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LHS
27,3
224
Received 20 July 2013
Revised 2 November 2013
Accepted 13 January 2014
Leadership in Health Services
Vol. 27 No. 3, 2014
pp. 224-239
© Emerald Group Publishing Limited
1751-1879
DOI 10.1108/LHS-07-2013-0032
Occupational stress and its
consequences
Implications for health policy and
management
Ali Mohammad Mosadeghrad
Health Management and Economics Research Centre, School of Health
Management and Information Sciences, Tehran University of Medical
Sciences, Tehran, Iran
Abstract
Purpose – This study aims to identify the status of occupational stress among a sample of hospital
employees in Iran. It further intended to reveal the harmful effects of occupational stress on employees’
health and well-being.
Design/methodology/approach – The study used a cross-sectional research design. A validated
questionnaire was used to collect data from hospital employees.
Findings – Job-related, working environment, interpersonal and organisational factors were related to
occupational stress. One-fourth of employees rated their occupational stress high. The major sources of
occupational stress were inadequate pay, inequality at work, too much work, staff shortage, poor
recognition and promotion, time pressure, job insecurity and lack of management support. High levels
of occupational stress have been linked to an increased risk of physical injuries, cardiovascular disease,
high blood pressure, depression and increases in negative personal behaviours such as anger, anxiety
and irritability. Occupational stress was positively associated with employees’ turnover intentions.
Research limitations/implications – The findings of this study are not generalisable to the wider
population of hospital employees in Iran due to the small sample size. Thus, future research should
involve additional samples.
Practical implications – The study has practical relevance for designing and implementing
strategies to decrease occupational stress among hospital employees.
Originality/value – This article contributes to health care theory and practise by identifying factors
contributing to employees’ occupational stress and examining the association between occupational
stress and two important employee outcomes – health status and turnover intention.
Keywords Human resource management, Stress, Hospitals, Employees, Occupational stress
Paper type Research paper
Introduction
Health care, with excessive workload, difficult working conditions, dealing with
difficult patients, uncertainty concerning treatment of patients and numerous
occupational health and safety hazards is essentially a stressful profession. Several
researchers have tried to identify sources of stress among health care employees.
The author would like to thank all the hospital employees who participated in the study. The
author is also grateful to the editor and anonymous LHS reviewers for their constructive
comments and guidance for improving this paper.
 Job related, individual, organisational and environmental factors influence Occupational
employees’ stress. The job itself including duties, responsibilities, heavy workload,
variations in workload, role ambiguity and role conflict can be a source of stress for
stress and its
employees (McGowan, 2001; Michie and Williams, 2003; and Robinson et al., 2003). The consequences
working environment such as resources shortage, problems with colleagues and poor
management styles can be stressful (Flanagan, 2006; Isikhan et al., 2004; and Steinhardt
et al., 2003). Organisational policies such as long work hours, inadequate training, job 225
insecurity, inadequate salary and lack of career prospects can also be stressful (McCann
et al., 2009; Mosadeghrad, 2013; and Schmitz et al., 2000). Socio-demographic predictors
of occupational stress include:
• gender (Cheng et al., 2001);
• educational level (Golubic et al., 2009);
• tenure (Chiang and Chang, 2012); and
• race (Mitchell et al., 2001).

Finally, personality characteristics have an influence on an individual’s ability to cope

with occupational stressors (Oginska-Bulik, 2006).
Occupational stress causes adverse outcomes for both employees and organisations.
Occupational stressors are serious threats to the health and well-being of health care
employees. Occupational stress may cause physical, mental and social illness for
healthcare professionals. It is associated with the following:
• chronic fatigue (Van der Ploeg and Kleber, 2003);
• disordered eating (King et al., 2009);
• headaches (Schaubroeck and Fink, 1998);
• increased blood pressure (Melamed et al., 2001);
• increased risk of cardiovascular diseases (Espnes and Byrne, 2008); and
• musculoskeletal pains (Eriksen et al., 2003).

Occupational stress may also cause psychological distress such as:

• emotional exhaustion (Coffey and Coleman, 2001; and Imai et al., 2004);
• mood disturbance (Healy and McKay, 2000);
• sleeping problems (Piko, 1999);
• lack of concentration (Shapiro et al., 2005);
• depression (Cho et al., 2008);
• anxiety (Bussing and Hoge, 2004); and
• suicidal ideation (O’connor et al., 2000).

