INTRODUCTION & REVIEW OF LITERATURE OF ASSESS THE LEVEL OF STRESS IN NURSES OFFICESS RELATED TO JOB STATISFACTION AT VARIOUS HOSPITAL IF U WANT TO MAKE YOUR RESEACRH, PROJECT, PPT ETC CONTACT ME ON EMAIL SACHINGONE220@GMAIL.COM

1. JAIPUR NATIONAL UNIVERSITY
SEEDLING SCHOOL OF NURSING
RESEARCH PROJECT
ON
A QUANTITATIVE STUDY TO ASSESS THE LEVEL OF
STRESS IN NURSES OFFICESS RELATED TO JOB
STATISFACTION AT VARIOUS HOSPITAL IN JAIPUR
GUIDED BY:
Dr. Mahendra Singh Ranawat
Assistant Professor
SUBMITTED BY:-
NIKITA KUMARI,
SACHIN KUMAR

2. Introduction
Background of the Study.
Stress is, essentially, a feeling of doubt about being able to cope with
problematic, undesirable alterations in the existent equilibrium or life
circumstances which is experienced when one perceives that the demands
of the environment exceed the resources to deal with or handle them
(Tansey et al., 2004). It has become one of the most serious health issues
in the modern world (Lu et al., 2003) as it occurs in any job and is even
more present than decades ago. Health care workers such as physicians
and nurses have been recognized as stressful occupations in both
developed and developing countries (Al-Dubai and Rampal, 2010).
Among the health care workers, nursing personnel are the largest group
employed by hospitals. As a result of ongoing change, nurses face
challenges requiring them to provide high-quality care at lower costs and
the impact of this on nurses has been considerable and farreaching. Nurses
are routinely exposed to dangers such as viruses, bacteria and needle prick
injuries. Staff shortages often force nursing staff to do work outside their
job definitions – often without appropriate training or remuneration.
Overworked nurses face much trauma and stress. In addition, the fall in
the number of staff to care for patients has caused the workload for nurses
to increase significantly. Overall, stress levels increase when more
patients have to be processed in the same number of hours and turnover
is faster than in the past.
In the realm of healthcare, nurses are the cornerstone of patient care,
serving as the frontline providers who deliver compassion, expertise, and
support to individuals in need. However, the noble pursuit of nursing is
often accompanied by a myriad of challenges, including high workloads,
emotional demands, and organizational constraints. These challenges,
collectively referred to as occupational stressors, have profound
implications for nurses' well-being, job satisfaction, and ultimately, the
quality of patient care.

3. This introduction sets the stage for a comprehensive exploration of the
levels of stress experienced by nurses in various hospital settings and its
intricate relationship with job satisfaction. Through an in-depth analysis
of existing literature, empirical evidence, and theoretical frameworks, this
research endeavors to shed light on the multifaceted dynamics shaping
nurses' experiences within the healthcare workforce.
The Nature of Occupational Stress in Nursing -Occupational stress in
nursing arises from a complex interplay of factors spanning individual,
interpersonal, and organizational domains. At the individual level, nurses
face inherent stressors related to the nature of their work, including
exposure to suffering and death, ethical dilemmas, and the responsibility
for making critical decisions under pressure. Interpersonal stressors
encompass conflicts with colleagues, challenging patient interactions, and
difficulties in maintaining work-life balance. Additionally, organizational
stressors such as staffing shortages, inadequate resources, and
administrative burdens further compound the stress experienced by nurses
in their daily practice.
The Impact of Occupational Stress on Nurses' Well-being- The
pervasive nature of occupational stress in nursing can have far-reaching
consequences for nurses' physical, emotional, and psychological well-
being. Prolonged exposure to stressors has been linked to a range of
adverse outcomes, including burnout, compassion fatigue, anxiety,
depression, and even post-traumatic stress disorder (PTSD). These
manifestations of distress not only impair nurses' quality of life but also
undermine their ability to provide safe, effective, and compassionate care
to patients.
Understanding Job Satisfaction in Nursing Job satisfaction, defined as
the pleasurable emotional state resulting from the appraisal of one's job or
job experiences, plays a pivotal role in shaping nurses' professional
fulfillment and retention. Key determinants of job satisfaction in nursing
include autonomy, recognition, workload, opportunities for professional
growth, and supportive work environments. Nurses who experience high

