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WHSXXX10.1177/2165079914565355Workplace Health & SafetyWorkplace Health & Safety

Workplace Health & Safety March 2015


Barriers to Work–Life Balance for Hospital Nurses

Kathleen Mullen, PhD, MS, RN1

Abstract: Nurses are loyal to their patients and Most nurses are happier when experiencing feelings of
coworkers. They often put the needs of others before achievement and satisfaction from their work rather than trying
their own and sometimes even before the needs of their to acquire an arbitrary sense of work–life balance (Vredenburgh
families. This concern for others can cause conflicts that & Trinkaus, 1983). One of the goals in this article is to recognize
manifest as stress. Of the more than 2 million nurses in the that nurses experience more satisfaction at home and work by
United States, more than 62% work in hospitals. Hospitals using tools to manage their stress.
are known to be both rewarding and stressful places Stress can manifest as physical complaints and emotional
to work. Like most workers, nurses face the challenge anxiety (Luca, Bellia, Bellia, Luca, & Calandra, 2014).
of balancing demands and achievements of work with Satisfactory integration of role achievement and enjoyment
those in their private lives. Hospital leaders can facilitate results in a positive emotional state experienced as WLB
improved work–life balance (WLB) for hospital nurses (Davis, Lind, & Sorensen, 2013; Winefield, Boyd, & Winefield,
by using tools already in place. Equally important, nurses 2014). However, the two areas of work and life are neither
can use their knowledge and resources to nurse the equally balanced nor fixed. In other words, WLB fluctuates
nurse within, which can greatly improve their experience within an acceptable zone based on a range of circumstances
of WLB, independent of the demands of their work and individual expectations.
Hospital Work Environment
Keywords: hospital nurses, work–life balance, employee Most hospitals provide care to sick patients regardless of
health, employee assistance program 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
ork–life balance (WLB) is a contemporary acronym patients, the law has also changed the way hospitals are
for achieving balance between work and lifestyle reimbursed for care. For example, hospital reimbursement is
ambitions. Although WLB is not well defined, the now evaluated based on a number of metrics including
implication is that the two experiences (work and home life) patient’s length of stay, industry guidelines for admissions
should be in a state of equilibrium for nurses to be happy and criteria, hospital readmission, hospital-acquired illnesses, and
healthy. Nurses often describe experiencing a lack of balance patient satisfaction ratings.
between their work and life outside of work. Yet if a sense of The Occupational Safety and Health Administration (OSHA;
balance between work and lifestyle demands could be 2014) describes hospitals as
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 some of the most stressful places to work with potential
those, more than 62% are employed by hospitals (American hazards that include life-threatening injuries and illnesses
Association of Colleges of Nursing [AACN], 2011). Hospitals complicated by overwork, understaffing, tight schedules,
deliver acute health care to patients and are known to be both paperwork, intricate or malfunctioning equipment,
rewarding and stressful work environments. The American complex hierarchies of authority and skills, dependent
Nurses Association (ANA, 2014) reports that the three most and demanding patients, and patient deaths.
frequent concerns of hospital nurses are related to staffing, No national standard for nurse–patient ratios (i.e., the
mandatory overtime, and workplace safety (ANA, 2014). number of patients a nurse is assigned during a shift) has been

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:
For reprints and permissions queries, please visit SAGE’s Web site at
Copyright © 2015 The Author(s)


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vol. 63  ■  no. 3 Workplace Health & Safety

