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Qualitative Study on Stress among Nurses Working at Private Sector, in

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 222 International Journal of Nursing Education. July-December 2013, Vol. 5, No. 2 DOI Number: 10.5958/j.0974-9357.5.2.100

Qualitative Study on Stress among Nurses Working at

Private Sector, in Suburban Kolkata

Suman Kr Roy1, Chandrani Chakraborti2, Sonali kar3, Sharmistha Chakrabarty4

1
Department of Community Medicine, College of Medicine and JNN Hospital, Kalyani, 2Department of Nutrition,
Swarupganj Pansila Balika Vidyalaya, Nabadwip, 3Kalinga Institute of Medical Sciences, Bhubaneswar, 4Department of
nutrition, Biharilal college, Kolkata

ABSTRACT

Introduction: Job stress can be defined as a harmful physical response that occurs when the job
requirement does not match the capabilities, resources or need of the worker, leading to poor health
or even injury. Nurses due to their occupation are exposed to high levels of stress due to conflict with
higher authorities, colleagues and often patients and their families, dealing with death and dying
patient, prolong duty hours and last but not the least, their own families.

Objective: To find out common workplace stressors of nursing profession and to explore the personal
and family life of nurses working in private sectors, as well as to study prevalence of common stress
related illness among nursing personnel.

Material and Method: Three medium sized (100 bedded) privately-managed tertiary care nursing
homes at suburban Kolkata, India were selected randomly. Al together 117 nursing personnel
consented to participate in this study. Socio-demographic information was collected through
interviewing respondents, using pretested questionnaire. In-depth focus group discussions were
held for better understanding about work place and family level stressors. Work place stressors were
arranged according to 'Garrett score'.

Results and Discussion: Understaffed department and over-work, poor salary, no appreciation for
good work, conflict with higher authority, fear of making mistake and lack of security of work were
identified through 'garrett ranking' as major factors for job stress. Anxiety and lack of enthusiasm are
common emotional symptom where as gastro-intestinal problems and musculoskeletal problems
are identified as common physical illness among nurses. 17.9% of study population considered family
level stress was more than work place stress where as 41% opined that job stress disturbed their
home life.

Keywords: Nurses, Job Stress, Garrett Ranking

INTRODUCTION different diseases like addiction, accident,

Job stress is the harmful emotional and physical
reactions resulting from the interactions between the
worker and her/his work environment where the
demands of the job exceed the worker’s capabilities
and resources1.
Though a certain amount of stress is required to
live and enjoy life, however, unremitting stress beyond
the individual’s coping capacity causes serious threat
to the individual’s physical and psychological well-
being. Widely available literature and meta-analysis
showed positive correlation between job stress and
hypertension, dyslipidemia, diabetes and major and
minor depression, disorder, etc.2.
Nurses due to the nature of their job are always
exposed to high levels of stress. Working in an enclosed
atmosphere, constantly dealing with death and the
dying, uncertainty concerning treatment plans,
excessive workload, poor staff support are the
prominent factors contributing to the nurse’s job stress
which lead to physical and psychological problems3,4,5.
Not only that, family life together with sexual and very
personal lives were jeopardized due to job-related
stress.3,6,7,8

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 International Journal of Nursing Education. July-December 2013, Vol. 5, No. 2 223

In India, studies related to stress in the nursing
profession are scanty. In contrast to the western world,
women’s’ role in Indian society is believed to be
traditional, emphasizing on age-old values that include
essentially childcare and looking after the family.
However, economic reasons brought the woman out
of her home and now she also faces the same challenges
that a man does. This resulted in striking a balance
between the home and workplace, resulting in
psychosocial problems never before encountered.
Therefore it becomes necessary to look into factors
responsible for work place and family level stress of
nurses.
Garrett ranking technique was used to rank the job
stressors felt by study population (women nurses).
RESULTS
Socio-demographic information: The socio-
demographic characteristics (Table-1) of the nursing
personnel showed that majority of them are in the age
group of 30-45yrs (48.7%), followed by more than 45
yrs (32.5%). 74.4% of nurses are currently married
where as only 1.7% are divorced. Out of 25 (21.4%)
unmarried, 18 (72% of unmarried) belonged to age
group <30 yrs.

