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. 2025 Feb 20;22(2):e70000. doi: 10.1111/jjns.70000

Pregnant nurses' occupational stress and associated factors: A comparative cross‐sectional study with other healthcare workers, physical workers, and desk workers

Marie Hino 1, Yasuhiko Ebina 2, Rika Yano 2,✉
PMCID: PMC11842949  PMID: 39980228

Abstract

Aim

To examine occupational stress levels and associated factors among pregnant nurses through a comparison with pregnant non‐nurses.

Methods

This cross‐sectional study included 1060 working pregnant women. Participants completed questionnaires including the Brief Job Stress Questionnaire, work conditions, obstetric conditions, Sense of Coherence Scale, and self‐management behaviors questionnaire. The participants were categorized into four groups: nurses, other healthcare workers, physical workers, and desk workers. Comparisons were made between the four groups and by gestational ages using Dunnett's test and chi‐squared test, and associated factors were examined using ordinal logistic regression analysis.

Results

Analysis of 847 valid responses showed that the nurse group had a higher occupational stress, higher job demand, and lower job control at any gestational age than the other profession groups. Nurses' occupational stress was associated with factors such as frequent overtime work, fewer break times, lower manager support, and lower prioritizing the fetus. Particularly, fewer break times and lower prioritizing the fetus were nurse‐specific associated factors.

Conclusions

The study showed that pregnant nurses are exposed to higher occupational stress throughout the entire pregnancy than other occupations. The stress was related to modifiable factors such as fewer break times and lower prioritizing the fetus. To manage occupational stress, pregnant nurses should avoid overtime, take breaks, and prioritize the fetus in the workplace. Hospital administrators would need to provide work coordination support and consider certain regulations regarding hazardous work restrictions for pregnant nurses. Future cohort studies are required to better understand occupational stress among pregnant nurses.

Keywords: midwife, nurse, occupational health, occupational stress, pregnant women

1. INTRODUCTION

Globally, approximately 70% of the nursing population is composed of women of reproductive age (Organisation for Economic Co‐Operation and Development, 2019). Nurses are at a higher risk of perinatal abnormalities owing to their complex, hazardous tasks and working conditions (Huang et al., 2016). Shift work, night shifts, and long working hours increase the risk of miscarriages, premature births, low birth weights, and gestational hypertension (Cai et al., 2019; van Melick et al., 2014). Heavy workloads, standing work, and handling antitumor drugs and sterilizing agents increase the risk of miscarriage, preterm birth, and congenital fetal malformations (Cai et al., 2020; Liu et al., 2023). Nurses who perform a combination of hazardous tasks are at a higher risk of perinatal abnormalities, and the incidence of perinatal abnormalities is significantly higher than in the general population (Liao et al., 2019). Some of these hazardous duties are restricted or prohibited by national maternal‐fetal protection systems and labor laws. However, in Japan, only 47.6% and 19.6% of pregnant nurses are exempt from night shifts and hazardous duty, respectively (Hino & Yano, 2024), meaning that less than half of pregnant nurses are granted these exemptions. This is suggested to be caused by nursing staff shortages and busy clinical practice (Hino & Yano, 2024). Although there have been calls to modify the working environment for pregnant nurses and improve protective provisions, no concrete measures have been considered. Thus, health hazards to pregnant nurses pose serious occupational health concerns (Rainbow et al., 2021).

Previous studies have suggested that the high risk of perinatal abnormalities among working pregnant women is influenced not only by demanding occupational factors but also by the associated occupational stress. Generally, pregnant women are highly vulnerable to stress during this period (Pais & Pai, 2018). Major stressors in pregnancy include discomfort and pain due to pregnancy‐associated physical changes causing physical symptoms such as impaired activity, easy fatigue, poor sleep, and nausea (Kazemi et al., 2017); anxiety, health, and childbirth fears; and frequent emotional fluctuations due to hormonal imbalances (Bjelica et al., 2018). Stressful events, relationships with others, and financial burdens serve as external stressors (Eick et al., 2020). Particularly, occupational stress is a significant factor for working pregnant women. According to the Job Demand Control (JDC) model (Karasek & Theorell, 1990), workers experience strong occupational stress when they perceive their job demand as high (job demand) and their sense of skill, ability, and control to meet these demands (job control) to be low. High occupational stress is associated with health risks such as hypertension (Khonde Kumbu et al., 2023), coronary heart disease (Li et al., 2015), insomnia (Yang et al., 2018), musculoskeletal symptoms (Lee et al., 2014), poor job performance (Alinejad et al., 2023), burnout, and turnover (Kachi et al., 2020) in workers. In working pregnant women, it significantly increases the risk of preterm births (Meyer et al., 2007), small‐for‐gestational‐age (Larsen et al., 2013), and reduced birth weights (Lee et al., 2011), suggesting its hazard.

