Transcript
Page 1: A comparative study of the perceptions of British mental health nurses and psychiatrists of their work environment

A comparative study of the perceptionsof British mental health nursesand psychiatrists of their work environment

Janie Dallender MSc

Research Associate, School of Health Sciences, University of Birmingham,

Birmingham

Peter Nolan PhD RGN RMN

Senior Lecturer, School of Health Sciences, University of Birmingham,

Birmingham, England

Joaquim Soares PhD

Senior Researcher, Centre for the Development of Health Services,

Stockholm

Sarah Thomsen MPH

Research Associate, National Institute for Psychosocial Factors and Health,

Stockholm

and Bengt Arnetz MD PhD

Professor of Psychosocial Medicine, National Institute for Psychosocial Factors

and Health, Stockholm, Sweden

Accepted for publication 21 January 1998

DALLENDER J., NOLAN P., SOARES J., THOMSEN S. & ARNETZ B. (1999) Journal of

Advanced Nursing 29(1), 36±43

A comparative study of the perceptions of British mental health nurses

and psychiatrists of their work environment

This comparative study of the perceptions of mental health nurses and

psychiatrists about aspects of their work environment was undertaken in the

West Midlands in England. The aim of the study was to ascertain the extent to

which the environment in which mental health professionals' work impacts on

their own mental and physical well-being. Seventy-four psychiatrists and 301

mental health nurses responded to a postal questionnaire. Analysis of data

indicated that signi®cant differences exist between nurses and psychiatrists in

their working conditions, their physical working environment, their sources of

support with a work-related problem, and the effects of their work on their own

mental and physical health. The main recommendation derived from this study

was to improve communication between mental health professionals and their

managers by giving more structured feedback and guidance about one's work

performance. This may help to alleviate the mental strain many mental health

professionals experience in their work.

Correspondence: Janie Dallender, School of Health Sciences,

The Medical School, Edgbaston, Birmingham B15 2TT, England.

Journal of Advanced Nursing, 1999, 29(1), 36±43 Experience before and throughout the nursing career

36 Ó 1999 Blackwell Science Ltd

Page 2: A comparative study of the perceptions of British mental health nurses and psychiatrists of their work environment

Keywords: mental health professionals, work environment, mental well being,

job satisfaction, work-related stress

INTRODUCTION

At a time when radical changes are taking place in health

services, it appears that work-related stress is on the

increase (Sutherland & Cooper 1990). Evidence is accruing

that the effects of these changes can result in reduced job

satisfaction, absenteeism, somatic complaints and mental

health problems (Cartwright 1979, Price & Mueller 1981).

Not only are these changes affecting professionals person-

ally, but they are also affecting how they undertake their

professional duties. It has been shown that prolonged

exposure to stressors in the health care environment not

only impairs care delivery, but may also be instrumental

in the development of negative and cynical attitudes

towards patients and colleagues (Maslach & Jackson 1982).

LITERATURE REVIEW

An extensive literature is being generated about the

environment in which health professionals work and the

impact it has on them both personally and professionally.

Traditionally, the selection, training and education of

professionals have tended to focus primarily on the

imparting of specialist knowledge and the acquisition of

appropriate skills, but relatively little attention has been

paid to the environment in which these skills are

practised. In the ®eld of mental health care particularly,

studies into the `social climate' or `therapeutic

environment' have been undertaken largely to assess the

impact of the environment on patients and clients, but

relatively few have examined its effects on professionals

themselves (Rothman 1971, Aubry et al. 1996).

Those studies which have examined the effects of

environment on professional practice have tended to

centre on doctors and nurses in physical health care,

which is understandable since they form the largest and

most visible groups in health care (Cushway et al. 1996).

In comparison, relatively little work has been done with

mental health professionals whose work has been tradi-

tionally seen as less glamorous and less visible (Jones

1989). One reason for the paucity of research in this area

may be due to the prevailing assumption that health care

professionals can cope, and have high expectations of

their abilities to help others (Sutherland & Cooper 1993).

Changes in working practices have had a greater impact

upon mental health professionals than upon their col-

leagues in general health care due to the different and

more severe nature of the stressors (Blachly et al. 1968).

Further evidence of this is provided by Russell et al.

