Nursing a Case of the Blues
Nursing a Case of the Blues: An Examination of the Role of Depression in Predicting JobRelated Affective Wellbeing in Nurses
Abstract
The current study explored the effect of depression, optimism and anxiety on job-related
affective wellbeing in 70 graduate nurses. It was predicted that depression and anxiety would
have a significant negative effect on job-related affective wellbeing, whereas optimism would
have a significant positive effect on job-related affective wellbeing. Questionnaires were
completed online or in hard-copy forms. Results revealed that depression, optimism and
anxiety were all significantly correlated to job-related affective wellbeing in the expected
direction, however, depression was found to be the only variable that made a significant
unique contribution to the prediction of job-related affective wellbeing. Possible
explanations for these findings are explored.
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Introduction
The nursing profession is in crisis, with a shortage of nurses documented in Australia
and worldwide. While a major contributing factor is the ageing workforce, a further problem
is the high attrition rate in student and recently graduated nurses (Brooks, Turner, Sheumack,
& Moloney 2008; Kells & Koerner, 2000). The transitional stage from student to registered
nurse has been widely recognised as a period of stress, role adjustment and reality shock for
graduate nurses (Amos, 2001). Studies exploring the transition process for graduate nurses
indicate that many find the experience overwhelming and often experience feelings of fear,
anger, confusion, shock, disillusionment (Ellerton & Gregor, 2003; Waite, 2004) and anxiety
(Jowett, Walton, & Payne, 1994). In light of these affective responses, the current study will
specifically explore the level of job-related affective wellbeing experienced by graduate
nurses who have transitioned from university to full-time work in the last three years. In
addition, the role of depression, anxiety and optimism in job-related affective wellbeing in
nurses will be explored.
Job-Related Affective Wellbeing
Affective wellbeing has been defined as the frequent experience of positive affect and
the infrequent experience of negative affect (Diener & Larsen, 1993). It is often domain
specific, and can be used to measure the positive and negative emotions evoked by the work
environment. Hence, job related affective wellbeing can be defined as an individual’s
feelings about themselves in relation to their job.
Job-related affective wellbeing should be distinguished from job satisfaction. Job
satisfaction incorporates an attitudinal component, which is influenced by an individual’s
affect and cognitions (Van Katwyck, Fox, Spector, & Kelloway, 2000). Conversely, jobrelated affective wellbeing is concerned only with an individual’s emotional reactions to their
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work. In other words, job related affective wellbeing measures the individual’s general level
of positive or negative feelings towards their job, whereas job satisfaction consists of the
individual’s beliefs or thoughts concerning their job.
Low job satisfaction is the most frequently cited reason as to why nurses leave the
profession (Aiken, Clarke, & Sloane, 2001; Cavanagh & Coffin, 1992; Cowin, 2002; Gauci
& Norman,1997; Tovey & Adams, 1999). Factors such as high stress, increased workload,
burnout, staff shortages, low support, shift work, low pay and conflict in interpersonal
relations are common reasons for dissatisfaction (Bowles & Candela, 2005; Lee, Song, Cho,
Lee, & Daly, 2003). Low job satisfaction has also been linked to increased stress,
absenteeism, emotional exhaustion, burnout and depression (Brookings, Bolton, Brown, &
McEvoy, 1985; Dolan, 1987; Fang, 2001; Kalliath & Morris, 2002; Pines, Kafry, & Etzion,
1980).
Past organizational research has tended to focus on measuring attitudinal based job
satisfaction rather than employee affective wellbeing. One limitation of this approach is that
attitudes have been found to be inconsistent over time and place (Van Katwyck et al., 2000).
As a result, employee’s level of job satisfaction may vary with one’s mood, potentially
confounding research results. Measuring affect rather than attitude may more accurately
reflect the work experience of graduate nurses.
High job-related affective wellbeing is shown to be beneficial on an individual and
organizational level. Research has demonstrated that job related wellbeing is positively
related to psychological and physical health (Sivanathan, Arnold, Turner, & Barling, 2004)
and general life satisfaction (Judge & Watanabe, 1993). Benefits for the organization include
lower staff turnover (Cooper, 2001; Judge & Locke, 1993; Shoenfelt & Battista 2004; Wright
& Bonett, 2007), lower levels of burnout (Lee et al., 2003; Wright & Hobfall, 2004) and
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greater job performance and satisfaction among employees (Wright & Cropanzano, 2000;
Wright & Hobfall, 2004).
To date, no psychological literature has investigated what factors influence job-related
affective wellbeing in nurses. This is an important area to explore because high job-related
affective wellbeing is associated with increased work performance, better health, less staff
turnover and decreased rates of burnout (Cotton, 2003; Harter, Schmidt, & Keyes, 2003).
