The Impact of Work Stress on Job Performance Among Nursing Staff in Al-Awda Hospital
, , and | Oct 13, 2022
Published Online: Oct 13, 2022
Page range: 89 - 110
DOI: https://doi.org/10.2478/fman-2022-0006
Keywords
© 2022 Mansour M. Alayoubi et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Work stress is one of the most important topics that have received the focus and attention of researchers and writers in the domain of administrative sciences, because of its negative repercussions on the individual, the organization, and society alike. They can adapt to it and benefit from its presence. It can be an incentive to push them to do more diligence at work and some of them fail in this, which leads to many psychological and health problems, and negatively affects their behavior, attitudes, and performance at work in particular and the level of performance of the organization in which they work in general.
Many organizations seek to improve their performance and achieve excellence in their services in various ways and in various sectors, including the health services sector, in order to keep pace with the rapid technological progress. Furthermore, to prove their ability to survive, grow, and continue in light of the existing severe competition, to achieve the aspirations of citizens in terms of their access to health services with the utmost speed, accuracy, quality, and competitive prices (Al-Otaibi, 2014, pp.1–2).
Health and nursing services are of great importance in the lives of members of society, because of the services they provide that form the basis of human life and its continuity, and then the ability to continue giving and working within the various activities that it seeks to achieve, and from here various organizations, especially health ones, seek to develop their performance (Daoud, et al., 2016, p.198).
The nursing profession is one of the human services professions in which workers are subjected to job pressures due to the large number of requirements and the increase in their burdens and responsibilities, which have negative effects that are reflected on their self-efficacy and their psychological and professional compatibility.
Based on this, the researchers wanted to conduct a study on the impact of work stress on the job performance of nursing workers in Al-Awda Hospital in Gaza Strip, because many hospitals seek to achieve excellence in their institutional performance and maintain the lead in their domain of work, and in order to raise this sector to the ranks of sectors global health.
For the purposes of the study, the following terms were defined:
Work Stress: Antonova (2016, p.16) defines work stress as “a form of physiological and emotional arousal that an individual experiences when he is exposed to a threatening or conflicting situation with a situation, another colleague or a customer.” Job Performance: Al-Zahir (2010, p.155) defined job performance as “the net effect of an individual's efforts that begin with abilities and awareness of the role or tasks, which thus refers to the degree of achievement and completion of the tasks that make up the individual's job.” Al-Awda Hospital: Al-Awda Hospital is the largest health facility affiliated with the Union of Health Work Committees. It was established in the year 1992. It was opened in April 1997 with a capacity of 53 beds and with the contributions of the local community, amounting to more than 75% of the construction cost, which is a source of pride. For every Palestinian, the number of beneficiaries for the year 2016 reached about 15,084 beneficiaries, with an increase in the number of beneficiaries by 15.3% compared to the year 2015. As a result of the expansion in Al-Awda Hospital, the number of beds has become 77, with the possibility of expansion in emergency cases, bringing the number of beds to 100 (
Many organizations, including health organizations represented by hospitals in particular, suffer from many problems due to the failure of their departments to keep pace with the modern administrative methods applied by international hospitals, as well as the rapid development of the tremendous in this aspect and the lack of rapid response by our hospitals to it, which led to the deterioration of performance especially at the level of services provided to patients. It was negatively reflected on the process of providing health and other services in government hospitals in general and nongovernmental hospitals in particular.
According to the report issued by WHO (2018, pp.5–7), which focuses on bureaucratic barriers that impede access to Palestinian health services, resulting from the occupation policies that restrict the freedom of movement of patients, health workers, and ambulances, and we summarize the most important of them:
The number of Gaza patients referred to healthcare in health facilities not affiliated with the Ministry of Health increased by 34% over the past five years. Health services are facing a state of chronic medical supplies shortage. The Central Drug Store in the Gaza Strip reported full access to an average percentage of essential medicines (32%), and of single-use medical devices (24%). The period from 2010 to 2016 witnessed a decrease in the number of hospital beds by 9%, a decrease in the number of nurses by 5%, and a decrease in the number of doctors by 21% per capita of the population in Gaza Strip. The war on Gaza in 2014, the effects of which continue to this day, led to the damage of 75 health facilities (17 hospitals, 58 clinics), and 44 facilities were closed at different stages as a result of damage or security reasons. Since April 2017, Gaza Strip has faced an aggravation of the electricity crisis, as electricity is only available for 4–6 hours per day after the measures taken by the Palestinian Authority to supply electricity from Israel, and hospitals were forced to postpone some surgeries and discharge patients prematurely, and reduce cleaning and sterilization services.
The administration of Al-Awda Hospital in Gaza Strip seeks to maintain a distinguished level of health service that it provides to all segments of patients, and given the harsh conditions experienced by the hospitals of Gaza Strip in general and Al-Awda Hospital in particular, it has arranged a high level of various pressures on the citizens, the administration of Al-Awda Hospital is concerned with reducing the internal work pressure related to the nature of tasks and roles performed by hospital staff in order to maintain a good level of focus in performance.
The main question: What is the effect of work stress on the job performance of the nursing staff in Al-Awda Hospital in Gaza Strip?
Several subquestions emerge from the main question:
Q1: What is the reality of the work stress of nurses in Al-Awda Hospital in Gaza Strip? Q2: What is the level of job performance for nurses in Al-Awda Hospital in Gaza Strip? Q3: Is there a correlation between work stress and job performance for patients in Al-Awda Hospital in Gaza Strip? Q4: What is the impact of work stress on the job performance of patients in Al-Awda Hospital in Gaza Strip?
The research seeks to achieve the following objectives:
identifying the reality of work stress among nurses in Al-Awda Hospital in Gaza Strip, identifying the level of job performance for nurses in Al-Awda Hospital in Gaza Strip, revealing the nature of the relationship between work stress and job performance for patients in Al-Awda Hospital in Gaza Strip, determining the impact of work stress on the job performance of patients in Al-Awda Hospital in Gaza Strip.
