Concept identification and definition
To prepare
Reflect on the phenomenon of interest and concepts you identified in the Week 2 Discussion. Based on insights you have gained this week, would you like to make any modifications to your phenomenon and/or concepts? If so, you may do so before posting to this Discussion.
Although you will identify more than one concept for your research, select one primary concept on which to focus for this Discussion. Your concept should be one word or a very short phrase (e.g., quality of life).
Review the literature to see how this concept is defined in various sources. Remember to look at literature across all disciplines in which this concept may be used. Also search for all known definitions of the word in an unabridged dictionary.
As you do this, consider the following:
Has the concept been developed directly from nursing or health care research or practice, or has it been borrowed or derived from another discipline?
To what degree is the concept abstract or concrete?
How suitable is this concept for your intended use?
Formulate a definition of the concept that aligns with your intended research. (Your definition may continue to evolve as you complete your concept analysis for the Assignment introduced this week. In addition, you will likely make adjustments as you proceed through this course and/or later in this PhD program if you continue to address the concept.)
By Day 3
Post your selected concept and provide a definition of it, as well as context to help your colleagues understand what you are addressing. Summarize at least one article that addresses the concept and discuss how the information presented relates to your own definition of the concept.
C O N C E P T A N A L Y S I S
Work engagement in nursing: a concept analysis
L. Antoinette Bargagliotti
Accepted for publication 17 September 2011
Correspondence to L. Antoinette Bargagliotti:
e-mail: [emailprotected]
L. Antoinette Bargagliotti DNSc RN FAAN
Professor
University of Memphis Loewenberg
School of Nursing, Memphis, Tennessee,
USA
A N T O I N E T T E B A R G A G L I O T T I L . ( 2 0 1 2 )A N T O I N E T T E B A R G A G L I O T T I L . ( 2 0 1 2 ) Work engagement in nursing: a
concept analysis. Journal of Advanced Nursing 68(6), 14141428. doi: 10.1111/
j.1365-2648.2011.05859.x
Abstract
Aim. This article is a report of an analysis of the concept of work engagement.
Background. Work engagement is the central issue for 21st century professionals
and specifically for registered nurses. Conceptual clarity about work engagement
gives empirical direction for future research and a theoretical underpinning for the
myriad studies about nurses and their work environment.
Method. Walker and Avants method of concept analysis was used. Nursing,
business, psychology and health sciences databases were searched using Science
Direct, CINAHL, OVID, Academic One File, ABI INFORM and PsycINFO for
publications that were: written in English, published between 1990 and 2010, and
described or studied work engagement in any setting with any population.
Results. Work engagement is a positive, fulfilling state of mind about work that is
characterized by vigour, dedication and absorption. Trust (organizationally,
managerially and collegially) and autonomy are the antecedents of work engage-
ment. The outcomes of nurses work engagement are higher levels of personal
initiative that are contagious, decreased hospital mortality rates and significantly
higher financial profitability of organizations.
Conclusion. When work engagement is conceptually removed from a transactional
job demands-resources model, the relational antecedents of trust and autonomy
have greater explanatory power for work engagement in nurses. Untangling the
antecedents, attributes and outcomes of work engagement is important to future
research efforts.
Keywords: autonomy, concept analysis, nurses work engagement, trust
Introduction
Work engagement in nursing is becoming strategically
important as three important factors converge: a global
shortage of nurses who are the largest group of healthcare
providers; political resolve to restrain the growth of rising
healthcare costs in industrialized nations; and a medical error
rate that threatens the health of nations. Since nurses report
low levels of work engagement (Fasoli 2010) by scoring
lower than other hospital groups (Blizzard 2005a) on
measures of work engagement, understanding engagement
is important. While the concept of work engagement emerges
from the new positive psychology (Luthans et al. 2007,
p. 541) that focuses on human strengths, rather than
limitations, work engagement has captured global research
attention because it is amenable to change (Luthans et al.
1414 2011 Blackwell Publishing Ltd
J A N JOURNAL OF ADVANCED NURSING
2007). The purpose of this concept analysis is to clarify the
concept of work engagement in nursing.
