in uence of patient-related stressor and the relationship with ...burnout in hospital nurses jin-hwa...

Influence of patient-related stressor andthe relationship with supervisor on

burnout in hospital nurses

Jin-Hwa Park1

1College of Nursing, The Research Institute ofNursing Science, Daegu Catholic University,

33 Duryugongwon-ro,17-gil, Nam-gu, Daegu, 42472, Korea

[email protected]

January 18, 2018

Abstract

Background/Objectives: This study examined thepredictors of burnout as perceived by Korean nurses in acutegeneral hospitals, focusing on patient-related stressor andthe relationship with supervisor.

Methods/Statistical analysis: Convenience samplewas obtained from Korean female nurses in acute generalhospitals in D city area between September 15 and October31 in 2016. Response rate was 90.7%(195/215). Descriptivestatistics, t-test, ANOVA, Pearsons correlation coefficient,and hierarchical multiple regression were used to analyzedata.

Findings: All of participants were female. Most par-ticipants were 25-29 years old (51.8%), university gradu-ates (66.7%), had 3-6 years clinical experience (33.3%) staffnurses (82.6%), and working in the internal medicine unit(33.9%). Patient-related stressor had strong positive influ-ence on burnout (r=.57, p¡.001) and relationship with super-visor had moderate negative influence on burnout (r=.27,

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p¡.001). The regression model accounted for 41% of thevariance in the outcome variables. Younger age youngerage (p=.004), not working in wanted unit (p=.002), morepatient-related stressor (p<.001), and worse relationship withthe supervisor (p=.031) were independently associated withhigher burnout scores.

Improvements/Applications: This study provides ev-idence that patient-related stressor and relationship withsupervisor are influencing factors for nurses burnout.

Key Words : Burnout, Female, Intraprofessional rela-tions, Nurses, Patient related stress

1 Introduction

Nurses working in the acute general hospital settings in Korea areexposed to many high levels of stressors such as coping with pa-tient’s complex illness, managing patients’ family members, andmaintaining high-quality and compassionate nursing care. Thisprolonged stress could result burnout. Burnout is a phenomenoncaused by repeated exposure to work-related stress1. Maslach andJackson defined burnout as ”a syndrome of emotional exhaustionand cynicism that occurs frequently among individuals who do’people-work’ of some kind”(p.99)2. Researches showed that burnouthas many adverse effects on the health of health care providers suchas chronic fatigue and neck pain3,4. Nurses are exposed to high lev-els of stress because the patients in acute general hospital settingare critically ill. However, the burnout can be alleviated with hav-ing good reciprocal relationships. The concept of relationship withthe supervisor is built upon the leader-member exchange theorywhich is based on social exchange theory5. According to this the-ory, exchanges such as communication, attitude, good contribution,recognition as well as frustration between managers and employeesstrongly correlate with job satisfaction6. In fact, research foundthat good relationship with supervisor has a statistically significantpositive effect on the level of nurses trust7.

Thus, the goal of this study was to identity the influences ofpatient-related stressor and the relationship with supervisor onburnout among inpatient general hospital Korean nurses, with afocus on the work environment determinants.

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2 Methods

2.1 Design

This is a cross-sectional descriptive survey to examine the predictorsof burnout in Korean nurses working in acute general hospitals.

2.2 Participants and ethical considerations

A convenience sample of 215 nurses working at acute general hospi-tals from D city and K province were invited to participate betweenSeptember 15 and October 31 in 2016. Of these, 195 completed self-administered questionnaires. Response rate was 90.7%(195/215).Participants were nurses with more than 1 year of experience cur-rently working in acute general hospital settings.

Approval for conducting this study was obtained from the DUniversity Institutional Review Board in Korea (No. 2016-0057).All staffs that participated signed informed consent. Participantswere informed that all responses would be kept confidential andanonymous. In addition, they were informed that they could with-drawal their responses whenever they want to.

2.3 Measures

Structured questionnaires were used to measure variables.

