A Study on Occupational Stress and Organizational Commitment among Nurses in Government Hospitals of Oman

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1 A Study on Occupational Stress and Organizational Commitment among Nurses in Government Hospitals of Oman Arvind Hans and Sanitha Sathyan Hospital is one of the sector in which there is always stress, because other than the daily activities which include like patients visiting doctors for daily checkup, or for small treatments. There can be emergency situations where many people are admitted at same time due to major accidents, or a major surgery which require a lot of preparation, time and hard work. These stresses affect the nurses in their professional and personal life. Although they work in shifts they spent half of their day in hospitals standing taking care of the patients without any rest or food. This makes them tired and worn out. Stress has a direct affect on commitment of nurses. If they are stressed, they may not care for the patients or may not be willing to take responsibility, and not be time conscious. The study was undertaken to identify the phenomena related to occupational stress and commitment among nurses in government hospitals in Oman. A combination of descriptive and conclusive research design was adopted. Two standard questionnaires related to stress and commitment was used to collect the data from nurses respectively. Sample size was 85 and unit of analysis was nurse working in these hospitals. SPSS and Smart PLS were used to analyze the data. Descriptive statistics, item reliability, correlation and multiple regression analysis were administered by using SPSS version Duration of the study was 6 months. Commitment level was found more compare to the stress level in these hospitals based on descriptive statistics. Correlation analysis confirmed a significant (p<0.05) and inverse (-0.516) relationship between occupational stress and commitment among nurses in these hospitals. Since, Stress was taken as an independent variable and Commitment as dependent variable in the study. The effect of stress on commitment was found relatively weak in multiple regression analysis. Smart PLS was used for testing the predictive validity of the proposed conceptual model and hypothesis in the study. The proposed hypothesis was accepted as T value was found as in bootstrapping method. The higher value of T indicates the significant relationships between the two constructs are there. Path coefficient (β) was reported as with p value less than The results clearly indicated the inverse and significant relationship between these two constructs (stress and commitment). The study reaffirmed the past theory and researches that Occupational stress and commitment is inversely related to each other. The path analysis also confirmed that the predictive validity of the proposed model is relatively weak in Oman's context as resultant R 2 reported was Keywords: occupational stress, commitment, descriptive statistics, regression analysis, Smart PLS 3.2.1, SPSS, path analysis. Dr. Arvind Hans, Assistant Professor, Department of Management, Waljat College of Applied Sciences, P.O. Box 197, Rusayl, P.C. 124, Muscat, Sultanate of Oman, arvind@waljat.net Ms. Sanitha Sathyan, Management Student, Department of Management, Waljat College of Applied Sciences, P.O. Box 197, Rusayl, P.C. 124, Muscat, Sultanate of Oman, bba12041@waljat.net

2 1. Introduction Stress is a major problem faced by everyone in their daily life or throughout their life. It can be related to education, family life, professional life etc. For parents the stress will be about education of their children, for students the stress will be to get good grades, for workers stress will be to do their work within time with efficiency etc. Stress is an important factor to ensure efficiency among the working population. But too much stress adversely affects their job efficiency, health as well as their social life. To cope with stress they adopt unhealthy habits such as drinking, smoking and having unnecessary medications. This makes the person weak and unhealthy. Stress has a direct relation with commitment among the workers. Commitment can be said as the honesty and dedication with which a worker works for his/her company. Commitments are of two types. Commitment on employee side will make him work for the betterment of the organization. Commitment can increase their performance level and brings out higher efficiency. It builds a strong relation between the employer and employee. Stress can reduce this level of commitment as the employee will become tired of the over stress created by the job. As both stress and commitment are inter related, we apply these factors among the nurse population of hospitals and how these variables affect their job. Medical services are the most important services which increase the surviving capacity of an average human being. Hospitals and all the medical staff play a very important role in a person s life. From birth to death, people depends on medical services for various reasons. We know doctors are the main leaders of medical services. Like doctors nurses are also responsible for treating and taking care of patients. They have to work during the morning shift or night shifts or even more than the working time. They also have to report to the doctors on patients condition and do paperwork. Nurses have to work so hard that sometimes they do not have food at right time and have to wait till their duty time is over. The work also affects their sleep as they do not get sufficient time for rest. Nurses always have to work in disease prone atmosphere where there is chance of the nurses getting sick themselves. They work day and night to improve and maintain our health conditions. Inspire of all these they work for curing the patients and to improve their health. As they work continuously without considering their health, they are prone to various kinds of stresses within as well as outside their work area. Stressors can decrease their productivity and efficiency which in turn affect their commitment towards hospital and also the patients. They face a lot of health issues which reduce their quality of work in hospitals. This can affect the health of the patients and also affect the reputation of the hospital. So Stress faced by nurses and their commitment level towards the hospital is a wide area for research which will discuss about the stressors within nurses, how it can be reduced and how their level of commitment affected by stress levels.

