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Article

The Impact of Workload on Workers’ Traumatic Stress and Mental Health Mediated by Career Adaptability during COVID-19

by
Souad Hassanie
1,*,
Olusegun A. Olugbade
2,
Georgiana Karadas
1 and
Özlem Altun
3
1
Business Administration, Faculty of Economics and Administrative Sciences, Cyprus International University, Via Mersin 10, Nicosia 99010, Turkey
2
School of Tourism and Hotel Management, Cyprus International University, Via Mersin 10, Nicosia 99010, Turkey
3
School of Tourism and Culinary Arts, Final International University, Beşparmak Sokak 6, Girne 99320, Turkey
*
Author to whom correspondence should be addressed.
Sustainability 2022, 14(19), 12010; https://doi.org/10.3390/su141912010
Submission received: 29 August 2022 / Revised: 12 September 2022 / Accepted: 19 September 2022 / Published: 22 September 2022
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Abstract

:
Building on career construction theory and the conservation of resources theory, this study investigated the impact of workload on healthcare workers’ mental health and secondary traumatic stress mediated by career adaptability during the COVID-19 pandemic. Data collected from 549 healthcare workers working in Lebanese private hospitals in a two-wave survey were utilized to evaluate the proposed conceptual model, using confirmatory factor analysis and structural equation modeling. Contrary to our propositions, the workload had a significant positive effect on career adaptability and mental health and a negative effect on secondary traumatic stress. Similarly, career adaptability had a significant positive impact on mental health whereas it had a negative significant impact on secondary traumatic stress. Moreover, the results indicated that career adaptability links workload to secondary traumatic stress; however, the sign of the mediating effect is contrary to the hypotheses of this study. Our unexpected results indicate that workload might be considered a challenging demand that enhances healthcare workers’ career adaptability and mental health and reduces secondary traumatic stress. Healthcare management and human resource managers should develop employees’ abilities to face subsequent large-scale pandemics and should create a positive working atmosphere by providing support and training to healthcare workers.

1. Introduction

As a global health threat, COVID-19 has led to unexpected modifications in workplace environments, tasks, and careers, specifically in the healthcare setting. During the pandemic, the performance of healthcare workers (HCWs) in combatting COVID-19 has been of paramount importance [1]. They have worked tirelessly to provide quality services including psychological, medical, and spiritual care to patients in a sustainable manner. Although healthcare systems have adopted effective strategies for infectious disease management such as social distancing, quarantines, and mandatory vaccination [2], HCWs were vulnerable to a high risk of infection due to the nature of their job [3]. For instance, in Italy, 9% of the reported positive cases up until 25 March 2020 were medical personnel, whereas there were 3300 HCWs infected in China, constituting 4% of the 81,285 reported cases up to this date [4]. Similarly, in Spain, 6500 HCWs (13.6%) were infected among 47,600 total cases, while in Turkey, there were 7428 HCWs infected, constituting 6.5% of all positive cases during the same time frame [4]. In the Lebanese context, the first case of COVID-19 was detected in February 2020. After almost one year, the total number of recorded cases had increased to 709,242, while the accumulated number of deaths was 9012. Within that chaotic year, the number of HCWs who were infected with COVID-19 was 2429 [5].
Due to longstanding political instability and continuous wars, long before the eruption of the COVID-19 pandemic, the Lebanese healthcare system was a fragmented system predominated by the private sector that provided 90% of healthcare services through private hospitals, clinics, and laboratories [6]. In addition, the Lebanese healthcare sector was characterized by its poor supporting work environment. Specifically, HCWs have suffered from bad work conditions, unsatisfactory salaries and benefits, high workloads, a lack of career development, limited autonomy, poor control over practice, and exposure to workplace violence [6]. However, the situation has become more dramatic, stressful, and traumatic during the pandemic. Under such conditions, HCWs strive to develop a new meaning in their work by capitalizing on adaptability and proactivity to navigate complex and challenging careers [7].
Recent studies indicated that HCWs were subjected to a heavy workload over a long period while they were caring for suspicious and infected patients, facing uncertainty, stigmatization, anxiety, and a shortage of personal protective equipment [8,9]. Workload refers to employees’ inability to accomplish multiple tasks due to time insufficiency [10]. Meanwhile, several researchers indicated that excessive workload is a critical key factor inducing anxiety, exhaustion, and fear among HCWs [11]. Specifically, the heavy workload associated with long working hours has affected HCWs’ ability to concentrate, demonstrating worry about being infected and excessive stress about heavy workloads [8]. Moreover, the unprecedented outbreak of COVID-19 has subjected most healthcare systems to unknown challenges affecting the mental health of HCWs adversely and thus inducing secondary traumatic stress [12]. According to the Public Health Agency of Canada (2014) [13], and in line with Wren-Lewis and Alexandrova (2021) [14], mental health refers to how individuals feel, think, and react in order to enhance their ability to enjoy life, face challenges, and cope with change. Meanwhile, other researchers argued that mental health is composed of positive mental health and ill mental health such as anxiety and stress [15]. On the other hand, secondary traumatic stress refers to a pattern of psychological symptoms that are witnessed by professionals being exposed to individuals who have experienced trauma [16]. Ultimately, traumatic events disrupt an individual’s psychological needs and have long-term effects on an individual’s self-perception, emotional regulation, and relational style [17]. Stemming from the aforementioned facts, the current paper examines the factors that influence HCWs’ positive mental health and ill mental health, demonstrated as secondary traumatic stress.
Despite hardships at work, individuals may become involved in career development processes to construct their life with multiple roles, securing their well-being and adaptive functioning [18]. Grounded in career construction theory (CCT), career adaptability is considered a critical element that can help individuals face unfavorable conditions and uncertain futures [7]. It is a psychosocial resource that enables individuals to handle, adapt to, and deal with transitions, traumas, and challenges in their careers [19]. Moreover, in agreement with the conservation of resource (COR) theory [20,21], Millear (2013) [22] revealed that individuals with more personal resources demonstrate higher rates of positive mental health and lower rates of ill mental health. Meanwhile, during the COVID-19 pandemic, HCWs have risked losing their essential resources or the ability to gain a return from their invested resources in a short period [23]. In light of the above evidence, the effect of workload on HCWs’ mental health and secondary traumatic stress could be better understood through the lens of career adaptability.
Based on the above-mentioned information, this study proposes and examines career adaptability as a mediator of the influence of workload on HCWs’ mental health and secondary traumatic stress, in line with the tenets of CCT and COR theory. Specifically, this study investigates: (1) the impact of workload on career adaptability, mental health, and secondary traumatic stress; (2) the linkage between career adaptability and both mental health and secondary traumatic stress; and (3) career adaptability as a mediator in these relationships. These interrelationships were investigated via data gathered from HCWs working in Lebanese private hospitals during the COVID-19 pandemic.
This study contributes to the healthcare management and vocational behavior literature in several ways. Firstly, previous studies indicated that most medical staff suffered from various psychological problems during pandemics [24]. In particular, HCWs witnessed excessive exhaustion, great family strains, and diminished security levels during the COVID-19 pandemic [8]. However, little attention is given to the association between workload and HCWs’ psychological health during pandemics [25]. For instance, workload as a job demand is an assigned responsibility that every employee must discharge in the workplace [10]. However, studies have demonstrated that the impact of such a job demand on employees’ outcomes depends on how employees appraise it [26,27]. Therefore, understanding the impact of workload on HCWs’ mental health and secondary traumatic stress during pandemics will contribute to the body of knowledge on career management literature and wellbeing.
Secondly, although the number of individuals experiencing long-lasting mental health problems during pandemics is high, mental health has attracted few researchers investigating planning and resource distribution [28]. In particular, mental health disturbances may become more severe as the situation becomes more arduous and consequently, researchers have called for further investigations to examine the impact of COVID-19 on HCWs’ mental health [9]. On the other hand, several researchers highly recommended the further assessment of secondary traumatic stress among HCWs, arguing that such an assessment may reveal a vivid clinical picture, improve service delivery, and provide future implications for managing traumatic stress [12,29]. Based on the above-mentioned gaps, investigating the impact of workload being imposed by the COVID-19 pandemic on HCWs’ mental health and secondary traumatic stress would significantly contribute to the academic and career management literature.
Thirdly, CCT emphasized that the social work environment would predict career adaptability [7]. Although career adaptability has been widely investigated, further investigation is necessary to enhance the body of knowledge on whether adaptability changes based on work-related activities available in different settings [30]. Moreover, a recent empirical study revealed that HCWs who are working in different hospital settings may respond to workload differently due to their inner efforts and abilities [31]. Therefore, an understanding of the association between workload, career adaptability, mental health, and secondary traumatic stress will contribute to the existing knowledge.
Fourthly, several empirical studies investigated the impact of career adaptability on work outcomes [32,33]; however, little is known about the relationship between workload and HCWs’ mental health and secondary traumatic stress. Therefore, this study will contribute to the CCT and career adaptability literature by empirically investigating the extent to which career adaptability explains the relationship between workload and HCWs’ mental health and secondary traumatic stress.
Finally, Savickas et al.’s model [7] related to work-related trauma did not rise to the level where it would block the development of ill mental health. Therefore, the COR theory has also been adopted in this paper to examine the relative contribution of career adaptability as a psychosocial resource to positive mental health, hindering other aspects of ill mental health such as secondary traumatic stress [20,21]. Moreover, integrating the CCT and COR theory to examine the mediation role of career adaptability in the proposed relationships contributes to the career management literature and psychological well-being.

