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Occupational stress, job satisfaction and job performance among hospital nurses in Kampala Uganda

Dissertation
Author: Rose Chalo Nabirye
Abstract:
Occupational stress, a common occurrence among various professions worldwide, is regarded as a major occupational health problem for healthcare professionals especially nurses. Occupational stress has been reported to affect job satisfaction and job performance among nurses, thus compromising nursing care and placing patients' lives at risk. Stress is a complex phenomenon resulting from the interaction between individuals and the environment. Therefore, significant differences in occupational stress, job satisfaction and job performance among nurses may exist due to different work settings. The aims of the study were to: (1) examine the relationships between occupational stress, job satisfaction and job performance among hospital nurses in Kampala City, Uganda; (2) establish whether personal background characteristics affect the relationships between occupational stress, job satisfaction and job performance; and (3) examine whether there is a difference in levels of occupational stress, job satisfaction and job performance by type of hospital. A non-experimental correlational design was used in the study. A total of 333 nurses from four hospitals completed the Nurse Stress Index, the Job Satisfaction Survey, and the Six-Dimensional Scale of Nurse Performance scales. Study findings demonstrated that there were significant differences in levels of occupational stress, job satisfaction and job performance between the public and private not-for-profit hospitals. Nurses in the public hospital reported higher levels of occupational stress and lower levels of job satisfaction and performance. There were significant negative relationships between occupational stress and job performance and between occupational stress and job satisfaction. Nursing experience, type of hospital, and number of children had a statistically significant relationship with occupational stress, job satisfaction and job performance. Type of hospital (public versus private), ward (obstetrics/gynecology versus other ward types), and job satisfaction were significant predictors of self-rated quality of job performance. Job satisfaction was shown to mediate the relationship between occupational stress and job performance. Large scale studies were recommended to identify sources of occupational stress and factors that enhance job satisfaction among hospital nurses in Uganda. Future research is needed to examine best practices for human resource managers to improve nurse motivation, job satisfaction and nurse performance in hospitals. Keywords: occupational stress, job satisfaction, job performance, personal characteristics, work characteristics, public hospital, private not-for-profit hospitals, best practices for human resource management.

TABLE OF CONTENTS Page COPYRIGHT ................................................................................................................. ii   ABSTRACT .................................................................................................................. iii   DEDICATION ............................................................................................................... v   ACKNOWLEDGEMENTS .......................................................................................... vi   LIST OF TABLES ....................................................................................................... xii   LIST OF FIGURES .................................................................................................... xiv   LIST OF ABBREVIATIONS ...................................................................................... xv   CHAPTER   1 INTRODUCTION   Health Care System in Uganda ............................................................................ 3   Statement of the Problem ..................................................................................... 4   Significance of the Study ..................................................................................... 6   Specific Aims of the Study .................................................................................. 7   Research Questions .............................................................................................. 7   Operational Definitions ........................................................................................ 8   Conceptual Framework ........................................................................................ 9   Assumptions for the Study ................................................................................. 10   2 LITERATURE REVIEW ..................................................................................... 11   Occupational Stress ............................................................................................ 11   Sources of Occupational Stress among Nurses ......................................... 12   Workload .................................................................................................. 13   Organizational Pressure ............................................................................ 15   Interpersonal Relationships/Intrinsic Nature of the Work ........................ 16   Professionalism ......................................................................................... 17   Effects of Occupational Stress ........................................................................... 18   Job Satisfaction among Nurses .......................................................................... 22   Job Performance among Nurses ........................................................................ 29   Summary of Literature ....................................................................................... 32  