3 Problem Statement Hospital is one of the sector in which there is always stress, because other than the daily activities which include like patients visiting doctors for daily checkup, or for small treatments there can be emergency situations where many people are admitted at same time due to major accidents, or a major surgery which require a lot of preparation, time and hard work and also there can be cases of many death on the same day. These stresses also affect the nurses who have to adjust between their professional and personal life. They may not be able to attend to the household chores or needs of their children due to the timings of their duty. Although they work in shifts they spent half of their day in hospitals standing taking care of the patients without any rest or food. This makes them tired and worn out. This shows up in their enthusiasm to work and the dedication with which they take care of their patients. Some hospitals ignore nurses and make them to do extra shifts and may not pay them well. The pay system is also a major stressor for nurses. So stress has a direct affect on commitment of nurses. They may not care for the patients, will not be willing to take responsibility, and not be time conscious. So here the main problem is stress faced by nurse, and how this affects their organizational commitment. Theoretical Concepts and Framework Stress in simple words mean tension or pressure felt under certain circumstances. Stress can be different for everyone. Occupational Stress can be defined as the response of the people when they are facing work demands and pressures which cannot be handled by their knowledge and abilities. It increases their challenge in workplace. (Occupational stress, 2015) Commitment to an organization is an important value required by the employees of that organization as it works as the blood of that organization. Organizational commitment can be defined as attachment of an organizational member to their particular firm psychologically. (Organizational Commitment: Definition, Theory & Types, 2015)It helps in the smooth functioning and progress of the organization. Commitment can be of two types. First is where the employee stays with the company due to the reason that it is their means of livelihood and there are no other options. Second is where the employee stays with the company as they truly wish to stay and improve the organization. The latter is useful for the organization for its organizational and financial development. Stress among nurses has been identified on the basis of various sources: Patient care, taking responsibility, coping to change, decision making work load, and people issues (superiors or colleagues), juggling personal and professional life, lack of job security and also low salary. The role of nurses can be stress filled due to long working hours, human suffering, physical labor, staffing and inter personal relationship. Stress may also result from juggling multiple roles at work, marriage and children. Overstress can contribute to absenteeism and turnover which lead to workforce crisis in hospitals. There is demand for better healthcare services as quality of services have been going down (Jennings, 2008). Stress has adverse affects on their job satisfaction, job security, less availability of resources, few promotions and development opportunities, greater responsibility, wide range of work area, loyalty and honesty towards the organization family, mental as well as physical health. They lose their interest in their jobs and there will be decrease in their commitment levels. In today s world job stress is very common among the adult population. Either it will be concerning unavailability of job or if jobs are available, how to retain the job. Stress can be useful for building efficiency among workers who are at various positions. Employees must not be lazy and lethargic to complete their task at hand. Stress can make them active and responsible in completing their job. But over stress can drain their energy and decrease their performance level. This can directly affect their commitment towards the organization. They will loss commitment under over stress and feel the work as a burden and will not aim for perfection. Stress among nurses can affect their quality of service towards the

