Nurses' Perceived Job Related Stress and Job Satisfaction in Amman Private Hospitals

Authors:

Ayman ALnems RN,

Fouad Aboads RN,

Murad AL-Yousef RN,

Nabeel AL-Yateem RN,

Nazih Abotabar RN

June, 2005

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Nurses' Perceived Job Related Stress and Job Satisfaction in Amman Private Hospitals

Background. Job dissatisfaction is becoming an increasingly large disorder. There has been little

research on nurse job satisfaction and job related stress in Jordan. Interest in job related stress is

renewed with each cycle of nursing shortage.

Aims. To identify variables of Jordanian nurses’ job satisfaction and job related stress.

Methods. A descriptive correlational cross sectional design using surveys guided this study through

convenience sample of 73 nurses. Data were analyzed using descriptive and inferential statistics.

Results. The lack of enough staff to adequately cover the unit is the most stressful event perceived

by the staff nurses as indicated by the Mean ( N= 73, Mean= 3.03). The experiencing discrimination

on the basis of sex and break down of the computer is the least stressful events perceived by the

staff nurses as indicated in the Mean (N= 73, Mean= 1.60). The total job satisfaction for the staff

nurses had been calculated using the mean and the standard deviation measures and the result was

(N= 73, Mean= 1.85); and this is an indication of dissatisfaction. There is a significant negative

relationship between the perceived job related stress and the job satisfaction of the staff nurses in

private hospital in Amman

Discussion. The most stressful subscale for staff nurses is the uncertainty concerning treatment, the

major factor of high level of stress is the lack of autonomy and independency in making decisions.

Shortage of staff and lack of resource in the work settings was also felt acutely and was frequently

stressful. There is a significant negative relationship between job related stress and job satisfaction.

Conclusion. This study indicates the importance of adopting strategies to reduce the perceived job

related stress and also adopting strategies to demonstrate more social support for the staff nurses in

the work place in the private hospitals in Amman.

Keywords: job satisfaction, Jordan, nurse, job related stress, validity, reliability

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INTRODUCTION

Job Satisfaction

The widespread nursing shortage and nurses’ high turnover has become a global issue

(Kingma, 2001) which is of increasing importance to both the developed and developing countries

(Cavanagh, 1990; Blegen, 1993; Hancock, 1998; Lee, 1998; Aiken et al., 2001; Fang, 2001; Lu et

al., 2002). In light of this, concern about recruitment and retention of nursing staff is increasing in a

number of countries (Lundh, 1999). While numerous factors have been linked to nurses’ turnover,

job satisfaction is the most frequently cited (Cavanagh and Coffin, 1992; Blegen, 1993; Irvine and

Evans, 1995), and therefore merits attention.

In the 1980s and 1990s, many researchers have been addressed nurse job satisfaction. The

understanding of nurse job satisfaction and its contributing variables are important for any health

care organization to exist and prosper. Job satisfaction is defined as the degree to which employees

enjoy their jobs (McCloskey & McCain 1987). Nurse Job satisfaction is a multidimensional

phenomenon that is influenced by many variables. Autonomy has been identified as the strongest

predictor of nurse job satisfaction, which in turn reflects positively on nurse retention (Boyle et al.

1999, Chaboyer et al. 1999, 2001, O’Rouke et al. 2000, Upenieks 2000, Finn 2001). Sengin (2003)

supported Hinshaw and Atwood (1984), who are in a comprehensive literature review identified

variables that influence nurse job satisfaction. These factors included: (1) demographic variables:

education, experience, and position in the hierarchy; (2) job characteristics: autonomy, tasks

repetitiveness, and salaries; and (3) organizational environment factors: degree of

professionalization, type of unit, and nursing care delivery model. Recent research identified new

variables that influence nurse job satisfaction such as environment and job settings (Shaver & Lacey

2003). Non-supportive work environments increase nurse’s stress and job dissatisfaction (Sims

2003), which negatively influence nurse retention.

Stamps and Piedmonte’s (1986) work on job satisfaction among nurses; Stamps and

Piedmonte’s conceptualization of job satisfaction was based on Vroom’s (1964) multiplicative need

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fulfillment theory, a widely used theoretical model from organizational psychology. In brief,

according to need fulfillment theory, work satisfaction is related to the extent to which the work

setting fulfills important personal needs. In this perspective the salience of needs varies, and the

greater the need, the more satisfied the individual will be when that need is fulfilled (Stamps &

Piedmonte, 1986). Maslow’s theory of human needs served as a guide for the identification of

needs. Stamps and Piedmonte also linked need fulfillment theory with social reference group

theory, which ‘‘significantly departs from the need fulfillment theory because it stresses the

importance of what other people feel in shaping the individual’s stated needs’’ (Stamps &

Piedmonte, 1986, p. 3). In linking these theoretical perspectives, Stamps and Piedmonte combined

the concepts of discrepancy (defined as the difference between an individual’s needs and the extent

to which the job fulfills those needs) and the social context of work (expected outcomes are

determined by a person comparing his or her work and rewards to those of others doing a similar

job). This formulation of job satisfaction thus combines psychological and sociological perspectives

on work. Stamps and Piedmonte (1986) conceptualized job satisfaction as comprising six

components: pay, autonomy, task requirements, organizational policies, interaction, and

professional status. Pay is defined as the dollar remuneration and fringe benefits received for work

done. Autonomy is the amount of job-related independence, initiative, and freedom either permitted

or required in daily activities. Tasks or activities that must be done as a regular part of the job are

considered task requirements. Organizational policies are the management policies and procedures

put forward by the hospital and nursing administration of the hospital. Interaction is defined as the

opportunities presented for both formal and informal social and professional contact during working

hours. Professional status includes both the individual’s and the community’s definitions of the

importance of a job. For Stamps and Piedmonte, job satisfaction derives from the congruence of

workers’ expectations about these six components of satisfaction and the degree to which the job

fulfills those expectations (reward). Conversely, discrepancy between expectations and fulfillment

leads to lower job satisfaction. The perceived importance or significance of the job, including the

