西南交通大学学报

第 58 卷 第 4 期 Vol. 58 No. 4
JOURNAL OF SOUTHWEST JIAOTONG UNIVERSITY Aug. 2 0 2 3
2023 年8月

ISSN: 0258-2724 DOI：10.35741/issn.0258-2724.58.4.2

Research article

Social Sciences

WORKLOAD, WORK-RELATED STRESS, AND EMOTIONAL

EXHAUSTION IN THE HEALTHCARE SECTOR

医疗保健行业的工作量、与工作相关的压力和情绪疲惫

Sandra Ingried Asaloei a,*, Edmond Leonard Jim b, Febry Hendra Jeskhiel Dien c, Basilius Redan Werang d
a
Faculty of Social and Political Science, Sam Ratulangi University
Manado, Indonesia, sandraаsaloei@gmail.com
b
Faculty of Medicine, Sam Ratulangi University
Manado, Indonesia
c
North Sulawesi Education Quality Assurance Agency
Manado, Indonesia
d
Fakultas Ilmu Pendidikan, Universitas Pendidikan Ganesha
Singaraja, Indonesia

Received: May 4, 2023 ▪ Reviewed: June 1, 2023

▪ Accepted: July 16, 2023 ▪ Published: July 31, 2023

This article is an open-access article distributed under the terms and conditions of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/4.0)

Abstract
Emotional exhaustion has been identified as a significant risk for professionals who work with people
in clinical services in hospitals. This study aimed to describe how workload and work-related stress
impact the emotional exhaustion of healthcare workers at Advent hospitals in Manado, Indonesia. To
attain this objective, we used three survey questionnaires to obtain data from 265 healthcare workers. The
obtained data were statistically analyzed using a simple linear regression analysis technique by employing
the SPSS software version 21. The results of the statistical analysis showed a positive impact of workload
on emotional exhaustion with the R2 coefficient value of 0.483 and the Sig. F change coefficient value of
0.000. It inferred that the workload and work-related stress positively impact the emotional exhaustion of
healthcare workers at Advent Hospitals in Manado, Indonesia. The findings of this study imply the need
for the management of Advent Hospitals to promote respectful and supportive interpersonal relationships,
encourage teamwork and shared goals among workers, and create social support systems to foster
workers‘ well-being and commitment. While emotional exhaustion among healthcare workers and its
predicting factors have been well documented in previous studies, this research context-specific approach
sheds new light on the issue. By conducting research in a specific hospital context, this study highlights
the importance of understanding the unique challenges faced by healthcare workers in different work
environments. This approach not only deepens our understanding of emotional exhaustion among
healthcare workers but also provides useful information for developing context-specific interventions
aimed at addressing the issue.

