Work-related well-being of registered nurses in South Africa
Van der Colff, Jacoba Johanna
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The nursing profession in South Africa currently faces a climate of uncertainty and change as governments struggle to contain healthcare while improving access, equity and health outcomes. These factors are placing an extra burden on people in a profession that is already encapsulated by an above-average risk environment for burnout and occupational stress. This research emerges from the need to enhance the work wellness of employees in an already burdened profession. Enhancement of work wellness depends on the successful diagnosis of burnout, work engagement and occupational stress. To be able to measure these constructs, it is important to use reliable and valid instruments, taking into account the cultural diversity in a multicultural setting such as South Africa. No validated instruments in this regard exist for the nursing profession in South Africa. Furthermore, little information is available regarding these constructs and the relationship between them, including sense of coherence and coping strategies. The general aim of this study was to validate the Maslach Burnout Inventory (MBI), the Utrecht Work Engagement Scale (UWES) and the Nursing Stress Indicator (NSI) for the nursing profession in South Africa; to analyse the differences between the levels of burnout and engagement of different biographical groups; to identify the major occupational stressors and to investigate the relationships between occupational stress, sense of coherence, coping, burnout and work engagement. A cross-sectional survey design was used, with stratified random samples (N = 818) taken of registered nurses in South Africa. The Maslach Burnout Inventory-Human Services Survey. the Utrecht Work Engagement Scale, the Nursing Stress Indicator, the Orientation to Life Questionnaire, the Coping Orientation for Problem Experienced Questionnaire, as well as a biographical questionnaire, was administered for the purpose of data collection. Cronbach alpha coefficients, exploratory factor analysis, Pearson product-moment correlations, multivariate analysis of variance (MANOVA), one-way analysis of variance (ANOVA), t-tests, descriptive statistics and multiple regression analysis were employed to analyse the data. Exploratory factor analysis with target rotations resulted in a three-factor model of burnout, consisting of exhaustion, depersonalisation and personal accomplishment, and a one-factor model of work engagement. The scales showed acceptable construct equivalence and internal consistencies for all three language groups, except for one item in the engagement scale, where a significant lower score was noticed for the African language speaking group. Practically significant differences were found in the burnout and engagement levels of registered nurses with regard to their age and rank, and in the case of work engagement, also regarding the years spent in nursing. T-tests revealed that burnout and engagement levels were influenced by the occurrence of a medical condition and a lack of specialised training, and in the case of burnout, also by longer working hours (full-time employment). Registered nurses reported significantly high levels of stress relating to staff shortage, inadequate salaries and excessive administrative duties. Lack of organisational support and job demands were the strongest predictors of burnout (emotional exhaustion and depersonalisation), together with a weak sense of coherence. Focus on and ventilation of emotions as a coping strategy was also related to emotional exhaustion. Low levels of burnout were found to be related to high levels of engagement. Multiple regression analysis revealed that occupational stress, a weak sense of coherence, approach coping, focus on and ventilation of emotions, and low seeking of emotional/social support predicted 33% of the variance in emotional exhaustion. Twenty-seven percent of the variance in depersonalisation was predicted by occupational stress, a weak sense of coherence, avoidance coping, focus on and ventilation of emotions, and a low turning to religion. Occupational stress because of job demands, a weak sense of coherence, approach coping strategies, focus on and ventilation of emotion, in the absence of avoidance as a coping strategy, predicted 17% of the variance in personal accomplishment, while low levels of occupational stress because of job demands, a weak sense of coherence, and approach coping strategies predicted 24% of the variance in engagement. Recommendations for future research were made.