Abstract
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Purpose
This study explored job stress experiences among pediatric ward nurses in Korea and identified the underlying meanings and patterns of these experiences using qualitative content analysis.
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Methods
Data were collected through individual in-depth interviews with 9 pediatric ward nurses who had at least 1 year of experience, thereby excluding nurses in the initial adaptation phase of clinical practice. The data were analyzed using qualitative content analysis.
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Results
Five categories of job stress experiences were identified: (1) cognitive and emotional burden related to the distinctive characteristics of children, (2) difficulties maintaining positive relationships with caregivers, (3) difficulties arising from job demands and organizational culture, (4) additional stress from caring for children from multicultural families, and (5) growth through overcoming stress. Pediatric nurses experienced heightened emotional labor related to developmentally appropriate care and caregiver interactions, as well as structural stress associated with organizational and interprofessional contexts. Despite these challenges, they described developing professional competence, resilience, and professional identity through accumulated experience and supportive relationships.
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Conclusion
Job stress among pediatric ward nurses is a multifaceted experience shaped by clinical, relational, organizational, and sociocultural contexts. Although stress created substantial challenges, nurses also described professional growth and resilience as they accumulated experience. These findings highlight the need for integrated educational and organizational strategies that address emotional labor, strengthen resilience, and promote equitable family-centered pediatric nursing care.
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Key words: Nurses; Occupational health; Pediatric nursing; Psychological stress; Qualitative research
INTRODUCTION
Pediatric nursing involves providing individualized care from birth through adolescence and requires the delivery of “developmentally appropriate nursing care.” Understanding children’s needs and emotions throughout the developmental continuum is a fundamental component of pediatric nursing [
1]. Pediatric nurses serve as healthcare professionals who address the clinical conditions and health problems of children across developmental stages [
2]. Hospitalization is a highly stressful experience for both children and their parents [
3]. Children experience anxiety and fear in response to unfamiliar environments and medical procedures, often expressing resistance to healthcare providers through crying or restlessness [
4]. Parents also experience heightened stress levels, such as depression, anxiety, and emotional instability, during their child’s hospitalization [
3,
5]. Accordingly, supporting parents’ emotional responses is considered an essential element in promoting children’s recovery and well-being [
6]. Pediatric nursing is grounded in the principles of family-centered care, in which caregivers are regarded as active partners as well as recipients of nursing care. While this approach emphasizes partnership and shared decision-making, it may simultaneously impose additional emotional and relational demands on pediatric nurses [
1,
7]. Pediatric nurses are frequently exposed to high levels of emotional labor because they must respond to children’s diverse developmental and healthcare needs and the high expectations of parents [
6]. Kim et al. [
8] in 2023 reported that parents often demand direct nursing care during hospitalization and expect nurses to understand and support their emotional circumstances. Pediatric nurses operate in a unique environment requiring complex partnerships with both children and their caregivers [
1,
9]. Recent studies indicate that these relational dynamics, combined with the demands of continuous coordination and communication with multiple healthcare professionals, act as primary stressors that distinguish their experience from that of general ward nurses [
8,
9].
Job stress is defined as negative emotions arising from the interaction between personal capabilities and the work environment, adversely affecting nurses’ physical, psychological, and social health [
10]. Given these complexities, pediatric nurses are particularly vulnerable to job stress and emotional labor while providing individualized nursing care. Prolonged exposure to job stress impairs therapeutic relationships and increases the risk of nursing errors, ultimately compromising patient safety and the overall quality of care [
10]. These findings underscore the critical need for effective strategies to manage job stress among pediatric nurses. However, most domestic and international studies to date have predominantly employed quantitative designs, focusing primarily on identifying correlations between predefined variables [
1,
5-
9]. Although these studies have contributed to identifying factors associated with job stress, they have limitations in capturing the lived experiences of pediatric nurses and the sociocultural context in which job stress occurs. Consequently, they provide limited insight into the contextual, relational, and experiential dimensions of job stress encountered in daily clinical practice [
10].
In particular, the complex interactions among children’s developmental characteristics, caregivers’ expectations, organizational culture, and emotional labor in pediatric settings are difficult to fully capture through quantitative methods alone [
1,
5,
7].
