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IJOA
28,1
226
Received 28 November 2018
Revised 16 March 2019
13 June 2019
Accepted 27 July 2019
International Journal of
Organizational Analysis
Vol. 28 No. 1, 2020
pp. 226-242
© Emerald Publishing Limited
1934-8835
DOI 10.1108/IJOA-11-2018-1597
Job stress and organizational
commitment in hospitals
The mediating role of perceived
organizational support
Inas Mohammed Saadeh and Taghrid Saleh Suifan
Department of Business, University of Jordan, Amman, Jordan
Abstract
Purpose – This study aims to examine the effect of job stress on perceived organizational support (POS)
and organizational commitment in hospitals in Amman, Jordan. It also investigated the mediating role of POS
on the relationship between job stress and organizational commitment.
Design/methodology/approach – The study used a cross-sectional, quantitative survey design to
collect data from 500 employees in six hospitals in Amman, Jordan. An Arabic version of a reliable and valid
measurement instrument was used. A convenience sample was selected from employees in the targeted
hospitals. Mediating effect was tested using the approach proposed by Baron and Kenny (1986). Validity and
reliability tests were applied, and regression analyses were used to test the study hypotheses.
Findings – The results revealed a significant negative effect of job stress on POS and organizational
commitment. The results also indicated full negative mediating effect of POS on the relationship between job
stress and organizational commitment.
Practical implications – This research promotes hospitals to implement strategies that reduce
employees’ job stress, increase levels of POS among employees working at hospitals, which, in turn, will
enhance employees’ commitment to their hospitals.
Originality/value – This study is one of the first to investigate the proposed effects in Jordan in particular,
and the Middle East in general. In addition, it contributes to the literature by examining the mediating effect
of POS on the relationship between job stress and organizational commitment. Recommendations are
provided to practitioners in hospitals based on the study results.
Keywords Jordan, Hospitals, Organizational commitment, Mediating effect,
Perceived organizational support, Job stress
Paper type Research paper
Introduction
Organizational commitment is a “hallmark” for the success of the organization; indeed,
committed employees are predicted to be more productive in their jobs (Sharma, 2016).
According to Naghneh et al. (2017), organizational commitment is an essential variable in
understanding employee conduct that has potentially serious consequences on the overall
performance of the organization and ignoring it has been dangerous for the organization.
Organizational commitment is defined as “the relative degree of identification of individual
identity with the organization and his or her participation and involvement in the
organization” (Alipour and Monfared, 2015, p. 278). It is considered as the most significant
motivational factor, implying that an employee can find him/her identity in the organization
while engaged in the organizational activities, combines with it and satisfied to be a
membership (Alipour and Monfared, 2015). Moreover, failure to research and learn about the
employees’ commitment to the organization leads to a massive increase in expenses due to
workforce turnover and recruiting new employees (Naghneh et al., 2017). Organizational Role of
commitment: perceived
[. . .] is characterized by a number of desirable outcomes including a strong belief in and acceptance organizational
of the goal and values of the organization, a willingness to work hard for the organization, and a support
desire to maintain membership in the organization (Al-Hawajreh, 2011, p. 1942).
Employees have a tendency to be committed to their organizations if they experience their
efforts are recognized (Abuseif and Ayaad, 2018). Meanwhile, uncommitted employees do not 227
pay thoughtful regard of their work, subsequently prompting poor performance towards
their organization (Abdallah et al., 2017). Similar to other sectors, organizational commitment
and job stress are important factors for the success of healthcare organizations (Alipour and
Monfared, 2015). Employees become more committed to the organization if they are given an
“opportunity to do important and challenging work, to meet and interact with interesting
people, and to learn new skills and develop as a person” (Chan et al., 2015, p. 27).
Stress is often characterized as a feeling of being overloaded (Ali and Kakakhel, 2013).
While each job entails some degree of stress, some jobs are considered more stressful than
others for the susceptibility of their responsibility (Ghasemzadeh et al., 2017). For example,
hospitals are considered a unique environment for their busy nature, possibility of
contamination and susceptibility to infections (Al-khasawneh and Futa, 2013). Job stress is
viewed as presenting risks to the individual when there are excessive demands but
inadequate supplies, prompting a rising tension in an individual (Rajan, 2014). Previous
researchers discussed that the efficiency of an organization is on excessive danger because
of stress (Zehra et al., 2017). From this perspective, working at hospitals is stressful because
