CONTINUING EDUCATION

Policy Perspectives on Occupational Stress

Louise C. O’Keefe, PhD, CRNP; Kathleen C. Brown, PhD, RN; Becky J. Christian, PhD, RN

ABSTRACT
Occupational stress is a major physical and mental hazard for many workers and has been found to contribute to cardio-
vascular disease, musculoskeletal disorders, mood disturbances, workplace injuries, and mental health problems. Health
care utilization related to these physical and mental health problems costs employers billions of dollars annually. To com-
bat this problem, employers should adopt a preventive approach and institute organizational and administrative changes
that require the participation of both management and workers. This article reviews policies that could impact the quality
of work life and influence organizational changes needed to achieve occupational health and safety. Occupational health
nurses play a vital role in designing and implementing policies to improve work environments and reduce occupational
stress. [Workplace Health Saf 2014;62(10):432-438.]

T he World Health Organization (WHO) (2013)

recognizes that health is a human right and that
policies promoting a healthy work life are key
to well-being. Optimal health is a benefit to society as a
whole, and is essential for economic and social develop-
ment (WHO, 2013). Workers’ exposure to psychosocial
hazards in the workplace has been acknowledged in the
United States and worldwide. To address these psychoso-
cial risks at work, Healthy People 2020 aims to increase
accessibility of workplace programs to reduce employee
stress (U.S. Department of Health and Human Services,
2011). Given that employed adults spend the majority of
their waking hours at work exposed to a variety of nega-
tive psychosocial influences, workplace policies must
be in place to improve workers’ health and safety. These
policies become even more important in turbulent eco-
ABOUT THE AUTHORS
Dr. O’Keefe is Assistant Professor and Director of Faculty and Staff Clin-
ic, University of Alabama in Huntsville, Huntsville, Alabama. Dr. Brown is
Professor and Chair (retired), Community Health, Outcomes and Systems,
School of Nursing, University of Alabama at Birmingham, Birmingham,
Alabama. Dr. Christian is Professor, School of Nursing, University of Ala-
bama at Birmingham, Birmingham, Alabama.
Submitted: March 17, 2014; Accepted: July 14, 2014; Posted online: Au-
gust 20, 2014
The authors disclose that they have no significant financial interests in
any product or class of products discussed directly or indirectly in this ac-
tivity, including research support.
Correspondence: Louise C. O’Keefe, PhD, CRNP, University of Alabama
in Huntsville, NB 335, 301 Sparkman Drive, Huntsville, AL 35899. E-mail:
louise.okeefe@uah.edu
doi:10.3928/21650799-20140813-02
nomic times when the economic survival of businesses
and families are threatened. This article discusses poli-
cies that improve the quality of work life, a significant
contributor to overall health and well-being.
The concept of stress was introduced by Selye in the
1930s (Cooper, Dewe, & O’Driscoll, 2001). Selye (1973)
defined stress as the organism’s response to any stressor
or demand and stated stress could have negative (“dis-
tress”) effects or could be positive (eustress). Eustress
motivates and challenges individuals to higher levels of
performance, but prolonged exposure to distress produces
ill health (Selye, 1974). Subsequent research explored the
relationship between the individual and the environment,
stressors, and other stimuli that can trigger a stress re-
sponse in the individual. Situations at work that can po-
tentially trigger stress include feelings of pressure when
nearing a deadline, limited time to complete work assign-
ments, changes in work routine, company downsizing,
lack of control over work tasks, inadequate skill to com-
plete assigned tasks, and difficult clients or colleagues
(Fletcher, Sindelar, & Yamaguchi, 2011). The National
Institute for Occupational Safety and Health (NIOSH)
has long recognized the effect of stress on health. NIOSH
(1999) defined occupational stress as “the harmful physi-
cal and emotional responses that occur when the require-
ments of the job do not match the capabilities, resources,
or needs of the worker” (p. 2). The European Agency for
Safety and Health at Work (2009) further clarified that
“work-related stress is experienced when the demands of

432 Copyright © American Association of Occupational Health Nurses, Inc.

the work environment exceed the workers’ ability to cope
with (or control) them” (p. 14).
