Individual Differences in Job Crafting and Its Relationship with Burnout in Nursing


 Background: The heavy work load and pressure to which nursing professionals are subjected leads to an increase in stress-related problems, such as burnout. Personal resources, such as job crafting, proactive personality, self-efficacy and regulatory focus are fundamental in palliating negative effects in the work environment.Objective: To analyze individual differences, with attention to proactive personality, regulatory approach and general self-efficacy in job crafting, and to determine the predictive power of these variables for burnout in nursing professionals. Methods: The sample was made up of 643 nurses. After correlation and descriptive analyses, multiple linear regression models were computed to find out the possible predictor role of the individual variables on burnout. Main Outcome Measures were: Proactive personality, Regulatory focus, Self-efficacy (participant beliefs concerning their ability to handle different daily situations adequately), Job Crafting behavior and Burnout.Results: The results showed that job crafting, proactive personality, general self-efficacy and the promotion regulatory focus were associated with a decrease in burnout in healthcare workers. Similarly, the predictive models for each of the factors in burnout in all cases included the increase in structural resources dimension of job crafting as the variable with the most weight. Furthermore, the increase in the social resources of Job Crafting for the social climate of the Burnout acted as mediator of this relationship.Conclusion: Job Crafting has been shown to be a variable promoting positive changes in the work environment that acts as a predictor of employee Burnout levels.


Background
Healthcare professionals are recognized by the World Health Organization [1] as the essential pillar of a strong, secure healthcare system. Of the European countries, Spain has the third smallest number of nursing professionals. So there is an urgent need for planning and improving human resources and working conditions in the healthcare system [2]. This shortage of professionals impacts on the workers employed, increasing their workload and the pressure perceived by nursing professionals [3,4], which leads to an increase in stress-related problems [5].

Burnout in healthcare professionals
Long-term exposure to job stress above the individual's capacity for coping with it can lead to burnout [6]. The burnout syndrome is more likely to appear when workers perceive lack of fairness, absence of reciprocity and imbalance between effort and reward [7]. Nursing professionals are usually faced with high levels of this syndrome, associated with heavy workloads, ineffective interpersonal relations, con icts between family life and job, and high stress [8][9][10].
In recent years, the number of nursing professionals who suffer from this syndrome has been increasing [11]. This result is a cause for concern due to the negative consequences to the individual and patients, families and healthcare organization as a whole [12]. This phenomenon can lead to the appearance of physical and psychological health problems among healthcare workers, in addition to being a key risk factor for burnout in nurses [13] and intention of quitting their job [14]. In care work, the presence of burnout has been related to a decrease in patient safety [9,15]. On an organizational level, it leads to high costs associated with the impact of nursing turnover, increase in physical and psychological disorders, and less quality and errors in patient care [16].

Importance of job crafting in nursing work
Although job stress can come about in very diverse situations, it is usually aggravated when the professionals have limited control over their work [17]. According to the World Health Organization [2], in Spain, over 70% of nursing professionals are somewhat or moderately dissatis ed with their autonomy and opportunities their job offers. This is partly because to date, the optimization of jobs has been done by the administration based on resources and demand [18]. However, the new economic trends based on the service sector have shown the need to include the professionals as active creators of their job [19], and that this improves the wellbeing and job performance of workers [20,21]. Job Crafting is the process in which workers actively in uence their jobs [22]. It speci cally refers to physical changes the works can make in their jobs. Physical changes have to do with the way tasks are performed, their scope or their number. And cognitive changes refer to how they perceive the work [23]. Thus, when job crafting is discussed, behavior is directed at increasing professional skills and development (which has been called increasing the job's structural resources), increasing interaction with fellow workers and supervisors (which means increasing the job's social resources), increasing proactivity in developing new and interesting job demands (that is, a growing demand for challenging work) and those which are directed at reducing stressful job demands (diminishing work demands) [24].
Active modi cation of the job by the employees themselves promotes positive results. For example, nursing professionals who have autonomy for controlling their employment situation, the rate of work and scheduling their tasks perceive their work as a signi cant experience [25]. Thus, intervention for creating a positive work environment based on signi cant recognition and active participation by nursing professionals, has shown bene cial effects in reducing burnout [26]. The study by Gordon et al. [21] showed how the presence of job crafting among healthcare professionals increased wellbeing and work signi cance. These authors observed a decrease in burnout and an increase in engagement and performance among nursing professionals that had received training in job crafting and a posteriori implementation of the jobs designed.