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viewpoints of the individual and of others (the social context), is also related to job satisfaction. In

addition, demographic factors that Stamps and Piedmonte considered cogent to the study of work

satisfaction include age, marital status, and type of education. Harris (1989) developed a self-report

measure of nurse stress. Harris’s research was derived from the work of stress response theorists

beginning with Selye (1956). Selye conceptualized stress as a response to disequilibrating stimuli

encountered in the social environment. In the stress response perspective discerning the nature and

importance of these stressors is critical to understanding and diagnosing stress and to developing

strategies to deal with its potentially deleterious physiological and psychological effects. Harris

(1989) found that difficulties in managing workload, conflicts among staff, lack of involvement in

decision making, perceived lack of support, and poor communication were important dimensions of

occupational stress among experienced nurses working in a variety of hospital and community

settings in southwestern England. In addition, perceived lack of preparation for the role and dealing

with death and dying were cited by Harris as sources of stress among nurses. Harris postulated that

consequences of perceived work-related stress include depression and that the resulting depression

is inversely related to composure, quality of patient care, and interpersonal and cognitive

effectiveness. Hinshaw and Atwood (1983) utilized a similar conceptualization of job stress in

research on nursing staff turnover: ‘‘Job stress involves those demands encountered within the roles

and functions of employment’’ (p. 141). Hinshaw and Atwood’s review of influential factors in job

stress among nurses included many of the dimensions of nursing practice used in Harris’s

instrument development. Stress and job satisfaction among nurses has been the subject of extensive

research for many reasons, including the relationship of these occupational attitudes to measures of

job performance (Ivancevich & Matteson, 1980; Jex, 1998). In addition, Hinshaw and Atwood

(1983) and Lucas, Atwood, and Hagaman (1993) reported that job stress and job satisfaction were

important correlates of anticipated and actual job turnover among nurses.

Aiken et al. (2001) found job dissatisfaction among nurses was highest in the United States

(41%) followed by Scotland (38%), England (36%), Canada (33%) and Germany (17%). One third

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of nurses in England and Scotland and more than one fifth in the United States planned on leaving

their job within 12 months of data collection. More striking, however, was that 27–54% of nurses

less than 30 years of age planned on leaving within 12 months of data collection in all countries.

Regarding the work climate, only about one third of nurses in Canada and Scotland felt that they

participated in developing their own work schedules in comparison with more than half in the other

three countries. When compared with other countries, the nurses in Germany (61%) reported that

they were more satisfied with the opportunities for advancement while the nurses in the United

States (57%) and Canada (69%) felt more satisfied with their salaries.

Stress

Stress in the workplace is often referred to as ‘occupational stresses. The basic rationale

underpinning the concept is that the work situation has certain demands, and that problems in

meeting these can lead to illness or psychological distress. Occupational stress is a major health

problem for both individual employees and organizations, and can lead to burnout, illness, labour

turnover, absenteeism, poor morale and reduced efficiency and performance (Sutherland & Cooper

1990). Work-related stress is estimated to be the biggest occupational health problem in the United

Kingdom (UK), after musculoskeletal disorders such as back problems and stress related sickness

absences cost an estimated £4 billion annually (Gray 2000).

Stress is part of everyday life for health professionals such as nurses, physicians, and hospital

administrators since their main responsibility focuses upon providing help to patients who are

usually encountering life crises. Typically, nurses from both public and private hospitals report a

similar pattern of stressful experiences (Dewe, 1987; Hingley and Cooper, 1986). Nurses rated high

workloads and dealing with ‘death and dying’ as their major stressful events (Hipwell et al., 1989).

In addition to pressures due to insufficient time and resources to complete nursing tasks,

organizational factors within the hospital appear to be major sources of stress and determining

factors of job satisfaction (Humphrey, 1992). Hospitals throughout the world are currently

undergoing massive changes to their organizational structure in an effort to reduce costs (Yin and

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Yang, 2002). In some cases, organizational change means hospital closure, job loss, reduced

employee status, and higher levels of workload (Burke and Greenglass, 2000). With shrinking

health care budgets, cutbacks in the workforce, and increasing demands for healthcare, nurses were

hypothesized to respond by experiencing increased levels of stress and reduced job satisfaction.

Nursing is an occupation characterized by a number of features not experienced in most other

professions. These include not only dealing with situations involving death and dying (on a regular

basis), but also more `mundane' stressors such as working long hours, and working shifts and

weekends. This provides an indication of the complex and demanding nature of this profession and

has encouraged much recent research on specific issues, including shift systems, work organization,

and violence in the workplace (Kundi M, Koller M, Stefan H, Lehner L, Kaindlsdorfer S,

Rottenbucher S., 1995). What is common to most of this research is the desire to establish the

impact and consequences of such pressures on the quality of working life and well-being of nurses.

The nursing profession and the stress commonly associated with it has been the subject of

considerable research for decades. This is perhaps not surprising given that nursing is widely

perceived to be one of the most inherently stressful of occupations, often characterized by high rates

of staff turnover, absenteeism and burnout (Dewe, 1987; Jamal, 1992). Research has also found that

stress has been commonly cited by nurses as a primary reason for choosing to leave the profession

(McGrath A, Reid N, Boore J., 1989)

Most studies on nurses have focused on those employed in hospitals or closely related health

care organizations. Of the earlier studies, it is those of Gray-Toft which have repeatedly attracted

attention. These authors identified seven sources of stress 1. Dealing with death and dying; 2.

