Social Support Moderates the Impact of Stress and Role Conflict on Life Satisfaction among Malaysian Nurses

Meguellati Achour1*, Ameen Ahmed Abdullah Alnahari2, Shahidra Binti Abdul Khalil2, Asmawati Muhamad3

1Department of Management, Faculty of Economics, Business and Management Sciences, University of Mohamed El Bachir El-Ibrahimi, Bordj-Bou Arreridj, 34030, Algeria

2 Fiqh and Usul Department, Academy of Islamic Studies, University of Malaya, 50603 Kuala Lumpur, Malaysia

3University of Malaya, 50603 Kuala Lumpur, Malaysia

*Corresponding Author’s Email: achour.meguellati@univ-bba.dz

ABSTRACT

Objective: This study examined the influence of role conflict and job stress on life satisfaction among nursing staff in Malaysian healthcare institutions, with social support as a moderator. Methods: To achieve the objectives of this study, the researchers prepared a questionnaire to collect the requisite data. The researchers sampled three hundred and thirty- five (335) nurses selected randomly from Malaysian healthcare institutions. Results: The findings reveal that social support plays an important moderating role between nurses’ job stress and life satisfaction. Conclusion: Nursing staff requires greater flexibility and support from friends, supervisors, and family to reduce stress levels and balance roles.

Keywords: Job Stress; Life Satisfaction; Nurses; Role Conflict; Social Support

INTRODUCTION

Many recent studies have indicated that high levels of work stress have a negative relationship with well-being. Research on job stress from a variety of perspectives can help to better understand and find the best strategies to mitigate the impacts of job stress on employee well-being (Villacarlos & Daño, 2020; Achour et al., 2021). In recent years, subjective well-being has become an exciting topic among scholars and policymakers (Clark, Yi, & Huang, 2019; Tan et al., 2020) and continues to be a subject of critical importance. People sometimes view subjective well-being as a measure of quality of life.

Several studies highlight that work-related stress is particularly prominent among nurses (Wang et al., 2020). Nursing is a demanding profession that requires proficient task performance to meet the required standards of healthcare. While dealing with human beings with illnesses, nursing entails providing care, compassion, and responsiveness to others’ needs. Work-related stress has become a global issue in the nursing workplace, with approximately 9.20% to 68.0% of nurses worldwide experiencing anxiety (Al-Yaqoubi, 2023).

This issue requires further investigation and empirical evaluation to find appropriate and effective solutions. Minimal stressors in daily life, on the other hand, contribute to high levels of life satisfaction and excellent health. A high level of life satisfaction is associated with better well-being and health (University of British Columbia, 2021). Furthermore, the quality of work life's impact on psychological well-being has implications for performance and productivity (Nancy et al., 2024). Hence, this study aimed to examine the effects of job stress and role conflict on life satisfaction among nurses in Malaysian healthcare institutions with social support as a moderator. This study empirically evaluated the efficacy of social support as a coping strategy for mitigating job stress.

Literature Review

Job Stress and Nurses

In recent years, attention to work-related stress has grown among public health researchers. Evidence shows that it significantly affects approximately one-third of workers each year (Hu et al., 2020). The most commonly reported stressors in nursing are a heavy workload (Madadzadeh, Barati, & Ahmadi Asour, 2018), the work environment, interpersonal relationships such as conflicts with physicians, and poor relationships with coworkers (Gheshlagh et al., 2017). Many researchers have found that 35.1% of nurse’s worldwide experience high levels of stress in hospitals (Almazan, Albougami, & Alamri, 2019). Then, the hypothesis for this study is:

H1: Job stress has a negative relationship with life satisfaction among nurses.

Role Conflict and Life Satisfaction

Role stress is a common job stressor in nursing. Nurses may experience work-role problems such as conflict, ambiguity, and distress due to the involvement of family caregivers in the care of hospitalized patients (Smits et al., 2022). Moreover, Isanawikrama, Hutomo, and Buana (2021) mention that the relationship between role conflict and life satisfaction is significant.

