DOI: 10.7860/JCDR/2018/27410.

11573
Original Article

A Study on the Occupational

Education Section

Stress, Job Satisfaction and Job

Performance among Hospital
Nurses in Ilam, Iran
Hamid Safarpour1, Sakineh Sabzevari2, Ali Delpisheh3

ABSTRACT Six Dimension Scale of Nursing Performance (6-DSNP) and

Introduction: Occupational stress and job satisfaction in also a demographic questionnaire. Data were analysed using
nursing are issues that affect job performance and the quality of descriptive and inferential statistics such as ANOVA and Pearson
care provided by nurses. correlation coefficient at the level of significance <0.05.
Aim: The aim of this study was to assess occupational stress, job Results: The mean of occupational stress and job satisfaction
satisfaction and job performance and how they are influenced of nurses was moderate and the mean job performance was at
by personal and work characteristics among hospital nurses in a high level. In this study, there was a significant relationship
Ilam, Iran in 2013. between occupational stress and job satisfaction (p=0.001) and
also occupational stress and job performance (p=0.04). There
Materials and Methods: In this descriptive cross-sectional
was no significant relationship between job satisfaction and job
study the sample included all nurses working in teaching
performance.
hospitals in Ilam. All of the participants were chosen by census
sampling method. The total number of nurses according to the Conclusion: The results of this study show the importance
inclusion criteria were 208, out of which 198 nurses completed of nurses’ occupational stress on their job satisfaction and
the questionnaire. Study tools included Harris’s Nurse Stress performance.In addition, the demographic variables were
Index (NSI), Spector’s Job Satisfaction Survey (JSS), Schwirian influential on the main variables in this study.

Keywords: Job stress, Nursing care, Nursing services, Quality of care

INTRODUCTION reduces the quality of nursing care. Also poor work performance
Occupational stress and job satisfaction in nursing are important and reduced quality of nursing services as caused by occupational
factors affecting job performance and quality of care provided stress and lack of job satisfaction are risk factors for patient safety
by nurses. Occupational stress is defined as harmful physical [8].
and emotional responses that occur when the requirements of Considering that occupational stress and job dissatisfaction can
a job do not match the resources, capabilities and needs of the increase the likelihood of quitting clinical environment by nurses,
worker [1]. Occupational stress is a common phenomenon among there was a need to address this issue in research studies. There is
health professionals around the world. It has been reported that a few numbers of studies in Iran that have addressed the relationship
occupational stress imposes considerable financial burden on health
between these variables and their influence by personal and
care systems. Researchers have shown that causes, levels and
work characteristics [9,10]. Therefore, this study aimed to assess
effects of occupational stress largely depend on factors such cultural
occupational stress, job satisfaction and job performance and how
awareness, nature and field of work [2]. Occupational stressors and
they were influenced by personal and work characteristics, among
low job control lead to poor job performance, decreased quality of
nursing care and less concern about the safety of patients [3]. hospital nurses in Ilam, Iran in 2013.

Job satisfaction is a subjective phenomenon that is the result

of synchronization between attitude and behaviour [4]. It has
MATERIALS AND METHODS
The present study was a cross-sectional descriptive-analytical
different elements including satisfaction for salary and potential for
research which has been conducted on three educational hospitals
creativity, autonomy, nature of work satisfaction of organizational
and individual promotion, co-worker’s satisfaction and availability of (Imam Khomeini, Mostafa Khomeini, and Taleghani) of Ilam, during
continuing educational opportunities [3]. Shortage of workforce in January to April 2013. Ethical Committee permission was taken.
one hand and high workload on the other hand cause occupational Inclusion criteria in this study were nurses with bachelor's degree or
stress which may affect work performance and job satisfaction higher, working full-time in the hospitals and having had at least one
[5]. The results of a study showed that the dissatisfaction was a year of experience. Nurses having bachelor’s degree in nursing or
result of poor working conditions, lack of management support and higher working full time in hospital and one year of experience were
resources, inequality in distribution of responsibilities, low wages included in study. Nurses having no interest to take part in the study,
and inflexible time schedule and manpower shortage [6]. less than one year of experience and part-time working nurses were
Job performance is defined as the actions and behaviours of excluded from this study. After referring to the each wards, the
individuals in roles and responsibilities of their work that contribute questionnaire was given to the participants and they were explained
to organizational goals [7]. how to fill it. All of the participants were chosen by census sampling
methods. The participants were asked to complete and return the
It has also been shown that a high level of occupational stress
questionnaire to the head nurse of the ward. After 10 days, the

