Nurses’ roles expose them to a lot of stress based upon the physical labour, exposure to human suffering, lengthy work hours, poor staffing, and interpersonal relationships that are central to the work they do. Nurses are expected to deliver humane, empathetic, culturally-sensitive and proficient care in working environments with limited resources and increasing responsibilities. Such imbalance between providing high quality care with limited resources leads to physical and mental stress. This stressful nature of nursing can ultimately lead to job dissatisfaction and burnout which among health care providers are important issues since they affect turnover rates, staff retention and ultimately the quality of patient care. A thoroughly validated self developed questionnaire with a reliability coefficient of 0.78 was used to explore the effect of work environment on the level of work stress and burnout among nurses. A purposive sampling technique was utilized to select 100 participants from the medical unit of the hospital. Three hypotheses were tested at a significant level of 0.05. Data were analyzed using ANOVA and Pearson’s Correlation. The study revealed that level of stress was higher among the staff nurses who had worked for only between 0 and 3 years, with mean stress score 46.0000. Findings further revealed that as the cadre rose, the nurses assumed that managerial roles were accountable for increased subordinates and oversee health related and administrative responsibilities and they experienced more stress. Also there is a significant relationship among work environment, stress and burnout among the nurses in the selected unit. In conclusion, though work conditions and environment are not favourable, there are job security and good interpersonal relationship among the nurses which cushion the stressful situations. It is therefore recommended that the management of the hospitals should provide a conducive work environment, providing necessary resources and adequate break periods to ensure staff welfare.
Every work environment especially within a hospital setup needs to be conducive, friendly and stress free to promote quality care and wellbeing of health care workers whose job demands are increasing day by day. This is as a result of advancement in technology and patient’s demand for quality in response to increasing health care cost. Stress is considered a normal part of life which is necessary occasionally as a push to increasing functional capacity, but when it is experienced over a prolonged period it becomes detrimental to health leading to a decline in productivity [
Stress can be defined as a particular relationship between the person and the environment that is assessed by the person as taxing or exceeding his or her resources and endangering his or her well-being [
As far back as the mid-1950s, stress was regarded as an occupational hazard and occupational stress cited as a significant health problem [
Among health care professionals, nurses have been found to be most prone to burnout [
Job satisfaction and burnout among health care providers are important issues since they affect turnover rates, staff retention and ultimately the quality of patient care [
The way that an individual views and processes stress determines how much stress is felt and how close the person is to burnout. Perceptions of job stress and burnout are not just a product of work conditions because not all workers, exposed to the same conditions, develop burnout or perceive stress [
According to psychological theories, stress is determined by the balance between the perceived demands from the environment and the individual’s resources to meet those demands [
The International Council of Nurses (ICN) (2008) [
The study utilized a descriptive design to explore the role of work environment and conditions on the level of work stress and burnout among nurses in medical unit of University College Hospital (UCH) The Medical Unit is made up of 7 wards, rendering nursing care to both male and female clients on admission in the hospital receiving medical and long term care for acute and mostly chronic illness that does not require surgical intervention. The wards under the medical unit include: West Three ward, South West Three, Central Ward 3rd, East Three, South East Three, East Two and Multi-Drug Resistant Ward.
The study population consisted of all professional nurses who are directly involved in patient care in the Medical Unit of University College Hospital, Ibadan. The professional nurses ranged between the cadres of Staff Nurse to Chief Nursing Officer.
It was a descriptive study which utilized a convenience sampling technique to select all available and willing Registered nurses from each ward in the unit, making a total of 100 registered nurses.
The sample size for this study was determined using sample size formula below [
where
n = Required sample size;
t = confidence level at 95% = 1.96;
P = Estimated population of professional nurses carrying out direct patient care in the medical unit = 80 out of a total nursing population of 1080 = 0.07;
m = margin of error tolerance at 5% = 0.05.
Sample size
Calculated sample size 100.
10% of calculated sample size = 10 added to make up for attrition.
Total number of respondents = 110.
A purposive sampling technique was adopted. This implies that all the nurses who are directly involved in nursing care of the patients on all the wards of the Medical Unit ranging between the cadres of Staff nurses and Chief Nursing Officers were included in the study.