Investigation into factors that increase job-related affective wellbeing may help make the
transition process easier for graduate nurses and, in turn, help reduce the high attrition rate
threatening the nursing profession. As nurses report higher depression rates than the average
population (Welsh, 2009), examining the relationship between depression and job-related
affective wellbeing may offer insight into ways to reduce attrition.
Depression
Depression is a clinical illness characterised by a number of specific symptoms that
last for at least two weeks, which can lead to impairment in occupational, social or other
areas of functioning. According to the International Classification of Diseases (ICD-10)
depression is defined by the presence of a lowered mood and the loss of interest or pleasure
in regular daily activities (World Health Organisation, 2010). According to the Australian
Bureau of Statistics (2008), around one million Australian adults and 160,000 young people
live with depression each year. On average, one in five females and one in eight males will
experience depression in their lifetime.
Depression and Nurses
Numerous studies have found that nurses are at high risk for depression (Ross,
Srisaeng, Yimmee, Somchid, & Sawatphanit, 2005; Ruggiero, 2005; Skinner & Scott, 1993;
Welsh, 2009). For example, Ruggiero (2005) found that in a sample of 247 registered nurses,
41% met the criteria for depression at the time of data collection. In another study, Welsh
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(2009) surveyed 150 medical nurses from three different hospitals in the United States.
Thirty-five percent of respondents reported mild to moderate depressive symptoms including
low mood, disrupted sleep, poor motivation and difficulty concentrating. Findings indicated
that depressive symptoms were correlated to stressful life events, lower income and greater
occupational stress. Similarly, Ross and colleagues (2005) examined rates of depression in
Thai nurses. They found that in a sample of 331 nurses 50.1% of participants met the
requirements for depression.
Research has found that stress is related to burnout, which has been found to be a
significant predictor of depression (Anderson, 2008; Baba, Galperin, & Lituchy, 1999;
Cotton, 2003). The relation between occupational stress and depression was explored by a
study conducted by Caan and colleagues (2000). Researchers interviewed 60 nurses in the
United Kingdom who had been treated for depression. Results indicate that more than half of
the participants reported that their jobs were the primary or sole cause of their depression.
These findings were corroborated by the results of a study conducted by Ruggiero (2005)
who found that depression had a significant negative relation with job-satisfaction (r= -.26), a
finding consistent with previous research (Norbeck, 1985; Packard & Motowidlo, 1987).
A search of the PsycInfo and Medline databases found no studies that explored the
effects of depression on job-related affective wellbeing in graduate nurses. However, there is
extensive evidence that stress and burnout are related to higher rates of depression (Anderson,
2008; Cotton, 2003). It is well established in the literature that the transition process for
graduate nurses is extremely stressful (Dyess & Sherman, 2009; Ellerton & Gregor, 2003).
As a result, based on the findings in the existing literature, the current study predicts that
graduate nurses with more depressive symptoms will report lower levels of job-related
affective wellbeing.
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Anxiety
Trait anxiety is a relatively stable and acquired disposition that is characterised by a
proneness to perceive a wide variety of situations as potentially threatening and to react to
them with apprehension and tension (Spielberger, 1966). Trait anxiety should be
differentiated from state anxiety which is a transitory emotional state of tension and
apprehension. According to the Australian Bureau of Statistics (2008) over two million
people in Australia experience an anxiety disorder each year. On average, one in three
women and one in five men experience an anxiety disorder during their lifetime.
Literature has demonstrated that trait anxiety has a high comorbidity with depression
(Sartorius, Ustun, Lecrubier, & Wittchen, 1996). This can be explained using Clark and
Watson’s (1991) Tripartite Model, which theorises that anxiety and depression have
significant overlap because they are both characterised by a component of general distress
(i.e. negative affect). To account for the meaningful differentiation between depression and
trait anxiety, Clark and Watson (1991) suggest that both are also characterised by additional
unique factors — specifically hyper arousal in anxiety and low positive affect in depression.
Anxiety and Nurses
An expanding body of literature suggests that the transition from university training to
full-time work often results in feelings of anxiety for graduate nurses (Gerrish, 2000; Jowett,
Walton & Payne, 1994; McKenna & Green, 2004; Oermann & Garvin, 2002; Thomka, 2001).
During this time, commonly cited sources of anxiety include increased accountability
(Gerrish, 2000; Oermann& Garvin, 2002), fear of interacting with doctors (Duchsler, 2001),
lack of support (Thomka, 2001) and having to perform clinical skills for the first time
(McKenna & Green, 2004). Chang and Hancock (2003) suggested increased anxiety may also
be due to role ambiguity (a lack of role clarity and understanding of expectations) and role
overload (having inadequate time to complete required work). While research examining the
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role of anxiety on job satisfaction in nurses is limited, studies in the general population have
found that anxiety is negatively related to job satisfaction (Martin & Clore, 2001; Sharma &
Sharma, 1989; Watson, 2000).
