Helping health care workers cope with stress

'This is costing employers a lot of money'

Health care workers are more stressed-out than workers from any other industry. They have high rates of depression. And while their challenges may seem to be personal ones, health care employers are beginning to recognize that mental health is a workplace concern, too.

Having an Employee Assistance Program (EAP) that relies solely on employees to seek counseling and other help isn't enough, says Clare Miller, director of the Partnership for Workplace Mental Health, which is part of the American Psychiatric Foundation. Employers need to be proactive in offering help, she says. To support employers, the Partnership has just released a new toolkit through its educational initiative, The Right Direction (

"The reality is that this is costing employers a lot of money — that's the business case [for addressing stress and depression]. But there's also a human reason," she says. "Employers realize more and more that they have a role in helping people get the care they need."

Workplace factors such as staffing and scheduling contribute to fatigue, stress and depression — and conversely, mental health issues lead to a loss of productivity.

An integrated approach to mental health incorporates the traditional EAP with wellness and occupational health to build resilience among employees, says Marguerite Wood, LICSW, director of the Employee Assistance & Wellness Program at South Shore Hospital in South Weymouth, MA.

Stress is a way of life in health care, but South Shore Hospital wants to buffer that with coping skills. "We want people in our field to have the ability to flourish and have ultimate functioning despite the stresses," she says.

More than 10% want help

About one in nine health care employees who contact their EAP are looking for help with stress and anxiety – more than any other industry, according to a report by ComPsych Corp. in Chicago, a global provider of EAP services.

About two in five calls to EAP from health care workers involve concerns about depression or other psychological issues, ComPsych found in an analysis.

As employers increasingly provide programs for chronic disease prevention such as health coaching and wellness activities, employees also seek similar assistance for mental health issues, says Miller.

"Employees actually want information from employers about health," she says. "They look to the employer for some of that help and support."

That is exactly what South Shore Hospital seeks to provide with its Self Care in Health Care program. The traditional debriefings that occurred to help staff deal with the aftermath of trauma care and stressful work situations just weren't enough, says Wood.

"We realized that our staff was faced with tremendous stress, just in delivering health care services, but they didn't have the skills to manage it," she says.

'Building community in the workplace'

South Shore sought to create a toolbox of coping strategies that draw from evidence-based modalities: Cognitive behavior therapy focuses on changing negative or irrational thoughts. Positive psychology teaches optimism and gratitude. Mindfulness-base stress reduction uses meditation techniques. And the relaxation response encourages a state of deep rest.

In a pilot study, Wood and her colleagues gathered a small, randomized group of nurse managers. Twelve of them logged the time they spent in mindfulness training and kept a gratitude journal. They also completed a pre- and post-questionnaire called the Perceived Stress Scale. Five served as a control group.

The nurse managers in the intervention group had a four-hour training in which they learned about the brain and the impact of stress, coping modalities and the effectiveness of stress reduction. Then they met for 90 minutes each week for three months.

"We did a lot of role playing," says Anna Micci, LICSW, and EAP consultant. "They brought issues and we worked together on them as a group."

Before the intervention, the nurse managers registered twice the stress as would be expected compared to the general population. After the intervention, the stress levels of the control group continued to rise, while the stress level of the intervention group declined slightly.

The nurse managers placed the greatest value on the group support. "It's building community in the workplace," says Wood.

Maintaining the support groups and coping skills is a challenge, but South Shore is planning to offer follow-up sessions this fall.

Hospital leadership has remained committed to the stress reduction program — which is a key to its success, says Wood. The hospital's EAP is also integrated with the employee wellness program. "It's a mind-body approach," she says.