This article was downloaded by: [University of Sydney] On: 05 January 2015, At: 15:47 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Community Health Nursing Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hchn20
Work Stress and Job Satisfaction for the Community Health Nurse Carol A. Boswell Published online: 07 Jun 2010.
To cite this article: Carol A. Boswell (1992) Work Stress and Job Satisfaction for the Community Health Nurse, Journal of Community Health Nursing, 9:4, 221-227, DOI: 10.1207/s15327655jchn0904_3 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0904_3
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
JOURNAL OF COMMUNITY HEALTH NURSING, 1992,9(4), 221-227 Copyright O 1992, Lawrence Erlbaum Associates, Inc.
Work Stress and Job Satisfaction for the Community Health Nurse Carol A. Boswell, RN, MSN
Downloaded by [University of Sydney] at 15:47 05 January 2015
Andrews, TX
The nursing profession has changed from the concept of the physician's handmaiden by the bedside to one of leadership within the community health setting. With the advent of the prospective payment system, the community health nurse (CHN) has been required to deal with patients who present with increasingly complex health needs. This increased responsibility of the CHN in the area of patient management can result in the development of stress and decreased job satisfaction. Research concerning job satisfaction and stress in regard to the CHN is limited to information concerning English health visitors, stress, and stress in other health settings (Butcher & Davis, 1988; Gillespie, 1987; Gough & Hingley, 1988; Stoner & Wankel, 1986; West & Savage, 1988). These studies investigated the effects of stress on the individual working in a health setting. The perception of nurses' satisfaction in their work setting has been studied to some degree in the hospital setting. Minimal information, however, is available concerning the relationship between job satisfaction and work stress for the CHN (Slavitt, Stamps, Piedmont, & Haase, 1987; Stoner & Wankel, 1986). To assist the CHN in mitigating the effects of work stress, the relationship between job satisfaction and work stress specifically in the community henlth setting needs to be delineated. The purpose of this study was to determine the relationship between work stress and job satisfaction among CHNs. THEORETICAL BACKGROUND
Stress was defined by Selye (1976) to encompass the responses which the body displayed in regard to perceived stimuli. Within Selye's General Adaptation Syndrome, the individual exists in one of three levels of adaptation to stress. These levels are the phases of: alarm, adaptation, and exhaustion. The alarm reaction occurs at the onset of stress as the individual initiates the "fight or flight" defensive behavior. The second phase-adaptation-begins when the body starts to adapt to the stress. Exhaustion is the final phase which occurs as the individual has expended all of his or her physical and emotional resources. The nurse's perception of the stress experienced in the job setting and the adaptaRequests for reprints should be sent to Carol A. Boswell, RN, MSN, 403 Northwest Tenth Street, Andrews. TX 79714.
Downloaded by [University of Sydney] at 15:47 05 January 2015
222
Boswell
tion level at which he or she is functioning affects the nurse's ability to manage and perform effective nursing care. The better the nurse comprehends the adaptation process, the more likely it is that the nurse will succeed in managing the stress encountered in the work setting. Lazarus and Folkman (1984) concluded that stress resulted from environmental events or stressors. The amount of daily conflicts experienced by an individual appeared to be the most important environmental event in determining adaptation and health (Lazarus & Folkman, 1984). Because the CHN functions within a relatively unstructured setting, many situations or daily conflicts which can tax or overwhelm the nurse may develop. When the nurse is aware of the concept of stress, the environmental events which appear as stressors can be addressed. Herzberg's (1982) motivation-hygiene theory investigated the concept of job satisfaction/job dissatisfaction. Within this theory, motivating and hygiene factors were delineated which aided in the determination of job satisfaction. Motivating variables are listed as: achievement, recognition, the work itself, and responsibility. In contrast, hygiene variables are listed as: company policy and administration, supervision, working conditions, salary, and status. As the CHN became aware of motivating and hygiene factors as denoted by Herzberg, these factors could be acknowledged and addressed in the work setting. Herzberg related that work satisfaction resulted from the presences of motivating factors and the absences of hygiene factors.