medical personnel are expected to respond to patients needs quickly (Chou, et al., 2014).
Medical practice usually has limitations and uncertainties; medical errors or mistakes might
be costly and harmful to the patient’s life and infrequently irreversible (Chou et al., 2014).
The idea of perceived organizational support (POS) was presented by Eisenberger and
Huntington (1986). They presented the ways of framing POS, examining the impact and
results of organizational support on individual and organizational fields (Ghasemzadeh
et al., 2017). Other researchers proposed that employees’ contribution to their organization
depends on what they expected to be rewarded in the future (Jeung et al., 2017). Accordingly,
employees with a sense of obligation or those individuals who not only worry about their
own success but also desire to fulfill their “debt of gratitude” through showing more
organizational commitment (Eisenberger and Huntington, 1986; Gargr and Dhar, 2014). An
agency-wide, general incentive for commitment could thus increase organizational trust in
employees for dealing with their prosperity (Ghasemzadeh et al., 2017).
Researchers have discussed that the high level of stress in the hospital environment is a
major factor to both physical and psychological health among healthcare professionals (Al
Makhaita et al., 2014). Stress is regarded as the greatest barrier in the effectiveness of
employee performance (Jehangir et al., 2011). However, literature has revealed that job stress
could be minimized by organizational support (Ahmed et al., 2016). It is challenging to the
organization to balance between emotional resources in a job context that emphasizes the
negative influences of stress and the lack of organizational support on the organization
(Ghasemzadeh et al., 2015).
Previous researchers used organizational support theory to organize and theoretically
integrate the POS literature, to interpret the role of POS in employee–organization
relationships (Kurtessis et al., 2017). According to organizational support theory (Eisenberger
and Huntington, 1986), workers’ socioemotional needs are met when the organization
demonstrates readiness to remunerate employees’ expanded exertion, and furthermore,
IJOA encourages them to work harder (Bukhari and Kamal, 2017; Yadav, 2016). Focus has also
28,1 been placed on the importance of employees’ perception of the exchange relationship with
their organizations, implying that commitment is a result of a social exchange relationship, in
which POS explains the employer’s part of the exchange (Sivalogathasan and Hashim, 2014).
Furthermore, organizational commitment is considered as the most motivational issue in
hospitals; committed employees can promote healthcare organizations’ performance and
228 achievement of organizations goals (Alipour and Monfared, 2015). Alipour and Monfared
(2015) further stated that in ensuring employees’ psychological and physical health, the most
important factor to study is job stress.
The success in providing quality patient care may come from the efficiency and
motivation of the medical healthcare provider (Dagget, et al., 2016). Job stress among
healthcare providers may lead to medical errors, negligence that influences patient safety
and low quality of care (Ahmed et al., 2016; Al-khasawneh and Futa, 2013; Labrague et al.,
2018). Accordingly, it is critical to pay additional consideration to job stress and to
improving the appropriate strategies for manage its negative impacts (Ahmed et al., 2016;
Al-khasawneh and Futa, 2013). From this perspective, exploring the significant relationship
between job stress and organizational commitment is critical in enhancing the quality of
healthcare provided in hospitals (Al-Hawajreh, 2011). Researchers have also discussed the
importance of examining the impact of perceived organizational on job outcomes,
organizational commitment and job stress (Labrague et al., 2018). Monitoring and
developing employees’ working conditions at hospitals can improve the safety of the
individual and the profitability of the hospital, with respect to expected outcomes of a
system of commitment and lower employee turnover (Hashish, 2017). According to Hashish
(2017), further research should examine the mediating effects of POS and organizational
commitment. Therefore, examining the relationship between job stress and organizational
commitment is important in improving the quality of healthcare (Al-Hawajreh, 2011). The
predictors of organizational commitment are necessary to be identified (Ali and Kakakhel,
2013). Research studies conducted in Jordan discussing job stress in the hospital
environment, as well as organizational commitment, has been scarce. The present research
was conducted to bridge such a gap. To the best of the researcher’s knowledge, this is the
first research that investigates this relationship in hospitals in Amman.
The purpose of this study is to examine the effect of job stress on POS and organizational
commitment in the healthcare sector in Amman, Jordan. In addition, it explores the effect of
POS on organizational commitment. Moreover, the mediating effect of POS on the
relationship between job stress and organizational commitment is investigated. To achieve
the objectives of the current study, data were collected from 500 employees in six hospitals
Amman.

