article

The influence of areas of worklife fit and work-life interference on burnout and turnover intentions among new graduate nurses

SHEILA A. BOAMAH R N , M N 1 and HEATHER LASCHINGER R N , P h D , F A A N 2

1Doctoral Student, Arthur Labatt Family School of Nursing, The University of Western Ontario, London, ON, Canada, and 2Distinguished University Professor, Arthur Labatt Family School of Nursing, The University of Western Ontario, London, ON, Canada

Correspondence Heather Laschinger

Arthur Labatt Family School of Nursing Health Sciences Addition University of Western Ontario London ON Canada, N6A 5C1 E-mail: [email protected]

BOAMAH S.A. & LASCHINGER H. (2015) Journal of Nursing Management The influence of areas of worklife fit and work-life interference on burnout and turnover intentions among new graduate nurses

Aim To examine the relationships among the overall person-job match in the six areas of worklife, work-life interference, new nurses’ experiences of burnout and intentions to leave their jobs. Background As a large cohort of nurses approaches retirement, it is important to understand the aspects of the nurses work-life that are related to turnover among new graduate nurses to address the nursing workforce shortage. Methods Secondary analysis of data collected in a cross-sectional survey of 215 registered nurses working in Ontario acute hospitals was conducted using structural equation modelling. Results The fit indices suggested a reasonably adequate fit of the data to the hypothesised model [v2 = 247, d.f. = 122, P = 0.001, v2/d.f. = 2.32, Incremental Fit Index (IFI) = 0.954, Comparative Fit Index (CFI) = 0.953, Root Mean Square Error of Approximation (RMSEA) = 0.06]. Person-job match in six areas of worklife had a direct negative effect on burnout (emotional exhaustion and cynicism), which in turn had a direct positive effect on turnover intentions. Work-life interference also influenced turnover intentions indirectly through burnout. Conclusion The study findings demonstrate that new graduate nurses’ turnover intentions are a recurring problem, which could be reduced by improving nurses’ working conditions. Retention of new graduate nurses could be enhanced by creating supportive working environments to reduce the susceptibility to workplace burnout, and ultimately, lower turnover intentions. Implications for Nursing Management Managers must employ strategies to enhance workplace conditions that promote a person-job fit and work-life balance to improve retention of new graduate nurses, and, thereby, lessen the nursing shortage.

Keywords: areas of worklife, burnout, retention, turnover intentions, work-life interference

Accepted for publication: 30 April 2015

Introduction

The worldwide shortage in the nursing workforce is well documented. The Canadian Nurses Association indicates that Canada may confront a shortage of

60 000 nurses by 2020 as a significant proportion of nurses near retirement age. In addition, 60% of cur- rently employed new graduate nurses will leave their jobs in the first year of employment (Beecroft et al. 2008, Brewer et al. 2011), further affecting the

DOI: 10.1111/jonm.12318

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Journal of Nursing Management, 2015

shortage of nurses available to care for patients (Hayes et al. 2006). Several studies have reported work-life issues such as stressful work environments and inadequate human resource management as major contributing factors to new nurses’ decisions to leave their jobs. Poor work environments have been linked to a number of deleterious and costly individual and organizational outcomes, such as job dissatisfaction, burnout, absenteeism, decreased productivity, poor care quality and increased turnover (Tourangeau et al. 2002, Hayes et al. 2006). These concerns have sus- tained a continuing interest in assessing the nurse work environment to ensure that the working condi- tions of newly graduated nurses are positive to foster retention of nurses and lessen the workforce shortage. Research suggests that new graduate nurses experi-