METHOD This research study employed a descriptive correlational method (Pearson productmoment correlation) to establish the relationship between work stress and job satisfaction in the community health setting.
Subjects The study sample included nurses who worked at official state and local public health agencies within the geographic area of Texas Public Health Region 3. Eightyfour registered nurses employed at 31 agencies were given the opportunity to complete the instrument. Fifty-one of these nurses returned the completed instrument. This response reflected a 61 % completion rate. A composite look at the CHN responding to this research project was: (a) female, (b) approximately 45 years old, (c) employed in other agencies prior to coming into the current position, (d) diploma degree educated, and (e) having performed some administrative functions. The sample included 51 individuals (96% females). The ages of the respondents ranged from 29 to 63 years with a mean age of 45. In regard to employment with the respondent's current agency, the range was 1 month to 33 years with a mean of 6%years. Thirty-nine percent of the respondents noted their level of educational preparation for nursing as a diploma in nursing. Thirty-two percent of the respondents related
Work Stress
223
holding a bachelor of science in nursing while 24% held an associate degree in nursing. Staff nurses were the major job classification of respondents.
Downloaded by [University of Sydney] at 15:47 05 January 2015
Instrument The instrument utilized in the project consisted of four separate scales which were: (a) employee demographics, (b) nurse job satisfaction scale (NJS), (c) work satisfaction scale (WSS), and (d) job stress scale (JSS). The instrument was developed by Hinshaw, Smeltzer, and Atwood (1987) to investigate job satisfaction and stress in an inpatient setting. This instrument was the only tool found that investigated the concepts of work stress and job satisfaction in the same tool. Because the tool was worded for an inpatient setting, the instrument was altered in an attempt to address the community health setting. The alterations substituted the words "health setting" for references to the "clinical unit.'' The employee demographic data tool provided a basic description of the respondents to the study. The NJS employed a 5-point Likert scale for the 23 questions. This tool indexed the professional/ occupational perspectives of the activities completed for wages. An interpretation of the tool's subscales reflected that as the combined score of the subscales increased, the amount of professional/occupational satisfaction perceived by the nurse increased. The third instrument was the WSS which had 32 items on a 5-point Likert scale. The WSS indexed the satisfaction which the worker perceived within the organization, and the functioning of the nursing staff. The interpretation of the tool delineated that an increase in the combined score of the subscales of the WSS correlated to the nurse's perceived and increased satisfaction in the area of nursing staff organization and function. The final instrument was the 49-item JSS with a 4point Likert scale. This tool investigated the stressors encountered by the nurse within the work setting. As the combined score of the subscales of the JSS increased, the perception of job stress by the nurse decreased. Content and construct validity was established as moderate to strong reliability for each of the tools employed. Within the causal modeling relationship, the tools performed as predicted. Procedure A letter covering the purpose of the survey, assurance of anonymity, and time involvemient was sent to each respondent with the questionnaire. Each questionnaire was numbered to provide information concerning the ratio of completed forms. After completing the questionnaire, the respondents returned the form in the postagepaid envelope. This process insured confidentiality of the questionnaire data. A total of 84 questionnaires were sent out. Analysis The plan for analyzing the data gained from this study included a descriptive presentation of the demographical data and a descriptive correlational analysis (Pear-
224
Boswell
son product-moment correlation) of the two scales: JSS and NJS (combination of the NJS and WSS scores). An increasing overall score on the NJS and WSS reflected an increased satisfaction with the role of community health nursing while an increasing overall score on the JSS reflected a decreased amount of job stress in the CHNs' role. If the descriptive correlational analysis of the JSS and the combined scores on the NJS and WSS displayed a positive correlation, the results would correlate to an inverse relationship between job stress and work satisfaction.
