Issues in Mental Health Nursing, 32:234–242, 2011Copyright © Informa Healthcare USA, Inc.ISSN: 0161-2840 print / 1096-4673 onlineDOI: 10.3109/01612840.2010.546494

Burnout, Social Support, and Job Satisfaction amongJordanian Mental Health Nurses

Shaher H. HamaidehThe Hashemite University, Al-Zarka, Jordan

Burnout occurs in occupations, such as nursing, where a signif-icant proportion of time is spent in close involvement with otherpeople. Mental health nursing has been considered an area thatis subjected to high levels of burnout. Burnout in mental healthnursing affects both individuals and organizations. The purposesof this study were to measure the levels of burnout and identifythe correlates of burnout among Jordanian mental health nurses.A descriptive correlational design was used to collect data frommental health nurses using the Maslach Burnout Inventory, So-cial Support Scale, Job Satisfaction Scale, and demographic andwork-related variables through a self-reported questionnaire. Thesample consisted of 181 mental health nurses recruited from allmental health settings in Jordan. Jordanian mental health nursesshowed high levels of emotional exhaustion and moderate levels ofdepersonalization and personal accomplishment. Scores of job sat-isfaction and social support were slightly higher than the midrange.Significant correlations were found among burnout categories, jobsatisfaction, social support, and demographic and work-relatedvariables. Predictor variables accounted for 32.7% of emotionalexhaustion, 27.7% of depersonalization, and 16.8% of personalaccomplishment. Results revealed that a comprehensive interven-tional approach aimed at minimizing the risk of burnout amongmental health nurses is needed. Such an approach should involveinterventions at both individual and organizational levels.

Over the last two to three decades, burnout, social support,and job satisfaction have become increasingly important in themental health nursing environment (Happell, Martin, & Pinika-hana, 2003). Maslach, Jackson, and Leiter (1996) describedburnout as a syndrome consisting of emotional exhaustion, de-personalization, and a reduced sense of personal accomplish-ment. Burnout was defined as “physical, emotional, and psy-chological responses to work-related stress (Maslach, Jackson,& Leiter, 1996, p. 3).” Physical responses include low energy,chronic fatigue, and weakness. Emotional responses includedepression, helplessness, and hopelessness. Psychological re-sponses include detached concern for patients, intellectualiza-tion of stressful situations, and withdrawal from clients andco-workers (Maslach & Jackson, 1981).

Address correspondence to Shaher H. Hamaideh, The HashemiteUnivesity, Al-Zarka, Jordan 13133. E-mail: shaher29@hu.edu.jo

Social support is characterized by affective support (i.e., love,liking, and respect), confirmation (i.e., confirming the moraland factual “rightness” of actions and statements), and directhelp (i.e., aid in work, giving information or money). Socialsupport has been found to be beneficial to well-being by meetingimportant human needs for security, social contact, approval,belonging, and affection (House, 1981). Nurses with low levelsof social support have higher levels of stress and burnout (Coffey& Coleman, 2001).

Job satisfaction has been described as a state that dependson the interaction of employees, their personal characteristics,and their expectations with the work environment and the orga-nization. Job satisfaction was found to have a strong negativeassociation with burnout and stress, especially among mentalhealth nurses and other mental health professionals (Wards &Cowman, 2007). The intent of this study is to examine the re-lationships among burnout, social support, job satisfaction, andother related demographic variables among Jordanian mentalhealth nurses.

BURNOUTBurnout is a psychological experience that manifests itself

in individuals, particularly those involved in difficult person-to-person relationships as part of their work, such as nursingprofessionals (Maslach, Schaufeli, & Leiter, 2001). Nurses, ingeneral, and mental health nurses, in particular, are generallyconsidered as a group at risk for burnout because they arein constant interaction and frequent interpersonal contact withpsychiatric clients and their families (Dickson & Wright, 2008;Kilfedder, Power, & Wells, 2001; Patrick & Lavery, 2007).

Many factors have been associated with burnout in mentalhealth nursing. These factors include: job satisfaction, availabil-ity of social support, various aspects of patient care (such as thesize of one’s caseload, type of patients, and violence at the work-site), various aspects of the work environment (such as staffing,shift work, income and wages, and extra duties), and the levelof stress. Nurses’ burnout results in psychological and physicalstrain, fatigue, headache, sleep disorders, low quality of patientcare, job turnover, and absenteeism. Other factors that increaseburnout levels are low nurses’ educational level, working night

234

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.

BURNOUT, SOCIAL SUPPORT, AND JOB SATISFACTION 235

shifts (Demir, Ulusoy, & Ulusoy, 2003), high levels of stress,poor coping styles (Burnard, Edwards, Fothergill, Hannigan, &Coyle, 2000; Edwards, 2000; Jaracz, Gorna, & Konieczna,2005), poor work environment, nurse inexperience (Kanai-Pak,Aiken, Sloane, & Poghosyan, 2008), job dissatisfaction, andoccupational stress (Happell, Pinikahana, & Martin, 2003).

Yousefy and Ghassemi, (2006) investigated levels of burnoutamong mental health nurses. Results showed that nurses work-ing in psychiatric units experienced a higher degree of emotionalexhaustion compared to those who worked in non-psychiatricunits. Jenkins and Elliott (2004) conducted a study to investi-gate and compare the levels of stressors and burnout of nursingstaff in acute mental health settings and to assess the impact ofsocial support on burnout and stress. They found that approxi-mately half of all nursing staff showed signs of a high burnoutlevel in terms of emotional exhaustion. Additionally, a high levelof coworker support was related to a lower level of emotionalexhaustion. Higher levels of social support is associated withlevels of depersonalization. In addition, strong negative correla-tions were found between social support and burnout (Eastburg,Williamson, Gorsuch, & Ridley, 2009). Also, high levels ofburnout among psychiatric nurses were associated with neg-ative feelings toward patients (Holmqvist & Jeanneau, 2006).Prevalence of burnout was also significantly higher for publichealth nurses in charge of mental health services than in publichealth nurses in charge of non-psychiatric services (Imai et al.,2006). In addition, Sahraian and colleagues found that psychi-atric nurses showed significantly higher levels of emotional ex-haustion and depersonalization in comparison with nurses work-ing in internal, surgical, and burn wards (Sahraian, Fazelzadeh,Mehdizadeh, & Toobaee, 2008).

