STRESS MANAGEMENT IN HEALTHCARE 1
Stress Management in Healthcare
School of Business, Liberty University
BUSI510: Organizational Behavior in Health Systems
Jane Satterfield, RN BSN
Respectfully Submitted to Dr. Galloway on 11/1/2023
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ABSTRACT
Stress has become a large part of the structure and organization of healthcare. Tensions of
the COVID-19 pandemic, nursing shortages, increased demands of patients with higher acuities,
and the demands of the healthcare business are a few of the many causes of stress and pressures
placed on the professionals within the present-day healthcare system. Other causes of workplace
stress can be the demands placed on oneself by the system, their team, or themselves within their
roles or the tasks required to complete. “Individual task demands include unrealistic deadlines,
fear of failure, new technology, lack of necessary resources (e.g., poor physical work
environment, such as noise, heat, and crowding), work overload, lack of control, and repetitive,
unchallenging work (work underload). Individual role demands include job ambiguity, conflict,
and difficulty balancing work and family life. Group demands include poor interpersonal
relationships with coworkers and/or supervisors, inadequate support, and lack of decision-
making participation. Organizational demands encompass politics, communication problems,
excessive rules and regulations, organizational structure and culture, lack of career development
activities, and change without clear strategic direction,” (Borkowski, 2021). How we cope with
stress, through programs or learned techniques, is called stress management. Stress management
programs and systems provide managers and leadership with tools and strategies to learn their
stress and how to manage it while promoting resilience and preventing burnout. These programs
are designed to give healthcare professionals the tools and knowledge to cope with the stressors
they combat daily. They provide techniques that can be applied daily within and outside their
professional space.
STRESS MANAGEMENT IN HEALTHCARE 3
When considering how stressful the healthcare profession is, we must acknowledge why
it is this way and how to manage it. The result of unresolved stress is burnout, and when
healthcare professionals become burnt out, they cannot provide standard quality of care
effectively and efficiently with the patient at the forefront of their work. Within healthcare,
nursing and physician shortages are causing even more strain and stress on the system as the
present staff must still care for all needing care, whether it is safe or not. Burnout has been a side
effect of exhaustion or overuse of a person or their abilities within their job needs. “Moral
distress or burnout can occur when nurses experience powerlessness, low levels of control,
inadequate support or resources, increased job stress, and high job demands,” (Guttormson, et al
2022, p. 128). While burnout has been used as a facetious expression or an excuse for nurses to
leave the profession, it has been documented and respected as a clinical diagnosis. “This review
focuses on burnout, an occupational phenomenon that results from chronic stress in the
workplace. After analyzing how burnout occurs and its different dimensions, the following
aspects are discussed: (1) a Description of the factors that can trigger burnout and the individual
factors that have been proposed to modulate it, (2) an identification of the effects that burnout
generates at both individual and organizational levels, (3) presentation of the main actions that
can be used to prevent and reduce burnout, and (4) recapitulation of the main tools that have
been developed so far to measure burnout, both from a generic perspective or applied to specific
occupations,” (Edú-Valsania, et al. 2022, p.1). Having a diagnosis code in the World Health
Organization’s ICD-11, burnout is a globally recognized diagnosis. This information is in support
of the fact that stress, exhaustion, and mental fatigue while working within the healthcare system
can lead to a mental health diagnosis, which in turn can prevent one from being able to work and
provide patients with standards of care. It gives foundation to burnout being more than a flippant
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expression or an excuse for healthcare professionals to leave the workforce. While burnout can
be experienced within any occupation of healthcare, it appears to be most commonly apparent in
those who are in patient-facing positions. The critically ill patients, long work hours, high-stress
shifts, and little support from employers and the organization all play a role in the phenomenon
of burnout. Not being prepared with resiliency strategies and techniques can also bleed into the
feeling of not having support from your employment system. This phenomenon is not
experienced only in the United States, but globally. While it is easy to focus on the United States,
we cannot overlook this growing concern. “An overview of the problem indicates ineffective
planning and use of available nursing resources, poor recruitment or an undersupply of a new
staff, and global demographic conditions,” (Marć, et al 2019, p.9).
