Article| Volume 53, ISSUE 6, P291-299, November 2005

The consequences of job stress for nurses’ health: Time for a check-up

      The processes and outcomes of nurses’ work are described extensively in studies about patient care, nursing education and training, job satisfaction, health care quality and management, and organizational behavior. These studies evaluate the relationship between nurses’ behavior and organizational health (ie, productivity) or between nurses’ behavior and patient health (ie, medical error). Fewer studies probe the association between the nature of nursing work and the status of nurses’ health despite the logical connection between how well nurses feel and how well they perform, or even, whether they discontinue working altogether for health reasons. Yet, for many nurses working in today’s health care environment, work is a stressful part of their lives. This article explores the connections between stressful work and nurses’ health, especially given the restructuring of their work in the current health care system. The working conditions that give rise to stress and the potential health consequences from it are well described in the general stress literature and summarized herein. Moreover, studies about nurses’ work and nurses’ health are discussed in light of the limitations for connecting job stress to job changes or health outcomes over time. Current approaches for dealing with nurses’ stress, such as the attraction to “Magnetism”, may inadvertently impede progress in this area. Recommendations for the future are included.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nursing Outlook
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cannon W.B.
        The inter-relationships of emotions as suggested by recent physiological researcher.
        Am J Psychol. 1914; 25: 256-282
        • Selye H.
        The stress in health and disease. Butterworth, Boston (MA)1976
        • Seligman M.
        Helplessness—on depression, development and death. Freeman Press, San Francisco (CA)1975
        • Lazarus R.
        • Folkman S.
        Stress. Springer, New York1984
        • Karasek R.
        • Theorell T.
        Health work. Basic Books, New York1990
      1. Sauter S. Murphy L. Organizational risk factors for job stress. American Psychological Association, 1995
        • National Research Council
        Record linkage techniques—1997. National Academy Press, 1997
      2. Schnall P. Belkci K. Landbergis P. The workplace and cardiovascular disease. State of the art reviews. 15. Hanley and Belfus, Philadelphia2000: 1
        • deJonge J.
        • van Breukelen G.
        • Landerweerd J.
        • Nijhouis F.
        Comparing group and individual level assessments of job characteristics in testing the job demand-control model.
        Hum Relat. 1999; 52: 95-122
        • Peterson C.
        Stress at work. Baywood, New York1999
        • Karesek R.
        • Schwartz J.
        • Pieper C.
        A job characteristics scoring system for occupational analysis. Center for Social Science at Columbia University, Pre-print series, New York1982
        • Siegrist J.
        Social variations in health expectancy in europe. 2004 (Final Programme Report, Available at:
        • Kasl K.
        An epidemiological perspective on the role of control in health.
        in: Sauter S.L. Hurell J. Cooper C. Job control and worker health. Wiley, London1989: 161-189
        • Marmot M.
        • Theorell T.
        Social class and cardiovascular disease.
        in: Johansson G. Johnson J. The psychosocial work environment. Baywood, New York1991
        • Johansson G.
        Job demands and stress reactions in repetitive and uneventful monotony at work.
        in: Johnson J. Johansson G. The psychosocial work environment. Baywood, New York1991
        • Frankenhauser M.
        A biopsychosocial approach to work life issues.
        in: Johnson J. Johansson G. The psychosocial work environment. Baywood, New York1991
        • Johansson G.
        • Aronsson G.
        • Lindstrom B.
        Social psychological and neuroendocrine stress reactions in highly mechanized work.
        Ergonomics. 1978; 21: 583-599
        • Sluiter J.
        • Frings-Dresen M.
        • Meijman T.
        • van der Beek A.
        Reactivity and recovery from different types of work measured by catecholamines and cortisol.
        Occup Environ Med. 2000; 57: 298-315
      3. Seplaki C, Goldman N, Weinstein M, Lin Y-H. How are biomarkers related to physical and mental well-being? Working paper No. 2003-04. Princeton (NJ): Office of Population Research, Princeton University.