2. Theoretical Framework

The career construction theory (CCT) and the conservation of resource theory (COR) were utilized as theoretical frameworks to develop the proposed relationships in this study.
CCT emphasizes that career development is a continuous process of adaptation depending on an employee’s ability to integrate personal needs with social expectations [19]. The theory investigates the processes in which employees self-manage work demands and traumas to achieve work-related development through integrating vocational self-concepts into work roles in a successful manner [19]. In particular, employees exert extra effort to control their careers over time through integrating psychosocial resources to achieve social expectations [34]. However, an individual’s personality and interests might significantly influence the career development process while they try to self-manage career transitions and traumas [7]. According to the CCT, career development depends on sequential interrelated processes related to willingness, ability, and adapting responses [30]. Willingness refers to adaptivity or adaptive readiness while ability refers to adaptability resources or career adaptability. Meanwhile, adapting responses refer to how individuals would react to challenges in their working environment. Accordingly, the career development process relies on the dynamic interaction of individuals with their existing environment [18]. Specifically, the degree to which employees demonstrate willingness and the extent to which they possess the ability to respond to constantly changing environmental conditions affect the success of integrating self-concepts with work roles [7].
Furthermore, the COR theory explains how stress is induced as individuals risk losing their essential resources or fail to secure their valuable resources after they become invested in their work [20,21]. According to the COR theory, individuals tend to protect and accumulate valuable resources such as personal characteristics, objects, conditions, and energies [20,21]. Ultimately, individuals value resources as ways to deal with life’s demands and challenges [22]. As a result, they tend to increase their resources dynamically by protecting their already existing resources and by gaining additional ones [20,21]. Previous research indicated that conserving, as well as accumulating, essential resources could help individuals deal with daily life events, challenges, and traumas, thus helping them maintain positive mental health and well-being [22]. Accordingly, this paper adopts career adaptability, which is a psychosocial resource [7] that helps HCWs deal with the challenges imposed by the COVID-19 pandemic to maintain well-being, mental health, and lower traumatic stress.
Stemming from the aforementioned facts, this paper adopts CCT and COR theory as relevant lenses to assess how HCWs would adapt to the traumatic situation imposed by the COVID-19 pandemic in the healthcare sector.

