Comparison of Nursing Stress in Public and Private Hospitals

Introduction

The profession of nursing is considered one of the most stressful professions in the world. Nursing is by nature a stressful occupation. Continuous and long-term stress can result in physical, psychological, and behavioral problems in nurses. Therefore these professionals have been researched time and again. To cope with these problems several coping styles are deployed by the nurse which help them deal with the everyday stressors of their life. It has been found via research that using certain unhealthy coping styles may result in a number of mental health problems (Srinivasan & Samuel, 2014).

Nursing is the kind of job in which professionals have to deal with immense workload which can result in a lot of health problems, both physical and psychological. Not only that, the patients that come to hospitals themselves accompany a host of problems with them such as the stress of being ill, being frightful and apprehensive about their future and often they are very bitter and sometimes even indignant. Nurses have to deal with all of this and have to maintain a sense of composure at the same time. Sometimes the nurses have to perform the role of doctors and deal with the attendants and patients which mean they have to take the insults that were meant for the doctors and wasn’t initially a part of their job requirement. Some patients and attendants can even be physically abusive at times; this can result in even more stress for the nurses. It is often seen that at times the patients are way too demanding and expect more than what their job entails, when those expectations are not met the patients can be aggressive and they tend to show their aggression in a both verbal and physical way. These stressors expose nurses to a host of problems, depression, anxiety and insomnia being a few of them (Srinivasan & Samuel, 2014).

There is an extreme scarcity of nurses in both the government and private hospitals in Pakistan which makes them a valuable asset, one that must not be taken for granted. This scarcity in the number of nurses is mainly due to the discrepancy between their workload and their pay scales which make them leave their homeland and migrate to countries that give them roper compensation for their work. The work-life issues threatening retention of nurses is of serious concern for health administrators. This shortage of nursing professionals in Pakistan was researched by the Joint Learning Initiative Report in 2004 and the World Health Report in 2006 and found Pakistan to be among those 57 nations that have the most significant lack of human resource (Hamid, Malik, Kamran & Ramzan, 2013).

There is no shortage of nursing schools and colleges in the country, there are roughly 109 nursing institutions and 44000 nurses on record in Pakistan but the lack of nurses are still a grave problem. There are insufficient nurses in comparison to the people that need medical attention. A country that has limited nursing professionals will have dire effects on its health care systems despite having sound technological facilities. This dearth in the amount of nursing staff is not just a matter for developing countries like Pakistan but also for the countries in the developed world. There are a host of reasons behind this deficiency in the amount of nursing staff, some of them being poor working conditions, low pay and poor job satisfaction. Among the factors that have contributed to the immense shortage of nurses in Pakistan are the increase in workload, lack of any admiration or reward such as monetary incentives and inflexible nursing management (Hamid, Malik, Kamran & Ramzan, 2013).

Therefore, there is a dire need to research this major work force of Pakistan that has been neglected and often taken for granted. This study was planned to examine occupational stressors that the nurses face, coping strategies they deploy to deal with those stressors, and mental health problems they have as a result of those stressors.

The aims of the research were to find out the differences among stressors of private and government hospital nurses. The objectives of this study were to find out the differences in the coping styles in nurses of government and private hospitals. The other objective was to find out whether faulty coping styles lead to mental health problems.

Literature Review

Sahraian, Davidi, Bazrafshan & Javadpour conducted a study in 2013 to find out the different kinds of occupational stressors faced by nurses across several wards, nurses working in surgical, internal and psychiatric wards were interviewed in teaching hospitals of Iran. In this cross-sectional study, 180 nurses were selected who worked in surgical, internal and psychiatric wards of 4 teaching hospitals. The results of the study indicated that nurses of surgical and internal wards showed significantly higher level of occupational as compared to the nurses working in psychiatric wards. It was ascertained through the results obtained that job stressors of nurses differ across different wards in the hospitals.

There are several sources of stress, the environment in which one works being one of the biggest stressors. The significance of management of occupational stress is acknowledged, it effects the production of work, and it is also found to be linked with the worker’s physical and mental health. This particular research sought to assess the basis and effects of work-related stress on the capability, output, and competence of nurses. Several factors of the job have been linked to stress for e.g., excess of work, feelings of powerlessness, lack of clarity about their role as a nurse and disagreements at work. Stagnancy in the expansion of career, fear of joblessness, feelings of being underestimated and ambiguity in the chances of growth and promotion are some of the other stressors that were observed. This research revealed that stress negatively effects work effectiveness, de-motivates the performance, and instills the feelings of detachment towards the organization and its workers (Moustaka & Constantinidis, 2010).

