Workplace stress in nursing: a literature review
Reader, School of Health Care Practice, Anglia Polytechnic University, Chelmsford, Essex, UK
Received for publication 19 June 2002 Accepted for publication 24 July 2003
Correspondence: Andrew McVicar, School of Health Care Practice, Anglia Polytechnic University, Chelmsford, Essex CM1 1SQ, UK. E-mail: firstname.lastname@example.org
M c V I C A R A . ( 2 0 0 3 ) Journal of Advanced Nursing 44(6), 633–642 Workplace stress in nursing: a literature review Background. Stress perception is highly subjective, and so the complexity of nursing practice may result in variation between nurses in their identiﬁcation of sources of stress, especially when the workplace and roles of nurses are changing, as is currently occurring in the United Kingdom health service. This could have implications for measures being introduced to address problems of stress in nursing. Aims. To identify nurses’ perceptions of workplace stress, consider the potential effectiveness of initiatives to reduce distress, and identify directions for future research. Method. A literature search from January 1985 to April 2003 was conducted using the key words nursing, stress, distress, stress management, job satisfaction, staff turnover and coping to identify research on sources of stress in adult and child care nursing. Recent (post-1997) United Kingdom Department of Health documents and literature about the views of practitioners was also consulted. Findings. Workload, leadership/management style, professional conﬂict and emotional cost of caring have been the main sources of distress for nurses for many years, but there is disagreement as to the magnitude of their impact. Lack of reward and shiftworking may also now be displacing some of the other issues in order of ranking. Organizational interventions are targeted at most but not all of these sources, and their effectiveness is likely to be limited, at least in the short to medium term. Individuals must be supported better, but this is hindered by lack of understanding of how sources of stress vary between different practice areas, lack of predictive power of assessment tools, and a lack of understanding of how personal and workplace factors interact. Conclusions. Stress intervention measures should focus on stress prevention for individuals as well as tackling organizational issues. Achieving this will require further comparative studies, and new tools to evaluate the intensity of individual distress.
Keywords: workplace stress, nursing recruitment and retention, stress management, organizational change
Stress is usually deﬁned from a ‘demand-perceptionresponse’ perspective (see Bartlett 1998). Lazarus and Folkman (1984) integrated this view into a cognitive theory of stress that has become the most widely applied theory in the study of occupational stress and stress management Ó 2003 Blackwell Publishing Ltd
(Lehrer & Woolfolk 1993, Rick & Perrewe 1995). The basic concept is that stress relates both to an individual’s perception of the demands being made on them and to their perception of their capability to meet those demands. A mismatch will mean that an individual’s stress threshold is exceeded, triggering a stress response (Clancy & McVicar 2002). 633
An individual’s stress threshold, sometimes referred to as stress ‘hardiness’, is likely to be dependent upon their characteristics, experiences and coping mechanisms, and also on the circumstances under which demands are being made. A single event, therefore, may not necessarily constitute a source of stress (i.e. be a ‘stressor’) for all nurses, or for a particular individual at all times, and may have a variable impact depending upon the extent of the mismatch (Lees & Ellis 1990). Assessing stress is likely to be very difﬁcult in an occupation as diverse and challenging as health care, yet...