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International Journal of Nursing Studies 52 (2015) 240–249

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International Journal of Nursing Studies


journal homepage: www.elsevier.com/ijns

Risk factors and prevalence of burnout syndrome in the


nursing profession
Guillermo A. Cañadas-De la Fuente a, Cristina Vargas a, Concepción San Luis b,
Inmaculada Garcı́a a, Gustavo R. Cañadas a, Emilia I. De la Fuente a,*
a
University of Granada, Spain
b
Universidad Nacional de Educación a Distancia, Spain

A R T I C L E I N F O A B S T R A C T

Article history: Background: The burnout syndrome is beginning to be regarded as an occupational illness
Received 28 November 2013 of high prevalence among nursing in Spain. Individuals suffering from the syndrome
Received in revised form 30 June 2014 manifest important health problems. More information about prevalence and risk factors
for burnout is needed to prevent the syndrome and to determine the most appropriate
Accepted 2 July 2014 clinical interventions when the disorder appears.
Objectives: Burnout levels were evaluated in a group of nurses. The objectives of this study
Keywords: were to estimate the prevalence of burnout, to identify the variables related to burnout
Burnout professional
and to propose a risk profile for this syndrome among the nursing personnel.
Cross-sectional studies
Setting: The study was carried out in public health centers in Andalusia (Spain).
Nursing
Prevalence
Methods: The sample consisted of 676 nursing professionals from public health centers.
Risk factors Dependent variables were the three Burnout dimensions: emotional exhaustion,
depersonalization and personal accomplishment. Independent variables were socio-
demographic, organizational, personality-related variables.
Results: The nurses manifested average to high burnout levels. There were statistically
significant differences in burnout levels associated with the following variables: age,
gender, marital status, having children, level of healthcare, type of work shift, healthcare
service areas and conducting administrative tasks. Burnout was also associated with
personality-related variables.
Conclusions: The prevalence of burnout among nursing professionals is high. Gender, age,
marital status, level of healthcare, work shift and healthcare service areas predicted at
least one of the dimensions of the syndrome. Neuroticism, agreeability, extraversion and
conscientiousness are personality traits that predict at least two of the dimensions of
burnout syndrome in nurses. Therefore, personality factors should be considered in any
theory of risk profiles for developing burnout syndrome in the nursing profession.
ß 2014 Elsevier Ltd. All rights reserved.

* Corresponding author at: Departamento de Metodologı́a de las Ciencias del Comportamiento, Facultad de Psicologı́a, Universidad de Granada, Campus
Universitario de Cartuja s.n., 18071 Granada, Spain. Tel.: +34 958243744; fax: +34 958243443.
E-mail addresses: gacf@ugr.es (G.A. Cañadas-De la Fuente), cvargas@ugr.es (C. Vargas), csanluis@psi.uned.es (C. San Luis), igarcia@ugr.es (I. Garcı́a),
grcanadas@ugr.es (G.R. Cañadas), edfuente@ugr.es (E.I. De la Fuente).

http://dx.doi.org/10.1016/j.ijnurstu.2014.07.001
0020-7489/ß 2014 Elsevier Ltd. All rights reserved.
G.A. Cañadas-De la Fuente et al. / International Journal of Nursing Studies 52 (2015) 240–249 241

