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.