Stress had been a problem and also one of the important issues in our society for years. It also had been a problem at workplaces too. The existing quantitative research aims to find the relationship between work stress and employee performance focusing on the doctors and nurses, specifically of PIMS hospital Islamabad, Pakistan. Random sampling technique was used to select 50 doctors and nurses of Pakistan Institute of Medical Sciences Islamabad. The results were made by using Correlation and linear regression. Findings of the research show inverse relationship between employee performances and stress. Therefore, it is suggested that the organizations should use techniques and methods to reduce pressure and stress among their doctors and nurses to have better performance.

1.1 Introduction

Not just internationally, but a lot of research has been done on job performance and stress in Pakistan also. Like other countries, stress is one of the major concerns of the organizations in Pakistan as well. For an institution to prosper, it is prerequisite that employees work in an environment free of stress. Stress results in a decrease in employees’ efficiency, increase in turnover and absenteeism (Ali, Raheem, Nawaz, & Imamuddin, July 2014). A great deal of studies nationally aims to realize the impact of stress on employee performance. Different researchers had worked to see the impact of stress on different dimensions of performance. For example, in a specific research it was proposed that (Ali, Raheem, Nawaz, & Imamuddin, July 2014) role conflict, workload and inadequate monitory reward are the main reasons of producing stress in employees (specifically private sector university employees), and this stress reduces their efficiency.

Lazaru 1990 defined stress in terms of transaction. He explained in his transactional model that Stress is a product of the transaction between the individual and the environment (Lazaru, 1990). Whereas, J.R Edward in his cybernetic theory explained stress as a discrepancy between the employee’s desired state and perceived state. This discrepancy may result in employee diminished performance especially in case of doctors and nurses.

1.2  Problem statement

All around the globe stress at workplace is a common problem from a long time which directly impact on the employee motivation and performance. In Pakistan, hospital industry is badly affected by poor performance issues. The study will help us to identify the reasons behind this poor performance and how much work stress is contributing to the occurrence of this issue.

1.3  Gap Analysis

Research is based on the topic “Impact of job stress on employee performance: a case of doctors and nurses”. This study covers the gap that exists in the literature regarding the effects of job stress on the performance of employees.

The first limitation was the time constraint. A lot of difficulty was faced due to less time available. Secondly, the environment of a public hospital is always busy, so the difficulty was faced in asking doctors and nurses to fill up the questionnaire. The staff did not favorably entertain the researcher.

1.4  Objectives of research

To find the relationship between stress and performance of doctors and nurses.

1.5  Research Questions

The current study wants to investigate that;

1. What is the effect of job stress on employee performance?
2. How salary packages, work hours affect staff performance?
3. Does hospital environment help to reduce work stress?

Chapter 2

Literature review:

2.1 Job Stress

There is a lot of literature on relationship between stress and job performance. Great deals of studies have linked work stress or occupational stress with different dimensions of performance. Specifically, with respect to the health sector, stress has a great impact on performance which eventually results into alarming outcomes. Occupational stress is described to affect job performance and job satisfaction among nurses, placing patients at danger. (NABIRYE, BROWN, PRYOR, & MAPLES, 2011). The stressors that causes work stress are described in many studies. Matters for instance work overload, negligent co-workers, criticism, uncooperative patients, and difficulties with physicians and lack of support from supervisors causes stress to nurses (Motowidlo, Manning, & Packard). The proposed research sees the effect of stress on two specific dimensions of work performance that is Quality of work life and organizational commitment. Studies had also revealed that occupational stress has a negative impact on quality of work life. (Bolhari, Rezaeean, Bolhari, & Zare, 2012) Whereas, some researchers propose that stress and quality of work life both goes side by side. (Ross & Vasantha, February, 2014) The head of department has to structure polices that must reduce the work load of employee/ doctors and nurses without affecting the productivity of the hospital’s department, for achieving successful work-life balance. Researchers also propose that stress leads to Affective states such as depression, anxiety and hostility as decrements in aspects of job performance, and that it is caused by some particular events that occur at work place during duties. (Motowidlo, Manning, & Packard).  Similarly, organization commitment is also associated with stress. Occupational stress is positively associated with employees’ turnover intentions. (Mosadeghrad, 2014). The above literature depicts the international perspective of the relationship between stress and performance and how stress affects quality of work life and organizational commitment.

