Problems with task mastery,social acceptance,and role clarity explain nurses’ symptoms of burnout during the first professional years: A longitudinal study

Abstract

BACKGROUND:

Symptoms of burnout among new professionals is a well-recognized problem but there is a lack of prevention programs. Effective interventions are based on an understanding of the processes that contribute to the development of a problem and suggest how it may be addressed.

OBJECTIVE:

Using the framework of organizational socialization, the objective of this study was to investigate if development of the socialization processes role clarity, social acceptance, and task mastery affects development of symptoms of burnout among new professionals and may specifically be targeted in transition-to-practice programs to prevent symptoms of burnout from occurring. We conducted this investigation by examining the relations between role clarity, social acceptance, task mastery, and symptoms of burnout the first year after professional entry, as well as the relations between changes in the socialization processes and changes in symptoms of burnout during the first three years following professional entry in a sample of new nurses.

METHOD:

Relationships between the socialization processes and symptoms of burnout were modeled using a linear latent growth model and data from a nationally representative sample of 1210 new registered nurses.

RESULTS:

Role clarity, social acceptance, and task mastery were related to symptoms of burnout cross-sectionally and longitudinally. Task mastery was the most important explanatory variable.

CONCLUSIONS:

The results suggest that an intervention designed to support the development of the socialization processes may be effective in preventing symptoms of burnout among new nurses. Interventions targeting role clarity, social acceptance, and task mastery during the first professional year may be expected to have effects during the following years as well, extending the value and importance of such interventions.

Keywords

Organizational socialization transition stress growth model

1 Introduction

Young adults make up the population group that experiences the highest level of stress [1]. Many are overwhelmed by the demands of their new profession and symptoms of burnout are reported already during their first professional years [2, 3]. Burnout is typically defined as a state that is characterized by symptoms that are related to one of three factors; exhaustion, disengagement, or experiences of reduced performance (e.g. [4 –7]). Typical symptoms are fatigue, indifference, restlessness, indecisiveness, and distractibility [8].

In a nationally representative Swedish sample of newly graduated nurses, every fifth new nurse was found to experience symptoms of burnout at some point during his/her first three years of clinical practice [3]. Similar results have been found internationally. Boamah and Laschinger [9] and Laschinger et al. [10] found that nearly half of the new Canadian nurses in their studies experienced symptoms of burnout. New nurses who experience high levels of stress and symptoms of burnout are less satisfied with their work [11, 12] and have more thoughts about leaving their employment positions [3 , 14] than their colleagues. This suggests a need to intervene to prevent symptoms of burnout from occurring in this group of professionals [3 , 15]. Preventative interventions are interventions that are implemented before the onset of a disorder with the purpose of preventing the disorder from occurring, to delay its onset, or to reduce its impact. Preventative interventions also include interventions that aim at promoting emotional, physical, and social well-being [16]. The early onset of symptoms of burnout among new nurses suggests that a preventative intervention should preferably be implemented at an early stage following professional entry, perhaps already as part of transition-to-practice programs. Unfortunately, the available knowledge of how to intervene to prevent symptoms of burnout from occurring among new professionals is limited [17 –20]. Because of this, more research needs to be directed towards developing effective interventions for this purpose [18 , 22]. Effective interventions are characterized by addressing a specific problem based on an understanding of the mechanisms or processes that contribute to the development of the problem at hand [23 –25]. Thus, the first step towards developing an intervention to prevent symptoms of burnout among new nurses is to identify the processes that contributes to the occurrence of these symptoms in this group.

It has been hypothesized that symptoms of burnout are caused by an over-activation of the stress response [26]. The stress response is activated in situations where there is a mismatch between perceived demands placed on an individual and his/her perceived capabilities (or resources) to handle these demands [27]. Through physiological, emotional, and behavioral adaptations, resources are allocated and thereby management of the situation is facilitated. However, if the stress response is activated repeatedly or over prolonged periods of time with insufficient periods of recovery, the physiological systems involved may suffer damage, resulting in symptoms of burnout [26]. In line with this hypothesis, results from a meta-analysis on the relationship between work exposure factors and development of symptoms of burnout (based on data from 25 studies, conducted over a period of 23 years, measuring work exposure [i.e. various forms of demands and resources], and symptoms of burnout at baseline and at least once again within a five-year period) showed that high levels of support at work protected against symptoms of burnout, while low support, high demands, and low job control increased the risk of developing symptoms of burnout [28].

