Hospital Study Links Career Stages to Nurse Stress and Life Satisfaction

A multicenter cross-sectional investigation conducted across nine public hospitals in Egypt has revealed that job-related stress is inversely related to nurses’ quality-of-life enjoyment and satisfaction, with the highest strain observed among professionals in the earliest phases of their careers. Published in Nursing Open, the observational study evaluated 277 registered nurses across Sohag Governorate and documented a powerful negative correlation between perceived workplace stressors and overall quality of life (Pearson correlation r = −0.83, p < 0.001). Drawing upon theoretical frameworks including the Job Demands–Resources model and the PERMA model of well-being, the researchers sought to understand how the distribution of workplace burdens and personal coping resources shifts across distinct career stages. The assessment established that cumulative professional experience corresponds to a progressive reduction in occupational strain alongside a concurrent increase in reported life satisfaction, shedding light on the critical occupational vulnerabilities that characterize early frontline clinical practice.

The study was designed and conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines to investigate occupational stress dynamics within public healthcare institutions in Upper Egypt. The research team focused on nine public hospitals geographically distributed across distinct sectors of Sohag Governorate, ensuring coverage across the governorate’s primary population centers. These facilities were selected because they provide a broad spectrum of specialized medical services to local populations—a clinical environment that inherently generates substantial occupational pressures—and employ a relatively large cadre of bachelor’s-prepared nursing personnel. The investigators utilized a descriptive-correlational, cross-sectional design because the primary objective centered on evaluating associations rather than verifying causal mechanisms. The authors noted that experimental randomization and longitudinal tracking were ethically challenging and practically unfeasible within the operational realities of multiple active hospital environments during the investigation period.

To assemble the study cohort, the researchers recruited a convenience sample of registered nurses holding at least one year of verified clinical experience within the selected hospital facilities. A statistical power analysis conducted prior to data collection, assuming an alpha level of 0.05, a medium effect size of f-squared = 0.15, and a statistical power of 0.80 based on standard methodological criteria, established that a minimum sample size of 184 participants was required to reliably detect significant associations. The final cohort comfortably exceeded this threshold: from 327 eligible nurses invited to participate across the nine hospitals, 290 completed and submitted electronic survey forms, and 13 submissions were subsequently excluded due to incomplete data records. This yielded a completed analytic sample of 277 nurses, reflecting a response rate of 88.7 percent across the participating clinical centers while acknowledging the sampling boundaries inherent to non-probability recruitment.

Participant demographics reflected the operational composition of regional hospital nursing departments. Female nurses comprised 58.5 percent of the sample (162 individuals), while male nurses accounted for 41.5 percent (115 individuals). The participants had a mean age of 27.32 ± 6.05 years, with 70.8 percent (196 individuals) falling into the 25-to-35 age bracket, 19.5 percent (54 individuals) aged under 25, 6.5 percent (18 individuals) aged 35 to 45, and 3.2 percent (9 individuals) aged older than 45. In terms of professional rank, direct care nurses represented 33.9 percent of the cohort (94 individuals) and head nurses made up 33.6 percent (93 individuals), alongside nursing supervisors at 21.7 percent (60 individuals), assistant nurse directors at 5.4 percent (15 individuals), and nurse directors at 5.4 percent (15 individuals). Marital status breakdowns indicated that 57.4 percent were single (159 individuals), 33.6 percent were married with children (93 individuals), and 9.0 percent were married without children (25 individuals).

Classification by professional tenure placed more than half of all participants in the earliest career interval. Nurses were grouped into four distinct professional phases: the exploration stage, spanning 1 to under 5 years of experience; the establishment stage, covering 5 to under 10 years; the advancement stage, comprising 10 to under 20 years; and the withdrawal stage, representing 20 or more years of service. Within the sampled cohort, 53.8 percent of participants (149 individuals) occupied the exploration stage, followed by 34.7 percent (96 individuals) in the establishment stage, 7.6 percent (21 individuals) in the advancement stage, and 4.0 percent (11 individuals) in the late-career withdrawal stage. This heavily skewed tenure distribution aligns with broader nursing workforce patterns in Egyptian public healthcare systems, where younger and newly qualified staff members carry the primary burden of frontline clinical rotations.

Workplace stressors were measured using the 23-item Work Stress Assessment Questionnaire, which captures six distinct dimensions of workplace pressure: Reward, Relation, Demand, Role, Control, and Support. Each statement is rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), where an overall arithmetic mean of 2.5 or greater indicates significant job-related stress. In the current cohort, the questionnaire demonstrated strong overall internal consistency (Cronbach’s alpha = 0.89), with domain-specific alpha coefficients reaching 0.84 for demands, 0.86 for control, 0.77 for support, 0.83 for role, 0.74 for relationships, and 0.86 for rewards. Quality of life was quantified using the 14-item Quality-of-Life Enjoyment and Satisfaction Questionnaire–Short Form, which assesses domains including physical health, emotional state, work, household responsibilities, social interactions, and leisure activities over the previous week. Scored on a 5-point scale with total raw scores ranging from 14 to 70, results are converted into percentage scores; scores below 70 percent indicate lower satisfaction relative to published community benchmark samples. The instrument showed acceptable internal reliability in this population (Cronbach’s alpha = 0.83).

