title: The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study.
abstract: BACKGROUND
  The frontline clinical manager role in healthcare is pivotal to the development of safe and healthy working conditions and optimal staff and patient care outcomes. However, in today's dynamic healthcare organizations managers face constant job demands from wider spans of control and complex role responsibilities but may not have adequate decisional authority to support effective work performance resulting in unnecessary job strain. Prolonged job strain can lead to burnout, health complaints, and increased turnover intention. Yet, there is limited research that examines frontline manager job strain and its impact on their well-being and work outcomes. The substantial cost associated with replacing experienced managers calls attention to the need to address job strain in order to retain this valuable organizational asset.
  
  
  OBJECTIVE
  Using Karasek's Job Demands-Control theory of job strain, a model was tested examining the effects of frontline manager job strain on their burnout (emotional exhaustion and cynicism), organizational commitment and ultimately, turnover intentions.
  
  
  METHODS
  Secondary analysis of data collected in an online cross-sectional survey of frontline managers was conducted using structural equation modeling.
  
  
  METHODS
  All 500 eligible frontline managers from 14 teaching hospitals in Ontario, Canada, were invited to participate and 159 responded for a 32% response rate.
  
  
  METHODS
  Participants received an email invitation with a secure link for the online survey. Ethics approval was obtained from the university ethics board and the respective ethics review boards of the 14 organizations involved in the study. The model was tested using path analysis techniques within structural equation modeling with maximum likelihood estimation.
  
  
  RESULTS
  The final model fit the data acceptably (χ(2)=6.62, df=4, p=.16, IFI=99, CFI=.99, SRMR=.03, RMSEA=.06). Manager job strain was significantly positively associated with burnout which contributed to both lower organizational commitment and higher turnover intention. Organizational commitment was also negatively associated with turnover intention and there was an additional direct positive relationship between job strain and turnover intention.
  
  
  CONCLUSIONS
  Preliminary support was found for a model showing that manager job strain contributes to burnout, reduced organizational commitment and higher turnover intentions. Findings suggest that organizations need to monitor and address manager job strain by ensuring managers' role demands are reasonable and that they have the requisite decision latitude to balance role demands.
authors.affiliation: Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Rm. H27, Health Sciences Addition (HSA), The University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5C1, Canada. Electronic address: cwong2@uwo.ca.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Wong
authors.affiliation: Human Resource Optimization, Arthur Labatt Family School of Nursing, The University of Western Ontario, Room H3A, Health Sciences Addition, London, Ontario N6A 5C1, Canada. Electronic address: hkl@uwo.ca.
authors.forename: Heather K
authors.initials: HK
authors.lastname: Spence Laschinger
mesh_terms: D002055:Burnout, Professional / Q000523:psychology*; D003430:Cross-Sectional Studies; D009718:Nurse Administrators / Q000523:psychology*; D010563:Personnel Turnover
keywords: Burnout; Frontline managers; Healthcare; Job strain; Organizational commitment; Path analysis; Turnover intention