Occupational Stress and Turnover Intention: Implications for Nursing Management

Document Type : Original Article

Author

Health Management and Economics Research Centre, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background
The main purpose of this study was to explore the status of occupational stress among hospital nurses in Isfahan, Iran. It also aimed to examine the relationship between nurses’ occupational stress and their intention to leave the hospital.
 
Methods
The study employed a cross-sectional research design. A validated questionnaire was used to collect data from 296 nurses. Respondents were asked to rate the intensity of 30 common occupational stressors using a five-point scale.
 
Results
A third of hospital nurses rated their occupational stress high. The major sources of stress were inadequate pay, inequality at work, too much work, staff shortage, lack of promotion, job insecurity and lack of management support. More than 35% of nurses stated that they are considering leaving the hospital, if they could find another job opportunity. Occupational stress was positively associated with nurses’ turnover intentions.
 
Conclusion
Hospital managers should develop and apply appropriate policies and strategies to reduce occupational stress and consequently nurses’ turnover intention.

Keywords

Main Subjects

References

1. Koys DJ. The effects of employee satisfaction, organizational citizenship behaviour, and turnover on organizational effectiveness: A unit-level, longitudinal study. Pers Psychol 2001; 54: 101–14. doi: 10.1111/j.1744-6570.2001.tb00087.x
2. Shaw JD, Gupta N, Delery JE. Alternative conceptualizations of the relationship between voluntary turnover and organizational performance. Academy of Management 2005; 48: 50–68. doi: 10.5465/amj.2005.15993112
3. Hart SE. Hospital ethical climates and registered nurses’ turnover intention. J Nurs Scholarsh 2005; 37: 173–7. doi: 10.1111/j.1547-5069.2005.00030.x
4. Waldman JD, Kelly F, Arora S, Smith HL. The shocking cost of turnover in health care. Health Care Manag Rev 2004; 29: 2–7. doi: 10.1097/00004010-200401000-00002
5. Zboril-Benson LR. Why nurses are calling in sick: the impact of health-care restructuring. Can J Nur Res 2002; 33: 89–107.
6. Hayes LJ, O’Brien-Pallas L, Duffield C, Shamian J, Buchan J, Hughes F, et al. Nurse turnover: a literature review - an update. Int J Nurs Stud 2011; 49: 887–905. doi: 10.1016/j.ijnurstu.2011.10.001
7. Tourangeau AE, Giovannetti P, Tu JV, Wood M. Nursing-related determinants of 30-day mortality for hospitalized patients. Can J Nurs Res 2003; 33: 71–88.
8. Whitman GR, Kim Y, Davidson LJ, Wolf GA, Wang SL. The impact of staffing on patient outcomes across specialty units. J Nurs Adm 2002; 32: 633–9. doi: 10.1097/00005110-200212000-00008
9. Almalki MJ, FitzGerald G, Clark M. The relationship between quality of work life and turnover intention of primary health care nurses in Saudi Arabia. BMC Health Serv Res 2012; 12: 314. doi: 10.1186/1472-6963-12-314
10. Battistelli A, Portoghese I, Galletta M, Pohl S. Beyond the tradition: test of an integrative conceptual model on nurse turnover. International Nursing Review 2013; 60: 103–11. doi: 10.1111/j.1466-7657.2012.01024.x
11. Brewer CS, Kovner CT, Greene W, Tukov-Shuser M, Djukic M. Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals. J Adv Nur 2012; 68: 521–38. doi: 10.1111/j.1365-2648.2011.05753.x
12. De Gieter S, Hofmans J, Pepermans R. Revisiting the impact of job satisfaction and organizational commitment on nurse turnover intention: an individual differences analysis. Int J Nurs Stud 2011; 48: 1562–9. doi: 10.1016/j.ijnurstu.2011.06.007
13. Han SS, Sohn IS, Kim NE. [New nurse turnover intention and influencing factors]. J Korean Acad Nurs 2009; 39: 878–87. doi: 10.4040/jkan.2009.39.6.878  
14. Leiter MP, Maslach C. Nurse turnover: the mediating role of burnout. J Nurs Manag 2009; 17: 331–9. doi: 10.1111/j.1365-2834.2009.01004.x
15. Mosadeghrad AM, Ferlie E, Rosenberg D. A Study of relationship between Job satisfaction, organizational commitment and turnover intention among hospital employees. Health Serv Manag Res; 21: 211–27. doi: 10.1258/hsmr.2007.007015
16. Mosadeghrad AM. Quality of working life: Antecedents to employee’s turnover intentions. Int J Health Policy Manag 2013; 1: 49–58. doi: 10.15171/ijhpm.2013.07
17. McNeese-Smith DK, van Servellen G. Age, developmental, and job stage influences on nurse outcomes. Outcomes Manag Nurs Pract 2000; 4: 97–104.
18. Chiang YM, Chang Y. Stress, depression, and intention to leave among nurses in different medical units: implications for healthcare management/nursing practice. Health Policy 2012; 108 : 149–57. doi: 10.1016/j.healthpol.2012.08.027
19. Davidson H, Folcarelli PH, Crawford S, Duprat LJ, Clifford JC. The effects of health care reforms on job satisfaction and voluntary turnover among hospital based nurses. Med Care 1997; 35: 634–45. doi: 10.1097/00005650-199706000-00008
20. Krausz M, Koslowsky M, Shalom N, Elyakim N. Predictors of intentions to leave the ward, the hospital, and the nursing profession. J Organ Behav 1995; 16: 277–88. doi: 10.1002/job.4030160308
21. Ullrich A, Fitzgerald P. Stress experienced by physicians and nurses in the cancer ward. Soc Sci Med 1990; 31: 1013–22. doi: 10.1016/0277-9536(90)90113-7
 