SOCIAL SUPPORTSocial support is defined as the combination of social rela-

tionships, emotional and behavioral interactions, and an indi-vidual perception about the adequacy or availability of differenttypes of support (Button, 2008). Social support involves empa-thy, care, love, and trust (emotional support); actual aid of time,money, and energy (instrumental support); information relevantto self-evaluation (appraisal support); and advice, information,and suggestions (informational support) (House, 1981). Socialsupport affects health by regulating thoughts, feelings, and be-haviors to foster an individual’s sense of meaning in life andfacilitate healthy behaviors. Social support also has been foundto improve well-being, decrease levels of stress and burnoutthat are associated with the work environment, and enhance jobsatisfaction (Sundin, Hochwalder, Bildt, & Lisspers, 2007).

Many sources of social support have been identified forhealth care workers, including nurses. Sources of social sup-port stemmed from the work (i.e., supervisors, colleagues, andcoworkers) and from the home (i.e., family members, spouse,and friends). Amarneh, AbuAl-Rub, and AbuAl-Rub (2009) in-vestigated the effect of social support from coworkers on job per-

formance among Jordanian hospital nurses. Results showed thatdemographic variables and coworker support explained 20%of the variation in job performance. Also, social support fromcoworkers enhanced the level of job performance, decreased thelevel of job stress, and enhanced work commitment (AbuAl-Rub, 2004; Hamaideh, Mrayyan, Mudallal, Faouri, & Kha-sawneh, 2008; Mrayyan, 2009; Mrayyan & Al-Faouri, 2008).

JOB SATISFACTIONJob satisfaction is best understood as a discrepancy between

how much a person wants or expects from a job and how muchthat person actually receives (Price, 2001). If the person’s expec-tations were met, they become satisfied; if not met, they becomedissatisfied. There are many sources of nurses’ job satisfaction.In their literature analysis about job satisfaction, Lu, While,and Barriball (2005) identified the following sources of nurses’job satisfaction: working conditions, interactions with patientsand coworkers, workload, scheduling, task requirements, pro-fessional training, personal achievement, praise, recognition,autonomy, job security, leadership style, physical working con-ditions, payment, and level of education. Job satisfaction is asignificant predictor of nursing absenteeism, burnout, and in-tention to leave job.

Job satisfaction is a complex phenomenon that relates tomany factors. Job satisfaction was found to be related to stressand burnout, organizational commitment, communication withsupervisors and coworkers, autonomy, recognition, age, years ofexperience, education, social support, workload, role ambiguity,and depression and hostility (Lu et al., 2005; Pinikahana, & Hap-pell, 2004). Low job satisfaction in nurses resulted in burnout,high turnover, low levels of patient care, nurses’ physical andpsychological disturbances, and higher stress levels (Happell,Martin, & Pinikahana, 2003; Mrayyan, 2009). Aronson (2004)conducted a study in psychiatric hospitals to examine the level ofjob satisfaction among nurses. Respondents reported high lev-els of pride in their hospitals but low levels of satisfaction withthe parent company. Also, high levels of burnout among mentalhealth nurses resulted in lower job satisfaction (Ogresta, Rusac,& Zorec, 2008; Spear, Wood, Chawla, Devis, & Nelson, 2004).In addition, low levels of burnout and availability of clinical su-pervision were found to enhance job satisfaction and decreaselevels of stress among psychiatric nurses (Hyrkas, 2005).

MENTAL HEALTH SERVICES IN JORDANThe health care system in Jordan is mainly composed of

three sectors: Ministry of Health (MOH), military, and privatesectors. Mental health service providers for the Jordanian pop-ulation provide mental health care and treatment in all threesectors. However, mental health services in Jordan are not wellunderstood, and many Jordanians have limited familiarity withpsychiatric disorders and treatment. The number of beds avail-able for psychiatric patients in Jordan is approximately 643. Ofthem, 500 beds are available for the MOH, 33 beds are in the

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.

236 S. H. HAMAIDEH

military sector, and 110 beds are for a private hospital (MOH,2009). In Jordan, the total number of nurses working in mentalhealth care settings is approximately 220 nurses. Of them, 160are working in the MOH, 30 in the military sector, and 30 inthe private sector (H. Al-araj), (personal communication, June2010). There is shortage of mental health nurses in Jordan. Theratio of mental health nurses to population in Jordan is 0.04nurses for every 100,000 individuals (MOH, 2009).

There have been a number of studies that examined burnout,job satisfaction, and social support among Jordanian nurses(AbuAl-Rub, 2004; Hamaideh et al., 2008; Mrayyan, 2005;Mrayyan & Al-Faouri, 2008). However, there appears to be littleconsideration of burnout among Jordanian mental health nursesworking in mental health care settings. Therefore, the aim of thisstudy was to examine the relationships among burnout, socialsupport, job satisfaction, and other related demographic vari-ables among Jordanian mental health nurses. More specifically,the study aimed to answer the following research questions:(1) What are the levels of burnout dimensions among Jorda-nian mental health nurses as compared to normative values? (2)What are the relationships among burnout categories, social sup-port, job satisfaction, and some demographic and work-relatedcharacteristics of Jordanian nurses working in mental health set-tings? and (3) What are the variables that best predict burnoutdimensions among Jordanian nurses working in mental healthsettings?