ence a great degree of stress associated with profes- sional role adjustment and adaptation such as staffing shortages, unsafe nurse–patient ratios, man- datory overtime and unsupportive work environments for which they are unprepared (Bowles & Candela 2005, Griffin 2005, Boychuck-Duchscher 2008, Scott et al. 2008). As a result, newly graduated nurses experience a mismatch between their ideals for work and their actual work – a transition often character- ised as a period of reality shock (Boychuck-Duch- scher 2008). This transition period for new nurses is considered a vulnerable time in which they form decisions about their intent to commit to their orga- nization and/or the profession (Beecroft et al. 2006, Lavoie-Tremblay et al. 2008). Recent studies have identified that up to 50% of new nurses change jobs within the first year of initial employment (Winfield et al. 2009), about 13% consider leaving their jobs (Kovner et al. 2006) and some leave the profession altogether (Bowles & Candela 2005, Scott et al. 2008). Numerous factors have been linked to new nurses’ turnover including heavy workload, high-level stress and burnout (Hayes et al. 2006, Laschinger 2012). Burnout among nurses has been identified as a key factor in nurses’ intention to leave their jobs and/or the nursing profession (Aiken et al. 2002). In a study with Canadian new graduate nurses, Cho et al. (2006) found that 66% of new nurses experi- enced severe burnout. Further, Aiken et al. (2002) reported that nurses experiencing high levels of burn- out intend to leave their current positions within a year in the United States. Recently, Rudman and Gu- stavsson (2011) found that 50% of Swedish new graduate nurses encountered severe burnout, which in turn, increased their intentions to leave their jobs in the first year of practice.

Studies indicate that work interference with personal life also influences nurses’ decision to leave the profes- sion (Greenhaus et al. 2006) owing to job dissatisfac- tion and psychological distress. Work-life balance is commonly thought to promote individuals’ psycholog- ical well-being and overall sense of satisfaction. In contrast, work-life imbalance culminates in high levels of stress, which affect the quality of life, and eventu- ally reduces individuals’ work effectiveness (Greenhaus et al. 2003). While many studies have linked turnover intentions to unsupportive work environments, job dissatisfaction and burnout, the impact of the work- life interference has received little attention to date. Given the critical shortage of nurses in the current workforce worldwide, research and leadership atten- tion is warranted. Therefore, the purpose of this study was to test a model linking new graduate nurses’ over- all person-job fit in the six areas of worklife and work-life interference to burnout and subsequently, job turnover intentions.

Theoretical framework for the study

This study uses a theoretical framework that inte- grates Maslach and Leiter’s (1997) areas of the worklife model and Greenhaus et al.’s (2003) theory of work-life balance. Maslach and Leiter (1997) theor- ised that a person-job match in six areas of worklife is central to the employees’ degree of engagement in work or burnout. The six areas include manageable workloads, control over work, rewards for contribu- tion, fair treatment, a sense of community and congru- ence between personal and organisational values. A ‘manageable workload’ refers to the job-related physi- cal and emotional demands an employee encounters under time and resource constraints. ‘Control’ is the professional capability of employees to make impor- tant decisions about their work, as well as their ability to gain access to resources necessary to do their job effectively. ‘Reward’ is the extent to which an employ- ee’s expectations are fulfilled by the social reward sys- tem; and this can be both intrinsic and extrinsic. ‘Community’ is the quality of social interaction at work, including relationships with colleagues, manag- ers and subordinates. ‘Fairness’ is the extent to which the decision-making process at work is perceived by employees as being impartial and the existence of managerial support in the organization. Moreover, finally, ‘values’ represent how an organization’s priori- ties and ethics are congruent with those of the employee (Maslach & Leiter 1997). Maslach and Leit- er (1997) argue that when an employee experiences

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high levels of these six areas of worklife, it reflects a high person-job match and, therefore, s/he is less likely to experience burnout. In contrast, chronic mis- matches or incongruences in these six areas can result in burnout. Studies have consistently supported the relationship

between person-job fit with these six worklife factors and work-related outcomes in nursing. Cho et al. (2006) found that a good fit with the six areas of worklife was related to lower emotional exhaustion, which in turn, affected organizational commitment. In contrast, a mismatch in one or more of the areas of work-life, such as unmanageable workload, has been most strongly related to new nurse emotional exhaus- tion (Cho et al. 2006) and feelings of cynicism in employees (Leiter & Maslach 2004). Laschinger and Grau (2012) tested a model linking workplace factors including the six areas of worklife and an intraper- sonal resource factor (psychological capital) to new graduate nurses mental and physical health outcomes. Unmanageable workload and perceived lack of fair- ness predicted emotional exhaustion among new grad- uate nurses, which subsequently influenced their physical and mental health. Greco et al. (2006) found similar results in a sample of experienced acute care nurses. Other studies have reported the relationship between person-job match in the areas of worklife and turnover intentions through burnout (Leiter & Maslach 2009). These findings are consistent with the areas of worklife model, and suggest ways that organi- zations can address situational variables that affect employees’ relationships with their work but do not address personal factors, such as work-life interfer- ence, that may influence the way new nurses experi- ence stress at work; and subsequently, their intentions to remain in their positions.

