Learning Nurse Newsletter - September 2011

Welcome to the September 2011 edition of the Learning Nurse Newsletter. We have enhanced and expanded our newsletters and now post all editions on this website. We publish three to four times a year to keep nurses, nursing student, nursing educators and other interested parties informed about developments and news at LearningNurse.com. (For more timely updates, follow us on Twitter.)

A stressed-out nurse.What Causes Nurses Stress at Work 

Nursing is a stress-laden profession. You often have to make quick decisions, and if you are wrong, dire consequences - including death - can be the result! You are frequently dealing with challenging and demanding "clients" - in pain, disoriented, confused, emotional and short on patience! Typically you are working in an environment where there is a shortage of staff and all the patients want your attention at the same time!

How well are nurses coping with all these stresses found at their work place? To find out, we analyzed the results of our Work Stress Profile that is located on this Learning Nurse website. This Profile measures the degree of stress faced by nurses on six factors:

1.  Job characteristics – This component measures the degree of stress related to general job characteristics such as work satisfaction, job and employer demands, and problems / tension at work.

2.  Pay and benefits – This measures stress related to compensation and benefits. It includes inadequate pay, poor promotional opportunities, little time off, etc.

3.  Work schedule – This component measures stress related to how your work is scheduled and organized. It includes shift work, long hours, required overtime, etc.

4.  Teamwork – This component measures stress related to working together as a group or team. This includes poor communication, tension and conflict, no co-operation, and unwillingness to help each other.

5.  Supervisors – This measures the degree to which your supervisors cause your stress. Your stress can be increased by supervisors who are rigid, non-supportive and don't listen or appreciate your contributions.

6.  Productivity – This component measures stress related to any personal problems, issues or commitments that may interfere with you being able to do your job.

To ensure that the work stress results were applicable to the nursing profession, we only used data where the test takers clearly self-identified themselves as a nurse. We also removed records for nursing students, nursing assistants and nursing educators as these numbers were too small to be reliable. The findings reported in this article are therefore based on the responses of 40 Practical Nurses and 51 Registered Nurses (n = 91). In this sample were 7 male nurses, a range of work experience from less than 5 years to more than 26 years, and the respondents worked in hospitals, clinics, continuing and home care and other nursing locations.

Figure 1 shows the average stress scores for the total sample of nurses. Each score was converted to a percent so that the maximum score is 100% and the minimum is 0%. The higher the stress scores are the higher the stress level.

Figure 1: Average Stress Factors Scores

Overall, for this group of nurses, the work stress factors are low to moderate. With an average total stress score of 39 (out of a maximum of 100%), our nurses appear to be coping relatively well. The highest sources work stress is teamwork (more likely the lack of it) followed by job characteristics (work satisfaction, employer and patients demands). The lowest cause of stress is personal productivity (personal problems, issues and time commitments).

Figure 2: Average Stress Factors Scores by Nurse Type

Figure 2 shows the differences in the sources of work stress for Practical Nurses (PN) compared to Registered Nurses (RN). Teamwork, supervisors and pay / benefits are greater sources of stress for Practical Nurses than for RNs. RNs experience more work stress when it comes to work scheduling.

Figure 3 below shows the sources of work stress for nurses working in a hospital setting versus a non-hospital environment. Nurses working in a hospital say that teamwork and productivity are greater sources of stress. Pay and supervisors appear to be more common stressors for those working in clinics, continuing care and home care.

Figure 3: Average Stress Factors Scores by Work Location


Figure 4: Average Stress Factors Scores by Years of Work Experience

Finally, in Figure 4 we compare the stress factors perceived by nurses working 5 years or less versus those nurses who have been working for more than 20 years. The younger nurses see teamwork, work scheduling and personal productivity as greater sources of stress than do the more experienced nurses.

The top ten individual stressors identified in this study were (from highest to lowest):

  • It is hard to receive a promotion. (Q2)
  • My job is demanding and creates tension. (Q35)
  • Angry or tense relationships exist at work. (Q26)
  • Conflict among co-workers causes a poor work environment. (Q33)
  • Clients / patients are becoming more difficult and demanding. (Q30)
  • Some things about my job are a problem. (Q18)
  • Communications with some of my co-workers is a problem. (Q4)
  • My supervisor does not make constructive suggestions on how I can do things more effectively. (Q41)
  • My supervisor does not let me know when I am doing a good job. (Q27)
  • There is not enough staff to adequately do the required work.( Q21)

Factors that caused the least stress among our nurses were (starting with least):

  • I know in advance what hours I will work. (Q40)
  • Personal commitments interfere with my work performance. (Q16)
  • I'm satisfied with my career choice. (Q10)
  • I lose time at work because of personal or family problems. (Q6)
  • Employer policy on payment of wages creates problems. (Q8)
  • I get support and assistance from my co-workers. (Q9)
  • I have health issues that keep me away from work. (Q39)
  • I am interested in, and happy with, my job. (Q25)
  • Everyone pitches in when a job needs to get done. (Q23)
  • I am able to complete my work before I go home for the day. (Q44)

The usual cautions apply to this research study. The sample size is relative small and it is unknown whether the respondents are representative of the larger population of nurses. However, the findings do provide some clues as to the levels and causes of work stress for the profession of nursing.

