Project – Prevalence and Determinants of Occupational Stress Among Healthcare Workers in Public Hospitals. Case study: Selected public hospitals in Lagos State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Occupational stress has become an important public health and workplace concern because of its potential effects on workers’ physical health, psychological well-being, productivity, and quality of service delivery. It occurs when the demands and pressures associated with a job exceed, or are perceived to exceed, an individual’s ability and available resources to cope effectively. In healthcare settings, occupational stress may arise from excessive workloads, long working hours, shift duties, emotional demands, exposure to suffering and death, inadequate equipment, and difficult interactions with patients and colleagues. Healthcare workers are particularly vulnerable because their responsibilities involve making decisions that can directly affect human life, often under time pressure and conditions of uncertainty. The World Health Organization (WHO, 2022) explains that working conditions can either protect or undermine mental health, depending on factors such as workload, job control, workplace relationships, and organisational support. Therefore, understanding occupational stress among healthcare workers is essential for protecting the workforce and maintaining effective healthcare services.

The prevalence of occupational stress among healthcare workers is an important issue because stress can affect individuals differently depending on the intensity, duration, and nature of their occupational demands. While occasional pressure may occur in almost every profession, persistent exposure to excessive demands without adequate recovery or support may contribute to emotional exhaustion, fatigue, reduced motivation, and burnout. The WHO (2022) identifies workplace psychosocial risks as factors requiring attention through appropriate organisational policies, preventive measures, and support systems. Evidence from healthcare settings also demonstrates that psychological distress and burnout have been substantial concerns among health and care workers. A report by the WHO and its collaborating partners found that considerable proportions of healthcare workers surveyed during the COVID-19 pandemic reported symptoms of anxiety, depression, and burnout, although these estimates relate to the pandemic period and should not be interpreted as current prevalence estimates for all healthcare workers (WHO, 2022). These findings reinforce the need for studies that measure occupational stress within specific populations and healthcare institutions.

Healthcare workers perform different professional and support functions, and their exposure to occupational stress may vary according to their responsibilities and working environments. Doctors may experience pressure associated with clinical decisions, emergency treatment, and responsibility for patient outcomes, while nurses may face prolonged bedside care, rotating shifts, staffing shortages, and demanding interactions with patients’ relatives. Medical laboratory scientists, pharmacists, radiographers, community health workers, and other healthcare personnel may also experience stress arising from time-sensitive duties, technical responsibilities, patient expectations, and limited resources. The WHO (2024) identifies time pressure, lack of control over work tasks, long working hours, shift work, insufficient support, and moral injury as important psychosocial risks for health workers. This indicates that occupational stress should not be understood exclusively as a problem affecting doctors or nurses. Rather, a comprehensive assessment should consider different categories of healthcare workers and examine whether occupational stress varies according to their professional roles and workplace conditions.

The determinants of occupational stress include a combination of organisational, occupational, interpersonal, and individual factors. Organisational determinants may include staff shortages, excessive workloads, inadequate remuneration, limited opportunities for professional development, poor communication, insufficient equipment, and lack of participation in workplace decisions. Occupational determinants may involve long shifts, night duty, frequent emergencies, high patient volumes, and exposure to traumatic clinical events. Interpersonal determinants may include workplace conflict, inadequate supervisory support, harassment, and difficult relationships with patients or colleagues. Individual characteristics, such as age, professional experience, family responsibilities, and coping resources, may also influence how workers perceive and respond to job demands. The WHO (2022) recommends addressing workplace mental health risks through organisational interventions, manager training, worker education, and appropriate individual support. Consequently, investigating occupational stress requires examining not only whether healthcare workers experience stress but also the workplace conditions and personal characteristics associated with it.

The consequences of occupational stress extend beyond the individual worker and may affect the overall performance of healthcare institutions. Prolonged stress can contribute to emotional exhaustion, chronic fatigue, absenteeism, reduced job satisfaction, and intentions to leave employment. In healthcare settings, these outcomes may affect staff retention, teamwork, communication, and the consistency of patient care. The WHO (2024) notes that prolonged occupational stress may contribute to burnout, increased staff turnover, reduced patient satisfaction, and a greater likelihood of diagnostic and treatment errors. Such outcomes are particularly concerning in public hospitals, where healthcare workers must respond to diverse patient needs while maintaining professional standards and patient safety. Occupational stress should therefore be viewed as both a workforce welfare issue and a potential organisational challenge. Identifying its prevalence and determinants can help hospital administrators develop targeted measures to improve working conditions, strengthen staff support, and sustain effective service delivery.

