Work-Related Stress, Burnout, and Job

Satisfaction of Dialysis Nurses in

Association with Perceived Relations
with Professional Contacts
Fatma Arıkan, RN, MS; Can Deniz Köksal, PhD; Çig̀dem Gökçe, MD, MRCP(UK)

F. Arıkan is with Antalya Health School, Department of Medical Nursing, and Dr. Köksal is with the Faculty of Economics and
Administrative Sciences, Akdeniz University, Antalya, Turkey. Dr. Gökçe is with Hisar Intercontinental Hospital, Istanbul, Turkey.

OBJECTIVE: We set out to determine levels of job-related stress, burnout, and job satisfaction in dialysis nurses and
their association with nurses’ perceptions regarding relations with co-workers, and co-worker opinions on the nursing
profession. The subjects compared in this study were employed in the dialysis units, intensive care units (ICUs) and
the most preferred (cardiology, general surgery and orthopedics wards) of three different hospitals.

METHODS: This descriptive and cross-sectional study was conducted in April 2003, and included 180 nurses:
31 working in dialysis units, 100 in ICUs, and 49 in the most preferred wards of the same hospitals. The study can-
didates were assessed with the use of a questionnaire regarding their socio-demographic characteristics, work
places, and views concerning their relations with and the opinions of their professional contacts. Other means of
data collection were the Work-Related Strain Inventory (WRSI), the Maslach Burnout Inventory (MBI) and the
Minnesota Work Satisfaction Questionnaire (MWSQ). Percentage estimations, the chi-square test, and variance
analysis were used for statistical evaluation of the data; p
0.05 was accepted as significant.

RESULT: When compared with ICU and ward unit nurses, dialysis nurses had evidence of decreased job stress
and burnout as well as increased job satisfaction, accompanied by decreased intention to leave the profession and
higher levels of positive views concerning their relationships with physician co-workers and the opinions of their
professional contacts toward the nursing profession.

CONCLUSION: This study confirmed some established predictors of job satisfaction, work-related stress, and burnout
and provided data on an unexplored area. Dialysis nurses appear to be at a decreased risk for job stress, burnout
and premature retirement from nursing, with higher levels of job satisfaction. Further. the quality of relationships
with physician co-workers and the opinions of professional contacts regarding the nursing profession as perceived
by nurses may be related to job stress, burnout and work satisfaction.

he high risk for professional environment that can threaten the wellness have lower levels of job satisfaction when

T burnout, job-related stress and job

dissatisfaction noted among nurses
has led to a growing interest in the
psychosocial work environment in the last
few decades.1 Burnout is a syndrome of
emotional exhaustion, depersonalization,
and diminished perception of personal
accomplishment that has been recognized
as an important occupational hazard for
various people-oriented professions, such as
those involving social services, healthcare,
and education.2,3
Job stress can be defined as the relation-
ship between an individual and her work
of the individual and eventually exhaust
her means of coping with changes and
problems.4 Work-related stress can lead to
depression, anxiety, and helplessness in an
individual and has negative effects such as
headache, muscle tension, and sleepless-
ness.5,6 Job satisfaction can exert a major
influence on job-related behaviors such as
professional dropout, absenteeism, and self-
reported job performance.7 Job satisfaction
has a special implication for the healthcare
services, and low levels lead to premature
loss of trained staff from their professional
environments. Nurses have been reported to
compared with other professionals.8
Professional satisfaction is the feeling
of contentment that is formed by how a job
is perceived by individuals and is one of the
most significant requirements for successf
and productivity.9-11 Workers are satisfied
when their needs are met in keeping with
their expectations.12
Healthcare workers have been
described as the professional group with
the highest risk for burnout, role conflict,
and job dis-satisfaction. The quality of care
provided by nurses is negatively effected
by problems related to job satisfaction,

