Chapter no. 2
2) A review of literature
Job stress has been recognized as a serious and chronic cause of individual suffering, irritation, strain and discomforts. As a matter of fact little research work has so far been carried out on the topic of job stress in Pakistan. On the other hand plenty of work has been done on the topic across the world particularly in the U.S.A and Europe. For the purpose of conducting review of relevant literature on the topic, the researcher was obliged to browse through Internet and to find relevant materials. The magnitude of research work done on job stress across the world and the quantum of data available on the topic on the Internet is phenomenal and is outside the scope of this chapter to incorporate it all. However an effort has been made to select a few closely related dissertations, reports and articles on the topic for review purpose.
This review examines published evidences on the causes and effects of job stress, and the implications for nurses/employees in organisations. It is worth mentioning here that in todays dynamic world the nursing profession is considered to be full of stress.
British Psychological Society, 1988 stated job stress as one of the top ten industrial diseases in the US”. Willcox (1994), reported that atleast 25% of the employees are psychlogically stressed at any one time. It has serious implications for the health of the workers in the society as a whole. The Health of The Nation (HMSO, 1992) describes that this area needs to be addressed to promote the health of the workers (government documents 1992).
‘Stress’ is “one of the most inaccurate words in the scientific literature” reported by williams (1994). The term sometimes indicates stressfull events and sometime indicate the effect of these events on work performance and sometime dis ordered health remarked by Maclean (1985). Marmot Et. Al 1987 reports that job stress is “lack of understanding how work enviroment make a person ill. Job stress refer to broad class of problems indicated by Lazarus (1971) “Any demand which atax the system, whatever it is, a physiological system, a social system or a psychological system, and the response of that system.” There is greater consensus about the meaning and effect of job stress. WHO (1986) stated that stress “is a dynamic state of mind characterized by reasonable harmony between a person’s abilities, needs and expectations, and environmental demands and opportunities.” Prof. Cox (1993) concentrates on the importance for general health of a state of balance between needs and demands, citing the World Health Organisation’s definition of well-being:
Research study on job stress concludes;
Hans Selye (1956) is considered as the father of stress research. The Stress of Life (1956), a book by Hans Seyle introduced the concept of stress in the public domain and his General Adaptation Syndrome [GAS] is a popular one amongst the research scholor of psychology and management. Stress “a state, manifested by a specific syndrome of biological events” Selye (1974). He argued that stress is not entirely a bad event. According to him stress is the reaction of the physical body toward a situation or event, which is demanding. “Any kind of normal activity can produce considerable stress without causing any harmful effects” (Selye, 1974), Selye 1982 clearly state that the non specific implication of any demand put on the body be its effect mental or somatic.
“The uncertainty that occurs at the organizational, unit, group, and individual levels. Uncertainty exists to the extent that knowledge about an event or condition requiring action or resolution is experienced as inadequate” reported by Schuler and Jackson (1986).
Edwards (1988) view about the stress is that “A negative discrepancy between an individual’s perceived state and desired state, provided that the presence of this discrepancy is considered important by the individual.”
Taylor (1992) reported about stress in the following words “Demands made upon us [internally or externally] which we perceive as exceeding our adaptive resources. If we try to cope and that is ineffective this gives rise to stress. If this stress is prolonged then lasting psychological and physical damage may occur.” Hereby demands we do mean that arise from the workload or work burden.
Cox (1993) perception of stress is from te assumption that stressor are discreat, time limited and various events of the life requiring adjustments or adaptaion are utterly associated with stress. Holmes and Rahe (1967) ranked the potential stressfull events which may be work or non work related such as death of spouse, divorce, marriage (not all negative), fired from work marital reconciliation, retirement, bussiness readjustment, change in work responsibilities trouble with boss change in work condition. (Holmes and Rahe, 1967).
“Job stress is the sum total of factors experienced in relation to work which affects the psychosocial and physiological homeostasis of the worker. The individual factor is termed a stressor and stress is the individual worker’s reaction to stressors.” Suggested by Weiman (1977).
