shiftwork and department-type related to job stress, work attitudes and behavioral intentions: a...
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JOURNAL OF ORGANIZATIONAL BEHAVIOR, VOL. 13,449464 (1992)
Shiftwork and department-type related to job stress, work attitudes and behavioral intentions: A study of nurses
MUHAMMAD JAMAL AND VISHWANATH V. BABA Department of Management. Concordia University, Montreal, Canada
Summary The present study examined the relationship of shiftwork and department-type with employees’ job stress, stressors, work attitudes and behavioral intention. Data were collected by means of a structured questionnaire from nurses ( N = 1 148) working in eight hospitals in a large, metropolitan city in eastern Canada. One-way ANOVA, MANOVA and two-way ANOVA were used to analyze data. Results generally support the prediction that nurses working on fixed shifts were better off than nurses working on rotating shifts in terms of the dependent variables of the present study. The prediction that nurses working in non-intensive care departments were better off than nurses work- ing in intensive care departments received mixed support at best. A few interaction effects of shiftwork x department-type on dependent variables were also noted,
The impact of socio-demographic variables - age, marital status, cultural background (English- versus French-speaking) - on the above relationships were also analyzed, Results are discussed in light of the previous empirical evidence on shiftwork and depart- men t-type.
Introduction
The nursing profession has long been considered a stressful one. It is one in which rates of absenteeism, staff turnover, and burnout are consistently high (Firth and Britton, 1989; Golden- berg and Waddell, 1990; Jamal, 1984; Kunkler and Whittick, 1991; Lane, Mathews and Presholdt, 1988; McLaney and Hurrell, 1988). Two factors are peculiar to hospital work environment: the prevalence of shiftwork and the situation of facing patients in distress, as well as death and dying, on a regular basis. These two factors have been suggested as possible contributors to high stress and strain among hospital personnel. This paper attempts to examine the effect of both shiftwork and department-type on job stress, work attitudes and behavioral intentions among nurses ( N = 1148) working in eight hospitals in a large eastern Canadian metropolis. In addition, the interaction effects of shiftwork and department-type on the dependent variables will also be examined. Moderating effects of variables such as age, marital status, and cultural
This study was supported by grants from the Social Sciences and Humanities Research Council of Canada (410-87-0106), (410-90-0401) and from Fonds pour la formation de chercheurs de l’aide a la recherche (FCAR-EQ-2650). The authors would like to acknowledge the assistance of Ms Jia-Lin Xie in the preparation of this manuscript. Requests for reprints should be addressed to Muhammad Jamal, Department of Management, Concordia University, Loyola Campus, Mon- treal, Quebec, Canada, H4B 1R6
0894-3796/92/050449-16$13.00 0 1992 by John Wiley &Sons, Ltd.
Received 18 December 1990 Revised Mu?? 1991
450 M. JAMAL AND V . V . BABA
background on the predicted influence of shiftwork and department-type on dependent variables will also be tested.
Shiftwork, which began during the First World War and proliferated during the second, has become a way of life for a significant number of employees in North America. Approximately one-sixth of the full-time labor force, and one-half of the part-time labor force, in North America is engaged in shiftwork (Flain, 1986). This proportion is higher still in occupations requiring 24-hour services. For example, 61 per cent of the employees in protective agencies, 43 per cent in food services and 36 per cent in health services are shiftworkers. Despite the prevalence of shiftwork practices in North America, relatively little is known about the effects of shiftwork on employees’ job behavior, physical and emotional health, social participation and family life. Shiftwork has not yet caught the attention of most researchers and educators in North America. With few exceptions (Baba and Jamal, 1991; Coffey, Skipper and Jung, 1988; Jamal, 1981, 1989; Jamal and Jamal, 1982; Parasuraman, Drake and Zammuto, 1982; Staines and Pleck, 1984), much of the information on the subject comes primarily from European countries (Knutsson, 1989). In a review of shiftwork research, Dunham (1977) argued that the majority of the problems associated with shiftwork may be due to these employees finding themselves out of line with established physiological or social rhythms. In favour of his argument, he contends that ‘most communities are oriented to some degree to a day work schedule and thus have business, recreational, social and other facilities available at the time most in demand by this timetable’. Thus, from his perspective, communities with shiftwork as a norm would probably be viewed less negatively from the point of view of shiftworkers than communities with day work as the norm. Most large- and medium-sized cities in North America would probably fall into the latter category of work pattern. Thus, if Dunham’s argument is valid, it is expected that non-day shift workers in metropolitan areas will tend to exhibit more problems than day shift workers.
Another plausible way to study shiftwork and employees’ reactions to it might be to examine the degree to which shift hours lead to the establishment of a daily routine for the individual. Shift hours which lead to a routine formation in life provide individuals with relatively fixed hours for work and non-work activities every day. Individuals on such work shifts can plan to fulfil family responsibilities, take part in regularly scheduled off-job activities, and cope with physical and mental fatigue better than individuals who work on rotational work shifts which have lower potential for routine formation. Rotating shifts force an individual to move from one shift schedule to another shift schedule of fixed intervals, such as preplanned intervals of every 10 working days. Individuals on rotating shifts thus experience a low degree of routine in everyday life and remain in a constant changing and adapting mode. Two comprehensive reviews of shiftwork, including the rotating shiftwork practices, concur with the above arguments (Moore-Ede and Richardson, 1985; Winget, Hughes and LaDou, 1978). Thus, it is suggested that nurses working on fixed work shifts will be better off than nurses working on rotating shifts with regard to job stress, work attitudes, and behavioral intentions.
The second unique factor to hospital environment is the constant exposure to suffering, ill- ness, death, and dying patients which must be faced by the people who work in such an environ- ment. A number of studies have been done concerning the psychological effects of intensive care unit (ICU) and non-intensive care unit nursing. Nurses in their regular jobs are faced not only with the physical needs of their patients, but also with heavy demands for sympathy and compassion. They are often expected to do the impossible in the way of providing comfort and care to the sick and to carry out tasks which are, by ordinary standards, disgusting, distasteful and frightening (Gentry, Foster and Froehling, 1972). For nurses working in intensive care units, these situational demands become even more pronounced (Becker-Carus and Gunthner,
SHIFTWORK, DEPARTMENT-TYPE AND STRESS 451
1989; Foxall, Zimmerman, Standley and Bene, 1990; Hipwell, Tyler and Wilson, 1989; Keane, Ducette and Adler, 1985; Maloney, 1982; Redfern, 1980).
