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Int J Nurs Stud. 2009 July ; 46(7): 894–902. doi:10.1016/j.ijnurstu.2009.03.004.

Factor structure of the Maslach Burnout Inventory: An analysis of


data from large scale cross-sectional surveys of nurses from eight
countries

Lusine Poghosyan, PhD, MPH, RN,


Assistant Professor of Nursing and Public Health, Bouve’ College of Health Sciences, School of
Nursing and School of Health Professions/Masters of Public Health (MPH), Northeastern University,
USA
Linda H. Aiken, Ph.D., FAAN, FRCN, and
The Claire M. Fagin Leadership Professor of Nursing, Professor of Sociology, Director, Center for
Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, USA
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Douglas M Sloane, PhD


Adjunct Professor, Center for Health Outcomes and Policy Research, School of Nursing, University
of Pennsylvania, USA

Statement
What is already known about the topic?
• Burnout is a global nursing workforce challenge that undermines nurse retention.
• Maslach Burnout Inventory is the most widely used instrument by researchers to
measure burnout.
• Maslach Burnout Inventory performs well in U.S. studies.

What this paper adds?


• Factor analysis of nurse surveys from 8 countries demonstrated that 22-item MBI has
a similar factorial structure across countries with differently organized and financed
health systems and different languages.
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• Evidence that the Maslach Burnout Inventory can be used with confidence to study
the correlates of nurse burnout globally.

Introduction and Background


Investigations of nurse burnout are highly relevant given the global shortage of nurses and the
need to retain qualified nurses in clinical care roles (Aiken, Buchan, Sochalski, Nichols, &
Powell, 2004). Additionally nurse burnout has been associated with patient dissatisfaction and
other measures of deficient care quality (Vahey, Aiken, Sloane, Clarke, & Vargas, 2004).

103 Robinson Hall, 360 Huntington Avenue, Boston, Massachusetts 02115-5000, Email: E-mail: l.poghosyan@neu.edu, Phone:
617.373.4966, Fax: 617.373.8675.
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Burnout was first introduced into the literature by Freudenberger in the early 1970s
(Freudenberger, 1974). He defined burnout as a state of fatigue or frustration that resulted from
professional relationships that failed to produce the expected rewards (Freudenberger, 1974;
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Freudenberger & Richelson, 1980). Maslach (1982) later defined burnout as a psychological
syndrome involving emotional exhaustion, depersonalization, and a diminished sense of
personal accomplishment that occurred among various professionals who work with other
people in challenging situations. In Maslach’s view, burnout undermines the care and
professional attention given to clients of human service professionals such as teachers, police
officers, lawyers, nurses, and others (Maslach, 1982).

There is no consensus on the measurement of burnout. The Maslach Burnout Inventory (MBI)
(Maslach & Jackson, 1981a) is the most commonly used instrument for measuring burnout.
The Maslach Burnout Inventory captures three dimensions of burnout: emotional exhaustion
(EE), depersonalization (DP), and personal accomplishment (PA). Maslach’s team
demonstrated, using data from U.S. samples that the subscales have good psychometric
properties (Maslach & Jackson, 1981a). Other researchers have added to the evidence
confirming the MBI as a useful tool for research (Greenglass, Burke, & Fiksenbaum, 2001;
Hastings, Horne, & Mitchell, 2004), and supporting the three dimensionality of the MBI (Evans
& Fischer, 1993). However, some researchers have conceptualized burnout as having a two-
factor structure that includes only the emotional exhaustion and depersonalization attributes
(Kalliath, O’Driscoll, Gillespie, & Bluedorn, 2000). Some have suggested viewing it as a
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unidimensional phenomenon (Brenninkmeijer & VanYperen, 2003; Halbesleben & Buckley,


2004). Still others have relied solely on the emotional exhaustion subscale of the MBI because
of its strong predictive properties (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Aiken &
Sloane, 1997).

