occupational stress in nurses in an australian general hospital

COMMUNITY HEALTH STUDIES VOLUME X. NUMBER 3. 1986

OCCUPATIONAL STRESS IN NURSES IN AN AUSTRALIAN GENERAL HOSPITAL

S. Linder-Pelz'. J . P. Pierce ' and M. Minslowt

'School of Public Health and Tropical Medicine, University of Sydney t Royal North Shore Hospital, St Leonards N S W 2065, Australia

Abstract This paper reports the levels of stress experi-

enced by registered and student nurses in a large metropolitan teaching hospital. A scale measure of current stress was developed and its psycho- metric properties assessed. Similar scale measures were constructed for the independent variables: nurses' personal attributes and perceived stressors. There was a symmetric distribution of stress scores and further analyses focused on the approximate 30% of nurses at the "high stress" end of the scale, assumed to be experiencing excessive stress. High stress was strongly associated with feeling poorly, poor self-worth, dissatisfaction with social supports, feeling worse as pressure builds up and dissatisfaction with own coping. The particular stressors affecting registered and student nurses. respectively. were identified.

In addition. lack of responsiveness of the nursing and medical managements affected stress among Registered Nurses (RN's), while lack of status in the medical team and job overload were significant stressors of Student Nurses (SN's). The risk of being highly stressed, given the presence of various personal attributes and job stressors, was estimated using logistic regression. Stress levels in different areas of the hospital were compared. and the personal and job stressor factors that most accounted for the high levels of stress in different areas were identified.

Introduction This paper reports some findings of a study of

occupational stress in nurses at a large hospital in Sydney and discusses them with reference to similar Australian studies. Current stress levels, as well as personal variables assumed to be related to stress, were assessed, jobstressors perceived by the nurses were identified and nurses were asked about their current stress management practices and their preferences among stress management courses. The paper reports the findings on stress levels and the extent to which these can be explained by personal variables and organisational stressors, respectively. The term 'stress levels', means the degree of distress experienced by the nurses. while

LINDER-PELZ, PIERCE, MINSLOW 307

'stressors' refers to the events and conditions outside individuals, which they perceive to be a cause of that distress.

This study assumes that stress is an individual's response to demands perceived as unpleasant in his or her personal or work environment. Stress i s exper ienced when t h e individual ' s coping capability is inadequate to meet those perceived demands. This is the Person-Environment-Fit theory of stress.' The social psychological construct of stress is a relative - not absolute - variable. There is no absolute, objectively assessed state of stress vs lack of stress; rather, everyone experiences some stress. What is needed for research purposes is a reliable way of assessing one individual's degree of stress compared with that of others. In particular, it is important to identify reliably those who have relatively very high levels and compare them with those people who have comparatively low levels.

Methods The sample frame was all 1461 registered and

student nurses employed at the hospital in August. 1983. Nurses from each area of the hospital volun- tarily distributed and collected the questionnaires from each work area. 983 (or 67%) of all registered and student nurses at the hospital at that time completed the questionnaire. 48% of the respondents were registered nurses (full-time, part-time and casuals) while the remaining 420 were students in all years of their nursing training. The majority of respondents were aged between 20 and 24 years, though the ages ranged from 17 to 65, and nursing experience varied from 0 through 40 years. Only 6% of respondents were men. Nurses in all types of hospital work were asked to participate in the study and while response rates varied in the different areas, all the major work areas were repre- sented.

In order to measure nurses' stress, ten ques- tions were asked using Likert-type scales. The ten scores were added to create a measure assessing the extent to which the nurses were currently feeling stressed and this additive measure is hence-

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forth cAled C U R R E N T STRESS. The items had fiicc validity and internal consistency reliability of 0.84 (Tables I & 2) .

