Professional practice environment and nursing work stress in neonatal units

Lopes, Raquel Pereira; Oliveira, Roberta Meneses; Gomes, Maria Salete de Brito; Santiago, Jênifa Cavalcante dos Santos; Silva, Renata Celly Rodrigues; de Souza, Fábio Lopes

doi:10.1590/1980-220X-REEUSP-2020-0539

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/1980-220X-REEUSP-2020-0539 copy

Professional practice environment and nursing work stress in neonatal units^* * Extracted from the thesis: “Ambiente de prática profissional, qualidade do cuidado e estresse no trabalho da equipe de enfermagem em unidades neonatais: análise multidimensional e plano de ação”, Universidade Estadual do Ceará, Programa de Pós-Graduação, 2018.

Ambiente de práctica profesional y estrés en el trabajo de enfermería en las unidades neonatales

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To assess the nurse professional practice environment of neonatal units and its relationship with the levels and main sources of occupational stress.

Method:

Cross-sectional descriptive, exploratory, correlational study performed with nursing professionals of neonatal units of four public hospitals. A sociodemographic/professional questionnaire, the Brazilian version of Practice Environment Scale, and the Work Stress Scale were applied. In the analysis, mean, standard deviation, and Pearson chi-squared, Likelihood Ratio, and Mann Whitney U tests were adopted for association among variables.

Results:

Participating professionals amounted to 269. The practice environment was evaluated as favorable by more than half of the sample (63.6%), showing a significant statistical association which was inversely proportional with occupational stress (p < 0.001). The insufficient number of professionals for quality care was the major source of stress for nursing technicians, whereas teamwork with doctors was the predominant factor for the evaluation of environment quality and high stress levels of nurses.

Conclusion:

Unfavorable practice environments increase the stress levels of nursing professionals in neonatal units and may compromise patient safety.

DESCRIPTORS
Neonatal Nursing; Working Environment; Occupational Stress; Physician-Nurse Relations; Intensive Care Units; Neonatal

Subscales and assertions		Mean (±SD)
Subscale 1 – Nurse participation in hospital affairs		2.69 (±0.7)
05.	Career development/clinical ladder opportunity.	2.61 (±1.0)
13.	Opportunities for advancement.	2.90 (±0.9)
17.	Administration that listens and responds to employee concerns.	2.42 (±0.9)
22.	Nursing administrators consult with staff on daily problems and procedures.	2.86 (±0.9)
Subscale 2 – Foundations for quality of care		2.88 (±0.5)
04.	Active staff development or continuing education programs for nurses.	3.08 (±0.8)
14.	A clear philosophy of nursing that pervades the patient care environment.	2.90 (±0.8)
15.	Working with nurses who are clinically competent.	3.18 (±0.7)
18.	An active quality assurance program.	2.76 (±0.9)
21.	A preceptor program for newly hired RNs.	2.74 (±0.8)
23.	Written, up-to-date nursing care plans for all Patients.	2.94 (±0.9)
24.	Patient care assignments that foster continuity of care, i.e., the same nurse cares for the patient from one day to the next.	2.57 (±1.0)
Subscale 3 – Nurse manager ability and leadership		2.76 (±0.7)
03.	A supervisory staff that is supportive of the nurses.	3.06 (±0.8)
06.	Supervisors use mistakes as learning opportunities, not criticism.	2.68 (±0.9)
09.	A nurse manager who is a good manager and leader.	2.95 (±0.8)
11.	Praise and recognition for a job well done.	2.51 (±1.0)
16.	A nurse manager who backs up the nursing staff in decision making, even if the conflict is with a physician.	2.63 (±0.9)
Subscale 4 – Resource adequacy		2.41 (±0.7)
01.	Adequate support services allow me to spend time with my patients.	2.69 (±0.9)
07.	Enough time and opportunity to discuss patient care problems with other nurses.	2.58 (±0.9)
08.	Enough registered nurses to provide quality patient care.	2.21 (±1.1)
10.	Enough staff to get the work done.	2.19 (±1.0)
Subscale 5 – Collegial nurse-physician relations		2.97 (±0.6)
02.	Physicians and nurses have good working relationships.	3.12 (±0.7)
12.	A lot of team work between nurses and physicians.	2.93 (±0.8)
20.	Collaboration (joint practice) between nurses and physicians.	2.86 (±0.7)
Overall scale		2.75 (±0.5)