Prevalence
Approximately 70% of U.S. workers consider their
workplace a significant source of stress and 51% report
that stress reduces their productivity (American Psycho-
logical Association, 2010). Health care utilization related
to stress-induced health problems costs U.S. industries
an estimated $68 billion annually and reduces company
profits by 10% (American Psychological Association,
2010; Azagba & Sharaf, 2011). Thus, the link between
occupational stress and health problems constitutes both
a societal and economic problem.
Moreover, occupational stress is a global concern.
The European Working Conditions Survey found that
in 2005, 20% of workers in the first 15 European Union
member states suffered from stress at work (European
Agency for Safety and Health at Work, 2009). Respon-
dents reported back pain (30%), overall fatigue (20%),
headaches (13%), irritability (11%), sleeping problems
(7%), anxiety (7%), and heart disease (1%).
NIOSH (1999) reported that 40% of workers sur-
veyed by Northwestern National Life Insurance Com-
pany stated their job was “very or extremely stressful”;
26% of workers surveyed by the Families and Work Insti-
tute reported they are “often or very often burned out or
stressed by their work”; and in a survey by Yale Univer-
sity, 29% of workers reported feeling “quite a bit or ex-
tremely stressed at work” (p. 2). Approximately 1 million
workers are absent from work daily due to stress and 40%
of job turnover is also related to stress (American Insti-
tute of Stress, 2009). Moreover, companies in the United
States lose more than $300 billion annually as a result of
accidents, absenteeism, employee turnover, diminished
productivity, direct health care, legal, and insurance costs,
and worker’s compensation related to stress (American
Institute of Stress, 2009). According to NIOSH (1999),
“health care expenditures are nearly 50% greater for those
workers who report high level[s] of stress” (p. 5). The
European Agency for Safety and Health at Work (2009)
reported that between 50% and 60% of all lost workdays
are related to occupational stress.
In industrialized countries, it is increasingly ac-
knowledged that psychosocial occupational risks are a
major public health concern. The prevention and man-
agement of these psychosocial hazards for workers are
slowly being addressed on the policy agenda (Leka, Jain,
Zwetsloot, & Cox, 2010). Workers have come to expect
protection from health and safety risks. Instituting protec-
tive prevention policies can curb these risks.
Consequences
NIOSH (2013) emphasizes that job stress can lead to
poor health, increasing the risk for cardiovascular disease,
musculoskeletal disorders, mood disturbances, work-
place injuries, and mental health problems. In a longi-
tudinal, cohort study of 21,290 female registered nurses,
Cheng, Kawachi, Coakley, Schwartz, and Colditz (2000)
reported that job stress can predict a decline in health that
WORKPLACE HEALTH & SAFETY • VOL. 62, NO. 10, 2014
is similar to the decline brought on by smoking and sed-
entary lifestyle. In 1996, stress-related illnesses, such as
depression and cardiovascular disease, were predicted to
be the leading cause of the global disease burden by the
year 2020 (Murray & Lopez, 1996). Other investigators
have demonstrated the negative health-related effects that
stress has on cardiovascular health (Franke, Ramey, &
Shelley, 2002); job stress appears to have a direct link to
cardiovascular disease and its risk factors (Chandola et
al., 2008).
In a large, prospective 19-year study of 6,895 men
and 3,413 women, a dose-response relationship be-
tween job stress and obesity was demonstrated (Brunner,
Chandola, & Marmot, 2007). Behavioral consequences
of stress include overeating or eating unhealthy foods,
fatigue, and lack of energy and motivation that could
contribute to chronic health conditions, such as pre-di-
abetes and obesity. Psychosocial effects of stress include
anxiety, irritability, sadness, depression, anger, feelings
of helplessness, and pessimism (American Psychologi-
cal Association, 2010; Han, Storr, Trinkoff, & Geiger-
Brown, 2011; Heraclides, Chandola, Witte, & Brunner,
2012; Montes & Kravitz, 2011).
Several studies have reported a positive relationship
between occupational stress and musculoskeletal pain
(Chen, Chang, Chang, & Christiani, 2005; Chen, Yu, &
Wong, 2002; Gershon, Lin, & Li, 2002). Chen, Yu, and
Wong (2002) reported that occupational stressors such
as environmental and ergonomic hazards were predictors
of musculoskeletal pain in temporary workers. In a study
with police officers, Gershon, Lin, and Lee (2002) dem-
onstrated that the predicted odds of back pain in officers
reporting work stress were 3.5 times the odds for officers
with no perceived work stress.
