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Abstract
Nurses experience significant stress and emotional exhaustion, leading to burnout and fatigue. This study assessed how the nurses’ mood and fatigue evolves during their shifts, and the temporal factors that influence these phenomena. Performing a two-level design with repeated measures with moments nested into a person level, a random sample of 96 nurses was recruited. The ecological momentary assessment of demand, control, effort, reward, coping, and nursing tasks were measured in order to predict mood and fatigue, studying their current, lagged, and accumulated effects. The results show that: (1) Mood appeared to be explained by effort, by the negative lagged effect of reward, and by the accumulated effort, each following a quadratic trend, and it was influenced by previously executing a direct care task. By contrast, fatigue was explained by the current and lagged effect of effort, by the lagged effect of reward, and by the accumulated effort, again following quadratic trends. (2) Mood was also explained by problem-focused and emotion-focused coping strategies, indicative of negative mood, and by support-seeking and refusal coping strategies. (3) Fatigue was also associated with direct care and the prior effect of documentation and communication tasks. We can conclude that mood and fatigue do not depend on a single factor, such as workload, but rather on the evolution and distribution of the nursing tasks, as well as on the stress during a shift and how it is handled. The evening and night shifts seem to provoke more fatigue than the other work shifts when approaching the last third of the shift. These data show the need to plan the tasks within a shift to avoid unfinished or delayed care during the shift, and to minimize accumulated negative effects.
Highlights
Nurses are exposed to significant stress at work, which can lead to burnout, provoking a deterioration in nurses’ health, a decrease in the quality of their care, and an increase in their intention to quit [1,2,3,4,5]
The distribution between the two hospitals was 47.42%/52.58%, and the mean number of years the nurses had been working at their current job was 9.86 (SD = 7.99), with a mean of 17.40 years of experience as a nurse (SD = 8.36)
The evening and night shifts as opposed to the morning and rotatory shifts, seem to provoke more fatigue than the other work shifts when approaching the last third of the shift, results that are in line with earlier findings [28]
Summary
Nurses are exposed to significant stress at work, which can lead to burnout, provoking a deterioration in nurses’ health, a decrease in the quality of their care, and an increase in their intention to quit [1,2,3,4,5]. Two widely studied models of work stress have been tested in the context of nursing—Karasek’s Demand-Control model [6] and Siegrist’s Effort-Reward Imbalance (ERI) model [7]. Nurses suffering high demands or an excessive workload and with little control or autonomy when carrying out their tasks tend to present greater health problems [8,9,10]. Res. Public Health 2020, 17, 7277; doi:10.3390/ijerph17197277 www.mdpi.com/journal/ijerph
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