Nursing Stress Scale Research Articles

Effect Of Job Stress On Job Satisfaction Among Nursing Staff In Sulimani Mental Health Hospitals

Background: Job stress is regarded as a harmful factor for both employees and organizations, which negatively affects the effectiveness of employees and the efficiency of organizational performance. Many occupations are exposed to different types of stress in the workplace environment. One of these occupations is nursing, which occupies essential roles and vital parts of the effectiveness of the health care system. Objective: To investigate the relationship between the effect of job stress on job satisfaction for nurses. Method: A descriptive study was conducted among nursing staff in mental health hospitals in Sulaimani. The process of the necessary data collection began from 25th May - 10th July 2016 and was obtained through a self-report convenient sample of (75) nurses. They distributed in three hospitals Soz Mental Hospital, Shahid Salahi Muhandis Hospital, and Mental Health Center / Teaching Hospital by using questionnaires were divided into three parts: First, socio-demographic characteristics consisted of eight items. Second, Expanded Nursing Stress Scale (ENSS). This consisted of (57) items ranged in nine subscales. Third, Job Satisfaction Survey (JSS), which included 36 items in nine subscales. Descriptive data and inferential data were used for analysis. the validity of the questionnaire was determined through a panel of (11) experts in the different fields and work settings. Results: The analysis of the data figured out that total average job stress among nursing staff at the mental hospitals was "Occasionally stressful- frequently stressful". The subscale death and dying from job stress took the highest level. Nursing staff had job satisfaction, subscale payment (salary) from job satisfaction took the lowest level. There were significant statistical relationships between the level of job stress subscales and demographic characteristics except for the training course dimension. There was no statistically significant correlation between total ENSS and total JSS. Conclusions: The death of the patients played an important role in perceiving job stress. The lack and delay in salary were a major factor in decreasing job satisfaction, although the level of job stress among nurses does not highly record. Also, most of the nurses were satisfied with their work. Keywords: Stress level, Job Satisfaction, Nursing Staff In Mental Health center

Occupational Stress and Burnout Syndrome among ICU Nurses. A Prospective Observational Study

Nurses in Intensive Care Units (ICU) may be exposed to considerable stress of work. High levels of stress in ICU nurses affect the quality of nursing and the quality of life at work. Determination of occupational stress levels, burnout syndrome and overall job satisfaction among ICU nurses. The research was conducted in Intensive Care Unit of Emergency Clinical County Hospital of Oradea, Romania. Data were collected from the questionnaires, 29 nurses (of the 35) were selected for this study. Professional stress factors have been assessed through Expanded Nurses Stress Scale (ENSS), burnout syndrome through Maslach Burnout Inventory-Human Services Survey (MBI-HSS), while overall job satisfaction was measured by a 7-step Likert scale. The highest levels of stress were associated with workload and conflicts with other health professionals, professional relationship between nurses have been described as the least stressful. About burnout levels: a high score for emotional exhaustion and depersonalization, and a low score for professional achievements. Professional satisfaction has reached an average level. The fidelity of the scales was verified by the Cronbach’s alfa coefficient: Expanded Nurses Stress Scale (ENSS) (0.98) and Maslach Burnout Inventory-Human Services Survey (MBI-HSS) (0.73).

The association of primary healthcare nurses' perceived stress with organizational culture and climate in a team context

Aim: The aim of the present study was to describe the association between primary healthcare (PHC) nurses' perceived stress and organizational culture and climate in a team context. Design: A descriptive, cross-sectional correlation study. Methods: 29 teams in 18 PHC centers situated in one Lithuanian county participated in the study. A total of 187 nurses completed the Expanded Nursing Stress Scale, while 344 healthcare professionals (including nurses) responded to the Organizational Social Context questionnaire. Results: Absolute values of Spearman's rho correlation coefficients between 0.19-0.24 (p < 0.01) were found when examining the association of nurses' stress with organizational culture and climate across PHC teams. Whether the culture was resistant or proficient seemed to have associations with some of the stress factors experienced by nurses. Additionally, how the whole team reported stress or functionality in their organizational climate seemed to be associated with perceived stress of nurses. Conclusion: Investigating the organizational culture and climate experienced by PHC teams may help identify manageable problems and decrease stress experienced by nurses. The study also allows the possibility of nursing scholars using the study's designs and instruments for further investigation of teams.

