Workload and occupational stress as determinants of workplace violence among hospital nurses: A cross-sectional correlational study
Keywords:
Workload, Occupational Stress, Workplace Violence, Nurses, HospitalsAbstract
Background and aim of the work: Workplace violence is a serious issue in healthcare services and can negatively impact safety, psychological well-being, and the quality of nurses' work. High workload and increased occupational stress can heighten nurses' vulnerability to an increased risk of violence in hospital environments. This study aims to analyze the relationship between workload and occupational stress concerning incidents of workplace violence among nurses.
Research design and methods: This cross-sectional correlational study was carried out at a public Type B hospital in Banda Aceh. Structured questionnaires were used to assess workload, occupational stress, and workplace violence among 207 staff nurses selected through probability sampling. These instruments, adapted from a previous study, were administered with informed consent over two weeks. The relationships among workload, occupational stress, and workplace violence were analyzed using univariate statistics and Spearman's rank correlation.
Results: The correlation analyses revealed that workload is significantly positively associated with workplace violence (r = 0.466, p < 0.001), indicating a moderate link where increased perceived workload corresponds with higher violence. Additionally, occupational stress showed a significant and stronger correlation with workplace violence (r = 0.542, p < 0.001).
Conclusions: High workload and occupational stress frequently raise the risk of workplace violence from patients, family members, or colleagues. This situation not only affects nurses' mental health but also compromises the quality of care and endangers the development of a patient safety culture in hospitals. These results underscore the importance of implementing effective workload management and stress reduction strategies to improve nurses' safety and well-being. (www.actabiomedica.it)
References
1. Putra A, Kamil H, Yuswardi Y, Darmawati D. Frontline nursing leadership and safety culture in psychiatric care: Evidence from Aceh Mental Health Hospital. Acta Biomed Atenei Parm. 2025;96(3):16852. doi: 10.23750/abm.v96i3.16852
2. WHO, OECD, World Bank. Delivering Quality Health Services: A Global Imperative. OECD Publishing; 2018.
3. Kamil H, Yuswardi Y, Darmawati D, Putra A. Patient Safety Culture in Aceh Mental Hospital. J Liaquat Uni Med Heal Sci. 2025;Sp. Issue:38–43. doi: 10.22442/jlumhs.2025.01318
4. National Academies of Sciences, Medicine Division, Board on Global Health & C on I the Q of HCG. Crossing the global quality chasm: improving health care worldwide. 2018.
5. Piaster EH, Mardiyati SH, Kartika P, Hasanah UU, AlMubaroq MM. Effect of Workload on Fatigue in Nurses in The Hospital of Surakarta in 2023. J Mitra Kesehat. 2024;7(1):50–63. doi: 10.47522/jmk.v7i1.363
6. Devita M, Maryana, Nurvinanda R. Hubungan Burnout dan Stress Kerja Terhadap Kinerja Perawat Dirumah Sakit Umum Daerah Depati Hamzah Kota Pangkalpinang Tahun 2024. J Kesehat Tambusai. 2025;6(1):3759–66. Available from: https://journal.universitaspahlawan.ac.id/index.php/jkt/article/view/41250/27621
7. Putra A, Yuswardi Y, Nuraeni F. Factors influencing nurses’ occupational stress while caring for COVID-19 patients: A retrospective study. Acta Biomed Atenei Parm. 2025;96(5):17009. doi: 10.23750/abm.v96i5.17009
8. Natasha CW, Putra A, Jannah N, Kamil H, Rachmah R. Beban Kerja Perawat Di Rumah Sakit Umum Daerah Kabupaten Aceh Jaya. J Ilm Mhs Fak Keperawatan. 2023;7(4).
9. Putra A, Kamil H, Adam M, Usman S. Prevalence of workplace violence in Aceh, Indonesia: A survey study on hospital nurses. Acta Biomed. 2024;95(1):e2024062. doi: 10.23750/abm.v95i1.15430
10. Putra A, Kamil H, Adam M, Usman S, Rauzatul Jannah S, Abdurrahman A. Workplace violence in healthcare: Insights into incidents, types, and reporting mechanisms for hospital nurses. Acta Biomed Atenei Parm. 2025;96(1):16356. doi: 10.23750/abm.v96i1.16356
11. Nelson S, Ayaz B, Baumann AL, Dozois G. A gender-based review of workplace violence amongst the global health workforce—A scoping review of the literature. Hammad N, editor. PLOS Glob Public Heal. 2024;4(7):e0003336. doi: 10.1371/journal.pgph.0003336
12. Putra A, Kamil H, Adam M, Usman S. Socio-Demographic and Workplace Violence among Nurses in Aceh, Indonesia: A Correlational Study. J Liaquat Univ Med Heal Sci. 2024;65–71. doi: 10.22442/jlumhs.2024.01127
13. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. 10th ed. Philadelphia: Wolters Kluwer; 2017.
14. Nursalam. Manajemen Keperawatan: Aplikasi dalam Praktik Keperawatan Profesional. 4th ed. Jakarta: Salemba Medika; 2014. 117 p.
