CHAPTER-1

INTRODUCTION

Stress is everywhere due to urbanization, changing life styles, technological

advancements, increased competitiveness, etc. turning the work places into stress
factories for employees making it the age of anxiety. Some words related to stress are
anxiety, pressure, worry, hardship, burden, fearfulness, nervousness, frustration, etc.
and even though they have different meanings the common reason underlying them all
is stress. Different people understand stress differently because it is a new and complex
concept. But it is important to understand stress and its functioning because it is
spreading everywhere around the world.

Stress is omnipresent in all walks of life and the employees feel excessively burdened
due to increased versatility of work places and work environment. Of all the kinds of
stress an individual faces in his entire life, job stress is the biggest and most important
among them all. Job stress is the first level result of having a job or of working in an
organization, which then results in second level result of having a job (first level result
of job stress), impacting employee job satisfaction, commitment, performance,
motivation, etc.

Occupational stress impacts organizational as well as employee performance, which

causes dissatisfaction among them. It disturbs the balance between employees‘ work
and life, resulting in higher turnover intentions and actual turnover among them,
making them not to want to come to office or perform their jobs.

1.1 Occupational Stress

The word ―STRESS‖ originated from the word ―Stringere‖ in Latin meaning to tighten.
Stress is the physical, mental, emotional and behavioural changes felt by us while
responding to changes in the outside world. Every individual has his own set of
resources and similarly every individual faces some demands, requirements or
pressures to use these resources to carry on daily functioning. Stress occurs when an
individual has this unpleasant feeling that his personal physical, social, emotional,
behavioural and other resources are less than the pressure, requirements and demands

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he faces. According to Holyroyd and Lazarus (1982) ―psychological stress requires a
judgement that environmental and/or internal demands exceed the individual‘s
resources for managing them‖.

Our bodies release some chemicals in blood which give us more energy and strength
when we feel stressed. This chemical release can be good if stress is caused by physical
danger as it helps an individual in fighting and protecting himself from the danger. But
this is bad if stress is caused by something emotional or psychological because there is
no outlet for this extra energy and strength thus impacting health negatively. The centre
for studies on human stress states that ―Some common features of things that can make
us feel stressed include experiencing something new or unexpected, something that
threatens your feeling of self, or feeling like you have little control over a situation.‖

A large number of studies have been conducted to have a clear and precise definition of
stress, understand its causes, symptoms and effects and what can be done to minimise it
or at least manage it effectively. People have been in stress since medieval times and
there were no clear definition of stress in those times, but generally stress referred to as
the pain, starvation, life hardships, etc. of those times. Stress still does not have
adequate concept clarity, even after numerous studies being conducted in the field.
Hans selye is considered to be the father and pioneer of research studies conducted on
stress in modern days. He first used the word stress in medical terms in 1920. He came
up with GAS (General Adaptation Syndrome) theory in 1936, which states how
different bodies respond in the event of facing stress. His theory defines stress in a
response based model. He defined stress as ―response of the body to any demand,
whether it is caused by, or results in, pleasant or unpleasant conditions‖ (Selye, 1976).
Another definition according to a response based model was given by Eliot (1988)
―stress may be viewed as the body‘s response to any real or imagined event perceived
as requiring some adaptive response and/or producing strain‖.

Some other researchers define stress as a stimulus based model. Acc to them, stress is
what causes a person to react when faced with a difficult or threatening situation.
Marshal and cooper (1979) defined it as ―stress is a stimulus or situation to which
man reacts with learned coping mechanism activated by homeostasis principle and
fuelled by energies which are in finite supply.‖ Another stimulus based definition given

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by Skinner (1985) defined stress as ―a reaction of a particular individual to a stimulus
event‖. These definition also lack in defining stress completely. For example, different
students feel different levels of stress during final examination. A well prepared student
will be far less stressed than an ill prepared student.

Therefore, a third way for defining stress emerged, which includes the way people
appraise and perceive the threatening and demanding situation, and their resultant
reactions. Here, the importance is being placed on the perceived danger or threat of a
situation for a particular individual, thereby including the individual differences in
situation appraisal. Lazarus, (1966) defined stress as "Stress refers to physiological,
behavioural and cognitive responses to events appraised as threatening or exceeding
one's coping responses and options." Here are some of the other popular definitions of
stress that are used commonly while defining stress.

Arnold in 1960 stated that, "Stress is any condition that disturbs normal functioning".

Wolff (1968) defined stress as; "Stress is a dynamic state within an organism in
response to a demand for adaptations‖.

Hans selye in 1979 further expanded his stress definition as ―stress is a ‗perception‘. It
is the demands that are imposed upon us because there are too many alternatives‖.

Humphrey in 1992 defined stress as; ―stress can be considered as any factor, acting
internally or externally that makes it difficult to adapt and that induces increased effort
on the part of the person to maintain a state of equilibrium both internally and with the
external environment‖.

Knotts (1996) stated that, ―A stress response occurs as a result of an individual‘s

interaction with and reaction to the stressor‖.

Stephen P Robbins (2006) defined ―stress arises from an opportunity, demand,

constraint, threat or challenge, when the outcomes of the event are important
and uncertain.‖

According to Angela Morrow RN, (2011), ―Stress is the body‘s reaction to a change
that requires a physical, mental or emotional adjustment or response. Stress can come
from any situation or thought that makes you feel frustrated, angry, nervous, or
anxious. Stress is caused by an existing stress causing factor or stressor‖.

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The centre for studies on human stress states that ―what contributes to stress can vary
hugely from person to person and differs according to our social and economic
circumstances, the environment we live in and our genetic makeup‖.

Even though a huge number of studies has already been conducted on stress and a wide
spread usage of the word stress is everywhere, there is still no conclusive definition of
stress that can define it completely and in totality. The term stress and the whole
concept of stress are still very vague and very difficult to be defined precisely and
accurately.

Whether a situation or condition causes stress to an individual or not can be ascertained

by its two-tier appraisal, i.e., primary and secondary appraisal. The primary appraisal is
done when the situation or condition starts to rise. The individual in primary appraisal
ascertains that whether the particular situation poses a threat to him or not. If it doesn‘t
then it is not considered as stressful. However, if it does than it requires a secondary
appraisal where the individual ascertains whether something can be done about it or not
and whether some effective options are available to deal with it. This secondary
appraisal ascertains the degree of stress that the individual has to face. The larger the
number of effective solutions available, the less stressful it is for the individual.
Therefore the presence or absence of stress and the degree of stress arising from a
situation depend on the individual appraising the situation. According to Hans Selye
(1976), stress lies in the eyes of the beholder, as it depends largely on how one
responds to what is happening rather than on what is happening. According to Lazarus
and Folkman (1984), a situation is seemed to be less threatening and stressful if the
individual believes that he can do something about it. They added an additional stage
called reappraisal in this process where the individual reappraises the original stressor
and its effects and the control he has on the effects.

