Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research
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Review
Determinants and prevalence of burnout in emergency
nurses: A systematic review of 25 years of research
Jef Adriaenssens a, *, Ve ́ ronique De Gucht b , Stan Maes c
a Leiden University, Institute of Psychology Health Psychology, PO Box 9555, 2300 RB Leiden, The Netherlands
b Leiden University, Institute of Psychology Health Psychology, 2300 RB Leiden, The Netherlands
c Leiden University, Institute of Psychology and Leiden University Medical Center Health Psychology, 2300 RB Leiden, The Netherlands
Contributions of the paper
What is already known about this topic?
Burnout is a state of depletion of resources of an
employee, as a result of a negative perception of the work
environment, and is characterized by (1) emotional
exhaustion, (2) depersonalization and (3) lack of
personal accomplishment.
Burnout has important consequences for the health care
provider (physical and mental), the patient (e.g. quality
of care) and the health care system (e.g. higher
absenteeism, turnover).
Nurses are found to be a high-risk group for burnout.
However, research suggests differences between nursing
specialties in predictors and outcomes.
What this paper adds?
On average, more than 25% of the emergency nurses
exceeded the cut-off for the different dimensions of
burnout.
International Journal of Nursing Studies xxx (2014) xxx–xxx
A R T I C L E I N F O
Article history:
Received 12 April 2014
Received in revised form 24 October 2014
Accepted 4 November 2014
Keywords:
Burnout
Emergency nursing
Literature review
Occupational stress
Work characteristics
A B S T R A C T
Background: Burnout is an important problem in health care professionals and is associated
with a decrease in occupational well-being and an increase in absenteeism, turnover and
illness. Nurses are found to be vulnerable to burnout, but emergency nurses are even more so,
since emergency nursing is characterized by unpredictability, overcrowding and continuous
confrontation with a broad range of diseases, injuries and traumatic events.
Objectives: This systematic review aims (1) to explore the prevalence of burnout in
emergency nurses and (2) to identify specific (individual and work related) determinants
of burnout in this population.
Method: A systematic review of empirical quantitative studies on burnout in emergency
nurses, published in English between 1989 and 2014.
Data sources: The databases NCBI PubMed, Embase, ISI Web of Knowledge, Informa
HealthCare, Picarta, Cinahl and Scielo were searched.
Results: Seventeen studies were included in this review. On average 26% of the emergency
nurses suffered from burnout. Individual factors such as demographic variables,
personality characteristics and coping strategies were predictive of burnout. Work
related factors such as exposure to traumatic events, job characteristics and organizational
variables were also found to be determinants of burnout in this population.
Conclusions: Burnout rates in emergency nurses are high. Job demands, job control, social
support and exposure to traumatic events are determinants of burnout, as well as several
organizational variables. As a consequence specific action targets for hospital manage-
ment are formulated to prevent turnover and burnout in emergency nurses.
ß 2014 Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: +32 478 230410.
E-mail address: j.adriaenssens@umail.leidenuniv.nl (J. Adriaenssens).
G Model
NS-2472; No. of Pages 13
Please cite this article in press as: Adriaenssens, J., et al., Determinants and prevalence of burnout in emergency nurses: A
systematic review of 25 years of research. Int. J. Nurs. Stud. (2014), http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
Contents lists available at ScienceDirect
International Journal of Nursing Studies
journal homepage: www.elsevier.com/ijns
http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
0020-7489/ß 2014 Elsevier Ltd. All rights reserved.
Determinants and prevalence of burnout in emergency
nurses: A systematic review of 25 years of research
Jef Adriaenssens a, *, Ve ́ ronique De Gucht b , Stan Maes c
a Leiden University, Institute of Psychology Health Psychology, PO Box 9555, 2300 RB Leiden, The Netherlands
b Leiden University, Institute of Psychology Health Psychology, 2300 RB Leiden, The Netherlands
c Leiden University, Institute of Psychology and Leiden University Medical Center Health Psychology, 2300 RB Leiden, The Netherlands
Contributions of the paper
What is already known about this topic?
Burnout is a state of depletion of resources of an
employee, as a result of a negative perception of the work
environment, and is characterized by (1) emotional
exhaustion, (2) depersonalization and (3) lack of
personal accomplishment.