Beehr and O’Hara (1987) used ‘stressor’ rather than ‘stress’ to refer to causal factors because“few people misinterpret stressor to mean the person’s reaction.” And uses ‘strain’ to mean “the state ofbeing stressed as evidenced by physiological, psychological or medical indices,”
Hans Selye (1951) report about The General Adaptation Syndrome [GAS] states that, in response to a stressor, an initial ‘alarm reaction’ is followed by a ‘stage of resistance’ in which resistance to the original stressor builds up but ability to resist new stressors is lowered. Eventually a ‘stage of exhaustion’ sets in which ends in catastrophic inability to cope with any form of stress.
2.1 The human face of nursing, (2001): Commented on nursing profession;
The female nurses’ faces challenging situations on daily basis. They face crying and dying patients and their task is stressfull , unrewarding and frightening.
2.2 The importance of the nursing profession is evident from the fact that the ILO has commissioned a manual with the title job stress in nursing profession to control and prevent the stress by Professor Cox (ILO 2001)
2.3 ILO (2001) reported.
The occupation of nursing is related with challenges and demanding tasks. It is also full of overload, role conflit and role ambiguity. So, there is a great need to initiate a stress intervention and stress management program for nurses.
2.4 ILO(2001) presented that various research studies have tried to work out the effect of job stress on job performance and job satisfaction of nurses. It has been established that a negative relation exist between job stress and job performance and job satisfaction.
2.5 Health and Safety Executive (HSE 2001) research report with the title; the workplace stress epidemic; reveals that 53% of the employees have experienced a stress in the work place, International Stress Management Association (2001) found that one out of four working force have suffered due to stress related sickness. One out of five has suffered extreme stress in the work palce.
2.5 The HSE(2001) research found, a highky significant co relation between extreme stress and poor working condition. The employees have reported a wide rang of health problems and behavior problems, Professor Andy Smith have confirmed the fact that job stress is one of the most evident problem in the work enviroment.
2.6 The Bristol team(2000)has reported that 30% increase in job stress has been occurred in the work enviroment. The major problems indicated by job stress related illness are depression, anxiety, backach and musculo skeletal disorders.
2.7 Chartered Management Institute in 2001has found that long hours work load, working late at night has become a culture in the todays modern organization and as such are sources of job stress.
2.8 This study by the CMI and healthcare(2000), has reportd that 25% of the executive had gone on sick leave in the past one year due to job stress, 75% of the executive has reported that job stress was demaging their home life, health, performace at work and satisfaction level..
2.9 The Health and Safety Executive (2001); research survey stated about sorces of stress and the circumstances which result in stress. The sources of stress are work overload, repetative work, role conflict, role ambiguity, danger, harasment and bullying, poor relation ship, in flexible shedule, lack of social support, confusion, lack of communication and poor working condition etc.
2.9.1Cary Cooper(1995), has argued that the trends in the american society are the major sources of job stress, such as working for long hours, down sizing and no contact culture.
2.10 According to Elizabeth Burtney (2002),who found the organization are full of stress and therefore we should focus on the stress intervention in the organization as wel as on stressed out indivisual.
2.11 Professor Stephen Palmer(2001)reported in his research study that stress in a universal thing. Everyone can be stressed and the threshold level of every body will be different. It depend on the person how he percieves a specific situation. Stress may be the result of the interactio between the person and enviroment.
2.11.1 Professor Cary Cooper (1995) has argued that insecurity in the organization stereo type attitude of the boss may be the major sources of stress. For employees it is necessary that they should have complete control on the job because of lack of control some time result in job stress.
2.11.2 Elizabeth Burtney of HEBS research(2004) reveals that stress in this modern world too carries a stigma in the closed style of management where the employees are expected to work hard and no concern is shown for their home life. The employees too never talk about the job stress.
2.12 Elizabeth Burtney of HEBS (2002)reported.That every job has some stress and the most stressful job is that where there is the element of change. Some professions such as health care education, games, and sports are highly stressful and risky.
2.13 Professor Cary Cooper(1997) has found the most stressful jobs of todays world. These are security personnels, social organization, education the proffession of nursing, medical and dentistry, sports and games, acting, jornalism, transportation and resturants.
2.14 Professor Cooper (1997)has assessedthat 60% increase in the job stress level has been occurred. Further he has measured the intensity of job stress in various proffession.
