The 3rd JNC international Conference The Heart of the Matter: Relevance of Nursing Responsiveness Job Stress Factors and Situations among Jordanian Staff Nurses at Governmental Hospitals Rufaida Al-Aslamiah College for Nursing and Midwifery Omaymah Al-Rajaby , RN,MSN Nursing “Presenter “ Ebtisam Haddad , RN,MSN Nursing Fawziah Ass'sd, RN,BSN Nursing Zeinab Al-Kurdi , RN,BSN Nursing Nida'a Al-Anani ,BA English Language “Proofreader” Luwiza Tuqan , BSC Computer Science “Print and Electronic Computer Services” Kamal Sahawneh , BSC Public And Environmental Sciences

Purpose The purpose of the study was to explore the major sources of job stress experienced by nurses working at MOH hospitals and its relationship to selected demographic variables and stress outcome.

Background According to MOH Statistics 2009 There are 12726 male and female staff nurses ,1985 midwives are working in different hospitals in Jordan , but 3036(24%) of the total number of staff nurses and 1203(60.6%) midwives are working at governmental hospitals The percentage of staff nurses and midwives for every 10.000 Jordanians is 21.28 staff nurses and 3.32 midwives

According to The Jordanian Nurses and Midwives Council statistics 2007 The documented work place violence cases are 33 male and female staff nurses and 3 midwives are exposed to physical violence at the governmental hospitals Otherwise , there are 4503(47%) about half of the total number of staff nurses and 36 midwives are working abroad Such alarming statistics (staff turn over , shortage of staff nurses and work place violence ) reflect the significance of the study

Significance of Study The study will provide a valuable information for nurses at different levels (administration , education and practice ) to deal with the problem of work-place stress.

Research Questions What are the psychological environmental factors that contribute to nurses' job stress? What are the social environmental factors that contribute to nurses' job stress ? What are the physical environmental factors that contribute to the nurses' job stress? What is the relationship between job stress and the selected respondents’ demographic variables; age, sex, marital status , job title , educational level, salary, practice area, experience, working shift, Unit department? What is the relationship between job stress and the anticipated outcomes ?

Design and Sample Descriptive, Cross-sectional Survey Design was used. A cluster sampling technique was used to select the sample. Three clusters were identified: north, middle, and south of Jordan. Simple random sample was used to identify the hospitals then a convenient sample of 436 registered nurses (RNs) was included in the study. Response rate was 87.2%  

Instrument and Data Collection A structured questionnaire consisted of three parts, 40 items divided into three stress sources categories, physical environment, social environment and psychological environment : Part one composed of 10 demographic questions, Part two “Nursing Stress Scale (NSS)” (Gray-Toft & Anderson, 1981) after modification with four responses on a Likert scale: “never stressful =1, occasionally stressful=2 , frequently stressful=3, very stressful=4)“.Part three is related to “outcomes of job stress” consisted of nine stress outcomes with two responses “no=1 and yes=2”.

Reliability & Validity Reliability of whole scale was measured by using the co-efficient alpha; it was (R=0.82), while the Reliability of the original scale (NSS) (Gray-Toft & Anderson, 1981) was (R=0.89). To examine the content validity of the instrument, a panel of three experts in nursing field were consulted, modifications were done according to their feedback . Moreover, a pilot study was conducted with 23 participants to determine the clarity of instrument, feedback indicated that the instrument was clear to the respondents.

Results

Distribution of Nurses by Demographic Variables % Nurse Position Head Nurse Midwife Supervisor Staff Nurse 36 14 49 324 8.5 3.3 11.6 76.6 Working Area Medical Surgical Maternal ICU-CCU Emergency Pediatric Mental Health 76 78 40 97 37 30 23 19.9 20.5 10.5 25.5 9.7 7.9 6.0 Years of Experience Less Than 5 years 5 – 10 years 11- 16 years Over 16 years 193 116 44 44.8 26.9 18.1 10.2 Working Shift A Shift B Shift C Shift Always Change 192 19 25 183 45.8 4.5 43.7

Distribution of Nurses by Types of Stress Stressors Mean SD Physical Environment 2.77 0.64 Work Load 0.71 Work Condition 0.69 Psychological Environment 2.64 0.55 Death & Dying Issues 2.67 0.72 Lack Of Administrative Support 2.51 0.79 Uncertain Concerning Treatment 2.50 0.67 Emotional Conflict 2.22 0.76 Social Environment 2.58 0.57 Conflict With Physician 2.65 Conflict With Supervisor 2.48 0.85 Conflict With Administrator 2.45 Nurse –Nurse Conflict 2.06 0.86 Over all stress

Differences in Gender Mean Scores Regarding Different Sources Of Stress P-Value T Mean Stressor 0.0001 3.83 Physical Environment 2.86 Female 2.62 Male 0.049 1.98 Social Environment 2.621 2.509 0.018 2.37 Psychological Environment 2.68 2.55 0.004 2.87 Over all stress 2.71

Psychological Environment Differences In Working Unit Means Scores Regarding Environmental Stress Over All Psychological Environment Social Environment Physical Environment F=3.003 F=2.822 F=2.698 F=3.016 P-Value=0.007 P-Value=0.011 P-Value=0.014 Mean Unit 2.59 2.60 2.54 2.68 Surgical 2.77 2.71 2.85 Maternity 2.80 2.79 2.95 ICU-CCU 2.51 2.49 2.44 2.65 Emergency 2.58 2.55 2.47 Pediatric 2.72 2.69 3.04 Mental Health

Differences in Working Hospital Mean Scores Regarding Environmental Stress Over All Social Environment Physical Environment F=2.550 F=2.535 F=2.626 P-Value=0.027 P-Value=0.028 P-Value=0.024 Mean Hospital 2.71 2.63 2.85 Al-Basheer 2.76 2.88 Al-Zarka 2.50 2.49 2.58 Al-Eman 2.70 2.81 Al-Karak 2.79 2.69 3.04 Al-Fuhais 2.56 2.44 Prinice Faisall

Differences in Nurses' Income Mean Scores Regarding Environmental Stress Over All Social Environment Physical Environment Salary F=3.448 F=4.895 F=2.991 P-Value=0.033 P-Value=0.008 P-Value=0.051 Mean 2.49 2.38 2.58 200-299 JD 2.65 2.78 300-499 JD 2.75 2.70 2.87 500 JD & over

NOTE: No Significance result with Education, shift ,age and marital status but with overall 5 years experience the nurses perceived high level of stress

Results of Stepwise Linear Regression P-Value T Beta Overall Stress 0.15 0.012 2.45 0.122 Having No Social Life F=5.99 P-Value=0.015 Physical Environment 0.021 0.004 2.92 0.144 Not Satisfied with Your Job F=8.54 P-Value=0.004 Social Environment 0.18 2.51 0.124 Having no Social Life 0.028 0.040 1.06 0.102 Planning to Change Job F=5.83 P-Value=0.003

Limitation The study was being applied only for governmental hospitals so we recommended the following :

Recommendation Replication of the study to the other health sectors besides focusing on hospitals and units which found to be highly stressed Applied stress management, mentorship and preceptorship programs in clinical areas Improving communication skills and leadership management style Implementing recognition strategies in clinical areas Integrating stress management program into nursing curriculum for undergraduate students

Conclusion This study suggests that nurse administrators should assess the different types of work stress and put a strategy plan in order to eliminate or reduce the physical, social, and psychological sources of stress and consequently build stress management programs for nursing staff.

Rufaida Al-Aslamiah College for Nursing and Midwifery

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