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Barriers to Work-Life Balance for Hospital Nurses

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DOI: 10.1177/2165079914565355 · Source: PubMed

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research-article2014
WHSXXX10.1177/2165079914565355Workplace Health & SafetyWorkplace Health & Safety
Workplace Health & Safety
PROFESSIONAL PR ACTICE
Barriers to Work–Life Balance for Hospital Nurses
Kathleen Mullen, PhD, MS, RN1
Abstract: Nurses are loyal to their patients and
coworkers. They often put the needs of others before
their own and sometimes even before the needs of their
families. This concern for others can cause conflicts that
manifest as stress. Of the more than 2 million nurses in the
United States, more than 62% work in hospitals. Hospitals
are known to be both rewarding and stressful places
to work. Like most workers, nurses face the challenge
of balancing demands and achievements of work with
those in their private lives. Hospital leaders can facilitate
improved work–life balance (WLB) for hospital nurses
by using tools already in place. Equally important, nurses
can use their knowledge and resources to nurse the
nurse within, which can greatly improve their experience
of WLB, independent of the demands of their work
environment.
Keywords: hospital nurses, work–life balance, employee
health, employee assistance program
W
ork–life balance (WLB) is a contemporary acronym
for achieving balance between work and lifestyle
ambitions. Although WLB is not well defined, the
implication is that the two experiences (work and home life)
should be in a state of equilibrium for nurses to be happy and
healthy. Nurses often describe experiencing a lack of balance
between their work and life outside of work. Yet if a sense of
balance between work and lifestyle demands could be
achieved, fewer nurses would report stress and more would be
living healthier lives at home and in the workplace.
More than 2.5 million nurses practice in the United States. Of
those, more than 62% are employed by hospitals (American
Association of Colleges of Nursing [AACN], 2011). Hospitals
deliver acute health care to patients and are known to be both
rewarding and stressful work environments. The American
Nurses Association (ANA, 2014) reports that the three most
frequent concerns of hospital nurses are related to staffing,
mandatory overtime, and workplace safety (ANA, 2014).
DOI: 10.1177/2165079914565355. From 1University of California School of Nursing. Address correspondence to: Kathleen Mullen, PhD, MS, RN, University of California School of
Nursing, 1215 Idylberry Road, San Rafael, CA 94903, USA; email: Kathleen.RN@gmail.com.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2015 The Author(s)
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March 2015
Most nurses are happier when experiencing feelings of
achievement and satisfaction from their work rather than trying
to acquire an arbitrary sense of work–life balance (Vredenburgh
& Trinkaus, 1983). One of the goals in this article is to recognize
that nurses experience more satisfaction at home and work by
using tools to manage their stress.
Stress can manifest as physical complaints and emotional
anxiety (Luca, Bellia, Bellia, Luca, & Calandra, 2014).
Satisfactory integration of role achievement and enjoyment
results in a positive emotional state experienced as WLB
(Davis, Lind, & Sorensen, 2013; Winefield, Boyd, & Winefield,
2014). However, the two areas of work and life are neither
equally balanced nor fixed. In other words, WLB fluctuates
within an acceptable zone based on a range of circumstances
and individual expectations.
Hospital Work Environment
Most hospitals provide care to sick patients regardless of
their ability to pay. Yet as nurses are aware, hospitals must
generate revenue to stay in business. Although the Affordable
Care Act has provided coverage for previously uninsured
patients, the law has also changed the way hospitals are
reimbursed for care. For example, hospital reimbursement is
now evaluated based on a number of metrics including
patient’s length of stay, industry guidelines for admissions
criteria, hospital readmission, hospital-acquired illnesses, and
patient satisfaction ratings.
The Occupational Safety and Health Administration (OSHA;
2014) describes hospitals as
some of the most stressful places to work with potential
hazards that include life-threatening injuries and illnesses
complicated by overwork, understaffing, tight schedules,
paperwork, intricate or malfunctioning equipment,
complex hierarchies of authority and skills, dependent
and demanding patients, and patient deaths.
