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.
Adriaenssens J., De Gucht V., Maes S. (2015). Determinants and prevalence of burnout
in emergency nurses
: a systematic review of 25 years of research. International Journal of Nursing Studies, 52(2), 649–661. doi:10.1016/j.ijnurstu.2014.11.004
Adwan J. Z. (2014). Pediatric nurses
' grief experience, burnout
and job satisfaction
. Journal of Pediatric Nursing, 29(4), 329–336. doi:10.1016/j.pedn.2014.01.011
Aiken L. H., Clarke S. P., Sloane D. M., Sochalski J., Silber J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout
, and job dissatisfaction. The Journal of the American Medical Association, 288(16), 1987–1993.
Balzer W. K., Kihm J., Smith P. C., Irwin J., Bachiochi P. D., Robie C., Sinar E. F. (1997). User's Manual for the Job Descriptive Index (JDI; 1997 Revision) and the Job in General (JIG) Scales. Bowling Green, OH: Bowling Green State University.
Cohen S., Janicki-Deverts D. (2012). Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 20091. Journal of Applied Social Psychology, 42(6), 1320–1334. doi:10.1111/j.1559-1816.2012.00900.x
Cohen S., Kamarck T., Mermelstein R. (1983). A global measure of perceived stress
. Journal of Health and Social Behavior, 24(4), 385–396.
Committee on Trauma
. (2014). Resources for optimal care of the injured patient: 2014. Chicago, IL: American College of Surgeons. Retrieved from https://www.facs.org
Daines P. A. (2000). Personality hardiness: An essential attribute for the ICU nurse? Dynamics (Pembroke Ont.), 11(4), 18–21.
Danna K., Griffin R. W. (1999). Health and well-being in the workplace: A review and synthesis of the literature. Journal of Management, 25, 357–384.
Farahbod F., Chegini M. G., Eramsadati L. K., Mohtasham-Amiri Z. (2015). The association between social capital and burnout
of a trauma
referral teaching hospital. Acta Medica Iranica, 53(4), 214–219.
Flinkman M., Laine M., Leino-Kilpi H., Hasselhorn H. M., Salantera S. (2008). Explaining young registered Finnish nurses
' intention to leave the profession: a questionnaire survey. International Journal of Nursing Studies, 45(5), 727–739. doi:S0020-7489(06)00347-6 [pii]
Harper E., Castrucci B. C., Bharthapudi K., Sellers K. (2015). Job satisfaction
: A critical, understudied facet of workforce development in public health. Journal of Public Health Management and Practice: JPHMP, 21(Suppl. 6), S46–S55. doi:10.1097/PHH.0000000000000296
Hayashi A. S., Selia E., McDonnell K. (2009). Stress and provider retention in underserved communities. Journal of Health Care for the Poor and Underserved, 20(3), 597–604. doi:10.1353/hpu.0.0163
Hinderer K. A., VonRueden K. T., Friedmann E., McQuillan K. A., Gilmore R., Kramer B., Murray M. (2014). Burnout
, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses
. Journal of Trauma
Nursing: The Official Journal of the Society of Trauma Nurses
, 21(4), 160–169. doi:10.1097/JTN.0000000000000055
Karkar A., Dammang M. L., Bouhaha B. M. (2015). Stress and burnout
among hemodialysis nurses
: A single-center, prospective survey study. Saudi Journal of Kidney Diseases and Transplantation: An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 26(1), 12–18. doi:SaudiJKidneyDisTranspl_2015_26_1_12_148712 [pii]
Khamisa N., Oldenburg B., Peltzer K., Ilic D. (2015). Work related stress, burnout
, job satisfaction
and general health of nurses
. International Journal of Environmental Research and Public Health, 12(1), 652–666. doi:10.3390/ijerph120100652
Laal N. A. M. (2010). Nursing and coping with stress. International Journal of Collaborative Research on Internal Medicine & Public Health, 2(5), 168–181.