Work-life interference

Work-life interference is an important factor in deter- mining organisational commitment, job satisfaction and turnover (Akintayo 2010). Parasuraman and Greenhaus (1997) define work-life interference as a form of inter-role conflict whereby the demands of one’s work and the demands of personal life are mutually incompatible, such that meeting demands in one domain (i.e. work) makes it difficult to meet demands in the other (i.e. home). A lack of balance between work and non-work activities is often associ- ated with lower psychological and physical well-being (Frone et al. 1997). Frone et al. (1997) demonstrated that work-related stressors primarily cause work-life

interference. Work-life interference can lead to feelings of frustration and negative job and health outcomes, such as job dissatisfaction and psychological distress (Allen et al. 2000). Studies have found that work demands such as workload, number of hours worked, shift work and overtime are strongly associated with work-life interference among nurses (Burke 2002, Van der Heijden et al. 2008). Specifically, nurses with a heavy workload and irregular work schedules are more likely to experience work-life interference as compared with their counterparts, and thus are less satisfied with their job and life (Burke & Greenglass 2001, Simon et al. 2004). In a study of US nurses, Grzywacz et al. (2006) reported 92% experienced work interference with the family. High levels of work-life interference have been associated with job dissatisfaction (Kovner et al. 2006), absenteeism, somatic problems and psychological burnout (emo- tional exhaustion and cynicism) among nurses. Studies have found that work-life interference influences nurses’ personal health and ability to provide quality patient care, which in turn, may lead to job dissatis- faction and ultimately, affect their decision to remain in their job (Grzywacz et al. 2006).

Burnout

Burnout is defined as a psychological response to chronic job stressors, which consists of three compo- nents: ‘emotional exhaustion’, ‘cynicism’ and ‘ineffi- cacy’ (Leiter & Maslach 2004). Emotional exhaustion is considered the main component of burnout, which results in cynicism toward one’s work and colleagues, and low efficacy levels (Leiter & Maslach 2004). High nurse burnout has been linked to negative organisa- tional outcomes such as increased absenteeism, decreased patient and job satisfaction (Leiter et al., 1998) and higher job turnover intentions (Parker & Kulik 1995). A study of Australian nurses revealed that younger graduate nurses were most vulnerable to experiencing burnout, and that management support was key in lowering emotional exhaustion (Spooner- Lane & Patton 2007). In burnout research, role con- flict has consistently been associated with employee burnout (Leiter & Maslach 2004). Individuals experi- ence role conflict when there is an enduring mismatch of the person and the work. When individuals lack sufficient time and support to accomplish their work, they are more likely to experience chronic exhaustion. As a result, such chronic exhaustion may have an emotional impact, which in turn may erode the dis- tinction between the employee’s personal life and their

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work (Leiter & Maslach 2004), and subsequently, the individual is likely to seek employment elsewhere.

Turnover intention

Turnover research has shown that an employee’s self- expressed intentions to leave their job are the best pre- dictor of actual turnover (Beecroft et al. 2008). High turnover intentions among newly graduated nurses are a major concern because they can result in high costs to the organization and impact negatively on an orga- nization’s capability to meet patient care needs (Hayes et al. 2006). Several studies have examined the rela- tionships between characteristics of the work environ- ment and turnover intentions and actual turnover among new graduate nurses (Halfer & Graf 2006, Kovner et al. 2006, Beecroft et al. 2008, Laschinger 2012). In a study with Canadian new graduate nurses, Lavoie-Tremblay et al. (2008) found the job turnover rate among nurses to be as high as 62%. Equally alarming, Scott et al. (2008) found that within 3 years of practice, 45% of new nurses intend to leave their current positions, compared with Beecroft et al. (2008) who reported that 35% of new graduate nurses intended to leave their position within a year. Although studies have shown that a small proportion of new graduate nurses intends to leave the profession, an increase in turnover intentions poses a huge con- cern because it is a consistent and immediate precur- sor to actual employee turnover, which in turn, leads to a further shortage of nurses.

