Posted: February 26th, 2023

Clinical Professor of Nursing (Dr Haizlip)

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Citation and Permalink:

Haizlip, McCluney, C., Hernandez, M., Quatrara, B., & Brashers, V. (2020). Mattering: How Organizations, Patients, and Peers Can Affect Nurse Burnout and Engagement. 
The Journal of Nursing Administration, 
50(5), 267–273.

Author Affiliations: Clinical Professor of Nursing (Dr Haizlip),
University of Virginia; Postdoctoral Fellow (DrMcCluney), Univer-
sity of Virginia School of Nursing and Darden School of Business;
Associate Professor of Business Administration (Dr Hernandez),
University of Virginia Darden School of Business; and Assistant
Professor of Nursing (Dr Quatrara) and Professor of Nursing,
Emerita (Dr Brashers), University of Virginia, Charlottesville.

The authors declare no conflicts of interest.
Correspondence: Dr Haizlip, University of Virginia School

of Nursing, McLeod Hall PO Box 800782, Charlottesville, VA
22908-0782 (

DOI: 10.1097/NNA.0000000000000882

JONA � Vol. 50, No. 5 � May 2020

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Volume 50, Number 5, pp 267-


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er H

ealth, Inc. All rights reserved.


Mattering: How Organizations, Patients,
and Peers Can Affect Nurse
Burnout and Engagement

Julie Haizlip, MD, MAPP
Courtney McCluney, PhD
Morela Hernandez, PhD

er H

Beth Quatrara, DNP, RN, CMSRN, ACNS-BC
Valentina Brashers, MD

OBJECTIVE: The aim of this study was to explore
professional mattering in a broad cohort of nurses.
BACKGROUND:Mattering is a construct from social
psychology that describes the feeling that one makes a
difference in the lives of others and has significance in
one’s community.
METHODS:Across-sectional surveyassessingmattering,
meaning, social support, burnout, and engagement was
administered to nurses and nurse practitioners working
in various specialties in the United States.
RESULTS: Higher levels of mattering at work were
associated with lower burnout and higher engagement.
Mattering was correlated with perceived social support
from one’s organization, supervisor, peers, and subor-
dinates. Open-ended responses describing experiences
of mattering at work included demonstrating profes-
sional competence, positive interactions with patients
and interprofessional peers, and receiving recognition
from one’s organization.
CONCLUSIONS: A perception of mattering at work
is associated with lower levels of burnout. Our data
suggest that affirming interactions with other health-
care team members promote a sense of mattering.

It is no secret that the prevalence of nurse burnout is
high. It has been almost 2 decades since a 1999 study
of more than 10 000 inpatient RNs demonstrated that
43% of those surveyed reported a high degree of emo-
tional exhaustion.1More recently, researchers have re-
ported that roughly half of direct care and charge
nurses in oncology and critical care are experiencing
burnout and secondary traumatic stress.2 Other stud-
ies have demonstrated that this emotional exhaustion
not only is limited to the inpatient setting but also oc-
curs in nurses in other practice settings.3 It has been
further demonstrated that emotional exhaustion and
associated cynicism predict a nurse’s desire to leave his
or her current job or, perhaps, the profession4 and that
nurse turnover is an important issue that has a signifi-
cant financial impact (5.2-8.1 million dollars) on the
average hospital.5 What is less obvious, perhaps, is
what those who lead healthcare organizations can do
to practically address this problem.

