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OJHAS Vol. 10, Issue 1:
(Jan-Mar 2011) |
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| Understanding
Job Stress among Healthcare Staff |
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Dola Saha, Assistant
Professor,
Rajesh
Kumar Sinha, Associate
Professor,
Kankshi Bhavsar,
Department of Health Information Management, Manipal
College of Allied Health Sciences, Manipal University, Manipal
– 576 104, Karnataka, India. |
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Address for Correspondence |
Associate Professor,
Department of Health Information Management,
Manipal
College of Allied Health Sciences,
Manipal University,
Manipal
– 576 104,
Karnataka, India.
E-mail:
rajesh.sinha@manipal.edu |
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Saha D, Sinha R, Bhavsar K. Understanding
Job Stress among Healthcare Staff. Online J Health Allied Scs.
2011;10(1):6 |
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Submitted: Jan 22,
2011 Accepted: Mar 31, 2011; Published: April 15, 2011 |
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| Abstract: |
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Introduction:
Job life is an important part of a person’s daily life. There are
many aspects of a job. A person may be satisfied with one or more aspects
of his/her job but at the same time may be unhappy with other things
related to the job. Objective:
To evaluate the sources of job stress (stressful aspects of work) among
the staff of a super specialty hospital & to suggest measures to
decrease level of job stress. Methodology: Descriptive study
employing 381 staff members of a super specialty hospital using a structured
personal interview questionnaire consisting of 21 sources of stress.
The hospital staff was asked to rate each item according to the extent
to which it had contributed to their stress as experienced in their
jobs in the past few months on a scale of 0 (not at all),1(a little),
2(quite a bit), 3 (a lot). A global rating of stress was also obtained.
Result: The prime sources of stress were found to be underpayment
(76%), excessive workload (70.3%), inadequate staff (48.6), & being
involved in the emotional distress of patients (46.7%). Conclusion:
The staffs of the hospital were in moderate stress due to the prime
stressors so adequate measures should be taken to alleviate these stressors.
This could be achieved through workload management, job redesign, &
by offering occupational health education.
Key Words:
Stress; Hospital, Satisfaction
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The Health
care systems are undergoing major structural and financial changes.
Ongoing changes in health care delivery system include an increase in
the complexity of cases, available treatment options and better informed
patients, computer surveillance of production, fewer health and retirement
benefits, and the feeling that professionals themselves have to work
longer and harder just to maintain their current economic status.1 These trends strongly influence the workplace environment
and are a potential source of stress and burnout among clinical and
non-clinical professionals working at the hospitals.
A descriptive
study was carried out at a 350-beded super specialty hospital for a
period of 5 months. The study included all the staff of the hospital
present at the time of the study including doctors, nurses, operation
theater staff, administrative and support staff, and therapeutic and
diagnostic staff (physiotherapists, laboratory technicians, radiologists,
radiographers, pathologists, microbiologists, and orthotics staff).
Housekeeping staff of the hospital, who were on contract, were excluded
from the study.
The questionnaire
used for the study was adapted from The Hospital Consultants’ Job
Stress and Satisfaction Questionnaire (HCJSSQ), 2002. The questionnaire
was customized by appropriate selection of questions & validated
by 5 experts (General Administrator, 2 physicians, Nursing Superintendent,
Human Resource manager). The questionnaire consisted of 21 questions
on sources of stress. The hospital staff were asked to rate each item
according to the extent to which it had contributed to the stress they
experienced in their jobs in the past few months on a scale of 0 (not
at all),1(a little), 2(quite a bit), 3 (a lot). Global rating of stress
was also obtained. In-depth observation of all the departments of the
hospital with consensus of the administrators was done & the data
was collected by means of structured personal interview questionnaire.
The relative
importance of different sources of stress was assessed by calculating
the percentage of staff reporting each item as contributing “not at
all” to “a lot” to their job stress. This was analyzed categorically
according to the percentage of scoring at each point on the scale.
