Introduction

Burnout reflects a condition of perceived failure or exhaustion caused by failure to meet the expected workload in terms of energy, strength, and resources (Efıl et al., 2022). Scholars have suggested that burnout is rooted in long-term work pressures and a lack of appropriate relief (Han & Kwak, 2022). Burnout may cause people to lack the necessary energy to work or reduce their work willingness (Nabizadeh-Gharghozar et al., 2020). Alsayed et al. (2022) suggested that excessive working time is the primary contributing factor to workplace burnout. Importantly, Cheng et al. (2007) found that the actual time workers put into work is often underestimated/underreported. However, as high-pressure workers, nurses are continually placed in high-pressure and high-risk working environments and constantly assigned to work multiple shifts, which is likely to lead to burnout (Kern et al., 2021).

In terms of self-perceived mental health, satisfaction is the most significant factor explaining changes in personal well-being (Søvold et al., 2021). The higher a staff's well-being, the higher their productivity and working performance (Abdullah et al., 2021). Workplace burnout and boredom are often the social and psychological results of a nurse's working environment, which can influence their well-being (Chen et al., 2022).

Resilience is a complex and dynamic process that enables nurses to adapt proactively to stressors and adversity (Cooper et al., 2020).

In a high-pressure working environment, medical staffs with better resilience are better able to maintain their personal and professional well-being (Hsiao et al., 2019). Improving nurse resilience helps nurses reduce emotional exhaustion, increase work engagement, overcome workplace challenges, and cope with adversity (F. Yu et al., 2019).

As nurses are often in high-pressure medical environments and perform shift work for long periods, their well-being often declines over time (Alsayed et al., 2022). However, studies on workplace burnout, resilience, and well-being in nurses are scarce in the literature. Thus, this study was designed to pursue the following: (a) understand the basic demographics and current workplace burnout, resilience, and well-being status of nursing staff; (b) investigate the correlations among these variables; and (c) investigate the significant predictors of well-being.

Methods Design and Sample

A cross-sectional and correlational research approach was used, and nurses at a medical center in central Taiwan were recruited as participants. Data collection and analysis took place from May 1, 2021, to January 20, 2022. Convenience sampling was used to conduct analysis. The inclusion criteria were nurses who (a) held a nurse or registered nurse license (Ministry of Examination, ROC, 2023), (b) were currently engaged in nursing work, and (c) were either a nursing staff or an assistant head nurse with a service length of at least 6 months. The exclusion criteria were as follows: (a) a service length of less than 6 months, (b) being a specialist nurse, (c) holding an administrative or educational position (i.e., head nurses and nursing teachers), and (d) not completing the questionnaire. The minimum sample size was calculated using the statistical G*Power software Version 3.0.10. Using this tool, the researchers performed multiple linear regressions and specifically fixed the model R2 deviation from zero (α = .05, p = .8, and effect size = 0.13; Ghods et al., 2022), with the calculation results indicating the need for data from at least 178 participants. Considering a possible 45% attrition rate (Emani et al., 2020), the total sample size was set to 300. Two hundred eighty-nine participants submitted valid questionnaires and 11 submitted invalid questionnaires (i.e., one nursing assistant, one supervisor, and seven specialist nurses), giving a valid response rate in this study of 96.33%.

Instruments

To explore the correlations among workplace burnout, resilience, and well-being in this sample, the following tools were used: a demographic characteristics questionnaire, a workplace burnout scale, a resilience scale, and a well-being scale.

Workplace burnout scale

The workplace burnout scale of Yeh et al. (2008) was used in this study to measure self-perceived overall burnout. The scale asks respondents to subjectively assess the frequency of various problems during the previous week and covers 21 items in the four dimensions of personal burnout, work-related burnout, client-related burnout, and overcommitment to work. This scale is scored on a 5-point Likert scale, with 4 = always, 3 = often, 2 = sometimes, 1 = seldom, and 0 = never. The four domains are scored separately. In terms of the personal burnout, work-related burnout, and overcommitment-to-work dimensions, the results were calculated by multiplying the original scores by 5 to achieve a score range between 0 and 100.

For the client-related burnout dimension, the result was calculated by the original score ×25÷6 to also achieve a score range between 0 and 100 points. Higher dimension scores are associated with a higher degree of burnout. The Cronbach's alpha coefficients ranged between .90 and .92 for “personal burnout,” “work-related burnout,” and “client-related burnout” and .84 for “overcommitment to work.” The content validity index was above .79 (Yeh et al., 2008). The results indicate that the scale had good internal consistency and validity and is a valid tool for evaluating workplace burnout. In this study, the Cronbach's α of the overall workplace burnout scale was .93.

