Post on 23-Jan-2023
LINKING PERSONAL BULLYING WITH NURSING STAFF TURNOVER INTENTIONS:
A MIXED METHODS STUDY OF PUBLIC SECTOR HOSPITALS IN PAKISTAN
BY
ASIF SHAHZAD
ENROLLMENT NO. 01-280122-004
SUPERVISOR: Dr. ABDUL SATTAR
A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENT FOR DEGREE OF
DOCTOR OF PHILOSOPHY
IN MANAGEMENT SCIENCES
TO
FACULTY OF MANAGEMENT SCIENCES
BAHRIA UNIVERSITY, ISLAMABAD
2018
i
BAHRIA UNIVERSITY, ISLAMABAD
APPROVAL SHEET
SUBMISSION OF HIGHER RESEARCH DEGREE THESIS
Candidate’s Name: Asif Shahzad
Discipline: Management Sciences
Faculty/Department: Management Sciences
I hereby certify that the above candidate’s work, including the thesis, has been completed to my
satisfaction and that the thesis is in a format and of an editorial standard recognized by the
faculty/department as appropriate for examination.
Signature(s): Principal Supervisor: _____________________
Date: _____________________
The undersigned certify that:
1. The candidate presented at a pre-completion seminar, an overview and synthesis
of major findings of the thesis, and that the research is of a standard and extent
appropriate for submission as a thesis.
2. I have checked the candidate’s thesis and its scope, format; editorial standards are
recognized by the faculty/department as appropriate.
Signature(s): Dean/Head of Faculty/Department:
Date:
iii
Dedication
First, I dedicate this thesis to my wife (Mariam) and daughters (Khadeeja and Haleema) for their
continuous encouragement, patience, prayers and help throughout my PhD journey.
Second, I dedicate this thesis to my late father (Mohammad Akhtar) and mother (Tahira Jabeen).
Their prayers were always with me throughout my PhD journey.
Last but not the least I dedicate this thesis to my sister (Mahjabeen/Guria) and brothers Khurram
Shahzad and Hassan Shahzad for their kind support, prayers and help.
iv
ACKNOWLEDGEMENT
First, I am very thankful to Allah Almighty for His Blessings upon me. I am thankful to
my research supervisor Dr. Abdul Sattar, who has been very kind and supportive throughout my
research work. This study would never have been finalized without his valuable efforts, guidance
and inputs. I would like to extend my thanks to my co-supervisor Dr. Riaz Ahmed. His research
skills and expert guidance put me on the right track and always motivated me to meet the
deadlines. He always tried his level best to provide me honest feedback about my work and
always helped and guided me whenever I needed it. I thank to my supervisor and co-supervisor
for their dedication, kind guidance and support. I would also like to thank to Professor Tanvir
Ahmed for guiding me about data analysis techniques. He taught me statistics and mathematics
during PhD journey. He has always been supportive throughout my thesis.
I would also like to thank Dr. Omer Farooq Malik for his kind help, advice and
continuous encouragement throughout my research work. Dr. Omer Malik particularly guided
me in quantitative data analysis phase. PLS-SEM analysis would not have been possible for me
to perform without his kind guidance and support. I would also like to thank Dr. Zahid Mahmood
for his encouragement, support and help. Dr. Mahmood guided me in the initial phase of my
research work particularly in the selection of studied variables and literature review part. In
preset study, data collection part was very challenging, I particularly thankful to the participants
of the study, who co-operated with me in data collection phase. Last but not the least, I thank to
all those people who helped me directly or indirectly throughout my PhD journey including
(faculty members, library staff, administrative staff, class fellows, and colleagues).
v
Plagiarism Undertaking
I, solemnly declare that research work presented in the thesis titled “linking personal
bullying with nursing staff turnover intentions: A mixed methods study of public sector hospitals
in Pakistan” is solely my research work with no significant contribution from any other person.
Small contribution / help wherever taken has been duly acknowledged and that complete thesis
has been written by me.
I understand the zero tolerance policy of the HEC and Bahria University towards
plagiarism. Therefore, I as an author of the above titled thesis declare that no portion of my
thesis has been plagiarized and any material used as reference is properly referred / cited.
I undertake that if I am found guilty of any formal plagiarism in the above titled thesis
even after award of PhD degree, the university reserves the right to withdraw / revoke my PhD
degree and that HEC and the university has the right to publish my name on the HEC /
University website on which names of scholars are placed who submitted plagiarized thesis.
Scholar / Author’s sign: _____________________
Name of the Scholar: _____________________
vi
Publications
Shahzad, A., & Malik, R. (2014). Workplace violence: An extensive issue for nurses in
Pakistan—A qualitative investigation. Journal of Interpersonal Violence , 29, 2021-2034.
Malik, F.0., Sattar, A., Shahzad, A., & Faiz, R. (2017). Personal Bullying and Nurses’ Turnover
Intentions in Pakistan: A Mixed Methods Study. Journal of Interpersonal Violence .
vii
ABSTRACT
The most important objective of the present research study was to test the relationship
between personal bullying (PB) incidents and nursing staff turnover intentions (TI) in the major
public sector hospitals of Pakistan. In addition, the role of job stress (JS) as mediating and
political skill (PS) as moderating variable were also assessed in the present study. In present
study, we used explanatory sequential mixed methods research design. Explanatory sequential
research has two phases, quantitative followed by qualitative. In Phase 1, data was collected
from 324 nurses through questionnaire and model was tested using Partial Least Squares (PLS).
In phase 2, for qualitative part, 11 nurses were interviewed so that they can explain results in
more detail. Results from the quantitative survey and qualitative part showed that there is a
significant positive association between personal bullying and nursing staff turnover intentions
and the link between personal bullying and turnover intentions was partially mediated by job
stress. Furthermore, political skill (PS) weakens the relationship between personal bullying (PB)
and job stress (JS). The most important limitations of the present study were the sample used,
which was from six public sector hospitals of Islamabad/Rawalpindi area. The present study is
the first to use a sequential explanatory mixed methods design to assess the mediating role of job
stress (JS) as well as to examine the moderating effect of political skill between personal
bullying and job stress linkage.
KEYWORDS: Sequential explanatory, personal bullying, moderation, job stress.
viii
Table of Contents
Dedication iii
Acknowledgement iv
Plagiarism Undertaking v
Abstract vii
List of Tables xii
List of Figures xiv
List of Abbreviations xv
List of Symbols xvii
Chapter 1: Introduction
1.1 Background of the study 1
1.2 Problem Statement 14
1.3 Research Questions 17
1.4 Research Objectives 17
1.5 Significance of the study 18
1.6 Organization of the study 20
Chapter 2: Literature Review
2.1 Personal Bullying 21
2.1.1 Bullying Models 22
2.1.2 Bullying as a process 24
Publications vi
ix
2.2 Turnover Intentions 27
2.2.1 Personal bullying and turnover intentions 31
2.3 Job Stress 33
2.3.1 Personal bullying and job stress 37
2.3.2 Job stress and turnover intentions 38
2.3.3 Mediating role of job stress 40
2.4 Political Skills 43
Chapter 3: Methodology
3.1 Research design 55
3.2 Research paradigm 57
3.3 Sampling plan 58
3.4 Quantitative data analysis 59
3.5 Structure equation modeling 60
3.5.1 Measurement model 62
3.5.2 Internal consistency reliability 62
3.5.3 Indicator reliability 63
3.5.4 Convergent reliability 63
3.5.5 Discriminant reliability 63
3.6 Evaluation of structural model 65
3.6.1 Coefficient of determination 65
3.6.2 Effect size 65
3.6.3 Path coefficients 65
x
3.6.4 Predictive relevance 66
3.7 Evaluation of multivariate assumptions 68
3.7.1 Multivariate outliers 68
3.7.2 Missing values 68
3.7.3 Normality test 69
3.8 Measures 69
3.8.1 Personal bullying 69
3.8.2 Turnover intentions 70
3.8.3 Political skill 70
3.8.4 Job stress 70
3.8.5 Controllable variables 70
3.9 Qualitative phase 71
3.10 Research ethics 72
Chapter 4: Results
4.1 Respondent Profile 73
4.2 Descriptive statistics 75
4.3 Structure equation modeling 77
4.3.1 Measurement model 77
4.3.2 Structural model 81
4.4 Qualitative phase 93
4.4.1 Qualitative findings 94
4.4.2 Interview Questions 99
xi
Chapter 5: Conclusion
5.1 Theoretical implications 121
5.2 Practical implications 124
5.3 Limitations 128
5.4 Future Research 129
5.5 Conclusion 130
References 131
Appendix 1: Quantitative Questionnaire 143
Appendix 2: PLS-SEM Outputs 149
Appendix 3: NVIVO Outputs 154
Appendix 4: Latent Variable Scores 157
Appendix 5: Sample Loadings 162
Appendix 6: Graphical Representation 169
Appendix 7: Plagiarism Report 173
xii
List of Tables
Table 2.1 Hypothesis of studies 49
Table 2.2 Operational definitions 50
Table 3.1 Features of reflective measurement model 62
Table 3.2 Main guidelines of reflective measurement model 64
Table 3.3 Guiding principles summary for structural model 67
Table 4.1 The main characteristics of sample 74
Table 4.2 Mean, Standard deviation, Skewness, and Kurtosis 76
Table 4.3 Results summary for reflective measurement model 78
Table 4.4 Heterotrait-Monotrait Ratio (HTMT) 79
Table 4.5 Fornell-Larcker test for discriminant validity 80
Table 4.6 Cross loadings 81
Table 4.7 Collinearity Assessment 82
Table 4.8 Results of main effect model 83
Table 4.9 Bootstrapping results of indirect effect 85
Table 4.10 Results of PLS-SEM Moderation model 86
Table 4.11 Effect size and predictive relevance of mediating variable 89
Table 4.12 Effect size and predictive relevance of moderating variable 90
Table 4.13 Conditional indirect effects 91
Table 4.14 Decision about hypothesis 92
Table 4.15 The main characteristics of sample 98
Table 4.16 The interview schedule 100
xiv
List of Figures
Figure 2.1 Theoretical framework 48
Figure 2.2 Process model of work stress 52
Figure 4.1 A main effect model 84
Figure 4.2 Interaction effect model 87
Figure 4.3 Interaction diagram 88
Figure 4.4 NVIVO Model 106
xv
List of Abbreviations
PLS Partial Least Squares
WHO World Health Organization
S-EXN-D Sequential-explanatory design
S-EXR-D Sequential-exploratory design
C-T-D Concurrent-triangulation design
C-E-D Concurrent-embedded design
S-T-D Sequential-transformative design
C-T-D Concurrent-transformative design
QUAN Quantitative
Qual Qualitative
TOQ Thinking of quitting
ITL Intention to leave
SFNJ Searching for new job
PMWS Process model of work stress
COR Conversation of resource
IV Independent Variable
DV Dependent Variable
MV Mediating variable
Mod Moderating variable
CV Controllable variable
xvi
SEM Structural equation modeling
MAV Multivariate analytical technique
MR Multiple regression
CB-SEM Covariance based structural equation modeling
VB Variance-based
RMM Reflective measurement models
ICR Internal consistency reliability
CR Composite reliability
AVE Average variance extracted
COD Coefficient of Determination
PC Path coefficients
OLS Ordinary least squares
NAQR Negative Acts Questionnaire-Revised
M Mean
SD Standard deviation
HTMT Heterotrait-Monotrait Ratio
VIF Variance Inflation factor
xvii
List of Symbols
α0 Intercept
α1 Slope
βo Intercept
β1 Slope
β2 Slope
β3 Slope
γ0 Intercept
γ1 Slope
γ2 Slope
e1 Disturbance term
e3 Disturbance term
e3 Disturbance term
f 2 Effect sizes
Q2 Predictive relevance
α Reliability
< Less than
> Greater than
1
CHAPTER 1: INTRODUCTION OF THE STUDY
This chapter starts with a background of the problem. In background, scholar discussed the
problem in detail as well as provided the reasons and outcomes of the problem. In introduction
chapter, scholar presented problem statement (PS), research questions, and research objectives of
the study. After that, significance of the study was discussed. Finally, at the end the structure of
thesis was presented along with a brief/short explanation of each chapter.
1.1 Background of the study
Turnover is a serious problem at workplace settings and it’s a global issue (Shaw, Delery,
Jenkins, & Gupta, 1998). Turnover is not only serious from individual and organizational
perspectives, but also critical from industry perspectives (Shaw, Delery, Jenkins, & Gupta,
1998). Over time, mostly organizations invest much resource in their staff members (Lee &
Mitchell, 1994). As discussed earlier, turnover affects direct costs (e.g., advertising, selecting
new employees) and indirect costs (e.g., low morale, high anxiety and low work performance) to
organizations (Mobley, 1982; Staw, 1980). In view of Waldman, Kelly, and Arora (2004) the
total cost for a newly recruited nurse averaged $15,825 and the cost of low efficiency ranged
from $5,245 to $16,102. A high turnover intention affects the overall motivation and morale of
nursing staff and as a result their ability to meet patient needs and to provide quality service
(Hayes, et al., 2006; Whitman, Kim, Davidson, Wolf, & Wang, 2002). Due to high turnover the
organization not only loses competent employee but also it has to spend much time and resources
in the recruitment and selection of new employee (Staw, 1980). Organizations now taking the
2
problem of turnover seriously and giving much attention is for the reason that turnover have
some severe consequences on organizations (Shaw, Delery, Jenkins, & Gupta, 1998). Generally,
turnover intention is one of the major antecedents of actual turnover (Begley, 1998) which is a
major issue for many organizations (Cascio, 1987; Waldman, Kelly, & Arora, 2004). In view of
Ajzen (1991) attitudes lead towards behaviors. Turnover intention is defined as when employees
think to quit the job (Tett & Meyer, 1993). It’s an attitude, when employees actually leave the
job then it will become a behavior. In present study our focus was on turnover intention.
Health care organizations also have to face the problem of nurse’s turnover (Gray & Phillips,
1996; Hayes, et al., 2006). There are many negative consequences of nurse’s turnover. Nursing
staff turnover effects negatively on the remaining staff to meet up patient requirements and also
to provide quality care (Grey & Phillips, 1996; Hayes et al., 2006). It was observed that the
turnover of nurses may lead to insufficient staffing, as a result low motivation and low morale
puts extra pressure on the ‘stayers’ due to increased work load. Severe consequences were
observed in the behavior of nurses which results in high anxiety, less work enjoyment and finally
think to quit the organization (Hayes, et al., 2006). Moreover, in view of Rothrock, (2007)
chances of mistakes are increased when organizations don’t have skillful staff members.
Similarly, patient’s satisfaction level is also reduced in absence of experienced staff.
Similarly, a turnover intention of nurses is a major problem in public sector hospitals in
Pakistan (Shahzad & Malik, 2014). According to the Economic Survey 2014-15, the total
population of Pakistan is about 191.71 million and there are 90,276 registered nurses available.
Pakistan like other developing countries is facing a challenge of human resource. The number of
staff is very less as compared to its population. The standard of providing quality service in
3
Pakistan is not satisfactory and patients are not fully satisfied (WHO, 2010). If we compare the
health sector of Pakistan with other countries health services so surprisingly in Pakistan the
nursing staff is very low in numbers as compared to other countries. Pakistan is not concentrating
and not making proper strategies to meet the needs of patients and to compete with world class
competition. There is a need to improve the number of nursing staff and at the same time to
improve the skills of nursing staff so they can provide better services to the patients.
A large number of nurses are leaving Pakistan and going to developed countries (WHO,
2010). Many capable and competent nurses left Pakistan and went to developed countries
because they were not satisfied with the working environment of public sector hospitals in
Pakistan (WHO, 2010). Many nurses from Pakistan are working abroad due to lack of respect,
low salaries and were not satisfied with the working environment (Shahzad & Malik, 2014).
According to WHO (2010) in earlier times in Pakistan that was in 1947 there were only 350
registered nurses and there was a serious scarcity of nurses in Pakistan for which first nurse’s
school was found in 1948 by the name of Gangaram hospital in Lahore. In 1973 Pakistan
Nursing Council came to existence for governing the issues related to nurses. Pakistan’s public
sector hospitals are seriously required to embark upon this problem, because in Pakistan the
number of hospitals and nurses is awfully less in contrast to its populace. It is important that
nurses may do their work without fear which will encourage young females adhere to this
profession and be proud of it.
There are many significant reasons of shortage of nursing in Pakistan. The main reason is
that Pakistani society gives less respect to this profession. The status of nursing job is considered
very low in Pakistan. Moreover, sometimes people misbehave with nurses. It was observed that
4
people bully nursing staff on minor issues. The working conditions are not satisfactory so
females sometimes reluctant to work as a nurse. Generally, nursing job is not considered an
impressive job and as people show less respect towards nursing staff (Lee & Saeed, 2001).
Nurses have less power, autonomy, and respect in the organizational settings (Lee & Saeed,
2001). It is important that nurses may do their work without fear and anxiety which will
encourage other young females to come and join this profession and work confidently and be
proud of it.
Many reasons of nurse’s turnover intentions have been discussed in previous studies, for
example, in view of Tai, Bame, and Robinson (1998) age, job satisfaction, and supervisor’s
behavior was the main predictors of turnover intentions. Similarly, Yin and Yang (2002)
reported that internal environmental factors such as stress and fear resulting from shortage of
staff. Furthermore, in view of Shaw, Delery, Jenkins, and Gupta (1998) pay, nature of work, and
electronic monitoring were the reasons of turnover intentions. It is also important and noteworthy
that employees leave the organization because they have been bullied at workplace (Einarsen &
Hoel, 2001). For example, in a UK-based study, approximately 25% of employees left and
quitted from their jobs because they were being bullied (Rayner, 1997). Numerous researchers
reported that bullying was one of the significant reasons of nurse’s turnover (Ahmed, 2012;
Quine, 2001).
Workplace bullying was explored as a significant reason for nursing staff turnover intentions
(Simons, 2008; Djurkovic, McCormack, & Casimir, 2008). Most of the time nursing staff
decides to quit the job because they face aggression at workplace (Johnson, 2009). Personal
5
bullying is a major stressor for nurses because nurses have to interact with people so there are
more chances of facing bullying incidents. Nurses face more aggression as compared to other
staff members (Houshmand, O’Reilly, Robinson, & Wolff, 2012). Similarly, it was observed in
Pakistan, that nurses think to leave the nursing profession when they experience abusive
behaviors.
Einarsen and Hoel (2001) discussed two main types of bullying behaviors: personal bullying
and work-related bullying. The work related bullying includes many aggressive behaviors such
as unnecessary monitor the work of staff, setting unmanageable deadlines, or not involving the
staff in main tasks. On the other hand personal bullying includes aggressive behaviors such as
verbal abuse, yelling, teasing, and constant criticism. Personal bullying related acts are very
common in the public sector hospitals in Pakistan and nurses face such acts frequently in
Pakistan (Shahzad & Malik, 2014). Therefore, in present study our focus was on personal
bullying incidents. Throughout the remainder of this study when we use the term bullying, it will
refer to personal bullying.
Personal bullying (e.g., teasing, yelling, insults, and criticism) are the most frequently
experienced forms of aggressive behaviors (Barling, Rogers, & Kelloway, 2001). In present
study, we were particularly interested in these types of abusive behaviors. In such jobs, where
interpersonal contact is required, employees may face such aggressive behaviors (LeBlanc &
Kelloway, 2002). In previous studies such aggressive behaviors have been reported with
different labels e.g. workplace mobbing (Leyman, 1990), workplace aggression (LeeBlank &
Kelloway, 2002), incivility (Andrson & Pearson, 1999), verbal abuse (Cox, 1991), interactional
6
justice (Bies & Moag, 1986), victimization (Aquino, 1999), workplace harassment (Richman et
al., 1999), and interpersonal conflict (Spector & Jex, 1998). As discussed, there are many
concepts exist in literature related to personal bullying. Therefore, it is vital for the researchers to
clearly define the term personal bullying in their study. In present study such types of behaviors
refer to personal bullying e.g. yelling, teasing, insults, rudeness, and criticism (Einarsen & Hoel,
2001).
Numerous researchers reported that verbal abuse is a stressor for employees and negatively
relates to employee’s outcomes (Barling, 1996; LeeBlank & Kelloway, 2002). In view of many
researchers’ employees have to face yelling, disrespect and threats frequently at workplace
(Anderson & Pearson, 1999; Daw, 2001). In previous studies, numerous researchers found
positive association between verbal aggression and job stress (LeeBlank & Kelloway, 2002).
Similarly verbal abuse is positively linked with (JD) job dissatisfaction (Budd, Arvey & Lawless,
1996) negatively associated with (Comm) commitment (Barling, Rogers, & Kelloway, 2001)
negatively associated with employee productivity (Barling et al., 2003), and positively associated
with job neglect (Schat & Kelloway, 2000). Furthermore, aggressive behaviors are positively
associated with stress (Einarsen & Mikkelsen, 2003). In another study, Quine (2001) found that
victims of verbal aggression reported low job satisfaction and high intent to leave the job.
Similarly, Tepper, Duffy, Hoobler, and Ensley (2004) reported that aggressive behaviors had a
negative impact on employee’s job satisfaction.
Personal bullying is a global issue and it is increasing very rapidly (Einarsen & Hoel,
2001). At workplace settings, anyone can be bullied, it is a common problem for everyone.
7
Generally, it is observed that most of the personal bullying incidents occur by male employees
against female employees, but in some cases it was also observed that personal bullying occur
man to man, woman to man, , or woman to woman. However results of bullying incidents differ
across studies, generally it was observed that women frequently experience more bullying
incidents than do men in Pakistan. Similarly, female employees probably observe and experience
more verbal aggression than male employees perpetrated by opposite sex especially by
supervisors and co-workers in the workplace settings. Infact, women have experienced the
problem of bullying at workplace ever since they come into the workplace settings. Generally,
personal bullying is any act of verbal abuse, criticism or rude behavior at workplace which has
the effect of making a female employee uncomfortable on the job, frustrating her, which
ultimately decreasing her ability to perform the job appropriately.
Nurse can be male (M) or female (F) but in present study our focus was on the female
nursing staff because female nurses were more at risk of bullying (Ahmed, 2012). Similarly, in
the context of Pakistan, owing to the fact that female nurses have to face this problem more than
the male nurses (Shahzad & Malik, 2014). In Pakistan’s society women is less valued than men
and in such society personal bullying is very common (Niaz, 2003). Most of the Pakistan’s
population lives in villages where there is scarcity of education and in addition women are rarely
allowed to get out of houses and for work (Niaz, 2003). In Pakistan majority of nurses belong to
poor families and that’s why the society does not give them much respect and so does the
organizations. Owing to this fact doctors/colleagues and patients/attendants insult them for minor
mistakes without any consideration which have a negative impact on their health and as a result
they start thinking of quitting the job.
8
Unfortunately, personal bullying is common everywhere, however, nurses have to experience
such bullying incidents frequently (Ahmed, 2012; Quine, 2001). It was reported that majority of
the nurses had faced bullying incidents at workplace (Quine, 2001). Similarly, nurses were also
more likely than other staff to have witnessed the bullying of others (Quine, 2001). Fifty percent
of nurses reported witnessing other people being bullied in the previous 12 months. Similarly,
over half of the nurses (55.5%) had experienced abuse in the past 6 months (Quine, 2001).
Social learning theory (Bandura, 1963) explained the phenomenon of bullying towards nurses in
Pakistan. According to this theory people behave just the way they see others behaving. When
people see others misbehaving, and insulting the nurses on minor issues, they also behave as they
see others. Besides, there are less hospitals as comparison of the demand of hospitals in
Pakistan, similarly nurses are in less numbers in Pakistan (WHO, 2010) when work burden
increases, nurses can’t treat all well, they cannot concentrate on their work well, as a result they
have to face bullying from doctors, and other paramedical staff .
