Healthcare workers experience stress in performing their respective jobs. Oftentimes, when the situation is no longer bearable, most of these workers, quit their jobs. This section is a review of literature regarding stress being experienced by nurses as well as other health workers. This will tackle the sources of this stress as well as its effects on the workers’ job performance. There will also be literature regarding the prevention and possible solution to address the pressing concern.
Sources of Work Related Stress
The experience of stress represents a psychological state. It can result from exposure, or threat of exposure, both to the more tangible workplace hazards and to the psycho-social hazards of work. The experience of stress is one important outcome of exposure to the hazards of work and to hazardous situations. Those hazards of work which are associated with the experience of stress are often termed stressors. Applied directly to nursing, contemporary theories of stress suggest that a situation which is typically experienced as stressful is perceived to involve work demands which are threatening or which are not well matched to the knowledge, skills and ability to cope of the nurses involved, or work which does not fulfill their needs, especially where those nurses have little control over work and receive little support at work or outside of work (Cox and Griffiths 1996).
Rodham and Bell (2002) investigated the perceptions and practices of junior healthcare managers with regards to work stress. The results showed that their practices and perceptions have a culture of acceptance and expectation of stress at work. There is also a combination of lack of awareness in effectively and proactively managing this stress.
In a study conducted by Al-Omar (2003), it showed that insufficient technical facilities, absence of appreciation, long working hours, and short breaks were factors contributing to the variations in the level of work stress in hospital staff of Saudi MOH. The study also revealed that Saudi national employees show a higher level of stress at work rather than those not from Saudi. Other factors were also found to be correlated with work stress. These factors are occurrence of health problems, changing the hospital, changing the job, quitting the practice, and undesired relationship with coworkers.
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In understanding the different context of stress in various cultural perceptions, Andal (2006) explored the stress levels of Filipino registered nurses working abroad. In her study, the identified nurse stressors are death and dying, conflict with physicians, inadequate preparation, problems with peers, problems with supervisors, workload, uncertainty concerning treatment, patients and their families, and discrimination. Similarly, Michie, Ridout, and Johnstone (1996) used the Nurse Stress Index (NSI), in determining the stress in nursing with patient’s satisfaction. The study showed that the pressures from coping with their patients as well as their relatives reflect three main problems: nurses’ ambivalence about dealing with death and dying; the growing problem of violence in nursing; and problems with nurse-patient relationships. It was also found out that the different conflict at home and at work are important sources of stress in the nursing profession.
A similar study conducted by McVicar (2003) identified the main sources of stress of nurses for many years. Among these are workload, leadership/management style, professional conflict and emotional cost of caring. The other causes perceived are the lack of reward and shift working. It is recommended that stress intervention measures should focus on stress prevention for individuals as well as tackling organizational issues.
Gelsema, Maes and Akerboom (2005) discussed the determinants of stress in the nursing profession. In 51 studies they have compiled from 1990-2005, it included psychological, behavioral and attitudinal stress indicators. These indicators have variety of outcomes such as job satisfaction, health complaints, absenteeism, and turnover. Challenging work, supervisor support, control and coping have been found out to alter the effects of a stressful work environment.
With regards to nurse working in psychiatric units, a review showed that a variety of factors are influencing the stress factors and job satisfaction of nurses. Particularly important to these are clinical leadership and quality inter-professional collaboration. It was found out that the job satisfaction of nurses is influenced by psychological stress and the quality of the clinical leadership (Konstantinos and Ouzouni 2008).
In a study conducted by AbuAlRub (2004) regarding the effect of stress on the job performance of nurses, as well as the relevance of support system, it was found out that social support system is important at the workplace as it enhances the level of job performance and decreases the level job stress being reported. The results also demonstrate that nurses that are reported with moderate level of job stress perform their jobs better rather than those with high or low level of stress.
Taylor, White and Muncer (1999) conducted an examination of the causes of stress of the nurses assigned in the National Health Service in England. Results were consistent with other studies. However, there were two ver significant causes for this particular case. The first one is the inadequate staffing levels which lead to the poor attitude and abilities among the staff. The second one is the relation of the patient’s suffering which affects the healthworkers’ stress level.
Jaracz, Gorna and Konieczna (2005) evaluated professional burnout among hospital nurses and its correlation on the perceive stress and styles in coping. The study concluded that the level of stress influences the professional burnout among nurses. There is diversity in the level of burnout depending on the specialization at work, which is not accompanied by a similar diversity in the subjectively perceived stress. The correlation between burnout and a coping style is rather weak, but statistically significant.
Zeytinoglu et al (2007) showed that nurse’s feel stressed and moderately satisfied with their jobs. Other factors aside from work intensification affect the stress of nurses. First, focusing on stress as an individual worker outcome, our results show that nurses who prefer to be employed in a different job status, such as working part-time but wanting to work full-time, are also the ones reporting stress. Nurses who continue to be employed in their jobs because of the importance of their income for their family’s economic well-being also report symptoms of stress. Heavy workload and perceived lack of organizational support are additional factors contributing to nurses’ increased stress. These factors constitute 27% of a nurses’ stress in Ontario, Canada.