Resilience scale

Utilizing X. Yu and Zhang's (2007) Resilience Scale for Medical Staff, the resilience of medical staff was divided into 10 items in four dimensions, including the meaning of work, difficulties in acceptance, emotional adjustment, and interpersonal pressure relief. Scoring is based on a 5-point Likert scale (1 = very inconsistent, 5 = very consistent), with a total score range of 10–50 points. Hsiao et al. (2019) previously applied this scale to medical staff from a teaching demonstration hospital in southern Taiwan, finding a Cronbach's α coefficient of internal consistency of .91 and a scale fitness of goodness of fit index = .973, indicating good reliability and validity. In this study, the Cronbach's α of the scale was .90.

Well-being scale

The well-being scale of Lin (2000) was used in this study. This scale includes 24 items in the four dimensions of positive emotions, interpersonal relationships, self-affirmation, and physical and mental health, with items scored on a 4-point scale (1 = very inconsistent, 4 = very consistent) and higher total scores associated with higher overall well-being. The Cronbach's α values of the subscales were positive emotions = .87, interpersonal relationships = .84, self-affirmation = .82, physical and mental health = .79, and overall scale = .93, and the correlation coefficient of criterion-related validity was .77–.86 (Lin, 2000). In this study, the Cronbach's α for the overall scale was .93.

Statistical Analysis

After coding, the collected data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation, on the Chinese version of IBM SPSS 23.0 (IBM Inc., Armonk, NY, USA). Inferential statistical analyses were conducted using independent t tests, Pearson product–difference correlation, one-way analysis of variance, and multiple stepwise regression analysis. The residual and error term of the regression model were examined using the Kolmogorov–Smirnov test. The results revealed that the values correspond to a normal distribution (Kolmogorov–Smirnov = 0.12, p > .05). For all statistical analyses, p < .05 was used to indicate statistical significance.

Ethical Considerations

Data collection in this study adhered to relevant ethical principles. Before implementation, the institutional review board reviewed and approved (No. 201123) the research, and the researcher recruited eligible nursing staff through Outlook. Potential candidates were permitted to read the anonymous research questionnaire instructions in the email and decide independently whether to complete the questionnaire. Those who agreed to participate filled in the Google Form to complete the questionnaire by themselves, and respondents who completed and submitted the questionnaire were given a stored-value gift card. The study collected data in a strictly confidential and anonymous manner, and participant identification information was coded to preclude the chance of data disclosure and ensure the confidentiality of participant data and privacy. The follow-up data analyses used statistics to analyze overall responses, and the results were used for academic research only. To protect the rights and interests of the research subjects, no specific personal answers were presented.

Results Demographic Characteristics, Workplace Burnout, Resilience, and Well-Being

The questionnaires were distributed to 300 nursing staff, and 289 valid responses were retrieved and used in subsequent analysis (valid return rate: 96.33%). The age of participants ranged between 23 and 65 years and averaged 40.56 (SD = 14.04) years. Nearly all of the participants (97.2%) were female, most (62.6%) were single, and 85.1% lived with family members. Most had completed a university education (83.4%) and currently had no children (62.3%). Most worked as registered nurses (81.7%) in internal or surgical departments (55.7%). Most worked on a monthly fixed-shift system (67.8%), and most rated their self-perceived health as extremely poor (45.3%; Table 1).