Many researchers examine yelling, insults, rudeness without identifying the (P) perpetrator
(Frone, 2000), they think that bullying does not differ by (P) perpetrator, this hypothesis may
result in under or over estimates the true effects of bullying on employee attitudes and behaviors
because the effect size from different sources (internal and external) may not be the same
(Hershcovis & Barling, 2007). In Pakistan, it is observed that the job of nursing staff is very
challenging and demanding. They have to perform several tasks simultaneously e.g. provide
assistance to doctors, patients care, guidance to patients relatives regarding medicines. It is
observed that nursing staff face bullying from both sources (doctors as well as patients). As
every patient expect good and quick service from nurses, but when they feel that they are not
9
properly served, they show aggression towards nurses. On the other hand when doctors see that
nurses are not assisting them properly, due to pressure on them they show aggression towards
nursing staff.
The internal source (doctor in present context) has stronger effects than outsider (patients) on
staff attitudinal and behavioral outcomes. When doctors show aggression towards nurses, it gives
impression to nurses that they are less important at workplace and their job in the organization is
not safe. On the other hand, aggression by outsiders (e.g. patients/patients relatives) will have
less negative effect on nurses because of the various options available to nurses. When nurses
experience bullying from patients, they may ask them to lower their voice, may direct their
reservations to a supervisor. At worst situation, the nurse need only suffer the negative event for
the duration of the transaction, after which the patient exits the hospital and no longer presents a
threat to the nurse. Nursing staff suffered embarrassment as a form of verbal aggression more
frequently from doctors (Ahmed, 2012). Nurses were more likely at risk of bullying than any
other group of workers because they work under the extreme conditions and work closely with
doctors, hospital admin and other paramedical staff members (Ahmed, 2012). Similarly, in
Pakistan, nurses in public sector hospitals have to face bullying incidents from doctors frequently
(Shahzad & Malik, 2014). Therefore, in present study, we focused only on internal source
(doctors) to estimate the true effects of bullying.
Unfortunately, in healthcare sector, bullying is either unreported or under-reported (Randle,
2003). This shows that most of the nurses when face bullying incidents remain silent, which
further increases the chances of bullying incidents in future (Randle, 2003). Similarly, in Jordan,
10
a number of unpleasant incidents of personal bullying are reported low because of the distress,
fear, not to politicize them, and feel reluctant to inform the top management or relevant body at
workplace (Ahmed, 2012). In Jordan, the frequency of bullying incidents is very high and over
half of the nursing staff (55.5%) had experienced bullying in the past 6 months. In Jordan, most
of the employees were verbally abused by senior staff. The frequency of verbal abuse was 37.1%
(Ahmed, 2012).
Unfortunately, majority of nurses exposed to bullying incidents did not report (Ahmed,
2012). Similarly, in Pakistan the nursing staff may quiet reluctant to report the bullying incidents
because of religious, cultural, and societal humiliation. Nurses refrained from talking about
bullying and it was considered a taboo but now this issue is being taken seriously from past few
years. It is time now that this matter should be taken seriously, so that the nurses can work in
peace and take good care of the patients as well. Specially, in Pakistan, it is of utmost importance
that such plans and strategies must be developed so that the nurses can work in peace without
facing bullying incidents.
In previous studies, researchers have discussed the direct link of bullying and turnover
intentions (Quine, 2001; Rayner, 1997, Ahmed, 2012) but this link needs to be explored in more
depth by exploring some mediating and moderating variables (Einarsen & Hoel, 2001).
Therefore, in present study, the concept of job stress was used as mediator between personal
bullying and turnover intention linkage and we also predicted that political skill will weaken the
link between personal bullying (PB) and job stress (JS) in present study. The phenomenon of job
stress (JS) is generally discussed as “the feeling of a person who is required to deviate from
11
normal or self-directed functioning in the work place as the result of opportunities, constraints, or
demands relating to potentially important work-related outcomes” (Parker & DeCotiis, 1983).
Political skill is a sort of personality characteristic which plays a vital part in teaching one to
react in different situations, understanding people, creating good terms with people and
interpersonal influence also play a significant part (Ferris et al., 1999). The (PMWS) process
model of work stress (Pratt & Barling, 1988; Barling, 1996) explain the direct as well as indirect
link of personal bullying and turnover intentions via job stress and also explain the buffering
effect of (PS) political skill between (PB) personal bullying and job stress linkage.
This model presents shocking workplace situations as (“stressors”), the employee’s personal
experience of such events as (“psychological stress”), and finally the employee’s response as
(“strain”). In present study, the incidences of personal bullying (stressors) strongly suggested as
shocking events for nurses due to whom they feel anxiety, frustration, and anger refers to job
stress and it further leads to turnover intentions as strain. The process model of work stress
suggests that personal related characteristic can play a moderating role between stressor and
stress linkage. In present study political skill is a personal related characteristic (Ferris et al.,
1999) which was introduced as moderator between personal bullying and job stress. It means that
those nurses who have high political skills they take less stress when they experience bullying
incidents.
Personal bullying is a complex issue (Einarsen & Hoel, 2001) and in previous studies it was
examined either quantitatively or qualitatively but it is required to be looked into through both
methods so we can validate both findings and bring forth better and thorough results. The
12
mixture of qualitative and quantitative research gives us better understanding of research
problem (Creswell, 2003). Mixed methods technique provides strengths that offset the
deficiencies and weakness of both qualitative and quantitative research and the two types of data
to bring more insight into the research problem than would be achieved by either single type of
data separately (Creswell, 2003).Therefore, in present study, we used mixed method approach. In
mixed method, researchers combine or links both qualitative and quantitative methods
(Cresswell, 2003). In mixed methods researchers focus on the research problem and use all
available approaches to explore the problem. There are three main reasons of using mixed
method in present study.
1. The research problem was complex and to make our arguments strong we need to explore
it by using both methods.
2. It is common that more evidences provide better arguments so by combining quantitative
and qualitative methods help the researchers to explore this problem with more
evidences.
3. In present time, mixed methods may be the preferred method within a research
community. It is difficult to handle but provides better results.
There are six different mixed methods design which researchers use according to their issue
and need (Cresswell, 2003).
1- Sequential-explanatory design (S-EXN-D)
2- Sequential-exploratory design (S-EXR-D)
3- Concurrent-triangulation design (C-T-D)
4- Concurrent-embedded design (C-E-D)
14
1.2 Problem Statement
Turnover is important from individual as well as from organizational perspectives (Shaw,
Delery, Jenkins, & Gupta, 1998). Turnover is not only the problem of nursing staff, infact all
types of organizations have to face this problem (Shaw, Delery, Jenkins, & Gupta, 1998).
Organizations realize the importance of competent employees and they invest on them (Lee &
Mitchell, 1994). Employees’ turnover has adverse impacts on organizational efficiency and
effectiveness (Mobley, 1982; Staw, 1980). It is a loss that should be avoided by the organization
and it should be taken seriously. Majority of the researchers believed that actual turnover takes
place when the individual thinks to quit the job (Mobley, Horner, & Hollingsworth, 1978). It
shows that actual turnover occurs due to increased turnover intentions in employees (Mobley,
Horner, & Hollingsworth, 1978). High turnover intentions decrease employee’s interest in work,
and harm employee’s abilities to achieve organizational goals and objectives (Mobley, Horner, &
Hollingsworth, 1978).
Different reasons of employees turnover intentions have been discussed among which
personal bullying is one of the significant predictor of employee turnover intention (Simons,
2008; Djurkovic, McCormack, & Casimir, 2008). Personal bullying (PB) is a stressor and main
problem for the nursing staff. They have to experience abusive behaviors more as compared to
other medical staff (Houshmand, O’Reilly, Robinson, & Wolff, 2012). Numerous researchers
linked personal bullying incidents with employee’s turnover intentions (Ahmed, 2012; Quine,
2001; Simons, 2008; Djurkovic, McCormack, & Casimir, 2008). In Pakistan, the public sector
hospitals nursing staffs have experienced and witnessed more personal bullying incidents as
15
compare to other categories of work due to which they have high turnover intentions (Shahzad &
Malik, 2014).
In previous studies researchers discussed the direct link of bullying incidents and turnover
intentions (Ahmed, 2012; Djurkovic, McCormack, & Casimir, 2008; Simons, 2008; Quine,
2001). As such, this approach holds conceptual and methodological weaknesses, failing to detect
any potential mediating and moderating construct between them. To fill the theoretical and
methodological gap in literature, the job stress was explored as an intervening variable between
personal bullying incidents and nursing staff turnover intentions. Moreover, for interaction
effect, the importance of political skill was examined as a moderating variable in personal
bullying and job stress linkage in present study. As discussed by Perrewe, Ferris, Frink, and
Anthony (2000) that political skill can play two types of role in stress and strain linkage. First,
generally, nursing staffs who are high in political skills they perceive less stressor at workplace
environment. Second, however, in some situations when they experience abusive behaviors so
they already know that how to resolve this issue, they are already skilled to tackle difficult
situations at workplace. Interestingly, researcher also observed in Pakistan that there are some
nurses who deals with a high level of daily stress due to bullying incidents do not stop working
efficiently. This is important to explore scientifically that what help them nurses to deal with
stressful situations. Therefore, the present study offers insight into the moderating role that
political skill plays in personal bullying - job stress linkage. Hence, the inclusion of political skill
as moderating variable would be theoretically legitimate and worth testing in present study.
As discussed earlier that personal bullying is a complex and sensitive issue (Einarsen &
Hoel, 2001) and it was examined either quantitatively or qualitatively. In present study, we tried
16
to fill these theoretical and methodological gaps as discussed earlier by using (SEMM)
sequential explanatory mixed method technique. It is necessary in this method that researcher
first collects quantitative data, he focused on quantitative part and after that he moves towards
the qualitative side. The objective of conducting qualitative interviews is just to validate the
quantitative results. In view of Clark and Cresswell (2011) the researcher follow (QUAN →
qual) approach means quantitative followed by qualitative. The link between bullying and
turnover intentions was also discussed by numerous researchers in previous studies but by using
mixed methods and exploring the mediating and moderating variables effects simultaneously in
this linkage makes this study admirable and novel. Accordingly, based on above discussion the
main purpose of the present sequential explanatory mixed method study was to test the direct as
well as indirect effect of personal bullying incidents on nursing staff turnover intentions via job
stress as mediating variable. In the same way, to test the moderating effect of political skill
between personal bullying and job stress linkage was also the purpose of the present study.
17
1.3 Research Questions
The following are the six specific (RQ) research questions of present study.
1- How does personal bullying impact nursing staff turnover intentions?
2- How does personal bullying impact nursing staff job stress?
3- How does job stress impact nursing staff turnover intentions?
4- How does (JS) job stress intervene/mediates between (PB) personal bullying incidents
and nurses turnover intentions linkage?
5- How does (PS) political skill moderate the link between (PB) personal bullying and (JS)
job stress?
6- To what extent do the qualitative results confirm the quantitative results?
1.4 Research Objectives
The following are specific objectives that driven from the problem statement of present
study:
1- To find out the association between (PB) personal bullying and nursing staff turnover
intentions in the major public sector hospitals of Pakistan.
2- To determine the link between (PB) personal bullying and nursing staff (JS) job
stress.
3- To determine the relationship between (JS) job stress and nursing staff (TI) turnover
intentions.
4- To determine the intervening effect of (JS) job stress between (PB) personal bullying
and (TI) turnover intentions of nurses.
18
5- To determine the interaction / moderating effect of political skill in the link between
personal bullying and job stress.
6- To determine whether qualitative findings validate the quantitative results.
1.5 Significance of the study
The present study has identified area of significance to those who have started or might
be interested to find out the association between (PB) personal bullying and (TI) turnover
intentions link of nursing staff. As far as the theoretical contributions of present study is
concerned, the present study highlights the intervening / mediating effect of (JS) job stress
between (PB) personal bullying and (TI) turnover intentions as well as the interaction /
moderating effect of (PS) political skill on personal bullying and job stress link which have not
been tested before. Similarly, the contextual contribution of present study is the sample of
present study. This study is of its first kind to test the complex model of personal bullying and
turnover intentions of nursing staff in the public sector hospitals in Pakistan. Furthermore, as far
as methodoligal contribution is concerned, viewing the complexity of personal bullying, a mixed
method was best suitable for us to explore this problem. It was required to be observed through
both ways so that we can come to a better conclusion. Therefore, in present study we focused on
(SEMM) sequential explanatory design which was missing in personal bullying and turnover
intention linkage.
Generally, nurses have less authority and facilities at workplace settings (Lee & Saeed,
2001). Therefore, the role of power/ authority cannot be ignored in bullying studies. This is a
significant reason which makes nurses at risk to personal bullying incidents perpetrated by senior
19
staff members. Most of the previous work on bullying, examined bullying incidents without
identifying the perpetrator, which shows that bullying does not differ by perpetrator. When
researchers do not identify the perpetrator, then the actual effects of bullying cannot be measured
because the value of regression co-efficient’s will be different (Hershcovis & Barling, 2010;
Hershcovis & Barling, 2007). Previous studies showed that personal bullying incidents toward
nursing staff are perpetrated most frequently by doctors in the healthcare settings due to their
formal as well as informal power (Brewer, Kovner, Obeidat, & Budin, 2013, Shahzad & Malik,
2014). Therefore, in present study, we focused on personal bullying incidents experienced by
nurses from doctors. This method will give us true effects and clear picture by focusing on one
single source (Hershcovis & Barling, 2007).
The present research work also intended to develop a theoretical framework that device
the plans and strategies to minimize the bullying incidents in the context of public sector
hospitals that ultimately reduce the turnover intentions of nursing staff. Similarly, a safe and
secure work setting may definitely attract hospital employees and specially nursing staff to work
and remain in their career specifically in case of a public sector hospitals of Pakistan. Moreover,
the study provided practical guidelines to the public sector hospitals of Pakistan to reduce the
bullying incidents and the turnover intentions of the nursing staff. The study will also provide
practical guidelines to the public sector hospitals of Pakistan to reduce the job stress and enhance
the political skill of the nursing staff.
20
1.6 Organization of the study
The present study is structured into five chapters. The next are the short descriptions of
each chapter.
Chapter 1: starts with the history/background of issue followed by the detailed problem
statement, research objectives and research questions. Moreover, we also discussed the
significance of the study in chapter-1.
Chapter 2: starts with broad discussion on studied variables and theories supporting the
conceptual framework of the study. The discussion on theorized linkages between study
variables with regard to previous research results is presented in detail. The chapter then presents
the conceptual framework of the study.
Chapter 3: The research design is discussed in detail and also research paradigm of the
study. We discussed the sampling plan, data collection procedure and data analysis part, and the
scales used to measures the studied variables. Moreover, data analysis techniques used in the
study are discussed in detail.
Chapter 4: The demographic features of the sample are presented in chapter 4. Findings
of the measurement model as well as structural model are also reported and discussed in detail.
The direct linkages, mediating effects, and moderated effects are reported and discussed in this
chapter. Additionally, the chapter also presents the findings of qualitative part. Finally, the table
of mixed method is also presented in this chapter.
Chapter 5: begins with the summary of quantitative and qualitative findings. The chapter
then presents the theoretical and practical implications of the study. Furthermore, limitations of
the study, future research directions and conclusion are also presented in this chapter.
21
CHAPTER 2: LITERATURE REVIEW
This study mainly aims to assess the association between personal bullying incidents and
turnover intentions of nursing staff with the inclusion of job stress as mediating variable and
political skill as moderating variable in the context of public sector hospitals in Pakistan. The
chapter starts with a detailed discussion on studied variables as well as supporting theories which
help the researchers to create linkages among variables. The chapter also provides a detailed
discussion on linkages of studied variables pertinent to the problem statement which has
discussed earlier in detail. The association between personal bullying and nursing staff turnover
intentions was discussed in the light of previous research studies. The role of job stress as
mediating variable and political skill as moderating variable are also discussed in detail. Finally,
based on the literature review, a research model is presented for present study.
2.1 Personal Bullying
Personal bullying was considered a taboo in research and organizational life (Hoel, Rayner,
& Cooper, 1999). In last 20 to 25 years, a lot of work has been done in the direction of awareness
about personal bullying in academic community and many books and articles have been written
on this theme (Einarsen, Raknes, & Matthiesen, 1994; Field, 1996; Leymann, 1986). Researchers
started to take interest and explore this issue in 1980’s (Leymann, 1986). First book written on
this issue was with the title “Mobbing psychological violence at work” (Leymann, 1986).
Personal bullying is thought to be social stressor in workplace settings (Einarsen & Raknes,
1991; Leyman, 1993). This issue was thoroughly explored by the researchers of Scandinavian
and they penned down many articles and books on this issue (Einarsen & Raknes, 1991;
22
Einarsen, Hoel, & Cooper, 2003). Personal bullying is now recognized as a problem in entire
world and this issue is now visible in the agenda of international organizations like International
Labor Office (ILO) and World Health Organization (di Martino, 2003).
Personal bullying consists of behaviors such as (e.g. verbal abuse, yelling, rude remarks,
extreme teasing, spreading false stories or rumors, and criticism (Einarsen & Hoel, 2001). If such
incidents occur over a period of time, e.g. about six months then we will label such incidents as
personal bullying (Einarsen & Hoel, 2001). Researchers have agreed to the frequency and they
used the term last six months in their researches (Einarsen & Skogstad, 1996; Vartia, 2001). That
is why, last six months was considered as the time frame in the operational definition of personal
bullying in present study. Researchers have used different terms for bullying such as “mobbing”
(Zapf, Knorz, & Kulla, 1996), “emotional abuse” (Keashly & Neuman, 2004), “victimization”
(Einarsen & Raknes, 1997) they all seem to refer to the same phenomenon. In Pakistan,
harassment and violence are interchangeably used with personal bullying (Shahzad & Malik,
2014) but in reality, these terms are little different, in personal bullying the main emphasizes on
verbal aggression, rude remarks, criticism, and extreme teasing (Einarsen & Raknes, 1997).
2.1.1 Bullying Models. Researchers presented few bullying models in previous studies, and the
focus was on the reasons behind bullying incidents at workplace settings.
1- Leymann model
2- Predatory bullying
3- Dispute related bullying
23
Researchers have different views about the reasons of bullying incidents at workplace.
Leymann, (1990) focused on organizational factors to be the basis of bullying. In his view
leadership style, work design and morale of management are the basic factors. If there are
deficiencies in leadership style, work design and low department morale then there will be more
chances of bullying incidents at workplace. Predatory bullying means when an employee is
attached to a group which is in opposition to the group favored by the leadership and its related
people. As a consequence, he has to face bullying (Archer, 1999). Dispute related bullying
constitutes interpersonal conflicts of the employee. When these conflicts exceed, consequently
employee has to face aggressive behaviors (Einarsen, 1999). There might be more reasons but
these are the few major reasons which were discussed in above three models.
Personal bullying has its roots in imbalance of power and employees having low
positions are usually teased, insulted and criticized (Zapf, Knorz, & Kulla, 1996). The bullied
have low resources and the bullies who are managers or supervisors have power at workplace
and sometimes colleagues bully the employee whom they know won’t be able to defend himself
(Zapf, Knorz, & Kulla, 1996). It was also observed that organizational culture where supervisor
is not supportive, and high power distance exist, employees have to face bullying incidents
(Shahzad & Malik, 2014). When we observe the culture of public sector hospitals in Pakistan, we
find all these aspects existing there, as a result, nurses have to face personal bullying incidents in
hospitals. Similarly, when hospitals lack facilities for the patients, they do not get proper
attention, procedures take too much time, doctors do not give proper attention to patients during
checkups, they don’t get medicines in time, then patients and attendants bully the nurses just
24
because they lack power at workplace and for being women they are considered weak (Shahzad
& Malik, 2014).
2.1.2 Bullying as a process. Bullying is a process (Einarsen, 2000; Leymann, 1990; Zapf &
Gross, 2001). There are four stages of bullying process.
1- “Aggressive behavior”
2- “Bullying”
3- “Stigmatization”
4- “Severe trauma”
In the beginning, employees consider negative act as an indirect aggression and finds it
difficult to confront. They remain confused but the first phase is very short. After that direct
negative behavior starts. Targets start getting insulted and threatened and then targets become
stigmatized and finds it difficult to defend themselves. Finally they get stressed and faced health
problems (Einarsen, 2000).
Rayner, (1997) reported that in United Kingdome almost half of the total respondents
experienced personal bullying incidents. In his views, bullying has become a significant part of
employee’s working lives. Similarly, Hogh, Hoel, and Carneiro (2011) reported that most of the
employees have to face bullying incidents. Similarly, in the context of nursing staff, forty percent
nurses reported experiencing bullying incidents in the previous 12 months, and majority of
nurses had witnessed the abusive behaviors (Quine, 2001).
25
Nurses have to face bullying incidents from two sides; 1- Doctors/colleagues, 2-
Patients/attendants. Why do doctors/colleagues and patients/attendants bully nurses in public
sector hospitals in Pakistan? To find the answer to this mystery we will have to go through two
theories.
1- The organizational model (Tangri, Burt, & Johnson, 1982)
2- Social learning theory (Bundara, 1963)
Theory of organizational model explains that at workplace, power and authority plays a
key role (Tangri, Burt, & Johnson, 1982). In public sector hospitals in Pakistan, doctors have
more authority and power than nurses that’s why they bully nurses. Nurses have less power and
authority due to which they get bullied. The social learning theory (Bandura, 1963) gives us a
first-hand view of the reasons why patients/attendants bully the nurses. When patients/attendants
see other patients/attendants insulting and rudely behaving with the nurses, they also adopt the
same behavior. This theory shows that people learn from their surroundings. Their behavior is in
same manner as they see others behaving.
Shahzad and Malik (2014) reported bullying incidents seriously affects health of nursing
staff. Despite of modernization and progressiveness, nurses still are getting bullied and due to
which lack of efficiency and effectiveness on work performance can be seen at workplace
settings. Personal bullying is more observable in places where employees have to socially
interact with people. Shahzad and Malik (2014) suggested that situational factors also contribute
to repeated bullying incidents towards nurses, for example, any person who is likely to verbally
26
abuse some nurse generally only act in that way when the situations and workplace settings
actually permit that form of behavior. It is observed that personal bullying is more likely to be
evident in highly power distance work environments, in organizations where power distance is
high then it is very common to observe personal bullying incidents towards staff.
Experiencing bullying has been shown to affect nurse’s physical and psychological well-
being (Quine, 2001). In the context of Pakistan, during interviews nurses reported that due to
bullying incidents they experienced stress, traumatized, nervous, and shocked (Shahzad & Malik,
2014). It is important to consider that the negative psychological and physical effects of personal
bullying on employees may have a negative effect also on the organizational culture by making a
stressful atmosphere for employees. Shahzad and Malik (2014) reported that when nurses are
disrespected at workplace, this will eventually have an impact on all nurses. Nurses who observe
and experience bullying incidents at work place settings, they think that the organizations do not
care about their well-being, and in the long run it leads to negative outcomes and ultimately they
think to quit the job. The effect of bullying can be a loss of devotion to the organization, loss of
firm belief in management, and also low productivity.
In modern world and high technology environment, women are the assets of every
organization. The advancement in technology and globalization has resulted in their increased
participation in the workplace settings. Now, in developed countries, female participation is
considered as the indicators of success and their skills and talent are highly appreciated and
recognized. Unluckily, there are always few perpetrators in every organization who do bullying
and don’t give them respect and create problems for them to stop their economic as well as social
development. In Pakistan, electronic media and newspapers frequently show cases of bullying
27
and harassment at workplace, which indicates that the workplace is not safe for women in
Pakistan. Bullying at workplace is a social humiliation which develops unhealthy environment.
It is now time that this matter should be taken seriously, so that the nurses can work in peace and
take good care of the patients as well.