Downloaded by [University of Sydney] at 15:47 05 January 2015
RESULTS
When the cumulative totals for the NJS and WSS were correlated to the JSS, the resulting Pearson r = .66 (Table 1). This result indicated a moderately positive correlation between the job stress and work satisfaction variables. Because an increasing cumulative job stress total reflected a decreasing level of job stress, the positive correlation between these variables would imply an increasing amount of work satisfaction resulting from this decrease in job stress. Each of the sections-NJS, WSS, and JSS-within the instrument had subscales which were also analyzed statistically. When the subscales of the NJS were correlated with the subscales of the JSS, several interesting positive correlations were discovered. A moderately positive correlation was found between the NJS subscale of quality of care and the JSS subscales of competence (r = .53), physical work environment (r = .67), staffing (r = .57), and patient outcome (r = .67; Table 2). This finding might be interpreted to mean that as the CHNs perceived that the quality of care for the patient changed, the stress resulting from the issues of competence, physical work environment, staffing, and patient outcome also changed. Another positive correlation found within these subscales (r = .74) and the only one which was highly correlated was between the subscale of quality of care (NJS) and time priorities (JSS). The findings reflect that as the nurse could set priorities to facilitate time management, the perceived quality of patient care improved. The WSS was used to demonstrate the fulfillment experienced by the CHN in regard to the organization of the work setting. The WSS subscale of task requirements demonstrated a moderately positive correlation with the JSS subscales of physical work environment (r = .54), staffing (r = .67), time priorities (r = .71), and patient outcome (r = .52; Table 3). The CHN observed that as the task requirements within the health setting were understood, the stress that resulted from physical work, environment, staffing, time priorities, and patient outcome was affected. The subscale did not provide answers as to the reasons for this correlation. The acquisition of knowledge concerning the task requirements in the health setting did not cause the reduction of stress concerning these items. However, a positive linear relationship between the variables was reflected within the study. A .05 level of probability was utilized within this project to establish a significant statistical finding. The probability of an inverse correlation existing between job satisfaction and work stress was discovered to be p = .0001 (Table 1). This finding
225
Work Stress TABLE 1 Pearson Correlation Coefficients
Job Stress Job stress Nurse job satisfaction
Nurse Job Satisfaction
1.00. 1.00
.66*
Downloaded by [University of Sydney] at 15:47 05 January 2015
*p < .0001.
reflected a statistically significant relationship between job satisfaction and work stress for the CHN. Whm the probability levels for the subscales were investigated, the information reflected several interesting aspects of the study. A statistically significant correlation between the NJS subscale of quality of care and each of the JSS subscales was discovered (Tmble 2). The CHNs in this study acknowledged that a relationship existed between the quality of care they were able to provide to the patient and the amount of job stress they experienced. As the nurses recognized an improvement in the quality of care the patient received, the nurse's job stress decreased. Another interesting aspect was the statistically significant relationship discovered between the time available to the nurse to do one's job requirements (NJS) and the level of work stress experienced (Tmble 2). When the nurse was given adequate time to manage the requirements of his or her job, the stress perceived by the nurse decreased. Another aspect was that task requirements was the only subscale on the WSS which reflected a statistically significant relationship with job stress (Table 3). As the nurse developed competency in the performance of the assigned tasks in the health setting, the stress experienced by the individual decreased. Finally, the respondents felt that the three concepts of quality of care, amount of time available to complete one's job, and task requirements were important in regard to the amount of work stress weathered by the CHN. TABLE 2 Job Stress-Nurse Job Satisfaction
Pearson Correlation Coefficients-NJS -