(1975) who found that psychiatrists had the highest

suicide rate among doctors and that trainee psychiatrists

had high levels of mental health problems as well as high

drop-out rates from training. Merklin & Little (1967) found

that junior psychiatrists experienced high levels of neu-

rotic symptoms and psychosomatic disturbances during

their training and concluded that this was an inevitable

part of their education.

Health care professionals differ signi®cantly from other

workers in that they have frequent close contact with

severe illness and death and are expected to alleviate the

distressing situation in which some patients and their

carers ®nd themselves (Maslach & Jackson 1982). They are

exposed to intense physical and emotional suffering and

are frequently the focus of primitive transference reactions,

both affectionate and hostile (Mowardi 1983). Despite

well-de®ned selection criteria for admission into the

health care professions, great variation has been found in

how individuals respond to stress and suffering (Keinan &

Melamed 1987). Heim (1991) observed the anomaly that

factors identi®ed as stressful by some respondents were

seen by others as those contributing most to job satisfac-

tion. Professionals who have doubts about being able to

cope are more likely to experience an impulse to disengage

from potentially dif®cult situations even though social or

other constraints prevent them from doing so (Carver &

Scheier 1988).

Arnetz (1991), in a study of physicians, found that this

extended to avoiding social activities, meeting friends or

even interacting socially with their own families. In the

same study, 25% of respondents stated that they felt unable

to unwind after work, while 8% acknowledged that they

relied on the consumption of excessive amounts of alcohol

in order to relax. He concluded that the work environment

and the way in which work was organized were closely

linked to stress over which respondents felt they had little

control. Nonetheless, Heim (1991) found that 97% of

doctors stated that their job satisfaction was high.

Similarly, studies of nurses' work have also identi®ed a

number of stressors such as role con¯ict, work load,

relations with senior colleagues, anxiety about death and

dying and con¯icts between home and work which affect

the personal and professional functioning of nurses (Hin-

gley & Harris 1986). Guppy & Gutteridge (1991) estimated

that 85% of stress in nurses was due to heavy workload,

55% was associated with poor relationships with senior

staff, and 43% was related to poor relationships with

colleagues. Patterns of connection and relationship were

also identi®ed in a study by Westmoreland (1993) as

constituent features of what made work meaningful to

hospital nurse managers.

Experience before and throughout the nursing career Perceptions of mental health nurses

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(1), 36±43 37

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The conclusion arrived at by Duquette et al. (1994), after

reviewing 300 studies, is that nursing is a particularly

stressful occupation. They found the best correlates of

burnout and stress in nursing to be role ambiguity,

workload, age and social support. However, Cash (1988)

has pointed to the dif®culty of trying to draw inferences

from this kind of meta-analysis due to studies having

different aims, deploying different instruments, and

conceptualizing stress and burnout in different ways.

Furthermore, studies have been conducted on different

nursing groups working in a variety of environmental

contexts.

In a large scale study of nurses and the work environ-

ment, Petterson et al. (1995) found that more than 90% of

nurses were satis®ed with their jobs, although female

nurses were more satis®ed than males. Despite the high

levels of reported satisfaction, however, 45% of nurses

had seriously considered leaving the profession at some

time in their career.

The reasons given were low salary, unchallenging and

repetitious work, lack of skills and poor career prospects.

The study also showed that 90% of nurses considered the

psychosocial environment in which they worked to be

important and more than 80% reported high levels of

mental strain in their jobs. Whilst most felt free to make

suggestions that would improve their working environ-

ment, a signi®cant number felt that these suggestions

would not be acted upon. When asked to identify how

their work environment could be altered so that the

quality of care could be improved, respondents listed the

acquisition of psychosocial skills, and skills for handling

crises, and improved management and clinical supervi-

sion. One of the most signi®cant ®ndings of this study was

that nurses who developed stress-related problems were

those who received least support and frequently ended up

working by themselves.

Despite the limited nature of the research into stress in

mental health nursing, evidence suggests that many of the

stressors which affect general nurses are also shared by

mental health nurses (Dawkins et al. 1985). There are,

however, signi®cant factors that relate speci®cally to

mental health nurses (Dunn & Ritter 1995). Cronin-Stubbs

& Brophy (1984) observed that the nature of mental health

care may predispose some professionals to burnout

because of the necessity of intense interpersonal

involvement with clients and their carers. This study

further suggests that staff who experience severe burnout

tend to avoid close contact with their families, thus

minimizing the potential positive effects of a supportive

home environment. Various studies have con®rmed that

violence is another major source of stress in mental

health nurses regardless of the context in which they

work (Dunn & Ritter 1995, Carson et al. 1995).

