In the recent decades, the nursing profession has reported the highest levels of job stress in comparison to all other healthcare professionals (Butterworth, Carson, Jeacock, White " Clements, 1999). In a survey done in 2002 and 2004, it was observed that nearly 60 percent and 55 percent respectively, of the nurses, perceived that their job stress was a significant issue in their work lives view (Buerhaus, Donelan, Ulrich, Norman " Dittus, 2006). The American Nurses Association (ANA) in 2011 conducted a survey that showed that stress results in the development of acute and chronic ailments in nurses. Consequently, the survey also highlighted overwork as a concern as it led to development of job stress.
The healthcare industry is continuously being affected by nurses' shortage. The nurses’ shortage has led to numerous debates concerning its impact on efficiency and effectiveness of the health-care delivery system (Al- Aameri, 2003). Another factor that is also of concern is the retainment of nurses. These two factors are believed to highly impact on the levels of job satisfaction which results in the development of stress. The American National Association of Professional Safety has listed the Nursing professions among the top forty occupations associated with high incidence of stress-related diseases. The same viewpoints are also held by scholars such as (Albrecht, 1982; Maloney, 1982; Roberts " Grubb, 2014) who assert that the nursing profession is one of the most stressful occupational jobs in the world. Azad " GholamiFesharaki, (2010) asserts that the Institute of Health and safety estimates that nearly 13.5 million working days and damages accruing to almost 4 billion pounds are lost as a result of injuries caused by occupational stress. Stress although useful in small levels has been linked with chronic ailments such as asthma, hypertension (high blood pressure) among others over a long period. Bardeh, Naji " Zarea, (2016) argue that job stress leads to an increase in the occurrence of occupational deprivation. Stress among the nurses results in negative repercussions especially in the outcomes of both the patients as well as the staff (Farquharson, Bell, Johnston, Jones " Johnston,2012).
The National Institute for Occupational Safety and Health (NIOSH) defines Job stress as the harmful physical and emotional responses that happen as a result of job requirements failing to align with a worker's needs, resources as well as capabilities (NIOSH, 1999). AbuRub, (2004) on the other hand defines job stress as any work situation that a person might perceive as threatening to perform their duties as a result of a mismatch between the activities demands and their capacity to handle the needs. Therefore, job stress is the interaction between the work environment, the characteristics of the employee, the requirements of a particular job and the pressures emanating from the interactions which result in the incapacity of the person to perform their duties (Najimi et al., 2012). Therefore, Stress is a state that results in mental or emotional strain or even tension and emanates from having to deal with adverse or demanding circumstances. Thus, job stresses are the negative emotional and physical responses that emerge as a result of the job requirements failing to match with the employee's needs, capabilities as well as resources to effectively handle the situation.
Huber (2014) asserts that the work of a nurse is not only stressful but also challenging. The reason is that nurses are exposed to complex situations which require special handling especially in the event of an emergency. Job stress accumulates on a daily basis, and if not resolved or adapted, it results in adverse outcomes which emanate from the occurrence of burnouts as well as the decrease in the productivity of the nurse. The scholar continues to argue that exposure to high amounts of stress results in the creation of momentum in the working process. The result is the negative impacts in organizations which are expressed as increased levels in job dissatisfaction, high levels of absenteeism, lower worker turnover as well as poor quality in service or product delivery. Therefore, there is a need to reduce the levels of job stress to mitigate the risks associated with the negative impacts of its outcomes.
Factors Associated with Job Stress in the Nursing Profession
Several factors have been identified over the years to lead to job stress. Leka et al., (2003) highlights these factors to encompass; undesirable organization culture which is usually as a result of organizations lacking unclear structures or having poor leadership. Secondly, employees’ dissatisfaction with their career development which is caused by job insecurity, lack of promotion prospects and unfair evaluation system. Thirdly, having unpleasant work content which emanates from engaging in tedious tasks as well as working in unpredictable schedules. Fourthly, the development of stress due to imbalance brought about by conflict between work and family demands (Leka et al., 2003). Other factors that have been identified to cause job stress include; increased job demands which are either the physical or psychological efforts needed to execute a particular job. Increased job demands are usually linked to work overload, fatigue, emotional exhaustion as well as psychosomatic symptoms (Adriaenssens et al., 2011). Studies have also indicated that interpersonal problems led to the development of job stress. These usually are caused by a conflict between colleagues, management/supervisors as well as other healthcare staff. Interpersonal conflicts have detrimental effects on the safety of the patients as they may result in the nurses making medical errors as well as increase the likelihood of a patient other adverse health outcomes (Baldwin " Daugherty, 2008). Chen et al., (2007) also asserts that nurses that are exposed to overworking, conflicts as well as perform role ambiguity are more likely to report increased higher job stress as well as lower job satisfaction.
