The burnout-depression conundrum: investigating construct-relevant multidimensionality across four countries and four patient samples.

This research seeks to contribute to the ongoing discussion about the distinctive nature of burnout and depression. In a first study, we relied on employee samples from four European countries (N = 5199; 51.27% women; Mage = 43.14). In a second study, we relied on a large sample of patients (N = 5791; 53.70% women; Mage = 39.54) who received a diagnosis of burnout, depressive episode, job strain, or adaptation disorder. Across all samples and subsamples, we relied on the bifactor exploratory structural equation modelling to achieve an optimal disaggregation of the variance shared across our measures of burnout and depression from the variance uniquely associated with each specific subscale included in these measures. Our results supported the value of this representation of participants' responses, as well as their invariance across samples. More precisely, our results revealed a strong underlying global factor representing participants' levels of psychological distress, as well as the presence of equally strong specific factors supporting the distinctive nature of burnout and depression. This means that, although both conditions share common ground (i.e. psychological distress), they are not redundant. Interestingly, our results also unexpectedly suggested that suicidal ideation might represent a distinctive core component of depression.

Engaging leadership and nurse well-being: the role of the work environment and work motivation-a cross-sectional study.

BACKGROUND: Healthcare literature suggests that leadership behavior has a profound impact on nurse work-related well-being. Yet, more research is needed to better conceptualize, measure, and analyse the concepts of leadership and well-being, and to understand the psychological mechanisms underlying this association. Combining Self-Determination and Job Demands-Resources theory, this study aims to investigate the association between engaging leadership and burnout and work engagement among nurses by focusing on two explanatory mechanisms: perceived job characteristics (job demands and resources) and intrinsic motivation. METHODS: A cross-sectional survey of 1117 direct care nurses (response rate = 25%) from 13 general acute care hospitals in Belgium. Validated instruments were used to measure nurses' perceptions of engaging leadership, burnout, work engagement, intrinsic motivation and job demands and job resources. Structural equation modeling was performed to test the hypothesised model which assumed a serial mediation of job characteristics and intrinsic motivation in the relationship of engaging leadership with nurse work-related well-being. RESULTS: Confirmatory factor analysis indicated a good fit of the measurement model. The findings offer support for the hypothesized model, indicating that engaging leadership is linked to enhanced well-being, as reflected in increased work engagement, and reduced burnout. The results further showed that this association is mediated by nurses' perceptions of job resources and intrinsic motivation. Notably, while job demands mediated the relationship between EL and nurses' well-being, the relationship became unsignificant when including intrinsic motivation as second mediator. CONCLUSIONS: Engaging leaders foster a favourable work environment for nursing staff which is not only beneficial for their work motivation but also for their work-related well-being. Engaging leadership and job resources are modifiable aspects of healthcare organisations. Interventions aimed at developing engaging leadership behaviours among nursing leaders and building job resources will help healthcare organisations to create favourable working conditions for their nurses. TRIAL REGISTRATION: The study described herein is funded under the European Union's Horizon 2020 Research and Innovation programme from 2020 to 2023 (Grant Agreement 848031). The protocol of Magnet4Europe is registered in the ISRCTN registry (ISRCTN10196901).

Boredom and engagement at work: do they have different antecedents and consequences?

This study aimed to demonstrate the empirical distinctiveness of boredom at work and work engagement in relation to their potential antecedents (job demands and job resources) and consequences (psychological distress and turnover intention) based on the Job Demands-Resources model. A three-wave longitudinal survey was conducted among registered monitors of an Internet survey company in Japan. The questionnaire included scales for boredom at work, work engagement, psychological distress, and turnover intention as well as participants' job characteristics and demographic variables. The hypothesized model was evaluated via structural equation modeling with 1,019 participants who were employed full-time. As expected, boredom at work was negatively associated with quantitative job demands and job resources and positively associated with psychological distress and turnover intention. In contrast, work engagement was positively associated with job resources and negatively associated with turnover intention. Thus, boredom at work and work engagement had different potential antecedents and were inversely related to employee well-being and organizational outcomes. However, contrary to expectations, qualitative job demands were not significantly associated with boredom at work. Further investigation is needed to understand the relationship between boredom and qualitative job demands, which require sustained cognitive load and the use of higher skills.