April 2007 Dialysis & Transplantation 1

 Stress, Burnout, and Job Satisfaction of Dialysis Nurses
job-related stress, and burnout.12-14 Heavy
workloads, long daily working hours, and
negative perceptions of work conditions
can lead to burnout.15,16
Wallcott investigated the work site
stress factors in public health nurses and
reported that adverse conditions like insuffi-
cient personnel, heavy workloads, commu-
nication problems with physicians, and
conflicts with families were associated with
increased burnout.17 Studies conducted on
healthcare personnel have shown that many
factors such as inadequate payment, lack of
harmony between received education and
actual work, inadequate ongoing education,
lack of the possibility of job advancement
and negative work conditions affect job
satisfaction.3,14,18
We hypothesized that dialysis nursing—
as the prototype of specialist nursing—
could manifest differences in job stress,
burnout, and satisfaction levels and that
these differences could be associated with
differences in the way they interpret their
relations with, and the opinions of, their
professional contacts.
Methods
Participants
This research was an observational, cross-
sectional, and comparative study. The
candidate subject population consisted of
180 nurses: 31 dialysis nurses, 100 inten-
sive care unite (ICU), and 49 ward nurses
working in the Antalya Social Security
Institution, Antalya State Hospital, and
Akdeniz University Faculty of Medicine
Hospital in Turkey. These hospitals cater to
blue-collar workers of low to lower-middle
class income levels; white- and blue-collar
workers of low to lower-middle class
income; and white- and blue-collar workers
with middle-class to high level incomes,
respectively, thus representing the entire
spectrum of patients cared for in Antalya.
Inclusion of the nurses of the three
hospitals mentioned was planned both to
avoid limiting the study to a particular
group of subjects working under specific
conditions and to increase the number of
subjects, since the number of dialysis nurses
in any single center was considered too low
to allow for healthy comparisons.
2 Dialysis & Transplantation April 2007
ICU nurses comprised the first and
“negative” control group; they were included
to allow comparison with nurses with possi-
bly the heaviest works loads and caring for
patients with medical disorders similar in
severity to those of dialysis patients.
Nurses from the most preferred wards
of the hospitals comprised the second and
“positive” control group. These preferred
wards were determined by an initial ques-
tionnaire addressed to all nurses working in
the hospitals in mention; they were asked
(anonymously) to list the three wards they
Job satisfaction has a special implication for the
healthcare services, and low levels lead to
premature loss of trained staff from their
professional environments. Nurses have been
reported to have lower levels of job satisfaction
when compared with other professionals.
would most prefer to work in; the response
rate of 79%. The nurse administrators of
the same hospitals were also asked about
requests made by nurses within the prior
2 years for in-hospital transfers to the most
favorite wards. Nurse administrators con-
firmed that the cardiology, general surgery,
and orthopedic wards were consistently
listed as the most favorite wards by nurses
during all internal audits.
The reason for trying to ascertain
the most preferred wards was to allow com-
parison between dialysis nurses and those
working in wards with possibly the best
working conditions, as perceived by the
subjects themselves. After determination of
the study candidates, i.e., all nurses working
in the dialysis, ICU, and preferred wards of
all three hospitals, they were approached by
a letter stating the objectives and methods of
the study, requesting their informed consent.
Of the total, 31 (93.9 %) of the dialysis, 100
(94.3 %) of the ICU, and 49 (84.5 %) of the
ward nurses consented to participate in
the study and comprised the actual study
subjects. This study was approved by the
institutional ethical authorities of all three
hospitals.
The research was conducted between
April 7 and April 25, 2003, immediately
after completion of the preparatory work
described above. The time period was
dictated primarily by an effort to gather
data rapidly while the nurses’ work places
and conditions were constant, particularly
before leaves for summer and religious
holidays began.
Questionnaires
After we determined the study candidates,
those that gave informed consent were
assessed with the use of a separate question-
naire inquiring their socio-demographic
characteristics, work places, and views con-
cerning their relations with and the opinions
of their professional contacts. Other means
of data collection were the Work-Related
Strain Inventory (WRSI), the Maslach
Burnout Inventory (MBI), and the
Minnesota Work Satisfaction Questionnaire
(MWSQ).
The data forms consisted of 75 ques-
tions: 15 initial socio-demographic and
work-related questions followed by 18
WRSI-, 22 MBI-, and 20 MWSQ-related
questions. Nurses were asked to choose
“positive,” “moderate,” or “negative” to
express how they perceived their relations
with co-workers and the views of their pro-
fessional contacts regarding the nursing
profession.
The first psychometric tool used in our
study was the WRSI, which is an 18-item,
4-point Likert type self-reporting tool.19
The WRSI was translated into Turkish by
Aslan et al., and its validity and reliability
were first investigated in a group of nurses
and confirmed subsequently for other health
care workers.20 The person answering the
inventory was required to assess the state-
ment contained in each item and denote its
relevance to her/his condition by choosing
one of the following options with a corres-
ponding score of 1 to 4: “completely
applies to me,” “almost completely applies
to me,” “somewhat applies to me,” and
