Are Nurses Healthier and Happier Than the General Public?

Are Nurses Healthier and Happier Than the General Public?

by Donna Schwartz-Barcott, RN, PhD, and T. P. Schwartz, PhD

During the last decade, an increasing amount of

research has been done on the health of nurses.

This work has been limited by a focus on illness

and single health behaviors as well as by a lack of

systematic comparisons with non-nurses.

Analysis of General Social Survey data from

the National Opinion Research Center is used to

compare the general health status, experiences

and behaviors, and general level of happiness of

nurses with non-nurses. Findings suggest that

nurses tend to evaluate their personal health sta-

tus more positively than non-nurses, although

nurses and non-nurses tend to be very similar in

terms of their smoking behaviors and the amount

of hospitalizations, disabilities, and stressful life

events that they experience. Nurses, however,

more often report using alcoholic beverages.

Finally, both nurses and non-nurses report

rather high levels of happiness with their per-

sonal lives and marriages.

Donna Schwartz-Barcott, R N , PhD, is Associate Professor, College of Nursing, University of Rhode Island, Kingston, Rl. T.P. Schwartz, PhD, is Director, Social Research Services, East Greenwich, RI.

S o m e research findings suggest that the health and happiness of nurses is a subject worth increased atten- tion. During the last decade there has been a growing body of research on the health status and practices of nurses. Studies have highlighted the fact that nurses are high consumers of cigarettes, alcohol and other drugs. Also, they suffer disproportionately from chronic diseases, back injuries, and depression (Coleman & Dickenson, 1984; Jacobsen, 1985; Naegle, 1988; USDHEW, 1976).

A good example of this literature is the well-known ”Nurses Health Study” at the Channing Laboratory at Harvard Medical School (AJN, 1988; Willett et al., 1987). This prospective study, begun in 1976, queried nearly 122,000 married female nurses, all members of the American Nurses’ Association, on health problems and health habits. It has led to many papers on factors that relate to breast cancer and coronary heart disease. However, it does not compare nurses to non-nurses and it does not directly address questions about general health status and happiness.

With the exception of two national surveys on the smoking behavior of nurses (USDHEW, 1976; USD- HHS, 1980), a major weakness in most of this research is that nurses are not systematically compared to non- nurses through the use of the same measures. Typically, one set of surveys involving nurses is con- trasted with another set of surveys that involve non- nurses. Secondly, each survey tends to deal with a single disease entity or health practice without any overall estimate of the nurses’ general state of health, much less their state of happiness.

Given that the profession of nursing is committed to the health and wellness of people, it is reasonable to assume that nurses value their own health, perhaps even more than their non-nurse cohorts. Additionally,

19 Nursing Forum Volume 25, No. 4, 1990


one would expect that nurses' good health, combined with their high employability and moderately high social status, would contribute to relatively high states of happiness in general and in specific aspects of their lives, such as home, marriage, and work. And yet, published work to date portrays a rather gloomy picture of the health of nurses, while at the same time failing to deal with their level of happiness. The assumption may be that nurses must not be very happy, given their poor state of health.

In ongoing research on nurses as a dynamic occupational group in the United States (Schwartz-Barcott & Schwartz, 19881, some revealing but neglected data have been uncovered. These findings permit comparisons between nurses and adult female non-nurses and the general adult population. The purpose of this article is to compare the general health and happiness of these three groups.

Contrary to the picture painted in recent

studies of nurses, the data presented in

column I of Table 1 show that most nurses

rate the "general state of their health to be

excellent or good.

Relevant data were found in the yearly General Social Surveys (GSS) or the National Opinion Research Center (NORC) at the University of Chicago. NORC conducts nationwide telephone interviews of independently drawn samples of English-speaking persons, age 18 and over. The intri- cate survey design has been shown to produce highly representative samples of the adult population of the United States in terms of age, sex, race, education, occupation, and many other characteristics. It is the representativeness of these samples that allows one to compare a relatively small subgroup (e.g., 256 20

nurses) with a much larger subgroup (e.g., 20,000 adults). Over the years the GSS has become widely regarded as "state- of-the-art" in terms of sampling design, accuracy, validity, and reliability of instru- ments and reporting procedures.

In the period of 1972-86 NORC completed about 20,000 interviews, including 256 interviews with registered nurses. These included questions about the respondents' health, health-related experiences and behaviors, as well as their lack of happiness. We analyzed these data on computers a t the University of Rhode Island, and found some intriguing patterns.

