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Burnout, Social Support, and Job Satisfaction among Jordanian Mental Health
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DOI: 10.3109/01612840.2010.546494 · Source: PubMed

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 Issues in Mental Health Nursing, 32:234–242, 2011
Copyright © Informa Healthcare USA, Inc.
ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.3109/01612840.2010.546494
Burnout, Social Support, and Job Satisfaction among
Jordanian Mental Health Nurses
Shaher H. Hamaideh
The Hashemite University, Al-Zarka, Jordan
Issues Ment Health Nurs Downloaded from informahealthcare.com by 213.186.187.137 on 02/28/11
Burnout occurs in occupations, such as nursing, where a signif-
icant proportion of time is spent in close involvement with other
people. Mental health nursing has been considered an area that
is subjected to high levels of burnout. Burnout in mental health
nursing affects both individuals and organizations. The purposes
of this study were to measure the levels of burnout and identify
the correlates of burnout among Jordanian mental health nurses.
A descriptive correlational design was used to collect data from
mental health nurses using the Maslach Burnout Inventory, So-
cial Support Scale, Job Satisfaction Scale, and demographic and
work-related variables through a self-reported questionnaire. The
sample consisted of 181 mental health nurses recruited from all
For personal use only.
mental health settings in Jordan. Jordanian mental health nurses
showed high levels of emotional exhaustion and moderate levels of
depersonalization and personal accomplishment. Scores of job sat-
isfaction and social support were slightly higher than the midrange.
Significant correlations were found among burnout categories, job
satisfaction, social support, and demographic and work-related
variables. Predictor variables accounted for 32.7% of emotional
exhaustion, 27.7% of depersonalization, and 16.8% of personal
accomplishment. Results revealed that a comprehensive interven-
tional approach aimed at minimizing the risk of burnout among
mental health nurses is needed. Such an approach should involve
interventions at both individual and organizational levels.
Over the last two to three decades, burnout, social support,
and job satisfaction have become increasingly important in the
mental health nursing environment (Happell, Martin, & Pinika-
hana, 2003). Maslach, Jackson, and Leiter (1996) described
burnout as a syndrome consisting of emotional exhaustion, de-
personalization, and a reduced sense of personal accomplish-
ment. Burnout was defined as “physical, emotional, and psy-
chological responses to work-related stress (Maslach, Jackson,
& Leiter, 1996, p. 3).” Physical responses include low energy,
chronic fatigue, and weakness. Emotional responses include
depression, helplessness, and hopelessness. Psychological re-
sponses include detached concern for patients, intellectualiza-
tion of stressful situations, and withdrawal from clients and
co-workers (Maslach & Jackson, 1981).
Address correspondence to Shaher H. Hamaideh, The Hashemite
Univesity, Al-Zarka, Jordan 13133. E-mail: shaher29@hu.edu.jo
234
Social support is characterized by affective support (i.e., love,
liking, and respect), confirmation (i.e., confirming the moral
and factual “rightness” of actions and statements), and direct
help (i.e., aid in work, giving information or money). Social
support has been found to be beneficial to well-being by meeting
important human needs for security, social contact, approval,
belonging, and affection (House, 1981). Nurses with low levels
of social support have higher levels of stress and burnout (Coffey
& Coleman, 2001).
Job satisfaction has been described as a state that depends
on the interaction of employees, their personal characteristics,
and their expectations with the work environment and the orga-
nization. Job satisfaction was found to have a strong negative
association with burnout and stress, especially among mental
health nurses and other mental health professionals (Wards &
Cowman, 2007). The intent of this study is to examine the re-
lationships among burnout, social support, job satisfaction, and
other related demographic variables among Jordanian mental
health nurses.
BURNOUT
Burnout is a psychological experience that manifests itself
in individuals, particularly those involved in difficult person-
to-person relationships as part of their work, such as nursing
professionals (Maslach, Schaufeli, & Leiter, 2001). Nurses, in
general, and mental health nurses, in particular, are generally
considered as a group at risk for burnout because they are
in constant interaction and frequent interpersonal contact with
psychiatric clients and their families (Dickson & Wright, 2008;
Kilfedder, Power, & Wells, 2001; Patrick & Lavery, 2007).
Many factors have been associated with burnout in mental
health nursing. These factors include: job satisfaction, availabil-
ity of social support, various aspects of patient care (such as the
size of one’s caseload, type of patients, and violence at the work-
site), various aspects of the work environment (such as staffing,
shift work, income and wages, and extra duties), and the level
of stress. Nurses’ burnout results in psychological and physical
strain, fatigue, headache, sleep disorders, low quality of patient
care, job turnover, and absenteeism. Other factors that increase
burnout levels are low nurses’ educational level, working night
 BURNOUT, SOCIAL SUPPORT, AND JOB SATISFACTION 235

