CHAPTER-2

LITERATURE REVIEW

Review of related literature is important for all researches. It helps in clearly defining
the problem, setting objectives for the study, formulating hypotheses to test the data,
selecting appropriate research design and sample size, framing the research
methodology to outline the research and interpreting the results in the light of the
previous researches. Some of the literature works reviewed for this study are:

Hans Selye (1956) categorised stress in 4 types, in his study, viz., distress (Bad-stress)
events which are unproductive and destructive in nature, eustress (Good Stress)
productivity enhancing events, hyper stress (over stress) uncontrolled, intolerable and
excessive stress, and hypo-stress (under Stress) very low level of stress.

Holmes and Rahe (1967) constructed a Social Readjustment Rating Scale (SRRS) that
assesses an individual‘s levels of stress exposure. The stress level is assessed by
assigning weights to life events of a person on the basis of the required changes and
readjustments on part of the individual.

Allen I. Kraut (1975) concluded in his study that employee‘s expressed intent is better
at predicting his turnover intentions than other job attitudes. He surveyed 911 salesmen
to study whether the employee‘s turnover or retention intentions for a company can be
predicted on the basis of employee job attitudes. According to the survey, actual
turnover rate of men with retention intentions was 9%, while of those with turnover
intentions was 30% in the period of 18 months. The correlations showed that,
employees‘ feelings about the work and the company as a place to work were main
reasons behind their willingness to stay with the organisation.

Beehr and Newman (1978) defined job stress as conditions which arise from the
interaction between people and jobs and is characterised by changes occurring in
people that hinders their normal functioning.

Sen (1981) studied stress in relation with demographic characteristics of employees. He

found out that stress decreased with increasing age and women were more stressed then
men. He also found out that employees in low income group or unmarried employees

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were under more stress. Large distance between home and work place and family size
were also responsible for higher levels of stress among employees.

Lazarus and Folkman (1984) through their transactional model of stress and coping
stated that stress development is a process of four stages, and according to them the
perception about the stressor (stress causing factor) is the most important part. The first
stage is primary appraisal in which, individual‘s knowledge about himself and the event
determine whether he or she is in stress, based upon his previous experiences. Second
stage is secondary appraisal in which, stress increases if the stressor is perceived
harmful or has already caused damage. In third stage of coping, an individual assesses
the stress management options available to him or her based upon the understanding of
secondary appraisal. And finally reappraisal occurs to ensure that the original stressor is
negated.

Sethi and Schuler (1984) outlined four major reasons in their study regarding job
stress and coping with job stress becoming important issues. Those were individual
employees‘ wellbeing, financial effects on organization, legal obligations of
organizations and effectiveness of organization.

Johnson et al. (1986) conducted study on how stress levels differ across different
sectors or industries. They found out that though all jobs had their own kinds of
stressors, the six jobs that had highest levels of stress were ambulance workers,
educators, social service providers, customer care and call centre executives, prison
guards and police officers. These scored minimum on physical heath, psychological
health and job satisfaction because of high level of emotional and human involvement.

Edward et al. (1987) studied the relationships between role stressors, physical
symptomatology and turnover intentions. They examined them through three
alternative specifications, viz., Beehr and Newman's study of employee health (1978),
role stress models by Schuler (1982) and theory of job satisfaction by Locke (1976).
They used LISREL VI analysis to get results that indicated that the most suitable
method to understand role stress and employee withdrawal is the revised Schuler
model.

Everly and Benson (1989) found that over stress exerts employee‘s body and causes
damage to the body. When body parts and important body systems, viz., the muscular

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system, endocrine system, immune system, cardiovascular system, nervous systems,
digestive systems, etc.; are worked for long time periods without breaks for rest and
relaxation, these body parts and systems started to malfunction and ultimately broke
down. The relationship between stress and physical disease existed because of stress‘s
impact on these body systems. According to them, stress causes psychological issues
too such as anxiety, burnout, sleep disorders, mood disorders, etc.

Karasek and Theorell (1990) stated that psychosocial stressors in the work
environment and the interaction of these stressors may have harmful effects for an
individual as well as organisation.

Cary Cherniss (1992) noted that burnout affected employee‘s performance. The study
measured the effects of burnout experienced in the early and later stages of jobs on
employees working as human service professionals in a period of 12 years. According
to the findings, burnout experienced in the early career stages had relatively less
significant negative impact on employees than burnout occurring in later stages of job
which can lead to career change among employees. The study cited that burnout
symptoms like inadequate concern for clients, no attachments with clients, tendency for
ill-treatment to clients, feeling discouragement, pessimism and fatalism about work,
etc. affected employee‘s performance. It also interpreted that lack of motivation and
involvement in work was felt by the individuals going through burnout.

Francene Sussner Rodgers (1992) conducted a study with a sample of employees

from Fortune 500 companies; and stated that, almost one third of men and half of the
women reported negative effects of work-family imbalance on their concentration
abilities at work. Life at work seemed much harder for women as compared to their
male counterparts.

Pestonjee (1992) stated that work stress progresses through a five step process, first
being honeymoon, i.e., starting a new job is exciting and challenging but employee
needs to cope and adapt to the new environment. Second was full throttle, when
employee gradually starts feeling lost, fatigued, confused, dissatisfied, sleep
disturbances, behavioural changes, etc. Third was chronic symptom, where
physiological symptoms like, mental and physical exhaustion and illness, anger,
depression, etc. Then came crisis, where the employee starts feeling oppressed,

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backaches, headaches, high blood pressure, sleep disorders, ulcers, asthma, etc. and the
last one was hitting the wall where an employee under constant stress along with its
physical and mental impact suffers from Burn out Stress Syndrome (BOSS) and reach
the end of his professional career. While on the other end Rust-Out Stress Syndrome
(ROSS) may occur due to very low levels of stress.

Ronald J. Burke (1993) studied the relationships between work satisfaction and
physical and emotional wellness of employees. According to the study, work stressors
and psychological burnout share significant relationship with emotional and physical
well being and self reported work attitudes of employees while work family conflict
and individual stress coping shared no such significant relationship with the same. The
study indicated that different studies classify occupational stress differently as work
environment, role stressors, organization‘s structure, job features, organizational
relationships, career planning and development, and work-family conflicts.