Conflict with physicians; 3. Inadequate preparation to deal with the emotional needs of patients and

their families; 4. Lack of staff support; 5. Conflict with other nurses and supervisors; 6. Workload;

7. Uncertainly concerning treatment.

In conclusion, job satisfaction of nurses is an important concept as levels of job satisfaction may

impact upon the global nursing workforce. Although the reported studies differed regarding levels

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of job satisfaction among nurses, the literature reveals that the sources of job satisfaction are

relatively similar, e.g., physical working conditions, relationships with fellow workers and

managers, pay, promotion, job security, responsibility, the recognition from managers and hours of

work. Furthermore, it seems that nurses who had received tertiary education felt less satisfied with

their jobs than those who had not received tertiary education. Most published research from various

countries indicates that job satisfaction is a significant predictor of nursing absenteeism, burnout,

turnover and intention to quit; however, there have been some inconsistent findings. Much research

has revealed that job satisfaction of hospital nurses is closely related to job stress, role conflict and

ambiguity, organizational commitment and professional commitment.

METHODOLOGY

The sample

The study population includes all staff nurses in private hospitals (Specialty hospital,

Islamic hospital, Arab heart center) in Jordan. Criteria for inclusion into the study is to be a

registered nurse ( staff nurse ), working in the same area for at least 6 months, full time employment

and able to read, write, and comprehend the English language in a competent way. The exclusion

criteria is to be a head nurse or supervisor, working in the same area less than 6 months, part time

employment staff nurse, and nurses who are permanent on one shift (A, B or C shift) . The nature of

supervisors and head nurses work and activities is different from the nature of staff nurses work and

activities. also, the stabilization of the staff nurse in the same area for a long period of time (more

than 6 months) will enable him/her to identify the stressors and it will give him/her the ability to

judge his/her job satisfaction appropriately. Also, the part time employment and to be permanent on

one shift (A, B or C shift) will not give an accurate picture on the job related stress and job

satisfaction. The criteria are derived from a research study conducted to investigate the effect of job

related stress on job performance among hospital nurses (Abualrub, 2004).

The convenience sampling method was used because it is easy for the researcher to reach

the sample participants; however, the researchers acknowledge that this type of non probability

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sampling method will provide little opportunity to control for biases. Based on a formulation of 80

% power, and medium effect size of (0.25), for a significant level of α = 0.025, the estimated

sample is 73 nurses according to the formula

(Leidly and Weissgeld, 1991) (∆ = effect size, β = 1- power, Z= from Z tables). The medium effect

size is the accepted effect size used for the most applied researches (as cited in Pilot, and Hungler,

1995).

Setting

Data was collected from the intensive care units, cardiac care units, floors, and the operation

rooms of the main private hospitals in Amman Specialty hospital, Islamic hospital, and Arab

medical center. The three hospital are of the main private hospitals in Amman; Specialty hospital

with a capacity of 200 beds and 12 ICU beds. The Islamic hospital with a capacity of 300 beds and

18 ICU beds. The Arab medical center with a capacity of 145 beds, 8 ICU beds, and 8 CCU beds.

Design

In this study, descriptive correlational method was used to examine the main job related

stressors affect the staff nurses and to examine the relationship between job related stress and job

satisfaction.

Instrument

Two instruments were used to elicit information about job related stress and the level of job

satisfaction (Appendices A&B) among staff nurses in Amman private hospitals. Job related stress,

defined as any work situation perceived by the participant as threatening because of the mismatch

between the situations demands and the individuals coping abilities, was measured with the 34-

items nursing stress scale (Gray-Toft & Anderson, 1981). Because stressors related to patients and

families are not included in the nursing stress scale but are considered among the stressors that

nurse experience (Hatrick & Hill, 1993), the eight items of the subscale on patients and families of

the expanded nursing stress scale were added to nursing stress scale ( French, Lenton, Walters, &

Eyles, 2000). The alpha coefficient for the whole scale was 0.92. It was 0.76 for the "death and

1

2

11

1

2 ∆×

−+−= βα

ZZn

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dying" subscale, 0.70 for the "conflict with a physicians," 0.73 for the "in adequate preparation,"

0.71 for the "lack of support," 0.70 for the "conflict with other nurses," 0.79 for "work load," 0.76

for "uncertainty concerning treatment," and 0.87 for "patients and families"(Abualrub, 2004).

The job satisfaction among staff nurses was measured by Job Satisfaction Survey. The Job

Satisfaction Survey, JSS is a 36 item, nine facet scales to assess employee attitudes about the job

and aspects of the job. Each facet is assessed with four items, and a total score is computed from all

items. A summated rating scale format is used, with five choices per item ranging from "disagree

very much" to “agree very much.” Items are written in both directions, so about half must be

reverse scored. The nine facets are Pay, Promotion, Supervision, Fringe Benefits, Contingent

Rewards (performance based rewards), Operating Procedures (required rules and procedures),

Coworkers, Nature of Work, and Communication. Below are internal consistency reliabilities

(coefficient alpha), based on a sample of 2,870 (Spector 1994).

Table 1 Internal consistency reliabilities (coefficient alpha) of Job Satisfaction Survey.

