Introduction
Job stress refers to the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker [1]. It is a complicated biopsychosocial response and a major concern in workplaces [2]. Existing literature has demonstrated that nurses’ job stress can stem from nursing profession and work-related problems, time allocation and workload problems, work environment and instrumentation problems, patient care problems, and management and interpersonal problems [3]. Therefore, this study assessed the job stress of nurses in these aspects. Due to serious patient conditions, interpersonal conflicts with doctors or colleagues, workplace violence involving patients or their relatives, and excessive workload, nursing is frequently regarded as a stressful profession [4]. Evidence has even shown that nurses have higher occupational stress levels than other health workers, including physicians [5]. The prevalence of nurses’ job stress has been reported to be as high as 45% [6]. Most studies have indicated that nurses work under medium to high stress levels [3, 4, 7, 8]. While moderate levels of stress can stimulate personal potential, excessive job stress can cause a plethora of adverse outcomes for nurses, such as reducing general well-being, lowering job satisfaction, elevating turnover rates, decreasing job performance, and making them more susceptible to negative emotions and occupational burnout [9‐11]. The emergence of negative emotions such as anxiety will, in turn, further aggravate nurses’ job stress, creating a vicious cycle that not only hinders their personal, family, and professional lives but also jeopardizes patient safety [7, 10, 12]. Given the importance of job stress among nurses, it is crucial to identify potential profiles of nurses’ job stress and further explore the predictors of different profiles to develop effective strategies to improve nurses’ job stress.
Background
The level of nurses’ job stress and its related demographic factors
Most studies reported that the job stress levels of nurses were above medium [3, 4, 7, 8]. Specifically, the mean scores of nurses’ job stress were 2.77 (SD = 0.54) and 2.92 (SD = 0.70) as measured by the Expanded Nursing Stress Scale (job stress is defined as an interactive phenomenon between job conditions and working persons, leading to changes in both psychological and physiological status) [4, 13] and the Nursing Job Stressor Inventory (job stress refers to a state of physical and mental imbalance caused by various needs and physical and psychological incompatibility in nursing work) [8, 14], respectively. Demographic factors, such as age, gender, education level, nurse’s department, marital status, work years, average monthly number of night shifts, and income, are crucial factors in the heightened stress levels observed among nurses [4, 11, 15, 16]. Specifically, nurses who identify as female, have a bachelor’s degree, are single, possess less work experience, or have poor health are more stressed at work [11, 17, 18]. Additionally, those working in ICU and emergency departments encounter more stressors than others [4]. Notably, nurses who dislike their profession tend to experience emotional burnout and thus endure greater job stress [18]. Nonetheless, the current studies have not adequately considered population heterogeneity.
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The relationship between nurses’ job stress and generalized anxiety disorder
Generalized anxiety disorder (GAD) is a common disorder with chronic, pervasive anxiety and worry accompanied by nonspecific physical and psychological symptoms such as restlessness, fatigue, irritability, or sleep disturbances [19]. One study revealed that 24.7% of nurses experienced a state of anxiety [10]. In another study, anxiety was prevalent among nurses during COVID-19, with up to 49.7% experiencing moderate or above anxiety [20]. Various studies have shown that nurses are susceptible to anxiety, which can significantly predict their stress levels [21]. The more pronounced the anxiety, the more stress the nurse feels [7]. Current research has only focused on the interaction between overall stress and anxiety, ignoring the fact that different levels of stress may correspond to distinct anxiety states, which needs to be further explored.
The relationship between nurses’ job stress and job performance
Job performance is defined as the expected actions and behaviors of individuals to meet organizational goals over an established period of time [22]. Nurse job performance determines the outcome of healthcare delivery, and excellent nursing performance ensures that patients receive appropriate care, reduces unnecessary treatments and procedures, prevents readmissions, etc [23‐25]. According to previous studies, job performance is negatively related to job stress [12, 26]. Nevertheless, little evidence has studied how job performance could affect job stress levels, necessitating additional exploration to better understand these associations.
In summary, recent studies mainly focused on the overall level of job stress and its related factors, ignoring the population heterogeneity of nurses’ job stress. Therefore, this study aims to (1) undertake a latent profile analysis to segment the nursing population into distinctive groups with different job stress levels and (2) investigate the factors that predict job stress among nurses, thereby proposing targeted interventions geared toward reducing job stress among nurses.
Methods
Design
A cross-sectional design was used in this study.