The calculated sample size was 100. Since 100 was the minimum sample size that can be studied, the researcher decided to increase the power of significance by including all the nurses in the Medical Unit who are involved in direct nursing care of patients and are willing to participate in the study in the sample frame, they were 110.
According to Suresh and Chandrashekara (2012) [
Professional nurses who are at the managerial post of Assistant Directors of Nursing as they are mostly on administrative schedule and are not directly involved in nursing care of the patients on the ward.
The need for the research and procedure for data collection was explained to the participants. Verbal consent was obtained from participant to participate in the study. They were informed that participation was entirely voluntary, confidential and anonymous.
The self-developed questionnaire was used to cover demographic characteristics, factors relating to job related stress from the work environment, work conditions and effect of stress on health. The instrument was trial- tested on 20 nurses in the medical unit of the State Hospital in Ibadan and the results had a co-efficient of 0.78. Showing that among similar groups, the questionnaire will consistently test and answer what it is meant for. Necessary corrections were made and the questionnaire was administered without any bias among the study population.
The researcher visited the wards in the selected unit of the hospital to serve the questionnaire personally to nurses who are willing to participate in the study, 110 questionnaires were served as some of the nurses were not around. Only 104 questionnaires were retrieved out of which only 100 were well filled the remaining 4 questionnaire were not adequately filled and could not be analyzed therefore were discarded.
The quantitative data was analyzed through content analysis. The responses were sorted out and grouped into similar and non similar responses
Comments were categorized and presented in simple percentages.
Hypotheses were tested using Analysis of Variance (ANOVA) and Pearson Correlation to relate work condition and work environment to stress and burnout among the nurses.
The results are presented based on the objectives and hypotheses
This study has revealed an either way relationship between work environment level of work stress and burnout among nurses. This is shown in
Stress | Remark | |
---|---|---|
Work environment: Pearson correlation Sig. (2-tailed) No. | 0.351 0.000 100 | Significant |
The results showed a positive correlation 0.351, the significance (2-tailed) is 0.000 in total respondents numbering 100. Correlation is significant at the 0.01 level (2 tailed), 0.000 is <0.01, this means that there is a significant relationship between work environment and stress and burnout among the nurses.
Work condition: Pearson correlation Sig. (2-tailed) No. | −0.033 0.745 100 | Not Significant |
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Looking at work conditions, there is a negative correlation −0.033, the significance (2-tailed) is 0.745 in a total respondents numbering 100. 0.745 is >0.01, this means that there is no relationship between work conditions and stress and burnout among the nurses.
Always present | Often present | Rarely present | Not present | Total | |
---|---|---|---|---|---|
Excessive noise disturbing my work on the ward | 69 (69%) | 20 (20%) | 9 (9%) | 2 (2%) | 100% |
Movement and interruptions from medical, para-medical and visitors disturbing my work on the ward | 58 (58%) | 34 (34%) | 6 (6%) | 2 (2%) | 100% |
Adequate lighting both day and night on the ward to promote work | 8 (8%) | 85 (85%) | 6 (6%) | 2 (2%) | 100% |
Adequate provision of privacy for procedures on the ward | 12 (12%) | 81 (81%) | 5 (5%) | 2 (2%) | 100% |
Pest and rodent such as flies, mosquitoes and rats | 62 (62%) | 21 (21%) | 11 (11%) | 6 (6%) | 100% |
Not at all | rarely | Sometimes | Often | Always | Total | |
---|---|---|---|---|---|---|
Do you feel run down and drained off physically and emotionally? | 1 (1%) | 1 (1%) | 48 (48%) | 45 (45%) | 5 (5%) | 100 (100%) |
