Work stress and organizational citizenship behaviors among nurses


Background: Work stress is one of the effective factors responsible for developing physical, mental, and behavioral consequences among nurses. The effect of occupational stress on nurse’s organizational citizenship behaviors (OCBs) has not been fully understood. Thus, this study aimed to assess the relationship between work stress and nurse’s OCB. Materials and Methods: In this descriptive-correlational study, 301 individuals of the personnel of the hospitals of Tabriz were recruited by stratified systematic random sampling. Instruments for gathering data were the Nurses Stress Scale and OCBs Questionnaire. Data were analyzed by the SPSS version 23 software using descriptive analysis and Pearson correlation coefficient tests. Results: Most of the nurses were highly stressed in work, having a significant association with sex and type of employment. Furthermore, work stress had a negative correlation with age and work experience. Nurses’ level of OCB was high and had a significant association with type of hospital, ward of service, organizational position, and type of employment. In addition, OCB had a positive correlation with age, work experience, and salary. There was no significant association between nurse’s stress at work and OCB. Conclusion: According to results, nurses were highly stressed. Thus, educating hospital managers regarding the features of work stress is essential. Furthermore, establishing appropriate educational workshops in the field of OCB for improving work condition and organizational efficiency among the personnel is a vital manner.

Keywords: Nurse, organizational citizenship behaviors, work stress

How to cite this article:
Agheli R, Roshangar F, Parvan K, Sarbakhsh P, Shafeh S. Work stress and organizational citizenship behaviors among nurses. Ann Trop Med Public Health 2017;10:1453-9


How to cite this URL:
Agheli R, Roshangar F, Parvan K, Sarbakhsh P, Shafeh S. Work stress and organizational citizenship behaviors among nurses. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Sep 24];10:1453-9. Available from:



Work stress is one of the most common and costly challenges in the workplace affecting practically everybody.[1] After backache, it is the second common difficulty related to work among nurses.[2],[3] According to Karasek’s job demands, control model, occupational stress occurs when psychological demand for work is high and control or decision-making is weak. This issue appears widely in stressful jobs. Nursing is an example of highly stressed jobs. The main reason is high psychological demand and low decision-making power.[4] In one study, 93% of nurses were exposed to workplace stressors which had a significant effect on their physical and mental health.[5] According to the American National Institutes of Health survey on 130 jobs, nurse’s referral to physicians for psychological health issues was rated 27.[6] The main factors linked with workplace stressors are uncertainty of duties, managers lack of support, lack of control on workplace, lack of cooperation with other healthcare team members,[7] high workload,[7],[8] encountering critically ill patients and witnessing their death, having conflict with physicians,[9] lack of reward and encouragement, professional conflict,[10] lack of facilities in unit, working with the opposite sex,[11] and invasive and aggressive behaviors.[8] Results of several research indicate that work stress and physical and mental deterioration lead to disruption of health, work-like conflicts, dissatisfaction and work hassle, contention between coworkers and changing service location, decline in the quality of nursing care, and decrease in performing duties among nurses.[12] The effects of stress on behavioral substances are as follows: disruption of concentration and decision-making, lack of motivation, augment of job errors, and having conflict with coworkers.[13] In the psychological perception, anxiety, insomnia, and depression are observed.[14] Severe stress changes the level of few hormones and neuropeptides such as epinephrine, norepinephrine, histamine, and cortisol. These changes have a great impact on flexibility, physical and psychological injuries, and performance.[15]

In general, staff behavior is classified into in-role and extra-role behaviors.[16] In-role behaviors are the official job duties, but extra-role behaviors are beyond official job duties and consist of volunteer, positive, autonomic, and altruistic behaviors for being helpful to the organization and members.[17] In 1983, Organ et al. initially introduced the phrase organizational citizenship behaviors (OCBs), and then, Barroso Castro et al. and Katz expanded it in later studies.[18] OCB consists of voluntary behaviors, in other words, actions beyond official duties. These behaviors are not rewarded by the organization but enhance its total effectiveness.[19]