4. levels of job satisfaction are more likely to exhibit greater engagement,
commitment, and resilience in their roles, leading to improved patient
outcomes and organizational performance.
The Interplay Between Occupational Stress and Job Satisfaction The
relationship between occupational stress and job satisfaction among
nurses is dynamic and multifaceted. While high levels of stress can detract
from job satisfaction by diminishing feelings of accomplishment,
autonomy, and recognition, job satisfaction, in turn, can serve as a buffer
against the negative effects of stress. Nurses who derive satisfaction from
their work may be better equipped to cope with stressors, maintain a
positive outlook, and persevere in the face of adversity.
Variability in Stress Levels and Job Satisfaction Across Hospital
Settings The experience of stress and job satisfaction among nurses is not
uniform and can vary significantly across different hospital environments.
Factors such as hospital size, patient population, specialty area,
organizational culture, leadership style, and availability of resources can
influence the prevalence and severity of stressors, as well as the
perception of job satisfaction among nursing staff. Understanding these
contextual factors is essential for tailoring interventions and strategies to
address the unique needs of nurses within specific hospital settings.
Job satisfaction is an important component of nurses' that can affect
patient safety, productivity and performance, quality of care, retention and
turnover, commitment to the organization and the profession. It is an
important determinant of nurses' retention and turnover, and may also
affect performance(1) Job dissatisfaction is becoming an increasingly
large disorder. Interest in job related stress is renewed with each cycle of
nursing shortage (2). Researchers contend that job satisfaction is possibly

5. the most significant yet elusive factor in understanding worker
motivation, performance and effectiveness, and recruitment and
retention(3).
Nurse Job satisfaction is a multidimensional phenomenon that is
influenced by many variables. Autonomy has been identified as the
strongest predictor of nurse job satisfaction, which in turn reflects
positively on nurse retention (4)
The widespread nursing shortage and nurses' high turnover has become a
global issue (5) which is of increasing importance to both the developed
and developing countries (6). Many factors may play an important role in
Job satisfaction such as environmental factors which included degree of
professionalization, organizational climate, supervision, and interpersonal
relationships. Characteristics of the job itself included pay, autonomy, and
job outcomes. In studies conducted at military civilian facilities job
satisfaction has been positively related to autonomy, coworker and
supervisor support, resource adequacy, professional growth, promotional
opportunity, and distributive justice. Stress levels have been shown to be
directly related to job satisfaction (7). In the 1980s and 1990s, many
researchers have been addressed nurse job satisfaction. The understanding
of nurse job satisfaction and its contributing variables are important for
any health care organization to exist and prosper. Job satisfaction is
defined as the degree to which employees enjoy their jobs (8). Stress is
part of everyday life for health professionals such as nurses, physicians,
and hospital administrators since their main responsibility focuses upon
providing help to patients who are usually encountering life crises.
Typically, nurses from both public and private hospitals report a similar
pattern of stressful experiences (9). Sources and indicators of stress are
varied; however, they could be recognized. Mild to moderate stress may
not be observed collectively, thus symptoms at this level of stress are
varied and depend on individuals' perceptions of stress (10,11). Nursing
provides a wide range of potential workplace stressors as it is a profession

6. that requires high levels of skills, teamwork and provision of continuous
care.
Maslach et al. (13), identified the following workplace stressors: conflict
with physicians, inadequate preparation, problems with peers, problems
with supervisor, discrimination, workload, uncertainty concerning
treatment, dealing with death and dying patients, and patients and their
families. Other sources of stress include workload, leadership/
management issues, professional conflict, mood disturbances, age and
experience, and emotional demands of caring (13-16). Whenever
Sengin,(17) reported that, work - related stress is estimated to be the
biggest occupational health problem in the United Kingdom (UK), after
musculoskeletal disorders such as back problems and stress related
sickness absences cost an estimated $4 billion annually. Hospitals
throughout the world are currently undergoing massive changes to their
organizational structure in an effort to reduce costs (18). In some cases,
organizational change means hospital closure, job loss, reduced employee
status, and higher levels of workload (19). Stress and job satisfaction
among nurses has been the subject of extensive research for many reasons,
including the relationship of these occupational attitudes to measures of
job performance (20). In addition, Shaver& Lacey (21) reported that job
stress and job satisfaction were important correlates of anticipated and
actual job turnover among nurses.
Role related stressors
Work load stressors.
Working hour related stressors
Stress
Job
Satisfaction