To date no research has examined the effect of anxiety on job-related affective
wellbeing. However, some studies have explored the relation between trait anxiety and
general wellbeing (Mathews, 1986; Raikkonen, Matthews, Flory, Owens, & Gump, 1999).
For example, de Beurs and colleagues (1999) examined the effect of anxiety on wellbeing in
659 elderly individuals. They found that anxiety was associated with increased disability and
diminished wellbeing. Based on the findings in the existing literature the current study
predicts that individuals with more symptoms of anxiety will report lower levels of jobrelated affective wellbeing. Similarly, due to the high comorbidity rate of depression and
anxiety, it is predicted that anxiety and depression will have a significant positive relation in
the current study.
Optimism
Another factor that is thought to influence the level of job-related affective wellbeing
during the transition process is optimism. Optimism is defined as the generalised expectancy
that good things will happen in the future and bad things will be minimal (Scheier & Carver,
1985). People with an optimistic orientation face life events with a positive outlook
increasing the likelihood that they will be able to better adjust to and overcome challenges
(Hayes & Weathington, 2007). For instance, researchers have found that optimistic
individuals are less likely to experience job burnout or feelings of tiredness and frustration
related to work (Chang, Rand, & Strunk, 2000).
There is support in the literature for optimism acting as a buffer against the effects of
stress (Chang et al., 2000; Peterson, 2000, Scheier & Carver, 1985; Tuten & Neidermeyer,
2004). In addition, researchers have found that optimism is associated with less stress and
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greater positive wellbeing (Aspinwall &Taylor, 1992; Hooker, Monahan, Shifren, &
Hutchinson, 1992; Khoo & Bishop, 1997; O’Brien, VanEgeren, & Mumby, 1995; Scheier &
Carver, 1992). Optimism is positively related to employee wellbeing (Burns & Gunderman,
2008; Gavin & Mason, 2004; Harter, Schmidt, & Hayes,2002; Hayes & Weathington, 2007;
Simmons, Nelson, & Neal, 2001) demonstrating a positive relation to a sense of purpose at
work, improved relationship with colleagues and increased level of happiness at work (Chiok,
2001; Gavin & Mason, 2004; Harter, Schmidt &Keyes, 2003). As a result, optimism is
thought to contribute to improved health and work fulfillment (Simmons et al., 2001).
Optimism has also been found to be associated with lower levels of depression. In a
classic study, Carver and Gaines (1987) examined the development of depressed feelings in
women after childbirth. They assessed optimism and depression in the last trimester of
pregnancy and again three weeks after delivery. They found that participants higher in
optimism reported fewer depressive symptoms at both time periods.
Optimism and Nurses
The literature exploring the benefits of optimism in the nursing profession is limited.
A handful of studies have examined the role of optimism on general psychological well being
in this population, however, to date no studies have examined the effect of optimism on
wellbeing specific to the work context (Luthans, Lesback, & Lesback, 2008). For example,
Cohen (1990) examined the role of optimism, stress, social support and coping on the
psychological wellbeing of 43 nurses. Results indicated that optimism accounted for 30% of
the variance in general psychological wellbeing in the sample. In a more recent study, Burke
and colleagues (2009) examined the effect of virtues (optimism, gratitude and proactive
personality) on psychological wellbeing and seven job-related outcomes (job satisfaction,
intent to quit, vigor, dedication, absorption, absenteeism and burnout). As a whole, virtues
were found to account for a significant amount of variance in four of these work-related
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outcomes (job satisfaction, vigor, dedication and days absent), with optimism predicting
absenteeism. Results also indicated that as a whole, virtues explained a significant amount of
the variance in burnout and psychological wellbeing, with optimism predicting general
positive affect, support and life satisfaction. Overall, results of this study suggested that
nurses who reported higher levels of virtues, such as optimism, were more satisfied with their
work and had higher levels of general wellbeing.
This is consistent with the findings of a study conducted by Richardson, Lounsbury,
Bhaskar, Gibson, and Drost (2009), who examined the relation between personality and
career satisfaction in 296 health care professionals (physicians, nurses, mental
healthprofessionals and administrators). Career satisfaction differs from job satisfaction in
that career satisfaction represents an individual’s feeling of satisfaction or dissatisfaction with
an entire career path (progress, trajectory, advancement and future prospects) rather than their
current job. Richardson et al. found that optimism, emotional stability, assertiveness,
extraversion and teamwork were associated with greater career satisfaction.
Similarly, Luthans and colleagues (2008) examined the role of state optimism on
supervisor ratings of performance in 72 nurses in the USA. State optimism was measured
using a modified version of Scheier and Carver’s (1985) Life Orientation Scale. The wording
of the scale was changed from “in general” to “right now” to reflect a more current state of
optimism in the work context. The results indicated a highly significant positive relation
between state optimism and the nurses’ supervisor rating of work performance.