Theory and hypotheses

Job stress
Stress is “a negative reaction toward events that are thought as to tax or exceed individual
coping ability” (Jehangir et al., 2011, p. 455). According to the US National Institute for
Occupational Safety and Health, job stress is defined as “the harmful physical and emotional
responses that occur when the requirements of the job do not match the capabilities,
responses or needs of the worker” (Al Makhaita et al., 2014, p. 79). The stress encounter was
first archived 50 years prior by Dr Hans Selye, a pioneer in stress research; he viewed stress
as a non-particular reaction of the human body to any demand on it (Jehangir et al., 2011).
Stress was also defined as “the psychological strain or distress resulting from exposure to
unusual or demanding situations, known as stressors” (Finney et al., 2013, p. 2). Job stress is
further defined as “a psychological state perceived by individuals when faced with Role of
demands, constraints, and opportunities [with] important but uncertain outcomes” (Yozgot perceived
et al., 2013, p. 519). Al-Hawajreh (2011), defined job stress as:
organizational
[. . .] any characteristic of the job environment that poses a threat to the individual, either support
excessive demands or insufficient supplies to meet the need and lead to a rising tension in a
person. (p. 1932).
Stress is a familiar, inevitable fact either in individual life, caused by many stressors at work 229
or at home or in any external environment (Al-khasawneh and Futa, 2013). The stressors
might be expected to be drawn out working hours at hospitals, unpalatable commotions,
sights, undue calm, sudden move from extraordinary to everyday errands, time pressure,
lack of additional opportunity and various other conditions (Jehangir et al., 2011). Stress
affects both the employees and the management simultaneously (Al-khasawneh and Futa,
2013). Thus, Beehr and Newman (1978), defined job stress as “a situation arising from the
reaction of people towards their tasks and results in changes that compel individuals to cope
and adjust and disrupt their normal performance” (cited in Jehangir et al., 2011, p. 454).
Previous research conducted in the USA found that almost half of the employees had
difficulty with work–life balance although the majority of them are in paid employment
(Amazue and Onyishi, 2016). In European countries, work–life conflict is a product of both
employment and domestic stresses, with stress at work having more impact on work–life
conflict than stress at home (Amazue and Onyishi, 2016). Related research conducted in the
Middle East compared work-related stress between nurses in Saudi Arabia and Jordan (Al
Makhaita et al., 2014). The overall prevalence of job stress among nurses in Saudi Arabia
was 45.5 per cent, compared with 30 per cent among Jordanian hospital nurses
(Al-Hawajreh, 2011; Al Makhaita et al., 2014). In another study on job stress among doctors
in Australia and Germany (Mache, 2012), the findings showed negative effects of prolonged
working hours on the stress levels of physicians. Moreover, encountering continuous
anxiety has been connected to physical ailments, mental affliction such as discouragement,
uneasiness, substance abuse, suicide and aggressive behavior (Mache, 2012).
In general, job stress is the result of the imbalance between the demands of the job and
the individuals’ abilities (Suifan et al., 2016; Jamal, 2016). According to Parker and Decotis
(1983), stressors are grouped into six categories: characteristics and conditions of the job
itself, conditions associated with the organization’s structure, climate, information flow, role-
related factors, relationships at work, perceived career development and external
commitments and responsibilities.
Moreover, employees suffering from work overload are not willing to go to their work
place because they think of their lack of energy, time and effort in performing their tasks;
indeed, working relationships with others at units of work are significant for employees’ and
organizational health (Suifan et al., 2017; Lai et al., 2015). Thus, organizational structure and
climate may make working conditions either satisfying or stressful (Lai et al., 2015). Job
stress among healthcare providers may lead to medical errors, negligence that influences
patient safety and low quality of care (Ahmed et al., 2016; Al-khasawneh and Futa, 2013;
Labrague et al., 2018).