4 patients which can be fatal to critical patients as well as normal patients. Lack of commitment and dedication on the side of nurses can also affect the hospital and its service quality. The hospital can identify the common stressors which are hindering the performance level of nurses and can adopt measures to eliminate or reduce its effect. This will provide a stress free working environment to the working staff and naturally increase their commitment level towards the patients as well as the organization. 2. Literature Review As per research the growing burden in workplace and clash between professional and personal life is a major stress factor among nurse. There are many professions where occupational stress is a major factor it can be for teachers, doctors, engineers, pilots, construction workers etc. From the researcher s view point nurses are considered to be facing more occupational stress as compared to people who are in other professions. Because they deal with more stressful situations as they have to meet special demands which is a part of their profession. Research relating to occupational stress is vital because studies conducted before have revealed that stress negatively affects health of nurse and also the hospital or clinic for which they work. Result of this is that there is increase in absenteeism sometimes quality of service provided by nurse gets affected. Some of the identified factors for stress among nurse are: Changing time shifts repeatedly. Conflict of role. Problem to communicate constantly with different people. Work they have to do which can be a burden sometimes due to overload. Daily dealing with death. Other factors can be that administrative staff may not be supporting them and the nurses are not given a word of encouragement which could motivate them. From previous research it is seen that patients receive bad care due to the stress faced by nurse. Because when nurses face stress the way they treat patients will also change. They will treat patients without showing many emotions; there will be lack of concern for patients. A nurse facing stress may have a negative attitude, may be short tempered, frequently absent from work, and they also may not use their skills and abilities to the maximum while doing the job. (Eleni et.al., 2010) The field of nursing involves variety of factors which causes stress as this job need adequate skills, ability to work in teams without hesitation in different situations, 24 hour nurses should be there to provide care, and also they should display the required emotions towards whom they treat which is mostly called as emotional labor. (McVicar, 2003) Other source for stress among nurse is the inter professional and intra professional clash which occurs among the physicians and nurses. (McVicar, 2003) A study conducted in UK by Mind among 2000 people shows that 34% of people consider their jobs stressful. Researchers have shown that workplace stress increase heart attack by 23%. This research has shown that workplace stress causes 7% (from 18 to 24 years old) of those surveyed to have thoughts of suicide and one in five people to have problems of anxiety. The methods used by the employees for coping with stress were smoking, taking anti depressants, taking over the counter sleeping pills, taking prescribed sleeping pills. (Glynn, 2013) The drastically changing workplace, higher quality demand from the consumers and fierce competition demands the organization to stay responsive to the changes. Employee commitment is crucial for this response for all fields of organizations. It is important to employ workers who have a positive response to their company culture. This kind of employee behavior is directly influenced by their immediate superiors or managers. Positive influences are important for employee commitment and for this quality of the management play an important role. To enhance the dedication and passion of employees towards the organization, an effective and enlightened workforce management should exist. This in turn helps in achieving the desired standards in customer service. Without employee commitment, there will be no improvement in any of the business fields. Uncommitted employees prevent a business from prospering and becoming a bane to the organization. (Judd, 2013) Nurses want to be valued by their organization and being part of a community of practice which gives them a value of meaning and value in their work. According to studies, nurses are attracted to a working environment where they can experience optimal meaning in their work. The Towers Perrin Talent Report (2003) reports that engagement rests on meaningful work experience. Organizations thrive on the work

5 done by the employees with their employee engagement. The nursing profession has become vital internationally and there is also an existing shortage of nurses. Due to this the current nurses are working for long hours and sacrificing their personal needs, for the benefit of the patients. (Beukes, 2013) Organization commitment is an important factor to retain the nurses. A major negative is the high nurse turnover which causes staff shortage. Recruitment of large number of nurses is a short term solution but for long term, retaining them would be the best option. Previous studies show various factors affect commitment levels like organizational characteristics, employee characteristics, job satisfaction, work conditions, and perceived organizational support (POS). POS is the support provided by the organization to the employees to do their job effectively and make them believe that the organization values their contribution and care for their well being. This theory is confirmed by studies that organizations which value a nurse s contribution and support to do their job effectively and to deal with stressful environment created within them a better sense of commitment and loyalty to the hospitals. Other important factors include job satisfaction and years of experience. (Siew PL, 2011) Job stress and commitment can be related. A study on relation between job stress and commitment in National Olympic and Paralympics Academy shows that there is a significant relationship between job stress and organizational commitment. When there is an increase in the amount of job stress, there will be decrease of commitment levels and vice versa. It also writes that the officials can increase the commitment levels by reducing the stressor factors and can thereby reduce the costs occurring due to lack of commitment from employees. (A. Khatibi, 2009) On the basis of study conducted among mentoring coordinators, stress has been affecting their emotional commitment towards organization. It has been identified that as there was an increase in the stress level, there was decrease in the sense of belongingness but it did not affect the overall continuance commitment of the employees towards the organization. (Michael et. al.,2009) Research and reports have been done to study the relationship between stress and commitment among nurses. A study conducted on nurses working in selected Jordanian hospitals reveals that stressors can be work conditions, poor staffing, role ambiguity, over workload and shift works which forces the nurses to deliver better patient care to more patients with fewer resources. Dissatisfaction with their professional status and a feeling of not possessing the rights and prestige compared to other professions can also be a cause for stress. The study also shows that commitment is negatively correlated with stress. When the stress levels are high, the commitment level comes down. The lack of such stressors can be associated with a rise in commitment levels. (Al-Hawajreh, 2011) 3. Hypothesis: Based on the literature review, a hypothesis can be proposed on the research in this area. It has been observed that in most of the research conducted worldwide there found an inverse but significant relationship between occupational stress and commitment. Therefore the following hypothesis can be proposed to explore the relationship between occupational stress and commitment among nurses in Government hospitals in Oman. Hypothesis: [H 1 ]: Occupational stress is negatively affecting the commitment among nurses in government hospitals. 4 Significance of Study Stress is seen everywhere in today s changing world and nursing profession is considered as one of the most stressful jobs. There are various stressors identified among nurses. The quality of a hospital depends on the nursing staff as they interact with the patient more than doctors. Stress and organizational commitment have a close association in the nursing profession. Nurses must be committed to their duties which decide the quality of patient care and eventually the status of the hospital. Due to increased work stress their dedication or commitment levels can decrease and have serious impact on the hospital s reputation. High stress levels can increase absenteeism, decreased level of responsibility and punctuality. This study helps to find out the present stress levels and commitment levels among nurses working in Government hospitals in Sultanate of Oman. It highlights the major stressors present among the nurses and how it is affecting their commitment levels towards the hospitals.