Self-Health Evaluations

Contrary to the picture painted in recent studies of nurses, the data presented in column I of Table 1 show that most nurses rate the "general state of their health to be excellent or good. Asked, "Would you say your own health, in general, is excellent, good, fair or poor," almost one-half of the nurses (45%) evaluated their health as excellent. An additional 38% rated their health as good. Only 17% saw themselves in fair or poor health.

Table 1. Self-Reported Condition of Health of Nurses, Other Females, and Adults in General

Nurses Other Females A d u 1 t s

Excellent 45.0%" ** 29.0%* 3 1 . 3 % * * Good 38.0%" ** 42.1%* 4 2.0 % * * Fair 12.5%" ** 21.7%" 19.9 % * * Poor 4.5%* ** 6.9%* 6 . 5 % * *

n 200 8,324 15,255 Other Responses O.O%* ** 0.2%* 0 . 2 % * *

* Significant difference between nurses and other females,

**Significant difference between nurses and adults in gen- p < .001. Cramer's V = .057.

eral, p < .01. Cramer's V = .036.

Nursing Forum Volume 25, No. 4,1990

In comparison, a little less than one third of other females (29.0%) and other adults (31.3%) evaluated their health to be excellent. Differences among nurses and other females and adults were less extreme (more similar) in the other response categories: “good,” “fair,” and ”poor.” The differences in percentages are significant, although the strengths of the measures of association, such as Cramer’s V, are weak.

The similarity among nurses, other females, and other adults becomes even more apparent when one realizes that at least 70% of the respondents evaluated their health status to be excellent or good whereas less than 10% of the respondents evaluated their health status to be poor. Thus, it can be said that the respondents as a whole evaluated their status quite high but that nurses were even more positive than were non-nurses.

Personal Health Experiences

As shown in Table 2, slightly more than half (56%) of the nurses in this study were not hospitalized or disabled during the five years prior to the survey. At the same time, 43% did experience at least one episode of hospitalization or disability. This percentage is very similar to the experiences of other females and other adults: 57% and 58%, respectively, had not been hospitalized or disabled. Likewise, 35% of other females and 40% of the adults indicated they were hospitalized or disabled some time during the five years prior to the survey. As expected, then, there were no significant differences in the hospitalization and disability experiences among nurses, other females, and the general adult population over a five- year period.

Table 3 presents data on nurses’ experiences with traumatic events (death, divorce, unemployment, in addition to hospitalization or disability). Part A of Table 3 indicates that 70% of the nurses did not experience any traumatic event during the year before the survey. This is a larger percentage than was found for other females (58%) and adults in general (at 59%), although this difference is not statistically significant.

Nursing Forum Volume 25, No. 4,1990

Table 2. Hospitalization and Disability of Nurses, Other Females, and Adults in General During Five Years Prior to Survey

Hospitalized Nurses Other Females Adults or Disabled

No 56.0% 56.9% 58.3% Yes, during 4.6% 7.6% 7.5% last year Yes, during 25.7% 20.9% 20.4% 4 years prior to last year Yes, during last 12.8% 13.1% 12.5% year and4 years prior to last year No answer and 0.9% 1.5% 1.4% other

n 109 4,349 7,433

This similarity among nurses, other females, and adults increases when one looks at a longer time frame, such as the five-year period covered in Part B of Table 3. Here, about 41 % of all respondents, regard- less of category, report one traumatic experience during the five years in question.

Thus, to this point, based on the data presented in Tables 1-3, nurses seem to be either slightly healthier or just about as healthy as non-nurses. More significant, statistically at least, is the fact that nurses tend to evaluate their health status somewhat more favorably than non-nurses. Both nurses and non-nurses: . Rate their personal health rather highly (i.e., at

least 70% of respondents across all categories rated their health as being excellent or good).

. Had moderate levels of hospitalization and disability in the previous five years (i.e., 35%-40% of the respondents across categories had experienced hospitalizations or disabilities during the previous five years).

. Had experienced no traumatic events in the 21


Table 3. Number of Traumatic Events Experienced by Nurses, Other Females and Adults in General During Five Years Prior to Survey

A.

Number of Traumatic Events During Last Nurses Other Females Adults Year

0 69.7% 57.6% 57.8% 1 21.1% 31.5% 31.6% 2 4.6% 6.6% 6 .5% 3 0.0% 0.3% 0 . 3 % 4 0.0% 0.0% 0 . 0 %

No answer 4.6% 3.9% 3 . 7 %

n 109 4,349 7,433

B.