Perceived organizational support

POS refers to working environment relationships and can be conceptualized using social
exchange theory as it is additionally in view of the idea of reciprocity among employees and
the organization (Sivalogathasan and Hashim, 2014). It can be defined as “the motivation of
organizational managers to value their employees’ contributions and to care about their
IJOA well-being” (Zhang et al., 2017, p. 389). In organizational science, it is important to consider
28,1 how the organization can add a positive contribution to their employees’ daily work life and
to remove obstacles that prevent them to do their best (Bukhari and Kamal, 2017).
Organizational support theory assumes “employees form general beliefs concerning how
much the organization values their contributions and cares about their well-being”
(Eisenberger et al., 2001, p. 42). Moreover, POS is “an experience-based attribution
230 concerning the benevolent or malevolent intent of the organization’s policies, norms,
procedures and actions as they affect employees” (Eisenberger et al., 2001, p. 42).
This theory proposes that the staff make convictions on how much the organization
supports their needs and values, in view of the interaction between organizational agents,
managers and supervisors (Ghasemzadeh et al., 2015). POS is “a key social exchange
variable defined as employees’ beliefs on the extent to which the organization values their
contributions and cares about their well-being” (Eisenberger and Huntington, 1986, p. 503;
Hea, et al., 2014, p. 2775). POS can reflect individual perceptions of the organization’s
willingness to give help when employees are expected to complete their activity successfully
and to meet their socioemotional necessities (Wu and Liu, 2014). After a series of research,
Eisenberger and Huntington (1986) proposed POS, describing it as the “extent for employees
to sense that their work or contributions are valued by the organization and the extent that
the organization pays close attention to their welfare.” These theoretical results served as
the basic foundation for many other following researchers. Fulei et al. (2014) reported that
when employees perceive the organization’s concern and support, they will spend more
effort and give better performance compared with employees who do not perceive that
support. As such, understanding the primary role of organizational support theory is
required to achieve the social-emotional requirements of employees and to improve
employer–employee relationship through supporting mutual interest, care and well-being
(Kunasegaran et al., 2016). POS likewise satisfies socioemotional needs, bringing about more
prominent distinguishing proof and commitment to the organization and an expanded
desire to help the organization succeed, as well as psychological well-being (Kurtessis et al.,
2017).
POS is perceived as how employees reciprocate supportive measures given by the
organization with respect to organizational commitment (Bukhari and Kamal, 2017; Yadav,
2016). According to organizational support theory (Eisenberger and Huntington, 1986),
workers’ socioemotional needs are met when the organization demonstrates readiness to
remunerate employees’ expanded exertion, and furthermore encourages them to work
harder (Bukhari and Kamal, 2017; Yadav, 2016). This perspective of POS is based on Blau’s
(1964) social exchange theory that explains the mutual expectations and perceptions in the
employee–organization relationship (Bukhari and Kamal, 2017; Yadav, 2016).
Organizational commitment. Organizational commitment has been defined as “the
relative strength of an individual’s identification with and involvement in a particular
organization” (Wu and Liu, 2014, p. 67). It occurs when “the identity of the person is linked to
the organization” or when “the goals of the organization and those of the individual become
increasingly integrated or congruent” (McBey et al., 2017, p. 993). Alipour and Monfared
(2015, p. 278), have defined organizational commitment as “the relative degree of
identification of individual identity with the organization and his or her participation and
involvement in the organization”. Organizational commitment is also:
[. . .] the process by which people come to think about their relationship with the organization
[and] a mind-set in which individuals consider the extent to which their own values and goals are
congruent with those of the organization (McBey et al., 2017, p. 993).
These definitions propose that commitment represents a situation in which an employee Role of
identifies with an organization and its objectives and is interested in maintaining perceived
membership to facilitate these objectives (McBey et al., 2017).
Early researchers discussed organizational commitment approach as discrete from work
organizational
attitude without explaining the nature or trends of links with these orientations, e.g. loyalty, support
job involvement and motivation (Sharma, 2016). The exchange approach proposed by
Becker (1960) improved the notion of “side-bets,” which produce a willingness to stay
attached to the object of commitment (Sharma, 2016). 231
Employees who have a high organizational commitment tend to be more enthusiastic
and are more obviously contributing to organizational goals (Wu and Liu, 2014).
Organizational commitment is a quintessential variable that might also pressure the
workers to obtain organizational goals and decorate its competitive edge over its
competitors (Abuseif and Ayaad, 2018). Therefore, organizational commitment influences
the intentions of personnel to remain in the organization except motivating personnel to
exert more effort for the organization (Abuseif and Ayaad, 2018). The researchers noticed
that there was a variations in nurses’ caring behavior from exclusive factors such as
conversation and care given to patients, and employment experience and skills; and these
variations raised the question, whether those who have a higher organizational commitment
would have a higher caring behavior to patients (Naghneh et al., 2017), it was confirmed a
significant positive correlation between organizational commitment and caring behavior of
nurses (Naghneh et al., 2017). According to Naghneh et al. (2017), previous research studies
was conducted at various hospitals in different countries conclude that there was a positive
impact of organizational commitment on the nurses caring behavior, job performance, job
satisfaction and reducing employees’ turnover. Moreover, organizational commitment can
realize a feeling of satisfaction, belonging, alliance and connection of employees to the
organization, progressively ideal job performance and budgetary achievement, and can
expand the productivity and the efficiency of the organization (Naghneh et al., 2017; Karami
et al., 2017). This implies that lower levels of organizational commitment or its deficiency
can in such as manner lead to a progression of issues in an organization including turnover,
absenteeism, the diminished quality of healthcare, irregularities with organizational
objectives and decreases in organizational income (Karami et al., 2017). The researchers
conclude that the organizational commitment had consequences for the employee’s quality
of work and life in every organization and, at long last, the quality of nursing cares (Karami
et al., 2017).
Studies demonstrate that committed workers are progressively steadfast in their conduct
(Naghneh et al., 2017). Furthermore, Al-Hawajreh (2011), in their examinations, demonstrated
that consideration and improving organizational commitment is an advantageous method to
decrease job stress among nurses. However, a study proposed that the perception of the
employees from the measure of equity in an organization had impacts on their demeanors to
the organizational commitment (Karami et al., 2017). This imply feeling absence of equity in
evaluations alongside dissatisfaction can prompt disappointment in the evaluations system,
It can likewise prompt decrease in employees’ soul, the organizational commitment and
ability to accomplish and advance proficient competency and productivity (Karami et al.,
2017).
The three-component model of commitment by Meyer and Allen (1991) states that there
are three “mind sets” that can portray an employee’s commitment towards him/her
organization (Sofat et al., 2015). First, affective commitment is “the employee’s emotional
attachment to, identification with, and involvement in the organization” (McBey et al., 2017,
p. 7; Wu and Liu, 2014, p. 67), implying that there is a powerful bond between the identity of
IJOA an employee and that of the organization (Alipour and Monfared, 2015; McBey et al., 2017).
28,1 Second, normative commitment refers to “the employee’s feelings of obligation to remain”
(Wu and Liu, 2014, p. 67) or “an individual’s feelings of obligation and loyalty to the
organization” (McBey et al., 2017, p. 7). These feelings may stem from familial or social
socialization forms that depict the association’s main goal as commendable (McBey et al.,
2017). Third, continuance commitment is associated with employees’ perception about the
232 cost of leaving their organization (Wu and Liu, 2014). It also refers to contributory ties, such
as monetary incentives, social situation, work-related experience, and improved relevant
skills, which can be an inception to tie the employee to the organization (McBey et al., 2017).

