Study on the Relationships between Nurses'Job Burnout and Subjective Well-being

Hai-Ying Qu，Chun-Mei Wang

Department of Psychology，Binzhou Medical University，Yantai，Shandong 264003，China

Original article

Study on the Relationships between Nurses'Job Burnout and Subjective Well-being

Hai-Ying Qu*，Chun-Mei Wang

Department of Psychology，Binzhou Medical University，Yantai，Shandong 264003，China

A R T I C L E I N F O

Article history:

15 March 2015

Accepted 22 April 2015

Published 20 September 2015

Nurses

Job burnout

Subjective well-being

Relationships

Objective:To study factors influencing nurses’job burnout and their subjective well-being and to explore the relationships between these two phenomena.

Methods:A total of 250 nurses from three hospitals in Shandong were evaluated with the Maslach Burnout Inventory and a subjective well-being scale.

Results:Nursing staff showed significantly different levels of job burnout（P＜0.05）according to the following characteristics:age，marital status，educational background，technical title，years of nursing experience，monthly income，manning quotas and parental status.Level of burnout is higher for nursing staff who are under the age of 30 years，are unmarried，had secondary education，had unofficial manning quota status，are childless，hold a primary title and whose years of nursing experience are less than five years.Statistical significance was found for life satisfaction（P＜0.05）with differences in age；marital status；technical title；years of nursing experience；monthly income；manning quota status；and parental status in positive emotion，negative emotion and degree.There is a significant negative correlation between every dimension of job burnout and life satisfaction and positive emotions for subjective well-being.Every component of job burnout was significantly positively correlated with negative emotions.（P＜0.05）

Conclusions:Age，marital status，educational background，technical title，years of nursing experience，monthly income，manning quotas and parental status have different influences on occupation burnout and subjective well-being.Dimensions of occupation burnout have functions of predicting subjective well-being.

?2015Shanxi Medical Periodical Press.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license（http://creativecommons.org/licenses/by-nc-nd/4.0/）.

1.Introduction

Burnout at work is a psychological reaction by an individual to continued sources of interpersonal stress in the workplace.Subjective well-being is the self-reported evaluation of the quality of life，that is，the subjective evaluation of individual happiness as the standard.It is a measure of individual quality of life of general key indicators.Preventing，mitigating and reducing burnout have a positive significance in improving people’s feelings of subjective well-being.

There are few studies on the relationship between job burnout and the subjective well-being of nursing staff in China.With the fast development of our society，residents have an increasing demand for medical services；therefore，the concept of patient-centred care becomes dominant.In addition，job burnout has become an important factor affecting nurses’quality of life and work efficiency for which it has increased nurses’occupational stress and burnout.1

Some studies have proven that nursing staff job burnout has a positive correlation with subjective well-being.2However，domestically，little research on the relationships between job burnout and subjective well-being in China has been conducted.The aim of this study was to explore the nursing staff’s factors associated with and characteristics of job burnout and its correlation with subjective well-being.

2.Material and Methods

2.1.Subjects

Two hundred and fifty nurses in three tertiary hospitals were selected to complete questionnaires.

The survey was completed three times from March to May，2013.Instructions for filling in the questionnaire were given in detail，and informed consent was obtained from each participant.Participants were told to finish the questionnaire on their own within the time allotted，and the questionnaires were collected shortly after they were filled in.Of the 250 questionnaires distributed，229 valid questionnaires were returned.The return rate was 91.6%.

2.2.Measures

2.2.1.General status

The questionnaire for general status collected personal characteristics including age，marital status，educational background，technical title，years of nursing experience，monthly income，manning quotas and parental status.

2.2.2.Maslach Burnout Inventory（MBI）3

The MBI contained three subscales:（1）the emotional exhaustion subscale，（2）the depersonalization subscale and（3）the diminished personal accomplishment subscale.Cronbach’s α value for the main scale was 0.93，and for the emotional exhaustion subscale，it was 0.91，for the depersonalization subscale it was 0.81，and for the diminished personal accomplishment subscale，it was 0.844，5.

2.2.3.Subjective Well-Being Scale6

The subjective well-being scale was used to investigate the individual’s positive emotions，negative emotions and status of life satisfaction.The scale，which consists of 19 items and is divided into three domains，was created by Dinner.All of the items were rated on a five-point Likert-type scale ranging from 1（totally inconsistent）to 5（totally consistent）.In addition，the correlation of the subscales and the main scale varied from 0.56 to 0.88，and the test-retest reliability was 0.85.

2.3.Data analysis

Data were analyzed by independent sample t-test，one-way ANOVA，correlation analysis and regression analysis.