Cluskey (1994) conducted a survey with management accountants and examined stress
and job strain relations. The study concluded that main reasons behind stress among
employees were unclear authority-responsibility relationships, excessive workload with
time restraints, strained relations at work place and lack of career planning and
development. An additional source of stress reported in the study was a mismatch
between employee‘s personality and his job demands.

Chand and Sethi (1997) conducted a study to examine the job related stressors among
150 banking junior officers in the state of Himachal Pradesh. The most significant job
related stressors came out to be role conflict and overload and strenuous working
conditions according to the study.

Bosma et al. (1997) studied the effects of job autonomy and control on probability of
having heart diseases among civil employees. The risk of having a heart disease
decreased with increase in job control and autonomy. Also the probabilities varied
between men and women based on job duration, employment level, type of disease, life
style choices, etc. It was also found out that moving an employee from high job control
position to low job control position caused sudden increase in aforesaid risk.

Sehgal (1997) studied the effects of role stress on the employee involvement or
alienation with job as well as the stress coping mechanism. It was found that role

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erosion and distance as well as resource deficiency were important reasons behind role
stress. According to the study avoidance style of coping was preferred and used more
frequently over other styles of coping by employees.

A. M. Williams (1998) studied the quality of care from nurses‘ perspectives and found
out that nurses perceived quality of care on the basis of degree to which patients‘
physical and psychosocial care needs along with extra care needs were met. According
to the study, quality nurse care acted in therapeutic effectiveness due to positive nurse-
patient relationships, positive nursing attributes and a well functioning nursing team.
Time shortages, lack of resources and stress and dissatisfaction among nurses were
found to be the reasons behind poor quality of care delivery and process of selective
focusing was used by nurses to deal with it.

Tai et al. (1998) stated that turnover intentions and turnover are difficult measures to
compute due to irregularities and inconsistencies in the record keeping methods across
various healthcare systems. There is no one standardized method of keeping records on
nursing turnover thereby making finding reasons and comparisons difficult in various
health organizations, which makes it difficult to generalize those results across various
studies.

Geurts, Rutte and Peeters (1999) studied antecedents and consequences of work
home interference (WHI) and found out that one home to work characteristic,
frequently over timing spouse, and three work to home characteristics, poor work
schedule, high work overload and too much dependence on superiors, pressurize WHI.
Furthermore, the WHI was found to have positive and significant association with
emotional exhaustion, sleeping disorders, depersonalization and psychosomatic health
problems. They concluded that WHI works as a moderator and mediates the impact of
work-home characteristics on employees‘ general, work related and psychosomatic
health.

Callaghan, Tak-Ying and Wyatt (2000) studied the factors regarding stress and
coping with stress among nursing professionals along with the impact of demographical
characteristics on stress conditions of nurses. They found out that paediatric nurses
went through highest level of stress. Also nurses at lower levels, single nurses and
female nurses reported higher stress levels than their counter parts. None of the

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relationships were found statistically significant except for stress and sickness
relationship. They concluded that the major reasons behind nursing stress were work
overload, organizational relationships and managerial support and most preferred stress
coping strategies were friends and peer support, implementing cognitive strategies and
enjoying leisure activities.

Cox, Griffiths and Rial-Gonzalez (2000) studied the impact of work and family
conflict among nurses. They concluded that 56% of nurses felt like work and life
dimensions interfere with each other. According to them the irregular hours in nursing
profession was the major factor interfering with their personal and family lives
disturbing their family events and routines, household chores, responsible for mood
swings, interfered with social life, and left no or little time for leisure activities.

Spector and Goh (2001) examined the impact of negative emotions on occupational
stress, by using ―any condition or situation that elicits a negative emotional response,
such as anger / frustration or anxiety / tension‖ definition of job stress to keep the focus
on only the negative emotional responses. They interpreted that emotions influence
employee‘s perceptions regarding work environment and conditions and negative
emotions put psychological and physical strains, decrease job satisfaction and
organizational commitment, cause heart disease and adverse health effects, etc. They
concluded that outcomes of stress are influenced by an employee‘s ability to manage
and control his/her negative emotions.

Kivimaki et al. (2002) revealed that those with high levels of stress at work had higher
mortality rates due to increased cardiovascular risks compared to those with low levels
of stress at work. Factors causing stress are age, job position and control, poor lifestyle
choices, perceived inequality at work, health issues, etc. The mortality rates were found
very high when linkages between high job strain, low job control and high effort
reward imbalance among employees were studied.

Slaski and Cartwright (2002) studied the relationships between emotional quotient,
health, work life quality, bad stress, managerial performance, retail managers‘ morale
and subjective stress. Study indicated that managers with higher emotional scores
suffered less from subjective stress showed better managerial performance and

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experienced better health and well-being supported by significant correlations in the
expected direction.

Escriba-Aguir and Bernabe-Munoz (2002) studied the causes of stress among

medical staff and found out that the main causes of stress among medical staff were
dealing with suffering and death of patients on regular basis and feeling responsible for
saving life. While some other work stressors include organizational relationships,
excessive workload and lack of staff, the possibility of lawsuit for malpractice,
uncertainty about diagnosis and treatment, and communicating bad news.

Holtom and O’Neill (2004) concluded that job embeddedness plays a significant role
in reducing turnover intentions and actual turnover among employees. Job
embeddedness includes all the reasons and benefits combined, that make an employee
stay in a job, and being embedded was connected with intent to stay in the organisation
by the study.

Tyson and Pongruengphant (2004) conducted a comparative study on occupational

stress, coping mechanisms and job satisfaction between public and private hospital
nurses and found out that nurses had significant increases in work load, life and death
encounters and demands to perform tasks out of capability zone in the span of five
years. They also concluded that public hospital nurses endure higher levels of stress
than private hospitals but they also have increased levels of job satisfaction due to
increase in experience, monetary compensation and organizational support in public
hospitals.