shifts (Demir, Ulusoy, & Ulusoy, 2003), high levels of stress,
poor coping styles (Burnard, Edwards, Fothergill, Hannigan, &
Coyle, 2000; Edwards, 2000; Jaracz, Gorna, & Konieczna,
2005), poor work environment, nurse inexperience (Kanai-Pak,
Aiken, Sloane, & Poghosyan, 2008), job dissatisfaction, and
occupational stress (Happell, Pinikahana, & Martin, 2003).
Yousefy and Ghassemi, (2006) investigated levels of burnout
among mental health nurses. Results showed that nurses work-
ing in psychiatric units experienced a higher degree of emotional
exhaustion compared to those who worked in non-psychiatric
units. Jenkins and Elliott (2004) conducted a study to investi-
gate and compare the levels of stressors and burnout of nursing
staff in acute mental health settings and to assess the impact of
social support on burnout and stress. They found that approxi-
Issues Ment Health Nurs Downloaded from informahealthcare.com by 213.186.187.137 on 02/28/11
formance among Jordanian hospital nurses. Results showed that
demographic variables and coworker support explained 20%
of the variation in job performance. Also, social support from
coworkers enhanced the level of job performance, decreased the
level of job stress, and enhanced work commitment (AbuAl-
Rub, 2004; Hamaideh, Mrayyan, Mudallal, Faouri, & Kha-
sawneh, 2008; Mrayyan, 2009; Mrayyan & Al-Faouri, 2008).
JOB SATISFACTION
Job satisfaction is best understood as a discrepancy between
how much a person wants or expects from a job and how much
that person actually receives (Price, 2001). If the person’s expec-
tations were met, they become satisfied; if not met, they become
dissatisfied. There are many sources of nurses’ job satisfaction.

mately half of all nursing staff showed signs of a high burnout

In their literature analysis about job satisfaction, Lu, While,
level in terms of emotional exhaustion. Additionally, a high level
and Barriball (2005) identified the following sources of nurses’
of coworker support was related to a lower level of emotional
job satisfaction: working conditions, interactions with patients
exhaustion. Higher levels of social support is associated with
and coworkers, workload, scheduling, task requirements, pro-
levels of depersonalization. In addition, strong negative correla-
fessional training, personal achievement, praise, recognition,
tions were found between social support and burnout (Eastburg,
autonomy, job security, leadership style, physical working con-
Williamson, Gorsuch, & Ridley, 2009). Also, high levels of
ditions, payment, and level of education. Job satisfaction is a
burnout among psychiatric nurses were associated with neg-
significant predictor of nursing absenteeism, burnout, and in-
ative feelings toward patients (Holmqvist & Jeanneau, 2006).
tention to leave job.
Prevalence of burnout was also significantly higher for public
Job satisfaction is a complex phenomenon that relates to
health nurses in charge of mental health services than in public
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many factors. Job satisfaction was found to be related to stress