The level of stress and its impact are different for different individuals. There is an
optimum level of stress for everyone and it varies from person to person. This level is
crucial to performance as any stress below this level will make the work boring and
hampers an individual‘s motivation to perform better. While any stress above this level
will also have an adverse affect on performance, thereby effecting an individual health
and attitudes towards work and organisation. An individual will strive to give his/her

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best performance at this optimum level of stress. This optimum level of stress depends
on a person‘s tolerance regarding stress. Some people perform their best when they are
under high level of stress while some people have poor tolerance for stress and their
performance lack even under very low level of stress. An individual‘s experience
regarding the stressors he is facing also affects his tolerance regarding stress. An
experienced person will perform better than inexperienced one under the same
stressors.

Beehr and Newman (1978) defined occupational stress as ―A situation wherein job-
related factors interact with a worker to change (i.e., disrupt or enhance) his or her
psychological or physiological condition such that the person (i.e., mind-body) is
forced to deviate from normal functioning.‖

Westman. M (2005) defines job stress as ―Job stress arises when demands exceed
abilities while job - related strains are reactions or outcomes resulting from the
experience of stress‖.

Causes and Symptoms of Stress

Employees feel continuously under stress and pressure to perform well in changing
dynamics of work caused by ever changing business environment factors. These
changes can be in external environment like technological advancements, international
political environment, foreign policies, industrial and labour laws, consumers‘ tastes
and trends, international market policies etc. Or these could be in internal environment
like extended working hours, work-place environment, virtual workplace settings,
workforce culture and diversity, work teams and groups, management style and
approach, etc.

There are numerous things related to life or job that can cause stress to employees.
These can be divided into organisation related, work related, job related and individual
related stressors. The top 10 stressors observed by Global business and Economic
Round table of Addiction and Mental Health are: lack of control, lack of
communication, inadequate appreciation, poor feedback (good or bad), lack of clarity in
policies and direction, mistrust, unfairness and office politics, pervasive uncertainty,
random interruptions and the treadmill syndrome.

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The organisation an employee works in and the kind of work environment it provides
to its employees plays an important role in assessing the level of stress of employees.
The most important organisation related stressors can be the management structure,
employee participation in management and managerial support and supervision. Other
stressors may include workplace power and politics, absence of proper authority and
responsibility structures, rapid organisational changes, reorganisations of internal
structures, long commutes, etc.

The kind of working environment employees have to work in also adds to employee
stress. It includes lack of social and co-worker support, co-worker rivalry, ambiguous
work practices, hazardous working conditions, unhealthy and unsanitary work place
conditions, unequal pay scale and unfair compensation, lack of appraisal and
recognition, poor remuneration and reward system, conflicts and hostility, etc.

Any job can cause stress to the employees too based on their reaction to the job
therefore job related stressors may include role conflict and ambiguity, job insecurity,
poor job design and description, unrealistic targets, demanding boss, authority and
responsibility mismatch, etc. Occupational stress also occurs when employees are
allocated with jobs that have demands and pressures outside the physical, mental or
psychological capabilities and resources of employees, thus making it hard for them to
cope up with these pressures and perform their jobs. Occupational stress can also occur
due to poor designing of jobs along with bad organizational and management structure
in an organization.

Similarly the nature and amount of work an employee has to do can also add up to the
stress s/he is facing. The work related stressors can be work under or over load,
monotonous work, occupational demands and resources mismatch, angry customers,
inflexible working hours or policy, etc.

Individual factors also cause stress to employees and these factors can be further
categorised in person related stressors, family related stressors and society related
stressors. The person related stressors can be educational level, poor career planning
and management, job insecurity, personal finances, fears and anxieties about the future,
health issues, personal growth and maturity, etc. The family related stressors can be
family relationships, family problems and outlook, economic stability, family size, etc.

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And the society related stressors can be low job and social status, value and cultural
differences, individual differences, poor inter-personal relationships, geographical and
departmental mobility, etc.

Any factor, whether physical or emotional, resulting in physical or mental imbalance

for an employee is occupational stressor. Even if these factors are not visible from the
outside for some time, they continue impacting employees from the inside leading them
towards turnover. Acc. to Bemana, et al. (2013), psychological stress is the most
dangerous type of stress as it affects employees psychologically more so than
physically and hence impacts their job performance severely. This results in decreasing
their job satisfaction and performance and increasing turnover intentions (Singh et al.,
1994). Other than that, the chronic job stress is the one that happens due to normal and
daily routines related to jobs and hence affects the daily working of employees, while
episodic stress is the result of some special or specific incidents, acc. to Eden and Dov
(1990).

Pressure at workplace is unavoidable as every job has some demands and resources for
employees which create a certain amount of pressure on employees to perform their
jobs in timely and efficient manner. An acceptable amount of this pressure is necessary
for employees to keep them in their best form to stay alert, feel motivated, learning
continuously and perform efficiently. But when this pressure surpasses the acceptable
measures or continues for long time periods, it starts increasing occupational stress
among the employees affecting their health, performance and behavior at work.

For example setting a goal or target to achieve within a specified period of time often
drives and motivates employees to perform better to reach that goal but if that target is
unachievable or too hard to be reached than that pushes employees under the condition
of stress due to non accomplishment of job. Even if employees reach the high target, if
this high target setting goes on for long time periods it puts employees under
continuous stress, negatively impacting their health, performance and productivity.
Feeling pressure while doing a job is very common, but it starts stressing employees
when they have no support or help from their supervisors, colleagues and peers. Every
occupation or job has its own stressors and the condition of occupational stress arises

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due to inefficient coping with these stressors which causes negative impact on physical,
mental, emotional, psychological and behavioral health of employees.

Numerous symptoms and reactions indicate or start showing when the employees are
going through stress. These indicators can be physical such as high blood pressure,
increased heart rate, insomnia, visible sadness and tiredness, wearsomeness, trembling,
changes in appetite or sleep pattern, fidgeting, headaches, pain in neck and lower back,
tiredness, motion changes, etc. The symptoms can be emotional and behavioural too
including general irritability, feeling helpless, haste, increased accident proneness,
frustration, anxiety, tension, inability to concentrate, mood swings, negative emotions,
anxious feeling for no specific reason, nervousness, short-tempered, etc.

Stress Process

Pestonjee in 1992 chalked out a process of five stages in which occupational stress
progresses. According to him, the first stage i.e., the honeymoon stage starts when an
employee enters any organisation. Since the employee is new on the job, it will provide
him with thrill and excitement for the upcoming job and will affect his performance
positively. However it will also have negative affects as the employee will have to
adjust, adapt and cope up with the new environment which can be stressful. The second
stage is full throttle stage. This stage starts when an employee has worked in an
organisation for long enough to start feeling tired and fatigued and showing symptoms
like lack of sleep, over eating, drinking and smoking, etc. The third stage is the chronic
symptom stage where employee shows more pronounced and chronic effects of stress
like depression, physical illness, exhaustion, etc.

