Factors Influencing Work Related Stress aand Alcohol aamong Students Nurses.
Organizational Support
Inadequate support from the health institution is regarded as work related
stress in nursing professionals and this motivate high level of turnover among the
nurses. Over half of nurses reportedly intend to leave the profession within the next 10
years, many within the next five years, which will cause a skills shortage in Western
Australia hospitals (Twigg, Duffield, Thompson, & Rapley, 2010). The opening of the
new Fiona Stanley Hospital and the need to have approximately 30% more nurses, as
well as the retirement of the baby boomers lead to overloaded nursing workforce
(Twigg et al., 2010). A study by Labrague (2013) indicate that slightly different
perspective, nursing students report negative interactions with clinical staff due to a
theory-practice gap as a major source of their work related stress; other stressors
include academic demands such as fear of failing, assignments, workload and
interaction with lecturers Teaching staff either in the university, or within the clinical
setting need to be aware of the negative impact they can have on their students so that
they are better equipped to support them. Students who may be juggling financial
stressors as well as academic and emotional stressors should be a high priority, rather
than solely focusing on the knowledge and skills the student needs to develop,
otherwise this can lead to student nurses leaving the profession before they complete
their studies further adding to the predicted nursing shortfall (Stodart, 2015). Having a
positive well-supported work environment encompassing peer support for staff, has
been shown to be beneficial in retaining nurses and reducing the perceived source of
demands (Scholes, 2015), although in the current climate having the time or staff to
focus on peer support and a positive work
environment can prove challenging, it is still something nurses and nurse managers
should still aim to accomplish (Harker, Hahn, Banks, & Orr, 2015).
Hospital Environment
The sources of work related stress within nursing are not limited to the
hospital environment rather community and rural nurses also perceive stressors within
their workplace environments. A study by Lenthall et al. (2011) examined perceived
stressors amongst the nursing workforce in remote communities of Australia. Three
hundred and forty nine registered nurses participated in the study, which report on
average that rural nurses work more than two days more per week than all registered
nurses nationally. The author attributes this to staff shortages, preventing them taking
time off to address physical and psychological concerns. Moreover rural nurses who
are in an isolated setting are associated with increased workplace stressors such as
professional isolation, role ambiguity and unclear role expectations. These findings
are consistent with other studies, which have explored the challenges rural nurses face
when practicing within a remote setting (Opie, Dollard, Lenthall, & Knight, 2013).
Lin, Liao, Chen, and Fan (2014) evaluated perceived demands focusing on shift work
among 320 general ward nurses from four regional hospitals in Taiwan. All worked
within the hospitals for more than three months, across different shift patterns.
Findings showed that regardless of the irregularity of the shift, work performed by the
nurses for example days, nights, and evening’s shifts; they still perceived moderate
levels of job stress. The authors attribute these findings to the amount of overtime
worked, in addition to the nurse’s normal weekly hours, and their continuously high
workloads, which far surpass that of nurses in other countries such as Australia or the
United State of America (USA). These findings are in contrast to those from a study
of 607 Korean nurses, that found that nurses undertaking rotating shifts reported
increased ill health compared to nursing staff who only worked day shifts (Koh et al.,
2014), and this is consistent with previous findings (Bae & Fabry, 2014) that shift
work has a negative effect on the health of nurses.
Lack of Role Clarity
This lack of role clarity has increased globally in recent years, fuelled by the
governing bodies apparent variations on scope of practice, and guidelines for the
nursing profession (Currie & Carr‐Hill, 2013), and the subsequent ways in which
nursing and non-nursing tasks are interpreted. This has led to increased stress within
the nursing profession as employers have sought to recruit nurses from oversees in an
attempt to fill their staffing shortfalls (Spence, Laschinger & Nosko, 2015). However,
the nurses training and original scope of practice have not been taken into
consideration or explored to ensure they are adequate (Hendson, Reis, & Nicholas,
2015), which has led the migrating nurse questioning their skills and suitability to
practice within these new practice areas (Malloy et al., 2014).