7. Statement of the Problem Stress free environment and job satisfaction
are essential factors for productive contribution of the employees. Clear
job description, normal workload and nominal working hour have
occupied an important place in determining stress free environment and
job satisfaction. At the same time when these factors are negative, e.g.,
unclear job description, high workload and long and unsocial working
hours will not only bring about stress but also affect their job satisfaction
leading to employee turnover. As nurses involve in patient care activities
they should be free from stress and they should be satisfied with their job.
When they are not provided with clear job description, normal workload
and acceptable working hours, they will develop stress which will not
only affect their concentration, judgement ability and patience but also
cause undue tiredness and forgetfulness. These effects will then reflect on
their patient care activities threatening the safety of the patients.
Therefore, it is essential to provide them clear job description, normal
workload and optimum working hours. In view of these aspects, this
research was undertaken in the study area to identify sources of stress
arising in the form of role related stressors, workload-related stressors and
working hour-related stressors and to provide suitable suggestions to
make essential regulations in these factors.
Scope of the Study The study has focused female nurses working in
general type of private hospitals in Tirunelveli district, Tamil Nadu, with
the qualification of Diploma in General Nursing and Midwifery (DGNM)
and Bachelor of Science in Nursing courses. The study has exclusively
focused the nurses working in intensive care unit, operation theatre, ward
and emergency departments. The study also focused the variables namely
role related stressors, workload-related stressors and working hour related
stressors and job satisfaction.

8. REVIEW OF LITERATURE
Stress
Occupational stress is the experience of negative feelings, such as
frustration, worry and anxiety, perceived to arise from work-related
factors (Kyriacou,2001). It is a state of mind of personal dysfunction as
a result of the conditions in the workplace, and one’s psychological and
physiological reactions to these uncomfortable, adverse, or intimidating
workplace conditions (Daniel et al., 1996). It is a condition arising from
the interaction of people and their jobs and characterized by changes
within people that force them to deviate from their normal functioning
(Beehr and Newman, 1978). Stressors are the factors that are involved in
the stress process (Schaufeli and Peeters,2000).
Relationship between Stress and Job Satisfaction
Job satisfaction and job stress are the two sides of the coin in Human
Resource Management. Occupational stress can reduce productivity,
increase mistakes and accidents at work, encourage absenteeism, lower
morale, increase conflict with others and cause physical and emotional
problems (Pflanz and Ogle, 2006) and finally poor life satisfaction (Pawar
and Rathod, 2007). High levels of work stress are associated with low
levels of job satisfaction. Sanchez et al. (2004) found that job pressure
was negatively associated and was the most important predictor of job
satisfaction. Vinokur-Kaplan (1991) stated that organization factors such
as workload and working condition were negatively related with job
satisfaction. Fletcher and Payne (1980) identified that a lack of
satisfaction can be a source of stress, whereas high satisfaction can
alleviate the effects of stress. The study of Landsbergis (1988) showed
that high levels of work stress are associated with low levels of job
satisfaction