6 5. Objectives of the Study The main objectives of our study are: 1. To identify the level of stress among nurses in hospital of Oman. 2. To identify the level of commitment among nurses in hospitals of Oman. 3. To find out the association between stress and commitment among nurses. 4. To determine the effect of stress on commitment among nurses in hospitals in Oman. 5. To verify the predictive validity of the conceptual model proposed in the study by Smart PLS. 6. To identify and report the important factors related to stress and commitment. 6. Scope of the Study Our study is to identify the stress and commitment levels among nurses who are an important part of the medical services. This study highlights how stress affects the commitment levels of nurses working in Government hospitals of Sultanate of Oman. The study focus on Government hospitals situated at Sur and JalanBani Bu Hassan. This study helps to identify the present stress and commitment levels existing among the nurses working in Government hospital. The study also focuses on understanding the association of stress and commitment among nurses. It helps to find methods to decrease the stress levels and thereby increase their commitment levels. A study on job stress and organizational commitment among nurses has not been taken as a research topic in Oman till date. So this study can help in development of the Government hospitals and also improve the quality of the medical services provided. 7. Research Methodology Research methodology is the strategy by which the research is conducted and the methods to be used in it. A combination of descriptive and conclusive research design was adopted to report and validate the phenomena related to occupational stress and commitment. A survey method was used to collect the data from the respondents. Two standard questionnaires were adopted to collect the data. Unit of analysis were hospital nurses in Oman. More than 100 questionnaires were distributed. 85 questionnaires were returned completely filled. Sampling is the process of studying about a population on the basis of samples drawn from it. In this project we consider universe as the hospitals in Oman. From universe, we are taking Government hospitals in Oman as population. Sample frame is taken Government hospitals in Sur region. Sample unit/frame consists of nurses working in different departments of Government hospitals in Sur and JalanBani Bu Hassan. Sample size, refers to the elements of the responded target population. The sample size was 85 in this study. Primary data was collected from two questionnaires in the study, whereas secondary data was collected from following sources to build the research framework and review of literature: 1. Internet sources. 2. Books and Journal research articles. 3. Electronic Research Database (EBSCO) Primary data is the first hand information collected directly from respondents for first time. We collected data through questionnaires of 2 types. Both questionnaires were structured questionnaires. The questionnaire of occupational stress was taken from Srivastava, A.K., Singh, A.P., (2000). The questionnaire of Organizational commitment was taken from Hyde, M.H. & Roy, R. (2005). In the questionnaire, female is coded as 0 and male is coded as 1. Age, gender, qualification and year of experience are collected from nurses through questionnaires.

7 8. Data Analysis Method First questionnaire used for measuring the stress index among nurses is Occupational Stress Questionnaire where 5 point likert type scale is used. It contains 46 questions which is taken as 1- strongly disagree, 2- disagree, 3- undecided, 4- agree, 5- strongly agree. 12 factors were considered by grouping the questions. There were false keyed items whose coding is taken opposite to the original code. The second questionnaire is for measuring the organizational commitment among nurses which uses 1-7 rating scale and consist of 22 questions. 8 questions were removed from the Organizational commitment questionnaire as 22 questions were sufficient to measure the commitment level within nurses. 2 factors which are goal fulfillment and positive thinking are not calculated. The scale for organizational commitment is 1-7 rating scale which is taken as 7- highly satisfied, 6 satisfied, 5 little satisfied, 4- neutral, 3- little unsatisfied, 2- unsatisfied, 1- not at all satisfied. Descriptive statistics was used to find the stress levels and commitment levels among nurses in the study. Correlation analysis was used to determine the between stress and commitment among nurses. Multiple Regression Analysis was used to see the linear relationship between stress and commitment. The regression analysis was used to observe the magnitude of effect on commitment by stress. Stress and reported demographic variables were taken as an independent variable. Commitment was considered as dependent variable in the study. Descriptive statistics, reliability analysis of scales, correlation and regression analysis was used by using statistical tool SPSS version But, the proposed conceptual model's predictive validity and hypothesis was analyzed by using Smart PLS Findings of the Study Cronbach s Alpha was used for finding the reliability of scales used in organizational commitment and organizational stress questionnaires. The reliability coefficient of.70 or higher is acceptable Reliability Analysis Table 1: Reliability Statistics of commitment Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items The Cronbach s Alpha value is which shows the scale used in commitment questionnaire is more reliable and consistent. Table 2: Reliability Statistics of stress Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items The Cronbach s Alpha value is which shows the reliability of the stress questionnaire used for project.

