DR MAHMUT AKBOLAT (Orcid ID : 0000-0001-8954-6314)

Accepted Article
Article type : Original Article

The Mediating Role of Work Alienation in the Effect of Workplace

Loneliness on Nurses’ Performance

Short Title: Workplace Loneliness and outcomes

Mustafa AMARAT1, Mahmut AKBOLAT2*, Özgün ÜNAL 3, Bilge GÜNEŞ KARAKAYA 4

1. MS, Research Assistant, Department of Healthcare Management, Business Faculty,

Sakarya University

2. PhD, Assoc. Prof, Department of Healthcare Management, Business Faculty,

Sakarya University

3. MS, Research Assistant, Department of Healthcare Management, Business Faculty,

Sakarya University

4. Master Student, Department of Healthcare Management, Graduate School of

Business, Sakarya University and Nurse, Yenikent Public Hospital.

Correspondence Author:

Mustafa AMARAT, Business School, Sakarya University, 54187 Esentepe Campus, Serdivan,
Sakarya, Turkey. Phone: 0090-531 892 42 79. E-mail: mustafaamarat@sakarya.edu.tr

Short Title: Workplace Loneliness and outcomes

This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which may
lead to differences between this version and the Version of Record. Please cite this article as
doi: 10.1111/jonm.12710
This article is protected by copyright. All rights reserved.
 Mustafa Amarat and Mahmut Akbolat designed the research, analyzed the data, and drafted
the manuscript. Özgün Ünal and Bilge Güneş Karakaya contributed to the research design,
data collection, interpretation, critical review and revision of the final manuscript. All authors
Accepted Article
have approved this version to be published and agree to be accountable for all aspects of
the work in ensuring that questions related to the accuracy or integrity of any part of the
work are appropriately investigated and resolved.

Ethical considerations

Official authorities’ permission was obtained to collect data before the survey was
implemented. The approval of the Ethics Committee of Sakarya University (Document no. 82
dated 10.03.2018) was also obtained. The participants were informed of the confidentiality
and anonymity of the surveys.

Funding

The author(s) received no financial support for the research, authorship, and/or publication
of this article.

Aim: The purpose of this study is to determine the mediating role work alienation

has in the effect of loneliness at the workplace on nurses’ job performance.

Background: The literature includes no research on the relationship between nurses’

workplace loneliness, work alienation, and job performance. The study used work

alienation as a mediating variable, which adds to the originality of the study. This

study was carried out to contribute to relevant field research.

Methods: The study used a cross-sectional research design and surveyed 138 nurses

working in a public hospital in Turkey. The data was analysed using descriptive

statistical methods, Pearson correlation analysis and the PROCESS macro Model 4

(Hayes, 2013) in the regression analysis.

Results: Workplace loneliness has a negative effect on job performance. This

negative effect is magnified when work alienation is used as a mediating variable.

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 Conclusion: Nurses’ loneliness at the workplace and work alienation leads to a

decline in their job performance.

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Implications for Nursing Management: Nursing managers should take into

consideration that nurses’ feelings of workplace loneliness and alienation can reduce

the nurses’ job performance. When managers create formal and informal support

networks, it can reduce nurses’ negative feelings of loneliness and alienation. Thus,

helping nurses to perform better at work.

Keywords: Loneliness at workplace, work alienation, job performance, nurse,

nursing management.

1. Introduction

This study investigated the mediating role that work alienation has in the effect of

workplace loneliness on job performance. The study sample was composed

especially of nurses because nurses are among the most valuable resources of the

healthcare industry (Nejati et al., 2016). According to the 2016 data, the total number

of nurses actively working in Turkey is 152,952. According to the Health Statistics

Yearbook, the number of nurses per hundred thousand people in Turkey is 257,

while it corresponds to 1098 in the OECD countries (22) (General Health Statistics,

2017). The low figures in Turkey increase the importance of nursing performance in

providing healthcare services. The effective, efficient and uninterrupted delivery of

healthcare services is, directly and indirectly, related to nurse performance (Top et

al., 2010). Considering that nursing performance is an important factor in patient

care, patient satisfaction, and patient safety, the subject has been of increasing

interest to researchers (Terzioglu et al., 2016).