On the organisational level, occupational stress is linked to employee performance (Abu

Al Rub, 2004). Stress decreases attention, concentration and decision-making and
judgement skills (Shapiro et al., 2005). A strong inverse relationship was found between
occupational stress and employees’ quality of working life (Machin et al., 2004; and
Mosadeghrad et al., 2011), morale (Machin et al., 2004), motivation (de Jonge et al., 2001),
job satisfaction (Flanagan and Flanagan, 2002; Grunfeld et al., 2000; and Redfern et al.,
LHS 2002) and organisational commitment (Khatibi et al., 2009; and Lambert and Paoline,
2008). Occupational stress also may lead to increased burnout and physical, mental and
27,3 emotional exhaustion (Spickard et al., 2002), absenteeism (Eriksen et al., 2003; and
Machin et al., 2004) and intention to leave workplace (Chou-Kang et al., 2005;
and Mosadeghrad, 2013). Occupational stress is also negatively related to quality of care
due to loss of compassion for patients and increased incidences of mistakes and practice
226 errors (Engström et al., 2006; Teng et al., 2010).
A conceptual framework aiming to explain the impact of occupational stress on
employees’ outcome is expressed graphically at Figure 1. There is a variety of
job-related, interpersonal, organisational and working environment factors influence a
person’s level of occupational stress. As shown, the relationship between occupational
stress and employees’ outcomes is moderated by individual and socio-cultural factors.

Methodology
Purpose and objectives
The purpose of this paper is fourfold: first, to assess the occupational stress level in
hospital employees in Isfahan, Iran; second, to reveal factors that influence hospital
employees’ occupational stress; third, to identify stress-related physical and mental
problems of hospital employees; and fourth, to examine the relationships between
occupational stress and employees’ turnover intention.

Design
The study utilised cross-sectional, descriptive and correlational design and survey
method.

Setting and sample

Hospital care in Iran is provided by government-financed Ministry of Health hospitals
(MOH), the social security organisation-affiliated hospitals (SSO) and private hospitals.

Figure 1.
Conceptual framework of
relationships between
occupational stress and
employee outcomes
The study was carried out at six hospitals, three MOH (two educational and one Occupational
non-educational) one SSO and two private hospitals. The six hospitals of the study were
selected to represent the three dominant hospital care systems in Iran. Seven hundred
stress and its
and forty employees were selected for this research after a pilot study by using the consequences
following formula (N ⫽ 2411, d ⫽ 0.03, z ⫽ 1.96 and s ⫽ 0.50). Employees who had less
than six-months working experience were excluded from this study.
227
Nz2s2
n⫽
Nd2 ⫹ z2s2

Instrument
A literature review was conducted to identify the occupational stress questions (French
et al., 2000; McVicar, 2003; McGowan, 2001 and Michie and Williams, 2003). From each
study, a list of questions was created. Using a Delphi technique, the organisational
behaviour and management experts’ opinions were used in completing this list. Factor
analysis was used to group questions into certain dimensions. These included stress
related to job, work environment, organisational policies and interpersonal relations
(Table I). Content and face validity were established by a panel of management experts
and hospital staff.
A pilot study was undertaken to test the relevance and clarity of the questions and to
refine them as needed to avoid misunderstandings. A small sample of 40 randomly
selected hospital employees who were not included in the sample received the
questionnaires. The questionnaires were found to be understandable and acceptable.
Cronbach’s alpha was computed for each scale using the SPSS-11 statistical package.
The reliability coefficient was 0.82 for occupational stress questionnaire (Table II).
Turnover intention was measured using a single item: “To what extent do you want to
leave this organisation, if you find another job opportunity?”

Job stressors Definition

Job-related stressors Anything related to duties, responsibilities and

Work environment-related stressors
Organisational policies-related stressors
Interpersonal relations-related stressors
organisational role that produces adverse
consequences for an individual such as
workload, time pressure and decision latitude
Anything related to an organisational
environment that produces adverse
consequences for an individual such as
inappropriate working condition, inadequate
equipment and hazardous situation
Anything related to organisational policies that
produces adverse consequences for an individual
such as inadequate pay, poor promotion
prospects, job insecurity and deficient leadership
Anything related to interpersonal relationships
that produces adverse consequences for an
individual such as bullying and harassment
behaviour from managers, co-workers and Table I.
customers Definition of job stressors
LHS Data collection
The sampling method was stratified as random sampling. Employees from various
27,3 departments of the hospitals participated in the survey. Informed consent was obtained
from all subjects following receipt of information on the purpose of the study,
assurances of anonymity and confidentiality. Respondents were asked to rate the
intensity of 30 common occupational stressors using a five-point scale (very low, low,
228 medium, high, very high).