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 Nurses’ commitment to their profession as well as the
nurse–patient ratios, though other states are working toward physical and emotional demands of working with sick and
similar staffing goals (Schultz, 2013). dying patients can place nurses at risk of failing to recognize
Likewise, nurses’ shift length is not regulated. Most hospital their own physical and emotional needs. By performing the
nurses work shifts of either 8.5 or 12.5 hr and many nurses are most basic patient assessment, nurses are able to identify
required to work overtime (Rogers, Hwang, Scott, Aiken, & indicators of stress. Likewise, they can provide evidence-based
Dinges, 2004). Nursing literature has documented that high recommendations for lifestyle changes to reduce stress.
nurse–patient ratios and nurse fatigue are risk factors for patient Although nurses are well educated about when and how to
accidents and injuries (McClelland, Switzer, & Pilcher, 2013; intervene to meet the needs of others, many discount their own
Stimpfel & Aiken, 2013; Stimpfel, Sloane, & Aiken, 2012). needs (Mullen et al., 2013).
However, the impact of nurse–patient ratios on WLB for hospital Stress is a consequence of work–life imbalance (O’Keefe,
nurses is unknown. Brown, & Christian, 2014). Stress is experienced physically and
As acknowledged by OSHA, hospital nurses are members of a emotionally (e.g., musculoskeletal disorders, pain, anxiety, and
complex health care team who provide care to sick and dying sleep disorders; Koh et al., 2014). Nurses learn to work under
patients and their families. These nurses must maintain a strict pressure, often with limited resources, but although nurses’
work flow to closely monitor patients for cardiac or respiratory work stress may be unique because of workplace demand, the
arrest, or more subtle changes in patients’ level of consciousness, stress from lifestyle demand is widely shared by all workers. For
blood chemistry, or risk behaviors (e.g., getting out of bed example, most hospital nurses are women. Depending on their
without assistance). As complex as the patient clinical own age, many nurses care for children or aging parents, and
environment may be, the health care team can be even more they also provide wages and benefits critical to their families’
complex. In addition to managers who monitor regulatory basic needs.
standards that affect reimbursement for care, the health care
team includes a wide range of health care specialists. Finding the Motivation to Change
Depending on specific patient health conditions, providers
contribute to their care in unique ways.
Although nurses are the largest group of hospital workers, staff Happiness lies not in the mere position of money;
nurses who provide direct patient care have little control over their it lies in the joy of achievement, in the
work environment. Successful solutions to improved WLB involve thrill of creative effort.
both the hospital and the individual nurse. In fact, most hospital —Franklin D. Roosevelt (1933)
leaders have resources to assist nurses in improving WLB. For
example, OSHA recommends leadership access tools available Nurses know that patient education should empower
through human resources and employee education departments individuals to take an active role in changing their lifestyles. The
(Table 1) to support nurses as they improve WLB. same is true for nurses who seek WLB. To help themselves cope
with the emotional consequences of poor WLB, nurses must
Nurses Take Action for Satisfying Life learn to nurse the nurse within. By doing so, nurses can be role
Nurses choose their profession for a variety of reasons. In a models for their colleagues.
study that explored injured nurses’ motivations to work, many Nurses can use their own knowledge and skills to improve
reported that becoming a nurse represented both a meaningful their WLB. Nurses need not wait for changes in hospital policy
way to be of service to others and at the same time provided a or nurse–patient ratio legislation, or leave their hospital
role identity that connected them to family members or admired positions to improve their WLB; nurses have individual power.
members of the community (Mullen, Gillen, Kools, & Blanc, The first step to improve WLB is to recognize that the
2013). 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 demands. Some nurses may prefer to keep a journal of
story. Nurses can begin by identifying individual priority areas; thoughts and ideas. Others may establish a contract for change
taking an inventory of individual needs and stressors is the with a supportive friend or mentor. Still others combine
first step in improving WLB. A second step is for nurses to several methods to use as their individual process changes and
realize that changing behaviors is challenging, requiring matures.
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. Implications for Occupational Health Nurses
Hospital employee health nurses support the health and
Steps That Can Make Changes wellness of nurses and other health care workers. Although
After acknowledging the need for change, nurses must find a occupational health nurses often focus on specific workplace
starting place, create an individual plan, and continue to assess rules and regulations for health and safety, acknowledging the
the need for modifications as circumstances evolve. A WLB importance of WLB to employee health is an emerging area. By
inventory can assist individuals to focus on priority areas where becoming more aware of the consequences of occupational and
rapid success is achievable, contributing to change momentum. personal stressors, employee health nurses can expand their
Lifestyle changes are not easy especially if attempted without role and increase their value to both workers and organizational
assistance; a key to success is finding individuals and processes leadership. OSHA suggests a variety of strategies to bridge
that can support change. Coaching, a tool for self-improvement, employee health to other employee assistance programs that are
is not new. Many health care providers employ nurses who already in place, resulting in better use of services, and
assist patients achieve and sustain positive lifestyle changes. improving employee health nurse and staff relations.
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 Improving work–life balance requires active, evidence-based
resources. Completing a WLB self-inventory (Table 2) can strategies. The process begins with self-reflection and progresses
establish areas to set in motion for an individualized change by taking action. Hospital nurses are drawn to the environment
process. for many of the same reasons that challenge their well-being. Yet
A lifestyle coach can establish a process to support change. nurses can learn individual strategies to achieve a sense of
Generalist life coaches, as well as nurse life coaches who have balance and well-being. This knowledge will support them as
specific insight into the complexities of health care, are they become successful and effective at work, maintaining roles
available. Finding a coach is similar to finding any other outside the hospital that bring happiness and joy. Recognizing
counselor. Valuable sources for finding a wellness coach to the need for and committing to change are the starting points
facilitate WLB include employer-sponsored employee for creating effective WLB.
assistance programs (EAP), trusted coworker and friend
referrals, or health coach training facilities. Nurses must Acknowledgments
choose a coach who engenders trust and confidence. If an The author would like to thank Mikako Arakida, RN, PHN, PhD,
individual coach is not realistic, other sources of support and professor, School of Nursing and Rehabilitation Science at
encouragement may improve nurses’ responses to conflicting Odawara International University of Health and Welfare, Japan


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vol. 63  ■  no. 3 Workplace Health & Safety

and Oi Saeng Hong, RN, PhD, FAAN, professor, University of experienced by nurses with injuries. Work, 50(2), 295-304. doi:10.3233/
California San Francisco, California. wor-131800
Occupational Safety and Health Administration. (2014). Hospital hazards.
Conflict of Interest Retrieved from
O’Keefe, L. C., Brown, K. C., & Christian, B. J. (2014). Policy perspectives
The author(s) declared no potential conflicts of interest with on occupational stress. Workplace Health & Safety, 62, 1-7. doi:
respect to the research, authorship, and/or publication of this 10.3928/21650799-20140813-02
article. 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.
Funding Health Affairs (Millwood), 23, 202-212.
The author(s) received no financial support for the research, Roosevelt, F. (1933). First inaugural address. Retrieved from http://www.
authorship, and/or publication of this article.
Schultz, D. (2013). Nurses fighting state by state for minimum staffing laws.
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Kathleen Mullen, PhD, MS, RN, is Assistant Clinical Professor-
nurses’ decision making during a 12-h day shift. Occupational Medicine volunteer at the University of California San Francisco,
(London), 63, 60-65. doi:10.1093/occmed/kqs189 Community Health Systems. Dr. Mullen’s work focuses on the
Mullen, K., Gillen, M., Kools, S., & Blanc, P. (2013). Hospital nurses impact of work injury and job loss on the individual, family,
working wounded: Motivations and obstacles to return to work as and community.


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