The Effect of Burnout and Its Dimensions on Turnover Intention Among Nurses: A Meta-Analytic Review

Burnout, Personal, and Occupational Factors as Predictors of Physician Assistant Faculty Intent to Leave After the COVID-19 Pandemic

INTRODUCTION

This study addressed whether burnout, personal, or occupational factors predicted physician assistant (PA) faculty intent to leave and established a new postpandemic national benchmark for PA faculty burnout and intent to leave.

METHODS

In spring 2023, a nonexperimental, cross-sectional survey was emailed to 2031 PA faculty drawn from program faculty listings and the PA Education Association member database. Descriptive statistics were used to describe the sample, and a multiple regression analysis was conducted to analyze the predictive ability of the independent variables on intent to leave.

RESULTS

The response rate was 30% (609 of 2031), with 496 responses (24.4%) included in the analysis. The sample reflected the population of PA faculty. The regression model significantly predicted intent leave ( P < .001). The adjusted R2 was 0.46, indicating the combination of independent variables predicted 46% of the variance in PA faculty intent to leave. Significant predictors included emotional exhaustion and identifying as multiracial ( P < .001), control and values ( P < .01), and depersonalization, fairness, rewards, and clinical year faculty role ( P < .05). The sample had moderate levels of burnout and experienced burnout at higher rates than in prepandemic studies. Physician assistant faculty in administrative leadership roles had the highest levels of burnout and intent to leave. Despite this, PA faculty intent to leave measures were similar to prepandemic levels.

DISCUSSION

Several of the predictive variables were related to well-being and social-emotional aspects of the workplace. These findings have implications for institutional policies and practices that support faculty well-being and workplace culture to enhance retention.

Turkish nurses' psychological resilience and burnout levels during the COVID-19 pandemic: A correlational study

AIMS

To investigate the relationship between the psychological resilience and burnout of nurses caring for COVID-19 patients and to determine the factors that affect their psychological resilience and burnout.

BACKGROUND

In pandemic diseases such as COVID-19, nurses experience burnout due to long working hours, decreased quality of life and anxiety/fear about their own/families' health. Psychological resilience helps to control burnout in nurses and prevent the development of a global nurse shortage.

DESIGN

This was a descriptive, correlational study.

METHODS

The sample of this study included 201 nurses in a Training and Research Hospital. The study used the Brief Resilience Scale and the Burnout Measure Short Version. Data were collected between 4 May and 1 June 2020. Statistical analysis was made with Pearson/Spearman, independent sample t test, one-way analysis of variance (ANOVA) test.

RESULTS

Nurses reported moderate burnout and psychological resilience, with a negative and highly significant correlation between psychological resilience and burnout levels.

CONCLUSIONS

In order to increase the quality of patient care/treatment, nurse managers need to reduce nurses' burnout and increase their psychological resilience. Nurses are recommended to adopt a healthy lifestyle, organize training programmes and implement psychological resilience interventions to prevent sleep disorders. Giving nurses the tools to understand what they need to manage within their locus of control will allow them to find a new sense of resilience, preventing potential burnout.

Social media use for work during non-work hours and turnover intention: the mediating role of burnout and the moderating role of resilience

Introduction

This study uses survey data from 504 Chinese teachers to investigate the relationship between social media use for work during non-work hours (SMUNW) and turnover intention, focusing on the mediating role of burnout and the moderating role of resilience in this relationship.

Methods

In November 2023, online survey links were sent to 529 teachers from Shandong Province, China, asking them to report their perceptions of SMUNW, burnout, resilience, and turnover intention. A sample of 504 valid responses was obtained. The analysis was performed using SPSS 26.0 and Hayes' PROCESS MACRO for SPSS for testing the hypotheses.

Results

The results revealed that burnout acts as a mediator in the relationship between SMUNW and turnover intention. In addition, resilience moderated the relationship between SMUNW and burnout such that when resilience was higher, the relationship between SMUNW and burnout was alleviated. Moreover, resilience moderated the indirect relationship between SMUNW and turnover intention through burnout such that when resilience was higher, the indirect relationship was alleviated.

