Journal of Nursing Research • VOL. 17, NO. 3, SEPTEMBER 2009

A Study of Job Stress, Stress CopingStrategies, and Job Satisfaction for

Nurses Working in Middle-LevelHospital Operating Rooms

Chung-Kuang Chen • Cecilia Lin* • Shu-Hui Wang** • Tung-Hsu Hou***

ABSTRACT

Background: Understanding the interactive relationshipsbetween demographics and work-related variables, jobstress, job stress coping strategies, and job satisfaction foroperating room (OR) nurses is important.

Purpose: The purpose of this study was to determine theStressors, the stress coping strategies, and the job satisfac-tion of nursing staff who worked in the OR and to evaluateinfluence of demographic characteristics on job stress, stresscoping strategies, and job satisfaction.

Methods: A cross-sectional research design was used tocollect data. Participants included 121 nurses with more than6 months of work experience at seven hospitals in Yuniln andChiayi Counties. Data were collected from March throughMay 2008. One hundred twelve questionnaires were retumed,giving a response rate of 92-56%. The questionnaire includedfour parts designed to gather data on demographics and work-related information, job stress, stress coping strategies, andiob satisfaction.

Results: Major findings of this study were as follows: (a)stress level and frequency perception of OR nurses weresignificantly related to the type of hospital; (b) the mostintense Stressor perceived by OR nurses was patient safety;(c) the Stressor most frequently perceived by OR nurses wasadministrative feedback; (d) although all job Stressors werepositively related to destructive stress coping strategies,professional status, patient safety, and OR environmentwere aiso positively related to constructive stress copingstrategies; (e) factors including work rewards, OR environ-ment, and administrative management of job satisfactionwere inversely related to destructive stress coping strate-gies; and (f) factors including work rewards, OR environment,and administrative management of job satisfaction wereinversely related to all job Stressors.

Conclusions/Implications for Practice: Major suggestionsof this study include the following: (a) hospitals shouldensure set standard operating procedures for the OR,strengthen the designed-in security of the OR working envi-ronment, and provide adequate safety protection equipmentTo safeguard OR staff and patients; (b) the OR departmentshould increase the quantity and the quality of stress reliefcourses; (c) the OR department should improve the OR envi-

ronment and the administrative management skills; and (d)the OR department should offer self-esteem-related trainingprograms to assist OR nursing staff to adopt constructivestress coping strategies.

KEY WORDS:job stress, stress coping strategy, job satisfaction.

IntroductionNurses are the backbone of the medical system and act asthe first line of patient medical care. Therefore., nursingquality is one of the most important factors determiningmedical service performance. Nursing work is one of themost stressful and challenging vocations because of itsneed for specialization, complexity, and requirement to han-dle emergency situations (Benoliel, McCorkle, Georgiadou,Dentón, &: Spitzer, 1990; Su, 1993). The negative influenceof job stress on nurses and hospitals is manifested throughabsence, unhealthiness, staff conflict, depression, staff turn-over, and inferior service (Foxall, Zimmerman, Standly, &Captain, 1990; Larson, 1987; Price & Murphy, 1984).

Prior studies have identified sources of job stress fornurses (Gray-Toft &c Anderson, 1981; Huang, Hwang, LinSc Sun, 2001; Lee &c Wang, 2002), tested the frequency ofStressors {Foxall et al., 1990; Wu, 1993), determined factorsrelated to job satisfaction {Chung, Chen & Huang, 2004;

MS, Teaching Assisrant, Office of Research and Development HeDoctoral Candidate, Graduate School of Management, NationalYunlin University of Science and Technology;

*MS, Director, Department of Medical Affairs, St. Joseph Hospital;

**RN, BSN, Head Nurse, Operating Room, St. Joseph Hospital;

*'^'ThD, Professor, Graduate Institute of Healthcare IndustrialManagement, National Yunlin University of Science and Technology.

Received: December 25, 2008 Revised: April 16, 2009 Accepted:May 7, 2009Address correspondence to: Ciiung-KujEig Gheii, No. 123, UniversityRd. Sec. 3, Douliou City, Yunlin County 64002, Taiwan, ROC.Tel: +886 (5) 534-2601 ext. 2533; Fax:'+8S6 (5) 531-2029;E-mail: chenck@)'untech,edu.tw

199

Journal of Nursing Research Chung-Kuang Chen et al,

Mueller &: McCloskey, 1990), and explored job stress cop-ing strategies (Dewe, 1993; Gribbins & Marshall, 1982).

