Environmental Factors
Several environmental factors were identified as the source of stress.
In general, these factors were beyond the control of the employees, and
their origin was the organization’s policies, job-related conditions,
and environmental factors not related to the job.
Job Demands: Job-related factors that are poorly designed and
lead to stress. All participants considered increasing workload as an
important source of stress in HCWs. One of the supervisors said:
The biggest problem for HCWs, especially foremen, is the high workload
and scope of work, they say: “we are confused about what to do”, now
that the Corona pandemic has occurred, their work has multiplied. (FGB)
HCWs had to be accountable to different supervisory units, they did
things for them and tried to satisfy the supervisors. A HCW said:
The main problem of our job is to have many branches, and we are in
contact with many superiors. (P18)
Participants repeatedly mentioned the pressure of working with clients.
The clients were diverse in terms of culture, education, beliefs,
values, and income. Therefore, the HCW was sometimes faced with
expectations from clients that are outside the health center services.
In addition, some clients did not follow the health recommendations. A
HCW told the interviewer:
Our clients have different social statuses, moral characteristics and
expectations, but they all receive the same service, and they may not be
satisfied with our services and may react with inappropriate behavior.
(P3)
Lack of job security and uncertain job prospects were the most common
concerns of HCWs with fixed-term contracts. Some of them had to endure
the problems and not protest in order to avoid the cancellation of the
contract.
Role Characteristics: Role characteristics were important
sources of stress in HCWs. An anxious situation for HCWs was when they
find the organization’s expectations to be in conflict with their own or
the client’s beliefs. One HCW said about the experience of being
severely warned by a superior after performing action contrary to
instructions:
Why did my work lead to a supervisor’s notice? I considered the
spiritual aspect of that work, I did a charitable work, why did this
end?!! (P6)
Lack of transparency in some career goals and expectations had led to
confusion and the impossibility of planning for HCWs. A number of HCWs
stated that sometimes several performance indicators are mentioned and
the HCW is forced to use even rest time to compensate for one indicator.
Moreover, all participants identified multitasking as a key problem for
HCWs. They believed that managers focus on HCWs. Health care workers are
at the forefront of most primary health care and new services. An
important source of stress among foremen was having two different roles
at the same time; supervisor and health service provider. One of the
foremen said:
Our workload is too much, our stress is too much. Every so often I worry
about work when I am at home; oh, today they sent me a few letters, I
have to do something, I have to do some planning … (P4)
Payment Policies: Participants attributed one of the causes of
health care workers’ psychological harassment to some payment policy
flaws. For example, payment was only for activities that can be
registered in the electronic system of health services, and there was no
payment for some activities such as health education. Participants,
especially HCWs with fixed-term contracts, considered payment based on
the type of employment contract as one of the factors of stress.
Employees with fixed-term contracts, despite having the same duties as
other employees, received lower salaries and did not receive some
bonuses, and felt a sense of injustice. One of the superiors said:
What makes them upset is that they say: “we all did, but how come
someone else has received more corona control bonuses or other bonuses!
What happened?” … (FGF)
Non-occupational Factors : In addition to environmental factors
related to the workplace, environmental factors not related to work,
such as parenting, family care, and financial problems, put pressure on
HCWs. A HCW who had two children said:
I use break time for nursing mothers’ law, which means I work one hour
less than my co-workers, and they register their performance in the
electronic health system in that one hour, but I cannot do that. I am
one hour behind them. (P1)