Likert-type scales were also used with the majority o f items that measured the personal variables which were posited to be associated with C U R R E N T STRESS. Items in the questionnaire were factor analysed and six factors identified, thus validating Q priori constructs. The items associated with each factor were added to form the variable. The constructs are shown in Table 1 and Appendix A. Table 2 shows these variables and their internal consistency reliabilities. Two of the variables ( Adaptability to Change and Thriving on Pressure) were single item measures using a seven point semantic differential scale.

Thirty four items relating to work stressors were generated from meetings with nurses at the hospital (Appendix B). The items were measured

using Likert-type scales and were factor analysed. Eight work stressors were thus identified. Table 3 shows the 8 work stressors and their internal consistency reliabilities.

The methods used to study the dependent and independent variables are reported more fully elsewhere.'

Findings As seen in Figure 1. there was a wide range of

C U R R E N T STRESS scores and the distribution was roughly bell shaped around the mean. In the present study where a stress score of 0 indicated presence of stress, student nurses had a mean score of 3 .8 f 1.60 (n = 412) while registered nurses had a mean score of 4.2 f 1.63 ( n = 540). This difference is significant at the p<.OOl level, and confirms the stressfulness of being a student nurse.'

TABLE I

Items in "Current Stress" Scale I . I n general. how stressful is your life at the moment'?

How true are each of the following of you? 2. I regularly feel tired and depressed so that at the end of the day all I want to d o is sleep. 3. Little things that brighten up my day don't seem to happen very often lately. 4. Recently I have found that it is the every day hassles in my life that have been getting me down. 5. Lately I have been feeling under a lot of stress. h. Close friends have noticed my irritability lately.

During the last week, how well do the following describe your lifestyle? 7. I have been dead tired when 1 have gone to bed. X. My time schedule has been too hectic. 9. At the end of the day I have been feeling very hassled.

10. There have been a number of things that have really brightened my day.

TABLE 2 Stress and Personal Variables as Measured in the Nurses' Survey

Variable No. of Possible Scale

Items in Range of N Mean (S.D.) Reliability Measure Scores* Estimate**

Current Stress 10 0-10 955 4.0 (1.6) 0.84 0.68 NA'**

Fccling poorly 7 7-28 910 20.7 (4 .4) Poor self-worth I 1-7 975 4.7 (1.6) Dissatisfied with social supports 3 0-2.5 962 1.7 (0.6) 0.63 Prefers slow change 1 1-7 958 4.2 (1.8) N A NA Feels worse as pressure builds up 1 1-7 960 3.5 (1.7) Dissatisfied with coping 5 5-35 970 22.7 (5.6) 0.75

*The ranges of CURRENT STRESS and 'satisfaction with social supports' were reduced because item scores were adjusted to give weight to number of response alternatives.

generally requircJ when using scale scores for comparisons among groups of respondents. **Estimate o f internal consistency reliability (Cronbach's Alpha) (2). A minimum scale reliability of 0.50 is

**"A = not applicable

LINDER-PELZ. PIERCE, MINSLOW 308 COMMUNITY HEALTH STUDIES

TABLE 3 Eight Stressors Ranked by Means

Reliability Mean Estimate*

1. Responsiveness of hospital and nursing management 4.4 . n o

4. Status in team. with respect to job itself and other staff 3.75 . X I

6. Interferences with proper role due to noise, not enough time, paperwork 3.5 .69 7. Training - credits, components of training, exams 3.1 .82

2. Parking 4.4 NA** 3. Overload - rosters, fatigue 3.9 .67

5 . Professional self-esteem - feelings that integrity and assertiveness are being 3.7 .79 questioned; lack of respect

8. Prospects - job security as nurse, career choices 2.8 ,611

*Cronbach's alpha coefficient of internal constancy reliability. A minimum of 0.50 is recommended for a scale score to be useful in comparison among groups of respondents.

