Original Article
Occupational stress among staff nurses: Controlling the risk to health Abstract Introduction: Nursing has been identified as an occupation that has high levels of stress. Job stress brought about hazardous impacts not only on nurses’ health but also on their abilities to cope with job demands. Objectives: This study aimed at finding out the degree of work‑related stress among the staff nurses and various determinants, which have a impact on it. Materials and Methods: Institutional‑based cross‑sectional study conducted on GNM qualified nurses. Predesigned and pre‑tested questionnaire covering their sociodemographic variables in part I and professional life stress scale by David Fontana in part II. Analysis used was Chi‑square test and logistic regression for various factors. Results: Risk for professional stress due to poor and satisfactory doctor’s attitude was found about 3 and 4 times more than with excellent attitude of doctors toward the staff nurses. A statistically significant association (P 35 Gender Male Female Marital status Married Unmarried No. of children No child 1 Child 2-3 Children Not applicable Place of residence Hospital campus Outside hospital campus
48 43 9 34 66 35 65 9 8 18 65 63 37
Table 2: Socio‑demographic determinants for professional stress Variables
Professional stress score 31‑45 Total Chi‑square (P value)
0‑15
16‑30
5 27 14 46
7 33 11 51
2 1 0 3
14 61 25 100
14 32 46
19 32 51
1 2 3
34 66 100
0.502 (0.778)
29 17 46
33 18 51
3 0 3
65 35 100
2.69 (0.609)
4 5 8 29 46
5 3 11 32 51
0 0 0 3 3
9 8 18 65 100
0.98 (0.614)
Age (year) 15-25 26-35 >35 Total Gender Male Female Total Marital status Unmarried Married Total No. of children No child 1 Child 2-3 Children Not applicable Total
8.33 (0.08)
Table 3: Perception of staff nurses regarding working environment Variable Perception of staff nurse for attitude Attitude of the doctor Attitude of the nurse Attitude of the paramedical Attitude of the patient attendant Night duty Yes Skip meal at duty Yes Toilet condition Enough time for rest Get enough holidays Job tiring Salary enough
Indian Journal of Occupational and Environmental Medicine - August 2014 - Volume 18 - Issue 2
Excellent
Satisfactory
Poor
31 44 20 9 Very safe 37 Often 9 Good 31 Yes 20 Yes 54 Yes 45 Yes 25
64 56 77 70 Reasonably safe 47 Occasionally 70 Satisfactory 64 No 80 no 46 No 55 No 75
5 0 3 21 Unsafe 16 Rarely 21 Bad 5
53
Parul, et al.: Occupational stress among staff nurses Table 4: Association between interpersonal relationship and professional stress
Table 6: Association between working environment and professional stress
Variables
Variables
Attitude of doctor Excellent Satisfactory Poor Total Attitude of nurse Excellent Satisfactory Total Attitude of para‑medical staff Excellent Satisfactory Poor Total Attitude of patient attendant Excellent Satisfactory Poor Total
Professional stress score 0-15 16-30 31-45 Total 20 25 1 46
11 37 3 51
0 2 1 3
31 64 5 100
25 21 46
18 33 51
1 2 3
44 56 100
9 37 0 46
10 38 3 51
1 2 0 3
20 77 3 100
4 34 8 46
4 35 12 51
1 1 1 3
9 70 21 100
Chi‑square (P value) 11.59, 021
3.71 (0.447)
3.31 (0.51)
3.4 (0.492)
Table 5: Strength of association between interpersonal relationships and working environment and professional stress Variables Reference Category category Doctor’s Excellent Poor Satisfactory attitude Department Emergency/ Medicine of posting ICU Surgery Pediatrics Obs/Gynecology Job tiring Yes No Enough Yes No salary
Odds ratio Std. Significance (logistic error regression) 3.97 2.97 0.32
1.44 0.53 0.64
0.34 0.04 0.07
0.41 0.54 0.28 0.43 2.29
0.68 0.86 1.03 0.50 0.60
0.19 0.47 0.22 0.09 0.17
ICU: Intensive care units
DISCUSSION Stress up to a certain extent, will improve peoples’ performance and quality of life because it is healthy and essential that they should experience challenges within their lives,[19] but if pressure becomes excessive, it loses its beneficial effect and become harmful,[20] because it is the reaction of people under pressure or other types of demands placed on them and arise when they worry that they cannot cope.[21] It is important that stress is a state, not an illness, which may be experienced as a result of an exposure to wide range of work demands and in turn can contribute to an equally wide range of outcomes,[22] which may concern the employees’ health and be an illness or an injury or changes in his/her behavior and lifestyle. Interpersonal relationships and stress In our study, 91% staff nurses were younger than 35 years with a mean age of 27.41 years (SD = 7.06), 34% were male nurses. 54
Department of posting Medicine Surgery Pediatrics Obs/gynecology ICU/Emergency Total Enough time to rest Yes No Total Job tiring Yes No Total Enough holidays Yes No Total Skip meals Often Occasionally Rarely Total Salary enough Yes No Total
