Last updated on 4/19/24 | First published on 4/19/24 | Literature review current through Nov. 2024
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INTRODUCTION
Overview
This topic is part of a document published by the U.S. National Institute for Occupational Safety and Health (NIOSH), which is in the public domain and may be freely copied or reprinted.[1]
Home healthcare work involves challenges that are not present in hospital or other inpatient healthcare settings. Not many studies have looked into stress levels of home healthcare workers, but the few studies that have show that home healthcare may be quite stressful. The home setting may involve stressors, such as lack of control over work planning, that are risks for shoulder and neck pain, especially when combined with physical risk factors such as strenuous postures. [2][3] Attracting workers and retaining them is a high priority for many home healthcare agencies, and providing a more healthful, less stressful, work climate is an important part of any retention strategy. The following sections discuss job stressors present in home healthcare work and provide suggestions for how job stress may be prevented or reduced for home healthcare workers.
Background
Definitions
What are some specific stressors of home healthcare workers?
NIOSH defines job 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”.[4] Job stressors include job and task demands such as work overload, time pressure, lack of task control and role ambiguity; and organizational factors, such as poor interpersonal relations, lack of support from supervisors and co- workers, and unfair management practices.[5] Other sources of stress, which may be of particular importance in the home healthcare environment, are socioeconomic factors, training and career development issues, and conflict be- tween work and family roles and responsibilities.[6]
Home healthcare workers report some of the same stressors as other healthcare workers:
- Ill and dying clients[7]
- Workload and time pressures[2]
- Increasing emphasis on healthcare cost savings[7]
- Patient aggression[8]
- Patients who are disoriented, irritable, or uncooperative[9]
In addition, home healthcare workers may have to deal with stressors that healthcare workers in hospitals or other inpatient healthcare settings do not: their work is not directly supervised, they generally work alone, they might travel through unsafe neighborhoods, and they may have to face alcohol or drug abusers, family arguments, dangerous dogs, or heavy traffic.
Employers may not take a proactive enough stance in removing workers from an unsafe work environment or in providing support when workers encounter abusive behavior from the client or the client’s family.[10] Families may expect more from home healthcare workers than their duties require them to provide. Workers may be unsure whose instructions they should follow: the client’s or those of the agency that employs them.[11]
Home healthcare workers face time pressures arising from their client loads. Time pressure may reduce the level of service.[11] Home healthcare workers report that they shorten their visits if they feel unsafe.[10] Workers may have to deal with clients who do not comply with prescribed medicine orders or who refuse services.[10] Home healthcare workers have reported an increase in paperwork per each client visit because of state and federal regulatory requirements.[7] Some studies suggest that home healthcare workers may have more on-the-job stress than other comparable jobs, like teachers and child care workers. Johansson [2] found that, compared with teachers and child care workers, home healthcare workers reported having less control over and being less excited by their work. Home healthcare workers took the most long-term sick leave (30 days or more per year) and had the second highest frequency of absenteeism.[12] PREVENTION
What can I do to prevent and control occupational stress?
Both employers and employees can take actions to reduce stress.
Recommendations for Employers
- Provide frequent, quality supervision and agency staff support.
- Provide adequate job training and preparation, including continuing education opportunities.
- Hold regular staff meetings in which problems, frustrations, and solutions can be discussed.
- Include lunch breaks and sufficient travel time in workers’ schedules and allow self-paced work.
- Have policies and procedures in place to ensure worker safety.[10]
- Provide access to an employee assistance program or other means of counseling support.
- Provide wages and benefits that are competitive with what other service organizations are offering.[11][2][13]
That last recommendation is particularly important for retaining home healthcare workers. In a survey sample, Kennedy-Malone
[14] found that 50% of home healthcare workers stated that “no pay increase” was a “very important” reason that they may re- sign; 40% said the same for “no health insurance.”
Recommendations for Workers
- Develop effective coping strategies; try to put a positive spin on things. For ex- ample, think of ways a stressful situation will help you become a better healthcare worker.
- Improve time management or planning skills through training your employer may provide.[7]
- Perform relaxation exercises you learn in training your employer may provide.[7]
- Develop supportive relationships with coworkers and others outside of your work environment.[7]
Stress management techniques really can lower your stress level. For example, nurses trained in relaxation techniques reported a significant increase in their ability to cope with stress at work.
[15]RESOURCES
- NIOSH. Stress topic page [www.cdc.gov/niosh/ topics/stress/].
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