The impact of workload and job satisfaction on occupational stress – A comparison among newly qualified and experienced midwives

Abstract

BACKGROUND:

Midwives are potentially exposed to high levels of occupational stress. The level of stress may be related to the job demands and job resources, as well as midwife seniority. To date, few studies on the determinants of occupational stress have examined Polish midwives.

OBJECTIVE:

This study aims to investigate the roles of workload, job satisfaction, and seniority in shaping the stress levels of midwives in Poland.

METHODS:

A cross-sectional approach and structural equation modeling (SEM) were used to compare two groups: newly qualified midwives (NQMs; n = 79) and experienced midwives (n = 99). All data were collected between January and November 2018.

RESULTS:

Analysis revealed that in both NQMs (β = 0.34, p = 0.006) and experienced midwives (β = 0.40, p < 0.001) workload was a positive predictor of occupational stress. In contrast, job satisfaction was found to be a negative predictor of stress in both groups (NQMs: β = -0.44, p < 0.001; experienced midwives: β = -0.57, p < 0.001). The study groups did not differ significantly in terms of the levels of workload, job satisfaction, and occupational stress.

CONCLUSION:

Workload and job satisfaction are predictors of occupational stress in midwives. The results of this study indicate the important role of job satisfaction and workload in the shaping of occupational stress levels. Resource-rich and low-stress work environments can enhance the quality of health care provided by midwives.

Keywords

Job stress midwife employee workload workplace personal satisfaction

1 Introduction

According to European Union law, midwifery is a profession that can be practiced after obtaining a specialized qualification. In the case of Polish midwives, this involves acquiring a bachelor’s degree in midwifery over six semesters and passing a professional exam. Upon completion, midwives may continue their professional training in a four-semester master’s degree program. Most midwives start to work after earning a bachelor’s degree, between the ages of 22 and 24. For the purposes of the presented project, midwives with less than four or five years of work experience are recognized as newly qualified midwives (NQMs). The distinction has two reasons. Firstly, previous studies discussed below were based on the standard of 5 years of experience. In 2019 Kool et al. showed, in a Dutch sample, significant differences between midwives with five or less years of seniority and older midwives. Secondly, our own qualitative analysis of subjective description of working conditions suggest noticeable differences between midwives distinction by Kool et al. Data from short interviews suggest that junior midwives had a declarative lower level of subjective well-being at work and evaluate job as more stressful. The five-year seniority seemed to be the turning point. Finally, based on the subjective above premises we decided to compare two groups. The present study had specific exploratory character because occupational group of NQMs has not been studied in Poland.

Current research indicates that maternal and newborn health is highly dependent on the quality of obstetric care [1]. The midwife profession, therefore, involves responsibility for the health and lives of patients and their families. Midwives also are required to follow international standards, laws, and facility regulations in their work. Meeting these requirements is fraught with occupational stress. Research shows that seniority may positively influence the ability to cope with occupational stress [2, 3]. However, this relationship has not been specifically studied in Polish midwives. Thus, the aim of this study is to fill this gap.

The current study examined whether workload and job satisfaction act as predictors of occupational stress in two groups: NQMs and experienced midwives. The results were intended to provide answers to three questions: 1) How do workload and job satisfaction relate to the occupational stress levels of Polish midwives? 2) Does the degree of correlation between the study variables significantly differ between NQMs and experienced midwives? 3) Is the level of workload, job satisfaction, and occupational stress significantly different between the study groups?

1.1 The relationship between workload, job satisfaction and occupational stress

According to the Job Demands-Resources model [4], occupational stress is mediated by two dimensions of the work environment: job demands and job resources. Job demands are the psychological, social, organizational and physical demands of the job required to complete the work, while resources are those aspects of work that promote the achievement of goals and reduce stress [5]. Among job demands, the majority of midwives (64.6%) cite workload and time pressure as significant requirements [6]. Of the resources important to midwives’ work, job satisfaction, which is negatively related to stress, has received relatively little research attention [7].