Professional stress score 0‑15 16‑30 31‑45
Total
15 10 4 4 13 46
8 6 7 2 28 51
0 0 1 0 2 3
23 16 12 6 43 100
8 38 46
12 39 51
0 3 3
20 80 100
12 34 46
30 21 51
3 0 3
45 55 100
27 19 46
27 24 51
0 3 3
54 46
1 35 10 46
7 33 11 51
1 2 0 3
9 70 21 100
18 28 46
7 44 51
0 3 3
25 75 100
Chi‑square (P value) 11.28 (0.024)
1.343 (0.511)
14.25 (0.0008)
3.95 (0.136)
4.88 (0.087)
9.07 (0.003)
One third staff nurses were married and out of them 18% had 2 or 3 children. Work life, however, is not independent from family life; these domains may even be in conflict [Table 1].[23,24] In our study professional stress was not significantly associated with socio-demographic factors like age, marital status, no of children and gender of the staff nurse [Table 2]. Study has revealed for poor doctors attitude has been perceived by 5% staff nurse, whereas 21% perceive poor attitude from patients side [Table 3]. Doctors attitude was perceived as significant association with professional stress [Table 4]; and risk for professional stress due to poor and satisfactory doctor’s attitude was found about 3 and 4 times more than with excellent attitude of doctors toward the staff nurses (OR = 2.97 and OR = 3.97, respectively). Similarly, Blair and Littlewood emphasized that work relationships are potential stressors.[25] In a study of 260 RNs, conflict with physicians was found to be more psychologically damaging than conflict within the nursing profession [Table 5].[26] Verbal abuse from physicians was noted to be stressful for staff nurses.[27] Similarly, Adib‑Hajbaghery and colleagues found that poor relationships between nurses and other health care professionals is a major source of occupational stress among hospital nurses.[28] French and colleagues[29] identified conflict with physicians, problems with peers and supervisors,
Indian Journal of Occupational and Environmental Medicine - August 2014 - Volume 18 - Issue 2
Parul, et al.: Occupational stress among staff nurses
and discrimination as stressors for nurses. Thus, developing good personal relationship at work place is necessary for the prevention of job stress among hospital nurses. Association between department of posting and stress The target study revealed a statistically significant association (P
Occupational stress among staff nurses: Controlling the risk to health Abstract Introduction: Nursing has been identified as an occupation that has high levels of stress. Job stress brought about hazardous impacts not only on nurses’ health but also on their abilities to cope with job demands. Objectives: This study aimed at finding out the degree of work‑related stress among the staff nurses and various determinants, which have a impact on it. Materials and Methods: Institutional‑based cross‑sectional study conducted on GNM qualified nurses. Predesigned and pre‑tested questionnaire covering their sociodemographic variables in part I and professional life stress scale by David Fontana in part II. Analysis used was Chi‑square test and logistic regression for various factors. Results: Risk for professional stress due to poor and satisfactory doctor’s attitude was found about 3 and 4 times more than with excellent attitude of doctors toward the staff nurses. A statistically significant association (P 35 Gender Male Female Marital status Married Unmarried No. of children No child 1 Child 2-3 Children Not applicable Place of residence Hospital campus Outside hospital campus
48 43 9 34 66 35 65 9 8 18 65 63 37
Table 2: Socio‑demographic determinants for professional stress Variables
Professional stress score 31‑45 Total Chi‑square (P value)
0‑15
16‑30
5 27 14 46
7 33 11 51
2 1 0 3
14 61 25 100
14 32 46
19 32 51
1 2 3
34 66 100
0.502 (0.778)
29 17 46
33 18 51
3 0 3
65 35 100
2.69 (0.609)
4 5 8 29 46
5 3 11 32 51
0 0 0 3 3
9 8 18 65 100
0.98 (0.614)
Age (year) 15-25 26-35 >35 Total Gender Male Female Total Marital status Unmarried Married Total No. of children No child 1 Child 2-3 Children Not applicable Total
8.33 (0.08)
Table 3: Perception of staff nurses regarding working environment Variable Perception of staff nurse for attitude Attitude of the doctor Attitude of the nurse Attitude of the paramedical Attitude of the patient attendant Night duty Yes Skip meal at duty Yes Toilet condition Enough time for rest Get enough holidays Job tiring Salary enough
Indian Journal of Occupational and Environmental Medicine - August 2014 - Volume 18 - Issue 2
Excellent
Satisfactory
Poor
31 44 20 9 Very safe 37 Often 9 Good 31 Yes 20 Yes 54 Yes 45 Yes 25
64 56 77 70 Reasonably safe 47 Occasionally 70 Satisfactory 64 No 80 no 46 No 55 No 75