Mental health nurses may also be disadvantaged in that

their work tends to be less visible than that of their general

nursing colleagues, and consequently they experience less

con®rmation of their worth (Jones 1989).

From the research undertaken thus far, it appears that

the work environment of health care professionals can

have adverse effects on their physical and mental well-

being. The consequences of this both in terms of cost to

the individual and to the health service can be consider-

able. The Royal College of Nursing has informed the NHS

Ef®ciency Task Force that Trusts could save millions each

year if they boosted staff morale, prevented back injuries,

and addressed absenteeism and high staff turnover (Royal

College of Nursing 1997). More effort is required in order

to produce valid and reliable measures of occupational

stress, its causes and how it might be alleviated.

Whilst there have been studies that have examined the

impact of the work environment either on psychiatrists or

mental health nurses, few comparative studies, to date,

have involved both groups. The aim of this study there-

fore, was to compare psychiatrists' and mental health

nurses' perceptions of their immediate work environment

and the effects it has upon them. Our main hypothesis was

there will be no signi®cant difference between psychia-

trists' and nurses' perceptions of their work environment.

METHOD

Setting and subjects

Between November 1996 and March 1997, psychiatrists

(quali®ed and trainee) and ®rst level mental health nurses

working in a cross-section of National Health Service

Trusts in the West Midlands, England, were surveyed

using a postal questionnaire. The sample was drawn from

staf®ng lists of quali®ed mental health workers held by the

personnel (human resources) managers of ®ve NHS Trusts.

A cross-section of employees working in the ®eld of

mental health responded to the questionnaire (Table 1).

The overall response rate was 47%, accounting for 375

employees. The response rate for psychiatrists was 60%

(n � 74) and for nurses, 45% (n � 301).

Table 1 Number and percentage in sample by professional

category

Professional category

Number of

employees

replying

Percentage

of sample

Consultant psychiatrist 46 12%

Senior psychiatric registrar 4 1%

Trainee psychiatrist 24 6%

Community psychiatric nurse 95 26%

Hospital-based nurse 201 54%

Unknown category 5 1%

Total 375 100%

J. Dallender et al.

38 Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(1), 36±43

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Measurements

The questionnaire contained 32 items which sought to

elicit data about the following areas: physical work

environment; psychosocial work environment; social cli-

mate; social support; coping; personal characteristics of

the respondent. No identi®cation code was used as a

means of tracing respondents or non-respondents. The

instrument was comprised of items that had already been

validated elsewhere (Arnetz 1997).

Sub-scales within the instrument were used either in

their original form or revised to enable them to measure

aspects of the work environment relevant to mental health

workers.

Procedure

Questionnaires and covering letters were sent to psychi-

atrists, trainee psychiatrists and mental health nurses in

their workplace via their personnel managers. The infor-

mation to the respondents regarding the survey was

outlined in the covering letter. The letter stated that we

were interested in obtaining the views of nurses and

psychiatrists regarding their work environment and that

the results of the study would be utilized to identify

working environments that are conducive to the provision

of good quality mental health care. The letter also stated

that the results would be completely con®dential and

anonymous and that their trust would receive a report

summarizing the main ®ndings of the study.

Stamped addressed envelopes were enclosed for return

of questionnaires which were to be sent directly back to the

researcher. Four weeks after the initial mailing, a reminder

was sent to all subjects via their personnel managers.

Throughout the study con®dentiality and anonymity were

guaranteed, and permission to distribute the question-

naires was sought from senior managers. Respondents

were assured that once data had been analysed, the

questionnaires would be destroyed. The researcher had

no direct contact with the respondents and was unknown

to the respondents prior to and during the study.

Statistical analyses

SPSS for Windows (version 6á1) software package was

used to input and analyse the data. Chi-square tests were

employed to analyse the differences in responses between

the professional categories. All tests were two-tailed and

statistical signi®cance was assumed at P � <0á05.