Letvak S. (2003). The experience of being an older staff nurse. Western Journal of Nursing Research, 25(1), 45–56.
Li Y., Jones C. B. (2013). A literature review of nursing turnover costs. Journal of Nursing Management, 21(3), 405–418. doi:10.1111/j.1365-2834.2012.01411.x
Maslach C. L. M., Jackson S. E. (1996). Burnout
inventory manual. 3rd ed. Palo Alto, CA: Consulting Psychologist Press.
Maslach C., Schaufeli W. B., Leiter M. P. (2001). Job burnout
. Annual Review of Psychology, 52(1), 397–422. doi:10.1146/annurev.psych.52.1.397
McVicar A. (2003). Workplace stress in nursing: A literature review. Journal of Advanced Nursing, 44(6), 633–642. doi:2853 [pii]
Milliken T. F., Clements P. T., Tillman H. J. (2007). The impact of stress management on nurse productivity and retention. Nursing Economic, 25(4), 203–210; quiz 211.
Poghosyan L., Aiken L. H., Sloane D. M. (2009). Factor structure of the Maslach Burnout
Inventory: An analysis of data from large scale cross-sectional surveys of nurses
from eight countries. International Journal of Nursing Studies, 46(7), 894–902. doi:10.1016/j.ijnurstu.2009.03.004
Ross J. S., Cha S. S., Epstein A. J., Wang Y., Bradley E. H., Herrin J., Krumholz H. M. (2007). Quality of care for acute myocardial infarction at urban safety-net
hospitals. Health Affairs (Project Hope), 26(1), 238–248. doi:26/1/238 [pii]
Russell S. S., Spitzmüller C., Lin L. F., Stanton J. M., Smith P. C., Ironson G. H. (2004). Shorter can also be better: The abridged job in general scale. Educational and Psychological Measurement, 64(5), 878–893. doi:10.1177/0013164404264841
Sabo B. M. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice, 12(3), 136–142. doi:IJN [pii]
Seago J. A., Spetz J. (2008). Minority nurses
' experiences on the job. Journal of Cultural Diversity, 15(1), 16–23.
Stanton J. M., Sinar E. F., Balzer W. K., Julian A. L., Thoresen P., Aziz S., Smith P. C. (2002). Development of a compact measure of job satisfaction
: the abridged job descriptive index. Educational and Psychological Measurement, 62(1), 173–191. doi:10.1177/001316440206200112
Stimpfel A. W., Sloane D. M., Aiken L. H. (2012). The longer the shifts for hospital nurses
, the higher the levels of burnout
and patient dissatisfaction. Health Affairs, 31(11), 2501–2509. doi:10.1377/hlthaff.2011.1377
Thorsen V. C., Tharp A. L., Meguid T. (2011). High rates of burnout
among maternal health staff at a referral hospital in Malawi: A cross-sectional study. BMC Nursing, 10, 9. doi:10.1186/1472-6955-10-9.
Tourangeau A. E., Cranley L. A. (2006). Nurse intention to remain employed: Understanding and strengthening determinants. Journal of Advanced Nursing, 55(4), 497–509. doi:JAN3934 [pii]
Werner R. M., Goldman L. E., Dudley R. A. (2008). Comparison of change in quality of care between safety-net
hospitals. The Journal of the American Medical Association, 299(18), 2180–2187. doi:10.1001/jama.299.18.2180
Weston M. J. (2006). Integrating generational perspectives in nursing. Online Journal of Issues in Nursing, 11(2), 2. doi.org/topic30/tpc30_1.htm [pii]
Wilkinson H., Whittington R., Perry L., Eames C. (2017). Examining the relationship between burnout
and empathy in healthcare professionals: A systematic review. Burnout
Research, 6, 18–29. doi:10.1016/j.burn.2017.06.003
Zangaro G. A., Soeken K. L. (2007). A meta-analysis of studies of nurses
' job satisfaction
. Research in Nursing & Health, 30(4), 445–458. doi:10.1002/nur.20202