Horizon Interdisciplinary Journal (HIJ). Volumen 1 (1): 25-34

Https://doi.org/10.56935/hij.v1i1.3

Working conditions, satisfaction and job stress in

nursing in the face of the COVID-19 pandemic: a voice

that must be heard

Daniela Lilian González-Sánchez

, Estefana Concepción Lara-Esquivel

and Nereyda

Cruz-Zúñiga

Autonomous University of Baja California. Faculty of Medicine and Psychology. Tijuana,

Baja California, Mexico.

Mexican Institute of Social Security/Department of Health Education and Research.

Tijuana, Baja California, Mexico.

Autonomous University of Baja California. Faculty of Health Sciences. Tijuana, Baja

California, Mexico.

*Corresponding author: Nereyda Cruz-Zúñiga, Autonomous University of Baja California. Faculty of

Health Sciences. Tijuana, Baja California, Mexico. E-mail: nereyda.cru[email protected].

Abstract. - The COVID-19 pandemic has caused the death of millions of people in the world,

including health personnel, with Mexico being one of the countries with the greatest loss of

human resources. Specifically, nursing professionals in the city of Tijuana, Baja California,

were subject to early exposure to COVID-19, which caused stress and job dissatisfaction as

a consequence of their working conditions. Likewise, the personnel reported feeling

insecure as a result of the social phenomenon characterized by negative exposure in social

networks, discrimination, rejection, verbal and physical aggression. Although the

professionals demonstrated a great capacity to adapt and cope with these conditions, it is

important to note that this capacity did not necessarily imply health wellbeing.

Keywords: Working conditions, Job satisfaction, Job stress, Nursing, COVID-19.

1. Introduction

The coronavirus pandemic (COVID-19),

caused the death of millions of people

around the world including health

personnel (Trilla, 2020). According to data

from the Pan American Health

Organization, in the first wave, Mexico was

the country with the greatest loss of health

human resources worldwide (Holshue et

al., 2020), with Tijuana, Baja California

being the most affected municipality in

this regard. This can be attributed to both

the geographic and demographic

characteristics of this entity, since it is the

third largest municipality in the country

with more than 1.7 million inhabitants. In

addition, it is considered the busiest

border in the world, bordering with

California, United States.

In context, it is possible to think that

Tijuana could have been subjected to an

earlier exposure to COVID-19 than the rest

of the country, this associated to the

importation of cases from California,

Horizon Interdisciplinary Journal (HIJ). Volumen 1 (1): 25-34

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since, in the first wave, Tijuana reported

the highest number of deaths at the

national level (170 deaths), with the highest

mortality rate (17.3 per 100,000 people),

being almost 6 times more than the

national rate (3.1 per 100,000 people),

(Friedman et al., 2020).

If we analyze the problem in depth, these

figures are quite predictable since the

health personnel in Tijuana, like the rest of

the world, faced the pandemic with a

shortage of medical supplies and lack of

infrastructure, which speaks of weakened

health systems (Oliveira et al., 2021). This,

without leaving aside the social

phenomenon that was experienced

throughout Mexico, characterized by

discrimination, rejection, verbal and

physical aggression, which was even

exposed in social networks, leaving a

negative message in society far from

reality, regarding the work done by health

professionals in the face of the pandemic.

Nursing professionals demonstrated a

great capacity to adapt to the situations of

the work and social environment;

however, it is important to establish that

this capacity did not necessarily imply

health well-being.

The manuscript describes the working

conditions, job satisfaction and job stress

experienced by nursing personnel during

the first wave of the COVID-19 pandemic,

findings that are described from the

perspective of the personnel themselves.

Finally, the impact of the pandemic on the

health well-being of nursing personnel is

described.

1.1 Topic Development

Although well-being and health are two

words that seem synonymous, in reality

they have considerable differences, this

can be seen in the definition of health

given by the World Health Organization

(WHO), being "a state of complete

physical, mental and social well-being, and

not merely the absence of disease or

infirmity" (World Health Organization

[WHO], 2014, p. 1). This definition includes

the term wellbeing which has a broader

scope, as it encompasses several axes that

are closely linked to quality of life,

economic and social wellbeing, as well as

professional or personal wellbeing

(Alcántara, 2008).