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 Hamid Safarpour et al., Occupational stress, job satisfaction and job performance among nurses. www.jcdr.net

questionnaires were collected from the head nurse of clinical ward. the distribution of data was assessed using Kruskal-Wallis test
The total number of nurses according to the inclusion criteria was and Mann-Whitney U test or independent t-test and in case of
208, of which 198 nurses completed the questionnaire. significance of relationship, post-hoc test was used to assess the
The questionnaire included four sections. The first section comprised nature of the relationship at the level of significance<0.05.
of demographic information and other three sections consisted of
NSI [11], JSS [12] and 6-DSNP [13]. Nurse Stress Index contained RESULTS
30 items, Job Satisfaction Survey 36 items and Six Dimension Scale In the present study, 78(39.4%) and 120 (60.6%) of the participants
of Nursing Performance questionnaire contained 52 items. Nurse were male and female, respectively. The mean age of the nurses
Stress Index is used to determine the sources of stress among was 31.59±5.48 years, and the average number of years of
nurses in hospitals and communicative environments. It consists work experience was 6.84±5.24 years, respectively [Table/Fig-1].
of 30 items and 6 subscales and each of the subscales contains The average score for job satisfaction was 107.62 (36-103: low
5 items. satisfaction, 104-143: moderate satisfaction and 144-216: high
satisfaction), showing that the level of job satisfaction among nurses
Participants are asked to rate their potential stressors on a 5-point
was moderate.
Likert scale ranging from 1= no pressure to 5= extreme pressure.
The NSI is self-reported and the respondents read and circle the In addition, the investigation of the relationship between job stress
selected score from 1= no pressure, 2= very little pressure, 3=
Socio-Demographic Characteristic Frequency (%)
moderate pressure, 4= high pressure, and 5= extreme pressure for
24-31 110 (55.5%)
each item. A total score was computed ranging from 30-150 and
means of subscales was calculated to assess relative importance of *Age 32-39 65 (32.9%)
sources of stress(30-60 no pressure, 60-90 very little pressure, 90- 40-48 23 (11.6%)
120 moderate pressure and 120-150 extreme pressure). Male 78 (39.4%)
Sex
The Job Satisfaction Survey aims to assess the degree to which Female 120 (60.6%)
people like their jobs, through assessment of nine subscales: Single 60 (30.3%)
pay, promotion, supervision, fringe benefits, contingent rewards, Marital Status
Married 138 (69.7%)
operating conditions, coworkers, nature of work and communication.
BSN** 182 (91.9%)
The respondents agree or disagree on a 6-point continuum for each Level of Education
item including; 1 much disagreement, 2 disagree moderately, 3 MSN*** 16 (8.1%)
disagree slightly, 4 agree slightly, 5 agree moderately, and 6 agree 1-7 129 (65.2%)
very much. Each sub-scale has four items resulting in a total of 36 Nursing experience (in years)
8-15 47 (23.7%)
items; however, some items are worded positively while others are 16-22 22 (11.1%)
worded negatively. In general, the scores are from 36-216 (36-103:
[Table/Fig-1]: The frequencies and percentages of socio-demographic
low satisfaction, 104-143: moderate satisfaction and 144-216: high characteristics of the participants.
satisfaction). * Mean = 31.59; SD = 5.48.

