|CONCEPTS AND ISSUES
|Year : 2019 | Volume
| Issue : 2 | Page : 92-96
Job stress among nurses
J Hepsi Bai1, Vinitha Ravindran2
1 College of Nursing, AIIMS, Bhubaneshwar, Odisha, India
2 College of Nursing, CMC, Vellore, Tamil Nadu, India
|Date of Submission||20-Nov-2019|
|Date of Acceptance||22-Dec-2019|
|Date of Web Publication||01-Jun-2020|
Mrs. J Hepsi Bai
College of Nursing, AIIMS, Bhubaneshwar, Odisha
Source of Support: None, Conflict of Interest: None
It is well known that nursing as a profession is considered stressful. Multiple factors such as patient-care demands, professional issues, work environment, organisation policies and procedures are associated with job stress in nursing. Personal- and family-related issues also play a vital role in causing stress for nurses. Job stress can inadvertently affect patient care as well as health of nurses. Appropriate coping strategies are needed to mitigate job stress and ensure optimal patient-care outcomes. Organisational and nurse supervisor's support is essential to enable nurses to cope with job stress. In this article, the prevalence and associated factors of job stress and the general coping strategies adopted by nurses are discussed.
Keywords: Job stress, coping, nurse
|How to cite this article:|
Bai J H, Ravindran V. Job stress among nurses. Indian J Cont Nsg Edn 2019;20:92-6
| Introduction|| |
Nursing is, by its nature, an occupation with higher degree of stress. Mitigating stress has become a major concern in many fields, especially in management, due to low productivity and poor staff morale as problems related to stress. Research has reported that there is a higher prevalence of suicide and psychiatry outpatient referrals for nurses among professional groups. It is also considered as a profession in which there are higher dropout rates during the training period. In 1960, occupational stress was initially assessed by Menzies, and he found patient-care load, change, holding responsibility and decision-making as the sources of nurses' stress at work. However, in the mid-1980's, the stressors varied due to the high utility of technology, rise in health-care cost and instability within the working environment.
| Prevalence of Stress|| |
The nation-wide study done by CareerBuilder in the US on anxiety levels among workers identified health-care professionals as having high levels of stress, and within this group, the nurses were the most stressed. A meta-analysis on the prevalence of work stress in nurses revealed that 69% of nurses in the United Arab Emirates experienced stress. Mwinga and Mugala  reported 93% of job stress found among nurses in Zambia. In another study from Australia, 32.4% of nurses had depression, 41.2% had anxiety and 41.2% experienced stress related to work. Depressive symptoms were identified in 35% of Chinese nurses, 51% of Brazilian nurses  and 33% of French nurse managers. This variation in the prevalence of stress and associative symptoms may be due to different management systems and organisational structure of the hospitals of different countries.
In India, one study identified 87.6% of the nurses to be experiencing stress, in which 2.1% had severe stress. Another study found 92% of nurses with stress, of which 52% had severe stress. These findings indicate a high prevalence of work-related stress among nurses in India and demand a need for further exploration of job stress and related factors.
| Causes of Job Stress|| |
There are various factors contributing to stress for nurses at workplace as follows:
Meeting basic needs of the patient and carrying out therapeutic interventions are the fundamental jobs of nurses. Specific patient-care situations have been found to be associated with stress for nurses. Dealing with death and dying, uncertainty regarding patient treatment, workload and inadequate preparation to deal with patient's emotional issues have been identified as the common causes of stress. Within the patient–nurse relationship, patients' poor attitude towards treatment and care and/or unreasonable demands from patients and their families also contribute to workplace stress in nurses.
Communication that is cordial and respectful is an essential aspect of teamwork. When there is a cleft in the communication, stress can result. Conflict with other health-care professionals and discrimination enhances stress at workplace. In addition, doctor's attitude towards nurses, conflict with physician and verbal abuse from physicians also affect the psychological well-being of nurses. Poor relationship between nurses also can cause stress.
A supportive and conducive work environment is essential for work to be completed smoothly. Stress generating from nursing work situations such as posting in busy areas (intensive care units, emergency) with tiring job and insufficient time for rest and meals, increased workload, pressure to complete care on time, staff shortage and lack of co-worker support and conflict with supervisors lead to stress. Oskins  identified situational stressors as imbalanced staffing pattern and distribution, understaffing, heavy paperwork, inadequate resources that hindered nurse's performance and contribute to stress and burnout.
