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RESEARCH ARTICLE

Core Self-Evaluation and Burnout among Nurses: The Mediating Role of Coping Styles Xiaofei Li1, Lili Guan2, Hui Chang3, Bo Zhang4*

1. Emergency Department, The First Affiliated Hospital of China Medical University, Shenyang, China, 2. Faculty of Nursing, Huaiyin Advanced Vocational and Technical School of Health, Huaian, China, 3. Social Education Department, Center for Health Education of Liaoning Province, Shenyang, China, 4. Nursing Department, The First Affiliated Hospital of China Medical University, Shenyang, China

*[email protected]

Abstract

Objectives: This study aimed to determine the potential association between core

self-evaluation and the burnout syndrome among Chinese nurses, and the

mediating role of coping styles in this relationship.

Methods: A cross-sectional survey was conducted in Shenyang, China, from May

to July, 2013. A questionnaire which consisted of the Maslach Burnout Inventory-

General Survey (MBI-GS), the Core Self-Evaluation Scale (CSE), and the

Simplified Coping Style Questionnaire (CSQ), was completed by a total of 1,559

nurses. Hierarchical linear regression analyses and the Sobel test were performed

to determine the mediating role of coping styles on the relationship between CSE

and burnout.

Results: Nurses who had higher self-evaluation characteristics, reported less

emotional exhaustion and cynicism, and higher professional efficacy. Coping style

had a partial mediating effect on the relationship between CSE and the burnout

syndrome among nurses.

Conclusions: Core self-evaluation had effects on burnout and coping style was a

mediating factor in this relationship among Chinese nurses. Therefore, the

improvement of coping strategies may be helpful in the prevention of burnout

among nurses, thus enhancing professional performance.

Background

Burnout is the result of continuous work pressures that are not effectively handled

[1] and is defined by three dimensions: emotional exhaustion (EE), cynicism (CY)

OPEN ACCESS

Citation: Li X, Guan L, Chang H, Zhang B (2014) Core Self-Evaluation and Burnout among Nurses: The Mediating Role of Coping Styles. PLoS ONE 9(12): e115799. doi:10.1371/ journal.pone.0115799

Editor: Delphine Sophie Courvoisier, University of Geneva, Switzerland

Received: September 12, 2014

Accepted: November 27, 2014

Published: December 26, 2014

Copyright: � 2014 Li et al. This is an open- access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and repro- duction in any medium, provided the original author and source are credited.

Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.

Funding: The authors have no support or funding to report.

Competing Interests: The authors have declared that no competing interests exist.

PLOS ONE | DOI:10.1371/journal.pone.0115799 December 26, 2014 1 / 12

and reduced professional efficacy (PE). Emotional exhaustion refers to an

individual being overextended emotionally, which leads to the depletion of an

individual’s resources. Cynicism refers to a negative, callous or excessively

detached response to various aspects of the job. Reduced professional efficacy

represents a general sense of one’s inefficacy at work and to a feeling of lack of

professional success and competency [2]. Burnout has been recognized as an

occupational hazard in various people-oriented professions [3]. In the area of

healthcare, nursing staff face high demands in terms of quality services, and are

subjected to numerous stressful situations. Therefore, nurses are at risk of burnout

[4]. A severe nursing shortage and an increase in demanding workload in terms of

physical, emotional and moral stress, combined with comparatively low wages

and devaluation of the profession have caused nurses to experience burnout in

China. Burnout among nurses can result in mental fatigue, anxiety, lack of

motivation, and absence from work [5], which undoubtedly threatens not only

their own health, but also that of their patients. Therefore, the prevention of

burnout among nurses is essential for improving the quality of patient care.

With regard to personal resources, traditional research on personality and

burnout has focused on the Big Five personality dimensions and emotional

affectivity [6, 7]. However, recently, Core self-evaluation (CSE) has received a

great deal of attention in personality research. CSE, a broad personality concept,

which describes an individual’s evaluation about themselves, their ability, and

their control, consists of four traits: self-esteem, general self-efficacy, locus of

control, and neuroticism [8]. Numerous studies have reported that CSE

significantly influenced salary [9], goal setting [10], job satisfaction [11], job

performance [10, 12], career commitment [13], and job burnout [13, 14]. In

addition, Spence Laschinger et al. identified the important role of CSE on nurse

managers’ burnout [15]. However, previous studies did not determine how CSE

influences burnout.