A number of findings relevant to this area have beenalready made. Nurse demographics are correlated withjob stress (Huang et al., 2001; Wu, 1993), stress response(Su, 1993), and job satisfaction (Chung et al., 2004}.Nurse job satisfaction correlates inversely to stress (Healy& Mckay, 2000; Leung, Spurgeon, & Cheung, 2007), jobStressors are positively related to stress response (Su, 1993),nurses adopt positive stress coping behaviors more oftenthan negative behaviors (Shih &c Chou, 2002), and jobstress correlates positively to negative stress coping strat-egies (Su, 1993).

The operating room (OR) is one of the most stimulatingand challenging hospital units in which nurses work.(Characteristics that lead uurses to experience pressure inthe OR include the need to work quickly, to face highermedical dispute risks, to work uncertain shifts, to handleprecision instruments, and to master complex techniques.According to previous studies, the OR is a unit of the hos-pital characterized by elevated stress and lower satisfaction(Chang & Hsu, 2000; Foxall et al., 1990; Su, 1993).

Job satisfaction affects quality of life (Yu et al., 2008).To promote OR nurse work performance and life quality,it is important to study the interactive relationships betweendemographics and such factors as work-related variables,job stress, job stress coping strategies, and job satisfaction.

Because of differences in patient conditions, workload,and instruments among different types of hospitals, ORnurses in different working environments may perceive jobstress and job satisfaction differently and as a result adoptdifferent stress coping strategies. Our review of the liter-ature found that no single study has addressed the issuesof job stress, job stress coping strategies, and job satis-faction for OR nurses working in different types of hos-pitals. Furthermore, no study focused on the relationshipbetween job stress, stress coping strategies, and job satis-faction in OR nurses.

Therefore, the obiective of this study was to investigatejob stress, stress copiug strategies, and job satisfaction inOR nurses working at different hospital types andrelationships between these factors. The conceptual frame-work for this study is illustrated in Figure 1.

Methods

ParticipantsThe researcher first contacted the chiefs and the headnurses in the OR departments of hospitals in Yuniin andChiayi counties and explained the purpose and the pro-cedure of this research to determine willingness to partici-pate. Five regional teaching hospitals (RTHs) and twocommunity teaching hospitals (CTHs) agreed to participate.Among the 121 OR nurses agreeing to participate, 112(92.56%) completed all questionnaires. All participantswere basic-level nurses working in the OR who had beenemployed for more than 6 months.

InstrumentsThe questionnaire used in this study included fourelements covering a demographic and work-related data,a Stressor scale, a stress coping strategy scale, and a jobsatisfaction scale. All items in the questionnaire weredesigned in reference to former studies (C'hang & Hsu,2000; Chung et al., 2004; Dewe, 1987; Foxall et al., 1990;Cray-Toft & Anderson, 1981; Huang et al., 2001; Mueller& McCloskey, 1990; Su, 1993; Wu, 1993) and wereevaluated and modified by nine scholars and practitionerswith relevant expertise.

Demographic and work-related data included age,marital status, number of children, religion, educationlevel, years of nursing experience, professional careerstatus (including experience at other hospitals, experiencein other departments, years employed in the present hos-pital, and years employed in the OR), whether the positionwas voluntary or appointed, whether the respondent hadattended courses for dealing with stress or not, shiftarrangement, professional title, salary, and hospital type.

The Stressor scale consists of two parts: stress levelperception and stress frequency perception. It is a 57-itemquestionnaire. The stress level perception scale wasmeasured with a 5-point Likert scale ranging from 1 («opressure) to 5 (extreme pressure). The stress frequencyperception scale was also measured with a 5-point Likertscale ranging from 1 {neuer) to 5 (always). Factor analysiswas used to determine the factor structure of the Stressor

Demographic dala and work-relatedvariables •

/

\

Stress frequency perception

\

Stress level perception

•

Job satisfaction

1

Stress coping strategics

Figure 1. Operating room nurses' personal demographic data may affect stress level perception and stress frequencyperception. Job stress correlates with job satisfaction, which, in turn, correlates with stress coping strategies.

