APPLIED PSYCHOLOGY: AN INTERNATIONAL REVIEW, 2003, 52 (4), 580 − 597

Reactions to Increased Workload:

GREENGLASS
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Effects on Professional Efficacy of Nurses

Esther R. Greenglass* and Ronald J. Burke
York University, Toronto, Canada

Kathleen A. Moore
Deakin University, Australia

Les résultats de recherches empiriques impliquant plusiers échantillons de

travailleurs différents supportent l’idée que la charge de travail est un stresseur
significatif associé à une variété de réactions psychologiques nuisibles, incluant
l’épuisement professionnel. La présente étude propose un modèle théorique
dans lequel la charge de travail contribue à la détresse et à la dépression. De
plus en plus, les organisations vivent des changements en conséquence à des
restructurations majeures. Par exemple, face aux restrictions budgétaires, les
hôpitaux ont été forcés à la restructuration, aux fusions, à la compression
d’effectifs, voire même à la fermeture. La charge de travail des employés, et
plus particulièrement des infirmières, a augmenté. Cette étude applique un
modèle théorique pour mieux comprendre l’impact de la charge de travail sur
les infirmières—et plus particulièrement sur leur détresse, épuisement profes-
sionnel, et dépression—à l’emploi d’hôpitaux subissant des compressions
d’effectifs. Les participants (n = 488) sont des infirmières à l’emploi d’hôpitaux
ayant vécu des restructurations dans lesquels des unités ont déjà été fermées
en conséquence à ces restructurations. Les résultats d’analyses d’équations
structurelles montrent que les données correspondent partiellement au modèle
et que la charge de travail a contribué de façon substantielle aux niveaux de
dépression via les réactions de détresse. D’autres résultats ont démontré que
le cynisme, la colère, et l’épuisement émotionnel ont significativement opéra-
tionnalisé les réactions de détresse. En liant la colére, le cynisme et l’épuise-
ment émotionnel dans un seul modèle prédisant les niveaux de détresse dus à
la charge de travail, cette étude est unique d’un point de vue théorique. Les
résultats indiquant que la colère, le cynisme, et l’épuisement émotionnel ont
opérationnalisé la détresse dénotent l’importance d’étudier les modèles de
réactions négatives et leurs conséquences sur la dépression. Les implications

* Address for correspondence: Esther R. Greenglass, Department of Psychology, York

University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada. Email: estherg@yorku.ca
Grateful acknowledgment is due to the Ontario Nurses’ Association, Lisa Fiksenbaum and
Graeme Mcdermid for their assistance and to York’s Faculty of Arts and School of Business for
supporting this research. Special thanks are due to the paper’s reviewers for their valuable input.

© International Association for Applied Psychology, 2003. Published by Blackwell Publishing,

9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.
 REACTIONS TO INCREASED WORKLOAD 581
des résultats sont discutées en regard d’interventions pouvant être utilisées par
les organisations pour réduire les charges de travail.

Research findings support the idea that workload is a significant stressor

associated with a variety of deleterious psychological reactions, including
burnout, in several different samples of workers. A theoretical model is put
forth in the present study in which workload is seen as contributing to distress
and depression. Increasingly, organisations are experiencing changes as a
result of extensive downsizing, restructuring, and merging. As a result of fiscal
restraint, hospitals have been forced to merge, close, downsize, and restructure.
Workloads have increased among hospital staff, particularly nurses. This
study applies a theoretical model to the understanding of the impact of work-
load on nurses employed in hospitals experiencing downsizing, particularly on
their distress, burnout, and depression. Respondents were 488 nurses who
were employed in hospitals that were undergoing restructuring and in which
units had already been closed as a result of restructuring. Results of structural
equation modeling showed that the data partially fit the model and that work-
load contributed substantially to levels of depression through distress reactions.
Further results showed that cynicism, anger, and emotional exhaustion
significantly operationalised distress reactions. This study is unique theoret-
ically in linking anger, cynicism, and emotional exhaustion in a single model
that predicts distress levels from workload. The findings that anger, cynicism,
and emotional exhaustion operationalised distress indicate the importance of
studying patterns of negative reactions and their consequences for depression.
Implications of the results are discussed for interventions that can be taken by
organisations in order to reduce workloads.

