Work 47 (2014) 491500 491

DOI 10.3233/WOR-131617
IOS Press

Exploring the impact of resilience,

self-efficacy, optimism and organizational
resources on work engagement
Stefanie Machea,b,c,, Karin Vitzthumc , Eileen Wankea, David A. Gronebergc , Burghard F. Klappb and
Gerhard Danzerb
a
Institute of Occupational Medicine, Charit Universittsmedizin Berlin, Free University and Humboldt
University, Berlin, Germany
b
Department of Medicine/Psychosomatics, Charit Universittsmedizin Berlin, Free University and Humboldt
University, Berlin, Germany
c
Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt,
Germany

Received 16 May 2012

Accepted 30 October 2012

Abstract.
BACKGROUND: The German health care system has undergone radical changes in the last decades. These days health care
professionals have to face economic demands, high performance pressure as well as high expectations from patients. To ensure
high quality medicine and care, highly intrinsic motivated and work engaged health care professionals are strongly needed.
OBJECTIVE: The aim of this study was to examine relations between personal and organizational resources as essential pre-
dictors for work engagement of German health care professionals.
METHODS: This investigation has a cross-sectional questionnaire study design. Participants were a sample of hospital doctors.
Personal strengths, working conditions and work engagement were measured by using the SWOP-K9, COPE Brief Question-
naire, Perceived Stress Questionnaire, COPSOQ and Utrecht Work Engagement Scale.
RESULTS: Significant relations between physicians personal strengths (e.g. resilience, optimism) and work engagement were
evaluated. Work related factors showed to have a significant influence on work engagement. Differences in work engagement
were also found with regard to socio-demographic variables.
CONCLUSION: Results demonstrated important relationships between personal and organizational resources and work engage-
ment. Health care management needs to use this information to maintain or develop work engaging job conditions in hospitals
as one key factor to ensure quality health care service.

Keywords: Health care, optimism, organizational resources, resilience, work engagement

1. Introduction tem has changed from a moderately stable one into

During the last decade the German healthcare sys-
Corresponding author: Stefanie Mache, Institute of Occupational
Medicine, Charit Universittsmedizin Berlin, Free University
and Humboldt University, Thielallee 69-73, 14195 Berlin, Germany.
Tel.: +30 450 529 596; E-mail: stefanie.mache@charite.de.
a more challenging and dynamic system [23,39,70].
Due to rising costs of healthcare, an aging popula-
tion, growing progress in the development of medi-
cal technology, and greater public awareness for bet-
ter quality of healthcare, pressures and demands on
health care professionals have increased [32,56,79].
The most affected healthcare employees are the doc-
tors and nurses who are required to deal with increased
demands for efficiency, cost awareness and improved

