title: Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study.
abstract: BACKGROUND
  High levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses' psychosocial work environment is necessary to respond to complex patients' needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses' and nurse managers' perceptions and experiences of staff nurses' workload; (3) To explain and interpret the two models by using the qualitative study findings.
  
  
  METHODS
  This mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models.
  
  
  RESULTS
  The two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness, quality and patient safety. Respondents' statements corresponded closely to the models' associations.
  
  
  CONCLUSIONS
  A deep understanding of various associations and impacts on studied outcome variables such as risk factors and protective factors was gained through the retested models and the interviews with the study participants. Besides thesofterwork characteristics - such as decision latitude, social capital and team cohesion - more insight and knowledge of thehardwork characteristic workload is essential.
authors.affiliation: Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.|Department of Nursing, Antwerp University Hospital, Wilrijkstraat 10, B- 2650 Edegem, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Van Bogaert
authors.affiliation: Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.|Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Peremans
authors.affiliation: Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.|Department of Nursing, Antwerp University Hospital, Wilrijkstraat 10, B- 2650 Edegem, Belgium.
authors.forename: Danny
authors.initials: D
authors.lastname: Van Heusden
authors.affiliation: Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.|Department of Nursing, Antwerp University Hospital, Wilrijkstraat 10, B- 2650 Edegem, Belgium.
authors.forename: Martijn
authors.initials: M
authors.lastname: Verspuy
authors.affiliation: Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
authors.forename: Veronika
authors.initials: V
authors.lastname: Kureckova
authors.affiliation: Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.|Department of Nursing, Antwerp University Hospital, Wilrijkstraat 10, B- 2650 Edegem, Belgium.
authors.forename: Zoë
authors.initials: Z
authors.lastname: Van de Cruys
authors.affiliation: Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.|Department of Health Care, Karel de Grote University College, Van Schoonbekestraat 143, B- 2018 Antwerp, Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Franck
keywords: Burnout; Job satisfaction; Quality of care; Sensitizing concepts; Structural equation model; Turnover intentions; Work engagement