Relationship Between Assertiveness and Stress Levels among Nurses in Pakistan: A Cross-Sectional Study

Relationship Between Assertiveness and Stress Levels among Nurses

Abstract

Nursing is widely known as one of the most stressful occupations in the world due to work and emotional overloads, and strict hierarchical workplace cultures. Organizational support is also minimal in Pakistan, which increases stress among nurses. Assertiveness, a necessary communication skill in successful nursing practice, is commonly thought to minimize stress; however, in hierarchical environments, it may increase stress. Objectives: To identify the association between assertive behavior and perceived stress among Pakistani nurses and to determine socio-demographic and professional determinants of stress. Methods: An analytical cross-sectional study design was adopted. A total of 106 registered nurses from public and private hospitals in Pakistan were included using convenience sampling. Data were collected using a structured questionnaire consisting of the Assertiveness Scale and the Perceived Stress Scale (PSS-10). SPSS version 25.0 was used for analysis, including descriptive statistics, Pearson correlation, simple linear regression, and one-way ANOVA. Results: Results showed a weak yet significant positive correlation between assertiveness and stress (r = 0.19, p=0.040), indicating that higher assertiveness is associated with higher stress levels. Assertiveness explained 3.7% of perceived stress. Employment status was also a significant factor (p = 0.04), while other variables were not significant. Conclusions: Assertiveness has a context-dependent impact on stress. Future interventions should combine assertiveness training with stress management and institutional support to improve nurses’ well-being.