The intensive care unit nurses work day-to-day in a setting where death is commonplace; where patients are desperately ill, mutilated, and comatose (cardiac surgery, myocardial infarc- tion, cancer and neurosurgery patients); where the workload is demanding both quantitatively and qualitatively; where the work space is limited; where health-care equipment is extremely complex and malfunctioning may endanger the lives of patients; and where communication between peers (nurse-nurse) and co-professionals (nurse-doctor) is often strained or virtually non-existent (Gentry et al., 1972; Maloney, 1982). As a result, nurses working in intensive care units have been perceived to encounter more stress and strain than nurses working in other units. There has been some empirical support for this contention (Gentry, el al., 1972; Hipwell et al., 1989; Kunkler and Whittick, 1991; Payne, Lande and Leahy, 1989; Weiner and Caldwell, 1981). Thus, it is hypothesized in the present study that nurses working in non- intensive care departments will be better off than nurses working in intensive care departments with regard to job stress, work attitudes, and behavioral intentions.
No systematic attempt has been made in the literature to examine the joint effects of shiftwork and department-type on nurses’job stress and strain, with the exception of one study (Parasura- man et al., 1982). However, in the Parasuraman et al. study, only nurses working on fixed shifts were included and nurses working on rotational shifts were not included. Moreover, in their study, they classified hospital department into primary versus team nursing, which was very different from the accepted classification in the literature (intensive care versus non- intensive care). Thus, the present study attempts to fill an important gap in our understanding of nurses’ job stress and strain by examining the joint effect of shiftwork and department-type on these variables.
Previous empirical research in behavioral sciences has, in general, indicated the importance of a number of sociodemographic variables such as age, marital status, gender, seniority and cultural background, in understanding not only employees’ reactions to job factors, but also their work attitudes and behavior (Frost and Jamal, 1979; Lee and Kanungo, 1984). In the area of shiftwork and department-type, a few studies have highlighted the importance of the above mentioned variables (Jamal and Jamal, 1982; Landeweerd and Boumans, 1988; Malaviya and Ganesh, 1976; Nicholson, Jackson and Howes, 1978). Thus, it is argued that the relationship of shiftwork and department-type with nurses’ job stress, work attitudes and behavioral inten- tions might be affected by a number of sociodemographic variables in the present study.
Research setting and subject The present study was conducted among nurses working in eight anglophone hospitals in the greater Montreal area, in Quebec, Canada. Data were collected by means of a structured ques- tionnaire. A total of 2236 questionnaires were distributed among the eight hospitals. Respondents were instructed to mail back the completed questionnaires, in prepaid envelopes, to the researchers at the university address. With one follow-up, 1 148 usable questionnaires were returned, yielding a response rate of 51 per cent. Respondents were found similar in age, edu- cation, marital status, seniority, gender distribution to all nurses ( N = 57000) registered on the role of Order of Nurses of Quebec (ONQ). However, more respondents claimed English as their mother tongue compared to the ONQ average, because the present study was done among English-speaking hospitals. The average respondent was 33 years of age, had held a nursing
452 M. JAMAL A N D V. V. BABA
license for 14 years and an average of 1.5 jobs in the last five years. Single nurses accounted for 44 per cent of the sample, 45 per cent were married, and 11 per cent belonged to ‘other’ categories. There were approximately twice as many (53 per cent) anglophone nurses as franco- phone (29 per cent), and 98 per cent of the nurses were female. All nurses belonged to the same union.
Measures Role ambiguity Role ambiguity was assessed using the scale developed by Rizzo, House and Lirtzman (1970). The scale contains four Likert-type items with 1-5 response categories ranging from ‘strongly agree’ to ‘strongly disagree’. A high score on this scale indicated a higher degree of role ambiguity.
Role overload Role overload was assessed using a modified version of the Michigan scale (Kahn, Wolfe, Quinn, Snoek and Rosenthal, 1964) reported by Baba and Harris (1989). The scale contains six Likert-type items with 1-5 response categories ranging from ‘strongly agree’ to ‘strongly disagree’. A higher score indicated a higher degree of role overload.
Job stress Job stress was measured with a nine-item scale adapted from Parker and Decotiis (1983). The original scale of Parker and Decotiis (1983) had 13 items. In the present study, because of union concerns and space limitation on the questionnaire, only nine of the 13 items were used. In Appendix A, job stress scale used in this study is provided. The scale is a Likert-type scale with response options from 1-5 indicating strong agreement to strong disagreement. A higher score on this scale indicated a higher degree ofjob stress.
Organizational commitment Organizational commitment was assessed using the Porter scale (Mowday, Steers and Porter, 1979). The scale contains 15 Likert-type items, with response options varying from ‘strongly agree’ to ‘strongly disagree’. This scale is widely used in management research and has reasonable psychometric properties. A higher score on this scale indicated a higher degree of organizational commitment.
Social support Social support was assessed using the instrument developed by House (1981). Respondents were asked to report how much they could depend on their immediate boss, peers, spouse/partner and relativeifriends to listen to their work-related problems. Response categories varied from 1 4 , with 1 representing ‘not at all’ and 4 representing ‘very much’. A higher score on this scale indicated a higher degree of social support.
Job satisfaction Job satisfaction was assessed using a one-item global measure of job satisfaction. The measure has five response options ranging from ‘extremely satisfied’ to ‘extremely dissatisfied’. A higher score on this measure indicated a higher degree of job satisfaction.
Work hours satisfaction Work hours satisfaction was also assessed using a one-item global measure of satisfaction.
SHIFTWORK, DEPARTMENT-TYPE AND STRESS 453
The measure has five response categories ranging from ‘extremely satisfied’ to ‘extremely dissatis- fied’ with working hours. A higher score on this measure indicated a higher degree of work hours satisfaction.