Table 1 - Participant Demographic Characteristics (N = 289) Characteristic n % Age (years; mean and SD) 40.56 14.04 Gender  Female 281 97.2  Male 8 2.8 Marital status  Couple (married, cohabited, and separated) 108 37.4  Single (unmarried, widowed, and divorced) 181 62.6 Living conditions (live with others)  Yes 246 85.1  No 43 14.9 Living with (multiple responses)  Sons and daughters 98 33.9  Grandchildren 6 2.1  Parents 122 42.2  Siblings 84 29.1  Friends 56 19.4  Foreign domestic helper 2 0.7  Grandmother 9 3.1 Religious belief  Yes 161 55.7  No 128 44.3 Educational level  Junior college 38 13.1  University 241 83.4  Graduate school and higher 10 3.5 Status of children (age of the youngest child)  < 3 years 37 12.8  3–12 years 43 14.9  > 12 years 29 10.0 Number of children  No children 180 62.3  Two children and less 36 12.5  Three children and more 73 25.2 Role category (multiple responses)  Sons or daughter 247 85.5  Husband/son-in-law 5 1.7  Parents/parents-in-law 79 27.3  Daughter-in-law/wife 104 36.0  Grandchild 55 19.0  Student 13 4.5 Years working for this hospital  6 months to 1 year 10 3.4  1–5 106 36.7  Over 5 173 59.9 Job title  Assistant head nurse/nurse team leader 49 17.0  Nurse 4 1.3  Registered nurse 236 81.7 Salary income (NTD)  ≤ 40,000 48 16.5  41,000-50,000 160 55.4  ≥ 51,000 81 28.1 Department  Emergency/intensive care unit 86 29.8  Psychiatry/pediatrics/gynecology 42 14.5  Medicine/surgery 161 55.7 Shift status  Flexible shifts 26 9.0  Two shifts 67 23.2  Fixed monthly shifts 196 67.8 On-the-job training  Yes 15 5.2  No 274 94.8 Exercise frequency  Never 89 30.8  Once or twice per week 175 60.5  More than 3 times per week 25 8.7 Self-perceived health condition  Good 9 3.1  Not good 29 10.1  Poor 120 41.5  Extremely poor 131 45.3

Note. Nurse: Only those who pass the junior examination can obtain a nurse license. Registered nurse: Only those who pass the senior examination can obtain a registered professional nurse license.

As shown in Table 2, the average scores for workplace burnout and personal burnout were 40.40 (SD = 11.96) and 10.55 (SD = 3.65), respectively. Meanwhile, the average scores for work-related burnout, client-related burnout, and overcommitment to work were 10.26 (SD = 3.53), 10.47 (SD = 4.18), and 9.12 (SD = 3.56), respectively (Table 2). With regard to average item scores, personal burnout was relatively high (2.11; SD = 0.73), and client-related burnout was relatively low (1.75; SD = 0.70).