Reisner (2004) conducted a study among nursing professionals regarding the duration
of time the employees felt under stress while working as nurse. The study found out
that almost all the nursing professionals experienced stress and got affected by it, which
may be for longer, medium or shorter time durations and even one-time experience, but
they all experienced stress.

Jamal (2005) stated in his study that work stress is the result of a dynamic interaction
between employees and their work environment. Job stress in the study is defined as an
individual‘s reaction to his work environment situations that seem threatening both
emotionally and physically.

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Albion, Fogarty and Machin (2005) conducted a study among various health workers
and found out that nurses had low morale and job satisfaction levels and were highly
distressed. Nurses working in large hospitals reported higher levels of stress due to
excessive demands from work, poor appraisal and recognition practices. High levels of
distress at work place and poor leadership and support were more responsible for stress
among mental health nurses than work load. The nurses reported high turnover
intentions and low quality of work life in the study.

Elfering, Semmer and Grebner (2006) studied the link between nursing stress and
patient safety incidents (occurring more than once) and found out that nurses have to
face many stressful events on a daily basis and a sizeable number of these events are
about patients‘ safety. The most stressful safety related incidents were found out to be
documentation mistakes, wrong medications, care delays and patient violence.
Increased probability of recurrence of safety incidents was attributed to time pressures,
low control over job and concentration issues among nurses. According to the study,
low job control, time crunch and job stress are most likely to risk patients‘ safety and
some initiatives to reduce job stress and increase job control are suggested in the study
to improve patient safety in hospitals.

Chandola, Brunner and Marmot (2006) studied the relationship between chronic
work stress and metabolic syndrome (having a heart disease) over a period of 14 years.
They based their study on three factors obesity, cholesterol and blood pressure.
According to their study, the probability of having the syndrome varied by age, sex and
employment grades. They found out that women were more exposed to risk (5 times)
then Men (2 times), with increasing age and higher job grades. Men were more exposed
to risk then women when they made bad health choices.

Bakker and Demerouti (2007) studied both the positive and negative effects of job
demands-resources model on different jobs, where demands included factors like work
stress, role ambiguity, social needs etc. and resources included factors like family
support, performance appraisals, role clarity, etc. It was found out that if job resources
were high, high motivation was there even for high job demands or work pressure;
while low job resources resulted in low motivation for high demanding or stressful
jobs.

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Coomber and Barriball (2007) stated that job stress and effective leadership had
significant impact on employees‘ job satisfaction and turnover intentions among
employees but education level and salary level did not seem to have that significant
impact, consistently in their study. Also, the results varied with changing work
scenarios and job positions.

Papageorgiou et al. (2007) stated that nursing profession is one of the most vulnerable
professions with respect to occupational stress due to high and special job demands
connected with the profession. They also stated that the number of stressors and stress
producing factors have increased significantly for the nursing profession in the last two
decades.

Zaghloul, Al-Hussaini and Al-Bassam (2008) studied the relationship between

nurses‘ satisfaction dimensions and their intentions to stay and found out that hospital‘s
benefits, policies, paid vacations, bonus, performance appraisal systems and reward and
recognition were the least contributing factors towards nursing satisfaction. They
concluded that nurses‘ intentions to stay can be predicted by measures other than salary
and monetary benefits. According to the study, the intentions to stay can be best
predicted by style of leadership and presence of challenging opportunities in the
organization.

Ongori and Agolla (2008) in their research study conducted in Botswana, revealed that
the major stressors among employees were uncertain future, work overload, lack of
resources, communication gaps and internal conflicts in the organisation. They also
found out that these stressors adversely affected employee retention, organizational
efficiency, motivation levels and revenues in the form of health care cost which in turn
negatively affected the overall organisational performance.

Moon Fai Chan et al. (2009) conducted a study to determine the factors that influence
turnover intentions among nursing staff. According to them, a large portion (39%) of
the nursing work force had high intentions to leave which can be significantly predicted
through their age, tenure, job satisfaction, and work place. They suggested framing and
implementing strategies to boost communication, enhance satisfaction and strengthen
organizational commitment among nurses.

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Nirmanmoh Bhatia et al. (2010) studied stress among nursing staff in Delhi and found
out that 87.4% of nurses were working under stress with time pressure as the most and
discrimination as the least important factors causing stress. Other sources of stress were
striving for work life balance, skill gaps, continuous learning and poor nurse patient
ratio while supervisor support did not contribute much in adding stress. They suggested
introducing stress reduction and management programmes focussing on important
stress causing factors to reduce stress among nurses.

Khairunneezam Mohd Noor (2011) studied the relationship between satisfaction with
work life balance and turnover intentions with job satisfaction and organizational
commitment acting as mediators. They found out that WLB satisfaction and turnover
intentions were negatively correlated and job satisfaction and organizational
commitment acted as partial mediators between them.

Maritta Kinnunen-Amoroso (2011) studied the experience of physicians and nurses

regarding job stress and its management and found out that the nurses‘ and physicians‘
found it hard to handle stress according to their experiences. They found out that there
was no particular direction or technique followed for stress management and reduction
and that most of the stress management activities were randomly selected and focussed
on individual level of stress management than on organizational level. They suggested
that the stress management activities should be directed at both individual and
organizational level and that the nurses‘, physicians‘ and psychologists‘ roles should be
further clarified for effective stress management.

Buffington et al. (2012) conducted a study on nursing employee retention. They found
out that there was no significant impact of age or years of experience on nurse
respondent‘s perceptions of work environment, support, encouragement, etc. but
significant differences were observed in job satisfaction, mentorship and educational
support based on different work settings (hospital or ambulance). They reported that
feeling lack of support and recognition from superiors was the major cause of stress
among nursing employees.

Lakshmi, Ramachandran and Boohene (2012) conducted a study on women nurses

working in government and private hospitals regarding their work life balance and the
related factors. According to them, both govt. and private hospital nurses suffer from

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work life balance issues and the hospitals need to address these issues and also support
them in attaining and maintaining work life balance, which will help in improving
performance. They also suggested hospitals to conduct periodical reviews regarding
work life balance and personal life satisfaction of employees, as avoiding it may land
them under severe stress conditions.