Discussion

The results of this study indicate that SMUNW is related to turnover intention through the mediating role of burnout. Furthermore, resilience moderates the influence of SMUNW on burnout and thus weakens the influence of SMUNW on turnover intention through burnout. This study expands our knowledge of the nuanced influence mechanisms of social media use in the context of increasing technostress among public employees. Practically, it suggests that managers should pay due attention to the impairments brought about by social media use, especially from the perspectives of preventing burnout and fostering resilience.

The mediating and moderating role of recovery experience between occupational stress and turnover intention in nurses caring for patients with COVID-19

AIM

This study aimed to investigate the relationships among occupational stress, recovery experience and turnover intention among nurses caring for patients with coronavirus disease 2019 (COVID-19).

BACKGROUND

The high turnover intention among nurses affect patient safety quality of patient care.

DESIGN

The cross-sectional study design was used. This study was guided by STROBE.

METHODS

Convenience sampling identified 202 registered nurses working in the COVID-19 wards of three tertiary general hospitals in two cities in South Korea. The collected data were analysed using SPSS version 26.0, and the PROCESS macro in SPSS was employed to estimate path coefficients and assess the adequacy of the model. The moderating effects of recovery experience on the pathway in which occupational stress of the participants affects turnover intention were verified using model 1 of the SPSS PROCESS macro proposed by Hayes.

RESULTS

The recovery experience did not significantly mediate the relationship between occupational stress and turnover intention. However, it had significant moderating effect on the relationship between occupational stress and turnover intention (β = .005, 95% CI [.001, .010]). The effect of occupational stress on turnover intention was dependent on recovery experience.

CONCLUSION

The results revealed that occupational stress among nurses caring for patients with COVID-19 affect the turnover intention and the level of recovery experience moderates this relationship. Thus, not only during the COVID-19 pandemic but also during challenging times of various infectious disease outbreaks, hospitals can enhance the health and well-being of nurses and promote the retention of nursing staff.

IMPLICATIONS FOR THE PROFESSION

During the COVID-19 pandemic, nurses have been exposed to understaffing and overwhelming workloads. However, policies for nurses' welfare and benefits are still insufficient, even as the pandemic comes to an end. The results of this study indicate that sufficient rest and appropriate nursing personnel are of utmost importance to nurses.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The straw that broke the nurse's back-Using psychological contract breach to understand why nurses leave

AIM

To deepen our understanding of why nurses decide to leave their occupation instead of changing jobs, we examined the antecedents that led to this decision through the theoretical lens of psychological contract breach.

DESIGN

A qualitative design with semi-structured interviews.

METHODS

We collected 28 interviewees from our social networks and a social media platform. We included professional nurses who had decided to leave or had left the occupation. We analysed our data with reflexive thematic analysis, thereby giving space for the interviewee voices to rise.

RESULTS

We identified various experiences of dissonance between interviewee expectations and reality. The interviewees expressed unfulfilled expectations or psychological contract breaches in relation to their occupation on different levels and over extended time periods. The psychological contract breaches and decisions to leave the occupation were built up over time because of continuous disappointment and dissonance between expectations and reality. The frustration, dissonance and unfulfilled expectations were expressed towards the institution of nursing rather than a specific employer or organization.

CONCLUSION

Unfulfilled expectations over a longer period might cause psychological contract breach, leading to turnover intentions. Our research brings novel insights into the psychological contract, as our findings indicate that the psychological contract can be formed and breached, also between the employee and the occupation. This means that turnover intentions might result in nurses leaving the profession rather than seeking work in new organizations.