In respect to OCB, the elements that have been earned great attention among researchers are sportsmanship, conscientiousness, altruism, civic virtue, and courtesy. In 1988, Organ proposed these five elements, and in 1990, Podsakoff et al. developed a standard measuring scale with the help of factor analysis for each of these five elements.[19],[20] According to findings, organizations that have staff with appropriate citizenship behaviors can function better.[21],[22] OCB effects inner and outer organizational factors and enhances staff’s performance quality and organizational function. Inner organization factors are job satisfaction, decrease in absence days and job destructive behaviors, increase of organizational commitment, decline of the intention to leave work, and improving organization atmosphere and spirit. Outer organization factors are quality of services, loyalty of customers, and customer satisfaction.[18] Kyung’s study revealed a direct relationship between group characteristics such as number of nurses, collective efficiency, salary, and OCB.[23] Organ and Konovsky, Podsakoff et al., Ackfeldt and Coote reported positive association between work perception and OCB.[21],[24],[25] In an analysis of 22 studies on 7000 subjects, Lepine et al. showed a positive relationship between OCB and quality of work life and job satisfaction.[26]

According to previous studies, only few job stressors and their effect on physical, behavioral, and psychological perspectives have been estimated among nurses and research has been done on few of the factors effective on OCB. Nonetheless, less study has been undertaken on the effect of work stress on nurses OCB. Reviewing the studies accomplished in Iran reveled no such study. Thus, the objective of this study was to assess the relationship between work stress and OCB.

Materials and Methods

This descriptive correlational study was accomplished in 2017 among male and female nurses working in educational-therapeutic units of cities located in the northeast of Iran. Nurses had at least 1-year clinical work experience and did not have any history of psychological distress, hospitalization in mental hospitals, or using psychotherapy medications. Based on a pilot study on thirty subjects, with a 0.05 type I error and 90% testing power, the sample size was calculated as 165. In this study, the sample size was enhanced to 300 subjects. After obtaining permission from the Ethics Committee (No: TBZMED. REC.1394.1020) and the Research Deputy of Tabriz University of Medical Sciences, sampling was done by stratified systematic random sampling.

After preparing a list of all the nurses of the hospitals, randomized sampling was administered to recruit nurses from each hospital in proportionate to its nurses. Data were gathered by a sociodemographic questionnaire, Nurses Stress Scale, and OCB questionnaire. For measuring nurses’ work stress, we used the Toft and Andersone’s questionnaire designed in 1981. This questionnaire consists of 34 questions and seven subscales including facing death and dying, conflicts with physicians, inadequate preparation to meet emotional needs of patients and their families, lack of support, conflicts with other nurses and supervisors, labor standards, and uncertainty concerning treatment. Scoring was from 0 (never) to 3 (severe stress) according to the Likert scale. Scores ≤39 were indicated as mild stress, scores between 40 and 62 implied moderate stress, and scores ≥63 as severe stress. The questionnaire was translated forward-backward. After consulting with 10 bilingual experts about language and cultural adaptation, the instrument’s validity was assessed. Furthermore, by accomplishing a pilot study, the instruments reliability was confirmed with an 85% alpha Cronbach’s scale.

For assessing nurses’ OCB, we used Podsakoff et al. questionnaire designed in 1990. This questionnaire consists of 24 questions and five dimensions including sportsmanship, conscientiousness, altruism, civic virtue, and courtesy. For responding to questions, we used the 7-point linear Likert scale and each item was scored from 1 (strongly agree) to 7 (strongly disagree). This instrument was also translated forward-backward. After consulting with ten bilingual experts about language and cultural adaptation, the instrument’s validity was assessed. Furthermore, by accomplishing a pilot study, the instrument’s reliability was confirmed with an 82% alpha Cronbach’s scale.

After gathering all the information, data were analyzed by the SPSS version 23 software (SPSS version 13). Descriptive analysis was used for measuring frequency, mean, and standard deviation. Furthermore, for assessing the relationships between variables, the Pearson correlation coefficient and regression (adjusting cofounders) were used. The independent t-test and variance analysis were used for assessing the differences of study variables according to demographic variables.


The findings of this research are depicted in [Table 1]. According to [Table 2], the mean score of all the items of work stress was above 1.5, indicating nurses’ high stress in work. 11.3% of nurses had mild stress, 28.6% had moderates stress, and 60.1% were severely stressed. In addition, the mean score of all the items of OCB was above 4, meaning that nurses had high OCBs.

Table 1: Frequency distribution of demographic variables

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Table 2: Mean and SD of the items of the Nurse’s work stress and Organizational citizenship behaviors questionnaires

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For assessing the relationship between nurse’s work stress and OCB we used the Pearson correlation coefficient test. According to [Table 3], there was a positive significant association between death and dying and Sportsmanship. Also there was a negative association between lack of staff support and Sportsmanship. This means that lack of support from managers and co-workers, declines Sportsmanship among nurses.