The Current Study
Collectively, the literature reviewed suggests that nursing is an extremely stressful
occupation, which is likely to make the transition from student to practicing nurse a difficult
one. To date, studies of the transition experiences of graduate nurse have tended to focus on
job satisfaction in relation to organisational variables and less on personal factors and health
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issues. Currently, no studies have explored the role of depression, anxiety or optimism on
job-related affective wellbeing in graduate nurses. The present study aims to fill this gap by
expanding the knowledge base about personal factors that influence job-related wellbeing in
recently graduated nurses. Results may be helpful in guiding the development of
interventions designed to improve wellbeing and retention during the transition process.
The main research question addressed in this study was: What individual factors
influence job-related affective wellbeing in graduate nurses? It was predicted that symptoms
of depression and anxiety would be associated with lower job-related affective wellbeing.
Additionally, it was predicted that optimistic nurses would report higher levels of job related
affective wellbeing (JAW) in addition to fewer symptoms of depression and anxiety. Due to
the high comorbidity rate of depression and anxiety established in the literature, it was also
expected that depression and anxiety would have a significant positive correlation. Finally, it
was hypothesised that all three independent variables (depression, anxiety and optimism)
would make a significant contribution to job-related affective wellbeing.
Method
Participants
Seventy participants (64 female, 6 male) took part in the current study. All
participants were nurses in Brisbane, Australia who had transitioned from university to fulltime work within the previous three years (2009-2011). Fifty-nine participants (84.3%) were
aged 20-29 years, five participants (7.1%) were aged between 30-39 years, four participants
(5.7%) were aged 40-49 years and 2 participants (2.9%) were aged 50 years or over.
Measures
Centre for Epidemiologic Studies Depression Scale (CES-D)
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The CES-D is a 20-item self-report scale that measures current depressive
symptomology, with an emphasis on depressed mood during the past week (Radloff, 1977).
The CES-D has been widely used to assess depressive symptoms in various community
populations and has empirical support in the literature (Boisvert, McCreary, Wight, &
Asmundson, 2003; Cohidon, Santin, Imbernon, & Goldberg, 2010). The CES-D has good
convergent validity with other measures of depressive symptoms (eg r >.50 with the
Hamilton Rating Scale [Boisvert et al., 2003]). Although it is not a diagnostic tool, the CESD does yield a total score that is indicative of degree of depression.
The scale incorporates depressive symptoms across four key areas: depressed affect,
positive affect, somatic complaints and interpersonal distress. Participants are presented with
a number of statements, such as “During the past week I was bothered by things that usually
don’t bother me” and asked to report the frequency with which these symptoms occurred
over the past week. This was done using a 4-point frequency scale ranging from 0 – 3 (0 =
rarely or none of the time, 1 = some or little of the time, 2 = occasionally or a moderate
amount of time and 3 = all of the time). Items that assessed positive affect, such as “During
the past week I was happy” were reversed scored (items 4, 8, 12 and 16). Total scores range
from 0-60, with higher scores indicating more symptoms of depression. Typically, scores of
16-26 are considered indicative of mild depression and scores of 27 or greater may indicate
major depression (Barns & Prosen, 1984; Radloff, 1977). Radloff (1977) reported an
adequate internal consistency (α > .84) and test-retest reliabilities ranging from .49 (12
months) to .67 (4 weeks). The lower reliabilities for long test-retest intervals may be
attributed to the cyclic nature of depression and depressive reactions to life events (Radloff,
1977). In the current study, the Cronbach Alpha coefficient was .91.
Anxiety Subscale of Hospital Anxiety and Depression Scale
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The anxiety measure from the Hospital Anxiety and Depression Scale (Zigmond &
Snaith, 1983) was used to measure generalised anxiety because it had been used in previous
studies to screen individuals for anxiety (Caci et al., 2003; Dunbar, Ford, Hunt, & Der, 2000).
This 7-item self-report scale measures the presence and severity of psychological anxiety
symptoms. Respondents were presented with statements, such as “I feel tense and wound
up”, and indicated the frequency with which they had experienced these symptoms over the
past week. Responses were indicated on a 4-point scale ranging from 0 - 3 (0 = rarely or
none of the time and 3 = most or all of the time). Item 4, “I can sit at ease and feel relaxed”,
was reversed scored. Possible scores ranged from 0-21. Researchers have suggested that a
score of 11 or higher may indicate the presence of an anxiety disorder, while a score of 8-10
generally indicates the presence of an anxious state (Zigmond & Snaith, 1983) and these
criteria were applied in the current study. Caci and colleagues (2003) reported a Cronbach’s
Alpha of .73 for the anxiety subscale in their study. In the current study, the Cronbach Alpha
coefficient was .87.
