Managing Job Stress: tips for patients and physicians

Job stress comes in different forms and affects your mind and body in different ways. Small things can make you feel stressed, such as a copy machine that never seems to work when you need it or phones that won't quit ringing. Major stress comes from having too much or not enough work or doing work that doesn't satisfy you. Conflicts with your boss, coworkers, or customers are other major causes of stress.

It's normal to have some stress. Stress releases hormones that speed up your heart, make you breathe faster, and give you a burst of energy. Stress can be useful when you need to focus on or finish a big project. But too much stress or being under stress for too long isn't good for you. Constant stress can make you more likely to get sick more often. It can make chronic pain worse and can also lead to long-term health problems such as heart disease, high blood pressure, back problems, and depression.

Look for these signs of job stress:

• Headaches
• Trouble sleeping
• Problems concentrating
• Short temper
• Upset stomach
• Job dissatisfaction and low morale

What causes job stress?

Most of the time, it's the major sources of stress that lead to job burnout and health problems. Job stress can affect your home life too. Here are some common sources of major job stress, with examples of each:

• Lack of control. Feeling as if you have no control over your work or job duties is the biggest cause of job stress. People who feel like they have no control at work are most likely to get stress-related illnesses. Here's an example:
• Shelly is responsible for putting together a report that her boss must deliver at a 4 p.m. meeting. She's been waiting all day for the notes and numbers she needs. Shelly finally gets the notes from her boss at 3:15 and rushes to prepare the report and charts and to make copies in time. She gets it done, but she feels mad and resentful. This is the third time this week that this has happened.

• Increased responsibility. Taking on extra duties in your job is stressful. You can get more stressed if you have too much work to do and you can't say no to new tasks.
• John volunteers for every new project, because he heard that's the best way to get promoted. But the tasks are starting to pile up, and he's feeling overwhelmed. He knows he can't really manage one more thing. But this morning, John's boss asked him to take on another project, and John agreed. Now he's more worried than ever about getting everything done.

• Job satisfaction and performance. Do you take pride in your job? If your job isn't meaningful, you may find it stressful. Are you worried about doing well at work? Feeling insecure about job performance is a major source of stress for many people.
• Raoul has worked in his new job for 8 months. He thinks he is doing well. But his boss doesn't say much, so Raoul isn't sure. He wonders if he's on the right track, but he's afraid to ask.

• Uncertainty about work roles. Being unsure about your duties, how your job might be changing, or the goals of your department or company can lead to stress. If you report to more than one boss, juggling the demands of different managers can also be stressful.
• Rosa's old manager was promoted. Now Rosa is working for someone new. She's heard that the new boss plans to "shake things up" in her department. The new boss just hired Emily, whose job seems to be the same as Rosa's. Rosa worries about what this means for her.

• Poor communication. Tension on the job often comes from poor communication. Being unable to talk about your needs, concerns, and frustrations can create stress.
• A new job with more responsibility and better pay just opened up in Jill's department. Jill knows she can do this job. And she's been with the company longer than anyone else on her team. She waits for her manager to ask if she is interested. But after several weeks, a coworker is promoted to the new job. Jill feels hurt and angry, but she doesn't say anything.

• Lack of support. Lack of support from your boss or coworkers makes it harder to solve other problems at work that are causing stress for you.
• Jeff works in a busy office answering customer complaint calls all day. It would be easier to handle all the calls if he could at least trade tips with his coworkers. But everyone else is busy too. His coworkers never make it out of their cubicles during the day, even to let off a little steam.

• Poor working conditions. Unpleasant or dangerous physical conditions, such as crowding, noise, or ergonomic problems, can cause stress.
• Sonya is exposed to constant noise at work. She wears earplugs, but at the end of her shift her ears are ringing. She often comes home with a headache.

What to do about job stress
You can reduce some job stress by learning how to manage your time and your job duties. Think about the kinds of events that trigger stress for you at work. Then you can focus on one or two things you can do that will help the most to reduce stress. Here are some ideas:

You and your boss

• Meet with your manager at least once a year (every 3 or 6 months is even better) to talk about your job and your performance. If a performance review is already part of your job, treat it as a chance to clear up issues that may be causing stress for you. Here are some questions to ask:
• What is expected of me in this job?
• Where is this company going? How do I fit into that plan?
• How am I doing? What are my strengths? How can I improve?
• What can I expect from you if there's a problem with my work or my job?
• If I continue to do well, how might my efforts to be recognized?

