satisfaction,
internal job motivation, and burnout-emotional exhaustion and each of the
exogenous variables in the study. As shown in Appendix J, many of the
variables were found to be significantly associated with the endogenous
measures and indicated promise for explaining and predicting burnout in
terms of the model shown in Figure 1-2 (pg. 7).
Exogenous Variables
Personal characteristics. Personal variables consisted of ability,
time, family demands, job expectations, personal work needs including
meaningfulness of work, responsibility for work outcomes, and knowledge
of work results, health, commitment to career, and personality. Among
the personal characteristics assessed family demands, knowledge of work
results, and health were all significantly associated with the situation
conducive to stress. With the exception of ability, time, and job
expectations, the personal characteristics were all significantly related
to job stress, and burnout-emotional exhaustion. Job expectations was
inversely related to internal job motivation. Personal characteristics
including meaningfulness of work, responsibility for work outcomes,
knowledge of work results and commitment to career were all significant 1y
associated with job satisfaction and internal job motivation. In
addition, while job expectation was significantly related to job
satisfaction, family demands was significantly associated with internal
job motivation. The personality variable was measured with three
psychological hardiness characteristics of commitment, challenge and
control with the total hardiness score. With the exception of job
satisfaction, the total psychological hardiness score was significantly
associated with the variables situation conducive to stress, job stress,
burnout-emotional exhaustion, and internal job motivation.

76
Organizational work characteristics. Organizational work variables
consisted of workload (workload and staff size), expected role
performance and role ambiguity, work group norms (skill variety, task
identity, task significance, autonomy), dealing with colleagues (dealing
with others at work), supervision, opportunity for advancement, pay,
support from others at work (social support satisfaction), organizational
climate and the economic-market condition (job security) measured with
the Job Diagnostic Survey.
As shown in Appendix J, the zero-order coefficient of correlation
between all the endogenous variables and expected role performance and
role ambiguity, supervision, opportunity for advancement and support from
peers at work were significant. Skill variety was significantly related
to all endogenous measures except situation conducive to stress and
burnout-emotional exhaustion. Task identity was significantly associated
with all the endogenous measures. The correlation of task significance
was significantly related to job satisfaction and internal job
motivation. Autonomy was significantly related to the situation
conducive to stress, job stress, and internal work motivation. Dealing
with others at work was significantly associated with all the dependent
variables. With the exception of the situation conducive to stress, and
internal work motivation, pay was significantly associated with the
endogenous measures. Job security was significantly related inversely to
burnout-emotional exhaustion, and positively related to job
satisfaction.
Endogenous Variables
Endogenous variables consisted of situation conducive to stress, job
stress, job satisfaction, internal job motivation, and burnout-emotional
exhaustion

77
As shown in Appendix J, situation conducive to stress was
significantly related to all the endogenous measures while job stress was
significantly correlated with all the endogenous measures. Burnout-
emotional exhaustion was significantly related to job satisfaction. Job
satisfaction was significantly related to internal job motivation.
Question 1
Question 1 addressed the significance of the relationship between
situational stress and the weighted linear combination of (a) a set of
personal variables and (b) a set of organizational variables. In
addition, this question also addressed which of the variables in the
model contributed significantly to the variance in situational stress.
Multiple regression analysis yielded an of .72, (F = 31.948;
df = 22, 277; p = .0001), indicating that 72% of the variance on the
situation conducive to stress variable was explained by the variables in
the regression model. Regression results in Table 4-1 show that the
personal variables family demands, health difficulties, and psychological
hardiness, and the organizational work variables, skill variety and job
security, were significant predictors of the situation conducive to
stress.
Personal variables that did not relate significantly to situational
stress were ability, time, job expectations, meaningfulness of work,
responsibility for work outcomes, knowledge of work results, and
commitment to career. Organizational variables that did not relate
significantly to situational stress were workload, expected role
performance and role ambiguity, task identity, task significance,
autonomy, supervision, dealing with others, opportunity for advancement,
pay, and support from peers at work. (See Table K-l in Appendix K for
results of the multiple regression for all variables.)

Table 4-1
Multiple Regression of Degree Situation Conducive to Stress on the
Variables Within Each Block of Characteristics
Block
Variable
Standard
coefficient
t-value
p value
Personal
Family demands
.621
12.180
.0001
characteristics
Health
.206
4.118
.0001
Psychological hardiness
-.086
-2.087
.0378
Organizational work
Skill variety
.102
2.281
.0233
characteristics
Job security
-.070
-l .843
.0664
R2 = .717 (F = 31.948; df = 22, 277; p
0001)

79
Question 2
Question 2 addressed the significant relationship between job stress
and the combination of (a) situation conducive to stress and (b) the
preceding exogenous variables (ten personal variables and twelve
organizational variables). In addition, this question also addressed
which of the variables in the model contributed significantly to the
variance in job stress.
Multiple regression analyses yielded an of .74, (F = 33.222;
df = 23, 276; p = .0001), indicating that 74% of the variance in job
stress was explained by the variables in the regression model.
Regression results in Table 4-2 show that the personal variables
including time (tenure), family demands, and health difficulties, the
organizational variables including workload, pay, supervision and job
security and the stress variable, situation conducive to stress were
significant predictors of job stress.
Personal variables that did not relate significantly to job stress
were ability, job expectations, meaningfulness of work, responsibility
for work outcomes, knowledge of work results, commitment to career and
psychological hardiness. Organizational variables that did not relate
significantly to job stress were expected role performance and role
ambiguity, skill variety, task identity, task significance, autonomy,
dealing with others, opportunity for advancement, and support from peers
at work. (See Table K-2 in Appendix K for results of the multiple
regression for all variables.)
Question 3
Question 3 addressed the significant relationship between job
satisfaction and the combination of (a) job stress, (b) situational

Table 4-2
Multiple Regression of Job Stress on the Variables Within Each Block of
Characteristics and Situation Conducive to Stress
Block
Variable
Standard
coefficient
t-value
p value
Personal
Time
-.1307
-1.824
.0693
characteristics
Family demands
.3339
5.425
.0001
Health
.1422
2.808
.0054
Organizational work
Workload
.0572
1.733
.0842
characteristics
Pay
.101
2.549
.0114
Supervision
-.0837
-1.781
.0761
Job security
-.0990
-2.685
.0077
Stress variable
Situation conducive to stress
.3652
6.262
.0001
R2 = .735 (F = 33.222; df = 23, 276; p = .0001)
oo
o

81
stress, and (c) the preceding exogenous variables (10 personal variables
and 12 organizational variables). In addition, this question also
addressed which of the variables in the model contributed significantly
to the variance in job satisfaction.
Multiple regression analysis yielded an of .64, (F = 20.413;
df = 24, 275; p = .0001), indicating that 64% of the variance in job
satisfaction was explained by the variables in the regression model.
Regression results in Table 4-3 show that the personal variables
including job expectations, meaningfulness of work, knowledge of work
results, health difficulties and organizational variables including task
identity, supervision, dealing with others, opportunity for advancement,
pay and job security and the stress variable, job stress, were
significant predictors of job satisfaction.
Personal variables that did not relate significantly to job
satisfaction were ability, time, family demands, responsibility for work
outcomes, commitment to career, and psychological hardiness.
Organizational variables that did not relate significantly to job
satisfaction were workload, expected role performance and role ambiguity,
skill variety, task significance, autonomy, and support from peers at
work. The stress variable degree situation conducive to stress did not
relate significantly to job satisfaction. (See Table K-3 in Appendix K
for results of the multiple regression for all variables.)
Question 4
Question 4 addressed the significant relationship between internal
job motivation and the combination of (a) job stress, (b) situation
conducive to stress, and (c) the preceding exogenous variables. In
addition, this question also addressed which of the variables in the

Table 4-3
Multiple Regression of Job Satisfaction on the Variables Within Each Block of
Characteristics, Job Stress and Situation Conducive to Stress
Block
Variable
Standard
coefficient
t-value
p value
Personal
Job expectations
-.1078
-2.801
.0055
characteristics
Meaningfulness of work
.2885
5.398
.0001
Knowledge of work results
.1061
1.978
.0489
Health
.1598
2.702
.0073
Organizational work
Task identity
.0996
2.449
.0150
characteristics
Supervision
.2192
4.080
.0001
Dealing with others
.1717
-3.559
.0004
Opportunity for advancement
.2125
3.086
.0022
Pay
.1392
2.976
.0032
Job security
-.0848
-1.948
.0525
Stress variables
Job stress
-.1404
-2.000
.0465
R2 = .6405 (F = 20.413; df = 24, 275; p
0001)

83
model contributed significantly to the variance in internal job
motivation.
Multiple regression analysis yielded an r2 of .54, (F = 13.552;
df = 24, 275; p = .0001), indicating that 54% of the variance of internal
job motivation was explained by the variables in the regression model.
Regression results in Table 4-4 show that the personal variables
including family demands, meaningfulness of work, responsibility for work
outcomes, commitment to career and health difficulties and organizational
work variables including autonomy, dealing with others, support from
peers at work and the stress variable situation conducive to stress were
significant predictors of internal work motivation.
Personal variables that did not relate significantly to internal job
motivation were ability, time, job expectation, knowledge of work
results, and psychological hardiness.
Organizational variables that did not relate significantly to
internal job motivation were workload, expected role performance and role
ambiguity, skill variety, task identity, task significance, supervision,
opportunity for advancement, pay, and job security. The stress variable
that did not relate significantly to internal job motivation was job
stress. (See Table K-4 in Appendix K for results of the multiple
regression for all variables.)
Question 5
Question 5 addressed the significant relationship between burnout-
emotional exhaustion and the combination of (a) job satisfaction,
(b) internal work motivation, (c) job stress, (d) situation conducive to
stress, and (d) the preceding exogenous variables. In addition, this
question also addressed which of the variables in the model contributed
significantly to the variance in burnout-emotional exhaustion.

Table 4-4
Multiple Regression of Internal Job Motivation on the Variables Within Each Block of
Characteristics, Job Stress and Situation Conducive to Stress
Block
Variable
Standard
coefficient
t-value
p value
Personal
Family demands
-.1442
-1.701
.0901
characteristics
Meaningfulness of work
.1325
2.196
.0290
Responsibility for work outcomes
.2168
4.185
.0001
Commitment to career
.1168
2.560
.0110
Health
-.1262
-1.890
.0599
Organizational work
Autonomy
.1713
3.538
.0005
characteristics
Dealing with others
.2759
5.065
.0001
Support from peers at work
.1819
3.041
.0026
Stress variables
Situation conducive to stress
.2509
3.058
.0024
R2 = .5419 (F = 13.552; df = 24, 275; p
0001)

85
Multiple regression analysis yielded an of 41, (F = 7.394;
df = 26, 273; p = .0001), indicating that 41% of the variance in
burnout-emotional exhaustion was explained by the variables in the
regression model. Regression results in Table 4-5 show the personal
variables that were significant predictors of burnout-emotional
exhaustion. Specifically, these were health difficulties, commitment to
career, and psychological hardiness. The significant organizational work
variables included workload, dealing with others, and job security and
the job stress outcome/variable job satisfaction.
Personal variables that did not relate significantly to burnout-
emotional exhaustion were ability, time, family demands, job
expectations, meaningfulness of work, responsibility for work outcomes,
and knowledge of work results. Organizational variables that did not
relate significantly to burnout-emotional exhaustion were expected role
performance and role ambiguity, skill variety, task identity, task
significance, autonomy, supervision, opportunity for advancement, pay,
and support from peers at work. The job stress outcome variable that did
not relate significantly to burnout-emotional exhaustion was internal job
motivation. The stress variables that did not relate significantly to
burnout-emotional exhaustion were job stress and the degree the situation
was conducive to stress. (See Table K-5 in Appendix K for results of the
multiple regression for all variables.)
In combination, these study questions have provided a test of the
full model of burnout. A major problem in testing the full model was
that the large number of variables found to be significantly associated

Table 4-5
Multiple Regression of Burnout-Emotional Exhaustion on the Variables Within Each Block of Characteristics,
Job Satisfaction, Internal Job Motivation, Job Stress and Situation Conducive to Stress
Block
Variable
Standard
coefficient
t-value
p value
Personal
Health
.2144
2.780
.0058
characteristics
Commitment to career
-.2822
-5.346
.0001
Psychological hardiness
-.1293
-2.138
.0334
Workload
.1175
2.349
.0195
Organizational work
Dealing with others
.1858
2.835
.0049
characteristics
Job security
-.1101
-2.183
.0299
Stress outcomes
Job satisfaction
-.3125
-3.995
.0001
R2 = .4132 (F = 7.394; df = 26, 273; p = .0001)

87
with burnout made parsimonious and interpretable statements of
relationship difficult. To proceed with this exploratory analysis it
seemed desirable to reduce the total number of variables by eliminating
those variables that were not significantly related to the next
endogenous variable on the path in the model. A fairly liberal alpha
level of .10 was chosen for variable inclusion in the path analysis to
guard against "over-trimming" of the model in this early stage of theory
building.
Reduced Model and Path Analysis
Contributions to Situational Stress
Table 4-6 contains the estimates of the direct effects of the
exogenous personal variables, and organizational exogenous variables on
the situation conducive to stress. An NE in the Direct Effects column of
Table 4-6 indicates that the path coefficient was not significantly
greater than .00 in the full-model analyses. An NE in the Indirect
Effects column indicates that the effect could not be estimated because
(a) one of the coefficients along the path had not been significantly
greater than .00 in the full model, and thus the path was omitted in the
reduced model, or (b) there was no indirect path between the particular
independent and dependent variable in the full model show in Figure 1-2.
As evidenced in Table 4-6, family demands had the strongest effect (.637)
on situation conducive to stress; skill variety had the weakest effect
(.062) on situation conducive to stress. This set of variables in the
reduced model explained 70% of variance of the situation conducive to
stress, as compared to 72% of variance that had been explained in the
full model

88
Table 4-6
Magnitudes of Direct and Indirect Effects on Situation
Conducive to Stress, Level of Perceived Job Stress,
General Job Satisfaction and Burnout
Effect
Variables
Direct Indirect Total
On Degree Situation Conducive to Stress
Family demands
.637
NE
.637
Health difficulties
.201
NE
.201
Psychological hardiness
-.091
NE
-.091
Skill variety
.062
NE
.062
Job security
-.095
NE
-.095
On Level
of Perceived
Job Stress
Degree situation conducive
to stress
.370
NE
.370
Time
-.034
NE
-.034
Family demands
.332
.236
.568
Health difficulties
.127
.074
.201
Psychological hardiness
NE
-.034
-.034
Workload
.042
NE
.042
Skill variety
NE
.023
.023
Supervision
-.183
NE
-.183
Pay
-.073
NE
-.073
Job security
-.095
-.035
-.130

89
Table 4-6continued
Effect
Variables Direct Indirect Total
On General Job Satisfaction
Degree situation conducive
to stress
NE
-.039
-.039
Level of perceived
job stress
-.106
NE
-.106
Family demands
NE
-.060
-.060
Job expectations
-.115
NE
-.115
Meaningfulness for work
.290
NE
.290
Knowledge of work
results
.100
NE
.100
Health difficulties
.193
-.021
.172
Psychological hardiness
NE
.004
.004
Skill variety
NE
-.002
-.002
Task identity
.096
NE
.096
Supervision
.237
.019
.256
Dealing with others
-.216
NE
-.216
Opportunity for
advancement
.196
NE
.196
Pay
.170
-.008
.162
Job security
-.099
.014
-.085
On Burnout-Emotional
Exhaustion
General job satisfaction
-.334
NE
-.334
Level of perceived job
stress
NE
.035
.035

90
Table 4-6continued
Effect
Variables
Direct
Indirect
Family demands
NE
.099
Job expectations
NE
.038
Meaningfulness of work
NE
-.097
Knowledge of work
results
NE
-.033
Commitment to career
-.276
NE
Health difficulties
.178
-.032
Psychological hardiness
-.114
-.012
Workload
.103
NE
Skill variety
NE
.009
Task identity
NE
.032
Supervision
NE
-.086
Dealing with others
.235
.072
Opportunity for
advancement
NE
-.065
Pay
NE
-.054
Job security
-.088
.017
Total
.099
.038
-.097
-.033
-.276
.146
-.126
.103
.009
.032
-.086
.307
-.065
-.054
-.071

