Introduction

Stress is an important factor in determining work output and satisfaction at work [1]. It is well known from various studies that healthcare workers across disciplines and irrespective of the type work may face job stress on a day to day basis [2]. Studies have demonstrated an inverse correlation between stress on the job and job satisfaction as well life satisfaction and quality of life [3, 4]. Hospital staff has shift duties and long hours of work that may increase their job stress and reduce satisfaction at work [5]. Dissatisfied hospital staff are more likely to provide inferior services and the physical, mental and social functioning of these workers may be affected substantially by the level of their job satisfaction [6]. Organizational psychological medicine in the recent years has focused on interventions that aim to reduce illness and improve wellness in hospital staff with an overall aim to enhance their quality of life in general [7]. Many studies have discussed stress, burnout and psychopathology in physicians and nurses as well as nursing students in India [8,9,10]. This stress has been related poor doctor’s attitude, posting in busy departments (emergency/ICU), inadequate pay, too much work and hospital policy. 40–45% of nursing staff in these studies were stressed across these studies. There is a dearth of Indian research on hospital staff such as ward assistants (ward boys), hospital cleaning staff (hospital sweepers) and rotational staff who work together as a team in hospitals. There is little or no data available on their job stress, job satisfaction or quality of life [11]. The present study was aimed at identifying job stress, job satisfaction and quality of life of various types of hospital staff based on the department they work in and the type of work they engage in a public hospital setting. For the purpose of the current study hospital staff meant Staff nurses, Student nurses, Ward boys and Sweepers from various departments of the hospital. The study also aimed at correlating the scores between various scales in this regard with respect to the whole sample.

Methodology

The study was a cross sectional study carried out in a public tertiary general hospital attached to a medical college within the city of Mumbai. After approval by the institutional ethics committee, the hospital staff was informed about the aims and objectives of the study. We approached 110 staff members and followed a systematic sampling method from various departments willing to participate in the study. A list of the staff in various departments was sought and every third staff member was interviewed. A total of 146 workers were contacted and 110 staff workers including Staff nurses, Student nurses, Ward boys and Sweepers from various departments of the hospital formed the final sample. They were interviewed in a single sitting using the following scales viz.

  1. 1.

    The Workplace Stress Scale (WSS) [12]—this is an 8 item Likert type scale with scores that range from 1 to 5 and a range of total scores from 8 to 40. The higher the score the greater is the level of stress. It has been used widely in a number of occupational health studies and has good reliability and validity.

  2. 2.

    The Generic Job Satisfaction Scale (GJSS) [13]—this is a 10 item Likert type scale made up of statements where the answers are scored in the range 1–5 from strongly disagree to strongly agree and total scores that range from 10 to 50. The scale has been used as a measure of job satisfaction and has good reliability and validity with a Cronbach alpha of 0.77.

  3. 3.

    WHO Quality of Life Brief Questionnaire (WHOQOL-BREF) [14]—it is a 26-item version of the WHOQOL-100 assessment. It is a standardized tool used across cultures to assess quality life with good reliability and validity across the world. It measures the QOL in four domains viz. physical, social, psychological and environmental along with a total score. It is one of the most commonly used and standardized measures of QOL across most studies.

The subjects comprised of staff only from departments that consented for the study. Hence staff from only a few departments formed part of the sample. All participants in the study were in the age range 18–60 years. No other specific inclusion or exclusion criteria were employed. The Hindi translations of the above scales were used for subjects that did not follow English.

Statistical Analysis

The comparison within groups based on the department the staff worked in (5 groups) and the type of work involved (4 groups) was done using a one way ANOVA and Tukey’s honest significance of difference (HSD) was used to ascertain intergroup differences. The correlation between total scales in the entire sample was done using a Spearman correlation considering the ordinal nature of the scales. All the statistics were computed using the VassarStats computerized statistical online software.

Results

The study sample consisted of 110 auxiliary health care workers. The age range of the sample 19–59 years with a mean age of 33.37 ± 12.36 years. The sample was divided into 5 groups based on the department they worked in and included 22 members each from the medicine, surgery, Intensive care unit (ICU), Rotational staff (that moved within departments) and psychiatry. The sample was also divided into 4 groups based on the work involved and they included staff nurses (n = 34, 30.9%), student nurses (n = 37, 36.6%), ward assistants or ward boys (n = 24, 21.8%) and sweepers (n = 15, 13.6%). All the staff in the study did shift works and rotated shifts regularly.