Keywords: Workload, Work-Related Stress, Emotional Exhaustion

 Asaloei et al. Workload, Work-Related Stress, and Emotional Exhaustion in the Healthcare Sector, Vol. 58 No. 4 Aug. 2023
13
摘要 情绪衰竭已被确定为与医院临床服务人员一起工作的专业人员的重大风险。本研究旨在描述
工作量和与工作相关的压力如何影响印度尼西亚万鸦老来临医院医护人员的情绪疲惫。为实现这
一目标，我们使用了三份调查问卷从265名医护人员那里获取数据。通过使用统计软件软件版本21
，使用简单线性回归分析技术对获得的数据进行统计分析。统计分析的结果表明，工作量对情绪
耗竭有积极影响，右2系数值为0.483，签名。F变化系数取值为0.000。它推断，工作量和与工作
相关的压力对印度尼西亚万鸦老来临医院医护人员的情绪疲惫有积极影响。这项研究的结果表明
，来临医院的管理层需要促进尊重和支持的人际关系，鼓励员工之间的团队合作和共同目标，并
建立社会支持系统以促进员工的福祉和承诺。虽然之前的研究已经充分记录了医护人员的情绪疲
惫及其预测因素，但这种针对特定背景的研究方法为这个问题提供了新的思路。通过在特定医院
环境中进行研究，本研究强调了了解医护人员在不同工作环境中面临的独特挑战的重要性。这种
方法不仅加深了我们对医护人员情绪耗竭的理解，而且还为制定旨在解决该问题的针对具体情况
的干预措施提供了有用的信息。
关键词: 工作量、工作压力、情绪疲惫
I. INTRODUCTION
Emotional exhaustion has been a topic of
interest for both researchers and healthcare
professionals [1]. The challenges posed by the
COVID-19 pandemic have tested the well-being
of people worldwide, with healthcare workers
being the most affected due to the increased risk
of exposure to the virus as they care for patients.
They were widely recognized as heroes for their
bravery in the face of uncertainty during new
health crisis [2].
There are various definitions of emotional
exhaustion in the existing literature. Emotional
exhaustion is defined in [3] as a result of intense
physical, affective, and cognitive strain that can
occur as a long-term consequence of exposure to
particular job demands, while [4] defined it as
the depletion of psychic energy or the draining of
emotional resources. Emotional exhaustion, is
described in [5] as the central quality of burnout,
while it is viewed as the core component of
burnout in [6]-[11].
Emotional exhaustion often occurs alongside
physical exhaustion, and its symptoms include a
lack of energy, less sleep, problems in one‘s
personal relationships, and increased alcohol
consumption [12]. When workers are emotionally
exhausted, they may no longer be able to remain
in their current personal or professional position
[13]. According to [14], almost half of the
workers experience high levels of emotional
exhaustion due to stressors such as heavy
workloads, low levels of support from
colleagues, personal engagement with their work,
a shortage of staff, the lack of professional
development opportunities, and the lack of
understanding of burnout.
The COVID-19 pandemic has had a
significant impact on the emotional exhaustion of
healthcare workers. Several factors are identified
as contributing to the emotional exhaustion of
healthcare workers. This study looks at two main
contributors. The first contributor is workload.
The workload is a concept that has multiple
dimensions, and therefore, it is difficult to define
it in a straightforward manner [15]. The workload
is the individuals‘ perception of the balance
between his or her own mental processing
abilities and the demands of the task at hand [16].
It can also be described as the intensity of job
assignments [17], or the feeling of being
overwhelmed by the demands of one‘s work
environment, which can lead to negative
emotions such as anxiety, frustration, and
annoyance [18].
The second contributor is work-related stress.
Work-related stress is a growing issue that is
affecting people all over the world, and it has
negative impacts on not only the workers‘ health
and well-being but also the productivity of
organizations. The World Health Organization
described work-related stress as the emotional
and physical strain that occurs when the demands
and pressures of work exceed a person‘s abilities
and resources for coping [19]. In a similar vein,
job stress is described as the negative physical
and emotional response that occurs when
workers‘ job demands do not match their skills
and needs [20]. Also, job stress is defined as the
experience of anxiety, worry, and depression
related to work [21].
Workload refers to the amount of work that
needs to be completed within a certain time