Nurses are considered an occupational group with high occupational stress. According to a previous study examining occupational stress by occupational type, blue‐collar (physical) workers, which frequently involve physical movement, are more stressful than white‐collar (desk) workers (Dėdelė et al., 2019). Healthcare workers, who are considered intermediate between blue‐collar and white‐collar work, have been reported to experience exceptionally high levels of occupational stress compared with other professions. Among them, nurses experience the highest levels of stress (Nam et al., 2016). Unique characteristics of stress among nurses have been reported, including high workloads; night shifts and long irregular shifts; interpersonal conflicts with colleagues, physicians, and patients; and understaffing (Lim et al., 2022). Several studies of pregnant nurses found that they experienced high physical strain and health concern levels in the workplace while simultaneously facing role conflicts in having to fulfill their professional responsibilities (Hino et al., 2024; Rainbow et al., 2021). These nurse‐specific occupational stressors have been suggested to contribute to nurses working even when in pain, potentially increasing risks of perinatal abnormality (Hino et al., 2024).

Occupational stress, thus, is hypothesized to be an important indicator of perinatal abnormalities for pregnant nurses. However, no studies have investigated occupational stress in pregnant nurses, and previous findings on pregnant nurses have been limited to qualitative examinations. Therefore, the actual situation and generalizability of previous findings on occupational conflict and stress among pregnant nurses have not been adequately examined. Additionally, as these previous studies were conducted only on pregnant nurses, whether occupational stress is specific to nurses or whether pregnant non‐nurses also experience the same stress is unclear. To consider measures to prevent perinatal abnormalities specific to pregnant nurses, occupational stress levels and associated factors need to be characterized through comparisons with other occupations. Therefore, the research questions for this study were defined as follows: Is occupational stress higher among pregnant nurses compared with pregnant non‐nurses? Are there differences in factors associated with occupational stress between pregnant nurses and pregnant non‐nurses? This study aimed to examine the characteristics of occupational stress levels and associated factors among pregnant nurses through comparison with non‐nurse groups. Non‐nurse occupations were categorized into three groups: physical workers, desk workers, and non‐nursing healthcare workers.

2. METHODS

2.1. Study design and participants

This study adopted a cross‐sectional design with a self‐administered questionnaire in accordance with the STROBE guidelines (von Elm et al., 2007) to enhance the reporting of observations. Data were collected between January and June 2024. Hospital facilities that handled more than 100 deliveries per year in Japan were selected from the list of medical institutions of the Ministry of Health, Labor, and Welfare, and 30 facilities were randomly selected in consideration of the required sample size. Selection was made to ensure that the proportion of perinatal health centers, general hospitals, and clinic hospitals in the participating facilities was equivalent to that in Japan to avoid bias in the participants' obstetric severity. A research description and cooperation request form were mailed to these 30 facilities, and 20 facilities in 10 cities agreed to participate in this study. Participants were pregnant women working as nurses or non‐nurses attending the participating facilities. The inclusion criterion was employment during pregnancy. The exclusion criteria were: (1) those aged <18 years and (2) those who had already retired at the time of the questionnaire response. The sample size was calculated using G Power ver. 3.19, t‐test (two‐tailed), α error = 0.05, power = 0.90, effect size = 0.30, with 109 participants (55 nurses and 55 non‐nurses). There was one nurse group (n = 55) and three non‐nurse groups (55 × 3 groups = 165), totaling 220 participants. Additionally, as this study sought to validate by gestational period, n = 220 × 3 gestational periods were used, making 660 the final sample size. Assuming a response rate of 60% and considering invalid responses, the final number of distributions was 1060.

2.2. Data collection

Questionnaires were mailed to 20 hospital administrators at the participating facilities. Prior to the survey, all hospital administrators were informed by the researcher, either in person or telephonically, about the purpose and survey methodology of the study. The hospital administrators then conveyed this information to the hospital and outpatient staff. Hospital staff selected working pregnant women who met the inclusion criteria, distributed questionnaires, and asked them to complete them. Since this study was a large‐scale survey with simultaneous distribution of the questionnaires at hospitals throughout Japan, the cooperation of hospital staff in distributing the questionnaires was necessary. No specific locations were specified where the questionnaires were to be completed. The participants were asked to place the completed questionnaires in an envelope and deposit them in a box provided at each hospital. The deadline was 1 month after the distribution. The completed questionnaires were collected by the hospital administrators and mailed to the researchers.

The participant occupations were categorized into the following four groups: nurses, healthcare workers, physical workers, and desk workers. The reason for classifying non‐nursing occupations into these three groups is that occupational stress is strongly influenced by physical workload. In general, occupations are classified as physical work or desk work (United States Department of Labor, 2001). Healthcare workers are considered to fall in between these two groups and therefore were separated as one group. Specifically, occupations other than nurses were classified according to the Japanese Standard Classification of Occupations (Ministry of Internal Affairs and Communications, 2009) as follows: healthcare workers group (occupational classification B), physical workers group (occupational classifications D, E, F, G, H, and K), and desk workers group (occupational classifications A and C). The nurse group included registered nurses and midwives. The healthcare workers group included primarily physicians, physical therapists, occupational therapists, and radiology technicians. The physical workers group included occupations that involved heavy work or work performed while standing, such as childcare workers, kitchen staff, cleaning staff, and delivery workers. The desk worker group included clerks, civil servants, financial workers, and other occupations, of which respondents indicated that they were primarily desk‐bound. To ensure that the characteristics of each profession were not overlooked, a comparative analysis was conducted on each variable before grouping the professionals to ensure that there were no significant differences between any of the variables.