1051-9815/14/$27.50 
c 2014 IOS Press and the authors. All rights reserved
492 S. Mache et al. / Exploring the impact of resilience, self-efficacy, optimism and organizational resources on work engagement
healthcare quality [35]. It is well known that that the
quality of medical treatment and care are positively re-
lated to the ability of clinics to ensure medical ser-
vices at the required professional standard. Physicians
and nurses play an important role to representing the
clinics competence. Their behavior towards patients
has significant influence upon patient satisfaction with
quality in care and treatment [75,77,81]. Therefore,
hospitals need highly competent physicians and nurses
who are willing to work efficiently towards organiza-
tional goals [38].
Due to the current organizational changes in hospi-
tals, the increase of job demands and job pressure [41,
45,53] health care professionals are forced to build in-
ner strengths in the form of psychological and organi-
zational resources in order to be able to cope with de-
manding job tasks. Without these resources health pro-
fessionals may develop negative health outcomes (i.e.
stress related diseases, burnout) [14].
However, there are still doctors and nurses who can
be characterized by having zest, power, work engage-
ment and job satisfaction even if the working situa-
tion is objectively unsatisfying. The question is why
some health care professionals are highly motivated
and work engaged and others are not? Motivational
concepts such as work engagement have not been stud-
ied sufficiently although discussed as important as-
pects for productivity and job performance [40,73].
Therefore, there is a need to identify positive and mo-
tivating predictors for work outcomes such as job per-
formance, especially for the health care services.
1.1. Literature review
Work engagement
During the last decade, awareness on work engage-
ment in the health sector has grown. Health care pro-
fessionals work engagement has become an increas-
ingly important factor and a precondition for high-
quality health care performance [33,44].
In this context work engagement is defined as a posi-
tive, fulfilling, work-related state of mind characterized
by vigour, dedication and absorption [66,67]. Vigour
means that the employee feels high levels of energy
and willingness to invest in work. Dedication is de-
fined as feelings of enthusiasm, pride and inspiration
about work. Absorption means being so fascinated and
engrossed in work that time passes very quickly and
nothing else matters [8,40,68].
Several studies investigated the motivational influ-
ence of work engagement on employees in various set-
tings, i.e. home-care employees, hotel receptionists,
managers and teachers [8,22,27,65].
All of these studies illustrate that an employee with
high work engagement shows better job outcomes: for
example, Halbesleben et al. and Hakanen et al. demon-
strated that work engagement increases concentration
on job tasks, job performance and organizational com-
mitment [28,31]. Furthermore, work engagement is re-
lated to organizational variables such as job satisfac-
tion, turnover intentions and organizational commit-
ment [1,17,24,84]. Some studies demonstrated a posi-
tive relationship between work engagement, health and
well-being [27,29,37,60].
Schaufeli et al. [69] argued that engaged employees
have a stronger sense of effectiveness with their work
and were more able to manage demanding job tasks.
Organizational resources and work engagement
Working conditions of health care professionals
have been investigated in several investigations show-
ing an important influence on job satisfaction, job per-
formance and intention to leave a hospital or health ser-
vices in general [3,36,48,53]. Only a few studies have
concentrated on positive work factors affecting doc-
tors intention to stay and work in hospital service or
motivational concepts to increase physicians job per-
formance.
These positive work factors (job resources) refer
to those physical, social, or organizational aspects of
the job that may: (1) increase job demands and the as-
sociated physiological and psychological costs; (2) be
functional in achieving work goals; or (3) stimulate
personal growth, learning, and development [5,66].
Several studies showed that supervisory feedback,
sufficient reward and recognition motivates employees
to work more efficiently and productively [18,34,26].
Bear et al. [4] demonstrated positive relations between
rewards and creativity for employees working in man-
ufacturing organizations.
Participation, autonomy in decision making and sup-
