西南交通大学学报

第 58 卷 第 4 期 Vol. 58 No. 4
JOURNAL OF SOUTHWEST JIAOTONG UNIVERSITY Aug. 2 0 2 3
2023 年8月

ISSN: 0258-2724 DOI：10.35741/issn.0258-2724.58.4.2

Research article

Social Sciences

WORKLOAD, WORK-RELATED STRESS, AND EMOTIONAL

EXHAUSTION IN THE HEALTHCARE SECTOR

医疗保健行业的工作量、与工作相关的压力和情绪疲惫

Sandra Ingried Asaloei a,*, Edmond Leonard Jim b, Febry Hendra Jeskhiel Dien c, Basilius Redan Werang d
a
Faculty of Social and Political Science, Sam Ratulangi University
Manado, Indonesia, sandraа[email protected]
b
Faculty of Medicine, Sam Ratulangi University
Manado, Indonesia
c
North Sulawesi Education Quality Assurance Agency
Manado, Indonesia
d
Fakultas Ilmu Pendidikan, Universitas Pendidikan Ganesha
Singaraja, Indonesia

Received: May 4, 2023 ▪ Reviewed: June 1, 2023

▪ Accepted: July 16, 2023 ▪ Published: July 31, 2023

This article is an open-access article distributed under the terms and conditions of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/4.0)

Abstract
Emotional exhaustion has been identified as a significant risk for professionals who work with people
in clinical services in hospitals. This study aimed to describe how workload and work-related stress
impact the emotional exhaustion of healthcare workers at Advent hospitals in Manado, Indonesia. To
attain this objective, we used three survey questionnaires to obtain data from 265 healthcare workers. The
obtained data were statistically analyzed using a simple linear regression analysis technique by employing
the SPSS software version 21. The results of the statistical analysis showed a positive impact of workload
on emotional exhaustion with the R2 coefficient value of 0.483 and the Sig. F change coefficient value of
0.000. It inferred that the workload and work-related stress positively impact the emotional exhaustion of
healthcare workers at Advent Hospitals in Manado, Indonesia. The findings of this study imply the need
for the management of Advent Hospitals to promote respectful and supportive interpersonal relationships,
encourage teamwork and shared goals among workers, and create social support systems to foster
workers‘ well-being and commitment. While emotional exhaustion among healthcare workers and its
predicting factors have been well documented in previous studies, this research context-specific approach
sheds new light on the issue. By conducting research in a specific hospital context, this study highlights
the importance of understanding the unique challenges faced by healthcare workers in different work
environments. This approach not only deepens our understanding of emotional exhaustion among
healthcare workers but also provides useful information for developing context-specific interventions
aimed at addressing the issue.

Keywords: Workload, Work-Related Stress, Emotional Exhaustion

 Asaloei et al. Workload, Work-Related Stress, and Emotional Exhaustion in the Healthcare Sector, Vol. 58 No. 4 Aug. 2023
13

摘要 情绪衰竭已被确定为与医院临床服务人员一起工作的专业人员的重大风险。本研究旨在描述
工作量和与工作相关的压力如何影响印度尼西亚万鸦老来临医院医护人员的情绪疲惫。为实现这
一目标，我们使用了三份调查问卷从265名医护人员那里获取数据。通过使用统计软件软件版本21
，使用简单线性回归分析技术对获得的数据进行统计分析。统计分析的结果表明，工作量对情绪
耗竭有积极影响，右2系数值为0.483，签名。F变化系数取值为0.000。它推断，工作量和与工作
相关的压力对印度尼西亚万鸦老来临医院医护人员的情绪疲惫有积极影响。这项研究的结果表明
，来临医院的管理层需要促进尊重和支持的人际关系，鼓励员工之间的团队合作和共同目标，并
建立社会支持系统以促进员工的福祉和承诺。虽然之前的研究已经充分记录了医护人员的情绪疲
惫及其预测因素，但这种针对特定背景的研究方法为这个问题提供了新的思路。通过在特定医院
环境中进行研究，本研究强调了了解医护人员在不同工作环境中面临的独特挑战的重要性。这种
方法不仅加深了我们对医护人员情绪耗竭的理解，而且还为制定旨在解决该问题的针对具体情况
的干预措施提供了有用的信息。

