© Springer International Publishing Switzerland 2015
Sanjay Patole (ed.)Management and Leadership – A Guide for Clinical Professionals10.1007/978-3-319-11526-9_10
Stress in the workplace affects everyone at some stage in their lives. Stress in itself can be used to promote productivity. However, there is a bell shaped curve relationship with a point when passed, the stressful input imparts a negative impact upon performances. Individuals react differently to stress. Personality traits and gender influence both our response and adaptation to stress. In the healthcare industry, stress is recognised to emanate from both within as well as from peers, colleagues, superiors, patients and events. Identifying stress is of paramount importance to implement coping mechanisms. These mechanisms can be initiated by the employer or the employee. Group debriefings and regular individual appraisals are powerful tools for managers to use especially in the face of major disasters. Exercise/activities and humour are some of the common methods individuals use to reduce or prevent stress. There is no ‘best’ exercise or activity other than one chosen by the user for the satisfaction this will produce for them. Humour whether self induced or group derived is a cheap, fast and burgeoning area of stress manipulation. Recent attention has spread to dietary manipulation including the use of probiotics which show great promise in improving mental and physical well being.
Life is not a matter of having good cards, but of playing a poor hand well
—Robert Louis Stevenson
Stress can be both contagious and uncontrollable.
Unhealthy stress can be modulated and ameliorated with correct understanding and commitment to change by all parties concerned.
Personality is a major factor in how we react to stress.
Diet, exercise, laughter and probiotics can reduce stress.
Stress is derived from the shortening of the word distress, denoting hardship or force exerted on a person for the purpose of compulsion. From the United Kingdom, the Health and Safety Executive’s (HSE) formal definition of work related stress is: “The adverse reaction people have to excessive pressures or other types of demand placed on them at work.” The HSE continue: Stress is not an illness—it is a state [1
]. However, if stress becomes too excessive and prolonged, mental and physical illness may develop [2
]. Studies have unequivocally shown that high stress levels reduce work efficiency, increase sickness leave, inculcate abnormal behaviour patterns and lead to a poor retention of staff. Similarly, outside of the work arena, high stress levels lead to addictive or dependent behaviour patterns, relationship issues, personal disease e.g. hypertension and overall a vastly reduced quality of life [2
We all become stressed, some more frequently than others. Our lifestyles can become completely built around stress—living to work as we often hear rather than working to live.
Stress is like spice—in the right proportion it enhances the flavor of a dish. Too little produces a bland, dull meal; too much may choke you.
Stresses at Work
More working days are lost per year in the UK from stress related illnesses than any other singular medical illness or accident at work. Nearly 17 % of UK workers thought their job was stressful or very stressful (HSE). Performance at work is negatively related to levels of stress with some workers actually showing increased productivity in the phase before burnout. Increasing stress also increases abnormal behavioural patterns in employees such as theft, vandalism and the crossing of professional boundaries [7
Believe it or not, there is a reasonable chance that you will see more of your work colleagues in your life than other people outside of the work environment. We sleep and work for an average of 8 h each per working day and spend variable amounts of time travelling to and from work as well as preparing for and awakening from sleep.
Therefore it makes practical sense to have as good a working life as possible so as to positively influence the remainder of your life—unless you do only live to work. For members of the last mentioned group, ask yourself how long it will take for people to miss your professional input—you will be surprised how short this time scale is!
Depending upon circumstances, stress at work will affect us all. Acute events such as a major disaster, unexpected treatment complications, a drug error, personality clash, feeling of low self esteem and difficulty in meeting deadlines are just some of the precipitating factors for stress [9
]. These factors can develop both a stress reaction in ourselves as well as affecting the incidence of stress in individuals within our workplaces. Some issues appearing minor to one person will be major to another [2
An amusing anecdote was a patient hooked up to an intravenous saline infusion who was the centre of attention during a consultant ward round. During the bedside discussions I noticed the man becoming more and more agitated. I stopped the discussion and asked him what it was that was obviously bothering him. He replied that he was soon to die if we didn’t stop the micro bubble of air coming down the IV giving set into his vein!
So what are the types of extrinsic stress that we can be exposed to at work?
The line manager or supervisor is reported to be the major cause of work place stress in some studies [11
]. Comments such as ‘they just don’t know what it is like’
do have a sense of truth about them.