If proper care is not taken at third stage then the employee enters the fourth stage of
stress development i.e., the crisis stage. At this stage the employee is under severe
stress and his body slowly starts giving up to stress in the form of chronic illness like
back pain, high or low B/P, insomnia, headaches, digestive disorders, sleep disorders,
etc. and the employee starts developing an escapist attitude towards work and his
problems. If the employee still keeps performing under these severe stress conditions
then he enters the fifth stage of stress which is hitting the wall stage, which might end
the professional career of an employee. In this stage the employee has used all of his

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resources to keep up with the demands of the job and ultimately feels burn out and
leaves the organisation.

Types of Stress

Stress can be categorised into anticipatory stress, current stress and residual stress.
Anticipatory stress is the way one responds to expected stress. It sharpens one's body
and mind for events that are about to happen and therefore is good in moderate amount,
But can be harmful if excessive as people will start focussing more on future rather
than present. Current stress is the one occurring currently and can produce optimal
performance if utilized effectively. Residual stress is the after-effects felt by the person
after current stress, i.e., the body remains active and alarmed for some time even after
experiencing stress. Acc. to the General Adaptation Syndrome (GAS) by Seyle (1976),
stress occurs in three stages, first, the alarm stage is initial shock phase of lowered
resistance and counter attack; second, the resistance stage leads to maximum
adaptations and individual equilibrium; and the third is the exhaustion stage which
results in collapse of adaptive mechanisms and have physical and mental affects for
employees.

Both good and bad experiences can cause stress to employees and therefore, all stresses
are not destructive in nature. Stress is considered to have both positive (eustress) as
well as negative (distress) sides to it. Eustress results in encouraging workers and
enhancing their work performance, while, distress may lead to negative effects on
workers‘ health and performance. Well-managed stress in appropriate amount can
trigger employees‘ performance and passion for their jobs, tap their hidden potential
and abilities and inspire innovation and creativity. On the other hand, over-stress may
kill brain cells which lead to creativity. The positive or negative results of stress depend
on the way employees perceive the situation. If an employee feels confident that he can
successfully accomplish the tasks assigned to him while handling all the subsequent
pressures, then stress works as a motivator (Halkos and Dimitrios, 2010). But now this
perception is changing again, as employees may react to stress immediately (short-term
reactions) as well as take longer time periods (long-term reactions) and research has
revealed that performance is negatively impacted even by low levels of stress, if stress
is continuous, because performance is negatively related to occupational stress. The

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organization and the management should properly manage the occupational stress
levels among employees to get the work done in effective and efficient manner.

Impact of Stress

Occupational stress negatively impacts both the employee performance and the
organisational performance. It impacts organisational performance negatively by
increasing absenteeism, turnover and turnover intentions among employees, low
productivity and profits, increase in fights, arguments and hostility, organisational
ineffectiveness, increasing legal and financial costs, etc. Stress also affects
organisations by decreasing performance and productivity, poor employee and
organizational commitment, hostile working environment with sometimes showing
aggression through strikes and lockouts, etc. Occupational stress impacts employees
negatively by reducing motivation, unproductive work behaviour, poor physical and
mental health, individual ineffectiveness, work-life imbalance, poor job performance
and satisfaction, etc. Occupational stress directly impacts employee‘s physical health,
emotions and thinking processes along with their performance.

Distress has negative effects not only for the employee but also for his family and the
organisation he serves. Distress has manifold negative effects for employees. It affects
the employee on health, cognitive, subjective, behavioural and physiological levels.
And when this distress is not handled properly or is handled by inappropriate measures,
like drinking, smoking, etc. it can result in disturbing the home and personal life of
employees. Child and spouse abuse, domestic violence and even family break-off can
be the after-effects of poor stress coping mechanisms.

The perceived effects of stress are changing as it is not always negative and when it is
positive it improves productivity of an organization (Spielberger, 1980). It acts as a
positive force for those employees who have a clear and calm approach regarding
dealing with stressful conditions by making them focus better on work, boost
determination to perform and putting them in action to accomplish the task in hand.
While it acts as a negative force yielding opposite results for those without any clear
approach regarding dealing with stress. An employee‘s ability to deal with and manage
occupational stress is what defines success and failure at a job.

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Stress Management

Stress impacts different people differently. One employee may feel little or no stress,
while another may feel over stressed from the same task because of the differences in
their experiences, outlooks and expectations. Stress is much more common in lower
level employees, because of meagre job control and autonomy. The level and
consequences of stress vary among organizations too, based on work practices and
policies. Therefore, organizations must begin to manage people at work differently by
respecting them and valuing their contributions.

Organisations and management can use various strategies to manage stress for
performance improvement and job satisfaction among employees like stress control
workshops, skill training, participation in decision-making, goal-setting and
management, social recognition, continuous training of employees, supportive work
climate, ploughing anger and energy into something positive, job enrichment,
enhancement and clarity, keeping employees busy, career counselling, planning and
development, meditation camps, employee assistant programmes, developing broader
perspective of life, flexi-time, introducing work-fun activities, work place harmony, job
sharing, etc. to retain their skilled employees. And employees can also resort to some
measures on their personal level like relaxation, cognitive therapy, smooth work-home
transition, being harmonious, office networking, yoga and meditation, physical
exercise, musical retreats, etc. for coping with stress.

Managing stress does not mean leaving jobs or making huge work place changes as all
kinds of jobs and workplaces have stress inherent in them. An employee cannot control
everything prevailing in his work environment and all the aspects of his job. What he
can do is change his own ways of dealing with difficult situations and related stress.
The most important thing is to focus on themselves and improve their own capabilities
and capacity to manage and reduce stress.

A person can feel stressed the moment he enters his work place, the reason could be
yesterday‘s incomplete work or a target to be achieved in near future or family related
burden, etc. A lot has been talked about managing stress while focussing on what
should be done or needs to be done in future to avoid stress, but what needs to be
focussed on is what should be done at the very moment the employee is feeling

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stressed, i.e., stress in the moment. To manage stress in the moment, an employee can
talk to him/her self. It has proven to be effective to talk positively to oneself in stressful
situations and improves control, concentration and performance of an employee.
Another strategy could be to find a friendly ear that will listen to you. It is believed to
relieve stress and put one at ease when one talks about his/her problems with someone.
Another effective strategy is thinking about the time when the stressful situations will
be over and one will be back to his/her normal routine.

