CREATING A HEALTHY WORK ENVIRONMENT

The causes and prevention of stress are interrelated, involving both workers who suffer burnout and the environment in which they work. To prevent stress, individuals must identify and resolve stress-producing issues, and employers must also identify and address workplace factors that cause stress. When healthcare professionals and their organizations both address these matters, both will benefit. Individuals experience less stress and organizations maintain a staff that provides patients with the highest quality care.

Providing assistance and effective interventions to protect healthcare professionals from the effects of workplace stress are of prime importance in addressing these stresses on an organizational level.

What Organizations Can Do to Improve the Work Environment

When employees suffer from stress and become cynical, detached, and exhausted, productivity is reduced, standards are compromised, and the reputation of the organization is diminished. This is particularly true in service industries such as those that provide healthcare.

RECOGNIZING STRESS

Positive organizational climates are characterized by ensuring that employees have the necessary support (e.g., staffing, equipment, orientation) to provide safe patient care. In order to establish such a climate, organizations must address the factors that lead to stress and burnout. It is important that an organization’s senior leaders:

  • Know the different forms of workplace stress, including burnout, compassion fatigue, and vicarious trauma
  • Understand the impacts of stress on both the organization and employees, how to recognize stress, and how to prevent it
  • Ensure that mental health services are available to employees, since mental health interventions can help alleviate workplace stress
  • Evaluate the working climate of the organization on a regular basis, soliciting input from all employees
  • Initiate education and training on the topics of burnout, vicarious trauma, and compassion fatigue
    (Dyrbye et al., 2017; Haik et al., 2017; NCADV, 2018)

Research has found that organizations can reduce the development of burnout by providing employees with:

  • The resources needed to do the work
  • Training to safely provide patient care
  • Fair pay
    (Yeatts et al., 2018)

IDENTIFYING INSTITUTIONAL ISSUES

To prevent burnout in employees, managers in organizations also work to identify the specific institutional issues that create stress and then take measures to alleviate them, namely:

  • Unclear job descriptions
  • Unreasonable job expectations
  • Ambiguous chain of command
  • Scant recognition and rewards
  • Chaotic or high-pressure environments
  • Destructive interpersonal dynamics
  • Mismatch of employee strengths with work assignments
  • Dubious ethical practices regarding honesty, integrity, kindness, respect, and confidentiality
    (NCADV, 2018)

Management asks—and acts upon—the following questions as a strategy to prevent caregiver burnout:

  • Workload. Are job expectations reasonable? If not, how can they be changed to match the need? Are job descriptions current, clear, and accurate? Is there a mismatch between employee strengths and work assignments? Is the work environment chaotic or high-pressured? If so, how can it be moderated to reduce worker stress?
  • Control. Is the chain of command clear and understandable? Does it foster efficiency, collegiality, and fulfillment of the organization’s mission? Is it being followed? If not, why not?
  • Rewards and recognition. Are performance standards clearly stated and known by employees? Are workers recognized and rewarded for meeting their performance standards? What else can the organization do to support and encourage employees?
  • Social community. Is there a positive, collegial work environment? If not, what is hampering its development? What can the organization do to foster a cooperative, supportive environment?
  • Fairness. Do workers feel they are treated with respect and fairness? Are work schedules flexible enough to get the job done yet meet the needs of staff members? Is there a fair wage for every category of worker? How do wages compare to other similar organizations?
  • Values. Is the institution known for its integrity? Are honesty, respect for human dignity, benevolence, autonomy, and justice encouraged and rewarded?
    (Blazey, 2016; Mayo Clinic, 2021)

PROVIDING EDUCATION AND TRAINING DURING A PANDEMIC

All employees require adequate education and training to achieve and maintain competency at work. This is particularly true during a pandemic. Formal and informal training during a pandemic can prepare healthcare workers to face the unique stressors involved in working under such conditions. Such training can include:

  • Specific and accurate information about transmission of the infectious agent and methods of containment
  • When and how to screen patients and, potentially, family members and visitors
  • When to institute quarantine and isolation
  • Ethical decision-making about triage and surge capacity issues

In order to increase the sense of confidence in one’s work-related performance, workers can also take part in training and/or planning exercises such as:

  • Managing limited resources
  • Implementing various levels of quarantine
  • Enforcing movement restrictions in the facility
  • Handling mass fatalities
  • Conducting mental health screening
  • Coping with high stress demands
  • Preparing for personal and family needs when required to be more involved at work or when in quarantine
  • Providing psychosocial support to colleagues
    (VA, 2020)

ADDRESSING BURNOUT AMONG MANAGERS

Managers are also at risk for stress and burnout. A study on nurse-manager role stress identified four essential themes describing stress and what is needed to alleviate that stress:

  1. Sink or swim. Study participants recounted being “thrown” into a management position without any orientation or mentor. They struggled with the transition from peer to manager without support from the organization and no feedback regarding how they were performing their new duties. Successful organizations develop an orientation program for managers and establish a mentor program for managers.
  2. There is no end. Managers often assume 24-hour-a-day accountability for the unit(s) they oversee. Study participants described feeling overwhelmed by this responsibility in conjunction with the workload of a manager and the constant additions of new or changing responsibilities. Successful organizations offer support to managers in the form of adequate clerical and ancillary staff and by establishing realistic goals.
  3. Support me. Participants expressed the need for balancing their work lives with their personal lives and requested that organizational leadership not reach out to them after hours unless it is an emergency. They also asked for overt support and the trust that they would oversee their units safely and professionally. Participants also described a need for clear expectations regarding their roles and responsibilities as well as feedback on their job performance.
  4. Finding balance. Managers expressed the need for support and assistance to “grow” into their roles as managers (e.g., mentors, adequate orientation). They described ways they had learned to achieve balance (e.g., not answering emails at home, decreasing the amount of paperwork they took home in the evenings, participating in some form of exercise).
    (Loveridge, 2017)

What Individuals Can Do to Improve the Work Environment

Healthcare professionals can create a healthy work environment by addressing the same causal factors as employers. This includes asking the following questions:

  • Workload. Am I assuming too many responsibilities? Am I getting enough sleep, rest, and relaxation? Am I taking care of myself? What can I do to balance the demands of my work with my energy, rest, and relaxation? Do I have unrealistic achievement goals and aspirations?
  • Control. Do I have to be “in charge” at all times and in all circumstances? Do I need to be perfect all times? Is the cost of perfection worth the reward it gives? What can I do to reduce the stress it creates?
  • Rewards and recognition. Does my work give me emotional and monetary rewards? Are they adequate for my needs? Am I appreciated and recognized by my colleagues and employer? If not, what can I do to receive recognition and feel good about myself?
  • Social community. Is my work environment chaotic and unstructured? Do I have a collegial working relationship with staff members? If not, what can I do to increase mutual respect and support and thus nurture myself and my coworkers?
  • Fairness. Do I feel that I am being treated fairly in work assignments, wages, or recognition? If not, are any institutional measures available to challenge the status quo and make things fair?
  • Values. Is there a mismatch of ethical values between me and my workplace? If so, is the problem systemic or is it limited to one person or one circumstance? What institutional measures are available to address the issue?
    (Loveridge, 2017)
CASE

A group of nurse managers has been troubled by an increase in signs and symptoms of burnout being exhibited among staff nurses. They realize that if they do not do something to curtail this increase, patient care will suffer, nurses may quit, and the workplace environment will become increasingly negative.

Some of the managers want to confine their problem-solving discussions to their managerial group. However, the majority of managers want to include staff members in the process. As one manager puts it, “If we don’t ask them for input, we will end up failing to address their concerns, and a bad situation will become worse.”

A focus group consisting of nurse managers and staff nurses is formed. Although the staff nurses are at first reluctant to speak freely about their concerns, the managers develop an environment for discussion in which the staff nurses eventually provide honest feedback and relay their concerns frankly.

Some initiatives agreed upon by the committee include:

  • Developing a staff-driven method of scheduling
  • Involving staff nurses in recruitment and retention efforts
  • Evaluating job descriptions for clarity
  • Establishing a rewards and recognition program

Discussion

The nurse manager group was correct in including staff nurses as part of the problem-solving effort. This helped to gain cooperation and accurately identify areas for improvement. Initiatives were then developed that were important to staff nurses while also helping nurse managers to increase positivity in the work environment.

CASE

Sandra is the staff development coordinator for a volunteer outreach clinic as well as the manager of the clinic’s vaccination program. This is in addition to her part-time job at a family practice office. She has also been approached about overseeing an annual health and wellness fair at her church and is seriously considering accepting the position.

Recently, the outreach clinic has been mandated to provide all volunteers with safety and diversity training similar to that required for county employees working in comparable positions. The clinic is given a two-month window in which to complete the training, and Sandra must oversee this effort.

With all that is on her plate, Sandra realizes that her work responsibilities, in addition to her personal and family life, have become overwhelming and that she is perilously close to burning out. Sandra looks at her behavior and realizes there are warning signs she has ignored: her sleep is not restorative, she is much less motivated than usual, she is unusually irritable, and she has stopped doing the “fun” things that were her recreational outlets.

At the monthly clinic staff meeting, Sandra grumpily admits that she has made very little progress implementing the volunteer training effort. Since both the tenor of her response and her reported lack of progress are not “typical Sandra,” her manager, Phong, calls a meeting with Sandra to discuss strategies. At the meeting, they write out all of the tasks currently on Sandra’s plate, both those associated with the clinic and others.

Phong remembers that Jorge, a new volunteer, is the trainer for the county afterschool program and recently conducted similar training for that group. She decides to assign Jorge to help Sandra and says she will set up a meeting between the two of them so that they can pool their skills and ideas.

Sandra also admits that she does not really want to volunteer for her church’s health fair but would feel guilty saying no since she was told that she was “the only one who could do a good job of it.” Sandra realizes this is not the case and identifies several others in her church who have the demonstrated ability to take on this project, resolving to recommend one of them to the pastor.

Sandra leaves the meeting with her manager knowing that she has dodged the bullet of burnout by being proactive in addressing her situation. She resolves to implement the ideas she and Phong came up with, both taking advantage of Jorge’s help with the volunteer training and declining to organize the church health fair. She also decides she will talk with her husband about finding ways to have fun together.

Discussion

Sandra and her employer both took preventative steps to avoid her burning out. Together, they assessed her workload and came up with a strategy involving her getting help from a coworker and reducing her other personal commitments.