2.3. Instruments

2.3.1. Personal demographic and obstetric conditions

Age, medical history, number of deliveries, history of miscarriages, non‐pregnant body mass index, and marital status were measured. Pregnancy status was assessed, including the number of weeks of pregnancy, presence or absence of pregnancy complications (e.g., threatened abortion, threatened preterm birth, hypertensive disorders of pregnancy, gestational diabetes mellitus), and the total number of minor problems (e.g., morning sickness, general fatigue, gastrointestinal symptoms, palpitations, sleepiness, urine leakage, dizziness, edema in the lower limbs, and back pain).

2.3.2. Brief job stress questionnaire (BJSQ)

The Brief Job Stress Questionnaire (BJSQ) (Inoue et al., 2014) was used to assess two job stress dimensions (job demand and job control) and social support. Based on the JDC model, the scale consists of items on job stressors, physical and psychological stress reactions, and workplace support, allowing researchers to choose which subitems to use depending on the study purpose. Therefore, this study measured items related to job demand (three items), job control (three items), and social support (manager, colleague, and family and friends support; three items each). Responses were scored on a 4‐point Likert scale ranging from 1 (disagree) to 4 (agree). Possible score ranges were 3–12 for job demand, job control, and social support from manager, colleague, and family and friends. Higher scores indicate greater perception of each dimension. Job demand and job control scores were dichotomized at the median, and occupational stress was classified as follows: (i) high stress: high job demand (>7.5), and low job control (<7.5); (ii) middle stress: high job demand (>7.5) and high job control (>7.5) or vice versa; and (iii) low stress: low job demand (<7.5), and high job control (>7.5). The scale has been tested for reliability and validity by its developers (Inoue et al., 2014) and is widely used for occupational health assessment in Japan, with the Ministry of Health, Labour and Welfare recommending it as a tool for measuring occupational stress in companies.

2.3.3. Work conditions during pregnancy

Profession, employment status, hazardous work, and use of maternity protection provisions (e.g., exemption from night shifts, short‐term working measures, and overtime exemption systems) were ascertained. Hazardous work includes night shifts, workloads, heavy lifting, standing work, break time, and overtime work. For item evaluation, night shifts were measured as yes or no; workload as 0 (very decreased) to 3 (increased); and other items as 0 (never) to 3 (always).

2.3.4. Self‐management behaviors questionnaire

The questionnaire comprised 35 items on six subscales: diet and nutrition (seven items), sleep and rest (five items), contraindications (two items), abnormality prevention (seven items), avoidance of burden movements (six items), and knowledge and self‐monitoring (eight items). These items complied with the World Health Organization (World Health Organization, 2020) and Japan Midwifery Society guidelines for pregnancy (Japan Academy of Midwifery, 2019). A 6‐point Likert scale (1 = not at all to 6 = always) was used. The total possible scores ranged from 35 to 210. Higher scores reflect better overall compliance with self‐management behaviors. The scale has been tested for reliability and validity by the developers (Hino & Yano, 2024).

2.3.5. Sense of coherence scale 13

The Japanese version of the Sense of Coherence Scale 13 (SOC‐13) (Yamazaki, 1999) was used. This is a shortened version of the SOC‐29 developed by Antonovsky (1987) and translated into Japanese by Yamazaki (1999). It comprises 13 items in three subscales (comprehensibility, manageability, and meaningfulness). Each item is rated on a 7‐point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The scores of all 13 items were summed, and the five negatively worded items were reversed. The total possible scores ranged from 13 to 91. A higher score indicates a higher level of SOC (Yamazaki, 1999). The reliability and validity of the SOC scale have been examined in previous studies (Eriksson & Lindström, 2005).

2.3.6. Self‐management difficulties scale

This scale assesses self‐management behavioral difficulties in pregnant women and comprises 32 items with four subscales: prioritizing the fetus (eight items), dueling roles of a worker and a pregnant woman (10 items), unsure about management (six items), and perceiving one's limits (eight items). Items were measured using a 6‐point Likert scale (1 = strongly disagree to 6 = strongly agree). The scoring method calculates the total score for each subscale, with higher scores indicating a higher perception of each concept. The possible total scores ranged from 10 to 60 for dueling roles of a worker and a pregnant woman, 8 to 48 for prioritizing the fetus and perceiving one's limits, and 6 to 36 for unsure about management. The reliability and validity of this scale have been confirmed by the developers (Hino & Yano, 2024).

