HCWs are nation’s most stressed workers
High work load, long shifts lead to burnout
Health care workers are more stressed than workers in any other industry, a recent survey found.
The finding made national headlines, mirroring other recent studies of worker stress. It is a bellwether of problems that could affect both patient care and worker health, says Naomi Swanson, PhD, chief of the Organization Science and Human Factors branch of the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati.
"The turnover rate among nurses can be very high, and burnout is one of the main reasons they give [for leaving]. All these stressors are major contributors to burnout," she says. "If we’re going to keep our nursing and health care workforce, we definitely need to deal with these issues."
Researchers can cite a list of factors: compassion fatigue, long shifts with few breaks, understaffing and high acuity of patients, even bullying and workplace violence. But employers should survey their own workers to find the problem areas and possible solutions, Swanson and others say.
"It’s vital to ask your employees," she says. "One organization may have issues with communication. Another organization may have issues with how work is distributed. They need to be able to recognize that and recognize the correct solution."
Survey: One in four HCWs plan to quit
Last fall, the national survey firm Harris Interactive asked about 3,200 workers about stress. Some 69% of health care workers reported feeling stressed and 17% said they were "highly stressed," according to CareerBuilder Healthcare, the survey sponsor.
Survey results also indicated a cause of the stress 55% of HCWs surveyed said their workload has gone up in the past year and as a result, 25% said they plan to change jobs in 2014.
As employers evaluate the stress level and its causes, they should solicit input from employees, says Jason Lovelace, president of CareerBuilder Healthcare. "It’s the responsibility of the employers to take a close look and make sure people are not being overworked," he says. "Highly stressed workers would be very concerning to me if I were an employer."
Nurses also have reported their concerns about stress in surveys by the American Nurses Association. In a 2011 health and safety survey of more than 4,600 nurses, the nurses cited the acute and chronic effects of stress as their top health and safety concern at work.
Stress also rises to the top of health concerns in an ongoing Health Risk Appraisal conducted by the ANA. Of almost 2,700 nurses responding to a question about stress, 80.6% said that "In my current work environment, I feel I am at a significant level of risk for workplace stress."
The Health Risk Appraisal is designed to provide feedback to nurses about their occupational and personal risk factors. In its aggregate data, Carpenter notes that the Health Risk Appraisal offers a "snap shot" of working and student registered nurses. ANA hopes to eventually gather the input from 30,000 nurses. (For more on the Health Risk Appraisal, see HEH, February 2014, p.21.)
"The most important thing employers can provide to reduce stress is a safe and healthy workplace, along with offering wellness promotion," says Holly Carpenter, BSN, RN, senior staff specialist for nursing practice and work environment at the ANA in Silver Spring, MD.
Employers can tap into the concerns of their own employees by providing a confidential survey or small discussion groups, suggests Swanson. Consulting firms or local universities can provide expertise to structure a survey tool, she says. Strategies can then be tailored to the needs of employees, she says.
"The primary issue is to find ways to reduce the stressors that are present," she says. For example, nurses may need shorter shifts or more breaks and fatigue-reducing strategies, she says.
Sleep deprivation adds to burden
The personal health habits of health care workers also play an important role in stress. About one-third of health care workers get six hours of sleep or less in a 24-hour period and about half (52%) of HCWs on the night shift have a short duration of sleep.1 The National Sleep Foundation defines healthy sleep as seven to nine hours per day.
Employers can provide education through a health promotion program and counseling through an employee assistance program. But the workplace design should encourage healthy habits, says Carpenter. Healthy food should be available for all shifts, and employees should have time for breaks, she says.
Nurses also benefit from a place to recharge, perhaps with deep-breathing, relaxation techniques, or even a quick nap, she says. That space could vary from a nap room, private break room, or even a small chapel, she says.
Resilience helps nurses get through times of stress, she says. "That can come from support groups or some other sharing mechanism. Sometimes it’s just a good friend," she says.
There are some positive signs in the research about HCWs, despite their stressful work lives. Health care employees are passionate about their work, and overall are more satisfied with their jobs than workers in other industries, says Lovelace.
"They really believe they’re making an impact," he says. "They’re there for a reason, and they see the results of their work firsthand."
Teamwork, communication and a balanced work load can help employees reduce stress — and the serious health risks that go with it, says Swanson. Stress has been associated with depression and cardiovascular disease, and fatigue leads to a higher risk of medical errors, she says.
Greater awareness of the impact of stress could lead employers to be more proactive, says Swanson. Shift work, scheduling and staffing have an overriding impact on the work life of nurses, she says.
For optimal patient care, "you want [nurses] to be at peak performance," says Swanson. "Employers need to invest in their workforce."
- Centers for Disease Control and Prevention. Short sleep duration among workers — United States, 2010. MMWR 2012;61:281-285.
