Occupational stress among student nurses: A natural experiment.

Abstract

This article describes a natural experiment that overcomes a number of methodological problems inherent in previous studies of occupational stress and strengthens evidence for the causal role of the work setting in influencing mental health and well-being. Student nurses (N = 164) were randomly assigned to one of four possible combinations of ward types such that two factors—type of nursing (medical/surgical) and sex of patients (male/female)—were systematicall y varied with counterbalancing of order effects. Self-reported levels of affective symptoms and perceptions of the work environment, together with independent data on sickness/absence, performance, and the objective work environment, were recorded longitudinally over the two ward periods. Within-subjects analyses showed significant differences between medical and surgical wards in affective symptoms and in perceived and objective measures of the work environment. Male and female wards differed primarily in the perceived environment, work satisfaction, and performance. Correlational analyses were used to examine the relationships between different types of measures. Further analysis of the main effects, with control for covariance, indicated that the perceived work environment contributed to the observed differences in affective distress between medical and surgical wards, while mitigating differences between male and female wards. In spite of extensive research, the causal role of the work environment in influencing mental health and well-being has not yet been adequately demonstrated. The difficulties in resolving this important issue are primarily methodological, and several recent papers have emphasized the limitations of