Polish midwives most often indicate that time pressure, shift work, excessive responsibilities, poor organization of work and aggression or threats from patients are significant stressors [8]. Many of these stressors can be related to Spector and Jex’s concept of workload [9]. Workload can be measured, for example, in terms of working hours, shift work, the scope of responsibilities, work standards or psychological requirements. Workload also has a timely dimension, i.e., the degree of workload is measured by the amount of work employees must perform in a certain period of time [10]. A study of Australian midwives confirms that workload is mainly due to time pressure [11], and other work suggests that workload increases midwives’ stress levels [12]. Based on these theoretical assumptions and previous research, our first hypothesis is:

H1. Workload increases midwives’ occupational stress levels.

Job satisfaction among midwives may stem from the perception of their work as being socially important. In a cognitive dimension, job satisfaction includes the perception of work conditions, prestige, accomplishments, and its potential for self-actualization. Research has shown that job satisfaction significantly increases work engagement [13] and can lead to higher quality health care. Moreover, attitudes toward work, as indexed by positive work evaluations, may be an important resource related to job stress [14]. Previous research also suggests that job satisfaction may reduce midwives’ stress levels [15]. However, this relationship has not been tested in the Polish setting, where the most commonly cited concern among midwives is work-related burnout, which negatively correlates to job satisfaction [16]. Therefore, the following hypothesis was tested:

H2. Job satisfaction lowers midwives’ occupational stress levels.

1.2 The role of seniority in the correlation between job demands, resources and occupational stress

The next phase of the study aimed to examine whether the significance of the correlations between workload, job satisfaction, and occupational stress differed among groups of midwives with different lengths of service. Previous research has indicated that midwives with more work experience are exposed to higher occupational stress [3] and that a job tenure of fewer than ten years is a predictor of higher stress levels [2]. A recent meta-analysis on the determinants of burnout also indicates that midwives with less than ten years of work experience are more likely to suffer from burnout [17]. Other work on the relationship between seniority and emotional exhaustion in a group of Polish midwives shows that midwives who have worked less than nine years are the most vulnerable to the negative effects of stress at work [18]. However, previous Polish studies also have shown no relationship between job tenure and perceived stress [19]. In sum, the previous research does not provide a clear-cut conclusion on the role of seniority in the shaping of the strength of the relationship between workload, job satisfaction and occupational stress. Therefore, the following hypothesis was tested:

H3. The significance of the relationship between workload and occupational stress and the association between job satisfaction and occupational stress are significantly different between NQMs and experienced midwives.

The results cited above suggest that the subjective perception of job demands (workload) and resources at work (job satisfaction) may be related to seniority. Compared to experienced midwives, NQMs are more likely to doubt the accuracy of their own clinical decisions [20]. As mentioned before, Kool et al. proved that midwives with five years or less seniority perceive their work as highly demanding [21]. While at least one study shows that the majority of midwives (79.5%) experience chronically increased workload [22], it is unknown whether Polish NQMs experience an increased workload as compared to experienced midwives. In addition, the role of seniority in the shaping of job satisfaction needs to be addressed. Studies from other countries indicate that age [23] and total job tenure [24] are negatively related to job satisfaction. Therefore, based on the literature cited above, the following hypothesis is:

H4. Mean levels of workload, job satisfaction, and occupational stress among NQMs are significantly different when compared to experienced midwives.

2 Methods

2.1 Procedures and sample

The current study was quantitative and cross-sectional in nature. All data were collected in 2018. Midwives were recruited through promotional materials left at their wards, via e-mail, and through personal communications. Data were collected via questionnaires that were delivered by the researchers to the midwives’ workplace. Prior to visiting the participants’ workplace, management approval was obtained.

In the first round of the study (T1), 263 midwives participated from whom sociodemographic data were collected, and independent variables such as workload and job satisfaction were measured. Additionally, all of participants formulated a few word answers on two descriptive questions: Why do you like your job environment? How stressful is your work? Two months later, in the second round of the study (T2), the dependent variable — occupational stress — was measured. Midwives who participated in both rounds of the study and completed all questionnaires were included in the analysis (N = 178). 67% of all participants completed both questionnaires and no statistically significant differences were observed between midwives who left the study and those who remained.