The National Academy ofMedicine has convened
an Action Collaborative on Clinician Well-Being and
Resilience and issued a call to explore and address burn-
out as an underrecognized threat to safe and high-quality
care.6 This collaborative, which includes national nurs-
ing leaders from the American Nurses Association, the
American Association of Critical Care Nurses, the
National League for Nursing, and the American As-
sociation of Colleges of Nursing among others, seeks
to understand the elements of organizations and prac-
tices that contribute to distress. However, the findings
of their studies will not be immediate, and the issues
of burnout, dissatisfaction, and turnover are pressing.
Furthermore, several of the systems issues that have
been proposed to contribute to burnout such as heavy


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patient loads, low levels of perceived organizational and
social support, and implementation of electronic health
records will not have easy fixes.1,7 Some authors have
proposed that helping nurses reconnect to the meaning
of their work may reduce burnout.8 However, others
report that having meaningful professions or conducting
work that is personally significant and that has a positive
meaning for others does not reduce the felt experience
of burnout.9 So the question becomes,what can be done
in the short term to ameliorate the stresses ofworking in

In other professions, it has been suggested that a
sense of mattering can enhance an individual’s ability to
cope with various work-related stresses.10-12 Mattering
is a psychosocial construct that describes an individual’s
perception that he or shemakes a difference in the lives
of others and is significant in the world.13,14 As it was
initially defined in the literature, mattering is com-
posed of 4 domains: awareness, reliance, importance,
and ego extension. Awareness encompasses the simple
idea that others are aware of your presence and, more-
over, your absencewould be noticed. Reliance suggests
that others depend on you or that you affect the lives of
those around you. Importantly, however, reliance is
something that must be perceived by the individual.
It is not enough to cognitively know others depend
on you (e.g., if I am not there, the unit will be short
staffed), but rather, you must feel as though others
need and desire your specific contribution. Feeling impor-
tant to others is the result of their genuine expressed care
and concern. Finally, ego extension represents the notion
that others feel a sense of pride in your successes or dis-
appointment in your failures, as though your perfor-
mance reflects not only on yourself but also on them.

It is not difficult to envision how the concept of
mattering can apply to one’s professional life. Each of
us wants to believe that we contribute to our work en-
vironment in a meaningful way. As investigators have
begun to consider what it means to matter at work,15

2 new dimensions have been proposed—interpersonal
and societal mattering. Interpersonal mattering describes
an individual’s perception of feeling recognized, valued,
and appreciated by the people with whom they work.
Societal mattering represents the belief that one’s
work contributes to society or meets a societal need.
Mattering at work may be particularly important for
healthcare professionals, because this desire to posi-
tively influence others’ lives is at the heart of our profes-
sional identity. Formany healthcare providers, “helping
others” is how they identify the meaning of their work.
Receiving feedback from patients, colleagues, or the
organization that suggests that one’s efforts are indeed
making a positive impact could heighten one’s sense of
mattering. Such external feedback is distinct from the in-
trinsic benefits and meaning that healthcare professionals


Copyright © 2020 Wolters Kluwer

often derive from helping others; rather, we propose that
a sense of mattering is derived from the cues provided
by their interpersonal and social contexts.

We postulate that this enhanced sense of mattering
may buffer the daily stressors and potentially diminish
the incidence of burnout. This study is designed to an-
swer the research questions: “Is there a relationship
between a sense of mattering and burnout in nurses”
and “Are the current definitions of mattering relevant
to nursing practice?”. It also begins to investigate the
relationships between mattering in nurses and ob-
jective measures of meaning, perceived support, and

Weused a cross-sectional survey design to collect data
from nurses and nurse practitioners in the United States
working across specialties. The survey consisted of
several previously validated scales and 2 open-ended
questions.We recruited participants through TurkPrime,
a research platform that improves the quality of
crowdsourcing data collection processes,16 to survey
nurses across geographic regions and healthcare set-
tings, which increases the ecological validity of our
findings. We restricted our sample to nurses and nurse
practitioners working full or part-time in the United

Demographic Questionnaire
Demographic data collected included age, gender, in-
come, race/ethnicity, profession, primary specialty,
highest level of education, and job characteristics.

Mattering at Work Scale
Mattering was measured using the 10-itemMattering
at Work scale (a = .93) on a 6-point Likert scale an-
chored by 1 (disagree very much) and 6 (agree very
much) that measures the dimensions of interper-
sonal and societal mattering.15 Example items in-
clude “I am connected to society through my work”
and “I feel like I matter to my colleagues/coworkers.”
Higher scores indicate higher perceptions of mattering
at work.