INTRODUCTION
Increasingly the workplace has been seen as an important consideration in
health because of people’s extensive involvement at work. Findings indicate
that the work setting and the organisation can contribute to job stress and
to psychological burnout. For example, when demands at work are excessive
and/or incompatible with one another, continued attempts to meet these
demands will be emotionally distressful. The workplace can be a source of
frustration and anxiety. Spector (1987) reports significant positive correla-
tions of excessive workloads, anxiety, frustration, and health symptoms.
Work stress can also trigger anger feelings that can result in higher levels of
anxiety (Greenglass, in press).
Research findings support the idea that workload is a significant stressor
that is associated with a variety of deleterious psychological reactions,
including burnout, in several different samples of workers (McDonald &
Korabik, 1991; Himle, Jayaratne, & Thyness, 1991; Lee & Ashforth, 1996).
Burnout can result from strain due to excessive workload. According to
Schaufeli, Leiter, Maslach, and Jackson (1996), burnout consists of three
dimensions: emotional exhaustion, cynicism, and reduced professional
efficacy that are assessed using the MBI-General Survey (MBI-GS). The

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582 GREENGLASS ET AL.

MBI-GS consists of generic items which measure burnout dimensions and

can be used in a variety of occupations. Emotional exhaustion is defined
as the depletion of energy; those who are exhausted feel overextended,
drained, and unable to recover. Cynicism refers to distancing oneself from
work itself and to the development of negative attitudes toward work in
general. Professional efficacy is a sense of professional accomplishment
and competence. This sense diminishes during burnout. Employee burnout
is costly to an organisation. Staff who experience burnout are likely to
withdraw from their job, invest less time and energy, do less work and do
it less well (Maslach & Leiter, 1997). Burnout leads to an inability to cope
with a changing workplace environment.
Excessive workload occurs when an employee perceives that he or she has
too many tasks to do in a period of time. Theoretically, burnout results
from a situation of chronic imbalance in which the job demands more than
the organisation can give and provides less (resources) than the individual
needs. Considerable research supports the idea that excessive workloads
contribute to burnout, in particular, emotional exhaustion (Greenglass,
Burke, & Konarski, 1998; Leiter, 1991). A meta-analysis by Lee and Ashforth
(1996) showed that workload and time pressure shared, on average, 42 per
cent to 25 per cent of variance with emotional exhaustion, a subscale of the
Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1986). Relation-
ships were weaker with the other burnout components. Moreover, research
on burnout and work stressors, including workload, supports the idea that
stressors are more likely to contribute directly to emotional exhaustion
and cynicism, and least to professional efficacy (Greenglass et al., 1998;
Leiter, 1991).
Other research findings suggest that stressors at work can also contribute
to worker cynicism, defined as hostile, suspicious, and disparaging attitudes
toward work situations (Greenglass & Julkunen, 1989). High workload is a
direct antecedent of negative psychological outcomes, including frustration,
burnout, and cynicism (Walker, 1986). Worker cynicism is deleterious to
both the organisation and individuals alike. Employees who are more cynical
toward organisational change express less motivation to exert change,
expect less personal success, and perceive fewer and less valuable intrinsic
and extrinsic rewards (Wanous, Reichers, & Austin, 1994). An increase
in workload, without adequate support and resources, may result in the
perception in workers that the psychological contract with their employer
has been eroded (Schaufeli & Enzmann, 1998), thus leading to feelings of
anger. State anger is defined as an emotional state marked by subjective
feelings that vary in intensity from mild annoyance or irritation to intense
fury and rage (Spielberger, 1988). Over time, the intensity of state anger
varies as a function of perceived injustice, attack, or unfair treatment by
others, and frustration resulting from barriers to goal-directed behavior.

© International Association for Applied Psychology, 2003.