Musyoka, Ogutu and Awino (2012) studied the positive impact of employee stress
(work stress) on organisational performance and stress manifestations (psychological,
physiological and behavioural changes) among employees. They revealed that if work
stress is kept at appropriate levels and managed properly, a positive relationship can be
established between stress and organisational performance, while non-work stress had
almost negligible impact on performance. Also, stress significantly impacted stress
manifestations, with major psychological changes being observed among employees
along with some behavioural changes and almost insignificant physical changes.

Lai and Chen (2012) used SEM with LISREL for data analysis in their study and
revealed that self-efficacy and efforts had positive impact on Job performance and
satisfaction which thereby reduced turnover intentions among employees, because of
negative relation with job satisfaction.

Diabelle Joy Macadangdang Pazcoguin (2013) identified the factors responsible for
employee turnover from the organisation. The study indicated that the factors
contributing highest towards employee turnover were compensation, followed by career
development.

Delina and Raya (2013) studied the factors affecting the work-life balance of married
women in health, academic and IT sectors and the challenges faced by them in
maintaining this balance. It was found that most married women were stressed
irrespective of the sector, age group, family size or partner‘s profession and that IT
professionals and women married to businessmen faced more difficulties in
maintaining work-life balance, then others. It was also found out that the work-life
balance improved with increase in age of working women and that work life balance
affected quality of life, happiness and life satisfaction among employees.

Du Plooy and Roodt (2013) conducted a study regarding prediction of turnover

intentions among employees with demographical and biographical variables acting as

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moderators. The demographical variables included were gender, age, race, education,
marriage, job level and geographical region. According to the findings of the study
marital status, age and race of employees had significant moderating effects on
turnover intentions predictions among them.

Malgorzata Kluczyk (2013) conducted a study in Ireland and concluded that work-life
imbalance has negative impact on work, family as well as psychological health of
employees due to work-life conflicts. The work-life conflicts also reduced job
satisfaction and organizational commitment among employees and resulted in
increasing stress, unhappiness and lack of confidence among employees. However any
negative relationships between family work conflicts and job satisfaction and
psychological health were not confirmed by the study and thus were not supported.

Arshadi and Damiri (2013) studied the relationship between stress and turnover
intentions as well as stress and employee performance with OBSE (Organisation Based
Self-Esteem) acting as a moderator. They found out that stress was negatively related
to performance and positively related to turnover intentions among employees; i.e., if
job stress increased, employees performance decreased while their turnover intentions
increased and vice-a-versa.

Chimote and Srivastava (2013) conducted a study to depict the benefits of healthy
work life balance from the perspectives of both the employees and the organization.
According to the study, reduced absenteeism and turnover intentions, enhanced
productivity and loyalty, improved organizational image and increased employee
retention are the benefits reaped through work life balance from organization‘s
perspective. While from individual perspective, the benefits from work life balance are
increased job autonomy, security and satisfaction, reduced stress and improved health.
No significant correlation was found between both the perspectives in the study.

Meenakshi and Subrahmanyam (2013) stated that the number of men facing work-
life balance problems is increasing and the generalisation that work-life balance is
woman‘s only issue is losing its grounding, although women still are more impacted by
work-life imbalance compared to men. According to them imbalance in work and life
leads to dissatisfying life, unhappiness, physical and mental illness, etc. They suggested
that organisations can train, coach and educate their employees regarding work-life

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balance, provide managerial support, design and implement WLB programs, provide
work location and time flexibility, etc. while the employees can use time management,
good organisation, friendly attitudes, stress coping skills, hobbies, etc. to maintain a
healthy balance in work and life. They stated that work-life balance impacts
employee‘s recruitment, retention/turnover, absenteeism, productivity, accident rates,
commitment and satisfaction, etc.

Yoon and Kim (2013) studied the relationships between job stress, emotional labour
and symptoms of depression among nurses in Korea to give suggestions regarding
stress management, stress prevention and stress reduction. According to the findings,
38% of nurses displayed symptoms of depression, with young and single nurses
showing high levels of the same. They concluded that job related stress triggered
strongly related depression symptoms regarding marriage, surface acting, job security
and rewards among nurses. They suggested creating nursing programs that will help in
reducing surface acting and controlling stress, thereby preventing depressive symptoms
development.

Abdollahi et al. (2014) studied the relationship between perceived stress and happiness
with the mediating role of hardiness among nurses and found out that hardiness acted
as partial mediator between happiness and perceived stress and that nurses with lower
levels of stress reported higher levels of hardiness and happiness. They found out that
nurses with hardi-attitudes perceive the situations as less stressful and therefore
experience higher levels of happiness. The study revealed that hardiness acts as a
cushion against perceived stress and facilitates happiness among nurses. They
suggested the findings to be useful for future training of nurses, as by imparting
hardiness training, the nurses‘ ability regarding stress management and happiness
among nurses can be enhanced.

Kumari, Joshi and Pandey (2014) conducted a study to find out the stressors and their
impact on employees and came up with the findings that work environment supervision
and work load were the major stressors among employees. 66% of the employees in the
age group of 20-29, felt impact of stress on their body; i.e., hyper-tension, headaches,
coronary diseases, etc.; and the percentage increased with increasing age, being approx.
93% for those above 40 years of age. The stress on mind; i.e. depression, mood swings,

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lack of self-confidence, etc.; ranged from approx. 80% for 20-29 age group to approx.
93% for 35-39 age group. Majority of the employees felt constantly under pressure,
imbalance in work and life, frustrated, depressed and unable to concentrate on work.

Jeroen trybou et al. (2014) conducted a study regarding relationship between job-
related stress and sickness absence among nurses and how DCS (Demand-Control-
Support) model, ERI-OC (Effort Reward Imbalance-Over Commitment) model or a
combination of both models help in predicting the relationship. According to the study,
long term and frequent sickness absence increases due to the nurses‘ perception of job
stress and ERI, while short term, long term and frequent sickness absence increases due
to Iso-strain and ERI-OC. They concluded that the combined model of DCS and ERI-
OC helps in predicting short term, long term and frequent sickness absence.