Stress is accompanied by the process of coping [16]. Coping styles are defined

as stable psychological and behavioral strategies to overcome or tolerate external

and internal challenges or stressors [17]. Some people cope with stress actively,

while others cope passively. Active coping strategies are either behavioral or

psychological responses designed to change the nature of the stressor itself or how

one thinks about it, whereas passive coping strategies lead people into activities

(such as alcohol use) or mental states (such as withdrawal) which prevent them

from directly addressing stressful events [18]. Coping behaviors of individuals

contribute to the explanation of why exposure to the same stressors may cause

burnout in some subjects, but not in others [19]. A study conducted in Hong

Kong by Wang et al. indicated that making use of effective coping strategies plays

a pivotal role in reducing stress among nurses [20]. The coping strategies used by

nurses may vary with respect to their personal, psychological, and cultural factors

[21]. A previous study reported that Chinese nurses tended to cope actively with

stress associated with decreased personal achievement, but passively when the

stress originated from resource and environment problems, patient care and

interaction issues, and from interpersonal relationships and management issues

Core Self-Evaluation and Burnout

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[22], suggesting regional differences in the coping styles of nurses. According to

previous studies, burnout can be alleviated by coping strategies. Active coping

may protect against the negative impact of stressors on adaptive outcomes by

strengthening the person’s coping efficacy in a specific situation [4]. However,

Payne et al. [23] concluded that the investigation of problem-focused and

emotion-focused coping in relation to burnout, oversimplied the coping-burnout

relationship in a sample of hospice nurses. The association between CSE and

burnout and the association between coping styles and burnout have been

investigated in previous studies [5, 13, 14, 15, 23]. In addition, Kammeyer-Mueller

et al. [24] investigated the role of CSE in the coping process, and demonstrated

that individuals with high CSE practice less avoidance coping. However, to our

knowledge, there has been no integrative effort to examine coping styles as a

mediator in the relationship between CSE and burnout.

Nurses need to care for themselves before they can provide care for their clients.

Given the high stress, difference in coping styles, as well as high workload in

Chinese nurses, there is a need to develop an educational program and strategies

for the prevention of burnout among nurses. For this purpose, it is important to

clarify the relationships between burnout, CSE, and coping styles among Chinese

nurses. In the present study, we examined the relationship between CSE and

burnout and determined the mediating role of coping styles on the relationship

between CSE and burnout using a cross-sectional survey of 1,559 Chinese nurses

from Shenyang, China.

Methods

Participants and procedure

A cross-sectional survey was conducted in Shenyang, China from May to July,

2013. Respondents in this study were selected from five hospitals which included

three university-affiliated hospitals, one provincial tertiary hospital, and one

municipal tertiary hospital. The inclusion criteria required that an individual held

the RN licensure granted by the Ministry of Health, PR China and was currently

working in one of the hospitals as a registered nurse. Head nurses and

administrators were excluded. Anonymous questionnaires were distributed and

collected during staff meetings in all hospital units by the researcher (the third

author) over a 4-week period. A sample of 1995 clinical nurses was recruited and

1,662 questionnaires were returned (return rate: 83.3%). 103 questionnaires were

discarded due to incomplete data, resulting in 1,559 analyzed questionnaires.

Ethical approval of the study was given by the medical ethics committee of

China Medical University. All participants signed an informed consent form.

Core Self-Evaluation and Burnout

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Instruments

Core Self-Evaluation Scale (CSE)

This scale was developed by Judge et al. [8] and is a 12-item self-report measure of

CSE. Items are rated from 1 (strongly disagree) to 5 (strongly agree). The scale

scores are the sum of the ratings of the items. Relevant items were reverse-coded.

The Chinese version of the CSE has previously been used in the Chinese

population and demonstrated good reliability and validity [25]. In this study, the

Cronbach’s alpha coefficient for CSE was 0.745.

Maslach Burnout Inventory–General Survey (MBI-GS)

The MBI-GS was developed by Maslach et al. [26, 27] and is a 15-item self-report

measure of job burnout which includes three dimensions, emotional exhaustion,

cynicism, and professional efficacy. The items are scored on a Likert scale from 0

(never) to 6 (every day). Higher scores on emotional exhaustion and cynicism

dimensions and lower scores on professional efficacy dimension indicated higher

levels of burnout. The Chinese version of the MBI has been widely used in Chinese

studies and has demonstrated satisfactory reliability and validity [28, 29]. In the

present study, Cronbach’s alpha coefficients for the three dimensions of MBI-GS

were 0.896, 0.747, and 0.825, respectively.

