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 AssistantProfessor 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, VA22908-0782 (

DOI: 10.1097/NNA.0000000000000882

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JONAVolume 50, Number 5, pp 267-273Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.


Mattering: How Organizations, Patients,and Peers Can Affect NurseBurnout and Engagement

Julie Haizlip, MD, MAPPCourtney McCluney, PhDMorela Hernandez, PhD

er H

Beth Quatrara, DNP, RN, CMSRN, ACNS-BCValentina Brashers, MD

OBJECTIVE: The aim of this study was to exploreprofessional mattering in a broad cohort of nurses.BACKGROUND:Mattering is a construct from socialpsychology that describes the feeling that one makes adifference in the lives of others and has significance inone's community.METHODS:Across-sectional surveyassessingmattering,meaning, social support, burnout, and engagement wasadministered to nurses and nurse practitioners workingin various specialties in the United States.RESULTS: Higher levels of mattering at work wereassociated with lower burnout and higher engagement.Mattering was correlated with perceived social supportfrom one's organization, supervisor, peers, and subor-dinates. Open-ended responses describing experiencesof mattering at work included demonstrating profes-sional competence, positive interactions with patientsand interprofessional peers, and receiving recognitionfrom one's organization.CONCLUSIONS: A perception of mattering at workis associated with lower levels of burnout. Our datasuggest that affirming interactions with other health-care team members promote a sense of mattering.

It is no secret that the prevalence of nurse burnout ishigh. It has been almost 2 decades since a 1999 studyof more than 10 000 inpatient RNs demonstrated that43% of those surveyed reported a high degree of emo-tional exhaustion.1More recently, researchers have re-ported that roughly half of direct care and chargenurses in oncology and critical care are experiencingburnout and secondary traumatic stress.2 Other stud-ies have demonstrated that this emotional exhaustionnot only is limited to the inpatient setting but also oc-curs in nurses in other practice settings.3 It has beenfurther demonstrated that emotional exhaustion andassociated cynicism predict a nurse's desire to leave hisor her current job or, perhaps, the profession4 and thatnurse turnover is an important issue that has a signifi-cant financial impact (5.2-8.1 million dollars) on theaverage hospital.5 What is less obvious, perhaps, iswhat those who lead healthcare organizations can doto practically address this problem.

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


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patient loads, low levels of perceived organizational andsocial support, and implementation of electronic healthrecords will not have easy fixes.1,7 Some authors haveproposed that helping nurses reconnect to the meaningof their work may reduce burnout.8 However, othersreport that having meaningful professions or conductingwork that is personally significant and that has a positivemeaning for others does not reduce the felt experienceof burnout.9 So the question becomes,what can be donein the short term to ameliorate the stresses ofworking inhealthcare?

In other professions, it has been suggested that asense of mattering can enhance an individual's ability tocope with various work-related stresses.10-12 Matteringis a psychosocial construct that describes an individual'sperception that he or shemakes a difference in the livesof others and is significant in the world.13,14 As it wasinitially defined in the literature, mattering is com-posed of 4 domains: awareness, reliance, importance,and ego extension. Awareness encompasses the simpleidea that others are aware of your presence and, more-over, your absencewould be noticed. Reliance suggeststhat others depend on you or that you affect the lives ofthose around you. Importantly, however, reliance issomething that must be perceived by the individual.It is not enough to cognitively know others dependon you (e.g., if I am not there, the unit will be shortstaffed), but rather, you must feel as though othersneed and desire your specific contribution. Feeling impor-tant to others is the result of their genuine expressed careand concern. Finally, ego extension represents the notionthat 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 ofmattering can apply to one's professional life. Each ofus wants to believe that we contribute to our work en-vironment in a meaningful way. As investigators havebegun to consider what it means to matter at work,15

2 new dimensions have been proposed—interpersonaland societal mattering. Interpersonal mattering describesan individual's perception of feeling recognized, valued,and appreciated by the people with whom they work.Societal mattering represents the belief that one'swork contributes to society or meets a societal need.Mattering at work may be particularly important forhealthcare professionals, because this desire to posi-tively influence others' lives is at the heart of our profes-sional identity. Formany healthcare providers, “helpingothers” is how they identify the meaning of their work.Receiving feedback from patients, colleagues, or theorganization that suggests that one's efforts are indeedmaking a positive impact could heighten one's sense ofmattering. 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 thata sense of mattering is derived from the cues providedby their interpersonal and social contexts.