Job stress and organizational commitment

Previous researchers discussed the impact of stress on employees with different degrees of
commitment towards their organization; employees who have a high level of sense of
commitment encounter more prominent measures of stress compared with employees who
are less committed (Al-Hawajreh, 2011). Different stressors come from different causes, such
as role conflict, work load, role ambiguity and autonomy (Gargr and Dhar, 2014). In terms of
correlation between job stress and organizational commitment, job stress has been revealed
to have a significant inverse relationship with organizational commitment (Ali and
Kakakhel, 2013; Gargr and Dhar, 2014; Haque and Aston, 2016). Indeed, there is a strong
effect from employees’ physical and psychological well-being on organizational
commitment (Eisenberger et al., 2010; Meyer and Maltin, 2010).
Individuals are less expected to have control over these aforementioned sources of stress
(Gargr and Dhar, 2014). Thus, job stress has a negative impact on employees’ attitude and
behaviors by lowering their performance and productivity (Haque and Aston, 2016). Self-
development wants are the main value for the feeling of organizational commitment;
therefore, it is expected that employees with more stress have less commitment towards
their organization (Gargr and Dhar, 2014).
There, the following hypothesis is proposed:

H1. Job stress negatively and significantly affects organizational commitment.

Job stress and perceived organizational support

Stress in hospitals is related to many conditions related to the work at hospitals; the most
contributing factors increasing job stress at hospitals are bias and absence of organizational
support (Ahmed et al., 2016). Excessive job stress arises when extra job demands or
requirements are complemented by organizational support deprivation; this combination
will affect employees’ performance negatively (Ahmed et al., 2016). Meanwhile, many
studies have discussed the negative significant correlation between job stress and POS
(Ghasemzadeh et al., 2015). Rhoades and Eisenberger (2002) reported that unfavorable work
conditions (i.e. the presence of stressors) has a negative correlation with POS. From this
perspective, the second hypothesis is proposed:

H2. Job stress negatively and significantly affects POS.

