INTRODUCTION:

In India the healthcare is develop into one of major areas in terms of income as well as employment. Healthcare includes hospitals, clinical trials, medical devices, telemedicine, outsourcing, health insurance, and medical tourism. The healthcare sector in India is increasing rapidly with an active pace with coverage, enhanced services, and increased spending by private and public enterprises.

The 21st century is called "the century of stress". There is no one without stress. Every child, from small children to the elderly, feels stressed. Stress is an imprecise reaction of the body at any request. Stress is referred as in the terms of physiological and physical affects on people, and there are mental and emotional ones. It is all situations or factors that can grounds stress.

Many factors affecting stress from the personality are one of the main factors. It depends on how much stress he/she can withstand. It also relates to the individual's coordination ability. The same situation can be tackled in different ways by the same person.

Occupational stress can be defined as the harmful emotional and physical reactions that occur when work demands do not coincide with people or workers. Although it is unlikely that a person who is constantly stressed at work will work effectively in other roles such as the parents, husband, wife, neighbors and community members. The cause of illnesses shows real impact on the organization and society of an individual.

The symptoms of stress vary by individual. However, according to help guides, they tend to be classified cognitively, physically, emotionally and behaviorally. Cognitive symptoms include memory problems, indecision, lack of concentration, lack of judgment, seeing only the bad side of the problem, thinking about anxiety and competition, constant concern, loss of objectivity etc. Physical symptoms include headache or backache, muscle tension as well as stiffness, diarrhea or constipation, dizziness, nausea, sleeplessness, rapid pulse, chest pain, weight gain or loss, sexuality desire loss, skin pain (i.e. urticaria or eczema) and frequent colds. Emotional symptoms include mood, upset, restlessness, irritability, inability to relax, tension, overwhelming, loneliness, feeling of isolation, and depression.

In Guntur district, a research done in four hospitals at a urban locale recognized that the significant reasons for worry among attendants are absence of break period during shifts, staff deficiency, insufficient help from the board, poor working conditions, deficient assets to work with, and absence of motivations for additional time. It clearly influences their wellbeing, mistakes in understanding consideration, increment turnover aims and non-appearance. The investigation further to investigate worry among nurses in Guntur region by discovering answers to the causes, types, adapting techniques and indicators of stress.

Stress could be a psychological and physiologic imbalance resulting from adverse circumstances (Preetham Sridar and Vijila Kennedy, 2012). Whenever an individual visit a hospital with any quite illness, he/she expects the doctors, nurses and even the support staff to indicate care and concern towards him/her or rather empathize with him/her (Elizabeth George, Zakkariya K.A, 2015). Especially the profession of nursing is invariably considered a stressful occupation within the healthcare system, these may negatively affect the health status of nurses, which could then hinder their professional performance and affect the standard of healthcare provided (Monika Agarwal, 2017). Every employee within the hospital is forced to possess a stressful and hectic lifestyle. If he fails to satisfy, he faces stress and other psychological problems (Pooja Dasgupta, Khushbu Dubey, 2015). It effects on physical body, which supplies rise to tension, anxiety, depression and anger (Maneet Kaur et., 2017). Employers and law should take up some more measures to assist working women to induce eliminate this serious threat. it's worth to review about problems of the nursing employee within the healthcare industry because works overload/overtime issues; poor salary for workers, shift work especially night work make stress among nursing employees both at personal and career wise additionally (Siva Prasad K.I., P. T. Raveendran, 2019).

REVIEW LITERATURE:

Xiaoyu Li Yaqing Zhang Dexiu Yan Fule Wen Yuanyuan Zhang (2020) they studied the relationships among perceived organizational support, job satisfaction, job control, and intention to stay, enriching the theoretical model of intention to stay. Nurse can develop nurses’ intention to stay by enhancing their perceived organizational support, job control and job satisfaction.

Adelaide M.A. Ofei, Yennuten Paarima, Theresa Barnes, Atswei A. Kwashie (2020) they identified that role of NMs in healthcare delivery is associated with work-related stress which if not properly addressed can reduce the quality and effectiveness of nursing units.