1. Demographic Characteristics of the
respondents
A total of
381 staff including 59 doctors, 115 nurses, 54 Administrative Staff,
46 supportive staff, 49 Therapeutic and Diagnostics staff, 48 Operation
Theatre Staff, and 10 Pharmacist participated in the study. (Table 1)
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Table 1:
Category-wise Distribution of Staff |
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Staff Categories |
Number |
Percentage
(%) |
| Doctors |
59 |
15% |
| Nurses |
115 |
30% |
| Administrative
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54 |
14% |
| Supportive
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46 |
12% |
| Therapeutic
& Diagnostics |
49 |
13% |
| OT |
48 |
13% |
| Pharmacy |
10 |
03% |
| Total
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381 |
100% |
2. Overall
Stress Score Frequency
Out of the
total population of 381 staff members, 17.8% (n=68) reported “none”
to “a little” overall stress levels and 7.1% (n=27) reported “none”
to “a little” overall satisfaction levels. As the objective of the
study was to evaluate the sources of stress among the staff who were relatively
stressed with their jobs, the above mentioned members were excluded
from further data analysis. (Table 2)
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Table 2: Overall stress score frequencies |
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Score |
Frequency |
Percentage
(%) |
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0
- Not at all |
20 |
5.2 |
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1 |
48 |
12.6 |
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2 |
133 |
34.9 |
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3 |
129 |
33.9 |
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4
– Extremely |
51 |
13.4 |
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Total |
381 |
100 |
3. Source of
Stress
Table 3 summarizes
the response (in percentage) of members reporting source of stress as
contributing “quite a bit” or “a lot” to overall job stress
in a descending order. The prime sources of stress, according to the
present study were underpayment (76%), excessive workload (70.3%), inadequate
staff (48.6), & being involved in the emotional distress of patients
(46.7%).
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Table 3: Sources of stress in descending order |
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Source of stress |
Response
Rate (%) |
| Feeling poorly
paid for the job |
76 |
| Having too
great an overall volume of work |
70.3 |
| Having inadequate
staff to do the job properly |
48.6 |
| Being involved
with the emotional distress of patients |
46.7 |
| Having inadequate
facilities (eg. Equipment, space) to do the job properly |
39.6 |
| Disruption
of home life through spending long hours at work |
34.8 |
| Having to
comply with increasing bureaucratic and regulatory procedures |
33.5 |
| Dealing with
patients or relatives having expectations that cannot be me |
33.2 |
| Having to
deal with angry, distressed or blaming relatives |
32.9 |
| Feeling under
pressure to meet deadlines |
30 |
| Being responsible
for the quality of work of other staff |
29.1 |
| Feeling you
have insufficient input into the management of your department or institution |
28.4 |
| Having to
take on more managerial responsibilities |
28.1 |
| Encountering
difficulties in relationships with staff of other department |
26.8 |
| Feeling that
the accumulated skills and expertise are not being put to their best
use |
26.6 |
| Encountering
difficulties in relationship with colleagues |
26.5 |
| Uncertainty
over the future funding of one’s department |
24.6 |
| Encountering
difficulties in relationship with managers |
23.6 |
| Having performance
targets which are unrealistic or unattainable |
22.7 |
| Being responsible
for the welfare of other staff |
21.1 |
| Disruption
of home life as a result of taking paperwork home |
12.1 |
3.1. Feeling
poorly paid for the job
Whopping 76%
(n=290) reported that they felt underpaid & it consecutively contributed
to their stress. Cooper (1983) identified 6 major categories of occupational
stress, this source fall under the category of “Job specific factor”.
According to the study “the greatest stress factors stemmed
from underpayment”.1,2
3.2. Having
too great an overall volume of work
About 70.3%
(n=268)members reported that the overall volume of their work was excessive.
Employees’ report that they are often stressed when they have too
little or too much to do.2 This is in conformance with
the study done by Al-Aameri, A. S “Source of job stress for nurses
in public hospitals” in which it is mentioned that one of the six
factors of occupational stress is pressure originating from workload.3 According to the study done by
Nilufar Ahsan “A Study of Job Stress on Job Satisfaction among University
Staff in Malaysia: Empirical Study “ the relationship between workload
pressure and job stress is significant
& that organization factors such as workload and working condition
were negatively related with job satisfaction.4
3.3. Having
inadequate staff to do the job properly
Approximately
48.6% (n=185) members, mostly junior doctors, nurses, billing &
marketing department staff, reported that being under-staffed contributed
“quite a bit” to “a lot” to their stress.
3.4. Being
involved with the emotional distress of patients
This is one
of the prime factors adding to the stress of around 46.7% (n=178) of
the population. This is in accordance with earlier studies which found
that job stress stemmed from “stress by compassion” e.g. "long
suffering of patients".1,5
3.5. Having
inadequate facilities to do the job properly
For 39.6% (n=151)
members, the above source contributed much to their stress whereas for
60.4% (n=230) it contributed “not at all” or “a little” to their
stress. Studies show that sometimes work setting creates physical stress
because of noise, lack of privacy, poor lighting, poor ventilation,
poor temperature control or inadequate sanitary facilities.6
3.6.