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3 METHODOLOGY ............................................................................................... 33   Study Design ...................................................................................................... 33   Ethical Considerations ....................................................................................... 33   Setting ................................................................................................................ 34   Study Sample ..................................................................................................... 35   Inclusion Criteria ...................................................................................... 35   Exclusion Criteria ..................................................................................... 36   Sample Size ........................................................................................................ 36   Instruments ......................................................................................................... 37   The Nurse Stress Index (NSI) ................................................................... 37   The Job Satisfaction Survey (JSS) ............................................................ 38   The Six Dimension Scale of Nursing Performance (6-DSNP) ................. 39   Pilot-testing of Instruments ................................................................................ 39   Data Collection Procedures ............................................................................... 40   Data Safety and Integrity ................................................................................... 41   Data Analysis ..................................................................................................... 42   Limitations of the Study .................................................................................... 43   4 FINDINGS ............................................................................................................ 44   Demographic Characteristics ............................................................................. 44   Work Characteristics .......................................................................................... 45   Instrument Reliability ........................................................................................ 47   Descriptive Statistics for Instrument Sub-scales ............................................... 50   Nurse Stress Index .................................................................................... 50   Job Satisfaction Survey ............................................................................. 51   Nurse Performance Scale .......................................................................... 52   Occupational Stress and Demographic Characteristics ..................................... 54   Occupational Stress and Work Characteristics .................................................. 55   Job Satisfaction and Demographic Characteristics ............................................ 57   Job Satisfaction and Work Characteristics ........................................................ 58   Job Performance and Demographic Characteristics .......................................... 60   Job Performance and Work Characteristics ....................................................... 61   Findings Related to Research Questions ........................................................... 63   Research Question 1 ................................................................................. 63   Research Question 2 ................................................................................. 64   Research Question 3 ................................................................................. 65   Research Question 4 ................................................................................. 67   Research Question 5 ................................................................................. 69  

5 DISCUSSION, CONCLUSIONS, IMPLICATIONS,    AND RECOMMENDATIONS ............................................................................. 73   Discussion .......................................................................................................... 73   Occupational Stress ................................................................................... 73   Job Satisfaction ......................................................................................... 75   Occupational Stress and Job Performance ................................................ 77   Characteristics, Stress, Job Satisfaction and Job Performance ................. 78   Mediating Role of Job Satisfaction on Stress and Job Performance ........ 79   Stress, Job Satisfaction and Job Performance by Hospital Type .............. 80   The Conceptual Framework ............................................................................... 81   Conclusions ........................................................................................................ 82  

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Implications ....................................................................................................... 83   Implications for Nursing Education .......................................................... 83   Implications for Nursing Practice ............................................................. 83   Recommendations .............................................................................................. 84   REFERENCES ............................................................................................................ 86   APPENDICES ............................................................................................................. 92   Appendix A: Institutional Review Board for Human Use Approval ................. 93   Appendix B: Permission to Use Research Instruments ................................... 104   Appendix C: Instruments ................................................................................. 109   Appendix D: Instrument Sub-scales and Number of Items ............................. 120  

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LIST OF TABLES

Table Page

1 Socio-demographic Characteristics of the Sample ................................................. 45  

2 Work Characteristics of the Sample ....................................................................... 46  

3 Number of Items and Cronbach’s Alphas for the NSI Sub-scales ......................... 47  

4 Number of Items and Cronbach’s Alphas for the JSS Sub-scales.......................... 48  

5 Number of Items and Cronbach’s Alphas for the 6-DSNP Sub-scales .................. 49  

6 Range of Possible Scores, Mean Scores and Standard Deviations for NSI ........... 50  

7 Range of Possible Scores, Mean Scores and Standard Deviations for JSS ............ 51  

8 Range of Possible Scores, Mean Scores and Standard Deviations for 6-DSNP .... 52  

9 Descriptive Analyses for Job Satisfaction (JSS) .................................................... 53  

10 Descriptive Analyses for Nurse Performance Scale .............................................. 54  

11 Mean Scores for Occupational Stress by Demographic Characteristics ............... 55  

12 Mean Scores for Occupational Stress by Work Characteristics ............................ 57  

13 Mean Scores for Job Satisfaction by Demographic Characteristics ...................... 58  

14 Mean Scores for Job Satisfaction by Work Characteristics .................................. 60  

15 Mean Scores for Job Performance by Demographic Characteristics .................... 61  

16 Mean Scores for Job Perofrmance by Work Characteristics ................................. 62  

17 Correlations for Job Performance, Job Satisfaction with Occupational Stress ..... 64  

18 Effect of Personal Background and Work Characteristics on the Relationships of Occupational Stress, Job Satisfaction and Job Performance Quality ............... 66  

19 The Final Predictive Model for Self-Rated Job Performance ............................... 67  

20 The Mediating Role of Job Satisfaction between Occupational Stress and Job Performance .......................................................................................................... 69  

21 Means for Occupational Stress, Job Satisfaction and Job Performance for the Different Hospitals ............................................................................................... 70  

xiii

22 Influence of Type of Hospital on Job Performance, Job Satisfaction and Occupational Stress .............................................................................................. 71  