Individual variables and their relationship with job crafting and burnout
Personal resources are fundamental in palliating the negative effects, such as burnout, that the job can generate, and promote work engagement and job crafting in healthcare professionals [4,27]. Professionals with a proactive personality are more likely to create their own jobs, that is, show more job crafting [28,29]. Proactive personality is a tendency to make intentional positive changes in one's setting [30]. In the work environment, this involves predisposition of an employee to identify opportunities, solve problems and take the initiative in promoting changes and improvements [31]. Proactive people tend to actively mold their work environment, promoting their own development and improving their professional adaptability [32]. Thus, this type of personality acts as a promotor of prosperity in the work environment, which in turn leads to improved professional adaptability [33]. Along this line, proactive personality has been shown to mediate in the relationship between presence of con icts in the family and the job and developing burnout [34]. Furthermore, this type of personality reduces emotional exhaustion and promotes creativity, engagement, effective decision-making, signi cance of work and feelings of personal achievement and pertaining to the organization [35][36][37].
Another individual variable that has been associated with job achievement is self-e cacy [38]. Thus, nurses with more faith in their capacity for problem-solving show more creativity in their work and can optimistically overcome the barriers to performing their tasks [39]. General self-e cacy refers to the perception that individuals have about their own performance in a variety of situations [40], affecting the way in which they think, are motivated and act [41]. For example, people with less perceived self-e cacy tend to imitate leaders [42]. Self-e cacy is related to beliefs about the extent to which one controls one's progress [43]. So it affects the choices people make with respect to the tasks, goals and functions they perform [44]. Among nurses with little work experience, perceived self-e cacy is a predictor of satisfaction and job performance [45]. In addition, it is related to dedication to oneself [46]. This variable has also been shown to be closely related to turnover in nursing, increasing retention of these workers in their job and patient satisfaction [47]. In this regard, self-e cacy has been found to be a protector variable against developing burnout [48,49] and a predictor of passion one's work [50]. Speci cally, self-e cacy acts as a mediator in the relationship between the work overload to which healthcare professionals are subjected and level of burnout [51,52].
The regulatory focus is another variable related to job performance. According to Higgins' theory [53], to reach their goals, individuals perform certain actions based on two self-regulatory systems: focus on promotion or on prevention. The focus on promotion encourages workers to obtain positive results, while the focus on prevention pays more attention to avoiding possible negative results [54]. Thus, even when people have similar goals, the way they are reached may be very different [55]. Both regulatory focuses can coexist to different extents in the professional [53]. Those who show high levels of regulatory focus on promotion show strong conscientiousness and performance of their tasks, while, professionals oriented toward avoiding errors show more anxiety [56]. Similarly, focus on promotion has a robust association with job crafting [29] and predicts performance of work [57]. The new focus of occupational psychology emphasizes the need to increase the effort to study how certain positive variables can be used to protect employees from job risk [23]. Added to this is the need to investigate the understanding of how job crafting can generate opportunities in different groups of employees [24]. In view of the above, the objective of this study was to analyze individual differences, with attention to proactive personality, regulatory focus and general self-e cacy in job crafting, and also analyze the predictive value of the variables and their relationships with burnout, in nursing professionals.

Method Participants
The original sample consisted of 672 nurses of whom 29 were eliminated because incongruencies or random answers had been detected. The study sample was therefore made up of a total of 643 nurses.