Burnout has important consequences for the health care
provider (physical and mental), the patient (e.g. quality
of care) and the health care system (e.g. higher
absenteeism, turnover).
Nurses are found to be a high-risk group for burnout.
However, research suggests differences between nursing
specialties in predictors and outcomes.
What this paper adds?
On average, more than 25% of the emergency nurses
exceeded the cut-off for the different dimensions of
burnout.
International Journal of Nursing Studies xxx (2014) xxx–xxx
A R T I C L E I N F O
Article history:
Received 12 April 2014
Received in revised form 24 October 2014
Accepted 4 November 2014
Keywords:
Burnout
Emergency nursing
Literature review
Occupational stress
Work characteristics
A B S T R A C T
Background: Burnout is an important problem in health care professionals and is associated
with a decrease in occupational well-being and an increase in absenteeism, turnover and
illness. Nurses are found to be vulnerable to burnout, but emergency nurses are even more so,
since emergency nursing is characterized by unpredictability, overcrowding and continuous
confrontation with a broad range of diseases, injuries and traumatic events.
Objectives: This systematic review aims (1) to explore the prevalence of burnout in
emergency nurses and (2) to identify specific (individual and work related) determinants
of burnout in this population.
Method: A systematic review of empirical quantitative studies on burnout in emergency
nurses, published in English between 1989 and 2014.
Data sources: The databases NCBI PubMed, Embase, ISI Web of Knowledge, Informa
HealthCare, Picarta, Cinahl and Scielo were searched.
Results: Seventeen studies were included in this review. On average 26% of the emergency
nurses suffered from burnout. Individual factors such as demographic variables,
personality characteristics and coping strategies were predictive of burnout. Work
related factors such as exposure to traumatic events, job characteristics and organizational
variables were also found to be determinants of burnout in this population.
Conclusions: Burnout rates in emergency nurses are high. Job demands, job control, social
support and exposure to traumatic events are determinants of burnout, as well as several
organizational variables. As a consequence specific action targets for hospital manage-
ment are formulated to prevent turnover and burnout in emergency nurses.
ß 2014 Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: +32 478 230410.
E-mail address: j.adriaenssens@umail.leidenuniv.nl (J. Adriaenssens).
G Model
NS-2472; No. of Pages 13
Please cite this article in press as: Adriaenssens, J., et al., Determinants and prevalence of burnout in emergency nurses: A
systematic review of 25 years of research. Int. J. Nurs. Stud. (2014), http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
Contents lists available at ScienceDirect
International Journal of Nursing Studies
journal homepage: www.elsevier.com/ijns
http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
0020-7489/ß 2014 Elsevier Ltd. All rights reserved.
A broad set of predictors for burnout in emergency
nurses was described: demographic and personality
characteristics, coping strategies, exposure to traumatic
events, job characteristics and organizational factors.
Level of professional autonomy, team spirit and social
support, quality of leadership, and frequency of exposure
to traumatic events were found to be strong predictors of
burnout in emergency nurses.
1. Introduction
Several studies show that a positive experience of the
work environment (low strain) is related to work engage-
ment and professional commitment, while a negative
perception (high strain) is related to a state of depletion of
resources, called ‘burnout’ (Ahola et al., 2009). In the early
’70s of the last century, Freudenberger defined burnout as
‘the extinction of motivation or incentive, especially where
one’s devotion to a cause or relationship fails to produce the
desired results’ (Freudenberger, 1974). Shortly after,
Christina Maslach defined burnout as a psychological
state resulting from prolonged emotional or psychological
stress on the job (Maslach and Jackson, 1981a,b; Maslach
et al., 2001). Maslach sees burnout as an internal emotional
reaction (illness) caused by external factors, resulting in
loss of personal and/or social resources: ‘Burnout is the
index of the dislocation between what people are and what
they have to do. It represents erosion in values, dignity, spirit,
and will—an erosion of the human soul. It’s a malady that
spreads gradually and continuously over time, putting people
into a downward spiral from which it’s hard to recover’
(Maslach and Leiter, 1997).
Burnout, as defined by Maslach, has three dimensions.