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Participants and setting
Snowball sampling was used to recruit participants through head nurses at a Grade-A tertiary hospital in southeast China from March 2023 to April 2023. Eligible nurses were given internet questionnaires through the online survey platform “Questionnaire Star” (https://www.wjx.cn) to reduce the risk of infection during the influenza A outbreak. The inclusion criteria for participants were as follows: (1) have a Chinese registered nurse license; (2) be employed full-time; and (3) have volunteered to participate in this study. The main statistical method used in this study was latent profile analysis (LPA). Previous studies showed that at least 300–500 samples were required for LPA [27]. Accordingly, 440 nurses were recruited and met the sample requirements of this study.
Measures
The demographic characteristics Questionnaire
The demographic characteristics questionnaire was devised by the research team and included gender, age, education level, marital status, work years, ward of affiliation, average monthly income, average monthly number of night shifts, health status, and professional attitude.
The nursing job Stressor Inventory (NJSI)
The NJSI [3] was developed by Li and Liu to measure the job stress of nurses. The scale consists of 35 items, including 5 domains: nursing profession and work-related problems (7 items), time allocation and workload problems (5 items), work environment and instrumentation problems (3 items), patient care problems (11 items), and management and interpersonal problems (9 items). Each item is designed as a 4-point Likert scale (1 = never encountered or experienced and 4 = encountered or experienced almost every day). The total mean score is the average of the sum of the scores for each dimension, with higher scores indicating greater stress. The Cronbach’s α of each dimension and the overall scale were within the range of 0.83 to 0.98 [3]. In this study, the Cronbach’s α of each dimension and the overall scale ranged from 0.607 to 0.923.
The generalized anxiety disorder 7-item Scale (GAD-7)
The GAD-7 [28] was developed by Spitzer et al. and translated into Chinese by He et al. [29], which was used to screen for anxiety and assess its severity. The scale was unidimensional and consisted of 7 items. It had a 4-point Likert structure and was scored from 0 (not at all) to 3 (nearly every day). The total score ranged from 0 to 21, with higher scores indicating higher levels of anxiety. A score of 10 or greater on the GAD-7 represents a reasonable cut point for identifying cases of GAD. Cut points of 5, 10, and 15 might be interpreted as representing mild, moderate, and severe levels of anxiety on the GAD-7 [28]. The Cronbach’s α of this scale was 0.856 [29], and the Cronbach’s α was 0.926 in this study.
The nurse job performance scale (NJPS)
The NJPS [30] was developed by Wang et al. to measure the level of job performance of nurses. The scale consists of 14 items and 3 dimensions named teamwork (6 items), work motivation (4 items), and work involvement (4 items). It had a 5-point Likert structure and was scored from 1 (strongly agree) to 5 (strongly disagree). The total mean score is the average of the sum of the scores for each dimension, with higher scores indicating higher levels of job performance. The Cronbach’s α of each dimension and the overall scale were within the range of 0.767 to 0.937 [30]. In this study, the Cronbach’s α of each dimension and the overall scale ranged from 0.654 to 0.904.
Data collection
The data was collected between March 2023 and April 2023. The investigators conducted the survey through the “Questionnaire Star”, and used unified guidelines to explain the purpose, filling methods, and content of the research. The data was exported from the backend of “Questionnaire Star”. The second person checked the data, and then two people completed the data entry. A total of 452 questionnaires were returned, of which 12 were excluded for selecting the same answer consecutively, and data from 440 respondents were eventually analyzed (97.3% effective response rate).
Data analysis
SPSS 27.0 and Mplus 8.7 were used for data analysis. The Kolmogorov‒Smirnov test was used to detect the normal distribution of a single variable. Since none of the continuous variables had a normal distribution, the median and interquartile range were employed to describe them. Additionally, descriptive analyses also included frequency (n) and percentages (%) for categorical variables. LPA was performed by Mplus 8.7. The optimal number of profiles was selected by the following model fit indices: the Akaike information criterion (AIC), the Bayesian information criterion (BIC), the adjusted Bayesian information criterion (aBIC), the Lo-Mendell-Rubin test (LMRT), the bootstrapped likelihood ratio test (BLRT), and entropy. The smaller the AIC, BIC, and aBIC are, the better the model is. The P values of LMRT and BLRT reached a significant level, indicating that the model with k profiles was superior to the model with K-1 profiles. The entropy ranges from 0 to 1, with a general requirement greater than 0.80. The closer to 1, the higher the classification accuracy [31]. The Kruskal-Wallis H test was used to compare the differences in job stress of nurses, demographic characteristics, generalized anxiety disorder, and job performance among different profile groups. Finally, ordinal logistic regression analysis was adopted to determine which factors predicted different latent profiles of nurse job stress.
