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Comparison of nursing stress in public and private hospitals

Nurses in emergency department are more exposed to stress than nurses in other departments. A descriptive qualitative design, with a deductive approach based on the Job Demand-Control-Support model was used. Fifteen emergency department nurses at two different hospitals were interviewed and the data were analyzed using a manifest content analysis.

Other important stressors were misunderstanding and conflicts between emergency department nurses and the other health care professionals, presumably related to hierarchy and power relations between health care professions. Creating a better working environment and a balance between the number of patients and nurses would reduce workload and stress, encourage ED nurses to stay in the profession and ultimately maintain patient safety.

Introduction Nursing is considered a stressful occupation, particularly in emergency departments EDwhere nurses encounter unpredictable events and specific stressors, such as trauma, violence, acute life-threatening conditions, sudden death and overcrowding [1].

Stress and well-being in nurses: a comparison of the public and private sectors.

Furthermore, they report more time pressure, higher job demands, lower decision-making authority, fewer adequate work procedures and fewer rewards compared to general hospital nurses [2]. ED nurses in public hospitals in Thailand have reported problems with heavy workloads, stressing situations involving patients and their relatives, violence in the ED, lack of skill improvement, low income, and difficult relationships within the nursing team.

Emergency care is also provided in the private care sector, but less is known if the experience of stress among ED nurses is the same as in public care sector. Background Karasek and Theorell [4] defined occupational stress using the Job Demand- Control-Support JDCS model, which describes interactions between demands, control and support at work.

  • Another source of support that they requested from the organization was extra income;
  • Background Karasek and Theorell [4] defined occupational stress using the Job Demand- Control-Support JDCS model, which describes interactions between demands, control and support at work;
  • This is one reason the Commonwealth and state governments need to improve the information available to consumers about the differences in clinical care, costs, waiting periods and facilities between the public and private systems;
  • Fifteen emergency department nurses at two different hospitals were interviewed and the data were analyzed using a manifest content analysis;
  • Work requirements beyond nursing, e.

Job demand refers to any psychological demand at work such as workload or time pressure. Job control dimension is divided into two aspects including skill discretion, which refers to the opportunity of skill used by the employee in his or her workplace, and decision authority refers to the autonomy of an employee to make a task-related decision by themselves at work.

The support dimension refers to the overall support at work that is available for a worker [4]. According to the model, employees who experience high psychological demands with low level of job control and low social support are likely to have a greater risk of stress and to suffer from poor health [4]. It can cause a variety of psychophysiological health-related problems and may have important consequences for the organization [5]. Previous studies have shown that occupational stress leads to negative consequences for ED nurses, such as stress-related psychophysiological illnesses, increased arousal and feeling of uneasiness [1] [3] [6] [7].

Due to this, ED nurses have higher rates of absenteeism and sick leave, decreased work performance [2] [8]more work-home conflicts and more intentions to leave the profession compared with nurses who work in other environments [2].

  1. Conclusions and Implication The work context and situations are important sources of stress among ED nurses in private hospitals.
  2. The participants who had only worked 1 - 2 years in the ED experienced problems with work management and decision-making.
  3. The result showing the three categories and seven sub-categories that emerged from the analysis. The hospitals have more than 200 inpatient beds each and provide a variety of treatments and health care services.
  4. The Medical journal of Malaysia.
  5. Hence, stress may lead to shortage of ED nurses.

Ultimately, the consequence may be impaired patient care [2]. The current study focuses on ED nurses working in private care in Thailand. In contrast, private hospitals require patient payment, usually through self-pay, private health insurance or employer-provided health insurance, but occasionally also through the Social Security System [10]. Differences in patient populations between public and private hospitals have been described; people with low-income use public and people with middle- to high-income tend to use private hospitals [11].

Due to economic expansion, globalization, international trade, and medical hub policies in Thailand [12] the number of private hospitals have increased [10] [13]. They host primary, secondary and tertiary care under the same roof and provide specialized care and treatment, including high-technology surgery.

How they compare

Public and private hospitals should provide the same standard of nursing care for all patients [15]. Nursing practice in Thailand is also influenced by Thai culture and beliefs, especially from Buddhist perspectives [16].