Chou, Yi Li and Hu (2014) carried a study on stress and burnout among different
hospital employees and interpreted that among the five medical professions, the highest
work-related burnout was among nurses (66%), then physician assistants (61.8%), then
physicians (38.6%), then administrative staff (36.1%) with the lowest being among
medical technicians (31.9%), respectively. Hierarchical regression analysis used by
them indicated that most of the variance (32.6%) was explained by job strain, over
commitment and low social support.

Kotteeswari and Tameem Sharief (2014) in their research study found out the factors
that cause stress to employees and the stress coping strategies considered effective in
reducing stress, at organisational as well as individual level. According to their
findings, majority of employees, irrespective of their age and gender, agreed with job
stress negatively impacting their performance and various stress coping strategies on
the organisational level; i.e., organisational structure, work culture, career management,
stress control workshops, etc.; as well as on individual level; i.e., exercise, relaxation,
therapies, socialisation, etc.; help in overcoming the problems caused by stress.

Natasha Khamisa et al. (2015) conducted a study to identify and analyze the
relationship between job stress, satisfaction, burnout and general health of 1200 nurses
using regression analysis. According to the findings, burnout and job satisfaction had
significant association with nurses‘ mental health, performance, productivity and

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patient care quality; and security in workplace affected job satisfaction and health
among nurses.

Sahukar Madhura et al. (2014) conducted a study on the relationships between job
stress, job satisfaction and psychosomatic health of IT Professionals and found out that
job stress, job satisfaction and health are significantly correlated. They also concluded
that correlation coefficients between job satisfaction and health differed on the basis of
yoga practice, being significant for yoga practitioners and insignificant for non-yoga
practitioners.

Isabelle Bragard et al. (2015) assessed the work life quality of nurses and physicians
working in emergency department in rural areas. According to the findings, the nurses
and physicians had low satisfaction regarding their access to education, while they had
average satisfaction regarding technical resources, transfer facilities, organizational
relationships, work life balance and emergency patient access to other departments.
They also found out that rural environmental setting had an average impact on quality
of work life among nurses and physicians working in rural areas.

Kim and Windsor (2015) explored how first line nurses define resilience and how is
resilience related to work life balance among nurses. According to the study, resilience
is shaped up by factors like positive thinking, taking responsibility, flexibility and
work-life separation. Resilience and work-life balance were perceived to consist of
dynamic and reflexive processes and such perception helped nurses in shifting their
focus from negative experiences, rigidity and task centred thinking to positive
experiences, flexibility and person centred thinking. The researchers concluded that the
importance of creating and sustaining resilience through work life balance helps in
increasing nurse retention rates.

Shelly Gupta (2015) studied the relationship between job stress and female employees
in banking sector and found out that major issues were strained work relations, poor
organisational image, hostile working environment, lack of motivation and support,
poor job design, and poor career planning and development. According to her the levels
and type of stress can result in low attraction and retention and high turnover intentions
among female employees in the banking industry.

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Kaur and Asha (2015) studied the level of occupational stress across four different
professions, doctors, nurses, bankers and professors, in Rohtak of Haryana. They found
out that doctors go through the highest level of stress followed by nurses and bankers,
who have almost same levels of occupational stress. Professors go through the
minimum levels of stress among the four professions. It was also found out that
professions with work overload, long working hours and non-congenial work place
have higher levels of stress.

Mohanty and Jena (2016) concluded that both the employers and employees,
especially with dual career families, have to work together for effective integration of
work-life balance practices in the organisation. It is very important to develop such
organisational culture that values work life balance initiatives and practices regardless
of demographic profiles of employees, for progressive and futuristic organizations.

Okeke, Echo and Oboreh (2016) found in their study that family pressures,
conflicting demands of various organisational stakeholders, organisational pressures
and excessive work hours or work load were the major stressors among employees.
They further found out that work stress had significant effect on employee‘s
productivity because they were negatively related and that effective stress management
and communication can reduce stress and enhance productivity among employees.

S. Sundararajan (2016) conducted a study on the factors leading to turnover in

Service sector. He found out that the major reasons behind employee turnover were
long working hours for low salaries, high internal and external pressures, work-life
imbalance and bad working environment. He suggested that less working hours at
competitive salaries, work-life balance programs and harmonious and safe working
environment can reduce both external and internal pressures, thereby reducing stress
and turnover intentions among employees. He also suggested that the organisations can
use training programs and career development programs to increase job satisfaction and
organisational commitment among employees.

Suifan, Abdallah and Diab (2016) investigated the effects of managerial support, job
autonomy and schedule flexibility on turnover intentions among private hospital staff
with work life conflict acting as a mediator. According to the findings, managerial
support had a significant direct negative effect while job autonomy had a significant

47
indirect negative effect through mediating role of work life conflict on turnover
intentions. Schedule flexibility did not report any significant effect, direct or indirect,
while work life conflict reported a significant positive effect on turnover intentions.

Jordan, Khubchandani and Wiblishauser (2016) conducted a study to ascertain the

relationship between stress and coping abilities of nurses in a Midwestern hospital in
USA. They also studied the impact of stress and perceived coping ability of nurses on
their health and performance. They found out that nurses were unhealthy in general as
92% of nurses were under moderate to severe stress, 78% slept less than average 8
hours, 69% had no exercise routine, 63% ate less than 5 vegetables or fruits per day and
22% were binge drinking. More than 60% nurses admitted to eating junk food and
stress eating in the survey. They concluded that nurses with high stress levels and poor
coping mechanisms had poor health and high health risks. They suggested that
organizations should provide nursing health promotion programs focusing equally on
stress reduction and management and healthy stress coping skill development among
nurses.

Yoshiko Yamaguchi et al. (2016) studied and analyzed the relationship between job
control and family-work balance and their impact on nurses‘ turnover intentions
regarding their organizations and profession. According to the study, the effects of job
control and family-work variables, and the effect of these variables on turnover
intentions, differ for nurses working in hospital, nursing homes and home healthcare
settings. The strength of turnover intentions predictability of these variables was found
in the order of nurses working in hospital settings, then home care settings and then
nursing homes, respectively. They suggested that nurse retention strategies should
differ according to health care settings for better results and that the strategies should
aim at reducing work family conflict for hospital nurses, allowing time for family
responsibilities for home health care nurses and enhancing job control for nursing home
nurses.