Scale Alpha Description

Pay .75 Pay and remuneration

Promotion .73 Promotion opportunities

Supervision .82 Immediate supervisor

Fringe Benefits .73 Monetary and nonmonetary fringe benefits

Contingent Rewards .76 Appreciation, recognition, and rewards for good work

Operating Procedures .62 Operating policies and procedures

Coworkers .60 People you work with

Nature of Work .78 Job tasks themselves

Communication .71 Communication within the organization

Total .91 Total of all facets

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Data collection procedures

Formal approval from the hospitals to conduct the study was gained before starting data

collection; also a permission from the authors to use the tools was gained. Participation in the study

is voluntary and based on the staff nurses ability to give informed consent, and then the staff nurses

will be invited to participate.

All gathered data and information were strictly confidential and will not be accessed by any

other party without prior permission of the participant. More over, the participant has the right to

withdraw any time they cannot complete the questionnaire.

Before giving the informed consent, data collectors explained the purpose of the study and it

was mentioned expressly to the participants that their responses will be treated confidentially and

anonymously, and that their participation is voluntary. The participants also were informed that it

would be impossible to identify individual answers, and they have the right to withhold their

responses if, for example, the questions were too private. The staff nurses from the selected

hospitals were asked to fill two questionnaires. The first questionnaire aims to measure Job related

stress, the second aims to measure job satisfaction. The staff nurses were informed that the

questionnaire will be given and collected during their working shift (8 hours) and the researchers

were present during that time for any questions.

Ethical consideration

The study was reviewed by the Ethics Committee of the Faculty of Nursing at the University of

Jordan. Approval from clinical faculty, intended hospitals, IRB, and subjects was gained. Several

Strategies were utilized to protect the subject's rights who agree to participate in this study. First,

oral written consent of the subjects was obtained prior to the administration of the questionnaire.

The subjects were informed of the purpose of the study, that the participation is voluntary, and that

they have the right to refuse to participate. Further, the subjects were told that they can refrain from

answering any questions and can terminate the interview at any time. Anonymity of the subjects

was maintained at all times. Data was organized by subject's codes, and the investigators keep the

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telephone numbers of the subjects in a separate locked file. The names and addresses of the subjects

will remain unknown to investigator

RESULTS

Descriptive results

Of the 73 nurses who responded, 42 nurses (57.5%) were male and 31 nurses (42.5 %) were

female nurses. 60.2% were younger than 25 years old, 26% were aged between 25-30 years, 4.1%

were aged between 31-35 years, 8.2% were aged between 35-40 years, and 1.3 % were more than

40 years. The nursing samples were, therefore, youthful nurses (the majority is younger than 25

years old). 31.5% of the sample is from the specialty hospital, 34.2% of the sample is from Islamic

hospital, and 34.2% of the sample is from the medical Arab center. 30.1% of the sample is working

in the ICU setting, 23.3% of the sample is working in the CCU setting, 23.3% of the sample is

working in the floor setting, and 23.3% of the sample is working in the operation room. During

filling the questionnaires 42.5% of the nurses were on A-shift, 31.5% of the nurses were on B-shift,

and 26% of the nurses were on C-shift during filling the questionnaires.

Expanded nursing stress scale (perceived job related stress)

To achieve the purpose of the study, the mean and the standard deviation were calculated for

the items and the subscales of the expanded nursing stress scale. The descriptive analysis indicates

that lack of enough staff to adequately cover the unit is the most stressful event perceived by the

staff nurses in the private hospitals as indicated by the Mean ( N= 73, Mean= 3.03). And the

experiencing discrimination on the basis of sex and break down of the computer is the least stressful

events perceived by the staff nurses in the private hospitals as indicated in the Mean (N= 73, Mean=

1.60).

The results have shown that the most stressful subscale is the uncertainty concerning

treatment (Inadequate information from a physician regarding the medical condition of a patient, A

physician ordering what appears to be inappropriate treatment for a patient, A physician not being

present in a medical emergency, Not knowing what a patient or a patient's family ought to be told

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about the patient's condition and its treatment, Uncertainty regarding the operation and functioning

of specialized equipment) as indicated by the Mean ( N= 73, Mean= 2.558), and the least stressful

subscale is the inadequate preparation (Feeling inadequately prepared to help with the emotional

needs of a patient's family, Being asked a question by a patient for which I do not have a

satisfactory answer, Feeling inadequately prepared to help with the emotional needs of a patient) as

indicated by Mean ( N= 73, Mean= 2.16). Table-2 demonstrates the most stressful subscales and the

least stressful subscale for the staff nurses:

Table 2 The most stressful subscales and the least stressful subscale for the staff nurses

Descriptive Statistics

N Mean Std. Deviation

Uncertainty by concerning treatment 73 2.5589 .6027

conflict with physician 73 2.5096 .4899

Work Load 73 2.4247 .4932

Death and dying 73 2.4070 .6347

conflict with other nurses 73 2.3890 .5695

Lack of staff Support 73 2.2603 .6787

Inadequate preparation 73 2.1644 .7139

Valid N (list wise) 73

The total perceived job related stress among the staff nurses in the private hospitals in

Amman has been calculated using the mean and the standard deviation measures and the result was

(N= 73, Mean=2.41). This is an indication that the staff nurses in the private hospitals are

(occasionally too frequently) perceiving the previous listed items as stressful events for them.

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Job satisfaction scale (Job satisfaction among staff nurses in the private hospitals in Amman):

The total job satisfaction for the staff nurses in the private hospitals has been calculated

using the mean and the standard deviation measures and the result was (N= 73, Mean= 1.85). And

this is an indication of dissatisfaction. In job satisfaction scale the majority of the nurses have

expressed the highest level of satisfaction regarding (the people they work with) as indicated by the

Mean (N= 73, Mean= 3.16) and they have expressed the lowest level of satisfaction regarding (the

duties that they have to do or accomplish at work) as indicated by the Mean (N= 73, Mean= 1.11).