1.2 Work Life Balance

Work life balance is important for any employee to work effectively and efficiently.
Work life balance in simple terms mean to maintain a balance between paid and unpaid
activities by a person. The activities they get paid for comes under the work dimension
while the activities they don‘t get paid for add to their personal life dimension. It has
been stated that an employee on an average should work for 46 hours a week and 1900
hours a year. If he has to work for more than that, this will lead to causing imbalance in
their personal and professional lives and can create stress and job dissatisfaction among
them. This stress and dissatisfaction often hinder their productivity and performance.

Work life balance has different meaning for employees and employers. For employees
it means the hard ships one faces while trying to balance and fulfil his work and family
life responsibilities. For employers it means to facilitate the employees with such a
work environment where they can focus on their work responsibilities without
worrying about their family responsibilities. Work-life balance also works differently
for men and women. They have different perceptions regarding work and life and they
attach different weightage to both. When women are more tilted towards family life and
render it more important devoting more time and efforts on family life, men are more
prone to choosing their jobs and personal interests over family responsibilities. So they
approach a perfect work life balance differently and achieve it in their own ways.

Causes and Impact of Work Life Balance

Work life balance means striking balance between ones professional life and personal
life, where personal life consists of both family and private time. So work life balance
consists of balancing all three, professional, family and personal dimensions of one‘s

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life. These dimensions require time, effort and energy on part of the employees. This
time, efforts and energy are considered as the resources of an employee and as these
resources are limited to an employee, he needs to consider the outcomes of dedicating
these resources to a particular dimension. The demands arising from different
dimensions for these resources create situations for employees where they have to make
decisions regarding resource allocation in order to balance all the dimensions perfectly
to have as minimum turbulences among them as possible. How many resources should
be deployed to various dimensions is subjective to the employees and no fix ratio can
be stated for that. A healthy work-life balance does not mean dividing these resources
equally to various dimensions, but it is about dividing them in such a way so as to
achieve harmony in all the dimensions of a person‘s life based on his decisions and
choices.

An imbalance occurs when demands from one dimension increase so much so to cause
disruption in other dimensions by leaving less resources for them. Work life imbalance
results because of work to life and life to work conflicts. Excessive demands from work
dimension can take toll on employees‘ personal life and similarly excessive demands
from life dimension can hinder their performance at work place. If it goes on for longer
time periods it disrupts the work-life balance of an employee thereby causing him stress
and leaving him dissatisfied.

There are a large number of negative outcomes of employees losing their work life
balance. These are increased stress and turnover intentions, reduced job satisfaction and
employee commitment, lack of concentration at work, health issues, lack of energy and
alertness, reduced productivity and performance, unhappiness and sleepiness at work,
etc. The negative effects of work-life imbalance can also include job exhaustion,
disruption of personal relationships, loss of enjoyment, etc. Work-life balance is
enhanced by creating and maintaining such supportive and flexible work environments
that will increase employee loyalty and productivity by providing them with
opportunities and flexibility to fulfil their family responsibilities. Therefore, the
organisations are putting forth enhanced efforts to help employees in creating,
achieving and then maintaining the balance so achieved in their personal and
professional lives.

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Work Life Balance Models

The work-life balance concept is not as simple as that. It has gone through a number of
stages and has evolved with each stage. Zedeck and Mosier in 1990 stated that work
life balance can be understood with the help of five models. These models discuss how
work life balance has evolved through time. The first model is the segmentation model.
According to this model, an employees work life and personal life can be segmented
into two different parts and these two parts have no relation with each other. That
means these two are independent of each other and do not have any effect on each
other. This model can be used only for theoretical knowledge as it does not hold any
ground in the recent working environment.

The second model they gave is the spill over model. According to this model, one of
the segments of an employee‘s life affects the other segments. These affects can be
either positive or negative. Although numerous research works have been done to
explore this model in the past, it requires further refinement, and so has also been
rendered ineffective. The third model given by them is compensation model. According
to this model, if an employee is lacking in one of the segments he can compensate for it
in other segments. For example, if an employee has a relatively easy job, he can
compensate by participating in more tedious community services. And if he is working
difficult jobs, he can use his free time for relaxation and leisure. The fourth model put
forth by them is instrumental model. This model states that the over work done in one
segment is compensated by reaping the benefits in the other segments. For example, if
an employee dedicates more of his hours in work dimension he will get paid more and
can reap the benefits of this extra money by spending it on himself and his family
members, thereby increasing satisfaction in his personal life.

The fifth and last model is conflict model. According to this model, demands do not
raise in only one segment at a time. The demands for time and efforts on part of the
employees can rise in all the segments simultaneously and can cause troubles, increase
stress and become overload for them. This increased stress and load can put the
employees under difficult situations to make difficult decisions thereby creating
conflicts among their personal and work lives. This model is gaining popularity these
days and has become the locus for many studies that are being done to understand the

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work life balance of employees. The reason behind increasing work-life conflicts could
be dual career families, increased work load, increased social comparisons, changing
family dynamics, increased nuclear families, single parenting, etc.

Work Life Balance Management

Employee‘s work-life imbalance causes stress and stress causes work-life imbalance.
Work-Life Balance (WLB) has become a noteworthy factor and strategic concern for
the HR personnel in employee‘s retention strategy as it affects employee‘s decision to
continue or not with an organization. Work-life balance is an employee‘s perception
regarding the personal, family and work dimensions of his life are working and
operating in harmony with minimal conflict. Work-life balance issues increase because
of dual-career families, job demands and resource mismatch, long working hours with
fewer holidays, increasing women in workplace, demographically diverse workforce,
etc. Work-life balance programs are the policies and procedures implemented in an
organization that enable employees to perform their jobs efficiently, while
simultaneously providing them with flexibility to handle personal and family problems.

A wide variety of WLB initiatives, practices and programs are designed and
implemented across various organizations and industries, to provide control to
employees over their personal as well as professional life, like childcare support, family
leave, flexible work-time, telecommuting, remote working, etc., so that they can
manage all of the competing demands of both the dimensions and avoid any negative
effects of spill over on these dimensions.

A number of special policies are implemented by organisations these days to help

employees in maintaining a good work-life balance. These include but are not limited
to flexi-time, telecommuting, compressed work weeks, part-time work, job sharing,
family parties and vacations, etc. Flexi-time helps employees in deciding the time
frame in which they are more comfortable and at ease at work. The employees
generally have to dedicate a fix number of hours at work, flexitime gives them the
liberty to decide which hours they want to dedicate. Telecommuting also refers to as
work from home. This saves employees a lot of time that is otherwise wasted in
commuting to and from work. This also gives them an opportunity to fulfil family
responsibilities while working their jobs. Compressed work weeks are when employees

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work extra hours on some days of the week in order to get an additional day off. This
again helps employees in saving the time wasted in commuting to and from office. It
also provides employees with longer weekends and they can plan their personal
activities accordingly.