Nursing is an extremely stressful job by nature and nurses use several coping strategies to deal with the stressors of their job. The aim of this study was to examine the major sources and consequences of job stress and coping mechanism amongst nurses in public health services. The research was both qualitative and quantitative in nature. It was concluded through this research that the nature of the work itself was the biggest stressor for nurses. The work itself included the setting of the work place, the monotony of work and the over burden of work. Some other stressors that were identified were the insensitive and unprofessional nature of the superiors, lack of acknowledgement and work place clashes. It was also found out that increased social support of friends, family and colleagues worked as a positive coping strategy against the effects of the occupational stressors. The participants relied on a number of other coping mechanisms to battle with the effects of the job (Beh & Loo, 2012).

Significance of the study

This research can highlight the occupational stressors of nurses, the mental health problems they get as a consequence of not being able to cope with those work related stressors. This will show a different side of these professionals that people often fail to see and take their services for granted.

Rationale of the study

As mentioned above there hasn’t been any research done on this population and even though this job is among the toughest jobs in the world, it’s not given much regard in our part of the world. This study will not only highlight the stressors that nurses face but will also serve as a stepping stone for further researches.

Research Questions

• What is the difference between the stressors of nurses of private and government hospitals?
• What is the difference in the coping styles of nurses of private and government hospitals?
• What is the difference in the mental health problems of nurses of private and government hospitals?
• Working in which ward is the most stressful for the nurses of both government and private hospitals?
• Which shift is the cause of most stress for the nurses of both government and private hospitals?
• Do faulty coping styles lead to mental health problems?

Hypotheses

• It is hypothesized that there will be no significant difference between the job stressors of private and government hospitals.
• It is hypothesized that there will be no significant difference between the coping styles of private and government hospitals.
• It is hypothesized that there will be no significant difference between the mental health problems of private and government hospitals.
• It is hypothesized that positive coping behaviors would be associated negatively with mental health problems in nurses, and negative coping behaviors would be associated positively with mental health problems in nurses.
• It is hypothesized that higher the level of job stressors, higher the degree of mental health problems in nurses.

Method

Research Design

A cross-sectional research design will be used for this study. It will be a comparative study as it aims to find difference between job stressors, coping styles and mental health problems of nurses of private and government hospitals. Therefore a Correlational study design will be used. This design tests for statistical relationship between two variables which are nurses of private and government hospitals.

Setting

Data will be collected from nurses of private and government hospitals.

Phase I. Exploring the Phenomenology

During the first phase the phenomenon of occupational stressors of the nurses will be explored. A total number of 50 nurses will be interviewed, 25 from government hospitals and 25 from private hospitals. Before beginning the interviews permission from the head nurse or the department of the nurses will be taken. The nurses will then be interviewed individually and will be asked about the stressors they face on a daily basis. Open ended questions will be asked so as to elicit more comprehensive and detailed responses from the nurses.

Phase II. Pilot Study

The second phase is the trial phase which will determine the feasibility of the research and will also determine the reliability and responsiveness of the items of the scale that is developed.

Main Study

In order to test the hypotheses the main study will be conducted.

Participants

This study will be conducted in government and private hospitals. The participants in this study will be a sample of 300 nurses, 150 from private hospitals and 150 from government hospitals.

Measures

1. Demographic data includes age, marital status, qualification, family system, no. of children, years of experience and the kind of institution.
2. Scales: occupational stress scale, cope scale and general health questionnaire.

The occupational stress scale is an indigenous scale which was developed according to the norms of our culture. The cope scale was also an indigenous scale which was adapted to find out the different coping styles of nurses in Pakistan. GHQ-12 was used to assess the mental health problems of the nurses, it is a psychometric tool often used to evaluate psychological distress, depression and anxiety.

Procedure

In order to collect data, the department of clinical Psychology University of Management and Technology Lahore will issue a letter which will explain the purpose of the research and data collection from different institutions. This letter will be presented to the nurses’ department at different government and private hospitals in order to obtain permission to collect data. Later the participants’ consent will be taken and the aim of the research will be explained to the participants. Ethical considerations will be considered and after the completion of data collection, results will be analyzed.

Analysis of Results

Once the data is collected, it will be analyzed by using SPSS 16.00 software program in order to test the hypotheses.