Disruption of home life through spending long hours at work
Out of the
total staff evaluated, 34.8% (n=133) reported the above stressor as
contributing “quite a bit” to “a lot” to their stress. Long
hours of work may result in difficulty dealing with responsibilities
at home, visiting friends, or pursuing a hobby that in turn contributes
to stress.7 According to the study “Job stress and job
satisfaction of physicians, radiographers, nurses and physicists working
in radiotherapy: a multicenter analysis by the DEGRO Quality of Life
Work Group” physicists expressed “reduction of
private life through high workload” as a source of stress.1
3.7. Having
to comply with increasing bureaucratic and regulatory procedures
Out of the
total population, 33.5% (n=128) reported that the above factor contributed
“quite a bit” to “a lot” to their stress. The hospital was preparing
for NABH accreditation during the period of the study which had resulted
in many changes being implemented in procedures & policies. Many
of these were relatively new to the staff and were contributing as a
potential source of stress.
3.8. Dealing
with patients or relatives having expectations that cannot be met
Studies have
shown that when expectations are realistic, life feels more predictable
and therefore more manageable. There is an increased feeling of control
because one can plan & make decisions accordingly.8
In this setting too, it was seen that around 33.2% (n=126) respondents
reported that dealing with unrealistic patient expectations added “quite
a bit” to “a lot” to their stress.
3.9. Having
to deal with angry, distressed or blaming relatives
Dealing with
angry, distressed or blaming relatives contributed “quite a bit”
to “a lot” for 32.9% (n=125) of population, to their stress. Staff
of front office, nursing, pharmacy & doctors are commonly in direct
contact with the patients. Any delay in providing the service or lack
of information creates a distress among the patients or relatives that
may contribute to the stress of these members.
3.10.
Feeling under pressure to meet deadlines
Of the total
respondents, 70% (n=267) reported that pressure to meet deadlines did
not add much to their stress. The affected 30% (n=114) were staff of
accounts, billing, insurance, help desk and orthotics departments at
the hospital as they have strict deadlines to complete their assigned
tasks.
3.11. Being
responsible for the quality of work of other staff
Only 29.1%
(n=111), especially the top managers & Head of Departments who were
responsible for the quality of work done by their staff, reported stress
due to this stressor.
3.12.
Feeling you have insufficient input into the management of your department or
institution
Only 28.4%
(n=108) reported that it contributed “quite a bit” or “a lot” to their stress.
It was observed that Staff members are willing to put in extra effort for
development of the organization & there is a high sense of belonging towards the
hospital.
3.13. Having
to take on more managerial responsibilities
For about 28.1%
(n=107) of the respondents having to take on more managerial responsibilities
contributed “quite a bit” to “a lot” to their stress.
This is in conformance with the study done by Al-Aameri, A. S “Source
of job stress for nurses in public hospitals” in which “managerial
roles” was one of the sources of stress among the nurses.3
Therefore, managers need to divide responsibilities & help employees
prioritize work that must be done.9
3.14.
Encountering difficulties in relationships with staff of other department
Around 26.8%
(n=102) stated that facing difficulties with staff of other department
contributed quite a lot to their stress. Cooper(1983) identified 6 major
categories of occupational stress, this source fall under the category
of “ relationships at work”.
Being disagreeably
treated by fellow workers was one of the reasons for stress among the
nursing assistants. This is in conformance with study conducted by Marina
Kaarna at Paarnu Hospital, Estonia.7
3.15.
Feeling that the accumulated skills and expertise are not being put to their
best use
For 26.6% (n=101)
of the respondents a feeling that their skills are not being put to
best use consecutively resulted in stress; whereas, 73.4% reported the
above factor as contributing not much to the stress.
An individual’s
skills & knowledge will not be put to its best use when he/she is
poorly managed or resourced and hence worker empowerment is necessary
to reduce this factor.
3.16.
Encountering difficulties in relationship with colleagues
Though a majority
of respondents did not face much difficulty in dealing with their colleagues,
but 26.5% (n=101) found this to contribute “quite a bit” to “a
lot” to their stress”. Though most of the staff claimed to have
a clear understanding and a feeling of trust among themselves, still
it was found that distinct personalities & working habits did sometimes
influence the interaction among colleagues.