  • Nurses in emergency department are more exposed to stress than nurses in other departments;
  • This can, for example result in that junior nurses may have to carry out tasks that senior nurse or physicians require them to do, even if they do not feel comfortable with it, which may influence their decisions regarding nursing care;
  • The participants described that the ED differs from other healthcare facilities, such as the medical-surgical outpatient department, where patients can book an appointment with the physician when they are in need of care and treatment;
  • Some described that when they were on duty and experienced stress, they walked away from the situation for a while and returned when they felt better;
  • A professional linguist approved the English translations and the analyzed data in English from codes to categories;
  • A professional linguist approved the English translations and the analyzed data in English from codes to categories.

This can, for example result in that junior nurses may have to carry out tasks that senior nurse or physicians require them to do, even if they do not feel comfortable with it, which may influence their decisions regarding nursing care. Tyson and Pongruengphant [17] studied stress in nurses in both the public and the private sector. Methods A descriptive qualitative design, with a deductive approach based on the JDCS model was used.

Setting and Participants Semi-structured interviews were conducted between May and August 2013. Twenty-eight ED nurses from two large private hospitals were recruited. The hospitals have more than 200 inpatient beds each and provide a variety of treatments and health care services.

Therefore, the participants were likely to have relevant experience in emergency care and a broad perspective of stressful situations. The inclusion criteria were RNs of either gender who worked full-time and had at least one year of experience in emergency care.

RNs with less than one year of experience in emergency care or were working part-time were excluded.

  • Emergency care is also provided in the private care sector, but less is known if the experience of stress among ED nurses is the same as in public care sector;
  • Some study participants in the current study considered leaving the ED because of occupational stress and job dissatisfaction;
  • The senior ED nurses had to concurrently perform several tasks; simultaneously caring for patients assigned to junior nurses and their own patients;
  • They also alleviated stress while they were at work by turning stress into a challenge and thinking positively:

All had a bachelor degree in nursing science and worked at a nurse practitioner level. The demographic information of the participants is shown in Table 1. Data Collection The interview guide Table 2 was based on previous studies [1] [3] [19].

Each participant was interviewed in a private room in the ED or in a private location of his or her choice. The interviews lasted until data saturation was obtained, between 25 and 80 minutes.

Data Analysis The audio-recorded interviews were transcribed verbatim by the first author NY and translated into English. The transcriptions were reviewed by a professional linguist to confirm their accuracy, consistency and to determine conceptual equivalence. A content analysis [20] with a deductive approach based on the Table 1.

Description of the participants demographics age, gender, job experience and marital status. The analysis procedure is depicted in Figure 1. The study was conducted in accordance with the Helsinki Declaration. Written consent was obtained before the interviews began.

  1. In contrast, private hospitals require patient payment, usually through self-pay, private health insurance or employer-provided health insurance, but occasionally also through the Social Security System [10].
  2. If I feel stressed while I am working, I will take a break, walk away, and then I will come back to fix the problem. The one who had the common cold did not understand and demanded to be treated first.
  3. Stress at the workplace, 14th February They could represent a difference in coping strategies between Thai and Western populations, as reported by Tyson and Pongruenphant [31].

Results Three main categories, including seven sub-categories, emerged from the data analysis and are shown in Figure 2. Work Context Is an Issue This category described what the participants experienced as causes of stress in the EDs in private hospitals. Providing urgent nursing care to critically ill patients implies working under pressure and in unpredictable situations. Multiple work tasks and excessive work hours, and in particular, tasks beyond the nursing role made them experience a high level of Figure 1.

Example of the analysis process from identifying to condensation of meaning units to finally creating sub-categories and categories. The result showing the three categories and seven sub-categories that emerged from the analysis.

The senior ED nurses had to concurrently perform several tasks; simultaneously caring for patients assigned to junior nurses and their own patients. One senior ED nurse stated: I have to take care of them newly graduated nursesas a mentor … It is like double tasks at the same time because I have to take care of my assigned patient, the newly graduated nurses, and their assigned patients!

