ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.

1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

ORIGINAL ARTICLE
HARDINESS AND OCCUPATIONAL STRESS IN NURSES MANAGERS OF HOSPITAL
INSTITUTIONS
HARDINESS E ESTRESSE OCUPACIONAL EM ENFERMEIROS GESTORES DE INSTITUIÇÕES
HOSPITALARES
HARDINESS Y ESTRÉS OCUPACIONAL EN ENFERMEROS GESTORES DE INSTITUCIONES
HOSPITALARIAS
Franciely Midori Bueno de Freitas 1, Marli Terezinha Oliveira Vannuchi 2, Maria do Carmo Lourenço Haddad3,
Larissa Gutierrez de Carvalho Silva4, Mariana Angela Rossaneis5
ABSTRACT
Objective: to determine the presence of Hardiness in nurses managers of hospital institutions. Method: a
cross-sectional, quantitative study carried out in five hospitals, three public, one private and one
philanthropic, that provide care, of medium and high complexity, in Southern Brazil. The study population
comprised 62 nurses who held positions of head of service or area coordinators. Two instruments were used to
evaluate occupational stress and the Hardiness Scale. Results: it was identified that 56% of the nurse
managers reported stress in their activities and that 40% of the participants were considered to have a stress
resistant personality (Hardiness). There was an inverse correlation between Hardiness and Stress, since as the
Hardiness increases, the stress decreased. Conclusion: Managing requires a high level of demand and the
development of strategies to combat stress resulting from the responsibilities inherent to managerial
positions. Descriptors: Stress, Psychological; Nursing, Supervisory; Burnout, Professional; Occupational
Health.
RESUMO
Objetivo: determinar a presença de Hardiness em enfermeiros gestores de instituições hospitalares. Método:
estudo quantitativo, transversal, realizado em cinco hospitais, três públicos, um privado e um filantrópico,
que prestam atendimento, de média e alta complexidade, no Sul do Brasil. Fizeram parte da população de
estudo 62 enfermeiros que ocupavam cargos de chefia de serviço ou eram coordenadores de áreas. Foram
utilizados dois instrumentos para avaliar o estresse ocupacional e a Escala de Hardiness. Resultado:
identificou-se que 56% dos enfermeiros gestores referiram estresse em suas atividades e que 40% dos
participantes foram considerados com personalidade resistente ao estresse (Hardiness). Verificou-se uma
correlação inversa entre o Hardiness e o estresse, uma vez que na medida em que o Hardiness aumentou, o
estresse diminuiu. Conclusão: gerenciar requer um elevado nível de exigência e o desenvolvimento de
estratégias para combater o estresse resultantes das responsabilidades inerentes aos cargos gerenciais.
Descritores: Estresse Psicológico; Supervisão de Enfermagem; Esgotamento Profissional; Saúde do
Trabalhador.
RESUMEN
Objetivo: determinar la presencia de Hardiness en enfermeros gestores de instituciones hospitalarias.
Método: estudio cuantitativo, transversal, realizado en cinco hospitales, tres públicos, uno privado y un
filantrópico, que prestan atención, de media y alta complejidad, en el Sur de Brasil. Se realizaron parte de la
población de estudio 62 enfermeros que ocupaban cargos de dirección de servicio o eran coordinadores de
áreas. Se utilizaron dos instrumentos para evaluar el estrés ocupacional y la Escala de Hardiness. Resultado:
se identificó que 56% de los enfermeros gestores refirieron estrés en sus actividades y que el 40% de los
participantes fueron considerados con personalidad resistente al estrés (Hardiness). Se verificó una
correlación inversa entre el Hardiness y el estrés, ya que en la medida en que el Hardiness aumentó el estrés
disminuyó. Conclusión: administrar requiere un alto nivel de exigencia y el desarrollo de estrategias para
combatir el estrés resultante de las responsabilidades inherentes a los cargos gerenciales. Descriptores:
Estrés Psicológico; Supervisión de Enfermería; Agotamiento Profesional; Salud Laboral.
1
Nurse, Master Student in Nursing, Graduate Program in Nursing, State University of Londrina / UEL. Londrina (PR), Brazil. E-mail:
franmidori@hotmail.com; 2Nurse, PhD, Professor, Department of Nursing, State University of Londrina / UEL. Londrina (PR), Brazil. E-
mail: vannuchi@sercomtel.com.br; 3Nurse, PhD, Professor, Department of Nursing, State University of Londrina / UEL. Londrina (PR),
Brazil. E-mail: carmohaddad@gmail.com; 4Nurse, Doctorate student in Nursing, School of Nursing, Ribeirão Preto / USP. Ribeirão Preto
(SP), Brazil. E-mail: larissagutierrez@yahoo.com.br; 5Nurse. PhD, Professor, Department of Nursing, State University of Londrina / UEL.