Do you find that you are prone to negative thinking about your job? | 8 (8%) | 69 (69%) | 19 (19%) | 4 (4%) | 0 (0%) | 100 (100%) |
Do you find that you are less sympathetic with people than perhaps they deserve? | 7 (7%) | 21 (21%) | 67 (67%) | 4 (4%) | 1 (1%) | 100 (100%) |
Do you find yourself getting easily irritated by small problems or by your team or co-workers? | 8 (8%) | 3 (3%) | 86 (86%) | 3 (3%) | 0 (0%) | 100 (100%) |
Do you feel misunderstood or unappreciated by your co-workers? | 5 (5%) | 11 (11%) | 81 (81%) | 3 (3%) | 0 (0%) | 100 (100%) |
Do you feel you have no one to talk to? | 12 (12%) | 61 (61%) | 25 (25%) | 2 (2%) | 0 (0%) | 100 (100%) |
Do you feel that you are achieving less than you should? | 3 (3%) | 11 (11%) | 72 (72%) | 13 (13%) | 1 (1%) | 100 (100%) |
Do you feel an unpleasant level of pressure to succeed? | 3 (3%) | 3 (3%) | 54 (54%) | 38 (38%) | 2 (2%) | 100 (100%) |
Do you feel you are not getting what you want out of your job? | 5 (5%) | 7 (7%) | 56 (56%) | 30 (30%) | 2 (2%) | 100 (100%) |
Do you feel you are in a wrong ward? | 15 (15%) | 67 (67%) | 15 (15%) | 3 (3%) | 0 (0%) | 100 (100%) |
Is your job becoming more demanding on you? | 2 (2%) | 3 (3%) | 42 (42%) | 46 (46%) | 7 (7%) | 100 (100%) |
Do you feel the hospital politics and protocols are frustrating your ability to do a good job? | 2 (2%) | 2 (2%) | 27 (27%) | 41 (41%) | 28 (28%) | 100 (100%) |
Do you feel there is more work to do than you practically have the ability to do? | 1 (1%) | 6 (6%) | 43 (43%) | 35 (35%) | 15 (15%) | 100 (100%) |
Do you feel you do not have time to do many of the important things in doing a quality job? | 2 (2%) | 4 (4%) | 54 (54%) | 35 (35%) | 5 (5%) | 100 (100%) |
Do you find that you do not have time to plan as much as you would like to? | 2 (2%) | 3 (3%) | 58 (58%) | 30 (30%) | 7 (7%) | 100 (100%) |
pondents indicating that they are rarely prone to negative thinking about their job and 67% rarely feel they are in the wrong ward. This means that despite the unfavourable work environment, work conditions are motivating. The socio-demographic characteristics revealed workers within the productive age with the younger nurses who form a greater percentage of the respondents being at the lower level of the professional ladder as presented on
Frequency | Percent | Valid percent | Cumulative percent | |
---|---|---|---|---|
Age range of respondents 21 - 30 years 31 - 40 years 41 - 50 years Above 50 years Total | 25 39 23 13 100 | 25.0 39.0 23.0 13.0 100.0 | 25.0 39.0 23.0 13.0 100.0 | 25.0 64.0 87.0 100.0 |
Sex distribution of respondents Male Female Total | 1 99 100 | 1.0 99.0 100.0 | 1.0 99.0 100.0 | 1.0 100.0 |
Respondents’ marital status Never married Married Divorced Widow Total | 40 56 3 1 100 | 40.0 56.0 3.0 1.0 100.0 | 40.0 56.0 3.0 1.0 100.0 | 40.0 96.0 99.0 100.0 |
Number of children of respondents 0 1 - 2 3 - 4 5 and above Total | 42 36 21 1 100 | 42.0 36.0 21.0 1.0 100.0 | 42.0 36.0 21.0 1.0 100.0 | 42.0 78.0 99.0 100.0 |
Level of education of respondents Diploma in nursing BSc./Bed. MSc./Med. Specialty programme Total | 49 36 1 14 100 | 49.0 36.0 1.0 14.0 100.0 | 49.0 36.0 1.0 14.0 100.0 | 49.0 85.0 86.0 100.0 |
Respondents currently pursuing an educational programme Yes No | 41.0 59.0 | 41.0 59.0 | 41 59.0 | 41 100 |
Respondent’s years of work experience in UCH 0 - 3 4 - 6 7 - 9 10 - 13 >13 Total | 41 27 15 7 10 100 | 41.0 27.0 15.0 7.0 10.0 100.0 | 41.0 27.0 15.0 7.0 10.0 100.0 | 41.0 68.0 83.0 90.0 100.0 |
Respondents’ professional cadre SN NO SNO PNO CNO Total | 40 27 16 9 8 100 | 40.0 27.0 16.0 9.0 8.0 100.0 | 40.0 27.0 16.0 9.0 8.0 100.0 | 40.0 67.0 83.0 92.0 100.0 |
No. | Mean | Std. deviation | F value | P value | Remark | |
---|---|---|---|---|---|---|
SN NO SNO PNO CNO Total | 40 27 16 9 8 100 | 46.0000 44.2222 45.0625 46.7778 47.2500 45.5400 | 4.70134 5.22813 7.63735 5.76146 4.71320 5.47247 | 0.796 | 0.530 | Not Significant |
Using one way ANOVA to test stress by cadre at Alpha level 0.05, P = 0.530 > 0.05 we fail to reject the hypothesis, which means there is no significant relationship between nurses’ cadre and stress and burnout among them.