Work and Meaning Inventory
Meaning of work was measured using the 10-item
Work and Meaning Inventory (a = .93) on a 5-point
Likert scale anchored by 1 (absolutely untrue) and 5
(absolutely true) thatmeasures themeaning an individ-
ual derives from their work.17 Example items include
“I have found a meaningful career” and “My work
helps me better understand myself.” Higher scores
indicate higher perceived meaning of work.

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Social Support
Social support was measured using an adapted 15-item
Eisenberger Social Support Scale (a = .93) on a 5-point
Likert scale anchored by 1 (strongly disagree) and 5
(strongly agree).18We captured respondents’ perception
of social support from their organization, supervisor,
peers or nurses at their same level, and subordinates.
Example items include “Help is available from my
organization when I have a problem” and “My super-
visor shows a lot of concern for me.” Higher scores
indicated higher perceived social support.

Burnout was measured using the 10-item subscale
for Burnout in the Professional Quality of Life scale
(a = .75) on a 5-point Likert scale anchored by 1
(never) and 5 (very often).19 Example items include
“I feel worn out because of my work as a nurse”
and “I feel bogged down by the system.” Five items
were reverse-coded so that higher scores indicated
higher experiences of burnout.

Engagement wasmeasured using the 18-itemmeasure
of Job Engagement (a = .95) on a 5-point Likert scale
anchored by 1 (strongly disagree) and 5 (strongly agree).20

Example items include “I devote a lot of energy to my
job” and “I work with intensity on my job.” Higher
scores indicated higher perceived engagement at work.

Open-ended Questions
Participants were asked to respond to the following
questions: “Please tell us what is meaningful to you
about your work,” and “Please tell us about a time
when you felt like you mattered at work.”

After approval by theUniversity of Virginia’s Social and
Behavioral Science Institutional Review Board, our
online survey created throughQualtrics®was launched
through TurkPrime. Informed consent was obtained
from participants before beginning the survey. Identi-
fying information was not collected; anonymity was
maintained. Participants were given 1 hour to complete
the survey; on average, the survey required approximately
20minutes to complete. It took approximately 10 days to
collect an appropriate sample size for our analysis.

Data Analysis
Descriptive statistics were used to describe sample char-
acteristics. Survey data were uploaded to SPSS (version
24; Armonk, New York) for analysis. We used Pearson
r statistic to report correlations between mattering,
meaning, social support, burnout, and engagement. In ad-
dition to statistical analyses, we conducted a content

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Copyright © 2020 Wolters Kluwer H

analysis of the open-ended responses to capture partici-
pants’ descriptions of mattering at work. Two researchers
(J.H. and C.M.) analyzed the themes identified in the content
analysis and achieved consensuswith strong agreement.

Three-hundred twenty-four RNs completed our sur-
vey, from a possible total of 362.We excluded respon-
dents who provide incomplete responses to our survey
items or did not finish the survey. Demographic char-
acteristics are presented in Table 1. A majority of par-
ticipants were female and white, had earned a BSN,
and were, on average, 39 years old. Most of our re-
spondents’ primary specialty was adult medical, and
a majority worked full-time and worked in private in-
patient settings. On average, participants had worked
in their current position for slightlymore than12 years.
There were no significant correlations found between
the demographic data reported in Table 1 on the vari-
ables we measured in this study.

The nurses in this sample tended to experience high
levels of engagement at work (mean [SD], 4.38 [0.60]).
Respondents also reported moderately high levels of
mattering at work (mean [SD], 4.93 [0.74]), meaning
of work (mean [SD], 4.33 [0.69]), and social support
from peers (mean [SD], 3.86 [0.84]) and subordinates
(mean [SD], 3.84 [0.84]).Moderate levels of social sup-
port from their organization (mean [SD], 3.50 [1.06])
and supervisor (mean [SD], 3.42 [0.92]) were reported.
Finally, the sample indicated relatively low levels of
burnout (mean [SD], 2.18 [0.61]). Correlational analy-
ses indicates that mattering is positively associated with
meaning, social support, and engagement. In contrast,
mattering demonstrates a strong negative correlation
with burnout. Cronbach’s ameasure of internal consis-
tency, means, standard deviations, and correlations for
our variables are presented in Table 2.