In Nigeria, occupational stress among healthcare workers deserves particular attention because healthcare institutions must operate within the available staffing, infrastructure, funding, and equipment resources while responding to continuing demand for medical services. Healthcare workers may face pressure arising from patient loads, demanding shifts, limited supplies, administrative responsibilities, and the emotional burden of treating seriously ill patients. A study by Obasohan and Ayodele (2015), which assessed job stress among 290 clinical healthcare workers in three selected healthcare organisations in Lagos State, established that job stress was a relevant issue requiring assessment and management in the local healthcare environment. Although the study provides useful historical evidence, its findings cannot automatically establish the current prevalence or determinants of occupational stress among workers in the particular public hospitals selected for the present research. Differences in institutional conditions, professional composition, staffing, and study periods may affect observed levels of stress. There is therefore a need for further research that specifically examines occupational stress among healthcare workers in selected public hospitals in Lagos State.

Lagos State is an important setting for studying occupational stress because its public hospitals provide healthcare services to a large and diverse population through different levels of medical care. Healthcare workers in these facilities may be required to manage routine consultations, emergencies, referrals, inpatient treatment, and other services that demand professional competence and sustained attention. The combination of clinical responsibility, administrative requirements, shift work, patient expectations, and available institutional resources may influence workers’ experiences of stress. Although earlier research in Lagos has examined job stress among clinical healthcare workers, further institution-specific evidence is needed to establish the current prevalence of occupational stress and investigate its associated determinants across the selected public hospitals (Obasohan & Ayodele, 2015). The present study will therefore assess the proportion of healthcare workers experiencing occupational stress, examine selected organisational and individual factors associated with stress, and determine whether occupational stress differs across relevant demographic and professional groups. The findings may provide evidence to guide hospital management, workplace health initiatives, staff welfare programmes, and policies aimed at supporting healthcare workers in Lagos State.

1.2 Statement of the Problem

Occupational stress among healthcare workers is a significant concern because it can undermine staff well-being, workplace performance, and the quality of patient care. Healthcare workers are routinely exposed to demanding situations involving emergencies, severe illnesses, patient suffering, heavy workloads, and decisions that may have life-threatening consequences. When these demands occur alongside inadequate rest, limited resources, or insufficient organisational support, workers may experience persistent psychological and physical strain. The World Health Organization (WHO, 2022) recognises that adverse working conditions and psychosocial risks can negatively affect mental health, work performance, and workers’ ability to remain productive. Although healthcare institutions depend on the competence and well-being of their personnel, insufficient attention to occupational stress may leave workers exposed to preventable workplace pressures.

A further problem is that occupational stress may arise from several interconnected factors, making it difficult to address without systematic assessment. Staff shortages, excessive patient loads, long working hours, shift duties, poor communication, inadequate equipment, and limited supervisory support may contribute to stress among healthcare workers. The WHO (2024) identifies excessive time pressure, insufficient control over work, long hours, shift work, and lack of support as important occupational risks in the health sector. However, the relative importance of these factors may differ across hospitals and professional groups. Without identifying the most prominent stressors within particular institutions, hospital administrators may find it difficult to develop interventions that address workers’ actual needs. This creates a need to investigate the organisational and individual factors associated with occupational stress in selected public hospitals in Lagos State.

Another concern is the possible effect of occupational stress on the delivery of healthcare services. Persistent stress may contribute to fatigue, emotional exhaustion, reduced job satisfaction, absenteeism, and staff turnover, thereby affecting workforce stability and continuity of care. In demanding clinical environments, excessive stress may also interfere with concentration, communication, and decision-making, with potential implications for patient safety. The WHO (2024) highlights the relationship between prolonged occupational stress and outcomes such as burnout, chronic fatigue, absenteeism, and increased staff turnover. Although these consequences are recognised internationally, their extent among healthcare workers in the selected public hospitals in Lagos State must be established through systematic local investigation. It is therefore important to determine the prevalence of occupational stress and examine its relationship with relevant workplace and personal characteristics.

Finally, although Obasohan and Ayodele (2015) investigated job stress among clinical healthcare workers in selected healthcare organisations in Lagos State, their findings do not establish the current prevalence and determinants of occupational stress among healthcare workers in the specific public hospitals covered by this study. Changes in staffing arrangements, workload, hospital resources, professional composition, and working conditions make it necessary to undertake further institution-specific research. The central problem addressed by this study is the lack of sufficiently specific, current evidence on the prevalence of occupational stress and the factors associated with it among healthcare workers in the selected public hospitals. The study will therefore determine the prevalence of occupational stress, identify the principal occupational and organisational stressors, examine relevant demographic and professional factors, and assess the association between selected determinants and occupational stress. Its findings may assist hospital management and public health authorities in developing evidence-based strategies for improving staff welfare and working conditions.