Regulatory Agencies
NIOSH, a key federal agency in the United States, sup-
ports research aimed at recognizing hazards in the work-
place and either eliminating or controlling these hazards
to provide safe working conditions for the U.S. workforce.
Workplace hazards include physical, biological, chemi-
cal, radiologic, and psychological and behavioral hazards
(Centers for Disease Control and Prevention [CDC], 2014;
Ongori & Agolla, 2008; U.S. Department of Health and
Human Services, 1987). The NIOSH Model of Job Stress
and Health delineates stressful job conditions that can lead
to injury and illness incidence, especially in the presence of
individual and situational factors (CDC, 2014). NIOSH re-
searchers use the Model of Job Stress and Health to guide
their investigations on working conditions and employee
health outcomes. Based on this model and research on oc-
cupational stress, NIOSH emphasizes stress management
as a valuable health promotion and prevention activity
(Murphy & Sauter, 2003; Ongori & Agolla, 2008; U.S.
Department of Health and Human Services, 1987).
NIOSH has promoted a management style that en-
courages employees to participate in decision-making
processes. Research has demonstrated that when employ-
ees have little control over decision-making, their job
stress increases and they are left feeling isolated and over-
433
whelmed (Karasek, 1979). NIOSH has encouraged moni-
toring employees’ perceptions of their job conditions,
management effectiveness, and the work environment
through focus groups or surveys (CDC, 2014; Murphy &
Sauter, 2003). Collecting these data provides evidence for
interventions to improve working conditions. NIOSH’s
model provides criteria for the development of an effec-
tive worker safety policy because the model and result-
ing criteria are based on research findings and encourage
worker involvement to reduce job stress in the workplace.
The European Union is beginning to establish a le-
gal obligation for employers to provide safe and healthy
work environments, although some member countries,
such as the United Kingdom, already have established
such practices (European Agency for Safety and Health
at Work, 2009). However, the European Union Health
and Safety Framework Directives state that employers
have a legal obligation “to ensure the safety and health of
workers in every aspect related to their work” (European
Agency for Safety and Health at Work, 2009, p. 1). The
Framework Agreement on Work-Related Stress, signed in
October 2004, “provide[s] employers and workers with a
framework to identify and prevent or manage problems
of work-related stress” (European Agency for Safety and
Health at Work, 2009, p. 4). The organizations within the
European Union that have signed this agreement are com-
mitted to implementing workplace safety programs with-
in 3 years after signing to prevent work-related stress.
In the United Kingdom, The Health and Safety Ex-
ecutive has developed management standards that in-
clude collaboration between employees and employers
to reduce work-related stress. To this end, “The Good
Practice Model” is used to maintain a healthy and safe
working environment for workers. This model includes
a comprehensive stress prevention program that requires
the participation of managers and workers to establish a
stress prevention strategy based on information from a
risk assessment for that particular organization (European
Agency for Safety and Health at Work, 2009).
The Economic and Social Impact of Occupational
Stress
The employer is responsible for ensuring a safe work-
place for all workers. When workers are injured or ill,
companies lose money due to the costs of workers’ com-
pensation and reduced productivity. Productivity can be af-
fected by worker performance, absenteeism, morale, and
turnover. In addition, the costs associated with ill or injured
workers include the expense of recruiting and training new
and replacement workers, treating ill or injured workers,
the workers’ inability to cope with work and social situa-
tions, and the possible loss of career opportunities and ul-
timately employment. Problems at work can strain family
and friend relationships, leading to depression and suicide
(International Labor Organization, 2012).
According to data from the Bureau of Labor Sta-
tistics (2008), U.S. workers who miss work because of
stress, anxiety, or a related disorder are usually absent ap-
proximately 8 days. The European Union estimates that
work-related stress affects at least 40 million workers in
434
its 15-member states each year and work-related stress
costs the European Union at least 20 billion Euros annu-
ally, a burden to the worker, the organization, and society
(European Agency for Safety and Health at Work, 2009).