port by colleagues and supervisors; also showed posi-
tive outcomes in employees job performance and sat-
isfaction [4,82].
Personal resources and work engagement
Personal resources such as resilience, self-efficacy
and optimism have been demonstrated as having essen-
tial influence on employees well-being and their abil-
ity to cope with work related stress factors.
 S. Mache et al. / Exploring the impact of resilience, self-efficacy, optimism and organizational resources on work engagement
Resilience is defined as a positive psychological ca-
pacity to rebound from adversity, uncertainty, conflict,
failure, or even positive change [49]. Recent stud-
ies have already investigated associations between re-
silience and ability to compete with job stress, mul-
titasking demands and organizational changes [21,52,
59,86].
In line with these studies additional investigations
have been performed in several work settings on op-
timism and self-efficacy; all showing a positive influ-
ence on employees health, job performance and work
ability [12,15,16,46].
For instance, Bakker [7] found that female school
principals with high personal resources which include
resilience, self-efficacy and optimism scored highest
in work engagement. Luthans et al. [52] argued that
employees who hold personal resources, such as opti-
mism, self-esteem, and active coping styles are more
able to control their work environment and to achieve
greater career success. Many studies in the literature
show the impact of personal resources but none have
explicitly focused on hospital physicians.
Purpose of this study
The central aim of the present study was to examine
how German health care professionals evaluate their
work engagement. In addition, we wanted to know
which individual character strengths and work related
conditions might have an impact on work engagement.
Consequently, the research questions were as fol-
lows:
1. How do physicians perceive their work engage-
ment?
2. Is health care professionals work engagement
associated with personal resources (resilience,
self-efficacy, optimism)?
3. Can health care professionals work engagement
be predicted by personal and/or organizational
resources?
2. Methods
2.1. Study design and setting
This investigation was a cross-sectional question-
naire design. Data collection took place between 2010
and 2011 in five hospital departments in Germany.
Medical fields were: Internal Medicine, Paediatrics
and Neurology. Included hospital departments were
comparable in size, number of patients/beds as far as
employed medical staff (e.g. residents, junior-doctors,
nurses).
493
2.2. Data collection
First, we informed the hospital management and su-
pervisors about our study design through email. Af-
ter getting their agreement from them we asked physi-
cians working in one of the included hospitals if they
were willing to participate in our voluntary study. Only
physicians with at least one year of work experience
in hospitals and working full-time were included in
the study. 320 postal questionnaires were sent to the
physcians. Participating doctors had three weeks to fill-
out the questionnaire. After this time we sent two re-
minders per email. A box was placed at each hospital
department, questionnaires could be returned there. At
the end, we received 223 questionnaires from the par-
ticipants, a return rate of 69.7%.
2.3. Variables
We included work related factors (e.g. job resources)
as independent variables. In addition, personal charac-
ter variables were also included in the questionnaire
(e.g. optimism, self-efficacy, resilience etc.) as possible
predictors for work engagement.
Work engagement was the dependent variable (out-
come variable); subscales are vigour, dedication and
absorption. Health professionals socio-demographic
characteristics might also have an effect on their rat-
ings; therefore we adjusted for age, gender, number of
years in training at the time of this study, marital status
and presence and number of children.
2.4. Instruments
Work engagement has been evaluated by using the
Utrecht Work Engagement Scale (UWES). It is a self-
report questionnaire and consists of three subscales
vigour (six items), dedication (five items), and absorp-
tion (six items) (in total 9 items) [68,69].
The questionnaire is a 7-point Likert scale ranging
from 0 (strongly disagree) to 6 (strongly agree). Items
were summed and divided by the number of items in
each scale. The higher each item was rated the higher
the overall work engagement.
Previous studies illustrated reference values: partici-
pants with a score higher or equal than 4.67 on the total
work engagement scale were considered to be (very)