Number of Traumatic Events During Last Nurses Other Females Adults 5 Years

0 32.1% 25.7% 25.6% 1 41.3% 41.1% 41.8% 2 20.2% 23.5% 23.7% 3 0.9% 4.9% 4.7% 4 0.9% 0.7% 0 .6%

No answer 4.6% 3.9% 3 .7%

n 109 4,349 7,433

Table 4. Use of Cigarettes and Alcoholic Beverages by Nurses, Other Females, and Adults in General

A.

Smoking Nurses Other Females Adults Behavior

Smokers 30.5% 33.1% 38.3% Nonsmokers 69.5% 66.7% 61.5% No answer 0.0% 0.2% 0.2%

n 128 5,180 8,944

B.

Drinking Nurses Other Females Adults Behavior Use alcohol 82.8%* "* 66.0%" 71/1%** Total abstainer 17.2%" ** 33.8%" 28.1%** No answer 0.0%" ** 0.2%" 0.3%""

n 128 5,060 8,944 *Significant difference between nurses and other females,

**Significant difference between nurses and other adults, p<.OOl, Cramer's V=.055.

pc.05, Cramer's V=.029.

C.

Excess Nurses Other Females Adults Drinking Yes 29.2% 29.0% 37.4% No 68.9% 69.7% 61.3% Don't know/ 1.9% 1.3% 1.3% no answer n 106 3,351 6,435

22 Nursing Forum Volume 25, No. 4,1990

previous year and no more than one traumatic event in the previous five years.

Smoking and Drinking Behaviors

Table 5. Level of Happiness and Enjoyment of Life Among Nurses, Other Females, and Adults

1.6

A.

Table 4 reports on responses to questions about smoking and drinking. Just less than a third (30.5%) of the nurses indicated they smoke, while a much larger percentage (83%) noted they use alcoholic beverages. When nurses were asked if they sometimes drink more than they think they should, more than one-fourth (29.2%) said "yes." The remainder of the Table indicates how similar nurses are to non-nurses in their smoking behavior (Question A) and drinking behavior related to excess (Question C). About one-third of the respondents indicated they smoke, although a slightly smaller percentage of nurses (30.5%) responded this way than did other females (33.1%) and adults (38.3%). The difference is not statistically significant. A similar pattern exists for Question C.

However, the 83% of nurses who answered "yes" to drinking liquor, wine, or beer, represents a statistically higher figure than the 66 % of other females and 71.1% of adults who indicated that use alcoholic beverages. At the same time, the strength of these relationships is weak.

Given this rather mixed picture, how do nurses describe their state of happiness? And how does their happiness compare with that of non-nurses?

Current Level Nurses Other Females Adults of Happiness

Very happy 35.7% 34.2% 32.9% Pretty happy 55.8% 52.7% 53.7% Not too happy 8.2% 12.5% 12.8% Don't know/ 0.0% 0.0% 0.0% No answer

n 269 11,165 19,787

B.

Happiness Nurses Other Females Adults of Marriage

Pretty happy 30.5% 32.1% 31.5% Not too happy 2.6% 3.7% 3.0% Don't know/ 0.0% 0.7% 0.7% No answer

Very happy 66.9% 63.5% 64.8%

n 154 6,016 11,272

C.

Personal Happiness

Previous research has suggested that, in the general population, health status and positive personal evaluations of health status correlate rather strongly with personal happiness, satisfaction with life, marriage, and personal situations (Adams, 1979; Berg, 1973). Table 5 presents responses to three questions about happiness and enjoyment of life.

More than 90% of the nurses indicated they are "pretty happy" or "very happy" with their personal lives. For nurses who are married, 97% responded they are "pretty happy" or "very happy" with theii

Nursing Forum Volume 25, No. 4, 1990

Enjoyment Nurses Other Females Adults of Life Exciting 52.8% " 41.6%" 44.5% Routine 44.1%" 50.9%" 48.7% Dull 2.5%" 6.0%" 5 . 5 % No opinion/ 0.6%" 1.4%" 1 . 4 % No answer

n 161 6,736 12,191

*Significant difference between nurses and other females, p<.05. Cramer's V=.039.

23


marriages. Additionally, more than one-half (52.8%) find life to be exciting.

Overall, the responses indicated that nurses and non-nurses are rather happy with their personal lives. About one-third of the nurses and non-nurses responded to Question A that they are “very happy.” At least another one-half of the respondents in each category indicated they were “pretty happy.” Less than 15% of the respondents indicated they were ”not too happy.” Nurses appear to be slightly more positive than non-nurses in their responses, although the differences are not statistically significant.

