Discussion
The results indicated that nurses in Ugandan hospitals experience moderate levels of occupational stress. In the present study, the older age groups, 40–49 and 50 years and above, and nurses with more than 20 years of experience reported the highest stress scores. These results contradicted previous studies in the United States in which young public health nurses and those with less experience perceived more occupational stress than older nurses (Kirkcaldy & Martin 2000). Bachelor of Science in Nursing (BSN) or higher educational levels reported higher perceived stress, which is in agreement with previous research (Lee & Wang 2002). It is not clear why nurses with higher education and more experience perceived more stress, but one possible explanation could be role conflict and role ambiguity. It has been reported that organizational and management attributes of work environments and institutional set- tings influence work-related stress among nurses (Sve- insdottir et al. 2006). In Uganda, nurses with BSN or masters degrees have no clear roles in the public hospitals and have no scheme of service in the Public Service. Role conflict and role ambiguity may contribute to stress for these nurses. However, as the current study did not explore organizational factors related to occupational stress, there is a need for further research to identify sources of stress for nurses with higher educational qualifications in Uganda. With regards to job satisfaction, nurses with lower educational qualifications (Enrolled Nurses and Enrolled Midwives) reported the highest levels of job satisfaction whereas those with higher education qualifications (RN, BSN and higher) reported the lowest
levels of job satisfaction. Nursing experience also influenced job satisfaction with less experienced nurses reporting higher levels of job satisfaction than those with more experience. It is not clear why those with a higher education level and more experienced nurses in the present study reported less satisfaction in their jobs. These results indicate a pattern which may be unique to the Ugandan situation. It can be argued that older nurses in Uganda may report more job stress because of social responsibilities such as caring for family members and a probable lack of social support. Nurses with less experience are usually younger and have less responsibility, especially in the social context of Uganda. The older, more experienced nurses may have larger families to care for, with the associated stress of those responsibilities and the possible perception that work could be interfering with their family lives (Patel et al. 2008). The number of children or the size of the family has financial implications for the nurse in the Ugandan social structure. In Uganda, employed family members are expected to provide financial support for their immediate and extended family members. Furthermore, higher levels of job satisfaction and job performance were found in nurses with no children than in nurses who had children. These results demonstrate the influence of family size in relation to job stress, job satisfaction and job performance for nurses in Uganda. In the present study, the lower job satisfaction found among experienced nurses may also be as a result of the fact that nurses who have worked for more than 10 years are often seeking promotion or advanced opportunities. These nurses could also be interested in becoming involved in decision and policy making at their workplace or receiving recognition for good work. This was observed in a recent study on satisfaction and intention to stay among current health workers in Uganda by the Ministry of Health (Ministry of Health 2007). Previous literature has demonstrated that nurses are likely to report low job satisfaction if they do not receive promotion and advancement opportunities (Lephalala et al. 2008). Results of the present study indicated a significant difference in job performance means by type of hospital. Furthermore, the public hospital had the lowest mean score for job performance among the four hospitals and there was a significant difference in means for the different hospitals. These results concur with a study done in Thailand where nurses in the public hospitals had more stress than those in private hospitals (Tyson & Pongruengphant 2004). Although no study comparing the public and private hospitals has been conducted
Discussion
The results indicated that nurses in Ugandan hospitals experience moderate levels of occupational stress. In the present study, the older age groups, 40–49 and 50 years and above, and nurses with more than 20 years of experience reported the highest stress scores. These results contradicted previous studies in the United States in which young public health nurses and those with less experience perceived more occupational stress than older nurses (Kirkcaldy & Martin 2000). Bachelor of Science in Nursing (BSN) or higher educational levels reported higher perceived stress, which is in agreement with previous research (Lee & Wang 2002). It is not clear why nurses with higher education and more experience perceived more stress, but one possible explanation could be role conflict and role ambiguity. It has been reported that organizational and management attributes of work environments and institutional set- tings influence work-related stress among nurses (Sve- insdottir et al. 2006). In Uganda, nurses with BSN or masters degrees have no clear roles in the public hospitals and have no scheme of service in the Public Service. Role conflict and role ambiguity may contribute to stress for these nurses. However, as the current study did not explore organizational factors related to occupational stress, there is a need for further research to identify sources of stress for nurses with higher educational qualifications in Uganda. With regards to job satisfaction, nurses with lower educational qualifications (Enrolled Nurses and Enrolled Midwives) reported the highest levels of job satisfaction whereas those with higher education qualifications (RN, BSN and higher) reported the lowest
levels of job satisfaction. Nursing experience also influenced job satisfaction with less experienced nurses reporting higher levels of job satisfaction than those with more experience. It is not clear why those with a higher education level and more experienced nurses in the present study reported less satisfaction in their jobs. These results indicate a pattern which may be unique to the Ugandan situation. It can be argued that older nurses in Uganda may report more job stress because of social responsibilities such as caring for family members and a probable lack of social support. Nurses with less experience are usually younger and have less responsibility, especially in the social context of Uganda. The older, more experienced nurses may have larger families to care for, with the associated stress of those responsibilities and the possible perception that work could be interfering with their family lives (Patel et al. 2008). The number of children or the size of the family has financial implications for the nurse in the Ugandan social structure. In Uganda, employed family members are expected to provide financial support for their immediate and extended family members. Furthermore, higher levels of job satisfaction and job performance were found in nurses with no children than in nurses who had children. These results demonstrate the influence of family size in relation to job stress, job satisfaction and job performance for nurses in Uganda. In the present study, the lower job satisfaction found among experienced nurses may also be as a result of the fact that nurses who have worked for more than 10 years are often seeking promotion or advanced opportunities. These nurses could also be interested in becoming involved in decision and policy making at their workplace or receiving recognition for good work. This was observed in a recent study on satisfaction and intention to stay among current health workers in Uganda by the Ministry of Health (Ministry of Health 2007). Previous literature has demonstrated that nurses are likely to report low job satisfaction if they do not receive promotion and advancement opportunities (Lephalala et al. 2008). Results of the present study indicated a significant difference in job performance means by type of hospital. Furthermore, the public hospital had the lowest mean score for job performance among the four hospitals and there was a significant difference in means for the different hospitals. These results concur with a study done in Thailand where nurses in the public hospitals had more stress than those in private hospitals (Tyson & Pongruengphant 2004). Although no study comparing the public and private hospitals has been conducted
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