The Six Dimensional Job Performance Questionnaire consist of six

Occupational Job perfor-
sub-scales and 52 items. The subscales include leadership, critical Job satisfaction
Demographic stress mance
care, teaching/collaboration, planning/evaluation, interpersonal Characteristic Mean± Mean± p- Mean± p-
relations/communications, and professional development. SD
p-value
SD value SD value
Respondents are asked to rate the items as to how often and
97.07± 107.9± 145.26±
how well they perform the behaviour/item to assess frequency and 24-31
19.76 18.86 17.94
quality of performance respectively. The nurses rate the items on a
100.78± 106.7± 145.72±
4-point scale with 1 = not expected in this job; 2=never or seldom; Age 32-39 p=0.01 NS NS*
19.25 19.85 20.72
3=occasionally and 4=frequently for column A, while column B is 106.42± 107.3± 150.5±
40-48
rated with 1=not very well; 2=satisfactorily; 3=well and 4=very well. 18.54 19.89 17.02
However, the items on the professional development sub-scale are 98.24± 110.23± 145.23±
Male
assessed for quality only. Since the sub-scales are of different lengths 20.95 18.09 22.26
Sex NS p=0.03 NS
ranging from 5 to 12 items, their scores are calculated according 100.24± 105.58± 145.95±
Female
to the average of ratings on behaviours/items per sub-scale. The 18.70 19.66 16.66
number of items in each sub-scale are as follows: Leadership=5; 94.52± 109.57± 143.27±
Single
Critical Care=7; Teaching/Collaboration=11; Planning/Evaluation=7; Marital 18.51 17.68 18.62
p=0.01 NS NS
Interpersonal Relations/Communication=12; and Professional Status 101.62± 106.78± 146.82±
Married
Development=10. 19.79 19.78 19.17
99.06± 107.47± 145.01±
Content validity method was used to measure the validity of all Level of BSN**
19.50 19.34 18.66 p=
three instruments. To evaluate the reliability of the instruments, 30 Edu- NS NS
0.01
cation 108.75± 111.13± 161.38±
questionnaires were given to the 30 participants in a pilot study. The MSN***
20.72 15.59 13
calculated Cronbach's alpha coefficient in this study was 0.81 for
99.04± 107.24± 145.26±
NSI, 0.80 for JSS and 0.90 for 6- DNSP. 1-7
Nursing 19.68 19.43 18.15
The data were analysed, using SPSS, statistical software version exper-
97.17± 109.62± 145.81±
ience (in 8-15 p=0.01 NS NS
16 (SPSS, Inc., Chicago, IL, USA) with descriptive and inferential years)
18.75 16.85 20.18
statistics. Descriptive parameters were calculated by descriptive 106.77± 105.59± 147.77±
16-22
statistics (frequency, percentage, standard deviation and mean) and 20.03 22.66 22

to calculate the inferential parameters variance or its non-parametric Total

99.45± 107.62± 170.44±
19.59 19.18 17.10
equivalent was used. Relevant correlation coefficient test was used
to investigate the relationship between occupational stress, job [Table/Fig-2]: Comparison of Mean and SD for occupational stress, job satisfaction
and job performance by socio-demographic characteristics.
satisfaction and job performance among the participants. To assess * Not significant
the relationship between occupational stress, job satisfaction and ** Bachelor of Science in Nursing
job performance with demographic information with respect to *** Master of Science in Nursing

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www.jcdr.net Hamid Safarpour et al., Occupational stress, job satisfaction and job performance among nurses.

Job Performance Occupational Stress Job Satisfaction Job Performance

Job Satisfaction Column A Column B Mean Mean Mean
Sub-Scales Sub-Scales Sub-Scales
(How frequent) (How well) (SD) (SD) (SD)
r p-value r p-value r p-value Workload
pressures
Occupational Stress -0.4 0.001 -0.23 0.001 -0.14 0.04 related to 17.02 11.71 14.28
Pay Leadership
Job Satisfaction 0.45 0.06 0.2 0.55 insufficient time (3.73) (2.49) (2.46)
(Managing
[Table/Fig-3]: Correlations for Job Satisfaction and Job Performance with Workload 1)
Occupational Stress in nurses.
Workload
pressures due
Occupational to resources
Job satisfaction Job performance and 16.67 13.63 20.38
stress Promotion Critical Care
Characteristic conflicting (3.94) (3.55) (3.19)
Mean± p- Mean± p- Mean± p- priorities
SD value SD value SD value (Managing
NICU 105.07± 112.20± 151.4±1 Workload 2)
14.21 16.14 7.92 Organizational
17.05 13.11 Teaching/ 28.79
ICU 92.33± 110.53± 146.61± Support and Supervision
(4.20) (3.65) Collaboration (4.94)
22.31 21.97 22.87 Involvement

CCU 89± 107.88± 189.38± Dealing with

16.67 Fringe 8.68 Planning/ 19.53
(Cardiac 29.74 30.33 21 Patients and
(4.88) benefits (3.42) Evaluation (3.18)
Care Unit) Relatives