One framework that specifically captures new professionals’ experiences of stress is organizational socialization [29]. Accordingly, new professionals’ experiences of stress are related to the development of task mastery, social acceptance, and role clarity [17], constructs that are related to the work exposure factors demands, support, and control that have been shown to affect the development of symptoms of burnout [28]. Task mastery refers to new professionals’ skills and experiences of being able to manage tasks effectively [30], social acceptance refers to newcomers’ inclusion in the new group of colleagues, and role clarity refers to the new professionals’ knowledge of what is expected within the professional role and what influence they may exert [31]. It is assumed that development of these constructs mediates acquisition of knowledge, skills, attitudes, and behaviors, thereby facilitating management of challenging situations and reducing experiences of stress. Because of this, the constructs are often referred to as socialization processes, that is, constructs that, as they develop, drive new professionals’ socialization [17 , 31–33]. In line with this assumption, it was recently shown that when new professionals experience episodes of higher levels of task mastery, social acceptance, and role clarity, they experience lower levels of stress [68].

The relationship between the indicators of socialization and new professionals’ experiences of stress, together with the assumption that symptoms of burnout are caused by an over-activation of the stress response, suggest that development of the socialization processes affect the risk of developing symptoms of burnout. That is, if the new professionals would develop increasing levels of task mastery, social acceptance, and role clarity, their stress response would be activated less often and, theoretically, their risk of developing symptoms of burnout would decrease. However, few studies have prospectively investigated the relationship between these processes and new professionals’ experiences of symptoms of burnout [17 , 35]. symptoms of burnout are often not apparent to the affected individual for a long time [36]. They develop progressively as the individual makes increasingly effortful attempts at managing demands [4, 37]. Therefore, to investigate if development of task mastery, role clarity, and social acceptance affects development of symptoms of burnout and may be targeted to prevent symptoms of burnout from occurring, with this longitudinal study we aimed to examine the relations between the socialization processes and symptoms of burnout the first year after professional entry, as well as the relations between changes in the socialization processes and changes in symptoms of burnout during the first three years following professional entry in a sample of newly registered nurses.

2 Method

2.1 Sample, recruitment and data collection

All nurses due to graduate from the 26 universities in Sweden offering undergraduate nursing programs during the spring of 2006 were invited to participate in a prospective longitudinal study called the LANE-study (Longitudinal Analysis of Nursing Education/Employment [38]). The eligible participants were sent a letter with written information about the study, including details about confidentiality and the right to withdraw from the study at any point in time without explanation.

Of the 2107 nursing students that were invited, 1459 (69%) gave their informed consent to participate. There was hardly any difference between the nursing students who chose to participate in the LANE-study and the sampling frame (i.e. the population of all 2107 eligible nursing students) regarding sex, country of birth, and residency. In the sampling frame, 86.0% were women, 90.6% were Swedish-born, and 21.9% lived in large cities. Corresponding numbers for the LANE-study participants were 89.4%, 91.1%, and 22.7%. Nineteen nurses actively withdrew from the LANE-cohort during the three-year period of the present study.

The present study focuses on the experiences of a subsample (n = 1210) of the LANE-study participants who at least once during the first three years after graduation confirmed that they were working as registered nurses and answered questions on experiences of symptoms of burnout (further details about the data collections are presented below). In this sample, 89.3% were women and about half (53.4%) had previous experience of working in health care. The majority were either working- or middle class (43.0% and 47.1% respectively) and were either living with a partner (63.7%) or alone (25.6%).

We collected data through pen-and-paper questionnaires that were sent to participants’ homes once they had completed one, two, and three years of clinical practice (Fig. 1) along with instructions on how to fill them out and return them (a pre-stamped return envelope was supplied). Reminders were sent at three and six weeks after participants had received the questionnaires. The measures included in the questionnaires were pilot-tested before the study. To ensure quality over time, the consecutive questionnaires were reviewed at the technical and language laboratory of Statistics Sweden (SCB). Data collection was managed by SCB (i.e. adding a coded identification number for longitudinal analyses to each participant’s questionnaire, printing and posting the questionnaires, sending out reminders, and registering data in electronic files for statistical analyses).

Fig.1

Flow of study subjects. Note: Y = year in clinical practice; BO = symptoms of burnout questionnaire; LANE = Longitudinal Analysis of Nursing Education/Employment.

