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Across the world, hospital nurses experience a high level of burnout. Exploring biochemical markers of burnout could help to understand physiological changes and may provide useful evidence for preventing burnout symptoms. The current study included 94 female nurses from one Chinese third-level hospital. The Maslach Burnout Inventory-General Survey (MBI-GS) was used to investigate burnout symptoms: emotional exhaustion, cynicism, reduced professional efficacy, as well as the burnout average. The HPT axis was tested by checking blood levels of thyroid-stimulating hormone (TSH), thyroxin (T 4 ) and triiodothyronine (T 3 ). Nonparametric tests showed that no significant difference in biochemical markers was found between the burnout and non-burnout groups. Spearman correlation analysis found that biochemical markers had no significant association with burnout symptoms, except weakly negative associations between reduced professional efficacy and blood pressure and heart rate. These findings show a rather poor correlation of the HPT axis on burnout symptoms. Expanding the biochemical index of the HPT axis, comparing well-defined samples and using longitudinal studies are recommended for further studies. [ABSTRACT FROM AUTHOR]

Objective The main objective was to ascertain the typical menopausal symptoms and job-related stress factors in Japanese nurses during the menopausal transition, and the associations of menopausal symptoms with job-related stress. A supplementary objective was to determine whether there were any differences in menopausal symptoms and job-related stress factors among nurses in managerial positions. Methods One thousand seven hundred female registered nurses aged 45-60 years who were working in hospitals in Japan were asked to complete a self-administered survey that included Greene's Climacteric Scale and the Brief Job Stress Questionnaire. Results The proportions of nurses who reported feelings of tiredness, irritability and difficulty in concentration were higher than the proportions with other menopausal symptoms. The proportions of nurses reporting feeling unhappy or depressed and having crying spells were higher among nurses in managerial positions than among other nurses. Stresses related to 'quantitative overload' on the Brief Job Stress Questionnaire among nurses in managerial positions were significantly greater than among nurses not in managerial positions, while stresses related to 'physical overload', 'job control', 'skill discretion', 'workplace environment' and 'job satisfaction' among nurses not in managerial positions were significantly greater than they were among nurses in managerial positions. Psychological symptoms were significantly correlated with poor job-related interpersonal relationships. Conclusions Health care practitioners should be aware that menopausal symptoms are associated with job-related stress during the menopausal transition. Information on the differences in these associations between nurses in managerial positions and other nurses is important as it will allow their health care to be managed on a more individual basis. [ABSTRACT FROM AUTHOR]

Abstract: A questionnaire-based descriptive pilot study was conducted among all nurses routinely working with MRI in the Northern part of Sweden to provide an indication of the self-reported prevalence of health complaints related to working with MRI systems. Fifty-nine nurses (88% response rate), with on average 8 (±6) years experience with MRI scanning procedures, returned the questionnaire. In total, 9 nurses (15%) reported regularly experiencing at least one of the health complaints (1–5% for specific health complaints) attributed to arise or be aggravated by their presence in the MRI scanning room. Stratification of the results indicated that reporting of adverse symptoms was not related to the level of occupational workload/stress. However, reporting of health complaints was related to the strength of the magnet(s) the nurses worked with, with 57% of symptoms reported by those nurses working with the strongest systems (both 1.5 and 3T scanners in this population). Although this descriptive study did not include a control population and was based on self-reporting of health complaints, these data indicate that the prevalence of reported health complaints is not related to perceived work load or occupational stress, but does confirm data from other occupational sectors and indicates that the prevalence of adverse health complaints increases with the strength of the MRI system for nurses as well. [Copyright &y& Elsevier]

Abstract: Background: Global nursing shortages have exacerbated time pressure and burnout among nurses. Despite the well-established correlation between burnout and patient safety, no studies have addressed how time pressure among nurses and patient safety are related and whether burnout moderates such a relation. Objectives: This study investigated how time pressure and the interaction of time pressure and nursing burnout affect patient safety. Design-setting participants: This cross-sectional study surveyed 458 nurses in 90 units of two medical centres in northern Taiwan. Methods: Nursing burnout was measured by the Maslach Burnout Inventory-Human Service Scale. Patient safety was inversely measured by six items on frequency of adverse events. Time pressure was measured by five items. Regressions were used for the analysis. Results: While the results of regression analyses suggest that time pressure did not significantly affect patient safety (β =−.01, p >.05), time pressure and burnout had an interactive effect on patient safety (β =−.08, p <.05). Specifically, for nurses with high burnout (n =223), time pressure was negatively related to patient safety (β =−.10, p <.05). Conclusion: Time pressure adversely affected patient safety for nurses with a high level of burnout, but not for nurses with a low level of burnout. [Copyright &y& Elsevier]