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 Organizational setting and conditions have been found to improve nursing

performance (Delucia et al., 2009; Yildiz et al., 2014). The literature includes research
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focusing on the relationship between nursing performance and a number of

variables including emotional intelligence (Al-Hamdan et al., 2016), mobbing

(Karcioglu & Akbas 2010), organizational justice (Ito et al., 2015), organizational

culture (Terzioglu et al., 2016) active communication style (Onay et. al, 2011), the job

itself, wages and working conditions (Yildiz et al., 2014), openness to experience

(Ellershaw et al.,2015), managerial competencies and professional autonomies (Kim

et al., 2014), meaningful work (Tong, 2018), alienation (Tummers & Den Dulk, 2013),

and loneliness (Ozcelik, & Barsade, 2011). According to a study conducted on nurses

in Turkey, nurses’ performance is affected by a number of factors including

workload, technological support, employee leave procedures, workplace safety,

employee health, the size of the working department, physical strength demanded,

tools and equipment, stress, physical work conditions, job orientation training,

disease severity, leadership style, noise level, employee rights, shift practice, role

uncertainty, the management and organizational structure of nursing services, work

autonomy, sexual harassment, the support for taking clinical decisions, social

integration and nurse relations, the stability of environment, opportunities for

promotion, clinical and vocational autonomy, in-service training, the financial

guarantee of medical practice errors, and the measurement and evaluation of

nursing performance (Top et al., 2010). However, nursing performance is affected

not only by organizational factors but also by nurses’ personality traits (Yeh et al.,

2016). Nursing is a job that requires high performance; thus, the knowledge of other

variables, if any, on nursing performance or mediating roles of these variables will

contribute to the literature and nursing management. Against this background, the

main purpose of this study is to determine the mediating role work alienation has in

the effect of workplace loneliness on job performance, as the literature does not

acknowledge this relationship.

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 2. Theoretical framework

2.1. Loneliness at workplace

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Loneliness exists all over the world and is a very common emotional experience.

People may have emotional and physical problems if they do not build relationships

(Dogan et al., 2009; Duck, 1991). Loneliness at the workplace occurs when people are

unable to have healthy relationships at work (Alper Ay, 2015). Wright and

colleagues (2006) defined workplace loneliness as a reflection of the negativities in

the quality of social interactions and individual relations. Workplace loneliness is

generally considered to have two dimensions: social loneliness and emotional

loneliness. Social loneliness arises from the lack of social relations and social

networks. People who feel social loneliness are unable to find a community to which

they feel they belong. Emotional loneliness refers to a condition in which people are

unable to establish close relationships and connections with others (Yılmaz &

Altınok, 2009), and also occurs when feelings and thoughts are not understood by

colleagues. Thus, people prefer not to share their feelings and thoughts with them

(Wright et al., 2006). The literature includes studies reporting that workplace

loneliness is associated with organizational commitment, burnout (Asık, 2016),

organizational cynicism (Alper Ay, 2015), organizational trust, job stress, job

satisfaction (Aytac, 2015; Tabancali, 2016) turnover intention (Demirbas & Hasit,

2016), and job performance (Ozcelik & Barsade, 2011). Although these studies did

not survey nurses, they are still worthy of note to underline the importance of the

subject. The literature includes a limited volume of research that, in detail, discusses

workplace loneliness that nurses may feel. Previous research conducted on health

workers argued that individuals are likely to experience loneliness at the workplace

if they do not have good productive relationships with their colleagues, and health

workers’ feelings of loneliness at the workplace have a negative effect on their

attachment to the organization (Stoica et al., 2014). Thus, it seems that individuals

experiencing workplace loneliness are likely to cause a number of negative

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 consequences in the functioning of organizations. Considering that health

institutions operate using a matrix organization structure (Tengilimoglu et al., 2017),

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workplace loneliness is of increasing importance in the functioning of organizations

and the management of patient care.

2.2. Work Alienation

Work alienation refers to a condition of psychological separation from one’s image

and social relations inside and outside the workplace. Karl Marx investigated the

economic effects of work alienation (Tummers & Den Dulk, 2013) and Melvin

Seaman (1959) addressed work alienation from a socio-political perspective. Under

the latter perspective, alienation is associated with the feelings of powerlessness,

meaninglessness, isolation, self‐estrangement, and normlessness. Mottaz (1981)

argued that the existing dimensions and measures of work alienation fail to take into

account internal differences among employees, and took into consideration

employees’ expectations and the importance of perceiving job dimensions for

employees. Within the scope of the present study, the dimensions of powerlessness,

meaninglessness, and self‐estrangement constitute the predictors of work alienation.

