A Guideline for Stress Management: Taking a leadership role in understanding and minimizing job stress during the COVID-19 crisis--Part I

This is the first of a two-part series that looks at the myriad ways stress manifests and affects our physical and mental health, and has particularly affected those in the medical laboratory profession throughout the COVID-19 pandemic. 

Health care workers encounter stress during their work day on a regular basis. According to the Centers for Disease Control and Prevention, “Studies indicate that health care workers have higher rates of substance abuse and suicide than other professions and elevated rates of depression and anxiety linked to job stress.”¹ During times of crisis, stress for most is increased. Addressing job stress in the health care environment under normal circumstances and during a crisis may alleviate some of its causes.

There is no clear definition of stress but according to Merriam-Webster Collegiate Dictionary, stress, in general, is “a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.”² One type of stress is job stress, where the stressors are work-related. According to the National Institute of Mental Health, stress affects everyone, not all stress is bad, long-term stress can harm your health, and there are ways to manage stress.³ People may experience stress for a short or long term, both which may harm you physically, emotionally and or mentally. Job stress can lead to burnout. According to on author, “workplace stress arises when people try to cope with tasks, responsibilities or other forms of pressure connected with their jobs, but encounter difficulty, strain, anxiety and worry in endeavoring to cope.” ⁴ When employees experience a stressful workplace condition it also has an effect on the organization. In some cases, the organization may be the cause.

We all handle and perceive stress differently. Stress comes from many sources and is handled in many different ways depending on the individual and the circumstances in which that person is exposed. Not all health care workers develop the same level of stress.

The added stress of the pandemic

During the COVID-19 pandemic health care workers in many cases worked longer hours under more pressure with higher demand for their service. The severity of COVID-19, the quick spread of the virus all over the world and the emergent need for resources made this crisis unlike any other we have dealt with in history. During this time health care and essential workers jeopardized their own health and the health of their loved ones just by the nature of doing their job. During the first week of the pandemic, health care workers were asked what their main areas of anxiety were. According to Shanafelt, Ripp, and Trockel, eight sources were identified:

(1) access to appropriate personal protective equipment;

(2) being exposed to COVID-19 at work and taking the infection home to their family;

 (3) not having rapid access to testing if they develop COVID-19 symptoms and concomitant fear of propagating infection at work;

(4) uncertainty that their organization will support/take care of their personal and family needs if they develop infection;

(5) access to childcare during increased work hours and school closures;

(6) support for other personal and family needs as work hours and demands increase (food, hydration, lodging, transportation);

(7) being able to provide competent medical care if deployed to a new area (eg, non-ICU nurses having to function as ICU nurses);

(8) lack of access to up-to-date information and communication.⁵

Knowing the cause of stress and where it is coming from is one of the first steps in reducing it.

Typical causes of job stress

In order for one to manage stress, identifying the typical causes and reactions to stress is necessary. Job stress often leads to increased absenteeism, lower productivity, workplace errors, mistakes, poor performance, poor relations, loss of concentration and overall burnout.⁴ Managers need to be aware of organizational stressors as well as their employee’s reaction to workplace stress. Job conditions that may lead to job stress include; air quality, excessive noise, uncomfortable working conditions or an employee’s commute to work. Additionally, stress may be due to: management styles, work roles, environmental conditions, interpersonal relationships and work tasks. ⁶

Healthcare workers may be stressed due to short staffing, long hours, working with hazardous substances, infectious agents, workload, time constraints, sleep deprivation, dealing with death and dying and perceived quality of care at the institutions in which one is employed.¹ A survey conducted by Koinis et al found that a person’s mental-emotional health is affected by their work environment as well as their ability to cope with stress.⁷

During a crisis, the added pressure to work under different conditions or change the way they work can cause stress. Many employees are resistant or do not like change. For change to be successful, employees need to be involved in the change, given information, training or instruction. According to Shranks there should be “methods for assessing how well or how badly individual employees are coping with the changes.”⁴ In addition, there should be methods in place such as assistance and coaching along with ways to monitor employees who are finding the changes difficult.⁴

