¶ … Stress and Job Performance in the Nursing Profession Sources and Consequences of Stress

Participants

Materials

Job Satisfaction and Feelings of Adequacy

Job Performance

Gender and Menopausal Status

Expected Results and Discussion

The relationship between work-related stress and job performance in the nursing profession

Work-related stress is best defined as the harmful emotional and physical reactions that often result from the interactions between the worker and his/her work environment where the demands of the job negatively affect the worker's capabilities and resources (European Agency for Safety and Health at Work, 2000).

When human beings are under stress, our bodies prepare for a "fight or flight response": adrenaline, cholesterol, and sugar are released into the bloodstream. This may result in anxiety or panic attacks, migraine headaches, stomach problems, back problems, racing heart beat, dizziness, sweaty hands, and other symptoms. While some stress is required to live a healthy and happy life, too much stress can cause wear and tear on our bodies, resulting in physical and psychological problems.

Figure 1: Risk: Pathways from hazard to harm.

SOURCE: European Agency for Safety and Health at Work, 2000.

There are many factors that may result in work-related stress in the nursing industry. The following list displays the most common factors that affect job performance (Wynee et al., 1993):

Working conditions: overtime, inadequate remuneration, hours of work, conflict, discrimination, and poor working conditions.

Working relationships: relationships with other nurses, managers, supervisors

Role conflict and ambiguity: poorly-defined roles, functions, expectations, and duties.

Organization structure: communication policy and practice, major changes in the workplace, culture of the organization, and lack of participation in decision-making.

Nature of the job: amount of physical and emotional stamina, workload and work pace.

In addition to these basic factors for stress, nurses must also deal with death and dying, inadequate preparation to deal with the emotional needs of patients and their families, the current nursing staff shortage, heavy workloads, and uncertainty concerning treatment plans.

There is a great deal of research suggesting that nursing is a stressful job and that the stress experienced by nurses can lead to a broad variety of work-related problems, including absenteeism, conflict, staff turnover, morale issues, and overall decreased worker effectiveness (Wunderlich, et al., 1996).Too much stress frequently results in burnout and the high turnover of nursing personnel. Thus, the causes and correlates of work-related stress, and the outcomes for job performance are of great concern to the overall nursing industry.

Sources and Consequences of Stress

This study attempts to identify the factors associated with work-related stress in the nursing industry. According to the literature review, these factors include extensive workloads, limited facilities and space, inadequate staffing, too much responsibility, a lack of continuing education, poor organization, excessive paperwork, inadequate communication with physicians, working tensions, and many other variables. Lack of recognition and lack of administrative support and leadership are also major causes of work-related stress.

Various studies of stress found that critical care nurses and intensive care nurses experience more stress than do nurses in other units (Wunderlich, et al., 1996). However, research has not consistently validated this finding (Foxall et al., 1990, p. 579). A survey of emergency room nurses, identified inadequate staffing and other resources, too many administrative tasks, changing trends in emergency department use, and patient transfer problems as major causes of stress. They also described shortages of nursing staff during busy periods and at night, and the use of untrained relief staff, as important factors in stress.

Excessive stress at the workplace can create morale problems that negatively affect the job performance of employees (Wunderlich, et al., 1996). The causal model developed from research on work-related stress and morale among nursing home employees accentuates both causes and outcomes of work-related stress (Weiler, et al., 1990). The outcomes of work-related stress are frequently linked to negative physical and psychological consequences. According to Weiler and colleagues (1990), these outcomes can include:

burnout, defined as a syndrome of emotional exhaustion, depersonalization, and lack of personal accomplishment; depression, which is the degree of negative affect experienced by nursing personnel; poor or low job satisfaction, which involves effective orientation of nursing personnel toward the work situation; and work involvement, defined as the degree to which nursing personnel identify with their job.

Many organizational factors have been cited that influence nursing stress, burnout, and productivity in nursing care, and often result in short-term or long-term absenteeism. Research by Hare and Pratt (1988) demonstrates that higher levels of nursing burnout, caused...