200

Stress. Coping, and Satisfaction for Nurses in the OR VOL. 17, NO. 3. SEPTEMBER 2009

scale. According to the Kaiser-Eigen value criterion of 1for determining the structure of factors (Kim & Mueller,1978), seven subscales were extracted from the 57 items.The alpha reliability coefficients of the seven subscales ofthe Stressor scale were between .84 and .94. The subscalesof the Stressor scale are as follows: professional status (13items), patient safety (4 items), OR environment (10 items),patient care (9 items), administrative management (9 items),interpersonal relationships (9 items), and administrative feed-back (3 items).

The stress coping strategy scale covered a 25-item ques-tionnaire. Stress coping strategy was measured with a5-point Likert scale ranging from 1 {never) to 5 (always).Factor analysis was used to determine the factor structureof the stress coping strategy scale. According to the Kaiser-Eigen value criterion of 1 and the scholars' suggestions fordetermining the structure of factors., two subscales wereorganized from the 25 items. Alpha reliability coefficientsfor the two stress coping strategy subscales were between.80 and .84. These subscales covered the aspects of construc-tive strategy (11 items) and destructive strategy (14 items).

The job satisfaction scale was arranged as a 27-itemquestionnaire, with job satisfaction measured according toa 5-point Likert scale ranging from 1 {strongly disagree) to5 {strongly agree). Factor analysis was used to extract thefactor structure of the job satisfaction scale. Five subscaleswere extracted from the 26 items (the total satisfactionitem was not included). Alpha reliability coefficients for thefive subscales of job satisfaction fell between .61 and .89.Subscales covered the aspects of work rewards (5 items),OR environment (9 items), self-esteem (2 items), adminis-trative management (8 items), and job ability (2 items).

Statistical AnalysisData from completed questionnaires were processed andanalyzed using SPSS version 10.0 (SPSS Inc., Chicago, IL).Descriptive statistics such as mean value and standarddeviation were used to describe participant characteristics,stress level perception, stress frequency perception, stresscoping strategics, and job satisfaction. Independent t test,analysis of variance (ANOVA), and Pearson's correlationwere used to determine correlations between stress levelperception, stress frequency perception, stress coping strat-egies, and job satisfaction based on variable character-istics. The level of significance for this study was set at .05.

ResultsDemographic Data and Work-RelatedVariablesDemographic data and work-related variables for the 112nurses in this study are shown in Table 1. All were women.1 he mean age of the participants was 32 years {SD = 5.80years, range = 21—48}. A slight majority were single (53.6%),

TABLE 1.

OR Nurse Demographic Data andWork-Related Variables (N = 112)

MBAge (years)

<2526-3031 40>40

Marital statusSingleMarriedWidowed or divorced

No. childrenNone12>2

ReligionNoneYes

Educational backgroundSenior vocational high schoolJunior collegeUndergraduateGraduate school

Years employed in nursing0.5-1>1-5>5-10>10-20>20

Professional Career Status 1:experience in other hospitalsYesNever

Professional Career Status 2:experience in other departmentsYesNever

Professional Career Status 3:years employed at present hospital<1>1-5>5-10>10-20>20

Professional Career Status 4:years employed in OR0.5-1>1-5>5-10>10-20>20

PositionVoluntaryAppointed

1933528

60502

6620188

6250

76440

1

82149286

6844

2488

193836145

194037133

9121

17.029.546.4

7.1

53.644.6

1.8

58.917.916.17.1

55.444.6

6.357.135.70.9

7.118.843.825.05.4

60.739.3

21.478.6

17.033.932.112.54.5

17.035.733.011.62.7

81.318.8

{continued}

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Journal of Nursing Research Chung-Kuang Chen et al,

TABLE 1.

Continued

Variable

A t t e n d e d i • • i • : ^

YesNever

Shift arrangementFixedShift

Professional titleRegistered nurseLicensed vocational nurse

Satan/ (NTS)<30,00030,001-35,00035.001 40,00040,001-45,00045,001 -50.000>50,000

Type of hospitalRegional teaching hospitalCommunity teaching hospital

2983

9103

8329

325472476

9913

25.974.1

8.092.0

74.125.9

2.722.342.021.46.35.4

88.411.6

Note. OR = operating room.

professed no religious beliefs (55.4%)., and received theirbasic education in junior college (57.1%). Most had 1 to 10years of nursing experience. In terms of their career, 60.7%had nursing experience in another hospital., 78.6% hadnever worked in another department, 50.9% had nursingexperience in their present hospital less than 5 years, and68.7% had I to 10 years of OR nursing experience. Most(81.3%) voluntarily accepted service in OR. Only 25.9%had attended stress release training. Most (92.0%) neededto work variable shifts, 42.0% had salaries betweenNT$35,001 and NT$40,000. Most (88.4%) worked inRTHs, whereas the remainder {11.6%) worked in CTHs.