All midwives included in the study were women employed full-time in public hospitals in the following provinces: Lower Silesia, Opole, Pomerania, Silesia and West Pomerania. The study sample was divided into two groups: NQMs with less than four years of work experience (n = 79) and experienced midwives with at least five years of work experience (n = 99).

2.2 Ethical considerations

All research procedures were evaluated and approved by the Ethical Committee of the Institute of Psychology, University of Opole. The study was conducted in accordance with the guidelines of the Declaration of Helsinki. Participation in the study was voluntary, with the option to opt out at any time, and participants gave their written informed consent to participate in the study. The data were stored electronically in an encrypted database.

2.3 Measures

Sociodemographic data were collected using a structured questionnaire of our own design. Workload was measured using the Quantitative Workload Inventory (QWI) [9] in a Polish adaptation [10]. The QWI is used to measure the quantitative workload expressed as the effort required to perform a large number of tasks within a limited time. The questionnaire consists of five questions measuring one factor and includes questions such as: “How often are you forced to do more work than you are able to?” The responses are given on a 5-point Likert scale ranging from 1 (less than once a month or never) to 5 (several times a day). Thus, higher scores indicate an increased workload. In our study, the reliability of the scale was Cronbach’s α= 0.82 for NQMs and α= 0.89 in the experienced midwives group.

Job satisfaction was measured using the Satisfaction With Job Scale [25]. This tool is used to measure the cognitive aspects of job satisfaction. The scale has a univariant structure and consists of five statements in the form of general assessments of the value of the work. A sample statement included in the tool is: “I have excellent working conditions.” The answers are given on a 7-point scale, from 1 (strongly disagree) to 7 (strongly agree). The level of job satisfaction can be inferred from the sum of the results obtained. In the NQMs group, the reliability of the scale was Cronbach’s α= 0.84, and in the group of experienced midwives α= 0.85.

The intensity of occupational stress was examined using the Perceived Stress Scale [26] in a Polish adaptation [27]. The scale consists of ten positions and has a univariant structure. This questionnaire is designed to measure general occupational stress, defined as an assessment of the perceived relationship between an individual and their work environment. Respondents assessed how often they felt an emotion or thought in a particular way over the past month as described in the question. The questionnaire contained questions such as: “During the past month, how often have you felt that you were not in control of important things in your professional life?” Each item on the test is rated on a 5-point scale. Individual points of the scale are described as follows: 1 (never), 2 (almost never), 3 (sometimes), 4 (quite often), and 5 (very often). The maximum score is 50 points and the minimum is 10 points; the higher the score, the greater the perceived stress at work. Questions 4, 5, 7, and 8 had an inverted meaning. The reliability in the group of NQMs was α= 0.85, and in the group of experienced midwives α= 0.76.

2.4 Analyses

In this analysis, the dependent variable was occupational stress. The explanatory variables were workload and job satisfaction, while the grouping variable was seniority. The bootstrap procedure was used in estimating the parameters of the research model to increase the precision of analyses based on linear models, especially with small samples. The model was estimated using the maximum likelihood method. First, the distribution of measured variables were evaluated using Shapiro-Wilk normality test. Secondly, the research model was evaluated using confirmatory factor analysis (CFA). Latent variables, i.e., workload, job satisfaction and occupational stress, were all components of the measurement scales. The comparative fit index (CFI), the Tucker-Lewis index (TLI), and the Root Mean Square Error of Approximation (RMSEA) were used to evaluate the fit of the model. The research model was then tested using structural equation modeling (SEM). A multigroup SEM analysis was conducted, which allows the model to be tested on two groups simultaneously. Statistical analyses were performed using IBM SPSS and Amos software.