Background: The International Hospital Outcomes Study found that organizational/managerial support for nursing has a pronounced effect on nurses’ job dissatisfaction, burnout and quality of care. However, these findings have not been validated in non-Western countries using the same study method and instrument. Objectives: The objectives of this study were to: (a) examine associations between job satisfaction and burnout, organizational support and quality of care reported by South Korean nurses, (b) identify the best predictors of job satisfaction among South Korean nurses through multivariate modeling and (c) compare findings of this study with those from the International Hospital Outcomes Study. Research method: This replication study used a cross-sectional survey design. The Pennsylvania Registered Nurse Survey used in the International Hospital Outcomes Study (IHOS) was administered to 496 registered nurses working at 23 acute hospitals in South Korea. A statistical model of job satisfaction was developed using logistic regression. Results: Job dissatisfaction was positively correlated to total burnout scores (r =.42, p <.001) and lack of organizational support (r =.36, p <.001). Multivariate analysis found that job satisfaction was significantly associated at the level of 0.05 with total burnout scores, amount of organizational support and satisfaction with nurse identity, with odds ratios of .92 (p <.001), 1.04 (p <.01) and 11.93 (p <.001), respectively. Korean nurses reported low quality of care in their practice setting and were less confident in their patients’ ability of self-management after discharge. Yet despite a high patient-to-nurse ratio (22 patients per nurse), Korean nurses had a higher job satisfaction rate (68.8%) and lower burnout scores (35.7) than their counterparts in the International Hospital Outcomes Study. Conclusion: The high patient-to-nurse ratio allows South Korean nurses to focus on more technical tasks that give less stress and have higher job satisfaction because of it. However, this also leads to the South Korean nurses having less confidence in their patient''s ability to take care of themselves upon discharge. South Korean nurses should also be given opportunity to advance themselves professionally and be recognized for their abilities while being given more responsibility for the clinical decision making in their patient''s care. [Copyright &y& Elsevier]

Abstract: Background: The use of fixed-term employment has increased lately, particularly in Europe and in the health care sector. Previous studies have shown that especially among the health care sector employee''s organizational justice perceptions and job control are important factors that are directly related to the welfare and attitudes of employees and may also help to buffer the negative impacts of many detrimental factors. Objective: The present study examined the association of employment type (fixed-term vs. permanent) with work interference with family (WIF) and sleeping problems. In addition, we examined whether organizational justice and job control were able to moderate above-mentioned associations. Design: Cross-sectional study design. Setting: A random sample of registered nurses in Finland from the Central Register of Health Care Professionals. Participants: 1767 Finnish registered nurses (1676 women and 91 men) aged 23–60 years (mean=42.6, SD=10.0) formed a final study sample. Methods: The relationships were studied by linear regression analyses and the effects of gender, age, marital status, employment sector, work shift, number of children, and overtime work hours were adjusted for. Results: Our results showed that organizational justice moderated the association between employment type and WIF. That is, those employees who were employed in fixed-term contracts and experienced low levels of organizational justice had higher levels of WIF than others. Employment type was not directly associated with WIF or sleeping problems. High justice levels were directly associated with less WIF and less sleeping problems, and high job control levels with less sleeping problems. Conclusion: According to our results it would be important to promote fair organizational procedures and management in the health care sector especially for those who are employed with fixed-term contracts and in organizations with a lot of fixed-term employees. [Copyright &y& Elsevier]

