Stress and job satisfaction among social workers, community nurses and community psychiatric nurses: implications for the care management model

Abstract

The introduction in April 1993 of new arrangements for assessment and care management following the NHS and Community Care Act 1990 (Department of Health 1990a) heralded a period of major transition for front-line workers in the health and social services. Policy expectations for the development of the purchaser/provider split and the 'new managerialism' have posed unprecedented ideological, organizational and professional challenges. Two years after the full implementation of the reforms a postal survey of the experiences of care managers about policy and practice changes was undertaken in Wales. This paper focuses on the stresses and satisfactions of care management practice among three distinct groups of front-line workers: social workers, community nurses and community psychiatric nurses. The results of multiple regression analyses, corroborated by qualitative data, implicate an increased workload in general and administrative work in particular, combined with reduced opportunities for client contact, as the main sources of stress. Being able to control or shape those factors impinging on the experience of stress and job satisfaction appears to lie at the heart of the dilemma. Practice and policy implications are considered.

Care management for older people with mental health problems: from evidence to practice

“…The completion and transmission of paperwork permeates most working days in occupations of this type (client and carerrelated paperwork occupied more practitioner time than any other single activity in this study), but consistently ranks among the least enjoyable aspects of such jobs. 40,65,66 There are, however, a number of areas that would have required sensitive exploration and support, including the possibility that social work practitioners would perceive an increased emphasis on multidisciplinary assessment as a challenge to their authority and that nursing staff would view any involvement in discussions of charging and finances with concern. [66][67][68][69] Care plans are needed to support, sustain and enhance the quality of life of older people with mental health problems in their own home and to provide assistance to their carers The care planning function of care management encompasses the identification of the most appropriate means of meeting the needs/goals identified in the assessment and the securing of the necessary services/resources to meet them.…”

“…40,65,66 There are, however, a number of areas that would have required sensitive exploration and support, including the possibility that social work practitioners would perceive an increased emphasis on multidisciplinary assessment as a challenge to their authority and that nursing staff would view any involvement in discussions of charging and finances with concern. [66][67][68][69] Care plans are needed to support, sustain and enhance the quality of life of older people with mental health problems in their own home and to provide assistance to their carers The care planning function of care management encompasses the identification of the most appropriate means of meeting the needs/goals identified in the assessment and the securing of the necessary services/resources to meet them. 33 An important feature of intensive care management arrangements for older people with mental health problems is the number and breadth of services required to enable individuals to remain in their own homes.…”

“…28,66,70 Nonetheless, the delivery of effective care management depends upon the establishment of trusting relationships between staff, users and carers that endure over time, 50,68,71,72 while the provision of supportive information systems and other practical arrangements may attenuate the administrative demands of care management. 66 Increasing staff' s awareness of the benefits to clients of indirect work is also important, since studies have shown that greater time spent on such Models of Care activities is associated with better client outcomes and increased service satisfaction.…”

“…28,66,70 Nonetheless, the delivery of effective care management depends upon the establishment of trusting relationships between staff, users and carers that endure over time, 50,68,71,72 while the provision of supportive information systems and other practical arrangements may attenuate the administrative demands of care management. 66 Increasing staff' s awareness of the benefits to clients of indirect work is also important, since studies have shown that greater time spent on such Models of Care activities is associated with better client outcomes and increased service satisfaction. 73,74 Financial arrangements which facilitate an integrated approach to the provision of health and social care for older people with mental health problems are required The financial arrangements consequent upon the introduction of intensive care management find expression at both the macro and the micro level.…”

Revisiting the Causes of Stress in Social Work: Sources of Job Demands, Control and Support in Personalised Adult Social Care

“…However, many stressors are extrinsic, and relate to organisational features of the working environment, and their interaction with wider societal, political and legislative contexts. There are many portrayals of modern-day social workers in England being engulfed in paperwork and bureaucracy; with a greater role in undertaking financial assessments and determining eligibility than in care provision; with reduced control and discretion over the range of permissible solutions to client needs; and working in departments enacting endemic organisational change and driven by new managerialism's emphasis on targets and financial prudence (Parry- Jones et al, 1998;Jones, 2001;Postle, 2002;Lymbery, 2006;Coffey et al, 2009).…”