Introduction
How many times have we complained to our family and friends about how stressful our job is; how much we dislike it, etc.? Job stress is a hot topic in the workplace and in the medical community, because we are learning more and more about how serious the human and economic cost of excessive negative stress can be.

     Think about it for a minute: how do you behave if the stress level at your job gets too excessive for too long? You may initially work with higher levels of alertness and energy, but if the stress doe snot lessen or you do not find a way to handle it you may skip breaks, feel tired, become apathetic, make more mistakes, have more accidents, call in sick more often, think in negative ways about your employer, and ultimately see similar unpleasant changes in your behavior away from work.

        We live in highly stressful times: layoffs in formerly secure industries, stringent regulations, economic uncertainty, and the like. Some occupational stress is unavoidable; some is necessary to maintain high levels of alertness. But if your job is making you sick, or you are experiencing burnout, you need to make some changes.

What's Burnout?
       Burnout used to be a term associated with health care workers and some other service professionals, but any of us can experience the emotional exhaustion, sense of depersonalization, and overall negativity which results from unrelieved work stress.

Are You Stressed Out At Your Job? Job stress has now become a source of major health problems. In a 1989 Gallup Survey of corporate managers and medical directors, 72 percent reported that stress-related medical problems were "fairly" or 'Very" pervasive, with affected employees losing an average of 16 work days per year. As many as 9 out of 10 American adults experience "high levels of stress" at least once or twice a week, with more than one out of four complaining of this on a daily basis.      High levels of stress carry a hefty price tag for the American industry. Stress may be costing us in excess of 200 billion dollars annually, more than ten times the cost of all strikes combined. Nationwide, workers' compensation claims for job stress now approach more than 20 percent of all awards, as compared to 2.5 percent in 1978. This apparently has become a lucrative field for many workers' compensation attorneys. They have taken to advertising in daily newspapers with headlines soliciting clients that ask a leading question, "Is your job making you sick?"      In New York and Los Angeles, the relationship between job stress and heart attacks is so well acknowledged that any police officer who suffers this problem on or off the job is assumed to have a work-related injury and is compensated accordingly. This even includes heart attacks while fishing on vacation or gambling in Las Vegas.     Job stress problem is by no means confined to this country. An International Labor Organization survey describes job stress as a "worldwide epidemic," that includes waitresses in Sweden, teachers in Japan, postal workers in America, bus drivers in Europe, and assembly line workers everywhere. No particular occupation or country appears to be immune.      In Japan, approximately 40 percent of teachers suffer from stress-related headaches, depression, and feelings of anxiety. In Switzerland, 25 percent of executives admitted to being very seriously dissatisfied with their work. At least 1 out of 5 of all workers in the United Kingdom complained of significant anxiety and depression and almost half of all salaried employees in the United States rep ort that they experience excessive stress with 15 percent suffering from clinical depression. Major sources of job stress include: Lots of responsibility but little authority. Not being able to voice complaints, express strong feelings or get things off your chest. Prejudice because of age, gender, race, or religion. Unpleasant working conditions due to polluted air, excessive noise,  fear of exposure to toxic or cancer-causing chemicals, or crowding. Chronic and unpredictable commuting problems which are uncontrollable, inability to work with superiors, coworkers or subordinates because of basic differences in goals and values. Inadequate recognition or reward for good job performance. Not being able to utilize personal talents and abilities to their full potential Lack of a clear job description or change of command with to o many different people demanding different things. Fear, uncertainty and doubt.     Of course, not every individual reacts in the same way under similar working conditions. Some people, characterized as Type As, often thrive in challenging, hectic, and seemingly stressful occupations that would over whelm most people, provided they are in control.      Various studies have confirmed correlation between high levels of stress with increased incidence of heart attacks and hypertension. Another study points to stress as another cause of cancer of the colon.        Swedish researchers followed more than a thousand workers over a ten-year period, documenting details concerning frequency and magnitude of life change events and stressful situations at work. Those individuals whop received their jobs as highly stressful were five times more likely to develop colorectal cancer than those who did not. Workers who were unemployed for more than six months also had twice as many malignant tumors as their working counterparts. Being forced to move more than 120 miles because of job requirements in creased the risk of colon cancer threefold. Individuals with a tendency to deny or suppress their anger are at an increased risk of colorectal cancer. This study found the job stress ranking higher than marital separation or death of a spouse as a cause of certain physical ailments.