Ethical considerations
The study was approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University (approval number: KY2023-063). Participants were informed about the purpose of the study, and their consent was obtained. To ensure the privacy of the participants, all data was made available only to members of the research team.
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Results
Latent profile analysis of job stress among nurses
To determine the optimal model, we began by specifying a model with two profiles and incrementally increasing the number of profiles. The model diagnostics for the overall samples are summarized in Table 1. For the reasons listed below, the four-profile model was deemed to be the best. First, as the number of profiles increased, five- and six-profile models showed only a slight decrease in AIC, BIC, and aBIC. Second, the entropy of the four-profile model was 0.815, indicating that the categorization was highly accurate. Finally, the LMRT of the six-profile model was not significant, indicating that the six-profile model was not superior to the previous models. Additionally, although the LMRT for the five-profile model was significant, its entropy score was below 0.8, rendering it unsuitable as an optimal model.
Table 1
Fit indices of LPA for nurses’ job stress profiles (N = 440)
Profiles | AIC | BIC | aBIC | Entropy | LMRT | BLRT | Proportion |
|---|---|---|---|---|---|---|---|
2 | 2108.652 | 2174.041 | 2123.265 | 0.814 | 0.060 | 0.000 | 0.748/0.252 |
3 | 1783.181 | 1873.090 | 1803.272 | 0.853 | 0.002 | 0.000 | 0.268/0.627/0.105 |
4 | 1680.950 | 1795.379 | 1706.521 | 0.815 | 0.023 | 0.000 | 0.166/0.548/0.229/0.057 |
5 | 1656.327 | 1795.277 | 1687.377 | 0.764 | 0.023 | 0.000 | 0.252/0.102/0.459/0.134/0.052 |
6 | 1631.428 | 1794.899 | 1667.958 | 0.771 | 0.942 | 0.000 | 0.102/0.045/0.420/0.252/0.052/0.127 |
Table 2 demonstrates domains and overall median scores of nurses’ job stress in different profiles. Profile 1 had relatively low job stress (median score = 1.63, item score ranging: 1–4), accounting for 16.6% of the total sample, and was named as the relatively low job stress group. Profile 2 had a relatively high level of job stress (median score = 2.03, item score range: 1–4), making up 54.8% of the entire sample, and was named as the relatively high job stress group. Profile 3 had a high level of job stress (median score = 2.37, item score range: 1–4), accounting for 22.9% of the total sample, and was designated as high job stress. Profile 4 had the highest level of job stress (median score = 2.89, item score range: 1–4), accounting for 5.7% of the total sample, and was named as the highest job stress group. Table 2 also shows significant differences across all job stress dimensions and overall scores among the four-identified nurse job stress profiles. Post hoc analysis revealed that profiles 1 to 4 have progressively higher levels of the nursing profession and work-related problems, time allocation and workload problems, work environment and instrumentation problems, patient care problems, management and interpersonal problems, and overall nurse job stress. The latent profile structure of nurses’ job stress is presented in Fig. 1.