3. Literature Review and Hypotheses Development

3.1. Workload and Career Adaptability

During the COVID-19 pandemic, the workload has increased tremendously as the number of infected patients has increased. Several papers revealed that HCWs experienced excessive workload (worked 16 to 22 h per day) and were exposed to a high risk of infection, and in turn, experienced physical and mental fatigue [11,35]. Similarly, a recent study revealed that doctors had to deal with 10 patients per hour; however, nurses had to take care of 200 patients per day [8]. Such workload would negatively affect healthcare service delivery and patients’ safety, and might render HCWs’ performance [36]. Meanwhile, previous studies that investigated the impact of workload on HCWs’ performance revealed inconsistent results. For instance, Asamani et al. (2015) [37] indicated that excessive workload pressure could improve HCWs’ jobs, while Baethge et al. (2015) [38] claimed that a high workload would diminish HCWs’ performance. Such inconsistency of results reveals that workers respond differently to specific crises because of their personalities, cultures, work environment, and employment. Recently, Pourteimour et al.’s (2021) [31] study revealed that there is a non-significant association between workload and HCWs’ job performance in COVID-19 care units in Iran, arguing that HCWs’ inner efforts, as well as external encouragement received from hospitals’ top management and community, affected HCWs’ responses to the current crisis.
Due to the inconsistency of results, this study utilized the concept of career adaptability to investigate how career development processes would mitigate the impact of traumatic events such as the COVID-19 pandemic. Career adaptability, anchored in the CCT, seeks to examine individuals’ flexibility while dealing with career transitions and challenges [7]. It can be considered as a psychosocial resource, as well as a self-regulatory, transactional competency that can help employees deal with future changes in their careers [39]. It promotes employees’ ability to handle uncertainties and overcome fears about their career future, thus ensuring successful transition across the career life span [7]. The career adaptability variable is composed of four psychosocial transactional competencies denoted by 4 Cs: concern, control, curiosity, and confidence [30]. Firstly, concern refers to the extent to which individuals demonstrate awareness and preparedness for their vocational future. Secondly, control refers to the extent to which individuals become involved in career-related decisions to control their resources. Thirdly, curiosity refers to the extent to which individuals develop their career or their career environment through exploring their skills, abilities, and knowledge. Finally, confidence refers to the extent to which individuals demonstrate self-efficacy, problem-solving, or any alternative measures to face career challenges and overcome obstacles [30]. Previous empirical studies indicated that career adaptability has a positive significant impact on various career outcomes such as in-role performance and employability [40].
In agreement with the CCT and COR theory, career adaptability would explain how individuals might adapt to the challenges within their career domain [19]. In particular, individuals would demonstrate adaptive readiness affecting their psychosocial resources that are necessary to face occupational challenges and traumatic events. Consequently, HCWs may become engaged in specific adaptive responses to address challenging situations [40]. This process yields beneficial adaptation outcomes such as development and satisfaction. Moreover, adaptive employees believe that they are able to solve career-related problems, thus developing their careers [41]. Accordingly, career adaptability is considered a self-regulatory competency adopted by employees to face career challenges inducing novelty in their occupational tasks [19]. Meanwhile, several empirical studies indicated that heavy workload may negatively influence HCWs’ performance and service delivery [36,38]. Under these circumstances, it is proposed that:
Hypothesis 1 (H1).
Workload is negatively related to career adaptability.

3.2. Workload, Mental Health, and Secondary Traumatic Stress

During the COVID-19 pandemic, HCWs were subjected to additional stressful situations such as heavy workload [8,31] while working under extreme pressure with infected and suspicious patients, affecting their mental health [35,39] and resulting in secondary traumatic stress [12]. Workload refers to excessive tasks to be accomplished by workers over a long duration [10]. Meanwhile, mental health refers to proper mental functioning that can enhance an individual’s performance and increase their ability to adapt to and cope with stressful situations [14]. On the other hand, secondary traumatic stress refers to the HCWs’ negative reactions such as intrusive thoughts, avoidant behaviors, psychological distress, and arousal affecting their proper functioning [42].
The uncertainty imposed by COVID-19 regarding the possibility of contracting or transmitting the disease to family and peers, as well as the absence of effective treatment, has increased the symptoms of anxiety, depression, and mental health disturbances among HCWs [43]. Moreover, the lack of preparations, security protocols, and protective equipment has resulted in a tremendous number of infected and deceased personnel among HCWs, driving them to develop trauma-related symptoms [39]. Similar studies indicated that HCWs would exhibit mental fatigue as well as psychological stress during the COVID-19 pandemic due to the heavy workload, shortage of medical staff, lack of appropriate medications and treatment protocols, and uncertainty imposed by the virus [9,35]. Furthermore, a recent study, conducted in Iran, revealed that the Iranian HCWs who treated patients infected with COVID-19 were subjected to a heavy workload, demonstrating poor mental health [44]. Accordingly, HCWs demonstrated a high prevalence of mental health disturbances and reported negative feelings about the heavy workload [8].
Moreover, empirical studies revealed that HCWs who are exposed to traumatic events while working directly with traumatized patients are affected personally and professionally [42] and may be exposed to secondary traumatic stress and burnout [12]. The exposure of HCWs to traumatized patients is likely to disrupt their cognitive schemas, modify their sense of trust, esteem, safety, and expectations of the world, and in turn, alternate their assumptions about others, thus developing secondary traumatic stress as a result of the stress induced by their desire to help the traumatized patients [17].
Similar studies were conducted during the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) outbreaks and had investigated their impacts on HCWs’ mental health. For instance, a previous study revealed that HCWs suffered from severe psychological stress such as anxiety, depression, and exhaustion during the SARS and MERS outbreaks [45]. However, in line with CCT, HCWs who possess professional knowledge regarding the transmission of some infectious diseases such as the human immunodeficiency virus and viral hepatitis, and are equipped with essential skills and competencies, may possess better mental health since they can control such challenging situations [46]. Meanwhile, COVID-19 seems to have lower mortality but a higher transmission rate than SARS and MERS [47]. Grounded in the COR theory, HCWs who face excessive work demands risk losing their physical and mental resources, leading to mental health disturbances, anxiety, and depression in a short time [43]. Based on the evidence, it is postulated that:
Hypothesis 2a (H2a).
Workload is negatively related to mental health.
Hypothesis 2b (H2b).
Workload is positively related to secondary traumatic stress.

