Graduation Year
2026
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Nursing
Major Professor
Usha Menon, Ph.D.
Committee Member
Rayna Letourneau, Ph.D.
Committee Member
Ryan Pace, Ph.D.
Committee Member
Jacqueline Munro, Ph.D.
Keywords
biomarkers, burnout, cognitive failure, nurses, occupational stress, physiological adaptations
Abstract
The sustainability and health of the nursing profession are immediate and pressing concerns. Despite decades of research, nurses continue to struggle with high levels of stress and burnout, raising concerns about patient safety and error risk. One in 10 patients is estimated to experience an adverse patient event, with half being preventable, underscoring the need to understand the factors that affect stress among nurses and the subsequent risk of adverse patient events. This dissertation has the following aims: 1) to evaluate whether cognitive failure risk that could lead to an adverse patient event was associated with subjective measures of stress, burnout, depressive symptoms, anxiety, and sleep and whether differences in risks were shown between day and night shift registered nurses (RNs) (Aim 1); 2) to explore nurses’ perceptions of stress, burnout, and risk factors for patient errors in hospital settings (Aim 2); and 3) to explore associations between subjective measures of stress, burnout, depressive symptoms, and anxiety with objective measures of physiological stress (i.e., hair and salivary cortisol concentrations) (Aim 3).
Aim 1 involved a cross-sectional study of 240 RNs in which three predictive factors of cognitive failure were identified through an online survey that could lead to an adverse patient event occurrence: years of RN experience, the interaction between depressive symptoms and anxiety, and chronic stress. Chronic stress was the strongest predictor, followed by the interaction effect between depressive symptoms and anxiety, and years of RN experience. Aim 2 involved a subgroup analysis of qualitative interviews with 23 RNs in which three primary themes contributing to stress, burnout levels, and increased risk for patient errors were identified: overload, health effects, and ambivalent dynamics. In interviews, participants also shared their ideal image of a nurse and recommendations for interventions. Aim 3 involved a subgroup of 45 RNs who gave hair and saliva samples to assess their chronic and acute physiological stress. Mixed effects modeling of cortisol level concentrations in hair identified two predictors of chronic stress: race and ethnicity, and working night shift. Saliva samples identified five predictors of acute stress: age, biological sex, years of experience as an RN, depressive symptoms, and working night shift.
The results of this study offer many opportunities for future research. A national study including a larger sample size of hospital-based nurses is warranted to validate our findings of predictors of cognitive failure risk and the results of objective measures of stress among the nursing population. Intervention studies are needed to evaluate the most effective and feasible modes of stress management and coping. Furthermore, a multi-pronged approach is necessary to address the current health and well-being of nurses, thus placing the onus on the health and well-being of nurses at both the individual and organizational levels.
Scholar Commons Citation
Pryor, Stacy L., "YouMatter: A Nursing Workforce Study" (2026). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/11389