Researchers had also pointed out the relationship between employee performance or efficacy on monetary awards and organizational structure. Positive relation lies between the monetary reward and employee efficiency and negative relation between the Organizational structure and employee efficiency (considering these monetary rewards and organizational structure as dimensions of stress) (Shah, et al., 2012).A research made result that Job stress has negative relation with job performance that means, with an increase in job stress, job performance falls (Jehangi, Kareem, Khan, & Jan, 2011).whereas, another researcher proposed four types of relationship between the measures of job stress and job performance .first is a negative linear relationship, which means that productivity decreases with work related stress (distress). Second states that Productivity can also increase as a consequence of stress indicating a positive relationship between the stress and productivity. Third states that there could be a curved linear or U-shaped relationship in which mild stress could increase the productivity initially up to a peak and then it declines as the person descends into a state of distress. Alternately, there need not be any quantifiable relationship between the two. (Dar, Akmal, Muhammad, & Kashif, May 2011).

The word or term pressure was taken from one of the eminent pressure analyst, Hans Selye, (Institute university aireen santé mentale de Montréal 2012). Passionate disturbance, physically damaging that happens when the activity does not require or associate with the worker’s abilities, assets and necessities, is characterized as „work stress‟ (Park, 2017), thus it is distinguished as a test rationally and physically of an individual, and even association (ILO 1986). In spite of, the breadth of work and studies led by Selye, numerous researcher restricted and scrutinized his thoughts and even one deduced in a (1951) British Medical Journal that „stress‟ other than acting naturally, it is likewise the reason for itself and inevitably the consequence of itself, (The American Institute of Stress n.d). During the 1960s, crafted by Holmes and Rahe (1967) exhibited that some major unpleasant encounters or occasions that comes to pass in a person’s life could truly imperil one’s well being condition, (ILO 2011).

With respect to during the 1970s, Cassel (1976) had presented an idea, and he conjectured that have obstruction was an extreme result of weight on a person’s wellbeing. Two components were distinguished to decide the dimension of a person’s have obstruction, one the person’s capacity to adapt and furthermore accepting help socially, (ILO 2011).

Worry as characterized by Arnold and Feldman (1986), is a reaction of an individual by means of to another or antagonistic circumstance in a workplace, (Walonick 1993). With respect to William and Huber (1986) stretch is a response from both mentally and physically and to interior and outside components of a circumstance in which the adaptiveness of an individual could be overextended (Walonick 1993). Word related pressure is characterized by Colligan and Higgins (2005) as a complex mental condition of riddle, (Akanji, 2015). At the point when the activity does not „marry‟ with your abilities or with the correct assets, both physical and feeling will respond and react hazardously and that is an indication of an occupation push, (Sauter and Murphy, 2013).

Occupation stretch comes in various type of sources and it plants a warmth on individuals in different ways. Almost certainly, the connection between the welfare and wellbeing of a worker and the physio social piece of the activity are very much recorded (Dollar and Metzer, 1999), lamentably just constrained work has been led on the impacts of particular stressors on a representative execution. In light of the interest control demonstrate (Karasek, 1979) work weight is one of the vital wellspring of employment push (Jungwee, 2007). What makes the distinction among requests and the capacity to give mental security in the family is non-other than occupation push (McCubbin and Figley 1983). Despite the fact that there is a significant research body that bargains with family and work, there hasn’t been much consideration (e.g., Jacobson, 1987) gave that really bargains work uncertainty on both conjugal and family lives (e.g., Buss and Redburn, 1983., Ahmed and Ramzan, 2013). Employment stress can be recognized either a constructive or an adverse pressure and it relies upon the impression of an individual between these two powers. It is a rarity indeed since work at pressure particularly is another marvel to the method for our advanced living.

2.2 Employee performance

There exist enormous theories on stress and work performance Lazaru defined stress in terms of transaction. He explained in his transactional model that Stress is a product of the transaction between the individual and the environment (Lazaru, 1990). The main focus of Lazarus’s transactional model is on appraisal. It states that appraisal binds a person and the environment. The model further explains primary and secondary appraisal reflecting the changing person- environment relationship. In alternative theory, Cooper’s theories of occupational stress, it was suggested that the aim of research must be to “understand linkages” that not just give expression to the stress process, but also provide a context for exploring individual well-being. (L.Cooper) Another theory called Cybernetic Theory explained stress as a discrepancy between the employee’s desired state and perceived state. This discrepancy may result in employee diminished performance especially in case of doctors and nurses. Stress is linked with reduced individual working in the working environment. (Edward, 1992). The emphasis in this theory is on feedback, information and time. Another theory on stress is Conservation of resource theory. The basic idea behind COR theory is that stressful situations lead to resource losses. For instance, clash with other people at work can reduce the individual’s energy, loss in time to deal with that problem and disturb them from their main job tasks, all of which will result in resource losses. (Hobfoll, 1989). Cooper’s theory of dynamic adaptive process suggests that the experience of stress is the result of a connection between various sources of pressure and the person having stress. (L.Cooper, p. 2000). These theories define stress at work place and the causes, reasons and consequences of stress in a work place. These theories also help researcher understand the concept behind the variables both dependent and independent.