3.3. Career Adaptability, Mental Health, and Secondary Traumatic Stress

The COVID-19 pandemic has been identified as a life-threatening event that has influenced the psychological health of HCWs, driving them to develop high levels of secondary traumatic stress [12] and mental health problems [24]. However, career adaptability is indicated to be an essential protective resource that helps individuals cope with traumatic situations such as the COVID-19 pandemic and career trauma [48,49]. In particular, career adaptability could help workers visualize the opportunities in the unanticipated challenges, driving them to adopt specific responses to recover rapidly from the unforeseeable outcomes of traumatic events and consequently, making employees respond to traumatic events in a calm manner [41].
Previous empirical studies have investigated the relationship between career adaptability and mental health. In particular, career adaptability could help individuals face future uncertainties by adapting to the modifications imposed by a specific situation. Such adaptation decreases inadaptability, enhances individuals’ well-being, and strengthens their mental health [19]. In line with the CCT, several researchers indicated that career adaptability and ill mental health are negatively correlated. Specifically, career adaptability would improve employees’ mental health and motivate them to seek more opportunities to overcome obstacles and achieve future goals [18]. On the other hand, studies have indicated that career adaptability had a significant positive effect on employees’ job satisfaction [49] and significant negative impacts on anxiety and traumatic stress [33]. In other words, career adaptability may help individuals visualize the opportunities in the unanticipated challenges, focus on these challenges, and recover from the unforeseeable outcomes. It is known that career adaptability is triggered by career-related challenges or changes relying on the individuals’ accumulated behaviors, attitudes, resources, and competencies that allow them to fit into a particular job [50]. Given CCT and COR theory, HCWs who possess career adaptability, as an essential psychosocial resource, experience more positive mental health and lower secondary traumatic stress. Therefore, it is proposed that:
Hypothesis 3a (H3a).
Career adaptability is positively related to mental health.
Hypothesis 3b (H3b).
Career adaptability is negatively related to secondary traumatic stress.

3.4. The Mediating Role of Career Adaptability

As the number of infected patients with COVID-19 increases, HCWs are subjected to huge work pressure and a heavy workload [31]. Consequently, HCWs’ psychological health is likely to be affected negatively [8]. While HCWs have exhibited poor mental health, anxiety, and depression during the pandemic [9,35,39], research also indicates that HCWs have developed secondary traumatic stress [12]. In particular, HCWs who are exposed to traumatized patients would exhibit disrupted cognitive schemas, intrusive thoughts, and avoidant behaviors [42]. However, career adaptability, which is a personal resource, may help individuals cope with work-related situations [19]. In line with the CCT, individuals who demonstrate adaptivity and willingness and who are equipped with career adaptability present valuable adaptation results [7]. Furthermore, in agreement with the COR theory, individuals who conserve their existing personal resources and are capable of gaining additional ones exhibit positive mental health and better well-being [22]. Such personal resources are particularly important for employees to cope with job demands such as workload [32]. Accordingly, career adaptability was considered an essential construct in mitigating the impact of the COVID-19 pandemic on HCWs’ psychological health [48]. Specifically, HCWs would visualize opportunities during a challenging and stressful event, making them prepared for a career-related scenario, and enabling them to overcome work challenges [18]. Furthermore, HCWs’ inner efforts and abilities would tailor their response to such a stressful event. In other words, when HCWs found their workload challenging due to the COVID-19 pandemic, the possession of adaptability resources would enable them to boost their mental health and experience reduced secondary traumatic stress [31]. Stemming from the aforementioned facts, it is postulated that:
Hypothesis 4a (H4a).
Career adaptability mediates the relationship between workload and mental health.
Hypothesis 4b (H4b).
Career adaptability mediates the relationship between workload and secondary traumatic stress.
The conceptual model in Figure 1 presents the interrelationships among the study constructs. In particular, the workload is shown to deteriorate HCWs’ mental health and increase their vulnerability to secondary traumatic stress. Moreover, the model proposes that career adaptability mediates the relationship between workload and the psychological health of HCWs.

4. Research Methodology

4.1. Study Design and Participants

The sample comprised HCWs such as physicians, nurses, radiology technicians, and laboratory technologists working in Lebanese private hospitals. All HCWs who were providing healthcare services for patients in various departments were considered eligible for the study for several reasons. First, HCWs are likely to have contact with symptomatic and asymptomatic patients in different departments within the hospital [51]. Specifically, a recent empirical study collected data from 1300 Italian HCW during the COVID-19 pandemic and revealed that HCWs suffered from several symptoms of ill mental health such as traumatic stress, depression, and anxiety, regardless of their profession (i.e., physicians, nurses, technologists, etc.) [35]. Furthermore, the researchers indicated that frontline young females demonstrated higher levels of mental health disturbances [35]. Accordingly, this paper collected data from HCWs without differentiating between the typology of professions. Second, various researchers recommended investigating HCWs’ mental health and secondary traumatic stress during the COVID-19 outbreak since these two constructs are rarely investigated among HCWs working in different departments [29]. Third, since HCWs play a critical role in combatting COVID-19 [1], a sample of HCWs working in different departments would provide future implications for managing HCWs’ psychological health and adaptability during traumatic events [12].
According to the Syndicate of Hospitals, there are 133 private hospitals in Lebanon. Only 17 hospitals were qualified by the Ministry of Public Health to admit, examine, and isolate suspicious and infected patients at the beginning of the pandemic. The 17 hospitals were contacted by the researchers; however, only 13 hospitals accepted the invitation to participate in this study. The data collection process was coordinated by the human resource managers in each hospital. The data were gathered in the early stage of the COVID-19 pandemic between 16 March and 29 March 2020, via two waves with a two-week lag time to prevent common method bias by separating the predictor and criterion variables [52]. The short time lag was also adapted to enhance insights regarding the short-term consequences of job characteristics [53]. Data collection procedures were performed following the ethical standards of the participating hospitals.
The study adapted several procedural remedies to minimize common method bias [52]. Firstly, data were gathered through the human resource managers in each hospital. Each human resource manager prepared a list with the HCWs’ names and identification codes to match the questionnaires. Then, they provided the supervisors in each department with a pack of surveys relevant to the number of HCWs. Secondly, each questionnaire had a cover page explaining the purpose of the study, ensuring the confidentiality of the information, as well as encouraging the voluntary participation of respondents. Moreover, the cover page indicated that there were no right or wrong answers in this survey. Thirdly, this study guaranteed anonymity, as HCWs were asked to return the questionnaires in sealed envelopes to the supervisors before delivering them to the human resource managers.
Five hundred and seventy-one HCWs were asked to complete Time 1 and Time 2 questionnaires. Five hundred and forty-nine questionnaires were obtained at both waves. The response rate was 96% which is considered acceptable in social science studies [54].
The findings of the research sample of 549 HCWs comprised 234 males (42.6%) and 315 females (57.4%), aged between 18 and 58. The findings showed that 238 (42.8%) participants had a bachelor’s degree, while 80 (14.6%) had a vocational school diploma. Moreover, in the sample, 399 (72.7%) participants reported that they were married and 175 (31.9%) had between sixteen and twenty years of experience in the health sector. Furthermore, 424 (77.2%) participants indicated that they had to work 41 to 50 h per week while 120 (21.9%) participants had to work 31 to 40 h per week.

