Stress Among Nurses: A Case Study At Healthcare Centers In Melaka


A nurse should perform as a caregiver, loveable, communicator and as well as a teacher among others. Hence, it lead the profession to the most stressful occupation ( Wu, Liao & Yeh, 2012 ). Nurses are facing several challenges due to the dynamic nature of the working environment and one of it is on how they manage their job stress. This study aim is to investigate the relationship between work overload and work-life balance towards job stress among nurses at healthcare centers in Melaka. This study employed quantitative research design and the data were analysed by using Statistical Package for the Social Sciences (SPSS). Data was obtained from 213 nurses and the results indicated a significant relationship for work-life balance towards job stress. However, for work overload, there was no significant relationship towards job stress. This paper aim to provide a beneficial information in terms of theoretical perspective and implementation practices to ensure people are aware about stress that being faced by nurses in healthcare center. Therefore, it is essential for the organization to ensure their nurses are well aware and understand the nature of the job contents and the environment of the workplace itself to ensure the nurses are able to regulate the level of the stress which directly encouraging them to sustain a conducive working environment.

Keywords: Nurseprivate healthcare centrejob stresswork overloadwork-life balance


Ministry of Health (MOH) is accountable for regulating the healthcare centres in Malaysia. Due to the high demand, Malaysia generally has an efficient and widespread system of healthcare, operating a two-tier healthcare system consisting of both a government-run universal healthcare centre system and a co-existing private healthcare center.

There are 297 healthcare centres run in Malaysia and the table below showed the segregation of healthcare centres for both government and private.

Table 1 -
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Nurses’ workload has increased over recent years in line with the rapid growth. Therefore, a multitasking’s nurse is vital to cope with demands. Nurses should play numerous of roles, for instance as a caregiver, loveable, communicator and a teacher among others. As Wu, Liao & Yeh, (2012) indicated, the nursing profession is among one of the most stressful occupation. This in line with the research done by Frassrand (2005) said that nurses is symbolized as heart of the healthcare centers.

There a lot of factors that lead to stress. As Blewett et. al., (2006) stated in their research, there are numerous of causes; for instance work life balance, poor work organization, work overload, poor management, personal matter, unsatisfactory working conditions and poor relationship at working place.

As a stress is building up in workplace, it is not only lead negative consequences on the individual itself, but it also produces other organizational consequences. The level of job dissatisfaction is quite high in nurses. Aiken et. al., (2011) indicated that 1 in 5 nurses intended to leave his or her designation as a result of dissatisfaction, burnout, and stress.

Problem Statement

To cater the demand of healthcare services, Malaysia offer 297 healthcare center which consists of private and government ownership, with an attractive proposition, world-class quality and competitively affordable. Moreover, with the outstanding performance especially from the private institution of healthcare centres, it ensure top quality, safe and effective treatments in comfortable surroundings with ease of access and affordable prices. Nevertheless, it complement the current public healthcare system.

However, dealing with the dynamic and challenging working environment, it demands for well verse and competence nurses. Nurses should competence with the knowledge and skills in order to perform and serve the patient well. Plenty of numerous roles, as a caregiver, loveable, communicator and a teacher among others would lead to stressful occupation (Wu et. al., 2012). In addition, the environment itself is competitive since the private healthcare center growth is the direct consequences of customer's negative perception in terms of quality offered by public healthcare centre (Lafond, 1995).

Therefore, this study aims to revisit the existing findings related to the stress among nurses (Pandian, 2013). This to ensure the findings of the study would address the essential information focusing on the relationship of work overload and work-life balance towards job stress especially focusing in the Malaysian context.

Research Questions

The general question of this study is to identify the level of stress faced by the nurses in the private healthcare centers. The specific questions are stated below;

Specific questions:

  • Is there any relationship between work overload and job stress?

  • Is there any relationship between work-life balance and job stress?

Purpose of the Study

This study aim to enhance the existing body of knowledge pertaining on the stress happen among nurses who is working in the private healthcare centers. Apart of that, the results derived from this study would help the Ministry of Health in terms of enhancing the existing policy regarding employment and to comprehend well on the nature of the nurse’s position.

By looking and revisit the existing policy, it would beneficial the law maker in order to enhance and improve the existing laws and regulations whereby to facilitate and protect the nurses especially in dealing with the risk of work stress. This would help them to reduce their stress which finally will improve their job performance. Along with policy enhancement, this study also would encouraging the nurses to more alert and well aware regarding the stressor and educate them on how to handle themselves in the stressful working environment.

Hopefully, the results and findings from this study would facilitate other future researchers to explore further on other factors that may emerge in modern life of nurses which is more challenging which it may lead to the worse stressful environment.

Research Methods

Conceptual frameworks for this study were derived from the previous literature on work overload and work-life balance towards job stress proposed by Pandian (2013). Hence, the model of this study, a conceptual framework of linking work overload and work-life balance on job stress, will be presented (see Fig. 1 ) and 2 hypotheses were proposed as stated below:

Hypothesis 1: There is a relationship between work overload and job stress.

Hypothesis 2: There is a relationship between work-life balance and job stress.