Data analysis
All data were analyzed using the statistical package for the social sciences (SPSS 11). To
normalise the Likert scale on 1- 5 scales for each domain of occupational stress
questionnaire, the sum of raw scores of items in each domain was divided by the
numbers of items in each domain, and for overall occupational stress, the sum of raw
scores of items were divided by 30. The possible justified scores were varied between 1
and 5. Scores of 2 or lower on the total scale indicate very low, scores between 2 and 2.75
indicate low, scores between 2.76 and 3.50 indicate moderate, scores between 3.51 and
4.25 indicate high and scores of 4.26 or higher indicate very high occupational stress.
The differences between groups were tested with the chi-square, independent t-test,
Mann–Whitney and Kruskal–Wallis tests. Then, the relationship between occupational
stress and its five dimensions was investigated by calculating Pearson’s correlation
coefficients. Regression analysis was used to identify the most important predictor
domains in occupational stress. The significance level was set at p ⬍ 0.05.

Results
Six hundred and eight employees filled out the questionnaires (82.2 per cent). More than
half of the participants were females (54.3 per cent) and over three-fourths (80.6 per cent)
were married. The majority had bachelor’s degree (45.4 per cent). More than half of the
employees (58.4 per cent) had an incomes of ⬍ 3 million Rials (poverty line in Iran in
2008); 48.7 per cent of employees had permanent employment (Table III).
The average employee age was 34.53 years (SD ⫽ 8.28) with the youngest aged 21
years and the oldest 60 years. The majority of the respondents were aged 20-30 years
(34.4 per cent), followed by 31-40 years (32.6 per cent). Employees had worked an
average of 10.8 years (SD ⫽ 8.07) in their career, with a minimum of 1 year and a
maximum of 32 years.
The mean score of employees’ occupational stress was 3.14 compared with the
possible range from 1.10 to 4.63 (Table IV). Overall, 26 per cent of hospital employees
reported that their job was very or extremely stressful. The major sources of
occupational stress were inadequate pay (3.79), inequality at work (3.75), insufficient
regular breaks at work (3.71), too much work (3.67), staff shortages (3.62), poor

Job stressors Item numbers Number of items Cronbach’s alpha

Job-related stressors 1-12 12 0.78

Work environment-related stressors 13-15 3 0.71
Table II. Organisational policies-related stressors 16-25 10 0.88
Internal consistency Interpersonal relations-related stressors 26-30 5 0.81
analysis Overall job stress 1-30 30 0.82
Demographic Job stress
Occupational
parameters Per cent of sample Mean SD stress and its
Gender consequences
Male 45.7 3.10 0.65
Female 54.3 3.18 0.68
Marital status
Single 19.4 3.21 0.60
229
Married 80.6 3.12 0.69
Education
Illiterate 0.7 2.67 0.58
Under diploma 14 2.85 0.53
Diploma 19.9 3.07 0.58
Post-diploma 15.8 3.16 0.60
Bachelor’s degree 45.4 3.24 0.69
Master’s degree or GP 3.6 3.28 0.68
Doctoral degree 0.7 3.31 0.52
Area of work
Managerial and clerical 12.0 2.97 0.62
Ancillary or logistic 19.4 3.01 0.60
Diagnostic 17.1 3.11 0.60
Therapeutic 51.5 3.24 0.71
Age (years)
20-30 34.4 3.15 0.67
31-40 32.6 3.20 0.71
41-50 29.1 3.12 0.63
⬎ 50 3.9 2.73 0.58
Tenure (years)
1-5 32.9 3.16 0.70
6-10 26 3.19 0.71
11-15 15.1 3.14 0.68
16-20 11.2 2.11 0.65
21-25 7.6 3.09 0.59
26-30 6.9 3.08 0.54
⬎ 30 0.3 2.82 0.60
Type of employment
Temporary 51.3 3.20 0.70
Permanent 48.7 3.08 0.66 Table III.
Received wages Percentage of participants
⬍ RLS3,000,000 58.4 3.16 0.66 and the mean score of
⬎ RLS3,000,000 41.6 3.12 0.69 their job stress