2.15According to an article with the title, “Job stress and job satisfaction” of employees in German radiotherapy (2001), which concludes that the greatest source of job stress stemmed from underpayment, crying patients,keeping patients fit and living,long hours, role conflict etc. Physicians and nurses showed a significantly higher stress level on scales such as structural conditions and particularly compassion than radiographers and physicists. Finally, rating of job stress and satisfaction depends significantly on the age group, gender, experience and the hospital.
2.16 K. CHANDRAIAH et. al. (1990) research study with title;Occupational Stress and Job Satisfaction among Managers, states;Individuals under excessive stress tend to find their jobs less satisfying. Some of their intrinsic or extrinsic needs may be thwarted or not met sufficiently.Corroborating many studies in the literature (Hollingworth et. al. 1988; Keller, 1975), the findingsof the present study also reveal the same. The subjects with lower job satisfaction were found to experience more stress in the form of overload,role ambiguity, role conflict, under participation, powerlessness and low status compared to those with higher job satisfaction. Age, therefore, was found to be of importance in these study findings. The results of the study reiteratethe significance of demands at each career development level as pointed out by Hallingworth.And the individuals encounter crisis at each developmental stage as hypothesized by Erickson.Significantly decreasing stress and increasing job satisfaction with increasing age was found among the managers and these confirm the importance of the developmental process.
2.17 An Empirical Study (1999) with title, “Effect of Job Stress” reported that; job stress is one of the vital issues in the organisation. It has been established that a negative relation exist between job stress and job performance, job stress and job satisfaction.
2.18 This review with title factors influencing stress and job satisfaction(2001): shows that various elements effect stress level and job satisfaction. These elements are leadership, quality control, relation between doctor and nurse. It has been established that a negative relationship exists between leadership, stress and job satisfaction.
Although a positive relationship between clinical leadership and nurses’ job satisfaction was found, the association between clinical leadership and quality of inter-professional collaboration is unclear. The association between these variables and job satisfaction is positive but tenuous. In addition, a positive but weak relationship was revealed between the clinical leadership and the quality of relationships amongst nurses. Organisational issues, lack of nursing staff and patient care were found to be related to ward type mental health nurses’ stress emerged as mediating variables between stress and job satisfaction.
2.19 Beatrice et. al. (2002) has found that the higher is the demand on job the higher will be the stress and demanding job negatively affect the health of the nurses and result in deterioration of general health.
2.20 Center for Organizational Health and Development(2002) researched on job related stress in nursing:The research appears to support the view that, together, factors inherent in the nursing role and in the organizational culture within which the nurse works are as important a determinant of the experience of stress by nurses as the type of nursing pursued. Stress in nursing reflects the overall complexity of the nurses’ role, rather than any particular aspects of their individual tasks. Different nursing groups report similar levels of stress, the profile of stressors associated with those similar levels differed somewhat between groups. However, the inter-group differences reported in those studies and others are not sufficient to argue for the separate treatment of the various nurse groups which exist in hospitals. Therefore, while strategies forstress management needs to be tailored to the generic group, hospital-based nurses, they do not need to be further tailored to distinguish between different types of hospital-based nurses.
2.21 HSE(1995) research study entitled health effects of stress in nursing” states that job stress negatively effect quality of nurses’ work it results in creating minor psychiatric morbidity, physical illness and a lot of other health related diseases. It also increases the musculo skeletal disorder and depression. Nurses are amongst those groups of profession which reported a higher level of stress.
2.22 The study here is of Kaohsiung City government employees, china human resource management deptt (2000), entitled job stress relation with social support and job performance.It has been proved in the above research study that there is great relevance between job stress and job performance. job stress is inversly propotional to job performance. Further social support has a great impact on level of job stress. Greater social support results in the reduction of stress level and hence increases the perfromance of the employees. The report also indicated that female employees feel more stressed as compared to male employees (Bheer 2000).
2.23 Ms santha et. al. (2003) research report has presented that the stress level of the employees has various effects on the employees as well as on the organization. Due to stress the employee may give more absenteeism, accidents, high turnover rate and impaired descion. Upto some extent stress may be a good thing. It gives the push and motivation to the employee. But extreme stress is harmful. It may result in poor performance and yet productivity of the employees is reduced.
