CONTINUING EDUCATION

Policy Perspectives on Occupational Stress Louise C. O’Keefe, PhD, CRNP; Kathleen C. Brown, PhD, RN; Becky J. Christian, PhD, RN

ABSTRACT Occupational stress is a major physical and mental hazard for many workers and has been found to contribute to cardiovascular disease, musculoskeletal disorders, mood disturbances, workplace injuries, and mental health problems. Health care utilization related to these physical and mental health problems costs employers billions of dollars annually. To combat this problem, employers should adopt a preventive approach and institute organizational and administrative changes that require the participation of both management and workers. This article reviews policies that could impact the quality of work life and influence organizational changes needed to achieve occupational health and safety. Occupational health nurses play a vital role in designing and implementing policies to improve work environments and reduce occupational stress. [Workplace Health Saf 2014;62(10):432-438.]

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he World Health Organization (WHO) (2013) recognizes that health is a human right and that policies promoting a healthy work life are key to well-being. Optimal health is a benefit to society as a whole, and is essential for economic and social development (WHO, 2013). Workers’ exposure to psychosocial hazards in the workplace has been acknowledged in the United States and worldwide. To address these psychosocial risks at work, Healthy People 2020 aims to increase accessibility of workplace programs to reduce employee stress (U.S. Department of Health and Human Services, 2011). Given that employed adults spend the majority of their waking hours at work exposed to a variety of negative psychosocial influences, workplace policies must be in place to improve workers’ health and safety. These policies become even more important in turbulent ecoABOUT THE AUTHORS

Dr. O’Keefe is Assistant Professor and Director of Faculty and Staff Clinic, University of Alabama in Huntsville, Huntsville, Alabama. Dr. Brown is Professor and Chair (retired), Community Health, Outcomes and Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama. Dr. Christian is Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama. Submitted: March 17, 2014; Accepted: July 14, 2014; Posted online: August 20, 2014 The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. Correspondence: Louise C. O’Keefe, PhD, CRNP, University of Alabama in Huntsville, NB 335, 301 Sparkman Drive, Huntsville, AL 35899. E-mail: [email protected] doi:10.3928/21650799-20140813-02

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nomic times when the economic survival of businesses and families are threatened. This article discusses policies that improve the quality of work life, a significant contributor to overall health and well-being. The concept of stress was introduced by Selye in the 1930s (Cooper, Dewe, & O’Driscoll, 2001). Selye (1973) defined stress as the organism’s response to any stressor or demand and stated stress could have negative (“distress”) effects or could be positive (eustress). Eustress motivates and challenges individuals to higher levels of performance, but prolonged exposure to distress produces ill health (Selye, 1974). Subsequent research explored the relationship between the individual and the environment, stressors, and other stimuli that can trigger a stress response in the individual. Situations at work that can potentially trigger stress include feelings of pressure when nearing a deadline, limited time to complete work assignments, changes in work routine, company downsizing, lack of control over work tasks, inadequate skill to complete assigned tasks, and difficult clients or colleagues (Fletcher, Sindelar, & Yamaguchi, 2011). The National Institute for Occupational Safety and Health (NIOSH) has long recognized the effect of stress on health. NIOSH (1999) defined occupational stress as “the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker” (p. 2). The European Agency for Safety and Health at Work (2009) further clarified that “work-related stress is experienced when the demands of

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the work environment exceed the workers’ ability to cope with (or control) them” (p. 14). Prevalence

