| Summary: | Background: While there is much research on work-related stress among nurses in the literature, little attention has been focused on the effect of work-related stress and burnout on nursing performance and job satisfaction in hospitals within Saudi Arabia. In particular, studies from the western region of Saudi Arabia are lacking. Therefore, this study focuses on nurses in Jeddah, the country’s entry port and a city that regularly hosts pilgrims. Jeddah is highly multicultural, and the second largest city in Saudi Arabia with nearly 4 million people including travellers; it has the largest foreigner to citizen population ratio in Saudi Arabia, and a particularly high proportion of hospital nurses non-native to Saudi Arabia. Aim: The aim of this thesis was to identify research gaps and to contribute to existing knowledge by developing hypotheses pertaining to the level of work-related stress and burnout among hospital nurses in different hospital types in Jeddah. The study further evaluated the relationship between work-related stress and burnout, and how this related to nursing performance and job satisfaction. The analysis also examined the relationships between these variables among hospital nurses, and whether relationships are different for different hospital types. Methods: A systematic review of existing research into nursing stress in Saudi Arabia between 2003 and 2014 was carried out. From the 81 articles identified from the database search, 8 met the inclusion criteria. At the onset a pilot study was conducted was done among hospital nurses in King Abdulaziz University. Thereafter, a quantitative survey of 567 nurses derived from three large hospitals representing each sector (private, public and other governmental agency sector hospitals) was conducted. Bilingual questionnaires were used to collect quantifiable, reliable, and valid data in order to test the hypothesis derived from the pilot study. The data was analysed by quantitative research method of cross-sectional analysis and correlational study. Findings: Results showed levels of work-related stress varied among nurses depending on the type of hospital where the nurses were employed. Furthermore, there was a positive relationship between levels of work-related stress and burnout among hospital nurses working in all three types of hospitals in Saudi Arabia. However, there was a very weak relationship between work-related stress and job performance among private hospital (International Medical Center) nurses compared to the strength of this relationship observed in public hospitals. Stress was a significant predictor of burnout among nurses while burnout was the strongest descriptor of the relationship between work-related stress and job satisfaction among nurses. The analysis outcome revealed that work-related stress had the highest impact on job satisfaction, which was facilitated by burnout. Nurses working in the public (King Fahad Hospital) and university (King Abdulaziz University Hospital) hospitals reported high levels of stress and burnout, and also conveyed low levels of job performance and high levels of dissatisfaction compared with nurses working in the International Medical Center (IMC). The type of hospital moderated the effect between burnout and job satisfaction in both King Fahad Hospital (KFH) and King Abdulaziz University Hospital (KAUH) but did not affect the International Medical Center (IMC). The relationship between stress and burnout was significantly stronger in nurses working in the IMC compared with the KFH and KAUH hospitals. However, burnout was not important in the relationship between stress and satisfaction for those who worked in IMC. Therefore, hospital type did appear to moderate the mediation effect between burnout and job satisfaction, even though, the mediation effect occurred only in KFH and KAUH hospitals but not in IMC. Conclusion: The study demonstrated that there is evidence of work-related stress among nurses in Jeddah, Saudi Arabia. Its prevalence depended on the age,experience,nationality and the employment status of the nurses. Work-related stress and burnout impacted negatively on job performance and job satisfaction in nurses in public (KFH) and university (KAUH) hospitals but not in private (IMC) hospitals. Notably, there is a mediated relationship between work-related stress and burnout and a moderated mediation difference between the type of hospitals. Both work-related stress and burnout have shown an effect on the level of job satisfaction of nurses and their job performance. In essence, measures should be taken to help alleviate work-related stress and burnout levels of nurses working in non-privately funded hospitals Saudi Arabia. This study recommends an increase hiring Saudi Arabian nurses, a review of task allocation policies for nurses, provision of targeted training for nurses, increased focused government funds allocation to healthcare, an adoption of an integrated stress prevention intervention and management program throughout the healthcare system of Saudi Arabia.
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