Correlation beetwen Characteristics and Workload with Nurses Job
Stress In-patient Unit Gedung a of Cipto Mangunkusumo Hospital
Jakarta
Juanda and Ria Utami Panjaitan
Faculty of Nursing, University of Indonesia, FIK UI Building, Jl. Prof. Dr. Bahder Djohan,
Depok, West Java-16424, Indonesia
Keywords: Workload, Job Stress, Nurses.
Abstract: Nurse is a profession specializing in providing health service which possesses high risk for work-related stress
due to greater workload. This study aimed to identify correlation between characteristics and workload with
nurses job stress In-Patient Unit Gedung A of Cipto Mangunkusumo Hospital Jakarta. The study design was
descriptive correlative and conducted in June 2017. The study involved 243 nurses who work In-patient Unit
Gedung A of Cipto Mangunkusumo Hospital Jakata with minimum nursing diploma education selected by
random sampling method and the distribution of the propotion of nurses in each room using the Proportionate
Stratified Random Sampling system. ENSS (Expanded Nursing Stres Scale) and nurse workload
questionnaire made by Idawati as the instrument. Instruments testing uses a significance of 5%, validity test
of work stress and workload instruments was validated. Hospital should take workload into consideration in
order to create a supportive working environment for nurses.
1 INTRODUCTION
Nursing is aimed at making the lives of people who
are in need better. It is about helping people while
they are ill, helping them throughout recovery, and
helping them maintain their health. It’s about
assisting people achieve better health and a better
quality of life through using their knowledge, skills,
and compassion (Hall, 2009)
In providing nursing care, nurse has
responsibilities and roles as caregiver, communicator,
advocator, and manager (Potter, 2013). The roles and
responsibilities support implementation of
comprehensive nursing care in biopsychosocial and
spiritual aspects. They also aim to prevent illness,
provide care for patient who is suffering from a
disease, disability, and dying patient, as well as
improving patient’s health.
Nurse is vulnerable to work-related stress in
performing his duty and profession. At work, nurse
meets and interacts with patient, family, visitor,
fellow nurse, and other health professionals from
multidisciplinary team and also complies with
policies in working environment. It may result in
excessive workload that overwhelms his physical,
emotional, and psychological condition (Kurnia,
2010).
Supardi (2007) outlined that one’s workload
should be in proportion with his own physical and
cognitive capacity as well as limitation. Each person
has distinctive approach in managing the workload to
be in proportion with his own ability. A person with
workload that exceeds his own capacity may
experience burnout which affect his mental and result
in fatigue, mood change, boredom, irritability, and
distress. Stress has a continuum ranging from
adaptive to maladaptive; mild stress is an adaptive
stress response followed by moderate stress which
may affect individual and severe stress that is
maladaptive and results in panic attack and
depression.
An interview involving 20 ward nurses in
Building A which conducted from November 20
th
through 24
th
2016 revealed several factors that
affected their performances including higher
workload, higher work demand, pressure to improve
performance from both patient and supervisor,
conflict with coworker or supervisor or another health
profession, shift work, exposure to dying patient, and
number of patients exceeding number of nurses.
154
Juanda, . and Utami Panjaitan, R.
Correlation beetwen Characteristics and Workload with Nurses Job Stress In-patient Unit Gedung A of Cipto Mangunkusumo Hospital Jakarta.
DOI: 10.5220/0008206701540162
In Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 154-162
ISBN: 978-989-758-406-0
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All r ights reserved

The issues may lead to stress in nurses and they
may experience headache, stiffness, neck pain, and
insomnia which contribute to lower concentration and
poor performance and even lower productivity in
providing nursing care.
2 METHODS
The study design was descriptive-correlative in which
dependent (characteristics and workload) and
independent (nurses job stress) variables were
analyzed to identify correlation between both
variables.
The study sample was nurses working in Inpatient
Department in Building A of Dr. Cipto
Mangunkusumo hospital. Participants were recruited
through quota sampling method with total number of
243 nurses who met the inclusion criteria established
by authors.
Data collection was conducted through
questionnaire. Univariate analysis was applied to
identify distribution of frequency of variables and
bivariate analysis was employed to identify
correlation between dependent and independent
variables.
