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Ethical leadership and decision authority effects on nurses' engagement, exhaustion and turnover intention

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Aim: The aim of the present study was to investigate emotional exhaustion, work engagement, and turnover intention in the nursing profession by exploring the antecedent effects of ethical leadership and job components such as decision authority. Background: Emotional exhaustion, low work engagement, and high turnover intention are prevalent issues in the nursing profession. The experience of feeling overworked has led to feelings of burnout and low morale among nurses in Ireland, which has prompted the authors to identify potential variables that reduce these outcomes-in this case, ethical leadership and decision authority. Design: A descriptive, cross-sectional survey design was used across three hospital sites. Methods: A cross-sectional sample of 89 nurses was recruited from three Irish hospitals to capture the experience of nurses between December 2017 - February 2018. Hypotheses were tested using path model analysis. Results: Ethical leadership positively predicted decision authority among nurses. Ethical leadership also had an indirect effect on all three outcome variables (work engagement, exhaustion, and turnover intention). Further effects were noted in relation to the mediators in relation to the three outcome variables. Decision authority had a positive effect on work engagement and related to lower turnover intention. Conclusions: The present study demonstrated the role of ethical leadership as a mechanism to positively affect job control and work experience outcomes for nurses at work. Ethical leadership style in hospitals and providing nurses with the authority to make decisions can improve their work experience and help to engage, support, and retain nurses. Impact: The study found support for the positive role of ethical leadership in relation to decision authority and as a positive predictor of work engagement, negative predictor of emotional exhaustion, and turnover intention among nurses.
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wileyonlinelibrary.com/journal/jan J Adv Nurs. 2021;77:198–206.© 2020 John Wiley & Sons Ltd

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 
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 
DOI : 10.1111/jan.14591
ORIGINAL RESEARCH:
EMPIRICAL RESEARCH – QUANTITATIVE
Ethical leadership and decision authority effects on nurses’
engagement, exhaustion, and turnover intention
Jayne McKenna | Debora Jeske
   
 
Correspondence
 
 
 
Funding information
  

Abstract
Aim:           
-

Background:         -
           
   
              

Design: 

Methods:         -


Results:        
        
-
  

Conclusions:            


    