The psychometric properties of the Burnout Assessment Tool in Norway: A thorough investigation into construct-relevant multidimensionality.

OBJECTIVE: The World Health Organization recognizes burnout as an occupational issue. Nevertheless, accurately identifying employee burnout remains a challenging task. To complicate matters, current measures of burnout have demonstrated limitations, prompting the development of the Burnout Assessment Tool (BAT). Given these circumstances, conducting an in-depth examination of the BAT's construct-relevant multidimensionality is crucial. METHOD: This study focuses on both the original 23-item BAT and the short 12-item version, using modern factor analytic methods to investigate reliability, validity, and measurement invariance in a representative sample from Norway (n = 493; 49.54% women). RESULTS: Our findings revealed that the bifactor exploratory structural equation modeling solution (burnout global factor and four specific burnout component factors) best explained the data for both BAT versions. All factors demonstrated adequate omega coefficients, with the global factor showing exceptional strength. Both BAT versions correlated highly with each other and with another burnout measure, suggesting convergent validity. Furthermore, both BAT versions achieved full (strict) measurement invariance based on gender. Finally, our results showed that burnout acts as a mediator in our proposed job demands-resources model as preliminary evidence of predictive validity. CONCLUSIONS: The study validates the Burnout Assessment Tool in the Norwegian context. The study supports the reliability, validity, and unbiased nature of the tool across genders. The findings also reinforce the importance of job demands and resources, along with burnout as a key mediator, in understanding workplace dynamics in accordance with job demands-resources theory.

Measuring work engagement in Thailand: development and validation testing of the Utrecht Work Engagement Scale - Thai version (UWES-TH).

This study aimed to develop and test the psychometric properties of a Thai-language version of the Utrecht Work Engagement Scale (UWES). The 17-item version of UWES was translated into Thai and a survey was conducted with 507 registered nurses at a public regional hospital in Thailand. Results showed that the alpha and omega total coefficients for the vigor, dedication, and absorption subscales were acceptable. Exploratory Structural Equation Modeling (ESEM) indicated that the three-factor model performed the best for both versions of UWES-17-TH and UWES-9-TH. Both versions correlated positively with job resources and negatively with cognitive, emotional, and physical job demands, and with emotional exhaustion and physical symptoms. They were found to have acceptable reliability and validity and can be used to study work engagement in Thai contexts. For practical reasons, UWES-9-TH might be preferred since it is shorter than the full version. Further studies should include different occupational groups and more male participants.

What makes nurses flourish at work? How the perceived clinical work environment relates to nurse motivation and well-being: A cross-sectional study.

BACKGROUND: Literature shows that the work environment is a main determinant of nurses' well-being and psychological strain; yet, the (psychological) mechanisms underlying this relationship remain understudied. OBJECTIVE: This study explored the underlying (psychological) mechanisms (why) and boundary conditions (when) by which characteristics present in the clinical work environment influence nurses' well-being. We investigated the mediating role of intrinsic motivation in the relationship of job demands and job resources with burnout vs. work engagement. In addition, we examined if job resources strengthen the relationship of job demands with intrinsic motivation and burnout. DESIGN: A cross-sectional survey study. SETTING(S): General acute care hospitals in Belgium (n = 14). PARTICIPANTS: Direct care nurses (n = 1729). METHODS: Data were collected by means of online questionnaires between October 2020 and July 2021. Study variables included burnout, work engagement, intrinsic motivation and a set of different job demands (workload, role conflicts, emotional demands, red tape) and job resources (performance feedback, autonomy, skill use, opportunity for growth, and value congruence). All variables were obtained using self-report measures. The central hypotheses were tested using structural equation modeling. RESULTS: Job resources appeared to be a crucial factor for nurses' health showing positive associations with work motivation (ß = 0.513) and work engagement (ß = 0.462) and negative associations with burnout (ß = -0.216). Job demands remained an essential factor that harms psychological health and is associated with increased burnout (ß = 0.489). Our results confirmed that intrinsic motivation mediated the relationship of job resources with work engagement (ß = 0.170) and burnout (ß = -0.135). In addition, job resources moderated the relationship of job demands with burnout (ß = -0.039). Against our expectations, we found no associations between job demands and intrinsic motivation or a moderation effect of job resources on the respective relationship. CONCLUSIONS: A highly demanding work environment can be a source of significant stress which may put nurses' health at severe risk. Nurses who perceive sufficient job resources such as feedback, autonomy and opportunities for growth and development, are likely to feel intrinsically motivated at work. In addition, it will foster their work engagement and prevent them from burning out, particularly when job demands are high. REGISTRATION: The study described herein is funded under the European Union's Horizon 2020 Research and Innovation program from 2020 to 2023 (Grant Agreement 848031). The protocol of Magnet4Europe is registered in the ISRCTN registry (ISRCTN10196901). TWEETABLE ABSTRACT: Providing nurses with sufficient resources will not only increase their motivation and engagement at work but also reduce their feelings of burnout.