9. Job Satisfaction of Nurses: A Literature Review
Background
According to Rivai (2006) “job satisfaction is a description of a person
feeling, happy or unhappy, satisfied or dissatisfied in work’’.
According to Salam (2014), the factors affecting job satisfaction are:
(1) salary,
(2) the job itself,
(3) colleagues,
(4) boss, and
(5) promotion and work environment.
The World Health Organization (WHO), the International Council of
Nurses (ICN) and the International Labour Organization (ILO) have
found that inadequate working conditions can affect nurses’ job
satisfaction (Hellín Gil et al., 2022). A number of studies have examined
job satisfaction among nursing staff (Liu, Aungsuroch & Yunibhand,
2016; Lu, Zhao & While, 2019; Aloisio, Coughlin & Squires, 2021).
Nurses and nursing staff in general are the largest group of employees
within healthcare and provide services continuously and uninterruptedly.
Therefore, their work performance and behavior contributes to the
creation of conditions that affect positively the provision of quality
services and produce a climate of satisfaction for the patients.
Nurses’ job satisfaction has been the subject of analytical studies at
international level and is an indirect indicator of the quality of
nursing services. In fact, studies have shown that reduced job
satisfaction is inextricably linked to low quality of nursing services,
ineffective care and negative patient outcomes (Moumtzoglou, 2010;
Kalisch & Lee, 2014; Lu, Zhao and While, 2019; Abidakun &
Ganiyu, 2020; Muwanguzi,2022).
According to Kourakos et al. (2012), in a study in Grece, they found that
women and older nurses stated that their work demands negatively
affect the time and energy that they allocate to themselves and their
family, while family issues do not seem to affect their work. In addition,

10. job satisfaction and personal achievement were found to be positively
correlated with each other, while job satisfaction and personal
achievements were found to be positively correlated with each other.
General factors also affect the satisfaction of nursing staff, such as
government support, administrative support and the employer's
commitment to nursing services. In Greece, low job satisfaction and
wish to leave the profession was affected by the fact that many nurses
sought transfer to other jobs in the same healthcare organization or in
primary settings and the irrational allocation of nursing positions in
public hospitals. Other Greek publications on nurses’ job satisfaction
revealed significantly lower scores compared to other professional
groups, and in addition hospital nurses do not perform their tasks as
good as in those working in primary settings. Variables such as
workload, supervisor support, work routine, salary and infrastructure
play an important role in nurses’ job satisfaction (Βorou et al., 2010;
Gogos & Petsetaki, 2011, Sapountzi-Krepia et all., 2017, Platis et all.,
2021).
Lack of job satisfaction and, worldwide, shortage of graduate nurses
are considered to be the main reasons for nurses’ leaving the
profession (Poghosyan et al., 2017; WHO, 2022). In another study
conducted in ten European countries it was found that 13% of nurses
often consider leaving the profession (Hasselhorn et al., 2005).
According to the findings of another study in Europe and the USA, the
proportion of nurses who were planning to leave their jobs ranged from
49% (in Finland and Greece) to 14% (in the USA) (Aiken et al., 2012;
The NNU report, 2022; WHO, 2022). The nursing staff shortage is a
continuing phenomenon in Europe and worldwide and it has received
significant research and media attention. The recruitment of nursing staff
is a international problem and research findings have recognised that
it is related to various factors, the main of them being low job
satisfaction (Tovey and Adams, 1999;
Kingma, 2007; Dor and Halperin, 2022). Low job satisfaction also has a
negative impact on the quality of patient care (McNeese-Smith, 1999)
and nurses’ physical and psychological health (Cavanagh, 1996;
Cavanagh and Bamford, 1997).

11. Factors Affecting Nurses’ Job Satisfaction
Among the common factors that affect nurses’ job satisfaction is the
hectic working rhythm in the hospital, the shortage of specialized
nurses, the low salary, the lack of opportunities for development, the
team work, and non-cooperative administration (Mari et al., 2018). In
addition, the overall job satisfaction is a combination of intrinsic and
extrinsic factors (Smerek and Peterson, 2007). In intrinsic job
satisfaction, employees take into account the type and the activities
they perform at work, while in extrinsic job satisfaction; nurses take
into account their collaboration with colleagues, the management style,
and the workplace communication (Tamata and Mohammadnezhad,
2022). Work-related factors affecting job satisfaction are related to
nurses’ desire to use their skills and competencies and to be able to
make a significant contribution to the patients care (Ozdoba et al.,
2022). On the management point of view, employers want people who
perform their tasks and contribute to the achievement of their business
goals. When administrative organizations find people who fit their
requirements and are happy with what is offered, then a win-win
situation arises between employer and employee. Job rotation in nursing
staff involves moving workers from one department to another in order
to increase their knowledge and skills in all areas. In a study in Greek
nursing population it was shown that job rotation was positively related
to job satisfaction and that gender and years of work were not affecting
job satisfaction (Platis et all, 2021)
Joining a Team
In contemporary societies, people live in a way where group
communication is usually taking place in many forms. In their
research, Shujaat et al. (2014) found that group work and
communication quality have an important impact on an employee’s
job satisfaction. One element of job satisfaction is the positive experience
of being part of a team that achieves the proper functioning of a
department or administrative organisation (Amos et al., 2005; Chen
and Johantgen, 2010; Cezar-Vaz et al., 2022). The clear definition of

