Job induced stress and management strategy among Healthcare Workers

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Stress is a multidimensional concept which is originally derived from the Latin word, “stringere” which refers to draw tight, to describe hardships and/or affliction (Cooper & Cartwright, 1997). It often occurs when individuals' physical and emotion do not match or cannot handle their job demands, constraints, and/or opportunities.
Stress is one of the most severe occupational risks and according to world health organization “work related diseases area wide spectrum of disease of multifactorial etiology which is partly associated with profession or working condition” (Milutinovic, Golubovic, Brkic & Prokes, 2012). Stress can because by acute or chronic physical and psychosocial stressors related with both personal and work lives (Yeboah, Ansong, Henry, Yiranbon, Anyan, et.al., 2014). Health care professionals usually affected with workplace stress due unique work responsibilities. Workplace stress led to decline in health status, work related injuries, (Salam, Abu-Helalah, Jorissen, Niaz, Mansour, et.al., 2014) worker-burnout and several physical and emotional problems (Al-Omar, 2003). Poor physical and mental outcomes are associated with high workload, conflict with colleagues, high job demands, poor supervision and lack of support (Khamisa, Oldenburg, Peltzer & Ilic, 2015). Health care profession is the one of the most demanding profession which faces and works under stress full environment to improve quality and productivity (Nishshanka, Akilendran & Muraleeswaran, 2016). Stress occurs when individual feel that they can not cope with the demands of work due to lack of experience, work ability or personality (Al Haddad, Al Mansur & Al Momatin, 2016). Work related stress occurs when conflict arises from the job demands and employees unable to handle it properly, the stress can become distress (Al-Makhaita, Sabra & Hafez, 2014).
Researchers identified six work-related stressors; demands, control, support, relationship, role, and change. These six categories of work-related stressors negatively impact on health care practitioner’s wellbeing and efficiency (Cousins, Mackay, Clarke, Kelly, Kelly & McCaig, 2004). The Control scale shows the way individual works. Demands scale shows workload, work patterns and work environment, role scale shows whether individual understands his role within organization, “change scale” indicate show organizational change is managed and communicated in the organization, “peer support’’ includes the encouragement, sponsorship and resources provided by colleagues, managers' support focused on the support provided by the organization and relationships scale includes promoting positive working to avoid conflict and dealing with unacceptable behaviour (Kerr, McHugh & McCrory, 2019).
World Health Organization has considered stress as a global epidemic, which has recently observed to be associated with 90% of visits to physicians (Akinboye, Akinboye & Adeyemo, 2020). Work-related stress is one of the most important workplace health risks for employees worldwide (Thian, Kannusamy & Yobas, 2013). Over the years work-related stress results in substantial costs to employees and organizations (Hart & Cooper, 2017; Salleh, Bakar & Keong, 2018; Beheshtifar, Hoseinifar & Moghadam, 2011), related to employees absenteeism and turnover, decreased productivity, physical illness, poor quality of health care services, and increase risk of medical errors (Konstantinos & Christina, 2018).
Globally, the costs of work-related stress are estimated to be $5.4 billion each year, which is one of the most frequently reported occupational health problems (Moustaka & Constantinidis, 2010).
Work-related stress has recognized as the main challenge for the nursing profession throughout the world and has negative emotional, physical, and psychological effects on the nurse (Mark & Smith, 2012; Onasoga, Osamudiamen & Ojo, 2013 ). Research evidence demonstrated that nurses suffer from high levels of work-related stress are threatening their health, patients’ lives, compromise the quality of nursing care, and increasing the cost of health care (Dollard, LaMontagne, Caulfield, Blewett & Shaw, 2007). Excessive occupational stress has been found to reduce the quality of nursing care (Sveinsdottir, Biering & Ramel, 2006). If a nurse is stressed, it is difficult to give holistic nursing care to patients which may increase patient mortality rate (Smeltzer, Bare, Hinkle & Cheever, 2008; Shirey, 2006). The nature of the nursing profession and the health care system are some of the contributors to work-related stress (Burke, 2013; Mojdeh, Sabet, Doosti, Hajian & Malbousizadeh, 2008). Research findings have indicated that the sources of occupational stress, its levels, and effects vary depending on local factors such as the nature of work, work setting, and cultural orientation. Thus, occupational stress among nurses may have significant differences in different countries due to different work settings and levels of social support (Evans, 2002). Therefore, identification of the sources and contributing factors to work-related stress is necessary for improving the stress management program in the organization.