关键词: 工作量、工作压力、情绪疲惫

I. INTRODUCTION understanding of burnout.

Emotional exhaustion has been a topic of The COVID-19 pandemic has had a
interest for both researchers and healthcare significant impact on the emotional exhaustion of
professionals [1]. The challenges posed by the healthcare workers. Several factors are identified
COVID-19 pandemic have tested the well-being as contributing to the emotional exhaustion of
of people worldwide, with healthcare workers healthcare workers. This study looks at two main
being the most affected due to the increased risk contributors. The first contributor is workload.
of exposure to the virus as they care for patients. The workload is a concept that has multiple
They were widely recognized as heroes for their dimensions, and therefore, it is difficult to define
bravery in the face of uncertainty during new it in a straightforward manner [15]. The workload
health crisis [2]. is the individuals‘ perception of the balance
There are various definitions of emotional between his or her own mental processing
exhaustion in the existing literature. Emotional abilities and the demands of the task at hand [16].
exhaustion is defined in [3] as a result of intense It can also be described as the intensity of job
physical, affective, and cognitive strain that can assignments [17], or the feeling of being
occur as a long-term consequence of exposure to overwhelmed by the demands of one‘s work
particular job demands, while [4] defined it as environment, which can lead to negative
the depletion of psychic energy or the draining of emotions such as anxiety, frustration, and
emotional resources. Emotional exhaustion, is annoyance [18].
described in [5] as the central quality of burnout, The second contributor is work-related stress.
while it is viewed as the core component of Work-related stress is a growing issue that is
burnout in [6]-[11]. affecting people all over the world, and it has
Emotional exhaustion often occurs alongside negative impacts on not only the workers‘ health
physical exhaustion, and its symptoms include a and well-being but also the productivity of
lack of energy, less sleep, problems in one‘s organizations. The World Health Organization
personal relationships, and increased alcohol described work-related stress as the emotional
consumption [12]. When workers are emotionally and physical strain that occurs when the demands
exhausted, they may no longer be able to remain and pressures of work exceed a person‘s abilities
in their current personal or professional position and resources for coping [19]. In a similar vein,
[13]. According to [14], almost half of the job stress is described as the negative physical
workers experience high levels of emotional and emotional response that occurs when
exhaustion due to stressors such as heavy workers‘ job demands do not match their skills
workloads, low levels of support from and needs [20]. Also, job stress is defined as the
colleagues, personal engagement with their work, experience of anxiety, worry, and depression
a shortage of staff, the lack of professional related to work [21].
development opportunities, and the lack of Workload refers to the amount of work that
needs to be completed within a certain time
 14