“does not apply to me.”
The second psychometric tool used in
our study was the MBI. This tool was
developed by Maslach and Jackson to
determine individual levels of profession-
related emotional exhaustion (EE) deper-
sonalization (DP), and personal accom-
plishment (PA); validity-reliability studies
of its Turkish translation were previously
conducted with physicians and nurses.21,22
The MBI contains 22 items and 3 types of
subscales. Subscales relevant to burnout are
the EE subscale, the aim of which is to elicit
employee feelings of emotional fatigue;
the DP subscale, which attempts to reveal
evidence of emotional estrangement and
detachment from clients; and the PA
subscale, which reflects self evaluation
regarding the degree of professional success.
The third psychometric tool employed
in our study was the WRSQ, developed by
Weis, Dawis, England, and Lofquist.23 Its
validity and reliability in healt care pers-
onnel in Turkey were investigated by
Ergin.24 The WRSQ is a 20-item tool in a
5-point Likert type format that elicits the
interviewee’s assessment of internal and
external satisfaction factors. It contains
items to reflect general satisfaction (GS),
internal satisfaction (IS), and external
satisfaction (ES) factors.
In this study the WRSI reliability coef-
ficient was found to be  = 0.77; the MBI
subcategory reliability coefficients were
found to be  = 0.87 (EE),  = 0.66 (DP),
 = 0.68 (PA) and the WRSQ subcategory
reliability coefficients were found to be  =
0.88 (GS),  = 0.85 (IS) and  = 0.76 (ES).
Statistical Analysis
The Statistical Package for the Social
Sciences packet program was used for data
analysis. Percentage estimation was used in
the evaluation of the nurses’ socio-demo-
graphic and job-related characteristics and
the chi-square test was used to determine the
differences in the nurses’ opinions regarding
their relations with co-workers and the
views of their team members, patients, and
administrators about the nursing profession.
Variance analysis was used in the evaluation
of relationships between individual and
work characteristics and psychometric tool
scores. A p-value less than 0.05 was accepted
to denote statistical significance.
Results
Owing to the vast amount of data generated
in our study, some of our findings will be
summarized without giving specific numeric
details. All differences and correlations
listed below were found to be statistically
significant.
One of the factors associated with
nurse-physician conflicts may be the insistence
on traditional professional roles in an age where
the boundaries between nurses and physician
responsibilities are changing or blurring.
When considered collectively, the
study subjects were found to have moderate
degree job stress and near-high emotional
exhaustion as well as moderate depersonali-
zation, near-low (perceived) professional
accomplishment and neutral job satisfac-
tion. Job stress was positively correlated
with burnout and negatively correlated with
job satisfaction in all groups. Factors asso-
ciated with and/or accompanying job
stress, burnout, and job satisfaction were
age, years of work as a nurse, hospital and
unit worked in, weekly work hours and
scheme, monthly number of night duties,
number of patients cared for per day, num-
ber of units changed within the last 5 years,
main reason for working in the current unit
as well as for choosing nursing as a profe-
ssion, and the intention to quit nursing.
Increased age emerged as an impor-
tant factor associated with psychometric
test results, with nurses older than 40
having the best and nurses younger than
32 having the worst emotional exhaustion
and depersonalization scores. Nurses
working in the University Hospital had
the highest emotional exhaustion and the
lowest job satisfaction scores. Nurses
within the first 10 years of their profession
had the highest job stress, emotional
exhaustion and depersonalization scores
as well as the lowest (perceived) personal
accomplishment and job satisfaction
scores.
Nurses working more than 49 hours
per week had lower (perceived) personal
success and job satisfaction scores than
those working 40-48 hours. Nurses working
within a rotation system with night duties
had higher job stress, emotional exhaustion
and depersonalization and lower (per-
ceived) personal success and job satisfac-
tion scores than those working only in
the daytime. Those called for more than
5 night duties per month had the worst psy-
chometric test results. Nurses caring for
fewer than 10 patients during the day had
scores reflecting higher job stress, emotional
exhaustion, and depersonalization and
lower (perceived) personal success and job
satisfaction.
Nurses who had changed units fewer
than 4 times within the previous 5 years
had better internal satisfaction scores than
those who had been subjected to frequent
changes. Nurses who had voluntarily chosen
their current unit had psychometric test
results reflecting decreased job stress, emo-
tional exhaustion and depersonalization as
well as higher (perceived) personal accom-
plishment and job satisfaction. The leading
reasons for voluntarily choosing a unit
were found to be completion of a course
or certificate program relevant to, special
interest in, or admiration of the communi-
cation of the team of a particular unit.
Those who had chosen nursing
because they admired the profession had
significantly higher job satisfaction and
lower emotional exhaustion scores than
those who had chosen it on consideration of
the ease of finding a job after graduation.
The mean emotional exhaustion score of
nurses who expressed intent to leave the
profession was much higher than those who
intended to continue to work.
Of note, 65.9 % of all study subjects
declared intention to leave the profession
within the near future without waiting for
formal retirement. Of particular note, nurses
April 2007 Dialysis & Transplantation 3
 Stress, Burnout, and Job Satisfaction of Dialysis Nurses

