Iran Journal of Nursing

Introduction
Nursing has always been one of the most stressful jobs. Nurses, as a key members of the treatment team, experience a lot of job stress that can cause fatigue and burnout in them and thus negatively affect their mental health. Job burnout is an emotional exhaustion state in which a person feels unable to meet job expectations and communicate with others. Job burnout can lead to absenteeism, leaving the job or having the intention to leave, reduced quality of life, reduced performance, and reduced quality of provided care, or reduced commitment to the organization. In nurses, it can negatively affect the quality of care, patient safety, and performance. 
Organizational climate has always been important in the nursing profession and in the hospital environment where the nurse’ performance is known as an important component in improving the quality of treatment. Given the importance of job burnout and organizational climate, especially in nurses and health care centers, and lack of study on their correlation and prediction in nurses, this study aims to determine the predictability of job burnout based on organizational climate in nurses working in the internal surgery wards of hospitals in Tehran, Iran.
Materials and Methods
This descriptive-correlational study with cross-sectional design was conducted in the internal surgical wards of four selected hospitals affiliated to Iran University of Medical Sciences. Participants were selected by a cluster sampling method. Inclusion criteria were at least 6 months of clinical experience, no experience of grief or crisis in the past 6 months, no use of psychiatric drugs in the past 6 months, no acute physical or mental illness, and at least a bachelor’s degree or higher. At 95% confidence level and considering a 80% test power, the samples size was estimated 200. To collect data, a demographic form surveying age, sex, marital status, work experience, employment status, job position, shift work, economic status, the Maslach burnout inventory (with 22 items, three subscales, 7-point Likert scale, and a total score of 0-154) and Halpin and Croft’s organizational climate description questionnaire (with 32 items, eight subscales, a 5-point Likert scale, and a total score of 32-160) were used. After obtaining a letter of introduction from the School of Nursing and Midwifery and obtaining ethical approval from the Research Ethics Committee of Iran University of Medical Sciences, questionnaires were distributed some in person and others online due to the Covid-19 pandemic. Data analysis was performed in SPSS v.24 software using descriptive statistics (frequency for qualitative variables and mean, maximum, minimum, and standard deviation for quantitative variables) and inferential statistics (independent t test, analysis of variance, and Pearson correlation test)
Results
Among the dimensions of organizational climate, the highest score was related to group spirit (14.8±2.4), followed by interest (13.9±3) and intimacy (13.2±3.2), respectively. In general, the majority of nurses (89%) had a high level of perceived organizational climate. In job burnout, the dimension of depersonalization (63.2±17) had the highest score than other two dimensions. Emotional exhaustion had a statistically significant correlation with all dimensions of organizational climate (except for group spirit and disengagement), where it had a negative correlation with the hindrance dimension and a positive correlation with other dimensions. This indicates that with the increase of hindrance, the score of emotional exhaustion decreases; i.e., it causes more emotional exhaustion. Emotional exhaustion had the highest correlation with the organizational climate dimension of interest. The personal accomplishment domain of job burnout had no statistically significant relationship with the organizational climate dimensions of hindrance, consideration, and production emphasis, but had a significant correlation with other dimensions of organizational climate, mostly with the intensity dimension. Furthermore, the depersonalization domain of job burnout had a significant negative correlation with the organizational climate dimensions of hindrance and disengagement, and a significant positive correlation with the dimension of interest, but had no significant correlation with other dimensions of organizational climate. The results of the analysis of variance showed that the dimensions of job burnout (P=0.008) and organizational climate (P=0.003) had a significant relationship only with employment status.
Discussion
The emotional exhaustion domain of job burnout had a statistically significant correlation with all dimensions of organizational climate except for group spirit and disengagement. Health workers, especially nurses and managers of different health centers should take measures to reduce job burnout and improve organizational climate and patient satisfaction according to the existing conditions and resources. It is recommended that the educational supervisors of the hospitals develop and implement in-service training focusing on the components of job burnout and organizational climate. 

Ethical Considerations
Compliance with ethical guidelines
This study obtained its ethical approval from the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.612). Participants’ information was kept confidential.

Funding
This article was extracted from a master thesis approved by Zahra Salehi, school of nursing and midwifery of medical surgical department of Iran University of Medical Sciences.

Authors' contributions
Editing & review, drafting, data collection: Zahra Salehi; Project administration: Daryadokht Masror-Roodsary; Investigation and methodology: Hamid Haqqani.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all the nurses working in the study hospitals and the officials of the School of Nursing and Midwifery for their cooperation.

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