Part-time work is very convenient for employees who cannot dedicate a lot of time at
work. It helps them in earning money by working without being short on their family or
personal responsibilities, like, mothers, old age people, people working two jobs,
people with time constraints, etc. Job sharing also works like part time jobs but here
two people share a job and if one cannot perform due to some reason the other can
cover up for them. Organisations are also including family activities these days at work
like family parties and vacations so that the employee‘s family also feel some sort of
connection with organisations.

Establishing, maintaining and enhancing work life balance is important for employees
to perform their jobs effectively along with maintaining harmony in their personal
lives. If this balance is compromised the work place becomes stressful for employees
and it gets difficult to get their work done. Their personal lives also get stressful adding
furthermore to their stress, pushing them towards leaving the organization.

1.3 Turnover Intentions

Continuous and increasing stress at work place and persistent work life balance
problems can lead to exhaustion and increase turnover intentions among employees.
Turnover intention means the mental decision of an employee about choosing between
staying with or leaving the job in reference. Persistent turnover intentions among
employees can lead to actual employee turnover. Max D'Souza, Head HR, South Asia,
ORG IMS Research, explained, "When work becomes a burden rather than passion to
excel and enjoy your work that is the time where stress leads to attrition."

According to Mano-Negrin and Kirschenbaum (1999) turnover intentions can be

predicted by the balance between pull (organizational benefits) and push (career
expectations) factors. According to them, employees may decide to stay longer with
organizations that have congenial working environments and good working conditions
for employees pulling them inside the organizations. While employees with higher

16
career aspirations and expectations, lean towards leaving if their requirements are not
met with pushing them outside the organization. They also concluded that this kind of
turnover behaviour is contradicted by career expectations if the organizations provide
with career advancement opportunities or if there is a possibility of unemployment after
leaving present job.

Types of turnover

Voluntary and involuntary are the two types of employee turnover. Voluntary turnover
is the desires of an employee to leave the organization on his own, while involuntary
turnover is when that particular job position is removed from the organization. Some
researchers have defined turnover as moving from one job to another in the same
organization, while some other researchers define turnover as leaving the organization
the employee is working in or even the profession for good. Turnover can be
categorized as internal and external too. Internal turnover is when employee gets
promotion or is internally transferred to another department or office of the company
thus leaving a spot open in his place. External turnover is when employee shifts to
some another company leaving the current organization for good.

Causes and Impact of Turnover Intentions

The reasons behind turnover intentions can be negative work environment, unfriendly
coworkers, career stagnation, better opportunities outside (career or salary wise),
improper training and support, long and tedious working hours, inadequate salaries and
poor working conditions, poor management, poor organizational growth and image,
etc. Some psychological changes such as sadness and feeling of helplessness also make
employees think about leaving the job and the organisation.

Many factors have been found responsible for turnover intentions among employees
through various studies. These can be categorised in four broad categories. Person
related factors include demographic characteristics, perceived social status of job,
physical, emotional and mental health of employees, stress resistance, skill and
knowledge levels, citizenship behaviour, etc. Organization based factors can include,
working environment, organizational and managerial structure, co-worker interaction
and support, recognition and reward adequacy, cohesiveness, physical safety of

17
employees, lay out of organization, facilities provided to employees, motivation and
leadership styles, work over or under load, training and development programs, etc.

Job related factors may include job and role clarity, job satisfaction and commitment,
career and growth prospective, salary and benefits, job demands and resources,
employee participation and empowerment, etc. Family related factors include the
conflicts caused in life by work and the conflicts caused in work by life, with long
working hours, shift work, overtime on holidays or at night etc making up for former
part, and responsibility of kids, parents, spouse, household chores etc. forming up the
latter part. Some or all of these factors combined lead to stress and job dissatisfaction
among employees which ultimately results in turnover intentions and actual turnover
among them.

Acc. To Kristof-Brown et al. (2005) and Edwards and Shipp (2007), one of the reasons
behind turnover intentions among employees is the P-E fit, i.e., Person-Environment
Fit. They found out that when employee feel mismatch or incompatibility between him
and the organization he works for, it leads to negative effects on employee performance
and the employee suffers from physiological, psychological and behavioural stress.
While a healthy P-E fit results in positive results for both the employees and the
organizations.

High turnover intentions can result in actual turnover causing hiring and training costs,
decline in productivity, low service quality, poor employee performance, low employee
morale, reduced loyalty and organizational commitment, loss of social capital,
decreased profitability, reduction in human capital, talent reduction, job dissatisfaction,
loss of customers, negative organizational image, etc. Therefore, employee turnover
intentions can have very negative effects on the organization and should be properly
taken care of.

It should also be noticed that turnover sometimes can be beneficial for the
organizations. For example sometimes it may result in reducing costs and financial
burdens for the organizations in the form of reduced salaries or benefits for the new
hires. Also it may help increase overall productivity of employees by finding right
employee-job or employee-organization fit. It will also help in increasing knowledge
base and instilling new ideas in the organization by bringing in new talent in the

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organization, reduction in turnover intentions and with drawl behaviour and even some
policy changes to attain and retain the newly hired staff, the kind of benefits that are
difficult to quantify. However a very high rate of turnover intentions and turnover only
have negative results as organizations may start to lose employees they want to retain.

Managing Turnover Intentions

Turnover intentions have negative effects for both the employees and the organizations
and if they are not taken care of for long time periods, they can result in actual
employee turnover which can cause huge financial and human costs to the employers.
Proper and effective management of turnover intentions to reduce them is necessary for
employee and organizational performance. The employers can resort to various
strategies to reduce turnover intentions among employees. Harmonious working
environment, effective leadership and motivation, fair remuneration systems, adequacy
of rewards and recognition, managerial support, participation in management and
decision making, stress management strategies, hygienic and safe working conditions,
job and role clarity, balanced authority and responsibility, etc. are some of the
necessities or requirements of a work place, which should be made available to the
employees in order to increase retention and reduce the turnover intentions among
them.

1.4 Nursing Staff

It has been concluded through several researches that the levels, effects and causes of
stress vary based on nature and field of work. The nursing professionals go through
high level of occupational stress as they have to face very difficult situations and
conditions involving human sentiments, emotions and feelings which are very hard to
deal with putting them under a lot of pressure and stress. Moreover due to the
complexity of nursing working structure and conditions and the scenarios of
emergencies in this profession result in a fairly imbalanced work and life for them,
where they cannot make enough time for their families and themselves. This could
increase turnover intentions among them potentially contributing towards actual
turnover to the extent of leaving the profession for good, increasing nursing staff
shortages as an end consequence.