health nurses in charge of non-psychiatric services (Imai et al.,
2006). In addition, Sahraian and colleagues found that psychi-
atric nurses showed significantly higher levels of emotional ex-
haustion and depersonalization in comparison with nurses work-
ing in internal, surgical, and burn wards (Sahraian, Fazelzadeh,
Mehdizadeh, & Toobaee, 2008).
SOCIAL SUPPORT
Social support is defined as the combination of social rela-
tionships, emotional and behavioral interactions, and an indi-
vidual perception about the adequacy or availability of different
types of support (Button, 2008). Social support involves empa-
thy, care, love, and trust (emotional support); actual aid of time,
money, and energy (instrumental support); information relevant
to self-evaluation (appraisal support); and advice, information,
and suggestions (informational support) (House, 1981). Social
support affects health by regulating thoughts, feelings, and be-
haviors to foster an individual’s sense of meaning in life and
facilitate healthy behaviors. Social support also has been found
to improve well-being, decrease levels of stress and burnout
that are associated with the work environment, and enhance job
satisfaction (Sundin, Hochwalder, Bildt, & Lisspers, 2007).
Many sources of social support have been identified for
health care workers, including nurses. Sources of social sup-
port stemmed from the work (i.e., supervisors, colleagues, and
coworkers) and from the home (i.e., family members, spouse,
and friends). Amarneh, AbuAl-Rub, and AbuAl-Rub (2009) in-
vestigated the effect of social support from coworkers on job per-
and burnout, organizational commitment, communication with
supervisors and coworkers, autonomy, recognition, age, years of
experience, education, social support, workload, role ambiguity,
and depression and hostility (Lu et al., 2005; Pinikahana, & Hap-
pell, 2004). Low job satisfaction in nurses resulted in burnout,
high turnover, low levels of patient care, nurses’ physical and
psychological disturbances, and higher stress levels (Happell,
Martin, & Pinikahana, 2003; Mrayyan, 2009). Aronson (2004)
conducted a study in psychiatric hospitals to examine the level of
job satisfaction among nurses. Respondents reported high lev-
els of pride in their hospitals but low levels of satisfaction with
the parent company. Also, high levels of burnout among mental
health nurses resulted in lower job satisfaction (Ogresta, Rusac,
& Zorec, 2008; Spear, Wood, Chawla, Devis, & Nelson, 2004).
In addition, low levels of burnout and availability of clinical su-
pervision were found to enhance job satisfaction and decrease
levels of stress among psychiatric nurses (Hyrkas, 2005).
MENTAL HEALTH SERVICES IN JORDAN
The health care system in Jordan is mainly composed of
three sectors: Ministry of Health (MOH), military, and private
sectors. Mental health service providers for the Jordanian pop-
ulation provide mental health care and treatment in all three
sectors. However, mental health services in Jordan are not well
understood, and many Jordanians have limited familiarity with
psychiatric disorders and treatment. The number of beds avail-
able for psychiatric patients in Jordan is approximately 643. Of
them, 500 beds are available for the MOH, 33 beds are in the
 236 S. H. HAMAIDEH
military sector, and 110 beds are for a private hospital (MOH,
2009). In Jordan, the total number of nurses working in mental
health care settings is approximately 220 nurses. Of them, 160
are working in the MOH, 30 in the military sector, and 30 in
the private sector (H. Al-araj), (personal communication, June
2010). There is shortage of mental health nurses in Jordan. The
ratio of mental health nurses to population in Jordan is 0.04
nurses for every 100,000 individuals (MOH, 2009).
There have been a number of studies that examined burnout,
job satisfaction, and social support among Jordanian nurses
(AbuAl-Rub, 2004; Hamaideh et al., 2008; Mrayyan, 2005;
Mrayyan & Al-Faouri, 2008). However, there appears to be little
consideration of burnout among Jordanian mental health nurses
working in mental health care settings. Therefore, the aim of this
Issues Ment Health Nurs Downloaded from informahealthcare.com by 213.186.187.137 on 02/28/11
study was to examine the relationships among burnout, social
support, job satisfaction, and other related demographic vari-
ables among Jordanian mental health nurses. More specifically,
the study aimed to answer the following research questions:
(1) What are the levels of burnout dimensions among Jorda-
nian mental health nurses as compared to normative values? (2)
What are the relationships among burnout categories, social sup-
port, job satisfaction, and some demographic and work-related
characteristics of Jordanian nurses working in mental health set-
tings? and (3) What are the variables that best predict burnout
dimensions among Jordanian nurses working in mental health
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settings?
METHOD
Design
Descriptive correlational cross-sectional design was em-
ployed to examine the levels of burnout dimensions and the
relationships among burnout dimensions, social support, job
satisfaction, and some demographic and work-related charac-
teristics among Jordanian mental health nurses.
Measures
For the purpose of this study, all scales were translated to Ara-
bic. All original norms were applied for the translated scales.
Translation was done from English into Arabic by a professional
English language translator. Back translation was done by an-
other professional English language translator. Then, the two
English forms (the original and the translated form) were com-
pared by two bilingual experts in the field. Pilot testing using a
sample of ten nurses was conducted to evaluate readability and
comprehensiveness of the scales. The scales were also checked
for cultural variation. Data was collected for this study using
a questionnaire composed of four parts, the Maslach Burnout
Inventory (MBI; Maslach et al., 1996), the Social Support Scale
(SSS; House & Wells, 1978), the Job Satisfaction Scale (JSS;
Quinn & Shepard, 1974), and a demographic and work-related
sheet.
Maslach Burnout Inventory
The MBI was used to measure burnout levels among Jorda-
nian mental health nurses. The MBI is a 22-item scale designed
to measure three dimensions of burnout: emotional exhaustion
(EE; 9 items), depersonalization (DP; 5 items), and personal ac-
complishment (PA; 8 items). The emotional exhaustion subscale
represents the basic individual stress dimension of burnout. It
refers to feelings of being overextended and depleted of one’s
emotional and physical resources. The depersonalization sub-
scale represents the interpersonal context dimension of burnout.
It refers to a negative or excessively detached response to var-
ious aspects of the job. The personal accomplishment subscale
represents the self-evaluation dimension of burnout. It refers to
feelings of incompetence and a lack of achievement and produc-
tivity at work (Maslach et al., 1996; Maslach et al., 2001). Each
item is answered on a seven-point response scale ranging from
0 “never” to 6 “everyday.” Responses are summed to obtain a
separate score for each of the three subscales, which can then be
categorized as low, medium, or high degrees of burnout accord-
ing to normative data. For the emotional exhaustion and deper-
sonalization subscales, high mean scores reflect high levels of
burnout, while for the personal accomplishment subscale. high
mean scores reflect low levels of burnout (Maslach & Jackson,