Table 3: Correlation Coefficient between Nurse’s work stress and OCB

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There was a significant negative association between lack of staff support and Courtesy. In other words, not having enough staff support, decreases Courtesy. In other words, not having enough support, decreases civic virtue. The Pearson correlation coefficient between nurse’s work stress and OCB was measured as 0.005 which indicated no significant association between nurse’s stress in work and OCB.

Based on [Table 4], since all the variables had a < 0.05, none of the variables of work stress, sex, work experience, and age were considered as predictors of OCB.

Table 4: Summary of Regression Analysis

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The results of this study indicate higher work stress among women in comparison to men. These findings are in parallel with Angela Decarla, Strike, and Bahrami et al. studies [6],[27],[28] and inconsistent with Khaghanizadeh et al.’s study.[29] Despite work liability, women’s housing and children responsibility are probably the main reason of their high stress in work.[30] A study by Strike regarding men’s engagement to work revealed that men tend to occupy themselves with work and other amusements than overwhelming stress.[28] Allen believes that men’s OCB is higher than women.[31] Nevertheless, Kidder and Parks and Organ believe that women have higher OCB.[19],[32] Podsakoff et al. did not declare confidently about the relationship between sex and OCB in their comprehensive review studies, this is mainly due to the lack of research in this era.[21] Similar to Dehghani et al.’s study, the results of this study indicate that there are no statistically significant differences in OCB between men and women.[33] Similar to the studies of Angela and Bahrami, the findings of our study revealed no significant association between nurse’s marital status and stress in work.[6],[27] However, in Khaghanizadeh’s study, single individuals had higher stress than married ones. This is mainly because of higher expectations from family, society, and workplace for single individuals. This feature leads to more work hours and workload. Thus, they might not be responsive to the abundant expectations.[29] Married nurses are enthusiastic and share work stress with their spouse thus endure less stress in work.[6] Similar to Dehghani et al.’s study, there was no statistically significant association between marital status and OCB.[33] Results indicate that nurses’ stress in work declines with aging and gaining work experience. These findings are similar to Demir et al., Yada, and Khaghanizadeh et al. studies [29],[34],[35] but contradict that of Bahrami et al.’s study.[6] It seems that aging and gaining work experience enhances nurse’s readiness for encountering stressful situations and work tensions are overwhelmed.[34] In addition, similar to Altuntas and Baykal, Kyung and Dehghani studies, we observed that OCB increases with aging and gaining experience in work.[23],[33],[36] Miao believes that people with different ages have different OCB.[37] Parallel to Bahrami et al.’s study, this study showed that work stress was not significantly different based on the type of hospital and ward of service.[6] Nonetheless, Foxall et al. believe that the feature of work stress is different in different units [38] and Haq et al. say that excessive workload is responsible for high stress in work.[11] In this study, nurse’s OCB was statistically dissimilar in different hospitals and units. Lowest OCB was observed in two hospitals where burning and psychological patients were treated and highest amounts were observed among two specialized eye hospitals. In Bolon’s study, OCB was different among individuals in different units as well.[39] Perhaps, this difference is because performing OCB is partially dependent on how much the staff of an organization believes that they are treated fairly.[40] According to Kyung, the OCB variables are job position, supervisor’s support, number of nurses in one nursing unite, and mean salary of one nursing unite.[23] Altuntas and Baykal proposed that organizations and job satisfaction are efficient factors of OCB.[36] Chu says that workload has a direct effect on nurse’s OCB.[41] Assessing nurses according to organizational position, it was observed that trainers had higher stress; however, this difference was not statistically significant. Roos claims that individuals with the least position in organizational hierarchy are more stressed due to limited partnership in decision-makings.[30] In Khaghanizadeh et al.’s study as well, supervisors had less stress than other nurses.[29] In this study, matrons significantly had higher OCB than the other nurses. Altuntas and Baykal and Kyung reported that having stressed job position is an effective factor on OCB.[23],[36] In organizations, people with higher job position tend to have higher organizational commitment in comparison to people who have lower job positions. This is mainly because stronger position authorizes individuals to have an impact on organizational decisions. In general, those with higher authority are free to centralize their behaviors on work. In regard to education, similar to Bahrami and Khaghanizadeh studies, there was statistically significant difference in nurse’s stress in work.[6],[29] However, beyond organizational settings, people’s socioeconomic image and reputation as stress work factors are measured by salary and level of education. People with lower socioeconomic image and reputation experience higher mental pressure.[29] In this study, nurse’s education had no effect on OCB which were inconsistent with the findings of Chu and Dehghani.[33],[41] In Chu et al.’s study, education level had a significant effect on OCB [41] and Dehghani et al. reported that higher education level diminishes OCB because people with lower educational level need to have higher OCB to preserve their job position and also have promotions.[33] There were no statistically significant differences between nurse’s shift and work stress and/or OCB. However, Khaghanizadeh et al. reported that night shift is an effective factor in disposing stress among staff in hospitals.[29] Night shifts disturb the circadian rhythm and thus deteriorate daily activity and nurse’s efficiency [11] and fasten job breakout.[34] In Altuntas and Baykal study, work shift is defined as an effective factor on OCB.[36] According to Dehghani et al.’s study, OCB was significantly different among nurses of different shifts.[33] There were also significant differences regarding type of employment. In respect to stress in work, the highest scores were for apprentice, contractual, official, and corporative nurses. In Dehghani et al.’s study, there was a significant association between OCB and type of employment.[33] Work satisfaction is implied as an efficient factor on nurse’s OCB.[36],[37],[39] In a study in China, there was a significant relationship between work satisfaction and OCB.[37] Factors such as salary, reward, job security, workload, and organizational justice have significant impact on job satisfaction and differ between types of employments.[33] Perception of organizational support and organizational justice enhances nurses OCB.[42] In this study, since the official staff had higher salary, job security, and job satisfaction than the corporative staff, they showed higher OCB. Furthermore, in regard to work stress, because apprentices had recently been doing clinical work at hospitals, they show higher stress than the official staff. In this study, there was a significant direct association between salary adequacy and nurse’s OCB. Kyung indicated a direct association between nurse’s salary and OCB.[23] There was an inverse insignificant association between salary adequacy and nurses’ stress in work. Salary and reward are efficient factors on work satisfaction.[33] The results of a meta-analysis reviewing 48 studies on 15,000 nurses indicated that work satisfaction has a strong relationship with reducing stress.[43] In parallel to few studies, nurses’ stress in work was significantly high,[44],[45] but in other studies, nurses’ stress in work was moderate.[46],[47] Similar to several studies, nurses’ OCB was tremendously high.[42],[48] The Pearson correlation coefficient between work stress and OCB was calculated as 0.005 indicating no significant association between work stress and OCB. The highest score obtained among the seven dimensions of work stress was for death and dying. In Greenfield et al.’s study, providing clinical practice and encountering dying patients are among the stressors.[49] In concordance to Yun et al. and Salimi et al. studies, conscientiousness or work ethic earned the highest score for OCB.[50],[51] Thus, since the health personnel’s job is interacted with human health, work ethic is highly important.[51] Ansari et al. believe that there is no significant direct relationship between stress in work and OCB. However, work stress by having an indirect effect on job satisfaction and organizational commitment has an impact on OCB.[52] Job satisfaction is an effective factor on OCB.[36],[37],[39] In a study by Zerat on the academic staff of Urmia University of Medical Sciences, a negative significant relationship was observed between work stress and OCB.[53] Chu believes stress effects organizational commitment which in turn effects nurses’ OCB. Furthermore, ambiguity in nurse’s role and workload has a direct effect on nurse’s OCB.[41] Li et al. confirmed a significant negative correlation between work stress and psychological and organizational ability among nurses.[54]


