title: Do hospital shift charge nurses from different cultures experience similar stress? An international cross sectional study.
abstract: BACKGROUND
  There is a need to improve understanding of role stress and how it affects nurses' wellbeing, burnout and health; and hence the quality and safety of patients' care, organizational outcomes and costs. The focus is on shift charge nurses in hospitals who are accountable during a specific shift for the patients' care and staff functioning in accordance with hospital and unit policy.
  
  
  OBJECTIVE
  To compare perceptions of stress and its intensity among hospital shift charge nurses amongst three countries: Israel, USA (state of Ohio) and Thailand.
  
  
  METHODS
  A cross-sectional study was performed across three countries, focusing on a convenience sample of 2616 hospital shift charge nurses recruited from 23 general hospitals.
  
  
  METHODS
  A validated shift Charge Nurse Stress Questionnaire was used to assess impacts of four factors: patient & family complaints, lack of resources, responsibility burden and professional conflict. Descriptive statistics were used to describe demographic and professional characteristics of the participants. Chi square and the Fisher Exact Test were performed to test for demographic differences amongst the three samples. Parametric and non-parametric tests were used to compare mean stress levels amongst the study samples.
  
  
  RESULTS
  The mean stress level for the total sample was 2.84 (±0.71) on a Likert scale of 1-5, implying moderate stress levels. Significant differences in stress levels were found among countries, with Thai nurses scoring the highest and Israeli nurses the lowest. Similar perceptions of stress intensity were found for all countries, with the factors "responsibility burden" and "lack of resources" considered the most stressful. Israeli and American nurses perceived similar situations as stressful and different from those perceived by Thai nurses. The findings can be partially explained by demographic, professional and cultural differences.
  
  
  CONCLUSIONS
  Similarities along with differences were found in the nature and levels of stress experienced across the studied countries. A prerequisite educational program should be mandatory for nurses prior to their nomination as shift charge nurses. Programs should be tailored to address the stress experienced by shift charge nurses. Ongoing mentorship and workshops are recommended to develop and maintain leadership abilities to cope with role stress. Future research should explore internationally the unique nature and stress of the shift charge nurse's role and replicate this study by using the Charge Nurse Stress Questionnaire in other countries. Further international comparative studies are recommended to evaluate stress perceptions of nurses in other roles and in different practice areas.
authors: Interdisciplinary Research, Rambam Health Care Campus, Haifa, Israel. Electronic address: h_admi@rambam.health.gov.il.
authors: Hanna
authors: H
authors: Admi
authors: Nursing Research Coordinator, Rambam Health Care Campus, Haifa, Israel.
authors: Yael
authors: Y
authors: Eilon-Moshe
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D009745:Nursing, Supervisory; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D013785:Thailand; D014481:United States
keywords: Hospital management; International comparative; Nursing; Role stress; Shift charge nurse