Occupational Stress among Healthcare Workers in the UK

Occupational Stress among Healthcare Workers in the UK

Stress experience has a significant negative impact on a healthcare professional and his/her service delivery. The issue of work-related stress is increasingly becoming a significant societal phenomenon in the United Kingdom. It calls for immediate interventions to address its surge and to promote mental well-being of nurses, doctors, and other healthcare workers. A survey recently carried out by national labour force council indicated that the annual incidence rate of stress and depression related to healthcare profession has skyrocketed to 900 per 100,000 employees in the UK alone (Tomioka et al., 2014).

It is important to understand that not all types of stress are negative. Stress can be classified into eustress and distress, where the later is desirable than the former. Eustress is least challenging and pleasant and results from output maximization. No healthcare professional can be effective in their workplace and personal lifestyle if they lack this inner positive stimulus. On the other hand, distress is negative and renders a person unable to control or monitor his/her response. Stress slavery results in low performance in the job environment as contributed by deteriorating personal health (Arnetz et al., 2015). Of keen to note is that a psychological or physical response to stress is mandatory for all humans.

For years now, occupational stress in healthcare has mutated into a global issue. It wields both psychological and mental health consequences and can lead to a waning satisfaction with a person’s occupation (Aghdasi et al., 2011). In fact, stress can lead to sick leaves and burn out for a small section of healthcare workers. In Western Europe, up to 10%of national GDP is lost on an annual basis because of turnover and absenteeism related to stress ailments. While absenteeism has been on a sharp decline over the past decade in UK healthcare sector, the rates are still higher when compared to equally stressful occupations in sectors like education, transport, or catering.

Occupational Stress

Occupational stress refers to a discomfort perceived or felt at a personal level. It is often triggered by so frequent and intense instances that they exceed an individual’s resources to handle them adequately as well as his personal capabilities. Occupational stress is a harmful emotional and physical response occurring when job requirements hardly match the worker’s capabilities (Nikolau & Tsaousis, 2013). While this work pressure can be positive, it has a negative impact when in excess. In this case, health care workers view themselves as unable to possess the necessary skills to launch an effective and direct challenge against the situation.

The latest technological innovation and advancements in the healthcare industry have tremendously increased the demographic statistics of persons accessing medical services in hospitals today. The number of nurses and doctors are also on the rise in the United Kingdom in an effort to deliver standard services to the growing number of patients (Kim et al., 2014). Therefore, professionals operating in a hospital environment are exposed to a significant amount of job stress hence raising the stress levels to them and the patients that seek their assistance.

Sources

            Some sources of stress include employment decisions, work overload, personal expectation, physical health, and social pressures. Work overload occurs when it is prerogative for a healthcare worker to concentrate and execute excessive tasks within a short time span. It also is prevalent when the management has unrealistic expectations to be delivered by medical professionals. Another cause of stress, though uncommon, is work underload, where a nurse’s job is too simple to fill his/her abilities. Underutilization can also occur when an employee is convinced that their job is not directly related to their area of specialization (Xie et al., 2011). It results in job ambiguity as a causative agent of stress because the healthcare worker has to perform tasks whose requirements are not outlined clearly. Role conflict causes occupational stress especially when female nurses need to work overtime while at the same time they have domestic roles as a parent and wife. It can result in a conviction of having little or no control over the work environment. To counter this, the management of a healthcare facility ought to accord healthcare employees a sense of control via involving them in decision making or letting them to plan their daily chores and routine tasks as per their capabilities to ensure attainment of job satisfaction and to minimize stress (Tsutsumi et al., 2011).

            Stress develops due to difficulties in maintaining and developing a relationship with workmates and other people in a healthcare environment. If work system, technology, management, or organizational change abruptly, it will take some time for medical professionals to adapt.  

Occupational Stress in UK

Europe is currently experiencing a negative discourse in its economy coupled with rising rates of unemployment that fuel job insecurities among the healthcare workers. In fact, it is one of the most complicating factors and a major cause of work-related stress not only in healthcare but in other sectors as well. Flexible working arrangements in healthcare are gaining prominence in the United Kingdom. They entail non-permanent contracts that shift from part-time to full-time working hours, short notice calls, or work split shifts. Temporary healthcare workers subjected to flexible conditions of employment often report cases of chronic work-related depression and stress (Kompier et al., 2014).