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

MethodsWeused a cross-sectional survey design to collect datafrom nurses and nurse practitioners in the United Statesworking across specialties. The survey consisted ofseveral previously validated scales and 2 open-endedquestions.We recruited participants through TurkPrime,a research platform that improves the quality ofcrowdsourcing data collection processes,16 to surveynurses across geographic regions and healthcare set-tings, which increases the ecological validity of ourfindings. We restricted our sample to nurses and nursepractitioners working full or part-time in the UnitedStates.

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

Mattering at Work ScaleMattering was measured using the 10-itemMatteringat Work scale (a = .93) on a 6-point Likert scale an-chored by 1 (disagree very much) and 6 (agree verymuch) 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 matteringat work.

Work and Meaning InventoryMeaning of work was measured using the 10-itemWork and Meaning Inventory (a = .93) on a 5-pointLikert 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 workhelps me better understand myself.” Higher scoresindicate higher perceived meaning of work.

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

BurnoutBurnout was measured using the 10-item subscalefor 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 itemswere reverse-coded so that higher scores indicatedhigher experiences of burnout.

EngagementEngagement wasmeasured using the 18-itemmeasureof Job Engagement (a = .95) on a 5-point Likert scaleanchored by 1 (strongly disagree) and 5 (strongly agree).20

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

Open-ended QuestionsParticipants were asked to respond to the followingquestions: “Please tell us what is meaningful to youabout your work,” and “Please tell us about a timewhen you felt like you mattered at work.”

ProcedureAfter approval by theUniversity of Virginia's Social andBehavioral Science Institutional Review Board, ouronline survey created throughQualtrics®was launchedthrough TurkPrime. Informed consent was obtainedfrom participants before beginning the survey. Identi-fying information was not collected; anonymity wasmaintained. Participants were given 1 hour to completethe survey; on average, the survey required approximately20minutes to complete. It took approximately 10 days tocollect an appropriate sample size for our analysis.

Data AnalysisDescriptive statistics were used to describe sample char-acteristics. Survey data were uploaded to SPSS (version24; Armonk, New York) for analysis. We used Pearsonr 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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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 contentanalysis and achieved consensuswith strong agreement.

ResultsThree-hundred twenty-four RNs completed our sur-vey, from a possible total of 362.We excluded respon-dents who provide incomplete responses to our surveyitems 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, anda majority worked full-time and worked in private in-patient settings. On average, participants had workedin their current position for slightlymore than12 years.There were no significant correlations found betweenthe demographic data reported in Table 1 on the vari-ables we measured in this study.

The nurses in this sample tended to experience highlevels of engagement at work (mean [SD], 4.38 [0.60]).Respondents also reported moderately high levels ofmattering at work (mean [SD], 4.93 [0.74]), meaningof work (mean [SD], 4.33 [0.69]), and social supportfrom 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 ofburnout (mean [SD], 2.18 [0.61]). Correlational analy-ses indicates that mattering is positively associated withmeaning, social support, and engagement. In contrast,mattering demonstrates a strong negative correlationwith burnout. Cronbach's ameasure of internal consis-tency, means, standard deviations, and correlations forour variables are presented in Table 2.

In response to the open-ended question about themeaning of their work, 82% of participants repliedthat helping others or serving patients was their pri-mary motivation. Eight percent noted their profes-sional expertise, and 4% discussed relationships withpeers or their organization in response to the questionabout meaning. When asked about an experience ofmattering, respondents provided descriptions ofpositive encounters and relationships with patients(52%). Additional themes also emerged in the storiesthat 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%), beingcared for as a person (4%), and knowing one hasgone the extra mile for a patient or colleague (10%).Themes, examples from respondents, the component


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Table 1. Demographic Information

Total 324

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

Race/ethnicityWhite 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)ProfessionNurse 263 (81%)Nurse practitioner 23 (7%)Other 34 (11%)

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

Current residentYes 28 (9%)No 291 (90%)

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

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

RegionUrban 123 (38%)Rural 79 (24%)Suburban 119 (37%)

Hours per weekFull-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. Supporta. Organization .95 3.50 1.06 0.43a 0.4b. Supervisor .91 3.42 0.92 0.35a 0.3c. Peer .89 3.86 0.84 0.48a 0.4d. 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 arepresented in Table 3.

DiscussionThe results of this cross-sectional survey study sup-port our hypothesis that a sense of mattering may bean important factor to consider in the professionalsatisfaction and psychological health of nurses. Thequantitative data demonstrate a positive associationbetween a sense of professional mattering and a num-ber of other metrics related to work satisfaction andengagement. Significant positive relationships werefound between mattering, meaning of work, perceivedsocial support at work, organizational commitment,and organizational engagement. Of particular interestwas the finding that mattering was more highly corre-latedwith perceived social support frompeers and sub-ordinates than with perceived social support fromone's supervisor. The nursing literature has often fo-cused on the relationship between nurses and their unitmanagers as being critical to the experience of theindividual nurse.21 Although our data do endorsethat perceived social support from one's supervisoris associated with professional mattering, they alsosuggest that the relationship with peers may be evenmore important. This finding supports the assertionthat nurse-to-nurse peer relationships have importanteffects on the work environment22 and certainly de-serves further investigation.