1981). For this sample, internal consistency for the total scale,
as measured by the Cronbach’s alpha coefficient, was 0.84 and
for EE, DP, and PA internal consistency was 0.91, 0.84, and
0.88, respectively.
Social Support Scale
The Social Support Scale (SSS; House & Wells, 1978)
was used to measure social support. The SSS is a four-item
scale measuring social support from the immediate supervi-
sor, coworkers, spouse/partner, and friends/relatives. For these
items, participants rate the extent to which each source fulfills
a particular supportive function; a four-point response scale is
used (0 = not at all, 1 = a little, 2 = somewhat, 3 = very much).
High scores reflect high levels of perceived support. The relia-
bility coefficient for the SSS was 0.84 (Jenkins & Elliott, 2004).
Cronbach’s alpha coefficients in 106 study subjects were 0.87,
0.80, 0.83, and 0.83 for supervisors, coworkers, the worker’s
family, and friends, respectively (Fujiwara, Tsukshima, Tsut-
sumi, Kawakami, & Kishi, 2003). For this sample, internal con-
sistency as measured by the Cronbach’s alpha coefficient was
0.85.
Job Satisfaction Scale
The Job Satisfaction Scale (JSS; Quinn & Shepard, 1974)
was used to measure nurses’ job satisfaction. The JSS is a
5-item questionnaire with a five-point Likert-type response scale
(1 = strongly disagree, 2 = disagree, 3 = undecided, 4 = agree,
5 = strongly agree) designed to measure job satisfaction. Higher
scores reflect greater job satisfaction. For this sample, internal
consistency as measured by the Cronbach’s alpha coefficient
was 0.76.
 BURNOUT, SOCIAL SUPPORT, AND JOB SATISFACTION
Demographic and Work-Related Sheet
Demographic and work-related characteristics were mea-
sured by a separate sheet. Data include: age, gender, marital
status, income level, number of household members, number
of dependents, presence of any chronic health problems, educa-
tional level, distance in kilometers (km) between home and work
setting, years of experience in general, years of experience in
mental health care settings, ward type (Chronic or Acute), shift
worked, number of patients in caseload, any previous partici-
pation in mental health workshops, experienced of physical or
verbal assault by mental health clients while working in a men-
tal health care setting. Intent to leave job was measured by a
single dichotomous item worded as follows, “Do you have the
intention to leave your current position/job?” (0 = No, 1 = Yes).
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Stress level, in general, was checked by asking the participants,
“In general, how would you rate the level of stress you usually
face in your work environment?” The five responses were 1 =
none, 2 = mild, 3 = moderate, 4 = severe, and 5 = very severe.
Sampling and Data Collection
The target population for the study was all Jordanian nurses
working in mental health care settings in Jordan, and all nurses
working in mental health care settings (approximately 220) were
invited to participate in the study. A total number of 220 ques-
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tionnaires were distributed by hand to the nurses through their
unit managers. If they agreed to participate, nurses were told
to return the completed questionnaire without his or her name
on it in a sealed box that was placed in the reception area of
each setting. This method was used to assure confidentiality and
anonymity. About 181 questionnaires were returned providing
a 82.3% response rate.
Ethical Consideration
Ethics approvals to conduct the study were obtained from the
Scientific Research Committees from the university where the
researcher is working and from the administrations of the mental
health care settings. In the letter inviting nurses to participate in
the study, information about the study’s purpose and confiden-
tiality was provided. Additionally, participants were told that
returning a completed questionnaire indicated consent to par-
ticipate and information about the study was explained. Nurses
also were told that their participation was voluntary and that they
were free to withdraw from the study at any time. Participants’
anonymity and confidentiality were assured.
Statistical Analysis
The Statistical Package for Social Sciences (SPSS) was used
to analyze data. Descriptive statistics were used to calculate fre-
quencies, mean scores, and standard deviations. The strength
and direction of relationships among variables were determined
using Pearson and Spearman Correlation Coefficients. Signif-
icance level was set at p < 0.05. Multiple linear regression
analysis (Enter Simultaneous Method) was performed to deter-
237
mine the variables that best predict burnout dimensions among
mental health nurses in Jordan. Assumptions of multiple linear
regression analysis were met. Residuals fit the model. Residu-
als were normally distributed, independent (not correlated with
one another), and not related to the explanatory variables. In
addition, there were no outliers in the data.
RESULTS
Demographic and Work-Related Variables
The total sample consisted of 181 participant nurses, of them,
101 (55.8%) were males. Age of the nurses ranged between 21
and 54 years (Mean = 30.94, SD = 7.24). The number of house-
hold members ranged between 1 and 12 persons (Mean = 5.03,
SD = 2.63). The number of dependents ranged between 0 and
10 persons (Mean = 3.03, SD = 2.34). Income level ranged
between 220 and 720 Jordanian Dinars (Mean = 372.9, SD =
117.16). Distance between work setting and home ranged be-
tween 1 and 120 kilometers (Mean = 29.85, SD = 30.04).
Participants’ years of general experience as a nurse ranged be-
tween 1 and 30 years (Mean = 8.29, SD = 7.08). Participants’
years of experience in a mental health setting ranged between 1
and 27 years (Mean = 5.85, SD = 5.98). Number of patients in
the wards (caseload) ranged between 4 and 61 patients (Mean =
20.08, SD = 14.90).
Of the total sample, 64 (35.4%) participated in mental health
workshops, 65 (35.9%) reported that they have intention to leave
their current job, 85 (47.0%) indicated that they experienced
physical violence from clients, and 144 (79.6%) reported that
they experienced verbal violence. Regarding stress in general;
33 (18.2%) reported very low/low stress, 99 (45.7%) reported
medium stress, and 49 (27.1%) reported high/very high stress.
Other demographic and work-related characteristics of the par-
ticipants can be seen in Table 1.
Burnout, Job Satisfaction, and Social Support Levels
Mean score of the EE subscale was 23.96 (SD = 31.91)
for Jordanian mental health nurses, which indicates that they
are in “high” burnout category. The mean score for the DP
subscale was 6.98 (SD = 7.07), indicating that nurses are in
the “moderate” burnout category. On the PA subscale, the mean
score was 31.58 (SD = 11.52). According to the PA subscale,
Jordanian mental health nurses are in the “moderate” burnout
category. On the EE subscale, a large number of nurses (n =
99, 54.7%) suffered from “high” level of burnout. On the DP
subscale, almost half of (n = 90, 49.7%) recorded “low” level of
burnout. Similarly, on the PA subscale, large number of nurses
(n = 92, 50.8%) recorded “low” level of burnout (see Table 2).
The mean job satisfaction score among Jordanian men-
tal health nurses was 2.89 (SD = 0.89). The highest mean
score was 3.12 (SD = 1.31) for the item “I am satisfied with
my present level of involvement in decision-making at work.”
The lowest mean score was 2.65 (SD = 1.4) for the item “I
 238 S. H. HAMAIDEH

