Stress among Nurses

The Causes Of Stress Among Nurses
Hans Selye defines stress as ‘the nonspecific response of the body to any demand for change’ (AIS, 1979). Job stressors are the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities or resources of the worker. Stress is defined as ‘an external cue that threatens the equilibrium of an individual’ (Gray-Toft and Anderson 1981: 639). ‘Stress is a psycho-physiologic arousal response occurring in the body as a result of a stimulus which becomes a “stressor” by virtue of the cognitive interpretation of the individual’. (Everly G.S.; Rosenfeld, R. pp. 4-5.) The perception of job stress is often mixed up with challenge. A challenge usually boosts us psychologically and physically and it also inspires us to learn new skills.

The concept of stress has two components, one component deals with a person’s perception of demands that are being made on them and other component deals with a person’s perception of their ability to meet those demands (Mc Vicar 2003: 633). Severe and long lasting distress leads to more consistently observed symptoms of emotional ‘burnout’ and severe psychological disturbance (Mc Vicar 2003: 634, Stordeur et al 2001: 534, Coffey 1999: 435). Emotional exhaustion leads to failure of being concerned about others and workers develop feelings of inadequacy (Stordeur et al 2001: 535). Various manifestations of burnout are insomnia, exhaustion, employment of different coping strategies, thinking of alternate career options.

Literature Review:
Literature shows that there are countless stressors which lead to stress in nurses (International Labor Organization 1998). Nursing literature is replete with descriptions of fatigue/ sleep deprivation, compassion fatigue, consequences of being bullied and other stress related maladies. (Graner, 2010) Work in which the demands imposed are threatening and not well matched to the knowledge, skills and ability to cope of the nurses involved, Work which does not meet the needs of the nurses involved, Situations in which nurses have little control over work, and Situations in which nurses receive little support at or outside or work. For many years, the main sources of distress for nurses are related to workload, leadership, professional conflicts and emotional cost of caring but there is disagreement as to the magnitude of their impact (McVicar 2003: 633). Stordeur et al. (2001) categorized stress in order of rigorousness of the impact, the most important are categorized as (a) elevated workload, (b) clash/conflict among colleagues (c) ambiguity about the assigned tasks (c) having an head nurse who always keeps an eye on activities of the nurses and is ready to detect errors. These categories are related to work overload and multi-tasking, lack of skills and ineffectiveness, lack of incentives (motivation and actuation), lack of support from colleagues, trust deficit and rivalry, role conflict and uncertainty, institutional limitations and finally house hold responsibilities/domestic demands (family demands and expectations). Work load is considered to be the most stressful among the eight areas of work stress (Boey et al 1997: 258). Janssen et al. (1999: 1366) confirmed that working under time pressure and highly demanding work are the major stressors faced by nurses. Demerouti et al. (2000) in their study of 185 nurses presented the model of burnout and life satisfaction which differentiates between two different categories of working conditions related to the development of stress among nurses (p. 456). These two categories are job demands and job recourses.

Jameton (1984) defined moral distress as taking place when “one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action”. This definition was further developed by Wilkinson (1987), who defined such distress as “the psychological disequilibrium and negative feeling state experienced when a person makes a moral decision but does not follow through by performing the moral behaviors indicated by that decision”. Taylor and Barling (2004) conducted a year-long research on 20 mental health nurses in order to locate the causes and sources of career fatigue and burnout (p. 117). They found that the attribute of mental illness of the nurses’ patients was an additional source of stress for them (p. 121). Nurses feel stressful when they feel that their judgment is devalued and dismissed by the doctors (Taylor and Barling 2004: 122). According to Silen et al. (2008: 225), nurses feel that their work is not commended by doctors, their knowledge is often underestimated and thus their suggestions are often not welcomed by the physicians which is the reason why nurses feel ‘frustrated’ (Silen et al. 2008: 225) and ‘burned out’ (Taylor and Barling 2004: 122).

The research literature supports the prediction that workplace factors will have direct effects on stress and job satisfaction as well as stress influencing job satisfaction (Kirkcaldy et al., 1999; Leong et al., 1996; Lyne et al., 2000). Stress is thought to be the major indicator to suicides. (Feskanish,Hastrup, Marshall, Colditz, Stampfer, Willett, Kawachi.,2002) Emergency nurses are in the position that they have higher stress levels. (Yang, Koh, Ng, Lee, Chan, Dong, Goh, Anantharaman, Chia., 2002) Demerouti et al. (2000: 456) noted that job demands are particularly stressful for nurses when they lack a good support network and do not have the prospect to discuss and improve patients’ quality of life.