2.4. Statistical analysis

Descriptive analyses were conducted, including means and standard deviation (SD) of continuous variables and frequencies and percentages of categorical variables. For statistical analysis, occupational stress was compared using chi‐squared or Fisher's exact tests for differences in the proportion of high, middle, and low stress between the nurse and other profession groups. The Bonferroni method was used to determine significance levels. The proportions of stress categories by trimester of pregnancy within each group were also compared using the same method. Next, Dunnett's test was conducted to compare the scores of the nurse group with the other profession groups for job demand and job control, with the nurse group as the control group. In this analysis, differences in overall scores and scores in each trimester of pregnancy were examined. Before these analyses, comparative analyses by trimester of pregnancy were conducted to confirm that there were no significant differences in the basic demographics.

Finally, univariate and multivariate analyses were conducted to screen factors related to occupational stress in all groups. The chi‐square test or analysis of variance was used for the univariate analysis, and ordinal logistic regression analysis with occupational stress as the dependent variable was used for the multivariate analysis. In the multivariate analysis, independent variables that were p < .100 in the univariate analysis and variables assumed to be related to occupational stress from existing studies (e.g., work factors) were entered. In the analysis, the variance inflation factor (VIF) was calculated to avoid multicollinearity effects on the results. Statistical significance was set at p < .050. Statistical analyses were performed using JMP Pro (ver. 16.1; SAS Institute Inc.).

2.5. Ethical consideration

The study was approved by the ethical review committee of the author's university (approval number: 23–76) and conducted in accordance with the Declaration of Helsinki (World Medical Association, 2013). Data were handled with strict confidence, and all data were kept anonymous. The participants were informed in writing about the nature of the study and that their participation was voluntary. Filling in the questionnaire was deemed to have consented to participate in this study.

3. RESULTS

3.1. Participant characteristics

A total of 1060 questionnaires were distributed, and 852 were collected (response rate: 80.4%). After excluding those who did not respond or did not meet the participation criteria, 847 valid responses (valid response rate: 99.4%) were included in the analysis. The distribution was as follows: nurse group, n = 172; healthcare worker group, n = 61; physical worker group, n = 309; and desk worker group, n = 305. The participants' characteristics and results for each variable are shown in Table 1.

TABLE 1.

Participant characteristics.