Table 2
Profile differences in nurses’ job stress and the results of post hoc analysis (N = 440)
Profile 1 (n = 73, 16.6%) | Profile 2 (n = 241, 54.8%) | Profile 3 (n = 101, 22.9%) | Profile 4 (n = 25, 5.7%) | H | p | Post hoc analysis | |
|---|---|---|---|---|---|---|---|
M (IQR) | M (IQR) | M (IQR) | M (IQR) | ||||
Nursing profession and work-related problems | 1.57 (1.36, 1.71) | 2.14 (1.86, 2.29) | 2.43 (2.29, 2.57) | 3.00 (2.86, 3.29) | 242.968 | < 0.001 | 1 < 2 < 3 < 4 |
Time allocation and workload problems | 2.00 (1.80, 2.30) | 2.40 (2.20, 2.60) | 3.00 (2.80, 3.20) | 3.40 (3.20, 3.60) | 217.278 | < 0.001 | 1 < 2 < 3 < 4 |
Work environment and instrumentation problems | 1.33 (1.00, 1.67) | 2.00 (1.67, 2.00) | 2.33 (2.00, 2.67) | 3.00 (2.67, 3.17) | 217.583 | < 0.001 | 1 < 2 < 3 < 4 |
Patient care problems | 1.82 (1.73, 1.91) | 2.00 (1.91, 2.18) | 2.36 (2.18, 2.55) | 2.91 (2.73, 3.00) | 242.865 | < 0.001 | 1 < 2 < 3 < 4 |
Management and interpersonal problems | 1.22 (1.11, 1.33) | 1.78 (1.56, 1.89) | 2.00 (1.89, 2.22) | 2.56 (2.33, 2.72) | 248.669 | < 0.001 | 1 < 2 < 3 < 4 |
Overall nurses’ job stress | 1.63 (1.51, 1.71) | 2.03 (1.94, 2.14) | 2.37 (2.31, 2.47) | 2.89 (2.81, 2.99) | 355.691 | < 0.001 | 1 < 2 < 3 < 4 |
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Fig. 1
Latent profile analysis results (N = 440)
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Descriptive analysis of participants and univariate analysis of different profiles
As shown in Table 3, the majority of participants were female (95.2%), had a bachelor’s degree (89.3%), and had an above fair health status (92.5%). More than half were in the age range of 26 to 35 (52.9%), internal or surgical ward (62.2%), average of 3-5-night shifts per month (56.1%), and average professional attitude (55.5%). More than two-thirds were married (70.2%) and had less than 16 years of work (68.6%). More than three quarters had an average monthly income above 8,000 (78.2%). The generalized anxiety disorder was at a mild level, with the median (interquartile range) of total generalized anxiety disorder being 7.00 (4.00, 9.00). For overall job performance, the median (interquartile range) was 3.86 (3.57, 4.12). Additionally, Table 3 summarizes the univariate comparisons between the four profiles for demographic characteristics, generalized anxiety disorder, and job performance. Nurses with different job stress profiles demonstrated significant differences in terms of health status, professional attitude, generalized anxiety disorder, and job performance.
Table 3
Profile differences in demographic variables, generalized anxiety disorder and job performance (N = 440)
Variables | Classification | n (%)/ M (IQR) | Profile 1 | Profile 2 | Profile 3 | Profile 4 | H | p |
|---|---|---|---|---|---|---|---|---|
n (%)/ M (IQR) | n (%)/ M (IQR) | n (%)/ M (IQR) | n (%)/ M (IQR) | |||||
Gender | Male | 21 (4.8) | 2 (2.7) | 11 (4.6) | 7 (6.9) | 1 (4.0) | 1.751 | 0.626 |
Female | 419 (95.2) | 71 (97.3) | 230 (95.4) | 94 (93.1) | 24 (96.0) | |||
Age | ≤ 25 | 40 (9.1) | 9 (12.3) | 19 (7.9) | 10 (9.9) | 2 (8.0) | 0.156 | 0.984 |
26–30 | 126 (28.6) | 19 (26.0) | 72 (29.9) | 27 (26.7) | 8 (32.0) | |||
31–35 | 107 (24.3) | 15 (20.5) | 58 (24.1) | 30 (29.7) | 4 (16.0) | |||
36–40 | 74 (16.8) | 14 (19.2) | 42 (17.4) | 13 (12.9) | 5 (20.0) | |||
≥ 41 | 93 (21.1) | 16 (21.9) | 50 (20.7) | 21 (20.8) | 6 (24.0) | |||
Education level | Junior college | 31 (7.0) | 5 (6.8) | 17 (7.1) | 9 (8.9) | 0 (0.0) | 1.895 | 0.594 |
Bachelor’s degree | 393 (89.3) | 67 (91.8) | 214 (88.8) | 88 (87.1) | 24 (96.0) | |||
Master’s degree or above | 16 (3.6) | 1 (1.4) | 10 (4.1) | 4 (4.0) | 1 (4.0) | |||