Major Frank Burns was the head of the MASH (mobile army surgical hospital) unit in the TV series around the time of the Korean war. He recognised the stress involved at the front line and his part to play—“We all know it is brutal up there at the front, especially those of us at the rear”.
Recognition that bosses can both initiate and attenuate stress is complicit in any organisation’s culture for a harmonious and productive work environment. A supportive boss or supervisor has been shown to also reduce the incidence of post-traumatic stress disorder [11
Almost all of us at some stage will feel irritated or angry with our fellow workers. This is one of the commonest effectors of stress. As such, this should be recognised as a normal everyday reaction and accepted by all concerned. However, a repetitive irritation and anger action directed towards someone when knowingly this will instigate such a response is victimisation or indeed bullying . Up to a third of all nurses have reported bullying [12
There are numerous other sources of stress such as employees you have to manage, patients’ attitudes particularly borderline personality disorders, natural consequences of a disease process—complications or death, media attention—front page news denigrating healthcare workers, deadlines for training, exams, research or writing papers, dealing with shift work. The list is not inclusive but shows that when you start examining your working lifestyle balance, there are many areas in which to look for changes. The following is a list of behavior patterns that is adapted from Simon Wein [13
]. The list is neither exhaustive nor validated. However, like the main religions or philosophies of the world express a manner in which to live your life, this list is aimed at reducing or removing the origins of stress in the workplace.
Fifteen Rules that All Workers Should Aspire to Holding—Adapted from Wein 
Do not scream or raise your voice or show exasperation.
Do not despair openly BUT if you do state it is frustration within!
Do not express anger in front of staff.
Do not lie or bend the truth to suit your own ends.
Do not play favourites with patients or staff.
Do not override/belittle junior, equal level or senior staff in public.
Do not abuse patients or family.
Do speak to junior staff privately on at least a weekly basis and for 15 min minimum time preferably 30 min.
Always show humility when praised and dutiful acceptance when corrected.
Always show objectivity in your appraisal of a situation.
Always use your own mistakes to teach others and not theirs.
Create an atmosphere of respect around you and your colleagues.
I think all of these rules are self explanatory. The first 14 rules will most certainly influence rule 15!
An interesting exercise is to print a copy of this list and tick off each day when you accomplish or part accomplish one of the 15 points then repeat it after you have had a stressful day. Then place crosses against the items when you feel others have not adhered to the 15 points in question and reflect upon your findings. Objectivity is fundamental when seeking out sources of stress or prevention strategies .
Working shifts particularly night shifts on a regular or irregular basis leads to many negative life events including early onset cardiovascular disease and cancer [2
]. Stress levels assessed in night shift workers compared to day shift workers are almost twice as high. Yet how many night shift workers say they work night as they are less stressful for them [2
The easiest way to avoid stressful situations is not to go to work! However, the easy option is only available as a last resort. So how do we cope with the purely extraneous influences upon our stress levels?
The first, second and third method is communication . A problem shared is a problem halved. Ensuring good communication channels with your work colleagues is imperative to enjoy a fruitful and healthy work life [12
]. There are many people at work who you can approach, from your mentor to your union representative. If they are the source of distress and direct communication is not of help then you could seek help from the institutional departments of psychological medicine or pastoral care. These departments are there for you as much as they are there for the patients.
If you don’t want to communicate then put yourself into the shoes of the person who is causing you the stress and envisage what view they are logically holding [14
]. Although their view may appear illogical to you today, tomorrow it may appear very differently. Over the years I have thought over many stress induced events directed at me or around me or initiated by me. One association I have found is as follows; the highest level of stress induced in others originates from the person who probably has or is having a near major life event but cannot see how it this is affecting themselves or those around them who are not directly involved with the instigating life event [9
]. The contagiousness of the stress from such individuals can be most debilitating to those around.
I once worked for an obsessive boss who always wanted to know who the person was who wrote in the patient notes as the level of identification in the institution was poor. Every day he would in some way or another make a comment about this. I could understand his frustration but despite discussing this he couldn’t see a solution. Half of my solution to this was to personally buy a stamp with my details on it. The other half of the solution was to remember to use the stamp! The desired effect was obtained though and eventually the boss on seeing the solution to his own distress persuaded the hospital administration to purchase everyone a stamp. However, he soon found another obsession to fill the gap!
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