1. INTRODUCTION
Prolonged exposure to workplace stress adversely affects health,
including contributing to coronary heart disease (CHD), depression, and
psychological disorders 1,2. Some professions,
including mental health nurses, have a higher propensity to experience
work-related stress3,4. Psychiatry nurses experience
burnout and a higher level of stress because of human factor demands and
environment4,5,6. Subsequently, nurses in the
pediatric intensive care unit (PICU) who have occupational-related
stress routinely changed jobs7. Similar to nurses,
emergency room physicians are prone to experiencing work-related stress
resulting in burnout8.
Adverse work environment stressors profoundly impact the physical and
psychological health of nurses9. Among Japanese
nurses, mental health was the primary reason for nurses who sought to
change jobs10. Laposa, Alden, and
Fullerton11 determined that trauma accounts for 20%
of the attrition of Canadian emergency department nurses in large urban
hospitals. Nurses intent to leave the profession identified
disproportionate work effort/reward distribution, high mental demands,
and increased job stress as the driving factors to seek a job
change12.
Nurses frequently experience significant working environment stressors
and challenging working conditions13. The stressful
working environment of nurses reduces job satisfaction and negatively
impacts patient care14. Consequently, the implications
of nurse turnover include economic impact, effects on nurse job
performance, and patient outcomes15. Shortages in the
nurse workforce market spurs healthcare executives to think
strategically about sustaining organizational effectiveness, including
improving preventable risk factors associated with nurse workplace
stress. However, no study has been done to date to examine the
relationship between nurse work setting and nurse job change due to work
stress using the National Sample Survey of Registered Nurses (NSSRN)
data. Understanding the effects of workplace stress on nurses may
encourage effective interventions and future strategies to ameliorate
nurse job change due to stress.
When the evidence of workplace stress disorder was studied, Czaja, Moss,
and Mealer16 found that nurses who were critically
exposed to significant stress levels had a higher intention to quit the
occupation. However, some nurses are finding methods to cope and remain
in the profession. As an illustration, some PICU nurses had substantial
risk factors for posttraumatic stress disorder (PTSD) but still adapted
well to the workplace stressors because they utilized resilient
mechanisms to cope with stress, including cognitive mindfulness therapy
and focus groups17. Job stress adversely affects life
expectancy. Holleyman et al. 3 suggested that career
area and work location contributed to the United Kingdom (U.K)
physicians reducing life expectancy. The issue of nurse work setting
related to nurse job change due to work stress requires further
evaluation.
The purpose of the study is to test the hypothesis that nurse workplace
stress facilitates nurse job change. As a result, this study
investigates the association between nurses’ work setting and job change
related to work stress, including adjusting for case-mix difference in
covariates. The covariates in the analysis include gender, ages grouped,
marital status, years since graduated from initial Registered Nurse (RN)
education grouped, household income, ethnicity, job satisfaction,
full-time status, employed with current employer in 2007, census
division, no patient care, represented by labor unions, intention
regarding principal RN position, plans to remain in nursing profession,
active RN license required, advanced practice RN certificate, Highest
RN/RN related education, primary patient population, and principal RN
position type.