The purpose of this study was to determine the prevalence of nursing job stress in Iranian hospitals until July 2018. By searching 6 databases, 22 relevant articles were identified. Based on a random effects model, the prevalence of nursing job stress in Iranian hospitals was found to be 50.5 percent, which is less than the value reported in Mwinga (2015) in Zambia (93 percent) (47), but higher than the value reported in Aoki (2011) in Thailand (26.2 percent) (48) and Al Hosis et al. (2013) in Saudi Arabia (34.2 percent) (49). The results of different studies suggest that the prevalence of nursing job stress varies by countries. Therefore, it is necessary to interpret the present findings with caution. It is also important to note that the research are based on the results of 22 studies, while the researches in other countries are based on one or two studies.
In this research, prevalence of nursing job stress was shown to decrease by 0.009 percent for each increase in the sample size by one person. This indicates that studies with small samples are prone to bias and may not provide valuable insights for healthcare managers and policymakers. Therefore, studies on prevalence of nursing job stress must ensure a representative sample size and the use of appropriate sampling methods.
A closer look at the prevalence of nursing job stress in these studies showed that it has increased in recent years. This could be due to the application of the study quality control process and selection of fewer studies from the period before 2010 due to poor quality. It must be noted that prior to 2010, fewer studies examined the prevalence of job stress in nurses and used incomplete methodologies. Therefore, increase in nursing job stress in the last few years may simply be due to an increase in stressors in the workplace rather than better documentation with more scientific methodologies (50, 17). Although the number of studies conducted before 2010 was less than those conducted afterwards due to qualitative screening, it must be noted that prevalence of stress in nurses is indeed increasing despite the implementation of different programs such as strategic planning, accreditation, and quality improvement. Perhaps one of the most important factors that have been overlooked by most healthcare managers and policymakers is the issue of increased nursing workload following the implementation of these programs (50–51).
This study showed that nursing job stress is more prevalent in the southern regions of Iran compared to other regions of the country. One of the reasons for this finding may be the fact that working in southern regions is harder due to bad and warm weather and the problems it causes, thus putting more work pressure and stress on nurses. As an example, in Iran, Mazloum et al showed Excessive heat can make problems such as heat exhaustion, neurological symptoms and psychological stress and reduced productivity in employees (52).
In recent years, a number of studies have been conducted on nursing job stress in Iranian hospitals. However, the results of these studies showed large dispersion and heterogeneity. Another key factor may be the instruments that have been used to measure job stress in nurses. Due to the development of different questionnaires, nursing job stress is measured differently. Therefore, differences between the results of the reviewed studies can be, in part, due to differences in the instrument used to measure this variable. For example, the Occupational Stress Questionnaire has been used in Osipow, Krishna, Stimer, and Steinmetz. Overall, there is no a comprehensive questionnaire for measuring job stress among nurses. Thus, there is a need for developing a comprehensive questionnaire for Iranian hospitals
Nursing job stress has been investigated in a limited number of Iran’s provinces. This shows that these studies have not been comprehensive, and this gap can be filled in future research.
One of the strengths of this study was a comprehensive and systematic research on important medical sites. On the other hand, it was studied the potential sources of heterogeneity by meta-regression and subgroups-analyses. However, this study had some limitations. One of the limitations of this study was the high heterogeneity of the reviewed studies. Moreover, these studies lacked sufficient information for measuring nursing job stress based on average age and hospital department.