Internal factors such as a person’s lacking confidence, being afraid, guilty, angry, or having health problems can lead to stress. A person may feel stressed having to deal with co-workers, supervisors or subordinates. Stress may be coming from a person’s home life, financial issues, dealing with an illness or a family member’s illness, marital or partner problems, problems with their children, child care or social issues. Some stress may be due to a person’s own negative self-talk, leading an unhealthy lifestyle, their personality, financial reasons, an illness, family or spouse issues, children or older parents needing care or other problems that may not be directly related to the job.

According to National Institute of Safety and Health (NIOSH), 40 percent of workers reported their job was very or extremely stressful; 25 percent view their jobs as the number one stressor in their lives, three fourths of employees believe that workers have more on-the-job stress than a generation ago; 29 percent of workers felt quite a bit or extremely stressed at work; 26 percent of workers said they were “often or very often burned out or stressed by their work” and job stress is more strongly associated with health complaints than financial or family problems.⁸

Stress for laboratory professionals is nothing new. Laboratory professionals are part of the health care team and yet there has been little research done specifically related to their job stress or job satisfaction. A study conducted by Rogers in 1983 showed 31 percent of the respondents surveyed implied they had high levels of stress. This study also showed that there was a significant correlation between high stress levels and job satisfaction. ⁹ A more recent survey study conducted by Garcia et al in 2020 showed 62.7 percent of respondents were satisfied or somewhat satisfied with their job but those surveyed felt a lot of stress on the job (53.4%) followed by a little stress (42.7%) to no stress at all (3.8%) and 0.1 percent not sure or do not know.¹⁰

Previous studies showed the main reasons for stress on the job for laboratory professionals were due to the pressure for immediate results, lack of communication, feeling valued and balancing work and life.^11,12 Garcia et al found 85.3 percent felt burnout as a laboratory professional. The majority of respondents that reported increased stress, burnout and work-life balance reported it was due to workload and short staffing. Lower levels of burnout and stress were identified in respondents whose institutions offered wellness and stress reduction programs. ¹⁰

Our body's response to stress 

“Understanding stress requires understanding a variety of complex interactions, including mental, emotional, physical and spiritual factors,” writes Leyden-Rubenstein.¹³ Not all stress is bad. It can propel us into action or make us realize we need to change. There are a number of reactions we may have when stressful situations arise such as the fight or flight response, increase in cortisol levels, body tenses, heart pumps faster, breathing becomes faster, increased sweat, digestion may stop in order to provide more blood to your brain, and muscles and immune system are diminished.

If a person is exposed to stress for a short time (acute) it does not usually cause long-term harm but if there is a long-term exposure to stress (chronic) than it may have detrimental effects on performance and health. If stress is extreme and not managed, some individuals may experience post traumatic stress disorder (PTSD), “a psychiatric disorder than can occur following the experience or witnessing of life-threatening events,” notes the National Institutes of Health.¹⁵

Physical symptoms caused by stress may include fatigue, restlessness, insomnia, nausea, loss of appetite, gastrointestinal disturbances, headaches, visual disturbances, weight loss or gain, sweating, chills, muscle twitching, tremors, and immune system disorders.^16,17 Emotional reactions often reflect anxiety, grief, detachment, guilt, agitation or depression.¹⁶ A person may exhibit crying, social withdrawal, poor decision making, poor problem solving, social withdrawal and other emotional symptoms. Behavioral reactions can be an increase or decrease in activity level, substance abuse (alcohol or drugs), difficulty communicating or listening, irritability, outbursts of anger, frequent arguments, inability to rest or relax, decline in job performance; increased absenteeism, frequent crying, excessive worry, avoidance of activities or places that trigger memories and becoming accident prone.¹⁷ Socially a person may isolate themselves, blame others, have difficulty getting help and have an inability to have fun or find pleasure.¹⁶

