Applied Nursing Research 31 (2016) 41–45

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Applied Nursing Research

journal homepage: www.elsevier.com/locate/apnr

Structural empowerment, job stress and burnout of nurses in China☆

Jiajia Guo, MD a, Juan Chen, MD b, Jie Fu, MD c, Xinling Ge, MD d, Min Chen, MD e, Yanhui Liu, PhD f,⁎
a
Lianyungang Higher Vocational College of Traditional Chinese Medicine, Lianyungang, China
b
Lianyungang Higher Vocational College of Traditional Chinese Medicine, Lianyungang, China
c
Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, China
d
Lianyungang Higher Vocational College of Traditional Chinese Medicine, Lianyungang, China
e
Lianyungang Higher Vocational College of Traditional Chinese Medicine, Lianyungang, China
f
School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: To investigate the status of structural empowerment, job stress and burnout in China, and to explore the
Received 5 March 2015 relationships among them.
Revised 27 August 2015 Methods: The questionnaires of CWEQ-II, job stressors and MBI were used to investigate 1002 nurses working at
Accepted 2 December 2015 tertiary-level hospitals.
Available online xxxx
Results: The average score of CWEQ-II was 2.23 ± 0.59. The score of EE of MBI was 29.75 ± 13.94, PA was 27.40 ±
11.21, both of them showed a high level of exhaustion, DP was 8.07 ± 5.82 and showed a middle level of exhaus-
Keywords:
Structural empowerment
tion. The findings showed that workload and time pressure were the most frequently encountered job stress
Job stressors among staff nurses, the score was 3.23 ± 0.95; There was a significantly correlation among structural empower-
Burnout ment, job stressors and the level of burnout(p b 0.05). Hierarchical regression analysis showed that structural
Nurses empowerment had significant influence on the every factors of job stressors (p b 0.05) and burnout, job stressors
had significant influence on the every factors of burnout (p b 0.05). Structural equation modeling analyses re-
vealed a good fit to the data based on various fit indices (χ2/df = 2.29, GFI = 0.945, CFI = 0.965, IFI = 0.966,
RMSEA = 0.061). Staff nurses felt that structural empowerment in their workplace resulted in lower levels of
job stress which in turn strongly influenced Burnout.
Conclusions: These results provide initial support for an expanded model of structural empowerment, and offer a
broader understanding of the empowerment process.
© 2016 Elsevier Inc. All rights reserved.

1. Introduction
The shortage of nurses the largest group in hospital settings is partic-
ularly acute. According to Anonymous (2006), there is a shortage of 4.3
million healthcare workers worldwide, which is expected to increase by
20% in the next two decades. China is contending with a very serious
nursing shortage compared to many other countries. The nature of
nursing work environments is believed to contribute substantially to
the current nursing shortage (Buerhaus, Staiger, & Auerbach, 2000).
When the environments are structured so that employees feel
empowered, they respond accordingly and rise to the challenges pres-
ent in their organization. Kanter (Kanter, 1977) argues that people
react rationally to the situation in which they find themselves. Kanter
(1979) stated that, if work environments can provide access to informa-
tion, support, resources necessary to do the job, and the opportunity to
learn and develop, they are empowering. Access to these empowering
structures is influenced by formal and informal power systems within
☆ Conflict of Interest: The authors declare that they have no conflict of interests.
⁎ Corresponding author. Tel.: +86 22 59596240.
E-mail address: yh_liu888@163.com (Y. Liu).
the organization. Formal power which can be enhanced when jobs are
flexible, central to the organizational goals, and allow the flexibility
comes from workplace positions that are visible and essential to achiev-
ing organizational goals. Informal power refers to the development of
effective relationships with superiors, peers and subordinates within
the organization. According to Kanter (1979), when the situations are
structured so that employees feel empowered, the organization benefits
in terms of improved employee attitudes and increased organizational
effectiveness. There are a lot of literatures about the positive effect of
structural empowerment, such as work effectiveness (Laschinger,
Wilk, & Greco, 2009), job satisfaction (Chunfeng & Zongkai, 2009), orga-
nization commitment (Jiajia, Yanhui, Hailin, & Chunling, 2011), self-
efficacy (Chunping, Yanhui, & Yin, 2011), autonomy (Laschinger &
Finegan, 2005). The ameliorating effects of structural empowerment
on outcomes, such as burnout (Greco, Laschinger, & Wong, 2006) and
job strain (Li, 2007) have also been mentioned in the nursing literature.
Burnout is a common phenomenon in nursing and other health pro-
fessions. According to Maslach (1982) burnout is a phenomenon in
which the cumulative effects of a stressful work environment gradually
overwhelm the defenses of staff members, forcing them to withdraw
psychologically. Burnout results in chronic emotional exhaustion