Turnover intention Turnover intention was assessed by asking the respondents to state the probability of their staying with the same hospital one year from the day the questionnaire was answered. This measure has been reported as a reasonably valid measure of actual turnover (Miller, Katerberg and Hulin, 1979). The measure has four response categories ranging from ‘not likely at all’ to ‘almost certain’. A higher score on this measure indicated a higher probability of leaving the present organization.
Commitment to nursing Commitment to nursing was assessed by asking the respondents whether or not, were they to begin their careers over again in life, they would choose nursing. The response categories on this measure varied from 1 to 4, with 1 representing ‘definitely not’ and 4 representing ‘definitely’. Thus, a higher score on this measure indicated a higher commitment to nursing as a profession.
Shiftwork Shiftwork information was obtained by asking the respondents about the shift or shifts they usually worked at their jobs. Those who worked on a permanent day, afternoon, or night shift were classified as having a fixed shift ( N = 290). Those who rotated between day shift and evening shift, or between day shift and night shift, or between evening shift and night shift were classified as having a partial rotation shift ( N = 335). Those who rotated among day, evening and night shifts were classified as working on rotational shift ( N = 522). The propor- tion of respondents working on different shifts in the present study was quite similar to overall proportion on the Order of Nurses of Quebec.
Department-type Information regarding department-type was obtained by asking the respondents in what area of the hospital wards they worked. Twelve wards were listed on the questionnaire and the respondents were asked to identify their wards. The 12 wards included: ( I ) medical or surgical; (2) obstetrics/gynaecology; (3) psychiatry; (4) emergency room; ( 5 ) ambulatory clinics; (6) chro- nic/convalescent care; (7) operating room; (8) recovery room; (9) ICU/CCU; (10) gerontology; ( 1 1 ) float time; (12) neonatal ICU. With the help of hospital personnel, these departments were classified into intensive care (ICD) ( N = 352), semi-intensive care ( N = 155) and non-inten- sive care ( N = 639). The proportion of nurses working in intensive care, semi-intensive care and non-intensive care departments approximated the overall pattern on the Order of Nurses of Quebec.
Intercorrelations among study variables, and reliability coefficients (alpha) of scales with multiple items, are presented in Table 1. Though there are many significant correlations among the study variables, the magnitude of the relationships is generally weak. Reliability coefficients varied from 0.60 (role ambiguity) to 0.88 (organizational commitment), and are within the
454 M. JAMAL A N D V . V. BABA
acceptable range for survey research. The role ambiguity scale was found to be somewhat less reliable than the other scales used in this study. It was nevertheless retained for further analysis due to its consistently higher reliability reported in the literature and its widespread use (Jackson and Schuler, 1985; Jamal, 1990; King and King, 1990).
Table 1. Intercorrelations among study variables
Variables (1) (2) (3) (4) (5) (6) (7) (8) (9)
(1) Role ambiguity* 0.60 (2) Role overload 0.33 0.70 (3) Job stress 0.30 0.57 0.83 (4) Organizational commitment -0.17 -0.16 -0.22 0.88 (5) Social support -0.22 -0.09 -0.11 0.14 0.82 (6) Job satisfaction -0.17 -0.14 -0.20 0.30 0.10 -
(7) Work hours satisfaction -0.10 -0.16 -0.22 0.18 0.11 0.39 -
(8) Turnover intention 0.13 0.13 0.18 -0.37 -0.04 -0.22 -0.17 - (9) Commitment to nursing -0.11 -0.13 0.20 0.27 0.05 0.27 0.27 -0.11 -
N = 1138, r = 0 . 0 7 , p < 0.01; r=O.lO.p < 0.001, *Values on the diagonal are Cronbach’s alpha.
One-way ANOVA, MANOVA and two-way ANOVA were used to examine the predicted relationship of shiftwork and department-type with nine dependent variables. To start with, a one-way analysis of variance (ANOVA), with unequal cell frequencies, was used to examine the differences between shiftwork and the dependent variables. Results are shown in Table 2. Significant differences were found among nurses on various shifts on eight of the nine depen- dent variables. Nurses on rotational shifts experienced a higher degree of job stress, role ambi- guity, role overload and turnover intention than nurses working on fixed shifts or partial rotation shifts. In addition, nurses on rotational shifts showed a lower degree of job satisfaction, work hours satisfaction and organizational commitment than nurses on fixed shifts or partial rotation shifts. With regard to commitment to nursing, nurses on partial rotation showed the lowest commitment as compared to nurses on fixed or rotational shifts. No differences in social support were found among nurses working on three different shifts.
Table 2. One-way ANOVA of hours of work and emdovees’ work attitudes
Hours of work
Variables Partial Rotational Fixed rotation shift
( N = 290) ( N = 335) ( N = 522) F-value P (1) Role ambiguity (2) Role overload ( 3 ) Job stress (4) Organizational commitment (5) Social support (6) Job satisfaction (7) Work hours satisfaction (8) Turnover intention
9.37* 15.09 25.64 51.83 12.31 3.86 4.09 1.72
9.50 15.91 26.63 50.25 12.38 3.71 3.25 1.82
10.03 16.72 28.44 49.58 12.34 3.38 3.08 1.98
iSi Commitment to nursing 2.29 2.03 2.25
4.38 0.01 10.92 0.01 12.95 0.0 1 3.73 0.01 0.54 NS
11.05 0.01 49.29 0.01
6.75 0.01 4.31 0.01
*Entries in columns are cell means; d.f: associated with each F-value are (2,1125).
SHIFTWORK, DEPARTMENT-TYPE AND STRESS 455
Table 3 reports the results of one-way ANOVA between department-type and the dependent variables. Significant differences were found among nurses working in various departments on five of the nine dependent variables. Nurses working in semi-intensive care departments experienced a lower degree of job stress, role overload, and showed lower turnover intention than nurses working in intensive care or non-intensive care departments. Similarly, nurses in semi-intensive care departments showed higher organizational commitment and work hours satisfaction than nurses working in intensive care or non-intensive care departments. No signifi- cant differences were found among nurses in three departments with regard to role ambiguity, social support, job satisfaction, and commitment to nursing.