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Longevity of life has increased globally and people now live for longer time periods
than before thereby increasing the number of old and aged people in population who
suffer from chronic and multiple diseases. This situation is leading to an increase in the
demand of healthcare services worldwide. We need a large nursing force to cope up
with the increasing healthcare demands but many countries are suffering from nursing
staff shortages putting the healthcare industry in difficult situation. This is resulting in
poor nurse-patient ratio. Poor nurse-patient ratio can start a downward trend or a
negative process in hospitals starting with overworked nurses not being able to
adequately use their professional skills, leading to increase in stress and stress related
consequences among them, which makes them lose interest in nursing, having burnout
and turnover intentions, and finally leaving the profession for good. Another drawback
of poor nurse-patient ratio is increased patient morbidity (catching new disease) and
patient mortality (death of patients) due to lack of proper and effective nursing care.

Nurses and Occupational Stress

Stress has now become omnipresent and can be seen affecting all kinds of jobs and
employees, differing only in the intensity of effects. Occupational stress touches all the
professions and stress issue has become significant being an occupational hazard and
needs to be managed without delay. The importance of researches regarding stress at
various levels and in different occupations is growing and the factors causing stress,
impact of stress and well-designed stress coping strategies are gaining attention at the
strategy level. Occupational stress is a well identified problem of nursing profession. In
fact, it has been stated through a number of studies that people in occupations
concerning other people problems like teachers, police personnel, health care staff, etc.
suffer from a lot more stress than those in other occupations.

Menzies was the first to study occupational stress in nursing in 1960, and he found out
four sources that bring anxiety among nursing staff namely, taking care of patients,
making difficult decisions, taking responsibility of patients and managing and adapting
to change. According to him, technological advancements, increase in health care costs
and turbulent working environment could be the reasons behind rising occupational
stress in nursing profession, which may increase absenteeism and turnover among
nursing staff, impacting and degrading the quality of patient care.

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Nursing is considered to be one of the most stressful professions among all the other
health related professions. Different research studies came up with different factors or
sources that cause occupational stress in nursing profession. Yazdan Panah and Dianat
(2004) found equipment and medicine shortage, physical working environment, lack of
standardised hospital equipment, lack of timely medical support; poor inter personal
communication and transmission of diseases as the most important reasons behind
stress in nursing. Ghacemi and Attar (2011) concluded that patient sufferings and
deaths, work place conflicts and work load are the major contributing factors towards
stress in nursing profession. Some other researchers claimed that factors like staff
shortages, miscellaneous work overloads, discrimination, poor organizational
relationships and management, etc. put the nursing staff under stress, reducing their
efficiency and productivity.

Papamichael in 2005, found working in shifts, bad working conditions, role ambiguity
and conflict, excessive communication needs, work overload, crucial and severe
incidents and dealing with deaths on routine basis as the most stress producing
situations in nursing profession. Lack of proper and positive feedback and support from
managerial, administrative and senior staff is also one of the important reasons for
nursing occupational stress.

According to Adib-Hajbaghery et al. (2012), lack of experience, logistics and nursing

staff, subdued organisation and management in hospitals, poor social status of nursing
profession, poor organisational relations and patient conditions are some of the factors
contributing to nursing stress, with the major one being the need and urge to be in a
situation of constant alarm. Nursing profession by its nature requires the nurses to be
attentive towards their surroundings and patients, as the conditions and status of
patients change severely and unexpectedly within short periods of time deeming to be
the most stressful factor of nursing profession. Acc. to them, excessive work overload
and bitter workplace experiences and events increase the intensity of occupational
stress for nurses. Wheeler (1997) stated that role ambiguity, work overload, demand
resource mismatch, workplace conflict and strenuous relations with patients and
management put the nurses under a lot of stress.

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According to Klinisk Sygepleje (2013), stress in nursing can be explained through these
six things i) nurses‘ desire to provide ideal care and nursing to the patient, ii) imposing
job related demands on one self, iii) feeling physical symptoms related to stress, iv)
exhibiting behavioural symptoms related to stress, v) experiencing psychiatric
symptoms of stress and vi) going through mental breakdown.

The main cause of stress in nursing profession is the profession itself because of its
nature. Nursing is considered a strenuous job by its nature, due to high and difficult
demands and a lot of responsibility with very little authority assigned to their jobs. This
combination of high job demands and responsibility with little authority becomes one
of the major reasons behind occupational stress among nursing staff. Included in these
stressors is an intense working environment, unstructured working hours including
nights, weekends and even holidays. The situations of communicating bad news to the
patients or their families and facing their emotional outburst, rage and violence make
this job even more stressful.

Nursing is a profession where nurses have to work in close contact with the patients.
This creates a connection between nurses and patients and the nurses feel guilty if they
cannot give sufficient time to their patients. The nurses feel a sense of duty and
responsibility towards patients and any lack in fulfilling them puts them under stress.
Nurses also felt responsible towards their colleagues and organisation they work for,
and if due to some reasons, they find themselves unable to perform their jobs
efficiently, it also results in increasing stress and burnout among them. The presence of
stressors in work environment and low control over job; result in poor performance,
low quality care and compromises in safety of patients.

Low job performance and satisfaction, poor quality of care and increased occupational
stress, together compose risk factors and reduce the safety of patients. Occupational
stress has negative impact on nurses‘ health and quality of life as well as on patient
outcomes. The process of providing care to patients is an interpersonal process
including sensitivity, intimate relationships, positive communication and expert nursing
by applying proper knowledge and skills. But nurses working under stress lose
compassion for patients, make errors and mistakes during practice and therefore lack in
providing quality care to patients. In the end, it‘s the patient who ultimately suffers

22
because of nurses‘ stress, because a nurse working under stress will be cold, indifferent,
impersonal and disappointed in general with the patient and the profession. However,
such effects of stress and burnout on patient outcomes, safety and care quality are not
very well evidenced or proved as a very limited number of researches have been done
to explore the relationship between stress and patient outcomes and only a few reflect a
direct or indirect effect of stress on care delivered and the patient results.

Occupational stress decreases the efficiency of nurses and increases occupational risks
and hazards while performing a job. Nurses under continuous stress will start behaving
negatively and short tempered, withdraw from work and resort to absenteeism that will
degrade their performance ultimately raising turnover intentions and actual turnover
among them. Shortage of nursing professionals is a wide spread concern for health
industry which results in work overload for the existing staff. This work overload and
staff shortage cause occupational stress among nurses which reduces their job
performance and satisfaction. Increased work load also impacts organisational
relationships as nurses have no or very less time to engage in interpersonal
communication, maintaining social contact, providing feedback, having discussion
about personal or professional matters, etc. Health professionals around the globe suffer
from occupational stress, which results in huge financial burden on health care
institutions and organizations. Occupational stress and job dissatisfaction are
considered as the most vital reasons behind absenteeism, turnover intentions and actual
turnover among nursing staff.