Specific stressors relate to nurses' job satisfaction, perceived quality of care, and turnover intention.

To determine which stressor has the highest occurrence and what stressors are related to nurse outcomes, such as job satisfaction, perceived quality of care, and turnover intention. Numerous stressors have been identified in nursing practice, but it is unclear if specific stressors are related to nurse outcomes. The study used a cross-sectional and descriptive-correlational research design. In July and August 2017, survey data were collected from 427 staff nurses employed in a large tertiary-level private hospital in Metro Manila, Philippines. The Nursing Stress Scale was used to measure stress frequency. Structural equation modelling was used to determine the relationship of stressors and nurse outcomes. Exploratory and confirmatory factor analyses indicate nine Nursing Stress Scale factors. Workload is the most frequent stressor. Moreover, workload was negatively related to job satisfaction and perceived quality of care. Workload and conflict with nurses were positively related to turnover intention. The Nursing Stress Scale has a different factor structure based on a survey of nurses in the Philippines. Only workload and conflict with nurses were related to specific nurse outcomes. Nurse managers should identify and mitigate stressors experienced by nurses since these can lead to turnover and poor quality of care.

Associations between Psychosocial Work Environment Factors with Work Engagement and Burnout in Nursing

The psychosocial work environment (i.e., job demands and resources) is a significant determinant of nurses’ health and motivation; yet, despite the close associations between specific work environment factors, various frameworks suggest different aspects as the most important among the rest. Having in mind the assumption that a more abstract level of analysis might be equally relevant for understanding the work environment and predicting significant outcomes, the aim of this study was to discern the latent factors of nursing work environment and to evaluate their significance in predicting nurses’ work engagement and exhaustion. Two hundred eleven nurses participated in a two-wave time-lagged survey (ΔT = 8 months). In this survey, 1 Expanded Nursing Stress Scale and several subscales of the Work Design Questionnaire were used to measure main job demands and resources in nursing. At that time, 2 participants were asked to fill out an Utrecht Work Engagement Scale and Copenhagen Burnout Inventory. Exploratory factor analysis (EFA) and hierarchical regression analysis were used for analyzing the data. The EFA results revealed that two factors can be discerned, each related to main job demands and resources accordingly. Based on these results, the aggregated indexes of job demands and resources were calculated. A linear regression analysis showed that these indexes predicted nurses’ work engagement and exhaustion no worse than specific factors, despite the loss of variance due to aggregation. Practical implications of such conclusions are also discussed in the article.

CE: Original Research: Work-Related Stress and Positive Thinking Among Acute Care Nurses: A Cross-Sectional Survey

To assess the relationship between perceptions of work-related stress and the use of positive thinking among acute care nurses. A cross-sectional survey consisting of the Expanded Nursing Stress Scale, the Positive Thinking Skills Scale (PTSS), and a demographic questionnaire was administered to a convenience sample of 298 RNs, which included nurses already working for an eight-campus health care system and newly hired nurses during orientation. Compared to the established group, the incoming RNs were generally younger, had less education, and reported higher levels of both work-related stress and positive thinking. Linear regression analysis revealed that an increase in perceived stress was predictive of an increase in positive thinking. The PTSS, which had not been previously tested among nurses, was found to be reliable and valid. This is the first U.S. study to evaluate the use of positive thinking in managing work-related stress among acute care nurses. The data suggest that positive thinking skills are being used to cope with such stress. But the mean PTSS scores for both groups were only slightly above midline, suggesting that nurses' use of positive thinking as a coping skill can be improved through formal training and education.