Life Orientation Test – Revised (LOT-R)
The LOT-R is a self-report measure of dispositional optimism (Scheier, Carver, &
Bridges, 1994). It is comprised of 10 items, which focus exclusively on the assessment of
generalised outcome expectancies. The scale has three positively framed items (items 1, 4
and 10), such as “In uncertain times I usually expect the best”; three negatively framed items
(items 3, 7 and 9), such as “If something can go wrong for me, it usually will”; and four filler
items (items 2, 5, 6 and 8), which are not included in the overall score. Participants indicated
the extent to which they agreed with these statements on a 5-point Likert Scale ranging from
strongly disagree to strongly agree (0-4). There are no cut-offs for optimists and
nonoptimists, rather the score represents a continuum where 24 indicates the most optimistic
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orientation and 0 indicates the least optimistic orientation. According to Scheier et al.
(1994), the scale has a Cronbach’s Alpha of .76. In the current study, the Cronbach Alpha
coefficient was .67. This was considered adequate as Kline (1999) proposed that when
dealing with psychological constructs values below .70 can be realistically expected due to
the diversity of the constructs being measured.
Job-Related Affective Wellbeing Scale (JAWS)
The Job-Related Affective Wellbeing Scale (JAWS) is a 30-item self-report scale that
measures a range of emotional reactions towards work (VanKatwyk, Fox, Spector, &
Kelloway, 2000). Items ask employees to indicate how often any part of the job has made
them feel each of 30 emotional states over the past 30 days. Responses were indicated on a
5-point scale (1 = almost never to 5 = extremely often or always) with high scores
representing high levels of each emotion. A positive emotion score was obtained by
summing the scores on the 15 positive affect items, whilst a negative emotions score was
calculated by summing the scores on the 15 negative affect items. The overall job-related
affective wellbeing score was calculated by reverse coding the negative affect items and then
adding them to the sum of the positive affect items. Overall scores ranged from 30-150.
There are no cut-offs for high and low job-related affective wellbeing, rather the score
represents a continuum, with higher scores indicating a higher level of job-related affective
wellbeing. Van Katwyk et al. (2000) reported a Cronbach’s Alpha of .95 for the overall
JAWS scale. In the current study, the Cronbach Alpha coefficient was .95.
Procedure
Participants were recruited through the alumni association of a Brisbane university
and a local Brisbane hospital. The university that participated contacted their past nursing
students via e-mail, which contained a web link to information about the current study and
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the survey. Similarly, the hospital e-mailed the same link to their nursing staff, however due
to low response rates (perhaps due to the limited computer access nurses have while on shift)
a paper copy of the measures was distributed to the pigeon holes of graduate nurses at one
hospital only. Participants provided an identifying code (initials and email address) on the
survey. This ensured potential duplicates (paper and electronic copy) were identified. No
duplicates were found.
All participants read an outline of the nature of the study before completing
demographic questions (age, gender and time since transitioning to full-time work as a nurse
to ensure all participants had transitioned within the last three years) and the questionnaire.
For online data collection, responses were saved in the researcher’s Survey Monkey account
and accessed via a password protected private computer. For collection of hard-copy
questionnaires, participants were advised to return their surveys in a sealed envelope to their
manager who then posted them back to the researcher. All steps of this procedure were
reviewed and approved by appropriate ethical bodies.
Results
Data were analysed using SPSS version 17 (SPSS Inc, 2010). Preliminary analyses
were performed to ensure no violation of the assumptions of normality, linearity and
homoscedasticity for the four variables (job-related affective wellbeing, depression, anxiety
and optimism). Tests of normality revealed that depression and anxiety scores were not
normally distributed. This was not unexpected as scores on these traits will vary depending
on the population. Subsequently, square root transformation was performed on these
variables to satisfy the requirements of normality (Pallant, 2001). To meet the required
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assumptions the transformed data for depression and anxiety was used in the correlation and
regression analyses.
Descriptive Statistics
The means and standard deviations for each variable are presented in Table 1.
Insert Table 1 about here
Correlations
The relations among job-related affective wellbeing, depression, anxiety and
optimism were investigated using Pearson product moment correlation coefficient. The
results are presented in Table 2.
Insert Table 2 about here
Results indicated a strong, negative correlation between depression and job-related
affective wellbeing, r = -.77, p < .01. As predicted, higher scores on the depression scale
were associated with low levels of job-related affective wellbeing. In fact, approximately
87% of individuals who scored in the lower quartile for job-related affective wellbeing had
depression scores over 16, which may suggest clinical levels of depression. Similarly, as
predicted there was a significant negative relation between anxiety and job-related affective
wellbeing, r = -.57, p < .01. Higher scores on the anxiety measure were associated with
lower levels of job-related affective wellbeing. A significant positive relationship was found
between optimism and job-related wellbeing, r = .38, p < .01, with higher levels of optimism
associated with higher levels of job-related affective wellbeing.