Presenting a set of recommendations that help the senior management in Al-Awda Hospital to develop and activate mechanisms that contribute to alleviating work stress, leading to improving the functional performance of patients.
The study derives its importance from the following points:
Scientific (theoretical) importance:
This study sheds light on one of the approaches to modern management thought, which is the impact of work stress on job performance in the reality of our Palestinian institutions. This study is useful and provides researchers and scholars with data and information in the domain of work stress and job performance through its findings and recommendations that may contribute to alleviating the negative effects of work stress on workers and the organization. Practical (applied) importance:
The importance of this study lies in the extent to which the recommendations it came out with have been achieved and applied, which may benefit the administration of Al-Awda Hospital in particular and other similar hospitals in general. It is possible that the current study of the senior management at Al-Awda Hospital provides information by showing the importance of applying to remove the effects of work stress, which in turn may contribute to improving the functional performance of patients at work, and extracting their latent energies, which in turn is reflected in achieving the general benefit of the hospital and progress and competition in the domain technical and administrative, as well as better perform their duties and services toward society.
The study seeks to test the validity of the following hypotheses:
Ho1: There is a statistically significant relationship at the level of significance (α ≤ 0.05) between the dimensions of work stress (nature of work, role conflict, professional growth, performance evaluation, and physical work environment) and job performance among nurses at Al-Awda Hospital. Ho2: There is a statistically significant effect at the level of significance (α ≤ 0.05) for the dimensions of work stress (nature of work, role conflict, professional growth, performance evaluation, and physical work environment) on the job performance of nurses in Al-Awda Hospital.
The scope of the study shall be as follows:
Objective limit: The research was limited to studying the impact of work stress on job performance, and the researchers relied on the dimensions of work stress from the study by Musa (2020, p.73) and Deniz, et al. (2015, p.372), which are the nature of work, role conflict, professional growth, evaluation performance, and physical work environment, and the dimensions of job performance were adopted from a study by Muhammad (2017), Solomon and Ayebale (2017), Keikha and Hadadi (2016). Human limit: The study is limited to surveying the opinions of nursing staff, mainly in Al-Awda Hospital, in addition to anesthesia, radiology, and physiotherapy technicians, due to the similarity of the nature of work with nurses. Spatial limitation: The study was conducted on Al-Awda Hospital in Gaza Strip.
Study of Musa (2020), which aimed to identify the impact of work stress on the level of job performance of teachers at Al-Qasim Green University in Iraq. The study reached several results, the most important of which are: There is a very large approval by the respondents on the reality of work stress at the researched university, where the relative weight reached 87%, and there is agreement on the level of job performance with a large degree of approval, where the relative weight reached 76%. There is a strong positive, statistically significant, positive correlation between work stress and job performance for academics at the university.
Study of Manzoor, et al. (2019), which aimed to identify the mediating role of social responsibility in the relationship between transformational leadership and job performance in small- and medium-sized companies in Pakistan. The study used the descriptive analytical method, and the study sample consisted of 300 employees who work in small- and medium-sized companies in Pakistan. The study used a questionnaire as a tool for data collection. The study concluded with a set of results, the most important of which are: That transformational leadership in small- and medium-sized companies has the ability to positively and completely predict the job performance of employees, and the results showed that corporate social responsibility significantly mediated the impact of transformational leadership on employee job performance.
Study of Hassan (2019) aimed to identify the impact of work stress on the performance of employees in Iraqi hospitals in the Fallujah Teaching Hospital Directorate. The study used the descriptive analytical approach and a stratified random sample was selected consisting of 100 male and female employees working in the hospital, and the questionnaire was used as a tool to collect data. The study reached several results, the most important of which are: There is a large approval by the respondents on the reality of work stress in Fallujah Teaching Hospital, where the relative weight reached 81.53%, and there is approval on the level of job performance with a large degree of approval, where the relative weight reached 82%. There is a strong, statistically significant positive correlation between work stress and job performance in the hospital.
Study of Paais (2018), which aimed to identify the impact of work stress, organization culture, and job satisfaction on the performance of employees at Bank Maluku in Indonesia. The study used the descriptive analytical method, and the study sample consisted of 196 employees of Bank Maluku, who were chosen by the random sampling method, and the study used a questionnaire as a tool for data collection. The study concluded with a set of results, the most important of which are: That work stress and the culture of the bank have a significant impact on the performance of the bank's employees in question, and the results showed that work stress has a negative impact on the performance of employees, which means that high work pressure will reduce the efficiency of the performance of employees in the bank, and that availability of job satisfaction has little effect on employee performance in the surveyed bank.
Study of Muhammad (2017), which aimed to identify the impact of work stress on the job performance of faculty members at the Institute of Technical Management in Iraq. The study used the descriptive analytical approach and a random sample consisting of 67 teachers and schools working in the Technical Institute was selected, and a questionnaire was used for collecting data. The study reached several results, the most important of which are: There is a large approval by the respondents on the reality of work stress at the Technical Institute, where the relative weight reached 75.04%, and there is agreement on the level of job performance with a large degree of approval, where the relative weight reached 83.84%. There is a direct, statistically significant relationship between work stress and job performance among faculty members at the Technical Institute.
Study of Keikha and Hadadi (2016), which aimed to identify the impact of the strategic intelligence of executives on the performance of employees in private banks in the Iranian city of Zahedan. The questionnaire was used to collect the data. The study concluded with a set of results, the most important of which are: That the strategic intelligence of managers in all its dimensions (competitive intelligence, business intelligence, and knowledge management) has a significant impact on the performance of employees in private banks, and the dimensions of strategic intelligence (competitive intelligence, business intelligence, and knowledge management) can help managers improve the performance of their employees.
Study of Deniz, et al. (2015), which aimed to demonstrate the importance of matching a person's profession with the work stress of the job he is assigned to perform, and the study was concerned with identifying the side effects resulting from the contradiction between the employee and his job, including the employee's personal well-being, in addition to health problems, and the study used the descriptive analytical approach in which a random sample was selected consisting of 135 male and female employees distributed to companies of various sizes and sectors in Turkey, and the questionnaire was used as a data collection tool, and the study reached several results, the most important of which are: There is a statistically significant relationship between a person's suitability for his job or not and work stress, and the results showed the importance of providing training programs to train employees to adapt to work stress, which will lead to increased levels of performance and reduced employee dissatisfaction.