2.3.1 Patient-related stressor

Patient-related stressor was measured by a 21-item scale8, whichwas translated into Korean by a bilingual faculty and then backtranslated into English. After that it was modified for nurses. Thescale is comprised of 4 themes: 8 items of disproportionate cus-tomer expectations, 5 items of customer verbal aggression, 4 itemsof disliked customers, and 4 items of ambiguous customer expecta-tions. A five-point scale was used with one (1) not at all and five(5) absolutely true to describe the types of stressor perceived bythe respondents, with a high score meaning a high level of stress.Cronbachs alpha coefficients of each themes in the original studywere .86, .72, .67, .68 respectively. A Cronbach’s alpha coefficients

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of reliability was calculated on the items with scores showing ac-ceptable total alpha of .98 and Cronbach’s alpha coefficients of eachthemes in the current study were .96, .94, .92, .92 respectively.

2.3.2 Relationship with supervisor

Relationship with supervisor was measured by a tool of leader-member exchange9. This is a 7-item instrument and each item wasrated on a five point Likert scale ranging from one (1) stronglydisagree to (5) strongly agree to describe the level of relationshipby the respondents, with a high score meaning good relationshipwith their supervisors. A Cronbachs alpha coefficients of reliabilityin the original study was .86 and in this study a total Cronbachalpha of .91 was calculated.

2.3.3 Burnout

Burnout was measured by an 10-item scale10. This scale is com-prised of 2 subgroups: 5 items of emotional exhaustion and 5 itemsof cynicism. A five point scale ranging from strongly disagree (1)to strongly agree (5) to describe the level of burnout perceived byrespondents, with a high score meaning a high level of burnout. Atotal Cronbachs alpha coefficients of reliability was calculated onthe items with scores of .98 and Cronbachs alpha coefficients of eachsubgroups in the current study were .86, 82 respectively.

2.4 Data analysis

The statistical methods programs used were IBM SPSS Statistics19. Data screening was performed before data were analyzed. Sta-tistical significance was set as p<.05.

To assess reliability of the measurement, Cronbach’s alpha coef-ficient index was calculated. Statistical method for this study usedas follows: (1) Descriptive statistics with frequency, percent, mean,standard deviation, minimum and maximum were used to identifythe general characteristics of the subjects and measures, (2) t-testand ANOVA with post-hoc Scheffes multiple range test were used toexamine the differences of variables according to general character-istics, (3) Pearson’s correlation coefficient was used to identify therelationship among patient-related stressor, the relationship with

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supervisor, and burnout, Lastly (4) hierarchical multiple regressionwas conducted to identify the influence of patient-related stressorand the relationship with supervisor on burnout.

3 Results and Discussion

None of variables had extreme value of skewness and kurtosis.Therefore, data transformation procedure was not performed forthe analysis. According to Tolerance and Variance Inflation Fac-tors (VIF) for individual variables for multiple regression, multi-collinearity was not reported11.

3.1 General characteristics

The subjects consisted of 195 female nurses. The average age ofsubjects was 28.37 years old. The majority of nurses were from 25to 29(n=101, 51.8%) and from 30 to 34 years of age. Of the re-spondents, 80.0%(n=156) were not married. The participants were4-year (n=130, 66.7%) or 3-year (n=53, 27.2%) college level or overmasters prepared (n=12, 6.2%) nurses. Most of the clinical experi-ence was from 3 to before 6 years (n=65, 33.3%), followed closely byfrom 6 to before 9 years (n=48, 24.6%) and from 1 to before 3 years(n=46, 23.6%). Majority of respondents were staff nurses (n=161,82.6%), compared to charged nurses (n=34, 17.4%). Of the respon-dents, 33.9%(n=66) worked in the internal medicine unit, followedby 33.3%(n=65) in the emergency room, 26.7%(n=52) in the gen-eral surgical unit, and 6.2%(n=12) in the intensive care unit. Themajority of nurses responded that they worked the place where theywant (n=134, 68.7%). These general demographic characteristicswere shown in Table 1.

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Table 1: General characteristics of subjects (N=195)

3.2 Degree of variables

Table 2 presents the item mean scores of the respondents on each ofthe measurement used as well as the range of item mean scores foreach measurement. The item mean score of patient-related stressorwas 3.47(range 1.00-5.00). The item mean score of disproportion-ate customer expectations, customer verbal aggression, disliked cus-tomers, and ambiguous customer expectations were 3.58, 3.38, 3.47,and 3.37 respectively (range 1.00-5.00, 1.00-5.00, 1.00-5.00, 1.00-5.00). The item mean score of the relationship with supervisor was3.10 (range 1.43-5.00). Lastly the item mean score of burnout was2.87(range 1.30-4.80). The item mean score of emotional exhaus-tion and cynicism were 3.19 and 2.78 respectively (range 1.00-5.00and 1.20-4.60).