Instruments
Proactive personality was evaluated with the Proactive Personality Scale (PPS) [30]. The brief version by Siebert et al. [37] in Spanish was used for this study. The instrument is made up of 17 items with answer choices on a seven-point Likerttype scale (from 1 = never to 7 = always). The McDonald's omega found for the scale was ω= .94.
Regulatory focus was evaluated with the Regulatory Focus Scale (RFS) [58]. This instrument, made up of 10 items, reports orientation toward promotion or prevention, following the Regulatory Focus Theory proposed by Higgins [53]. Each orientation is in turn divided into two scales, openness to new things (ONT) and autonomy (A), in orientation toward promotion; and orientation toward prevention includes the orientation toward expectations from others (OEO) and sense of obligation (SO) subscales. The answers are rated on a seven-point Likert-type scale (from "de nitely false" to "de nitely true"). The McDonald's omega for the scale was ω= .84.
The Spanish version [59] of the General Self-e cacy Scale [60] was used to nd out participant beliefs concerning their ability to handle different daily situations adequately. The instrument consists of 10 items and the answer format follows a four-point Likert-type scale (1= wrong and 4= right). Internal consistency was ω= .93.
For evaluation of Job Crafting behavior, the Spanish version [24] of the Job Crafting Scale (JCS) [61] was used. This instrument consists of 21 items with answers coded on a seven-point Likert-type scale (from 1 "never" to 7 "always"). These items are grouped around four factors: increase in structural resources of the job, decrease in work demands, increase in social demands of the job, and growing demand for challenging work. The McDonald's omega for each of the factors was ω= .94, ω= .89, ω= .82 y ω= .84, respectively.
Burnout was evaluated using the Brief Burnout Questionnaire [62], speci cally, the Spanish validation for healthcare workers (Brief Burnout Questionnaire Revised for Nursing Personnel CBB-R) [63]. The scale consists of four factors evaluated by 15 items answered on a ve-point Likert-type scale. Reliability was ω= .74 for job satisfaction; ω= .70 on the social climate factor; ω= .84 on personal impact; and ω= .69 on the motivation for quitting factor. Procedure Data were collected from care professionals who were volunteer participants. After explaining the purpose and relevant information on the study, they were asked to answer the questionnaires sincerely, guaranteeing the con dentiality of their answers. The questionnaires were administered online, including control questions for detecting random answers. This study was approved by the Bioethics Committee of the xxxxxxxxxxxxxx (Ref: xxxxxxxxxxxxxxxxx).

Data analysis
First, to explore the relationships of the variables, correlation analyses were performed and descriptive statistics were calculated. A two-stage cluster analysis was done for burnout which enabled cases to be classi ed by mean scores on each of the burnout dimensions. For the comparative analysis of the clusters to detect whether there were signi cant differences with regard to the rest of the variables in the study, a Student's t test was done using the Cohen's d to estimate the effect size.
Then stepwise multiple linear regression models were estimated. For each of the models, the burnout dimensions were entered as the dependent variables. The predictor variables were those where statistically signi cant differences were found after the comparative analysis: Proactive personality, Regulatory focus (Openness to new things, Autonomy, and Sense of obligation), Self-e cacy, and Job Crafting (Increasing structural job resources, Increasing social job resources, and Increasing challenging job demands). Data processing and analysis was done using the SPSS statistical package version 23.0 for Windows.
Finally, a simple mediation analysis was performed, taking the burnout dimensions as dependent variables. In each case, the possible mediators entered were those involved in the equation resulting from each of the linear regression models computed. The PROCESS macro for SPSS [64] with bootstrapping using 5000 bootstraps was applied to process the mediation models.