By analyzing the previous studies, it becomes clear to us that:
Most of the previous studies dealt with by researchers are recent studies between the years 2014 and 2020. The study agreed with previous studies in using the descriptive approach as a study method, such as: Musa (2020), Hassan (2019), and Paais (2018), due to its relevance to the subject of the study, and the current study agreed with most of the previous studies in its use. The questionnaire is a tool for the study. The places of application of previous studies varied, including Arabic studies (Iraq, Syria, and Algeria) as a study of Muhammad (2017), a study of Keikha and Hadadi (2016), and a study of Deniz, et al. (2015). Previous studies made use in defining the study problem, study variables, hypotheses, and study tools, and in strengthening the results of the current study with previous studies and comparing them with the previous ones.
The current study is distinguished from previous studies in that it was applied to a nongovernmental hospital, Al-Awda Hospital in Gaza Strip, and it is one of the few studies - as far as the researchers know - being conducted in Palestinian society, and it mainly focuses on studying the impact of work stress on job performance.
Work stress has become one of the important issues that we rarely find to have an impact on various levels, especially the administrative ones, especially since every individual faces one type or another of pressures at work.
Many scholars and specialists have worked hard to put a specific definition of work stress, so they defined it (Al-Ahmadi, 2007; Shehada, R. Y., et al., 2020) as: “External forces that cause physical distortion in the body's structure or disrupt its functions,” and Arqawi, S. M., et al. (2018, p.29) defined it as: “The extent of a person's response to external stimuli and forces causing stress, while neglecting the effect of the interaction of other factors such as the individual's own characteristics with the characteristics and conditions of the work environment, upon which the amount of pressure a person feels is determined,” defined by Dags Land (2012, p.22) as: “An imbalance at work due to the tensions that occur in it, making it impossible to fulfill the role he plays at work.” Mowafak (2014, p.121) defines it as: “the disproportion between the skills and abilities that the individual possesses and what the work requires,” while Taher and Amir (2015, p.179) refer to it as: “A measure of the effect of the outcome of the interaction between a group of factors, the most important of which is the individual and the work environment, resulting from poor harmony and compatibility between the individual and the work environment in which he works, and this effect may be positive or negative, and may result in deviation of the individual from his normal performance of the duties assigned to him.” In light of the foregoing, it is clear that most studies did not agree on a specific definition of work stress, and in order of the above, researchers procedurally define work stress as the employee's perception or feeling of imbalance in his psychological and physical state as a response to circumstances and events in a work environment like the hospital.
The importance of studying work stress lies in several points, the most important of which are (Arqawi, et al., 2020, p.1120):
Providing the appropriate climate in the work environment, in a way that enables the decision maker to take his decisions and better exercise his powers and administrative tasks. Achieving the objectives of the institution in a proper manner and maximizing its profits in accordance with what is planned and established in the executive programs. Raising the motivation of individuals and decision makers in the organization by raising and improving their abilities to face the pressures of work and the difficult situations they face, which is reflected positively on improving productivity. Developing the skills of rapid response and effective dealing with internal and external pressures facing individuals and decision makers in the institution, and thus developing managerial skills in light of the prevailing atmosphere of pressure on decision makers and working individuals. Creating a spirit of cooperation and the rule of team spirit between superiors and subordinates, increasing understanding and positive constructive participation, which contributes to raising the morale of employees and their sense of active participation in making the present and future of the institution.
From the foregoing, we conclude that the study of work stress is generally useful in enabling the organization to improve the performance of its employees by following various serious and effective means of follow-up, supervision, and guidance to identify strengths and weaknesses to improve their performance according to work requirements, taking into account the social and psychological conditions of employees.
Many sources contribute to the emergence of work stress, the most prominent of which are:
Stresses resulting from the nature of work: Shamia, et al. (2018) and Abdalmenem, et al. (2018, 2019) indicate that there are jobs that suffer from work pressure more than others. Whose owner cannot carry out the tasks assigned to him even if his personal skill level is high. Stress resulting from role conflict: The role conflict is one of the important causes of work stress, and it counteracts the conflict that occurs to the individual as a result of the presence of different work demands. Stresses resulting from occupational growth: Professional growth is defined as the path that shows the group of jobs in which the human resource is graded during his career in the organization either vertically through promotion, or horizontally through transfer, and professional growth is important not only because they obtain material income bigger but because they achieve a better position and face a new challenge, and the job is a source of self-realization and career advancement for a person (Abu Naser, et al., 2016; Ahmad, et al., 2019; Salama, et al., 2017). Stresses resulting from performance appraisal: Al-Maani and Akhwarsheida (2006); Msallam, et al., (2019); and Salama, et al. (2018) define performance appraisal as: “objective judgment on the extent to which employees contribute to accomplishing the tasks assigned to them, and their behavior during work.” Stress resulting from the physical work environment: The physical work environment is related to the work site, its design, arrangement of furniture, equipment, devices, lighting, ventilation, humidity, noise, and so on (Al Hila, et al., 2017; El Talla, et al., 2018; FarajAllah, et al., 2019).
From the foregoing, we conclude the multiplicity of events that employees may be exposed to and cause them stress that is reflected in their work, whether these events are painful such as: the death of a relative, a friend or family disputes, or exposure to great losses, or sudden pleasant events such as obtaining a sudden promotion, or receiving an unexpected award. It must be said that what is considered a cause of stress for some may not be the same for others. The employee feels pressure when the interaction between the causes of pressure with his personal characteristics such as his abilities, his level of intelligence, and his personality style.
Job performance contributes to the organization's success process through its repercussions and impact, and all organizations seek to pay attention to job performance, trying to raise the level of performance of their employees through a set of factors that affect it directly or indirectly.