Work engagement has been studied by the disciplines of
nursing, psychology, education and business in more than
one million people. The participants for these studies have
been nurses and other professionals in the US (Mackoff &
Triolo 2008a,b, Simpson 2009b, Palmer et al. 2010), Canada
(Spence-Laschsinger et al. 2006), the Netherlands (Brake
et al. 2007), South Africa (Rothman 2008), Australia (Parker
& Martin 2009), Ireland (Freeney & Tiernan 2009), Norway
(Andreassen et al. 2007, Vinje & Mittlemark 2008), Finland
(Hakanen et al. 2008a), China (Lu et al. 2011) and Spain
(Jenaro et al. 2010).
Work engagement contributes to a distinctive body of
nursing knowledge because it theoretically underpins the
actions of nurses and nurse managers as they create a practice
environment that either supports safe and effective care or
does not. According to the IOM (2003) report, the US nurses
work environment is a threat to patient safety. Lakes (2007)
review of 54 nursing studies of the practice environment, and
Cummings et al.s (2010) review of 53 studies of the effects of
nursing leadership on nursing practice attest to an enduring
nursing interest in creating a practice environment that
supports safe and effective care.
Background
Clarifying the concept of work engagement is important in
nursing because as Rafferty and Clark (2009) noted, The
danger with concepts like engagement is that they can
become unwieldy, fuzzily-defined terms invoked as panaceas
for the dilemmas of workforce management (p. 876).
Simpsons (2009a) nursing review of the research on work
engagement concluded that there is an essential need to
differentiate the antecedents from defining attributes because
these have been interchangeably used. This conceptual
confusion has prompted four distinctive lines of research:
personal engagement, burnout/engagement, work engage-
ment and employee engagement (Simpson 2009a).
Fasoli (2010) characterized work engagement as the fifth
line of inquiry emerging from the American Academy of
Nursings Magnet study of the characteristics of hospitals
that attract and retain nurses (McClure et al. 1983). The
original MagnetTM study gave empirical evidence for what
came to be known as the essentials of magnetism (clinical
competence, RN/MD relationships, autonomy, support for
education, nurse manager support, cultural values and
adequacy of staffing). According to Fasoli (2010) the original
magnet research in the US was followed by a second wave
that shifted the focus to patient outcomes, a third wave that
compared Magnet designated hospital outcomes to their non-
Magnet cohorts, a fourth wave that focused on measuring the
professional environment and now an emerging fifth wave
focused on work engagement. Engagement moves beyond
retention to the strategic question of how to engage nurses in
their professional practice (Wagner 2006, Fasoli 2010). The
related concept of embeddedness points out why engagement
may or may not be related to retention. Embeddedness is an
enduring attachment to a job and work setting that occurs
because of the constellation of factors that keep a person in
one job. Links, person-job fit and the sacrifices that leaving
would entail are factors that grow over time to cause
embeddedness (Halbesleben & Wheeler 2008). In contrast,
work engagement is directly related to the work itself that
could be done in multiple settings.
A model of work engagement (Bakker & Demerouti 2008)
that is intuitively appealing and one that has captured
important research attention is one that is based on job
resources and demands (JD-R).
The job demands-resources model
The JD-R model (Bakker & Demerouti 2008) posits that in
all jobs, there are demands and varying resources to meet
those demands. Demands are the job requirements that
require employee effort to achieve. Resources are aspects of
the job that either enable the work to be done, ameliorate
work demands, reduce the personal cost of doing work, or
develop the work-related skill sets of the person (Demerouti
et al. 2001). The JD-R model posits that burnout occurs
when resources are inadequate and work engagement occurs
when resources are high. Subsequently, in a JD-R model, high
resource levels become the antecedent of work engagement.
The JD-R model is conceptually rooted in Lazarus and
Folkmans (1984) transactional model of stress and coping
that describes stress as the outcome of situations where
demands (stressors) exceed available resources (coping).
However, as Hobfoll (1989) cogently noted, the inherent
flaw in all transactional or balance models of stress and
coping is the tautology that neither side of the equation
(demands or resources) has meaning without the other.