Table 3. One-way ANOVA of nursing departments and employees’ work attitude
Variables
Type of department
Intensive Semi- Non-
care care care intensive intensive
( N = 352) ( N = 155) ( N = 639) Pvalue P
Role ambiguity Role overload Job stress Organizational commitment Social support Job satisfaction Work hours satisfaction Turnover intention Commitment to nursing
9.75* 15.29 26.11 48.90 12.18 3.60 3.70 1.97 2.1 1
9.55 14.72 25.29 51.73 12.46 3.77 3.76 1.64 2.19
9.72 16.76 28.25 50.83 12.42 3.56 3.33 1.87 2.25
0.27 16.94 13.59 4.68 0.94 1.23 6.11 5.75 1.42
NS 0.01 0.01 0.01 NS NS 0.0 1 0.01 NS -
*Entries in columns are cell means; d.Jassociated with each F-value are (2,1125).
Since the dependent variables were somewhat intercorrelated, multivariate analysis of variance (MANOVA) was also employed. Shiftwork and department-type respectively, served as indepen- dent variable one-by-one and the nine outcome variables served as the dependent variables. MANOVA results are presented in Table 4. As shown in Table 4, the multivariate effect for shiftwork was highly significant, F(9,1128) = 6 . 2 7 , ~ < 0.01. Univariate results showed significant differences on six of the nine dependent variables, indicating reasonable similarity with results obtained from one-way ANOVA. The multivariate effect for department-type was also signifi- cant, F(9,1125) = 2.96, p < 0.01. Univariate results showed significant differences on five of the nine dependent variables, indicating remarkable similarity with results obtained from one way ANOVA. In general, results from MANOVA for both shiftwork and department-type enhanced confidence in results obtained through one-way analysis of variance.
Two-way ANOVAs were performed to examine the interaction effects of shiftwork and depart- ment-type on the dependent variables. Results are presented in Table 5 . Main effects of shiftwork and department type, respectively, on the dependent variables appeared to be quite similar to results obtained through one-way ANOVAs. Significant interaction effects were found between shiftwork and department-type with regard to job stress and commitment to nursing. Nurses on rotational shifts in non-ICD had the highest degree of job stress whereas nurses on fixed shifts in ICD had the lowest job stress. Nurses on rotational shifts in ICD showed the lowest commitment to nursing while nurses on fixed shifts in ICD showed the highest.
In order to assess the possible moderating effects of variables other than shiftwork and depart- ment-type on the study dependent variables, two-way ANOVAs were performed in which shift-
456 M. JAMAL A N D V. V. BABA
Table 4. Multivariate and univariate results of shiftwork factor and department-type factor X nine depen- dent variable analvses of variance
Variable Multivariate effect
Shiftwork Department-type
Univariate effects
(1) Role ambiguity (2) Role overload (3) Job stress (4) Organizational commitment (5) Social support (6) Job satisfaction (7) Work hours satisfaction (8) Turnover intention (9) Commitment to nursing
df
(9,1128) (9,1125)
Shift-time F-value
2.17 (2,1135) (2,1135) 7.65* (2,1135) 9.50* (2,1135) 1.31 (2,1130) 0.28 (2,1130) 9.33* (2,1135) 37.31* (2,1130) 4.09* (2,1130) 4.51*
(df>
F-value
6.27* 2.96*
Department-type F-value
0.04 (2,1130) (2,1130) 10.54*
(df>
(2,1135) 5.49* (2,1135) 4.74* (2,1135) 3.821- (2,1130) 0.64 (2,1130) 2.17 (2,1130) 4.02* (2,1135) 0.39
* p < 0.01; t p < 0.05.
Table 5. A summary of two-way ANOVA of shiftwork and department-type with dependent variables
Role ambiguity
Shiftwork (S) 4.32* Department (D) 0.05 S x D 1.71
Job satisfaction
Shiftwork (S) 10.38t Department (D) 0.049 S x D 1.16
Role overload
6.48t 12.34t 1.56
Work hours satisfaction
41.92t 0.50 0.32
Job stress 8.81f 9.20t 2.21*
Turnover intention
4. I3* 3.06$ 0.97
Organizational Social comrnitmen t support
2.08 0.09 4.49* 0.99 0.40 1.55
Commitment to nursing
3.45$ 2.11 2.69$
* p 5 0.01. I p 5 0.001. $ p I 0.05. $Entries in columns are F-values; d.J associated with F-values for main effects are 2 and for interaction effects are 4.
work was kept as the first independent variable and age, marital status and mother tongue were, respectively, kept as the second independent variable one by one. Results are presented in Table 6 . The main effects of shiftwork did not change much when age, marital status and mother tongue were, respectively, introduced as alternative variables. However, age had signifi- cant main effects on job stress, organizational commitment, social support and turnover inten- tion. Further, significant interaction effects of shiftwork and age were found for work hours satisfaction and commitment to nursing. Nurses under 25 years of age working on fixed shifts showed the highest commitment to nursing. and nurses in the 2 6 3 5 age group working on rotational shift showed the lowest. Nurses under 25 years of age working on fixed shifts showed the highest work hours satisfaction while nurses in the over-35 age group working on rotational shifts showed the lowest satisfaction.
Tabl
e 6.
A s
umm
ary
of tw
o-w
ay A
NO
VA
of s
hiftw
ork,
age
, mar
ital s
tatu
s and
mot
her t
ongu
e w
ith d
epen
dent
var
iabl
es
Var
iabl
es
ambi
guity
ov
erlo
ad
stre
ss
com
mitm
ent
supp
ort
satis
fact
ion
satis
fact
ion
inte
ntio
n to
nur
sing
R
ole
Rol
e Jo
b O
rgan
. So
cial
Jo
b W
ork
hour
s T
urno
ver
Com
mitm
ent
(a)
Shift
wor
k (S
) 3.
71*
8.84
1-
6.53
1-
1.11
0.
44
7.53
t 39
.591
- 2.
52"
3.34
* 0.2
411
1.29
4.