What is already known about the topic? depersonalization accompanied by low levels of personal
accomplishment among nursing personnel (Al-Turki,
 Excessive levels of continual stress can result in burnout. 2010). All of these research studies found that the work
 Nurses suffering from burnout usually manifest psycho- environment and the nurses’ personal and social situa-
somatic, emotional, attitude and behavioral problems. tion have an impact on the advent and potentially on the
development of the disorder (Albaladejo et al., 2004).
What this paper adds As Vargas et al. (2014) and Pereda-Torales et al. (2009)
argue, any evidence of the protective and risk factors for
 A high percentage of nurses from the Andalusian Health burnout are of great interest to the scientific community.
Service presented medium-high levels of burnout. More information about these factors is needed to prevent
 Burnout is largely explained by individual personality burnout syndrome and to determine the most appropriate
traits and the healthcare field where the nurses work. clinical interventions when the disorder appears. Thus,
Explanatory models associated with each of the Burnout research in the field addresses two types of relevant
dimensions included other socio-demographic and variables: personal variables (socio-demographic and
organizational variables. personality-related variables) and organizational variables
 An initial risk profile for burnout syndrome in this group (those pertaining to the occupational environment of the
of professionals is established. participating nurses) (Aydemir and Icelli, 2013).
Personal variables have traditionally been regarded as
1. Introduction less relevant than organizational variables. Nevertheless,
an organizational stressor, such as a work overload, can
The burnout syndrome is a significant problem in lead to different levels of burnout, depending on the
modern working environments and its prevalence has personality factors of the employee (Shimizutani et al.,
increased substantially over the past decade. The most 2008). In other words, some people are more susceptible to
accepted definition of burnout is that proposed by Maslach burnout than others. It is thus crucial to take individual
and Jackson (1981), who described it as a response to differences into account in order to better understand why
chronic work-related stress comprising three components some people are at greater risk of burnout than others
or dimensions: emotional exhaustion, depersonalization, (Maslach et al., 2001; Pick and Leiter, 1991).
and personal accomplishment. Emotional exhaustion Socio-demographic variables have been studied exten-
refers to the physical and emotional overloads that result sively though the results obtained have been contradicto-
from interactions with co-workers and healthcare users. ry. With regard to age, some studies conclude that burnout
Depersonalization is the development of cynical attitudes decreases with age (Alacacioglu et al., 2009; Kanai-Pak
and responses toward fellow workers and the beneficiaries et al., 2008), whereas others report the opposite (Losa
of the services that one provides. Reduced personal Iglesias et al., 2010) or even question the association
accomplishment refers to the tendency of nurses to adopt between age and the syndrome (Gosseries et al., 2012). The
a negative self-concept as a consequence of unrewarding high levels of burnout in younger workers could be due to
situations. From a long-term perspective, overwork and the fact that this group has less professional experience
high stress levels can cause workers to suffer burnout and thus have not had sufficient time to formulate effective
(Tucker et al., 2012). However, in return, both personal strategies for dealing with occupational stress (Bilge,
resources and job resources can lead to engagement, 2006). When Alarcon et al. (2009) performed a meta-
positive outcomes, greater efficiency, and commitment to analysis of the relation between gender and burnout, they
work, all of which are directly opposed to burnout (Garrosa found that there are important gender-specific differences
et al., 2011; Schaufeli and Bakker, 2004). in burnout levels. More specifically, women seem to
Individuals suffering from burnout usually manifest experience more emotional exhaustion whereas men are
psychosomatic problems (weakness and insomnia), emo- more prone to depersonalization. A possible reason for is
tional problems (anxiety and depression), attitude pro- that unlike men, women tend to respond more emotionally
blems (hostility, apathy and distrust) and behavioral to stressful work situations (Schaufeli and Enzmann,
problems (aggressiveness, irritability and isolation), 1998). With regard to marital status, various studies
among other problems (Adriaenssens et al., 2012; Jans- conclude that married individuals are more likely to suffer
son-Frojmark and Lindblom, 2011; Leape et al., 2012). from emotional exhaustion, though the results of other
Moreover, burnout affects nurses’ workplaces, both public studies contradict this finding (Al-Turki, 2010; Lin et al.,
and private (more sick leave, diminished work effective- 2009; Moreira et al., 2009). On the other hand, married
ness, more absenteeism, etc.). The users of healthcare people have higher levels of personal fulfillment than
services are also affected as the quality of healthcare single people (Maslach, 2003), which could be due to the
deteriorates (Brinkert, 2010; Clausen et al., 2012; Schmidt support that they receive from their partners. There are
and Diestel, 2012). also conflicting results about having children. The pre-
Because of the nature of their job, nurses are at risk of vailing view is that nurses with children have higher levels
developing burnout syndrome (Lorenz et al., 2010). of emotional exhaustion (Moreira et al., 2009), although
Recent studies relate high levels of emotional exhaustion nurses with children also report higher personal accom-
to an increase in morbidity associated with related plishment (Ayala and Carnero, 2013). Nurses with children
psychiatric disorders (Renzi et al., 2012). Other studies are generally older, more stable, and more emotionally
report high prevalence rates of emotional exhaustion and mature (Maslach, 2003), which contributes to a feeling of
242 G.A. Cañadas-De la Fuente et al. / International Journal of Nursing Studies 52 (2015) 240–249