8 9.2. Descriptive Analysis Table 3: Descriptive analysis of commitment (Factors Average) N Mean Factor 1(Work Environment) (Q21,22,13,11,16,17,19,14,5) Factor 2 (Affection Towards Organization) (Q20,18,15,8,4,12) Factor 3(Contentment) (Q2,6,9,10) FACT 4(Career Goal) (Q3) FACT 5(Empathy) (Q7) FACT 6(Empowerment) (Q1) Valid N (listwise) 85 Average 4.93 N denotes the number of observations taken which are 85. Mean is the average. Highest mean is shown by FACT 6 (5.56) which indicates Empowerment and the least is shown by Factor 3 (4.62) which indicates Contentment. Highest factor affecting the commitment among nurses is Empowerment. Lowest factor present among nurses in the present working condition is Contentment. Total average value for commitment factors is 4.93.

9 Table 4: Descriptive analysis of Occupational Stress (Factors Average) N Mean FACT1 (Role Overload) (Q1,13,25,36,44,46) FACT2 (Role Ambiguity) (Q2,14*,26,37) FACT3 (Role Conflict) (Q3,15*,27,38*,45) FACT4 (Unreasonable group & political pressures) (Q4,16,28,39) FACT5(Responsibility for persons)(q5,17,29) FACT6(Under participation)(q6*,18*,30*,40*) FACT7 (Powerlessness) (Q7*,19*,31*) FACT8 (poor peer relations) (Q8*,20*,32*,41*) FACT9 (Intrinsic impoverishment) (Q9,21*,33*,42) FACT10 (low status) (Q10*, 22*,34) FACT11 (Strenuous working condition) (Q12,24,35,43*) FACT12 (Unprofitability) (Q11,23) Valid N (listwise) 85 Average 2.86 N shows the sample size which is 85. * shows the false keyed items. Highest stressor present among the nurses is Powerlessness which is indicated by FACT 7 (3.12) and the lowest factor which affects the stress among nurses is Role Ambiguity indicated by FACT 2 (2.53). Total average value for stress is 2.86 which show low stress.

10 9.3. Correlation analysis Table 5: Correlations between stress and commitment Commit Stress Commit Pearson Correlation ** Sig. (2-tailed).000 N Stress Pearson Correlation ** 1 Sig. (2-tailed).000 N This table shows the correlation between stress and commitment with Pearson Correlation values as This indicates that when value of stress increases the value of commitment will decrease. Commitment and stress are moderately and inversely correlated. The significance value is less than 0.05 which indicates there is high level of significance of correlation between stress and commitment Regression Analysis Regression analysis was done to predict the value of commitment based on the value of stress, age and year of experience. Table 6: Model Summary Model R R Square Adjusted R Square Std. Error of the Estimate a a. Predictors: (Constant), Stress, Years of Exp, Age According to the Model Summary table of linear regression analysis value of R is and value of adjusted R Square is It shows 25.1% variation in commitment based on stress, age and year of experience. Table 7: ANOVA

11 Model Sum of Squares df Mean Square F Sig. 1 Regression b Residual Total a. Dependent Variable: Commitment b. Predictors: (Constant), Stress, Years of Exp, Age In this table p<0.05, shows that the outcome variable which is commitment can be significantly predicted by age, year of experience and stress collectively. Table 8: Coefficients Model Unstandardized Coefficients Standardized Coefficients B Std. Error Beta t Sig. (Constant) AGE Years of Exp Stress a. Dependent Variable: Commitment Standard coefficients value shows that age is positively related to commitment whereas years of experience and stress are inversely related to commitment. Regression analysis between stress and commitment Table 9: Model Summary (Only stress was taken as independent variable) Model R R Square Adjusted R Square Std. Error of the Estimate a