 REACTIONS TO INCREASED WORKLOAD 583
Thus, to the extent that workload is related to frustration and anxiety, it
should lead to feelings of anger.
Other research suggests that negative emotions tend to coexist in a
configuration. For example, Spielberger, Jacobs, Russell, and Crane (1983)
report a positive correlation between state anxiety and state anger in college
students. Polivy (1981) reports that anger, depression, and anxiety tend to
co-occur in both laboratory and natural settings in university students.
Greenglass (1987) found positive correlations between state anger, depres-
sion, and state anxiety in women managers. Groen (1975) suggests that, in
discussing the role of emotion and its relationship to health, rather than
examining a single emotion, there is a need to focus on how anxiety, rage,
and depression combine to contribute to psychosomatic illness. In their
study of conservation of resources in a student and community sample,
Hobfoll and Lilly’s (1993) structural model yielded distress as a latent
variable which was measured using anxiety and depression scores assessed
at the time of test administration.
When individuals experience an increase in workload, there should be
an increase in their emotional exhaustion, cynicism, and anger, resulting in
an increase in distress. And distress should contribute positively to depression.
According to research by Schaufeli and Enzmann (1998), depression is a
consequence of burnout. Empirical research on the discriminant validity of
emotional exhaustion and depression shows that the emotional exhaustion
component of burnout is related to depression; both share about 20 per cent
of their variance (Schaufeli & Enzmann, 1998). Cynicism too is related to
depression, insofar as it expresses self-defeat and apathy (Meyerson, 1990).
Cynicism reduces energy available for performing work and developing
creative solutions to work problems (Schaufeli et al., 1996). Cynicism
diminishes one’s potential for building professional efficacy. Anger at work
is a significant predictor of depression (Greenglass, 2000). Anger is also
significantly related to depression in college students (Kopper & Epperson,
1996). According to Weiner (1982), anger (directed toward the self) results
in depression. Thus, distress, defined as emotional exhaustion, cynicism,
and anger, should lead to depression. Distress should also lead to reduced
professional efficacy since individuals are unable to accomplish tasks
defined as part of their professional role.

THE MODEL LINKING WORKLOAD AND DEPRESSION

In the model put forth in the present study, workload is seen as leading to
distress, operationalised by cynicism, emotional exhaustion, and anger. Dis-
tress at work is seen as leading to depression as well as to lower professional
efficacy (see Figure 1). According to this model, workload is seen as leading
to depression through professional efficacy and through distress. Beck’s

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584 GREENGLASS ET AL.

FIGURE 1. Theoretical model of the impact of nurses’ workload.

(1967) cognitive theory of psychopathology is an appropriate overarching

theoretical framework within which to link these relationships. According
to Beck’s theory, depression can be precipitated by stressful situations that
overtax individuals. Frequent precipitators of depression include situations
that lower an individual’s self-esteem as well as those that thwart achievement
of important goals. Beck argues that when individuals are exposed to such
stressors, they respond with ideas of personal deficiency, self-blame, and
pessimism. In depression, these ideas or schemas, according to Beck, consist
of negative conceptions of the person’s own worth, of his/her personal
performance, and nihilistic expectations. Once evoked, these schemas lead
to depression.
In the present model, workload is the independent variable, depression
is the dependent variable, and distress and professional efficacy are each
partial mediators of the workload–depression relationship (see Figure 1).
Workload is seen as leading to distress, conceptualised here as schema in
Beck’s terms, and emotional exhaustion, cynicism, and anger are affective
reactions. Cyncism and anger components should arise from the thwarting
of goals, i.e. difficulty in completing one’s work, and emotional exhaustion
arises as a result of being overtaxed by having too much to do. Distress
should precipitate depression since affective reactions (i.e. cynicism,
emotional exhaustion, and anger) facilitate activity of the schemas and
consequently enhance the downward spiral in depression (Beck, 1967, p. 289).
Workload should also lead to lower professional efficacy since having too