Abbasi, Milad, Somayeh Farhang, Madvari, Mehri, Ahmad, Ebrahimi, Poursadeghiyan, M. Marioryad, Ghaljahi (2019) they identified the connection between the variables of age, work experience, and the number of patients per shift and scores of work-related quality of life was statistically considerable.

Tanaya Nayak, Pravat Kumar Mohanty, Chandan Kumar Sahoo (2018) they derived the linkages between the organizational commitment, quality of work life and workplace empowerment. The effect of workplace empowerment on employee commitment is primarily due to the high quality work life of healthcare professionals.

RESEARCH GAP:

There is no previous studies have made the study on the impact of occupational stress on working performance of nurses and organizational effectiveness. Therefore, the researchers focuses on to study the occupational stress at hospitals in Guntur District.

STATEMENT OF THE PROBLEM:

A literature review which were presented in the earlier focused on occupational stress of different dimensions such as working conditions, decision making, occupational stability, role conflict, role ambiguity, discrimination, workload, work-life balance, organizational culture, participation, poor peer relationships, quality of work life, organizational commitment, low status, powerlessness, teamwork, intrinsic improvement, pressure from top management, apart from these the other traditional aspects such as unprofitability, remuneration, creativity, improvement of technology wages and benefits, canteen facilities, medical facilities, incentives, welfare activities, absence of time. It's a way to think about an organization and it creates a sense of fulfillment in employees mind and they contribute together with employee satisfaction, improves hospital productivity and overall effectiveness.

SIGNIFICANCE OF THE STUDY:

The study finds out the factors affecting occupational stress to reduce stress levels of women nurses in public and private hospitals in Guntur District. The study throughs a light on significant differences in women nurse stress levels between different categories of government and private sector and also analyze the effects of various causes of stress on women nurses.

OBJECTIVES OF THE STUDY:

· To examine the impact of stress on working performance of nurses and organizational effectiveness in hospitals

· To put forth certain suggestions based on the findings that have been arrived for the consideration of the policy maker to take appropriate decisions to reduce occupational stress

HYPOTHESIS:

H0 1: There is no significant difference in the perceptions of the women nurses for the Employee Engagement, Emotional Intelligence, Health Problems, Congenial Work Environment, Organizational Culture, Quality of Work life, Loss of Concentration, Memory Loss, Group Dynamics, Work life balance, Happiness Management, Interpersonal Conflicts, Job Satisfaction, Attrition, Negative Attitude variables in the Public and Private sector hospitals in Guntur District.

H1 1: There is significant difference in the perceptions of the women nurses for the Employee Engagement, Emotional Intelligence, Health Problems, Congenial Work Environment, Organizational Culture, Quality of Work life, Loss of Concentration, Memory Loss, Group Dynamics, Work life balance, Happiness Management, Interpersonal Conflicts, Job Satisfaction, Attrition, Negative Attitude variables in the Public and Private sector hospitals in Guntur District.

RESEARCH METHODOLOGY AND SAMPLING:

Sampling in the study involves both the selection of hospitals and respondents. Four hospitals were chosen based on their viable presence and contribution towards hospitals. From the chosen hospitals, employees are selected as sample respondents using purposive sampling technique. This includes 30 employees as respondents from each hospital. The total number of respondents is 120. The collected data has been analyzed with regression analysis. Regression is used to identify if there is any significant effect of independent variable with dependent variable and to know at what extent they are influenced by the independent variable and identify all the hospitals included in the study.

DATA ANALYSIS AND RESULTS:

Regression Models:

The statistical tool is used to identify if there is any significant effect of independent variable with respect to public and private sector. The model is used to test each of the factors of dependent variable to what extent they are influenced by the independent variable.

Table 1: Regression Model: Employee performance in Public sector hospitals

Model Summary
Model	R	R Square	Adjusted R Square	Std. Error of the Estimate
Public	.974^a	.948	.945	.252

a. Predictors: (Constant), Employee Engagement, Emotional Intelligence, Health Problems, Congenial Work Environment, Organisational Culture, Quality of Work life, Loss of Concentration, Memory Loss, Group Dynamics, Work life balance, Happiness Management, Interpersonal Conflicts, Job Satisfaction, Attrition, Negative Attitude.