The first dimension of the burnout syndrome is ‘‘emotional
exhaustion’’. When the emotional reserves are depleted,
employees feel that they are no longer able to provide work
of good quality. They have feelings of extreme energy loss
and a sense of being completely drained out of emotional
and physical strength (Maslach and Jackson, 1981a,b). The
second dimension ‘‘depersonalization’’ is defined as the
development of negative attitudes, such as cynicism and
negativism, both in thinking as well as in behavior, in
which coworkers and service recipients are approached
with derogatory prejudices and treated accordingly
(Maslach and Jackson, 1981a,b). The third aspect is ‘‘lack
of personal accomplishment’’. This is defined as lack of
feelings regarding both job and personal competence and
failure in achieving goals (McDonald-Fletcher, 2008;
Maslach and Jackson, 1981a,b). There is a general
consensus in the literature that emotional exhaustion is
the central or core dimension of burnout (Gaines and
Jermier, 1983; Sonnentag et al., 2010).
The consequences of burnout are multiple. Apart from a
decrease in the quality of care (in case of health care jobs), a
relationship was found between burnout and the occur-
rence of musculoskeletal disorders, depression, obesity,
insomnia, alcohol intake and drug abuse (Poghosyan et al.,
2010a; Sorour and El-Maksoud, 2012; Iacovides et al., 1999;
Moustaka and Constantinidis, 2010). Burnout also has a
negative impact on the quality of life of the employee, with
more intra-relational conflicts and aggression (Wu et al.,
2011). Finally, burnout can also lead to a significant
economic loss through increased absenteeism, higher
turnover rates and a rise in health care costs (Borritz
et al., 2006).
The prevalence of burnout, assessed by use of a self-
report instrument in a general working population in
Western countries, ranges from 13% to 27% (Norlund
et al., 2010; Lindblom et al., 2006; Kant et al., 2004;
Houtman et al., 2000; Aromaa and Koskinen, 2004). Nurses
are known to be at higher risk for the development of
burnout then other occupations (Maslach, 2003; Gelsema
et al., 2006). Research showed that nurses indeed report
high levels of work related stress (Hasselhorn et al., 2003;
Smith et al., 2000; Clegg, 2001; McVicar, 2003) and that
30% to 50% reach clinical levels of burnout (Aiken et al.,
2002; Poncet et al., 2007; Gelsema et al., 2006). According
to several authors, the demands that burden the nurses (in
terms of work setting, task description, responsibility,
unpredictability and the exposure to potentially traumatic
situations) and the resources they can rely on, are strongly
related to the content of their job and their nursing
specialty (Browning et al., 2007; Ergun et al., 2005; Eriksen,
2006; Kipping, 2000; Mealer et al., 2007). Emergency (ER)
nursing is a specialty that differs from other nursing
specialties: work in emergency departments is hectic,
unpredictable and constantly changing. ER-nurses are
confronted with a very broad range of diseases, injuries
and problems. Moreover, due to the hectic work conditions
and overcrowding, emergency nurses often have to move
from one urgency to another, with often little recovery time
(Alexander and Klein, 2001; Gates et al., 2011). As a
consequence, rates of burnout are found to be very high in
emergency nursing settings (Hooper et al., 2010; Potter,
2006).
2. The review
2.1. Aim
The aim of the present review is (1) to examine the level
of burnout in ER-nurses and (2) to identify specific
determinants of burnout in these nurses, including various
individual and work-related factors.
2.2. Search methods
The databases NCBI PubMed, Embase, ISI Web of
Knowledge, Informa HealthCare, Picarta, Cinahl and Scielo
were searched in June 2014 for original research publica-
tions that were written or published in the last 25 years
(1989–2014) in English, concerning exposure to occupa-
tional stress and its consequences in ER-nurses, in terms of
burnout. Furthermore, the references of the retrieved
papers were searched for additional links. For this search,
combinations of the following keywords were used: strain,
stress*, occupational stress, work stress, work-stress,
workplace stress, work environment, ER, E.R., trauma
center, triage room, A&E, ambulance, critical care facility,
emergency service, first aid, ‘‘Emergency Service, Hospital’’
[Mesh], ‘‘Emergency Medical Services’’ [Mesh], ‘‘Emergen-
cy Nursing’’ [Mesh], ‘‘Emergency Medicine’’ [Mesh], nurse*,
G Model
NS-2472; No. of Pages 13
Please cite this article in press as: Adriaenssens, J., et al., Determinants and prevalence of burnout in emergency nurses: A
systematic review of 25 years of research. Int. J. Nurs. Stud. (2014), http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
J. Adriaenssens et al. / International Journal of Nursing Studies xxx (2014) xxx–xxx2
nurses was described: demographic and personality
characteristics, coping strategies, exposure to traumatic
events, job characteristics and organizational factors.