Correlations results

The effect of demographic variables

Two tailed T-test (independent sample test) had been used to investigate the effect of gender

on the perceived job related stress and job satisfaction (There were more male nurses 57.5% than

female nurses 42.5%). There were no significant statistical differences in perceived job related

stress due to gender as indicated by (t = - 1.468, sig. = .147 > 0.05) and no significant statistical

differences in job satisfaction due to gender as indicated by (t = .751, sig. = .455 > 0.05); Hence

male and female doesn’t differ.

One way ANOVA test had been used to investigate the effect of age, shift rotation ( A, B, or

C shift ), and the work place ( ICU, CCU, Floor, Operating room) on the perceived job related stress

and job satisfaction. There were no significant statistical differences in job related stress due to age

as indicated by (F= 1.133, sig. = .348 > 0.05).And no significant differences in job satisfaction due

to age as indicated by (F= 2.044, sig. = .098 > 0.05). There were no significant statistical

differences in perceived job related stress due to shift rotation (A, B, or C shift) as indicated by (F=

.427, sig. = .654 > 0.05) and no significant statistical differences in job satisfaction due to shift

rotation (A, B, or C shift) as indicated by (F= 1.299, sig. = .279 > 0.05). Also, There were no

significant statistical differences in perceived job related stress due to work place (ICU, CCU,

Floor, Operation room) as indicated by (F= .539, sig. = .657 > 0.05) but there is significant

statistical differences in job satisfaction due to work place as indicated by (F= 3.711, sig. = .015 <

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0.05).To know which work places have made this significant relation, a Post Hoc Test had been

used, the results have shown that CCU and Floor nurse contribute to this significant statistical

difference. These results indicate that the CCU and Floor nurses are under a high level of stress and

this contribute to high level of dissatisfaction between them.

The effect of perceived job related stress on job satisfaction

To achieve the purpose of identifying the effect of perceived job related stress on job

satisfaction of the staff nurses in the private hospitals in Amman, a Pearson correlation test has been

performed. There is a significant negative relationship between the perceived job related stress and

the job satisfaction of the staff nurses in private hospital in Amman as indicated by (Pearson

correlation = -.283, sig. = .015 < 0.05). And this correspondent with results of the researches that

have studied the relationship between jobs related stress and job satisfaction.

DISCUSSION

The purpose of the study was to describe the main stressors affecting staff nurses in private

hospitals in Amman. Researchers have found that the most stressful subscale for staff nurses is the

uncertainty concerning treatment (Inadequate information from a physician regarding the medical

condition of a patient, A physician ordering what appears to be inappropriate treatment for a patient,

A physician not being present in a medical emergency, Not knowing what a patient or a patient's

family ought to be told about the patient's condition and its treatment, Uncertainty regarding the

operation and functioning of specialized equipment). Researchers can conclude from the previous

mentioned results that the major factor of high level of stress is lack of autonomy and independency

in making decisions. The majority of the nurses felt unable to make decisions at least sometimes,

and powerless to change unsatisfactorily situations. Although some of the nurses felt inadequately

trained or equipped for their job, it was also felt that the nurses did not always utilize their training

and experience. In relation to the stressors in nursing itself, many of the nurses experienced too little

time in which to undertake their work. Shortage of staff and lack of resource in the work setting was

also felt acutely and was frequently stressful.

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And the least stressful subscale is the inadequate preparation (Feeling inadequately prepared

to help with the emotional needs of a patient's family, being asked a question by a patient for which

I do not have a satisfactory answer, Feeling inadequately prepared to help with the emotional needs

of a patient). It may be of the most important findings of this study. The results clearly suggest that

nurses are avoiding emotional demands of the patients as evidenced by least mean (N=73, Mean =

2.164 for the inadequate preparation to meet emotional need of the patient). So, it is suggested that a

coping mechanism specific to nursing may be that nurses unconsciously reduce stress in their job by

setting a nursing objectives as physical objectives and avoid the emotional objectives in their job

and that’s opposing the philosophy of holistic care in nursing and converting the nurses into

machines regarding the performance of their work. It is indeed time of care for staff nurses and the

time to look for the main stressors and reducing it to achieve the concept of holistic care in nursing

(the physical, emotional, social and spiritual aspect of care).Ways in which this caring could be

achieved are to enhance the ability of the work groups to support each other, and to have more

counseling services. Because poor clinical structure, poor relationships with other professions and

lack of a higher level of education for nurses may all lead to lower levels of confidence and higher

stress levels, these issues need to be confronted as a means of caring for staff. The recently agreed

clinical structure (more clearly related to the preparation for the role) may lead to increased

autonomy and satisfaction. Better relationships with other professions (e.g. physician/nurse) may

also relieve stress. This could be achieved through closer integration during parts of training to

enhance understanding of each others roles. A higher level of education for nurses will lead to

increased confidence and an ability to discuss issues as equals with professional colleagues. Seeking

strategies to relieve the stressors that are affecting the staff nurse in the private hospitals is one of

the major tasks that the private hospitals should concern to achieve a higher level of satisfaction for

the staff nurses and for the customers (patients and their families in the organization).Also, when

there is adequate job satisfaction between the staff nurse, there will be more stability and more

retention for the staff nurses in the organization.