Occupational stress and work ability among nurses in an academic hospital

Background: Occupational stress is one of the key factors in reducing staff productivity in any organization with physical and psychological impacts on employees. Nursing is among the most stressful professions. Therefore, this study aimed to assess the extent of perceived level occupational stress and its association with work-related and non-work related variables as causes of stress and work ability among nurses in a Public Medical College Hospital.&#x0D; Methods: A cross sectional study was done among nurses in Shaheed Suhrawardy Medical College Hospital (ShSMCH) dmi.ng July 2015-June 2016 among 197 nurses, selected through a simple random sampling. Face to face interview was conducted, using a pretested semi-structured questionnaire. Occupational stress and work ability were measured using Expanded Nurses Stress Scale Questionnaire (ENSS) and WorkAbility Index Questionnaire (WAIQ). Appropriate statistical analysis was performed to see the level of significance.&#x0D; Results: Majority (69.0%) of the study population were between the age of 21 to 39 years, 94.gG/o were female, 68.0% were married, 79.2% were Muslim, 84.3% had diploma, 91.4% fumily income were equal or more than Tk 40,000, 95.5% did clinical work. Some 25.0% worked in medicine ward, 22.8% worked at surgery ward and 90.9% worked more or less than 50 hours per week. Only 5.1% found to be high stress and 94.6% low stress. Significant difference was found between female and male, occupational stress and religion, educational status, type of work, occupational stress and work ability (p&lt;.0.05).&#x0D; Conclusion: Severe occupational stress is associated with reduced work ability. So, it is recommended to decrease occupational stress to increase work ability, although identification of sources of occupational stress seems necessary in order to adopt appropriate stress management strategies.&#x0D; Bangladesh Med Res Counc Bull 2018; 44: 113-117

When safety climate is not enough: Examining the moderating effects of psychosocial hazards on nurse safety performance.

To examine the association between components of safety climate and psychosocial hazards with safe work behaviours and test the moderating effects of psychosocial hazards on the safety climate-safety performance relationships. The effects of a strong safety climate on safety performance are well cited, however, the conditions that have an impact on this relationship warrant attention. While the psychosocial hazards commonly reported by nurses are predictors of well-being and job attitudes, evidence suggests that these may also place boundaries on the effects of safety climate on safe work practices. This study used a cross-sectional design to collect data from 146 nurses. Participants were recruited through convenience sampling and snowball sampling methods in 2017. Nurses completed an online questionnaire and received a $5 e-gift card as compensation. SPSS v.23 and PROCESS v3.0 were used to analyse the data. A strong safety climate was positively associated with nurses' safety performance. While psychosocial hazards did not predict safety performance, they did moderate the safety climate-performance relationship. High levels of perceived stressors weakened the association between promoting two-way safety communication, the use and implementation of procedures to promote safe work practices and management's endorsement of health and safety with safe work performance. The positive effects of safety climate on nurses' safety performance are contingent on the levels of psychosocial hazards nurses experience. When aiming to improve safety performance among nurses, it is important for efforts to also focus on the psychosocial conditions of the work environment.

Assessment of occupational related stress among nurses in two selected hospitals in a city southwestern Nigeria

This study assessed frequency of stressful event among nurses and how stressful they perceived those events to be.This descriptive design study was carried out among nurses in two selected hospitals. In all 183 nurses recruited using simple random sampling participated in the study. Ethical clearance was obtained from appropriate IRB. The instrument used for data collection was the Nursing Stress Scale. Descriptive and inferential statistics were used for data analysis.Most frequently stressful aspect of nurses work include; inadequate staff to cover ward work load (2.55); performing procedures that patients experience as painful (2.30); and lack of drugs and equipment required for nursing care (2.30). On the overall, workload was the most frequently stressful aspect of nurses’ work followed by death and dying. Three most stressful aspect of nurses’ work was observed to be, not having enough staff to adequately cover the load of the ward (3.72); lack of drugs and equipment required for nursing care (3.45); and death of patient with whom you develop a close relationship (3.43). No significance difference was observed in the level of stress experienced by nurses in the two hospital (99.35 vs 93.27; t = 1.492, p = 0.137). Also, in the level of stress experience by the junior and the senior nurses (99.76 vs 95.41; t = 1.127; p = 0.261).In conclusion, nurses are susceptible to occupational stress because of intense daily activity. Nurses are not ever thought as needing help but only as the care givers.

A Cross-Sectional Study of Perceived Stress, Mindfulness, Emotional Self-Regulation, and Self-Care Habits in Registered Nurses at a Tertiary Care Medical Center.

IntroductionWorkplace stress and burnout may influence nurses’ physical and emotional well-being, which can impact the quality of care patients receive and their overall satisfaction with their hospitalization.ObjectivesThe objectives of the study were to evaluate whether there are significant statistical relationships between nurses’ perceived stress, frequency of stressors, mindfulness, emotional self-regulation, self-care habits, and patient satisfaction scores.MethodsThe study took place over the course of 4 weeks. In this study, 340 nurse participants were surveyed using cross-sectional voluntary sampling design. The survey included previously developed and validated instruments. SAS v. 9.4 was used for statistical analysis.ResultsSignificant differences were noted in average patient satisfaction scores by perceived stress; major nursing units in the Death and Dying, Conflict with Physicians, Lack of Support, and Work Load subscales of the Nursing Stress Scale; and major nursing units and dispositional mindfulness.ConclusionsHospital administrators can use this information in their organizations and set priorities and tailor mindfulness-based stress-reduction interventions for nursing professionals.

