Impact of Job Stress on Job Performance with Moderating Role of Emotional Intelligence and Mediating Role of Depression in Health Care Workers in Tertiary Care Hospital in Peshawar: A Cross-Sectional Study

This research aims to investigate the influence of job stress on job performance and how depression mediate this impact on job performance and the buffering effect of the Emotional Intelligence. For this purpose, Participants were selected by using Convenient Non-Random sampling technique. Data were collected from 259HCWs (Doctors, Nurses and Allied Health Care Professionals) in the three public tertiary care of Peshawar with the help of a well-organized questionnaire. Data have been analyzed by using SPSS version 26. The result revealed that the incidental effect (indirect effect) of job Stress on job performance via Depression was significant, and the mediation effect of depression accountedfor 69.3% of the total effect of job stress on job performance of HCWs. The association between job stress and job performance was stronger for HCWs with Emotional intelligence than for HCWs with high EI. Emotional Intelligence is significantly positively correlated with Job Performance, negatively correlated with Job Stress whereas the data don’t show any significant correlation between EI and Depression in HCWs. Job Stress is positively correlated with depression and show negative correlation with Job Performance. Data revealed that depression have significant positive correlation with Job Stress. The results may help the organizations to design interventions and methods to improve the health and work performance of healthcare professionals in comparable contexts, which would eventually benefit both the employees and the standard of patient care along with the recommendation for future researches.

Any organization's success is always based on the engagement and efficiency of its workforce. The pillar for any healthcare organization's increased productivity is the job performance of its health personnel. Poor health outcomes for hospitalized patients are caused by health personnel performing at a lower level, which lowers productivity in public hospitals (Ousman, 2022). The significance of a worker's psychological health and physical well-being has been recognized by organizations throughout the world in order to achieve success on both an organizational and individual levels (Zaman et al., 2021). Employee performance is greatly impacted by elements including job stress, job satisfaction, and mental health. These issues can cause problems with thinking clearly and cause workers to lose interest in their jobs. This situation is a result of the employee's tiredness, poor self-evaluation skills, and low self- esteem. These circumstances may negatively affect a worker's productivity at work negatively affect a worker's productivity at work negatively affect a worker's productivity at work (Arif et al., 2022). The epidemic of job stress in the workplace is getting worse. Healthcare organizations, together with governments and legislators, confront formidable obstacles in their efforts to maintain access to and affordability of healthcare. This necessitates that healthcare organizations change and perform better. Without the assistance and outstanding performance of healthcare workers, these obstacles cannot be overcome. A lack of healthcare workers is another significant issue facing healthcare institutions, which is brought on by an ageing population and the resulting rise in healthcare demand. With all these obstacles, the healthcare industry is likely one of the most crucial ones where organizational performance has to alter and improve. Changes and improvements in organizational performance will be closely linked to employee performance (i.e., their actions and behaviors), as the majority of the work in the healthcare sector includes people. Healthcare professionals' job performance is essential to achieving organizational goals. (Krijgsheld et al., 2022). According to the International Council of Nurses (ICN), there are many stresses that we could list that nurses would be aware of as happenings in the hospital settings that they deal with on a regular basis. Long hours, unpleasant sights and sounds, excessive quiet, abrupt transitions from challenging to easy activities, deadline pressure, the lack of a second chance, confined spaces, and other factors all contribute to stress (Jehangir et al., 2009). Employees who are more stressed out and burned out at work are likely to put in less effort and perform worse than those who are not as stressed out at work. The performance of the employee at work is impacted by a number of factors. Employee performance is greatly impacted by factors including job stress, job satisfaction, and mental wellbeing, which can impair one's ability to think clearly and cause one to lose enthusiasm for their jobs. This situation is a result of the employee's tiredness, poor self-evaluation skills, and negative self. These situations could make it difficult for an employee to complete their duties. Previous researches have demonstrated that, through mediator variables, occupational stress can have an indirect impact on job performance (Deng et al., 2019) (Arif et al., 2022). Demands, control, support, relationships, roles, and change were the six work-related stressors that researchers found. These six types of workplace pressures have a detrimental effect on the efficiency and well-being of healthcare professionals (Tabussum et al., 2021). According to estimates, work stress costs the economy $150 billion a year in lost productivity and workers' reimbursement (Pflanz & Ogle, 2006). Numerous studies currently exist that demonstrate how important work is in determining one's physical and mental wellbeing. In light of the Covid-19 epidemic, recent research has revealed rising depression rates among healthcare workers (HCWs), with consequences for both productivity and quality of service (Fond et al., 2022). One of the most important but overlooked population health concerns in the world is depression. One of the high-risk groups for poor mental health outcomes globally is the healthcare workforce. According to published studies, HCWs are at an intolerably high risk of experiencing psychological distress, anxiety, emotional weariness, and depression. This is especially true for depression, which in high-income countries ranged among HCWs from 21.53 percent to 32.77 percent in 2015, far higher than the global average of 4.40 percent. (Abraham et al., 2021). Stressors in the workplace have a direct impact on the relationship between depression and the worker. The primary independent variable that could lead to depression and impair job performance was a high level of job stress exposure (Gherardi-Donato et al., 2015). Physical, psychological, and social stimulants lead to depression and physical stress, which are intimately associated, whereas a variety of stressors that cause chronic exhaustion cause depression (Tahira et al., 2021). It has also been argued that burnout plays a causative role in the onset of depression, with certain publications stressing this correlation (Fond et al., 2022). According to Prescott, stress and depression have a "bidirectional" causal relationship. The first can result in the second, who can result in the second, and both can worsen one another. According to Prescott, "it's quite obvious that persistent stress increases the incidence level of depression (Cooper, 2021)." Job satisfaction (JS) and job performance is a key component that has been linked to depression. Work engagement includes a variety of factors, including autonomy, the nature of the work, advancement policies, coworker satisfaction, and the chance to acquire the necessary information and skills (Islam et al., 2022). Positive patient outcomes are less likely for healthcare personnel who are content in their jobs. Healthcare professionals that are depressed frequently struggle to perform at work, which negatively impacts their production. According to study, depression has a detrimental effect on both the standard of healthcare and productivity at work (Sun et al., 2022). Depression is predicted to result in lost productivity costs to the US economy somewhere between $36.6 and $51.5 billion a year (Lerner et al., 2010). Because of their job role, healthcare professionals are more likely to experience mental health issues. The development of COVID-19 in Pakistan created a situation unheard of for healthcare staff who served on the front lines and making judgments under immense pressure (Waheed et al., 2022). A cross-sectional study published on PubMed described the prevalence of depression among COVID-19 frontline practitioners between 1 December 2019 and 15 September 2020, including nurses, physicians, and medical professionals. The pooled depression proportions were calculated using random effects models. Findings: We located 57 studies from 17 different countries. When all healthcare workers were considered, depression prevalence was 24% (95% CI: 20-28%), 25% for nurses (95% CI: 18-33%), 24% for doctors (95% CI: 16-31%), and 43% for frontline personnel (95% CI: 28-59%) (Olaya et al., 2021). EI is being used widely in research and is regarded as a crucial indicator of job performance (JP). This may be demonstrated by the fact that emotional intelligence (EI) is the ability to manage one's emotions along with cognitive processes in order to encourage oneself to attain both proximal and distal goals. A person's interest frequently conflicts with the group's interests when practices are tumultuous and there is a crisis.1 The term emotional intelligence (EI) is typically used in the context of practice, and is particularly relevant to the health Care fields because of the influence that trauma has had on varied job situations (Alonazi, 2020). Emotional intelligence is the ability to think emotionally precisely and to use feelings and emotional intelligence to form ideas, all of which have a big impact on health outcomes. The association between mental health and performance is moderated by emotional intelligence (i.e., an interactive as opposed to direct effect exists) (Lindebaum, 2019). The sense of stress in a person is frequently linked to emotional intelligence. Actually, a lot of researchers have hypothesized that it can moderate the impacts of stress and depression. Employees who were able to control their own emotions as well as those of their coworkers reported less psychological problems. According to a study conducted at a hospital in Spain, caregivers with higher emotional quotients had less stress than those with lower quotients (Hatta et al., 2020). According to studies in the field of emotional intelligence, there is an inverse link between several measures of emotional intelligence and depression. Additionally, emotional intelligence plays a crucial role in comprehending how stress affects mental health and how it influences the relationship between stress and depression (Batool & Khalid, 2009). In contrast, high Emotional Clarity has been associated with greater life satisfaction. People who are conscious of their emotions will be more adept at treating emotional issues and, as a result, will feel more emotionally well-adjusted than those who are less talented. Similarly, individuals who can quickly recognize a particular emotion in difficult circumstances will devote less cognitive resources to their emotional responses, allowing them to consider alternate behaviors, focus on other tasks, or employ more adaptive coping mechanisms (Extremera & Fernández-berrocal, 2006). The importance EI, is its immediate constructive impact on job performance, and its assertiveness in light of potential future success. According to Joseph and Newman, people with emotional intelligence trust in constant learning and put their emphasis on imparting vision before anything else (Dhani, 2016). Depression and stress from the workplace may be protected against by emotional intelligence (EI). The ability to understand, manage, and interact with one's own emotions as well as those of others is known as emotional intelligence (EI). Participants thought those working in the healthcare sector who scored higher on EI were better able to manage work-related stress, keep their mental health in check, and provide superior patient care. This study is about the impact of job stress on job performance and how depression alleviates and affects JP. WE will discuss how the emotional intelligence negotiates between the stress, depression and job performance to overcome the effect of work stress and depression on JP. This study's focus is specifically on the medical staff in a tertiary care hospital in Peshawar. This cross-sectional study will collect information at a particular moment to find the connections between work stress and performance at work, emotional intelligence, and depression in this particular context. The results of this study can assist discover solutions to lessen the detrimental effects of workplace stress on the health and performance of healthcare workers and also offer insightful information about the variables impacting job performance.