Approximately 70% of U.S. workers consider their workplace a significant source of stress and 51% report that stress reduces their productivity (American Psychological Association, 2010). Health care utilization related to stress-induced health problems costs U.S. industries an estimated $68 billion annually and reduces company profits by 10% (American Psychological Association, 2010; Azagba & Sharaf, 2011). Thus, the link between occupational stress and health problems constitutes both a societal and economic problem. Moreover, occupational stress is a global concern. The European Working Conditions Survey found that in 2005, 20% of workers in the first 15 European Union member states suffered from stress at work (European Agency for Safety and Health at Work, 2009). Respondents reported back pain (30%), overall fatigue (20%), headaches (13%), irritability (11%), sleeping problems (7%), anxiety (7%), and heart disease (1%). NIOSH (1999) reported that 40% of workers surveyed by Northwestern National Life Insurance Company stated their job was “very or extremely stressful”; 26% of workers surveyed by the Families and Work Institute reported they are “often or very often burned out or stressed by their work”; and in a survey by Yale University, 29% of workers reported feeling “quite a bit or extremely stressed at work” (p. 2). Approximately 1 million workers are absent from work daily due to stress and 40% of job turnover is also related to stress (American Institute of Stress, 2009). Moreover, companies in the United States lose more than $300 billion annually as a result of accidents, absenteeism, employee turnover, diminished productivity, direct health care, legal, and insurance costs, and worker’s compensation related to stress (American Institute of Stress, 2009). According to NIOSH (1999), “health care expenditures are nearly 50% greater for those workers who report high level[s] of stress” (p. 5). The European Agency for Safety and Health at Work (2009) reported that between 50% and 60% of all lost workdays are related to occupational stress. In industrialized countries, it is increasingly acknowledged that psychosocial occupational risks are a major public health concern. The prevention and management of these psychosocial hazards for workers are slowly being addressed on the policy agenda (Leka, Jain, Zwetsloot, & Cox, 2010). Workers have come to expect protection from health and safety risks. Instituting protective prevention policies can curb these risks. Consequences

NIOSH (2013) emphasizes that job stress can lead to poor health, increasing the risk for cardiovascular disease, musculoskeletal disorders, mood disturbances, workplace injuries, and mental health problems. In a longitudinal, cohort study of 21,290 female registered nurses, Cheng, Kawachi, Coakley, Schwartz, and Colditz (2000) reported that job stress can predict a decline in health that

is similar to the decline brought on by smoking and sedentary lifestyle. In 1996, stress-related illnesses, such as depression and cardiovascular disease, were predicted to be the leading cause of the global disease burden by the year 2020 (Murray & Lopez, 1996). Other investigators have demonstrated the negative health-related effects that stress has on cardiovascular health (Franke, Ramey, & Shelley, 2002); job stress appears to have a direct link to cardiovascular disease and its risk factors (Chandola et al., 2008). In a large, prospective 19-year study of 6,895 men and 3,413 women, a dose-response relationship between job stress and obesity was demonstrated (Brunner, Chandola, & Marmot, 2007). Behavioral consequences of stress include overeating or eating unhealthy foods, fatigue, and lack of energy and motivation that could contribute to chronic health conditions, such as pre-diabetes and obesity. Psychosocial effects of stress include anxiety, irritability, sadness, depression, anger, feelings of helplessness, and pessimism (American Psychological Association, 2010; Han, Storr, Trinkoff, & GeigerBrown, 2011; Heraclides, Chandola, Witte, & Brunner, 2012; Montes & Kravitz, 2011). Several studies have reported a positive relationship between occupational stress and musculoskeletal pain (Chen, Chang, Chang, & Christiani, 2005; Chen, Yu, & Wong, 2002; Gershon, Lin, & Li, 2002). Chen, Yu, and Wong (2002) reported that occupational stressors such as environmental and ergonomic hazards were predictors of musculoskeletal pain in temporary workers. In a study with police officers, Gershon, Lin, and Lee (2002) demonstrated that the predicted odds of back pain in officers reporting work stress were 3.5 times the odds for officers with no perceived work stress. Regulatory Agencies

NIOSH, a key federal agency in the United States, supports research aimed at recognizing hazards in the workplace and either eliminating or controlling these hazards to provide safe working conditions for the U.S. workforce. Workplace hazards include physical, biological, chemical, radiologic, and psychological and behavioral hazards (Centers for Disease Control and Prevention [CDC], 2014; Ongori & Agolla, 2008; U.S. Department of Health and Human Services, 1987). The NIOSH Model of Job Stress and Health delineates stressful job conditions that can lead to injury and illness incidence, especially in the presence of individual and situational factors (CDC, 2014). NIOSH researchers use the Model of Job Stress and Health to guide their investigations on working conditions and employee health outcomes. Based on this model and research on occupational stress, NIOSH emphasizes stress management as a valuable health promotion and prevention activity (Murphy & Sauter, 2003; Ongori & Agolla, 2008; U.S. Department of Health and Human Services, 1987). NIOSH has promoted a management style that encourages employees to participate in decision-making processes. Research has demonstrated that when employees have little control over decision-making, their job stress increases and they are left feeling isolated and over-