Level of professional autonomy, team spirit and social
support, quality of leadership, and frequency of exposure
to traumatic events were found to be strong predictors of
burnout in emergency nurses.
1. Introduction
Several studies show that a positive experience of the
work environment (low strain) is related to work engage-
ment and professional commitment, while a negative
perception (high strain) is related to a state of depletion of
resources, called ‘burnout’ (Ahola et al., 2009). In the early
’70s of the last century, Freudenberger defined burnout as
‘the extinction of motivation or incentive, especially where
one’s devotion to a cause or relationship fails to produce the
desired results’ (Freudenberger, 1974). Shortly after,
Christina Maslach defined burnout as a psychological
state resulting from prolonged emotional or psychological
stress on the job (Maslach and Jackson, 1981a,b; Maslach
et al., 2001). Maslach sees burnout as an internal emotional
reaction (illness) caused by external factors, resulting in
loss of personal and/or social resources: ‘Burnout is the
index of the dislocation between what people are and what
they have to do. It represents erosion in values, dignity, spirit,
and will—an erosion of the human soul. It’s a malady that
spreads gradually and continuously over time, putting people
into a downward spiral from which it’s hard to recover’
(Maslach and Leiter, 1997).
Burnout, as defined by Maslach, has three dimensions.
The first dimension of the burnout syndrome is ‘‘emotional
exhaustion’’. When the emotional reserves are depleted,
employees feel that they are no longer able to provide work
of good quality. They have feelings of extreme energy loss
and a sense of being completely drained out of emotional
and physical strength (Maslach and Jackson, 1981a,b). The
second dimension ‘‘depersonalization’’ is defined as the
development of negative attitudes, such as cynicism and
negativism, both in thinking as well as in behavior, in
which coworkers and service recipients are approached
with derogatory prejudices and treated accordingly
(Maslach and Jackson, 1981a,b). The third aspect is ‘‘lack
of personal accomplishment’’. This is defined as lack of
feelings regarding both job and personal competence and
failure in achieving goals (McDonald-Fletcher, 2008;
Maslach and Jackson, 1981a,b). There is a general
consensus in the literature that emotional exhaustion is
the central or core dimension of burnout (Gaines and
Jermier, 1983; Sonnentag et al., 2010).
The consequences of burnout are multiple. Apart from a
decrease in the quality of care (in case of health care jobs), a
relationship was found between burnout and the occur-
rence of musculoskeletal disorders, depression, obesity,
insomnia, alcohol intake and drug abuse (Poghosyan et al.,
2010a; Sorour and El-Maksoud, 2012; Iacovides et al., 1999;
Moustaka and Constantinidis, 2010). Burnout also has a
negative impact on the quality of life of the employee, with
more intra-relational conflicts and aggression (Wu et al.,
2011). Finally, burnout can also lead to a significant
economic loss through increased absenteeism, higher
turnover rates and a rise in health care costs (Borritz
et al., 2006).