The findings and research gaps identified in the existing literature has led to the foundation of developing a Supporting Theory for this study as shown in Figure 1. The suggested model contends that depression mediates the association between job stress and poor job performance. The association between occupational stress and performance is also thought to be moderated by emotional intelligence, with low emotional intelligence people experiencing a stronger relationship.

Figure 1: Supporting Theory: Impact of Job Stress on Job Performance with Moderating Role of Emotional Intelligence and Mediating Role of Depression.

This research model incorporates both the mediating role of depression and the moderating role of emotional intelligence in order to provide a thorough understanding of the complex relationships between job stress, emotional intelligence, depression, and job performance among healthcare workers in a tertiary care hospital in Peshawar. With the help of a quantitative research methodology, such as a survey, the proposed model may be tested, and information from a sample of workers in various organizations can be gathered. Standardized scales to assess job stress, depression, emotional intelligence, and job performance may be included in the study instrument. To test the stated hypotheses, the acquired data can be analyzed using statistical techniques like regression analysis and mediation analysis.

Hypothesis

• Ha1: There is negative relationship between job stress and job performance among health professionals in a Tertiary Care Hospital in Peshawar.
• Ha2: There is positive relationship between job stress and depression among healthcare workers in a Tertiary Care Hospital in Peshawar.
• Ha3: Depression mediates the relationship between job stress and job performance among healthcare workers in a Tertiary Care Hospital in Peshawar.
• Ha4: Emotional Intelligence moderates the relationship between job stress, depression and job performance.

Study design, data gathering, data analysis, and result interpretation all adhere to a set of rules and guidelines. Study design, data gathering, data analysis, and result interpretation all adhere to a set of rules and guidelines. The study's design, population, sampling procedures, sample size, and data collection from respondents is all covered in detail in this chapter. The several actions that will be followed for the data analysis in the current study are also described in depth.

Study Design

This research will use an analytical cross-sectional design, which entails choosing groups for which a variable will be investigated without using any random pre-selection procedures.

Population and Settings

Public sector Tertiary care Hospitals in Peshawar is selected for conducting this research study. The study population will be made up of all of the medical and nursing personnel at the HMC, KTH, and LRH in Peshawar.

Duration

The research was conducted in the three-government tertiary care hospital (HMC, KTH, LRH) in Peshawar from January, 2023 to march, 2023.

Sample Size

Data were collected from 259 Health Care Workers (Doctors, Nurses, Allied professionals) through Convenience sampling.

Sampling Technique

Convenience non-probability sampling Method will be used for selecting the subjects. it will be used because of its simplicity, cost-effectiveness, and time efficiency. Moreover, it can be useful for exploratory studies or to obtain a quick snapshot of our study.

Data Collection Tools

A pre-formed data sheet was used for data collection. Beside biographic information the data sheet consisted of four other part Questioners which is Wong and Law Emotional Intelligence Scale (WLEIS), Job Stress Questioners, Depression Questionnaire from Hospital Anxiety and Depression Scale and Individual work performance scale were used for assessing the job performance of the health care workers.

The survey questionnaire was sectioned into two segments. Gender, age group, profession, organization, marital status among the demographic details that were gathered from the study participants in the first segment. The measurement scales for each of the study variables presented on the conceptual model were included in the second segment of the survey. Scales that were developed and validated by authors in past studies offered a suitable fit for the current study. In this regard, scales that were already applied in studies in the context of organic food were given preference. The English language was used to carry out the survey. Wordings of a few scales were adjusted in order to adapt and better fit according to the context of this study. All of the items in the following measures were evaluated on a 5-point Likert scale ranging is 0=Never, 1=Occasionally, 2=sometimes, 3=often, 4=Always except depression which is discussed below.

Biographic Data

First part of the questionnaire shared consisted on HCW, s personal data such as Name, Organization, Profession, years of experience, marital status and email address in optional.

Emotional Intelligence

The Wong and Law Emotional Intelligence Scale (WLIES; Wong & Law, 2002) was created to give a quick assessment of emotional intelligence (EI) appropriate for workplace research. It includes 16 items to measure the EI. Internal consistency reliability was 0.87.

Job Stress

Workplace stress scale was used to measure the job stress of HCW, s which is consisted on total of eight item and was a five-point Linkert scale The Cronbach alpha for this was 0.89.

Depression

Depression scale from Hospital Anxiety and Depression scale were used to measure the Depression in HCW, s working in the Hospital. It was a 5-point scale ranging from 0=Not at all, 1=Sometimes, 2=Very often, 3=Most of the time, 5=All the time. The Cronbach alpha for this was 0.91.

Job Performance

The individual work performance scale for assessing the Job performance having 16 items with a little modification by the expert were used for this. Internal consistency reliability measured was 0.72 for this 5-point Linkert scale.