4.2. Instrumentation

This study adapts scale items from previous empirical studies with well-known validated measures (listed in the Supplementary Materials). All of the surveys were prepared utilizing the back-translation technique. In particular, all questionnaires that were prepared in the English language were translated into the Arabic language and then translated back to the English language via professional translators. These questionnaires were piloted with twenty HCWs who assessed the understandability and readability of the items. The results indicated that there was no need to conduct any change in the wording of the questions.

4.2.1. Workload

Respondents completed the workload scale in Time 1 survey [55]. It consisted of 9 items. Responses to items were created in a five-response format (1 = strongly disagree to 5 = strongly agree) (Alpha = 0.72).

4.2.2. Career Adaptability

The Career-Adapt-Abilities-Scale Short Form (CAAS-SF) was utilized to assess career adaptability (Time 1 survey) [56]. CAAS-SF consists of 12 items, with three items for each of the four sub-dimensions: concern, control, curiosity, and confidence. It assesses the essential resources needed to cope with traumatic life events or undesirable professional conditions. Responses to items were created in a five-response format (1 = strongly disagree to 5 = strongly agree). The Cronbach’s alpha of the total career adaptability scale for this study was 0.99, while the Cronbach’s alpha of each of the four subscales was 0.98 for concern, 0.99 for control, 0.99 for curiosity, and 0.97 for confidence.

4.2.3. Mental Health

General Health Questionaire-12 was borrowed to assess HCWs’ mental health (Time 2 survey) [57]. It is a unidimensional screening tool used to determine the positive performance of mental functioning by examining the extent of effectiveness and success felt by individuals in various settings. Responses to items were created in a four-response format (0 = not at all, 1 = no more than usual, 2 = rather more than usual, 3 = much more than usual). Although Cronbach’s alpha is relatively low (Alpha = 0.50), alpha values ranging between 0.5 and 0.7 represent moderate reliability [58].

4.2.4. Secondary Traumatic Stress

HCWs’ secondary traumatic stress was measured by the Secondary Traumatic Stress Scale (STSS) (Time 2 survey) [59]. This 17-item scale was utilized in other empirical studies [42]. Responses to the item scales were created on a five-response format (1 = never, 2 = rarely, 3 = every once in a while, 4 = sometimes, 5 = very often). However, there was a modification such that the word ‘patients’ was used instead of ‘clients’ in the items. The modified version was pretested before the actual distribution of questionnaires to HCWs (Alpha = 0.93).
Respondents’ age, gender, marital status, educational level, working hours, and clinical experience were included in the Time 1 survey and considered as control variables. Data regarding the profession of HCWs were not collected based on the justifications mentioned above.

5. Results

5.1. Data Analysis

A two-step approach was followed for data analysis [59]. The validity (convergent and discriminant) and the internal consistency reliability were assessed via confirmatory factor analysis, while the anticipated hypotheses were tested through structural equation modeling. Further, Amos 24 was used to appraise the significance of the indirect path analysis among constructs by applying the bootstrapping method [60]. The researchers bootstrapped the sample 5000 times at a 95% confidence interval. The minimum discrepancy (CMIN), standardized root mean square residual (SRMR), root mean square error of approximation (RMSEA), degrees of freedom (DF), parsimony normed fit index (PNFI), comparative fit index (CFI), Tucker–Lewis index (TLI), and incremental fit index (IFI) were used to estimate the measurement and path analysis [54].

5.2. Psychometric Properties of the Measures

There were four latent variables and 50 observed variables in the measurement model. However, to improve the normality and reliability of the measure, a three-item parcel was created for workload and four-item parcels were created for career adaptability, secondary traumatic stress and mental health, with the items in each measure randomly assigned since the pre-test factor analysis demonstrated high factor loadings of the original items [61]. One item parcel was deleted from mental health due to low loading and measurement error. A similar approach was adopted by several researchers [62].
The results demonstrated that measurement items conform to the assumptions of confirmatory factor analysis of the sample since the skewness values ranged between 0.015 and 1.073, and kurtosis results were between −0.333 and −1.709 [54]. Furthermore, the results demonstrated that the loadings had acceptable fit statistics model fit statistics: CMIN = 177.493; DF = 50; CMIN/df = 3.55; CFI = 0.99; IFI = 0.99; TLI = 0.98; RMSEA = 0.068; SRMR = 0.049. Further, all the loadings were significant (p < 0.001). Likewise, the validity (convergent and discriminant) was examined based on a Fornell and Larcker criterion [63]. All item loadings (as shown in Table 1) were between 0.66 and 0.99, hence confirming the convergent validity of the measures. Furthermore, the value of the average variance extracted (AVE) for each variable was greater than the squared correlation of other variables, establishing the discriminant validity.
Table 2 presents the mean, standard deviation, and correlation findings of the latent variables.

