The Relationship between Dual Role Conflict and Work Stress of Female Nurses

Introduction: Work stress is the most common problem experienced by health workers including nurses. In certain occasion, nurses did series of tasks that not in accordance with their physical abilities, expertise, and time. Therefore, stress associated works was commonly reported. The purpose of this study was to determine the relationship between dual role conflict and work stress of female nurses in the clinical setting. Methods: This study applied a cross-sectional approach. The sample was obtained by using purposive sampling. A total of 80 female nurses involved in the study . Data was conducted by self-report questionnaire sheet instrument. Descriptive and inferential statistics were applied to analyzed data. The significant level was set as p ≤ 0.05. Results: The results indicated that the majority (66.2%) of female nurses experienced high dual role conflict, and most of them (72.5%) experienced heavy work stress. Based on the results of the Spearman Rho test, it was found that the value of p ≤ 0.001 (p ≤ 0.05) and the value of r ₛ = 0.698. The current study shows strong and significant relationship between dual role conflict and work stress among female nurses. Conclusions : In comparison to female nurses in the outpatient rooms, one day care, or other settings, those who work in inpatient ward with dual roles presented a higher workload. Stress associated with heavy workload found to be a common. Nurse managers should concern on promoting and supporting working environment by way monitoring work-load. Cite this as: Putri, T. V. N., Qowi, N. H., & Ubudiyah, M. (2023). The Relationship between Dual Role Conflict and Work Stress of Female Nurses. Fundam Manaj. Nurs. J. 6(1), 25-29 doi.org/10.20473/fmnj.v6i1.46989


INTRODUCTION
Work stress is the highest problem experienced by health workers, one of them is in the nurse group. Work stress is related to the many tasks and responsibilities which must be carried out by nurses compared to other professions (Nurcahyani dkk., 2016). Unproportioned tasks to physical abilities, expertise and time will become a source of work stress (Ministry of Health RI, 2020). Health and Safety Executive (2019) indicates that nurses have a high level of stress. Work stress itself is excessive workload, feelings of distress and emotional tension that hinder individual performance.
The results of a survey conducted by the Indonesian Nurses Association (PPNI) in 2018 mentioned that nurses in Indonesia experienced heavy work stress. Nurses who experience work stress complain that they often feel dizzy, tired, unable to rest because of the high workload and time consuming (Rhamdani & Wartono, 2019). The results of a survey conducted by PPNI in 2017 confirmed that about 50.9% of nurses working in four provinces in Indonesia experienced work stress including frequent headaches, fatigue, unable to rest due to high workload and time consuming (Herqutanto, et all, 2017).
The results of an analysis of several journals conducted by Faoziah, et all,. (2020) indicated that the work stress of nurses was 83.7%. Nurse work stress is more dominantly experienced by a woman. Habibi & Jefri., (2018) exposed that at Kwaingga Hospital, Keerom Regency the incidence of stress in female nurses was 58.75%, while at dr. Soedarso hospital Pontianak, female nurses who experienced moderate work stress amounted to 88% (Rachmaningrum & Makmuriana, 2018). Work stress can be affected by organizational conditions such as setting organizational direction and policies, changes in organizational strategy, finances, work demands, responsibility for others, changes in working hours, unfavorable changes between work groups, and multiple role conflicts (Pratama, 2020).
Women who are wives and mothers as well as workers tend to have work-family conflict because women have other roles outside their home as career women (Habibi & Jefri., 2018). This phenomenon will lead to a situation called Dual Role Conflict (Faoziah, et all, 2020). Multiple role conflicts are caused by pressure from work and family (Greenhaus & Beutell, 2020). Multiple role conflicts occur because there is conflict from one or more roles that demands more so that one role cannot be fulfilled (Chtistensen, Karhleen and Barbara, S., 2016), namely the role of a housewife and the role of a hospital nurse (Rahmanita, 2020).

METHODS
This research used analytic correlation design with a cross-sectional approach. It was conducted at x Hospital in Lamongan in February 2023. The population in this study were 95 female nurses with inclusion criteria including willing to be respondents by filling out an information consent sheet, married female nurses (had husbands & children), and widowed nurses who had children. Exclusion criteria were nurses who were on leave, nurses who carried out study assignments, nurses who did not fill out the questionnaire completely, widowed female nurses who did not have children. The sampling technique used purposive sampling. The number of samples was 80 married female nurses. The research instrument used a questionnaire sheet. The data were analyzed by using the Spearman Rho test.

Frequency Distribution of Respondents'
Characteristics Data on Table 1 indicate that 71 out of 80 (88.8%) female nurses are aged between 26 and 35 years, and only 4 (5%) female nurses are aged between 17 and 25 years. A total of 49 (61.2%) female nurses are Bachelor of Nursing graduates, 40 (50%) female nurses have been working for 1-5 years, and 15 (18.8%) female nurses have been working for more 11 years. Almost all of them (88.8%) have been married for a long time (1-15 years). For the number of children, 49 (61.2%) female nurses have 2 children, and 10 (12.5%) female nurses have 3 children. In terms of distance to the hospital, it is obtained that 27 (33.8%) female nurses traveled for 11-20 minutes, and 13 (16.2%) female nurses traveled more than 30 minutes. A total of 56 (70%) female nurses lived at home with husband and children and a small portion, namely 5 (6.2%) female nurses living with children, for the work space it was found that almost the majority (70%) female nurses worked in inpatient rooms and 4 (5%) female nurses worked in the central surgery installation. Most of them have

Identifying The Dual Role Conflicts of Female
Nurses Data on Table 2 indicate that 53 female nurses (66.2%) experienced high dual role conflict. A total of 20 (25%) female nurses experienced moderate dual role conflict, and 7 (8.8%) female nurses experienced low dual role conflict.