Perceived organizational support and organizational commitment

Organizational commitment reflects the individual’s belief in the goals and values of the
organization, acceptance of these goals and values, desire to exert reasonable effort in behalf
of the organization, and strong wish to remain in it (Shra’ah et al., 2013).
 According to organizational support theory (Eisenberger and Huntington, 1986), a sense Role of
of commitment is generated in employees when they receive suitable treatment from the perceived
organization. POS is considered as a more influential cause of organizational commitment
(Eisenberger et al., 2001; Eisenberger and Huntington, 1986). Employees perceive a high
organizational
degree of organizational support in terms of the degree that an organization cares about support
their well-being (Eisenberger and Huntington, 1986). In turn, they display increased
organizational commitment (Wu and Liu, 2014). Furthermore, increasing levels of POS
among employees have a direct impact on professional self-concepts, emotional belonging, 233
optimism and level of self-efficacy, which are important to improve organizational
commitment (Labrague et al., 2018). Therefore, the following the third hypothesis is
proposed:

H3. POS positively and significantly affects organizational commitment.

The mediating role of perceived organizational support between job stress and
organizational commitment
There is much evidence that job stress affects organizational commitment negatively;
employees perceiving less support from their organization will have less organizational
commitment (Gargr and Dhar, 2014). In addition, it is acknowledged that job stress will
negatively affect POS (Ahmed et al., 2016; Ghasemzadeh et al., 2015). The reduced levels of
POS resulted from job stress will, in turn, decrease organizational commitment levels.
Previous research supports the social exchange judgment that employees’ commitment to
the organization is remarkably affected by their perception of the organization’s
commitment to them (Eisenberger and Huntington, 1986). Higher organizational support
logically leads to lower work–life conflict, such as job stress, and a higher organizational
commitment (Amazue and Onyishi, 2016). From this perspective, the fourth hypothesis is
proposed:

H4. POS significantly mediates job stress-organizational commitment relationship.

Method
Sample
The population of the current study consisted public and private hospitals in Amman,
Jordan. There are five public hospitals and 41 private hospitals in Amman. The researchers
contacted these hospitals to require their approval to participate in the study, and two public
hospitals and four private agreed to participate. The unit of analysis represented employees
in all managerial levels. The total number of employees working in the six hospitals that
agreed to participate is 8,703. The appropriate sample size for this population is 368
(Sekaran and Bougie, 2016). To achieve the targeted sample size, the researchers decided to
distribute more questionnaires as possible. Ultimately, 540 questionnaires were distributed
to the targeted respondents. Proportional sampling was used to decide the number of
respondents in each hospital. Next, convenience sampling was used to distribute the
questionnaires to the targeted sample size in each hospital. Out of the distributed
540 questionnaires, 526 were returned and 26 were rejected, so the final number of usable
questionnaires was 500 representing a response rate of 92.5 per cent. This rate is higher than
other similar studies conducted in Jordan (Abdallah et al., 2017; Ayoub et al., 2017; Obeidat
et al., 2017). Respondents were contacted personally by the researchers, and this explains the
high response rate. The researchers met the selected employees in the six hospitals and
IJOA discussed with them their feelings towards their jobs. Many employees complained that
28,1 they were dissatisfied with the working conditions in their hospitals, and they were hoping
to have better conditions. In addition, most employees believed that there was a lack of
managerial support, especially in private hospitals. Also, many employees in both private
and public hospitals complained of work overload because of staff shortage. Employees in
private hospitals were dissatisfied with job insecurity and complained that they may be laid
234 off if they require to improve the working conditions.
Measures. A survey questionnaire was developed to collect the required data for the
current study. High-reliability constructs used in previous studies were adopted. The
questionnaire contained 30 items for measuring the research variables: 13 items to measure
job stress adopted from Parker and Decotis (1983), 11 items to measure POS adopted from
Eisenberger and Huntington, (1986) and 6 items to measure organizational commitment
adapted from Meyer and Hersocovitch (2001). The questionnaire was prepared in English
and then translated to Arabic language. Both versions were reviewed by five professors in
business administration, and modifications were made as needed. Respondents were asked
to indicate their agreement or disagreement with the statements provided using a five-point
Likert scale where 1 indicated strongly disagree and 5 indicated strongly agree.