55$
6.04
$ 13
.20t
3.
28*
0.55
12
.371
- 2.
15
S x
A
1.38
1.
12
0.42
0.
52
0.46
0.
92
2.58
* 0.
67
2.32
*
(b)
Shif
twor
k (S
) 4.
00$
9.53
1-
l0.0
9t
1.32
0.
11
8.93
t 43
.801
. 4.
23$
3.85
$ M
arita
l Sta
tus (
MS)
! 0.
35
0.93
3.
38*
9.42
1.
4.38
3.
14*
1.17
9.
61t
2.86
* S
XM
S
1.22
1.
23
0.73
0.
65
0.61
1.
08
1.16
1.
51
1.25
(c)
Shif
twor
k (S
) 3.
03*
1 1.9
51-
12.3
1-t
2.04
0.
07
8.37
1-
45.7
71-
4.28
$ 3.
56*
Mot
her t
ongu
e (M
T)B
6.
23$
5.01
$ 0.
55
1.97
1.
61
9.06
1-
0.30
11
.821
- 1.
58
Age
(A)§
Sx
MT
0.
63
0.56
1.
86
0.85
0.
87
0.86
1.
21
0.72
1.
01
*p <
0.05
. tp
< 0.
001.
Sp
< 0.
01.
$Age
was
cod
ed a
s fol
low
s: u
p un
til 2
5 ye
ar =
I, 2
6 to
35
= 2,
ove
r 35
= 3.
11 E
ntrie
s in
col
umns
are
F-v
alue
s; d
.f: f
or m
ain
effe
cts a
re (2
, 113
0) an
d fo
r int
erac
tion
effe
cts (4, 11
25).
(Mar
ital
stat
us w
as co
ded
as fo
llow
s: s
ingl
e = I,
mar
ried
= 2,
oth
ers =
3.
R Mot
her t
ongu
e w
as c
oded
as f
ollo
ws:
Eng
lish
= 1
, Fre
nch
= 2
, oth
ers =
3.
P Y
458 M. JAMAL A N D \i. V. BABA
Marital status had significant main effects on job stress, organizational commitment, job satisfaction, turnover intention and commitment to nursing. Similarly, mother tongue had main effects on role ambiguity, overload, job satisfaction and turnover intention. However, none of the interaction effects of shiftwork and marital status or shiftwork and mother tongue were significant .
In Table 7, a summary of two-way ANOVAs of department-type, age, marital status, and mother tongue with dependent variables is presented. Similar to shiftwork results, main effects of department-type did not change much when age, marital status, and mother tongue were, respectively, introduced as alternative variables. A significant interaction effect of department- type and age was found for commitment to nursing as a career. Nurses under 25 years of age working in ICD showed the highest commitment to nursing, while nurses in the over-35 age group working in non-ICD showed the lowest commitment to nursing. In addition, significant interaction effects of department-type and marital status for role ambiguity, role overload and work hours satisfaction were also found. Nurses in the ‘other’ category of marital status working in ICD experienced the highest role ambiguity, while nurses in the same category working in non-ICD reported significantly lower role ambiguity. Nurses in the ‘other’ category of marital status working in ICD reported the highest role overload, whereas married nurses working in semi-ICD reported the lowest role overload. Finally, married nurses working in ICD showed the lowest work hours satisfaction, whereas single nurses working in semi-ICD showed the highest work hours satisfaction.
Discussion
The results of the present study, taken from a large sample of Canadian nurses indicated that nurses working on fixed shifts (the measure of a high routine-oriented work shift) appeared to be ‘better off than nurses on rotating shifts (a low degree of routine-oriented work shift) in terms of job stress, stressors, organizational commitment, job and work hours satisfaction, turnover intention and commitment to nursing. However, a note ofcaution is warranted concern- ing routine formation in shift schedules. The degree of routine as experienced or perceived by nurses was not directly assessed in the present study. Respondents were not asked to express whether or not shift times lead to routine formation in their lives. It was assumed that nurses on fixed shifts would have a high degree of routine formation, while nurses on rotating shifts would have a lower degree of routine. A fruitful area for future research could be the examination of the relationship between shift times and employees’ perception of routine formation.
Before the results are discussed any further, a note of caution is warranted about the measures of job satisfaction, work hours satisfaction, turnover intention and commitment to nursing. These variables were assessed with single items involving self reported measures. Future researchers should use standardized measures of these concepts for greater confidence in their findings.
The findings of the present study on shiftwork, in general, support our earlier conclusions: that workers assigned to rotating shifts are prone to higher job stress and strain, physical and emotional health problems, and exhibit more submarginal work behaviors than do workers who are assigned permanently to day, afternoon, or even night shifts (Baba and Jamal, 1991). A study of hospital employees by Colligan, Frockett and Tasto (1979) concluded that ‘relative to nurses on permanent shifts, rotating shift nurses exhibited a significantly higher rate of clinic visits and took more sick days for serious illness’. In two other studies, nurses working on rotating shifts showed lower mental and physical health, job satisfaction, organizational
Tab
le 7
. A s
umm
ary
of tw
o-w
ay A
NO
VA
dep
artm
ent-t
ype,
age
, mar
ital s
tatu
s and
mot
her t
ongu
e w
ith d
epen
dent
var
iabl
es
Soci
al
Job
Wor
k ho
urs
Tur
nove
r C
omm
itmen
t R
ole
Rol
e Jo
b O
rgan
. V
aria
bles
am
bigu
ity
over
load
st
ress
co
mm
itmen
t su
ppor
t sa
tisfa
ctio
n sa
tisfa
ctio
n in
tent
ion
to n
ursi
ng
(a)
Dep
artm
ent (
D)
Age
(All1
D
xA
Mar
ital S
tatu
s (M
S)I
Dx
MS
Mot
her t
ongu
e (M
T)R
Dx
MT
(b)
Dep
artm
ent (
D)
(c)
Dep
artm
ent (
D)
0.21
* 1.
10
0.45
0.23
0.
62
2.72
5
0.11
7.
491:
1.
26
15.4
07
1.19
1.
55
16.2
67
1.31
2.
