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Job Stress

Helen Burnett* starts each workday with 15 minutes of prayer and meditation. In her line of work, every moment of relaxation helps.

As a nurse in a Midwestern psychiatric hospital, Burnett faces all of the typical hassles that can make the modern workplace so maddening: office politics, tedious paperwork, long hours, and a pace that barely gives her a chance to breathe. Throw in a steady stream of biting, kicking, screaming, swearing, psychotic clients, and you have a working definition of a stressful job.

Millions of workers can relate. The National Institute for Occupational Safety and Health (NIOSH) reports that 25 percent of all Americans believe their job is the most stressful part of their lives. It isn't always just run-of-the-mill, teeth-gnashing, pencil-breaking stress, either. A host of studies link job strain to a wide range of illnesses, from headaches and backaches to heart disease. NIOSH warns that job stress can put workers at higher risk for cardiovascular disease, muscle and skeletal disorders, mood disturbances, workplace injury, and mental health problems, including depression and burnout.

Anyone who still thinks job stress is no big deal should consider this: In a four-year study of over 21,000 nurses published in the British Medical Journal, Harvard researchers concluded that job stress can sap a person's health just as surely as smoking or a sedentary lifestyle can. In fact, according to the American Institute of Stress, a million U.S. workers a day are absent from their jobs because of stress-related complaints.

If stress is like a time bomb, the ticking in Burnett's ears should be deafening. But ask her how she's doing, and you get a hearty, sincere "great." She hardly ever gets sick, and she usually feels happy and energetic. Every time she walks out of that psychiatric ward in a good mood, she proves an important point: Whether you're a nurse, a police dispatcher, or an accountant approaching tax day, it may be possible to overcome or eliminate overwhelming job stress.

It isn't all about you

Burnett did it by making changes in herself and the way she views her work. She prays, she meditates; she receives a regular weekly massage, eats well, and gets plenty of sleep. And she's learned to shut out the frustrations and to focus on the elements of the job that she truly loves.

But those methods don't work for everybody. NIOSH's approach to alleviating stress at work is twofold: change the organization AND learn how to manage your stress. The agency's Stress at Work guide has this to say: "Evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy. On the basis of experience and research, NIOSH favors the view that working conditions play a primary role in causing job stress." Stress management programs alone "often ignore important root causes of stress, because they focus on the worker and not the environment." And the positive effects from depending only on stress management programs or techniques tend to be short-lived, the agency concludes.

The culprits behind workplace stress -- aside from the nature of the work itself -- include lack of autonomy; overwork or not enough work the work pace and environment; lack of job security, control over work hours, pr opportunity for advancement; and relationships with supervisors and co-workers. According to NIOSH, large and small companies are taking more preventive steps to keep employees' stress levels to a minimum. General awareness about job stress, a commitment from top management to prevent it, and input from employees about what would help are essential to stopping job stress where it starts.

The National Association of Working Women, better known as 9 to 5, suggests it's wrong to blame yourself for what might well be a systemic problem at your workplace. By figuring out what problems you share with co-workers and brainstorming about them, you are that much closer to reducing your job stress, the organization advises.

One of the first steps to overcoming job stress is understanding the source, says Ernie Randolfi, Ph.D., a Montana-based business consultant and expert on stress management. Highly demanding work, office bickering, and a lack of resources can drag anyone down, but in many cases the real issue is control. People who believe they have some autonomy at their job have strong protections against stress, while those who feel powerless can be quickly wiped out, Randolfi says. The ad executive trying to land a million-dollar account may be under pressure, but he probably wouldn't want to spend a day in the chair of the person who answers his or her phones.

Having little control over one's job can be hard on the nerves and the ego, but it can be even more dangerous to the body. A five-year study of over 10,000 British government employees published in the British Medical Journal found that a lack of autonomy on the job nearly doubled a person's risk for heart disease. Another large study, published by the Center for Health Policy and Research, concluded that job redesign and flexibility in scheduling practices are strategies that could help prevent workplace injuries.

Stop it at the source

Like many nurses, Burnett knows a few things about imbalances of power. Several years ago, she worked with doctors who gave a lot of orders but never asked for input. And at one point, she had to dodge flying surgical instruments while a surgeon had a tantrum about another nurse. Predictably, she started suffering intense headaches and backaches. The strain even began to threaten her work. "Being under stress affects your judgment," she says. "That's when you start injuring yourself or making medication errors." It was time to quit or get help -- and she didn't feel like quitting.

Burnett decided to see a psychologist, a move that helped her become more assertive and regain a sense of control. She started offering advice to doctors. After all, she spent more time with patients than anyone else -- and doctors started listening. After taking a stress management class, she made some changes in her life that boosted both her mood and her health.

Exercise, sleep, frequent doses of relaxation, and increased assertiveness: Burnett's approach could be a blueprint for anyone suffering from job stress. But Randolfi agrees that lifestyle changes aren't always enough. In many cases, he says, workers have to stop stress at its source. For instance, people who feel powerless can take the initiative on a new project or simply ask the boss for flex time -- anything that gives them more control over their work.

But many workers can't adjust their jobs to suit themselves. Those burgers still need to be flipped and those files still have to be organized, no matter how burned-out a person feels. When workers can't change their work environment or duties -- or find another job -- they may have to look inward, Randolfi says. With the help of a counselor, psychologist, or other professional, many employees can learn to tune out the frustrating parts of their job and focus on its rewards. "Changing a person's way of thinking is the most difficult way to manage stress, but it's potentially the most successful," he says, parting ways with NIOSH.

In some cases, of course, job stress may be sending a message. "Some people are just not fit to be insurance salesmen or car salesmen," Randolfi says. Whenever a person's job clashes violently with his or her personality, it's probably time to polish up the resume and check out the want ads.

For Burnett, finding a different line of work never seemed like an option. Even at her lowest points, she wanted to stay in nursing. And now that she's learned how to handle stress, no amount of kicking, screaming, or biting can convince her otherwise.

* Helen Burnett is a pseudonym.

Further Resources

National Institute for Occupational Safety and Health http://www.cdc.gov/niosh/stresswk.html
The federal agency has produced a comprehensive report on job stress.

Occupational Safety and Health Administration (OSHA) http://www.osha.gov
800-321-6742

References

Bosma H, Marmot MG, Hemingway H, et al. Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study. BMJ;n314:558-65. Yawen C, Ichiro K, et al. Association between psychological work characteristics and health functioning in American women: prospective study. BMJ,320:1432-6.

Tetrick LE, Slack KJ, Da Silva N, Sinclair RR. A comparison of the stress-strain process for business owners and nonowners: differences in job demands, emotional exhaustion, satisfaction, and social support. J Occup Health Psychol 5(4):464-76.

Furlan R, Barbic F, Piazza S, Tinelli M, Seghizzi P, Malliani A. Modifications of cardiac autonomic profile associated with a shift schedule of work. Circulation;102(16):1912-6.

Haufler AJ, Feuerstein M, Huang GD. Job stress, upper extremity pain and functional limitations in symptomatic computer users. Am J Ind Med;38(5):507-15.

Dembe A et al. The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States. Occupational and Environmental Medicine 62(9):588-97

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