who evaluated the nurse-physician profes- 69.4 % of ward nurses declared the same. the profession. Dialysis nursing is the pro-
sional relationships in their unit and the When compared with the ICU and ward totype of specialist nursing and can thus
views of their co-workers, patients, and nurses, more dialysis nurses rated their pro- offer the means of studying the effects of
administrators regarding the nursing pro- fessional relationships with physicians and specialized nursing on job stress and satis-
fession as positive had lower job stress, the opinions of their co-workers, patients, faction experienced by nurses.
emotional exhaustion and depersonaliza- and administrators regarding the nursing This is, to our knowledge the first
tion scores as well as higher (perceived) profession as positive. While 64.5 % of study to extensively analyze job stress,
personal success and job satisfaction scores dialysis nurses evaluated their professional burnout, and satisfaction in dialysis nurses
than nurses who rated the same items as relationships with physicians as positive, in comparison with ICU and ward nurses.
moderate or poor. this ratio fell to 27 % in ICU nurses. While We hope our findings will increase the
Dialysis nurses had lower job stress the majority (80.6 %) of dialysis nurses interest in studying and improving the work
and burnout as well as higher job satisfac- perceived the opinions of their physician conditions and professional interactions of
tion levels when compared with the ICU teammates on the nursing profession as nurses in different units, so that the current
and ward nurses (Table I). With respect to positive, only 18 % of ICU and 36.7 % of crisis can be dealt with.
the factors summarized above that were ward nurses expressed the same view. Similar This study confirmed our hypothesis by
found to be significantly associated with findings were noted between dialysis nurses showing that dialysis nurses had decreased
psychometric test results in our study, dial- and the control groups when questioned how job stress and burnout and increased job
ysis nurses were older and more experi- they rated the opinions of their other team- satisfaction as compared with ICU nurses
enced than the other groups; their weekly mates, patients, and administrators related to and ward nurses. ICU nurses were chosen
work hours were not less than ICU nurses the nursing profession (Table II). for comparison owing to their shared char-
but did not involve night duties; the number acteristics with dialysis nurses, namely, car-
of patients they cared for during the day ing for patients similar in disease severity
was higher than those of the ICU and ward Discussion and using advanced medical techniques and
nurses; they had not made frequent work equipment. ICU nurses were considered
place changes within the last 5 years; the Nursing as a profession is currently facing “negative” controls, i.e., those with the
majority of them had voluntarily chosen its greatest crisis. Despite a rapidly aging highest work load and therefore possibly
their units and their profession; and they population with the need for increasing the highest job stress and burnout levels.
had a decreased intention to quit nursing. numbers of trained nurses, professional In contrast, nurses working in the most
While 25.8 % of dialysis nurses recruitment rates are falling and dropout preferred wards of their hospitals were con-
expressed an intention to leave the profe- rates are rising around the world. sidered “positive” controls, i.e., those
ssion within the near future without waiting Specialized nursing may provide a way of expected to have the lowest levels of job
for formal retirement, 59 % of ICU and attracting highly motivated individuals to stress and burnout. In keeping with our
pre-study projections, ICU nurses did have
psychometric test results reflecting high
job stress and burnout as well as low job
TABLE I: Differences in the mean psychometric tool scores of dialysis satisfaction but ward nurses did not have
nurses compared with intensive care unit and ward nurses. the expected positive psychometric test
Psychometric Dialysis ICU Ward P1-2 P1-3 P2-3 results. This indicates that working in the
Tool Nurses (1) Nurses (2) Nurses (3) most popular wards is not sufficient in itself
to positively affect job stress, burnout, and
n = 31 n = 100 n = 49 satisfaction.
Mean SD Mean SD Mean SD When analyzed in detail, the decreased
job stress and burnout and higher job satis-
WRSI 31.55 6.13 37.27 7.6 37.08 5.63 0.000 0.000 0.060
faction levels of dialysis nurses was not
MBI-EE 13.19 6.12 20.21 6.41 20.31 5.68 0.000 0.000 0.929 found to be due to working in dialysis units
MBI-DP 2.77 2.51 6.79 3.41 6.69 3.30 0.000 0.000 0.774 per se, but associated with their being older,
more experienced and free of night duties,
MBI-PA 22.39 3.40 19.23 4.34 19.98 3.92 0.000 0.006 0.308 with fewer work place changes and
MWSQ-GS 3.59 0.53 2.26 0.52 3.16 0.62 0.000 0.002 0.045 increased voluntary choice of work place
and profession as compared to controls.
MWSQ-IS 3.86 0.48 3.18 0.59 3.29 0.68 0.000 0.000 0.321
Indeed, the number of patients cared for by
MWSQ-ES 3.20 0.69 2.63 0.62 2.96 0.71 0.000 0.148 0.004 dialysis nurses in the daytime was higher
than those of ICU and ward nurses, indicat-
DP = depersonalization, EE = emotional exhaustion, ES = external satisfaction, GS = general satisfaction, ing that increased personal work load did
IS = internal satisfaction, MBI = Maslach Burnout Inventory (MBI), MWSQ = Minnesota Work Satisfaction not lead to increased stress and burnout or
Questionnaire, PA = personal accomplishment, WRSI = Work-Related Strain Inventory.
decreased job satisfaction if accompanied by

