Stress hinders top job performance
All jobs are not equal when it comes to stress. Health care workers, including those in hospice, get more than their share of this unpalatable job feature.
"There are a variety of things that make hospice work stressful. There is the urgency of our work. We all know we really only have one chance with the people we work with and that urgency is a real stressor," says Mary Raymer, ACSW, president of Raymer Psychotherapy and Consultations Services in Acme, MI. In addition to creating workplace problems for hospice managers, high stress levels can also end up costing them money.
The current health care environment, where competition for managed care contracts pushes hospices into mergers and alliances, causes job insecurity which results in stress. Deficiencies in hospice programs cause stress and burnout. "Unavailable resources, insufficient education or supervision, or a lack of structural support and rewards can also contribute to stress," she says.
Stress can result in employee turnover, absenteeism, poor morale, and a change toward improper behavior, according to Raymer and Helaine Holly, a consultant and trainer in Dixon, CA, who frequently teaches people how to handle stress.
There’s no quick fix to stress in the workplace. "An organization can’t just provide a stress-reduction workshop and expect that will take care of things if they are not providing the organizational support such as time off, excellent supervision, and maybe an employee support group," says Raymer. While hospice managers can’t wave a magic wand and remove stress from the workplace, they can create working conditions that reduce stress, provide avenues of stress relief, and help employees learn how to manage stress.
Coping with stress: Personal responsibility
The first step is to teach people how to help themselves. Each person needs to identify his or her stressors and then learn how to control them, advises Holly. What might be negative stress for one person is positive stress for another. For example, some people work well under deadlines and others don’t. That’s why it is important for each person to identify his or her stressors. Signs of negative stress include muscle tension, an upset stomach, and high blood pressure. When people know what their stressors are they can begin to work on relieving those stressful situations with relaxation techniques such as deep-breathing exercises, explains Holly. Also, it’s important for people to learn what to say to themselves in stressful situations. How we talk to ourselves, or react to the stressors we identify, will often determine the impact they have.
These techniques help people take control, and the more a person feels in control the less stressful the situation, says Holly. Managers can learn ways to handle stress from books, trainers, and classes, and pass the information along to employees.
In addition, managers can look at the workplace to determine ways to relieve stress. One way is to create clear job descriptions and employee policies. "People are stressed when they don’t know what is expected of them," says Raymer.
Check out working conditions. "For a lot of hospices there is far too many staff in a very small space," explains Raymer. In such situations, managers should consider establishing quiet zones, more flexible work schedules, or allowing people to do some work at home, such as documentation.
Employees need support as well. They need to know their supervisor will help them in difficult situations, whether accompanying them to a patient’s home or giving them the opportunity to review a medical technique they haven’t used recently.
Even with precautions such as teaching employees stress management techniques and providing a good working environment, people get into difficult situations. To identify employees who aren’t dealing well with a stressful situation, managers should practice "active listening" when talking with employees. Active listening entails paying attention to tone of voice, rapidity of speech, and body posture, as well as hearing the words a person says, explains Holly. When a person seems to be succumbing to stress, a manager might reward him or her in some way, such as giving the person a day off. (For more information on ways to rejuvenate employees, see related story on p. 8.)
Some problems can be avoided by making sure you have the appropriate person in each position. Good interviewing techniques will help identify people who are able to handle the stress the job creates. "Every job is stressful. We can’t remove the stress, but perception is about 50% of stress. Certain personality types talk to themselves in ways that make everything more stressful," says Raymer. (For details on how to uncover a person’s coping skills during a job interview, see related story on p. 9.)
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