Conceptualizing the antecedents of work engagement as
personal and organizational resources that mediate or are
mediated by job demands has mixed empirical support as
noted in Tables 2 and 3. However, the JD-R model fails to
explain how work engagement occurs in adverse conditions
when demands are extraordinarily high and resources are
scarce as in an emergency or natural disaster. Moreover, this
transactional approach means that nurses work engagement
is solely dependent on the dubious outcome of a balancing act
JAN: CONCEPT ANALYSIS Engagement
2011 Blackwell Publishing Ltd 1415
between demands/resources. Subsequently, this relegates the
dedication of nurses, a distinguishing characteristic of the
profession (Fagermoen 1997, Pask 2005, OConnor 2007), to
being a transactional commodity that occurs because some-
one else dispenses resources. And, work engagement becomes
externally controlled.
Method
Walker and Avants (2010) model of concept analysis was
used. Their eight-step model includes selecting the concept
for analysis, determining the aim, identifying uses of the
concept, determining defining attributes, constructing cases,
identifying the antecedents and consequences of the concept
and defining the empirical referents for the concept.
Data sources
The Cumulative Index of Nursing and Allied Health
(CINAHL), Science Direct, OVID (Lippincott), Academic
One File, ABI INFORM and PsycINFO were systematically
searched using the keywords: work engagement, engagement,
work engagement in nursing. The inclusion criteria included:
written in English, published between 1990and 2010, and
described or studied work engagement in any setting with any
population. Because Kahn (1990) first described work
engagement in 1990, all articles between 1990 and 2010
were reviewed against the inclusion criteria of theoretical
work or empirical studies of work engagement.
Results
The results of the concept analysis include the uses of the
concept, the definitions of engagement and work engage-
ment, the attributes, three constructed cases, the antecedents,
the consequences and the empirical referents.
Uses of the concept
The Encarta World English Dictionary North American
Edition (2009) defined engagement as: agreement to marry,
commitment to attend, short job, battle, and an active or
operational state. Engagement connotes encounter when
used in the phrase the rules of engagement. For example,
Laurence (2007) described his ostracism by soldiers when his
news reports violated their rules of engagement or unspoken
rules of conduct about reporting from a battlefield.
Nursing has used the term engagement as engaged
scholarship, civic engagement and clinical engagement.
Engaged scholarship describes the work of faculty who
engage students as active learners in real world settings
(engaged pedagogy), collaborate with practice colleagues to
conduct community-based research and collaborate in
practice (Burrage et al. 2005). Civic engagement refers to
the political activism of nurses to shape health policy at local,
state, national and international levels (Gehrke 2008). At a
micro level, Ellefson and Kims (2005) qualitative study of
Norwegian nurses revealed that clinical engagement
included: nursing approaches and movements in time, space
and perspectives; involvement as in knowing the patient; and
clinical actions that were therapeutic, caring and efficient.
Definitions of work engagement
The empirical and theoretical definitions of work engagement,
as noted in Tables 13, have focused either on the person/
organization interaction or on the experience of the person
who is engaged in work. Tying the efforts of the person to
organizational goals can be found in two similar definitions of
work engagement: the harnessing of organizational member
selves to their work roles as a way of self-expression in work
(Kahn 1990, p. 694) and working collegially to meet organi-
zational goals (Seymour & Dupre 2008). However, when the
focus is shifted to the experience of the person, work
engagement is defined as a positive, fulfilling work-related
state of mind (Schaufeli et al. 2002, p. 465) and well-being at
work that is characterized by vigour, dedication, and
absorption (Schaufeli & Bakker 2003).
Vinje and Mittlemarks (2008) qualitative study of com-
munity health nurses work engagement defined work
engagement as searching for, experiencing, and holding on
to the meaningful work that enables one to lives ones values
(p. 200). Alternatively, Maslach and Leiter (1997) defined
engagement as the polar opposite of burnout and Shimazu
and Schaufeli (2008) as the antithesis of burnout. Efforts to
differentiate work engagement from burnout using Warrs
(2002) four dimensions of work well-being in a study of
South African police officers did not conceptually untangle
the two concepts (Rothman 2008). For the purposes of this
analysis, Schaufeli et al.s (2002) earlier definition of work
engagement as a positive, fulfilling work-related state of
mind (p. 465) is used.
