Examination of a cognitive model of stress, burnout, and intention to resign for Japanese nurses

Aim: A reduction in burnout is required to decrease the voluntary turnover of nurses. This study was carried out with the aim of establishing a cognitive model of stress, burnout, and intention to resign for nurses. Methods: A questionnaire survey was administered to 336 nurses (27 male and 309 female) who had worked for < 5 years at a hospital with multiple departments. The survey included an evaluation of burnout (Maslach Burnout Inventory), stress (Nursing Job Stressor Scale), automatic thoughts (Automatic Thoughts Questionnaire-Revised), and irrational beliefs (Japanese Irrational Belief Test), in addition to the intention to resign. Results: The stressors that affected burnout in the nurses included conflict with other nursing staff, nursing role conflict, qualitative workload, quantitative workload, and conflict with patients. The irrational beliefs that were related to burnout included dependence, problem avoidance, and helplessness. In order to examine the automatic thoughts affecting burnout, groups with low and high negative automatic thoughts and low and high positive automatic thoughts were established. A two-way ANOVA showed a significant interaction of these factors with emotional exhaustion, but no significant interaction with depersonalization and a personal sense of accomplishment. Only the major effect was significant. The final model showed a process of "stressor -> irrational beliefs -> negative automatic thoughts/positive automatic thoughts -> burnout". In addition, a relationship between burnout and an intention to resign was shown. Conclusion: These results suggest that stress and burnout in nurses might be prevented and that the number of nurses who leave their position could be decreased by changing irrational beliefs to rational beliefs, decreasing negative automatic thoughts, and facilitating positive automatic thoughts.