The Determination of the validity test is done by
means of a correlation test between the scores of each
items statements with a score corresponding to a
significancy level of 5%.
3 RESULT
The study was conducted in June 2017 at In-Patient
Unit Gedung A of Cipto Mangunkusumo Hospital
Jakarta by involving 243 participants.
Table 1: Participant’s Characteristics (n=243).
Characteristic Frequency (%)
Gender
- Male
- Female
42
201
17,3
82,7
Age
- < 25 years
- 26-35 years
- 36-45 years
- 46-55 years
111
60
46
26
45,6
24,7
19
10,7
Characteristic Frequency (%)
Marital Status
- Married
- Single
- Widow/Widower
112
118
13
46,1
48,5
5,4
Educational Background
- Diploma III
- Bachelor (S1)
222
21
91,3
8,7
Years of Service
- < 5 years
- 5-10 years
- > 10 years
137
31
75
56,5
12,6
30,9
Table 1 indicates that majority of participants
were females (n= 201, 82.7 %), aged between 17 to
25 years old (n=111, 45.6 %), and single (n=118, 48.6
%). Most of them were Diploma III/Vocational
nursing graduates (n=222, 91.3 %) and had been
working for less than 5 years (n=137, 56.5 %).
Table 2: Correlation between Demographic Characteristics
and Work Stress (n=243).
Variable
Work Stress
Tot
al
P
Val
ue
OR
C
I 95%
Mild Moderate
n % n %
Gender
Male
Female
32
12
6
76,2
62,7
1
0
7
5
23,8
37,3
42
20
1
0,9
5
2,78
5
Age
17-25
years
26-35
years
36-45
years
46-55
years
10
8
60
37
26
97,3
100
80,4
100
3
0
9
0
2,7
0
19,6
0
11
1
60
46
26
0,5
8
3,59
5
Marital
Status
Single
Married
Widow/wi
dowed
66
79
13
56
70,5
100
5
2
3
3
0
44
29,5
0
11
8
11
2
13
0,0
02
12,7
77
Education
Nursing
Diploma
Bachelor
of Nursing
14
3
15
64,4
71,4
7
9
6
35,6
28,6
22
2
21
0,5
19
0,41
5
Years of
Service
< 5 years
5-10 yrs
> 10 years
73
25
60
53,3
80,7
80
6
4
6
1
5
46,7
19,3
20
13
7
31
75
0,0
01
19,7
44
Table 2 indicates that 126 female nurses and 32
male nurses were affected by mild stress. The
statistical analysis revealed p value 0.95 > 0.05 which
implied a there is no correlation between gender and
work stress in nurses working in Inpatient
Correlation beetwen Characteristics and Workload with Nurses Job Stress In-patient Unit Gedung A of Cipto Mangunkusumo Hospital
Jakarta
155

Department in Building A of Dr. Cipto
Mangunkusumo hospital
Majority of participants aged 17 to 25 years old
and 108 participants were affected by mild stress, 60
participants aged 26 to 35 years old affected mild
stress, 39 participants aged 36 to 45 years old affected
mild stress, and 26 participants aged 46 to 55 years
old were affected by mild stress. The statistical
analysis revealed p value 0.58 > 0.05 which implied
a there is no correlation between age and work stress
in nurses working in Inpatient Department in
Building A
The table also shows that most of single
participants were affected by mild stress and 79
married participants were affected by mild stress. The
statistical analysis revealed p value 0.002 < 0.05
which implied a significant correlation between
marital status and work stress in nurses working in
Inpatient Department in Building A of Dr. Cipto
Mangunkusumo hospital. OR values was 12,777
which suggested that participants with single status
marital were 12,777 times more likely to be affected
by moderate stress than those with
married/widow/widowed.
Majority of Diploma III/Vocational graduate
nurses were affected by mild stress and 15
undergraduate nurses were affected by mild stress.