JSS Competence P Physical Environment P Staffing P Team Respect P Time Priorities P Emotional Support P Competence Feelings P Patient Outcome P
-
-
Quality of Care
Enjoyment
Time to Do One's Work
0.52 0.0001 0.55 0.0001 0.57 0.0001 0.35 0.0095 0.74 0.0001 0.42 0.0019 0.46 0.0005 0.67 0.0001
0.26 0.0579 0.16 0.2414 0.15 0.2702 0.25 0.0714 0.21 0.1323 0.20 0.1465 0.11 0.4239 0.23 0.0923
0.23 0.0897 0.47 0.0003 0.61 0.0001 0.33 0.0166 0.68 0.0001 0.32 0.0169 0.03 0.7978 0.43 0.0014
226
Boswell TABLE 3 Job Stress-Work Satisfaction
Pearson Correlation Coefficients- WSS Pay or Reward
JSS
Competence
P Physical Environment
P Staffing P
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Team Respect
P Time Priorities P
Emotional support P Competence Feelings
P Patient Outcome
P
0.20 0.1483 0.11 0.4068 0.10 0.4647 0.00 0.9873 0.17 0.2145 - 0.02 0.8473 -0.03 0.7963 0.32 0.0205
Professional Status
Interaction Cohesion
Administration
Task Requirements
0.21 0.1263 -0.01 0.9581 0.04 0.7694 0.26 0.0597 0.07 0.5979 0.05 0.6838 0.01 0.9290 0.18 0.1818
0.33 0.0164 0.25 0.0636 0.29 0.0357 0.25 0.0734 0.37 0.0067 0.18 0.1868 0.24 0.0808 0.20 0.1428
0.12 0.3839 0.09 0.5172 0.18 0.1795 0.23 0.0881 0.23 0.0877 0.14 0.3126 - 0.02 0.8574 0.07 0.5946
0.32 0.0189 0.53 0.0001 0.67 0.0001 0.33 0.0142 0.71 0.0001 0.28 0.0428 0.21 0.1225 0.51 0.0001
DISCUSSION
This research project was conducted to determine if a relationship existed between work stress and job satisfaction for the CHN. Work stress was defined as any element within the work setting which could potentially result in distress for the nurse. In contrast, job satisfaction was designated as the act of fulfilling an individual's desires, expectations, and demands in the work place. It was hypothesized that as job satisfaction increased, the distress perceived by the CHN would decrease resulting in less work stress. The research project postulated that a higher level of work stress was associated with a decreased amount of job satisfaction. When the instrument utilized within this project was employed in a hospital setting, the stressors for the inpatient setting were identified as a lack of team respect and feelings of incompetence. In this study, the community health stressors were delineated to be quality of care, time to do one's job, and task requirements. Each area of nursing practice has its own stressors which necessitate individualized approaches to stress management. The specific stressors for each area of nursing practice have to be identified so that adequate methods of coping can be developed. The information discovered in this project can be generalized to CHNs working in a rural Texas setting. A larger sample of CHNs would need to be analyzed before the statistical information can be generalized to the population of CHNs at large. RECOMMENDATIONS FOR FURTHER RESEARCH
Additional research within the field of community health nursing is needed in regard to work stress and job satisfaction. A tool concerning work stressors and job satisfiers specific to the community health setting needs to be developed and tested
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instead of the reworking of a tool designed for the inpatient setting. The tool should address the size of the work setting (the entire community), the educative aspects of the role (prevention and health promotion for the community members), and differences within the support sources for the nurse (equipment, team members, and administrative support), as well as the unique demands of community health nursing practice. One implication for community health nursing practice from this study is the need for orientation and inservice programs that include the areas of task requirements and time to do one's job on an ongoing basis. The nurses functioning within the community health agencies in this study were primarily diploma prepared. These nurses are trained for bedside nursing. Orientation and inservice programs within the community health setting should address the nurse at his or her current level of education. In conclusion, multiple areas within the field of community health nursing need to be researched. Community health nursing issues are only now beginning to be investigated by the nursing profession. Stress within the community health setting is only one of the many areas which needs to be studied, documented, and effectively managed. Only through sound research can new and innovative strategies to manage stress be developed within the field of community health nursing.
