Heather K' Spence Laschinger, RN, PhD

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Individual and Contextual Predictors of Nurses
Burnout/Engagement and Job Satisfaction Testing
a Multi-level Model
Heather K. Spence Laschinger, RN,
PhD Distinguished University Professor and
Associate Director Nursing Research School of
Nursing, Faculty of Health Sciences The
University of Western Ontario, London, Ontario,
Canada Email - hkl_at_uwo.ca Joan Finegan,
PhD Professor, Department of Psychology University
of Western Ontario, London, Ontario,
Canada Piotr Wilk, PhD Scientist Middlesex-London
Health Unit London, Ontario Academy of
Management Meeting August 8-13, 2008 Anaheim,
California Funded by Social Sciences Humanities
Research Council of Canada
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Campus ScenesUniversity of Western Ontario
Email hkl_at_uwo.ca
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Background and Rationale for Study

• Impending workforce shortage crisis as Baby
  Boomers near retirement necessitates serious
  attention to understanding factors that attract
  and retain employees
• The health care sector in Canada is particularly
  at risk for labour shortages, notably in the
  nursing profession (McMullin Cooke, 2004)
• A third of nurses in a large international study
  were dissatisfied with their jobs and reported
  high levels of burnout, potentially worsening the
  shortage (Aiken et al., 2001).
• Employee empowerment an effective means of
  counteracting the disempowering effects of
  stressful working conditions (Kanter, 1989
  Pfeffer, 1994 Spreitzer, 1995)
• Leadership plays an important role in creating
  empowering working conditions that prevent
  burnout and promote retention of employees.

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Purpose

• To test a multi-level model linking unit level
  leadership and structural empowerment to
  individual nurses experiences of burnout/
  engagement and job satisfaction
• To examine the role of a personal disposition
  variable, core self evaluation, in the model.

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Structural Empowerment access to
organizational structures that enable employees
to accomplish their work in meaningful ways
(Kanter, 1979).

• Kanter (1977) describes four organizational
  empowerment structures
• Access to information
• Access to support
• Access to resources needed to do the job
• Opportunities to learn and grow.
• Access to these empowerment structures is
  facilitated by
• Formal power
• Informal power

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Structural Empowerment and Retention Factors

• Structural empowerment significant predictor of
• _ Fit with 6 Areas of Worklife (Laschinger
  Finegan, 2007 Cho, 2007).
• Job Satisfaction (Laschinger, et al, 2004
  Manojlovich, 2005).
• Job Commitment (Laschinger, Finegan, Shamian,
  2001 Young-Ritchie, 2006)).
• - Turnover intentions (Nedd, 2007).
• Burnout (Laschinger, Finegan, Shamian Wilk,
  2003).

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Extensive support for Kanters workplace
empowerment theory in nursing population at
individual level of analysisBUT

• No studies considered unit or contextual effects
  of empowerment using a multi-level approach
• OR
• Included both situational and personal
  dispositional variables in explanatory models

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Multi-Model Tested in the Study
LMX Quality
Empowerment
Level 2 (Unit)
Level 1 (Individual)
Emotional Exhaustion
Job Satisfaction
Core Self-Evaluation
Cynicism
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Leader Member Exchangethe nature and quality
of the relationships between the leader and
followers that forms over time plays a vital role
in employee responses to their work environments
(Graen, 1984 Liden, Maslyn, 1998)

• High quality LMX relationships consists of
• Contribution (performing work beyond minimal
  expectations)
• Affect (friendship and liking)
• Loyalty
• Professional Respect
• High LMX managers more likely to create
  conditions that ensure followers can accomplish
  meaningful work.

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• LMX quality related to empowering conditions
• Trust, exchange of information, resources
• (Uhl-Bien, 1991).
• Perceived access to information, resources, and
  support (Wayne, Shore Liden, 1997).
• Nurse managers work empowerment and job
  satisfaction (Laschinger, Purdy, Almost, 2007).
  
• We expected high LMX at the unit level to result
  in greater unit level empowerment.

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Burnout..a syndrome in which a previously
committed, helping professional gradually
disengages from full participation in a job in
response to excessive job-related stressors.
(Maslach, 1981)

• Burnout consists of 3 components
• Emotional exhaustion
• Depersonalization/Cynicism
• Personal accomplishment/Efficacy
• Burnout in nurses linked to
• Decreased self efficacy or competence (Gordon,
  1994)
• Decreased job satisfaction and increased physical
  health symptoms (Jamal Baba, 2000)
• - Poor mental and physical health (Shirom et
  al)
• We expected burnout to be an outcome of unit
  level conditions and an antecedent of individual
  nurse job satisfaction.

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Core Self-Evaluation Broad personal dispositional
variable that describes an individuals
evaluation of themselves and their self worth,
shown to be an important predictor of how
employees interpret events in their work lives
(Judge 2001).

