Individual Factors
It was found that beyond the external environment, the personal characteristics and performance of employees, superiors, and managers can lead to stress in HCWs. These factors put pressure on HCWs directly and indirectly.
Personality Characteristics: The personality characteristics of the employee were considered by the participants as an effective factor in adopting anxiety-causing behaviors or strengthening stressful conditions in the workplace, such as extreme idealism. A HCW said:
People’s personality is definitely effective, people have a calm personality and are very carefree, and people who have an anxious personality know that they are doing their job right, yet they get anxious when it threatens others. (P3)
A number of HCWs were stressed following some beliefs. Such as believing in the insistence of some superiors to find weaknesses in the performance of the HCWs and HCW’s perceptions of his or her colleagues. A HCW stated the cause of his or her stress after receiving a warning from a superior about a work error:
I was very upset, because of the egotistical pride of my colleagues. I did not feel punished, I realized in them the feeling of pride and superiority, and it bothered me. (P6)
Cognitive Factors: A person’s processing and understanding of what happens at the workplace was identified as an effective factor in stress. It was found that when HCWs feel the organization has wronged them or they consider their superiors to be the cause of their lack of progress and promotion, HCWs understand the existence of injustice in the organization and this issue becomes very annoying for them. A HCW who had 18 years of experience and was looking for a job promotion for a long time said:
It may not be understandable to others, but I, who have expanded my skills and expect progress, see injustice. (P11)
On the other hand, it was found that the health care worker’s dissatisfaction with her job performance leads to self-blame and stress, and this is due to not meeting the expectations that she has of herself. One participant stated that she would like everyone to be satisfied with her, that her inability to satisfy others makes her anxious.
Some HCWs stated that concerns, such as responding to superiors, performing sensitive services, and reacting in some communication situations, may lead to anxiety.
Job level in the organizational structure was another concept that was mentioned. Some HCWs believed that their job level in the organization is lower compared to some jobs in primary health centers. They considered this to be the cause of their lack of motivation and mental abuse. Several participants believed that some managers and superiors place little value on HCWs working in primary health care centers. A HCW said:
When I see that my job does not have a high value and level in the organization, the position, and level it should have, this is painful; otherwise I really like my job and tasks. (P8)
Behavioral Factors: The behavior of HCWs, colleagues, supervisors, and clients in the workplace was stated as an important and common source of stress. HCWs and superiors repeatedly emphasized that the presence of harassment in the workplace is effective behavior that increases the psychological pressure on employees. In this study, it was found that bad manners, tension and poor respect in the relationships of employees, supervisors, and clients caused severe emotional suffering. A superior said about the tension between a supervisor and a HCW:
That supervisor had a strong conflict with the health worker in front of other colleagues and even in front of clients. After this happened, the HCW said: “I am very embarrassed among the people of this village”. (FGH)
In addition, HCWs mentioned the impact of the employee’s reaction and skill in different communication situations. A HCW said about the stress of talking to a client at the time of running out of daily consumables:
When the alcoholic pad runs out, I stress about how to convince the client that we don’t have the vaccine and he or she should come again. (P20)
On the other hand, some participants stated that incomplete performance of tasks, lack of daily planning and carelessness in performing sensitive tasks by HCWs cause anxiety and distress.
Supervisory Function: The performance of supervisors was prominently mentioned as an important and effective factor in occupational stress. The unfair performance of managers and supervisors was reported as an important factor in creating feelings of resentment in HCWs. One HCW had been selected as an exemplary employee several times, but managers had promoted another employee who was performing poorly. She said:
What are the rules of job promotion? What are the criteria? This torments me a lot. (P10)
Superiors and HCWs believed that monitoring methods are one of the causes of anxiety. In addition, supervisors’ poor skills in supervision, training, and problem analysis created stressful challenges for HCWs. The challenge that most of the participants revealed was the type of reaction of superiors towards an employee who performs well compared to an employee with poor performance. So, sometimes an employee who worked well was given more work. A manager described this issue as follows:
Entrusting the work to a better employee is the right way because the management system should be based on meritocracy, but the problem is that the assignment of work and benefits are not proportionate. On the other hand, out of compassion, we don’t want the weak employee to lose his or her job. Nonetheless, we don’t have a solution to deal with him, and so we leave his work to his or her colleagues. The mistake is here. (FGK)