Work stressors and intention to leave among nurses in isolation nursing units during COVID-19: a cross-sectional study

Work stressors are factors within work environments that have been shown to affect workers’ stress levels [1, 2]. The disparity between work demands and a worker’s capabilities results in work-related stress, which correlates with physical and psychological health issues, increased absenteeism, and employees’ intentions to leave from their positions [3]. Workplace stress will escalate if workers perceive a lack of support from their peers and managers [2].

Workplace stress has numerous negative effects on healthcare providers, categorized as follows: psychological effects, including anxiety, depression, and job dissatisfaction; behavioral effects, such as sleep disturbances, absenteeism, and turnover; and physical effects, including headaches, irritable bowel syndrome, and hypertension [4]. The aforementioned effects are seen as elements influencing the quality of patient care, establishing a correlation between these consequences, burnout, and poor patient safety [5]. Healthcare professionals, particularly nurses, face several stressors in their work environment [6]. Stressors for nurses may stem from several aspects, including legal and employer-related concerns, work-life balance, professional practice, and external values and beliefs toward nursing [7].

The COVID-19 pandemic has intensified these pre-existing issues, imposing significant additional strain on healthcare personnel who were at the forefront of a worldwide health crisis [8, 9]. Since COVID-19 rapidly spread, there has been a greater need than ever before for efficient viral management in order to contain the virus and treat patients. As a result, nurses faced new and significant stresses, such as the potential for infection, fear of death, emotional exhaustion, isolation, and the fear of infecting loved ones [10, 11]. Also, The increased number of patients and a shortage of healthcare workers resulting from illness and fatalities elevated stress levels, resulting in an exacerbated occupational and psychological burden on nurses [12].

The turnover rate among healthcare professionals, especially nurses, constitutes a substantial global concern. The heightened demand for healthcare services and the substantial expenses related to recruiting and training render nurse retention essential, particularly during emergencies such as the COVID-19 pandemic [13, 14]. Similar to many other countries, Jordan faces challenges in nurse retention attributed to elevated working stress and a propensity to depart, particularly in the setting of COVID-19 [15]. Previous studies revealed that healthcare workers who dealt and compacted with COVID-19 reported high psychological effects including stress, anxiety, and depressive symptoms [16]. Ali, Cole, Ahmed, Hamasha and Panos [17] indicated that 71% of nurses were concerned about treating COVID-19 patients and demonstrated a high level of workload-related stress resulting from providing care for infected individuals. Also, they found that 82% of nurses have stress about the transmission of infection to their friends and family [17].

Several factors contributed to feelings of stress among healthcare workers. These factors include the followings: lack of personal protective equipment; inadequate guidance and training in dealing with COVID-19; time pressure and long work hours; the risk of catching infection; the risk of bringing the infection to family members; the uncertainty of information about COVID-19; and colleagues’ fear [18]. Elevated stress levels resulted in a rise in sick leave requests and absenteeism among healthcare workers, therefore exacerbating workloads, increasing burdens on their colleagues, and adversely impacting overall patient care [19]. Also, elevated fear levels associated with COVID-19 were correlated with diminished job satisfaction, increased psychological discomfort, and increased organizational and professional intentions to leave [20].

Work pressures on nurses’ intention to leave, especially in isolation nursing units during the COVID-19 pandemic, are crucial. Few studies have examined nurses stress and turnover in isolation units during the COVID-19 pandemic. This study explores these issues in Jordan, a Middle Eastern context overlooked in the literature. This research also sheds light on infectious disease pandemic stressors like fear of contagion, lack of support, and the psychological toll of working in isolation units. These insights are crucial for healthcare managers and policymakers to develop targeted job stress and turnover interventions, especially in future pandemics or crises. Thus, our findings indicate theoretical and practical aspects that may improve nurse retention and patient care under comparable future situations. Thus, this study aims to identify the nurse’s perceptions of work stressors and intention to leave and to investigate the relationship between the previously mentioned variables among Jordanian nurses in isolation units during the COVID-19 pandemic.

One hundred and fifty-four nurses participated in the current study, who ranged in age from 23 to 39 with an average age of 29.59 years (SD = 3.8). The majority of the sample age were 45.5%. The nurses had an average of years of practicing in nursing 55.2% (1–5 years). Nurses had an average of 8.27 months in practicing nursing in COVID-19 isolation units and 61.1% of the sample had worked in the COVID-19 isolation unit for (6–8) months. More than half of the sample was married. The majority of the sample (74.7%) had a bachelor’s degree in nursing, as Table 1.

