Satisfaction with coworkers varied by age and was lowest in those between the ages of 60 and 69 (7.33 ± 2.42) years. Post hoc analysis revealed that nurses in the age group of 30–39 years were more satisfied with their coworkers than nurses between the ages of 60 and 69 (11.28 ± 3.54 vs. 7.32 ± 2.42; p < .05) years. Female nurses were more satisfied with their coworkers than male nurses (10.39 ± 3.69 vs. 7.25 ± 2.53; p < .05). Higher satisfaction with coworkers was also observed in nurses without children compared with those with children (12.44 ± 3.10 vs. 9.06 ± 3.53; p < .05). Nurses working in the MICU were more satisfied with their coworkers than ED nurses and SICU nurses (p < .05).
Pearson correlations were used to examine the relationships among various dimensions of burnout, perceived stress score, and job satisfaction subscales (Table 4). Perceived stress scores correlated negatively with personal accomplishment (r = −.233; p < .05), satisfaction of the nurses with work on their present job (r = −.335; p < .05), and supervision (r = −.277; p < .05). Nurses with higher perceived stress scores had higher depersonalization (r = .331; p < .05) and higher emotional exhaustion (r = .523; p < .05). The nurses with higher personal accomplishment scores had lower emotional exhaustion (r = −.231; p < .05) and higher satisfaction with work on their present job (r = .310; p < .05). A negative correlation was observed between emotional exhaustion and satisfaction with work on their present job (r = −.450; p < .05) and overall job satisfaction in general (r = −.270; p < .05). Nurses with higher emotional exhaustion scores also had higher levels of depersonalization (r = .548 p < .05) and were more satisfied with their coworkers (r = .362; p < .05). Nurses with lower satisfaction with work on their present job had higher levels of depersonalization (r = −.262; p < .05) and higher satisfaction with their job in general (r = .420; p < .05). Depersonalization scores also positively correlated with the nurse's satisfaction with coworkers (r = .498; p < .05). Nurses with higher satisfaction with their pay had lower satisfaction with the supervision they received (r = −.302; p < .05). The levels of satisfaction with the opportunities for promotion did not correlate significantly with any of the studied measures (Table 4).
To the best of our knowledge, this is the first comprehensive study examining the prevalence and relationships among burnout, job satisfaction, and perceived stress in trauma nurses at a Level I safety-net trauma center. The higher than average perceived stress score observed in our study sample may have increased the trauma nurses susceptibility to stress-induced illness (Cohen et al., 1983; Cohen & Janicki-Deverts, 2012; Laal, 2010; Milliken, Clements, & Tillman, 2007). Moreover, in our study sample, nurses who reported health problems had higher perceived stress scores. Perhaps personal health problems may have impacted perceived health scores (Danna & Griffin, 1999). Therefore, it is imperative from an organizational perspective to provide opportunities for trauma nurses to use coping strategies that can assist them to lead a healthier work life. Given those findings, it would also be desirable to consider personal health issues in job assignments if such issues are brought to the attention of nurse manager by the nurse.
It is critical for nursing administration to be aware of these factors impacting the job satisfaction of trauma nurses in order to be able to make better decisions that impact their job performance. Although it is agreeably hard to improve satisfaction in terms of limiting factors such as pay in a safety-net hospital setting with budgetary constraints, efforts should be focused on other impactful intrinsic motivators. For example, altering the level of responsibility by ensuring adequate support from ancillary unit staff, promoting positive organizational culture, and enhancing coworker relationships would enhance satisfaction and may reduce job turnover that is usually high in nursing (Harper et al., 2015; Li & Jones, 2013).
The finding of high emotional exhaustion and higher levels of depersonalization but higher satisfaction with coworkers suggests that in the safety-net setting, the employee-to-employee relationship does not weigh as much in creating burnout but rather another significant variable might be at play. Indeed, depersonalization positively correlated with satisfaction with coworkers in part due to the realization that they are all part of the same system or work environment. Likewise, we noted lower work satisfaction and higher level of depersonalization but higher satisfaction with the job, suggesting that although the staff may be experiencing burnout, they are not necessarily dissatisfied with their nursing profession or their job per se but again the work environment seems to be of prime importance. These study findings further point out the significant role of the work environment in generating nursing burnout. Indeed, they emphasize the importance of creating a sophisticated strategy with a focus on the work environment to block the spiral leading to burnout.
Poor interpersonal relationships at a workplace have been previously identified to be a risk factor for decreased job satisfaction (Zangaro & Soeken, 2007). Furthermore, cohesive and supportive coworkers are vital determinants of satisfaction in nurses (Tourangeau & Cranley, 2006). In our study, older nurses, males, and those with children had lower satisfaction with their coworkers. Although several factors may influence these findings, initiatives to minimize major source of stress such as intergenerational conflict with younger nurses and support groups can enhance coworker relationships (Letvak, 2003; Weston, 2006).
In addition, recognition programs can be established to promote acknowledgement of the contributions made by nurses. Perhaps, this can then help enhance the work engagement and thus overall job satisfaction. Although resources are scarce in safety-net institutions, a significant effort should be made at the administrative level to provide adequate human and material resources to help encourage team building and foster a harmonious work environment in the various nursing units. Likewise, nursing supervisors should demonstrate availability and willingness to assist nursing staff in addressing work related or personal difficulties and encourage them to work in a pleasant work environment. A demonstrated synergistic effort by the nursing leadership, hospital administration, and the nurses themselves can immensely help alleviate burnout or stress at the work place.
A number of limitations should be considered while interpreting the results of the present study. First, the cross-sectional design of the study prevents any causal associations. Second, despite the anonymous nature of the study, there may be a report bias as the measures studied were self-reported. In addition, the generalizability of the findings to a wider trauma nursing population is a limitation as the nurse participants in this study are specific to one Level I safety-net trauma center, and there may be other factors intrinsic to facilities making comparisons difficult.
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