Job stress and satisfaction among the staff members at a cancer center

Abstract

Although it is evident that working with cancer patients can be stressful, explanations have differed as to why this is so and little attention has been paid to the rewards of this work. One hundred ninety clinical staff members at a comprehensive cancer center representing 91% of eight disciplines studied were interviewed using a semistructured format about the factors influencing their job satisfaction. The fact that the staff members almost uniformly rated their satisfaction as high (8.2 on a scale of 1 to 10) precluded the detection of discriminating variables. Satisfaction with the way they met their goals also was'high; most identified potentially achievable goals, relied heavily on the interdisciplinary team, and experienced changes in their attitudes and approach during their first 2 years in the field, primarily increased realism. A major discomfort for physicians was the inability to provide optimal care. Ethical issues were a major discomfort for nurses. Death itself and staff conflict were less important sources of discomfort than in previous reports.Cancer 64:975-982, 1989.HE DIFFICULTY that many oncology units encounter T in maintaining adequate numbers of qualified staff members has generated considerable interest in the factors influencing job satisfaction and staff turnover. With a few notable exceptions, the literature has focused on single explanations of stress. Some authors have emphasized the discomfort associated with proximity to death, noting a tendency of certain staff members to withdraw emotionally from dying patients.',' Others have described "burn out" from overinvolvement with the patient's and identify the major difficulty for staff members as maintaining appropriate expectations of themselve~.~.~ Still others have located the real problem in the work envir~nment,'.~ emphasizing the importance of the relationships among members of the treatment team. The most comprehensive model of occupational stress is that proposed by Vachon: who describes an interaction among several variables including the particular challenges of the work, the attributes that individuals bring to it, the characteristics of the work setting, and the coping mechanisms that staff members develop. Her observations, based on informal interviews with many caregivers in a variety of clinical settings, are the most extensive currently.

A Qualitative Study of Oncologists' Approaches to End-of-Life Care

“…Supportive colleagues, viewing oneself as a therapeutic agent, and a closer relationship with patients and families could all contribute to increased job satisfaction and decreased burnout. [10][11][12] Our conceptual model of the development of communication skills and their relationship to job satis-faction and burnout has features in common with models used by adult learning theorists such as Schon, Meizrow, and others to explain the processes of professional growth and development in adulthood. [13][14][15][16] These theorists suggest that a learner's ability to identify, conceptualize, and describe a complex task like communication allows the learner to experiment in an intentional way that supports continued skill development, resulting in increased satisfaction with work tasks.…”

Communication between nurses and simulated patients with cancer: evaluation of a communication training programme

“…They seem to be afraid of losing control over the situation when not using these tactics (Webster 1981). Consequently, particularly in cancer care, nurses report a need for communication training programmes in which they learn to communicate effectively on emotional issues and psychosocial aspects, and learn how to integrate these issues usefully in delivering medical or technical care in nursing practice (Peteet et al 1989, Ross et al 1992.…”

Studying stress in care givers: art or science?

“…Research suggests the greatest stress among health service personnel is experienced by those involved directly in patient care with a high level of responsibility (Bates & Moore, 1975) and there is now a substantial body of work concerned with identifying specific stressors for staff in oncology (Delvaux et al, 1988;Peteet et al, 1989). Particular attention has been given to the strain of caring for the dying (Vachon, 1987) but any issues which evoke in staff a sense of helplessness or failure or which create uncertainty and/or conflict may be appraised as stressful.…”

“…Inexperienced staff, particularly those with idealistic goals of treatment and unrealistic expectations of themselves are vulnerable (Peteet et al, 1989) particularly if life outside work fails to relieve stress generated in the job. Job dissatisfaction and feeling unsupported were important predictors of burn-out in clinical nurse specialists (Yasko, 1983).…”

“…In general, those who believe that events in their lives are under their own control cope more effectively with stress (Krause & Stryker, 1984). High job satisfaction in oncology has been described among staff who were altruistic and orientated towards personal relationships in their work as well as realistic in their attitudes to cancer and to treatment goals (Peteet et al, 1989). Most of this work has been carried out in the United States and there may be cross-cultural differences.…”