An Exploration of Job Stressors of Clinical Nursing Instructors in Taiwan

Shu-Yuan Chang and Tsung-I Pai

Abstract. The purpose of the qualitative research was to explore the nature of work-related stressors of clinical nursing instructors in Taiwan. The research was guided by Hardy and Conways theory of Role Strain to explore eight Taiwanese clinical instructors work-related stress and the role problems. The results found that clinical nursing instructors work-related stressors include inadequate role occupancy, increasing work demands, deficient role preparedness, lowered role control, insufficient role support, and role bargain. When a clinical instructor with lowered role control experiences more stressors, the situation of role stress will deteriorate. Role support and role bargain are the buffers of work-related stress to adapt clinical instructors for the rapidly changing educational and medical environment. Consequently, adequate role credibility for role occupancy is a necessary strategy for reducing clinical instructors work-related strain during organizational rapid change.

Introduction
Stress is unavoidable in the 21st century which is filled with competitive opportunities particularly in the work setting. In terms of Taiwanese higher education, since the mid-1990s, many colleges have struggled to restructure into universities (Chou, 2004; Lee, Chen, & Chen, 2001; Ministry of Education of Taiwan, 2005). While the restructuring movement is occurring, organizations are forced to change and become more effective and efficient in order to adapt to the changing environment (Irving & Coleman, 2003; Lopopolo, 2002; Robbins, 2003; Siu, 2003). Accordingly, the complex competitions and reforms in higher education have increased the complexity of educator roles and responsibilities and outlined role problems (Lee, et. al, 2001). These transformations in the role of educators not only create stress (Chen, 2003; Lin, 2003) but also challenge their commitment to the organizations. Hence, the challenge of the 21st century also stresses organizational management and survivability.

Purpose of the Study

The purpose of this study was to probe the clinical nursing instructors perceptions of work-related stressors. The goal of this research was to build a complete picture of clinical instructors work-related stress in order to best understand the possible relationship between work-related stress and organizational commitment of that clinical nursing instructor to the school of nursing.

Research Questions
What were work-related stressors of Taiwanese clinical nursing instructors?

Theoretical Framework
The research used the theory of Role Stress and Strain by Hardy and Conway (1988) as the theoretical framework to examine the work-related stress of clinical instructors (Figure 2). The theory of Role Stress and Strain by Hardy and Conway (1988) was guided by the structure role theory, social exchange theory, and symbolic interaction. It is helpful to identify and predict the role problems as well as create role awareness and creatively develop the individual to deal with work-related stress in order to adapt to reality (Hardy & Conway, 1988).

Methodology
This was the second part of the two-phase sequential explanatory design of mixed research. The qualitative interviews were conducted with eight clinical nursing instructors who were volunteers. The clinical instructors provided their insights regarding their work related stressors. According to the eight participants perspective, this study used a phenomenological method to deduce their work-related stressors. These interviews were transcribed and grouped into themes and codes.