Qualitative content analysis provides a systematic approach for interpreting both manifest and latent content within participants’ narratives, enabling the identification of recurring patterns, categories, and contextual meanings embedded in lived experiences [
11]. This method is especially suitable for examining job stress in pediatric nursing, where stress is shaped by multifaceted clinical, relational, and organizational contexts [
12]. Therefore, this study aimed to explore pediatric nurses’ experiences of job stress using qualitative content analysis, to identify key categories and patterns that characterize these experiences, and to generate contextualized knowledge that may inform the development of educational, organizational, and support strategies tailored to pediatric nursing practice. Ultimately, this study seeks to contribute to improving pediatric nurses’ job performance and supporting the provision of high-quality, family-centered pediatric nursing care.
METHODS
Ethical statements: This study was approved by the Institutional Review Board (IRB) of Kyungwoon University (IRB No. KW-2025-A-4). Written informed consent was obtained from all participants prior to data collection.
1. Study Design
This qualitative study employed qualitative content analysis to explore the job stress experiences of pediatric ward nurses through individual in-depth interviews. This research was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [
13].
Participants were pediatric ward nurses working at a tertiary hospital, a general hospital, and a children’s hospital located in Daegu Metropolitan City. Consistent with the inclusion criteria used in a previous study involving pediatric nurses [
14], participants were required to have at least 1 year of clinical experience in a pediatric ward. After obtaining permission from the nursing department, potential participants were approached in person by the researcher and recruited using purposive and snowball sampling methods.
To focus on job stress specific to pediatric nursing practice, nurses in the initial adaptation phase were excluded because their stress primarily reflects general entry-level nursing demands [
15]. Head nurses were also included as interview participants because pediatric ward job stress is closely linked not only to direct care situations but also to unit-level operational demands such as staffing management, bed and workload allocation, handling complaints and mediating conflicts, and overseeing safety and quality. As key informants, head nurses were considered able to provide the organizational context in which job stress is generated and managed. Although overall clinical experience was considered during the study design based on the classification by Jang [
15], it was not used as a formal inclusion criterion but was reported as part of the participant characteristics. A total of 9 pediatric nurses were recruited. After receiving an explanation of the study purpose and procedures, including the audio recording of interviews and the use of transcribed data, all participants provided written informed consent, and the study was completed without any dropouts (
Table 1).
To explore job stress experiences among pediatric nurses, individual in-depth interviews were conducted. In-depth interviews are a widely used qualitative data collection method that facilitates the systematic exploration of participants’ perceptions, experiences, and meanings related to a specific phenomenon through face-to-face interaction [
16]. This approach allows researchers to obtain rich descriptive data relevant to identifying patterns and categories within qualitative content analysis [
12]. To enhance the quality of interview data, the researcher contacted the participants in advance and conducted the interviews after establishing rapport through informal conversation. Interviews were conducted from July 3 to August 24, 2025, with each session lasting approximately 60–90 minutes. Interview locations were selected by participants to ensure comfort and privacy, including small conference rooms within hospitals, empty classrooms during academic breaks, quiet nearby cafés, or private meeting rooms where interruptions from others were unlikely.
Interviews began with informal conversation and gradually progressed to the main topics. During interviews, the researcher maintained a neutral stance, noted key concepts, and sought clarification when responses were unclear. All interviews were audio-recorded with consent, transcribed verbatim by the researcher, and reviewed repeatedly to ensure accuracy. Data collection continued until analytic saturation was reached, defined as the point at which no new codes or categories emerged from the data [
17]. In this study, no new codes were identified after the seventh interview, and subsequent interviews confirmed data redundancy. Therefore, data collection was concluded after interviewing 9 participants. To ensure consistency in the interviews, all interviews were conducted by the first author. Field notes were used during the interviews to record participants’ statements and to document key concepts as they emerged. The participants had no prior relationship or conflicts of interest with the interviewer. Each participant was interviewed once. When responses were unclear or required confirmation, clarification was obtained during or immediately after the interview to ensure accurate recording and interpretation of participants’ statements.