Item	Statement	Mean (±SD)
01	The distribution of tasks in my area has been making me nervous.	2.55 (±1.1)
02	My work’s type of control irritates me.	2.32 (±0.9)
03	The lack of autonomy in my work is distressing.	2.42 (±1.0)
04	I have been feeling upset about the lack of confidence of my superior on my work.	2.02 (±1.0)
05	I feel irritated with the deficiency in disseminating information on organizational decisions.	2.83 (±1.2)
06	I feel upset about the lack of information about my tasks at work.	2.32 (±1.0)
07	I am irritated at the lack of communication between my colleagues and me.	2.10 (±1.0)
08	I feel upset because my superior treats me poorly in front of my coworkers.	2.16 (±1.3)
09	Performing tasks which are beyond my capacity bothers me.	2.42 (±1.3)
10	I get in a bad mood having to work for many hours straight.	2.45 (±1.3)
11	The communication between me and my superior bothers me.	2.00 (±1.0)
12	I get upset with discrimination/favoritism in my work environment.	2.86 (±1.3)
13	I am bothered by the deficiency in professional training.	2.47 (±1.2)
14	I get in a bad mood because I feel isolated in the organization.	1.89 (±0.9)
15	I am irritated because my superiors undervalue me.	2.48 (±1.2)
16	The little perspective of career growth has been distressing me.	2.68 (±1.3)
17	I have been feeling upset for working at tasks below my skills.	1.93 (±0.9)
18	Competition at my work environment has been putting me in a bad mood.	1.99 (±0.9)
19	The lack of comprehension on what my responsibilities are at this work have been irritating me.	2.16 (±0.9)
20	I have been feeling nervous because my superior gives me contradictory orders.	1.94 (±1.0)
21	I feel irritated because my superior hides my well-done work in front of other people.	2.05 (±1.0)
22	Insufficient time to perform the amount of work I have makes me nervous.	2.59 (±1.2)
23	I feel upset by my superior avoiding giving me important responsibilities.	1.91 (±0.8)
Overall scale		2.28 (±0.6)

Practice environment (PES)	Stress levels (WSS)
Practice environment (PES)	Low or none n (%)	Intermediate n (%)	High n (%)	Total n (%)	p^* *Likelihood ratio p.
Unfavorable	15 (18.8)	27 (33.8)	38 (47.5)	80 (100.0)	<0.001
Mixed	2 (11.1)	10 (55.6)	6 (33.3)	18 (100.0)
Favorable	65 (38.0)	72 (42.1)	34 (19.9)	171 (100.0)
Total	82 (30.5)	109 (40.5)	78 (29.0)	269 (100.0)

PES statement – Brazilian version	Stress levels (WSS)
	Low or none			Intermediate			High
	Nur.	Tech.	p-value^ Mann-Whitney U p.	Nur.	Tech.	p-value^ Mann-Whitney U p.	Nur.	Tech.	p-value^ Mann-Whitney U p.
PES2	3.19	3.42	0.040	2.98	3.19	0.053	2.59	3.04	0.030
PES4	3.00	3.38	0.193	2.88	3.31	0.006	2.48	2.96	0.018
PES7	2.59	2.93	0.195	2.40	2.78	0.033	1.96	2.37	0.103
PES8	2.93	2.16	0.004	2.29	2.07	0.272	2.44	1.86	0.014
PES10	2.89	2.09	0.002	2.36	2.04	0.080	2.41	1.84	0.012
PES12	3.15	3.22	0.315	2.74	3.04	0.011	2.33	2.82	0.017
PES14	3.33	3.11	0.462	2.64	3.16	0.001	2.41	2.55	0.411
PES18	2.96	2.85	0.688	2.69	3.00	0.040	2.30	2.53	0.215
PES19	2.74	3.02	0.141	2.52	3.07	0.002	2.30	2.51	0.300
PES20	2.96	3.13	0.313	2.71	3.03	0.024	2.37	2.69	0.068
PES23	2.89	3.27	0.061	2.64	3.09	0.010	2.74	2.78	0.803
PES24	3.11	2.42	0.008	2.64	3.02	0.141	2.70	2.37	0.165

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E-mail: reeusp@usp.br

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[1] Corresponding author: Roberta Meneses Oliveira, Rua Nadir Saboya, 1080, Casa 13, Sapiranga, 60833-344 – Fortaleza, CE, Brazil, menesesroberta@yahoo.com.br