3 Results

The distributions of measured variables were similar to normal distribution. The skewness and kurtosis coefficients were between –1 to 1. The stress experienced at work in both study groups was at an average level. In the NQMs group, it was equal to M = 28.82, SD = 5.65, and in the experienced midwives group, M = 29.26, SD = 5.28. The number of hours worked per week was higher in the experienced midwives’ group (M = 47.27) compared to the NQMs’ group (M = 41.42), and this difference was statistically significant (t = –2.92, p = 0.004). In addition, experienced midwives worked multiple jobs significantly more often than NQMs (t = –3.66, p < 0.001). All NQMs and 94.94% of experienced midwives worked shifts. The sociodemographic data can be found in Table 1. No significant associations were observed between the number of hours worked per week, shift work, working more than one job, ward, education level, and occupational stress. The results of the correlation analysis suggest that, in both study groups, workload correlated positively, and job satisfaction correlated negatively, with occupational stress. Seniority was strongly correlated with age (r = 0.96, p < 0.001); hence, only seniority was included in the analyses. In the experienced midwives’ group, seniority was significantly negatively correlated with job satisfaction (r = –0.20, p < 0.01). Descriptive statistics and correlation coefficients between variables in the NQMs’ group are provided in Table 2, and in Table 3 for the experienced midwives’ group.

Table 1
Participant’s demographic characteristics (N = 178)

NQMs Experienced midwives

n = 79 n = 99

Age M = 23.96 SD = 1.5 M = 46.37 SD = 9.21

Seniority M = 1.34 SD = 0.79 M = 22.95 SD = 9.44

Working hours per week M = 41.42 SD = 6.68 M = 47.27 SD = 18.49

Swift work % 100 94.94

Number of work places %

One 89.9 67.7

Several 10.1 32.3

Ward of working %

Childbirth 5.1 24.2

Gynaecology 22.8 17.2

Maternity 32.9 13.1

Gynecology-maternity 29.1 20.2

Neonatal 1.3 4

Obstetric and neonatal 6.3 8.1

Pregnancy pathology 2.5 7.1

Intensive therapy for newborns 0 5.1

Clinic 0 1

Education %

Midwivery high school 0 11.1

Bachelor’ degree in midwifery 97.5 79.8

Master’s degree in midwifery 2.5 9.1

	NQMs	Experienced midwives
Age	M = 23.96	SD = 1.5	M = 46.37	SD = 9.21
Seniority	M = 1.34	SD = 0.79	M = 22.95	SD = 9.44
Working hours per week	M = 41.42	SD = 6.68	M = 47.27	SD = 18.49
Swift work %	100	94.94
Number of work places %
One	89.9	67.7
Several	10.1	32.3
Ward of working %
Childbirth	5.1	24.2
Gynaecology	22.8	17.2
Maternity	32.9	13.1
Gynecology-maternity	29.1	20.2
Neonatal	1.3	4
Obstetric and neonatal	6.3	8.1
Pregnancy pathology	2.5	7.1
Intensive therapy for newborns	0	5.1
Clinic	0	1
Education %
Midwivery high school	0	11.1
Bachelor’ degree in midwifery	97.5	79.8
Master’s degree in midwifery	2.5	9.1

Table 2

Descriptive statistics and r-Pearson’s correlation coefficients for NQMs (n = 79)

	M	SD	1	2	3	4
1. Seniority	1.34	0.79
2. Working hours per week	41.42	6.68	0.19
3. Workload	19.01	4.22	0.18	0.14
4. Job satisfaction	21.51	5.28	0.06	0.05	0.003
5. Occupational stress	28.82	5.65	0.08	0.003	0.26^**	–0.38^***

^** p < 0.01, ^** p < 0.001.

Table 3

Descriptive statistics and r-Pearson’s correlation coefficients for experienced midwives (n = 99)

	M	SD	1	2	3	4
1. Seniority	22.95	9.44
2. Working hours per week	47.27	18.49	0.02
3. Workload	19.09	5.33	–0.10	0.004
4. Job satisfaction	21.31	6.09	–0.20^**	–0.09	–0.13
5. Occupational stress	29.26	5.28	0.16	0.13	0.37^***	–0.55^***

^** p < 0.01, ^*** p < 0.001.

The validated research model included three latent variables: workload, job satisfaction, and occupational stress. All factor loadings significantly loaded the main factors. The model showed adequate, though not a perfect fit to the data (χ² = 224.746, df = 129, p < 0.001, CFI = 0.93, TLI = 0.92, RMSEA = 0.065).

