Objective:
There has been a recent resurgence of literature addressing sources of stress and dissatisfaction in the work environment for inpatient nurses. The objective of this study was to identify key sources of stress, strain, and coping and determine the influence of demographic items on these issues with an inpatient registered nurse sample from four diverse healthcare sites. The long-term objective is to use these results to create cross-site interventions to improve the work environments in order to decrease nurses’ stress and increase satisfaction.
Design:
This study was exploratory and used a mixed methods approach combining survey research with focus groups.
Population, Sample, Setting, Years:
This exploratory study gathered occupational adjustment data (stress, strain, and coping) from over 650 inpatient RNs using a standardized instrument and select demographic information. After baseline findings were obtained from the survey, focus groups were conducted at each site for clarification. There were 20 focus groups conducted across the four sites with over 125 RNs attending these sessions.
The data were obtained from four diverse settings; rural and urban, independent and system-owned institutions in a large Midwestern region over a three-year period.
Names of the variables or concepts:
A 140-item, Likert scale instrument, the Occupational Stress Inventory (OSI-R) was used. The OSI-R has 14 sub scales that address stress, strain, and coping and were used as dependent variables for the study. Stress scales are role overload, role insufficiency, role ambiguity, role boundary, responsibility, and physical environment. Strain scales are vocational strain, psychological strain, interpersonal strain, and physical strain. Coping scales are recreation, self-care, rational-cognitive, and social support. Demographic items obtained included items such as year born, educational preparation, years in current department, years in current hospital, years in field. Alpha coefficients for the OSI-R sub scales ranged from .70-.94.
Methods:
A voluntary sample of nurses completed the paper and pencil OSI-R and demographic sheets at each site, which takes approximately 30 minutes to complete. These data were collected at either staff meetings or scheduled sessions held exclusively for this purpose. No personal identifiers were obtained. To ensure consistency between sites trained research assistants gathered all data. After descriptive statistics were obtained differences between groups were analyzed using T-tests or ANOVAs using the sub scales of the OSI-R as dependent variables and the demographic items as independent variables.
Focus groups followed to help clarify the findings of the OSI-R using semi-structured interviews hand-coded independently by the two key investigators. Only consistent themes found by both are reported.
Findings:
Aggregate findings indicated the top three problematic stress or strain scales were physical environment, responsibility, and physical strain. Responsibility was found within the top three problematic stress or strain scales at all four sites. Physical strain was found at three sites, while two sites indicated role boundary as problematic. Data from two of the four sites indicated that social support was the most prominently form of coping used.
Baby Boomer nurses (born between 1946-64) had significantly worse stress scores than Generation X nurses (born between 1965-84) or Matures (born between 1909-1945) on sub scales of role insufficiency, role ambiguity, and role boundary. Other demographic variables had varying degrees of significance with the dependent variables of the OSI-R, but no such pattern was observed as with age cohort.
Focus groups found congruence across sites with three prominent themes. They were 1) increasingly difficult workloads as a result of increased patient acuity and increased numbers of admissions, discharges, and transfers - or unit "speed-up", 2) the need for more unit manager support, and 3) the need to provide customer service without the appropriate resources to do so.
Conclusions:
Inpatient staff nurses have consistently provided information both in this study and other key research to healthcare leaders as to the sources of their stress and dissatisfaction. Baby Boomers, the largest group of working registered nurses in inpatient care and in most cases the most seasoned, has even greater stress and strain than other cohorts.
Implications:
Inherent in the work of nurses is a certain level of stress, however the current work environment for staff nurses seems untenable. Perhaps the most frustrating issue is that nurses have provided consistent information for the past five years about the key sources of stress and dissatisfaction but they have seen little or no significant improvements. The implications are clear - unless those in healthcare leadership shift from thinking of the nurse as commodity to the nurse as valuable partner there will continue to be significant problems for the profession and the entire healthcare industry.
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