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Occupational stress


All work environments have the potential to cause stressful situations, but are healthcare settings particularly demanding? According to a 2008 report by the National Institute of Occupational Safety and Health, studies indicate healthcare workers have higher rates of substance abuse and suicide than other professions. They also have elevated rates of depression and anxiety linked to job stress. Chronic stress also may lead to physical illness and injury. Other illnesses commonly associated with chronic stress include high blood pressure, stomach ulcers, migraines, panic attacks, and insomnia. Some studies have linked chronic stress to cancer. Mental health disorders often rank as the first or second most common cause of extended sick leave, exceeded only by musculoskeletal disorders.
Multiple factors have been associated with stress specific to the nursing profession. The nursing shortage and inadequate staffing levels lead to work overload and time pressure. Shift work and long work hours may result in sleep deprivation, making adaptation to heavy work loads more difficult. Safety and health issues, such as exposure to infectious and hazardous substances, needlestick injuries, and exposure to work-related violence or threats, contribute to work­place stress. Organizational factors that may lead to stress include role ambiguity, low decision latitude, effort-reward imbalance, career development issues, and lack of social support at work. Nursing care also can impose high psychological demands, such as dealing with difficult or seriously ill patients.
To preserve and maintain health, nurses must assess their level of and response to stress. Many signs and symptoms indicate cumulative stress, including sleep disturbances, changes in eating pattern, increase in smoking or alcohol consumption, avoidance of social situations, and sexual difficulties. More subtle indicators of stress include irritability, apathy, poor concentration, and indecisiveness. Nurses experiencing cumulative stress may require intervention by a healthcare professional.
An essential way to cope with stress is to maintain personal physical and mental health. Assertive be­havior, adequate social support, self-efficacy, re­­silience, and optimism are traits common to those able to cope effectively with stressful work and personal situations. To achieve a work/life balance, nurses (who are experienced in promoting their patients’ health) must learn to enhance and protect their own well-being by maintaining physical and emotional health. Strategies to achieve a work/life balance include:
•    getting regular exercise
•    eating a balanced diet
•    managing time efficiently
•    communicating assertively
•    using relaxation or meditation techniques
•    finding humor in stressful situations.
Organizational change is another effective strategy for reducing occupational stress. Research suggests that organizational approaches are more successful in enhancing the work environment, with improvements that are more sustainable over time compared with individual approaches. By offering less stressful work environments, employers benefit through reductions in absenteeism, presenteeism (coming to work despite illness), turnover, workplace injuries, and errors. Successful organizational stress interventions must involve workers at all stages of intervention (planning, development, implementation, and evaluation) and must have significant commitment from leadership. Efforts to decrease workloads, enhance staffing levels, create healthy work schedules, maintain safe working environments, provide health promotion programs, and offer career development opportunities are examples of organizational solutions to reduce occupational stress.
Nurses dedicate their time at work to enhancing the health status of their patients. Nurses’ own wellness needs must be a priority to ensure lifelong health and work/life balance.

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Katie E. Slavin is a Senior Staff Specialist in ANA’s Center for Occupational and Environmental Health.

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