When pressure becomes stress

StressFor many years stress has been seen as a weakness, but the many case studies and legal precedents clearly indicate it can happen to anyone in the pressurised workplace of the 21st century.

There can be little doubt that many staff in the NHS are experiencing serious pressure in several areas of their work and it is a management responsibility to explore this and work with staff to reduce the pressure to a manageable, motivational level. There are many factors at play here, however, including staffing levels, staff competencies, staff expectations, patients expectations, remuneration, professionalism, resources, politics, and so on.

According to the NHS Employers (2008), stress is believed to account for over 30 per cent of sickness absence in the NHS, costing the service £300-400 million per year. The Healthcare Commission’s 2007 staff survey found that 33 per cent of staff questioned said they had felt unwell because of work-related stress over the past 12 months.

The first thing most of us need to clarify is the meaning of the term ‘stress’. Stress is one of those words that everyone uses but it seems to mean something different every time it is used. People talk about experiences being stressful – everything from getting up late to getting divorced. They describe themselves as stressed when they often mean busy or being prevented from doing what they want to do.

What is stress?
The International Stress Management Association (ISMA) in conjunction with the Health and Safety Executive (HSE) defines stress as “the adverse reaction people have to too much pressure”. The key word in this definition is adverse. An adverse reaction is not good, especially when related to health.
Therefore, stress is not good for you. In training sessions run by ISMA approved trainers, delegates are asked if they think stress is good for them and around 60 per cent think it is – until they read the definition. This poses the question: what is it they think is good for them? The answer to this is pressure.

Challenges and pressures are part of life and we need them to motivate and stimulate us. Interestingly, some people really thrive on pressure and feel low and below par (stressed) if they are not being pushed or pushing themselves. We can, however, all experience too much pressure and this is what is meant by stress.

It is interesting to note that not enough to do, creates stress as well as too much pressure. The trick is to get the right amount of pressure for you. This makes stress a very personal response.

Legal compliance
There is no specific law relating to stress. In 1974, the Health and Safety at Work etc Act placed duties of care on employers and employees. For example, section 2 (1) placed the duty on employers to ensure the health and safety of all employees at work, as far as is reasonable and practicable. In 1988 a further amendment to this stated “ill health resulting from stress caused at work has to be treated the same way as ill health due to other physical causes present in the work place.”

1999 saw The Management of Health & Safety at Work Regulations, which required all employers of five or more people to carry out regular risk assessments, identify hazards and take action. In 2001, HSG 218 was produced which offered practical advice on dealing with workplace stress and identified the key workplace hazards that would become the basis for a risk assessment.

Responsibility for managing stress was placed on managers. This means that managers need to be trained to deal with of the effect of too much work related pressure on their staff. They were introduced in 2004 and act as guidance and best practice for managers at all levels to focus on the six workplace risk factors. Further guidance and clarification was issued in 2007 HSG 218 revised (see the HSE website).

The cost of stress
From the NHS Employers statement above, the HSE and CIPD, it is clear that absence due to stress cost organisations like the NHS huge amounts of money. Public sector organisations have a higher absence rate than the private sector and at an average of ten days per annum, sickness absence among the 1.3 million NHS employees is significant. Not all sickness is due to stress but typical symptoms of stress are susceptibility to minor ailments like headaches, migraines, irritable bowel, anxiety and musculoskeletal problems as well as high blood pressure, heart conditions and other life threatening illnesses.

Dealing with work related
There is a clear process in place for organisations to deal with stress:
• Create a workable policy for managers to follow
• Train senior management in the reasons and method of measuring stress/wellbeing
• Train managers to implement the Management Standards for stress
• Train employees to understand what stress is and how to manage it at a personal level
• Implement a confidential organisational risk assessment and identify areas of concern and best practice
• Talk to staff and find out more about the best practice and if it can be spread
• Celebrate best practice
• Talk to staff in areas of concern and find out if they have solutions to their concerns
• Brainstorm solutions and get buy in for the one(s) chosen
• Implement staged solutions and test effectiveness by polls/audit.
This puts the onus on managers at all levels to listen, implement and measure agreed solutions to local issues identified within the organisation.

Harrogate and District NHS Foundation Trust have used this method successfully: “We can see notable improvements in the 2008 audit” is a quote from the work done which can be seen as a case study on the HSE website www.hse.gov.uk/stress/casestudies/harrogate-nhs-trust.htm

You will notice that there is no mention of Indian Head massage, Reflexology or Reiki. These and other holistic interventions are excellent to energise and rebalance the body but can be of limited effect if the employee returns to the situation which is causing them to display symptoms of stress. If there is a work related issue, there should be clear guidance to all staff to indicate their concerns to their manager, using the six Risk Factors in the HSE Management Standards and for the manager to respond by discussion possible solutions.

Employee responsibility
The employee has a responsibility to identify and manage stress as well. Each individual has their own life blueprint created by life experiences and resultant beliefs as well as the values which have been instilled since childhood. It is important to remember that they were employed for a set of appropriate skills which they still have but under excessive pressure may be demonstrating changed behaviour.

If a situation is perceived as a challenge their body biochemistry will immediately change (increase in adrenaline/nonadrenaline/cortisol). This is a natural response to challenge and if the individual deals with the situation all will return to ‘normal’. If, however, the individual continues to worry or replay the scenario(s) in their head for hours/days/weeks, further biochemical changes will occur affecting mood, behaviour and health. This may eventually result in absence and chronic ill health. They may be able to change the unhelpful behaviour themselves or can be signposted to help within the organisation or seek a qualified stress management practitioner. This will result in developing resilience as they will learn how to limit the thinking style which ‘winds them up’ and attempt to think about situations differently resulting in balanced body chemistry.

In summary, the way forward is to:
• have a good, clear stress management/wellbeing policy
• train all managers to apply the management standards (based on the six risk factors)
• encourage managers at all levels to take stress seriously and look at the work factors that may be causing too much pressure.
• train managers to employ coaching techniques – using skilled questioning and listening will help both parties to identify perceived pressures and this can be enough to clarify a potentially stress inducing situation
• regularly (every 12-18 months) carry our a risk assessment for stress, communicate the results, devise action plans and work the plan
• listen to staff – even minor adjustments in work load, flexibility in timing and personal encouragement can reduce perceived pressures and enhance commitment
• refer staff to professional support systems which are focused on coping outcomes and resilience.
Why not take part in National Stress Awareness day (NSAD) 3 November 2010? There are lots of free downloads on the ISMA site and you may be able to get a free Stress Adviser for your NSAD activity. Visit

And why not take part in the National Stress Management Awards. For more information see

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