4 Dialysis & Transplantation April 2007

TABLE II: How dialysis nurses are viewed by members of the healthcare team and by patients.
Characteristics Work Area x2 x2 x2
Nurse -Physician Dialysis (1) ICU (2) Ward Unit (3) sd sd sd
Professional Relationship P1-2 P1-3 P2-3
n % n % n %
positive 20 64.5 27 27.0 20 40.8 14.48 5.10 5.22
moderate 8 25.8 52 52.0 25 51.0 2 2 2
negative 3 9.7 21 21.0 4 8.2 0.001 0.078 0.073
Physicians’ Opinions .about
Nursing Profession
positive 25 80.6 18 18.0 18 36.7 42.24 15.53 7.59
moderate 3 9.7 51 51.0 23 46.9 2 2 2
negative 3 9.7 31 31.0 8 16.4 0.000 0.000 0.022
Nurses’ Opinions about
Nursing Profession
positive 23 74.2 33 33.0 14 28.6 16.66 15.92 3.05
moderate 4 12.9 42 42.0 16 32.7 2 2 2
negative 4 12.9 25 25.0 19 38.7 0.000 0.000 0.217
Support Personnel’s Opinions about
Nursing Profession
positive 27 87.1 41 41.0 19 38.8 2.70 18.65 0.581
moderate 4 12.9 41 41.0 23 46.9 2 2 2
negative 18 18.0 7 14.3 0.000 0.000 0.748
Patients' Opinions about
Nursing Profession
positive 25 80.6 55 55.0 26 53.1 6.81 6.41 0.135
moderate 3 9.7 29 29.0 14 28.6 2 2 2
negative 3 9.7 16 16.0 9 18.4 0.033 0.041 0.935
Hospital Administrators’ Opinions about
Nursing Profession
positive 13 41.9 18 18.0 17 34.7 11.04 1.22 6.81
moderate 13 41.9 37 37.0 19 38.8 2 2 2
negative 5 16.2 45 45.0 13 26.5 0.004 0.542 0.033
Total 31 100 100 100 49 100

factors favorably affecting these job-related
parameters. The importance of having
decreased job stress and burnout and higher
satisfaction was underlined by the
decreased ratio of intention to quit nursing
found in dialysis nurses when compared
with both control groups.
Another finding of note was the associ-
ation between psychometric results and the
way nurses perceived their relations with
physician co-workers and the views of their
professional contacts. Nurses who thought
there were positive nurse-physician profes-
sional relationships in their units and who
thought that their co-workers, patients, and
administrators had positive views about the
nursing profession had lower work-related
stress, emotional exhaustion, and deperson-
alization scores and higher personal accom-
plishment as well as general, internal, and
external satisfaction scores compared with
those who rated the same items as moderate
or negative. These differences were parti-
cularly notable between dialysis nurses and
the control groups. Our study underscores
the need for improved working conditions
with fewer unit changes, weekly work hours,
and night duties, as well as better interac-
tions with professional contacts in order to
decrease job stress, burnout, and dropout
and to increase job satisfaction in nurses.
Our findings are in keeping with pre-
vious studies that have shown that physi-