The COVID-19 pandemic appears to have exacerbated the growing strain healthcare
professionals feel. This also impacted staffing, mental health, and the overall pressures put on the
healthcare system. The COVID-19 Pandemic affected all aspects of the world as we know it.
COVID-19 and the conditions nurses worked in during that time will leave a negative mark on
those on the front lines. “There is no doubt that nursing in the time of COVID‐19 is having a
profound effect on the mental health of nurses, especially clinicians on the front lines of the
pandemic, and governments need to be seriously concerned with investing in nursing.” (Turale,
et al. 2021, p. 14). Frontline workers, including nurses and patient-facing staff within the
hospitals, did not have the opportunity or ability to stop working or quarantine when the
pandemic hit the United States. They worked despite the personal protective equipment (PPE)
shortages and the droves of patients coming to be tested, treated, or reassured, regardless of the
fear of becoming ill or the risk of exposure. The effect that the pandemic had on the mental
health of nurses and healthcare professionals can be seen as a direct correlation to the shortages
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we are currently experiencing. COVID-19 also impacted the formal education and training of
nurses, physicians, and other healthcare staff. “Although nursing faculty across the country have
done an astonishing job in providing continuity in their students’ educational programs that were,
like almost everything else in the country, brought to a halt by COVID-19, it is still unclear what
portion of the prelicensure nursing student population graduated on time,” (Spurlock, D. 2020, p.
303). Not having the proper preparation and education caused healthcare professionals to come
to the workforce with the expectation of jumping in and providing quality care to patients
without the complete understanding, knowledge, and proper training that had previously been
required before beginning their practice. “Despite their professionalism, overburdened,
overworked, and under-equipped healthcare systems may account for higher stress among these
individuals. It is already known that the pandemic may have led to an increase in burnout among
these workers. The chronic stress observed is a risk factor for mental and physical health issues,”
(Courraze, et al. 2021). Researchers have shown that the pandemic added additional stress and
pressure onto the already burdened healthcare professionals.
Another current concern and problem is the global nursing shortage that all healthcare
systems and entities are experiencing. The nursing shortage has highlighted a vicious cycle:
nursing and other healthcare professionals are leaving their profession due to stress; those in the
healthcare profession are becoming more stressed due to staffing shortages. We know there is a
growing issue, but how is it being addressed, and are the proposed solutions effective? Why are
nurses unable to meet the expectations and demands placed on them by their patients and
employers? While many answers to this question have been provided, the problem continues to
grow without a clear path to resolution that can be recognized and used globally. The pressure
and weight of the pandemic placed on our front-line nurses and healthcare workers was heavy
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and since has left a void that has not been filled. This leads to patient demise, medication errors,
improper or ineffective patient education, and higher readmission rates. Many people
acknowledge the nursing shortage is a growing problem, but we must also evaluate the
effectiveness of the proposed solution. Another factor we should address is the financial
investment a nurse has for their healthcare system and entity. The stress placed on management,
leadership, cost, and profit centers to allow the business of healthcare to remain afloat is a
significant stressor to the system. To be adequately trained is extensive and costly when done
correctly and effectively. The time, effort, and money it takes to train any healthcare professional
is substantial. Training and competency are requirements as the lives of other people are at stake.
Administering medications, monitoring patient vital signs and symptoms, and performing
procedures and surgeries are all tasks that cannot be poorly educated on. “The total cost of
turnover, which includes pre-and post-hire expenses, is between $7.875 million and $8.449
million in the United States. To break this number down, organizations spend approximately
$300,000 annually for every 1% increase in nursing turnover” (Gellasch, P., 2015, p. 64). The
numbers represented in this article prove how the financial burden of health care falls on our
consumers and patients. “Perhaps the most noteworthy consequence is that nursing shortages
directly contribute to increased health care costs (Roberts, n.d.). One study reported hospitals
with inadequate staffing are positively correlated with higher readmission rates (McHugh et al.,
2013); unnecessary hospital re-admission costs the Center for Medicare & Medicaid Services
approximately $26 billion annually (Lavizzo-Mourey, 2013). High patient-to-nurse ratios are
associated with increased urinary tract and surgical site infections (Cimiotti et al., 2012).