Hypothesized model

Based on theory and empirical research linking the six areas of worklife and work-life interference to burnout, we suggest that individuals who experience greater person-job fit with Leiter and Maslach’s (2004) areas of worklife, and lower levels of work- life interference will experience lower levels of burnout and subsequently, lower turnover intentions

(Figure 1). In particular, we hypothesise that new graduate nurses’ experience of work-life interference will be positively related to their likelihood of devel- oping burnout (emotional exhaustion and cynicism) in their first 2 years of employment, which in turn, will lead to an increase in their intention to leave their job.

Methods

Design and sample

A predictive, non-experimental survey design was used to examine the relationships described in the study model. We tested the model using data from a larger study of Canadian registered nurses’ work-life well- being. New graduate nurses in Ontario (n = 215) in the second wave of a larger study (n = 1015) consti- tuted the sample for this study. A modified version of the Total Design Method (Dillman 2007) was used to maximise response rates. Nurses received a survey package mailed to their home that included a letter explaining the study, a questionnaire, return envelope and coffee voucher. In 4 weeks after the initial mail- ing, a reminder letter was sent, followed by a second questionnaire 4 weeks later, a replacement question- naire package was sent to all non-responders. Data for this study were collected from July to October 2013. The study was approved by the research ethics board at the University of Western Ontario.

Measures

The measures in the study were standardised question- naires with acceptable psychometric properties and demonstrated construct validity (Schaufeli et al. 1996, Kelloway et al. 1999, Leiter & Maslach 2004, Hay- man 2005). Internal consistency reliabilities (Cron- bach’s alpha) for all scales are reported in Table 2 and all alpha coefficients were within acceptable ranges.

Turnover intentions

Burnout

Areas of worklife fit

Work-life interference Figure 1

Hypothesised model proposing the direct relationship.

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The ‘Areas of Worklife Scale’ (AWS) (Leiter & Mas- lach 2004) was used to measure nurses’ person-job match in six areas of worklife. The AWS consists of 18- items measuring the six areas of worklife: manageable workload (three items), control (three items), reward (three items), community (three items), fairness (three items), and values (three items). Items are measured on a five-point Likert scales with rating from 1 (strongly disagree) to 5 (strongly agree). A person-job match is reflected by a score >3.0 (Leiter & Maslach 2004) and misfit between the worker and the workplace as a low score of <3.0. The mean of each subscale is summed to produce a measure of the overall degree of the match in the areas of worklife with a possible score ranging from 6 and 30. Acceptable Cronbach alpha values have been reported for the AWS ranging from 0.70 to 0.82 (Leiter & Maslach 2004). Work-life interference was measured using the

‘Work Interference with Personal Life (WIPL) Scale’ developed by Fisher-McAuley et al. (2003) and vali- dated by Hayman (2005). The WIPL consists of seven-items measuring the balance between individ- ual’s professional and personal life using a seven-point Likert scale ranging from 1 = not at all to 7 = all the time. A high score indicated higher levels of interfer- ence and low levels of interference are interpreted as satisfaction with the overall work-life balance. Accept- able Cronbach’s alpha of 0.93 has been reported for the WIPL (Hayman 2005). New graduate burnout was assessed using the emo-

tional exhaustion and cynicism subscales of the ‘Mas- lach Burnout Inventory-General Survey’ (MBI-GS) (Schaufeli et al. 1996). Each subscale consists of five items rated on a seven-point Likert scale ranging from never (0) to daily (6). A sample of an item includes, ‘I feel emotionally drained from work’. Burnout is reflected in higher scores on emotional exhaustion and cynicism. Previous research using the MBI-GS among nurses suggests that it is highly reliable with reported Cronbach’s alpha levels of 0.92 for emotional exhaus- tion and 0.85 for cynicism (Laschinger & Grau 2012). Similar studies have reported alpha coefficients for this scale ranging from 0.88 to 0.89 (Cho et al. 2006, Greco et al. 2006). The outcome variable, intention to leave job, was

measured using three items adapted from Kelloway et al.’s (1999) ‘turnover intention scale’. A sample of items include, ‘I plan on leaving my job within the next year’, ‘I have been actively looking for other jobs’, and ‘I do not want to remain in my job’. These items were rated on a Likert scale ranging from strongly disagree (1) to agree strongly (5). The scale has acceptable

internal consistency (Cronbach alphas = 0.87 and 0.92) and constructs validity in samples of new graduate nurses (Laschinger & Grau 2012).