12 a. Predictors: (Constant), Stress Regression analysis done between only stress which is the independent variable and commitment which is dependent variable, it shows 25.8% variance within commitment based on stress prevailing among nurses. Table 10: ANOVA (Only stress was taken as independent variable) Model Sum of Squares df Mean Square F Sig. 1 Regression b Residual Total a. Dependent Variable: Commit b. Predictors: (Constant), Stress This table shows the significance of prediction of commitment by the regression model which has significance, p<0.05 Table 11: Coefficients (Only stress was taken as independent variable) Unstandardized Coefficients Standardized Coefficients Model B Std. Error Beta t Sig. 1 (Constant) Stress a. Dependent Variable: Commit Standard coefficient value is same as the correlation value which ensures that stress and commitment are inversely and moderately correlated Discussion on findings of the study After analysis of questionnaire following was interpreted: To understand the reliability of scale used in questionnaire Reliability analysis was done. In questionnaire used to measure commitment the value of Cronbach s Alpha is 0.960, and in the questionnaire used to measure stress value is Both values indicate that scale used in questionnaire is more consistent and reliable to measure the stress and commitment levels present among the nurses working in public hospitals. Next Descriptive Analysis was done to understand how various factors are affecting stress and commitment. Empowerment is the one of the factor which is affecting commitment the most and contentment is the least affecting factor. By giving more empowerment to the nurses their commitment towards the hospital as well as patients will be increasing. The major stressor can be identified as powerlessness which reduces empowerment among nurses which in turn reduces commitment and the least affecting stressor can be identified as role ambiguity among the nurses as they are ready to handle multiple roles within the hospitals.

13 To find out the correlation between stress and commitment, Correlation Analysis was done. After doing Pearson s correlation analysis the result was This indicates that stress and commitment are moderately and inversely correlated as the value of stress increases, the commitment level decreases and vice versa. This could be because of the various stressors prevailing among the nurses and affecting the commitment. The significance value is less than To analyze the effect of independent variables that is stress, age and years of experience on dependent variable commitment, Regression Analysis was done. In the Model Summary table value of adjusted R Square is which shows there exists 25.1% variation in commitment because of stress, age and years of experience. In Anova table, value of p<0.05 shows that commitment can be significantly predicted using regression model. Regression analysis was done taking only stress as independent variable and commitment as dependent variable. The adjusted R square value is 0.258, showing 25.8% of variance of commitment on the basis of stress. It is highly significant as p< Determining Conceptual Model Predictive Validity and Hypothesis Testing by Using Smart PLS Conceptual framework between Commitment and Occupational stress was verified by Smart PLS in order to test the hypothesis under conclusive research design. The reliability test was conduct to verify the items and scale reliability used in the study to go for further analysis using Smart PLS Reliability analysis: Cronbach s Alpha reliability method was applied to check reliability of all items in the questionnaire. Reliability test was applied using SPSS version and the reliability measures were given in the Table 12. The initial reliability coefficient value was found as for occupational stress questionnaire. The eighteen (18) insignificant items were again deleted based on item- total statistics to improve the measurement model. Then, the reliability coefficient value was found as The Commitment initial reliability coefficient value was Only one insignificant item was screened out to improve the measurement model. The remaining 21 Occupational Stress items were again tested for items reliability. The reliability coefficient value was found as As the reliability score is higher compare to the initial reliability test further analysis can be done to verify the structural model. It can be inferred that the standard scale used in the study to identify commitment and occupational stress among nurses working in government hospitals need revision in Omani context. Table 12: Cronbach s Alpha Reliability of the measure Scale Cronbach s No. of Items Cronbach s Alpha No. of Items Alpha after deleting items Occupational Stress Commitment Conceptual Background The two constructs of the study are conceptually related to each other by the structural model as shown: Figure 1: Conceptual framework Occupational Stress Commitment

14 Measurement Model evaluates the relation between manifest variable (Observed items) and Exogenous/Endogenous latent variable by analyzing the factor loading on each constructs (Hulland, 1999).Structural model verify the relationship between exogenous latent variable and endogenous latent variable by analyzing path coefficients between them. Higher path coefficients and resultant R 2 values reported is the indicator of better model predictive ability. The study used Smart PLS to estimates the measurement model and structural model simultaneously (Ringle, et. al., 2005). The proposed model is shown in Figure1.The proposed model has two latent construct as occupational stress and commitment Measurement Model: Tenenhaus, M., Esposito Vinzi V., Chatelin Y. M. and Lauro C. (2005) introduce three criteria to determine the overall quality of the model. Specifically, a path model can be assessed at three levels: 1. The quality of the measurement model 2. The quality of the structural model 3. Each structural regression equation used in the structural model The quality of the measurement model: The quality of the measurement model was tested by assessing the individual item and scale reliability followed by convergent and discriminant validity of constructs measures. Initially the relationships were displayed between the constructs of occupational stress and commitment (Bhakar, et. al., 2012). PLS algorithm was applied and the resultant relationships, coefficients and values of loading were reported in Figure, Commitment as an endogenous latent variable in the study and Occupational stress as exogenous latent variable.

