What is ‘stress’?

The term ‘stress’ has had mixed press over the years either because of poor understanding of what the term means or due to the range of interpretations that we often give to it. For many, stress is seen as a necessary part of any challenging job that can contribute to positive results; from this perspective stress can put us on alert and focuses our resources. This might be called ‘positive’ stress, with the conclusion drawn that if any employee expects their work to be free even of this type of stress then they are being unrealistic and are doomed to mediocrity. However, there is a considerable distance between this concept of positive stress and the stress that can adversely affect workers, both in their general wellbeing and performance of their designated tasks. WorkSafe, the New Zealand regulator of safety in the workplace notes that work-related stress is increasingly becoming an issue in the workplace and community and states:

“There is often confusion between challenge and stress in the workplace. While challenge at work can have positive effects on people, work-related stress is a work-related health issue that can pose risks to psychological and physical health.”
Worksafe.govt.nz

It would be more appropriate to avoid the term ‘stress’ when referring to positive and challenging impacts upon the worker, as it appears to be a misnomer – a more appropriate term for this ‘positive stress’ might be ‘arousal’ (a clinical term that differs in meaning from its general connotation), or to manufacture a term, that a person is ‘adrenalised’.

Stress is more generally perceived as a negative condition, more appropriately associated with the term ‘distress’. One important resource describes stress as:

“...a feeling of being overwhelmed, worried or run down... (and) untreated chronic stress can result in serious health conditions including anxiety, insomnia, muscle pain, high blood pressure and a weakened immune system (and) can lead to major illnesses such as heart disease, depression and obesity.”
American Psychological Association

In New Zealand, the primary workplace legislation is the Health and Safety at Work Act 2015 (HSWA), which, although it doesn’t mention ‘stress’, does acknowledge that health refers to physical and mental health, and that mental fatigue is an example of hazards that must be managed:

“...hazard includes a person’s behaviour where that behaviour has the potential to cause death, injury, or illness to a person (whether or not that behaviour results from physical or mental fatigue, drugs, alcohol, traumatic shock, or another temporary condition that affects a person’s behaviour).”
Interpretation section, HSWA 2015

Stress can lead to poor health and risk

Health professionals are able to describe clinical criteria of disorders that people would agree may, in part or whole, result from stress. Many of these are mood disorders and/or anxiety disorders such as Major Depression Episodes, Social Phobia, Obsessive-Compulsive Disorders, Post-traumatic Stress, Acute Stress Disorders or Adjustment Disorder. Many of these conditions can arise from a single incident or from reduced resilience arising from ongoing pressures. Many of these mental health conditions have stigma attached, such that seeking help from their doctor or therapists may not be an initial response. When these conditions develop gradually, distress may not be identified, and self-medicating strategies may be the preferred choice, such as increased alcohol use, non-prescription medicines, or even gambling, to provide respite. These strategies can themselves become problems as tolerance develops and may also be hidden for fear of stigma.

Workplace stress – Employer responsibilities

Employer obligations under the HSWA are to identify risk, eliminate it if possible, or if not possible, consider how to minimise the risk.

Under the HSWA ‘the environment’, WorkSafe includes:

“...the psychological work environment, including overcrowding, deadlines, work arrangements (eg the effects of shift-work and overtime arrangements), and impairments that affect a person’s behaviour, such as work-related stress and fatigue, and drugs and alcohol.”
Worksafe.govt.nz

Workplace stress – are non-work causes exempt?

Many occurrences, both inside and outside of work, can contribute to our ability to tolerate and respond effectively to our role in the workplace. Some evidence suggests that stress may be less due to its actual presence than the way the person appraises a situation. This suggests that stress should be addressed both in general terms and should take account of individual differences (Oliver et al, 2002).

Under the HSWA there is a primary duty of care (s36) to ensure the health of workers and conditions at the workplace are monitored to prevent injury or illness arising from the business and this may suggest that if the stress-induced illness arose from factors external to work, this would exonerate the employer from liability. This is not as black and white as it seems. If a worker is clearly experiencing problems with their work which in the past they may have found to be within their ability to address (problems possibly due to external factors), there may still be an obligation to provide help both ethically and perhaps legally. The apportionment of attribution to factors external or internal to the employee’s work is not only a difficult objective process but, in any arbitration,, the focus may be on failure to attend to overt symptoms of distress displayed at work, wherever they may have originated. The HSWA emphasises responsibility to both prevent and reduce harm to employees resulting from hazards that will impact upon the more complex domain of mental well-being.