On comparing the scores on various scales in staff based on department of work it was noted that psychiatry and ICU staff scored higher on QOL scores compared to surgery and rotational staff which was clinically significant though the one way ANOVA did not reveal a statistical significance. Workplace stress was however lowest in rotational and psychiatry staff while highest scores were seen in medicine and ICU staff (F = 11.03, p < 0.0001). Job satisfaction was highest amongst psychiatry and medicine staff and though ANOVA revealed a statistical significance (F = 2.5, p = 0.0469), there were no major differences in scores observed across departments with lowest scores being reported from surgery staff (Table 1).

Table 1 Scores on various scales based on department of work
Full size table

On comparing the staff based on the type of work performed QOL scores was highest for staff and student nurses versus ward assistants and sweepers (F = 3.76, p = 0.0138). Workplace stress was lowest amongst student nurses and ward assistants while staff nurses showed high scores in this regard (F = 4.53, p = 0.0049). There were no differences across groups on job satisfaction scores though all scores demonstrated moderate to high scores on the scale (Table 2).

Table 2 Scores on various scales based on the type of job
Full size table

The total scores of the entire sample across all scales was correlated using the Spearman correlation and it was perceived that workplace stress correlated negative with QOL (r = −0.4629). There was a strong positive correlation between job satisfaction and QOL (r = 0.4493) while a very strong negative correlation between job stress and satisfaction was noted (r = −0.06749) (Table 3).

Table 3 Correlation table between various scales (R values—Spearman Rho)
Full size table

Discussion

Job Satisfaction

The study looked at hospital staff all from the same hospital. Staff working in a tertiary general public hospital would usually have a stable job and fixed work hours with a good salary. Working in a public hospital like a municipal hospital involved in the study also involves regular leave and provident fund benefits and health insurance unlike many jobs in the private healthcare sector. Jobs with a secure future and steady growth are usually satisfying [15]. The employees across various departments showed similar scores on the job satisfaction scale. This was seen in all departments with lowest scores in the surgery staff but these low scores were actually in the moderate range of job satisfaction. This also held true irrespective of the type of work involved in keeping with the factors described above.

Job Stress

Job stress was lowest among the psychiatry and rotational staff. It has been shown that staff working in mental health facilities may be more resilient and may adapt over the years more to job stress keeping in mind the training they undergo in handling patients with psychiatric disorders [16]. Job stress was also low in rotational staff. We hypothesize that the fact that they moved from department to department gave them no permanent responsibility for work in any sector and may have helped in alleviating their job stress. Medicine, ICU and surgery staffs treat more high risk cases and serious patients and this may probably contribute to their job stress. Deaths in medical and surgical wards as well as ICUs are higher and may add to job stress [17]. Job stress was also lowest in student nurses probably due to the fact that they may not be held responsible for errors that may inadvertently occur in the learning period. It is well documented that student nurses undergo far less stress than staff nurses in a hospital as the learning period is usually enriching and fulfilling compared to the working phase [18]. In our study the rotational staff has lowest scores on job stress but had poor scores on job satisfaction and quality of life (Table 1). This may due to the unstable nature of the duties and irregular timings as well non-stability of work in a single department like non-rotational staff.

Quality of Life (QOL)

Quality of life (QOL) was reported to be highest in ICU and psychiatry staff in keeping with their training and their ability to deal with stress unlike staff in other departments [19]. QOL was far greater in staff like nursing staff and student nurses compared to labour staff like ward assistants and sweepers. This may be due to education levels, differences in salaries and socio-cultural factors that may play a role.

The staff nurses in the study had greater QOL scores than ward assistants though they scored higher on job stress and lower on job satisfaction. This may be due to the stressful nature of their job and probably certain personal characteristics which were not explored and beyond the scope of the current study.

Job stress correlated negative with QOL and job satisfaction while job satisfaction correlated positively with QOL. This is in keeping with studies done in healthcare and other populations worldwide [20,21,22].

The current study was limited by a small sample size and many departments like gynaecology and paediatrics not being considered. There were many confounding factors like socio-demographic factors, financial status and psychopathological factors that were not considered during the evaluation which could have affected outcomes.

Conclusions

The study stresses that it is important that job stress be addressed on a regular basis in health care auxiliary workers in hospitals with aim to improve their quality of life and promote job satisfaction. Further studies that compare larger samples across different hospitals are warranted.