In response to the open-ended question about the
meaning of their work, 82% of participants replied
that helping others or serving patients was their pri-
mary motivation. Eight percent noted their profes-
sional expertise, and 4% discussed relationships with
peers or their organization in response to the question
about meaning. When asked about an experience of
mattering, respondents provided descriptions of
positive encounters and relationships with patients
(52%). Additional themes also emerged in the stories
that resulted in a sense of mattering. These themes in-
cluded demonstration of their professional expertise
(25%), interactions with colleagues and/or the or-
ganization (42%), feeling appreciated (34%), being
cared for as a person (4%), and knowing one has
gone the extra mile for a patient or colleague (10%).
Themes, examples from respondents, the component


ealth, Inc. All rights reserved.

Table 1. Demographic Information

Total 324

Women 304 (94%)
Men 18 (6%)

White 254 (78%)
Black 32 (10%)
Latinx/a/o 16 (5%)
Other 22 (6%)

Age, y Mean (SD), 39.12 (12.6)
Income Mean (SD; range), 5.94

(1.86; $50 000-$75 000)
Nurse 263 (81%)
Nurse practitioner 23 (7%)
Other 34 (11%)

Primary specialty
Medical 2 (32%)
Surgery 18 (6%)
Pediatrics 34 (11%)
OB/GYN 21 (7%)
Radiology 5 (2%)
Other 141 (44%)

Current resident
Yes 28 (9%)
No 291 (90%)

Highest education
BSN 241 (74%)
MSN 37 (11%)
DNP 13 (4%)
PhD 7 (2%)

Organizational setting
Academic 34 (11%)
Private outpatient 96 (30%)
Private inpatient 161 (50%)
Health department 27 (8%)

Urban 123 (38%)

79 (24%)

Suburban 119 (37%)

Hours per week
Full-time 219 (68%)
Part-time 71 (22%)
Half-time 25 (8%)
Less than half-time 5 (2%)

Tenure in position Mean (SD), 12.58 (10.88)

Table 2. Descriptive Statistics, a Reliability, and Co

a Mean SD 1

1. Mattering .89 4.93 0.74 —
2. Meaning .95 4.33 0.69 0.67a —
3. Support
a. Organization .95 3.50 1.06 0.43a 0.4
b. Supervisor .91 3.42 0.92 0.35a 0.3
c. Peer .89 3.86 0.84 0.48a 0.4
d. Subordinate .94 3.84 0.84 0.44a 0.3

4. Burnout .80 2.18 0.61 −0.47a −0.
5. Engagement .97 4.38 0.60 0.50a 0.5

aP < .01.


Copyright © 2020 Wolters Kluwer

of mattering, and the frequency of these topics are
presented in Table 3.

The results of this cross-sectional survey study sup-
port our hypothesis that a sense of mattering may be
an important factor to consider in the professional
satisfaction and psychological health of nurses. The
quantitative data demonstrate a positive association
between a sense of professional mattering and a num-
ber of other metrics related to work satisfaction and
engagement. Significant positive relationships were
found between mattering, meaning of work, perceived
social support at work, organizational commitment,
and organizational engagement. Of particular interest
was the finding that mattering was more highly corre-
latedwith perceived social support frompeers and sub-
ordinates than with perceived social support from
one’s supervisor. The nursing literature has often fo-
cused on the relationship between nurses and their unit
managers as being critical to the experience of the
individual nurse.21 Although our data do endorse
that perceived social support from one’s supervisor
is associated with professional mattering, they also
suggest that the relationship with peers may be even
more important. This finding supports the assertion
that nurse-to-nurse peer relationships have important
effects on the work environment22 and certainly de-
serves further investigation.

