Stress, burnout and coping strategies in the emergency and intensive care hospital departments

Doctors and nurses working at the accident and emergency (A&E), and intensive care departments are at risk of burnout. They often spend substantial time in intense interactions with other people, centered on patients? health problems (physical, psychological and social) that may lead to feelings of anger, anxiety and frustration, and eventually to burnout. Burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment (Maslach & Jackson, 1981) The purpose of this chapter is to assess work stressors, burnout and stress-coping mechanisms among doctors and nurses at the A&E and intensive care departments. A quantitative design using the survey approach was used to collect data from a sample of 200 participants with a response rate of 71% (n=154) Work stressors were associated with burnout in both doctors and nurses. Workload was the most salient work stressor in the sample. Nurses experienced more stress (M=1.5, SD=0.4) than doctors (M=1.2, SD=0.4) in all the work stressor variables examined. The A&E department was reported as more stressful than the intensive care department. Avoidance-oriented and task-oriented coping were the most and the least frequently reported coping strategies respectively. Additionally, only emotion-oriented coping strategy was significantly different between doctors and nurses, and this strategy was also significantly positively correlated with all the variables in the adapted nursing stress scale, and the three burnout variables. Death and dying was most strongly correlated with emotion-oriented coping. This chapter provides an assessment of stress, burnout and coping experienced by both doctors and nurses within the A&E and intensive care departments. Methods that may mitigate stress in these environments may be adequate staffing, supportive management, stress management programs, as well as improvement in communication strategies between doctors and nurses.

A pre-post test evaluation of the impact of the PELICAN MDT-TME development programme on the working lives of colorectal cancer team members

Background - The PELICAN Multidisciplinary Team Total Mesorectal Excision (MDT-TME) Development Programme aimed to improve clinical outcomes for rectal cancer by educating colorectal cancer teams in precision surgery and related aspects of multidisciplinary care. The Programme reached almost all colorectal cancer teams across England. We took the opportunity to assess the impact of participating in this novel team-based Development Programme on the working lives of colorectal cancer team members. Methods - The impact of participating in the programme on team members' self-reported job stress, job satisfaction and team performance was assessed in a pre-post course study. 333/568 (59%) team members, from the 75 multidisciplinary teams who attended the final year of the Programme, completed questionnaires pre-course, and 6-8 weeks post-course. Results - Across all team members, the main sources of job satisfaction related to working in multidisciplinary teams; whilst feeling overloaded was the main source of job stress. Surgeons and clinical nurse specialists reported higher levels of job satisfaction than team members who do not provide direct patient care, whilst MDT coordinators reported the lowest levels of job satisfaction and job stress. Both job stress and satisfaction decreased after participating in the Programme for all team members. There was a small improvement in team performance. Conclusions - Participation in the Development Programme had a mixed impact on the working lives of team members in the immediate aftermath of attending. The decrease in team members' job stress may reflect the improved knowledge and skills conferred by the Programme. The decrease in job satisfaction may be the consequence of being unable to apply these skills immediately in clinical practice because of a lack of required infrastructure and/or equipment. In addition, whilst the Programme raised awareness of the challenges of teamworking, a greater focus on tackling these issues may have improved working lives further.

Within-role, extra-role and anti-role behaviours in retail banking

Purpose: This paper aims to explore front line employee performance in retail banking and presents distinct components of employee performance, including extra-role and sabotage behaviours. Design/methodology/approach: Data was collected from Irish bank employees. Usable responses were received from 404 respondents and subjected to exploratory factor analysis. Structural Equation Modeling (SEM) was used to undertake a confirmatory factor analysis of the emergent five-factor model. Findings: Results indicate front line employee performance is multi-faceted and comprised of civility, assurance and reliability, customer orientation, as well as extra-role behaviour and anti-role behaviour, or sabotage. Research limitations/implications: This exploratory study focuses on the Irish banking sector. To explore the generalisabilty of results, replication studies among other samples of branch banking employees in other countries are in order. Moreover, our survey is limited to the views of branch employees. We advocate research among bank managers and customers to triangulate potentially divergent views about performance. Practical implications: Findings have implications for recruitment, training and rewards. To ensure new hires are service minded, managers must consider their potential for extra-role or sabotage behaviour. Employees who demonstrate extra-role behaviours must be rewarded to encourage the adoption of such behaviours. Managers must also seek to minimise job stress in order to curtail anti-role behaviours. Originality/value: This paper offers insights into employees' views about their own performance at the front line. It extends the conceptualisation of service quality, by considering extra-role behaviour and sabotage as components of employee performance. © Emerald Group Publishing Limited.

Adjusting to job relocation:relocation preparation can reduce relocation stress

This study, for the first time, examines the relationship between pre-move relocation preparation with psychological well-being to job relocation. Psychological reactions of 54 relocators were measured before and after their move. The greater the reported pre-move relocation preparation the better was the relocators' post-move mental health and job-related contentment and enthusiasm. Furthermore, pre-move relocation preparation was associated with reduced problems during the move and this, in turn, resulted in better post-move adjustment.

The effects of prior moves on job relocation stress

This study examines the relationship between the number of prior moves, time living in an area and psychological reactions of employees undergoing job relocation. Relocating employees from a single organization completed questionnaires on average six weeks before and 10 weeks after their move. Results show that the greater the number of prior moves the lower was the reported stress following the move. However, the relationship between number of prior moves and well-being also followed a quadratic trend such that those with few and those with many prior moves reported the greatest stress. Furthermore, the longer the relocator had lived in the area prior to moving, the greater was the general stress and the job-related anxiety and depression following the move.