3.Results

3.1.Demographic data of nurses in the study

The basic situations of the 229 nurses are shown in Table 1.

Table 1Demographic data of the caregivers being investigated（n=229）.

3.2.Comparisons of job burnout and subjective well-being among age，marital status，educational background，technical title，years of nursing experience，monthly income，manning quota status and parental status

As shown in Table 2，the differences of nurses’total scores for job burnout，emotional exhaustion，depersonalization and low personal accomplishment among age，marital status，technical title，years of nursing experience，manning quotas and parental status are statistically significant（P＜0.05）.

The differences in nurses’emotional exhaustion and depersonalization according to educational background and monthly income were statistically significant as well（P＜0.05）.

The further Scheffe post hoc comparisons showed the following:In the three dimensions of job burnout and total score，nurses aged less than 30 years scored significantly higher than those between 30 and 40 years and those between 40 and 50 years.Unmarried nurses scored significantly higher than the married nurses.Nurses with a primary technical title scored significantly higher than those with an intermediate or with advanced technical title.The group with 5-10 years of nursing experiences scored higher than any other groups in the aspects of emotional exhaustion and depersonalization.The group with less than five years of nursing experience scored higher than other groups in low personal accomplishment.The group with unofficial manning quota status had higher scores than those with official status.Nursing staff who have no child have a higher burnout level than other nursing staff in emotional exhaustion，depersonalization and low personal accomplishment.

In the aspect of subjective well-being，nursing staff in different marital status and manning quota status have significant differences in positive emotions，negative emotions，life satisfaction and total score for subjective well-being（P＜0.05）.Nursing staff with different technical title and parental status have significant differences in negative emotions，life satisfaction and total score forsubjective well-being（P＜0.05）.Nursing staff in different age categories，years of nursing experience，and monthly income have significant differences in life satisfaction and total score for subjective well-being（P＜0.05）.

Further Scheffe post hoc comparisons showed the following:in the aspects of positive emotions and life satisfaction，nurses who are married have a higher level than those who are single；the group with official manning quota status have a higher level than those with unofficial status.In the aspects of life satisfaction and total scores of subjective well-being，the group with an advanced technical title have a higher level than the other two groups.In the dimension of life satisfaction，nurses with fewer than five years of nursing experience scored lowest，followed by those with 5-10 years of experience and then by the group with 11-15 years of nursing experience.The group with 16-20 years of experience in nursing had the highest total score for subjective well-being.The group under 30 years of age had a higher level than other groups in life satisfaction and subjective wellbeing.The group with an educational background of a bachelor’s degree or above had a higher level than other groups of positive emotion and life well-being.The childless group had a higher level than other nursing staff of negative emotion.

Nurses with different monthly income have significant differences in the life satisfaction dimensions and total score of subjective well-being（P＜0.05）.Post hoc comparison showed that nurses with a monthly income between 2 000 and 3 000 yuan and 3 000 yuan or more scored significantly higher in the aspect of negative emotion.Nurses with a monthly income of 3 000 yuan or more，2 000 yuan or less and 2 000-3 000 yuan had significantly higher scores in the aspect of life satisfaction（P＜0.05）.Nurses with a monthly income of 3 000 yuan and more rated significantly higher than the nurses with other monthly income levels in the aspects of positive emotion and life satisfaction.Nurses with a monthly income of 2 000-3 000 yuan rated significantly higher than those with other monthly income levels in negative emotion.

Nursing staff that have no children have significantly lower scores for life satisfaction than those in all categories of those with children（P＜0.05）.The group with an educational background of college or above had a higher level than other groups in positive emotion and life satisfaction；the group with no children has a higher level than other groups in negative emotion.

3.3.The relationships between nurses’job burnout and subjective well-being

3.3.1.Correlation between job burnout and subjective well-being

As shown in Table 3，positive emotion and life satisfaction have a statistically significant，positive correlation with emotional exhaustion，depersonalization and low personal accomplishment，while negative emotion has a negative correlation with job burnout and the total score of subjective well-being.The correlation coefficient was-0.603.

3.3.2.For regression analysis in this study，stepwise regression analysis was used to further examine the relationships among variables based on previously established significant correlations.Regression models were created using the total score of subjective well-being，positive emotion，negative emotion and life satisfaction as the dependent variables and three dimensions of job burnout as independent variables

As shown in Table 4，the regression equation of positive emotion that contains emotional exhaustion and diminished personal accomplishment has a significant predicting effect for positive emotion.The regression equation of negative emotion that contains emotional exhaustion，depersonalization and diminished personal accomplishment has a significant forecasting effect for negative emotion.The regression equation of life satisfaction that contains emotional exhaustion and diminished personal accomplishment has a significant predicting effect for life satisfaction.The regression equation of the total score of subjective well-being that contains emotional exhaustion，depersonalization and diminished personal accomplishment has a significant predicting effect for the total subjective well-being score.