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 REACTIONS TO INCREASED WORKLOAD 585
much to do can prevent individuals from fulfilling their professional role.
According to Beck, lower professional efficacy would be a schema that
would precipitate depression because of its association with negative
conceptions of one’s personal role performance, i.e. too much to do results
in inability to perform well in the nursing role. Beck argues that individuals
respond to stressors with ideas of personal deficiency. Therefore, lower
professional efficacy is expected to result from distress given its association
with workload, i.e. the stressor.
The model put forth in this study is tested in a sample of nurses employed
in hospitals that are in the process of being downsized. Research findings
indicate that excessive workload is often found in survivors of downsizing
as they struggle to complete the work formerly assigned to the victims of
downsizing (their peers and superiors) (Cameron, Freeman, & Mishra,
1991; Cascio, 1993; Kozlowski, Chao, Smith, & Hedlund, 1993; Worrall &
Cooper, 1997). Research indicates further that when downsizing takes place,
emotions can run high, including anger, anxiety, cynicism, and resentment
(O’Neill & Lenn, 1995). This is probably due to several negative perceptions
during organisational downsizing, including the perception that workers
were treated unfairly, that the psychological contract was eroded, and
that future employment is insecure (Burke & Nelson, 1997; Schaufeli &
Enzmann, 1998).
Nurses represent a good sample in which this model can be tested because
of changes in their work role due to extensive hospital restructuring and
downsizing, resulting in cutbacks. Financial cutbacks in public funding to
the health-care system in Canada have resulted in widespread closures of
beds, hospital units, and even hospitals themselves. As a result of these
closures, there have been significant staff reductions. Since nurses are the
largest single occupational group employed by hospitals, their jobs were
most affected by restructuring measures. In Ontario, for example, during
the past decade, hospitals have lost 11,000 acute care beds. In the last few
years more than 3,700 full-time equivalent registered nurses have lost their
jobs in Ontario (Davidson, 1996). Thus, many nurses experienced job
insecurity regarding the future of their hospital positions.
In times of budget cuts and layoffs, employees often experience an
increase in workload. As a result of these changes in the hospitals, including
fewer qualified staff to care for patients, nurses’ workload has significantly
increased and as a result, their stress levels. Stress levels in nurses increase
when more patients have to be cared for in the same number of hours with
a constantly shrinking pool of available qualified nursing staff. Nurses
themselves were saying that cuts in staffing levels were causing problems, with
nurse:patient ratios being increased from 1:3 to 1:5 or 1:6 (Freudenheim,
1999). Research indicates that workload is a direct antecedent of negative
psychological outcomes such as frustration and burnout, including cynicism

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586 GREENGLASS ET AL.

(Walker, 1986). Further data indicate that the announcement of harsh and
immediate layoffs by organisational management contributed to employee
cynicism. These conditions also lead to high job insecurity (Roskies &
Louis-Guerin, 1990). And job insecurity has been found to be associated
with worker anger and hostility (Kleinfield, 1996).
Quantitative workload is a consistent stressor in nurses, as demonstrated
by Moore, Kuhrik, Kuhrik, and Katz (1996) in their study of acute care
nurses and by Armstrong-Stassen (1994) in her study of burnout in nurses.
Workload among nurses is one of the most significant predictors of negative
mental health outcomes (Tyler & Cushway, 1995), stress (Kaufman & Beehr,
1986; Gray-Toft & Anderson, 1983; Moore et al., 1996), less job satisfaction
(Schaefer & Moos, 1993), and burnout (Armstrong-Stassen, Cameron, &
Horsburgh, 1994). To the extent that nurses experience an increase in
workload, their emotional exhaustion and cynicism should increase, since
these aspects of burnout are most likely to be affected by work stressors
(Greenglass et al., 1998; Leiter, 1991).
Stress resulting from workload can also exacerbate cynical hostility or
indifference towards work. For example, research findings have reported
a significant positive relationship between cynical hostility and work stress
in a sample of 640 men and women government employees (Fiksenbaum &
Greenglass, in press). Workload can also lead to increased feelings of anger
in nurses to the extent that it is related to frustration and anxiety. This is
supported by findings that over time, the intensity of state anger varies as
a function of perceived injustice, attack, or unfair treatment by others
(Spielberger, 1988). According to the present model, emotional exhaustion,
cynicism, and anger in nurses should define distress in nurses. And distress
is expected to predict positively to depression and negatively to professional
efficacy.
Distress in nurses should lead to depression since distress will be associ-
ated with feelings of depletion, exhaustion, and helplessness due to being
overwhelmed with uncompleted work. And, to the extent that nurses feel
distressed, their feelings of professional efficacy should be lower, given that
they are unable to complete the tasks that are part of their professional role.

METHOD

Respondents and Procedure

Respondents were 488 nurses employed in hospitals. Data were collected
using a confidential and anonymous mail-out questionnaire that was sent
directly to respondents’ homes. In the cover letter, respondents were told
not to put their names on the questionnaire, that this was a voluntary task,
and they were asked to send their completed questionnaires directly to the

© International Association for Applied Psychology, 2003.