5.3. Tests of the Hypothesized Model

The results in Figure 2 demonstrated that the hypothesized model fits the data reasonably well with the following fit statistics: CMIN = 380.725; DF = 64; CMIN/df = 5.949; CFI = 0.97; IFI = 0.97; TLI = 0.96; RMSEA = 0.080; SRMR = 0.066. Hypothesis 1 proposes that workload is negatively related to career adaptability. However, as indicated in Figure 2, workload and career adaptability (β1 = 0.15, z= 3.31) are positively and significantly related, hence, Hypothesis 1 is not supported. Hypothesis 2a proposes that workload is negatively related to mental health. The findings in Figure 2 show that workload and mental health (β21 = 0.28, z = 4.18) are positively and significantly related, hence, Hypothesis 2a is not supported. Hypothesis 2b proposes that workload is positively related to secondary traumatic stress. The findings in Figure 2 show that workload and secondary traumatic stress (β22 = −0.31, z = −5.88) are negatively and significantly related, hence, Hypothesis 2b is not supported. In the same way, Hypothesis 3a proposes that career adaptability is positively related to mental health. The results in Figure 2 demonstrate that career adaptability and mental health (β31 = 0.05, z = 0.98) exhibit positive and non-significant relationship. Thus, there is no support for Hypothesis 3a. Hypothesis 3b proposes that career adaptability is negatively related to secondary traumatic stress. The results in Figure 2 demonstrate that career adaptability and secondary traumatic stress (β32 = −0.10, z = −2.03) exhibit a negative and significant relationship. Thus, the empirical data support Hypothesis 3b.
The mediating effects of career adaptability were shown in Table 3. The study implemented a bootstrapping method with a 5000-sample size, accelerated confidence interval, and a bias-corrected percentile to estimate the significance of the indirect path [64]. There is no support for the mediating effects of career adaptability (Hypotheses 4a and 4b) as hypothesized despite the significant mediating effect of career adaptability on the relationship between workload and secondary traumatic stress. This is because the sign of the effect of workload on career adaptability is not consistent with the proposed hypotheses. The major factor that may be responsible for such inconsistent signs is that workload may have been appraised as a challenging demand that will enhance an employee’s learning, growth, and goal achievement [26].

6. Discussion and Conclusions

6.1. Summary of Results

This paper proposed and examined the relationships between workload and HCWs’ mental health and secondary traumatic stress mediated by career adaptability with data gathered from HCWs working in private hospitals in Lebanon during the COVID-19 pandemic. The above-mentioned interrelationships among constructs were developed in line with the tenets of CCT and COR theory. Although all hypotheses were significant except H3a and H4a, most hypotheses were not supported except H3b.
Contrary to our propositions, the findings of this research indicated that workload has a significant positive effect on HCWs’ career adaptability and mental health; whereas it has a significant yet negative effect on secondary traumatic stress. Such inconsistent signs might be related to the way HCWs perceived their work environment demonstrating different responses to different job demands [26]. For instance, studies have demonstrated that the categorization of job demand (e.g., workload) as either a challenge or hindrance is likely to be different in various work settings. Workload may have been categorized as a challenging work demand that empowers and enables HCWs to stimulate learning and growth, and attain their goals during the COVID-19 pandemic [65]. Therefore, such a categorization of workload enables HCWs to experience enhanced career adaptability, good mental health, and reduced secondary traumatic stress. This is consistent with the tenets of CCT and COR theory, that emphasize that career development and adaptation depend on employees’ ability to integrate personal needs with social expectations and adjust during traumatic conditions [17,19]. In particular, the early stage of COVID-19 was a challenging period wherein the entire world was figuring out effective measures to combat the disease from spreading. Thus, HCWs in Lebanon may have been able to relatively adjust during a pandemic by realizing they were key players in combating the pandemic, and may have taken the situation as an opportunity to learn more, develop, and be proud to be one of those who significantly contributed to saving lives, in contrast to the frustrating period before the pandemic that has been characterized by its poor supporting work environment [6].
As proposed, the findings reveal that career adaptability has a negative significant effect on HCWs’ secondary traumatic stress. On the other hand, and inconsistent with the paper’s preposition, career adaptability has a non-significant effect on mental health. This is consistent with previous empirical studies that indicated HCWs are subjected to high levels of secondary traumatic stress [12]. However, the findings seem to have supported the existing reports that career adaptability would mitigate the impact of the COVID-19 pandemic and career transitions, and in turn enable HCWs to respond calmly [41]. This is also consistent with the CCT, which emphasizes the individual’s ability to cope during traumatic situations. According to a recent study, career challenges trigger, to a great extent, career adaptability depending on employees’ behaviors, competencies, and perceptions of their work environment [50]. Meanwhile, the results of the study revealed a non-significant relationship between career adaptability and HCWs’ mental health, contradicting previous empirical studies. Specifically, previous empirical papers indicated that career adaptability enhanced HCWs’ mental health by helping them visualize the opportunities in stressful events such as the COVID-19 pandemic [18,41]. Similarly, along with the tenets of the COR theory, conserving and accumulating personal resources would enhance individuals’ mental health [22].
Moreover, the results of the study did not provide support for the mediating role of career adaptability between workload and both mental health and secondary traumatic stress despite the significant yet negative mediating effect of career adaptability between workload and secondary traumatic stress. Such inconsistency of signs indicates that HCWs appraised workload as a challenging demand rather than a hindrance stressor, thus enhancing career adaptability and reducing secondary traumatic stress. This is consistent with previous empirical studies which demonstrated that the categorization of job demands into challenge and hindrance stressors has never been straightforward [26,27]. In particular, challenge stressors induced attentiveness among employees while it increased their anxiety [66]. It seems that HCWs who perceived workload as a challenging work demand were motivated to provide quality care service as caregivers playing a crucial role in combating COVID-19. It is evident that such responsibility enables the HCWs to learn more about COVID-19 by initiating their adaptability resources, and in turn, enables them to experience reduced secondary traumatic stress. This is consistent with the tenets of CCT regarding person–environment interaction. Specifically, based on the tenets of CCT, the abilities of the individual to adjust to trauma may change depending on the situation and time that person–environment interaction presents.