The survey data also demonstrated a significant
negative correlation between professional mattering
and burnout as measured by the ProQoL.19 These data
only demonstrate that there is a negative relationship—
that those with higher scores on professional mattering
scales have lower indicators of burnout—and we can-
not make assumptions about causality. However,
these findings are consistent with our hypothesis that
a greater sense of professional mattering may be pro-
tective against burnout.

rrelations Among Survey Items

2 3 4 5 6 7

1a —
3a 0.62a —
7a 0.64a 0.50a —
4a 0.45a 0.31a 0.57a —
52a −0.49a −0.47a −0.45a −0.32a —
4a 0.37a 0.26a 0.43a 0.42a −0.35a

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Table 3. Content Analysis of Open-ended Responses to Mattering Question

Theme Example Frequency


“Nurses save lives, whether its catching an arrhythmia or doing CPR on someone.” (R44;
reliance, societal)

“Stopped a patient from arresting because I noticed his O2 Sat dropping and he was slightly
short of breath. Found he had a pulmonary embolism on V/Q Scan.” (R64; reliance)

80 (25%)

Relationship with

“I had a newmomwho was scared to take care of her premmie baby. I worked with this mom
everyday to learn how to handle, bathe, and feed her baby. She turned into a confident
capable caretaker for her baby. It was so rewarding to see her grow and become themom she
needed and hoped to be for her baby.” (R132, reliance, interpersonal)

163 (52%)

Interaction with

“I remember telling others that I am looking for a new job and the response was that people
were very sad and that they needed me to stay. That I’m a hard worker and if I left the unit
would be in huge trouble.” (R212; awareness)

“Whenever a coworker says thank you for my help. After every case when a MD says thank
you. A person who I meet in public says the institution I work for has helped him/her. This in
part is my success.” (R319; awareness, ego extension)

79 (24%)

Experiences with

“I was asked to speak to Joint Commission formy department’s process and procedures. After,
I was praised by my immediate supervisor and later received a personal hand written note
from the company’s CEO thanking me for an outstanding job. I later found out the Joint
Commission representative used me, saying my name, as an example of excellence when
speaking to the CEO about her findings.” (R234; ego extension)

“I received a compliment from my coworker when I helped them with a task when they were
crunched for time. This led to me receiving recognition frommymanager.” (R36; importance)

58 (18%)

Feeling appreciated “A patient specifically mentioned my name as someone who went out of their way to take of
them and make them comfortable.” (R93; awareness, importance, interpersonal)

“When I was told directly I make a difference to others and to the organization. Also when a
patient says thank you.” (R59; awareness)

108 (34%)

Going the extra mile “A patient’s family was unable to make it in time for her double bypass surgery as they were
traveling across the country. I took the presponsibility to stay with her as her support system
until her family arrived. She expressed extreme gratitude many times.” (R61; awareness,

“When I helped a patient find something they had misplaced that was very valuable to them.”
(R304; awareness, interpersonal)

34 (10%)

Being cared for as a

“Whenmy daughter passed and so many of my coworkers and supervisors showed lots of love
and support.” (R258; importance, interpersonal)

12 (4%)

Written responses to the questions “Please tell
us what is meaningful to you about your work” and
“Please tell us about a timewhen youmattered at work”
provide depth to our quantitative statistical analysis.
The answers about meaning were fairly general and
often succinct. However, the responses to the question
about mattering were often narratives about an experi-
ence with a specific patient or colleague. Responses to
the mattering question demonstrated the impact a small
gesture or appreciative comment can have. Although
we provided no context or education about the psy-
chosocial construct of mattering, respondents detailed
experiences that demonstrated each of the 4 initially
described components of mattering (awareness, reliance,
importance, and ego extension), as well as both of the
professional domains of mattering (interpersonal and
societal). We therefore believe that the current defini-
tions of mattering and mattering at work reflect the
experience of nurses.