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One of the interesting findings in this study on the staff nurses in the private hospitals is that

there is a significant statistical difference in job satisfaction due to the workplace (ICU, CCU,

Floor, Operation room) as indicated by (F= 3.711, sig. = .015). To know which work places have

made this significant statistical difference, a Post Hoc Test has been done and the results have

shown that CCU and Floor nurse contribute to this significant statistical difference. These results

indicate that the CCU and Floor nurses are under a high level of stress and this contribute to high

level of dissatisfaction between them. These results putting the CCU and Floor nurse under the

microscope to see the main stressors made them unsatisfied on their job. To achieve the holistic

care, we have to care for the nurses who are providing the care and to relieve their stressors to

enable them providing the emotional aspect of care as equal as physical aspect of care

Stress and job satisfaction among nurses has been the subject of extensive research for many

reasons, including the relationship of these occupational attitudes to measures of job performance

(Ivancevich & Matteson, 1980; Jex, 1998). In addition, Hinshaw and Atwood (1983) and Lucas,

Atwood, and Hagaman (1993) reported that job stress and job satisfaction were important correlates

of anticipated and actual job turnover among nurses. The results that investigate the relationship

between perceived job related stress and job satisfaction have shown that there is a significant

negative relationship between job related stress and job satisfaction among staff nurses in private

hospitals in Amman as indicated by (Pearson correlation = -.283, sig. = .015 < 0.05). And this

correspondent with results of the researches that have studied the relationship between jobs related

stress and job satisfaction.

This study indicates the importance of adopting strategies to reduce the perceived job related

stress and also adopting strategies to demonstrate more social support for the staff nurses in the

work place in the private hospitals in Amman. Nurse Managers should promote an organizational

culture characterized by cooperation, social integration, and team work among nurses to reduce the

stressors and thus achieve the holistic care provided by the nurses and improve the quality of care

provided for the patients in the private hospitals. Moreover, researchers recommend to foster

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cooperation, social interaction concepts, and effective coping mechanism among nursing students

for future behaviors. Students who learn the importance of cooperation and social integration during

their education might better understand the significance of coworker support in the work place.

Limitation of the study

The main limitation of the study is the convenience sampling method which increases the

probability of systemic sampling error, and reduces the power of the study. Also, the presence of

more than one researcher in data collection procedure, could affect the results, and the consistency

of the instrument. The use of a long questionnaire as a data collection method could affect the

process of sample recruitment and thus decrease the response rate among staff nurses. Also, the

time and funding limitation could affect the result of the study.

19

REFERENCES

Aiken, L., Clarke, S., Sloane, D., Sochalski, J., Busse, R., Clarke, H., Giovannetti, P., Hunt, J.,

Rafferty, A., Shamian, J., 2001. Nurses’ reports on hospital care in five countries. Health Affairs 20

(3), 43–53.

Blegen, M., 1993. Nurses’ job satisfaction: a meta-analysis of related variables. Nursing Research

42 (1), 36–41.

Blegen, M., 1993. Nurses’ job satisfaction: a meta-analysis of related variables. Nursing Research

42 (1), 36–41.

Boyle D.K., Bott M.J., Hansen H.E., Woods C.Q. & Taunton R.L. (1999) Managers_ leadership

and critical care nurses_ intent to stay. American Journal of Critical Care 8 (6), 361–371.

Burke, R.J., Greenglass, E.R., 2000. Effects of hospital restructuring on full time and part time

nursing staff in Ontario. International Journal of Nursing Studies 37, 163–171.

Cavanagh, S., 1990. Predictors of nursing staff turnover. Journal of Advanced Nursing 15, 373–

380.

Cavanagh, S., Coffin, D., 1992. Staff turnover among hospital nurses. Journal of Advanced Nursing

17, 1369–1376.

Decker, F. (1997). Occupational and nonoccupational factors in job satisfaction and psychological

distress among nurses. Research in Nursing & Health, 20, 453–464.

Dewe PJ. Identifying the causes of nurses' stress: A survey of New Zealand nurses. Work Stress

1987; 1: 15-24.

Dewe, P.J., 1987. Identifying the causes of nurses’ stress: a survey of New Zealand nurses. Work

and Stress 1, 15–24.

Gray P. (2000) Mental Health in the Workplace: Tackling the Effects of Stress. Mental Health

Foundation, London.

Hancock, C., 1998. Keeping staff means demonstrating to nurses that they matter. Nursing Times

Research 3 (3), 165–166.

20

Harris, P.E. (1989). The Nurse Stress Index. Work & Stress, 3, 335–346.

Hingley, P., 1984. The humane face of nursing. Nursing Mirror 159 (21), 19–22.

Hingley, P., Cooper, C.L., 1986. Stress and the Nurse Manager. Wiley, New York, NY.

Hinshaw A. &Atwood J. (1984) Nursing staff turnover, stress and satisfaction: models, measures,

and management. In Annual Review of Nursing Research, Vol. 1 (H. Werley& J. Fitzpatrick eds),

pp. 133–155. Springer Company, New York, NY.

Hinshaw, A. & Atwood, J. (1983). Nursing staff turnover, stress, and satisfaction: Models,

measures and management. Annual Review of Nursing Research, 1, 133–153.

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.

Humphrey, J.H., 1992. Stress Among Women in Modern Society. Charles C. Thomas, Springfield,

IL.

Irvine, D.M., Evans, M.G., 1995. Job satisfaction and turnover among nurses-integrating research

across studies. Nursing Research 44 (4), 246–253.

Ivancevich, J., & Matteson, M. (1980). Stress and work: A managerial perspective. Glenview, IL:

Scott, Foresman. Jex, S. (1998). Stress and job performance. Thousand Oaks, CA: Sage.

Jamal M, Baba VV. Shiftwork and department-type related to job stress, work attitudes and

behavioural intentions: A study of nurses. J. Organiz. Behav. 1992; 13: 449±464.

Kingma, M., 2001. Nursing migration: global treasure hunt or disaster-in-the-making? Nursing

Inquiry 8, 205–212.