The first author was a female registered nurse (RN), an assistant professor, and a PhD (Doctor of Philosophy) candidate in nursing. She had more than 17 years of pediatric ward experience and extensive clinical expertise in pediatric nursing. She had completed doctoral-level coursework in qualitative methodology and attended additional workshops on qualitative research methods to further strengthen her research competence.
4. Measurement
To explore the job stress experiences of pediatric ward nurses, data were collected using a researcher-developed semi-structured interview guide. The interview guide was developed based on a review of the literature on pediatric nursing stress and qualitative interview methodology [
16] and was refined through discussions among 3 researchers. It was subsequently reviewed by 2 experts in qualitative research to ensure clarity and content validity (
Table 2). No pilot testing of the interview guide was conducted prior to data collection. The interview questions consisted of open-ended items designed to elicit participants’ experiences of job-related stress in pediatric nursing practice. Interviews were conducted flexibly, allowing participants to describe their experiences freely. The interviewer adjusted the wording and depth of questions according to participants’ responses and used probing questions when necessary to obtain more detailed information. Examples of the core interview questions included: “What feelings or thoughts have you experienced while caring for hospitalized children?” and “Have you ever experienced emotions such as difficulty, fear, anxiety, tension, or worry (i.e., stress) while working as a pediatric ward nurse?” Examples of probing questions included: “Could you explain that in more detail?”, “Could you provide a specific example?”, and “How did that situation affect you?”
Data were analyzed using qualitative content analysis as described by Graneheim and Lundman [
11] in 2004. This approach is an inductive method in which coding categories are derived directly from the data rather than from preconceived categories or theoretical frameworks. All interviews were audio-recorded and transcribed verbatim. The transcripts were read repeatedly to gain an overall understanding of the data. Words, phrases, and sentences related to the study purpose were highlighted as meaning units. These meaning units were condensed while preserving their core meaning, and appropriate labels representing the underlying concepts were generated to form initial codes. Similar codes were grouped into subcategories and categories based on shared characteristics [
11,
12].
Coding was performed independently by 3 researchers, including the first author. The first author’s clinical background in pediatric nursing enabled interpretation grounded in the practice context, while the co-researchers’ formal training and extensive experience in qualitative research—including multiple publications—enhanced the methodological rigor of the analysis. Discrepancies in coding were resolved through discussion among the researchers until consensus was reached. When necessary, consultation with an external qualitative research expert was sought.
No qualitative data analysis software was used; all coding and data analysis were performed manually.
6. Rigor and Trustworthiness
The rigor of this qualitative study was established in accordance with the criteria by Lincoln and Guba [
18] of credibility, transferability, auditability, and confirmability.
Credibility was enhanced by selecting participants relevant to the study purpose and conducting interviews in quiet, private settings where pediatric nurses could speak openly without interruption. Participants had no prior personal or professional relationship and no conflicts of interest with the researchers, minimizing potential bias or power imbalance. Probing questions were used to obtain detailed descriptions when responses were abstract or unclear.
When responses were unclear or required confirmation, clarification was obtained during or immediately after the interview to ensure accurate recording and interpretation of participants’ statements. Participants were also asked to confirm the researcher’s understanding of their responses, thereby enhancing the accuracy and credibility of the data. Throughout the research process, the researchers reflected on potential preconceptions related to pediatric nursing stress.
To further enhance the quality of data collection, several strategies were implemented throughout the interview process. Prior to the interviews, informed consent was obtained, and participants were encouraged to speak freely. Efforts were made to create a comfortable atmosphere; participants who appeared tense or hesitant were reassured and encouraged to share their experiences openly. During the interviews, the researcher ensured that participants had sufficient opportunity to express their views in detail and used supportive prompts when necessary. To minimize interviewer bias, the researcher acknowledged the possibility of personal preconceptions and emphasized that there were no right or wrong answers and that participants’ perspectives could change during the interview. These procedures facilitated open and authentic responses and further strengthened credibility.
Transferability was supported by providing detailed descriptions of participants’ clinical characteristics, research context, and analytic procedures. Direct quotations from participants were included to allow readers to assess the applicability of the findings to other settings.