The statistical analysis revealed p value 0.519 > 0.05
which implied a there is no correlation between
education and work stress in nurses working in
Inpatient Department in Building A
The table also describes that most participants
who had been working for less than 5 years 73 nurses
were affected by mild stress and those with 5 to 10
years of service 25 nurses or more than 10 years of
service 60 nurses were affected by mild stress. The
statistical analysis revealed p value 0.001 < 0.05
which implied a significant correlation between years
of service and work stress in nurses working in
Inpatient Department in Building A of Dr. Cipto
Mangunkusumo hospital. OR values was 19,744
which suggested that participants with years of
service < 5 years were 19,744 times more likely to be
affected by moderate stress than those with years of
service 5-10 years and >10 years.
Table 3 reveals that 146 out of 231 participants
(63.2%) with moderate workload were affected by
mild stress and 85 of them were affected by moderate
stress (36.8%). All 12 participants with higher
workload were affected by mild stress (100%).
The statistical analysis revealed p value 0.009 <
0.05 which implied a significant correlation between
workload and work stress in nurses working in
Inpatient Department in Building A of Dr. Cipto
Mangunkusumo hospital. OR values was 6,791 which
suggested that participants with moderate workload
were 6.791 times more likely to be affected by
moderate stress than those with higher workload.
Table 3: Correlation between Workload and Stress-Related
Work (n=243).
Workload
Work Stress
Total
P
Value
OR CI
95%
Mild Moderate
n % n %
Low
Moderate
High
Total
0
146
12
158
0
63,2
100
65
0
85
0
85
0
36,8
0
35
0
231
12
243
0,009 6,791
4 DISCUSSION
4.1 Participant Characteristics
Demographic characteristics in this study included
gender, age, marital status, educational background,
years of service, and workload. Majority of
participants were females (n=201, 82.7%), aged 17 to
25 years old (n=111, 45.6%), single (n=118, 48.5%),
Diploma III graduates (n=222, 91.3%), had been
working for less than 5 years (n=137, 56.5%) and had
moderate workload (n=231, 95%). Therefore, it can
be concluded that most participants were females,
aged 17 to 25 years old, single, Diploma III graduate
nurses who had been working for less than 5 years
and had moderate workload.
4.2 Relationship between Participant
Characteristics and Nurses Job
Stress
The findings revealed that majority of nurses in
Building A of RSCM were females (n=201, 82.7%).
A study by Khoddin (2012) revealed that 75 out of 94
(79.8%) participants were females and only 19 of
them were males (20.2%) which indicated greater
number of female nurses than the male ones. Guntur’s
study (2009) described that marginalization of female
roles in public associated with power relation which
established and developed in nursing profession
generates stereotype that nursing profession is more
suitable for females rather than males. Furthermore,
some patients perceive that female nurses are
somehow more agile in performing their duties and
marginalization process which creates the stereotype
that nurse is a female’s job leads to domination of
females in organization structure in nursing.
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Authors believed that it was resulted from the
notion that nursing profession is less appealing for
males and that females are more conscientious and
careful in performing their duties than males; nursing
academic is known to have higher number of female
students than the male ones; females show more
respect than males; and that females show higher
level of patience and sincerity than their male
counterparts which lead to greater number of female
nurses recruited by hospital.
A study conducted by Ismafiaty (2012) reported
that 66.7% female nurses were affected by work-
related stress; it was possibly because female mostly
uses her feeling in dealing with a problem. Males are
required to be stronger than females which encourage
them to use their mind in solving a problem over their
own feelings.
The finding corresponded with Khoddin’s study
(2012) which revealed that 75 out of 94 participants
were females (79.8%) and only 19 of them were
males (20.2%). Chi square test revealed a significant
correlation between gender and work stress among
nurses with X value 7.733 and p value 0.021 < α
(0.05). Individual’s personality contributed to this
result. A male is more likely to be extrovert than
female who tends to be introvert. The tendency makes
female to be restrictive in sharing her problems with
coworker that, in turn, becomes a psychological
burden and may turn into a stressor if it is not solved
appropriately and eventually lead to stress-related
work.
The study findings suggest disproportionate
number of female and male participants (201 females
or 82.7% and 42 males or 17.3%) which did not allow
a conclusion to be drawn from such circumstance in
Inpatient Department in Building A of Dr. Cipto
Mangunkusumo hospital.