In nursing, role conflict may occur due to the nature of the profession. Task shifting and job rotation are common practices to increase efficiency and improve health care services. Furthermore, these practices promote practical knowledge among nurses, improve their understanding and credentials, and enrich and expand job assignments (Yoshioka-Maeda, 2021). According to Yoshioka-Maeda (2021), task-shifting moves tasks from highly qualified healthcare workers to less specialised ones.

Therefore, the current paper proposes to empirically test the following hypothesis.

H2: Role Conflict has a negative correlation with life satisfaction among nurses.

Social Support for Nurses

Previous literature has verified that social support helps nurses reduce stress, manage work- family conflict, and improve well-being (Azim & Islam, 2018; Günüşen, Wilson, & Aksoy, 2018). Hamaideh et al. (2024) highlighted in their study the importance of resilience and social support in reducing and coping with perceived stress among nurses. Social support is a crucial resource for nurses; thus, a lack of recognition from supervisors and colleagues can negatively impact their physical and psychological well-being (Al-Shehri et al., 2023). However, the need for social support for nurses may vary. Male or female nurses may need different social support depending on the context. For instance, in Saudi Arabia, male dominance and gender segregation mean that male nurses need less social support than their females. This may be different in other countries where women dominate the profession. Other than that, unmarried colleagues require less support than married nurses, who require more (Azim & Islam, 2018).

Azim and Islam (2018) suggested that junior nurses should receive higher levels of social support than their more experienced counterparts. Fathi and Simamora (2019) supported the conclusion that support from senior nurses is crucial for other nurses. They argued that instrumental support is an effective coping strategy for job stress among nurses in Indonesia, and they emphasized the importance of promoting peer support through team spirit and teamwork. The World Health Organization (WHO) emphasized the importance of these aspects through the concept of task-sharing in nursing (WHO, 2007). Therefore, the current paper proposes the following hypothesis:

H3: Social support has a significant moderating role in the relationship between job stress and life satisfaction among nurses.

Model of the Study

Figure 1: The Hypothesized Model of the Study (H1, H2, H3)

METHODOLOGY

Research Validity

This study used a questionnaire developed by the researcher to collect the requisite data from nurses. To determine the validity of this questionnaire, each question was reviewed based on feedback from three experts. The data was pretested with 40 participants’ nurses working at Malaysian healthcare institutions.

Measures

Kopelman, Greenhaus, & Connolly (1983) developed eight scales to measure role conflict. Responses were coded on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The reliability coefficient (alpha) of the role conflict scale was 0.76.

Job Stress was measured using the workplace stress scale. It was developed by the Marlin Company and the American Institute of Stress (The Workplace Stress Scale by Marlin Company, 2009).

Life Satisfaction was measured using five items developed by Diener et al. (1985), and the Cronbach’s alpha was 0.87.

Social Support was measured by using 12-items. This variable was developed by Zimet et al. (1988).

Ethical Consideration

The study received the Ethical Permission f rom the Medical Ethics Committee of University Malaya Medical Center, Malaysia with the reference number MECID No. 20148- 476 on 25th October 2014.

RESULTS

Participants and Procedure

The sample represents different fields of study and ethnic groups, comprising Malay (97.6%), Indian (0.9%), and others (1.5%). Their ages ranged between 21 and 60 years. All respondents completed a questionnaire booklet containing three sections. The majority of the respondents were female (93.3%), while 5.7% were male. The majority of the respondents have a Degree (88.1%), Master (6.6%), or Diploma (5.1%). 36.4% of the respondents have 11 to 20 years of work experience at Malaysian healthcare institutions; 34.6% of respondents have less than 5 years’ work experience; 25.4% have 5 to 10 years work experience; and 3.3% have 21 to 30 years work experience at Malaysian healthcare institutions. Most of the respondents are married (65.1%), 33.4% are single, and 0.9% are divorced. The majority of the respondents work shift work (71.9%), while the rest have office hours (27.2%). 42.4% of the respondents are working 45 to 49 hours per week, 30.1% work between 36 and 44 hours per week, 13.7% work around 50 to 59 hours per week, 9.6% work less than 16 hours a week, and 3% work between 16 and 35 hours weekly (Table 1).

