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Nurses and Stress: How do They Cope? Renee J. Lark and Francine J. Nesheim Ferris State University

NURSES AND STRESS Abstract Stress and stress management are great concerns in the nursing profession. There are many components of stress in the nursing profession, which can be effectively managed. The target audience is registered nurses and student nurses. Nurses and nursing students are interested in what stress is, why it is such a concern in the nursing profession, and how it can be managed effectively. Techniques for stress reduction include mindfulness, physical activity, spirituality,

wellness classes, and tips for nurse managers to promote a less stressful environment for nursing staff. These techniques can be implemented to assist nurses and nursing students with stress management, which is something that will be helpful throughout nursing practice.

NURSES AND STRESS Nurses and Stress: How do they cope? Long hours, a fast paced work environment, demanding and difficult doctors, high acuity patients, questioning families, and unappreciative managers are all part of a nurses work. Then they go home to screaming kids, homework, housework and life. It is inevitable and unavoidable, stress; it is a part of every human experience, especially in todays society

described as hurried and accelerated change (Pender, Murdaugh, & Parsons, 2011). Nursing as a profession is stressful and many times can lead to burnout, errors in judgment, lapses in safety precautions, and a decision to leave the profession (Johnston, Jones, Charles, McCann, & McKee, 2013). For these reasons, it is vitally important to study nurses and stress in order to gain an understanding of what stress is, the impact stress has on nurses, the potential impact and outcome of their care (Johnston et al., 2013), and effective strategies for managing stress. Stress: What is it? Stress is a daily part of everyones life. According to Kingdon and Halvorsen (2006), stress is defined as a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being, (p. 607). These types of relationships can have psychological, physiological and behavioral responses, and demonstrate a change in physical, mental, social and even spiritual health (Ganster & Rosen, 2013). Physically, recurrent exposure to stressful situations triggers tension and fatigue. Nurses tend to bottle up emotions such as anxiety, depression, fear and anger, which in turn result in unhealthy coping behaviors like overeating, consuming alcohol and smoking. There is an increase in absenteeism, hostility and aggression, which ultimately leads to a decrease in productivity and efficiency thus resulting in lapses of patient safety efforts (Kingdon & Halvorsen, 2006).

NURSES AND STRESS Nurses at a High Risk for Stress Nurses are often at a high risk for stress due to the nature of the profession. Many stressful situations, including death of a patient, are commonly encountered. Stress is often present from nursing school until the point of retirement. Stress in the Nursing Profession Nurses in an acute care setting at the hospital are often overwhelmed with patient

assignments due to staffing limitations. They may have a hard time being able to meet all of the needs of all of their patients, leading to feelings of failure as a nurse (Johnstone, 2013). Research indicates that future nurses are aware of this stress in nursing school and that nurses anticipate this stress long before they actually enter the workforce. Because it is expected, many nurses treat the stresses of the job as normal and internalize their feelings as opposed to seeking ways to effectively deal with the stress, essentially leading to more problems later on (Hensel & Stoelting-Gettelfinger, 2011). Additionally, nurses report physical activity and stress management as the two wellness activities that nurses are least likely to participate in, making them more susceptible to stress (Hensel & Stoelting-Gettelfinger, 2011). It is common for nurses to work long hours as well. Long shifts can decrease time spent with family and interfere with life/work balance (Spiers, 2012). When nurses are expected to work long shifts or come in extra they are even more susceptible to the damaging effects of stress. Students Facing Stress Due to the nature of the profession, it is suggested that more focus should be placed on teaching nursing students proper stress management. Nursing students face a very challenging time because they must handle all of the stressors of education demands as well as learning how


to deal with the life and death situations that patient care presents. Common sources of stress for nursing students include, examinations, deadlines, fear of making an error in patient care, demands of studying after work, and watching suffering, (Hensel & Stoelting-Gettelfinger, 2011, p. 291). Additionally, stress interferes with the ability to think clearly, which may inhibit the student from retaining all of the information that is required. Many nurses report that they feel unprepared to handle the stressors of the profession at graduation. If a nurse develops a strong self-concept and ability to manage the stress of his or her workplace, they are much more likely to experience satisfaction in their job. For this reason, development of a strong selfconcept and stress management techniques at the nursing student level may lead to less of a chance of burnout and job dissatisfaction later in life (Hensel & Stoelting-Gettelfinger, 2011). Effective Strategies for Stress Management In the midst of physical and psychological demands on nurses, it is essential that they implement strategies to manage their stress. Various methods have been proven to decrease stress. Practicing Mindfulness One way that nurses may be able to overcome stress is to practice mindfulness. This is a technique that can help nurses recognize when they are getting stressed and allow them to pause and focus on the moment before getting overwhelmed. The first steps of practicing mindfulness are to recognize your current emotion, and allow it to happen for a moment. The overwhelmed nurse may have to take a minute to recognize that he or she is stressed and that it is okay to experience that for a moment. Next, the nurse should investigate what is the cause of stress and what exactly is causing the negative emotions at the moment. This leads to the last step which is non-identification. Non-identification means that while the nurse acknowledges the stress of the