TABLE 1 was reported to be higher among females, those who intend to

Demographics and Work-Related Characteristics (N = 181) leave their job, nurses who work in units with lower caseloads,
and those who perceive stress level as high. DP correlated neg-
Variable n % atively with PA, job satisfaction, social support, experiencing
Marital Status physical and verbal assault, and intending to leave the job and
Single 74 40.9 correlated positively with stress level in general. DP was found
Married 107 59.1 to be higher among those who intend to leave their job and nurses
Educational Level experiencing physical and verbal assault. On the other hand, PA
Associate-LPN 24 1.3 correlated positively with job satisfaction, social support, age,
Diploma-3 years 50 27.6 participation in mental health workshops, intention to leave cur-
Bachelor-BSN 101 55.8 rent job, and psychiatric experience and correlated negatively
Master-MSN 6 3.3 with gender, caseload, and stress level in general. PA was found
Ward to be higher in older nurses, those who do not intend to leave
Acute 95 52.5 their job, those who participated in mental health workshops,
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Chronic 86 47.5 and nurses with longer psychiatric experience (see Table 3).
Shift Worked
Morning Shift 86 47.5 Predictors of Burnout Categories
Afternoon/Evening/Rotated 95 52.5 Three separated multiple linear regressions analysis (Enter
Shift Method) were done to detect the predictors of EE, DP, and PA.
Job Title The independent variables that entered the three models were
Ward Head 28 15.5 demographics and work-related variables, social support, and
Practicing Nurse 153 84.5 job satisfaction. Significant models emerged for EE, DP, and
Place of Work PA. For EE, seven variables predicted emotional exhaustion
MOH 156 86.2 and accounted for a total variance of 32.7%. For DP, three
Royal Medical Services 16 8.8
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variables predicted depersonalization and accounted for a total