Auditability was ensured by maintaining consistency throughout data collection and analysis. All interviews were conducted by the same researcher using a consistent interview guide. Analytic notes documenting methodological decisions and category development were maintained, enabling the research process to be traced.
Confirmability was strengthened through reflexive practices and ongoing discussions among the research team to minimize the influence of researchers’ biases on data interpretation.
All authors reflected on their prior clinical or professional experiences related to pediatric nursing stress and revisited these reflections during data analysis to ensure that interpretations were grounded in participants’ accounts rather than researchers’ assumptions. Prior assumptions—for example, that stress would primarily arise from relationships with caregivers or from difficulties with intravenous procedures—were discussed among the research team during the early stages of the study. As data collection progressed, these assumptions were revisited and compared with emerging findings. Ongoing discussions among the research team were conducted to minimize the influence of researchers’ biases on data interpretation.
RESULTS
As a result of analyzing the participants’ interviews, meaningful statements were identified from the interview transcripts and used to generate initial codes. Codes with similar meanings were then grouped into subcategories. Subcategories were further abstracted into higher-level categories based on similar situational and experiential characteristics, as well as shared emotional responses reflected in the data. Through this analytic process, the job stress experiences of 9 pediatric nurses were organized into 5 categories, 14 subcategories, and 32 codes (
Table 3).
1) More delicate and personalized care required for pediatric patients
Participants stated that pediatric nursing requires close observation of subtle changes in children who are unable to communicate verbally, individualized care tailored to each child’s developmental stage, and considerable patience, making it more demanding than adult nursing.
“Adults can express discomfort or pain verbally, but children cannot, so they might cry persistently until very late at night.” (Participant 4)
“Even among children of the same chronological age, developmental levels vary, so focusing on these differences is appropriate.” (Participant 1)
“Children sometimes suddenly hit or bite, kick hard, or put objects like watches in their mouths. We must endure this as part of care.” (Participant 4)
2) Precision required in medication dosage calculation
Participants placed great importance on medication administration. They expressed concerns about patient safety incidents due to incorrect calculations and dosages, and emphasized that for young children, even a small dosage error can be fatal, requiring extra caution.
“For steroids, an adult may receive 1 ampule, but for pediatric patients, the dosage varies based on body weight (like 0.25 or 0.34).” (Participant 1)
“Sometimes the attending physician says ‘mL’ but we interpret it as ‘mg,’ causing confusion.” (Participant 2)
3) Family-centered nursing including pediatric patient’s parents
Participants described pediatric nursing as “whole-family care,” noting that both children and their parents experience anxiety in the unfamiliar hospital environment, so care includes not only the child but also the parents.
“Parents need emotional support, as they naturally feel anxious when their child is ill.” (Participant 1)
“The child is 1 year old, and the mother is 1 year old too.” (Participant 1)
“In pediatrics, parents initiate hospitalization decisions and participate throughout treatment. The parent-child pair is treated as a unit, unlike adult care.” (Participant 1)
2. Difficulties in Maintaining Positive Relationships with Caregivers
1) Difficulty establishing positive relationships with parents
Participants described experiencing difficulties when interacting with parents whom they perceived as uncooperative or demanding. This caused stress for the participants and led to feelings of disappointment toward parents they had considered cooperative, making it challenging to build positive relationships.
“‘Why make my precious child suffer?’ like this… There seems to be little compromise regarding the child’s issues.” (Participant 3)
“Please warm the milk, heat the food, bring water,’ Like this....” (Participant 4)
2) Excessive expectations and criticism from parents and guardians
Participants experienced various negative emotions such as suspicion, hypersensitivity, disappointment, and anger during interactions with parents, which caused them psychological stress and feelings of self-doubt.