2.2 Turnover Intentions
Actual turnover takes place when individual thinks to quit the job (Mobley, Horner, &
Hollingsworth, 1978). It shows that actual turnover occurs due to increased turnover intentions in
employees (Mobley, Horner, & Hollingsworth, 1978). The main emphasizes of most turnover
research is on employees leaving rather than entering the organization (Price, 2001). In view of
Mobley, Horner, and Hollingsworth (1978) turnover intention is an entire process. This process
starts with a shocking event and as theses shocking events continue, employee gets frustrated and
dissatisfied with his job which also becomes the source of excessive job stress (Mobley, Horner,
& Hollingsworth, 1978). Moreover, in such situation employee lacks his positive behavior and
seizes to help his colleagues and his performance also gets affected (Mobley, Horner, &
Hollingsworth, 1978).
Turnover could be voluntary as well as involuntary (Shaw, Delery, Jenkins, & Gupta, 1998).
In case of voluntary turnover, or a quit, employee’s terminate the employment relationship, that
was initiated by the employees, whereas on the other hand, in case of involuntary turnover, or a
discharge, an employer’s decision to terminate the employment relationship (Dess & Shaw,
2001; Shaw, Delery, Jenkins, & Gupta, 1998). Mostly researchers discussed about the voluntary
turnover of employees and in literature much attention was given on the employees voluntarily
28
leaving the organization (Price, 2001). Employee voluntary turnover has direct as well as indirect
effect on an organization (Staw, 1980; Mobley, 1982). Direct effects consist of the recruitment
and training cost of new employees (Staw, 1980; Mobley, 1982). The indirect effects of turnover
contain low motivation and low morale among remaining employees, and they also have to bear
work overload (Mobley, 1982; Morrell, Loan-Clarke, & Wilkinson, 2004).
According to Tett and Meyer (1993) turnover intention is the desire of an employee to leave
the organization. Turnover intention is generally discussed as attitudinal (TOQ, thinking of
quitting), decisional (ITL, intention to leave), and behavioral (SFNJ, searching for new job)
process (Mobley, Horner, & Hollingsworth, 1978). Turnover intention is a desire of an employee
to search for other options in other organizations (Tett & Meyer, 1993). As discussed earlier that
turnover could be voluntary (employees wish to leave the organization) or can be involuntary
(supervisors make individuals terminated, Mobley, Horner, & Hollingsworth, 1978). However it
is to be checked that the turnover was on behalf of the organization or the employee took the
initiative. Involuntary turnover is initiated from the organization when the organization observes
an employee not performing in accordance to the demands of the organization, the employee is
terminated and new employee is hired on his place (Dess & Shaw, 2001; Shaw, Delery, Jenkins,
& Gupta, 1998). Involuntary turnover indicated the malfunctioning of an employee for which he
was turned over (Dess & Shaw, 2001; Shaw, Delery, Jenkins, & Gupta, 1998). On the other
hand, when an employee leaves a job, it is called voluntary turnover (Mobley, Horner, &
Hollingsworth, 1978).
29
It was observed that three factors play significant role in turnover intentions of employees.
1. Demographic factors
2. Professional perceptions
3. Organizational conditions
In previous researches the most significant demographic factors discussed were age, gender,
education, and tenure (Tett & Meyer, 1993). Turnover intentions are higher in young employees.
Employees having longer tenure have fewer intentions to leave an organization. However,
marital status and gender do not have much to do with the turnover intentions. It was observed
that women having children at home are mainly inclined to quit the job. Similarly those
employees who are in stress and not satisfied with their jobs have more turnover intentions (Tett
& Meyer, 1993). In the same way, organizational conditions play significant role in the
employee’s turnover intentions. Employees who are over loaded, less support from their
colleagues and are not satisfied with their salaries have high turnover intentions. In the same
way, personal bullying is one of the major reason of nursing staff turnover intentions (Djurkovic,
McCormack, & Casimir, 2008; Simons, 2008). A voluntary turnover results in the loss of the
knowledge, skills and abilities of the employee (Dess & Shaw, 2001). Moreover, organization
has to bear the cost of replacement and training of new employee which causes loss of both time
and money for the organization (Mobley, 1982). It has been discussed by researchers that
employees are the potential assets of every organization. Their importance seemed to be
imperative because organizations are made-up of people, not technology or structure. Therefore,
30
minimizing personal bullying incidents may be significant for the organizations to reduce the
turnover rate, and to uplift the overall performance of the employees. The bullying incidents
cause employees to quit their job (Quine, 2001).
The theory of “Conversation of Resource” Hobfoll (1989) also supporting the above
mentioned contentions that bullying incidents lead to high turnover intentions in organizational
context. A high turnover intention takes place when individuals has a fear to the loss of his/her
basic workplace necessities in terms of (a) objects (money and job security), (b) peer support,
conditions (quality of employee role) (c) energies (level of energy and time), and finally (d)
personal characteristics (beliefs such as a (PO) positive outlook) that ultimately lead towards
high turnover intentions of the employees. It might be argued in the context of public sector
hospitals there is a cause and effect link between (PB) personal bullying and nurse’s turnover
intentions. As discussed earlier in the case of public sector hospitals it might be contended when
the nursing staff experienced bullying incidents the turnover intentions of his/her increases.
Based on the theory of “Conversation of Resource” individuals have a fear to loss their basic
necessities of their job that ultimately increases their turnover intentions which cause damage to
the organization.
As we have discussed earlier, numerous reasons or factors play important role in nurse’s (TI)
turnover intentions such as work burden, less authority at workplace and low job satisfaction
(Hayes, et al., 2012). In the same way, one cannot ignore the role of personal bullying incidents
towards nursing staff turnover intentions (Simons, 2008; Djurkovic, McCormack, & Casimir,
2008). Generally, nurses when face aggressive behaviors at workplace they often think to leave
either their present job, or in some severe cases they plan to leave the nursing profession
31
(Johnson, 2009). Similarly, in Pakistan, personal bullying is one of the major problems for the
nurses in public sector hospitals and due to bullying incidents their turnover intentions increases
(Shahzad & Mailk, 2014). The review of relevant literature showed that personal bullying caused
nurses to be upset because they are unable to provide their services up to the required standards
to meet the needs of the stakeholders, which subsequently influenced their turnover intentions
and increased their potential to make mistakes (Zapf, Knorz, & Kulla, 1996). When nurses face
bullying from doctors, they get upset and can’t concentrate on their work and they start thinking
about quitting the organization and in this way their turnover intentions increases (Shahzad &
Malik, 2014).
2.2.1 Personal bullying and turnover intentions linkage. Personal bullying is a continuing
process, when employees are exposed to bullying incidents they often think to quit the
organization (Hogh, Hoel, & Carneiro, 2011). The effects of personal bullying incidents may
include difficultly with interpersonal relations and increased turnover intentions of the
employees within the organization (Shahzad & Malik, 2014). The theory of organizational model
Tangri, Burt, and Johnson (1982) explains the phenomenon of abusive behaviors (verbal
aggression) and nurses turnover intentions in the public sector hospitals in Pakistan. This theory
suggests that power at workplace is derived from the chain of command and how they are related
vertically and horizontally, who holds what positions, and who has the power and access to the
most important resources at workplace settings. In the public sector hospitals in Pakistan, nurses
may generally be positioned at lower levels as compared to others that’s why they have to face
personal bullying incidents frequently from doctors (Shahzad & Malik, 2014). The outcomes of
32
personal bullying incidents have been estimated to be far more costly to the hospital
administration in the form of high turnover intentions.
A large number of research studies have discussed a positive association between
personal bullying incidents and turnover intentions (Djurkovic, McCormack, & Casimir, 2008;
Shahzad & Malik, 2014). In the same way, Bowling and Beehr (2006) reported that personal
bullying was positively associated with turnover intentions of employees at workplace.
Numerous studies also have discussed that large number of employees at workplace quit their
jobs and do not even think to rejoin that organization due to personal bullying incidents (Quine,
2001; Rayner, 1997). In the same way, Shahzad and Malik (2014) discussed a positive link
between personal bullying incidents and nursing staff turnover intentions. Similarly, in the
context of nursing staff in Jordan, personal bullying incidents and turnover intentions are
positively associated (Ahmed, 2012). Thus, we drive:
Hypothesis 1: There is a positive relationship between personal bullying and nurses turnover
intentions.
33
2.3 Job Stress
The word, stress was used in the world of sciences in 17th century initially, especially in
the fields of engineering and physics (Hinkle, 1974). Selye (1987) has contributed significantly
in this context. Stress is defined as an organism’s response to a demand or event that challenges
it (Selye, 1987). Stress has a negative impact on the health of the nursing staff (HSE, 2006).
Houtman (2005) reported that it is now in the agenda of countries that stress is an unenthusiastic
thing for health of employees. The employees who are generally stressed are unhealthy, they
have less motivation, high turnover intentions and it affects the overall productivity of the
organization (Houtman, 2005). It is now realized that organizations have to bear the loss of
billions of dollars due to disability claims, absenteeism and turnover (Ryan & Watson, 2004).
Generally, the phenomenon of job stress is discussed “the feeling of a person who is required
to deviate from normal or self-directed functioning in the work place as the result of
opportunities, constraints, or demands relating to potentially important work-related outcomes”
(Parker & DeCotiis, 1983). Job stress has a negative impact on the health of nursing staff
(Ahmed, 2012; Quine, 2001). Joseph (2013) reported that job stress is an unenthusiastic thing for
health of employees. The employees who are generally stressed are unhealthy, they have less
motivation, high turnover intentions and it affects the overall productivity of the organization
(Shahzad & Malik, 2014). The situations that cause job stress are referred to as stressors (Joseph,
2013). In view of Joseph (2013) stressors can be classified into three types:
34
1. “Catastrophic-events”
2. “Major-life changes”
3. “Daily-hassles”
A catastrophe is something that can happen unexpectedly. Catastrophes might be natural
disasters such as, hurricanes, fires, floods, earthquakes, and tornadoes. Moreover, major life
changes events such as losing one’s job, death in family, and divorce. Similarly, daily hassles
referred to our jobs, social settings and relationships and everyday living conditions.
Generally researchers discussed the process model of stress to understand the effects of
bullying incidents at workplace settings. There are three main components in process model of
work stress (Pratt & Barling; Barling, 1996).
1- “Stressor”
2- “Stress”
3- “Strain”
Stressor Stress Strain
This study presents personal bullying as stressor, job stress as (stress), and turnover
intentions as strain. This indicates that personal bullying leads to job stress which further leads to
turnover intentions of nursing staff of public sector hospitals in Pakistan. According to process
model of stress, stressor is a shocking event or a situation which harms the employee. Stress is
the internal response of the employee in the form of depression, anxiety and anger, whereas,
35
strain is the outcome. In present study, we explored job stress as mediating variable in the
relationship of verbal abuse and turnover intentions of nursing staff in public sector hospitals in
Pakistan. In present study, we explored job stress as mediating variable in the relationship of
verbal aggression and turnover intentions of nursing staff in public sector hospitals in Pakistan.
Mediating variable means that X leads to M and M further leads to Y. X has a link with M and
M is also associated with Y. X is (IV) independent variable, (M) is mediating variable and Y is
dependent variable (Baron & Kenny, 1986).
Generally, a mediating/intervening variable is one that explains the relationship between
an independent variable (Personal bullying) and a dependent variable (Turnover intentions) via
the inclusion of a third variable (Job Stress), known as a mediating variable. Mediating variable
helps investigators to better understand the link between the independent and dependent
variables. In present study, we introduced job stress as mediating variable. It’s mean that
personal bullying leads to job stress and job stress further leads to turnover intentions of the
nursing staff of public sector hospital in Pakistan.
The mediating variable Job stress (JS) is regressed on the independent variable personal
bullying (P.B). This phase is measured by estimating the following regression equation:
JS = α0 + α1P.B + e1 Equation (2.1)
(Where α1 is the slope, α0 is the intercept coefficient, and e1 is the disturbance or error term)
The turnover intention (D.V) is regressed on the personal bullying (I.V). This step is
discussed in equation 2.2:
TI = βo+ β1P.B + e2 Equation (2.2)
36
(Where β1 is the slope, β0 is the intercept coefficient and e2 is the disturbance term)
The turnover intentions (D.V) is all together (simultaneously) regressed on the personal
bullying (I.V) and the job stress (M.V). This step is reported in below regression equation:
TI = γ0 + γ1PB + γ2 JS+ e3 Equation (2.3)
(Where γ1 and γ2 are the slopes, γ0 is the intercept coefficient and e3 is the disturbance term)
Numerous researchers have linked personal bullying towards nurses with high job stress
(Ahmed, 2012; Quine, 2001). The review of relevant literature showed that verbal abuse,
criticism and playing jokes caused nurses to be upset because they are unable to provide their
services up to the required standards to meet the needs of the patients, which subsequently
influenced their work performance and increased their potential to make mistakes (Quine, 2001).
The personal bullying and the subsequent inability of the nurses to provide good quality of care
are detrimental to both the nurses and the healthcare institution (Ahmed, 2012). In view of
Barish (2001) personal bullying may have a detrimental effect on job stress of nursing staff.
The theory of organizational models (Tangri, Burt, & Johnson, 1982) suggests that
people use their power and frequently bully their subordinates on the basis of high power at
workplace. This theory suggests that nurses are low in ranks and viewed by this model as being
vulnerable to psychological and economic consequences of personal bullying incidents. This
model presents personal bullying to aspects of structure of the workplace that provides
asymmetrical relations between supervisors and subordinates. The nursing staff that may have
comparatively lower positions at workplace and have a vulnerable position are more chances to
be the victims. Conversely perpetrators are the one who are higher in workplace hierarchy and
not likely to be reported by the sufferer. Shahzad and Malik (2014) argued female nurses’
37
experiences of personal bullying incidents and found far-reaching effects on their personal life,
high job stress, and level of patient care.
2.3.1 Personal bullying and Job Stress. Personal bullying is considered as a social stressor in
workplace settings (Zapf, 1999). When an employee faces personal bullying incidents he or she
gets shocked and uncomfortable at workplace (Shahzad & Malik, 2014). Personal bullying has a
significant impact on nurse’s job stress (Ahmed, 2012). Job stress starts with a shocking event
and whenever employee memories or recalls the painful memories of the event he or she loses
his concentration in his work and he can’t enjoy his job at workplace (Zapf, 1999). In view of
Quine (2001) most of the employees were stressed out due to personal bullying incidents. In the
same way, Ahmed (2012) discussed that employees reported that personal bullying incidents
became the cause of their job stress. Exposure to verbal aggression has been discussed as a
significant source of job stress at workplace settings (Vartia, 2001). The victims of verbal
aggression discussed more job stress compared to employees from the workplaces with no
experiencing aggressive behaviors (Vartia, 2001). Similarly, Shahzad and Malik (2014)
discussed that exposure to verbal aggression leads to job stress among the most of the nursing
staff in the context of public sector hospitals in Pakistan. Based on the above discussion, we
hypothesized that:
Hypothesis 2: There is a positive relationship between personal bullying and job stress.
38
2.3.2 Job Stress and Turnover Intentions. Job stress and turnover intentions have positive
relationship (Gupta & Beehr, 1979; Summers, DeCotiis, & DeNisi, 1995). Nurses have to deal
with patient disease, death, shocking events and other stressors which make their job stressful
(Shahzad & Malik, 2014). In the same way, nurses take job stress due to work burden,
inadequate timings, and staff shortage (Ahmed, 2012). Nurses do more errors and make more
mistakes in stress and quality of patient care is decreased (Shahzad & Malik, 2014). It is obvious
that when the employee experiences job stress he or she cannot concentrate on his work, in this
situation the turnover intentions of the employees increases due to job stress, which is not only
distressing for the employee but also for the organization (Quine, 2001).
Due to high turnover intentions, hospitals have to face many problems, they have to bear
extra expenditure on hiring new nursing staff and on the other hand remaining nurses have to
manage the work burden due to the absence of nurses, which ultimately results in patients not
having quality care (Shahzad & Malik, 2014). Job stress is one of the significant reasons of high
turnover intentions of employees (Summers, DeCotiis, & DeNisi, 1995). When nurses perceive
that their wellbeing, security and health are not properly managed by the organization and they
frequently face stressors like personal bullying then they take job stress and decide to quit the
job. That is why many researchers have developed a positive association between job stress and
turnover intentions of employees (Gupta & Beehr, 1979; Summers, DeCotiis, & DeNisi, 1995).
According to planned behavior theory (Ajzen, 1991) attitudes leads to behaviors,
generally, attitudes are the reasons or antecedents of the actual behaviors. On the basis of this
discussion one can say that turnover intentions are the reasons for actual turnover at workplace.
39
It was reported by many researchers that nursing staff who have high turnover intentions are
more likely to quit the job than those nurses who have low turnover intentions (Mobley, Horner,
& Hollingsworth, 1978; Chen, Hui, & Sego, 1998; Hom & Hulin, 1981). Similarly, in view of
Gupta and Beehr (1979) job stress is associated to turnover intentions. Furthermore, in view of
Rogers and Kelloway (1997) fear of future violence is also associated to turnover intentions of
employees. In the same way, Chang and Lyons (2012) discussed a positive link between job
stress and turnover intentions of employees. This leads to the following hypothesis:
Hypothesis 3: There is a positive relationship between job stress and turnover intentions.
40
2.3.3 Mediating role of job stress. The employees who experienced verbal abuse have lot of job
stress (Ahmed, 2012; Zapf, 1999) and sometimes it gets so worst that they start thinking of
quitting the job (Shahzad & Malik, 2014). Most of the bullied employees get isolated and fall a
prey to frustration, nervousness and depression (Leymann, 1993). Once in a while almost every
employee has to face aggression, but frequent bullying creates severe health problems (Quine,
2001). Personal bullying is not only stressful for bullied employee but those who witness the
event also have a bad impact on their health which affects the overall productivity of the
organization (Einarsen, Raknes, & Matthiesen, 1994).
Verbal aggression increases job stress in nursing staff which further increases turnover
intentions. This shows job stress mediates between verbal abuse and turnover intentions. As
discussed earlier, the emotional reactions to personal bullying incidents develop a job stress
among employees in form of irritation, shock, fear, depression, and fear of returning to work. It
is observed in Pakistan, that most of the employees within the organizations who experienced
bullying incidents take leave to avoid the perpetrator and in severe cases employees think to quit
their jobs because they are unable to cope with the job stress that occur due to the personal
bullying. It was observed in Pakistan that verbal abuse was a significant source of job stress at
workplace which ultimately leads to the turnover intentions of the individuals. In the same way,
it was found that nursing staff who had not experienced any kind of personal bullying incidents
reported low job stress, while those who had experienced both emotional abuse and at least one
other form of bullying had the highest job stress that lead to the higher turnover intentions from
the job (Ahmed, 2012).
41
(AET) Affective Event Theory (Weiss & Cropanzano, 1996) to some extent also explains
the connections between employee’s internal influences (e.g. sentiments, cognitions, feelings,
mental states and their responses to events that occur in their working life). Affective event
theory constitutes two aspects: 1- workplace uplifts, 2- workplace hassles. When a positive event
takes place at workplace due to which nurses feel delighted, that is workplace uplift. If a negative
event takes place that is workplace hassle, however, personal bullying is a workplace hassle for
nursing staff (Zapf, 1999). When nurses experience personal bullying incidents, their facial
expressions and progress depicts their stress and bad mood. In such situations they get upset and
start thinking of quitting the job. All this discussion brings to our attention that personal bullying
leads to job stress and job stress further leads to turnover intentions of nursing staff. Moreover,
the (PMWS) process model of stress (Barling, 1996) also supports job stress as mediator
between verbal aggression and turnover intentions linkage. This model discusses shocking
workplace incidents as (“stressors”), the nursing staff personal experience of such incidents as
(“psychological stress”), and finally the nurse’s response as (“strain”). In the light of this model,
in present study personal bullying refers to stressor and when nurses experience job stress due to
bullying it refers to stress and finally nurses think to quit the job refers to strain. It shows that job
stress is playing a mediating role between personal bullying and turnover intentions.
The conversation of resource (COR) theory also explains how personal bullying impacts
on turnover intentions and stress (Hobfoll, 1998). The main theme of COR theory is that
employee try to attain, retain, and defend their resources. Resources consist of both type’s
material resources (e.g., accommodation, transportation,) and psychosocial resources (e.g., social
support, self-efficacy). According to conversation of resource (COR) theory, job stress develops
42
when individuals at workplace are helpless with resource loss, or fail to gain resources. The main
theme of COR theory is that resource loss is more hurtful and severe than resource gain because
it shows a major threat to individuals (Gorgievski & Hobfoll, 2008). Resource loss is typically
linked with stress, low energy, high turnover intentions and ultimately damaged mental and
physical health (Westman, Hobfoll, Chen, Davidson, & Lasky, 2004).
According to LeBlanc and Barling (2005) the majority of both media and research
attention has been on supervisors (insider aggression). The relevant literature on aggression has
showed that supervisor aggression is connected with job stress (Frone, 2000). Similarly, in
Pakistan, Shahzad and Malik, (2014) reported that employees face bullying from supervisors
which increases their stress level and increases their turnover intentions. As discusses above
Barling, (1996) applied stressor/strain model and he reported that exposure to verbal aggression
is a stressor that leads to stress and subsequently leads to psychological, physical and behavioral
outcomes (Strain). Generally, when employees face such kind of aggressive behaviors at
workplace they feel stress and the level of enthusiasm and motivation towards work reduces and
turnover intentions increase (Shahzad & Malik, 2014). Therefore, we hypothesized that:
Hypothesis 4: Job stress partially mediates between personal bullying incidents and nurses
turnover intentions.
43
2.4 Political Skill
Pfeiffer (1981) pioneered in introduction of the term political skill. Later on Mintzberg
(1983) worked on this concept, and then work stopped on this variable. After a long time, Ferris
et al. (1999) explored it fully and also developed a scale to measure it. Political skill is a sort of
personality characteristic which plays a vital part in teaching one to react in different situations,
understanding people, creating good terms with people and interpersonal influence also play a
significant part (Ferris et al., 1999). Political skill can be defined as “the ability to effectively
understand others at work and to use such knowledge to influence others to act in ways that
enhance one’s personal and organizational objectives” (Ferris et al., 2005). Employees having
political skill have better social skills, they are confident and they know how to behave in a
specific situation and tackle different situations (Ferris et al., 1999). Political skill is appreciated
in organizational settings and every employee can acquire these skills through training (Ferris et
al., 1999).
Political skill can easily be acquired and can also be developed by the passage of time. Some
employees have political skill more than others and they have more control on the environment
(Ferris et al., 1999). Employees lacking these skills have less confidence, they are socially weak
and they have less control on their environment. The nurses who are social and whose
networking ability is better and who understand people psyche better have more political skill
than others, and their political skill enable them to decrease their pressure by sharing with others
in cases of job stress in contrast to nurses who have less political skill (Ferris et al., 1999). The
present study explored political skill as moderator in the relationship between personal bullying
44
and job stress. Moderating effects are evoked by variables whose variation influences the
strength or the direction of a relationship between an independent and dependent variable
(Barron & Kenny, 1986). In the context of present study, moderator (political skill) is a variable
that can make the relationship between personal bullying and job stress either stronger or
weaker. A moderating link can be considered as an interaction. It occurs when the association
between personal bullying incidents and job stress depends on the level of political skill.
The moderation equation of present study is given below.
JS = β0 + β1PB + β2PS + β3PB*PS + e1
Note: JS= Job stress, PB = Personal bullying, PS = Political skills
In previous studies two types of scales were used to measure political skill. First one is
uni dimensional scale which has six questions (Ahearn, Ferris, Douglas, Hochwarter &
Ammeter, 2004). Second is a multi-dimensional scale which constitutes four classes of political
skill (Ferris et al., 2005).
1- “Social-astuteness”
2- “Interpersonal-influence”
3- “Network-ability”
4- “Apparent-sincerity”
Social astuteness is when a person observes his social environment and understands it. He
is aware of himself and he can interpret others behavior as well. Interpersonal influence is the
knowledge of an employee to influence others interpersonally. It constitutes his effective
45
communication style which creates ease for not only oneself but for others. Network ability is
relationship building, employee having political ability can make friends, relations and coalitions
easily. Apparent sincerity constitutes honesty and sincerity. People with political skill are
considered honest and genuine by other people (Ferris et al., 2005). Both scales have been used
in previous studies. In present study, we used uni-dimensional scale of political skill as it suits
our definition of political skills and objective more appropriately.