Defining attributes of work engagement
The defining attributes are those characteristics of the
concept that both define and differentiate the concept
(Walker & Avant 2010). The employment and expression
of the persons preferred self in task behaviors that promote
connections to work and to others, personal presence…. and
L. Antoinette Bargagliotti
1416 2011 Blackwell Publishing Ltd
active, full role performance (Kahn1990, p. 770), being
emotionally connected to each other (Harter et al. 2002a)
and cognitively vigilant (Harter et al. 2002a) have been
described as attributes of work engagement.
Vigour, dedication and absorption (Schaufeli & Bakker
2004) have been commonly used attributes in work engage-
ment research. When work engagement is conceptualized as
the antithesis of burnout, the attributes of work engagement
become energy, involvement and efficacy as the polar
opposites of burnout (Maslach & Leiter 1997). Vigour is
the energy and enthusiasm that the person brings to the work
setting. Dedication is being devoted, inspired and believing
that the work has a purpose. Absorption is being immersed in
the work to the extent that it is difficult to leave and time
becomes less relevant (Schaufeli & Bakker 2004).
Most recently, Vinje and Mittlemark (2008) described
three inter-related attributes of nurses work engagement:
having a calling (p. 198) which provides the path to
meaningfulness; zest which happens when experiencing
meaningfulness in work; and vitality, which is the ability to
hold onto meaningfulness in work. The two most commonly
agreed on dimensions of work engagement are high levels of
energy and identification with work (Bakker et al. 2008).
Vigour, absorption and dedication (Schaufeli & Bakker
2004) were selected as defining attributes of work engage-
ment because as indicated in Table 3 they have been widely
used in work engagement research (Schaufeli & Bakker 2003,
Wong et al. 2010, Jenaro et al. 2010).
Constructed cases
Constructed cases illuminate the concept by describing the
concepts presence in a model case, the absence of a concept
in a contrary case and the differences between the concept
and a closely associated concept in a related case (Walker &
Avant 2010).
Model case
JM, BSN, CCRN has practiced for 10 years in the intensive
care unit (ICU) of an acute care hospital that also has a Level
1 trauma centre. She excitedly tells her colleague that she had
the most wonderful day because she knew that Mr Ts tidal
volume and fluids needed to be increased before his blood
gases, blood pressure and urine output continued to deteri-
orate. Her colleagues and her manager congratulate her on
seeing what they did not see. Dr J. congratulated her on her
good call and asked how she knew. She helped Mr Ts wife
find ways to ensure her husband had some uninterrupted rest.
She was able to help a younger nursing colleague who was
Table 1 Emergence of work engagement definitions, attributes and measurement.
Kahn (1990)
Maslach and Leiter
(1997)
Schaufeli et al.
(2002)
Harter et al.
(2002a)
Vinje and Mittlemark
(2008)
Definition Harnessing of
organizational
members selves to
work roles (p. 694)
Opposite end of
burnout continuum
Positive, fulfilling
work-related state of
mind (p. 465)
Searching for,
experiencing, and holding
on to the meaningful work
that enables one to live
ones values (p. 200)
Defining
attributes
Use of preferred self
(skill, talent) in
performing tasks,
presence, and
connection to others
in fulfilling role
Energy (vs. exhaustion)
Involvement
(vs. cynicism)
Efficacy (instead of
reduced efficacy)
Vigour high energy
levels with willingness
to persist in investing
in work even during
difficult times
Dedication enthusiasm
and identification with
work
Absorption deep
engrossment in work
Extended engagement
model adds personal
efficacy
Emotionally
connected
to each other;
cognitively
vigilant
Calling a path to
meaningfulness
Zest experience
meaningfulness
Vitality hold onto
meaningfulness
Measurement Grounded theory that
was later scored
Maslach Burnout
Inventory (MBI-GS)
(Maslach & Jackson
1981)
Utrecht Work
Engagement
Scale (UWES)
Q-12 Phenomenology
JAN: CONCEPT ANALYSIS Engagement
2011 Blackwell Publishing Ltd 1417
Table 2 Antecedents of work engagement.