Impact: 
-

KEYWORDS


... Meanwhile, excessive nurse turnover rates have become a major problem, hurting healthcare organizations and patient outcomes. The intention of nurses to leave their jobs has been partly linked to a lack of nurse engagement in their organizations [36,63]. The study examined the relationship between work engagement and turnover intentions, assessing the mediating role of the resilience of nurses. ...
... Even though the current study projected adequate work engagement, which is similar to other studies in China [64], Egypt [65], Saudi Arabia [66] and the USA [34], sustained effort is needed to include nurses in healthcare system decision-making. According to McKenna and Jeske [63] and Huang et al. [67], giving nurses more opportunities to take the initiative and participate in hospital affairs can significantly increase their work engagement, which will improve other nursing job outcomes. Nurses who work in positive practice environments report higher job satisfaction and lower rates of turnover and thus increase their work engagement [68]. ...
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Full-text available
Introduction Healthcare organizations experience difficult challenges as a result of nursing staff turnover. This is because it not only interrupts continuity of service but also its financial implications. Aim The purpose of the study was to find out the effects of work engagement on nurses' intentions to leave their jobs while considering resilience as a mediating factor. Methods The study used a descriptive-analytical design using a survey questionnaire on nurses working in different healthcare settings. The Utrecht Work Engagement Scale, the Brief Resilience Scale, and the Turnover Intention Scale were among the validated scales that were employed. The hypothesized relations were tested using descriptive and mediation analyses at a significance of <0.05. Results Though the turnover intention (n = 3.83 ± 1.42) and the level of work engagement (n = 4.03 ± 1.32) among nurses were high, their level of resilience of nurses was average (n = 2.48, SD: 0.63). Resilience had a negative association with turnover intention (β = − 0.5699, p < .0001), and there was also a significant negative association between work engagement and turnover intentions among nurses with resilience mediating the relationship (β = -0.0367, p < .05). Conclusion Disengaged nurses are more likely to leave their jobs. Moreover, resilience acts as a mechanism through which work engagement influences turnover intentions. The study emphasizes the need to encourage work engagement among nurses to lessen intentions to leave the profession. Among factors that can improve work engagement and resilience to reduce turnover include conducting regular engagement assessments, fostering positive workplace cultures, employing flexible scheduling practices, and offering resources for personal and professional development.
... 21,22 Ethical leadership induces higher levels of flourishing, proactive work behaviors, 23 increased work engagement, 24 effective management of resources, and reduced emotional exhaustion and turnover intentions among nurses. 25 ...
... Furthermore, prior research indicates that the motivation to blow the whistle is often sparked by an individual's sense of responsibility, 14 a trait that ethical leadership nurtures among followers. 25 Hence, we hypothesize: ...
Article
Background: Cultivating internal whistleblowing among nurses is of paramount importance to nurse leaders. Yet, the literature on how nurse leaders can foster this phenomenon among nurses is limited. Additionally, the underlying mechanisms linking leadership behaviors to internal whistleblowing intentions remain underexplored. Aim: This study aimed to examine how ethical leadership is linked to internal whistleblowing intentions among nurses through the mediating effect of psychological safety. Research design: A multicenter cross-sectional research design was used for this study. Participants and research context: This study involved 201 nurses working in three tertiary governmental hospitals across three cities in Egypt. Data were collected between October and December 2023, using an introductory information form, the Ethical Leadership Scale, the Psychological Safety Scale, and the Internal Whistleblowing Intentions Scale. Structural equation modeling was used to evaluate study hypotheses. Ethical consideration: Research Ethics Committee of Faculty of Nursing, Port Said University, Egypt approved the study (reference number: NUR (6/8/2023)(28)), and each participant signed the informed consent form before participation in the study. Results: Ethical leadership was positively linked to nurses’ psychological safety and internal whistleblowing intentions. Psychological safety mediated the link between ethical leadership and nurses’ internal whistleblowing intentions. Conclusion: Our study suggests that nurse leaders can foster nurses’ intentions to blow the whistle internally by adopting ethical leadership behaviors and enhancing psychological safety among nurses.
... Some studies have pointed out that turnover intentions are influenced by individual characteristics such as gender, marital status, and education level [7]. Other studies have found that factors such as the work environment, organizational climate, and leadership style are closely related to turnover intentions [4,[8][9][10]. These findings provide important guidance for understanding and intervening in nurses' turnover behaviors. ...