April 2007 Dialysis & Transplantation 5

 Stress, Burnout, and Job Satisfaction of Dialysis Nurses
cians are at the top of the list of sources of
negative attitudes and behaviors nurses
encounter in the workplace. One of the fac-
tors associated with nurse-physician con-
flicts may be the insistence on traditional
professional roles in an age where the
boundaries between nurses and physician
responsibilities are changing or blurring.
However, the conflict between nurses and
physicians and other professional contacts
has been evaluated in a very limited num-
ber of research studies. Even so, the avail-
able data shows that the difficulties experi-
enced by nurses in the workplace are not
limited to communication problems but
include verbal and physical attacks and
abuse directed by physicians, other co-
workers including other nurses and nurse
administrators, patients, and families.
Changing the negative views of nurs-
ing will require cultivation of a better
image of the nursing profession by other
professionals, in society in general, in the
media, and in nurses themselves. In parallel
with our finding that nurses who thought
that other nurses and nursing administra-
tors had a negative view of the nursing pro-
fession had the worst work-related stress,
burnout, and satisfaction scores, Farrell
determined that Australian nurses were
exposed to violence directed by other nurs-
es and did not think that their nursing
administrators protected them.25 In a note-
worthy study from Turkey, Sever deter-
mined that there was a communication
breakdown and serious conflict between
nurses and that these problems were the
cause of increased work-related stress and
deceased motivation.26 Demir reported that
positive feedback received from co-work-
ers decreased emotional exhaustion and
depersonalization in nurses.27 In short, in
order to decrease professional conflict,
stress, and burnout nurses need to achieve
better cooperation and communication
among each other.
Patients and their families appear to
have significant influence in a nurse’s job-
related psychometric results. Nurses who
thought that their patients had negative
views about nursing as a profession had
negative findings with respect to job stress,
burnout, and satisfaction levels in our
study, which underlines the importance of
the nurse interaction with patients. One
research study that supported our findings
6 Dialysis & Transplantation April 2007
was conducted by Sofield and Salmond in
the United States. They found that, after
physicians, patients were the second leading
source of verbal abuse directed at nurses.28
The problem is not limited to any one
country. Henderson and Lynch, et al.,
reported that nurses in Canada and
England, respectively, were frequently
exposed to the abusive attitude and/or
behavior of their patients and relatives.29,30
Verbal and physical abuse directed by
patients and their relatives is without doubt
a factor in the decreasing attraction of nurs-
ing as a profession. To prevent this abuse,
serious changes must be made in educa-
tional and healthcare institutions to foster
and support self-respect and assertiveness
in nurses. Improved images of nursing in
society through the elimination of negative
stereotypes in popular media would also
contribute to this end and should be a
goal for all nursing educators and admini-
strators if nursing is to continue to attract
motivated individuals dedicated to their
profession.
Conclusion
Our findings suggest that although dialysis
nurses have decreased job stress and
burnout and higher job satisfaction scores
than ICU and ward nurses, this is not due to