Two-thirds of the study sample (787 subjects) answered all three questionnaires, one-fifth of the sample (233 subjects) answered two questionnaires, and the remaining (190 subjects) answered only one of the questionnaires. The response rates over the three years were 92.1%, 80.0%, and 77.4%. Attrition rates over time was investigated using a regression procedure referred to as marginal logistic regression [39] or ‘repeated measures logistic regression’, using Generalized Estimation Equations in IBM SPSS Statistics 24 [40]. The main effects of time, age, gender, self-rated health, and marital status, as well as the interaction between these variables and time, were tested with the Wald Chi-square statistic [38, 41]. One main effect was found for time, reflecting that the attrition rates declined across time (Wald χ²= 19.2; p = 0.001). No other main effects or interaction effects were found.

We evaluated the potential impact of missingness on the longitudinal models by comparing levels of the outcome variable (i.e. symptoms of burnout) and the predictor variables at one measurement wave with attrition at the following wave. In general, correlations approached zero and ranged (in absolute terms) between 0.005 and 0.070. No significant associations were found indicating that symptoms of burnout predicted attrition over time (correlations ranging between 0.020 and 0.061). The same results were found for task mastery (correlations ranging between – 0.005 and – 0.007), role clarity (correlations ranging between – 0.010 and 0.008) and co-worker support (correlations ranging between – 0.057 and 0.025). However, for leadership support, lower levels of support two years after graduation predicted attrition at the last data collection (r = 0.070; p = 0.038).

The study was conducted in accordance with the Helsinki Declaration of ethical principles for medical research involving human subjects [42]. Approval for the study was received from the Research Ethics Committee at the Karolinska Institute, Sweden (Dnr KI 01-045; 2006/973-32).

2.2 Measurement

In Table 1, the descriptives of the measurements in the study are presented. In addition, the cross sectional correlations between the measurements one year following professional entry are included.

Table 1
Correlations and descriptives of measurements

Measurements Cross sectional correlation at Y1 Time Items N Alpha MIIC M SD

1 2 3 4

1 Role clarity (QPS Nordic) Y1 3 1090 0.8 0.58 3.96 0.71

Y2 3 863 0.82 0.62 3.98 0.70

Y3 3 760 0.80 0.59 4.07 0.69

2 Leadership support (QPS Nordic) 0.27 Y1 6 1076 0.90 0.60 3.17 0.95

Y2 6 867 0.91 0.64 3.29 0.99

Y3 6 762 0.91 0.64 3.22 1.04

3 Co-worker support (QPS Nordic) 0.27 0.33 Y1 3 1075 0.63 0.44 4.07 0.66

Y2 3 866 0.65 0.43 4.04 0.65

Y3 3 763 0.64 0.42 4.00 0.66

4 Task mastery (QPS Nordic) 0.40 0.19 0.20 Y1 3 1090 0.79 0.55 3.95 0.62

Y2 3 868 0.77 0.54 3.98 0.60

Y3 3 762 0.77 0.54 4.03 0.61

5 Symptoms of burnout (SWEBO) – 0.31 – 0.29 – 0.33 – 0.44 Y1 9 1057 0.89 0.48 1.67 0.51

Y2 9 837 0.88 0.45 1.69 0.46

Y3 9 751 0.90 0.47 1.70 0.48

Measurements	Cross sectional correlation at Y1	Time	Items	N	Alpha	MIIC	M	SD
1 Role clarity (QPS Nordic)					Y1	3	1090	0.8	0.58	3.96	0.71
					Y2	3	863	0.82	0.62	3.98	0.70
					Y3	3	760	0.80	0.59	4.07	0.69
2 Leadership support (QPS Nordic)	0.27				Y1	6	1076	0.90	0.60	3.17	0.95
					Y2	6	867	0.91	0.64	3.29	0.99
					Y3	6	762	0.91	0.64	3.22	1.04
3 Co-worker support (QPS Nordic)	0.27				0.33	Y1	3	1075	0.63	0.44	4.07	0.66
					Y2	3	866	0.65	0.43	4.04	0.65
					Y3	3	763	0.64	0.42	4.00	0.66
4 Task mastery (QPS Nordic)	0.40	0.19	0.20		Y1	3	1090	0.79	0.55	3.95	0.62
					Y2	3	868	0.77	0.54	3.98	0.60
					Y3	3	762	0.77	0.54	4.03	0.61
5 Symptoms of burnout (SWEBO)	– 0.31	– 0.29	– 0.33	– 0.44	Y1	9	1057	0.89	0.48	1.67	0.51
					Y2	9	837	0.88	0.45	1.69	0.46
					Y3	9	751	0.90	0.47	1.70	0.48

Note: QPS Nordic = General Questionnaire for Psychological and Social Factors at Work; SWEBO = Scale of Work Engagement and Symptoms of burnout; N = Number of subjects; Alpha = Cronbach’s alpha; MIIC = mean inter-item correlation; M = mean score; SD = standard deviation; Y = year in clinical practice.