For more information, see:

• Stress Management: Reducing Stress by Being Assertive.

You and your job

• Get organized. Keep track of your projects and deadlines by making a list of what's urgent. Decide what matters most and what can wait.
• Don't put things off. Use a schedule planner to plan your day or week. Just seeing on paper that there is time to get each task done can help you get to work. Break a large project into small steps, and set a deadline for each one.
• Learn to say "no." Don't overcommit yourself. If you take on too much, you're creating stress.
• Focus. Do one thing at a time. In some cases, you can do two things at a time. But if you start to feel stressed, go back to doing one thing at a time.
• Concentrate. Try to limit distractions and interruptions. Ask others to give you a block of time when you are not disturbed.
• Delegate. Ask someone else to take on a task. It's not always important to have all the control.

For more information, see:

• Stress Management: Managing Your Time.

Take care of yourself

• Unplug. Don't let the technologies that help you do your work get in the way of your leisure time. Consider turning off cell phones or beepers when you are with family or friends. And avoid checking work email when you're not at work.
• Be realistic. Remember that everyone has good days and bad days at work. For more information, see the topic Stop Negative Thoughts: Choosing a Healthier Way of Thinking.
• Reward yourself. When you finish a difficult task, celebrate. Enjoy a snack at your desk, or—if your job permits—take a short walk or visit with a coworker.
• Schedule time for fun. If you spend every second of your day getting things done, you may resent never having time for yourself. If your employer offers a flexible work schedule, use it in a way that fits your work style. Go into work earlier and take a longer break at lunch to make time for a yoga class or a walk.
• Practice breathing and relaxation techniques. You can do these at home or in a quiet place at work. For more information, see:

• Stress Management: Breathing Exercises for Relaxation.
• Stress Management: Doing Guided Imagery to Relax.
• Stress Management: Doing Progressive Muscle Relaxation.

Setting a goal to reduce stress
First, identify what's creating stress at work. Maybe it's lack of control over your job. Or maybe it's worry about losing your job or how you are doing at work. You might feel stress because you're unable to express your thoughts and ideas to your boss and coworkers.

Think about why you want to reduce stress at work. You might want to protect your heart and your health by reducing stress. Or maybe you simply want to enjoy your life more and not let work stress control how you feel. Your reason for wanting to change is important. If your reason comes from you—and not someone else—it will be easier for you to make a healthy change for good.

Next, set a goal for yourself that involves reducing your stress level. Think about both a long-term and a short-term goal.

Here are a few examples:

• Shelly's long-term goal is to reduce stress by managing her frustration over things she can't control at work. Her short-term goal is to learn to do deep breathing and relaxation exercises when she gets stressed. She'll try it the next time her boss hands her a last-minute project.
• Jill's long-term goal is to reduce stress by speaking up at work and expressing her interests and ideas more effectively. Her short-term goal is to practice being more assertive. When she's ready, she'll contribute an idea at a department meeting.
• Raoul's long-term goal is to reduce stress by having a better understanding of what's expected of him at work. His short-term goal is to find out how he is doing now. He plans to schedule a meeting with his boss to talk about his performance and how he can improve.
• John's long-term goal is to reduce stress by learning to say "no" to projects he doesn't have time to handle. His short-term goal is to get organized and prioritize the projects he has now. He is going to make a list of all of his work and then prioritize the tasks that are most important.

After setting your goals, think about what might get in your way. Use a personal action plan to write down your goals, the possible barriers, and your ideas for getting past them. By thinking about these barriers now, you can plan ahead for how to deal with them if they happen.

Most important, make sure you get support from friends and family in your efforts to reduce job stress. If your company has an employee assistance program, you might use it to talk with a counselor. A counselor can help you set goals and provide support in dealing with setbacks.

Know when to quit
If you are truly miserable because of a stressful job, it may be time to think about changing jobs. Make sure you know whether it is you or the job that's the problem.

Before you quit, spend time thinking about other job options. Not having a job will probably also lead to stress. Getting another job before you quit is best, but sometimes that isn't possible. Decide what is less stressful for you—unemployment or being miserable in your current job. It might help to talk with a counselor about your choices.

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