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Job stressors and social support behaviors: Comparing intensive Care Units to
wards in Jordan

Article  in  Contemporary nurse: a journal for the Australian nursing profession · February 2009
DOI: 10.5172/conu.673.31.2.163 · Source: PubMed

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Job stressors and social support

behaviors: Comparing intensive
care units to wards in Jordan
ABSTRACT Studies about nurses’ stressors and social support behaviors are limited.This
study explored differences between Intensive Care Units (ICUs) and wards in
regard to Jordanian nurses’ job stressors and social support behaviors as well as
predictors of the two concepts.
A quantitative research design using a survey method was used.The Nursing
Stress Scale (NSS) (Gray-Toft & Anderson 1981) and the Inventory of Social
Supportive Behaviors (ISSB) (Barrera, Sandler & Ramsay 1981) were used to
collect data from a convenience sample of 228 nurses who were working in 12
ICUs and 235 nurses who were working in nine wards of 13 hospitals, with a
total response rate of 66.2%.
Stressors in ICUs were higher than those in wards.The ICUs scored higher
Key Words than wards in ‘conflict with physicians’ subscale of NSS.The ICUs scored higher
job stressors; than wards in ‘emotional support’ and ‘tangible assistance’ subscales of ISSB.
social support Shift worked, model of nursing care, and level of education predicted nurses’ job
behaviors; stressors in ICUs and wards.‘Model of nursing care’ was a shared predictor of
nurses; ICUs;
wards; retention social support behaviors in ICUs and wards.
and recruit- High job stressors and low social support behaviors were evidenced in
ment; Jordan Jordan. Job stressors were higher in ICUs than those in wards, thus more social
support behaviors should be provided to nurses in ICUs.
Nurses’ stressors should be assessed and managed. In all settings in general
Received 29 July 2008
Accepted 4 March 2009
CN
and in ICUs in particular, nurse managers should use various social support
behaviors to buffer the influence of job stressors on nurses.

INTRODUCTION
urses in hospitals are more prone to

MAJD T MRAYYAN
Associate Professor
Dean, Faculty of Nursing
Hashemite University
Zarqa, Jordan
N experience job stressors than those in
other settings, which may apply for ICU nurses
when compared to ward nurses (Albar Marin &
Garcia-Ramirez 2005; Maslach, Shaufeli & Leit-
er 2000).

