Stress is an important psychological concept that can negatively affect health, well-being, and job performance [1, 2]. Globally, stress is known as one of the harms to human resources causing visible harmful impacts on individual and social life [3]. Job stress is stress that is work-related and it is one of the most important health issues related to human behaviour that can lead to severe mental collapse and different psychological–behavioral disorders [4, 5].

Stress levels experienced among different professions or jobs differ as some professions tend to have higher levels of stress. Nursing is one of the professions with high levels of stress, although specialties and work settings for nurses vary greatly. Nurses are required to provide both medical and emotional support to patients and their families and are expected to hide their negative emotions, which itself is a form of stress [6]. Previous studies have established that the experience of stress at work has unwelcome effects, both on the health and safety of workers and on the health and effectiveness of their organizations [5, 7]. Stress rises when the expectation of a job becomes too much for an employee to handle, resulting in serious mental, physical, and emotional conditions/illnesses, family problems, alcohol, and substance abuse among many workers. In addition, it causes absenteeism from work, accidents at work, and low productivity. The cost of stress is estimated to be millions of dollars every year for employer organizations [7-11].

As an occupation, nursing has a collection of circumstances leading to stress, including a highly demanding job with poor support, rapidly changing circumstances, shortage of resources and staff, and dealing with death and dying. These factors are inherent in nursing and are compounded by environmental factors such as difficult patients and their families, relationships with physicians, low institutional commitment to nursing, and the delivery of poor-quality care. In addition, responsibilities, such as the need to undertake continuing professional development and part-time education and the emotional nature of the job, contribute to the interactive stress and the daily stress of nurses' work [7, 12, 13].

Work-related stress in nursing occurs due to different work factors that place job demands on nurses [3, 14, 15]. Additionally, many of the emotional and physical symptoms that are common among nurses, such as headaches, fatigue, depression, anxiety, and the inability to cope, can be attributed to or exacerbated by stress [16].

Stress in the workplace impairs both the quality and quantity of work and has been a strong contributing factor to accidents or near misses in healthcare settings, such as affecting service delivery [17]. Stress has been linked to low job satisfaction, reduced productivity, and an increase in occupational accidents and health complaints [18]. It is often believed that when a staff is tired, there is bound to be a misuse of equipment which may lead to damage or injury to the staff or the product. Stress has a powerful effect on the mind and, therefore, a significant effect on one's health and well-being. Stress is linked to leading causes of death, including heart disease, suicide, accidents, and cancer [17]. Nurses are individuals with sensitive jobs who deal with the health of society, people and their functioning influences both their health and the health of other society individuals. Hence, the study investigated stress levels and coping strategies among nurses in selected hospitals in an urban metropolis in North Central Nigeria.

The findings from the study showed that participants experienced a wide range of signs and symptoms of stress. Accordingly, the participants showed a wide range of cognitive, physical, emotional, and behavioural signs and symptoms when confronted with stressful events. The highest cognitive emotional signs and symptoms experienced by participants were anxiousness, worry, being afraid, and difficulty in concentration; these results were similar to the findings of Eldin et al. [23, 24] on stress among nurses in Australia, where concern, feeling of unwell and fear were the highest cognitive-emotional symptoms experienced by the participants. The highest physical and behavioural signs and symptoms experienced by nurses in the current study were aches and pains, frequent cold and flu, chest pain, rapid heartbeat, eating more or less, sleeping more or less and procrastination of tasks. These agreed with the findings of [25] Taj-Eldin et al. [26], where the most common signs and symptoms experienced by participants were headache, pain, irritability, loss of appetite, cold and flu, stomach ache and sweating.

Findings from this study showed that more than half of the participants experienced a moderate level of stress, especially due to frequent night shifts, poor lightening, unsafe environment, no support from senior colleagues, no motivation for further education, conflicting roles with other professions, continuous dealing with client problems and bullying and harassment from patients’ relatives. These findings are similar to the study by Kokoroko and Sanda [27]) who reported that there was a moderate level of stress among nurses who worked at a college hospital in Eritrea. It is crucial for nurses to be healthy and to work in a relatively safe work environment to care for their patients. Moreover, the provision of nursing care requires that the nurse is in the right frame of mind and relaxed to ensure accurate calculation of patient medications, answer her clients' questions professionally, and carry out nursing assessments, among other duties. All these are left undone or done with some errors when the work environment is perceived to be unconducive by the nurse.