Private Sector 9 5.0
seldom think about finding an occupation other than nursing.”
The mean score for total social support from all sources as
perceived by Jordanian mental health nurses was 1.79 (SD =
.80). The highest source of social support was found to be from
nurses’ spouse/partner (Mean = 1.91, SD = 1.19) followed by
that received from colleagues (Mean = 1.89, SD = 0.89), then
from supervisors (Mean = 1.75, SD = 1.05). The lowest so-
cial support was received from friends/relatives (Mean = 1.62,
SD = 1.10).
Correlations among Variables
EE correlated negatively with job satisfaction, social support,
gender, experiencing physical and verbal assault, and caseload
and correlated positively with DP and stress level in general. EE
variance of 27.7%. For PA, three variables predicted personal
accomplishment and accounted for a total variance of 16.8%
(see Table 4 for the predictor variables).
DISCUSSION
The first goal of this study was to examine the levels of
burnout categories among Jordanian mental health nurses. Re-
sults revealed high levels of EE, and moderate levels of DP and
PA among mental health nurses in Jordan. Results of this study
are congruent with the results of most international studies, such
as those in the US (Hanrahan, Aiken, McClaine, & Hanlon,
2010), England (Edwards et al., 2006; Jenkins & Elliott, 2004),
Belgium (Stordeur, D’hoore, & Vandenberghe, 2001), Japan
(Fujiwara et al., 2003; Imai et al., 2006), and Iran (Sahraian et al.,
2008; Yousefy & Ghassemi, 2006). However, other research
studies showed that burnout levels were lower than those found

TABLE 2
Mean Scores, Standard Deviations, Frequencies (n), and Percentages (%) of Respondents for Burnout Subscales (N = 181).
Subscales Mean (SD) High n (%) Moderate n (%) Low n (%)
EE 23.96 (13.91) 99 (54.7) 31 (17.1) 51 (28.2)
DP 6.98 (7.07) 62 (34.2) 29 (16.1) 90 (49.7)
PA 31.58 (11.52) 70 (38.7) 19 (10.5) 92 (50.8)
EE: Emotional Exhaustion (low ≤ 13, moderate 14–20, high ≥ 21)
DP: Depersonalization (low ≤ 4, moderate 5–7, high ≥ 8)
PA: Personal Accomplishment (low ≥ 34, moderate 33–29, high ≤ 28)
 Issues Ment Health Nurs Downloaded from informahealthcare.com by 213.186.187.137 on 02/28/11
For personal use only.

TABLE 3
Correlations among Burnout Categories, Job Satisfaction, Sources of Social Support, and Demographics (N = 181)
1 2 3 4 5 6 7 8 9 10 11 12 13
1 EE 1.00
∗∗
2 DP .533 1.00
∗
3 PA –.020 –.179 1.00
4 JS –.313∗∗ –.349∗∗ .187∗ 1.00
5 SS –.280∗∗ –.301∗∗ .172∗ .392∗∗ 1.00
∗∗
6 Age .029 –.089 .200 .021 –.118 1.00
7 Gender –.186∗ –.042 –.167∗ –.086 –.031 –.123 1.00
8 Workshop –.001 .038 .202∗∗ .007 –.138 –.214∗∗ .133 1.00
9 Ph. Assault –.353∗∗ –.261∗∗ –.044 .105 .210∗∗ –.307∗∗ .166∗ .277∗∗ 1.00
∗ ∗
10 Vb. Assault –.272∗∗ –.220∗∗ .017 .036 .104 –.169 .175 .289∗∗ .477∗∗ 1.00
11 Leave –.282∗∗ –.194∗∗ .170∗ .203∗∗ .048 .052 .099 .000 .103 .065 1.00
12 Caseload –.171∗ .006 –.186∗ .070 .058 .105 .214∗∗ .075 .007 .099 –.062 1.00
13 P. Exp. .036 –.117 .195∗∗ .041 .003 .706∗∗ –.125∗ –.287∗∗ –.471∗∗ –.313∗∗ .106 –.009 1.00
14 Stress level .353∗∗ .429∗∗ –.265∗∗ .414∗∗ .394∗∗ .025 .007 .043 .200∗∗ .177∗ .228∗∗ .025 .045
EE: Emotional Exhaustion, DP: Depersonalization, PA: Personal Accomplishment, JS: Job Satisfaction, SS: Social Support, Ph: Physical assault, Vb.: Verbal
Assault, P. Exp: Psychiatric experience. Stress: Stress in general. Pearson Correlation employed with continuous data, Spearman rho Correlation employed with
categorical data.
∗
Correlation is significant at 0.05 level.
∗∗
Correlation is significant at 0.01 level.

