Nursing a Case of the Blues

Nursing a Case of the Blues: An Examination of the Role of Depression in Predicting Job-

Related 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, job-

related 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 job-

related 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 full-

time 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 CES-

D 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 job-

related 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 the recently graduated nursesing population. 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 job-related 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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