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Relationship of Assertive Behavior and Stress among Nurses

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DELHI PSYCHIATRY JOURNAL Vol. 18 No. 2 OCTOBER 2015

Original Article

Relationship of Assertive Behavior and Stress

among Nurses
S.K. Maheshwari 1, Kanwaljit Kaur Gill2
1
University College of Nursing, BFUHS, Faridkot (Pb)
2
College of Nursing, Sarabha, Ludhiana (Pb)
Contact: S.K. Maheshwari, Email: [email protected]

Abstract
Introduction: Nurses with high assertive behavior are likely to deliver therapeutic patient
care as they can stand up for their rights and refuse unreasonable requests but nurses
show submissive behaviour which result in high stress, burden and low self esteem. Present
study aimed to examine the relationship of assertive behaviour and stress among nurses.
Methods: In a co-relational, cross sectional survey, 220 eligible nurses working in selected
hospitals of Punjab were identified conveniently and assessed using Socio demographic
Data Sheet, Rathus Assertiveness Schedule (RAS) and Perceived Stress Scale (PSS). Data
were analyzed using descriptive statistics, Independent t-test, ANOVA and Pearson’s
correlation. Results: Assertive behavior has large negative correlation with stress at 0.01
level of significance (r= -0.720**). Older nurses who are on regular job, studied from
Govt. nursing institutions and working in Govt. hospitals were more assertive. Nurses
those are older, regular, joined nursing by their wish, studied from Govt. nursing colleges
and working in Govt. hospital had low stress as compared to others. Conclusion: Study
concluded that non-assertive behaviour of nurses results in high stress. Nurses should
behave assertively as it directly affects the stress and burden. Policy makers can plan and
organize assertiveness training or other intervention for non assertive nurses so that they
can be trained for assertive behaviour and communication.
Key Words: Assertive behaviour, Stress, Nurse

Introduction group standards.2 Assertive nurses value what they

Nursing is a major component of the health care think and feel personally empowered, have higher
delivery system and nurses make up the largest self esteem and self respect.3 They recognize their
employment group within the system. Nurses are own strengths and limitations. In addition, being
providing care and comfort to those suffering from assertive means taking responsibility for his life and
illness and injury. Nurses communicate with each his choices. It also means not blaming other people
other, with patients and with members of the health or circumstances for what happens to him. 4
team both verbally and nonverbally and transmit their Assertiveness is true assertiveness if it is in the form
thoughts, feelings and massages.1 of trait in personality.
Assertiveness is a one style of communication Assertive behavior develops respect towards
which reflects nurse’s expression of their genuine self and others, promotes self-disclosure, self control,
feelings, standing up for their legitimate rights, and increase confidence5 and positive appreciation of
refusing unreasonable requests. Assertive nurses self-worth. It is the most effective way of solving
resist undue social influences, disregard arbitrary interpersonal problems and conflicts. Assertive
authority figures, and refuse to conform to arbitrary nurses become happier, less manipulative, feel better
356 Delhi Psychiatry Journal 2015; 18:(2) © Delhi Psychiatric Society
OCTOBER 2015 DELHI PSYCHIATRY JOURNAL Vol. 18 No. 2

