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Revista Ecuatoriana de Ciencia, Tecnología e
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Navas L., Humberto W., Impact
of occupational stress on nursing
professionals who provide
hospital care. Original Article.
INSPILIP. 2023; Vol. 7, Spec.
Num.
Scientific magazine INSPILIP.
Volume 7, Special Number
November 2023
The author declares to be free of any
personal or commercial association
that may involve a conict of interest
in connection with the article, as
well as having respected the ethical
principles of research, such as having
requested authorizations from the
institution where the study was
conducted, permission to use the data,
informed consents and in the case of
observational studies and clinical
trials, authorization from a CEISH,
ARCSA, Environment, among
others, according to the category. In
addition, the license to publish images
of the person or persons appearing in
the manuscript. Therefore, INSPILIP
is not responsible for any aectation
to third parties, neither INSPI as
publishing entity, nor the Editor, the
responsibility of the publication is of
absolute responsibility of the authors.
Patricio Vega Luzuriaga
EDITOR-IN-CHIEF
iD
Navas-Fonseca Lizeth
a
, lnavas0010@uta.edu.ec
iD
Jiménez-Hurtado William
a
, * wa.jimenez@uta.edu.ec
a. Technical University of Ambato, Nursing Career. Ambato, Ecuador.
*Correspondence: William Jiménez Hurtado, Email: wa.jimenez@uta.edu.ec
Identication of the responsibility and contribution of the authors: The authors declare
having contributed in the original idea (LNF, WJH), study design (LNF, WJH), data collection
(LNF), data analysis (LNF, WJH), draft writing and article writing (LNF, WJH).
Date of Entry: 13/09/2023.
Date of Aproval: 30/11/2023.
Date of Publication: 30/11/2023.
Impact of occupational stress on nursing professionals who provide hospital care
Impacto del estrés laboral en los profesionales de enfermería que otorgan cuidados hospitalarios
Original Article
Open Access
Abstract
Citation
Introduction: One of the factors such as excessive working hours in nursing
professionals poses a risk to their professional health, likely aecting the quality
and productivity of the service provided. Objective: To determine the impact
of job stress on part-time nursing professionals at the Technical University
of Ambato. Methodology: A descriptive, non-experimental cross-sectional
study was conducted. A survey was administered using the Spanish version of
the Nursing Stress Scale (NSS) during July 2023. All part-time nursing sta
working at the Technical University of Ambato as clinical instructors (n=50)
were included. Data such as age and hospital work service were considered.
Full-time nursing sta were excluded. Results: The surveyed nursing
professionals predominated in services such as Operating Room 18% (n=9),
Emergency 12% (n=6), Neonatology 12% (n=6), and Surgical Hospitalization
10% (n=5), with an average age of 38.6 years (Min 24 - Max 59). Regarding the
determination of job stress based on evaluated stressors, scores characterized
as "sometimes" predominated with 54% (n=27), followed by "never" with 26%
(n=13), "frequently" with 16% (n=8), and nally "very frequently" with 4%
(n=2). Conclusion: Stress related to disagreement with a patient's treatment
was found to have a signicant impact on the job stress of nursing professionals.
Keywords: Job Stress, Nursing, Health Impact Assessment.
DOI: 10.31790/inspilip.v7i22.551
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Resumen
Introducción: Uno de los factores como la carga
horaria laboral excesiva en los profesionales
de enfermería, resulta un riesgo para la salud
profesional con probable afección en la calidad
y productividad del servicio brindado. Objetivo:
Determinar el impacto del estrés laboral en los
profesionales de enfermería contratados a medio
tiempo en la Universidad Técnica de Ambato.
Metodología: Se realizó un estudio descriptivo, no
experimental transversal. Se aplicó una encuesta
con la Escala de estresores laborales versión
española Nursing Stress Scale (NSS), durante el
mes de julio de 2023. Se incluyó a todo el personal
de enfermería que labora medio tiempo en la
Universidad Técnica de Ambato como docentes
de práctica hospitalaria (n=50). Se consideraron
datos como edad y servicio de labores hospitalarias.
Se excluyó al personal de enfermería de tiempo
completo. Para determinación de la frecuencia
y porcentaje del estrés laboral. Resultados:
Los profesionales de enfermería encuestados
predominaron en los servicios como Quirófano 18
% (n=9), Emergencia 12 % (n=6), Neonatología
12 % (n=6) y Cirugía Hospitalización 10 %
(n=5), con una edad promedio de 38,6 años
(Min 24 – Max 59). La determinación del estrés
laboral según los estresores evaluados predominó
el puntaje caracterizado como “alguna vez” con
el 54 % (n=27), seguido del puntaje “nunca”
con el 26 % (n=13), puntaje “frecuentemente”
con el 16 % (n=8) y nalmente el puntaje “muy
frecuentemente” con el 4 % (n=2). Conclusión:
El estresor sobre el desacuerdo con el tratamiento
de un paciente se relacionó y causo mayor
impacto en el estrés laboral de los profesionales
de enfermería.