Figure 1: Research Framework: Work Overload and Work-life Balance on Job Stress
Research Framework: Work Overload and Work-life Balance on Job Stress
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This study mainly employed the quantitative and the common type approaches is self-report survey (Shaughnessy & Zechmeister, 1997). 300 respondents (nurses) of this study are randomly selected from two private healthcare centers in Bandar Melaka. 300 questionnaires were disseminated to the respective respondent. A total of 213 nurses responded to the questionnaire. It depicted 71% response rate and it is beyond than 30% as stated by Sekaran (2003).

In Part 1, three sections covered 23 questions which are work overload (9 questions), work-life balance (7 questions) and job stress (7 questions). While in Part 2, five questions on demographic information of participants. These demographic variables were treated as control variables in this study. Five-point Likert scale was employed for each variable in the questionnaire which anchors being (1) strongly disagree to (5) strongly agree.

The reliability of the variables was analyzed with Cronbach’s Alpha and the value for each variable was depicted as the table below. As for hypotheses testing, this study employed the Pearson Product-Moment Correlation.

Table 2 -
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For this study, there are 213 total numbers of nurses from private healthcare centers involved in this survey. Thus, it is important to identify the characteristics and other details of the sample and it provides the researcher a clear background of sample used in this study. Table 3 showed the details on each profile.

Table 3 -
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According to Table 4 , there were moderate level of stress perceived by the nurses whereby presented by the calculated mean at 3.95 and standard deviation at 0.48. The result also showed the moderate level of for work overload, which stated mean and standard deviation for 3.92 and 0.53. However, for work-life balance was perceived as low, each of calculated mean and standard deviation depicted at 2.06 and 0.56.

Table 4 -
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Hypotheses were tested using the Pearson Product-Moment Correlation. In line with conservative approach, two-tailed test of significance set at 0.05 level was used and Table 5 showed the summary of correlations between independent variables and dependent variable.

Table 5 -
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For the hypothesis 1, the result from the table stated that p > 0.05 and r = .033, this indicate that the null hypothesis was accepted. Therefore, there is no significant relationship between work overload and job stress. Although the previous research found that one of stressor is work overload, and the samples were perceived a moderate level of work overload, however, it seem that the nurses itself are well comprehended and capable to handle the job stress. This finding is align with the previous research that found one of the components that lead to the better performance of healthcare center is the proficient nurses (Frassrand, 2005).

However, for the hypothesis 2, the results was indicated that p < 0.05 and r = -0.245. Since p-value was lesser than 0.05, the null hypothesis were rejected. Therefore, there is a significant relationship between work-life balance and job stress. Meanwhile, the magnitude of the correlation of relationship is low (Guilford, 1978) and the directional is negative whereby when nurses perceived their work-life balance is decreasing, it lead to increasing the job stress. This result depicted in line results with previous research done by Blewett et. al., (2006) and Wu et. al., (2012) that stated the profession of nurse is challenging and surrounding with stress.


Derived from the conceptual framework that linked the stressor to the job stress (Pandian, 2013), this study found two results as the completion of the research questions. First, this study found the level of stress faced by nurses is moderate, in line Fink’s statement (2010), stress is something that cannot be avoided because of the readjustment to fulfil the demand of the job’s dynamic. This depicted the conducive working environment whereby the nurses acknowledge the presence of the stress and capable to handling. For stressor, the nurses perceived moderate level of work overload, meanwhile for work-life balance, it indicated low. Since the design of the job itself is challenging, nurses need to be proficient in playing multiple roles in order to fulfil the work scope mandate. However, for work-life balance, action or policy should be revisit and probe in order to ensure the capabilities of nurses to handle it is adequate.

Second, as the result from the correlation assessment, only work-life balance is significant related with the job stress. Although the link showed a low magnitude of relationship, the management of the healthcare centers should critically and proactively enhancing a family friendly policies, such as flexible job arrangements.

Inevitable, no research study is complete. This study was employed limited number of samples and location, thus the result cannot be generalized throughout the entire population. Despite with these limitations, this study would beneficial to the healthcare centers in reassess and clarifies the stressor and the implication of job stress and this may support the need for re-evaluation of current practices which lead to the improvement.


There are many special persons who deserve thank for their contribution to this dissertation. My honest appreciation is offered to them for their advice, contribution and cooperation, without them this study would not have been possible done with successful. I would like express a very special thanks to team members for continue encouragement and support for completing this research.


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31 July 2018

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Ramli, A. A., Yazid, A. Z. M., Selvam, N. A. P., Zainol, N. F., Zamri, M. N. E., & Batumalai, S. A. (2018). Stress Among Nurses: A Case Study At Healthcare Centers In Melaka. In N. Nadiah Ahmad, N. Raida Abd Rahman, E. Esa, F. Hanim Abdul Rauf, & W. Farhah (Eds.), Interdisciplinary Sustainability Perspectives: Engaging Enviromental, Cultural, Economic and Social Concerns, vol 44. European Proceedings of Social and Behavioural Sciences (pp. 464-470). Future Academy.