Conservation of Resource Theory in Addressing Stress Among Healthcare Workers

Abstract

An analysis of the stress factors prevalent in healthcare that led to burnout and negative patient outcomes. The application of Conservation of Resources Theory was used to analyze the stress factors, how those factors tie into employee burnout, and what the most efficient methods of addressing burnout are.

The paper presents an overview of COR theory, the methodologies used to analyze stress in healthcare, and the necessity of addressing stress in the most efficient ways.

16 articles were selected to review that analyzed the application of COR theory, the roles of stress in burnout, and how COR theory was utilized to find the most efficient ways of addressing burnout and stress. The articles were picked on the following search criteria: use of COR theory in healthcare, the inclusion of remediation steps for stress, and the inclusion of peer reviewed research to back up the data presented.

Keywords: Option 3. Conservation of Resources, Stress in Healthcare.

Introduction

Stress among healthcare workers can lead to reduced quality of care among patients. In addition to poorer patient outcomes stress can lead to an overall reduction in job satisfaction, burnout, and eventually the resignation of staff. Stress factors include exposure to critically ill or terminal patients, inefficient processes, and a lack of resources leading to excess burden among healthcare workers. Addressing these stress factors is key to avoiding burnout. The application of Conservation of resources theory will be utilized to analyze the issue of stress, and how organizations can address these issues in the most effective way possible.

Case Studies/Review

Explanation of the Theory

In order to address the challenges of handling stress in healthcare organizations, it’s important to understand the root causes of stress, and productive ways to manage and remediate stress in the organization. Using the Conservation of Resources Theory (COR Theory), we can begin to explain organizational stress, in order to remediate.(Alvaro et al., 2010)

Stress, in medical terms, is “a physical, mental, or emotional factor that causes bodily or mental tension that can be external or internal and can initiate a fight or flight response. Stress can be a positive motivating factor, allowing individuals to address the stress factors. It can also be negative factor when it leads to overwhelming individuals, or causes them to initiate a flight response. Responding to stress takes an individual’s mental or emotional effort. (Davis)

Psychological Commodities (psychological processes tied to resources) that are valued are the basis of COR theory. Examples of these commodities included job satisfaction, work/life balance, and the quality of work/life balance. Understanding these psychological processes allows us to examine components of healthcare work that lead to increased stress factors that can negatively impact workers and patients. (Halbesleben et al., 2008) These commodities are regarded as finite resources in COR theory.

COR Theory acknowledges that stress is a result of the combination of the subjective perception of events exceeding available resources or being overly taxing, i.e. stress is the over-utilization of an individual’s psychological commodities. It’s necessary for resources to be provided to mitigate stress factors such as change and increased workload, or the threat of loss will lead to the defense of assets. Defense of assets entails the withdrawal from interpersonal relationships, or decreased dedication to work.(Alvaro et al., 2010)

Factors outside of the work environment are also acknowledged by the COR Theory. If external factors add negative stress to an employee, such as home life, or other negative social factors, emotional and physical resources will be depleted, on top of those depleted due to work. COR theory seeks to address individuals holistically in order to provide solutions to the challenges. (Alvaro et al., 2010)

Examples of external factors affecting stress have been studied due to the SARS and COVID-19 pandemics. Social isolation, fear of spreading infection to family, and increased levels of social anxiety due to media coverage of the pandemic are examples of stressors that are external from the work environment, but that add to stress levels at work. During the pandemic the risk of getting loved ones infected was a particularly high stressor for healthcare workers, causing them to limit their exposure to coworkers and patients as much as possible. (Ali et al., 2020)

Burnout as a Result of Stress and its Effects on Employees

Burnout can be defined as the extended exposure of a person to chronic emotional stressors in the work environment. Emotional exhaustion, physical and mental fatigue, and weariness are key components of burnout among healthcare workers. This prolonged exposure to stressors can lead to an individual’s inability to cope with any additional input of stress. (Rogala et al., 2015)

While all professions have levels of stress and burnout, studies show that healthcare workers face an increased rate of burnout, as compared to other professions, because of the increased level of workload, and because of the emotional impact of dealing with critically ill or terminal patients. Institutional conflict in healthcare, due to the complex nature of the work involved, and the interactions between medical and non-medical aspects of the industry, are also stress factors unique to healthcare. (Ruotsalainen et al., 2015)

Additional examples of stress factors leading to burnout can be found in the experiences of healthcare workers during the SARS pandemic. These factors include quarantine and the loss of interpersonal interactions outside of work, and uncertainty about the safety of family members, especially for those healthcare workers who fear bringing exposure to the virus home to their families. There are the additional levels of stress at work, due to higher patient rates and more severe illness. (Maunder et al., 2008) These stress factors have been seen again during the COVID-19 pandemic, which is exponentially larger in scale than what happened during the SARS outbreak.