IMPACT

The study addresses the problem of nurse shortage by showing the root reasons for deciding to leave the occupation. Our findings show how psychological contract breaches over time erupt as turnover intentions regarding the occupation rather than a job. The results guide healthcare managers and decision-makers to recognize factors leading to a psychological contract breach, thereby enabling the retention of nurses.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

'A sense of self, empowerment and purposefulness': professional diversification and wellbeing in Australian general practitioners

BACKGROUND

Burnout and workforce shortages comprise a vicious cycle in medicine, particularly for Australian general practitioners (GPs). Professional diversification, whereby individuals work multiple roles across their week, may help address this problem, but this strategy is under-studied.

METHODS

We surveyed 1157 Australian GPs using qualitative and quantitative questions examining professional diversification, values, autonomy, and wellbeing. Quantitative data were analysed using inferential statistics, whilst qualitative data were analysed using inductive thematic analysis. We triangulated the data by using the qualitative findings to inform further quantitative testing.

RESULTS

Approximately 40% of the sample had diversified. Although diversifying was not significantly associated with wellbeing, the qualitative data indicated that diversification supported GPs' wellbeing by enhancing career sustainability, accomplished through various pathways (e.g. value fulfilment, autonomy, variety). Subsequent quantitative analyses provided evidence that these pathways mediated the relationship between diversification and wellbeing. To diversify, GPs needed particular personal qualities, external supports, flexibility, and serendipity. Barriers to diversifying mirrored these factors, spanning individual (e.g. skillset) and situational levels (e.g. autonomy, location).

CONCLUSIONS

Diversification can support GPs' wellbeing if it meets their needs. Organisations should focus on publicising opportunities and accommodating requests to diversify.

Assessing the mediation pathways: How decent work affects turnover intention through job satisfaction and burnout in nursing

AIM

This study aimed to assess the potential mediating roles of nurses' job satisfaction and burnout in the association between decent work and turnover intention.

BACKGROUND

There is a global challenge of nursing shortages in healthcare systems worldwide. Decent work is crucial for safeguarding the rights and professional development outcomes of nurses. However, there is currently limited research on decent work among nurses, and there is a lack of studies exploring the relationships between nurses' decent work, job satisfaction, burnout, and turnover intention.

METHODS

A cross-sectional survey design was employed with a sample of 460 nurses from three hospitals: The Affiliated Hospital of Hangzhou Normal University, Hangzhou Third People's Hospital, and Hangzhou Red Cross Hospital. The STROBE checklist was used. Mediation analysis using the PROCESS Macro was used to examine the relationships between decent work, job satisfaction, burnout, and turnover intention.

RESULTS

The results showed that nurses' perception of decent work directly influences their turnover intention. Additionally, these findings strongly support the role of job satisfaction and burnout as mediating factors in the relationship between decent work and turnover intention.

CONCLUSIONS

Decent work reduces nurse burnout and turnover intention of enhancing their job satisfaction.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study's findings have important implications for healthcare organizations and policymakers. Recognizing the pivotal role of decent work in nurses' job satisfaction and well-being can guide the development of strategies to improve working conditions and reduce turnover rates. It is imperative for healthcare institutions to prioritize creating safe, supportive, and equitable work conditions for nurses, as this can contribute to higher job satisfaction and, subsequently, lower turnover rates.

Utility of salivary cortisol profile as a predictive biomarker in nurses' turnover risk: a preliminary study

BACKGROUND

Predicting nurse turnover risk is crucial due to the global nursing shortage; however, existing predictors, such as fatigue and burnout, lack objectivity. Salivary cortisol is a non-invasive marker of stress and fatigue, but its utility in predicting nurse turnover risk is unknown. We examined whether salivary cortisol profiles across three different day shifts in a month are predictors of the extent of nurses' reluctance to stay in their current jobs.

METHODS

This preliminary longitudinal study followed forty female nurses who engaged in shift work at a university hospital for 3 months. Data at enrollment were collected including demographics, working conditions, chronic fatigue (the Japanese version of the Occupational Fatigue/Exhaustion Recovery Scale), and burnout (Japanese Burnout scale). Salivary cortisol was measured before the three different day shifts (after awakening) during the first month, and the means of these measurements were used as the cortisol profile. The extent of reluctance to stay was assessed using the numerical rating scale at 3 months.

