Original Article

Workload as A Cause of Occupational Stress

Among Registered Staff Nurses

Ghulam Abbas Panhwar1, Pir Bux Jokhio2, Humaira Wagan3, Husun Banu Channar4

Abstract

Objective: To evaluate the sources of occupational stress related to workload among registered staff
nurses.
Methods: A cross-sectional study was conducted among 100 staff nurses. "Hospital consultants, job
stress & satisfaction questionnaire (HCJSSQ)" was applied for data collection purpose. The ques-
tionnaire was formulated by an appropriate selection of questions and validated by 5 experts (one
general administrator, two physicians, one nursing superintendent, and one human resource man-
ager). The study was carried out during February-July 2016. The questionnaire consisted of 08 ques-
tions on sources of stress related to workload.
Results: All the invited nurses agreed to participate. The mean age of the selected sample was 32.29
years and SD ± 7.025. The analysis of the data revealed that 'having an inadequate staff to do the job'
was the biggest stressor followed by 'being on on-call and 'providing patient care within
multidisciplinary teams as 2nd and 3rd stressors. 'Feeling under pressure to meet deadlines', 'too
great magnitude of overall work', 'having inadequate equipment to do job properly', 'disturbance of
home life due to long hours duty' and 'being unable to cure patients' were identified as 4th, 5th, 6th,
7th, and 8th number stressors respectively.
Conclusion: Nurses are facing various types of stressors, which may affect organizational culture and
a factor for low-quality care for patients as well as the individual wellbeing of a staff nurse. These
stressors should be handled carefully on a priority basis by proper workload management, availability
of facilities, good pay scale, reward system, initiate occupational health education or support to con-
tinue education.
Keywords: Workload, occupational stress, nurses.
IRB: Approved by Liaquat University of Medical and Health Sciences. Dated: 19 th November 2016.
DOC#LUMHS/CE/PG/-1560-63.
Citation: Panhwar GA, Jokhio PB, Wagan H, Channar HB. Workload as A Cause of Occupational
Stress Among Registered Staff Nurses [Online]. Annals of ASH & KMDC 2019;24:.

(ASH & KMDC 24(3):160;2019)

not immune to those stressors. There are various

Introduction
reasons for feeling insecurity such as doctors' poor
Stress is a type of reaction resulted due to a attitude, work environment, managerial issues,
demand that is difficult to cope with and ultimately postings and busy departments (ICUs) and too
requires extra energy that is not available to the much work1. The workload is a precursor that con-
stressed
_________________individual.
____________________Nurses working
______________________________in
_____hospitals
_________________are
_____ verts occupational stress from a single word to
1,3
Benazir Institute of Nursing, symbol and a leading problem for health profession-
Shaheed Mohtarma Benazir Bhutto Medical College
2
Begum Bilquis Sultana Institute of Nursing, als all over the world. It can reduce happiness in
Peoples University of Medical and Health Sciences life, increase blood pressure, intensify heart prob-
4
Peoples School of Nursing,
Liaquat University of Medical and Health Sciences lem, low immunity, may be involved in drug addic-
tion and disturb the overall status of mental and
Correspondence: Dr. Pir Bux Jokhio
Begum Bilquis Sultana Institute of Nursing physical health2. The definition of occupational
Peoples University of Medical and Health Sciences stress in nursing is the physical & emotional re-
Email: pjokyo@pumhs.edu.pk
Date of Submission: 30th April 2019 sponses that happen because of inadequate work
Date of Acceptance: 18 th October 2019

