Worker health and wellness Injury prevention

Stress in the workplace

Keeping stress in check could create a healthier – and safer – workforce

Stress in the workplace

Warning signs of stress

“The first warning signs of stress are primarily emotional, and anger is one of the first ones,” Miller said. When workers find themselves feeling these emotions more quickly or more intensely than they normally would, it is an indicator of high stress levels.

“Muscle contraction headaches, or tension headaches, are one of the really early physical signs,” he said, as are intestinal issues such as heartburn or gastroesophageal reflux disease. Additionally, according to the American Institute of Stress, workers suffering from stress may experience shortness of breath, hair loss, changes in appetite, fatigue or panic attacks. 

Miller draws a distinction between acute stress and the more dangerous chronic stress. “When you’re under acute stress, you know you’re stressed,” he said. “But when it’s chronic stress, it becomes so much a part of the landscape of your life that you don’t even realize it’s there and it just grinds on and on and on. It just wears people out, wears their immune system out so that they develop all kinds of diseases.”

The impact on safety

Although the link between stress and  worker health is becoming stronger through a wide range of studies, the impact stress has on the safety of workers is not as well-known.

“The data are weaker for injuries [being related to stress] than they are for illnesses,” Sauter said. “But I would say the weight of the evidence points to a linkage between both stress and illness and workplace injury.”

NIOSH calls for more research, yet cites “growing concern” that stress can lead to incidents by interfering with safe work practices. In a recent survey of nurses conducted by the American Nurses Association in Silver Spring, MD, 80 percent said on-the-job stress levels impact workplace safety, and 59 percent of nurses said when they feel pressured they are more inclined to work faster and take shortcuts.

“Accident levels go up dramatically when stress climbs,” Miller said, pointing out stress also can increase the incidence of workplace bullying and violence.

Employer response

So how can employers act to mitigate stress in the workplace? The first step is to find out what is causing the stress. “You have to measure what goes on,” Miller said. “Once you measure it, you can manage it, but you can’t manage what you can’t measure.”

“Although there are some common denominators, there is no ‘one-size-fits-all’ solution” to managing stress in the workplace, Rosch said. He recommended employers perform a stress audit, where workers can anonymously list the various things that cause them stress. From there, he said, employers can “analyze the results to determine what are the most common stressors and whether any of these are the employer’s responsibility or require some remedial action.”

NIOSH’s stress document noted that some employers believe stress is a natural part of the workplace and applying pressure to workers will make them productive. However, the paper also noted “studies show that stressful working conditions are actually associated with increased absenteeism, tardiness, and intentions by workers to quit their jobs – all of which have a negative effect on the bottom line.”

The institute identified some common characteristics among organizations that have a healthy, low-stress, highly productive workforce. Rather than being high pressure, these organizations were likely to recognize employees for good work performance and provide a structure that values workers and allows them room for advancement.

Managing stress in the workplace may not only be beneficial for employees’ health – it also can have a positive impact on the organization’s bottom line. Stress costs employers money in many ways. Although health care costs may have the largest impact on the company’s bottom line, the American Institute of Stress determined workplace stress costs American businesses an estimated $300 billion annually in the form of workplace incidents, turnover, presenteeism, insurance premiums, disability and workers’ compensation.

To have a truly positive impact on the health of the workforce, Miller believes employers need to legitimately invest in combating stress. “You have to develop a culture of wellness in the workplace to really deal with it effectively,” he said. “Stress is a huge chunk of that wellness culture.”

Are the dangers of stress sufficiently recognized?

“There’s a lot of controversy” about recognizing stress as a legitimate medical concern, said Steven Sauter, coordinator of NIOSH’s Work Organization Stress-Related Disorders Program and co-author of NIOSH’s document “Stress … at work.” Both employers and those in the medical industry still feel some uncertainty about the health effects of stress, “although the weight of the evidence certainly points toward associations between stress and a variety of health outcomes,” Sauter said.

Paul J. Rosch, president of the American Institute of Stress in Yonkers, NY, pointed out that the National Institutes of Health, the Institute of Medicine and many cardiologists acknowledge the link between stress and hypertension and cardiovascular disease – although some in the field believe the medical community’s response to stress has not been strong enough. 

“It’s not as accepted as I would like it to be,” said Lyle H. Miller, chairman and CEO of Boston-based Stress Directions Inc., “but it’s much more accepted than it was 20 years ago or 30 years ago.” 

He laid part of that blame on the structure of the medical system in the United States and its dependence on specialization. “If you go to a cardiologist, he has no idea about your tension headaches; he has no idea about your stomach and bowel problems,” which can be indicators of stress, Miller said. “It used to be you would go to the doctor and would run through your symptoms and they would really treat you as a whole person,” he said. “But now they want to treat the individual symptoms of a specific system. And we don’t function that way – we function as a whole.”

Miller also believes doctors are too inclined to medicate when they do not have the full picture of what is causing cardiovascular or other stress-related health problems in patients. “If your only tool is a hammer, then the whole world is a giant nail,” he said.  

But this medication can lead to additional health problems for workers, as they now are subject to the myriad of side effects of various medications – some of which could impair their workplace performance, he said.

– LC

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