Some interesting expectations emerge in the community regarding how emergency workers – and indeed others, such as military personnel – experience and deal with stress.
It’s almost as though there are two poles. One is represented by empathy and appreciation for those who have to work long hours, and are exposed to the blood, violence and tragedy that characterises their service.
The other treats stress as par for the course: “if you’re doing that work, then you’ve got to expect to be stressed, and you’ve got to be tough enough to take it. You knew what you were getting into…”
There is another view, somewhere in the middle, that dismisses the validity of stress injury claims, seeing them as a rort. Compensation for stress is incredibly difficult to achieve. But let’s not focus on compensation – we should be focusing on what happens before someone becomes severely stressed in the first place.
The sources of stress in emergency workers are often misconstrued, and this is frequently demonstrated when stress injury claims are submitted. Conventional wisdom would suggest that stress in the emergency services comes from witnessing or being close to the difficult situations workers encounter: violence, drug-use, death, and injury.
These are known as “job content” stressors – “content” because they constitute the things that are experienced when carrying out one’s work. By contrast, it is now well known that “job context” factors, such as the degree and quality of supervision received by workers, the interpersonal relationships at work, and opportunities for leaning and advancement, are experienced as being as stressful as the job content stressors. This has been consistently found in research performed in Australia and internationally.
Why might this be the case?
There are a few possible reasons why job context stressors are as important as content stressors for emergency personnel. Firstly, emergency service personnel are trained to respond to difficult situations. Many people performing these jobs self-select into particular units or squads, knowing what events, and what potential achievements, are likely to come.
Secondly, they are experienced in being exposed to such events, and become more so by virtue of doing their jobs. That’s not to say that there won’t be traumatic events that affect trained, experienced personnel in a significant negative way – just that training and experience can act as a “buffer” to some extent.
While these findings have been specific to the emergency services, there is no reason to think that these relationships are not more general. Medical staff are exposed to similar traumatic events; and similar relationships may be found among miners and workers exposed to difficult work environments.
What does this mean for reducing stress?
The strategies most frequently relied upon to reduce stress are characterised as post hoc (that is, after the stress has occurred), enacted at an individual level. Examples would include counselling (post-hoc, individual) and resilience training (individual and arguably post hoc). Both of these strategies are good, but both are far better when used as parts of a complete risk control strategy.
Such a strategy which might include more preventative and active interventions, such as consultation about how work is performed and could be redesigned to be better, and ongoing formal and informal workplace health monitoring.
The job context issues that are experienced as stressful should receive at least the same degree of focus as content issues, particularly in organisations where they are known from research to be problematic.
Job context stressors can be reduced by a well developed set of plans to educate or retrain line staff as they move into managerial positions, and genuinely fostering cultures that are open, inclusive, and encourage cooperation and joint achievement rather than competition.
We need to change how we think about stress at work – it’s not just an individual issue, not just an environmental issue, but a combination of both. I’m often asked about the nature or degree of the combination: 60/40, 50/50, 30/70? There is no single answer on this, it is not exact, and depends on the case. And to some extent such figures are purely hypothetical.
Relative contributions of work and life events are sorted out later with experts and the courts, using evidence, reasonable care and conservatism. What employees and employers need to know in advance is that there are multiple contributing factors, and so interventions that focus too heavily on one or the other aren’t likely to be very effective. Indeed, the most effective (and least used) stress interventions are those that challenge the way work is currently performed.
I know that implementing some of the strategies above sounds like Utopia. Such change is difficult to achieve with under-resourced, overstretched staff, and highly entrenched cultures, similar to many emergency service providers.
But if all we can achieve now is a better understanding of where work stress comes from, then consequent better controls, and more informed attitudes when dealing with people who have stress-related injuries can’t be a bad thing.
Carlo Caponecchia is a lecturer in the School of Aviation at UNSW.
This opinion piece was first published in The Conversation.