COMMENTARY

Alleviating Job Stress in Nurses

Rashaun Roberts, PhD; Paula L. Grubb, PhD; James W. Grosch, MBA, PhD

Disclosures

June 25, 2012

Editorial Collaboration

Medscape &

In This Article

Approaches to Reducing Job Stress in Nurses

Because job stress and its consequences are serious, growing concerns for nurses, patients, hospitals, and the healthcare industry as a whole, approaches to reduce nursing stress must be identified. Effective approaches could ensure better safety and health outcomes in nurses, leading to safe, efficient, and high-quality patient care, ultimately alleviating the economic consequences of stress on hospitals, industry, and the economy.[13,108]

Some approaches to addressing nursing stress target the worker (person-focused interventions), others target the work environment (organization-focused interventions), and still others target both.

Person-Focused Interventions

A stress management program (SMP) is an example of a person-focused intervention. Almost half of employers in the United States provide some type of stress management training for their workforces.[1] These programs improve the ability of workers to cope with difficult work situations by educating them about the nature and sources of stress and the effects of stress on health, and build skills to reduce stress (eg, time management or relaxation skills).[1] SMPs can rapidly reduce the symptoms of stress, such as anxiety and sleep disturbance, and have the advantage of being inexpensive and easy to implement.[109]

However, SMPs tend to be generic. Through a participatory approach in which job stress practitioners work collaboratively with nurses, SMP content that is directly relevant and applicable to the specific work environment, interpersonal issues, and job characteristics or tasks encountered by nurses can be developed, implemented, and evaluated. Customized nurse SMPs that are practical for use on and off the job may have the best potential for positively influencing the health and well-being of nurses.

Organization-Focused Interventions

The disadvantage of SMPs -- even if they are customized -- is that they don't address the psychosocial stressors of the healthcare environment. Organization-focused interventions, however, can address this deficit. These interventions involve identifying the stressful aspects of the job (eg, excessive workload, conflicting expectations) and then designing strategies to reduce or eliminate these stressors. The advantage of this approach is that it directly addresses the root causes of work-related stress. Some examples of organization-focused interventions include the following:

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

  • Designing jobs to provide meaning, stimulation, and opportunities for workers to use their skills;

  • Clearly defining workers' roles and responsibilities;

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

  • Improving communication;

  • Reducing uncertainty about career development and future employment prospects;

  • Providing opportunities for social interaction among workers; and

  • Establishing work schedules that are compatible with demands and responsibilities outside the job.

Similar to SMPs, organization-focused interventions should be customized according to work setting. Nurses and management staff can work with job stress practitioners to diagnose organizational and work-unit conditions that contribute to stress. Once these conditions are properly diagnosed, approaches to counter or eliminate them can be developed. For example, in hospital settings such interventions could target staffing ratios, adjust work hours or shifts, incorporate rest breaks, and provide a more balanced workload.

Integrated Stress Prevention

The strongest efforts to improve working conditions using organization-focused interventions are unlikely to eliminate stress completely. Consequently, a combination of person- and organization-focused interventions is often the most useful approach for preventing stress at work.[110] An integrated stress prevention program should include the following:

  • Building general awareness about job stress (causes, costs, and control);

  • Securing top management commitment and support for the program;

  • Incorporating employee input and involvement in all phases of the program; and

  • Establishing the technical capacity to conduct the program (eg, specialized training for in-house staff or use of job stress consultants).

If well-planned and implemented, integrated programs potentially can be effective in reducing or eliminating job stress for nurses. Each approach has unique advantages: Person-focused interventions have a more positive effect on individual outcomes, and organization-focused interventions have a more positive effect on organizational outcomes.[110]

Integrated job stress and other health and safety interventions targeted to the special needs of nurses and their work settings will facilitate the overarching goal of improving their health and safety.

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