REFERENCES Butcher, P., & Davis, H. (1988). A personal effectiveness and stress management course for community health workers: A pilot study. Patient Education and Counseling, 12(4), 13-27. Gillespie, C. (1987). Stress-reducing strategies. Nursing Times, 83(39), 30-32. Gough, P., & Hingley, P. (1988). Combating the pressure. Nursing Times, 84(2), 43-45. Herzberg, F. (1982). The managerial choice to be efficient and to be human (2nd ed., rev.). Salt Lake City: Olympus Publishing. Hinshaw, A. S., Smeltzer, C. H., & Atwood, J. R. (1987, June). Innovative retention strategies for nursing staff. Journal of Nursing Administrators, pp. 11-1 9. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer. Selye, H. (1976). The stress of life (rev. ed.). New York: McGraw-Hill. Slavitt, D. B., Stamps, P. L., Piedmont, E. B., & Haase, A. M. B. (1987). Nurses' satisfaction with their work situation. Nursing Research, 27(2), 114-120. Stoner, J. A. F., & Wankel, C. (1986). Management (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall. West, M., & Savage, Y. (1988). Visitations of distress. Nursing Times, 84(31), 43-44.
Journal of Community Health Nursing Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hchn20
Work Stress and Job Satisfaction for the Community Health Nurse Carol A. Boswell Published online: 07 Jun 2010.
To cite this article: Carol A. Boswell (1992) Work Stress and Job Satisfaction for the Community Health Nurse, Journal of Community Health Nursing, 9:4, 221-227, DOI: 10.1207/s15327655jchn0904_3 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0904_3
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
JOURNAL OF COMMUNITY HEALTH NURSING, 1992,9(4), 221-227 Copyright O 1992, Lawrence Erlbaum Associates, Inc.
Work Stress and Job Satisfaction for the Community Health Nurse Carol A. Boswell, RN, MSN
Downloaded by [University of Sydney] at 15:47 05 January 2015
Andrews, TX
The nursing profession has changed from the concept of the physician's handmaiden by the bedside to one of leadership within the community health setting. With the advent of the prospective payment system, the community health nurse (CHN) has been required to deal with patients who present with increasingly complex health needs. This increased responsibility of the CHN in the area of patient management can result in the development of stress and decreased job satisfaction. Research concerning job satisfaction and stress in regard to the CHN is limited to information concerning English health visitors, stress, and stress in other health settings (Butcher & Davis, 1988; Gillespie, 1987; Gough & Hingley, 1988; Stoner & Wankel, 1986; West & Savage, 1988). These studies investigated the effects of stress on the individual working in a health setting. The perception of nurses' satisfaction in their work setting has been studied to some degree in the hospital setting. Minimal information, however, is available concerning the relationship between job satisfaction and work stress for the CHN (Slavitt, Stamps, Piedmont, & Haase, 1987; Stoner & Wankel, 1986). To assist the CHN in mitigating the effects of work stress, the relationship between job satisfaction and work stress specifically in the community henlth setting needs to be delineated. The purpose of this study was to determine the relationship between work stress and job satisfaction among CHNs. THEORETICAL BACKGROUND
Stress was defined by Selye (1976) to encompass the responses which the body displayed in regard to perceived stimuli. Within Selye's General Adaptation Syndrome, the individual exists in one of three levels of adaptation to stress. These levels are the phases of: alarm, adaptation, and exhaustion. The alarm reaction occurs at the onset of stress as the individual initiates the "fight or flight" defensive behavior. The second phase-adaptation-begins when the body starts to adapt to the stress. Exhaustion is the final phase which occurs as the individual has expended all of his or her physical and emotional resources. The nurse's perception of the stress experienced in the job setting and the adaptaRequests for reprints should be sent to Carol A. Boswell, RN, MSN, 403 Northwest Tenth Street, Andrews. TX 79714.
Downloaded by [University of Sydney] at 15:47 05 January 2015
222
Boswell
tion level at which he or she is functioning affects the nurse's ability to manage and perform effective nursing care. The better the nurse comprehends the adaptation process, the more likely it is that the nurse will succeed in managing the stress encountered in the work setting. Lazarus and Folkman (1984) concluded that stress resulted from environmental events or stressors. The amount of daily conflicts experienced by an individual appeared to be the most important environmental event in determining adaptation and health (Lazarus & Folkman, 1984). Because the CHN functions within a relatively unstructured setting, many situations or daily conflicts which can tax or overwhelm the nurse may develop. When the nurse is aware of the concept of stress, the environmental events which appear as stressors can be addressed. Herzberg's (1982) motivation-hygiene theory investigated the concept of job satisfaction/job dissatisfaction. Within this theory, motivating and hygiene factors were delineated which aided in the determination of job satisfaction. Motivating variables are listed as: achievement, recognition, the work itself, and responsibility. In contrast, hygiene variables are listed as: company policy and administration, supervision, working conditions, salary, and status. As the CHN became aware of motivating and hygiene factors as denoted by Herzberg, these factors could be acknowledged and addressed in the work setting. Herzberg related that work satisfaction resulted from the presences of motivating factors and the absences of hygiene factors.