Job Stress Level PerceptionThe mean stress level perception score was 3.01. Amongthe seven stress scale subscales, patient safety was ratedhighest (M = 3.39, SD = 1.01), followed by administrativefeedback (M = 3.18, SD = 0.95), OR environment (M =3.10, SD = 0.83), administrative management (M = 3.01,SD = 0.71), professional status (M = 3.00, SD = 0.74),patient care (M - 2.91, SD = 0.67), and interpersonalrelationships (M = 2.64, SD = 0.67).

According to a one-way ANOVA and a t test of stresslevel perception of the seven job Stressors for each demo-graphic data and work-related variables, the variable oftype of hospital showed significant variance in terms ofprofessional status [t = 2.51, f? = .02), with nurses employedat RTHs perceiving greater professional status stress thanthose employed at CTHs. The professional title variableshowed significant variance in terms of patient safety (t =-2.07, p = .04), with registered nurses perceiving greater

stress attributable to patient safety rather than the licensedvocational nurse peers. The variable of whether the positionwas voluntary or appointed shows significant variance interms of administrative management (/ = -2.46, p = .02).Nurses who served voluntary in the OR perceived loweradministrative management stress than those who had beenappointed. Furthermore, variables including number of chil-dren (F = 2.78, p - .04), shift arrangement {t = - 2 .91 ,p = .01), and type of hospital (t = 2.86, p = .01) showsignificant variance in terms of administrative feedback,whereas nurses who worked in changing shifts or thoseemployed at RTHs perceived greater administrative feed-back stress (see Table 2). After a SchefPs test, we found thatnurses with no children perceived greater administrativefeedback stress than those who had more than two children.

Job Stress Frequency PerceptionMean score for stress frequency perception was 3.05.Among the seven subscales of the Stressor scale, adminis-trative feedback was rated highest (M = 3.28, SD = 0.92),followed by patient safety (M = 3.21, SD = 1.02),administrative management (M = 3.16, SD = 0.70), ORenvironment (M = 3.11, SD = 0.80), professional status(M = 3.08, SD = 0.72), patient care (M = 2.95, SD = 0.72),and interpersonal relationships {M = 2.76, SD = 0.66).

According to a one-way ANOVA and a t test of jobStressor frequency for each demographic characteristic andwork-related variable, the age variable shows significantvariance in terms of professional status (f = 3.32, p = .02).Variables of age (F = 4.93, p = .00), years employed attheir present hospital (F = 2.53, p = .04), years employedin the OR (F = 3.45, p = .01), and whether the positionwas voluntary or appointed (t = - 2 .03 , p = .05) eachshow significant variance in terms of administrativemanagement stress. Nurses who reported serving volun-tarily in the OR perceived lower administrative manage-ment stress frequency than those reporting having beenappointed. The variable of hospital type showed signifi-cant variance in terms of interpersonal relationships (t =2.25, p = .04) and administrative feedback (f = 2.46, p =.02), with nurses employed at RTHs perceiving a higherfrequency of interpersonal relationship and administrativefeedback stress than those employed at CTHs.

After a Scheffs test, we found that participants olderthan 40 years and who had worked in the OR for morethan 20 years perceived more frequent administrativemanagement stress than others.

Stress Coping StrategyThe mean score for stress coping strategy with regard toconstructive stress coping strategies was 3.63 (SD = 0.5).The destructive stress coping strategies score was 2.66(SD = 0.52). The most frequently occurring 10 stresscoping strategy behaviors all belong to the constructivestrategy category.