METHOD

DesignDescriptive correlational cross-sectional design was em-

ployed to examine the levels of burnout dimensions and therelationships among burnout dimensions, social support, jobsatisfaction, and some demographic and work-related charac-teristics among Jordanian mental health nurses.

MeasuresFor the purpose of this study, all scales were translated to Ara-

bic. All original norms were applied for the translated scales.Translation was done from English into Arabic by a professionalEnglish language translator. Back translation was done by an-other professional English language translator. Then, the twoEnglish forms (the original and the translated form) were com-pared by two bilingual experts in the field. Pilot testing using asample of ten nurses was conducted to evaluate readability andcomprehensiveness of the scales. The scales were also checkedfor cultural variation. Data was collected for this study usinga questionnaire composed of four parts, the Maslach BurnoutInventory (MBI; Maslach et al., 1996), the Social Support Scale(SSS; House & Wells, 1978), the Job Satisfaction Scale (JSS;Quinn & Shepard, 1974), and a demographic and work-relatedsheet.

Maslach Burnout InventoryThe MBI was used to measure burnout levels among Jorda-

nian mental health nurses. The MBI is a 22-item scale designedto measure three dimensions of burnout: emotional exhaustion(EE; 9 items), depersonalization (DP; 5 items), and personal ac-complishment (PA; 8 items). The emotional exhaustion subscalerepresents the basic individual stress dimension of burnout. Itrefers to feelings of being overextended and depleted of one’semotional and physical resources. The depersonalization sub-scale represents the interpersonal context dimension of burnout.It refers to a negative or excessively detached response to var-ious aspects of the job. The personal accomplishment subscalerepresents the self-evaluation dimension of burnout. It refers tofeelings of incompetence and a lack of achievement and produc-tivity at work (Maslach et al., 1996; Maslach et al., 2001). Eachitem is answered on a seven-point response scale ranging from0 “never” to 6 “everyday.” Responses are summed to obtain aseparate score for each of the three subscales, which can then becategorized as low, medium, or high degrees of burnout accord-ing to normative data. For the emotional exhaustion and deper-sonalization subscales, high mean scores reflect high levels ofburnout, while for the personal accomplishment subscale. highmean scores reflect low levels of burnout (Maslach & Jackson,1981). For this sample, internal consistency for the total scale,as measured by the Cronbach’s alpha coefficient, was 0.84 andfor EE, DP, and PA internal consistency was 0.91, 0.84, and0.88, respectively.

Social Support ScaleThe Social Support Scale (SSS; House & Wells, 1978)

was used to measure social support. The SSS is a four-itemscale measuring social support from the immediate supervi-sor, coworkers, spouse/partner, and friends/relatives. For theseitems, participants rate the extent to which each source fulfillsa particular supportive function; a four-point response scale isused (0 = not at all, 1 = a little, 2 = somewhat, 3 = very much).High scores reflect high levels of perceived support. The relia-bility coefficient for the SSS was 0.84 (Jenkins & Elliott, 2004).Cronbach’s alpha coefficients in 106 study subjects were 0.87,0.80, 0.83, and 0.83 for supervisors, coworkers, the worker’sfamily, and friends, respectively (Fujiwara, Tsukshima, Tsut-sumi, Kawakami, & Kishi, 2003). For this sample, internal con-sistency as measured by the Cronbach’s alpha coefficient was0.85.

Job Satisfaction ScaleThe Job Satisfaction Scale (JSS; Quinn & Shepard, 1974)

was used to measure nurses’ job satisfaction. The JSS is a5-item questionnaire with a five-point Likert-type response scale(1 = strongly disagree, 2 = disagree, 3 = undecided, 4 = agree,5 = strongly agree) designed to measure job satisfaction. Higherscores reflect greater job satisfaction. For this sample, internalconsistency as measured by the Cronbach’s alpha coefficientwas 0.76.

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.

BURNOUT, SOCIAL SUPPORT, AND JOB SATISFACTION 237

Demographic and Work-Related SheetDemographic and work-related characteristics were mea-

sured by a separate sheet. Data include: age, gender, maritalstatus, income level, number of household members, numberof dependents, presence of any chronic health problems, educa-tional level, distance in kilometers (km) between home and worksetting, years of experience in general, years of experience inmental health care settings, ward type (Chronic or Acute), shiftworked, number of patients in caseload, any previous partici-pation in mental health workshops, experienced of physical orverbal assault by mental health clients while working in a men-tal health care setting. Intent to leave job was measured by asingle dichotomous item worded as follows, “Do you have theintention to leave your current position/job?” (0 = No, 1 = Yes).Stress level, in general, was checked by asking the participants,“In general, how would you rate the level of stress you usuallyface in your work environment?” The five responses were 1 =none, 2 = mild, 3 = moderate, 4 = severe, and 5 = very severe.

Sampling and Data CollectionThe target population for the study was all Jordanian nurses

working in mental health care settings in Jordan, and all nursesworking in mental health care settings (approximately 220) wereinvited to participate in the study. A total number of 220 ques-tionnaires were distributed by hand to the nurses through theirunit managers. If they agreed to participate, nurses were toldto return the completed questionnaire without his or her nameon it in a sealed box that was placed in the reception area ofeach setting. This method was used to assure confidentiality andanonymity. About 181 questionnaires were returned providinga 82.3% response rate.