http://dx.doi.org/10.1016/j.apnr.2015.12.007
0897-1897/© 2016 Elsevier Inc. All rights reserved.
42 J. Guo et al. / Applied Nursing Research 31 (2016) 41–45
(overextended and exhausted by one's work), depersonalization (un-
feeling and impersonal approach towards recipients of one's care),
and personal accomplishment (competence and successful achieve-
ments in one's work). It is a malady that spreads gradually and contin-
uously over time, putting people into a downward spiral from which
it is hard to recover. Burnout has been studied extensively in nursing
settings. Nurses' burnout results in low level of patient satisfaction
and staff nurse job satisfaction (Aiken, Clarke, Sloane, Sochalski, & Silber,
2002; Doris, Aiken, Sloane, et al., 2004). Aiken et al. (2002) showed that
the level of nurse burnout was influenced by work environment which
provided good relationships among the peers and leaders, and job au-
tonomy. Garrosa, Bernardo, & Lianq (2008) found that work stress
could significantly predict nurse burnout.
Seyle (1965) defined stress as a consequence of the interaction be-
tween the stimulus and the response. A lot of sources lead to job stress
in nursing work environment, such as workload, work environment,
and the relationships between the colleges and soon. Job stress is
most likely to occur when there is a poor fit between workers and
work environment (Garrosa et al., 2008; Margolus & Kroes, 1974). Job
stress had a negative impact on both the nurse and the patient. When
individuals cannot deal effectively with the effects of stress, lots of neg-
ative effects appear, such as burnout, more workers' compensation
claims, low work satisfaction, conflict and violence and so on (Garrosa
et al., 2008; Gordon, 1991). If the job stress cannot be handled in time,
the level of patient care satisfaction would decrease.
In recent years, a lot of research studies have been conducted on
work-related factors in China, such as job burnout, job stresses, self-
esteem, job satisfaction, turnover intention, job control, and social sup-
port among nurses. The results revealed that nurses in China experience
a high level of job stress and burnout. However, the number of studies
about the relationship between nurses' perceptions of empowerment
and job stress, and burnout has been limited. Therefore, the aim of
this study was to examine structural empowerment, job stress, and
burnout among Chinese clinical nurses. This study will help to inform
Chinese health administrators, government officials and educators, re-
garding the importance of providing an effective work environment
for clinical nurses.
1.1. Research questions
It is important to investigate whether or not Kanter's theory is gen-
eralizable to other populations of nurses in other countries, the follow-
ing research questions were proposed: (1) What is the level of
Hypothesized mode to be tested
Structural
empowerment
Job stress
Methods
Sample
Fig. 1. Hypothesized mode to be tested.
structural empowerment, job stress and burnout perceived by Chinese
nurses? (2) What are the relationships among structural empower-
ment, job stress and burnout among Chinese nurses? We hypothesized
that structural empowerment would have a direct effect on job stress,
which in turn would have a direct effect on burnout (Fig. 1).
2. Methods
2.1. Sample
This study used a convenience sample that consisted of nurses work-
ing in ten teaching hospitals that were located in Beijing, Tianjin, Shang-
hai, Hangzhou, Changsha, Chongqing of China (n = 1080). The hospitals
are categorized as tertiary first-class hospitals, the highest rank in the
Chinese health-care system. Following ethical approval, the nursing
staff received a questionnaire through the hospital mail. A reminder let-
ter was sent three weeks following the initial survey package. Question-
naires were completed and returned by 1002 nurses, representing a
response rate of 92.8%. We focused on this sample in this study. Partic-
ipants were all female, and most were baccalaureate (94.6%), with an
average age of 30.21 years (SD = 6.38) and the mean number of years
of nursing experience was 9.48(SD = 3.99). All the units the nurses re-
ported working had similar organizational structures and all the partic-
ipants were responsible for direct care.
2.2. Instruments
Structural empowerment was measured by the Conditions for Work
Effectiveness-II (CWEQ-II) (Laschinger, Finegan, & Shamian, 2001). The
CWEQ-II which consists of 19 items measures nurses' perception of
their access to work empowerment structures described by Kanter (in-
formation, support, resources, opportunity, formal and informal
power). The items are rated on a 5-point Likert scale. The subscale
was obtained by summing and averaging the items which create scores
ranging from 1 to 5. An overall empowerment scale was created by av-
eraging the 6 subscales (range: 1–5). A higher score indicates greater
perceived structural empowerment. The Cronbach's alpha reliability co-
efficients from previous studies ranged from 0.79 to 0.82. In the present
study, the Cronbach's alpha reliability coefficients for the six subscales
and total-item ranged from 0.72 to 0.91. The item-total correlations
ranging from r = 0.74 to r = 0.82. A two-item global empowerment
scale, which is used for validation purposes, correlated positively with
Emotional
Exhaustion
Depersonaliz
Burnout -ation
Personal
Accomplish-
ment
 J. Guo et al. / Applied Nursing Research 31 (2016) 41–45 43