The study result also reveals that 111 out of 243
participants were aged between 17 to 25 years old
(48.5%). A study conducted by Anwar (2007)
reported that adolescents aged 17 to 25 years started
to regard themselves as adults and were able to
demonstrate maturity in mind, attitude, and behavior
which encourage them to seek for job. An
organization infrequently hires employee older than
25 years for a job that is masses, routine, and
repetitive in nature since it requires high durability,
precision, pace, and accuracy; all of which are
difficult for older employee (Nugroho, 2010).
Authors reckoned it was because people aged
between 17 to 25 years are within their productive
age. People in productive age tend to work harder.
Building A of RSCM is an inpatient unit with highest
bed capacity among other units that require power of
youths who are able to work hard and possess
stronger physical capability rather than those in late
adulthood who are more likely to have declining
physical capability and lower work performance.
The study results also indicated that 111 out of
243 participants were aged between 17 to 25 years old
(48.5%), 60 of them were aged between 26 to 35
years old (25.7%), 46 of them were aged between 36
to 45 years old (19%), and 26 of them were aged
between 46 to 55 years old (10.7%). Febriandini’s
study (2016) suggested that there was a significant
association between age and work stress in nurses.
This study finding revealed that 24 out of 46
participants aged between 22 to 31 years old were
affected by moderate stress (82.7%). Individual older
than 30 years may possess better understanding of
various issues which reduces stress; it is also linked
with more stable thinking process and maturity in
making a decision.
A study conducted by Jusnimar (2012) reported
that 25.9% out of 33 participants aged 20 to 40 years
old were suffering from mild stress and 74.1% of
them were affected by moderate stress. 66.7% of
participants aged between 41 to 65 years old were
affected by mild stress while 33.3% of them were
suffering from moderate stress. It shows that older
participants had lower stress due to higher
competence in performing duties and easier
adjustment with new environment which facilitated
stress management.
The findings show that participants aged between
17 to 25 years old and between 26 to 35 years old
were more likely to be affected by stress (n=171,
70.3%) than participants aged between 36 to 45 years
old and between 46 to 55 years old (n=72 orang,
29.3%). Authors believed that advancing age
contributed to this finding. Advancing age enables
people to control their emotions, think rationally, be
wiser, more tolerant, and open to another’s opinion or
view thus facilitate stress management at work.
Moreover, Dr Cipto Mangunkusumo hospital is a
national reference hospital providing health services
for patients with various medical conditions and
complications; such condition may be difficult for
nurses aged between 17 to 25 years old with least
experience in providing nursing care and may
eventually lead to stress.
The study result indicates that 118 out of 243
participants were singles (48.5%), 112 of them were
married (46.1%) and 13 of them were widows or
widowers (5.4%). It implies that most participants
were yet to get married. Marriage compels greater
responsibility on individual which makes him regard
a stable job as important and valuable matter (Siagian,
Correlation beetwen Characteristics and Workload with Nurses Job Stress In-patient Unit Gedung A of Cipto Mangunkusumo Hospital
Jakarta
157

2009). However, Rizal (2010) stated that many
organizations prefer to hire single people as employee
as they tend to be more focused at work and prioritize
their job rather than married people who may have
had their focus divided for their family. Such
condition also applied among nurses in Building A of
RSCM since majority of them were aged 17 to 25
years old, an age group in which single status is
common. Absence rate is also higher among married
women, especially those who have children. In
addition, married nurses’ role and responsibility are
shared between their community and profession,
increasing their vulnerability to various issues.
Allowances may also contribute to this as hospital is
not required to provide allowance for employee’s
family if the employee is yet to get married since
RSCM is a Public Service Agency that also hires non-
civil servant staff whose wage is independently
managed and provided by the hospital itself.
A study conducted by Ismafiaty (2012) reported
that there was a significant association between
marital status and work-related stress. 13 out of 27
participants were singles and 2 of them were affected
by work-related stress (15.4%) and 4 out of 14
married participants (50%) were also affected by
work-related stress. It suggested that work stress was
more common among married participants than the
single ones. It was probably because married
participants were burdened with marriage issues
while the single ones were not; the issues hinder their
work performances and lower their concentration at
work and eventually lead to work stress.
