Workplace stress and control

The relationship between workplace stress and control an article by Chris Graham – views expressed employees own

You are sitting outside in your garden, chilling out with a cup of tea. As you sip, it feels warming but the chilly wind swirls around you. You want more tea but are distracted by bees foraging flowers. Another sip. Disappointment follows. It is cold and unpleasant. The temperature of the tea has rapidly dropped. There is nothing you can do about it. The only control you have is to drink quickly. This is a typical experience of day to day control in our lives.

June and Harry are care assistants working in the older adult social care industry. June works in a nursing home, Harry works for a domiciliary care agency supporting people in their own homes. They both love working with people, particularly with older adults. The reason is that they both enjoy listening to the lives they have led and how they enjoy living now. They like to help others. Behind this, is the strong belief: as you grow more fragile and frailer, you need to keep your independence and in control of your life as much as possible. Both have similar duties, but their workplaces in relation to control, are very different.

June’s nursing home is an 80-bed unit. All residents have been assessed by the statutory agencies for a variety of reasons, as being unsafe to continue living alone in their home. The company tries very hard and is committed to making the nursing home as much like a home as they can. The General Manager organises the clinical and care teams to enable the residents to make their own choices.

June works every shift with her team, who all have specific duties to complete. The shift plan is designed to be efficient. There are set times for all residents to wake up, helped to wash, get dressed and “transferred” out of bed. The process is reversed mid evening night before the night shift is on duty. The kitchen staff have set mealtimes, as they produce high volume meals. 80 different meals are not possible. There are only three food choices. The staff order bulk ingredients, some weekly. others monthly.  They can only change request for meal plans fortnightly. They are all encourage to spend time in the lounge areas. Here, the Social Activities organiser arranges special events. This is limited to the majority of resident’s requests. There are visitor time rules. The décor is centrally controlled as well. It is difficult for residents to have all their own treasured possessions. Room size does not vary that much. In the nursing home, no resident can choose who they live with. 

Over time, June chats during care tasks, getting to know people who live there. Their likes and loves. Everyone is different. Although June understands why the nursing home is organised, she feels frustrated at the lack of control she has in her care work. She wants people to get up and go to bed when they want. To eat what they like every day. To enjoy leisure activities that are uniquely meaningful for them. This stresses June.  

Harry’s workplace is different to June. He knocks on the door of his client’s house and waits to be invited in. He has a pre agreed care plan, but what he actually doesis influenced by how that person is feeling that day of the visit and on how they like to live in their own home. People choose when they go to sleep and wake up. Harry helps stock their kitchen with what food they want to eat that week. He asks what they want for a meal and then helps prepare. Harry not only gets to know everyone but also the home they live in. Each room has many ornaments and items that reflect how they have lived their lives. Every room tells a personal story. He knows the neighbours who drop in. By making choices “in the moment” of providing care, Harry feels in control of his job. He feels no stress.

A new manager now supervises Harry as his immediate manager. Harry has worked with his previous manager for many years but they have now retired. The new manager Lucy is keen to monitor every domiciliary care visit in a lot more detail. Lucy does not know Harry, so the trust is not there. The time duration of each visit and the specific tasks Harry perform is not only more tightly specified but Harry must record precisely what he does. Lucy questions Harry each week. Slowly the control of what he can do by himself is being lost. This is stressing Harry.

There is change in June’s nursing home as well. A General Manager has been recruited. Bill professionally trained as a Social Worker. He has experience in and passionately believes in Person Centred Planning (PCP). It is a way of care working where the function of the workplace is determined by the resident. Great effort is made to understand each person as unique with individual needs. Bill challenges every routine at the nursing home from the PCP perspective. From the laundry and cleaning team, the social activity coordinators and the nursing/care assistant teams. Bill gives June a small group of residents to be responsible for. She is given PCP training. Now, June has the time to talk to each of the residents.  June feels she has the authority to determine, as much as it is possible in a nursing home environment, for each of the residents to share with her, how they want their lives to be. This means using her skills of listening with patience as it does take time for each resident to trust her. In making care decisions June find this complex and challenging as there are health and safety rules to be compliant with. June feels she has far more job control, she does not feel stressed anymore.

There is pressure for Bill to keep the nursing home at 100% occupancy because of ever rising costs such as energy bills. June has been working extra hours including AM and PM back-to-back (double) shifts on a regular basis. She has lost her control over her preferred work life balance. She has two teenage children who expect her to cook and clean for them. Her husband often works away, which means rather than resting and relaxing, June is performing household chores she would like not to do. Often, she feels too tired to go out with friends and have fun. This loss of control at home life means she feels trapped, so the stress returns making her nursing home work stressful as well. 