Ethical ConsiderationEthics approvals to conduct the study were obtained from the

Scientific Research Committees from the university where theresearcher is working and from the administrations of the mentalhealth care settings. In the letter inviting nurses to participate inthe study, information about the study’s purpose and confiden-tiality was provided. Additionally, participants were told thatreturning a completed questionnaire indicated consent to par-ticipate and information about the study was explained. Nursesalso were told that their participation was voluntary and that theywere free to withdraw from the study at any time. Participants’anonymity and confidentiality were assured.

Statistical AnalysisThe Statistical Package for Social Sciences (SPSS) was used

to analyze data. Descriptive statistics were used to calculate fre-quencies, mean scores, and standard deviations. The strengthand direction of relationships among variables were determinedusing Pearson and Spearman Correlation Coefficients. Signif-icance level was set at p < 0.05. Multiple linear regressionanalysis (Enter Simultaneous Method) was performed to deter-

mine the variables that best predict burnout dimensions amongmental health nurses in Jordan. Assumptions of multiple linearregression analysis were met. Residuals fit the model. Residu-als were normally distributed, independent (not correlated withone another), and not related to the explanatory variables. Inaddition, there were no outliers in the data.

RESULTS

Demographic and Work-Related VariablesThe total sample consisted of 181 participant nurses, of them,

101 (55.8%) were males. Age of the nurses ranged between 21and 54 years (Mean = 30.94, SD = 7.24). The number of house-hold members ranged between 1 and 12 persons (Mean = 5.03,SD = 2.63). The number of dependents ranged between 0 and10 persons (Mean = 3.03, SD = 2.34). Income level rangedbetween 220 and 720 Jordanian Dinars (Mean = 372.9, SD =117.16). Distance between work setting and home ranged be-tween 1 and 120 kilometers (Mean = 29.85, SD = 30.04).Participants’ years of general experience as a nurse ranged be-tween 1 and 30 years (Mean = 8.29, SD = 7.08). Participants’years of experience in a mental health setting ranged between 1and 27 years (Mean = 5.85, SD = 5.98). Number of patients inthe wards (caseload) ranged between 4 and 61 patients (Mean =20.08, SD = 14.90).

Of the total sample, 64 (35.4%) participated in mental healthworkshops, 65 (35.9%) reported that they have intention to leavetheir current job, 85 (47.0%) indicated that they experiencedphysical violence from clients, and 144 (79.6%) reported thatthey experienced verbal violence. Regarding stress in general;33 (18.2%) reported very low/low stress, 99 (45.7%) reportedmedium stress, and 49 (27.1%) reported high/very high stress.Other demographic and work-related characteristics of the par-ticipants can be seen in Table 1.

Burnout, Job Satisfaction, and Social Support LevelsMean score of the EE subscale was 23.96 (SD = 31.91)

for Jordanian mental health nurses, which indicates that theyare in “high” burnout category. The mean score for the DPsubscale was 6.98 (SD = 7.07), indicating that nurses are inthe “moderate” burnout category. On the PA subscale, the meanscore was 31.58 (SD = 11.52). According to the PA subscale,Jordanian mental health nurses are in the “moderate” burnoutcategory. On the EE subscale, a large number of nurses (n =99, 54.7%) suffered from “high” level of burnout. On the DPsubscale, almost half of (n = 90, 49.7%) recorded “low” level ofburnout. Similarly, on the PA subscale, large number of nurses(n = 92, 50.8%) recorded “low” level of burnout (see Table 2).

The mean job satisfaction score among Jordanian men-tal health nurses was 2.89 (SD = 0.89). The highest meanscore was 3.12 (SD = 1.31) for the item “I am satisfied withmy present level of involvement in decision-making at work.”The lowest mean score was 2.65 (SD = 1.4) for the item “I

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.

238 S. H. HAMAIDEH

TABLE 1Demographics and Work-Related Characteristics (N = 181)

Variable n %

Marital StatusSingle 74 40.9Married 107 59.1

Educational LevelAssociate-LPN 24 1.3Diploma-3 years 50 27.6Bachelor-BSN 101 55.8Master-MSN 6 3.3

WardAcute 95 52.5Chronic 86 47.5

Shift WorkedMorning Shift 86 47.5Afternoon/Evening/Rotated

Shift95 52.5

Job TitleWard Head 28 15.5Practicing Nurse 153 84.5

Place of WorkMOH 156 86.2Royal Medical Services 16 8.8Private Sector 9 5.0

seldom think about finding an occupation other than nursing.”The mean score for total social support from all sources asperceived by Jordanian mental health nurses was 1.79 (SD =.80). The highest source of social support was found to be fromnurses’ spouse/partner (Mean = 1.91, SD = 1.19) followed bythat received from colleagues (Mean = 1.89, SD = 0.89), thenfrom supervisors (Mean = 1.75, SD = 1.05). The lowest so-cial support was received from friends/relatives (Mean = 1.62,SD = 1.10).

Correlations among VariablesEE correlated negatively with job satisfaction, social support,

gender, experiencing physical and verbal assault, and caseloadand correlated positively with DP and stress level in general. EE

was reported to be higher among females, those who intend toleave their job, nurses who work in units with lower caseloads,and those who perceive stress level as high. DP correlated neg-atively with PA, job satisfaction, social support, experiencingphysical and verbal assault, and intending to leave the job andcorrelated positively with stress level in general. DP was foundto be higher among those who intend to leave their job and nursesexperiencing physical and verbal assault. On the other hand, PAcorrelated positively with job satisfaction, social support, age,participation in mental health workshops, intention to leave cur-rent job, and psychiatric experience and correlated negativelywith gender, caseload, and stress level in general. PA was foundto be higher in older nurses, those who do not intend to leavetheir job, those who participated in mental health workshops,and nurses with longer psychiatric experience (see Table 3).