In NQMs, workload showed a significant positive relationship with occupational stress (β = 0.34, p = 0.006), while job satisfaction showed a significant negative relationship with this variable (β = –0.44, p < 0.001). Among experienced midwives, workload was positive predictor (β = 0.40, p < 0.001), and job satisfaction was negative predictor (β = –0.57, p < 0.001), of occupational stress. Based on this results, hypotheses H1 and H2 were fully confirmed. Workload and job satisfaction explained 31% of the variance in occupational stress among NQMs (R² = 0.31, p < 0.001) and 54% of the variance in occupational stress among experienced midwives (R² = 0.54, p < 0.001). Analysis of the results suggests that the significance of the relationship between workload and stress (Fig. 1), and between job satisfaction and stress (Fig. 2), is weaker in NQMs, compared to experienced midwives. Based on this data, hypothesis H3 was accepted.

Fig. 1

Regression plot for the relationship between workload and occupational stress for NQMs and experienced midwives.

Fig. 2

Regression plot for the relationship between job satisfaction and occupational stress for NQMs and experienced midwives.

T-tests revealed that there were no significant differences between NQMs and experienced midwives in terms of mean levels of workload (t = –0.10, p = 0.91), job satisfaction (t = 0.22, p = 0.82), and occupational stress (t = –0.53, p = 0.59). Therefore, hypothesis H4 was rejected.

4 Discussion

The present study examined the links between workload, job satisfaction, seniority, and occupational stress in a sample of Polish midwives. The study compared two groups: NQMs with less than four years of work experience and experienced midwives. The results support the JD-R model’s assumptions regarding the role of job demands and job resources in the shaping of occupational stress levels. According to the order of the hypotheses reviewed, theoretical and practical implications will be discussed.

Hypothesis H1 concerned the predictive role of the workload against occupational stress. In the study sample, the level of workload was at a medium-high level (NQMs M = 19.01; experienced midwives M = 19.09), and it turned out that workload leads to greater occupational stress in both study groups. These results are in agreement with a study of Dutch NQMs [28] that pointed to workload as one of the most stressful requirements of the job. The level of the workload for midwives is due to, among other things, time pressure, a significant number of duties, and a high level of professional and ethical responsibilities. Workload and other responsibilities are significant predictors of physical, mental, and emotional work-related burnout [29]. According to their own subjective assessments, the surveyed midwives have to cope with having to act quickly once or twice a day, exerting mental effort, and insufficient time to work, as well as performing more duties than possible.

The purpose of testing the second hypothesis was to see if job satisfaction reduces occupational stress. The results suggest that job satisfaction in the study sample was at an average level for both groups (NQMs, M = 21.51; experienced midwives, M = 21.31, out of a possible 35). These results are in agreement with Uchmanowicz et al. [16], and when taken together, lead to the conclusion that Polish midwives are moderately satisfied with their jobs. Previous work indicates that job satisfaction is strongly shaped by self-assessment of one’s job [30]. Thus, Polish midwives, on average, generally rate their work as valuable and socially appreciated. Job satisfaction was also found to reduce occupational stress in the study sample. Hence, job satisfaction is a significant and important resource in coping with stress. Indeed, the negative relationship between job satisfaction and stress is well documented in the literature [31]. It is important to point out that, although the surveyed midwives reported only an average liking for their work, even an average level of job satisfaction was sufficient to significantly reduce the psychological costs associated with this work.

The first part of hypothesis H3 concerned the role of seniority in shaping the strength of the correlation between workload and occupational stress. Based on the literature review, it was not possible to clearly predict which of the study groups would show a stronger correlation between workload and stress. Previous data suggested that workload might be a stronger predictor of stress and its negative psychological consequences among younger workers [32]. On the other hand, research on a sample of Polish midwives suggested no such correlation [19]. The current data shows that workload raised stress levels more strongly in the group of experienced midwives. In the study sample, seniority was highly related with the age of the respondents. Ng and Feldman [33] showed that older workers do not perceive their mental and physical health as lower than younger workers despite declines in clinical indicators of physical health (blood pressure, cholesterol, and body mass index) that are positively correlated with age. Thus, it can be said that subjective health scores do not decline with age, but objective measures of physical health are lower in older workers. It may be that the observed medium-high level of workload more strongly increases workplace stress in experienced midwives because of a lower endurance for onerous time pressure induced by increased biological age. According to the JD-R model, excessive requirements can lead to stress, resulting in occupational burnout. Prior data demonstrate that a job tenure of more than five years is a significant predictor of the components of burnout, including emotional exhaustion and lack of job engagement [34].