recognition and promotion (3.61), time pressure (3.60), job insecurity (3.58) and poor
management support (3.48).
Employees scored a mean of 2.88 and 2.73 on a five-point scale for role ambiguity and
role conflict, respectively, as occupational stressors. While 21.2 per cent of employees
found role ambiguity (unclear job description) a source of stress, 41.1 per cent of
employees saw role contradiction (unclear role expectations) stressful.
The Kruskal–Wallis test revealed that the total occupational stress scores was
differed among six hospitals (chi-square ⫽ 22.195, df ⫽ 5, p ⫽ 0.00). Employees’
LHS occupational stress in public hospitals was less than private and semi-public hospitals
(Table IV). The differences between values of employees’ occupational stress in these
27,3 hospitals were statistically significant (p ⬍ 0.001).
The employee’s occupational stress in therapeutic (clinical) and diagnostic
departments was higher than ancillary and administrative departments. A statistical
significant association was seen between employees’ occupational stress and their area
230 of work or specialty (p ⬍ 0.001). Nurses and physicians showed the highest levels of
occupational stress. The mean score of employees’ occupational stress in the psychiatry
ward (4.07), internal medicine (3.91), orthopaedics (3.62), surgery (3.55), obstetrics (3.53),
admission (3.44), ICU (3.43), paediatrics (3.42), cardiology (3.35), operation room (3.38),
accident and casualty department (3.27), physiotherapy (3.26), coronary care unit (3.21)
and laboratory department (3.03) was high. Employees experienced low occupational
stress in non-specialised and clinical environments such as library (2.32), secretariat
(2.73) and administrative office (2.82).
As Table V shows, employees reported more occupational stress than managers.
However, the differences between values were not statistically significant (t ⫽ ⫺0.137
and p ⫽ 0.891).
High levels of occupational stress have been linked to an increased risk of physical
injuries; cardiovascular disease; high blood pressure; depression; and increases in
negative personal behaviours, such as anger, anxiety and irritability (Table VI). Female
employees experienced more job stress-related physical and mental problems than their
male colleagues (r, p ⫽ 0.02). Overall, 257 employees (42.3 per cent) had to use work
stress-related leave. Employees’ work stress-related leave was, on average, 7.77 days
(total, 1997 days).

Public Semi-public Private

hospitals hospitals hospitals Overall
Job stress dimensions Mean SD Mean SD Mean SD Mean SD

Job-related stress 3.05 0.79 3.36 0.81 3.13 0.77 3.12 0.73
Table IV. Interpersonal relations 2.92 0.94 3.11 0.94 2.72 0.83 3.06 0.92
The mean of employees’ Work environment 3.15 0.96 3.25 0.93 3.26 0.98 3.20 0.83
job stress in different Organisational
hospitals (on a five-point policies 3.06 0.76 3.38 0.65 3.23 0.70 3.16 0.73
scale) Overall job stress 3.07 0.70 3.30 0.60 3.15 0.66 3.14 0.67