RESULTS

Among the forty female nurses (mean [SD] age, 28.3 [5.1]), all completed follow-up and were included in the analysis. The cortisol profile was associated with the extent of reluctance to stay (P = 0.017), and this association was significant despite adjustments for chronic fatigue and burnout (P = 0.005). A multiple regression model with chronic fatigue, burnout, and job tenure explained 41.5% of the variation in reluctance to stay. When the cortisol profile was added to this model, the association of the cortisol profile was significant (P = 0.006) with an R2 of 0.529 (ΔR2 = 0.114).

CONCLUSIONS

This preliminary study conducted in an actual clinical setting indicated the potential of the salivary cortisol profile across three different day shifts in a month to predict nurses' reluctance to stay in their current jobs. The combination of subjective indicators and the cortisol profile would be useful in predicting nurses' turnover risk.

Examining the Impact of Burnout on Hospital Nurses Engaged in Shift Work: Insights From a Nationwide Cross-Sectional Study in Malaysia

Introduction

Shift workers follow nonstandard schedules that encompass overnight duty, rotational timetables, or permanent night work which can lead to misaligned core circadian physiology. Shift work has been associated with sleep deprivation, burnout, and metabolic syndrome among healthcare workers.

Objective

We aimed to examine if shift nurses working in Malaysian public hospitals are more predisposed to burnout and to determine the predictors of burnout in this profession.

Method

This national-level cross-sectional study was conducted among nurses in public hospitals in Malaysia between July and November 2019 using self-administered questionnaires. Maslach Burnout Inventory-Human Service Survey was used to determine burnout. Multistage stratified sampling was used to recruit nurses from 32 hospitals. A complex sampling analysis was performed.

Results

Among the 1,491 hospital nurses, more than half (70.8%) of them followed shift work schedules. Shift nurses were mostly below 40 years old (80.9%), diploma holders (87.2%), and of lower professional grades (64.2%). The prevalence of overall burnout, as well as the domains of emotional exhaustion and depersonalization, was higher among shift nurses (27.1%) as compared to their counterparts (22.4%). Nurses who performed more than six night shifts per month were 2.6 times more predisposed to burnout.

Conclusion

Shift work is integral to ensure round-the-clock nursing care for patients. However, nurses are increasingly faced with more shift duties due to heavy patient loads and staff shortages. Modified work schedules must be implemented to provide sufficient rest time for shift nurses to mitigate burnout. Additionally, proper human resource projection and distribution are imperative to prevent worsening burnout.

The impact of meaning in life and professional happiness on the turnover intention of health care workers: a cross-sectional study from China

INTRODUCTION

The turnover and shortage of health care workers (HCWs) have been a worldwide problem for healthcare organizations. The primary aim of this study was to identify the factors influencing the intention of Chinese HCWs to leave their job, especially meaning in life and professional happiness.

METHODS

This observational cross-sectional study, conducted among 1125 full-time HCWs, assessed demographic variables, meaning in life, professional happiness, and turnover intention by a survey. The survey was distributed to HCWs in three tertiary hospitals. The data were analyzed by T-tests, ANOVA, Kruskal-Wallis tests and hierarchical linear regression model.

RESULTS

There were statistically significant differences in turnover intention of HCWs by gender, age, role, educational level, years in practice, and number of monthly night shifts. HCWs' meaning in life and professional happiness were negatively associated with the turnover intention. Furthermore, after controlling for other factors, meaning in life explained 3.7% of the turnover intention and professional happiness explained 13.4%.

CONCLUSION

In our study, positive psychological factors were related to turnover intentions. Professional happiness was the strongest predictor. Thus, health human resource managers should foster positive psychology among HCWs to reduce their turnover.

