Dissertations & Theses (Open Access)

Date of Award

Summer 8-2016

Degree Name

Doctor of Philosophy in Nursing (PhD)


Duck-Hee Kang, PhD

Second Advisor

Deborah J. Jones, PhD, MS, RN

Third Advisor

Margaret Beier, PhD

Fourth Advisor

Stephan Motowidlo, PhD



Consecutive 12-hr workdays can contribute to increased stress and fatigue and negative biological responses in nurses, potentially compromising quality of patient care and safety. The primary purpose of this study was to assess changes in stress, fatigue, and biological responses (salivary cortisol and alpha-amylase) over three consecutive 12-hr workdays in acute care nurses and how stress and social resources function in predicting fatigue and biological responses.


In a prospective study, 81 acute care nurses completed questionnaires and provided saliva samples four times: pre-shifts and post-shifts of day 1 and day 3.


Although stress and biological responses did not change, fatigue increased significantly from pre-shift day1 to post-shift day 3, particularly in night shift nurses. Stress measured with a visual analog scale significantly predicted fatigue at the end of day 1 and day 3. High social resources buffered negative impact of stress on fatigue of day 1.


Fatigue increased over consecutive workdays and stress can influence fatigue in acute care nurses. Social resources, on the other hand, may buffer the negative impact of stress on fatigue. Focused research is necessary to assess the effects of stress on fatigue and patient safety issues over consecutive workdays, incorporating biological responses in nurses at various settings.

Clinical Relevance

Because stress and fatigue may lead to compromised patient care and safety, additional research and interventions need to be tested in these topics.


Work, Stress and Fatigue, Quality of care, Social resources, Biomarkers



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