Agha, Azmi and Irfan (2017) conducted a study to measure the impact of work life
balance on job satisfaction in Oman. The findings stated that any kind of interferences
between work and personal life have negative impact on job satisfaction, while work
and personal life enhancement have positive effects on job satisfaction.

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Lee-Peng et al. (2017) analyzed the relationship between job demands control among
nurses in Taiwan and its influence on their work life balance. According to the study,
both job demands and job control had significant relationships with work life balance
dimensions and significantly predicted the same. Increase in job demands resulted in
work and life imbalance. Job control positively impacted both the personal and work
life enhancement while also increasing both work life to personal life and personal life
to work life interferences. They suggested reducing psychological and other job
demands between career and family and maintaining job control at a particular level for
establishing healthy work life balance among nurses.

Lu et al. (2017) investigated the relationships between job satisfaction, job stress,
work–life conflict and turnover intentions. According to them, urban/rural area setting,
weekly working hours, age and type of institution significantly impacted turnover
intentions. Turnover intentions were negatively related to job satisfaction and positively
related to job stress and work– life conflict. They suggested that increasing salary,
reducing working hours, providing training and career development opportunities,
managerial support and encouragement can significantly contribute towards the
reduction of turnover intentions.

Adib-Hajbaghery, Khamechian and Alavi (2017) conducted a study on factors

influencing nurses‘ perception of job stress and found out three factors namely, nurses
perception of job stress, professional interest and choosing career over family that
affect their perception regarding job stress. Acc to the study, the nurses defined stress
as a situation where their work (quality of care) and life (personal and family) are
negatively impacted due to occupational pressures. They concluded that continuous
work pressure, low social status and relationship with managers were the major sources
of stress among nurses and suggested better logistics, improved system coordination
and cordial nurse-manager relationships as measures to reduce stress among them.

Sauer and McCoy (2017) studied the impact of bullying on nurses‘ health and
concluded that higher number of bullying incidents resulted in lower physical and
mental health scores among nurses. According to the study, bullied nurses have poor
mental and physical health which negatively impacts their quality of life and patient
care delivery.

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Xiaorong Luan et al. (2017) did a comparative study on the relationship between job
stress and burnout among senior and head nurses and found significant differences
between the both. The highest stress causing factors for both senior and head nurses
were work overload and time problems. Job stress and burnout were found to be
positively correlated for both the senior and head nurses but the relationship was found
stronger for senior nurses. Burnout was more evident among senior nurses due to lack
of perceived job control, than head nurses.

Durgun and Kaya (2018) conducted a study to analyze the attitudes of emergency
department nurses towards patients and their safety and found out that the attitudes of
nurses towards the safety of their patients was average and there were no significant
differences in their attitudes based on their demographic characteristics. Besides the
demographic characteristics, emergency department certification and experience,
training regarding patient safety, nurses‘ perception regarding patient safety, and
hospital and emergency department quality certification also showed no relationship
with nurses‘ attitudes towards patient safety.

Elizabeth Fiske (2018) studied the stress causing factors and satisfiers for the nurses
working in the neonatal intensive care unit (NICU) and found out that inadequate
staffing was the major reason behind stress among NICU nurses. Most of the NICU
nurses found their jobs stressful but were not stressed by their working environment.
The nurses were satisfied with their perceived stress coping abilities and confident
regarding their knowledge and their care providing abilities. The nurses desired better
team work in NICUs and enhanced support and respect from their supervisors and
physicians. Most of the stress coping strategies were found to be focussed on task
completion.

Handerson Silva-Santos et al. (2018) studied the conditions that lead to making errors
in nursing profession and found out that nursing technicians and consultants were more
prone to making mistakes. The maximum number of mistakes occurred in day time and
the health institution made the maximum number of complaints through coordinated
nursing services. They concluded that work intensity and understaffing are the most
common reasons underlying making mistakes in nursing profession.

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Khan, Griffin and Fitzpatrick (2018) studied nurses‘ perception regarding
transformational leadership of nurse managers and staff nurse empowerment using a
descriptive correlation design. The results of the study indicated moderate correlation
between the two factors and even lower degree of correlation between transactional
leadership and perceived nurses‘ empowerment.

Leodoro J Labrague et al. (2018) conducted a review study on causes and coping of
stress among nurse managers. According to the study, the nurse managers mainly went
through moderate levels of stress, the main sources of stress being workloads, demand-
resource imbalance and financial issues. The most effective ways of coping with stress
were found to be increasing social support and enhancing job autonomy and control for
nurse managers.

Michael Korber et al. (2018) did a comparative study between physicians and nurses
of rural municipal hospital and urban university hospital regarding their perceived work
load, job satisfaction and work life balance. University hospital nurses assessed
organising their daily routine better than municipal hospital nurses. Similarly,
university hospital physicians were found better in applying knowledge than those at
municipal hospital. Municipal hospital physicians were better satisfied with their
workload while university hospital physicians reported being under work and time
pressure on a regular basis. Both hospital nurses reported sufficient work life balance
maintenance opportunities, while municipal hospital physicians reported better work
life balance opportunities than university hospital physicians. According to the study,
the findings regarding nurses did not differ much between the hospitals, while the
differences in perceived workload and stress among the hospitals‘ physicians differ
significantly. The perceived job stress and workload among university hospital
physicians was significantly higher than municipal hospital physicians.

Nancy Armstrong (2018) conducted a review study on workplace incivility

concerning nurses and how to manage it in health care settings. According to the study,
much research is not available in the area and what is available is not quality research.
The suggestions provided in the study to manage workplace incivility consist of
providing education and training to nursing staff regarding workplace incivility, how to

51
respond to such behaviours and providing practice opportunities and activities for these
newly acquired skills.