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CN Majd T Mrayyan
‘Social support’ is the social relationships and
transactions that help individuals to cope with
stressful situations (Hamaideh et al. 2008; Albar
Marin & Garcia-Ramirez 2005; Maslach et al.
2000).
In the current healthcare arena, nurses’ stres-
sors are prevalent, which mandate the use of
various social support behaviors to overcome
these stressors. Studies about nursing were usu-
ally non-comparative; they were conducted in a
single type of hospitals or settings (Pinikahana &
Happell 2004; Happell, Martin & Pinikahana
2003; Boyle et al. 1999; Bowler & Mallik 1998),
thus this study aimed at comparing ICUs to
wards.
In Jordan, this is the second study about nurs-
es’ stressors and social support behaviors (Ham-
aideh et al. 2008), and the first international
comparative study about the two concepts in
ICUs as compared to wards. Performing a com-
parative study between ICUs and wards was
determined by the recent changes in healthcare
systems that mandate that more nurses work
with patients who require intensive care. It is
important to assess nurses’ stressors in order to
have positive patient and organizational out-
comes. Nurse managers should develop social
support behaviors to decrease nurses’ stressors
at various clinical settings.
PURPOSE OF THE STUDY
The purpose of this study was to answer the fol-
lowing research questions:
1. What are the differences of sample’s demo-
graphics in ICUs as compared to wards?
2. What are the differences between ICUs and
wards in term of Jordanian nurses’ job stres-
sors?
3. What are the differences between ICUs and
wards in term of social support behaviors
provided to Jordanian nurses?
4. What are the predictors of Jordanian nurs-
es’ job stressors in ICUs?
5. What are the predictors of Jordanian nurs-
es’ job stressors in wards?
164 CN Volume 31, Issue 2, February 2009
6. What are the predictors of social support
behaviors in ICUs? and
7. What are the predictors of social support
behaviors in wards?
LITERATURE REVIEW
Research about nurses’ stressors has grown
in the last two decades; however, studies about
social support behaviors are recently evolved
(Albar Marin & Garcia-Ramirez 2005). Provid-
ing social support is an effective and compre-
hensive strategy to decrease nurses’ stressors
(Hamaideh et al. 2008). Social support differs
according to culture; however, there are some
common human aspects of social support pro-
vided to nurses.That is there are some similari-
ties in work environments such as the nature of
communication with physicians, the need for
work privileges and need for better staffing and
shortened and adaptive working hours, thus
some social support behaviors are generic and
may apply to nurses regardless to their cultures.
‘Critical Care Nursing’ can be loosely defined
as that specialty of nursing focused on the care
and treatments of critically ill patients.This gen-
erally encompasses nurses working in ICUs, in
Postanaesthetic Recovery Rooms, in Emergency
Departments, and in Renal Dialysis Unit (Wil-
liams et al. 2001). In Jordan, we used ‘Critical
Care Nursing’ to mean nurses who work in ‘Car-
diovascular Care Units (CCUs)’, while ICUs inc-
lude General ICU, Medical ICU, Surgical ICU,
Intermediate ICU, Neuro ICU, Neonatal ICU,
Emergency Room, Recovery Room, Delivery
Room, and Operating Room.
Worldwide, critical care nurses [intensive
care nurses] are vital part of critical care team.
These nurses contribute to improved patient
outcomes, reduced morbidity and mortality, re-
duced complications and errors, and reduced
overall costs (Robnett 2006). However, the
major challenge of this specialty is to ensure an
adequate supply of appropriately trained criti-
cal [intensive] care nurses and staff.
Williams et al. (2001) reported that critical
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Job stressors and social support behaviors: Comparing intensive care units to wards
care has been a specialty within nursing for
almost 50 years. This specialized practice has
established professional organizations in many
developed countries; however, this specialty is
recently emerged in many developing countries.
Common issues of intensive care nurses include
understaffing, stressful working conditions, scan-
ty educational programs, and insufficient wages.
In Jordan, ICUs are usually better staffed than
wards, but nurses in ICUs commonly suffer
high job-related stress and burnout and low
payments.
Requirements of ‘Intensive Care Nursing’
differ from one country to another. For exam-
ple, requirements of this sociality in the UK
are very clear such as ICU knowledge; that is
84% score are demonstrated by Basic Knowl-
edge Assessment Tool or valid certification or
demonstration of knowledge and competency,
successful completion of ACLS within 18 months
of employment and updated every two years
(University of Kentucky Chandler Medical Cen-
ter 2003). In Jordan, ICU nurses are specialized
by ‘experience’ rather than by ‘advanced and
specialized ICU education’. In developed coun-
tries, Intensive Care Nursing has very organized
professional associations (University of Ken-
tucky Chandler Medical Center 2003); howev-
er, this specialization does not have professional