Through the researchers’ review of a number of writings and research that dealt with the study of job performance, it is possible to present some attempts to define job performance, where job performance is defined as: “the end result of the activity to be implemented” (Wheelen and Hunger, 2017, p.243). Noe (2009, p.329) defined it as: “if the organization wants to achieve the competitive advantage, it must be able to manage the behavior and results of its employees, through performance evaluation until the efficiency of their performance is recognized.” Naama and Ali (2011, p.132) defined it as: “the employee's implementation of his duties and responsibilities assigned to him by the organization or entity with which his job is related. The researchers (Robbins and Judge, 2013, p.555) referred to it as: “the combination of efficiency and effectiveness in doing the basic tasks required of the individual.” Waiyaki (2017, p.17) describes job performance as” “the value of a set of employee behaviors that directly contribute to the transfer of organizational resources to the goods or services produced by the organization.”
In order of the above, the researchers define job performance procedurally as: the outputs achieved by the employees in Al-Awda Hospital as a result of the effort expended while carrying out the duties, tasks, and responsibilities assigned to them, to the fullest.
Al-Tai and Al-Janabi (2013, p.32) see that job performance consists of the following elements:
Knowledge of Job Requirements: This includes general knowledge, technical and professional skills, general background about the job, and related domains. Quality of Work: It is represented in the extent of what the individual realizes about the work he is doing, and the desire, skills and ingenuity he possesses to organize and implement the work without making mistakes. Quantity of Work Performed: The amount of work that the employee can accomplish under normal work conditions, and the speed of this achievement. Perseverance and Trust: It includes seriousness and dedication to work, the employee's ability to take responsibility for work and complete work on time, and the extent to which this employee needs guidance and direction from supervisors.
It is clear from the above that these elements are among the basic pillars of the employee in his job, which can only judge the effectiveness of the employee's performance and distinction through the availability of these elements, as well as these elements constitute an important focus for determining the level of employee performance, and maintaining the excellence of the organization and its survival at the forefront level.
There are a number of factors affecting employee performance, including (Muhammad, 2017, pp.150–151):
Absence of Specific Goals: An organization that does not have detailed plans for its work, goals, and production rates required to be performed, will not be able to measure what has been achieved or hold its employees accountable for their performance because there is no predetermined standard for that. The employee who performs well with the employee who performs poorly. Lack of Participation in Management: The lack of participation of employees at different administrative levels in planning and decision making contributes to the existence of a gap between the administrative leadership and employees at lower levels. Thus to a weak sense of responsibility and teamwork to achieve the goals of the organization, this leads to a low level of performance among these employees because they feel that they did not participate in setting goals to be achieved or in solving the problems they face in performance, and may consider themselves marginalized in the organization. Different Levels of Performance: One of the factors affecting the performance of employees is the lack of success of administrative methods that link performance rates and the material and moral return that they get. Employee performance in order to effectively distinguish between a hard-working employee with a high performance, a hard-working employee with an average performance, a lazy employee, and an unproductive employee. Job Satisfaction Problems: Job satisfaction is one of the main factors affecting the level of performance of employees. Job dissatisfaction or low job satisfaction leads to poor performance and lower productivity. Job satisfaction is affected by a large number of organizational and personal factors for the employee, such as social factors, age, educational qualification, gender, and customs and traditions, and organizational factors such as responsibilities and duties, the system of promotions and incentives in the organization. Administrative Laxity: Administrative laxity in the organization means wasting working hours in unproductive matters and may even have a negative impact on the performance of employees. Administrative laxity may arise as a result of leadership or supervision style, or the prevailing organizational culture in the organization.
The researchers believe that there are other factors that have an impact on job performance, such as: management and its methods of doing things, organizational social relations and their quality, the system of incentives and rewards, communications within the organization, regularity or lack of work, absenteeism, accidents, and work turnover.
The study followed the descriptive analytical approach, which depends on the study of reality or the apparent, and is concerned with describing it accurately and expressing it descriptively or quantitatively through the use of the applied method, by collecting data, analyzing its contents and testing the study hypotheses.
The study population is defined as all the vocabulary of the phenomenon that the researchers study, and based on the study problem and its objectives, the target community consists of all nursing workers mainly in Al-Awda Hospital, in addition to (anesthesia technicians, radiology, physical therapy, laboratories, and pharmacists).
This is due to the similarity of the nature of work with the nurses, who number approximately 60 male and female employees, where the administrative employees and workers in maintenance and services were excluded due to the nature of the study (Statistics of the Personnel Department, 2020).
The researchers used the comprehensive survey method for all members of the study population; due to the small size of the study population, all questionnaires were retrieved, and after examination, it was found that all questionnaires are valid for analysis.
From Table 1 it is clear that:
Thirty-five percent of the study sample are males, while 65% are females. The researchers attribute the increase in the percentage of females compared to males to the nature of work in Al-Awda Hospital, and the tendency of its management to employ females because one of the largest departments of the hospital is the obstetrics and gynecology department, and the reception, emergency, and daily care department. A male nursing. The percentage of 23.3% of the study sample have a postgraduate qualification, 50% have a bachelor's degree, while 26.7% have a diploma. This indicates that the surveyed category is a qualified category, because employees under graduate and bachelor's studies face more pressure at work than their colleagues with other scientific qualifications. Forty percent of the study sample had years of service of 5 years or less, 10% had years of service from 6 to less than 10 years, 23.3% had years of service from 10 to less than 15 years, while for 26.7% their service years are 15 years or more. This means diversity in the experiences of administrative staff in Al-Awda Hospital, and that most of the respondents have appropriate years of service in their domain of work, and they can be able to express their opinions about the impact of work stress on job performance in Al-Awda Hospital.