Duquette and colleagues (1994) reveal that organizational stressors influence the development of burnout, especially role ambiguity, staffing, and workload; age; and buffering factors including hardiness, social support, and coping.
In addition to examining the effects of work-related stress on job performance, this paper aims to determine whether or not oestrogen, a female sex hormone often prescribed to relieve menopausal symptoms, plays a key role in job-related stress in the nursing industry. Oestrogen may make women more sensitive to the effects of stress, according to recent studies. In experiments with rats, researchers have analyzed the effects of stress on the function of a brain area called the prefrontal cortex (PFC), which governs cognitive abilities such as short-term memory and concentration. In the study, female and male rats were exposed to different levels of stress and then tested on short-term memory task. When they were stress-free, both the male and female rats performed equally well on the task. Both the male and female rats made major memory errors after being exposed to high levels of stress. However, after exposure to moderate levels of stress, the female rats showed impaired ability on the memory task while the male rats did not. That suggests the female rats are more sensitive to the PFC-impairing effects of stress.

The researchers monitored the female rats' oestrus cycles and found they showed this sensitivity to moderate stress only when they were in a high-oestrogen phase. To further investigate the effect of oestrogen, they removed the ovaries of a new group of female rats, which meant those rats had no circulating oestrogen. A time-capsule containing either oestrogen or placebo was inserted in these female rats. The altered rats were then subjected to the same stress and memory tests. The study found the implanted oestrogen created the same sensitivity to stress as natural oestrogen.

The researchers concluded that high levels of oestrogen act to enhance the stress response, resulting in greater stress-related cognitive impairments. A greater understanding of this process may lead to a better understanding of why women are more susceptible to stress-related disorders such as depression and post-traumatic stress disorder. That could help in the development of improved treatments for those disorders. In the nursing industry, it could be a key factor in determining how the level of oestrogen hormone correlates with work-related stress. This paper hypothesizes that the greater the level of oestrogen, the more stressful a nurse will perceive her work environment to be. This paper also hypothesizes that the job performance of male nurses and post-menopausal female nurses is more negatively correlated to stress than the job performance of pre-menopausal female nurses, as men and post-menopausal women have less oestrogen than pre-menopausal women.

Method

Participants

In March 2004, we mailed questionnaires to 50 nurses and a total of 25 usable questionnaires were returned: 14 from women RNs and 11 from men RPNs. After taking into account nurses who were ineligible, this represents a response rate of 50%. This paper was largely supported by an extensive literature, which helped to correlate job-related stress and oestrogen levels to job performance.

Materials

Job Satisfaction and Feelings of Adequacy

On a 1-5 Likert scale where 1 is equal to "Strongly Disagree" and 5 is equal to "Strongly Agree," participants were asked to rate their feelings of job satisfaction and adequacy.

The following statements were presented to participants in this section:

1. I always feel extremely exhausted after I get off from work.

2. I am satisfied with my job.

3. I always work overtime.

4. I feel extremely depressed when facing the death of a patient.

5. I always have conflicts with physicians.

6. I have difficulty sleeping.

7. I find myself feeling overwhelmed by my job.

8. I find time to do things that I enjoy.

9. I look forward to going to work everyday.

10. How many hours a day do you work?

11. How many breaks per day do you take?

Job Performance

On a 1-5 Likert scale where 1 is equal to "Strongly Disagree" and 5 is equal to "Strongly Agree," the participant's supervisors were asked to rate the participant's job performance.

The following statements were presented to supervisors in this section:

1. This nurse makes more mistakes (job-wise) in comparison to other nurses working in the same station.

2. This nurse is capable of working long hours (6-8 hours straight) without taking a break.

3. This nurse comes to work inadequately prepared.

4. This nurse has an excellent overall job performance.

5. This nurse is always late for work.

6. This nurse does his or her job quickly and correctly.

7. The nurse regards his or her patients as the top priority.

8. This nurse gets along well with patients.

9. This…