about themselves and reach their goals more easily. Shipton (2002) found that emotions generated
Nurses who display assertive behaviour are more by stress in clinical experience have been reported
likely to maintain rigorous patient care practices to lead to nervousness, depression, anxiety, fear,
while also assisting patients in expressing their own disappointment, hopelessness and inferiority. 19
needs. Assertive nurses are also better skilled at Assertive behaviour of nurses can help to control
communicating effectively with other members of stress and anger and improve coping skills. Being
the health care team than unassertive nurses.6 assertive can also help to boost self-esteem and earn
Factors which promote assertive behavior others’ respect.20
among nurses at work include age, 7 sex, 7 high Assertive behavior does not mean to be
education, 8 seniority in job, 9 knowledge, 9 impertinent or use silly or indecent language. Every
confidence,9 experience7-8 and wearing of uniform.9 nurse needs to be assertive as she has to make her
Senior staff nurses are more assertive than junior patients fight for life. During their training period
staff nurses.9 Older age nurses are less assertive especially in clinical posting, they need to undergo
than young age. Diploma holder nurses are less thorough clerkship, not just to obtain their degree.
assertive than graduate nurses.10 The existence of the above problems raised the
Although studies have found asser tive awareness of the researcher that most of the
behaviour in nurses to be an invaluable component professional nurses in an academic hospital setting
of successful professional practice,8 nurses have were lacking assertive behavior and only a few
traditionally been taught to be acquiescent and to were situationally assertive.
be the submissive helpers of doctors. Nursing has In view of paucity of evidence over the subject
been described as an oppressed discipline that in India, the present study is aimed to assess the
remains the underdog in the medicine profession.11 relationship of assertive behavior with stress among
Chan (2002) suggested that the culture of nursing nurses in selected hospitals of Punjab. Study will
has encouraged passivity rather than assertiveness. also measure the association of assertive
As a result of this, there is a high probability that behaviour and stress level with selected socio-
professional nurses may not conduct themselves demographic and professional characteristics of
with sufficient assertiveness both in the work place nurses. Moreover, the findings of this study will have
and in advancing their careers.12 significance in the field of assertiveness training.
Professional nurses frequently did not express The findings will help the future nurse practitioner
their opinions or provide constructive criticism and and researcher to develop effective guidelines
suggestions in nursing practice. 13 Timmins and concerning the scheduling and formatting of
McCabe (2005)14 reported that the nurses behave assertiveness training from the results of the study.
in a passive, nice way and was ‘less adept at Also, specific recommendations for further research
disagreeing with others’ opinions and providing in assertiveness training will be drawn from the
constructive criticism’.7,9 results of this study.
Lack of assertiveness result in feelings of
helplessness and powerlessness. Nurses frequently Material and Methods
suffer emotional trauma because they have poor A descriptive cross sectional survey was done
communication skills and are unable to express their to assess the relationship of assertive behavior and
feelings about their needs and worries. Nurses who stress with each other and with other demographic
are unable to discuss important issues with others variables among nurses. The present study was
develop self-destr uctive beliefs which are conducted in the November-December 2013 at
emotionally damaging for them. They may also fourteen conveniently selected hospitals located in
develop maladaptive behaviors in order to cope with four districts of Punjab. The hospitals were selected
these emotions.15 Non-assertive behavior among on the basis of expected availability of nurses, giving
nurses results in high stress,16-17 low self esteem,18 permission to conduct the study and convenience in
frustration, anxiety and mental fatigue. Nurses have terms of distance. The population under study are
burden of other people’s work due to inability in the nurses working in the selected hospitals of
saying “no”. Punjab. Sample consisted of staff nurses of various
Delhi Psychiatry Journal 2015; 18:(2) © Delhi Psychiatric Society 357
DELHI PSYCHIATRY JOURNAL Vol. 18 No. 2 OCTOBER 2015