JOB STRESS POLICIES
A workplace policy concerning job stress should
include ways to reduce occupational stress and its as-
sociated costs (e.g., absenteeism, treatment of injuries
and illnesses related to occupational stress, and improv-
ing employee well-being, retention, and productivity).
Evidence exists delineating the relationships among oc-
cupational stress, well-being, work-related costs, and
productivity (Fabius et al., 2013; LaMontagne, Keegel,
& Vallance, 2007). Improving employers’ understanding
of the health and economic benefits that can result when
job stress is decreased may encourage management to de-
velop and implement job stress policies.
An effective job stress policy should include a state-
ment from the employer that demonstrates the company’s
commitment to providing a healthy and safe environment
for all employees. Managers are responsible for the im-
plementation of job stress policies and the company is
responsible for providing the necessary resources to man-
age occupational stress. Employers should conduct regu-
lar risk assessments to identify areas of potential work
stress, provide training for all managers and supervisors,
and offer confidential counseling to employees affected
by work-related stress. Responsibilities of managers, oc-
cupational health and safety personnel, human resources
professionals, and safety representatives should be out-
lined in the policy. The company’s safety committee
should be responsible for implementing and reviewing
the policy annually. The outcomes of an effective occu-
pational stress policy can be measured in cost savings.
Because health care costs are increasing and health care
expenditures are 50% greater for workers reporting high
stress levels, implementation of policies that reduce em-
ployee stress is advantageous to the organization and the
employees (CDC, 2014; NIOSH, 2004).
According to NIOSH, reducing occupational stress
requires a two-prong approach (CDC, 2014). Organiza-
tional change is needed in combination with stress man-
agement programs. To prevent job stress, management
must evaluate workloads that are congruent with work-
ers’ capabilities, clearly define employee roles and re-
sponsibilities, and provide opportunities for employees to
contribute to decision-making. The desirable effect of or-
ganizational change and effective stress management pro-
grams is a reduction in health care and other related costs,
including from absenteeism, presenteeism, turnover, oc-
cupational injuries, workers’ compensation claims, and
health care and legal costs. Medibank in Australia (2008)
demonstrated monetary savings with effective stress
management programs. Stress-related presenteeism and
absenteeism cost the Australian economy $14.81 billion
a year and directly cost employers $10.11 billion a year
(Medibank, 2008). However, with an effective stress-
reduction policy, cost savings for the organization can
be realized. An example of a successful worksite health
Copyright © American Association of Occupational Health Nurses, Inc.
promotion program that supports a healthy lifestyle and
stress reduction is at the Johnson and Johnson Family of
Companies. This program has been in effect for the past
30 years. Henke, Goetzel, McHugh, and Isaac (2011) re-
viewed health care costs for the period of 2002-2008 and
found an average annual per employee savings of $565
in 2009 dollars. This savings translates to a return on
investment of $1.88 to $3.92 for every dollar Johnson and
Johnson spent on their health promotion program.
In contrast, the likely outcome if occupational stress
is not addressed at a workplace is continued increase in
health care expenditures and loss of productivity. The
cost of instituting a stress management program can be
offset by fewer sick days, more productivity, and less
employee turnover. Retaining experienced workers can
result in less recruitment and training of new employees.
In an organization that values communication, feedback,
and teamwork, the potential benefit of healthy employees,
and, in turn, a healthy, productive business environment
cannot be overestimated (Medibank, 2008). In the worst-
case scenario, an organization with an unsafe, unhealthy
workplace will produce more sick leave days, workers’
compensation payments, worker turnover, and health care
costs, and less productivity.
It makes business sense to engage a healthy work-
force. The only resistance companies display is com-
plaining about the cost of instituting stress management
programs, although this cost can be offset by worker
productivity. In its 2001 report, the International Labour
Organization provided an example of a company success-
fully preventing stress and increasing productivity. The
Swiss-Swedish company, Asea-Brown Boveri, success-
fully decreased sick leave rates and musculoskeletal in-
juries and increased productivity in its female blue-collar
employees by focusing on increasing work-related skills
and involvement of workers in the organization (Interna-
tional Labour Organization, 2001).
PSYCHOSOCIAL HAZARDS AND STRESSORS
To minimize the detrimental effects of stress on
employees and organizations, employers should iden-
tify and address the causes of stress in the workplace.
