Stress and cortisol as predictors of fatigue in medical/surgical nurses and nurse leaders: A biobehavioral approach

Abstract

Objective: High acuity and long work hours are significant contributors to nurses’ stress. Studies evaluating consecutive workdays with the use of biobehavioral methods are limited in the US. The aim of this study was to assess changes in and the relationship between stress, fatigue, and cortisol.Methods: In an observational within-subject design, we studied stress, fatigue and cortisol before and after 2 consecutive 12-hour day shifts in an acute care setting. Specifically, the study was designed to: (1) assess the effect of stress on fatigue; (2) examine the effect of stress on cortisol; (3) compare the levels of stress, fatigue, and cortisol; and (4) compare the responses of stress, fatigue, and cortisol between acute care, day shift staff nurses and nurse leaders.Results: Stress, fatigue, and cortisol increased significantly from baseline to Day 2 (p = .001, .004, and .010, respectively; paired t-test). In a comparison of nurses and nurse leaders, stress and fatigue at baseline were significantly higher in acute care nurses than in nurse leaders (p ≥ .00 and .05, respectively; independent t-test). At the end of 2 consecutive shifts, cortisol was significantly higher in staff nurses than in nurse leaders (p = .001).Conclusions: Competing initiatives pressure nurse leaders to work long hours to support organizational goals, sometimes at the expense of a healthy work environment. Nurses from direct care staff to executives should be educated in and demonstrate best practices in relation to endorsements from the American Nurses Association on fatigue and interventions to lessen the risks to patient safety.

<p>Salivary Cortisol, Subjective Stress and Quality of Sleep Among Female Healthcare Professionals</p>

“…For example, night shift workers may need 3-4 days to adjust their circadian rhythms of cortisol secretions. 48,49 All nurses, from clinical staff to executives, should also be trained to identify those with impaired stress coping and adopt interventions to reduce the risks to patient safety. 49 Policy makers and workplace managers must consider shift patterns in the UAE healthcare system.…”

“…48,49 All nurses, from clinical staff to executives, should also be trained to identify those with impaired stress coping and adopt interventions to reduce the risks to patient safety. 49 Policy makers and workplace managers must consider shift patterns in the UAE healthcare system. This will contribute to higher professional and personal satisfaction, as well as to an enhanced sense of achievement, and alleviate burnout syndrome.…”

Consecutive Shifts: A Repeated Measure Study to Evaluate Stress, Biomarkers, Social Support, and Fatigue in Medical/Surgical Nurses

“…Among the results, nurses walked less during the third consecutive night shift and sat more during the second and third consecutive night shifts compared to day shift nurses. Stress, fatigue, and cortisol levels increased significantly from baseline to day 2 in this study [20]. The current study was interested in whether stress and fatigue increased over consecutive shifts.…”

“…The sample size was computed a priori using a G*Power 3.1 [34] for paired t-tests considering a small effect size (Cohen's d = 0.34). These values were estimated based on findings reported in a pilot study [20]. At α = 0.05 and Cohen's d = 0.34, a paired t-test will have 80% power using a sample size of 71 [34].…”