 REACTIONS TO INCREASED WORKLOAD 587
researchers in a stamped self-addressed envelope. Respondents were told
that the health-care sector continues to be restructured and changed and that
the researchers were interested in studying individuals’ work experiences in
challenging times. They were also told that the results would be available to
the public and that they would be based on large groups so that individuals
would remain anonymous.
Two versions of the questionnaire were sent. While both consisted of
items assessing work conditions in hospitals, one included questions assess-
ing anger-related variables and the other, work and family roles. In this
study, data are presented only for nurses who were sent the version of the
questionnaire assessing anger-related variables and work conditions in
hospitals. Questionnaires were sent to 3,892 Ontario hospital nurses who were
members of the nurses’ union. Respondents were randomly chosen by a
computer-generated program. Of these, 1,363 questionnaires were returned,
thus yielding a response rate of 35 per cent, and 677 of these respondents
responded to the questionnaire consisting of anger-related variables.
Respondents were asked to indicate specific restructuring initiatives from
a list of 16 that had occurred in their hospitals. These included, “budget
cuts”, “staff layoffs”, “beds closed”, and “units closed”, for example. While
respondents varied in terms of the number of restructuring initiatives that
had occurred in their hospitals, all respondents in this study indicated that
some units had been closed in their hospital. Thus, of the 677 nurses who
responded to the questionnaire, 488 indicated that some units had been
closed in their hospital. Only these respondents were included in this study.
Respondents were primarily women. They were employed in at least 11
different nursing units, with approximately two-thirds working in medical/
surgical, intensive care/coronary, emergency, and obstetrics units. Approx-
imately one-half of respondents worked part-time and one-half were super-
visors. The nurses came from all over Ontario, from communities varying
in size from 50,000 to over 1 million people. On average the nurses were
employed 9 years on their current unit and 13 years in their current hospital.
Most of the sample had a RN (Registered Nursing) degree, either college
or hospital based. Thus, the majority of the sample were professional nurses
who had completed an approved college or hospital program and were
required to provide continued competency evidence and to re-register every
year. Approximately one-half of respondents were full-time registered nurses.

Measures
Workload was assessed in a 4-item measure (α = .70) that measured the
nurse’s quantitative workload. An example of a workload item is, “My
workload has increased as a result of the lack of resources”, followed by a
5-point scale from strongly disagree (1) to strongly agree (5).

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588 GREENGLASS ET AL.

Emotional exhaustion, Cynicism, and Professional efficacy were assessed

using the MBI-General Survey (MBI-GS) (Schaufeli et al., 1996). The items
in this scale are generic and without reference to service recipients as are the
items of the Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1986).
Response alternatives went from never (0) to every day (6). Emotional
exhaustion (α = .90) consists of five items. An example from this scale is,
“I feel emotionally drained from work”. This is similar to the concept of
emotional exhaustion of the MBI which is defined as feelings of being
emotionally overextended. Cynicism (α = .82) is composed of five items and
reflects indifference or a distant attitude towards work. An example is, “I
just want to do my job and not be bothered”. Cynicism is to be contrasted
with Depersonalization (MBI), defined as a callous response toward people
who are the recipient of one’s services. Professional efficacy (α = .73)
consists of six items and refers to satisfaction with past and present accom-
plishments and an individual’s expectations of continued effectiveness at
work. An example is, “In my opinion, I am good at my job”.
Anger was measured using the State Anger subscale of the State-Trait
Anger Expression Inventory (STAXI) developed by Spielberger (1988). The
STAXI is a self-report scale consisting of six scales. State Anger (S-Anger)
is a 10-item scale (α = .91) that measures the intensity of one’s angry
feelings at a particular time. Response alternatives went from (1) “not at
all” to (4) “very much so”. In the present study, the instructions for this
scale were modified to ask respondents to indicate how they felt at the
present time about working in their hospital. An example of state anger is,
“I am furious”. Depression was assessed using the 11–item depression
subscale (α = .88) of the Hopkins Symptom Checklist (HSCL) (Derogatis,
Lipman, Rickels, Uhlenhuth, & Cori, 1979). Response alternatives went
from never (1) to extremely often (4). An example of an item is, “How often
have you felt blue in the last three months?”
Distress is defined as a latent variable in structural equation modeling
comprising cynicism, anger, and emotional exhaustion.