“Almost 90% of parental demands ‘Please try to insert the IV on my child in one try.’” (Participant 1)
“I feel like I keep causing this child pain... It’s kind of a self-reproach. Honestly, after the first or second poke, by the third time, I start to feel scared. It’s really hard to try again....” (Participant 4)
“‘Is it okay to be this incompetent? In such a big hospital, is there really no one capable of doing this? It feels like everyone’s skills are pretty lacking, just not up to the mark?’ like this.....” (Participant 2)
“Since it’s a single room, we have patients with infections. So, we put up all the caution marks. Parents even watch closely to see if nurses wash their hands when moving from the infected patient’s room.” (Participant 7)
3. Difficulties Arising from Job Demands and Organizational Culture
1) Reduced sense of belonging due to individualism and lack of solidarity
According to the head nurse, recent nurses tend to expect senior nurses or someone else to look after them rather than proactively approaching colleagues to collaborate, and this growing tendency to focus only on their own tasks rather than helping one another is weakening teamwork. As a result, she noted that solidarity is diminishing and the sense of belonging within the ward appears to be gradually declining.
“They don’t take the initiative to approach first but expect senior nurses or someone else to look after them.” (Participant 3)
“It feels like everyone’s just looking after their own patients—‘your patient is your responsibility, my patient is mine’—and only doing their own share.” (Participant 3)
2) Psychological burnout due to authoritarian attitudes of certain physicians
Participants experience verbal attacks, authoritarianism, insults, and blame-shifting from doctors amid unclear boundaries of responsibility, leading to feelings of anger and helplessness, which can undermine both patient safety and teamwork.
“A child underwent an appendectomy and was admitted to the ward, but the head surgeon prescribed the same antibiotic at a ridiculously high dosage compared to what the pediatrician prescribed. As a nurse, I had to ask for clarification, so I contacted him, and he said, ‘Why can’t a nurse do that calculation? If that’s the case, we don’t need nurses. We can just work with assistants. How can we work together if that’s all a nurse can do?’... There are a lot of situations like this these days....” (Participant 3)
“Some attending physicians don’t answer calls, express irritation, or remain silent when asked questions.” (Participant 2)
3) Vicious cycle of stress
Some participants expressed concern about the negative impact of stress on pediatric care. Emotional exhaustion, physical depletion, and decreased motivation reduce direct caregiving quality.
“Stress causes me to explain things perfunctorily or speak tersely, which is apparent through facial expressions and work attitude.” (Participant 3)
“Stressful situations lead to more frequent nursing errors.” (Participant 1)
4. Additional Stress from Caring for Children from Multicultural Families
1) Difficulties in information gathering, nursing, and stabilization due to language barriers
As the number of foreign children and parents increases, participants experience difficulties and concerns about communication barriers and potential problems in the treatment process.
“Non-verbal communication, like body language, or demonstrating procedures—these tend to be more necessary with parents from other cultures compared to Korean mothers.” (Participant 1)
“A parent gave medication incorrectly because they couldn’t understand it was not an antipyretic, confusing it by color.” (Participant 4)
2) Conflicts between caregiver expectations and nursing practices due to cultural differences
While striving to respect diverse cultures, participants faced difficulties due to differences in hygiene beliefs, lifestyle, and dietary customs among varied cultural backgrounds.
“People from India often wear hijabs. they also wear them inside the hospital. They walk around at night wearing black hijabs....” (Participant 2)
“In Western countries, people wash less often, sometimes only every 2 or 3 days. Even in the summer, the child wasn’t bathed despite sweating a lot. The child kept sucking on unwashed hands, causing repeated gastroenteritis. Although the child took enough medicine, they kept getting sick because of sucking dirty hands without washing.” (Participant 4)
3) Need for institutional support and education
Participants recognize the need for policy support in nursing care for children from multicultural families. Foreign parents often do not even know how to properly administer fever medication, and communication barriers make explanations and education more difficult.
“The health center provides multilingual maternity handbooks for multicultural mothers, but these lack detailed guidelines on how to manage fever or administer antipyretics, and instead contain a lot of product promotional content.” (Participant 4)
“It would be good to gather some multicultural mothers and offer them such lectures.” (Participant 4)
5. Growth through Overcoming Stress
1) Becoming proficient in pediatric nursing
Participants strive to acquire professional knowledge about pediatric diseases and nursing interventions, improve their clinical skills, and prioritize understanding and empathy to build positive relationships with the children’s parents.