Powerlessness is a feeling that individuals have no control over decision-making

processes. At the workplace, individuals have no right to have a voice in the process

of products and services they work for (Seeman, 1959). Meaninglessness refers to a

condition where people think that their contribution to their organization is limited

and they are unable to comprehend its importance (Mottaz, 1981). Meaninglessness

occurs when employees do not understand organizational goals (Tummers et al.,

2015). Self‐estrangement is when employees feel they are unable to respond to their

own wishes and needs. When this feeling emerges, employees are unable to attach

importance to any internal motivation factor; instead, external motivation factors

(such as money) become more important (Otrar & Halacoglu, 2011). Previous

research in Turkey reported that 87.3% of nurses experience moderate levels of

workplace alienation (Ertekin & Ozmen, 2017). Another piece of research on actively

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 working nurses in Turkey also reported moderate to high levels of workplace

alienation (Yetis, 2013). There can be many reasons for employees’ feelings of work
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alienation. These reasons result from environmental factors or organizational factors

(Ozer et al., 2017). In the research of Chiaburu and colleagues (2014), the predictors of

work alienation includes job design, personality traits, supportive leadership and the

job itself, while the results of work alienation include employee attitudes (job

satisfaction, job participation, organizational identity, and organizational

commitment), withdrawal (absenteeism), turnover intention, burnout, task

performance, organizational citizenship behaviour, hostile and opposing behaviour,

and side effects (drinking and smoking). There is also a negative relationship

between work alienation and performance (Santas et al., 2016; Tummers & Den

Dulk, 2013).

2.3. The mediating role of work alienation in the effect of loneliness at the

workplace on job performance

This study measured the effect of nurses’ workplace loneliness on their job

performance and the mediating role of work alienation in this effect. This subject

was selected in this study because the variables of workplace loneliness and work

alienation are important for job performance and there has recently been an increase

in the level of nurses’ work alienation (Tummers & Den Dulk, 2013; Ertekin &

Ozmen, 2017; Stoica et al., 2014). Due to the lower number of nurses in Turkey

compared to the OECD countries and the increasing number of patients, extra

performance is expected of nurses. This performance of nurses is of key importance

for hospitals and patients. The literature reports a negative relationship between

workplace loneliness and performance although research samples do not involve

nurses (Ozcelik & Barsade, 2011).

Hospitals operate in matrix organizational structures. It is thought that, when nurses

who are supposed to work as a member of a team feel lonely at workplace in this

organizational structure, it adversely affects both individual and organizational

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 performance. Nurses who experience social and emotional loneliness do not feel that

they belong to anywhere within the organization and fail to develop relationships
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with other nurses and superiors. Especially when they prefer not to share their

feelings and thoughts with colleagues and by extension experience workplace

loneliness, this will lead to a negative effect on their performance. Accordingly, the

following hypothesis is formulated:

H1: Workplace loneliness has a negative effect on job performance.

Increased work alienation harms workplace relationships of nurses who should

work as a team (Kartal, 2017b). When nurses’ workplace relationships are damaged,

it is likely to affect their performance. Accordingly, the following hypothesis is

formulated:

H2: Work alienation has a negative effect on job performance.

The study used the concept of work alienation as the mediating variable. Recent

research reported critical levels of work alienation among nurses. There is a

relationship between work alienation, workplace loneliness (Gozukara et al., 2017)

and performance (Ozcelik, & Barsade, 2011). Thus, it seems that the coexistence of

workplace loneliness and alienation are likely to have a greater effect on job

performance. Accordingly, the following hypothesis is formulated:

H3: Work alienation has a mediation role in the effect of workplace loneliness on job

performance.

3. Methods

3.1. Design and Sample

We conducted a cross-sectional correlational study using questionnaires. The study

was carried out in a public hospital with a capacity of 347 beds, employing 180

nurses in the Sakarya province, Turkey. As for the inclusion criterion, all participants

were required to have worked for a least one year in the same department they were

currently working in. In line with this criterion, 143 nurses composed the research

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 population. Sampling was not selected and targeted to reach the entire population.

However, 138 (96.5%) nurses attended surveys. Among 138 participants, 73.3% were
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women; the mean age was 34.89± 8.07. Most of the participants (70%) were

undergraduates.

3.2. Instruments

The questionnaire included demographic questions about the participant’s age,

gender and educational background and three measuring instruments.