Results and Discussion Work-related Stressors

In the results of the research, six categories were identified in the study including (a) inadequate role occupancy, (b) increasing work demands, (c) deficient role preparedness, (d) lowered role control, (e) insufficient role support, and (f) role bargain. The following table presented the themes in each category. These six stressors of clinical instructors would be discussed as follows: Inadequate role occupancy. In terms of role occupancy of nursing education, clinical nursing instructors are involved in two professions including nursing education and clinical nursing practice. They are asked to be proficient in both domains. Qualitative participants reflected that student nurses of the 21st century have a very low learning motivation and willingness as well as their low stress-resistance. Dealing with students insufficient preparation and poor motivation challenged role occupancy of clinical instructors. This finding is in agreement with the quantitative result of this research. Additionally, complex role expectations are the source of clinical instructors worked-related strain. While working in dynamic environments, clinical instructors in this research find it difficult to facilitate their role occupancy between ideal role expectation and actual reality. These differing expectations also influence role performances. Inadequate role occupancy causes clinical instructors role ambiguity. Due to lack of clarity of role identity and disagreement with role expectations, the clinical instructors experience role ambiguity as they transition from old role to new role, which supports the previous findings of Clifford, (1999), Hardy and Conway (1988), Kelly (2003), and Oermann (1998). Hence, it is important to shift to the positive from the negative in these role expectations and re-identify the role. Increasing work demands. Increasing work demands bring about role overload. The competitive nature of Taiwanese society spells rapid changes in educational and medical environments. In order to respond to the competition, clinical instructors are expected to perform new tasks and finish the amount of work within a limited time frame. Clinical instructors perceive too many unpredictable tasks from the workplaces demands and expectations but they do not have enough time to prepare themselves. After the heavy workload, role overload ensues, which supports the theory of Role Strain of Hardy and Conway (1988) and Robbinss (2003) aspect of organizational change. Hence, increasing work demands not only challenge clinical instructors role competence but also influence their physical and psychological health. Deficient role preparedness. Deficient role preparedness creates role incompetence and role incongruity for clinical instructors. Sufficient role preparedness is a vital strategy for role occupancy. Some clinical instructors cannot fulfill their obligation when work-related demands and role expectations are greater than individual competency and role performance. They find it difficult to fit into their work because of role incompetence and incongruity, which supports previous finding of Clifford, (1999) and Hardy and Conway (1988). Hence, during organizational change, continuously maintaining proficiency in the role credibility is the greatest challenge for clinical instructors professional development (Kelly, 2003). Lowered role control. The stressor of lowered role control results in role conflict for clinical instructors. Clinical instructors are involved in an actual clinical environment to facilitate student nurses learning. An environment of lowered role control brings about difficulties for clinical instructors in carrying out their role obligations and responsibilities. Uncertain role set and a lack of autonomy not only cause clinical instructors to perceive conflict about membership with clinical work groups but also lead to neglect of the learning needs of student nurses. For this reason, working on the situation of lowered role control makes clinical instructors role stress worse. This finding is consistent with previous researches (Hemingway & Smith, 1999; Robbins, 2003). Consequently, lowered role control is the most important predicament for the role strain of a clinical instructor. Insufficient role support. Role support is an external buffer to diminish the impact of stress. When clinical instructors suffer job stress from a complicated clinical practice, they wish to get mental support and suggestions from their schools and peers. They also expect that the support can provide insight into people's actions and guidance as to strategies that might be used to better balance and cope with their job

demands. Unfortunately, because of being assigned to off campus locations, they experience difficulty in getting immediate facilitation and support. If a clinical instructor gets appropriate role supports, that is helpful to improve the role problems and negotiate for a change of role expectations. Hence, clinical instructors view role support as a common strategy for role and career development that has potential benefits for improving clinical instructors work-related stress and increasing their connection with their school. This finding is consistent with previous research of Chen (2003) and Robbins (2003). Role bargain. Role bargain is an internal buffer to adjust to role stress. Clinical instructors applied role bargain to find reasonable causes of role problems and negotiate for a change of the role expectations in the workplace. Qualitative participants reported that their stress comes from personal self-demand and self-expectation and the results of teaching evaluation. Love this job and graduated from this school are the main reasons that led most participants to continue work as a clinical nursing instructor of the university. Besides this, clinical instructors have some expectations that relate to their clinical teaching. Hence, in the process of the role bargain, clinical instructors develop strategies and cope with the stressors in order to best prepare for their role occupancy (Hardy & Conway, 1988).