The employees having political skill are more confident, they remain calm in tense
situation, and they can tackle the social stressors and neutralize their effects on strain reactions
(Ferris et al., 1999). It was discussed in the previous researches that political skills can reduce the
effect of stressors on the stress (Perrewe, Ferris, Frink, & Anthony, 2000). This means that those
employees who have more political skill take less stress as compared to those who have less
political skill (Ferris et al., 1999). Those employees who understand others are confident, they
are settled in their environment, they are less stressed which means they neutralize the effect of
stressors. Similarly, those employees who have good political skills have good relations with
other people. It shows that employees who have good relations with their colleagues and
supervisors have good capability to tackle the difficult situation at the workplace.
Similarly, those employees who have high political skill take less stress, because they
know how to handle the things. In view of Perrewe, Ferris, Frink, and Anthony (2000) political
skill (PS) can have two types of major effects in the context of stress and strain linkage. First,
those employees who have high political skill generally they take less stress at workplace
settings. Second, when they have to experience verbal aggression in the workplace, they handle
46
them calmly and politically and in this way their performance and work related activities do not
affect by such stressors. Furthermore, in view of Harvey, Harris, Harris, and Wheeler (2007)
political skill reduced the negative impacts of social stressors on job stress and enhance overall
employee’s satisfaction level. Similarly, researchers mentioned that for future research political
skill should be tested as a moderator for more stressor-strain relationships (Harvey, Harris,
Harris, & Wheeler, 2007; Perrewe, Ferris, Frink, & Anthony, 2000).
A political skill was seen as moderator in the relationship of personal bullying and job
stress in present study. If employee utilizes his political skill properly, one can decrease the job
stress on oneself. Politically skilled employees are self-confident, they can control their
impressions and workplace interactions. They have the capability of tackling difficult situations,
controlling their behavior and interacting with others in such situations as a result they take less
stress. Personal bullying is a social stressor for the nurses (Shahzad & Malik, 2014). When they
face personal bullying incidents, they go through frustration and anxiety, nurses having political
skill manage themselves, discuss it with people, and remain confident. They don’t take this
shocking event as a threat, but as a challenge and use their interpersonal skills to solve it. Infact,
nurses when face personal bullying incidents, they use their political skill to get a hold on this
stressful and difficult situation and take less stress. Nurses lacking political skill get over stressed
and thus their turnover intention further increases. Furthermore, according to (PMWS) process
model of work stress (Pratt & Barling, 1988; Barling, 1996) personal related characteristic can
play a moderating role between stressor and stress relationship. In present study political skill is
personal related characteristic (Ferris et al., 1999). It means that those nurses who have high
political skills, they take less stress when they experience bullying incidents. That is why we
47
hypothesize that political skill buffers the impact of verbal abuse on job stress, meaning nurses
having high political skill take less stress when bullied. Based on this discussion the following
testable hypothesis is formulated to answer the central research questions of the present study.
Hypothesis 5: Political skill moderates between personal bullying and job stress linkage.
48
Our hypotheses are summarized in Figure 2.1. The present study model is based on the
process model of stress (Pratt & Barling, 1988; Barling, 1996) and conveys that personal
bullying incidents have a direct as well as indirect impact on turnover intentions via job stress as
mediator. Further, we predicted that personality related characteristic (i.e. political skill)
moderates between personal bullying and job stress.
Figure 2.1: The Theoretical Framework of the study.
H5
H2 H3
H1
Mediation: H4
Note: Personal bullying = Independent Variable; Job stress = Mediating Variable; Political skill=
Moderating Variable; Turnover intentions = Dependent Variable.
(IV)
Personal
Bullying
(Moderator)
Political Skill
(DV)
Turnover
Intentions
(Mediator)
Job Stress
Control
Variables
Age
Education
49
Table 2.1: Hypothesis of Studies
Hypothesis-1
There is a positive relationship between personal bullying and turnover intentions.
Hypothesis-2
There is a positive relationship between personal bullying and job stress.
Hypothesis-3
There is a positive relationship between job stress and turnover intentions.
Hypothesis-4
Job stress partially mediates between personal bullying and turnover intentions.
Hypothesis-5
Political skill moderates between personal bullying and job stress.
50
Table 2.2: Operational definitions of studied variables
“Personal
bullying”
“Personal bullying consists of behaviors such as making insulting remarks,
excessive teasing, spreading gossip or rumors, and persistent criticism” (Einarsen
& Hoel, 2001)
“Turnover
Intentions”
“Turnover intention is defined as the desire of an individual to leave an
organization” (Tett & Meyer, 1993).
“Job Stress”
“The term job stress is used to describe “the feeling of a person who is required to
deviate from normal or self-directed functioning in the work place as the result of
opportunities, constraints, or demands relating to potentially important work-
related outcomes” (Parker & DeCotiis, 1983).
“Political
Skills”
“Political skill means the ability to effectively understand others at work and to
use such knowledge to influence others to act in ways that enhance one’s personal
and/or organizational objectives” (Ferris et al., 2005).
In present study, we explored job stress as mediating variable in the relationship bullying
events and turnover intentions. Personal bullying is a stressor for nurses, which increases the
stress level of nurses and when stress increases it increases the turnover intentions of nurses. In
present study, we explored job stress as mediating variable which is one of the major
contributions of the study. Moreover, political skill was seen as moderator in the relation of
personal bullying and job stress in present study. If employee utilizes his political skill properly,
one can decrease the job stress on oneself. Political skill is also one of the major theoretical
contributions of the present study which has been discussed earlier in detail. The theme of
present study is based on process model of work stress (Pratt & Barling, 1988). In present study,
personal bullying is a stressor for employees, job stress is the stress and turnover intentions is
51
strain, it shows that when employees face bullying at work place, they experience job stress and
it further increases their turnover intentions. In present study, job stress is playing a mediating
role between personal bullying and turnover intentions. Mediating variable means that X
(personal bullying) leads to M (job stress) and M (job stress) further leads to Y (turnover
intentions). X has a link with M and M is also associated with Y. X is independent variable, M
is mediating variable and Y is dependent variable (Baron & Kenny, 1986). Furthermore,
according to process model of work stress (Pratt & Barling, 1988; Barling, 1996) personal
related characteristic can play a moderating role between stressor and stress relationship. In
present study political skill is personal related characteristic (Ferris et al., 1999).
52
Fig 2.2: Process Model of Work Stress
The theme of present study is based on process model of work stress (Pratt & Barling,
1988; Barling, 1996).
In present study, according to process model of work stress (Pratt & Barling, 1988, Barling,
1996) personal bullying is a stressor. Job stress is a stress and turnover intention is a strain.
Furthermore political skill (person related characteristic) is playing a moderating role in stressor
and stress relationship. Therefore, the study intended to make a workable analytical framework,
which will help a comprehensive inquiry of the conceptually related factors i.e. highlighted from
the relevant and important review of literature. The theoretical framework posits four variables,
which can be labeled as personal bullying, job stress, political skill, and turnover intentions.
Furthermore, Age and education were entered as controllable variables. The framework depicts
the personal bullying as an independent variable, turnover intentions is taking into account as
dependent variables, job stress is explored as mediator between bullying events and turnover
intentions and political skill is explored as moderator between bullying events and job stress.
53
There are five different types of variables included in theoretical framework of present
study. The five types are independent variable (I.V), dependent variable (D.V), mediating
variable (M.V), moderating variable (Mod.V), and control variables (C.V). An independent (I.V)
variable is one that effect the dependent variable (D.V) in positive or negative manner.
Generally, with one unit of increase in the (I.V) independent variable, we carefully see the
change in (D.V) dependent variable, whether there is any variation (increase or decrease) in the
dependent variable as unit increases in (I.V) independent variable. On the other hand, the (D.V)
dependent variable is the variable of main interest to the investigators. The aim of the
researcher’s is to assess or calculate the variation in the (D.V) dependent variable. The (M.V)
mediating variable is also known as (I.V) intervening variable. It means that (I.V) independent
variable leads to (M.V) mediating variable and then further it leads to (D.V) dependent variable
(Baron & Kenny, 1986). The concept of moderation is getting much popularity in research
settings. The (M.V) moderating variable has a strong conditional/contingent effect on the
relationship of independent - dependent variables linkage. The inclusion of a third variable (the
moderating variable) the initially estimated relationship between the independent and the
dependent variables modifies (Baron & Kenny, 1986). The control variable in research is the
experimental part which is constant and unchanged throughout the scientific investigation. A
variable in an analysis which is constant in order to calculate the association between two other
studied variables is known as the control variable.
The present chapter discusses that bullying events has a direct impact on nursing staff
turnover intentions. The model further suggests that job stress mediates between bullying events
and nursing staff turnover intentions. The model further proposes that political skill buffered the
54
effect such that the relationship between personal bullying and job stress was weaker among
nurses who were higher in political skill. The next chapter highlights and discusses the
methodology adopted to test the hypotheses developed in this chapter.
55
CHAPTER 3: METHODOLOGY
This chapter discusses the methodology of present study. This study used a mixed
methods design to check the linkage between personal bullying and turnover intentions directly
and indirectly via job stress as intervening variable. Moreover, political skill was also tested as a
moderating variable in present study between personal bullying and job stress linkage. The
chapter comprises of research design, research paradigm, sampling techniques, measures,
procedures of data collection and data analysis techniques. The study explains the techniques
used for quantitative and qualitative data analysis and hypothesis testing. The technique used for
quantitative data analysis was structural equation modeling (SEM). There are two sub models in
SEM, measurement model and structural model. The chapter also explains the process of both
models. The technique used for qualitative data analysis was grounded theory method (Strauss &
Corbin, 1990). The chapter also explains the integration of quantitative and qualitative findings.
The chapter also includes assumptions of data analysis and ethics in research.
3.1 Research design
Research design is a general plan or strategy through which we examine research questions
(Kalaian, 2008). In the selection of research design, factors which play their part are: purpose of
the study, sample of participants, time horizon, data collection method, data analysis method
(Sekaran, 2003). Generally research design is classified in three categories: quantitative research
design, qualitative research design, and mixed methods research design (Creswell, 2003). In
present research we used mixed methods research design. This study made use of mixed method
56
so that it increases the strength of both approaches and brings forth better conclusion. In mixed
method both quantitative and qualitative research techniques are applied in single study. In
mixed method, we employ multiple approaches to answer the queries. It involves induction,
deduction, and abduction (Cresswell, 2003).
1. Induction: (discovery of patterns)
2. Deduction: (testing of hypothesis)
3. Abduction: (relying on the best set of explanations)
Qualitative and quantitative both are important and useful. Mixed methods used both methods
in one study to bring forth near to perfect results. Mixed method is the third paradigm and it
plays part as a bridge between qualitative and quantitative. Generally, quantitative research is
criticized for not taking view point of people, social context is ignored and qualitative is
condemned that they can self-create story and it also has the issue of generalization. Mixed
method is brought in use because it hides the weaknesses of both quantitative and qualitative
methods and brings forth its strengths at their best so that we get flawless results (Cresswell,
2003).
As discussed earlier, personal bullying is a complex issue that is why qualitative and
quantitative combination gives better results. If we study personal bullying only through
quantitatively, then we will not get complete results. We can get better results by adding view
points and social settings of the nurses that is why this study utilizes mixed methods. Researcher
has to choose the style of mixed method in accordance of the research objectives. The intent of
the present study is to find the linkage between abusive behaviors and turnover intentions of
57
nursing staff and to explore mediating and moderating variables. Therefore, in present study
sequential explanatory research was used which has two phases, quantitative followed by
qualitative (Clark & Creswell, 2011). In Phase 1, data of 324 nurses was collected through
survey/questionnaire. In Phase 2, 11 nurses were interviewed so that they can explain results in
detail.
3.2 Research Paradigm
Selection of paradigm is significant and it aids researcher to make philosophical
assumptions in research and it also facilitate in choosing instruments and methods. In the field of
management sciences exploration of any phenomenon, ontology and epistemology relies on
paradigm (Saunders, Lewis, & Thornhill, 2011).
Basically, there are three types of paradigm (Lincoln & Guba, 2000)
1. Positivism
2. Interpretivism
3. Pragmatism
Positivists say that there is only one reality and they believe in quantifiable world. On the
other hand interpretivist say that emotions and feelings are not quantifiable and individuals have
their own perception of reality. Pragmatism does not indulge in paradigm wars, its theory is to
combine both qualitative and quantitative into one study (Cresswell, 2003). Researchers, classify
these paradigms on the basis of ontological, epistemological, axiological and methodological
58
elements. Ontology refers to reality, epistemology means the relationship between knower and
would be knower, as in between research participant and researcher. Axiology deals in role of
your values in research process, whereas methodology tells how you conduct a research.
In present study, we selected pragmatism paradigm. In pragmatism paradigm as far as
ontology is concerned, assumes both single and multiple realities. Researcher tests hypothesis
and presents multiple perspectives. In epistemology, pragmatism paradigm researcher supposes
practicality. Researcher collects such data which well addresses research questions. Axiology
constitutes multiple stances, in pragmatism it uses both biased and unbiased perspectives and
methodology combines all. The researcher collects both quantitative and qualitative data and
then mixes it (Cresswell, 2003).
It is significant in pragmatism paradigm that one should understand both subjective that
is individual and objective that is material. For instance, in this study nurses were given
standardized instruments to be filled for quantitative data, so that their turnover intentions due to
personal bullying incidents may be measured. In addition it is also vital that they should be
deeply interviewed for the insider perspectives. Mixed method this brings forth useful
information.
3.3 Sampling Plan
Participants of the present study were the nursing staff. The data was collected through self-
administered questionnaire from six Islamabad/Rawalpindi public sector hospitals, including
consent forms signed and an orientation about the study. The biggest challenge for the researcher
was the data collection, owing to the fact that bullying is considered a taboo and employees
59
hesitate to talk and trust someone about it (Shahzad & Malik, 2014). Furthermore, the complete
list of nursing staff is not available so in this situation simple random sampling was not possible.
Keeping in mind all these constraints, the researcher used personal links to collect the data. In
present study, we used convenience sampling technique. In present study we used convenience
sampling technique because the theme of the research is sensitive and people are reluctant to talk
about sensitive issues (Saunders, Lewis, & Thornhill, 2011). The sample size was 324 in present
study for quantitative phase.
It is important to note that random sampling only works when the complete list of participants is
available. In other words, the complete list of all the subjects in the target population must be
obtained (Saunders, Lewis, & Thornhill, 2012). When the purpose is the generalization of theory
and the complete list of participants is not available in a given context then non-probability
sampling is appropriate (Hulland et al., 2017). In the second phase “qualitative” follow-up part,
we conducted 11 interviews, and the time duration was approximately 25 to 30 minutes,
including giving brief orientation about the research and signing of the consent forms from the
respondents. All the participants (nursing staff) interviewed were females.
3.4 Quantitative Data Analysis Phase
In quantitative phase, the causal relationships among studied variables were examined.
The data was collected through self-administered questionnaire from six public sector hospitals
of nursing staff. Partial least squares (PLS), specifically SmartPLS v. 3.2.3 was used to test the
study model, we used PLS for both measurement and the structural model. The choice of PLS
over co-variance based technique was due to the following reasons: (1) PLS is soft as far as the
60
assumptions about the distribution of variables, there is no strict assumptions (2) The focus of the
present study was on the development of theory with introducing new mediator and moderator;
and (3) finally the study model is challenging to test while using SEM particularly with the
inclusion of interaction term (Henseler, Ringle, & Sinkovics, 2009; Chin, 2010; Hair, Ringle, &
Sarstedt, 2011).
3.5 Structural Equation Modeling (SEM)
(SEM) Structural equation modeling is a latest technique and has become the choice for
researchers to use for data analysis (Hair, Ringle, & Sarstedt, 2011). Through SEM researchers
are testing difficult and complex relationships between studied variables particularly latent
constructs that in past could not be easily tested. Structural equation modeling (SEM) has seen a
remarkable rise in interest and utilization over the last decade. (SEM) Structural equation
modeling is a (MAV) multivariate analytical technique used to concurrently test and estimate
difficult and complex relationships among studied variables (Hair, Hult, Ringle, & Sarstedt,
2016). Partial least squares (PLS) is also a valuable and increasingly applied technique to
examine (SEM) structural equation models. While SEM is similar to (MR) multiple regression in
the judgment that both approaches test relationships between studied variables, SEM is able to at
the same time examine multi-level dependence relationships, means ‘‘where a (DV) dependent
variable becomes an (IV) independent variable in relationships within the same theoretical
model. The advantage of applying (SEM) enables investigators to more effectively evaluate
measurement models and structural model, mainly when the structural model involves multiple
dependent variables, latent variables based on multi-dimension indicator variable in a structural
61
model. SEM helps and facilitates the evaluation/assessment of direct, indirect, interaction and
total effects (Hair, Ringle, & Sarstedt, 2011).
In SEM analysis, researchers focus and consider two kinds of methods: (CB-SEM)
covariance-based techniques (Joreskog, Sorbom, du Toit, & du Toit, 1999) and (VB) variance-
based partial least squares (Lohmöller, 1989; Wold, 1985). Covariance (CB) SEM develops
covariance matrix on structural equations. This technique focuses on decreasing the differences
between theoretical covariance matrix and estimated covariance matrix. However, there are some
assumptions that should be fulfilled for this technique. For example data should be normal and
minimum sample size. If strict assumptions of CB SEM cannot be fulfilled, then researcher
should utilize variance based PLS SEM approach (Hair, Ringle, & Sarstedt, 2011). PLS SEM
works efficiently on complex models and less data and it does not impose rigid assumptions of
normality of data (Hair, Hult, Ringle, & Sarstedt, 2016). PLS SEM uses OLS technique of
regression. It aims to minimize the errors and increase the R2 (Hair, Ringle, & Sarstedt, 2011).
PLS SEM is also suitable where mediating and moderating variables are examined together
(Hair, Hult, Ringle, & Sarstedt, 2016). PLS SEM provides brilliant results in such situations.
That is why in present study PLS SEM is utilized since this study constitutes independent
variable, dependent variable, mediating, moderating and controllable variables all at the same
place.
PLS model is defined through two ways.
1. Structural model
2. Measurement model
62
Structural model is also known as inner model and it also tells us of the relationship
between latent variables (Hair, Hult, Ringle, & Sarstedt, 2016). Measurement model is also
called outer model and it informs us about latent variable and its manifest variables (Henseler,
Ringle, & Sinkovics, 2009). By combining measurement model and structural model we get
complete structural equation model.
3.5.1 Measurement Model. It is however important to differentiate between reflective and
formative measurement model in discussing measurement model (Hair, Hult, Ringle, & Sarstedt,
2013). In reflective measurement models arrows indicate from latent variable to its indicators
whereas, in formative measurement model arrows indicate from indicators to variables
(Henseler, Hubona, & Ray, 2016). This study utilizes reflective measurement model and its
characteristics are given in table-3.1 below.
Table 3.1: Features of reflective measurement models (Petter, Straub, & Rai, 2007)
Path of causality is from construct/variable to its indicators.
Indicators are lexes/expressions of the variable/construct.
Indicators are interchangeable; having a common use and reducing of an
indicator will not interrupt the conceptual scope of construct.
In reflective models indicators and constructs have the related nomological
net.
(RMM) Reflective measurement models are evaluated by (ICR) internal consistency reliability,
(CV) convergent validity and (DV) discriminate validity and indicator reliability (Hair, Ringle,
& Sarstedt, 2011). The guidelines are presented in table 3.2.
63
3.5.2 Internal Consistency Reliability. Cronbach’s alpha was the old ways of checking internal
consistency and it estimated reliability of observed variables on the basis of inter correlations
(Chin, 1998). Cronbach’s alpha has an assumption that indicators are all equally weighted (Chin,
1998). Similarly Cronbach’s alpha is sensitive about number of items, due to which internal
consistency gets underestimated (Hair, Ringle, & Sarstedt, 2011). It is better to use composite
reliability (CR) to check internal consistency reliability (Hair, Ringle, & Sarstedt, 2011). CR
should be greater than 0.70 (Werts, Linn, & Joreskog, 1974; Nunnally, 1978).
3.5.3 Indicator Reliability. Standardized indicator outer loading’s square is also called indicator
reliability (Hair, Ringle, & Sarstedt, 2011). We also name it variance extracted from the item
(Hair, Ringle, & Sarstedt, 2011). Rule of thumb is that latent variable should at least explain 50%
of each indicator’s variance (Hair, Ringle, & Sarstedt, 2011). It means that outer loading of the
indicator should be more than 0.708 because when we will find the square (0.708)2 of this value
it will be equal to 0.50.Usually 0.7 is an acceptable value of outer loading (Henseler, Ringle, &
Sinkovics, 2009).
3.5.4 Convergent Validity. We observe in convergent validity that in same construct, how
positively a measure correlates with other alternative measures (Hair, Ringle, & Sarstedt, 2011).
Generally a convergent validity is checked through a process named average variance extracted
(AVE) and its value should be more than 0.50 (Fornell & Larcker, 1981).
3.5.5 Discriminant Validity. Discriminate validity shows how one construct is different from
other (Hair, Hult, Ringle, & Sarstedt, 2016). Cross loadings is one of the ways through which
discriminate validity can be checked. In which we observe that loadings of one indicator should
be more than loadings of other indicators of the construct (Chin, 1998). The second most
64
commonly used procedure is Fornell Larker’s criteria (Fornell & Larker, 1981). In this method,
the square root value of AVE is compared to correlations of the latent variable. In general, the
square root of each construct’s AVE should be greater than its highest correlation with any other
construct. Finally, we also used HTMT method to check discriminant validity. The HTMT
technique is an estimate for the factor association/correlation (more precisely, an upper
boundary). In order to clearly differentiate between two factors, the HTMT should be
considerably smaller than one (Henseler, Ringle, & Sinkovics, 2009).
Table-3.2: Main guidelines for assessing reflective measurement models
Criterion
Recommendations
Reference
Internal-consistency
reliability (ICR)
CR must be more than 0.70.
(Nunnally, 1978)
Indicator reliability (IR)
Indicator loadings (IL) are expected to
be greater than 0.70.
(Hair, Ringle, &
Sarstedt, 2011)
Convergent validity (CV)
The AVE must be more than 0.50.
(Hair, Ringle, &
Sarstedt, 2011)
Discriminant validity (DV)
An indicator’s loading (IL) on the
related/connected variable/construct
must be greater than all of its (L)
loadings on other variables (i.e., the
cross loadings).
(Chin, 1998)
65
3.6 Evaluation of the Structural Model
The main condition for assessing the structural model are: the goodness of fit R2 values,
the significance of regression coefficients, the f 2 effect sizes along with the q2 effect size, and the
predictive relevance Q2 (Hair, Ringle, & Sarstedt, 2011). The following section discusses each
condition for the evaluation of the structural model.
3.6.1 (COD) Coefficient of Determination (R2 Value). Goodness of fit (R2 value) is mainly
used measure to find the structural model. R2 value explains the variation in (D.V) dependent
variable due to (I.V’s) independent variables. The R2 value lies between 0 and 1. If value is close
to 1 then it is considered a good model (Hair, Ringle, & Sarstedt, 2011). Generally (R2) values of
0.75, 0.50, and 0.25 in PLS models are assumed as substantial, moderate, and weak (Hair, Hult,
Ringle, & Sarstedt, 2016).
3.6.2 Effect Size f2. f 2 helps the researchers to evaluate the size of the effect by using Cohen’s
(1988) f 2 method. Researchers calculated f 2 effect sizes as the increase in R2 relative to the
amount of variation of the dependent/endogenous variable that remains unexplained (Henseler,
Ringle, & Sinkovics, 2009). As per Cohen (1988), values of f 2 which are 0.35, 0.15 and 0.02
respectively, represent large, medium and small effects.
