A Cross Sectional Study Evaluating Psychosocial Job Stress and Health Risk in Emergency Department Nurses

Abstract

Nurses experience psychosocial work stress that may negatively affect physical and mental health over time. In this cross-sectional study we investigated prevalence of job stress and oxidative stress in nurses, and determined if significant relationships exist between higher job stress scores and demographic factors and working conditions. Emergency department nurses (n = 42) were recruited from a University Hospital following Institutional Review Board approval. Job stress indicators, effort-reward ratio and overcommitment were evaluated from survey questionnaires using the effort-reward imbalance model, and associations with age, sex, body mass index, and working conditions were measured by logistic regression analysis. Oxidative stress biomarkers, 8-isoprostane, malondialdehyde, and antioxidant levels were measured from urine specimens. Job stress was prevalent with effort-reward ratio > 1 in 93% and overcommitment > 50 in 83% of the study participants. Age, body mass index, years of experience, weekend work, work hours per week, and shift work showed strong associations with effort-reward ratio and overcommitment scores. Malondialdehyde was higher in participants with high overcommitment. We report that psychosocial job stress is prevalent among nurses, as revealed by the high effort-reward and overcommitment scores. Job stress may be reduced through implementation of appropriate stress reduction interventions.

Keywords: effort–reward imbalance; job stress; lipid peroxidation; nurses; oxidative stress.

Figure 1

A flow diagram showing the study design. This study design was adopted following Institutional Review Board (IRB) approval to investigate the impact of psychosocial stress on emergency department nurses in a United States hospital.

Figure 2

Psychometric properties showing effort–reward imbalance (ERI) questionnaires. Effort–reward imbalance survey questionnaires included three effort questions (1–3), seven reward questions (4–10), and six overcommitment questions (1–6).

Figure 3

Flow diagram showing rationale for various statistical methods used for data analysis. Two types of statistical analyses were performed: Descriptive statistics for computing percentage (%), mean, standard deviation (SD), median, range of variables; and analytical statistics: Shapiro–Wilk test was performed to determine normality, Wilcoxon–Mann–Whitney test was used to analyze non-parametric data, and binary logistic regression analysis was performed to measure association between job stress indicators, and independent variables ERR: Effort Reward Ratio; OC: Overcommitment.

Figure 4

Scatter plot showing correlation between overcommitment (OC) and oxidative stress biomarker, malondialdehyde (MDA). OC was determined from the effort–reward imbalance (ERI) questionnaires filled out by study participants (n = 42). Spearman rank correlation showing positive correlation between OC vs. MDA (Rho = 0.13, p = 0.40).

Figure 5

Scatter plot showing correlation between job stress indicators, effort–reward ratio, and overcommitment. Job stress (ER ratio, and OC) was determined from the effort–reward imbalance (ERI) questionnaires filled out by study participants (n = 42). ERR and OC scores were found to be normally distributed. Pearson r correlation was used to define relationship between ERR and OC scores (Pearson r correlation = 0.38, 95% CI 0.087–0.614, p = 0.01).

Figure 6

Graphical representation comparing malondialdehyde level in high and low overcommitted nurses. Malondialdehyde (MDA) was measured in the urine samples of the study participants and compared (OC > 50 vs. OC ≤ 50; p < 0.04) using Mann–Whitney test.

Figure 7

Graphical representation comparing 8-isoprostane levels in day shift and night shift female nurses. 8-isoprostane (8-IsoP) levels were measured in the urine samples and compared (female day shift nurses vs. female night shift nurses; p < 0.001) using Mann–Whitney non parametric test. A significant difference was observed in 8-IsoP levels between female day shift and night shift nurses (p < 0.001).