91
Contributions to Perceived Job Stress
Table 4-6 presents the estimates of direct and indirect effects
among the exogenous personal and organizational variables and the stress
variable situation conducive to stress. Estimates of indirect effects
were calculated as the product of the path coefficients of variables
connected by arrows that lay on the path between the variables of
interest. For example, the indirect effect of family demands on
perceived job stress was (.637) X (.370) = .236. This reflects the
effect of family demands, acting through the situational stress variable,
on the nurses' perceived job stress. Family demands also have a direct
effect on perceived job stress, represented by the path coefficient of
.332. The personal exogenous variable family demands had the strongest
effect (.568) on level of perceived job stress; the organizational
exogenous variable skill variety had the weakest effect (.023) on
perceived job stress. This set of variables in the reduced model
explained 71% of variance in job stress, as compared to 74% of the
variance explained with the full model.
Contributions to Job Satisfaction
Table 4-6 also contains the estimates of the direct and indirect
effects of the exogenous personal variables and organizational variables
and the stress variable job stress on general job satisfaction. The
personal exogenous variable meaningfulness of work had the strongest
effect on general job satisfaction; the organizational exogenous variable
skill variety had the weakest total effect on general job satisfaction.
This set of variables in the reduced model explained 62% of variance of
general job satisfaction, as compared to 64% of the variance explained in
the full model

92
Contributions to Burnout-Emotional Exhaustion
Finally, Table 4-6 contains the estimates of the direct and indirect
effects among the personal and organizational exogenous variables, the
stress variables and job satisfaction on the endogenous variable
burnout-emotional exhaustion. As expected, general job satisfaction had
the strongest total effect on burnout-emotional exhaustion (-.334);
however, skill variety had the weakest total effect on burnout-emotional
exhaustion (.009). This set of variables in the reduced model explained
38% of variance of burnout-emotional exhaustion, as compared to 41% of
the variance explained in the full model.
Goodness-of-Fit
Assessment of goodness-of-fit of the reduced model was performed.
The chi-square goodness-of-fit test for the burnout-emotional exhaustion
model among critical care nurses was 39.12 (df = 37, p = .3315),
indicating a good fit of the model to the data. The larger the
probability associated with the chi-square values, the better the fit of
the model to the data (Pedazur, 1982). This finding, however, must be
interpreted with caution, recognizing that the model would fit the data
less well if a cross-validation sample had been used. Nevertheless, the
model tested here seems to hold promise for future confirmatory
investigations.
The path diagram graphically displayed in Figure 4-1 represents a
proposed pattern of causal relationships among a set of personal
exogenous variables, organizational exogenous variables, and endogenous
variables (i.e., situation conducive to stress, job stress, job
satisfaction, and burnout-emotional exhaustion). The first page of
Figure 4-1 (pg. 93) shows paths to the endogenous variable degree

93
Family Demands
Job Expectation
Meaningfulness
for Work
Knowledge of
Work Results
Committment to
Career
Health Difficulties
Psychological
Hardiness
Work Load
Skill Variety
Task Identity
Supervision
Dealing with Others
Opportunity for
Advancement
Pay
Job Security
R2 -.700
.547 e
Degree Situation
Conducive to
Stress
Figure 4-1
Reduced Model of Burnout

94
Family Demands
Job Expectation
Meaningfulness
for Work
Knowledge of
Work Results
Committment to
Career
Health Difficulties
Psychological
Hardiness
Work Load
Skill Variety
Task Identity
Supervision
Dealing with Others
Opportunity for
Advancement
Pay
Job Security
Figure 4-1continued

95
Family Demands
Figure 4-1continued

96
Family Demands
Job Expectation
Degree Situation
Conducive to
Stress
Meaningfulness
for Work
Knowledge of
Work Results
Committment to
Career
Health Difficulties
Psychological
Hardiness
Work Load
Skill Variety
Task Identity
Supervision
Dealing with Others
Opportunity for
Advancement
-.276
.178
Level of
-.114
Perceived
Job Stress
General
Job
Satisfaction
R2 ..384
Burnout
Emotional
Exhaustion
.785 e
Figure 4-1continued

97
situation conducive to stress. The second page of Figure 4-2 (pg. 94)
shows paths to the endogenous variable level of perceived job stress.
The third page of Figure 4-1 (pg. 95) shows paths to the endogenous
variable general job satisfaction. The last page of Figure 4-1 (pg. 96)
shows paths to the endogenous variable burnout-emotional exhaustion. No
indirect paths with effects less than .05 have been included in this
diagram, as suggested by Land (1969). The correlation between exogenous
variables is conventionally illustrated by a curve line with arrow heads
at both ends indicating that a relationship between exogenous variables
were not analyzed in the model. For the purpose of clarity,
correlational arrows have not been drawn in Figure 4-1 due to the large
number of exogenous variables included in the model. The correlations
between the exogenous variables included in the model are shown in
Table 4-7

Table 4-7
Intercorrelatlons of Exogenous Variables of the Path Analytic Model of Burnout
Among Critical Care Nurses
1 2 3 4 5 6 7
1.
Family demands

-.074
-.057
-.32
-.025
.74
-.45
2.
Job expectations
-.099
.144
.079
-.80
.069
3.
Meaningfulness of work
.495
.22
.026
.174
4.
Knowledge of work results
.195
-.263
.362
5.
Commitment to career
.062
.108
6.
Health
.388
7.
Psychological hardiness
8.
Workload
.026
.051
.077
.127
.064
.061
.133
9.
skill variety
-.107
.087
.451
.367
.227
-.117
.247
10.
Task identity
-.142
.020
.0234
.341
.099
-.099
.060
11.
Supervision
-.150
.027
.378
.480
.187
-.163
.205
12.
Dealing with others
-.340
.010
.167
.336
.057
-.334
.431
13.
Opportunity for advancement
-.070
.006
.621
.491
.342
-.0001
.150
14.
Pay
.184
.018
.136
.080
.192
.192
-.150
15.
Job security
.066
-.003
.163
.129
.069
.090
.141

CHAPTER V
DISCUSSION, INTERPRETATIONS, CONCLUSIONS AND RECOMMENDATIONS
Overview
This study was designed to collect data and to test a
path-analytical model of the theoretical conceptualization of burnout for
critical care nurses. The model of interest tested was an expansion of
the model offered by Perlman and Hartman (1982). The sample consisted of
300 female, critical care staff nurses who had worked for at least three
months in a medical, surgical or cardiac intensive care unit at a
tertiary, regional or community hospital in Northeastern, Northwestern,
Northcentral, and Southern regions of the State of Florida. The analysis
included estimation of magnitudes of direct and indirect effects of
exogenous and endogenous variables using path analysis. The overall
conclusion derived from the analyses was that a modified model of
burnout, containing most of the major elements posited by Perlman and
Hartman provided a good fit to the data obtained from this sample.
Specifically, the path analysis of burnout indicated that family J
demands, health difficulties, psychological hardiness, skill variety, and
dissatisfaction with job security are causally linked to a situational
stress variable for nurses in critical care settings. Together these
variables explained 70% of the variance in situational stress. This
situational stress variable is in turn linked to perceived job stress,
which is also directly affected by family demands and health
difficulties, as well as by dissatisfaction with nursing supervision,
99

100
dissatisfaction with pay, and dissatisfaction with job security.
Together these variables explained 71% of the variance in perceived job
stress. Job stress then directly leads to job dissatisfaction. In
addition, job dissatisfaction is also directly influenced by job
expectations, meaninglessness of work, knowledge of work results, and
health difficulties, and as well as by degree of task identity,
supervisor dissatisfaction, dealing with others on the job,
dissatisfaction with opportunities for advancement, dissatisfaction with
pay, and satisfaction with job security. Together these variables
explained 62% of the variance in general job satisfaction. Then burnout-
emotional exhaustion is directly affected by job dissatisfaction, as well
as low commitment to the career, health difficulties, low psychological
hardiness, workload, dealing with others on the job, and dissatisfaction
with job security. Altogether, however, these variables explained only
38% of the variance in burnout-emotional exhaustion.
The original full model proposed in this study had five endogenous
variables. Namely these were the degree in which a situation is
conducive to stress, perceived job stress, job satisfaction, internal job
motivation, and burnout. One of these internal job motivation was
deleted in the reduced model using the pre-established statistical
criterion. From a theoretical perspective, however, this variable was
probably the weakest in the model because it was chosen to represent what
Perlman and Hartman had originally called "psychological response" and,
in retrospect, may not have adequately represented the theorists'
Intent.
Causes of Burnout
The major results of this study demonstrated that among critical
care nurses, general job satisfaction had the strongest total inverse
direct effect on burnout-emotional exhaustion. Because the association

101
of burnout and job satisfaction has been reported in previous studies of
helping professionals (Hackman & Oldham, 1978; Jayaratne & Chess, 1983)
including nurses (Paredes, 1982; Stone et al., 1984) this finding
replicated for critical care nurses, is consistent with previous
empirical results. For example, a study conducted by Paredes (1982) has
shown that job dissatisfaction accounted for the largest proportion of
variance in burnout for nurses. In addition, based on findings by
Hackman and Oldham (1974) scores on the Job Diagnostic Survey on job
satisfaction were negatively correlated with burnout-emotional
exhaustion for helping professions. The implication drawn from the
findings of this study is that burnout-emotional exhaustion is caused by
a growing dissatisfaction with the job among critical care nurses. In
other words, burnout-emotional exhaustion is an outcome of job
dissatisfaction.
Still another major finding in the present study is that personal
variables (i.e., psychological hardiness, health difficulties, and
organizational commitment) and organizational variables (i.e., dealing
with others at work, workload, and dissatisfaction with job security)
have important direct relationships to burnout-emotional exhaustion.
Kobasa et al. (1979, 1982) defined a hardy individual as one who has
control over situations, seeks a challenge and remains fully committed to
the situation. Kobasa et al. (1982) found that personality-based
hardiness functions prospectively as a resistance resource in decreasing
stressful life events. Persons low in hardiness find themselves and the
environment meaningless and threatening. They are frightened by change,
have little tolerance of ambiguity and see themselves as incapable.
Keane et al. (1985) and McCranie et al. (1987) explored the relationship
of psychological hardiness, demographics, and burnout among nurses using

102
the Hardiness Test (Kobasa, 1987). They reported that burnout
consistently was negatively correlated with psychological hardiness.
Their finding supports the view that hardiness constitutes as a
generalized resistance resource for nurses working in intensive care
settings. The findings and conclusions from this present study about the
direct effects of psychological hardiness on burnout among critical care
nurses confirm and expand upon earlier findings and substantiate the
theoretical formulation offered by Perlman and Hartman (1982) that the
personal characteristic personality has an impact on the process of
burnout.
The finding of a direct effect of health difficulties on burnout-
emotional exhaustion was also interesting, but not surprising,
considering the theoretical framework by Perlman and Hartman (1982) in
which they suggested that helping professionals' health may directly
affect the response to stress that includes burnout. In addition,
Maslach and Jackson (1981) reported that psychosomatic illness and use of
tranquilizers were significantly related to burnout-emotional exhaustion.
Health difficulties measured in this study are characterized by physical
manifestations of stress and include somatic complaints, difficulty
sleeping, eating difficulties, and drug and alcohol abuse. What is
interesting about these findings is that the reported health symptoms of
stress and their direct effect on burnout-emotional exhaustion was
significant in a relatively young group of female critical care nurses.
A possible explanation for the direct linkage of health difficulties to
burnout-emotional exhaustion is that perhaps the coping strategies used
by the critical care nurses studied were not sufficiently developed and

103
consequently were ineffective in preventing burnout. This is a
speculation because coping was not examined directly in this study.
Kimmel (1982) measured coping with the Ways of Coping Scale (Lazarus &
Folkman, 1989) as well as through assessment of role conflict, role
ambiguity, household support, and burnout. His sample consisted of
nurses from a metropolitan hospital. He reported that coping variables
were the best predictors of burnout. Further research to examine how
health difficulties and coping mechanisms affect burnout might be
fruitful for other helping professions.
The findings from this study also suggest that burnout-emotional
exhaustion can result from a low commitment to the career and a high
degree of dealing with others (colleagues) at work. Dealing with others
(colleagues) was measured in this present study as the degree to which
the job requires the nurse to work closely with other people in carrying
out the work activities including other organizational members. These
findings expand upon earlier research by Gaines and Jermier (1983), Dames
(1983), and Leiter and Maslach (1988) and support the theoretical
conceptualization offered by Perlman and Hartman (1982). Furthermore,
Leiter and Maslach (1988) cited interactions with coworkers as the most
important source of burnout in the work setting and, similarly, the
present study findings demonstrate a moderate effect (pc = .235),
supporting the importance of the interpersonal aspect with others at work
as a source of burnout-emotional exhaustion.
There are important implications to these findings. Colleagues on
the job include supervisors, other nurses, doctors and administrators who

104
are significant individuals that the critical care nurse has to deal with
in the job setting. The results from this study indicate that the
critical care nurse needs emotional energy and resources to relate and
deal with them because these colleague relationships can be even more
stressful than anticipated and contribute to burnout-emotional
exhaustion. Another implication is that if the critical care nurse must
frequently deal with others at work, it is important that she relate
positively to her nursing and medical peers, seeking opportunities for
comfort, advice, praise and support from this essential group because
this may assist in warding off emotional strain and exhaustion that is
likely to occur. In conclusion, these findings suggest that contact with
people at work may be a major source of frustration, distress, or
conflict among critical care nurses. In addition, with the presence of a
low commitment to continue work, the negative experience of dealing with
others, and job dissatisfaction then burnout-emotional exhaustion is
likely to be perceived among critical care nurses.
The results of this study also indicate that workload is linked to
burnout-emotional exhaustion among critical care nurses and provides
support to findings by other researchers. For example, burnout has been
correlated with a greater percentage of time in direct care of clients
(Lewiston, Conley & Blessing-Moore, 1981; Maslach & Jackson, 1982), more
difficult client problems (Meadow, 1981; Pines & Maslach, 1978), and
caseload (Maslach & Jackson, 1984a-b). Similarly, nursing researchers
have found that the more hours worked and more hours of direct patient
contact, the increased risk of burnout (Dames, 1983; Des, 1981). These
researchers also stated that the more hours working with patients with
grave prognoses, the higher the burnout scores. The direct relationship

105
of workload to burnout-emotional exhaustion found in this study lias
support from the literature and makes theoretical as well as practical
sense.
The relationship between the economic/market conditions and its
direct structural association with burnout-emotional exhaustion has been
proposed theoretically (Perlman & Hartman, 1982). The economic/market
condition was measured as job security in this study. Results from this
study indicated that job security dissatisfaction had an independent path
leading directly to burnout-emotional exhaustion. A possible explanation
is that critical care nurses may perceive that this is a time of economic
uncertainty and hardship for the nursing profession. The increasing
shortage of nurses, the increasing number of patients who will need
nursing services and the fewer services available to care for the
patients presents an unstable situation. However, the findings of this
study are confusing because the nurse should not express dissatisfaction
with job security in the presence of the current number of vacant nursing
positions available nation wide. For example, one possible explanation
is that there may be ambiguity about the degree and kind of expertise
required of the nurse with the rapid changes in medical technology. In
the face of mounting patient needs and reduced services nurses may be
faced with the need to adapt their goals and methods from an idealistic
approach to a more practical, efficient way to providing care to their
patients resulting in a sense of insecurity, resulting in dissatisfaction
with the insecure nature of their job as well as professional insecurity.
In addition, the present hospital structure of nursing has made vertical

106
mobility increasingly difficult for the staff nurse. "Burned out" staff
nurses, particularly those with 4-5 years of good experience in critical
care, may find few, if any, opportunities to rise in their profession.
Thus, they may feel "stuck in their job and resentful about having to
remain in their present job. Their sense of frustration may grow, and
feelings of burnout increase.
Maslach and Jackson (1981) analyzed separately the three components
of burnout among helping professionals including nurses with the Job
Diagnostic Survey. Although significant relationships were found between
feedback from the job itself and burnout-emotional exhaustion, feedback
from supervisors or from coworkers and burnout-emotional exhaustion,
skill variety and burnout-emotional exhaustion; and satisfaction with
opportunities for advancement and burnout-emotional exhaustion, the
findings reported by Maslach and Jackson (1981) were not replicated in
this present study among critical care nurses.
Causes of Job Dissatisfaction
The findings from this study indicate that job stress, as well as
job expectations, experienced meaninglessness of work, health
difficulties, degree of task identity, dissatisfaction with nursing
supervision, dealing with others on the job, dissatisfaction with
opportunities for advancement, dissatisfaction with pay, and satisfaction
with job security have direct effects on job dissatisfaction. A major
conclusion from these study findings is that job satisfaction of critical
care nurses is a function of personal and organizational variables and
job stress. This conclusion is strengthened by the fact that earlier
research supports these findings (French, Rodgers, & Cobb, 1974; Nord,
1977; Vachon, 1987)

