Accepted Manuscript

Title: The Effects of Authentic Leadership, Six Areas of

Worklife, and Occupational Coping Self-Efficacy on New
Graduate Nurses’ Burnout and Mental Health: A
Cross-sectional Study

Author: LASCHINGER Heather K. Spence BORGOGNI

Laura CONSIGLIO Chiara READ Emily

PII: S0020-7489(15)00064-4
DOI: http://dx.doi.org/doi:10.1016/j.ijnurstu.2015.03.002
Reference: NS 2525

To appear in:

Received date: 26-9-2014

Revised date: 3-3-2015
Accepted date: 3-3-2015

Please cite this article as: Spence, L.A.S.C.H.I.N.G.E.R.H.K., Laura,

B.O.R.G.O.G.N.I., Chiara, C.O.N.S.I.G.L.I.O., Emily, R.E.A.D.,The Effects
of Authentic Leadership, Six Areas of Worklife, and Occupational Coping
Self-Efficacy on New Graduate Nurses’ Burnout and Mental Health: A
Cross-sectional Study, International Journal of Nursing Studies (2015),
http://dx.doi.org/10.1016/j.ijnurstu.2015.03.002

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1 Contribution of the Paper

2 What is already known on this topic?

3  The new graduate nurse transition to professional practice can be stressful for newcomers to
4 the profession, leading to early career burnout and decreased emotional well-being.

 Nurse managers’ authentic leadership behaviours have been associated with healthy work

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5

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6 environments and positive work and health outcomes among new graduate nurses.

7 What this paper adds:

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8  Our findings suggest that authentic leaders play an important role in creating working conditions
9 that optimize the match between new graduate nurses’ expectations and the reality of the work

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10 environment (AWL match) and strengthen new nurses’ confidence in their ability to cope with
11 the demands of their jobs, thereby protecting them from burnout development and poor
12 mental health.

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13  Our results suggest that an expanded model of burnout recently proposed by Borgogni and
14 colleagues (2012) incorporating interpersonal strain at work in addition to emotional exhaustion
15 and cynicism provides a more comprehensive description of new graduate burnout.
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1 Title: The Effects of Authentic Leadership, Six Areas of Worklife, and Occupational Coping
2 Self-Efficacy on New Graduate Nurses’ Burnout and Mental Health: A Cross-sectional Study
3

4 Author information:

5 LASCHINGER, Heather K. Spence, PhD, RN, FAAN, FCAHS

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6 Distinguished University Professor and

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7 Arthur Labatt Family Nursing Research Chair in Health Human Resource Optimization
8 Arthur Labatt Family School of Nursing
9 Faculty of Health Sciences

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10 Health Sciences Addition, H41
11 The University of Western Ontario
12 London, Ontario, Canada

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13 e. hkl@uwo.ca
14 t. 519-661-2111 ext. 86587
15

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16 BORGOGNI, Laura, PhD
17 Professor of Work and Organizational psychology
18 Department of Psychology
19 Sapienza University of Rome
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20 Rome, Italy
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22 CONSIGLIO, Chiara, PhD
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23 Department of Psychology
24 Department of Psychology
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25 Sapienza University of Rome

26 Rome, Italy
27
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28 READ, Emily, MSc, Doctoral Student

29 Arthur Labatt Family School of Nursing
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30 Faculty of Health Sciences

31 Health Sciences Addition, H38
32 The University of Western Ontario
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33 London, Ontario, Canada

34
35
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37 Corresponding Author: Dr. Heather Laschinger
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39

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1 The Effects of Authentic Leadership, Six Areas of Worklife, and Occupational Coping Self-

2 Efficacy on New Graduate Nurses’ Burnout and Mental Health: A Cross-Sectional Study

3 Abstract

4 Background – New nurse burnout has personal and organizational costs. The combined effect of

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5 authentic leadership, person-job fit within areas of worklife, and occupational coping self-

6 efficacy on new nurses’ burnout and emotional wellbeing has not been investigated.

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7 Objectives - This study tested a model linking authentic leadership, areas of worklife,

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8 occupational coping self-efficacy, burnout, and mental health among new graduate nurses. We

9 also tested the validity of the concept of interpersonal strain at work as a facet of burnout.

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Design – A cross-sectional national survey of Canadian new graduate nurses was conducted.

Participants – Registered nurses working in direct patient care in acute care settings with less
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12 than 3 years of experience were selected from provincial registry databases of 10 Canadian
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13 provinces. A total of 1009 of 3743 surveyed new graduate nurses were included in the final
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14 sample (useable response rate 27%).

15 Methods - Participants received a mail survey package that included a letter of information,
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16 study questionnaire, and a $2 coffee voucher. To optimize response rates non-responders

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17 received a reminder letter four weeks after the initial mailing, followed by a second survey
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18 package four weeks after that. Ethics approval was obtained from the university ethics board

19 prior to starting the study. Descriptive statistics and scale reliabilities were analyzed. Structural

20 equation modeling with maximum likelihood estimation was used to test the fit between the data

21 and the hypothesized model and to assess the factor structure of the expanded burnout measure.

22 Results - The hypothesized model was an acceptable fit for the data (χ2 (164) = 1221.38; χ2 ratio

23 =7.447; CFI =.921; IFI =.921; RMSEA =.08). All hypothesized paths were significant. Authentic

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1 leadership had a positive effect on areas of worklife, which in turn had a positive effect on

2 occupational coping self-efficacy, resulting in lower burnout, which was associated with poor

3 mental health.

4 Conclusions - Authentic leaders may play an important role in creating positive working

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5 conditions and strengthening new nurses’ confidence that help them cope with job demands,

6 thereby protecting them from developing burnout and poor mental health. Leadership training to

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7 develop supervisors’ authentic leadership skills may promote the development of person-job fit,

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8 thereby increasing occupational self-efficacy and new nurses’ wellbeing.

