Occupational Health
Factors Associated with Organizational Stress Among Intensive Care Unit Healthcare Workers in Somalia Hospital
Last reviewed: March 2026
Key Findings
- Healthcare workers in the ICU setting experienced significant levels of organisational stress, driven by high workload demands, emotional burden of critical care, and resource constraints.
- Factors including long working hours, inadequate staffing, exposure to critically ill and dying patients, and limited organisational support were significantly associated with higher stress levels.
- Nurses and junior medical staff reported higher levels of stress compared to senior physicians, reflecting disparities in workload distribution and decision-making autonomy.
- The study recommended organisational interventions including improved staffing ratios, stress management programmes, peer support networks, and institutional policies to protect the wellbeing of ICU staff.
Background and Context
Healthcare workers in Intensive Care Units (ICUs) operate in one of the most demanding environments within the hospital system. The ICU setting is characterised by high patient acuity, complex medical decision-making, frequent exposure to death and dying, 24-hour operational demands, and the emotional burden of caring for critically ill patients and their families. These occupational pressures contribute to elevated levels of organisational stress, which can manifest as physical exhaustion, emotional burnout, decreased job satisfaction, and ultimately, compromised quality of patient care.
Organisational stress — defined as the psychological strain experienced by individuals as a result of workplace demands that exceed their perceived capacity to cope — is a widely recognised occupational health concern in healthcare settings worldwide. While individual resilience and coping strategies play a role, organisational factors such as staffing levels, workload distribution, management support, and institutional culture are frequently identified as the primary drivers of stress in healthcare workplaces.
This study, published in Volume 12, Issue 1 of the Malaysian Journal of Public Health Medicine, investigated the factors associated with organisational stress among ICU healthcare workers, contributing to the understanding of occupational health challenges in critical care environments.
Study Design and Methods
The study employed a cross-sectional design to assess the prevalence and determinants of organisational stress among healthcare workers in the ICU. Data were collected using validated stress assessment instruments and structured questionnaires that captured information on demographic characteristics, job-related factors, organisational climate, and perceived stress levels.
The study population included various categories of ICU healthcare workers — nurses, physicians, and support staff — allowing for analysis of stress patterns across different professional groups. Statistical analyses were conducted to identify factors significantly associated with organisational stress, including workload indicators, working hours, years of experience, staffing ratios, and perceived organisational support.
Prevalence and Distribution of Stress
The findings indicated that a substantial proportion of ICU healthcare workers experienced significant levels of organisational stress. The distribution of stress was not uniform across professional groups: nurses and junior medical staff reported consistently higher stress levels compared to senior physicians and administrators. This differential reflected several factors, including the direct patient care burden borne predominantly by nursing staff, the limited decision-making autonomy of junior staff, and the emotional toll of sustained bedside contact with critically ill patients.
Working hours emerged as a significant correlate of stress, with staff working longer shifts or more frequent overtime reporting higher stress levels. The nature of ICU shift work — particularly night shifts and rotating schedules — disrupts circadian rhythms and limits recovery time, compounding the effects of workplace demands on physical and psychological health.
Organisational Factors
Several organisational factors were identified as significant contributors to ICU staff stress. Inadequate staffing was a primary driver, as insufficient nurse-to-patient ratios increased individual workload and reduced the time available for quality patient care and professional recovery between tasks. Resource constraints, including limited availability of essential medical supplies and equipment, added to the operational burden on staff.
The quality of organisational support — encompassing management responsiveness to staff concerns, availability of professional development opportunities, and institutional recognition of staff contributions — was inversely associated with stress levels. Staff who perceived their organisation as supportive and responsive to their needs reported lower stress levels, even when facing comparable workload demands.
The emotional labour inherent in ICU work was an additional dimension of stress. Regular exposure to patient suffering, death, and the grief of families requires substantial emotional resources from healthcare workers. Without adequate institutional mechanisms for emotional support — such as debriefing sessions, counselling services, and peer support programmes — the cumulative emotional burden can lead to compassion fatigue and burnout.
Implications for Healthcare Management
The study’s findings pointed to several evidence-based strategies for reducing organisational stress in ICU settings. Improving staffing ratios to match patient acuity levels was identified as the most impactful intervention, directly addressing the primary driver of excessive workload. Implementing structured stress management programmes, including training in coping techniques, mindfulness practices, and resilience building, could help individual staff members manage unavoidable workplace pressures more effectively.
Establishing formal peer support networks and regular debriefing sessions following critical incidents or patient deaths was recommended to address the emotional dimensions of ICU work. Creating a workplace culture that acknowledges and validates the psychological challenges of critical care, rather than treating stress as a sign of personal weakness, could help reduce stigma around seeking support.
Limitations
The cross-sectional design of the study limited the ability to establish causal relationships between organisational factors and stress outcomes. The study was conducted in a specific hospital setting, and findings may not be directly transferable to other ICU environments with different organisational structures, staffing models, and patient populations. Self-reported stress measures may be subject to reporting bias, and the study did not include objective physiological stress markers.
Significance for Occupational Health
This research contributed to the growing body of evidence on occupational stress in healthcare settings, with specific relevance to the critical care environment. The identification of modifiable organisational factors as primary stress drivers provided an evidence base for institutional interventions aimed at protecting the wellbeing of ICU staff while maintaining high standards of patient care. As healthcare systems worldwide face challenges related to workforce sustainability and burnout, studies such as this offer valuable guidance for creating healthier, more supportive work environments in the most demanding clinical settings.
Factors associated with organizational stress among Intensive Care Unit healthcare workers. Malaysian Journal of Public Health Medicine. 2012;12(1).