METHOD This research study employed a descriptive correlational method (Pearson productmoment correlation) to establish the relationship between work stress and job satisfaction in the community health setting.
Subjects The study sample included nurses who worked at official state and local public health agencies within the geographic area of Texas Public Health Region 3. Eightyfour registered nurses employed at 31 agencies were given the opportunity to complete the instrument. Fifty-one of these nurses returned the completed instrument. This response reflected a 61 % completion rate. A composite look at the CHN responding to this research project was: (a) female, (b) approximately 45 years old, (c) employed in other agencies prior to coming into the current position, (d) diploma degree educated, and (e) having performed some administrative functions. The sample included 51 individuals (96% females). The ages of the respondents ranged from 29 to 63 years with a mean age of 45. In regard to employment with the respondent's current agency, the range was 1 month to 33 years with a mean of 6%years. Thirty-nine percent of the respondents noted their level of educational preparation for nursing as a diploma in nursing. Thirty-two percent of the respondents related
Work Stress
223
holding a bachelor of science in nursing while 24% held an associate degree in nursing. Staff nurses were the major job classification of respondents.
Downloaded by [University of Sydney] at 15:47 05 January 2015
Instrument The instrument utilized in the project consisted of four separate scales which were: (a) employee demographics, (b) nurse job satisfaction scale (NJS), (c) work satisfaction scale (WSS), and (d) job stress scale (JSS). The instrument was developed by Hinshaw, Smeltzer, and Atwood (1987) to investigate job satisfaction and stress in an inpatient setting. This instrument was the only tool found that investigated the concepts of work stress and job satisfaction in the same tool. Because the tool was worded for an inpatient setting, the instrument was altered in an attempt to address the community health setting. The alterations substituted the words "health setting" for references to the "clinical unit.'' The employee demographic data tool provided a basic description of the respondents to the study. The NJS employed a 5-point Likert scale for the 23 questions. This tool indexed the professional/ occupational perspectives of the activities completed for wages. An interpretation of the tool's subscales reflected that as the combined score of the subscales increased, the amount of professional/occupational satisfaction perceived by the nurse increased. The third instrument was the WSS which had 32 items on a 5-point Likert scale. The WSS indexed the satisfaction which the worker perceived within the organization, and the functioning of the nursing staff. The interpretation of the tool delineated that an increase in the combined score of the subscales of the WSS correlated to the nurse's perceived and increased satisfaction in the area of nursing staff organization and function. The final instrument was the 49-item JSS with a 4point Likert scale. This tool investigated the stressors encountered by the nurse within the work setting. As the combined score of the subscales of the JSS increased, the perception of job stress by the nurse decreased. Content and construct validity was established as moderate to strong reliability for each of the tools employed. Within the causal modeling relationship, the tools performed as predicted. Procedure A letter covering the purpose of the survey, assurance of anonymity, and time involvemient was sent to each respondent with the questionnaire. Each questionnaire was numbered to provide information concerning the ratio of completed forms. After completing the questionnaire, the respondents returned the form in the postagepaid envelope. This process insured confidentiality of the questionnaire data. A total of 84 questionnaires were sent out. Analysis The plan for analyzing the data gained from this study included a descriptive presentation of the demographical data and a descriptive correlational analysis (Pear-
224
Boswell
son product-moment correlation) of the two scales: JSS and NJS (combination of the NJS and WSS scores). An increasing overall score on the NJS and WSS reflected an increased satisfaction with the role of community health nursing while an increasing overall score on the JSS reflected a decreased amount of job stress in the CHNs' role. If the descriptive correlational analysis of the JSS and the combined scores on the NJS and WSS displayed a positive correlation, the results would correlate to an inverse relationship between job stress and work satisfaction.
