Paradox at Work: Unraveling Stress and Turnover in Healthcare: Evidence in Indonesian Hospitals

Albert Diaz Pratama; Innocentius Bernarto

doi:10.37641/jimkes.v14i1.4782

Authors

Albert Diaz Pratama Universitas Pelita Harapan, Indonesia
Innocentius Bernarto Universitas Pelita Harapan, Indonesia

DOI:

https://doi.org/10.37641/jimkes.v14i1.4782

Keywords:

Job Demands, Job Resources, Leadership, Turnover Intention, Work Stress

Abstract

This study aims to analyze the influence of leadership, job demands, and job resources on work stress and turnover intention of hospital staff, with work stress as a mediating variable. The study was conducted on medical and non-medical staff at three hospitals in Indonesia using a quantitative approach. A sample of 200 respondents was selected through purposive sampling with the criteria of a minimum of six months of service and direct involvement in hospital operations. Data were collected through a structured questionnaire and analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM). The results showed that leadership, job demands, and job resources significantly influenced work stress. Leadership and job demands also positively influenced turnover intention. In addition, work stress was shown to mediate the influence of leadership, job demands, and job resources on turnover intention. This study concluded that effective leadership management, job demand management, and job resource optimization play a significant role in reducing work stress and turnover intention of hospital staff. These findings provide practical implications for hospital management in improving workforce well-being and retention.

Downloads

Download data is not yet available.

References

Ahmad, A. (2018). The relationship among job characteristics organizational commitment and employee turnover intentions: A reciprocation perspective. Journal of Work-Applied Management, 10(1), 74-92.

Aliu, F., & Kutllovci, E. (2025). Exploring job satisfaction’s impact on turnover tendency among employees in Kosova’s microfinance institutions. International Journal of Organizational Analysis, 33(3), 665-681.

Atalla, A. D. G., Mostafa, W. H., & Ali, M. S. S. (2025). Exploring the link between Paradoxical leadership and nurses’ career maturity: the mediating role of organizational learning. BMC nursing, 24(1), 559-570.

Baquero, A., Khairy, H. A., & Al-Romeedy, B. S. (2025). Workplace stressors and the intention to quit: the role of psychological distress and psychological flexibility among hospitality employees. Tourism and Hospitality, 6(2), 72-81.

Belete, A. K. (2018). Turnover intention influencing factors of employees: An empirical work review. Journal of Entrepreneurship & Organization Management, 7(3), 1-7.

Bhat, M. A., Tariq Khan, S., & Rainayee, R. A. (2023). Assessment of perceived labor market conditions in employees’ turnover intention model–mediation and moderation analyzes. PSU Research Review, 7(1), 1-32.

Chen, B., Wang, L., Li, B., & Liu, W. (2022). Work stress, mental health, and employee performance. Frontiers in psychology, 13(1), 100-112.

Chênevert, D., Kilroy, S., Johnson, K., & Fournier, P. L. (2021). The determinants of burnout and professional turnover intentions among Canadian physicians: Application of the job demands–resources model. BMC Health Services Research, 21(1), 993-1004.

Deng, H., Wu, W., Zhang, Y., Zhang, X., & Ni, J. (2022). The paradoxical effects of COVID-19 event strength on employee turnover intention. International Journal of Environmental Research and Public Health, 19(14), 8434-8450.

Diko, T. K., & Saxena, S. (2023). Mediating role of employee engagement with transformational leadership and turnover intention. Public Organization Review, 23(4), 1639-1660.

Fahrosa, S. M., Ramli, A. H., Mariam, S., Purnomo, S. H., & Tablante, D. H. (2025). Techno resources, transformational leadership, job satisfaction and turnover intention. Jurnal Ilmiah Manajemen Kesatuan, 13(5), 931–950.

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate data analysis (8th ed.). London: Cengage Learning.

Junaidi, A., Sasono, E., Wanuri, W., & Emiyati, D. (2020). The effect of overtime, job stress, and workload on turnover intention. Management Science Letters, 10(16), 3873-8885.

Kloutsiniotis, P., Mihail, D., Mylonas, N., & Pateli, A. (2022). Transformational leadership, HRM practices and burnout during the COVID-19 pandemic: The role of personal stress, anxiety, and workplace loneliness. International Journal of Hospitality Management, 102(1), 103-115.

Maniscalco, L., Enea, M., De Vries, N., Mazzucco, W., Boone, A., Lavreysen, O., … Matranga, D. (2024). Intention to leave, depersonalisation and job satisfaction in physicians and nurses: A cross-sectional study in Europe. Scientific Reports, 14(1), 2312-2325.

Manoppo, V. (2020). Transformational leadership as a factor that decreases turnover intention: The mediation of work stress and organizational citizenship behavior. The TQM Journal, 32(1), 1395–1412.

Martins, P., Nascimento, G., & Moreira, A. (2023). Leadership and turnover intentions in a public hospital: The mediating effect of organisational commitment and moderating effect by activity department. Administrative Sciences, 13(1), 18-30.

Mawardi, M. C. (2022). Alternative work arrangements, work environment, and job stress on job satisfaction and turnover intention. Golden Ratio of Human Resource Management, 2(1), 27-39.

