NAILA ASHRAF MM141048

Impact of Emotional Labor and Work Overload on Turnover Intentions Among Nurses in Pakistan; Mediation Effect of Workplace StressNAILA ASHRAFHRM-19(MM141048)

To examine the impact of Emotional labor and work overload among nurses in Pakistan; with mediating role of workplace stressResearch Objectives:

Rationale of the Study:Turnover intentions can be defined as an intention to leave the job (Fang, 2010).

Turnover intentions can be minimized by offering learning opportunities (Proost, Ruysseveldt & Dijke, 2011), introducing organiztion-related attitudes (Takeuchi & Takeuchi, 2013), creating an ethical climate within the organiztion (Suliman & Al-Junaibi, 2010) or conducting exit interviews (Al-Ahmadi, 2013).Introduction

Literature ReviewEmotions constitute our feelings that can have an important impact on our daily life activities. (Rafiee, Kazemi & Alimiri, 2013)

The concept of Emotional Labor was first introduced by Hochschild in 1983.

It is a kind of labor for a person to conceal his true feelings and show emotional neutrality during job in a situation (Morris & Feldman, 1996).

Emotional Labor & Turnover Intentions:Although there has been great advancement in medical technology but quality care of patients still depends on effective healing relationship between physicians and patients (Larson & Yao, 2005).

Deep Acting Vs. Surface Acting

Surface acting predicts the emotional labor more precisely than deep acting (Mann & Cowburn, 2005).

Emotional Labor & Turnover Intentions: Physicians who receive training to display required emotions show more job satisfaction and their patients also become more satisfied (Psilopanagioti, Anagnostopoulos, Mourtou & Niakas, 2012).Emotional Labor & Turnover Intentions:

Physicians enjoy more job satisfaction when they engage themselves in empathy and deep acting instead of surface acting (Larson & Yao, 2005).

Emotional labor sometimes causes stress and burnout because employees feel pressurized to manage their emotions for the sake of organizational goals (Brotheridge & Grandey, 2002).Emotional Labor & Turnover Intentions:Nurses may feel emotional-physical fatigue through continuous emotional labor which results in increased absenteeism and in extreme cases they tend to leave the job (Hackett, Bycio & Guion, 1989).

Increased emotional labor can result in high level of turnover intentions among nurses (Wolkomir & Powers, 2007).

Hypothesis 1: Emotional labor is positively associated with turnover intentions.

Emotional Labor & Turnover Intentions:Only 0.56 nurses and midwives for every 1000 individuals in Pakistan (WHO).

Increased Technological pressure in hospitals has increased the amount of workload on nurses (Kwiecien & Wujtewicz, 2012).

Nurses work day and night in the hospitals and different shifts requires different amount of nursing workload with different nurse-to-patient ratio (Vitacca, Clini, Porta & Ambrosino, 2000).Work overload and Turnover Intentions:There is more burden of work for nurses during morning and evening as compared to night (Debergh, Myny, Herzeele, Maele, Miranda, Colardyn, 2012).

If managers build a positive work environment with reasonable workload then it influences the employees positively and results in improved performance and decreased turnover intentions (Valentine, Godkin, Fleischman, Kidwell, 2010).Work overload and Turnover Intentions:Improved nursing education also results in changed role of senior nurses who usually assume the responsibilities giving training to junior nurses about how to manage workload (Townsend, Wilkinson, Bamber & Allan, 2001).

Amount of workload for nurses increases in medical intensive care units (MICUs) where patients need continuous and high level of care and treatment (Saulnier, 2001).

Work overload and Turnover Intentions:Nurses also perform the task of providing psychological support to the patients in addition to the physical care and this is extra burden on them which is usually not compensated and this may lower their job satisfaction and increase their intentions to quit the job (Salerno, Livigni, Magrini & Talamanca, 2012).

Hypothesis 2: Work overload is positively associated with turnover intentions.Work overload and Turnover Intentions:Working in an organization is not necessarily an easy job because it may adversely affect the psychological state of working people e.g. stress and depression (Brief & Aatieh, 1987).

Stress in the workplace has now become a serious problem for employers, workers and other existing societies (Bhatti, Shar, Shaikh & Nazar, 2010).

Workplace Stress and Turnover intentions:Stress can be caused by emotional demands of work which can lead to depression (Psilopanagioti, Anagnostopoulos, Mourtou & Niakas, 2012).