Kundi M, Koller M, Stefan H, Lehner L, Kaindlsdorfer S, Rottenbucher S. Attitudes of nurses

towards 8-h and 12-h shift systems. Work Stress 1995; 9: 134-139.

Lee, F.K., 1998. Job satisfaction and autonomy of Hong Kong registered nurses. Journal of

Advanced Nursing 27, 355–363.

Lee, H., Song, R., Cho, Y.S., Lee, G.Z., Daly, B., 2003. A comprehensive model for predicting

burnout in Korean nurses. Journal of Advanced Nursing 44 (5), 534–545.

21

Lu, K.Y., Chious, S.L., Chang, Y.Y., 2000. A study of the professional commitment changes from

nursing students to registered nurses. The Kaohsiung Journal of Medical Science 16, 39–46.

Lundh, U., 1999. Job satisfaction among Swedish nurses and laboratory technologists. British

Journal of Nursing 8 (14), 948–952.

Lyon, B. (2000). Stress, coping, and health: A conceptual overview. In V.H. Rice (Ed.), Handbook

of stress, coping, and health: Implications for nursing research, theory, and practice (pp. 3–23).

Thousand Oaks, CA: Sage.

McCloskey J.C. & McCain B. (1987) Satisfaction, commitment, and professionalism of newly

employed nurses. IMAGE: Journal of Nursing Scholarship 19 (10), 20–24.

McGrath A, Reid N, Boore J. Occupational stress in nursing. Int. J. Nurs. Stud. 1989; 26: 343-358.

P. Gray-Toft and T.G. Anderson (1981 a): "The nursing stress scale: development of an

instrument", in Journal of Behavioral Assessment, Vol. 3. 1981, pp. 11-23.

P. Gray-Toft and T.G. Anderson (1981 b): "The Stress among hospital nursing staff: its causes and

effects", in Social Sciences and Medicine, Vol. 15A. 1981, pp. 539-647.

Selye, H. (1956). The stress of life. New York: McGraw-Hill.

Sengin K.K. (2003) Work-related attributes of RN job satisfaction in acute care hospitals. Journal of

Nursing Administration 33 (6), 317–320.

Shaver K. & Lacey M.L. (2003) Job and career satisfaction among staff nurses. Journal of Nursing

Administration 33 (3), 166–171.

Sims C.E. (2003) Increasing clinical, satisfaction, and financial performance through nurse-driven

process improvement. Journal of Nursing Administration 33 (2), 68–75.

Stamps, P.L., & Piedmonte, E.B. (1986). Nurses and work satisfaction. Ann Arbor, MI: Health

Administration Press.

Sutherland V. & Cooper C. (1990) Understanding Stress. A Psychological Perspective for Health

Professionals. Chapman & Hall, London.

Vroom, V.H. (1964). Work and motivation. New York: Wiley.

22

Yin, J.C., Yang, K.P., 2002. Nursing turnover in Taiwan: a meta-analysis of related factors.

International Journal of Nursing Studies 39, 573–581.

23

APPENDICES

A. Expanded nursing stress scale (questionnaire 1).

B. Job satisfaction survey (questionnaire 2).

24

APPENDIX (A): EXPANDED NURSING STRESS SCALE

Age: …………..

What is your sex?

A) Male B) Female

What is the highest level of nursing education that you have?

A) RN B) Others

In which type of setting do you work?

A) ICU

B) CCU

C) Floor

D) Operation Room

Below is a list of situations that commonly occur in a work setting. For each situation you

Have encountered in your presenting work setting, would you indicate how stressful it has

Been for you:

1 = Never stressful.

2 = occasionally stressful.

3 = frequently stressful.

4 = extremely stressful.

0 = doesn’t apply.

25

APPENDIX (A): EXPANDED NURSING STRESS SCALE (ENSS).

Expanded Nursing Stress Scale (ENSS)

Please circle the one number for each question that comes closest to reflecting your

opinion About it.

Never stressful

Occasionally stressful

Frequently stressful

Extrem

ely stressful

Doesn’t Apply

1 Performing procedures that patients experience as painful 0 1 2 3 4

2 Criticism by a physician 0 1 2 3 4

3 Feeling inadequately prepared to help with the emotional needs of a patient's

family

0 1 2 3 4

4 Lack of opportunity to talk openly with other personnel about problems in the

work setting.

