Impact of Emotional Labor and

Work Overload on Turnover

Intentions Among Nurses in
Pakistan; Mediation Effect of
Workplace Stress
NAILA ASHRAF
HRM-19
(MM141048)

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

Rationale of the Study:

Why I
conducted
research on
this topic?

Research Gap

Introduction

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).

Literature Review

Emotional Labor & Turnover

Intentions:

Emotions 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.

Work overload and 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.

Workplace Stress 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.

Theoretical Framework:
Emotional
Labor
Workplac
e Stress
Work
Overload

Turnover
Intention
s

Hypotheses:

H1: 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.

Methodology:
Industry: Nursing Sector
Sample Size: 150
5-point likert scale Questionnaire

5=
Strongly
Agree

1=
Strongly
Disagree

Correlation Analysis:
Predictors

Emotional Labor

Work Overload

0.041

Turnover Intentions

0.033

0.568**

Workplace stress

0.059

0.657**

0.408**

Regression Analysis:
Regression analysis for Outcomes
Workplace stress

Predictors

beta

Step 1
Control variables
Step 2
Emotional labor
Workload
Workplace stress

Turnover Intention

beta

.053

.183*
.245*

.037
.023

.08*
.083*

.034

.166
.243**

.062
.077

.003
.015**

.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:

Mediated Regression
Analysis:
Turnover Intentions
R2

Predictor
R2

Mediation workplace stress

Step 1
Control variables
Step 2
Workplace stress
Step 3
Emotional labor
Work overload

Beta

.11

.174**

.226
.418

.024

.068**

.40
.083

.007
.077

Control variables were Gender, Age, Qualification and Experience.

*p<.05
**p<.01

Mediated Regression Analysis:

Baron and Kenny (1986) third condition requirement

Table 3 shows that when we controlled the mediator in the

second step we found that there exists no significant
relationship between work overload and turnover intentions
with p = 0.131 and = 0.418.

This shows that all the three conditions are satisfied so we

accept our fourth hypothesis. This means that there is need of
mediator (workplace stress) as no significant relation exists
without it.

Discussion:

The results of the analysis suggested that there exists no significant

positive association between emotional labor and turnover intentions
so first hypothesis was rejected.

Arguments supporting the rejection of first hypothesis:

Some

researchers are of the view that emotional labor will not

necessarily lead to turnover intentions if employees pursue deep
acting instead of surface acting during their job activities (Mann &
Cowburn, 2005).

Instead,

deep acting leads to job satisfaction which decreases the level

of turnover intentions (Lee, An & Noh, 2014).

Discussion:
So

it can be concluded that most of

the nurses in Pakistan use deep
acting instead of surface acting
while treating their patients and this
display of naturally felt emotions
results in low level of stress.

Nurses

in Pakistan enjoy their job

while feeling inner satisfaction in
providing their services.

Discussion:

The second hypothesis was accepted that work overload is

positively associated with turnover intentions.

Arguments supporting the acceptance of second hypothesis:

Acute shortage of nurses in Pakistan Pakistan Nursing Council

statistics
Lack of proper training and shortage of funds
Poor Management and lack of guidance to nurses leading to
wastage of time and energy

Discussion:

Long working hours and family responsibilities

Third hypotheses was rejected that workplace stress mediates the

relationship between emotional labor and turnover intentions.

Arguments supporting the rejection of third hypothesis:

In Pakistan being a collectivist society (Hofstede, 1983), nurses

usually work in a relatively comfortable workplace environment
where they easily develop friendly interpersonal relationships with
colleagues, doctors and patients etc.

Discussion:

Increased sharing of personal problems and released

anxiety and low level of workplace stress.

As 67% of workplace stress is due to internal factors

(Bhatti, Shar, Shaikh & Nazar, 2010) so we can conclude
that nurses in Pakistan pursue deep acting instead of
surface acting.

Discussion:

Fourth hypothesis was accepted that workplace stress

mediates the relationship between work overload and
turnover intentions.

Arguments supporting the acceptance of fourth hypothesis:

Nurses in Pakistan feel stressful after working for long and

odd working hours. Some nurses have to work for both day
and night shifts during emergency cases and they receive no
additional compensation for night shift.

Discussion:
Majority of nurses in Pakistan
are females. They join nursing
because their parents cannot
afford their higher education
and instead they prefer to get
the stipend from nursing to
fulfill their financial needs.
These women also have to work
hard at home to fulfil family
demands (Noor & Maad, 2008).

Research Implications:

At government level funds should be created for training of

nurses. This will help nurses to provide better services for
improved patient care while using deep acting for expression
of their emotions.

Empower Pakistan Nursing Council (PNC) and provide it with

adequate funds to make nursing a career oriented profession in
order to motivate people to join this. This will help to
overcome the problems of shortage of nurses.

Research Implications:

Dire need to recruit more nurses in order to minimize heavy

workload on nurses.

Serious and urgent measures are required to improve the system

of compensation and rewards e.g. nurses working during night
shift must be rewarded with additional compensation.

Family friendly work policies.

Limitations and Future Directions:

Future researchers can also study the impact of other

variables e.g. workplace environment, hospital policies and
patients behavior and work to family conflict on turnover
intentions among nurses.

Economic and social factors such as unemployment and

inflation can also be taken as mediating variables.

Emotional labor can also be studied among teachers,

professors, air hostesses and service sector employees in
Pakistan.

Conclusion:

Nurses in Pakistan have to work for long and hectic hours

owing to the shortage of staff and family responsibilities.

This increases their workload and they feel stressful which

ultimately increases their turnover intentions while these
nurses avoid being stressful through emotional labor because
they pursue deep acting instead of surface acting.

Improved system of nursing hiring, training and their

management can help to overcome these problems of nurses
in Pakistan.

References:

Beh, L. S., & Loo, L. H. (2012). Job Stress and Coping Mechanisms among Nursing
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Chan, L. L., Shaffer, M. A., & Snape, E. (2004). In search of sustained competitive
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resource management practices on firm performance. The International Journal of
Human Resource Management, 15(1), 17-35.

Fox, M. L., Dwyer, D. J., & Ganster, D. C. (1993). Effects of stressful job demands and
control on physiological and attitudinal outcomes in a hospital setting. Academy of
Management Journal, 36(2), 289-318.

Wunder, R. S., Dougherty, T. W., & Welsh, M. A. (1982, August).A Casual Model of
Role Stress and Employee Turnover.In Academy of Management Proceedings (Vol.
1982, No. 1, pp. 297-301).Academy of Management.

Thanks

Thanks