greater personal fulfillment. Nonetheless, their higher Certain occupational variables, such as the type of
level of emotional exhaustion could stem from the shift (De la Fuente et al., 2013; Stimpfel et al., 2012),
responsibility of having children and the problem of seniority (Cabrera Gutiérrez et al., 2005), or work-related
reconciling work and family life. emotional demands (Bartram et al., 2012), have been
Over the last decade, several studies underline the related to burnout. Emotional exhaustion levels are lower
significance of psychological variables and have found that among those who have worked at the same job or in the
certain personality traits could be conducive to the advent same type of healthcare service for more time and among
of the syndrome or, on the contrary, may protect against those who work in service areas that are considered less
the development of the disorder (Fornes-Vives et al., 2012; stressful. The contrary result occurs, for example, among
Hudek-Knezević et al., 2011; Narumoto et al., 2008). All those who work in the intensive care unit (Ayala and
previous studies have focused on the relationship between Carnero, 2013). Excessively short breaks between work
personality and burnout by using Five Factor Theory or the shifts contributes to greater emotional exhaustion
so-called ‘‘big five’’. This model has been one of the most (Drach-Zahavy and Marzuq, 2013), and insufficient time
widely used trait measurement theories, and describes for completing tasks generates higher levels of emotional
personality in terms of five basic factors. The ‘‘big five’’ exhaustion and depersonalization (Naruse et al., 2012);
personality factors are neuroticism (level of emotional these stressful job conditions can result in reduced
instability), agreeableness (level of interpersonal tenden- personal accomplishment (Garrosa et al., 2010). This may
cies to approach or reject others), conscientiousness (level be due to the fact that these professionals lack sufficient
of self-control and self-determination), extraversion (level resources to be able to successfully adapt to highly
of energy and sociability), and openness to experience demanding work contexts that can vary considerably
(level of intellectual curiosity and esthetic sensibility) (e.g., from day to day.
Costa and McCrae, 1992; McCrae and Costa, 1999). In this These findings indicate that the panorama of research
sense, Alarcon et al. (2009) found that emotional exhaus- on the burnout syndrome has varied considerably over the
tion and depersonalization have a negative relationship last 40 years. Initially, burnout research was composed of
with emotional stability, agreeableness, conscientious- exploratory empirical studies whose objective was to
ness, and extraversion. On the other hand, personal quantify burnout levels in professionals and identify some
accomplishment is positively related to emotional stabili- of the covariables related to the development of the
ty, agreeableness, conscientiousness, extraversion, and syndrome. Although there are currently different
openness to experience. approaches to elaborating a model of burnout risk, most
Neuroticism (the opposite of emotional stability) is authors seem to agree on the existence of a structured set
characterized by a tendency to negatively interpret events of personal and occupational risk factors associated with
(Watson and Clark, 1984) and show negative emotions burnout dimensions (Aydemir and Icelli, 2013).
such as anxiety, depression, and frustration (Costa and In this type of model, work environment variables are
McCrae, 1992). For this reason, people with higher levels of generally regarded as those most closely related to this
neuroticism tend to use coping strategies based on syndrome (Maslach et al., 2001). Nevertheless, there
avoidance and distraction (Bakker et al., 2006). In all remains a certain controversy regarding the relevance of
likelihood, this type of behavior could lead to higher levels socio-demographic variables, above all as variables that
of emotional exhaustion and depersonalization along with modulate other burnout variables. Finally, recent research
a lower sense of personal accomplishment. Agreeability is highlights the need to consider personality factors and
associated with individuals who are more cooperative, incorporate them into the profile of professionals most at
flexible, and trusting (Costa and McCrae, 1992). In stressful risk of developing the syndrome. For this reason, the
situations, such people seem to use coping strategies that research described in this paper examined whether
focus directly on the problem. The use of effective coping personality factors are relevant to a burnout risk profile
strategies is also characteristic of responsible people who for nursing professionals.
are able to organize and plan their work and time (Costa This study had the following objectives: (1) to estimate
and McCrae, 1992). Similarly, extroverts, who by nature the prevalence of burnout syndrome; (2) to study the
are more sociable, enthusiastic, and self-confident (Costa association between burnout levels and variables tradi-
and McCrae, 1992), are more likely to be optimistic and are tionally considered risk factors for the syndrome; and (3)
thus able to positively reevaluate problems (Bakker et al., to define the burnout syndrome risk profile in a sample of
2006). Finally, openness to experience is typical of nurses.
independent people who are tolerant of ambiguity and
who are capable of embracing new experiences and ideas 2. Methods
(Costa and McCrae, 1992). People with a more open mind
often use humor as a strategy to cope with stressful 2.1. Participants
situations (McCrae and Costa, 1986). The use of the most
effective coping strategies, which is characteristic of A total of 676 nursing professionals from the Andalu-
people with the positive personality factors of emotional sian Health Service (Spain) comprised the study sample.
stability, agreeableness, conscientiousness, extraversion, The average age of the participants was 44.58 (SD = 8.18),
and openness to experience, can led to lower levels of and the percentage of women was 66%. All participants had
emotional exhaustion and depersonalization as well as a bachelor’s degrees and provided partial or total direct care
higher level of personal accomplishment. as professional nurses. The overall response rate was
G.A. Cañadas-De la Fuente et al. / International Journal of Nursing Studies 52 (2015) 240–249 243