Organisational stressors along with other stressors affect job performance and productivity. Inadequate pay, lack of organisational support, lack of resources including workforce (inadequate staff to cover duties including supporting staff) and material (patient-care equipment and supplies), improper communication, increased job demands, competition between hospitals, use of sophisticated technologies, objection to professional growth and advancement opportunities and poor organisational structure were identified as factors that lead to stress in nurses.,,
The personal factors that were associated with stress for nurses in workplace include age (more than 30 years), female gender, family obligations, prolonged working duration (12-h shift) and less experience. Other personal stressors such as crossing the professional boundaries with patient, perfectionism personality, unrealistic expectations, feelings of inadequacy, feeling a sense of mastery over things, history of mental illness, emotional imbalance, high orientation to own losses and vulnerabilities and physically unfit and frighten towards own death and losses were identified as factors associated with stress.,
| Coping Strategies|| |
It is believed that the best management practice for stress is learning healthy coping strategies. Coping is a process of moderating the outcome of stress which effect on psychological and physical well-being of an individual to prevent distress and burnout. Folkman et al. have identified two distinct coping strategies: emotion-focused coping which could alleviate emotional distress and problem-focused coping which attempts to manage or alter the problem-causing distress. Problem-focused coping includes attempts taken to focus on altering the stressful event, while emotion-focused coping includes attempts taken to alter stressful feelings. Nurses typically employ problem-focused coping strategies, purposively targeted at solving the problem at hand, when they perceive control over stressful events. When nurses feel that the stressful situation in itself is to be intervened, they may use emotion-focused coping and targeting at reducing negative emotions. A systematic review found that in Asian and Australian nurses, problem-focused coping was related to better mental health, whereas emotion-focused coping was associated with reduced mental health.
Ab Latif and Mat Nor  stated that nurses utilise adaptive and maladaptive coping strategies as given in [Table 1].
A qualitative study done with 18 nurses in Iran showed that nurses adopt specific coping strategies to counteract stress. Nurses controlled stressful situation through right measures within the professional boundaries called 'situational control strategy', which includes taking immediate action to control sudden emergency condition of patients and professional errors, communicating the physician and health-care team members, implementing physician orders, exchanging the shift duty, obtaining permission for off duty, leaving work with delay to control working conditions and empathising and sympathising with patients and their family members. They also used 'preventive monitoring of situation' to control the current stressful situation at work area, including proactive monitoring of patient status, regular evaluation with on-going action through concentration, being on-call, follow-up, enhancing accuracy and safety, predicting stressful event and readiness for instant and correct actions. 'Self-controlling strategies' helped nurses cope by accepting and tolerating the stressful event, utilising recreational facilities, involving in sports, thinking positively, emotional ventilation and cry which can reconstruct mentally and evacuate occupational stress.
Nurses also utilise different types of coping strategies rather than just one. It depends on stressful situations in the working areas, personality of an individual nurse, type of stressors (patient-, physician-, profession-, environment- and organisation-related stressors) and availability of resources and the environment., In addition, Zyga et al. reported age, gender, experience, educational level, job position, type and duration of the shift, nurse–patient ratio and marital status determine the type of coping strategies adopted by nurses.
| Suggested Strategies to Reduce Stress|| |
Managing job stress is a vital part for nurses to enhance the physical, psychological wellness and improve work productivity. Based on the literature review, certain coping strategies [Figure 1] that could be practiced by nurses in work area to alleviate stress are proposed.
| Professional Strategies|| |
Presence of mutual understanding and collaboration
Managing conflict in the workplace is time-consuming but is a necessary task for the nurses and nurse managers. It can be exercised by a mutual understanding of situations, clarity in communication and equally shared power in decision-making, which can ultimately reduce work-related stress and conflict among nurses. The collaboration enhances job satisfaction.
Job rotation is an important way to decrease conflict among nurses at workplace. A prior discussion on the needs of the patient as well as the team by the nurse managers in the unit is essential before rotation. Job rotation stimulates nurses to perform well; permits for professional growth and opportunity to update the skill and knowledge in other areas; enhances quality patient care and helps acquire multiple capabilities which can ultimately reduce job burnout.
Researchers found that organisational/agency support, co-worker support, social support and empowerment have brought down job stress. High social support was found with a reduction in stress and burnout. It has positive effect on organisational productivity and mental well-being among workers. Specific organisational/agency support measures useful for nurses are given in [Table 2]. It is the responsibility of the manager to have a staff support system in the organisation. It can also involve the formation of formal or informal groups for patient care, supervision and mentoring. Schwartz rounds, an organised forum, in which all nurses can gather regularly to share and discuss the social and emotional issues of workplace should be facilitated in all organisations.
| Psychological Strategies|| |
Nurses are exercising the 'super-human philosophy' where they are excellent at coping with anything comes in their personal or professional domains.,, Other psychological strategies which can be adopted by them to alleviate job stress are given in [Figure 2].
| Organisational Strategies|| |
Organisational strategies have a great impact on managing job stress among nursing personnel. Organisation also has the responsibility to alleviate the stressors in working environment. It can include formulating stress policy, stress management, taking action and risk assessment.,,
Examples for each of these constructs are given in [Table 3].
| Conclusion|| |
'Grant me the courage to change the things I can change, the serenity to accept those that I cannot change and the wisdom to know the difference' – Reinhold Niebuhr.
Job stress is prevalent and is an important predictor of job satisfaction and patient outcomes. It is the responsibility of the hospital management and nurse supervisor to recognise stressors at workplace, to alleviate them by modifying the environment and formulating policies and protocols to streamline the patient- and profession-related issues which create stress. Nurses should also be trained in stress managing and coping strategies to strengthen their coping resources. Further studies on culture- and environment-specific stress factors and an understanding of specific coping strategies that are adopted by nurses are needed to include training on stress and stress management for nurses in every setting.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]