Palabras clave: Estrés Laboral, Enfermería,
Evaluación del Impacto en la Salud.
Introduction
The nursing profession plays an important role
in medical and hospital care. Nurses assume
responsibilities that include providing direct patient
care, administering medications, monitoring
vital signs, performing medical procedures, and
providing emotional and health education to
patients and their families, establishing them as
essential components of medical teams.
In addition to their direct role in patient care,
nurses signicantly contribute to improving access
to and the quality of healthcare through close
collaboration with other healthcare professionals
to ensure comprehensive and coordinated care,
especially in hospital settings where patients have
complex medical and emotional needs.
The nursing profession faces signicant challenges
that must be addressed to ensure the continuity
and improvement of patient care. Workplace
conditions, such as workload and stang
availability, can have a direct inuence on the
quality of care provided. Studies have shown that
poor working conditions impact nurses' morale,
sta retention, and patient safety. Forty-four
percent of nursing sta have reportedly left the
profession due to working conditions, with 27%
expressing dissatisfaction with the level of patient
care provided. Workplace dissatisfaction and
patient distress have also been linked to decreased
quality of care and patient satisfaction.
These occupational challenges result in increased
work stress and tension, particularly among
healthcare professionals in hospitals, with
negative consequences for physical and emotional
well-being. Workplace stress can be caused by
various factors, including task overload, unrealistic
deadlines, lack of adequate resources, insecurity,
a toxic environment, and lack of control over
working conditions. In this context, it is essential
to address working conditions such as stress
associated with health status and the productivity
of professionals and, consequently, the quality of
healthcare.
Although there are few studies evaluating the
overall prevalence of occupational stress among
nursing professionals in Latin America, the
available evidence suggests that occupational
stress is a signicant problem in the region. For
example, in Brazil, it was found that 70% of
healthcare professionals reported experiencing
occupational stress, while in Mexico, a prevalence
of 60% with high levels of occupational stress was
reported. These gures contradict the assertion
that occupational stress in nursing is limited in
Latin America. Rather, although scarce, studies
demonstrate that occupational stress aects a
signicant proportion of nursing professionals in
Latin American countries.
Ecuador is a country where 54% of individuals
experience general stress, resulting from various
factors prevalent in dierent establishments,
primarily in healthcare settings. These factors
are recognized by the World Health Organization
(WHO), including unpleasant or monotonous
tasks, excessive workload, lack of resources
to supply the workplace, inadequate supplies
for patient care, poor relationships among
professionals, among others. These reports lead
to a serious deterioration in the productivity of
healthcare professionals who have direct contact
DOI: 10.31790/inspilip.v7i22.551
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Revista Ecuatoriana de Ciencia, Tecnología e
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Código ISSN 2588-0551
with patients, such as those in the nursing eld.
In Ecuador, several studies show that healthcare
workers face situations that increase stress levels,
such as the level of responsibility in hospitals, the
presence of noise, inadequate lighting, insucient
space to perform daily tasks, lack of sta to
cover various areas, poor communication with
colleagues, and insucient patient information.
Additionally, high levels of stress have been found
among nurses. It is estimated that at the hospital
level, 29.8% of nurses experience high levels of
stress, with excessive workload and exposure to
patient suering and death being the main stressors.
Furthermore, in a study across several Latin
American countries including Ecuador,
approximately 60% of nurses reported experiencing
signicant levels of occupational stress, mainly
related to workload overload, sta shortage, and
inadequate working environment.
In the workplace, there is a level of stress
generated by the dierent activities and demands
in each position, with the healthcare sector shown
to have higher stress levels. Due to multiple
stressful factors, burnout syndrome, also known as
occupational burnout syndrome, can be triggered.
This syndrome appears as a response to prolonged
pressure generated in the workplace. Both stress
and burnout syndrome are situations that personnel
experience during their working hours; however,
they do not refer to the same thing. Stress describes
temporary processes, whereas burnout syndrome
is the response to chronic stress manifested by
negative attitudes towards one's own work.
The eects of occupational stress vary among
healthcare professionals and negatively impact
their well-being and performance. High levels
of stress have been observed in hospital nurses;
however, studies evaluating their prevalence and
impact in Ecuador are scarce. Therefore, this study
aimed to determine the impact of occupational
stress on nursing professionals providing hospital
care. The research question was: What are the
main occupational stressors and their prevalence
among the studied nurses? This was conducted
using the application of the Nursing Stress Scale
(NSS) Spanish version.