hospitals were selected by the researcher for the test–retest reliability 8 weeks later was 0.86 (Rathus
study. The group included only those staff nurses 1973). 21 The reliability was established for the
who were present at the time of data collection, present study through test retest method (r = 0.91)
registered with nursing council, working full time in
Perceived Stress Scale (Cohen et al, 1983)22
Govt or private hospital and willing to participate. A
sample of convenience was taken to recruit 220 staff Perceived stress of the nurses was measured
nurses for the study. The tools used for the study using the perceived stress scale (PSS-10). PSS is a
were Socio demographic Data Sheet, Rathus standardized 10 -item likert scale which assesses
Assertiveness Schedule and Perceived Stress the degree to which situations in one’s life is
Scale. 22 appraised as stressful during the past month. There
are six negative and four positive questions for which
Socio-demographic Data Sheet the subjects were required to choose from a scale
Socio-demographic data sheet is used for of 5 alternatives ‘never ’, ‘almost never ’,
recording of socio-demographic details of the nurses ‘sometimes’, ‘fairly often’, ‘very often’ relating to
and developed by researchers. Administration time their feeling of being stressed on a 0-4 scale. Item
is approximately 2-5 minutes. This tool had two nos. 1, 2, 3, 6, 9 and 10 are negative and item nos. 4,
parts. Part A: It has total eight items related to socio- 5, 7 and 8 are positive in nature. The negative
demographic information of the nurses which are element is intended to assess lack of control and
age, gender, marital status, religion, area of residence, negative affective reactions, while the positive
type of family, presently staying with and monthly element measures the degree of ability to cope with
self income (Rs.). Part B: It has total eight items existing stressors. Items are easy to understand and
related to professional characteristics of the nurses the response alternatives are simple to grasp.
which includes qualification, joined nursing as Administration time is approximately 3-5 minutes.
professional carrier, type of nursing college/school Scores are obtained by reversing the scores on the
from where took basic nursing training, years of four positive items, e.g., 0=4, 1=3, 2=2, etc. and then
experience in nursing, designation/position, nature summing across all 10 items. Scores range from
of job, type of hospital and area of work (ward). 00 to 40 and greater scores indicated higher
Appropriate content validity of the tool was perceived stress. It has acceptably high validation
established by twelve experts from psychiatry, and reliability scores. Co-efficient alpha reliability
psychology and nursing and appropr iate for PSS found between 0.8-0.84. The reliability was
modifications were made. The reliability was established for the present study through test retest
established through test retest method (r =1). method (r =0.81)
The tools were translated into Punjabi language
Rathus Assertiveness Schedule (Rathus, 1973)21
under the guidance of language experts and
Rathus Assertiveness Schedule was used in this amendments were made according to suggestions.
study to assess the assertiveness skills and subject’s Back translation in English was done to ensure the
impr ession of one’s own assertiveness and content and meaning. Trial out of the tool was done
frankness. It is a standardized, short structured, self to ensure the reliability and understanding of the tool.
administered six point rating scale. Administration Pilot study was conducted and the study was found
time is approximately 10 minutes. It contains 30 items to be feasible.
out of which 17 are described as negative/ passive
and 13 of them as positive. Six points along with Ethical considerations
their scoring range from very uncharacteristic of Prior to administration of tools, a participant
me (-3) to (+3) very characteristic of me. Scores information sheet explaining the purpose of the study
range between -90 to +90. Higher scores indicate was read out and handed over to the subject. All
that subjects perceived themselves as being high the questions and queries were discussed and sorted
assertive in their relationships with other people. The out before actual data collection. An informed
scale has relatively high internal consistency and written consent form was signed by each subject
stability. The spilt-half reliability was 0.77 and the before data collection. All the subjects were ensured

358 Delhi Psychiatry Journal 2015; 18:(2) © Delhi Psychiatric Society

OCTOBER 2015 DELHI PSYCHIATRY JOURNAL Vol. 18 No. 2

that confidentiality and anonymity was maintained Table-1. Distribution of Subjects as per
throughout the study. Permission was obtained from Socio-demographic Characteristics (N=220)
Institutional Ethical Committee to carry out the study.
Socio-demographic characteristics f (%)
Written permission was also obtained from various
Civil Surgeons, Medical Supdt. or Director of the Age in Years Mean (SD) 32.42 (7.59)
Age in Category 21-30 yrs 120 (54.5)
respective hospitals before data collection.
>30-40 yrs 61(27.7)
Statistical Methods >40-50yrs 36 (16.4)
>50 yrs 3(1.4)
The data was analyzed by Statistical Package Gender Male 11 (5)
for Social Sciences (SPSS) version 21. The nurse p Female 209 (95)
< 0.05 was established as a criterion of statistical Marital Status Married 141 (64.1)
significance for all the statistical procedures Unmarried/Single    67 (30.4)
Divorced/widow/Sep 12 (5.5)
performed. Appropriate descriptive and inferential Religion Hindu 57 (25.9)
statistics were employed to analyze data as per Christian 16 (7.3)
objectives of the study. Frequency and percentage Sikh 147 (66.8)
distribution of sample characteristics was computed. Area of residence Rural 71 (32.3)
Urban 149 (67.7)
Mean (SD) of assertive behavior and stress of the
Type of family Nuclear family 149 (67.7)
nurses was calculated. Correlation between Joint family 71 (32.3)
assertive behavior and stress was determined by Presently you are With family/ 157 (71.4)
Carl Pearson’s method. ANOVA and t-test were staying member(s)
used to determine the relationship of selected socio- With friends 42 (19.1)
Alone 21 (9.5)
demographic characteristics with assertive behavior Monthly self Mean (SD) 26345.45
and stress score. income (Rs) (10236.64)
Results Table 2: Distribution of Subjects as per
Socio-demographic characteristics Professional Characteristics (N=220)
As shown in table 1, the mean age of the Professional characteristics f (%)
subjects was 32.42 (SD + 7.59) years and little over
Qualification GN M 122 (55.5)
half (54.5%) was in the 21-30 years age group GNM with 1 yr 5 (2.3)
category. Maximum of the subjects were female diploma
(95%), married (64.1%) and belong to Sikh religion B.Sc.Nursing/PB BSc 86 (39.1)
(66.8%). Two third of the subjects (67.7%) were PG or above (in nursing) 7 (3.2)
residing in rural area where as same number of Joined nursing as Voluntarily 117 (53.2)
subjects belong to nuclear family. Majority (71.4%) professional carrier By force of parents/friends 103 (46.8)
of the subjects were presently staying with their Type of nursing Govt. 119 (54.1)
family members. Mean monthly income of the school/college from Private 101 (45.9)
subjects was Rs. 26345.45 (SD + 10236.64). where trained
nursing
Professional characteristics Experience in Mean (SD) 8.58 (7.54)
As shown in table 2, half of the subjects were nursing (yrs)
qualified up to GNM. Half of the subjects (53.2%) Designation Staff nurse 188 (85.5)
PHN 10 (4.5)
joined nursing voluntarily. A little over half studied
Nursing sister/Ward 22 (10)
basic nursing from Govt. institutions. Mean years
Incharge
of experience in nursing profession was 8.58 (7.54) Nature of job Regular 135 (61.4)
years. Maximum of the subjects (85.5%) had staff Contractual 85 (38.6)
nurse designation and three fifth of them (61.14%) Type of hospital Govt 185 (84.1)
were working on regular basis. Majority of the Private 35 (15.9)
subjects (84.1%) were working in Govt hospital. Area of work General ward 110 (50)
Half of the subjects (50%) were working in general (ward) Intensive ward 80 (36.4)
ward. OPD 30 (13.6)
Delhi Psychiatry Journal 2015; 18:(2) © Delhi Psychiatric Society 359
DELHI PSYCHIATRY JOURNAL Vol. 18 No. 2 OCTOBER 2015