The prevalence of burnout, assessed by use of a self-
report instrument in a general working population in
Western countries, ranges from 13% to 27% (Norlund
et al., 2010; Lindblom et al., 2006; Kant et al., 2004;
Houtman et al., 2000; Aromaa and Koskinen, 2004). Nurses
are known to be at higher risk for the development of
burnout then other occupations (Maslach, 2003; Gelsema
et al., 2006). Research showed that nurses indeed report
high levels of work related stress (Hasselhorn et al., 2003;
Smith et al., 2000; Clegg, 2001; McVicar, 2003) and that
30% to 50% reach clinical levels of burnout (Aiken et al.,
2002; Poncet et al., 2007; Gelsema et al., 2006). According
to several authors, the demands that burden the nurses (in
terms of work setting, task description, responsibility,
unpredictability and the exposure to potentially traumatic
situations) and the resources they can rely on, are strongly
related to the content of their job and their nursing
specialty (Browning et al., 2007; Ergun et al., 2005; Eriksen,
2006; Kipping, 2000; Mealer et al., 2007). Emergency (ER)
nursing is a specialty that differs from other nursing
specialties: work in emergency departments is hectic,
unpredictable and constantly changing. ER-nurses are
confronted with a very broad range of diseases, injuries
and problems. Moreover, due to the hectic work conditions
and overcrowding, emergency nurses often have to move
from one urgency to another, with often little recovery time
(Alexander and Klein, 2001; Gates et al., 2011). As a
consequence, rates of burnout are found to be very high in
emergency nursing settings (Hooper et al., 2010; Potter,
2006).
2. The review
2.1. Aim
The aim of the present review is (1) to examine the level
of burnout in ER-nurses and (2) to identify specific
determinants of burnout in these nurses, including various
individual and work-related factors.
2.2. Search methods
The databases NCBI PubMed, Embase, ISI Web of
Knowledge, Informa HealthCare, Picarta, Cinahl and Scielo
were searched in June 2014 for original research publica-
tions that were written or published in the last 25 years
(1989–2014) in English, concerning exposure to occupa-
tional stress and its consequences in ER-nurses, in terms of
burnout. Furthermore, the references of the retrieved
papers were searched for additional links. For this search,
combinations of the following keywords were used: strain,
stress*, occupational stress, work stress, work-stress,
workplace stress, work environment, ER, E.R., trauma
center, triage room, A&E, ambulance, critical care facility,
emergency service, first aid, ‘‘Emergency Service, Hospital’’
[Mesh], ‘‘Emergency Medical Services’’ [Mesh], ‘‘Emergen-
cy Nursing’’ [Mesh], ‘‘Emergency Medicine’’ [Mesh], nurse*,
G Model
NS-2472; No. of Pages 13
Please cite this article in press as: Adriaenssens, J., et al., Determinants and prevalence of burnout in emergency nurses: A
systematic review of 25 years of research. Int. J. Nurs. Stud. (2014), http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
J. Adriaenssens et al. / International Journal of Nursing Studies xxx (2014) xxx–xxx2
‘‘Nurses’’[Mesh], nursing staff, health professional, para-
medic, medical staff, critical incident, critical event,
traumatic event, predictor, determinant. The primary
outcome key words were burnout, exhaustion, fatigue,
‘‘Burnout, Professional’’ [Mesh] and M.B.I. but also the
secondary outcomes job satisfaction, turnover, mental
health, occupational health, anxiety, depression, somatic,
post-traumatic stress, secondary traumatic stress, ‘‘Stress
Disorders, Post-Traumatic’’ [Mesh], PTSD and P.T.S.D were
taken into account.
Studies were included only if the following criteria were
met: the respondents under study (N 40) were nurses,
and a well-defined part of the respondents worked in an
emergency unit or in ambulance care, (2) the focus of the
study had to be on determinants/predictors of burnout,
(3) the study had to be empirical and quantitative and
(4) the response rate was higher than 25%.
2.3. Search outcome
The literature search in the different databases revealed
489 research papers but 142 duplicates were removed
from the list. From the remaining 347 articles the titles and
abstracts were screened and another 289 papers were
excluded because (1) the research was qualitative, (2) the
paper did not describe primary research or (3) the paper did
not adequately report on the target population, determi-
nants or outcomes. From the remaining 58 articles, includ-
ing four additional articles that were found by use of the
snowball method, hard copies were acquired and checked
Literature search in NCBI Pubmed,
Embase, ISI Web of Knowledge,
Informa Health Care, Picarta, Cinahl
and Scielo:
489 research papers
Title and abstract screening (type of
research, primary research, clear
descripon of target populaon,
determinants and outcome
347 research papers
Removal of 142 duplicates
289 papers excluded
58 remaining with 4 addional
studies (snowball method) checked
according to inclusion and exclusion
criteria
11 papers excluded
(no separate data for ER-nurses)
5 papers excluded
(response rate <25%)
1 paper excluded
(subsample of ER-nurses too small)
41 remaining studies checked for
burnout as outcome measure
24 papers excluded
17 studies included in the review
Fig. 1. Flow diagram of strategy used to indentify literature.
