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Back, Hyun, and Chang: Association between Emotional Labor, Emotional Dissonance, Burnout and Turnover Intention in Clinical Nurses: A Multiple-Group Path Analysis across Job Satisfaction
Original Article

J Korean Acad Nurs 2017;47(6):770-780.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.6.770

Association between Emotional Labor, Emotional Dissonance, Burnout and Turnover Intention in Clinical Nurses: A Multiple-Group Path Analysis across Job Satisfaction

Chi-Yun Back1, Dae-Sung Hyun2, Sei-Jin Chang3,

1Department of Medicine, Yonsei University Graduate School, Seoul

2Department of Biostatistics and Computing, Yonsei University Graduate School(Seoul), Seoul

3Department of Preventive Medicine · Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Address reprint requests to : Chang, Sei-Jin Department of Preventive Medicine · Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine, 20 IIsan-ro, Wonju 26426, Korea Tel: +82-33-741-0343 Fax: +82-33-747-0409 E-mail: chang0343@yonsei.ac.kr

Received 18 May 2017       Revised 16 November 2017       Accepted 18 November 2017

Copyright © 2017 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was conducted to investigate the influence of emotional labor, emotional dissonance, and burnout on nurse's turnover intention and examine the effect of job satisfaction on the relationships among emotional labor, emotional dissonance, burnout, and turnover intention.

Methods

The sample consisted of 350 nurses recruited from 6 general hospitals in 2 cities in Korea. A multiple-group analysis was utilized. Data were analyzed using SPSS statistics 23 and AMOS 20.

Results

In the path analysis, turnover intention was directly related to burnout in clinical nurses who had a high job satisfaction (b=.24, p=.003), while it was indirectly related to emotional dissonance (b=.13, p=.002). In the multiple-group path analysis, turnover intention was directly related to emotional dissonance (b=.18, p=.033) and burnout (b=.26, p=.002) for nurses with low job satisfaction.

Conclusion

These results indicate that manuals and guidelines to alleviate the negative effects of emotional labor, emotional dissonance, and burnout, and to increase job satisfaction are strongly required to reduce turnover intention in nurses at the organizational level as well as at the individual level.

Keywords: Emotions, Nurses, Burnout, Personnel turnover, Job satisfaction

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Figure 1.
Conceptual framework.
jkan-47-770f1.tif
Figure 2.
A path diagram of the study.
jkan-47-770f2.tif
Table 1.
Difference in Emotional Labor, Emotionnal Dissonance, Burnout and Turnover Intenttion Based on Job Satisfaction (N=350)
Variables Categories Total Low job satisfaction High job satisfaction t p
M±SD n (%) or M±SD n (%) or M±SD
Emotional Labor
Emotional demanding and regulation 79.54±13.42 82.08±13.98 77.55±12.65 3.17 .002
Overload and conflict in customer service 74.57±20.82 78.86±20.67 71.20±20.37 3.46 .001
Organizational surveillance and monitoring 48.54±20.22 52.38±20.12 45.52±19.83 3.19 .002
Emotional dissonance 67.67±20.23 73.38±18.82 63.18±20.21 4.83 <.001
Burnout 16.61±3.21 17.72±2.80 15.73±3.25 6.03 <.001
Turnover intention 18.94±3.82 20.95±3.22 17.36±3.51 9.86 <.001

Low job satisfaction <10 scores, High job satisfaction ≥10 scores.

Table 2.
Results of Differences Between Endogenous Variables and Exogenous Variables in the Two Models
Endogenous variables Exogenous variables χ2 df Δχ2 p
Emotional dissonance ← Emotional demanding and regulation 30.99 13 9.10 .003
Overload and conflict in customer service 22.83 13 0.94 .332
Organizational surveillance and monitoring 21.93 13 0.04 .841
Burnout ← Emotional dissonance 22.13 13 0.68 .410
Turnover intention ← Emotional dissonance 25.13 13 3.24 .072
Burnout 22.00 13 0.10 .744
Table 3.
Standardized Estimates, Critical Ratio, Squared Multiple Correlation, Standardized Direct, Indirect, and Total Effect for Modified Model
Endogenous variables Exogenous variables CR SMC Direct effect Indirect effect Total Effect
SE (p) SE (p) SE (p)
Path analysis among all nurses Emotional dissonance Emotional demands and regulation 9.16 .59 .33 (<.001) .33 (<.001)
   all nurses    dissonance Overload and conflict in custtomer 9.86 .38 (<.001) .38 (<.001)
   service
Organizational surveillance a monitoring and 7.72 .29 (<.001) .29 (<.001)
Burnout    monitoring Emotional dissonance 12.55 .31 .55 (<.001) .55 (<.001)
Burnout Emotional dissonance 12.55 .31 .55 (<.001) .55 (<.001)
Turnover intention Emotional dissonance 1.61 .15 .09 (.106) .18 (.001) .27 (.002)
Burnout 5.47 .32 (<.001) .32 (<.001)
Multiple-group path Emotional Emotional demands and regulation 8.38 .60 .41 (<.001) .41 (<.001)
   analysis by high job satisfaction    dissonance Overload and conflict in custtomer 6.18 .32 (<.001) .32 (<.001)
   satisfaction    service
Organizational surveillance and 5.55 .27 (<.001) .27 (<.001)
   monitoring
Burnout Emotional dissonance 8.86 .29 .53 (<.001) .53 (<.001)
Turnover intention Emotional dissonance −0.39 .05 −.03 (.694) .13 (.002) .10 (.199)
Burnout 2.98 .24 (.003) .24 (.003)
Multiple-group path analysis by low job Emotional dissonance Emotional demands and regulation 4.46 .55 .24 (<.001) .24 (<.001)
   analysis by low job satisfaction dissonance Overload and conflict in custtomer 7.08 .43 (<.001) .43 (<.001)
   satisfaction    service Organizational surveillance and 5.19 .32 (<.001) .32 (<.001)
Organizational surveillance a monitoring and 5.19 .32 (<.001) .32 (<.001)
   monitoring
Burnout Emotional dissonance 7.14 .25 .50 (<.001) .50 (<.001)
Turnover intention Emotional dissonance 2.13 .16 .18 (.033) .13 (.003) .31 (.001)
Burnout 3.13 .26 (.002) .26 (.002)
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