NURSES AND STRESS current situation, it is not something that defines him or her. It is choosing to let go of the negativity of the stress of the situation and moving on while doing the best he or she can

do. Mindfulness has been proven to decrease stress and anxiety in many high-stress jobs, such as policeman and the military in addition to nurses (Johnstone, 2013). Physical Activity Physical activity at a moderate intensity has been shown to reduce short-term physiological reactions to brief psychosocial stressors (Asztalos, M., Wijndaele, K., DeBourdeaudhuij, I., Philippaerts, R., Matton, L., Duvigneaud, N., Thomis, M., Lefevre, J., & Cardon, G., 2012). These can be seen by a positive change in systolic and diastolic blood pressure, decreased muscle tension, and improvement in self reported psychological symptoms. Exercise can also assist people recover more quickly from stressors (Asztalos, et. al, 2012). The role of exercise for stress management has shown to be corrective and preventive. Physical activity has also shown to reduce reactivity to and quicker recovery from stressors (Asztalos, et al., 2012). Physical activity also acts in several other benefits. It helps to increase production of endorphins, the brains feel-good neurotransmitters, also known as a runners high (Mayo Clinic, 2013). It is also like meditation in motion in that by routinely focusing on the exercise performed, energy and optimism result; which keeps an individual calm and clear in everything they do (Mayo Clinic, 2013). Exercise also improves moods by increasing self-confidence and improves sleep often disrupted by stress (Mayo Clinic, 2013). Finally it is important to find any exercise activity that will be enjoyable and easy to make part of a regular routine in order to help unwind after a stressful work day (Mayo Clinic, 2013).

NURSES AND STRESS Spirituality Spirituality has been identified as an effective means of managing stress. According to

Tuck, Alleyne, & Thinganjana (2006), the use of an individuals religion as a coping strategy has been associated with positive outcomes to stressful life events. There is also a more encouraging affect and increase in spiritual growth with less depression, anxiety and distress (Tuck, et al., 2006). In addition, spirituality has been a safeguard against the adverse results of everyday life stressors (Tuck, et al., 2006). There needs to have some efforts to bring awareness of spirituality and support spiritual development among nurses, as it has prevailing implications for stress reduction and should be encouraged amongst nurses (Tuck, et al., 2006). Stress Management and Wellness Classes All nurses and especially nursing students in particular, may benefit from wellness and stress management classes. Studies have indicated that a two-week online stress management course can be effective at stress reduction for at least six months following the class. For this reason employers may want to consider offering a course like this to nurses, as stress reduction leads to increased job satisfaction and better retention rates. Additionally, nursing elective courses demonstrating wellness and self-care have been shown to decrease stress for up to seven years (Hensel & Stoelting-Gettelfinger, 2011). This indicates that it may be valuable for nursing schools to make wellness or stress-management classes a part of their curriculum. Tips for Employers There are several methods that nurse managers can implement to make the workplace less stressful for nursing staff. Creating a workplace that feels like a community and offering recognition for a job well done can go a long way in decreasing stress for nurses. Communication among co-workers is also essential in preventing workplace

NURSES AND STRESS stress. While there are some factors that are inherently stressful about nursing, providing a caring and cohesive work environment can go a long way to reduce stress among nursing staff

(Spiers, 2012). The culture of the workplace also has a large impact on stress. In places where it is acceptable and encouraged to voice stresses and concerns there is actually less stress overall and a happier work environment (Spiers, 2012). Conclusion Stress amongst nursing is part of everyday life, and it is not going away. Stress affects individuals both physically as well as psychologically, and can have a profound effect on a nurses personal and professional life. What is important is determining what the stress is and how to manage it. By implementing many of the described practices such as mindfulness, physical activity, spirituality, stress management and wellness classes, nurses are likely to be successful at managing their stress levels, and are more likely to be happier in their career.

NURSES AND STRESS References Asztalos, M., Wijndaele, K., DeBourdeaudhuij, I., Philippaerts, R., Matton, L., Duvigneaud, N., Thomis, M., Lefevre, J., & Cardon, G. (2012). Sports participation and stress among women and men. Psychology of Sport and Exercise. 13 (4) 466-483 http://dx.doi.org/10.1016/j.psychsport.2012.01.003 Ganster, D.C. & Rosen, C.C. (2013). Work stress and employee health: A multidisciplinary

review. Journal of Management. 39 (5) pp 1085-1122. DOI: 0.1177/0149206313475815. Hensel, D. & Stoelting-Gettelfinger, W. (2011). Changes in stress and nurse self-concept among baccalaureate nursing students. Journal of Nursing Education, 50(5), 290-293. doi: 10.3928/10.3928/01484834-20110131-09 Johnstone, D. (2013). How to work with stress and challenging emotions. New Mexico Nurse 58(1), 12. Retrieved from: http://www.healio.com/journals/jne Johnstone, D.,W., Jones, M.C., Charles, K., McCann, S.K., & McKee, L. (2013). Stress in Nurses: Stress-Related Affect and Its Determinants Examined Over the Nursing Day. Annals of Behavioral Medicine. 45:348-356. DOI 10.1007/s12160-012-9458-2. Kingdon, B. & Halvorsen, F. (2006). Perioperative Nurses Perceptions of stress in the workplace. AORN Journal. 84(4), 607-612, 614 http://dx.doi.org/10.1016/S0001-2092(06)63939-2 Mayo Clinic (2013). Exercise and stress: Get moving to manage stress. Stress management: In-depth. Retrieved from: http://www.mayoclinic.com/health/exercise-andstress/SR00036 Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Stress Management and Health Promotion. Health promotion in nursing practice. (6th ed.). Upper Saddle River, NJ:

NURSES AND STRESS Prentice-Hall. Spiers, C. (2012). A no-nonsense approach to stress management. Occupational Health, 64(6) 16-17. Retrieved from: http://joh.sanei.or.jp/e/index.html Tuck, I. Alleyne, R., & Thinganjana, W. (2006). Spirituality and stress management in healthy adults. Journal of Holistic Nursing. Vol.24(4), 245-53 doi: 10.1177/0898010106289842