Distribution of the study sample members according to personal data (
(
| Personal data | The number | Percentage (%) | |
|---|---|---|---|
| Gender | Male | 21 | 35 |
| Female | 39 | 65 | |
| Scientific qualification | Postgraduate Degree | 14 | 23.3 |
| Bachelor Degree | 30 | 50 | |
| Diploma Degree | 16 | 26.7 | |
| Years of service | 5 years or less | 24 | 40 |
| From 6 to less than 10 years old | 6 | 10 | |
| From 10 to less than 15 years old | 14 | 23.3 | |
| 15 years and over | 16 | 26.7 | |
The researchers developed a questionnaire based on theoretical literature and previous studies in order to study “the impact of work stress on the job performance of nursing workers in Al-Awda Hospital in Gaza Strip,” where the questionnaire consisted of three main domains:
The First Section: It is the personal data of the respondents (gender, educational qualification, and years of service). Second Section: It is about work stress, divided into 5 domains, and it consists of 25 paragraphs as follows:
The First Domain: Work stress resulting from the nature of work; The Second Domain: Work stress resulting from the conflict of roles; The Third Domain: Work stress resulting from professional growth; Fourth Domain: Work stress resulting from performance appraisal; Fifth Domain: Work stresses resulting from the physical work environment. Third Section: It is about job performance, and it consists of 10 paragraphs.
The validity of the questionnaire means that the questionnaire measures what it was designed to measure, so that the questionnaire is comprehensive of all the elements that must be included in the analysis, in addition to the clarity of the paragraphs, so that they are understandable to everyone who uses it (Peterson, 2000, p.85). The validity of the questionnaire was ascertained through the apparent honesty “the sincerity of the arbitrators’ opinions,” and the internal consistency, where the values of the correlation coefficient ranged between 0.535 and 0.894, which are strong correlation coefficients and indicate the strength of the paragraphs’ association with the domains to which they belong, and thus the paragraphs are considered true for what was developed to measure it. The validity of the questionnaire was confirmed through structural validity.
The stability of the questionnaire is “that the questionnaire gives the same results if it is reapplied several times in a row” (Peterson, 2000, p.75). Adjustment (0.926), in addition to Cronbach's alpha coefficient, where it was found that its value for the questionnaire as a whole (0.926), and these values are considered high and reassuring for the stability of the study tool.
It can be concluded from the results of the validity and reliability tests that the questionnaire is valid in measuring what it was designed to measure, and is very stable, which qualifies it to be an appropriate and effective measurement tool for this study and can be applied with confidence.
The Kolmogorov–Smirnov Test was used to test whether the data follow a normal distribution or not. As it was found that the test value is 0.927 and the probability value (Sig.) is 0.379, which is greater than the significance level (0.05). Therefore, the data distribution follows a normal distribution, where parametric tests were used to analyze the data and test the study hypotheses.
The data was unloaded and analyzed through the Statistical Package for the Social Sciences (SPSS22), where the following statistical tests were used:
Percentages and frequencies: to describe the study sample. Arithmetic mean, relative weight, and standard deviation. Cronbach's Alpha Test to determine the stability of the resolution items. The Kolmogorov–Smirnov Test to test whether the data follow a normal distribution. T-Test in the case of one sample (T-Test), and the researchers used it to verify the significance of the average for each of the questionnaire items. Pearson Correlation Coefficient: This test is based on studying the relationship between two variables. The researchers used it to calculate the internal consistency and the structural validity of the questionnaire, as well as to study the relationship between the domains. Linear Regression Model Multiple.
The results of the study will be presented and discussed as follows:
Q1: What is the reality of the work pressures of nurses in Al-Awda Hospital in Gaza Strip?
The arithmetic mean, relative, and standard deviation were used to determine the degree of agreement, as in Table 2.
Arithmetic mean, relative, and standard deviation for all areas of work stress
(
| Statement | SMA | Relative weight | Standard deviation | Sig. | Rank | |
|---|---|---|---|---|---|---|
| The first area: Work pressures resulting from the nature of work | ||||||
| 1 | I feel tired because of the abundance and variety of work I do. | 3.57 | 71.40 | 1.031 | *0.000 | 1 |
| 2 | I need more time to finish the work assigned to me. | 3.23 | 64.60 | 1.395 | *0.000 | 4 |
| 3 | I am assigned with tasks outside the official working hours. | 2.80 | 56.00 | 1.260 | *0.000 | 5 |
| 4 | I find it difficult to move from place to place while working. | 3.27 | 65.40 | 1.247 | *0.000 | 3 |
| 5 | I find it difficult and complicated in the tasks assigned to me. | 3.27 | 65.40 | 1.219 | *0.000 | 2 |
| All paragraphs of the field stresses resulting from the nature of work | 3.22 | 64.50 | 0.979 | *0.000 | ||
| The second area: Pressures resulting from the conflict of roles | ||||||
| 1 | I see that my skills and abilities are not employed in my work. | 2.83 | 56.60 | 1.251 | *0.000 | 5 |
| 2 | I get upset when the supervisory management tries to change my decisions. | 3.27 | 65.40 | 1.351 | *0.000 | 1 |
| 3 | I get upset when I delegate my powers to one of my colleagues. | 3.23 | 64.60 | 1.095 | *0.000 | 2 |
| 4 | I see that I am in conflict and confrontation with my superiors at work. | 2.83 | 56.60 | 1.224 | *0.000 | 4 |
| 5 | I see that the requirements of work conflict with the requirements of my family life. | 2.87 | 57.40 | 1.295 | *0.000 | 3 |
| All paragraphs of the stress field resulting from the conflict of roles | 3.00 | 60.1 | 0.991 | *0.000 | ||
| The third area: Pressures resulting from professional growth | ||||||
| 1 | I see that the courses given to me are not enough. | 3.63 | 72.60 | 0.991 | *0.000 | 5 |
| 2 | I feel the lack of opportunities for professional growth such as conferences and scholarships. | 3.77 | 75.40 | 0.851 | *0.000 | 3 |
| 3 | I feel a lack of career advancement opportunities from promotions and bonuses. | 3.77 | 75.40 | 0.998 | *0.000 | 4 |
| 4 | I feel there are few opportunities for me to learn new skills in my job. | 3.87 | 77.40 | 0.965 | *0.000 | 1 |