The relation of problem-solving confidence, perceived tolerance, and situation-specific coping efforts to occupational burnout was examined among nurses in physical rehabilitation units. Consistent with predictions, confidence in one’s ability to handle problems and perceived tolerance were significantly predictive of lower burnout scores, regardless of time spent on the job. Of the coping variables, emotion-focused coping was significantly associated with higher burnout scores (Elliott et al 1996).
Respondents from Certified Registered Nurse Anesthetists (CRNA) showed that a broader scope of practice experience an increase in the job stress in relation to overload of responsibilities, however, they use coping resources effectively (Alves, 2005).
Critical care nurses experienced high levels of stress .The areas that produced the most stress varied depending on work in the ED or the ICU. Most of the stressors from the ED were the result of patient care, particularly from chronic and/or unstable patients. Most ICU stressors were the result of management of the unit, particularly inadequate staffing .The most frequently used coping skills by both the ED and ICU were the use of humor and talking about stressors with others. Nurses in the ED and ICU experienced comparable amounts of feelings of burnout according to the findings. The ED reported a wide range of emotional exhaustion, while ICU reported medium levels of emotional exhaustion. The ED reported med-high levels of depersonalization, while the ICU reported low-med levels of depersonalization. The majority of ED and ICU nurses expressed medium levels of personal accomplishment. These findings were congruent with much of the research available on stress and burnout in critical care nurses (Mims and Stanford 2004).
Stress levels, psychological distress and life events are all associated within time and across time. At baseline, life events and stress contributed significantly to psychological distress. The pattern of psychological distress differed between the nursing students and the newly qualified nurses with a high level in the nurses after qualifying and starting their career. Stress, individual traits, adverse life events and psychological distress are all interrelated. Future lines of enquiry should focus on the transition between being a nursing student and becoming a nurse (Watson, et al 2008).
Effects of Stress in the Workplace
Mojoyinola (2008) investigated the effects of work related stress in the workplace specifically in Ibadan Metropolis, Nigeria. The study established that job stress has significant effect on physical and mental health of the nurses. It also established that there was a significant difference in personal and work behaviour of highly stressed nurses and less stressed nurses. Based on these findings, it was recommended that the government (Federal or State) and Hospital Management Boards should improve the welfare of the nurses. It was also recommended that their morale should be boosted by involving them in policy or decision-making concerning their welfare or care of their patients. Their salary should be reviewed and that they should be promoted as at when due.
The effect of work stress in menstrual patterns of nurses in American and Italian nurses were studied Hatch, Talamanca and Salerno (1999). In their study, it showed that American nurses, especially those assigned to high stress units, had an increased risk for long and monophasic cycles. The similar pattern was also observed from the Italian nurses. In addition, the rotating shift work pattern prevalent in the Italian group was possibly associated with higher rates of short cycles and inadequate luteal phases when compared with those of nurses working fixed shifts either day or night.
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Peterson (2009) investigated the relationship of job stress, job satisfaction and the workers’ intention in leaving. The results showed that the main effects of job demands, social support and self-efficacy provided partial support for the JDC-S model when examining job stress, job satisfaction and intention to leave the job. Only self-efficacy was significantly related to intention to leave the profession. There was no evidence of moderating effects of social support or self-efficacy. An understanding of factors in the work environment that influence new nurses may assist in supporting them during the transition. By exploring the effects of demands, control, social support and self-efficacy on new graduatesâ€Ÿ job stress, job satisfaction and intention to leave. Similarly, Williams (2003) investigated the same subject matter. The study showed correlation between the jobs related stress of nurses and their intention to leave.
Methods to Reduce and Address the Stress Concern
According to Conner and Ulrich (1999), Human Resources face the most important challenge of today which is managing organizational change. There is no industry perhaps that needs rapid change other than healthcare industry (Lowery 1997).
In a study by Lewandowski (2003), she noted that organizational factors affect workers’ frustrations and to some extent, burnt outs. To address these concerns, she recommended empowerment strategies for management of the workforce. Supervisors can engage with a dialogue with their staff to suggest improvements that can help in decreasing frustrations in the workplace. These discussions could include but not limit to both work conditions and ways in how to improve services. Strategies that serve client empowerment could have the benefit of providing the workers with a rewarding work environment. Working towards the organizational change with the clients, according to Lewandowski, is a more potent antidote to the sense of isolation and powerlessness experienced by workers.