Lambert et al. (2004) conducted a cross-cultural comparison of workplace stressors in Japan, Thailand, South Korea and the USA (Hawaii). Their results suggest that nurses in all four countries ranked workload and dealing with death/dying of the patients as the greatest of all workplace stressors. Moral distress is one kind of stress that is experienced by nurses (Silen et al 2008: 229, Zuzelo 2007: 343). Jameton (1984) in Silen et al (2008: 229) defined moral distress as taking place when “one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action”. This definition was further developed by Wilkinson (1987) in Silen et al (2008: 229), who defined such distress as “the psychological disequilibrium and negative feeling state experienced when a person makes a moral decision but does not follow through by performing the moral behaviors indicated by that decision”. The main causes of moral distress for nurses is when the nurse want to out in the best possible effort for the betterment of patients but are prevented from doing so by a shortage of staff, time constraints, and economic factors (Silen et al 2008: 229, Zuzelo 2007: 351 ). Objective of this study:

To find the various causes of job stress among nurses
Workplace factors have direct effect on stress and job satisfaction. Emergency nurses are a highly stressful profession.
Stress leads to increasing suicide rates.


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Coffey, M. (1999). Stress and burnout in forensic community mental health nurses: an investigation of its causes and effects. Journal of Psychiatric and Mental Health Nursing 6(6), 433-443.
Demerouti, E., Bakker, A., Nachreiner, F., Schaufeli, W. (2000). A model of burnout and life satisfaction amongst nurses. Journal of Advanced Nursing 32(2), 454-464. Everly, G.S., and Rosenfeld, R., The Nature And Treatment Of The Stress Response, pp. 4-5. Fairbrother, K., & Warn, J. (2002). Workplace dimensions, stress and job satisfaction. Journal of Managerial Psychology 18(1), 8-21.

Feskanich, D., Hastrup, J.L., Marshall J.R., Colditz, G.A., Stampfer, M.J., Willett, W.C., Kawachi, I. (2002). Stress and Suicide in the Nurses’ Health Study. Journal of Epidemiology and Community Health 56 (2), 95-98. Gray-Toft, P., Anderson, G. (1981.) Stress among hospital nursing staff: its causes and effects. Sot So. Mud. Vol ISA. P!J 639 10 647. 1981.

Happell, B., Martin, T., Pinikahana, J. (2003). Burnout and job satisfaction: a comparative study of psychiatric nurses from forensic and a mainstream mental health service. International Journal of Mental Health Nursing 12(1), 39-47.

Janssen, P., De Jonge, J., Bakker, A. (1999). Specific determinants of intrinsic work motivation, burnout and turnover intentions: a study among nurses. Journal of Advanced Nursing 29(6), 1360-1369

Kirkcaldy, B., Martin, T. (2000). Job stress and satisfaction among nurses: individual differences. Stress Medicine 16(2), 77-89.

Kirkcaldy, B., Cooper, C.L. and Furnham, A.F. (1999), The relationship between type A, internality-externality, emotional distress and perceived health. Personality and Individual Differences 26, 223-35.

Lambert, V., Lambert, C., Itano, J., Inouye, J., Kim, S., Kuniviktikul, W., Sitthi- mongkol, Y., Pongthavornkamol, K., Gasemgitvattana, S., Ito, M. (2004) Cross-cultural comparison of workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health among hospital nurses in Japan, Thailand, South Korea and the USA (Hawaii). International Journal of Nursing Studies 41(6), 671-684.

McVicar, A. (2003). Workplace stress in nursing: a literature review. Journal of Advanced Nursing 44(6), 633-642.

Silen, M., Tang, P., Wadensten, B., Ahlstrom, G. (2008). Workplace distress and ethical dilemmas in neuroscience nursing. Journal of Neuroscience Nursing 40(4), 222.

Stordeur, S., D’Hoore, W., Vandenberghe, C. (2001). Leadership, organizational stress, and emotional exhaustion among hospital nursing staff. Journal of Advanced Nursing 35(4), 533-542.

Taylor, B., Barling, J. (2004). Identifying sources and effects of carer fatigue and burnout for mental health nurses: a qualitative approach. International Journal of Mental Health Nursing 13(2), 117-125.

Yang, Y., Koh, D., Ng, V., Lee, C.Y., Chan, G., Goh, S.H., Anantharaman, V., & Chia, S.E. (2002). Self perceived work related stress and the relation with salivary IgA and lysozyme among emergency department nurses. Occupational and Environmental Medicine 59(12), 836-841. Zuzelo, P. (2007). Exploring the moral distress of registered nurses. Nursing Ethics 14(3), 344.

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