12. the goals of the team and the commitment of its members to their
implementation, the cohesion and mutual trust between partners, the
possibility of autonomy, and the fair reward system based on the
recognition of work offered are strong incentives to improve the
efficiency of the nursing team (Connelly et al., 2003). Also, teamwork
has been positively associated with higher levels of job satisfaction
(Rocha et all., 2019). Supervisor support in team work can be a source
of job satisfaction, especially inorganisations with higher levels of
teamworking (Griffin et al., 2001).
Psychological factors and Emotional exhaustion
Job satisfaction is influenced by internal factors of the workplace such
as productivity. It is emphasized that improving employee satisfaction
leads to an increasement of productivity, while dissatisfaction can lead
to increased absenteeism, late attendance and complaints. The
employees’ mentality, behaviors and personality are contributing to the
concept of job satisfaction for each staff member (Laschinger and
Havens, 1997; Collins et al., 2000). Job satisfaction is described even
in terms of psychological concepts, including attitudes towards work,
work ethic, professional development, and work development (Aiken
et al., 2001; Cowin, 2002). Burnout has been classified by the WHO as
an occupational disease and has its roots to chronic stress (Acea-
López et al., 2021). It has been described as having three dimensions:
emotional exhaustion, depersonalization and sense of low personal
accomplishment (Maslach and Leiter, 2016). Nevertheless, this frequently
causes emotional,behavioral, psychosomatic and social changes, as
well as a loss of work efficiency and disturbances in family life
(Pérula et al., 2016). Burnout is often identified in health care
environments and the factors contributing to its development and
consequences for individuals, organisations, or their patients are not
always studied in depth (Dall' Ora et al., 2020). Lee et al. (2004) argued
that stress in the workplace does not reach burnout levels for the nurse
as a factor influencing job satisfaction. They argue, also, that the
satisfaction that nurses feel in their personal lives is correlated with job
satisfaction and burnout. It was demonstrated that nurses who had low

13. levels of job satisfaction and high levels of burnout also had moderate
levels of satisfaction about their lives in general. Nursing staff who
reported high levels of life satisfaction, high levels of personal
achievement and low emotional exhaustion usually did not work at
night and, also, mentioned that they were happy with their
professional position. Similar findings regarding work-related stress and
satisfaction have been proven in supported by Yang and Baik (2016) and
Nam et al. (2016) researches.
Safe Working Conditions
A safe working environment leads to a healthy working environment.
A safe and healthy working environment includes the use of modern
machinery, the logistical equipment and programmes for everyday
clinical routine, as well as the psychological support and empowerment
of nursing staff (Shirey, 2006). The nursing team is motivated and
becomes more creative in a healthy environment that meets the need
for collegiality, for conflict avoidance, promotes good interpersonal
relationships, prefers reconciliation and compromise, and protects
employees from burnout (Hudson, 2008; Schmalenberg and Kramer,
2009). Reasonable shift allocation, faire division of labour, licensing,
efficiency bonuses, the facilitation and the provision of assistance to
nurses by the nursing services by granting them educational leaves,
have a very important impact on job satisfaction. The rational and
impartial way the boss-leader manages these issues, and the fairness
and honesty on his part are the basis for the team's commitment to
achieving its visions and goals creating a healthy working environment
(Kramer et al., 2010; Sherman et al., 2011).
Reward and Monetary Reward
The major categories of rewards are intrinsic, extrinsic, financial and
non-financial (Bonenberger et al., 2014). It is worth to emphasize that
behavior is a function of its consequences. Therefore, by enhancing