Moloney, W., Boxall, P., Parsons, M., & Cheung, G. (2018). Factors predicting registered nurses’ intentions to leave their organization and profession: A job demands‐resources framework. Journal of advanced nursing, 7(4), 864-875.

Muppidi, S., & Manoharan, G. (2025). Fostering workplace well-being: the key to happiness, productivity, and retention. In Development of Self-Awareness and Wellbeing: Global Learning Challenges in a Shifting Society (pp. 479-504). New York: IGI Global Scientific Publishing.

Pandey, D. L. (2020). Work stress and employee performance: an assessment of impact of work stress. International Research Journal of Human Resource and Social Sciences, 7(5), 124-135.

Pattali, S., Sankar, J. P., Al Qahtani, H., Menon, N., & Faizal, S. (2024). Effect of leadership styles on turnover intention among staff nurses in private hospitals: The moderating effect of perceived organizational support. BMC Health Services Research, 24(1), 199-210.

Purnomo, S. H., Ramli, A. H., & Banca, C. A. S. (2025). Transformational leadership, work culture, employee engagement, job satisfaction, turnover intention in banks. Jurnal Ilmiah Manajemen Kesatuan, 13(2), 819–826.

Qureshi, M. I., Iftikhar, M., Abbas, S. G., Hassan, U., Khan, K., & Zaman, K. (2013). Relationship between job stress, workload, environment and employees turnover intentions: What we know, what should we know. World Applied Sciences Journal, 23(6), 764-770.

Rahayu, A., Ramli, A. H., Mariam, S., Kusnadi, K., & Tablante, D. (2025). The role of organizational commitment mediation on turnover intention of private bank employees. Jurnal Ilmiah Manajemen Kesatuan, 13(2), 851–870.

Rindu, R., Lukman, S., Hardisman, H., Hafizurrachman, M., & Bachtiar, A. (2020). The relationship between transformational leadership, organizational commitment, work stress, and turnover intention of nurses at private hospitals in Indonesia. Open Access Macedonian Journal of Medical Sciences, 8(E), 551–557.

Sadaf, M., Mukhtar, U., Nemati, A. R., Yousaf, R., & Javed, W. (2022). Impact of organizational value system, perceived organizational support, and job satisfaction on organizational commitment. Journal of Entrepreneurship, Management, and Innovation, 4(1), 71-99.

Sobaih, A. E. E., Gharbi, H., & Abu Elnasr, A. E. (2022). Do you feel safe here? The role of psychological safety in the relationship between transformational leadership and turnover intention amid COVID-19 pandemic. Journal of risk and financial management, 15(8), 340-352.

Soedira, V. N., Husniati, R., & Rialmi, Z. (2021). The influence of career development and work environment on the turnover intention of employee millennial who lives in RW 10, Depok Village, Depok City. Jurnal Ilmiah Manajemen Kesatuan, 9(2), 41–50.

Sokhanvar, M., Kakemam, E., Chegini, Z., & Sarbakhsh, P. (2018). Hospital nurses’ job security and turnover intention and factors contributing to their turnover intention: A cross-sectional study. Nursing and Midwifery Studies, 7(3), 133–140.

Sun, R., & Wang, W. (2017). Transformational leadership, employee turnover intention, and actual voluntary turnover in public organizations. Public Management Review, 19(8), 1124-1141.

Suryawan, I. G. R., Ardana, I. K., & Suwandana, I. G. M. (2021). Transformational leadership, work stress and turnover intention: the mediating role of job satisfaction. American Journal of Humanities and Social Sciences Research (AJHSSR), 5(1), 146-157.

To, W. M., & Huang, G. (2022). Effects of equity, perceived organizational support and job satisfaction on organizational commitment in Macao's gaming industry. Management Decision, 60(9), 2433-2454.

Tziner, A., Rabenu, E., Radomski, R., & Belkin, A. (2015). Work stress and turnover intentions among hospital physicians: The mediating role of burnout and work satisfaction. Revista de Psicología del Trabajo y de las Organizaciones, 31(3), 207-213.

Vanesa, V. (2021). The effect of transformational and transactional leadership on employee negative behavior mediated by work stress. International Journal of Science, Technology & Management, 2(1), 23-37.

Wahyudi, L., Panjaitan, H. P., & Junaedi, A. T. (2023). Leadership style, motivation, and work environment on job satisfaction and employee performance at the environment and hygiene Department of Pekanbaru City. Journal of Applied Business and Technology, 4(1), 55-66.

Yang, H., Lv, J., Zhou, X., Liu, H., & Mi, B. (2017). Validation of work pressure and associated factors influencing hospital nurse turnover: A cross-sectional investigation in Shaanxi Province, China. BMC Health Services Research, 17(1), 112-130.

Yaqin, A. A., & Indradewa, R. (2025). The effect of compensation, workload, and work life balance on turnover intention. Jurnal Ilmiah Manajemen Kesatuan, 13(4), 2279-2292.

Yong, P., & Zhang, J. (2025). How transformational leadership reduces teachers’ role stress: Dual mediation of affective commitment and job satisfaction. Frontiers in Psychology, 16(1), 16-30.

Zheng, G., Liu, H., Wang, Y., & Chen, B. (2021). The embedded paradox of organizational turnover and professional autonomy. Research on Social Work Practice, 31(6), 662–670.