Table-3. Mean (SD) score of assertive behavior and stress and their correlation (N=200)
Variable Range Mean (SD) df r p value
Assertive behaviour -36 to 14 -10.76 (8.69) 199 -0.720** .01
Stress 16-38 30.92 (4.65)
** correlation is significant at the 0.01 level( 2 tailed), 0.7-0.9 indicates very large correlation.

Table 3 states that the mean (SD) of assertive

behavior is -10.76 (8.69) and it range from -36 to
14. Similarly, mean (SD) of stress is 30.92 (4.65)
and it range from 16 to 38. The correlation between
assertive behavior and stress was calculated with
Pearson’s product moment correlation and it was
found that assertive behavior has large negative
correlation with stress at 0.01 level of significance
(r= -0.72**), indicating that as the assertive behavior
increased, stress level goes decreased. (Figure 1)
As shown in table 4, subjects who were in age Figure 1: Correlation between Assertive behavior and
group of >50 yrs were more assertive as compared Stress
to subjects who were younger (p<.001). Gender,
Table 5 shows that nurses who studied nursing
marital status, religion, residence, type of family and
from Govt. nursing schools/colleges were more
present staying with has no relationship with
assertive than private schools/colleges (p<.001).
assertive behavior.
Subjects working on regular basis were more
Table 4: Relationship of selected socio-demographic characteristics with assertive behaviour
score (N=220)
Socio-demographic characteristics N Mean SD t/F df p value

Age in Years 21-30 yrs 120 -12.72 7.65

>30-40 yrs 61 -11.95 8.20
>40-50yrs 36 -2.81 8.20 15.8 3 .000**
>50 yrs 3 -3.67 10.21

Gender Male 11 -12.36 3.6 -.628 218 .531

Female 209 -10.67 8.8

Marital Status Married 141 -10.11 8.97

Unmarried/Single    67 -12.42 8.05 1.835 2 .162
Divorced/widow/Sep 12 -9.17 8.05

Religion Hindu 57 -11.49 8.77

Christian 16 -7.50 7.55 1.337 2 .265
Sikh 147 -10.83 8.74

Area of residence Rural 71 -11.01 7.6 -.30 218 .765

Urban 149 -10.64 9.18

Type of family Nuclear family 149 -10.06 9.22 1.73 218 .084
Joint family 71 -12.23 7.29

Present stay with With family/family member(s) 157 -9.95 9.16 3.029 2 .050
With friends 42 -13.62 7.50
Alone 21 -11.10 5.86

** significant at 0.01 level

360 Delhi Psychiatry Journal 2015; 18:(2) © Delhi Psychiatric Society

OCTOBER 2015 DELHI PSYCHIATRY JOURNAL Vol. 18 No. 2

Table 5: Relationship of selected professional characteristics with assertive behaviour score