2.2.1 Predictor variables

We measured role clarity, social acceptance and task mastery using short forms of scales from the General Questionnaire for Psychological and Social Factors at Work (QPS Nordic [43]). The short forms were developed using factor analysis following rigorous psychometric testing of the original scales with special focus on the measurement invariance of the scales across different occupational groups [44, 45]. The three role clarity items asked about the respondents’ experiences in relation to their professional role (sample item: How often do you experience there to be clearly defined goals for your work?). Social acceptance was measured using two scales, one measuring leadership support with six items and the other measuring support from co-workers with three items (sample items: How often do you experience that you get support from your closest managers if you need it? [leadership]; How often do you experience that you get support and help in your work from your co-workers if you need it? [co-worker]). The three task mastery items asked about the respondents’ mastery experiences in relation to the work that they performed (sample item: How often do you experience that you are satisfied with the quality of the work that you do?). Thus, a total of four measures were included in the study to measure the three socialization processes. All scales were responded to using a five-point Likert scale ranging from “Very seldom or never” to “Very often or always”.

2.2.2 Outcome variable

We measured the participants’ experiences of symptoms of burnout using the Scale of Work Engagement and symptoms of burnout (SWEBO [8, 46]). SWEBO consists of two factors that measure levels of symptoms of burnout and work engagement separately. In this study we only included the burnout factor. It consists of three subscales with three items each – exhaustion, disengagement, and inattentiveness – and each scale is composed of three mood adjectives (sample items: exhausted [exhaustion]; indifferent [disengagement]; unfocused [inattentiveness]) that were derived based on several conceptualizations of burnout [7 , 47–49]. In order to capture the current levels of symptoms of burnout (which are context dependent), all of the items in SWEBO are phrased in relation to the work context and the respondents are instructed to take into account their feelings over the previous two weeks. The items were rated using a four-point frequency response format ranging from “Not at all” to “All of the time”.

2.3 Statistical analysis

We used a linear latent growth model [50] to model the longitudinal trajectory of symptoms of burnout development and to address the cross-sectional relationships of achieved levels of the socialization processes and symptoms of burnout one year into the profession, as well as the relationships between changes in the processes from year one to year two as well as year three and changes in symptoms of burnout during the same time.

The current recommendation for longitudinal analysis with missing data is to use an inclusive analysis strategy (i.e. not using list-wise deletion) that includes the use of Full Information Maximum Likelihood (FIML) methods that can handle missing data [51]. This method of estimation thus means that it is not necessary for the respondents to have participated in all waves of measurement in order to be included in the analysis. However, when covariates are added to the model as independent variables (here the time-variant socialization variables) a significant loss in sample size occurs because it is required that the participants’ data for the independent variables are complete and the advantage of using FIML is lost. Thus, for the longitudinal model including time-variant variables, we decided to impute missing data using multiple imputation (MI). In line with current recommendations for MI, a total of 40 new datasets were generated and parameter estimates from these datasets were pooled during the same procedure in Mplus 7.1 [51, 52].

At each time point of the study (one, two and three years into the profession), we used the exhaustion, disengagement, and inattentiveness subscales of SWEBO as indicators for a latent burnout factor. We estimated two fixed effects (the intercept and the slope) as well as variance and covariance around these parameters (i.e. three random effects) using FIML in Mplus 7.1 [52]. We evaluated model fit using recommendations based on simulations [53]. Specifically, good model fit was indicated by a standardized root mean square residual (SRMR) below 0.08, a root mean square error of approximation (RMSEA) of around 0.05, and a comparative fit index (CFI) of around 0.95. In order to ensure measurement invariance in the longitudinal model (i.e. strong factorial invariance), all factor loadings and intercepts of all indicators were set equal across time [54]. In order to identify strain in the longitudinal model, a stepwise procedure [53] was used in which configural invariance (i.e. equal form) was tested, followed by a test for metric invariance (i.e. equal loadings), and finally a test for strong factorial invariance (i.e. equal intercepts). As additional constraints were added in this stepwise procedure (equal loadings, equal intercepts), good model fit was indicated by a fit index at approximately the same level. The Δ CFI value was used because of its independence of both model complexity and sample size. A Δ CFI value smaller than – 0.010 indicates that the null hypothesis of invariance should not be rejected [55].

