TOTAL GRAVEDAD NPI-Q TOTAL ESTRÉS NPI-Q

SYMPTOMS OF STRESS DISEASE

CORONARY HEART DISEASE MENTAL ILLNESS ROLE IN THE ORGANIZATION RELATIONSHIPS AT WORK CAREER DEVELOPMENT ORGANIZATIONAL STRUCTURE AND CLIMATE NON-WORK FACTORS INDIVIDUAL _{ORGANIZATIONAL} SYMPTOMS Raised Blood Pressure Depressed Mood Excessive Drinking Irritability

Chest Pains

High Absenteeism High Labor Turnover Industrial Relations Difficulties

Poor Quality Control

PROLONGED STRIKES FREQUENT AND SEVERE ACCIDENTS

[31]

(Firth, Williams, Herbison & McGee, 2007), and policy officials in Aotearoa New Zealand (Baehler & Bryson, 2009) to name a few. However, some research has compared the same occupational group across different countries. For example, Cooper and Hensman (1985) compared how occupational stress was experienced by executives in 10 different countries. McCormick and Cooper (1988) extended that comparison and added executives in

Aotearoa New Zealand to the literature.

Yet more research has focused on comparisons between different occupational groups within the same country. For example, the International Labour Organization (ILO, 1996) examined five occupational groups (air traffic control, nursing, offshore oil and gas production, bus driving, and shop floor work) in the United Kingdom. In addition Johnson et al. (2005) compared occupational stress across 26 occupations in the United Kingdom. Of particular interest from their research is their ranking of occupations on the variables of psychological wellbeing, physical health, and job satisfaction. Roberson Cooper (2002, as cited in Johnson et al., 2005) developed a survey called ASSET that measures sources of occupational stress, and Johnson et al. (2005) used the benchmark scores from ASSET to compare their findings against. In Table 2.1 below, occupations in italics report scores higher than those benchmarked in ASSET and indicate worse than average psychological wellbeing and physical health, and lower than average job satisfaction. When it comes to psychological wellbeing and physical health, a rank of 1 indicates the worst level and a rank of 26 indicates the best level. When it comes to job satisfaction, a rank of 1 indicates the lowest level and a rank of 26 indicates the highest level.

[32] Table 2.1

Occupations ranked on psychological wellbeing, physical health, and job satisfaction (Johnson et al., 2005).

Rank Psychological Wellbeing Physical Health Job Satisfaction

1 Social services providing care Ambulance Prison officer

2 Teachers Teachers Ambulance

3 Fire brigade Social services providing care Police

4 Ambulance Customer services – call centre Customer services – call centre 5 Vets Bar staff Social services providing care

6 Lecturers Prison officer Teachers

7 Clerical and admin Mgmt (private sector) Nursing

8 Mgmt (private sector) Clerical and admin Medical/dental

9 Prison officer Police Allied health professionals

10 Research – academic Teaching assistant Bar staff

11 Police Head teachers Mgmt (private sector) 12 Customer services – call centre Secretarial/business support Fire brigade

13 Director (public sector) Research – academic Vets

14 Allied health professionals Lecturers Clerical and admin 15 Bar staff Senior police Mgmt (public sector)

16 Nursing Nursing Lecturers

17 Medical/dental Mgmt (public sector) Head teachers 18 Senior police Allied health professionals Teaching assistant

19 Secretarial/business support Medical/dental Secretarial/business support 20 Head teachers Accountant Director (public sector) 21 Mgmt (public sector) Fire brigade Research – academic

22 Accountant Vets Senior police

23 Teaching assistant Director (public sector) School lunchtime supervisors

24 Analyst Analyst Accountant

25 School lunchtime supervisors School lunchtime supervisors Analyst

26 Director/MD (private sector) Director/MD (private sector) Director/MD (private sector)

The key take-home points are that reported levels of stress vary between occupational groups, and that some occupational groups experience higher than average levels of stress. The reasons for the variation will differ depending on what sources of occupational stress are relevant for that occupation. In addition, according to the transactional-appraisal-coping model of stress the variations will also depend on how individuals appraise the demands, and the coping strategies that they can draw on to moderate their experience of stressors.