This study examines the work stressors perceived by nurses and their correlation with the intention to leave during the COVID-19 pandemic at two hospitals in Jordan, specifically within isolation units. These frontline healthcare workers faced exceptional challenges, leading to increased stress and psychological burden. The majority of the sample (85.7%) had a ‘higher level of work stressors’ which means that nurses who were working at COVID-19 units were exposed to workplace stressors. This finding aligns with research by Zheng, Zhou, Qiu, Yan, Yue, Yu, Lei, Tu and Hu [24], which similarly indicated heightened stress levels among nurses during the pandemic, especially in settings treating COVID-19 patients. These investigations underscored the mental and physical burdens nurses faced as a result of heightened patient loads, extended working hours, and the persistent fear of viral infection. This outcome is expected since the nursing profession is considered a stressful profession, especially with COVID-19 pandemic. Studies emphasized that the COVID-19 pandemic was a stressful event for nurses who deal with confirmed cases of COVID-19 [10, 11, 25]. Dealing with COVID-19 patients raises the stress level among nurses; this might be due to several factors such as fear of contagion, the dramatic increase in the number of patients, deficient knowledge about the virus, and fear to catch the infection and deliver it to family members.

The current study identified WD as the most commonly reported stressor among participants, consistent with prior research findings. This stressor was significantly increased by the substantial rise of COVID-19 patient cases. Throughout the pandemic, the nurse-to-patient ratio was markedly elevated, necessitating that nurses frequently assume supplementary non-nursing responsibilities to bolster the healthcare system. These findings align with the conclusions of Maraqa, Nazzal and Zink [19], who similarly noted that nurses encountered increased stress levels due to intensified work demands during the COVID-19 crisis. These findings are consistent with research highlighting nurses’ unique and severe pandemic challenges. Due to increased workloads and the emotional toll of the pandemic, nurses faced burnout, compassion fatigue, and job dissatisfaction, according to studies. Numerous studies have linked workload and staffing shortages to nurses’ stress and burnout during the pandemic [26, 27].

In this study, nurses ranked WFC second in stress. Previous research have shown that nurses struggle to balance work and family. Rotating shifts in nursing were a primary cause of WFC. These schedules sometimes interrupt nurses’ social lives and prevent them from spending time with their family on weekends, vacations, and evenings. Due to coworker illness, nurses must work greater hours to fill staff shortages, which adds to the burden. Ekici, Cerit and Mert [28] also found that rotating shifts and long hours negatively affected nurses’ work-life balance. Stress and fatigue from tight schedules affect nurses’ capacity to maintain healthy familial and social ties outside of work. Ekici, Cerit and Mert [28] noted that these work-related pressures can lead to burnout, job dissatisfaction, and worse quality of life for nurses, especially if extra work hours are not compensated with recovery or social time.

The third stressor found in the study was PL, representing the emotional burden faced by healthcare workers when interacting with suffering and ill patients. This finding is especially pertinent in relation to the COVID-19 pandemic, as it aligns with the increased stress and trauma encountered by healthcare workers due to the influx of patients, particularly those who were seriously ill or deceased. The rise of COVID-19 cases in Jordan resulted in a significant increase in the mortality rate among patients, presumably fostering emotions of helplessness and powerlessness among healthcare workers, thereby intensifying their stress and emotional fatigue. This result is consistent with findings from Blanco-Donoso, Moreno-Jiménez, Amutio, Gallego-Alberto, Moreno-Jiménez and Garrosa [29] reported that healthcare workers, particularly nurses, were deeply affected by the constant exposure to patients in critical conditions, leading to emotional burnout, feelings of powerlessness, and a sense of psychological distress. This shared experience of powerlessness reflects the cumulative emotional burden placed on nurses, especially in the face of the rapid escalation of the pandemic.

Workplace violence and bullying (WVB) have long been shown to stress nurses and cause physical, psychological, and professional problems. According to earlier studies, nurses reported WVB, especially in high-stress contexts like emergency rooms (EDs). According to Guissi, Pinho, Vieira, Ranali, Martins, Bandini and de-Lucca [30], coworker disrespect increases job stress. A poisonous work environment and heightened emotional and psychological distress among healthcare personnel are caused by unprofessional behavior, including bullying and verbal abuse, according to the study. This supports the recent findings that WVB directly affects nurses’ stress levels. Nursing well-being is shaped by workplace culture and relationships, and a bad work environment can worsen pressures that harm physical and mental health. In addition, Al-Ghabeesh and Qattom [31] found that 90% of emergency department nurses were bullied, highlighting the problem in nursing. In emergency care, when patient turnover, important decision-making, and significant work pressure are common, bullying was shown to be severe and frequent. Our study found that ED nurses are bullied by colleagues and patients, which leads to burnout and work dissatisfaction. Targeted interventions may be needed to address bullying in EDs due to its prevalence.

In our analysis, more than half of the participants had a slightly positive level of intention to leave, which means nurses who work at the COVID-19 unit had the intent to quit their job and are more likely they will in the future. 21.4% of the sample had a moderately positive intention to leave level. These outcomes are expected because the clinical practice of nursing at COVID-19 units is stressful. Our finding align with Labrague and de Los Santos [20], who revealed that an increased level of fear of COVID–19 was associated with decreased job satisfaction, increased psychological distress, and increased organizational and professional intentions to leave. High work demands, a high number of COVID-19 patients, and fear of COVID-19. Additionally, quarantine conditions might influence nurses to be more overworked, stressed, and had low job satisfaction. This might push nurses to think about leaving their jobs.