    Burnout does not happen overnight. As with many types of illnesses or other assaults on a person's mental and physical wellness, burnout usually develop s over time-sometimes creeping up on the person like an insidious 
parasite. As a nurse, I have experienced burnout several times. Each time has been very painful to me personally and professionally, yet I have learned from these experiences. My goal in this chapter is to assist you to identify your risk factors for "burning out," and to learn ways to prevent it from occurring.

Self-Assessment: Are You at Risk for Burnout?
     As in the other chapters in this book, the first step to learning how to prevent occupational burnout is to take a look at yourself, your job, and your feelings about it. This chapter is not designed to be a major text on career counseling; it is only one area of the overall topic. If you want to pursue career changes or do more extensive work in this area, there are a variety of books such as What Color is Your Parachute? by Richard Nelson Bolles which can be very helpful.

     There are certain occupational settings or workplace characteristics which can lead to job stress, and ultimately place you or your coworkers at risk for burnout:

           unfair evaluations
           pay inequities
           frequent policy changes
           rotating shifts
           frequent moving or relocation
           lack of participation in decision making
           excessive regimentation
           poor communication
           conflicting goals: worker-organization; worker-worker
           poor working conditions: lack of privacy, noise, poor lighting
           safety hazards
           lack of recognition
           lack of trust
           repetitive tasks
           time pressures, and so on.

      Any of these sound familiar? In general, if much is expected yet little empowerment is provided or rewarded, and little available with which to do the job, a job can have a significant potential for burnout.

     Based on the characteristics listed, take some time to look at your job-the good and bad points. Are there factors of the organizational structure which make your job more stressful? Problems with supplies? Problems with unfair policies? Take time to write these down; just the act of writing down your concerns regarding your job and your experience with occupational stress will help to focus your ideas. The purpose of this exercise is to explore areas of your job which maybe causing you stress, and to think of possible solutions which can help you to prevent burnout. Focus your ideas around some of the major areas within a job that cause you stress.

Instructions:  Job stress can develop within several different areas of a work situation. For each area listed below, write down any aspects which you believe are unnecessarily stressful. Don't try to censor or rank the problems at this point-just write!

Area	Stressor
Policies	For in stance, are the policies made and changed arbitrarily? Unfair demands?
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
Structure	For instance, do you work in a  highly centralized office? Too big  or too small?
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
Process	One of the first things you learn in total quality management training is  that most problems in an organization are process problems-not people problems. For example, do you have to fill out several pieces of paper to  order paper clips?
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
People	Too many people in a small space can cause job stress; too few people to do  the work can also be a major stressor.  You may have other issues that other you.
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
The role you play	Do you feel conflict between your own principles and the needs of the job? Are  you doing the type of work you enjoy.  Do you have the authority to make decisions?  your responsibilities commensurate  with your authority?
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________
	_________________________________________________________________

        Good. Now that you have thought about these issues, it helps to look at how they are impacting on your ability to manage your stress. Unrelieved job stress can lead to burnout, and burnout involves the entire mind-body- spirit-emotions continuum. It is easier to prevent burnout rather than to treat it. Part of your prevention is to write a Job Care Plan. This will give you a framework for improving your abilities to handle occupational stress-how to rum self-destructive frustration into productive self-growth and change.