As described above, and from common-sense, different people have different capacities, and these may change over time. They may also change as a result of new behaviours and perceptions, also from an individual’s attempts to solve their problems, resulting in dysfunction. Such a scenario may be:

John is a long-term employee who has carried out his work competently over time. Unfortunately his relationship has problems and his partner has now left. He does not wish to disclose this to others at work because of embarrassment and also because he is by nature a private person. He finds it hard now to sleep when alone and found that by drinking alcohol at night, this helps him sleep. His sleep is poor quality, resulting in fatigue during the day, and feelings of regret, sadness and hopelessness (symptoms of depression disorder). Gradually, his work suffers, his sense of failure increases, and he receives a reprimand from his boss (his first). He increases his alcohol use to avoid ruminating negative thoughts, but his fatigue and depression worsens. An incident occurs at work when he reacts to comments from another worker about his poor risk-management, and John over-reacts, receiving another reprimand from his boss. He is now missing work-days due to alcohol over-use, is moody at work, and failing to adequately do his job. Other workers avoid him because he is surly, and he is eventually placed on a performance management plan, later receives a formal warning and is subsequently dismissed. With the loss of his job, John attempts to end his life. In recovery, he feels he wasn’t supported at work, had for many years been a high functioning employee, and when he was over-stressed, was criticised and finally fired. He sought advice and was told he may have a valid complaint.

There were several opportunities that John’s stress could have been addressed in a reasonable and effective manner that may have both retained a previously good employee, and assisted John to functionally address his dysfunctional coping behaviour and sense of loss. His home life had definitely spilled into his work life, and whereas there is a good argument that it was not the workplace that was initially causing his distress, it is a fact that life’s problems outside of work can impact upon our ability to function at work. The change in John’s functioning at work was out of character and symptoms of lack of sleep and alcohol abuse as well as changes in attendance were also out of character, signifying possible health issues. The success or otherwise of a claim by John will impact upon the employer and the employee, and will result in some perception by other employees around employee-employer relationships.

Proactive approach regardless of origin

In addressing these uncertainties, taking into account the costly sanctions that occur from non-compliance, adverse publicity and effects upon employee-employer relations resulting from such incidents, the best-practice approach may be to interpret the term ‘work-related stress’ as simply ‘stress’. This suggests that little time should be expended upon determining the origin of the stress, and that employers may benefit from proactive programmes that can commonly enhance either an employee’s ability to deal with previously challenging issues or change their perspective of their ability to deal with it. Such programmes may involve education and information regarding alcohol misuse, Internet misuse, identifying early stages of depression, budgeting, and promoting healthy lifestyles as well as available resources. These approaches can both prevent adverse coping strategies developing as well as stopping or reversing the adverse effects of many of these behaviours/conditions. Certainly, a timely intervention may result in a solution, engender a caring culture in the workplace, and prevent ‘burnout’ (a synonym for depression that work may have contributed to).

Workplace stress – causes

Workplace stress, if hard to define, can occur as a result of working within an environment where the employee has little control:

“Workplace stress’ then is the harmful physical and emotional responses that can happen when there is a conflict between job demands on the employee and the amount of control an employee has over meeting these demands. In general, the combination of high demands in a job and a low amount of control over the situation can lead to stress."
Canadian Centre for Occupational Health & Safety (CCOHS)

In the modern workplace, uncertainty around continued employment and the effects globally of unforeseeable events that may impact locally, can place its own uncertainty around control over one’s own continued employment. Uncertainty, and thereby stress, can also arise from redundancies (actual or perceived possibility), un-resourced increases in productivity demanded by employers, poor workplace cultures where employees feel unvalued, high turnover of staff, lack of consultation or input, and many other factors.

Murphy (1995) identified five categories of stress within the workplace and examples of distress within each:

1. The job itself: eg too much or too little work; variety, speed of and worthwhileness of the work; ability to decide aspects of the work; shiftwork, isolation and noise/odours/heat etc.
2. Employee’s role: eg unclear role, multiple managers, responsibility under or over expectations.
3. Career: eg under or over-promotion, perceived low job security, few career development opportunities, low job satisfaction.
4. Work relationships: eg negative relationships with those above, at same level or below the employee’s; perceived fear of personal safety, such as harassment.
5. The Organisation: eg ability to make decisions; the way management operates; the way the organisation communicates with its employees.

Effects of stress on the employee

Health professionals who work in the field of addictions are aware that these pressures can heighten the prevalence and incidence of addictive behaviours, many of which will impact upon the workplace (eg Internet addiction, alcohol and drugs, gambling and rate of tobacco use). Isolating behaviour commonly accompanies these problems, often resulting in late-stage identification, with accompanying longer-term addiction being the rule.

Commonly there will be irritability, anxiety, depression, family problems and reduction in ability to perform their work. In many cases, physical health will be affected as a result of mental stress, with these symptoms being more readily identified by the employee or their co-workers/employer. Examples are fatigue (whether or not work-load has increased), indigestion, sleep problems, headaches and migraines, and frequent ‘opportunistic’ illnesses.

Beehr (in Lu 1999) identified a number of workplace stress signs including:

• Withdrawing from the job
• Not showing up
• Coming in late
• Leaving early
• Avoiding phone calls
• Rise in blood pressure
• An increase in drinking

Options to reduce stress

Each employment environment will have its own ‘culture’ as to how people deal with each other and the organisation deals with its employees. When an organisation states and implies through its operation that it values its employees, their wellbeing is enhanced. Wellbeing refers to physical as well as psychological states, and results in benefits for the organisation, such as optimal performance, lower ‘sick’ days off, lower staff turnover and enhanced motivation. Encouragement to develop such a culture should be the role initially, of a good and effective employer. Failure to do so will also encourage further legislation such as the HSWA with more punitive penalties as well as organisational costs.