Oliver Hammig (2018) conducted a cross sectional study among health professionals
in Switzerland regarding burnout and their intentions to leave the profession. They
found out that exposures, i.e., workloads (physical, mental, emotional and temporal)
and job stressors had positive and strong association with outcomes, i.e., burnout and
turnover intentions. Work life imbalance and effort reward imbalance were found to be
major reasons for burnout and turnover intentions, significantly mediating the
relationships between the exposures and the outcomes and significantly predicting them
all. According to the study, work-life imbalance significantly predicted burnout
symptoms and effort-reward imbalance significantly predicted turnover intentions
among health professionals, especially nurses. They suggested decreasing workload
and job stress, reducing effort-reward imbalances and facilitating work life integration
to discourage burnout and turnover intentions as well as reducing actual turnover,
career endings, staff shortages and early retirements among health professionals.

Garcia-Sierra and Fernandez-Castro (2018) studied and analyzed the relationship

between empowerment and engagement among nurses based on the style of leadership.
According to the findings, transformational leadership have direct and positive
influence on structural empowerment among nurses, which in turn have direct and
positive influence on nurse engagement, thereby establishing a positive but indirect
influence of transformational leadership on nurse engagement through the mediating
role of nurse empowerment.

Amir Hossain Pishgooie et al. (2019) studied the relationship between stress and
anticipated turnover with appropriate style of leadership. According to the study, both
the transformational and transactional styles of leadership have significant negative
relationships with stress and turnover intentions among nurses, whereas, a positive
relationship was observed between laissez-faire style of leadership and stress and
turnover intentions among nursing staff.

Huanhuan Li et al. (2019) conducted a review study on how affective aromatherapy

and massage is in managing stress among nursing staff. According to the study, aroma
therapy and massage had positive and beneficial impact on employee stress, but there

52
was no sufficient proof or evidence to support the findings. Since the relevant number
of studies was very less (n=10) there was a high risk of bias and the findings were not
reliable. The researchers suggested further research to clearly and accurately study the
impact of therapy and massage on nursing stress.

Hui Grace Xu et al. (2019) conducted a study on emergency department doctors and
nurses regarding factors causing stress and their stress coping strategies. The study
concluded work overloads, inadequate skill match and low nurse patient ratio as
frequent high stress factors. Death and child sexual abuse were reported as less frequent
high stress causing factors. The staff perceived their work environment consisting of
high levels of work load, moderate levels of self realization and low levels of conflicts.
According to the study, the stress coping strategies used by most of the staff were
trying to not be effected as much as possible and trying different ways to handle
stressful situations.

Lu, Zhao and While (2019) conducted a review based study regarding job satisfaction
among hospital nurses. According to the study findings, most papers concluded that job
satisfaction impacts absenteeism and turnover and is impacted by performance and
commitment, leadership, shift work and performance-reward linkages. Nurses‘ job
satisfaction is found in correlation with working environment, organizational and
professional commitment, job stress and empowerment, patient satisfaction, etc. They
concluded that nurses‘ job satisfaction is vital to both patients‘ perception of quality of
care and nurse retention.

Tang and Hudson (2019) did a research study on retention among nurse managers.
The aim of the study was to outline such strategies that will help nurse managers in
increasing job satisfaction and decreasing turnover intentions. The strategies suggested
excluded compensatory issues and included three areas that came under the authority of
nurse managers being, job autonomy, performance appraisal and communication
structures.

Lama Bakhamis et al. (2019) studied ―The Burnout Syndrome‖ in hospital registered
nurses (RN), its causes, consequences on RNs and role in RN shortage. The study
depicted that burnout among RNs can be categorized based on four factors, individual,
organizational, managerial and work related and that burnout results in increasing

53
turnover, decreasing performance, degrading care quality and threatening patients‘
health and safety. The burnout rate was found higher in hospitals with low nurse-
patient ratio and among young nurses.

Liselotte N Dyrbye et al. (2019) conducted a comparative study to analyze the

association between burnout and work-life integration satisfaction between nurses and
other professions. According to the study, nursing burnout was predicted by
demographic characteristics, work hours and educational status, while, work-life
integration satisfaction was predicted by work hours only. The pooled multi variable
analysis concluded that while nurses did not differ from other workers in showing
burnout symptoms, they differ from other workers as they struggle with work life
integration and may have lower work life integration satisfaction.

M. Marc et al. (2019) analysed the global and local policies that results in nursing staff
shortage and suggested some remedies to overcome the same. According to them,
nursing staff shortage is an outcome of multiple factors, the major ones being
inefficient usage of nursing resources, poor recruitment and staffing policies, low rate
of newcomers and global demographic environmental factors. They suggested
improving working conditions, implementing effective compensation policy,
restructuring employment conditions and providing enhanced and upgraded methods of
learning and development.

Peter Holland et al. (2019) studied the impact of nurses‘ perceived work load on their
work life balance satisfaction and turnover intentions with the mediating role of high
involvement work practices (HIWP). According to the study, perceived workload
among nurses significantly increased their turnover intentions and nurses‘ work life
balance satisfaction mediated the relationship. The findings suggested that high
involvement work practices when extended with organizational support towards nurses
can help in reducing turnover intentions among them.

Yi-Chuan Chen et al. (2019) conducted a study on the relationships between nurse
patient ratio and nurses‘ workload, job satisfaction, burnout and turnover intentions.
The researchers found out that personal and client burnout and job dissatisfaction
significantly mediates the association between patient nurse ratio and turnover
intentions among nurses. According to the study, higher nurse patient ratio resulted in

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higher burnout, personal and client related, and higher job dissatisfaction, which in turn
resulted in higher intentions to leave.

Man-Li Du et al. (2020) conducted a study to assess the mental health of nurses
working on different posts. The study found positive relationships between post of the
nurses and their interpersonal relationships, depression and hostile behaviours. While it
had negative relationships with somatisation, scope of job involvement and
communication. They concluded that the post of the nurse and post related knowledge,
skills and risks have significant association with nurses‘ mental health.

Janicka, Basinska and Soltys (2020) studied the relationship between personality
traits and flexibility in stress coping among nurses with the mediating role of age and
seniority. They studied how venturesomeness, impulsiveness and empathy correlate
with the flexibility in stress coping. Venturesomeness found to be positively correlated
with flexibility while the rest of the two showed no such relationship. Similarly, only
venturesomeness played an important role in predicting stress coping flexibility on the
basis of nurses‘ personality traits, while the other two did not. The researchers found a
low statistically significant relationship between stress coping flexibility and
venturesomeness among nurses.