3.6.3 Path Coefficient Estimates. The single path coefficients (PC) of the PLS structural model
can be discussed/inferred and interpreted as standardized beta coefficients of (OLS) ordinary
least squares regressions (Hair, Ringle, & Sarstedt, 2011). Observing the indication of structural
paths using algebraic sign a priori, gives partial experimental justification of theoretically
understood associations between underlying variables (Henseler, Ringle, & Sinkovics, 2009).
66
For significance of path coefficients requires t values examination, bootstrapping assurance
intervals, and p values (Henseler, Ringle, & Sinkovics, 2009; Hair, Ringle, & Sarstedt, 2011).
3.6.4 Predictive Relevance q2 and Q2. An added estimation of structural model establishes its
competence to forecast. Stone-Geisser’s Q2 is the leading assessment of predictive relevance
(Stone, 1974) and it may be considered by means of blindfolding procedures. In the structural
model, values of Q2 more/greater than zero show that the (IV) independent variables have
predictive relevance for the (DV) dependent variable under consideration (Hair, Ringle, &
Sarstedt, 2011). Related to the f 2 effect size method to evaluate R2 values, the relative effect of
predictive relevance (PR) can be matched by means of the measure to the q2 (EZ) effect size
(Hair, Ringle, & Sarstedt, 2011). The guidelines for assessing the structural model are presented
in Table 3.3.
67
Table 3.3: Guiding principles’ summary for structural model evaluation
Condition
Recommendations
R2 value
R2 values of (0.25), (0.5) or (0.75) can
be described as low, moderate and
high respectively in the structural
model.
(Hair, Ringle, &
Sarstedt, 2011)
Effect size f 2
f 2 : (0.35), (0.15) and (0.02) show
large, medium and small effects.
(Cohen, 1988)
Estimate Path coefficient
Path relationships expected values in
the structural model needs to be found
with respect to scale, sign and
implication (the latter through
bootstrapping).
(Chin, 1998)
Predictive relevance Q2 and
q2
Use blindfolding; Q2 > 0 is analytical
of predictive relevance; q2: 0.35, 0.15
and 0.02, is large, medium and small
degree of predictive relevance.
(Stone, 1974)
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3.7 Evaluation of Underlying Assumptions of Multivariate Data
To estimate any multivariate model, it is necessary for researchers to test the underlying
assumptions because these assumptions have a significant impact on the multivariate
associations they represent (Hair, Ringle, & Sarstedt, 2011).
3.7.1 Multivariate Outliers. In present research, the Mahalanobis D2 statistic was utilized to
detect multivariate outliers. Mahalanobis D2 is a multidimensional form of a z-score. Generally,
the detection of multivariate outlier case is related with its D2 is 0.005 or less, which follows a
chi-square distribution with degrees of freedom equal to the number of independent variables
included in the analysis. After careful evaluation of multiple operations of the Mahalanobis D2
statistic, there was no case detected as a multivariate outlier.
3.7.2 Missing values Analysis. In quantitative phase, 382 employees were invited to participate
and 324 employees (response rate 84.8.1%) agreed to participate. In 324, as far as missing values
are concerned so there were total of eight missing values from 3 respondents who did not
respond at least one question among the total of 5 variables. One participant left two values
missing and the rest of the two respondents with three values missing, indicating none of 324
respondents had more than 2 % of no response rate. Taken altogether, no sequence/patterns with
underlying missing data process were recommended. Therefore, any omission of the variables
and/or cases was considered not to be required to improve the missing data problem. In present
study mean imputation (Hair, Hult, Ringle, & Sarstedt, 2013) was suitable considering the
sample size, so all of the 8 missing values were replaced with a mean score of all the other values
in the variables.
69
3.7.3 Normality Test. Generally, there exists no direct and complete test for multivariate
normality, so, a rule of thumb would be to examine each construct independently and assume
that they are multivariate normal if they are individually normal (Hair, Hult, Ringle, & Sarstedt,
2013). One of a few techniques of testing normality of data is to screen for skewness and kurtosis
values, which is a normally done procedure. The values of skewness between -1 and +1 are
considered excellent and between -2 and +2 acceptable as is same to kurtosis values (Hair, Hult,
Ringle, & Sarstedt, 2013). In present study, this criterion was used for normality test. The values
of skewness and kurtosis were within the -2 and +2 acceptable range.
3.8 Measures
The present study includes one dependent variable (Turnover intentions), one mediating variable
(Job stress), one moderating variable (Political skill) and one independent variable (Personal
bullying). The descriptive statistics of each of these measurement variables is presented and
discussed in the following section of “Descriptive statistics for the study variables”. The
standardized instruments were utilized to measure the variables in present research.
3.8.1 Personal bullying. Personal bullying acts were assessed using the (NAQR) Negative Acts
Questionnaire-Revised (Einarsen, Hoel, & Notelaers, 2009) comprising 12 items. For each item,
respondents were requested to indicate how often they have faced/experienced these negative
behaviors at work place from doctors, during the last six months, with the response alternative:
‘‘Never,’’ ‘‘Now and then,’’ ‘‘Monthly,’’ ‘‘Weekly,’’ and ‘‘Daily’’. A sample item is ‘Being
shouted at or being the target spontaneous anger’. The (CR) Composite Reliability for the P.B
scale was 0.928.
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3.8.2 Turnover Intentions. Turnover intentions were assessed using 3 items developed by
(Mobley, Horner, & Hollingsworth, 1978). A sample item is ‘I think a lot about leaving the
organization.’ CR for the scale was 0.847.
3.8.3 Political skill. We measured political skill with uni-dimensional 6-item scale (Ahearn,
Ferris, Hochwarter, Douglas, & Ammeter, 2004). A sample item is ‘It is easy for me to develop
good rapport with most people’. The CR for the P.S scale was 0.953.
3.8.4 Job stress. Job stress was measured with 5 items (Lambert, Hogan, Camp, & Ventura,
2006). A sample item is ‘When I’m at work I often feel tense or uptight.’ CR for the scale was
0.855.
3.8.5 Demographic control variables. In present study, age and education were included in the
structural model as control variables. These two variables were assumed to effect employee
turnover intentions (Griffeth, Hom, & Gaertner, 2000).
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3.9 Qualitative Phase
Generally, in qualitative phase the main emphasizes is on words rather than numbers and
quantification as far as data analysis is concerned. The paradigm which researchers follow is
interpretivist. Researchers agreed that qualitative research differs from quantitative research.
Most clearly, qualitative research inclines towards social settings and words rather than numbers.
The focus is on the social settings and point of view of participants. The data is unstructured here
and may face generalization issue in research settings. In qualitative work, researchers focus on
individual and groups, how they describe social or human problem. In present study, the
interview questions for the qualitative phase were open-ended and most of them were adapted
from the questionnaire developed by Shahzad & Malik (2014). In interview guide, there were
questions such as, “Have you experienced or witnessed an incident of personal bullying?” “How
worried are you about personal bullying in your current workplace?” and “In your opinion, what
are the impacts of personal bullying on nurses’ daily life and work?” The researchers read all
interviews independently and used NVivo software for information processing.
For qualitative interview data analysis, grounded theory method (Strauss & Corbin, 1990)
was used in the current research. In Management sciences field, grounded theory technique is a
systematic methodology involving the development of theory through the analysis of interview
data. Grounded theory is a technique which works in a reverse direction from positivist research.
Grounded theory starts with the collection of interview data. Researcher follows few systematic
steps in grounded theory. Researcher examines the interview data in detail, repeated concepts are
examined critically and are labeled with codes. From codes researcher make concepts, and then
these concepts are converted into categories. Finally, these categories become the basis for new
72
theory. Moreover, in NVivo, we used text search, word cloud, cluster analysis, and matrix coding
queries.
3.10 Research ethics
The issue of ethics in research is very important (Sekaran, 2003). This issue becomes
more important/vital if the research involves contact with the members who work as participants
in the study (Polonsky & Waller, 2011). In view of Cooper and Emory (1995) the
scientist/researcher should follow few steps to take care of the rights of respondents: (1) During
data collection stage researcher must communicate the respondents about the possible benefits
expected from the study, (2) researcher must explain the respondents that their rights will be safe
and protected by maintaining complete secrecy and privacy of the responses, and (3) researcher
must ask the respondents to read the informed consent form.
As said by Polonsky and Waller (2011), there are six common ethical points that should
be considered in research studies: (1) The most important is voluntary participation, (2)
communicating informed consent, (3) communicating the major findings, (4) privacy and
secrecy, (5) the possibility for damage, (6) no conflict of interest. The important ethical advices
as discussed above, the cover letter of questionnaire communicated the participants the benefits
expected from the research work, promising/assuring respondents that their rights will be secure
and completely safe by maintaining complete secrecy and privacy of the responses, and also
communicated participants that the questionnaire has few sensitive questions/items and they are
always free not to answer any sensitive question/item that makes them uncomfortable and
painful.
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CHAPTER 4: RESULTS
The main objective of the study was to examine the relationship between personal
bullying and turnover intentions of nursing staff with the inclusion of job stress as mediator and
political skill as moderator by using mixed methods. Results are presented and discussed in
detail starting from respondent’s profile, descriptive statistics, reliability and validity of
measures, bivariate correlations followed by structural equation modeling and also qualitative
findings. In the end the integration of quantitative and qualitative findings were also discussed.
4.1 Respondents profile
In present study, we first discussed the quantitative phase and after that we discussed the
qualitative phase. In quantitative phase, data was collected from 324 nursing staff of public
sector hospitals in Pakistan. The data collection took place from six public sector hospitals of
Islamabad and Rawalpindi. The average age of respondents was 39 years, and the average
organizational tenure was 11 years. Respondents were well-educated, with majority holding a
Bachelor’s degree or higher. In the qualitative follow-up, a total of 11 interviews were
conducted, and each interview took 25 to 30 minutes, including consent forms signed and an
orientation about the interviews. Interviewees included nurses who volunteered to participate in
interviews. All the nurses interviewed were females. Demographics of quantitative phase are
reported in Table 4.1.
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Table 4.1: The Main Characteristics of the Sample (N = 324)
Characteristics
Frequency
Percent
Gender
(Male)
(Female)
0
324
0%
100%
Age
(Less than 30 years)
(30-40 years)
(More than 40 years)
90
99
135
28%
31%
41%
Educational Level
(12 years degree)
(14 years degree)
(16 years degree)
119
153
52
37%
47%
16%
Tenure
(Less than 5 years)
(5-10 years)
(More than 10 years)
39
125
160
12%
39%
49%
75
4.2 Descriptive Statistics and Reliability of Measures
The descriptive statistics such as mean (M), standard deviation (SD), skewness , kurtosis
and reliability(α) measures are reported in Table - 4.2 of studied variables, the variable personal
bullying showed the consistency among the items (α = 0.914), job stress (α = 0.744), political
skill (α = 0.941), and turnover intentions (α = 0.729). Skewness between -1 and +1 is considered
excellent and between -2 and +2 acceptable as is same to kurtosis (Hair, Hult, Ringle, & Sarstedt,
2013). This criterion was used for normality test in this study. The kurtosis and skewness values
of the indicators were within the -2 and +2 acceptable range.
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Table 4.2: Mean, Standard deviation, Skewness, Kurtosis, Cronbach, Items Description
Latent Variable Indicator’s Skewness Kurtosis Mean Std.Dev Cronbach’s
Alpha
Personal
bullying
PB1
PB2
PB3
PB4
PB5
PB6
PB7
PB8
PB9
PB10
-0.601
-0.578
-0.499
-0.529
-0.588
-0.558
-0.504
-0.598
-0.525
-0.550
-0.450
-0.360
-0.480
-0.288
-0.282
-0.508
-0.301
-0.365
-0.390
-0.302
3.65
3.65
3.74
3.73
3.83
3.66
3.66
3.82
3.80
3.83
1.15
1.09
1.06
1.01
1.01
1.12
1.01
1.04
0.98
1.00
0.914
Job stress
JS1
JS2
JS3
-0.516
-0.594
-0.696
0.071
-0.196
0.248
3.96
3.70
3.91
0.80
1.01
0.92
0.744
Political Skill
PS1
PS2
PS3
PS4
PS5
PS6
-0.321
-0.357
-0.446
-0.268
-0.312
-0.489
-1.18
-0.717
-1.168
-1.152
-1.131
-0.591
3.50
3.53
3.65
3.46
3.46
3.66
1.31
1.31
1.18
1.29
1.30
1.16
0.941
Turnover
Intentions
TI1
TI2
TI3
-0.660
-0.626
-0.814
0.140
0.144
1.169
3.92
3.91
3.90
0.87
0.88
0.85
0.729
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4.3 Structural Equation Modeling
Partial least squares (PLS), specifically SmartPLS v. 3.2.3 (Ringle, Wende, & Becker,
2015), was used to estimate both the measurement and the structural model. The preliminary
output includes metrics to evaluate the measurement features of the outer model, which is what
the variables/constructs and their indicators are called in PLS-SEM. The standard metrics
provided by SmartPLS are the indicator loadings, path coefficients, cross loadings, interconstruct
correlations, Cronbach alphas and composite reliability, convergent validity (AVE), latent
variable scores, t-values, and more. In present study, a systematic process of examining the
loadings and removing indicators with loadings below .70 was followed (Hair, Ringle, &
Sarstedt, 2011). The result was the elimination of two items of the original 12 items scale of
personal bullying. Note that the two items were also eliminated from the job stress scale. All
item loadings were above the threshold value of 0.7, except for two items from the personal
bullying scale and two items from the job stress scale. Owing to their weak loadings, these four
items were removed from further analysis. In PLS-SEM model, first we examined the outer
model in an effort to validate the measurement model (Hair, Hult, Ringle, & Sarstedt, 2013).
4.3.1 Measurement Model. In present study, there were four latent variables with reflective
measurement models (personal bullying, turnover intentions, job stress, and political skill). In
our final model, after removing two items from personal bullying, and dropped two items from
job stress scale, all outer loadings of the reflective constructs personal bullying, job stress,
political skills, and turnover intentions were well above the threshold value of 0.70. Only one
indicator PB_7 still showed 0.679 loading but we retain this item in our final model because our
reliability did not affect after removing it and as it is closed to 0.7. The composite reliability
78
values of 0.928 (personal bullying), 0.847 (turnover intentions), 0.855 (job stress), and 0.953
(political skill) demonstrated that all reflective constructs have high levels of internal consistency
reliability. Convergent validity assessment builds on the AVE value as the evaluation criteria. In
the present study, the AVE values of personal bullying (0.563), turnover intentions (0.649), job
stress (0.664), and political skill (0.774) are well above the required minimum level of 0.50
(Hair, Hult, Ringle, & Sarstedt, 2013), thus indicating convergent validity for all constructs.
Results are presented in table - 4.3.
Table- 4.3: Results summary for reflective measurement model
Latent Variable Indicator’s Loadings Composite
Reliability
AVE Convergent
validity
Personal bullying
PB1
PB2
PB3
PB4
PB5
PB6
PB7
PB8
PB9
PB10
0.786
0.700
0.822
0.736
0.761
0.772
0.679
0.803
0.708
0.724
0.928
0.563
Yes
Job Stress
STRESS1
STRESS2
STRESS3
0.797
0.808
0.839
0.855
0.664
Yes
Political Skill
PS1
PS2
PS3
PS4
PS5
PS6
0.931
0.934
0.757
0.932
0.936
0.766
0.953
0.774
Yes
Turnover Intentions
TI1
TI2
TI3
0.804
0.829
0.782
0.847
0.649
Yes
79
Finally, the HTMT, Fornell-Larcker criterion and the cross loadings methods were used
for discriminant validity. The HTMT is an estimate for the factor correlation (more precisely, an
upper boundary). In order to clearly discriminate between two factors, the HTMT should be
significantly smaller than one. Table- 4.4 shows that all variables achieve discriminant validity.
Table-4.4: Heterotrait-Monotrait Ratio (HTMT)
P.B P.S STR T.I
P.B
P.S 0.090
J.S 0.488 0.141
T.I 0.530 0.062 0.596
Note: P.B = Personal bullying; P.S = Political Skill; T.I = Turnover Intentions and J.S = job
stress
According to the guideline given by Fornell-Larcker, the square root of the Average
variance extracted (AVE) of each variable should be greater than the variable’s highest
correlation with any other variable in the studied model. Table-4.5 shows the final results of the
Fornell-Larcker criterion assessment with the square root of the reflective construct’s AVE on
the diagonal and the correlation between the constructs in the lower left triangle. In present
study, overall, the square roots of the AVEs for the reflective constructs personal bullying
(0.750), job stress (0.814), turnover intentions (0.805), and political skill (0.879) are all higher
than the correlations of these constructs with other variables in the path model. From the analysis
it is noted that personal bullying is positively correlated to turnover intentions (r = 0.437**,
p<0.01), similarly, personal bullying is positively correlated to job stress (r = 0.406**, p<0.01),
80
and job stress is positively correlated to turnover intentions (r = 0.443**, p<0.01). Results are
presented in table 4.5.
Table 4.5: Fornell–Larcker test for discriminant validity
S.NO Variables Mean Std.Dev Age Edu P.B J.S P.S T.I
1 Age 38.6 10.26
2 Edu 13.5 1.3 0.007
3 P.B 3.7 0.79 -0.010 -0.120 0.750
4 J.S 3.8 0.74 0.03 -0.056 0.406** 0.814
5 P.S 3.5 1.11 0.030 0.056 0.039 0.119* 0.879
6 T.I 3.9 0.70 -0.012 -0.012 0.437** 0.443** 0.040 0.805
Diagonal values in bold are square root of the AVEs and off-diagonal values are correlations
between the constructs.
Note: Edu = Education; P.B = Personal bullying; J.S = Job stress; P.S = Political Skills; T.I =
Turnover Intentions
*p < .05, **p < .01
Alternatively, cross loadings were also reported in present study. Discriminant validity is
proved when an indicator’s loading on a construct is higher than all of its cross loadings with
other constructs (Hair, Ringle, & Sarstedt, 2011). Table-4.6, shows the loadings and cross
loadings for every indicator. All indicator loadings were higher than their respective cross
loadings, providing further evidence of discriminant validity. Thus, overall discriminant validity
was achieved with the PLS-SEM analysis. Results are presented in table 4.6.
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Table: 4.6- Cross Loadings
Political Skill Job stress Turnover
Intentions
Personal
Bullying
PS_1 0.9307 0.1041 0.048 0.0783
PS_2 0.9338 0.0943 0.0293 0.0616
PS_3 0.7575 0.1048 0.0298 -0.0182
PS_4 0.9323 0.1148 0.0585 0.0736
PS_5 0.9362 0.1012 0.0418 0.066
PS_6 0.7662 0.1064 0.0029 -0.0406
JS_1 0.0746 0.7972 0.3279 0.3317
JS_2 0.085 0.8081 0.3678 0.356
JS_3 0.1301 0.8392 0.3855 0.2945
T.I_1 0.0115 0.3436 0.8043 0.3401
T.I_2 -0.0055 0.3971 0.8291 0.3738
T.I_3 0.0989 0.3265 0.7822 0.3349
PB_1 -0.0278 0.2618 0.3853 0.7861 PB_2 0.0953 0.2297 0.2616 0.7001 PB_3 -0.0016 0.3188 0.3625 0.8221 PB_4 0.0459 0.3561 0.2982 0.7361 PB_5 0.0446 0.3567 0.3113 0.7612 PB_6 -0.0278 0.2731 0.3757 0.7721 PB_7 0.1173 0.2692 0.2449 0.6791 PB_8 0.0258 0.2775 0.3549 0.8031 PB_9 0.0252 0.3394 0.2995 0.7081 PB_10 0.0359 0.3408 0.3587 0.7243
The indicator JS_1 has the highest value for the loading with its corresponding construct
job stress (0.7972), while all cross loadings with other constructs are considerably lower. The
same findings hold for the other indicators of job stress as well as the indicators measuring
turnover intentions, political skill, and personal bullying. Overall, HTMT, cross loadings as well
as the Fornell-Larcker criterion provided evidence for the constructs discriminant validity.
4.3.2 Structural Model. We used a data set with 324 observations for our empirical PLS-SEM
analysis. Before interpreting the results, the researchers checked the structural model for
collinearity issues. We used latent variable scores for assessing the collinearity issues. Each
82
predictor constructs tolerance value should be higher than 0.20 and VIF (variance inflation
factor) value should be lower than 5 (Hair, Ringle, & Sarstedt, 2011). If this criteria fulfilled than
there is no issue of collinearity. Results are presented in table-4.7.
Table 4.7: Collinearity Assessment (Turnover Intentions: Dependent Variable)
Constructs VIF Tolerance
Personal bullying 1.192 0.839
Job stress 1.208 0.828
Political Skill 1.015 0.986
All VIF values are clearly below the threshold of 5. Therefore, collinearity among the
predictor constructs is not an issue in the structural model, now we can continue to examining
the path coefficients. Similarly, we also checked the heteroscedasticity issue in error terms
through scatter diagram and that there was no issue of heteroscedasticity in error terms, the error
variance was constatnt. Additionally, we also conducted unmeasured latent methods factor test
(Podsakoff, MacKenzie, Lee, & Podsakoff, 2003) to address the common method variance issue.
The results indicated that common method bias was not a problem in the present study.
The path co-efficient’s enable us to understand the relationship among the variables.
Personal bullying has a positive direct effect on turnover intentions (β = 0.313, p value < 0.05).
Personal bullying has a positive direct effect on job stress (β = 0.403, p value < 0.05). Job stress
has a positive direct effect on turnover intentions (β = 0.318, p value < 0.05). As a rule of thumb,
path coefficients with standardized values above 0.10 are generally significant and those with
values below 0.10 are usually insignificant (Hair, Hult, Ringle, & Sarstedt, 2013). In present
study, we also evaluated the path co-efficient’s for their significance by means of bootstrapping
which is a latest technique. In this study, 1,000 bootstrap subsamples were used to measure the
83
significance of path co-efficient’s. After running the bootstrap, SmartPLS showed the t values.
The critical value for significance level of 5% (α = 0.05) probability of error was 1.96 was used
in present study. If calculated T-value is greater than the critical value then we conclude that path
coefficient is significant. As shown in Figure 4.1, the R2 for job stress was 0.176 and the R2 for
turnover intentions was 0.277. Together, the results implied a satisfactory and substantial model.
Finally, the analysis of control variables suggested that the effects of age and education on
turnover intentions were insignificant. Results are presented in Figure- 4.1 and Table: 4.8.
Table: 4.8 Results of Main effect model
Hypothesis
Hypothesis Paths
Path co-efficient’s
T-values
Accept/reject significance
H1 P.B T.I 0.313 3.172 Accept**
H2 P.B JS 0.403 4.120 Accept***
H3 JS T.I 0.318 2.716 Accept**
PS JS 0.103 1.015 Insignificant
Age T.I -0.020 0.239 Insignificant
Education T.I 0.040 0.446 Insignificant
Note: P.B = Personal bullying, T.I = Turnover Intentions, JS = Job Stress, PS = Political Skills,
Critical t-values for a two-tailed test are: < 1.96 (p = .05**), and for one tail < 1.6 (p = .05**).
84
In next step, for hypothesis 4, we checked the effect of mediating variable, whether job
stress mediates the relationship between personal bullying and turnover intentions. A necessary
condition is the significance of the relationship between personal bullying and job stress (i.e., β =
0.403) as well as between job stress and turnover intentions (i.e., β = 0.318). This was confirmed
by the evaluation of the structural model results. The indirect effect’s size is 0.128, and its
significance was again tested using the bootstrap subsamples. The indirect effect was the product
of the direct effects between personal bullying and job stress as well as between job stress and
turnover intentions. The product of these direct effects needed to be computed for each of the
Figure
e
– 4.1: A Main Effect Model
0.103(1.015) - 0.020(0.239)
0.403(4.120) 0.318(2.716)
0.313(3.172) 0.040(0.446)
Note: t - values in parenthesis
: Direct effect
(IV) Personal Bullying
Moderator
Political Skill
R 2 = 0.277 (D.V)
Turnover Intentions
R 2 = 0.176
Job
Mediator
Stress
Age
Education
85
1,000 subsamples. In present study, the bootstrapping standard deviation (which equals the
standard error in bootstrapping) has a value of 0.055. The t value of the indirect effect is
0.128/0.055 = 2.327 and we concluded that the role of job stress as mediating variable is
significant. Bootstrapping results of the indirect effect are presented in table- 4.9.
