Modern life is full of stress. Nursing is, by its very nature, an occupation subject to a high degree of stress. This profession involves working with people who are themselves suffering a considerable degree of stress. During the past few decades, stress has been given the attention of researchers in many and varied fields. A primary reason why researchers are studying stress lies in the recognition by management that stress-related problems are reducing productivity and morale.
Stress has been regarded as an occupational hazard since the mid 1950s. In fact, occupational stress has been cited as a significant health problem, work stress in nursing was first assessed in 1960. In 1960, Menzies identified sources of anxiety among nurses as patient care, decision making, taking responsibility, and change1. Since the mid-1980s, nurses’ work stress has been escalating due to increasing use of technology, continuing rises in health care costs, turbulence within the work environment2. Work stress and burnout remain significant concerns in nursing, affecting both individuals and organizations.
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Factors influencing job stress in nursing
a. Hospital focused stressors
Ivancevich and Matteson identified five most hospital-focused stressors as procedures, policies, programs; human resource development; politics; working conditions; rewards, and communications.
b. Job focused stressors
At the job level category, the most stressful areas were time pressures, role conflict, and responsibility for people, relationships with other nurses, and relationships with superiors.
c. Professional stressors
Cronin-Stubbs and Velso-Friedrich identified that inter personal relationship with co-workers, supervisors, subordinates, physicians, patients, and new employees - professional stressors. Blair identified poor doctor’s attitude, poor attitude from patients side, conflict with physicians are psychologically damaging than conflict within the nursing profession.
d. Situational stressors:
Oskins identified the situational stressors as nurses' ability to cope with or manage the working environment as poor staffing patterns, working with a high percentage of inexperienced personnel, patient’s families threatening to sue, need to counsel the family of a dying patient by the busy intensive care nurse, presence of a very congested busy & noisy intensive care environment and the intensive care nurse working during a personal crisis.
e. Patient/personal related stressors
Nurses experience stresses from patient care were dealing with death & dying, uncertainty regarding patient treatment, workload, sexual harassment & conflict. The personal stressors for nurses in work places were age (more than 30 years), female gender, family obligations, prolonged work duration (12 hours shift), other personal factors including personality characteristics (perfectionism), over involvement with patients, self-esteem, sense of mastery, unrealistic expectations, feelings of inadequacy, history of psychiatric illness, emotional demands, increased awareness of own losses, vulnerabilities, and fear of own death and cumulative losses.
f. Organizational stressors
Stress-generating nursing work situations, which can be of physical, psychological or social nature in the organization increased job demands, use of sophisticated technologies, competition among hospitals, nursing shortage, work overload, lack of task autonomy and feedback, reduced advancement opportunities, and poor remuneration.
g. Health care system stressors
Depending upon the health care system involved nurses experience stress due to heavy paperwork & increased workload, understaffing & decreased resources, too many patients dying at one time, organization stresses (scheduling conflicts, funding issues), lack of communication and/or support from administration, role conflict &View death as failure.
h. Interpersonal stressors
Along with other factors interpersonal stressors exist in work places were conflicts with colleagues, poor communication among staff, and lack of supportive, collaborative workplace relationships, low team morale, disagreement about goals of care, patients’ family dynamics, patient psychological issues, and poor relationship with patient/family.
Impact of job stress among staff nurse
i. Physical impact
- Tiredness Fatigue, Disrupted sleep patterns
- Increased pulse rate & BP Shallow, rapid respirations
- Muscular tension
- Loss of appetite Overeating, Indigestion
- Constipation, Diarrhea Dry mouth, Excessive perspiration
- Nail-biting, Increased use of alcohol or other drugs
- Irritability and impatience, Frequent worry and anxiety, Moodiness
- Feeling sad or upset Loss of sense of humor, Poor concentration, memory lapses,
- Ambivalence, Feeling overwhelmed by even minor problems
ii. Professional impact
- Loss of motivation and commitment.
- Poor staff attitude and behavior
- Staff working increasingly long hours but for diminishing returns
- Erratic or poor timekeeping.
- Poor morale and a lack of engagement.
- Increased intentions to leave job.
- High intension to leave the job
- Poor morale
- Lack of engagement
iii. Organizational Impact
- High turnover
- Decrease productivity
- Decrease organizational commitment
- High disciplinary problems
iv. Impact in relation to patient care
- Poor quality of care
- Less efficacy of health service delivery
- Poor relation with patients
- Less job satisfaction
- Decrease output/ productivity
- High incidence of error rate
- Poor decision making
- Deterioration in planning and control of work
- Poor time keeping
- Questions ability to provide good care
- Avoiding patients and families
- Disinterest in and concern for patients
- Believe patient’s complaints to be manipulative
- Derogatory or inappropriate jokes
- Lack of clarity about professional role
- Feel imposed upon
- Sense of professional loneliness
- Social distancing
v. Psychological impact
- Frustration, Anxiety
- Feeling depleted and irritable
- Anger, Depression, Guilt
- Low self-esteem and self-doubt
- Hopelessness & Helplessness
- Loss of interest, meaning and purpose
- Conflict with colleagues & team
- Less cope with demand
- Increased isolation
- Memory disturbances
- Impaired judgment and reasoning
- Short attention span
- Suicidal ideation
- Lack of self confidence
- Less efficacy
- Isolation from patient
- Poor satisfaction
An aging workforce along with higher patient acuity, shorter hospital stay, and other workplace changes contribute to job stress among nurses. Stressors in work environment and its impact has to be studied in-depth so that management of stress and appropriate coping strategies could be adopted by them.
- Menzies IE. Nurses under stress. Internatl Nurs Rev 1960;7:9-16
- Maslach, C. (1976). Burned-out. Human Behavior, 5(9), 16-22
- Ivancevich J & Matteson M. Organizational Level Stress Management. Journal of Organizational Behavior Management, (1986) 8(2), 229-248
- Burbeck R, Coomber S, Robinson SM, Todd C. Occupational stress in consultants in accident and emergency medicine: A national survey of levels of stress at work. Emerg Med J 2002;19:234-8
- Cronin-Stubbs D, Brophy EB. Burnout: Can social support save the psychiatric nurses? J Psychosoc Nurs Mental Health Serv. 1985;23:8–13
- Oskins S . Identification of situational stressors and coping methods by intensive care nurses. Heart and Luna. 1999 8(5), 953-960.
- Miyata A, Arai H, Suga S Job stressors and coping mechanisms among emergency department nurses in the armed force hospital of Taiwan. Int J. 2010;5(10):626–33
- RS Mehta, RN Chaudhary. Relationship between general health, occupational stress and burnout in critical care. 2010;23:54-63
- Mathew N Effect of Stress on job satisfaction among nurses in Mumbai. Journal of Business and Management Volume 7, Issue 2 (Jan. - Feb. 2013), PP 47-51