Injuries, exposures increase with work stress
Verbal abuse, safety climate are main stressors
Hospital health care workers who report low job satisfaction, verbal abuse, a high level of environmental bothers, and a poor safety climate have high levels of work stress and therefore more injuries, according to a recent study led by Robyn R.M. Gershon, DrPH, MHS, a senior research associate in the department of environmental health sciences at the Johns Hopkins University School of Hygiene and Public Health in Baltimore.1
Gershon analyzed 1,716 responses to a 12-page questionnaire submitted to health care workers at three hospitals in Texas, Maryland, and Minnesota. Work stress measurements were derived from an associated questionnaire (see questionnaire excerpt inserted in this month's issue) and then were correlated with answers to the lengthier questionnaire on individual (age, gender, education, occupation), psychosocial (conflicts of interest, HIV/AIDS attitudes, risk perception, fear), and organizational (safety climate, supervisory support, job/task factors, environmental conditions) factors.
Respondents fell mainly into three job categories: nurses, 53%; physicians, 19%; and technicians, 17%. Most respondents were female (79%), with more than 13 years of education (81%), a mean age of 35.8 years, an average tenure of six years in their present position, and 10.8 years tenure in the health care field. Sixty-five percent worked between 40 and 50 hours per week, and 21% worked rotating shifts.
Stress linked with blood exposures
The researchers found the strongest correlation between work stress and organizational factors such as safety climate and bloodborne exposures, Gershon says.
"We found that workers who reported a lot of work stress did have an increased number of accidents," she says. "Accidents were related to work stress, especially needlesticks and other bloodborne exposures."
Twenty-seven percent of respondents had a bloodborne exposure in the previous six months, with 14% of those being needlestick injuries. HCWs with high work stress were 1.6 times more likely to have a bloodborne exposure, according to the survey. Bloodborne exposures were linked to work stress through statistical multiple regression analysis, Gershon explains.
HCWs under stress are subject to making mistakes in judgment, she explains, "because work stress makes you inattentive, preoccupied, less alert, and less aware. It is correlated with depression, anxiety, and somatization. Although it works indirectly, work stress is correlated with outcomes."
The study also revealed that HCWs with low job satisfaction were seven times more likely to have reported work stress. Verbal abuse (from supervisors, co-workers, patients, and patients' families) also was associated with work stress. Workers who were verbally abused were three times more likely to have work stress.
HCWs who perceived a lax safety climate at their hospital were 4.5 times more likely to have high work stress. In addition, those who perceived environmental bothers (poor temperature control, loud noise, poor air quality, overcrowding, odors, poor lighting, and fear of bodily harm) in the workplace were 2.5 times more likely to have work stress. Workers who noted poor availability of safety equipment were 1.8 times more likely to have work stress.
"Part of work stress is [due to] how hard and how fast you have to work, but interestingly enough, those job task factors were not as important as safety climate and the environment and how people treated you," Gershon says. "Health care workers are used to working very hard, so that's not what does it. What does it is how good your supervisor is to you, how good your feedback is, and how well they treat you as the decent human being you are."
Good working conditions are essential to reducing work stress, she adds.
"Patients are one thing and the hard work is another, but if you have to work in a dump with poor lighting and poor climate control, and you don't have a break room, and you don't have a place to put your lunch, things that little can eat at you," she says.
Form TQI teams
Hospital officials who want to reduce needlestick injuries and other accidents, as well as the costs associated with them, should pay attention to factors that cause work stress, Gershon states.
"It's very simple," she maintains. "They have to improve the safety climate and address the environmental concerns. They can hold focus groups and form TQI [total quality improvement] teams. Everyone is talking about reinventing the workplace, but they don't do it. You have to form teams and listen to what they say."
Gershon emphasizes that accidents and injuries associated with work stress are not the workers' fault.
"It's not their fault that they are stressed out," she says. "The hospital has to provide the best possible work environment it can. What's the big deal about having a break room, having a microwave and a small refrigerator available to workers? It's not that much to ask, but even a small intervention like that can make a big difference. It sends a powerful message that [employees] are important. How much does it cost for a supervisor to tell you what a good job you did? A frequent pat on the back, not just once a year, costs nothing."
Gershon suggests that employee health practitioners can prove to administrators that stress is costly by administering the stress measurement questionnaire to workers, then putting interventions into place (including easily accessible stress reduction classes) and remeasuring in six months or a year.
"Look at accident rates and workers' compensation costs before and after," she advises. "It's a great way to prove how much stress is costing your institution."
[Editor's note: For more information on how to measure stress and its associated costs at your hospital, call Gershon at (410) 955-3046 or e-mail at [email protected].]
Reference
1. Gershon RRM, Karkashian C, Kasting C, et al. The correlation between workstress, organizational factors, and bloodborne exposures. Presented at the National Safety Council Region 3 Conference on Injury Prevention. Ellicott City, MD; April 1994. *
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