18 Sources of Occupational Stress A career in nursing is inherently fraught with numerous stressors. Nurses are on the front line of human suffering on a daily basis. Yet, they are expected to be at their best at all times. Hospice nurses, specifically, work with patients who are preparing for their own deaths and families who are working toward letting go of someone dear to them. In these difficult circumstances, hospice nurses are expected to simultaneously provide support for patients and families, control their own emotions, and work through the losses of multiple patients. Other job-related stressors, such as office politics and interpersonal conflict, can also add a significant burden. This chapter addresses the sources of stress for nurses. After reading this chapter, you will be able to: ■ Identify sources of occupational stress for hospice nurses ■ Describe workplace factors that increase occupational stress ■ Discuss the effects of personality types and generational differences in the workplace OCCUPATIONAL STRESS AND HOSPICE NURSING Occupational stress, also called “job stress,” is defined as a harmful physical and emotional response that occurs when the requirements of a job are mismatched to the abilities of the workers, the resources provided by the employer, or the expectations of the employer (Najimi, Goudarzi, & Sharifirad, 2012; Roberts, Grubb, & Grosch, 2012). Occupational stress can also be related to dynamics such as workload and the nature of the job (Orly, Rivka, Rivka, & Dorit, 2012). Each day, hospice nurses face stressors in the office, on the road, in patients’ homes, and while on call. Hospice nurses who work in inpatient settings face similar stressors during their shifts. Some sources of occupational stress for nurses include (Happell et al., 2013; Roberts et al., 2012): ■ Heavy workloads ■ Unsupportive management ■ Shift work and long work hours ■ On-call requirements ■ Handover procedures ■ Lack of professional progression/opportunity ■ Lack of control ■ Interpersonal conflict ■ Bullying and physical violence ■ Insufficient resources ■ Poor reward systems Fast Facts in a Nutshell According to the World Health Organization (2016, para. 1), a healthy job is “likely to be one where the pressures on employees are appropriate in relation to their abilities and resources, to the amount of control they have over their work, and to the support they receive from people who matter to them.” Stressors specific to hospice nursing include (Peters et al., 2012; Tunnah, Johnstone, & Jones, 2012): ■ Frequent exposure to death and dying ■ Family grieving ■ Family conflict ■ High workloads ■ Workload pressure ■ Lack of a support system/isolation ■ Psychological distress related to frequently facing existential issues ■ Communication issues with the interdisciplinary team ■ Inadequate preparation for providing end-of-life care LATERAL VIOLENCE AND WORKPLACE BULLYING One serious issue that has been repeatedly identified as a source of occupational stress for nurses is lateral violence, which is sometimes called “workplace bullying.” Lateral violence is defined as behavior that consistently causes an individual or group to feel belittled, degraded, intimidated, or harassed in the workplace. Workplace bullying can also include exclusion of certain individuals or groups (Allen, Holland, & Reynolds, 2015). Fast Facts in a Nutshell Nurse–nurse bullying undermines patient care and reduces the work performance of nurses (Hutchinson & Jackson, 2013). Aggression in the workplace may manifest in any number of ways, including blatant disregard for mutual respect within the workplace or low-level incivilities such as ignoring or excluding coworkers from activities (Taylor & Kluemper, 2012). Workplace bullies undermine and demean their coworkers and rally the support of others against the target to reinforce aggressive behaviors and further isolate the target (Becher & Visovsky, 2012). Some examples of aggressive behaviors in the workplace include: ■ Criticizing ■ Intimidation ■ Blaming ■ Fighting ■ Refusing to help ■ Public humiliation ■ Withholding behaviors (silent treatment, exclusion, or omission) ■ Name calling ■ Threatening behaviors or actions ■ Gossiping ■ Isolating ■ Ignoring ■ Giving unreasonable assignments (Becher & Visovsky, 2012) Lateral violence, also called “horizontal violence,” is especially prevalent in nursing, with more than half (61%) of nurses reporting that they experienced horizontal violence in the workplace (Becher & Visovsky, 2012). Lateral violence results in psychological and physical issues such as: ■ Headaches ■ Stress ■ Impatience ■ Nervousness ■ Impaired sleep ■ Diminished social skills ■ Depression ■ Inability to concentrate ■ Inability to cope with stressors ■ Posttraumatic stress disorder (Allen et al., 2015) Other factors also contribute to stress in the work environment. For example, the way that personalities blend or clash within the team can have a profound effect on occupational stress. PERSONALITY TYPES IN THE WORKPLACE
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