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Background Young nurses are the backbone of the intensive care unit nursing team. Their turnover intentions not only directly impact the physiological health and life outcomes of critically ill patients but also significantly affect the efficient operation of the healthcare system. Previous research has noted the association between nurse emotional exhaustion and turnover intentions. However, few studies have examined how both external and internal resources simultaneously moderate this relationship, especially among young intensive care unit nurses. This study explore the potential mechanisms by which emotional exhaustion affects turnover intentions among young intensive care unit nurses. On this basis, it investigates how organizational justice and organizational-based self-esteem, as critical work resources, moderate the relationship between emotional exhaustion and turnover intentions. Methods A cross-sectional survey design was adopted. A total of 490 questionnaires were distributed, with a final valid response rate of 91.2%. SPSS 27.0 was utilized for descriptive analysis and Pearson correlation analysis. AMOS 25.0 was employed to construct the Structural Equation Model and the Bootstrap test. Results Emotional exhaustion among young intensive care unit nurses positively predicts turnover intention, with job performance playing a mediating role. The indirect effect of job performance accounts for 3.24% of the total effect. Organizational justice and organizational-based self-esteem respectively moderated the relationship between emotional exhaustion and turnover intention. The combined indirect effects accounted for 17.18% and 12.76% of the total effect, respectively. Organizational justice and organizational-based self-esteem, as well as organizational justice, organizational-based self-esteem, and job performance, respectively played a chain mediating role between emotional exhaustion and turnover intention. The indirect effect accounted for 3.82% and 3.63% of the total effect, respectively. Conclusion Emotional exhaustion has a positive predictive effect on turnover intention among young intensive care unit nurses, with job performance playing a mediating role. Organizational justice and organizational-based self-esteem, as key work resources, moderated this relationship, mitigating the impact of emotional exhaustion on turnover intention. Clinical trial number Not applicable.
... This finding indicates that ethical leadership is significantly associated with organizational-related outcomes; nurse job performance is a crucial component of overall organizational performance, thereby providing robust support for our research conclusions. McKenna's research (13) noted that ethical leadership positively influences decision-making power and serves as a positive predictor of work engagement, while also being a negative predictor of emotional exhaustion and turnover intention. Both enhanced work engagement and reduced turnover intention contribute positively to job performance, further reinforcing our conclusion that ethical leadership is a positive predictor of nurses' job performance. ...
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Background Ethical leadership is crucial in nursing management, and self-compassion is increasingly recognized as a significant factor influencing nurses’ job performance. Although the link between ethical leadership and nurse job performance has been established, the specific mechanisms that underlie this relationship remain unclear. Additionally, there is a paucity of research examining the potential role of self-compassion in this context. This study aims to investigate the relationship between self-compassion, ethical leadership, and nurses’ job performance while also validating the mediating role of self-compassion. Methods This study employed a convenience sampling method to conduct a cross-sectional online survey involving 968 nurses from four tertiary-level hospitals in Xi’an, China, conducted between April and May 2024. Participants completed self-report questionnaires that included the Ethical Leadership Scale, Self-Compassion Scale, and Job Performance Scale. Data analysis was performed using descriptive statistics, the Mann–Whitney U test, the Kruskal-Wallis H rank sum test, Spearman correlation analysis, and the PROCESS tool within SPSS. Results The analysis revealed a significant positive correlation between ethical leadership and self-compassion (r = 0.631, p < 0.01), as well as between ethical leadership and job performance (r = 0.688, p < 0.01). Additionally, a positive correlation was found between self-compassion and job performance (r = 0.564, p < 0.01). Mediation analysis indicated that self-compassion partially mediated the relationship between ethical leadership and job performance. The overall impact of ethical leadership on job performance (β = 0.680) comprised a direct effect (β = 0.499) and an indirect effect mediated by self-compassion (β = 0.181). The mediating effect accounted for 26.62% of the total effect. Conclusion The results of this study indicate that ethical leadership not only directly predicts nurses’ job performance but also indirectly influences it by enhancing their levels of self-compassion. Consequently, nursing managers should prioritize the cultivation and reinforcement of ethical leadership styles while fostering a supportive environment that promotes effective self-compassion practices. Implementing these strategies is essential for improving nurses’ job performance and well-being, ultimately contributing to a higher quality of care and greater stability within the nursing team.
... In addition to organizational reforms, leadership approaches also significantly influence burnout prevention. A cross-sectional sample of 89 nurses found that ethical leadership, while not eliminating emotional exhaustion, still negatively affects it (McKenna & Jeske, 2020). This finding implies that adopting ethical leadership practices can enhance trust, provide more significant support, and grant nurses more autonomy, creating a supportive environment at SunnyCare. ...