Downloaded by [University of Sydney] at 15:47 05 January 2015
RESULTS
When the cumulative totals for the NJS and WSS were correlated to the JSS, the resulting Pearson r = .66 (Table 1). This result indicated a moderately positive correlation between the job stress and work satisfaction variables. Because an increasing cumulative job stress total reflected a decreasing level of job stress, the positive correlation between these variables would imply an increasing amount of work satisfaction resulting from this decrease in job stress. Each of the sections-NJS, WSS, and JSS-within the instrument had subscales which were also analyzed statistically. When the subscales of the NJS were correlated with the subscales of the JSS, several interesting positive correlations were discovered. A moderately positive correlation was found between the NJS subscale of quality of care and the JSS subscales of competence (r = .53), physical work environment (r = .67), staffing (r = .57), and patient outcome (r = .67; Table 2). This finding might be interpreted to mean that as the CHNs perceived that the quality of care for the patient changed, the stress resulting from the issues of competence, physical work environment, staffing, and patient outcome also changed. Another positive correlation found within these subscales (r = .74) and the only one which was highly correlated was between the subscale of quality of care (NJS) and time priorities (JSS). The findings reflect that as the nurse could set priorities to facilitate time management, the perceived quality of patient care improved. The WSS was used to demonstrate the fulfillment experienced by the CHN in regard to the organization of the work setting. The WSS subscale of task requirements demonstrated a moderately positive correlation with the JSS subscales of physical work environment (r = .54), staffing (r = .67), time priorities (r = .71), and patient outcome (r = .52; Table 3). The CHN observed that as the task requirements within the health setting were understood, the stress that resulted from physical work, environment, staffing, time priorities, and patient outcome was affected. The subscale did not provide answers as to the reasons for this correlation. The acquisition of knowledge concerning the task requirements in the health setting did not cause the reduction of stress concerning these items. However, a positive linear relationship between the variables was reflected within the study. A .05 level of probability was utilized within this project to establish a significant statistical finding. The probability of an inverse correlation existing between job satisfaction and work stress was discovered to be p = .0001 (Table 1). This finding
225
Work Stress TABLE 1 Pearson Correlation Coefficients
Job Stress Job stress Nurse job satisfaction
Nurse Job Satisfaction
1.00. 1.00
.66*
Downloaded by [University of Sydney] at 15:47 05 January 2015
*p < .0001.
reflected a statistically significant relationship between job satisfaction and work stress for the CHN. Whm the probability levels for the subscales were investigated, the information reflected several interesting aspects of the study. A statistically significant correlation between the NJS subscale of quality of care and each of the JSS subscales was discovered (Tmble 2). The CHNs in this study acknowledged that a relationship existed between the quality of care they were able to provide to the patient and the amount of job stress they experienced. As the nurses recognized an improvement in the quality of care the patient received, the nurse's job stress decreased. Another interesting aspect was the statistically significant relationship discovered between the time available to the nurse to do one's job requirements (NJS) and the level of work stress experienced (Tmble 2). When the nurse was given adequate time to manage the requirements of his or her job, the stress perceived by the nurse decreased. Another aspect was that task requirements was the only subscale on the WSS which reflected a statistically significant relationship with job stress (Table 3). As the nurse developed competency in the performance of the assigned tasks in the health setting, the stress experienced by the individual decreased. Finally, the respondents felt that the three concepts of quality of care, amount of time available to complete one's job, and task requirements were important in regard to the amount of work stress weathered by the CHN. TABLE 2 Job Stress-Nurse Job Satisfaction
Pearson Correlation Coefficients-NJS -