G Model
NS-2472; No. of Pages 13
Please cite this article in press as: Adriaenssens, J., et al., Determinants and prevalence of burnout in emergency nurses: A
systematic review of 25 years of research. Int. J. Nurs. Stud. (2014), http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
J. Adriaenssens et al. / International Journal of Nursing Studies xxx (2014) xxx–xxx 3
medic, medical staff, critical incident, critical event,
traumatic event, predictor, determinant. The primary
outcome key words were burnout, exhaustion, fatigue,
‘‘Burnout, Professional’’ [Mesh] and M.B.I. but also the
secondary outcomes job satisfaction, turnover, mental
health, occupational health, anxiety, depression, somatic,
post-traumatic stress, secondary traumatic stress, ‘‘Stress
Disorders, Post-Traumatic’’ [Mesh], PTSD and P.T.S.D were
taken into account.
Studies were included only if the following criteria were
met: the respondents under study (N 40) were nurses,
and a well-defined part of the respondents worked in an
emergency unit or in ambulance care, (2) the focus of the
study had to be on determinants/predictors of burnout,
(3) the study had to be empirical and quantitative and
(4) the response rate was higher than 25%.
2.3. Search outcome
The literature search in the different databases revealed
489 research papers but 142 duplicates were removed
from the list. From the remaining 347 articles the titles and
abstracts were screened and another 289 papers were
excluded because (1) the research was qualitative, (2) the
paper did not describe primary research or (3) the paper did
not adequately report on the target population, determi-
nants or outcomes. From the remaining 58 articles, includ-
ing four additional articles that were found by use of the
snowball method, hard copies were acquired and checked
Literature search in NCBI Pubmed,
Embase, ISI Web of Knowledge,
Informa Health Care, Picarta, Cinahl
and Scielo:
489 research papers
Title and abstract screening (type of
research, primary research, clear
descripon of target populaon,
determinants and outcome
347 research papers
Removal of 142 duplicates
289 papers excluded
58 remaining with 4 addional
studies (snowball method) checked
according to inclusion and exclusion
criteria
11 papers excluded
(no separate data for ER-nurses)
5 papers excluded
(response rate <25%)
1 paper excluded
(subsample of ER-nurses too small)
41 remaining studies checked for
burnout as outcome measure
24 papers excluded
17 studies included in the review
Fig. 1. Flow diagram of strategy used to indentify literature.
G Model
NS-2472; No. of Pages 13
Please cite this article in press as: Adriaenssens, J., et al., Determinants and prevalence of burnout in emergency nurses: A
systematic review of 25 years of research. Int. J. Nurs. Stud. (2014), http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
J. Adriaenssens et al. / International Journal of Nursing Studies xxx (2014) xxx–xxx 3
Table 1
Overview of the selected studies, the basic characteristics and results.
Author, year of publication and
origin of the study
Design* Approached (Ap) sample and
Response rate & participants (Pt)
Measure of
Burnout
Translation
procedure
Measure of determinants &
(instrument used)
EE DP PA
Adali and Priami (2002)
Greece
CS Ap: 414 nurses
Pt: 233 nurses (56.2%)
99 nurses general ward
83 nurses ICU
51 ER nurses
MBI-HSS T/BT-AA Age R = 0.54**
SE = 0.19
Psychological demands (WES) R = 3.61 **
SE = 1.26
Level of innovation (WES) R = 2.16 **
SE = 0.81
Supervisor support (WES) R = 0.72 *
SE = 0.34
Task orientation (WES) R = 0.91 ***
SE = 0.65
Alexander and Klein (2001)
Scotland
CS Ap: 160 ambulance workers
Pt: 110 ambulance workers (69%)
40 ER nurses%)
70 EMT
MBI-HSS OVI Age
Hardiness (commitment) (HS)
Hardiness (feelings of control) (HS)
Hardiness (feelings of challenge) (HS)
Organizational satisfaction (workplace)
r = 0.12 ns
r = 0.51 ***
r = 0.35 ***
r = 0.26 **
r = 0.29 **
r = 0.04 ns
r = 0.45 ***
r = 0.27 **
r = 0.15 ns
r = 0.31 ***
r = 0.29**
r = 0.45***
r = 0.37***
r = 0.20 *
Ariapooran (2014)
Iran
CS Ap: 200
Pt: 173 hospital staff (86.5%)
84 ER-nurses
79 non-ER-nurses
ProQOL R-IV NIP Social support (peers & family) (MSPSS) N.D. N.D. N.D.