The study result coincided with Jusnimar’s study
(2012) which reported that work stress was frequently
affecting married participants (73.9%). The stress
could be a result of internal conflict within family or
financial issues which strain them at work.
Authors presumed that married people have
higher possibility to be affected by stress that may
influence their lives. The stress was resulted from
greater responsibility and role in family, society, and
job. Inappropriate management of stress will
certainly affect one’s performance at work. Nurse
should be able to manage, prevent, and cope with the
stress resulting from duties and responsibilities in
family so it does not turn into stressor at work and
cause work-related stress.
The study findings suggested that there were 222
Diploma III graduate nurses (91.3%), and 21
undergraduate nurses (8.7%). A study by Jusnimar
(2012) revealed that 26 out of 33 participants were
Diploma III graduate nurses (78.8%) and 7 of them
were undergraduate nurses (21.2%) which indicated
greater number of Diploma III graduate nurses than
the undergraduate nurses. Education is an indicator
reflecting individual’s competence in doing a job.
Individual with certain educational background is
considered worthy of certain position at work
(Hasibuan, 2005). Mandini (2013) described that
Diploma III/Vocational nursing education is aimed to
prepare its graduates with skills/vocations which
encompasses 60% practice and 40% theory in its
curriculum so the graduates are ready to be employed.
Authors suggested that higher number of vocational
nurses in Indonesia is partly responsible for this
phenomenon which leads to higher number of
vocational nurses employed by hospitals.
Information of job vacancy in RSCM which is
distributed among fellow vocational nursing
graduates promotes them to apply to work in RSCM.
Undergraduate nurses do not only provide nursing
care for patients but also manage them and serve as a
coordinator, planner, and developer in nursing thus
cause most of them to hold certain managerial
position while vocational nurses are mostly assigned
in patient service.
Authors suggested that vocational nurses are more
likely to be affected by work-related stress than
undergraduate nurses. It was possible because
undergraduate nurses had greater understanding on
stress, adaptation, and coping than the vocational
ones which indirectly affected them in coping with
stress and dealing with all stressors in their working
environment. Disproportionate number of
participants based on educational background (222
Diploma III nurses or 91.3% compared with 21
undergraduate nurses or 8.7%) complicates authors in
drawing conclusion from such condition.
The study findings revealed that 137 out of 243
participants had been working in Dr Cipto
Mangunkusumo hospital for less than 5 years
(56.5%), 31 of them had been working for 5 to 10
years (12.6%), and 75 of them had been working for
more than 10 years (30.9%). Jusnimar’s study (2012)
reported that 17 participants had been working in
hospital for 1 to 5 years (51.5%), 7 participants had
been working for 5 to 10 years (21.2%), and 9
participants had been working for more than 10 years
(27.3%) which suggested that majority of them had
been working for 1 to 5 years. Siagian (2009) stated
that longer years of service in organization does not
always mean higher productivity. Authors believed
that there was higher number of participants with 1 to
5 years of service due to greater work satisfaction in
early years of service and it gradually decreases over
the next 5 or 8 years and steadily increases again over
8 years. Fresh graduate is thought to have better
comprehension of nursing theory and its application.
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Moreover, RSCM opens job vacancy 3 times a year
and the recruited graduates are mostly assigned in
Building A that possesses highest bed capacity
among other units.
Ismafiaty (2012) described that 6 out of 18 nurses
with less than 5 years of service were suffering from
work-related stress (22.2%) and 3 out of 9 nurses with
over than 5 years of service were also affected by
work-related stress (11.11%). That finding suggested
that nurses with less than 5 years of service were more
likely to be affected by work-related stress; it was due
to lack of experience than those with longer years of
service.
The finding contradicted Giriwati’s study result
(2011) revealing that majority of nurses who had been
working for over than 10 years were affected by
work-related stress (52.6%). It is probably because
nurses with longer years of service are given higher
position in organization which includes greater
responsibility and work demand that eventually lead
to work-related stress. The stress may also be
resulting from boredom due to following similar
routines for decades.