Adjusting for inflation using the Consumer Price Index-Urban (CPI-U) with a base year of 2005,
surgical site infections cost an organization between $10,443 to $25,546 per infection and $589
STRESS MANAGEMENT IN HEALTHCARE 7
to $758 per catheter-associated urinary tract infection (Scott, 2009). In addition, inadequate
staffing ratios contribute to ventilator-associated pneumonia, central line-associated bloodstream
infection, and Clostridium difficile infection; these five nosocomial infections directly cost the
U.S. health care system (adjusted for CPI-U) between $28.4 and $33.8 billion annually (Scott,
2009). Certainly, low staffing levels are not solely responsible for hospital-acquired infections
and their subsequent costs; however, they are a major contributor” (Snavely, T., 2016, p. 99-100).
This quote encompasses many different numbers and statistics that highlight the financial
burdens of burnout and turnover. The staff shortage has been proven to lead to premature
discharges, poor patient outcomes, ignorance of health risks to prevent a more extended
admission, and improper discharge teaching.
Other causes of workplace stress can be the demands placed on oneself by the system,
their team, or themselves within their roles or the tasks required to complete. “Individual task
demands include unrealistic deadlines, fear of failure, new technology, lack of necessary
resources (e.g., poor physical work environment, such as noise, heat, and crowding), work
overload, lack of control, and repetitive, unchallenging work (work underload). “Individual role
demands include job ambiguity, role conflict, and difficulty balancing work and family life.
Group demands include poor interpersonal relationships with coworkers and/or supervisors,
inadequate support, and lack of decision-making participation. Organizational demands
encompass politics, communication problems, excessive rules and regulations, organizational
structure and culture, lack of career development activities, and change without clear strategic
direction,” (Borkowski, 2021). In dealing with these types of stress and pressures, there are two
options for managing stress: to change your environment or to change yourself. This is referred
to as stress management. Another term for stress management is coping. Coping with stress at
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work can be defined as “an effort by a person or an organization to manage and overcome
demands and critical events that pose a challenge, threat, harm or loss to that person and that
person’s functioning or to the organization as a whole” (Schwarzer, 2004, p. 342). In his article,
Schwarzer gives managers a model within their team that provides four perspectives to cope with
and manage stress. These four perspectives are reactive coping, anticipatory coping, preventive
coping, and proactive coping. “Reactive coping refers to efforts to deal with a stressful encounter
that either is ongoing or has already happened, such as a job loss or demotion. Anticipatory
coping pertains to efforts to deal with an inevitable event that is certain to occur shortly, such as
public speaking, a job interview, or downsizing. Preventive coping refers to an effort to build up
resistance resources, whereby the level of stress felt by an individual is reduced (the severity of
impact is minimized) if a critical event is expected to occur in the future. Proactive coping is
building up general resources that facilitate movement toward challenging goals and personal
growth, such as hardiness training and learned optimism” (Schwarzer, 2004). The use of this
model allows one feeling the stresses and burdens of their situation and encourages them to use it
as fuel for opportunities and not as a mere response to stress.
Now that we have addressed what stress is, what stress becomes (burnout), and proposed
models to manage stress, we can now discuss proposed techniques and methods to reduce
workplace stress and how to promote resilience within your team. There are many programs and
systems that managers and leaders can acquire for their teams to gain knowledge of stress
management and how to prevent burnout properly. Stress management programs often involve
breathing and stretching exercises, yoga, meditation, and massage. The programs’ goals are to
lessen the adrenaline response to minor stress. One of these programs that has been used and
studied around healthcare is known as the SMART program. “The SMART Program is a multi-
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modal program developed at the Benson-Henry Institute for Mind Body Medicine that teaches
various skills to reduce the physical, cognitive, emotional, and behavioral effects of stress. This
program contains four main components to build resilience to stress: mind-body skills (different
meditation techniques, mini relaxations, and yoga), traditional stress management techniques,
healthy lifestyle behaviors (sleep, exercise, nutrition, and social support), and cognitive
reappraisal and adaptive coping skills (adapted from cognitive behavioral therapy, acceptance,
and commitment therapy, and positive psychology),” (Dossett, et al., 2021). It was found during
this study that the reductions in perceived stress from moderately high to minimal and
corresponding improvements in mental health are particularly striking in this cohort. More
significant decreases in perceived stress and improvements in job satisfaction in this cohort were
found after completing the pilot program. This is just one program out of many offered to restore
resiliency and promote positive stress management within healthcare organizations.