9 Keywords: authentic leadership, areas of worklife, new graduate nurses, occupational coping

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self-efficacy, burnout, mental health

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1 Introduction

2 The demographic profile of the nursing workforce is shifting as a greater number of

3 nurses approach retirement and increasing numbers of new graduates enter the workforce to take

4 their place (Canadian Institute of Health Information, 2013). The transition process from student

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5 to practicing nurse can be stressful for newcomers to the profession and many struggle to build

6 confidence in meeting job demands, often leading to burnout, a sustained response to chronic

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7 emotional and interpersonal stressors at work (Maslach & Leiter, 1997), and, subsequently, poor

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8 mental health (Laschinger & Grau, 2012; Laschinger, Grau, Finegan, & Wilk, 2010; Peterson et

9 al., 2008; Rudman & Gustavsson, 2011). In addition to the personal toll of burnout on nurses’

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health, there is also evidence to suggest that early career burnout in the first two years of practice

influences new nurses’ desire to leave the profession (Beecroft, Dorey, & Wenton, 2008). Job
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12 and career turnover are costly for the healthcare system, resulting in lost productivity and per
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13 nurse replacement costs that have been estimated to be $21,514 CAD (O’Brien-Pallas et al.,
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14 2006) which adjusted for inflation would be ~$25, 340 in 2014 (US Department of Labor, 2014).

15 Given the personal and organizational costs of burnout, it is essential to provide new nurses with
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16 the support needed to develop confidence in their professional skills during this crucial transition
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17 period to prevent burnout and its negative consequences.

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18 Leaders can make a difference in facilitating new graduate nurse transitions by creating

19 environments that promote self-confidence and decrease stress and potential burnout. Past

20 research has shown that empowering leadership styles such as authentic leadership can help new

21 graduate nurses feel engaged and supported in their jobs (Giallonardo, Wong, & Iwasiw, 2010;

22 Laschinger, Wong, & Grau, 2013) and are associated with lower levels of burnout (Laschinger,

23 Wong, & Grau, 2012). By developing positive, honest relationships with new nurses, leaders

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1 provide a supportive workplace that optimizes the fit between new graduate nurses’ workplace

2 expectations and their experience at work as a place where learning can occur and self-

3 confidence can grow, thereby strengthening their intrapersonal resources. One such resource is

4 occupational coping self-efficacy which refers to employees’ appraisal and confidence that they

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5 can handle the demands of their job (Pisanti, Lombardo, Lucidi, Lazzari, & Bertini, 2008).

6 Higher levels of occupational coping self-efficacy have been shown to be related to lower levels

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7 of burnout among nurses (Pisanti et al., 2008). To our knowledge no studies have examined how

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8 authentic leadership may directly or indirectly influence new graduate nurses’ occupational

9 coping self-efficacy, and how these factors together influence burnout and mental health. Thus,

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the primary purpose of this study was to test a model linking supervisor authentic leadership

behaviours with new graduate nurses’ person-job fit, occupational coping self-efficacy, burnout,
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12 and mental health in the first three years of practice.
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13 In this study we used an expanded model of burnout described by Borgogni, Consiglio,

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14 Alessandri, and Schaufeli (2012) that incorporates interpersonal strain at work as a component of

15 burnout, in addition to the two core components (emotional exhaustion and cynicism) originally
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16 described by Maslach & Jackson (1981). Interpersonal strain at work is defined as psychological
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17 disengagement from colleagues at work in response to overwhelming social and emotional

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18 demands. This expanded model may capture a more comprehensive description of new graduate

19 nurses’ burnout than studies to date, given research suggesting that positive workplace

20 relationships are important to new graduate nurses’ transition to the workplace (Bowles &

21 Candela, 2005). Therefore a second aim of this study was to examine the validity of this model

22 in a previously unstudied population - new graduate nurses.

23 Theoretical Framework

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1 This study integrates concepts from Avolio and Gardner’s (2005) theory of authentic

2 leadership, Maslach and Leiter’s six areas of worklife model (Leiter & Maslach, 2004; Maslach

3 & Leiter, 1997), Pisanti et al.’s (2008) conceptualization of occupational coping self-efficacy,

4 and Borgogni et al.’s (2012) concept of interpersonal strain at work as part of the expanded

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5 model of burnout. The theoretical underpinnings of the concepts in our proposed model are

6 described in the upcoming paragraphs.

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7 Authentic Leadership

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8 Luthans and Avolio (2003) described authentic leaders as leaders who are “confident,

9 hopeful, optimistic, resilient, transparent, moral/ethical, future-oriented, and give priority to

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developing associates to be leaders” (p. 242). Authentic leaders are positive, transformational,

moral leaders who are true to themselves and aim to bring out the best in themselves and others.
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12 They communicate their genuine selves to others through four key behaviours: relational
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13 transparency (presenting themselves as they truly are), balanced processing (considering

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14 differing points of view before making decisions), moral/ethical behaviour (acting in accordance

15 with internal moral and ethical values), and self-awareness (having insight about self and
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16 influence on others) (Avolio & Gardner, 2005; Walumbwa, Avolio, Gardner, Wernsing, &
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17 Peterson, 2008). Importantly, authentic leaders foster the development of their followers’
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18 intrapersonal resources such as psychological capital (Avolio & Gardner, 2005), that is, their

19 sense of optimism, hope, resiliency, and self-efficacy. These positive psychological resources

20 heighten followers’ self-awareness and self- regulatory behaviors, contributing to positive self-

21 development and confidence (Luthans & Avolio, 2003; Avolio & Gardner, 2005).