15 Figure 2: Initial path model

16 Reliability: Individual factors reliability was assessed by examining the loadings of associated factors on their respective latent constructs in PLS modeling (Hulland, 1999). The factors loading were reported in Figure 2. Reliability of each variable was assessed through Fornell and Larcker s (1981) measure of composite reliability in addition to Cronbach s (1951) alpha. This measure is preferred over Cronbach s alpha because it offers a better estimation of variance shared by the respective indicator (Hair et al., 2006). In this study composite factor reliability coefficient of the constructs ranged from to as shown in Table 13, which met the standard of 0.70 as suggested by Fornell and Larcker (1981). Table 13: Composite Reliability Sl. No Composite Reliability 1 Occupational Stress Commitment The factor loading, cronbach alpha, composite reliability and Average Variance Extracted (AVE) values calculated by PLS algorithms were tabulated in Table 14. Table 14 : Cronbach alpha, Composite reliability and AVE Latent variables Cronbach s Alpha Composite Reliability AVE Occupational Stress Commitment Convergent validity: Convergent validity refers to the degree of agreement in two or more measures of same construct (Camines & Zeller, 1979). Fornell & Larcker (1981) indicated that convergent validity is not established because variance extracted values are less than 0.5 in occupational stress. Results indicated that the variance extracted from the items ranged from.270 to reported in Table 14. It was inferred that the scale used for Occupational Stress did not possess convergent validity but, commitment scale possessed convergent validity. It may be inferred that standard scale of stress used in Omani context need to be moderated in future research for better measurement model and thus the structural path for the same can be validated. Discriminant Validity: Discriminant validity is adequate when constructs have an AVE loading greater than 0.5 meaning that at least 50% of measurement variance was captured by the construct (Chin, 1998). From the report, discriminant validity was confirmed because the diagonal elements are higher than the off-diagonal values in the corresponding rows and columns. The diagonal elements are the square root of the AVE score for each construct (i.e. Stress and commitment).

17 Table 15: Discriminant Validity Results: Fornell-Larcker Criterion Commitment Occupational Stress Commitment Occupational Stress The diagonal element values were shown in the Table 15 was higher than the off-diagonal values. The result indicated that the constructs of Occupational Stress and commitment possessed Discriminant Validity. It can be said the standard scales of occupational stress and commitment can be used to determine the structural model predictive validity Structural Model Analysis: Hypothesis was tested by computing path coefficient (β), where as R 2 measured a construct s percentage variation that is explained by the model (Wixom& Watson, 2001). Conceptual model hypothesized that stress is negatively impacting the commitment of nurses in government hospitals in the study. The statistical significance of path coefficient (β) between these two latent constructs was measured by T statistics reported in bootstrapping shown in Figure 3.

18 Figure 3: Bootstrapping method Since the objective of PLS is to maximize variance explained rather than fit, therefore prediction oriented measures such as (R 2 ) are used to evaluate PLS models (Chin, 1998). A bootstrap procedure using