In the article of Abbasi and Hollman (2000), they examined the cause of turnover in the workplace. Among the causes that they noted are the hiring processes, managerial style, lack of employee recognition, lack of competitive compensation system, and toxic workplace environment. With these mentioned causes, they noted recommendations to address the same. First, the employers should provide strong leadership in an environment with a runway pace, change is constant and uncertainty is never ending. Managers should be required of ingenuity and strategic wisdom to a greater degree in managing the workforce. They must always keep in mind that the employees are the major contributors in the efficient achievement of an organization’s goals. Hiring and training the right people is very important, as well as adapting managerial styles that are appropriate for today’s workers. Employee recognition should also be practiced as well as compensating superior performances and creating a non-toxic and productive working environment.
Mimura and Griffiths (2006) reviewed the current approach in the stress intervention of nurses. These are stress management programs that are being conducted in the nursing profession. The review showed that the programs show more effectiveness basing on the provision of personal support than environmental management for the reduction of stress.
Davis, et al (2005) studied the effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses. The findings indicate that aromatherapy massage and music significantly reduced anxiety levels. Regular on-site aromatherapy massage with music has the potential to increase the job satisfaction of the staff and decrease the number of sick leave.
Mackenzie, Poulin, and Carlson (2005) investigated the effectiveness of brief mindfulness-based stress reduction intervention. The results showed that together with a natural fit between mindfulness philosophies and nursing practice theory, suggest that mindfulness training is a promising method for helping those in the nursing profession manages stress, even when provided in a brief format.
Judkins and Ingram proposed a long-term solution for decreasing stress among nurse managers. Use of an education module can be effective by increasing knowledge of stress and hardiness, and increasing hardiness levels. Through increased hardiness among managers and staff, organizations can expect higher levels of commitment, more involvement of staff in workplace issues, and greater receptivity to changes in work environment.
In a study conducted by Zarowin (2001), he examined the ways on how to keep the best employees for the coming century and to re-model the corporate benefits to be able to meet the need of the new workforce. The first way according to Zarowin, is the crafting of new package dividends. These packages are benefits more enriched with programs tailored-fit to an individual’s needs. While the study did not specifically measure the pay back it was reported that year after year absenteeism and turnover rates were lowered. Another note that was emphasized is family-support packages especially with female workers with dependents. Based on the study, this kind of programs often creates an affirmative response from workers in continuing their tenure in the healthcare organization where they belong. The third note emphasized by Zarowin is the adapting non-traditional work schedules such as flexitime schedules, part-time contracts, job sharing and others. Finally, he emphasized that employers need to focus on the importance of communication in the workplace.
Arandelovic and Ilic (2006) studied possible prevention of stress in the workplace. It is generally agreed that improving the ability to cope with stress is a valuable strategy in the process of combating stress. Once the existence of stress has been recognized and the stressors identified, action to deal with stress should be taken. Intervention of the external socioeconomic environment, intervention on technology and work organization, intervention in working place and task structure, intervention to improve individual responses and behaviour, specific intervention for health protection and promotion.
Strategies for Retention of Nurses
The most obvious result of nurses’ stress is just to quit their jobs. This worst case scenario can be prevented. A healthcare organization that has good employees’ retention policies, is able to reduce the employees intention to quit, and subsequent turnover, thereby saving organizations the considerable financial cost and effort involved in the recruitment, use of vicars, induction and training of replacement staff.
Several organizations have distinct ways in retaining employees. The Healthcare Industry can pattern these strategies. Denton (1992) wrote an article about how Federal Express keeps the loyalty of their employers. Based on the article, one of the company’s key is the advancements after hiring. Career advancement of employees is enforced, as well as incentive programs that help their people to become motivated. Acknowledgment of employees’ efforts is also practiced which is essential, according to the officers of Federal Express, in keeping the employees satisfied with their work. The company is also open in the suggestions of their employees and in fact gives awards to the best suggestions. Another key for the employee retention is the open communication between employers and employees. They use various kinds of techniques such as message boards and feedback forms. According to Denton (1992), Federal Express’ ways in retaining employees are worth emphasizing; however, these are not the only ones. Their strategies may not be appropriate for all organizations, but one main point is universal. If organizations want to keep their employees, it must think of comprehensive ways on how to keep the employees fit and involved in the workplace so that they will not quit.
According to Risher and Stopper (2002), successful organizations understand the dimensions of commitment in retaining its workforce. These organizations promote a sense of inclusion and camaraderie in all workers; membership and pride that include the use of language and rituals; security and fairness; fulfilment and growth; and economic interdependence.
Langan (2002) states that to address the issue of retention, employers are opting to adapt the new employee incentive system. Employers find that in combining traditional salary and additional benefits package and other highly desirable benefits of employment, they are able to attract and retain employees. In some employment settings, employees are offered with such conveniences.
As Wiggins (1998), wrote in his article, “On Keeping Good Employees”, he enumerated pointers for the subject matter: discover the things that the employee don’t like and get rid of these as many as possible; give emotional rewards generously for good works; compensate them properly; clam on the silver handcuffs; be as flexible as possible; remove the abusive people fast; promote only the best employees; try to talk them out of quitting.
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