Nurse Burnout
Abstract Duxbury, M.L., Armstrong, G.D., Drew, D.J., & Henly, S.J.(1984). Head nurse
leadership style with staff nurse burnout and job satisfaction in neonatal intensive care units. Nursing Research (33),2, pp 97-101.
Summary: A quantitative study was designed and conducted by these authors for the purpose of determining relationships of head nurse leadership style with self-assessed, self-reported staff nurse burnout and job satisfaction in NICU’s. Three previously developed validity and reliability tested instruments were used to measure the one independent variable and two dependent variables. The tools utilized and their corresponding validity/reliability measures were: Instrument Validity Reliability Minnesota Satisfaction Stated “valid” 0.87 (Cronbach’s alpha) Questionnaire (MSQ) not reported Tedium Scale Stated “valid” 0.92 (Cronbach’s alpha) Questionnaire (MSQ) not reported Leadership Opinion Stated “valid” 0.78-0.91 Questionnaire (LOQ) not reported
Each of these instruments was administered to 283 staff nurses employed in 14 NICU’s. The sample was derived from a subsampling of all reported level III NICU’s; selective sampling was done to “include both high and low turnover units.” These instruments were chosen in an effort to answer the two research questions:
Are there relationships between staff nurses perceptions’ of head nurse structure and consideration, and staff nurses satisfaction and burnout? 2) Are there relationships between consensus perception of each head nurse leadership style and staff nurses burnout and satisfaction in NICU?
Pearson’s correlations were calculated between each of the variables to determine the above relationships. The findings for the first question were that “consideration” and “structure” elements of leadership are distinct with a correlation of -0.10; staff nurses satisfaction and burnout have a correlation of -0.41; head nurses consideration directly relates to staff nurses satisfaction (r=0.55, p<.001) and to burnout (r=-0.29, p<.001). And, structure alone is related to neither satisfaction nor burnout. It does, however, have a clear effect in combination with consideration. That is, the amount of structure the head nurses exercised was not related to nurse burnout or satisfaction if that head nurse also had high consideration.
To answer question 2, mean staff nurses scores were computed to establish consensus ratings as to head nurses style. Both burnout and satisfaction demonstrated significant relationships to head nurses consideration and structure. Burnout was highest and satisfaction was lowest (at significant levels) when the H.N. leadership style was one of low consideration and high structure. ANOVA for burnout was [F(3,279)=3.9,p<.01]. ANOVA for satisfaction was [F(3,279)=3.1,p=<.3].
Critique:
Given the many factors which impact on the job satisfaction, productivity, and attrition of nursing staff, coupled with the very high nurse vacancy rates and the high cost of nurse recruitment and training, it is imperative that we focus on factors which affect the foregoing. Identification of these factors through research efforts is critical for appropriate planning, education, and praxis to reverse or reduce job dissatisfiers and increase satisfaction and retention. This article identifies pragmatic issues clearly within the control of nursing administration to effect change. Such studies are of vital importance to the profession of nursing and to health care organizations as they struggle for survival and stabilization.
In terms of the design of the study, a few questions/concerns come to mind. First, the design is pre-experimental, a one shot case study, and thus creates the potential for significant confounding of results. The threats to both internal and external validity are great since many other factors could have contributed to the findings. Second, the “selective drawing of the subsample” also poses questions as to the validity of the study. The process utilized for this requires further discussion in the article to resolve this question. Another area lacking full description is the testing procedure; variances in procedure and approach among test administrators raises the threat of test reactivity. The final potential threat to validity requiring clarification is the manner in which the authors “slightly modified ” the LOQ. This action could bring into question instrument validity and reliability.
To summarize, this was a pragmatic, well grounded clinical study which makes contributions to bodies of knowledge relevant to human resource management and organization theory. This (and related studies) are necessary for the resolution or improvement of the health care delivery crisis we face today. Clarification of raised issues and strengthening of design, as well as study replication are indicated, however.
Key Words:
Job satisfaction of nurses, leadership style, retention, burnout, work environment, work satisfiers/dissatisfiers.