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whelmed (Karasek, 1979). NIOSH has encouraged monitoring employees’ perceptions of their job conditions, management effectiveness, and the work environment through focus groups or surveys (CDC, 2014; Murphy & Sauter, 2003). Collecting these data provides evidence for interventions to improve working conditions. NIOSH’s model provides criteria for the development of an effective worker safety policy because the model and resulting criteria are based on research findings and encourage worker involvement to reduce job stress in the workplace. The European Union is beginning to establish a legal obligation for employers to provide safe and healthy work environments, although some member countries, such as the United Kingdom, already have established such practices (European Agency for Safety and Health at Work, 2009). However, the European Union Health and Safety Framework Directives state that employers have a legal obligation “to ensure the safety and health of workers in every aspect related to their work” (European Agency for Safety and Health at Work, 2009, p. 1). The Framework Agreement on Work-Related Stress, signed in October 2004, “provide[s] employers and workers with a framework to identify and prevent or manage problems of work-related stress” (European Agency for Safety and Health at Work, 2009, p. 4). The organizations within the European Union that have signed this agreement are committed to implementing workplace safety programs within 3 years after signing to prevent work-related stress. In the United Kingdom, The Health and Safety Executive has developed management standards that include collaboration between employees and employers to reduce work-related stress. To this end, “The Good Practice Model” is used to maintain a healthy and safe working environment for workers. This model includes a comprehensive stress prevention program that requires the participation of managers and workers to establish a stress prevention strategy based on information from a risk assessment for that particular organization (European Agency for Safety and Health at Work, 2009). The Economic and Social Impact of Occupational Stress

The employer is responsible for ensuring a safe workplace for all workers. When workers are injured or ill, companies lose money due to the costs of workers’ compensation and reduced productivity. Productivity can be affected by worker performance, absenteeism, morale, and turnover. In addition, the costs associated with ill or injured workers include the expense of recruiting and training new and replacement workers, treating ill or injured workers, the workers’ inability to cope with work and social situations, and the possible loss of career opportunities and ultimately employment. Problems at work can strain family and friend relationships, leading to depression and suicide (International Labor Organization, 2012). According to data from the Bureau of Labor Statistics (2008), U.S. workers who miss work because of stress, anxiety, or a related disorder are usually absent approximately 8 days. The European Union estimates that work-related stress affects at least 40 million workers in

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its 15-member states each year and work-related stress costs the European Union at least 20 billion Euros annually, a burden to the worker, the organization, and society (European Agency for Safety and Health at Work, 2009). JOB STRESS POLICIES A workplace policy concerning job stress should include ways to reduce occupational stress and its associated costs (e.g., absenteeism, treatment of injuries and illnesses related to occupational stress, and improving employee well-being, retention, and productivity). Evidence exists delineating the relationships among occupational stress, well-being, work-related costs, and productivity (Fabius et al., 2013; LaMontagne, Keegel, & Vallance, 2007). Improving employers’ understanding of the health and economic benefits that can result when job stress is decreased may encourage management to develop and implement job stress policies. An effective job stress policy should include a statement from the employer that demonstrates the company’s commitment to providing a healthy and safe environment for all employees. Managers are responsible for the implementation of job stress policies and the company is responsible for providing the necessary resources to manage occupational stress. Employers should conduct regular risk assessments to identify areas of potential work stress, provide training for all managers and supervisors, and offer confidential counseling to employees affected by work-related stress. Responsibilities of managers, occupational health and safety personnel, human resources professionals, and safety representatives should be outlined in the policy. The company’s safety committee should be responsible for implementing and reviewing the policy annually. The outcomes of an effective occupational stress policy can be measured in cost savings. Because health care costs are increasing and health care expenditures are 50% greater for workers reporting high stress levels, implementation of policies that reduce employee stress is advantageous to the organization and the employees (CDC, 2014; NIOSH, 2004). According to NIOSH, reducing occupational stress requires a two-prong approach (CDC, 2014). Organizational change is needed in combination with stress management programs. To prevent job stress, management must evaluate workloads that are congruent with workers’ capabilities, clearly define employee roles and responsibilities, and provide opportunities for employees to contribute to decision-making. The desirable effect of organizational change and effective stress management programs is a reduction in health care and other related costs, including from absenteeism, presenteeism, turnover, occupational injuries, workers’ compensation claims, and health care and legal costs. Medibank in Australia (2008) demonstrated monetary savings with effective stress management programs. Stress-related presenteeism and absenteeism cost the Australian economy $14.81 billion a year and directly cost employers $10.11 billion a year (Medibank, 2008). However, with an effective stressreduction policy, cost savings for the organization can be realized. An example of a successful worksite health