Identifying Work Stress for Female Nurses.
Data on Table 3 indicate that 58 (72.5%) female nurses experience severe work stress, 16 (20%) female nurses experienced moderate work stress, 6 (7.5%) female nurses experienced mild work stress.

The Relationship between Dual Role Conflict and
Work Stress of Female Data on Table 4 indicate that 66.2% of female nurses experience high dual role conflicts, moderate (25%), and low (8.8%). Female nurses who household assistants, 72 (90%) female nurses did not have household assistants experience work stress are categorized as severe (72.5%), moderate (20%), and mild (7.5%).
Based on the test results using the Spearman Rho test and using the SPSS 16.0 program with a significant level value of p = 0.000 (rs) = 0.698, H1 was accepted, meaning that there was a relationship between multiple role conflict and work stress of female nurses with a strong correlation level.

Conflict of Dual Roles of Female Nurses
The results showed that most female nurses experienced a high level of dual role conflict. This is shown by the results of the questionnaire which stated that female nurses were less able to manage time, the demands of one of the roles experienced by female nurses, and the existence of a behavior mismatch desired by the role (family or work).
According to Ruswanti & Jacobus (2015), having multiple roles is certainly a very difficult thing to do because it requires high concentration and a high emotional level as well. Dual role conflicts tend to be experienced by nurses who are married and have children (Arlinda, 2019). Female nurses who are married and have children have heavier roles and responsibilities than unmarried women. The woman also has a dual role because besides playing a role in the family. The woman also plays a role in her career. Conflict between work and family describes the clash between work responsibilities and at home.
Factors affecting the level of dual role conflict for a worker are the number of children or family members, time pressure, family support and childcare or household work assistance (Korabik, 2018). A married woman who finally chooses to work if she has support from her family, she will not feel guilty for leaving family matters to work. Someone  (Hurlock, E. B, 2020). In early adulthood, a person will be less able to minimize the occurrence of dual role conflicts because at this age stage many new things will be faced.

Work Stress of Female Nurses
Based on the results of the study, it was found that most female nurses experienced work stress levels in the severe category. This is shown by the results of the questionnaire which stated that there were physical symptoms such as changes in metabolism, increased heart rate and breathing, increased blood pressure, and headaches. Psychological symptoms such as job dissatisfaction, pressure and anxiety, irritability, and boredom occur. Occurrence of behavioral symptoms such as changes in productivity, changes in eating patterns, rapid speech, anxiety and sleep disturbances.
Nurse work stress is caused by excessive workload, dual role conflicts, difficulties in establishing relationships with colleagues, difficulties in dealing with critical patients, treatment uncertainty, unsafe work environment, not being included in decision making (Gelsema, 2020), and lack of support for nurse (Hurrel., McLaney, 2014). The absence of social support for someone who works can cause discomfort in carrying out work and duties, so that a person tends to be more easily exposed to work stress (Indah, 2017). The high social support provided by the people around the nurse will be able to suppress the high level of work stress that occurs in the work environment (Suryaningrum, 2015). Therefore, high social support is needed to minimize the risk of work stress. Siagian (2020) states that a person in early adulthood has psychological characteristics in the form of not having enough maturity in thinking, not being able to think rationally, not being able to make strategies in solving problems and not having good management of emotional control. Poor emotional control management makes a person in the early adult stage less able to deal with and solve a problem so that it will cause stress. Early adulthood is referred to as the most productive period in a person's life. The reason is, at this time, a person begins to have ambitions, dreams, and desires, both personal ones such as a spouse or job. So that at this time is a time when people's productivity is high which makes them vulnerable to stress. Early adulthood is a young age where a person tends to be less able to control the occurrence of work stress, in contrast to workers who are in the old age category which can be said to have more ability to control stress

The Relationship between Dual Role Conflict and Work Stress of Female
The test results using the Spearman Rho test showed a significant level value of p = 0.000 (rs) = 0.698, meaning that there was a relationship between dual role conflict and work stress of female nurses with a strong correlation level. Someone will experience role conflict if he has two or more pressures that occur simultaneously and if he tries to comply with one of them, then he will experience difficulties (Luthans, 2017). Conflicts that occur between work and family make nurses unable to balance their time and energy, causing these nurses to experience fatigue or overload which then triggers work stress (Ruswanti & Jacobus, 2015).
The fatigue experienced by a nurse due to the many roles and tasks that must be carried out will affect the emotional and mentality of the nurse, and trigger a woman to experience stress (Judge, 2019). Role conflict tends to lead to work stress because when work matters interfere with family life, pressure often occurs on individuals to reduce time spent at work and provide more time for family, and vice versa (Judge, 2019). Conflict between work and family has a close relationship with depression, somatic complaints (Frone et al, 2020), and anxiety disorders (Saranani, 2022). Prolonged conflicts can cause stress because it cannot be resolved causing physical and psychological imbalances, as a form of reaction to pressure that is too intense (Frone et al, 2020). Working women will tend to experience work stress because on the one hand women act as housewives who must first handle family affairs, husband, children and other matters related to the household. But on the other hand, women are workers who have to complete their work at work. This demand has the potential to cause working women to experience work stress.

CONCLUSION
Most female nurses have a high level of dual role conflict. Most female nurses have a heavy level of work stress. The correlation test shows a relationship between multiple role conflict and work stress of female nurses. Female nurses are more at risk of experiencing work stress. Efforts to reduce work stress include building satisfying, pleasant and cooperative relationships with co-workers to reduce work stress. Effective communication and support with superiors can also minimize work stress and multiple role conflicts.