Table 1: Demographic Information of the Sample (N= 335)

To test the hypotheses, SPSS software was employed. Further, IBM SPSS 25 software was utilized to run the analysis. Table 2 shows that a significant and positive relationship was found between job stress and role conflict (r =0.664, p =0.000 <0.01). The results indicated that the increase in job stress led to an increase in role conflict. A significant and negative relationship was found between job stress and social support (r = -0.198, p = 0.000.01), and a negative correlation was found between job stress and life satisfaction (r = -0.131, p = 0.000 < 0.01). The results indicated that increased social support may help reduce job stress among nurses. Additionally, the findings showed that reduced job stress led to increased life satisfaction among nurses. Moreover, there is a positive and significant relationship between social support and life satisfaction (r = 0.222, p = 0.000 < 0.01). The results indicated that increased interest in social support led to an increase in life satisfaction.

Table 2: Correlations between Job Stress, Social Support, Role Conflict, and Life Satisfaction

*P <0.05. **P <0.01.

Dependent Variable: Life Satisfaction

All variables were entered into the regression equation. In step one, job stress entered, and this model was statistically significant (F = 2.861, p < 0.05, R2 = 0.047). In the second step, the interaction between job stress and social support was explored. The model R2 was significantly greater than zero (F = 7.045, p < 0.05, R2 = 0.067). In the third step, the interaction between job stress, social support, and job stress × social support was entered, along with life satisfaction as a dependent variable (F = 7.393, p < 0.05, R2 = 0.091) (Table 3). The results reveal that social support strengthens the relationship between job stress and life satisfaction. It shows that social support plays an important moderating role between nurses’ job stress and life satisfaction. According to these findings, established hypotheses H1, H2, and H3 are supported.

Table 3: Multiple Regression Analysis Testing the Moderating Effects of Social Support on the Relationship Between Job Stress and Life Satisfaction

DISCUSSION

Job Stress and Life Satisfaction among Nurses

The findings of this study show a negative relationship between job stress and life satisfaction among nurses. Furthermore, the results suggest that when job stress increases, there is an expected decrease in life satisfaction. Several studies support this result, including those by Achour et al. (2021), and Baştuğ (2021). Khalil, Ali, and Othman (2024) also found that there was a direct negative relationship between perceived stress levels and life satisfaction levels among nurses. Healthcare workers experience high job stress, contributing to negative health outcomes and poor patient care (Thapa & Pradhan, 2024). Post-COVID-19 outbreaks have increased, posing an unprecedented threat and challenge to public health around the world. Due to a lack of adequate human resources, nurses are required to undertake an increased workload on the clinical frontlines of this epidemic (Zhan et al., 2020).

Baye et al. (2020) suggested that hospital administration and other concerned stakeholders design a strategy and introduce necessary measures to minimise workload, such as hiring more nurses and rescheduling work shifts to alleviate work-related stress among nurses. Ishola, Kenku, and Aroyewun (2018) mentioned that work affects employees’ life fulfilment. When it comes to work that is meaningful and pleasant, it enriches life satisfaction. However, in terms of nursing staff workload, long and unpredictable work hours, as well as challenging work conditions and demands, perpetuate work-family conflict (Awosusi, 2010).

Role Conflict and Life Satisfaction

This study found a negative relationship between role conflict and life satisfaction among nurses in Malaysian healthcare institutions and recommended that for each unit increase in role conflict, there was an expected decrease in the life satisfaction of nurses. Moreover, the results of this research showed that nurses who experienced higher degrees of role conflict reported lower levels of life satisfaction. Role conflict arises due to multiple commitments to different domains of an individual’s life. According to Anicich and Hirsh (2017), employees experiencing demanding job responsibilities, lower productivity, tension, or psychological withdrawal are associated with role conflict. Furthermore, role conflict and job stress have significant effects on employees' performance, increasing absenteeism and turnover. Eventually, stress has a comprehensive effect on an individual’s life (Yunita & Saputra, 2019).

