STRESS AND JOB-SATISFACTION AMONG SOCIAL-WORKERS, COMMUNITY NURSES AND COMMUNITY PSYCHIATRIC-NURSES - IMPLICATIONS FOR THE CARE MANAGEMENT MODEL

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