Volume No. 24 (3), September 2019 265

 Ghulam Abbas Panhwar, Pir Bux Jokhio, Humaira Wagan, Husun Banu Channar

or disturbing factors in the environment3. Research Subjects and Methods

showed workload as a factor that affects staff
A cross-sectional study was conducted among
nurses' work capabilities negatively. Staff nurses
100 staff nurses working in a tertiary care hospital,
faced a lot of work stress that is related to the indi-
Hyderabad/Jamshoro Sindh. The sample size was
vidual, surroundings, environmental and manage-
calculated by keeping the confidence level at 95%,
ment factors4. Generally, the profession "Nursing"
confidence interval 05%12. The study period was
is characterized by job stress due to job demands.
February - July in 2016. Amanda Ramirez et al,
The profession nursing is a very noble and appre-
2008, Hospital Consultants' Job Stress & Satisfac-
ciable profession but at the same level, it is also a
tion Questionnaire (HCJSSQ) was administrated to
very stressful job2. In spite of that occupational
collect data. The questionnaire was formulated by
stress cited as an important health issue5,6,7.
an appropriate selection of questions & validated by
Menzies was the first who evaluate the work-related
5 experts (one General Administrator, two physi-
stress in nursing8. Four sources of anxiety in nurs-
cians, one Nursing Superintendent, and one Human
ing have identified by the World Health Organization
Resource manager). The questionnaire consisted of
(WHO): client care, a power of decision-making,
08 questions on sources of workload related stres-
taking responsibility, as a change agent. From the
sors. Inclusion criteria for this study was a regis-
mid-1980s, nurses' work-related stress is being re-
tered staff nurse, with valid Pakistan Nursing
searched because it is implicating negativity on
Council registration card, having at least two years
health care cost, continuously9. If a frequency of
of experiences of direct nursing care in this hospi-
stress persistently increases, it can change the
tal, whereas the excluding criteria included a regis-
physical health status leading to chronic stress, in
tered nurse working on a contract basis since last
spite of those who can cope with the short-term
one year and a nurses who remained on leave for
stress process10. The burning issue is related to job
last month. After taking permission from hospital
stress, among nurses invited to all concerned au-
administration & the staff nurses working in different
thorities of administrative or management sites in
wards who fulfilled the inclusion criteria, the nurses
the healthcare setup. With the help of good man-
were invited for study participation.
agement skills, these stressor issues can be re-
solved in a very positive manner11. There were 08 statements related to the nature
of workload sources and participants were asked to
Above discussion reveals, that work-related
rate each statement according to the statement on
stress is a major reason that staff nurses fail to
the interval type scale of 0 (not at all), 1 (a little), 2
discharge their duties with their full potential. That
(quite a bit), 3 (a lot), (as they have experienced it)
is the reason that workload related stress phenom-
and later these questionnaires were collected by
enon must be given priority. Researching this area
the investigator. The data from the duly filled ques-
is essentially warranted to search for reasons be-
tionnaires were tabulated and analysed using the
hind workload and find solutions so that nurses can
SPSS (version 16) for frequencies and percentages
discharge their professional duties with full potential
as descriptive data. These data were calculated and
and responsibility. This is the way that this re-
portrayed in tables and figures.
search has been conceptualized. This research
study was done to evaluate the source of work
Results
stress and frequency of stress and for recommen-
dations to decrease the level of work-related stress During our six months (February-July 2016)
in staff nurses of Liaquat University Hospital study period, total one hundred (n=100) staff nurses
Jamshoro. were invited and all agreed to participate in this
study turning the response rate at 100%. The mean
age of participants was 32.29 years; median as 30

266 Annals Abbasi Shaheed Hospital & Karachi Medical & Dental College
Workload as A Cause of Occupational Stress Among Registered Staff Nurses

Table 1. Frequencies and percentages of each descriptive statement related to workload source

S# Item (Causes of stress related to workload) Responses

0 (Not at all) 1 (A little) 2 (A bit) 3 (A lot)

Normal Mild Moderate Severe

1 Disruption of your home life through spending long hours at work 06 (10%) 07 (11%) 13 (21%) 37 (58%)
2 Having inadequate equipment to do your job properly 05 (08%) 06 (10%) 15 (24%) 37 (58%)
3 Feeling under pressure to meet deadlines 03 (05%) 04 (07%) 17 (27%) 39 (61%)
4 Having too great an overall volume of work 01 (02%) 07 (11%) 21 (33%) 34 (54%)
5 Having inadequate staff to do your job properly 01( 02%) 01 (02%) 25 (40%) 36 (57%)
6 Disruption of your home life as a result of being on call 02 (03%) 02 (03%) 30 (48%) 29 (46%)
7 Providing patient care within multi-disciplinary teams 02 (03%) 03 (05%) 33 (52%) 25 (40%)
8 Being unable to cure patients 07 (11%) 09 (14%) 19 (30%) 28 (45%)

16 (33%) 39 (63%) 173 (275) 265( 419)

and SD + 7.025 years. The minimum age was 24 Discussion

years while the maximum age was 45 years. Ten
participants of the study sample (10%) were male It has been observed that a sufficient workload,
nurse and 90 (90%) female, making male to female management policy, adequate delegation of author-
ratio 1:9. ity along with responsibility, recognition of efforts
along with ongoing training, stress and time man-
The prime source of stress was found as agement will go a long way in managing stress in
workload. Among the study sample, 63 (63%) par- this profession13. The results of this study provide
ticipants responded that they had felt occupational evidence that occupational stress is common
stress due to workload. The analysis of the data re- among registered nurse. According to the results of
vealed that the 'having an inadequate staff to do the our study, it was revealed that 'having an inadequate
job' was the biggest stressor as 25 (40%) and 36 staff to do the job' was the biggest problem and
(57%) respondents termed it as the moderate and source of workload related stress source. In other
severe cause of the stress. On the statement 'on words, it is once again confirmed that staff shortage
call as a reason for home life disturbance resulting is the universal phenomena of today's world.
in job stress' received second most stress factor as Nurses are one of the victims of workload stress
30 (48%) and 29 (46%) respondents had moderate due to staff shortage. The findings of the study are
and severe stress. 'Providing patient care within well supported by a study14 conducted in Ethiopia.
multidisciplinary teams' was the third stressor that The study14 revealed that due to staff shortage,
affected 33 (52%) and 25 (40%) respondents mod- nurses have to work over an extended period (more
erately and severely respectively. Feeling under than 50 hrs/week). Moreover, night shifts are also a
pressure to meet deadlines, too great magnitude of cause of workload related stress among staff
overall work , having inadequate equipment to do nurses. In another study15, it was identified that
job properly, disturbance of home life due to long work-related pressure among staff nurses is the
hours duty and being unable to cure patients, main reason of their exhaustion and burn out. If
were termed as fourth, fifth, sixth, seventh and managers and policy makers do not head to resolve
eighth number stressors respectively, as the data the issue of burnout, it will aggravate already exist-
had revealed (Table. 1). ing staff shortage problem, leading to a decline in

