Work-Related Stress and Turnover Intention during Covid-19 among Nurses in Hospital Universiti Sains Malaysia
Authors: Ling Kui Siang , Yusuf Azlina 
Published: November 2022

The outbreak of COVID-19 had significantly impacted the healthcare system, placing it under tremendous strain. Nurses were shown to have suffered the impact of the pandemic, suggested traumatization and estimated a mass turnover intention among nurses globally due to the pandemic [1]. The objective of this cross-sectional study is to assess the prevalence of work-related stress and turnover intention among nurses in the Hospital Universiti Sains Malaysia (Hospital USM). This hospital is a teaching hospital with 830 beds that offers various specialties recognized as Hybrid COVID Hospital in managing patients.

This study utilized multi-stage sampling. The population was stratified into three strata which were, Medical-Surgical wards, Specialty wards (Pediatric, Obstetrics and Gynecology), and Critical Care wards. Next, the wards were selected through a simple random method. The nurses from the selected wards who follow inclusion criteria; nurses with grade U29 or U32 (KUP) with at least one year of working experience [2] were invited to join the study. A total of 365 nurses participated in this study by answering a self-administered questionnaire through Google Forms sent to them. The questionnaire included three parts; Part A sociodemographic data, Part B Nurse Stress Index (NSI) with scoring ranging from 30-150 and Part C Turnover Intention Scale (TIS-6) with a scoring of 9-18[3]. The NSI is categorized into four categories: 30-60= no pressure, 61-90= very little pressure, 91-120= moderate pressure and 121-150=extreme pressure[3]. As for TIS-6, a score <18 indicates a desire to stay whereas ≥18 indicates a desire to leave [3].

The collected data were analyzed using SPSS version 26.0. Sociodemographic characteristics, the prevalence of work-related stress and turnover intention were analyzed descriptively. Pearson correlation test was used to analyze the correlation between work-related stress and turnover intention. Nearly half of the nurses experienced little (40.8%) to moderate (42.5%) level of work-related stress however 73.3% of the nurses reported that they did not have the intention to leave (Table 1 and Table 2). The mean score of work-related stress and turnover intention showed that the nurses were in a moderate level of stress (90.78), with low turnover intention (16.42). Next, the findings showed a significant and positive correlation between work-related stress and turnover intention (r= 0.559, p< 0.001) (Table 3).
This study found that work-related stress was significant among nurses although the data were collected towards the end of the pandemic approaching endemic phase. This could be explained by the uncertainty of the disease which was among the factors that could contribute to stress among frontliners [4]. Although the stress level is significant, the nurses in this study have low intention to leave. This could be possibly due to the job security working in government sector as this study was done in a semi-government hospital where the nurses receives benefits and securities such as salary remuneration and pension scheme[5]. Findings of the study shows a positive correlation between work-related stress and turnover intention. It is known that prolonged stress causes negative impact towards the physical and mental health of nurses, subsequently being the contributing factor towards turnover intention[6].

Nevertheless, this study implies that healthcare personnel should be alert regarding the issues and consequences related to work-related stress and turnover intention. Appropriate strategies or recommendations should be done to improve nurses’ satisfaction and addressing issues related that surround the nursing practice environment to improve the quality of work life among nurses and thus, improve the quality of care delivered and patient safety, thus retaining highly skilled nurses.