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Occupational Stress

Occupational Stress

Occupational Stress



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.



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]


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]


  • NIOSH. Stress topic page [www.cdc.gov/niosh/ topics/stress/].

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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.


  1. Johansson JA. Psychosocial work factors, physical work load and associated musculoskeletal symptoms among home care workers. Scandinavian journal of psychology. 1995;volume 36(2):113-29.
  2. Brulin C, Gerdle B, Granlund B, Höög J, Knutson A, Sundelin G et al. Physical and psychosocial work-related risk factors associated with musculoskeletal symptoms among home care personnel. Scandinavian journal of caring sciences. 1998;volume 12(2):104-10.
  3. . Stress...at work. Cincinnati, OH: U.S. Department of Health and Human Services, Cen- ters for Disease Control and Prevention, Nation- al Institute for Occupational Safety and Health. DHHS (NIOSH) Publication No. 99–101. NIOSH. 1999;.
  4. Hurrell J, Murphy L et al. Psychological job stress In: Rom W, ed. Environmental and occupational medicine. 2nd ed. Boston, MA: Little and Brown. 1992;.
  5. Sauter S, Swanson N et al. An ecological model of musculoskeletal disorders in office work. In: Moon S, Sauter S, eds. Psychosocial factors and musculoskeletal disorders in office work. New York: Taylor & Francis . 1996;.
  6. Davidhizar R. Let stress make you--not break you. Home healthcare nurse. 1999;volume 17(10):643-50.
  7. El-Askari E and DeBaun B. The occupational haz- ards of home health care. In Charney W., Fragula G. eds. The epidemic of health care worker injury: an epidemiology. Boca Ratonm FL: CRC Press. 1999;.
  8. . Occupational outlook handbook 2008– 2009 Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics BLS. 2008;.
  9. Kendra MA, Weiker A, Simon S, Grant A, Shullick D et al. Safety concerns affecting delivery of home health care. Public health nursing (Boston, Mass.). 1996;volume 13(2):83-9.
  10. Prager SB. The vagaries of home health care: a critical review of the literature. The Journal of long term home health care : The PRIDE Institute journal. 1996;volume 15(1):19-29.
  11. Brulin C, Goine H, Edlund C, Knutsson A [1998a] et al. Prevalence of long-term sick leave among female home care personnel in northern Sweden. J Occup Rehab 8(2):103–111. 1998;.
  12. Stonerock C. Home health aides: home care's "endangered species". Home care provider. 1997;volume 2(1):15-7.
  13. Kennedy-Malone L. The stay or stray phenomena. Home Healthc Nurse. 1996;.
  14. Murphy LR. A comparison of relaxation methods for reducing stress in nursing personnel. Human factors. 1983;volume 25(4):431-40.
Topic 2428 Version 1.0


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