We need to be aware that all stress is not negative. Selye a famous psychologist held for two categories of stress, namely good or desirable stress (eustress) and bad or undesirable stress (distress). Eustress is pleasant, or at least challenging, and it always produced maximization of output. It is evident that without this positive inner stimuli no one can be effective in ones life. Distress is something negative and has no capacity to monitor or control a stress filled event in ones life. Here one fails to control oneself and become a slave to stress causing distress and loss to oneself and to the organization he or she belongs. A physical or psychological response is mandatory to occur stress in any living being. (Middleton, 2009).
Occupational stress among the health professionals has been a global problem for years now. It can have an adverse mental and physical health consequences and can lead to decreased satisfaction with one’s job. For a small group of employees it can even lead to a burnout and sick leaves. Job stress thus has not only negative consequences on themselves, but also for the organization they work. Estimates are that 10% of the Gross National Product in European countries is lost due to stress related absenteeism and turnover. Although absenteeism’ in health care is declining the past few years, it is still high compared to other stressful occupational settings such as education, catering industry or transport (Roy, 2010)
The researcher has carried out this study in a private hospital in India named Jubilee Memorial Hospital Thiruvananthapuram. In this study the researcher has focused on the occupational stress of the nurses. This study is an attempt to identify the cause and consequences of occupational stress of the nurses. This study also will identify the need to have an effective stress management strategy to promote quality nursing care in the hospital.
Occupational stress can be explained as ‘a discomfort which is felt and perceived at a personal level and triggered by instances that are too intense and frequent in nature so as to exceed a person’s coping capabilities and resources to handle them adequately’. (Perriwe and Gavoster, 2010) Evidence from researches suggests that certain individuals in a variety of occupations are increasingly exposed to unacceptable levels of job-related atmosphere it makes them burnout (Aamodt, 2009). Therefore, Occupational stress can be defined as ‘a harmful physical and emotional response that occur when the requirements of a job do not match the capabilities of the worker’. “This pressure at work can be positive, leading to increased productivity” (Baer, 2006). However, when this pressure becomes too much to handle, it has a negative impact. Here the individuals look themselves as being unable to cope and not to possess the necessary skills to challenge this situation (Griffin & Moorhead, 2009),
Advancements in the healthcare industry combined with latest technological innovations in the medical science have increased the number of people accessing the services of the healthcare industry today. The increased number of nurses in hospitals have proportionately increased their efforts to deliver their best services to the patients. Thus professionals like nurses working in hospitals are exposed to considerable amount of job stress. This in turn is having serious psychological and physical effects on those individuals as well to the patients who seek their services (Baer, 2006).
1.3. SOURCES OF OCCUPATIONAL STRESS
Generally there are various sources of occupational stress such as personal expectations, employment decisions, social pressures, living arrangements, relationships, physical health, information overload, etc (Olpin & Hesson, 2009). Apart from the factors mentioned above there are few important sources that pertain directly to the research topic. The first one among them is Work Overload. It occurs when the job requires excessive work speed, output, or concentration. Secondly Work Under load. It is having work that is too simple or is insufficient to fill one’s abilities. Third one is Underutilization that occurs when workers feel, the job does not use their work related knowledge (Gurung, 2010). Fourthly, Task demands that include the design of the individual’s job, working conditions, and the physical work layout. Again, Role Demands are those pressures placed on a person as a function of the particular role he or she plays in an organization. (Irving et., al. 2010). Role overload is a common grief that expressed when the employee is expected to do more than time permits. Another cause of job stress is Job Ambiguity. It occurs when tasks and requirements are not clearly outlined ( Hales, 2009).
Role Conflict is another important source of occupational stress. For instance, a worker’s job may require excessive overtime that conflicts with the worker’s family roles of spouse and parent or having to play different roles at work simultaneously can cause stress. Another important source of work stress results form workers sensing that they have little control over the work environment and over their own work behavior. Research indicates that providing workers with a sense of control over their work environment, through techniques such as giving them a voice in decision making processes or allowing them to plan their own work tasks, reduces work stress and increases job satisfaction (Kavitha, 2009).
Stress can develop from difficulties in developing and marinating relationships with other people in the work setting. Organisational Change is another source of stress. Some common change situations that lead to worker stress include: changes in work system and work technology, change in company policy and managerial or personnel changes. Some chief executive officers create culture characterized by tension, fear, and anxiety. They even force to establish unachievable to perform in the short run, impose excessively tight control. They even routinely fire employee who don’t measure up. Apart from these above mentioned factors there can also be other individual factors that can cause occupational stress (Middleton, 2009).
1.4. IMPACT OF STRESS IN THE LIFE OF A NURSE
Occupational Stress is a serious ongoing issue in the profession of nursing. Lack of organizational support, increased technological advances, personal and family relationship issues etc., also can contribute to the emotional exhaustion of the nurses. Apart from these, the very nature of the profession, the intense and rigid work routines, exposure to pain and post traumatic events of life, etc. also can lead them to stress ( Wicks, 2006).