22 AL theory has gained empirical support in both the management and nursing literature.

23 In nursing, nurses who perceive their leaders to engage in authentic behaviours feel empowered

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1 and supported in their jobs (Laschinger et al., 2012). Wong and Laschinger (2013) found that

2 authentic leadership positively influenced nurses’ performance through structural empowerment

3 in their workplace. Bamford, Wong and Laschinger (2013) linked authentic leadership to a

4 positive fit between nurses’ job expectations and actual levels of the six basic areas of worklife

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5 proposed by Leiter and Maslach (2004): workload, control, rewards, fairness, sense of

6 community, and value congruence. Bamford, Laschinger, and Wong (2013) also found that

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7 person-job fit among the six areas of worklife fully mediated the influence of authentic

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8 leadership on nurses’ work engagement. Based on theory and research we hypothesized that will

9 have a positive influence on areas of worklife match (H1).

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11
Six Areas of Worklife Model

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Maslach and Leiter (1997) theorized that there are six areas of worklife in which a
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12 person-job match can enhance employee engagement at work. Workload refers the amount of
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13 time and resources available to an employee to satisfy job demands. Control relates to
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14 professional autonomy and is the extent to which employees are able to make important

15 decisions about their work. Rewards involve the financial, social and/or internal recognition for
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16 employee work contributions. Community involves the quality of working relationships with
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17 others in the organization including managers, colleagues and subordinates. Fairness is the
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18 extent to which decision making processes are open and respectful. Finally, value congruence

19 represents the match between the organization’s priorities and values and those of the employee

20 (Maslach & Leiter 1997). In an examination of data from several databases (n = 6815), Leiter

21 and Maslach (2004) found that the six areas of worklife were all significantly related to burnout.

22 Areas of worklife match (person-job fit) has also been related to intrapersonal resources,

23 such as, psychological capital (Laschinger & Grau, 2012). It is reasonable to expect that when

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1 nurses feel that their expectations match existing conditions in the workplace, they will be more

2 likely to meet job demands and therefore have increased self-efficacy for performing their role.

3 We therefore hypothesized a positive relationship between areas of worklife match and

4 occupational coping self-efficacy (H2).

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5 Occupational Coping Self-Efficacy

6 Occupational coping self-efficacy, an employee’s appraisal of their ability to meet job

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7 demands, is a work-related intrapersonal resource that may be developed by working with an

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8 authentic leader. Occupational coping self-efficacy is more specific than the more general notion

9 of psychological capital (Luthans, Avolio, Avey, & Norman, 2007), in that it refers to an

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individual’s perceived confidence in his/her ability to cope with work demands. In the

occupational literature, coping self-efficacy has been associated with lower levels of strain and
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12 higher adaptive coping skills. For example, employees with high coping self-efficacy have been
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13 found to engage in proactive coping such as persistence in the face of difficulties (Schwarzer &
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14 Knoll, 2003) rather than avoiding stressors or indulging in self-soothing behaviours without

15 addressing the situation at hand (Kraij, Garnefski, & Maes, 2002). Pisanti et al. (2008) also
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16 found that OSCE mediated the relationship between job strain and employee burnout.
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17 Previous research has linked leadership behaviours to employee self-efficacy. For

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18 example, Manojlovich (2005) found that nurse managers’ empowering leadership behaviours

19 had a significant effect on nurses’ role self-efficacy. Less is known about the relationship

20 between authentic leadership and employees’ individual characteristics. Laschinger and Fida

21 (2014) found a positive relationship between and general self-efficacy in a study of new nurses.

22 To our knowledge, the relationship between authentic leadership and job-specific self-efficacy

23 has not been examined but it is reasonable to expect that when leaders create workplaces that

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1 provide employees with conditions that match their expectations (areas of worklife match),

2 employees would logically develop increased confidence in meeting job demands. We therefore

3 hypothesize that authentic leadership indirectly influences nurses’ occupational coping self-

4 efficacy by fostering greater areas of worklife match (H3).

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5 Burnout: An Expanded Model

6 Maslach & Jackson (1981) originally conceptualized burnout as a psychological

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7 syndrome affecting helping professionals exposed to prolonged job strain characterized by

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8 feelings of emotional exhaustion (the feeling of being emotionally depleted and worn out

9 resulting from the individual’s job), depersonalization (a lack of or detached response towards

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the job), and personal inefficacy (competency and success in performing the job). Later

depersonalization was reconceptualized as cynicism, defined as a negative attitude towards one’s

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12 work in an effort to mentally distance oneself, when the model was revised to make it more
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13 applicable to workers beyond the helping professions (Maslach & Leiter, 1997; Schaufeli, Leiter,
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14 Maslach, & Jackson, 1996). There is general agreement that emotional exhaustion and cynicism

15 are the core elements of burnout (Maslach, Schaufeli, & Leiter, 2001). There is, however,
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16 disagreement among burnout theorists as to the status of personal accomplishment, with some
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17 suggesting that it may better reflect the concept of work engagement (Schaufeli & Bakker, 2004;
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18 Schaufeli & Salanova, 2007; Schaufeli & Taris, 2005).

19 Recently Borgogni et al. (2012) proposed that interpersonal strain at work, defined as

20 feelings of being uncomfortable and disengaged in relationships with others at work caused by

21 excessive social requests and pressures, is missing from the traditional model of burnout. They

22 contend that this relational aspect was lost when depersonalization (the uncaring response

23 towards patients) was later replaced by cynicism. They argue that interpersonal strain at work

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1 provides additional explanatory value to understanding the burnout phenomenon because it

2 describes the detrimental effects of prolonged work stress on individuals’ co-worker interactions.