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A serious issue impacting healthcare systems is burnout syndrome amongst nurses and other healthcare workers. The damage and impact on healthcare systems are severe and far-reaching in many organizations. It affects workforce stability, healthcare workforce morale, patient quality of care, organizational growth, and a company’s bottom line by adding more risk. This study investigates factors commonly contributing to burnout syndrome amongst nurses and healthcare employees at SunnyCare Solutions, a healthcare provider facing systematic challenges amidst an attempt to scale and expand their healthcare facilities. The research explores solutions by drawing on insights from workforce management, burnout prevention, strategic risk management, and change management by conducting a narrative literature review. The study reviewed various academic resources, including databases such as Google Scholar, PubMed, ProQuest, JSTOR, and Marymount Library, as well as journal articles and dissertations. Key drivers of burnout, such as heavy workloads, understaffing, and inadequate support systems, were identified. Metrics from recent studies revealed that most nurses face burnout risks, with high turnover rates and reduced morale severely impacting patient outcomes. These findings underscore the pressing need for healthcare organizations to adopt proactive measures. Based on these findings, the review outlines practical recommendations to reduce burnout, improve employee well-being, and create a sustainable work environment. Integrating frameworks like Kotter’s 8-Step process and the Double Loop Learning Model is highlighted as a pathway to fostering resilience and critical thinking within the workforce. In addition, the emphasis on Human Capital Risk Management, empathetic leadership, and ethical decision-making serves as a foundation for addressing immediate and systemic challenges. The findings suggest these interventions address immediate organizational challenges and position SunnyCare as a model for creating a patient-centered, high-performing healthcare system. By adopting actionable strategies such as improved staffing models, robust support systems, and employee engagement initiatives, SunnyCare can set a benchmark for resilience and innovation in the broader healthcare sector. These efforts represent an opportunity to transform systemic challenges into long-term success, ensuring employee and patient well-being.
... Research has established the crucial significance of nursing leaders in fostering retention by offering positive leadership influence and creating healthy work environments, ultimately enhancing job satisfaction, and minimizing unsatisfactory work experiences (Mckenna & Jeske, 2020). Furthermore, certain leadership styles such as transformational leadership have been linked to improved patient safety outcomes, decreased patient fatality, higher care satisfaction, and decreased adverse events including medication errors (Lappalainen et al., 2020). ...
... Various leadership styles, such as transformational, transactional, autocratic, and laissez-faire, have been studied. Nursing leadership signifcantly infuences retention by fostering positive leadership, healthy work environments, job satisfaction, and reducing negative work experiences [5]. Nurse managers empower nurses through positive environments. ...
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Aim To establish current evidence on the relationship between transformational nursing leadership and turnover intention. Background The persistent nursing shortage in healthcare has led to heightened demands for addressing both current needs and the healthcare requirements of a growing population. Recognizing the pivotal role of nursing leadership in fostering retention, this review highlights the influence of positive leadership on nursing staff. Evaluation. An integrative review, guided by Whittemore and Knafl's (2005) framework, was conducted using articles sourced from four online databases deducing to an inclusion of sixteen quantitative articles, one systematic review, and one integrative review published between 1992 and 2022. Key Issues. The study reveals conflicting evidence regarding the sole impact of transformational leadership on the nursing staff's intention to remain. However, it highlights transformational leadership's ability to enhance job satisfaction and organizational commitment contributes significantly to retention. Conclusion Using transformational leadership can effectively bolster nursing staff retention along with promoting other favorable workplace outcomes. Implications for Nursing Management. This review underscores the importance of enhancing leadership skills within nursing management. This involves not only fostering transformational leadership but also cultivating positive work-related outcomes to optimize nursing staff retention.
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Pengambilan keputusan yang efektif merupakan kemampuan dasar yang harus dimiliki ahli kesmas untuk mendukung kompetensi kepemimpinan. Keputusan dan kepemimpinan merupakan dua hal yang tidak bisa dipisahkan karena keduanya saling melengkapi dan mempengaruhi. Pemimpin sejati adalah yang mampu mengambil keputusan, namun keputusan tidak akan efektif jika tidak ditetapkan berdasarkan proses kepemimpinan. Keputusan di bidang kesehatan bersifat kompleks dan tidak mudah untuk ditetapkan oleh pemimpin atau administrator kesehatan. Untuk itu dibutuhkan kemampuan dan strategi dalam proses pengambilan keputusan oleh pemimpin di bidang kesehatan.
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he research aims to identify the role of organizational narcissism applied in public organizations and its role in developing and enhancing the behaviours and practices of employees that aim to achieve their well-being. The research was applied to the community of the departments of the Ministry of Higher Education and Scientific Research in each of (the Administrative and Financial Department, the Department of Construction and Projects, the Department of Studies, Planning and Follow-up, the Office of the Undersecretary of the Ministry for Administrative Affairs), through a deliberate sample consisting of (75) managers who hold the position of department managers and their assistants and division officials. The research questionnaire relied on collecting data. The data were processed using a set of descriptive and inferential statistical methods within the (AMOS) statistical program. The research came out with a set of results, the most important of which is the availability of the components of organizational narcissism that contributed significantly to raising and maintaining the enhancement of organizational well-being in the organization under research.