| 5 | Opportunities for promotion and advancement in my current job are not satisfactory. | 3.77 | 75.40 | 0.9270 | *0.000 | 2 |
| All paragraphs of the stress area resulting from professional growth | 3.76 | 75.20 | 0.675 | *0.000 | ||
| Fourth domain: Stresses arising from performance appraisal | ||||||
| 1 | I feel the lack of competencies capable of evaluating my performance. | 3.33 | 66.60 | 0.795 | *0.000 | 4 |
| 2 | I get upset when my department's management doesn’t tell me about my job performance evaluation. | 3.60 | 72.00 | 0.887 | *0.000 | 2 |
| 3 | I realize that the way I am being evaluated is far from objective. | 3.27 | 65.40 | 1.039 | *0.000 | 5 |
| 4 | I feel the department's feedback on my performance is of little use. | 3.53 | 70.60 | 1.065 | *0.000 | 3 |
| 5 | I am upset about the lack of diversity in the assessment methods used. | 3.73 | 74.60 | 0.8990 | *0.000 | 1 |
| All paragraphs of the stress field result from the performance appraisal | 3.49 | 69.80 | 0.735 | *0.000 | ||
| Fifth domain: Stresses caused by the physical work environment | ||||||
| 1 | I feel that my work needs safety and security. | 4.10 | 82.00 | 1.003 | *0.000 | 1 |
| 2 | I suffer from noise in my workplace. | 3.83 | 76.60 | 1.278 | *0.000 | 3 |
| 3 | I suffer from poor lighting in my workplace. | 3.48 | 69.60 | 1.260 | *0.000 | 5 |
| 4 | I am upset because the devices used in my work are not working well. | 3.87 | 77.40 | 1.065 | *0.000 | 2 |
| 5 | I feel insufficient ventilation in my workplace. | 3.50 | 70.00 | 1.127 | *0.000 | 4 |
| All paragraphs of the field stress resulting from the physical work environment | 3.76 | 75.23 | 0.913 | *0.000 | ||
| 3.44 | 68.80 | 0.569 | *0.000 | |||
The arithmetic mean is statistically significant at the 0.05 level of significance.
It is clear from Table 2 that:
The arithmetic mean of the first domain “Work Stress resulting from the nature of work” is equal to 3.22, meaning that the relative arithmetic mean is 64.50%, the standard deviation value is 0.979, and that the probabilistic (Sig) value equals 0.000. This means that there is agreement with a medium degree by the sample members on the paragraphs of this domain. The researchers attribute the result to the fact that the nursing staff in Al-Awda Hospital suffer from work pressure more than others, as the job includes a little control and oversight, and the nurses feel tired as a result of the large number and variety of work they do due to work pressure. On the hospital resulting from the large number of patients visiting the specialized hospital clinics. The arithmetic mean of the second domain “work stresses resulting from the conflict of roles” is equal to 3.00, meaning that the relative arithmetic mean is 60.1%, the value of the standard deviation is 0.991, and that the probabilistic (Sig) value is equal to 0.000. This means that there is agreement with a medium degree by the sample members on the paragraphs of this domain. The researchers attribute the result to the nurses in the hospital feeling limited in their expectations and work demands related to the role they play, and nurses feel annoyed when functional powers are delegated by the hospital administration to nurses who are incompetent, which leads to the entry of some nurses into conflict and a confrontation with management, and some coworkers. In addition, some requirements of their family life conflict with the requirements of working in the hospital. The arithmetic mean of the third domain “Work Stress resulting from occupational growth” is equal to 3.76, meaning that the relative arithmetic mean is 75.20%, the standard deviation value is 0.675, and the probabilistic (Sig) value is equal to 0.000 and this means that there is a large degree of agreement by the sample members on the paragraphs of this domain. The researchers attribute the result to the fact that the nurses in Al-Awda Hospital need to provide continuous and advanced training courses to improve their job performance to keep pace with changes in the health and administrative domain, and here it is worth noting the need to participate in attending conferences and scientific seminars related to the nature of work. In addition, nurses must be given opportunities for career advancement, including promotions and rewards of all kinds. The arithmetic mean of the fourth domain “work pressure resulting from performance evaluation” is equal to 3.49, meaning that the relative arithmetic mean is 69.80%, the standard deviation value is 0.735, and the probabilistic value (Sig) equals 0.000 and this means that there is a great agreement by the sample members on the paragraphs of this domain. The researchers attribute the result to the lack of objective judgment on the extent of the nurses’ contribution to the completion of the work entrusted to them, and on their behavior and behavior during work, and the nurses feel the lack of benefit from the observations made by the hospital administration toward their job performance, in addition due to the lack of diversity of evaluation methods used. The arithmetic mean of the fifth domain “work stresses resulting from the physical work environment” is equal to 3.76, meaning that the relative arithmetic mean is 75.23%, the standard deviation value is 0.913, and the probabilistic value (Sig) equals 0.000 and this means that there is an agreement by the sample members on the paragraphs of this domain. The researchers attributed the result to the lack of high-quality and appropriate equipment to perform the work, and the offices and devices in the work offices may be located in a way that does not help the nurses to perform the work in a way that suits the nature of the work, in addition to their suffering from noise due to overcrowding, pressure from patients and visitors, insufficient means of ventilation available in workplaces, and lack of means of occupational safety and security. In general, it can be said that the arithmetic mean equals 3.44, that the relative arithmetic mean equals 68.80%, the value of the standard deviation is 0.569, and that the probability value (Sig) equals 0.000 and this means that there is a large degree of approval by the sample members on the work stress paragraphs in general, the researchers attribute this to the fact that these pressures (the nature of work, role conflict, professional growth, performance evaluation, and the physical work environment) affect the nurses in Al-Awda Hospital, which may be rapid, and lead to a direct impact on the nurses’ behavior, negatively or positively. This result agreed with the findings of the study of Musa (2020), the study of Hassan (2019), and the study of Muhammad (2017).
Q2: What is the level of job performance for nurses in Al-Awda Hospital in Gaza Strip?