A focus on organizational change such as job redesign
to remove or reduce sources of stress or psychological
hazards at work is needed, rather than focusing only on
offering individual stress management programs (Leka
& Jain, 2010). A psychological hazard is any hazard
that has the potential of causing mental and physical
harm by overwhelming workers’ coping mechanisms
and abilities to work in a healthy and safe manner (Cox
& Griffiths, 2005). Examples of workplace stressors
that may be categorized as psychosocial hazards in-
clude job content and control, workload, shift work,
environment and equipment, occupational violence
and bullying, role of the worker in the organization,
and career development (WHO, 2013).
Job Content and Control
Repetitive work is one example of how job content
can be a psychological and physical hazard. Repetitive
WORKPLACE HEALTH & SAFETY • VOL. 62, NO. 10, 2014
work can be monotonous, leading to depression and
anxiety. Physically, it can increase the incidence of pos-
tural and musculoskeletal problems (Leka & Jain, 2010).
NIOSH has encouraged a culture of health and wellness
in work environments through policies that reduce the in-
cidence of work-related musculoskeletal disorders (CDC,
2011). To reduce musculoskeletal injuries, employ-
ers have constructed policies initiating ergonomic pro-
grams and redesigning jobs and tasks, scheduling more
breaks, and rotating workers through several tasks to re-
duce psychological and physical stress. By creating jobs
with varying physical demands and adjusting the pace of
work, more control can be given to employees during the
work day. Policies that prevent musculoskeletal problems
due to repetitive work contribute to a safer work environ-
ment, increase employees’ sense of security and control,
lower health care costs, and improve worker productivity
(CDC, 2011).
Workload
Workload can impact employee health. Most work-
places have workload policies specific to the place of
employment and occupational role. For example, a work-
load policy in a construction company will differ from a
workload policy for a university (Leka & Jain, 2010). The
issue of workload is especially significant in nursing be-
cause heavy workloads for hospital nurses adversely af-
fect patient safety and job satisfaction, leading to a higher
turnover and contributing to the nursing shortage. Work-
load issues in the U.S. health care system have resulted
in state legislation mandating patient-to-nurse ratios (in
California) or participation of nurses in staffing decisions
(14 other states) (Carayon & Gurses, 2008).
Shift Work
The effect of shift work on circadian rhythms and
disruption of sleep has been well documented in the lit-
erature. Approximately 25% of North American employ-
ees work shifts (NIOSH, 2012). Shift work is common in
factories, mines, health care, transportation services, and
police and firefighting work, contributing to increased
risk of chronic illness and occupational stress. Heart rate
and blood pressure have been shown to follow a circadian
rhythm and research has demonstrated an increased risk
of coronary events among shift workers (Leka & Jain,
2010). Family and social life are affected by shift work,
as is occupational safety due to the fatigue experienced
when employees work shifts.
Policies about shift schedule design usually address
the length of the rotation period, the direction of the shift
schedule, beginning and end of the shift period, and time
off during socially desirable times such as weekends (Ca-
nadian Center for Occupational Health and Safety, 2010).
Policies on flexible work schedules contribute to more
committed employees and allow workers to manage their
work and family obligations without choosing between
the two. Employees working flexible schedules used
less sick and leave time and reported fewer symptoms
of stress, benefiting both workers and employers (Butler,
Grzwacz, Ettner, & Liu, 2009; Halpern, 2005).
435
Environment and Equipment
Noise is a physical hazard that can affect health by
acting as a physical and psychological stressor. High
levels of noise damage the middle and inner ear, and, if
prolonged, may give rise to stress, anxiety, tension, irrita-
bility, fatigue, and impaired work performance (NIOSH,
2013). According to NIOSH (2013), occupational hearing
loss is the most common work-related injury in the Unit-
ed States. An estimated $242 million is spent annually on
workers’ compensation for hearing loss disability, with
approximately 22 million U.S. workers exposed to haz-
ardous noise levels at the workplace. NIOSH has recom-
mended national standards for noise and has established
policies on the prevention of workplace hearing loss. The
European Union also has a policy on noise exposure be-
cause of the recognized health effects of noise on hear-
ing, blood pressure, and mental health (Kephalopoulos,
Paviotti, & Anfosso-Ledee, 2012). Leka and Jain (2010)
reported that male workers exposed to noise at work had
a 43% increased risk for sickness absence of 2 weeks or
longer compared to workers who reported no exposure to
occupational noise.