6.2. Theoretical Implications

The study’s findings enhance the current knowledge of healthcare management, psychology, and vocational behavior literature in several ways.
First, the results concerning the impact of workload on career adaptability, mental health, and secondary traumatic stress contradict the study propositions despite the significance of the relationships. There are several explanations for such unexpected results. For instance, HCWs working in different departments might demonstrate different responses to workload due to variations in their abilities, competencies, and inner efforts [31]. Moreover, the workload might have been appraised by employees as a challenge stressor rather than a hindrance demand, leading to unexpected work outcomes [26,27]. As a result, in line with the CCT and COR theory, HCWs demonstrate higher career adaptability, better mental health, and lower levels of secondary traumatic stress as they seek opportunities in stressful events such as the COVID-19 pandemic.
Second, this study responded to recent calls from previous empirical studies to investigate the impact of workload on HCWs’ psychological health during the COVID-19 pandemic [25]. In particular, previous studies revealed that HCWs witnessed mental health disturbances and secondary traumatic stress during the pandemic and recommended further investigations to investigate mitigating the impact of subsequent eruptions of outbreaks on HCWs’ psychological health [12]. Therefore, using the CCT and COR theory, career adaptability was treated as a mediator linking workload to secondary traumatic stress and mental health. Moreover, the findings discussed above provided additional insights into healthcare management since no existing empirical studies have investigated the linkages between workload, mental health, and secondary traumatic stress via the mediating role of career adaptability.
Third, previous empirical studies revealed that workload may be appraised as a challenge to demand in one service sector and as a hindrance to demand in different industrial settings [27]. In particular, this study provides support to the inconsistent results of previous studies on the appraisal of workload by various employees from different work settings and the impact of job demands on various work outcomes [26,27]. The study validates CCT and COR theory regarding the ability of HCWs to adapt to trauma and uncertainty during COVID-19 due to their adaptability resources, as evidenced by the mediating role of career adaptability in the relationship between workload and secondary traumatic stress among HCWs in the Lebanese private healthcare sector.

6.3. Managerial Implications

Since the COVID-19 pandemic is still an ongoing crisis, the current study provides several managerial implications for policymakers, healthcare managers, and human resource managers. First, concerning the findings of H1, H2a, and H2b, HCWs seem to have appraised workload as a challenging work demand, thus demonstrating high levels of career adaptability, good mental health, and lowered secondary traumatic stress. Accordingly, healthcare management should manage workload and create a positive working atmosphere by providing support, training, and rewards to motivate and empower employees. Moreover, human resource managers should continuously support and develop employees’ abilities to face uncertainties through the implementation of high involvement work practices to buffer the impact of workload on HCWs’ psychological health. Specifically, human resource managers could improve HCWs’ well-being by enhancing their participation in the decision-making process, advancing their communication skills, and increasing their involvement in managing work patterns. Moreover, group-based performance pay would enhance employees’ ability to handle career-related challenges and increase career adaptability [67].
Second, the results indicate that career adaptability has a negative significant effect on secondary traumatic stress and a non-significant impact on mental health. Accordingly, healthcare management should design specific interventions after analyzing HCWs’ career-related needs. In particular, healthcare management can enhance HCWs’ career adaptability by introducing orientation programs, self-esteem development activities, decision-making training, and education-seeking opportunities. Moreover, human resource managers should consider career adaptability as a critical selection criterion during recruitment to select high-potential workers. Further, healthcare top management should train their managers and supervisors to be capable of providing support for HCWs during pandemics. Consequently, managers and supervisors should help HCWs to develop the skills, knowledge, and competencies to face traumatic events. Healthcare top management should develop a platform where HCWs can discuss their problems with their managers. Further, hospitals’ top management should respond effectively to HCWs’ complaints and cultivate a positive work environment.
Third, healthcare top management should promote awareness about mental health care among HCWs. Therefore, an effective psychiatric intervention would reduce the adverse psychological effects of pandemics among HCWs. Moreover, healthcare management should organize regular screening such as online psychological counseling, solidarity sessions, financial support, on-site psychological guidance, and psychiatric treatment.

6.4. Limitations and Future Research

Although this study contributes to the literature in several ways, a few potential drawbacks and future research suggestions should be taken into consideration. First, this study examined the impact of workload on HCWs’ career adaptability, mental health, and secondary traumatic stress during COVID-19. Although career adaptability is an essential construct that may help employees respond to traumatic events effectively, future research should examine personality traits, organizational support, and psychological capital as moderators and/or mediators between such relationships. Moreover, researchers could investigate how HCWs might appraise workload in future studies. In addition, future studies could investigate how HCWs’ different profiles would influence their perceptions regarding workload and career adaptability.
Second, this study examined the model’s interrelationships utilizing cross-sectional data obtained from HCWs working in private hospitals in Lebanon with a two-week time interval. Therefore, the causal relationship established in this study cannot be generalized. As a remedy, longitudinal research should be beneficial to clarify the causation of the proposed relationships.
Third, data were collected at an early stage of the pandemic without knowing how long the pandemic would last. Accordingly, future research could replicate this study after some time (maybe a year or two) to examine how HCWs’ perceptions of workload would influence their career adaptability, mental health, and traumatic stress.
Fourth, the data obtained in this study was self-reported depending on participants’ memory and social conformity. Consequently, results may be underestimated leading to incomplete information. As a result, future research should investigate patients’ perceptions regarding HCWs’ performance to understand how HCWs’ perceptions of workload could affect patient satisfaction.
Fifth, the data collection process in each hospital was coordinated by human resource managers which can lead to selection bias. As a remedy, future research should directly contact HCWs to assure their utmost confidentiality. Finally, the present study can be replicated in other countries with a larger sample size and in other service industries to investigate how employees appraise work demands and their impact on work outcomes.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/su141912010/s1, Supplementary File S1: Measurement Items.