The role of attributions in reactions to job relocation

Job relocation refers to the process of simultaneously moving to a new job and house and this can cause considerable stress for the relocator and his/her family. Based upon an attributional analysis, we predicted that negative psychological reactions would be a function of (1) number of relocation problems, and (2) making pessimistic attributions for relocation problems (that is, the tendency to attribute negative events to internal, stable and global causes). Furthermore, these factors should interact, such that individuals with many relocation problems who also make pessimistic attributions will experience the worst psychological reactions. The results from a cross-sectional survey of 93 relocators supported these predictions. As expected, those relocators who had many relocation problems and made pessimistic attributions reported the worst mental health and relocation-specific stress. In addition, a reanalysis of a longitudinal study of relocators by Martin (1996) also supported the above predictions using attributions of perceived control. Furthermore, the relocators predicted to be most at risk (many problems}/low control) reported the worst changes in mental health during the course of the move.

The impact of the introduction of visual display terminals on the job characteristics, job satisfaction and well-being of users in government offices

The proliferation of visual display terminals (VDTs) in offices is an international phenomenon. Numerous studies have investigated the health implications which can be categorised into visual problems, symptoms of musculo-skelctal discomfort, or psychosocial effects. The psychosocial effects are broader and there is mixed evidence in this area. The inconsistent results from the studies of VDT work so far undertaken may reflect several methodological shortcomings. In an attempt to overcome these deficiencies and to broaden the model of inter-relationships a model was developed to investigate their interactions and Ihc outputs of job satisfaction, stress and ill health. The study was a two-stage, long-term investigation with measures taken before the VDTs were introduced and the same measures taken 12 months after the 'go-live' date. The research was conducted in four offices of the Department of Social Security. The data were analysed for each individual site and in addition the total data were used in a path analysis model. Significant positive relationships were found at the pre-implementation stage between the musculo-skeletal discomfort, psychosomatic ailments, visual complaints and stress. Job satisfaction was negatively related to visual complaints and musculo-skeletal discomfort. Direct paths were found for age and job level with variety found in the job and age with job satisfaction and a negative relationship with the office environment. The only job characteristic which had a direct path to stress was 'dealing with others'. Similar inter-relationships were found in the post-implementation data. However, in addition attributes of the computer system, such as screen brightness and glare, were related positively with stress and negatively with job satisfaction. The comparison of the data at the two stages found that there had been no significant changes in the users' perceptions of their job characteristics and job satisfaction but there was a small and significant reduction in the stress measure.

The role of emotional labour and role stress on burnout and psychological strain in high contact service employees

This study examines the relationships between job demands (in the form of role stressors and emotional management) and employee burnout amongst high contact service employees. Employees in customer facing roles are frequently required to manage overwhelming, conflicting or ambiguous demands, which they may feel ill-equipped to handle. Simultaneously, they must manage the emotions they display towards customers, suppressing some, and expressing others, be they genuine or contrived. If the in-role effort required of employees exceeds their inherent capacity to cope, burnout may result. Burnout, in turn, can have serious detrimental consequences for the psychological well being of employees. We find that both emotional management and role stressors impact burnout. We also confirm that burnout predicts psychological strain. In line with the Job Demands and Resources Model, we examine the mitigating impact of perceived support on these relationships but do not find a significant mitigating impact.

A longitudinal study examining the psychological reactions of job relocation

A longitudinal study is reported of relocating employees (n= 51) and their partners (n= 31) who relocated between two cities in England. A nonmoving comparison group of employees from the same organization (n= 58) was included. The subjects completed a questionnaire before (approximately 6 weeks) and after (approximately 10 weeks) the relocation. Results showed that relocating employees' pre-move general stress was similar to that of nonmoving employees. Moreover, male relocators' stress reduced significantly following the move, while female relocators stayed the same. Stress specific to relocation was very high for relocating employees and partners, and remained so following the move. Evidence was found to show a relationship between attributions of the causes of relocation problems and the experience of stress.

Well-structured teams and the buffering of hospital employees from stress

Membership in well-structured teams, which show clarity in team and individual goals, meet regularly, and recognize diverse skills of their members, is known to reduce stress. This study examined how membership of well-structured teams was associated with lower levels of strain, when testing a work stressors-to-strains relationship model across the three levels of team structure, namely well-structured, poorly structured (do not fulfill all the criteria of well-structured teams) and no team. The work stressors tested, were quantitative overload and hostile environment, whereas strains were measured through job satisfaction and intention to leave job. This investigation was carried out on a random sample of 65,142 respondents in acute/specialist National Health Service hospitals across the UK. Using multivariate analysis of variance, statistically significant differences between means across the three groups of team structure, with mostly moderate effect sizes, were found for the study variables. Those in well-structured teams have the highest levels of job satisfaction and the least intention to leave job. Multigroup structural equation modelling confirmed the model's robustness across the three groups of team structure. Work stressors explained 45%, 50% and 65% of the variance of strains for well-structured, poorly structured and no team membership, respectively. An increase of one standard deviation in work stressors, resulted in an increase in 0.67, 0.70 and 0.81 standard deviations in strains for well-structured, poorly structured and no team membership, respectively. This investigation is an eye-opener for hospitals to work towards achieving well-structured teams, as this study shows weaker stressor-to-strain relationships for members of these teams.