**Not applicable because single-item measure was used.

FIGURE 1:CURRENT STRESS LEVELS

22

20

1 8

16

1 4

1 2

10

0

6

4

2

0

21

0 1 2 3 4 5 6 7 8

STRESSED LEVEL of STRESS NOT STKESSED

LINDER-PELZ, PIERCE, MINSLOW 309 COMMUNITY HEALTH STUDIES

TABLE 4

Percentage of High and Low Stress Nurses, Respectively.with Low Ratings on Other Personal Variables

High Stress** Low Stress (N = 200) (N = 150)

I. Feel poorly (Burnt Out) 16 Yo 10% * 2. Poor self-worth 54"/0 19%*

4. Prefer SLOW change 56 Yo 47% NS 5. Feel worse as pressure builds 69% 31 yo * 6. Dissatisfied with coping 76% 14%

3. Dissatisfied with supports 84% 16% *

'Comparison o f percentages i s statistically significant at p<.Ool level. **High and Low are respectively the lower and upper thirds (approximately) of the scale.

The almost symmetrical distribution of CUR- RENT STRESS scores is noteworthy; similar small proportions of nurses are relatively stress-free and relatively extremely stressed. while the majority report some stress. As expected. most nurses, like the rest of the population. experience some stress while only small proportions report relatively little or lots of stress. To the extent that methodological differences permit comparisons. this finding confirms the levels of stress reported by NSW nurses in a 1979 study', which showed that about 80% of all nurses reported some anxiety while under 20% said they were not affected. Although several other studies have been made of Australian nurses' stress0, none have assessed nurses' stress levels; most have focussed o n the stressors perceived by nurses in their work environment.

Nurses with unusually high or low stress were defined as those scoring 2.9 or less and 5.1 or more, respectively, on the CURRENT STRESS scale. Table 4 compares the percentages of high and low stress nurses who rated themselves distressed or dissatisfied on other personal variables. Immedi- ately apparent is the association of stress with feeling poorly, having poor self-worth, dissatisfaction with social supports, feeling worse as pressure builds up and being dissatisfied with coping*. The chances of being highly stressed.

Logistic regression was used to estimate the 'Note that this measure of satisfaction with coping in general does not take into account the coping strategies practised. or their frequency. The relationship between the coping hchaviour practiscd and the cxprcsscd need for training and coping among nurscs in this hospital will hc prcscnted in a separate papcr.

+The lower and uppcr 27.4% (approx) respectively. o f the C U R R E N T STRESS scale.

chances of experiencing high stress rather than low stress'. given the presence of other personal and job stressor characteristics. The adjusted odds ratio or 'relative risk'. is the chance of experiencing high stress, controlling for the other independent variables in the analysis. It was decided that it would be most appropriate to treat registered and student nurses as distinct subgroups. The two subgroups differed significantly not only on current stress levels but also on feeling poorly and perceived stressors; furthermore, analysis and planned interventions should be separate since students and registered nurses have different organisational structures within the hospital.

The 45% of registered nurses in the middle stress group, rather than 'high' or 'low'. were excluded from the analysis. Of the remainder, 51 were excluded due to missing data in one of the significant variables in the analysis, thus the logistic regression was performed on 258 (or 83%) of eligible registered nurses.

Six variables had a significant independent effect on stress. Table 5 shows how the relative risk of high stress among registered nurses increases with variations in those 6 variables.

The first logistic regression for students indicated 9 variables, each of whose presence significantly increased the chances of reporting high stress. When variables with a regression coefficient/SE ratio of less than 1 were rejected, the sample size was increased and 5 variables were confirmed as significantly increasing the odds of high stress. Table 6 presents the relative risk of high stress among student nurses after adjusting for other variables.