14. positive comments, with moral reward, public visibility especially to
young employees, morale is strengthened and a positive working
environment is created (Greco et al., 2006). Among the main elements
that affect job satisfaction are the good working conditions, the
relationship with co-workers, the in-job training opportunities, job
security policy, and institution's overall policies. In addition,
motivation, and lack of it, can affect employees' performance (Baron
1983). The attitudes dominating the employee-employer collaboration
can edure employee rewarding (Hafiza et al., 2011). Rewards may be in
the form of a good salary, bonuses, good facilities in the work
environment, travel programs and holiday allowance increase the
employees’ job satisfaction and has a good effect on their job
performance. The need for advancement in the hierarchy of the nursing
services needs to be supported and evaluated with feedback, trust and
dialogue to avoid a competitive climate. People with innovative ideas,
with love for progress, for knowledge and managerial skills in a healthy
working environment are promoted anddeveloped accordingly by the
nursing service (Bailey, 2010). Boru et al. (2010) argue that professional
development opportunities and work conditions play an important role
in nurse satisfaction. Initially, monetary remuneration was recognized
as a factor of "occupational health" and not as an incentive. This
means salary is a factor to maintain constant job satisfaction, but this in
itself will not give satisfaction. A possible increase in monthly wages
will not necessarily help to increase the level of satisfaction (Ahlburg
and Brown Mahoney, 1996). Low earnings and work intensity
negatively affect job satisfaction (Stringer et al., 2011). A satisfactory
salary is an important factor both in the job search process and in
retaining employees and avoiding resignations (May et al., 2006). The
main reasons why staff had low job satisfaction were working the
difficult job conditions and the low salaries (Bodur,2002).

15. Occupational Health Nurse Job Satisfaction Two studies were found in
the literature directly related to job satisfaction in occupational health
nurses. In the study by Conrad, Conrad, and Parker (1985), job
satisfaction among occupational health nurses was examined. Ninety
seven randomly selected occupational health nurses responded to the
Minnesota Satisfaction Questionnaire. It was determined that
occupational health nurses, as compared with hospital nurses, were
significantly more satisfied with compensation, creativity, and
independence. Hospital nurses questioned were significantly more
satisfied with advancement, authority, coworkers, responsibility, security,
and technical supervision. Occupational health nurses were least satisfied
with advancement, technical supervision, and compensation; they were
most satisfied with social service, moral values, and achievement (Conrad
et al., 1985).
Job Satisfaction and Nurse Empowerment The remainder of the
literature review focuses on nurses and job satisfaction related to
empowerment, job satisfaction related to the work environment, nurse
retention, nurses’ stress level, and the importance of support from nurse
management. This literature can be used as a resource since some of these
same topics apply to the proposed study of the overall job satisfaction and
stress level of the occupational health nurse. The topic of registered
nurses’ empowerment and intent to leave their current position and/or
profession was examined in a study by Zurmehly, Martin, and Fitzpatrick.
(2011) Empowerment is an important component of job satisfaction.
This study tried to identify a relationship between empowerment and
intent to leave a current job. Thirteen hundred fifty-five nurses
participated in a web-based survey. The nurses completed 9 measures of
personal demographics, empowerment, intent to leave their current
position, and intent to leave the profession. The nurses’ empowerment
scores had a mean of 18.85, with a range from 6 to 30,. The nurses

16. perceived moderate levels of empowerment. The RNs least likely to leave
their current position had significantly higher empowerment scores than
those most likely to leave their current position. Overall, 310 (25.2%)
indicated a slight chance in seeking work or change of employer in the
near future; 261 (21.2%) reported uncertainty; 87 (7.1%) indicated a good
chance; and 69 (5.5%) indicated they would definitely leave in the near
future. Reasons associated with the intent to leave included organizational
factors of: supervisor (18%), job stress (14.8%), co-worker relations
(9.7%) salary benefits (6.5%), management (4.5%), and job assignment
(3.4%). The results of this study are important for nurse leaders to
consider and utilize empowerment and intent to leave as new concepts in
which to measure nurse retention.
Job Satisfaction and Nurses’ Work Environment Baernhodt and Mark
(2009) conducted a study that examined whether or not there are
differences in hospital characteristics, nursing unit characteristics, the
nurse work environment, job satisfaction, and turnover rates in rural and
urban nursing units. Both urban and rural nursing units were compared in
a national random sample of 97 United States hospitals, between 99-450
beds, which included 194 nursing units. Data on hospital characteristics
were obtained from the AHA and the hospital’s study coordinator.
Nurses’ job satisfaction was measured using a 27-item organizational job
satisfaction scale. Turnover rates were the total number of RNs who ended
their employment on the unit during a six month period. The mean nurse
response rate was 62%. Nursing units in rural hospitals were significantly
smaller than in urban hospitals (29.4 beds vs. 33.8 beds, P<0.02). Work
complexity, availability of support services, and safety climate were
similar in the two groups and across hospital size. For the nurse work
environment, three variables differed significantly between rural and
urban hospitals. Compared to units in urban hospitals, the proportion of
RNs was significantly lower in rural hospitals (50.1% vs 59.6%,
P<0.000), and in the units in rural hospitals with bed size categories of
200-299 (P<0.01) and 300-450 (P<0.000). Rural hospital units had a

