Confidentiality in Nursing Practice

Topics: Nursing, Stress, Occupational health psychology Pages: 23 (7700 words) Published: August 19, 2010

Workplace stress in nursing: a literature review
Andrew McVicar

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:

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

A. McVicar

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...

References: Baglioni A.J. Jr, Cooper C.L. & Hingley P. (1990) Job stress, mental health and job satisfaction among UK senior nurses. Stress Medicine 6, 9–20. Ball J., Pike G., Cuff C., Mellor-Clark J. & Connell J. (2002) RCN Working Well Survey. RCN Online, (last accessed May 2003). Bartlett D. (1998) Stress, Perspectives and Processes. Health psychology Series. Chapter 1. Stress and Health, OUP, Buckingham, pp. 1–21. Bloodworth C., Lea A., Lane S. & Ginn R. (2001) Challenging the myth of the 12-hour shift: a pilot evaluation. Nursing Standard 15, 33–36. Boyle A., Grap M.J., Younger J. & Thornby D. (1991) Personality hardiness, ways of coping, social support and burnout in critical care nurses. Journal of Advanced Nursing 16, 850–857. Bratt M.M., Broome M., Kelber S. & Lostocco L. (2000) Influence of stress and nursing leadership on job satisfaction of paediatric intensive care unit nurses. American Journal of Critical Care 9, 307– 317. Brown H. & Edelmann R. (2000) Project 2000: a study of expected and experienced stressors and support reported by students and qualified nurses. Journal of Advanced Nursing 31, 857–864. Buchan J. (2002) What’s it worth to work nights? Nursing Standard 16, 20–21. Carson J, Wood M., White H. & Thomas B. (1997) Stress in mental health nursing: findings from the Mental Health Care survey. Journal of Mental Health Care 1, 11–14. Ceslowitz S.B. (1989) Burnout and coping strategies among hospital staff nurses. Journal of Advanced Nursing 14, 553–557. Charnley E. (1999) Occupational stress in the newly qualified staff nurse. Nursing Standard 13, 33–36. Clancy J. & McVicar A. (2002) Physiology and Anatomy: A Homeostatic Approach, 2nd edn. Chapter 22: Stress., Arnold, London, pp. 611–633. Constable J.F. & Russell D.W. (1986) The effect of social support and the work environment upon burnout among nurses. Journal of Human Stress 12, 20–26. Deeming C. & Harrison T. (2002) The long view. Nursing Standard 16, 12–13. Demerouti E., Bakker A., Nachreiner F. & Schaufeli W.B. (2000) A model of burnout and life satisfaction amongst nurses. Journal of Advanced Nursing 32, 454–464. Department of Health (1998a) The NHS Plan. DH, London.
Ó 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 633–642
A. McVicar Hipwell A.E., Tyler P.A. & Wilson C.M. (1989) Sources of stress and dissatisfaction among nurses in four hospital environments. British Journal of Medical Psychology 62, 71–79. Holyoake D., Singleton C. & Wheatley F. (2002) Answer the question. Nursing Standard 174, 24. Hope A., Kelleher C.C. & O’Connor M. (1998) Lifestyle practices and the health promoting environment of hospital nurses. Journal of Advanced Nursing 28, 438–447. Jones M.C. & Johnston D.W. (2000) A critical review of the relationship between perception of the work environment, coping and mental health in trained nurses and patient outcomes. Clinical Effectiveness in Nursing 4, 74–85. Kivimaki M., Elovainio M. & Vahteera J. (2000) Workplace bullying and sickness absence in hospital staff. Occupational and Environmental Medicine 57, 656–660. Lazarus R.S. & Folkman S. (1984) Stress, Appraisal and Coping. Springer Publishing, New York. Learthart S. (2000) Health effects of internal rotation of shifts. Nursing Standard 14, 34–36. Lees S. & Ellis N. (1990) The design of a stress-management programme for nursing personnel. Journal of Advanced Nursing 15, 946–961. Lehrer P.M. & Woolfolk R.L. (1993) Principles and Practice of Stress Management. Guildford Press, London. Leveck M.L. & Jones C.B. (1996) The nursing practice environment, staff retention and quality of care. Research in Nursing and Health 19, 331–343. Lucas M.D., Atwood J.R. & Hagaman R. (1993) Replication and validation of anticipated turnover model for urban registered nurses. Nursing Research 42, 29–35. MacKenzie L. (2002) Lessons from the past. Nursing Standard 16, 20–21. McGowan B. (2001) Self-reported stress and its effects on nurses. Nursing Standard 15, 33–38. McNeese-Smith D. (2000) Job stages of entry, mastery and disengagement among nurses. Journal of Nursing Administration 30, 140–147. Morano J. (1993) The relationship of workplace social