Authors concluded that majority of nurses with
less than 5 years of service were more vulnerable to
work-related stress. Lack of experience in managing
stressors at work contributed to the development of
stress. There is a discrepancy in capacity between
junior and senior nurse in managing pressures and
stressors at work. The longer years of service, the
more competent a nurse is in doing his job; however,
junior nurse is required to be able to adjust himself
with working environment before gaining mastery
over his job which indirectly results in stress and
burden.
4.3 Relationship between Workload
and Nurses Job Stress
Workload is a strain perceived by participants in
providing nursing care in Dr Cipto Mangunkusumo
Jakarta hospital. 231 out of 243 nurses perceived
moderate workload (95%) and 12 of them perceived
higher workload (5%).
Adiprana (2008) outlined 3 aspects in calculating
workload which includes physical, mental, and time.
Physical workload emphasizes on activity that
requires physics such as bed making, lifting patient,
pushing medical instruments, and imbalance patient-
nurse ratio. Mental workload focuses on role conflict,
poor relationship with supervisor or colleague, and
facing patient’s family who is in panic. Time
workload includes pressure to complete nursing care
documentation on time, pressure to make a decision
promptly, and working overtime due to inadequate
number of nurse.
The statement corresponds with Rodahl’s study
(2000, in Pracinasari, 2013) describing that workload
is influenced by internal and external factors.
External factor originates from the outside of
employee’s body and it includes 3 stressors, namely
duty, organization, and working environment.
Internal factor stems from within the nurse himself
that includes psychological factor, motivation,
satisfaction, and perception. The internal and
external factors consist of workload either in the form
of physical, mental, or time.
This study finding suggested that 231 out of 243
nurses perceived moderate workload (95%) and 12 of
them perceived higher workload (5%). Authors
believed the imbalance nurse-patient ratio in which
amount of patient overwhelms amount of nurse
results in additional nursing interventions that should
be provided by a nurse thus increase his workload. In
addition, Dr Cipto Mangunkusumo hospital is a
national reference hospital providing health services
for patients with various medical conditions and
dependency level, partial care through total care,
which directly doubles the nurse’s workload
depending on patient’s dependency level. Providing
direct and indirect nursing intervention and health
education also bring impact on nurse’s workload.
These factors made participants perceive moderate to
severe workload, either in form of physical, mental,
or time. Workload should be designated to each
individual according to his age and gender since
disproportionate workload will lead to strain at work.
The study result revealed that 158 out of 243
nurses were affected by mild stress (65%) and 85 of
them were affected by moderate stress (35%).
Robbins (2008) described that sources of stress
may stem from environmental, organizational, and
individual factors. Environmental factors that
provoke stress include noise, poor ventilation, and
insufficient facility. Organizational factors include
conflict with supervisor, colleague or coworker, poor
communication, pressure to complete a task in limited
time and working climate. Individual factors include
individual needs and characteristics (age, gender, and
educational background).
The findings indicated that participants aged
between 17 to 25 years old and between 26 to 35 years
old were more vulnerable to work-related stress
(n=171, 70.3%) than those in the age group of 36 to
45 years and 46 to 55 years (n=72, 29.3%). Authors
reckoned that it was because advancing age enables
people to control their emotions, think logically, be
Correlation beetwen Characteristics and Workload with Nurses Job Stress In-patient Unit Gedung A of Cipto Mangunkusumo Hospital
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wiser, more tolerant, and open to another’s opinion or
view thus facilitates stress management at work.
Inadequate interaction and communication in
working milieu such as poor communication between
associate nurse and his head nurse, fellow nurse, other
health professionals, or employees from another
hospital may turn into a stressor. Poor communication
often results in misunderstanding or misperception on
information that may lead to error in providing
nursing care and provoke stress. The distinction in
human personality causes friction and conflict in the
organization and results in work stress. However, the
hospital has organized attempts to refresh and
maintain interaction or relation among employees by
organizing staf / family gathering twice a year,
however, no other activities implemented such as
exercise in hospital to maintain physical and mental
well-being.
146 out of 231 participants with moderate
workload were affected by mild stress (63.2%) and all
12 participants with higher workload were also
affected by mild stress (100%). The statistical
analysis revealed p value 0.009 < 0.05 suggesting that
there was a significant correlation between workload
and work stress in nurses working in Inpatient
Department in Building A of Dr. Cipto
Mangunkusumo hospital. It was also revealed OR
value of 6.791 implying that participants with
moderate workload were 6,791 times more likely to
be affected by stress than those with higher workload.