No national standard for nurse–patient ratios (i.e., the
number of patients a nurse is assigned during a shift) has been
vol. 63  ■  no. 3
Table 1.  OSHA: Methods of Reducing Hospital Worker Stress (OSHA, 2014)
1.  Educate nurses about the consequences of personal stress.
2.  Use stress management programs offered by the Employee Health Service.
3.  Promote the availability of confidential counseling through employee assistance programs (EAP).
4. Target in-service education opportunities to improve workers’ skills and confidence in coping with specific hospital-based
workplace situations such as cancer, death and dying, child abuse, and violence.
Note. OSHA = Occupational Safety and Health Administration.
established. Currently, California is the only state with mandated
nurse–patient ratios, though other states are working toward
similar staffing goals (Schultz, 2013).
Likewise, nurses’ shift length is not regulated. Most hospital
nurses work shifts of either 8.5 or 12.5 hr and many nurses are
required to work overtime (Rogers, Hwang, Scott, Aiken, &
Dinges, 2004). Nursing literature has documented that high
nurse–patient ratios and nurse fatigue are risk factors for patient
accidents and injuries (McClelland, Switzer, & Pilcher, 2013;
Stimpfel & Aiken, 2013; Stimpfel, Sloane, & Aiken, 2012).
However, the impact of nurse–patient ratios on WLB for hospital
nurses is unknown.
As acknowledged by OSHA, hospital nurses are members of a
complex health care team who provide care to sick and dying
patients and their families. These nurses must maintain a strict
work flow to closely monitor patients for cardiac or respiratory
arrest, or more subtle changes in patients’ level of consciousness,
blood chemistry, or risk behaviors (e.g., getting out of bed
without assistance). As complex as the patient clinical
environment may be, the health care team can be even more
complex. In addition to managers who monitor regulatory
standards that affect reimbursement for care, the health care
team includes a wide range of health care specialists.
Depending on specific patient health conditions, providers
contribute to their care in unique ways.
Although nurses are the largest group of hospital workers, staff
nurses who provide direct patient care have little control over their
work environment. Successful solutions to improved WLB involve
both the hospital and the individual nurse. In fact, most hospital
leaders have resources to assist nurses in improving WLB. For
example, OSHA recommends leadership access tools available
through human resources and employee education departments
(Table 1) to support nurses as they improve WLB.
Nurses Take Action for Satisfying Life
Nurses choose their profession for a variety of reasons. In a
study that explored injured nurses’ motivations to work, many
reported that becoming a nurse represented both a meaningful
way to be of service to others and at the same time provided a
role identity that connected them to family members or admired
members of the community (Mullen, Gillen, Kools, & Blanc,
2013).
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Workplace Health & Safety
Nurses’ commitment to their profession as well as the
physical and emotional demands of working with sick and
dying patients can place nurses at risk of failing to recognize
their own physical and emotional needs. By performing the
most basic patient assessment, nurses are able to identify
indicators of stress. Likewise, they can provide evidence-based
recommendations for lifestyle changes to reduce stress.
Although nurses are well educated about when and how to
intervene to meet the needs of others, many discount their own
needs (Mullen et al., 2013).
Stress is a consequence of work–life imbalance (O’Keefe,
Brown, & Christian, 2014). Stress is experienced physically and
emotionally (e.g., musculoskeletal disorders, pain, anxiety, and
sleep disorders; Koh et al., 2014). Nurses learn to work under
pressure, often with limited resources, but although nurses’
work stress may be unique because of workplace demand, the
stress from lifestyle demand is widely shared by all workers. For
example, most hospital nurses are women. Depending on their
own age, many nurses care for children or aging parents, and
they also provide wages and benefits critical to their families’
basic needs.
Finding the Motivation to Change
Happiness lies not in the mere position of money;
it lies in the joy of achievement, in the
thrill of creative effort.