Statistical analysis

Statistical analysis was conducted using the StataCorp software (version 13.0) (StataCorp, College Station, TX, USA). Descriptive and inferential analyses of major study variables as well as Cronbach alpha reliability of study instruments were conducted. The hypothesised model in this study was analysed using path analysis within structural equation modelling (SEM) procedures using the AMOS (Arbuckle 1997) program (version 21). Major study variables were modelled as latent vari- ables with their respective indicators. A sample size of 100–200 is recommended (Hoyle 1995) to have confi- dence in the goodness-of-fit tests. In addition, a model should contain 10–20 times as many observations as variables (Mitchell 1993), thus, our sample size of 215 participants for four variables in our model was consid- ered to be sufficient to detect significant effects. There are several criteria to evaluate model fit, including omnibus fit indices such as the chi-square (v2) and the chi-square/degrees of freedom ratio (v2/d.f.), and incre- mental fit indices such as the Incremental Fit Index (IFI) (Bollen 1989), and the Comparative Fit Index (CFI) (Bentler & Bonett 1980). Although low chi-square val- ues are preferred in this analysis, chi-square is sensitive to sample size, and thus, in a model with a relatively large sample size, the null hypothesis is expected to be rejected almost all of the time. Owing to this limitation, the chi-square was used only to evaluate the relative dif- ferences in fit among competing models. The generally agreed upon critical value for the CFI and IFI is 0.90 or higher (Kline 1998). Also, the Root Mean Square Error of Approximation (RMSEA) (Browne & Cudeck 1989) was used as a measure of the lack of fit between the data and the model, and values between 0.00 and 0.06 indicate a good fitting model (Hu & Bentler 1999). To estimate the significance of indirect effects in the model, the bias-corrected bootstrapping method was per- formed because this procedure has greater statistical power in small samples (Cheung & Lau 2008).

Results

Participants

The demographic profile for the sample of new gradu- ates is presented in Table 1. The majority of nurses were female (90%), averaging 27 years of age and

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1-year nursing experience as a registered nurse. Most held a baccalaureate nursing degree (99%). Approxi- mately 45% worked in medical–surgical units and 19% on critical care units. They worked primarily in full-time (63%) or part-time (33%) positions and worked between 20 and 39 h per week (54%). Approximately, 45% of nurses intend to stay in their

current position within 3–10 years whereas others (45%) intend to stay active in their position for <3 years.

Descriptive statistics and correlations

The means, standard deviations (SDs) and Cronbach’s alpha reliabilities, and correlation matrix for the major study variables are presented in Table 2. Over- all, new graduate nurses perceived a relatively good fit between their expectations for practice and the reality of the six areas of worklife in their work environment (mean = 3.29, SD = 0.52). Nurses’ perception of a sense of community had the best fit with their experi- ence (mean = 3.75, SD = 0.84), while manageable workload and fairness were the farthest from their expectations (mean = 2.59, SD = 0.87; mean = 2.95, SD = 0.67, respectively). Nurses also perceived a per- son-job fit in rewards, control and value congruence, respectively (mean = 3.51, SD = 0.92; mean = 3.47, SD = 0.69; mean = 3.44, SD = 0.81). Manageable workloads were most strongly related to emotional exhaustion, and a sense of community and rewards were most strongly related to both burnout compo- nents (see Table 2). Forty-six per cent of the nurses in this study were in

the severe burnout category according to Maslach et al.’s (1996) norms (score >3.0). On average, nurses reported high levels of emotional exhaustion (mean = 3.32, SD = 1.58). Scores for cynicism for nurses in the current study were relatively low (mean = 1.70, SD = 1.66), with only 18% scoring above the 3.0 cut point. The nurses in our sample reported moderate levels of work-life interference (mean = 3.54, SD = 1.47) and low intentions (mean = 2.47, SD = 1.29) to leave their current jobs.