Stress among staff nurses: A hospital-based study

Background: Stress can be described as a dynamic and reciprocal relationship between the person and the environment. Nursing is an occupation with a constellation of circumstances leading to stress. Work-related stress (occupational stress) can be damaging to a person's physical as well as mental status, which directly and indirectly affecting their quality and productivity of work. Hence, an attempt has been made with an aim to assess stress-perceived stress among staff nurses in Mysore city, India. Methodology: The descriptive cross-sectional study was conducted among 500 staff nurses selected from eight hospitals in Mysore City, India, using multistage sampling technique. Study duration was 5-month period and response rate was 100%. A structured questionnaire was administered to assess stress using Perceived Stress Scale (PSS) and Expanded Nursing Stress Scale (ENSS). Results: A cross-sectional study consisted of 500 staff nurses. Majority of the participants (467 [93.4%]) had diploma and 454 (90.8%) nurses worked on day shift. Nearly 277 (55.4%) had a moderate level of perceived stress and 249 (49.8%) had moderate occupational stress. Significant positive correlation (r = 0.144, P

Nurse Leader Initiatives to Decrease Job Stress on the Acute Care Unit

Nurses are expected to provide high quality, safe healthcare in working environments where limited resources and increasing responsibilities are common. An imbalance between providing high quality care and managing or minimizing the assault of stressors can lead to increased job stress. Nurses on the Acute Care Unit (ACU) of a Midwestern, rural hospital utilized the Nursing Stress Scale (NSS) developed by Gray-Toft &amp; Anderson (1981) to analyze aggregated mean data self-reported scores for job stressors before and after focused change initiatives. Nurses selected and led change initiatives for the top five scoring stressors that nurses concurred were modifiable using interprofessional interventions. Multidisciplinary teams collaborated to choose educational sessions, updated resources, and revised communication tools in an attempt to decrease job stress on the unit. The results of the second NSS when compared to the first survey overall demonstrated decreased stress mean scores in six of the seven subscales. The specific nurse led unit initiatives decreased self-reported job stress in four of the five areas. This project found encouraging results in decreasing job stress by implementing nurse led change initiates on the ACU. &#x0D; Keywords: nursing, job stress, leadership, change initiatives

Analysis of the occurrence and influencing factors of metabolic syndrome in clinical nurses

Objective To investigate the present situation of nurse's metabolic syndrome, and explore the correlation between diet, behavior and occupational stress and nurse's metabolic syndrome. Methods In April to May 2015, using stratified cluster random sampling method, a total of 393 nurses in Fuzhou were investigated by physical examination, blood tests, Nurse Stressor Scale (NSS) and a general information questionnaire for metabolic syndrome and its influencing factors. Totally 393 questionnaires were distributed and 380 valid questionnaires were collected. Results There were 54 cases of metabolic syndrome among 380 nurses, accounting for 14.21%. Logistic regression analysis showed that age, working age, occupational stress, sleep time, the amount of meat in diet, cooking oil were the risk factors of metabolic syndrome (P<0.05) . The physical exercise and the quantity of vegetables in diet were the protective factors of metabolic syndrome (P<0.05) . Conclusions Unreasonable diet, inadequate exercise and occupational stress are the factors that affect the metabolic syndrome in nurses, which are related to their professional characteristics. Key words: Nurses; Metabolic syndrome; Diet; Behavior; Occupational stress; Influencing factors

The relationships between coping, occupational stress, and emotional intelligence in newly hired oncology nurses.