Post CCU 103.22± 100.44± 146.22± Home and Work Interpersonal

15.89 Contingent 10.35 33.57
17.22 17.28 16.14 Conflicts Relations/
(4.48) rewards (3.16) (5.41)
Communication
Emer- 109.36± 106.02± 145±
gency 21.10 19.44 19.75 Confidence and
16.16 Operating 11.26 Professional 29.86
Ward Competence in
(4.18) conditions (2.38) Development (4.46)
Role
Ward/ Internal 102.50± p= 104.92± 144.13±
Medical 16.81 16.12 p= 0.03 16.58 NS 13.04
Unit 0.02 Coworkers
(2.96)
Surgical 98.45± 108.90± 145.05±
16.48 14.43 22.41 Nature of 14.42
work (3.90)
haemod- 87± 114.75± 134.5±
ialysis 15.51 12.52 24.35 Comm- 11.47
unication (3.39)
Burn 100.29± 108.57± 152.14±
Ward 16.67 19.20 14.64 Total 16.57 11.96 24.4
Total Total
(4.23) (3.21) (3.94)
Psyc- 117.57± 88± 138.86±
hiatric 9.88 16.81 13.38 [Table/Fig-5]: Mean and SD of occupational stress, job satisfaction and job
performance sub-scales.
Paediatric 103.67± 101.58± 141.92±
15.92 16.46 11.92 The results showed that nurses had high levels of job performance.
Operation 107.21± 116.75± 137.5± The greatest amount of stress was related to the psychiatric ward
room 6.63 5.12 5.74
and the lowest was related to haemodialysis ward [Table/Fig-4].
[Table/Fig-4]: Comparison of mean and SD for occupational stress, job satisfaction
and job performance by workplace. The highest level of stress was related to workload associated with
lack of time, organizational support and conflict and the lowest level
and demographic variables showed a significant correlation between of stress was related to the dimension of work-family conflict. In
occupational stress and age, marital status, work experience and addition, based on this table, the highest job satisfaction was related
the type of unit/ward. The average job satisfaction in men and to the nature of work and the lowest job satisfaction was related to the
women were 110.23 and 105.58, respectively, indicating greater job dimensions of the fringe benefits and contingent rewards. Moreover,
satisfaction in men. Average job satisfaction in single and married the highest level of job performance was related to communication/
nurses was 109.57 and 106.78 respectively. There was a significant interpersonal relations and the lowest job performance was related
relationship between education level and job performance. (p =0.01) to the dimensions of leadership [Table/Fig-5].
[Table/Fig-2].
A significant inverse correlation was found between occupational DISCUSSION
stress and job satisfaction among the nurses (r= -0.48, p=0.001). The results of this study showed that nurses had moderate levels
This indicates that higher job stress will lead to the lower job of occupational stress. However, most studies have reported high
satisfaction. The inverse significant relationship was found (r = levels of occupational stress [9,14]. In line with our results; other
studies have also reported moderate level of occupational stress
-.023, p = .001) between occupational stress and job performance
among nurses [15,16]. The reasons could be the necessary training
as measured by the self-rated frequency of activities (how often
given to the nurses, proper collaboration and good communication
the participants performed the nursing activities). Also, there was
amongst nurses as well as high level of job satisfaction, which affect
significant positive relationship between occupational stress and job
the level of occupational stress in the nurses. The findings also
performance, measured as how well the participants performed their
showed that nurses’ job satisfaction was at the medium level. This
activities (r = -0.14, p = 0.04). This indicated that higher stress levels result is consistent with many study results that showed medium
were associated with lower levels of self-rated job performance level of job satisfaction [15-18]. Perhaps the reason of moderate
quality. In this study, there was no significant relationship between nursing satisfaction in our study is due to lack of other employment
job satisfaction and job performance [Table/Fig-3]. opportunities and the changing jobs, and good relationship and
There was a significant relationship between job satisfaction and cooperation with the supervisors in their work setting, which led
the workplace among nurses. According to the results the highest them to cope with their jobs and working conditions.
job satisfaction was related to the nurses working in operating room The results of this study also showed that nurses have high levels of
and the lowest job satisfaction was related to the psychiatric ward. job performance. This is in contrast to the study by Nabirye RC et

Journal of Clinical and Diagnostic Research. 2018 Jun, Vol-12(6): JC01-JC05 3

 Hamid Safarpour et al., Occupational stress, job satisfaction and job performance among nurses. www.jcdr.net