Interfering with research

Given that this study relies on questionnaires to get data and that responses from study participants were gathered via an online survey approach, there may be no or very little risk that research interference will be present. Additionally, data were gathered cross-sectionally, and respondent involvement in the study was purely voluntary. The majority of researchers in the past have used the online survey technique for data collection, primarily because it not only significantly lowers the overall costs of set-up and administration but also helps by saving time and effort. This is one of the main reasons for using online questionnaires as an instrument for conducting the survey. Since the study participants' responses to questionnaires used in this investigation have been acquired via the it. Furthermore, using this method enables you to get in front of more people in a short amount of time. There is also the advantage of less researcher intervention, which lowers the risk of possible responder bias. This method facilitates respondents' completion of the surveys and gives them adequate time to submit meaningful and well-supported replies.

Ethical Considerations

The Director of KTH, HMC, and LRH were consulted regarding their approval for the data gathering. Each participant was shown and given an explanation of an informed consent form before agreeing to participate. All participants were given the assurance of anonymity. Only primary data collectors and supervisors have access to the entire dataset, which is confidential.

Data Analysis Procedure

The data were evaluated using SPSS version 27.0. While frequencies and percentages were only used for nominal and ordinal data in descriptive statistics, mean and standard deviation were calculated for all variables used in tables and graphs. Additionally disclosed were the validity of the measurements and the Pearson's correlation between the investigated variables. The macro programme PROCESS of SPSS was used to conduct the moderated mediation analysis (Hayes, 2013). This study made use of Model 59 from the macro programme PROCESS (version 3.3). Job Performance served as the dependent variable, with Job Stress indicated as the independent variable. Emotional IQ was listed as the moderator variable, whereas depression was reported as the mediator. The pupils' socio-demographic data was listed as a covariate. 5000 bootstrap samples were used to estimate the conditional direct and indirect effects using Preacher and Hayes' (2008) asymptotic and resampling procedures. When the bias- corrected and accelerated 95 percent confidence interval (BCa 95 percent CI) did not contain zero, effects were deemed significant. Two-tailed p values with less than 0.05 were considered statistically significant.

The study concluded with total of 259 participants working at public tertiary care center in Peshawar. This study's main objective is to determine the relationship between job performance and stress, as well as the function that depression plays as a mediator between those two factors and emotional intelligence as a moderator. The research methodology used in this study was described in detail in the previous chapter, while the findings from the analysis of the survey data, which included quantitative analysis (i.e., demographic results), descriptive analysis, correlation analysis, and regression analysis of the variables used in this research project, are presented in the current chapter. The quantitative analysis of the dataset made up of demographic variables comes first. After that, in order to evaluate every hypothesis, put forth in this study model, it was decided to look into the connections between emotional intelligence, job performance, and factors like job stress and depression.

Demographics

The demographics variables under study were age, gender, marital status, occupation and organization as well as job experiences whose statistics is given below.

Age Distribution

Analysis brought forward that Health care workers having age 21-25 were 168 (64.8percentage), age 26-30 were 54 which is 20.7 percentage, whereas HCWs age 31-35 were 27 (10.4percentage). HCWs having age greater than 35 make 3.8percentage of the total study participants.

Table 1: Age Distribution.

Gender Distribution

Among the participants of this study 40.4percentage, n=102 were female whereas 60.6 percentage n=157 were male.

Table 2: Gender Distribution.

Marital status

Among 259 participants n=50 (19.3percentage) was married and 80.7percentage which is n=209 were the unmarried HCWs.

Table 3: Marital status.

Occupation

23.6percentage, n=61 of the Health Care Workers participated in this study was Doctors, n=37 (14percentage) were Nurses whereas n=161 which is 62.2 percentage of all the participants were the Allied Health Care professionals.

Table 4: Occupation.

Organization Distribution

The total number of HCWs participated in this study from HMC was n=139, 51.7percentage, whereas n=56, 21.6percentage were from KTH and 26.6percentage, n=69 was from LRH.

Table 5: Organizational Distribution.

Years of Experience

Most of the HCWs were experienced 1-5 years which was n=220, (84.9percentage) and about n=33 was those having experience of 6-10 years which is 12.7percentage of the total. Those having experience 6-10 years were n=4, (1.5percentage) and n=2, about 0.8percentage were those who have experience greater than 15 years.

Figure 2: Years of Experiences.

Reliability analysis

Reliability of each scale was measured using Cronbach’s alpha. We found Cronbach’s alpha (α) reliabilities for Emotional Intelligence is = 0.87, Job Stress = 0.89, Depression = 0.91 and Job Performance = 0.72.

Descriptive Analysis

Means, standard deviations of job stress, Depression, emotional intelligence and job performance are given in Table 6.

Table 6: Mean and standard Deviation.

Correlations among Job Stress, Depression, EI and Job Performance

The table 7 below lists the correlation coefficients for the various study variables. A correlation analysis of the study's variables reveals the relationship between the variables. It reveals if the variables have a strong or weak, favorable or unfavorable relation. Emotional Intelligence is significantly positively correlated with Job Performance (r=0.363, p lessthan 0.01), negatively correlated with Job Stress (r=-0.024, p lessthan 0.01) whereas the data don’t show any significant correlation between EI and Depression (r=0.007, p lessthan o.o1) in HCWs. This analysis supports the hypothesis Ha3: There will be positive impact between Emotional Intelligence and Job Performance. This analysis also accepts the second part of the hypothesis Ha2: There will be negative association between Emotional Intelligence with job stress and reject its first part which is there will be negative association between Emotional Intelligence with depression.

Table 7: Correlations among Job Stress, Depression, Emotional Intelligence and Job Performance.

Job Stress is positively correlated with depression (r=0.363, p lessthan 0.01) and show negative correlation with Job Performance (r=-0.14, p lessthan o.o1) which shows that hypothesis Ha1 (1) Job stress significantly affect the job performance is accepted. Data revealed that depression have significant positive correlation (r=0.283, p lessthan 0.01) with Job Stress.

Testing for the Mediation Model

As shown in Table 3, after controlling for demographic variables of Gender, Age, Occupation, Years of Experience, the data shows that job stress and depression have positive association (β=0.3681, t=6.2455, p lessthan 0.001). This means that as job stress increases, the level of depression also tends to increase. Similarly, the β value between depression and job performance was 0.5969 at t= 4.1533, p lessthan 0.001, indicating a negative relationship between these two variables. The direct effect of job stress on job performance shown by the statistical values was weak and in positive direction (β =0.0969, t=0.6648, p lessthan 0.001) which is not mediated by depression. The mediation analysis with 5000 bootstrap samples shows that the indirect effect of job Stress on job performance via Depression was 0.2197, and since it’s the mediation effect of depression accounted for 69.3percentage of the total effect of job stress on job performance HCWs.

Mediating Variable

Figure 3: Mediating role of Depression.

In the healthcare sector, occupational stress is a common problem that has serious effects on both job performance and general wellbeing. Depression, which serves as mediating variables, respectively, can have an impact on the relationship between job stress and job performance. Overall, these results suggest that job stress can indirectly affect job performance through its impact on depression. Specifically, higher levels of job stress can lead to higher levels of depression, which in turn can lead to lower job performance. They suggest that depression plays mediation role among the dependent and independent variable under study.

Table 8: Mediation model.