Job demands Job resources
Personality
characteristics
Organizational
actions
Organizational
life
Job demands are physical,
social or organizational
efforts of the job that
require sustained physical
and/or mental efforts
(Demerouti et al. 2001,
p. 501) that lead to energy
depletion and exhaustion
(Schaufeli & Bakker
2004)
Job resources are
motivational. physical,
social, or organizational
aspects of the job that may:
(1) function in achieving
work goals; (2) reduce job
demands and the
associated physiological
and psychological costs;
(3) stimulate personal
growth and development
(Demerouti et al. 2001,
p. 501)
Kim et al. (2009) study
(n = 187 Subway workers
and managers in 51 stores)
of the Big 5 personality
characteristics
[neuroticism (negative
affect), extroversion,
agreeableness,
conscientiousness and
openness to new
experiences] found that
conscientiousness
positively predicted work
engagement and
neuroticism inversely
predicted engagement
Clarity of
expectations
and basic materials
and resources are
provided
Feelings of
contribution
to the organization
Belonging to
something
beyond oneself
Workload, control over
work
Reward and recognition
(ongoing weekly
feedback)
Sense of community
(collegial social
support)
Fairness as opposed to a
lack of transparency
and promotions not
handled equitably
(Freeney and Tiernan
2009)
Bacon and Mark (2009)
study (n = 146 hospitals,
2720 patients, 3718
nurses in 286 nursing
units) found that hospitals
with >5% increase in
admission and higher
complexity were
negatively related to
work engagement
Kim et al. (2009) study
(187 Subway managers
and workers) found that
skill variety and
management position were
predictive of engagement
Buoyancy (daily resilience)
is a personal belief that
one can effectively manage
problems (Parker &
Martin 2009)
(PsyCap) composite of
self-efficacy, optimism,
hope, and resilience as
greatest contributor to
organizational
commitment (Luthans
et al. 2007) (n = 167
management college
students; n = 115
engineers and technicians
of Fortune 500 company
and n = 144 insurance
company employees)
Opportunities for
growth and
development
(Harter et al.
2002b)
Recognition,
person-job fit and
energy that comes
from being valued
in a climate that
supports employee
interests/passions.
(Kerfoot 2007)
Higher levels of support
staff and of work
engagement of nurses
were related to higher
patient satisfaction
ratings
Schaufeli and Bakker
(2004) motivational job
resources are collegial
social support,
performance feedback
and coaching
Job resources leads to
work engagement which
leads to personal initiative
that leads to work-unit
innovation that leads to
personal initiative that
leads to engagement, and
predicts future resources
(Hakanen et al. 2008a)
Job control is the job
resource that leads to
work engagement
(Mauno et al. 2007)
Personal resources of
self -efficacy
Optimism
Organizationally based
self-esteem
(Xanthopoulou
et al. 2009)
Trust (willingness to
accept vulnerability and
positive expectations) in
top management,
supervisors and co-worker
engagement has a
spiralling effect in that one
leads to more of the other.
Trust is based on belief
that trustee is competent
(knowledgeable &
capable), reliable, open
(free flow of information),
and concerned (will not
behave opportunistically
and will act in trustors
best interest) (Chugtai &
Buckley 2008)
L. Antoinette Bargagliotti
1418 2011 Blackwell Publishing Ltd
Table 3 Empirical findings about work engagement.
Investigator Sample Methods Findings
Level of
evidence *
Harter et al.
(2002a)
Meta-analysis of 42
studies (n = 36
companies, 7936
business units, 198,
514 employees
Gallup Workplace Audit r = 077 between overall satisfaction and
employee engagement; 70% higher
success rate of business units above
median on work engagement than those
with below the median rates of work
engagement; 103% higher rate of success
when work engagement above/below
median was compared across companies
Level 1
Spence-Laschsinger
et al. (2006)
N = 322 nurses in
Ontario, Canada
acute care hospitals
Maslach Burnout Inventory
(MBI-GS)
Areas of Work Life (AWF)
Nurses reported greatest degrees of match
in community, value congruence and
rewards and mismatch in workload,
fairness and control. 53% reported
severe burnout; Greater control was
predictive of less onerous workloads,
greater rewards, better collegial
relationships and greater sense of
organizational fairness
Level III-3
Andreassen et al.