Predictors of Burnout CategoriesThree separated multiple linear regressions analysis (Enter

Method) were done to detect the predictors of EE, DP, and PA.The independent variables that entered the three models weredemographics and work-related variables, social support, andjob satisfaction. Significant models emerged for EE, DP, andPA. For EE, seven variables predicted emotional exhaustionand accounted for a total variance of 32.7%. For DP, threevariables predicted depersonalization and accounted for a totalvariance of 27.7%. For PA, three variables predicted personalaccomplishment and accounted for a total variance of 16.8%(see Table 4 for the predictor variables).

DISCUSSIONThe first goal of this study was to examine the levels of

burnout categories among Jordanian mental health nurses. Re-sults revealed high levels of EE, and moderate levels of DP andPA among mental health nurses in Jordan. Results of this studyare congruent with the results of most international studies, suchas those in the US (Hanrahan, Aiken, McClaine, & Hanlon,2010), England (Edwards et al., 2006; Jenkins & Elliott, 2004),Belgium (Stordeur, D’hoore, & Vandenberghe, 2001), Japan(Fujiwara et al., 2003; Imai et al., 2006), and Iran (Sahraian et al.,2008; Yousefy & Ghassemi, 2006). However, other researchstudies showed that burnout levels were lower than those found

TABLE 2Mean Scores, Standard Deviations, Frequencies (n), and Percentages (%) of Respondents for Burnout Subscales (N = 181).

Subscales Mean (SD) High n (%) Moderate n (%) Low n (%)

EE 23.96 (13.91) 99 (54.7) 31 (17.1) 51 (28.2)DP 6.98 (7.07) 62 (34.2) 29 (16.1) 90 (49.7)PA 31.58 (11.52) 70 (38.7) 19 (10.5) 92 (50.8)

EE: Emotional Exhaustion (low ≤ 13, moderate 14–20, high ≥ 21)DP: Depersonalization (low ≤ 4, moderate 5–7, high ≥ 8)PA: Personal Accomplishment (low ≥ 34, moderate 33–29, high ≤ 28)

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.

TAB

LE

3C

orre

latio

nsam

ong

Bur

nout

Cat

egor

ies,

Job

Satis

fact

ion,

Sour

ces

ofSo

cial

Supp

ort,

and

Dem

ogra

phic

s(N

=18

1)

12

34

56

78

910

1112

13

1E

E1.

002

DP

.533

∗∗1.

003

PA–.

020

–.17

9∗1.

004

JS–.

313∗∗

–.34

9∗∗.1

87∗

1.00

5SS

–.28

0∗∗–.

301∗∗

.172

∗.3

92∗∗

1.00

6A

ge.0

29–.

089

.200

∗∗.0

21–.

118

1.00

7G

ende

r–.

186∗

–.04

2–.

167∗

–.08

6–.

031

–.12

31.

008

Wor

ksho

p–.

001

.038

.202

∗∗.0

07–.

138

–.21

4∗∗.1

331.

009

Ph.A

ssau

lt–.

353∗∗

–.26

1∗∗–.

044

.105

.210

∗∗–.

307∗∗

.166

∗.2

77∗∗

1.00

10V

b.A

ssau

lt–.

272∗∗

–.22

0∗∗.0

17.0

36.1

04–.

169∗

.175

∗.2

89∗∗

.477

∗∗1.

0011

Lea

ve–.

282∗∗

–.19

4∗∗.1

70∗

.203

∗∗.0

48.0

52.0

99.0

00.1

03.0

651.

0012

Cas

eloa

d–.

171∗

.006

–.18

6∗.0

70.0

58.1

05.2

14∗∗

.075

.007

.099

–.06

21.

0013

P.E

xp.

.036

–.11

7.1

95∗∗

.041

.003

.706

∗∗–.

125∗

–.28

7∗∗–.

471∗∗

–.31

3∗∗.1

06–.

009

1.00

14St

ress

leve

l.3

53∗∗

.429

∗∗–.

265∗∗

.414

∗∗.3

94∗∗

.025

.007

.043

.200

∗∗.1

77∗

.228

∗∗.0

25.0

45

EE

:E

mot

iona

lE

xhau

stio

n,D

P:D

eper

sona

lizat

ion,

PA:

Pers

onal

Acc

ompl

ishm

ent,

JS:

Job

Satis

fact

ion,

SS:

Soci

alSu

ppor

t,Ph

:Ph

ysic

alas

saul

t,V

b.:

Ver

bal

Ass

ault,

P.E

xp:

Psyc

hiat

ric

expe

rien

ce.

Stre

ss:

Stre

ssin

gene

ral.

Pear

son

Cor

rela

tion

empl

oyed

with

cont

inuo

usda

ta,

Spea

rman

rho

Cor

rela

tion

empl

oyed

with

cate

gori

cald

ata.

∗ Cor

rela

tion

issi

gnifi

cant

at0.

05le

vel.

∗∗C

orre

latio

nis

sign

ifica

ntat

0.01

leve

l.

239

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.

240 S. H. HAMAIDEH

TABLE 4Predictors of Burnout Categories (N = 181)

