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Environment, health, & safety


Challenges are motivating. When we meet and overcome challenges, we learn new skills that help us master our job. However, challenges shouldn’t be confused with job stress. Both challenges and stress present some level of initial discomfort, but challenges energize us psychologically and physically, whereas stress is detrimental. According to the National Institute for Occupational Safety and Health, this is because stress triggers harmful physical and emotional responses if the requirements of the job don’t match the capabilities, resources, or needs of the worker.

The 2001 Health and Safety Survey of the American Nurses Association (ANA) found that acute and chronic effects of stress and overwork were the top health and safety concerns for nurses. Similar surveys in 2007 and 2008 confirmed the earlier findings.

Many stressors contribute to these results. They include time pressure, lack of sleep, fatigue, role ambiguity and conflict, exposure to infectious or hazardous substances, lack of social support, exposure to workplace violence, and career development issues.

The relationship between job stress and ailments has been studied for years. Early warning signs of job stress include headache, difficulty concentrating, short temper, upset stomach, job dissatisfaction, and low morale. Research suggests that some psychological disorders, such as depression and burnout, stem partly from job stress levels.

Effects of job stress also can be behavioral, as manifested by sleep problems, absenteeism, or presenteeism (when an employee shows up for work but is distracted or not mentally present). Such environmental stressors as odor, noise, air quality, amount of ambient light, and workplace temperature, humidity, and aesthetics (including wall color) can influence nurse job satisfaction and may be an incentive to change jobs.

Ways to mitigate stressors

Wellness programs are increasing within healthcare organizations. One goal of these programs is to create a healthy, less stressful workplace. Achieving this goal leads to higher levels of productivity, as individual healthcare workers begin to feel valued and can better concentrate on their work.

An organization-wide response to reducing stressors is not a one-step process, and requires buy-in at all levels. It begins with an evaluation of employees’ perceptions about the workplace, including health concerns and job satisfaction. Every workplace is unique, so it’s critical to perform a workplace assessment. Interventions to introduce after this assessment may include improving definitions of roles and responsibilities, redesigning jobs, improving communication and report mechanisms, increasing staff participation in decisions, reducing career uncertainty, and increasing opportunities for social interaction.

Nurse administrators have a particular responsibility in creating healthy work environments and assisting with management of job stress in the workplace. According to ANA’s Code of Ethics, “The nurse participates in establishing and maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.”

Of course, individuals can take actions to reduce their own stress level. These include learning coping strategies, such as progressive relaxation techniques, and improving time management. Individuals also should strive to improve interpersonal skills, as this helps to communicate their needs and set boundaries with others. This, in turn, reduces miscommunication that can result in stressful interactions with colleagues.

Another option is a technique that incorporates bio­feedback and mindfulness-based stress reduction. With this approach, the individual learns to become more aware of his or her thoughts, feelings, and body sensations and to relate to them differently. This improved awareness of the “here and now” helps the person become more “mindful” and better able to see with discernment. Individuals also learn to let go of the past and fears about the future.

Whatever method of stress reduction an organization or individual uses, it’s clear that confronting job stress can lead to a healthier workforce and better nurse retention, which ultimately provides a benefit to patients as well. To learn more, go to

Nancy L. Hughes is the director of ANA’s Center for Occupational and Environmental Health.

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