Findings

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According to data from the 2003 Canadian Community Health Survey (CCHS), nearly one in three employed Canadians, about 5.1 million, reported that most days at work were “quite” or “extremely” stressful.

This article focuses on workers entrusted with providing health care to Canadians.  Clearly, the well-being of this group of workers, which includes not only doctors and nurses, but also occupations such as ambulance attendants, technicians and therapists, is an important concern.  The analysis compares levels of work stress — a factor that has been linked to poor physical and mental health and to occupational injury — among various types of health care providers.^1,2  Associations between stress and selected job-related, socio-demographic and personal characteristics are also described.

Health care providers highly stressed

In 2003, health care providers comprised 6% of the Canadian work force aged 18 to 75 (data not shown).  Nearly half (45%) of these workers, or 413,000, reported that most days on the job were “quite” or “extremely” stressful (hereafter referred to as “high” stress).  This compared with 31% of all other employed people (data not shown).

The likelihood of high job stress among health care providers varied from a low of one in five (19%) dental hygienists to two-thirds (67%) of head nurses and nurse supervisors (Chart 1).  Others with high work stress were medical laboratory technicians, specialist physicians, general practitioners and family physicians, and registered nurses (other than head nurses and supervisors); in these groups, the proportions reporting high work stress ranged from 58% to 64%.

In addition to dental hygienists, health care providers who were relatively less likely to report high work stress included physiotherapists (29%) and nurse aides and orderlies (34%).

Work-related factors

The likelihood of high work stress was positively related to income.  About half of health care providers whose personal income was $40,000 or more reported high work stress, compared with 28% of those with incomes less than $20,000, and 42% of those in the $20,000 to $39,999 range (Table 1).

Work stress also varied according to logistical features of the job, such as shifts and number of hours worked.  Health care providers whose schedule was other than a regular daytime shift were more likely to report high work stress.  Those who worked less than 35 hours per week were not as likely as those with longer hours to report high stress.  Self-employed health care providers were less likely to report high work stress than were those who worked for others.

Personal factors

High work stress was reported by 42% of male health care providers and 46% of their female counterparts, a difference that was not statistically significant (Table 1).  However, there were differences by age.  Health care providers younger than 25 were less likely to report high work stress (31%) than were those aged 25 or older.  This may reflect the nature of the jobs that people these ages hold, specifically, having less responsibility at younger ages.  Work stress peaked at ages 35 to 54, with about 50% of health care providers in this age range reporting high work stress.  The proportion fell to 41% among those aged 55 to 75. 

In addition to questioning respondents about stress at work, the CCHS asked about stress in their daily lives.  Nearly four in five (78%) health care providers who reported that their lives were “quite a bit” or “extremely” stressful also reported high work stress.  This may partly reflect the impact that work stress has on a person’s life in general, or perhaps a tendency for people who feel stressed at work to perceive high stress in other situations.

Links to dissatisfaction

Similar to the association between day-to-day stress and work stress, life dissatisfaction was strongly related to work stress.  Three-quarters (75%) of health care providers who were “dissatisfied” or “very dissatisfied” with their lives reported high work stress.  

Work stress differed to a smaller, but signficant, extent by level of general health.  Health care providers who described their health as “good,” “very good” or “excellent” were less likely to report high work stress (43%) than were those who saw their health as “fair” or “poor” (55%).  It is reasonable to assume that coping with compromised health may compound the stressfulness of work.

To summarize, the results of bivariate analysis indicate that the proportion of health care providers who reported high work stress varied according to their job and to conditions intrinsic to the job, such as shift work and number of hours worked.  But the likelihood of perceiving stress on the job also varied according to personal characteristics of the worker.

Doctors, nurses most stressed

Multivariate analysis was used to examine the relationship between the job and perceived work stress, while controlling for the effects of personal characteristics and other influences.  The association between work stress and each job category was examined in separate logistic regression models that adjusted for the potentially confounding effects of day-to-day stress, life satisfaction, general health, sex and age.

Even when influences outside the workplace were taken into consideration, specialist physicians, general practitioners/family physicians, and registered nurses (excluding supervisors and head nurses) had a statistically elevated likelihood of work stress relative to other health care providers (Table 2).  Consistent with the bivariate results, the odds ratio for nurse supervisors and head nurses also appeared to be elevated, but fell just short of significance (p = 0.053), likely because of inadequate statistical power.  For medical laboratory technicians, the elevated likelihood of high work stress did not persist when other influences were controlled, suggesting that the association observed in bivariate analysis was at least partially accounted for by factors outside the job.

The multivariate analysis also indicated that the odds of high work stress were significantly lower, compared with all other health care workers, for laboratory technologists, dental hygienists, and nurse aides and orderlies.

This multivariate analysis indicates that health care providers are far more likely than employed people in general to feel that their jobs are highly stressful.   Physicians and nurses report the most stress, even when influences outside the job are taken into account.  Because doctors and nurses bear a major responsibility for delivering health  care, these findings should concern all Canadians.