The impact of stress in the life of Nurses needs to be dealt with almost importance. Stress of nurses has strong effects on important work outcomes especially in the quality of care in a hospital. Stress always caused decreased work performance and increased absenteeism and turnover in the health care industry. The result of occupational stress that results from overwork can be seen in the condition called burnout among the nurses (Scott, 2009). A nurse suffering from burnout became less energetic and less interested in her jobs. She or he will be emotionally exhausted, apathetic, depressed, irritable and bored. They tend to find fault with all aspects in their work environment, including co-workers, and react negatively to the suggestions of others even to the patients of their care. Here the quality of their work deteriorates but not necessarily the quantity. (Thomas, 2009) The rapid change in medication protocols and the development of new procedures and equipments may frustrate nursing staff when they are not given adequate training and time to incorporate these changes into their profession and work patterns (Middleton, 2009).
1.5. THE PROBLEM STATEMENT
Nursing is a highly stressful profession as they deliver uncompromising services to the patients in a very highly stressful job environment. It combines a number of highly technical tasks requiring expert knowledge and personal engagements with patients requiring empathy and compassion. The nursing profession is becoming very advanced and complex. Increased job stress is prevalent among the nurses and hence the identification of source of stress and effective coping mechanism is very important for health of nurses as well as the profession itself. It can have adverse mental and physical health consequences and can lead to decreased satisfaction with one’s job (Weiner & Craighead, 2010).
The hospital selected for the study is a 250 bedded multi specialty hospital that was established in the year 1975. It was given the award for the best Health Care provider award by the State government in 2002. The institution received the Citizen Award in 2004. There are 115 nurses employed in the hospital. It has different departments like General Medicine, General & Minimal invasive Surgery, Gynecology & Obstetric, Pediatric Orthopedic, ENT, Dental, Eye, Skin Plastic& Cosmetic Surgery, Cardiology, Neurology, Chest Medicine, Urology, Oncology, Psychiatry, Psychology, Physiotherapy, Pathology and Anesthesiology. There is a Nursing School attached to the Hospital that promotes quality nursing education. The hospital thus educates more than 200 students every year through its Nursing and Para- medical education institutions. The hospital has facilities to perform a wide variety of surgeries. The Hospital has an average number of 200 inpatients and 750 outpatients in a day. The hospital conducts health, immunization, and awareness programme in the rural areas of the state fulfilling its social responsibility.
Occupational stress among the Nurses has been a global problem for years now. The researcher has selected Jubilee Memorial hospital for conducting the research because the researcher has been a field work trainee at this organization during his previous studies. Primary observation of the researcher is that there are visible reasons for stress among the nurses in this hospital such as, Prime responsibility and heavy work load, Depleting interpersonal relationships, Conflicts with physicians and other medical staff, Unable to maintain a balance between work and home demand, Constant witness to serious injuries and deaths and so on. Though there are various other stress related issues existing in the hospital, they seem to be oblivious of the of the impact of it. A research in this area will provide adequate awareness of the present situation to the Nurses and the hospital management. The recommendations will be a key to the future interventions to have a better coping mechanism to promote quality care in the hospital.
1.12. LIMITATIONS OF THE STUDY
Since the researcher has limited respondents for his study the generalisation of the study is limited and so it can’t be applied to the whole of Nursing professionals. The prefixed time of the completion of the research is another limitation of the research. The use of self prepared questionnaire and the interview schedule all these were limited by time and availability. It consumed a lot of time, energy and money. The expression through the questionnaire can even be biased and limited.
1.13. OUTLINE AND STRUCTURE OF RESEARCH
The study on Occupational stress of the nurses and its impact is vividly described in five chapters.
Chapter – 1: This chapter is an introduction of the research topic itself. A brief explanation of stress, occupational stress, it’s causes and it’s impact in the profession of nurses, a brief explanation of the organizational profile, research question, aim and objectives and significance of the study is explained here.
Chapter – 2: The second chapter is the review of literature examining the existing body of literature on stress and occupational stress.
Chapter -3: The third chapter will explain the methodology used in the research. Different techniques used to gather data for the purpose of research and its relevance, the problems faced by the researcher to obtain relevant data etc are explained in this chapter.
Chapter -4: The fourth chapter deals with the analysis of the data collected and the findings are included. In this section the researcher will closely examine the connection between the objectives, reviewed literature and the findings.
Chapter -5: The last section of this research report is recommendation and relevant conclusion.
In the modern era, nursing profession is a stressful occupation. This study will critically analyse various sources of the occupational stress of the Nurses and its negative impact on their profession. It is definite that future interventions to prevent stress in nurses will be offered as a standard part of a benefit package within all health care organizations. The researcher is optimistic that the Nursing profession will have decreased amount of stress and a well developed increased coping mechanism which will in turn increase job satisfaction and increased quality work performance in Nursing Care.