3 Interpersonal strain at work seems to be of particular relevance in settings where

4 interactions with others are an essential part of one’s work (Borgogni et al., 2012). There is

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5 growing empirical support for this expanded model of burnout. Borgogni et al. (2012) provided

6 strong evidence for the construct validity of their measure of interpersonal strain at work within

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7 this three-component model. A recent study of call centre operators showed that work self-

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8 efficacy was inversely related to interpersonal stain, emotional exhaustion, and cynicism, which

9 in turn reduced employee absenteeism (Consiglio, Borgogni, Alessandri, & Schaufeli, 2013).

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Borgogni et al.’s (2012) expanded model captures the socio-emotional aspect of burnout

that comes from developing and maintaining relationships with others at work. Research has
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12 shown that positive work group interactions are important for new graduates’ transition to the
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13 professional work role (Bowles & Candela, 2005). In the current study we hypothesized that new
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14 graduate nurses with higher levels of occupational coping self-efficacy would experience lower

15 levels of burnout (including interpersonal strain at work) because they believe they have
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16 sufficient personal resources to successfully deal with the demands of their job (H4). We further
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17 hypothesized that occupational coping self-efficacy mediates the relationship between areas of
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18 worklife match and burnout (H5). That is, leaders can help prevent burnout among new graduate

19 nurses by creating supportive work environments which help them develop occupational coping

20 skills that provide them with the confidence to meet the demands of their new professional role.

21 Finally, we were interested in investigating the influence of burnout on nurses’ mental

22 health and wellbeing. The detrimental health effects of burnout are well established in the

23 literature (Abdi, Kaviani, Khaghanizadeh, & Momeni, 2007; Laschinger & Fida, 2014; Peterson

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1 et al., 2008). There is accumulating evidence supporting the positive association between

2 burnout and ill-health (Ahola et al.,2005; Shirom, Melamed, Toker, Berliner, & Shapiro, 2005;

3 Toppinen-Tanner et al., 2005). Furthermore, there also is evidence that burnout mediates the

4 effect of excessive job demands on various indicators of ill-health (Ahola & Hakanen, 2007;

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5 Bakker, Demerouti, De Boer, & Schaufeli, 2003; Hakanen, Bakker, & Schaufeli, 2006; Schaufeli

6 & Bakker, 2004). Thus, we hypothesized that new nurses’ burnout would be associated with

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7 poor mental health (H6).

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8 The overall hypothesized model is illustrated in Figure 1. To our knowledge this is the

9 first study to test this model in the new graduate nurse population.

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11 Figure 1. Hypothesized theoretical model an

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13 Methods
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14 Study Design

15 This study used cross-sectional data of a national study of new graduate nurses working

16 in direct care roles across Canada. Ethics approval was obtained from the university ethics board

17 prior to starting the study. Registered nurses with less than 3 years of experience were randomly

18 selected from professional registry databases of 10 Canadian provinces (CIHI, 2013).

19 Participants received a mail survey package that included a letter of information, study

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1 questionnaire, and a $2 coffee voucher. Using Dillman, Smyth, and Christian’s (2009) procedure

2 to optimize response rates, non-responders received a reminder letter four weeks after the initial

3 mailing, followed by a second survey package four weeks after that. To ensure confidentiality

4 participant surveys were coded using unique personal identification numbers.

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5 Participants

6 A total of 1009 of 3743 surveyed new graduate nurses from across Canada were included

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7 in the final sample (useable response rate 27%). Eligible participants were new graduate nurses

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8 with less than 3 years of nursing experience working in direct patient care settings. Participants

9 were not eligible for the study if they had > 3 years of nursing experience or were not currently

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working in direct patient care.

Instruments an
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12 Standardized questionnaires with acceptable reliability (Cronbach’s alpha) and validity
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13 (confirmatory factor analysis) were used to measure each of the main study variables.
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14 Authentic Leadership

15 The Authentic Leadership Questionnaire (Walumbwa et al., 2008) consists of 16 items

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16 that measure four dimensions of authentic leadership behaviour: self-awareness (4 items), moral-
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17 ethical perspective (4 items), balanced processing (3 items), and transparency (5 items).

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18 Participants rate items on a 5 point Likert scale from 0 = not at all to 4 = frequently, if not

19 always). Items were summed and averaged to create a total score for authentic leadership.

20 Previous studies have supported the reliability and validity of this instrument generally

21 (Walumbwa et al., 2008) and among new graduate nurses (Cronbach’s α = 91) (Giallonardo et

22 al., 2010). In the current study Cronbach’s α was .96.

23 Areas of Worklife

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1 Leiter and Maslach’s (2011) Areas of Worklife Scale measures six dimensions of the

2 work environment that contribute to employees’ experience: workload, control, reward, a sense

3 of community, fairness, and values congruence. This instrument contains 18 items rated on a

4 Likert scale from 1 = strongly disagree to 5 = strongly agree. Five items are reverse-scored. An

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5 overall score was created by summing and averaging item scores. Cronbach’s α was .81 in the

6 current study, demonstrating acceptable scale reliability.

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7 Occupational Coping Self-Efficacy

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8 Pisanti et al.’s (2008) Occupational Coping Self-Efficacy scale consisting of nine items

9 was used. Respondents rated the extent to which they believed that they would cope with

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stressful occupational situations on a 5-point Likert scale (1 = strongly disagree to 5 = strongly

agree). An overall score was created by summing and averaging the items. Higher scores indicate
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12 higher occupational coping self-efficacy. Consistent with Pisanti et al. (2008), Cronbach’s α was
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13 .83 in the current study.