Personal Factors
These findings demonstrated that the personal factors cause clinical instructors to have different levels of stress. The discussion of the results and findings was reported as follows: Work-experience. In personal factors, the stressor of deficient role preparedness, inadequate role occupancy, and negative role bargain draw work-related stress for the clinical instructors teaching. Interestingly, the results indicated experienced instructors take the job longer than inexperienced ones, and they do not significantly suffer lower role strain than inexperienced ones. This result disagrees with previous findings of Chen (2003), Lin (2003), and Robbins (2003). Yet, the qualitative results illustrated that stress related to role credibility for inexperienced clinical instructors is about difficulty in transferring to their role. They are failing to be effective clinical instructors. Clinical instructors have to continue efforts to enhance their role credibility no matter if they are experienced or inexperienced. Clinical instructor with a masters degree. The clinical instructors work-related strain comes from lack of role clarity and disagreement with role expectation. Qualitative participants who were clinical instructors with a masters degree described that the practical reality often violates individuals responsibility and professional codes in nursing teaching. Due to uncertainty in role set, they tend to seek a justification for whether clinical instructors should lose their professional standards or change their teaching principles according to students preferences or clinical environments. This finding is consistent with Cliffords (1999) aspect that role clarity is fundamental to a clinical instructor fitting into a clinical teaching. Clinical instructors with masters degree are aware of role uncertainty and role incompatibility in a clinical setting. Their professional commitment tends to substitute for organizational commitment. So, they based maintaining a membership with their organizations on continuance commitment. Clinical instructor with a baccalaureate degree.. Clinical instructors role strain will be induced by individuals perception of job insecurity (Robbins, 2003). Due to preference for masters degree, qualitative participants stated insufficient educational level became one of the stressors for clinical instructors with a baccalaureate degree. These findings agree with OConnors (2001) point of view: ineffectiveness of clinical instructors is related to deficiency of clinical expertise and formal education. For this reason, they felt a sense of insecurity in their jobs. This finding is consistent with Robbinss (2003) point of view that lack of job stability becomes a characteristic of an organizational change for clinical instructors with baccalaureate degree. Moreover, whether to continue their contract or not depends on their role performances. So, clinical instructor with a baccalaureate degree base maintaining the membership with their school on affective and obligation attachment.

Conclusion
Complex role expectations are the source of clinical instructors worked-related stress during the school restructuring. The clinical instructors with masters degree experience role ambiguity and role incongruity due to lacking clarity of role identity and disagreeing with role expectations while clinical

instructors with baccalaureate suffer role strain from individuals perception of job insecurity. Workrelated stress for inexperienced clinical instructors is about difficulty in transferring to their role. Even experienced instructors have to keep on establishing their role credibility. Hence, experienced clinical instructors do not significantly suffer lower role strain than inexperienced ones. Six work-related stressors of clinical nursing instructors include inadequate role occupancy, increasing work demands, deficient role preparedness, lowered role control, insufficient role support, and role bargain. When a clinical instructor with lowered role control experiences more stressors, the situation of role stress will deteriorate. Role support and role bargain are the buffers of work-related stress to adapt clinical instructors for the rapidly changing educational and medical environment. If a clinical instructor gets appropriate role supports, that is helpful to minimize the role problems and negotiate for a change of role expectations. Consequently, adequate role credibility for role occupancy is a necessary strategy for reducing clinical instructors work-related strain. Figure 1 illustrated the relationship among work-related stressors of clinical instructors.

Implications for Clinical Instructors Self-Awareness

This research provides a complete perspective on recognizing work-related stressors of clinical nursing instructors. The results highlight work-related stressors to increase of clinical instructors role awareness and build role credibility. The implications are as follows: 1. Report the work-related stress early. 2. Build positive philosophy in nursing education. 3. Need to continuously strengthen role credibility for role occupancy. 4. Must update professional knowledge and skills in both domains of clinical practice and nursing education through continuing education, or professional development. 5. Make sure to use appropriate instructional strategy to facilitate student nurses success in a clinical setting.

Recommendations
This research provides a complete perspective on understanding work-related stressors of clinical nursing instructors. The results highlight the current difficulty in nursing education. In order to clarify and re-identify the role of clinical instructor, recommendations for future research include the following: 1. Replicate this study using a large sample. 2. Explore the characteristics of effective clinical instructors from students, teachers, and staff nurses standpoints. 3. Explore the role expectations for graduate students from nursing education and nursing practices standpoints.

Role occupancy Role bargain Role support

Work demands

Role control

Role preparedness Figure 1. The relationship among clinical instructors work-related stressors

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