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promotion program that supports a healthy lifestyle and stress reduction is at the Johnson and Johnson Family of Companies. This program has been in effect for the past 30 years. Henke, Goetzel, McHugh, and Isaac (2011) reviewed health care costs for the period of 2002-2008 and found an average annual per employee savings of $565 in 2009 dollars. This savings translates to a return on investment of $1.88 to $3.92 for every dollar Johnson and Johnson spent on their health promotion program. In contrast, the likely outcome if occupational stress is not addressed at a workplace is continued increase in health care expenditures and loss of productivity. The cost of instituting a stress management program can be offset by fewer sick days, more productivity, and less employee turnover. Retaining experienced workers can result in less recruitment and training of new employees. In an organization that values communication, feedback, and teamwork, the potential benefit of healthy employees, and, in turn, a healthy, productive business environment cannot be overestimated (Medibank, 2008). In the worstcase scenario, an organization with an unsafe, unhealthy workplace will produce more sick leave days, workers’ compensation payments, worker turnover, and health care costs, and less productivity. It makes business sense to engage a healthy workforce. The only resistance companies display is complaining about the cost of instituting stress management programs, although this cost can be offset by worker productivity. In its 2001 report, the International Labour Organization provided an example of a company successfully preventing stress and increasing productivity. The Swiss-Swedish company, Asea-Brown Boveri, successfully decreased sick leave rates and musculoskeletal injuries and increased productivity in its female blue-collar employees by focusing on increasing work-related skills and involvement of workers in the organization (International Labour Organization, 2001). PSYCHOSOCIAL HAZARDS AND STRESSORS To minimize the detrimental effects of stress on employees and organizations, employers should identify and address the causes of stress in the workplace. A focus on organizational change such as job redesign to remove or reduce sources of stress or psychological hazards at work is needed, rather than focusing only on offering individual stress management programs (Leka & Jain, 2010). A psychological hazard is any hazard that has the potential of causing mental and physical harm by overwhelming workers’ coping mechanisms and abilities to work in a healthy and safe manner (Cox & Griffiths, 2005). Examples of workplace stressors that may be categorized as psychosocial hazards include job content and control, workload, shift work, environment and equipment, occupational violence and bullying, role of the worker in the organization, and career development (WHO, 2013). Job Content and Control

Repetitive work is one example of how job content can be a psychological and physical hazard. Repetitive

work can be monotonous, leading to depression and anxiety. Physically, it can increase the incidence of postural and musculoskeletal problems (Leka & Jain, 2010). NIOSH has encouraged a culture of health and wellness in work environments through policies that reduce the incidence of work-related musculoskeletal disorders (CDC, 2011). To reduce musculoskeletal injuries, employers have constructed policies initiating ergonomic programs and redesigning jobs and tasks, scheduling more breaks, and rotating workers through several tasks to reduce psychological and physical stress. By creating jobs with varying physical demands and adjusting the pace of work, more control can be given to employees during the work day. Policies that prevent musculoskeletal problems due to repetitive work contribute to a safer work environment, increase employees’ sense of security and control, lower health care costs, and improve worker productivity (CDC, 2011). Workload

Workload can impact employee health. Most workplaces have workload policies specific to the place of employment and occupational role. For example, a workload policy in a construction company will differ from a workload policy for a university (Leka & Jain, 2010). The issue of workload is especially significant in nursing because heavy workloads for hospital nurses adversely affect patient safety and job satisfaction, leading to a higher turnover and contributing to the nursing shortage. Workload issues in the U.S. health care system have resulted in state legislation mandating patient-to-nurse ratios (in California) or participation of nurses in staffing decisions (14 other states) (Carayon & Gurses, 2008). Shift Work

The effect of shift work on circadian rhythms and disruption of sleep has been well documented in the literature. Approximately 25% of North American employees work shifts (NIOSH, 2012). Shift work is common in factories, mines, health care, transportation services, and police and firefighting work, contributing to increased risk of chronic illness and occupational stress. Heart rate and blood pressure have been shown to follow a circadian rhythm and research has demonstrated an increased risk of coronary events among shift workers (Leka & Jain, 2010). Family and social life are affected by shift work, as is occupational safety due to the fatigue experienced when employees work shifts. Policies about shift schedule design usually address the length of the rotation period, the direction of the shift schedule, beginning and end of the shift period, and time off during socially desirable times such as weekends (Canadian Center for Occupational Health and Safety, 2010). Policies on flexible work schedules contribute to more committed employees and allow workers to manage their work and family obligations without choosing between the two. Employees working flexible schedules used less sick and leave time and reported fewer symptoms of stress, benefiting both workers and employers (Butler, Grzwacz, Ettner, & Liu, 2009; Halpern, 2005).