Elini et al. suggested two kinds of interventions or measures for stress prevention and
management among nurses. The first one or the primary kind of interventions is the
organization based interventions, where focus is kept on the organizational factors to
manage occupational stress. It includes identifying the stressors prevailing in the
organization, evaluating them and taking corrective and preventative measures for the
same. It also includes reducing the work overload among employees by matching job
demands with employee capabilities and also through rational management of the
existing nursing staff.

The second one or secondary kind of interventions is person based interventions, where
the focus is kept on employees working in the organization, i.e., nurses. It includes

23
providing training, expert psychologist help, breaks before leaving for home etc. to the
nurses. It also includes forming support groups in organization that will help the nurses
in identifying sources of stress, knowing that they are not the only ones feeling
stressed, providing opportunities to exchange opinions and experiences with others,
conduct self analysis and managing stress.

Pandazopoulou-Fotinea (2003), recommended three strategies to help employees in

coping up with stress. The first one is to either reduce or modify the stressors to
decrease their impact on employees or to move the employees away from the stressors
if stressors can‘t be reduced. The second one is to adjust and modify the whole working
environment according to the coping needs and capabilities of employees. And the third
one is to improve and enhance the coping capabilities of employees by using social
support and various stress relieving strategies like meditation, relaxation, exercising,
etc. According to the study, stress management practices depend on what is easier to
change, the situation or the employee‘s attitude towards the situation. Organizations
should empower and motivate their employees to perform to the maximum of their
potential to maximize their return on investment in employees.

For successful implementation of above mentioned suggestions and some more, the
management needs to work in tandem with nursing staff. The organizations need to
ensure and promote the physical as well as mental health and safety of their nursing
staff, for which the help of specialists and experts in the related fields can be taken by
recruiting them for the nursing staff. Pateraki et al. (1995), suggested that the
prevention and management mechanisms for occupational stress should be well
coordinated and the organization should focus on minimizing the stress causing factors
and enhancing the psychophysical capabilities and stability of nurses early in the
organization. It is considered necessary to reorganize the working environment by
removing maximum possible number of stressors, providing training to the staff
regarding stress management, and helping them adjust and perform better in their
surrounding environment.

All of these strategies and measures should be implemented in coordination and the
employers should be sincere and honestly interested in promoting their employees‘
health and safety. It is also important that organizations should pay attention to stress

24
symptoms among nurses as early as possible and take preventative and corrective
actions to avoid worsening of their situations. Early stress management will help in
increasing self esteem and improving self image among nurses and it is important to
raise awareness and train nurses regarding identifying the early signs of stress for its
successful implementation.

Nurses and Work Life Balance

Nurses work as care providers to patients at the hospitals and they also have to work as
care providers for their family members as well. Since they provide care to different
people in both the realms of work and life, it can be very overwhelming and confusing
for them. They have to provide care at home before and after work and care to patients
at work and it can become difficult to strike a balance between both the care giving
roles. Demands from both the work and home dimensions can build up stress and cause
work life imbalance among nurses resulting in physiological and psychological burden
among them.

Nursing is predominantly a woman‘s profession; hence, the work-life balance issues

pertaining to women employees form the major part for nursing work life balance
studies. Most of the nurses are women who have larger share of family responsibilities
and demands such as; providing care to family members, doing household chores, etc.
Women play multiple roles as part of a family like mother who takes care of her
children, a wife, a caregiver for other family members who need care like parents,
younger siblings, a wage earner to extend financial support, and participate in
household chores and many other responsibilities. Similarly they play multiple roles in
nursing profession like documentation of patients, providing them medication
assistance, educating patients about their sickness and treatment, taking care of patients,
communication link between doctors and patients, etc. Other than that they have to
actively engage in achieving organizational goals, being an active team member, a
friendly colleague to doctors, nurses and other staff, etc.

Work overload is an ever existing problem among nursing staff and since work role of
an employee is always in contradiction with his family role, increased work load results
in creating imbalance between work and family for employees. This conflict between
work and family also results in increasing occupational stress because fulfilling

25
responsibilities of one role gets in the way of other‘s which leads to dissatisfaction,
stress and turnover intentions among nursing employees. The conflict between family
role and work role of nurses is perceived to be one of the important and frequent
sources of stress.

Thoits in 1991 stated that if an employee wants to identify the factors that stress him,
he should find the role he identifies with the most. For example, an employee has
several roles to perform like that of a father/ mother, husband/wife, son/daughter,
superior/subordinate, peer/friend, etc. These roles set some identity and behavioural
rules and when an employee successfully perform the role he identifies the most with, it
enhances his self-awareness and reduces stress and vice-a versa.

Having a healthy work-life balance helps employees in reaching to their potential there
by benefitting both the employees and the organisations. Employees benefit by
enhanced job satisfaction, increased job security, healthy and happy work environment,
increased financial benefits, etc. Organisations benefit by increased organisational
performance, harmonious work environment, enhanced organisational commitment,
reduced turnover intentions and turnover, increased cost benefits, happy, content and
motivated workforce, etc. According to Kane and Kartha (1992) and Kane (1999) one
effective measure to stop work life balance induced turnover intentions is job sharing.
According to them, job sharing among nurses increases job satisfaction, reduces stress
and decreases turnover intentions for nursing staff while improving employee health.

Many factors affect work life balance in nursing profession. Flexible schedules can
help in improving work life balance while lack of job control can have negative impact
on work life balance of nursing staff. Increasing autonomy and supervisory support also
helps in gaining work life balance among nursing staff yielding positive results like
reduced absenteeism, improved performance, enhanced productivity and job
satisfaction, improved mental and physical health, etc. Factors that negatively affect
work life balance among nursing staff are shift work, coerced time, staff shortages and
work overload, increased nursing turnover, increased number of patients and low nurse
patient ratio, etc. which also increase occupational stress in nursing profession.

Occupational stress among nurses affects their personal, social and family lives. The
family of the nursing staff is deeply impacted by the nature of their work and shift

26
working system which is a salient feature of nursing profession. Occupational stress has
negative impact on nurses‘ work life balance and therefore organizations can introduce
the provision of breaks before heading home or some kind of leisure activities for
nurses to help them relax and relieve them from carrying the stress home and help them
in striving for a healthy work life balance. Another measure by Vetter et al. (2001) is by
bringing in work and time flexibility and self scheduling to incorporate familial time
needs of employees, so they can maintain their work life balance and achieve higher
job satisfaction thereby reducing their intent to leave.

Nurses and Turnover Intentions

The nursing profession is considered to be a demanding and difficult job as it has dual
responsibility of taking care of sick people and providing comfort to the dying which
takes a toll on nursing employees both physically and emotionally. Nurses are required
to be empathetic and understand what patient needs, which will ultimately improve
patient care and health delivery system in totality. Though the nurses play such an
important, critical and irreplaceable role in health care industry, the nursing staff
shortage is a matter of concern globally. The continuous rise in nursing staff shortages
is worrisome and has negatively impacts patient outcomes and quality of care
delivered. Many studies have shown that a large number of nurses have turnover
intentions and intend to even leave the profession altogether.