Social Support as Coping Strategies among Nurses

This study empirically evaluated the efficacy of social support as a coping strategy for reducing job stress. Social support is not only important for reducing the symptoms of mental health problems but also helps people adapt to new situations and norms during the pandemic (Kassim & Badayai, 2023). Günüşen, Wilson, and Aksoy (2018) reported that all participants expressed that social support from colleagues made it easier to cope with unfavourable conditions, including stress. The findings show a negative correlation between social support and job stress.

Another cross-sectional study involving 353 nursing professionals from a hospital showed that social support, lack of autonomy at work, hostile relationships with colleagues, and lack of recognition are statistically associated with levels of stress, anxiety, and depression (Assis et al., 2022). Social support helps individuals manage stress more effectively. Nursing students could use coping strategies and social support as tools to minimize the effects of stress (Loureiro et al., 2024). People who feel supported are better able to cope with stress and adapt to changes in their lives (Bry & Wigert, 2022).

The present study also demonstrates a positive correlation between social support and life satisfaction. Chichi (2023) identified that the majority of the nurses experienced severe stress. Zhan et al. (2020) recommended nursing leaders and hospital managers take positive and effective measures to eliminate the sources of nursing work pressures while stabilizing the emotions of their nursing teams. Mo et al. (2020) also reported that nurses involved in COVID-19 control, prevention, and treatment were generally under heightened pressure. They suggested that nursing management, specifically nurse leaders, pay attention to the work stress and influencing factors of nurses fighting against COVID-19 and offer solutions to support their mental health.

Limitations

This study has highlighted the effects of job stress and role conflict on life satisfaction among nurses in Malaysian healthcare institutions, with social support serving as a moderator. However, this study only includes nurses from selected Malaysian healthcare institutions. Extending similar studies to include other Malaysian institutions, such as academic institutions, would enhance their quality and interest.

CONCLUSION

This study investigated the effects of job stress and role conflict on life satisfaction among nurses in Malaysian healthcare institutions, using social support as a moderator. Job stress was found to have a significant and negative effect on life satisfaction among nurses. In other words, high job stress and role conflict were associated with decreased life satisfaction. Job stress and role conflict are considered significant causes and sources of stress for working women, particularly nurses. The current study emphasizes the importance of social support as a moderator in the relationship between job stress and nurses' life satisfaction. Nurses with high social support, compared to those with low support, experienced lower levels of job stress, suggesting that support from family, friends, and colleagues can mitigate daily stress, role conflict, and workloads for nurses.

Based on the results of this study, the authors advise researchers in the future to study the effects of stress on different facets of nursing, like performance, commitment, and family satisfaction. Future research needs to address the use of social support as the best strategy to reduce stress and role conflict, as well as improve nurses' well-being. Healthcare institutions must pay serious attention to the relationships between stress, role conflict, workloads of nurses, and other related constructs, including individual satisfaction. Healthcare institutes should provide nurses with more opportunities to reduce stress levels and balance roles by offering help and greater flexibility.

Recommendation

The present study highlights the importance of social support in reducing the effect of job stress on the life satisfaction of nurses. For this purpose, the following are some recommendations:

Hospital management should organize seminars and workshops to help nurses cope with role conflict and job stress as well as improve their subjective well-being, including life satisfaction. Hospital management should give nurses more flexibility to get social support, especially from managers, family, and close friends. Nurses should receive ongoing training and information to make them aware of their needs and wants. Managers should encourage an open-door system so that nurses can come for help whenever they experience problems.

Conflict of Interest

The authors declare that they have no conflict of interests.

