Prevalence and determinants of occupational stress among healthcare workers at Bo Government Hospital, Sierra Leone: a cross-sectional study
This cross-sectional study of 260 healthcare workers at Bo Government Hospital in Sierra Leone reveals a high prevalence (38.5%) of occupational stress driven primarily by modifiable system-level factors, including excessive working hours, low job control, inadequate remuneration, and chronic understaffing.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the high-stakes environment of a hospital, the well-being of the staff is as critical as the medicine they administer. When the demands of a job outstrip a person's resources, time, or support, a specific kind of strain takes hold known as occupational stress. This is not merely feeling tired after a long shift; it is a state where the pressure of the work overwhelms the worker's ability to cope, leading to physical and emotional exhaustion. For healthcare workers, who are responsible for the lives and health of others, this strain is particularly dangerous. It can erode their own health, reduce their productivity, and ultimately compromise the safety of the patients they serve. Understanding where this stress comes from is the first step toward fixing it, especially in regions where hospitals often operate with very few resources and heavy patient loads.
Researchers at Njala University set out to measure this invisible burden at Bo Government Hospital, the main public facility serving the Southern Province of Sierra Leone. This hospital acts as a lifeline for over a million people, yet it operates under persistent challenges, including a severe shortage of staff, unreliable electricity, and a lack of basic medical supplies. The team wanted to know exactly how many workers were suffering from high levels of stress, what specific conditions were causing it, and which factors made some workers more vulnerable than others. They focused on a diverse group of employees, including doctors, nurses, laboratory technicians, pharmacists, and administrative staff, to get a complete picture of the hospital's atmosphere.
To gather their data, the researchers asked 260 workers to fill out a questionnaire about their daily experiences. They used a standard tool to measure perceived stress, asking how often workers felt overwhelmed, unable to control important things in their lives, or unable to cope with pressures. They also asked about specific workplace conditions, such as whether they felt supported by their managers, if they had enough equipment, and how many hours they worked. The results revealed a stark reality: nearly four out of ten workers were experiencing high levels of occupational stress, while almost everyone else reported at least a moderate level of strain. In total, more than 85 percent of the staff felt the weight of their work was too heavy. Nurses reported the highest levels of stress, followed closely by allied health professionals and laboratory technicians.
The study identified a clear pattern in what was driving this distress. The most common complaint was not a lack of skill or personal weakness, but a lack of resources. Nearly 90 percent of the workers said they were understaffed and faced an unmanageable workload. Over 80 percent reported that they did not have enough equipment or supplies to do their jobs properly, and nearly 80 percent struggled with long or irregular working hours. Violence from patients or visitors was also a frequent source of fear and anxiety. When the researchers analyzed the data to see which factors independently predicted high stress, they found that working more than 48 hours a week was the strongest driver. Workers who clocked these long hours were three times more likely to be highly stressed than those who worked fewer hours. Other major factors included feeling a lack of control over their work decisions, being unsatisfied with their salary, and lacking support from supervisors.
Interestingly, the study found that being female or having many years of experience did not significantly change a worker's risk of high stress. This suggests that the problem is not about who the worker is, but about the conditions they work in. Even experienced staff, who might be expected to handle pressure better, were just as affected by the structural failures of the hospital. The researchers concluded that the stress is not a personal failing of the staff but a systemic issue rooted in the hospital's organization. The solution, they argue, lies in fixing the system itself: enforcing limits on working hours, giving staff more say in how their work is managed, improving pay, and ensuring that hospitals are adequately staffed and supplied. Without these changes, the workforce remains under constant strain, threatening both their own health and the quality of care they provide to the community.
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