A Hierarchical Model of Occupational Burnout in Nurses Associated With Job-Induced Stress, Self-Concept, and Work Environment.

Abstract

Nurses may experience different levels of occupational burnout in different unit and hospital settings. However, pooling multilevel data in an analysis ignores independent, environmental, and sociocultural contexts of ecological validity. This study aimed to explore a hierarchical model of occupational burnout that is associated with job-induced stress, nurse self-concept, and practice environment in nurses working in different units and hospitals. A cross-sectional study was conducted, and 2,605 nurses were recruited from seven hospitals. The outcomes were measured using the Maslach Occupational Burnout Inventory-Human Services Survey, Nurses' Self-Concept Instrument, Nurse Stress Checklist, and Nursing Work Index-Revised. Hierarchical Linear Modeling 6.0 software was used to conduct hierarchical analysis on the study data. On the nurse level, job-induced stress was a significant factor affecting emotional exhaustion (β = 0.608, p < .001) and depersonalization (β = 2.439, p < .001), whereas nurse self-concept was a significant factor affecting emotional exhaustion (β = -0.250, p < .001), depersonalization (β = -1.587, p < .001), and personal accomplishment (β = 4.126, p < .001). Furthermore, emotional exhaustion and depersonalization were significantly related to level of education (β = 0.111, p < .01; β = 0.583, p < .05). No significant unit-level associations were identified between occupational burnout and the factors of job-induced stress, nurse self-concept, and practice environment (p > .05). The intragroup correlation coefficient for emotional exhaustion was 2.86 (p < .001). The findings of this study confirm that individual nurse characteristics are strong predictors of emotional exhaustion, depersonalization, and personal accomplishment as these relate to occupational burnout. In addition, nurse self-concept was identified as the most important predictor of all three aspects. In clinical practice, self-concepts about nursing may reduce occupational burnout. Nursing managers formulating new policies should consider nursing background and offer autonomous control over practice.