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Environment and Equipment

Noise is a physical hazard that can affect health by acting as a physical and psychological stressor. High levels of noise damage the middle and inner ear, and, if prolonged, may give rise to stress, anxiety, tension, irritability, fatigue, and impaired work performance (NIOSH, 2013). According to NIOSH (2013), occupational hearing loss is the most common work-related injury in the United States. An estimated $242 million is spent annually on workers’ compensation for hearing loss disability, with approximately 22 million U.S. workers exposed to hazardous noise levels at the workplace. NIOSH has recommended national standards for noise and has established policies on the prevention of workplace hearing loss. The European Union also has a policy on noise exposure because of the recognized health effects of noise on hearing, blood pressure, and mental health (Kephalopoulos, Paviotti, & Anfosso-Ledee, 2012). Leka and Jain (2010) reported that male workers exposed to noise at work had a 43% increased risk for sickness absence of 2 weeks or longer compared to workers who reported no exposure to occupational noise. Occupational Violence and Bullying

According to the Bureau of Labor Statistics (2011), homicide is one of the leading causes of death in the workplace. In 2010, 506 homicides occurred in U.S. workplaces. Violence at the workplace is not an individual issue, but rather is a concern that requires companies to develop policies to prevent violence by decreasing opportunities for violent behavior at work. The economic impact of workplace violence includes lost productivity, legal expenses, property damage, and turnover. Emotional costs can be more subtle; the effects of trauma can include depression, isolation, anxiety, sleep disturbances, sick leave, and absenteeism. The U.S. Occupational Safety and Health Act of 1970 requires that employers provide a safe work environment, free of hazards that are likely to cause death or serious physical harm to employees (Occupational Safety and Health Administration, 2014). The Occupational Safety and Health Administration has provided guidelines to aid in the development of policies and procedures for handling potential and actual violent situations and should include procedures for training employees to recognize and respond to potential violence and report violent incidents safely and develop violence prevention and intervention programs. Workers should be referred to a health care professional if exposed to violent situations at work. Exposure to workplace bullying, defined as repeated actions toward employees with the intent of intimidation and humiliation, is associated with anxiety, depression, insomnia, and stress (Leka & Jain, 2010). Bullying behavior creates feelings of helplessness and undermines workers’ rights to dignity at work. The targets of bullying experience exceptional stress and are at risk for post-traumatic stress disorder (Leka & Jain, 2010). It is imperative that policies address psychological intimidation and confidential ways to report it. Employers should have a zero tolerance anti-bullying policy that specifies

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an independent contact, such as a human resource representative, who should be contacted when an employee reports bullying. Various organizations, such as the Occupational Safety and Health Administration and the European Agency for Safety and Health at Work, have websites and resources to guide employers in establishing anti-bullying policies and programs at their workplaces. Role in Organization

Employees can experience stress, ambiguity, and conflict as a result of their roles in organizations. Illdefined expectations can lead to role stress linked to job satisfaction and turnover (Leka & Jain, 2010). Role conflict has been linked to a decline in job performance, performing the minimum job requirements. To avoid role conflict, job descriptions must be explicit in delineating job responsibilities to avoid role ambiguity. When organizations change, employees may experience changes in work roles. Role change may lead to stress, and if changes are perceived as a loss of authority or responsibility, workers may respond with inappropriate coping strategies. Managers must be aware that employees may perceive any change as stressful. Introduction to new roles and responsibilities should be provided to new employees and managerial support should be provided via training. In a study of 5,357 employees from Denmark, long-term illness among female employees was associated with role conflict, low reward, and poor management quality (Lund, Labriola, Christensen, Bultmann, & Villadsen, 2006). Career Development