the CWEQ-II (r = 0.55), supporting the construct validity of this Table 1

instrument. Means and standard deviations for major study variables (N = 1002).

The MBI was used to measure the burnout (Maslach & Jackson, Score range Mean SD
1986). It consists of 22 self-descriptive statements which measure Total structural empowerment 1–5 2.23 0.59
three aspects of burnout: emotional exhaustion (EE), depersonalization Support power 1–5 2.40 0.77
(DP) and decreased personal accomplishment (PA). Items are rated on a Opportunity power 1–5 2.39 0.72
7-point Likert scale ranging from 0 (never) to 6 (every day). Each sub- Resource power 1–5 2.33 0.77
Information power 1–5 2.04 0.78
scale was obtained by summing the items (the range of EE which con-
Informal power 1–5 2.23 0.66
sists of 9 items is 0–54, the range of DP which consists of 5 items is Formal power 1–5 1.92 0.76
0–30, the range of PA which consists of 8 items is 0–48). High scores Burnout
in the EE or DP scales, or low scores in the PA scale, indicate high levels Total emotional exhaustion 0–54 29.75 13.94
of burnout. Each subscale score can be categorized as low, average or Total depersonalization 0–30 8.07 5.82
Total personal accomplishment 0–48 27.40 11.21
high burnout as defined by normative data. Our study adopted a defini-
Job stressor
tion of burnout used in a recent survey of hospital resident staff in the Nursing work and professional issues 1–5 3.14 0.81
United States: EE N 26 and/or DP N 9 and/or PA b 34 (Shanafelt, Bradley, Work environment and instruments 1–5 3.00 1.08
Wipf, & Back, 2002). In the current study, the Cronbach's alpha reliabil- Patient care 1–5 3.10 0.75
Workload and time distribution 1–5 3.23 0.95
ity coefficient for the EE was 0.74, and DP was 0.82, PA was 0.82.
Collegial nurse–physician work relations 1–5 2.53 0.80
The questionnaire of job stressors was designed by Li & Liu (2000),
which have been widely validated in China. It measures the sources of NOTE: Items of Burnout are rated on a 7-point Likert scale ranging from 0 (never) to 6
(every day). The subscale of Emotional Exhaustion consists of 9 items, the subscale of De-
nurses' stress. It consists of 22 items which measure five aspects of job personalization consists of 5 items, and the subscale of Personal Accomplishment consists
stressors: nursing work and professional issues, work environment of 8 items.
and instruments, patient care, workload and time distribution, collegial
nurse–physician work relationships. Items are rated on a 5-point Likert
scale. High scores in the job stressors questionnaire indicate high levels relatively high levels of EE and PA (mean = 29.75, SD = 13.94, and
of stress. The Cronbach's alpha reliability coefficients for the five sub- mean = 27.40, SD = 11.21, respectively), and moderate level of DP
scales ranged from 0.84 to 0.93. (mean = 8.07, SD = 5.85). In total, 57.1% of participants in high EE
range, 54.3% in high DP range and 42.3% in high PA range. Table 2 pre-
2.3. Statistical analysis sents that the EE, DP, PA experienced by Chinese nurses were signifi-
cantly higher than American nurses [20] (t = 10.14, p b 0.05, t = 3.04,
The Statistical Package for Social Sciences (SPSS) 17.0 was used to p b 0.05, t = −15.26, p b 0.05). Structural empowerment was signifi-
conduct descriptive and inferential statistical analyses. Reliability analy- cantly negatively related to EE and DP(r = − 0.27, p b 0.05, r =
ses (Cronbach's alpha) were conducted for the measures of all the major − 0.35, p b 0.05), and significantly positively to PA (r = 0.38,
study variables. Descriptive statistical analyses were carried out to an- p b 0.05). Each subscale of job stressors was significantly negatively re-
swer the first research question. Pearson's correlation analysis, the hier- lated to structural empowerment (r = −0.35 to −0.47, p b 0.05).
archical multiple linear regression analyses and structural equation The hierarchical multiple linear regression analyses revealed that