81.6%. Nine participants were excluded from the study non-random way from 19 General Hospitals and 18
because of missing data. primary healthcare centers.
This study was conducted according to the ethical
2.2. Instruments guidelines of the Helsinki declaration. In addition, ethics
committee approval was not required because no patients
A set of questionnaires was administered to obtain were involved. All participants received written informa-
socio-demographic and occupational information. The tion on the study and gave their verbal informed consent.
following variables were assessed: age, gender, marital They received no incentive for their participation. They
status (married, separated or divorced, unmarried, were explicitly informed that they were free to abandon
and widowed), number of children (no children, one the study at any time. The participation in the question-
child, two children, and three or more children), the naire research involved no particular risk. Thus, all of the
level of healthcare (primary vs. hospital healthcare), participants contributed to the study voluntarily, individ-
healthcare service areas (surgical healthcare, medical ually, and anonymously. Data were confidentially obtained
attention healthcare, maternal and infant healthcare, in accordance with Law 15/99 of December 13, 1999
emergency and critical healthcare, and community (Organic Law for the Protection of Personal Data). The time
healthcare), job shift (rotating, morning shift, afternoon needed to complete the questionnaire was 45 min.
shift, and night shift), on-call requirement (yes vs. no),
administrative tasks in their occupational area (yes vs. 2.4. Data analysis
no), seniority in the current job and seniority in the
profession. Student’s t test and an analysis of variance were used to
Burnout syndrome was measured using the Maslach analyze the differences between averages after checking
Burnout Inventory (MBI; Maslach and Jackson, 1981) the assumptions required for applying these tools. In the
adapted for the Spanish population (Seisdedos, 1997). It cases in which equal population variances could not be
comprises 22 items with a seven-point Likert response assumed, the Welch or Brown–Forsythe approaches were
scale from zero (‘‘Never’’) to six (‘‘Every day’’). The MBI has applied, and the Games–Howell test was used to assess
three dimensions: emotional exhaustion (EE; nine items), post hoc differences. Effect sizes were calculated using
depersonalization (D; five items) and personal accom- Cohen’s d and h2.
plishment (PA; eight items). Individuals with a high level of Multiple linear regression models constructed with
burnout were defined based on the Spanish cut-off scores. backward stepwise regression were used because of the
For emotional exhaustion, the cut-off point for a high level lack of theoretical and empirical agreement on the
was >24; for depersonalization, it was >9; and for significance of these variables in explaining the dimen-
personal accomplishment, it was <33. Therefore, high sions of burnout. When the assumptions were checked,
scores for emotional exhaustion and depersonalization, heteroscedasticity was observed. For this reason, a
and low scores for personal accomplishment were heteroscedasticity consistent covariance matrix was esti-
regarded as indicative of burnout. Cronbach’s alpha values mated following Mackinnon and White’s procedure. The
were obtained for the sample (Aguayo et al., 2011). The analyses were performed using SPSS version 20.0 and R
following alpha values were obtained: 0.88 for emotional 2.15.2 software.
exhaustion, 0.68 for depersonalization, and 0.84 for
personal accomplishment. 3. Results
The Revised NEO Personality Inventory (NEO-FFI)
(Costa and McCrae, 1992) adapted for the Spanish 3.1. Description of burnout levels and estimated prevalence
population (Costa and McCrae, 2002) was also used. The
NEO-FFI provides a global evaluation of the five personality The descriptive analysis of the variables included in the
factors: neuroticism, extraversion, openness to experience, study is shown in Table 1.
agreeableness, and conscientiousness. The inventory The average EE score was 17.96 (SD = 10.97, the lowest
comprises 60 items with a five-point Likert response value was 0 and the highest was 54): 41% of the
scale; 12 items correspond to each dimension. Cronbach’s participants presented a low level of EE; 34% had a
alpha values (Aguayo et al., 2011) were obtained for the medium level; and 25% had a high level according to the
sample: 0.79 for the dimension of neuroticism; 0.79 for cut-off points established for the Spanish adaptation of the
extraversion; 0.70 for openness; 0.74 for agreeableness; MBI (Seisdedos, 1997). For the D dimension, the average
and 0.80 for conscientiousness. score was 6.56 (SD = 5.57, the lowest value was 0, and the
highest was 28): 39% of the participating nurses had a low
2.3. Procedure level of D; 32% had a medium level; and 30% had a high
level. Finally, the average score for the PA dimension was
A cross-sectional study was conducted. The nursing 36.81 (SD = 8.52, the lowest value was 0 and the highest
union (hereafter SATSE for its initials in Spanish) in was 48): 30% of the sample had a low level of PA; 25% had a
Andalusia was contacted through the provincial delegate medium level; and 45% had a high level.
in Granada. Then, the SATSE, in collaboration with the The estimated prevalence of high levels of EE was 21%
authors, contacted nursing staff members in public health (with a confidence interval of 18–24%). It was estimated
institutions in Andalusia (Spain) and requested their that 30% of nursing professionals presented high levels of D
participation in the study. The data were collected in a (with a confidence interval of 26–33%), and 44% of them
244 G.A. Cañadas-De la Fuente et al. / International Journal of Nursing Studies 52 (2015) 240–249