Testing for the Moderation Model

The moderated mediation model was tested by using Model 59 in the macro program PROCESS of SPSS (Hayes, 2013) and the results. As can be seen from the table, in Model 1 with Depression as the dependent variable, after controlling for socio-demographic variables (gender, age, occupation, experience etc.), Job stress was significantly positively correlated with Depression (β = -.4685, t = - 3.3463, p lessthan 0.001). The interaction effect of job stress and emotional intelligence (Job Stress x Emotional Intelligence) on depression was also significant (β = .0071, t = .8056, p greaterthan 0.01). In Model 2 job performance as the dependent variable, after controlling for sociodemographic variables (gender, age, experiences, etc.), job performance was not significantly associated with depression (β=-0.918, t=-.8421, p greaterthan 0.001) while significantly correlated to job stress (β = 3.0776, t = 2.4943, p lessthan 0.001). The emotional intelligence also shows significant correlation with job performance (β = 1.2145, t = 2.49, p lessthan 0.05). The interaction effect of JS and EI (Job Stress x Emotional Intelligence) with job performance was significant (β = -.0492, t=.0161, p lessthan 0.01) whereas the interactive effect of depression and EI (Depression x Emotional Intelligence) is not significant (β =.0258, t=1.4024, p greaterthan 0.01).

Table 9: Moderation Model.

According to barn and Kenny if the interaction term i.e., independent*moderator and the dependent variable is significant, the moderation is accepted. The association between job stress and job performance was stronger for medical students with Emotional intelligence (βsimple=.6180, t=2.44, p lessthan 0.001) than for medical students with high EI (βsimple=-.1690, t=-.9434, p greaterthan 0.001). Additionally, the bias-corrected bootstrap analyses show that emotional intelligence was able to reduce the direct impact of occupational stress on job performance Through depression. Job stress specifically exerted a stronger influence on job performance through the mediating effect of depression for HCWs with low EI (1SD below the mean), whereas for medical students with high EI (1SD above the mean), job stress exerted a weaker influence on job performance through the mediating effect of depression [BETA =.0264, 95 percent CI]. Emotional intelligence refers to the ability to recognize and manage one's emotions and effectively interact with others. In the context of job stress and job performance, high emotional intelligence can help healthcare workers better cope with stressors and maintain their performance levels. Workers with higher emotional intelligence are more likely to exhibit resilience, problem-solving skills, and effective communication, which can buffer the negative effects of job stress on job performance. They may be better equipped to regulate their emotions, adapt to changing work environments, and maintain productivity even in stressful situations. They might be more capable of controlling their emotions, adjusting to shifting work conditions and continuing to be productive even under pressure.

Summary of Accepted and Rejected Hypothesis

The main aim of this particular study is to examine the relationship job stress, emotional intelligence, depression and job performance. The research study involves four main hypothesis and the results of the hypotheses based on the regression analysis are shown in table 10 given in table no 10.

Table 10: Results of Hypotheses Test.

In this research discussion, own research or review the work of others, discuss the strengths and limitations of different research methods, and explore potential applications of research findings are revealed. The following questions could be explored in research on the effect of job stress on job performance with the mediating role of depression and the moderating function of emotional intelligence:

• To what extent does job stress negatively impact job performance?
• How does depression mediate the relationship between work stress and JP?
• How does EI affect how well a person performs when under stress at work?
• Are their individual differences in emotional intelligence that make some employees more resilient to job stress than others?
• How can organizations promote emotional intelligence and support employees in managing JS to improve JP?

Detailed results and statistics of the data collected in this study were presented in this chapter. As explained earlier the theoretical model of this research has its basis on four proposed hypotheses which are discussed below.

Job Stress, Depression and Job Performance

Ha1: There is negative relationship between job stress and job performance among health professionals in a Tertiary Care Hospital in Peshawar. In this study Job Stress show weakly negative correlated to Job Performance (r=-0.14, p lessthan 0.01) which accept the hypothesisHa1. Due to a variety of circumstances, including intense patient care obligations, lengthy workdays, heavy workloads, exposure to stressful situations, and organizational constraints, healthcare personnel frequently experience high levels of workplace stress. These pressures can cause physical and mental exhaustion, which can have an impact on a healthcare professional's general health and quality of life. Workplace stress has been linked to a higher risk of depression in healthcare employees. The demanding nature of the job combined with issues like burnout, emotional tiredness, and work-life imbalance can make it more likely for healthcare professionals to experience depressive symptoms. Their capacity to handle stress may be further hampered by depression, creating a vicious cycle of deteriorating mental health. Job performance and job stress are negatively correlated with each other which are also shown by other research studies in Pakistan and many other countries and our study is showing the same. Job stress can have a significant impact on job performance, and it is well established that job stress is associated with decreased job satisfaction, decreased productivity, and increased absenteeism and turnover. Job performance can also be influenced by depression, which can negatively impact motivation, concentration, and decision- making. The relationship between job stress and job performance can be influenced by a number of things. The organization's resources and assistance, such as sufficient staffing, training, and access to appropriate tools, can help mitigate the detrimental impacts of job stress on performance. Individual coping mechanisms, such as social support and problem-solving abilities, may also help to lessen the negative effects of stress on work performance. Workplace stress be able to have a variety of effects on performance. High amounts of stress can affect cognitive function, making it harder to concentrate, make decisions, and solve problems. It may also have an impact on physical health, contributing to exhaustion, burnout, and higher absenteeism rates. Job stress can also result in lower productivity overall, lowered job satisfaction, and greater inclinations to quit. However, in our study depression have positive correlation with JP which in many other studies shows negative correlation. However, according to one theory, there is a considerable positive association between workplace stress and employee Job performance (Ismail et al., 2015; Soomro et al., 2019), indicating that stress and depression can motivate workers to put in extra effort and increase productivity. Job performance and job stress were negatively correlated with each other which are also shown by other research studies in Pakistan and many other countries. Job stress was found to be inversely correlated with job performance in a study by Bakker et al. (2004), with high levels of stress causing lower levels of performance. A meta-analysis by Podsakoff et al. (2007) and another study by Schaufeli and Enzmann (1998) discovered that job stress was negatively correlated with job performance across a range of industries and job types. The scientists noticed that regardless of the precise methods employed to evaluate job stress or performance, the negative association between job stress and job performance remained constant. Job stress was linked to a number of detrimental consequences, such as decreased job performance, increased absenteeism, and decreased job satisfaction, according to Cavanaugh et al studies from the year 2000. (Ousman, 2022). Data revealed that depression have significant positive correlation (r=0.283, p lessthan 0.01) with Job performance. Job stress also leads to depression in workers.as job stress increases the chances of depression also decrease in health care workers. HCWs having low job stress will perform better which will leads to the health care setting to achieve its goals. Job stress can arise from a variety of sources, such as high workload, lack of control over one's work, poor relationships with colleagues or supervisors, and insufficient rewards or recognition. When employees experience chronic job stress, they may become emotionally exhausted, lose motivation, and struggle to concentrate. These symptoms can lead to decreased job performance, such as lower productivity, decreased work quality, and increased absenteeism. Impact of job insecurity on HCW’s anxiety and depression, and these psychological strains could influence employees’ self-rated task performance due to MTI in tertiary care hospital of Peshawar. However, in our study depression have positive correlation with JP which in many other studies shows negative correlation. However, according to one theory, there is a considerable positive association between workplace stress and employee Job performance (Ismail et al., 2015; Soomro et al., 2019), indicating that stress and depression can motivate workers to put in extra effort and increase productivity. Job performance and job stress were negatively correlated with each other which are also shown by other research studies in Pakistan and many other countries. In conclusion, stress and depression have a substantial impact on work performance, contributing to lost working days, reduced productivity, and other negative outcomes. Assessing stress and depression levels in the workforce and promoting work fitness can provide employers with critical insights to effectively intervene and manage these challenges. Prioritizing employee mental health not only benefits individuals but also yields positive results for organizations, fostering a healthier and more productive work environment. Workplace performance can be significantly impacted by job stress in a variety of organizations additionally; stress can have an impact on coworkers' interpersonal interactions, resulting in disagreements and a breakdown in teamwork. Depending on their business, workplace culture, and management methods, various organizations may have differing amounts of job stress. Due to the demanding nature of the work, some industries, like healthcare and emergency services, may naturally have greater stress levels. Organizations can decrease the detrimental effects of work-related stress on job performance by prioritizing employee well-being, providing resources, and implementing stress management plans. Increased levels of workplace stress can have a detrimental effect on worker burnout, job satisfaction, and productivity. When under excessive stress at work, people may find it difficult to concentrate, make intelligent decisions, and handle their tasks effectively. A few examples of the negative physical and psychological repercussions that job stress can have include more absenteeism, higher turnover rates, and reduced employee engagement. Organizations may improve employee resilience, job happiness, and general performance by encouraging a healthy work-life balance, offering resources for stress reduction, and creating a good work environment. To maintain an engaged and effective staff, organizations must ultimately recognize and treat occupational stress.