Despite the fact that health well-being is

one of the most precious assets, along with

love, family union, work or professional

success, it has been affected in nursing

personnel over the years by social,

economic and political factors. With

regard to social factors, we can highlight

those that are inherent to the individual,

related to family problems and/or friction

between work groups, due to exhausting

working hours and work overload. Political

and economic factors have led to informal

hiring, low wages and lack of job and social

security (Zárate et al., 2020, p. 36).

These factors were exacerbated during

the COVID-19 pandemic, due to the

precarious working conditions of Nursing

around the world such as shortage of

professionals, personal protective

equipment, technological tools and

continuous training actions.

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Consequently, in addition to affecting the

productivity of the organization and the

quality of care offered to users, it had and

continues to have a significant negative

impact on the health well-being of the

nursing professional, which unfortunately

has been left in the background (Cassiani

et al., 2020).

The previously described phenomenon

can be explained through Betty Neuman's

systems theory, which refers to the fact

that well-being exists when the person

interacts in harmony with his/her

environment, and his/her needs are

satisfied (Neuman & Fawcett, 2011, p. 12),

which did not happen with the Tijuana

Nursing professionals. This was confirmed

in a recent research conducted in the

region by the Fundación Enfermera Delia

Ruíz Rivas based on this theory.

This research made it possible to identify

the factors that had a negative effect on

the health well-being of personnel in the

locality, where social factors such as

changes in lifestyle, separation from loved

ones, anguish at the thought of going to

work related to the fear of personal

and/or family contagion, confinement and

social discrimination were the main

stressors that led to instability.

This research allowed us to identify the

factors that had a negative effect on the

health well-being of the personnel in the

locality, where social factors such as

changes in lifestyle, separation from loved

ones, anguish at the thought of going to

work related to the fear of personal

and/or family contagion, confinement and

social discrimination were the main

stressors that led to instability.

According to the results, in the work

environment, the factors that added to

this problem and that favored job

dissatisfaction and stress were lack of

knowledge, changes in work teams, work

overload, hasty entry of inexperienced

personnel and emergent hospital

reconversion. Not to mention the fact of

having to provide intensive care to

colleagues who became ill and

unfortunately passed away, as well as the

perceived lack of job protection that led to

a sense of job disappointment.

The instability of the health well-being of

professionals in Tijuana was manifested by

a decrease in vitality, alterations in mental

health and social function, as a result of

the presence of anxiety and depression.

There were even those who debuted with

one or more Chronic Non-Communicable

Diseases (NCDs) such as obesity, diabetes

mellitus and systemic arterial

hypertension. Despite the fact that the

personnel with these diseases were

considered vulnerable and for safety

reasons had to remain at home, a high

percentage had to return to work due to

the lack of personnel.

Systems theory refers to the fact that the

environment, in this case the workplace,

has an important influence on the

individual. The latter is due to the fact that

work is not only an activity with

productive purposes, but also a generator

of a sense of belonging and identity and

therefore contributes to the development

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of the person (Neuman & Fawcett, 2011, p.

8). For this reason, working conditions play

a fundamental role because they are

related to all those physical, social and

administrative factors that affect the work

environment and directly affect the

worker. With all that was experienced

during the pandemic, it can be inferred

that nursing personnel had to face a major

problem.

This is why the science of care, as nursing

is known, for the first time has to raise its

voice and take care of itself, that is, take

care of the professional caregiver. This

means that, although working conditions

play an important role in the health of the

worker and although this relationship is

not always linear, health well-being

depends on the way in which professionals

respond personally to the demands of

work, as well as the resources that the

organization makes available to its

workers.

Therefore, in order to rebuild the health

well-being of nursing personnel after the

COVID-19 pandemic, it is essential to work

on the physical and emotional aspects in

conjunction with the work environment.

The aim is for the nursing professional to

be able to enjoy life and at the same time

to face in a better way the problems that

are inherent to the person and his/her

profession, either by making decisions,

dealing with and adapting to difficult

situations or dialoguing about his/her

needs and desires.