Author Contributions

Conceptualization, S.H., O.A.O. and G.K.; methodology, S.H. and G.K.; software, O.A.O.; formal analysis, O.A.O.; writing—original draft preparation, S.H.; writing—review and editing, O.A.O., G.K. and Ö.A.; supervision, O.A.O. and G.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

All procedures performed in this study involving data collection were following the ethical standards of the participating hospitals.

Informed Consent Statement

Informed consent was obtained from all individual participants included in this study.

Data Availability Statement

The data generated and analyzed during the current study are available from the corresponding author upon reasonable request.

Acknowledgments

In this research, we are grateful for the assistance of anonymous reviewers and the editors for their invaluable comments to improve this paper.

Conflicts of Interest

The authors declare no conflict of interest.

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Figure 1. Research model.
Figure 1. Research model.
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Sustainability 14 12010 g002 550
Figure 2. Hypothesized model estimate. Note: CMIN = Minimum discrepancy; DF = Degrees of freedom; CFI = Comparative fit index; IFI = Incremental fit index; PNFI = Parsimony normed fit index; RMSEA = Root mean square error of approximation; SRMR = Standardized root mean square residual.
Figure 2. Hypothesized model estimate. Note: CMIN = Minimum discrepancy; DF = Degrees of freedom; CFI = Comparative fit index; IFI = Incremental fit index; PNFI = Parsimony normed fit index; RMSEA = Root mean square error of approximation; SRMR = Standardized root mean square residual.
Sustainability 14 12010 g002
Table
Table 1. Confirmatory factor analysis results.
Table 1. Confirmatory factor analysis results.
Scale ItemsLoadingst-ValuesAVEAlpha
Workload (Wload) 0.550.72
Wload 10.841.00 *
Wload 20.7713.43
Wload 30.665.45
Career adaptability (Cadpt) 0.970.99
Cadpt 10.961.00 *
Cadpt 20.9748.43
Cadpt 30.9834.15
Cadpt 40.9931.91
Secondary traumatic stress (STS) 0.740.93
STS 10.861.00 *
STS 20.7724.51
STS 30.7926.56
STS 40.9832.00
Mental health (MNTH) 0.520.50
MNTH 10.851.00 *
MNTH 2------
MNTH 30.897.60
Note. (1) All loadings are significant at the 0.001 level. CR = Composite reliability; AVE = Average variance extracted; CMIN = Minimum discrepancy; DF = Degrees of freedom; CFI = Comparative fit index; IFI = Incremental fit index; TLI = Tucker–Lewis index; RMSEA = Root mean square error of approximation; SRMR = Standardized root mean square residual; --- Item deleted. * Item scale fixed at 1.00. (2) Wload = Workload; Cadpt = Career adaptability; STS = Secondary traumatic stress; MNTH = Mental health.
Table
Table 2. Mean, standard deviation, and correlations of variables.
Table 2. Mean, standard deviation, and correlations of variables.
VariablesMeanSD1234567
1. Age2.991.05-
2. Education3.510.990.675 **-
3. Experience4.051.120.879 **0.643 **-
4. Workload3.700.480.118 **0.323 **0.151 *-
5. Career adaptability4.630.470.0330.092 *0.0190.159 **-
6. Secondary traumatic stress3.860.69−0.202 **−0.381 **−0.198 **−0.325 **−0.153 **-
7. Mental health1.520.38−0.0520.035−0.0150.115 **0.029 −0.138 **-
Note. SD = Standard deviation. * Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed).
Table
Table 3. Bootstrapping results of the mediating effect of career adaptability.
Table 3. Bootstrapping results of the mediating effect of career adaptability.
Hypothesized Mediated EffectsUnstandardized Indirect EstimatesLLCIULCIp Value
WloadSustainability 14 12010 i001CadptSustainability 14 12010 i001STS
(0.228 a × −0.112 b)		−0.025−0.032−0.0020.01
WloadSustainability 14 12010 i001CadptSustainability 14 12010 i001MNTH
(0.228 a × 0.03 b)		0.007−0.0070.0300.24
Note: (1) A bootstrapping method with 5000 sample size generated at 95% confidence interval (CI) was adopted to test the significance of the indirect effects. Gender and age were the control variables; LLCI = lower-level confidence interval; ULCI = upper-level confidence interval. (2) Wload = Workload; Cadpt = Career adaptability; STS = Secondary traumatic stress; MNTH = Mental health, a: denotes the direct effect of the predictor variable on the mediator, b: denotes the direct effect of the mediator on the criterion variable.
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MDPI and ACS Style

Hassanie, S.; Olugbade, O.A.; Karadas, G.; Altun, Ö. The Impact of Workload on Workers’ Traumatic Stress and Mental Health Mediated by Career Adaptability during COVID-19. Sustainability 2022, 14, 12010. https://doi.org/10.3390/su141912010

AMA Style

Hassanie S, Olugbade OA, Karadas G, Altun Ö. The Impact of Workload on Workers’ Traumatic Stress and Mental Health Mediated by Career Adaptability during COVID-19. Sustainability. 2022; 14(19):12010. https://doi.org/10.3390/su141912010

Chicago/Turabian Style

Hassanie, Souad, Olusegun A. Olugbade, Georgiana Karadas, and Özlem Altun. 2022. "The Impact of Workload on Workers’ Traumatic Stress and Mental Health Mediated by Career Adaptability during COVID-19" Sustainability 14, no. 19: 12010. https://doi.org/10.3390/su141912010

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