Total Nurses Healthcare workers Physical workers Desk workers p
n = 847 n = 172 n = 61 n = 309 n = 305
n (%) n (%) n (%) n (%) n (%)
Age (years); mean (SD) 31.8 (4.9) 31.7 (4.3) 32.7 (4.7) 30.9 (5.2) 32.5 (4.7) .162 a
Parity
Primipara 462 (54.5) 80 (46.5) 32 (52.5) 175 (56.6) 175 (57.4) .106 b
Multipara 385 (45.5) 92 (53.5) 29 (47.5) 134 (43.4) 130 (42.6)
Gestation period
First trimester 98 (11.6) 19 (11.1) 3 (4.9) 41 (13.3) 35 (11.5) .197 b
Second trimester 374 (44.1) 77 (44.8) 32 (52.5) 144 (46.6) 121 (39.7)
Third trimester 375 (44.3) 76 (44.1) 26 (42.6) 124 (40.1) 149 (48.8)
Marital status
Married 800 (94.5) 163 (94.8) 60 (98.4) 286 (92.6) 291 (95.4) .216 b
Unmarried (single/divorced) 47 (5.5) 9 (5.2) 1 (1.6) 23 (7.4) 14 (4.6)
Medical history
Yes 144 (17.0) 48 (27.9) 13 (21.3) 38 (12.3) 45 (14.8) .050 b
Previous abortions history
Yes 135 (15.9) 30 (17.4) 7 (11.5) 41 (13.3) 57 (18.7) .207 b
BMI at non‐pregnancy (kg/ m2); mean (SD) 21.5 (3.4) 21.4 (3.0) 21.1 (2.7) 22.0 (4.0) 21.2 (3.1) .872 a
Pregnancy conditions
Threatened abortion 17 (2.0) 8 (4.7) 0 (0.0) 5 (1.6) 4 (1.3) .039* , b
Threatened preterm birth 33 (3.9) 11 (6.4) 3 (4.9) 9 (2.9) 10 (3.3) .246 b
Hypertensive disorders of pregnancy 9 (1.1) 3 (1.7) 0 (0.0) 4 (1.3) 2 (0.7) .561 b
Gestational diabetes mellitus 27 (3.2) 4 (2.3) 2 (3.3) 6 (1.9) 15 (4.9) .177 b
Employment type
Fulltime employee 635 (75.0) 157 (91.3) 50 (82.0) 201 (65.0) 227 (74.4) <.001** , b
Non‐fulltime employee 212 (25.0) 15 (8.7) 11 (18.0) 108 (35.0) 78 (25.6)
Profession
Registered nurse — 158 (91.9) — — —
Midwife — 14 (8.1) — — —
Department
Outpatient — 27 (15.7) — — —
Ward — 115 (66.9) — —
Intensive care unit/High care unit — 7 (4.0) — — —
Operation room — 5 (2.9) — — —
Others — 18 (10.5) — — —
Working conditions
Very decreased/Decreased 439 (51.8) 109 (63.4) 34 (55.7) 177 (57.3) 119 (39.0) <.001** , b
Not changed/Increased 408 (48.2) 63 (36.6) 27 (44.3) 132 (42.7) 186 (61.0)
Heavy lifting
Always/Sometimes 318 (37.5) 105 (61.0) 22 (36.1) 171 (55.3) 20 (6.6) <.001** , b
Not often/Never 529 (62.5) 67 (39.0) 39 (63.9) 138 (44.7) 285 (93.4)
Standing work
Always/Sometimes 544 (64.2) 163 (94.8) 51 (83.6) 267 (86.4) 63 (20.7) <.001** , b
Not often/Never 303 (35.8) 9 (5.2) 10 (16.4) 42 (13.6) 242 (79.3)
Overtime work
Always/Sometimes 373 (44.0) 126 (73.3) 30 (49.2) 117 (37.9) 100 (32.8) <.001** , b
Not often/Never 474 (56.0) 46 (26.7) 31 (50.8) 192 (62.1) 205 (67.2)
Ensuring break times
Always/Sometimes 756 (89.3) 144 (83.7) 57 (93.4) 263 (85.1) 292 (95.7) <.001** , b
Not often/Never 91 (10.7) 28 (16.3) 4 (6.6) 46 (14.9) 13 (4.3)
Night work
Yes 55 (6.5) 44 (25.6) 0 (0.0) 11 (3.6) 0 (0.0) <.001** , b
Social support; mean (SD)
Manager 8.0 (2.3) 7.7 (2.1) 8.3 (2.2) 8.2 (2.5) 7.9 (2.3) .078 a
Colleague 8.5 (2.3) 8.6 (1.9) 8.6 (2.2) 8.8 (2.3) 8.2 (2.4) .051 a
Family and Friends 11.3 (1.3) 11.2 (1.3) 11.3 (1.3) 11.3 (1.3) 11.3 (1.2) .941 a
Self‐management behaviors; mean (SD) 150.9 (23.1) 144.2 (22.0) 151.4 (17.1) 151.9 (24.2) 153.5 (23.0) <.001** , a
Sense of Coherence Scale 13; mean (SD) 37.0 (7.8) 37.0 (7.4) 39.2 (6.6) 37.4 (8.0) 36.1 (8.0) .052 a
Self‐management difficulties scale; mean (SD)
Prioritizing the fetus 32.2 (3.2) 30.7 (2.8) 31.4 (2.3) 33.0 (3.2) 32.3 (3.3) <.001** , a
Dueling roles 34.5 (4.6) 37.9 (3.8) 34.7 (3.9) 33.9 (4.7) 32.7 (4.5) <.001** , a
Unsure about management 20.1 (3.8) 22.3 (3.6) 20.6 (3.7) 20.0 (3.9) 18.7 (3.5) <.001** , a
Perceiving one's limits 27.6 (3.3) 33.2 (2.7) 28.5 (3.3) 27.1 (3.5) 24.8 (3.1) <.001** , a
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Note: Dueling roles, dueling roles of a worker and a pregnant woman. Cronbach's α for each scale in this study; Social support: 0.87–0.88, Self‐management behaviors questionnaire: 0.91, Sense of Coherence Scale 13: 0.84, Self‐management difficulties scale: 0.88–0.90.

Abbreviations: BMI, body mass index; p, p‐value; SD, standard deviation.

*

p < .050;

**

p < .010.

a

Analysis of variance (nurses vs. healthcare workers vs. physical workers vs. desk workers).

b

Chi‐squared test (nurses vs. healthcare workers vs. physical workers vs. desk workers).

The mean age (SD [range]) of all participants was 31.8 (4.9 [19–47]) years, and the mean age (SD [range]) of nurses was 31.7 (4.3 [23–42]) years. No significant differences were observed in the mean age of the groups. No other differences in individual attributes were observed between groups. In terms of pregnancy status, the proportion of threatened abortion occurrences among nurses was significantly higher than in the other professions group. Additionally, only the physical workers group had a significantly lower incidence of threatened preterm birth when the nurse group was used as a control. Regarding employment status, the proportion of full‐time employees in the nurse group was significantly higher than that in the other professions group.

3.2. Occupational stress by occupational groups

The nurse group had a significantly higher proportion of high stress (52.9%) and a lower proportion of low stress than the other three groups (Table 2). Analyses by gestational period demonstrated similar results. Additionally, the nurse group had significantly higher job demand and lower job control than the other three groups (Table 3). The results were similar in the analysis by gestational period.