ANOVA^a
Model		Sum of Squares	df	Mean Square	F	Sig.
Public	Regression	384.770	15	25.651	403.557	.000^b
	Residual	21.230	334	.064
	Total	406.000	349

a. Dependent Variable: Employee Performance

b. Predictors: (Constant), Employee Engagement, Emotional Intelligence, Health Problems, Congenial Work Environment, Organisational Culture, Quality of Work life, Loss of Concentration, Memory Loss, Group Dynamics, Work life balance, Happiness Management, Interpersonal Conflicts, Job Satisfaction, Attrition, Negative Attitude

RESULT AND ANALYSIS:

The result shows that the model is fit for Public sector hospitals as the value of public sector hospitals is less than .050 that is .000. Therefore it can be concluded that the model is fit for the study.

Coefficients^a
Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig.
Model		B	Std. Error	Beta	t	Sig.
Public	(Constant)	-3.069	.296		-10.385	.000
	Quality of Work life	.017	.010	.022	1.619	.106
	Job Satisfaction	.264	.022	.346	11.930	.000
	Organisational Culture	.003	.009	.004	.310	.757
	Work life balance	-.025	.012	-.034	-2.071	.039
	Happiness Management	-.409	.027	-.380	-15.151	.000
	Congenial Work Environment	.842	.046	.938	18.247	.000
	Attrition	.577	.026	.680	22.599	.000
	Negative Attitude	-.295	.029	-.395	-10.330	.000
	Group Dynamics	-.014	.013	-.017	-1.085	.279
	Health Problems	-.010	.013	-.012	-.773	.440
	Loss of Concentration	.009	.011	.013	.829	.408
	Memory Loss	.007	.012	.009	.583	.560
	Emotional Intelligence	-.047	.019	-.065	-2.420	.016
	Interpersonal Conflicts	.477	.015	.709	32.405	.000
	Employee Engagement	.008	.022	.009	.348	.728

a. Dependent Variable: Employee Performance

ANOVA^a
Model		Sum of Squares	df	Mean Square	F	Sig.
Public	Regression	517.277	15	34.485	116.670	.000^b
	Residual	98.723	334	.296
	Total	616.000	349

a. Dependent Variable: Organizational Effectiveness

b. b. Predictors: (Constant), Employee Engagement, Emotional Intelligence, Health Problems, Congenial Work Environment, Organisational Culture, Quality of Work life, Loss of Concentration, Memory Loss, Group Dynamics, Work life balance, Happiness Management, Interpersonal Conflicts, Job Satisfaction, Attrition, Negative Attitude

RESULT AND ANALYSIS:

Coefficients^a
Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig.
Model		B	Std. Error	Beta	t	Sig.
Public	(Constant)	8.373	.637		13.139	.000
	Quality of Work life	.031	.022	.033	1.389	.166
	Job Satisfaction	-.978	.048	-1.042	-20.523	.000
	Organisational Culture	-.028	.020	-.035	-1.427	.154
	Work life balance	-.060	.026	-.065	-2.294	.022
	Happiness Management	.745	.058	.562	12.812	.000
	Congenial Work Environment	-1.059	.100	-.958	-10.642	.000
	Attrition	1.036	.055	.991	18.816	.000
	Negative Attitude	-.514	.061	-.560	-8.363	.000
	Group Dynamics	-.005	.029	-.005	-.177	.860
	Health Problems	-.014	.027	-.015	-.525	.600
	Loss of Concentration	.055	.025	.062	2.246	.025
	Memory Loss	.016	.026	.016	.597	.551
	Emotional Intelligence	-.773	.042	-.874	-18.623	.000
	Interpersonal Conflicts	.445	.032	.537	14.021	.000
	Employee Engagement	-.934	.049	-.879	-19.252	.000

a. Dependent Variable: Organizational Effectiveness

ANOVA^b
Model		Sum of Squares	df	Mean Square	F	Sig.
Private	Regression	326.177	15	21.745	80.243	.000^a
	Residual	90.511	334	.271
	Total	416.689	349

a. Predictors: (Constant), Employee Engagement, Happiness Management, Emotional Intelligence, Work life balance, Memory Loss, Interpersonal Conflicts, Congenial Work Environment, Group Dynamics, Job Satisfaction, Negative Attitude, Attrition, Health Problems, Organisational Culture, Quality of Work life, Loss Of Concentration

b. Dependent Variable: Employee performance

RESULT AND ANALYSIS:

The result shows that the model is fit for Private sector hospitals as the value of private sector hospitals is less than .050 that is .000. There fore it can be concluded that the model is fit for the study.