Table-4.9: Bootstrapping Results of the indirect effect
PB JS
Path a
JS T.I
Path b
Indirect effect
Ab
Sample 0 0.360 0.159 0.057
Sample 1 0.364 0.475 0.173
Sample 2 0.385 0.197 0.076
Sample 3 0.415 0.420 0.174
Sample 4 0.362 0.289 0.105
Sample 5 0.382 0.372 0.142
Sample 6 0.406 0.554 0.225
Sample 7 0.427 0.241 0.102
Sample 8 0.337 0.266 0.089
Sample 9 0.386 0.373 0.144
Sample 10 0.632 0.428 0.270
……….. ………. ……… ………
Sample 999 0.624 0.442 0.276
Note: PB = Personal bullying, TI = Turnover Intentions, JS = Job stress
The significant indirect effect concluded that job stress mediates the relationship between
personal bullying and turnover intentions. Furthermore the strength of mediation was also
analyzed. The direct effect of personal bullying on turnover intention was 0.313, while the
indirect effect via job stress was 0.128. Thus, the total effect had a value of 0.313 + 0.128 =
0.441. The VAF equals the in direct effect divided by the total effect and had a value of
0.128/0.441 = 0.290. Consequently, 29 % of personal bullying effect on turnover intentions was
explained via the job stress mediator. Since the VAF was greater than 20% but less than 80%,
this condition can be considered as partial mediation.
86
In next step, for hypothesis-5, we analyzed the moderating role of political skill in the
relationship of personal bullying and job stress. We hypothesized political skill negatively
influence the relationship between personal bullying and job stress. The higher the political
skills, the weaker the relationship between the two constructs. Results are presented in table-4.10
and figure-4.2.
Table: 4.10: Results of PLS-SEM Moderation Model
Hypothesis Hypothesis Path Path co-efficient T-value Accept/reject
significance
H4 Interaction JS -0.249 2.221 Accept**
Note: Interaction = Interaction between PB and Political skills, JS = Job stress, Critical t-values
for a two-tailed test are: >1.96 (p < .05*), and for one tail >1.6 (p < .05*)
87
Results showed that the interaction of political skill and personal bullying has a negative
effect on job stress (-0.249). The relationship between personal bullying and job stress (i.e., the
simple effect in the moderator model) had a value of 0.394. If the political skill become higher
(i.e., political skills is increased by one standard deviation point), this would imply that the
relationship between personal bullying and job stress would decrease by the size of the
interaction term and obtain the value of 0.394 – 0.249 = 0.145. Hence, when political skills get
higher, personal bullying becomes less important for the explanation of job stress. Exactly the
opposite kind of interpretation holds for situation of lower political skills (i.e., political skills is
decreased by one standard deviation point).
Figure: 4.2: Interaction effect model: Political skill as Moderator
0.107(1.078) - 0.020(0.234)
- 0.249(2.221)
0.394(4.569) 0.319(2.696)
0.312(3.177) 0.040(0.452)
Note: t - values in parenthesis
: Direct effect
: Moderating effect
(IV) Personal Bullying
Moderator
Political Skill
R 2 = 0.278 D.V
Turnover Intentions
R 2 = 0.238
Job
Mediator
Stress
Age
Education
88
Here, personal bullying would increase in its importance for explaining job stress. Such
conclusion only holds, however, when the interaction term is significant. Consequently, we run
the bootstrapping procedure with 324 bootstrap cases, 1000 bootstrap samples were used the no
sign changes option, and mean replacement for missing values to conduct the significance test
for the relationship between the interaction term and job stress. The analysis yields a t value of
2.221 for the path linking the interaction term and job stress. Therefore, we found support for a
significant moderating effect of political skills on the relationship between personal bullying and
job stress. The figure 4.3 is also showing a moderating effect of political skills.
Figure 4.3: Interaction between personal bullying and political skill
The effect size f2 allows evaluating an independent variables contribution to dependent
variables R2 value. The f2 values of 0.02, 0.15, and 0.35 indicate an exogenous constructs small,
1
1.5
2
2.5
3
3.5
4
4.5
5
Low Personal Bullying High Personal Bullying
Job
Str
ess
Low Political
skill
89
medium, or large effect, respectively, on an endogenous construct. In present study, accordance
with the rules of thumb for the f2, the effect size of job stress mediating variable can be
considered small. Results are presented in Table-4.11.
We also used blindfolding to obtain cross-validated redundancy measures for mediating
and moderating construct. The computation of the q2 effect size is an analogous procedure.
However, instead of the R2 values, the q2 values of the predictive relevance are used as inputs
(after running the blindfolding procedure). For example, the endogenous latent variable turnover
intention has a q2 value of 0.1795 (q2 included). After deleting job stress from the path model and
re-estimating the model with the blindfolding procedure, the q2 of turnover intentions only has a
value of 0.1231 (q2 excluded). These two values are the inputs for computing the q2 effect size of
job stress on turnover intentions. As a relative measure of predictive relevance q2, values of 0.02,
0.15, and 0.35 respectively indicate that an exogenous construct has a small, medium, or large
predictive relevance for a certain endogenous construct. Here, the q2 effect size for this
relationship can be considered low.
Table-4.11: Effect size and predictive relevance for mediating variable job stress
Summary of
Results
R2 value Q2 value Path co-
efficient
F2 effect
size
q2 predictive
relevance
PB---JS-----TI 0.280 0.1795 0.402, 0.319
PB ----- T.I 0.190 0.1231 0.436
0.125 0.068
Note: PB = Personal bullying, TI = Turnover Intentions, JS = Job stress
F2 effect size = R2incl - R2
excl / 1 - R2incl
0.280 – 0.190 / 1- 0.280 = 0.125
90
q2 predictive relevance = Q2incl - Q2
excl / 1 - Q2incl
0.1795 - 0.1231 / 1 - 0.1795 = 0.068
Similarly, In accordance with the rules of thumb for the f2, the effect size of political skill
moderating variable can be considered small. The q2 effect size for this relationship can also be
considered low. Results are presented in Table-4.12.
Table-4.12: Effect size and predictive relevance for moderating variable political skills
Summary of Results R2 value Q2 value F2 effect
size
q2 predictive
relevance
PB, PS, Interaction --- JS 0.238 0.1501
PB, PS ----- JS 0.172 0.1140
0.086 0.042
Note: PB = Personal bullying, PS = Political Skills, Interaction = PB*PS, JS = Job stress
F2 effect size = R2incl - R2
excl / 1 - R2incl
0.238 – 0.172 / 1- 0.238 = 0.086
q2 predictive relevance = Q2incl - Q2
excl / 1 - Q2incl
0.1501 - 0.1140 / 1 - 0.1140 = 0.042
91
Additionally, PROCESS (Hayes, 2013) estimates the conditional effect of personal
bullying on turnover intentions via job stress. However, this part was not hypothesized in present
study. Table – 4.13 shows that the indirect effect of personal bullying on turnover intentions via
job stress is generally positive and decreases with increasing levels of political skill, even turning
negative at some stage. Therefore, job stress mediates the influence of the personal bullying on
turnover intentions as long as a low level and medium level of political skill exists. Otherwise,
the indirect effect is non-significant.
Table 4.13: Conditional indirect effects of personal bullying on turnover intentions at values of
political skills as moderator (process, Hayes Model)
Mediator Political Skill Effect Boot SE BootLLCI BootULCI
Job Stress -1.0015 .2055 .0491 .1135 .3094
Job Stress .0000 .1262 .0332 .0674 .1976
Job Stress 1.0015 .0468 .0294 -.0022 .1159
Note: Values for political skills (PS) (moderator) are the mean and plus/minus one standard
deviation (SD) from mean.
92
Table 4.14: Decision about hypothesis
S.No Hypothesis Decision
Hypothesis-1
“There is a positive relationship between
personal bullying and turnover intentions”
Accept
Hypothesis-2
“There is a positive relationship between
personal bullying and job stress”
Accept
Hypothesis-3
“There is a positive relationship between job
stress and turnover intentions”
Accept
Hypothesis-4
“Job stress partially mediates
between personal bullying and turnover
intentions”
Accept
Hypothesis-5
“Political skill moderates between personal
bullying and job stress”
Accept
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4.4 Qualitative Phase
Moreover, 11 qualitative interviews were conducted from nurses in present study to
validate the quantitative findings, the demographics are presented in table-4.15. In present study
we used NVIVO software for information processing. The grounded theory method helps
researchers for open coding (Strauss & Corbin, 1990). As discussed earlier, grounded theory
technique is a systematic methodology involving the development of theory through the analysis
of qualitative interview data. Grounded theory is a sound technique which works in a
reverse/opposite direction from positivist research. Grounded theory follows systematic steps. It
starts with the collection of interview data. Researcher follows few systematic steps in grounded
theory. Researcher examines the interview data in detail, repeated concepts are examined
critically and are labeled with codes. From codes researcher make concepts, and then these
concepts are converted into categories. Finally, these categories become the basis for new theory.
Furthermore, In NVivo, we used text search, word cloud, cluster analysis, and matrix coding
queries for information processing. The main objective of qualitative phase was to validate the
quantitative findings. The major qualitative findings are reported below.
94
4.4.1 Qualitative Findings
In this study, qualitative interviews of nurses were held. During interviews nurses reported
that;
“It is an everyday practice for us to deal with difficult situations. Nursing is a difficult and
demanding profession. Doctors sometimes use harsh words. Some doctors are nice and they
take care of us but sometimes they insult us.”
Another nurse added;
“Verbal abuse is the most common form of personal bullying that we face. Once I was
talking to my family member on the phone, I had to give them an important message from
someone, when I came inside the room, a patient was sitting with the doctor. The doctor
insulted me in front of the patient and said that you don’t concentrate on your work. You are
negligent and you are always busy on phone.”
A nurse further said;
“Once an old doctor proposed me, I rejected his proposal and said that I am the age of your
daughter, to this he showed verbal aggression and I left the room.”
One more nurse added;
“On one occasion, a patient with his family was waiting for his turn. After a long time they
didn’t get their turn because doctor was busy with some other patients. When I asked to
doctor that patients are waiting, he behaved so rudely with me.”
95
Another nurse shared her views in these words;
“Our working culture needs to be improved, nurses are undermined and our environment is
not suitable for nurses. We don’t share with others about personal bullying incidents due to
shame and fear.”
A nurse was of the view;
“Personal bullying incidents cause’s health hazards to the nurses, their mood gets off, their
entire day goes unpleasant and job stress rises. Their work gets affected and they feel like
quitting. She also added that we are not trained to tackle bullying incidents.”
Another nurse added;
“There are some nurses who are elderly and are working for a long time. They have adjusted
to this atmosphere, they know how to tackle the situations and they have less turnover
intentions. Moreover, nurses who have political skill are not only aware of themselves but
they also understand others, they take less job stress and their work doesn’t get affected as
well. Nurses having political skills are less threatened by bullying incidents and they know
how to get out of difficult situation.”
A nurse suggested;
“Policies should be developed at government and organizational levels in favor of nurses so
that they feel safe at workplace. Their workload should be reduced, improvement in work
96
facilities and discouraging bullying incidents can reduce the turnover intentions of nursing
staff.”
Some senior nurses informed that;
“Now circumstances are getting better, We have seen situation ten years ago and we are
witnessing conditions now, overall improvement is visible, but if we compare it with other
countries improvement is still required.”
Few more stories;
“I am not fully satisfied, as you know that we have financial problems so we have to work and
face problems. Life is very difficult for women in Pakistan. Our working environment is not
supportive and frequently people misbehave with us.”
“I am very much worried. We are basically low in ranks so those people who are superior to us,
sometimes they rudely behave with us.”
“Yes many times I have observed bullying incidents and also experienced such shocking events.
Most of our colleagues are good but few people have always attitude problems so they
misbehave with us.”
“We feel job stress when we experience bullying incidents, we feel bad and cannot concentrate
on work. Our whole life gets upset.”
“Those nurses who have high political skills they take less job stress. They are more social, they
share their experiences and gets normal. Political skill is necessary for nurses”.
97
It is observed that by and large nurses leave their job due to bullying incidents.
Sometimes nurses have to bear the brunt of others for example, if the doctor doesn’t come in
time for checkup or patients have to stand in long queues for fee payment, patients and their
attendants misbehave with the nurses even when the nurses don’t have to do anything with these
problems. Similarly it is also observed that sometimes when number of patient’s increases, the
nurses can’t pay attention to all simultaneously or they can’t stay with the doctors all the time, in
such cases doctors verbally misbehave with the nurses. Unfortunately there are no proper rules or
procedures in hospitals, which nurses might follow to report against bullying instances. In some
hospitals there are procedures to report bullying but they are not handled properly which result in
increased rate of bullying. Successful anti-bullying strategies in healthcare settings can improve
nurses’ morale and organizational effectiveness. Additionally, improvement in work
environment can improve the quality of care provided as well as retention of the nursing staff in
public sector hospitals in Pakistan.
98
Table 4.15: The Main Characteristics of the Sample (N = 11).
Characteristics
Frequency
Percent
Gender
Male
Female
0
11
0%
100%
Age
Less than 30 years
30-40 years
More than 40 years
02
04
05
18%
36%
46%
Educational Level
12 years degree
14 years degree
16 years degree
03
06
02
27%
55%
18%
Tenure
Less than 5 years
5-10 years
More than 11 years
02
03
06
18%
27%
55%
As discussed earlier that in present study, the interview questions for the qualitative phase
were open-ended and most of them were adapted from the questionnaire developed by Shahzad
and Malik (2014). The complete list of interview questions is given below. The interview
schedule and field notes are presented in tables- 4.16 and 4.17.
99
4.4.2. Interview Questions
1. “Can you please briefly introduce yourself? (Name, age, marital status, work experience,
Job description and education”.)
2. “Are you satisfied, with the working environment of your organization? Please explain”.
3. “Do you have any idea about the term personal-bullying”?
4. “How worried are you, about bullying in your current workplace”?
5. “Do you feel you, are adequately trained in what to do in these situations?
6. “Have you experienced, or witnessed an incident of bullying”?
7. “In your opinion, what are the impacts of bullying on nurses daily life, and work”?
8. “Do you think that the personal bullying has direct, as well as indirect relationship with
turnover intentions through job stress? If so, please explain”.
9. “Do political skills can play an important role in reducing job stress among nursing staff?
If so, please explain”.
10. “In your opinion, what are the important measures that would reduce bullying at
workplace.
11. Would you like to add something else?
12. Do you have any questions to ask?
100
Table- 4.16: The interview schedule
S.No
Questions Prompt Reason
1.
Can you please briefly introduce
yourself?
Age, Education
Rapport building
2.
Are you satisfied with the working
environment of your organization?
Please explain.
Satisfied with colleagues,
working hours,
organizational culture
Understanding
3.
Do you have any idea about the term
personal bullying?
Criticism, verbal
aggression, Rude
behavior, shouting
Understanding
4.
How worried are you about bullying
in your current workplace?
Observed bullying
incidents, faced bullying
incidents
Frequency
5.
Do you feel you are adequately trained
in what to do in these situations?
What to do, how to handle
the situation
Training need
assessment
6.
Have you experienced or witnessed an
incident of bullying?
Any bullying incident at
workplace?
Employee
experiences
7.
In your opinion, what are the impacts
of bullying on nurses daily life and
work?
Does it make you feel bad
about life and organization
Outcomes of
bullying
8.
Do you think that the personal
bullying has direct as well as indirect
relationship with turnover intentions
through job stress? If so, please
explain.
Bullying leads to stress
and it further leads to
turnover intentions of
nursing staff
Mediating role of
job stress
9.
Do political skills can play an
important role in reducing stress
Social skills, networking
ability, personality of
Moderating role of
political skills
101
among nursing staff? If so, please
explain.
nurses
10.
In your opinion what are the important
measures that would reduce bullying
at workplace
Individuals role,
organizations role to
reduce bullying
Possible solutions
to reduce the
problem
11.
Would you like to add something
else?
Anything you have not
mentioned earlier?
Other information
12.
Do you have any questions to ask?
Please elaborate the
purpose of research
Closing
102
Table- 4.17: Example of Field Notes during interviews
Major Questions Field Notes
Are you satisfied with the working
environment of your organization? Please
explain.
Our working environment needs to be
improved, nurses are undermined and overall
our environment is not suitable for nurses. We
don’t know whom to report and what are the
policies. Nurses don’t share with others about
bullying incidents due to shame and fear and
consider it a part of their job.
I am not fully satisfied with the working
environment, we have financial problems,
therefore we have to work outside and we face
bullying at workplace.
Life is very difficult for women in Pakistan.
Our working environment is not ideal. Due to
lack of education and economic issues, people
misbehave with females, they don’t know how
to talk and treat women. Our working
environment needs to be improved. I am not
satisfied with working conditions. We face lot
of difficulties while working there.
Do you have any idea about the term personal
bullying?
Yes bullying is very common here. Verbal
abuse is the most common form of bullying
that we face. Once I was talking to my family
member on the phone, I had to give them an
important message from someone, when I
came inside the room, a client was sitting with
the doctor. The doctor insulted me in front of
the client and said that you don’t concentrate
on your work.
You are negligent and you are always busy on
phone. Yes I know, we have to face this issue
frequently.
Bullying is very common here, nursing
profession is at the top as far as bullying is
concerned. Yes, I know about it, bullying
means rude behavior, insult, and verbal abuse.
Bullying is a global issue and these abusive
behaviors are very common in our society.
103
How worried are you about bullying in your
current workplace?
It is an everyday practice for us to get bullied.
Sometimes doctors use harsh words. Some
doctors are very nice and they take care of us.
Some doctors give us a hard time and they
insult us often. I am very much worried. We
are basically low in ranks so those people who
are superior to us, sometimes they rudely
behave with us. It is very common, we
frequently experience these problems. We face
bully incidents from doctors and sometimes
other paramedical staff. Sometimes we have to
experience bullying on very minor issues.
Do you feel you are adequately trained in what
to do in these situations?
Most of the time, we don’t know how to tackle
different difficult situations, and organizations
should conduct more safety programs for us
and should take this issue seriously. I don’t
think so, I don’t know what to do and how to
protect myself in difficult situations. Training
is required. I don’t know how to handle, but
due to shame or fear of job loss, we do not
react. We do not report.
Have you experienced or witnessed an incident
of bullying?
Yes many times I have experienced and also
witnessed bullying incidents. Once, an old
doctor who was very much elder than me
proposed to me. I rejected his proposal and
said that I am the age of your daughter, to this
he abused me and I left the room. Yes many
times I have observed it and also faced such
events. Most of colleagues are good but few
people have always attitude problems so they
misbehave with us.
In your opinion, what are the impacts of
bullying on nurses daily life and work?
Bullying cause’s health hazards to the nurses,
their mood get off, their entire day goes
unpleasant and stress rises. Their work gets
affected and they feel like quitting. She also
added that we are not trained to tackle bullying
and stress reduction. We feel stress when we
experience bullying events, we feel bad mood
and don’t want to do work. Our whole life gets
104
upset. I feel nervous, upset. My stress level
increases. I can’t concentrate on my work, my
productivity also reduces.
Do you think that the personal bullying has
direct as well as indirect relationship with
turnover intentions through stress? If so, please
explain.
Yes, I agree with this statement. Due to
bullying we experience stress, and stress leads
to turnover intentions. Bullying leads to
turnover intentions and also bullying has a link
with stress. Yes, bullying, stress and turnover
are highly correlated with each other. Bullying
leads to stress and stress further leads to
turnover intentions.
I feel nervous, upset. My stress level increases.
I can’t concentrate on my work, my
productivity also reduces.
Do political skills can play an important role in
reducing stress among nursing staff? If so,
please explain.
There are some nurses who are elderly and are
working for a long time. They have adjusted to
this atmosphere, they know how to tackle the
situations and they have less turnover
intentions. Moreover, nurses who have
political skills are not only aware of
themselves but they also understand others,
they take less stress and their work doesn’t get
affected as well. Nurses having political skills
are less threatened by bullying and they know
how to get out of difficult situation.
Those nurses who have high political skills
they take less stress. They have strong links
with people, they share their experiences and
gets normal. Yeah, it helps a lot. Social skills
are necessary for nurses. Nurses who have
political skills they take less stress. Nurses
having political skills are less threatened by
bullying and they know how to get out of
difficult situation.
Policies should be developed at government
and organizational levels in favor of nurses so
that they feel safe at workplace. Their
workload should be reduced, salaries should be
raised. Improvement in work facilities and
discouraging bullying can reduce the rate of
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In your opinion what are the important
measures that would reduce bullying at
workplace
turnover. Management should develop policies
for safety of nurses. They should organize
trainings for nurses. They should improve their
reporting system. We should work in all three
areas. Individual level, organization level and
country level to solve these problems, so
nurses can work without facing problems, and
they can perform well and turnover problem
will also be reduced.
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In present study, Nvivo software was used for information processing. The output of
Nvivo model is presented below. After careful analysis of qualitative interviews findings through
grounded theory Nvivo draw the following model. The Nvivo model is presented in fig 4.4. The
NVIVO model is same as our present study model, it indicates that qualitative findings validate
the quantitative findings.
Figure 4.4: Nvivo Model
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We also presented the comparison of information from interviews and survey data in
table -4.18.
Table – 4.18: Comparison of information from survey data and interviews
Major Hypothesis Quantitative findings Qualitative findings Decision
Hypothesis-1
Path co-efficient = 0.313
T-value = 3.172
Significant
Due to personal
bullying we feel so
bad at workplace.
Bullying incidents
increases our turnover
intentions. We do not
want to stay here.
Qualitative findings
validate
quantitative
findings
Hypothesis-2
Path co-efficient = 0.403
T-value = 4.120
Significant
We feel stress when
we experience
personal bullying
incidents, we feel bad
and our stress level
increases.
Qualitative findings
validate
quantitative
findings
Hypothesis-3
Path co-efficient = 0.318
T-value = 2.716
Significant
When we are in
stress, we don’t want
to do work, and think
to quit the present
job.
Qualitative findings
validate
quantitative
findings
Hypothesis-4
indirect effect’s size ab =
0.128
T-value = 2.327
Significant
Due to personal
bullying we
experience job stress,
and job stress further
leads to turnover
intentions of nursing
staff.
Qualitative findings
validate
quantitative
findings
Hypothesis-5
Path co-efficient = -0.249
Nurses who have
political skill are not
Qualitative findings
108
T-value = 2.221
Significant
only aware of
themselves but they
also understand
others, they take less
job stress and their
turnover intentions
are low. Nurses
having political skills
are less threatened by
bullying and they
know how to get out
of difficult situation.
validate
quantitative
findings
In present study, qualitative findings validate the quantitative findings that there is a
positive relationship between personal bullying and turnover intentions, job stress mediates
between personal bullying and turnover intentions and political skill moderates the relationship
between personal bullying and job stress. The integration/mixing of quantitative and qualitative
findings both are giving us the same message. In quantitative part, our focus is on numbers, and
in qualitative part our focus is on words, so numbers and words both are giving us the same
message in table-4.18. Therefore, we can say that in present study, qualitative part is validating
the quantitative part. The present study is of its first kind to link personal bullying with nursing
staff turnover intentions with the inclusion of mediating and moderating variables by using
mixed methods research in the context of public sector hospitals in Pakistan.
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CHAPTER 5: DISCUSSION
The chapter no. 5 discusses the findings of the quantitative and qualitative phases. The
flow of discussion is organized according to the sequence of hypothesis. Furthermore, the
theoretical and practical implications of study have been discussed. The chapter also elaborates
the limitation of the study and directions for future study. The conclusion of the study is also
presented at the end.
