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)