0 1 2 3 4

5 Conflict with a supervisor 0 1 2 3 4

6 Breakdown of computer 0 1 2 3 4

7 Inadequate information from a physician regarding the medical condition of a

patient

0 1 2 3 4

8 Patients making unreasonable demands 0 1 2 3 4

9 Being sexually harassed 0 1 2 3 4

10 Feeling helpless in the case of a patient who fails to improve. 0 1 2 3 4

11 Conflict with a physician 0 1 2 3 4

12 Being asked a question by a patient for which I do not have a satisfactory answer 0 1 2 3 4

26

13 Lack of opportunity to share experiences and feelings with other personnel in the

work setting

0 1 2 3 4

14 Floating to other units/services that are short-staffed 0 1 2 3 4

15 Unpredictable staffing and scheduling 0 1 2 3 4

16 A physician ordering what appears to be inappropriate treatment for a patient 0 1 2 3 4

17 Patients' families making unreasonable demands 0 1 2 3 4

18 Experiencing discrimination because of race or ethnicity 0 1 2 3 4

19 Listening or talking to a patient about his/her approaching death 0 1 2 3 4

20 Fear of making a mistake in treating a patient 0 1 2 3 4

21 Feeling inadequately prepared to help with the emotional needs of a patient 0 1 2 3 4

22 Lack of an opportunity to express to other personnel on the unit my negative

feelings towards patients

0 1 2 3 4

23 Difficulty in working with a particular nurse (or nurses) in my immediate work

setting

0 1 2 3 4

24 Difficulty in working with a particular nurse (or nurses) outside my immediate

work setting

0 1 2 3 4

25 Not enough time to provide emotional support to the patient 0 1 2 3 4

26 A physician not being present in a medical emergency 0 1 2 3 4

27 Being blamed for anything that goes wrong 0 1 2 3 4

28 Experiencing discrimination on the basis of sex 0 1 2 3 4

29 The death of a patient 0 1 2 3 4

27

30 Disagreement concerning the treatment of a patient 0 1 2 3 4

31 Feeling inadequately trained for what I have to do 0 1 2 3 4

32 Lack of support from my immediate supervisor 0 1 2 3 4

33 Criticism by a supervisor 0 1 2 3 4

34 Not enough time to complete all of my nursing tasks 0 1 2 3 4

35 Not knowing what a patient or a patient's family ought to be told about the

patient's condition and its treatment

0 1 2 3 4

36 Being the one that has to deal with patients' families 0 1 2 3 4

37 Having to deal with violent patients 0 1 2 3 4

38 Being exposed to health and safety hazards 0 1 2 3 4

39 The death of a patient with whom you developed a close relationship 0 1 2 3 4

40 Making a decision concerning a patient when the physician is unavailable 0 1 2 3 4

41 Being in charge with inadequate experience 0 1 2 3 4

42 Lack of support by nursing administrators 0 1 2 3 4

43 Too many non-nursing tasks required, such as clerical work 0 1 2 3 4

44 Not enough staff to adequately cover the unit 0 1 2 3 4

45 Uncertainty regarding the operation and functioning of specialized equipment 0 1 2 3 4

46 Having to deal with abusive patients 0 1 2 3 4

47 Not enough time to respond to the needs of patients' families 0 1 2 3 4

48 Being held accountable for things over which I have no control 0 1 2 3 4

28

49 Physician(s) not being present when a patient dies 0 1 2 3 4

50 Having to organize doctors' work 0 1 2 3 4

51 Lack of support from other health care administrators 0 1 2 3 4

52 Difficulty in working with nurses of the opposite sex 0 1 2 3 4

53 Demands of patient classification system 0 1 2 3 4

54 Having to deal with abuse from patients' families 0 1 2 3 4

55 Watching a patient suffer 0 1 2 3 4

56 Criticism by nursing administration 0 1 2 3 4

57 Having to work through breaks 0 1 2 3 4

58 Not knowing whether patients' families will report you for inadequate care 0 1 2 3 4

59 Having to make decisions under pressure 0 1 2 3 4

29

APPENDIX (B): JOB SATISFACTION SURVEY

JOB SATISFACTION SURVEY

Paul E. Spector

Department of Psychology

University of South Florida

Copyright Paul E. Spector 1994, All rights reserved.

Please circle the one number for each question that comes closest to reflecting

your opinion About it.

Disagree very much

Disagree moderately

Disagree slightly

Agree moderately

Agree very much

1 I feel I am being paid a fair amount for the work I do. 0 1 2 3 4

2 There is really too little chance for promotion on my job. 0 1 2 3 4

3 My supervisor is quite competent in doing his/her job. 0 1 2 3 4

4 I am not satisfied with the benefits I receive. 0 1 2 3 4

5 When I do a good job, I receive the recognition for it that I should receive. 0 1 2 3 4

6 Many of our rules and procedures make doing a good job difficult. 0 1 2 3 4

7 I like the people I work with. 0 1 2 3 4

8 I sometimes feel my job is meaningless. 0 1 2 3 4

9 Communications seem good within this organization. 0 1 2 3 4

10 Raises are too few and far between. 0 1 2 3 4

11 Those who do well on the job stand a fair chance of being promoted. 0 1 2 3 4

12 My supervisor is unfair to me. 0 1 2 3 4

30

13 The benefits we receive are as good as most other organizations offer. 0 1 2 3 4

14 I do not feel that the work I do is appreciated. 0 1 2 3 4

15 My efforts to do a good job are seldom blocked by red tape. 0 1 2 3 4

16 I find I have to work harder at my job because of the incompetence of people

I work with.

0 1 2 3 4

17 I like doing the things I do at work. 0 1 2 3 4

18 The goals of this organization are not clear to me. 0 1 2 3 4

19 I feel unappreciated by the organization when I think about what they pay

me.

0 1 2 3 4

20 People get ahead as fast here as they do in other places. 0 1 2 3 4

21 My supervisor shows too little interest in the feelings of subordinates. 0 1 2 3 4

22 The benefit package we have is equitable. 0 1 2 3 4

23 There are few rewards for those who work here. 0 1 2 3 4

24 I have too much to do at work. 0 1 2 3 4

25 I enjoy my coworkers. 0 1 2 3 4

26 I often feel that I do not know what is going on with the organization. 0 1 2 3 4

27 I feel a sense of pride in doing my job. 0 1 2 3 4

28 I feel satisfied with my chances for salary increases. 0 1 2 3 4

29 There are benefits we do not have which we should have. 0 1 2 3 4

30 I like my supervisor. 0 1 2 3 4

31

31 I have too much paperwork. 0 1 2 3 4

32 I don't feel my efforts are rewarded the way they should be. 0 1 2 3 4

33 I am satisfied with my chances for promotion. 0 1 2 3 4

34 There is too much bickering and fighting at work. 0 1 2 3 4

35 My job is enjoyable. 0 1 2 3 4

36 Work assignments are not fully explained. 0 1 2 3 4