AMBULATORY BLOOD PRESSURE AND JOB STRESS IN NURSES

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The overall goal of this project is to study the effects of job stress on the cardiovascular system of working women. By studying nursing, a predominantly female profession characterized by frequent job turnover and early burnout, we plan to evaluate the contributions of job stress to 24- hour ambulatory blood pressure and heart rate in women nurses (ages 20-30 years) studied under natural conditions on work days and on non-work days. To satisfy this goal, we will study 300 registered nurses. We hypothesize that stress in nursing is associated with elevated levels of blood pressure at work which spill over to blood pressure elevations after work and during sleep and may even lead to increased levels on days away from work, thereby increasing the risk of hypertension along with other cardiovascular and health complications. Not only are higher overall levels of job stress expected to influence average blood pressure levels, but we expect acute blood pressure elevations throughout the working day to be associated with specific situations known to be particularly stressful for nurses (i.e., emergency situations; interactions with patients, other nurses, and physicians). We expect that the predicted blood pressure rise in response to job stress will be dependent on a number of moderating factors which we plan to study: a nurse's marital status, young children at home, a husband who helps in household chores, social support from one's family and co-workers, and individual personality characteristics. -In addition, we will compare blood pressure and heart rate responses to job stress in nurses in differing job specializations (emergency, general medical/surgical, intensive care), with the prediction that the job associated with highest stress (emergency nursing) will be accompanied by the greatest increases in blood pressure during work and non-work periods. Evaluations of catecholamines and cortisol will help to determine underlying mechanisms. Because of the suggestion that estrogen may serve as a protection against coronary heart disease, we will also evaluate the influence of menstrual cycle on blood pressure, by studying women during both the luteal and follicular phases. Both blood pressure and heart rate are expected to be higher during the luteal than during the follicular phase. The results of this Investigation should add to our information on the physiological and health outcomes of job stress, an area which until recently either excluded women or failed to analyze gender differences.