69

Reported Work-related Stressors among

Staff Nurses in Metro Manila

Aubrey Dayrit1 and Fritz Gerald Jabonete2*

1
College of Nursing, Chinese General Hospital College, Philippines
2
Department of Nursing, College of Allied Health, National University
*Corresponding Author: fgvjabonete@national-u.edu.ph

Abstract: Work-related stress became an increasing global problem affecting all

categories of workers including healthcare professionals. World Health Organization
reported that stress, especially related to work is currently the second most frequent
health problem and is a significant problem of our times. Several studies revealed
that nurses are under greatest work stress and highest physical, psychological, and
emotional strain. This study also examined relationships between work-related
stressors and selected socio-demographic factors. It utilized the Modified Expanded
Nurses Stress Scale (ENSS). A descriptive-correlation and cross-sectional design
were used. The study was conducted by hospital staff nurses in a tertiary government
and non-government hospital in Metro Manila. The predominant work-related
stressor that occasionally occurs in the work setting was workload while
discrimination stressors never occur. Respondents reported the moderate level of
stress (M=2.66, SD=0.85) on the nine subscales. Work-related stressors are
significantly related to age (χ2 = 20.05), civil status (χ2 = 17.48) number of patients
(χ2 = 16.11) and length of service (χ2 = 21.27). Sixty-six (58.41%) respondents
claimed that there is stress management program seminar offered in their hospital.
Twenty-three (20.35%) respondents claimed that there is no stress management
program being conducted in their hospital. Nurses reported the moderate level of
stress in all subscale of the modified, expanded nursing stress scale. Effective coping
mechanisms and stress management program, and policies are emphasized. It is
recommended to revisit the staffing and scheduling plan and provide enough staff to
cover the unit to address workload stressors. It may be useful to consider
teambuilding activities between nurses and physicians to strengthen team work and
collaboration. A training program can be devised that culturally-fit and evidence-
based.

Keywords: stress; work-related stress; nursing stress; coping mechanism

1. INTRODUCTION
1.1 Background
Work-related stress becomes an increasing global problem affecting all
categories of workers including healthcare professionals. This is brought by
a fast changing technological world that creates waves of demands and
pressures at work settings. Stress, especially related to work is the second
most frequent health problem and is a significant problem of our times that
affects both physical and mental health of the people (WHO, 2014).
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National Institute of Occupational Safety and Health (2014) defined

work stress as harmful physical and emotional responses that occur when job
requirement do not match the worker's capabilities, resources, and needs.
Nursing is recognized as a stressful demanding occupation (Higgins, 2003;
Zaghloul, 2008). Stress has been observed among various professionals
without exemption. Previous researches reported that nurses, regardless of
workplace or culture, are confronted with a variety of stressors. Indeed,
nursing is considered as the highest stressful job among 40 stressful
professions (Mozhdeh et al., 2007). The First Asia Health Survey in 2006 by
Reader’s Digest and Nielsen Media across seven Asian countries including
the Philippines, found out that Filipinos are the most stressed-out in which
two out of five Filipinos (43%) are affected by stress-related illness like
hypertension.
In the Philippines, work-related stress has received very minimal
attention. There are only a few studies related to stress being done. As a
future administrator, it is important to look at specific areas and to investigate
those issues affecting our staff and our patient as well in the organization.
Thus, this study determined the most prevalent work-related stressors and the
level of stress utilized by nurses working in selected public and private
hospitals in Metro Manila. Nurses’ awareness about the different types of
work-related stressors will help them in taking the first step to manage or
handle even before they encounter it. This can provide the basis for the
administration in designing an evidenced-based stress management program
to develop a healthy and competent nurse.
To reach this end, the study answered the following question:
1. What are the predominant work-related stressors experienced by nurses
regarding the following factors:
1.1 workload stressors
1.2 death and dying stressors
1.3 patient and family stressors
1.4 uncertainty concerning treatment
1.5 conflict with physician
1.6 inadequate emotional preparations
1.7 problem with supervision stressors
1.8 problem with peer stressors
1.9 discrimination
2. What is the work-related stress level of nurses working in a hospital
regarding the following work-related stressors:
1.1 Physical
1.2 Psychological
1.3 Social working environment
3. Is there a relationship between the work-related stressors and the
following selected socio-demographic variables:
3.1. Age
3.2. Civil status
3.3. Acuity of care
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3.4. Highest educational attainment