It is important to consider that, in general,

people's lives and circumstances change

continuously, therefore, their character,

thoughts and feelings also fluctuate.

Sometimes it is normal to feel discomfort

such as sadness, worry, fear or uneasiness.

But these types of feelings become a

problem when they begin to hinder daily

life for a prolonged period of time.

Therefore, they must be identified and

treated early and effectively.

1.1.1 Searching for Strategies

On the other hand, nursing leaders must

work together with the relevant

authorities to generate strategies to

improve the conditions of the work

environment, where the latter offers the

possibility to develop and achieve job

satisfaction. This is so that workers have

access to or possess a fair economic

reward, as well as work and personal

resources that turn work demands into a

source of learning that produces job

satisfaction, giving meaning to the work

performed.

1.1.2 Work overload

One of the main problems in the city of

Tijuana is that most personnel work

between 40 and 60 hours per week, similar

to working conditions in other countries

(Rendón et al., 2020). This can be

attributed to the lack of personnel and the

need for nurses to work two shifts to

improve their income, causing physical

and emotional overload, negatively

influencing their wellbeing.

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1.1.3 Contractual Status

During the pandemic, nursing personnel

were hired on an emergency basis in the

city, 47.7% of whom had a non-permanent

contractual situation, i.e., temporary or

fee-based. These personnel experienced

stress and job dissatisfaction with respect

to the work area to which they were

assigned, being subjected to

circumstances that constantly challenged

their capacities for emotional coping,

containment and resilience: the existence

of great emotional pressure in the areas of

direct care, ethical and moral dilemmas

(Buitrago et al., 2021).

1.1.4 Labor Recognition

Regarding compensation, at the national

level, the President of the Republic

informed that a COVID bonus would be

granted to nursing personnel working in

the first line of care, and that Merit Notes

would also be given in an extraordinary

way to the personnel who integrated the

COVID-19 patient care teams

(Government of Mexico, 2020). However,

in Tijuana this was not the case in all cases;

there were health professionals who did

not receive such compensation, either

because they worked in private

institutions or because in some public

institutions these bonuses were raffled

and were not granted to 100% of the staff,

generating dissatisfaction and stress, as

well as low perception of labor protection.

1.1.5 Obesity and its Relationship with the

Work Environment

One aspect to highlight is that there was a

significant difference between the

physical activity of nursing personnel in

private and public institutions; this

difference may be due to the guidelines

and requirements of these institutions as

part of their hiring or to the fact that the

personnel hired in the private sector are

recent graduates and younger, so that

their energy and desire to gain work skills

and abilities lead them to perform greater

physical activity and a greater number of

functions in the labor field, in addition to

having a contractual situation that does

not have a fixed contract.

These data may be different from the staff

of public institutions where they have a

stable job and are only limited to their

activities, in this sense age plays a

fundamental role since in public

institutions you can find older and more

experienced nursing staff.

The causes of overweight and obesity are

fundamentally determined by an increase

in the intake of caloric foods rich in sugars

and fats, coupled with a generalized

decrease in physical activity, generating

an energy imbalance (Barnett, 2017); this in

turn influenced by genetic, behavioral,

psychological and physical and social

environment factors.

In this sense, nursing personnel are not

exempt from overweight and obesity,

considering them as a vulnerable group

with a frequency that increases in those

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who are not sufficiently active, in those

who increase the consumption of meals

during working hours and in those who

work night or rotating schedules, being

the age groups from 25 to 34 years old the

most frequent with overweight and from

45 to 55 years old with obesity (Verón &

Auchter, 2020).

In 2022 the Centers for Disease Control

and Prevention (CDC), indicated that as

people's weight increases to overweight

and obesity levels also increase the risks of

suffering or developing NCDs such as

DM2, HTN, heart disease, among others

(Centers for Disease Control and

Prevention, 2022; Colosia et al., 2013;

National Institutes of Health, 2022; Shariq

& Mckenzie, 2020).