In order to examine which of the socialization variables had an effect on levels of symptoms of burnout at each point in time, we added time-variant predictors to the latent growth model to predict both concurrent and future levels of the outcome variable (see Fig. 2 for an illustration of how time-variant predictors were added to the latent growth model). Of all the parameters illustrated in Fig. 2, only the parameter estimates related to the cross-sectional relations at the first year in the profession and those related to the changes between year one and year two and three respectively will be presented in the Results section (see relations I, II, and III in Fig. 2). The parameter estimates of relation I will be interpreted as cross-sectional relations between the socialization variables and symptoms of burnout. The parameter estimates of relation II will be interpreted as reflecting relations between changes in the socialization variables between the first and second year of clinical practice and the changes in symptoms of burnout between the first and second year of clinical practice (controlling for a general linear change in symptoms of burnout and levels at year one). The parameter estimates of relation III will be interpreted in the same way as the parameter estimates of relation II, but now addressing change between the first and third year of practice.

Fig.2

Latent growth model with time-variant predictors of relations I, II and III. Note: Y = year in clinical practice; I = relation I (cross-sectional relations between socialization variables and symptoms of burnout at the first year of clinical practice); II = relation II (relations between changes in the socialization variables between the first and second year of clinical practice and change in symptoms of burnout during the first and second year of clinical practice); III = relation III (relations between changes in the socialization variables between the first and third year of clinical practice and change in symptoms of burnout during the first and third year of clinical practice).

3 Results

Over the first three years of clinical practice, the new nurses experienced a statistically significant increase in symptoms of burnout (slope = 0.027, p = 0.009). The model fit of the longitudinal model (imposing strong factorial invariance) was good and fit indices were at approximately the same levels as for less restricted measurement models. The fit indices are presented in Table 2.

Table 2
Model fit for measurement invariance and longitudinal models

χ ² df RMSEA CFI SRMR

Models

Burnout (equal form) 29.11 15 0.03 0.99 0.02

Burnout (equal loadings) 31.21 19 0.02 0.99 0.02

Burnout (equal intercepts) 55.45 24 0.03 0.99 0.02

Model with time-variant predictors (see Fig. 2) 369.11 108 0.05 0.95 0.03

	χ ²	df	RMSEA	CFI	SRMR
Burnout (equal form)	29.11	15	0.03	0.99	0.02
Burnout (equal loadings)	31.21	19	0.02	0.99	0.02
Burnout (equal intercepts)	55.45	24	0.03	0.99	0.02
Model with time-variant predictors (see Fig. 2)	369.11	108	0.05	0.95	0.03

Note: χ2 = chi-square statistics; df = degrees of freedom; RMSEA = root mean square error of approximation; CFI = comparative fit index; SRMR = standardized root mean square residual.

The first set of results concerned the relationships (cross-sectional) between the socialization variables role clarity, social acceptance, and task mastery, and the outcome symptoms of burnout. The higher the participants’ levels of role clarity, co-worker- and leadership support, and task mastery one year into the profession, the lower their levels of symptoms of burnout were. The new nurses’ experiences of task mastery and leadership support were most strongly related to their experience of symptoms of burnout. The standardized parameter estimates are presented in Table 3.

Table 3

Cross-sectional and longitudinal relations between socialization variables and symptoms of burnout

	Standardized parameter estimates of relations I– III
Predictors	I	II	III
Role clarity	– 0.09^*	– 0.22^***	– 0.02
Leadership support	– 0.23^***	– 0.17^***	– 0.16^***
Co-worker support	– 0.12^***	– 0.10^**	– 0.09^*
Task mastery	– 0.35^***	– 0.23^***	– 0.23^***

Note: Y = year in clinical practice. I = relation I (cross-sectional relations between socialization variables and symptoms of burnout at the first year of clinical practice); II = relation II (relations between changes in the socialization variables between the first and second year of clinical practice and change in symptoms of burnout during the first and second year of clinical practice); III = relation III (relations between changes in the socialization variables between the first and third year of clinical practice and change in symptoms of burnout during the first and third year of clinical practice). ^*p < 0.05; ^**p < 0.01; ^***p < 0.001.