3.17.
Uncertainty over the future funding of one’s department
It was found
that only around 24.6% (n=94) stated that the future funding of one’s
department contributed to their stress. This factor was found to mainly
influence the orthotic and maintenance departments of the hospital.
3.18.
Encountering difficulties in relationship with managers
Relationship
with the superiors includes opportunity to talk, trust on the superior
with personal or work related concerns, being well informed & updated
about work & being supportive.7 The study shows that
encountering difficulties with managers contributed “quite a bit”
to “a lot” of stress to 23.6% (n=90) of the respondents.
3.19. Having
performance targets which are unrealistic or unattainable
Rapidly changing
global scene is increasing the pressure of workforce to perform maximum
output and enhance competitiveness. Indeed, to perform better to their
job, there is a requirement for workers to perform multiple tasks in
the workplace to keep abreast of changing technologies.10
The ultimate results of this pressure have been found to be one of the
important factors influencing job stress in their work.11
The present study too found that approximately 22.7% (n=86) respondents
stated that the above factor contributed a lot to their stress. These
include unrealistic expectations of superiors & colleagues.
3.20. Being
responsible for the welfare of other staff
Being responsible
for the welfare of other staff contributed “not at all” to “a
little” to the stress in 78.9% (n=301) people & 21.1% (n=80) reported
otherwise. This is one of the managerial responsibilities that mainly
influence top & middle managers.
3.21.
Disruption of home life as a result of taking paperwork home
Disruption
of home life as a result of taking paperwork home did not add much to
the stress in 87.9% (n=335) people & only 12.1% (n=46) reported
otherwise.
The prime sources
of stress among the staff were found to be excessive workload, underpayment,
inadequate staff & being involved in emotional distress of patients.
Therefore, it was recommended to the management to look into the staffing
matters. It was also recommended that salary should be reviewed and
that they should be promoted as and when due.
Workload management
is one of the vitally important factors of job satisfaction. The following
points, as propagated by Canadian Centre for Occupational Health &
Safety, could be followed for better workload management: Time management;
activity logs- Identifying where time is wasted in working life; to
do lists- Focusing attention on the most important tasks; delegation;
and most importantly learning to relax.
Since job design
was found to be an important factor contributing to stress of the employees,
it was suggested that there should be some degree of social support
and recognition in the workplace and the employee should feel that the
job leads to some sort of desirable future
Most importantly,
not to forget that elements of the workplace itself can be a cause of
stress. Stress management training and counseling services can be helpful
to individuals. Look for the root cause of the stress and address them
as quickly as possible.
The study conducted
to identify sources of stress in healthcare personnel of each category
showed that the prime sources of stress were underpayment, excessive
workload, inadequate staff, & being involved in the emotional distress
of patients. It has been found that a proper workload management
policy, adequate delegation of authority along with responsibility,
recognition of efforts along with ongoing training, stress and time
management will go a long way in managing stress in these personnel.
- Sehlen
S et al. Job stress
and job satisfaction of physicians, radiographers, nurses and physicists
working in radiotherapy: a multicenter analysis by the DEGRO quality
of life work group. Radiation Oncology 2009;4:6
Shakir S et al.
Job satisfaction among doctors working at teaching hospital of Bahawalpur,
Pakistan. Journal of Ayub Medical College Abbottabad 2007;19(3):42-45
Al-Aameri
AS. Source of job
stress for nurses in public hospitals. Saudi Medical Journal. 2003 Nov;24(11):1183-1187.
Ahsan N et al.
A study of job stress on job satisfaction among university staff in
Malaysia: Empirical Study. European Journal of Social Sciences 2009;
8(1): 121-131
Ramirez
AJ, Graham J, Richards MA, Cull A.
Mental health of hospital consultants: the effects of stress and satisfaction
at work. Lancet 1996; 347(9003):724-728.
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http://health.discovery.com/centers/stress/articles/stressinworkplace/stressinworkplace_02.html Accessed May 12th, 2010
Kaarna M. The
importance of job satisfaction in hospital quality process. MPH 2007:4.
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http://www.nhv.se/upload/dokument/forskning/Publikationer/MPH/2007/MPH2007-4_Marina_Kaarna.pdf. Accessed July 20th, 2010
Posen DB. Stress management
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Dale Collie. Overcome
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http://www.ezinearticles.com/?overcome-the-top-10-causes-of-workplace-stress&id=1202. Accessed July 20th, 2010
Cascio WF.
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