Table 1. Socio-demographic characteristics of Nurses

OBJECTIVES (N=117)

1. To find out common workplace stressors of No. %

nursing profession. 1. Age
a) < 30 years 22 18.8
2. To explore the personal and family life of nurses b) 30-45 yrs. 57 48.7
working in private sectors. c) > 45 yrs. 38 32.5
2. Marital Status
3. To study prevalence of common stress related
a) Current married 87 74.4
illnesses among nursing personnel.
b) Un-married 25 21.4
c) Divorced or Widowed 5 4.2
METHODOLOGY
3. Family type
Study Setting: The data has been collected from a) Joint 41 35
Emergency Departments, Out-patient Departments, b) Nuclear 76 65
Intensive care units, Medical Wards, and Surgical 4. Income
Wards of three medium sized (up to 100 bedded) a) Upto Rs. 5000/- 59 50.4
tertiary care privately run nursing homes located at b) Rs. 5000-10000 37 31.6
district 24 pgs(N). c) Rs. > 10000 21 18
5. Department
Study Sample: The sample consisted of 117 nurses,
a) ICCU 30 25.6
working in the previously mentioned settings for at
b) Operation Theater 17 14.5
least 6 months continuously with full time
c) General ward 44 37.6
employment and consented to participate in this study.
d) OPD 19 16.2
Head nurses and supervisors were excluded from the
d) Emergency dept. 7 5.9
sample because of their work nature that is different
from staff nurse’s work nature. All willing nurses were Out of total 117 nurses participated in this study 44
included in this study. (37.6%) were from general-ward followed by ICCU &
ITU (31.5%), OPD (16.2%), and Operation Theater
Tools and technique: Selected nursing personnel (14.5%). Majority (65%) of respondents of this study
were interviewed with pretested and predesigned belonged to nuclear family. The study also showed that
questionnaire to record pertinent data. Focus group 65% or the majority of nurses belonged to nuclear
discussions were carried out in each institution for in- families whereas only (35%) belonged to joint families.
depth analysis and study of their views and opinions Majority of private sector nurses are poorly paid.
regarding the job stress and family environment and Majority (50.4%) earn less than Rs.5000. Only 18% of
its impact on their physical and mental health. Al nurses’ were paid Rs. >10000/- month.
together 15 focus group discussions were held with 7
to 10 participant in each. The total collected data was Personal and family life: Regarding personal life
assimilated and analyzed to bring the results. Henry of nursing personnel (Table 2) it was found that 55.4%

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 224 International Journal of Nursing Education. July-December 2013, Vol. 5, No. 2

of ever married nurses had scope of recreation where
as corresponding figure among unmarried was 80%,
and this difference is statistically significant. This
study also revealed that 76% of the unmarried nurses
have the right to spend money as they wish, where as
only 51.1 % married nurses enjoy that right (p<0.05).
Majority of Unmarried nurses (68%) did not have
mandatory responsibilities for house-hold work while
only 7.6% of married nurses enjoyed that advantage.
63.1% of married nursing personnel managed
household responsibility either of her own or partially
assisted, whereas corresponding figure for unmarried
was only 12%. 25% of married nurses did not receive
any kind of co-operation from their family members
while only 4% of unmarried received same kind
treatment from their family members.

Table 2. Personal Life of Married & Unmarried Nursing Personnel

Ever Married Un Married Total Statistical

N1=92 N2= 25 (N=117) significance
No. % No. %
1. Scope of recreation
a) Yes 51 55.4 20 80 71 (60.7%) Chi sq. 4.97,
b) No 41 44.6 5 25 46 (39.3%) p=<0.05
2. Right to spend money on her own
a) Yes 47 51.1 19 76 66 (56.4%) Chi sq. 4.96,
b) No 45 48.9 6 24 51 (43.6%) p=<0.05
3. Involvement in household work
a) Do of her own or Partly assisted 58 63.1 3 12 61 (52.1%)
b) Wholly assisted 27 29.3 5 20 32 (27.3%) Chi sq. 45.1,
c) No responsibility 7 7.6 17 68 24 (20.5%) p=<0.0001
4. Kind of cooperation received from family members
a) Receive co-operation only when asked for 53 57.6 6 22 59 (50.4%) Chi sq. 28.8,
c) Spontaneously co-operate 16 17.4 18 72 34 (29.1%) p=<0.001
d) No cooperation at all 23 25 1 4 24 (20.5%)
5. Sole earning member of family 14 15.2 2 8 16 (13.7%) Chi sq. 0.36,
p>0.05
6. Home stresses more than work 21 22.8 1 4 21 (18.8%) Chi sq.- 3.41,
p >0.05
7. Work disturbed home life 45 48.9 3 12 48 (41%) Chi sq. 9.59,
p <0.01

