Occupational Health & Nursing

Stress and Its Associated Factors Amongst Ward Nurses in a Public Hospital Kuala Lumpur

Abstract and Background

Occupational stress exists across all professions, but the nursing profession consistently experiences higher levels of work-related stress compared to many other healthcare worker categories. Nurses face a constellation of stressors including heavy workloads, long and irregular working hours, emotional demands of patient care, exposure to suffering and death, interpersonal conflicts, and role ambiguity. In Malaysia’s public healthcare system, where demand for services often outpaces staffing capacity, these pressures can be particularly acute.

Stressful conditions at the workplace contribute to high turnover rates and burnout among nurses, which in turn affects the quality of patient care and the sustainability of the healthcare workforce. This study aimed to determine the level of stress and identify associated factors among in-patient ward nurses working in a public hospital in Kuala Lumpur, providing evidence to inform occupational health interventions and workforce management strategies.

Methodology

A cross-sectional study using stratified random sampling was conducted among 114 staff nurses recruited from five different departments in a public hospital in Kuala Lumpur. The five departments represented a range of clinical acuity and patient complexity, allowing for meaningful comparisons of stress prevalence across different work environments within the same institution.

Respondents completed a single set of validated, self-administered questionnaires including the Depression, Anxiety, and Stress Scale (DASS), a widely used and psychometrically robust instrument for measuring negative emotional states. The DASS provides separate subscale scores for depression, anxiety, and stress, with severity classifications ranging from normal to extremely severe. Data were analysed using SPSS version 17, with descriptive statistics, chi-square tests, and other appropriate inferential methods employed to examine relationships between stress levels and demographic, occupational, and departmental variables.

Key Results

Stress Prevalence by Department

The study found that the prevalence of stress was not uniform across hospital departments. The Department of Medicine recorded the highest stress prevalence compared to the other four departments studied. This finding is consistent with international literature suggesting that medical wards, which typically manage patients with complex, chronic, and often deteriorating conditions, place particularly high emotional and cognitive demands on nursing staff.

Statistical analysis confirmed a significant relationship between stress prevalence and the type of department (p < 0.05), supporting the hypothesis that departmental characteristics, including patient acuity, staffing ratios, pace of work, and the nature of clinical demands, play a meaningful role in determining nurses’ stress levels.

Associated Factors

The study examined multiple potential correlates of stress including sociodemographic characteristics (age, marital status, educational level), occupational factors (years of experience, shift patterns, workload perceptions), and organisational factors (supervisory support, departmental culture). The analysis identified several factors that contributed to elevated stress levels, though the relationship between demographic variables and stress was more nuanced, with some factors not reaching statistical significance at the p < 0.05 threshold.

Context Within Malaysian Healthcare

Malaysia’s public healthcare system serves as the primary provider of hospital services for the majority of the population, with public hospitals operating at high occupancy rates and frequently facing workforce shortages. The Malaysian nursing workforce has experienced ongoing challenges with recruitment, retention, and attrition, with workplace stress being consistently identified as a contributing factor to job dissatisfaction and turnover intention.

Subsequent research published in the Malaysian Journal of Public Health Medicine has continued to examine occupational stress among Malaysian nurses, including studies examining stress, stressors, and coping strategies among nursing students, and investigations into the relationship between occupational stress, job satisfaction, and intent to leave among nurses in tertiary hospitals. These studies collectively paint a picture of a profession under considerable strain, reinforcing the importance of evidence-based interventions to support nurse wellbeing.

Implications and Recommendations

The findings carry important implications for hospital administrators, nursing leaders, and health policymakers. Departments with higher stress prevalence may benefit from targeted interventions such as stress management workshops, peer support programmes, improved staffing ratios, and enhanced supervisory support. The significant variation in stress levels across departments suggests that a one-size-fits-all approach to nurse wellbeing is unlikely to be effective; instead, interventions should be tailored to the specific stressors and demands of each clinical environment.

At the policy level, addressing nurse stress requires attention to systemic factors including workforce planning, compensation, career development pathways, and the creation of organisational cultures that prioritise staff wellbeing alongside patient care quality.

Limitations

The study was conducted in a single public hospital in Kuala Lumpur, which may limit the generalisability of findings to other hospitals and geographic settings within Malaysia. The cross-sectional design provides a snapshot of stress levels but cannot establish causal relationships or track changes over time. The sample size of 114, while adequate for the analyses performed, may limit the power to detect smaller effect sizes. Self-reported measures may also be subject to response bias.

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