2.4

Occupational Stress and the Heath Sector

In terms of Cartwright and Cooper‟s (1997) six sources of stress (intrinsic to the job, role in the organisation, relationships at work, career development, organisational structure and climate, and non-work factors), the health sector is no different from other occupational groups. However, because of the nature of the health sector, some of those six

[33]

sources are more predominant than others. For example, Landsbergis (1988) found that occupational stress was higher for hospital and nursing home employees when work overload (intrinsic to the job) and low decision latitude (role in the organisation) were combined. Piper (2006) asserts that human conflict (relationships at work) is one of the most pervasive challenges in health sector organisations. Indeed in the nursing literature, human conflict (particularly conflict between colleagues) is referred to as horizontal violence (McKenna, Smith, Poole & Coverdale, 2003), highlighting the prevalence of the problem. Browning, Ryan, Thomas, Greenberg, and Rolniak (2007) examined three nursing specialties (nurse practitioners, nurse managers, and emergency nurses) and found that burnout was more predominant in nursing specialties that had the least control over the workplace and patient outcomes.

As well as variations in sources of stress between health sector specialties or

disciplines, the level and experience of stress also varies. For example, according to Moore and Cooper (1996) although mental health professionals are subjected to similar sources of stress as other health sector professionals, the nature of dealing with troubled people means that mental health professionals also face different occupational stress issues. Gellis (2002) compared occupational stress between social workers and nurses, and found both

similarities and differences in the levels and experience of stress between the two disciplines. Lloyd, McKenna, and King (2005) compared occupational stress between occupational therapists and social workers, and found that social workers reported slightly more occupational stress than occupational therapists.

The key point is that just as levels and experience of stress vary according to occupational group, there is also variation between health sector specialties or disciplines because the sources of stress and situational factors vary between them. However, from an occupational stress perspective, the problem for all health sector specialties is that patient care suffers when stress is high (Kahn, 1993; Simon 2004). Since patient care outcomes are one measure of organisational performance, it is the central argument of this thesis that health and disability sector organisations in Aotearoa New Zealand should be proactive about taking all practicable steps not just to isolate or minimise occupational stress, but to build and maintain healthy workplaces. While healthy workplaces in the sector would

[34]

obviously benefit staff by reducing levels of stress it will also have positive flow on effects for the patients that use the health services.

2.5

Chapter Conclusion

The models presented in this chapter each contribute to our understanding of the phenomenon of occupational stress in different ways. However, the transactional-

appraisal-coping model really starts to shed light on how complex and multidimensional the process of occupational stress really is. Additionally, McGowan (2004) refinement of the model explicitly acknowledges that work demands have positive (eustress) outcomes and not just have negative (distress) outcomes for individuals and organisations. The transactional model also recognises that situational factors as well as individual differences can impact the experience of occupational distress or eustress. However, focus in the literature is still on stress, and the negative connotation that goes with it, rather than shifting the lens of analysis to wellbeing and healthy work. In addition, to date little (if any)

research attention has been directed to the ways in which indigenous cultures experience occupational stress or wellbeing, and how that might differ from other cultures. Given that all of the models of occupational stress have been developed from a Western, individualist perspective, it is time that their relevance and appropriateness for indigenous collectivist cultures is examined.

The challenge for organisations, then, is not simply to reduce levels of

occupational stress, but to create healthy workplaces that maximise the positive outcomes for employees and therefore the organisation. One way to create healthy workplaces is to examine work demands within the organisation to identify ways in which those demands can be modified to reduce stress or build healthy workplaces. Some of the sources of work demands (stress) identified in this chapter are not always within the organisation‟s control, such as the isolation of rural work, or the emotional toll that may result from working in palliative care. However, many work demands, including culturally relevant and

appropriate responses to those demands, are within the control of the organisation and would be relatively easy and cost effective to fix compared to the cost of doing nothing.

[35]

This chapter also demonstrated that occupational stress varies across occupations, with some occupations such as teachers, ambulance officers and police being rated as more stressful than others. And, in the health sector, occupational stress also varies between health specialties or disciplines. Additionally, some sources of occupational stress within the health sector, such as interpersonal conflict, appear more prevalent than for other industries. According to the transactional model of stress, in addition to organisations addressing some of the sources of work demands, those in high-stress industries could also improve the individual and organisational stress outcomes by helping employees develop more effective coping strategies suited to that industry. The imperative for the health sector to address these issues is about more than just providing „nice‟ employee and organisational outcomes. Since patient care suffers when health sector staff are stressed, patients too will benefit from health sector organisations‟ efforts to address occupational stress issues.

The next chapter examines the Aotearoa New Zealand context of occupational stress, including legislation and other issues such as the Treaty of Waitangi in the public sector and government policy in the health and disability sector. It will also include discussion of the limited research conducted on Māori occupational stress.

[36]