Table 1
Descriptive analysis of the variables.
Marital status (n = 663) % (n) On-call requirement (n = 651) % (n)
Married 74 (492) Yes 34 (219)
Separated or divorced 7 (47) No 66 (432)
Unmarried 18 (120)
Widowed 0.6 (4) Administrative tasks (n = 659) % (n)
Yes 6 (36)
Children (n = 664) % (n) No 95 (623)
No children 21 (141)
One child 20 (132) Seniority present job (n = 648) M (SD)
Two children 46 (302) 10.59 (9.19)
Three or more children 13 (89)
Seniority profession (n = 673) M (SD)
Level of healthcare (n = 675) % (n) 21.55 (8.27)
Primary healthcare 68 (457)
Hospital healthcare 32 (218) Neuroticism (n = 673) M (SD)
27.73 (7.62)
Healthcare service areas (n = 676) % (n)
Surgical healthcare 15 (101) Agreeableness (n = 673) M (SD)
Medical attention healthcare 26 (178) 45.52 (6.53)
Maternal and infant healthcare 8 (51)
Emergency and critical healthcare 25 (171) Conscientiousness (n = 673) M (SD)
Community healthcare 26 (175) 46.17 (5.69)

Job shift (n = 669) % (n) Extraversion (n = 673) M (SD)


Rotating 55 (369) 42.68 (7.17)
Morning shift 42 (283)
Afternoon shift 0.6 (4) Openness (n = 673) M (SD)
Night shift 2 (13) 38.98 (6.86)

presented low levels of PA (with a confidence interval of women, t(671) = 3.81, p < 0.001, d = 0.31, with a higher
40–48%). level of D observed in men (M = 7.69; SD = 5.71) than in
women (M = 5.97; SD = 5.41). Similarly, significant differ-
3.1.1. Explanatory models and factors associated with each of ences were found in D, t(376.87) = 2.83, p = 0.005,
the burnout dimensions d = 0.24, between those working in hospitals
There were no significant differences associated with (M = 6.12; SD = 5.28) and primary healthcare nurses
socio-demographic and occupational variables for the EE (M = 7.47; SD = 6.07). There were also significant differ-
dimension. There were statistically significant correlations ences between the groups of participants who worked in
between EE and the five personality factors: neuroticism different healthcare service areas, FBF(4, 552.56) = 3.72,
(r = 0.58, p < 0.001); agreeableness (r = 0.37, p < 0.001); p = 0.005, h2 = 0.20. The nurses working in community
conscientiousness (r = 0.30, p < 0.001); extraversion healthcare (M = 7.60, SD = 6.16) showed a higher level of
(r = 0.41, p < 0.001); and openness to experience depersonalization than those working, for example, in
(r = 0.11, p = 0.005). The variables that appear to be the the field of maternal and infant healthcare (M = 4.56,
best predictors of EE (neuroticism, agreeableness, extra- SD = 4.71), Games–Howell = 3.04, p = 0.003. Finally, signif-
version, marital status, level of healthcare, healthcare icant differences in D, t(41.92) = 2.32, p = 0.026, d = 0.32,
service area and type of work shift) (see Table 2) were used were found between the professionals who had never
in the model that explained 39% of the variance in this performed administrative tasks in their occupational
dimension, F(8, 551) = 46.30, p < 0.001. area (M = 6.67; SD = 5.62) compared with those who had
For the dimension of depersonalization, statistically participated in healthcare administration (M = 4.89;
significant differences were found between men and SD = 4.40).

Table 2
Summary of the multiple linear regression model in emotional exhaustion.

Predictor B Standard error Beta t p 95% CI

Intercept 20.76 4.91 4.23 <0.001 11.13, 30.40


Neuroticism 0.63 0.06 0.47 10.26 <0.001 0.51, 0.75
Agreeableness 0.24 0.07 0.15 3.33 <0.001 0.38, 0.10
Extraversion 0.24 0.06 0.17 3.87 <0.001 0.36, 0.12
Married vs. unmarried 2.64 1.28 0.10 2.06 0.040 5.17, 0.12
Children vs. no children 2.45 1.29 0.10 1.90 0.058 0.09, 4.98
Hospital vs. primary 1.89 0.94 0.09 2.01 0.045 3.74, 0.04
Rotating vs. permanent 2.23 0.85 0.11 2.61 0.009 0.55, 3.91
Emergency and critical vs. surgical 1.83 1.03 0.06 1.78 0.076 0.19, 3.85

Note: R2Adj ¼ 0:39; p < 0.001.


G.A. Cañadas-De la Fuente et al. / International Journal of Nursing Studies 52 (2015) 240–249 245

Table 3
Summary of the multiple linear regression model in depersonalization.

Predictor B Standard error Beta t p 95% CI

Intercept 23.99 2.88 8.35 <0.001 18.34, 29.64


Neuroticism 0.13 0.03 0.19 4.03 <0.001 0.07, 0.20
Agreeableness 0.31 0.04 0.39 7.89 <0.001 0.39, 0.23
Conscientiousness 0.11 0.04 0.14 2.68 0.008 0.19, 0.03
Women vs. men 0.97 0.42 0.09 2.28 0.023 0.14, 1.80
No administrative tasks vs. administrative tasks 1.53 0.66 0.07 2.31 0.021 2.83, 0.23
Emergency and critical vs. maternal and infant 1.84 0.66 0.09 2.81 0.005 3.13, 0.56
Emergency and critical vs. community healthcare 1.00 0.48 0.08 2.10 0.036 0.07, 1.93
Age 0.06 0.03 0.10 2.32 0.021 0.12, 0.01
Seniority present job 0.08 0.03 0.14 2.89 0.004 0.03, 0.13

Note: R2Adj ¼ 0:35; p < 0.001.