RESULTS

Characteristics of the sample

Table 2 shows there were no signi®cant differences

between the two groups with regard to: age; marital

status; the presence of children under the age of 16 years

living at home; being the primary carer of the child/

children; and length of service over 6 years. There were

signi®cant differences, however, for gender, and length of

service of less than 6 years (P < 0á01). Table 2 shows race

to be statistically signi®cant; however, the number of

cells with expected frequencies of <5 in this group was

over 20%.

Working conditions

Psychiatrists worked on average 51 hours per week, whilst

mental health nurses worked 38 hours. Psychiatrists

Table 2 Base-line characteristics of sample

Characteristics of sample

Psychiatrists (%)

(n = 74)

Nurses (%)

(n = 301)

Age

<30 years 19 13

30±39 years 37 47

40±49 years 30 28

50±59 years 11 11

>59 years 3 1

Marital status (married) 84 81

Race

Caucasian 71 85

Asian 22 3

Other 7 12

Female 29 64

Child under 16 years 48 59

Primary carer of child 6 13

Length of service

<1 year 11 1

1±5 years 21 8

6±10 years 15 19

>10 years 53 72

Table 3 Coping strategies for dealing with `too much work' by

professional group; percentage agreeing with statement.

**P < 0á01

Coping responses

Psychiatrists

(%)

Nurses

(%)

Feel a failure 48 26

Become upset 33 39

Accept it as unavoidable 71 62

Think of something else 34 44

Make a plan of action 89 83

Seek a solution 76 88

Keep problem to oneself 55 19**

Seek help and support 60 82**

Take it one step at a time 79 86

Experience before and throughout the nursing career Perceptions of mental health nurses

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(1), 36±43 39

Page 5: A comparative study of the perceptions of British mental health nurses and psychiatrists of their work environment

tended to work signi®cantly more overtime than nurses,

43% and 27%, respectively (v2(3) � 8á2, P < 0á05). Fur-

thermore, psychiatrists were more likely to state that they

`never' or `rarely' have time to complete their work (45%)

compared to nurses (29%, v2(4) � 19á3, P < 0á01), al-

though there was no signi®cant difference between the

two groups in terms of having `too much work' to do.

Table 3 shows the coping responses of psychiatrists and

nurses when they had `too much work'.

The table illustrates how both psychiatrists and nurses

favoured `active' coping strategies when faced with `too

much work to do'. However, psychiatrists were more

likely to adopt the `passive' coping strategy of `keeping the

problem to themselves', whilst the nurses were more

likely to actively `seek help and support' (P < 0á01).

Differences were found in the level of supervisory

duties between nurses and psychiatrists. A signi®cantly

higher proportion of psychiatrists supervised staff on a

weekly basis whereas a greater proportion of nurses who

had supervisory duties tended to supervise on a monthly

basis (v2(4) � 19á3, P < 0á01, see Table 4). When asked:

`How hard must you work in order to accomplish your

daily tasks?', a higher proportion of nurses (61%) than

psychiatrists (47%) stated they worked `hard' to accom-

plish their daily tasks (v2(2) � 8á4, P < 0á05). Sixteen per

cent of psychiatrists and nurses reported that they `did not

work very hard'. A higher percentage of psychiatrists

(59%) felt dissatis®ed with their salaries compared to

nurses (38%, v2(3) � 17á5, P < 0á05).

Physical working environment

Perceptions of the degree of exposure to adverse factors in

the physical environment of work were explored and

signi®cant differences were found between the two

groups.

Eighteen per cent of nurses compared to 3% of psychi-

atrists regularly had to lift heavy objects (v2(3) � 21á9,

P < 0á01). Nurses were often exposed to `too much noise'

(16%) which was not a problem for any of the psychia-

trists (v2(3) � 20á1, P < 0á01). However, psychiatrists were

more likely to work in poorly ventilated surroundings

than nurses (65% v 53%, v2(3) � 9á9, P < 0á05) and were

more likely to engage in sedentary work (86% v 72%)

(v2(3) � 35á9, P < 0á01). No signi®cant difference was

found between psychiatrists and nurses in terms of

exposure to insuf®cient light.

Social climate

No signi®cant differences were found between psychia-

trists' and nurses' perceptions of the social climate at

work. Over 70% of psychiatrists and nurses reported that:

there was a pleasant atmosphere at work; that their

colleagues were supportive; that they got on well with

senior colleagues; and that people worked well as a team.

