Occupational stress has been a long-standing concern of the health care industry. Studies indicate that health care workers have higher rates of substance abuse and suicide than other professions and elevated rates of depression and anxiety linked to job stress.
In addition to psychological distress, other outcomes of job stress include burnout, absenteeism, employee intent to leave, reduced patient satisfaction, and diagnosis and treatment errors.
The purpose of this article is to
identify the sources of occupational stress,
identify the adverse health effects of occupational stress, and
recommend work practices to reduce occupational stress.
What causes occupational stress?
The National Institute for Occupational Safety and Health (NIOSH) defines occupational stress as “the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker.”
The following workplace factors (job stressors) can result in stress:
Job or task demands (work overload, lack of task control, role ambiguity)
Organizational factors (poor interpersonal relations, unfair management practices)
Financial and economic factors
Conflict between work and family roles and responsibilities
Training and career development issues (lack of opportunity for growth or promotion)
Poor organizational climate (lack of management commitment to core values, conflicting communication styles, etc.)
Stressors common in health care settings include the following:
Inadequate staffing levels
Long work hours
Shift work
Role ambiguity
Exposure to infectious and hazardous substances
Stressors vary among health care occupations and even within occupations, depending on the task being performed.
In general, studies of nurses have found the following factors to be linked with stress:
Work overload
Time pressure
Lack of social support at work (especially from supervisors, head nurses, and higher management)
Exposure to infectious diseases
Needlestick injuries
Exposure to work-related violence or threats
Sleep deprivation
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Role ambiguity and conflict
Understaffing
Career development issues
Dealing with difficult or seriously ill patients
Among physicians, the following factors are associated with stress:
Long hours
Excessive workload
Dealing with death and dying
Interpersonal conflicts with other staff
Patient expectations
Threat of malpractice litigation
The quality of patient care provided by a hospital may also affect health care worker stress. Beliefs about whether the institution provides high quality care may influence the perceived stress of job pressures and workload because higher quality care maybe reflected in greater support and availability of resources.
What are the potential adverse health effects of occupational stress?
Stress may be associated with the following types of reactions:
Psychological (irritability, job dissatisfaction, de##pression)
Behavioral (sleep problems, absenteeism)##
Physical (headache, upset stomach, changes in ##blood pressure)
An acute traumatic event could cause post traumatic stress disorder (PTSD). Not every traumatized person develops full-blown or even minor PTSD. 4
Although individual factors (such as coping strategies) and social resources can modify the reaction to occupational stressors to some degree, working conditions can play a major role in placing workers at risk for developing health problems.
How can stress be controlled in the workplace?
As a general rule, actions to reduce job stress should give top priority to organizational changes that improve working conditions. But even the most conscientious efforts to improve working conditions are unlikely to eliminate stress completely for all workers. For this reason, a combination of organizational change and stress management is often the most successful approach for reducing stress at work.
Organizational Change Intervention
The most effective way of reducing occupational stress is to eliminate the stressors by redesigning jobs or making organizational changes. Organizations should take the following measures:
Ensure that the workload is in line with workers’ ##capabilities and resources
Clearly define workers’ roles and responsibilities##
Give workers opportunities to participate in deci##sions and actions affecting their jobs
Improve communication##
Reduce uncertainty about career development and ##future employment prospects
Provide opportunities for social interaction among ##workers5
The most commonly implemented organizational interventions in health care settings include
team processes,
multidisciplinary health care teams, and
multi-component interventions.
Team process or worker participatory methods give workers opportunities to participate in decisions and actions affecting their jobs. Workers receive clear information about their tasks and role in the department. Team-based approaches to redesign patient care delivery systems or to provide care (e.g., team nursing), have been successful in improving job satisfaction and reducing turnover, absenteeism, and job stress.
Multidisciplinary health care teams (e.g., composed of doctors, nurses, managers, pharmacists, psychologists, etc.) have become increasingly common in acute, long-term, and primary care settings. Teams can accomplish the following:
Allow services to be delivered efficiently, without sacrificing quality
Save time (a team can perform activities concurrently that one worker would need to provide sequentially)
Promote innovation by exchanging ideas
Integrate and link information in ways that individuals cannot
Multicomponent interventions are broad-based and may include
risk assessment,
intervention techniques, and
education.6
Successful organizational stress interventions have several things in common:
Involving workers at all stages of the intervention
Providing workers with the authority to develop, implement, and evaluate the intervention
Significant commitment from top management and buy-in from middle management
An organizational culture that supports stress interventions
Periodic evaluations of the stress intervention
Without these components (in particular, management support) it is not likely that the intervention will succeed.
Stress Management Intervention
Occupational stress interventions can focus either on organizational change or the worker. Worker-focused interventions often consist of stress management techniques such as the following:
Training in coping strategies
Progressive relaxation
Biofeedback
Cognitive-behavioral techniques
Time management
Interpersonal skills
Another type of intervention that has shown promise for reducing stress among health care workers is innovative coping, or the development and application by workers of strategies like changes in work methods or skill development to reduce excessive demands. 7
The goal of these techniques is to help the worker deal more effectively with occupational stress. Worker-focused interventions have been the most common form of stress reduction in U.S. workplaces. Although worker interventions can help workers deal with stress more effectively, they do not remove the sources of workplace stress, and thus may lose effectiveness over time.
From: CDC NIOSH