One of the key goals of stress management programs is protecting the mental health of
healthcare professionals. “Protecting the mental health of healthcare professionals is a priority
for policymakers. Moreover, physically and mentally exhausted workers are more likely to make
mistakes at work,” (Chirico, et al. 2020). This should encourage policymakers to push for
resiliency programs and mental health support for all who work in and around healthcare. If
those who are caring for people cannot even care for themselves, then how supportive is our
healthcare system? In an effort to address the needs of healthcare workers, Penn Medicine
developed a program called Coping First Aid (CFA) that is hosted on a digital platform for
convenience and to encourage its use. “Coaches provide non-intrusive practical care, assess
needs and concerns, and focus on listening and comforting those in need. Coaches are also
trained to help link HCWs to needed services and support and engage in structured, collaborative
STRESS MANAGEMENT IN HEALTHCARE 10
problem-solving,” (Arnold, et al. 2022). Other medical centers and healthcare systems should use
the format and easy of this program to support their healthcare workers with their stress
management and mental health needs.
Many verses in the Bible speak about stress and how to manage it. Matthew 6:34 says,
“Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient
for the day is its own trouble.” Alternatively, “do not be anxious about anything, but in
everything by prayer and supplication with thanksgiving let your requests be made known to
God,” from Philippians 4:6. While stress, anxiety, and burnout are valid emotions that are
mentioned and recognized by God, He encourages us not to let it prevent us from doing good
work or shining His light. God enables us in Psalm 94:19 that He is our peace even when we are
full of stress and fears. “When the cares of my heart are many, your consolations cheer my soul.”
Knowing that our fears and stresses are acknowledged should encourage us to feel validated in
our worries and rely on Christ for strength, comfort, wisdom, and understanding.
In conclusion, stress has become a large part of the structure and organization of
healthcare. Tensions of the COVID-19 pandemic, nursing shortages, increased demands of
patients with higher acuities, and the demands of the healthcare business are a few of the many
causes of stress and pressures placed on the professionals within the healthcare system. Other
causes of workplace stress can be the demands placed on oneself by the system, their team, or
themselves within their roles or the tasks required to complete. Individual task demands include
unrealistic deadlines, fear of failure, new technology, lack of necessary resources (e.g., poor
physical work environment, such as noise, heat, and crowding), work overload, lack of control,
and repetitive, unchallenging work (work underload). “Individual role demands include job
ambiguity, role conflict, and difficulty balancing work and family life. Group demands include
STRESS MANAGEMENT IN HEALTHCARE 11
poor interpersonal relationships with coworkers and/or supervisors, inadequate support, and lack
of decision-making participation. Organizational demands encompass politics, communication
problems, excessive rules and regulations, organizational structure and culture, lack of career
development activities, and change without clear strategic direction,” (Borkowski, 2021). How
we cope with stress, through programs or learned techniques, is called stress management. Stress
management programs and systems provide managers and leadership with tools and strategies to
learn their stress and how to manage it while promoting resilience and preventing burnout. These
programs are designed to give healthcare professionals the tools and knowledge to cope with the
stressors they combat daily. They provide techniques that can be applied daily within and outside
their professional space.
STRESS MANAGEMENT IN HEALTHCARE 12
References:
Arnold, K. T., Becker-Haimes, E. M., Wislocki, K., Bellini, L., Livesey, C., Kugler, K.,
Weiss, M., & Wolk, C. B. (2022). Increasing access to mental health supports for
healthcare workers during the COVID-19 pandemic and beyond through a novel
coaching program. Frontiers in psychiatry, 13, 1073639.
https://doi.org/10.3389/fpsyt.2022.1073639
Borkowski, N. (2021). Organizational behavior in health care. (4th ed.). Burlington, MA:
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