The Work Alienation Scale was developed by Mottaz (1981) and adapted to Turkish by

Ozer et al. (2017). The original scale consists of the sub-scales of powerlessness,

meaninglessness and self-estrangement, each of them consisting of 7 items. 4 items

were excluded from the Turkish adaptation because they reduced the reliability of

the scale. Two of the excluded items are from powerlessness sub-scale (3. and 6.

items) and others are from meaningless sub-scale (9. and 11. items). This study used

the 17-item scale in line with the Turkish validity and reliability study. Scale

questions comprised of questions relevant with whether the nurses feel themselves

free when doing their work, their perceptions of the importance of the job they

perform, whether their job is satisfactory. The five-point Likert scale, ranging from

1= strongly disagree to 5=strongly agree, was used. High scores demonstrate high

levels of the work alienation. The Cronbach’s alpha coefficient of the scale was

found to be 0.775. The Cronbach’s alpha of the Turkish version was 0.75 (Ozer et al.,

2017).

The Loneliness in the Workplace Scale developed by Wright, Burt and Strongman (2006)

consists of 16 items. Dogan and colleagues (2009) carried out the validity and

reliability study of the Turkish version. The scale consists of two sub-scales

including emotional deprivation at work (9 items) and social companionship at work

(7 items). The scale involved the questions related to whether nurses feel the support

of their colleagues in the workplace and in social issue and whether they have

common activities with their colleagues. The scale used in this research was a five-

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 point Likert scale ranging from 1= strongly disagree to 5=strongly agree. High scores

indicate high levels of the loneliness of nurses in the workplace. The Cronbach’s
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alpha coefficient of the scale was found to be 0.918. The Cronbach’s alpha of the

Turkish version was found to be 0.800 (Dogan et al., 2009).

The Job Performance Scale was developed by Goris et al. (2013). Toklu (2016) carried

out the Turkish validity and reliability study of the scale. The scale consists of a

single dimesion and 5 items. In this scale, nurses self-evaluated their job

performance. The scale questions measure the perception of nurses related to

whether they do their duties in complete and timely manner. The scale was a five-

point Likert scale ranging from 1= strongly disagree to 5=strongly agree. High scores

represent high levels of the job performance. The Cronbach’s alpha coefficient of the

scale was found to be 0.786. The Cronbach’s alpha of the Turkish version was found

to be 0.853 (Toklu, 2016).

3.3. Data collection

The data was collected by the researchers using surveys in the Yenikent Public

Hospital in Sakarya, Turkey between March 10 and April 10, 2018. The participants

who met the inclusion criterion were included in the study. The survey form

delivered to the participants involved information about the purpose of the study

and the documents of ethics and institutional approval. The participants were given

sufficient time to fill in the survey anonymously. The survey forms were collected in

sealed envelopes to ensure the confidentiality and anonymity of the participants.

3.4. Statistical analysis

The data was analysed using the SPSS statistics V 22 and the PROCESS Macro. The

p-value was accepted to be at 0.025 confidence interval since the hypotheses are one-

tailed. First, descriptive statistical analysis (frequency, mean, standard deviation)

was performed. Later, the internal consistency of the scales was tested and the

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 correlation between the variables was analysed. Hayes’ (2013) Model 4 was used to

identify the mediating role of work alienation in the effect of workplace loneliness
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on job performance.

4. RESULTS

4.1. Descriptives and correlations

Table 1 shows the mean values, standard deviations and correlation values of the

variables. The mean workplace loneliness (2.33±0.395) and the mean work alienation

(2.45±0.439) were low; however, the mean job performance (4.03±0.491) was high.

According to the results of the correlation analysis, there was a positive correlation

between workplace loneliness and work alienation (r = 0.818). However, there was a

negative correlation between job performance and workplace loneliness (r = - 0.709)

and the relationship between job performance and work alienation was also negative

(r = -0.701). According to these results, as the work alienation and workplace

loneliness of the nurse’s decrease, their work performance increases.

4.2. Mediation analysis

The SPSS PROCESS macro model 4 was used to identify the effect of workplace

loneliness on job performance and the mediating role of alienation in this effect.

Table 2 shows, in detail, the analysis results given in Figure 1.

According to the analysis results, both workplace loneliness (β=-0.461) and alienation

(β =-0.449) had a negative effect on job performance. Additionally, work alienation

played a mediating role in the effect of workplace loneliness on job performance (β =-

0.421) and increased the negative effect of workplace loneliness on job performance

(β =- 0.882) (H1, H2 and H3 Accepted).