In a broader context of insecurity caused by contemplation of unemployment, especially for persons working in the public healthcare sector, a sense of vulnerability is setting in, given that the government is planning on reducing the number of employees and improving their level of productivity. In England, for instance, the government has assured the public that NHS (National Health Service) budget will not be altered. Despite these assurances, changes in service delivery and healthcare work structures will eventually impact in employment. In light of this, occupational stress among doctors, nurses and other healthcare professionals is more likely to be an employment feature like other public sectors specifically targeted for layoffs and budget cuts.   It has been argued that healthcare professionals (like nurses) experience higher levels of work-related depressions and stress when compared with larger working population.

The department of health care in the United Kingdom incurs a considerable cost due to deteriorating employee health because of work-related stress. The government can save approximately $500 Million annually if it implements strategies to minimize occupational stress among healthcare professionals. The physical, emotional, and intellectual labour involved in daily healthcare differentiates those working in other job sectors from those that specialize in the provision of healthcare services (Kim et al., 2014). Therefore, the intervention strategies to manage psychological impact of working in a healthcare facility should be distinct from those applied in the generalized workplace.

Stress in Nursing

Nursing is an occupation that exhibits high levels of stress in healthcare. National Institute of Occupational Health and Safety in the UK conducted an investigation that found out that nurses had higher than expected incidences and disorders related to stress. Occupational stress not only affected nurses’ ability to cope with work demands but also it led t hazardous impact to their health conditions. As a result, their efficiency in the delivery of healthcare services is greatly impaired (Becke et al., 2014). Studies also indicate that more than a quarter of healthcare workers experience psycho-physiological symptoms of stress, with nearly 40% seeking medical advice in the past half a year. Different healthcare workers experience occupational stress in specific ways. Over the past few years, discussions have emerged in the UK regarding the nature of stressors as experienced by healthcare workers that work in high-risk environment such as the emergency department. In fact, there is a growing recognition that healthcare professionals offering emergency services are exposed to higher risks due to a regular experience of critical incidences. Therefore, it cannot be denied that nurses and doctors in this department hold positions that demand confrontation of additional stressors such as patient violence, abrupt children death, inappropriate attendees, and verbal or physical abuse.

Experienced healthcare workers can easily cope with stresses occurring for short time periods, but chronic stresses have tendencies to produce prolonged altercation of psychological state. The effectiveness of counter responses is dependent on the situation which they are applied (Kim et al., 2014). Coping behaviours refer to strategies used to help stress victims to solve rising problems and minimize stress. It is the individual’s behavioural and cognitive efforts to manage external and internal requirements in an environment-person transaction. Different people apply different coping strategies to deal with incidences of depression. Medical practitioners should view coping strategies within specified situational, cultural, or social context. More than 100 sampled intensive care workers served with self-report questionnaires in Birmingham indicated that task overload was one of the main stressor in healthcare and majority workers used planning as a coping strategy (Lesahe & Berjot et al., 2013). Besides, particular personality traits such as extraversion and openness are associated with lesser stress levels from the patient and are common among healthcare workers in intensive care units.

Understanding what emergency healthcare workers do to survive and cope with extreme incidences can shed light on the necessary measures that should be taken to assist persons vulnerable to persistent traumatic reactions. The issues of burnout, occupational stress and coping among emergency health care workers are of universal and fundamental concern to administrators and managers of healthcare facilities (Kwon & Lee, 2011). Researchers in the UK conducted a study to investigate occupational stress source and intervention strategies among sampled healthcare workers from all across the country. The information gathered was useful in determination and formulation of health conditions of these professionals thus an improvement in the quality of health care provision in UK medical facilities. Modification of stress is possible via utilization of proper stress management skills.