TABLE 2.

Occupational stress by occupational groups.

Total Nurses Healthcare workers Physical workers Desk workers p c
n = 847 n = 172 n = 61 p a n = 309 p b n = 305
n (%) n (%) n (%) n (%) n (%)
Occupational stress High 182 (21.5) 91 (52.9) 9 (14.8) <.001 51 (16.5) <.001 31 (10.2) <.001
Middle 326 (38.5) 50 (29.1) 26 (42.6) 130 (42.1) 120 (39.3)
Low 339 (40.0) 31 (18.0) 26 (42.6) 128 (41.4) 154 (50.5)
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Abbreviation: p, p‐value.

a

Chi‐squared test (nurses vs. healthcare workers).

b

Chi‐squared test (nurses vs. physical workers).

c

Chi‐squared test (nurses vs. desk workers).

TABLE 3.

Job demand and job control by occupational groups.

Total Nurses Healthcare workers Physical workers Desk workers
n = 847 n = 172 n = 61 n = 309 n = 305
Mean (SD) Mean (SD) Mean (SD) p a Mean (SD) p b Mean (SD) p c
Job demand 7.1 (2.5) 8.7 (2.1) 6.9 (2.1) <.001 6.8 (2.4) <.001 6.6 (2.4) <.001
Job control 8.3 (2.2) 7.2 (1.8) 8.4 (1.9) <.001 8.3 (2.4) <.001 8.9 (2.0) <.001
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Note: Cronbach's α for job demand and job control was 0.82 and 0.78.

Abbreviations: p, p‐value; SD, standard deviation.

a

Dunnett's test (nurses vs. healthcare workers).

b

Dunnett's test (nurses vs. physical workers).

c

Dunnett's test (nurses vs. desk workers).

3.3. Associated factors of occupational stress by occupational groups

Univariate analyses of occupational stress and the independent variables were conducted for each occupational group (Supplementary file S1). Based on the results, ordinal logistic regression analysis with occupational stress as the dependent variable was conducted for each occupational group (Table 4).

TABLE 4.

Results of multivariate analysis of occupational stress by occupations.

Variables Nurses Healthcare workers Physical workers Desk workers
OR 95% CI p OR 95% CI p OR 95% CI p OR 95% CI p
Work conditions
Night work [Yes] 1.2 0.5–1.3 .371 ‐ ‐ ‐ 1.2 0.6–2.2 .666 ‐ ‐ ‐
Workload [Decreased] 0.8 0.5–1.1 .220 0.4 0.1–1.7 .230 0.4 0.1–1.4 .178 0.6 0.3–1.1 .103
Heavy lifting [more] 1.3 0.9–1.9 .151 1.0 0.5–2.2 .924 1.1 0.8–1.4 .555 1.1 0.7–1.9 .576
Standing work [more] 1.7 0.8–3.5 .160 1.9 0.8–5.1 .176 1.8 1.2–2.8 .011* 1.2 0.9–1.7 .176
Ensuring break times [more] 0.5 0.3–0.9 .026* 0.6 0.1–2.8 .528 0.9 0.6–1.2 .371 0.9 0.5–1.5 .604
Overtime work [more] 1.8 1.2–2.7 .002** 2.6 1.3–5.8 .012* 1.5 1.1–1.9 .004** 2.2 1.6–2.9 <.001**
Social support
Manager 0.8 0.6–0.9 .011* 0.9 0.6–1.4 .759 0.9 0.8–1.0 .020* 1.0 0.8–1.1 .604
Colleague 1.0 0.8–1.2 .836 ‐ ‐ ‐ 1.0 0.9–1.1 .922 1.0 0.8–1.1 .597
Self‐management behaviors 1.0 0.9–1.1 .405 ‐ ‐ ‐ 1.0 0.9–1.1 .696 1.0 0.9–1.1 .248
Self‐management difficulties scale
Prioritizing the fetus 0.8 0.7–0.9 .010* ‐ ‐ ‐ 1.0 0.9–1.1 .909 1.0 0.9–1.1 .340
Dueling roles 1.1 0.9–1.2 .397 ‐ ‐ ‐ 1.0 0.9–1.1 .386 1.0 0.9–1.1 .316
Unsure about management 1.1 1.0–1.3 .051 1.3 1.1–1.7 .013* 1.0 0.9–1.1 .639 1.0 0.9–1.1 .499
Perceiving one's limits ‐ ‐ ‐ 1.2 1.0–1.4 .046* 1.3 1.1–1.5 <.001** 1.4 1.1–1.6 .001**
Adjusted R 2 0.42 0.38 0.40 0.39
p <.001** .006** <.001** <.001**
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Note: Ordinal logistic regression analysis; dependent variable: occupational stress, independent variables: work conditions, social support, self‐management behaviors, and self‐management difficulties scale, adjusted variable: age.

Abbreviations: CI, confidence interval; Dueling roles, dueling roles of a worker and a pregnant woman; OR, odds ratio; p, p‐value.

