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Working Mothers

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Waylon Allen
Waylon Allen

Psychology For Graduate Nurses P

Purpose: This study tested a theoretical model of new graduate nurses' worklife derived from the job demands-resources model to better understand how job demands (workload and bullying), job resources (job control and supportive professional practice environments), and a personal resource (psychological capital) combine to influence new graduate experiences of burnout and work engagement and, ultimately, health and job outcomes.

Psychology For Graduate Nurses P

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Methodology/approach: A descriptive correlational design was used to test the hypothesized model in a sample of newly graduated nurses (N = 420) working in acute care hospitals in Ontario, Canada. Data were collected from July to November 2009. Participants were mailed questionnaires to their home address using the Total Design Method to improve response rates. All variables were measured using standardized questionnaires, and structural equation modeling was used to test the model.

Practice implications: The model suggests that managerial strategies targeted at specific job demands and resources can create workplace environments that promote work engagement and prevent burnout to support the retention and well-being of the new graduate nurse population.

Aim: This paper is a report of a study conducted to test a model linking new graduate nurses' perceptions of structural empowerment to their experiences of workplace bullying and burnout in Canadian hospital work settings using Kanter's work empowerment theory.

Results: The final model fit statistics revealed a reasonably adequate fit (χ = 149, d.f. = 37, IFI = 098, CFI = 098, RMSEA = 009). Structural empowerment was statistically significantly and negatively related to workplace bullying exposure (β = -037), which in turn, was statistically significantly related to all three components of burnout (Emotional exhaustion: β = 041, Cynicism: β = 028, EFFICACY: β = -017). Emotional exhaustion had a direct effect on cynicism (β = 051), which in turn, had a direct effect on efficacy (β = -034). Conclusion. The results suggest that new graduate nurses' exposure to bullying may be less when their work environments provide access to empowering work structures, and that these conditions promote nurses' health and wellbeing.

The dual degree of Master of Science in Finance (MSF) and Master of Science in Business Analytics (MSBA) was designed to respond to such needs to prepare graduates for the challenges of the 21st century.

We included papers written in English that measured the association between burnout and work-related factors or outcomes in all types of nurses or nursing assistants working in a healthcare setting, including hospitals, care homes, primary care, the community, and ambulance services. Because there are different theories of burnout, we did not restrict the definition of burnout according to any specific theory. Burnout is a work-related phenomenon [8], so we excluded studies focussing exclusively on personal factors (e.g. gender, age). Our aim was to identify theorised relationships; therefore, we excluded studies which were only comparing the levels of burnout among different settings (e.g. in cancer services vs emergency departments). We excluded literature reviews, commentaries, and editorials.

The majority had cross-sectional designs (n = 87, 97%); of these, 84 were entirely survey-based. Three studies were longitudinal. Most studies were undertaken in hospitals (n = 82). Eight studies surveyed nurses at a national level, regardless of their work setting.

Sample sizes ranged from hundreds of hospitals (max = 927) with hundreds of thousands of nurses (max = 326 750) [20] to small single-site studies with the smallest sample being 73 nurses [21] (see Additional file 3).

Further 15 studies looked specifically at nurse staffing levels, and most reported that when nurses were caring for a higher number of patients or were reporting staffing inadequacy, they were more likely to experience burnout. No studies found an association between better staffing levels and burnout.

While three studies did not find a significant association with staffing levels [32, 45, 46], three studies found that higher patient-to-nurse ratios were associated with Emotional Exhaustion [47,48,49], and in one study, higher patient-to-nurse-ratios were associated with Emotional Exhaustion, Depersonalisation, and Personal Accomplishment [50]. One study concluded that Emotional Exhaustion mediated the relationship between patient-to-nurse ratios and patient safety [51]. Akman and colleagues found that the lower the number of patients nurses were responsible for, the lower the burnout composite score [52]. Similar results were highlighted by Faller and colleagues [53]. Lower RN hours per patient day were associated with burnout in a study by Thompson [20].