modeling were used to answer the second research question. structural empowerment, job stressors explained a significant in
Structural equation modeling AMOS 7.0 statistical program was amount of variance in all three aspects of burnout: EE (R 2 = 33.7;
used to analyze the hypothesized model in this study. Structural equa- p b 0.01), DP (R 2 = 24.3; p b 0.05) and PA (R 2 = 24.2; p b 0.01)
tion modeling (SEM) is a comprehensive approach to testing relations (Table 3). The predictor variables accounted for 33.7% of the variance
among variables. There is little consensus in the SEM literature in EE. Each block of predictors explained a significant amount of vari-
concerning the best index of overall fit for evaluating structural equa- ance: structural empowerment explained 10.3% of the variance when
tion models. Based on Hoyle's recommendations (Hoyle & Panter, entered first, job stressors added a further 23.4% on the second step. In
1998), several criteria were used to evaluate fit of the model. These in- the final model, formal power (β = − 7.42, p b 0.05), workload and
cluded omnibus fit indices such as the chi-square (χ 2) (Joreskog & time distribution (β = 3.92, p b 0.01), and collegial nurse–physician
Sorbom, 1989) and the chi-square/degrees of freedom ratio (χ 2/df) work relations (β = 3.04, p b 0.01) were the strongest predictors of
and incremental fit indices such as the comparative fit index (CFI) EE. The predictor variables accounted for 24.3% of the variance in DP.
(Bentler, 1988), and the incremental fit index (IFI) (Bollen, 1989). In ad- Each block of predictors explained a significant amount of variance:
dition, the root mean square error of approximation (RMSEA) advocat- structural empowerment explained 4.1% of the variance when entered
ed by Browne & Cudeck (1989) was used. The generally agreed upon first, job stressors added a further 20.2% on the second step. In the
critical value for the CFI and IFI is 0.90 or higher. The RMSEA is the stan- final model, support power (β = − 0.62, p b 0.05) and collegial
dardized summary of the average covariance residuals and is thus a nurse–physician work relations (β = 2.93, p b 0.01) were the strongest
measure of the lack of fit between the data and the model. Low values predictors of DP. The predictor variables accounted for 24.2% of the var-
(between 0 and 0.06) indicate a good fitting model. iance in PA. Each block of predictors explained a significant amount of
variance: structural empowerment explained 21.2% of the variance
3. Results when entered first, job stressors added a further 3.0% on the
second step. In the final model, informal power (β = 4.93, p b 0.01)
The means and standard deviations of study variables are presented was the strongest predictors of PA, followed by opportunity
in Table 1. Overall, nurses did not consider their workplace to be highly power (β = −2.13, p b 0.05) and nursing work and professional issues
empowering, they perceived themselves to have a moderate degree of (β = −2.28, p b 0.05).
access to work empowerment structures overall as measured by the An analysis of goodness-of-fit statistics revealed a good fit according
CWEQ-II. Contrary to Italy studies (mean = 2.51, SD = 0.94) were the to standards recommended by Bentler and Bonett (χ2/df = 2.29, GFI =
least empowering conditions in their work settings (mean = 1.92, 0.945, CFI = 0.965, IFI = 0.966, RMSEA = 0.061). Fig. 2 displays the
SD = 0.76, and mean = 2.23, SD = 0.66, respectively). The main standardized parameter estimates for structural part of the model. The
sources of the job stress in this study were nursing work and profession- outcome revealed that structural empowerment had a direct, negative
al issues, workload and time distribution (mean = 3.14, SD = 0.81, effect on the job stressors (B = − 0.17), EE (B = − 0.18), and DP
mean = 3.23, SD = 0.95, respectively). Nurses in this study reported (B = − 0.02), which had direct positive effect on the PA (B = 0.41).
44 J. Guo et al. / Applied Nursing Research 31 (2016) 41–45

Table 2
Burnout of this survey compared with norm of Maslach.