22. O’Connor DB, O’Connor RC, White BL, Bundred PE. The effect of job strain on British general practitioners’ mental health. J Ment Health 2000; 9: 637–54. doi: 10.1080/713680290
23. McVicar A. Workplace stress in nursing: A literature review. J Adv Nurs; 44: 633–42. doi: 10.1046/j.0309-2402.2003.02853.x
24. Robinson JR, Clements K, Land C. Workplace stress among psychiatric nurses. J Psychosoc Nurs Ment Health Serv 2003; 41: 32–42.
25. Stordeur S, D’Hoore W, Vandenberghe C. Leadership, organisational stress and emotional exhaustion among hospital nursing staff. J Adv Nurs 2001; 35: 533–42. doi: 10.1046/j.1365-2648.2001.01885.x
26. Anjazab B, Farnia F. [The relationship between job stress and behavioural and mental responses of obstetricians in Yazd public hospitals]. The Journal of Shahid Sadoughi University of Medical Sciences 2002; 10: 32–8.
27. Bianchi ER. Stress and coping among cardiovascular nurses: a survey in Brazil. Issues Ment Health Nurs 2004; 25: 737–45. doi: 10.1080/01612840490486818  
28. McGowan B. Self-reported stress and its effects on nurses. Nurs Stand 2001; 15: 33–8. doi: 10.7748/ns2001.07.15.42.33.c3050
29. Adib-Hajbaghery M, Khamechian M, Masoodi Alavi N. Nurses’ perception of occupational stress and its influencing factors: A qualitative study. Iran J Nurs Midwifery Res 2012; 17: 352–9.
30. Oginska-Bulik N. Occupational stress and its consequences in healthcare professionals: The role of type D personality. Int J Occup Med Environ Health 2006; 19: 113–22. doi: 10.2478/v10001-006-0016-7
31. Schmitz N, Neumann W, Opperman R. Stress, burnout and locus of control in German nurses. Int J Nurs Stud 2000; 37: 95–9. doi: 10.1016/s0020-7489(99)00069-3
32. Hurst TE, Hurst MM. Gender differences in mediation of severe occupational stress among correctional officers. Am J Crim Justice 1997; 22: 121–37. doi: 10.1007/bf02887343
33. Purcell SR, Kutash M, Cobb S. The relationship between nurses’ stress and nurse staffing factors in a hospital setting. J Nurs Manag 2011; 19: 714–20. doi: 10.1111/j.1365-2834.2011.01262.x
34. Golubic R, Milosevic M, Knezevic B, Mustajbegovic J. Work-related stress, education and work ability among hospital nurses. J Adv Nurs 2009; 65: 2056–66. doi: 10.1111/j.1365-2648.2009.05057.x
35. Espnes GA, Byrne DG. Occupational stress and cardiovascular disease. Stress Health 2008; 24: 231–8. doi: 10.1002/smi.1203
36. King KA, Vidourek R, Schwiebert M. Disordered eating and job stress among nurses. J Nurs Manag 2009; 17: 861–9. doi: 10.1111/j.1365-2834.2009.00969.x
37. Van der Ploeg E, Kleber RJ. Acute and chronic job stressors among ambulance personnel: predictors of health symptoms. Occup Environ Med 2003; 60: 40–6. doi: 10.1136/oem.60.suppl_1.i40
38. Cho JJ, Kim JY, Chang SJ, et al. Occupational stress and depression in Korean employees. Int Arch Occup Environ Health 2008; 82: 47–57. doi: 10.1007/s00420-008-0306-4
39. Gandham SR. Occupational stress: Time for a policy. The Health & Safety Practitioner 2000; 18: 20–1.
40. Reynolds S. Psychological well-being at work: Is prevention better than cure? J Psychosom Res 1997; 43: 93–102. doi: 10.1016/s0022-3999(97)00023-8  
41. Shapiro SL, Astin JA, Bishop SR, Cordova M. Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. Int J Stress Manag 2005; 12: 164–76. doi: 10.1037/1072-5245.12.2.164
42. Engström M, Ljunggren B, Lindqvist R, Carlsson M. Staff satisfaction with work, perceived quality of care and stress in elderly care: psychometric assessments and associations. J Nurs Manag 2006; 14: 318–28. doi: 10.1111/j.1365-2934.2006.00625.x
43. Teng CI, Hsiao FJ, Chou TA. Nurse-perceived time pressure and patient-perceived care quality. J Nurs Manag 2010; 18: 275–84. doi: 10.1111/j.1365-2834.2010.01073.x
44. Fiabane E, Giorgi I, Musian D, Sguazzin C, Argentero P. Occupational stress and job satisfaction of healthcare staff in rehabilitation units. Med Lav 2012;103: 482–92.