Predictor Variables Beta t p Adj R2 Total Variance

Emotional Exhaustion 0.327 32.7%1. Caseload –0.167 –2.21 0.0282. Gender (Female vs. Male) –0.147 –2.07 0.0393. Marital Status (Single vs. Married) 0.260 2.71 0.0074. Ward (Acute vs. Chronic) 0.146 2.09 0.0455. Intention to Leave Job (No vs. Yes) 0.17 2.52 0.0136. Physical Assault (No vs. Yes) 0.231 2.96 0.0047. Stress Level 0.175 2.32 0.022Depersonalization 0.277 27.7%1. Distance between Home and Work 0.291 3.55 0.0012. Physical Assault (No vs. Yes) 0.207 2.56 0.0113. Stress Level 0.263 3.38 0.001Personal Accomplishment 0.168 16.8%1. Caseload –0.173 –2.06 0.0402. Stress Level –0.178 –2.13 0.035

in this study. For example, in Poland (Jaracz et al., 2005), Croa-tia (Ogresta et al., 2008), and the United Kingdom (Kilfedderet al., 2001, Sherring & Knight, 2009), burnout levels weremoderate; while in other countries, such as Australia (Happell,Pinikahana, & Martin, 2003; Pinikahana & Happell, 2004) andFinland (Hyrkas, 2005), levels of burnout were reported to below. High levels of burnout among Jordanian mental healthnurses may be explained by a poor psychosocial work environ-ment as evidenced by low social support from colleagues andsupervisors. High burnout levels also may be due to workingwith difficult and uncooperative patients with bad prognoses,which may lead to helplessness, frustration, and emotional ex-haustion for the nurse (Maslach et al., 2001). Lack of clinical su-pervision may also contribute to the high level of burnout amongJordanian mental health nurses because clinical supervision wasfound to be beneficial for mental health professionals in termsof job satisfaction, stress, and burnout levels (Edwards et al.,2006; Hyrkas, 2005; Ito, Eisen, Sederer, Yamada, & Tachimori,2001). It appears that despite high levels of burnout reported bynurses, the majority of them indicate that they are satisfied withtheir job. It also appears that the level of social support experi-enced by nurses from their supervisors was relatively low. It istherefore possible that support is one of the primary factors ininfluencing levels of burnout.

The second goal of this study was to investigate the rela-tionships among burnout categories, social support, job sat-isfaction, and some demographic and work-related variables.The results revealed that there were strong relationships amongthe studied variables. The present findings are in keeping withother studies that reported that high levels of social support andjob satisfaction correlated negatively with burnout (Sherring &Knight, 2009; Sundin et al., 2007). A number of authors have re-

ported a positive relationship between lack of social support andburnout, especially support between supervisors and colleagues(Stordeur et. al., 2001). Poor relationships with supervisors andcolleagues resulted in burnout when there is no possibility ofexchanging experiences and ideas, as well as when there is alack of possible feedback from supervisors. Social support may,in some way, provide a protective effect against burnout, per-haps by giving nurses an opportunity to express their feelings,thereby minimizing any sense of isolation and creating a forumfor passing on coping strategies. Also, nurses with high lev-els of burnout are more likely to be considering leaving theirjob. Nurse staffing turnover and nurses’ intention to leave theirjob are particular issues among Jordanian nurses, in general(AbuAl-Rub & Al-Zaru, 2008; Mrayyan, 2005). Furthermore,negative correlation between job satisfaction and burnout hasbeen confirmed in some previous studies (Kalliath, & Morris,2002; Spear et al., 2004). Therefore, nurses’ job satisfaction andsocial support should be included in plans to improve the qual-ity of care for mental health nurses. A positive relationship wasfound between years of experience in psychiatric setting andPA. This is congruent with other studies that found that burnoutlevels were higher among inexperienced nurses (Kanai-Paket al., 2008).

The third goal of this study was to identify the factors thatbest predict burnout dimensions among Jordanian mental healthnurses. Results revealed that there were many factors that con-tributed to burnout categories. EE was predicted by caseload,gender, marital status, ward, intention to leave job, physical as-sault, and stress level in general. DP was predicted by distancebetween work and home, physical assault, and stress level ingeneral. PA was predicted by caseload and stress level in general.Stress level was a unique predictor of all burnout dimensions.

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.

BURNOUT, SOCIAL SUPPORT, AND JOB SATISFACTION 241

There is no doubt that stress and burnout levels are closely re-lated. Most studies of stress and burnout reveal that high levels ofstress increase the level of emotional exhaustion and deperson-alization, and decrease the level of personal accomplishment(Stordeur et al., 2001). For example, Ogresta and colleagues(2008) found that physical and psychological manifestationsof stress predicted emotional exhaustion and depersonalization.The identification of stress sources, as well as the personal andcontextual factors that contribute to stress, may result in theprevention of stress and protection of the mental health nurses.Caseload size (nurse to patient ratio) was found to predict EEand PA. Nurses in hospitals with the highest caseloads are morelikely to experience job burnout and job dissatisfaction thannurses in hospitals with lower caseloads (Aiken, Clarke, Sloane,Sochalski, & Silber, 2002). Further, intention to leave the jobwas a predictor for EE. Also, physical assault was a predictorfor EE and DP. Ito and colleagues (2001) found that perceivedrisk of assault, job satisfaction, and social support were amongthe variables that predicted intention to leave job among psychi-atric nurses. This effect of staffing caseload, physical assault,intention to leave job, and burnout suggest that improving nursestaffing could decrease turnover and burnout, decrease nurses’intention to leave their job, and reduce hospital cost (Aikenet al., 2002; Jourdain & Chenevert, 2010; Mrayyan, 2005).Regarding gender and marital status, results of this study re-vealed that male and single nurses were more emotionally ex-hausted and had lower PA. These results were congruent withother studies which revealed that burnout levels were higheramong male and single nurses (Edwards et al., 2006; Sahraianet al., 2008). Nurses in acute wards were more emotionallyexhausted than those working in chronic wards despite thehigher caseload size in chronic units. This may be explainedby the fact that acute wards have more complicated and dif-ficult patients, high workloads, many non-nursing tasks (e.g.,coordination with other health care professionals), frequent ad-missions and discharges, and high risks of physical and verbalassaults.

LimitationsEmploying cross-sectional design allows relationships be-

tween variables to be identified at one point of time only anddoes not allow causal relationships among variables to be es-tablished; therefore, longitudinal designs are crucial for furtherunderstanding of the development of burnout over time. Also,data for this study were obtained by self-report, which may re-flect bias in reporting. Participants may have underestimatedor overestimated their level of burnout, social support, and jobsatisfaction.