The quiet quitting scale: Development and initial validation

Introduction

COVID-19 pandemic causes drastic changes in workplaces that are likely to increase quite quitting among employees. Although quiet quitting is not a new phenomenon, there is no instrument to measure it.

Objective

To develop and validate an instrument assessing quiet quitting among employees.

Methods

We identified and generated items through an extensive literature review and interviews with employees. We carried out the content validity by content experts and we calculated the content validity ratio. We checked face validity by conducting cognitive interviews with employees and calculating the item-level face validity index. We conducted exploratory and confirmatory factor analysis to investigate the quiet quitting scale (QQS) factorial structure. We checked the concurrent validity of the QQS using four other scales, i.e., Copenhagen burnout inventory (CBI), single item burnout (SIB) measure, job satisfaction survey (JSS) and a single item to measure turnover intention. We estimated the reliability of the QQS measuring Cronbach's alpha, McDonald's omega, Cohen's kappa and intraclass correlation coefficient.

Results

After expert panel review and item analysis, nine items with acceptable corrected item-total correlations, inter-item correlations, floor and ceiling effects, skewness and kurtosis were retained. Exploratory factor analysis extracted three factors, namely detachment, lack of initiative and lack of motivation, with a total of nine items. Confirmatory factor analysis confirmed this factorial structure for QQS. We found statistically significant correlations between QQS and CBI, SIB, JSS and turnover intention confirming that the concurrent validity of the QQS was great. Cronbach's alpha and McDonald's omega of the QQS were 0.803 and 0.806 respectively.

Conclusion

QQS, a three-factor nine-item scale, has robust psychometric properties. QQS is an easy-to-administer, brief, reliable and valid tool to measure employees' quiet quitting. We recommend the use of the QQS in different societies and cultures to assess the validity of the instrument.

The effect of psychological contract on turnover intention among nurses: a meta-analytic review

BACKGROUND

The turnover intention (TI) of nurses is common, posing a threat to modern healthcare organizations. Psychological contract (PC) is a predictor of TI, affecting significantly nurse's TI. However, the extent of the association between PC and nurse's TI is unknown. We performed a meta-analysis to quantitatively analyze the relationship between PC and nurse's TI.

METHODS

We searched nine electronic databases from inception to July 2023. Observational studies were included using a retrieval strategy related to PC and TI. Meta-analyses of common effect and random effect models were performed using R software with Spearman or Pearson correlation coefficients. Meta-regression, subgroup analysis, publication bias, and sensitivity analysis were also carried out .

RESULTS

Eighteen studies including 8,908 nurses were identified. Based on various PC-related perspectives, 16 studies explored nurses' TI in terms of the content and three-dimensional structure of PC. Of these, 9 studies reported the negative direction of the correlation between PC and TI (r ranged from - 0.20 to -0.45), whereas 7 studies reported the positive direction of the correlation between PC and TI (r ranged from 0.32 to 0.50). The PC total and its dimensions were found to have moderately significant associations with TI, with the exception of the PCE and PCE-I. Additional, 2 studies reported the relationship between the outcome of PC and TI, the PCF, PCB, and PCV were powerful predictors of nurses' TI. Meta-regression and subgroup analysis found that only nurses working in specialized departments might be the source of heterogeneity.

CONCLUSIONS

To our knowledge, this was the first meta-analysis to quantitatively examine the relationship between PC and TI among nurses. The findings reaffirmed the necessity for healthcare administrators and the medical profession to valued nurse' good interpersonal, social support, humanistic environment, and meet nurses' psychological and spiritual needs in addition to their material demands. Moderators of the connection between PC and TI, based on meta-regression and subgroup analyses, should be carefully explored as they may aid in identifying nurses' TI. Additional, longitudinal research, as well as mixed research, should be conducted to more comprehensively explore the relationship between PC and TI.