(2007)
N = 235 Norwegian
bank employees
Workaholism Scale
(Norwegian version)
UWES (Schaufeli &
Baker 2003) Cooper
Stress Index MBI-GS
Subjective Health
Complaints Inventory
Years worked at bank and enjoyment of
work explained 29% of the variance in
Work Engagement (R2 = 029 in 2 step
model)
Level III-3
Brake et al. (2007) N = 497 Dutch
dentists
Ultrecht Work Engagement
Scale (UWES)
Maslach Burnout
Inventory General
Survey (MBI-GS)
High levels of work engagement that
persisted across age groups; Burnout
dimensions of emotional exhaustion and
depersonalization were negatively
correlated to work engagement
Level III-3
Mauno et al. (2007) (NT1 = 735; NT2 = 623)
2 year longitudinal
study
random sample of
Finnish healthcare
workers at three
hospitals in one
healthcare district
Survey
UWES
Job Insecurity Scale
Quantitative Workload
Inventory (QWI)
Job control (time and
method) Organizational
Based Self Esteem
(OBSE) Management
quality (4 items) from the
Organizational Culture
Inventory-50
High levels of vigour and dedication were
stable over time and most predicted by
job resources (control and OBSE)
Level III-3
Hakanen et al.
(2008a)
3 year cross-lagged
study (n = 2,555
Finnish dentists)
Dentists Experienced Job
Resources Scale (DEJRS)
3 job demands (workload,
work content, and
physical work
environment)
Family/partner Support
Scale Home Demands
UWES; MBI
Burnout, Work Engagement, Depression,
and Organizational Commitment were
stable at Time 1 (T1) and Time 2 (T2)
3 years later
Home demands/home resources did not
affect well-being factors
Job resources at T1 effected work
engagement at T2. Burnout at T1
predicted depression at T2; Lack of job
resources at T1 predicted burnout at T2
Level III-3
JAN: CONCEPT ANALYSIS Engagement
2011 Blackwell Publishing Ltd 1419
Table 3 (Continued).
Investigator Sample Methods Findings
Level of
evidence *
Mackoff and Triolo
(2008a)
N = 30 outstanding
nurse managers
Nurse Manager
Engagement
Questionnaire
Interview
Signature behaviours of mission drive,
generativity and/or, identification,
boundary clarity, reflection,
self-regulation, attunement, change agility,
affirmative framework were associated
with work engagement
Level III-3
Mackoff and Triolo
(2008b)
N = 30 outstanding
nurse managers
Nurse Manager
Engagement
Questionnaire
Interview
Organizational cultures of learning, regard
meaning, generativity and excellence were
associated with work engagement
Level III-3
Rothman (2008) N = 677 South African
police officers;
Stratified random
sample
Minnesota Job Satisfaction
Questionnaire
MBI-GS
UWES
Police Stress Inventory
Cynicism was related to exhaustion
(r = 059), dedication related to
vigour (r = 078), lack of support was
related to stressfulness of job demands
(r = 072), intrinsic job satisfaction
related to extrinsic job satisfaction
(r = 061), vigour and dedication led
to work engagement which is related
to work-related well-being. In a
4-factor model, job satisfaction
(r = 045) and work engagement
(r = 043) were related to work-related
well-being while burnout (r = 091)
and occupational stress (r = 035)
were not
Level III-3
Vinje and
Mittlemark (2008)
N = 11 Norwegian
community health
nurses identified as
exemplary
Qualitative analysis of
interviews
(phenomenological
interview to gather data
and hermeneutic interview
to interpret data)
Meaningfulness
Calling
Zest for work
Vitality
Level IV
Freeney and
Tiernan (2009)
N = 20 Irish nurses in
general and psychiatric
units of an acute care
hospital
Focus groups Barriers to work engagement-
Organizational life (workload, lack of
control, reward, fairness, lack of sense of
community and values conflict between
caring and hospital focus on finance
Engagement was related to intrinsic reward
of seeing patients recover, social support
from colleagues, and energy
Level IV
Simpson (2009b) N = 167
medical-surgical
RNs in 6 hospitals
UWES-9
Turnover Cognitions
Scale (TCS)
Index of Work Satisfactions
(IWS-R)
Job Search Behavior Index
(JSBI)
The combination of professional status,
interaction, and thinking of quitting
explained 46% of the variance