Despite the limitations, this study contributes to the develop-ment of mental health care by providing information on burnout,social support, and job satisfaction among Jordanian mentalhealth nurses. This study was strengthened by the sample size

which accounted for about 82% of the target population (allJordanian mental health nurses).

Conclusions and ImplicationsParticipants with high levels of emotional exhaustion and de-

personalization were more likely to be considering leaving theirjob; therefore, improving working conditions, ensuring a safeworking environment, increasing job satisfaction, and trainingsupervisors to support their staff are important steps in reducingburnout levels. Results of this study draw attention to the impor-tance of improving the psychosocial work environment amongmental health nurses. To decrease burnout among mental healthnurses, administrators should also increase continuing educa-tion programs for nurses, especially those programs that dealwith stress management, coping skills, and personal skills andaccomplishments, and those that update knowledge.

Burnout affects the way in which mental health nurses carefor their clients. Therefore, there is a need to consider waysin which burnout can be ameliorated and, thus, enable mentalhealth nurses to provide optimal care for their clients, enhancewell-being, decrease stress and turnover among mental healthnurses (Robinson, Clements, & Land, 2003), and decrease thefrequency of sick leave (Sherring & Knight, 2009). Also, emo-tional exhaustion may be offset by minimizing conflicting tasksand providing advice and support for non-work issues.

Declaration of interest: The authors report no conflicts ofinterest. The authors alone are responsible for the content andwriting of the paper.

REFERENCESAbuAl-Rub, R. (2004). Job stress, job performance, and social support among

hospital nurses. Journal of Nursing Scholarship, 36(1), 73–78.AbuAl-Rub, R., & Al-Zaru, I. (2008). Job stress, recognition, job performance,

and intension to stay at work among Jordanian hospital nurses. Journal ofNursing Management, 16, 227–236.

Aiken, L., Clarke, S., Sloane, D., Sochalski, J., & Silber, J. (2002). Hospitalnurse staffing and patient mortality, nurses burnout, and job dissatisfaction.Journal of the American Medical Association, 288(16), 1987–1993.

Amarneh, B., AbuAl-Rub, R., & AbuAl-Rub, N. (2009). Co-workers’ supportand job performance among nurses in Jordanian hospitals. Journal of Re-search in Nursing. doi: 10.1177/1744987109347134

Aronson, K. (2004). Job satisfaction of nurses who work in private psychiatrichospitals. Psychiatric Services, 56(1), 102–104.

Burnard, P., Edwards, D., Fothergill, A., Hannigan, B., & Coyle, D. (2000).Community mental health nurses in Wales: Self-reported stressors and copingstrategies. Journal of Psychiatric and Mental Health Nursing, 7, 523–528.

Button, L. (2008). Effect of social support and coping strategies on the relation-ship between health care related occupational stress and health. Journal ofResearch in Nursing, 13(6), 498–524.

Coffey, M., & Coleman, M. (2001). The relationship between support and stressin forensic community mental health nursing. Journal of Advanced Nursing,34(3), 397–407.

Demir, A., Ulusoy, M., & Ulusoy, M. F. (2003). Investigation of factors influenc-ing burnout levels in the professional and private lives of nurses. InternationalJournal of Nursing Studies, 40, 807–827.

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.

242 S. H. HAMAIDEH

Dickson, T., & Wright, S. (2008). Stress and burnout in forensic mental healthnursing: A literature review. British Journal of Nursing, 17(2), 82–87.

Eastburg, M., Williamson, M., Gorsuch, R., & Ridley, C. (2009). Social support,personality, and burnout in nurses. Journal of Applied Psychology, 24(14),1233–1250.

Edwards, D. (2000). Stressors, moderators, and stress outcomes: Findings fromthe All-Wales community mental health study. Journal of Psychiatric andMental Health Nursing, 7, 529–537.

Edwards, D., Burnard, P., Hannigan, B., Cooper, L., Adams, J., Juggessur,T., Fothergill, A., & Coyle, D. (2006). Clinical supervision and burnout: Theinfluence of clinical supervision for community mental health nurses. Journalof Advanced Nursing, 15, 1007–1015.

Fujiwara, K., Tsukshima, E., Tsutsumi, A., Kawakami, N., & Kishi, R. (2003).Interpersonal conflict, social support, and burnout among home care workersin Japan. Journal of Occupational Health, 45, 313–320.

Hamaideh, S., Mrayyan, M., Mudallal, R., Faouri, I., & Khasawneh, N. (2008).Jordanian nurses’ job stressors and social support. International NursingReview, 55, 40–47.

Hanrahan, N., Aiken, L., McClaine, L., & Hanlon, A. (2010). Relationshipbetween psychiatric nurse work environments and nurse burnout in acutecare general hospitals. Issues in Mental Health Nursing, 31, 198–207.

Happell, B., Martin, T., & Pinikahana, J. (2003). Burnout and job satisfaction:A comparative study of psychiatric nurses from forensic and a mainstreammental health services. International Journal of Mental Health Nursing, 12,39–47.

Happell, B., Pinikahana, J., & Martin, T. (2003). Stress and burnout in forensicpsychiatric nursing. Stress and Health, 19, 63–68.

Holmqvist, R., & Jeanneau, M. (2006). Burnout and psychiatric staff’s feelingstowards patients. Psychiatric Research, 145, 207–213.

House, J. (1981). Work stress and social support. Reading, MA: Addison-Wesely.

House, J., & Wells, J. (1978). Occupational stress, social support and health. InA. McLean, G. Black, & M. Colligan (Eds.), Reducing occupational stress:Proceedings of a conference (pp. 8–29). Washington, DC: National Instituteof Occupational Health and Safety.