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 5. DISCUSSION

The last healthcare reforms implemented in Turkey has increased Turkish people’s
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access to health services (SB, 2017). The increase in access was not in parallel to the

increase in the number of healthcare staff. The number of nurses in Turkey is about 5

times less compared to those of the OECD countries (Health Statistics Yearbook,

2017). According to the analysis results, the mean job performance scores of nurses

were higher than their mean workplace loneliness and work alienation scores. The

analysis results are consistent with nurses’ mean job performance scores reported in

recent research in Turkey (Kartal, 2018; Saygili et al., 2016; Aktas & Gurkan, 2015;

Aktas & Simsek, 2013). It is an expected result that the nurses achieved high

performance scores because it is considered a necessity for nurses, though low in

number, to show a high level of performance in order to meet increasing demands.

The results of nurses’ mean alienation scores are both consistent and inconsistent

with recent research. While there are researchers reporting that nurses experience

intense feelings of alienation and have high and moderately high levels of alienation

(Ertekin & Ozmen, 2017; Yetis, 2013), some researchers have reported similar results

to those of the present study (Ozer et al., 2017; Tummers & Den Dulk,2013). The

literature includes similar (Alper Ay, 2015) and different (Kagan et al., 2017) results

of nurses’ alienation. One of the reasons for different results is the difference

between the sample in this study and that of Kagan et al. (2017). Their sample did

not include all nurses but only the nurses working in an infection isolation room.

The nurses working in the infection isolation room as a requirement of their job may

have caused this difference. The analysis results showed that workplace loneliness

had a negative effect on job performance and work alienation led to an increase in

this effect. These results are consistent with previous research (Kartal, 2018; Kartal,

2017a; Kaynak et al., 2016; Toklu, 2016; Shantz, 2015; Tummers & Den Dulk, 2013;

Gozukara et al., 2017; Ozcelik & Barsede, 2011). These previous studies reported

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 correlations between work alienation and job performance, workplace loneliness and

job performance, and work alienation and workplace loneliness.

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Based on the results of the present study and previous studies, higher levels of

workplace loneliness and work alienation are associated with lower levels of job

performance. Thus, workplace loneliness and work alienation can be accepted as

significant variables in terms of nurses’ job performance.

6. CONCLUSION

Job labour is more important in the health sector involving high labour intensity

compared to other sectors. Nurses play a crucial role in the uninterrupted, effective

and efficient delivery of healthcare services and in the achievement of patient safety

and satisfaction during the delivery of services. The results of this study have

confirmed that nurses in Turkey show high job performance. Additionally, they

have also proven the negative effect of workplace loneliness and work alienation on

job performance.

7. LIMITATIONS OF THE STUDY

The main limitation of this study is that it was carried out in only one public

hospital. Thus, it is recommended to replicate the study in public and private

hospitals in larger samples to increase the generalisability of the study results.

8. IMPLICATIONS FOR NURSING MANAGEMENT

The currently low number of nurses and the gradually increasing volume of services

add to the importance of job performance. Work alienation and workplace loneliness

are important variables in nursing performance. Due to the unique characteristics of

the healthcare services, healthcare staff should work in harmony with each other

within the matrix organisational structure. Job performance of individuals who

experience workplace loneliness and work alienation will decrease over time,

possibly leading to a decrease in organisational performance and emotional

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 commitment (Ozcelik & Barsede, 2018). The research results have revealed a

necessity of nurse managers to take action against the possibility of nurses’

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alienation and loneliness at the workplace. Nurse managers should first determine

the possible causes of loneliness and alienation within their organisation. If actual

causes are known, action can be taken against adverse conditions that nurses

experience. Training nurses in dealing with such situations can be a possible action,

informing nurses about possible effects of their job and teaching coping strategies

and ways of dealing with loneliness and alienation. Additionally, the establishment

of good communication between nurses and other health professionals and the

mobilisation of managerial support can help to reduce nurses’ negative feelings such

as alienation and loneliness. It seems that actions and support networks can also

help to increase the cooperation and collaboration among nurses and their

participation in decision-making processes and the organisational structure.

Loneliness and alienation can be perceived as an obstacle to the efficient and

effective delivery of services. Thus, it is important for nurse managers to perform

measurements at certain times to prevent and reduce loneliness and alienation.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,

authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or

publication of this article.