The Simplified Coping Style Questionnaire (CSQ)

This questionnaire developed by Xie YN [30] was based on the Ways of Coping

questionnaire by Folkman and Lazarus [31] and is a 20-item self-report that

includes two dimensions, active coping (12-item) and passive coping (8-item).

The items were measured using four-point Likert scales (05 never; 35 very

often). The instrument has been commonly used in China and the internal

consistency measured by Cronbach’s alpha was reported to be 0.78 [30]. In this

study, the Cronbach’s alpha coefficients for the two dimensions of SCSQ were

0.796 and 0.728, respectively.

Demographic data sheet

Demographic data including gender, age, educational level, work experience, and

job rank were obtained from a structured questionnaire.‘‘Educational level’’was

categorized as ‘‘high school or under’’, ‘‘junior college’’ and ‘‘undergraduate or

above’’. ‘‘job rank’’ was categorized as ‘‘junior nurse’’, ‘‘senior nurse’’ and ‘‘nurse-

in-charge’’.

Statistics

Data were imported to the Epidata 3.1 database. All analyses were conducted

using SPSS 17.0 for Windows and all statistical tests were two-sided (a50.05). The distributions of dimensions of burnout in categorical demographic

characteristics were tested by one-way ANOVA. Pearson correlation was

performed to test the relationship between core self-evaluation, coping styles, and

burnout. Baron and Kenny’s [32] technique was used to test the mediating effect

of coping styles on the relationship between core self-evaluation and burnout.

Core Self-Evaluation and Burnout

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According to Baron and Kenny [32], the following conditions should be satisfied

to establish mediation: (1) The independent variable (CSE) is significantly

associated with the dependent variable (Emotional exhaustion/Cynicism/

Professional efficacy), (2) the independent variable (CSE) is significantly

associated with the mediator (Active coping/Passive coping), and (3) the mediator

(Active coping/Passive coping) is significantly associated with the dependent

variable (Emotional exhaustion/Cynicism/Professional efficacy), and the effect of

the independent variable (CSE) on the dependent variable (Emotional exhaus-

tion/Cynicism/Professional efficacy) reduces when the mediator (Active coping/

Passive coping) is added to the model (partial mediator). If the independent

variable does not affect the dependent variable when the mediator is added to the

model, then full mediation is established.

Before performing the regression analyses, all the continuous variables were

centered in order to avoid multicollinearity [33]. In addition, tolerance and the

variance inflation factor were used to check for multicollinearity. We performed

Pearson correlation and one hierarchical linear regression analysis for each of the

three burnout dimensions to test the mediating effect. In step one of the

hierarchical linear regression analyses, the control variables and positive results of

variance analysis were added to the model. In the present study, we included

gender, age, educational level, work experience and job rank in the model as

potential confounders. Because educational level and job rank are categorical

variables without a linear trend, dummy variables for these two variables were set.

For educational level, ‘‘High school or under’’ was set as the reference group. For

job rank, ‘‘junior nurse’’ was set as the reference group. In step 2, core self-

evaluation was added. In step 3, active coping and passive coping were added.

In addition, the statistical significance of the mediation effect was confirmed

using the Sobel test.

Results

The demographic and working characteristics of the subjects and the distribution

of each dimension of burnout in the categorical items are shown in Table 1. Mean

emotional exhaustion, cynicism, and professional efficacy differed across the age

and work experience groups. Nurses aged 30–40 years had the highest scores in

emotional exhaustion and cynicism and nurses aged over 40 years had the highest

scores in professional efficacy. The group with 10–15 years work experience had

the highest scores in the three dimensions of burnout. Mean emotional

exhaustion and cynicism differed between male and female nurses. Female nurses

were more easily affected by emotional exhaustion and cynicism. Mean emotional

exhaustion and professional efficacy differed among the job rank groups. Senior

nurses had the highest scores in emotional exhaustion, whereas nurse-in-charge

had the highest scores in professional efficacy. In addition, mean professional

efficacy differed across the education level groups. Nurses with an undergraduate

degree or above had the highest scores in professional efficacy.

Core Self-Evaluation and Burnout

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Pearson correlations

The results of Pearson correlation analysis among core self-evaluation, coping

styles, and burnout are shown in Table 2. The CSE scale was significantly

correlated with the dimensions of burnout (r520.343, 20.345, 0.282, P,0.01),

where nurses with a higher score on the CSE scale had better professional efficacy,

whereas nurses with a lower score on the CSE tended to be more susceptible to

emotional exhaustion and cynicism. In addition, CSE was significantly associated

with the dimensions of coping styles (r50.314, 20.254, P,0.01), where nurses

with active coping styles were found to have a higher score on the CSE scale and

passive coping styles had a negative impact on the CSE score.

