Maslach Burn-out Scale

According to the Maslach Burn-out Scale and the Expanded Stress Scale, there are a variety of factors that contribute to increased stress levels among rural nurses. This finding is consistent with a previous study, which found that lengthy work hours are a major cause of stress and inefficiency among nurses (Kendrick, 2000). Similarly, evidence suggests that when nurses work more than twelve hours a day, the rate of errors increases. Furthermore, nurses who work longer shifts have greater stress, which contributes to not only burnout but also tension (Rogers, 2004). Besides, patients' admission and few nurses' result in serious issues related to effectively provision of health care services. The findings also demonstrated that 38% (Figure 1) of the respondents were above 51 years and they had at least a diploma or higher education in nursing practice and experience working in the Bahamas. Moreover, the findings of this study showed that participants strongly agreed (Figure 2), which demonstrates several factors result in increased stress level among nurses, in particular, political, discrimination religious and cultural factors. These findings are in line with Dixon (2003) who stated that diversity in nursing staff s is an important factor that reinforces cultural competence in the healthcare structure. In any case, cultural competence is a vital factor when it comes to considerably influencing the delivery of services among health care professionals (Dixon, 2003). Based on the findings 53% of nurses working in rural settings were occasionally stressed (Figure 3 and 4) while 47% were either extremely stressed or never stressed. This shows that nurse burn out is a result of several factors including lack of stationery supplies, lack of staffing, long work hours, lack of professionalism in peers, poor management, work overload, lack of pharmaceutical and medical management resources, lack of patient compliances, lack of access to continuing education, and poor living environment . This is backed by a study by Ermak, (2014) alleging that nurse burnout is caused by various factors such as lack of social support, monotonous job, inability to control a person's tasks and work-life balance. Again, evidence shows that nursing working in rural areas face numerous problems related to inadequate resources, time, equipment, inadequate professional support, and inadequate access to education, workload and sicker patients when they decide to seek medical services (Bushy, 2006). According to this study, there is inadequate data on factors that influence nurses working in rural areas and also programs to tackle these factors. As such, further studies must focus on how to address factors that lead to burnout among nurses, particularly among nurses working in rural settings. Dealing with these factors can help in restoring the compassion of nurses; hence contribute to quality service provision and ultimately patient satisfaction. Nonetheless, in the "Maslache Burn Scale" the respondents were inclined towards extremes while in the "Expanded Nursing Stress Scale", participants responded within the scale. Owing to the fact that the Maslach Burnout Scale and the Expanded Stress Scale are structured in a different manner, future studies are needed to identify factors to harmonize them. This study augments the inadequate literature on job contentment of nurses working in rural settings. By looking at the nurses working in healthcare facilities in rural settings with the intricacies of access and isolation, such as the Bahamas, the study presents a unique insight as to whether such factors are also commonplace in developed economies. It turns out the most momentous predictors of job-related stressors of rural practicing nurses in the Bahamas stems from work climate and supervision. The association between work climate and how it leads to stress and burnout has been tackled in studies on developed nations. According to Aiken et al. (2002) work environment is a way employees conceptualize their work environment and established a considerable linkage to job-related stress and burnout. When the harmony between workers and the management is unpleasant, it may most likely culminate into heightened stress levels, an aspect that adversely impacts the delivery of care in a healthcare environment. Findings from this study demonstrated that the lack of support from the management and immediate supervisors among other factors that originate from supervisors being too critical, to handling abusive patients. Other factors that heighten stressors originate from not having adequate time to respond to the needs of patients' families and for being held responsible for things they have no control over. All these plethoras of variables have had a negative bearing among nurses working in the rural Bahamas in terms of aggravated stress levels, burnout and discontentment. A qualitative study by Aiken et al. (2002) asserts that the significance of interpersonal associations in the workplace is elementary as far as motivation is anything to go by. However, in the situation where practicing nurses work and stay in proximity to their colleagues, good interpersonal ties play a critical role in scaling back work-related dissatisfaction. While poor remuneration of health workers has been touted as one of the stressors in most studies, there is also evidence, which shows that nursing practice is a strong job satisfier. Nonetheless, in this study, there is empirical evidence of the negative association of inherent stress levels and burnout with job dissatisfaction. The literature review offered some insight to the disgruntlement of nurses and how it is the cause of underperformance which affects the quality of healthcare outcomes. And yet, further research should be undertaken to establish the impacts of nurses practicing beyond their scope of practice, dissatisfaction, stress and burnout in rural settings.

Research Implications

To adequately understand stress level among nurses working in rural settings, there is a need for solid conceptualizations to connect different issues related to stress. Currently, research is carried out without a solid conceptual and theoretical framework. A more detailed blueprint of burnout and stress among nurses in rural settings should be designed, after which empirical studies could be carried out to explore the complex associations in a prospective way (Ermak, 2014). Performing work stress based on a solid conceptual and theoretical framework can help intervention studies to examine the effective strategies to reduce work-related stress. Besides the use of descriptive designs, studies should investigate the impacts of nurse stress on patients' outcomes. This can help in increasing an understanding of burnout as well as stress on patients' safety. Since nurse administrators are in charge of creating a good environment for nurses to practice and service delivery to patients, it is of great importance to use interventions that mitigate stress and burnout among nurses. The findings of these studies would have a threefold impact by reducing stress among nurses while ensuring satisfaction in their jobs (Ermak, 2014). In turn, satisfaction could increase management and improve the work environment for nursing staff. Eventually, improved workplace conditions could be useful in correcting the inadequate of people interested in pursuing nursing careers. Even though findings constantly demonstrated that nurse burnout is mainly linked to job discontentment, a few studies have examined the association between nurse burnout and patient satisfaction. Moreover, outcomes are also inconsistent with the two findings that examined the association between burnout, increased mortality and the failure to rescue patients that need urgent attention. The aspect of the low nurse-patient ratio is another variable that comes with a lot of discontentment. Consequently, practice implications seem vague when it comes to the impacts of work stress on the nursing staff. The lack of clarity stems in part from the intricacies of work -related stress and burnout theory.

References

Aiken, L., Clarke, S., Sloane, D., Sochalski, J., & Silver, J. (2002). Hospital Nurse Staffing and patient mortality, nurse burnout, and ob dissatisfaction . JAMA , 1987-1993.

Bushy, A, P. R. (2006). Bushy: NursiNg iN rural aNd FroNtier areas. Retrieved from Nursing in Rural and Frontier Areas: Issues, Challenges and Opportunities : http://www.hcs.harvard.edu/~hhpr/wp-content/uploads/2012/05/Bushy.pdf

Dixon M, E. (2003). Advance Healthcare Network for Nurses. Retrieved from Diversity in Nursing: http://nursing.advanceweb.com/Article/Diversity-in-Nursing.aspx

Ermak, L. (2014, January 27). National Nurses United. Retrieved from Beating the burnout: Nurses struggle with physical, mental and emotional exhaustion at work: http://www.nationalnursesunited.org/news/entry/beating-the-burnout-nurses-struggle-with-physical-mental-and-emotional-exha/