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14 Burnout

15 Emotional exhaustion and cynicism were measured using the emotional exhaustion and
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16 cynicism subscales of the Maslach Burnout Inventory-General Survey, each consisting of 5 items
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17 rated on a 6-point Likert scale from 0 = never to 6 = daily. Interpersonal strain at work was
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18 measured using the 6-item scale validated by Borgogni et al. (2012) using the same rating scale

19 (example item “At work, I find myself to be insensitive to other people’s problems”). Higher

20 scores reflect higher levels of burnout. Each scale has demonstrated acceptable reliability and

21 validity in past studies (Borgogni et al., 2012; Laschinger et al., 2010). In this study Cronbach’s

22 α was .82, .92, and .92 for interpersonal strain at work, emotional exhaustion, and cynicism,

23 respectively.

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1 Mental Health

2 Mental health was measured using the depressive symptoms scale of the General Health

3 Questionnaire (Goldberg & Williams, 1988) which consists of 12 items that respondents rate on

4 a 4-point Likert scale from 1 = not at all to 4 = much more than usual. Items were reverse coded

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5 so that high scores reflected good mental health. Items were summed and averaged to create a

6 total score. Past studies have shown acceptable validity and reliability (Pennikilampi-Kerola,

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7 Miettunen, & Ebeling, 2006) and in this study Cronbach’s α was .85.

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8 Data Analysis

9 Descriptive statistics and scale reliabilities using all items for each individual scale were

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analyzed using the Statistical Package for the Social Sciences (SPSS), version 22.0 (IBM Corp.,

2014). Data were screened for missing data and participants who did not answer any items for
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12 variables included in the model were excluded from the analysis (n=6). Overall, <1% of the data
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13 was missing and results from Little’s MCAR test showed that these values were missing
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14 completely at random (χ2 (241) = 194.102, ρ = .991). Mean imputation was used to replace the

15 missing values. This method of dealing with missing data is not always recommended because
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16 in some cases it can reduce variance (Schafer & Graham, 2002). In the current study there were
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17 very few missing values and we had a large sample size therefore mean imputation was not
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18 expected to have a significant effect on the variance of the variables. In order to check this, the

19 hypothesized model was tested with missing values and again after mean imputation. The results

20 were identical, supporting our decision to use this method. Prior to testing the hypothesized

21 model, a preliminary confirmatory factor analysis of the factor structure of the expanded burnout

22 measure was conducted using structural equation modeling (SEM) analysis in AMOS, version

23 22.0 (IBM, 2014).

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1 SEM with maximum likelihood estimation was used to test the fit between the data and

2 the hypothesized model using AMOS software, version 22.0 (IBM, 2014). SEM is a statistical

3 technique that uses the shared variances between variables (i.e. covariances) to estimate causal

4 effects among variables (Hoyle, 2012). We used the hybrid SEM approach described by Kline

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5 (2011) which tests the effect of both manifest and latent variables simultaneously. We modeled

6 burnout as a second-order latent model to evaluate the construct validity of Borgogni et al’s

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7 (2012) new 3-factor model of burnout. The measures of other variables in the model have well-

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8 established validity; therefore, to simplify our already complex model total scores were modeled

9 as manifest variables. The maximum likelihood estimation method approximates model

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parameters that are most likely to result in the observed data (Hoyle, 2012). SEM provides

estimates of model fit by comparing the covariance structure of the observed data to that of the
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12 theorized model (Hoyle, 2012). A perfect fit means that there is no discrepancy between the
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13 model and the observed data.

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14 As recommended by Kline (2011), the following fit statistics were used to assess the fit

15 between the covariance structure of the data and the hypothesized model: Chi-square (χ2), Chi-
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16 square ratio (χ2/df), comparative fit index (CFI), incremental fit index (IFI), and Root Mean
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17 Square Error of Approximation (RMSEA). The χ2 test is a goodness of fit test used to test the
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18 null hypothesis that there is no difference between the hypothesized model covariance matrix

19 residuals and the actual covariance matrix residuals. If χ2 is significant (ρ < .05) we accept the

20 alternative hypothesis that there is a significant difference between the model and the data.

21 Importantly, χ2 increases as a function of sample size and as a result is almost always significant

22 (Hoyle, 2012), therefore additional fit statistics were used. The chi-square ratio is calculated by

23 dividing χ2 by its degrees of freedom, therefore it represents the χ2 per degrees of freedom (< 3 is

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1 acceptable but < 2 better). The CFI represents the ratio between the discrepancy of the

2 hypothesized model and the discrepancy of the independence model, a model where the variables

3 are uncorrelated. The CFI represents the extent to which the model of interest is better than the

4 independence model. Values that approach 1 indicate acceptable fit (.90 or greater is acceptable).

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5 IFI is a relative fit index that compares the hypothesized model to the independent model where

6 none of the variables are correlated. Values range from zero, representing the worst possible

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7 model fit, to 1, representing the best possible fit. RMSEA is a measure of discrepancy between

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8 the data and the model relative to the degrees of freedom in the model (< .08 is acceptable). By

9 examining all five of these standard fit indices, we obtain a better overall picture of the degree to

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which the model fits the data to evaluate the strength of the theorized causal model.