705
17.3
77
4.59
1:
1.26
9.80
$ 6.
121:
1.
20
12.1
77
4.58
5 0.
92
12.8
67
0.99
0.
60
3.73
1:
5.30
1:
1.42
4.97
$ 10
.607
1.
59
4.37
1:
1.99
0.
73
1.26
13
.057
1.
78
0.73
4.
061:
0.
25
0.82
1.
32
1.83
0.48
5.
381:
1.
88
0.33
4.
991:
1.
75
0.36
10
.767
0.
42
3.751
: 2.
558
0.29
2.85
5 2.
895
2.10
5
3.48
5 1.
17
1.29
2.21
15
.437
1.
20
4.04
$ 13
.947
0.
21
4.24
$ 10
.917
1.
49
1.53
1.
23
2.12
5
2.47
8 1.
64
0.94
2.82
4 3.
104
0.99
*Ent
ries
in c
olum
ns a
re F
-val
ues;
d.f
for m
ain
effe
cts a
re (2
, 113
0) an
d fo
r int
erac
tion
effe
cts (
4, 1
125)
. tp
< 0.
001.
$p
< 0.
01.
gp <
0.05
. I)
Age
was
cod
ed a
s fol
low
s: u
p un
til 2
5 ye
ar =
1,2
6 to
35 =
2, o
ver 3
5 =
3.
1Mar
ital
stat
us w
as c
oded
as f
ollo
ws:
sing
le =
1, m
arrie
d =
2, o
ther
s = 3.
B
Mot
her t
ongu
e was
cod
ed a
s fol
low
s: E
nglis
h =
1, F
renc
h =
2, o
ther
s =
3.
Q
460 M. JAMAL A N D V . V. BABA
commitment, job performance and higher absenteeism, tardiness and turnover intention than nurses working on fixed shifts (Jamal, 1981; Jamal and Jamal, 1982). In a more recent study of nurses from five hospitals in the southeastern section of the U.S., Coffey et a[. (1988) found that nurses on rotating shifts showed the lowest job performance and highest job-related stress in comparison to nurses working on other shifts. A Finnish study also found that the group of nurses in irregular shifts (rotational shifts) experienced more stress than other employees (Olsson, Kandolin and Toropainen, 1990). Thus, in conclusion, it can be said that the literature is unequivocal in documenting the disruptive impact of rotational shifts on a number of factors including health, family life, stress, work attitudes and behavior among employees in general, and among nurses working in hospitals in particular.
The results of department-type and nurses’ job stress, strain and organizational commitment are not as clear as the results of shiftwork and the dependent variables. It was suggested earlier that nurses working in non-intensive care departments would be better off than nurses working in intensive care or semi-intensive care departments with regard to job stress, work attitudes and behavioral intentions. However, no significant differences were found among nurses working in various departments on four of the nine dependent variables. Among the five significant relationships between department-type and dependent variables, the results were mixed and did not show a clear pattern. Contrary to our prediction, nurses in non-intensive care departments showed the highest job stress and role overload compared to nurses in other departments. Similarly, nurses in semi-intensive care departments showed the highest organizational commit- ment and work hours satisfaction and were least desirous to leave their present hospital compared to nurses in intensive care or non-intensive care departments. These inconsistencies in results are quite in line with the empirical findings concerning department-type and employees’ work attitudes and behavior in hospital settings (Nichols, Springford and Searl, 1981; Weiner and Caldwell, 1981). For example, Johnson (1979) and Keane et al. (1985) found almost no indication that intensive care department nurses could be differentiated from others on variables such as stateitrait anxiety, negative self-concepts and feelings of hopelessness, entrapment and frust- ration. Nichols et a[. (1981) reported that levels of job satisfaction and morale were in fact higher among intensive therapy nurses than those working in other departments. Similarly, Maloney (1 982) found that nurses in non-intensive units had significantly higher state anxiety, trait anxiety, psychosomatic complaints and more interpersonal difficulties with their family and friends than nurses working in intensive care units. In addition, he found ‘no notable difference between the two groups of nurses in their response to the question on job satisfaction/ dissatisfaction and boredom’. Finally, in his study, similar to our study, non-intensive care nurses reported a significantly higher level of workload. A more recent study of British nurses (Hipwell et al. 1989) also found that ‘workload’ was notably higher among non-specialized (non-intensive care) nurses than specialized (intensive care) nurses.
With the hope of finding a somewhat more meaningful pattern of results in the present study, departments were also classified into intensive care and non-intensive care. The middle category ‘semi-intensive care’ was ignored. The results, when using the new classification, did not change in any appreciable way. Thus, in conclusion, one might wonder that perhaps the literature on nursing department-type has been overly dramatic in its description of intensive-care nurses, leading to the belief that intensive-care nursing is formidably high on job stress and strain, and is costly with regard to personal and organizational outcomes (Foxall et a). 1990; Maloney, 1982). However, it is felt that there is a definite need for more research in order to clarify the situation.
The results from the two-way ANOVAs to detect possible interaction effects of shiftwork and department-type on the study’s nine dependent variables indicated only two significant
SHIFTWORK, DEPARTMENT-TYPE A N D STRESS 461
interactions. By and large, these results showed that in understanding nurses’ job stress, strain and organizational commitment in the present sample, shiftwork is more important than depart- ment-type. The main effects of shiftwork on dependent variables remained more or less unchanged when department-type was used as the second independent variable. Even in the two significant interaction effects observed, nurses working on fixed shifts were better off than nurses on rotating shifts with regard to job stress and commitment to nursing as a career.
The results from the moderators’ analyses (age, marital status, mother tongue) of shiftwork, department-type and the dependent variables again produced only a few significant interaction effects. But the three moderators showed significant main effects with a number of dependent variables. For example age, marital status, and mother tongue were, respectively, significantly associated with job satisfaction and turnover intention. Similarly, both age and marital status were significantly associated with job stress and organizational commitment. These findings are consistent with the bulk of empirical literature on the topic (Jamal, 1981; Kanungo, 1980; Lee and Kanungo, 1984). Since the three sociodemographic moderators did not much change the results of shiftwork and dependent variables, it emphasizes the importance of shiftwork in understanding nurses’ job stress, work attitudes and behavior. By and large, employees work- ing on rotating shifts suffer more adversely than other employees working on fixed shifts. To eliminate shiftwork entirely is impossible, given society’s need for round-the-clock services. Therefore, shiftwork will continue to be a fact of life for a significant proportion of the labor force in North America and in other industrialized countries. There are, however, a number of options available which would probably reduce the adverse effects of rotating shifts on employees and these have been reviewed elsewhere (Jamal, 1989).