107
The personal variable, job expectations, measures the individual
worker's expectation for job growth. This measure is viewed as an
individual characteristic which is predicted to affect how positively an
employee will respond to a job with a high motivating potential or
challenge. The data from this study indicated that expectations for
growth or challenge on the job was inversely linked to satisfaction with
their current job. Stone et al. (1984) studied nurses experiencing
burnout and found that they were dissatisfied with their jobs because
there were limited opportunities for personal growth on the job.
Similarly, the data from this study indicated that high job expectations
for growth and challenge among critical care nurses is causally linked to
low job satisfaction in their current job and dissatisfaction with
opportunities for advancement at work is causally linked to low job
satisfaction.
The personal variable, experienced meaningfulness of work, was
identified as a personal work need as presented by Perlman and Hartman
(1982). Experienced meaningfulness of work is defined as the need to
which the nurse experiences the job as one which is generally meaningful,
valuable and worthwhile. Unique to this study is the finding that
meaninglessness of work had the strongest direct effect on job
dissatisfaction in the model studied.
The personal variable, knowledge of work results, was identified as
a personal work need as identified by the burnout model offered by
Perlman and Hartman (1982). Knowledge of work results measured the
nurse's need to know on a continuous basis how effectively she is

108
performing on the job. Unique to this study is the finding that a low
level of knowledge of work results had a minimal direct causal linkage to
job dissatisfaction. Further study of this relationship seems
indicated.
The finding that health difficulties have a direct causal
relationship to job satisfaction is unique to this study. It suggests
that health difficulties have a causal link to job satisfaction. This
finding, however, is not surprising because the health difficulties
variable, which is a measure of physical symptoms of stress in this
present study, has consistently provided a direct effect on all the
sequences of stress in this model including the situation conducive to
stress, job stress, and burnout-emotional exhaustion. Health
difficulties is considered as a stressor in the burnout model and
contributes to burnout-emotional exhaustion through its direct and
indirect effects on job satisfaction. It is important to point out that
the variable health difficulties also had direct effects on the other
stages of stress and burnout-emotional exhaustion.
According to the research by Hinshaw and Atwood (1984) and Jayaratne
and Chess (1983), organizational work-related characteristics, including
work task identity, supervision, and pay, were significant factors
relating to job satisfaction. Their findings, in conjunction with the
significance of interpersonal group interactions and ability to relate to
others and its relation to job satisfaction indicated by Slavitt et al.
(1987), support the direct linkages of task identity, supervision, pay
and the degree of dealing with others, to job satisfaction found in the

109
present study of critical care nurses. Further study of the structural
arrangement of these variables is indicated among other helping
professions.
In this present study, the organizational variable, satisfaction
with the opportunity for advancement, was measured as the degree to which
the nurse is satisfied with the opportunity for personal growth and
development in the job. The findings indicate a direct causal link
between satisfaction with the opportunity for advancement and job
satisfaction. This finding is not surprising because promotional
opportunity has been identified as a common predictor of job satisfaction
in other studies (Jayaratne & Chess, 1983). The structural relationship
suggested by this study has support from the literature and makes
theoretical sense.
In this present study, the organizational characteristic, job
security, was measured as the amount of perceived job security. Its
direct inverse effect on job satisfaction is confusing and difficult to
interpret. Low job security causing job satisfaction is an
uninterpretable finding. In reviewing the zero order correlational
table, although the correlational coefficient between the variables job
security and job satisfaction is positive (.17), following path analysis
the path coefficient converted to a low negative value (-.099). This may
simply have been a function of sampling error.
One feature that clearly stands out is that whereas 62 percent of
the total variance is explained by the personal and organizational
variables and job stress in the determination of job satisfaction, only

110
38 percent of the total variance is explained by the personal and
organizational variables and situation conducive to stress and job
satisfaction for burnout-emotional exhaustion. It appears that the model
employed fits the concept of job satisfaction better than it fits the
concept of burnout-emotional exhaustion. By implication then, although
some of the personal and organizational variables are predictive of job
dissatisfaction and burnout-emotional exhaustion, some significant
variables related to burnout-emotional exhaustion appear to have been
omitted from the model. Determination of the missing variables linked to
burnout-emotional exhaustion is necessary for future empirical research.
Comparison of Job Dissatisfaction and Burnout
Earlier research by Jayaratne and Chess (1983) on job satisfaction
and burnout in social work suggests that these two concepts are discrete
entities. The variables, challenge of the job, promotional opportunity,
and financial rewards, were found to be the best predictors of job
satisfaction and promotions was the only predictor of burnout-emotional
exhaustion according to their study results. In other words, only
promotional opportunity was a common predictor of job satisfaction and
burnout-emotional exhaustion. In addition, workload, which has been
related to burnout in prior literature, did not appear to be an important
predictor of burnout and job satisfaction for their sample of social
workers. Although earlier research (Jayaratne & Chess, 1983) supported
the individuality of the concepts job satisfaction and burnout, the
findings from this research are not as straightforward in defining two
distinct concepts. This study suggests that health difficulties, dealing

Ill
with others on the job, and satisfaction with job security, are common
predictors of both job satisfaction and burnout. By contrast, commitment
to the career appears to be the prime determinant in burnout-emotional
exhaustion, but the challenge of the job, the experienced meaningfulness
of work, knowledge of work results, task identity, opportunity for
advancement, pay and supervision satisfaction appear to play the major
roles in job satisfaction. In addition, the burnout literature has
indicated that workload is an important contributor to burnout and the
findings from this study point this out as well. In summary, it appears
that job satisfaction and burnout are somewhat related in terms of causal
attributes; however, variables in this path analytic model explain the
variance of job satisfaction to a greater extent than they do for
burnout-emotional exhaustion.
Causes of Job Stress
The results from this study reveal that the stress variable
situation conducive to stress and personal variables, including stressful
family demands and health difficulties, and organizational variables
including supervisor dissatisfaction, dissatisfaction with pay and job
security are causally related to job stress among critical care nurses.
Although these findings do not support the structural relationships of
the variable job stress with all of the variables posited by Perlman and
Hartman (1982), the findings of this present study have practical
significance and warrant further investigation.
The stress variable, situation conducive to stress, had the greatest
direct effect on job stress. The situation conducive to stress and job
stress variables were measured with The Daily Hassles Scale including the

112
section measuring inner and future concerns of stress and the section
measuring job stress, respectively. Inner and future concerns of stress
are characterized as troubling thoughts about the future, concern about
the meaning of life, trouble relaxing, concerns with inner conflicts,
concerns about getting ahead and concerns about life in general. These
stressors arise in any situation where individuals are confronted with
demands outside the work place that threaten to overwhelm their
capabilities and resources. Job stress is characterized by stressors in
the work environment including difficulty getting along with coworkers,
dislike of work, problems with employees, unchallenging work, job
dissatisfactions, and hassles from the boss or supervisor. These job
stressors happen at the work place and threaten to overwhelm the
employee's capabilities and resources.
Another stressor that also had a major direct effect on job stress
was family demands which was also measured with The Daily Hassles Scale.
Family demand stressors are characterized as household responsibilities,
home financial responsibilities, and stress within the immediate home
environment and the neighborhood.
The personal variable, health difficulties, is another stressor that
had a modest direct effect on job stress. Health difficulties are
characterized by physical manifestations of stress and include difficulty
with sleeping and appetite, and a variety of somatic complaints as was
measured with The Daily Hassles Scale. These results are interesting
because they suggest that job stress is a function of both organizational
stressors and personal variables.

113
The organizational variables that had a minimal influence on job
stress among critical care nurses include dissatisfaction with
supervision, pay, and job insecurity. These findings are unique to this
study and warrant further investigation.
The present study contributes additional information to the
similarities of job stress and job satisfaction. The evidence suggests
that job stress and job dissatisfaction relate similarly to the same
personal variable health difficulty and organizational variables
including dissatisfaction with supervision and pay. This pattern is
unique to this study and suggests that job stress and job satisfaction
may not be completely distinct concepts but possess some commonality of
causal dimensions.
Although the evidence suggests that job stress and burnout relate
similarly to the health difficulties and dissatisfaction with job
security, family demands, dissatisfaction with supervision, and pay are
the prime determinants in job stress. By contrast, low commitment to
career, low psychological hardiness, and high degree of dealing with
others on the job appear to take the major role in the linkage to
burnout-emotional exhaustion. This suggest that although job stress and
burnout-emotional exhaustion may possess some commonality there are also
distinct causal linkages between personal and organizational variables
and these two concepts among critical care nurses.
The theoretical implication of these study findings is that job
stress is a complex phenomenon. It is affected by personal stressors,
such as family demands, the situation conducive to stress, and health

114
difficulties, as well as by organizational variables, such as
supervision, pay and job security are perceived as stressful aspects of
the job among critical care nurses studied. Information about personal
stressors and organizational characteristics is necessary to understand
the critical care staff nurse's reaction to the job. The fact that the
pattern of personal stressors and organizational characteristics were
somewhat similar for job stress and job satisfaction suggests that the
process that links job stress to job satisfaction may be a fundamental
process. However, it is also interesting to identify that the pattern of
personal and organizational variables were somewhat dissimilar for job
stress and burnout-emotional exhaustion. Further study is indicated to
explore the relationship between these two concepts.
Limitations and Recommendations
This research provides an initial test of a comprehensive model for
explaning the contributions of personal and organizational variables to
burnout-emotional exhaustion among critical care nurses. The results of
this study suggest a good fit of personal and organization variables to
the burnout model among critical care nurses. Nevertheless, it cannot be
concluded that the model reflects the true causal process. It is
recommended that this model be considered as formative or exploratory
rather than definitive for six reasons:
First, the study focused only on critical care nurses. Further
research will be necessary on other organizational and cultural settings
and among other helping professional employees before these findings can
be generalized to greater numbers of helping professionals. Second, a

115
test of the model using data based on self-report measures collected at a
single point in time makes it difficult to identify the causal
relationships between personal variables and organizational variables,
situation conducive to stress, job stress, job satisfaction and
burnout-emotional exhaustion. Such cross-sectional data make it
difficult to determine the effects of stressors and moderators in the
model. A more definitive determination of both causal effects and
moderating effects would require that further studies employ longitudinal
designs. Third, the identification and refined measurement of critical
personal and organization variables that might increase the explanatory
power of the burnout model should be an ongoing attempt balanced with
efforts to achieve parsimony of the explanation of burnout. In addition,
as evidenced in the results of the burnout model among critical care
nurses additional variables need to be identified and included in the
model because the indicated that the variables in the model account
for only 38 percent of the variance in burnout-emotional exhaustion. For
example, individual coping techniques, actual work performance and
turnover intentions might be other candidates for incorporation into the
model of burnout. Furthermore, subgrouping differences among the
critical care nurses sampled within the nine hospitals studied may be
great and reflect idosyncracies within organizational systems. For
example, the findings might reflect a very different kind of worker
burnout related to nursing administration burnout, i.e., a burned out
system. Fourth, an assumption of path analytical techniques is that
there is no measurement error. Although established instruments were

116
used for this study, self-report measures were employed, and some were
fairly short in length. Thus, even though established instruments were
used, difficulty with validity and reliability should not be ruled out as
a possible explanation for some of the nonsignificant results.
Additional research is needed using models in which latent variables
underlying the measured variables are posited through the use of linear
structural analyses (Joreskog & Sorbom, 1984). Fifth, another assumption
of path analytical techniques is that the explanatory personal and
organizational variables in the burnout model do not create a problem of
multicollinearity. The assumption was violated in several instances.
For example, the correlations between family demands and degree situation
conducive to stress (r = .81, p = .0001), and between family demands and
job stress (r = .76, p = .0001) indicated that the variables were
redundant in this sample. However, to have eliminated the variables
family demands, situation conducive to stress or job stress would have
deleted a major purpose of this study, which was to test a model
developed from a theoretical formulation. A sixth recommendation centers
on the need for cross-validation of the reduced model on an independent
sample of critical care nurses. Because of the relatively large number
of variables in the model, and because of the exploratory nature of this
work, it seemed appropriate to estimate the magnitudes of direct and
indirect effects in the reduced model on the sample used for initial
variable selection with the full model. This, however, may have resulted
in suprious estimates of some effects of the model.
Despite these limitations, the present study represents an important
extension of work of previous researchers who have examined only

117
correlations among large sets of variables or tested a single regression
model for predicting job burnout or job satisfaction.
Conclusions
In conclusion, this study has provided an exploratory analysis of
the progression of stress within the individual and within the work
setting to job dissatisfaction and burnout-emotional exhaustion. As
such, it provides an important first step in developing a comprehensive
causal model of burnout. First, these study results have clarified
relationships among personal variables, including commitment to the
career, health difficulties and a psychological hardiness; organizational
variables including workload, the degree of dealing with others at work
and the degree of satisfaction with job security; and burnout-emotional
exhaustion. Second, they have provided a framework for explaining the
variance of personal and organization-work variables among critical care
nurses in relation to the the degree that a situation is conducive to
stress, perceived job stress, job satisfaction, and burnout-emotional
exhaustion. Third, these results provide a perspective on the
relationship between burnout-emotional exhaustion and job satisfaction
in regard to the direct effects of personal and organizational variables.
Finally, the study results provide insight needed for a more precise
delineation of what is pertinent to the development of burnout-emotional
exhaustion. This research indicates that there is a progression of
burnout that includes situational stress, job stress, job
dissatisfaction, and burnout-emotional exhaustion. The research reported
here furthers this process, and provides important direction for future

118
study of how personal and organization variables, stressors and job
dissatisfaction contribute to burnout-emotional exhaustion in the helping
professions

APPENDIX A
INVITATION AND CONSENT FOR PARTICIPATION FROM
CRITICAL CARE NURSES

August 7, 1989
Dear Critical Care Nurse:
Your assistance with a research study would be greatly appreciated.
Your institution has been chosen as an important and significant provider
of Critical Care Nursing in the State of Florida. I am conducting a
study on career stress as it affects critical care nurses. Please
complete the attached questionnaires which examine some of the components
and symptoms of job stress. Do not leave any parts unanswered but rather
answer all the questions in the best possible way that you see fit. Be
assured, of course, that all responses will remain completely anonymous,
and no individual or institution will be identified in the report. I am
undertaking the study as part of my doctoral program at the University of
Florida.
I will share a summary of the findings with all Nursing Departments
that participate. Since the issue has so much professional importance, I
sincerely hope that you will be able to assist in the study. You will
agree, I am sure, that the issue is an important one and I would be happy
to share a summary of the total study with you.
No harm is incurred from participation in the study. Participants
may withdraw at any time.
Thank-you.
Joyce Stechmiller, R.N., CCRN, MSN
Project Director,
Adult Critical Care Nursing
I consent to complete the questionnaire battery.
120

APPENDIX B
PROCEDURES FOR ADMINISTRATION

PROCEDURES FOR ADMINISTRATION
The researcher and/or a graduate assistant, will meet with the
critical care staff nurses at an already scheduled staff meeting and the
study will be placed on the staff meeting agenda. The researcher and/or
the graduate assistant will invite the critical care staff nurses to
participate in the study following a brief description of the
dissertation. The questionnaires will be handed out to those staff
nurses who are interested in participating. The participants will be
instructed to complete the questionnaires on their own time away from the
work setting. The staff nurses will be requested to place the completed
questionnaires in an enclosed sealed envelope and return the envelop to a
designated box in the unit nursing lounge within one week.
All subjects will be guaranteed anonymity. A graduate assistant and
the nurse researcher will pick up the questionnaires on a daily basis
until all the questionnaires are returned.
122

APPENDIX C
DEMOGRAPHIC SHEET AND WORK SURVEY

DEMOGRAPHIC SHEET AND WORK SURVEY
1.Age (check one):
Under 20 40-49
20-29 50-59
30-39 60 or over
2. Marital status (circle one):
1 = single
3 = separated
3. Education (check one):
ADN
Some graduate work
2 = married
4 = divorced
BSN
Diploma
4. How long have you worked as a staff nurse in critical care?
Number of months and/or years
5. How long have you worked as a staff nurse at this institution?
Number of months and/or years
6. How many hours do you work on the average per week in the ICU?
Hours per week
124