Hyrkas, K. (2005). Clinical supervision, burnout, and job satisfaction amongmental health and psychiatric nurses in Finland. Issues in Mental healthNursing, 26, 531–556.

Imai, H., Nakao, H., Nakagi, Y., Niwata, S., Sugioka, Y., Itoh, T., & Yoshida,T. (2006). Prevalence of burnout among public health nurses in charge ofmental health services and emergency care systems in Japan. EnvironmentalHealth and Preventive Medicine, 11, 286–291.

Ito, H., Eisen, S., Sederer, L., Yamada, O., & Tachimori, H. (2001). Factorsaffecting psychiatric nurses’ intention to leave their current job. PsychiatricService, 52(2), 232–234.

Jaracz, K., Gorna, K., & Konieczna, J. (2005). Burnout, stress and styles ofcoping among hospital nurses. Annals Academiae Medicae Bialostocensis,50, 216–219.

Jenkins, R., & Elliott, P. (2004). Stressors, burnout and social support: Nurses inacute mental health settings. Journal of Advanced Nursing, 48(6), 622–631.

Jourdain, G., & Chenevert, D. (2010). Job demands—resources, burnout, andintention to leave nursing profession: A questionnaire survey. InternationalJournal of Nursing Studies, 47(6), 709–722.

Kalliath, T., & Morris, R. (2002). Job satisfaction among nurses: A predictor ofburnout levels. Journal of Nursing Administration, 32, 648–654.

Kanai-Pak, M., Aiken, L., Sloane, D., & Poghosyan, L. (2008). Poor work envi-ronment and nurse inexperience are associated with burnout, job satisfaction

and quality deficits in Japanese hospitals. Journal of Clinical Nursing, 17,3324–3329.

Kilfedder, C., Power, K., & Wells, T. (2001). Burnout in psychiatric nursing.Journal of Advanced Nursing, 34(3), 383–396.

Lu, H., While, A., & Barriball, K. (2005). Job satisfaction among nurses: Aliterature review. International Journal of Nursing Studies, 42, 211–227.

Maslach, C., & Jackson, S. (1981). The measurement of experienced burnout.Journal of Occupational Behavior, 2, 99–113.

Maslach, C., Jackson, S., & Leiter, M. (1996). Maslach Burnout Inventorymanual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press.

Maslach, C., Schaufeli, W., & Leiter, M. (2001). Job burnout. Annual Reviewof Psychology, 52, 397–422.

Ministry of Health.(2009). Ministry of Health Annual Statistical Book. Re-trieved from http://www.MOH.gov.jo/moh/En/home.php

Mrayyan, M. (2005). Nurses job satisfaction and retention: Comparing publicand private hospitals in Jordan. Journal of Nursing Management, 13, 40–50.

Mrayyan, M. (2009). Job stressors and social support behaviors: Comparingintensive care units to wards in Jordan. Contemporary Nurse, 31(2), 163–175.

Mrayyan, M., & Al-Faouri, I. (2008). Nurses’ career commitment and job per-formance: Differences across hospitals. Nursing Leadership, 21(2), 101–117.

Ogresta, J., Rusac, S., & Zorec, L. (2008). Relation between burnout syndromeand job satisfaction among mental health workers. Croatian Medical Journal,49, 364–374.

Patrick, K., & Lavery, J. (2007). Burnout in nursing. Australian Journal ofAdvanced Nursing, 24(3), 43–48.

Pinikahana, J., & Happell, B. (2004). Stress, burnout and job satisfaction in ruralpsychiatric nurses: A Victorian study. Australian Journal of Rural Health,12, 120–125.

Price, J. (2001). Reflections on the determinants of voluntary turnover. Interna-tional Journal of Manpower, 22(7), 600–624.

Quinn, R., & Shepard, L. (1974). The 1972–73 quality of employment survey.Ann Arbor, MI: University of Michigan, Survey Research Center.

Robinson, J., Clements, K., & Land, C. (2003). Workplace stress among psy-chiatric nurses: Prevalence, distribution, correlates, and predictors. Journalof Psychosocial Nursing, 14(4), 32–41.

Sahraian, A., Fazelzadeh, A., Mehdizadeh, A., & Toobaee, S. (2008). Burnoutin hospital nurses: A comparison of internal, surgery, psychiatry, and burnswards. International Nursing Review, 55, 62–67.

Sherring, S., & Knight, D. (2009). An exploration of burnout amongcity mental health nurses. British Journal of Nursing, 18(20), 1234–1240.

Spear, J., Wood, L., Chawla, S., Devis, A., & Nelson, J. (2004). Job satisfactionand burnout in mental health services for older adults. Australian Psychiatry,12(1), 58–61.

Stordeur, S., D’hoore, W., & Vandenberghe, C. (2001). Leadership, organiza-tional stress, and emotional exhaustion among hospital nursing staff. Journalof Advanced Nursing, 35(4), 533–542.

Sundin, L., Hochwalder, J., Bildt, C., & Lisspers, J. (2007). The relationshipbetween different work-related sources of social support and burnout amongregistered and assistant nurses in Sweden. International Journal of NursingStudies, 44, 758–769.

Wards, M., & Cowman, S. (2007). Job satisfaction in psychiatric nursing. Jour-nal of Psychiatric and Mental Health Nursing, 14, 454–461.

Yousefy, A., & Ghassemi, G. (2006). Job burnout in psychiatric and medicalnurses in Isfahan, Islamic Republic of Iran. Eastern Mediterranean HealthJournal, 12(5), 662–669.

Issu

es M

ent H

ealth

Nur

s D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Win

dsor

on

07/1

5/14

For

pers

onal

use

onl

y.