1.1.6 Social Discrimination

An important sociocultural difference is

the way in which the world's population

reacted to health personnel during the

pandemic, from countries that revered

nursing personnel as heroes and where

every night the cities resounded with a

massive applause in gratitude to health

personnel, valuing the risk to their own

lives to attend and save the population to

countries like Mexico, where some people

even children saw nursing personnel as

"dirty", "infected" and as a potential risk to

their health; For this reason, they did not

wait for verbal and physical aggressions

and mistreatment, even denying them

access to transportation services.

Discrimination was more than evident, so

that social networks and national and

international newspapers did not stop

exposing the different cases that were

presented (Abuabara, 2020). These facts

were generators of labor and social stress

that depended largely on the capabilities

and resources of the worker to cope with

them, as well as their culture and personal

situation outside of work. It is important to

remember that psychosocial factors at

work can become dysfunctional negative

conditions that can provoke a maladaptive

response. Therefore, discrimination can

be considered as a psychosocial risk factor

(Montes-Berges & Ortúñez, 2021).

1.1.7 Health Well-Being and its Relationship

to Job Satisfaction and Perception of Job

Protection

It was observed that job satisfaction and

the perception of job protection increase

the health well-being of Tijuana

professionals, since the higher the job

satisfaction and perception, the greater

the improvement in general health,

physical role, vitality and social function.

On the other hand, the perception of job

disappointment and job stress decrease

the worker's health well-being, becoming

a risk factor for their physical and mental

health, affecting the worker's general

health, social function and emotional role.

Therefore, the health well-being of the

worker depends significantly on his or her

job satisfaction and the conditions in

which he or she works.

According to the data found, more than

95% of the participants presented medium

job satisfaction, with a predominance of

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job-related stress and interpersonal

relationships with colleagues. Although

job satisfaction in general is not different

among the participating health

institutions, it can be seen that there is a

variation according to the work pressure

and work monotony experienced in each

institution, also including the professional

competencies of the staff.

In relation to social well-being, it can be

said that general health is the dimension

most affected, followed by the vitality and

mental health of the worker. In this sense,

the working conditions experienced by

workers are related to their physical

function, either because of the activities

they perform or the work area in which

they work. Likewise, the work area in

which they work is related to the physical

role (techniques and procedures), the

emotional aspect, mental health and work

seniority; it should be noted that work

seniority directly involves or affects the

worker's vitality, mental health, work

category and area of work of the

personnel, making them more vulnerable

with respect to their physical wellbeing.

Thus, it can be seen that occupational

health directly affects the well-being of

workers, from the perception of their work

and the generation of stress in it, so that

when there is little job satisfaction the

worker may also perceive little protection

in their work, which could generate stress

and anguish in going to work, aspects that

may contribute to the high probability of

developing non-communicable diseases

that affect their well-being and health.

2. Conclusions

The results found incite the authorities of

the institutions to work on continuous

improvement strategies where

occupational health and well-being of

workers is managed, as well as physical

health, emotional and mental health

aspects, among others; this in order to

reduce occupational stress and reduce the

risks that this entails in the worker's health

according to the stipulations of NOM-

035-STPS-2018 (NOM, 2018) where it is

mentioned that psychosocial risk factors

should be identified and the work

environment and conditions should be

measured to carry out prevention

measures and actions to control

psychosocial risks, in addition to favoring

the work environment (Secretaría de

Gobernación, 2018).

Therefore, it is suggested to consider the

working conditions, work areas and other

variables of the work environment of the

nursing staff that directly influence the

occupational health and well-being in

health of the worker as fields of study,

considering this as a safe place to maintain

optimal well-being and reduce health

risks.

This in turn will indirectly contribute to

provide optimal quality care and warmth

to users, where the risks of work stress,

anxiety about going to work or low work

perception are not conditions that affect

the welfare and health of workers and

users. In addition, it would be important to

start working on action strategies to care

for, reduce or promote well-being and

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occupational health in the work areas. It is

hoped that the results reported will

contribute to a positive change for the

health of the nursing profession.

3. Acknowledgments

We thank the Fundación Enfermera Delia

Ruiz Rivas for its invaluable support for the

development of this article and the

development of research in Nursing.

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