5 0 3 21 Unsafe 16 Rarely 21 Bad 5
53
Parul, et al.: Occupational stress among staff nurses Table 4: Association between interpersonal relationship and professional stress
Table 6: Association between working environment and professional stress
Variables
Variables
Attitude of doctor Excellent Satisfactory Poor Total Attitude of nurse Excellent Satisfactory Total Attitude of para‑medical staff Excellent Satisfactory Poor Total Attitude of patient attendant Excellent Satisfactory Poor Total
Professional stress score 0-15 16-30 31-45 Total 20 25 1 46
11 37 3 51
0 2 1 3
31 64 5 100
25 21 46
18 33 51
1 2 3
44 56 100
9 37 0 46
10 38 3 51
1 2 0 3
20 77 3 100
4 34 8 46
4 35 12 51
1 1 1 3
9 70 21 100
Chi‑square (P value) 11.59, 021
3.71 (0.447)
3.31 (0.51)
3.4 (0.492)
Table 5: Strength of association between interpersonal relationships and working environment and professional stress Variables Reference Category category Doctor’s Excellent Poor Satisfactory attitude Department Emergency/ Medicine of posting ICU Surgery Pediatrics Obs/Gynecology Job tiring Yes No Enough Yes No salary
Odds ratio Std. Significance (logistic error regression) 3.97 2.97 0.32
1.44 0.53 0.64
0.34 0.04 0.07
0.41 0.54 0.28 0.43 2.29
0.68 0.86 1.03 0.50 0.60
0.19 0.47 0.22 0.09 0.17
ICU: Intensive care units
DISCUSSION Stress up to a certain extent, will improve peoples’ performance and quality of life because it is healthy and essential that they should experience challenges within their lives,[19] but if pressure becomes excessive, it loses its beneficial effect and become harmful,[20] because it is the reaction of people under pressure or other types of demands placed on them and arise when they worry that they cannot cope.[21] It is important that stress is a state, not an illness, which may be experienced as a result of an exposure to wide range of work demands and in turn can contribute to an equally wide range of outcomes,[22] which may concern the employees’ health and be an illness or an injury or changes in his/her behavior and lifestyle. Interpersonal relationships and stress In our study, 91% staff nurses were younger than 35 years with a mean age of 27.41 years (SD = 7.06), 34% were male nurses. 54
Department of posting Medicine Surgery Pediatrics Obs/gynecology ICU/Emergency Total Enough time to rest Yes No Total Job tiring Yes No Total Enough holidays Yes No Total Skip meals Often Occasionally Rarely Total Salary enough Yes No Total
Professional stress score 0‑15 16‑30 31‑45
Total
15 10 4 4 13 46
8 6 7 2 28 51
0 0 1 0 2 3
23 16 12 6 43 100
8 38 46
12 39 51
0 3 3
20 80 100
12 34 46
30 21 51
3 0 3
45 55 100
27 19 46
27 24 51
0 3 3
54 46
1 35 10 46
7 33 11 51
1 2 0 3
9 70 21 100
18 28 46
7 44 51
0 3 3
25 75 100
Chi‑square (P value) 11.28 (0.024)
1.343 (0.511)
14.25 (0.0008)
3.95 (0.136)
4.88 (0.087)
9.07 (0.003)
One third staff nurses were married and out of them 18% had 2 or 3 children. Work life, however, is not independent from family life; these domains may even be in conflict [Table 1].[23,24] In our study professional stress was not significantly associated with socio-demographic factors like age, marital status, no of children and gender of the staff nurse [Table 2]. Study has revealed for poor doctors attitude has been perceived by 5% staff nurse, whereas 21% perceive poor attitude from patients side [Table 3]. Doctors attitude was perceived as significant association with professional stress [Table 4]; and risk for professional stress due to poor and satisfactory doctor’s attitude was found about 3 and 4 times more than with excellent attitude of doctors toward the staff nurses (OR = 2.97 and OR = 3.97, respectively). Similarly, Blair and Littlewood emphasized that work relationships are potential stressors.[25] In a study of 260 RNs, conflict with physicians was found to be more psychologically damaging than conflict within the nursing profession [Table 5].[26] Verbal abuse from physicians was noted to be stressful for staff nurses.[27] Similarly, Adib‑Hajbaghery and colleagues found that poor relationships between nurses and other health care professionals is a major source of occupational stress among hospital nurses.[28] French and colleagues[29] identified conflict with physicians, problems with peers and supervisors,
Indian Journal of Occupational and Environmental Medicine - August 2014 - Volume 18 - Issue 2
Parul, et al.: Occupational stress among staff nurses
and discrimination as stressors for nurses. Thus, developing good personal relationship at work place is necessary for the prevention of job stress among hospital nurses. Association between department of posting and stress The target study revealed a statistically significant association (P