Lack of career development opportunities may be perceived by employees as a source of stress, a threat to job security, or redundancy. This situation takes on even more importance in difficult economic times. Employees may experience increasing anxiety and stress leading to depressive mood and increased blood pressure. In a large study of 14,691 employees, investigators reported that job insecurity was more prevalent among employees in small companies, those with less education, blue-collar workers, construction workers, and older women (Cheng, Chen, Chen, & Chang, 2005). Regression analyses demonstrated that job insecurity was strongly associated with poor health. Given the importance of job security to wellbeing, managers should have career development programs to educate and retain employees. These programs should aid employees in defining career goals and matching employees’ needs to the needs of their organizations. Training programs provide employees with new skills to enhance current capabilities and prepare them for future job opportunities, benefitting both employees and the organization by retaining skilled workers. ROLE OF OCCUPATIONAL HEALTH NURSES Through close contact with workers, occupational health nurses can identify hazards to workers’ health and safety. The occupational health nurse should be aware of the job characteristics that are potential psychosocial hazards to employees. Cognitive and emotional demands,

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work overload, increasing use of technology in the workplace, shift work, ineffective communication, insufficient staff, organizational changes, and bullying are potential stressors that can have an impact on the psychological and physical well-being of employees. Hazards can arise from any change in the organization or new practices. Employees often view occupational health nurses as sources of support and guidance because they provide assistance through problem-solving, listening and counseling, assisting employees to cope, and expertly assessing workers’ readiness to return to work. Occupational health nurses are clinicians, nurse specialists, managers, coordinators, health educators, counselors, and advisors. Because of the autonomy of the occupational health nursing role, these nurses are often the bridge between management and employees, contributing to health and safety policies, and influencing the quality of work life. By being present at the workplace, occupational health nurses can influence the content of policies about stress reduction. Workers frequently discuss both health complaints and potential sources of occupational stress in the workplace with occupational health nurses. These conversations can provide input into creating, reviewing, and updating policies. In addition, occupational health nurses should assume key roles in assessing stress among employees using individual interviews, group discussions, formal surveys such as Karasek’s job stress questionnaire, and review of absenteeism, illness, and turnover rates, which are objective measures of stress. Occupational health nurses are also responsible for designing and implementing stress management programs and referring employees to confidential employee assistance programs. Therefore, occupational health nurses advise and participate in the development of effective company-wide stress management policies and programs. Occupational health nurses demonstrate evidencebased practice to guide and support the psychological health of employees, conduct occupational health assessments, and provide guidance on a range of health issues, work ability, and safety, especially those issues that affect performance at work. Policies should designate the occupational health nurse’s responsibilities in participating in management team discussions and decision-making to improve the work culture, identify stressors, refer employees if needed, and monitor and manage the care of the employee when returning to work. Occupational health nurses use research findings and translate them into practice to improve nursing care. Research on work stress and occupational health is well established and may be incorporated into practice. Occupational health nurses often produce reports on sick-time use, health promotion initiatives, and interventions such as modifying working environments or changing work practices to enhance health and safety. Careful analysis of these data may identify illnesses and absences attributable to stressful work environments. Occupational health nurses can discuss sensitive information with employees regarding their perceptions of the work environment and because of the long history of trust that society places on nurses. Employees believe that occupational health

IN SUMMARY

Policy Perspectives on Occupational Stress O’Keefe, L. C., Brown, K. C., Christian, B. J. Workplace Health and Safety 2014;62(10):432-438.

1

Occupational stress is a global problem with workers reporting a host of psychological and physical problems resulting from job stress.

2 3

Causes of work stress include repetitive work, workload, shift work, noise, occupational violence and bullying, and role conflict.

An effective work stress policy defines employers’ commitments to providing a healthy and safe work environment.

4

Occupational health nurses design and implement policies that can improve work environments and reduce work stress.

nurses can be trusted to maintain confidentiality and this trust builds optimal relationships. CONCLUSION Occupational health nurses play a vital role in designing and implementing policies that can improve worksites and reduce occupational stress. Because stressful work conditions are linked to impaired mental and physical health, policies that build employees’ coping skills and resilience to stress and avoid stress-related illness are essential for both workers and their employers. Organizational and employee-focused policies and interventions can successfully reduce stress among workers, offer long-term prevention of stress-related health problems, and play a critical role in determining the health of the workforce. With individuals spending most of their waking time at work, it is imperative that places of employment protect and promote the health of workers through the development of policies to reduce workplace stress. Employers should adopt policies that ensure the health of workers is valued, supported, and promoted. Moreover, proactive policies for health promotion and stress reduction will ensure committed and loyal employees, control health care costs, and improve productivity. REFERENCES

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Policy perspectives on occupational stress.

Occupational stress is a major physical and mental hazard for many workers and has been found to contribute to cardiovascular disease, musculoskeletal...
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