Support climate

There were no signi®cant differences in the amount of

support received by nurses and psychiatrists from their

managers and colleagues. Most psychiatrists (83%) and

nurses (66%) felt that they had the support of their

managers `sometimes', `often' or `always'. Similarly, 62%

of psychiatrists and 70% of nurses felt they `often' or

`always' had the support of work colleagues.

When confronted with a work-related problem, how-

ever, most psychiatrists said they would turn to either

their colleagues or their partners for support. This was

similar for nurses, although a signi®cantly higher propor-

tion would turn to their line managers or a therapist

(P � 0á01, Table 5). Overall, just over half of all nurses

and psychiatrists were satis®ed with the amount of

support they received with work-related problems.

Psychosocial work environment

A third of nurses and 23% of psychiatrists rated their

work as `always' psychologically taxing whilst 46% and

53%, respectively, said it was `often' taxing. Nevertheless,

most mental health workers were satis®ed with their

work. Fifty-eight per cent of psychiatrists were satis®ed `to

some degree' and 20% `to a great degree'. Less than 1% of

psychiatrists reported that they were `not at all satis®ed'.

Similarly, two out of three nurses were satis®ed with their

Table 5 Sources of sought support for a work-related problem.

*P < 0á05

Sources of

sought support

Psychiatrists

n (%)

Mental health nurses

n (%)

Colleagues 64 (90) 280 (85)

Partner 50 (70) 216 (74)

Manager 46 (64) 217 (75)*

Friends 46 (64) 168 (59)

Family 30 (13) 142 (51)

Therapist 6 (9) 36 (13)*

Table 4 Extent of supervisory duties. P < 0á001

Frequency of

supervisory duties Nurses Psychiatrists

None 57 (19á3) 12 (16á2)

Daily 122 (41á4) 35 (47á3)

Weekly 49 (16á6) 26 (35á1)

Monthly 67 (22á7) 1 (1á4)

J. Dallender et al.

40 Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(1), 36±43

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work `to some degree', 13% `to a great degree' and less

than 1% were `not at all satis®ed'. There were no signi-

®cant differences in these responses between the groups.

Two-thirds of psychiatrists and nurses perceived that

they had less in¯uence over their work than they wished

and a large percentage felt that they rarely received clear

work directives from their line managers. A third of nurses

and 47% of psychiatrists `never' or `rarely' received clear

information as to what was expected of them. Over half of

nurses and two-thirds of psychiatrists `never' or `rarely'

received positive feedback when they had `done a good

job'. Thirty-one per cent of nurses `often' or `always'

received feedback when they had done a poor job com-

pared to only 1% of psychiatrists (v2(4) � 20á3, P < 0á01).

Mental well-being

Although there were no signi®cant differences between

psychiatrists and nurses in the frequency with which they

reported irritation, emotional exhaustion, physical

exhaustion and tiredness at the thought of doing their

job, Table 6 serves to illustrate the degree of negative

mental well-being for both groups. This table also shows

that the only signi®cant differences between nurses and

psychiatrists was the frequency with which they felt

`restless', with a higher proportion of psychiatrists feeling

`restless' daily than nurses (v2(4) � 10á3, P < 0á05), and

more nurses `not caring about the results of their work (v2

(4) � 11á9, P < 0á05).

DISCUSSION

The response rate (47%) to this survey was fairly low. One

reason may be due to the growing number of surveys being

targeted at service providers in a bid to improve ef®ciency

as stipulated in recent health and social welfare reforms.

Health professionals are perhaps becoming increasingly

disinclined to ®ll in yet another questionnaire, especially

if they feel that imparting information about one's

workplace could be used to justify staff reductions. Whilst

the overall response rate was low, the response rate from

psychiatrists (60%) was good. This may be because

psychiatrists feel less threatened or that they perceive

their work environment to be an important issue. Those

who did respond tended to have been in their profession

for over 10 years which may indicate a sense of security in

their post or, if near retirement, a perception that they

have little to lose by frank disclosures in questionnaires.

The majority of questions in the survey were completed by

respondents, suggesting that the questions were compre-

hensible and relevant.

One of the most interesting results relates to the number

of hours worked by psychiatrists compared to nurses.