The Greek Burnout Assessment Tool: Examining Its Adaptation and Validity.

Burnout is a significant challenge in the workplace. Its extent is global and its unfavourable consequences are diverse, affecting the individual, the organization, and society. The aim of the present study was to examine the adaptation and assess the validity of the Greek version of the Burnout Assessment Tool (BAT). The adaptation process included the translation and back-translation of the BAT. Data were collected from 356 Greek employees from diverse sectors. Confirmatory factor analysis and item response theory were utilized to assess the validity of the Greek version of the BAT. According to the findings of the present research, the core symptoms scale and the secondary symptoms scale of BAT-23 and BAT-12 models demonstrated adequate structures for the analysis and measurement of burnout in the Greek context. Finally, the psychometric performance of the BAT-GR-12 compared to the BAT-GR-23 establishes it as a more optimum instrument for the assessment of burnout across Greek working adults.

How to assess severe burnout? Cutoff points for the Burnout Assessment Tool (BAT) based on three European samples.

OBJECTIVE: Despite decades of burnout research, clinical validated cut-off scores that discriminate between those who suffer from burnout and those who don't are still lacking. To establish such cut-off scores, the current study uses a newly developed questionnaire, the Burnout Assessment Tool (BAT) that consists of four subscales (exhaustion, mental distancing, and emotional and cognitive impairment). Separate cut-offs were computed for those at risk for burnout and those suffering from severe burnout for the original BAT-23 as well as for the shortened BAT-12. METHODS: Relative operating characteristic (ROC) analyses were carried out using representative samples of healthy employees from The Netherlands (N=1370), Belgium (Flanders; N=1403) and Finland (N=1350). In addition, samples of employees who received a burnout diagnosis were used (N=335, 158 and 50, respectively). RESULTS: The diagnostic accuracy of the BAT (area under the curve) ranges from good to excellent with the exception of mental distancing, which is fair. The country-specific cut-off values as well as their specificity and sensitivity are comparable to those of the pooled sample. CONCLUSIONS: In addition to country-specific cut-offs, general cut-offs can be used tentatively in other similar countries, pending future replication studies. Caution is warranted for using cut-offs for mental distance as the sensitivity and specificity of this subscale is relatively poor. It is concluded that the BAT can be used in organizational surveys for identifying employees at risk for burnout and, in clinical treatment settings, for identifying those with severe burnout, keeping in mind the tentativeness of the present cut-offs.

Work Engagement: A meta-Analysis Using the Job Demands-Resources Model.

Although the construct of work engagement has been extensively explored, a systematic meta-analysis based on a consistent categorization of engagement antecedents, outcomes, and well-being correlates is still lacking. The results of prior research reporting 533 correlations from 113 independent samples (k = 94, n = 119,420) were coded using a meta-analytic approach. The effect size for development resources (r = .45) and personal resources (r = .48) was higher than for social resources (r = .36) and for job resources (r = .37). Among the outcomes and well-being correlates explored, the effect size was highest for job satisfaction (r = .60) and commitment (r = .63). Furthermore, moderation analysis showed that (a) concerning the occupational role, work engagement finds a low association with turnover intention among civil servants, volunteer workers, and educators; (b) collectivist cultural environments reported a greater association of feedback with engagement than individualistic environments; (c) the relationship between personal resources and engagement was stronger among workers with university degrees than workers with high school diplomas. Furthermore, the absorption dimension showed a lower effect with all variables under investigation than vigor and dedication.

Resilience mechanisms at work: The psychological immunity-psychological elasticity (PI-PE) model of psychological resilience.

