Problem: The quality of working conditions for nurses has become an increasingly important issue over the past decade, as hospital restructuring and changes in health care delivery have often translated into increased workload and increased unpredictable change for nurses. A large survey of registered nurses in Ontario’s acute care hospitals has shown a clear contrast in the health profiles of full and part-time nurses (Shamian et al., 2002). It is hypothesized that full-time nurses have a greater risk of work-related health problems due to their greater work environment exposure.
Background: Mental health disorders are now rivaling musculoskeletal problems as the leading cause of work-related disability. Consequently, assessing the impact of stressful work environments has become an increasingly important research activity. There are a number of instruments for measuring work stressors, and two of the most widely used include Karasek’s job strain model (Karasek, 1998) and Siegrist’s effort reward imbalance (ERI) model (Siegrist, 1996). In nursing research, the Nurse Work Index (NWI-R) has been used as a nurse-specific measure of the work environment (Aiken and Patrician, 2000). Non-work exposures, including life situations and parental role demands, have also been shown to be important factors, both on their own and in conjunction with work, possibly due to the juggling of multiple roles that can develop (Cohen et al, 1983; Luecken et al., 1997). However, one of the remaining challenges in directly linking work or life stressors to health problems is the paucity of biological evidence for a causal pathway. Recent animal research examining cortisol as a potential biomarker for stress is starting to address this issue of causality. Evidence from human subjects, including some studies involving nurses, is also beginning to accumulate (Goldstein et al., 1999). This emerging evidence, coupled with recent field method developments, such as non-invasive sampling through saliva collection, has made it possible to consider large-scale epidemiologic studies that can better explore the causal pathway for stress (Kirschbaum and Hellhammer, 1994). However, some uncertainty remains regarding the best methods of sample collection and type of cortisol analysis.
Modified by: Sarah Dusky