Home stress contributes significantly to the stress
faced by nurses. Over-all 18.8% of nursing personnel
and 22.8% of ever married nurses opined that for them
home stresses were more than work place stresses
where as over-all 41% of nurses thought that work
place stress disturbed their home of family life.
Detailed conversation (FGD) with them highlights the
following as reasons: prolonged shifts and duty hours
(29%), inability to perform household tasks well (25%),
inability of taking good care of children and carrying
out other responsibilities (18%) and financial matters
(10%). Majority of nurses look after the home, cooking,
cleaning, etc as they cannot afford much domestic
help.
Health and Emotional status of nurses: Table 3 and
table-4 express the physical health status of nurses and
emotional symptoms suffered by nurses respectively.
Problems of being overweight (34.2% among >45 yrs
age group), having musculoskeletal problems
including backache (over-all 44.4%), and suffering from
gastrointestinal disorders including GERD (50.4%),
insomnia (23.9%), chronic headache (21.3%),
palpitation (35%) and hypertension (23.9%) are
common health problems reported in this study.
Emotional symptoms like lack of enthusiasm (49.6%),
anxiety (43.6%), irritability (37.6%), sadness (30.7%) and
tendency to avoid people (38.5%) were common among
nurses in this study.

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 International Journal of Nursing Education. July-December 2013, Vol. 5, No. 2 225

Table 3. Health status of nurses Table 4. Emotional symptoms suffered by nurses

S. No. No. % Emotional symptoms No.(N= 117) %

1. BMIa) < 17.5 b) > 25 0622 5.118.8 Tiredness 43 36.7
2. Musculoskeletal problem 52 44.4 Lack of enthusiasm 58 49.6
3. Gastrointestinal Problem 59 50.4 Absentmindedness 20 17.1
4. Insomnia 28 23.9 Irritability 44 37.6
5. Chronic Headache 29 24.8 Anxiety 51 43.6
6. Hypertension 28 23.9 Depression 36 30.7
7. Diabetes 19 16.2 Loneliness 30 25.6
8. Palpitation 43 36.7 Tendency to avoid people 45 38.5

Work place stressors: Table 5 described common stress level among them.
work stressors as felt by selected respondents and

Table 5. Common work place stressor as felt by Nurses

Stressors Not Stressful Very mild Mild Moderate Severe

Conflict with higher authority 10 35 10 51 11
-8.50% -29.90% -8.50% -43.60% -9.40%
Verbal harassment 12 41 13 47 4
-10.30% -35% -11.10% -40.10% -3.40%
Criticism by physician 27 46 19 21 4
-23% -39.30% -16.20% -17.90% -3.40%
Harassment by patient party 11 49 17 31 9
-9.40% -41.90% -14.50% -26.50% -7.70%
Unpredictable scheduling 25 38 19 30 5
-21.30% -32.50% -16.20% -25.60% -4.30%
Being blamed for anything that goes wrong 17 13 38 47 2
-14.50% -11.10% -32.50% -40.10% -1.70%
Understaffed department and over-work 13 19 13 51 21
-11.10% -16.20% -11.10% -43.60% -17.90%
Lack of opportunity for professional development and training 22 33 21 37 4
-18.80% -28.20% -17.90% -31.60% -3.40%
Watching patient to suffer 30 42 20 19 6
-25.60% -35.90% -17.10% -16.20% -5.10%
Poor salary 16 21 17 45 18
-13.70% -17.90% -14.50% -38.50% -15.40%
Lack of security in work 17 28 19 39 14
-14.50% -23.90% -16.20% -33.30% -11.90%
No appreciation for good work 10 18 33 47 9
-8.50% -15.40% -28.20% -40.10% -7.70%
Experiencing discrimination due to race or ethnicity 92 11 8 5 1
-78.60% -9.40% -6.80% -4.30% -0.80%
Conflict with co-workers 16 31 22 43 5
-13.60% -26.50% -18.80% -36.70% -4.30%
Conflict with sub staffs 70 31 8 7 1
-59.80% -26.50% -6.80% -5.90% -0.80%
Insufficient training 23 24 28 31 11
-19.70% -20.50% -23.90% -26.50% -9.40%
Shifting duty 11 39 16 49 2
-9.40% -33.30% -13.70% -41.90% -1.70%
Fear of making mistake 14 27 22 41 13
-11.90% -23.10% -18.80% -35% -11.10%

