Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings

The aim of this study was to investigate whether nurses' efforts and rewards, as well as the effort-reward imbalance (ERI) and burnout, differ between subjects working in psychiatric vs. medical hospitals and between nurses under education and examined nurses respectively. Furthermore, the relationship between ERI and burnout was evaluated. Nursing is associated with high levels of emotional strain and heavy workloads. Burnout and a negative ERI can result in high absenteeism and turnover and have been identified as reasons why nurses leave their profession. In the last decade, working conditions of the nursing profession have changed in Germany, but somatic and psychiatric hospitals developed in different ways. This development may lead to different profiles. A sample of 389 nurses (78.8% female) in four German hospitals was investigated. A total of 147 nurses worked in psychiatric hospitals and 236 nurses worked in medical (somatic) hospitals. Fifty participants were still under education. The Effort-Reward Imbalance Inventory measures effort, reward and overcommitment at job and provides an imbalance score between effort and reward. The Maslach Burnout Inventory with the subscales, emotional exhaustion, lack of accomplishment and depersonalization, was also used. Nurses working in medical hospitals reported more burnout and had higher ERI scores. Subjects under education were comparable to examined nurses in terms of burnout but had lower ERI scores. Multiple regression analyses showed all ERI scales to be significant predictors for emotional exhaustion, while age, field of work and educational status further predict effort or ERI respectively. At present, the working situation of nurses in different settings appears to be characterized by a perceived imbalance of effort and reward and is associated with a high risk of developing burnout symptoms.