Table 1 Descriptive statistics of respondents (n = 215)

Demographics Mean SD

Age 27.61 6.95 Years of experience on current unit 0.69 0.56 Years of experience in nursing 1.00 0.42

Frequencies Count %

Gender Female 193 89.77 Male 22 10.23

Highest education level attained BSc N 214 99.53 Masters in nursing 1 0.47

Unit specialty Med-surg 96 44.65 Critical care 40 18.60 Maternal-child 13 6.05 Mental health 13 6.05 Float pool or nursing resource unit 16 7.44 Community health 16 7.44 Long-term care 16 7.44 Geriatric/Rehab 5 2.33

Current employment status Full-time 134 62.91 Part-time 71 33.33 Casual 8 3.76

Average hours worked per week ≤19 10 4.67 20–39 115 53.74 ≥40 89 41.59

Expect to stay active in current position <3 years 97 45.13 3–10 years 97 45.13 >10 years 21 9.74

Table 2 Means, standard deviations and correlations for study variables

Variable M SD a 1 2 3 4 5 6 7 8 9 10 11

1. Areas of worklife 3.29 0.52 0.70 1 2. Workload (WKLD) 2.59 0.87 0.73 0.47 1 3. Control (CON) 3.47 0.69 0.57 0.71 0.27 1 4. Reward (REW) 3.51 0.92 0.81 0.75 0.20 0.36 1 5. Community (CMTY) 3.75 0.84 0.73 0.75 0.19 0.41 0.62 1 6. Fairness (FAIR) 2.95 0.67 0.40 0.57 0.01* 0.42 0.27 0.31 1 7. Value (VAL) 3.44 0.81 0.81 0.68 0.07* 0.44 0.41 0.38 0.44 1 8. Emotional exhaustion (EXH) 3.32 1.58 0.92 !0.56 !0.53 !0.32 !0.42 !0.42 !0.21 !0.26 1 9. Cynicism (CYN) 1.70 1.66 0.92 !0.63 !0.29 !0.41 !0.49 !0.54 !0.31 !0.43 0.69 1 10. Work-life interference 3.54 1.47 0.92 !0.41 !0.47 !0.26 !0.24 !0.23 !0.20 !0.18 0.57 0.43 1 11. Job turnover 2.47 1.29 0.87 !0.59 !0.20 !0.40 !0.48 !0.46 !0.34 !0.42 0.54 0.64 0.38 1

Correlation is significant at P < 0.05 (two-tailed) *not significant.

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Test of the hypothesized model

The final model revealed a good fit (v2 = 247, d.f. = 122, P = 0.001, v2/d.f. = 2.32, IFI = 0.95, CFI = 0.95, RMSEA = 0.06). As illustrated in Fig- ure 2, the person-job fit in the six areas of worklife had a significant negative direct effect on workplace burnout (b = –0.71, P < 0.001), which in turn, had a significant positive effect on turnover intentions (b = 0.77, P < 0.001). As hypothesised, work interfer- ence with life domains had a direct positive effect on burnout (b = 0.30, P < 0.001). The standardised direct and indirect effects are presented in Table 3 and direct effects are illustrated in Figure 2. The results from 5000 bootstrapping samples showed a significant indirect relation between areas of worklife fit and turnover intentions through burnout (b = !0.54; 95% CI: !0.65 to !0.41). Also, burnout mediated the effect of work-life interference on turn- over intentions (b = 0.22; 95% CI: 0.12–0.32). The results provide support for the hypothesized model.

The final model explained 46% of the variance in turnover intentions.