ACKNOWLEDGEMENT

The authors would like to express their sincere gratitude to all the nurses who participated in this research at the University of Malaya Medical Centre (UMMC), Malaysia, for their valuable contributions and cooperation. The authors also express their gratitude to the University of Malaya Medical Centre (UMMC) for granting approval and permission to carry out this study, and for their support and assistance throughout the data collection process. Furthermore, the authors acknowledge the research team members for their efforts in collecting, analyzing, and interpreting the data along with their financial support, English editing expertise, and dedication greatly improved the quality of this research.

REFERENCES

Achour, M., Muhamad, A., Syihab, A. H., Mohd Nor, M. R., & Mohd Yusoff, M. Y. Z. (2021). Prayer moderating job stress among Muslim nursing staff at the University of Malaya Medical Centre (UMMC). Journal of Religion and Health, 60, 202-220. https://doi.org/10.1007/s10943-019-00834

Almazan, J. U., Albougami, A. S., & Alamri, M. S. (2019). Exploring nurses' work-related stress in an acute care hospital in KSA. Journal of Taibah University Medical Sciences, 14(4), 376-382.https://doi.org/10.1016/j.jtumed.2019.04.006

Al-Shehri, M. M., Harazi, N., Alhassani, S., Alshahrani, W. A., Almzmommi, F., Almalki, O. S., & Qusti, S. N. (2023). Prevalence of Work-Related Stress and its Associated Factors among Nursing Staff in King Abdallah Complex at Jeddah City. Journal of Pharmaceutical Research International, 35(31), 27-36. https://doi.org/ 10.9734/jpri/2023/v35i317464

Al-Yaqoubi, S. (2023). Exploring Work-Related Stress and Coping Strategies among Omani Nurses Working in Tertiary Governmental Hospitals at Muscat: A Cross-Sectional Study. Open Journal of Nursing, 13(6), 368-385.https://doi.org/10.4236/ojn.2023.136025

Anicich, E. M., & Hirsh, J. B. (2017). The psychology of middle power: Vertical code- switching, role conflict, and behavioral inhibition. Academy of Management Review, 42(4), 659-682.https://doi.org/10.5465/amr.2016.0002

Assis, B. B. D., Azevedo, C., Moura, C. D. C., Mendes, P. G., Rocha, L. L., Roncalli, A. A.,... & Chianca, T. C. M. (2022). Factors associated with stress, anxiety and depression in nursing professionals in the hospital context. Revista Brasileira de Enfermagem, 75, e20210263.https://doi.org/10.1590/0034-7167-2021-0263

Awosusi, O. (2010). Assessment of quality of working-life of nurses in two tertiary hospitals in Ekiti State, Nigeria. African Research Review, 4(2), 113-124. https://doi.org/ 10.4314/afrrev.v4i2.58295

Azim, M. T., & Islam, M. M. (2018). Social support, religious endorsement, and career commitment: A study on Saudi nurses. Behavioral Sciences, 8(1), 8. https://doi.org/10.3390/bs8010008

Baştuğ, G. (2021). Investigation of life satisfaction and work stress in employees doing office exercise. Progress in Nutrition 2021, 23(1), 1-6. https://doi.org/10.23751/pn.v23iS1.11071

Baye, Y., Demeke, T., Birhan, N., Semahegn, A., & Birhanu, S. (2020). Nurses’ work-related stress and associated factors in governmental hospitals in Harar, Eastern Ethiopia: A cross- sectional study. PLoS One, 15(8), e0236782.https://doi.org/10.1371/journal.pone.0236782

Bry, A., & Wigert, H. (2022). Stress and social support among registered nurses in a level II NICU. Journal of Neonatal Nursing, 28(1), 37-41. https://doi.org/10.1016/j.jnn.2021.03.010

Chichi, C. C. C. (2023). Effect of Work-Related Stress on the Wellbeing of Nurses: A Descriptive Study. EAS Journal of Nursing and Midwifery, 5(5), 140-7. https://doi.org/10.36349/easjnm.2023.v05i05.009