The role of bidirectional associations between depression, anxiety, and emotional exhaustion on turnover intention among nurses: a multicenter cross-sectional study in China

BACKGROUND

A high turnover rate in nursing has become a global concern. Mental health issues may increase the turnover intention of nurses and lead to turnover behaviors. However, very little is known about the role of bidirectional associations between emotional exhaustion and depression/anxiety on turnover intention. This study aimed to examine the associations among depression, anxiety, emotional exhaustion and turnover intention, and to test the role of bidirectional associations between depression, anxiety, and emotional exhaustion on turnover intention among nurses.

METHODS

An online multicenter cross-sectional study was conducted in Hunan Province, China, from December 2021 to February 2022. The questionnaire collected data from the Turnover Intention Scale, the Emotional Exhaustion Scale, the Patient Health Questionnaire-2, and the Generalized Anxiety Disorder Scale-2, as well as sociodemographic information. Data analysis was performed by univariate analysis, Pearson correlation analysis, multiple linear regression analysis, and structural equation modeling.

RESULTS

The average turnover intention score among Chinese nurses was 14.34 ± 3.75. The prevalence of depression and anxiety was 25.9% and 22.3%, respectively. Depression (r = 0.378, P < 0.001), anxiety (r = 0.391, P < 0.001), and emotional exhaustion (r = 0.532, P < 0.001) were positively associated with turnover intention. Emotional exhaustion partially mediated the associations between depression/anxiety and turnover intention, with both mediating effects accounting for 60.7%. The mediating ratios of depression/anxiety on the associations between emotional exhaustion and turnover intentions were 17.6% and 16.5%, respectively.

CONCLUSIONS

Depression, anxiety, and emotional exhaustion showed significant positive effects on turnover intention among nurses. Emotional exhaustion played a partial mediation role between depression/anxiety and turnover intention, while depression/anxiety played no significant mediation role between emotional exhaustion and turnover intention.

The resilience of emergency and critical care nurses: a qualitative systematic review and meta-synthesis

Background

Due to the unique work environment, emergency and critical care departments nurses face high job pressure, often resulting in burnout and a high turnover rate. Public health emergencies such as the Corona Virus Disease 2019 pandemic tend to exacerbate these problems further. Therefore, improving the resilience of nurses is crucial to enhance their retention rates.

Objective

This systematic review and meta-synthesis of qualitative studies on the resilience of emergency and critical nurses were conducted to provide a reference for clinical managers to develop strategies for improving the resilience of nurses.

Methods

Following databases were searched for relevant studies: CINAHL Plus, Elsevier, Cochrane Library, Embase, Medline, OVID, Pubmed, Science Direct, LWW and Web of Science, China National Knowledge Network (CNKI), Wanfang Database (CECDB), VIP Database, and Sinomed. Google Scholar and Opengrey were used to search for gray literature. The literature search period was from the establishment of the database to April 2023. The systematic review of qualitative studies followed the Joanna Briggs Institute (JBI) approach, including critical appraisal using the JBI Checklist and synthesis through meta-synthesis. Confidence of evidence was assessed with JBI's ConQual process.

Results

A total of 12 articles were identified, with 59 main results and 9 new integrated categories. Also, 3 themes, i.e., risk factors, protective factors, and personal growth, and 9 sub-themes, i.e., working pressure, negative emotion, an organizational issue, active learning, sense of occupational benefit, social support, self-cognition and regulation, learn to adapt, and self-actualization, were formed.

Conclusion

The resilience of emergency and critical care nurses depends on various factors. Managers should prioritize the mental health of nurses and implement measures to enhance their resilience through social support, team building, and psychological capital development. Additionally, management models can be updated based on domestic and international experience to improve nurses' job involvement, optimize nursing quality, and promote the advancement of the nursing profession.

Effects of work-family conflict on turnover intention among primary medical staff in Huaihai Economic Zone: a mediation model through burnout

Background

Countries worldwide face the challenge of how medical personnel manage conflicts between work and family. Especially after the challenge of the COVID-19 epidemic, it is necessary to explore the possible mechanisms of work-family conflict, burnout, and turnover intention among primary medical staff.