Bernaldo-De-Quiros
et al. (2014)
Spain
CS Ap: 504 ER workers
Pt: 441 ER workers (87.5%)
127 nurses
135 doctors
179 ER care assistants
MBI-HSS TP-PP Exposure to insults
Exposure to threatening behavior
Exposure to physical aggression
N.D.
N.D.
N.D.
N.D.
N.D.
N.D.
N.D.
N.D.
N.D.
Browning et al. (2007)
United States
CS Ap: 228 nurses (symposia)
88 ANP’s
40 nurse managers
100 ER nurses
Pt: 228 nurses (symposia) (100%)
MBI-HSS OVI Mastery (McDermott) r = 0.17 *
r = 0.12 *
N.D
Perceived control (McDermott) r = 0.19 **
Escriba` -Agu ̈ ir et al. (2006);
Escriba-Agu ̈ ir and
Pe ́ rez-Hoyos (2007)
Spain
CS Ap: 945 staff ER
Pt: 639 staff ER Ward (67.7%)
280 nurses
359 doctors
MBI-HSS TP-PP High psychological demands (JCQ)
Low job control (JCQ)
Low social support supervisor (JCQ)
Low social support colleagues (JCQ)
High static physical demands (JCQ)
High dynamic physical demands (JCQ)
OR = 4.98***
OR = 0.90 ns
OR = 2.89**
OR = 0.93 ns
OR = 1.80 ns
OR = 1.71 ns
N.D. N.D.
Garcia-Izquierdo and
Rios-Risquez (2012)
Spain
CS Ap: 262 ER nurses
Pt: 191 ER nurses (73%)
MBI-GS TP-PP Interpersonal conflicts (NSS)
Lack of resources (NSS)
Excessive workload (NSS)
Lack of social support (NSS)
Exposure to traumatic events (NSS)
r = 0.35 *
r = 0.17 **
r = 0.39 *
r = 0.33 *
r = 0.16 **
r = 0.42 *
r = 0.18 **
r = 0.34 *
r = 0.38 *
r = 0.09 ns
r = 0.23*
r = 0.12 ns
r = 0.10 ns
r = 0.21*
r = 0.05 ns
Helps (1997)
United Kingdom
CS Ap: 57 ER nurses
Pt: 51 ER nurses (89.5%)
MBI-HSS OVI No relevant determinants N.D. N.D. N.D.
Hooper et al. (2010)
United States
CS Ap: 138 nurses (different wards)
Pt: 108 nurses (82%)
49 ER nurses
32 ICU nurses
16 Nephrology nurses
12 oncology nurses
ProQOL R-IV OVI No relevant determinants N.D. N.D. N.D.
G Model
NS-2472; No. of Pages 13
Please cite this article in press as: Adriaenssens, J., et al., Determinants and prevalence of burnout in emergency nurses: A
systematic review of 25 years of research. Int. J. Nurs. Stud. (2014), http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
J. Adriaenssens et al. / International Journal of Nursing Studies xxx (2014) xxx–xxx4
Overview of the selected studies, the basic characteristics and results.