Managers Employees
Job stress dimensions Mean SD Mean SD p-value

Job-related stress 3.11 0.82 3.13 0.78 0.76

Interpersonal relations 3.20 0.89 3.15 0.92 0.29
Table V. Work environment 2.99 0.92 3.08 0.95 0.90
The mean of employees Organisational
and managers’ job stress policies 3.18 0.65 3.20 0.74 0.61
(on a five-point scale) Overall job stress 3.12 0.68 3.15 0.68 0.73
Occupational stressors such as too much work, hazardous situation, lack of abilities to Occupational
do the job, staff shortages, time pressure, lack of training, inadequate resources and
inappropriate working conditions were related to staff physical injuries. Low decision
stress and its
latitude, role contradiction, conflict in the workplace, discrimination at work, job consequences
insecurity, lack of management support and bullying and harassing behaviour from
customers were related to staff psychological illness (e.g. depression).
There was strong correlation between the occupational stress of employees and their 231
gender (r ⫽ 0.134 and p ⫽ 0.001), age (r ⫽ ⫺0.131 and p ⫽ 0.002), tenure (r ⫽ ⫺0.110 and
p ⫽ 0.008), graduation level (r ⫽ ⫺0.125 and p ⫽ 0.002), their place of work (r ⫽ ⫺0.179
and p ⫽ 0.001) and type of employment: permanent or contract employment (r ⫽ ⫺0.085
and p ⫽ 0.04).
Female employees reported higher occupational stress than their male colleagues.
Women because of their responsibilities at both home and workplace are facing double
stress. Men and women experienced different stressors at work. While insufficient pay
was the main stressor for male employees, female employees complained more about
discrimination at work, too much work (quantity burden) and insufficient regular
breaks at work. Female employees reported more occupational stress resulting from
organisational policies and interpersonal relations than their male counterparts (p ⬍
0.01). Nevertheless, men used more work stress-related leave than women (nine vs seven
days a year).
There is a meaningful difference in stress among various ages. Occupational stress
was higher in younger employees. Occupational stress peaked at ages 31-40, with about
30.3 per cent of hospital personnel in this age range reporting high occupational stress.
Older employees with more years of experience had less occupational stress than their
younger colleagues. Regarding marital status, although the average occupational stress
among single employees was higher than the married ones according to Mann–Whitney
test, there was no meaningful difference (p ⫽ 0.665).
Calculations of Spearmen’s ratios revealed the strongest correlation between total
occupational stress and occupational stressors related to organisational policies,
job-related, interpersonal relations and work environment. As Table VII shows, this
relationship was statistically significant in all cases (p ⬍ 0.001).
Correlation analysis revealed that occupational stressors such as low decision
latitude (0.680), given responsibility without the authority to take decisions (0.666), job
insecurity (0.635), bullying and harassment behaviour from managers (0.631),
discrimination at work (0.623), poor management support (0.616), inadequate equipment

Job stressors Percentage

Anxiety 27.3
Headache (migraine) 26.15
Anger 23.5
Back pain 21.7
Gastrointestinal problems 19.9
Irritability 18.1 Table VI.
Depression 17.4 Employee job-related
Foot pain 13.3 problems in study
Cardiovascular disease 7.7 hospitals
LHS (0.615), bullying and harassment behaviour from co-workers (0.608), conflicting
demands (0.590), job identity (0.542), lack of recognition and promotion prospects
27,3 (0.541), role ambiguity (0.537), bullying and harassment behaviour from customers
(0.494), role contradiction (0.479) and policies and regulations (0.329) had more effect on
employees’ occupational stress.
Multiple regression analysis was used to assess the impact of independent
232 organisational, job-related and individual variables upon self-reported stress
(dependent variable). Job-related factors explained the largest amount of the variance in
employee occupational stress (80.2 per cent), followed by organisational factors,
interpersonal relations and work environment. With regard to job-related factors, time
pressure explained the largest amount of the variance, followed by conflicting demands,
needing more consciousness for doing tasks (quality burden), lack of coordination
between the job and employee abilities and too much responsibility. Employees’
characteristics explained a smaller amount of variation in occupational stress.

Discussion
The occupational stress of Iranian hospital employees who participated in this survey
was at a medium level, mainly because of inadequate salaries, inequality at work,
excessive workload, staff shortage, poor promotion, job insecurity and poor
management support. These findings are consistent with other studies’ that found
Iranian hospital employees face moderate (Faraji et al., 2012; and Sharif et al., 2011) or
high occupational stress (Ghasemi et al., 2011; Tabatabaei et al., 2012). They also
reported increased staff shortage, heavy workload, low pay and job insecurity as the
main stressors for Iranian hospital employees.
High levels of occupational stress were associated with poor health and increased
turnover intention. Occupational stress caused physical and mental problems for
hospital employees. Heavy workload, hazardous situation, staff shortages, lack of
training and inadequate resources were related to employees’ physical injuries. Low
decision latitude, role contradiction, conflicting demands, job insecurity and poor
management support caused psychological distress for employees.
Employees were more likely than managers to report job-related stress. They were
more dissatisfied with the salaries, benefits and workload. The current study showed
that female employees are more vulnerable to the effects of occupational stress on health
than their male colleagues. While men experienced higher job demand and role-related
stressors, women reported higher occupational stress related to organisational policies
and interpersonal relations.