This make me stressed because of too many tasks at the same time [RN5].

Comparison of nursing stress in public and private hospitals

Lack of work experience was also associated with stress. The participants who had only worked 1 - 2 years in the ED experienced problems with work management and decision-making. When they were in charge, they felt that they could not manage both their work tasks and their colleagues, particularly the senior nurses.

A high number of patients and a shortage of nursing staff also increased workload and stress: This leads to shortage of nursing staff, and sometime there is a high workload, too many patients and not enough nursing staff. The medical service at an ED relies on the priority of patients with more severe conditions; however, the participants described that some patients and their relatives did not understand that and felt that they should be treated with the same priority as patients with severe conditions: A patient came to the ED with a common cold, but another patient came with a severe cut.

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The one who had the common cold did not understand and demanded to be treated first. Private hospital patients and their relatives also had high demands and expectations because they paid a high fee for medical and nursing services. Sometimes they behaved disrespectfully, which had a detrimental effect on the participants.

Moreover, the participants explained that in Thai culture, people value physician more highly than nurses and feel like nurses are not health care professionals: They patients and their relatives just want to talk to the physician, not with the nurse because they do not believe and respect us as a health care professional.

As you know, in Thai culture, the people give a high value to a physician, not a nurse like us [RN3]. The participants described that the ED differs comparison of nursing stress in public and private hospitals other healthcare facilities, such as the medical-surgical outpatient department, where patients can book an appointment with the physician when they are in need of care and treatment. In contrast, when someone has an accident and arrives at the ED, hospital policy requires the ED staff to provide health care comparison of nursing stress in public and private hospitals the patient can pay or not.

The participants indicated that this situation was a cause of stress: Collaborating with Other Health Care Professionals in the ED and Other Departments Working with other health care professionals in the ED and other departments was expressed as a stressor and contributed to conflicts among ED nurses, nurses in other departments and other health care professionals, such as pharmacists and particularly physicians.

Some physicians rarely provided treatment according to the hospital treatment guidelines, which led to conflicts between the ED nurses and the physicians: Such conflicts created misunderstandings and miscommunication among ED nurses and other health care professionals.

They also depended on the hierarchy and the differences in power relations among health care professions. One junior ED nurse described her experience: The ward nurses, especially the intensive care unit ICU nurses, often refused to receive patients from the ED or demanded the ED nurses to perform all of the nursing procedures for patients before the ICU accepted them.

This resulted in conflicts between ward nurses and ED nurses: They ask so many questions, and we have to do everything completely before transferring a patient to them.

These conflicts led to an inability for the nurses to work together: One ED nurse described her experiences with poor physical health experiences: Another ED nurse shared her experiences of poor psychological health caused by occupational stress: The nurses also reported social problems when they encountered stress at work.

This problems mainly affected relationships with their family and partner: Experiences of Poor Nursing Performance and Feelings of Uncertainty about Resignation Stress in the ED contributed to feelings of uncertainty about whether to leave or continue working at the current workplace among the ED nurses: Furthermore, the ED nurses described their experiences that stress affected the delivery of nursing care.

They provided incomplete nursing care, and they worked more slowly because of stress: Alleviating Stress Consequences The ED nurses stated three types of coping behaviors including avoidance, debriefing, and positive reframing. Some described that when they were on duty and experienced stress, they walked away from the situation for a while and returned when they felt better: If I feel stressed while I am working, I will take a break, walk away, and then I will come back to fix the problem.

The reason that I walk away is so I can plan and think about how to solve the problem [RN3]. In the workplace, debriefing by talking with colleagues, especially close and trusted ones, was an effective method of stress release among the emergency nursing team: They also alleviated stress while they were at work by turning stress into a challenge and thinking positively: Sometimes I like it. They the patients ask me many questions, and I give them a lot of information as well.

Additionally, they described several stress-releasing methods in daily life, such as sleeping, exercise, and making merits and meditating according to Buddhist practice.

Seeking and Accepting Support The organization provided some support for reducing employee stress, for example, by providing sports activities: The hospital director just gives us a stress assessment survey.