N Emotional exhaustion Depersonalization Personal accomplishment

This survey 1002 29.75 ± 13.93 8.07 ± 5.82 27.40 ± 11.21

Norm of M 1104 22.19 ± 9.53 7.12 ± 5.22 36.54 ± 7.34
t 10.143 3.042 −15.262
P 0.000 0.003 0.000

The job stressors had a direct positive effect on EE (B = 0.49) and DP
(B = 0.34), which had direct negative effect on the PA (B = − 0.11).
Structural empowerment also indirectly forecast EE (B = −0.09), DP
(B = −0.06) and PA (B = 0.02) through the job stressors.
4. Discussion
The total degree of reported structural empowerment in the sample
of our study is thought to be moderate, suggesting that there is still
room for increasing the perceptions of empowerment of nurses. Similar
to previous Chinese findings, the score of information power was lower,
because hospitals in China sustain a more traditional organization that
still maintains a hierarchy of power. This score possibly indicates that
the clinical nurses perceived they knew little about the current state
of the hospital and the values and goals of top management. The respon-
dents reported the lowest score on access to formal power. In China, al-
though everyone has interpersonal relationship networks, they have
limited opportunity to access formal power. Chinese nurses in present
study, the degree of EE and DP were statistically higher than the degree
of those in North American (Maslach & Jackson, 1986), and the degree of
PA was statistically lower. The results suggest that staff nurses in China
experienced higher degree of burnout, which is possible because of
nurses in China undertaking more work because work settings are
short of nurses seriously. In this study, workload and time distribution
is the main source of job stress. According to Yu's study (Yu & Chen,
2007), workload and time distribution is also the main source of job
stress in the ten hospitals in the Sichuan province. The shortage of
nurses the largest group in hospital settings is particularly acute, there-
fore the nurses do not have enough time to perform job tasks. In China,
the public traditionally has viewed nurses as assistants for physicians
and primarily responsible for making beds and giving medication,
which lead to non-nursing work accounted for a lot time of nurses,
such as nursing documents writing, taking medicine for the patient to
the pharmacy, etc.
Perceived access to structural empowerment was significant predic-
tor of nurses' experiences of EE, DP and PA. These findings are consistent
with previous research by Laschinger, Joan, & Piotr (2011) and O’Brien
(2010). Laschinger et al. (2011) found that when nursing staff experi-
enced higher level of empowerment, they had lower level of emotion
exhaustion. The findings strengthen the importance of creating envi-
ronments which provide access to information, resources, support,
and opportunities to learn and develop, which are empowering
structures that enhance employees' power to accomplish work within
an organization.
The results of this study find that empowerment has an impact on
the degree of job stress experienced at work. More specifically, staff
nurses felt that structural empowerment in their workplace resulted
in lower levels of job stress, which is consistent with finding in previous
research in North America (Laschinger et al., 2001). The result hints that
higher levels of empowerment may offset the amount of job stress ex-
perienced by nurses. It is reasonable to expect that when nurses are
empowered fully, job stress will be diminished. Given that job stress
has negative impact on physical, emotional, and behavioral aspects of
employees (e.g., burnout), every effort should be made to minimize
the extent of job stress experienced by nurses.
The research finds that job stress has a positive effect on burnout the
nurses experienced, which is consist with Garrosa's finding. Garrosa
et al. (2008) found a significant positive relationship between job stress
and nurse burnout. It implies that if the level of job stress rise, the level
of burnout enhances too, in contrary, if the degree of job stress con-
tinues to drop, the level of burnout experienced by nurses would dimin-
ish, probably disappear.
Structural empowerment explained 4.1%–21.2% in three dimensions
of burnout. When the variables of structural empowerment were con-
trolled, job stress explained 3%–23.4% in three dimensions of burnout.
The results of this study revealed that job stress played an important
role in the relationship of structural empowerment and the dimensions
of burnout. This suggests that perceived access to structural empower-
ment in the work settings has an impact on the degree of job stress

Table 3
The hierarchical multiple linear regression analyses results for structural empowerment, job stressor and three dimensions of burnout (N = 1002).

