“If I compare the situation right now to the one several years ago, there are the same number of beds and the same number of patients but fewer staff. This means that we have to work nights/weekends. It is so difficult to claim for overtime, I just end up working for free. All work, no recognition – it just gets to you after a while.”
– focus group participant in a recent study on role overload.
Role overload means feeling that you have too much to do and not enough time in which to do it.
Role overload has been linked to increased levels of anxiety, fatigue, burnout, depression and emotional and physiological stress and to decreased satisfaction with family and work.
A recent WSIB-funded study by three business professors sheds new light on the impact of underfunding on the hospital workplace.
“The Etiology and Reduction of Role Overload in Canada’s Health Care Sector” interviewed workers at four Ottawa hospitals. In addition, 1400 workers filled out in-depth surveys – the majority (84 per cent) were female. The majority of Allied health professionals and technical staff were members of OPSEU. Authored by Dr. Linda Duxbury (Carleton University), Dr. Christopher Higgins (University of Western Ontario) and Dr. Sean Lyons (Univeristy of Guelph), the 213-page report looks at causes and possible solutions to role overload.
Looking at previous studies, the authors note that compared to other professions, health professionals have the lowest level of trust in their employers, lowest level of commitment to their employers, the lowest ratings of workplace communications, the least influence on workplace decisions and least supportive and healthy workplaces.
One study notes the “quality of work life among health care workers has deteriorated to the point where it is impeding the capacity of the system to recruit and retain the staff needed to provide effective patient care.”
Canadians in health occupations miss more work due to illness or disability than other occupations. A CMA survey indicated nearly half of Canadian physicians were in an advanced state of burnout.
The reasons for workload were many, including the most obvious – staff shortages.
Despite the government’s emphasis on multi-disciplinary teams, health care workers pointed out this contributed to the sense of overwork given the time needed to coordinate, schedule, and communicate. The focus groups highlighted the need for constant repeating and rehashing of issues. They also noted that there was a lack of training in how to work in teams.
Workers also complained they could never get away from work – requests for vacation and lieu days were often denied, while taking sick time often meant coming back to even more work. People complained there was no coverage for lunch or breaks.
With hospitals required to provide a greater data stream, front line workers spoke about the demand for documentation has increased over the last several years while time to complete it had decreased.
“The documentation has to be done – for due diligence, for professional standards, for administration – but there is no time in the day for it,” said one focus group participant. “I often end up doing it on my own time, and resenting it. I did not go into this profession to be a secretary.”
Seemingly contradictory, the hospital workers suggested that there was not enough communications and too much communications. Lack of transparency led them to feeling harassed and under pressure. On the other hand, they also felt bombarded by messages, making it difficult to distinguish what was important.
Other contributors included the lack of training and training time, too few resources, the high expectation of patients and their families, the requirement to wear too many hats, the unpredictability of their jobs and the feeling that work was never finished.
Managers were stressed by a lack of job security, particularly after leaving a unionized environment.
One manager told the study: “I spent too much of my time selling and implementing new changes – there is no time to evaluate the change and quite honestly, find it hard to convince others that this is the right thing to do when I am not convinced myself – but I have no choice.”
Management were the group with the highest level of turnover – only 44 per cent of managers had been in their jobs longer than five years.
Para-Medical/Allied health suggested that this group was the most impacted by lack of resources.
Physicians said resources allocated for the government’s wait times strategy actually meant patients outside of those priority areas had to wait longer. They said physicians in private clinics were taking the “easy” patients, leaving physicians working in the hospitals with more complex patients.
Respondents made three suggestions to personally cope with overload – make sure you have some downtime, have positive interactions with colleagues, and set life priorities, not just work priorities.
The suggestion for their hospitals was more varied: provide adequate support, respect and recognize the work they do, provide adequate rewards, allow time to regroup and socialize with colleagues, improve the leadership and culture, improve communication, fix/improve infrastructure, and provide more resources.
More from this report in coming days. To download the full report, go to:
http://www.sprott.carleton.ca/news/2010/docs/complete-report.pdf
For the Executive Summary, go to:
http://www.sprott.carleton.ca/news/2010/docs/executive-summary.pdf
OPSEU Diablogue 
The recent study on ‘role-overload’ among health-care workers is an important wake-up call for all health-care organizations as well as all Canadians. The study indicates that workload, constant change, work pace and increasing complexity of patient care contribute to high rates of absenteeism, fatigue, stress and eventually, burnout. The study’s findings come at a time when we’re already in the midst of major recruitment and retention activities to quell a nation-wide nursing shortage. In light of this, RNAO has developed a series of Healthy Work Environment guidelines that address leadership, staffing, workload, workplace health, safety and the well-being of nurses. These guidelines provide recommendations to create healthy work cultures. The next step is to put these tools into action for the sake of nurses, other health-care staff and our patients
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