2.24 NIOSH (1999) reported that;
40% of workers say their job is extremely stressfull.
26% of workers report burnout during working hours.
2.25 David’s and Theresa’s(1999)have reported that 25% of the employees have considered there job stressful, 75% of the employees say that the task is the modern organisation is more stressful than earlier. Job stress may give a lot of problems during the work and it is attached with health problems etc.
2.26 NIOSH (2001) model of job stress is self explanatory;
STRESSFUL JOB CONDITION=RISK OF INJURY & ILLNESS.
(Individual/situation factor apply)
2.27 The NIOSH (1999) research study on gender and job stress finds that sex descrimination and role conflict and role ambiguity and family demand may have more severe effect on female employees. Stress can be reduced in the organisation by introducing a change in the workplace. It may result in the reduction of stress levels for both workers male and females. The organization should promote family friendly policiy, discourge sex descrimination.
2.28 The research study with the title “Women in Construction” has reported that women in the construction industry have complaints of frequent harasment isolation and abuses by her co workers. The turn over of the female workers in the construction industry is higher as compared to others. Female labours in this industry are always at higher risk due to lack of safety measures and trainings.
2.29 In the research study by NIOSH (1999) of females workers in the internal revencue service (IRS), which states that musculoskeletal discomfort can be reduced to a great extent if periodic rest is provided to the worker during working hours. It may result in higer job performance.
2.30 NIOSH (2001) has presented in a survey that 60% of the woman workers have reported that stress is a great problem for them. They have cited that the following are the major sources of stress during job for females employees, role conflict and role ambiguity, poor relationship with other workers, burden of work, rush poor working enviroment, monotonus and repetitive work, lack of control over job, demands etc.
2.31 Journal of Occupational and Environmental Medicine (2001) indicated that in the current era the stress related expenditure on employees is 50% higher than the early period.
2.32Encyclopaedia of Occupational Safety and Health(2001)states that high demanding jobs enhances the risk of cardiovascular diseases, musculoskeletal disorders, psychological problems, injuries at work, suicide, cancer, ulcer and impaired immune function.
2.33 NIOSH(2001) research report on job stress health and productivity states that job stress has inverse relation with productivity and it negatively affect the health of the employees. Stressful working condition results in poor health of the employees. Job stress increases absenteeism, tardiness, higher turnover and poor health.
2.34 Journal of Applied Psychology (2001)reseacrh report with the title “Stress Prevention and Job Performance” states that effect of intervention programe on job stress is very encouraging. The organization should educate employee on job stress, inform the employees regarding policies of the organization, how to reduce job stress and initiate employees support program. Stress prevention program encourage employees and results in enhanced production.
2.35 NIOSH (2000)has reported thaton average employees remain off the job for alost 20 days due to job stress, so job stress results in increased absenteeism.
2.36 The report by national insurance company 1992 enitiled employee burnout states that job stress directly propotional to burn out. Employees stress level should be reduced to avoid employee’s burn out.
In the research study by the national insurance company that female workers feel more stressed than male workers. The chances of burnout and physical sickness related to job stress are more among female workers. The reason may be that the women are paid less than male workers.
2.37 European Agency (2001) research report has mentioned the following details which may be considered at the cost of
Each year millions of working days are lost due to job stress.
The cost of job stress in term of money is in millions of dollars.
2.38 Many studies have tried to determine the posible positive relationship between job stress and violance at work drug use. One study has established the fact that job stress creates negative indivisuals and has negative effect on the organization. The workers who experienced job stress start using drugs and alcohol and tobacco to reduce there tension, so job stress is one of the reason for drinking in the workers ILO (2001).
2.39 University of utara(2004), Malaysia, school of accounting, report on job stress among professional accountants working in selected public firms, a Malaysia case, establish and extends that job stressors faced by workers during job includes workload, role conflict, role ambiguity, lack of job autonomy and lack of job control.