The major reasons behind turnover intentions among nursing staff are found to be work
place environment, unsatisfactory wages, organizational characteristics, geographical
regions, daily commute, lack of motivation and co-worker support, etc. Another major
reason behind turnover intentions among nurses is low job satisfaction, and therefore
increasing job satisfaction will help in retention of employees. These high levels of job
dissatisfaction and resulting turnover from nursing profession could be attributed to
poor management and organization in hospitals. According to Hulin (1991), turnover
intentions among nurses are highly dependent on the availability of viable and suitable
job options too. The turnover intentions among nurses increase with increase in job
options and reduce if there are no other jobs available to take if they leave the current
one.

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The burnout and turnover is observed to be higher in the beginning years of this
profession as maximum cases of turnover in nursing profession occur within two years
of joining. A large number of nurses leave this profession in the budding years due to
stressful and demanding nature of job which takes a toll on them as feel guilty and
regret over leaving a job they are emotionally attached to.

Krausz et al. (1995) stated that nurses leave in a progressive manner, i.e., they do not
decide to leave the profession directly but first leave the ward, then leave the
organization they work for and if the intentions to leave still persist then ultimately the
profession altogether. They also stated that intentions to leave the ward and
organization played major role in depicting professional turnover intentions.

High turnover intentions among nursing staff if left unmanaged can cause actual
turnover resulting in reducing organization‘s capabilities to fulfil patient needs and
degrading the quality of patient care. From the nurses‘ point of view, a high turnover
intentions and turnover rate have negative effects on motivation and productivity of
those who stayed as they watch their colleagues and peers leave and have to get
acquainted with new people replacing them.

Nurse turnover poses dual threat for patient health and for the organisation. High
turnover rates are linked with poor patient care and outcomes through several studies.
Some studies have proven the effect of turnover among nursing staff on patient
outcomes in the form of health and duration of stay of patient in the hospital and the
quality of care they received. In addition it also adds to the problems of health
organizations and health care industry in the form of huge financial and non financial
costs, which requires immediate attention. Therefore it has become utmost necessary
for hospitals and health organizations to take precautionary and corrective measures to
reduce turnover intentions and actual turnover among nurses, to survive for longer time
periods.

Judge (1993) and George and Jones (1996) stated that the relationship among
employee‘s job satisfaction and turnover intentions depends on employee‘s mind set.
According to them, employees with positive disposition, moods and attitudes regarding
their jobs and themselves will have higher intentions to leave than those with negative
disposition based on the satisfaction derived from the job. Acc. to them people with

28
positive frame of mind will be action oriented and optimistic people, with high level of
self efficacy, who will not hesitate to take proactive measures and steps to change their
jobs or professions to increase their job satisfaction. However, the relationships
between stress, turnover and performance for nursing staff are not easy to predict
through these studies as a significant number of nurses show no or meagre signs of
turnover even though facing a number of stressors. The nurses are believed to be
psychologically hardened to high levels.

There are some researchers who studied the factors that help in reducing turnover
intentions or act as moderators to reduce turnover intentions among nursing staff. Sense
of professionalism among employees is one of those factors that hesitates employees
from leaving their profession. Similarly attachment to one‘s job or profession also
stimulates employees to not leave their profession. Organizational commitment among
employees also stops employees from leaving the organization they are working for.
Career commitment however, have an opposite effect on employees, as those who are
committed to their careers and want to grow professionally will have higher intent to
leave the organizations with poor growth opportunities to reach new levels in their
careers.

Another strategy that is proven effective to discourage turnover intentions and retain
employees in nursing profession is empowerment of employees as workplace
empowerment results in positive working behaviours and attitudes among nurses.
Furthermore, it is also proven that the nurses who feel empowered are highly expected
to attain the PE fit between them and the organization. Increased nursing retention
results in better patient outcomes by better care delivery, increase in satisfaction among
patients and reduction in stay time in hospital. Nurse retention also helps in reducing
financial costs that come along with the hiring and training of new nurses in place of
the leaving ones.

Turnover intentions and turnover are emerging as huge threats for efficient operation
and running of businesses and the major reason for turnover intentions and turnover
among nursing staff is stress. Hospitals are introducing many employee friendly
policies these days in order to keep their nursing staff from leaving the organisation, to
retain the staff they already have and to generate a sense of organisational commitment

29
among them. Many HR policies these days are introduced in hospitals with the motive
of enhancing nurse retention and organisational commitment.

The work places have become very dynamic and versatile these days with the rapidly
changing and evolving business environment. These changes are modifying the ways
work used to be done traditionally. The workplaces are becoming more and more
demanding requiring increased effectiveness and efficiency on part of employees in
order to compete and keep their jobs. These increasing demands and pressures at work
interrupt with the personal lives of employees leaving them with less time and energy
for their family and personal needs. This causes an imbalance between their work and
personal lives leading to stress and burnout. Stress is not good for employees as well as
the organisation. It affects their performance negatively and creates unhappiness in
general regarding their jobs as well as the organisation they are working for. This
results in increasing turnover intentions among employees and if are not taken care of
for long time periods, can lead to actual turnover among employees.

Stress among nursing staff can be caused by a number of factors like job
dissatisfaction, work life imbalance, role ambiguity, excessive work load, shift work,
power structure and politics, financial insecurity, unhealthy work environment, unclear
authority and responsibility lines, difficult patients, dealing with deaths etc. Therefore
many hospitals are now focussing on these aspects of their organizations and are taking
major steps to enhance nurse involvement and retention and reduce occupational stress
in hospitals.

Florence Nightingale was the first woman to influence and bring reforms in nursing in
India. The conditions of nursing were very poor during independence with understaffed
hospitals, poor social and professional status of nursing, lack of specialized and
structured knowledge and skills and meagre living and working conditions for nurses.
The situation slowly improved and progressed over the years with changes in staffing
policies, setting up of special nursing schools and colleges, improving living
conditions, providing equipment and infrastructure for better working conditions,
designing and implementing training programmes, enhancing skill and knowledge,
reorganisation of health services, etc. but an implementation gap in policies still exist
leaving scope for further improvement.

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Nursing staff consists of two thirds of the health work force employed in India. Their
role is highly important and critical in promoting health care services, in prevention and
treatment of diseases and sickness and in providing care and rehabilitation to patients.
Their contributions are important but not sufficient enough in developing counties
including India, towards realization of UN goals.

Though nursing in India as a profession is on the rise and going through massive
changes to bring in success and getting people interested in joining this profession,
there is still a long way to go to development of nursing in India. The issues regarding
nurse recruitment and selection, training, placement, career growth, etc. are still
existent and due attention is needed to be paid for a bright future of nursing in India.

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