Coefficients^a
Model		Unstandardized Coefficients		Standardized Coefficients	T	Sig.
Model		B	Std. Error	Beta	T	Sig.
Private	(Constant)	-2.449	.610		-4.013	.000
	Quality of Work life	-.084	.040	-.115	-2.107	.036
	Job Satisfaction	.415	.030	.608	13.635	.000
	Organisational Culture	.112	.046	.129	2.417	.016
	Work life balance	.013	.019	.020	.686	.493
	Happiness Management	-.085	.025	-.114	-3.438	.001
	Congenial Work Environment	-.013	.027	-.015	-.461	.645
	Attrition	.009	.026	.012	.363	.717
	Negative Attitude	.015	.024	.021	.646	.518
	Group Dynamics	.036	.025	.046	1.444	.150
	Health Problems	-.362	.056	-.331	-6.492	.000
	Loss Of Concentration	.718	.095	.790	7.539	.000
	Memory Loss	.535	.053	.623	10.158	.000
	Emotional Intelligence	-.294	.059	-.389	-4.989	.000
	Interpersonal Conflicts	.060	.021	.078	2.803	.005
	Employee Engagement	.228	.046	.295	4.992	.000

a. Dependent Variable: Employee performance

ANOVA^b
Model		Sum of Squares	df	Mean Square	F	Sig.
Private	Regression	447.588	15	29.839	66.608	.000^a
	Residual	149.626	334	.448
	Total	597.214	349

b. Dependent Variable: Organizational Effectiveness

RESULT AND ANALYSIS:

The result shows that the model is fit for Private sector hospitals as the value of private sector hospitals is less than .050 that is .000. Therefore it can be concluded that the model is fit for the study.

Coefficients^a
Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig.
Model		B	Std. Error	Beta	t	Sig.
Private	(Constant)	7.562	.785		9.639	.000
	Quality of Work life	-.720	.051	-.826	-14.076	.000
	Job Satisfaction	.437	.039	.535	11.166	.000
	Organisational Culture	-.902	.060	-.862	-15.099	.000
	Work life balance	-.040	.024	-.051	-1.645	.100
	Happiness Management	-.041	.032	-.046	-1.278	.202
	Congenial Work Environment	-.055	.035	-.055	-1.556	.121
	Attrition	.033	.033	.035	1.006	.315
	Negative Attitude	.049	.030	.055	1.613	.100
	Group Dynamics	.042	.032	.045	1.300	.194
	Health Problems	.638	.072	.488	8.902	.000
	Loss Of Concentration	-.918	.123	-.843	-7.495	.000
	Memory Loss	1.019	.068	.990	15.034	.000
	Emotional Intelligence	-.465	.076	-.515	-6.146	.000
	Interpersonal Conflicts	.037	.027	.040	1.345	.180
	Employee Engagement	-.894	.059	-.968	-15.249	.000

a. Dependent Variable: Organizational Effectiveness

Table-5: Regression Model: Concluding summary

Dependent factor		Sectors	Influencing factors	Sectors	Influencing factors
Employee performance		Public	· Job Satisfaction, · Happiness Management · Congenial Work Environment · Attrition · Negative Attitude · Interpersonal Conflicts · Work life balance · Emotional Intelligence	Private	· Job Satisfaction · Health problems · Loss of concentration · Happiness Management · Memory loss · Intelligence · Employee engagement · Quality of work life · Organizational culture · Interpersonal conflicts
Dependent factor	Sectors		Influencing factors	Sectors	Influencing factors
Organizational Effectiveness	Public		· Job Satisfaction · Happiness Management · Congenial Work Environment · Attrition · Negative Attitude · Emotional Intelligence · Interpersonal Conflicts · Employee Engagement · Work life balance · Loss of Concentration	Private	· Quality of Work life · Job Satisfaction · Organizational culture · Health problems · Loss of concentration · Memory loss · Emotional Intelligence · Employee engagement · Work life balance · Negative attitude

FINDINGS:

· From the regression model it shows that, Employee performance is highly influenced by the job satisfaction, happiness management and interpersonal conflicts in both the sector hospitals.