3.5. Length of service
3.6. Type of hospital
3.7 Area of assignment

1.2 Statistics of Stress

Work-related stress accounts for $200-300 billion a year in American
work-related worker stress is implicated in 60-90% of medical problems.
The First Asia Health Survey conducted by Reader’s Digest and Nielsen
Media Research among 24,000 Asians from the Philippines, Hong Kong,
India, Malaysia, Singapore, Taiwan, and Thailand. It was found out that
Filipinos were the most stressed-out people, where more than two out of five
Filipinos (43 %) said they were affected by stress, which is contrary to the
popular belief that Filipinos are most laid-back in Asia.

1.3 Signs and symptoms of stress

Williams (2003) listed the symptoms of a person who is suffering from
stress. Among these symptoms include changes in appearance, in behavior
and habits. Furthermore, Cartwright and Cooper (1997) identified stress
symptoms as individual and organizational. The identified individual
symptoms include raise in blood pressure; depressed mood; excessive
drinking; irritability; and chest pain while organizational symptoms are
manifested by high absenteeism; high labor turnover; industrial relations
difficulties; and poor quality control are organizational symptoms
encountered in response to stressors. It can be noted that signs and symptoms
of stress affect the physical, psychological, social and cultural well-being.

1.4 Stress Level of Hospital Nurses

Several studies done globally have shown that occupational stress is
prevalent in nursing profession. Saini et al. (2011) reported that 92 % of
nurses in their study experienced average stress while 8% experienced high
levels of stress. Similarly, Jahromi et al. (2014) reported that most nurses
(76.41%) also suffered medium levels of stress. Makie (2006) emphasized
that stress and coping among registered nurses working in a South African
tertiary hospital revealed a high case of the reported stress which he admitted
was high enough to be considered serious.

1.5 Socio-Demographic Factors and Stress of Nurses

The literature reveals factors such as age, gender, marital status, salary,
family income, job position, number of children, number of patients handled
per shift, highest educational attainment, length of service, working hours per
shift, and type of hospital are related to work-related stressors.
Myhren et al. (2013) showed that the experienced staffs were less
vulnerable than inexperience staff to job stress. Similarly, Miriam (2008)
reported a significant association was found between level of stress and age
and years of experience. She concluded that nurses who were older, with
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more experience and high income, had low-stress level. Hussein et al. (2012)
reported that with every increase of one year experience the score of stress
level decreases. Likewise, On the other hand, Lee (2003) and Makie (2006)
reported that the longer the nurses had worked in their units, the more likely
they were to experience stress.
It was reported in Germany that married individuals handled stress
better that those who never get married, divorced, separated and widowed
(Wilson & Oswald, 2005). This showed as evidence of how marriage affects
physical and psychological health. Ghareeb et al. (2014), reported moderate
to severe stress among those who are not married in their study on assessment
of work stress and organizational commitment among female nurses in
Egypt. This explained the feeling of loneliness and unhappiness felt by single
female single nurses. Previous studies had concluded that job-related stress,
emotional labor, and depressive symptoms among unmarried or single
Korean nurses are vulnerable to depressive symptoms. This finding is also
similar in the study of Hussein et al (2012) which reported that married
participants showed lower stress levels than those who were single.
Carayon and Gurses (2008) explained the impact of workload on
nursing stress and burnout. It emphasized that high workload is a key job
stressor for nurses in a variety of care settings, such as ICUs. Saini et al.
(2011) found that nurses with high levels of professional accomplishment
perceived significantly lesser degree of stress among intensive care nurses at
tertiary care hospital in Chandigarh, India.
Rasasi et al (2015) found that 60% of the nurses reporting severe
stress are coming from private sector compared to 40% from the
governmental sector in their study on work-related stress among 295 nurses
working in Dubai. In contrast, Katyal et al. (2013) reported that
governmental hospital nurses were found to have significantly higher
emotional exhaustion and depersonalization as compared to nurses working
in private hospitals.