organizations in many developing countries
such as Jordan.
ICUs versus wards
Work environments in ICUs are different than
those in wards, which could be related to many
factors such as the chronicity of patients’ dis-
eases, type of leadership behaviors, model of
nursing care, and technological advancements.
More acute and complicated cases are admitted
to ICUs, in turn more assertive but supportive
leadership styles are needed; these styles are
mandated because of the acute nature of patients’
conditions. At the same time, these assertive
leaders should help their staff to overcome ICU-
related stressors. Primary nursing care model
CN
and case management and advanced technology
are commonly used in ICUs; these models and
technology require more specialized nurses
(American Association of Critical-Care Nurses
2008). As a former ICU nurse, the current
researcher can attest that patients’ outcomes
are more positive and rewarding in ICUs; for
example there were many successful cardio-
pulmonary resuscitation (CPR) in the teaching
hospitals where the researcher was working,
which is also supported in some recent studies
(Schmalenberg & Kramer 2007; Robnett 2006).
Nurses in ICUs contribute to improved patients’
outcomes such as reduced morbidity and mor-
tality and complications (Robnett 2006). How-
ever, such outcomes will not suddenly occur;
foundations should be established such as ade-
quate staffing and supportive work environ-
ments (Schmalenberg & Kramer 2007).
In their paper ‘changing the work environ-
ment in ICUs to achieve patient-focused care,’
McCauley and Irwin (2006) reported that there
is a massive move toward patient-focused care.
In turn, healthy work environments are needed
with a focus on skilled communication and col-
laboration. Unhealthy work environments will
result in the occurrence of job stressors, which
mandates designing leadership and managerial
interventions to help nurses to overcome and
adapt to their job stressors; these interventions
include but are not limited to providing social
support behaviors.
Job stressors
Stress is unavoidable and inevitable. Severity and
symptoms of stress are dependent on individuals’
characteristics (Albar Marin & Garcia-Ramirez
2005; Stordeur, D’hoore & Vandenberghe 2001;
Demerouti et al. 2000; Maslach et al. 2000;
Smith et al. 2000). Although it may not be pre-
ventable, stress should be assessed and treated at
its early stages; this prevent the occurrence of
burnout (Albar Marin & Garcia-Ramirez 2005;
McGowan 2001; Shader et al. 2001; Maslach et
al. 2000; Healy & McKay 1999).
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CN Majd T Mrayyan
Work stressors are varied; they include con-
flict with physicians, inadequate preparation,
problems with peers, problems with supervisor,
discrimination, workload, uncertainty concern-
ing treatment, dealing with death and dying
patients and patients and their families, leader-
ship and management issues, professional con-
flict, mood disturbances, age and experience,
emotional demands of caring, lack of skills and
short years of experience, conflict with others
especially nurses and physicians, lack of clarity
about tasks and goals, low social support at
workplace, and the nursing shortage (McVicar
2003; Finlayson et al. 2002; McGowan 2001;
Payne 2001; Bratt et al. 2000; Brown & Edel-
mann 2000; Demerouti et al. 2000; French et al.
2000; Healy & McKay 2000). ‘Workload’ and
dealing with issues of ‘death and dying’ were the
most prevalent stressors among Jordanian nurs-
es (Hamaideh et al. 2008). The researchers re-
ported that shift worked, nurses’ educational
level, and model of nursing care were the best
predictors of Jordanian nurses’ stressors.
Studies about nurses’ job stressors and social
support behaviors in ICUs were very limited. A
marked exception was Tyler and Ellison (1994)
who reported that nurses’ coping with ‘death
and dying’ as a source of distress was ranked
more highly in ICUs as compared to medical-
surgical care units, and that nurses in theatres
ranked ‘emotional aspects’ of stressors lower
than nurses in units.
Social support behaviors
Social support behaviors are social and emo-
tional and cognitive transactions that prevent
the appearance of stressors and reduce their
consequences (Maslach et al. 2000; Albar Marin
& Garcia-Ramirez 2005). Sources of social sup-
port include supervisors (Bakker et al. 2000),
families and friends, and co-workers (Peeters &
Le Blanc 2001).
Jordanian nurses reported ‘emotional sup-
port’ as the most supportive social behavior that Instruments
they usually receive to overcome their job stres- The Nursing Stress Scale (NSS) was used to
166 CN Volume 31, Issue 2, February 2009
sors. Shift worked, model of the nursing care,
marital status, and unit’s organizational struc-
ture were the best predictors of social support
behaviors (Hamaideh et al. 2008).
METHODS
In 2006, a quantitative study was conducted to
compare nurses’ job stressors and social support
behaviors between ICUs and wards, and identify
predictors of the previous concepts in both set-
tings.
Sample and settings
A convenience sample of 463 nurses was rec-
ruited from 13 hospitals in Jordan; in which
there were 12 ICUs and nine wards. No
sampling criterion was setup except that the