(N=220)
Professional characteristics N Mean SD t/F Df p value

Qualification GN M 122 -11.72 9.22 1.788 3 .15

GNM with additional one year diploma 5 -6.2 7.12
B. Sc. Nursing (including Post basic) 86 -9.47 7.87
Post graduation or above (in nursing) 7 -13.14 7.86

Joined nursing Voluntarily 117 -11.45 7.94 -1.26 218 .207

as carrier
By force of parents/ friends 103 -9.97 9.44

College of basic Govt. 119 -8.54 8.68 4.27 218 .001**

nursing education Private 101 -13.38 7.98

Designation Staff nurse 188 -11.22 8.22 1.965 2 .143

PHN 10 -7.00 13.22
Nursing sister / Ward Incharge 22 -8.50 9.81

Nature of job Regular 135 -7.97 7.5 6.54 218 .001**

Contractual 85 -15.19 8.64

Type of hospital Govt 185 -9.15 7.82 6.989 218 .001**

Private 35 -19.29 8.16

Area of work General ward 110 -11.02 8.62 2.011 2 .136

(ward) Intensive ward 80 -11.49 8.58
OPD 30 -7.87 8.94

** significant at 0.01 level

Table 6: Relationship of selected socio-demographic characteristics with stress score (N=220)

Socio-demographic characteristics N Mean SD t/F df p value

Age in Years 21-30 yrs 120 31.79 3.93

>30-40 yrs 61 31.54 3.72
>40-50yrs 36 27.28 6.28 11.221 3 .000**
>50 yrs 3 27.00 5.00

Gender Male 11 32.55 2.21 1.192 218 .235

Female 209 30.83 4.73

Marital Status Married 141 30.77 4.86

Unmarried/Single    67 31.33 4.17 .422 2 .656
Divorced/widow/Sep 12 30.33 4.87

Religion Hindu 57 31.54 4.35

Christian 16 30.25 4.36 .778 2 .461
Sikh 147 30.75 4.80

Area of residence Rural 71 31.49 3.79 1.267 218 .206

Urban 149 30.64 4.99

Type of family Nuclear family 149 30.58 5.12 -1.581 218 .115
Joint family 71 31.63 3.38

Presently you are With family/family member(s) 157 30.52 4.73 2.089 2 .126
staying With friends 42 32.07 4.54
Alone 21 31.57 3.97

** significant at 0.01 level

Delhi Psychiatry Journal 2015; 18:(2) © Delhi Psychiatric Society 361

DELHI PSYCHIATRY JOURNAL Vol. 18 No. 2 OCTOBER 2015

assertive than contractual nurses (p<.001). Nurses relationship with assertiveness. Lee Jong-Sun et al
working in Govt. hospitals were more assertive than (2013)23 investigated the impact of perceived stress
private hospitals (p < .001). and self-esteem on work-related stress and
Qualification, joined nursing as professional depression and found that work-related stress was
carrier, designation/position and present area of work positively associated with depression. Perceived
(ward) has no relationship with assertive behavior. stress was inversely related to self-esteem and
As shown in table 6, nurse who were in older positively associated with work-related stress and
age group had less scores on stress as compared to depression, respectively. Self-esteem was negatively
nurses who were younger (p < .001). associated with work-related stress and depression.
As shown in table 7, nurses who joined nursing Pawar Manisha N(2014)24 reported that majority
as carrier by force of parents had more score on (42%) of the nurses had severe stress at workplace
perceived stress as compared to those who joined and highly significant association was found between
nursing voluntarily (p < .035). Nurses who took the level of stress and the demographic variables.
training of nursing from Govt. nursing schools/ Madu S N, Mamomane J (2003)25 examined
colleges had less score on stress as compared to the levels of stress among nurses and reported higher
private schools/colleges (p < .001). Nurses working levels of work-related stress. Study concluded the
on contractual basis had more stress as compared need of stress management program to reduce work-
to regular (p < .001). Nurses working in Govt. related sources of stress. Van Servellen G, Topf M,
hospitals had low stress score as compared to private Leake B (1994)26 found that work-related stress
hospital (p < .002). and emotional exhaustion were associated with

Table-7. Relationship of selected professional characteristics with stress score (N=220)