Table 2The differences in different age，marital status，educational background，technical title，years of nursing experience，monthly income，manning quota status，and parental status between job burnout and subjective well-being among nursing staff（M±SD）.

Table 3The relationship between job burnout and subjective well-being among nurses.

Table 4Regression analysis of variables among job burnout and subjective well-being.

4.Discussion

4.1.Factors influencing job burnout among nursing staff

4.1.1.The influence of age and years of nursing experience on job burnout among nursing staff

Every dimension of job burnout showed differences based on age and number of years of nursing experience.Nursing staff whose age was below 30 had a higher score in emotional exhaustion，depersonalization and diminished personal accomplishment.This result indicates that age influences nurses’job burnout，younger nurses are more likely to take on more work tasks.

Nursing staff with 5-10 years of nursing experience had a higher scores for emotional exhaustion and depersonalization.Nurses in this age group are in the stage of their career in which they are focusing on the quality of care and finding solutions to problems in the field of nursing.However，their management skills have not fully developed yet.The emotions of the nursing staff will become increasingly exhausted with diminishing work enthusiasm due to the increasingly heavy burden of nursing work，interpersonal relationships and physicianpatient relations.7This study considers that nurses who have been working for 5-10 years are at a turning point in their families and their places of work；most nursing staff at this stage are first-time parents and are adjusting to the social role of parents.In addition，as their facilities are at a critical period，if they really like the nursing profession，naturally they will seek further development，in this case，the pressures of promotion and improvement will increase.They might find that leaving the office regularly will appear as if they dislike their job or that there is a difference between work expectations and reality.

As age and years of nursing experience increase，nursing staff increasingly enter a mature period in which their welfare and position will be improved，meanwhile，work experience has accumulated and problems can be well managed.As a result，pressure is reduced gradually over time.

4.1.2.Influence of marital status and parental status onjob burnout among nursing staff

Marital status has a significant influence on reported depersonalization and diminished personal accomplishment（P＜0.05）.Single nurses scored significantly higher in these categories than married nurses.

Parental status has a significant influence in depersonalization，emotional exhaustion and diminished personal accomplishment（P＜0.05）.Nursing staff without children reported higher scores in these dimensions than their co-workers who have children.

We inferred that this is because nursing staff who are single or without children have fewer years of nursing experience，less work experience and high work pressure；therefore，their burnout levels were higher than those who are married and/or are parents.

4.1.3.Influence of educational background and status of technical title on job burnout among nursing staff

Educational background has a significant influence in the dimension of emotional exhaustion and depersonalization（P＜0.05）.The group with only a secondary degree reported the highest scores in these categories.Additionally，technical title has a significant influence within the dimension of emotional exhaustion，depersonalization and diminished personal accomplishment（P＜0.05）.

The probable reason may be as follows:Nursing staff with lower educational backgrounds and primary technical titles take on less fulfilling tasksdifferent tasks in their position and lack a sense of accomplishment compared with nursing staff with higher education and intermediate or advanced technical titles.

4.1.4.The influence of monthly income and manning quota status on job burnout among nursing staff

Monthly income showed significant differences in the dimension of emotional exhaustion and depersonalization（P＜0.05）and had no significant difference in the dimension of diminished personal accomplishment（P＜0.05）.

The lower monthly income the nursing staff gets，the higher the degree of depersonalization they report.This relationship may be because nurses who stay at a lower level of income do not have high living expenses and standards of consumption；therefore，the pressure from the economic aspect of life influences their level of personalization.

Manning quota status showed a significant effect in the dimensions of depersonalization and diminished personal accomplishment（P＜0.05）.Nursing staff with an unofficial status scored significantly higher in these dimensions than the nurses with official status.This result may be because the unofficially appointed nurses do not have manning quotas and lack a sense of job security.

4.2.Status of subjective well-being among nursing staff

4.2.1.The influence of age and years of nursing experience on subjective well-being of job burnout among nursing staff

The study showed that the group under 30 years ofage obtained a higher score on negative emotion.The probable reason may be as follows:they were young and did not have much experience，and they were not mature enough to accomplish certain tasks，which related to their weak ability to endure difficulties8.