Occupational Violence and Bullying
According to the Bureau of Labor Statistics (2011),
homicide is one of the leading causes of death in the
workplace. In 2010, 506 homicides occurred in U.S.
workplaces. Violence at the workplace is not an individ-
ual issue, but rather is a concern that requires companies
to develop policies to prevent violence by decreasing op-
portunities for violent behavior at work. The economic
impact of workplace violence includes lost productivity,
legal expenses, property damage, and turnover. Emo-
tional costs can be more subtle; the effects of trauma can
include depression, isolation, anxiety, sleep disturbanc-
es, sick leave, and absenteeism. The U.S. Occupational
Safety and Health Act of 1970 requires that employers
provide a safe work environment, free of hazards that
are likely to cause death or serious physical harm to em-
ployees (Occupational Safety and Health Administration,
2014). The Occupational Safety and Health Administra-
tion has provided guidelines to aid in the development
of policies and procedures for handling potential and ac-
tual violent situations and should include procedures for
training employees to recognize and respond to potential
violence and report violent incidents safely and develop
violence prevention and intervention programs. Workers
should be referred to a health care professional if exposed
to violent situations at work.
Exposure to workplace bullying, defined as repeated
actions toward employees with the intent of intimidation
and humiliation, is associated with anxiety, depression,
insomnia, and stress (Leka & Jain, 2010). Bullying be-
havior creates feelings of helplessness and undermines
workers’ rights to dignity at work. The targets of bul-
lying experience exceptional stress and are at risk for
post-traumatic stress disorder (Leka & Jain, 2010). It is
imperative that policies address psychological intimida-
tion and confidential ways to report it. Employers should
have a zero tolerance anti-bullying policy that specifies
436
an independent contact, such as a human resource rep-
resentative, who should be contacted when an employee
reports bullying. Various organizations, such as the Oc-
cupational Safety and Health Administration and the
European Agency for Safety and Health at Work, have
websites and resources to guide employers in establishing
anti-bullying policies and programs at their workplaces.
Role in Organization
Employees can experience stress, ambiguity, and
conflict as a result of their roles in organizations. Ill-
defined expectations can lead to role stress linked to
job satisfaction and turnover (Leka & Jain, 2010). Role
conflict has been linked to a decline in job performance,
performing the minimum job requirements. To avoid role
conflict, job descriptions must be explicit in delineating
job responsibilities to avoid role ambiguity.
When organizations change, employees may expe-
rience changes in work roles. Role change may lead to
stress, and if changes are perceived as a loss of authority
or responsibility, workers may respond with inappropri-
ate coping strategies. Managers must be aware that em-
ployees may perceive any change as stressful. Introduc-
tion to new roles and responsibilities should be provided
to new employees and managerial support should be pro-
vided via training. In a study of 5,357 employees from
Denmark, long-term illness among female employees
was associated with role conflict, low reward, and poor
management quality (Lund, Labriola, Christensen, Bult-
mann, & Villadsen, 2006).
Career Development
Lack of career development opportunities may be
perceived by employees as a source of stress, a threat to
job security, or redundancy. This situation takes on even
more importance in difficult economic times. Employees
may experience increasing anxiety and stress leading to
depressive mood and increased blood pressure. In a large
study of 14,691 employees, investigators reported that
job insecurity was more prevalent among employees in
small companies, those with less education, blue-collar
workers, construction workers, and older women (Cheng,
Chen, Chen, & Chang, 2005). Regression analyses dem-
onstrated that job insecurity was strongly associated with
poor health. Given the importance of job security to well-
being, managers should have career development pro-
grams to educate and retain employees. These programs
should aid employees in defining career goals and match-
ing employees’ needs to the needs of their organizations.
Training programs provide employees with new skills to
enhance current capabilities and prepare them for future
job opportunities, benefitting both employees and the or-
ganization by retaining skilled workers.