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Results also found a significant negative correlation between optimism and depression
r = -.45, p < .01, indicating that nurses with higher optimism scores reported fewer depressive
symptoms. Similarly, optimism was found to have a significant negative correlation to
anxiety, r = -.30, p < .01, with those reporting higher optimism scores also reporting fewer
symptoms of anxiety.
Finally, support was found for the expected high comorbidity of depression and
anxiety as these variables had a strong positive correlation, r = .79, p < .01, indicating that
individuals reporting more depressive symptoms also reported more symptoms of anxiety.
Standard Multiple Regression
A standard multiple regression was performed between job-related affective
wellbeing as the dependant variable and depression, anxiety and optimism as independent
variables. Since no a priori hypotheses had been made to determine the order of entry of the
predictor variables, a standard multiple regression was used for the analyses (Field, 2009).
The current study had a sample size of 70, which exceeded the minimum requirement of 45
(based on 3 predictors) recommended by Stevens (1996). Alternatively, using G*Power 3
(Faul, Erdfelder, Lang, & Buchner, 2007) for this design and analysis (setting the apriori
effect size to .15, p-level to .05, power to .80) with three predictors variables, a sample of 76
was needed. Overall, the sample size for these analyses was considered sufficient.
Results of evaluation of assumptions revealed that all assumptions had been met
(Pallant, 2001). Collinearity statistics revealed tolerances above .33 and VIF values below
3.08 indicating that the multicolliearity assumption was met. The correlation matrix
indicated no perfect correlations between IVs indicating the singularity assumption was not
violated. Inspection of the residual scatterplot and normal probability plot revealed normally
distributed, linear, homeoscedastic errors of prediction between predicted and obtained DV
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scores, as well as independence of residuals. The maximum mahalanobis distance was 18.82
(Case 20), which violated the critical value of chi-square (16.27) indicating the presence of
one multivariate outlier. All other mahalanobis distances fell below the critical chi-square
value indicating that no other multivariate outliers were present. Due to the adequate sample
size of the current study the outlier was not removed (N = 70) (Field, 2009).
Table 3 displays the unstandardized regression coefficients (B), the standardised
regression coefficients (β), the squared semipartial correlations (sr2), R2 and adjusted R2.
Insert Table 3 about here
R2 for the regression was significantly different from zero, F(3,65) = 32.88, p < .001,
indicating that the IVs together significantly predicted job-related affective wellbeing. The
R2 indicated that the IVs explained 60% of the variance associated with job-related affective
wellbeing. However, the hypothesis that all three independent variables (depression, anxiety
and optimism) would make a significant contribution to job-related affective wellbeing was
only partially supported. Results indicated that depression contributed significantly to the
prediction of job-related affective wellbeing, t =
-6.13, p < .01, however, neither anxiety
nor optimism made a significant unique contribution to job-related affective wellbeing. The
unique variance associated with depression was 23% (sr2 = .23), anxiety was < 1% (sr2= <
.01) and optimism was < 1% (sr2 = < .01).
Quartile Analysis
As Depression was the only independent variable that made a unique contribution to
the prediction of job-related affective wellbeing a quartile analysis was completed to examine
the relation between the extent of depressive symptoms and the changes in all other variables
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(job-related affective wellbeing, anxiety and optimism). Data were observed according to
depression quartiles. Depression scores were divided into upper and lower quartile groups.
The quartile of participants with the lowest depression scores (M = 3.29) were then compared
to the quartile of participants with the highest depression scores (M= 24.75). Approximately
25% of participants scored 16 or above on the CES-D, indicating that over one-quarter of
respondents had elevated depression scores. The mean optimism, anxiety and job-related
affective wellbeing (JAW) score for each quartile is presented in Table 4.
Insert Table 4 about there
Independent Samples t-test
An independent samples t-test was conducted to compare job-related affective wellbeing in
low and high depression groups. There was a significant difference in job-related affective
wellbeing between low depression (M = 117.10) and high depression (M = 84.95) groups, t
(39) = 8.63, p <.05. These results provide further evidence that depression, as measured by
the CES-D, was significantly associated with job-related affective wellbeing. Specifically,
the results show that individuals who reported more depressive symptoms were more likely
to also report lower job-related affective wellbeing.
Additionally, there was a significant difference in optimism scores between
participants who had high depression scores (M = 17.43) and those with low depression
scores (M = 13.25), t (39) = 4.11, p < .05, suggesting that individuals who reported fewer
depressive symptoms also reported higher levels of optimism. Levels of anxiety were also
found to be significantly different between the high (M = 9.70) and low depression groups (M
= 1.95), t (39) = -7.33, p < .05, suggesting that individuals who reported fewer depressive
symptoms were also more likely to report fewer symptoms of anxiety.