*

p < .050;

**

p < .010.

Occupational stress factors in the nurse group included fewer break times (odds ratio [OR] = 0.5, 95% confidence interval [CI] = 0.3–0.9), frequent overtime work (OR = 1.8, 95% CI = 1.2–2.7), lower manager support (OR = 0.8, 95% CI = 0.6–0.9), and lower prioritizing the fetus score (OR = 0.8, 95% CI = 0.7–0.9). Regarding the healthcare workers group, frequent overtime work (OR = 2.6, 95% CI = 1.3–5.8), higher unsure about management score (OR = 1.3, 95% CI = 1.1–1.7), and higher perceiving one's limits score (OR = 1.2, 95% CI = 1.0–1.4) were associated with occupational stress. Regarding physical workers group, frequent standing work (OR = 1.8, 95% CI = 1.2–2.8), frequent overtime work (OR = 1.5, 95% CI = 1.1–1.9), lower manager support (OR = 0.9, 95% CI = 0.8–1.0), and higher perceiving one's limits score (OR = 1.3, 95% CI = 1.1–1.5) were associated with occupational stress. Regarding the desk workers group, frequent overtime work (OR = 2.2, 95% CI = 1.6–2.9) and higher perceiving one's limits score (OR = 1.4, 95% CI = 1.1–1.6) were associated with occupational stress. The VIF ranged from 1.0 to 1.8 in both multivariate analyses, confirming no multicollinearity effects for the results.

4. DISCUSSION

This study aimed to examine the characteristics of occupational stress levels and associated factors among pregnant nurses by comparing them with other professions. The study's results showed that pregnant nurses had higher occupational stress, higher job demand, and lower job control in all trimesters. Occupational stress has been suggested to be associated with perinatal abnormalities (Meyer et al., 2007); however, it has never been examined in pregnant nurses. This study is the first to quantitatively demonstrate that occupational stress levels and risk of abnormality are high in nurses at any gestational period. Notably, occupational stress levels in the nurse group were significantly higher than in the desk workers group, as well as in other physical workers and healthcare workers groups with physically demanding tasks. The risk of perinatal abnormalities among pregnant nurses has been suggested to be mainly influenced by burdensome tasks, such as heavy workloads and occupational hazards (Jiang et al., 2023; Simcox & Jaakkola, 2008). However, this study showed that occupational stress among pregnant nurses is also related to modifiable factors such as overtime work, fewer break times, and difficulty in prioritizing the fetus.

The reason for the higher occupational stress levels for nurses compared with other professions can be attributed to their occupational characteristics. In this study, job demand was significantly higher in the nurse group than in the other groups. For this reason, nurses spend most of their work time caring for patients (Hendrich et al., 2008). Specifically, they spend an average of 5.7 hours standing and over 1.7 hours walking during a 12‐hour workday (Benzo et al., 2021). A recent study reported that nurses consume approximately ≥1521 Kcal during a 12‐hour shift, including standing and heavy work (Allan et al., 2019), which shows how physically demanding nursing work can be. The maternal‐fetal protection regulates the limitations of standing and heavy work for pregnant women. However, 163 (94.8%) of the nurse participants answered that they were “always” standing, and 105 (61.0%) answered that they “always” performed heavy lifting work, revealing that more than half of the participants continued to perform burdensome work even after pregnancy. These work conditions were the largest factor in increasing job demand in the nurse group. Additionally, job control among nurses was significantly lower than in other professions. Nursing work is characterized by having to respond to the sudden needs and unpredictable events of patients under permanent time pressure (Vinckx et al., 2018). Particularly, night shifts are less staffed than the day shifts, and in Japan, one nurse is required to take care of 10 patients, but the number of nurses to patients is relatively low compared with some other countries (Morita et al., 2023). Furthermore, night shifts of 16 hours or more account for more than half of the two‐shift system in Japan, forcing even pregnant women to work long hours (Japanese Nursing Association, 2017). These occupational characteristics may limit nurses' control over their work order and behaviors. Additionally, nurses experienced more difficulty maintaining control of their work after pregnancy than previously. The nurses felt increased physical and mental burdens from their work when they became pregnant and felt frustrated that they could not move as much as they wanted and could not fulfill their nursing abilities (Quinn, 2016). Furthermore, they tended to ignore their physical and mental symptoms and continue to work because of a sense of guilt for inconveniencing patients and colleagues and a sense of professional responsibility (Hino et al., 2024; Rainbow et al., 2021). The study's results quantitatively supported these findings regarding the occupational stress levels of pregnant nurses.