The survey data also demonstrated a significantnegative correlation between professional matteringand burnout as measured by the ProQoL.19 These dataonly demonstrate that there is a negative relationship—that those with higher scores on professional matteringscales have lower indicators of burnout—and we can-not make assumptions about causality. However,these findings are consistent with our hypothesis thata 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 slightlyshort of breath. Found he had a pulmonary embolism on V/Q Scan.” (R64; reliance)

80 (25%)

Relationship withpatients

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

163 (52%)

Interaction withcolleagues

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

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

79 (24%)

Experiences withorganization

“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 notefrom the company's CEO thanking me for an outstanding job. I later found out the JointCommission representative used me, saying my name, as an example of excellence whenspeaking 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 werecrunched 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 ofthem 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 apatient 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 weretraveling across the country. I took the presponsibility to stay with her as her support systemuntil her family arrived. She expressed extreme gratitude many times.” (R61; awareness,interpersonal)

“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 aperson

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

12 (4%)

Written responses to the questions “Please tellus 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 andoften succinct. However, the responses to the questionabout mattering were often narratives about an experi-ence with a specific patient or colleague. Responses tothe mattering question demonstrated the impact a smallgesture or appreciative comment can have. Althoughwe provided no context or education about the psy-chosocial construct of mattering, respondents detailedexperiences that demonstrated each of the 4 initiallydescribed components of mattering (awareness, reliance,importance, and ego extension), as well as both of theprofessional domains of mattering (interpersonal andsocietal). We therefore believe that the current defini-tions of mattering and mattering at work reflect theexperience of nurses.

The narratives about mattering that demonstratedrelationships with or dedication to patients were notsurprising. The primacy of a nurse's responsibility torespect, serve, and advocate for patients is core to the

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professional identity and ethics of nursing.23 Thesestories illustrate how the interactions with patientscan validate one's professional role and can instill asense of mattering. Recognitions such as the DAISYAward for Extraordinary Nurses highlight specificdescriptions of a nurse's caring and compassion andprovide a tangible reminder of how nurses matter inthe lives of patients and their families.24,25

Gratitude from a patient or family member isclearly meaningful, and yet, for some nurses, simplyknowing for themselves that they had provided skilledand compassionate care was enough. However, nurseshave 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 respondappreciatively.

For this reason, perhaps, themost notable findingfrom the qualitative data about experiencingmatteringwas the importance of interactionswith interprofessionalcolleagues. Relationships with coworkers and the or-ganization were brought up 10-fold more often whendiscussing mattering (42%) as compared with mean-ing (4%). Responses to the question about mattering


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demonstrate how even small, seemingly inconsequen-tial interactions with colleagues can contribute signif-icantly to an individual's sense of mattering. Nursesalso 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 werenoticed and remembered by nurses, and those interac-tions contributed to their sense of mattering.

One disturbing finding in the data is that there areindividual 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 surprisingto find that these individuals had higher burnout scorescompared 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 thesenurses are not getting or not recognizing positive, ex-ternal feedback that their contributions are noticedand valued. This suggests that there are opportunitiesfor peers or organizations to intervene and create anenvironment that promotes a sense of mattering.

Implications for LeadersThis study demonstrates that, in a broad sample ofnurses, a higher perception of mattering is correlatedwith self-reported lower levels of burnout and higherscores on meaning in work, engagement, and insti-tutional commitment surveys. It further shows thatnurses 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 helpnurse 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 implementationof new technologies such as the electronic health re-cord. As solutions for these challenges are being soughtand trialed, it is within the power of an institution tocreate and encourage strong relationships and positivefeedback processes among those who work there. Anorganization can create a forum for demonstrationsof genuine gratitude for and among nurses. Althoughmany organizations already recognize examples ofprofessional excellence and organizational apprecia-tion of extraordinary effort, taking notice of the day-to-day efforts of those who consistently demonstratecommitment to their patients and colleagues may beequally important. The DAISY Award provides recog-nition for patient-focused efforts.24,25 Might we findsimilar ways to celebrate efforts that enhance the worklives of our colleagues? According to the data from thisstudy, these seemingly simple interventions have a no-table effect on individual nurses and promote a senseof mattering.

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


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14. Elliott G, Kao S, Grant AM.Mattering: empirical validation ofa social-psychological concept. Self and Identity. 2004;3(4):339-354.

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