APPENDIX D
DAILY HASSLES SCALE DIRECTIONS AND SAMPLE ITEMS

THE DAILY HASSLES SCALE
NAME: SEX:
IDENTIFICATION NUMBER (OPTIONAL): DATE:
Directions:
Hassles are irritants that can range from minor annoyances to fairly
major pressures, problems, or difficulties. They can occur few or many
times in any given time period. Listed below are a number of ways in
which a person can feel hassled.
When you respond to the items, you must have a specific time period in
mind. Please indicated the time period you will be thinking about:
Past month
Past week
Yesterday
Today
Other:
Read each item and circle 0 if the item was no hassle for you in the time
period shown above. If it was a hassle, indicate how severe the hassle
was by circling 1, 2, or 3.
126

127
SEVERITY
How much of a None or
hassle was Did Not Somewhat Moderately Extremely
this for you? Occur Severe Severe Severe
1.Misplacing or
or losing things ....0 1 2 3
2. Troublesome
neighbors ........0 1 2 3
3. Social
obligations 0 1 2 3
4. Inconsiderate
smokers 0 1 2 3
5.Troubling thoughts
about your future ....0 1 2 3
6.Thoughts
about death 0 1 2 3
7 Health of a
family member ......0 1 2 3
8. Not enough
money for
clothes ....0 1 2 3
9. Not enough
money for
housing 0 1 2 3
10.Concerns about
owing money ..0 1 2 3

APPENDIX E
JOB DIAGNOSTIC SURVEY DIRECTIONS AND SAMPLE ITEMS

JOB DIAGNOSTIC SURVEY
This questionaire was developed as part of a Yale
University study of jobs and how peole react to them.
The questionnaire helps to determine how jobs can be
better designed, by obtaining information about how
people react to different kinds of jobs.
On the following pages you will find several different kinds of questions
about your job. Specific instructions are given at the start of each
section. Please read them carefully. It should take no more than
25 minutes to complete the entire questionnaire. Please move through it
quickly.
The questions are designed to obtain your perceptions
of your job and your reactions to it.
There are no "trick" questions. Your individual answers will be kept
completely confidential. Please answer each item as honestly and frankly
as possible.
Thank you for your cooperation.
For more information about this questionnaire and its use, please
contact:
Prof. J. Richard Hackman
Department of Administrative Sciences
Yale University
New Haven, Connecticut 06520
OR
Prof. Greg R. Oldham
Department of Business Administration
University of Illinois
Urbana, Ilinois 61801
129

130
SECTION ONE
This part of the questionnaire asks you to
describe your job, as objectively as you can.
Please do not use this part of the questionnaire to show how much
like or dislike your job. Questions about that will come later.
Instead, try to make your descriptions as accurate and as
objective as you possibly can.
A sample question is given below.
A. To what extent does your job require you to work with mechanical
equipment ?
1 2
3
4
5 -
6 7
Very little; the
Moderately
Very much; the job
job requires almost
requires almost
no contact with
constant work with
mechanical equip
ment of any kind
mechanical equipment
You are to circle the
number
which is the most
accurate description of
your job.
If, for example, your job requires you to work
with mechanical equipment a good deal of the time
but also requires some paperwork you might circle
the number six, as was done in the example above.
If you do not understand these instructions, please ask for assistance.
If you do understand them, turn the page and begin.

APPENDIX F
WORKLOAD AND STAFF SIZE

WORKLOAD AND STAFF SIZE
Circle the response that best describes your typical work day as a
critical care staff nurse:
1. The workload that I must deal with as a critical care staff nurse
is:
Satisfactory Unsatisfactory
1 2 3 4 5
2. The current staff size that is employed in the critical care unit of
which I am employed is:
Adequate Inadequate
1 2 3
4
5
132

APPENDIX G
HARDINESS TEST DIRECTIONS AND SAMPLE ITEMS

PERSONAL VIEWS SURVEY
Below are some items that you may agree or disagree with. Please
indicate how you feel about each one by circling a number from 0 to 3 in
the space provided. A zero indicates that you feel the statement is not
at all true; circling a three means that you feel the item is completely
true.
As you will see, many of the items are worded very strongly. This
is to help you decide the extent to which you agree or disagree.
Please read all the items carefully. Be sure to answer all on the
basis of the way you feel now. Don't spend too much time on any one
item.
0 = Not at all true
1 = A little true
2 = Quite a bit true
3 = Completely true
1. I often wake up eager to take up my life where ....0123
it left off the day before.
2. I like a lot of variety in my work 0 1 2 3
3. Most of the time, my bosses or superiors will ....0123
listen to what I have to say.
134

APPENDIX H
COMMITMENT TO CAREER

COMMITMENT TO CAREER
I. Do you wish that you could leave the field of nursing?
YES NO
1 2 3 4 5
136

APPENDIX I
MASLACH BURNOUT INVENTORY DIRECTIONS AND SAMPLE ITEMS

HOMAN SERVICES SURVEY
How Often:
0
1
2
3
4
5
6
Never
A few times
a year or
less
Once a
month
or less
A few
times a
month
Once
a week
A few
times
a week
Every
day
How Often (0-6) Statements
! I feel emotionally drained from my work.
2. I feel used up at the end of the workday.
3. I feel fatigued when I get up in the morning
and have to face another day on the job.
4. I can easily understand how my recipients
feel about things.
138

APPENDIX J
MEANS, STANDARD DEVIATIONS AND CORRELATIONAL ANALYSIS

Table J-l
Descriptive Statistics for Exogenous Variables
Standard
Variable N Mean deviation
Ability
Time (tenure)
Family demands
Job expectations
Meaningfulness of work
Responsibility for work outcomes
Knowledge of work results
Commitment to career
Health difficulties
Hardiness total
Workload
Expected role performance
Skill variety
Task identity
Task significance
Autonomy
Supervision
Dealing with others
Opportunity for advancement
Pay satisfaction
Social support
Job security
300
117.82
68.858
300
139.327
103.192
300
.751
.408
300
4.104
2.446
300
5.752
.844
300
5.751
.653
300
4.999
.946
300
3.537
1.357
300
.501
.396
300
69.310
11.01
300
4.973
.804
300
4.668
.898
300
5.916
.818
300
4.212
1.112
300
6.152
.777
300
5.909
.905
300
4.950
1.27
300
6.116
.787
300
5.459
.893
300
3.903
1.608
300
5.639
.766
300
5.207
1.224
140

141
Table J-2
Descriptive Statistics for Endogenous Variables
Standard
Variable
N
Mean
deviation
Situation conducive to stress
300
.717
.387
Job stress
300
.659
.427
Emotional exhaustion
300
2.589
1.070
Depersonalization
300
1.543
1.150
Personal accomplishment
300
3.442
.832
Job satisfaction
. 300
4.949
1.110
Internal work motivation
300
5.874
.640

Table J-3
Correlation Analysis for Exogenous and Endogenous Variables
1
2
3
1.
Ability
1.00000
0.89440
0.04366
0.0
0.0001
0.4512
2.
Time
0.89440
1.00000
0.01008
0.0
0.0
0.8620
3.
Family
0.04366
0.01008
1.00000
demands
0.4512
0.8620
0.0
4.
Job
-0.02178
0.01052
-0.07389
expectations
0.7072
0.8560
0.2019
5.
Meaningfulness
0.10422
0.09824
-0.05672
of work
0.0715
0.0894
0.3276
6.
Responsibility for work
0.07600
0.07119
-0.04572
outcomes
0.1893
0.2189
0.4301
7.
Knowledge of work
0.03750
0.07315
-0.32342
results
0.5176
0.2064
0.0001
8.
Commitment
-0.15944
-0.16250
-0.02536
to career
0.0056
0.0048
0.6617
9.
Health
-0.018913
-0.04861
0.74082
0.7545
0.4015
0.0001
10.
Commitment
-0.04229
-0.03446
-0.40811
0.4656
0.5522
0.0001
11.
Control
0.00491
0.00628
-0.45914
0.9325
0.9138
0.0001
4
5
6
7
-0.02178
0.10422
0.07600
0.03750
0.7072
0.0715
0.1893
0.5176
0.01052
0.09824
0.07119
0.07315
0.8560
0.0894
0.2189
0.2064
-0.07389
-0.05672
-0.04572
-0.32342
0.2019
0.3276
0.4301
0.0001
1.00000
-0.09955
-0.09524
0.14481
0.0
0.0852
0.0997
0.0120
-0.99559
1 .00000
0.46875
0.49537
0.0852
0.0
0.0001
0.0001
-0.09524
0.46875
1.00000
0.33132
0.0997
0.0001
0.0
0.0001
0.14481
0.49537
0.33132
1.00000
0.0120
0.0001
0.0001
0.0
0.07881
0.22048
0.17508
0.19506
0.1734
0.0001
0.0965
0.0007
-0.08136
0.02629
-0.02759
-0.2b371
0.1598
0.6501
0.6341
0.0001
0.04871
0.23368
0.13445
0.37583
0.4006
0.0001
0.0198
0.0001
0.06427
0.18148
0.07654
0.38735
0.2671
0.0016
0.1861
0.0001
o
ro

1
2
12.
Challenge
-0.02431
-0.01391
0.6750
0.8104
13.
Hardiness
-0.02379
-0.01657
total
0.6815
0.7755
14.
Work load
-0.09834
-0.13526
0.0891
0.0191
15.
Expected performance
0.07320
0.07991
and role ambiguity
0.2061
0.1674
16.
Skill variety
0.02823
0.03579
0.6262
0.5368
17.
Task identity
0.07467
0.07281
0.1971
0.2085
18.
Task significance
0.01217
0.03710
0.8337
0.5221
19.
Autonomy
0.00145
0.04832
0.9800
0.4044
20.
Supervision
0.08011
0.09683
0.1664
0.0941
21.
Dealing with others
0.01566
0.04398
0.7871
0.4479
22.
Opportunity for
-0.03958
-0.01288
advancement
0.4946
0.8242
3
4
5
6
7
0.31506
0.07315
0.02813
0.04129
0.18416
0.0001
0.2064
0.6274
0.4762
0.0014
0.44539
0.06874
0.17449
0.09830
0.36287
0.0001
0.2352
0.0024
0.0892
0.0001
0.02611
0.05193
0.07693
0.00234
0.12709
0.6524
0.3701
0.1839
0.9678
0.0277
0.09146
-0.02005
0.40521
0.31916
0.51095
0.1139
0.7294
0.0001
0.0001
0.0001
0.10797
0.08719
0.45108
0.28964
0.36740
0.0618
0.1319
0.0001
0.0001
0.0001
0.14232
0.01999
0.23370
0.17042
0.34135
0.0136
0.7302
0.0001
0.0031
0.0001
0.00814
0.01280
0.29239
0.26893
0.17996
0.8884
0.8253
0.0001
0.0001
0.0018
0.14242
-0.00310
0.23224
0.09614
0.23209
0.0135
0.9574
0.0001
0.0965
0.0001
0.15037
0.02687
0.37790
0.23261
0.47950
0.0091
0.6430
0.0001
0.0001
0.0001
0.33998
0.00985
0.16711
0.17281
0.33611
0.0001
0.8688
0.0037
0.0027
0.0001
0.07025
0.00604
0.62118
0.42258
0.49151
0.2251
0.9170
0.0001
0.0001
0.0001
143

1
2
23.
Pay
-0.05374
-0.05205
0.3537
0.3690
24.
Support from peers
0.05616
0.04306
from work
0.3323
0.4574
23.
Job security
-0.14232
-0.12126
0.0136
0.0358
1.
Degree situation conducive
0.01130
-0.03829
to stress
0.8455
0.5088
2.
Level of perceived
0.00089
-0.06446
job stress
0.9878
0.2657
3.
Emotional exhaustion
0.06884
0.02616
0.2345
0.6517
4.
Depersonalization
-0.02813
-0.05497
0.6275
0.3427
5.
Personal accomplishment
-0.00901
0.00635
0.8765
0.9128
6.
Job satisfaction
0.06026
0.06385
0.2982
0.2703
7.
Internal job
0.06270
0.05951
motivation
0.2790
0.3042
8
9
1.
Ability
-0.15944
-0.01813
0.0056
0.7545
3
4
5
6
7
0.18420
0.01799
0.13692
0.15160
0.07963
0.0014
0.7563
0.0117
0.0085
0.1689
0.1283
-0.00706
0.49499
0.39189
0.39284
0.0754
0.9030
0.0001
0.0001
0.0001
0.06616
-0.00288
0.16275
0.11925
0.12898
0.2533
0.9604
0.0047
0.0390
0.0255
0.81395
-0.04134
-0.10069
-0.05379
-0.35257
0.0001
0.4756
0.0817
0.3532
0.0001
0.76131
-0.09135
-0.20731
-0.14046
-0.41107
0.0001
0.1143
0.0003
0.0149
0.0001
0.15583
-0.04884
-0.27614
-0.13571
-0.26021
0.0068
0.3992
0.0001
0.0187
0.0001
0.13154
-0.06600
-0.23036
-0.20045
-0.24799
0.0227
0.2545
0.0001
0.0005
0.0001
0.05722
0.10051
0.29973
0.22412
0.13941
0.3233
0.0822
0.0001
0.0001
0.0157
0.09754
-0.12487
0.58331
0.35615
0.39106
0.0917
0.0306
0.0001
0.0001
0.0001
0.21928
-0.08091
0.44186
0.44901
0.36868
0.0001
0.1622
0.0001
0.0001
0.0001
10
11
12
13
14
0.04229
0.00491
-0.02431
-0.02379
-0.09834
0.4656
0.9325
0.6750
0.6815
0.0891
144

8 9
2.
Time
-0.16250
-0.04861
0.0048
0.4015
3.
Family
-0.02536
0.74082
demands
0.6617
0.0001
4.
Job
0.07881
-0.08136
expectations
0.1734
0.1598
5.
Meaningfulness
0.22048
0.02629
of work
0.0001
0.6501
6 .
Responsibility
0.17508
-0.02759
for work
0.0023
0.6341
outcomes
7.
Knowledge
0.19506
-0.26371
of work
0.0007
0.0001
results
8.
Commitment
1.00000
-0.06209
to career
0.0
0.2838
9.
Health
-0.06209
1.00000
0.2838
0.0
10.
Commitment
0.20192
-0.33921
0.0004
0.0001
11.
Cont rol
0.11436
-0.38642
0.0478
0.0001
12.
Challenge
-0.05578
-0.30706
0.3356
0.0001
10
11
-0.03446
0.00628
0.5522
0.9138
-0.40811
-0.45914
0.0001
0.0001
0.04871
0.06427
0.4006
0.2671
0.23368
0.18148
0.0001
0.0016
0.13445
0.07645
0.0198
0.1861
0.37583
0.38735
0.0001
0.0001
0.20192
0.11436
0.0004
0.0478
0.33921
-0.38642
0.0001
0.0001
1.00000
0.83720
0.0
0.0001
0.83720
1.00000
0.0001
0.0
0.64671
0.54134
0.0001
0.0001
12
13
-0.01391
-0.01657
0.8104
0.7750
-0.31056
-0.44539
0.0001
0.0001
0.07315
0.06874
0.2064
0.2352
0.02813
0.17449
0.6274
0.0024
0.04129
0.09830
0.4762
0.0892
0.18416
0.36287
0.0014
0.0001
-0.05578
0.10812
0.3356
0.0614
-0.30706
-0.388831
0.0001
0.0001
0.64671
0.94504
0.0001
0.0001
0.54134
0.90361
0.0001
0.0001
1.00000
0.80507
0.0
0.0001
14
0.13526
0.0191
0.02611
0.6524
0.05193
0.3701
0.07693
0.1839
0.00234
0.9678
0.12709
0.0277
0.06417
0.2678
0.06135
0.2895
0.12879
0.0257
0.12660
0.0283
0.09576
0.0978
145