Descriptive evaluation of the stress assessment instruments identified substantial overall strain across the workforce, accompanied by a total mean job stress score of 80.91 ± 13.98 and an average item mean of 4.13 ± 0.70. When individual stressor domains were examined, Reward emerged as the most acute source of workplace strain, presenting the highest average score at 3.94 ± 0.91 (total domain mean 11.82 ± 2.74). The Relation domain ranked second with an average score of 3.56 ± 0.78 (mean 10.69 ± 2.33), closely followed by Demand at 3.60 ± 0.73 (mean 14.39 ± 2.92). Role clarity and responsibilities scored an average of 3.64 ± 0.61 (mean 21.80 ± 3.64), Control averaged 3.33 ± 0.80 (mean 13.32 ± 6.36), and Support scored lowest at 3.01 ± 0.84 (mean 9.04 ± 2.51). On the life satisfaction inventory, participants achieved a total mean score of 2.74 ± 0.33, with 73.65 percent of respondents (204 individuals) falling below the 70 percent community reference benchmark, leaving only 26.35 percent (73 individuals) in the satisfactory category. Domain rankings showed economic status (3.45 ± 1.31) and physical health (3.43 ± 1.06) scoring highest, whereas leisure activities (2.29 ± 1.27), overall well-being (2.51 ± 1.43), and social relationships (2.53 ± 1.45) scored lowest.

Analysis across professional experience brackets revealed that job-related stress steadily declined as nurses advanced through their professional careers, while life enjoyment and satisfaction showed a corresponding upward trajectory. Nurses in the exploration stage exhibited the highest stress levels at 80.04 ± 13.63 and the lowest quality-of-life scores at 2.49 ± 0.36. Among nurses in the establishment phase, mean stress dropped to 73.48 ± 10.34 while life satisfaction rose to 2.68 ± 0.23. For nurses in the advancement stage, stress decreased further to 69.35 ± 11.56, with life satisfaction reaching 2.70 ± 0.45. Finally, nurses in the withdrawal stage recorded the lowest stress at 64.67 ± 8.48 and the highest satisfaction scores at 2.89 ± 0.87. Inferential testing confirmed that these differences across career stages were statistically significant for both job stress (Welch’s F = 14.087, degrees of freedom 3, 37.45, p < 0.001) and quality-of-life satisfaction (Welch’s F = 8.790, degrees of freedom 3, 33.29, p < 0.001). Similar significant variations appeared across age brackets and professional roles, with frontline bedside nurses reporting significantly higher stress and lower life satisfaction than senior administrative directors.

The observed differences across demographic and professional variables provide practical context for interpreting hospital workforce pressures. While female nurses reported marginally higher mean stress (81.49 ± 10.43) than male nurses (80.58 ± 11.49), and male nurses reported slightly higher life satisfaction (2.84 ± 0.24) than females (2.80 ± 0.33), independent t-tests demonstrated that gender differences were not statistically significant (t = −0.675, p = 0.501 for stress; t = 1.168, p = 0.244 for satisfaction). In contrast, age groups differed markedly: participants younger than 25 years experienced the highest occupational stress (79.68 ± 13.68) and lowest satisfaction (2.44 ± 0.46), whereas those older than 45 years registered the lowest stress (63.45 ± 12.46) and highest satisfaction (2.77 ± 0.13), with Welch’s ANOVA confirming significance (stress F = 6.211, p = 0.002; satisfaction F = 7.074, p < 0.001). Furthermore, direct care nurses experienced substantially higher stress (76.43 ± 12.78) and poorer satisfaction (2.32 ± 0.45) than nurse directors, who averaged 65.56 ± 6.21 for stress and 2.80 ± 0.40 for satisfaction (Welch’s F = 8.013 and F = 13.379, both p < 0.001).

The study authors highlighted several methodological limitations that restrict the broader interpretation of their results. First, the cross-sectional study design captures data at a single point in time and precludes establishing direct causal mechanisms between workplace stressors, career progression, and quality-of-life outcomes. Second, recruitment relied on convenience sampling across public hospitals within a single Egyptian governorate, which introduces potential selection bias and limits generalizability to private healthcare centers or facilities in other administrative regions. Third, the career-stage subgroups were unevenly populated; the late-career withdrawal category included only 11 participants, constraining statistical power for pairwise comparisons involving senior personnel. Fourth, the survey instruments were administered in their original English versions without local cultural adaptation, which may have introduced subtle measurement discrepancies despite verified scale reliability. Finally, the authors noted potential non-response bias, emphasizing that longitudinal studies with balanced career cohorts will be required to confirm how occupational stressors evolve over extended clinical tenures.

Subject of Research: Occupational stress and quality of life across nursing career stages

Article Title: Job‐Related Stressors and Quality‐Of‐Life Enjoyment and Satisfaction Across Nurses' Career Stages: A Multicenter Cross‐Sectional Study

Article References: Ali, H. I., Abdeen, S. M. M., & Ewise, H. S. (2026). Job‐Related Stressors and Quality‐Of‐Life Enjoyment and Satisfaction Across Nurses' Career Stages: A Multicenter Cross‐Sectional Study. Nursing Open, 13(11), Article e70978. https://doi.org/10.1002/nop2.70978

Image Credits: AI Generated

DOI: 10.1002/nop2.70978

Keywords: nursing research, occupational stress, quality of life, career stages, workplace health, cross-sectional study, hospital administration, healthcare workforce, Related, Stressors, Quality, Life