Discussion

The purpose of this study was to investigate the extent to which nurses’ overall person-job fit in the six areas of worklife and work-life interference are related to their job turnover intentions through experience of burnout (emotional exhaustion and cynicism) within the first 2 years of practice. To our knowledge, this is the first study to link empirically areas of worklife and new graduates’ experiences of worklife interfer- ence to burnout, and its subsequent influence on turn- over intentions. The results of this study highlight the role of both structural (areas of worklife) and personal (work-life interference) factors in jointly influencing new graduate nurses’ intention to stay in their jobs. Our findings support Maslach and Leiter’s contention that organisational structures within the workplace play an important role in shaping and enhancing

Model Fit Statistics: χ2 = 247, d.f. = 122, P = 0.001, χ2/d.f. = 2.32, IFI = 0.95, CFI = 0.95, RMSEA = 0.06

Exhaustion Cynicism

Fairness

Workload

0.87

0.48 Turnover intentions

β = 0.77

β = 0.30

β = 0.71

Control 0.32

0.60 0.72

0.74

0.59 0.78

WRKLF1 WRKLF2 WRKLF3 WRKLF4 WRKLF5 WRKLF6 WRKLF7

0.89 0.93 0.89 0.300.850.860.89

JOBTO1 JOBTO2 JOBTO3

0.93 0.79 0.91

Reward Community

Value

Burnout

Areas of worklife

Work-life interference

Figure 2 Final study model proposing the direct relationship among areas of worklife, work-life interference, burnout and turnover intentions. Note: Standardised coefficients (P < 0.001). Bootstrap resample = 5000; percentile and bias corrected confidence intervals is on 95 percent. WRKLF1-WRKLF7 (the seven items of work-life interference); JOBTO1-JOBTO3 (the three items of turnover intentions).

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employee work life. The analysis suggests that new graduate nurses’ overall person-job fit in the six areas of worklife is an important factor influencing nurses’ intention to stay in their jobs by decreasing the likeli- hood of burnout. The mediation effect of burnout in the analysis is pivotal to understanding the impact of workplace factors on nurse outcomes, such as turn- over intentions. This finding is similar to Leiter and Maslach (2009) who linked quality of nurses’ work- life to turnover intentions, and found that nurses’ per- son-job fit in all six areas of worklife had an indirect effect on turnover intentions through burnout. Similar to findings of other studies (Leiter & Maslach 2004, Laschinger et al. 2006, Laschinger & Grau 2012), we found that overall person-job fit in the six areas of worklife predicted lower burnout. In a recent study, Laschinger et al. (2015) found that managers’ leader- ship behaviours had a positive effect on areas of worklife, which in turn had a positive effect on occu- pational coping self-efficacy, resulting in lower burn- out. The results of these studies underscore the need for nurse leaders to create healthy work environments that foster a person-job fit, which subsequently lower the development of burnout among nurses. Six areas of worklife reflect new nurses’ sense of

person-job fit between their job expectations and their actual working conditions. Perceived person-job fit in the six areas of worklife may be a protective factor in employees’ experiences at work. In this study, per- ceived sense of community in the work setting and rewards for their contributions were most strongly related to lower burnout among new graduate nurses. These relationships have been consistently demon- strated in other studies (see Laschinger et al. 2006, Laschinger & Grau 2012). A sense of community in the workplace is crucial especially for new nurses as it fosters a greater sense of trust and cohesiveness among staff. A cohesive work environment enables staff members to communicate effectively, share responsi- bilities in getting the work done and feel like valued

members of the team (DiMeglio et al. 2005). The strong relationship between unmanageable workload and burnout was not surprising and has been fre- quently shown in previous research. The nursing shortage and budget constraints culminate in inade- quate staffing and by extension heavy workload in many nursing units. Studies have found that when employees perceive their workloads to be reasonable, they are less time pressured to accomplish their work and, therefore, are less likely to experience feelings of emotional exhaustion and cynicism (Leiter & Maslach 2004). As a result, employees are less likely to leave their jobs. In this study, work-life interference was significantly

associated with higher levels of burnout among new graduate nurses. Our findings corroborates existing lit- erature, which indicates that a negative impact of work on other life domains (work-life interference) plays an important role in the extent to which employees experience burnout and subsequently, rein- force their intention to leave their job (Kelloway et al. 1999, Khan et al. 2014). Support for the relationship between work-life interference and turnover intentions through burnout is original. In this study, 81% of new graduates reported varying degrees of work inter- ference with personal life. This is consistent with research by Grzywacz et al. (2006), who found that 50% of nurses in the US suffer from chronic work- family conflict. Studies have linked work-family con- flict to lower job satisfaction (Kovner et al. 2006) and burnout among nurses (Burke & Greenglass 2001), but few studies have examined the mechanisms involved in this relationship.