Various initiatives within the organisation will both help to reduce stress as well as assist in the prevention of stress development. These are:

• Having available an employee assistance programme providing self-accessed confidential counselling for staff who are experiencing problems, whether work driven or not.
• Providing talks and other resources on early identification of risky behaviour (eg alcohol abuse, Internet abuse, gambling risks), stress symptoms (eg anxiety, depression), and resources to deal with them once identified.
• Developing strategies to encourage co-worker and self-identification and help-seeking when such symptoms and behaviours arise. These should be without punitive elements that may discourage openness.
• Talks and information provided during work-time around healthy living.
• Providing examples that the organisation cares, such as discouraging a culture of long hours at work.
• Providing other evidence of a caring culture within the organisation eg enhanced sick leave provisions that can be accessed confidentially when needed, functions to recognise effort, encouraging teambuilding.

Job designs are, of course, also an important focus and should be designed to reduce stress factors (CCOHS):

• Jobs should be challenging, with a variety of aspects.
• The job should have aspects of autonomy – the employee can make some decisions in the performance of the job.
• There should be a career path available.
• There should be optimising of skills through on the job training and if possible, qualification earning opportunities.
• There should be recognition of skills, performance, initiative and loyalty.
• There should be clear descriptions of the job and reasonable expectations associated with it.
• The line of responsibility should be transparent and linear.
• There should be a safe and reasonable complaints process.
• Feedback and discussion of processes should be encouraged.
• There should be adequate time to perform tasks to required standards.
• And many more.

Examples that may reduce stress

WorkSafe has provided a range of possibilities that may reduce workplace stress. These include upskilling supervisors and managers to identify and intervene when stress in employees is identified. The suggestions are:

• Set achievable demands in agreed hours of work.
• Match worker’s skills and abilities to job.
• Workers have a level of control over their pace of work.
• Develop multi-disciplinary teams to share ideas and perspectives on ways to address situations.
• Involve workers in decisions that may impact their health and safety, and have processes to enable workers to raise issues and concerns they might have.
• Ensure managers and supervisors have the capability and knowledge to identify, understand and support workers who may be feeling stressed.
• Provide workers with access to independent counselling services.
• Have agreed policies and procedures to prevent or resolve unacceptable behaviour.
• Engage and consult with workers before implementing change processes, and ensure they genuinely have the ability to influence the decisions you make.
  Worksafe.govt.nz

An additional option that may suit roles that inherently can result in stress, or for management roles is (usually) monthly professional supervision, an option that is increasingly being accessed, especially where supervisors have mental health and/or addiction qualifications. This ensures a regular check of an employee’s well-being is taking place. Abacus has provided this service to a number of organisations (see this website's [www.acts.co.nz] homepage.

Conclusion

Legislation places important obligations upon employers to eliminate or reduce hazards at work, and although the focus is upon workplace stress, there is often a difficulty in distinguishing between that and factors that may initiate outside of the workplace. In addition, it is always possible that failure to address symptoms of stress exhibited in the workplace because they first developed outside of work, will necessarily be a defence to a failure to provide the primary duty of care under the Act. There is the added consideration that may add to the uncertainty: an employee under stress from an external stressor (e.g. alcohol, internet pornography or internet abuse, excessive gaming or gambling) may continue with the behaviour during work-time, perhaps legitimising the stressor as now being in the workplace. This may especially be the case if the behaviour is part of the job description, e.g. Internet access as part of an IT job, or a culture of heavy drinking on Fridays in the work canteen may exacerbate depression in an alcohol abusing employee. This can suggest that the workplace may become a hazardous place for the employer.

However, an organisation that focuses upon stress reduction in the workplace through a number of well-researched strategies that signal respect and concern for the employee, should have little fear of the consequences of such legislation.

The adoption of a culture that identifies such stressors, not only to avoid penalties, but also to provide a safe and caring environment, will be rewarded with a happy and healthier workforce with consequential benefits of efficiency, productivity and staff motivation. Such outcomes do not occur by chance. A programme to identify stressors and other hazards in the workplace is a requirement under the HSWA. This is also an opportunity to design and incorporate a more proactive programme that goes beyond the Act’s requirements. This may involve a greater input than paid training for the health & safety representative, regular (but brief) presentations on health matters for all staff, development of supportive rather than punitive strategies for those experiencing difficulties that may have originated outside of the workplace, and employee assistance programmes.

This demonstration of intention to establish a positive and inclusive culture is likely to repay a proactive and farsighted leadership through employee goodwill alone, while avoiding serious sanctions that have been signalled by the legislation.

References

1. American Psychological Association: www.apa.org
2. CCOHS. Canadian Centre for Occupational Health & Safety. www.ccohs.ca
3. Health and Safety at Work: www.legislation.govt.nz
4. Lu C (1999) Healthy men: coping with workplace stress.
5. Murphy L (1995) Occupational Stress Management: current status and future direction. In Trends in Organizational Behavior 2:1-14
6. Oliver J & Brough P (2002) cognitive appraisal, negative affectivity and psychological well-being. NZ J Psychology 31:1:2-7.
7. WorkSafe.govt.nz