      4. Schnall P. Belkci K. Landbergis P. Baker D. The workplace and cardiovascular disease. State of the art reviews. 15. Hanley and Belfus, Philadelphia2000: 1
      5. Johnson J. Johannson G. The psychosocial work environment Work organization, democratization and health. Baywood, New York1991
        • Bernard B.P.
        Musculoskeletal disorders (MSDs) and workplace factors.
        National Institute for Occupational Safety and Health, Centers for Disease Control. Public Health Service, Cincinnati1997 (Available at:
        • Van der Doef M.
        • Maes S.
        The job demand-control (-support) model and psychological well-being.
        Work Stress. 1999; 13: 87-114
        • Schrues P.
        • Taris T.
        Construct validity of the demand-control model.
        Work Stress. 1998; 12: 66-84
        • Fox M.L.
        • Dwyer D.J.
        • et al.
        Effects of stressful job demands and control on physiological and attitudinal outcomes in a hospital setting.
        Acad Manag J. 1993; 36: 289-318
        • Landbergis P.
        Occupational stress among health care workers.
        J Organ Behav. 1988; 9: 217-239
        • McNeely E.
        In the shadow of the organization: work and well-being on the front line: a comparative analysis of the psychosocial milieu of work in hospitals and its effect on employee health [dissertation]. Brandeis University, Waltham (MA)1995
        • Wharton A.S.
        • Erickson R.J.
        The consequences of caring.
        Sociol Q. 1995; 36: 273-296
        • Hall E.
        Double exposure.
        Int J Health Serv. 1992; 22: 239-258
        • Hochschild A.
        • Machung A.
        The second shift. Viking, New York1989
        • Bliese P.
        • Castro C.
        Role clarity, work overload and organizational support.
        Work Stress. 2000; 14: 65-73
        • House J.
        • Landis K.
        • Umberson D.
        Social relationships and health.
        in: Conrad P. Kern R. The sociology of health and illness critical perspectives. St. Martin’s Press, New York1990: 85-94
        • National Institute for Occupational Safety and Health
        The changing organization of work and the safety and health of working people. NIOSH, Cincinnati, OH2002 (Pub. No. 2002-116.)
        • Johnson J.
        Social support and job strain.
        in: Johnson J. Johannson G. Psychosocial work environment work organization, democratization and health. Baywood Publishing, Amityville (NY)1991
        • Constable J.F.
        • Russell D.W.
        The effect of social support and the work environment upon burnout among nurses.
        J Human Stress. 1986; 12: 20-26
        • Colditz G.A.
        • Manson J.E.
        • Hankinson S.E.
        The nurses’ health study.
        J Womens Health. 1997; 6: 49-62
        • Michael Y.
        • Colditz G.A.
        • Coakley E.
        • Kawachi I.
        Health behaviors, social networks, and healthy aging.
        Qual Life Res. 1999; 8: 711-722
        • Peipins L.
        • Burnett C.
        • Alterman T.
        • Lalich N.
        Mortality pattern among nurses. American Public Health Association, Washington (DC)1995 (American Public Health Association 123rd Annual Meeting and Exhibition, San Diego, California, Oct. 29-Nov. 2, 1995. Oct:47.)
        • Lie J.-A.S.
        • Kjaerheim K.
        Cancer risk among female nurses.
        Eur J Cancer Prev. 2003; 12: 517-526
        • Simon M.
        • Kummerling A.
        • Hasselhorn H.M.
        • Next Study Group
        Work-home conflict in the European nursing profession.
        Int J Occupat Environ Health. 2004; 10: 384-391
        • Clarke S.
        • Rockett J.
        • Sloane D.
        • Aiken L.
        Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses.
        Am J Infect Control. 2002; 30: 207-216
        • Karas B.
        • Conrad K.
        Back injury prevention Interventions in the workplace.
        AAOHN. 1996; 44: 189-196
        • Hignett S.
        Work-related back pain in nurses.
        J Adv Nurs. 1996; 23: 1238-1246
        • Bongers P.M.
        • de Winter C.R.
        • Kompier M.A.J.
        • Hildebrandt V.H.
        Psychosocial factors at work and musculoskeletal disease.
        Scand J Work Environ Health. 1993; 19: 297-312
        • Bureau of Labor Statistics
        Work-related injury and illness statistics by occupation. 1990-2003 (Available at:
        • Bureau of Labor Statistics
        Work-related injury and illness statistics by industry. 1990-2003 (Available at:
        • Ruser J.
        The changing composition of lost work-day injuries.
