The Impact of Nurse Stress, Job Distress, Job Satisfaction, and Mood on Patient Outcomes

This study examines the intercorrelations among nursing home healthcare providers’ stress, job distress, job satisfaction, and mood, as well as the relationships between these factors and patient outcomes. Additionally, the study investigates the effect that Butler University’s Music First! program had on nurse job perceptions. A total of 63 nurses from nine long-term care facilities completed questionnaires asking about stress, job distress, and global job satisfaction. Nurses’ depression, anxiety, and hostility were also assessed, with the 15-item Profile of Mood States questionnaire. Of these 63 nurses, 20 completed the questionnaires at three time points during the implementation of the Music First! intervention. Patient outcomes included standardized assessments of agitation, psychiatric symptoms, cognitive functioning, and depression, as well as documented instances of patient falls and reportable behaviors. Intercorrelations among nurse stress, job distress, job satisfaction, and affect ranged from r = –. 565 to r = . 627. All correlations except one reached statistical significance. Similarly, correlations between patient outcomes and nurses’ job-related self-reports documented strong relationships between nurses’ affective responses to their jobs and patient outcomes. For example, the patients of nurses reporting greater stress at work were more agitated (r = .335) and exhibited more severe dementia (SLUMS r = –.291), more severe psychiatric symptoms (r = .293), and more frequent reportable behaviors (r = .436) than did patients of nurses reporting less stress. Finally, the Music First! program was associated with a near-significant decrease in nurses’ job-related stress (p = .054). Although these results are correlational and cannot determine the direction of these relationships, these findings do suggest that improving nurses’ feelings about their jobs, improving patient behaviors, or implementing programs designed to improve patients’ quality of life can have a positive impact on the nursing home environment. Many individuals face job-related stressors throughout their careers. Jobrelated stress is defined by the Centers for Disease Control and Prevention (CDC, BUTLER JOURNAL OF UNDERGRADUATE RESEARCH, VOLUME 7 154 2014) as “the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. ” Nurses experience job-related stress at an extremely high rate compared to people in other occupations (Redfern et al., 2002). Nurses who are newer to the field report higher rates of stress than do nurses who have been in the field for longer; this is possibly a result of better coping mechanisms by the moreexperienced nurses (Zimmerman et al., 2005). Job-related stress is essential to understand because it affects the nurses who experience it as well as their patients. Several research studies have documented the negative effects of jobrelated stress in the nursing profession. When nurses experience high amounts of stress, they are more prone to absences (Dugan et al., 1996). Additionally, increased job-related stress is correlated with lower job satisfaction (Redfern et al., 2002; Zimmerman et al., 2005). Finally, there is an association between stress and commitment. The more stressed nurses are, the less committed they are to their roles (Redfern et al., 2002). One possible outcome of prolonged job-related stress is career burnout, which is defined as a “multidimensional, complex phenomenon that involves exhaustion, cynicism, and ineffectiveness” (Maslach et al., 2001). Burnout, like job-related stress, is linked to absenteeism, decreased job satisfaction, decreased occupational commitment, and increased stress levels (Maslach et al., 2001). In a comprehensive study, nurses were found to be particularly vulnerable to career burnout when compared to more-advanced healthcare practitioners, with this difference being upward of 20% (Lyndon, 2016). Burnout may be particularly problematic in nursing homes. Mukamel and colleagues (2009) found that staff in this setting experience turnover at a rate of 55% to 75%. For nurses who do not leave their positions, those who experience burnout take more short-term absence leaves as a result of their emotional exhaustion and also take longer absence leaves than do peers who experience less burnout (Anagnostopoulus & Niakas, 2010). Beyond the effect on the nurses themselves, career-related burnout and job stress negatively influence the quality of care that the nurses’ patients receive. In a study examining nurse burnout and common infections (urinary tract and surgicalsite) during hospital stays, higher rates of nurse burnout led to higher rates of patient infections (Cimiotti et al., 2012). Burnout can be associated with depersonalization and emotional exhaustion, and these in turn have also been demonstrated to affect patient safety as perceived by nurses (Halbesleben et al., 2008). Beyond burnout, nurses’ stress levels in general also negatively affect patient outcomes. As stated previously, when nurses experience more job-related BUTLER JOURNAL OF UNDERGRADUATE RESEARCH, VOLUME 7 155 stress, they are less committed to their jobs. This is an issue because nurse commitment is directly correlated with patients’ quality of life (Bishop et al., 2008). In units where nurses report higher stress levels, there have also been more patient incidents, patient falls, and medication errors (Dugan et al., 1996). Thus, nurse stress, as well as burnout, is important because of its consistent negative effect on patient care and outcomes. Although several studies have examined nurse stress and patient outcomes in large, multi-unit hospital settings, few have been conducted within the setting of a nursing home. The current study investigated nursing home healthcare providers’ stress, job distress, job satisfaction, and mood, as well as the impact that these factors have on patient outcomes in the nursing home setting. The first hypothesis was that higher stress levels would negatively correlate with job satisfaction but positively correlate with job distress and negative affect. The second hypothesis was that these four factors would relate to patient outcomes, with high levels of stress, job distress, and negative affect being negatively associated with and high levels of job satisfaction being positively associated with patient outcomes. More specifically, higher levels of stress, job distress, and negative affect were expected to negatively affect patient outcomes, but higher levels of job satisfaction were anticipated to relate to more positive patient outcomes. In addition to these relationships, the current study evaluated the impact of Butler University’s Music First! program on nursing home staff. Music First! examines the effect that listening to personalized music playlists has on sundowning behaviors of individuals with dementia. Prior research indicates that passive listening to individualized music selections improves both agitation and cognition of nursing home residents with dementia (Gerdner, 2000; Shiltz et al., 2015, 2018). In investigating the effect of this program on nurses’ job-related perceptions, the third hypothesis of this study was that Music First! would decrease nurses’ levels of stress and job distress as well as improve their mood and job satisfaction through its positive effects on the dementia-related symptoms of the patients in their care.