Marital status | Married | 309 (70.2) | 50 (68.5) | 172 (71.4) | 69 (68.3) | 18 (72.0) | 0.463 | 0.927 |
Single | 126 (28.6) | 22 (30.1) | 66 (27.4) | 31 (30.7) | 7 (28.0) | |||
Divorced or widowed | 5 (1.1) | 1 (1.4) | 3 (1.2) | 1 (1.0) | 0 (0.0) | |||
Work years | 1–5 | 108 (24.5) | 24 (32.9) | 54 (22.4) | 23 (22.8) | 7 (28.0) | 0.285 | 0.963 |
6–10 | 122 (27.7) | 13 (17.8) | 76 (31.5) | 28 (27.7) | 5 (20.0) | |||
11–15 | 72 (16.4) | 12 (16.4) | 33 (13.7) | 21 (20.8) | 6 (24.0) | |||
≥ 16 | 138 (31.4) | 24 (32.9) | 78 (32.4) | 29 (28.7) | 7 (28.0) | |||
Ward of affiliation | Internal ward | 130 (29.5) | 22 (30.1) | 75 (31.1) | 26 (25.7) | 7 (28.0) | 2.275 | 0.517 |
Surgical ward | 144 (32.7) | 28 (38.4) | 78 (32.4) | 29 (28.7) | 9 (36.0) | |||
Gynecological/ maternity ward | 16 (3.6) | 4 (5.5) | 7 (2.9) | 5 (5.0) | 0 (0.0) | |||
Paediatric ward | 25 (5.7) | 3 (4.1) | 14 (5.8) | 8 (7.9) | 0 (0.0) | |||
Emergency | 20 (4.5) | 0 (0.0) | 11 (4.6) | 7 (6.9) | 2 (8.0) | |||
Operating theatre | 35 (8.0) | 6 (8.2) | 21 (8.7) | 5 (5.0) | 3 (12.0) | |||
ICU | 34 (7.7) | 4 (5.5) | 13 (5.4) | 15 (14.9) | 2 (8.0) | |||
Others | 36 (8.2) | 6 (8.2) | 22 (9.1) | 6 (5.9) | 2 (8.0) | |||
Average monthly income (RMB) | < 5000 | 13 (3.0) | 1 (1.4) | 9 (3.7) | 3 (3.0) | 0 (0.0) | 4.152 | 0.245 |
5000–8000 | 83 (18.9) | 15 (20.5) | 52 (21.6) | 14 (13.9) | 2 (8.0) | |||
8000–10,000 | 143 (32.5) | 27 (37.0) | 74 (30.7) | 30 (29.7) | 12 (48.0) | |||
> 10,000 | 201 (45.7) | 30 (41.1) | 106 (44.0) | 54 (53.5) | 11 (44.0) | |||
Average monthly number of night shifts | < 3 | 157 (35.7) | 25 (34.2) | 90 (37.3) | 33 (32.7) | 9 (36.0) | 2.848 | 0.416 |
3–5 | 247 (56.1) | 41 (56.2) | 139 (57.7) | 55 (54.5) | 12 (48.0) | |||
> 5 | 36 (8.2) | 7 (9.6) | 12 (5.0) | 13 (12.9) | 4 (16.0) | |||
Health status | Good | 191 (43.4) | 43 (58.9) | 109 (45.2) | 33 (32.7) | 6 (24.0) | 25.114 | < 0.001 |
Fair | 216 (49.1) | 28 (38.4) | 121 (50.2) | 57 (56.4) | 10 (40.0) | |||
Poor | 33 (7.5) | 2 (2.7) | 11 (4.6) | 11 (10.9) | 9 (36.0) | |||
Professional attitude | Like | 130 (29.5) | 39 (53.4) | 67 (27.8) | 21 (20.8) | 3 (12.0) | 16.039 | < 0.001 |
Dislike | 66 (15.0) | 5 (6.8) | 25 (10.4) | 24 (23.8) | 12 (48.0) | |||
Average | 244 (55.5) | 29 (39.7) | 149 (61.8) | 56 (55.4) | 10 (40.0) | |||
Generalized anxiety disorder | 7.00 (4.00, 9.00) | 4.00 (2.00, 6.00) | 6.00 (4.00, 8.00) | 8.00 (6.50, 14.00) | 11.00 (8.00, 17.00) | 91.954 | < 0.001 | |
Job performance | 3.86 (3.57, 4.12) | 4.21 (3.86, 4.64) | 3.86 (3.57, 4.00) | 3.79 (3.39, 4.07) | 3.64 (3.04, 3.89) | 39.931 | < 0.001 | |
Teamwork | 4.00 (3.83, 4.33) | 4.33 (4.00, 4.83) | 4.00 (3.83, 4.17) | 4.00 (3.50, 4.33) | 3.67 (3.33, 3.83) | 55.911 | < 0.001 | |
Work motivation | 4.00 (3.50, 4.25) | 4.25 (3.75, 4.75) | 4.00 (3.50, 4.00) | 4.00 (3.50, 4.00) | 4.00 (3.50, 4.00) | 20.567 | < 0.001 | |
Work involvement | 3.75 (3.25, 4.00) | 3.75 (3.50, 4.25) | 3.75 (3.25, 4.00) | 3.50 (3.00, 4.00) | 3.00 (2.50, 4.00) | 24.282 | < 0.001 |
Predictors of latent profiles of nurses’ job stress
As shown in Table 4, factors that were significant in the univariate analysis were included as independent variables in the ordinal logistic regression model. Compared with nurses with a poor health status, those with a fair or above health status were less likely to be allocated to the higher job stress groups (OR = 0.366, 95% CI = 0.171, 0.784; OR = 0.394, 95% CI = 0.190, 0.819). When compared with nurses with average professional attitudes, those who disliked nursing as a career had a risk of up to 2.300 times higher exposure to high levels of job stress (OR = 2.300, 95% CI = 1.327, 3.983). Generalized anxiety