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Stress. Coping, and Satisfaction for Nurses in the OR VOL, 17, NO. 3, SEPTEMBER 2009

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Stress. Coping, and Satisfaction for Nurses in the OR VOL, 17, NO. 3, SEPTEMBER 2009

According to a one-way ANOVA and a t test of jobstress coping strategies for each demographic character-istic and work-related variable, the variables of maritalstatus {F = 3.48, p = .03) and number of children (f =3.73, p = .01) showed significant variance in terms ofdestructive coping strategies.

After a Scheff's test, we found that nurses who weresingle or had no children more frequently adopted destruc-tive stress coping strategies than the others.

Job SatisfactionThe mean score for job satisfaction was 2.96. Among thefive subscales of the job satisfaction scale, job abilityscored highest (M = 3.26), followed by self-esteem (M =,î.O7) and OR environment (M = 2.96). The suhscale workrewards (M = 2.40) was the lowest scoring satisfactionsubscale (see Table 3). The lowest three job satisfactionindexes included overtime pay (M = 2.20, SD = 0.88),on duty pay (M = 2.20, SD = 0.93), and night shift pay(M = 2.29, SD = 0.92).

According to a one-way ANOVA and a t test of jobsatisfaction for each demographic characteristic and work-related variable, variables of having attended courses forcoping with stress (i = -2 .15 , p = .04), shift arrangement(t = 2.58, p = .02), and type of hospital (i = -2 .45 , p = .03)showed significant variance in terms of work rewards.Nurses who had participated in courses dealing with stressmanagement, worked according to a varying shift sched-ule, or were employed at CTHs perceived higher workreward satisfaction. The variable of salary showed signifi-cant variance in terms of OR environment (F = 3.11, p =.01). The variables of years employed in nursing (F = 2.77,p = .03), years employed in their present hospital {F =2.71, p = .03), salary (F = 3.5S, p = .01), and type ofhospital {t = - 2 . 7 3 , p = .02) showed significant variancein terms of self-esteem. Nurses employed at CTHsperceived higher self-esteem satisfaction than thoseemployed at RTHs (see Table 3).

Using a Scheff's test, we found that nurses withmonthly salaries less than NT$30,000 perceived lowerOR environment satisfaction than others. Participantsemployed in nursing for more than 20 years perceivedhigher self-esteem satisfaction than those who had beenemployed in nursing for 1 to 5 years. Furthermore, thoseemployed in their present hospital for more than 20 yearsperceived higher self-esteem satisfaction than thoseemployed in their present hospital for less than 5 years.Finally, those with monthly salaries less than NT$30,000perceived lower self-esteem satisfaction than others.

Relationships Between Job Stress, StressCoping Strategies, and Job SatisfactionAfter the Pearson's correlation coefficient test, we foundthat among the seven subscales of the Stressor scale, profes-

sional status, patient safety, and OR environment correlatedpositively with constructive stress coping strategies. Allsubscales of the Stressor scale correlated positively witb de-structive stress coping strategies (see Table 4).

After the Pearson's correlation coefficient test, we foundthat among the seven subscales of Stressors, the stress levelperception of all subscales correlated positively with thefrequency reception of all subscales.

After the Pearson's correlation coefficient test, we foundthat among the five subscales of job satisfaction, satisfac-tion with work rewards, OR environment, and adminis-trative management correlated inversely with stress levelperception. The self-esteem subscale correlated inverselywith stress level perceptions of patient care, administrativemanagement, interpersonal relationships, and administra-tive feedback subscales (see Table 5).

After the Pearson's correlation coefficient test, we foundthat in the five job satisfaction subscales, satisfaction withwork rewards, OR environment, and administrative man-agement all correlated inversely with frequency of adoptingdestructive stress coping strategies. Self-esteem satisfactioncorrelated positively with frequency of adopting construc-tive stress coping strategies (see Table 6).

DiscussionDemographic Data and Work-RelatedVariablesData analysis in this study showed that OR nurses olderthan 40 years who had been working at their presenthospital for more than 20 years or had been working inthe OR for more than 20 years perceived higher frequencyof all job stress factors compared with their youngercounterparts. However, of all such, only differences on theadministrative management subscale registered statisticalsignificance. These findings are consistent with those ofMao and Lee (1992) but not of Wu (1993). This ispossibly due to the physical and mental condition of theelder OR nurses not being optimal for OR nursing workbecause OR nurses must work under situations tbat arefluid and rapidly changing, handle precision instruments,and learn advanced techniques. However, in this study,only eight nurses were older than 40 years, five had beenworking at their present hospital for more than 20 yearsand three had been working in the OR for more than 20years. Therefore, the above conclusion should be appliedonly with appropriate care. It is suggested that futureresearch may target this issue.