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 REFERENCES

Aktas & Gurkan,(2015). Mediatiıng Role of Occupational Commitment in The Interactions of

Accepted Article
Work-Family & Family-Work Conflict with Individual Performance: A Research On Nurses.

Dogus University Journal, 16(2), 139-154.

Aktas, H., & Simsek, E. (2014). The Interactıons of Organizational Silence with Perceived

Individual Performance, Organizational Culture and Demographic Variables. Dokuz Eylul

University The Journal of Graduate School of Social Sciences, (28), 24-52.

Al‐Hamdan, Z., Oweidat, I. A., Al‐Faouri, I. & Codier, E. (2017). Correlating Emotional

intelligence and job performance among jordanian hospitals’ registered nurses. In Nursing

forum. 52(1), 12-20. DOI: 10.1111/nuf.12160

Alper Ay, F. (2015). The Relationships Between Abusive Management, Workplace

Loneliness and Organizational Cynicism: A Study for Health Professionals. Journal of

International Social Research, 8(41),1116-1126.

Asık, N.A (2016). The Impact Of Lonelıness In The Workplace on Burnout. Business and

Managament Studies: An International Journal. 4(3), 366-384. DOI: 10.15295/bmij.v4i3.168

Aytac, S. (2015). Loneliness as mediator between job satisfaction and intention to leave: A

study on prison staff in Turkey. Arabian J Bus Manag Review, 5(167), 1-4.

Chiaburu, D. S., Thundiyil, T., & Wang, J. (2014). Alienation and its correlates: A meta-

analysis. European Management Journal, 32(1), 24-36. DOI:

https://doi.org/10.1016/j.emj.2013.06.003

DeLucia, P. R., Ott, T. E., & Palmieri, P. A. (2009). Performance in nursing. Reviews of human

factors and ergonomics, 5(1), 1-40. DOI 10.1518/155723409X448008

Demirbas, B., & Hasit, G. (2016). Loneliness at Workplace and Its Effect on the Intention to

Leave:

An Application on the Academicians. Anadolu University Journal of Social Sciences, 16(1). 137-

158.

Dogan, T., Cetin, B., & Sungur, M. Z. (2009). Reliability and validity of the Turkish version of

Loneliness at Work Scale. Anatolian Journal of Psychiatry, 10(6), 271-277.

This article is protected by copyright. All rights reserved.

 Duck S. (1991).Staying healthy with a little help from friends? Duck (Ed.), Human Relationships:

An Introduction to Social Psychology, Newbury Park, Sage,

Accepted Article
Ellershaw, J., Fullarton, C., Rodwell, J. & Mcwilliams, J. (2016). Conscientiousness, openness

to experience and extraversion as predictors of nursing work performance: a facet‐level

analysis. Journal of nursing management, 24(2), 244-252. DOI: 10.1111/jonm.12306

Ertekin, P., & Ozmen, D. (2017). Identification of the Variables Which Predict Alienation

from Work in Nurses Who Are Studying at a University Hospital. Journal of Education and

Research in Nursing 14(1), 25-30. DOI:10.5222/HEAD.2017.025

Goris, J. R., Vaught, B. C., Pettit, & Jr J. D., (2003), “Effects of trust in superiors and influence

of superiors on the association between individual-job congruence and job

performance/satisfaction”, Journal of Business and Psychology, 17 (3), 327-343.

Gozukara, I., Mercanlı, A. C., Capuk, S., & Yıldırım, O. (2017). Impact of Turnover Intention

on Loneliness and the Mediating Effect of Work Alienation. Business Management and

Strategy, 8(1), 18-38. https://doi.org/10.5296/bms.v8i1.10521

Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. A

Regression‐Based Approach. London: The Guilford Press

Ito Y., Nakamura S., Kimura R. et al. (2015) Relationship between organizational justice and

psychological distress among hospital nurses. The Kitasato Medical Journal 45 (1), 38–44.

Kagan, I., Fridman, S., Shalom, E., & Melnikov, S. (2017). The effect of working in an

infection isolation room on hospital nurses’ job satisfaction. Journal of nursing management.

26(2), 120-126 DOI: 10.1111/jonm.12516

Karcıoglu F. & Akbas S. (2010) Association between mobbing at workplace and job

satisfaction. Ataturk University Journal of Economics & Administrative Sciences. 24 (3), 139–161.