There is significant impact of efforts and reward on emotional state of employees which are associated with job stress and turnover intentions (Rehman, Khan & Afzal, 2010).Workplace Stress and Turnover intentions:Job stress has significant relationship with burnout and emotional exhaustion (Azeem, 2013).

Low level of stress results in lower emotional exhaustion and lower turnover intentions (Mulki, Jaramillo & Locander, 2008).

Hypothesis 3: Workplace stress mediated the relationship between Work overload and Turnover intentions.Workplace Stress and Turnover intentions:Workload is major cause of workplace stress (Bhatti, Shar, Shaikh & Nazar, 2010).

Nursing workload varies from shift to shift and it results in different levels of stress at different times which leads to high intentions to leave the job (Debergh, Mmyny, Herzeele, Maele, Miranda & Colardyn, 2012).

Stress related to family life may arise due to hectic schedule and this is associated with high turnover intentions (Noor & Maad, 2008).Workplace Stress and Turnover intentions:Workload also causes workplace stress which contributes to 16% of the overall stress as employees have to work for long hours (Bhatti, Shar, Sheikh & Nazar, 2010).

Increased workload results not only in physical fatigue but also causes psychological effects such as anxiety and stress (Fox, Dwyer & Ganster, 1993).

Workplace Stress and Turnover Intentions:High level of stress can lead to increased intentions to leave the job (Siu, Cheung & Lui, 2014).

High work expectations can also result in high level of stress which leads to high turnover intentions (Chen, Polyhart, Thomas, Anderson & Bliese, 2011).

Hypothesis 4: Workplace stress mediates the relationship between work overload and turnover intentions.Workplace Stress and Turnover Intentions:Theoretical Framework:Emotional LaborWork OverloadWorkplace StressTurnover IntentionsH1: Emotional labor is positively associated with Turnover intentions.H2: Work overload is positively associated with Turnover intentions.H3: Workplace stress mediates the relationship between Emotional Labor and Turnover intentions.H4: Workplace stress mediates the relationship between Workload and Turnover intentions.

Hypotheses:Industry: Nursing SectorSample Size: 1505-point likert scale Questionnaire

Methodology:Correlation Analysis:Predictors12341Emotional Labor12Work Overload0.04113Turnover Intentions0.0330.568**14Workplace stress 0.0590.657**0.408**1Regression analysis for Outcomes Workplace stress Turnover Intention

Predictors beta R R beta R R

Step 1Control variables .053 .034

Step 2Emotional labor .183* .037 .08* .166 .062 .003Workload .245* .023 .083* .243** .077 .015** Workplace stress .174** .024 .068**

N=155, Control variables, Gender, Age, Qualification and Experience* P _ .05** P _ .01

Regression Analysis:Regression analysis shows that there is no significant relationship between emotional labor and turnover intentions with value of p = 0.12 and t = 1.71 while = 0.166 i.e. any variance in emotional labor doesnt cause sufficient variance in turnover intentions. As p should be less than 0.05 and t must be greater than 2 so our first hypothesis is rejected that emotional labor is positively associated with turnover intentions.

Further analysis shows that there exists significant relationship between work overload and turnover intentions with p = 0.021 and t = 3.18 while = 0.243** so our second hypothesis is accepted that work overload is significantly positively associated with turnover intentions.

Regression Analysis:For third and fourth hypotheses we used Baron and Kenny (1986) method for testing the effect of mediation which requires accomplishment of three conditions for effective mediation. First two conditions require significant relation between independent variable and mediator and also between mediator and dependent variable.

We found that no significant relationship exists between emotional labor and workplace stress with p = 0.22 and t = 1.09 with = 0.183 whereas the relation between workplace stress and turnover intentions is significant having p = 0.014 and t = 3.96 where = 0.174**. So third hypothesis is rejected as results violate the first condition of mediation by Baron and Kenny (1986). Regression Analysis:Moreover results showed that there is significant relationship between work overload and workplace stress with p = 0.045 and t = 2.12 while = 0.245* and the relation between workplace stress and turnover intentions is also significant as stated above thus satisfying first two conditions of Baron and Kenny for fourth hypothesis.

In order to check the third condition we used mediated regression analysis whose table is given below:Regression Analysis:Turnover Intentions Predictor Beta R2 R2

Mediation workplace stressStep 1Control variables .11

Step 2 Workplace stress .174** .024 .068**

Step 3Emotional labor .226 .40 .007Work overload .418 .083 .077

Control variables were Gender, Age, Qualification and Experience.*p