The mediating role of coping styles on the relationship between

CSE and emotional exhaustion

As shown in Table 3, both CSE score and active coping style were negatively

associated with emotional exhaustion (b520.500 and 20.148, respectively,

P,0.01), the higher the score on the CSE scale and the more active coping style a

nursing professional had, the lower the chance of emotional exhaustion.

Conversely, a positive correlation between emotional exhaustion and passive

coping style was observed in our subjects (b50.308, P,0.01). Importantly, coping

Table 1. Demographics and working variables of the subjects and distribution of the MBI-GS.

Variable N(%) Mean(SD)

Emotional exhaustion Cynicism Professional efficacy

Gender P50.011 P50.010 P50.161

Male 60(3.8%) 11.58(7.19) 7.57(5.06) 24.42(9.58)

Female 1499(96.2%) 14.28(8.05) 9.67(6.20) 25.90(7.95)

Age (yr) P50.011 P50.037 P50.004

,30 1027(65.9%) 14.41(7.81) 9.46(6.00) 25.39(8.02)

30–40 334(21.4%) 14.42(8.27) 10.31(6.60) 26.42(7.37)

.40 198(12.7%) 12.58(8.60) 9.03(6.27) 27.21(8.87)

Education level P50.210 P50.099 P50.007

High school or under 213(13.7%) 13.29(7.67) 9.08(5.94) 24.93(8.68)

Junior college 840(53.9%) 14.37(7.83) 9.44(6.00) 25.54(7.87)

Undergraduate or above 506(32.5%) 14.23(8.49) 10.04(6.54) 26.71(7.91)

Work experience(years) P50.000 P50.026 P50.003

,5 862 (55.2%) 14.10(7.64) 9.35(5.85) 25.18(8.06)

5–10 326 (20.9%) 15.14(8.41) 9.99(6.55) 26.30(7.22)

10–15 88 (5.6%) 15.92(7.54) 11.22(6.59) 27.05(6.26)

.15 283 (18.2%) 12.75(8.67) 9.34(6.48) 26.94(8.65)

Job rank P50.029 P50.209 P50.000

Junior nurse 756 (48.5%) 13.98(7.57) 9.31(5.78) 24.83(8.26)

Senior nurse 533 (34.2%) 14.86(8.17) 9.81(6.43) 26.72(7.15)

Nurse-in-charge 270 (17.3%) 13.36(8.91) 9.94(6.71) 26.93(8.62)

doi:10.1371/journal.pone.0115799.t001

Core Self-Evaluation and Burnout

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styles (Active coping/Passive coping) had a partial mediating effect on the

relationship between CSE and emotional exhaustion, in that the regression

coefficient for CSE was reduced when coping styles were added to the model

(from b50.500 to b50.396). The result of the Sobel test confirmed the

significance of the mediating effect of active coping (z525.66, P,0.001) and

passive coping (z526.44, P,0.001). In addition, gender, age, and job rank

affected emotional exhaustion.

The mediating role of coping styles on the relationship between

CSE and cynicism

As shown in Table 4, both CSE and active coping style were negatively associated

with cynicism (b520.390 and 20.107, respectively, P,0.01). However, negative

coping style was positively associated with cynicism (b50.288, P,0.01). Coping

style not only directly impacted the cynicism score, but also affected it indirectly

by partially mediating the relationship between CSE and cynicism. The regression

Table 2. Means, standard deviations (SD) and correlations of all variables.

Variables Mean SD 1 2 3 4 5 6

1 Emotional exhaustion 14.18 8.03 1

2 Cynicism 9.59 6.18 0.704** 1

3 Professional efficacy 25.84 8.02 0.027 0.001 1

4 Core self-evaluation 40.47 5.34 20.343** 20.345** 0.282** 1

5 Active coping 24.11 5.38 20.156** 20.144** 0.271** 0.314** 1

6 Passive coping 9.96 4.13 0.206** 0.239** 20.095** 20.254** 0.171** 1

*P,0.05, **P,0.01 (two-tailed).

doi:10.1371/journal.pone.0115799.t002

Table 3. Results of hierarchical linear regression analyses, with emotional exhaustion as the criterion variable.