COR Theory also addresses the processes that occur once burnout has been reached. This is important in being able to respond to the symptoms of burnout caused by work stress. This allows organizations to plan a response to provider burnout that may lead to negative patient results, which are tied to providers pulling away from patients due to exhausted emotional resources. (Halbesleben et al., 2008)

Concerns Regarding Stress in Healthcare

The negative effects of burnout include not just psychological impact, but also physical health impacts. Reduced immune response and physical exhaustion are examples of the physical effects of burnout. Since burnout is a result of stress that occurs when an employee is impacted by stress in their work environment, and because it affects job performance negatively, it becomes necessary for employers and policymakers to address burnout. (Otto et al., 2021)

Stress levels will increase in caregiving situations because of the emotional burden associated with caring for others. This caregiving leads to “resource loss” or the emotional energy utilized in caregiving. The more time that is spent in caregiving the greater the perceived burden associated with caregiving. This expenditure of emotional resources leads to caregivers seeking additional ways to increase resources, whether that is more help, or finding ways to lighten the emotional burden associate with the stress of caregiving.(Hong & Harrington, 2016)

While it’s important for organizations to address burnout, healthcare workers also have a role to play in addressing stress and burnout. Burnout among healthcare workers can play a role in patient outcomes. Burnout is the emotional exhaustion that occurs as a response to stress in the workplace. It will lead to workers pulling away from others associated with the job, and a reduced feeling of accomplishment. (Halbesleben et al., 2008) Because of this impact to patient care, it’s key for healthcare workers to identify these symptoms, and to address them in the organization so that remediating steps can be implemented.

Patient outcomes are not the only concerns organizations should have regarding burnout. Burnout can also lead to staff turnover, decreased performance, and decreased job satisfaction among workers. Organizations will suffer from employee burnout because of the loss of talent due to staff turnover, and reduced efficiencies of current staff. Resources (employees) are not optimized, due to burnout, causing employees to have a reduced ability to interact with patients and coworkers, and thus not able to respond to new situations or emergencies. COR theory works to address these causal stressors and to find the most efficient way to address them. (Halbesleben et al., 2008)

Other Factors Affecting Stress

Healthcare workers also must contend with other stress factors, for example violence against workers that may occur in the Emergency Department. In addition to assault due to the presence of patients suffering from psychiatric conditions, the influence of illicit substances, and other acute conditions, there are psychological stress factors such as fear, anger, PTSD, and others due to the exposure of workplace violence. These additional factors, along with the higher exposure to critically and terminally ill patients lead to increased stress factors for those working in EDs. (D’Ettorre et al., 2018)

Negative leadership styles also negatively affect stress among healthcare workers. While it’s fully accepted that work alienation can occur among workers that are exposed to positive leadership styles, such as supportive or transformational leaders, it is much more pronounced in leadership styles that are more aversive in nature. (Fatima et al., 2018)

Stress also increases based upon the expectations of workers to have “positive” interactions with patients or customers. Having to do the emotional labor of appearing positive can increase exhaustion for those team members that are only “surface acting” or forcing a positive attitude, versus those workers that take actual joy out of interacting with others. (Zhao et al., 2020)

Reducing Stress

Reducing stress factors is necessary to keep healthcare workers from burnout, thus ensuring better patient outcomes, and increased employee job satisfaction. Some types of interventions utilized in reducing stress include cognitive interventions that help change the way employees approach work, and how they feal. There are also relaxation techniques that help employees reach physical and mental relaxation, through either physical activity such as exercise of massage. There are also organizational level strategies such as increasing resources or modifying the way work is conducted. (Ruotsalainen et al., 2015)

Studies analyzing solutions for addressing burnout and compassion fatigue are relatively new, however recent studies show that there are a few solutions that are effective. One would be the inclusion of structured meditation. Another, effective solution is the inclusion of focused education around the subject of burnout, teaching coping mechanisms and risk factors. (Cocker & Joss, 2016)

The American Nurses Association has a guideline of ethics for members that states the professional ethical standards expected of its members. This guideline includes provisions that ensures “the nurse’s primary commitment is to the patient” however, in addressing the role of stress and burnout, the guideline also servers a reminder that “the nurse owes the same duty to themselves as to others”. (Ali et al., 2020)