period [22]. According to [22], work-related budget, (b) accurate results, (c) strong
stress occurs when workers are unable to representativeness, (d) proper data collection
effectively handle the demands and challenges of methods, (e) valuable statistical implications, and
their job. Work-related stress can arise in a (f) minimal researcher bias.
variety of situations and can be exacerbated when Three survey questionnaires were distributed
workers feel unsupported by their supervisors to 265 healthcare workers who were selected
and coworkers and lack control over their work through convenience sampling from those
processes [19]. Work-related stress can be caused working at Advent Hospital in Manado,
by various factors, including conflicts with Indonesia. The convenience sampling method
coworkers or supervisors, frequent changes in the was chosen due to the rotating shifts of
workplace, excessive workload, low salaries, and healthcare workers‘, which made it difficult to
feelings of insecurity about one‘s job, such as the determine a specific time frame for data
possibility of being laid off [23]. collection. This sampling approach allowed for a
A huge number of previous studies have diverse representation of healthcare workers
investigated the workload impact [24]-[29] and across different shifts and ensured a sufficient
stress at work [30]-[39] on emotional exhaustion. sample size for statistical analysis.
The increased workload and stress faced by To measure healthcare workers‘ perceptions
healthcare workers during the COVID-19 of their emotional exhaustion, we used a
outbreak likely contributed to emotional questionnaire of 7 items from [46]. The list of
exhaustion [40]-[41]. This study aimed to items used a four-point Likert scale marked from
describe how workload and work-related stress 1 (strongly disagree) to 4 (strongly agree). The
impact the emotional exhaustion of healthcare samples of questionnaire items in the English
workers at Advent hospitals in Manado, version are as follows: ―I feel I get tired of my
Indonesia. As far as we are aware, there have current job,‖ ―I feel unenthusiastic about my
been no empirical studies that examined the profession,‖ ―I feel drained of energy when I
causal relationships among the surveyed come home from work,‖ ―I feel drained of both
variables within the context of Indonesia in emotional and cognitive energy at work,‖ ―I feel
general and the Advent Hospitals in particular. drained after working during my shifts,‖ and
Only one previous study [42] looked at the stress ―Interacting with people all day long is a
of healthcare workers in Indonesia during the significant strain for me.‖ The Cronbach‘s alpha
COVID-19 outbreak. coefficient was used to test the instrument
Thus, this study intended to bridge the reliability. For this study, the coefficient value of
existing knowledge gap in the existing literature Cronbach‘s alpha was 0.886.
by examining the causal relationships among the To measure healthcare workers‘ perceptions
surveyed variables, taking the healthcare workers of their workload, we modified a questionnaire of
at Advent Hospitals in Manado, Indonesia, as the 8 items from [29]. An Indonesian language
population and samples. Three research questions version of the questionnaires using a four-point
were probed to guide this study: (a) Does the Likert scale marked from 1 (Strongly Disagree =
workload impact significantly the emotional SD) to 4 (Strongly Agree = SA) was distributed
exhaustion of health care workers at Advent to 265 healthcare workers working at the Advent
Hospitals in Manado, Indonesia? (b) Does the Hospitals in Manado, Indonesia. The samples of
work-related stress impact significantly the questionnaire items in the English version are as
emotional exhaustion of health care workers at follows: ―I experience stress regularly at work,‖
Advent Hospitals in Manado, Indonesia? A ―I feel pressure to meet unrealistic deadlines and
quantitative survey research design was time constraints,‖ ―I have to work very hard,‖
employed to answer these research questions. and ―It is hard to balance different demands that
are made on me.‖ The Cronbach‘s alpha
II. MATERIALS AND METHODS coefficient was used to test the internal reliability
As this study sought to describe the impact of of the instrument. For this study, the coefficient
the workload and work-related stress on the value of Cronbach‘s alpha was 0.888.
emotional exhaustion of healthcare workers To measure the healthcare workers‘
working at the Advent Hospitals in Manado, perceptions of their work-related stress, we
Indonesia, a quantitative approach using a survey modified a questionnaire of 9 items from [47].
research design was employed to obtain data An Indonesian language version of the
from 265 healthcare workers. A survey research questionnaire using a four-point Likert scale
design was used as several current studies [43]- marked from 1 (Strongly Disagree = SD) to 4
[45] offered the following benefits: (a) low (Strongly Agree = SA) was distributed to 265
 Asaloei et al. Workload, Work-Related Stress, and Emotional Exhaustion in the Healthcare Sector, Vol. 58 No. 4 Aug. 2023
15

healthcare workers working at the Advent Indonesia.