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 226 International Journal of Nursing Education. July-December 2013, Vol. 5, No. 2

• Maximum (43.6%) nurses are having moderate
stress towards conflict with higher authority and
work overload, followed by shifting duty (41.9%),
verbal harassments from higher authority (40.1%)
and being blamed for everything that goes wrong.
that 60.7% of nurses were not getting job satisfaction
and 52.1% of them wanted to quit job if better
alternative was available.
DISCUSSION

• Substantial portion of respondents were Stress affecting nurses across the globe has been
moderately stressed due to poor salary (38.5%), convincingly documented in the literature.4 Apart from
conflict with co-workers (36.7%) and lack of work place stress nurses also suffer from stress due to
security of work (33.3%). work-home interface i.e. Competing demands on time
and expectations of work place and home.3 Stress
• 17.9% and 15.4% of respondents were severely
occurs when the capacity to deal with a problem is
stressed due to over- work and poor salary
inadequate. Though a certain amount of stress is
respectively.
required to live and enjoy life, however, unremitting
• Majority of respondents did not experienced stress beyond the individual’s coping capacity causes
discrimination due to race or ethnicity (78.6%) and serious threat to the individual’s physical and
conflict with sub-staffs (59.8%). psychological well-being. Widely available literature
and meta-analysis showed positive correlation
• Maximum respondents were mildly stressed due between job stress and different diseases like addiction,
to harassment by patient party (41.9%) and accident, hypertension, dyslipidemia, diabetes and
watching patient to suffer (35.9%). major and minor depression, disorder, etc.3.
Table 6: Stressors among Nurses (Henry Garrett
Nurses due to the nature of their job are always
ranking)
exposed to high levels of stress. In case of nurses stress
Stressors Total Score Mean Score Ranking can originate both from the workplace and home.
Conflict with higher authority 8523 72.84 IV
According to the present study, understaffed
Verbal harassment 8348 71.35 X
department and over-work, poor salary, no
Criticism by physician 8047 68.78 XV
appreciation for good work, conflict with higher
Harassment by patient party 8295 70.89 XI
authority, fear of making mistake and lack of security
Unpredictable scheduling 8172 69.85 XIII
of work were identified through ‘garrett ranking’ as
Being blamed for anything 8418 71.95 VII
that goes wrong major factors for job stress among women nurses
Understaffed department 8729 74.61 I working at medium size private nursing homes.
and over-work Previous study in Tamilnadu, India also reflected more
Lack of opportunity for 8248 70.49 XII
professional development
or less similar observation9.
and training
Watching patient to suffer 8061 68.89 XIV
For a woman with dual commitment, stress also
Poor salary 8614 73.62 II
originates from home due to several reasons such as
Lack of security in work 8475 72.44 VI prolonged duty hours, especially night duty, inability
No appreciation for good work 8554 73.11 III to look after their children, carrying out family
Experiencing discrimination 7561 64.62 XVII responsibilities etc. As traditional Indian joint family
due to race or ethnicity system is eroding due to change of socio-economic and
Conflict with co-workers 8357 71.43 VII cultural values, majority of nurses belonged to nuclear
Conflict with sub staffs 7649 65.38 XVI
family. Majority of them were poorly paid by their
Insufficient training 8354 71.40 IX
employer (50.4% of them earned <Rs. 5000/- per
Shifting duty 8348 71.35 X
month). More-over 56.4% and 39.3% of them did not
Fear of making mistake 8501 72.66 V
have the right to spend money of her wish and scope
Over all, (Table-6) understaffed department and of recreation respectively. Not only that 52.1% of nurses
over-work, poor salary, no appreciation for good work, were either did their household responsibilities like
conflict with higher authority, fear of making mistake cooking, child care etc. of their own or only partially
and lack of security of work were identified through assisted. 20.5% of them received no co-operation from
‘garrett ranking’ as major factors for job stress among their family members. All this pointed out that though
women nurses working at medium size private the nurses augment the family income, they were not
nursing homes. Focus group discussion also revealed given the same status as that of the men’s’. Denial of