Methodology
A descriptive study with a non-experimental
quantitative approach was conducted. A survey
on the impact of occupational stress in providing
hospital care was administered during the month
of July 2023. The sample included all part-time
nursing sta working at the Technical University
of Ambato (n=50) as clinical practice instructors.
Demographic data such as age and the department
where they carried out their daily duties were
collected. Full-time nursing sta were excluded
from the study.
The Spanish version of the Nursing Stress Scale
(NSS) was applied to determine the frequency and
percentage of occupational stress. However, this
study focused on evaluating occupational stress
rather than Burnout Syndrome, as they are related
but distinct concepts. Occupational stress describes
a temporary process of tension in response to
work stressors, while Burnout Syndrome is a
prolonged response to chronic stress manifested
in exhaustion, depersonalization, and reduced
personal accomplishment.
Data collection and evaluation of occupational
stress in nursing sta utilized the NSS scale
physically, created in 1998 by Pamela Gray-Toft
and James G. Anderson. This scale measures
the frequency of stressful situations for hospital
nursing sta, consisting of 34 items. Scores range
as follows: never (0), sometimes (1), frequently
(2), very frequently (3), with a total score ranging
from 0 to 102 points. It has a Cronbach's alpha
above 0.8, validating the feasibility of the
instrument's application.
The scale, along with the description of each
stressor and its scores, is available at the
following link: https://drive.google.com/le/
d/19YSFd2wONISrNdYL1hewnZgu281NY6-p/
view?usp=sharing.
Statistical analysis
The collected data were digitized into Microsoft
Excel 2019 and processed using the statistical
platform SPSS version 27. Frequencies and
percentages were calculated for categorical
variables, and measures of central tendency were
calculated for continuous variables.
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Ethical considerations
This research adhered to the ethical principles
of the Declaration of Helsinki. Additionally,
the study was reviewed by the Research Ethics
Committee for Human Subjects at the Technical
University of Ambato, with approval letter
080-CEISH-UTA-2023, dated April 20, 2023.
Results
According to the analysis conducted, nursing
sta predominated in the areas of Operating
Room, Emergency, Neonatology, Surgery and
Hospitalization, comprising 52% (n=26), with an
average age of 38.6 years, ranging from a minimum
of 24 years old to a maximum of 59 (Table 1).
The determination of occupational stress according
to the evaluated stressors was predominantly
characterized as "sometimes" with 54% (n=27),
followed by "never" with 26% (n=13), "frequently"
with 16% (n=8), and nally "very frequently"
with 4% (n=2) (Table 2). In the study, the factors
that inuenced the onset of occupational stress
were identied. With a score of 1 (sometimes),
stressor 14 (disagreement with patient treatment)
predominated with a percentage of 80% (n=40).
With a score of 2 (frequently), stressors 3
(performing nursing care that is painful for patients),
4 (feeling powerless in cases of no improvement in
patients), and 20 (fullling nursing role in other
services due to sta shortage) predominated, each
with percentages of 36% (n=18). With a score of
3 (very frequently), stressors 6 (mentioning or
hearing about the possible death of a patient) and
28 (not having enough time to provide emotional
support to users) predominated, with a percentage
of 30% (n=15) each (Table 2).
Discussion
The present study was conducted among part-time
nursing sta, and according to the results, the
reasons for the sta experiencing work stress
can be explained by analyzing the main stressors
identied in this study.
The most prevalent stressor was disagreement
with patient treatment, reported by 80% (n=40)
of the surveyed nurses. This could be attributed
to the perception among professionals that the
prescribed treatments are not the most suitable
or that there are better alternatives, leading to
frustration and powerlessness in not being able to
modify therapeutic decisions.
Other signicant stressors included performing
painful procedures and witnessing suering in
patients without apparent improvement, reported
by 36% (n=18) each, as well as feeling powerless
in the face of patients' lack of improvement, also
reported by 36% (n=18). These ndings reect the
distress experienced by nursing sta in response
to the suering and deterioration of patients under
their care.
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Likewise, covering nursing duties in various
services due to sta shortages was reported as a
stressful factor by 36% (n=18) of respondents.
This indicates issues with stang levels and an
excessive workload distributed across various
hospital areas.
On the other hand, 30% (n=15) stated that
mentioning or witnessing patient deaths and
not having time to provide emotional support
impacted their occupational stress. This highlights
the emotional burden of caring for seriously ill or
terminally ill patients.
It is evident that nursing sta are a group of
healthcare professionals who frequently experience
high levels of stress due to the nature of their work.