8
9
13.
Hardiness
0.10812
-0.38831
total
0.0614
0.0001
14.
Work load
0.06417
0.06135
0.2678
0.2895
15.
Expected performance
0.22779
-0.06812
and role ambiguity
0.0001
0.2395
16.
Skill variety
0.22688
-0.11724
0.0001
0.0424
17.
Task Identity
0.09863
-0.09859
0.0881
0.0883
18.
Task significance
0.08461
0.02514
0.1437
0.6645
19.
Autonomy
0.13026
-0.07517
0.0240
0.1942
20.
Supervision
0.18700
-0.16249
0.0011
0.0047
21.
Dealing with others
0.05654
-0.33432
0.3290
0.0001
22.
Opportunity for
0.34157
-0.00010
advancement
0.0001
0.9986
23.
Pay
0.19244
0.19242
0.0008
0.0008
10
11
12
13
14
0.94504
0.90361
0.80507
1.00000
0.13293
0.0001
0.0001
0.0001
0.0
0.0213
0.12879
0.12660
0.09576
0.13293
1.00000
0.0257
0.0283
0.0978
0.0213
0.0
0.17439
0.17708
-0.03522
0.12715
0.01900
0.0024
0.0021
0.5434
0.0277
0.7431
0.27856
0.24555
0.11787
0.24712
0.09924
0.0001
0.0001
0.0413
0.0001
0.0862
0.08800
0.11603
-0.05988
0.06018
0.02458
0.1283
0.0446
0.3013
0.2988
0.6715
0.19829
0.20471
0.06101
0.17953
0.07399
0.0006
0.0004
0.2922
0.0018
0.2013
0.32919
0.31840
0.20498
0.32455
0.07571
0.0001
0.0001
0.0004
0.0001
0.1909
0.23633
0.26897
0.01639
0.20459
-0.09043
0.0001
0.0001
0.7775
0.0004
0.1181
0.41848
0.44756
0.26982
0.43176
-0.01484
0.0001
0.0001
0.0001
0.0001
0.7980
0.24965
0.14915
-0.02901
0.14993
0.02965
0.0001
0.0097
0.6167
0.0093
0.6090
0.04495
-0.20199
-0.16482
-0.14952
-0.05337
0.4380
0.0004
0.0042
0.0095
0.3569
146

8
9
24.
Support from peers
0.16894
-0.08028
from work
0.0033
0.1655
25.
Job security
0.06890
0.08977
0.2341
0.1200
1.
Degree situation conducive
-0.05534
0.69301
to stress
0.3395
0.0001
2.
Level of perceived
-0.12110
0.66394
job stress
0.0360
0.0001
3.
Emotional exhaustion
-0.38037
0.19172
0.0001
0.0008
4.
Depersonalization
-0.40679
0.20693
0.0001
0.0003
5.
Personal accomplishment
0.37453
-0.06283
0.0001
0.2780
6.
Job satisfaction
0.026396
0.16092
0.0001
0.0052
7.
Internal job
0.24874
-0.21551
motivation
0.0001
0.0002
15
16
1.
Abi li ty
0.07320
0.02823
0.2061
0.6262
2.
Time
0.07991
0.03579
0.1674
0.5368
10
11
12
13
14
0.20026
0.23077
0.04208
0.18385
0.01727
0.0005
0.0001
0.4678
0.0014
0.7657
0.17431
0.08383
0.11111
0.14084
0.02996
0.0024
0.1475
0.0546
0.0146
0.6053
0.42812
-0.44038
-0.32482
-0.45140
0.03375
0.0001
0.0001
0.0001
0.0001
0.5604
0.39456
-0.42526
-0.25455
-0.40838
0.08432
0.0001
0.0001
0.0001
0.0001
0.1451
0.17995
-0.08835
-0.12991
-0.15115
0.08921
0.0018
0.1268
0.0244
0.0087
0.1231
0.24562
-0.14992
-0.10385
-0.19284
0.11796
0.0001
0.0093
0.0725
0.0008
0.0412
0.27449
0.19684
0.12087
0.22809
0.04027
0.0001
0.0006
0.0364
0.0001
0.4872
0.04748
-0.02519
-0.17020
-0.04652
-0.03165
0.4125
0.6639
0.0031
0.4220
0.5851
0.33436
0.32512
0.11933
0.30067
-0.03119
0.0001
0.0001
0.0389
0.0001
0.5905
17
18
19
20
21
0.07467
0.01217
0.00145
0.08011
0.01566
0.1971
0.8337
0.9800
0.1664
0.7871
0.07281
0.03710
0.04832
0.09683
0.04398
0.2085
0.5221
0.4044
0.0941
0.4479
4>

15
16
3.
Family
-0.09146
-0.10797
demands
0.1139
0.0618
4.
Job
-0.02005
0.08719
expectations
0.7294
0.1319
5.
Meaningfulness
0.40521
0.45108
of work
0.0001
0.0001
6.
Responslbl11ty
0.31916
0.28964
for work
0.0001
0.0001
outcomes
7.
Knowledge
0.51095
0.36740
of work
results
0.0001
0.0001
8.
Commitment
0.22779
0.22688
to career
0.0001
0.0001
9.
Health
-0.06812
-0.11724
0.2395
0.0424
10.
Commitment
0.17439
0.27856
0.0024
0.0001
11.
Control
0.17708
0.24555
0.0021
0.0001
12.
Chailenge
-0.03522
0.11787
0.5434
0.0413
13.
Hardiness
0.12715
0.24712
total
0.0277
0.0001
17
18
19
20
21
0.14232
-0.00814
-0.14242
-0.15037
-0.33998
0.0136
0.8884
0.0135
0.0091
0.0001
0.01999
0.01280
-0.00310
0.02687
0.00958
0.7302
0.8253
0.9574
0.6430
0.8688
0.23370
0.29239
0.23224
0.37790
0.16711
0.0001
0.0001
0.0001
0.0001
0.0037
0.17042
0.26893
0.09614
0.23261
0.17281
0.0031
0.0001
0.0965
0.0001
0.0027
0.34135
0.17996
0.23209
0.47950
0.33611
0.0001
0.0018
0.0001
0.0001
0.0001
0.09863
0.08461
0.13026
0.18700
0.05654
0.0881
0.1437
0.0240
0.0011
0.3290
0.09859
0.02514
-0.07517
-0.16294
-0.33432
0.0883
0.6645
0.1942
0.0047
0.0001
0.08800
0.19829
0.32919
0.23633
0.41848
0.1283
0.0006
0.0001
0.0001
0.0001
0.11603
0.20471
0.31840
0.26897
0.44756
0.0446
0.0004
0.0001
0.0001
0.0001
0.05988
0.06101
0.20498
0.01639
0.26982
0.3013
0.2922
0.0004
0.7775
0.0001
0.06018
0.17953
0.32455
0.20459
0.43176
0.2988
0.0018
0.0001
0.0004
0.0001
148

15
16
14.
Work load
0.01900
0.09924
0.7431
0.0862
15.
Expected performance
1.00000
0.33955
and role ambiguity
0.0
0.0001
16.
Skill variety
0.33955
1.00000
0.0001
0.0
17.
Task identity
0.35800
0.20740
0.0001
0.0003
18.
Task significance
0.21134
0.40271
0.0002
0.0001
19.
Autonomy
0.27122
0.34872
0.0001
0.0001
20.
Supervision
0.57005
0.25713
0.0001
0.0001
21.
Dealing with others
0.19196
0.44186
0.0008
0.0001
22.
Opportunity for
0.53004
0.47944
advancement
0.0001
0.0001
23.
Pay
0.25969
-0.05032
0.0001
0.3851
17
0.02458
0.6715
0.35800
0.0001
0.20740
0.0003
1.00000
0.0
0.13026
0.0241
0.09208
0.1115
0.29877
0.0001
0.07589
0.1899
0.33051
0.0001
0.09381
0.1049
18
19
0.07399
0.07571
0.2013
0.1909
0.21134
0.27122
0.0002
0.0001
0.40271
0.34872
0.0001
0.0001
0.13026
0.09208
0.0241
0.1115
1.00000
0.17343
0.0
0.0026
0.17343
1.00000
0.0026
0.0
0.19203
0.17262
0.0008
0.0027
0.28596
0.31542
0.0001
0.0001
0.28231
0.31435
0.0001
0.0001
-0.00832
0.04237
0.8859
0.4647
20
21
-0.09042
-0.01484
0.1181
0.7980
0.57005
0.19196
0.0001
0.0008
0.25713
0.44186
0.0001
0.0001
0.29877
0.07589
0.0001
0.1899
0.19203
0.28596
0.0008
0.0001
0.17262
0.31542
0.0027
0.0001
1.00000
0.15034
0.0
0.0091
0.15034
1.000000
0.0091
0.0
0.57896
0.16522
0.0001
0.0041
0.22139
-0.27601
0.0001
0.0001

15
16
24.
Support from peers
0.42608
0.37565
from work
0.0001
0.0001
25.
Job security
0.21757
0.01248
0.0001
0.8295
1.
Degree situation conducive
-0.12381
-0.05410
to stress
0.0321
0.3504
2.
Level of perceived
-0.22682
-0.17543
job stress
0.0001
0.0023
3.
Emotional exhaustion
-0.17370
-0.05484
0.0026
0.3438
4.
Depersonalization
-0.23838
-0.16599
0.0001
0.0039
5.
Personal accomplishment
0.19468
0.21697
0.0007
0.0002
6.
Job satisfaction
0.44621
0.19744
0.0001
0.0006
7.
Internal job
0.32593
0.45934
motivation
0.0001
0.0001
22
23
1.
Ability
-0.03958
-0.05374
0.4946
0.3537
2.
Time
-0.01288
-0.05205
0.8242
0.3690
17
18
19
20
0.25229
0.24434
0.21759
0.55193
0.0001
0.0001
0.0001
0.0001
0.00899
0.11940
0.24168
0.26150
0.8768
0.0388
0.0001
0.0001
0.14440
-0.02476
-0.14673
-0.22595
0.0123
0.6693
0.0109
0.0001
0.17573
-0.04053
-0.21225
-0.34672
0.0023
0.4843
0.0002
0.0001
0.17137
0.03275
-0.04334
-0.26352
0.0029
0.5721
0.04545
0.0001
0.26164
-0.02330
-0.06851
-0.23005
0.0001
0.6877
0.2368
0.0001
0.04282
0.15769
0.11612
0.16426
0.4599
0.0062
0.0445
0.0043
0.33171
0.12266
0.07119
0.51866
0.0001
0.0337
0.2189
0.0001
0.15772
0.28710
0.36801
0.27062
0.0062
0.0001
0.0001
0.0001
24
25
1
2
0.05616
-0.14232
0.01130
0.00089
0.3323
0.0136
0.8455
0.9878
0.04306
-0.12126
-0.03829
-0.06446
0.4574
0.0358
0.5088
0.2657
21
0.22115
0.0001
-0.00462
0.9365
-0.27039
0.0001
-0.31755
0.0001
0.12158
0.0353
-0.04192
0.4695
0.01032
0.8588
-0.13660
0.0179
0.50730
0.0001
3
0.06884
0.2345
0.02616
0.6517
150

22 23
3.
Family
-0.07025
0.18420
demands
0.2251
0.0014
4.
Job
0.00604
0.01799
expectations
0.9170
0.7563
5.
Meaningfulness
0.62118
0.13692
of work
0.0001
0.0177
6.
Responsibility
0.42258
0.15160
for work
0.0001
0.0085
outcomes
7.
Knowledge
0.49151
0.07963
of work
0.0001
0.1689
results
8.
Commitment
0.34157
0.19244
to career
0.0001
0.0008
9.
Health
-0.00010
0.19242
0.9986
0.0008
10.
Commitment
0.24965
-0.04495
0.0001
0.4380
11.
Control
0.14915
-0.20199
0.0097
0.0004
12.
Challenge
-0.02901
-0.16482
0.6167
0.0042
13.
Hardiness
0.14993
-0.14952
total
0.0093
0.0095
24
0.10283
0.0754
0.00706
0.9030
0.49499
0.0001
0.39189
0.0001
0.39284
0.0001
0.16894
0.0033
0.08028
0.1655
0.20026
0.0005
0.23077
0.0001
0.04208
0.4678
0.18385
0.0014
25
1
0.06616
0.81395
0.2533
0.0001
-0.00288
-0.04134
0.9604
0.4756
0.16275
-0.10069
0.0047
0.0817
0.11925
-0.05379
0.0390
0.3532
0.12898
-0.35257
0.0255
0.0001
0.06890
-0.05534
0.2341
0.3395
0.08997
0.69301
0.1200
0.0001
0.17431
-0.42812
0.0024
0.0001
0.08383
-0.44038
0.1475
0.0001
0.11111
-0.32482
0.0546
0.0001
0.14084
-0.45140
0.0146
0.0001
2
3
0.76131
0.15583
0.0001
0.0068
-0.09135
-0.04884
0.1143
0.3992
-0.20731
-0.27614
0.0003
0.0001
-0.14046
-0.13571
0.0149
0.0187
-0.41107
-0.26021
0.0001
0.0001
-0.12110
-0.38037
0.0360
0.0001
0.66394
0.19172
0.0001
0.0008
-0.39456
-0.17995
0.0001
0.0018
-0.42526
-0.08835
0.0001
0.1268
-0.25455
-0.12991
0.0001
0.0244
-0.40838
1
o

0.0001
0.0087
151

22
23
14.
Work load
0.02965
-0.05337
0.6090
0.3569
15.
Expected performance
0.53004
0.25969
and role ambiguity
0.0001
0.0001
16.
Skill variety
0.47944
-0.05032
0.0001
0.3851
17.
Task identity
0.33051
0.09381
0.0001
0.1049
18.
Task significance
0.28231
-0.00832
0.0001
0.8859
19.
Autonomy
0.31435
0.04237
0.0001
0.4647
20.
Supervision
0.57896
0.22139
0.0001
0.0001
21.
Dealing with others
0.16522
-0.27601
0.0041
0.0001
22.
Opportunity for
1.00000
0.38627
advancement
0.0
0.0001
23.
Pay
0.38627
1 .00000
0.0001
0.0
24
25
1
2
3
0.01727
0.02996
0.03375
0.08432
0.08921
0.7657
0.6053
0.5604
0.1451
0.1231
0.42608
0.21757
-0.12381
-0.22682
-0.17307
0.0001
0.0001
0.0321
0.0001
0.0026
0.37565
0.01248
-0.05410
-0.17543
-0.05484
0.0001
0.8295
0.3504
0.0023
0.3438
0.25229
-0.00899
-0.14440
-0.17573
-0.17137
0.0001
0.8768
0.0123
0.0023
0.0029
0.24434
0.11940
-0.02476
-0.04053
0.03275
0.0001
0.0388
0.6693
0.4843
0.5721
0.21759
0.24168
-0.14673
-0.21225
-0.04334
0.0001
0.0001
0.0001
0.0002
0.4543
0.55193
0.26150
-0.22595
-0.34672
-0.26352
0.0001
0.0001
0.0001
0.0001
0.0001
0.22115
-0.00462
-0.27039
-0.31755
0.12158
0.0001
0.9365
0.0001
0.0001
0.0353
0.66214
0.31387
-0.11658
-0.23151
-0.32576
0.0001
0.0001
0.0436
0.0001
0.0001
0.12324
0.35290
0.10762
0.12311
-0.21749
0.0329
0.0001
0.0627
0.0330
0.0001
152

22
23
24.
Support from peers
0.66214
0.12324
from work
0.0001
0.0329
25.
Job security
0.31387
0.35290
0.0001
0.0001
1.
Degree situation conducive
-0.11658
0.10762
to stress
0.0436
0.0627
2.
Level of perceived
-0.23151
0.12311
job stress
0.0001
0.0330
3.
Emotional exhaustion
-0.32576
-0.21749
0.0001
0.0001
4.
Depersonalization
-0.332330
-0.12746
0.0001
0.0273
5.
Personal accomplishment
0.24659
0.10522
0.0001
0.0688
6.
Job satisfaction
0.61746
0.40161
0.0001
0.0001
7.
Internal job
0.42007
-0.03840
motivation
0.0001
0.5076
4
5
1.
Ability
-0.02813
-0.00901
0.6275
0.8765
2.
Time
-0.05497
0.00635
0.3427
0.9128
24
25
1.00000
0.22085
0.0
0.0001
0.22085
1.00000
0.0001
0.0
0.14462
-0.04682
0.0122
0.4191
0.26936
-0.10396
0.0001
0.0722
0.22639
-0.16897
0.0001
0.0033
0.26452
-0.02339
0.0001
0.6866
0.23659
0.14211
0.0001
0.0137
0.42478
0.17348
0.0001
0.0026
0.44875
0.03122
0.0001
0.5902
6
7
0.06026
0.06270
0.2982
0.2790
0.06385
0.05951
0.2703
0.3042
1
2
-0.14462
-0.26936
0.0122
0.0001
-0.04682
-0.10396
0.4191
0.0722
1.00000
0.78169
0.0
0.0001
0.78169
1.00000
0.0001
0.0
0.26221
0.28319
0.0001
0.0001
0.21501
0.25697
0.0002
0.0001
-0.10521
-0.11292
0.0688
0.0507
-0.01077
-0.11343
0.8526
0.0497
-0.13188
-0.26063
0.0223
0.0001
3
-0.22639
0.0001
-0.16897
0.0033
0.26221
0.0001
0.28319
0.0001
1.00000
0.0
0.60774
0.0001
-0.29516
0.0001
-0.42493
0.0001
-0.04243
0.4641
153