23 Post Hoc Results of Differences in Means in Occupational Stress, Job Satisfaction and Job Performance by Hospital ..................................................... 72  

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LIST OF FIGURES

Figure Page

1 Diagram of Theoretical/Conceptual Model .............................................................. 10

 

xv

LIST OF ABBREVIATIONS 6-DSNP Six Dimensional Scale of Nurse Performance AIDS Acquired Immuno-Deficiency Syndrome BSN Bachelor of Science in Nursing EM Enrolled Midwife EN Enrolled Nurse ENT Ear, Nose and Throat GDP Gross Domestic Product HIV Human Immunodeficiency Virus ICU intensive care unit ILO International Labor Organization IPR interpersonal relations JSS Job Satisfaction Survey M Mean MoH NGO Ministry of Health Non-Governmental Organization NHS National Health Service NSI Nurse Stress Index OSH Occupational Safety and Health RM Registered Midwife RMN Registered Mental-health Nurse RN Registered Nurse RN/M Registered Nurse/Midwife

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RPN Registered Pediatric Nurse SD standard deviation SNO Senior Nursing Officer SPSS Statistical Package for Social Sciences UBOS Uganda Bureau of Statistics UK United Kingdom US United States WHO World Health Organization

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CHAPTER 1 INTRODUCTION

Occupational stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the resources, capabilities and needs of the worker (Alves, 2005; Bianchi, 2004; Lindholm, 2006; Nakasis & Ouzouni, 2008). The International Labor Organization (ILO) asserts that all countries, professions and all categories of workers, families and societies are affected by occupational stress (Ogon, 2001). According to Alves (2005), 40% of all American workers perceive their jobs as being extremely stressful. Similar findings are noted in the United Kingdom, where occupational stress is estimated to be the largest occupational health problem (Edwards & Burnard, 2003). Additionally, research has demonstrated that as workload and work-associated stress increase, turn- over rates of workers are also noted to increase. Thus, occupational stress results in considerable costs to organizations in terms of absenteeism, loss of productivity, and health care resources (AbuAlRub, 2004; Cottrell, 2001; Gueritault-Chalvin, Kalichman, Demi, & Peterson, 2000; Nakasis & Ouzouni, 2008). Lack of productivity due to occupational stress and its related effects, including staff conflicts, recruitment and retention problems, burnout, absenteeism, litigation and rapid turn-over, and lack of job satisfaction, has been reported to cause significant monetary costs to the National Health Service [NHS] Trusts in the UK (Cottrell, 2001; Mackay, Cousins, Kelly, Lee, & McCaig, 2004). Alves (2005) reported that organizations spend as much as $75 billion a year on stress-related

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outcomes including physical injuries at work and absenteeism; while the World Health Organization (WHO, 2002) estimates the cost of stress and stress-related problems to organizations to be in excess of $150 billion annually. Job stressors and low job control have also been shown to be risk factors for patient safety and to lead to poor job performance including reduced quality of nursing care (Sveinsdottir, Biering, & Ramel, 2006). Occupational stress has also been associated with chronic health problems like cardiovascular disease, musculoskeletal disorders, physical injuries and cancers (Alves, 2005; Bradly & Cartwright, 2002). Mental illness and serious health compromising behaviors such as increased risk for suicide, substance abuse (such as smoking and alcohol consumption), poor diet and lack of exercise are also associated with occupational stress (Adeb-Saeedi, 2002; Oginska-Bulik, 2006). The common sources and effects of occupational stress identified in the literature are from the perspective of American and European workers. Since occupational stress has been reported to affect all societies and professions (Ogon, 2001), it can be assumed that nurses working in Ugandan hospitals experience occupational stress. Research has further demonstrated that the sources of occupational stress, its levels and effects vary greatly depending on local forces such as nature of work, work setting and cultural orientation. Thus, significant differences in occupational stress among nurses in different countries may exist due to different work settings and levels of social support (Evans, 2002). At present, there are scant data about sources of occupational stress and its relationship with job satisfaction and job performance in African countries or in Uganda in particular. There is, therefore, a need to understand the predictors of occupational stress and the levels and inter-

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relationships of occupational stress, job satisfaction and job performance among nurses working in Ugandan hospitals.