The second part of hypothesis H3 concerned the difference in the strength of the correlation between job satisfaction and occupational stress in groups with different seniorities. The current results suggest that job satisfaction is a stronger negative predictor of stress among experienced midwives as compared to NQMs. This is consistent with previous data showing a stronger negative correlation between job satisfaction and stress among older workers than younger workers [35]. The weaker negative correlation for NQMs may be explained by the fact that job satisfaction in this group is an important, but not the most important resource, for coping with stress. Findings from previous studies indicate that team support, work variety (lack of routine), and employment conditions are important work resources for NQMs [28]. Positive cognitive job evaluation is more important in coping with stress in the experienced midwives. Job satisfaction consists of the assessment of aspects such as working conditions and the possibility to achieve desired goals at work. Although the study groups did not differ in their level of overall job satisfaction, in experienced midwives, the job evaluation score as subjectively liked and providing a sense of personal satisfaction was a more important job resource.

Based on theoretical foundations and subjective descriptions of work conditions, hypothesis H4 proposed that levels of workload, job satisfaction, and occupational stress would significantly differ in midwives across seniority. However, the results showed that these variables did not differ between groups. Previous studies on this topic have been inconclusive. For example, Mullen et al. [36] reported a negative correlation between seniority and stress but no significant correlation between seniority and job satisfaction. In relation to a sample of Polish midwives, this study is part of a series of publications documenting the lack of a direct correlation between seniority and job satisfaction [30], and the lack of correlation between seniority, workload and occupational stress [19]. Similar to studies from other countries [2], Polish NQMs do not report, higher occupational stress levels compared to their more experienced colleagues. Similar levels of workload, job satisfaction, and occupational stress may be explained by the same way both groups respond to events at work [37]. A large number of duties and high responsibility are rated by both junior and senior midwives as unpleasant time pressure— a major factor of workload. The number of hours worked per week was significantly higher in the group of experienced midwives compared to the group of NQMs, and experienced midwives worked multiple jobs significantly more often than NQMs. This may mean that with an objectively higher burden, older midwives experience a subjective burden at levels similar to NQMs. More effective evaluation of time pressure at work in experienced midwives may be due to a higher sense of self-efficacy, which is positively correlated with seniority [18]. Self-efficacy is a positive appraisal of one’s abilities and competence, and is positively related to the perception of work as feasible despite difficulties. In the light of the current results, it can be inferred that experienced midwives rate multiple responsibilities as less stressful, but workload increases stress levels faster in this group. It is corresponding to data from interviews. Results only partially confirm distinction based on the standard of 5 years of experience.

A stronger correlation between workload, job satisfaction and occupational stress in the group of experienced midwives can also be explained in statistical terms. A model in which the variables explaining stress were workload and job satisfaction explained a smaller percentage of the variance of stress in the group of NQMs (R² = 0.31), compared with an identical model in experienced midwives (R² = 0.54). Thus, more than half of the variance of stress remains unexplained in the NQM group.

We also observed no significant relationship between job satisfaction and workload. This result is consistent with Herzberg’s theory of no direct relationship between reductions in negative hygiene factors (e.g., workload) and increased job satisfaction [38]. At the same time, in both groups, the strength of the link between workload (requirements at work) and occupational stress is weaker than the strength of the correlation between job satisfaction (resources at work) and stress. This may suggest that, in the work of Polish midwives, resources play a more important role in reducing occupational stress. According to the JD-R model, resources can reduce subjective feelings of workload, leading to lower stress. Further research should focus on identifying the resources that can lower the experienced level of job demands and, thus, decrease occupational stress levels. It also seems reasonable to examine what role other stressors identified by Spector and Jex [9], organizational constraints and interpersonal conflicts at work, play in the shaping of stress levels.