• 4 Dimensions
• Self Esteem overall value that people place on
  themselves
• General Self-efficacy refers to ones view of
  their ability to cope, perform, and achieve
  success
• Locus of Control the belief that one can control
  a broad set of factors experienced in life
• Emotional Stability the tendency to be confident
  and secure

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• Core Self-Evaluations related to
• Job satisfaction in various work settings (Judge
  Bono, 2001 Judge, Bono Locke, 2000)
• Job performance (Judge et al, 2000)
• Lower job stress and strain
• LMX quality, empowerment and job satisfaction
  (Laschinger, Purdy, Almost, 2007)
• We hypothesized that CSE would influence nurses
  experience of burnout at the individual level of
  analysis.

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Job Satisfaction

• Job Satisfaction Related to
• Leadership behaviour (Irvine Evans, 1995
  Laschinger et al., 1999 McNeese-Smith, 1995).
• Nurses' structural and psychological empowerment
  (Laschinger, Finegan, Shamian Wilk, 2003,
  2004).
• LMX quality (Laschinger, Purdy, Almost, 2007)
• Few nursing studies have examined cross-level
  effects on job satisfaction.

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Multi-Model Tested in the Study
LMX Quality
Empowerment
Level 2
Level 1
Emotional Exhaustion
Job Satisfaction
Core Self-Evaluation
Cynicism
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Methods

• Design A multi-stage Stratified Cluster
  Sampling Design
• Sample 7875 staff nurses in 217 hospital
  units in 21 Ontario hospitals
• Data Collection Mail survey using Dillman
  approach (2000).
• Return rate 40
• Staff nurses N 3156

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Demographic Profile

• Mean Age 42
• 95.3 Female
• Mean years of working experience 16.95
• High Burnout (M3.15) gt 3.0

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Instrumentation

• Leader Member Exchange
• LMX-MDM (Liden and Maslyn, 1998).
• Empowerment
• Conditions for Work Effectiveness
  Questionnaire-II (Laschinger et al., 2001).
• Core Self Evaluation
• Core Self Evaluation Scale (Judge, et al., 2003).
• Burnout
• Emotional Exhaustion and Cynicism subscales of
  the Maslach Burnout Inventory-General Survey
  (Schaufeli, Leiter, Maslach, Jackson, 1996).
• Job Satisfaction
• Job Diagnostic Survey (Laschinger Havens,
  1997).

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Data Analysis

• Multilevel SEM Modeling (Muthén Muthén, 2006)
• Permits modeling relationships among individual
  and contextual variables at different levels of
  analysis (both within and cross levels).
• Models the non-independence of observations due
  to cluster sampling by specifying a model for
  each level of the multilevel data. (Longford
  Muthén 1992 McDonald 1994 Muthén, 1989).

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Aggregation of Level 2 variables

• Direct Consensus Composition Model (Chan, 1998)
• (Shared meaning of LMX quality and empowerment on
  unit)
• Aggregation justification
• LMX rwg77
• Structural Empowerment rwg.93
• Multilevel justification Significant unit
  differences on L1 variables

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Final Model
LMX Quality
Empowerment
.25
Level 2
Level 1
Emotional Exhaustion
Job Satisfaction
-.13
Core Self-Evaluation
-.42
.62
Cynicism
-.47
-.16
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Summary of Results

• Good fit of the hypothesized model to the
  observed relations in the data (Chi Square12.03,
  CFI.997, TLI.945, RMSEA.06).
• Both unit level LMX quality and structural
  empowerment had direct effects on individual
  nurses job satisfaction.
• Supports notion of empowerment as a group level
  construct
• Unit level LMX had a significant negative effect
  on individual nurses feelings of cynicism
• Unit level empowerment had a significant negative
  effect on emotional exhaustion.
• CSE had an impact on job satisfaction through
  burnout.

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Conclusions

• The link between LMX quality and empowerment at
  the unit level suggests that managers can make a
  difference in creating empowering, satisfied work
  groups.
• Results support cross-level effects within
  nursing work environments.
• Unit level leadership and empowerment influence
  individual nurses experiences of burnout and job
  satisfaction.
• Personal belief systems play a role in addition
  to situational factors.
• Context matters.

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Strategies for Healthy Workplaces

• Most burnout interventions are individual-specific
  or treatment focused, not prevention focused.
  Few interventions based on changing structural
  sources of burnout (Nelson, Quick Simmons,
  2001)
• Our results demonstrate that both contextual
  situational factors and personal belief systems
  can have an impact on burnout, therefore
  prevention strategies must address both to
  promote healthy satisfying workplaces that
  attract and retain nurses.
• Nursing leadership plays an important role in
  creating conditions that can help manage the
  nursing workforce shortage.

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Thank you!
Email hkl_at_uwo.ca
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Means and Standard Deviations of Major Study
Variables