Health care workers are faced with issues of increased patient activity, shortage of staff, team conflict, unclear work roles, heavy workload, increased supervisory responsibilities, lack of autonomy and fear of litigation (Fitzpatrick, 2002; Calnan & Wainwright, 2001). Evidence from research has also revealed that job stress could impact on the general health and well-being of the worker (Tzeng, Chung & Fan, 2009; Owolabi, Owolabi, OlaOlorun & Olofin, 2012). Psychological health problems due to job stress may also result in poor overall work performance among health workers and subsequently, reduced productivity (Vanagas & Bihari-Axelsson, 2005). Bearing in mind the critical role being played by health care workers in ensuring delivery of optimal care to patients, job stress and its consequences need to be addressed. The existing body of evidence suggests that exposure of health care workers to very minimal/no stress tends to promote both patient and provider satisfaction (Tzeng et. al., 2009).

Stress is an inevitable factor in human existence. However, the level of stress differ among various professions and often related to the nature of the job, available facilities and workload (Okpua & Itoya,2019). Job induced stress among healthcare providers is a global problem; and 68% of healthcare providers are faced with job stress (Dagger & Mills, 2017). Reports show that over 1.1 million people die annually due Job induced stress (Zamanian & Jamali, 2018).
Worldwide more than one in three people in most countries report sufficient criteria for at least one form of stress in their jobs at some point in their lives (Maxon, 1999). Job stress is estimated to be the biggest occupational health problem in the United Kingdom, after musculoskeletal disorders such as back problems (Gray, 2000). More than half a million people in the United Kingdom are believed to be suffering from job stress, depression or anxiety, suggesting a 30% rise from 1990 (NIOSH, 2007; Smith, 2000). This problem is not unique to the United Kingdom; studies from Australia (ACTU, 2000), Canada (NIOSH, 2007) and the United States (AIS, 2002) also report that job stress is highly prevalent. Evidence also suggest that distress is the major cause of poor turn over in the health sector; and with continued distress at the workplace, the healthcare providers often develop psychological and physiological dysfunctions and decreased motivation in excelling in their position(Armstrong,2019). Although data are limited, there are indications that job stress is also a problem of public health significance in low and middle-income countries, including Nigeria.
The health care profession has been documented to have a higher than expected incidence of stress-related health disorders (NIOSH, 2007). Health workers with job stress experience impaired physical and mental functioning, increased absenteeism, accidents, litigation, errors of judgement and action, conflict and interpersonal problems, violence and a high use of health care services (CIHI, 2007; NIOSH, 2008; WHO, 2009). The disability caused by job stress is just as great as the disability caused by workplace accidents or other common medical conditions such as hypertension, diabetes, and arthritis (Kalia, 2002).Often people in caring professions handle human problems at the expense of losing their own psychological balance. Health professionals such as physicians, dentists, nurses and health technologists have also been reported to have higher than expected rates of substance use and suicide, as well as elevated rates of depression and anxiety linked to job stress (NIOSH, 2008).
Health workers tend to work long hours in jobs which expose them to emotionally tasking situations. This may lead to psychological distress that often goes unnoticed. The effect this stress has on their psychological health drives them to develop either positive or negative coping mechanisms for them to continue doing their jobs. Also, high job stress reduces productivity (Kalia, 2002), and this may have an untold impact on health care service delivery by health workers.
In Africa, prevalence of job stress among health care workers has been reported to be on the increase, being as high as 28% in a study conducted among medical doctors working in public hospitals in South Africa (Van Zyl, 2002; Govender, Mutunzi & Okonta, 2012). In a study conducted in South west Nigeria, more than a quarter (26.2%) of health care workers perceived themselves to have experienced job stress. In the study, prevalence of reported job stress was 11.1% and 19.8% among physicians and nurses respectively (Owolabi et. al., 2012). Another study done in Benin, South south Nigeria reported 14% of doctors as having an increased likelihood of psychological morbidity due to job dissatisfaction arising from job stress (Ofili, Asuzu, Isah & Ogbeide, 2004).

Thank you great readership, in my next post I'll delineate the following:
*Perceived Sources of Job-related Stress in the Health settings.
*Effects of Job Stress on Quality of Life.

• Management strategy of work stress.