Results
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12 Participants (n=1009) were mostly female (92.5%), averaging 27.43 years of age (SD
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13 6.35), and 1.20 years (SD .51) of nursing experience (Table 1). Most (92.8%) had a bachelor’s
te

14 degree in nursing and worked full-time (60.8%) or part-time (28.6%) in medical-surgical

15 (50.5%), critical care (17.9%), or maternal-child (10.4%) specialty areas.

p

16
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17
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18

19

20

21

22

23

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1 Table 1. Participant Characteristics (n=1009)

Demographic Characteristic Mean SD
Age 27.43 6.35
Years of Nursing Work Experience 1.20 0.51
Gender N %
Female 926 92.5

t
Male 75 7.5

ip
Highest Level of Nursing Education N %
Four year BScN degree 934 92.8

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College Nursing Diploma 71 7.1
Master’s degree in nursing 2 0.2

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Specialty of current unit N %
Medical-surgical 506 50.5
Critical care 179 17.9

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Maternal-child 104 10.4
Mental health 61 6.1
Nursing Resource Unit/Float Pool 38 3.8
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Community Health 57 5.7
Long-term Care/Rehabilitation 57 5.7
Current employment status N %
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Full time 611 60.8

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Part time 287 28.6

Casual 107 10.6
2
p

3 Descriptive Results for Major Study Variables

ce

4
5 Descriptive results for main study variables are presented in Table 2. All measures

6 demonstrated acceptable reliability (Cronbach’s α .81-.95). On average, the new graduate nurses
Ac

7 rated their supervisors’ authentic leadership behaviors as 2.60 out of 4.0 (SD 0.87), areas of

8 worklife as 3.26 out of 5 (SD 0.47), and their occupational coping self-efficacy as 3.60 out of 5.0

9 (SD 0.55). On average, and consistent with Consiglio’s (2014) findings with Italian healthcare

10 workers, the nurses reported higher emotional exhaustion levels (M 3.24, SD 1.48) than

11 interpersonal strain at work and cynicism (M 1.17, SD .98 and M 1.60, SD 1.56, respectively).

12 Emotional exhaustion levels were in the ‘severe’ burnout category according to Schaufeli et al.’s

Page 18 of 36
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1 (1996) norms (> 3.0). Average rating of mental health was positive, 2.78 (SD 0.47) out of a

2 possible score of 4.0.

3 Correlations among all study variables were significant. Authentic leadership was related

4 to areas of worklife (.50), occupational coping self-efficacy (.20), interpersonal strain at work (-

t
ip
5 .20), emotional exhaustion (-.19), cynicism (-.25), and mental health (.22). Areas of worklife

6 was also significantly correlated with occupational coping self-efficacy (.35), interpersonal strain

cr
7 at work (-.45), emotional exhaustion (-.50), cynicism (-.58), and mental health (.51). In addition

us
8 to being significantly associated with authentic leadership, occupational coping self-efficacy had

9 significant correlations with interpersonal strain at work (-.23), emotional exhaustion (-.31),

10

11 an
cynicism (-.35), and mental health (.38). Finally, interpersonal strain at work was related to the

core burnout dimensions (.44 and .55 for emotional exhaustion and cynicism, respectively), and
M
12 to mental health (-.39), consistent with Consiglio (2014).
d

13 Table 2. Means, standard deviations, and internal consistency of major study variables
Variable M SD α 1 2 3 4 5 6
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1. Authentic Leadership 2.60 0.87 .96 -

2. Areas of Worklife 3.26 0.47 .81 .50 -
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3. Occupational Coping SE 3.60 0.55 .83 .20 .35 -

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4. Interpersonal Strain 1.17 0.98 .82 -.20 -.45 -.23 -

5. Emotional Exhaustion 3.24 1.48 .92 -.19 -.50 -.31 -.44 -
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6. Cynicism 1.60 1.56 .92 -.25 -.58 -.35 -.55 .68 -

7. Mental Health (positive) 2.78 0.47 .85 .22 .51 .38 -.39 -.57 -.62
14 Note: All correlations significant p < .05
15

16 SEM Results

17 3-Factor Burnout Measurement Model

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1 Burnout was modelled as a second-order latent variable consisting of three first-order

2 latent variables, each representing a component of burnout (emotional exhaustion, cynicism, and

3 interpersonal strain at work). Results of testing our model showed that the item factor loadings

4 for each of the three burnout components of burnout were acceptable (> .50) for all items. Paths

t
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5 between the first-order latent variables (emotional exhaustion, cynicism, and interpersonal strain

6 at work) and the second-order burnout latent variable were significant (β = .80, .96, and .59,

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7 respectively).

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8 Structural Model

9 The hypothesized model was supported by the model fit statistics, indicating that the data

10

11 an
fit the hypothesized model (χ2 (164) = 1221.38; χ2 ratio=7.447; CFI=.921; IFI=.921;

RMSEA=.08) (Figure 2). All hypothesized paths were significant at the ρ < .01 level (Table 3).
M
12 authentic leadership was found to have a direct effect on areas of worklife (β = .50), which in
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13 turn had a direct effect on new graduate nurses’ occupational coping self-efficacy (β = .35), and
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14 subsequently, on burnout (β = -.41); burnout subsequently had a negative effect on mental health

15 (β = -.69). As shown in Table 3, areas of worklife significantly mediated the effect of authentic
p

16 leadership on new graduate nurses’ occupational coping self-efficacy (β = .175) and occupational
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17 coping self-efficacy significantly mediated the effect of areas of worklife on burnout (β= .144).
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18 Finally, the indirect effects of authentic leadership on both burnout and mental health were

19 significant (β = .072 and β = .05, respectively). The results provide support for the hypothesized

20 model.

21
22
23
24
25
26

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1 Figure 2. SEM results

2

t
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3

4
5 Table 3. Coefficient estimates for path model
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Standardized Estimates

Direct Effects β CR ρ
AL→ AWL .500 18.322 <.01
d

AWL → OCSE .350 11.848 <.01

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OCSE → Burnout -.413 -12.575 <.01

Burnout → Mental Health -.692 -23.486 <.01
p

Indirect Effects
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AL→ AWL → OCSE .175 - <.01

AWL→ OCSE → Burnout .144 - <.01
AL→ AWL→ OCSE→ Burnout -.072 - <.01
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AL→ AWL → OCSE → Burnout→ Mental Health .050 - <.01

6 Note: AL = authentic leadership; AWL = areas of worklife; OCSE = occupational coping self-
7 efficacy
8

9 Discussion

10 Overall, the results supported the hypothesized model linking authentic leadership to new

11 nurses’ perceptions of person-job fit (areas of worklife) and OCSE, and subsequent burnout, and

Page 21 of 36
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1 mental health. Furthermore, the results provide additional empirical support for Borgogni et al.’s

2 (2012) expanded model of burnout which includes interpersonal strain at work in addition to the

3 core dimensions of emotional exhaustion and cynicism.