nurses had to be working in hospital settings. Of
possible 700 participants, 228 nurses were
recruited from ICUs (out of 300 questionnaires;
response rate was 76%) and 235 nurses from
wards (out of 400 questionnaires; response rate
was 58.7%). Of those nurses, 139 nurses were
recruited (out of 200 questionnaires; response
rate was 69.5%) from governmental hospitals,
190 nurses (out of 250 questionnaires; response
rate was 76%) from educational hospitals, and
135 nurses (out of 250 questionnaires; response
rate was 54%) from private hospitals. A total
response rate of 66.2% was obtained.
Ethical measures
Permissions to conduct the study were obtained
from the university where the researcher is
currently working as well as from hospitals’ ad-
ministrators. Contacted through their nurse
managers, nurses were invited to participate in
the current study while assuring the voluntarily
nature of the participation. Nurses’ anonymity
and confidentiality of their information were
ensured; all questionnaires were numerically
coded, and the overall results only were shared
with nursing administrators.
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Job stressors and social support behaviors: Comparing intensive care units to wards
measure nurses’ job stressors (Gray-Toft &
Anderson 1981).This is a 34 item 4-point Lik-
ert scale with ranges from: 1 = never; 2 =
occasionally; 3 = frequently; and 4 = very fre-
quently. For the original total scale, a Cron-
bach’s alpha of .92 was reported, and in the
current study a Cronbach’s alpha of .90 was
obtained. In the current research, this scale has
the following subscales with their reported
Cronbach’s alphas: Death and Dying (.83); Con-
flict with Physician (.82); Inadequate Prepara-
tion (.84); Lack of Support (.84); Conflict with
Nurses (.82);Workload (.83); and Uncertainty
Concerning Treatments (.82). Any mean score
above 2 was considered as a nursing stressor.
The Inventory of Social Supportive Behaviors
(ISSB) was used to measure social support
behaviors (Barrera et al. 1981).This is a 40 item
5-point Likert scale with ranges from: 1= not at
all; 2= once or twice; 3= about once a week;
4= several times a week; and 5= about every
day. A high reliability as evidenced by high
Cronbach’s alphas of .92 to .94 for the original
scale, and in the current study a high Cron-
bach’s alpha of .93 was obtained. In the current
research, this scale has the following subscales
with their reported Cronbach’s alphas: Guid-
ance (.74); Emotional Support (.80); and Tangi-
ble Assistance (.90). Any mean score above 3
was considered as a social support behavior.
Before collecting the data, a pilot study was
conducted through 30 nurses to assess the
appropriateness and comprehensiveness of the
research instruments to Jordanian nurses; no
revisions were required. The instruments were
administered without translation; English is the
official teaching language in all nursing schools
in Jordan. Also, the sample was limited to Regis-
tered Nurses (RNs) only; they are able to com-
municate in English.
For the purpose of this research, the author
developed a demographic form to measure the
following characteristics: gender (male, female);
marital status (single, married, separated/
divorced, widowed); shift worked (day 12
Volume 31, Issue 2, February 2009
CN
hours), evening (12 hours), day (8 hours),
evening (8 hours), night (8 hours), rotating (A,
B, C); time commitment for work (part-time,
part-time); level of education (associate, diplo-
ma, baccalaureate, master, doctorate); age (less
than 25 years, 25–34 years, 35–44 years, 45–54
years, 55 years or more); years of experience in
nursing (less than one year, 1–2 years, 3–4
years, 5–9 years, 10 years or more); years of
experience in hospital settings (less than one
year, 1–2 years, 3–4 years, 5–9 years, 10 years
or more); average daily census (1–5 patients,
6–10 patients, 11–15 patients, 16–20 patients,
more than 20 patients, type of units/wards (list
of units and wards); ward/unit’s organizational
structure (vertical, horizontal, matrix, unclear);
ward/unit’s model of nursing care (Primary,
team. functional, unclear); ward/unit’s decision
making style (authoritative–unilateral, partici-
pating–bilateral, mixed, unclear); and type of
hospitals (governmental, teaching, private).
DATA ANALYSES
Data analyses were performed at a significance
level of .05. Statistical Package for Social Sci-
ences (SPSS) (Version 15, 2007) was used to
generate descriptive and inferential statistics.
Means, standard deviations, and frequencies
were reported for sample’s variables. Chi-square
tests were used to compare sample’s demo-
graphics between ICUs and wards. F-tests were
used to compare nurses’ job stressors and social
support behaviors between ICUs and wards.
Regression analyses were used to determine
predictors of nurses’ job stressors and social
support behaviors (Polit & Beck 2006). Com-
parisons between ICUs and wards were possible
because there were not any extreme differences
between standard deviations of variables.
FINDINGS
Sample’s profile
There were some significant differences in the
following sample’s demographics: gender (more
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CN Majd T Mrayyan