Variables Emotional Exhaustion

Step 1(b) Step 2(b) Step 3(b)

Gender 2.745** 2.628** 2.812**

Age 20.316** 20.265** 20.273**

Work experience(years) 0.116 0.096 0.103

Job rank-1 1.623** 1.675** 1.847**

Job rank-2 2.454* 2.384* 2.718**

Core self-evaluation 20.500** 20.396**

Active coping 20.148**

Passive coping 0.308**

R2 0.020 0.134 0.158

D R2 0.020 0.114 0.024

Note: Job rank-1 indicates ‘‘senior nurse’’ vs. ‘‘junior nurse’’, Job rank-2 indicates ‘‘nurse-in-charge’’ vs. ‘‘junior nurse’’. *P,0.05, **P,0.01 (two-tailed).

doi:10.1371/journal.pone.0115799.t003

Core Self-Evaluation and Burnout

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coefficient for CSE in relation to cynicism score was reduced from 0.39 to 0.303

(P,0.01) when coping styles were added to the regression analysis. The result of

the Sobel test supported the significance of the mediating effect of active coping

(z525.26, P,0.001) and passive coping (z527.00, P,0.001). In addition,

gender, age, and work experience also affected cynicism.

The mediating role of coping styles on the relationship between

CSE and professional efficacy

The impact of coping styles on professional efficacy is shown in Table 5. Both CSE

and active coping style were positively associated with professional efficacy (b5

0.413 and 0.329, respectively, P ,0.01). However, passive coping style was

negatively associated with professional efficacy (b5 20.148, P ,0.01). More

importantly, coping styles (active coping/passive coping) indirectly affected

professional efficacy by partially mediating the relationship between CSE and

professional efficacy, in that the regression coefficient for CSE decreased when

active coping/passive coping was added to the regression analysis (from b50.413

to b50.283, P,0.01). The result of the Sobel test supported the significance of the

mediating effect of active coping (z58.47, P,0.001) and passive coping (z53.54,

P,0.001).

Discussion

This study investigated the relationship between CSE, coping styles, and burnout

dimensions among Chinese nurses, and demonstrated that CSE was an integrated

personality variable that may affect job burnout, and coping styles might have

both a direct and indirect effect on burnout. Our data suggest that strategies

which promote active coping styles among nursing professionals may help to

reduce job burnout, and thus enhance nursing efficacy. With regard to the

relationship between CSE and burnout, CSE was shown by our study and others

Table 4. Results of hierarchical linear regression analyses, with cynicism as the criterion variable.

Variables Cynicism

Step 1(b) Step 2(b) Step 3(b)

Gender 2.082* 1.998** 2.194**

Age 20.195* 20.155* 20.159*

Work experience(years) 0.167* 0.149* 0.164*

Core self-evaluation 20.390** 20.303**

Active coping 20.107**

Passive coping 0.288**

R2 0.008 0.126 0.159

D R2 0.008 0.117 0.033

*P,0.05, **P,0.01 (two-tailed).

doi:10.1371/journal.pone.0115799.t004

Core Self-Evaluation and Burnout

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[13, 14] to be a possible predictor of job burnout. This was supported by our data

which showed that nurses with higher CSE scores had less emotional exhaustion

and cynicism and higher professional efficacy. CSE is a deep personality trait.

Those with higher CSE scores will always have higher self-confidence and esteem,

and a more positive attributive style [13], which may result in lower levels of

emotional exhaustion and cynicism. CSE reflects the long-term faith of

individuals in their ability to maintain a stable self and a sense of control, which

are important in the evaluation of individual ability [34, 35]. Thus, those with a

higher CSE score might have a higher level of professional efficacy.

Positive factors relating to the prevention of nursing burnout such as hardiness,

active coping, and social support were found to be the most important buffering

factors [4]. In the present study, active coping was negatively associated with

emotional exhaustion and cynicism, and was positively associated with

professional efficacy. These findings contribute to the understanding that coping

styles have a significant effect on burnout, and active coping may be a positive

resource for combating burnout.

As shown in Table 3, as passive coping increased, emotional exhaustion scores

increased accordingly. This is consistent with Gibbons’ study [36], where active

coping and older age played a clear role in decreasing vulnerability to emotional

exhaustion and cynicism. It appears that younger nurses experience more burnout

than their older colleagues. This may indicate that with increased life experience,

individuals might have a lower tendency to use passive coping styles and more

confidence, thus have less burnout. Active coping is helpful in preventing

cynicism, and this is in agreement with a previous study which found that active

coping style can decrease the negative impact of stressors by strengthening one’s

Table 5. Results of hierarchical linear regression analyses, with professional efficacy as the criterion variable.