2.40 A research report in Saudi Medical Journal (2003)titled“Job satisfaction and organizationalcommitment “ states that female nurses are more satisfied and contented in the public sector hospital, the study further reveals that satisfied nurses provide higher output as compared to less satisfied nurses. The other factor for higher production from nurses is there comittment toward job.
2.41 A report in journal of health (2003) with title “stress and suicide in nurses” revealed that the relation between stress and suicide remained U shaped.when the job stress and home stress are combined, five fold increase in risk of suicide among women occurs.risk of suicide among high stress women is more compare to low stress experience by women.
2.42 School of Health Science (2002),Blekinge Institute of Technology Karlskrona,Sweden entitled “job stress of nurses” concludes that stress contains amongst other the element of moral. There is shortage of nurses in the health care and organisational structure too impedes nursing performance to avoid the negative consequences of stress for nurses moral support is required. In ICU stress and complex situation are common for all nurses, the stress implication are sometime ethical issues, morbidity and burn out, the report revealed.
2.43 Queensland University of Technology(2002), thesis with the title “The influence of work stress and work support on burnout in public hospital nurses” States that female nurses with high level of stress and little support have experience high rate of burnout. Job stressors were the main predictors of Emotional Exhaustion, Conflict. Changes in the objective conditions at work have had major implications for nurses’ subjective experiences of work, with increasing numbers of nurses feeling stressed and as a consequence, are opting to work part-time or leave the profession
2.44 HSJ – HEALTH SCIENCE JOURNAL(2005), REPORT CARRYING THE TITLE “job stress and job satisfaction”shows that a strong negative relationship was found between clinical leadership, inter-professional collaboration, and stress and job satisfaction. Although a positive relationship between clinical leadership and nurses’ job satisfaction was found, the association between clinical leadership and quality of inter-professional collaboration is unclear. The association between these variables and job satisfaction is positive but tenuous. In addition, a positive but weak relationship was revealed between the clinical leadership and the quality of relationships amongst nurses. Organisational issues, lack of nursing staff and patient care were found to be related to ward type mental health nurses’ stress emerged as mediating variables between stress and job satisfaction.
2.45 A research study by Deptt of medicine(2006). University of Ottawa, enitiled, “job stress corelation with job satisfaction and burn out”The findings are that medical staff frequently faces burn out due to high level of job stress. The turn over rate amongst the highly stressed workers are very high. The problem of burnout is common amongst the staff of cancer unit.
2.46 A research paper by School of Health Care Practice 2006, Anglia Polytechnic University, Chelmsford, Essex(2009), UK,entitled “Workplace stress in nursing” finds that workload, management style, professional conflict and emotional cost of caring and leadership style, lack of reward and shift working are the main sources of stress for nurses for many years. Stress management programe should concentrate on stress prevention as well as how organization should takle this vital issue.
2.47 The Graduate College University of Wisconsin-Stout (2005), Research Paper with title OCCUPATIONAL STRESS IN MENTAL HEALTH COUNSELORS, concludes that,The mental healthcounselors involved in completing the survey instruments scored an average of2.57 on afive point scale, with past administrations of the Weiman Occupational Stress Scalehaving yielded a baseline score of 2.25. The mental health counselors in this study scoredon average 13% higher than the calculated WOSS baseline. Employees in publiclyfunded institutions (Winnebago Mental Health) experience greater perceived work stressthan those counselors in privately funded clinics.
2.48 Research studyconducted by Carol Brewer(2000)mentioned that new comers in the profession of nursing confront enhanced stress as compared to existing lot .New nurses have reported the following are the major sources of job stress for them; complex jobs ,long hours,overtimes frequently, role conflict, role ambiguity, dangerous working conditions,abuses, inadequate resources and strain.
2.49An Exploratorystudy(2001) to dig out the job stressors conducted in Tiawan on nurses concludes that changes in the today’s organizations,role conflict, role ambiguity,lack of social support,working environment in the hospital, demanding job of nurses are the main stressors for nurses.