Having control over the job was examined in seven studies. Galletta et al. found that low job control was associated with all MBI subscales [40], as did Gandi et al. [61]. Leiter and Maslach found that control predicted fairness, reward, and community, and in turn, fairness predicted values, and values predicted all MBI subscales [35]. Low control predicted Emotional Exhaustion only for nurses working the day shift [62], and Emotional Exhaustion was significantly related to control over practice setting [63]; two studies reported no effect of job control on burnout [44, 64].

Working night shifts was associated with burnout (composite score) [68] and Emotional Exhaustion [62], but the relationship was not significant in two studies [69, 70]. Working on permanent as opposed to rotating shift patterns did not impact burnout [71], but working irregular shifts did impact a composite burnout score [72]. When nurses reported working a higher number of shifts, they were more likely to report higher burnout composite scores [68], but results did not generalise in a further study [69]. One study found working that overtime was associated with composite MBI score [73]. On-call requirement was not significantly associated with any MBI dimensions [71].

Patient characteristics/requirements were investigated in four papers. When nurses were caring for suffering patients and patients who had multiple requirements, they were more likely to experience Emotional Exhaustion and Cynicism. Similarly, caring for a dying patient and having a high number of decisions to forego life-sustaining treatments were associated with a higher likelihood of burnout (measured with a composite score) [76]. Stress resulting from patient care was associated with a composite burnout score [73]. Patient violence also had an impact on burnout, measured with CBI [81], as did conflict with patients [76].

There was an association between opportunity for career advancement and all MBI dimensions [77]; however, another study found that having promotion opportunities was not related to burnout [79]. Moloney et al. found that professional development was not related to burnout [67]. Two studies considered pay. In one study, no effect was found on any MBI dimension [73], and a very small study (n = 78 nurses) reported an effect of satisfaction with pay on Emotional Exhaustion and Depersonalisation [34]. Job insecurity predicted Depersonalisation and PA [79].

Focussing on mental health, one study found that burnout predicted mental health problems for newly qualified nurses [30], and Emotional Exhaustion and Cynicism predicted somatisation [42]. Depressive symptoms were predictive of Emotional Exhaustion and Depersonalisation, considering therefore depression as a predictor of burnout [108]. Rudman and Gustavsson also found that having depressive mood and depressive episodes were common features of newly qualified nurses who developed or got worse levels of burnout throughout their first years in the profession [26]. Tourigny et al. considered depression as a predictor and found it was significantly related to Emotional Exhaustion [107].

Regarding adverse events, high DEP and low Personal Accomplishment predicted a higher rate of adverse events [85], but in another study, only Emotional Exhaustion predicted adverse events [51]. When nurses were experiencing high levels of Emotional Exhaustion, they were less likely to report near misses and adverse events, and when they were experiencing high levels of Depersonalisation, they were less likely to report near misses [112].

The field has been dominated by cross-sectional studies that seek to identify associations with one or two factors, rarely going beyond establishing correlation. Most studies were limited by their cross-sectional nature, the use of different or incorrectly applied burnout measures, the use of common methods (i.e. survey to capture both burnout and correlates), and omitted variables in the models. The 91 studies reviewed, while highlighting the importance of burnout as a feature affecting nurses and patient care, have generally lacked a theoretical approach, or identified mechanisms to test and develop a theory on the causes and consequences of burnout, but were limited in their testing of likely mechanisms due to cross-sectional and observational designs.

The mission of the psychology graduate program is to provide students with the knowledge, skills, and intellectual habits required for successful careers in research, teaching, and professional service. We offer a doctoral program (a terminal master's degree is not offered) leading to the Ph.D. in Psychology with concentrations in:

Admission to the Psychology graduate program is highly selective. All of our graduate students study core substantive areas of psychological science as well as more specific areas in their specialization. Under the supervision of qualified faculty, and as appropriate for their specialization and career goals, our graduate students also:

Prospective students with a bachelor's degree in another field can apply to the Accelerated 15-month Program provided they have successfully completed the following nursing prerequisite courses prior to starting the program: nutrition, chemistry (with lab), statistics, anatomy and physiology (I and II), microbiology, and developmental psychology. The 15-month program is completed in four consecutive semesters of full-time study and can begin in the fall (September) or spring (January) semester. By the end of the accelerated program, you will be prepared to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to obtain licensure.


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