An international research on Occupational stress and its consequences Implications for health policy and management aimed to investigate the status of occupational stress in employees of the hospital in Iran. The study also showed harmful effects of occupational stress. It used a questionnaire method for research purpose based on a cross sectional method of research. The research states that occupational stress results in harmful outcomes for both the organization and the employee. Moreover, it also causes psychological distress. The study had linked organizational stress to performance of the employee at hospitals. The study accessed the occupational stress level in hospitals, identified stress related problems and effect of stress on turnover of employee. The researcher selected seven hundred and forty employee for research out of which six hundred and eight employees filled the questionnaire. The sampling technique used was random sampling. Pilot testing was done on 40 employees. Data analysis was performed by using SPSS 11. As a result of this research, 26% of hospital employees reported that their job was extremely stressful and the sources of stress were less pay, regular breaks at work, inequality at work, too much work, staff shortages. The research also concluded an increase in duty and work environment-related stress can result in more interpersonal tensions. Heavy workload was pointed out to be one of the most significant associated features of stress for Iranian hospital employees. The most occupational stressors for hospital employees found in this study were poor promotion prospects, inadequate pay, too much work, inequality at work,  time pressure, job insecurity, poor management support and staff shortages. (Mosadeghrad, 2014).

2.3 Relationship between job stress and employee performance

With the help of collected literature on both international and national perspective of job stress and employee performance and the different theories on stress at workplace, it is now clear in understanding the relationship between the two variables. Moreover, the above mentioned research has a close relation in features of the current research in terms of dimensions of the two variables and the population of study. In addition to this, the current research and the research by Ali Muhammad are both based on quantitative method. Therefore, the link between the two researches is quite close. The only difference in the two researches is the choice of dimensions. The dimensions of independent variable, that is job stress, selected by the current research is rule of organization and work load on employee similarly, the dimensions of employee performance chosen in the current research is quality of work life and organizational commitment. The current research will perceive the impact of work related stress or occupational stress on employee performance with respect to the anticipated dimensions.

Both Cox and Griffiths (1995), made a system that helps in assessing the methodology of managing distressing circumstances. It is relied upon the effect of an outside stressor (Lazarus and Cohen, 1977; Antonovsky and Kats, 1967; Cohen 1984).This model spotlights on the auxiliary attributes of the pressure procedure, i.e. which stressors are probably going to prompt which results in which populaces, anyway value-based perspectives are intellectual, and spotlight on the dynamic relationship that happens among people and their condition as far as mental and enthusiastic procedures (Cox et al., 2000).This model examinations more on subjective methodologies instead of G.A.S.- Selye’s, it is additionally considered as a standout amongst the most unique model that can provide food on individual contrasts and recognizes other elective strategies when managing pressure (Mark and Smith, 2008).This model accentuation on improving the significance of stress-the board, it likewise proposes different techniques in overseeing mental reactions to stretch (Sabrina, 2017).

Anyway the primary restriction of this model lies on its effortlessness that does not think about ecological, science and social components. Another test is to lead any exploratory research where it covers on emotional angles. A few clinicians even have their own questions that regardless it needs to assess and enhances (Sabrina,2017). Numerous different speculations were talked about in connection with stress and employment execution. Nutrient Model (Warr, 1987) evidently was investigated and explored on couple of Dutch human services medical caretakers and their associates (Jonge and Schaufeli, 1998). This said display was expected that activity self-rule, work requests and social help in working environment relates to fundamental three key pointers and they are fulfillment in employment, nervousness related occupations and encountering passionate weariness (Jonge and Schaufeli, 1998). Basically, some activity characters do have nonstop impact where wellbeing conditions does increments „additional decrement‟ with the expansion of measurements up to where it demonstrates no impacts both emphatically and contrarily thus these attributes can be identified with security, compensation and even certain noteworthy occupations (Buunk et al., 1998).

2.4 Theoretical framework

1. Independent variable is work stress
2. Dependent variable is Doctors’ performance
3. Mediators are salary, rewards and work hours
4. Moderator is hospital environment

2.5 Hypothesis

H_O: Stress has a significant impact on Doctors performance

H₁: Stress has insignificant impact on Doctors performance

H_2: Relationship between performance and stress depends on salary packages and work hours

H_3: Hospital environment moderates’ relationship between doctor’s performance and work stress.