Health Care System in Uganda Uganda, which is listed among the developing countries, is located in East Africa. The country is bordered by Kenya in the east, Sudan in the north, Democratic Republic of Congo in the west, Tanzania in the south and Rwanda in the southwest (UBOS, 2005). Uganda is characterized by poor health and developmental statistics. For example, life expectancy (in years) at birth for males and females is 48 and 51 respectively and the infant mortality rate is 136 per 1000 live births; with 7.6 % of gross domestic product (GDP) expenditure on health (WHO, 2005). The health infrastructure in Uganda is composed of hospitals, health centers and aid posts which may belong to the government, non government organizations (NGOs) or to individuals (private). The hospitals are categorized as national referral, regional referral or district/rural hospitals. The health centers are graded as health center IV, III, II according to level of service, which is at the county, sub-county, and parish levels respectively. There are a number of training schools and universities which offer certificate/diploma and degree courses for healthcare professionals. Two-thirds of these belong to the government and a third to NGOs and individuals (http://www.health.go.ug/health_units.htm ). The training schools for nurses are distributed in various regions/districts throughout the country. Nursing education includes various programs leading to different cadres of nurses depending on the educational level of entry to the program and the length of the program. Enrolled Nurses or Midwives (EN or EM) training lasts two and a half years and eligible students must have acquired a Uganda Certificate of Education or

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its equivalent. This level of training has been phased out, but the cadre of nurses still exists in the hospitals. The registered level training is a three year program and eligible students must have a Uganda Advanced Level Certificate of Education or its equivalent. Graduates at this level can be general nurses (RN), midwives (RM), pediatric nurses (RPN) or mental health nurses (RMN). In the past, registered level nurses could complete further education in any other discipline of interest to get an equivalent certificate diploma after practicing for a minimum of two years. For example, an RN could apply to complete RM preparation and vice versa and train for one and a half years, creating another cadre of nurses, the Registered Nurse/Midwives (RN/M) or double trained nurses. This type of further education was referred to as horizontal training while that of an EN or EM midwife to registered level was termed vertical training. Double training has been phased out and nurses are encouraged to pursue further education in the same line, which is, general nursing, midwifery, pediatrics, etc. The Public Health Nurse (PHN) program is a two year program only offered to nurses who have done at least two disciplines at the registered level. The BSN is a four year university level program plus an additional one year internship. The BSN program prepares nurses to acquire competencies in nursing, midwifery, primary health care (community nursing), and research.

Statement of the Problem A human resource crisis exists in resource-constrained countries like Uganda due to the macroeconomic and governing factors. A shortage of nursing staff has been reported with a ratio of one nurse (nurses and midwives combined) to a population of 3,065. It has also been reported that despite employing 30,000 health

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care workers in 2004, an extra 5,000 qualified staff were needed to address the serious staff shortage (Dieleman, et al., 2007). The situation has been compounded by the HIV/AIDS pandemic as the high number of HIV/AIDS patients leads to excessive workload and increased tasks. There are continuous complaints by Ugandan nurses about work overload, and the demand for nurses continues to grow as many drop out of work with very little intervention seen. It has been reported that there is lack of enough space in the hospitals and they are overcrowded with very sick patients. The situation is worsened by lack of facilities and shortage of nurses, which is likely to cause stress to the nurses (Ojoatre, 2008). For example, according to the government newspaper (New Vision), one of the senior staff in Mulago Hospital reported that there were only 8-12 staff members including nurses, midwives and doctors for five wards in the department of Obstetrics and Gynecology at any one time. The staff manages the patient load which is three times the load that is expected for 24 staff members on one ward. At the First Global Forum on Human Resources for Health that took place in Uganda in 2008 it was observed that there was an imbalance between the number of nurses trained in the country and those who register to practice. It was speculated that nurses have migrated to other countries, have joined other fields, or sit at home due to the poor work conditions. Nurses also complain of working all day long despite the high numbers of very seriously ill patients who require more attention. They have further complained that their work is very stressful citing the very high nurse-patient ratio which is reported to be 1:1000. The nurse-patient ratio is reported to be above the 1:2 or 1:5 recommended by the World Health Organization for fatal complications and common illnesses respectively (Natukunda, 2008).