Recently, scientists have shifted their focus from studying psychological resilience as a single, isolated construct (e.g. attribute or outcome) to studying it as a dynamic process encompassing a number of temporally related elements. Models depicting this process explain why some people adapt to stressor exposure, whereas others do not. To date, these process models did not sufficiently explain how people adapt differently to a stressor. To address this issue, we developed a new model of psychological resilience, called the Psychological Immunity-Psychological Elasticity (PI-PE) model. The aim of this article is to clarify this model and to discuss its added value. First, we explain how we derived the PI-PE model from the literature regarding both the crucial elements in any resilience process model and the (mal)adaptive outcomes following stressful events. Secondly, we describe the different elements that make up the model. Characteristic of the PI-PE model is that it distinguishes between two pathways of psychological resilience - psychological immunity and psychological elasticity - with four adaptive outcomes, namely sustainability, recovery, transformation and thriving. To explain how people arrive at these different outcomes, we argue that two consecutive mechanisms are critical in these pathways: tolerance and narrative construction. Taken as a whole, the PI-PE model presents a comprehensive framework to inspire both research and practice. It explains how the process of psychological resilience works differently for different people and how to support individuals in their process towards successfully and differently adapting to stressors.

The moderating effect of employee growth climate on the relationship between work engagement and job outcomes among plantation workers in North Sumatra, Indonesia.

The current study investigates the moderating effect of employee growth climate on the relationship between work engagement and job outcomes among plantation workers in North Sumatra, Indonesia. Three individual-level job outcomes are investigated, namely, intra-role behavior, employee learning, and innovative work behavior. Six hundred and seven Indonesian plantation workers from one of the biggest palm oil plantations in Indonesia participated. Work engagement and employee growth climate were positively related to the three types of job outcomes, as expected. Furthermore, the relationship between work engagement-intra-role behavior and work engagement-innovative work behavior was moderated by employee growth climate. However, no moderating effect of employee growth climate was observed for the relationship between work engagement-employee learning. Thus, organizations may create programs to foster employee growth climate and aware of their employees' learning behaviors.

Validation of the Japanese version of the Dutch Boredom Scale.

OBJECTIVES: The current study aimed to validate the Japanese version of the Dutch Boredom Scale (DUBS-J), a new boredom scale that comprehensively assesses employees' emotional, cognitive, and behavioral responses to low-stimulus work situations. METHODS: The translated and back-translated DUBS was administered via an internet survey to 1358 Japanese employees from various occupations. Confirmatory factor analysis (CFA) was conducted to evaluate factorial validity. In order to evaluate discriminant validity with other work-related, well-being constructs, CFA was conducted, and the square root of average variance extracted (AVE) for the DUBS-J and the square of the inter-construct correlations were compared. Construct validity was evaluated based on the correlation coefficients between boredom at work on the one hand and potential antecedents and consequences on the other hand. RESULTS: Confirmatory factor analysis supported the expected one-factor model. CFA and AVE supported the discriminant validity of DUBS-J with work engagement, workaholism, and job satisfaction. Construct validity was generally supported by expected correlations of boredom at work with possible antecedents and consequences. Internal consistency was confirmed with Cronbach's alpha coefficient = .88, and the results of principal component analysis (PCA). Test-retest reliability was confirmed with intraclass correlation coefficients = .62. CONCLUSION: The current study confirmed that DUBS-J is an adequate measure of boredom at work that can be used in the Japanese context.

The psychometric properties and measurement invariance of the Burnout Assessment Tool (BAT-23) in South Africa.

BACKGROUND: Burnout is an increasing public health concern that afflicts employees globally. The measurement of burnout is not without criticism, specifically in the context of its operational definition as a syndrome, also recently designated as such by the World Health Organisation. The Burnout Assessment Tool (BAT-23) is a new measure for burnout that addresses many of the criticisms surrounding burnout scales. The aim of this study is to determine the validity, reliability, and measurement invariance of the BAT-23 in South Africa. METHOD: A quantitative, cross-sectional survey, approach was taken (n = 1048). Latent variable modelling was implemented to investigate the construct-relevant multidimensionality that is present in the BAT. For measurement invariance, the configural, metric, scalar, and strict models were tested. RESULTS: The analyses showed that the hierarchical operationalisation of BAT-assessed burnout was the most appropriate model for the data. Specifically, a bifactor ESEM solution. Composite reliability estimates were all well above the cut-off criteria for both the global burnout factor and the specific factors. The measurement invariance tests showed that gender achieved not only strong invariance, but also strict invariance. However, ethnicity initially only showed strong invariance, but a test of partial strict invariance did show that the mean scores could be fairly compared between the groups when releasing certain constraints. CONCLUSIONS: The BAT-23 is a valid and reliable measure to investigate burnout within the Southern African context.