Associations between the varying levels of emotional intelligence in newly hired oncology nurses and their responses to stress and coping were examined. The secondary aim was to analyze whether emotional intelligence could moderate their choice of problem-focused or emotion-focused coping strategies. Newly hired nurses (n=114) were recruited from a national cancer institute. Data were collected through surveys using the Ways of Coping Questionnaire, the Nursing Stress Scale, and the Emotional Quotient Inventory between the eighth and twelfth weeks post-hire date. Descriptive and bivariate statistical analyses were conducted on all variables. Regression models determined whether emotional intelligence moderated the choice of coping strategies. Emotional intelligence had a mean value of M=105.24, SD=13.02, and occupational stress scores were M=65.57, SD=15.68. Significant negative correlations were found for occupational stress and problem-focused coping (r=-.189, P=.022), emotional intelligence and emotion-focused coping (r=-.340, P=.000), and emotional intelligence and occupational stress (r=-.428, P<0.001). Positive correlations were noted between occupational stress and emotion-focused coping (r=.189, P=.022) and emotional intelligence and problem-focused coping (r=.340, P=.000). Emotional intelligence did not predict the choice of coping strategies. Although emotional intelligence did not moderate coping strategies in newly hired nurses, using problem focused coping to address occupational stress during the initial employment period may be a protective factor for coping with stress in the oncology workplace.

Occupational stress and stressors experienced by the newly practicing nurses in intensive care units

Background and objective: Nurses working in critical care units face occupational stress particularly in the first six months of their practice; however, research on nurses’ perceived stress during this period is extremely limited. The aim of the study was to assess occupational stress and stressors experienced by the newly practicing nurses in intensive care units (ICUs).Methods: Design: A cross-sectional, descriptive, quantitative research design. Settings: Four ICUs in a university hospital in Alexandria governorate, Egypt. Participants: A convenient sample of 100 intern nurses who had their first clinical work experience in ICU during the internship. Method: This is a cross-sectional, descriptive, quantitative survey study conducted in four ICUs in Alexandria university hospital, Egypt. A questionnaire sheet consisting of two parts was used to collect data. Part one is the nursing stress scale and part two is the respondents’ socio-demographic and work-related data. Descriptive and bivariate statistical analyses were used to describe study variables and their associations.Results: All of the studied newly practicing nurses in ICUs experienced either moderate (43%) or high (57%) stress level. There are differences between the perceived stress reported by the studied nurses according to their characteristics (e.g., sex, marital status, having private work). These differences were not statistically significant. Death and dying, workload, and inadequate preparation are the top ranked stressors; average scores are 2.22, 2.20, and 2.13 respectively. In their first two months of experiences, nurses perceived inadequate preparation and death and dying as the highest stressors. This ranking differs among nurses with 3-4 months of experience and nurses with 5-6 months of experience.Conclusions and recommendations: Newly practicing nurses in ICUs face a significant level of stress. Death and dying, workload, and inadequate preparation are the top ranked stressors. Recommendations: Stress-management program must be initiated for new practicing nurses in ICU. Death and dying in ICU are highly needed topics to be embedded into nursing curriculum. Strategies to help graduate nurses cope must be implemented.

Perceived job stress among community nurses: A multi-center cross-sectional study.

China is reforming its health care system, which aimed to strengthen primary health care through building community health centers (stations) and assigning a "gate-keeper" role to primary care providers. Community nurses play a key role in the reform. Little is known about the level of job stress among community nurses. Thus, this study aims to explore the level of perceived job stress and its influencing factors among community nurses. A cross-sectional design was used to conduct a survey with 1015 nurses from 56 community health centers in Sichuan province. Job stress was measured by the Community Nurses Stress Scale. Data were collected between March and November 2015. Community health nurses in China perceived high levels of job stress. The job stress was related to nurses' individual characteristics and work environments. Permanently employed nurses, shift workers, and those older than 45years age and with less training related to community nursing and involvement in childcare were more likely to experience high levels of stress. Reform is required of the community nursing personnel system, and development of continuing education programs and stress-alleviating measures to reduce community nurses' job stress. The results of this study favour future advanced practice community health nursing practice and education.

Resilience training: Effects on occupational stress and resilience of critical care nurses.

Working as a nurse, by its nature, causes a high degree of stress. Nurses are exposed to the higher levels of occupational, physical, and mental stresses in critical care units than the nurses in other units of a hospital. The aim of this study was to determine the effect of training for resilience on the intensive care unit nurses' occupational stress and resilience level. This study is a quasi-experimental intervention study that was done by recruiting 30 nurses who were selected from critical care units of an educational hospital in Sari City, Iran, through convenience sampling between April 2015 and February 2016. The resilience training was provided in 5 sessions of 90 to 120minutes. The pretest-posttest approach was used in this study, and the nurses completed the Connor-Davidson Resilience Scale, and Expanded Nursing Stress Scale, before and 2weeks after the training program. The mean score of the occupational stress of the participants decreased significantly after the intervention (P=.001), and the mean score of resilience increased significantly after the intervention (P=.001). The results confirm the effectiveness of resilience training on occupational stress and resilience level of nurses working in the intensive care units.