The narratives about mattering that demonstrated
relationships with or dedication to patients were not
surprising. The primacy of a nurse’s responsibility to
respect, serve, and advocate for patients is core to the

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Copyright © 2020 Wolters Kluwer H

professional identity and ethics of nursing.23 These
stories illustrate how the interactions with patients
can validate one’s professional role and can instill a
sense of mattering. Recognitions such as the DAISY
Award for Extraordinary Nurses highlight specific
descriptions of a nurse’s caring and compassion and
provide a tangible reminder of how nurses matter in
the lives of patients and their families.24,25

Gratitude from a patient or family member is
clearly meaningful, and yet, for some nurses, simply
knowing for themselves that they had provided skilled
and compassionate care was enough. However, nurses
have limited control over how their patients will re-
spond to them. Even when optimal care is delivered,
a patient who is scared or in pain may not respond

For this reason, perhaps, themost notable finding
from the qualitative data about experiencingmattering
was the importance of interactionswith interprofessional
colleagues. Relationships with coworkers and the or-
ganization were brought up 10-fold more often when
discussing mattering (42%) as compared with mean-
ing (4%). Responses to the question about mattering


ealth, Inc. All rights reserved.

demonstrate how even small, seemingly inconsequen-
tial interactions with colleagues can contribute signif-
icantly to an individual’s sense of mattering. Nurses
also expressed that knowing that their peers or organi-
zations depend on them provided a sense of mattering.
Specifically, daily interactions and small acts of grati-
tude, recognition, and caring between colleagues were
noticed and remembered by nurses, and those interac-
tions contributed to their sense of mattering.

One disturbing finding in the data is that there are
individual nurses who can clearly articulate the mean-
ing of their work who, when asked about mattering,
responded with a statement such as “I cannot remem-
ber the last time I mattered” (n = 7). It is not surprising
to find that these individuals had higher burnout scores
compared with the larger sample (mean, 2.79 vs 2.18).
It is unlikely that the efforts of these nurses are not ap-
preciated by someone. However, it is clear that these
nurses are not getting or not recognizing positive, ex-
ternal feedback that their contributions are noticed
and valued. This suggests that there are opportunities
for peers or organizations to intervene and create an
environment that promotes a sense of mattering.

Implications for Leaders
This study demonstrates that, in a broad sample of
nurses, a higher perception of mattering is correlated
with self-reported lower levels of burnout and higher
scores on meaning in work, engagement, and insti-
tutional commitment surveys. It further shows that
nurses derive a sense of mattering from their patients,
from their professional expertise, and from feeling


Copyright © 2020 Wolters Kluwer

appreciated and supported by their patients, colleagues,
and organization. These findings may serve to help
nurse leaders address issues of nursing burnout, turn-
over, and attrition.

There are a number of dissatisfiers in nursing prac-
tice that are challenging to address such as understaff-
ing, diminishing reimbursement, and implementation
of new technologies such as the electronic health re-
cord. As solutions for these challenges are being sought
and trialed, it is within the power of an institution to
create and encourage strong relationships and positive
feedback processes among those who work there. An
organization can create a forum for demonstrations
of genuine gratitude for and among nurses. Although
many organizations already recognize examples of
professional excellence and organizational apprecia-
tion of extraordinary effort, taking notice of the day-
to-day efforts of those who consistently demonstrate
commitment to their patients and colleagues may be
equally important. The DAISY Award provides recog-
nition for patient-focused efforts.24,25 Might we find
similar ways to celebrate efforts that enhance the work
lives of our colleagues? According to the data from this
study, these seemingly simple interventions have a no-
table effect on individual nurses and promote a sense
of mattering.

In conclusion, we propose that nurse leaders may
foster a greater sense ofmattering in their staff by gen-
erating a culture that encourages strong relationships
and explicit cues of appreciation among nurses as
well as other interprofessional colleagues. This feeling
of mattering could in turn lead to higher levels of resil-
ience and engagement.


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