Harry has fallen in love. He is living with his partner Jim who has a well-paid job he enjoys but works part time as he values his leisure time. They both enjoy the same activities particularly travelling around the UK rock climbing together. Harry decides to go part time as well. He has established a much better relationship with his manager. Lucy has been given positive feedback from Harry’s clients and now understands the importance of the way Harry manages his care work. She now has a deep trust in Harry to do what the clients want. She wants to keep Harry long term so has agreed for Harry to go part time so that he has more control of his work life balance. This has meant agreeing not to offer any additional shifts unless he asks for some. Going away for rock climbing mini breaks keeps Harry refreshed. Lucy has discovered that his care work is even better, the agency’s positive caring reputation is increasing. Lucy decides to extend Harry’s way of working to other workers. The stress that Harry had experienced has now disappeared. 

Let’s dive a little deeper in regards June’s and Harry’s control in their workplaces.

Think right now, how does your Line Manager communicate with you in regards control and stress? There are three ways of communicating.

1. You are free to perform the task expected of you, in your chosen way. You monitor your performance, if mistakes are made, they are corrected. The communication with your Line Manager is essentially a free-floating discussion. Line Manager control is absent: you have trusted professional autonomy. An example for both June and Harry, would be something is troubling the resident or client. Their job is to discover what it is and how the care service can help.

2. The core of your job may be complex. Your Line Manager trusts you to use your skills and knowledge to perform well. They do not monitor your work performance that closely. How you precisely carry out your job is still up to you. Your Line Manager may give you advice, which you are free to ignore. However, if you choose a different work approach, you must take personal responsibility should this go wrong. An example would be June to construct a Person Centred Plan  with a resident.

3. Your Line Manager makes a “command decision” in the form of an instruction. There is no freedom for you to chose how and when you perform the ordered task. When you perform the task, a standard is expected to be achieved. Should you not perform as instructed, then a potential disciplinary procedure may be triggered. An example would be Harry arriving more than 10 minutes late for a domiciliary care visit. If this is repeated several times, then the control process of investigation and disciplinary sanction such as a verbal warning may follow.

The more instruction and advice communication happens, the greater the potential feeling of job control and the likelihood for stress to rise. Stress can worsen and become anxiety if you feel your manager is micromanaging you or is coercively controlling you.  Essentially the control over you feels dangerous and threatening. Let’s explore this.

Harry felt micromanaged initially with Lucy. He felt she was standing over his shoulder watching everything he did. Every task however small, was being observed. Each observation was being evaluated, leading to the feeling of being judged. Fear springs up when there is the fear of negative or harsh unfair judgement. For Harry, nothing he did felt right. It was like a bag over his face making breathing difficult. Invisible chains were locked around his arms and legs. Micromanagement is stressful because it makes you feel like puppet. The manager is pulling your strings limiting the personal control you have.

It was tough management that June was exposed to when the General Managerwho was under pressure to maximise bed occupancy. Her care work was not closely scrutinised. She understood the financial risks the company was under. Tough management is fair and understandable given the future of the nursing home financial situation. But manager bullying is not only unacceptable, but it triggers harmful stress. Lets explore this with June.

The Team Leader took a dislike to June. He privately did not agree with the introduction of the Person Centred Planning system. He saw an opportunity to bully June, to make her an example to others in the team. He did this by shouting at her when she was alone, publicly suggesting her care work was not efficient given the financial situation. June felt humiliated when he implied June was letting the care team down by being reluctant to say yes to every request for short notice additional shifts. “Minimum staffing cover is essential.” 

Bullying robs a person’s dignity and power. Purposeful humiliation causes stress to become overwhelming, so anxiety take over: “fight or flight”. Stand up and challenge or become quiet and submissive. June attempted to cope by avoiding (flight) by her attempts to avoid the bullying behaviour is blocked by the team leader, so she feels trapped and powerless.

A more hidden control form of bullying is coercion and control. Here a Line Manager attacks and tries to deconstruction a care worker’s identity. Using their manager power, they use subtle methods of removing their independent worker control to such an extent, they start to lose their sense of self. Any form of independent control is slowly stripped away, often without the worker being aware, leaving the person utterly dependent on their manager. “Agency” is the capacity of individuals to have the power to fulfil their potential at work and in their personal lives. Agency are the thoughts and actions taken by Harry and June that express their individual powerwhilst working. Are you aware of your workplace control you might be experiencing right this moment ?

You may want to view the Health and Safety Executive talking toolkit on stress and control.

Do you feel involved in how decisions about your job are made? Think about whether you feel listened to and trusted. 

To explore more deeply think about how you are consulted and given any opportunities to improve the work you do. Ask yourself: Do you feel your skills are used to good effect? How could your existing skills be used more effectively? 

What improvements could be put in place to help with any of the issues you are experiencing. Think about you, your line manager, your organisation.

Does bullyingly or coercion control happen in your workplace to the point you are overwhelmed with stress? It is more frequent than you may think. If so, do contact us at Mind.