1.6 Synthesis
Nurses working in hospitals are exposed in a very stressful
environment that could affect their health, the delivery of quality patient care,
and consequently the organization they belong.
Foreign and local literature showed high statistics on work-related
stress. In the Philippines, there were only few studies on stress from the
nurses' point of view. The recognition of work-related stress issue remains
low and unmanaged. Several studies identified other factors that might have
direct or indirect influence on stress level like age, gender, marital status, job
position, number of children, salary per month, family income, number of
patients handled per shift, highest educational attainment, length of service,
working hours per shift, and type of hospital. However, only age, civil status,
number of patients handled per shift or acuity of care, highest educational
attainment, length of service, and type of hospital were proven by literature
 73

to have a strong association with work-related stress among nurses working

in hospitals.
This study will focus on doing a preliminary assessment of nurses'
perceived work-related stressors before recommending a stress management
program at the patient care unit level.

1.7 Conceptual Framework

The concepts of this study are anchored in the identified work-related
stressors by French et al. (2000) such physical, psychological and social
working environment. These identified work-related stressors are the
dependent variable of the study. On the other hand, the socio-demographic
factors including age, civil status, number of patients handled per day or
acuity of care, highest educational attainment, length of service, and type of
hospital are the independent variables.

SOCIO-DEMOGRAPHIC WORK-RELATED
FACTORS STRESSORS

 Age Physical
 Civil status
 Acuity of care Psychological
 Highest Educational Attainment
Social Working Environment
 Length of service
 Type of hospital
Fig 1. The Relationship between Selected Socio-demographic Factors and
Work-related Stressors

2. METHODOLOGY
2.1 Study Design
The study utilized a descriptive-correlation and single cross-
sectional design. A survey method was utilized in the data collection.

2.2 Study Setting

The study was conducted to hospital staff nurses in a tertiary
government and non-government hospital in Metro Manila. The study setting
was selected because of the accessibility of the researcher and a former
employee in one hospital selected in this study. Hospital A is an 800- bed
capacity private tertiary hospital within Manila. It is one of the oldest and
most advanced hospitals in Manila which was founded in 1878 during the
Spanish times. It has steadily grown in excellence, fame and service in its
138 years of existence. Now in the new millennium, it has continued to
expand its breath of charity services. On the other hand, Hospital B is a
tertiary government hospital with 1200 bed capacity. This hospital provides
excellent tertiary medical care, hospitalization, and out-patient services. This
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hospital is also committed to deliver compassionate and sustainable health

services through proficient professionals and top line technology. Both
hospitals have 300-350 personnel under nursing services. The nurse-patient
ratio for both hospitals ranges 1:15-20.

2.3 Sample
The respondents are registered nurses assigned to the general ward and
special unit to have direct contact to the adult patient and their relatives for
at least one-year experience as a nurse. The special areas include emergency
unit, paediatrics, ICU, operating room, delivery room, and post-anesthesia
care unit. It excluded nurse volunteers, trainee nurses, nurse supervisors, and
nurse.

2.4 Sampling Design

Stratified random sampling was used in selecting participants for the
study. They were divided into two strata: general ward nurses and special
area nurses.