ROLE OF OCCUPATIONAL HEALTH NURSES
Through close contact with workers, occupational
health nurses can identify hazards to workers’ health and
safety. The occupational health nurse should be aware
of the job characteristics that are potential psychosocial
hazards to employees. Cognitive and emotional demands,
Copyright © American Association of Occupational Health Nurses, Inc.
work overload, increasing use of technology in the work-
place, shift work, ineffective communication, insufficient
staff, organizational changes, and bullying are potential
stressors that can have an impact on the psychological
and physical well-being of employees.
Hazards can arise from any change in the organiza-
tion or new practices. Employees often view occupational
health nurses as sources of support and guidance because
they provide assistance through problem-solving, listening
and counseling, assisting employees to cope, and expertly
assessing workers’ readiness to return to work. Occupa-
tional health nurses are clinicians, nurse specialists, man-
agers, coordinators, health educators, counselors, and advi-
sors. Because of the autonomy of the occupational health
nursing role, these nurses are often the bridge between
management and employees, contributing to health and
safety policies, and influencing the quality of work life.
By being present at the workplace, occupational
health nurses can influence the content of policies about
stress reduction. Workers frequently discuss both health
complaints and potential sources of occupational stress
in the workplace with occupational health nurses. These
conversations can provide input into creating, reviewing,
and updating policies. In addition, occupational health
nurses should assume key roles in assessing stress among
employees using individual interviews, group discus-
sions, formal surveys such as Karasek’s job stress ques-
tionnaire, and review of absenteeism, illness, and turnover
rates, which are objective measures of stress. Occupation-
al health nurses are also responsible for designing and
implementing stress management programs and referring
employees to confidential employee assistance programs.
Therefore, occupational health nurses advise and partici-
pate in the development of effective company-wide stress
management policies and programs.
Occupational health nurses demonstrate evidence-
based practice to guide and support the psychological
health of employees, conduct occupational health assess-
ments, and provide guidance on a range of health issues,
work ability, and safety, especially those issues that affect
performance at work. Policies should designate the oc-
cupational health nurse’s responsibilities in participating
in management team discussions and decision-making
to improve the work culture, identify stressors, refer em-
ployees if needed, and monitor and manage the care of
the employee when returning to work.
Occupational health nurses use research findings
and translate them into practice to improve nursing care.
Research on work stress and occupational health is well
established and may be incorporated into practice. Occu-
pational health nurses often produce reports on sick-time
use, health promotion initiatives, and interventions such
as modifying working environments or changing work
practices to enhance health and safety. Careful analysis
of these data may identify illnesses and absences attribut-
able to stressful work environments. Occupational health
nurses can discuss sensitive information with employees
regarding their perceptions of the work environment and
because of the long history of trust that society places
on nurses. Employees believe that occupational health
WORKPLACE HEALTH & SAFETY • VOL. 62, NO. 10, 2014
IN SUMMARY
Policy Perspectives on
Occupational Stress
O’Keefe, L. C., Brown, K. C., Christian, B. J.
Workplace Health and Safety 2014;62(10):432-438.
1
Occupational stress is a global problem with
workers reporting a host of psychological and
physical problems resulting from job stress.
2
Causes of work stress include repetitive work,
workload, shift work, noise, occupational vio-
lence and bullying, and role conflict.
3 An effective work stress policy defines employ-
ers’ commitments to providing a healthy and safe
work environment.
4 Occupational health nurses design and imple-
ment policies that can improve work environ-
ments and reduce work stress.
nurses can be trusted to maintain confidentiality and this
trust builds optimal relationships.
CONCLUSION
Occupational health nurses play a vital role in design-
ing and implementing policies that can improve work-
sites and reduce occupational stress. Because stressful
work conditions are linked to impaired mental and physi-
cal health, policies that build employees’ coping skills
and resilience to stress and avoid stress-related illness
are essential for both workers and their employers. Orga-
nizational and employee-focused policies and interven-
tions can successfully reduce stress among workers, offer
long-term prevention of stress-related health problems,
and play a critical role in determining the health of the
workforce. With individuals spending most of their wak-
ing time at work, it is imperative that places of employ-
ment protect and promote the health of workers through
the development of policies to reduce workplace stress.
Employers should adopt policies that ensure the health of
workers is valued, supported, and promoted. Moreover,
proactive policies for health promotion and stress reduc-
tion will ensure committed and loyal employees, control
health care costs, and improve productivity.
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