TABLE 5 Relative Risk of Stress for Registered Nurses (258)*

Relative Risk** P Value Poor self-worth* * * Good self-worth Prefer slow change Adapts to rapid change Feels worse as pressure builds up Thrives in pressure Dissatisfied with coping Satisfied with coping Feels poorly Feels well Team status is not a stressor Team status is a stressor Overload is not a stressor Overload is a stressor Interferences are not a stressor Interferences are a stressor Responsiveness of management is not a stressor Responsiveness of management is a stressor Dissatisfied with supports Satisfied with sumorts

I .o 0.4 1 .u 1.4 1 .o 0.3 1 .o 0.4 1 .o 0.3 1.0 0.5 1 .o 1.5 1 .o 1.3 1 .o 2.8 1 .o 0.3

p<.os

NS

p< .0s

p<.OS

p<.o5

NS

NS

NS

p< .05

Q<.o5 *This is 83% of cases eligible for the logistic regression analysis - 51 cases were rejected due to missing data.

**Relative risks were obtained using logit analysis of GENSTAT (A General Statistical Program. 1983 Lawes

"*The upper and lower 27.4% (approx.) of the scale represents the two contrasted sub-groups for each variable Agricultural Trust. Rothamsted Experimental Station).

TABLE 6 Relative Risk of Stress for Student Nurses (195)*

Relative Risk** P Value Male * * * Female I .4 NS

Adapts to rapid change 0.7 NS

1 .o Prefer slow change I .0

Dissatisfied with coping 1 .o Satisfied with coping 0.3 p< .0s Dissatisfied with supports 1 .o Satisfied with supports 0.1 p< .05 Feels poorly 1 .0 Feels well 0.1 p<.05 Status in team is not a stressor Status in team is a stressor 3.3 p< .05 Job overload is not a stressor Job overload is a stressor 4.3 p< .05 Job prospects are not a stressor

1 .o 1 .o 1 .o 1 .o

Job prospects are a stressor 1.4 NS Interferences are not a stressor Interferences are a stressor 1.1 NS

*This is 87% of eligible cases- 29 were rejected from logistic regression analysis due to missing data. **Relative risks were obtained using logit analysis of GENSTAT (A General Statistical Program. 1983 Lnwes

***The upper and lower 27.4% (approx.) of the scale represent the two contrasted sub-groups for each variable. Agricultural Trust).


In summary. while the order of priority of the independent variables in contributing to the degree of stress can be produced by multiple regression analysis. the logistic regression enables the calcu- lation of the adjusted odds rario for the likelihood ofa person being in the high vs low stress category. Thus Table 5 shows that -

- registered nurses who have poor self-worth are more than twice as likely to suffer excessive stress than those who have good self-worth;

- those who don't thrive on pressure are three times as likely to suffer severe stress than those who do thrive o n pressure;

- dissatisfaction with socal supports increases the risk of severe Stress threefold;

- nurses feeling poorly have three times the chance of being in the severe stress category;

- those perceiving responsiveness of management to be a severe stressor are almost three times as likely to experience excessive stress.

With respect to student nurses (Table 6 ) : -

- those who are dissatisfied with their present coping are three times as likely to experience severe stress;

- dissatisfaction with social supports and feeling poorly increase the risk of severe stress tenfold;

- perceiving team status and job overload to be

severe stressors increases the risk of experiencing severe stress at least threefold.

Stress varies in different areas of the hospital. The significant difference between the mean

stress scores of registered and student nurses, in favour of the registered nurses, has already been noted.

With nurses from all areas of the hospital involved in this study, a comparison of stress levels according to type of work was possible. Table 7 ranks the work areas beginning with the one with the highest proportion of nurses in the 'high stress' category. Thus. according to Table 7, four types of hospital work had excessive proportions of stressed nurses: spinal, maternity, medical and intensive care units. in that order. A multiple comparison was done among the means of these four high stress work types but no significant differences were found. However, when the weighted mean of these four were compared with the weighted mean of the remaining 10 work types, the difference in mean stress scores was significant at the p<.OOl level. The finding was the same using both the pooled variance and the weighted variance. In other words, the work types with greater than expected proportions of highly stressed nurses did not differ significantly among themselves but did differ significantly from the other work types with regard to stress scores.