2.5 Sample Size

The sample size was computed using proportional allocation. The
formula below was used to calculate the sample size assumed at 95%
confidence level.
𝑁𝑖
𝑛𝑖 (𝑠𝑎𝑚𝑝𝑙𝑒 𝑠𝑖𝑧𝑒 𝑝𝑒𝑟 𝑠𝑡𝑟𝑎𝑡𝑢𝑚) = 𝑛 ∗
𝑁

Where:
𝑁𝑃𝑄
𝑛= 𝑁
+ 𝑃𝑄
𝐷2
𝑍𝑡𝑎𝑏
𝐷=
𝐵

𝑛 = 𝑠𝑎𝑚𝑝𝑙𝑒 𝑠𝑖𝑧𝑒
𝑁𝑖 = 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑝𝑒𝑟 𝑠𝑡𝑟𝑎𝑡𝑢𝑚
𝑃 = 𝑝𝑟𝑜𝑝𝑜𝑟𝑡𝑖𝑜𝑛 = 0.5
𝑄 = 1 − 𝑃 = 0.5
𝑁 = 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑍𝑡𝑎𝑏 = 𝑐𝑟𝑖𝑡𝑖𝑐𝑎𝑙 𝑣𝑎𝑙𝑢𝑒 = 1.644854, where α = 0.05
𝐵 = 𝑚𝑎𝑟𝑔𝑖𝑛 𝑜𝑓 𝑒𝑟𝑟𝑜𝑟 = 0.05

Using the above formula, this study required a total of 277

respondents. The required sample size for public hospital includes 104
general ward nurses and 77 special areas for a total of 181 respondents. On
the other hand, 70 general ward nurses and 26 for the special areas, a total of
96 respondents in the private hospital.
A post-hoc power analysis revealed that for an effect size (0.35),
power (0.90) as significant at the 5% level, a sample of 234 respondents
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would be required. In this study, an oversampling of 20 % for possible

attrition was considered making it 280. However, only 275 responded the
study.
A computer-generated randomizer was used in the selection of
samples.

2.6 Expanded Nursing Stress Scale

The Expanded Nursing Stress Scale (ENSS) is a 34- item self-report
questionnaire that measures the frequency and level of work-related stress
among nurses (French et al., 2000). It incorporates 57 items with nine-
subscales. Among these subscales are categorized it into three dimensions
such as: a) Physical which includes Workload; b) Psychological which
includes Death and Dying, Inadequate Emotional Preparation, and
Uncertainty Concerning Treatment; c) Social Working Environment which
includes Conflict with Physicians, Problems with Peers, Problems with
Supervisor, Patients, and their Families, and Discrimination.

2.7 Psychometrics
Internal consistency reliability was assessed using Cronbach's
coefficient alpha. The 57-item ENSS demonstrated improved reliability (α =
.96) (French et al, 2000) over the original NSS (α = .89) of Gray-Toft &
Anderson (1981). Individual subscale reliability ranged from α =.88
(problems with supervisors) to α = .65 (discrimination). For this study, the
overall Cronbach alpha was 0.97 and for the frequency of stressors was 0.98
and considered reliable.

2.8 Data Collection Procedure

An ethics approval was attained UP Manila Review Ethics Board
(UPMREB) with assigned protocol no. UPMREB 2015-421-01. A pilot test
was conducted prior the conduct of this study. The researchers sought
permission from the Chief of the hospital and the chief nurses to administer
the survey in their institution. After hospital approval was gained, the
researcher with the aid of a research assistant started to hand down the brown
envelopes the different unit heads. The letter addressed the purpose of the
study and the direction for completing the survey. After two weeks that
survey questionnaire was distributed, the researcher and the research assistant
returned to collect the questionnaires. Respondents who did not answer the
questionnaires within the given period were followed up personally.

2.9 Data Analysis

Obtained data was encoded in MS Excel and was analyzed using the
software R. Both descriptive and inferential statistics were used.
Descriptive statistics was used in determining the main work-related
stressors and in measuring the level of stress among nurses.
Chi-square tests the relationship between the demographic
characteristics and level of stress (per dimension). Spearman Rank
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Correlation was utilized to test the relationship between level of stress and
coping mechanism.
Moreover, to test the significant difference in the level of stress
between public and private hospitals, Wilcoxon Rank Sum test was
employed.
The respondents were asked an open-ended question on other work-
related stressors they encountered at their workplace, on the availability of
stress management program offered in their hospital, on other strategies they
were using to cope with work-related stress, and on other occupational
hazards. Thematic analysis of qualitative responses was done.
Table 1 describes the socio-demographic characteristics of the
respondents from the two (2) participating hospitals.