al., which reported that the nurses’ performance to be low [15]. Also, conclusion in their study [15]. As work experience is obtained with
Fort AL et al., reported moderate level of job performance among increasing age and given the fact that problems and stresses of
nurses [19]. The result suggests that in this study Bachelor’s Degree family life and environment outside the hospital increases, it may
(BSN) or higher. In other studies, nurses with different education have a greater impact on occupational stress of experienced people
levels such as Nursing Assistant (NA), Registered Nurse (RN), and compared with less experienced people. Furthermore, people with
nurses with BSN were included. higher work experience have more responsibilities that causes
In addition, there was a significant inverse relationship between increased occupational stress.
occupational stress with frequency and intensity of job performance. Furthermore, there was a significant relationship between gender
Nabirye RC et al., also showed a significant relationship between and job satisfaction in the study population so that job satisfaction in
occupational stress with intensity of job performance but in their men was more than women. This is in contrast to Nabirye RC study
study there was no significant relationship between occupational that showed no significant relationship between gender and job
stress with frequency of job performance [15]. This can be due to satisfaction [15]. Considering the fact that nursing is a demanding
the high workload and shortage of workforce which may cause occupation and regarding the physiological systems of women in
change in frequency of nurses’ job performance and may increase such a stressful environments, thereby the level of satisfaction is
lower among women. Besides, the lower satisfaction in women
or decrease the frequency of some of their activities. In this study
also stems from low fringe benefits, working at night shift and being
there was no significant correlation between mentioned reasons
away from family and children for long hours.
with occupational stress. Also, Jahangir M et al., reported an inverse
relationship between occupational stress and job performance In terms of workplace, there was a significant relationship between
[10]. job satisfaction and the type of workplace. This result is in line
with previous studies results [10,18,21,24]. However, Nabirye
The study showed a significant inverse relationship between stress RC et al., reported no relationship between work experience and
and job satisfaction among the nurses. These results are consistent job satisfaction [15]. There was a positive significant correlation
with previous studies that have reported an inverse relationship between level of education and job performance. Nabirye RC et al.,
between stress and job satisfaction [3,16,20]. This might be due reported in their study that there is a significant correlation between
to physical and mental stress caused by occupational stress and these two variables such that by increasing the level of education
environmental pressure. This can result in less concentration at job performance also increases [15]. This might be due to increased
work place and disruption of one's personal life which subsequently level of scientific and technical knowledge of nurses with master’s
can decrease job satisfaction of nurses. degree that can positively affect their performance. In terms of
The results of this study showed no significant relationship income, the results indicated a positive correlation between income
between job satisfaction and job performance. In contrast, some and the job performance intensity which was in line with Nabirye RC
studies reported a significant relationship between job satisfaction et al., and Roud D et al., studies results [15, 24].
and job performance [15,21]. Our result might be due to proper
selection of nurses for each ward by managers as well as periodic CONCLUSION
training of nurses in the workplace. This can result in satisfactory The results of this study indicated a significant association between
job performance of nurses regardless of their job satisfaction. The occupational stress and job satisfaction as well as occupational
results of investigating the correlation between nurses occupational stress and job performance. In addition, the demographic variables
stress and their demographic characteristics revealed that there is a were influential on the main variables in this study.
meaningful positive relationship between the age of nurses with their In this regard, several approaches can be used to improve the level
occupational stress so that by increasing age, occupational stress of performance and also reduce job-related stress among nurses.
also increases. In this study, younger nurses had less occupational Such approaches include proposing training programs in order to
stress than older nurse. This result is consistent with findings of earlier familiarize the nurses with the problem and its causes, familiarize
studies that reported a significant positive correlation between age managers with occupational stress, job satisfaction and their effects
and occupational stress [15,22]. In fact, with increasing age people on nurses, emphasis on its early detection in clinical environments,
encounter greater external pressures that may have an impact on providing supportive services in the clinical areas for people at risk,
their occupational stress. Moreover, the perception of people about and increasing job security of nurses.
life will change, their control over environment will change and also
in terms of social standing they experience changes and all of these LIMITATION
factors affect occupational stress. The study was based on self-reports by the participants; therefore,
Moreover, there was a significant relationship between marital status other methods of assessment should be utilized to obtain objective
and occupational stress, which means occupational stress among data such as using physiological measures, to assess occupational
married people was more than single people. This result was in line stress. Also, job performance should be assessed by observation
with findings of previous studies [20,23]. Considering the fact that and using a pre-determined checklist filled by researcher.
marriage has an important impact on people’s life, it might cause
more external stress on individual and subsequently bring about Acknowledgements
more stress at work place. We would like to thank all experts, researchers and nurses who
In this study there was a significant relationship between helped in this study. We would also like to thank Mr. Aziz Erfani for
occupational stress and the type of ward. This was inconsistent his constant support.
with the study by Nabirye RC et al., who reported no significant
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PARTICULARS OF CONTRIBUTORS:
1. Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2. Department of Nursing, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
3. Department of Epidemiology, Faculty of Public Health, Ilam University of Medical Sciences, Ilam, Iran

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Sakineh Sabzevari,
Associate Professor, Department of Nursing, Razi School of Nursing and Midwifery,
Kerman University of Medical Sciences, Kerman, Iran. Date of Submission: Feb 09, 2017
E-mail: [email protected] Date of Peer Review: Apr 26, 2017
Date of Acceptance: Mar 09, 2018
Financial OR OTHER COMPETING INTERESTS: None. Date of Publishing: Jun 01, 2018

Journal of Clinical and Diagnostic Research. 2018 Jun, Vol-12(6): JC01-JC05 5

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