—Franklin D. Roosevelt (1933)
Nurses know that patient education should empower
individuals to take an active role in changing their lifestyles. The
same is true for nurses who seek WLB. To help themselves cope
with the emotional consequences of poor WLB, nurses must
learn to nurse the nurse within. By doing so, nurses can be role
models for their colleagues.
Nurses can use their own knowledge and skills to improve
their WLB. Nurses need not wait for changes in hospital policy
or nurse–patient ratio legislation, or leave their hospital
positions to improve their WLB; nurses have individual power.
The first step to improve WLB is to recognize that the
changes needed are indeed individual. Each nurse who
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Workplace Health & Safety March 2015

Table 2.  Work–Life Balance—A Self-Inventory

•  List role models who have an acceptable balance between demands at home and work.
•  What is keeping you from the happiness you deserve from your life at work and home?
•  Reflect on the events of today—describe how you dealt with the stress experienced today.
•  N
 ame one of the smallest things on your list that, if it were done, would feel like a weight had been lifted from you. How
about another small thing? Can you name three small things that are waiting for your time?
•  Y our situation is unique but others share similar experiences of feeling stressed. Who might you turn to for support to begin
the self-kindness change requires?
•  How do you experience stress in your mind/body/spirit?

experiences the effects of work–life imbalance has a unique
story. Nurses can begin by identifying individual priority areas;
taking an inventory of individual needs and stressors is the
first step in improving WLB. A second step is for nurses to
realize that changing behaviors is challenging, requiring
support, encouragement, permission, and a belief in self-
worth. For nurses, similar to others who provide direct patient
care, this step might require new thinking and new behaviors.
Steps That Can Make Changes
After acknowledging the need for change, nurses must find a
starting place, create an individual plan, and continue to assess
the need for modifications as circumstances evolve. A WLB
inventory can assist individuals to focus on priority areas where
rapid success is achievable, contributing to change momentum.
Lifestyle changes are not easy especially if attempted without
assistance; a key to success is finding individuals and processes
that can support change. Coaching, a tool for self-improvement,
is not new. Many health care providers employ nurses who
assist patients achieve and sustain positive lifestyle changes.
Now nurses must access tools they use to advocate for their
clients to help themselves make healthy lifestyle changes. When
work and lifestyle demands collide, nurses can take advantage
of nursing the nurse within by using familiar tools and
resources. Completing a WLB self-inventory (Table 2) can
establish areas to set in motion for an individualized change
process.
A lifestyle coach can establish a process to support change.
Generalist life coaches, as well as nurse life coaches who have
specific insight into the complexities of health care, are
available. Finding a coach is similar to finding any other
counselor. Valuable sources for finding a wellness coach to
facilitate WLB include employer-sponsored employee
assistance programs (EAP), trusted coworker and friend
referrals, or health coach training facilities. Nurses must
choose a coach who engenders trust and confidence. If an
individual coach is not realistic, other sources of support and
encouragement may improve nurses’ responses to conflicting
demands. Some nurses may prefer to keep a journal of
thoughts and ideas. Others may establish a contract for change
with a supportive friend or mentor. Still others combine
several methods to use as their individual process changes and
matures.
Implications for Occupational Health Nurses
Hospital employee health nurses support the health and
wellness of nurses and other health care workers. Although
occupational health nurses often focus on specific workplace
rules and regulations for health and safety, acknowledging the
importance of WLB to employee health is an emerging area. By
becoming more aware of the consequences of occupational and
personal stressors, employee health nurses can expand their
role and increase their value to both workers and organizational
leadership. OSHA suggests a variety of strategies to bridge
employee health to other employee assistance programs that are
already in place, resulting in better use of services, and
improving employee health nurse and staff relations.
Summary
Improving work–life balance requires active, evidence-based
strategies. The process begins with self-reflection and progresses
by taking action. Hospital nurses are drawn to the environment
for many of the same reasons that challenge their well-being. Yet
nurses can learn individual strategies to achieve a sense of
balance and well-being. This knowledge will support them as
they become successful and effective at work, maintaining roles
outside the hospital that bring happiness and joy. Recognizing
the need for and committing to change are the starting points
for creating effective WLB.