4 5
3.
Family
0.13154
-0.05722
demands
0.0227
0.3233
4.
Job
-0.06600
0.10051
expectations
0.2545
0.0822
5.
Meaningfulness
-0.23036
0.29973
of work
0.0001
0.0001
6.
Responsibility
-0.20045
0.22412
for work
0.0005
0.0001
outcomes
7.
Knowledge
-0.24799
0.13941
of work
0.0001
0.0157
results
8.
Commitment
-0.40679
0.37453
to career
0.0001
0.0001
9.
Health
0.20693
-0.06283
0.0003
0.2780
10.
Commitment
-0.24562
0.27449
0.0001
0.0001
11.
Control
-0.14992
0.19684
0.0093
0.0006
12.
Challenge
-0.10385
0.12087
0.0725
0.0364
13.
Hardiness
-0.19284
0.22809
total
0.0008
0.0001
6
7
0.09754
0.0917
-0.21928
0.0001
0.12487
0.0306
-0.08091
0.1622
0.58331
0.0001
0.44186
0.0001
0.35615
0.0001
0.44901
0.0001
0.39106
0.0001
0.36868
0.0001
0.26396
0.0001
0.24874
0.0001
0.16092
0.0052
-0.21551
0.0002
0.04748
0.4125
0.33436
0.0001
0.02519
0.6639
0.32512
0.0001
0.17020
0.0031
0.11933
0.0389
0.04652
0.4220
0.30067
0.0001
Ln
4>

4
5
14.
Work, load
0.11796
0.04027
0.0412
0.4872
15.
Expected performance
-0.23838
0.19468
and role ambiguity
0.0001
0.0007
16.
Skill variety
-0.16599
0.21697
0.0039
0.0002
17.
Task identity
-0.26164
-0.04282
0.0001
0.4599
18.
Task significance
-0.02330
0.15769
0.6877
0.0062
19.
Autonomy
-0.06851
0.11612
0.2368
0.0445
20.
Supervision
-0.23005
0.16426
0.0001
0.0043
21.
Dealing with others
-0.04192
0.01032
0.4695
0.8588
22.
Opportunity for
-0.32330
0.24659
advancement
0.0001
0.0001
23.
Pay
-0.12746
0.10522
0.0273
0.0688
6
7
-0.03165
-0.03119
0.5851
0.5905
0.44621
0.32593
0.0001
0.0001
0.19744
0.45934
0.0006
0.0001
0.33171
0.15772
0.0001
0.0062
0.12266
0.28710
0.0337
0.0001
0.07119
0.36801
0.2189
0.0001
0.51866
0.27062
0.0001
0.0001
-0.13660
0.50730
0.0179
0.0001
0.61746
0.42007
0.0001
0.0001
0.40161
-0.03840
0.0001
0.5076
155

4
5
24.
Support from peers
-0.26452
0.23659
from work
0.0001
0.0001
25.
Job security
-0.02339
0.14211
0.6866
0.0137
1.
Degree situation conducive
0.21501
-0.10521
to stress
0.0002
0.0688
2.
Level of perceived
0.25697
-0.11292
job stress
0.0001
0.0507
3.
Emotional exhaustion
0.60744
-0.29516
0.0001
0.0001
4.
Depersonalization
1.00000
-0.35664
0.0
0.0001
5.
Personal accomplishment
-0.35664
1.00000
0.0001
0.0
6.
Job satisfaction
-0.29000
0.16063
0.0001
0.0053
7.
Internal job
-0.18169
0.17793
motivation
0.0016
0.0020
6
7
0.42478
0.44875
0.0001
0.0001
0.17348
0.03122
0.0026
0.5902
0.01077
-0.13188
0.8526
0.0223
0.11343
-0.26063
0.0497
0.0001
0.42493
-0.04243
0.0001
0.4641
0.29000
-0.18169
0.0001
0.0016
0.16063
0.17793
0.0053
0.0020
1.00000
0.14002
0.0
0.0152
0.14002
1.00000
0.0152
0.0
156

APPENDIX K
MULTIPLE REGRESSION OF THE FULL MODEL

158
Table K-l
Multiple Regression of Degree Situation Conducive to Stress on the
Variables Within Each Block of Characteristics
Block
Variable
Standard
coefficient
t-value
p value
Personal
Ability
074
1 .010
.3132
characteristics
Time
r^
O

1
-1.454
.1471
Family demands
.621
12.180
.0001*
Job expectations
.033
0.974
.3308
Meaningfulness of work
-.038
-0.803
.4225
Responsibility for work outcomes
.030
.774
.4393
Knowledge of work results
-.074
-1.573
.1168
Health
.206
4.118
.0001*
Commitment to career
1

o
H
v£>
-0.532
.5950
Psychological hardiness
-.086
-2.087
.0378*
Organizational work
Workload
.013
.389
.6978
characteristics
Expected role performance and role ambiguity
.0 24
.531
.5959
Skill variety
.102
2.281
.0233*
Task identity
-.011
-0.296
.7675
Task significance
-.025
-.694
.4884
Autonomy
-.008
-.207
.8358
Supervision
-.036
-.762
.4496

Table K-lcontinued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
.049
L .148
.2520
Opportunity for advancement
-.008
-0.135
.8925
Pay
.0006
.015
.9880
Support from peers at work
-.017
-.357
.7216
Job security
-.070
-1.843
.0664*
R2 = .717 (f = 31.948, p = .0001)
159

Table K-2
Multiple Regression of Job Stress on the Variables Within Each Block of
Characteristics and Situation Conducive to Stress
Standard
Block
Variable
coefficient
t-value
p value
Personal
Ability
.1136
1.589
.1133
characteristics
Time
-.1307
-1.824
.0693*
Family demands
.3274
5.339
.0001*
Job expectations
-.0461
-1.402
.1620
Meaningfulness of work
-.0700
-1.534
.1262
Responsibility for work outcomes
-.0280
-.747
.4555
Knowledge of work results
-.0175
-.381
.7033
Health
.1296
2.587
.0102*
Commitment to career
-.0484
-1.402
.1621
Psychological hardiness
.0396
.984
.3262
Organizational work
Workload
.0572
1.733
.0842*
characteristics
Expected role performance and role ambiguity
-.0140
-.322
.7476
Skill variety
-.0162
-.371
.7111
Task identity
.0028
.081
.9352
Task significance
.0526
1.475
.1413
Autonomy
-.0408
-1.111
.2676
Supervision
-.1072
-2.360
.0190*

Table K-2continued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
.0105
.254
.8000
Opportunity for advancement
.0109
.185
.8532
Pay
.101
2.549
.0114*
Support from peers at work
-.0545
-1.203
.2 299
Job security
-.0990
-2.685
.0077*
Stress variable
Situation conducive to stress
.3652
6.262
.0001*
R2 = .735 (F = 33.222
P
0001)

Table K-3
Multiple Regression of Job Satisfaction on the Variables Within Each Block of
Characteristics, Job Stress and Situation Conducive to Stress
Standard
Block
Variable
coefficient
t-value
p value
Personal
Abi lity
-.0059
-.070
.9442
characteristics
Time
.0151
.180
.8575
Family demands
.1332
1.773
.0773*
Job expectations
-.1078
-2.801
.0055*
Meaningfulness of work
.2885
5.398
.0001*
Responsibility for work outcomes
.0420
.960
.3381
Knowledge of work results
.1061
1.978
.0489*
Health
.1598
2.702
.0073*
Commitment to career
.0639
1.582
.1147
Psychological hardiness
-.0394
-.837
.4034
Organizational work
Workload
-.0308
-.794
.4281
characteristics
Expected role performance and role ambiguity
.0179
.353
.7242
Skill variety
-.0334
-.656
.5124
Task identity
.0996
2.449
.0150*
Task significance
-.0207
-.648
.5173
Autonomy
-.0543
-1.266
.2065
Supervision
.2192
4.080
.0001*
162

Table K-3continued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
-.1717
-3.559
.0004*
Opportunity for advancement
.2125
3.086
.0022*
Pay
.1392
2.976
.0032*
Support from peers at work
-.0237
-.447
.6550
Job security
-.0848
-1.948
.0525*
Stress variables
Job stress
-.1404
-2.000
.0465*
Degree situation conducive to stress
-.0569
-.782
.4346
R2 = .6405 (F = 20.413, p
0001)

Table K-4
Multiple Regression of Internal Job Motivation on the Variables Within Each Block of
Characteristics, Job Stress and Situation Conducive to Stress
Standard
Block
Variable
coefficient
t-value
p value
Personal
Abi lity
.0654
.691
.4900
characteristics
Time
-.0484
-.510
.6104
Family demands
-.1442
-1.701
.0901*
Job expectations
-.0706
-1.624
.1055
Meaningfulness of work
.1325
2.196
.0290**
Responsibility for work outcomes
.2068
4.188
.0001*
Knowledge of work results
.0200
.330
.7414
Health
-.1262
-1.890
.0599*
Commitment to career
.1168
2.560
.0110*
Psychological hardiness
.0420
.7 90
.4299
Organizational work
Workload
-.0696
-1.590
.1130
characteristics
Expected role performance and role ambiguity
.0134
.234
.8148
Skill variety
.0254
.441
.6593
Task identity
-.0186
-.406
.6853
Task significance
.0326
.691
.4900
Autonomy
.1713
3.538
.0005*
Supervision
-.0387
-.639
.5236

Table K-4continued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
.2759
5.065
.0001*
Opportunity for advancement
.0243
.313
.7545
Pay
-.101
-.194
.8465
Support from peers at work
.1819
3.041
.0026*
Job security
-.0758
-1.542
.1243
Stress variables
Job stress
-.0068
-.086
.9314
Degree situation conducive to stress
.2509
3.058
.0024*
R2 = .5419 (F = 13.552
P
0001)

Table K-5
Multiple Regression of Burnout-Emotional Exhaustion on the Variables Within Each Block of Characteristics,
Job Satisfaction, Internal Job Motivation, Job Stress and Situation Conducive to Them
Standard
Block
Variable
coefficient
t-value
p value
Personal
Ability
.1590
1.478
.1404
characteristics
Time
-.1344
-1.246
.2139
Family demands
-.0943
-.970
.3330
Job expectations
-.0375
-.743
.4583
Meaningfulness of work
-.0872
-1.191
.2347
Responsibility for work outcomes
.0230
.396
.6921
Knowledge of work results
-.0497
-.717
.4742
Health
.2144
2.780
.0058*
Commitment to career
-.2822
-5.346
.0001*
Psychological hardiness
-.1293
-2.138
.0334*
Organizational work
Workload
.1175
2.349
.0195*
characteristics
Expected role performance and role ambiguity
.0673
1.039
.2998
Skill variety
.0275
.421
.6743
Task identity
-.0351
-.667
.5055
Task significance
.0585
1 .090
.27b5
Autonomy
.0186
.331
.7410
Supervision
.0799
1.126
.2612

Table K-5continued
Block
Variable
Standard
coefficient
t-value
p value
Dealing with others
.1858
2.835
.0049*
Opportunity for advancement
-.0257
-.286
.7754
Pay
-.0046
-.075
.9400
Support from peers at work
-.0756
-1.094
.2749
Job security
-.1101
-2.183
.0299
Job stress outcomes
Job satisfaction
-.3125
3.995
.0001*
Internal job motivation
.0841
1.214
.2258
Stress variables
Job stress
.0328
.362
.7180
Degree situation conducive to stress
.1209
1.275
.2033
R2 = .4132 (F = 7.394
P
0001)

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BIOGRAPHICAL SKETCH
Joyce Kolbek Stechmiller was born in Passaic, New Jersey, on
September 5, 1947. She graduated from Clara Maass School of Nursing in
May, 1968, with a diploma in nursing. After graduation, she began work
as a staff nurse in the Recovery Room and Surgical Intensive Care Unit of
Johns Hopkins Hospital, Baltimore, Maryland, and entered the
baccalaureate nursing program at the University of Maryland in Baltimore.
In May, 1972, she graduated with a baccalaureate degree in nursing. From
1972 to 1975, she served as nurse researcher at the Johns Hopkins
Hospital. During that time she also completed a master's degree in
medical-surgical clinical specialist nursing from the University of
Maryland.
In 1975, she began employment at Boston City Hospital and Boston
State College as a cardiovascular clinical nurse specialist and
instructor of baccalaureate nursing students. In 1977, she moved to
Gainesville, Florida, and joined the nursing faculty at the University of
Florida. Over the past thirteen years she has held several positions as
a nursing instructor. She entered in the doctoral program in the College
of Education at the University of Florida in January, 1985.
177

I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is fully
adequate, in scope and quality, as a dissertation for the degree of
Doctor of Philosophy.
Professor of Foundations of Education
k#-
Hannelore L. Wass, Chairperson
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is fully
adequate, in scope and quality, as a dissertation for the degree of
Doctor of Philosophy.
Linea M. Crocker
Professor of Foundations of Education
I certify that I
conforms to acceptable
adequate, in scope and
Doctor of Philosophy.
have read this study and that in my opinion it
standards of scholarly presentation and is fully
quality, as a dissertation for the degree of
Barry Gulnagh
Associate Professor of Foundations of
Education
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presenta£ijon -anchis fully
adequate, in scope and quality, as a dissertation Loithe degxe^of
Doctor of Philosophy.
Robert
Profesi
of Psychology
This dissertation was submitted to the Graduate Faculty of the
College of Education and to the Graduate School and was accepted as
partial fulfillment of the requirements for the degree of Doctor of
Philosophy.
December, 1990
Chairman, Foundations o
Education (-
Dean, College of Education
Dean, Graduate School



Table 4-2
Multiple Regression of Job Stress on the Variables Within Each Block of
Characteristics and Situation Conducive to Stress
Block
Variable
Standard
coefficient
t-value
p value
Personal
Time
-.1307
-1.824
.0693
characteristics
Family demands
.3339
5.425
.0001
Health
.1422
2.808
.0054
Organizational work
Workload
.0572
1.733
.0842
characteristics
Pay
.101
2.549
.0114
Supervision
-.0837
-1.781
.0761
Job security
-.0990
-2.685
.0077
Stress variable
Situation conducive to stress
.3652
6.262
.0001
R2 = .735 (F = 33.222; df = 23, 276; p = .0001)
oo
o


18
attitudes toward clients, loss of ideals, and irritability. A third
component is characterized by unfavorable responses toward oneself and
ones personal achievements, with depression, withdrawal, low morale,
lowered production, and a decrease in effective coping.
Stages in Development of Burnout
Maslach (1982a) described a progression of stages in burnout leading
from emotional exhaustion to depersonalization and finally ending with
decreased personal accomplishment. Helping professionals who have
emotional exhaustion feel drained, used up, and repleted without
resources. As a protective mechanism, some helping professionals acquire
a cold indifference to others needs, become detached to close
relationships, and acquire a callous disregard for the feelings of
others. The occurrence of this dehumanizing attitude heralds in the
second component of the burnout syndrome, depersonalization, which
consists of the expression of poor opinions about clients, actively
disliking them, expecting the worst from them, ignoring their requests,
and giving inappropriate help and care. The third aspect of the burnout
syndrome is decreased personal accomplishment, which consists of helping
professionals developing a sense of inadequacy in dealing with their
clients. The helping professional may even develop a poor self-esteem
and perceive of himself as a failure. As a result, depression,
absenteeism, poor job performance, and changing jobs may occur.
Similar developmental models have been suggested by other
researchers. For example, Edelwich and Brodsky (1980) designed a
four-phase developmental process: (a) enthusiasm with high energy, high
hopes, and unrealistic job expectations; (b) stagnation, in which the job
is no longer perceived as the central force of a worker's life;