Table 2 - Workplace Burnout, Resilience, and Well-Being (N = 289) Variable Mean SD Workplace burnout scale (0–100 points), mean (SD) score = 40.40 (11.96) 1.92 0.57  Personal burnout (20 points)   1. Do you often feel tired? 2.11 0.73   2. Do you often feel that you are exhausted (completely exhausted)? 2.72 0.77   3. Do you often feel emotionally exhausted (very tired)? 2.18 0.84   4. Do you often feel that “I am going to be worn out”? 2.27 0.85   5. Do you often feel weak and seem to be getting sick? 1.76 0.95   Total points (100 points): 10.55 × 5 = 52.8 points 1.63 0.89  Workplace-related burnout (20 points)   1. Does your work make you feel emotionally exhausted? 2.05 0.71   2. Does your work make you feel frustrated? 2.26 0.89   3. After 1 day of work, do you feel exhausted (fatigue)? 1.89 0.72   4. Does thinking about working one full day before going to work make you feel out of energy? 2.26 0.84   5. Do you feel that every minute at work is unbearable (feeling tired all the time)? 2.21 0.96   Total points (100 points): 10.26 × 5 = 51.3 points 1.63 0.86  Client-related burnout (24 points)   1. Do you find it difficult to interact with service subjects? 1.75 0.70   2. Do the service subjects make you feel tired? 1.60 0.75   3. Do you hope to reduce the contact time with service subjects? 1.95 0.78   4. Are you fed up with service subjects? 1.76 0.97   5. Do you think you receive less from service subjects than you pay? 1.71 0.81   6. Do you want to get rid of service subjects as soon as possible? 1.82 0.94   Total points (100 points): 10.47 × 25/6 = 43.63 points 1.63 0.90  Overcommitment to work (20 points)   1. Do you start thinking about work the moment you get up in the morning? 1.82 0.71   2. Do you think about work when you come home from work? 1.99 1.05   3. Do you still think about work when you go to bed? 2.04 0.94   4. Do you sacrifice other activities for work? 1.84 0.94   5. Do you want to devote more time and energy to your work? 2.11 0.95   Total points (100 points): 9.12 × 5 = 45.6 points 1.14 0.86 Resilience scale (10–50 points), mean (SD) score = 26.79 (5.64) 2.69 0.56  Meaning of work (10 points)   1. I know my work can help people directly or indirectly. 2.97 0.69   2. I know my work is meaningful. 2.91 0.73   Total points (100 points): 5.94/10*100 = 59.4 points 3.03 0.77  Acceptance of difficulties (15 points)   1. When meeting difficulties at work, I will try to find ways to overcome them. 2.70 0.68   2. When meeting difficulties at work, I can view them in a humorous or optimistic way. 2.89 0.73   3. I can accept that some difficulties at work are inevitable. 2.48 0.90   Total points (100 points): 8.10/15 × 100 = 54.0 points 2.73 0.78  Emotional adjustment (15 points)   1. When in a bad mood, I can recall and tell what has affected my mood. 2.56 0.65   2. I know how to turn to a peaceful mood from angry or depressed emotions. 2.65 0.74   3. I know how to relieve burnout or stress caused by work. 2.57 0.73   Total points (100 points): 7.69/15*100 = 51.3 points 2.46 0.78  Interpersonal pressure relief (10 points)   1. I usually care about and encourage others. 2.53 0.71   2. When being in a bad mood, I can find the right person to express my feelings. 2.56 0.78   Total points (100 points): 5.06/10 × 100 = 50.6 points 2.50 0.86 Well-being scale (24–96 points), mean (SD) score = 43.25 (8.66) 1.80 0.36  Positive emotions (36 points) 1.85 0.39   1. I can control my life. 1.90 0.58   2. My ideology can be realized. 1.66 0.59   3. I think things in the world are good. 1.73 0.59   4. I like myself. 1.97 0.53   5. My participation makes things better. 1.88 0.48   6. I think the world is a good place. 1.88 0.54   7. I always keep a relaxed mood. 1.73 0.57   8. I can solve problems in life. 1.98 0.46   9. I feel guaranteed and secure in life. 1.90 0.53   Total points (100 points): 16.62/36 × 100 = 46.2 points  Interpersonal relationship (20 points)   1. I am interested in caring about other people's affairs. 2.03 0.37   2. I think I can bring happiness to others. 1.93 0.53   3. I think it's very interesting to be with friends. 1.92 0.52   4. I am loving and caring to others. 2.17 0.49   5. I like to help others. 2.07 0.48   Total points (100 points): 10.15/20 × 100 = 50.75 points 2.08 0.45  Self-affirmation (24 points)   1. I like my life. 1.82 0.49   2. My life is purposeful and meaningful. 1.87 0.60   3. My life is rewarding. 1.88 0.60   4. I think I am attractive. 1.88 0.54   5. I have confidence in myself. 1.76 0.58   6. I am satisfied with things in my life right now. 1.75 0.62   Total points (100 points): 10.90/24 × 100 = 45.4 points 1.77 0.62  Physical and mental health (16 points)   1. I engage in sports regularly. 1.39 0.53   2. My health condition is good. 1.21 0.86   3. I have good eating habits. 1.60 0.62   4. I get enough sleep. 1.44 0.65   Total points (100 points): 5.58/16 × 100 = 34.9 points 1.33 0.69

The average scores were 26.79 (SD = 5.64) for resilience, 5.94 (SD = 1.38) for meaning of work, 8.10 (SD = 2.04) for difficulties in acceptance, 7.69 (SD = 1.95) for emotional adjustment, and 5.06 (SD = 1.42) for interpersonal pressure relief (Table 2). In terms of average item scores, meaning of work was relatively high at 2.97 (SD = 0.69), and interpersonal pressure relief was relatively low at 2.53 (SD = 0.71).

The average scores were 43.25 (SD = 8.66) for well-being, 16.62 (SD = 3.48) for positive emotions, 10.15 (SD = 1.84) for interpersonal relationships, 10.90 (SD = 2.96) for self-affirmation, and 5.58 (SD = 2.14) for physical and mental health (Table 2). In terms of average item scores, interpersonal relationships was relatively high at 2.03 (SD = 0.37), and physical and mental health was relatively low at 1.39 (SD = 0.53; Table 2).

Correlations Between Well-Being and Demographic Characteristics, Workplace Burnout, and Resilience

Married nurses had better overall well-being (p < .01), positive emotions well-being (p < .05), and self-affirmation well-being (p < .001) than those who were single; those with religious beliefs had higher overall well-being and physical and mental health than those without; and number of children was significantly correlated with self-affirmation (p < .05). Moreover, job title was shown to correlate significantly with overall well-being, positive emotions, interpersonal relationships, and self-affirmation (p < .05). In addition, exercise frequency was significantly correlated with overall well-being (p < .001), positive emotions (p < .05), interpersonal relationships (p < .001), self-affirmation (p < .001), and physical and mental health (p < .001); self-perceived health was significantly correlated with overall well-being, positive emotions, interpersonal relationships, self-affirmation, and physical and mental health (p < .001; Table 3).

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