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Aim To report an analysis of the concept of authentic leadership. Design Concept analysis. Data Sources Data sources included core databases: CINAHL, PubMed, Embase, ProQuest, APA PsycINFO, ERIC, ABI/Inform and Tomlinson's Nursing Core Collection (2010). Methods Walker and Avant's method was used to identify descriptions, antecedents, consequences and empirical referents of the concept. Model, related and contrary cases were developed. Results Defining attributes were identified as self‐awareness, transparency, balanced processing, internalised moral perspective, caring, shared decision making and moral/ethical courage. Antecedents were authenticity, positive psychological capacities, life experiences, leadership development programme, supportive organisational climate and an ethical climate. Consequences are employee well‐being and satisfaction, positive work environment and enhanced performance and safety. Conclusion While authentic leadership is an emerging and popular leadership approach, there are gaps in relation to agreed definitions. Moreover, core textbooks within the subject area also fail to provide these definitions. This concept analysis represents the first comprehensive and robust analysis of the concept of authentic leadership that will serve to reliably inform research, education and practice. Implications for the Profession and/or Patient Care This analysis reveals that authentic leadership can have a positive effect on staff well‐being and satisfaction, their work environment, performance and ultimately safety. This has potential for a positive impact on patient care and patient outcomes by fostering an ethical and supportive work environment. Impact This study revealed a new comprehensive understanding of authentic leadership that provides conceptual clarity that will guide research and practice in the field, which refines the existing understanding, highlighting essential attributes and their relevance in nursing practice. Patient or Public Contribution No patient or public contribution.
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Prior research has established the role of ethical leadership in promoting positive workplace outcomes. Nevertheless, in the wake of scandal, what is the perception of ethical leadership by new entrants into the scandalized profession? Can ethical leadership still promote positive behavior? Path analysis using survey data from 159 beginning nurses reveals the presence of ethical leadership after the worst tragedy in the history of England’s National Health Service (NHS). Furthermore, nurses respond to perceived ethical leadership with increased helping behaviors and decreased experience of burnout. This confirms and extends previous research linking ethical leadership to job satisfaction, organizational commitment, and job engagement, and to an increased likelihood to report unethical practice. Survey respondents entered nursing at a time when the profession was highly scrutinized in the shadow of crisis at the Mid Staffordshire NHS Foundation Trust.
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In times of global demographic changes, strategies are needed for improving nursing staff retention. We examined the association of care setting (nursing homes and home care) with geriatric nurses’ intention to leave their job and their profession. Thus far, it is unclear why nurses’ turnover intention and behaviour do not differ between care settings, although working conditions tend to be better in home care. We used the Job Demands-Resources model to explain indirect and buffering effects by job demands (time pressure, social conflicts) and resources (task identity, supervisor support, and co-worker support) via nurses’ perceived health and job satisfaction on nurses’ leaving intentions. The present cross-sectional questionnaire study was conducted with a sample of N = 278 registered nurses and nursing aides in German geriatric care. As expected, there was no direct relationship between care setting and leaving attitudes. Demands and resources predicted the intention to leave with job satisfaction as mediator. We found more demands in nursing homes but no differences in resources. Serial mediation effects of care setting on intentions to leave via demands/resources and health/job satisfaction as mediators were found only for time pressure and social conflicts. Unexpectedly, there were no clear differences between intention to leave the job and the profession. As hypotheses were only partly confirmed, other buffering and detrimental effects on leaving intentions are discussed. The present data suggest that detailed concepts for personnel and career planning in geriatric care are needed.
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This study used a person-centered approach to examine the across-time relationships between job demands and job resources on the one hand and employee well-being (burnout and work engagement) on the other. On the basis of the job demands-resources model and conservation of resources (COR) theory, increases in demands and decreases in resources across time were expected to result in unfavorable changes in well-being across time. The results of a 2-wave study among 172 nurses and 273 police officers showed several common patterns across both samples: (a) participants who experienced an increase of demands showed a significant increase in burnout, whereas participants who reported having low resources at both measurement times also showed a significant increase in burnout; (b) participants who experienced decreasing resources reported a significant increase in burnout and a significant decrease in engagement; (c) participants who were exposed to chronic low job resources in a highly demanding environment showed a significant increase in burnout; and (d) participants who were exposed to decreased job resources in a highly demanding environment showed a significant increase in burnout.