male nurses (n=133, 58.6%) were employed
in ICUs while more female nurses (n=126,
63.6%) were employed in wards) (P=.009);
marital (more single nurses (n=156, 68.7%)
were employed in ICUs while more married
nurses (n=96, 41.4%) were employed in
wards) (P=.030); age (more young nurses (less
than 25 years) (n=103, 45.2%) were working
in ICUs as compared to those in the same age
category in wards (n=84, 35.7%)) (P=.044);
years of experience in nursing (more experienced
nurses (10 years or more) (n=31, 13.2%) were
working at ICUs as compared to those in the
same category in wards (n=24, 10.6%)) (P=
.040); patient census (23.1% (n=52) of nurses in
ICUs reported that their unit/ward’s patient
census was more than 20 patient/ day versus
33.6% (n=79) in wards) (P=.001); and model of
nursing (only 2.2% (n=5) of nurses in ICUs
reported that their model of nursing care was
not clear as compared to 8.1% (n=19) in
wards) (P=.035) (see Table 1).
Differences of nurses’ job stressors
and social support behaviors
While there were no significant differences
in nurses’ job stressors subscales except in
‘conflict with physician’ (P=.021), there were
significant differences in two social support
behaviors subscales of ‘emotional support’ (P=
.002) and ‘tangible assistance’ (P=.008) (see
Table 2).