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 International Journal of Nursing Education. July-December 2013, Vol. 5, No. 2 227
rights in any form is definitely a type of deprivation
of liberty, which results in physical or mental torture.
This was reflected by the observation that 22.8% of
married nurses consider home stress was more than
work related stress to them. For unmarried nurses
these pictures were different one as they receive greater
family support, financial freedom and adjustment from
family compared to their married counterparts.
Work stress can be considered as a useful criterion
of organizational performance for hospitals10, because
one of its deleterious effects is reduced job satisfaction,
found to be an indirect cause of absenteeism among
nursing staff 11 . Among the eighteen work place
stressors identified through focus group discussion,
most of the nurses felt ‘understaffed department and
over-work’ , ‘poor salary’ , ‘ no appreciation for good
work’, ‘conflict with higher authority’, ‘fear of making
mistake’, and ‘lack of job security, as major factors for
causing job related stress. Patient care is such an area
which need highly motivated workforce. Excessive job
stress and lack of job satisfaction coupled with family
stress ultimately leads to poor patient care services as
nursing is one of the most vital part of any hospital
services. Every organization should assess the
magnitude of stress and analyze it to recognize the
need for action. This is called a “stress audit.” 12
Hospital managements should address those issues for
better quality of care and patient satisfaction.
CONCLUSION
Stress reduces both quality of life and work.
Nursing is a very sensitive job and nurses must remain
less stressful for public interest. Measures must be
taken by health authorities and by the nursing staff
themselves to reduce stress. Discussion with the
respondents has brought the following points into
focus:
1. Accepting nuclear family as reality in modern
socio-economic context, Govt. should take
initiative to establish community based child care
center or crèche either of their own or through PPP
model for working women.
2. Govt. NGOs and mass media should take greater
initiative to change the attitude of family members
towards working women as well as nursing
professionals.
47. Suman Roy--222--228.pmd 227
3. Hospital authorities should take initiative to
reduce stress among nurses through regular
counseling, health checkup, imparting in service
training and introducing carrier development
schemes, organizing workshops to impart
awareness about dealing stresses and relaxation
techniques etc.
ACKNOWLEDGEMENT
Authors want to acknowledge ‘Foundation for
Developmental Challenges and Social Research’ for
logistic support provided for this work. We also
acknowledge all nurses participated in this study and
authorities of concerned nursing homes for rendering
their helping hand for this study.
Conflict of Interest: None
Ethical Clearance: College of Medicine and JNM
Hospital, Kalyani, West-Bengal.
Source of Funding: Self financed. Logistic support
like vehicle by whenever needed provided
‘Foundation for Developmental Challenges and Social
Research’
REFERENCES
1. European Agency for Safety and Health at Work.
Stress at Work.http://agency.osha.eu.int/
publications/factsheets/facts8. November 2000
2. Wong D, ,Leung S,So C, Lam D. Mental Health
of Chinese Nurses in Hong Kong: The Role of
Nursing Stresses & Coping Strategies. Online
Journal of Issues in Nursing. Vol-6;5(2),2001.
3. Fact sheet; Nursing Matters,International Council
of Nurses(ICN) on Occupational stress and
Threat to Worker Health,2009.
4. Lazarus RS. Psychological stress and coping
process. New York: McGraw-Hill; 1966.
5. J. K. Mojoyinola. Effects of Job Stress on Health,
Personal and Work Behaviour of Nurses in Public
Hospitals in Ibadan Metropolis, Nigeria Ethno-
Med., 2(2): 143-148 (2008).
6. Rowe MM. Hardiness, Stress, Temperament,
Coping and Burnout in Health Professionals and
Hospital Staff. A J Health Behaviour 1997;21(3):
161-171.
7. Stress and Psychiatric Disorder in Healthcare and
Hospital staff. Lancet 2000;355(Feb12):533-37.
8/26/2013, 5:22 PM
 228 International Journal of Nursing Education. July-December 2013, Vol. 5, No. 2
8. Bryant C, Fairbrother.G, Fenten P, The relative
influence of Personal and Workplace Descriptors
on Stress. Brit J.Nurses.2000;9(13):876-80.
9. Dr. M. Eswari, Dr. S. Saravanan. A Study on Job
Stress Among Women Nurses in Coimbatore
City,Tamilnadu. IJRMT, Vol-1,No.2;December
2011: 97-100.
10. Oaklander H. &Fleishman E.A. (1964) Patterns
of leadership related to organizational stress in
hospital settings. Administrative Science
Quarterly 8, 520-532.
47. Suman Roy--222--228.pmd 228
11. Gray-Toft P. & Anderson J.G. (1985)
Organizational stress in the hospital:
development of a model for diagnosis and
prediction. Health Services Research 19, 753-774.
12. Prativa P. Kane Stress causing psychosomatic
illness among nurses: Indian J Occup Environ
Med. 2009 April; 13(1): 28–32.
8/26/2013, 5:22 PM
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