17. significantly lower proportion of RNs with baccalaureate or higher degree
(27.2% vs 35.3%, P<0.0006). RNs’ experience, expertise, and
commitment to care were almost identical in the two groups, as were the
professional practice variables, decentralization, autonomy, and relational
coordination. This study revealed that rural/urban location was not
significantly associated with nurse job satisfaction or turnover rates, but
several characteristics of the nursing unit and factors in the nurse work
environment were associated with these outcomes. For the entire sample,
availability of support services, commitment to care, and autonomy had a
positive influence on nurse job satisfaction. Creating better support
services, work flow with less complexity, a nurse work environment that
supports autonomous nursing practice, and nurses who are committed to
patient care, were identified as strategies for recruiting and retaining
nursing staff. It was determined that leaders in rural hospitals can also
improve the work environment by providing nurses with more educational
opportunities (Baernholdt & Mark, 2009).
Nurse Retention 11 Omar, Abdul Majid, and Johari (2013) conducted a
study about the relationship between job satisfaction, nurse retention, and
the intention to leave among nurses in Malaysian public schools. The role
of moral obligation as a mediator on the relationship between job
satisfaction and intention to leave was also examined. A survey was
conducted that measured perceived job satisfaction, moral obligation,
intention to leave, and demographic data. A total of 700 surveys were
distributed, with a 62.3% response rate (N=436). The researchers
determined that job satisfaction was significantly and negatively related
to intention to leave (r= -0.4369) and job satisfaction had a significant
positive relationship with moral obligation (r=0.473). There was a
significant mediating effect of moral obligation on the relationship
between job satisfaction and intention to leave. These findings are
important for nurse managers to utilize when considering retention
strategies for nurses. The effect of moral obligation on nurse retention has

18. not been studied in the U.S. or with occupational health nurses
specifically.
Nurses’ Stress Levels A Norwegian study by Begat, Ellefsen, and
Severinsson (2005) surveyed 71 nurses to determine if workplace stress
levels correlated with job satisfaction, perception of psychosocial work
environment, and the outcomes of clinical nursing supervision on nurses’
experiences of well-being. Nurses were sampled from two hospitals. Data
was collected through questionnaires and analyzed by descriptive and
inferential statistics. The nurses’ satisfaction with their work environment
was determined based on six factors: “job stress and anxiety”,
“relationship with colleagues”, “collaboration and good Nurses’ Stress
Levels A Norwegian study by Begat, Ellefsen, and Severinsson (2005)
surveyed 71 nurses to determine if workplace stress levels correlated with
job satisfaction, perception of psychosocial work environment, and the
outcomes of clinical nursing supervision on nurses’ experiences of well-
being. Nurses were sampled from two hospitals. Data was collected
through questionnaires and analyzed by descriptive and inferential
statistics. The nurses’ satisfaction with their work environment was
determined based on six factors: “job stress and anxiety”, “relationship
with colleagues”, “collaboration and good communication”, “job
motivation”, “work demands”, and “professional development”. 12
Factor one measured job stress/anxiety. This accounted for a correlation
of (15.05%) with Cronbach’s alpha of (α=.83), and factor one attributed
increased stress to nurses feeling they had too much to do (α=.90) and
being stressed out on the job (α = .87). Factor two looked at relationships
with colleagues resulting in an overall correlation of (13.66%, α = .63).
Specifically, nurses identified a need to discuss problems (α =.80),
responsiveness of subordinates (α16 =.77), colleagues openness to new
ideas (α =.75), and the ability to get information (α =.64). In Factor three,
collaboration/communication was responsible for (11.2%) overall with an