How do you compare? Take the anonymous Work Stress Profile at LearningNurse.com and compare your results to the ones published here. (This will also give us more data to analyze). Then work on the skills and attitudes needed to effectively reduce stress at your workplace. You will be glad you did as your nursing work will be more enjoyable.


Learning Nurse Users

Analyzing the Learning Nurse website statistics from January to August 31, 2011 shows the following

  • 47,400 unique visitors (IPs), growing every month
  • 80,000 visits with 1.34 million page views and 136 GB of traffic
  • 24 hour traffic (many from night shifts)
  • 23% spent 15 minutes or more per visit (6,800 visits were 15 to 30 minutes, 6,700 visits were 30 minutes to 1 hour, and 4,800 visits were over an hour long!).

The geographical locations of Learning Nurse visitors was as follows:

  • 53% from the United States -with the highest traffic from California (11% of all US traffic), New York (10%), Pennsylvania (7%), Minnesota (7%), Texas (6%), Florida (4%), Kentucky (4%), Maryland (4%), Georgia (3%), New Jersey (3%), Ohio (3%), Washington (3%), Indiana (3%), Illinois (2%) and North Carolina (2%)
  • 13% from the United Kingdom (Great Britain)
  • 10% from Canada - all 10 provinces with the highest traffic from British Columbia (29% of all Canadian traffic), Ontario (21%), Manitoba (16%), Saskatchewan (15%) and Alberta (14%)
  • 7% from Australia with the highest traffic from Victoria (37% of total Australian traffic), New South Wales (35%), Queensland (15%) and Western Australia (6%)
  • 3% from Malaysia, 3% from New Zealand, 2% from Philippines and 2% from India
  • 7% from 18 other countries - China, Columbia, Cypress, Ireland, Jamaica, Japan, Korea, Pakistan, Saudi Arabia, Ukraine, etc.  

The above traffic analysis was done only on those visitors that viewed 500 pages or more. It is likely that people from many more countries visited the site, but we were only interested in the regular and heavy users of the Learning Nurse resources. 

The Learning Nurse website has a loyal following with a high rate of repeat visits. This is demonstrated by:

  • Some 82% of visitors come directly from a bookmark or URL entry
  • 14% come to the website from a search engine - Google, Yahoo and Bing; "nursing quizzes" is the most common search term with Learning Nurse being listed at the top of these search engines
  • Only 4% of traffic comes from links on other websites
  • Over 133% of visitors bookmark the website.

Despite the fact that our visitors are increasing every month, we are still a long way away from reaching the approximately 5 million English speaking nurses on this planet.

New and Improved

Since the March 2011 Newsletter, we have made several additions and changes to the Learning Nurse website. These include:

  • Our avatar-based Nasal and Sinus Problems simulation won an honorable mention at the 2010 Articulate Guru Awards.
  • Created a new category of quizzes - Nursing Care of Older Persons - and added six new quizzes: Person-Centered Care, Hearing and Vision Loss, Mobility and Falls, Pain Management Sleep in Older People and End-of-Life Care.
  • Added Professional Practice quiz
  • Added Spiritual and Cultural Assessment quiz
  • Added Perinatal Depression quiz.

We also added our first fully narrated quiz - Right Drug Quiz II. This quiz is designed to let nurses see and hear the names of commonly confused drugs. Our initial experience with this narrated quiz is that it takes a lot more work (and money) to create, the quiz files are significantly larger in size (affecting download speeds) and most users are not listening to the full narration anyway.  Therefore, at this time we are not sure whether to continue to add more narrated quizzes or not.

Our initial purpose behind our interactive quizzes was to provide an informal and convenient learning resource for nurses to self-assess and refresh their knowledge. We deliberately made the quizzes anonymous so that nurses could feel safe in doing them without fear that their supervisors, employers or regulatory bodies would have access to their results.