We found that nurses with more tban two childrenperceived the lowest level of job stress across all factorsand that those with no children experienced the highestjob stress level. These findings are similar to those of Su(1993), but not Lee (1989). It may be that nurses whohave more children place more value on their family andhave more life experiences than those with no children.

205

Journal of Nursing Research Chung-Kuang Chen et ai.

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207

Journal of Nursing Research Chung-Kuang Chen et al.

TABLE 4.

Pearson Correlation Between Stress Level Perception and Stress Coping Strategies

rrItemConstructiveDestructive

Note OR = operating'p<.05. -*ö<,01.

OTessionaiStatus

.19*

.44**

room.

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UHEnvironment

24**

,36**

fatientCare,06,43**

AdministrativeManagement

,12, 4 1 * *

InterpersonalRelationships

,10,48**

Administrative 'Feedback

,144 1 ' "

Because only eight nurses had more than two children inthis study, the above conclusions should also only beapplied with appropriate care.

This study found that nurses who voluntarily served inthe OR perceived lower frequency of joh stress across allfactors than those who had been appointed, although onlythe administrative management subscale achieved statisti-cal significance. This could be inferred by the possibilitythat nurses who volunteered for service in the OR werealready aware of and prepared for the complex nature ofOR work. It can therefore be recommended that volun-teers be given priority consideration when superintendentsof hospitals recruit nurses for the OR.

This study showed no significant difference in level orfrequency perception of stress between nurses who hadparticipated in courses dealing with stress managementand those who had not. Only 25.89% of OR nurses in thisstudy had participated in such courses. Stress managementtraining hours for OR nurses may not be long enough andstress management courses may not be of sufficientquality. To assist OR nurses to deal more effectively withjob stress, access to training and quality of stress reductioncourses should be improved.

This study also showed that nurses employed at RTHscompared with those employed at CTHs perceived morestress and reported a higher frequency of job stress,

resulting in lower job satisfaction. In Taiwan, OR nurseworkload in higher level hospital practice has increased,with increasing multiple, complex, and critical patient careproblems. It is suggested that the administrative depart-ment of hospitals design appropriate management andreward systems for OR nurses based on the type ofhospital they operate.

Job StressStudy analysis shows that patient safety accounted for thehighest stress level perception among OR nurses. This isrelated to OR work being high risk and including manyemergency situations as well as to keen public awarenessof the patient safety issues and the high incidence of medi-cal disputes, which are frequently reported in the media(Lin, Chen, &i Hou, 2007). It is strongly recommendedthat hospitals implement standard operating procedures inthe OR, strengthen OR working environment securitydesign, and provide safety protection equipment adequateto safeguard OR staff and patients.

Study findings show that administrative feedback wasmost frequently cited factor in job stress, followed bypatient safety. These findings are similar to previousresearch findings (Huang et al., 2001; Su, 1993). The highprofile role of administrative feedback in stress frequency

TABLE S.

Pearson Correlation Between Stress Level Perception and Job Satisfaction

«iItem ^ ^ ^ _

Work rewaíusOR environmentSelf-esteemAdministrative

managementJob ability

Professional, Status

- .27**- ,38**-,15- ,34**

-.03

PatientSafety

- .25**- .26**-.00- . 3 1 * *

-,13

OREnvironment

- .30**- .37**-.15- .38**

-.02

PatientCare

- .35**- ,45**-.20*- ,40**

- , 1 1

Administrative liManagement P

- ,41"*- .50**- .30**- .50**

-.08

leHHWHwUP^^^

-,24*- .46**- .25**- 3 6 * *

.02

- 3 4 * *- .22*- .39"*

.09

Note. OR = operating room.*p<.Ob. "p<01 .

20S

Stress, Coping, and Satisfaction for Nurses in the OR VOL. 17, NO. 3, SEPTEMBER 2009

TABLE 6.

Pearson Correlation Between Job Satisfaction and Stress Coping Strategies

ConstructiveDestructive

Note. OR = operating room.*p< .05. '"*p<.01.

may be attributed to intense competition within the medi-cal industry, competition that places great emphases onreducing costs and workforce and raising efficiency.