28
demands at home did not experience different levels of burnout than
nurses who experienced greater household demands than emotional support
at home.
Paredes (1982) studied the effects of social support and
psychological resources on the relationship between burnout and job
dissatisfaction. The findings showed a significant negative relationship
between supervision and co-worker support and burnout. Supervisor
support was more significant in burnout reduction than co-worker or off-
the-job support. Nurses who reported high levels of perceived
psychological support appeared to benefit most from social support in
terms of burnout reduction and job satisfaction.
Kanner, Kafry, and Pines (1981) and Pines, Aronson, and Kafry (1981)
found that on-the-job and off-the-job social support were negatively
related to burnout. Constable and Russell (1986) measured supervisor
support and found that this variable was a major predictor of burnout.
However, there was a significant association only with the emotional
exhaustion dimension of burnout. These results indicate that high levels
of support from supervisors can directly decrease feelings of emotional
exhaustion and, therefore, affect the potential for burnout among nurses.
In addition, their findings indicated significant moderating effects of
supervisor support on the relationship between job enhancement and
emotional exhaustion.
Finally, Chiriboga and Bailey (1986) reported that nurses who relied
more on their supervisor for support proved more likely to report
burnout. Additionally, reliance on co-worker support also correlated


PERSONAL VIEWS SURVEY
Below are some items that you may agree or disagree with. Please
indicate how you feel about each one by circling a number from 0 to 3 in
the space provided. A zero indicates that you feel the statement is not
at all true; circling a three means that you feel the item is completely
true.
As you will see, many of the items are worded very strongly. This
is to help you decide the extent to which you agree or disagree.
Please read all the items carefully. Be sure to answer all on the
basis of the way you feel now. Don't spend too much time on any one
item.
0 = Not at all true
1 = A little true
2 = Quite a bit true
3 = Completely true
1. I often wake up eager to take up my life where ....0123
it left off the day before.
2. I like a lot of variety in my work 0 1 2 3
3. Most of the time, my bosses or superiors will ....0123
listen to what I have to say.
134


Table 3-10continued
Variables in this study
Instrument
Items
General job satisfaction
JDS
Section
3
(3,
9,
13)
Section
5
(2,
8)
Psychological response-
JDS
Section
3
(2,
6,
10, 14)
internal job motivation
Section
5
(1,
9)


APPENDIX I
MASLACH BURNOUT INVENTORY DIRECTIONS AND SAMPLE ITEMS


33
Examples of hygiene factors include salary, supervision, policy, and
working conditions.
The theoretical conceptualization of job satisfaction by Herzberg
has been studied extensively among nurses (Hinshaw & Atwood, 1984, 1987;
Slavitt, Stamps, Piedmont, & Haase, 1978). Hinshaw and Atwood (1987)
reviewed the job satisfaction literature and identified 19 significant
factors relating to job satisfaction which were divided into two
categories: personal and work-related characteristics. Personal
characteristics included age, gender, intelligence, educational level,
experience as a nurse, tenure and position in the hierarchy. Work
related characteristics included the specialty area, nursing care
delivery model, supervision, tasks, outcomes and pay. These researchers
concluded that although these variables have been identified as
significantly associated with job satisfaction, the relative impact of
the personal and organizational variables acting directly and indirectly
with job satisfaction has not been determined.
The more relevant theory of job satisfaction related to this study
is the person-environment fit model of occupational stress (French,
Rodgers, & Cobb, 1974). This theoretical approach relates occupational
stress to job satisfaction. As a result of the interaction between the
person holding a job and the environment in which he or she is employed
with good person-environment fit, the job provides the necessary needs of
the individual (salary, fringe benefits, social involvement, opportunity
to achieve, and a sense of self worth). On the other hand, if the job is
too strenuous or too demanding, job stress and burnout may result. Job


116
used for this study, self-report measures were employed, and some were
fairly short in length. Thus, even though established instruments were
used, difficulty with validity and reliability should not be ruled out as
a possible explanation for some of the nonsignificant results.
Additional research is needed using models in which latent variables
underlying the measured variables are posited through the use of linear
structural analyses (Joreskog & Sorbom, 1984). Fifth, another assumption
of path analytical techniques is that the explanatory personal and
organizational variables in the burnout model do not create a problem of
multicollinearity. The assumption was violated in several instances.
For example, the correlations between family demands and degree situation
conducive to stress (r = .81, p = .0001), and between family demands and
job stress (r = .76, p = .0001) indicated that the variables were
redundant in this sample. However, to have eliminated the variables
family demands, situation conducive to stress or job stress would have
deleted a major purpose of this study, which was to test a model
developed from a theoretical formulation. A sixth recommendation centers
on the need for cross-validation of the reduced model on an independent
sample of critical care nurses. Because of the relatively large number
of variables in the model, and because of the exploratory nature of this
work, it seemed appropriate to estimate the magnitudes of direct and
indirect effects in the reduced model on the sample used for initial
variable selection with the full model. This, however, may have resulted
in suprious estimates of some effects of the model.
Despite these limitations, the present study represents an important
extension of work of previous researchers who have examined only


100
dissatisfaction with pay, and dissatisfaction with job security.
Together these variables explained 71% of the variance in perceived job
stress. Job stress then directly leads to job dissatisfaction. In
addition, job dissatisfaction is also directly influenced by job
expectations, meaninglessness of work, knowledge of work results, and
health difficulties, and as well as by degree of task identity,
supervisor dissatisfaction, dealing with others on the job,
dissatisfaction with opportunities for advancement, dissatisfaction with
pay, and satisfaction with job security. Together these variables
explained 62% of the variance in general job satisfaction. Then burnout-
emotional exhaustion is directly affected by job dissatisfaction, as well
as low commitment to the career, health difficulties, low psychological
hardiness, workload, dealing with others on the job, and dissatisfaction
with job security. Altogether, however, these variables explained only
38% of the variance in burnout-emotional exhaustion.
The original full model proposed in this study had five endogenous
variables. Namely these were the degree in which a situation is
conducive to stress, perceived job stress, job satisfaction, internal job
motivation, and burnout. One of these internal job motivation was
deleted in the reduced model using the pre-established statistical
criterion. From a theoretical perspective, however, this variable was
probably the weakest in the model because it was chosen to represent what
Perlman and Hartman had originally called "psychological response" and,
in retrospect, may not have adequately represented the theorists'
Intent.
Causes of Burnout
The major results of this study demonstrated that among critical
care nurses, general job satisfaction had the strongest total inverse
direct effect on burnout-emotional exhaustion. Because the association


172
Jayaratne, S., & Cness, W. (1983). Burnout. In B. Farber (Ed.), Stress
and burnout in the human service professions (pp. 142-154). New York:
Pergamon Press.
Jenkins, J. F., & Ostcbega, Y. (1986). Evaluation of burnout among
oncology nurses. Cancer Nursing, 9_, 108-116.
Joreskog, K. G., & Sorbom, D. (1984). LISREL VI: Analysis of linear
structural relationship by maximum likelihood, instrumental variables
and least square methods (3rd ed.). Mooresville, IN: Scientific
Software, Inc.
Kahn, R. L. (1978). Job burnout: Prevention and remedies. Public
Welfare, 36(2), 61-63.
Kanner, A. D., Kafry, D., & Pines, A. (1981). Conspicuous in its
absence: The lack of positive conditions as a source of stress. In
E. A. McConnell (Ed.), Burnout in the nursing profession (p. 131).
St. Louis: C. V. Mosby.
Keane, A., Ducette, J., & Adler, D. (1985). Stress in ICU and non ICU
nurses. Nursing Research, 34(4), 231-236.
Kerlinger, F. N., & Pedhazur, E. J. (1973). Multiple regression in
behavioral research. New York: Holt, Rinehart and Winston.
Kelly, J., & Cross, D. (1985). Stress, coping behaviors, and
recommendations for intensive care and medical surgical ward registered
nurses. Research Nursing Health, 8_, 321-328.
Kimmel, M. R. (1982). Coping strategies, social support, and role
related problems and predictors of burnout in nurses (Doctoral
dissertation, California School of Psychology, 1981). Dissertation
Abstracts International, 42, 4612B.
Kobasa, S. C. (1979). Stressful life events, personality and health:
An inquiry into hardiness. Journal of Personality and Social
Psychology, 37, 1-11.
Kobasa, S. C., Maddi, S. R., Donner, E. J., Merrick, W. A., & White, H.
(1984). The personality construct of hardiness. Unpublished
manuscript.
Kobasa, S. C., Maddi, D. R., & Kahn, S. (1982). Hardiness and health:
A prospective inquiry. Journal of Personality and Social Psychology,
42_, 168-177.
Land, K. C. (1969). Principles of path analysis. In E. F. Borgatta
(Ed.), Sociological methodology (pp. 3-37). San Fransico:
Jossey-Bass.
Larson, C. C., Gilbertson, D. L., & Powell, J. A. (1978). Therapist
burnout: Perspectives on a critical issue. Social Casework, 59,
563-565.


Table K-5
Multiple Regression of Burnout-Emotional Exhaustion on the Variables Within Each Block of Characteristics,
Job Satisfaction, Internal Job Motivation, Job Stress and Situation Conducive to Them
Standard
Block
Variable
coefficient
t-value
p value
Personal
Ability
.1590
1.478
.1404
characteristics
Time
-.1344
-1.246
.2139
Family demands
-.0943
-.970
.3330
Job expectations
-.0375
-.743
.4583
Meaningfulness of work
-.0872
-1.191
.2347
Responsibility for work outcomes
.0230
.396
.6921
Knowledge of work results
-.0497
-.717
.4742
Health
.2144
2.780
.0058*
Commitment to career
-.2822
-5.346
.0001*
Psychological hardiness
-.1293
-2.138
.0334*
Organizational work
Workload
.1175
2.349
.0195*
characteristics
Expected role performance and role ambiguity
.0673
1.039
.2998
Skill variety
.0275
.421
.6743
Task identity
-.0351
-.667
.5055
Task significance
.0585
1 .090
.27b5
Autonomy
.0186
.331
.7410
Supervision
.0799
1.126
.2612


77
As shown in Appendix J, situation conducive to stress was
significantly related to all the endogenous measures while job stress was
significantly correlated with all the endogenous measures. Burnout-
emotional exhaustion was significantly related to job satisfaction. Job
satisfaction was significantly related to internal job motivation.
Question 1
Question 1 addressed the significance of the relationship between
situational stress and the weighted linear combination of (a) a set of
personal variables and (b) a set of organizational variables. In
addition, this question also addressed which of the variables in the
model contributed significantly to the variance in situational stress.
Multiple regression analysis yielded an of .72, (F = 31.948;
df = 22, 277; p = .0001), indicating that 72% of the variance on the
situation conducive to stress variable was explained by the variables in
the regression model. Regression results in Table 4-1 show that the
personal variables family demands, health difficulties, and psychological
hardiness, and the organizational work variables, skill variety and job
security, were significant predictors of the situation conducive to
stress.
Personal variables that did not relate significantly to situational
stress were ability, time, job expectations, meaningfulness of work,
responsibility for work outcomes, knowledge of work results, and
commitment to career. Organizational variables that did not relate
significantly to situational stress were workload, expected role
performance and role ambiguity, task identity, task significance,
autonomy, supervision, dealing with others, opportunity for advancement,
pay, and support from peers at work. (See Table K-l in Appendix K for
results of the multiple regression for all variables.)


JOB DIAGNOSTIC SURVEY
This questionaire was developed as part of a Yale
University study of jobs and how peole react to them.
The questionnaire helps to determine how jobs can be
better designed, by obtaining information about how
people react to different kinds of jobs.
On the following pages you will find several different kinds of questions
about your job. Specific instructions are given at the start of each
section. Please read them carefully. It should take no more than
25 minutes to complete the entire questionnaire. Please move through it
quickly.
The questions are designed to obtain your perceptions
of your job and your reactions to it.
There are no "trick" questions. Your individual answers will be kept
completely confidential. Please answer each item as honestly and frankly
as possible.
Thank you for your cooperation.
For more information about this questionnaire and its use, please
contact:
Prof. J. Richard Hackman
Department of Administrative Sciences
Yale University
New Haven, Connecticut 06520
OR
Prof. Greg R. Oldham
Department of Business Administration
University of Illinois
Urbana, Ilinois 61801
129


COMMITMENT TO CAREER
I. Do you wish that you could leave the field of nursing?
YES NO
1 2 3 4 5
136


30
Organizational Characteristics
The organization variables include workstress, the work environment,
job enhancement and job satisfaction.
Work stress
Work stress has been identified as another contributing factor of
burnout. It has been consistently reported that (Chiriboga & Bailey,
1986; Jenkins & Ostehya, 1986) nurses who experienced more frequent
work-related stress reported greater burnout. According to Chiriboga and
Bailey (1986), the work stress variables were second only to work
environment measures in their degree of contribution to the explained
variance in burnout. Work hassles and work distractions were the
significant contributors. The more hassled the nurses felt, the more
likely they were to feel burned out. It is important to point out that
these are not the big stressful events; they are the smaller day-to-day
hassles that can exert a cumulative effect. The distraction variable
focused on trivial things: interruptions in the nurse's work, due to
physicians, nursing staff, or visitors. Nurses who reported more hassles
also reported more burnout. Their findings suggest that distracting and
annoying day-to-day stress in the hospital work environment exerted the
major stress on nurses, and that may lead to burnout.
Work Environment
Work environment variables including worker involvement, type of
unit, type of hospital, amount of patient contact and job enhancement
(variety of tasks and new approaches, autonomy, clarity, physical comfort
and work pressure) are strongly associated with burnout. Worker
A


107
The personal variable, job expectations, measures the individual
worker's expectation for job growth. This measure is viewed as an
individual characteristic which is predicted to affect how positively an
employee will respond to a job with a high motivating potential or
challenge. The data from this study indicated that expectations for
growth or challenge on the job was inversely linked to satisfaction with
their current job. Stone et al. (1984) studied nurses experiencing
burnout and found that they were dissatisfied with their jobs because
there were limited opportunities for personal growth on the job.
Similarly, the data from this study indicated that high job expectations
for growth and challenge among critical care nurses is causally linked to
low job satisfaction in their current job and dissatisfaction with
opportunities for advancement at work is causally linked to low job
satisfaction.
The personal variable, experienced meaningfulness of work, was
identified as a personal work need as presented by Perlman and Hartman
(1982). Experienced meaningfulness of work is defined as the need to
which the nurse experiences the job as one which is generally meaningful,
valuable and worthwhile. Unique to this study is the finding that
meaninglessness of work had the strongest direct effect on job
dissatisfaction in the model studied.
The personal variable, knowledge of work results, was identified as
a personal work need as identified by the burnout model offered by
Perlman and Hartman (1982). Knowledge of work results measured the
nurse's need to know on a continuous basis how effectively she is


Table 4-5
Multiple Regression of Burnout-Emotional Exhaustion on the Variables Within Each Block of Characteristics,
Job Satisfaction, Internal Job Motivation, Job Stress and Situation Conducive to Stress
Block
Variable
Standard
coefficient
t-value
p value
Personal
Health
.2144
2.780
.0058
characteristics
Commitment to career
-.2822
-5.346
.0001
Psychological hardiness
-.1293
-2.138
.0334
Workload
.1175
2.349
.0195
Organizational work
Dealing with others
.1858
2.835
.0049
characteristics
Job security
-.1101
-2.183
.0299
Stress outcomes
Job satisfaction
-.3125
-3.995
.0001
R2 = .4132 (F = 7.394; df = 26, 273; p = .0001)


105
of workload to burnout-emotional exhaustion found in this study lias
support from the literature and makes theoretical as well as practical
sense.
The relationship between the economic/market conditions and its
direct structural association with burnout-emotional exhaustion has been
proposed theoretically (Perlman & Hartman, 1982). The economic/market
condition was measured as job security in this study. Results from this
study indicated that job security dissatisfaction had an independent path
leading directly to burnout-emotional exhaustion. A possible explanation
is that critical care nurses may perceive that this is a time of economic
uncertainty and hardship for the nursing profession. The increasing
shortage of nurses, the increasing number of patients who will need
nursing services and the fewer services available to care for the
patients presents an unstable situation. However, the findings of this
study are confusing because the nurse should not express dissatisfaction
with job security in the presence of the current number of vacant nursing
positions available nation wide. For example, one possible explanation
is that there may be ambiguity about the degree and kind of expertise
required of the nurse with the rapid changes in medical technology. In
the face of mounting patient needs and reduced services nurses may be
faced with the need to adapt their goals and methods from an idealistic
approach to a more practical, efficient way to providing care to their
patients resulting in a sense of insecurity, resulting in dissatisfaction
with the insecure nature of their job as well as professional insecurity.
In addition, the present hospital structure of nursing has made vertical


