Subjective and objective measurements of nurses’ stress and recovery

OBJECTIVES: High workloads and stress of healthcare workforce are global phenomena. We aimed to study work related stress and recovery of nurses with both subjective and objective methods, also aiming to examine if associations exist between subjective high work stress and need for recovery, and objectively measured stress and recovery. METHODS: Study sample comprised 65 nurses employed in the City of Helsinki. Heart rate variability (HRV) measurements were conducted for 3 consecutive days with ECG-based device in real-life setting, including 2 workdays and 1 day off. Objective stress and recovery were assessed from HRV and HRV-based stress and recovery variables. Participants filled out an electronic survey, where work stress was measured with Effort-reward imbalance scale and recovery after work with Need for recovery scale. RESULTS: Proportion of nurses with effort-reward ratio >1, indicating work stress, was high (84.6%), as was proportion of those with high need for recovery (64.6%). High need for recovery (score ≥54.5) was associated with lower RMSSD during sleep (p = 0.014) and higher absolute stress index (p = 0.009) on workdays. In high need for recovery group, stress balance (p = 0.040) and relaxation percentage (p = 0.033) were significantly lower on workdays than day off. In moderate work stress group, stress balance (p = 0.042), relaxation percentage (p = 0.041) and absolute relaxation index (p = 0.035) were lower on workdays than day off. No significant differences were observed within other groups. CONCLUSIONS: Majority of participants suffered from work stress or high need for recovery. Based on our results, nurses’ high need for recovery is reflected in lower sleep time HRV, indicating worse physiological recovery. In those with high need for recovery, physiological recovery was also worse on workdays when compared with day off. Our findings highlight the importance of recovery, and in the future, nurses’ recovery and work stress should be increasingly monitored. KEY MESSAGES: • Nurses’ high need for recovery is reflected in lower sleep time heart rate variability. • Nurses’ recovery and work stress should be increasingly monitored.