Professional characteristics N Mean SD t/F df p value

Qualification GN M 122 31.16 4.57 1.205 3 .309

GNM with additional one year diploma 5 31.60 2.79
B.Sc. Nursing (including Post basic) 86 30.34 4.82
Post graduation or above (in nursing) 7 33.29 4.57
Joined nursing as Voluntarily 117 31.54 4.48 2.126 218 .035*
carrier By force of parents/ friends 103 30.21 4.75
College of basic Govt. 119 29.97 4.91 -3.342 218 .001**
nursing education Private 101 32.03 4.07
Designation Staff nurse 188 31.14 4.51 2.196 2 .114
PHN 10 28.2 5.83
Nursing sister / Ward Incharge 22 30.23 5.05
Nature of job Regular 135 30.04 4.96 -3.608 218 .000**
Contractual 85 32.31 3.73
Type of hospital Govt 185 30.51 4.86 3.065 218 .002**
Private 35 33.09 2.33
Area of work General ward 110 30.89 4.78 .485 2 .616
(ward) Intensive ward 80 31.21 4.48
OPD 30 30.23 4.70

** significant at 0.01 level

Discussion greater health problems in the form of anxiety,

The present study is an attempt to understand depression, and somatic complaints among hospital
the relationship of assertive behavior with stress nurses. Lee and Crockett (1994)27 reported that
among nurses. Result revealed that there is large assertiveness training is effective in treating self
negative significant relationship between assertive perceived levels of stress and sub assertive
behaviour and stress and non-assertive nurses are behaviour among nurses in Taiwan. Tavakoli Shedeh
highly stressed. This is in consistent with previous et al (2009) 28 conducted a study to check the
research which reports that stress has negative effectiveness of assertiveness training and
362 Delhi Psychiatry Journal 2015; 18:(2) © Delhi Psychiatric Society
OCTOBER 2015 DELHI PSYCHIATRY JOURNAL Vol. 18 No. 2

expressive writing on acculturative stress in to the understanding of assertiveness. Findings of

international students. The results indicated that the study will act as a catalyst to carry out more
group assertiveness training improves emotional extensive research in a larger sample and in other
adjustment of international students, but expressive settings and such research work enforce evidence
writing has mixed effects and needs further based practice.
development and study. Study recommends that assertiveness training
The possible reason for negative relationship and other such techniques may be given to the non
between assertive behavior and stress may be that assertive nurses to build their self concept and to
assertive persons are likely to experience a higher reduce their stress and improve coping. A longitudinal
level of psychological well being and a lower level study may be conducted on large sample to assess
of emotional deficit. Assertive persons are able to the effects of assertive training on assertive
maintain positive mental states due to their capability behaviour and stress.
to efficiently manage their situations and ability to Conclusion
say ‘no’ to undesired work.7 When a person accepts
his/ her faults and simultaneously recognizes his/ The findings of the present investigation suggest
her strengths and positive qualities, the person will that assertive behaviour and stress has a significant
experience strong self worth and low stress. and strong negative correlation. Nurses should be
Present study revealed that older nurses who regularly assessed for their assertive behaviour as
are on regular job, studied from Govt. nursing it affects the stress, burden and coping. Assertive-
institutions and working in Govt. hospitals were more ness training may be included in curriculum to
assertive where as gender, marital status, religion, inculcate assertive behaviour in nurses.
residence, type of family and present staying with Further research needs to be done to investigate
has no relationship with assertive behavior. On the the socio-cultural circumstances that may hinder or
contrary, Kilkus8 reported younger nurses as the enhance individuals assertive behaviour.
most assertive. Limitations
Nurse who were in older age group had less Data were collected from selected hospitals of
stress as compared to nurses who were younger (p four districts of Punjab. The data in the present study
< .001). Nurses who joined nursing as carrier by may be subject to selection bias as the nurses were
force of parents had more stress as compared to conveniently selected. In order to make findings
those who joined nursing voluntarily (p < .035). generalizable, a large geographical area based study
Nurses who took training of nursing from Govt. based on random sampling technique is
nursing schools/colleges had less stress as compared recommended to assess assertive behaviour and
to private schools/colleges (p < .001). Nurses stress. Finally, researcher acknowledge the limitation
working on contractual basis had more stress as of cross sectional design with respect to temporal
compared to regular basis (p < .001). Nurses relationship and imputation of causality of study
working in Govt. hospitals had low stress as findings.
compared to private hospital (p < .002). These
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