Kartal, N. (2017a). Evaluating the Relationship Between Work Engagement, Work

Alienation and

Work Performance in Healthcare Professionals, (Master's thesis, Social Sciences Institute).

Ankara

This article is protected by copyright. All rights reserved.

 Kartal, N. (2017b). A Survey To Measure The Level Of Work Alıenatıon Of Healthcare

Professıonals: A Revıew Of Unıversıty, Publıc And Prıvate Hospıtal Dıfferences. Gumushane

Accepted Article
University Electronic Journal of the Institute of Social Science, 8(21). 114-130.

Kartal, N. (2018). Evaluating the relationship between work engagement, work alienation

and work performance of healthcare professionals. International Journal of Healthcare

Management, 1-9. DOI:/10.1080/20479700.2018.1453969

Kaynak, R., Toklu, A. T., Elci, M. & Toklu, I. T. (2016). Effects of Occupational Health and

Safety Practices on Organizational Commitment, Work Alienation, and Job Performance:

Using the PLS-SEM Approach. International Journal of Business and Management, 11(5), 146-

166. DOI: 10.5539/ijbm.v11n5p146

Kim, Y. S., Eo, Y. S. & Lee, N. Y. (2014). Effects of Head Nurses' Managerial Competencies

and Professional Nurse Autonomy in Nursing Performance. Journal of Korean Academy of

Nursing Administration, 20(4), 437-445. DOI: /10.11111/jkana.2014.20.4.437

Marx K. Alienated labor. Committee for Marxist Direction; 1844.

Michie S. & West M.A. (2004) Managing people and perfor-mance: an evidence based

framework applied to health serviceorganizations. International Journal of Management

Reviews. 5/6 (2), 91–111. DOI: /10.1111/j.1460-8545.2004.00098.x

Mottaz CJ. (1981). Some determinants of work alienation. Sociol Q. 22(4):515–529.,

Nair, N., & Vohra, N. (2010). An exploration of factors predicting work alienation of

knowledge workers. Management Decision, 48(4), 600-615. DOI: /10.1108/00251741011041373

Nejati, A., Rodiek, S., & Shepley, M. (2016). The implications of high‐quality staff break areas

for nurses’ health, performance, job satisfaction and retention. Journal of nursing management,

24(4), 512-523. DOI: 10.1111/jonm.12351

Onay, M., Suslu, Z. H. & Kılcı, S. (2011). The Effects of Communicatıon Style and Non-

Verbal Communication Level on Employees' Work Performance: A Study on the Mail

Distributors and Nurses. Organizasyon ve Yonetim Bilimleri Dergisi, 3(1), 57-66.

This article is protected by copyright. All rights reserved.

 Otrar M, & Halacoglu B. (2011) Job alienation scale validity and reliability study in

academicians. International Conference on Educational Sciences, Bishkek Kyrgyzstan:

Accepted Article
Kyrgyz-Turkish Manas University.

Ozcelik, H., & Barsade, S. (2011). Work loneliness and employee performance. Academy of

Management Proceedings, 1, 1–6. DOI: 10.5465/AMBPP.2011.65869714

Ozcelik, H., & Barsade, S. G. (2018). No Employee an Island: Workplace Lonelıness and Job

Performance. Academy of Management Journal, 0, ja. DOI:/10.5465/amj.2015.1066

Ozer, O., Ugurluoglu, O., Saygılı, M., & Songur, C. (2017). The impact of work alienation on

organizational health: A field study in health sector. International Journal of Healthcare

Management, 1-7. DOI:10.1080/20479700.2017.1312804

Santas, G., Isik, O., & Demir, A. The effect of loneliness at work; work stress on work

alienation and work alienation on employees’ performance in Turkish health care

institution. South Asian Journal of Management Sciences. 10(2), 30-38. DOI:

10.21621/sajms.2016102.03

Saygili M., Eriguc G. & Ozer O. (2016). Determining Organizational Silence and Employee

Performance Levels of Healthcare Professionals. The Journal of Academic Social Science Studies,

49(1), 485-500. DOI:/10.9761/JASSS3625

General health statistics, (2017) retrived from: http://rapor.saglik.gov.tr/istatistik/rapor/

(accessed: 28 Apr 2018)

Seeman, M. (1959). On the Meaning of Alienation. American Sociological Review, 24(6), 783-791

DOI: 10.2307/2088565

Shantz, A., Alfes, K., Bailey, C. & Soane, E. (2015). Drivers and Outcomes of Work

Alienation Reviving a Concept. Journal of Management Inquiry. 1-12. DOI:

10.1177/1056492615573325

Stoica, M., Brate, A. T., Bucuţă, M. & Morar, S. (2014). The association of loneliness at the

workplace with organizational variables. European Journal of Science and Theology, 10(5), 101-

112.

