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:

ii

Copyright @ [2018] by Shahzad, Asif

All Rights Reserved

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).

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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

xiii

Table 4.17 Field notes 102

Table 4.18 Comparison of qualitative and quantitative findings 107

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)

13

5- Sequential-transformative design (S-T-D)

6- Concurrent-transformative design (C-T-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.

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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

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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)

68

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.

73

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

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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),

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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.

81

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

93

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

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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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organizational psychology, 5(2), 215-237.

143

APPENDIX 1: QUNATITATIVE QUESTIONNAIRE

144

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

149

APPENDIX 2: PLS-SEM OUTPUTS

150

Direct effect Model

151

Moderation effect Model

152

PLS-SEM direct effect T-values

153

PLS-SEM Moderation effect T-values

154

APPENDIX 3: NVIVO OUTPUTS

155

Text Search Query

156

Word cloud:

Matrix Coding & Model through NVIVO:

157

APPENDIX 4: LATENT VARIABLE SCORES

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

162

APPENDIX 5: SAMPLE LOADINGS

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

0.8 0.7 0.8 0.8 0.7 0.8 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 0.8 0.7 0.8

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

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 0.7 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

169

APPENDIX 6: GRAPHICAL REPRESENTATION

170

Histograms

171

Bar Charts

172

Normal QQ Plots

173

APPENDIX 7: PLAGIARISM REPORT