support to perceived work-related stress among staff nurses. Journal of Post Anaesthesia Nursing 8, 395–402. Morrison R.S., Jones L. & Fuller B. (1997) The relation between leadership style and empowerment on job satisfaction of nurses. Journal of Nursing Administration 27, 27–34. Ng V., Koh D., Chan G., Ong H.Y., Chia S.E. & Ong C.N. (1999) Are salivary immunoglobulin A and lysozyme biomarkers of stress among nurses? Journal of Occupational & Environmental Medicine 41, 920–927. Parkes K.R. (1986) Coping in stressful episodes: the role of individual differences, environmental factors and situational characteristics. Journal of Personality and Social Psychology 51, 1277–1292. Payne N. (2001) Occupational stressors and coping as determinants of burnout in female hospice nurses. Journal of Advanced Nursing 33, 396–405. Phillips S. (1996) Labouring the emotions: expanding the remit of nursing work? Journal of Advanced Nursing 24, 139–143. Plant M.L., Plant M.A. & Foster J. (1992) Stress, alcohol, tobacco and illicit drug use amongst nurses: a Scottish study. Journal of Advanced Nursing 17, 1057–1067. RCN (2002) Royal College of Nursing Congress 2002 report summarised. Nursing Standard 16, 4–9. Reid K. & Dawson D. (2001) Comparing performance on a simulated 12-hour shift rotation in young and older subjects. Occupational & Environmental Medicine 58, 58–62. Reid N., Robinson G. & Todd C. (1994) The 12-hour shift: the views of nurse educators and students. Journal of Advanced Nursing 19, 938–946. Rick C. & Perrewe P.L. (1995) Occupational Stress Handbook. Taylor & Francis, London. Rick J., Briner R.B., Daniels K., Perryman S. & Guppy A. (2001) A Critical Review of Psychosocial Hazard Measures. HSE Books, HMSO, Norwich. Also available at research/crr_pdf/2001/crr01356.pdf (last accessed May 2003). Sarafino E.P. (2002) Health Psychology. Biopsychosocial Interactions, 4th edn, Chapter 3. Stress – Its Meaning, Impact and Sources. John Wiley & Sons, New York, pp. 70–96. Schaefer J.A. & Moos R.H. (1993) Work stressors in health care: context and outcomes. Journal of Community and Applied Social Psychology 3, 235–242. Schmitz N., Neumann W. & Opperman R. (2000) Stress, burnout and locus of control in German nurses. International Journal of Nursing Studies 37, 95–99. Scott A.J. (2000) Shift work and health. Primary Care; Clinics in Office Practice 27, 1057–1078. Selye H. (1976) The Stress of Life. McGraw-Hill, New York. Shader K., Broome M.E., West M.E. & Nash M. (2001) Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. Journal of Nursing Administration 31, 210–216. Simoni P.S. & Paterson J.J. (1997) Hardiness, coping and burnout in the nursing workplace. Journal of Professional Nursing 13, 178– 185. Smith P. & Gray B. (2001) Reassessing the concept of emotional labour in student nurse education: role of link lecturers and mentors in time of change. Nurse Education Today 21, 230–237. Smith A., Brice C., Collins A., Mathews V. & McNamara R. (2000) The Scale of Occupational Stress: A Further Analysis of the Input of Demographic Factors and Type of Job. HSE Books, HMSO, Norwich. Also available at researchpublications (last accessed May 2003). Steenland K. (1996) Epidemiology of occupation and coronary heart disease: research agenda. American Journal of Industrial Medicine 30, 495–499. Stordeur S., D’Hoore W. & Vandenberghe C. (2001) Leadership, organisational stress and emotional exhaustion among hospital nursing staff. Journal of Advanced Nursing 35, 533–542. Tyler P.A. & Cushway D. (1995) Stress in nurses: the effects of coping and social support. Stress Medicine 11, 243–251. Tyler P.A. & Ellison R.N. (1994) Sources of stress and psychological well-being in high-dependency nursing. Journal of Advanced Nursing 19, 469–476. Waters A. (2002) Turns around the clock. Nursing Standard 16, 13. Williams A. (2001) A literature review on the concept of intimacy in nursing. Journal of Advanced Nursing 33, 660–667. Williams S., Michie S. & Pattani S. (1998) Improving the Health of the NHS Workforce. The Nuffield Trust, London.
Ó 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 633–642
Continue Reading

Please join StudyMode to read the full document

You May Also Find These Documents Helpful

  • Nursing Practice Essay
  • Essay about Confidentiality in Nursing Practice
  • Nursing Practice Act Essay
  • Nursing practice act Essay
  • nursing practice act Essay
  • Theories and Practice of Adult Nursing Essay
  • nursing Essay
  • Essay on Nursing

Become a StudyMode Member

Sign Up - It's Free