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Discussion
The transitional stage from student to registered nurse has been widely recognised as
a period of stress for graduate nurses (Amos, 2001; Dyess & Sherman, 2009; Ellerton &
Gregor, 2003; Gerrish, 2000; Newton & McKenna, 2007; Thomka, 2001; Waite, 2004). This
vital development period may influence not only their commitment to the profession but also
their physical and psychological wellbeing. Identifying factors to enhance job-related
wellbeing in graduate nurses is critical given the high attrition rate and the changes within the
healthcare environment.
In the current study, higher depression and anxiety scores had a significant negative
correlation with job-related affective wellbeing, indicating that individuals with more
depressive symptoms and higher anxiety reported lower levels of wellbeing in relation to the
work context. These results are consistent with the findings of previous research which found
that depression and anxiety were associated with low general wellbeing (Baba et al., 1999; de
Beurs et al., 1999; Mathews, 1986; Raikkonen et al., 1999; Ruggiero, 2005). Optimism was
found to have a significant positive relation with job-related affective wellbeing; that is, more
optimistic nurses reported higher levels of job-related affective wellbeing. As predicted,
optimism had a significant negative relation with depression and anxiety, indicating that more
optimistic individuals were less likely to experience symptoms of depression and anxiety.
These finding are consistent with the current literature on generalised optimism and its
association with greater wellbeing (Burns & Gunderman, 2008; Chang & Strunk, 2008;
Goodman, Chesney, & Tipton, 1995; Khoo & Bishop, 1997; Scheier & Carver, 1992).
Additionally, depression was found to have a significant positive relation with anxiety,
indicating that individuals with higher depression scores were more likely to report increased
symptoms of anxiety. This finding is consistent with the high comorbidity rate between
depression and anxiety established in the existing literature (Sartorius et al., 1996).
19
Results indicated that as a whole depression, anxiety and optimism played a
significant role in predicting job-related affective wellbeing in nurses. However, depression
was the only variable that had a significant unique correlation with job-related affective
wellbeing (sr2 = .23), explaining a substantial 23% of its variance. Anxiety and optimism did
not make a significant unique contribution to the prediction of job-related affective
wellbeing. Possible explanations for these results are discussed below.
That higher levels of depression correlates with lower levels of job-related affective
wellbeing is consistent with the current literature (Anderson, 2008; Baba et al., 1999; Caan et
al., 2000; Ratchneewan et al., 2005; Skinner & Scott, 1993; Welsh, 2009) and not surprising
because depression is considered to be a state of extreme negative affect. Those who have
more depressive symptoms are more likely to have negative feelings about themselves, life
and their ability to change things for the better. Such a triad of self-defeating conclusions
lead to negative affect with respect to one’s life in general and one’s job in particular (Judge
& Lock, 1993).
Results of the quartile analysis and independent sample t-test demonstrated that
individuals with higher depression scores differed significantly from individuals with lower
depression scores in their job-related affective wellbeing, optimism and anxiety scores.
Specifically, nurses with more depressive symptoms had significantly more symptoms of
anxiety and significantly less optimism and job-related affective wellbeing than nurses with
low depression. These results provide further evidence for the detrimental impact depression
can have on graduate nurses.
Explaining the Relationship between Anxiety and Job-related Affective Wellbeing
Like optimism, anxiety did not have a significant unique contribution to JAW.
Anxiety is characterised by a presence of negative affect and hyperarousal. Research has
20
demonstrated that anxiety does not necessarily indicate the absence of positive affect (Clark
& Watson, 1991). As a result, participants higher in anxiety in the current study may still
have experienced positive affect in relation to their work, potentially reducing the predictive
power of anxiety.
Depression, however, is characterised by a presence of negative affect and an absence
of positive affect, suggesting that individuals higher in depression may have experienced
increased negative affect and diminished positive affect in relation to their job. As jobrelated affective wellbeing is a measure of both positive and negative affect, it is not
surprising that depression explains a larger unique variance in JAWS than anxiety.
Depression and anxiety were highly correlated (r = .79), potentially due to an overlap of
negative affect item content. As depression has been found to be highly prevalent in nurses,
it is possible that the depression measure in the current study already accounted for the
influence of negative affect on job-related affective wellbeing, potentially reducing the
predictive power of anxiety.
Additionally, it is important to note that the anxiety subscale of the HADS was
designed to assess the presence and severity of anxiety symptoms, rather than to distinguish
between the different types of anxiety. As a result, it is possible that some individuals
experienced functional anxiety, while others experienced dysfunctional anxiety. These
different types of anxiety may have differentially impacted JAW, potentially further reducing
the predictive power of anxiety in the current study.