Ru-Wen Liao et al. (2020) constructed a model to analyse and determine the
associations of occupational burnout with job stress, self concept and working
environment among nurses. According to the model, emotional exhaustion and
depersonalization is significantly affected by job induced stress and nurse self concept,
while, personal accomplishment is significantly affected by nurse self concept only.
Emotional exhaustion and impersonalization had significant relationship with level of
education, while, occupational burnout was found to have no significant relationship
with job stress, nurse self concept and work environment factors.

Susan Armijo-Olivo et al. (2020) investigated how nursing time effects resident care,
minimum care hours effect care quality and nursing staff coverage effects patient
outcomes in long term care facilities, by reviewing existing literature. They concluded
that most of the literature was of poor quality and more quality research is needed to be
done to prove definitive and conclusive association between nursing time and coverage
and care quality; and to analyze the effect of varying former factor on the latter.

55
Yuguang Xie et al. (2020) studied the impact of transformational leadership on intent
to stay among nurses‘ working in old age care industry and found out that leadership
and clan culture both impact job satisfaction and commitment, thus indirectly
impacting intent to stay. According to the study, professional identity has significant
positive effect on nurses‘ intentions to stay.

Yuko Ono et al. (2020) studied the factors and association between work-life conflict
and gender based discrimination among health professionals in Japan and found out
that gender did not affect perceived work life conflict among nurses, teaching faculty
and employees aged between 30 to 39 years. According to the findings, men perceived
higher gender based discrimination regarding work content and incidental tasks, while
women perceived higher gender discrimination regarding promotions and performance
appraisals. Both men and women perceiving gender based discrimination were exposed
to higher risk of work-life conflict. They suggested promoting gender equality in the
organisations to attain healthy work life balance.

Amarneh et al. (2021) conducted a study to analyze the impact of person-environment

(PE) fit on turnover intentions among nurses and found that person job (PJ) fit and
Person Supervisor (PS) fit have significant impact on job satisfaction among nurses,
while person organisation (PO) fit doesn‘t. It was also concluded that PE fit was at a
significantly moderate level between job satisfaction and turnover intentions. They
suggested clarity in communicating organizational values and goals, ensuring PE fit at
entry level, conducting proper and effective orientation programs and employee
empowerment practices as strategies to discourage turnover and enhance retention
among nursing staff.

Gribben and Semple (2021) conducted a review study on the factors that contribute
towards work life balance and burnout among nurses working in adult oncology
department. A total of 20 studies formed the part of this study. Only one of the studies
focused on work life balance among nurses while all the studies included burnout.
According to the study, the burnout among oncology nurses was based on either the
ability of nurses to thrive, i.e., their ability to struggle against workplace burnout or
their personal perspectives that influence burnout among them. Burnout among
oncology nurses was specifically influenced by excessive work load and severity of

56
patients‘ disease and health. The development of burnout among oncology nurses was
found to be influenced by work culture, shift work and overtime and nurses‘ personal
characteristics. The researchers suggested that both the nurses and the organizations
need to work together on their levels to build resilience against burnout and promote
wellness among employees to build and sustain workforce capacity.

Junichi Tanaka et al. (2021) studied the gap between actual and ideal work life
balance for acute care ward nurses and its association with their quality of life and
found out that work gap scores were significantly higher for nurses living alone than
for those living with their families. Similarly, the family gap scores were also found
higher for nurses living alone than with families. They also found out that increase in
work life balance gap resulted in reduced quality of life among nurses. They concluded
that nurses living alone had greater burden of work and the family life of those living
with family was shielded by their families. The association between work life balance
gap and quality of life was also proved in the study.

Joshi et al. (2021) conducted a study on stress to measure its relationship with job
performance in nursing profession. They found out that all the nurses underwent stress
from mild to severe range of stress. While 53% of nurses reported moderate level of
stress, 45% of nurses were under severe stress. They also found out that younger nurses
were more susceptive to stress than those aging more than 40 and that job stress and
performance share negative relationship.

Matarsat, Rahman and Abdul-Mumin (2021) studied the relationship between work-
family conflicts, health and job satisfaction among nurses working in high dependency
and general settings. According to the findings, work-family conflict shares inverse
relationship with nurses‘ health status and job satisfaction. However it was also found
that nurses working in general settings experienced higher job satisfaction and better
health status even though facing higher level of work life conflicts, than nurses working
in high dependency settings. Age, marital status and smoking status also impact job
satisfaction among nurses.

Matsuo et al. (2021) concluded in their study that the nurses showing behaviour of
striving for attaining work life balance had comparatively lower turnover intentions
than those showing no or less striving behaviour for work life balance. It was also

57
found out that sense of coherence did not have significant impact on turnover intentions
among nurses. They suggested that providing healthy and comfortable work life
balance and support programs to do so will help in reducing turnover intentions and
actual turnover among employees.

Oscar Dousin et al. (2021) studied the relationship between work life balance, need for
achievement and turnover intentions among nurses with employee well being as a
mediator in two phases between the years 2015 to 2017. The researchers did hypothesis
testing through survey method to find out results in phase 1 while they further explored
the first phase results by conducting interviews in phase 2. According to the phase 1
findings, job satisfaction acts as a mediator while money and life satisfaction do not
between financial success, work life balance and turnover intentions for nurses. Phase 2
revealed four factors that further explore phase 1 results namely, working conditions,
compensation, team practices and pressure on senior nurses. The researchers suggested
enhancing flexibility in work schedules, facilitating teamwork, restructuring
compensation structure and discarding time based promotion policies to reduce work
life balance issues and discourage turnover intentions among nurses.

Rosnawati muhamad robat et al. (2021) studied the differences regarding

occupational stress among hospital and non-hospital nurses, and found out that there
are not much differences in both regarding household stressors but vary hugely
regarding work place stressors as hospital nurses are under greater stress mainly due to
shift work in hospital settings.

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