Job Stress and Depression

Ha2: There is positive relationship between job stress and depression among healthcare workers in a Tertiary Care Hospital in Peshawar. Our result shows that Job Stress is positive correlated with depression (r=0.363, p lessthan 0.01) and the hypothesis Ha2 is accepted. Prescott claimed that there is "bidirectional" causality between stress and depression. The first can lead to the second, who can lead to the first, and both can make each other worse. The association between job-related stress and depression can be influenced by a number of mediating factors. The negative effects of job stress on mental health can be mitigated by individual characteristics like resilience, coping mechanisms, and social support. Organizational measures can also help to lower the risk of depression among healthcare professionals, such as putting stress management programmers into place, encouraging work-life balance, and creating a supportive workplace. Stress and depression have become increasingly recognized as significant factors impacting work performance and overall productivity in the workplace. Research indicates that stress alone is responsible for between 50 and 60 percent of all lost working days (Tahira et al., 2021). Moreover, when individuals experience depression, their work performance can be further impaired, particularly when combined with exposure to psychosocial work stresses. Depressed workers often face numerous challenges that can hinder their ability to fulfill their job responsibilities effectively. Compared to their non-depressed counterparts, individuals with depression are more likely to experience job loss, opt for early retirement, take frequent absences, and encounter functional restrictions at work. These issues not only affect the individual's performance but also have a direct impact on overall organizational productivity and efficiency. Recognizing the importance of stress and depression assessments, as well as evaluating work fitness for employees, provides employers with valuable insights into their workforce. By understanding the stressors and mental health challenges faced by their employees, employers can develop targeted intervention strategies to effectively manage these difficulties. Implementing stress and depression assessments can help identify individuals who may be at risk or currently struggling with these conditions. This proactive approach enables employers to offer appropriate support and resources to employees, fostering a healthier work environment. Interventions may include stress management programs, counseling services, flexible work arrangements, and wellness initiatives tailored to address the specific needs of the workforce. By addressing stress and depression in the workplace, employers can significantly improve employee well-being and job satisfaction. This, in turn, enhances employee engagement, motivation, and overall performance. Companies that prioritize employee mental health and provide necessary support are more likely to retain talented individuals and reduce turnover rates.

Job stress, Depression and Emotional Intelligence

EI is negatively correlated with Job Stress (r=-0.024, p lessthan 0.01) which is consistent with the study of Hatta et al., 2020) whereas the data don’t show any significant correlation between EI and Depression (r=0.007, p lessthan o.o1) in HCWs which reject this part of the above hypothesis and this is opposite of what most of the study have showed. The association between job stress, emotional intelligence, depression, and job performance in healthcare employees must be understood. The control of workload, the provision of suitable resources and assistance, and the promotion of a good work-life balance are among methods that should be prioritized by organizations in their efforts to lessen employee stress. Additionally, encouraging emotional intelligence through training and development initiatives might improve healthcare employees' capacity to manage stress and keep up their best work standards. A study has also indicated a negative and significant relationship between work stress and emotional intelligence. The analysis's findings show that a teacher's emotional intelligence score decreases as job stress increases. For every increase in emotional intelligence units, working stress dropped dramatically by 0.264. Emotional intelligence was positively and significantly connected with job performance. The findings indicate that a teacher's performance score increases with their emotional intelligence. For every unit improvement in emotional intelligence, job performance increased considerably by 0.580(Hatta et al., 2020). Research has shown that individuals with high emotional intelligence are better able to manage job stress and are less likely to experience depression. They are also more resilient and adaptable, which can help them cope with challenging situations in the workplace. In contrast, individuals with low emotional intelligence may struggle to manage job stress and are more likely to experience depression. They may have difficulty recognizing and managing their own emotions, as well as the emotions of others, which can lead to interpersonal conflicts and difficulties in the workplace. It has been discovered that lower levels of stress at work among healthcare personnel are correlated with higher emotional intelligence. Strong emotional intelligence abilities increase the likelihood that healthcare workers may use coping mechanisms that help them deal with stressors more effectively, such as problem-solving, reaching out for social support, and engaging in self- care activities. They can remain resilient and upbeat in the face of difficulties at work thanks to their emotional intelligence. However, in this study depression doesn’t show any association with EI for which further studies should be needed on large scale. People with emotional intelligence are better able to control their emotions and efficiently manage stress. It does not, however, ensure that people will always use these abilities or have access to useful coping mechanisms. Health care professionals may encounter obstacles to using effective coping techniques, such as time restraints, a lack of resources, or insufficient support networks. The advantages of emotional intelligence may not be completely realized in such circumstances, resulting in a lack of association with depression. Emotional IQ and depression assessments can be difficult and arbitrary. The complete spectrum of personal experiences and nuanced differences may not be captured by measurement instruments used to evaluate emotional intelligence or depression. Due to assessment issues, it may be difficult to determine whether emotional intelligence and depression are related. Moreover, the environment in the healthcare industry is inherently stressful due to the high levels of stress, emotional demands, and exposure to trying circumstances. Even emotionally intelligent healthcare workers may experience extreme pressures that might hasten the onset of depression. The protective advantages of emotional intelligence may be outweighed by external variables including workload, organizational climate, a lack of support, or structural flaws with the healthcare system.

The conversation concluded by highlighting the connections between job stress, depression, and emotional acuity among healthcare professionals. It emphasized the necessity for organizations to identify and manage factors that contribute to workplace stress while also placing a high priority on helping healthcare workers develop their emotional intelligence abilities. It is thought that by doing this, healthcare professionals' mental health can be enhanced, resulting in better patient outcomes and a more effective healthcare system as a whole. Although developing emotional intelligence and stress management skills may not be able to completely eliminate occupational stress, they can provide people the tools and resources they need to manage and lessen its consequences. Emotional intelligence and stress management strategies can greatly improve employee well-being and lower the risk of negative health impacts when used in conjunction with other organizational efforts, such as a supportive work environment, reasonable workloads, and access to resources.