TABLE 7 Stress by Work Type: Percent of Nurses in Each Area Rating Stress as Severe (Upper 27.4% of Scale)

Response** YO In Work Type (N) rate (YO ) High Stress

58 48 63 39

Spinal* (29) Maternity' (83) Medical Wards' (153) 68 37

72 32 96 29 76 26

Students (137) Surgery (261)

58 23 85 21

Nursing Administration (23) Nurse Educators (34) Outpatients and Short-Stay Dialysis (26) 58 20 Psychiatric Unit (11) 79 20 Accident and Emergency (25) 37 17

76 16 29 10

Operating Theatres (78)

no 0 Paediatrics (12) Short Stav 18)

Intensive Care Units' (89)

*These are the work areas in which one third or more of nurses rate themselves as 'severely stressed'. A proportion of 27.4% or more of nurses at the high stress end of the scale is more than one would expect. assuming a normal distrihution of stress scores.

**The proportion of nurses in each area who responded.


Writers on stress among nurses have often argued that ICU nursing is more stressful than other types of nursing.' However. recent reviews have refuted that view and two previous Australian studies have demonstrated that surgical and medical ward nurses often perceive job stressors as more severe than do ICU nurses."- Three explanations have been put forward for the relative lack of stress reported by ICU nurses: that they enjoy consider- able support from the ICU nursing team, that nurses select themselves into that type of work according to personality factors such as thriving on pressure, and that ICU nurses use more effective coping behaviours. "'

The present study supports the view that ICU nursing is not the most stressful kind of nursing. In accordance with Gentry and Parkes' reasons as to why ICU nurses are relatively stress-free." we found that neither job overload nor interferences with the real role of nurses were particularlysevere stressors for ICU nurses at this hospital. Poor job prospects, unsatisfactory status in medical team, being held in poor professional regard by co- workers and lack of management responsiveness were more severe stressors perceived by ICU nurses.'

For each of the four nursing types with high proportions of severely stressed nurses. stress scores were regressed on the personal and stressor variables. In each area, two to four variables were found to contribute significantly to nurses' reported stress. As seen in Table 8, the explanants of CURRENT STRESS are similar in all four areas, although their relative importance differs in each. Feeling poorly predicts stress in all four areas, while nurses' dissatisfaction with their supports and having poor self-worth predict stress in three of the 'high stress' areas of the hospital. As mentioned earlier, the mean stress levels did not differ among these four areas. Conclusions

Care must be taken in interpreting these results as cross-sectional surveys cannot indicate causality. The internal consistency reliability of our measure of CURRENT STRESS was demonstrated, and its construct validity was evidenced by its correlation with measures of feeling poorly, dissatisfaction with coping and dissatisfaction with social supports. When used in combination with measures of nurses' job stressors and of nurses' coping behaviours, this measure of stress can be useful in identifying work-type specific needs for organisa-

TABLE 8 Stepwise Regression of Current Stress on Personal and Stressor Variables in the

4 Most Stressful Work Tvoes Standardised S.E. of P is

RZ Co-efficient Unstandardised less (Beta) . B than

I.C.U.3 (n = 88) Dissatisfaction with supports Poor self-worth Feeling poorly

R? = .39 Medical Wards (n = 152) Feeling poorly Dissatisfaction with coping Job interferences* Poor self-worth

Maternity (n= 83) Dissatisfaction with supports Feeling poorly Poor self-worth The training process*

Spinal (n = 27) Feeling poorly Dissatisfaction with supports

R: = .S2

.35

.27

.24

.37

.27 - .26

.19

- R2 = .50

.41 .24 .28

. .22

.31 ,005

.ll .os

.04 .os

.03 001

.03 .w5

.02 .OOS

.09 .os

.28

.04

.08

.02

.001

.05 ,005 .05

.68 .06 .005

.44 .49 .05 R: = .I0

'Job stressor variables


tional interventions and prsonnel ni;inagemeiit. a s well as personal stress maniigement programs. Measures of stress. stressorh and coping could be used in a prospective study to shed light upon outcomes of nurses' stress such as absenteeism. t u r n o v e r , i l l - h e a l t h a n d i m p a i r e d s o c i a l functioning.