working in dialysis units per se, but to hav-
ing better conditions and improved profes-
sional interactions in their work places.
Continuing education for nurses would
enable them to either voluntarily choose
their units or to accept and identify with
them, develop means to foster supportive
professional relations within their units
based on mutual respect and trust, avoiding
overextended work hours and too many
night duties, and support young and inex-
perienced nurses by pairing them with
experienced colleagues. All of these
actions could help decrease job stress and
burnout and thereby increase job satisfac-
tion in all nurses.
When compared to ICU and ward
nurses, dialysis nurses in our study had
decreased job stress and burnout as well as
increased job satisfaction and higher fre-
quencies of positive views concerning their
relations with physician co-workers and the
opinions of their professional contacts
toward the nursing profession. These dif-
ferences were accompanied by a decreased
intention to leave the profession. As the dif-
ferences noted in dialysis nurses did not
appear to be the result of their being dialy-
sis nurses per se, but rather to the condi-
tions prevailing in their units, we suggest
that dialysis nursing could be used as a
model to improve the conditions of other
branches of nursing.
Acknowledgements
We are grateful to all of the nurses who
participated in this study. This study
received external funding from the Akdeniz
University Scientific Research Project Unit
and was a masters’ thesis for F. Arikan at
Afyon Kocatepe University School of
Nursing. D&T
References
1. Tyler P, Cushway D. Stress in nurses: the effects of
coping and social support, Stress Med. 1995;11:
243-251.
2. Maslach C, Burned-out. Hum Behav. 1976;5:16-22.
3. Maslach C, Goldberg J. Prevention of burnout: new
perspectives. Appl Prev Psychol. 1998;7:63-74.
4. Lazarus R, Folkman S. Stress, Appraisal, and
Coping. New York: Springer; 1984.
5. Aslan SH, Alparslan ZN, Aslan O, Kesepara C,
Unal M. Gender related factors to burnout among
Turkish health professionals. Ann Med Sci. 1998;
7:101-106.
6. Cam O. Burnout of the nursing educators at the
universities and related to variables, Ege Üniver-
sitesi Hemşirelik Yüksekokulu Dergisi. 1996;12(1):
9-20.
7. Nagy MS. Using a single-item approach to measure
facet job satisfaction. J Occup Organ Psychol.
2002;75:77-86.
8. Glisson C, Durick M. Predictors of job satisfaction
and organizational commitment in human service
organizations, Adm Sci Q. 1988;33:61-81.
9. Berns SS. Job Satisfaction and Conflict Manage-
ment. 3rd ed. Toronto, Ontario, Canada: The Mosby
Company; 1984:132.
10. Aksayan S, Velioǧlu P. Saǧlık ocaǧı ve hastanelerde
çalışan hemşirelerin örgütsel iş doyum etkenleri
[Organizational job satisfaction factors of nurses
working in public health clinics and hospitals].
Cumhuriyet Üniversitesi, III. Sivas: Ulusal Hemşire-
lik Kongresi Kitabı; 1992:635-646.
11. Musal B, Elçi ÇÖ, Ergin S. Professional satisfaction
of specialist physicians. Toplum ve Hekim (Soc
Physician). 1995;10(68):2-7.
12. Piko BF. Burnout, role conflict, job satisfaction and
psychosocial health among Hungarian health care
staff: a questionnaire survey. Int J Nurs Stud.
2005;42:503-513.
13. Piyal B, Celen U, Şahin N, Piyal YB. Job satisfaction
of employees in the Ankara University Medical
Faculty. Ankara Üniversitesi Tıp Fakültesi Mecbuası.
2002;53(4):241-250.
14. Gözüm S. Research of organizational factors that
affect job satisfaction of nurses and nurses who
work in preventive health care and their relationship
Stress, Burnout, and Job Satisfaction of Dialysis Nurses