RESULTS
The independent and dependent variables were all normally distributed
with no evidence of outliers or skewness. There was no multicollinearity or
singularity in the data. The correlations among the variables, together with
their means and standard deviations, are presented in Table 1.
Prior to running the structural model, the measurement model for the
latent variable, distress, comprising cynicism, anger, and emotional exhaus-
tion, as responses to increased workload was confirmed ( χ2 1.89, p > .05).
Cronbach alpha for the three items was .76. The intercorrelations between
the factor items for distress are presented in Figure 2.

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 REACTIONS TO INCREASED WORKLOAD 589
TABLE 1
Correlation Matrix of Workload, Professional Efficacy, Reactions to Workload, and
Depression, Means and Standard Deviations

N = 488 Work ProfE Anger Cyn EE Dep

Workload 1
Professional Efficacy − .14** 1
Anger .36*** − .12** 1
Cynicism .31*** − .22*** .50*** 1
Emotional Exhaustion .47*** − .14** .48*** .62*** 1
Depression .25*** − .19*** .49*** .47*** .45*** 1
M 14.76 4.69 17.22 2.64 3.37 19.09
SD 3.03 .94 6.33 1.57 1.37 5.34

** p < .01; *** p < .001.

FIGURE 2. Final model representing effect of nurses’ workload on professional

efficacy, distress reaction, and depression.
KEY p < .001
p < .05 ---------------
p > .05 ...................

The theoretical model presented in Figure 1 was tested through structural

equation modeling (Joreskog & Sorbom, 1989) using AMOS Version 3.61
(Arbuckle, 1996). The independence chi-square ( χ2 770.33, p = .000)
confirmed the presence of intercorrelations in the data and, therefore, its

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590 GREENGLASS ET AL.

suitability for SEM analysis. The goodness of fit test ( χ2 (6) 25.43, p = .000)
and the ratio of degrees of freedom to chi-square (c/min 6.36) failed to
support the theoretical model although other fit indices were highly satisfac-
tory (GFI .984; AGFI .913; NFI .967; IFI .972; TLI .894; CFI .972) except
for the RMSEA .104, p = .009. While the high chi-square probability may
be an artifact of the large sample size (Bollen, 1989), a modification index
suggested a negative correlation between professional efficacy and cynicism
which was substantively congruent.
This modification provided an improved fit of the data to the model
( χ2 15.72, p = .001, GFI .990; AGFI .928; NFI .980; IFI .983; CFI .983;
RMSEA .092, p = .047) (Bentler & Bonnet, 1980; Browne & Cudeck, 1993;
Hair, Anderson, Tatham, & Black, 1995; Tabachnick & Fidell, 1996) (see
Figure 2). The final model indicated that nurses’ perceptions that their
workload was increased explained 37 per cent of the variance in their
reaction of distress, which was operationalised by cynicism, anger, and
emotional exhaustion. High levels of workload together with nurses’ distress
response predicted a substantial 54 per cent of the variance in depression.
A suppressor effect was present in the model (Hair et al., 1995; Tabachnick
& Fidell, 1996). Nurses’ distress in relation to their increased workload
suppressed the positive relationship between workload and levels of depres-
sion (r = .25, see Table 1).1 As a result of this suppressor effect, higher
workload was associated with lower feelings of depression (β = −.28). The
direct and indirect effects in the model are presented below.

Direct Effects
Nurses’ perceptions of increased workload following hospital restructuring
directly increased their level of distress (β = .61). The distress factor com-
prised feelings of cynicism, anger, and emotional exhaustion with the last
contributing slightly more to the latent factor (49%) than each of the other
variables (36% and 43%, respectively). This distress factor directly contrib-
uted to depression (β = .86). Workload was negatively related to depression
(β = −.28). As indicated above, this relationship in the current model
stemmed from a suppressor effect exerted by distress. A direct effect was
present from the distress response to professional efficacy (β = −.13, p < .05).
While this path achieves statistical significance and suggests a reduction
in nurses’ professional efficacy as a result of the emotional distress they
experienced following increased workload, the magnitude of this path is not
substantial (β = −.13).

