The relationship between occupational stressors and mental health among nurses working in different level of hospitals

Objective: The purpose of this study was to investigate general occupational stressor in nurses, and variation of occupational stressors and mental health status among nurses working in different level of hospitals. Methods: The study population was from all qualified hospitals of New Hospital Accreditation between 2010 and 2013. A cross-sectional questionnaire survey using systematic sampling method was performed in North, Central, South and East Taiwan. The participants were full-time nurses working in medical centers, reginal hospitals, district hospitals and psychiatry hospitals. The questionnaires included the following contents: The Nurses Occupational Stressor Scale (NOSS), occupational burnout inventory, Brief Symptom Rating Scale (BSRS-5) and demographics. The JMP version 10.0 statistical software was used for data analysis. Results: A total of 3,297 questionnaires were eligible for final analysis, response rate was 75.8%. The mean age was 32.7 years (SD 7.3), and the average work tenure was 10.2 years (SD 7.2). Most of them were on day shifts(8 hours). The mean working hour was 9.1 hours per day and 46.3 hours per week. For 8-hour shifts, the actual mean working hour was 9 hours per day and 46 hours per week, whereas for 12- hour shifts, the mean working hour was 12.7 hours per day and 57.8 hours per week. The mean NOSS score was 63.3 (SD 14.1). The major occupational stressors were different across hospitals, overall“poor workplace relationships with colleagues”,“the patient might have contagious disease, such as SARS and AIDS”,“having to bear negative sentiments of patients and/or of their relatives”,“having to be a substitute for other specialized units,”and“compulsory alteration of family activities due to work responsibilities,” were the most common occupational stressors, and most of them were classified as “Occupational Hazards” subscale of NOSS. Of all participants, 34.8% reported to be in good mental health, 34.3% reported to have minor mental disorders, 24.8% in moderate mental disorders and 7% in severe conditions. Nearly 2/3 (65.2%) of participants reached the cutpoint (BSRS-5 score≥6) for common mental disorders. Conclusions and Recommendations: This study identified that nurses with mean NOSS score of 25% tile (NOSS score≥72) were more likely to have personal burnout, client burnout, stress and job dissatisfaction. In summary, stressors are different across hispitals, periodically identify nusing stressors using NOSS and to improve working environment for nurses are warranted.