Londrina (PR), Brazil. E-mail: marianarossaneis@gmail.com

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INTRODUCTION
Currently, psychological stress is one of the
most studied variables due to its
consequences both physically and
psychologically and it is a nonspecific reaction
of the body to any demand, internal or
external.1 Depending on the level of stress, it
can be considered as positive for the
organism, resulting in reactions that lead the
individual to move, to get enthusiastic,
offering the best in himself for they work.
However, if there is a level of stress that is
beyond the control of the individual, they may
present adverse reactions to his organism and
compromising their work.2
Nursing professionals represent the largest
contingent of human resources in hospital
institutions, being the center of their work
the care of the human being. It is developed
through a close connection between the
patient / user and the worker, who
experiences direct and uninterrupted pain,
death, suffering and many other feelings and
reactions triggered by the disease process,
which can lead to stress.3-4
Occupational stress is one of the main
difficulties faced by workers and a managerial
challenge for the institutions. Its concept is
related to a reaction that the individual may
have to the demands and pressures at work
that do not fit his knowledge and abilities,
and which tests his ability to face the
situation. The negative impacts of stress are
manifold and can include physical,
psychosomatic and psychosocial problems that
can lead to work accidents and low
productivity.5-6
To minimize occupational stress and its
influences on the health of the professional,
as well as all negative repercussions for the
organization, some strategies are used. Among
them, is the identification of the Stress-
Resistant Personality - Hardiness.7
The Hardiness would be the finding that
some individuals develop a resistance in
relation to experienced stressors events.
These characteristics would be derived from
three components: commitment, control and
challenge.8-9
Commitment is expressed by the ability to
engage with what is done or what is relevant
to you, identifying the events, things and
people that are meaningful to you within your
environment. Control, however, refers to the
tendency to act and feel as if it were not
influenced by the contingents of life. The
challenge comprises a conviction, a belief that
instability is a normal occurrence in the
individual's life, but that changes are
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DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725
Hardiness and occupational stress in nurses...
interesting for personal growth and not a
threat to safety. 8-9
The interactions of the three
characteristics indicate that Hardiness has
interventions in the preservation of health,
functioning as a resistance resource to protect
individuals from stressors and is a possibility
of coping with stress in the work of the nurse.
Thus, the individual with the hardy
personality presents a more optimistic, valued
and improved attitude, which can increase
satisfaction with work and profession, as well
as decrease health problems due to stress.7
The aim of this study, was to provide
information on the presence of hardiness, in
nurse managers, and, thus, contribute to the
identification of the weaknesses in these
nurses in the face of stressful situations and
the search for coping strategies used to
optimize the work process. Through the
above, the purpose of this study, was to
determine the presence of Hardiness in nurse
managers of hospital institutions.
METHOD
A quantitative cross-sectional study in five
hospitals located in a municipality of the State
of Paraná, Brazil. Three are public, one
private and one philanthropic, and they
provide care of medium and high complexity.
The study population comprised 62 nurses
who held positions of head of service or
coordinators of areas, called supervisors,
managers or directors. Nurses with at least,
one year of work in the management function
were included in the survey, and professionals
who were on leave or leave were excluded.
They were considered as losses when they
were not found after three search attempts,
or, still, those that refused to participate in
the study.
Data were collected in 2014, through the
application of two instruments. The first
questionnaire was about occupational stress
and was created in France by Professor
Benjamin Stora of the HEC-ISA Center, who
authorized replication in Brazil.2 The other
questionnaire was about the Hardiness Scale,
a validated instrument for the Portuguese
language and for the use in nurses.7
The first instrument has two parts, the
initial one seeks the socio-demographic and
occupational data, and the second part, refer
to data on occupational stress, subdivided into
three blocks. Block I has 49 questions
regarding sources of stress. Block II contains
35 statements related to stress symptoms.
In order to classify the subjects of the
research as stressed or not in relation to the
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questions of blocks I and II, the average of the
questionnaire was calculated, and, after that,
of each of the participants. It was considered
stressed what was equal to or above the
average, and as not stressed those who were
below average.
Block III is composed of questions regarding
working conditions and was analyzed by
means of simple frequency. The Hardiness
Scale is a self-report instrument that features
30 Likert-type items with affirmations about
life, and the interviewee should mark how he
feels about each. Their score ranges from zero
(nothing true) to three (completely true). The
result of the Hardiness Scale is obtained by
summing the items, having the scores of items
three, four, five, six, eight, 13, 16, 18, 19, 20,
22, 23, 25, 28 and 30 inverted to then, be
added, allowing for the result for total
composition of the scale and by three
domains, as follows: Commitment (one, six,
seven, 11, 16, 17, 22, 27, 28 and 30), Control
(two, two, three, three, eight, nine, 12, 15,
18, 20, 25 and 29) and Challenge (four, five,
ten, 13, 14, 19, 21, 23, 24 and 26). Scale
scores can range from zero to 90 for the full
scale composition; and for domains between
zero and 30.