It is opined that the major stressors experienced by nurses are problems related to the physical environment, lack of equipment to work with, and being exposed to health and safety hazards. It also showed that problems related to the work environment are associated with occupational stress in nursing [28, 29]. Poor working conditions such as crowded work areas, noise, heat, strong odour, dangerous conditions, and physical strain are also considered potential sources of stress in the workplace [30]. The present study also showed that shifting, especially night duty, caused an increased high level of stress among nurses. A similar observation has been reported elsewhere [31].

In all nine subscales of coping strategies, positive reintegration and religious coping were the most used strategies by the participants, followed by active coping, use of instrumental social support, mental disengagement, focus on and venting of emotion, humor, denial, behavioral engagement. These findings are similar to the conclusion from a previous study conducted by Alfulani et al. [32], which showed that nurses used a variety of coping strategies to deal with workplace stressors. The beneficial effects of employees using coping strategies have been identified to include increase job satisfaction, reduced rate of absenteeism, turn over, and other work-related tensions [3]. Correspondingly, Bhatnagari [1] also agreed with the findings of the current study that regardless of the country, self-control, social support, planful coping, and positive reappraisal were found to be the four most utilised ways of coping.

Findings from the current study revealed that the mean scores for signs and symptoms of stress were observed to be highest for participants in Hospital C, and this observation was irrespective of the subscale considered. This could be due to the fact that the nurses in Hospital C experienced more stress and workload than in Hospitals A and B. Moreover, the difference observed could not be far from the fact that the hospitals are autonomous, having control over their mode of operation in the different or peculiar work environment and management, which to a large extent, contribute to the stress experienced by nurses. Earlier investigators have reported similar observations [28, 33]. In the current study, there was a significant relationship between age, gender, and year of experience of participants, and signs and symptoms. This is similar to the findings of Manzar et al. [34, 35], which revealed that signs and symptoms of stress could be influenced by the age and gender of the participants, although this was not in agreement with the study of Devebakan [6] where age and gender were not related to signs and symptoms of stress.

In this study, the highest stress level was reported by nurses from Hospital C, followed by Hospital B and then nurses from Hospital A. The highest stress level reported by nurses from Hospital C could be linked to the fact that Hospital C is the only pediatric specialty hospital in the state receiving referrals from all other hospitals for pediatric cases. Moreover, by virtue of its location, it is situated at the centre of the Ilorin metropolis. This makes it more accessible to customers of health care services. In view of the above, it can be deduced that Hospital C experiences a higher influx of patients than the other two hospitals. Moreover, the shortage of staff resulting in inadequate nurses to cover the units adequately may be a reason for the frequently stressful conditions. This was in line with a study done in Jordan which showed that the differences in the level of stress experienced by nurses showed that the lack of enough staff to cover all units was the most stressful event perceived by the nurses [29].

The lowest level of stress reported by nurses from Hospital A could be due to the fact that the scope of practice of the nurses is narrower when compared with others. It is the only General Hospital among the hospitals studied and cannot be compared with others in terms of funding, the quantity of manpower, specializations, and better conditions of service. It is reported [35] that adequate funding, enough manpower, and better condition of service can reduce the level of stress experienced by nurses. Al-Aameri [36] stated that adequate knowledge of stress and its coping strategies could enhance the appropriate use of coping strategies by nurses in the management of stress. The current study also showed that there exists a relationship between participants’ age, gender, years of experience, and stress level. This observation corroborates the reports of earlier investigators [6, 8, 36] who indicated that stress levels can be influenced by age, gender, shift work, and work experience.

The study was cross-sectional in approach; thus, participants were not investigated over a period of time. In addition, the findings are within the context of the study location, thus may not be generalised. However, these limitations did not in any way invalidate the study findings.

This research study has highlighted the significant results of the effect of stress and coping strategies among nurses in selected hospitals in Ilorin, Kwara State. The study reveals the different physical and behavioural signs and symptoms of stress among nurses. A moderate level of stress was experienced by the majority of the participants, and positive coping strategies utilized include positive reintegration, religious coping, active coping, use of instrumental social support, mental disengagement, focus on and venting of emotion, humor, denial and behavioral engagement. There was a significant relationship between participants’ socio-demographic characteristics (working experience, gender, nursing cadre) and signs and symptoms of stress. Furthermore, the results also indicated a significant relationship between stress level and participants’ age, gender, cadre, family status, and work experience

Hospital administrators and other relevant stakeholders in the health sector should ensure the provision of necessary infrastructures and ensure that the work environment is safe and conducive for nurses and other healthcare professionals to work. Moreover, periodic and continuous training on stress management should be ensured to reduce the effects of stress experienced by nurses, thereby promoting positive coping strategies as well as the provision of quality nursing care and practice.