References Baba, V. V. and Harris, M. J. (1989). ‘Stress and absence: A cross-cultural perspective’. In: Rowland,
K., Nedd, A. and Ferris (Eds), Research in Personnel and Human Resources Management Supplement, Vol. 1 , JAI Press, Greenwich, CT, pp. 3 17-337.
Baba, V. V. and Jamal, M. (1991). Routinization of job context and job content as related to employees’ quality of working life: A study of Canadian nurses. Journal of Organizational Behavior, 11.
Becker-Carus, C. and Gunthner, G. (1989). ‘Stress and situation specific coping behavior in intensive care unit nursing staff, Work and Stress, 3,353-358.
Coffey, C., Skipper, Jr. J. K. and Jung, F. D. (1988). ‘Nurses and shiftwork: Effects on job performance and job-related stress’, Journal of Advanced Nursing, 13,245-254.
Colligan, M. J., Frockett, I. J. and Tasto, D. L. (1979). ‘Frequency of sickness absence and worksite clinic visits among nurses as a function of shift’, Applied Ergonomics, 10, 79-85.
Dunham, R. B. (1977). ‘Shiftwork: A review and theoretical analysis’, Academy of Management Review, 2,62&634.
Firth, H. and Britton, P. (1989). ‘Burnout, absence and turnover amongst British nursing staff, Journal of Occupational Psychology, 62,55-59.
Flain, P. 0. (1986). ‘Work schedules of Americans: An overview of new findings’, Monthly Labor Review, 109 (1 l), 3-6.
Foxall, M. J., Zimmerman, L., Standley, R. and Bene, B. (1990). ‘A comparison of frequency and sources of nursing job stress perceived by intensive care, hospice and medical-surgical nurses’, Journal0 f Advanced Nursing, 15, 577-584.
Frost, P. J. and Jamal, M. (1979). ‘Shiftwork, attitudes and reported behaviour: Some association between individual characteristics and hours of work and leisure’, Journal of Applied Psychology, 64,77-81.
Gentry, W. D., Foster, S. B. and Froehling, S. (1972). ‘Psychological response to situational stress in intensive and non-intensive nursing’, Heart and Lung, 1,793-796.
Goldenberg, D. and Waddell, J. (1990). ‘Occupational stress and coping strategies among female baccalaur- eate nursing faculty’, Journal of Advanced Nursing, 15,53 1-543.
Hipwell, A. E., Tyler, P. A. and Wilson, C. M. (1989). ‘Sources of stress and dissatisfaction among nurses in four hospital environments’, British Journal of Medical Psychology, 62,71-79.
462 M. JAMAL AND V. V. BABA
House, R. J. (1981). Work Stress and Social Support, Addison-Wesley, Don Mills, Ontario, Canada. Jackson, S. E. and Schuler, R. S. (1985). ‘A meta-analysis and conceptual critique of research on role ambi-
guity and role conflict in work settings’, Organizational Behavior and Human Decision Processes, 36,16-78. Jamal, M. (1981). ‘Shiftwork related to job attitudes, social participation and withdrawal behavior: A
study of nurses and industrial workers’, Personnel Psychology, 34, 535-541. Jamal, M. (1984). ‘Job stress and job performance controversy: An empirical assessment’, Organizational
Behavior and Human Puformance, 33, 1-2 1. Jamal, M. (1989). ‘Shiftwork creates unusual problems’, Personnel Journal, 68 (9, 1 1 4 1 17. Jamal, M. (1990). ‘Relationship ofjob stress and Type A behaviour to employees’ job satisfaction, organiza-
tional commitment, psychosomatic health problems and turnover motivation’, Human Relations, 43, 727-738.
Jamal, M. and Jamal, S. M. (1982). ‘Work and non-work experiences of employees on fixed and rotating shifts: An empirical assessment’, Journal of Vocalional Behavior, 29,282-293.
Johnson, M. (1979). ‘Anxietyhtress and the effects of disclosure between nurses and patients’, Advances in Nursing Science, 1, 1-20.
Kahn, A. L., Wolfe, D. M., Quinn, R. P., Snoek, J. D. and Rosenthal, R. (1964). Organizational Stress, Wiley, New York.
Kanungo, R. N. (1980). Biculturalism and Management, Butterworth, Toronto. Keane, A., Ducette, J. and Adler, D. C. (1985). ‘Stress in ICU and non-ICU nurses’, Nursing Research,
King, L. A. and King, D. W. (1990). ‘Role conflict and role ambiguity: A critical assessment of construct
Knutsson, A. (1989). ‘Shiftwork and coronary heart disease’, Scandinavian Journal of Social Medicine,
Kunkler, J. and Whittick, J . (1991). ‘Stress management groups for nurses: Practical problems and possible
Landeweerd, J. A. and Boumans, N. P. G. (1988). ‘Nurses’ work satisfaction and feelings of health and
Lane, I . M., Mathews, R. C. and Presholdt, P. H. (1988). ‘Determinants of nurses’ intentions to leave
Lee, M. and Kanungo, R. (Eds) (1984). Management of Work and PersonalL$k Problems and Opportunities,
Malaviya, P. and Ganesh, K. (1976). ‘Shiftwork and individual differences in the productivity of weavers
Maloney, J. P. (1982). ‘Job stress and its consequences on a group of intensive care and non-intensive
McLaney, M. A. and Hurrell, Jr., J. J. (1988). ‘Control, stress, and job satisfaction in Canadian nurses’,
Miller, H. E., Katerberg. C. H. and H u h , C. H. (1979). ‘Evaluation of the Mobley, Horner and Hollings-
Moore-Ede, M. C. and Richardson, G. S. (1985). ‘Medical implications of shiftwork’, Annual Review
Mowday, R. T., Steers, R. M. and Porter, L. W. (1979). ‘The measurement of organizational commitment’,
Nichols, K. A,, Springford, V. and Searl, J. (1981). ‘An investigation of distress and discontent in various
Nicholson, N., Jackson, P. and Howes, G. (1978). ‘Shiftwork and absence: An analysis of temporal needs’,
Olsson, K., Kandolin, I. and Toropainen, K. K. (1990). ‘Stress and coping strategies of three shiftworkers’,
Parasuraman, S., Drake, B. H. and Zammuto, R. F. (1982). ‘The effects of nursing care modalities and
Parker, D. F. and DeCotiis, T. A. (1983). ‘Organizational determinants of job stress’, Organizational
Payne, R., Lande, D. and Leahy, M. (1989). ‘Work and nonwork factors as perceived causes of symptoms
34,231-236.