Acknowledgments
The author would like to thank Mikako Arakida, RN, PHN, PhD,
professor, School of Nursing and Rehabilitation Science at
Odawara International University of Health and Welfare, Japan

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 vol. 63  ■  no. 3
and Oi Saeng Hong, RN, PhD, FAAN, professor, University of
California San Francisco, California.
Conflict of Interest
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
American Association of Colleges of Nursing. (2011). Nursing fact sheet.
Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/
nursing-fact-sheet
American Nurses Association. (2014). Top issues for staff nurses. Retrieved
from http://www.nursingworld.org/EspeciallyForYou/Staff-Nurses/
staffnurses
Davis, S., Lind, B., & Sorensen, C. (2013). A Comparison of burnout among
oncology nurses working in adult and pediatric inpatient and outpatient
settings. Oncology Nurses Forum, 40, 303-311.
Koh, S. J., Kim, M., Oh, D. Y., Kim, B. G., Lee, K. L., & Kim, J. W. (2014).
Psychosocial stress in nurses with shift work schedule is associated with
functional gastrointestinal disorders. Journal of Neurogastroenterology
and Motility, 20, 516-522.
Luca, M., Bellia, S., Bellia, M., Luca, A., & Calandra, C. (2014). Prevalence of
depression and its relationship with work characteristics in a sample of
public workers. Neuropsychiatric Disease and Treatment, 10, 519-525.
McClelland, L. E., Switzer, F. S., III, & Pilcher, J. J. (2013). Changes in
nurses’ decision making during a 12-h day shift. Occupational Medicine
(London), 63, 60-65. doi:10.1093/occmed/kqs189
Mullen, K., Gillen, M., Kools, S., & Blanc, P. (2013). Hospital nurses
working wounded: Motivations and obstacles to return to work as
Downloaded from whs.sagepub.com at KAISER PERMANENTE MEDICAL CEN on May 21, 2015
View publication stats
Workplace Health & Safety
experienced by nurses with injuries. Work, 50(2), 295-304. doi:10.3233/
wor-131800
Occupational Safety and Health Administration. (2014). Hospital hazards.
Retrieved from www.osha.gov/SLTC/etools/hospital/index.html
O’Keefe, L. C., Brown, K. C., & Christian, B. J. (2014). Policy perspectives
on occupational stress. Workplace Health & Safety, 62, 1-7. doi:
10.3928/21650799-20140813-02
Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken, L. H., & Dinges, D. F.
(2004). The working hours of hospital staff nurses and patient safety.
Health Affairs (Millwood), 23, 202-212.
Roosevelt, F. (1933). First inaugural address. Retrieved from http://www.
millercenter.org/president/speeches/speech-3280
Schultz, D. (2013). Nurses fighting state by state for minimum staffing laws.
Retrieved from http://www.kaiserhealthnews.org/stories/2013/april/24/
nurse-staffing-laws.aspx
Stimpfel, A. W., & Aiken, L. H. (2013). Hospital staff nurses’ shift length
associated with safety and quality of care. Journal of Nursing Care
Quality, 28, 122-129. doi:10.1097/NCQ.0b013e3182725f09
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the
shifts for hospital nurses, the higher the levels of burnout and patient
dissatisfaction. Health Affairs (Millwood), 31, 2501-2509. doi:10.1377/
hlthaff.2011.1377
Vredenburgh, D. J., & Trinkaus, R. J. (1983). An analysis of role stress
among hospital nurses. Journal of Vocational Behavior, 22, 82-95.
Winefield, H. R., Boyd, C., & Winefield, A. H. (2014). Work-family conflict
and well-being in university employees. The Journal of Psychology, 148,
683-697.
Author Biography
Kathleen Mullen, PhD, MS, RN, is Assistant Clinical Professor-
volunteer at the University of California San Francisco,
Community Health Systems. Dr. Mullen’s work focuses on the
impact of work injury and job loss on the individual, family,
and community.
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