disorder was a risk factor for nurse job stress, in other words, nurses with high levels of generalized anxiety disorder were more inclined to experience greater job stress (OR = 1.190, 95% CI = 1.139, 1.244). Job performance was a protective factor for nurses’ job stress, and high levels of job performance were more likely to be allocated to lower job stress groups (OR = 0.969, 95% CI = 0.943, 0.996). Our findings were further confirmed through visual analysis (Fig. 2), which demonstrated that nurses’ job stress was affected by factors such as health conditions, professional attitudes, generalized anxiety disorder, and job performance levels.
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Table 4
Ordinal logistic regression analysis of nurses’ job stress (N = 440)
Variables | Estimate | Std. Error | p | OR | 95% CI for OR |
|---|---|---|---|---|---|
Health status = Good | -1.006 | 0.389 | 0.010 | 0.366 | (0.171, 0.784) |
Health status = Fair | -0.932 | 0.373 | 0.013 | 0.394 | (0.190, 0.819) |
Reference group a | 0 | - | - | - | - |
Professional attitude = Like | -0.436 | 0.232 | 0.060 | 0.647 | (0.411, 1.019) |
Professional attitude = Dislike | 0.833 | 0.280 | 0.003 | 2.300 | (1.327, 3.983) |
Reference group b | 0 | - | - | - | - |
Generalized anxiety disorder | 0.174 | 0.023 | < 0.001 | 1.190 | (1.139, 1.244) |
Job performance | -0.032 | 0.014 | 0.023 | 0.969 | (0.943, 0.996) |
Fig. 2
Sankey diagrams display the distribution of profiles based on their distinct characteristics (N = 440). High job performance indicates a median level or higher, while low job performance indicates a lower than median level
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Discussion
To the best of our knowledge, this is the first study to identify the potential profiles of nurses’ job stress and their predictive factors. Nurses’ job stress could be categorized into four profiles: relatively low job stress, relatively high job stress, high job stress, and the highest job stress. Generalized anxiety disorder, job performance, health status, and dislike of nursing as a career were predictors of different profiles.
The latent profiles of job stress for nurses
Four distinct latent profiles of job stress were as follows: Profile 1, relatively low job stress, accounting for 16.6%; Profile 2, relatively high job stress, accounting for 54.8%; Profile 3, high job stress, accounting for 22.9%; and Profile 4, the highest job stress, accounting for 5.7%. This indicated that the job stress of most nurses was at a relatively high level, which was consistent with previous studies [4]. High levels of job stress can increase nurse turnover rates, negatively impact their physical and mental health, and job performance, and even compromise patient safety [11, 32]. Therefore, nursing managers should prioritize nurses’ high levels of job stress. The profiles in this study showed uniform shapes, with the highest mean scores on time allocation and workload problems, and the lowest mean scores on management and interpersonal problems, which is in line with the findings of the domestic scholar [16]. This is likely because the places surveyed are Grade-A tertiary hospitals with a great number of admitted patients, high patient turnover, a high proportion of critically ill patients, and inadequate nursing staffing. These factors resulted in a significant increase in nursing workload and time constraints, thereby putting them under greater pressure [16]. To reduce nurse workload and alleviate stress, nursing managers should focus on optimizing nursing processes, implementing flexible scheduling arrangements, and deploying personnel resources rationally.