19. alpha of 0.72. When they belonged to fellowship, nurses reported a
positive relationship (α =.88) and when they were able to collaborate with
others (α =.84). Factor four (10.7%, α = .74) showed that when nurses
were engaged at work, they felt more job motivation (α =.81) and nurses
also found the work interesting and stimulating (α =.75). Factor five
looked at work demands (7.8%, α =.64), specifically planning. There was
a correlation between stress and no job description (α =.79) and lack of
planning or routines (α = .78). Lastly, Factor six found a positive
correlation with professional development (5.9%) and nurses being
encouraged to develop new skills (α =.85). Overall, these six factors
explained 64.3% (α =-.75) of the principal components of nurses
perceptions of their psychosocial work environment (Begat et al., 2005).
It was concluded that job-related stress and anxiety are directly caused by
ethical conflicts in nursing. Support by clinical nursing supervision may
have a positive influence on nurse perceptions of well-being. It may also
have a positive effect on nurses’ physical symptoms, feelings of anxiety,
as well as being in control of the situation. There were clear differences
between the nurses who received clinical nursing support and those that
did not. This study is important for nursing managers to understand the 13
importance of providing support to nurses, and the role it plays in overall
job satisfaction. Another survey of work related stress was conducted with
1,780 nurses in Michigan (Fletcher, 2001). Researchers found that nurses
believed they were being asked to provide more care with less staff and
that patients had unrealistic expectations of the level of care (Fletcher,
2001). The respondents rated their mean professional stress as high,
compared to other health professions (R= .90). Additionally, the nurses
rated their job satisfaction as 5.04 on a scale from 1 to7, indicating that
they were somewhat satisfied with their job, and they rated their
likelihood of leaving the profession as 4.08 on a scale from 1 to 5
indicating a low likelihood of leaving the profession (Fletcher, 2001).
A qualitative exploratory study looked at work related stressors and
coping mechanisms in hospital registered nurses (Hall, 2004). The

20. researcher interviewed 10 nurses in Kentucky and found that they
believed that a shortage of skilled labor and polychronicity was
responsible for their increased stress levels. The nurses identified
categories that they felt were responsible for their stress and among them
system barriers, self-expectations, shortage of skilled labor, and
colleague’s inexperience as the most common reasons they were unable
to meet the patients’ needs and provide safe quality care. The study also
found that negative communication, including anger and discourtesy,
experienced in interactions with other health care professional, doctors,
and patients and families was a source of stress. When effective
communication broke down, nurses tended to withdraw from the situation
and focus on when their shift would end or resign themselves to a situation
they believed would not change (Hall, 2004).
Summary This literature review has determined that nurse
empowerment, work environment, stress level, and support of nurse
management, all play a role in the job satisfaction and retention of the
nurse. Nurses who feel less empowered and have higher stress levels
related to work conditions, also have higher intent to leave and decreased
job satisfaction (Zurmehly et al., 2011). Work-related stress can
contribute to low job satisfaction and increased likelihood of nurses
leaving the profession (Begat et al., 2005). The overall work environment
can influence the nurse’s intent to leave (Baernhodt & Mark, 2009). These
findings emphasize the importance of multiple concepts impacting nurse
satisfaction and retention rates and should be of great interest to nurse
leadership

21. Research Objectives
The objectives of the study are listed in what follows:
1) To assess the level of stress among nursing officers.
2) To find the relationship between perceived stress level and job
satisfaction among nursing officer in various hospitals.
3) To associate the relationship between stress and job satisfaction with
their selected demographic variables such age gender educational
status etc.
By addressing these objectives, this research endeavors to contribute to
the body of knowledge surrounding occupational stress and job
satisfaction in nursing, thereby informing policy decisions, managerial
practices, and interventions aimed at fostering a healthier and more
fulfilling work environment for nurses across diverse healthcare settings.

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