Additionally, although multiple factors result in job stress, there are usually different from one firm to another. Consequently, the reason for the development of job stress is different from one person to another. Scholars have performed numerous studies over the years to ascertain this, and some examples of these studies include; Paul, (2001) argues that job stress is one of the significant workplace health risks in both developing and developed nations. There are several workplace factors also known as job stressors that contribute to increased levels in an organization. Paul (2001) identifies the workplace stressors to emanate from interpersonal relationships within these organizations. These might take the form of supervisors’ behaviors, disputes between colleagues, subordinates as well as management policies.
In a literature search performed by Mc Vicar (2003) between periods 1985 to April 2003 aimed at identifying sources of stress in adults and child care nursing, the findings were that the causes of stress included; personal conflict, leadership/management style, workload, professional conflict as well as the emotional cost of caring. The literature search was performed using various key search words such as nursing, stress, distress, job satisfaction, staff turnover. Additionally, Mc Vicar (2003) also utilized the United Kingdom Department of Health document as well as literature to find out the vies of the practitioners that were consulted. However, although the above mentioned were identified as the sources of stress in the nursing profession, there lacked an agreement regarding the magnitude of their impact (Mc Vicar,2003). Wheeler (2010) also identified that interpersonal relationships between healthcare personnel were the cause of Mexican nurses working at a public hospital in Puebla experiencing high levels of stress at work. Another study conducted by (Davey et al. 2014) revealed that the high risk of professional stress was as a result of poor and satisfactory physician attitudes. The study further showed that risk for occupational stress as a result of physician attitudes towards staff nurses was three to four times higher in hospitals that had negative physician attitudes in comparison to those that physicians had positive attitudes. Stress can be defined as an environmental situation that requires an individual to perform tasks that threaten their capacity and resources for achieving the tasks. The development of stress emerges as a result of the failure to meet the conditions needed to bring out a difference in the rewards and not meeting the demands (Grath, 1976). In work, the demand is so high that employees might try to avoid it by withdrawing. Employee withdraws may either be psychological whereby they fail to show interest or do not get involved in the work. Secondly, it might also be physical which might entail coming late to work or not coming to work at all or coming and being lazy at work. Lastly, it might also involve resignation which is leaving the task altogether. (Beehr "Newman,1978). Therefore, to overcome some of these obstacles in the hospitals, there is a need for nurse managers to focus on the causes of stress among the nurses. The focus aims to help minimize costs as well as improve performance. Hence, it is imperative that healthcare firms to emphasis on the development of an environment that focuses on improving job satisfaction as well as retaining experienced and productive employees.
As already highlighted, the sources of stress among workers can be from internal (within the individual) or external (within the working environment). Studies have revealed that the internal personal characteristics might also result in the development of job stress. Some of the inner personal features might include; flexibility, type A behavior as well as interactions with colleagues. Saleh, Saleh "AbuRuz, (2013) also argues that there are also external factors associated with stress development and they include; the lack of adequate management, changes in the roles performed by the worker and lack of employee and environment conflict (Saleh, Saleh "AbuRuz, 2013).
Alarcon, Eschleman " Bowling, (2009) study, revealed that a person’s traits are crucial in influencing their ability to adapt to stressful situations. The reason is that it influences one’s ability to develop perception regarding the environment they are working (Alarcon, Eschleman " Bowling, 2009). Another area of study is the Positive affectivity (PA). PA is a personality trait that has been understudies thus requires further investigations. The reason is that an individual can exhibit positive emotions when exposed to different situations (Watson et al., 1988). According to various researches, people with high PA are usually more energetic, passionate as well as earnest in all their endeavors in comparison to those with low PA. Van Yperen, (2003), argues that those people with low-PA are passive, lazy as well as indifferent. High PA has been closely linked with increased job satisfaction, improved performance as well as better working attitudes. Other factors related to high PA among employees included; reduced burnout levels as well as have a turnover (Thian, Kannusamy " Klainin-Yobas, 2013).
Almalki, FitzGerald, " Clark, (2012); Alsagri, (2014) studies within the Saudi Healthcare sector also associate the following variables with job stress; first the working conditions in Saudi hospitals, role conflict, and ambiguity as well as working relationships. Other factors identified entail; organizational structure and culture, lack of shift flexibility, lack of opportunities for career development and the demanding nature of the nursing profession. Al-Hosis, Mersal, and Keshk (2013), also established that some of the factors related to job stress included; workloads, responsibilities, patient and family issues and time constraints, leading to health issues. The conclusions were drawn upon investigating job stress among public hospital nurses in the Qassim region. In a study conducted by Al-Hosis et al. (2013) that entailed the use of descriptive explorative design and a purposive sample of 152 Saudi nurses from the four Ministry of Health hospitals, it was found out that the lack of social support from colleagues as well as hospital management lead to the development of health issues among the nurses. Kamal, Al-Dhshan, Abu-Salameh, Abuadas and Hassan (2012) also conducted a research to identify job stressors among nurses in Taif public hospitals. The study identified job stressors among these nurses as dealing with patients and their families. Secondly, failure to deal with patients' emotional needs. Thirdly, increased workload among the nurses. Fourthly, conflicts between the nurses and supervisors. Other indicators identified by the study were; uncertainty while administering treatment, conflicts between nurses and physicians among others. Lastly, a study by Kamal et al. (2012) which employed descriptive-correlational cross-sectional analysis to perform data analysis from a convenience sample of 148 nurses also had the same conclusions when they used an expanded nursing stress scale and job satisfaction scales while conducting their research.