        Three Key Steps in the next phase of your assessment:

Prioritize
	Of the items you listed or described during the last few pages, what are the major causes of stress for you?
	1.______________________________________________________________________________________
	2.______________________________________________________________________________________
	3.______________________________________________________________________________________
Personalize
	How does each of these affects you as a person? Be specific.
	1.______________________________________________________________________________________
	2.______________________________________________________________________________________
	3.______________________________________________________________________________________
Plan
	For the top 3 stressors you listed above, can you, either working alone or with your coworkers/ supervisors  develop a realistic plan of action to improve any of the  situations causing you stress?
	1.______________________________________________________________________________________
	2.______________________________________________________________________________________
	3.______________________________________________________________________________________

       Now that you have done this part of the exercise, you have identified some important areas of your job which are causing you excessive stress. You have written down some ideas on possible solutions also. Don't feel bad if these aren't the greatest ideas in the world-that was not the point of the exercise. It would be wonderful if you have solved the problem, but even if you haven't, you have gained an insight which will help you in all areas of your stress management program. You have learned how to think through a problem to get a handle on the way out of the situation.

                                                                                           Assessment + Problem - solving = Control

       One of the biggest causes of stress in the workplace, I believe, is a feeling that you do not have any control over what happens. Your voice is not heard in policy making, or schedule making, or you are given arbitrary decisions. Each of us has had our own experiences; a lack of control- a state of "disempowerment" is a common complaint among many workers. By looking at your job stressors rationally and exploring possible answers, you are making an attempt to regain some level of control over your situation. You may not be able to change the way the supplies are ordered, or you may not be able to make the doctor write the orders so you can read them, but you can control how these things affect you. You can control how you react!

       For each of the plans you wrote on the page before, now ask yourself these questions:

       Can I make this change or improvement on my own, or do I need to involve other people at work?

       Am I committed to working for the change or improvement I have planned?

       Is this change or improvement possible given the resources of the workplace?

       If you decide that you want to work for this plan, go for it! But we all know that there are many stressors which cannot be changed by you or anybody else, e.g. governmental regulations or a bad quarterly cash flow may not be 'fixable.' In that case, you can still work on yourself-which may be of most benefit in the long run.

       Gaining control and making organizational changes may take time, if it is 
possible at all in the setting you work in. Long-term efforts like these are important, but you will need to institute some control over your personal work behavior now to prevent or treat burnout while you are moving toward other changes. When you see that you are at risk for burnout, or when you begin to notice changes in your physical and emotional well being, take action! You can take some very solid steps back to wellness tomorrow—without leaving your job, relying on substances, or getting into other negative patterns.

       The first action to take is to be realistic; set achievable goals for yourself. For example, do not set out to finish an entire rep ort in one day if that is not realistic—set a goal of how ever many pages you can reasonably write in your workday.

       Secondly, take your breaks! One of the first things I give up when I am under a lot of work stress is my lunch break. It's easy to get into the habit of eating on the run, or at your desk while you take care of your messages. Don't do it! You are entitled to your breaks, and you will find that taking a few minutes from your work or your clients can be very healing. You can learn to make your breaks even more relaxing by sitting some where quietly for 5 -10 minutes, closing your eyes, and focusing on breathing slowly and deeply. You will find the tension in your body start to melt.

      Take care of yourself when you are away from work. Commit to having a balanced life of friends, family, hobbies, exercise, nutrition, and spiritual experiences. All of these things work together to help keep you whole, to keep you healthy.

       Think of three things you can do at work tomorrow which will give you a break from the stress. Whatever you decide to do must be realistic, appropriate for the setting you are working within, and must be a wellness promoting activity. (Extra cup s of coffee, or doughnuts will not help you relax!) To give you an example, one of the things I do during the work week is eat under a particularly beautiful oak tree every Friday. This is my reward for surviving another week, and help s me to begin the end of the week. I call it "decompression." Think of what will work for you!

       1. ____________________________________________________________________________________________

       2. ____________________________________________________________________________________________

       3. ____________________________________________________________________________________________

      Good start! You know what you can do, what you want to do. The next step is to put it into practice.

      Finish writing whatever you need to make your Job Care Plan "user- friendly," and then take a copy with you to work. Post it somewhere that you can see, but where it is not obvious to your coworkers. Look at it several times a day. Write down your goals on the calendar, and check-off when you accomplish them Give yourself some praise for making this important step! Change is often difficult, and almost always scary. But, as we have emphasized throughout this book, making the commitment to change is often an integral part of moving towards higher levels of wellness. Preventing or learning to manage occupational stress is part of this commitment. Congratulations on having the courage to make things better!