Job SatisfactionAnalysis shows that work rewards accounted for thelowest job satisfaction. Overtime pay, on duty pay, andnight shift pay comprised the lowest job satisfaction in-dexes. These findings are consistent with those of previousstudies (Chang & Hsu, 2000; Chung et al., 2004). A sug-gestion is for the OR nurse reward system to take intoaccount nonfixed shifts, workforce, and stress levels in theOR. The improvement of job satisfaction for OR nursesand the encouragement of constructive stress coping be-haviors should be urgently considered.

Relationships Between Job Stress, StressCoping Strategies, and Job SatisfactionAnalysis shows that job Stressors all relate positively todestructive stress coping strategies. However, professionalstatus, patient safety, and OR environment were also posi-tively related to constructive stress coping strategies. Thesefindings are also similar to those of previous studies (Cheng,Tsai, & Chen, 1999; Su, 1993). It is possible that appro-priate stress is helpful for OR nurses to adopt constructivestress coping strategies w^hereas excessive stress encour-ages OR nurses to adopt destructive stress coping strate-gies (Cheng et al, 1999; Lee, 1992).

Analysis of this study shows that all job Stressors wererelated inversely to work rewards, OR environment, self-esteem, and administrative management of job satisfac-tion. These findings are consistent to those of previousstudies (Cimete, Gencalp, & Keskin, 2003}. It is suggestedchat tbe OR manager should measure the perception levelof job stress of OR nurses and help nursing staffs adapt to¡ob stress and promote job satisfaction and life quality.

Further, analysis of this study shows job satisfactionsscores for work rewards, OR environment, and administra-tive management to be inversely related to destructive stresscoping strategies. These findings are consistent with thoseof previous studies (Healy & Mckay, 2000). It is suggestedtliat the OR department should improve the OR envi-

ronment, the administration management skills, and therationalization of OR work rewards system to reduce theprobability of destructive stress coping strategies adoption.

Results of this study show the perception of self-esteemjob satisfaction to be positively related to constructive stresscoping strategies and inversely related to the level of jobstress perception of patient care, administrative manage-ment, interpersonal relationships, and administrative feed-back factors. These findings are consistent with those of aprevious study (Lee, 1989). It is suggested that the OR de-partment should offer self-esteem and assertiveness-relatedtraining program to assist the OR nursing staff adopt con-structive stress coping strategies.

ConclusionsThe foremost finding of this study is tbat perception of thelevel and frequency of Stressors and job satisfaction forOR nurses is significantly related to different types ofhospitals. OR nurses working at RTHs perceive more fre-quent and more intense job stress and lower job satisfac-tion than those working at CTHs.

Another finding of this study is that patient safety ac-counted for the highest stress level perception score of allOR nurse job Stressors. Administrative feedback accountedfor the most frequently perceived stress faced by OR nursejob Stressors.

The third finding of this study is that the job Stressorsof professional status, patient safety, and OR environmentare positively related to constructive stress coping strate-gies. All job Stressors are positively related to destructivestress coping strategies. Job satisfaction factors includingwork rewards, OR environment, and administrative man-agement were found to be related inversely to destructivestress coping strategies. The job satisfaction factors of workrewards, OR environment, and administrative managementwere found inversely related to all job Stressors.

Previous researchers focused only on medical centers oron one type of hospital. Instead, this study contributes tofilling the gaps in tbe research on OR staff. This study alsoprovides further findings on the relationships between jobstress, job stress coping strategies, and job satisfaction.

However, participants of this study were limited tothose serving in middle-level hospitals in Yuniin and

209

Journal of Nursing Research Chung-Kuang Chen et al.

Chiayi counries in Taiwan. The conclusions of thisresearch may not apply to OR nurses at hospitals of otherlevels or those working in other regions or countries.

AcknowledgmentsThe authors acknowledge the study participants and thechiefs and head nurses of the Changhua Christian Hos-pital Yunlin Branch, the China Medical University BeigangHospital, the Chia Yi Hospital, the National Taiwan Univer-sity Hospital Yunlin Branch, the St. Martin De Porres Hospital,the Buddhist Tzu Chi General Hospital Dalin Branch, andthe St. Joseph's Hospital. Grateful appreciation also goesto the St. Joseph's Hospital for its grant {No. 9703}.

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