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)