1
This suppressor effect was confirmed (a) in a series of multiple regressions and (b) by using
the manifest variables of cynicism, anger, and emotional exhaustion in the model instead of
the latent variable of distress.

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 REACTIONS TO INCREASED WORKLOAD 591

Indirect and Total Effects

Increased workload had an indirect impact on depression through nurses’
feeling of distress (β = .52).2 However, the total impact of workload on
depression was attenuated by the negative relationship between work and
depression (β = −.28) yielding a total effect of workload on depression of
β = .24.

DISCUSSION
The hypothesis that hospital nurses’ workload would lead to feelings of
distress (cynicism, anger, and emotional exhaustion), a decreased sense of
professional efficacy, and depression, was partially supported by the data.
These results confirm previous findings that workload in nurses predicts
negative mental health outcomes (Tyler & Cushway, 1995), stress (Kaufman
& Beehr, 1986; Gray-Toft & Anderson, 1983; Moore et al., 1996), and
burnout (Armstrong-Stassen et al., 1994).
Heavy workloads significantly predicted a distress reaction in nurses
(37% explained variance). While the item loadings for cynicism, anger, and
emotional exhaustion, which operationalised distress, ranged from .60 to
.70, respectively, not one of these emotions appears to dominate the
distress reaction. Workload, mediated by nurses’ distress reaction to their
workload, contributed substantially to levels of depression in nurses (54%).
The relationship between the latent factor of distress and depression is so
strong as to be almost synonymous with depression and lends support to
Oswin’s (1978) argument that burnout equals “profession depression”
among nurses. It is important to note that consideration of the strength of
the latent factor is more influential in predicting depression than any of its
individual components, as presented in the correlation matrix (see Table 1).
There is no difference in the variance shared by cynicism, anger, and
emotional exhaustion with depression (r = .45 to .49). Interestingly, at the
same time, the data showed that high workload was associated with lower
levels of depression (β = −.28). This finding is contradicted by the correla-
tion of r = .25 observed earlier between nurses’ workload and depression
(see Table 1). This apparent anomaly is resolved when the suppressor effect
of nurse distress, as a reaction to workload, is taken into account. That is, any
negative effect workload may have on depression has been suppressed, and
in this case, subsumed under the general feelings of distress, operationalised
by cynicism, anger, and emotional exhaustion. It is also possible that the
(implicit) causal link in the model between workload and depression is

2
β .61 * β .86

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592 GREENGLASS ET AL.

inverted. That is, people who are depressed may avoid taking on work more
than those who are not depressed. According to Burns (1999), depressed
people have a tendency to behave in self-defeating ways, including avoiding
work. It is also possible that when supervisors and managers recognise the
symptoms of depression in workers (Johnson & Indvik, 1997), they may
assign them a lower workload than those who appear capable of handling
more work. These are issues deserving of further research.
Nurses’ professional efficacy was not substantially affected either by high
workload or by the distress reaction to this workload, as only 3 per cent of
the variance in professional efficacy was explained by these factors. These
findings are consistent with those reported by Leiter (1991) that, compared
to emotional exhaustion, professional efficacy (personal accomplishment) is
least responsive to the nature and intensity of work stressors, including
workload. Similar findings have been reported in teachers by Greenglass,
Burke, and Konarski (1997). Thus, in the present context, professional
efficacy in nurses was not affected by workload, nor did it mediate the
effects of workload on depression. Using precepts from Beck’s (1967) theory
of depression, it was hypothesised that workload would lead to lower
professional efficacy and this would precipitate depression because of its
association with negative conceptions of one’s role performance. However,
the data suggest that, despite their workload and its associated distress,
nurses felt confident in solving problems that arose at work, felt they were
good at their job, and felt confident in getting things done, as shown for
example in responses to three of the items assessing professional efficacy
(Schaufeli et al., 1996). Contrary to expectation, workload did not lead to
lower feelings of professional efficacy and self-esteem since nurses continued
to hold expectations of effectiveness at work, despite their workload. This
suggests that there may be other factors that maintain professional efficacy
in the face of stressors such as workload. Previous research suggests that
personal resources, including self-efficacy, optimistic self-beliefs about being
able to deal with critical demands by means of adaptive actions (Cherniss,
1990), and control coping (Leiter, 1991), can contribute to higher personal
feelings of accomplishment in one’s work role. While the study of individual
resources is beyond the scope of this study, future research may explore the
role of individual resources either as main effects (Latack, 1986) or as buffers
(Cohen-Mansfield, 1995) of depression.
This study is the first to theoretically link anger, cynicism, and emotional
exhaustion in a single model which predicts distress levels from workload.
The findings that anger, cynicism, and emotional exhaustion operationalised
distress, indicates the importance of studying patterns of negative reactions
and their consequences for depression. The present findings support Polivy
(1981) and Groen (1975) who argue for the simultaneous study of anxiety,
rage, and depression and their role in psychosomatic illness.