Table 4-1
Multiple Regression of Degree Situation Conducive to Stress on the
Variables Within Each Block of Characteristics
Block
Variable
Standard
coefficient
t-value
p value
Personal
Family demands
.621
12.180
.0001
characteristics
Health
.206
4.118
.0001
Psychological hardiness
-.086
-2.087
.0378
Organizational work
Skill variety
.102
2.281
.0233
characteristics
Job security
-.070
-l .843
.0664
R2 = .717 (F = 31.948; df = 22, 277; p
0001)


THE DAILY HASSLES SCALE
NAME: SEX:
IDENTIFICATION NUMBER (OPTIONAL): DATE:
Directions:
Hassles are irritants that can range from minor annoyances to fairly
major pressures, problems, or difficulties. They can occur few or many
times in any given time period. Listed below are a number of ways in
which a person can feel hassled.
When you respond to the items, you must have a specific time period in
mind. Please indicated the time period you will be thinking about:
Past month
Past week
Yesterday
Today
Other:
Read each item and circle 0 if the item was no hassle for you in the time
period shown above. If it was a hassle, indicate how severe the hassle
was by circling 1, 2, or 3.
126


93
Family Demands
Job Expectation
Meaningfulness
for Work
Knowledge of
Work Results
Committment to
Career
Health Difficulties
Psychological
Hardiness
Work Load
Skill Variety
Task Identity
Supervision
Dealing with Others
Opportunity for
Advancement
Pay
Job Security
R2 -.700
.547 e
Degree Situation
Conducive to
Stress
Figure 4-1
Reduced Model of Burnout


29
with burnout. The correlations between inadequate psychological support
and higher burnout are consistent with the findings of Edelwich and
Brodsky (1983), Freudenberger and Richelson (1980), and Pines, Aronson,
and Kafry (1981).
Coping Behavior
Another important variable in the study of burnout is coping
behaviors used to reduce job stress. Kimmel (1982) measured coping with
the Ways of Coping Scale by Lazarus as well as role conflict, role
ambiguity, household support, demographic characteristics and burnout.
His sample included head nurses, supervisors, staff nurses, licensed
practical nurses, and nurses aids from a metropolitan hospital in New
York. He reported that coping variables were the best predictors of
burnout. Chiriboga and Bailey (1986) also measured coping with the Ways
of Coping Scale, and burnout. Their results indicated that the nurses
most vulnerable for burnout are younger and unmarried, work in critical
care units, have less involvement in work conditions, experience more
work hassles and distractions in the work place, and are more reliant on
nursing supervisor for support. In addition, these nurses used
anticipated coping which was significantly associated with burnout.
However, because only one variable out of nine measures of coping
strategies contributed significantly to burnout in their study, they
concluded that coping variables were not the best predictors of burnout.
In contrast, Stone et al. (1984) found that nurses endorsing a higher
number of effective coping skills suffer less burnout.


Ill
with others on the job, and satisfaction with job security, are common
predictors of both job satisfaction and burnout. By contrast, commitment
to the career appears to be the prime determinant in burnout-emotional
exhaustion, but the challenge of the job, the experienced meaningfulness
of work, knowledge of work results, task identity, opportunity for
advancement, pay and supervision satisfaction appear to play the major
roles in job satisfaction. In addition, the burnout literature has
indicated that workload is an important contributor to burnout and the
findings from this study point this out as well. In summary, it appears
that job satisfaction and burnout are somewhat related in terms of causal
attributes; however, variables in this path analytic model explain the
variance of job satisfaction to a greater extent than they do for
burnout-emotional exhaustion.
Causes of Job Stress
The results from this study reveal that the stress variable
situation conducive to stress and personal variables, including stressful
family demands and health difficulties, and organizational variables
including supervisor dissatisfaction, dissatisfaction with pay and job
security are causally related to job stress among critical care nurses.
Although these findings do not support the structural relationships of
the variable job stress with all of the variables posited by Perlman and
Hartman (1982), the findings of this present study have practical
significance and warrant further investigation.
The stress variable, situation conducive to stress, had the greatest
direct effect on job stress. The situation conducive to stress and job
stress variables were measured with The Daily Hassles Scale including the


TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS iii
LIST OF TABLES vii
LIST OF FIGURES ix
ABSTRACT x
CHAPTERS
I INTRODUCTION 1
Background of the Problem ......... ... 1
Statement of the Problem .......... 3
Purpose of the Study ............. 5
Significance of the Study 10
Limitations 12
Assumptions ........................ 13
II REVIEW OF THE LITERATURE 14
Derivation of the Concept Burnout ............. 14
Definitions of Burnout 15
Stages in Development of Burnout 18
Causes of Burnout ............. 19
Conceptual Models of Burnout ............... 21
Burnout of Nurses ............... 24
Personal Characteristics 25
Demographics .... ........ 25
Personal Stressors 26
Personality Characteristics ........ 26
Social Support 27
Coping Behavior ... ..... 29
Organizational Characteristics 30
Work stress 30
Work Environment ............ 30
Job Satisfaction ......... 32
Theoretical Framework ........ 34
III METHODOLOGY 39
Sample of Respondents 39
Study Design and Procedures ................ 43
iv


APPENDIX J
MEANS, STANDARD DEVIATIONS AND CORRELATIONAL ANALYSIS


4
5
14.
Work, load
0.11796
0.04027
0.0412
0.4872
15.
Expected performance
-0.23838
0.19468
and role ambiguity
0.0001
0.0007
16.
Skill variety
-0.16599
0.21697
0.0039
0.0002
17.
Task identity
-0.26164
-0.04282
0.0001
0.4599
18.
Task significance
-0.02330
0.15769
0.6877
0.0062
19.
Autonomy
-0.06851
0.11612
0.2368
0.0445
20.
Supervision
-0.23005
0.16426
0.0001
0.0043
21.
Dealing with others
-0.04192
0.01032
0.4695
0.8588
22.
Opportunity for
-0.32330
0.24659
advancement
0.0001
0.0001
23.
Pay
-0.12746
0.10522
0.0273
0.0688
6
7
-0.03165
-0.03119
0.5851
0.5905
0.44621
0.32593
0.0001
0.0001
0.19744
0.45934
0.0006
0.0001
0.33171
0.15772
0.0001
0.0062
0.12266
0.28710
0.0337
0.0001
0.07119
0.36801
0.2189
0.0001
0.51866
0.27062
0.0001
0.0001
-0.13660
0.50730
0.0179
0.0001
0.61746
0.42007
0.0001
0.0001
0.40161
-0.03840
0.0001
0.5076
155


15
16
14.
Work load
0.01900
0.09924
0.7431
0.0862
15.
Expected performance
1.00000
0.33955
and role ambiguity
0.0
0.0001
16.
Skill variety
0.33955
1.00000
0.0001
0.0
17.
Task identity
0.35800
0.20740
0.0001
0.0003
18.
Task significance
0.21134
0.40271
0.0002
0.0001
19.
Autonomy
0.27122
0.34872
0.0001
0.0001
20.
Supervision
0.57005
0.25713
0.0001
0.0001
21.
Dealing with others
0.19196
0.44186
0.0008
0.0001
22.
Opportunity for
0.53004
0.47944
advancement
0.0001
0.0001
23.
Pay
0.25969
-0.05032
0.0001
0.3851
17
0.02458
0.6715
0.35800
0.0001
0.20740
0.0003
1.00000
0.0
0.13026
0.0241
0.09208
0.1115
0.29877
0.0001
0.07589
0.1899
0.33051
0.0001
0.09381
0.1049
18
19
0.07399
0.07571
0.2013
0.1909
0.21134
0.27122
0.0002
0.0001
0.40271
0.34872
0.0001
0.0001
0.13026
0.09208
0.0241
0.1115
1.00000
0.17343
0.0
0.0026
0.17343
1.00000
0.0026
0.0
0.19203
0.17262
0.0008
0.0027
0.28596
0.31542
0.0001
0.0001
0.28231
0.31435
0.0001
0.0001
-0.00832
0.04237
0.8859
0.4647
20
21
-0.09042
-0.01484
0.1181
0.7980
0.57005
0.19196
0.0001
0.0008
0.25713
0.44186
0.0001
0.0001
0.29877
0.07589
0.0001
0.1899
0.19203
0.28596
0.0008
0.0001
0.17262
0.31542
0.0027
0.0001
1.00000
0.15034
0.0
0.0091
0.15034
1.000000
0.0091
0.0
0.57896
0.16522
0.0001
0.0041
0.22139
-0.27601
0.0001
0.0001


1
2
12.
Challenge
-0.02431
-0.01391
0.6750
0.8104
13.
Hardiness
-0.02379
-0.01657
total
0.6815
0.7755
14.
Work load
-0.09834
-0.13526
0.0891
0.0191
15.
Expected performance
0.07320
0.07991
and role ambiguity
0.2061
0.1674
16.
Skill variety
0.02823
0.03579
0.6262
0.5368
17.
Task identity
0.07467
0.07281
0.1971
0.2085
18.
Task significance
0.01217
0.03710
0.8337
0.5221
19.
Autonomy
0.00145
0.04832
0.9800
0.4044
20.
Supervision
0.08011
0.09683
0.1664
0.0941
21.
Dealing with others
0.01566
0.04398
0.7871
0.4479
22.
Opportunity for
-0.03958
-0.01288
advancement
0.4946
0.8242
3
4
5
6
7
0.31506
0.07315
0.02813
0.04129
0.18416
0.0001
0.2064
0.6274
0.4762
0.0014
0.44539
0.06874
0.17449
0.09830
0.36287
0.0001
0.2352
0.0024
0.0892
0.0001
0.02611
0.05193
0.07693
0.00234
0.12709
0.6524
0.3701
0.1839
0.9678
0.0277
0.09146
-0.02005
0.40521
0.31916
0.51095
0.1139
0.7294
0.0001
0.0001
0.0001
0.10797
0.08719
0.45108
0.28964
0.36740
0.0618
0.1319
0.0001
0.0001
0.0001
0.14232
0.01999
0.23370
0.17042
0.34135
0.0136
0.7302
0.0001
0.0031
0.0001
0.00814
0.01280
0.29239
0.26893
0.17996
0.8884
0.8253
0.0001
0.0001
0.0018
0.14242
-0.00310
0.23224
0.09614
0.23209
0.0135
0.9574
0.0001
0.0965
0.0001
0.15037
0.02687
0.37790
0.23261
0.47950
0.0091
0.6430
0.0001
0.0001
0.0001
0.33998
0.00985
0.16711
0.17281
0.33611
0.0001
0.8688
0.0037
0.0027
0.0001
0.07025
0.00604
0.62118
0.42258
0.49151
0.2251
0.9170
0.0001
0.0001
0.0001
143


56
General satisfaction. An overall measure of the degree to which the
employee is satisfied and happy with the job.
Internal job motivation. The degree to which the employee is self
motivated to perform effectively on the jobi.e., the employee
experiences positive internal feelings when working effectively on
the job, and negative internal feelings when doing poorly.
Specific satisfaction. A number of short scales which provide
separate measures of satisfaction with:
(a) Job security
(b) Pay and other compensation
(c) Peers and coworkers ("social" satisfaction)
(d) Supervision
(e) Opportunities for personal growth and development on the job
("growth" satisfaction)
Finally, the JDS measures the strength of the individual's desire to
obtain growth satisfactions from his or her work. This measure is called
the growth need strength index and is viewed as an individual
characteristic which is predicted to influence how well a worker will
react to a job with a high motivating potential (Hackman & Oldham,
1978).
Psychometric Properties of JDS
Reliability. Internal consistency reliabilities for the eighteen
subscales are reported as generally satisfactory with a range from a high
of .88 to a low of .56. The term scale is used to refer to the summary
score obtained for each variable measured by the JDS. On the basis of
these results the reliability estimates are satisfactory. The
psychometric properties of the variables on this sample are presented in
Table 3-8


Copyright 1990
by
Joyce Kolbek Stechmiller


73
exhaustion, that included ten personal variables, twelve organizational
variables, the degree to which the situation is conducive to stress, job
stress, job satisfaction, and internal work motivation. Multiple
regression analyses were used to answer the study questions. In a post
hoc analysis, each independent variable that made a significant
contribution to the variance explained in one or more dependent variables
was included in a path analysis. Path analysis, as described by Pedhazur
(1982), was used to estimate the magnitudes of the direct and indirect
effects of these selected variables on perceived levels of stress,
general job satisfaction, and burnout-emotional exhaustion,
respectively


92
Contributions to Burnout-Emotional Exhaustion
Finally, Table 4-6 contains the estimates of the direct and indirect
effects among the personal and organizational exogenous variables, the
stress variables and job satisfaction on the endogenous variable
burnout-emotional exhaustion. As expected, general job satisfaction had
the strongest total effect on burnout-emotional exhaustion (-.334);
however, skill variety had the weakest total effect on burnout-emotional
exhaustion (.009). This set of variables in the reduced model explained
38% of variance of burnout-emotional exhaustion, as compared to 41% of
the variance explained in the full model.
Goodness-of-Fit
Assessment of goodness-of-fit of the reduced model was performed.
The chi-square goodness-of-fit test for the burnout-emotional exhaustion
model among critical care nurses was 39.12 (df = 37, p = .3315),
indicating a good fit of the model to the data. The larger the
probability associated with the chi-square values, the better the fit of
the model to the data (Pedazur, 1982). This finding, however, must be
interpreted with caution, recognizing that the model would fit the data
less well if a cross-validation sample had been used. Nevertheless, the
model tested here seems to hold promise for future confirmatory
investigations.
The path diagram graphically displayed in Figure 4-1 represents a
proposed pattern of causal relationships among a set of personal
exogenous variables, organizational exogenous variables, and endogenous
variables (i.e., situation conducive to stress, job stress, job
satisfaction, and burnout-emotional exhaustion). The first page of
Figure 4-1 (pg. 93) shows paths to the endogenous variable degree


15
consists of adaptive mechanisms that are instituted to destroy the
stressor and restore homeostasis. Exhaustion, which occurs if the body's
adaptive resources are depleted, is irreversible and results in death.
Once the stressor is perceived as a genuine stressor, the condition is
recognized as stress and the general adaptation syndrome.
The concept of coping as human adaptation to stress has been studied
by many psychologists. French, Rodgers, and Cobb (1974) proposed a model
for adaptation to stress that considers the interaction of
characteristics of the individual and environment. A cognitive appraisal
analysis of psychological stress has been addressed by Lazarus (1977),
who defined coping as problem solving attempts to deal with threatening
conditions. Coping, in this approach, depends on how individuals
appraise their encounters with the environment with regard to the
potential of those encounters as threatening, harmful, or challenging.
Burnout has been identified as a syndrome resulting from a negative
response to occupational stress. Researchers in a variety of
specialities, including educational psychology, clinical and social
psychology, psychiatry, sociology, cultural anthropology, nursing,
occupational medicine, and personnel management have provided an
important volume of literature which constitutes the background for the
present study. The following review of literature is concentrated on
job-related personal, psychological, and organizational factors that form
the basis for burnout.
Definitions of Burnout
Freudenberger (1974) first used the term "burnout" to describe an
unfavorable response among helping professionals working in psychiatric


I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is fully
adequate, in scope and quality, as a dissertation for the degree of
Doctor of Philosophy.
Professor of Foundations of Education
k#-
Hannelore L. Wass, Chairperson
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is fully
adequate, in scope and quality, as a dissertation for the degree of
Doctor of Philosophy.
Linea M. Crocker
Professor of Foundations of Education
I certify that I
conforms to acceptable
adequate, in scope and
Doctor of Philosophy.
have read this study and that in my opinion it
standards of scholarly presentation and is fully
quality, as a dissertation for the degree of
Barry Gulnagh
Associate Professor of Foundations of
Education
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presenta£ijon -anchis fully
adequate, in scope and quality, as a dissertation Loithe degxe^of
Doctor of Philosophy.
Robert
Profesi
of Psychology
This dissertation was submitted to the Graduate Faculty of the
College of Education and to the Graduate School and was accepted as
partial fulfillment of the requirements for the degree of Doctor of
Philosophy.
December, 1990
Chairman, Foundations o
Education (-
Dean, College of Education
Dean, Graduate School