Clark, W. A., Yi, D., & Huang, Y. (2019). Subjective well-being in China’s changing society. Proceedings of the National Academy of Sciences, 116(34), 16799-16804. https://doi.org/ 10.1073/pnas.1902926116

Diener, E. D., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71-75.

https://doi.org/10.1207/s15327752jpa4901_13

Fathi, A., & Simamora, R. H. (2019, March). Investigating nurses’ coping strategies in their workplace as an indicator of quality of nurses’ life in Indonesia: a preliminary study. In IOP conference series: Earth and Environmental Science (Vol. 248, No. 1, p. 012031). IOP Publishing. https://doi.org/10.1088/1755-1315/248/1/012031

Gheshlagh, R. G., Parizad, N., Dalvand, S., Zarei, M., Farajzadeh, M., Karami, M., & Sayehmiri, K. (2017). The prevalence of job stress among nurses in Iran: A meta-analysis study. Nursing and Midwifery Studies, 6(4), 143- 148. https://doi.org/10.4103/nms.nms_33_17

Günüşen, N. P., Wilson, M., & Aksoy, B. (2018). Secondary traumatic stress and burnout among Muslim nurses caring for chronically ill children in a Turkish hospital. Journal of Transcultural Nursing, 29(2), 146-154. https://doi.org/10.1177/1043659616689290

Hamaideh, S., Abu Khait, A., Al Modallal, H., Malak, M., Masa’deh, R., Hamdan-Mansour, A., & AL Bashtawy, M. (2024). Relationships and Predictors of Resilience, Social Support, and Perceived Stress among Undergraduate Nursing Students. The Open Nursing Journal, 18(1).1-10. https://doi.org/10.2174/0118744346238230240103055340

Hu, D., Kong, Y., Li, W., Han, Q., Zhang, X., Zhu, L. X., ... & Zhu, J. (2020). Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinical Medicine, 24, 1-10. https://doi.org/10.1016/j.eclinm.2020.100424

Isanawikrama, I., Hutomo, E. J., & Buana, Y. (2021). Role of Stress to Quitting Intention Between Men and Women Employees in Hotel Industry. Ganaya: Jurnal Ilmu Sosial dan Humaniora, 4(3), 867-889. https://doi.org/10.37329/ganaya.v4i2.1429

Ishola, A. A., Kenku, A. A., & Aroyewun, F. T. (2018). Work-family conflict and demographic variables as co-variants of life satisfaction among nurses from selected healthcare facilities in the ibadan metropolis. International Journal of Caring Sciences, 11(1), 523-528. ttps://www.internationaljournalofcaringsciences.org/docs/60_isola_original_11_1.pdf

Kassim, S. N. F., & Badayai, A. R. A. (2023). Social Support and Coping Strategies as Mediators in The Relationship Between Feeling of Loneliness and Mental Health. International Journal of Academic Research in Business and Social Sciences, 13(6), 1037 – 1055. https://doi.org/10.6007/IJARBSS/v13-i6/17549

Khalil, N. E. M., Ali, S. O., & Othman, H. T. (2024). The Mediating Role of Emotional Intelligence in the Relationship between Perceived Stress and Life Satisfaction among Nursing Intern Students. Assiut Scientific Nursing Journal, 12(41), 97-107. https://doi.org/10.21608/asnj.2024.255771.1737

Kopelman, R. E., Greenhaus, J. H., & Connolly, T. F. (1983). A model of work, family, and interrole conflict: A construct validation study. Organizational Behavior and Human Performance, 32, 198–215. https://doi.org/10.1016/0030-5073(83)90147-2

Loureiro, F., Peças, D., Neves, A. C., & Antunes, A. V. (2024). Coping strategies and social support in nursing students during clinical practice: A scoping review. Nursing Open, 11(2), e2112. https://doi.org/10.1002/nop2.2112

Madadzadeh, M., Barati, H., & Ahmadi Asour, A. (2018). The association between workload and job stress among nurses in Vasei hospital, Sabzevar city, Iran, in 2016. Journal of Occupational Health and Epidemiology, 7(2), 83-89. https://doi.org/10.29252/johe.7.2.83

Marlin Company and the American Institute of Stress, “The Workplace Stress Scale: Attitudes in the American Workplace VII,” 2009 https://www.stress.org/wp- content/uploads/2011/08/2001Attitude-in-the-Workplace-Harris.pdf. Accessed on 6th July, 2022.