Job stressors 1 2 3 4 5

1. Overall job stress ⫺

2. Stress related to the job 0.776** ⫺
3. Stress related to human relations 0.835** 0.607** ⫺
4. Stress related to work environment 0.715** 0.535** 0.547** ⫺
5. Stress related to organisational policies 0.869** 0.620** 0.677** 0.531**
Table VII. 6. Intention to leave the organisation 0.254** 0.187** 0.155** 0.113** 0.246**
Inter-correlations between
job stress Note: ** Correlation is significant at the 0.01 level (two-tailed)
At present, Iran is subject to the United Nations, the USA and the European Occupational
Union economic sanctions. The imposed sanctions directly or indirectly affect
economic activity, employment status and quality of life of Iranian people.
stress and its
Economic restrictions had contributed to shortages of staff and resources. Hospital consequences
employees in this study complained about staff shortages, too much work and job
insecurity.
Employees working in semi-public hospitals reported higher level of occupational 233
stress as compared to employees working in public and private hospitals. They face
high duty-related stressors. Semi-public hospitals provide free health care services to
social security-insured patients. Consequently, the demand for services in these
hospitals is very high. The findings also showed that all four dimensions of occupational
stress are inter-related. Therefore, it can be concluded that an increase in duty and work
environment-related stress can result in more interpersonal tensions. Tankha (2006)
similarly found that hospital employees in private hospitals experienced more
occupational stress than employees in public hospitals.
Stress scores were significantly higher for employees in clinical departments. Nurses
and physicians in psychiatric, internal medicine, orthopaedics, surgery and obstetrics
wards experienced more occupational stress and were more likely to leave their
positions than the staff in other departments. These findings support the assumption
that nursing and medicine are stressful occupations, and nurses and physicians are
more prone to a high degree of stress and burnout than other staff in health care settings.
Occupational stressors in nursing and medicine include excessive workloads, staff
shortage, irregular working hours, dealing with patients, uncertainty concerning
treatment of patients, conflict with other colleagues, dealing with death and dying
people and concerns about technical knowledge and skills (McGowan, 2001; Robinson
et al., 2003; and Sharif et al., 2011).
Dissatisfaction with remuneration was a major source of distress for Iranian hospital
employees. Lack of benefit and reward is an increasing source of frustration and
contributes to employees’ turnover. The findings of this study revealed that employees’
income was associated with their intentions to quit. Similarly, other studies found that
pay and benefits were the major determinants of occupational stress and turnover
intention (Ernst et al., 2004).
Heavy workload and inadequate staff to cover duties were the most significant
associated factors of stress for Iranian hospital employees. Several studies have
highlighted work overloads and time pressure as significant contributors to work stress
among health care professionals (Al-Aameri, 2003; Grunfeld et al., 2000). An excessive
workload increases job tension and decreases job satisfaction, which, in turn, increases
the likelihood of turnover (Aiken et al., 2002; and Strachota et al., 2003). Inadequate
staffing also inversely influence the quality of provided health care services and patient
outcomes (Whitman et al., 2002).
Unfairness and inequality at work (lack of organisational justice) were also
reported as main occupational stressors among hospital employees in this study.
Findings from the study showed that treating people unfairly could result in a series
of negative or stress-related reactions that increase the risk of poor physical and
mental health. These findings are consistent with those findings of McCann et al.,
2009 and Wilkinson, 2005.
LHS Job insecurity was found in this study as a factor that negatively influences
occupational stress of hospital employees. Job insecurity threatened employees in the
27,3 private sector more than those in the public sector. Because private hospitals are
profit-oriented, there is redundancy resulting from over staffing. This is in contradiction
with the findings of Ogunjimi et al.’s (2009) study that found public sector employees are
less satisfied with their job security.
234 The current study showed that promotion opportunities were another significant
predictor of occupational stress among study participants. Life-long learning,
professional growth and advancement promote employees’ job satisfaction, and enable
continued provision of high-quality health care services (Donner and Wheeler, 2001). It
is therefore recommended that managers provide equal promotion opportunities for
employees. Managers should promote employees to key positions and increase their
involvement in decision-making (AbuAlrub and AL-Zaru, 2008).
Poor professional relationship and lack of social support at the workplace were
important predictors of occupational stress among Iranian hospital employees. Social
support, supportive relationships with colleagues and group cohesion reduce the
occurrence and the impact of job stress (Piko, 1999; and Steinhardt et al., 2003).
Education, training and emphasising teamwork help improve cooperation among
professionals in health care organisations.
The findings revealed that organisational policies had the strongest correlation with