Studies conducted in Jordan reveal that job stress among their nurses was a result of work and family imbalance, economic factors, the difficulty of the nursing profession, increased peer competition as well as the organizational environment. These findings were as a result of a study done by (Al-khasawneh " Futa, 2013) when he measured the performance of 58 nurses by analyzing their creativity and innovation, problem-solving abilities and decision making. The research entailed analyzing a random sample of 120 nurses was selected from King Abdullah Hospital in Irbid city. The data was then analyzed the use of descriptive statistics and tested through a coefficient. The findings of the research were that there existed the relationship between organizational environment and performance was positive. Consequently, this relationship was also positive when linked with job difficulty and performance. The recommendations of the study entailed making improvements on hospital organizational environment. Lastly, hospital managers as well as the leadership to provide social support thus reducing the stress levels among nurses.
Chen, Lin, Wang, and Hou (2009), conducted research to determine the stressors, the stress coping strategies, and job satisfaction among nurses. The study was done on 121 nurses working at seven hospitals in Yunlin and Chiayi Counties. The results were that each type of hospital had its stress level as well as the frequency of perception among the nurses. Nevertheless, it was also established that patient safety was the primary contributor to job stress among the nurses. The study also found out different working environment, as well as administrative management styles, influenced job satisfaction and job stress. Furthermore, it was also revealed that nurses beyond the age of 40 and above and had worked more than 20 years had more stress in comparison to those who were younger and had worked for a shorter number of years. Additionally, nurses that were single or had no children experienced coping difficulties than others. Lastly, the nurses that had a monthly salary of less than USD 950 (NT$ 30,000) also had lower job satisfaction when compared to those earning the minimum. Consequently, the nurses that had been employed in the same hospital for nearly two decades exhibited higher levels of self-esteem in comparison to those employed in the hospital for less than five years.
A study aimed at evaluating the relationship between stress levels and characteristics of organizations and psychical traits among nurses was done by Piko (1999). The investigations were dome in public hospitals located in Csongrad County, Hungary. The findings of the research were that levels of stress among nurses could be indicated by regular alcohol drinking, smoking, use of tranquillizers as well as sleeping pills. The study also revealed that older nurses (between the ages of 51-60) and those that are on a rotating night shift are easily affected by stress.
Job Stress and Workers Engagement
Schaufeli et al., (2002), defines workers engagement as the levels at which employes are passionate about their jobs, show loyalty to a firm as well as their willingness to go the extra mile to ensure that the goals and objectives of the firm are achieved. Employee engagement is measured in three aspects. These aspects include; vigor which is the level of commitment as well as energy shown by the employee. Secondly, dedication which is perception of value that an employee feels they have in a firm. Lastly, absorption which is the extent that the employee will go to ensure that the firm achieves its goals and objectives
(Freeney " Tiernan, 2009). The various studies have indicated that PA and WE concepts have a positive relationship with work stress as well as over negative job outcomes (Schaufeli " Bakker, 2004). The ASWE- Affective Shift Theoretical Model of Work Engagement argues that there is a positive relationship between PA and work engagement (ASWE: Bledow et al., 2011). Additionally, people who exhibit high levels of PA are seen as the baseline of positive moods (Watson " Clark, 1984).
Impact of Job Stress in the Nursing Profession
Job stress consequences, especially for the nursing profession, have highly been studied. Job stress within the nursing profession is highly linked to decreased job satisfaction, increased psychological distress, physical complaints and absenteeism (Borda " Norman, 1997). (Roberts " Grubb, 2014), identifies some of the stress related outcomes to include; depression, sleep problems, feelings of inadequacy, self-doubt, lowered self-esteem, irritability, and physical disturbance (Roberts " Grubb, 2014). Job stress is also believed to result in disproportionately high rates of general illness, increased the incidence of psychiatric outpatient consultation, and psychiatric admissions in this working population (Metules " Bolanger, 2000; Roberts " Grubb, 2014). Both individual and situational factors affect the development of the perception that one has regarding their work environment, they also play a role in influencing job stress. A good example that best illustrates this is workload. Workload refers to the manner in which assignments are assigned and the amount of control that one has regarding their completion, the support that they receive from their superiors, the extrinsic and intrinsic rewards as well as the working conditions play a huge role in developing the notion of the environment as either being stressful or less stressful (Roberts " Grubb, 2014). Today, there is a lot of literature that illustrates the exposure of nurses in their field of operation. The nursing field is stressful due to the numerous on job demands that result in the development of stress. The nurses are not only subjected to physical needs but also emotional ones which are as a result of interacting with their patients (McNeely, 2005). Additionally, they are also subjected to long working hours which is a result of shortage as well as lack of skills or support needed to relieve the workload (Freshwater " Cahill, 2010; Jennings, 2007).
Job Satisfaction Among the Nurses