© International Association for Applied Psychology, 2003.

 REACTIONS TO INCREASED WORKLOAD 593
The response rate in the present study was not high, probably due in
part to the long questionnaire (13 pages) that respondents were asked to fill
out. At the same time, it is worth noting that the current nursing sample
was representative of the larger population of nurses on a number of key
variables, thus making the response rate less of a problem. For example,
approximately 80 per cent of nurses in Canada are employed in hospitals
(Canadian Nurses Association, 1990). While 47 per cent and 51 per cent of
the current sample was employed full- and part-time, respectively, in 1997
in Ontario, 49 per cent of all nurses worked full-time and 47 per cent
worked part-time (College of Nurses of Ontario, 1997). In the current
sample of nurses, most were women. The nursing profession in Ontario is
also mainly women. In the present sample, nurses come from hospitals and
communities which vary in size. These are representative of the hospitals in
Ontario which also vary in size, as do the Ontario communities in which
they are located. Taken together, these data indicate that the current sample
of nurses is representative of the population of nurses in the province of
Ontario. While the relationship between demographic variables and the
restructuring variables is interesting, their investigation is beyond the scope
of this study.
There are many factors that may lead to high workload in nurses such
as diminished resources and increased demand for hospital services, for
example. The present data do not permit conclusions to be drawn as to why
nurses were distressed about their workload. And while nurses varied on
several demographic variables, relationships between these variables and
those under study were beyond the scope of this study.
At the same time, there are strategies that can be implemented to deal
with work overload in nurses. Support, information sharing, and input into
decision making are all approaches that can be implemented by management
in order to ameliorate feelings of distress associated with workload in
nurses. The present findings have implications for interventions that can
be taken by hospital administrations regarding work overload. Given that
nurses perceive that they have too much to do, the administration can be
proactive by making available to nurses resources and social support to
assist them in accomplishing their duties. As suggested by Greenglass,
Fiksenbaum, and Burke (1996), informational support from one’s supervisor
may buffer negative consequences of stressors by helping to structure one’s
workload so that it matches more closely the individual’s resources. In this
way, informational support may reduce role overload and exhaustion. The
provision of practical support may also prove useful in that it provides
greater control to nurses over their work, thus resulting in a decrease in
their emotional exhaustion. Affective support may reduce cynicism and
anger by restoring equity to a relationship between the employee and the
hospital where employees have had high workloads.

© International Association for Applied Psychology, 2003.

594 GREENGLASS ET AL.

These observations would follow from equity theory which states that
people pursue reciprocity in their interpersonal and organisational rela-
tionships (Rousseau, 1989). What they invest and gain from a relationship
should be proportional to the investments and gains of the other party in
the relationship. This is known as distributive equity. When they perceive
relationships to be inequitable, they feel distressed and are motivated to
restore equity (Buunk & Schaufeli, 1999). Thus, with high workloads, there
should be an increase in anger and cynicism, due to a broken psychological
contract. However, the negative affective states associated with this dis-
tributive inequity may in turn be buffered through greater attention to
procedural equity. Procedural equity refers to the perceived fairness of the
processes that lead to distributive inequity. Interventions that include social
support, information sharing, and input into decision making, are all
approaches which enhance perceived procedural justice. Hence, managerial
implementation of such interventions may well reduce feelings of distress
thus helping nurses better cope with work overload.

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