with job satisfaction, burnout and absenteeism,

Türk Hemşireler Derneǧi Dergisi. 1997;77(2-3):
37-45.
15. Maslach C, Jackson SE. The measurement of
experienced burnout. J Occup Behav. 1981;2:
99-113.
16. Sutherland VJ, Cooper CL.. Identifying distress
among general practitioners: predictors of psycho-
logical ill-health and job dissatisfaction. Soc Sci Med.
1993;37:575-581.
17. Walcott JA, Ervin NE. Stressors in the workplace:
community health nurses. Pub Health Nurs. 1992;
9(1):65-71.
18. Aksakal NF, Ozkan Z, Baykan Z, Aycan S. Job satis-
faction of health personnel in service in primary
health-care centers in Gölbaşı region. Saǧlık ve
Toplum (Health Soc). 1999;9:4-14.
19. Revicki DA, May HJ, Whitley TW. Reliability and
validity of the Work-Related Strain Inventory among
health professionals. Behav Med Fall. 1991;17(3):
111-120.
20. Aslan SH, Alparslan ZN, Aslan O, Kesepara C,
Unal M.. Gender related factors to burnout among
Turkish health professionals. Ann Med Sci. 1998;
7:101-106.
21. Maslach C, Jackson SE. The Maslach Burnout Inven-
tory. 2nd ed. Palo Alto, CA: Consulting Psycholo-
gists Press; 1981:1-17.
22. Ergin C. Adaptation of MBI for Turkish nurses and
physicians, VII. National Congress of Psychology.
Ulusal Psikoloji Kongresi Bilimsel Çalışmaları
[National Psychology Conference of Scientific Stud-
ies], September 22-25, 1992. Ankara: Association
of Turkish Psychologists; 1992:143-155.
23. Weiss DJ, Dawis RV, England GW, Lofquise LH.
Minnesota Studies in Vocational Rehabilitation: 22,
Manual for Minnesota Satisfaction Questionnaire.
Vocational Psychology Research, University of
Minnesota, 1967.
24. Ergin C. “Job description tool” as a measure
of job satisfaction: adaptation, validity and relia-
bility study. Türk Psikoloji Dergisi, 1997;12(39):
25-36.
25. Farrell GA. Aggression in clinical settings: nurses’
views. J Adv Nurs. 1997;25:501-508
26. Sever (Dinç) A. Research of nurses’ methods of
coping with stress and their results. İstanbul Üni-
versitesi Saǧlık Bilimleri Enstitüsü Hemşirelik Ana
Bilim Dalı, 1997, İstanbul.
27. Demir A. An examination of nurses’ level of burnout
and some factors affecting level of burnout.
Cumhuriyet Üniversitesi Saǧlık Bilimleri Enstitüsü
Hemşirelik Programı Yüksek Lisans Tezi,1995,
Sivas.
28. Sofield L, Salmond SW. Workplace violence. A focus
on verbal abuse and intent to leave the organiza-
tion. Orthop Nurs. 2003;22:274-283.
29. Henderson AD. Nurses and workplace violence:
nurses’ experiences of verbal and physical abuse
at work. Can J Nurs Leadersh. 2003;16(4):82-98.
30. Lynch J, Appelboam R, McQuillan PJ. Survey of
abuse and violence by patients and relatives
towards intensive care staff. Anaesthesia. 2003;
58:893-899.

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