The D dimension was significantly correlated with the (r = 0.45, p < 0.001), and openness to experience (r = 0.24,
following variables: seniority on the job (r = 0.10, p < 0.001). The regression model explains 42% of the
p = 0.009); neuroticism (r = 0.41, p < 0.001); agreeableness variance in PA, F(8, 551) = 52.35, p < 0.001. This dimension
(r = 0.48, p < 0.001); conscientiousness (r = 0.37, of burnout can be predicted by the following variables:
p < 0.001); extraversion (r = 0.30, p < 0.001); and open- neuroticism, agreeableness, conscientiousness, extraver-
ness to experience (r = 0.19, p < 0.001). The model based sion, openness and the level of healthcare where the nurses
on the variables measured explained 35% of the variance, work (see Table 4).
F(9, 550) = 34.59, p < 0.001. The results indicate that
neuroticism, agreeableness, conscientiousness, gender, 4. Discussion
having performed administrative tasks, healthcare service
areas, age, and seniority in the same job are the best The results obtained in this study indicate a relatively
predictors of this dimension of burnout (see Table 3). high estimated prevalence of burnout syndrome among
In the analysis of the personal accomplishment nurses. These results are similar to those obtained by other
dimension, significant differences, t(607) = 1.97, p = 0.049, researchers (Van Bogaert et al., 2009). More specifically,
d = 0.20, were found between married individuals similar results have been obtained in other Spanish studies
(M = 37.14; SD = 8.40) and single individuals (M = 35.43; (Albaladejo et al., 2004; Caballero Martı́n et al., 2001),
SD = 8.87). Likewise, the participants with children although our research found higher percentages of nurses
(M = 37.17; SD = 8.50) reported more personal accomplish- with high and moderate levels of burnout, which is
ment than those without children (M = 35.42; SD = 8.44), probably because of the differences between the occupa-
t(671) = 2.18, p = 0.029, d = 0.21. The nurses with perma- tional conditions at the time that the earlier studies were
nent work shifts (M = 37.53; SD = 8.77) manifested higher conducted and the conditions at the time of this study. The
levels of personal accomplishment than those who worked current economic crisis in Spain and other countries now
rotating shifts (M = 36.23; SD = 8.25), t(664) = 1.967, forces nurses to work longer hours for lower pay, and there
p = 0.05, d = 0.15. Similarly, participating nurses who had is also less job stability (Herrera-Amaya and Manrique-
carried out administrative tasks reported higher levels of Abril, 2008; De Cola and Riggins, 2010).
personal accomplishment (M = 40.14, SD = 6.18) than those Intermediate levels of emotional exhaustion were
who had not performed this type of task (M = 36.75, found. There were no differences associated with other
SD = 8.53), t(43.14) = 3.12, p = 0.003, d = 0.40). variables, such as age (our data were similar to those in
The PA dimension is significantly correlated with other work) (Gosseries et al., 2012; Vilaregut Puigdesens
seniority on the job (r = 0.10, p = 0.011), neuroticism et al., 2004) or gender (Chrisopoulos et al., 2010; Gosseries
(r = 0.41, p < 0.001), agreeableness (r = 0.42, p < 0.001), et al., 2012). The results for emotional exhaustion may be
conscientiousness (r = 0.53, p < 0.001), extraversion related to the presence or absence of other variables

Table 4
Summary of the multiple linear regression model in personal accomplishment.

Predictor B Standard error Beta t p 95% CI

Intercept 4.84 3.79 1.28 0.201 12.28, 2.59


Neuroticism 0.12 0.04 0.12 2.83 0.005 0.20, 0.04
Agreeableness 0.22 0.06 0.19 4.01 <0.001 0.10, 0.28
Conscientiousness 0.38 0.06 0.32 6.67 <0.001 0.23, 0.41
Extraversion 0.27 0.05 0.25 5.34 <0.001 0.16, 0.35
Openness 0.06 0.047 0.05 1.28 0.200 0.03, 0.14
Hospital vs. primary 1.60 0.57 0.10 2.83 0.005 0.49, 2.71
Seniority present job 0.05 0.04 0.06 1.32 0.187 0.16, 0.03
Seniority profession 0.07 0.04 0.08 1.69 0.090 0.01, 0.17

Note: R2Adj ¼ 0:42; p < 0.001.