“I often open pediatric nursing books. When I wonder what medicine to use or what we can’t do, I find myself looking it up in the book.” (Participant 4)
“As a mother of 2, I try my best to understand parents’ perspectives.” (Participant 1)
2) Emotional burden management and resilience building
Participants found strength through supportive communication with colleagues and family, sharing experiences to cope emotionally and mentally, thereby fostering growth as pediatric nurses.
“You’re really good at it. When you encourage them like this, they seem to gain strength from it and keep adding more and more...” (Participant 3)
“...But that process involves getting some criticism. You have to overcome those challenges, and I think it’s important to manage and get through them well.” (Participant 1)
3) Becoming established as a pediatric nurse
Participants described their role as companions throughout the child’s health challenges and developmental growth. Witnessing children’s healthy growth and receiving gratitude and recognition from parents were described as sources of emotional satisfaction and professional affirmation.
“I’ve seen this child since infancy, and now they come as elementary students.” (Participant 4)
“When moms say, ‘Oh, we really come to this hospital because you, nurse, are here,’ that’s when my self-esteem really soars.” (Participant 4)
“This is painful, but just a quick sting once and it’s over. It hurts less than when you pick your nose... (omitted) ... I explain this to the child, and after one shot, they say it didn’t hurt at all and bravely face it. Since then, the child has been handling injections well.” (Participant 5)
DISCUSSION
Using qualitative content analysis, this study explored the job stress experiences of pediatric ward nurses and identified 5 interrelated categories. The findings suggest that job stress among pediatric ward nurses is a multifaceted phenomenon arising from children’s developmental characteristics, interactions with caregivers, organizational culture, increasing multicultural care demands, and the ongoing process of professional growth. One strength of this study is its focus on pediatric ward nurses as a specific clinical group, rather than treating them as part of a broader nursing population. In addition, the categories were derived directly from field data, allowing stress experiences to be organized in a systematic and practice-based manner. By moving beyond an emphasis on individual coping, the results draw attention to structural and relational factors that shape stress and offer meaningful implications for clinical practice and organizational policy.
The first category reflects the cognitive and emotional burden associated with providing developmentally appropriate care for children. Previous studies have reported that pediatric nursing entails greater cognitive demands than adult nursing, as it requires continuous interpretation of nonverbal cues and close monitoring of behavioral changes [
3]. Similarly, participants in this study described persistent tension and emotional regulation while caring for children who were unable to clearly articulate their symptoms. These findings suggest that pediatric nursing extends beyond the performance of technical tasks and is characterized by substantial emotional labor. Although Hochschild [
19] first introduced the concept of emotional labor in 1983, subsequent healthcare research has expanded its application to clinical settings by emphasizing its psychological and organizational implications. In pediatric care, emotional labor becomes particularly intensified due to triadic interactions among nurses, children, and caregivers. Emotional labor involves the active regulation and management of emotions in professional practice [
9]. Pediatric nurses are particularly vulnerable to these demands because they must navigate complex interpersonal relationships while providing individualized care [
6,
9]. In addition, weight-based medication calculations and ambiguous medication orders further intensify this burden by reinforcing the high-risk nature of pediatric nursing practice, increasing nurses’ sense of responsibility, and amplifying stress because even minor errors may have serious consequences.