1.3 Aim and Objectives of the Study

1.3.1 Aim of the Study

The aim of this study is to determine the prevalence and determinants of occupational stress among healthcare workers in selected public hospitals in Lagos State.

1.3.2 Specific Objectives

The specific objectives are to:

1. Determine the prevalence of occupational stress among healthcare workers in selected public hospitals in Lagos State.

2. Identify the major occupational and organisational factors contributing to stress among healthcare workers in the selected hospitals.

3. Examine the relationship between selected demographic and professional characteristics, such as age, sex, professional cadre, and years of work experience, and occupational stress.

4. Determine the association between selected workplace factors, including workload, working hours, shift duties, and perceived organisational support, and occupational stress among healthcare workers in the selected hospitals.

1.4 Research Questions

The study will answer the following questions:

1. What is the prevalence of occupational stress among healthcare workers in selected public hospitals in Lagos State?

2. What are the major occupational and organisational factors contributing to stress among healthcare workers in the selected hospitals?

3. What relationship exists between selected demographic and professional characteristics and occupational stress among healthcare workers?

4. What association exists between selected workplace factors and occupational stress among healthcare workers in the selected hospitals?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance.

H₀: There is no statistically significant association between selected workplace factors (workload, working hours, shift duties, and perceived organisational support) and occupational stress among healthcare workers in selected public hospitals in Lagos State.

1.6 Significance of the Study

The findings of this study may be beneficial to the following groups.

Hospital management: The findings may help hospital administrators identify major sources of occupational stress and develop appropriate measures to improve working conditions, staffing arrangements, communication, and employee welfare.

Healthcare workers: The study may improve awareness of occupational stress, its determinants, and the importance of early recognition, healthy coping strategies, adequate rest, and appropriate workplace support.

Public health authorities: The results may provide evidence to support occupational health policies, staff welfare programmes, and mental health initiatives for healthcare workers in public hospitals.

Patients and the general public: Improved staff well-being may support better communication, continuity of care, and safer healthcare delivery.

Policymakers: The study may provide information useful for reviewing staffing policies, working-hour arrangements, workplace safety measures, and institutional support for healthcare personnel.

Researchers and students: The findings may serve as a reference for future studies on occupational stress, healthcare workforce well-being, and workplace determinants of stress in Nigeria.

1.7 Scope of the Study

The study will focus on the prevalence and determinants of occupational stress among healthcare workers in selected public hospitals in Lagos State, Nigeria. The target population will include eligible healthcare personnel, such as doctors, nurses, medical laboratory scientists, pharmacists, and other relevant healthcare professionals employed in the selected facilities.

The study will assess the prevalence of occupational stress using a clearly defined and appropriate measurement instrument. It will also examine selected occupational and organisational factors, including workload, working hours, shift duties, and perceived organisational support, alongside demographic and professional characteristics such as age, sex, professional cadre, and years of work experience. The findings will apply primarily to the selected hospitals and should not automatically be generalised to every public or private healthcare facility in Lagos State.

1.8 Operational Definition of Terms

Occupational stress: The psychological and physical strain experienced by a healthcare worker in response to perceived excessive or difficult work demands, measured using the instrument selected for this study.

Prevalence: The proportion of eligible healthcare workers who meet the study’s defined criteria for occupational stress during the specified assessment period.

Determinants: Individual, occupational, and organisational characteristics examined for their association with occupational stress.

Healthcare workers: Personnel directly involved in healthcare delivery or related clinical and diagnostic services in the selected public hospitals.

Workload: The volume, intensity, and complexity of tasks a healthcare worker is expected to complete within a given period.

Shift duties: Work schedules that require healthcare workers to provide services during different periods, including evenings, nights, weekends, or rotating shifts.

Organisational support: The extent to which healthcare workers perceive that their employer and supervisors value their contributions, address their concerns, and provide resources necessary for effective work.

Public hospital: A healthcare institution owned, funded, or administered by a government authority to provide medical services to the public.

Burnout: A work-related syndrome associated with chronic workplace stress that has not been successfully managed; it is related to, but not identical with, occupational stress.

Project – Prevalence and Determinants of Occupational Stress Among Healthcare Workers in Public Hospitals. Case study: Selected public hospitals in Lagos State.