Nursing has been represented as an occupation fraught with stress. The results of this study provide evidences that nurses are highly stressed at work. Based on the negative association between work stress and job satisfaction, we can imply that the personnel who have adequate job satisfaction and are committed to their organization tend to be more involved in OCB. Subsequently, satisfaction and commitment induced the staff to have actions in regards or negatively to the aims and preferences of the organization. With a relative increase in satisfaction and commitment, a considerable amount is articulated as OCB.[53]

According to studies, organizations who have better staff citizenship behaviors have higher functionality.[21],[22] In relation to the significance of human resources in fulfilling the objectives of health organizations, considering the effective factors on cognition and behavioral variables of the staff is essential. Thus, efficient planning in the event of reducing nurses’ job stressors and accomplishing the perspectives of OCB by holding sufficient educational courses and workshops among staff could have a significant effect on invigorating job satisfaction, trust, function, and efficiency of the organization.

Restriction of the statistical population to nurses of public hospitals and not using validated clinical measuring methods such as interviewing are few of the limitations of this study.


This article was written based on a dataset of MSc., with the financial support of Tabriz University of Medical Sciences. We would like to gratitude the managers, hospitals, and nurses who kindly facilitated the performance of this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.



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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_272_17


[Table 1], [Table 2], [Table 3], [Table 4]

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