The second category highlights job stress arising from relationships with caregivers and reveals a gap between the principles of family-centered care and the realities of clinical practice. Previous studies have shown that parents of hospitalized children often have high expectations regarding nurses’ technical competence and timely responses and may express dissatisfaction when these expectations are not met [
8]. In Korea, the ultra-low fertility rate of 0.75 in 2024 has further intensified parental protectiveness and reinforced child-centered attitudes [
20]. Within this social context, the findings indicate that interactions with caregivers may impose a disproportionate emotional burden on nurses. These findings suggest that implementing family-centered care without sufficient consideration of nurses' emotional labor may inadvertently increase job stress rather than provide support [
21]. Accordingly, organizational strategies should move beyond simply endorsing partnership and incorporate concrete structural supports. First, structured communication training tailored to managing interactions with highly anxious or high-conflict caregivers should be incorporated into continuing education programs. Second, clear institutional policies for managing verbal aggression, unreasonable demands, and patient or caregiver complaints should be established to protect nurses from disproportionate emotional burden. Third, formal debriefing mechanisms following emotionally challenging encounters may help reduce accumulated stress. Finally, staffing allocation and workload adjustments should reflect the intensity of caregiver interaction in pediatric units. Therefore, reframing nurse–parent relationships as collaborative caregiving partnerships requires not only conceptual agreement but also explicit organizational support and safeguards. The third category reflects job stress arising from job demands and organizational culture. Participants described a diminished sense of belonging resulting from individualized work practices and limited peer support. They also reported that hierarchical and authoritarian attitudes among some physicians caused psychological distress, including feelings of intimidation and anger. These findings are consistent with previous studies suggesting that problems in collaboration with physicians, conflicts among colleagues, and the quality of teamwork and organizational culture have a substantial impact on stress levels [
22]. Such organizational contexts intensified nurses’ emotional labor, contributing to a vicious cycle of emotional exhaustion, reduced work engagement, and diminished quality of care. These findings suggest that pediatric nurses’ job stress should be understood not merely as an individual vulnerability but as a structurally reinforced experience shaped by organizational culture and power dynamics. This underscores the importance of stress management approaches that extend beyond individual coping strategies to include team-based interventions and the cultivation of collaborative, respectful work environments [
23,
24]. These findings highlight the central role of organizational culture in shaping pediatric nurses' job stress experiences.
Beyond organizational and interprofessional stressors, the fourth category addresses additional stress associated with caring for children from multicultural families. Participants reported that language barriers complicated information gathering, medication education, and symptom assessment, increasing concerns about the accuracy of care and patient safety. These findings are consistent with previous studies indicating that communication difficulties constrain the delivery of effective nursing care. As multicultural encounters in pediatric settings become increasingly common in Korea [
25], multicultural nursing competence should be recognized as essential institutional resources for promoting child health equity [
26]. Therefore, professional medical interpreter services, multilingual educational materials, and culturally appropriate clinical guidelines should be regarded not only as mechanisms for reducing nurses’ workload and emotional burden but also as essential institutional resources for promoting child health equity [
26].
The fifth category, “growth through overcoming stress,” highlights the dynamic role of job stress in the professional development of pediatric nurses. Participants described developing pediatric-specific knowledge and clinical skills while cultivating greater empathy for children and their caregivers through repeated exposure to stressful situations. These findings are consistent with previous research suggesting that stress does not inevitably result in negative outcomes, but may facilitate positive adaptation and resilience [
27]. In this study, resilience emerged not as an inherent personal trait but as a dynamic process fostered through collegial support, recognition from caregivers, and accumulated clinical experience. This indicates that the integration and reinterpretation of stressful experiences play a crucial role in the formation of professional identity among pediatric nurses.
In summary, job stress among pediatric ward nurses is a multidimensional phenomenon shaped by children's developmental characteristics, emotional labor associated with caregiver interactions, organizational culture, job structure, and increasing multicultural care demands. Therefore, moving beyond approaches that emphasize individual coping strategies, multilevel support is needed that integrates strengthened team-based collaboration, the cultivation of a respectful organizational culture, comprehensive education that includes pediatric and multicultural competencies, and improvements in work structure.
First, because participants were recruited from pediatric wards in a single metropolitan area, the findings may have limited transferability to other settings. Second, although all participants had at least 1 year of experience, differences in clinical experience may have influenced the diversity of reported job stress experiences. To enhance the trustworthiness of the study, efforts such as investigator triangulation, maintaining an audit trail, and ongoing reflexivity were implemented throughout the research process.
CONCLUSION
This study provided an in-depth exploration of job stress among pediatric ward nurses using qualitative content analysis, revealing subjective experiences and emotional responses that are difficult to capture through quantitative research. The findings suggest that pediatric ward nurses' job stress is intensified by complex clinical situations, emotional labor associated with caregiver interactions, organizational culture, and high interpersonal demands, underscoring the need for practical educational and organizational support strategies tailored to pediatric nursing practice. To this end, tailored education should be systematically developed that reflects career stage-specific competencies and learning needs (e.g., communication with guardians, managing emotional labor, and multicultural nursing competencies), and organizational support should be expanded through enhanced team-based communication and appropriate workload allocation. In addition, sustainable work environments for pediatric nurses should be fostered through parallel efforts to implement acuity-based staffing, establish systems for responding to verbal abuse and caregiver complaints, expand multicultural support resources, and provide accessible mental health support programs. Future research should broaden its scope to multiple institutions and regions and compare job stress across different career stages, using mixed-methods and longitudinal designs that incorporate objective stress indicators to better understand the relationship between job stress and the quality of nursing care.