4 Our findings add support to the growing body of literature suggesting that authentic

t
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5 leadership behaviours play a role in creating positive outcomes for new graduate nurses

6 including lower levels of burnout (Laschinger & Fida, 2013, 2014; Laschinger et al., 2012) and

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7 better mental health (Laschinger & Fida, 2014). In our study, we found that authentic leadership

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8 influenced burnout and mental health indirectly through new nurses’ perceived match with six

9 areas of worklife and occupational coping self-efficacy, to our knowledge a previously unstudied

10

11
leadership mechanism.

an
Our results suggest that use of authentic leadership behaviors by managers may positively
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12 influence new graduate nurses’ occupational coping self-efficacy, both directly, and indirectly
d

13 through areas of worklife match. In our study there was a significant direct relationship between
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14 authentic leadership and areas of worklife, meaning that new graduate nurses who perceived

15 their leader to be self-aware, transparent, ethical, and inclusive in their decision making
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16 processes also felt that their work expectations in terms of workload, control, rewards, a sense of
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17 community, and values congruence were met. Previous studies found that authentic leadership is
Ac

18 related to areas of worklife match (Bamford, Wong, & Laschinger, 2013; Wong & Giallonardo,

19 2013) and our results provide further empirical support that authentic leaders may influence new

20 graduate nurses’ work experiences by providing them with a supportive, healthy work

21 environment that helps build professional confidence in their nursing abilities and skills.

22 These findings are congruent with authentic leadership theory which highlights the role

23 of leaders in providing employees with a supportive work environment that promotes work

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1 effectiveness (Gardner et al., 2005). By engaging in authentic leadership behaviours nurse

2 managers may influence the six areas of worklife in Maslach and Leiter’s (2003) model,

3 resulting in a better fit between the reality of the workplace conditions and new graduate nurses’

4 expectations. Authentic leaders create ethical, inclusive work environments and provide

t
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5 employees with support and opportunities for development (Gardener et al., 2005),

6 characteristics reflected by Maslach and Leiter’s (1997) areas of worklife. By building sincere,

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7 transparent relationships with followers and displaying integrity and congruence with internal

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8 moral values, nurse managers help create working conditions that promote new graduate nurses’

9 autonomy and involvement with decisions (control), appropriate workload assignments, and

10

11 an
provide them with resources and recognition (rewards). By developing positive leader-follower

relationships, authentic leaders also foster a sense of community, fairness, and respect that align
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12 with new graduate nurses’ values. In these ways, authentic leaders create positive working
d

13 conditions that may influence new graduate nurses’ perceptions of their work experience.
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14 Importantly, new graduate nurses who reported high levels of areas of worklife match

15 had greater levels of occupational coping self-efficacy. This is an important finding because new
p

16 graduates’ appraisals of being able to meet job demands is a key factor in their successful
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17 transition to the graduate role as they begin their professional careers and face new challenges.
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18 Our findings suggest that working conditions that provide areas of worklife match may play an

19 influential role in helping new graduate nurses develop confidence in their ability to handle their

20 new professional role and that authentic leaders play an important role in creating these

21 conditions. This finding is consistent with authentic leadership theory which suggests that

22 authentic leaders cultivate psychological capital in their followers by helping them to develop

23 self-awareness and by fostering personal and professional growth (Avolio & Gardner, 2005).

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1 For example, by giving new graduate nurses reasonable workload assignments and support to

2 make good clinical decisions and ask for help, nurse leaders can help reinforce new graduate

3 nurses’ confidence in their skills and abilities. By recognizing and rewarding new nurses for

4 their progress and good work, nurse managers provide positive reinforcement that encourages

t
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5 them to believe in themselves and increases their job-specific self-efficacy. Authentic leaders

6 may also have an indirect effect on occupational coping self-efficacy by facilitating a sense of

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7 community where all are welcome, treating everyone fairly, and reinforcing positive

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8 organization values. It makes sense that when new nurses feel a sense of belonging and fairness,

9 and feel that their organization has values in line with their own, they will feel more confident in

10

11 an
their ability to do a good job. These are some of the ways in which areas of worklife match may

enhance new graduate nurses’ occupational coping self-efficacy.

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12 As Maslach and Leiter (1997) explain, areas of worklife match also plays a key role in
d

13 preventing job burnout and the current findings suggest that occupational coping self-efficacy
te

14 may mediate this relationship. By creating a positive work environment that meets new graduate

15 nurses’ expectations, authentic leaders may help newcomers to the profession develop positive
p

16 coping strategies for meeting the demands of the nursing role during the stressful transition
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17 period. The significant negative relationship between occupational coping self-efficacy and
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18 burnout may suggest that higher occupational coping self-efficacy may protect new nurses from

19 developing early career burnout and thereby foster emotional well-being. This is important for

20 the nursing profession given the well-established links between new nurse burnout and nurse

21 retention outcomes, such as job dissatisfaction and career turnover intentions (Laschinger et al.,

22 2013; Rudman & Gustavsson, 2011).

