title: A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community.
abstract: OBJECTIVE
  The aim of the study was to examine the variety, frequency and severity of stressors experienced by community mental health nurses (CMHNs) in Wales.
  
  
  BACKGROUND
  Numerous studies undertaken throughout the United Kingdom (UK) have indicated that those health professionals working as part of community teams are experiencing increasing levels of stress and burnout. Sample sizes have tended to be small and participants have been drawn mainly from sites in England.
  
  
  METHODS
  A questionnaire booklet, which included a number of validated measures, was distributed to 614 CMHNs. These included Maslach Human Services Survey, Community Psychiatric Nursing (CPN) Stress Questionnaire, PsychNurse Coping Questionnaire, Rosenberg Self-Esteem Scale and General Health Questionnaire GHQ-12. The study was the largest of its kind conducted in the UK.
  
  
  RESULTS
  Data were collected from 301 CMHNs, representing a response rate of 49%. Community mental health nurses identified the most stressful issues as trying to maintain a good quality service in the midst of long waiting lists and poor resources and having too many interruptions while trying to work in the office. The best demographic predictors of high stress scores were having an unsupportive line manager, working with a specific client group and not having job security. These factors accounted for 20% of the variance in the total stress score. When the results from the psychometric instruments were included, 46% of the variance in the total stress score was accounted for. The predictive variables were emotional exhaustion, working with a specific client group, job security and alcohol consumption.
  
  
  CONCLUSIONS
  These findings indicate that there is a need to create more supportive environments both in terms of job security and management support, especially for those working in the fields of severe mental illness and rehabilitation.
authors.affiliation: School of Nursing and Midwifery Studies, University of Wales College of Medicine, Cardiff, UK.
authors.forename: D
authors.initials: D
authors.lastname: Edwards
authors.forename: P
authors.initials: P
authors.lastname: Burnard
authors.forename: D
authors.initials: D
authors.lastname: Coyle
authors.forename: A
authors.initials: A
authors.lastname: Fothergill
authors.forename: B
authors.initials: B
authors.lastname: Hannigan
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000209:etiology*; D003156:Community Mental Health Services; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016272:Occupational Health; D011568:Psychiatric Nursing / Q000706:statistics & numerical data*; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014852:Wales; D000078329:Workforce