Results
Proactive personality, regulatory focus and self-e cacy and their relationship with job crafting: Correlations and descriptive analyses As observed in Table 1, proactive personality correlated positively with all the regulatory focus components, both in promotion and prevention. Furthermore, proactive personality was related positively to self-e cacy. The Job Crafting dimensions were positively correlated in all cases with proactive personality: Increasing structural job resources, Decreasing hindering job demands, Increasing social job resources, and Increasing challenging job demands.
Self-e cacy showed positive correlations with four elements of the regulatory focus, and also with the dimensions of Job Crafting. Finally, the relationships established between the components of regulatory focus and Job Crafting were positive and signi cant in all cases.   Table 2 shows the mean scores on the individual variables and the Job Crafting components when the Burnout pro les found based on the cluster analysis were compared. As observed, Cluster 2 has signi cantly higher scores than Cluster 1 in Proactive personality, Openness to new things, Autonomy, Sense of obligation, Self-e cacy, Increasing structural job resources, Increasing social job resources, and Increasing challenging job demands. No statistically signi cant differences were found between Burnout pro les for the regulatory focus Orientation to the expectations of others factor, and for the Job Crafting Decreasing hindering job demands dimension.  Mediation models Based on these results, we saw a need to evaluate whether, in those cases where more than one variable was included in the equation, the factors with the least predictive value were acting as mediators in the effect of the IStJR dimension of Job Crafting on the Burnout components. To nd out, we computed simple mediation models, in which the mediators were the factors involved in the corresponding equation in each case. Thus, the individual resources mentioned above are determinant in promoting signi cant change in work behavior and Job Crafting [27,29]. According to previous studies, the presence of proactive personality is associated with proactive behavior in creating work [23]. Similarly, since the perception of self-e cacy affects how one acts and individual motivation [41], it is no wonder that those with a stronger tendency to create their own job, also show higher levels of general self-e cacy. Our results concerning the regulatory focus differ somewhat from the meta-analysis of Rudolph et al. [29]. These authors found a relationship between all the dimensions of Job Crafting except decrease in hindering job demands and the promotion regulatory focus.
Furthermore, the second objective of this study was to analyze the predictive value of the above variables and their relationships with Burnout, among nursing professionals. The cluster analysis showed two groups of workers. The mean scores in proactive personality, self-e cacy, regulatory focus and Job Crafting were signi cantly higher for professionals in Cluster 2, except in the regulatory focus Orientation toward expectations from others factor and Job Crafting's Decrease hindering job demands, where no differences were found between the groups. Thus, the professionals least affected by the burnout syndrome showed higher levels in all the individual variables mentioned above. This coincides with the literature, which suggests that Job Crafting [21,26], proactive personality [35][36][37], general self-e cacy [48,49] and the promotion regulatory focus are associated with a decrease in Burnout among workers.
The predictor models for each of the Burnout factors in all cases showed an increase in the Job Crafting structural resources as the variables with the most weight. This result follows the proposal by Gordon et al. [21], in which Job Crafting was a negative predictor of Burnout level in workers. After computing the mediation models, it was found that self-e cacy mediated in the relationship between the Burnout personal impact factor and Job Crafting, although they do have a direct effect on personal impact. Self-e cacy was related to beliefs about the extent to which one controls one's own future [43], which could mean more control of the negative effect of work on one's life.
The model of Job Crafting's increase in structural resources and personal dissatisfaction in Burnout established proactive personality of direct effect, but not as the mediator in this relationship. Thus, having a personality directed at actively promoting positive changes in the surroundings promotes signi cance of work [35] and improvement in professional adaptability [32], when changes are made and improve the work environment [31].
Finally, the burnout factor related to the relationship workers have with their coworkers and superiors at work (social climate) had as a predictor, like the rest of the dimensions, the increase in the structural resources of Job Crafting, where the mediator was the increase in social resources of job crafting. Thus, the increase in interaction with coworkers and superiors [24] acted as a mediator in the predictor effect of the increase in job skills and competencies on social climate at work. Therefore, levels of Burnout in nursing caused partly by de cient relations with superiors and coworkers [8][9][10], are lessened by the direct effect of actively increasing job skills and by the mediating effect of the increase in interactions with other workers.

Conclusions
Work and social changes that we have been witnessing in recent times have promoted a need to investigate the protective effects of positive individual variables against job risks. Job Crafting has been shown to be a variable promoting positive changes in the work environment that acts as a predictor of employee Burnout levels.
Among the limitations of this study, is the di culty in comparing the results, because even though the Burnout Brief Questionnaire Revised Nursing Health Personnel (CBB-R) has shown adequate psychometric properties for this group of workers, the shortage of studies done to date based on this scale impedes comparison of ndings. In addition, the area where the professionals were working, which could be related to Job Crafting, was not taken into account. In areas of major structuring, where the ability for active Job Crafting is more limited, such as the Emergency Room, there may be less Job Crafting by employees, and the relationships with Burnout may be different.
This study showed the possibility of palliating the negative effects of burnout by increasing the professionals' ability to design their own job. Thus, training in Job Crafting, along with the rest of the variables analyzed for healthcare employees could decrease burnout associated with very high levels of chronic job stress.  Simple mediation model for ISoJR on the relationship between the IStJR dimension of Job Crafting and Social climate of burnout