        Mon Labor Rev. 1999; (June): 7-11
        • Boden L.
        • Ruser J.
        Workers compensation “reforms”, choice of medical care provide and reported workplace injuries.
        Rev Econ Stat. 2003; 85: 923-929
        • Needlman J.
        McNeely, Kovner, Minnick.
        Hospital Nurses’ Working Conditions and Patient Outcomes, 2001-2005. City (state) Agency for Health Care Research and Quality, 2005 (RO1 #RO1 HS11988)
        • Bureau of Labor Statistics
        BLS NEWS. 2004 (Dec.14)
        • Brosche T.A.
        Death, dying and the ICU nurse.
        Dimens Crit Care Nurs. 2003; 22: 173-179
        • McNeely S.
        Stress and coping strategies in nurses from palliative, psychiatric and general nursing areas.
        Health Manpow Manage. 1996; 22 (3): 10-12
        • Kobasa S.
        • Maddi S.
        • Kahn S.
        Hardiness and health.
        J Pers Soc Psychol. 1982; 42: 168-177
        • Leichter H.
        “Evil habits” and “personal choices”.
        Milbank Q. 2003; 81: 603-627
        • Kerr M.S.
        • Frank J.
        • Shannon H.
        • Norman R.
        • Wells R.
        • Neumann P.
        Biomechanical and psychosocial risk factors for low back pain at work.
        Am J Public Health. 2001; 91: 1069-1075
        • O’Brien-Pallas L.
        • Shamian J.
        • Thomson D.
        • Alksnis C.
        • Koehoorn M.
        • Kerr M.
        • et al.
        Work-related disability in Canadian nurses.
        J Nurs Scholarsh. 2004; 36: 352-357
        • Hemingway
        • Carla Smith
        Organizational climate and occupational stressors as predictors of withdrawal behaviors and injuries in nurses.
        J Occup Organ Psychol. 1999; 72: 285-299
        • Hall E.
        Gender, work control, and stress.
        in: Johnson J. Johansson G. The psychosocial work environment work organization, democratization and health. Baywood Publishing, New York1991
        • Aiken L.
        Improving patient safety: the link between nursing and quality of care. Research in Profile. Robert Wood Johnson Foundation, Princeton (NJ)2005 (February Issue 12.)
        • Sochalski J.
        “Is more better?.
        Med Care. 2004; 42: II-67-II-73
        • Needleman J.
        • Buerhaus P.
        • Mattke S.
        • Stewart M.
        • Zelevinsky K.
        Nurse-staffing levels and the quality of care in hospitals.
        N Engl J Med. 2002; 346: 1715-1722
        • Woodward C.A.
        • Shannon H.S.
        • et al.
        The impact of re-engineering and other cost reduction strategies on the staff of a large teaching hospital.
        Med Care. 1999; 37: 556-569
        • Norrish B.R.
        • Rundall T.G.
        Hospital restructuring and the work of registered nurses.
        Milbank Q. 2001; 79: 55-79
        • Brannon R.
        Intensifying care, the hospital industry, professionalism, and the reorganization of the nursing labor process. Baywood Publishing, New York1996
        • Cheng Y.
        • Kawachi I.
        • Coakly E.
        • Schwartz J.
        • Colditz G.
        Association between psychosocial work characteristics and health functioning in American women.
        BMJ. 2000; 320: 1432-1436
        • McClure M.
        • Poulin M.
        • Sovie M.
        • Wandelt M.
        Magnet hospitals. American Nurses Association, Kansas City (MO)1983
        • Aiken L.
        • Patrician P.
        Measuring organizational traits of hospitals.
        Nurs Res. 2000; 49: 146-153
        • McClure M.
        • Hinshaw A.
        Magnet hospitals revisited. American Academy of Nurses, Kansas City (MO)2002
        • McNeely E.
        In the shadow of the organization—work and well-being on the front-line. Brandeis Univeristy, Heller School of Social Policy, Waltham (MA)1995
        • Needleman J.
        • McNeely E.
        • Kovner C.
        • Minnick A.
        Preliminary unpublished findings of the Nursing Working Conditions Project. Funder Agency for Health Care Research and Policy, 2005
      6. Keefe S. Magnet not attractive to all. Available at: New England. Jan. 17, 2005.

        • Division of Nurses, Bureau of Health Professions, Health Resources and Service Administration
        National Sample of Registered Nurses.
        Preliminary findings. US Department of Health and Human Services, Rockville (MD)2000 (March)


      Eileen McNeely is Director for the Training Program in Occupational Health Services, Research and Policy, in the Department of Environmental Health, Occupational Health Program, Harvard University School of Public Health, Boston, MA.