Married respondents across all three categories are even more positive in their evaluations of their happiness in marriage (Question B). About two-thirds of all respondents answered ”very happy” to the question. Less than 5% indicated they were ”not too happy.” More than 90% of the people in all three categories indicated they were at least ”pretty happy” with their marriages.

Only in response to the questions about ”enjoyment of life” (C) did nurses differ significantly from non-nurses. More than fifty percent (52.8%) of the nurses found life to be exciting, whereas slightly more than forty percent (41.6%) of the females responded this way. Nearly one-half of all respondents indicated life was rather “routine” and only small percentages-less than 10%-indicated that life was dull. The differences in percentages between nurses and other females are significant although the strengths of the measures of association, such as Cramer’s V, are weak.

Responses to these three questions, then, indicate that most respondents are rather happy with their lives and marriages. Nurses seem to be even more positive in these regards.

Conclusions

Nurses’ self-reports of their health status were significantly higher than the reports of other females and of adults in general. Nurses tended to rate their health as excellent more frequently than their cohorts. The

24

reason for this difference is not entirely clear. Possibly, nurses are healthier than their comparison groups.

However, we have no clear reason from this survey or others done in the past to believe that nurses are healthier. Possibly, nurses know more about health and they ”practice” it in their own lives. Perhaps nurses rate themselves as healthy because they have first-hand knowledge of what it means to be unhealthy. Nurses may be less apt to acknowledge minor aches and pains when answering this question.

Responses to these three questions, then,

indicate that most respondents are rather

happy with their lives and marriages.

Nurses seem to be even more positive in

these regards.

Drinking and happiness are more characteristic of nurses than non-nurses in our sample. This may seem to present an inconsistency. How can nurses be drinking and yet be as happy as they claim? We are not able to answer this question from the present study. We only know that 80% of the nurses report they drink alcoholic beverages. We do not know how frequently or how much they drink. Possibly, they drink very responsibly and this contributes to their happiness because they recognize the appropriateness of their behavior and it reduces stress in their jobs and personal lives. We are conducting correlational studies to examine fhis and other possible relationships.

Nurses differed from their cohorts in response to the question about ”enjoyment of life.” Nurses inter- act daily with clients who are in very vulnerable situations. Nurses probably are particularly aware of how

continued on page 34

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continued from page 24

difficult it is to live a “normal” life when faced with acute or chronic illnesses, poverty, mental disorders, or any number of other impaired conditions. Perhaps nurses, more than other occupational groups, appreci- ate their health and their good fortune to be able to live without impairment. Each day may bring a cer- tain sense of excitement because nurses know they can help people who are less fortunate than themselves. It would be worthwhile to study nurses’ basic philosophic beliefs about life. Nurses often express how important it is to have a high quality of life, and may differ from the general population because of first-hand experiences they share with clients.

References

Adams, D. (1979). Analysis of life satisfactions index. Journal of Gerontology, 34,470-474.

(Clinical News), 1324-1325. Staff. (1988). Nurses as barometers for women’s health. A J N 88

Berg, R. (1973). Health status indices. Chicago: Hospital Research &

Coleman, L., & Dickenson, C. (1984). The risks of healing: The haz- ards of the nursing profession. In W. Charkin (Ed.), Double Exposure (pp. 37-56). New York: Monthly Review Press.

Health Cure Women International, 6,353-368.

Educational Trust.

Jacobsen, A. (1985). Sex role identity and depression in nurses.

Naegle, M. (1988). Drug and alcohol abuse in nursing: An occupa-

Schwartz-Barcott, D., & Schwartz, T. (1988). How nurses vote. A J N

tional hazard? Nursing Life, 8,42-8,50-52,54.

88,1191-1193.

United States Department of Health Education & Welfare. (1976). Survey of health professionals, 1975. (CDC No. 21-74-552 (p)). Atlanta: National Clearinghouse for Smoking and Health.

United States Department of Health and Human Services. (1980). Report of the surgeon general (DHHS Pub. No. 0-326-003). Washington, DC: US. Government Printing Office.

Willett, W., Meir, J., Gokditz, G., Rosner, B., Hennekens, C., & Speizer, F. (1987). Moderate alcohol consumption and the risk of breast cancer. N m England Journal of Medicine, 316,1174-1180.

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Are Nurses Healthier and Happier Than the General Public?