highly engaged [61]. In addition, health professionals
who evaluated vigor with a score  4.81 were very
vigorous. Those who scored dedication with a score 
4.91 were highly dedicated. Scores  4.41 means ab-
sorption is highly scored [61]. Validity and reliability
were proved and verified [67].
494 S. Mache et al. / Exploring the impact of resilience, self-efficacy, optimism and organizational resources on work engagement
2.5. Organizational resources
The German version of the Copenhagen Psychoso-
cial Questionnaire was used to evaluate job-related
and psychosocial factors at work [43,57]. The ques-
tionnaire include 12 subscales measuring i.e., job de-
mands (e.g. emotional and quantitative demands), job
resources (i.e., quality of leadership, opportunities for
development, social support). Items are scored on a
Likert scale and transformed to a scale ranging from
0 (minimum value, e.g., do not agree at all) to 100
points (maximum value, e.g., fully agree).
Previous investigations proved quality criteria of the
COPSOQ [57]. We also verified them: Cronbachs al-
pha coefficients ranged between = 0.69 to = 0.79.
All intercorrelations were calculated between r =
0.30 r = 0.70.
2.6. Personal resources
Personal characteristics were also included in the
survey. We asked for coping strategies by using the
German version of the Brief Resilient Coping Scale
(BRCS) [74]. The questionnaire includes 28 items as-
sessing coping behavior in past difficult or unpleasant
situations. Four scales contain items on support cop-
ing, positive reframing, avoidant coping and ac-
tive coping. Cronbachs alpha ranged between = 0.70
to 0.80.
In addition, the Self-Efficacy, Optimism and Pes-
simism (SWOP-K9) was also included [71]. The
SWOP-K9 assesses individuals perception of self-
efficacy, optimism and pessimism on three indepen-
dent scales (in total nine items) (QUELLE) [71]. Cron-
bachs alpha ranged between g 0.67 to 0.82. The test
quality criteria have also been discussed in previous in-
vestigations [71].
2.7. Statistical analysis
We evaluated questionnaire data as follow: at first,
we performed a descriptive analysis (evaluation of me-
dians and standard deviations (SD). We coded the cat-
egory does not apply and item non-response as miss-
ing values. As a precondition for the correlation and
regression analyses, we proved whether the variables
were normally distributed. Pearsons r or Spearmans
rho was calculated to examine correlations between
variables. All p-values given were two-tailed. P-values
of less than 0.05 were considered significant [13]. Data
were calculated using the SPSS R
software package for
social sciences; Version 18.0.
2.8. Ethical considerations
Ethical approval was granted by the Free University
and the Humboldt University Berlin.
3. Results
At first, we evaluated health professionals socio-
demographic characteristics. A total of 63% of the re-
spondents were female physicians; 37% male. Mean
age was 31 years (SD = 5.25 years). Years of work ex-
perience was rated with a mean score of 6 years (SD =
5.2 years).
Of the participants, 65% were married or cohabiting
and 31% had children.
3.1. Work engagement and relations to
socio-demographic variables
In total, work engagement was rated as follow: To-
tal work engagement was scored with a mean of M =
4.07; SD = 0.89. The subscale Vigor was evaluated
with an average score of M = 3.84; SD = 0.91; the
subscale Dedication with M = 4.37; SD = 0.97 and
the subscale Absorption with M = 3.76, SD = 0.95.
A total of 26% of the respondents could be classi-
fied as highly engaged. By analyzing the subscales re-
sults showed that 24% of the participants are highly
vigorous, 29% highly dedicated and 25% highly ab-
sorbed. Work engagement was significantly related to
age (r = 0.21; P < 0.05). Older physicians reported
lower scores of work engagement than younger physi-
cians.
In addition, we also found a significant correlation
between work engagement and gender. We analyzed
that male doctors scored significantly higher on vigour
(mean 4.21 0.82) than female physicians (mean 3.89
0.91, P < 0.05, d = 0.21).
We found no significant correlations between mar-
ried and single physicians (P < 0.05) with regard to
work engagement.
3.2. Relations between personal resources and work
engagement
In contrast, positive associations were analyzed be-
tween personal resources and work engagement. For
instance, positive correlations were found between
physicians resilience and work engagement (r =
0.31; P < 0.01).
 S. Mache et al. / Exploring the impact of resilience, self-efficacy, optimism and organizational resources on work engagement 495