Validity and reliability

Exploratory factor analysis (EFA) was conducted to determine the underlying structure
between the variables in the analysis (Hair et al., 2010). For conducting EFA, three
assumptions needed to be achieved. First, the Kaiser–Meyer–Olkin measure of sampling
adequacy must be more than 0.50; second, the eigenvalue for each factor must be more than
one; and third, factor loading for each item must be more than 0.40 (Hair et al., 2010).
Principal component analysis was used, as the objective of this analysis was to summarize
most of the main information into a minimum number of factors for forecasting purposes. In
addition, varimax rotation method was used to validate obliquely rotated factors, to
determine the correlated factors specifically. A total of six items were deleted either because
their loadings were less than 0.40 or they loaded onto more than one factor. Table I presents
the final items and the EFA results.
Reliability of the constructs was tested using Cronbach’s alpha coefficient. The alpha
values were 0.882 for job stress, 0.767 for POS and 0.757 for organizational commitment.
These values indicated acceptable internal consistency with a > 0.70 for the three
constructs (Hair et al., 2010).
Common method bias was tested using Harmon’s single factor procedure. All the study
items were loaded into a principal component factor analysis with no rotation. The output
exposed four factors with eigenvalues greater than 1.0, which accounted for 69.5 per cent of
the variance, with the highest factor (first factor) accounting for 39.6 per cent, implying that
common method bias was not a concern in this study (Harman, 1976; Podsakoff et al., 2003).

Results
To test the study hypotheses, regression analysis was used. As for the mediating effect,
Baron and Kenny’s (1986) technique was applied. This four-step approach is widely adopted
among researchers to test mediation effects (Albuhisi and Abdallah, 2018; Zhao et al., 2010).
According to this technique, the following conditions should be met. First, the independent
variable should significantly predict the dependent variable. Second, the independent
variable should significantly predict the mediating variable. Third, the mediating variable
should significantly predict the dependent variable. Finally, multiple regression analysis
should be conducted with both the independent and mediating variables to test whether
 Factor 1 Factor 2 Factor 3
Item no. Item description JS POS OC

JS2 Working here leaves little time for other activities 0.904
JS4 I have too much work and too little time to do it in 0.864
JS1 I spend so much time at work that I cannot see the forest for the trees 0.832
JS5 I sometimes dread the telephone ringing at home because the call might be job-related 0.761
JS3 I frequently get the feeling I am married to the company 0.656
JS8 I have felt fidgety or nervous as a result of my job 0.636
JS9 My job gets me more than it should 0.608
JS6 I feel like I never have a day off 0.607
JS7 Too many people at my level in the hospital get burned out by job demands 0.580
JS12 Sometimes, when I think about my job, I get a tight feeling in my chest 0.513
POS6 The hospital would fail to notice, even if I did the best job possible 0.894
POS1 The hospital values my contribution to its well-being 0.764
POS3 The hospital strongly considers my goals and values 0.732
POS11 The hospital takes pride in my accomplishments at work 0.716
POS5 The hospital really cares about my well-being 0.695
POS4 The hospital would ignore any complaint from me 0.594
POS7 The hospital would grant a reasonable request for a change in my working conditions 0.589
POS8 The hospital is willing to help me when I need a special favor 0.515
OC1 Remaining a member of this hospital is important to me 0.801
OC2 I would be very happy to spend the rest of my career with this hospital 0.536
OC3 It would be costly for me to leave this hospital now 0.842
OC5 I would feel guilty if I left this hospital now 0.785
Eigenvalue 6.900 2.773 1.688
% of variance 31.363 12.603 7.671

constructs
organizational
perceived

235
Role of

EFA for the study

Table I.
support
IJOA they significantly predict the dependent variable. Full mediation effect exists if the
28,1 significant effect acquired from the first step becomes insignificant in the fourth. However, if
the significant effect acquired from the first step is reduced but still significant, then partial
mediation exists.
As shown in Table II, the effect of job stress on organizational commitment was negative
and significant; therefore, hypothesis H1 was supported. The effect of job stress on POS was
236 also negative and significant; therefore, hypothesis H2 was also supported. As for the effect
of POS on organizational commitment, the results showed positive and significant effect;
therefore hypothesis H3 was supported.
As for the mediating effect, the results showed that the direct effect of job stress on
organizational commitment (in the first step: b = 0.227, p < 0.001) decreased and became
insignificant (in the fourth step: b = 0.083, p > 0.05), indicating that POS fully negatively
mediates the relationship between job stress and organizational commitment. Therefore,
hypothesis H4 was supported.