246 G.A. Cañadas-De la Fuente et al. / International Journal of Nursing Studies 52 (2015) 240–249

(particularly occupational variables) that could be rele- Regarding personal accomplishment, several authors
vant. These factors, which are likely to cause emotional have previously obtained results similar to those in this
exhaustion (Demerouti et al., 2000), are closely related to study (Ayala and Carnero, 2013). Although married nurses
the other dimensions of burnout (Cebriá et al., 2003; suffer from greater emotional exhaustion, they also have
Dormann and Zapf, 2001; Sobrequés et al., 2003). higher personal accomplishment levels. Some authors
Furthermore, similarly to other work, this study reveals hypothesize that married nurses with offspring lead more
a relationship between emotional exhaustion and the rewarding lives (Al-Turki, 2010; Klersy et al., 2007; Lin
various personality dimensions. As emotional exhaustion et al., 2009). Working in shifts causes instability and
increases, the degree of neuroticism increases (McManus reduces personal accomplishment (Jenaro Rı́o et al., 2007)
et al., 2011) whereas conscientiousness (Biaggi et al., and work engagement (Sawatzky and Enns, 2012). Reach-
2003), agreeableness (Hudek-Knezević et al., 2011), ing a more advanced age in the profession sometimes has a
extraversion (McManus et al., 2011) and openness to beneficial effect on this dimension (Lin et al., 2009) and
experience (Gustafsson et al., 2009) decrease. sometimes has a detrimental effect (Gutiérrez Alanis and
The role of depersonalization in burnout syndrome is Martı́nez Alcántara, 2006). These results lead one to
controversial, and opinions vary. For some authors, there consider whether some sort of temporary or permanent
are no gender differences in depersonalization, whereas promotion has been achieved, as in the case of the nurses
others affirm precisely the opposite (Maccacaro et al., working on administrative tasks (Van Bogaert et al., 2009).
2011; Moreira et al., 2009). The results of our study The voluntary nature of managerial posts and the
indicate that the male nurses who participated in the previously mentioned positive reinforcement increase
research had higher levels of depersonalization than the work engagement of nurses in such positions (Wajid
female participants. et al., 2011). Consequently, it is not surprising that their
Another interesting result is that nurses in community average levels of personal fulfillment are higher than those
healthcare have higher depersonalization levels than of nurses who do not do administrative work.
nurses who perform healthcare tasks in other areas. This Based on the previous considerations, it could be
finding is not new. Despite Hausmann’s (2009) descrip- assumed that adequate levels of personal accomplishment
tion of the stimulating work in rural areas for nursing will result in improved physical and mental health for
students, other studies affirm that more years in this type nursing professionals (Nathan et al., 2007), which, in turn,
of work result in higher levels of depersonalization may generally improve the quality of healthcare provided
(Dormann and Zapf, 2001; Figueiredo Ferraz et al., 2012), by nursing staff as well as their occupational productivity
and the average level of seniority in the profession is high (Nayeri et al., 2009).
in the present sample. This factor is so important that its This study has limitations that should be considered
repercussions transcend the psychosocial level. Nurses when interpreting the results. Firstly, the design used
also begin to suffer quantifiable organic repercussions makes it impossible to derive conclusions regarding causal
that can be detected with a simple blood analysis, as relations. In future studies, a longitudinal design could be
noted in various studies (Casado et al., 2008; Domı́nguez implemented that would show the progression of the
Fernández et al., 2012). However, nurses working in burnout process. Another limitation was the use of a non-
maternal and infant healthcare show lower levels of randomized sample. Nevertheless, the size of the sample as
burnout than nurses in other fields, which coincides with well as the fact that the workers came from various
the results obtained in other recent studies (Nuñez Beloy healthcare centers help to counteract this problem and
et al., 2010). provide a realistic panorama of health services. Finally,
The crucial role of intermediate-level and high-level since certain groups have a relatively small sample size,
administrative nursing staff cannot be overstressed. It is the results pertaining to them should be taken with
clearly their responsibility to create a less hostile work caution.
environment for nursing professionals; otherwise, the
nursing staff will not be satisfied with management 5. Conclusions
(Albaladejo et al., 2004; Pucheu, 2010). If administration
and management cannot accomplish this task, the quality The objective of this study was to identify the possible
of healthcare deteriorates considerably because of the risk factors for developing burnout and to provide
occupational overload and increased pressure on nurses. explanatory models for its various dimensions. The models
This will ultimately affect their colleagues (Deschamps indicate that four personality traits (neuroticism, agree-
Perdomo et al., 2011; Spooner-Lane and Patton, 2007; Van ableness, extraversion and conscientiousness) are signifi-
Bogaert et al., 2013). Time limits on patient contact time cant. The first two are predictors of all the dimensions of
may dehumanize treatment (Hospital Ibáñez and Guallart burnout, and the others are predictors of two of the
Calvo, 2004). Nursing professionals who accept managerial dimensions. This indicates that Five Factor Theory and its
posts often become more engaged with the institution, ‘‘big five’’ personality factors should be considered in any
possibly because such positions are voluntary. This theory of risk profiles for developing burnout syndrome in
commitment is reinforced by the fact that they were the nursing profession.
designated for the post. This combined with the fact that Other variables were also examined as potential
they spend less time with patient could be responsible for predictors of burnout syndrome. First, the healthcare
the fact that these professionals tend to have lower levels setting in which nursing professionals perform their duties
of depersonalization. predicts emotional exhaustion, depersonalization, and
G.A. Cañadas-De la Fuente et al. / International Journal of Nursing Studies 52 (2015) 240–249 247