Study

The sampled study subjects were 90 from different departments. All of them were baccalaureate degree holders. The first section of questionnaire captured details on personal profile including experience as a healthcare professional, rank at the workplace, descriptive demographic statistics, and marital status. In the second section of the questionnaire, respondents were required to identify sources of stress from the listed 60 items. In addition, the researchers used a Likert scale of four points ranging from extreme stress (4 points) to no stress (1 point) (Lesahe & Berjot et al. 2013).  To determine the total score per healthcare worker, analysts added the study subject’s responses to 60 listed items. The score range was between 0 and 240, with the highest corresponding with extreme stress level. 80% of the respondents were women below the age of 50 years while the rest were men with less than 5 years experience as healthcare workers. For female healthcare workers, the mean standard deviation was 162.28 indicating that their stress scale was high. Some of the most frequent stressors in the workplace for both men and women include issues that relate to workload, physical environment, handling anger and aggressive behaviour among patient's relatives, and exposure to safety and health hazards (Lesage & Berjot, 2013). Others included inadequate support by healthcare facility administrators, lack of equipment and non-cooperation among the workers during medical emergencies.

The strategies that were mostly used by nurses to curb stress included self-control and positive reappraisal (each had a standard deviation of 3.0 and mean of 12.90). On the other hand, the least applicable strategy was acceptance of responsibility (standard deviation of 2.60 and a mean score of 5.63). A significant correlation exists between sex and use of coping scale, hence an implication that females applied these coping strategies more as compared to males. Worth noting is that more than 70% of healthcare workers reported satisfaction with their occupations (Webster et al., 2011).

Stressors

The study on UK healthcare workers reveals that issues that relate to physical environment were major sources of stress. A striking similarity exists between the outcome of this study with universal stressors as identified in literary work such as criticism, anger management, and aggressive behaviour. Most scholars identify organizational environment as one of the main sources of perceived stress. In a healthcare setting, this speculation is amplified given the wide range of stressors in the United Kingdom.

It is speculated that the reason most of the healthcare workers identified positive reappraisal as a coping strategy was because of religion and educational background. Healthcare professionals such as nurses are mostly religious in the United Kingdom. Hence, spirituality plays a major role in their decision making. However, as they acquire more education and gain experience in their work environment, it is probable that they will employ other stress management strategies like problem-solving. Nurses and doctors use coping strategies based on personal views and resources. Coping entails a conscious effort to minimize stress. Therefore, using this model, all the coping measures can be categorized into two classifications (Webster et al., 2011). The first category involves problem-focused attempts by a healthcare worker to alter or regulate problems that cause stress in the workplace. The second strategy is focused on personal emotions, whereby the employee attempts to control emotional responses to a stressful situation in the workplace.

Emotional Approach

People tend to employ emotionally focused approaches as compared to strategies focused on solving the arising problems. Perceptions of an individual's control over a stressful situation in the workplace influence a decision to apply a specific coping strategy to solve a stressful situation. If a healthcare worker perceives a stressful situation as overwhelming and beyond their control, he/she is likely to employ emotional strategies to cope with the stress. On the other hand, healthcare professionals that perceive an opportunity to overturn a stressful situation and to keep it in control apply problem- focused strategies. A few medical professionals accept responsibility as a way of confronting a stressful situation.

Impact of Stress on a Healthcare Worker

Nurses and other healthcare workers can get exhausted emotionally if they lack the support of the organization or due family and personal relationship matters. Older professionals may not be able to adapt to advancing medical technologies resulting in higher unhealthy stress levels. The impact of high stress and depression in the life of a healthcare worker should be handled with utmost importance. The stress of healthcare workers such as nurses and doctors wield a stronger effect on work outcomes especially regarding the care quality and service delivery in a hospital (Mark et al., 2012).  Burnout nurses workers become less interested and less energetic in performing their tasks. They get apathetic, emotionally exhausted, bored, or depressed. They look for faults in all aspects of their workplace that include initiating conflicts with colleagues or reacting negatively to ideas and suggestions of co-workers. Even worse, stressed healthcare workers can react negatively to patients under their care. Their work quality drops drastically, but not necessarily the service time. Nursing staff can be frustrated by alteration of medication protocols or introduction of new procedures is awareness is not created in time or when they are not given adequate time to adopt and incorporate changes to their work patterns and profession. 

Intervention Strategies for Occupational Stress in Healthcare

Coping with stress is a fundamental research area in reducing employees’ perceived stress levels. Attention should be shifted on ways of minimizing stress cases in medical profession to promote quality of services delivered in the institution and to improve employee health. Coping accounts for cognitive and behavioural efforts to tolerate, to familiarize and minimize internal and external conflicts and demands among them (Arnetz et al., 2015). Interventional strategies and coping efforts like these serve two main functions: regulation of stressful emotions and management of problem-focused stress. In addition, it should be understood that people make use of these two defence functions to manage and regulate stressful demands. It is an implication that stress management strategies in healthcare are made in response to appraisals.