validity’, Psychological Bulletin, 107, 48-64.
44,1-35.
solutions’, Journal of Advanced Nursing, 16, 172-176.
stress in three psychiatric departments’, International Journalof Nursing Studies, 25,225-234.
their profession’, Journal of Organizational Behavior, 9, 367-372.
Praeger, New York.
in an Indian textile mill’, JournalofApplied Psychology, 61, 774776.
care nurses’, Advances in Nursing Science, 4, 3142.
Work and Stress, 2, 2 17-224.
worth model of employee turnover’, Journalof Applied Psychology, 64,509-5 17.
of Medicine, 36,607-6 17.
Journal of Vocational Behavior, 14,22&247.
types of nursing’, Journal ofAdvariced Nursing, 6, 31 1-338.
Journal ofOccupationa1 Psychology, 51, 127-137.
Le Travail Hurnain, 53, 175-188.
shift assignments on nurses’ work experiences and job attitudes’, Nursing Research, 31,364367.
Behavior and Human Performance, 32, 160-177.
of psychological strain’, Work and Stress, 3,341-35 1.
SHIFTWORK, DEPARTMENT-TYPE A N D STRESS 463
Redfern, S. J . (1980). ‘Hospital sisters: Work attitudes, perceptions and wastage’, Journal of Advanced
Rizzo, J. R., House, J. R. and Lirtzman, S. I. (1970). ‘Role conflict and ambiguity in complex organizations’,
Staines, G. L. and Pleck, J . H. (1984). ‘Nonstandard work schedules and family life’, Journal of Applied
Nursing, 5,45 1466.
Administrative Science Quarterly, 15, 150-1 63.
Psvcholonv, 69,515-523. Weiner, M: F. and Caldwell, T. (1981). ‘Stresses and coping in ICU nursing’, General Hospital Psychiatry,
3. 129. Winget, C. M., Hughes, L. and LaDou, J. (1978). ‘Physiological effects of rotational work shifting: A
review’, Journal of Occupational Medicine, 20,204-21 0.
Appendix A
Job stress scale used in present study 1. I have often felt fidgety or nervousness as a result of my job 2. My job gets to me more than it should 3. There are lots of times when my job drives me right up a wall 4. Sometimes when I think about my job I get a tight feeling in my chest 5. I feel guilty when I take time off from the job 6. I have too much work to do and too little time to do it in 7. Too many nurses get burned out by job demands 8. I sometimes dread the telephone ringing at home because the call might be job-related 9. I feel like I never have a day off
3 c1 k > r > z U
5 A
ppen
dix
B 5 W
Cel
l mea
ns fo
r eac
h ca
tego
ry o
f the
thre
e po
tent
ial m
oder
ator
s (ag
e, m
arita
l sta
tus,
mot
her t
ongu
e) o
n st
udy'
s ni
ne d
epen
dent
var
iabl
es
Var
iabl
es
Age
* M
arita
l sta
tus?
M
othe
r ton
gue3
M
oder
ator
(1)
(2)
(3)
(1)
(2)
(3)
(1)
(2)
(3)
(N=
293)
(N
=40
4)
(N=
379)
(N
=50
6)
(N=
514)
(N
= 1
26)
(N=
611)
(N
=32
8)
(N=
206)
(I
) R
ole
ambi
guity
9.
69
9.78
9.
59
9.62
9.
67
10.0
0 9.
61
10.1
5 9.
15
(2)
Rol
e ov
erlo
ad
15.5
3 16
.05
16.1
0 15
.45
16.1
0 15
.85
15.3
5 15
.83
16.1
9 (3
) Jo
b st
ress
28
.23
27.3
7 26
.35
28.6
0 26
.44
29.0
3 27
.21
27.3
5 27
.01
(4)
Org
aniz
atio
nal c
omm
itmen
t 50
.51
48.4
3 51
.97
49. I
7 5 1
.67
45.4
3 51
.21
49.2
8 50
.41
(5) S
ocia
l sup
port
12
.42
12.0
1 11
.87
12.1
7 12
.12
11.6
4 12
.27
11.7
9 12
.06
(7)
Wor
k ho
urs s
atis
fact
ion
3.23
3.
20
3.56
3.
32
3.43
3.
23
3.39
3.
23
3.48
(8
) Tu
rnov
er i
nten
tion
2.04
1.
96
1.65
2.
02
1.71
1.
91
1.83
2.
10
1.63
(9
) C
omm
itmen
t to
nurs
ing
2.32
2.
11
2.18
2.
15
2.26
1.
97
2.24
2.
11
2.07
*Age
was
code
d as
follo
ws:
up
until
25
= I,
26-3
5 =
2, o
ver 3
5 =
3.
?Mar
ital s
tatu
s w
as c
oded
as f
ollo
ws:
smgl
e =
1, m
arri
ed =
2, o
ther
s = 3
. $M
othe
r ton
gue
was
cod
ed a
s fol
low
s: E
nglis
h =
1, F
renc
h =
2, o
ther
s = 3
.
(6)
Job
satis
fact
ion
3.50
3.
43
3.78
3.
54
3.73
3.
35
3.54
3.
48
3.99