Explaining the Relationship between Optimism and Job-related Affective Wellbeing
Despite the positive correlation found between optimism and JAW, the results of this
study found that optimism did not contribute significantly to the prediction of JAW. This
finding was unexpected considering that beneficial effects associated with optimism are well
21
documented in the literature (Carver, Scheier, & Segerstrom, 2010; Carver & Gaines, 1987;
Chang & Strunk, 2008; Hayes & Weathington, 2007; Scheier & Carver, 1985).
One possible explanation for this unexpected finding may be explained using
Luthan’s theory that optimism has both a trait and a state component (Luthans, 2002; Luthans
& Youseff, 2007). Trait optimism refers to the generalised expectation that good things will
happen, whereas state optimism is thought to be a malleable, manageable construct that may
change based on situational and contextual factors. Trait optimism is thought to relate more
strongly to general outcomes (such as general wellbeing and long-term health), whereas the
specific outcome expectancies of state optimism may relate more strongly to proximal
context related outcomes, such as job-related affective wellbeing (Kluemper, Little &
DeGroot, 2009) . Luthans and colleagues (2008) provided support for the predictive power
of state optimism in a study, which examined the relation between state optimism and work
performance in 72 nurses. Results indicated that state optimism significantly contributed to
work performance, as rated by supervisors. Additionally, Hayes and Weathington (2007)
investigated the relation between trait optimism and burnout in 120 restaurant managers. As
in the current study, they found a significant correlation between the two variables, however,
optimism had no significant unique association with burnout.
Although the theoretical mechanisms for trait and state optimism are the same (a
positive explanatory style and self-regulation will lead to positive health outcomes), the
particular situational and contextual factors found on the job may override general
tendencies. As a result, graduate nurses may feel pessimistic on the job, even if they
generally feel optimistic in life, or vice versa. Thus, in the case of nurses, organisational
culture may override the influences of an individual’s optimism to impact attitudes and
behaviour, potentially explaining why trait optimism did not predict nurse’s job-related
affective wellbeing in the current study. In other words, an employee’s optimism on the job
22
may affect the positive and negative emotions felt on the job, more accurately than their
general tendency to feel optimistic.
The literature has clearly established that nursing is a stressful profession, particularly
for graduate nurses. High stress, increased workloads, staff shortages, shift work and low
social support are likely to increase the probability of burnout, potentially resulting in low
state optimism in some nurses. As trait and state optimism are two independent constructs
(Kluemper et al, 2009) it is possible that participants in the current study who reported
higher levels of trait optimism may have had lower state optimism in the work context,
potentially influencing their job-related affective wellbeing. Due to the stressful nature of
nursing, it seems likely that individuals who are able to maintain higher state optimism in
stressful conditions are more likely to have higher trait optimism than lower trait optimism.
This may explain why optimism was correlated to, but did not predict, job-related affective
wellbeing in the current study.
Limitations
A primary limitation of the current study is the cross-sectional survey design. As data
was taken at a single point in time, it does not provide a baseline measurement for each
variable or allow us to infer direction or causality. In other words, the current study does not
help us determine whether depression leads to low job-related affective wellbeing or if low
job-related affective wellbeing leads to depression, as it can only tell us that the two factors
are significantly related. In addition, we are unable to determine what level of depressive
symptoms the nurses exhibited when they entered the profession.
A further limitation of the current study was the small sample size, which reduced the
generalizability of the findings. The response rate of participants appeared to be low
considering the large number of nurses at the organisations contacted, potentially resulting in
23
a response bias. It is possible that graduate nurses with severe depression may not have taken
the initiative to complete the questionnaires due to feelings of hopelessness or limited
emotional resources associated with depression. This may have potentially resulted in an
underestimation of the role of depression on job-related affective wellbeing. Similarly, the
fact that only six males completed the survey indicates that the findings are only applicable to
the female nursing population.
Implications of Findings
The current study explored individual factors that influence job-related affective wellbeing in
a cohort of recently graduated nurses. Results demonstrated that depression is significantly
related to job-related affective wellbeing. Additionally, results indicated that graduate nurses
may be at higher risk for depression. These findings provide further support for the
importance of supporting new nurses during this difficult transition. As the transition process
for graduate nurses is highly stressful (Amos, 2001) and the attrition rate in student and
recently graduated nurses is high (Brooks et al., 2008; Kells & Koerner, 2000), it is
imperative that nurses are provided with appropriate support during this time. The results of
the current study may be used to guide the direction of possible interventions. For example,
interventions designed to reduce depression and emotional stress may help to improve jobrelated affective wellbeing in graduate nurses. This may, in turn, aid the recruitment and
retention problems that are plaguing the profession.
Declaration of interest – The authors report no conflicts of interest.
24
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