The results presented here may be important to researchers and practitioners in the field of health psychology for several reasons. First, the positive correlation between workload and occupational stress, which has been confirmed many times before [39, 40], was moderated by the role of seniority. While the level of workload in the current study was medium-high regardless of seniority, it is worth noting that the effects of job requirements on stress were increased in experienced midwives. Chronic excessive job demands are positively associated with depression [41], and depression is more commonly diagnosed among older adults [42]. This may underline the importance of paying special attention to the level of workload among senior midwives. The practical dimension of these findings lies in the negative effects of occupational stress on health care quality. High levels of stress can lead to occupational burnout [43], which manifests as, among other things, loss of concern for patients, increased negative emotions toward work, and decreased commitment to work. A particularly compelling aspect of the current results is the indication that resources at work play an important role in coping with stress. Positive evaluation of work as rewarding moderately reduces stress. Polish midwives are, on average satisfied with their jobs. Thus, it is worth implementing systemic solutions that would raise the level of job satisfaction. One potential change could be to raise the prestige of the midwifery profession in Poland, for instance, through increased salaries, motivational allowances, gratifications for raising the level of education and covering the costs of participation in training. Enhancing the prestige of the profession can also be accomplished by increasing midwives’ participation in scientific endeavors. Increasing collaboration between health care practitioners and researchers would benefit both professional groups. More importantly, such cooperation could improve the quality of health care in Poland. Innovative management of public health services is one of the most important challenges of responsible public policy. The correlation between management style and the psychological costs of work may inspire further research. Arguably, effective resource management at work would reduce subjective levels of job demands, stress and their negative consequences.

4.1 Limitations

One limitation of the current study is limited sample size. Previous Polish studies of midwives’ psychological functioning have been conducted with a similar number of participants; however, increasing the sample size could increase the reliability and accuracy of the results. However, advanced statistical analysis is a strength of this research. To the best of our knowledge, this is one of the first studies to use structural equation modeling to analyze data collected from a group of Polish midwives. It is worth noting, however, that the model fit rates to the data, while satisfactory, were not very high. Increasing the sample could improve the model’s fit. On the other hand, the research model included two observable variables. One of the basic assumptions in structural equation modeling is to ensure a large enough sample, even larger than 500 cases [44]. This is a requirement when testing complex models with several explanatory variables [45]. The more variables, the larger the sample required. Given the model estimation method used (maximum likelihood method) and the number of variables studied, it can be inferred that the sample was sufficiently large for reliable parameter estimation [46]. The current study’s external validity could also be enhanced by conducting this project in a longitudinal manner with repeated measurements. Here, the independent variables and the dependent variable were measured separately, with a two-month interval. Other studies show that measuring all study variables twice (e.g., every six or nine months) significantly increases the reliability of results [47]. Finally, an important flaw of study is group distinction based on uncertain foundations. This reduces the research value of this paper. However, the study was exploratory in the Polish context. The presented results can be useful despite shortcomings and partially unconfirmed hypotheses.

5 Conclusions

Job satisfaction and workload are significant predictors of occupational stress for midwives in Poland. Workload significantly increases, and job satisfaction significantly decreases the levels of occupational stress. The relationship between workload and occupational stress was stronger in the group of experienced midwives compared to the group of NQMs. Job satisfaction reduces stress more strongly in the group of experienced midwives. NQMs and experienced midwives did not differ significantly in job satisfaction, workload, and perceived occupational stress.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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	NQMs		Experienced midwives
	n = 79		n = 99
Age	M = 23.96	SD = 1.5	M = 46.37	SD = 9.21
Seniority	M = 1.34	SD = 0.79	M = 22.95	SD = 9.44
Working hours per week	M = 41.42	SD = 6.68	M = 47.27	SD = 18.49
Swift work %	100		94.94
Number of work places %
One	89.9		67.7
Several	10.1		32.3
Ward of working %
Childbirth	5.1		24.2
Gynaecology	22.8		17.2
Maternity	32.9		13.1
Gynecology-maternity	29.1		20.2
Neonatal	1.3		4
Obstetric and neonatal	6.3		8.1
Pregnancy pathology	2.5		7.1
Intensive therapy for newborns	0		5.1
Clinic	0		1
Education %
Midwivery high school	0		11.1
Bachelor’ degree in midwifery	97.5		79.8
Master’s degree in midwifery	2.5		9.1