Differential associations of occupational stress dimensions with job burnout subscales among nurses

The differential associations through which specific dimensions of occupational stress contribute to distinct components of job burnout among nurses remain insufficiently elucidated, particularly in the post-pandemic context. This study aimed to assess the status of occupational stress and burnout and, crucially, to investigate the specific associations between stress dimensions and burnout components among clinical nurses.

A cross-sectional study was conducted and 3,654 registered nurses who completed an anonymous online survey. Validated instruments were utilized to assess job burnout and nursing occupational stress across multiple domains. Multivariable logistic regression analyses were performed to identify occupational stress factors independently associated with each dimension of job burnout.

Nurses reported mild-to-moderate overall occupational stress (mean total score = 64.19 ± 21.20; mean item score = 1.83 ± 0.61). However, burnout levels were notable, with scores of 21.33 ± 5.87 for emotional exhaustion (EE), 10.06 ± 3.20 for depersonalization (DP), and 23.13 ± 4.23 for personal accomplishment (PA). All five stress dimensions showed significant positive correlations with EE (r = 0.436-0.542) and DP (r = 0.345-0.489), and weak negative correlations with PA (r = -0.122 to -0.150). Regression analyses revealed distinct patterns of association: EE was independently associated with all five stress dimensions, most strongly with "nursing management and interpersonal relationships" (NMIR) (OR = 3.738, 95% CI: 2.294-6.089, p < 0.001) and "workload and time allocation" (WTA) (OR = 2.801, 95% CI: 2.205-3.559, p < 0.001). DP was specifically associated with "patient nursing care" (OR = 2.401, 95% CI: 1.564-3.688, p < 0.001), NMIR (OR = 2.036, 95% CI: 1.139-3.639, p = 0.016), and "work environment and resources" (OR = 1.486, 95% CI: 1.075-2.054, p = 0.017). For low PA, only NMIR (OR = 3.415, 95% CI: 1.772-6.583, p < 0.001) and WTA (OR = 0.556, 95% CI: 0.347-0.890, p = 0.014) were significant independent factors, with NMIR stress being the strongest correlate.

This study identifies a disconnect between moderate stress perception and significant burnout, highlighting heterogeneous associations linking specific stress dimensions to different burnout components. It underscores stress related to management and interpersonal relationships as a central, pervasive factor associated with burnout. Interventions targeting organizational leadership and the relational climate are essential for mitigating burnout and fostering nurse well-being.