JSS Competence P Physical Environment P Staffing P Team Respect P Time Priorities P Emotional Support P Competence Feelings P Patient Outcome P
-
-
Quality of Care
Enjoyment
Time to Do One's Work
0.52 0.0001 0.55 0.0001 0.57 0.0001 0.35 0.0095 0.74 0.0001 0.42 0.0019 0.46 0.0005 0.67 0.0001
0.26 0.0579 0.16 0.2414 0.15 0.2702 0.25 0.0714 0.21 0.1323 0.20 0.1465 0.11 0.4239 0.23 0.0923
0.23 0.0897 0.47 0.0003 0.61 0.0001 0.33 0.0166 0.68 0.0001 0.32 0.0169 0.03 0.7978 0.43 0.0014
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Boswell TABLE 3 Job Stress-Work Satisfaction
Pearson Correlation Coefficients- WSS Pay or Reward
JSS
Competence
P Physical Environment
P Staffing P
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Team Respect
P Time Priorities P
Emotional support P Competence Feelings
P Patient Outcome
P
0.20 0.1483 0.11 0.4068 0.10 0.4647 0.00 0.9873 0.17 0.2145 - 0.02 0.8473 -0.03 0.7963 0.32 0.0205
Professional Status
Interaction Cohesion
Administration
Task Requirements
0.21 0.1263 -0.01 0.9581 0.04 0.7694 0.26 0.0597 0.07 0.5979 0.05 0.6838 0.01 0.9290 0.18 0.1818
0.33 0.0164 0.25 0.0636 0.29 0.0357 0.25 0.0734 0.37 0.0067 0.18 0.1868 0.24 0.0808 0.20 0.1428
0.12 0.3839 0.09 0.5172 0.18 0.1795 0.23 0.0881 0.23 0.0877 0.14 0.3126 - 0.02 0.8574 0.07 0.5946
0.32 0.0189 0.53 0.0001 0.67 0.0001 0.33 0.0142 0.71 0.0001 0.28 0.0428 0.21 0.1225 0.51 0.0001
DISCUSSION
This research project was conducted to determine if a relationship existed between work stress and job satisfaction for the CHN. Work stress was defined as any element within the work setting which could potentially result in distress for the nurse. In contrast, job satisfaction was designated as the act of fulfilling an individual's desires, expectations, and demands in the work place. It was hypothesized that as job satisfaction increased, the distress perceived by the CHN would decrease resulting in less work stress. The research project postulated that a higher level of work stress was associated with a decreased amount of job satisfaction. When the instrument utilized within this project was employed in a hospital setting, the stressors for the inpatient setting were identified as a lack of team respect and feelings of incompetence. In this study, the community health stressors were delineated to be quality of care, time to do one's job, and task requirements. Each area of nursing practice has its own stressors which necessitate individualized approaches to stress management. The specific stressors for each area of nursing practice have to be identified so that adequate methods of coping can be developed. The information discovered in this project can be generalized to CHNs working in a rural Texas setting. A larger sample of CHNs would need to be analyzed before the statistical information can be generalized to the population of CHNs at large. RECOMMENDATIONS FOR FURTHER RESEARCH
Additional research within the field of community health nursing is needed in regard to work stress and job satisfaction. A tool concerning work stressors and job satisfiers specific to the community health setting needs to be developed and tested
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instead of the reworking of a tool designed for the inpatient setting. The tool should address the size of the work setting (the entire community), the educative aspects of the role (prevention and health promotion for the community members), and differences within the support sources for the nurse (equipment, team members, and administrative support), as well as the unique demands of community health nursing practice. One implication for community health nursing practice from this study is the need for orientation and inservice programs that include the areas of task requirements and time to do one's job on an ongoing basis. The nurses functioning within the community health agencies in this study were primarily diploma prepared. These nurses are trained for bedside nursing. Orientation and inservice programs within the community health setting should address the nurse at his or her current level of education. In conclusion, multiple areas within the field of community health nursing need to be researched. Community health nursing issues are only now beginning to be investigated by the nursing profession. Stress within the community health setting is only one of the many areas which needs to be studied, documented, and effectively managed. Only through sound research can new and innovative strategies to manage stress be developed within the field of community health nursing.
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