239
 240 S. H. HAMAIDEH

TABLE 4
Predictors of Burnout Categories (N = 181)
Predictor Variables Beta t p Adj R2 Total Variance
Emotional Exhaustion 0.327 32.7%
1. Caseload –0.167 –2.21 0.028
2. Gender (Female vs. Male) –0.147 –2.07 0.039
3. Marital Status (Single vs. Married) 0.260 2.71 0.007
4. Ward (Acute vs. Chronic) 0.146 2.09 0.045
5. Intention to Leave Job (No vs. Yes) 0.17 2.52 0.013
6. Physical Assault (No vs. Yes) 0.231 2.96 0.004
7. Stress Level 0.175 2.32 0.022
Depersonalization 0.277 27.7%
1. Distance between Home and Work 0.291 3.55 0.001
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2. Physical Assault (No vs. Yes) 0.207 2.56 0.011

3. Stress Level 0.263 3.38 0.001
Personal Accomplishment 0.168 16.8%
1. Caseload –0.173 –2.06 0.040
2. Stress Level –0.178 –2.13 0.035

in this study. For example, in Poland (Jaracz et al., 2005), Croa-
tia (Ogresta et al., 2008), and the United Kingdom (Kilfedder
et al., 2001, Sherring & Knight, 2009), burnout levels were
moderate; while in other countries, such as Australia (Happell,
For personal use only.
ported a positive relationship between lack of social support and
burnout, especially support between supervisors and colleagues
(Stordeur et. al., 2001). Poor relationships with supervisors and
colleagues resulted in burnout when there is no possibility of

