NIOSH: Take steps to reduce hazard of stress

Health workers need more than coping strategies

It just takes an evening of viewing the television drama ER to know that hospital work is stressful. But the stress that evolves into an occupational hazard isn't from treating trauma victims or mysterious illnesses.

The stressful work environment — inadequate staffing, long hours, poorly defined roles, lack of communication — can lead to physical, behavioral, and psychological problems, including high blood pressure, sleeplessness, absenteeism, job dissatisfaction and depression. It also can impair performance and affect the interaction between employees and patients.

The National Institute for Occupational Safety and Health (NIOSH) provides an overview of stress as a hazard in hospitals and possible interventions in a brochure on Exposure to Stress. The brochure is part of a series on occupational hazards in hospitals (

"Many people think it's just part of the job that they have to deal with, [but] it is important to look at occupational stress as an occupational hazard," says Naomi Swanson, PhD, chief of the organizational science and human factors branch at NIOSH in Cincinnati.

Techniques and interventions

Despite the inherent challenges in health care, stress can be reduced both through stress management techniques and organizational interventions, Swanson says. Stress management techniques include exercise, meditation and relaxation, and coping mechanisms. But that is not enough, according to NIOSH. "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."

NIOSH encourages organizational changes that:

• ensure that the workload is in line with workers' capabilities and resources;

• clearly define workers' roles and responsibilities;

• give workers opportunities to participate in decisions and actions affecting their jobs;

• improve communication;

• reduce uncertainty about career development and future employment prospects;

• provide opportunities for social interaction among workers.

Multidisciplinary care teams — for example, composed of physicians, nurses, pharmacists, managers — can improve communication and give frontline workers a greater opportunity for input. The most successful interventions in hospitals involve "teams of employees identifying problems within the workplace and recommending solutions," says Swanson.