Hospitals in Manado, Indonesia. The samples of
questionnaire items in the English version are the III. RESULTS
following: ―I have too much to do during the As mentioned above, this study aimed to
COVID-19 outbreak,‖ ―I feel disconnected from describe the potential impact of workload and
others,‖ ―I have a lot of worries,‖ ―I feel burnout work-related stress on the emotional exhaustion
mentally,‖ ―I feel overwhelmed by the demands of healthcare workers. With the help of SPSS
placed upon me,‖ and ‗I do not have enough time software version 21, the responses of 265
for myself‘. The Cronbach‘s alpha coefficient healthcare workers on the questionnaires were
was used to assess the internal reliability of the analyzed. We were really aware that testing the
instrument." In this study, the coefficient value of data normality is a prerequisite in data analysis
Cronbach‘s alpha was 0.708. using a simple linear regression model. However,
The obtained data were statistically analyzed due to the large number of samples in the study,
using the simple linear regression analysis we disregard the prerequisite test [48].
technique by employing the software Statistical Based on the proposed research questions, the
Package for the Social Sciences (SPSS) version objective of this study was twofold. The first
21. Two research hypotheses were investigated in objective is to describe the prospective impact of
this study as follows (a) Workload positively workload on the emotional exhaustion of
impacts the emotional exhaustion of health care healthcare workers working at Advent Hospitals
employees at Advent Hospitals in Manado, in Manado, Indonesia. The significant results of
Indonesia; and (b) Work-related stress positively statistical analysis on the causal relationships
impacts the emotional exhaustion of health care among the variables are presented in Table 1.
workers at Advent Hospitals in Manado,

Table 1.
Workload and its impact on health care workers‘ emotional exhaustion
Model Summary
Model R R Square Adjusted R Std. Error of Change Statistics
Square the Estimate R Square Change F Change df1 df2 Sig. F Change
1 0.695a 0.483 0.481 2.19654 0.483 245.626 1 263 0.000
a
Predictors: (Constant) Workload

The data displayed in Table 1 showed a hypothesis is unconfirmed. It inferred that 48.3 %
positive impact of the workload on the health of healthcare workers‘ emotional exhaustion
care workers‘ emotional exhaustion as the could be explained by their workload, while the
coefficient value of R Square (R2) is 0.483 and remaining 51.7 % should be attributed to other
the coefficient value of Sig. The F Change is variables that are not the focus of this study.
0.000. This result demonstrates that the second The second objective is to describe the
research hypothesis ―Workload positively prospective impact of work-related stress on the
impacts the emotional exhaustion of the health emotional exhaustion of healthcare workers
care workers at Advent Hospitals in Manado, working at Advent Hospitals in Manado,
Indonesia‖ is confirmed, while the null Indonesia.

Table 2.
Work-related stress and its impact on healthcare workers‘ emotional exhaustion
Model Summary
Model R R Square Adjusted R Std. Error of Change Statistics
Square the Estimate R Square Change F Change df1 df2 Sig. F Change
1 0.583a 0.339 0.337 2.48274 0.339 135.123 1 263 0.000
a
Predictors: (Constant), Work_Related_Stress

The significant results of statistical analysis Change is 0.000. It demonstrates that the second
on the causal relationships among the variables research hypothesis ―Work-related stress
are presented in Table 2. The data displayed in positively impacts the emotional exhaustion of
Table 2 showed a positive impact of work-related the health care workers at Advent Hospitals in
stress on the health care workers‘ emotional Manado, Indonesia‖ is confirmed, while the null
exhaustion as the coefficient value of R Square hypothesis is unconfirmed. It inferred that 33.9 %
(R2) is 0.339 and the coefficient value of Sig. F of healthcare workers‘ emotional exhaustion
 16

could be explained by their work-related stress, of healthcare workers working at Advent