This article is protected by copyright. All rights reserved.

 Tabancali, E. (2016). The Relationship between Teachers’ Job Satisfaction and Loneliness at

the Workplace. Eurasıan Journal Of Educatıonal Research, (66), 263-280. DOI:

Accepted Article
/10.14689/ejer.2016.66.15

Tengilimoglu, D., O. Isık & M. Akbolat. (2017). Health Management Administration. Nobel

Akademik Yayincilik.

Terzioglu, F., Temel, S., & Uslu Sahan, F. (2016). Factors affecting performance and

productivity of nurses: professional attitude, organisational justice, organisational culture

and mobbing. Journal of nursing management, 24(6), 735-744. DOI: 10.1111/jonm.12377

Toklu, A.T. (2016). Investigation of the Effectiveness Of Occupational Health and Safety

Practices in Organizational Context, Working and Work Performance in Employees.

unpublished doctoral dissertation. Gebze.

Tong, L. (2018). Relationship between meaningful work and job performance in nurses.

International journal of nursing practice. 24(1), 1-6. DOI: 10.1111/ijn.12620.

Top, M., Gider, O. & Unalan, D. (2010). Analysis of Organizational Variables (Factors)

Affecting Job Performance in Hospital Sector: A Fıeld Study Based On Nurses in Kayseri

and Kocaeli Provinces. Istanbul University Faculty of Business Administration Management

Institute of Economics Management Journal, (66), 71-96.

Tummers, L. G, & Den Dulk, L. (2013). The effects of work alienation on organisational

commitment, work effort and work‐to‐family enrichment. Journal of nursing management,

21(6), 850-859. DOI: 10.1111/jonm.12159

Tummers, L., Bekkers, V., van Thiel, S., & Steijn, B. (2015). The effects of work alienation and

policy alienation on behavior of public employees. Administration & Society, 47(5), 596-617.

DOI: 10.1177/0095399714555748

Vratskikh, I., Al-Lozi, M. & Maqableh, M. (2016). The Impact of Emotional Intelligence on

Job Performance via the Mediating Role of Job Satisfaction. International Journal of Business

and Management, 11(2), 69. DOI:10.5539/ijbm.v11n2p69

Wright, S. L., Burt, C. D. & Strongman, K. T. (2006). Loneliness in the workplace: Construct

definition and scale development, NZ J Psychol 35 (2), 59-68.

This article is protected by copyright. All rights reserved.

 Yeh, S. C. J., Yuan, K. S., Chen, S. H. S., Lo, Y. Y., Chou, H. C., Huang, S., ... & Wan, T. T.

(2016). The moderating effect of leadership on the relationship between personality and
Accepted Article
performance. Journal of nursing management, 24(7), 869-883. DOI: 10.1111/jonm.12391

Yelboga, A. (2006). Investigation of the Relationship between Personal Properties and

Business Performance” Is-Guc, The Journal of Industrial Relations & Human Resources, 8(2), 196-

211.

Yetis Z. (2013). Alineation for the Work of the Nurses Working İn Public Hospitals. Ataturk

University. Unpublished master's thesis. Erzurum.

Yildiz, S., Savci, G. & Kapu, H. (2014). The Effect of Motivational Factors on Job Performance

and

Turnover Intention. Manısa Celal Bayar University the Faculty of Economic and Administrative

Sciences Jpurnal. 21(1), 233-249.

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 Table 1 Correlation Analysis and Descriptive Statistics
Accepted Article
1 2 3 Mean SD

Workplace Loneliness
1 2.43 0.395
(1)

Alienation (2) .818** 1 2.75 0.439

Job Performance (3) -.709** -.701** 1 4.03 0.491

Table 2: Direct and Indirect Effects

Direct Indirect Total

Variables Effect Effect Effect LLCI ULCI t p

Workplace Loneliness -0.461 -0.421 -0.882 -0.730 -0.190 -3.374 0.010

Alienation -0.449 -0.693 -0.205 -3.640 0.000

The Dependent variable is job performance.

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Accepted Article

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