The hardy individual was the one who
obtained a high score in the sum total of the
three domains, or at least two of them. The
mean value above 20 points for each subscale
(commitment, control and challenge) was
considered for this study and as hardy the
individual who obtained the value in two or
more of these subscales.
To verify if there was a relationship of
Hardiness to stress, the Correlation
Coefficient Test (Spearman) was used, with a
significance of p <0.05 and a 95% confidence
limit. For the data analysis, the statistical
software IBM SPSS Statistics 20, BioEstat 5.0
and Microsoft Excel 2010 were used.
This research had the project approved in
the Committee of Ethics in Research with
human beings with opinion CEP / UEL no.
116/2012 and CAAEE 0580381 2.4.0000.5231.
RESULTS
The research was composed of 62 nurses,
43 of whom answered the questionnaires. The
majority of the population was composed of
women (84%), aged between 25 and 57 years,
with a mean age of 39 years. Regarding
marital status, 56% had a stable union, 14%
were divorced and 30% were single. Those
who had children totaled 63% of the
interviewees, of whom, 40% had two children.
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Hardiness and occupational stress in nurses...
With respect to graduate studies, 7% had a
doctorate degree, 14%, master's degree and
77%, specialization. Only one person did not
perform any graduate studies. Of the
specializations, 15% were focused on health
management.
Regarding the employment bond issue, it
was highlighted that 63% of the statutory,
14%, of contractors and 23% had other types
of ties. The statutory employment relationship
was the one that had the largest number of
participants due to the participation of three
public hospitals in the research. Of the 44% of
nurses who were stressed according to the
sources of stress, 74% were statutory. When
linking stress and double employment, only
two of the five who worked in two jobs were
stressed. In relation to the time of work in the
position, there was predominance of up to
two years, with 37% of the individuals. From
two to four years, 19%; four to eight years,
23%; eight to 12 years, 7%; and over 12 years
were found 14% of those studied.
As for the working time in the institution,
25% were identified in the institution for more
than 20 years and 14% in less than two years.
Regarding work shifts, 60% worked full
time; 19%, at night; 16%, in the morning;
2.5%, in the evening and 2.5% in rotation
between schedules. Nursing managers who
had another employment relationship
corresponded to 12% of respondents.
Of the participants, 58% did not have this
job as the main source of family income.
When questioned if they had leisure, 72%
answered affirmatively, being leisure with the
family the most cited. When questioned if
they perceived stress in their work, 56% of
nurse managers reported stress in their
activities.
When verifying if the participants of the
study had resistance to the stress (Hardiness),
it was verified that 40% were considered
hardy individuals. Regarding its subscales, the
control strategy was the one with the highest
score (39.5%), followed by the control (37%)
and the challenge, with only one individual
(2%).
When performing the correlation between
stress and Hardiness through the Spearman
Coefficiency Test, it was verified that there
was no significant value (correlation
coefficient = -0.44 and the value of ρ = 0.08).
However, although there is no significance, an
inverse correlation can be seen once the
result is negative. That is, this result
demonstrated that as the Hardiness increases
the stress decreases.
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DISCUSSION
The research population was composed,
mostly, of females, a common situation found
among Nursing professionals in Brazil. This
fact occurs through the professionalization of
the human capacity to care, present in the
characteristics of women.10
The mean age of 39 years showed that the
population was composed of more
experienced nurses, an important fact to
occupy a managerial position, which requires
professional experience, among other things.
The time in the organization or in the sector
in which they act is indicated as a factor that
accredits the nurse to carry out their
activities, giving them greater autonomy and
decision power. This, together with the
technical knowledge of the managers and
associated with the conceptual and relational
aspects, is consolidated as a fundamental
competence for the exercise of the
management.
Emphasis is placed on the significant
number of professionals who have undergone
a postgraduate course, evidencing the concern
that nurses are having with the professional
improvement, since the products of the
training performed can revert to the quality of
care provided to clients. The realization of a
specialization course stimulates the
performance of others, as shown in a study
about the profile and competencies of Nursing
managers in accredited hospitals, showing
that after the specialization, a large part of
the professionals opted to undertake post-
graduate courses Stricto sensu ( masters and
doctorates), which are of an academic and
research nature, with essentially scientific
objectives, while specialization has a practical
/ professional meaning.12
Only five nurses took graduate courses in
Nursing Administration. Although not a
relatively high number, the experience gained
in the management of care over the years,
attitudes, managerial skills, personal values,
and the ability to work with what the
institution can offer, are also issues important
for the nurse to be competent for the
management and considered by the
organization in the selection of management
positions. Care management requires
knowledge and experience, since it is a
process that materializes through a set of
practices that are interdependent and
complementary to one another.13
Occupational stress was present in 24
nurses who managed this study. In the Nursing
work process, managing requires a high level
of demand, due to the competencies assigned
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Hardiness and occupational stress in nurses...