Pinikahana, & Martin, 2003; Pinikahana & Happell, 2004) and
Finland (Hyrkas, 2005), levels of burnout were reported to be
low. High levels of burnout among Jordanian mental health
nurses may be explained by a poor psychosocial work environ-
ment as evidenced by low social support from colleagues and
supervisors. High burnout levels also may be due to working
with difficult and uncooperative patients with bad prognoses,
which may lead to helplessness, frustration, and emotional ex-
haustion for the nurse (Maslach et al., 2001). Lack of clinical su-
pervision may also contribute to the high level of burnout among
Jordanian mental health nurses because clinical supervision was
found to be beneficial for mental health professionals in terms
of job satisfaction, stress, and burnout levels (Edwards et al.,
2006; Hyrkas, 2005; Ito, Eisen, Sederer, Yamada, & Tachimori,
2001). It appears that despite high levels of burnout reported by
nurses, the majority of them indicate that they are satisfied with
their job. It also appears that the level of social support experi-
enced by nurses from their supervisors was relatively low. It is
therefore possible that support is one of the primary factors in
influencing levels of burnout.
The second goal of this study was to investigate the rela-
tionships among burnout categories, social support, job sat-
isfaction, and some demographic and work-related variables.
The results revealed that there were strong relationships among
the studied variables. The present findings are in keeping with
other studies that reported that high levels of social support and
job satisfaction correlated negatively with burnout (Sherring &
Knight, 2009; Sundin et al., 2007). A number of authors have re-
exchanging experiences and ideas, as well as when there is a
lack of possible feedback from supervisors. Social support may,
in some way, provide a protective effect against burnout, per-
haps by giving nurses an opportunity to express their feelings,
thereby minimizing any sense of isolation and creating a forum
for passing on coping strategies. Also, nurses with high lev-
els of burnout are more likely to be considering leaving their
job. Nurse staffing turnover and nurses’ intention to leave their
job are particular issues among Jordanian nurses, in general
(AbuAl-Rub & Al-Zaru, 2008; Mrayyan, 2005). Furthermore,
negative correlation between job satisfaction and burnout has
been confirmed in some previous studies (Kalliath, & Morris,
2002; Spear et al., 2004). Therefore, nurses’ job satisfaction and
social support should be included in plans to improve the qual-
ity of care for mental health nurses. A positive relationship was
found between years of experience in psychiatric setting and
PA. This is congruent with other studies that found that burnout
levels were higher among inexperienced nurses (Kanai-Pak
et al., 2008).
The third goal of this study was to identify the factors that
best predict burnout dimensions among Jordanian mental health
nurses. Results revealed that there were many factors that con-
tributed to burnout categories. EE was predicted by caseload,
gender, marital status, ward, intention to leave job, physical as-
sault, and stress level in general. DP was predicted by distance
between work and home, physical assault, and stress level in
general. PA was predicted by caseload and stress level in general.
Stress level was a unique predictor of all burnout dimensions.
 BURNOUT, SOCIAL SUPPORT, AND JOB SATISFACTION
There is no doubt that stress and burnout levels are closely re-
lated. Most studies of stress and burnout reveal that high levels of
stress increase the level of emotional exhaustion and deperson-
alization, and decrease the level of personal accomplishment
(Stordeur et al., 2001). For example, Ogresta and colleagues
(2008) found that physical and psychological manifestations
of stress predicted emotional exhaustion and depersonalization.
The identification of stress sources, as well as the personal and
contextual factors that contribute to stress, may result in the
prevention of stress and protection of the mental health nurses.
Caseload size (nurse to patient ratio) was found to predict EE
and PA. Nurses in hospitals with the highest caseloads are more
likely to experience job burnout and job dissatisfaction than
nurses in hospitals with lower caseloads (Aiken, Clarke, Sloane,
Issues Ment Health Nurs Downloaded from informahealthcare.com by 213.186.187.137 on 02/28/11
Sochalski, & Silber, 2002). Further, intention to leave the job
was a predictor for EE. Also, physical assault was a predictor
for EE and DP. Ito and colleagues (2001) found that perceived
risk of assault, job satisfaction, and social support were among
the variables that predicted intention to leave job among psychi-
atric nurses. This effect of staffing caseload, physical assault,
intention to leave job, and burnout suggest that improving nurse
staffing could decrease turnover and burnout, decrease nurses’
intention to leave their job, and reduce hospital cost (Aiken
et al., 2002; Jourdain & Chenevert, 2010; Mrayyan, 2005).
Regarding gender and marital status, results of this study re-
For personal use only.
vealed that male and single nurses were more emotionally ex-
hausted and had lower PA. These results were congruent with
other studies which revealed that burnout levels were higher
among male and single nurses (Edwards et al., 2006; Sahraian
et al., 2008). Nurses in acute wards were more emotionally
exhausted than those working in chronic wards despite the
higher caseload size in chronic units. This may be explained
by the fact that acute wards have more complicated and dif-
ficult patients, high workloads, many non-nursing tasks (e.g.,
coordination with other health care professionals), frequent ad-
missions and discharges, and high risks of physical and verbal
assaults.
Limitations
Employing cross-sectional design allows relationships be-
tween variables to be identified at one point of time only and
does not allow causal relationships among variables to be es-
tablished; therefore, longitudinal designs are crucial for further
understanding of the development of burnout over time. Also,
data for this study were obtained by self-report, which may re-
flect bias in reporting. Participants may have underestimated
or overestimated their level of burnout, social support, and job
satisfaction.
Despite the limitations, this study contributes to the develop-
ment of mental health care by providing information on burnout,
social support, and job satisfaction among Jordanian mental
health nurses. This study was strengthened by the sample size
241
which accounted for about 82% of the target population (all
Jordanian mental health nurses).
Conclusions and Implications
Participants with high levels of emotional exhaustion and de-
personalization were more likely to be considering leaving their
job; therefore, improving working conditions, ensuring a safe
working environment, increasing job satisfaction, and training
supervisors to support their staff are important steps in reducing
burnout levels. Results of this study draw attention to the impor-
tance of improving the psychosocial work environment among
mental health nurses. To decrease burnout among mental health
nurses, administrators should also increase continuing educa-
tion programs for nurses, especially those programs that deal
with stress management, coping skills, and personal skills and
accomplishments, and those that update knowledge.
Burnout affects the way in which mental health nurses care
for their clients. Therefore, there is a need to consider ways
in which burnout can be ameliorated and, thus, enable mental
health nurses to provide optimal care for their clients, enhance
well-being, decrease stress and turnover among mental health
nurses (Robinson, Clements, & Land, 2003), and decrease the
frequency of sick leave (Sherring & Knight, 2009). Also, emo-
tional exhaustion may be offset by minimizing conflicting tasks
and providing advice and support for non-work issues.
Declaration of interest: The authors report no conflicts of
interest. The authors alone are responsible for the content and
writing of the paper.
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