Given the lack of consensus about the measurement of burnout in the U.S. where the MBI was
developed, it is not surprising that measurement issues are of even greater concern in
international research. Researchers have expressed concerns about the existence of burnout in
countries with different work environments and organizational structures, and about the ability
of research instruments generally and the MBI in particular to capture burnout in those settings.

International studies of burnout have included both single-country samples (Kanste, Miettunen,
& Kyngäs, 2006; Langballe, Falkum, Innstrand, & Aasland, 2006) and, in a few cases, multi-
country samples (Aiken et al., 2001; Perrewe et al., 2002). These studies have often used
different instruments to measure burnout and neglected to investigate the performance of those
instruments in the context of the countries. In some cases, the studies have lacked representative
samples of nurses, and some of the multi-country studies used data derived using decidedly
different research protocols. Moreover, several researchers have demonstrated that some of
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the items included in the MBI subscales fail to measure the latent construct and yield low
loadings on the factors or cross-load on more than one factor (Byrne, 1991; Koeske & Koeske,
1989), while others have demonstrated different (and better) item loadings (Higashiguchi et
al., 1999) and factor structures altogether (Schmitz, Neumannb, & Oppermannb, 2000).

A recent meta-analysis looked at 45 studies that explored the factorial structure of the MBI
(Worley, Vassar, Wheeler, & Barnes, 2008). Only 5 of these 45 studies used samples of nurses,
mainly in English speaking countries, and in some of these studies the samples included other
professionals as well. The sample sizes in most studies were less than optimal for conducting
factor analysis, and in some of the larger sample studies certain items were removed from the
MBI. Comrey and Lee (1992) suggest the sample size for factor analysis equal to 300 is good,
500 is very good, and 1,000 is excellent. Taking into account that the interpretation of the three
dimensions of the MBI is different for nurses than for other professionals (Vanheule, Rosseel,
& Vlerick, 2007), the small sample sizes of most studies, and the lack of studies using

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representative international samples of nurses, the evidence is limited and somewhat


ambiguous regarding the performance of the MBI among nurses internationally.
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This study investigates the factorial structure of the full MBI among large representative
samples of nurses from eight countries, including English and non-English speaking countries,
and provides evidence regarding the utility of the MBI in cross-national burnout research. The
development of a strong instrument should help to advance burnout research and contribute to
the design of successful interventions to reduce nurse burnout.

Burnout Measurement
While burnout measures have been developed by other researchers, including the Burnout
Measure (BM) (Pines & Aronson, 1981) and the Copenhagen Burnout Inventory (CBI)
(Kristensen, Borritz, Villadsen, & Christensen, 2005), the MBI is the most widely used
instrument by researchers. The development of the MBI was based on early research by
Maslach and Jackson, who conducted interviews and surveys among various professionals.
Those interviews served as a basis for three-subscale MBI. Maslach and Jackson investigated
the performance of the three MBI subscales and demonstrated that they had good psychometric
properties; Cronbach’s alpha for all three subscales were above 0.7. Also, they established the
convergent validity of the MBI by correlating individual MBI scores with: 1) measures of
various outcomes, such as job dissatisfaction, that were hypothesized to be related to burnout
subscales; 2) job characteristics that were expected to contribute to the development of burnout
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such as difficult workloads; and 3) behavioral ratings provided by other persons who knew the
individuals scored very well (e.g. spouses and co-workers). All correlations provided evidence
about the validity of the MBI and its dimensions (1981b).

A review of 34 burnout studies by Hwang and colleagues (2003) concluded that even though
all three factors of the MBI have not been replicated exactly across studies, there was
considerable evidence that the MBI is a useful tool across a wide range of occupations,
languages, and countries. The studies reviewed were conducted by many different researchers
using differing research protocols and study designs. The unique advantage of this study is that
it explores the factorial structure and performance of the MBI using a common investigator
and instrument in eight countries, thus adding new knowledge regarding burnout measurement
cross-nationally.