Many organizations globally are opting to recruit second level nurses (enrolled
nurses) or unregistered health professionals (health care assistants), to work alongside
registered nurses, in a bid to address staff shortages and the ever increasing healthcare
costs (Jacob, McKenna, & D'Amore, 2015). This increases the perceived demands
placed on the registered nurse, as the complexity of patient’s needs and conditions are
ever increasing, forcing them to delegate tasks, which they perceive they should
complete. This poor skill mix negatively affects the quality of patient care (Eygelaar
&Stoltenberg, 2012), due to the differences in competency levels and scope of
practice, and is also linked to increased length of stay and hospital costs (Clark,
Moule, Topping, & Serpell, 2015).
The correlation between quality patient care, workloads, as well as nurse
staffing levels and patient outcomes have been positively correlated as reported in
numerous studies (Bogaert, Clarke, Willems, & Mondelaers, 2013). In a UK study of
more than 2,000 nurses, over half of the participants’ reported that they had felt
unwell due to the high workloads within their work area as a result of an inadequate
nurse patient ratio, which has resulted in an increase rate of absenteeism and level of
perceived ill health (Parish, 2013).
A literature review conducted by Humphries et al. (2014) supports this view,
and suggests that nursing workloads are part of an ever increasing spiral whereby
there are fewer nurses caring for patients with more complex needs, leading to more
nurses leaving the profession (Bogossian et al., 2014; Humphries et al., 2014). This
situation will continue until policy makers globally implement the correct staffing
levels for nurses, thus enabling quality patient care to occur (Carrigan, 2013). The
global nursing shortages and poor staffing levels intensifies this lack of role clarity
and merging of tasks, with the registered nurse still striving to provide quality patient
care, leading to an increase in their perceived internal demands (Toh et al., 2012).
According to Thaler and Rosen (2014), the labor market offers a unique
natural-experimental setting for observing the probability of pay and compensation
trade-off. Workers are willing to accept additional risks, such as a high workload and
extra work time, if they can obtain a salary or fringe benefit compensation affording
them the same expected utility level. Much like workers, family-business owners may
manage salary or fringe benefit compensation for which they are willing to pay
workers a wage premium. This premium is bound by the family business capacity to
meet the cost of providing additional workplace security while maintaining the same
profit maximizing level.
Research focusing solely on the student’s nurses nursing workforce is very
limited and most are more than 10 years old, thus questioning its relevance in today’s
workforce. Findings of a study by Ross-Adjie, Leslie, and Gillman (2007) reported
work related stress factors to include excessive workloads, violence against nursing
staff and poor skill mix, insufficient time to provide quality patient care as a major
demand. Further recent study conducted by Harrison, Hauck, and Hoffman (2014)
noted that there are different stress factors that influence student nurses in different
health institution either in rural and urban settings. More research is needed to explore
if work related stress factors are transferable to the wider nurse workforce. In Kenya
however, the researcher asserts that work related stress and Alcohol use among the
student nurses in internship has become a culture and tradition, socially and
economically to which they were socialized in their upbringing and also peer pressure
as a way of coping with their circumstances in order to strengthen themselves from
the expected pressure.
Workload in Hospital
From a slightly different perspective, nursing students report negative
interactions with clinical staff due to a theory-practice gap as a major source of their
work related stress; other stressors include academic demands such as fear of failing,
assignments, workload and interaction with lecturers (Labrague, 2013). Teaching
health staff either in the university or within the clinical setting needs to be aware of
the negative impact they can have on their students so that they are better equipped to
support them. Johansson, Sandahl and Hasson (2013) are supportive of these findings
in a comparative study evaluating the work related stress of nurse managers. The
authors found that the self-reported work related stress levels of nurse managers was
less than that of registered nurses, which may be due to the fact that they have greater
autonomy over their workload. Workload among the student nurse was also found to
be a work related stressor. A study by Opie et al. (2011) compared occupational stress
between remote and hospital-based nursing within Australia. They found similarities
in stressors raised by both nursing groups, for example job demands and workloads.