A cognitive appraisal can take secondary and primary forms. In primary cognitive appraisal, for instance, if an employee has his/her self-esteem on the line, chances are he/she will exhibit shame or anger as an emotional reaction. On the other hand, for a worker that has his/her physical well-being on the line, he/she will be worried or fearful. In secondary cognitive appraisal, the stressed healthcare worker should discover what he can to restore his full potential as a hardworking employee.

 Reappraisal is a third appraisal strategy and is based on secondary and primary feedbacks.  For instance, a healthcare worker must accept that the job is labour intensive and demanding. Thereafter, he has to cope with the situation by seeking professional help. After a successful recovery, it will be hard for him to perceive his initial stance as threatening or stressful (Chang et al., 2015).  Coping with stress is multidimensional and depends on personal experiences and the nature of the situation. Therefore, it can be argued that the process of coping involves the events taking place at a stressful moment and the execution of situation-specific action as soon as a demanding situation arises. 

Mechanisms of Coping with Stress

Different employees can apply different strategies o cope with stress. Problem-focused strategies involve generation of options to resolve issues as they arise. A stressed healthcare worker should also evaluate cons and pros of different challenges and the steps implement in solving problems. Moreover, this stress intervention strategy is particularly effective if an employee has a higher degree of control over external factors and stressors. Often, this coping strategy is linked with overall well being.

Emotionally-focused intervention strategies involve striving to tame emotional distress associated with specified situation. Some of the most appropriate coping mechanisms, in this case, include positive reframing of events, social support, venting of emotions, and denial. Prayer or humour are effective forms of coping when the stance of appraisal is that there is absolutely no other strategy to be applied to modify challenging, threatening or harmful work or environmental conditions (Chang et al., 2015).

A study conducted on old, certified and experienced healthcare workers revealed that they calmed themselves down as an emotional response to stress whenever faced with a difficult situation at the workplace. Other emotion-focused strategies that the workers used in the study to cope with stress include stress internalization, verbalizing stressors with co-workers and friends, engaging in hobbies to distract themselves, and cracking jokes. Others stated that social support was an effective and important way to cope with stress in a wok environment. The only difference is that these healthcare workers relied on problem-focused strategies like problem-solving, planning and adding resources to challenge occupational stress (Mark et al., 2012 p. 69).  As many studies have found, men employ problem-solving strategies more often as compared to female healthcare workers.

Proactive behaviour involves anticipation of potential stressors to act in advance with an aim of preventing stress from ever occurring. Proactive behaviour such as offsetting, modification, or elimination of stressful events can minimize the risk of stress before their occurrence. Some of the important skills associated with such behaviour are future planning, organization of personal thoughts and setting goals. Healthcare workers should have a vision when engaging in proactive coping. They should see future opportunities, demands, and risks but should not engage on mental though of these losses or threats. Rather, they should perceive them as future challenges. In this way, intervention to stressful situations transforms into goal management from risk management, hence personal growth and future success.

Gender Differences in Coping with Stress

Stress affects women more than men. Females demonstrate higher rates of fatigue and mental and physical illnesses as compared to men (Djindinjic et al, 2013). If women are given a sense of autonomy and freedom to interact freely with workmates, it is likely that their stress levels will reduce as they become more satisfied with their work. Furthermore, occupational stress depressive symptoms are correlated to gender with men experiencing less depression than women. Male healthcare workers employ maladaptive strategies to cope with stress as women use adaptive and passive strategies. However, other researchers have discovered no substantial distinction between the way male and female healthcare employees handle stressful situations because of a strong correlation existent between job satisfaction and forms of social support (Mark et al., 2012).

Age Difference and Coping with Occupational stress

Age-related distinction in reaction to stressors is evident in mental and physical capabilities of healthcare workers. Older employees are faced with multiple challenges especially if they are required to perform multiple tasks beyond their abilities (Chang et al., 2015). Even though they are experienced in handling stress, old workers are delicate beings mostly vulnerable to health conditions hence escalation of stress levels, unlike young people who are energetic and ready to execute complex tasks.