ARTICLE INFORMATION
Table 1.General characteristics of participants (N=9)
|
No. |
Gender |
Age (yr) |
Marital status |
Pediatric ward career (yr) |
Total clinical career (yr) |
Position |
Hospital type |
|
1 |
F |
46 |
Married |
8.0 |
13.0 |
Head nurse |
Pediatric hospital |
|
2 |
F |
30 |
Single |
3.4 |
8.0 |
Staff nurse |
General hospital |
|
3 |
F |
51 |
Married |
26.0 |
29.0 |
Head nurse |
General hospital |
|
4 |
F |
35 |
Married |
11.0 |
14.0 |
Head nurse |
Pediatric hospital |
|
5 |
F |
33 |
Single |
11.0 |
11.0 |
Staff nurse |
Pediatric hospital |
|
6 |
F |
37 |
Married |
7.0 |
14.0 |
Staff nurse |
General hospital |
|
7 |
F |
49 |
Married |
3.4 |
28.0 |
Head nurse |
General hospital |
|
8 |
F |
49 |
Married |
9.8 |
28.1 |
Charge nurse |
Tertiary hospital |
|
9 |
F |
34 |
Single |
9.0 |
12.0 |
Charge nurse |
General hospital |
Table 2.Interview guide and questions
|
Questions |
|
Introduction |
• Before starting, please introduce yourself. |
|
• We will talk about job stress experienced by pediatric ward nurses. |
|
Opening |
• What are your main responsibilities as a pediatric ward nurse? |
|
• How have you perceived the stress you experienced while working in a pediatric ward? |
|
Transition |
• Please describe your personal experiences of job stress in the clinical pediatric ward setting. |
|
Core questions |
• What tasks or responsibilities do pediatric ward nurses actually perform in their daily practice? |
|
• What feelings or thoughts have you experienced while caring for hospitalized children? |
|
• Have you ever experienced emotions such as difficulty, fear, anxiety, tension, or worry (i.e., stress) while working as a pediatric ward nurse? |
|
• What effects, either positive or negative, do you think job stress during nursing tasks has on pediatric nursing? |
|
• What strategies or approaches can be used to effectively manage stress and enhance the nursing competencies of pediatric ward nurses? |
|
• How have you overcome the difficulties or stress you encountered in pediatric nursing practice? |
|
• What efforts did you make, and which of these factors did you consider most important? |
|
• Probing questions: Could you explain that in more detail?, Could you provide a specific example?, How did that situation affect you? |
|
Closing |
• To summarize, we have discussed your experiences of job stress as a pediatric ward nurse. |
|
• Do you have any additional comments to add? |
Table 3.Subcategories and categories of the study
|
Category |
Subcategory |
|
Cognitive and emotional burden due to the uniqueness of “children” |
• More delicate and personalized care required for pediatric patients |
|
• Precision required in medication dosage calculation |
|
• Family-centered nursing including pediatric patient’s parents |
|
Difficulties in maintaining positive relationships with caregivers |
• Difficulty establishing positive relationships with parents |
|
• Excessive expectations and criticism from parents and guardians |
|
Difficulties arising from job demands and organizational culture |
• Reduced sense of belonging due to individualism and lack of solidarity |
|
• Psychological burnout due to authoritarian attitudes of certain physicians |
|
• Vicious cycle of stress |
|
Additional stress from caring for children from multicultural families |
• Difficulties in information gathering, nursing, and stabilization due to language barriers |
|
• Conflicts between caregiver expectations and nursing practices due to cultural differences |
|
• Need for institutional support and education |
|
Growth through overcoming stress |
• Becoming proficient in pediatric nursing |
|
• Emotional burden management and resilience building |
|
• Becoming established as a pediatric nurse |
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