Objectives

This study aims to observe the turnover intention of Chinese primary medical staff and explore the relationship between work-family conflict, burnout, and turnover intention.

Methods

A cross-sectional study included a turnover intention questionnaire, the Maslach Burnout Inventory-General Survey (MBI-GS), and the Work-Family Conflict Scale (WFCS) to understand turnover intention, burnout, and work-family conflict among primary medical staff in four cities (Xuzhou, Linyi, Huaibei, and Shangqiu cities) within the Huaihai Economic Zone. Spearman correlation analysis and hierarchical multiple regression analysis were used to examine the related factors of turnover intention. Structural equation modeling (SEM) was used to study the mediating role of burnout between work-family conflict and turnover intention.

Results

In this study, there is a positive correlation between work-family conflict and turnover intention (P < 0.01). Demographic characteristics, work-family conflict, and burnout explained 2.3%, 20.3%, and 8.8% of the incremental variances, respectively. Burnout mediated the association between work-family conflict and turnover intention.

Conclusions

Burnout can be regarded as a mediator between two different variables: work-family conflict and turnover intention. Improving work-family conflict and alleviating burnout may play a key role in reducing the willingness of primary medical staff to resign. Corresponding measures can be taken to balance the conflict between work and family, alleviate burnout, reduce turnover rates, and build a primary medical staff team with higher medical service quality and stability.

Protective Factors against Morally Injurious Memories from the COVID-19 Pandemic on Nurses' Occupational Wellbeing: A Cross-Sectional Experimental Study

The COVID-19 pandemic was a fertile ground for nurses' exposure to self- and other-Potentially Morally Injurious Events (PMIEs). Our study explored the effects of nurses' memories of self- and other-PMIEs on occupational wellbeing and turnover intentions. Using an experimental design on a convenience sample of 634 Romanian nurses, we tested a conceptual model with PLS-SEM, finding adequate explanatory and predictive power. Memories of self- and other-PMIEs were uniquely associated with work engagement, burnout, and turnover intentions, compared to a control group. These relationships were mediated by the three basic psychological needs. Relatedness was more thwarted for memories of other-PMIEs, while competence and autonomy were more thwarted for memories of self-PMIEs. Perceived supervisor support weakened the indirect effect between type of PMIE and turnover intentions, through autonomy satisfaction, but not through burnout. Self-disclosure weakened the indirect effect between type of PMIE and turnover intentions, through autonomy satisfaction, and both burnout and work engagement. Our findings emphasize the need for different strategies in addressing the negative long-term effects of nurses' exposure to self- and other-PMIEs, according to the basic psychological need satisfaction and type of wellbeing indicator.

Salivary Biomarker Profiles and Chronic Fatigue among Nurses Working Rotation Shifts: An Exploratory Pilot Study

Although nurses’ fatigue affects their well-being and patient safety, no effective objective measurements exist. We explored the profiles of salivary biomarkers associated with nurses’ chronic fatigue across several shifts. This longitudinal study involved 45 shiftwork nurses and collected their saliva samples before two night and two day shifts for a month. Chronic fatigue was measured using the Cumulative Fatigue Symptom Index before the first night shift. Biomarker profiles were analyzed using hierarchical cluster analysis, and chronic fatigue levels were compared between the profiles. Cortisol profiles were classified into high- and low-level groups across two day shifts; the low-level group presented significantly higher irritability and unwillingness to work. Secretory immunoglobulin A (s-IgA) profiles across the four shifts were classified into high- and low-level groups; the high-level group had significantly higher depressive feelings, decreased vitality, irritability, and unwillingness to work. Cortisol (two day shifts) and s-IgA (four shifts) profiles were combined, and (i) cortisol low-level and s-IgA high-level and (ii) cortisol high-level and s-IgA low-level groups were identified. The former group had significantly higher chronic fatigue sign and irritability than the latter group. The profiles of salivary cortisol and s-IgA across several shifts were associated with nurses’ chronic fatigue.