Background: Cherniss''s pioneering research on burnout, based on grounded theory, focused specifically on competence crisis among new graduates, and identified negative attitude changes as the core phenomenon in the progression from competence crisis into early career burnout. In this model, the two main burnout dimensions of exhaustion and dysfunctional coping are ordered sequentially; i.e., initial exhaustion develops, due to dysfunctional coping (cynicism and disengagement), into burnout. Objective: To test the sequential-developmental model of burnout originally proposed by Cherniss, using a psychometric approach. Design: A sample of 933 early-career nursing professionals, recruited from a Swedish population-based cohort (response rate 81%), were assessed three years after graduation, using items from a burnout inventory. Data were analysed using the Rasch measurement model. Results: The psychometric tests showed that data adhere to a sequential-developmental model when examined using the one-parameter item response approach. When tested against external variables, the prevalence of low mood, low levels of job performance and health problems increased monotonically along this sequential-developmental model of early career burnout. Conclusion: Among early-career nursing professionals burnout may be operationalized as a one-dimensional sequential-developmental model. This model resembles the results found in the literature on transition and socialization, and the association between these psychometric results and studies on nursing students’ transition and socialization into working life are discussed. [Copyright &y& Elsevier]

Background: Formerly unconnected lines of research have shown that both the perceived incongruence between personal and organizational goals and meeting self-control demands at work exert adverse influences on indicators of job strain. Objectives: Going beyond this research and drawing on recently developed theoretical notions on self-control depleting a limited control resource, the present study examines – in addition to main effects – also interactive effects of both stressors on various indicators of strain that include not only self-report measures (dimensions of burnout, psychosomatic complaints) but also absence data (sum of days absent, absence frequency) as behavioural outcome. Design: A cross-sectional questionnaire survey was conducted in combination with absence data referring to a time period of 12 months after administration of the questionnaires. Setting: A municipal organization for residential elderly care with six nursing homes located in a large German city. Participants: Questionnaires were distributed to the whole nursing staff of which 242 staff members filled in the questionnaire and permitted collecting their absence data (67% participation rate). Methods: In addition to descriptive statistics and bivariate correlations, hierarchical moderated regression analyses were performed. Results: Findings revealed significant main effects of both predictors on the criterion measures with signs corresponding to expectations. Over and above these main effects, the two-way interaction between goal incongruence and self-control demands added a significant amount of incremental variance to the prediction of exhaustion, depersonalization, psychosomatic complaints as well as the time lost index of absenteeism. In the measure of absence frequency, this interaction failed to reach significance. As hypothesized, the form of the interactions indicated that the adverse influences of self-control demands are strengthened with an increase in the perceived mismatch between personal and organizational goals. Conclusions: Improving the fit between personal and organizational goals and strengthening the individual control resource could make health care workers less vulnerable against the depleting effects of meeting self-control demands at work. [Copyright &y& Elsevier]

Background: Nursing is considered as a risk profession with high levels of stress and burnout, and these levels are probably increasing. Objectives: This study assessed temporal and cross-sectional relationships between job stressors, hardy personality and coping resources on burnout dimensions among nurses. Design: Temporal and cross-sectional effects were evaluated. A sample of 98 nurses from Portugal completed the Nursing Burnout Scale at two time points. The data were analysed using descriptive statistics, Pearson correlations, and hierarchical linear regression analyses regressing Wave 2 burnout dimensions. Results: The study confirmed the specific contribution of control and challenged hardy personality dimensions as the explanation of burnout. However, commitment did not show any effects in this study. Social support and active coping were also relevant predictors of burnout dimensions. Specifically, active coping had an inverse temporal effect on depersonalisation and lack of personal accomplishment. In relation to the burnout process, depersonalisation appeared as an antecedent of lack of personal accomplishment. Conclusions: The present study is an initial step to comprehend the link between job stressors, hardy personality, coping resources and diminishing burnout. [Copyright &y& Elsevier]