employee occupational stress. Structural and organisational changes such as
restructuring, downsizing, right sizing and re-engineering can result in a change in the
nature of work for many employees and eventually their lay-off or relocation. These
organisational changes may result in excessive work demands, time pressure and role
conflicts, which cause stress for employees (Giga et al., 2003).
Developing a supportive social environment and applying corporate wellness
programmes improve employees’ job satisfaction and reduce occupational stress.
An emphasis on staff health and safety, education and training, managers’ and
employees’ cohesion and recognition and rewards have a positive impact on
employees’ quality of work life and well-being. Corporate wellness programmes
promote the adoption of organisational practices and personal behaviour conducive
to maintaining or improving employee physiological, mental and social well-being
(Ho, 1997). Improving management systems and structures, assuring employee
autonomy and participation, enhancing work environment, providing necessary
education and training and demonstrating value to employees could reduce
employees’ occupational stress. Jobs should be designed in ways that provide
meaning, motivation and opportunities for employees to use their skills. Employees’
workload should be in line with their capabilities and resources. Employees’ roles
and responsibilities should be clearly defined. Necessary education and training
should be provided for employees to be able to do their duties effectively. They
should be given opportunities to participate in decisions and actions affecting their
jobs. Workplace discrimination should be minimised and preferably eliminated.
Work environment and working procedures should be optimised.
In addition to applying organisational policies and strategies to improve employees’
quality of working life, employees should use personal strategies to enhance their
self-controlling skills to cope with job stress. Preventive stress management
programmes should be available for hospital employees.
Conclusion and implications for management Occupational
This study makes several distinct contributions. First, using a cross-sectional approach,
the level of employees’ occupational stress among a group of hospital employees in
stress and its
Iranian hospitals was examined. Second, factors contributing to employees’ consequences
occupational stress were identified. Third, the impact of occupational stress on
employees’ health status was investigated. Fourth, the relationship between
occupational stress and employees’ turnover intention was examined. 235
Hospital employees reported moderate levels of job-related stress. Factors that may
influence the level of employees’ occupational stress were demographic variables of
gender, age, tenure, graduation level, place of work, type of employment, type of hospital
and the four subscales of occupational stressors, as indicted in Table I. Occupational
stressors related to job itself, organisational policies, interpersonal relations and work
environment were the best predictors of occupational stress among hospital employees.
Occupational stress was associated with poor physical and mental health and increased
turnover intention.
There are several practical implications that can be derived from the findings. The
findings alert health care managers to become more knowledgeable about occupational
stress, the risk factors, mechanisms and effects. Because occupational stress is an
important determinant of employees’ retention, it is very important to reduce it by
applying the right human resources polices. The most occupational stressors for
hospital employees found in this study were inadequate pay, inequality at work, too
much work, staff shortages, poor promotion prospects, time pressure, job insecurity and
poor management support.
Hospital managers must apply appropriate policies and strategies to prevent and
reduce these occupational stressors. Such stress management programmes can decrease
the level of employees’ occupational stress by increasing their satisfaction with policies,
work conditions, compensation and promotion. Besides, there are many strategies for
coping with occupational stress that employees should adopt to cope with stress easily
and effectively. Physical activity, meditation, healthy lifestyle and time management
can help employees to cope with their occupational stress.

Limitations and implications for future research

The findings should be interpreted with caution, as the participants were hospital
employees from a particular province of Iran and do not represent all hospital employees
in this country. More research in this area is needed before generalizing the study
findings. More studies that involve hospital employees from other countries would
enrich the literature on occupational stress among hospital employees, which could, in
turn, generate strategies to improve the global retention of hospital employees. Future
research also needs to explore the effects of variables that were not measured in this
study, which can also directly or indirectly influence feelings of occupational stress,
such as external environmental factors.

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Further reading
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disorders”, Journal of Psychophysiology, Vol. 11 No. 3, pp. 238-247.

Corresponding author
Ali Mohammad Mosadeghrad can be contacted at: mosadeghrad@gmail.com

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