In summary, it is clear that stress is part and parcel of the healthcare environment. Employees such as nurses and doctors are faced with stressful situations on a daily basis, given the demands of their workplace and a requirement for them to deal with extreme cases of illnesses, injuries and emergencies. However, employing effective coping and stress management strategies helps them to be satisfied with their jobs and to avoid burnout.

References

Aghdasi, S., Kiamanesh, A. R., & Ebrahim, A. N. (2011). Emotional Intelligence and Organizational Commitment: Testing the Mediatory Role of Occupational Stress And Job Satisfaction. Procedia-Social and Behavioural Sciences, 29, 1965-1976.

Arnetz, B. B., Lucas, T., & Arnetz, J. E. (2015). Organizational Climate, Occupational Stress, and Employee Mental Health: Mediating Effects of Organizational Efficiency. Journal of Occupational and Environmental Medicine, 53(1), 34-42.

Backé, E. M., Seidler, A., Latza, U., Rossnagel, K., & Schumann, B. (2014). The Role of Psychosocial Stress at Work for the Development of Cardiovascular Diseases: A Systematic Review. International Archives of Occupational and Environmental Health, 85(1), 67-79.

Chang, S. J., Koh, S. B., Kang, D., Kim, S. A., Kang, M. G., Lee, C. G., ... & Kim, J. W. (2015). Developing an Occupational Stress Scale for Korean Employees. Korean Journal of Occupational and Environmental Medicine,17(4), 297-317.

Djindjic, N., Jovanovic, J., Djindjic, B., Jovanovic, M., & Jovanovic, J. J. (2012). Associations Between the Occupational Stress Index and Hypertension, Type 2 Diabetes Mellitus, and Lipid Disorders in Middle-Aged Men And Women. Annals of Occupational Hygiene, mes059.

Kim, B. N., Oh, H. S., & Park, Y. S. (2014). A Study of Nurses' Resilience, Occupational Stress and Satisfaction. Korean Journal of Occupational Health Nursing, 20(1), 14-23.

Kompier, M. A., Taris, T. W., & Van Veldhoven, M. (2014). Tossing and Turning-Insomnia in Relation to Occupational Stress, Rumination, Fatigue, and Well-Being. Scandinavian Journal of Work, Environment & Health, 238-246.

Kwon, K. J., & Lee, S. H. (2011). Occupational Stress and Coping Styles as Factors Affecting the Burnout of Clinical Nurses. Journal of Korean Academy of Nursing Administration, 18(4), 383-393.

Lesage, F. X., & Berjot, S. (2013). The validity of Occupational Stress Assessment Using a Visual Analogue Scale. Occupational medicine, kqr037.

Mark, G., & Smith, A. P. (2012). Effects of Occupational Stress, Job Characteristics, Coping, and Attributional Style on the Mental Health and Job Satisfaction of University Employees. Anxiety, Stress & Coping, 25(1), 63-78.

Mark, G., & Smith, A. P. (2012). Occupational Stress, Job Characteristics, Coping, and the Mental Health of Nurses. British journal of health psychology, 17(3), 505-521.

Nikolaou, I., & Tsaousis, I. (2013). Emotional Intelligence in the Workplace: Exploring Its Effects on Occupational Stress and Organizational Commitment. The International Journal of Organizational Analysis, 10(4), 327-342.

Tomioka, K., Morita, N., Saeki, K., Okamoto, N., & Kurumatani, N. (2014). Working Hours, Occupational Stress and Depression among Physicians. Occupational Medicine, 61(3), 163-170.

Tsutsumi, A., Kayaba, K., & Ishikawa, S. (2011). The impact of Occupational Stress on Stroke across Occupational Classes and Genders. Social Science & Medicine, 72(10), 1652-1658.

Webster, J. R., Beehr, T. A., & Love, K. (2011). Extending the Challenge-Hindrance Model of Occupational Stress: The Role of Appraisal. Journal of Vocational Behaviour, 79(2), 505-516.

Xie, Z., Wang, A., & Chen, B. (2011). Nurse burnout and its association with occupational stress in a cross‐sectional study in Shanghai. Journal of advanced nursing, 67(7), 1537-1546.