Purpose of the study


The purpose of this study was to investigate the performance of the items and the subscales of
the Maslach Burnout Inventory (MBI) by validating its factorial structure and investigating the
reliability of the subscales in the eight countries for which we had samples of nurses. Our results
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should help future researchers to know whether the MBI is an equally valid and reliable measure
of the different dimensions of burnout in different countries and whether cross-national
comparisons are possible using the MBI.

Methods
Parent studies
This investigation was conducted using data from the International Hospital Outcomes Study
(Aiken, Clarke, & Sloane, 2002). In 1998–1999, the study was conducted among nurses in four
countries (the U.S., Canada, the U.K., and Germany) (Aiken et al., 2001); in 2001 it was
replicated in New Zealand (Finlayson, Aiken, & Nakarada-Kordic, 2007); in 2002 it was
replicated in Russia and Armenia (Aiken, 2005; Aiken & Poghosyan, 2009); and in 2005 it
was replicated in Japan (Kanai-Pak, Aiken, Sloane, & Poghosyan, 2008). The response rates
for nurses surveyed in the original four countries in 1998–99 ranged from 42 percent to 53

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percent. The response rates in the replications were 37% in New Zealand, 75% in Russia, 100%
in Armenia, and 84% in Japan.
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In the U.S., a 50 percent sample of registered nurses who were licensed in and residents of the
state of Pennsylvania were surveyed. The respondents included over 13,000 nurses employed
in 209 adult acute care hospitals. In Canada, nurses working in all adult acute care hospitals in
three provinces (Ontario, Alberta, British Columbia) were surveyed and respondents ultimately
included over 17,000 nurses in 303 different hospitals (the complete census of registered nurses
working in adult acute care hospitals in Alberta was surveyed, while in British Columbia and
Ontario representative samples from nurses working in acute care hospitals were drawn). In
the U.K. and Germany, hospitals were asked to provide the lists of nurses employed at the
hospitals, and all nurses in those lists were surveyed. In the U.K. 9,855 nurses from 63 hospitals
and in Germany 2,681 nurses from 29 hospitals responded to the survey. In those countries
questionnaires were distributed to all nurses on the units of the participating hospitals, and
nurses returned them to the research team after completion.

In New Zealand nurses working in 19 publicly-funded non-specialty hospitals were surveyed.


The surveys in these countries were conducted following a modified Dillman (1978) approach
to mail surveys. The surveys were mailed to nurses with envelopes for returning the completed
questionnaires, and surveys were returned by 4,799 nurses in the 19 hospitals. In Japan, 19
hospitals participated in the survey in 2005 (Kanai-Pak et al., 2008). The nursing directors of
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the hospitals were contacted about the study. After receiving the approval and the agreement
of the nursing directors, nurses in participating hospitals were surveyed. The questionnaires
along with a cover letter were distributed to each nurse in their units. The nurses were instructed
to complete the questionnaires in private and return them in the special box on each unit, and
5,956 surveys were completed by the nurses in these hospitals.

In the decidedly smaller replication in 2002 of the International Hospital Outcomes Study in
Armenia and Russia, two hospitals in each country known for having more advanced
professional nursing were selected to participate (Aiken & Poghosyan, 2009). Overall 840
nurses participated in the study from these four hospitals.

In all countries, studies utilized virtually the same questionnaire. Translations of the
questionnaire wording to languages other than English were back-translated and carefully
checked for differences in meaning. There were, however, some variations in the data collection
procedures-- in some countries, the data collection took place in hospital settings while in other
countries nurses had the surveys mailed to their homes—and some differences in response
might result from these differences in procedures. After comparing the original and translated
versions of the instruments they were pilot-tested for final revisions.
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Participants
In this study we restrict our attention to nurses working in adult general hospitals. The final
sample of nurses for the analyses described below included 54,738 nurses in 646 hospitals in
the eight countries. Selected characteristics of the nurse samples in the different countries are
presented in Table 1. The mean age of the nurses in Japan (29.2 years) was somewhat younger
than in the other countries, where it ranged from roughly 34 to 42 years, and their experience,
or number of years in nursing, was decidedly less-- about 7 years in Japan vs. 11 to 18 years
in the other countries. While females predominated in all samples of nurses, the percentage of
male nurses varied considerably across countries, from only 1 percent in Russia and Armenia
to 8 percent in the U.K. and 15 percent in Germany. No question about nurse education was
included in the surveys of Russian and Armenian nurses, but in the other countries educational
credentials do differ markedly, at least in the sense that while only between 10 and 20 percent