Job Performance and Emotional Intelligence

Emotional Intelligence is significantly positively correlated with Job Performance (r=0.363, p lessthan 0.01). As the EI increase the JP increase by 0.363. This association has been also proofed by many previous studies. For a variety of reasons, employees who have strong emotional intelligence typically perform better at work. First of all, they are more aware of their own emotions, which help them control stress, maintain concentration, and make wise choices even in difficult circumstances. Their ability to properly control their emotions and keep a happy attitude is made possible by their self-awareness, which also increases their resilience and capacity to recover from setbacks additionally, those with high levels of emotional intelligence have excellent interpersonal skills, which help them manage social situations and develop strong bonds with subordinates, superiors, and clients. They are skilled at successfully speaking, appreciating the viewpoints of others, and settling disputes amicably. This capacity for interpersonal interaction promotes teamwork, collaboration, and a positive workplace culture, all of which improve work output. Additionally, emotional intelligence is vital to effective leadership. Leaders with high emotional intelligence are better able to encourage, inspire, and direct their team members because they are more sensitive to their needs and emotions. They are great at motivating and influencing others, which increases worker engagement and productivity. Emotional intelligence is also essential for handling stress and conflict. People with high emotional intelligence are better able to control their emotions under pressure, remain composed, and make thoughtful decisions. Additionally, it assists them in navigating problems and finding creative solutions, creating a productive work atmosphere. In conclusion, there is a strong relationship between emotional intelligence and job performance. People with high emotional intelligence are better able to control themselves and their interpersonal relationships, which improves job performance. Therefore, in order to foster a more effective and happier workplace, organizations should be aware of the importance of emotional intelligence and take it into account when evaluating and growing their staff. Employees with high EI are thought to have more solid working relationships with coworkers and have higher integrity (Rosete, Ciarrochi, 2005), as they are able to create better and more positive interactions that boost performance (2002) Wong, Law; (2016) Dhani, Sharma. Our study's findings confirm this, demonstrating that teamwork performance, accuracy, and competence are all higher among personnel with high EI scores than among those with low EI scores (Dhani, 2016). The findings showed that caregivers' emotional intelligence was linked to their capacity for both physical and emotional care (Nightingale et al., 2018). According to studies, job performance and emotional intelligence are related. Our outcome is similar to the results of numerous old researches. It has been demonstrated that emotional intelligence (EI) has major components that improve leadership, critical care, professional growth, interpersonal interactions, planning, and cooperation aspects of job performance. (Chauhan et al., 2022). Researches also shows that in comparison to evaluating the emotions of only one person (other or self), evaluating the emotions of two people (other and self) had a less positive correlation with job performance in social employment. For workers who interact with people, it stands to reason that when one's own emotions are utilized or in charge, job performance is increased. When evaluating the emotions of others, one's drive and focus may be aided by self-focused emotion use and regulation. To use an example, service workers must exert self-regulatory effort to effectively manage the emotions of their clients. Using and managing one's own emotions enhances the beneficial effects of evaluating others' emotions on job performance in social jobs. Dana Joseph, Jing Jin, Daniel Newman, and Hernest O'Boyle (2015) investigated the link between emotional intelligence and job performance by a meta-analysis of the data from 15 carefully selected studies. Their study can be considered the most up-to-date and trustworthy source of knowledge on the subject at this moment. They discovered a moderate (0.29) correlation between emotional intelligence and supervisors' assessments of an employee's job performance. Emotional intelligence can only accurately predict 8.4percentage of your employees' performance, according to this statistic. The mild correlation between EI and work performance is not as significant or practically advantageous as most EI proponents claim. General Mental Ability (GMA), in contrast, predicts 26percentage of someone's effectiveness at work and has a strong association with job success (Gallì, n.d.). According to a survey, nearly 75percentage of hiring managers claimed they preferred an employee's EQ over their IQ. Everyone agrees that emotional intelligence is a desirable trait that can improve communication, leadership, and problem-solving in the workplace. Additionally, researchers believe that training and practice might make one more adept at this skill. Although some people are naturally good at handling emotions, anyone may develop their capacity for understanding and logic. This can be highly beneficial in a workplace where relationships and business decisions frequently depend on interpersonal understanding, teamwork, and communication. Although personality and background are the main determinants of emotional intelligence, it is something that may be cultivated with practice. A 2011 study demonstrated that people who received training in crucial emotional competences experienced long-lasting increases in emotional intelligence. Along with these changes, their social connections, physical and mental health, and cortisol (a stress hormone) levels also improved (Utilizing-Emotional- Intelligence-in-the-Workplace-4164713, n.d.).

The Mediating Role Depression

Ha3: Depression mediates the relationship between job stress and job performance among healthcare workers in a Tertiary Care Hospital in Peshawar. Regression mediation analysis using 5000 bootstrap samples revealed that depression played a mediating role between JS and JP. The indirect effect of job depression on job performance through depression was 0.21, and since depression's effect on mediation accounted for 69.3percentage of the overall effect of job stress on job performance HCWs, it was determined that depression. Healthcare workers face unique challenges due to the demanding nature of their profession, including high job stress levels, long working hours, and exposure to critical situations. The cumulative impact of these stressors can contribute to mental health issues such as depression. Numerous studies now exist that demonstrate how important work is in determining one's physical and mental wellbeing. In light of the Covid-19 pandemic, recent research has revealed rising depression rates among healthcare workers (HCWs), with consequences for both productivity and quality of service. Depression may serve as a balancing agent between occupational stress and productivity. Healthcare workers may experience depression as a result of job stress because of the ongoing pressure and stress that can have a severe impact on their mental health. In response, depression can worsen work performance by lowering motivation, energy, and general engagement in tasks connected to the job. The negative effects of occupational stress on job performance can be made worse by depression, leading to a downward spiral. A helpful paradigm for comprehending the connection between workplace stress, depression, and job performance among healthcare employees is the workplace Demands-Resources (JD-R) model. This hypothesis states that stress from a job's expectations, such as a heavy workload, can result in depression, which then has an impact on how well a person performs at work. Resources related to the job (such as autonomy and social support) can serve as 'buffers', reducing the detrimental effects of job stress on depression and subsequent job performance. According to studies, people who suffer job stress are more likely to experience depression, which can worsen the consequences of job stress on work performance. In a 2017 study, Chen and colleagues discovered that depression served as a partial mediating factor between occupational stress and job performance. In other words, the existence of depression contributed to the explanation of the detrimental effects of occupational stress on job performance. Depression is one of the top three issues that employee assistance professionals are concerned about, according to Mental Health America. The relationship between JS and JP can be mediated by depression. Individuals who experience job stress may be more likely to experience symptoms of depression, which can then affect their job performance. For example, an employee who is experiencing symptoms of depression may have difficulty focusing on their work, have decreased motivation to complete tasks, and may make more errors than usual. Therefore, it is important for employers to take steps to reduce job stress and provide resources for employees who may be experiencing depression. This can include offering mental health services, promoting work-life balance, and creating a supportive work environment. Additionally, depression can impair a healthcare professional's ability to effectively handle work-related stress. Higher emotional reactivity is a common symptom of depression, which can make people more sensitive to stress. The negative thought processes and warped perceptions that are frequently linked to depression can exaggerate the sense of work stress, increasing feelings of overwhelm and lowering resilience. As a result, healthcare staff could struggle to meet their job's obligations, which could compromise their performance. In the relationship between occupational stress and performance among healthcare employees, depression plays a mediating role. Organizations may be able to enhance employee job performance and general job satisfaction by addressing workplace stressors and providing support for the mental health of healthcare professionals. The mediating influence of depression highlights how crucial it is to treat workplace mental health issues. Healthcare organizations should prioritize the identification and support of healthcare workers experiencing depressive symptoms. Implementing mental health initiatives can help increase awareness, lessen stigma, and provide resources for getting professional help. Examples include employee assistance programmers, counseling services, and educational campaigns. By establishing a culture of support and prioritizing mental well-being, companies can offset the harmful impacts of depression on job performance. Future studies should prioritize longitudinal research and assess the efficiency of therapies in lowering work-related stress and delaying the onset of depression in healthcare settings.