Volume No. 24 (3), September 2019 267

 Ghulam Abbas Panhwar, Pir Bux Jokhio, Humaira Wagan, Husun Banu Channar

patients' quality care provision. “Being on call in an job properly' are worth being mentioned. "Being un-
emergency that disturbs family life” was termed as able to cure patients" is also one way or other way
the second most important cause of the workload related to poor staffing and limited resources prob-
related stress. The findings of our study are well lems. The findings of the study are well supported
supported by study14 that terms 'to be on call in an by a study17 that clarifies that workload is a major
emergency' as another cause of the stress. Study14 contributor towards the decline in quality care is-
reveals that 68.2% of staff nurses are stressed due sue. Therefore, this issue must be solved on priority
to their home disturbance when they were called for bases. They argued that one cannot expect the
unscheduled duty hours. continuity of quality care provision if an organization
is understaffed or have limited resources/ instru-
The third important source of workload related
ments to deal with the issue of quality care provi-
stress was identified as 'providing patients' care in
sion. Therefore, the workload issue may not be
a multidisciplinary team'. One of the reasons be-
taken for granted. This issue must be solved on pri-
hind stress due to this issue is poor communica-
ority bases as patients safety is always upheld
tion between different members of the team. The
high in terms of outcomes and safety measures. In
results of the study are well supported by a study1
a study2 conducted in the Kingdom of Saudi Arabia,
conducted in an Indian tertiary hospital in 2008.
occupational stress was mainly associated with the
The afore mentioned study1 revealed that poor com-
nature of nurses' jobs. For example, nurses be-
munication between a nurse-physician was at the
came stressed once patients did not respond to
heart of the issue. Moreover, nurses became more
treatments when patients were terminally ill and
stressed when physicians used abusive language
nurses felt immensely pressured for their communi-
against them. It was lobbied that interpersonal com-
cation on the issue of poor prognosis. It was as-
munication issues must be resolved to mitigate the
sumed as the most difficult time to break the bad
negative effects of conflicts on patients' care. In the
news as it was closely connected to nurses' devel-
context of patients' direct care, there was another
opment of moral distress. The study3 conducted
aspect identified in a study16 conducted in India.
among psychiatric nurses at a major governmental
The study revealed that nurses became stressed if
psychiatric hospital in KSA also revealed that 61%
a patient died during their direct care. Death of a
of the studied population (psychiatric nurses) was a
patient created feelings of anxiety and uncom-
victim of occupational stress on a moderate level.
fortableness among them as some of the nurses
The study3 had measured the severity level of
blamed themselves for not providing optimal care to
stress among only 4% of the studied population
the one who died during their care.
that is in the contract of our study. Our study has
There were other reasons related to workload verified that 56% of the study population had severe
stressor such as 'feeling under pressure to meet stress. The difference is notable as the nurses
deadlines, magnitude of overall work', having inad- working in KSA may have strong mental capabili-
equate equipment to do job properly, disturbance of ties to cope with occupational stresses. From the
home life due to long duty hours and being unable results of our study, we have concluded that our
to cure patients, were termed as fourth, fifth, sixth, sample lacked coping strategies and it is time that
seventh and eighth number stressors respectively, management should arrange counselling session for
as the data had exposed. Feeling under pressure to grieved nurses as they can develop coping skills to
meet deadlines, the magnitude of overall work and successfully deal with the issue of occupational
disturbance of home life due to long duty hours are stress.
discussed in the context of workload. Remaining
two important variables of 'being unable to cure pa-
tients' and 'having inadequate equipment to do the

268 Annals Abbasi Shaheed Hospital & Karachi Medical & Dental College
Workload as A Cause of Occupational Stress Among Registered Staff Nurses

Conclusion Conflict of Interest

It has been observed that a sufficient workload, The authors of the study do not have any con-
management policy, adequate delegation of author- flict of interest with findings of authors of previous
ity along with responsibility, recognition of efforts studies.
along with ongoing training, stress and time man-
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270 Annals Abbasi Shaheed Hospital & Karachi Medical & Dental College