to its position, related to the continuous need
for personnel management and conflicts
generated by the diversity of professional
profiles, as well as to the collections of the
superior heads and subordinates on the
conduct and decisions to be taken or have
already taken place.2
When analyzing the participants regarding
whether or not they possessed Hardiness, it
was observed that only 17 had this personality
resistant to stress. The research also
demonstrated an inverse relationship between
Hardiness and stress. Corroborating with a
study carried out with medical residents, one
confirms the assertion that one of the positive
effects of Hardiness is the modification of the
perception of the stressors.14
It is noted that all individuals, who were
considered Hardiness, scored on the control
subscale. This shows that the nurse with high
control tries to maintain an influence on the
results, instead of being impotent and passive
in the face of the situations (14). These
characteristics are evident in nurse managers
who have responsibilities to their staff and to
the work process.
The ability to control allows the individual,
to perceive, in many stressful events,
predictable consequences, and consequently
to manipulate the stimuli to their benefit. In
this way, they benefit mainly, by the high
degree of autonomy. In addition to a stress-
control training, it is worth emphasizing the
importance of institutional programs that aim
to develop social skills related to
communication and interpersonal relationship
skills.15-6
Research4 shows that the higher the
Hardiness value in the commitment subscale,
the greater is the nurse appreciation. These
professionals do not easily give themselves up
to the pressure and get deeply involved in
what they do. This being, of great relevance,
because they are in an environment where the
focus is not only the patient, but, also, the
family.
Only one nurse obtained the Challenge
subscale. This means that, for a portion of this
population, there is a difficulty in dealing with
the unexpected and with the changes, in
order to seek resources to meet sudden
situations evaluated as stressors. The
Challenge domain refers to the belief that
change is customary, which is understood as
an opportunity for personal growth. Thus, the
effects of stress are minimized, since the
situation is assessed by the individual as a
challenge rather than a threat. Organizations
and their managers can no longer afford not
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Freitas FMB de, Vannuchi MTO, Haddad MCL et al.
to learn how to respond effectively to the
challenges posed by stress.17
A study conducted on Bournout Syndrome18
and associated factors in health professionals
from a public hospital suggest through the
results that personalities characterized by
commitment, control and challenge are
associated with higher levels of personal
fulfillment and lower levels of exhaustion and
distant attitudes. They emphasize that the
resistant personality can, therefore, preserve
health, improve performance and promote a
less stressful lifestyle.
Another research carried out on the
formation of the resistant personality in
Nursing managers, was raised strategies that
stimulate the Hardiness. With regard to
commitment, it can encourage and reward the
risks associated with working with patients,
group discussions about commitment to
problem solving in conflict management and
assertiveness. In control, it is suggested to
create a creative work environment,
encouraging and rewarding creativity related
to new ideas and new practices and to give
greater autonomy to the individual. As for the
challenge, strategies can be focused on
promoting new learning experiences among
employees, changing practice and behavior,
engaging in group activities, engaging people
with practice in change processes to promote
positive change. 19
It can be said that Hardiness is a tool in the
face of stress, since this Tough Personality
allows a different way of dealing with
situations evaluated as stressors in order to
minimize them. In this sense, the relevance of
studying the Hardiness Personality is
highlighted in order to know how different
professionals behave in front of the stressors
and the benefits that Hardiness presents.7,20
CONCLUSION
It was verified that only 40% of the nurses
managers of hospital institutions had the
personality resistant to the stress (Hardiness)
and presented a significant predisposition to
the commitment and the control. This
indicates that they are professionals engaged
in their activities and involved with people
and what happens around. However, because
they are deficient in the Challenge domain,
they are estimated to be absorbed by the
desire for convenience and security.
Occupational stress and Hardiness were
inversely proportional. A greater number of
stressed nurses (56%) than those who had a
stress-resistant personality (40%), however,
being hardy does not mean that the person
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DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725
Hardiness and occupational stress in nurses...
will eliminate the stressors , but, rather, will
modify the perception to stress and instigate
strategies for its confrontation. Because it can
be apprehended, it is suggested that
institutions, through the sectors of permanent
education and human resources, have it as an
alternative to minimize labor stress, and, as a
consequence, will bring valuation and
motivation to the professional.
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English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4199-205, Oct., 2017 4204
ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

Submission: 2016/09/24
Accepted: 2017/09/22
Publishing: 2017/10/15
Corresponding Address
Mariana Angela Rossaneis
Universidade Estadual de Londrina
Av. Robert Koch, 60
Bairro Operária
CEP: 86038-350  Londrina (PR), Brazil

English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4199-205, Oct., 2017 4205