The Moderating role of Emotional Intelligence

Ha4: Emotional Intelligence moderates the relationship between job stress, depression and job performance. This research study also supports this hypothesis like the other studies in Pakistan and other countries. For medical students with low emotional intelligence (simple = -.1690, t = -.9434, p greaterthan 0.001) compared to those with high emotional intelligence (simple =.6180, t = 2.44, p 0.001), the relationship between job stress and job performance was higher. Additionally, the bias-corrected bootstrap analyses show that emotional intelligence was able to reduce the direct impact of workplace stress on job performance through depression. Job stress specifically had a stronger impact on job performance through the mediating effect of depression for HCWs with low EI (1SD below the mean) compared to medical students with high EI (1SD above the mean), with a weaker impact on job performance through the mediating effect of depression [ =.0264, 95percentageCI]. Emotional intelligence is the capacity to understand, be aware of, and effectively manage one's own emotions as well as those of others. It involves recognizing and managing emotions associated to work-related responsibilities, interactions with coworkers or clients, and the overall work environment. Healthcare professionals heavily rely on EI. This is unquestionably true, particularly for individuals in professions like medicine and nursing that require regular interaction with patients. EI plays a significant role in these competencies, which are distinctive to each healthcare position and are necessary for staff to perform well (Alonazi, 2020). Relationship between job stress and performance may be moderated by emotional intelligence. People with high emotional intelligence may be better equipped to handle workplace pressures, which would lessen its detrimental effects on job performance. For instance, a worker with high emotional intelligence might be better able to identify and control their emotions, interact with coworkers in an efficient manner, and sustain healthy working relationships. Given that a higher EI level was associated with more effective coping methods being used by ICU nurses, it is possible that EI has an effect on coping mechanisms. The association between occupational stress and depression among HCWs was found to be reduced by emotional intelligence in one study by Schutte, Malouff, and Thorsteinsson (2013). Particularly among careers who reported experiencing high levels of job stress, they discovered that higher levels of EI were linked to reduced levels of depression. In other words, HCWs who were more adept at identifying, comprehending, and controlling their emotions were less likely to suffer from depression as a result of work stress. (Martins et al., 2010). Similar findings were made by Fuentes and colleagues in their 2015 study, which indicated that emotional intelligence mediated the association between teachers' job performance and job stress. They discovered that whereas instructors with low EI were more likely to suffer unfavorable impacts of job stress on performance, teachers with high EI were better able to manage job stress and maintain job performance. The association between depression and job performance among managers was found to be mediated by emotional intelligence in a study conducted by Goleman and colleagues in 2001. They discovered that even when experiencing depressive symptoms, managers with high EI were better able to control their emotions and sustain job performance. Our study result is similar to the previous studies. Emotional intelligence can play a moderating role between job stress, depression, and job performance. Individuals with higher levels of EI may be better able to recognize and manage their emotions, cope with job stress, and maintain job performance. Therefore, it is important for employers to promote emotional intelligence among employees, through training or other interventions, as a means of improving employee well-being and job performance. Employees that are emotionally intelligent are better able to manage the pressures and obstacles of the workplace. They are adept at identifying stress indicators and the emotional triggers that support their well-being. Due to their increased self-awareness, they can manage their stress levels in a proactive manner, so reducing the negative effects it has on their physical and mental health. Minimizing poor emotional baggage and improving emotional skills are essential in managing workplace stressors. Job Performance is the most significant dependent variable for researchers in a variety of professions since people spend so much of their life at work. Equipping their staff with emotional intelligence is a paradigm change that service-based organizations in particular are emphasizing on. Job stress can negatively impact job performance, and this relationship can be mediated by depression and moderated by emotional intelligence. Organizations may benefit from implementing strategies to reduce job stress, such as providing training in stress management techniques, promoting work-life balance, and fostering a positive work environment. Additionally, organizations may consider providing resources to support employees experiencing depression, such as employee assistance programs or mental health services. Finally, organizations may benefit from promoting emotional intelligence through training programs and incorporating emotional intelligence assessments into the hiring process.

Implications

For organizations like healthcare facilities, professionals and specialists like Nurses and doctors, this study offers some beneficial and practical implications. Healthcare facilities may benefit from implementing stress management programs and interventions to lessen the detrimental effects of job stress on job performance (Waghachavare et al., 2013). Healthcare professionals can learn emotional intelligence skills through training and coaching to better control their emotions and deal with work stress (Goleman, 2000).

This study will help the health care organizations in:

• Assessing the essential role of emotional intelligence: The study emphasizes the significance of emotional intelligence in modifying the association between work stress and performance. Employers can use this knowledge to help healthcare professionals better manage work-related stress and enhance their performance by offering emotional intelligence training.
• Understanding the role of depression: The study reveals how depression mediates the link between occupational stress and performance. Organizations can use this data to spot staff members who could be depressed and offer them the help they need to manage their mental health and enhance their performance at work.
• Developing effective stress management strategies: The study highlights how critical it is for healthcare personnel to acquire efficient stress management techniques. Health care settings can utilize this data to create and put into practice stress management programmers that will aid healthcare staff in coping with work-related stress, lowering their risk of depression, and enhancing job performance.

The interaction of emotional intelligence, work-related stress, depression, and job performance in healthcare professionals emphasizes the significance of treating these problems holistically. Healthcare workers' capacity to effectively manage stress and lessen the effects it has on their ability to perform their jobs can be improved through strategies aimed at enhancing emotional intelligence through training programmers and support systems. Additionally, healthcare workers who experience depressed symptoms should be identified and treated to assist reduce the negative mediating effects of depression on job performance. Healthcare professionals' job performance can be improved and the adverse consequences of job stress can be reduced by properly screening them for the condition and offering them the proper assistance and treatment (Katon et al., 2007).It seems that supervisors who utilize health-promoting management techniques that emphasize creating a work framework, exhibiting care, and expressing support can mitigate the negative effects of perceived stress on workers' psychological well-being and productivity at work. Beside practical implications this study has also Ha theoretical implications. The current study has examined the relationships between JS, JP, EI and Depression and the Mediating effect of Depression on job Performance and how EI buffer its effects on JP which, has contributed theoretically to the existing literature. Although this association among these variables has been explored in the past in various studies conducted in different cultural contexts but the results have been contradicting somewhere and supported the previous result in other which strength the evidence about the association. The study presents empirical evidence that supports the Job Demand-Control- Support (JDCS) model's assertion that job stress has a detrimental effect on job performance(“Healthy Work: Stress, Productivity, and the Reconstruction of Working Life,” 1990).According to the Cognitive Activation Theory of Stress (CATS), the study emphasizes depression's mediation function in the connection between occupational stress and job performance(Ursin & Eriksen, 2010).According to the Trait Emotional Intelligence (TEI) model, the study also demonstrates that emotional intelligence moderates the association between job stress and job performance. (Petrides & Furnham, 2003).