Variables Professional efficacy

Step 1(b) Step 2(b) Step 3(b)

Age 20.153 20.189 20.180

Work experience(years) 0.126 0.131 20.131

Education-1 0.537 0.664 0.767

Education-2 0.935 1.161 1.272

Job rank-1 1.882** 1.856** 1.673**

Job rank-2 1.984 2.061 1.533

Core self-evaluation 0.413** 0.283**

Active coping 0.329**

Passive coping 20.148**

R2 0.018 0.096 0.136

D R2 0.018 0.078 0.041

Note: Job rank-1 indicates ‘‘senior nurse’’ vs. ‘‘junior nurse’’, Job rank-2 indicates ‘‘nurse-in-charge’’ vs. ‘‘senior nurse’’. Education-1 indicates ‘‘Junior college’’ vs. ‘‘High school or under’’, Education-2 indicates ‘‘Undergraduate or above’’ vs. ‘‘High school or under’’. *P,0.05, **P,0.01 (two-tailed).

doi:10.1371/journal.pone.0115799.t005

Core Self-Evaluation and Burnout

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coping efficacy and dynamics in a specific situation [4]. Dysfunctional coping

strategies in nurses results in the deterioration of nurse-patient relationships, and

failures are increasingly experienced leading to a gradual sense of lack of personal

accomplishment [4]. Nurses who usually face disease, death and other situations

tend to develop emotionally-negative characteristics, and feelings of emotional

exhaustion. If no effective resources are adopted to cope with exhaustion, this will

lead to cynicism and reduced professional efficacy. Conversely, when a successful

coping style is adopted (e.g., active coping), nurses can achieve their goals and

professional efficacy improves. Moreover, Folkman and Lazarus [31] stated that

the problem-solving coping style can result in an improvement in the person-

environment relationship, thus achieving a better cognitive appraisal and a more

positive emotional response. An optimistic coping strategy can result in nurses

using problem solving to deal with their difficulties to effectively reduce their

stress levels [37].

Our study revealed that coping styles (Active coping/Passive coping) partially

mediated the effects of CSE on emotional exhaustion, cynicism and professional

efficacy. Nurses with lower CSE might be more likely to use passive coping which

in turn leads to higher levels of emotional exhaustion and cynicism, and lower

levels of professional efficacy. Compared to changing the CSE score in nurses, it

might be more positive and feasible for hospitals to conduct nurse training on

problem-solving skills with the goal of helping nurses develop and employ active

coping styles to deal with the stress they face at work. This type of training would

be expected to improve nurses’ health and well-being and to reduce professional

burnout, and thus improve the quality of healthcare.

Although the present study demonstrates the important role of self-evaluation

and coping styles on job burnout among Chinese nursing professionals, there are

limitations regarding the design of the study. Firstly, we conducted this study in

large general hospitals, which may not necessarily reflect the burnout experienced

by nurses in different hospitals and community health centers. Secondly, the study

relied only on self-report measures which may have introduced bias. Therefore,

future studies in different hospitals and consisting of more objective parameters,

such as behavioral and physiological indicators, as well as broader influencing

factors, will provide more insightful knowledge regarding the inter-relationships

between self-evaluation, coping styles, and nursing burnout. In addition, this was

a cross-sectional study, thus the causality could not been established in this study.

Prospective studies should be conducted in the future to confirm the findings

obtained in this study.

Conclusions

The present study demonstrated that CSE may be a possible predictor of job

burnout among nursing professionals, indicating that nurses with a high CSE

score display less burnout. More importantly, coping style might be an important

factor which can affect burnout directly or indirectly by partially mediating the

Core Self-Evaluation and Burnout

PLOS ONE | DOI:10.1371/journal.pone.0115799 December 26, 2014 10 / 12

relationship between CSE and job burnout. Our results suggest that when active

coping strategies are adopted, burnout is likely to be reduced. Therefore,

interventions focused on the improvement of coping strategies may be helpful in

the prevention of job burnout in nurses, thus enhancing nursing care efficacy.

Supporting Information

S1 Table. The clinical data of 1559 nurses, which were analyzed in this study.

doi:10.1371/journal.pone.0115799.s001 (XLS)

Acknowledgments

We would like to give our heartfelt thanks to all the nurses who participated in

this study.

Author Contributions Conceived and designed the experiments: XFL BZ. Performed the experiments:

HC LG. Analyzed the data: HC. Contributed reagents/materials/analysis tools:

XFL LG. Wrote the paper: XFL BZ.

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