This result was supported by Khoddin’s study
(2012) which reported a significant association
between workload and stress-related work in nurses
with Chi Square test revealing p value 0,010. Higher
workload brings impact on employee’s physic and
mental and may become a stressor at work.
A study conducted by Dewi (2014) on nurses in
Pasar Rebo hospital reported that participants with
higher workload were affected by severe work-
related stress (46.7%). Furthermore, the study also
revealed that nurses with lower workload were also
affected by severe work-related stress (44.4%). Mild
work-related stress affected 53.3% nurses with higher
workload and 56% nurses with lower workload.
This finding is supported by Aoki’s study (2010)
in Ratchaburi Thailand which concluded a significant
link between workload and work stress among nurses.
His study also reported that higher workload may
increase the risk for stress among nurses. The study
also mentioned that 70% nurses perceived high
workload and 30% of them perceived moderate
workload, while 70% of them were affected by
moderate work stress and 30% of them were affected
by severe work stress.
Irwandi (2007) defined workload as frequency of
activity based on mean of each activity in certain time
interval and consists of physical or mental workload
that may lead to work-related disorder or disease.
Authors presumed the correlation between
workload and work stress in nurses working in
Inpatient Department in Building A of Dr. Cipto
Mangunkusumo hospital stemmed from moderate or
severe physical workload which affected them in a
way or may even result in work-related disorder or
disease. All mental activities involve interpretation,
perception, and processing of acquired information.
At work, nurse meets and interacts with patient,
family, visitor, fellow nurse, and other health
professionals from multidisciplinary team and also
complies with policies in working environment. It
may result in excessive workload that overwhelms his
physical, emotional, and psychological condition.
Adiprana (2008) outlined 3 aspects in calculating
workload which includes physical, mental, and time.
Physical workload emphasizes on activity that
requires physics such as bed making, lifting patient,
pushing medical instruments, and imbalance patient-
nurse ratio. Mental workload focuses on role conflict,
poor relationship with supervisor or colleague, and
facing patient’s family in panic. Time workload
includes pressure to complete nursing care
documentation on time, pressure to make a decision
promptly, and working overtime due to inadequate
number of nurse.
Individual who experiences mental burden such
as role conflict, poor relation with supervisor or
coworker and responsibility for patient’s recovery
would be affected by stress at work. In addition, job
demand that seldom exceeds employee’s capacity or,
in other word, excessive workload that is difficult to
deal with would provoke stress in such employee.
Work-related stress can also be caused by amount of
patient that surpasses amount of nurses thus require
nurses to work overtime.
It is safe to conclude that nurse who is assigned
with a workload that exceeds his own capacity would
experience burnout which affect his mental and result
in fatigue, mood change, boredom, irritability, and
distress. A high job demand, pressure to improve
performance from both patient and supervisor,
conflict with coworker or supervisor or another health
profession, shift work, exposure to dying patient,
number of patients overwhelming number of nurses,
and requirement to fill out non-nursing
documentation (such as filling out incidence report
for monthly performance evaluation) may become a
burden leading to work-related stress.
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5 CONCLUSION
Authors concluded that majority of participants were
aged 17 to 25 years old, females, single, Diploma
III/vocational nursing graduates, had been working
for less than 5 years, perceived moderate workload,
and affected by mild stress.
There was a significant correlation between
marital status, years of service, and work-related
stress. There was also significant association between
workload and work-related stress in nurses.
Furthermore, participants with moderate workload
were more likely to be affected by moderate stress
than those with higher workload.
It is recommended for hospital to improve
communication and inform nursing manager to take
employee’s age and gender into consideration when
assigning workload. Hospital is expected to designate
the nurse with a workload that is suitable with his own
competency. Furthermore, hospital is also expected to
maintain and improve staff and family gathering
activity in order to refresh nurse’s physical and
psychological condition and to regularly organize
exercise for employee at least once a week to
maintain physical and psychological well-being.
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