The second set of results concerned the relationship between changes in role clarity, social acceptance, and task mastery between the first and second year of clinical practice and changes in symptoms of burnout between the first and second year of clinical practice. Increasing levels of role clarity, support from co-workers and leadership, and task mastery were related to decreasing levels of symptoms of burnout from year one to year two in clinical practice. Looking at the relative importance of the socialization variables, increases in the new nurses’ experiences of task mastery and role clarity were most strongly related to decreases in their experiences of symptoms of burnout. The results are presented in Table 3.

The third and final set of results concerned the relationships of change in the socialization variables and symptoms of burnout from the first to the third year of clinical practice. Increasing levels of task mastery, leadership support, and collegial support (in order of relative strength) were still related to decreasing levels of symptoms of burnout from year one to year three. However, change in role clarity was not related to change in symptoms of burnout during the same period. The results are presented in Table 3.

4 Discussion

Although it is greatly recognized that transitioning into a new profession is a stressful experience, the relationships between the socialization processes task mastery, role clarity, and social acceptance and symptoms of burnout have not previously been thoroughly investigated [17 , 35]. Understanding the relationships between these processes and symptoms of burnout may contribute to the development of interventions that may be included in transition-to-practice programs to prevent symptoms of burnout among new professionals. Therefore, with this study we sought to investigate the relations between role clarity, social acceptance, task mastery, and symptoms of burnout the first year after professional entry, as well as the relations between changes in the socialization processes and changes in symptoms of burnout during the first three years following professional entry. We conducted our investigations using a sample of newly registered nurses, a group known to experience high levels of symptoms of burnout [3 , 10].

We found that the socialization processes could explain new nurses’ experiences of symptoms of burnout during the first year of clinical practice. New nurses who had realized higher levels of task mastery, role clarity, and social acceptance during their first professional year experienced lower levels of symptoms of burnout. In addition, the longitudinal analysis showed that increasing levels of the socialization processes during the first three years of clinical practice were related to decreasing levels of symptoms of burnout during the same period. These results are in line with and expand previous results showing that role clarity, social acceptance, and task mastery affect new nurses’ experiences of stress week-by-week during the first professional months [68]. Thus, the results suggest that the socialization processes are suitable targets for an intervention aiming to prevent symptoms of burnout among new nurses.

Task mastery was the most important explanatory variable for symptoms of burnout both cross-sectionally and longitudinally. This finding seems valid as symptoms of burnout are the consequence of repeated or prolonged activation of the stress response, the stress response is activated when there is a perceived mismatch between demands and capabilities [26], and task mastery refers to one’s perceived ability to manage challenging situations [30, 43]. This result is in line with previous studies suggesting that perceived lack of competence in managing responsibilities is a major source of stress for new nurses [2 , 56–59] as well as research showing that exposure to high demands is a risk factor for developing symptoms of burnout [28]. Thus, to reduce the risk of symptoms of burnout among new nurses, it is particularly important to support the development of task mastery during the first professional years. Organizations who wish to do so may benefit from making sure that their new employees enjoy enactive mastery experiences, have access to successful co-worker models, and receive encouraging performance feedback [30]. In addition, perceived ability to successfully manage challenging tasks is not merely dependent on actual competencies but also on the performance expectations. This supports previous propositions that nurses should be considered as novices for at least their first 12 months of practice [57], and not be expected to function as experienced nurses before they have been given the opportunity to develop the skills and knowledge needed to do so.

Recently there has been an increased focus on individual-level antecedents of newcomers’ socialization (e.g. [60]). Looking at newcomers’ information seeking behaviors as an individual-level antecedent, appraisal information (i.e. information on how well one is functioning/performing in relation to one’s requirements) was found to be the most important kind of information sought by newcomers and in fact the strongest predictor of newcomer adjustment [32]. Based on this, Bauer et al. [32] proposed that newcomers should be encouraged to seek information about how they are doing, and if they could do something differently to develop further. This information-seeking behavior is typically included in a class of behaviors called proactive behaviors (e.g. [32 , 62]). Proactive behavior has been found to be a stronger predictor of newcomer learning than organizational antecedents [63]. Other proactive behaviors found to be important for the socialization of new professionals are behaviors such as monitoring and imitating the behaviors of experienced colleagues, and practicing new skills [61]. These behaviors are important to develop task mastery [30]. Thus, supporting new nurses’ engagement in proactive behaviors early on in the profession may be an additional strategy to strengthen task mastery and reduce the risk of symptoms of burnout in this professional group.

