title: Predicting emotional exhaustion among haemodialysis nurses: a structural equation model using Kanter's structural empowerment theory.
abstract: OBJECTIVE
  To test an explanatory model of the relationships between the nursing work environment, job satisfaction, job stress and emotional exhaustion for haemodialysis nurses, drawing on Kanter's theory of organizational empowerment.
  
  
  BACKGROUND
  Understanding the organizational predictors of burnout (emotional exhaustion) in haemodialysis nurses is critical for staff retention and improving nurse and patient outcomes. Previous research has demonstrated high levels of emotional exhaustion among haemodialysis nurses, yet the relationships between nurses' work environment, job satisfaction, stress and emotional exhaustion in this population are poorly understood.
  
  
  METHODS
  A cross-sectional online survey.
  
  
  METHODS
  417 nurses working in haemodialysis units completed an online survey between October 2011-April 2012 using validated measures of the work environment, job satisfaction, job stress and emotional exhaustion.
  
  
  RESULTS
  Overall, the structural equation model demonstrated adequate fit and we found partial support for the hypothesized relationships. Nurses' work environment had a direct positive effect on job satisfaction, explaining 88% of the variance. Greater job satisfaction, in turn, predicted lower job stress, explaining 82% of the variance. Job satisfaction also had an indirect effect on emotional exhaustion by mitigating job stress. However, job satisfaction did not have a direct effect on emotional exhaustion.
  
  
  CONCLUSIONS
  The work environment of haemodialysis nurses is pivotal to the development of job satisfaction. Nurses' job satisfaction also predicts their level of job stress and emotional exhaustion. Our findings suggest staff retention can be improved by creating empowering work environments that promote job satisfaction among haemodialysis nurses.
authors.affiliation: School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Hayes
authors.forename: Clint
authors.initials: C
authors.lastname: Douglas
authors.forename: Ann
authors.initials: A
authors.lastname: Bonner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002055:Burnout, Professional / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009520:New Zealand; D009741:Nursing Staff, Hospital / Q000523:psychology*; D015279:Organizational Culture; D011209:Power, Psychological; D006435:Renal Dialysis / Q000451:nursing*; D013315:Stress, Psychological / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology*; D055815:Young Adult
keywords: burnout; emotional exhaustion; haemodialysis nursing; job satisfaction; job stress; nephrology; renal; structural equation modelling; work environment; workplace empowerment theory