However, it appears that more nurses are using our quizzes for professional development and are wanting evidence that they have successfully completed them. Our current quiz software cannot easily provide a Certificate of Completion or a printout of the quiz results. Therefore we are looking at transferring the quizzes to another software program that can. However, this means redoing 100 plus quizzes with 7,500 questions! This will require a huge investment in effort, time and money on our part.

Quiz Results

We now have 112 nursing quizzes with 7,700 questions! However, from our poll at our Test and Quiz Center, nurses say they want even more quizzes.

As of this writing, some 95,000 Learning Nurse quizzes (with over 2.43 million questions) have been done and recorded. Between 200 to 300 quizzes are now completed every 24 hours! The quiz results are tracked on the website in real time, both in a searchable query table, and in a series of statistical reports for each quiz.

The 15 most popular quizzes are: (N)

  • Anatomy Terminology I (7,154)
  • Medical Terminology I (3,959)
  • Disease Terminology I (3,746)
  • Anatomy Terminology II (3,243)
  • Anatomy and Physiology (2,906)
  • Safe Medication Principles (2,857)
  • High Blood Pressure (2,385)
  • Cardiology Terms (2,222)
  • Cardiovascular System (2,173)
  • Endocrine System (2,151)
  • Medication Abbreviations (1,953)
  • Pediatric Nursing I (1,937)
  • Urinary System (1,913)
  • Disease Terminology II (1,908)
  • Infection Prevention and Control (1,860).

The ten least completed quizzes are: (N)

  • Perinatal Depression (20)
  • End-of-Life Care (21)
  • Suicide Prevention (23)
  • Sleep (27)
  • Herb-drug Interactions (28)
  • Spiritual / Cultural Assessment (45)
  • Rectal Disorders (51)
  • Limb Pain (52)
  • Hearing and Vision Loss (53)
  • Dangerous Drug Combinations (88).

It should be noted that many of the quizzes in the "least completed list" were only added recently. The complete list of the Learning Nurse quiz results sorted by descending frequency can be seen here.

Average scores are computed for all of the completed Learning Nurse quizzes. The 15 highest scoring quizzes are: (average percent)

  • Medication Abbreviations (93%)
  • Tablet Dosage Calculations (88%)
  • Injection Dosage Calculations (88%)
  • Fluid Dosage Calculations (88%)
  • Managing Patient Rage (86%)
  • Intravenous Flow Rates (86%)
  • Cardiology Terms (82%)
  • Metric Conversion (80%)
  • Anatomy Terminology II (77%)
  • Antidotes (76%)
  • Anatomy Terminology I (74%)
  • Disease Terminology I (74%)
  • Disease Terminology II (74%)
  • Fatigue (74%).

The ten quizzes with the lowest average scores were:

  • Cancer Risks (36%)
  • Dangerous Drug Combinations (41%)
  • Diarrhea (46%)
  • Nutritional Disorders (47%)
  • Diagnostic Tests I (47%)
  • Substance Misuse (49%)
  • Mental Status (50%)
  • Skin Disorders (50%)
  • Diagnostic Tests II (50%)
  • Herb-Drug Interactions (52%).

The completed list of the Learning Nurse quiz results sorted by descending average scores is available here.

Conferences and Research Papers

I did two workshops - Use of Interactive Quizzes for Professional Development and Use of Avatars in Nursing Education Simulations - at the Canadian Association of Continuing Health Education (CACHE) / National Continuing Competence Conference (NCCC) in Banff Canada, on April 13-15, 2011. Copies of these two presentations are available for viewing and downloading in our Library.

We recently completed a literature review of the research related to effectiveness of online and distance education. You can get a copy of this paper that contains a summary of the research findings and references in our Library section under Research Reports.


About Learning Nurse

The Learning Nurse Resource Network (LearningNurse.com) was created by Steppingstones Partnership, Inc. and went online in April 2008. The purpose of this nursing professional development resource is to make available free, informal, accessible and convenient learning opportunities for nurses. Because of the shortage of nurses in many facilities, it is very difficult to get away for traditional courses and workshops. This is particularly true in smaller and rural areas where it nearly impossible to obtain leave and funding to attend professional development events.

Although the Learning Nurse was originally designed for all levels of practicing nurses, it has become popular with nursing students, graduate students and nurses returning from leaves. Many of the visiting nurses take time during breaks in their night shift to review and refresh their nursing knowledge and skills using our quizzes and e-learning modules.

That's it for now. If you have any questions, comments or suggestions, please let me know. Thanks for your continuing interest and support.

Best regards,

Russ Sawchuk
Webmaster and Editor

Note: Permission is granted to reprint all or part of the information in this newsletter provided that the source - LearningNurse.com - is credited.


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