The measure of leadership support was the second most important explanatory variable for new nurses’ experiences of symptoms of burnout one year into the profession, and more important than support from co-workers. This too is in line with previous research showing that a supportive work environment protects against developing symptoms of burnout [28]. It has been suggested that the majority of socialization occurs through interactions between the newcomer and the experienced members of the organization, and that more research is needed to investigate what it is that insiders do to facilitate the socialization of new employees [60]. In line with this suggestion, we included two measures that focused on the support provided by the managers and the co-workers separately. The results indicate that, to reduce the risk of symptoms of burnout among new nurses, it is particularly important to strengthen support provided by managers. This is in line with previous findings showing that if new professionals’ social networks include supervisors as well as peers, learning that is central to becoming established in a new professional role is positively affected [64].

Change in role clarity from year one to year three of the profession was not related to change in symptoms of burnout during the same period. We were surprised by this result as role clarity has consistently been included in organizational stress models such as the job-demands resources model [47] and the job-strain model [65] over decades of research, and job control (a construct closely related to role clarity), was found to be related to the risk of developing symptoms of burnout in a recent meta-analysis [28]. In addition, role clarity was related to experiences of stress in Frögéli, Rudman, & Gustavsson (2019). It is possible that this non-significant result reflects a ceiling effect.

Together with the results from Frögéli, Rudman, & Gustavsson (2019), the results of this study indicate that role clarity, social acceptance, and task mastery influence both the short term experience of stress, as well as the longer term risk of developing symptoms of burnout. These findings support the suggestions that symptoms of burnout result from over-activation of the stress response [26]. In Frögéli, Rudman, & Gustavsson (2019), we suggested that stress among new professionals during the transition into a new profession could be reduced by supporting the development of the socialization processes. The results from this study support this suggestion and furthermore suggest that such interventions targeting task mastery, social acceptance, and role clarity during the first professional year may be expected to have effects during the following years as well, not only by reducing experiences of stress but also by reducing symptoms of burnout. This finding extends the value and importance of such interventions.

4.1 Methodological discussion

Role clarity, task mastery, and social acceptance are well established as mediators of socialization within a range of professions [31, 32], and high levels of stress are seen in the general population of new professionals [1]. Therefore, it seems likely that the findings of this study would be generalizable beyond the nursing profession.

This kind of periodic survey may be susceptible to single events that cause a responder to answer in a way during a particular point in time that happens to be an outlier in relation to other points in time. If the frequency of data collection is low, the outlier will not be detected [66].

This study included a nationally representative sample of new nurses, data was longitudinal, and there was no strong attrition bias. The statistical analysis employed, in which all predictor variables are entered into the model at the same time, has the benefit that the relative strength of the variables may be studied. However, it is important to recognize that the standardized parameter estimates presented for each variable is the estimate for the effect of that variable when controlling for the other variables. This means that a variable that may be a statistically significant explanatory variable on its own is not recognized as statistically significant in the model as more of the variance in the outcome is explained by other variables. This does not mean that the variable is not important; it just means that it is less important than one (or some) of the other variables.

Whether changes in the socialization processes cause changes in symptoms of burnout, or changes in symptoms of burnout cause changes in the socialization processes cannot be decided based on the results of this study. The first scenario is typically highlighted in the socialization literature [17], but is has also been suggested that low levels of energy (a typical symptom of symptoms of burnout) hinders engagement in behaviors that are assumed to contribute to the development of role clarity, social acceptance, and task mastery [67]. A bidirectional model is perhaps the most ecologically valid. Finally, as this study only included self-reported data, it is possible that the effects are overestimated.

4.2 Conclusions

We found that task mastery, role clarity, and social acceptance affect the risk of developing symptoms of burnout during the first three years following a professional transition. The results suggest that an intervention designed to support the development of these socialization processes may be effective in preventing symptoms of burnout among new nurses. Supporting the development of task mastery and leadership support seems to be of particular importance as these processes were the strongest explanatory variables.

Conflict of interest

None to report.

Footnotes

Acknowledgments

The authors acknowledge the participating nurses and AFA Insurance supporting this research [grant number 070106; 140007].

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