Anaesthetists work in high stress, high risk environments where errors may result in patient injury or death. Long-term occupational or work-related stress is associated with poor physical health outcomes including cardiovascular disease, chronic inflammation, obesity, elevated blood pressure, diabetes, arthritis, and skin diseases, as well as psychological harm including burnout, depression, anxiety, PTSD and sleep disorders. For the practitioner, the consequence is poor general health with the potential for compromised quality of care for patients. For the healthcare organisation, this may negatively impact patient safety and satisfaction, and result in an increase in staff absenteeism, turnover and attrition, and litigation; which altogether impedes efficient management of patient wait lists and financial resources.
Occupational stress can be described as a pattern of responses that arise when staff experience work demands that they perceive to be exceeding their knowledge, skills, or capabilities. Unmanaged occupational stress makes it difficult for workers to cope with job demands effectively, which can lead to burnout and psychological distress. There are a number of occupational stress models that can be used to investigate occupational stress. The high-demand, low control model investigates the level of demands in a person's job and how much control (discretion, authority, or decision-making power) they have over their responsibilities. Limited control leads to increased stress. A second approach, the Effort-Reward Imbalance (ERI) model, examines the relationship between efforts and rewards at work – working hard without receiving proper recognition or being treated unfairly creates a stressful imbalance.
When faced with a stressful situation, the human body releases cortisol and the autonomic nervous system (ANS) is triggered, evoking the “fight-or fight” response as a survival mechanism. When the body is exposed to ongoing stress, excess cortisol can disrupt physiological responses including blood pressure, blood supply to muscles, and cell metabolism. Heart rate variability (HRV) can be used to assess ANS status and provides an indication of how well an individual’s body handles stress or adapts to stressful situations. HRV is the variation in time between heartbeats. Low HRV indicates not much variability between heartbeats and can be a sign of stress, fatigue and poor health. High HRV indicates that timing between beats is more flexible and responsive and therefore more resilient to stressful situations. Measurement of HRV may be useful in determining levels of occupational stress.
The aim of the proposed multi-site study is to investigate the stress in anaesthetists and examine contributing factors such as job demand, job control, individual and organisational support, workplace conflict, and reward and recognition. We will use a mixed methods design comprising quantitative (survey and physiological measures) and qualitative (interview/workshop) components. For the survey component, we will assess stress subjectively using a questionnaire based on the Demand-Control and ERI models. Participants will complete the main survey at two time points: T1–baseline and T2–six months later. For the physiological component we will measure anaesthetists’ HRV levels, sleep and activity levels using wearable technology. Participants will wear the devices for one week between T1 and T2. The devices will provide a continuous measure of HRV and other physiological measures for the set period. Many studies that measure HRV are conducted under laboratory conditions with healthy subjects using ECG technology. This study investigates occupational stress and HRV measured in a working setting and outside of work using wearable technology. Using co-design methodology, we will conduct online workshops/interviews with anaesthetists after T2 to gather insights and recommendations for managing stress in the workplace. We will explore workplace elements such as work design, job control, workload, relationships with coworkers and group identity, cooperation and teamwork, fairness in work process, effort and reward at work, and other workplace conditions that may relate to stress. We will ask participants to generate potential solutions and recommendations to manage workplace stress.
Triangulating data between surveys, physiological monitoring, and workshops/interviews involves integrating these diverse sources to enhance the validity and reliability of research findings. Surveys provide quantitative data that can reveal patterns and trends, while physiological monitoring offers objective, real-time measurements of physical functions. Interview data provides qualitative insights into participants' experiences and perspectives. By combining these methods, we can cross-verify information, identify discrepancies, and gain a more comprehensive understanding of stress in anaesthetists. Findings may provide insights into the factors that contribute to stress of anaesthetists within the workplace; and can inform work design and interventions to reduce anaesthetists’ occupational stress and resulting burnout and psychological distress.
Dr Neil Paterson, Associate Professor Paul Lee-Archer, Queensland Children’s Hospital, Dr Laura Ferris, The University of Queensland, Professor Stewart Trost, School of Human Movement and Nutrition Sciences, The University of Queensland.
The project was awarded A$69,584 funding through the ANZCA research grants program for 2026.