45. Mosadeghrad AM, Ferlie E, Rosenberg D. A study of relationship between job stress, quality of working life and turnover intention among hospital employees. Health Serv Manag Res J 2011; 24: 170–81. doi: 10.1258/hsmr.2011.011009
46. Hsu HY, Chen SH, Yu HY, Lou JH. Job stress, achievement motivation and occupational burnout among male nurses. J Adv Nurs 2010; 66: 1592–601. doi: 10.1111/j.1365-2648.2010.05323.x
47. Khatibi A, Asadi H, Hamidi M. The Relationship between job stress and organizational commitment in National Olympic and Paralympic Academy. World Journal of Sport Sciences 2009; 2: 272–8.
48. Lambert E, Paoline EA. The influence of individual, job and organizational characteristics on correctional staff job stress, job satisfaction and organizational commitment. Crim Justice Rev 2008; 33: 541–64. doi: 10.1177/0734016808320694
49. Cartledge S. Factors influencing the turnover of intensive care nurses. Intensive Crit Care Nurs 2001; 17: 348–55. doi: 10.1054/iccn.2001.1599
50. Chou-Kang C, Chi-Sheng C, Chieh-Peng L, Ching Yun H. Understanding hospital employee job stress in a practical setting: The moderating role of locus of control. The Journal of Management Development 2005; 24: 837–55. doi: 10.1108/02621710510627019
51. French SE, Lenton R, Walters V, Eyles J. An empirical evaluation of an expanded nursing stress scale. J Nurs Meas 2000; 8: 161–78.
52. Aghilinejad M, Attarchi MS, Golabadi M, Chehregosha H. [Comparing stress level of woman nurses of different units of Iran university hospitals]. Journal of Army University Medical Sciences 2010; 8: 45–8.
53. Faraji O, Valiee S, Moridi G, Ramazani AA, Rezaei-Farimani M. [Relationship between job characteristic and job stress in nurses of Kurdistan University of Medical Sciences educational hospitals]. IJNR 2012; 7: 54–63.
54. Molazem Z, Mohammadhoseini S, Karimi Z. [A Study on Job StressMaking Factors and their Degrees of Stressfulness from the Nurses’ Viewpoint in the University Hospitals of Kohgiluyeh & Boyrahmad]. Armaghane-danesh 2005: 10: 95–103.
55. Sharif F, Rad F, Gholamzadeh S. Sources of occupational stress and coping strategies among nurses. Iran J Nurs Midwifery Res 2011; 16: 42–7.
56. Rahmani F, Behshid M, Zamanzadeh V, Rahmani F. [Relationship between general health, occupational stress and burnout in critical care nurses of Tabriz teaching hospitals ]. IJN 2010; 23: 54–63.
57. Ernst ME, Messmer PR, Franco M, Gonzalez JL. Nurses’ job satisfaction, stress, and recognition in a paediatric setting. Pediatr Nurs 2004; 30: 219–27.
58. Shields MA, Ward M. Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. J Health Econ 2001; 20: 677–701. doi: 10.1016/s0167-6296(01)00092-3
59. Al-Aameri AS. Source of job stress for nurses in public hospitals. Saudi Med J 2003; 24: 1183–7.
60. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288: 1987–93. doi: 10.1001/jama.288.16.1987
61. Strachota E, Normandin P, O’Brien N, Clary M, Krukow B. Reasons registered nurses leave or change employment status. J Nurs Adm 2003; 33: 111–7. doi: 10.1097/00005110-200302000-00008
62. McCann L, Hughes CM, Adair CG, Cardwell C. Assessing job satisfaction and stress among pharmacists in Northern Ireland. Pharmacy World & Science 2009; 31: 188–94. doi: 10.1007/s11096-008-9277-5
63. Wilkinson R. The impact of inequality: How to make sick societies healthier. New York: The New Press; 2005. doi: 10.1056/nejmbkrev39107
64. Ogunjimi LO, Ajibola CA, Akah LU. Comparative analysis of stressors on job performance of public and private health workers in Calabar, Nigeria. International NGO Journal 2009; 4: 97–103.
 

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History

  • Receive Date: 10 May 2013
  • Revise Date: 24 July 2013
  • Accept Date: 15 July 2013
  • First Publish Date: 24 July 2013

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