Despite working, on average, 20 hours a week more than

nurses, psychiatrists were more likely to state that they

`never' or `rarely' had time to complete their duties. This

may be linked to having more frequent supervisory duties

than nurses or to the fact that psychiatrists appear less

likely to seek help when they have too much work to do.

This perceived lack of time by psychiatrists to complete

their duties raises issues about the training they receive in

skills such as time management and delegation, as well as

about the number of patients they are expected to see.

However, no overall signi®cant differences were found

between hours worked, length of service and other aspects

of the work environment.

Most mental health workers were engaged in a high

level of sedentary work which tended to be carried out in

poorly ventilated conditions. This was especially so for

psychiatrists who apparently spend a lot of time in their

of®ces either seeing patients or writing reports. This

implies that the amount of time they spend outside

their of®ces either meeting other health professionals or

in their local community is fairly limited. However,

within their workplace most of the respondents reported

that they enjoyed favourable relations with their col-

leagues and managers. This contrasts starkly with the

Table 6 Mental well being

Well-being

Per week (%) Per month (%) Per year (%) Never (%)

indicators Medics Nurses Medics Nurses Medics Nurses Medics Nurses

Irritation 54 41 32 46 13 12 1 1

Restlessness 28 32 39 27 19 32 14 9

Emotional

exhaustion

39 49 43 32 18 16 0 3

Physical

exhaustion

44 42 33 39 16 15 7 4

Tiredness 22 27 32 31 34 29 12 13

Not caring

about work

2 7 8 8 37 19 53 66

Works calmly 84 89 11 8 4 2 1 1

Experience before and throughout the nursing career Perceptions of mental health nurses

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(1), 36±43 41

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work of Guppy & Gutteridge (1991) who found that 50% of

the stress in their general hospital subjects was account-

able to poor work relationships.

Although most mental health workers in this survey

found their job psychologically taxing, the results reported

for nurses were much lower than those found by Petterson

et al. (1995). Similarly, respondents reported a high

degree of satisfaction with their work although again not

quite as high as that reported in previous studies (Heim

1991, Petterson et al. 1995). Unfortunately, no information

was readily available about the actual client morbidity

levels in the different districts which may have helped to

cast light on the self-reported levels of mental well-being

and job satisfaction.

Communication between psychiatrists, nurses and their

managers appeared limited, especially with regard to

positive feedback. Most respondents stated that, in addi-

tion to not receiving constructive feedback from their

seniors, they also received little guidance in the carrying

out of their duties. Psychiatrists, in particular, received

less feedback than nurses from their managers about their

work. This lack of communication combined with

assumptions that health care professionals can cope has

serious implications for staff morale and could account

for the high levels of mental health problems among

psychiatrists found in earlier studies (Russell et al. 1975,

Merklin & Little 1967). The extent of mental and physical

strain experienced daily by both groups was found in our

survey to be considerable. This supports previous research

indicating high levels of mental stress found in mental

health professionals (Blachly et al. 1968).

Although both groups of respondents regarded commu-

nication in their work environment to be poor, neverthe-

less, the majority of respondents felt they had the support

of their managers and colleagues. This is important when

considering the ®ndings of Petterson et al. (1995) who

stated that nurses who developed stress-related problems

were those who received least support. As well as

respondents perceiving they had the support of their

managers and colleagues, they also reported there was a

pleasant atmosphere at work, that they got on well with

their seniors, and worked well as a team.

Yet, even in such favourable conditions the level of

mental and physical strain was still fairly high. This

suggests that whilst support and good relations with

colleagues are important as previous studies have

indicated, these of themselves are not suf®cient. It is

the quality of communication between staff and their

managers that is the crucial issue in alleviating stress. This

entails providing staff with regular constructive feedback

and guidance about how they are performing in their work

The challenge to managers is that, in addition to providing

cost-effective services, there is an overwhelming need to

create working environments structured in a way which

allows con®rmation of the value of staff and the

contribution they make to health care to be regularly

communicated. Further research is required on how con-

structive feedback and guidance can be best communicated

to staff by their managers in the current climate.

Therefore the null hypothesis may be rejected as

signi®cant differences were found between psychiatrists'

and mental health nurses' perceptions of their work

environment with regard to their working conditions,

physical working environment, and mental well-being.

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