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of the nurses from Canada, the U.K., Germany and Japan were educated in university settings,
the same was true of more than a third of the nurses in the U.S. and New Zealand.
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Measurement
Burnout was measured using the emotional exhaustion (EE), depersonalization (DP) and
personal accomplishment (PA) subscales that are parts of the 22-item MBI (Maslach &
Jackson, 1981a). The EE subscale describes feelings of being emotionally exhausted because
of the work and contains nine items. The PA subscale contains eight items that describe beliefs
of competence and successful achievement at work. The DP subscale describes detached and
impersonal treatment of patients and consists of five items. Each of the 22 items asks nurses
to describe their feelings on a 7-point scale, ranging from never having those feelings to having
those feelings a few times a week.

Statistical methods and data analysis


This study used both confirmatory and exploratory factor analysis to investigate the factor
structure of the MBI in different samples of nurses. Factor analysis involves considering the
joint distribution of the full set of variables in an inventory and combining variables into factors
when they are correlated with one another and independent of the other variables in the set
(Tabachnick & Fidell, 1996). Our use of factor analysis was guided by Tabachnick and Fidell
(1996), Comrey and Lee (1992), and Kim and Mueller (1978). In this study, factor analysis
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allows us to determine whether the items of the MBI comprise the same factors or subscales
in all countries that were originally suggested by Maslach and Jackson (1981a). Exploratory
factor analysis was used after the confirmatory factor analysis showed that the factor structure
of the 22 items was not entirely consistent with the three subscales in the original Maslach
Burnout Inventory in any of the countries.

In our analyses principal component methods were used to extract factors, and after extracting
the three factors they were rotated with both varimax and promax rotations to achieve
interpretable results. Promax rotation was preferable to varimax rotation since the three factors
of the MBI were found to be significantly correlated. The models were evaluated for their
ability to produce subscales that have items with loadings (or item-to-factor correlations) higher
than 0.3. Items that had loadings of lower or equal to 0.3 were excluded from consideration
for inclusion; loadings greater than 0.3 are considered minimal (Merenda, 1997) and loadings
of 0.40 are considered important (Hair, Anderson, Tatham, & Black, 1998). After the three
subscales of the MBI were extracted, they were investigated for their internal consistencies.
The coefficient of reliability (Cronbach’s alpha) for each subscale in every country was
calculated to determine how well the items in each subscale measure the latent construct. We
calculated correlation coefficients to assess how strongly the subscales were associated with
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one another in the various countries and, to describe the levels of burnout in each country, we
calculated means and standard deviations on each MBI subscale.

Results
Factorial Structure of the MBI and Equivalence of the Items
Table 2 provides the goodness-of –fit statistics for the confirmatory factor analysis model for
each country. While the values of the Root Mean Square Error of Approximation (RMSEA)
and Bartlett’s Comparative Fit Index (CFI) approach the values that are usually considered
acceptable (i.e., RMSE < .06 and CFI > .90, respectively), the RMSEA shows an acceptable
fit only in Russia and the CFI value is unacceptable in every country. Moreover, the chi-square
statistic indicating the goodness-of-fit in each country suggests an unacceptable fit of model
to data in every country. As such, Maslach’s original 3-factor solution does not appear to be