Abstract: Objective: Burnout among nurses is an issue of concern, and preventive interventions are important to implement and evaluate. This study investigated levels and predictors of change in burnout dimensions after an intervention for help-seeking nurses. Methods: Nurses participating in a self-referral, counseling intervention, from 2004 to 2006 in Norway, were followed with self-reporting assessments. One-year follow-up was completed by 160/172 (93%, 155 women and 5 men). Results: Mean level of emotional exhaustion (one dimension of burnout, scale 1–5) was significantly reduced from 2.87 (SD 0.79) to 2.52 (SD 0.8), t =5.3, p <0.001, to the level found in a representative sample of Norwegian nurses. The proportion of nurses seeking psychotherapy increased after the intervention, from 17.0% (25/147) to 34% (50/147), p <0.001. Less reduction in emotional exhaustion was independently predicted by reporting a work-related conflict (β −0.53 (SE 0.13), p <0.001) or by getting a period of sick leave (β −0.28 (SE 0.12), p <0.05) after the intervention. Conclusions: A short-term preventive intervention could contribute to reduction of emotional exhaustion in nurses. Work-related conflict and sick leave after the intervention were negatively associated with this reduction. Practice implications: Preventive interventions to reduce burnout for nurses should be considered, as well as programs for preventing or handling conflicts at work. [Copyright &y& Elsevier]

Abstract: Background: Resilience in the workplace has been described as a means of facilitating adaptation in stressful environments, and therefore has application in nursing contexts. However, little research has examined how personal characteristics such as age, nursing experience and education contribute to resilience in clinical environments such as the operating room (OR). Objective: First to identify the level of resilience, and second, investigate whether age, experience and education contribute to resilience in an Australian sample of OR nurses. Methods: A predictive survey design was used. A random sample of 1430 nurses who were members of the Australian College of Operating Room Nurses association were surveyed. The survey included the 25-item Connor–Davidson Resilience Scale, and demographic questions. A standard regression model tested the hypothesis that age, years of OR experience and education contributed to resilience in OR nurses. Results: A total of 735 (51.4%) completed, usable surveys were returned. Pearson''s correlations demonstrated modest but statistically significant associations between age (p<0.001), and years of OR experience (p<0.0001), and resilience. In the multiple regression model, only years of OR experience predicted resilience (p<0.0001) and explained a small 3.1% of the variance in resilience. Conclusions: In OR nurses, resilience appears to be predicted by other attributes and is not necessarily dependent on an individual''s personal characteristics. Thus, recruitment to the OR should not be based on the conventional notion that an older nursing workforce will have greater longevity and hence be more stable. If younger, less experienced nurses are adequately supported, they may thrive in the OR environment. [Copyright &y& Elsevier]

Abstract: Background: Job burnout is an important predictor of nurse retention. Reliable and valid measures are required to monitor this phenomenon internationally. Objective: To evaluate the applicability of the Maslach burnout inventory (MBI) in international nursing research. Design: Secondary analysis of cross-sectional hospital nurse survey data from eight countries. Settings: Hospitals in the U.S., Canada, the U.K., Germany, New Zealand, Japan, Russia and Armenia. Participants: 54,738 direct care professional nurses from 646 hospitals in eight countries. Methods: Confirmatory and exploratory factor analysis were undertaken to identify the factor structure of the MBI. The internal consistencies of the subscales were investigated. Results: Exploratory factor analysis revealed three factors being extracted from the 22-item Maslach burnout inventory. In nearly all countries the two items (6 and 16) related to the “stress” and “strain” involved in working with people loaded on the depersonalization subscale rather than the emotional exhaustion subscale to which they were initially assigned. The three subscales exhibited high reliability with Cronbach alphas exceeding the critical value of 0.70. The correlation coefficients for the emotional exhaustion and depersonalization subscales were strong and positive. Conclusions: The 22-item Maslach burnout inventory has a similar factor structure and, with minor modifications, performed similarly across countries. The predictive validity of the emotional exhaustion and depersonalization subscales might be improved by moving the two items related to stress and strain from the emotional exhaustion to the depersonalization subscale. Nevertheless, the MBI can be used with confidence as a burnout measure among nurses internationally to determine the effectiveness of burnout reduction measures generated by institutional and national policies. [Copyright &y& Elsevier]