personal accomplishment. Second, marital status and work Alarcon, G., Eschleman, K.J., Bowling, N.A., 2009. Relationships between
personality variables and burnout: a meta-analysis. Work Stress 23
shift appear to be related to emotional exhaustion and (3), 244–263.
predict at least one of the dimensions of burnout. Among Albaladejo, R., Villanueva, R., Ortega, P., Astasio, P., Calle, M.E., Domı́nguez,
this group of professionals, gender, age, healthcare service V., 2004. Sı́ndrome de burnout en el personal de enfermerı́a de un
hospital de Madrid.(Burnout syndrome among nursing staff at a
areas, and previous experience in healthcare administra- hospital in Madrid). Rev. Esp. Salud Publ. 78 (4), 505–516.
tion are all related to depersonalization. Al-Turki, H.A., 2010. Saudi Arabian nurses are they prone to burnout
In summary, based on the information collected, an syndrome? Saudi Med. J. 31 (3), 313–316.
Ayala, E., Carnero, A.M., 2013. Determinants of burnout in acute and
initial risk profile for burnout syndrome in nursing critical care military nursing personnel: a cross-sectional study
personnel can be specified. The main explanatory factors from Peru. PLOS ONE 8 (1), e54408.
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should be paid to the levels of depersonalization by gender a study among volunteer counselors. J. Soc. Psychol. 146 (1), 31–50.
Bartram, T., Casimir, G., Djurkovic, N., Leggat, S.G., Stanton, P., 2012. Do
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in primary healthcare nurses compared with nurses between emotional labour, burnout and intention to leave? A study of
working in hospitals). Finally, the study emphasizes that Australian nurses. J. Adv. Nurs. 68 (7), 1567–1578.
Biaggi, P., Peter, S., Ulich, E., 2003. Stressors, emotional exhaustion and
the prevalence of burnout syndrome is high among nurses aversion to patients in residents and chief residents. What can be
and that this group is therefore at risk of developing it. done? Swiss Med. Wkly. 133 (23–24), 339–346.
More research on this subject is needed to shed light on Bilge, F., 2006. Examining the burnout of academics in relation to job
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the contradictory results published to date. It is essential to Brinkert, R., 2010. A literature review of conflict communication causes,
gather information that will improve the risk profile costs, benefits and interventions in nursing. J. Nurs. Manag. 18 (2),
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future research, we plan to focus on the identification of
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Acknowledgements atención primaria.(Influence of burnout on pharmaceutical expendi-
tures among primary care physicians). Gac. Sanit. 17 (6), 483–489.
Chrisopoulos, S., Dollard, M.F., Winefield, A.H., Dormann, C., 2010. In-
This research was carried out with the support of the creasing the probability of finding an interaction in work stress
Sindicato de Enfermerı´a de Andalucı´a (SATSE; The Nursing research: a two-wave longitudinal test of the triple-match principle.
Union of Andalucı́a). J. Occup. Organ. Psychol. 83 (1), 17–37.
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resources and long-term sickness absence in the Danish eldercare
Conflict of interest. None.
services: a prospective analysis of register-based outcomes. J. Adv.
Nurs. 68 (1), 127–136.
Funding. This work was funded by the Excellence Research Costa, P.T., McCrae, R.R., 1992. Revised NEO Personality Inventory (NEO-
Projects P07HUM-02529 and P11HUM-7771 (Junta de Anda- PI-R) and NEO Five-Factor Inventory (NEO-FFI): professional manual.
Psychological Assessment Resources, Odessa, FL.
lucı́a-Spain). The funders had no role in study design, data
Costa, P.T., McCrae, R.R., 2002. Inventario de Personalidad NEO Revisado
collection and analysis, decision to publish, or preparation of (NEO PI-R). Inventario NEO reducido de Cinco Factores (NEO-FFI).
the manuscript. Manual. (Revised NEO Personality Inventory (NEO-PI-R). NEO Five-
Factor Inventory (NEO-FFI) Abbreviated Manual) TEA Ediciones, S.A.,
Madrid.
Ethical Approval. The current study was conducted according De Cola, P.R., Riggins, P., 2010. Enfermeras en el trabajo: expectativas y
to the ethical guidelines of the Helsinki declaration. Ethics necesidades.(Nurses in the workplace: expectations and needs). Int.
committee approval was not required for this study because Nurs. Rev. 57 (3), 360–368.
De la Fuente, E.I., Lozano, L.M., Garcı́a-Cueto, E., San Luis, C., Vargas, C.,
no patients were involved. Cañadas, G.R., et al., 2013. Development and validation of the
Granada Burnout Questionnaire in Spanish police. Int. J. Clin. Health
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