Implications for Nursing Management

This study contributes to a nuanced understanding of the role of leadership in creating a positive work envi- ronment and work-life balance as concrete strategies for mitigating employee burnout and ultimately,

Table 3 Estimated coefficients for path model

Structural paths Unstandardized coefficient (b)

Standardized coefficient (b)

Standard error

Critical ratio

P- value

Direct effects Areas of worklife ? Burnout !1.805 !0.700 0.261 !6.913 <0.001 Work-life interference ? Burnout 0.724 0.295 0.218 3.318 <0.001 Burnout ? Turnover intentions 0.8.46 0.773 0.790 10.721 <0.001

Indirect effects Areas of worklife ? Turnover intentions !1.526 !0.541 0.061 – <0.001 Work-life interference ?Turnover

intentions 0.613 0.228 0.052 – <0.001

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retaining nurses. The results of this study suggest that leadership practices that foster organisational support and workplace conditions that promote person-job fit are important to new nurse retention. It is crucial for healthcare managers to encourage initiatives to ensure that new nurses have manageable workloads to pre- vent the emergence of burnout. Nurse leaders can draw on the study findings to promote a workplace culture that fosters a sense of community and involves an adequate reward system for recognising nurses’ contributions. Furthermore, work-life interference may be curtailed if organisations promote family-friendly work environments, with supervisors encouraging paid time off as a benefit, flexibility in work schedules and decreasing demands for mandatory overtime shifts. The direct effect of areas of worklife on burnout

suggest that when nurse managers create supportive working conditions, they promote a greater sense of fit between nurses’ expectations of quality work life and organizational goals, thereby lowering employees’ experience of burnout. Areas of worklife and work- life interference had a combined effect on burnout suggesting the need for managers to address both per- sonal and structural factors jointly. However, the rela- tive impact of areas of worklife fit is almost three times stronger than work-life interference indicating that greater emphasis on structural factors might potentially lead to far-reaching implications for staff retention. Although not as strong, the significance of work-life interference in this study also makes it imperative for managers to account for it and to dis- cuss strategies for new nurses that may be useful in preventing this imbalance.

Limitations

The study findings must be interpreted with caution given the limitations associated with the cross-sec- tional design and its inability to infer causality (Polit & Beck 2012). A longitudinal design would allow us to observe changes over time to better understand this process. There is potential for a response bias as a result of using self-report surveys (Polit & Beck 2012). Common method variance (CMV) may also be of concern when the same participant completes all measures in a single study. However, Spector (2006) argues that well-validated, multi-item scales decrease the likelihood of CMV. Two subscales of the areas of the worklife construct (i.e. control and fairness) had low Cronbach alpha values (a < 0.70). Several reasons potentially account for this observation of which two are pertinent. First, given that alpha depends on the

number of items on the scale, the lower Cronbach alpha values are likely due to the fewer number of items on the two subscales. Second, alpha is also affected by reverse scored items. Some of the items on the subscales were reverse coded to reduce response bias. Another limitation is that the sample obtained from the CNO database excludes some nurses from the sampling frame who refused to release their con- tact information for research purposes.

Conclusion

This study supports the theory and research suggesting that nurses’ overall person-job fit in the six areas of worklife play an important role in the extent to which employees experience burnout and subsequently increased turnover intentions. Our results contribute to a growing body of empirical evidence showing the association between work-life interference and turn- over intentions. In light of current nursing shortage, it is important for nurse managers to create workplace conditions for new graduate nurses that foster a greater sense of congruence between work-life expec- tations and reality and that do not interfere with the work-life balance. In doing so, new graduate nurses are more likely to experience success in their transi- tion to their role, thereby contributing to the retention of new nurses in the nursing workforce.

Source of funding

Canadian Institute of Health Research (267421).

Ethical approval

Approval for this study was obtained from the research ethics board at the University of Western Ontario.

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