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consonant with the observed data in these countries, though by at least two of the indicators it
does come reasonably close.
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The results of the exploratory factor analysis, shown in Table 3, do nonetheless result in three
factors being extracted from the 22-item MBI. The slope of the Scree test (not shown) explicitly
demonstrated the existence of the three factors in each country, and virtually all MBI items
yielded loadings higher than 0.3 on the three different factors that were extracted. The primary
difference between the three factors extracted in the exploratory analysis and the original three
subscales suggested by Maslach is that in all countries the item stating that “Working with
people all day is really a strain for me” loads on the depersonalization factor rather than the
emotional exhaustion factor, and in seven of the eight countries the same is true of the item
stating that “Working directly with people puts too much stress on me.” In Russia, one item
(“I feel frustrated by my job”) from Maslach’s emotional exhaustion subscale loaded on the
depersonalization factor, another (“I feel I’m working too hard on the job”) loaded on the
personal accomplishment subscale, and one other item “I feel patients blame me for their
problems” failed to load on any of the subscales. In Armenia, three of the original five items
in Maslach’s depersonalization subscale (including the “Blame” item just mentioned) failed
to load on any scale, as did one of the eight items in the original personal accomplishment
scale. The only item that did not yield a sufficient loading on any of the factors in the other six
countries was the “Blame” item in Germany.
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In summary, in nearly all countries three useful subscales emerge with only slight modification
—the two items (6 and 16) related to the “stress” and “strain” involved in working with people
should be included in the depersonalization subscale rather than the emotional exhaustion
subscale to which they were initially assigned. These three subscales—now a 7-item EE
subscale, an 8-item PA subscale, and a 7-item DP subscale-- are almost fully supported by the
exploratory factor analysis in all of the countries except Armenia, where three of the DP items
failed to load on that subscale and one item (6) cross-loaded on the EE subscale, and to lesser
extent in Russia, where items 13 and 14 loaded on the DP and PA subscales rather than the EE
subscale.

The fact that one other item failed to exhibit a substantial loading in Germany (item 22 on the
DP subscale) and another item failed to exhibit a substantial loading in Armenia (item 21 on
the PA subscale) is largely ignorable. This is suggested by the fact that all three of the resultant
scales yield Cronbach alphas, shown in the top panel of Table 4, which exceed the critical value
of .70, except for the depersonalization subscale in Armenia. With that one exception, the three
subscales, in spite of including a single non-performing item in one or two countries that do
not greatly reduce their scalability, provide useful subscales that can be consistently defined
in all countries.
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The correlations between the three subscales are presented in the middle panel of Table 3. The
EE and PA were mildly negatively correlated except Japan, Russia and Armenia, where
correlations were virtually nil. The correlation coefficients ranged from −.15 to −.25 in the five
countries where these two subscales were negatively correlated. The correlation coefficients
for the EE and DP subscales were strong and positive and ranged across the eight countries
from 0.42 to 0.60. The correlations between DP and PA dimensions were negative and
relatively similar across all countries except Japan, where the two subscales were only weakly
correlated and in Armenia, where the DP subscale is suspect.

The bottom panel of Table 3 shows the average scores on the different burnout subscales across
countries. Because of differences in research protocols across countries, these differences
should be interpreted cautiously. Japanese nurses exhibit higher levels of emotional exhaustion
and depersonalization and lower levels of personal accomplishment than nurses in countries

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other than Armenia and Russia. German nurses exhibit less emotional exhaustion than similar
countries. Russian and Armenian nurses are quite unlike nurses from any other countries with
respect to having lower average scores on all three subscales at once.
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Discussion
This study used confirmatory and exploratory factor analyses to investigate the factorial
structure of the MBI in eight countries, and while Maslach’s initial configuration of the burnout
inventory was not completely confirmed, with minor modifications the three-factor structure
of the MBI was largely validated. Except for two items, nearly all of the MBI items loaded
significantly on the factors they were expected to, in virtually all countries. Even though a few
items of the MBI subscales did not load on the original subscales, the items performed similarly
in most countries and the lack of item loadings in the few cases may be explained by the
properties of the original instrument rather than country-specific differences. Moreover, the
range of the item loadings was narrow suggesting that there is no large variation in terms of
how each item performs in a specific country. Overall, the EFA demonstrated that the MBI
performs relatively similarly across countries and the item loadings provided evidence about
their equivalency across countries.

