Factor structure of the Maslach burnout inventory: An analysis of data from large scale cross-sectional surveys of nurses from eight countries

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Abstract

Background

Job burnout is an important predictor of nurse retention. Reliable and valid measures are required to monitor this phenomenon internationally.

Objective

To evaluate the applicability of the Maslach burnout inventory (MBI) in international nursing research.

Design

Secondary analysis of cross-sectional hospital nurse survey data from eight countries.

Settings

Hospitals in the U.S., Canada, the U.K., Germany, New Zealand, Japan, Russia and Armenia.

Participants

54,738 direct care professional nurses from 646 hospitals in eight countries.

Methods

Confirmatory and exploratory factor analysis were undertaken to identify the factor structure of the MBI. The internal consistencies of the subscales were investigated.

Results

Exploratory factor analysis revealed three factors being extracted from the 22-item Maslach burnout inventory. In nearly all countries the two items (6 and 16) related to the “stress” and “strain” involved in working with people loaded on the depersonalization subscale rather than the emotional exhaustion subscale to which they were initially assigned. The three subscales exhibited high reliability with Cronbach alphas exceeding the critical value of 0.70. The correlation coefficients for the emotional exhaustion and depersonalization subscales were strong and positive.

Conclusions

The 22-item Maslach burnout inventory has a similar factor structure and, with minor modifications, performed similarly across countries. The predictive validity of the emotional exhaustion and depersonalization subscales might be improved by moving the two items related to stress and strain from the emotional exhaustion to the depersonalization subscale. Nevertheless, the MBI can be used with confidence as a burnout measure among nurses internationally to determine the effectiveness of burnout reduction measures generated by institutional and national policies.

Section snippets

Introduction and background

Investigations of nurse burnout are highly relevant given the global shortage of nurses and the need to retain qualified nurses in clinical care roles (Aiken et al., 2004). Additionally, nurse burnout has been associated with patient dissatisfaction and other measures of deficient care quality (Vahey et al., 2004).

Burnout was first introduced into the literature by Freudenberger in the early 1970s (Freudenberger, 1974). He defined burnout as a state of fatigue or frustration that resulted from

Parent studies

This investigation was conducted using data from the International Hospital Outcomes Study (Aiken et al., 2002a, Aiken et al., 2002b). In 1998–1999, the study was conducted among nurses in four countries (the U.S., Canada, the U.K., and Germany) (Aiken et al., 2001); in 2001 it was replicated in New Zealand (Finlayson et al., 2007); in 2002 it was replicated in Russia and Armenia (Aiken, 2005, Aiken and Poghosyan, in press); in 2005 it was replicated in Japan (Kanai-Pak et al., 2008). The

Factorial structure of the MBI and equivalence of the items

Table 2 provides the goodness-of-fit statistics for the confirmatory factor analysis model for each country. While the values of the root mean square error of approximation (RMSEA) and Bartlett's comparative fit index (CFI) approach the values that are usually considered acceptable (i.e., RMSE < 0.06 and CFI > 0.90, respectively), the RMSEA shows an acceptable fit only in Russia and the CFI value is unacceptable in every country. Moreover, the Chi-square statistic indicating the goodness-of-fit in

Discussion

This study used confirmatory and exploratory factor analyses to investigate the factorial structure of the MBI in eight countries, and while Maslach's initial configuration of the burnout inventory was not completely confirmed, with minor modifications the three-factor structure of the MBI was largely validated. Except for two items, nearly all of the MBI items loaded significantly on the factors they were expected to, in virtually all countries. Even though a few items of the MBI subscales did

Conflict of interest

All authors have no conflicts of interest.

Sources of funding

This work was supported by NINR/NIH grant R01NR04513-11 and P30NR05043-09.

Ethical approval

This study is covered by Institutional Review Board (IRB) of the University of Pennsylvania, protocol 176400, “Outcomes of Nurse Practice Environments” (Aiken, PI), approved through 12/6/08.

Acknowledgments

This research was supported by the National Institute for Nursing Research (R01NR04513-11 and P30NR05043-09, Linda Aiken, principal investigator) and by AMN Healthcare, Inc. We thank Dr. Eileen Lake and Tim Cheney for their assistance. American International Health Alliance funded the study in Armenia and Russia. We thank the investigators from the other countries: Masako Kanai-Pak, Japan, Anne Marie Rafferty, the U.K., Carole Estabrooks, Canada, Mary Finlayson, New Zealand, and Reinhard Busse,

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