This study has supported the view that ICU nursing is by no means the most stressful kind of nursing, although it is among the worst. It would seem more useful, in future studies of stress among nurses, to study the personal vs job causes of stress in the various types of nursing work than to worry

about which work setting IS t h c i i iost stressful. The finding that 1;ic.L ol' Stip1m-t is associated with stress. and the implication that the impact of job stressors is cushioned hv support. is consistent with several studies.

The findings huggest that nurses' personal characteristics. including self-worth and satisfaction with supports. play ;I larger part in their stress than do job stressors. Logistic regression provides a set of statements about how certain personal and job attributes increase one's chances of being severely stressed. Future studies should use this approach and compare their findings with those of the present study.

References

McGrath. JE. A Conceptual Formulation for Research on Stress. In McGrath. J E (Ed). Social and Psychologicul Fuctors in Stress. Holt, Rinehart and Winston, Inc. 1970; Jenkins. CD. Psychological Modifiers of Re- sponse to Stress. J Human Stress 1979:.5(4): 3- 15: Cooper, CL & Marshall, J . Occupational Sources of Stress: A Review of the Literature Relating to Coronary Heart Disease and Men- tal 111 Health. J Occup P.sychol 1076;49: I I - 28; Davidson, MJ & Cooper. CL. A Model of Occupational Stress. J Occup Med l081;23(8): 554-574. These works are referred to in a comprehensive review of the occupational stress literature by Anne F. Wyatt: Per.son- Environment Fit in Student Nurses. Treatise. University of Sydney, 19x3.

Allen. MJ and Yen. WM. Introduction to Measurement Theory. Brooks-Cole, Califor- nia, 1979.

Linder-Pelz, S. Pierce, J P and Minslow. M. Nurses' Occupational Stress: A Study of Stress and the Need for Stress Management Among Nurses at Royal North Shore Hospital, Syd- ney: July, 1984.

King, LA. Occupational stress among student nurses. M Psych Treatise University o f New South Wales, 1982.

LINDER-PELZ, PIERCE, MINSLOW 3 I4

5. Blatch, JC. Andronicos. C and Rob, MI. Study of Nurses' Lifestyles. NMHR Working Puper N o . 48. Sydney July 1979.

6. Ness. A. Stress- Itseffect on registered nurses and patient care. The Australion Nurses'Jour- nu1 July 1982; 12( I): 47-48: Bates. EM and Moore. BN. Stress in Hospital Personnel. MJA 107.5; 2:76.5-767; Cross. DG and Kelly, JG. Stress and coping strategies in hospitals. The Austruliun Nur.sc,s Journal 1983;13(2): 43-46.

7. Steffen, S & Bailey. J . Sources of Stress & Satisfaction in ICU Nurses. Focus Nov-Dec 1970; 26-32; Oskins. SL. Identification of situational stressors and coping methods by intensive care nurses. Heart and Lung 1979;8(5):9.53-960; McHenry, L. Situational Anxiety Levels and the Intensive Care Unit Staff Nurse. 1.s.sue.s in Mental Health Nursing 1981;3(4):341-351; Hurst, J . Nurses who give the Intensive Care: The Complex members of modern medical technology are putting greater demands on nurses. The National Times (Australia), May 18-24, 1984:20-21.

8. Stehle. JL. Critical Care Nursing Stress. Nurs- ing Research 1981 ;30(3): 182-186; Maloney, JP. Job stress & its consequences on a group of intensive care and non-intensive care nurses. Advunces in Nursing Sciences, January IOX2;4( 2):3 1-4 I .