Table 1 Table 2
Correlation coefficients between psychological, organizational re- Multiple hierarchical regression analysis
sources and work engagement
Predictors R2 R2
Scales Vigor Dedication Absorption Socio-demographic variables 0.04 0.04
Psychological variables Personal resources 0.22 0.18
Self-efficacy 0.30** 0.34** 0.28** Job demands 0.32 0.10
Optimism 0.31** 0.35** 0.29** Job resources 0.54 0.22
Pessimism 0.27* 0.21 0.18 Total R2 0.54
Resilience 0.33** 0.32** 0.27**
Organizational resources
Possibilities for development 0.37** 0.40** 0.35**
In the second step (model 2), personal resources
Influence at work 0.35** 0.37** 0.38** accounted for an additional 18% of the variance (R2
Degree of freedom at work 0.28** 0.30** 0.32** change = 0.18; p < 0.01; the R2 increased to 0.22).
Social relationships 0.23** 0.24** 0.21** Resilience was found to have a positive and signif-
Social support 0.31** 0.38** 0.32**
Feedback 0.26** 0.35** 0.19*
icant relationship with work engagement ( = 0.26,
Quality of leadership 0.32** 0.34** 0.31** p < 0.01). Similarly, optimism ( = 0.18; p <
*P < 0.05; **P < 0.01. 0.01) and self-efficacy were also found to be signifi-
cantly and positively related to work engagement ( =
A significant positive correlation exists between 0.20, p < 0.01).
self-efficacy and work engagement (r = 0.30; P < In the third step, job demands made up an additional
0.01) as far as between optimism and work engage- 10% of the variance. Quantitative demands revealed a
ment (r = 0.32; P < 0.01). significantly negative beta weight ( = 0.18, p <
A negative correlation has been found between pes- 0.01).
simism and work engagement (r = 0.23; P < 0.01). In the final step, included job resources accounted
for an additional 22% of variance.
3.3. Relations between organizational resources and Three job resources revealed significantly posi-
work engagement tive beta weights: possibilities for development =
0.23, p < 0.01; quality of leadership = 0.19, p <
We found that most of the correlations between the 0.01; sense of community = 0.21, p < 0.01; (see
three work engagement dimensions and the work con- Table 2). The final model explained 54% of the vari-
dition variables were statistically significant. Work en- ance.
gagement correlated positively with job resources, es-
pecially with Influence at work, Opportunities for
development and Degree of freedom (r = 0.30 4. Discussion
r = 0.40, P < 0.01). and social support (r = 0.36,
P < 0.01).
The main aim of this study was to investigate the ef-
In detail, we also focused on the sub dimensions of
fects of personal and organizational resources on work
work engagement vigor, dedication and absorp-
engagement. Our findings revealed that in particular re-
tion and found significant correlations between them
silience, participation and influence at work are signif-
and physicians job resources (r = 0.21 0.40; P <
icant predictor of work engagement. These finding are
0.01) (see Table 1).
consistent with those of previous researchers.
3.4. Regression analysis for work engagement
4.1. Personal resources and working engagement
Hierarchical regression analysis was also conducted.
Work engagement was used as the dependent variable. Personal resources, optimism, resilience and self-
Table 2 displays the ratios of variance. At first, demo- efficacy were positively associated with work engage-
graphic variables such as age, gender and marital sta- ment. Unfortunately, only a few studies have been
tus were statistically controlled. Based on model 1, the performed on optimism, self-efficacy etc. and work
control variables accounted for 4% of the variance in engagement. However, this minority is in line with
work engagement. Of the control variables, years of our results showing that optimistic and resilient peo-
experience ( = 0.09; p < 0.05) and marital status ple work harder and it is easier to motivate them.
( = 0.15, p < 0.05) were significantly related to Seligman (2002) has found in his research that opti-
work engagement. mism was positively related to the performance of sales
496 S. Mache et al. / Exploring the impact of resilience, self-efficacy, optimism and organizational resources on work engagement
agents [72]. In addition, in the study of Chinese factory
workers mentioned previously by Luthans et al. [50],
optimism was also found to have a significant relation-
ship with rated performance. A study by Youssef and
Luthans found employees optimism to be related to
their performance, satisfaction, and happiness [85]. It
is not causally explained whether high work engage-
ment may be a partial result of optimistic thinking.
A study by Greenberg and Arakawa also found that
managers sense of optimism is correlated to their own
work engagement. However, managers optimism has
not been shown to directly influence the engagement
level of his or her employees [62].
If this assumption can be verified in the future im-
portant practical implications can be deduced espe-
cially for human resources management and the re-
cruitment of professionals. Since work engagement has
been proven as an essential factor to increase job per-
formance [65,84]; optimistic employees are more work
engaged and the more work engaged the employees the
better the job performance.
We also found a significant positive correlation be-
tween self-efficacy and work engagement.
Recently published studies are in line with our find-
ings showing that the higher a persons self-efficacy,
the more likely the employee initiates job tasks, is
able to meet various job demands, acts and decides
autonomously and can handle job challenges or work
problems [10,11,76].
Luthans and Peterson investigated relations between
managers self-efficacy and work engagement [51].
They also demonstrated that managers who are highly
engaged do often lead in a motivated and visionary way
so that their employees also become very engaged in
their work [51].
This confirms the conceptual relationship between
self-efficacy and work engagement as suggested in lit-
erature. Specifically, studies have shown that the higher
a persons self-efficacy, the more likely she or he
will be to initiate tasks, sustain effort toward task ac-
complishment, and persist when problems are encoun-
tered [11,76].
Several other authors have also investigated the re-
lationships between personal resources and work en-
gagement in different work settings. For example,
Rothmann and Storm investigated work engagement
among police officers [6,63]. This research team found
that engaged police officers were more optimistic, self-
efficient and showed active coping styles [6]. Xan-
thopoulou et al. [83] investigated technicians work en-
gagement in relation to self-efficacy, self-esteem, and
optimism. Results indicated that these resources were