Nurses' occupational stress was associated with factors such as frequent overtime work, fewer break times, lower manager support, and lower prioritizing the fetus. Frequent overtime work was a factor that increased occupational stress not only in the nurse group but also in all occupational groups. Overtime work increases the amount of working time pregnant women spend at the workplace and interferes with their rest and sleep at home (Hino & Yano, 2024). Particularly, overtime work for pregnant nurses has been reported to be directly associated with perinatal abnormalities such as impending miscarriage, suggesting a strong physical and mental stress response due to overtime work (Jiang et al., 2023). This study's results confirm the dangers of overtime work for working pregnant women, including nurses. Nurses' occupational stress was associated with manager support. According to the JDC model, social support such as family support alleviates occupational stress. However, the results suggest that manager support has a direct influence, especially among nurses. This result is consistent with previous findings (Zare et al., 2021). In this study, lower manager support was also associated with occupational stress in the physical workers group as well as the nurse group. Common to these two groups was the inclusion of pregnant women who worked night shifts and frequent physical strain tasks. Adjustment of work content, including night shifts, and avoidance of burdensome tasks are difficult to achieve by the will of individual workers and require adjustment and consideration by managers. These findings explain these results.

Fewer break times and lower prioritizing the fetus were the occupational stressors found only in the nurse group. In the nurse group of this study, 83.7% of the respondents reported that they always or sometimes get break times, which was significantly lower than the desk workers group (95.7%) and the healthcare workers group (93.4%). This suggested that the work characteristics required nurses to be busy and to respond to emergencies due to understaffing. Additionally, working continuously without any breaks deprives nurses of time to monitor themselves and the fetus, and the biggest factor in forcing them to push themselves to work (Hino & Yano, 2024). These results emphasize the importance of ensuring breaks for pregnant nurses. Prioritizing the fetus, defined as the degree of belief that the fetus comes first during work (Hino et al., 2024), was significantly lower in the nurse group than in the other occupational groups. Pregnant nurses have been shown to prioritize the needs of their patients, unable to leave a patient in need of help or in mortal danger in front of them, even if their own or their child's health is at risk (Hino et al., 2024; Rainbow et al., 2021). This study showed that an environment in which prioritizing the fetus is difficult is one of the occupational stressors specific to pregnant nurses.

4.1. Implications for clinical practice

This study revealed a high level of occupational stress and the characteristic associated factors among pregnant nurses, highlighting the need to consider the following measures: First, pregnant nurses must fully understand their own high‐risk levels and adopt awareness and behaviors that will enable them to deliver safely. They should avoid overtime work, ensure adequate break times, and work with prioritizing the fetus. Second, hospital administrators and nursing managers must provide appropriate support to pregnant nurses. Adjusting work duties, exempting overtime, ensuring break times, providing information on the maternal‐fetal protection system, and emotional support from managers would contribute to alleviating occupational stress among pregnant nurses. Third, hospitals and government authorities formulating labor regulations and maternal‐fetal protection schemes would need to consider certain provisions for night shifts, ensuring break times and exemptions from overtime work for pregnant nurses. Additionally, considering a review of the nursing system, such as strengthening the overall staffing of nurses, would be necessary.

4.2. Limitations

This study had several limitations. First, due to the cross‐sectional study design, causal relationships could not be established. Second, the participants were healthy pregnant women employed at the time of response; therefore, examining occupational stress in pregnant women unable to work was not possible. Future cohort studies from early pregnancy should be conducted to better understand occupational stress among working pregnant women, including nurses.

5. CONCLUSIONS

This study showed that pregnant nurses had higher occupational stress, higher job demand, and lower job control than the other occupations. Occupational stress among pregnant nurses was associated with factors such as frequent overtime work, fewer break times, lower manager support, and lower prioritizing the fetus. Particularly, fewer break times and lower prioritizing the fetus were nurse‐specific associated factors. To manage occupational stress, pregnant nurses should avoid overtime work, take break times, and prioritize the fetus in their workplace. Hospitals and government authorities would need to consider certain regulations regarding hazardous work restrictions for pregnant nurses. Future cohort studies are required to better understand occupational stress among pregnant nurses.

AUTHOR CONTRIBUTIONS

Marie Hino, Yasuhiko Ebina, and Rika Yano contributed to the conception and design of this study and the acquisition of data; Marie Hino performed the statistical analysis and drafted the manuscript. Marie Hino, Yasuhiko Ebina, and Rika Yano critically reviewed the manuscript and supervised the whole study process. All authors read and approved the final manuscript.

CONFLICT OF INTEREST STATEMENT

There are no conflicts of interest to declare.

Supporting information

Supplementary File S1: Supporting Information.

JJNS-22-e70000-s001.docx (24.4KB, docx)

ACKNOWLEDGMENTS

We would like to express our sincere thanks to all the participants, nurses, midwives, hospital managers, and staff who participated in this study. This study was supported by JSPS KAKENHI Grant Number JP23H03179 (2023).

Hino, M. , Ebina, Y. , & Yano, R. (2025). Pregnant nurses' occupational stress and associated factors: A comparative cross‐sectional study with other healthcare workers, physical workers, and desk workers. Japan Journal of Nursing Science, 22(2), e70000. 10.1111/jjns.70000

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Supplementary Materials

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