The perceived work related stress that nurses’ report due to increased workloads
continues to influence the level of dissatisfaction and intention to stay in the profession
(Wright, 2014). Koh et al., (2014) attribute occurrence of stress at workplace as the
amount of overtime worked, in addition to the nurse’s normal weekly hours, and their
continuously high workloads, which far surpass that of nurses in other countries such as
Australia or the USA. These findings are in contrast to those from a study of 607 Korean
nurses that found that nurses undertaking rotating shifts reported increased ill health
compared to nursing staff who only worked day shifts.
The correlation between quality patient care, workloads, as well as nurse
staffing levels and patient outcomes have been positively correlated as work related
stressor (Coetzee, Klopper, Ellis, & Aiken, 2013). In a UK study of more than 2,000
nurses, over half of the participants’ reported that they had felt unwell due to the high
workloads within their work area as a result of an inadequate nurse patient ratio,
which has resulted in an increase rate of absenteeism and level of perceived ill health
(Parish, 2013).
Lifestyle and Work Related Stress
The impact generated by the abusive use of alcoholic beverages is well known
from both the point of view of health and social effects (Davis, 2014). This pattern of
consumption has significant repercussions in working relationships, reducing
productivity and compromising work safety, besides increasing absenteeism and
presenteeism phenomena (Cricco-Lizza, 2014). Therefore, there are enough ethical,
legal, economic and safety reasons to intensify investment in early prevention, given
the potential damage and problems caused by the abusive use of alcohol (Davis,
2014). Evidence shows that various psychological, behavioral and environmental
manifestations are associated with abuse of alcohol, the majority of which are often
related to work (Donnelly, 2014).
An increasing number of studies such as Donovan, Doody, and Lyons (2013)
evaluating the phenomenon of drugs can also be observed in the literature, especially in
the area of nursing. However, few studies have discussed the issues related to substance
use or alcohol consumption lifestyle by nursing professionals, which are among the most
important worker health problems, considering the predisposing aspects of the working
reality of these professionals. The use of alcohol and/or other drugs can be considered a
problem on an even greater spectrum, known as health behavior (Edward, Ousey,
Warelow, & Lui, 2014).). This can be most broadly defined as a set of actions carried out
by individuals with the aim of maintaining health, using or not healthcare services, such
as the practice of physical activity, the sleep-wake cycle, adequate nutrition, minimization
of the consumption of psychoactive substances and the damage caused by their use and
abuse(Faresjö, Jullander, Göttmalm & Theodorsson, 2014).
Health behavior can be influenced by various factors that involve social
determinants of health, such as socioeconomic, family, environmental and cultural
conditions, besides personal characteristics involving genetics and emotional aspects.
According to Farrelly, (2014) nursing professionals often dedicate much more
attention to the care of others than to self care, which may be due to lack of time for
leisure activities and for taking care of appearance, or lack of attention to diet. Such
behavior may be a reflection of the working environment, in which actions aimed at
the health of the nursing professional rarely happen (Goodnite, 2014). Studies
evaluating health behavior among nursing professionals are developing in the
scientific literature. Few articles were found in a search performed on database
indexes (Geraghty & Oliver, 2015), whereby one assessed stress and the others
assessed its association with alcohol use, although they were not simultaneously
examined with health behavior. One study that approximated to this context was on
Burnout Syndrome among healthcare professionals and its association with risky
health lifestyle such as inactivity, poor diet, abusive use of alcoholic beverages and
psychoactive substances (Hallman, O'Connor, Hasenau & Brady, 2014).
REFERENCES
Allan, A., & Cooke, E. (2012). A review of the literature regarding stress among
nursing students during their clinical education. International Nursing Review,
61(3).