Background: Delirium in elderly hip-fracture patients is common and results in negative patient outcomes and increased nursing workload. Design and objective: The study was part of an evaluation of the interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) in a Swiss university hospital. Nursing workload was compared before and after implementing the program, using a quasi-experimental design. Participants: Included were 200 patients who were 65 years of age or older, recovering from hip-fracture surgery on a trauma ward (intervention) or on the other surgery wards. Methods: Workload was compared before and after implementing the program on the trauma ward and was also compared on other surgery wards. Nursing workload for each patient was evaluated by means of data obtained from the nursing workload management system. Data were collected in a 4-month timeframe in 2004 and 2005 respectively. Differences for workload in total and workload for day, evening, and night shifts on postoperative days 1–5 were calculated, controlled by co-morbidity. Subgroup analysis was performed for patients categorized by nurses as ‘confused’. Results: Total workload decreased slightly from Year 1 to 2 by 6.4% and 4.2% for patients on the trauma ward and other surgery wards. However, workload during night shifts on the trauma ward decreased significantly by 22% (p =.004), while there was not a significant change on the other surgery wards. Sub-analyses for ‘confused’ patients found that the workload at night on the trauma ward decreased significantly by 23% (p =.01), while it did not change significantly on other surgery wards. Higher co-morbidity and nurses’ labelling patients as ‘confused’ were associated with increased workload (p <.001). Conclusions: After implementing the program, decreased workload at night was found on the trauma ward. Delirium was detected and treated more quickly which led to less care needed at night. The reason for the slight drop in workload on all wards requires further investigation. [Copyright &y& Elsevier]

Abstract: Background: Qualified nurses commonly report several work-related problems, which may threat their health and work ability, and may have an impact upon retention. Objective: The aim of the present study was to investigate whether perceived work ability is a predictor for different types of thinking of quitting and for actual exit from the workplace. Design: A prospective study has been performed based on 3329 Italian registered nurses which responded to both measurements of the Nurses’ Early Exit Study. Institutions were selected by means of a stratified sampling procedure. All the 7447 nurses working in that healthcare organizations were recruited for the study. Baseline questionnaire was collected from 5504 nurses. Response rate at follow-up was 63.4%. Two hundred and fifty-five nurses left the job in the course of the investigation. Methods: Several multiple logistic regression analyses were performed controlling for indicators of work-related well-being, socio-demographic, and labour-market characteristics. Results: As a whole, our results show that among nurses younger than 45 years work ability is a significant predictor of different types of thinking of quitting, but not of actual exit from the workplace: a lower perceived work ability was associated with a higher desire to undertake further education (OR: 3.05; 95% CI: 1.30–7.18) and/or to change workplace (OR: 4.03; 95% CI: 1.84–8.83) or profession (OR: 6.67; 95% CI: 2.78–15.99). In contrast, among the older nurses (>45), only actual exit was predicted by lower work ability scores (OR: 7.14; 95% CI: 1.15–44.13), along with the perception of a larger availability of free nursing posts in the region (OR: 2.70; 95% CI: 1.13–6.43). Conclusion: Therefore, we conclude that in the relationship between low perceived work ability and intended or actual exit, a significant part is explained by age itself, but also by the age-related differences in occupational and life opportunities. This contribution concludes with some age-related policies aimed at boosting nurses’ retention. [Copyright &y& Elsevier]

Abstract: Content analysis on nurses’ perception about the nature of occupational stress was performed in this study to identify emic and etic experiences of occupational stress. Nurses from Hungary, Israel, Italy, U.K., and the U.S., gave their responses in writing to the question: “What causes you the most stress or anxiety on your job?” in the dominant tongue of their country. Results indicate both etic and emic sources of job-related stress. ‘Performing certain tasks’ and ‘type of patients’ were invariant sources of stress across all five nations. Furthermore, nurses in the U.K. reported ‘skillset of staff’ as a source of stress and Hungarian nurses indicated ‘low salary’ and ‘lack of resources’ as sources of job stress more frequently than nurses in the other nations of this study. [Copyright &y& Elsevier]