This study found a significant negative relationship connected the work stressors scores with nurses’ ages, and the experience duration in each nursing, current hospital, and in COVID-19 isolation units. The finding might be explained as that younger and less experienced nurse do not yet acquire effective coping mechanisms with such stressors as older and more experienced nurses. Furthermore, nurses who hold high education levels had more psychological and cognitive development in interpretation and coping with stressors than nurses who hold less level of education. For marital status, single nurses had a high level of stressors than married nurses because single nurses during the COVID-19 pandemic were forced to cover the work schedule in longer shifts than married nurses. These results were supported by studies [17, 32]. Our findings contradict to Higazee, Rayan and Khalil [33] who reported that being married with high education level scored relatively high levels of job-related stress.

This study found a significant negative relationship connected the intention to leave with nurses’ ages, and experience duration in each of the nursing, current hospital, and COVID-19 isolation units. This might be explained by the fact that younger and less experienced nurses are more likely ready to take the risk of quitting their occupational position because there is a strong perception that they can easily find another job. Further, there is a significant difference in scoring for marital status where single nurses recorded high scores of intentions to leave than married nurses because married nurses had more responsibilities toward their families. Education levels had also a significant difference in the scoring of intention to leave, whereas participants who hold higher education degrees had a lower intention to leave score. Furthermore, nurses who hold higher education degrees had other administrative roles besides working with patients in the workplace, and thus their contact with patients is less than nurses who hold less degree of education. These results are consistent with studies reported that being young was one of the major factors that contributed to the intention to leave among nurses [18]. Yáñez, Afshar Jahanshahi, Alvarez-Risco, Li and Zhang [34] asserted that older healthcare providers had lower levels of intention to leave compared to their younger colleagues. These results are not going in line with Nashwan et al., who found that age, marital status, and educational level had no significant differences in intention to leave [35].

Our findings showed that work stressors have a significant positive relationship with the intention to leave. This could be explained as nurses who have more work stressors may not be satisfied with their job which led them to leave their work. On the other hand, working in COVID-19 units may contribute to psychological distress and dissatisfaction that lead to nurses’ intention to leave. A previous study asserted that work stressors were a path for the intention to leave whereby stressors led to job dissatisfaction and leaving the profession [36]. In general, these findings are consistent with Labrague and de Los Santos [20]. Regarding the relationship between each work stressor and intention to leave, there were significant positive correlations between all work stressors and intention to leave with differences in the strength of the correlation. Previous research has also shown that organizational factors like leadership and career advancement had an excessive impact on the intention to leave [37]. Nursing students should be well prepared for working under pressure, dealing with work stressors, and working during crisis such as COVID-19. Therefore, stress management and crises courses should be integrated with the nursing curricula of undergraduate students to help them in dealing with such crises [38, 39].

The generalizability of the findings is limited by several factors. First, the technique of convenience sampling limits the ability to generalize findings beyond the studied population. Second, the study exclusively includes governmental institutions, with no private or military hospitals included. This may restrict the generalizability of the findings to various healthcare sectors. Third, the findings might not be generalized to other contexts because they were based on nurses working in COVID-19 isolation units. The online survey may have been avoided by nurses who don’t use the Internet or follow technology. This constraint might bias selection and exclude non-technical nurses.

Furthermore, response bias might occur when using self-report questionnaires since participants might have given less thoughtful or socially desirable replies. To further understand stress and intention to leave, future studies should include resilience, emotional intelligence, and burnout. Literature increasingly acknowledges these aspects as important to nurses’ mental health and career choices. Such variables would provide a more comprehensive view of how individual and organizational factors affect nurses’ results.

This study aimed to explore Jordanian nurses’ perceptions of work stressors and their intention to leave, specifically during the COVID-19 pandemic in isolation units, and to investigate the relationship between these variables. The findings indicated that the majority of nurses reported positive levels of work stressors, with a substantial proportion reporting strong positive levels of WFC. In the same vein, a substantial proportion of nurses exhibited positive intention to leave. Demographics affected work stressors and intention to leave. Work stressors and their intention to leave were higher for single nurses than married nurses. In addition, nurses with lower education levels reported higher stress levels. Customized therapies based on individual features are needed. Notably, the investigation found a moderate, positive, and statistically significant correlation between work stressors and intention to leave. This suggests that the probability of nurses intending to leave their positions increased as work stressors increased. The findings show that nurses who may be more sensitive due to personal or professional circumstances need focused stress-reduction techniques. Nurse retention and healthcare system sustainability amid future public health catastrophes depend on supportive and well-resourced workplaces.