Discussion
The current study examined the mediating role of POS on the relationship between job
stress and organizational commitment in hospitals in Amman, Jordan. It hypothesized that
job stress negatively impacts organizational commitment directly and indirectly through
POS.
The study results proved that job stress negatively and significantly related to
organizational commitment and POS. These results are in line with some previous studies
(Labrague et al., 2018; Nouri and Soltani, 2017). The results also showed a positive
significant effect of POS on organizational commitment. This results is also consistent with
previous studies (McBey et al., 2017; Labrague et al., 2018; McBey et al., 2017).
The findings also proved that perceived organization support has full negative
mediating effect on the relationship between job stress and organizational commitment.
Based on reciprocity, employees are more responsible in retrieving organizational resources
via implementing organizational objectives through their rigorous participation and useful
support (Khan et al., 2015). Moreover, based on the social exchange theory, employees are
emotionally attached to their organization and morally committed to reciprocate positively
to organizational commitment (Bukhari and Kamal, 2017). Therefore, adding value to the
work environment and revealing obstacles that hinder employees to operate effectively are
necessary to achieve such reciprocity (Bukhari and Kamal, 2017). On the other hand,
organizational commitment has been accounted for to give numerous advantages to
organizations (Abdallah et al., 2017).

Step 1 Step 2 Step 3 Step 4

Variables OC POS OC OC

Constant 3.854*** 4.134*** 1.689*** 2.143***

Table II. JS 0. 227*** 0.415*** 0.083
Regression analysis POS 0.383*** 0.349***
for the mediating R 0.227 0.415 0.383 0.39
R2 0.052 0.172 0.147 0.152
effect of POS Adjusted R2 0.05 0.17 0.145 0.149
between job stress F-value 27.084*** 103.362*** 85.500*** 44.605***
and organizational
commitment Note: ***p < 0.01
Consequently, achieving organizational commitment entails hospitals to exert effort in Role of
minimizing job stress levels, which, in turn, will increase POS levels, and the latter will perceived
enhance organizational commitment.
organizational
Practical implications support
In the healthcare system, especially hospitals, human resources are a significant factor in
the success of organizational efficiency (Alipour and Monfared, 2015). Therefore,
hospitals should focus on their human capital and restructure their management style to
237
maintain their employees’ organizational commitment at the optimum level. According to
the organizational support theory, when organizations consider their employees’
attributions, the latter perceive a positive valuations of the former based on reciprocity
and their degree of identification with the organization (Kim et al., 2016). Therefore,
hospitals must manage the stress level of their employees to increase the latter’s
organizational commitment level (Alipour and Monfared, 2015). In addition, minimizing
the levels of job stress will enhance POS. This entails adopting strategies, which include
implementing employee-centered policies, improving the employees’ working conditions,
minimizing their work overload, enhancing teamwork between employees and their
supervisors, focusing on organizational rewards instead of accountability, ensuring
autonomy, offering practical development opportunities and granting suitable payments
and promotion (Labrague et al., 2018). The enhanced levels of POS will, in turn, increase
organizational commitment. Hospital leaders play a significant role in ensuring that these
supportive structures care for the employees, value their contributions, consider their
well-being, and regard their competence; in this way, positive organizational outcomes
are improved (Labrague et al., 2018).
Although the concept of perceived organization support is still ambiguous in Jordanian
hospitals, it should be adopted by managers to increase organizational efficiency and
improve quality of patient care. Perceived organization support can be enhanced through
open channels, such as a shared clear vision between employees and supervisors, and
promoting trust-based environment hospital-wide. Hospitals should also focus on equity
principles between employees while fostering reward and accountability system, and
provide support that minimizes job stress and increases perceived organizational support
and organizational commitment.

Conclusion
This research was conducted in selected hospitals in Amman to examine the mediating
effect of POS in the relationship between job stress and organizational commitment. The
findings indicated a significant inverse relationship between job stress and organizational
commitment and POS, and a significant positive relationship between POS and
organizational commitment. The results also revealed the importance of full mediation effect
of POS on the relationship between job stress and organizational commitment; meaning,
employees’ organizational commitment increases when job stress level decreases. According
to previous studies, if the level of POS increases, the quality of patient care improves while
maintaining hospital success.

Limitations and recommendations for future research

This research has some limitations that could be considered in future studies. First, the use
of convenience sampling limits the generalizability of the results. Due to difficulties of
applying the simple random method, participants in each hospital were selected using the
convenience sampling. Further studies could apply the simple random method to confirm
IJOA the results of the current study. Second, the majority of contacted hospitals declined to
28,1 participate in this research because of their internal policies. To improve the perception of
employee’s organizational support at hospitals, hospitals policies still need some adaptation
focusing more on employees’ perception of organizational support. The limited number of
included hospitals may have affected the results. Further studies are recommended with a
sample including most of operating hospitals. In addition, future studies could compare
238 accredited and non-accredited hospitals with regard to study variables.

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Corresponding author
Inas Mohammed Saadeh can be contacted at: inas.saadeh@yahoo.com

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