TABLE 1: SIGNIFICANT DIFFERENCES OF SAMPLE’S DEMOGRAPHICS (N=463)

ICUs Wards
(N=228)* (N=235)*
Variables n % n % χ2** DF P

Gender 6.89 1 .009

Male 133 58.6 109 46.4
Female 94 41.4 126 63.6
Marital status 7.03 2 .030
Single 156 68.7 132 56.9
Married 69 30.4 96 41.4
Separated/divorced 2 .9 4 1.7
Age 8.12 3 .044
Less than 25 years 103 45.2 84 35.7
25–34 years 110 48.2 121 51.5
35–44 years 14 6.2 25 10.6
45 years and more 1 .4 5 2.2
Years of experience as a nurse 10.00 4 .040
Less than one year 40 17.6 36 15.4
1–2 years 64 28.2 40 17.1
3–4 years 53 23.3 68 29.1
5–9 years 46 20.3 59 25.2
10 years or more 24 10.6 31 13.2
Unit/ward’s daily census 70.17 4 .001
1–5 patients 76 33.8 19 8.1
6–10 patients 52 23.1 31 13.1
11–15 patients 26 11.6 53 22.6
16–20 patients 19 8.4 53 22.6
21 and more patients 52 23.1 79 33.6
Model of nursing care 8.63 3 .035
Primary 85 37.4 80 34.0
Team 87 38.3 81 34.5
Functional 50 22.1 55 23.4
Unclear model 5 2.2 19 8.1
* Some totals don’t equal to 463 because of missing data. ** Asymp. Sig (2-sided).

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Job stressors and social support behaviors: Comparing intensive care units to wards CN
TABLE 2: MEANS, STANDARD DEVIATIONS, AND SUBSCALES OF NURSES’ JOB STRESSORS AND SOCIAL SUPPORT
BEHAVIORS (N=463)
ICUs (N=228) Wards (N=235)
Number _ _
Subscales of items X (SD) X (SD) F* P**

Nurses’ stressors 34 79.02 (15.79) 77.61 (14.94) .967 .326

Death and dying 7 16.43 (3.88) 16.19 (4.08) .428 .513

Workload 6 14.62 (3.44) 14.46 (3.78) .211 .646
Conflict with physicians 5 11.52 (3.08) 10.91 (2.90) 5.35 .021
Conflict with other nurses 5 11.57 (3.23) 11.60 (3.12) .013 .908
Uncertainty concerning treatment 5 11.50 (2.89) 11.47 (2.96) .018 .894
Inadequate preparation 3 6.73 (1.77) 6.61 (1.87) .535 .465
Lack of support 3 6.64 (2.11) 6.39 (1.80) 1.99 .159

Social support behaviors 40 98.78 (26.38) 92.43 (24.83) 7.09 .008

Guidance 15 37.84 (10.50) 36.14 (10.48) 3.02 .083

Emotional support 15 38 (10.63) 35 (10.39) 9.27 .002
Tangible assistance 10 22 (7.16) 20.49 (6.62) 7.17 .008
* Equal variances are not assumed. ** Sig. (2-tailed).

TABLE 3: SIGNIFICANT DIFFERENCES OF I NDIVIDUAL I TEMS OF NURSES’ JOB STRESSORS (N=463)

ICUs (N=228) Wards (N=235)
_ _
Items X (SD) X (SD) F* P**

Performing procedures which patients

experience as painful 2.54 (.847) 2.34 (.893) 3.76 .053
Fear of making a mistake in treating a patient 2.29 (.928) 2.12 (.907) 4.19 .041
Lack of an opportunity to share experiences
and feelings with other personnel on the unit 2.22 (.928) 2.06 (.880) 3.81 .051
Disagreement concerning the treatment of a patient 2.19 (.951) 2.01 (.899) 4.39 .037
* Equal variances are not assumed. ** Sig. (2-tailed).