Mo, Y., Deng, L., Zhang, L., Lang, Q., Liao, C., Wang, N., Qin, M., & Huang, H. (2020). Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. Journal of Nursing Management, 28(5), 1002-1009.https://doi.org/10.1111/jonm.13014

Nancy, S., Malhotra, P., Munjal, S., Singh, S., Sharma, D., & Gomathi, S. (2024). QWL Existence and its Impact on Psychological Wellbeing among Academicians: Theoretical Perspectives and Literature Review. Migration Letters, 21(S1), 1032-1043. https://migrationletters.com/index.php/ml/article/view/7467

Smits, M. A., Boezeman, E. J., Nieuwenhuijsen, K., De Boer, A. G., Nieveen van Dijkum, E. J., & Eskes, A. M. (2022). Family involvement on nursing wards and the role conflicts experienced by surgical nurses: A multicentre cross‐sectional study. Scandinavian Journal of Caring Sciences, 36(3), 706-716. https://doi.org/10.1111/scs.13032

Tan, J. J., Kraus, M. W., Carpenter, N. C., & Adler, N. E. (2020). The association between objective and subjective socioeconomic status and subjective well-being: A meta-analytic review. Psychological Bulletin, 146(11), 970. https://doi.org/10.1037/bul0000258

Thapa, S., & Pradhan, P. M. S. (2024). Occupational stress and its correlates among healthcare workers of a tertiary level teaching hospital in Kathmandu, Nepal, during COVID-19 pandemic: a cross-sectional study. BMJ Public Health, 2(1), 1-9. https://doi.org/10.1136/bmjph-2023-000126

University of British Columbia. (2021, March 3). High life satisfaction linked to better overall health. ScienceDaily. www.sciencedaily.com/releases/2021/03/210303091405.html. Accessed on 17th July, 2022.

Villacarlos, F. A., & Daño, J. C. (2020). The seven motivational characteristics of clinical nurse managers. Malaysian Journal of Medical Research (MJMR), 4(2), 19-31. https://doi.org/10.31674/mjmr.2020.v04i02.004

Wang, J., Okoli, C. T., He, H., Feng, F., Li, J., Zhuang, L., & Lin, M. (2020). Factors associated with compassion satisfaction, burnout, and secondary traumatic stress among Chinese nurses in tertiary hospitals: A cross-sectional study. International Journal of Nursing Studies, 102, 103472. https://doi.org/10.1016/j.ijnurstu.2019.103472

World Health Organization. (2007). Task Shifting: Rational Redistribution of Tasks among Health Workforce Teams: Global Recommendations and Guidelines. https://iris.who.int/bitstream/handle/10665/43821/9789?sequence=1. Accessed on 12th July 2023.

Yoshioka‐Maeda, K. (2021). Developing sustainable public health care systems for responding to COVID‐19 in Japan. Public Health Nursing, 38(3), 470-472. https://doi.org/10.1111/phn.12861

Yunita, P. I., & Saputra, I. G. N. W. H. (2019). Millennial generation in accepting mutations: Impact on work stress and employee performance. International Journal of Social Sciences and Humanities, 3(1), 102-114. https://doi.org/10.29332/ijssh.v3n1.268

Zhan, Y., Ma, S., Jian, X., Cao, Y., & Zhan, X. (2020). The current situation and influencing factors of job stress among frontline nurses assisting in Wuhan in fighting COVID-19. Frontiers in Public Health, 8, 579866. https://doi.org/10.3389/fpubh.2020.579866

Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30-41. https://doi.org/10.1207/s15327752jpa5201_2