Author, year of publication and
origin of the study
Design* Approached (Ap) sample and
Response rate & participants (Pt)
Measure of
Burnout
Translation
procedure
Measure of determinants &
(instrument used)
EE DP PA
Adali and Priami (2002)
Greece
CS Ap: 414 nurses
Pt: 233 nurses (56.2%)
99 nurses general ward
83 nurses ICU
51 ER nurses
MBI-HSS T/BT-AA Age R = 0.54**
SE = 0.19
Psychological demands (WES) R = 3.61 **
SE = 1.26
Level of innovation (WES) R = 2.16 **
SE = 0.81
Supervisor support (WES) R = 0.72 *
SE = 0.34
Task orientation (WES) R = 0.91 ***
SE = 0.65
Alexander and Klein (2001)
Scotland
CS Ap: 160 ambulance workers
Pt: 110 ambulance workers (69%)
40 ER nurses%)
70 EMT
MBI-HSS OVI Age
Hardiness (commitment) (HS)
Hardiness (feelings of control) (HS)
Hardiness (feelings of challenge) (HS)
Organizational satisfaction (workplace)
r = 0.12 ns
r = 0.51 ***
r = 0.35 ***
r = 0.26 **
r = 0.29 **
r = 0.04 ns
r = 0.45 ***
r = 0.27 **
r = 0.15 ns
r = 0.31 ***
r = 0.29**
r = 0.45***
r = 0.37***
r = 0.20 *
Ariapooran (2014)
Iran
CS Ap: 200
Pt: 173 hospital staff (86.5%)
84 ER-nurses
79 non-ER-nurses
ProQOL R-IV NIP Social support (peers & family) (MSPSS) N.D. N.D. N.D.
Bernaldo-De-Quiros
et al. (2014)
Spain
CS Ap: 504 ER workers
Pt: 441 ER workers (87.5%)
127 nurses
135 doctors
179 ER care assistants
MBI-HSS TP-PP Exposure to insults
Exposure to threatening behavior
Exposure to physical aggression
N.D.
N.D.
N.D.
N.D.
N.D.
N.D.
N.D.
N.D.
N.D.
Browning et al. (2007)
United States
CS Ap: 228 nurses (symposia)
88 ANP’s
40 nurse managers
100 ER nurses
Pt: 228 nurses (symposia) (100%)
MBI-HSS OVI Mastery (McDermott) r = 0.17 *
r = 0.12 *
N.D
Perceived control (McDermott) r = 0.19 **
Escriba` -Agu ̈ ir et al. (2006);
Escriba-Agu ̈ ir and
Pe ́ rez-Hoyos (2007)
Spain
CS Ap: 945 staff ER
Pt: 639 staff ER Ward (67.7%)
280 nurses
359 doctors
MBI-HSS TP-PP High psychological demands (JCQ)
Low job control (JCQ)
Low social support supervisor (JCQ)
Low social support colleagues (JCQ)
High static physical demands (JCQ)
High dynamic physical demands (JCQ)
OR = 4.98***
OR = 0.90 ns
OR = 2.89**
OR = 0.93 ns
OR = 1.80 ns
OR = 1.71 ns
N.D. N.D.
Garcia-Izquierdo and
Rios-Risquez (2012)
Spain
CS Ap: 262 ER nurses
Pt: 191 ER nurses (73%)
MBI-GS TP-PP Interpersonal conflicts (NSS)
Lack of resources (NSS)
Excessive workload (NSS)
Lack of social support (NSS)
Exposure to traumatic events (NSS)
r = 0.35 *
r = 0.17 **
r = 0.39 *
r = 0.33 *
r = 0.16 **
r = 0.42 *
r = 0.18 **
r = 0.34 *
r = 0.38 *
r = 0.09 ns
r = 0.23*
r = 0.12 ns
r = 0.10 ns
r = 0.21*
r = 0.05 ns
Helps (1997)
United Kingdom
CS Ap: 57 ER nurses
Pt: 51 ER nurses (89.5%)
MBI-HSS OVI No relevant determinants N.D. N.D. N.D.
Hooper et al. (2010)
United States
CS Ap: 138 nurses (different wards)
Pt: 108 nurses (82%)
49 ER nurses
32 ICU nurses
16 Nephrology nurses
12 oncology nurses
ProQOL R-IV OVI No relevant determinants N.D. N.D. N.D.
G Model
NS-2472; No. of Pages 13
Please cite this article in press as: Adriaenssens, J., et al., Determinants and prevalence of burnout in emergency nurses: A
systematic review of 25 years of research. Int. J. Nurs. Stud. (2014), http://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
J. Adriaenssens et al. / International Journal of Nursing Studies xxx (2014) xxx–xxx4
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