The findings of this study are consistent with the findings in the literature but add to our
knowledge because of the international scope of the investigation. Two EE items load on the
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DP subscale rather than the EE subscale in all countries (in the case of items 16), “Working
with patients is really a strain for me,” or in most countries (in the case of item 6), “Working
with people directly puts too much stress on me.” A similar finding was demonstrated by other
researchers (Beckstead, 2002; Byrne, 1991). Both items describe nurses’ feelings of strain and
stress from working with people or patients. Since feelings of stress and strain are similar to
the negative feelings captured by the items on the depersonalization subscale, it is not surprising
that these two items load on the DP subscale. The consistency of this finding across countries
suggests that it should be taken into consideration in future revisions of the instrument.

Since the factor analysis was performed with samples of nurses in different countries, some
differences in item loadings were anticipated (Tabachnick & Fidell, 1996). It is not realistic to
expect that the factor loadings will be identical for all groups (Byrne, 1991). Nurses from
different countries may perceive and report items differently which may result in variability
in the MBI loadings.

In all countries, the EE and DP subscales were significantly correlated. This finding is
consistent with the findings reported by other researchers (Byrne, 1991; Maslach & Jackson,
1981b). Among nurses in all countries, their feelings of emotional exhaustion,
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depersonalization, and personal accomplishment are similarly correlated, suggesting that


emotionally exhausted nurses or nurses who are experiencing depersonalizing feelings
perceive that these conditions are associated with their accomplishments at work. Additionally,
very weak or almost no relationship between feelings of emotional exhaustion and
depersonalization with personal accomplishment in Japan may suggest that these nurses have
different perceptions about their own accomplishments. In Asian countries, professionals may
have unique ways of defining their accomplishments at work (Tang, 1988). Future research is
needed to understand how nurses in Asian countries rate their work performance and
accomplishments, and what are the factors associated with their accomplishments at work.

Even though comparing burnout levels across countries using mean scores of the MBI
subscales is not the main focus of this study, some of the patterns in the scores are worth
investigating in future research. The high burnout rates in the U.S. and Canada are consistent
with their short average length of hospital stay. Hospitals in the U.S. have the shortest average

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length of stay in the world. When hospital length of stay is short, nurses do the same amount
of work but in a shorter period of time, and the cycle of admissions and discharges is more
rapid which places a significant burden on nurses. Germany has a long length of stay and low
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burnout but this may change now that Germany has adopted prospective payment for hospitals
using Diagnosis Related Groups that in the U.S. led to significant reductions in length of stay.
Japan does not follow the pattern expected by average length of stay as we observed high rates
of burnout and long lengths of stay. This discrepancy was addressed in a recent paper showing
that in Japan a young and inexperienced nurse workforce in hospitals and poor physician-nurse
relations appear to explain the comparatively high burnout rates (Kanai-Pak et al., 2008). This
study has several limitations. The data collection protocol and the nurses surveyed differed in
some ways across countries, and that variability may influence the findings. The relatively
small sample of nurses and hospitals in Armenia and Russia may be a factor in the results from
these countries. While attempts to verify the accuracy of translations were undertaken, we
cannot completely rule out the possibility that there may be some inaccuracies in the
translations. Nonetheless, it is unusual to have a measure of nurse burnout across so many
different countries located in different parts of the world, and it is remarkable that the factor
structure of the MBI was as consistent across countries as we found.

Nurse job-related burnout was observed in countries with very different types of health services
organization, financing, and resources. It is important to investigate the causes of burnout and
to identify potential solutions to address the phenomenon. This study demonstrated that 22-
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item MBI has a similar factorial structure and, with minor modifications, performed similarly
across countries. While additional investigations of the factor structure of the MBI using other
samples would be useful, the modified versions of the subscales can be used with greater
confidence as burnout measures among nurses internationally to determine the effectiveness
of burnout reduction measures generated by institutional and national policies.