This study showed that those with 16-20 years of nursing experience reported the highest scores on positive emotion and life satisfaction，while the nurses with 5-10 years of nursing experience showed the highest score on negative emotion.This result may be due to the more experienced nurses having more of both clinical nursing experience and living experience；therefore，they can coordinate conflict from all aspects and regulate their mood well.In addition，nurses with the most nursing experience also have the most experience with selfintegration and can maintain a calm state of mind. Thus，they can put more energy and emotion into their work and utilize their potential in their nursing careers.

4.2.2.Influence of marital status and parental status on subjective well-being among nursing staff

Marital status and parental status showed an influence on subjective well-being among nursing staff.The married group scored higher than the single group in positive emotion and life satisfaction，and the single group reported a higher score in negative emotion.Nurses whose children received a bachelor’s or higher degree showed a higher score in life satisfaction.This outcome may be because of the increase and improvement in the children’s ages and educational background，they are able to care for themselves and therefore alleviate the family mental burden.

4.2.3.The influence of technical title on subjective well-being among nursing staff

Technical title and position can reflect an individual’s level of comprehensive ability to some degree.Nursing staff with different technical titles have significantly different levels of subjective well-being.Nurses who have higher technical titles would have more working experience and higher salaries than others；therefore，their material needs would be easily met and their subjective well-being positively affected.Primary nurses had a higher score in negative emotion compared with nurses with intermediate and advanced job titles in positive emotion and life satisfaction.A survey about the influencing factors on the sense of happiness among elementary healthcareworkers，whichwas analyzedby Hezhen，9shows that intermediate and advanced health care workers report a higher-level sense of happiness. Related studies show that nurses with a high level technical title and post have a higher sense of happiness than the others.This finding may relate to the higher social expectations and greater role in their own workplace.10

4.2.4.Influence of monthly income and manning quota status on subjective well-being among nursing staff

Different monthly income categories show significant differences in the dimension of life satisfaction for subjective well-being（P＜0.05）.Nursing staff whose monthly income is 5000 yuan or above had the highest score in the total score for subjective well-being.Nursing staff in different manning quota status categories of subjective well-being showed significant differences in positive emotion，negative emotion and life satisfaction（P＜0.05）.In the dimension of positive emotion and life satisfaction，the official group scored higher than the unofficial group.This result may be because manning quotas represent job security and a guarantee of economic resources which have great influence on the nurses’subjective well-being.

4.3.Influence of job burnout on subjective well-being among nursing staff

Numerous studies have shown that job burnout has a high correlation with subjective well-being.A high level of job burnout may cause a decline in subjective well-being.The dimension of negative emotion has a significantly positive correlation with job burnout，whereas positive emotion and job burnout had a negative correlation.The score was influenced by job burnout to some degree.Once the energy and effort which are used for adjusting to the individual’s work pressure is exhausted，it will lead to psychosomatic disease，and affect the individuals’subjective well-being.11，12

It is stated that job burnout is one of the important causes of a decline in subjective well-being.Regression analysis was used in this study to further reveal the relationship between job burnout and subjective well-being. The regression equation of positive emotion，which contains emotional exhaustion and diminished personal accomplishment，were significant.The regression equation of negative emotion，which contains the factors of emotional exhaustion，depersonalization and diminished personal accomplishment，has significant predicting effects for negative emotion.The regression equation of life satisfaction，which contains the factors of emotional exhaustion and diminished personal accomplishment，has significant predicting effects for life satisfaction.The regression equation of subjective well-being，which contains the factors of emotional exhaustion，depersonaliza-tion and diminished personal accomplishment，has significant predicting effects for subjective well-being.The relationship between job burnout and subjective well-being is not a direct effect and there may be some intermediate factors such as age and technical title.Further analysis of this complex relationship will be conducted in a follow-up study.

5.Conclusions

Factors including age，marital status，educational background，technical title，years of nursing experience，monthly income，manning quota status and parental status have different influences on job burnout and subjective well-being.The level of subjective well-being can be influenced by the job burnout of nursing staff.The higher the level the nurses feel in job burnout，the lower the level of life satisfaction and positive emotions they experienced.However，the scores for the negative emotion dimension will be higher than the other dimensions. Factors of emotional exhaustion，depersonalization and diminished personal accomplishment have a positive predictive effect on the total score of subjective well-being.

Conflicts of interest

All contributing authors declare no conflicts of interest.

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28 December 2014

in revised form

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E-mail address:qhy8949@163.com（H.-Y.Qu）.

Peer review under responsibility of Shanxi Medical Periodical Press.

http://dx.doi.org/10.1016/j.cnre.2015.09.003

2095-7718/?2015 Shanxi Medical Periodical Press.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license（http://creativecommons.org/licenses/by-nc-nd/4.0/）.