Arslan, S., Özlü, Z. K., Özer, N., Nazik, E., Gümüs, K., & Özlü, I. (2015).
Investigating the Stress Level of Nurses Working at Emergency Care
Services: A Pilot Study. International Journal of Caring Sciences, 8(2), 420.
Austin, T. (2011). Relationship between nurse leader emotional intelligence and
registered nurse job satisfaction. (Dissertation/Thesis), ProQuest Dissertations
Publishing. Australian Institute of Health, 113
Bachman, J.G, Staff, J, O’Malley, P.M., & Freedman-Doan, P. (2013): Adolescent
work i.ntensity, school performance, and substance use: Journal Development
Psychology, 49 (11): 2125-2128.
Bae, S.-H., & Fabry, D. (2014). Assessing the relationships between nurse work
hours/overtime and nurse and patient outcomes: Systematic literature review.
Nursing Outlook, 62(2), 138-156.
Basińska, M. A., Andruszkiewicz, A., & Grabowska, M. (2011). Nurses’ sense of
coherence and their work related patterns of behaviour. International Journal
of Occupational Medicine and Environmental Health, 24(3), 256-266.
Beanland, C. (2013). Tackling the workforce shortage. Australian Nursing Journal,
20(11), 47-48.
Bennett, E., & Alliex, S. (2014). A workforce development strategy for nursing in
early parenting services in Australia: Solutions for the 'baby boomer' exit from
the nursing workforce. Australian Journal of Child and Family Health
Nursing, 11(1), 10-16.
Blomberg, K., Isaksson, A. K., Allvin, R., Bisholt, B., Ewertsson, M., Kullén
Engström, A. & Högskolan, I, S. (2016). Work related stress among newly
graduated nurses in relation to workplace and clinical group supervision.
Journal of Nursing Management, 24(1), 80-87.
Boals, A., & Banks, J. B. (2012). Effects of Traumatic Stress and Perceived Stress on
Everyday Cognitive Functioning. Cognition & Emotion, 26(7), 1335-1343.
Boer, J., van Rikxoort, S., Bakker, A. B., & Smit, B. J. (2014). Critical incidents
among intensive care unit nurses and their need for support: explorative
interviews. Nursing in critical care, 19(4), 166-174.
Bogaert, P., Clarke, S., Willems, R., & Mondelaers, M. (2013). Nurse practice
environment, workload, burnout, job outcomes, and quality of care in
psychiatric hospitals: a structural equation model approach. Journal of
Advanced Nursing, 69(7), 1515-1524.
Cairney, J., Kwan, M. Y., Veldhuizen, S., & Faulkner, G. E. J. (2014). Who uses
exercise as a coping strategy for stress? Results from a national survey of
canadians. Journal of physical activity & health, 11(5), 908-916
Carrigan, C. (2013). Safe staffing: Critical to care. Australian Nursing Journal: ANJ,
The, 20(10), 26-29.
Castner, J., Ceravolo, D. J., Foltz-Ramos, K., & Yow-Wu Bill, W. (2013). Nursing
Control Over Practice and Teamwork. Journal of Issues in Nursing, 18(2), 1-1.
Clark, A., Moule, P., Topping, A., & Serpell, M. (2015). Rescheduling nursing shifts:
scoping the challenge and examining the potential of mathematical model
based tools. Journal of Nursing Management, 23(4), 411-420.
Cooper, D.R & Schindler, P.S (2013). Business Research Methods. New York: Mc
Cope, V., Jones, B., & Hendricks, J. (2016). Why nurses chose to remain in the
workforce: Portraits of resilience. Collegian (Royal College of Nursing,
Australia), 23(1), 87-95.
Craft, J. A., & Gordon, C. J. (2015) Understanding Pathophysiology. Sydney.
Elsevier.