At the individual level of NSS, there were
some significant differences in performing pro-
cedures which patients experience as painful
(P=.053) (approached the significance); fear of
making mistakes while treating patients (P=
.041); lack of opportunities to share experi-
ences and feelings with other personnel on the
unit (P=.051) (approached the significance);
disagreement concerning the treatments of
patients (P=.037); all these stressors were high-
er in ICUs (see Table 3).
At the individual level of ISSB, there were
significant differences in many social support
behaviors. In descending order, the highest two
means were: be physically available to support
nurses in stressful situations (P=.026); and the
availability of a place where the nurse could get
a way for awhile at the time of having a stressor
(P=.046) (see Table 4).
Predictors of nurses’ job stressors
in ICUs and wards
Shift worked was the only predictor of nurses’
job stressors in ICUs (R2=.044, F= 10.06,
P=.002), while model of nursing care (R2
=.030, F= 7.03, P=.009), and level of educa-
tion (R2=.059, F=1.06, P=.001) were predic-
tors of nurses’ job stressors in wards (see Tables
5 and 6).

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CN Majd T Mrayyan

TABLE 4: SIGNIFICANT DIFFERENCES OF I NDIVIDUAL I TEMS OF SOCIAL SUPPORT BEHAVIORS (N=463)

ICUs (N=228) Wards (N=235)
_ _
Items X (SD) X (SD) F* P**

Physical presence in stressful situation 2.46 (1.04) 2.24 (1.13) 4.98 .026
The availability of a place where the nurse
could get a way for awhile 2.41 (1.15) 2.15 (1.10) 5.89 .016
Look after nurses’ possessions when they are away
(pets, plants, home, apartment, etc.) 2.36 (1.17) 2.14 (1.18) 4.00 .046
Perform activities with nurses to help them get their
mind off of things 2.65 (1.15) 2.40 (1.17) 5.31 .022
Talk with nurses about some interests of them 2.81 (1.23) 2.43 (1.11) 12.16 .001
Let nurses know that they did something well 2.74 (1.19) 2.47 (1.23) 5.51 .019
Tell nurses that they would keep things that they
talk about private 2.67 (1.22) 2.34 (1.14) 9.01 .003
Give nurses something (a physical object other than
money that they needed) 2.46 (1.20) 1.94 (1.15) 23.20 .001
Agree that what nurses wanted to do is right 2.61 (1.18) 2.38 (1.22) 4.26 .039
Joke to try to cheer nurses up 2.70 (1.35) 2.36 (1.22) 7.86 .005
Pitch in to help nurses do something that needed
to get done 2.47 (1.15) 2.21 (1.08) 6.26 .013
Loan nurses money (you under 25JD) 2.14 (1.26) 1.84 (1.09) 7.11 .008
* Equal variances are not assumed. ** Sig. (2-tailed).

Predictors of social support organizational structure (R2=.053, F=6.30,

behaviors in ICUs and wards
Shift worked (R2=.084, F=20.05, P=.001),
model of nursing care (R2=.119, F=14.74,
P=.001), work commitment (R2=.138, F=
11.66, P=.001), and decision making style (R2
=.155, F=9.98, P=.001) were predictors of
social support behaviors in ICUs. Model of
nursing care (R2=.033, F=7.72, P=.006),
P=.002), and martial status (R2=.070, F=
5.68, P=.001) were predictors of social sup-
port behaviors in wards (see Tables 5 and 6).
DISCUSSION
Job stressors are serious clinical practice issue;
it has negative consequences on patients, organ-
izations and the professionals themselves (Albar

TABLE 5: STEPWISE MULTIPLE REGRESSION FOR VARIABLES PREDICTING NURSES’ JOB STRESSORS AND
SOCIAL SUPPORT BEHAVIORS IN ICUS (N=228)
Regression
Variables R R2 Adjusted R2 R2 change coefficients F P

Nurses’ job stressors

Shift worked .209 .044 .039 .044 .209 10.06 .002

Social support behaviors

Shift worked .289 .084 .079 .084 .250 20.05 .001
Model of nursing care .344 .119 .111 .035 .211 14.74 .001
Work commitment .372 .138 .126 .020 .133 11.66 .001
Decision making style .394 .155 .140 .017 –.133 9.98 .001