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Table 2: Degree of variables (N=195)

3.3 Differences in variables according to generalcharacteristics

Table 3 provides the differences of patient-related stressor, the re-lationship with supervisor, and burnout according to general char-acteristics.

Table 3: Differences in variables according to general characteristics(N=195)

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PS=Patient-related Stressor, RS=Relationship with the super-visor

The patient-related stressor differed significantly according tonurses current position and the working unit. Staff nurses showedstatistically significant higher patient-related stress (t=39.98, p¡.001).Nurses who worked in the emergency room reported statisticallysignificant higher patient-related stress than those who worked in-ternal medicine or intensive care unit (F=8.61, p<.001).

The relationship with supervisor showed statistically significantdifferences by working unit and whether they worked the placethey wanted. Participants who worked in the intensive care unitshowed the highest statistically significant good relationship withsupervisor than those who worked in the emergency room (F=4.55,p=.004). Nurses who worked the place where they wanted re-ported statistically significant better relationship with the super-visor (t=5.00, p=.027).

The burnout differed significantly according to age, spouse, cur-rent position, and the wanted unit. Respondents aged between25 and 29 showed a higher statistically significant difference withburnout compared with those aged 35 and over (F =3.67, p=.007).Nurses with no spouse reported statistically significant higher burnoutthan those who had a spouse (t=6.93, p=.009). Staff nurses showeda higher statistical significance in burnout than charged nurses(t=10.86, p=.001). Burnout was also statistically significantly highin nurses where the place was not their wanted place to work(t=8.75, p=.004).

3.4 Correlations among the measurement scales

Table 4 showed the correlation coefficients among measurementscales. There were highly statistically significant positive corre-lations between patient-related stressor burnout (r=.57, p<.001).However, there were negatively significant correlations between therelationship with supervisor and burnout (r= -.29, p<.001). Lastly,the relationship with supervisor was also negatively statistically sig-nificant correlated with patient-related stressor (r= -.27, p<.001).

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Table 4: Correlations among variables (N=165)

3.5 Predictors of burnout

As shown in Table 5, hierarchical multiple regression was performedto identify if the addition of information regarding patient-relatedstressor (model 2) and then the relationship with supervisor (model3) improved the prediction of burnout beyond that afforded by age,spouse, current position, and wanted unit (model 1).

Table 5: Results of hierarchical multiple regression analysis forburnout (N=165)

PS=Patient-related Stressor, RS=Relationship with the super-visor

In model 1, addition of age, spouse, current position, and wantedunit results in a significant increment in R2 as much as 10% of thevariance (F=6.42, p¡.001). Only current position (β=-.17, p=.024)and wanted unit (the place where they want to work: β=.19,p=.005) were statistically significant predictors of explaining theburnout. At the model 2, addition of patient-related stressor alsoresults in an increment in R2 as 30% of the variable (F=26.40,

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p¡.001). Age (β=-.18, p=.011), wanted unit (β=.20, p=.001), andpatient-related stressor (β=.60, p¡.001) were statistically signifi-cant predictors of burnout. With all the independent variables, thelast model (model 3) showed R2 as 41% of the variance (F=23.22,p<.001) and the relationship with supervisor resulted in an incre-ment in R2 as 1%. Age (β=-.21, p=.004), wanted unit (β=.18,p=.002), patient-related stressor (β=.56, p<.001), and relationshipwith supervisor (β=-.13, p=.031) were statistically significant pre-dictors of explaining burnout.

3.6 Discussion

This paper tried to examine the relationship among patient-relatedstressor, relationship with supervisor, and burnout and to identifythe influence of patient-related stressor and relationship with su-pervisor on nurses’ burnout in Korean acute general hospitals. Theitem mean score of burn out in this study was 2.98 with range1.30-4.80. This item means burnout score of nurses was moderate.