3. RESULTS
3.1 Demographics
As shown in Table 1, the respondents in this study belong to the age
range of 22 to 60 years old. Majority of them or 191 (69.5%) belongs to the
age group of 21 to 30 years old while the lowest number (3.7%) of nurses is
from the age group of above 50 years old. Most respondents are single with
188 (68.4%). More than half of the respondents are assigned in general wards,
150 (54.5%). On the other hand, there are 123 (44.7%) assigned in the special
areas. Regarding number of patients handled per shift, the highest
percentages are those handling more than 1 to 5 patients per shift with 90
(32.7%). Majority of the respondents or 240 (87.3%) surveyed are college
graduate. 177 (64.4%) respondents are in the service between 1 to 5 years as
a nurse.

Table 1. Demographic Characteristics of Respondents

Percent
Socio-Demographic Characteristics Frequency
(%)
(N=275)
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Age
21-30 191 69.5
31-40 34 12.4
41-50 26 9.5
>50 10 3.6
Civil Status
Single 188 68.4
Married 82 29.8
Separated/ Divorced 2 0.7
Widow/er 2 0.7
Area of Assignment
General Ward 150 54.5
Special Area/Ward 123 44.7
No. of Patients Handled
1-5 90 32.7
6-10 56 20.4
11-15 43 15.6
16-20 14 5.1
>20 71 25.8
Highest Educational Attainment
College 240 87.3
with MA units 26 9.5
MA/S graduate 4 1.5
with Ph.D. units 2 0.7
Ph.D. graduate 1 0.4
Others 1 0.4
Length of service (in years)
1-5 177 64.4
6-10 42 15.3
11-15 19 6.9
16-20 12 4.4
21-25 5 1.8
26-30 8 2.9

Table 2 presents the summary of the frequency of occurrence of

stressors in the work-related of nurses in this study. Topped off the list is
workload stressors that have been reported to occur occasionally at work
setting. Similarly, stress was occasionally experienced from sources such as
death and dying, patient and family, uncertainty concerning treatment,
conflict with a physician, inadequate emotional preparation, the problem with
supervision stressors, and the problem with peer stressors follows. Lastly,
discrimination stressor never occurs.

Table 2 Work-Related Stressors among Hospital Nurses

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Work-Related Stressors Mean (SD) Interpretation

Workload Stressors 2.73 (0.75) Occasionally
Death and Dying stressors 2.55 (0.59) Occasionally
Patient and Family Stressors 2.42 (0.75) Occasionally
Uncertainty Concerning Treatment 2.31 (0.58) Occasionally
Conflict with Physician 2.28 (0.58) Occasionally
Inadequate Emotional Preparation 2.25 (0.59) Occasionally
Problem with Supervision Stressors 2.20 (0.78) Occasionally
Problem with Peers Stressors 2.10 (0.57) Occasionally
Discrimination 1.42 (0.67) Never

Table 3 shows the summary of the over-all stress level of nurses.

Findings reveal that nurses from hospitals experienced a moderate level of
stress on the nine subscales. The patient and family were identified as the
source of stress at a moderate level. Three work-related stressors yield the
second highest source including workload, death and dying, and uncertainty
concerning treatment. Other sources of stress that were identified conflict
with a physician, discrimination, the problem with supervision stressor,
inadequate emotional preparation, and problem with a peer.

Table 3. Level of Stress among Hospital Nurses

Measures of Stress
Mean (SD) Interpretation

Physical
Workload Stressors 2.75(0.80) moderate
Psychological
Death and Dying Stressors 2.75(0.92) moderate
Uncertainty Concerning Treatment 2.75(0.81) moderate
Inadequate Emotional Preparation 2.42(0.74) moderate
Social Working Environment
Patient and Family Stressors 2.91(0.95) moderate
Conflict with Physicians 2.64(0.82) moderate
Discrimination 2.63(1.29) moderate
Problem with Supervision Stressors 2.59(0.93) moderate
Problem with Peers Stressors 2.12(0.68) moderate
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Table 4 shows the relationship between work-related stressors and