Italian Validation of the 12-Item Version of the Burnout Assessment Tool (BAT-12).

The Burnout Assessment Tool (BAT) has shown satisfactory validity evidence in several countries, with the 23-item version of the instrument reporting adequate psychometric properties also in the Italian context. This paper is aimed to present results from the Italian validation of the 12-item version of the BAT. Based on a sample of 2277 workers, our results supported the factorial validity of a higher-order model represented by 4 first-order factors corresponding to the core dimensions of burnout, namely exhaustion, mental distance, and emotional and cognitive impairment. The measure invariance of the BAT-12 between data collected before and during the COVID-19 pandemic was supported. However, ANCOVA results suggest a higher score on the second-order burnout factor on data collected during the COVID-19 pandemic in comparison with earlier data. In line with the JD-R model, the BAT-12 total score reported a positive association with job demands (i.e., workload, time pressure, and role conflict) and a negative association with job resources (i.e., job autonomy, coworkers' support) and personal resources (i.e., optimism, social self-efficacy, and task self-efficacy). Additionally, the BAT-12 showed a negative association with work engagement components (i.e., vigor, dedication, and absorption) and positive job attitudes (i.e., job satisfaction, affective commitment). All in all, our results identify the Italian version of the BAT-12 as a brief and reliable tool for measuring burnout among workers.

A workplace organisational intervention to improve hospital nurses' and physicians' mental health: study protocol for the Magnet4Europe wait list cluster randomised controlled trial.

INTRODUCTION: The increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the well-being of healthcare professionals. METHODS AND ANALYSIS: Magnet4Europe is a cluster randomised controlled trial, with wait list controls, designed to evaluate the effects of organisational redesign, based on the Magnet model, on nurses' and physicians' well-being in general acute care hospitals, using a multicomponent implementation strategy. The study will be conducted in more than 60 general acute care hospitals in Belgium, England, Germany, Ireland, Norway and Sweden. The primary outcome is burnout among nurses and physicians, assessed in longitudinal surveys of nurses and physicians at participating hospitals. Additional data will be collected from them on perceived work environments, patient safety and patient quality of care and will be triangulated with data from medical records, including case mix-adjusted in-hospital mortality. The process of implementation will be evaluated using qualitative data from focus group and key informant interviews. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee Research UZ/KU Leuven, Belgium; additionally, ethics approval is obtained in all other participating countries either through a central or decentral authority. Findings will be disseminated at conferences, through peer-reviewed manuscripts and via social media. TRIAL REGISTRATION NUMBER: ISRCTN10196901.

The impact of engaging leadership on employee engagement and team effectiveness: A longitudinal, multi-level study on the mediating role of personal- and team resources.

Most research on the effect of leadership behavior on employees' well-being and organizational outcomes is based on leadership frameworks that are not rooted in sound psychological theories of motivation and are limited to either an individual or organizational levels of analysis. The current paper investigates whether individual and team resources explain the impact of engaging leadership on work engagement and team effectiveness, respectively. Data were collected at two time points on N = 1,048 employees nested within 90 work teams. The Multilevel Structural Equation Modeling results revealed that personal resources (i.e., optimism, resiliency, self-efficacy, and flexibility) partially mediated the impact of T1 individual perceptions of engaging leadership on T2 work engagement. Furthermore, joint perceptions of engaging leadership among team members at T1 resulted in greater team effectiveness at T2. This association was fully mediated by team resources (i.e., performance feedback, trust in management, communication, and participation in decision-making). Moreover, team resources had a significant cross-level effect on individual levels of engagement. In practical terms, training and supporting leaders who inspire, strengthen, and connect their subordinates could significantly improve employees' motivation and involvement and enable teams to pursue their common goals successfully.

Burnout Assessment Tool (BAT): Validity Evidence from Brazil and Portugal.