(P < 0001) in work engagement; professional status and interaction moderated the relationship between thinking of quitting and work engagement Level III-3 L. Antoinette Bargagliotti 1420 2011 Blackwell Publishing Ltd unsure about her clinical judgment, double-check her assess- ment. She is thrilled that her task forces work on handoffs will be tested as a standard procedure for the hospital. She loves nursing. This is a model case because of the energy and enthusiasm (vigour) JM displays in her work. Her dedication to nursing work is exemplified by her careful attention to the condition of her patient, her meaningful involvement of the family in providing care, her consensual validation of a younger nursing colleague and her work on hand-offs to improve nursing practice. She is absorbed in the practice of nursing. Contrary case TN, BSN became a nurse because her parents thought nursing was a good profession for her. She has practiced for 2 years in a surgical unit. The unit is well staffed, she believes her salary and benefits are excellent and she enjoys her younger colleagues. She works nights so that she does not have to see families or physicians and can minimally interact with patients. She is planning to practice for only six more months until she is married. Her job enables her to have the time to plan and pay for her wedding. This is a contrary case because none of the attributes of work engagement, dedication, absorption, or vigour are present. Related case AB, BSN declines the offer of another position because she does not want to leave her current job in the ICU. She has practiced in this unit for 5 years and knows the practice patterns of physician and nurse colleagues. Her salary and benefits are excellent, the hospital is close to her home and her work schedule enables her to have the time she wants to devote to her family. Her supervisor is not engaged in the patient care issues of the unit because he has no background in critical care. Nursing is a job for most of her colleagues and she misses having colleagues who want to discuss intriguing cases. She is dedicated to providing the best possible care for patients but avoids asking questions that could lead to change because that would cause problems. Subsequently, her work is not as interesting or absorbing as it once was. This is a related case because it describes embeddedness, a closely related but different concept (Walker & Avant 2010). In this case, dedication (although limited) is the only attribute of work engagement that is present. The excellent salary and benefits, schedule, geographical convenience and familiarity that anchor A.B. to this job describe embeddedness. Absorp- tion would create questions leading to change that would cause problems in this work setting. Enthusiasm would be misunderstood as being too involved. Table 3 (Continued). Investigator Sample Methods Findings Level of evidence * Jenaro et al. (2010) N = 8 nurse managers 256 RNs and 148 certified nursing assistants (CNAs) Modified Survey on Job Satisfaction (Cantera 2003) General Health Questionnaire (GHQ-28) (Lobo et al. 1986) WES (Spanish version) 133% of nurses (including CNAs) scored high on all 3 measures of work engagement. Satisfaction with position, less social dysfunction and less stress with patient care explained 42% of the variance and 346% (P < 0001) of the variance in vigour Level III-3 Wong et al. (2010) N = 280 acute care registered nurses in Ontario, Canada Authentic Leadership Questionnaire (ALS) (Avolio & Gardner 2005) UWES-short form, Personal identification with the Leader (Kark et al. 2003), Helping and Voice Behaviors Scale (VanDyne & LePine 1998), International Survey of Hospital Staffing and Organization of Patient Care Outcomes (Aiken et al. 2001) Authentic leadership directly affected trust (b = 43, P < 0001). Trust affected work engagement (b = 019, P < 0001), Social identification (identification with the work group) affected work engagement (b = 041, P < 0001) Level III-3 *National Health and Medical Research Council Australian Government levels of evidence used. JAN: CONCEPT ANALYSIS Engagement 2011 Blackwell Publishing Ltd 1421 Antecedents Antecedents are those factors that precede the occurrence of the concept (Walker & Avant 2010). Kahn (1990) likened engaging in work to entering into a contract. There is meaningfulness (a valued benefit), safety (protective guar