Acknowledgments
This research was supported by the National Institute for Nursing Research (R01NR04513 and P30NR05043, Linda
Aiken, principal investigator) and by AMN Healthcare, Inc. We thank Dr. Eileen Lake and Tim Cheney for their
assistance.

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Table 1
Characteristics of Nurse Sample in Eight Countries

U.S. Canada U.K. Germany New Zealand Japan Russia Armenia

Variables M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD)

Age (years) 39.9(9.7) 42.2(8.9) 35.3(9.0) 35.3(8.9) 40.7(9.9) 29.2(7.4) 36.3(11.9) 34.0(8.9)
Poghosyan et al.

Experience (years)
 Nursing 14.2(9.9) 17.7(9.2) 10.9(8.4) 12.5(8.9) 15.5(9.8) 7.3(7.2) 15.1(11.4) 12.8(8.6)
 Hospital 10.4(8.2) 12.3(7.8) 7.6(6.5) 9.4(8.0) 8.3(7.9) 6.0(6.6) -- --
 Unit 7.3(6.5) 8.5(6.7) 5.0(4.7) 6.7(6.5) 4.9(5.6) 2.8(2.8) 9.6(8.7) 10.0(7.4)
Gender (N,%)
 Male 797(6.2) 428(2.5) 798(8.1) 408(15.4) 320(6.7) 232(3.9) 4(1) 4(1)
 Female 12,196(93.8) 16,899(97.5) 9,020(91.9) 2,238(84.6) 4,446(93.3) 5,624(94.4) 447(99) 384 (99)
Nursing Educationa (N, %)
 Non-university 7,780 (58.9) 13,941(80.5) 8,532(86.6) 1,934(72.1) 1,036(21.6) 4,792(82.0) -- --
 University 4,714 (35.8) 2,505(14.5) 1,036(10.5) 432(16.1) 1,687(35.2) 994(17.0) -- --
 Other 680 (5.2) 870(5.0) 110(1.1) 315(11.8) 2,046(42.6) 58 (1.0) -- --
Sample (N)
 Hospitals 209 303 63 29 19 19 2 2
 Nurses 13,204 17,403 9,855 2,681 4,799 5,956 442 398

a
The Non-University education category combines Diploma, Associate Degree, and vocational school nurses; The University Education category combines nurses with Bachelors, Masters, and other
university degrees.
--
Data on hospital experience and educational credentials were not collected in Russia and Armenia.

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Table 2
Goodness-of-Fit Statistics for the Confirmatory Factor Analysis Model for Each Country

U.S. Canada U.K. Germany New Zealand Japan Russia Armenia


Goodness-of-Fit Indicators

Chi-square 19488 23292 12217 2420 5441 7522 493 723


df 206 206 206 206 206 206 206 206
Poghosyan et al.

Probability <.001 <.001 <.001 <.001 <.001 <.001 <.001 <.001


RMSEA .09 .08 .08 .07 .08 .08 .06 .08
Bartlett’s .86 .86 .85 .87 .85 .85 .85 .82

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Table 3
Results of Exploratory Factor Analysis: Loadings of MBI Items on Each Factor

Item Loadings

MBI Subscales U.S. Canada U.K. Germany New Zealand Japan Russia Armenia
Poghosyan et al.

Emotional Exhaustion (EE) Subscale


1. Feel emotionally drained from 0.93 0.89 0.86 0.72 0.89 0.91 0.88 0.73
work
2. Feel used up at the end of the 0.94 0.90 0.88 0.85 0.90 0.92 0.80 0.69
workday
3. Feel fatigued when get up in the 0.86 0.85 0.81 0.67 0.82 0.84 0.74 0.80
morning
20. Feel like at the end of the rope 0.58 0.58 0.57 0.37 0.55 0.67 0.53 0.49
8. Feel burned out from work 0.77 0.78 0.77 0.91 0.75 0.62 0.87 0.73
13. Feel frustrated by job 0.75 0.69 0.54 0.60 0.59 0.37 (0.36) 0.57
14. Feel working too hard on the 0.72 0.71 0.60 0.62 0.67 0.53 [0.40] 0.53
job
6. Working with people puts too (0.59) (0.50) (0.45) 0.36 (0.46) (0.38) (0.31) 0.40
much stress
16. Working with patients is a (0.60) (0.54) (0.50) (0.42) (0.46) (0.44) (0.63) (0.51)
strain