The Burnout Assessment Tool (BAT) has been gaining increased attention as a sound and innovative instrument in its conceptualization of burnout. BAT has been adapted for several countries, revealing promising validity evidence. This paper aims to present the psychometric properties of the Brazilian and Portuguese versions of the BAT in both the 23-item and 12-item versions. BAT's validity evidence based on the internal structure (dimensionality, reliability, and measurement invariance) and validity evidence based on the relations to other variables are the focus of research. A cross-sectional study was conducted with two non-probabilistic convenience samples from two countries (N = 3103) one from Brazil (nBrazil = 2217) and one from Portugal (nPortugal = 886). BAT's original structure was confirmed, and it achieved measurement invariance across countries. Using both classic test theory and item response theory as frameworks, the BAT presented good validity evidence based on the internal structure. Furthermore, the BAT showed good convergent evidence (i.e., work engagement, co-worker support, role clarity, work overload, and negative change). In conclusion, the psychometric properties of the BAT make this freely available instrument a promising way to measure and compare burnout levels of Portuguese and Brazilian workers.

Psychometric Properties of the Italian Version of the Burnout Assessment Tool (BAT).

The most popular instrument to measure burnout is the Maslach Burnout Inventory (MBI). Recently, to overcome some of the limitations of the MBI, a new instrument has been proposed, namely the Burnout Assessment Tool. The purpose of this study is to examine the psychometric properties of the Italian version of the BAT. This tool is comprised of a set of four core dimensions (BAT-C; i.e., exhaustion, mental distance, cognitive and emotional impairment) and two secondary symptom dimensions (BAT-S; i.e., psychological and psychosomatic complaints). Data were collected on a sample of 738 participants from heterogeneous sectors and professional roles. In the sample women were slightly overrepresented (52.9%), the participants had a mean age of 41.57 years (SD = 10.51) and a mean organizational tenure of 9.65 years (SD = 8.50). The reliability and factorial structure of the BAT-C and BAT-S, together with the convergent and discriminant validity of BAT-C and MBI were explored, as well as the incremental validity to the BAT-C, over and beyond the MBI. Our results confirmed the factorial validity of a two-factor second-order factor model (BAT-C and BAT-S) represented by 4 first-order factors in the case of BAT-C and 2 first-order factors for BAT-S. Results also attested that BAT-C explains additional variance of the BAT-S, above and beyond what is explained by the MBI-GS. All in all, this study provided evidence that the Italian version of BAT represents a reliable and valid tool for measuring burnout in the work context.

The Ecuadorian Version of the Burnout Assessment Tool (BAT): Adaptation and Validation.

This study aimed to adapt and show evidence of validity for the Ecuadorian version of the Burnout Assessment Tool (BAT) considering only its "core" dimensions. The adaptation process included its translation and back translation. For content validation, expert reviews and focus groups were carried out. A confirmatory factor analysis was used to identify the psychometric properties and dimensionality of the scale. The reliability of the scale was assessed through the alpha, omega and composite reliability indices. To carry out the study, the questionnaire was applied to a sample of workers with a high level of education in Ecuador. In total, 2237 respondents were considered in the analysis. The results showed that the hierarchical model for BAT-23 and its short version, the BAT-12 scale, is the most adequate structure for analysis of the construct in the Ecuadorian context. The reliability of the general factor of burnout and its dimensions, evaluated by composite reliability, omega and Cronbach's alpha, showed satisfactory indices. The findings obtained provide support for the reliability and validity of the Burnout Assessment Tool for the Ecuadorian context.

Within- and between-person factor structure of the Oldenburg Burnout Inventory: Analysis of a diary study using multilevel confirmatory factor analysis.

The study examined the factor structure of burnout, as measured with the Oldenburg Burnout Inventory. The participants were 235 employees of a public administration agency who assessed their burnout online for 10 consecutive working days. Two models were tested with multilevel confirmatory factor analysis, assuming the same one or two-factor structure at the within- and between-person levels. Both models showed a reasonable fit to the data, but due to a strong correlation between exhaustion and disengagement and low within-person reliability for disengagement, a unidimensional model seems more valid. A cross-level invariance was not confirmed for either of the structures, showing that factor loadings for the same items differ significantly between the levels. This suggests that burnout is not the same latent variable at each level; rather, there are factors other than daily burnout that influence person-level scores and ignoring these across-level discrepancies may lead to biased conclusions.