2.50 European Journal(2005) of Social Sciences, reportentitled “Link between Job Stress and Job Satisfaction” signify that job stress and job satisfaction are invrsely corelated. According to Stamps & Piedmonte (1986) job satisfaction has been found significant relationship with job stress. One study of general practitioners in England identified four job stressors that were predictive of job dissatisfaction (Cooper, et al., 1989). In other study, Vinokur-Kaplan (1991) stated that organization factors such as workload and working condition were negatively related with job satisfaction. Fletcher & Payne (1980) identified that a lack of satisfaction can be a source of stress, while high satisfaction can alleviate the effects of stress. This study reveals that, both of job stress and job satisfaction were found to be interrelated. The study of Landsbergis (1988) and Terry et al. (1993) showed that high levels of work stress are associated with low levels of job satisfaction. Moreover, Cummins (1990) have emphasized that job stressors are predictive of job dissatisfaction and greater propensity to leave the organization. Sheena et al. (2005) studied in UK found that there are some occupations that are reporting worse than average scores on each of the factors such as physical health, psychological well-being, and job satisfaction. The relationship between variables can be very important to academician. If a definite link exists between two variables, it could be possible for a academician to provide intervention in order to increase the level of one of the variables in hope that the intervention will also improve the other variable as well (Koslowsky, et al., 1995).
2.51 A Study of Job Stress and Job Satisfaction among UniversityStaff in Malaysia, a research article(2007)investigates what corelation exists between job stress and job satisfaction? Inverse relationship exists between job stress and job satisfaction. The stressors that have been taken for research contain leadership style and interference by management, relationship with peers, work burden, role ambiguity, and role conflict.
2.52Faculty of Education (2001), University of Ibadan, article entitled“Effects of Job Stress” states that stress has negative effect on health, physical and mental, work behaviour,and performance,satisfaction level.
2.53 Heavy workloads, difficult students and lack of resources are stressing out Australian teachers (1999). Many also experience stress from increasing violence and bullying. In one recent year, 274 teachers in Victoria were either assaulted or threatened by students and another 70 were attacked by colleagues. Over the past five years , 910 teachers in Victoria and 1150 teachers in New South Wales have filed worker compensation claims for anxiety,depression,nervous breakdown and other stress related symptom. Union leaders say these figures are just the tip of the iceberg: Teacher are very reluctant to proceed with those claims because it just adds another problem and additional stress, explains Australian education union president John Gregory Teaching in Australia may be stressful, but the profession seems to be under siege in the Uk , Janice Howell a primary school teacher in Newport (South Wales)is one of the casualties. She initially had the assistance of an English language teacher but that teacher took long-term leave with no replacement. Unable to cope with 28 kids, 11 of them with learning or behavioral difficulties, Howell had a nervous breakdown.
After recovering several months later, Howell complained to the school about the intolerable stress. Rather than providing support, the school added two more troubled kids to Howells class. One student, new to Wales, ran away one morning and was seen playing near dangerous mudflats. Although he was taken home safely, no one told Howell until the end of the day. This led to Howells second breakdown, ending her career. From being a confident, well adjusted teacher who enjoyed her job I became depressed and dysfunctional, says Howell for the first time in my life I did hate to go to work. It got to the stage that I was physically unable to enter the classroom.
2.54 Nebuo Miuro (1999)quoted in the book about stress that employees are under a lot of pressure from his employer to get a new restaurant ready for its launch. The interiors fitter from Tokyo worked late, sometimes until 4.30 in the morning. After one such marathon, Miuro caught a few hour sleep, then return for another long day. But he didn’t get very far. The 47 year old suddenly took ill and keeled over while picking up his hammer and nails. He died a week later. The corners verdict was that Miuro died of Karoshi_death by overwork. Karoshi accounts for nearly 10000 deaths each year in Japan. Research indicates that long work hours cause an unhealthy lifestyle such as smoking, poor eating habits, lack of physical exercise and sleeplessness. This result in weight gain, which, along with stressful working conditions, damages the cardiovascular system and leads to strokes and heart attacks. Karoshi came to the public spotlight in the 1970s when Japans economy was booming, but the country’s current recession is making matters worse.companies are laying off employees and loading the extra work onto those who remain. Performance based expectations are replacing life qtime employment guarantees, putting further pressure on employees to work long hours. Many also blame Japans samurai spirit culture which idolizes long work hours as the ultimate symbol of company loyalty and personal fortitude. Being exhausted is considered a virtue