15. Retnosari DF, Dwiyanti E. Relation Between Workload and Nutritional Status With Fatigue Working of Outpatient Installation Nurses in RSI Jemursari [in Indonesian]. J Ilm Keperawatan (Scientific J Nursing). 2017 Mar 2;3(1 SE-):8–17. Available from: https://journal.stikespemkabjombang.ac.id/index.php/jikep/article/view/2
16. Pillastrini P, Banchelli F, Guccione A, et al. Global Postural Reeducation in patients with chronic nonspecific neck pain: cross-over analysis of a randomized controlled trial. Med Lav. 2018;109(1):16–30. doi: 10.23749/mdl.v109i1.6677
17. Yildirim D, Aycan Z. Nurses’ work demands and work–family conflict: A questionnaire survey. Int J Nurs Stud. 2008;45(9):1366–78. doi: 10.1016/j.ijnurstu.2007.10.010
18. Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and Factors Associated With Nurse Burnout in the US. JAMA Netw Open. 2021;4(2):e2036469–e2036469. doi: 10.1001/jamanetworkopen.2020.36469
19. Badri IA. Hubungan beban kerja dan lingkungan kerja dengan stres kerja perawat ruangan ICU dan IGD. Hum Care J. 2020;5(1):379. doi: 10.32883/hcj.v5i1.730
20. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(2):227–39. doi: 10.1348/014466505X29657
21. Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, De Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One. 2017;12(10):e0185781. doi: 10.1371/journal.pone.0185781
22. Afshari Saleh L, Niroumand S, Dehghani Z, Afshari Saleh T, Mousavi SM, Zakeri H. Relationship between workplace violence and work stress in the emergency department.. Vol. 12, Journal of Injury and Violence Research. 2020. p. 183–90. doi: 10.5249/jivr.vo112i2.1526
23. Adriaenssens J, De Gucht V, Maes S. Causes and consequences of occupational stress in emergency nurses, a longitudinal study. J Nurs Manag. 2015;23(3):346–58.
24. Alsharari AF, Abu-Snieneh HM, Abuadas FH, Elsabagh NE, Althobaity A, Alshammari FF, et al. Workplace violence towards emergency nurses: A cross-sectional multicenter study. Australas Emerg Care. 2022;25(1):48–54. doi: 10.1016/j.auec.2021.01.004
25. Swamy L, Mohr D, Blok A, et al. Impact of Workplace Climate on Burnout Among Critical Care Nurses in the Veterans Health Administration. Am J Crit Care. 2020;29(5):380–9. doi: doi.org/10.4037/ajcc2020831
26. Mulaindah D, Sahrul S. Gambaran stres kerja perawat IGD Rumah Sakit X yang ada di Makassar. J Psikol Ski (Sosial Klin Ind Organ. 2019;1(1):93–103. Available from: https://jurnal.uit.ac.id/JPS/article/view/170
27. Davey K, Ravishankar V, Mehta N, Ahluwalia T, Blanchard J, Smith J, et al. A qualitative study of workplace violence among healthcare providers in emergency departments in India. Int J Emerg Med. 2020;13(1):33. doi: 10.1186/s12245-020-00290-0
28. Liu J, Gan Y, Jiang H, et al. Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Occup Environ Med. 2019;76(12):927–37. doi: 10.1136/oemed-2019-105849
29. Putra A, Kamil H, Adam M. Understanding the factors related to workplace violence incidents among nurses in Aceh, Indonesia. Med Hist. 2025;9(1–2):16423. doi: 10.69124/mh.v9i1-2.16423
30. García-Pérez MD, Rivera-Sequeiros A, Sánchez-Elías TM, Lima-Serrano M. Workplace violence on healthcare professionals and underreporting: Characterization and knowledge gaps for prevention. Enfermería Clínica (English Ed). 2021;31(6):390–5. doi: 10.1016/j.enfcle.2021.05.001
31. Kibunja BK, Musembi HM, Kimani RW, Gatimu SM. Prevalence and Effect of Workplace Violence against Emergency Nurses at a Tertiary Hospital in Kenya: A Cross-Sectional Study. Saf Health Work. 2021;12(2):249–54. doi: 10.1016/j.shaw.2021.01.005
32. Mahdarsari M, Maurissa A, Putra A. Exploring the Factors Related to Workplace Violence among Nurses in Two Districts of Aceh Province. J Liaquat Uni Med Heal Sci. 2025;Sp. Issue:57–63. doi: 10.22442/jlumhs.2025.01321
33. OSHA. Guidelines for preventing workplace violence for health care and social service workers. Prairie Rose. 2016;66(1 Suppl).
34. Al‐Omari H. Physical and verbal workplace violence against nurses in Jordan. Int Nurs Rev. 2015;62(1):111–8. doi: 10.1111/inr.12170
35. Park M, Cho SH, Hong HJ. Prevalence and Perpetrators of Workplace Violence by Nursing Unit and the Relationship Between Violence and the Perceived Work Environment. J Nurs Scholarsh. 2015;47(1):87–95. doi: 10.1111/jnu.12112
36. Zhang SE, Liu W, Wang J, et al. Impact of workplace violence and compassionate behaviour in hospitals on stress, sleep quality and subjective health status among Chinese nurses: a cross-sectional survey. BMJ Open. 2018;8(10):e019373. doi: 10.1136/bmjopen-2017-019373
37. Edward KL, Ousey K, Warelow P, Lui S. Nursing and aggression in the workplace: a systematic review. Br J Nurs. 2014;23(12):653-4, 656-9. doi: 10.12968/bjon.2014.23.12.653
38. Schiavo R. Health communication: From theory to practice. John Wiley & Sons; 2013.
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