period [22]. According to [22], work-related
stress occurs when workers are unable to
effectively handle the demands and challenges of
their job. Work-related stress can arise in a
variety of situations and can be exacerbated when
workers feel unsupported by their supervisors
and coworkers and lack control over their work
processes [19]. Work-related stress can be caused
by various factors, including conflicts with
coworkers or supervisors, frequent changes in the
workplace, excessive workload, low salaries, and
feelings of insecurity about one‘s job, such as the
possibility of being laid off [23].
A huge number of previous studies have
investigated the workload impact [24]-[29] and
stress at work [30]-[39] on emotional exhaustion.
The increased workload and stress faced by
healthcare workers during the COVID-19
outbreak likely contributed to emotional
exhaustion [40]-[41]. This study aimed to
describe how workload and work-related stress
impact the emotional exhaustion of healthcare
workers at Advent hospitals in Manado,
Indonesia. As far as we are aware, there have
been no empirical studies that examined the
causal relationships among the surveyed
variables within the context of Indonesia in
general and the Advent Hospitals in particular.
Only one previous study [42] looked at the stress
of healthcare workers in Indonesia during the
COVID-19 outbreak.
Thus, this study intended to bridge the
existing knowledge gap in the existing literature
by examining the causal relationships among the
surveyed variables, taking the healthcare workers
at Advent Hospitals in Manado, Indonesia, as the
population and samples. Three research questions
were probed to guide this study: (a) Does the
workload impact significantly the emotional
exhaustion of health care workers at Advent
Hospitals in Manado, Indonesia? (b) Does the
work-related stress impact significantly the
emotional exhaustion of health care workers at
Advent Hospitals in Manado, Indonesia? A
quantitative survey research design was
employed to answer these research questions.
II. MATERIALS AND METHODS
As this study sought to describe the impact of
the workload and work-related stress on the
emotional exhaustion of healthcare workers
working at the Advent Hospitals in Manado,
Indonesia, a quantitative approach using a survey
research design was employed to obtain data
from 265 healthcare workers. A survey research
design was used as several current studies [43]-
[45] offered the following benefits: (a) low
14
budget, (b) accurate results, (c) strong
representativeness, (d) proper data collection
methods, (e) valuable statistical implications, and
(f) minimal researcher bias.
Three survey questionnaires were distributed
to 265 healthcare workers who were selected
through convenience sampling from those
working at Advent Hospital in Manado,
Indonesia. The convenience sampling method
was chosen due to the rotating shifts of
healthcare workers‘, which made it difficult to
determine a specific time frame for data
collection. This sampling approach allowed for a
diverse representation of healthcare workers
across different shifts and ensured a sufficient
sample size for statistical analysis.
To measure healthcare workers‘ perceptions
of their emotional exhaustion, we used a
questionnaire of 7 items from [46]. The list of
items used a four-point Likert scale marked from
1 (strongly disagree) to 4 (strongly agree). The
samples of questionnaire items in the English
version are as follows: ―I feel I get tired of my
current job,‖ ―I feel unenthusiastic about my
profession,‖ ―I feel drained of energy when I
come home from work,‖ ―I feel drained of both
emotional and cognitive energy at work,‖ ―I feel
drained after working during my shifts,‖ and
―Interacting with people all day long is a
significant strain for me.‖ The Cronbach‘s alpha
coefficient was used to test the instrument
reliability. For this study, the coefficient value of
Cronbach‘s alpha was 0.886.
To measure healthcare workers‘ perceptions
of their workload, we modified a questionnaire of
8 items from [29]. An Indonesian language
version of the questionnaires using a four-point
Likert scale marked from 1 (Strongly Disagree =
SD) to 4 (Strongly Agree = SA) was distributed
to 265 healthcare workers working at the Advent
Hospitals in Manado, Indonesia. The samples of
questionnaire items in the English version are as
follows: ―I experience stress regularly at work,‖
―I feel pressure to meet unrealistic deadlines and
time constraints,‖ ―I have to work very hard,‖
and ―It is hard to balance different demands that
are made on me.‖ The Cronbach‘s alpha
coefficient was used to test the internal reliability
of the instrument. For this study, the coefficient
value of Cronbach‘s alpha was 0.888.
To measure the healthcare workers‘
perceptions of their work-related stress, we
modified a questionnaire of 9 items from [47].
An Indonesian language version of the
questionnaire using a four-point Likert scale
marked from 1 (Strongly Disagree = SD) to 4
(Strongly Agree = SA) was distributed to 265
 Asaloei et al. Workload, Work-Related Stress, and Emotional Exhaustion in the Healthcare Sector, Vol. 58 No. 4 Aug. 2023
15

healthcare workers working at the Advent Indonesia.

Hospitals in Manado, Indonesia. The samples of
questionnaire items in the English version are the
following: ―I have too much to do during the
COVID-19 outbreak,‖ ―I feel disconnected from
others,‖ ―I have a lot of worries,‖ ―I feel burnout
mentally,‖ ―I feel overwhelmed by the demands
placed upon me,‖ and ‗I do not have enough time
for myself‘. The Cronbach‘s alpha coefficient
was used to assess the internal reliability of the
instrument." In this study, the coefficient value of
Cronbach‘s alpha was 0.708.
The obtained data were statistically analyzed
using the simple linear regression analysis
technique by employing the software Statistical
Package for the Social Sciences (SPSS) version
21. Two research hypotheses were investigated in
this study as follows (a) Workload positively
impacts the emotional exhaustion of health care
employees at Advent Hospitals in Manado,
Indonesia; and (b) Work-related stress positively
impacts the emotional exhaustion of health care
workers at Advent Hospitals in Manado,
III. RESULTS
As mentioned above, this study aimed to
describe the potential impact of workload and
work-related stress on the emotional exhaustion
of healthcare workers. With the help of SPSS
software version 21, the responses of 265
healthcare workers on the questionnaires were
analyzed. We were really aware that testing the
data normality is a prerequisite in data analysis
using a simple linear regression model. However,
due to the large number of samples in the study,
we disregard the prerequisite test [48].
Based on the proposed research questions, the
objective of this study was twofold. The first
objective is to describe the prospective impact of
workload on the emotional exhaustion of
healthcare workers working at Advent Hospitals
in Manado, Indonesia. The significant results of
statistical analysis on the causal relationships
among the variables are presented in Table 1.