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Nurses have also observed that working when tired results in mistakes for which they are blamed; therefore, they would rather not go to work under the circumstances. This is in addition to the public outcry about the deteriorating nursing care in Ugandan hospitals. Since there are no established occupational health services due to limited resources and lack of occupational health professionals, there is a risk of continuous loss of nurses, either due to stress related diseases or attrition due to lack of job satisfaction (OSH WORLD, 2008; UBOS, 2005).

Significance of the Study Studies of potential sources and effects of occupational stress have been conducted among nurses in the United States and Europe. However, stress is a complex phenomenon which results from interaction between an individual and the environment in which the person exists. Thus, significant differences in occupational stress among nurses may exist due to different work settings and levels of social support (Evans, 2002). It was further asserted that occupational stress is a function of local forces, pressures and cultures that requires customized interventions (Muscroft & Hicks, 1998). Therefore, this study examined associations between occupational stress, job satisfaction and job performance among hospital nurses in Uganda. The results of this study may be used to guide policy makers and nurse managers to develop a stress prevention/management model specific to the Ugandan situation. Prevention and management of occupational stress among nurses will not only improve their health but may improve job satisfaction and nursing care, which will in turn reduce costs for the healthcare organizations as well as individuals.

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Specific Aims of the Study The specific aims of the study were to: 1. Examine relationships between occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. 2. Establish whether personal background characteristics influence occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. 3. Examine whether there is a difference in levels of occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda by type of hospital; that is, government versus private not-for-profit (faith- based) hospitals.

Research Questions The research questions in this study were as follows: 1. Is there a relationship between occupational stress and job performance among hospital nurses in Kampala, Uganda? 2. Is there a relationship between occupational stress and job satisfaction among hospital nurses in Kampala, Uganda? 3. Do personal background characteristics affect the relationships among occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda? 4. Does job satisfaction mediate the relationship between occupational stress and job performance among hospital nurses in Kampala, Uganda? 5. Are there differences in levels of occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda by type of hospital?

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Operational Definitions The following operational definitions were used in this study: Hospital nurse refers to any individual who qualified as a nurse or midwife at any level (degree, diploma, or certificate), is registered by the Uganda Nursing Council to practice nursing or midwifery, and is working in a hospital setting in Uganda. Personal background characteristics include the following demographic and work characteristics: age, gender, marital status, number of children, hospital, ward/ department, nursing education, years of nursing experience, responsibility, and hours worked on a typical day. These were measured by an investigator developed demographic questionnaire. Occupational stress refers to the harmful physical and emotional responses that occur when the requirements of the job do not match the resources, capabilities and needs of the worker (Alves, 2005). Occupational stress was measured by the Nurse Stress Index (NSI) developed by Harris (Harris, 1989). Job satisfaction refers to the level or degree to which employees like their jobs (Spector, 1997). Hospital nurses’ job satisfaction was measured by the Job Satisfaction Survey (JSS) developed by Spector in 1985 (Spector, 1997). Job performance refers to how effectively an individual carries out his/her roles and responsibilities related to his/her job (AbuAlRub, 2004). The Six Dimension Scale of Nursing Performance (Schwirian, 1978) was utilized to measure hospital nurses’ job performance or effectiveness in carrying out their roles and frequencies of responsibilities in relation to patient care.

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Conceptual Framework The conceptual models/frameworks identified in the literature that have been used to guide the study of occupational stress and coping are Lazarus and Folkman’s cognitive theory of stress and coping (Lazarus & Folkman, 1984) and Karasek’s Demand-Control Model (Karasek, 1979). According to Lazarus and Folkman’s (1984) cognitive theory of stress and coping, stress is defined by the interaction between the individual and the environment. Demands from the environment exceeding the available resources result in stress or coping, depending on the individual’s appraisal of the environmental effects or stressors. The variables in the theory that guided this research are personal and workplace characteristics. Workplace and work characteristics act as environmental stressors while personal characteristics may facilitate the individual nurse’s ability to carry out the process of appraisal of the stressors. Occupational stress and coping will result accordingly, depending on the level of appraisal. The individual’s perception of how much control he/she has is a factor which leads to feelings of stress when the situation is perceived as uncontrollable or to feelings of positive coping if the situation is perceived as controllable. According to the Demand-Control Model (Karasek, 1979), there is interaction of objective work load demands in the environment and the employee’s decision latitude to meet the demands. Decision latitude is defined as the authority which the individual employee has to make job decisions and the opportunity to utilize and develop skills on the job (Karasek, 1979). Long term exposure to situations with increased demands but with low control leads to low productivity and health related problems. The assumption in the model is that psychological strain results from joint effects of work demands and the decision-making freedom available for the employee

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facing the demands. In other words, jobs with high demands but with low control increase the risk of stress-related illness. The variables in this model which guided the study are job demands or job strain (workload pressures).