The arithmetic mean, relative, and standard deviation were used to determine the degree of agreement, as in Table 3.
Arithmetic mean, relative, and standard deviation for all items of job performance
(
| Statement | SMA | Relative weight | Standard deviation | Sig. | Rank | |
|---|---|---|---|---|---|---|
| 1. | I always make sure to take advantage of my work time. | 4.30 | 86.00 | 0.696 | *0.000 | 2 |
| 2. | I am ready to do any additional tasks assigned to me. | 4.10 | 82.00 | 0.915 | *0.000 | 3 |
| 3. | My workplace is crowded with visitors. | 4.07 | 81.40 | 0.778 | *0.000 | 5 |
| 4. | I look forward to new responsibilities in addition to my current duties. | 3.67 | 73.40 | 0.986 | *0.000 | 8 |
| 5. | I communicate with my colleagues and work in a team spirit. | 4.47 | 89.40 | 0.676 | *0.000 | 1 |
| 6. | I have previously submitted ideas and suggestions that were useful in developing my performance. | 4.07 | 81.40 | 0.972 | *0.000 | 4 |
| 7. | I usually do more work than the expectations of my superiors. | 3.60 | 72.00 | 1.061 | *0.000 | 9 |
| 8. | I look forward to new responsibilities in addition to my current duties. | 3.70 | 74.00 | 1.013 | *0.000 | 7 |
| 9. | Too many questions hinder my work. | 3.30 | 66.00 | 0.979 | *0.000 | 10 |
| 10. | The working procedures are clear enough. | 3.80 | 76.00 | 0.7550 | *0.000 | 6 |
| 3.90 | 78.13 | 0.449 | *0.000 | |||
The arithmetic mean is statistically significant at the 0.05 level of significance.
It is clear from Table 3 that:
The arithmetic mean of the domain of “functional performance” is equal to 3.90, meaning that the relative weight is 78.13%, the value of the standard deviation is 0.449, and that the probability value (Sig) is equal to 0.000, which means that there is a large agreement by the sample members of the paragraphs of this domain, and the researchers refer the result to the fact that the nurses in Al-Awda Hospital perform their functional tasks entrusted to them according to the required quality standards, and the hospital administration has succeeded in providing an atmosphere conducive to work and productivity in the hospital, and worked to determine the functional tasks of all workers to eliminate duplication of work and overlap. In terms of authority, in other words, it worked on defining the employee's duties.
In addition, the training programs offered to employees contributed to improving the performance level of employees to accomplish their job duties. In addition, the hospital administration encouraged communication and communication between employees and teamwork, and was keen to make good use of working good hours. This result agreed with the findings of the study of Musa (2020), the study of Hassan (2019), and the study of Muhammad (2017).
Ho1: There is a statistically significant relationship at the level of significance (α ≤ 0.05) between the dimensions of work stress (nature of work, role conflict, professional growth, performance evaluation, and physical work environment) and job performance among nurses at Al-Awda Hospital.
To test this hypothesis, the “Pearson correlation coefficient” test was used, and the Table 4 illustrates this. Table 4 shows that the correlation coefficient is equal to 0.318, and that the probability value (Sig.) is equal to 0.013, which is less than the significance level 0.05, and this indicates the existence of a positive, statistically significant relationship between stress and job performance among nurses in Al-Awda hospital.
Correlation coefficient between work stress and job performance among nurses in Al-Awda Hospital
(
| Hypothesis | Pearson correlation coefficient | Sig. |
|---|---|---|
| There is a statistically significant relationship at the level of significance (α ≤ 0.05) between the dimensions of work stress (nature of work, role conflict, professional growth, performance evaluation, and physical work environment) and job performance among nurses at Al-Awda Hospital. | 0.318 | 0.013 |
| There is a statistically significant relationship at a significant level (α ≤ 0.05) between the nature of work dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital. | 0.106 | 0.421 |
| There is a statistically significant relationship at a significant level (α ≤ 0.05) between the role conflict dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital. | 0.318 | 0.013* |
| There is a statistically significant relationship at a significant level (α ≤ 0.05) between the dimension of professional growth as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital. | 0.512 | 0.000* |
| There is a statistically significant relationship at a significant level (α ≤ 0.05) between the performance evaluation dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital. | 0.379 | 0.000* |
| There is a statistically significant relationship at a significant level (α ≤ 0.05) between the physical work environment dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital. | 0.151 | 0.248 |
The correlation is statistically significant at significance level (α ≤ 0.05).
When examining the dimensions of the reality of work stress, the following was found:
There is no statistically significant relationship between the nature of work dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient was 0.106 and statistical significance was 0.421, which is greater than 0.05. There is a statistically significant relationship between the dimension of role conflict as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient reached 0.318 and statistical significance 0.013, which is less than 0.05. There is a statistically significant relationship between the dimension of professional growth as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient reached 0.512 and the statistical significance 0.000, which is less than 0.05. There is a statistically significant relationship between the performance evaluation dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient reached 0.379 and the statistical significance 0.000, which is less than 0.05. There is no statistically significant relationship between the physical work environment dimension as one of the dimensions of work stress and job performance among nurses at Al-Awda Hospital, where the correlation coefficient was 0.151 and the statistical significance was 0.248, which is greater than 0.05.
The researchers attribute the result to the fact that the nurses in Al-Awda Hospital feel pressure at work due to the conflict between their work and their personal requirements, which requires making a greater effort in compatibility between these two roles to alleviate the pressure caused by it. The nurses also feel constant fear for their health as a result of the working conditions and a special risk after the emergence of the Corona epidemic, and the absence of clear criteria upon which the process of evaluating the nurses’ performance is based, which makes them feel high pressure; in addition, the hospital administration does not provide enough nurses with the opportunity to develop new skills that improve their job position, which makes them feel pressure. The result of the hypothesis agreed with some results of previous studies, such as the study of Musa (2020), the study of Hassan (2019), and the study of Muhammad (2017).