· From the regression model it shows that, Organizational effectiveness is highly influenced by the Job satisfaction, Emotional Intelligence, Employee engagement, Work life balance and Loss of concentration in both the sector hospitals.

· From the research, it is identified that for Employee performance in public sector the unique variables are Congenial Work Environment, attrition, negative attitude, work life balance, and in private sector are health problems, loss of concentration, memory loss, employee engagement, quality of work life and organizational culture.

· From the research, it is identified that for organizational effectiveness in public sector the unique variables are happiness management, Congenial Work Environment, attrition, Interpersonal conflicts and in private sector are quality of work life, organizational culture, health problems, memory loss.

SUGGESTIONS:

· In the both the sectors, Employee performance is highly influenced by the interpersonal conflicts. Conflicts may arise due to low self esteem, misunderstandings, lack of communication, job dissatisfaction, work stress etc. that ultimately affects the hospital productivity. Therefore, management should develop the team bonding spirit and conducting one on one meeting in regular intervals can reduce the stress. At the same time management should provide seminars and workshops on organizational conflict management from time to time for the nurses in the hospitals.

· In the both the sectors, Organizational Effectiveness is highly influenced by the Employee engagement. It is well known fact that engagement level of nurses was the ultimate predictor of patient mortality rates. Low engagement in work place arises in nurses due to lack of personnel and career development, low salary and recognition. So the management should encourage nurse’s involvement in decision making, commitment and emotional involvement with respective to their personnel growth and development.

· From the research, it is identified that happiness management is the influencing factor in public sector. Even small efforts can have big rewards when it comes to employee happiness. Peer-to-peer recognition is especially effective in the healthcare sector, recognizing the work they do and congratulating them for a job well done can go a long way toward boosting their happiness. Keeping nurses happy will be an important part of organizational effectiveness.

· From the research, it is identified that memory loss is the dominating factor in private sector. When the nurses are working in more diversified areas at hospitals they are unable to concentrate on dual aspects and forget few things. Hence it leads to poor performance. So the management can engage the nurses by initiating a discussion on performance issues.

CONCLUSION:

The nurse in Public and Private sector hospitals maintains the same occupational stress, but government hospitals are better than Private sector hospitals. Even though the private sector hospital nurses feel less stress because still, they maintain healthy relations with superiors, co-workers, and subordinates. This type of environment leads to better working conditions in hospitals. This will positively influence on employee performance and organizational effectiveness of nurses on occupational stress at hospitals.

FURTHER SCOPE OF THE STUDY:

Further research should be considered to gather more information regarding the nurses in hospitals. There are certain limitations of the study that must be acknowledged. First the sample selected for the study involves only the Guntur district. Where the sample size 120 is very low, for further research, the researchers need to increase the number of respondents involved in the research study.

REFERENCES:

1. Abbasi, Milad, Somayeh Farhang, Madvari, Mehri, Ahmad, Ebrahimi, Poursadeghiyan, M; Marioryad, Ghaljahi (2019) “Interactive Effect of Background Variables and Workload Parameters on the Quality of Life among Nurses Working in Highly Complex Hospital Units: A Cross- Sectional Study” , “Journal Of Clinical And Diagnostic Research” , Volume: 13, Issue: 1, Pages: LC8-LC13.

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Received on 09.03.2020 Modified on 10.04.2020

Asian Journal of Management. 2020;11(3):225-232.

DOI: 10.5958/2321-5763.2020.00035.9

Model Summary
Model	R	R Square	Adjusted R Square	Std. Error of the Estimate
Private	.866^a	.749	.738	.669