They may be subjected to stressful situations such
as assessing severely ill or traumatized individuals,
making rapid and critical decisions, handling
excessive workloads, task rotation, and resource
shortages. Therefore, nursing work proves to be a
challenge that tests the knowledge, autonomy, and
skills of the professional, decreasing their coping
capacity in various situations encountered in the
workplace.
In a study conducted in 2018 with 43 nursing
professionals at the Montilla Hospital (Spain),
titled "Burnout Syndrome in Nursing Sta:
Association with Hospital Environment
Stressors," the Occupational Stressors Scale and
the Maslach Burnout Inventory-Human Services
Survey (MBI-HSS) were used. The results
reect that the dimension of depersonalization
on the scale (MBI-HSS) is inuenced by hospital
stressors (NSS), where the most common ones
are: death and suering, workload, uncertainty
regarding treatment, hierarchy issues, inadequate
preparation, lack of support, not knowing how
to handle equipment properly, problems among
nursing sta, temporary shifts to other services
with sta shortages, thus demonstrating that
burnout syndrome is related to the stressors
mentioned above, which vary according to the
service in which healthcare professionals work.
This research aligns with the present study, as both
nd that the main stressors for nursing sta are
related to workload, disagreement with treatments,
problems among colleagues, and service changes.
In particular, the stressor regarding disagreement
with patient treatment was one of the most
prevalent in our study, consistent with the ndings
of the 2018 study.
On a global scale, the prevalence of work stress
among nurses varies, although it is believed to
be highest. Work stress levels among nurses
have been recorded in several countries, such as
in northwest Egypt, at 29.2%, and in Wollega,
Western Ethiopia, with values exceeding 29.8%.
In other nations, work stress rates among nurses
also vary. In Addis Ababa, Ethiopia, a prevalence
of 37.8% has been reported, while in Arsi Zone,
central Ethiopia, it was 53%. In East Gojjam Zone,
northwest Ethiopia, a prevalence of 57.3% was
reported, and in Harar, eastern Ethiopia, it reached
66.2%. Outside of Ethiopia, a prevalence of 74%
was reported in Botswana, 87.4% in Delhi, 56.5%
in Slovenia, 75% in Iran, and 45.5% in Saudi
Arabia (13).
Hence, the results of this study are consistent
with recent research reporting high levels of
occupational stress among Ecuadorian nurses,
primarily associated with excessive workload
and nursing sta shortages. For example, a study
in 2019 found a prevalence of 29.8% of high
work stress among hospital nurses in Guayaquil,
identifying excessive workload and exposure
to patient suering/death as the main stressors.
Likewise, the shortage of nurses relative to the
population has been identied as a relevant factor
in the occurrence of work stress.
Conclusions
In conclusion, the impact of work stress on part-
time nursing professionals providing hospital care
was not very signicant according to the results of
the present study. This is because the frequency of
stress characterized as "sometimes" prevailed in
54% of the responses, indicating a moderate level.
The stressor related to disagreement with patient
treatment was identied and predominated
among the work stressors in the studied nursing
professionals. This addresses the objective of
identifying the main stressors in this group.
When examining specic hospital areas,
Operating Room, Emergency, Neonatology, and
Hospitalization emerged as the zones with the
highest frequency of surveyed professionals and
recorded higher scores of work stress. This nding,
aligned with the objective of recognizing critical
areas of work stress, oers valuable insights for
management and eective intervention in hospital
environments.
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This study suggests, based on the results found,
that the survey should be applied to full-time
operational sta who are in direct contact with
patients. Ultimately, these results underline the
need to specically address stress derived from
disagreements in patient treatments and highlight
the importance of implementing support strategies
in areas identied as most prone to generating work
tensions. This analysis provides a solid starting
point for the design of personalized interventions
aimed at improving well-being and work quality
in these critical areas, thereby contributing
to a healthier and more sustainable working
environment for part-time nursing professionals.
Peer Review
The manuscript underwent blind peer review and
was promptly approved by the Editorial Team of
the INSPILIP journal.
Availability of Data and Materials
The data supporting this manuscript are available
upon request to the corresponding author.
Conicts of Interest
The authors declare no conicts of interest.
Funding
Self-funded by the authors.
Acknowledgments and Contributors
The authors express gratitude to the INSPILIP
Scientic Digital Journal for its openness to
academic scientic contributions from our country.
Translator's Note: I, Jean Louis León S., have
translated this academic document from Spanish
to English to facilitate its accessibility to a wider
audience. While every eort has been made
to ensure accuracy and delity to the original
text, any discrepancies or errors are solely my
responsibility. Should there be any questions or
concerns regarding the translation, please feel
free to contact me at jeanlleons2005@gmail.com.
Thank you for entrusting me with the translation
of this document.
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