Date of Award

Summer 2023

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Johnson, Norah L.

Second Advisor

Bekhet, Abir

Third Advisor

Guttormson, Jill


Nurse burnout leads to attrition from hospital nursing positions and the nursing profession prior to typical retirement age. Yet some nurses choose to stay despite burnout. Previous research indicates that nurses stay due to the rewards they receive from work but the relationships between different types of work rewards, work-related burnout, and intention to leave are poorly described. The ability to implement or execute altruistic behaviors may also represent an under-recognized work reward. Thus, the purpose of this study is to investigate the relationships between work rewards, work-related burnout, and intention to leave nursing positions and the nursing profession and to explore the potential role of altruism execution as a work reward.This correlational cross-sectional study included 843 United States hospital nurses. Greater years in the nursing profession was correlated with lower work-related burnout (β=-0.167, p<0.001). Higher adjusted patient ratio had a significant relationship with poorer perceived working conditions (β =-0.461, p=0.001) and opportunities for collegiality and growth (β =-0.551, p<0,001). Improved managerial relationships (β =-0.197, p<0.001), perceived working conditions (β =-0.238, p<0.001), and global job satisfaction (β =-0.204, p<0.001) were correlated with lower work-related burnout. Greater work-related burnout was correlated with increased intention to leave the current position (β=0.007 p<0.001) and the nursing profession (β=0.136, p<0.001). Higher pay satisfaction was correlated with greater intention to leave the profession (β=-0.333, p=0.037). A two-factor solution explained 57.7% of variance in altruism execution item responses and were named ‘altruistic engagement with work’ and ‘workplace barriers to altruism.’ Greater years in the profession (β =-0.006, p=0.037) correlated with greater altruistic engagement with work. Higher adjusted patient ratio (β=-0.008, p=0.048) and fewer years in the profession (β=0.010, p<0.001) were correlated with greater workplace barriers to altruism. Greater altruistic engagement with work (β=-8.942, p<0.001) and workplace barriers to altruism (β=-16.386, p<0.001) was correlated with greater work-related burnout. Execution of altruism may be an underrecognized reward that nurses achieve through work that is pertinent to work-related burnout. Pay satisfaction is one aspect of a holistic decision-making process to leave the profession. Combinations of reward mechanisms may be necessary to effectively improve nurse retention.

Included in

Nursing Commons