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Job stressors and social support behaviors: Comparing intensive care units to wards
TABLE 6: STEPWISE MULTIPLE REGRESSION FOR VARIABLES PREDICTING NURSES’ JOB STRESSORS
SUPPORT BEHAVIORS IN WARDS (N=235)
Variables R R2 Adjusted R2
Nurses’ job stressors
Model of nursing care .173 .030 .026
Level of education .243 .059 .059
Social support behaviors
Model of nursing care .181 .033 .029
Organizational structure .230 .053 .044
Marital status .265 .070 .058
Marin & Garcia-Ramirez 2005; McGowan 2001;
Shader et al. 2001; Maslach et al. 2000; Smith et
al. 2000).
Nurses in ICUs and wards were different in
many of their characteristics; these differences
could be related to the characteristics of work
environments and the characteristics of work-
force (Mrayyan 2007; Mrayyan 2005). For exam-
ple, in the current sample, there were more male
nurses employed in ICUs; this is consistent with
current trend of shortage of female nurses and
the surplus of male nurses in Jordan; more male
students are pursuing nursing as a career; nurs-
ing has very low unemployment rate.
At the whole sample, nurses perceived ‘fre-
quently’ the presence of nurses’ stressors; this
indicates high job stressors which are supported
by the findings of Hamaideh et al.’s (2008).
Also, nurses perceived that ‘once or twice’ they
received social support behaviors; this indicates
low social support (Hamaideh et al. 2008).
ICUs scored higher than wards only in ‘con-
flict with physicians’ as a job stressor (Hamaideh
et al. 2008; McVicar 2003; Finlayson et al. 2002;
McGowan 2001; Payne 2001; Bratt et al. 2000;
Demerouti et al. 2000; French et al. 2000; Healy
& McKay 2000). Stressors in ICUs were higher
than wards, this could be interpreted as that
ICUs are closed areas that have many restrictive
policies and procedures, thus ICUs may not be
viewed as favorable work environments (Mray-
yan 2007), and in turn nurses may choose to
Volume 31, Issue 2, February 2009
CN
AND SOCIAL
Regression
R2 change coefficients F P
.030 .201 7.03 .009
.029 .172 1.06 .001
.033 .232 7.72 .006
.020 –.145 6.30 .002
.018 –.035 5.68 .001
work in wards. In consequence, the nursing
shortage will be more prevalent in ICUs, and
will result in more stressors (AbuAlRub 2007;
Van Der Ploeg & Kleber 2003). In ICUs, patients
are critically ill and are presented with complex
health conditions; procedures are multiple and
painful; mistakes while treating patients are not
tolerable, and disagreement over treatments of
complex conditions may occur as these patients
are treated by multiple specialties. A possible
consequence of the nursing shortage and work-
load in ICUs that nurses may not have the
opportunity to share their experiences and feel-
ings with other personnel.
Little attention has been paid to social sup-
port in clinical settings in general and in specific
clinical settings such as ICUs in particular (Bar-
rera 2000). Social supports differ in nature;
it could be emotional support, providing guid-
ance, or providing tangible assistance. Social sup-
port could be provided by family and friends,
co-workers, and supervisors (Hamaideh et al.
2008). In the current study, ICUs scored higher
than wards in two subscale of ISSB ‘emotional
support’ and ‘tangible assistance;’ this could be
related to the fact that ICUs are closed areas;
people are more close to each others, thus they
may provide emotional support for each others.
As ICU nurses deal with critical conditions
under increased workload, nurses may be pro-
vided with more tangible assistance to help them
to overcome ICU stressors. Tangible assistance
CN 171
CNJ 31_2_internal.qxd 23/03/2009 5:59 PM Page 172
CN Majd T Mrayyan
may start with providing simple things such as
peer assistance and offering coffee breaks.
ICUs scored higher than wards in some social
support behaviors; specifically that nurses were
physically available to support other nurses ex-
periencing stressful situations, which could be
applied more to nurses in ICUs, which may also
be interpreted that there is more privacy at
ICUs; a closed unit may provide a stressful nurse
with an opportunity to get away for awhile.
In the current study, shift worked predicted
nurses’ job stressors (Hamaideh et al. 2008) in
ICUs.The average mean of the worked shifts at
ICUs was the evening shift. This explains such
predication; this type of shifts may influence
negatively nurses’ management of their daily life
activities, especially if they assume multiple
roles at the jobs as well as at homes (Van Der
Ploeg & Kleber 2003). Primary nursing care
model was commonly used in ICUs while team
and functional were commonly used in wards.
Primary nursing care model may impose more
job demand on RNs as it needs more clinical
and leadership skills (Marquis & Huston 2003;
French et al. 2000); this could be viewed as a
job stressor in ICUs.Team and functional nurs-
ing models may impose more job demands on
nurses in areas related to communication with
other teams, patients and each others. Function-
al nursing care model may result in fragmented
care while team nursing care model requires
adequate ‘nurse: patient ratio’ (Marquis & Hus-
ton 2003; French et al. 2000); these two factors
could be viewed as job stressors in wards.Thus,
the use of any of these nursing care models
requires providing social support behaviors
for the nursing staff (Hamaideh et al. 2008).
Although 69% of nurses in wards held Baccalau-
reate degree, they may not receive job enrich-
ment opportunities as those in ICUs; which
could be considered as a job stressor in wards.
Predictors of social support behaviors could
be explained as follows: as the evening shift was
the mean of the worked shifts in ICUs, nurses
who assume such duty may need more social
172 CN Volume 31, Issue 2, February 2009
support behaviors especially if these nurses are
married; they assume additional roles such as
house managers, wives, and mothers (Hamaideh
et al. 2008). Primary nursing model requires
more skills of RNs; more leadership, decision
making and communication skills are needed
(Marquis & Huston 2003). Full time nurses have
more restrictive work schedules and looking
forward to be involved in decision making
process (Mrayyan & Al-Faouri 2008); all these
variables mandate providing more social sup-
port behaviors for nurses who work in ICUs. At
wards, team and functional nursing care models
were commonly used; these models may create
stressors for nurses as they are time consuming,
require leadership and communication skills, in
turn these nurses should receive a considerable
amount of social support (Marquis & Huston
2003; French et al. 2000). The use of vertical
organizational structure may pinpoint to a
centralized decision making process, which may
mandate the use of more social support behav-
iors to buffer the effect of such type of decision
making style on nurses (Mrayyan & Al-Faouri
2008). Little attention has been paid to social
support especially for women (Barrera 2000).
As they have multiple roles in life, women may
need more social support than men.
IMPLICATIONS
To avoid its negative reflection on nurses and
patients and organizations, nurses’ job stressors
should be decreased and managed early and effi-
ciently. One key intervention to decrease nurses’
stressors is to provide nurses with social support
behaviors.The results of this study have implica-
tion for practice, education, and research.
For practice, caused by the nature of their
work environments, nurses in ICUs should
receive more social support behaviors, particu-
larly the ‘emotional support’ and ‘tangible assis-
tance.’Various conflicts with physicians should
be viewed as unacceptable and managed as early
as possible; close units may contribute more for
the occurrence of frictions among staff. In all
CNJ 31_2_internal.qxd 23/03/2009 5:59 PM Page 173
Job stressors and social support behaviors: Comparing intensive care units to wards
settings in general and units in particular, mutu-
al communication and collaboration rather than
competition should be encouraged and used in
various meetings.
For education, courses at the undergraduate
and graduate level should emphasize on com-
munication, conflict management, and stress
management. On jobs, nurses should be intro-
duced to various issues related to job stressors
and social support through various lectures and
seminars (Hamaideh et al. 2008).
For research, the results of the current study are
not generalizable as it used convenience sampling
technique; a larger and random sample is recom-
mended in further studies. To explore the con-
cepts in depth, a qualitative research design is
recommended in future research.
Limitations of the study
The sample of clinical settings in this study
was not sufficient, thus the results may not be
generalized to the whole population. A larger
sample has to be considered to make the com-
parison between nurses in ICUs and wards
more accurate.
SUMMARY AND CONCLUSIONS
High nurses’ job stressors and low social sup-
port behaviors were evidenced in the current
study. The majority of sample’s demographics
were different. Using subscales, ICUs scored
higher than wards in one subscales of NSS and
two subscales of ISSB. Using individual items of
scales, job stressors were higher at ICUs, and in
turn more social support behaviors were pro-
vided. Shift worked, model of nursing care, and
level of education predicted nurses’ job stres-
sors in ICUs and wards. Model of nursing care
was a shared predictor of social support behav-
iors in ICUs and wards.
In all settings in general and in ICUs in par-
ticular, nurses’ job stressors should be decreased
by providing various social support behaviors.
Decreasing job stressors will reflect positively
CN
on the quality of patient care and the quality of
nurses’ lives.
Acknowledgements
The researchers would like to thank all nurses
who participated in this study. Many thanks are
conveyed to all Teaching and Research Assistants
who participated in data collection and manage-
ment.
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