Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 20;78(2):e20240282.
doi: 10.1590/0034-7167-2024-0282. eCollection 2025.

Stress and fatigue in nurses in critical care units and their association with salivary cortisol

[Article in English, Portuguese]
Dnieber Chagas de Assis  1 , Deisy Vivian de Resende  1 , Robinson Sabino-Silva  1 , Maria Helena Palucci Marziale  2
Affiliations

Stress and fatigue in nurses in critical care units and their association with salivary cortisol

[Article in English, Portuguese]
Dnieber Chagas de Assis et al. Rev Bras Enferm. .

Abstract
in English, Spanish

Objectives: to evaluate the association between stress, fatigue and salivary cortisol levels in nurses working in emergency units (EU) and surgical units (SU).

Methods: cross-sectional study conducted in two university hospitals with participation of 66 nurses. The Nursing Stress Inventory and the Fatigue Assessment Scale were applied, and saliva samples were obtained to determine cortisol concentration.

Results: high levels of stress and fatigue were observed in 50.8% and 46% of the professionals, respectively. Nurses in EU had higher levels of stress and fatigue and lower secretion of salivary cortisol during the work shift compared to nurses in the SU, without statistical significance. Cortisol secretion in the morning period was correlated with fatigue (ρ=0.25 and p=0.04).

Conclusions: the results suggest a dysregulation of the hypothalamic-pituitary-adrenal axis in nurses from the EU and a significant correlation between fatigue and cortisol secretion in the morning period.

Objetivos:: evaluar la asociación entre estrés, fatiga y niveles de cortisol salival en enfermeros de unidades de emergencia (UE) y quirúrgica.

Métodos:: estudio transversal en dos hospitales universitarios con 66 enfermeros. Se aplicaron el Inventario de Estrés en Enfermeros y la Escala de Evaluación de la Fatiga, y se obtuvieron muestras de saliva para determinar la concentración de cortisol.

Resultados:: se observaron niveles elevados de estrés (50,8%) y fatiga (46%) en los profesionales. Los enfermeros de las UE presentaron niveles más elevados de estrés y fatiga y menor secreción de cortisol salival durante el turno de trabajo en comparación con los enfermeros de la unidad quirúrgica, sin significancia estadística. La secreción de cortisol por la mañana se correlacionó con la fatiga (ρ=0,25 y p=0,04).

Conclusiones:: los resultados sugieren una desregulación del eje hipotálamo-hipofisario-adrenal en enfermeros de la UE y una correlación significativa entre la fatiga y la secreción de cortisol por la mañana.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Mean salivary cortisol concentration throughout the workday, Ribeirão Preto, São Paulo, Brazil, 2023
Figura 1
Figura 1. Concentração média de cortisol salivar ao longo do dia de trabalho, Ribeirão Preto, São Paulo, Brasil, 2023
See this image and copyright information in PMC

References

    1. Kudielka BM, Buchtal J, Uhde A, Wüst S. Circadian cortisol profiles and psychological self-reports in shift workers with and without recent change in the shift rotation system. Biol Psychol. 2007;74(1):92–103. doi: 10.1016/j.biopsycho.2006.08.008. - DOI - PubMed
    1. Assis DC. Associação da expressão circadiana do cortisol de enfermeiros segundo trabalho em turnos, estresse ocupacional e fadiga. Ribeirão Preto: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo; 2018. p. 185. [dissertation] - DOI
    1. Chahbounia R, Gantare A. Managing Occupational Health Issues through Coaching, Emerging Perspectives from Emergency and Intensive Care Nurses: A Mixed-Method Study. Nurs Rep. 2023;13(3):1077–1089. doi: 10.3390/nursrep13030094. - DOI - PMC - PubMed
    1. Gerding T, Wang J. Stressed at Work: investigating the relationship between occupational stress and salivary cortisol fluctuations. Int J Environ Res Public Health. 2022;19(19):12311. doi: 10.3390/ijerph191912311. - DOI - PMC - PubMed
    1. Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and Factors Associated With Nurse Burnout in the US. JAMA Netw Open. 2021;4(2):e2036469. doi: 10.1001/jamanetworkopen.2020.36469. Erratum in: JAMA Netw Open. 2021 Mar 1;4(3):e215373. Erratum in: JAMA Netw Open. 2023;6(4):e2312593. - DOI - PMC - PubMed