while the remaining 66.1 % should be attributed Hospitals in Manado, Indonesia, as indicated by
to other variables that are not the focus of this the R2 coefficient value of 0.339 and the Sig. F
study. Change coefficient value of 0.000. It
demonstrates that for every point increase in the
IV. DISCUSSION variable ―work-related stress‖ will increase 0.339
Work-related stressors, including heavy points in the variable ―emotional exhaustion‖.
workloads and mistreatment, as well as job Conversely, for every point decrease in the
insecurity, may negatively affect the health of variable ―work-related stress‖ will decrease 0.339
workers [49]-[50]. Current work conditions, points in the variable ―emotional exhaustion‖. In
including these stressors, are causing difficulties other words, a higher level of work-related stress
for workers [49]-[51]. Emotional exhaustion has leads to a higher level of emotional exhaustion
been identified as a significant risk for and vice versa. The findings of this study comply
professionals who work with people in clinical with research findings of [25] and [57] that job
services in hospitals [53]. The results of stress is positively related to emotional
statistical analysis showed a positive impact of exhaustion.
workload on the emotional exhaustion of Generally speaking, heavy workloads and
healthcare workers working at the Advent chronic stress can lead to emotional exhaustion,
Hospitals in Manado, Indonesia, as indicated by which can have negative impacts on both
the R2 coefficient value of 0.483 and the Sig. F physical and mental health [58]. Positive
Change coefficient value of 0.000. It emotions can help prevent work-related stress
demonstrates that for every point increase in the and emotional exhaustion. Research has shown
variable ―workload‖ will be an increase of 0.483 that mindfulness-based stress reduction
points in the variable ―emotional exhaustion‖ and techniques can be effective in reducing
for every point decrease in the variable psychological symptom] [59]. It is suggested that
―workload‖ will decrease by 0.483 points in the healthcare workers on the front line adopt
variable ―emotional exhaustion‖. In other words, sensible work schedules, practice self-
a higher level of workload leads to a higher level management, and engage in mindfulness
of emotional exhaustion and vice versa. The activities as a way to reduce the risk of
findings of this study comply with research exhaustion [60]. Team leaders and administrators
findings [29] that workload was positively related of Advent Hospitals should organize
to emotional exhaustion. The findings of this mindfulness-based and self-management
study are also in line with research findings of activities to improve healthcare workers‘ ability
[54] and [55] that workload impacts positively on to cope with stress and prevent emotional
the emotional exhaustion of nurses. exhaustion. From this viewpoint, implementing
Healthcare workers are more likely to thrive workplace wellness programs that teach skills for
in their jobs when the demands and pressures psychological detachment, provide personal
they face are appropriate for their skills and resources such as optimism, and use relaxation
knowledge, they have some control over their techniques could be a way for healthcare workers
work and how they do it, they receive support to take care of themselves. Training in optimism
from their supervisors and colleagues, and they as a skill may help protect the well-being of
are involved in decision-making processes related healthcare workers by creating healthy
to their jobs. When these conditions are not met, environments and positive expectations, similar
they are more likely to experience work-related to how recovery may increase energy levels.
stress [19] and, in turn, negatively affect workers‘ These programs should also address balancing
mental health and increase their risk of work and life by adjusting working hours.
developing conditions such as anxiety, burnout,
depression, and substance abuse disorders [56]. V. CONCLUSION
Emotional exhaustion is also caused by a long The healthcare industry is one of the most
period of constant life stress, whether by personal demanding and challenging fields, and healthcare
stress at home or stress related to work [37]. The workers are often exposed to various sources of
incongruence between organizational demands stress and workload, which can lead to emotional
and a worker‘s resources to meet these demands exhaustion. This study sheds light on the impact
leads to work-related stress on the job and of workload and work-related stress on emotional
overtime emotional exhaustion [34]. The results exhaustion among healthcare workers at Advent
of statistical analysis showed a positive impact of Hospitals in Manado, Indonesia. The conclusion
work-related stress on the emotional exhaustion depicted from the results of the statistical analysis
 Asaloei et al. Workload, Work-Related Stress, and Emotional Exhaustion in the Healthcare Sector, Vol. 58 No. 4 Aug. 2023
17

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