Personal Accomplishment (PA) Subscale


4. Can easily understand patients’ 0.40 0.42 0.38 0.49 0.40 0.56 0.35 0.54
feelings
7. Deal effectively with the 0.50 0.55 0.47 0.89 0.48 0.64 0.51 0.64
patients’ problems

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9. Feel positively influencing 0.64 0.63 0.57 0.64 0.62 0.56 0.62 0.70
people’s lives
12. Feel very energetic 0.46 0.44 0.41 0.55 0.36 0.52 0.35 0.63
17. Can easily create a relaxed 0.62 0.61 0.59 0.51 0.63 0.69 0.74 0.75
atmosphere
18. Feel exhilarated after working 0.63 0.62 0.58 0.63 0.58 0.62 0.80 0.54
with patients
19. Have accomplished 0.73 0.74 0.73 0.67 0.73 0.72 0.64 0.60
worthwhile things in job
21. Deal with emotional problems 0.52 0.54 0.53 0.53 0.50 0.51 0.48 --
calmly
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Item Loadings

MBI Subscales U.S. Canada U.K. Germany New Zealand Japan Russia Armenia

Depersonalization (DP) Subscale


5. Treat patients as impersonal 0.61 0.61 0.61 0.56 0.62 0.62 0.50 0.49
Poghosyan et al.

“objects”
10. Become more callous toward 0.79 0.83 0.82 0.75 0.86 0.70 0.82 --
people
11. Worry that job is hardening 0.71 0.72 0.68 0.58 0.75 0.62 0.78 --
emotionally
15. Don’t really care what 0.64 0.65 0.66 0.65 0.68 0.56 0.75 0.56
happens to patients
22. Feel patients blame for their 0.41 0.37 0.38 -- 0.43 0.49 -- --
problems

Notes. Factor loadings are derived using a Promax rotation, and range in value between 0 and 1.0. Loadings that were lower than 0.3 are represented by -- in this table. Shaded items of the EE subscale
that are enclosed in parentheses loaded on the DP subscale. The shaded item of the EE subscale that is enclosed in square brackets loaded on the PA subscale.

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Table 4
Correlations, Internal Consistency Indices, and Description of the MBI Subscales in each Country

Subscales U.S. Canada U.K. Germany New Zealand Japan Russia Armenia

Cronbach’s alphas
EE (7 items) 0.93 0.92 0.89 0.86 0.90 0.88 0.80 0.80
Poghosyan et al.

PA (8 item) 0.78 0.79 0.75 0.79 0.76 0.82 0.77 0.77


DP (7 item) 0.82 0.82 0.80 0.75 0.82 0.80 0.71 0.36

Correlations
EE*PA −0.25 −0.24 −0.15 −0.24 −0.17 0.05 −0.08 0.10
EE*DP 0.60 0.59 0.57 0.59 0.58 0.60 0.42 0.52
PA*DP −0.33 −0.32 −0.22 −0.35 −0.27 −0.10 −0.24 0.12

Means and Standard deviations


EE 22.0(10.6) 20.4(9.9) 19.7(9.6) 14.4(8.0) 19.8(9.7) 25.0(9.6) 15.1(9.7) 8.4(8.9)
PA 37.0(8.3) 37.2(7.6) 35.8(7.6) 37.1(8.6) 37.9(7.6) 24.3(8.7) 20.4(18.0) 21.9(15.0)
DP 9.4(8.0) 8.3(7.2) 8.9(7.4) 7.4(6.0) 8.3(7.5) 12.4(8.1) 3.6(5.6) 3.7(4.8)

Note. Correlation coefficients were obtained from factor analysis procedures with promax rotation.

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