The effort-reward imbalance model as predictor of Portuguese nurses’ stress responses and job attitudes

Abstract

Work-related stress among health professionals has been identified as an important health problem around the world, including Portugal. This study sought to test the variables of the Effort-Reward Imbalance model (ERI) as predictors of stress responses and organizational outcomes amongst Portuguese nurses. The role of overcommitment for work place health is also considered. The sample consists of 310 female hospital-based nurses, from the northern region of Portugal (Age: M = 33.83; SD = 8.70). Measures were a Socio-demographic and Professional Questionnaire, and the Portuguese versions of the Effort Reward Imbalance Inventory (ERI), to assess job effort and reward, effort-reward imbalance ratio and overcommitment; the General Health Questionnaire (GHQ-12) and the Brief Personal Survey-Revised (BPS-R), to measure stress responses; and the Organizational Climate Questionnaire (QuACO) to measure job attitudes regarding organizational climate. A subgroup of 59 nurses were also assessed using biological indicators of stress, i.e. salivary cortisol levels at the time of awakening (e.g. Ct(+0), Ct(+30), CAR, TMCR). Data from GHQ-12 revealed clinical levels of psychological distress in 75.8% of the total sample (2/3 cut off). The ERI model produced significant independent effects for both nurses’ stress responses (e.g. psychological distress, pressure overload) and job attitudes (e.g. global satisfaction with meetings and work environment). Overcommitment emerged as a significant moderator of the relationship between perceived occupational stress and nurses’ stress responses (e.g. pressure overload). It was also an important predictor of salivary cortisol measures: Ct(+0) (ß = .28) and TMCR (ß = .26). The total variance explained by all predictors and hierarchical tested models ranged from 3.5% to 29.0%. Results highlight the incidence of psychological distress in Portuguese nurses and point to the relevance of the ERI model variables in explaining stress responses and job attitudes in this context. Findings can guide intervention development to improve occupational health for women in the nursing profession.