Work-Related Stress and Job Performance in Nursing

Introduction

Work-related stress is best defined as the harmful emotional and physical reactions that often result from the interactions between the worker and his or 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 heartbeat, 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.

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 (Wynne et al., 1993):

In addition to these basic stressors, nurses must also deal with death and dying, inadequate preparation to handle 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 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 have found that critical care nurses and intensive care nurses experience more stress than 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. Nurses also described shortages of nursing staff during busy periods and at night, and the use of untrained relief staff, as important contributing factors.

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:

Many organizational factors have been cited that influence nursing stress, burnout, and productivity, and that often result in short-term or long-term absenteeism. Research by Hare and Pratt (1988) demonstrates that higher levels of nursing burnout, caused by excessive stress, may be related to the nature of physically and emotionally strenuous work tasks, limited training, low wages and benefits, and poor staff-to-patient ratios. 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 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 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. When stress-free, both male and female rats performed equally well on memory tasks. Both groups made major memory errors after exposure 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, suggesting that 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, eliminating circulating oestrogen. A time-release capsule containing either oestrogen or a placebo was then implanted in these rats. The altered rats were subsequently subjected to the same stress and memory tests. The study found that 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 better insight into why women are more susceptible to stress-related disorders such as depression and post-traumatic stress disorder, and could help in the development of improved treatments for those conditions. In the nursing industry, oestrogen could be a key factor in determining how hormone levels correlate 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. It also hypothesizes that the job performance of male nurses and post-menopausal female nurses is more negatively correlated with stress than the job performance of pre-menopausal female nurses, since men and post-menopausal women have lower oestrogen levels than pre-menopausal women.

In March 2004, questionnaires were mailed to 50 nurses, and a total of 25 usable questionnaires were returned: 14 from female RNs and 11 from male RPNs. After accounting for ineligible nurses, this represents a response rate of 50%. This paper was also supported by an extensive literature review, which helped to correlate job-related stress and oestrogen levels with job performance.