Independent variable Dependent variable

Emotional exhaustion Depersonalization Personal accomplishment

Step 1 Step 2 Step 1 Step 2 Step 1 Step 2

Structural empowerment
Opportunity power 2.50 2.21 0.52 0.50 1.26 1.50
Information power −0.36 −1.76 0.99 0.46 −2.27⁎ −2.13⁎
Support power −1.58 −1.50 −0.50 −0.21 3.78⁎ 3.70⁎
Resource power −2.22 −1.87 −1.57⁎ −0.62 1.49 1.32
Informal power 0.20 −0.93 −0.57 −0.77 4.93⁎ 4.93⁎⁎
Formal power −4.00⁎ −7.42⁎ 0.31 −0.30 −1.32 −1.58

Job stressor
Nursing work and professional issue 1.21 0.11 −2.28⁎
Workload and time distribution 3.92⁎⁎ −0.36 0.90
Work environment and instruments −0.90 0.45 0.002
Patient care −2.17 0.38 −1.71
Collegial nurse–physician work relations 3.04⁎ 2.93⁎⁎ 1.59
F 6.54⁎⁎ 15.63⁎⁎ 2.46⁎ 9.86⁎⁎ 15.37⁎⁎ 9.80⁎⁎
R2 0.103 0.337 0.041 0.243 0.212 0.242
⁎ p b 0.05.
⁎⁎ p b 0.01.
 J. Guo et al. / Applied Nursing Research 31 (2016) 41–45
The relationships among structural empowerment,
job stress and burnout
Emotional
-0.18
Exhaustion
Structural
-0.02
empowerment
0.41
Depersonal
-ization
-0.17
0.49
Job stress 0.34 Personal
Accomplis-
-0.11
hment
N 1002, χ2/df 2.29,
GFI 0.945, CFI 0.965
IFI 0.966, RMSEA 0.061
Fig. 2. The relationships among structural empowerment, job stress and burnout.
experienced by nurses, which in turn influences burnout ultimately.
This study supports the results of previous research by Laschinger
et al. (2011) who found that the nurses who experienced higher levels
of empowerment had lower level of emotion exhaustion. This finding
is also consistent with those of Li et al. (2008). Job stress explained al-
most twice as structural empowerment in EE. When nurses are not
empowered enough in work environment, they are not able to partici-
pate in decision making and to control their practice (Kanter's concept
of structural empowerment), job strain occurs, which in turn leads to
EE when it is not handled in time by nurses' managers. EE is the core el-
ement of burnout, which results in DP and PA. The result showed that
formal power, workload and time distribution, and collegial nurse–
physician work relations were the strongest predictors of EE. Nurse'
managers should make every intervention measures to maximize the
degree of formal power, minimize the level of workload and maintain
harmonious work relationships. Support power and collegial nurse–
physician work relations were the strongest predictors of DP. If the
leaders in hospital settings provide the relevant information and advice
which is necessary to work to staff nurses, and construct harmonious
work relationships, the level of DP would be eased. Informal power
was the strongest predictors of PA. The result hints that effective rela-
tionships with superiors, peers and subordinates within the organiza-
tion can reduce the level of PA.
5. Limitations
Given the cross-sectional nature of this study, the findings must be
viewed with caution. The limitations of this study are the limited geo-
graphical distribution, the size of the sample and the type of data collec-
tion. The instruments used in the study were developed by researchers
from a Western culture. Even though these instruments were found to
have good reliability for this study, one still wonders if the instruments
were suitable for Chinese participants. Nevertheless, we think that our
results are noteworthy and provide challenges for future research and
cross-validation in different settings.
6. Conclusions and implications for nursing
The results suggest that working in environment that empowers
nurses to practice according to professional standards and that also
has lower level of job stress may protect nurses from burning out in
work settings, which provides further support for Kanter's theory. By
linking the structural empowerment with job stress, we gain a broader
understanding of how these structural organizational factors influence
45
employees' feelings of burnout. Given the current workforce shortage
in health care, every effort must be made to create and maintain healthy
work conditions for nurses to ease the level of job stress and burnout.
Acknowledgments
The authors would like to thank the 1002 nurses who participated in
this study.
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