Table 1.
Workload and its impact on health care workers‘ emotional exhaustion
Model Summary
Model R R Square Adjusted R Std. Error of Change Statistics
Square the Estimate R Square Change F Change df1 df2 Sig. F Change
1 0.695a 0.483 0.481 2.19654 0.483 245.626 1 263 0.000
a
Predictors: (Constant) Workload

The data displayed in Table 1 showed a
positive impact of the workload on the health
care workers‘ emotional exhaustion as the
coefficient value of R Square (R2) is 0.483 and
the coefficient value of Sig. The F Change is
0.000. This result demonstrates that the second
research hypothesis ―Workload positively
impacts the emotional exhaustion of the health
care workers at Advent Hospitals in Manado,
Indonesia‖ is confirmed, while the null
hypothesis is unconfirmed. It inferred that 48.3 %
of healthcare workers‘ emotional exhaustion
could be explained by their workload, while the
remaining 51.7 % should be attributed to other
variables that are not the focus of this study.
The second objective is to describe the
prospective impact of work-related stress on the
emotional exhaustion of healthcare workers
working at Advent Hospitals in Manado,
Indonesia.

Table 2.
Work-related stress and its impact on healthcare workers‘ emotional exhaustion
Model Summary
Model R R Square Adjusted R Std. Error of Change Statistics
Square the Estimate R Square Change F Change df1 df2 Sig. F Change
1 0.583a 0.339 0.337 2.48274 0.339 135.123 1 263 0.000
a
Predictors: (Constant), Work_Related_Stress

The significant results of statistical analysis
on the causal relationships among the variables
are presented in Table 2. The data displayed in
Table 2 showed a positive impact of work-related
stress on the health care workers‘ emotional
exhaustion as the coefficient value of R Square
(R2) is 0.339 and the coefficient value of Sig. F
Change is 0.000. It demonstrates that the second
research hypothesis ―Work-related stress
positively impacts the emotional exhaustion of
the health care workers at Advent Hospitals in
Manado, Indonesia‖ is confirmed, while the null
hypothesis is unconfirmed. It inferred that 33.9 %
of healthcare workers‘ emotional exhaustion