Abstract: Background: Previous research has identified international and cultural differences in nurses’ workplace stress and coping responses. We hypothesised an association between problem-focused coping and improved health, emotion-focused coping with reduced health, and more frequent workplace stress with reduced health. Objectives: Test the above hypotheses with Australian and New Zealand nurses, and compare Australian and New Zealand nurses’ experience of workplace stress, coping and health status. Participants and settings: Three hundred and twenty-eight New South Wales (NSW) and 190 New Zealand (NZ) volunteer acute care hospital nurses (response rate 41%) from randomly sampled nurses. Design and method: Postal survey consisting of a demographic questionnaire, the Nursing Stress Scale, the WAYS of Coping Questionnaire and the SF-36 Health Survey Version 2. Results: Consistent with hypotheses, more frequent workplace stress predicted lower physical and mental health. Problem-focused coping was associated with better mental health. Emotion-focused coping was associated with reduced mental health. Contrary to hypotheses, coping styles did not predict physical health. NSW and NZ scored effectively the same on sources of workplace stress, stress coping methods, and physical and mental health when controlling for relevant variables. Conclusions: Results suggest mental health benefits for nurses who use problem-solving to cope with stress by addressing the external source of the stress, rather than emotion-focused coping in which nurses try to control or manage their internal response to stress. Cultural similarities and similar hospital environments could account for equivalent findings for NSW and NZ. [Copyright &y& Elsevier]

This study examined the anthropometry and anthropometric fit of a group of nurses in Western Cape private hospitals. Anthropometric variables were measured using a sample of nurses and a correlation matrix generated. All nurses were given a questionnaire concerned with operational problems in the work environment and musculoskeletal pain. The nurses reported numerous problems in the working environment, including lumbar backache, inadequate space and equipment that caused bodily discomfort. There were consistent, statistically significant associations between the frequency of occurrence of these problems and the anthropometric data indicating that the problems were caused or amplified by body size variability and were not simply general usability problems which would affect all nurses irrespective of their body dimensions. [ABSTRACT FROM AUTHOR]

Presents a study which examined the relationship of nurse burnout and patient satisfaction with nurse and physician care, provision of information and hospital care. Methodology used in the study; What burnout results from; Statistical information on correlations among nurses' scores and patient satisfaction ratings.

The ubiquity of EHRs in healthcare means that small EHR inefficiencies can have a major impact on clinician workload. We conducted a sequential explanatory mixed methods study to: 1) identify EHR-associated workload and usability effects for clinicians following an EHR change over time, 2) determine workload and usability differences for providers (MD and Advance Practice Nurses) versus nurses (RNs and MAs), 3) determine if usability predicts workload, 4) identify potential sources of EHR design flaws. Workload (NASA-Task Load Index) and usability (System Usability Scale) measures were administered pre, 6-8 month and 30-32 months post-implementation. We found significant increase in perceived workload post-implementation that persisted for 2.5 years (p < .001). The workload increase was associated with usability ratings, which in turn may relate to EHR interface design violations identified by a heuristic evaluation. Our findings suggest further innovation and attention to interface design flaws are needed to improve EHR usability and reduce clinician workload. [ABSTRACT FROM AUTHOR]

Fatigue arising from excessive work demands is a known safety challenge in hospital nurses. This study aimed to determine which measures of work demands during nursing work are most predictive of hospital nurse fatigue levels at the end of the work shift. Measures of work demands of registered nurses from two hospital units in the United States were collected from organizational data sources, wearable sensors, and questionnaires. Fatigue levels were measured at the start and end of each shift using the Brief Fatigue Inventory. Multilevel linear regression analysis was used to predict end of shift fatigue based on work demand variables. The best fit model included multiple variables from organizational data sources and a physical activity variable measured by a wearable sensor. Organizational data can be used to create dynamic measures of work demands as they occur and predict end of shift fatigue levels in hospital nurses. [ABSTRACT FROM AUTHOR]

Abstract: In psychoneuroendocrinology research, salivary measures have become increasingly important. While several studies focus on determinants of salivary cortisol such as age, gender, and gynaecological variables, less research has focused on confounding variables of salivary alpha-amylase (sAA). In a large sample of nurses (N =215) we analyzed the impact of age, gender, intake of oral contraceptives, smoking, coffee consumption as well as psychological parameters, such as work stress and burnout, on basal diurnal sAA release. Saliva was collected at 07:00h, 11:30h, 17:30h, and 20:00h on a working day during early shift. Only gender could be identified to have an impact on sAA, with females having a more pronounced sAA increase over the course of the day. Whereas depression, anxiety, work stress and burnout were not associated with sAA, a small negative correlation between social difficulties, measured with the Chronic Stress Screening Scale, and sAA could be identified. [ABSTRACT FROM AUTHOR]