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Background: Work engagement in professional nursing practice is critically important to consider when addressing key challenges of health systems, including the global nursing shortage, pressures to reduce health care spending, and increasing demands for quality care and positive outcomes for patients. However, research on work engagement in professional nursing practice has not yet been synthesized and therefore, does not provide a sufficient foundation of knowledge to guide practice and further research. Objectives: The overall aim of this systematic review is to determine what is currently known about the antecedents and outcomes of work engagement in professional nursing practice. Design: Systematic review. Data sources: The search strategy included eight electronic databases: CINAHL, MEDLINE, PsycINFO, PROQUEST, SCOPUS, Web of Science, EMBASE, and Business Source Complete. The search was conducted in October 2013. Quantitative and qualitative research that examined relationships between work engagement and antecedent or outcome factors was included. Review methods: Quality assessment, data extractions, and analysis were completed on all included studies. Data extracted from included studies were synthesized through descriptive and narrative synthesis. Content analysis was used to categorize factors into themes and categories. Results: 3621 titles and abstracts were screened and yielded 113 manuscripts for full text review. Full text review resulted in 18 included studies. All factors examined were grouped into either influences or outcomes of work engagement. A total of 77 influencing factors were categorized into 6 themes: organizational climate, job resources, professional resources, personal resources, job demands, and demographic variables. A total of 17 outcomes of work engagement were categorized into 3 themes: performance and care outcomes, professional outcomes, and personal outcomes. Based on the results, we adapted the Job Demands-Resources (JD-R) model and developed the Nursing Job Demands-Resources (NJD-R) model for work engagement in professional nursing practice, which reflects key adaptations related to organizational climate and professional resources. Conclusions: Our findings indicate that a wide range of antecedents, at multiple levels, are related to registered nurses' work engagement. Positive outcomes of work engagement are valuable to both performance and the individual nurse. The NJD-R model offers nursing science a valuable beginning framework to understand the current evidence, further direct nursing research, and begin to guide practice and policy. The results offer opportunities for nurse leaders to promote work engagement in professional nurses through action on organizational level resources.
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Aim: The present study aimed to deepen the understanding of the relationships among job demands, control, social support, burnout and engagement in nurses. Background: Burnout is a prevalent phenomenon among nurses because of the interaction between high demands and low resources, according to the job demands-resources model. Methods: A descriptive, correlational design was used in a stratified random sample of 100 nurses recruited from two Spanish hospitals. Job demand, social support, control, engagement, and burnout were measured. Data were analysed by hierarchical regression analysis. Results: Social support is a significant predictor of nurses' engagement and demands is a predictor of nurses' burnout. Work engagement moderates the relationship between job demands and burnout. Conclusions: The process that leads to burnout and the process that leads to engagement are not isolated processes; engagement acts as a moderator of burnout. Implications for nursing management: The prevailing paradigm in combating burnout in nursing can be changed and could be based on the enhancement of nurses' strengths through increasing engagement.
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Aim: The present study aimed to deepen the understanding of the relationships among job demands, control, social support, burnout and engagement in nurses. Background: Burnout is a prevalent phenomenon among nurses because of the interaction between high demands and low resources, according to the job demands-resources model. Methods: A descriptive, correlational design was used in a stratified random sample of 100 nurses recruited from two Spanish hospitals. Job demand, social support, control, engagement, and burnout were measured. Data were analysed by hierarchical regression analysis. Results: Social support is a significant predictor of nurses' engagement and demands is a predictor of nurses' burnout. Work engagement moderates the relationship between job demands and burnout. Conclusions: The process that leads to burnout and the process that leads to engagement are not isolated processes; engagement acts as a moderator of burnout. Implications for nursing management: The prevailing paradigm in combating burnout in nursing can be changed and could be based on the enhancement of nurses' strengths through increasing engagement.
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This chapter outlines the building blocks of the job demands–resources (JD-R) theory, a theory that has been inspired by job design and job stress theories. Whereas job design theories have often ignored the role of job stressors or demands, job stress models have largely ignored the motivating potential of job resources. JD-R theory combines the two research traditions, and explains how job demands and (job and personal) resources have unique and multiplicative effects on job stress and motivation. In addition, JD-R theory proposes reversed causal effects: whereas burned-out employees may create more job demands over time for themselves, engaged workers mobilize their own job resources to stay engaged. The chapter closes with a discussion of possible JD-R interventions.