Moderating effect of occupational stress on spirituality and depression of Registered Nurses in tertiary hospital: A structural equationmodel.

The aim of this study was to determine the influence of spirituality to depression and to determine the moderating effect of occupational stress among Registered Nurses. Depression is a major contributor to the global burden of disease and it is influenced by several factors. Spirituality can be a protective factor against depression. However, it remains underexplored among nurses who experience several precipitating factors of depression, including occupational stress. Cross-sectional, predictive-correlational study. From August - December 2017, 242 purposively selected nurses from selected tertiary hospitals completed a four-part survey packet composed of the "robotfoto," Spirituality Assessment Scale, Expanded Nursing Stress Scale, and Beck's Depression Inventory-II. Structural equationmodelling analysed the influence of spirituality to depression, while multigroup analysis determined the moderating effect of occupational stress. "Personal faith, spiritual contentment, and religious practice" negatively influenced depression, generating a good model. Occupational stress significantly moderated the influence of spirituality to depression, with a significant inverse U-shaped effect for both "personal faith" and "religious practice" and a non-significant decreasing effect for "spiritual contentment". The stress-moderated model of the influence of spirituality to depression highlights three significant points. First, there is a need to develop individualized, spiritually based interventions based on the spiritual needs of Registered Nurses. Second, policies geared towards positive spirituality in the workplace and spiritual support to nurses must be explored. Finally, nurse managers must identify the sources of occupational stress and implement stress-reducing programmes in the workplace.

Survey on the Viewpoints of Nursing Managers on the Impact of Implementation of The Health System Development Plan on their Stress and Job Satisfaction in Hospitals

Introduction: The aim of this study was to determine the viewpoint of nursing managers on the impact of implementation of the health system development plan on their stress and job satisfaction in hospitals of Babol University of Medical Sciences. Methods: This study is a descriptive study. In this study, the population of the study consisted of all metrons, supervisors and head nurses in hospitals affiliated to Babol University of Medical Sciences in 2017. Sampling method: Census; Sample size: In this research were 70 people; Research tool: Nursing job stress (Nursing Stress Scale) questionnaire (34 questions). The next questionnaire is the Spector's job satisfaction questionnaire (36 questions). In terms of validity, the questionnaires have been reviewed by experts and their reliability has been reported by Cronbach's alpha of 0.88 for this tool. Data analysis method: The data will be entered into SPSS version 22 using the statistical analysis. Findings: The results show that there is a significant relationship between the viewpoint of nursing managers on the impact of implementation of the health system development plan on their stress and job satisfaction in hospitals of Babol University of Medical Sciences in 2017 (Significant level less than 0.05). Conclusion: Despite the implementation of the health care development plan in nursing managers of hospitals affiliated to Babol University of Medical Sciences in 2017, their stress levels are more than average, and their job satisfaction is more than expected.&#x0D;

Work-Related Stress Factors in Nurses at Slovenian Hospitals - A Cross-sectional Study.

BackgroundSurveys conducted among healthcare workers revealed that nursing staff often face various stressors associated with occupational activities, which reduce their work efficiency. The aim of the study was to establish the level of stress in nurses working at hospitals in Slovenia and to identify stress-related factors.MethodsA cross-sectional epidemiological design and a standardized instrument called the “Nursing stress scale” were used. The sample included 983 nurses from 21 Slovenian hospitals. The research was conducted in 2016.ResultsPrevalence of high level of stress was 56.5% of respondents (M (median)=75). Prevalence of high level of stress and stress factors may be statistically significant attributable to dissatisfaction at work (p<0.001), disturbing factors at work (p<0.001), inability to take time off in lieu after working on weekend (p=0.003), shorter serving (p=0.009), fixed-term work (p=0.007), and an increased number of workdays on Sunday (p=0.030).ConclusionThe stress rate and stress factors are substantially influenced by variables reflecting work organization, competences and skills of healthcare management to work with people. Results reflect the need for nursing management and policy makers to design strategies to ensure adequate staffing, efficient organization and an encouraging work environment.