The main aim of the study was to examine the relationship between personal bullying and
turnover intentions of nursing staff with the inclusion of job stress as mediator and political skill
as moderator by using mixed methods research. The qualitative and quantitative findings both
showed that personal bullying increases job stress in nurses which further increases their
turnover intentions. Furthermore, political skill buffered the effect such that the relationship
between personal bullying and job stress was weaker among nurses who were higher in political
skills. Our quantitative and qualitative both findings showed that personal bullying and turnover
intentions are positively linked. Due to personal bullying incidents, turnover intentions of
nursing staff increases. Our findings are consistent with the earlier findings which showed that
turnover intentions have deep connection with bullying incidents (Djurkovic, McCormack, &
Casimir, 2008; Houshmand, O’Reilly, Robinson, & Wolff, 2012; Lee, Lee, & Bernstein, 2013).
Our findings showed that personal bullying has positive link with job stress. Our findings are
consistent with earlier findings which showed that job stress has deep link with bullying
incidents (Ahmed, 2012; Quine, 2001; Vartia, 2001). Our findings also showed that job stress
and turnover intentions are positively linked. Our findings are consistent with earlier findings
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which showed that job stress has deep link with turnover intentions (Gupta & Beehr, 1979;
Summers, DeCotiis, & DeNisi, 1995).
In present study, we explored job stress as a mediator between personal bullying and
turnover intentions linkage. Personal bullying incidents are major source of the increased job
stress level of nursing staff, which further leads to their turnover intentions. When job stress
develop among nurses due to personal bullying incidents, their turnover intention increases and
they desire to give up their job to reduce job stress. When job stress increases, nurses are
incapable of offering their services on the professions which eventually reduce their competence
and productivity causing harm to the organization. Our findings showed that job stress mediates
between personal bullying and turnover intentions. Personal bullying has direct as well as
indirect link with turnover intentions via job stress. This study finds job stress as a mediator
between personal bullying and turnover intentions. We explored job stress as a mediator with the
help of process model of work stress (Pratt & Barling, 1988; Barling, 1996). The findings
sensibly confirm the whole scenario and support literature review as discussed earlier. Moreover,
our results showed that political skill buffered the effect such that the relationship between
personal bullying and job stress was weaker among nurses who were higher in political skills.
Individuals who possess political skill perceive social stressors as less threatening (Perrewe,
Ferris, Frink, & Anthony, 2000). We explored political skill as a moderator with the help of
process model of work stress (Pratt & Barling, 1988, Barling, 1996).
Turnover intention is a serious problem at workplace settings. This is not only the problem of
Pakistan, generally, it’s a global issue. As discussed earlier that the turnover intention is a strong
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predictor of actual turnover. Turnover intention leads to actual turnover. Theory of planned
behavior (Ajzen, 1991) explained this phenomenon in detail. According to theory of planned
behavior, attitudes lead to behaviors. Turnover intention means, when employees think to quit
the job, it is basically an attitude, when employees actually leaves the job then it becomes a
behavior. In present study, our focus was on turnover intention. It’s a serious issue and
organizations have to bear a lot of loss in the form of loosing talented employees and low
productivity. Numerous reasons of turnover intention have been discussed in literature among
which bullying is one of the significant reasons of employee turnover intentions. When
employees experience bullying incidents at workplace, they think to quit the job.
Generally aggressive behaviors (e.g., yelling, insults, teasing, criticism) refers to personal
bullying, it is very important in the context of public sector hospitals in Pakistan to explore this
phenomenon in more depth that why do people show aggression towards nurses. There are few
significant reasons behind it. Firstly, the working conditions of public sector hospitals need to be
improved, the facilities are not meeting the international standards. When patients and their
relatives visit hospitals and unfortunately they don’t get proper services, they show aggression
towards nursing staff. Similarly, nurses have to face bullying incidents from doctors as well.
There are few important reasons why do doctors show aggression towards nurses. 1- They bully
nurses based on high power and authority at workplace. 2- The personality of doctors plays an
important role. Those doctors who are aggressive in nature, they tend to show more aggression
towards nurses on minor things. 3- As discussed earlier, that public sector hospitals lack in
facilities, so in rush days, when pressure is build, they get frustrated and show aggression
towards nursing staff. However, on the other side, sometimes nurses have to face bullying
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incidents because of their own deficiencies. Sometimes when they don’t perform their tasks
efficiently, or ignore the patients, they have to face aggression.
Moreover, cultural aspects cannot be ignored as far as bullying incidents are concerned.
Culture plays a vital role in bullying incidents. The culture of Pakistani public sector
organizations is based on power and authority. In Pakistani organizations, it was observed that
people use their power to bully their subordinates. Similarly, in Pakistani culture, nurses are
generally considered a weak entity. Furthermore, the literacy rate is low, unemployment rate is
high, economic conditions are not satisfactory, therefore aggression is expected in such
circumstances. When nursing staff experience bullying incidents, they get frustrated, their mood
gets off, anxiety level increases, and ultimately they think to quit their jobs. It was observed that
bullying incidents not only disturbs nurses work life but it also impacts on their family life.
Nurses do not concentrate on their work and patients care. Their emotional health disturbs. They
do more mistakes in their work and their overall productivity decreases.
Organizations should take few steps to minimize bullying at workplace. They should
discourage bullying at every level. They should invest on nurses to improve their skills. Through
training and development programs they can overcome on their deficiencies. Hospitals should
increase the nursing staff to reduce work burden. As discussed earlier that the culture plays a
vital role in bullying incidents. Teamwork and supporting culture should be promoted at
workplace. On the other hand, nurses should improve their political skills. In both ways either
reducing bullying incidents or by improving the political skills of nursing staff, the job stress will
be reduced and ultimately it will reduce the turnover intentions of nursing staff. Bullying
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incidents should be taken seriously in Pakistan. It should be addressed at every level. More
research is needed on bullying issues to create awareness among people. By highlighting this
problem and taking proper measures this problem can be minimized in public sector hospitals in
Pakistan.
In Pakistan woman is not as much respected as men. She is considered as a responsibility
of her father and after marriage she becomes the responsibility of her husband. Less attention is
given towards the education of girls and their job as a nurse is not appreciated, and those females
who show courage and join nursing profession they think to quit the job due to personal bullying
incidents. Therefore, there is scarcity of nurses in Pakistan. Time is changing fast and now it is
high time that government should pay attention towards nursing staff and spend money on
training and development of nurses. This will impose a positive impact on our hospitals. It is
obligatory to provide them better and safe working environment.
Reducing bullying incidents may be important for the organizations to lower the stress
level, and to increase the overall productivity of the organization. In fact, as mentioned earlier,
nurses of public sector hospitals are at high risk of rude and negative behaviors that are
perpetrated by doctors who they are required to interact with, while performing their assigned
tasks. Infact, nurses are relatively powerless and at a high risk of being bullied at workplace, it is
not surprising that personal bullying is common and extensive within this sector of the
employees. Moreover, participants shared that they were often uninformed and usually not aware
of how to report an incident of personal bullying at workplace, and that they normally did not
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have contact with or information of any organizational official with a higher level of workplace-
authority.
As mentioned earlier, the present study’s results provide important statistics to the
management about the nursing staff, who are employed, are really at an increased risk for
personal bullying incidents that is perpetrated by the doctors. For that reason, in order to address
the problem of personal bullying among nursing staff, the administration should implement real
and preventive anti-bullying policies, with the intention of better protect this group of vulnerable
staffs from these negative conducts. Moreover, by bringing the above problems to the attention
of the top management, we have confidence in that the present study may help these
organizational leaders be aware of the fact that most of the personal bullying behaviors are
perpetrated by internal people. It is the fundamental right of a nurse to be respected at work place
and feels safe there, so that the productivity of the organization may increase. They may also be
able to give the patients quality services.
As discussed earlier that in previous researches, researcher’s main focus was on the
internal sources. They assumed that employees face personal bullying incidents from internal
sources (Anderson & Pearson, 1999; Frone, 2000) but we cannot ignore the role of outsiders
particularly in service sector (Grandey, Dickter, & Sin, 2004). Many times employees face
aggression from outsiders (Grandey, Dickter, & Sin, 2004). According to USPS commission
(2000), found that 2.3 % employees reported physical assault from outsiders (member of the
public), 2.4% reported sexual harassment from outsiders, and 7.7% employees reported verbal
aggression from outsiders. Another Canadian study reported that employees face 38% verbal
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aggression from outsiders. Similarly, in LeBlanc and Kelloway’s (2002) study aggressive
behaviors (e.g., criticism, teasing, and insults) by members of the public occur more frequently.
In the same way, aggressive behaviors by outsiders, such as being yelled at, threatened,
or treated rudely, is not a rare experience for employees (Grandey, Dickter, & Sin, 2004). For
example, in one study 82% employee’s experienced aggressive behaviors (e.g., criticism,
teasing, and insults) from outsiders in the past year (Harris & Reynolds, 2003). Similarly, in
Pakistan, it was observed that employees face aggressive behaviors from outsiders. In view of
Spratlen (1995) 21% employees reported that they experienced verbal aggression from outsiders.
Similarly, in another study, employees reported 43% aggressive behaviors from outsiders
(Grandey, Tam, & Brauburger, 2002). Employees experience stress when they face aggressive
behaviors from outsiders (Andersson & Pearson, 1999; Averill, 1983). Furthermore, when
employees experience aggression from outsiders, it reduces their energy towards work (George,
1989). Hence, employees face aggressive behaviors (e.g., criticism, teasing, and insults) from
outsiders as well as from insiders frequently which increase their job stress and increase their
turnover intentions at workplace.
Personal bullying has been discussed as an extreme stressor for nursing staff and has been
linked to a number of negative consequences. On the basis of process model of work stress
(Barling, 1996), we hypothesized that personal bullying leads to job stress and it further leads to
turnover intentions. Job stress mediates between personal bullying and turnover intentions.
Similarly, on the basis of process model of work stress (Barling, 1996), we hypothesized that
political skill plays a moderating role between personal bullying and job stress. Results of
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structure equation modeling (PLS-SEM) analysis supported our hypothesis. In Pakistan, it was
observed that the job of nursing staff is very challenging and demanding. They have to perform
several tasks simultaneously e.g. patient care, dealing with patients relatives, dealing
emergencies, and provide assistance to doctors. It was observed that nursing staff face personal
bullying from both sources (doctors as well as patients). As every patient expect satisfactory and
quick service from nurses, but when they feel that they are not properly served and they have to
wait for long time, they show aggression towards nurses. Moreover, majority of the people in
Pakistan are illiterate they do not show patience and respect towards nursing staff, in this way
nurses have to face yelling, criticism and rude behaviors from patients side. On the other hand
when doctors see long ques of patients, work burden and observe that nurses are not meeting the
deadlines, due to pressure on them they show aggression towards nurses. In previous studies,
researchers have reported that employees have to face aggression from both sources internal as
well as external (Grandey, Tam & Brauburger, 2002).
The insider-focused aggressive behaviors research has shown that aggressive behaviors
are linked with stress (Frone, 2000). Similarly, in Pakistan, Shahzad and Malik, (2014) reported
that employees face bullying incidents from internal sources which increases their stress level
and increases their turnover intentions. The conversation of resource (COR) theory explains how
psychological aggression impacts on job stress and turnover intentions of nursing staff (Hobfoll,
1998). The basic idea of COR theory is that employees struggle to obtain, retain, and protect
their resources. Resources include both material resources (e.g., transportation, housing) and
psychosocial resources (e.g., self-efficacy, social support). According to COR, job stress occurs
when employees at workplace are threatened with resource loss, or fail to gain resources. A basic
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idea of COR theory is that resource loss is more harmful and severe than resource gain because it
represents a major threat to survival (Gorgievski & Hobfoll, 2008). Resource loss is typically
linked with stress, low energy towards work, damaged mental and physical health, and ultimately
high turnover intentions (Westman, Hobfoll, Chen, Davidson, & Lasky, 2004). Psychosocial
resources (e.g., self-efficacy, social support) are especially important, since employees invest
them to obtain (Hobfoll, 1989). In this context, job stress and turnover intention is particularly
relevant due to its sensitive nature. When nursing staff face criticism, insults, and teasing from
doctors they have a fear of losing their resources which increases their stress level and ultimately
it leads towards turnover intentions. In this tense situation nursing staff use their social support to
minimize this tense situation and get back to normal functioning at work place. They use their
political skills to handle situation, therefore COR theory also helps researchers to understand the
role of political skill in stressor and stress relationship.
Barling, (1996) discussed stressor/strain model and he mentioned that stressor leads to
stress and stress further leads to strain. Furthermore, personality related characteristics can play a
moderating role between stressor and stress relationship. Generally, when employees face such
kind of aggressive behaviors (e.g., criticism, insults, and teasing) at workplace they feel stress
and the level of enthusiasm and motivation towards work reduces and their turnover intentions
increases. Furthermore, personal related characteristic (political skill) plays a moderating role
between stressor and stress relationship. It means that those nurses who have high political skills,
they take less stress when they experience bullying incidents. High political skills employee’s
work hard and enjoy their work. Results showed that high political skills employees are highly
successful, they are optimistic, and believe they can satisfy their needs by participating in roles
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within the organization. High political skills employees work well in tough situations, they have
good communication skills, they have good networking skills, and they know how to behave in
different situations.
Mediating variable means that X (personal bullying) leads to M (job stress) and M (job
stress) further leads to Y (turnover intentions). X has a link with M and M is also associated
with Y. X is independent variable, M is mediating variable and Y is dependent variable (Baron &
Kenny, 1986). The findings showed that persona bullying increases job stress which further
increases their turnover intentions. In present study (criticism, yelling, insults, rude behaviors)
which comes under personal bullying were examined and employees face such behaviors
frequently at workplace. Our findings are consistent with the earlier findings which showed that
employees frequently experience criticism, insults, and teasing at work place (Barling et al.,
2003; Glomb, 2002). In present study, we examined the effects of personal bullying on nurses
job stress and turnover intentions from internal source (doctors). It is important for researchers
to clearly mention the source in aggression related studies because the impact of aggression on
employees from internal source and the external source is not the same (Hershcovis et al., 2007).
The present study provides some insights into how outcomes differ in magnitude by
source of aggression. When employees experience aggression from supervisor, they attribute this
negative experience to the organization, employees have a psychological contract with their
organization (Rousseau, 1990). They expect that they will be safe and treated well by their
supervisors at work place, but when they are not treated well in the form of aggression, they feel
insecure, blame their organization and much uncomfortable. In this way the magnitude of insider
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effect is higher than the aggression from outsider. In present study, we explored job stress as a
mediator. Personal bullying incidents are the major source of increased job stress level of nurses,
which further leads to high turnover intentions. When job stress develops among employees due
to aggression incidents, their energy towards work reduces and they desire to give up their job to
reduce job stress. When job stress increases, employees are incapable of offering their services
on the professions which eventually reduce their competence and productivity causing harm to
the organization. When job stress increases employees are unable to devote their energies on the
jobs, which increases their turnover intentions and ultimately decrease their efficiency causing
damage to the organization.
Moreover, culture of the organization should be friendly, team work should be promoted.
Stress symptoms may be reduced with the help of stress management training. In recent years job
stress has become a major issue for human resource administration. Organizations must ensure
that they have proper resources which can reduce job stress at workplace settings, examples of
these resources can be occupational health services, training departments and an in-house
psychologist or counselor who can manage employee’s well-being. At last, government should
pay attention towards education and spend money on training and development of employees.
This will impose a positive impact on our organizations.
In Pakistan, it is vital for the public sector hospitals to provide the nurses safe
environment. Personal bullying can be reduced by making few adjustments. Some of these
adjustments are to be made by the organization and some by the nurses. The organizations have
to improve services, increase the number of nurses, so that their work burden decreases and they
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can concentrate on their work. Nurses should be given training to upgrade their skills so that they
can do their work more vigilantly and perfectly so that patients have no objections against them.
There should be raise in the pays of the nurses so that in this time of inflation they can
concentrate on their work. Organizations should improve their reporting system so that nurses
can easily report any problem that they face. Moreover, culture of the organization should be
supportive, team work should be promoted and proper awareness programs should be arranged
for the nurses against bullying.
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5.1 Theoretical Implications
Present study observes the connection between personal bullying and nursing staff
turnover-intentions and results showed their significant positive relation. Similarly, job stress
mediates between personal bullying and turnover intentions and political skill buffers the relation
between job stress and personal bullying. The major contribution of the present study is
exploring job stress as mediator and political skill as moderator which has not been done in any
bullying theory before. The findings presented in this study clearly show that personal bullying is
a significant issue for public sector hospitals in Pakistan. Nurses exposed to bullying incidents
are likely to show increased levels of job stress. It can be concluded in the light of the literature
review that bullying does not refer to a single negative behavior, but occurs frequently with
increasing severity over time. When nursing staff continuously experience bullying incidents,
they feel stress and find themselves helpless and they do not enjoy their work. The painful
memories of bullying incidents disturb nursing staff and it is very difficult to concentrate or even
find suitable words to express their feelings for that painful situation. Thus, the current research
extends our understanding of the complex processes that link personal bullying to turnover
intentions.
Personal bullying and its links with job stress are poorly understood in Pakistan, and has
been the major focus of this study. Due to personal bullying incidents, the job stress level of
nurse’s increases, which further leads to their turnover intentions. In bullying theory we explored
job stress as a mediator. When job stress develops among nursing staff due to personal bullying
incidents, turnover intention increases because people are not happy with their job and they want
to quit it to reduce job stress. They switch to jobs which provide better facilities at workplace.
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When job stress increases, nurses are unable to devote their energies on the jobs, which
ultimately decrease their efficiency and productivity causing damage to the organization. This
study finds job stress as a mediator between personal bullying and turnover intentions. The
findings empirically prove the facts and support literature review as explained earlier.
This study also explored political skill as moderator. Infact, nurses should improve their
political skill, so that they may get less stressed, they may have less turnover intentions and
would do better work. As we have put on organization the responsibility of supporting the
nurses, it is on the other hand necessary for the nurses as well to improve their political skills.
With that not only their confidence will increase but their ability of coping with the difficult
situation will also develop. Nurses having high political skill take less stress. They have adjusted
themselves and so they take shocking events normally. They have gained perfection in work,
they are well familiar to people and they don’t get stressed up so they don’t think of quitting.
High political skill employees work hard and they like their work. Previous studies have shown
that social support from colleagues/supervisors is positively associated with high energy towards
work (Bakker & Demerouti, 2008; Hakanen, Bakker, & Schaufeli, 2006). Those employees who
have high political skill they take less stress when they experience bullying incidents because
they know how to handle tough situations.
As noted by (Lazarus, 1999), the fit between a person and the environment is a
determinant of the amount of strain experienced. Our findings indicate that politically skilled
nurses may be a better fit for public sector hospitals in Pakistan. Politically skilled nurses are
more likely to fit into public sector contexts because they have the capability of adapting their
behavior to fit environments where interpersonal interactions are important for achieving
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success. Thus, the moderating effects of political skill on the bullying–stress linkage supports the
perspective that political skill serves as a resource that aids nurses in coping with stressors,
enhances employees’ understanding of bullying incidents, and provides individuals with a sense
of control over the environment. As a result, politically skilled employees tend to view bullying
incidents as less threatening and, therefore, experience fewer strains associated with bullying.
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5.2 Practical Implications
It is crucial for the workplace to make policies in regard to this issue and make this issue
a constituent of agenda like America, Australia and Britain have taken serious measures for this
issue and made it a part of their agenda. Less tolerance should be shown against bullying in
organization. Reporting system should be improved and crystal clear. Nurses should be made
bold enough to report and they should be given justice. In Pakistan, nurses do not report because
they are frightened and they fear the loss of their honor that is why they don’t report. This
situation boosts the problem rather than diminishing it. Pakistan’s government should also make
nurses and hospital friendly policies and should make the policies a part of their agenda.
Specially concentrate on the hospitals of public sector by investing and putting them under
observation to improve their condition. Organizations should improve their culture, secure the
environment, discourage authoritarian style, promote supportive leadership, and hire nurses
according to need. Improve their services so that patients may not have any problems and
training sessions for the nurses should be held so that they can improve the deficiencies in their
work.
1- Healthcare being an inherently demanding occupation with long working hours,
hardworking conditions, dealing with difficult patients and many safety threats. Role
of the hospital nurses is important in providing healthcare services and the
administration of patient concern in the hospitals. Nursing profession is not only
high-risk of bullying incidents but also hectic. Nurses are frequently confronted with
severe stressors. Having the responsibility of treatment of patients, dealing with
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accidents cases and deaths are also the sources of stress among the nurses. Therefore
nurses are also suggested to utilize personal strategies to increase their self-
controlling skill to deal with stress. In particular, making sure that organizations have
a clear bullying instruction, an efficient coverage system for irritation and human
resources performances should be performed to address workplace bullying. A main
barrier to improvement in the prevention of this issue is lack of understanding about
personal bullying and its management. The nurse’s turnover intentions can be reduced
by reducing bullying incidences. The management of the hospital can ensure
reduction in bullying incidents by taking measures as suggested under:
2- Management should ensure that sufficient staff is available for appropriate concern of
patients. Appropriate recruitment can diminish crowd, work burden, waiting time, and
stress.
3- Management should keep in mind the necessities of patients to match staff
proficiency, join up less experience nurses with more experienced nurses. They are
required to work as a team instead of working in isolation.
4- To deal with bullying incidents professionally, there must be education and
preparation on workplace bullying prevention programs for nurses.
5- The role of friendly management is very significant to reduce bullying incidents in
the organization.
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6- Nurses should report when they experience or observe any bullying incident, as well
as hospital administrations should improve reporting system in the hospitals.
Our findings showed that job stress plays a mediating role between personal bullying and
turnover intentions of nursing staff of public sector hospitals in Pakistan. The stress level of
nurses increases when they experience stressors like bullying and ultimately they think to quit
the job. In such kind of situations, the nursing staff should be well aware about resources
accessible to them for reducing the stress level. Organizations must ensure that they have proper
resources which can reduce job stress at workplace settings, examples of these resources can be
occupational health services, training departments and an in-house psychologist or counselor
who can manage nursing staff well-being. Moreover, organizations must ensure formal
programs, for example to facilitate and help the nurses who face various problems in their work
and family lives. To facilitate the nursing staff, employee assistance program should be in place
at workplace. These types of initiatives would definitely help the nursing staff in reducing the job
stress problem by educating them in different stress management techniques like meditation and
relaxation.
Moreover, our findings showed that political skill buffers the stressor-stress linkage
suggesting that administration should make serious efforts to enhance nurse’s political skill.
Management may possibly consider techniques such as, developmental simulations, drama-based
training and behavior modeling as ways to develop and enhance employee’s political skill
(Ferris, Anthony, Kolodinsky, Gilmore, & Harvey, 2002). Such kind of initiatives would not
only be benefit for nursing staff but will also help organizations to achieve their objective. On
the other hand, nursing staff should also make every effort to develop and improve their political
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skill in order to deal with challenging workplace settings and competitive job market. Finally, to
reduce bullying incidents at workplace, organizations should conduct exit interviews with nurses
to know the reasons for leaving. It is not time consuming activity and not expensive, and if
organization will conduct exit interviews activity seriously, the inside information gained
through this activity would be very useful to minimize bullying incidents (Pearson & Porath,
2005; Brewer, Kovner, Obeidat, & Budin, 2013).
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5.3 Limitations
1- The novice researchers may explore this issue by further targeting private and semi-
private healthcare sectors because findings may vary. It will definitely require more
time and financial resources.
2- Time limitation and cost of surveying were one of the major limitations in conducting
the study.
3- The data was collected at one point in time (cross sectional study). Consequently,
longitudinal studies are required to causality inferences.
4- The data collection stage was also a real challenge for researcher because issue was
complex.
5- Limited issues were tested in the present model, whereas other factors like
organizational structure, organizational culture, and leadership styles may also help in
reducing turnover intentions.