This research study highlights the following empirical evidences.

• Advancing our understanding of the impact of job stress on job performance: The study advances our knowledge of the intricate connection between job stress and performance in the healthcare industry. The significance of emotional intelligence and depression in mediating and moderating this link is shown by the study.
• Enhancing our knowledge of emotional intelligence: The study throws more light on how important emotional intelligence is in the workplace. The study emphasizes the significance of emotional intelligence in influencing how workplace stress and performance relate among healthcare personnel.
• Expanding our knowledge of depression: The study emphasizes how depression plays a mediation role in the connection between job stress and job performance in healthcare personnel. The relationship between stress and mental health at work can be better understood with the use of this knowledge.

Limitations and Future Directions for Research

Before the results of the current study can be broadly interpreted, just like in any other research, it is crucial to recognize the limitations that still exist in it. These restrictions might end up being beneficial in directing researchers towards promising areas for future study. Although the study offers insightful information, it is vital to take into account its limitations and potential research areas. The following limitations and suggestions for future researches should be consider:

Future studies could take a sample of people living in other provinces or cities of Pakistan as well, or study samples across different cultures from other developing nations to help build up a better understanding of this phenomenon. However, this study is only limited to those people who are currently residing in KPK and working in KP Hospitals. Examining how this paradigm applies to people who live in urban and rural settings is another exciting topic that can be the focus of research. Only a glimpse of the data at a particular point in time is provided by the cross-sectional study design. It would be easier to grasp the connections between work stress, emotional quotient, depression, and performance in the workplace if longitudinal research followed participants over an extended length of time. Additionally, we conducted Non-random convenience research using a small sample of HCWs Therefore, for better results, future researchers should conduct such studies on large scales and randomly pick the participants. The respondents in this study may not accurately represent the population due to the convenience method's non-probability sample selection process. To improve the representativeness of the sample under study, it is advised that future research use different sampling approaches, such as the stratified sampling method based on regional classification or other demographic criteria. The study's sample size is very small due to scheduling restrictions. It is recommended that subsequent researchers and future studies employ a bigger sample size to improve the generalizability of their research's findings. The study's primary subject matter is the staff of a particular Peshawar tertiary care hospital. Healthcare professionals working in other situations or various geographical regions might not be able to directly apply the findings. The study's findings would be more broadly applicable if they were replicated in various healthcare settings. We haven’t found correlation of demographic variables with the JP, EI, Depression and Job stress. Future researchers can also find the association of the dependent, independent, mediating and moderating variables under study with demographic variables that weather they have impact on it or not. Moreover, as the data for this study was collected by administering online survey questionnaires, it results in a likelihood of some respondent bias; upcoming researchers may make use of other data collection methods to make sure that they obtain findings that are more reliable and accurate. Another interesting area of research is to compare the relationship between job stress, job performance, depression, and emotional intelligence in different professions. This research could provide insight into the unique challenges faced by individuals in different occupations and highlight the interventions that are most effective for enhancing job performance. Despite the fact that the study focuses on the mediating role of depression and the moderating function of emotional intelligence, it is imperative to take other potential mediators and moderators into account. Workplace resources, organizational culture, and social support are a few more variables that may have an impact on the link between job stress and performance. To learn more about the mechanisms at work, future studies might look into these extra factors. The cultural differences can influence the way individuals perceive and respond to job stress; it would be valuable to conduct cross-cultural studies that examine the relationship between job stress and job performance in different cultures. This research could also explore how emotional intelligence and depression mediate and moderate this relationship across cultures. Researchers can conduct intervention studies to examine the effectiveness of different interventions aimed at reducing job stress, depression, and improving emotional intelligence in enhancing job performance. This research can explore the impact of various interventions such as mindfulness training, cognitive-behavioral therapy, or stress management programs. More in-depth analysis of health-promoting management practices’ specific impacts on personnel performance and psychological well-being should be done in future studies. Additionally, additional research is required in this area because our measure of health-promoting management practices has not been verified (Meunier et al., 2022). Implementing strategies to lessen work-related stress, improve emotional intelligence, or cure depression in healthcare employees may offer useful insights into the possible advantages for improved job performance. Such therapies' efficacy would be assessed using experimental designs with control groups. A more thorough examination of the experiences and perspectives of healthcare workers might be possible by combining qualitative techniques with quantitative ones, such as focus groups and interviews. This mixed-methods approach may offer deeper understanding of the underlying mechanisms and aid in the discovery of novel treatments or tactics. Overall, there is a need for further research to better understand the complex relationship between job stress, job performance, depression, and emotional intelligence, and the factors that mediate and moderate this relationship. By conducting rigorous research in this area, researchers can develop more effective interventions aimed at enhancing job performance and reducing the negative impact of job stress on mental health. By addressing these limitations and exploring the suggested future directions, researchers can further enhance our understanding of the complex interplay between job stress, emotional intelligence, depression, and job performance among healthcare workers in tertiary care hospitals, ultimately leading to more effective interventions and support systems.

Organizational success is based on the engagement and efficiency of its workforce. Poor health outcomes for hospitalized patients are caused by health personnel performing at a lower level, which lowers productivity in public hospitals. Job stress, job satisfaction, and mental health can negatively affect a worker's productivity at work. Healthcare organizations must change and perform better to maintain access to and affordability of healthcare. Without the assistance and outstanding performance of healthcare workers, these obstacles cannot be overcome. To accomplish organizational goals, healthcare workers' job performance is vital. On the basis of result obtained from 259 respondents this study revealed the job stress can lead to depression which in turn effect the job performance. Depression mediates the relation-ship between JS and JP. Job stress both directly and indirectly through depression weakens the job performance. Job stress is correlated with job performance negatively. EI has positive correlation with JP and negatively correlated with JS while show no relation with Depression which is contradicted with the other researches result. Moreover, EI plays a moderating role and buffer the effect of JS on JP. HCWs having high EI can cope with job stress and perform better which help in achieving the overall aim of the health care settings and patient satisfaction. Workplace stress has a big impact on how well healthcare employees perform. While depression can mitigate the negative effects of job stress on job performance, emotional intelligence can regulate this link. Organizations may promote the wellbeing and productivity of their healthcare personnel by acknowledging and addressing these aspects. Hence, the current study has examined the relationships between JS, JP, EI and Depression and the Mediating effect of Depression on job Performance and how EI buffer its effects on JP which, has contributed theoretically to the existing literature. The research studies that comply with can greatly benefit from the insightful knowledge gained from the empirical results of this study. These findings also offer some useful implications for health care settings that are intended to promote EI teaching training for HCWs to learn coping skills and how to express their emotions, as well as how Organizations ought to create safe working environments for the HCWs to perform better.

List of Acronyms/Abbreviations

HCWs: Health Care Workers; JP: Job Performance; JS: Job Stress; EI: Emotional Intelligence; HMC: Hayat Abad Medical Complex; KTH: Khyber Teaching Hospital; LRH: Lady Reading Hospital; KPK: Khyber Pakhtunkhwa.