Cricco-Lizza, R. (2014). The Need to Nurse the Nurse: Emotional Labor in Neonatal
Intensive Care. Qualitative Health Research, 24(5), 615-628.
Currie, E. J., & Carr‐Hill, R. A. (2013). What is a nurse? Is there an international consensus? International Nursing Review, 60(1), 67-74.
Davis, J. M. (2014). Hair Cortisol as a Biomarker of Stress in Mindfulness Training
for Smokers. Journal of Alternative & Complementary Medicine, 20(8), 630-
634.
Dawson, A. J., Stasa, H., Roche, M. A., Homer, C. S. E., & Duffield, C. (2014).
Nursing churn and turnover in Australian hospitals: Nurses perceptions and
suggestions for supportive Strategies. BMC nursing, 13(1), 11-11.
De Almeida, V., A., Shadvar, S., Lepage, S., & Rennick, J. E. (2016). Experienced
pediatric nurses’ perceptions of work-related stressors on general medical and
surgical units: A qualitative study. International journal of nursing studies, 60,
216-224.
Donnelly, T. (2014). Stress among nurses working in an acute hospital in Ireland.
British Journal of Nursing, 23(13), 746-750.
74
Donovan, R. O., Doody, O., & Lyons, R. (2013). The effect of stress on health and its
implications for nursing. British journal of nursing 22(16), 969-973.
Doran, D., Jeffs, L., Rizk, P., Laporte, D. R., Chilcote, A. M., & Bai, Y. Q. (2015). Evaluating the late career nurse initiative: a cross ‐
sectional survey of senior nurses in Ontario. Journal of Nursing Management, 23(7), 859-867.
Dung, J.S., & Wang, M.S. (2013). The case for alcohol research as a focus of study by
nurse researchers. South AfricaNursing Journal.4.1.89-90
Drury, V., Craigie, M., Francis, K., Aoun, S., & Hegney, D. G. (2014). Compassion
satisfaction, compassion fatigue, anxiety, depression and stress in registered
nurses in Australia: Phase 2 results. Journal of Nursing Management, 22(4), 519-
531.
Edward, K.-l., Ousey, K., Warelow, P., & Lui, S. (2014). Nursing and aggression in the
workplace: a systematic review. British Journal of Nursing, 23(12), 653-659.
Etwel, F., Russell, E., Rieder, M. J., Van Uum, S. H., & Koren, G. (2014). Hair cortisol
as a biomarker of stress in the 2011 libyan war. Clinical & Investigative
Medicine, 37(6), E403-408. 119
Faresjö, Å., Jullander, M., Göttmalm, S., & Theodorsson, E. (2014). Higher perceived
stress and poorer health reflected in elevated cortisol concentrations measured in
extracts of hair from middle-aged healthy women. BMC Psychology, 2, 30-39.
Farrelly, R. (2014). What's right with nursing? British Journal of Nursing, 23(14), 823-
823.
Field, A. P. (2013). Discovering statistics using IBM SPSS Statistics. 4. London:
SAGE.
Galbraith, N. D., Brown, K. E., & Clifton, E. (2014). A Survey of Student Nurses'
Attitudes Toward Help Seeking for Stress. Nursing Forum, 49(3), 171-181
Geraghty, S., & Oliver, K. (2015). Is work-related stress affecting nurses and midwives?
Australian Nursing and Midwifery Journal, 23(3), 32.
Giga, J. & Hoel, A (2003). Theoretical and methodological problems within
occupational stress and burnout research’, Human Relations, 41:351–369.
Goodnite, P. M. (2014). Stress: A Concept Analysis. Nursing Forum, 49(1), 71-74.
Hallman, I. S., O'Connor, N., Hasenau, S., & Brady, S. (2014). Improving the Culture of
Safety on a High-Acuity Inpatient Child/Adolescent Psychiatric Unit by
Mindfulness-Based Stress Reduction Training of Staff. Journal of Child &
Adolescent Psychiatric Nursing, 27(4), 183-189.