selected socio-demographic variables. It can be noted that work-related
stressors is significantly related to age (χ2 = 20.05, p=0.02), civil status (χ2 =
17.48, p=0.02), number of patients (χ2 = 16.11, p=0.00), and length of service
(χ2 = 21.27, p=0.03). However, there was no relationship was found with
educational attainment (χ2 = 1.75, p=0.55) type of hospital (χ2 =9.58, p=0.15),
area of assignment (χ2 =5.08, p=0.36), and type of hospital (χ2 =9.58, p=0.15).

Table 4. Relationship between Work-related Stressors and Socio

demographic Variables

Socio-Demographic Variables χ2 the

Age 20.05 0.02*
Civil status 17.48 0.02*
No. of patients 11.27 0.18
Educational attainment 1.75 0.55
Length of service 21.27 0.03*
Type of Hospital 9.57 0.15
Area of Assignment 5.08 0.36

*p-value <0.05 is considered significance

3.2 Qualitative Responses

To enrich the result of gathered quantitative data, respondents were
asked an open-ended question on other work-related stressors they
encountered at their workplace, on the availability of stress management
program offered in their hospital, on other strategies they were using to cope
with work-related stress, and on other occupational hazards.
Table 5 below shows the qualitative responses generated from the 96
respondents of Hospital A (public) and Hospital B (private). The responses
are categorized as physical, psychological, social, organizational, and
personal or nurse factors.
The physical factor has the highest identified other stressor among nurses
(30%, N=29). This is followed by a social factor (29%, N=28). Psychological
factor obtained the least number of responses (3%, N=3).

Table 5. Other Stressors Encountered among Nurses

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Frequency
Other Identified stressors (%)
(N=96)
Physical Factor
Understaff 9 (9.38)
work overload 5 (5.21)
pulled to other unfamiliar areas 4 (4.17)
Overtime 3 (3.13)
frequent schedule change 2 (2.08)
time pressure 2 (2.08)
additional research works 1 (1.04)
administrative work 1 (1.04)
asking a professional fee from doctors 1 (1.04)
staff absenteeism 1 (1.04)
Psychological Factor
the insufficient financial capacity of patients/
relatives 2 (2.08)
death of a patient 1 (1.04)
Social Factor
conflict with co-staff/ among patient's 14 (14.8)
demanding and uncooperative relatives 5 (5.21)
conflict with co-staff/ among patient's relatives 3 (3.13)
demanding and uncooperative patient 3 (3.13)
demanding doctors 1 (1.04)
lack of team support 1(1.04)
miscommunication among staff 1 (1.04)
Organizational Factor
lack/ defective/ malfunctioning equipments 9 (9.38)
inadequate supply of medicines 7 (7.29)
conflicting policies/ new policies 3 (3.13)
not paid well 2 (2.08)
Personal/Nurse Factor
personal issues 6 (6.25)
distance from home 2 (2.08)
sudden illness 2 (2.08)
acquiring diseases 2 (2.08)
disorganized family relationship (nurse) 1 (1.04)
home rules 1 (1.04

Table 6. Stress Management Program Utilized by Nurses

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Frequency
Stress Management Programs Percent
(N=113)
Stress management seminar 66 58.41
None at all 23 20.35
Yoga/ laughter therapy/zumba/outing 7 6.19
Conflict management seminar 6 5.31
Do not know/ not sure 6 5.31
Not all staff given opportunity to
participate 3 2.65
Physical exercise 1 0.88
Spiritual seminar 1 0.88
Table 6 shows the themes generated from the qualitative responses
among 113 participants. Sixty-six (58.41%) respondents claimed that there is
stress management program seminar offered in their hospital. Twenty-three
(20.35%) respondents said there is no stress management program is being
conducted in their hospital.