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1 Our findings also provide support for Borgogni et al.’s (2012) expanded model of

2 burnout. Our CFA results demonstrated the validity of a three-factor model of burnout that

3 includes emotional exhaustion, cynicism, and interpersonal strain at work, supporting the

4 inclusion of interpersonal strain at work as a valid burnout facet. Furthermore, the interpersonal

t
ip
5 strain at work factor structure was supported, consistent with Borgogni et al’s (2012) results and

6 adding further empirical support for this measure. The results demonstrated that interpersonal

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7 strain at work is a related but distinct facet of burnout (including cynicism) as argued by

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8 Borgogni et al. (2012). These findings provide evidence for the relevance of Borgogni et al.’s

9 expanded model of burnout to the new graduate nurse population and provide a more

10

11 an
comprehensive description of the nature of burnout in this population.

New graduate nurses in this study did not report high levels of interpersonal strain at
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12 work, which is consistent with Consiglio’s (2014) and Borgogni et al’s (2012) findings from
d

13 studies of Italian healthcare workers. Nevertheless, in their studies interpersonal strain at work
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14 was significantly related to both the emotional exhaustion and cynicism components of burnout

15 and to poor physical health. Similarly, in our study interpersonal strain at work also was strongly
p

16 related to both exhaustion and cynicism and to poor mental health. Furthermore interpersonal
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17 strain at work was significantly related to areas of worklife highlighting the importance of this
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18 facet of burnout and the need for nurse managers to ensure that new nurses’ workplaces

19 encourage positive interpersonal relationships among co-workers. Taken together, these studies

20 linking interpersonal strain at work as a component of burnout to both poor mental and physical

21 health provide evidence of the value of incorporating interpersonal strain at work into a more

22 comprehensive conceptualization of burnout and point to additional interventions for nurse

23 managers’ efforts to create healthy work environments that retain nurses.

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1 New nurses’ ratings of emotional exhaustion were considerably higher than the cynicism

2 and interpersonal strain at work dimensions. Consistent with burnout theory, Laschinger and

3 Fida (2013) showed that burnout development among new graduate nurses may be a staged

4 process, whereby prolonged feelings of emotional exhaustion lead to cynical attitudes about

t
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5 one’s job and work role over time. This may also be the case for relational difficulties

6 represented by interpersonal strain at work. In other words, sustained feelings of emotional

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7 exhaustion may cause novice nurses to feel that they no longer have the capacity to deal

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8 effectively with other people and their demands, resulting in feelings of interpersonal strain at

9 work. Given that most of the nurses in our sample were in their first year of practice, it is

10

11 an
possible that at the time of the survey they had not yet experienced the chronic effects of

emotional exhaustion, that is, high levels of cynicism and interpersonal strain at work. However,
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12 new nurses’ emotional exhaustion levels in this study were severe according to established
d

13 norms (Schaufeli et al., 1996), suggesting that timely efforts to address this undesirable state of
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14 affairs are needed. Our results suggest that one burnout prevention strategy may be to build

15 occupational coping self-efficacy by engaging in authentic leadership behaviours that foster

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16 person-job fit.
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17 Limitations
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18 The primary limitation of this study is the cross-sectional nature of the study design

19 which precludes strong statements of causality. A one-year follow-up data collection is planned

20 which will allow us to determine the validity of our model over time. Common method variance

21 is also a potential concern because data were collected using self-report measures from the same

22 individuals at the same time. However, Spector (2006) argues that can be less of a problem

23 when psychometrically sound measures are employed. Finally, the response rates is somewhat

Page 26 of 36
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1 lower than previous studies of new graduate nurses (Laschinger & Fida, 2014; Laschinger &

2 Grau, 2012) which may limit the generalizability to some extent. However, demographics in this

3 national sample are similar to our previous studies in provincial samples which may offset this

4 somewhat. Finally, our sample was sufficiently large to estimate stable effects.

t
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5 Conclusion

6 Burnout is an occupational hazard that has detrimental effects on the mental health of

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7 new graduate nurses and may threaten retention of this valuable health human resource

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8 (Laschinger & Fida, 2013; Laschinger et al., 2012). Our findings suggest that authentic leaders

9 may play an important role in strengthening new nurses’ confidence in their ability to cope with

10

11 an
the demands of their jobs, thereby protecting them from burnout development and poor mental

health. Our results suggest that leadership training to develop supervisors’ authentic leadership
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12 skills may be a useful strategy for cultivating healthy work environments that promote
d

13 occupational self-efficacy that may encourage retention of newcomers to the profession. This
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14 research adds to the growing body of work demonstrating the power of leadership in facilitating

15 new graduate nurses’ transition to the nursing profession.

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16
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17
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18

19

20

21

22

23

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22 Authentic Leadership: Development and Validation of a Theory-Based Measure. Journal

23 of Management, 34(1), 89-126.

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1 Wong, C. A., & Giallonardo, L. (2013). Authentic leadership and nurse‐assessed adverse patient

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2 outcomes. Journal of Nursing Management, 21(5), 740-752.

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3 Wong, C. A., & Laschinger, H. K. (2013). Authentic leadership, performance, and job

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4 satisfaction: the mediating role of empowerment. Journal of Advanced Nursing, 69(4),

5 947-959.

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Acknowledgements
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8 This study was funded by the Canadian Institutes of Health Research (CIHR) Partnerships for

9 Health Systems Improvement (PHSI) Grant # PHE-122182

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1 What this paper adds:

2  Our findings suggest that authentic leaders play an important role in creating working conditions
3 that optimize the match between new graduate nurses’ expectations and the reality of the work
4 environment (AWL match) and strengthen new nurses’ confidence in their ability to cope with
5 the demands of their jobs, thereby protecting them from burnout development and poor
6 mental health.

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7  Our results suggest that an expanded model of burnout recently proposed by Borgogni and
8 colleagues (2012) incorporating interpersonal strain at work in addition to emotional exhaustion
9 and cynicism provides a more comprehensive description of new graduate burnout.

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