related to work engagement [83].
A longitudinal study performed by Bakker et al.
showed that self-efficacy and optimism make a unique
contribution to explaining variance in work engage-
ment over time [9]. They explained that these personal
resources have a stronger impact on work engagement
than other job resources [9].
Several other studies verified our findings showing
that the investigated personal resources are warrantors
of high work engagement in combination with job re-
sources (social support from colleagues/chiefs, ade-
quate opportunities for individual development) [83].
The relation between resilience and work was an-
other interesting result of our study. Resilient people
show higher scores of work engagement. However,
some studies have found similar results: a study by
Othman et al. investigated and verified associations be-
tween resilience hope and work engagement [58]. In
addition, it has been proven that resilient employees
are able to recover earlier from a setback and adapt
resourcefully to change with confidence and flexibil-
ity [47,80].
From the research fields identified within the re-
viewed studies, it is notable that there is very little re-
search specifically into the relations between resilience
and work engagement [25].
Further research should extend the focus on re-
silience and work engagement in several work settings
to generalize our results.
4.2. Organizational resources and work engagement
While analyzing for correlations between work-
related factors and work engagement we found evi-
dence for some job resources having a positive influ-
ence on work engagement.
Our findings showed that employees who rated in-
fluence at work, opportunities for development and
social support high, also scored work engagement
with high values.
Previous studies have also shown that job resources
such as social support from colleagues and supervi-
sors, constructive performance feedback, autonomy,
and learning opportunities are positively associated
with work engagement [6,67].
Various researchers also demonstrated the motiva-
tional importance of job resources. In particular, oppor-
tunities for development, feedback, advanced training
play an intrinsic role for employees motivation [2]. In
addition, autonomy has been shown to play an extrin-
sic motivational role to achieve work goals and perfor-
mance [20,55,64].
 S. Mache et al. / Exploring the impact of resilience, self-efficacy, optimism and organizational resources on work engagement
A recent investigation revealed supportive colle-
agues and constructive feedback increase the probabil-
ity of being successful in achieving job goals [66]. As
a consequence, employees work engagement and job
satisfaction will increase.
Several other studies have also shown a positive rela-
tionship between job resources and work engagement
in different work settings. Hakanen et al. [27] repli-
cated our findings on Finnish teachers; Koyuncu et
al. [42] examined work engagement and antecedents
on women managers and professionals employed by a
large Turkish bank. Maslach and Leiter [9,54] revealed
that particularly job control, innovative and social cli-
mate, rewards and recognition are significant predic-
tors of work engagement.
Recent longitudinal studies proved evidence on
causal effects of job resources and work engagement
in different work settings [19,30]. All the above men-
tioned studies confirmed that a lack of participation in
decision making and opportunities for individual de-
velopment can be linked to low levels of work engage-
ment, job dissatisfaction and higher levels of frustra-
tion, as far as intentions to leave and depression [78].
Hospital management and supervisors should focus
on increasing their employees work engagement by
offering emotional and instrumental support, construc-
tive feedback and opportunities for individual career
development. Improved work ability can be the result
which is linked to low sick leaves and higher produc-
tivity for high quality medicine.
4.3. Limitations
There are a few limitations in this study. Our in-
vestigation was based on a questionnaire (self-report),
which may cause measurement bias [13].
In addition, we analyzed the included parameters
only once (cross-sectional study design). In conse-
quence, we cannot imply cause and effect between the
independent and dependent variables.
Third, only limited predictor variables (e.g. self-
efficacy, resilience) were examined. Other psycholog-
ical parameters such as zest, curiosity, creativity or
open-mindedness may also play an important role in
predicting work engagement. Future studies should in-
vestigate additional psychological and organizational
variables.
In addition, our study sample includes only physi-
cians working in German hospitals. The research
should be replicated with a larger sample, among other
healthcare professionals and/or different other occupa-
tions/work settings.
497
4.4. Implications
Since resilience, self-efficacy and other personal re-
sources influence work engagement, it would be worth-
while for chiefs and hospital administrations to encour-
age and increase these potentials among health care
professionals. It is really important to support health
care professionals to enlarge skills that will aid them in
being more resilient to handle stressful work demands
and workplace adversity. Providing skill trainings for
employees and supervisors to enlarge personal and or-
ganizational resources are strongly recommended in
this connection. Health care professionals who have
been trained successfully will hopefully show greater
work engagement, health and job performance.
5. Conclusions
The findings of this study provide a theoretical
framework for understanding the relations among per-
sonal resources (e.g. resilience), work-related resou-
rces (e.g. social support) and work engagement. Re-
sults show that working conditions and resilience were
among the important factors in determining and im-
proving work engagement of hospital physicians.
The identification of the factors that may encour-
age positive working attitudes and job performance
as it directly affects the quality of medical treatment
and the well-being of the patients is strongly recom-
mended. Hospital management/administration should
provide more resources to enable health professionals
to become more engaged in their work. Strong evi-
dence exists that job and personal resources are impor-
tant antecedents of work engagement. Future research
should investigate further concepts having an influence
on work engagement.
Acknowledgements
We would like to thank all health care profession-
als for their participation. We also thank Mrs. Gabriele
Volante for language-editing.
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