129
5.4 Directions for Future Research
The researchers may explore this issue further by targeting different sectors (hospitals,
education) because findings may vary. It will definitely require more time and financial
resources. The data collection stage was also a real challenge for researcher because issue was
sensitive and complex. In present study, we explored job stress as mediator, and political skill as
moderator, however, researchers can test the impact of organizational culture as moderator and
fear as mediator in the relationship of personal bullying and turnover intention. By exploring
these factors new dimensions of research can be generated. For future study it is recommended to
test the model (same or addition of other factors) in different regions and sectors, so there is a
need to work upon other variables that may contribute. In present study our focus was on internal
source (doctors), so in future researchers can explore the external source (patients) and can
examine the bullying incidents. In present study our focus was on female nurses, so in future
researchers can focus on male nursing staff.
130
5.5 Conclusion
A nurse turnover intention is a major challenge for many healthcare services. This study
linked personal bullying incidents with nursing staff turnover intention. Personal bullying is a
continuing problem and has a negative implication for the well-being of nurses. The results
provided support for the present model, indicating that personal bullying is associated with
nursing staff turnover intentions and job stress mediates the relationship between personal
bullying and turnover intentions. There is a significant association between personal bullying and
turnover intentions through job stress in nursing staff of public sector hospitals in Pakistan. This
information could be used to develop appropriate strategies to reduce bullying and to reduce the
turnover intentions of nursing staff. Results also indicate that political skill attenuates the
negative effects of bullying incidents on job stress. Therefore, it is also important for nurses to
improve their political skill, to reduce job stress and to promote safe nursing care. The issue of
bullying needs to be tackled on individual, organizational and national levels so that nurses may
not face bullying incidents. As a result, they will not be stressed, will not decide to leave the
organization and their concentration will remain in their work which will benefit the overall.
131
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Research Questionnaire
Dear Respondent,
We are seeking you to participate in a survey that aims to assess personal bullying and its
impact on nursing staff turnover intentions. The survey seeks to ascertain the extent of bullying
incidents toward nursing staff of public sector hospitals in Pakistan and explore its negative
effects on the emotional and psychological states of nursing staff.
Participation is voluntary. This study poses little to no risk to its participants. Privacy will
be ensured through confidentiality. I will do my best to ensure that confidentiality is maintained
by not citing your name within the actual study. Your participation in the study will involve
filling a questionnaire with an estimated length of 20-30 minutes.
We do not anticipate any direct benefit to you from your involvement in the survey
without any payment or other compensation. However, you may feel a sense of relief at being
asked some of the questions. Completing the survey may help you to identify the primary issues
with nursing staff of public sector hospitals in Pakistan.
If you decide to participate in the survey, please complete the survey instrument and return it to
the researchers in the enclosed self-addressed envelope. A summary of the results will be
available to participants upon request.
Thank you so much for taking the time to read this information, and we hope you decide
to complete the survey. If you agree to participate in interview part please tick the box given
below to give your consent.
145
Consent
Researcher: Asif Shahzad, PhD scholar, Bahria University Islamabad Campus.
Asifshahzad062@gmail.com
Demographic and Background Information:
(Please note, your information will not be sold or given to outside entities. It is for internal use
only. Please tick in the appropriate space).
• Gender: Female ____________ Male ______________
• Marital Status: Married ________ Unmarried ____________
• Education level: _________________
• Age Group: __________________
• Tenure: ________________________
146
Personal Bullying
The following set of statements describes your general perception towards the bullying incidents
in your current organization. For each statement, please indicate to which extent you feel it is
agreeable or disagreeable. Please Encircle or Tick one answer. Respondents were requested to
specify the frequency on which they had been the target of behavior in the previous six months
on 5-points Likert type scales.
No Description Never
Now
and
then
monthly weekly daily
Personal bullying
1 Being humiliated or ridiculed in
connection with your work. 1 2 3 4 5
2 Spreading of gossip and rumors about
you. 1 2 3 4 5
3 Being ignored, or excluded 1 2 3 4 5
4
Having insulting or offensive remarks
make about your person. (i.e. habits
and background) your attitudes or your
private life.
1 2 3 4 5
5 Being shouted at or being the target
spontaneous anger (or rage). 1 2 3 4 5
6 Hints or signal you are from other that
you should quit your job. 1 2 3 4 5
7 Repeated reminders of your errors or
mistakes 1 2 3 4 5
8 Being ignored or facing a hostile
reaction when you approach. 1 2 3 4 5
9 Persistent criticism of your work and
effort. 1 2 3 4 5
10 Having allegations made against you. 1 2 3 4 5
11 Practical jokes carried out by people
you don’t get along with 1 2 3 4
5
12 Being the subject or excessive teasing
and sarcasm. 1 2 3 4
5
147
Job Stress
The following set of statements describes your stress. For each statement, please indicate to
which extent you feel it is agreeable or disagreeable. Please Encircle or Tick one answer. There
is no right or wrong answer. The participants are requested to reply to the questions with respect
to the six months since the event happened.
No Description Strongly
Disagree Disagree Neutral Agree
Strongly
Agree
Job stress
1 A lot of time my job makes me very
frustrated or angry. 1 2 3 4
5
2 I am usually under a lot of pressure
when I am at work. 1 2 3 4
5
3 When I’m at work I often feel tense
or uptight. 1 2 3 4
5
4 I am not at ease when I’m working 1 2 3 4 5
5 There are a lot of aspects of my job
that make me upset. 1 2 3 4
5
Political Skills
The following set of statements describes your political skills. For each statement, please
indicate to which extent you feel it is agreeable or disagreeable. Please Encircle or Tick one
answer. There is no right or wrong answer.
No Description Strongly
Disagree Disagree Neutral Agree
Strongly
Agree
1 I understand people very well 1 2 3 4 5
2 I am good at getting others to
respond positively to me 1 2 3 4 5
148
3 I usually try to find common ground
with other 1 2 3 4 5
4 It is easy for me to develop good
rapport with most people 1 2 3 4 5
5 I am able to make most people feel
comfortable and at ease around me 1 2 3 4 5
6 I find it easy to envision myself in
the position of others 1 2 3 4 5
Turnover Intentions
The following set of statements describes your turnover intentions in your organization. For each
statement, please indicate to which extent you feel it is agreeable or disagreeable. Please
Encircle or Tick () one answer. There is no right or wrong answer.
No Description Strongly
Disagree Disagree Neutral Agree
Strongly
Agree
1 I think a lot about leaving the
organization 1 2 3 4 5
2 I am actively searching for an
alternative to the organization 1 2 3 4 5
3 As soon as it is possible, I will
leave the organization 1 2 3 4 5
158
Latent Variable score
(Only first 150 latent scores are presented due to space saving)
P.S J.S T.I P.B
-0.318 -3.045 -3.688 -2.349
0.544 -1.229 -1.302 -1.084
-1.083 0.659 0.119 -0.846
0.156 -1.229 0.573 -0.451
1.316 -0.855 -0.391 1.080
0.077 0.505 0.628 0.860
1.316 -0.700 -0.846 0.114
-0.059 -1.686 -1.757 -2.010
1.316 -0.326 -0.336 1.006
-0.648 -0.855 -0.792 -1.310
1.316 -0.244 -0.391 -0.967
1.316 0.962 1.083 0.154
1.316 0.587 0.573 0.087
-1.742 0.131 0.119 0.676
0.407 1.490 1.539 -0.251
0.077 0.659 0.575 0.908
0.512 0.131 0.119 -0.323
-1.083 -0.398 -0.338 -0.245
0.521 0.962 1.083 -1.342
0.156 -1.229 -1.302 0.168
-0.753 -0.855 -0.792 -0.362
0.987 0.131 0.119 0.050
-0.753 1.490 0.575 0.345
-0.503 -1.686 1.083 0.331
-0.173 -0.244 0.117 0.629
0.156 -0.700 0.575 -2.446
1.316 -0.855 1.539 1.592
0.156 -2.963 -1.813 -1.350
-2.322 0.213 0.628 -0.389
1.316 -0.409 0.171 -0.442
0.191 -0.855 -1.302 -0.389
-0.173 0.505 -0.846 -1.124
0.736 -1.675 -0.391 -1.185
-1.083 -3.491 0.573 -1.934
-0.173 -1.603 1.083 -1.702
0.156 -2.517 0.628 0.043
159
-0.503 1.490 1.539 0.324
0.156 0.131 -0.391 -1.090
0.987 -0.629 0.119 -1.947
0.407 0.131 -1.757 -1.148
-0.253 1.490 1.029 0.844
0.657 -2.060 1.083 0.550
-1.887 -1.301 -1.247 0.088
-0.503 -0.700 -0.336 0.331
-2.322 -2.589 0.119 -1.879
-1.847 1.490 -0.336 0.605
-0.753 -0.244 -1.813 -0.683
0.987 -0.398 1.029 0.603
0.736 1.033 -1.703 -1.213
-1.992 0.131 -1.758 -0.171
-1.663 0.505 0.119 -0.635
0.156 -0.772 0.119 -0.603
0.156 -0.921 -2.211 -0.624
1.316 -1.075 -2.722 -0.941
0.407 -1.229 0.120 -1.382
0.688 1.490 1.084 -0.338
0.736 1.490 1.084 1.256
0.406 0.962 1.539 1.514
0.077 -0.855 -0.792 -1.749
-0.832 -1.229 -0.849 -1.255
-0.753 -1.229 -1.813 -2.125
0.736 -0.326 0.575 0.531
0.987 -0.772 -0.792 -1.172
-0.753 -0.700 -0.336 -2.446
0.987 -0.480 -1.302 -0.657
0.987 0.505 -0.338 0.099
0.407 0.962 -2.722 0.088
0.077 -2.060 -0.336 -0.259
0.262 0.131 -3.177 -0.463
-0.832 -0.398 -2.268 -1.396
-0.068 -0.398 -0.847 -1.856
-0.173 0.131 -1.703 -2.144
-0.753 -0.398 -1.302 -0.472
0.736 -0.326 -0.338 -0.096
-1.992 -1.229 -1.302 -0.623
-1.381 -0.326 -0.336 -0.019
160
-1.083 -0.398 -0.338 -1.326
-1.003 -1.603 -1.812 -1.723
-0.503 -0.244 -0.391 0.320
0.657 1.490 1.539 -2.190
-1.083 1.116 1.029 0.088
-0.799 0.131 0.119 -1.172
-1.083 -1.229 -1.302 -1.175
-1.083 -3.045 -3.177 -3.208
-1.083 -0.172 -0.390 -1.715
-0.173 -0.244 -0.391 0.277
-1.083 -1.229 -1.302 -2.921
1.316 1.490 1.539 0.074
1.316 -0.244 -0.391 -1.679
-1.083 -0.700 -0.846 -2.409
-1.083 0.742 0.520 -0.673
-1.412 -0.700 -0.846 -0.392
-1.412 0.659 1.084 0.318
0.592 1.490 0.573 -0.711
0.736 0.131 -0.283 -0.144
0.029 -2.589 -2.268 -1.196
0.657 0.659 1.084 1.117
-1.557 0.505 1.083 1.104
-1.083 -0.618 -1.357 0.129
-1.083 -0.326 0.575 0.047
0.657 0.962 1.084 0.091
-0.969 1.490 -0.847 -1.261
0.736 1.490 -0.338 -3.111
0.736 0.659 -1.758 0.247
0.736 -0.700 0.119 0.247
0.657 -1.075 -0.338 1.009
1.316 1.490 0.119 -1.832
0.657 1.490 1.539 0.564
-1.412 -0.926 -1.302 -0.872
0.657 -1.064 0.172 -0.803
-2.322 -1.229 -0.846 -0.609
0.077 1.033 1.084 -0.929
0.736 -0.772 -0.792 -0.616
0.327 0.505 -0.846 0.127
0.987 0.131 1.084 -0.505
0.077 -0.855 0.575 0.458
161
-0.977 1.490 0.174 0.364
-0.173 -0.326 -0.391 0.505
1.316 0.577 -0.846 -0.464
0.407 -2.060 0.120 -0.293
-2.177 -0.326 -0.792 0.436
0.103 0.131 -0.338 0.001
0.657 -0.326 -1.356 -0.409
0.077 0.131 0.630 0.508
0.657 0.659 -0.792 0.207
0.407 1.490 1.539 1.592
1.316 -0.398 0.627 1.092
-0.503 -0.326 -0.336 0.158
-2.322 0.131 0.119 -0.251
-0.753 0.962 1.083 0.777
1.316 0.659 0.575 1.592
-1.412 0.433 0.627 0.860
0.359 0.213 0.064 0.663
1.316 0.659 0.575 0.327
1.316 0.285 0.065 -0.674
-0.173 0.962 1.083 0.307
-0.753 -0.326 -0.336 -0.157
-1.083 -1.229 -1.302 0.072
1.316 -1.229 -1.302 0.059
1.316 0.285 0.065 0.071
1.316 0.962 1.083 -0.199
1.316 0.659 0.575 0.048
-1.992 1.033 1.084 1.103
-0.503 0.587 0.573 0.290
0.407 -0.700 -0.846 0.290
-0.503 0.962 1.083 1.592
0.327 -0.244 -0.391 0.075
-0.423 0.587 0.120 0.061
-0.173 1.033 -0.846 1.117
-0.582 -1.449 0.628 -0.913
163
200 samples loadings are presented due to space saving
(Loadings are rounded to one decimal point due to space saving).
B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 P1 P2 P3 P4 P5 P6 S1 S2 S3 T1 T2 T3
0.8 0.7 0.8 0.8 0.7 0.7 0.8 0.7 0.7 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.8 0.9 0.8 0.8
0.8 0.7 0.7 0.9 0.7 0.8 0.8 0.6 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.8 0.9 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.9 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.9 0.8 0.8
0.8 0.7 0.6 0.8 0.6 0.8 0.8 0.6 0.8 0.5 0.8 0.8 0.9 0.9 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.9
0.8 0.7 0.7 0.8 0.8 0.8 0.8 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.9 0.7 0.8 0.7 0.8 0.8 0.7
0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.9 0.7 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.9 0.8 0.8 0.8 0.8
0.7 0.7 0.8 0.8 0.8 0.8 0.7 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.9 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.8 0.9 0.8 0.8
0.7 0.8 0.6 0.8 0.7 0.8 0.7 0.6 0.8 0.7 0.9 1.0 0.7 0.9 1.0 0.7 0.8 0.8 0.8 0.9 0.7 0.8
0.8 0.7 0.6 0.8 0.7 0.7 0.7 0.6 0.8 0.7 1.0 1.0 0.5 1.0 1.0 0.5 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.9 0.8 0.8
0.7 0.7 0.7 0.8 0.8 0.8 0.7 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.7 0.9 0.8 0.8
0.8 0.6 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 1.0 1.0 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.9 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.9 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.5 0.5 1.0 0.5 0.5 1.0 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.7 0.7 0.8 0.8 0.8 0.8 0.9 0.9 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.7 0.8 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.8 0.7
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.6 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.8 0.9 0.8 0.8
0.7 0.7 0.7 0.8 0.8 0.8 0.7 0.7 0.8 0.8 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.9 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.7 0.6 0.7 0.8 0.7 0.7 0.7 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.6 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.7 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.6 0.7 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.8 0.8 0.7 0.8
164
0.7 0.8 0.7 0.8 0.7 0.8 0.7 0.7 0.8 0.7 1.0 1.0 0.6 1.0 1.0 0.7 0.8 0.8 0.8 0.8 0.8 0.7
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 1.0 1.0 0.7 0.9 1.0 0.7 0.8 0.8 0.8 0.9 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.8 0.8 0.8 0.7 0.8 0.7 0.8 0.8 1.0 1.0 0.5 1.0 1.0 0.5 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.6 0.7 0.7 0.7 0.7 0.6 0.7 0.7 0.6 0.6 1.0 0.6 0.6 1.0 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.8 0.8 0.6 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.7 0.9 0.8 0.8
0.8 0.7 0.6 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.9 0.8 0.8 0.8
0.8 0.7 0.7 0.9 0.8 0.7 0.8 0.6 0.8 0.7 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.8 0.7
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.9 0.9 0.9 0.9 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.7 0.7 0.9 0.7 0.8 0.8 0.7 0.8 0.7 0.1 0.1 0.9 0.1 0.1 0.9 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.8 0.7 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.9 0.8 0.8
0.8 0.7 0.6 0.8 0.7 0.7 0.8 0.6 0.8 0.7 0.6 0.6 1.0 0.6 0.6 1.0 0.8 0.8 0.7 0.8 0.8 0.7
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.9 0.9 0.9 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.6 0.8 0.8 0.8 0.7 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.7 0.8 0.6 0.8 0.7 0.8 0.7 0.6 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.7 0.8 0.8 0.8 0.8 0.7 0.8 0.8 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 1.0 1.0 0.6 1.0 1.0 0.6 0.9 0.8 0.8 0.9 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.6 0.8 0.7 0.8 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.7 0.9 0.9 0.6 1.0 1.0 0.6 0.8 0.9 0.8 0.9 0.8 0.8
0.7 0.7 0.7 0.8 0.7 0.8 0.7 0.7 0.8 0.7 0.9 0.9 0.8 0.9 1.0 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.6 0.8 0.6 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.7 0.8 0.8 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.7 0.7 0.8 0.8 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.9 0.8 0.8 0.8 0.8
0.7 0.7 0.7 0.8 0.7 0.7 0.7 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.7 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.7 0.8 0.9 0.7
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.6 0.8 0.8 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.7 0.9 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.8 1.0 1.0 0.8 0.8 0.9 0.8 0.9 0.8 0.8
0.8 0.8 0.6 0.9 0.7 0.8 0.8 0.6 0.8 0.6 0.9 0.9 0.7 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.7 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.9 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.9 0.8 0.8 0.9 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.6 0.8 0.7 0.8 0.8 0.6 0.8 0.6 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.7 0.8 0.8 0.8 0.7 0.9 0.9 0.8 0.9 1.0 0.8 0.9 0.9 0.8 0.9 0.8 0.8
0.8 0.7 0.7 0.9 0.7 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.9 0.8 0.8
0.8 0.7 0.8 0.9 0.7 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.9 0.8 0.8
166
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0.8 0.7 0.6 0.8 0.7 0.8 0.7 0.6 0.8 0.6 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.7 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.7 0.7 0.7 0.8 0.8 0.8 0.7 0.7 0.8 0.7 1.0 1.0 0.7 0.9 1.0 0.7 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.8 0.6 0.9 0.6 0.8 0.8 0.5 0.8 0.6 1.0 1.0 0.5 1.0 1.0 0.5 0.8 0.9 0.8 0.9 0.8 0.7
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.6 0.7 1.0 0.6 0.7 1.0 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.6 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.7 0.7 1.0 0.8 0.8 1.0 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.8 0.7 0.7 0.8 0.7 0.9 0.9 0.9 0.9 0.9 0.9 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.7 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.7 0.9 0.9 0.9 0.9 0.9 0.9 0.8 0.8 0.9 0.9 0.8 0.9
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.8 0.9 0.9 0.7 0.9 1.0 0.7 0.8 0.9 0.8 0.8 0.8 0.9
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.9 0.9 0.7 0.9 0.9 0.7 0.9 0.8 0.7 0.9 0.8 0.8
0.7 0.7 0.6 0.8 0.7 0.8 0.7 0.6 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.8 0.9 0.8 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.7 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.8 0.9 0.9 0.9 0.9 0.9 0.9 0.8 0.8 0.8 0.9 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.8 0.9 0.9 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.7 0.7 0.9 0.7 0.7 1.0 0.8 0.8 0.8 0.8 0.8 0.8
0.7 0.6 0.6 0.8 0.7 0.7 0.7 0.6 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.6 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.7 0.8 0.8 0.8 0.8 0.9 1.0 0.7 0.9 0.9 0.7 0.8 0.8 0.8 0.8 0.8 0.9
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.8 0.6 0.8 0.7 0.8 0.8 0.6 0.8 0.6 1.0 1.0 0.6 1.0 1.0 0.7 0.9 0.9 0.8 0.8 0.8 0.7
0.8 0.7 0.8 0.9 0.8 0.8 0.8 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.7 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.8 1.0 1.0 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.6 0.8 0.6 0.8 0.8 0.6 0.8 0.6 0.9 0.9 0.7 1.0 1.0 0.8 0.8 0.8 0.8 0.9 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 1.0 0.7 0.8 0.8 0.7 0.9 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8 0.7 0.8
0.7 0.7 0.6 0.8 0.8 0.8 0.7 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.7 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.6 0.9 0.6 0.8 0.8 0.6 0.9 0.6 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.7 0.8 0.9 0.8
0.8 0.7 0.8 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.9 0.9 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.9 0.9 0.8 0.8
167
0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.6 0.8 0.7 0.8 0.8 0.7 0.8 0.7 1.0 1.0 0.8 1.0 1.0 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.9 0.8 0.8 0.8 0.7 0.8 0.7 0.9 0.8 0.9 0.9 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.6 0.6 1.0 0.6 0.6 1.0 0.9 0.9 0.8 0.9 0.7 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.7 0.8 0.6 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.8 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.6 0.9 0.7 0.8 0.8 0.6 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.9 0.8 0.8 0.8
0.7 0.7 0.7 0.8 0.7 0.8 0.7 0.7 0.8 0.6 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.7 0.8 0.8 0.9 0.8 0.8 0.8
0.7 0.7 0.5 0.8 0.7 0.8 0.7 0.5 0.8 0.6 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.8 0.7 0.9 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.8 0.8 0.8 0.7 0.8 0.8 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.7 0.9 1.0 0.8 1.0 1.0 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.6 0.8 0.7 0.8 0.7 0.6 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.7 0.7 0.7 0.8 0.7 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.8 0.5 0.5 1.0 0.5 0.5 1.0 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.6 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.9 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.7 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.9 0.8 0.9 0.7 0.8
0.8 0.7 0.8 0.9 0.8 0.8 0.8 0.8 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.6 0.8 0.7 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.8 0.8 0.6 0.8 0.7 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 1.0 1.0 0.8 1.0 1.0 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.7 1.0 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.9 0.9 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.6 0.6 1.0 0.6 0.6 1.0 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.8 0.8 0.8 0.9 0.9 0.8 0.8
0.7 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.9 1.0 0.7 1.0 0.9 0.7 0.8 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.8 0.8 0.7 0.8 0.7 0.3 0.3 1.0 0.3 0.3 1.0 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.8 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.8 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.9 0.8 0.8 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.9 0.8 0.8 0.8
0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.8 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.9 1.0 0.8 0.9 0.9 0.8 0.8 0.8 0.7 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.8 0.7 0.7 0.8 0.8 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.7 0.8
168
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0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 0.9 0.9 0.8 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.9
0.8 0.7 0.6 0.8 0.7 0.8 0.8 0.6 0.8 0.6 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.6 0.8 0.8 0.6 0.8 0.6 1.0 1.0 0.5 1.0 1.0 0.5 0.9 0.8 0.8 0.8 0.8 0.8
0.8 0.8 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.8 0.6 0.8 0.7 0.8 0.8 0.6 0.8 0.6 1.0 1.0 0.6 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.7 0.8 0.8 0.7 0.8 0.6 0.9 0.9 0.9 0.9 0.9 0.9 0.8 0.9 0.8 0.8 0.8 0.8
0.8 0.8 0.6 0.8 0.6 0.8 0.8 0.6 0.8 0.6 0.8 0.8 0.9 0.8 0.8 0.9 0.8 0.9 0.8 0.9 0.9 0.8
0.8 0.7 0.7 0.8 0.7 0.7 0.8 0.6 0.8 0.7 0.9 0.9 0.7 0.9 0.9 0.7 0.7 0.8 0.8 0.8 0.7 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.7 1.0 1.0 0.5 1.0 1.0 0.6 0.8 0.8 0.8 0.8 0.8 0.8
0.8 0.7 0.7 0.8 0.8 0.7 0.8 0.7 0.8 0.8 1.0 1.0 0.7 1.0 1.0 0.7 0.8 0.8 0.8 0.8 0.8 0.8