Ho2: There is a statistically significant effect at the level of significance (α ≤ 0.05) for the dimensions of work stress (nature of work, role conflict, professional growth, performance evaluation, and physical work environment) on the job performance of nurses in Al-Awda Hospital.
To test this hypothesis, multiple linear regression was used and the Table 5 illustrates this.
Multiple regression analysis
(
| Independent variables | Regression coefficients | T-value test | Sig. |
|---|---|---|---|
| Fixed amount | 0.263 | 0.624 | 0.362 |
| Work nature | 0.068 | 0.653 | 0.632 |
| Role conflict | 0.243 | 3.246 | 0.003 |
| Professional growth | 0.186 | 2.653 | 0.012 |
| Performance evaluation | 0.283 | 5.268 | 0.000 |
| Physical work environment | 0.046 | 0.475 | 0.624 |
| Correlation coefficient = 0.397 | Adjusted coefficient of determination = 0.385 | ||
| F-test value = 5.721 | P value = 0.000 | ||
From the results shown in Table 5, the following can be concluded:
Correlation coefficient = 0.397, adjusted coefficient of determination = 0.385, which means that 38.5% of the change in the functional performance of the two patients in Al-Awda Hospital was explained by the linear relationship and the remaining percentage may be due to other factors affecting the functional performance of the two patients in Al-Awda Hospital. The value of the F-test was 5.721, and the probability value is 0.000, which means rejecting the null hypothesis and accepting the existence of a statistically significant relationship between work stress and job performance for the two patients in Al-Awda Hospital. It was found that the variable (role conflict, professional growth, and performance evaluation) affects the job performance of patients in Al-Awda Hospital, while the other variables (the nature of work and the physical work environment) have a weak effect.
Job Performance =
0.263 + 0.068 (nature of work) + 0.243 (role conflict) + 0.186 (professional growth) +
0.283 (performance evaluation) + 0.046 (physical work environment)
This result may be due to the nurses in Al-Awda Hospital feeling tired from the large number and variety of work they do, and they need more time to complete the work due to the specificity of the nature of the emergency. Upset by the devices, equipment, and furniture used in the work inside the hospital.
The study concluded a set of results as follows:
The results of the study showed that 68.8% of the study sample believe that the reality of work stress among nurses in Al-Awda Hospital in Gaza Strip, which is highly agreeable. The results showed that the reality of work stress among nurses in Al-Awda Hospital in Gaza Strip, according to their relative importance, was as follows:
the relative weight of the total work stress axis resulting from the physical work environment was 75.23%, which is a great agreement, the relative weight of the total work stress axis resulting from occupational growth was 75.20%, which is a highly agreeable degree, the relative weight of the total work stress axis resulting from the performance appraisal was 69.80%, which is highly agreeable, the relative weight of the total work stress axis resulting from the nature of work was 64.50%, which is a medium degree of approval, the relative weight of the total work stress axis resulting from the conflict of roles was 60.1%, which is a medium degree of approval. The results of the study revealed that 78.13% of the study sample believe that the level of job performance of nurses in Al-Awda Hospital in Gaza Strip is of great agreement. The results of the first hypothesis showed that there was a statistically significant relationship at the level of significance (α ≤ 0.05) between the dimensions of work stress and job performance among nurses in Al-Awda Hospital in Gaza Strip, where the correlation coefficient was 0.318. As for the results of the subhypotheses of the first hypothesis, they were as follows:
there is no statistically significant relationship between the nature of work dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient was 0.106 and statistical significance was 0.421, which is greater than 0.05, there is a statistically significant relationship between the dimension of role conflict as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient reached 0.318 and statistical significance 0.013, which is less than (0.05), there is a statistically significant relationship between the dimension of professional growth as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient is 0.512 and the statistical significance is 0.000, which is less than 0.05, there is a statistically significant relationship between the performance evaluation dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient reached 0.379 and the statistical significance 0.000, which is less than 0.05, there is no statistically significant relationship between the physical work environment dimension as one of the dimensions of work stress and job performance among nurses in Al-Awda Hospital, where the correlation coefficient was 0.151 and the statistical significance was 0.248, which is greater than 0.05. The results showed that there was a statistically significant effect at the level of significance (α ≤ 0.05) between the dimensions of work stress (role conflict, professional growth, and performance evaluation) on the job performance of nurses at Al-Awda Hospital in Gaza Strip. And it was found that the effect of the dimension (the nature of work and the physical work environment) is weak.
In light of the theoretical framework of the study, and the results that resulted from it, the researchers make the following recommendations:
The necessity for the senior management in Al-Awda Hospital to pay attention to all dimensions of work stress, and the elements that contribute to improving the job performance of nurses, the results of which showed their importance, and their impact on improving job performance in Al-Awda Hospital. Develop a job description for hospital workers in general and nurses in particular to clearly define the tasks, duties, and responsibilities of the nurses, alleviating their sense of pressure resulting from the conflict of roles. Contribute to the activation of training programs by revealing the actual skills and knowledge of nurses, the true value of the training programs they receive, and their ability to develop their skills in the work they perform, while designing programs appropriate to their actual needs. Giving the subject of performance evaluation special attention and care, and conducting it on objective bases that make the nurses feel fair and equal. Improving the organizational climate for work by providing a comfortable and appropriate work environment for patients, and providing means of safety and protection from risks that may face them, which raises morale and relieves the feeling of work pressure. The necessity of adopting new dimensions of the administrative and professional development policy in the work environment, in which consideration is given to the social and psychological conditions of workers, especially nurses. Enable the hospital administration to improve the performance of its staff by following up on, supervising, and directing various serious and effective means to identify strengths and weaknesses in the nurses’ performance. Work to increase nurses’ enthusiasm for work and their assumption of the tasks and responsibilities entrusted to them, which contributes to improving performance that matches the quality standards and specifications required by work in the hospital. Encouraging nurses to submit proposals and development ideas that contribute to improving the quality of job performance. The hospital administration continues to motivate employees and encourage them to change, innovate, and create and work according to the highest levels of job performance.