professional cadre and incidence of stress and burnout. These findings are in line with Wu et al. (2007) [
In another study, a general construct labeled “organizational support” exhibited the expected negative relationship with work exhaustion [
The results of this study show that environmental factors have a significant effect on the level of stress of the nurses more than work conditions. This can be attributed to the fact that as the nurses indicate, there is good interpersonal relationship among them which may go a long way in reducing stress and burnout in relation to work conditions. The younger nurses who are new in the system and most of them never marry experience a higher level of stress and burnout.
When workers are happy, it is reflected in the quality of their work output. In order to promote quality nursing care in the University College Hospital, the Board of Management should look into the unconducive work environment as this may affect not only the nurses but also other workers and patients within the hospital who are not included in this study.
Based on the findings and the implication of the study for nursing, it is suggested that nurses should ensure that
SA | A | UD | D | SD | Total | |
---|---|---|---|---|---|---|
The roster is done to favour individual request | 3 (3%) | 9 (9%) | 8 (8%) | 76 (76%) | 4 (4%) | 100% |
There is enough time to complete my work and report for the shift | 2 (2%) | 11 (11%) | 4 (4%) | 79 (79%) | 4 (4%) | 100% |
I have enough time to go for my break on every shift | 0 (0%) | 1 (1%) | 4 (4%) | 71 (71%) | 24 (24%) | 100% |
There is adequate provision of functioning equipment to aid smooth nursing care | 2 (2%) | 38 (38%) | 42 (42%) | 9 (9%) | 9 (9%) | 100% |
I am confident that my job is secured | 6 (6%) | 87 (87%) | 4 (4%) | 2 (2%) | 1 (1%) | 100% |
My salary and other incentives are up to standard | 1 (1%) | 6 (6%) | 8 (8%) | 74 (74%) | 11 (11%) | 100% |
I am always promoted when due | 0 (0%) | 8 (8%) | 29 (29%) | 55 (55%) | 8 (8%) | 100% |
There is enough opportunity and encouragement to further my education and for seminars | 4 (4%) | 79 (79%) | 6 (6%) | 6 (6%) | 5 (5%) | 100% |
All amenities needed for my comfort at every shift are provided | 0 (0%) | 0 (0%) | 2 (2%) | 37 (37%) | 61 (61%) | 100% |
There is adequate staff covering every shift | 0 (0%) | 2 (2%) | 1 (1%) | 30 (30%) | 67 (67%) | 100% |
There is good human relation among every staff on the ward | 11 (11%) | 75 (75%) | 7 (7%) | 4 (4%) | 3 (3%) | 100% |
I can always go to my boss for assistance anytime I have a job or personal problem | 8 (8%) | 59 (59%) | 23 (23%) | 7 (7%) | 3 (3%) | 100% |
the board of management of UCH provides means of promoting a conducive work environment by looking into the factors identified.
This study should be replicated in other units with less chronically ill patients who do not stay long in the hospital. It can also be replicated in other states in Nigeria, with a larger population.
GuobadiaPauline Ojekou,OdetolaTitilayo Dorothy, (2015) Effect of Work Environment on Level of Work Stress and Burnout among Nurses in a Teaching Hospital in Nigeria. Open Journal of Nursing,05,948-955. doi: 10.4236/ojn.2015.510100