4. DISCUSSION
This study indicated that age of the participants significantly affects
his/her stress level psychologically and socially. This means that younger
nurses experienced a higher level of stress compared to older nurses due to
differences in work experiences. This was supported in the study of Ghareeb
et al. (2014) which found that highest percentage of moderate to severe level
of stress were from ages less than 30 years old. Similarly, Miriam (2008)
reported a significant association was found between level of stress and age
and years of experience. She concluded that nurses who were older, with
more experience and high income, had low-stress level. However, this is
inconsistent with the findings of Galdikiene et al (2016) found that nurse with
older age reported increased levels of experienced stress.
It is evident in this study that single has higher stress level compared
to those who are married. This was contradicting to the idea that single should
be less stressful since they don’t have a double burden like those who are
married who have enormous responsibilities to their families. A possible
explanation why married ones have less stress level compared to those who
are single is mainly because of the influence of marriage as a major support
system in the Filipino culture that could be considered as a factor that
decreases the level of stress among married respondents. However, these
findings contrasted with the study in Germany that married individuals
handled stress better that those who never get married, divorced, separated
and widowed (Wilson & Oswald, 2005).
The number of patients handled per shift considerably influences
their level of stress, probably because the respondents lack competency to
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handle high patient load due insufficient experiences leading them to feel that
they are unable to provide the needed psychosocial care.
Most respondents of this study are college graduate. However, it was
found out that work-stressor is not significantly related to educational
attainment. Likewise, Ayed et al. (2014) reported that educational attainment
has no relationship on job stress among the respondents in their study on
exploring the work-related stress sources and its effect among the Palestinian
Nurses at the Government Hospitals. However, this finding was contrasted
in the study by Saini et al. (2011) which showed that nurses with high levels
of professional accomplishment perceived the significantly lesser degree of
stress among intensive care nurses at tertiary care hospital in Chandigarh,
India. This explains the greater amount of stress experienced by ICU staff
nurses who perform hand-on care for the patient than those who perform
supervisory and administrative functions.
This study did not support that work stressors have a significant
relationship to the type of hospital. It only means that workload of a nurse
either in public or private hospital does not significantly affect the level of
stress felt by the staff nurse. However, Rasasi et al. (2015) found that 60%
of the nurses reporting severe stress are coming from private sector compared
to 40% from the governmental sector in their study on work-related stress
among 295 nurses working in Dubai. This can be inferred that work-stressors
do not matter whether the nurse works in public or private hospitals. This
further validated the findings of Rasasi et al. (2015) which reported that
nurses from both public and private hospitals report a similar pattern of
stressful experiences.
As a summary, findings revealed a significant relationship between
work-related stressors and age, civil status, and length of service. However,
there was no significant relationship between work-related stressors and
number of patients, education attainment, type of hospital, and area of
assignment.

5. CONCLUSION
It is predominant that work-related stressor occasionally occurs in the
work setting as reported by the respondents in this study. Nurses reported
moderate level of stress in all subscale of the modified, expanded nursing
stress scale. This implies that their level of stress was within the borderline
between mild and severe stress. Hence, effective coping mechanisms or stress
management program, and policies is vital before turning this out into a
severe level which may have a negative effect in the health, job performance,
and quality patient care of these nurses. Respondents reported the highest
moderate level of stress on patient and family stressors. Age, civil status, and
length of service had a significant relationship to the work-related stress
level. On the other hand, a number of patients handled per shift, educational
attainment, type of hospital, and area of assignment had no significant
relationship to work-related stress level. Given the findings, it is
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recommended to revisit the staffing and scheduling plan and provide enough
staff to cover the unit to address workload stressors. It may be useful to
consider teambuilding activities between nurses and physicians to strengthen
team work and collaboration. A training program can be devised that
culturally-fit and evidence-based. This has an implication for policy-making
for the occupational health condition of the staff.
It is suggested that future studies increase the number of hospitals
and widen the population size including to other specialty areas such as
emergency room, operating room, intensive pediatrics, post-anesthesia care
unit, etc. to enhance the generalizability of the findings. It may be
considerable to look at the effect of stress on nurses’ health, job performance,
and patient safety in the Philippine setting.

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