COMMUNITY HEALTH STUDIES

9. Cross, DG & Kelly, JG. Stress and Coping Strategies in Hospitals: A Comparison of Intensive Care Units and Ward Registered Nurses. Ausrralian Nurses Journal 1983; 13: 43-46. 1983; Fallon. A. Nursing Stress, Coping and Burnout. M.A. thesis, Macquarie Univer- sity. 1983.

10. Maloney, JP. Op. Cit.; Cross DG and Kelly JG. Op. Cit.; Gentry and Parkes. Psychologic stress in intensive care unit and non-intensive

care unit nursing: A review of the past decad, Heart and Lung 1982:11(1):43-47: Cook. C and Mandrillo, M. Perceived Stress and Sit1 ational Supports. Nursing Managemcnr Sep 1982; 13( 9):3 1-33.

11. Gentry and Parkes 0p.Cit.

12. Steffen, S & Bailey, J . Op. Cit.: Cook an Mandrillo. Op. Cit; Gentry and Parke Op. Cit.

APPENDIX A

“Feeling Poorly” I have been troubled by:

1. Sore back 2. Tight neck muscles 3. Headaches 4. Skin rash 5. Coldlflu- 6. Overall I have been feeling very fit 7. I feel that my health has not been up to par recently

‘‘Poor Self-worth” People don’t seem to value or understand my capabilities

“Dissatisfied with Social Supports” I always have someone to talk to and listen to me when I’m down Recently my personal relationships don’t seem to be giving me the joy that they should My relationship with family and friends has been excellent

“Prefers Slow Change” How would you describe yourself? Find rapid change challenging come slowly

“Feels Worse as Pressure Builds Up” How would you describe yourself? I feel worse as pressure builds up pressure

“Dissatisfied with Coping” I am happy about: 1. The way I manage my time 2. The way I keep regular stressful events under control 3. The way I assert myself and express the things that worry me 4. The way I handlekommunicate with my family 5. The way I interact with people

Prefer change to

(1) t 7)

I thrive on

t 1) (7)

LINDER-PELZ, PIERCE, MINSLOW 315 COMMUNITY HEALTH STUDIl

APPENDIX B

“Responsiveness” Stressor Importance of following as major stressor in your life:- I . Slowness in responding to needed change in the hospital 2. Lack of perception of major problems by hospitalhursing administration

bLOverload” Stressor Importance of the following as major stressors in your life:- I . Heavy physical workload 2. Fatigue because of night duty and sleep problems 3. Problems with unfair rosters

“Team Status” Stressor Importance of the following as major stressors in your life:- I. Lack of communication with other staff re patients 2. Not included in discussion on patient management 3. My level of responsibility unresolved 4. Lack of apfropriate orientation to new tasks or areas 5. Lack of in ividuality in lob

“Interference with ‘Proper’ Role-Fulfilment” Stressor Importance of the following as major stressors in your life:- I . Too much paperwork 2. Work overload - no time to do all needed tasks 3. Work overload - no time to train new people 4. Unnecessary noise at workplace 5. Difficulty in getting maintenance of equipment outside main block

“Professional Self-Esteem’’ Items Importance of the following as major stressors in your life:- I . Repercussions for being assertive 2. Lack of respect for professional capabilities 3. Frequent questioning of personal integrity 4. Conflict between responsibility expected in maior issues and yet n o t given in minor ones

”Career Prospects” Stressor Importance of the following as major stressor in your life:- I . Limited number of career prospects open to nurses 2. Insecurity o f employment as nurse

“Training Process” Stressor Importance of the following as major stressors in your life:- I. Conflict theory taught in NSC and ward practice 2. Problems with organisation in education 3. Problems with organisation of clinical components of training 4. Inability to be credited with partially completed courses 5 . The wai exams etc. are organised 6 . Metho of displaying exam results

LINDER-PELZ, PIERCE, MINSLOW 316 C O M M U N I T Y HEALTH STUDIES

occupational stress in nurses in an australian general hospital

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