Work and Personal Factors Cognitive Factors Behavioral Outcome

     

JJ      Figure 1 Diagram of Theoretical/Conceptual Model

Assumptions for the Study The study was conducted under the following assumptions: 1. Occupational stress can be measured and self reported by nurses. 2. Stressors occur in life and work environments and individuals react to these stressors. 3. Nurses work in stressful environments that each individual nurse appraises and reacts to differently. Environmental

Stressors ( Workplace factors) - Type of hospital - Ward/unit - Responsibility - Hours worked on a typical day Personal Characteristics:

- Age - Sex - Nursing Education - Nursing experience - Marital Status - Number of children

OCCUPATIONAL STRESS

JOB SATISFACTION

JOB PERFORMANCE

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CHAPTER 2 LITERATURE REVIEW This chapter provides a review of literature related to occupational stress, job satisfaction, and job performance among nurses of all specialties in or outside the hospital. The first section of the review is related to sources and effects of occupational stress. The second section includes a review of factors that affect job satisfaction and the third section reviews factors related to job performance. An abundance of research has been reported on occupational stress, job satisfaction and job performance among nurses in the United States (U.S.), Europe, and Asia, but very little in Africa. It should be noted that even the limited research in Africa was conducted only in South Africa and no research was reported on in east, west, north or central African nurses. This phenomenon was observed by Adejumo and Lekalakala-Mokgele (2009) in their study appraising African nursing scholarship where 68.3% of the publications in the past two decades were from South Africa, 5.2% from West Africa, and 3.3% from East Africa. These findings may be due to the fact that African nurses outside of South Africa have limited research skills and rarely publish. Occupational Stress Many studies have investigated occupational stress occurrence among various professions in the U.S, Europe and Asia. Researchers have examined effects of stress on employee health, job satisfaction, job performance, and coping strategies. As a

Full document contains 138 pages
Abstract: Occupational stress, a common occurrence among various professions worldwide, is regarded as a major occupational health problem for healthcare professionals especially nurses. Occupational stress has been reported to affect job satisfaction and job performance among nurses, thus compromising nursing care and placing patients' lives at risk. Stress is a complex phenomenon resulting from the interaction between individuals and the environment. Therefore, significant differences in occupational stress, job satisfaction and job performance among nurses may exist due to different work settings. The aims of the study were to: (1) examine the relationships between occupational stress, job satisfaction and job performance among hospital nurses in Kampala City, Uganda; (2) establish whether personal background characteristics affect the relationships between occupational stress, job satisfaction and job performance; and (3) examine whether there is a difference in levels of occupational stress, job satisfaction and job performance by type of hospital. A non-experimental correlational design was used in the study. A total of 333 nurses from four hospitals completed the Nurse Stress Index, the Job Satisfaction Survey, and the Six-Dimensional Scale of Nurse Performance scales. Study findings demonstrated that there were significant differences in levels of occupational stress, job satisfaction and job performance between the public and private not-for-profit hospitals. Nurses in the public hospital reported higher levels of occupational stress and lower levels of job satisfaction and performance. There were significant negative relationships between occupational stress and job performance and between occupational stress and job satisfaction. Nursing experience, type of hospital, and number of children had a statistically significant relationship with occupational stress, job satisfaction and job performance. Type of hospital (public versus private), ward (obstetrics/gynecology versus other ward types), and job satisfaction were significant predictors of self-rated quality of job performance. Job satisfaction was shown to mediate the relationship between occupational stress and job performance. Large scale studies were recommended to identify sources of occupational stress and factors that enhance job satisfaction among hospital nurses in Uganda. Future research is needed to examine best practices for human resource managers to improve nurse motivation, job satisfaction and nurse performance in hospitals. Keywords: occupational stress, job satisfaction, job performance, personal characteristics, work characteristics, public hospital, private not-for-profit hospitals, best practices for human resource management.