In the regression model, patient-related stressor, relationshipwith supervisor and the demographic variables such as age andwanted unit accounted for approximately 41% of the variance innurses’ burnout. In particular, patient-related stressor was thestrongest predictor, uniquely accounting for 30% of the variancein nurses’ burnout. The findings from this study indicate nursesfelt that when they were good relationship with the supervisor, adecrease in burnout could result in.

Nurse managers or administrators can provide self-care educa-tional program to nurses that decrease stress from patients andalso provide some interventional program to improve the relation-ship between nurses and their supervisors, so that they could pro-vide high quality of nursing care. Systems should be established topromote the communication between nurses and their supervisorsand be emphasized to collaborating with patients and their familymembers. These ways will be helpful to alleviate nurses’ burnout.

4 Conclusion

This paper proposed the predictors of burnout. Despite the breadthof studies available regarding patient-related stress, relationship

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with supervisor, and burnout in the inpatient settings, there is apaucity of literature investigating the relationships of these vari-ables. The objective of this work is to investigate the patient-related stressor and the relationship with supervisor on nurses’burnout working in acute general hospital settings. Nurse com-prise the largest portion of healthcare professionals in the hospitalsettings, the prevention of nurses burnout and intent of leave shouldbe considered. Nurse managers or administrators need to focus onareas that could retain nurses.

References

[1] Trbojevi-Stankovi J, Stojimirovi B, Soldatovi I, Petrovi D, NeiD, Simi S, Work-related Factors as Predictors of Burnout inSerbian Nurses Working in Hemodialysis. Nephrology NursingJournal, 2015, 42(6), pp. 553-62

[2] Maslach C, Jackson S E, The Measurement of ExperiencedBurnout. Journal of Occupational Behaviour, 1981, 2, pp.99113. http://dx.doi.org/10.1002/job.4030020205

[3] Steege L M, Pinekenstein B J, Knudsen A, Rainbow J G,Exploring Nurse Leader Fatigue: A Mixed Methods Study.Journal of Nursing Management, 2017, 25(4), pp.276-86.http://dx.doi.org/10.1111/jonm.12464

[4] Nicoletti C, Spengler C M, Lubli T, Physical Work-load, Trapezius Muscle Activity, and Neck Pain inNurses’ Night and Day Shifts: A Physiological Eval-uation. Applied Ergonomics, 2014, 45(3), pp.741-6.http://dx.doi.org/10.1016/j.apergo.2013.09.016

[5] Byun G, Dai Y, Lee S, Kang S, Leader Trust, Competence,LMX, and Member Performance: A Moderated MediationFramework. Psychological Reports, 2017, 120(6), pp. 1137-59.http://dx.doi.org/10.1177/0033294117716465

[6] Vasset F, Marnburg E, Furunes T, Dyadic Relationshipsand Exchanges in Performance Appraisals. Nordic Journalof Nursing Research & Clinical Studies, 2012, 32(1), pp.4-9.http://dx.doi.org/10.1177/010740831203200102

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[7] Chen C-H V, Wang S-J, Chang W-C, Hu C-S, The Effect ofLeader-Member Exchange, Trust, Supervisor Support on Orga-nizational Citizenship Behavior in Nurses. Journal of NursingResearch, 2008, 16(4), pp. 321-8.

[8] Dormann C, Zapf D, Customer-Related Social Stressors andBurnout.s Journal of Occupational Health Psychology, 2004,9(1), pp.61-82. http://dx.doi.org/10.1037/1076-8998.9.1.61

[9] Scandura T A, Graen G B, Moderating Effects of InitialLeader-Member Exchange Status on the Effects of a Leader-ship Intervention. Journal of Applied Psychology, 1984, 39(3),pp.428-36. http://dx.doi.org/10.1037/0021-9010.69.3.428

[10] Lee E-K, Heo C-G, Convergent Interaction Effects ofSix Worklife Area on Relation between Nurse Pa-tients related Stress and Burnout. Journal of theKorea Convergence Society, 2017, 8(8), pp.105-14.http://dx.doi.org/10.15207/JKCS.2017.8.8.105

[11] Meyers L S, Gamst, G, Multiple Regression. In: Applied Multi-variate Research: Design and Interpretation, Sage: California,LA, p.180-2.

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