19 1000/5000 sub samples was performed to evaluate the statistical significance of path coefficient according to Chin s (1998). The following Table 16 showed hypothesized path coefficient along with their bootstrap values, T values. Table 16: Path coefficient along with their bootstrap values, T values Mean, STDEV, T-Values, P-Values Occupational Stress -> Commitment Original Sample (O) Sample Mean (M) Standard Error (STERR) T Statistics ( O/STERR ) P Values The relationship between Occupational Stress and commitment was found significant because path coefficient between these two latent constructs were significant as Т= (Table value is suppose to be significant if it is more than 1.96 at α (significance level) of 0.05 degree of freedom > 120). Since T value is more than 1.96 indicating that the proposed path between occupational stress and commitment of nurses working in government hospitals of Oman was significant. The path coefficient (β) was reported here as , suggested that there was an inverse but a significant relationship exist between these two constructs (stress and commitment) in the study. Since, proposed relationship between these two latent constructs is significant, proposed hypothesis was accepted based on the above analysis. It was inferred that occupational stress significantly and negatively affects the commitment of nurses working in government hospitals in Oman. (R 2 ) was reported as Since R 2 measures a construct s percentage variation. It was inferred that 30.3 percent of variation in the commitment was explained by occupational stress construct. Since, the value of construct s variation (R 2 ) was found relatively at the lower side, it was inferred that the proposed model s predictive validity was weak in Omani context. 11. Conclusion: The descriptive analysis reflected that the level of commitment was more compare to the stress among the nurses because the mean values of commitment was reported more than 4 on 5 point likert scale. Correlation analysis confirmed that stress and commitment were significantly but inversely and moderately related to each other. The findings suggested that with an increase in the level of stress in the working environment, the commitment level of nurses would be reduced in these hospitals. Their commitment levels are also affected by other factors like age and years of experience at a small range. The descriptive statistics indicated that with the increases in age, commitment level also increased among nurses because they get enough idea to perform the assigned job and become comfortable performing other assigned duty. But years of experience had a negative relationship with commitment level. This might be due to the monotony in the job. Performing similar jobs for a long time in the same designation resulted such phenomena. Major stressor identified was powerlessness and major factor affecting commitment was empowerment, which is related with having power to take their own decisions on regular work schedule. Over dependency and too much instruction by seniors and head of departments were not preferred by nurses. PLS analysis revealed that commitment of these nurses working in government hospital is inversely proportional to stress with a coefficient of This clearly indicates that 100 point change in the stress would bring 55.1 point changes in commitment among nurses working in government hospitals of Oman inversely. As, T value was reported as (more than 1.96) the hypothesized conceptual relationship between Occupational Stress and commitment was significant. Since, path coefficient between these two latent constructs were reported as It was inferred occupational stress is significantly but inversely

20 affecting the commitment among nurses of government hospitals in Oman. Hypothesis [H 1 ] was accepted based on the above analysis. The predictive validity of the proposed conceptual model was found relatively weak in Omani context, because resultant R 2 reported in the model was only.303. It indicates that, there was only 30.3 percentage variance observed on commitment because of the change in stress. The study reaffirms the past research findings where these two phenomena were negatively associated with each other. Further, it proves a theory that if occupational stress is more in an organization, the commitment shall be relatively lesser among the employees. It can also be inferred that if commitment towards organization is more, overall organizational health is better. It indicates that, the employees working in such organizations are satisfied because they exhibit high level of commitment and face lesser stress. Finally, it was concluded that there exists an inverse relationship between occupational stress and commitment among nurses in government hospitals of Sultanate of Oman. 12. Suggestions & Directions for Future Research According to sources, The Study on Occupational Stress and Commitment among Nurses is a project study which has not been conducted in Oman so far. It has a wide scope for future research as it can help to study the problems faced by the nurses in their working career. This study helps to reveal the stressors and commitment levels existing among nurses. These might be the probable direction for future research Research can be done to explore more about stressors. As the study was focused on Government hospitals, through this study, Government can use the data to improve the working conditions of nurses in government hospitals and they can improve their commitment levels. The same research can be replicated in private hospitals as well to observe the relationship between these two variables. The further study in these areas can be extended to other sectors to study the phenomena related to these two construct. Other variables can be added with these two constructs to design a comprehensive research study in various other sectors. References: 1. A. Khatibi, H. A. (2009). The Relationship Between Job Stress and Organizational Commitment. Retrieved from 2. Al-Hawajreh, K. (2011). Exploring the Relationship between Occupational Stress and organizational commitment among Nurses in Selected Jordanian Hospitals. Retrieved from 3. Beukes, I. ( 2013). Organisational commitment, work engagement and meaning of work of nursing staff in hospitals. 4. Bhakar, S. S., Bhakar, S., Bhakar, S., & Sharma, G. (2012). The impact of co-branding on customer evaluation of brand extension. Prestige International Journal of Management & IT, Carmines, E., and Zeller, R., Reliability and Validity Assessment. Sage Publications, Beverly Hills, California. 6. Chin, W. W. (1998). The partial least squares approaches to structural equation modeling. In: G. A. Marcoulides (Ed.), Modern Methods for Business Research Mahwah, NJ: Lawrence Erlbaum Associates, Cronbach, L.J. (1951). Coefficient alpha and internal structure of tests. Psychometrika, 16, Eleni, M., Fontini, A., Maria, M., Ioannis, Z. E., Constantine, K., Theodoros, C.K. (2010), A. research in occupational stress among nursing staff - a comparative study in capital and regional hospitals. Hellenic Journal of Nursing Science, 3 (3), Fornell, C., & Larcker, D.F. (1981). Evaluating structural equation models with unobservable variables and measurement error, Journal of Marketing research, 18(1),

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