could be explained by their work-related stress,
while the remaining 66.1 % should be attributed
to other variables that are not the focus of this
study.
IV. DISCUSSION
Work-related stressors, including heavy
workloads and mistreatment, as well as job
insecurity, may negatively affect the health of
workers [49]-[50]. Current work conditions,
including these stressors, are causing difficulties
for workers [49]-[51]. Emotional exhaustion has
been identified as a significant risk for
professionals who work with people in clinical
services in hospitals [53]. The results of
statistical analysis showed a positive impact of
workload on the emotional exhaustion of
healthcare workers working at the Advent
Hospitals in Manado, Indonesia, as indicated by
the R2 coefficient value of 0.483 and the Sig. F
Change coefficient value of 0.000. It
demonstrates that for every point increase in the
variable ―workload‖ will be an increase of 0.483
points in the variable ―emotional exhaustion‖ and
for every point decrease in the variable
―workload‖ will decrease by 0.483 points in the
variable ―emotional exhaustion‖. In other words,
a higher level of workload leads to a higher level
of emotional exhaustion and vice versa. The
findings of this study comply with research
findings [29] that workload was positively related
to emotional exhaustion. The findings of this
study are also in line with research findings of
[54] and [55] that workload impacts positively on
the emotional exhaustion of nurses.
Healthcare workers are more likely to thrive
in their jobs when the demands and pressures
they face are appropriate for their skills and
knowledge, they have some control over their
work and how they do it, they receive support
from their supervisors and colleagues, and they
are involved in decision-making processes related
to their jobs. When these conditions are not met,
they are more likely to experience work-related
stress [19] and, in turn, negatively affect workers‘
mental health and increase their risk of
developing conditions such as anxiety, burnout,
depression, and substance abuse disorders [56].
Emotional exhaustion is also caused by a long
period of constant life stress, whether by personal
stress at home or stress related to work [37]. The
incongruence between organizational demands
and a worker‘s resources to meet these demands
leads to work-related stress on the job and
overtime emotional exhaustion [34]. The results
of statistical analysis showed a positive impact of
work-related stress on the emotional exhaustion
16
of healthcare workers working at Advent
Hospitals in Manado, Indonesia, as indicated by
the R2 coefficient value of 0.339 and the Sig. F
Change coefficient value of 0.000. It
demonstrates that for every point increase in the
variable ―work-related stress‖ will increase 0.339
points in the variable ―emotional exhaustion‖.
Conversely, for every point decrease in the
variable ―work-related stress‖ will decrease 0.339
points in the variable ―emotional exhaustion‖. In
other words, a higher level of work-related stress
leads to a higher level of emotional exhaustion
and vice versa. The findings of this study comply
with research findings of [25] and [57] that job
stress is positively related to emotional
exhaustion.
Generally speaking, heavy workloads and
chronic stress can lead to emotional exhaustion,
which can have negative impacts on both
physical and mental health [58]. Positive
emotions can help prevent work-related stress
and emotional exhaustion. Research has shown
that mindfulness-based stress reduction
techniques can be effective in reducing
psychological symptom] [59]. It is suggested that
healthcare workers on the front line adopt
sensible work schedules, practice self-
management, and engage in mindfulness
activities as a way to reduce the risk of
exhaustion [60]. Team leaders and administrators
of Advent Hospitals should organize
mindfulness-based and self-management
activities to improve healthcare workers‘ ability
to cope with stress and prevent emotional
exhaustion. From this viewpoint, implementing
workplace wellness programs that teach skills for
psychological detachment, provide personal
resources such as optimism, and use relaxation
techniques could be a way for healthcare workers
to take care of themselves. Training in optimism
as a skill may help protect the well-being of
healthcare workers by creating healthy
environments and positive expectations, similar
to how recovery may increase energy levels.
These programs should also address balancing
work and life by adjusting working hours.
V. CONCLUSION
The healthcare industry is one of the most
demanding and challenging fields, and healthcare
workers are often exposed to various sources of
stress and workload, which can lead to emotional
exhaustion. This study sheds light on the impact
of workload and work-related stress on emotional
exhaustion among healthcare workers at Advent
Hospitals in Manado, Indonesia. The conclusion
depicted from the results of the statistical analysis
 Asaloei et al. Workload, Work-Related Stress, and Emotional Exhaustion in the Healthcare Sector, Vol. 58 No. 4 Aug. 2023
17
is that workload and work-related stress
positively affect healthcare workers‘ emotional
exhaustion.
The results of the study have important
practical implications for managing Advent
Hospitals and potentially for other healthcare
contexts in Indonesia. The findings of the study
suggest that healthcare organizations need to
prioritize the well-being and commitment of their
workers in order to prevent emotional exhaustion,
which can lead to burnout and negatively affect
patient care. Therefore, the management of
Advent Hospitals in Manado should promote
respectful and supportive interpersonal
relationships, encourage teamwork and shared
goals among healthcare workers, and create
social support systems to foster workers‘ well-
being and commitment.
The findings of this study make a valuable
contribution to the body of existing knowledge
on emotional exhaustion among healthcare
workers. Although numerous studies have
investigated the relationship between workload,
work-related stress, and emotional exhaustion,
this study provides a unique perspective by
focusing on healthcare workers at Advent
Hospitals in Manado, Indonesia. The research
results also add to the growing body of evidence
that highlights the importance of addressing the
well-being and commitment of healthcare
workers to prevent emotional exhaustion and
burnout.
While this study provides valuable
information about the relationship between
workload, work-related stress, and emotional
exhaustion among healthcare workers in Advent
Hospitals in Manado, it is important to note that
the findings may not be generalizable to other
healthcare contexts within Indonesia. Therefore,
it would be beneficial to conduct further research
with a wider range of areas and hospitals to
generate more comprehensive findings.
Future studies could also consider exploring
other factors that contribute to emotional
exhaustion, such as work-life balance, job
satisfaction, and organizational culture.
Moreover, studies could investigate the
effectiveness of interventions aimed at reducing
workload and work-related stress and promoting
the well-being and commitment of healthcare
workers. Ultimately, the findings of this study
provide an important starting point for further
research and underscore the importance of
prioritizing the well-being of healthcare workers
in Indonesia and beyond.
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