Discussion

People will attempt to prevent burnout naturally, by making changes in their home, work, and personal environments. All aspects of a person’s life can add to the effects of stress in the workplace and lead the burnout. Often times people are ill equipped to properly address the causes of burnout, leading to further frustration and compounding the stress factors affecting them. (Otto et al., 2021)

Examples of burnout are plentiful in the world of the COVID-19 pandemic. Being able to maintain safe and high-quality patient care is highly tied to the need for healthcare workers to remain physically and mentally well. Since burnout is tied to a lack of resources, and we know that personal issues can add to the effect of burnout on the job, this year has provided challenges in addressing stress and maintaining the necessary quality of care. (Chersich et al., 2020)

The experiences of healthcare workers during the COVID-19 pandemic has led to increasing levels of stress, raising anxiety and PTSD. This increased stress can lead to a reduction of resources (workers ability to handle stress) and leads to them having decreased patient outcomes as well as leading to self-doubt in treatment decisions. These inefficiencies have to be addressed at an organizational and individual level in order to deal with the extreme nature of the situation. (Chersich et al., 2020)

The role of job gratification in reducing workplace stress, thus reducing burnout is tied to multiple factors. Training healthcare workers to care for the patient on a more personal level is one way to increase job gratification. This type of empathetic relationship also leads to greater patient outcomes because the patient becomes involved in their healthcare by feeling able to share their opinions. It is essential that the employees come to positive patient interactions as a part of their natural personality, otherwise forced requirements for “positive” interactions can compound stress factors. (Zwack & Schweitzer, 2013)

Burnout can be addressed in multiple ways, including individually focused efforts, organizational based efforts, and a combination of the two. Among the most effective individually focused methods self-care workshops that taught healthcare workers mindfulness was highly effective. Training programs that focused on stress management and communication skills were also effective. Making use of physical methods for stress reduction such as massage, meditation, and yoga were also highly effective. Organizations bear a responsibility for making these options available to workers.(Zhang et al., 2020)

From an organizational focused approach, the use of flexible or rotating schedules helped to address burnout. Reduction of workload by the use of additional resources (hiring supplemental workers) also helped to address stress and burnout. In addition, trainings around teamwork building, stress management, and in person debriefs were effective. Organizations that included extended interdisciplinary care teams that included mental health and other professions were effective at reducing burnout as well.(Zhang et al., 2020)

It’s important to note that the increased levels of stress observed during the COVID-19 pandemic has been shown to lead to increased burnout. Over 52% of healthcare professionals polled during the pandemic expressed that they considered quitting their job. While we noted the previous studies done during the SARS pandemic, it seems that not enough work was done to prepare healthcare workers for another large scale stressor. (Ali et al., 2020)

What is common between both events is the belief that organizational support is essential in mitigating burnout. Many healthcare workers viewed both events, and their work tied to the events, as an “act of duty,” however positive support from organizational administration led to a higher degree of job satisfaction, and better coping strategies for healthcare workers. In addition to organizational support, healthcare workers that focused on the facts necessary to do their jobs, and who focused their engagement with their patients, dealt with less burnout than those workers that over consumed media reports. (Ali et al., 2020)

While healthcare workers tend to be most satisfied when engaging in unforced compassion towards those they are treating, it’s important to note that the happiest workers had a high level of self-compassion. As previously noted, mindfulness leads to a reduction of stress by increasing happiness among healthcare workers. Studies also show that reducing isolation from others through the use of techniques that address isolation is also important. (Benzo et al., 2017)

Organizations that implement the above remediations are able to reduce the impact of stress on healthcare workers, allowing them to extend their individual emotional and physical resources, and preventing an exhaustion of these resources. The proactive prevention of burnout, by using COR theory to analysis the causes, lead to higher patient outcomes, and lower staff turnover, as well as increased job satisfaction among workers. (Otto et al., 2021)

Conclusion

COR theory has been used to analyze stress factors, and burnout, in the healthcare fields for the last decade. While the time period for data gathering has been relatively short, the ability to analyze stress factors, based on both internal and external criteria, has led to a greater understanding of what causes burnout, and what the most efficient ways of addressing it are.

COR theory has shown that organizations bear a responsibility to give employees the training necessary to address burnout. They also must allow employees the flexibility in schedules to be able to avoid burnout, as well as incorporate healthy personal activities such as meditation, exercise, and yoga. Addressing the root causes of burnout in the most efficient way possible will lead to more positive patient outcomes, and reduced staff fatigue and turnover.

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