Factors predicting job stress of nurses
Health status and occupational attitude
Health status and occupational attitude are demographic factors that predict the job stress of nurses. Our study demonstrated that nurses with poor health status were more likely to experience higher job stress, which is consistent with previous studies [17]. One possible explanation is that individuals with poor health may experience more difficulties in managing emotions and effective communication with colleagues and patients, which can aggravate the adverse effects of stress. Additionally, nurses who are grappling with their own health issues may be more susceptible to the influence of organizational factors such as workload, staffing, and leadership, which can intensify their stress levels [33]. Therefore, healthcare organizations should acknowledge the interplay between nurses’ health and job stress and offer appropriate support and resources to alleviate their job stress. Notably, those who disliked nursing as a career had a risk of up to 2.300 times higher exposure to high levels of job stress. This finding is consistent with the results of a study conducted by Teymoori et al. [18]. This may be because participants who hold negative attitudes toward nursing are more susceptible to experiencing negative emotions and may struggle to cope with unexpected situations at the job, ultimately leading to ineffective stress reduction. Moreover, in contrast to previous studies [4, 18], this study found no significant relationship between gender and job stress, which may be attributed to the limited sample size of male nurses.
Generalized anxiety disorder
In this study, nurses were generally at a mild level of anxiety, which was consistent with earlier research indicating that nurses are susceptible to anxiety [10]. Additionally, the study identified generalized anxiety disorder as a risk factor for job stress among nurses. Previous studies have also confirmed that anxiety can predict the stress level of nurses [21]. The more obvious the anxiety is, the more stress nurses feel [7]. The potential reason for this situation may be that nurses experiencing chronic anxiety are vulnerable to poor sleep, fatigue, impaired ability to think rationally, and markedly reduced problem-solving ability, leading to an exacerbation of their stress levels [34, 35]. How to effectively address the anxiety state of nurses and its negative effects is also a topic to be explored.
Job performance
High levels of job performance are more likely to be allocated to lower job stress groups in this study. Previous studies have also demonstrated a negative correlation between job performance and job stress [12]. This could be attributed to better job performance, indicating that nurses have higher work abilities, possess greater proficiency in their profession, are capable of completing tasks on schedule [36], and are more resilient to stress, which in turn, results in lower perceived job stress. Although job performance and job stress have a reciprocal relationship, the exact causal relationship between the two needs to be verified through longitudinal studies. Additionally, how to enhance job performance and maximize its positive influence needs to be further investigated.
Clinical implications
Nursing managers are recommended to reduce nurses’ job stress by lowering their anxiety levels, enhancing their job performance, improving their health status, and changing their professional attitudes toward nursing. Specific suggestions for nursing managers are as follows: (1) To effectively lower anxiety levels of nurses by optimizing the scheduling system, providing a conducive working environment, and offering psychological support; (2) To enhance nurses’ job performance by providing professional skills training, optimizing work processes (e.g., introduce efficient information management systems), and strengthening teamwork; (3) To improve nurses’ health status by arranging reasonable working hours that ensure adequate rest time for nurses and providing sports facilities for nurses to exercise in free time; (4) To change nurses’ professional attitudes toward nursing by enhancing professional identity and providing continuous education.
Limitations
This study has certain limitations. First, this study adopted the snowball sampling method to recruit participants from only one tertiary hospital, limiting the generalizability of the results. Further study with a random sampling method to recruit participants from multiple centers is needed. Second, this was a cross-sectional study that cannot determine causality between variables; a longitudinal study is needed in the future. Third, the number of male nurses recruited in this study was small; as many male nurses as possible need to be recruited to further explore the relationship between gender and job stress. Last, self-report questionnaires were used to collect data, which may be subject to self-report bias. Objective indicators could be adopted in future studies.
Conclusions
The majority of nurses were classified into profile 2, and their job stress was relatively high. Lowering anxiety levels, enhancing job performance, improving nurses’ health status, and changing professional attitudes toward nursing may be effective ways to reduce nurses’ job stress.
Acknowledgements
We wish to thank all nurses who participated in the study.
Declarations
Ethics approval and consent to participate
The study was approved by the First Affiliated Hospital of Wenzhou Medical University (approval number: KY2023-063). Informed consent was obtained from all the participants. The study was conducted in accordance to relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Statement
We get permission to use scales in the research process.
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