According to the American Psychological Association (APA) men and women may handle stress differently. Both men and women tend to choose sedentary activities, such as listening to music, reading, watching television over healthier behaviors. Men are more likely to play sports and listen to music. Women report they are more likely to eat as a way of managing stress, they also claim to eat unhealthy food because of stress. Men are more likely to do nothing to manage stress. Women are more likely than men to report a great deal of stress. Married women report more stress than single women. Women are more likely to report money and the economy as sources of stress. Men are more likely to report that work is a source of stress. Fifty percent of women have reported their stress has increased over the past five years.¹⁸ As a manager, these facts are important to take into consideration. Not all employees will respond to stress in the same way but gender may play a role in some of these differences.

Stay tuned for Part II of this series, which will look at ways laboratory professionals can better manage stress.

References

1. Center for Disease Control and Prevention, National Institute for Occupational Safety and Health. Exposure to Stress: Occupational Hazards in Hospitals. 2008.

2. Merriam-Webster Dictionary. Stress. https://www.merriam-webster.com/dictionary/stress. Accessed March 30, 2021.

3. National Institute of Health (NIH). https://www.nimh.nih.gov/health/publications/stress/index.shtml. Accessed March 28, 2020.

4. Shranks, Jeremy. Stress at Work. Burlington, MA. Elsevier Butterworth-HeinemannLinacre House. 2005.

5. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. Published online April 07, 2020. doi:10.1001/jama.

6. The American Institute on Stress Workplace Stress (n.d.). Retrieved from https://www.stress.org/workplace-stress/.

7. Koinis A, Giannou V, Dranktaki V, Angelania S, StaTou E, Saridi M. The impact of healthcare workers work environment on their mental-emotional health coping strategies: the case of a local general hospital. Health Psych Res.1984;3:12-17.

8. American Psychological Association. Coping with Stress.  https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html Accessed March 30, 2021.

9. Rogers DA. Stress and Job Satisfaction among Clinical Laboratory Scientists. Am J Med Tech. 1983;49(3):183-188.

10. Garcia E, Kundu I, Kelly M., Soles R, Mulder L, Talmon G. The American Society for Clinical Pathology’s job satisfaction, well being and burnout survey for laboratory professionals. Am J Clin Pathol. April 2020; 153:470-486.

11. Malleson MT, Ivancevich JM. Stress and the medical technologist II: sources and coping mechanism. Am J Med Tech. 1982;48(3): 169-176

12. Garcia E, Kundu I, Kelly M., Soles R, Mulder L, Talmon G. The American Society for Clinical Pathology’s job satisfaction, well being and burnout survey for laboratory professionals. Am J Clin Pathol. April 2020; 153: 449–469.

13. Leyden-Rubenstein, L.A. The Stress Management Handbook. Keats Publishing Inc. New Canaan, Ct, 1998.

14. Bamber, M. Overcoming your Workplace Stress: a CBT-Based Self Help Guide. New York, N.Y. Routledge an imprint of Taylor & Francis Group, 2011.

15. National Institute of Health (NIH). Facts about Post –Traumatic Stress Disorder, 2001. https://www.hsdl.org/?view&did=774179. Accessed May 21, 2020.

16. Defraia GS. EAP-based critical incident stress management: utilization of practice-based assessment of incident severity level in responding to workplace terror. Intl J Emerge Mental Health Resilience. 2013;15(2):105-122.

17. U.S. Department of Health and Human Services (DHHS). A Guide to Managing Stress in Crisis Response Professions. DHHS Pub. No. SMA 4113. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.

18. American Psychological Association. Stress and Gender. https://www.apa.org/news/press/releases/stress/2011/gender#:~:text=The%20Impact%20of%20Stress%3A%20Gender%20Differences&text=Only%2052%20percent%20of%20men,to%2051%20percent%20of%20women. Accessed March 30, 2021.