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Avoiding stress in the workplace: taking care of you

Sue Spencer
RGN NDN PWT BA MSc PGCE MA
Senior Lecturer in Nursing
University of Northumbria

No one would argue that nursing is an easy job and that confronting patients and carers, let alone colleagues every day, can take its toll on our sense of wellbeing. Nor is it news to any nurse that we live in a society that can seriously damage our equilibrium.

Day-to-day pressures may affect our wellbeing, as well as financial and family concerns. As a nurse, you are almost certainly working in a stressful and demanding environment, and this stress can be harmful. I include in this being unoccupied; you might find yourself in a job that is too comfortable, boring, or too easy and, as a result, you find yourself underwhelmed by what you are asked to do. When you are asked to do a little bit extra you find yourself overreacting to that request.

Many of us need to be purposefully occupied and engaged in our work and, often, when we are in an undemanding role, we can begin to feel tension and anxiety. Some of us have been in our jobs for much longer than we anticipated and this, too, can cause tension as we justify to ourselves why we haven't moved on and developed our career. 

As a nurse you do need to look after yourself and ensure that you are not being damaged by stress. In severe cases it can result in burn-out and can put patients' health at risk, as well as the nurse themselves.1 No single intervention for your stress management is likely to be effective and it is always worth exploring a multi-method approach as both the stress itself and our response to it is multi-dimensional.

As nurses we become used to the mental, emotional and physical demands of the role and taking time to look after yourself can seem selfish and really difficult to justify. A recent Royal College of Nursing (RCN) publication strongly recommends that nurses try to reduce stresses, manage their responses to stress and find ways of managing occupational stress.1 Remember, we are all unique - one person's stressor is another's stimuli and their route to success. Comparing our capacity to cope with others can be very unhelpful indeed and potentially more damaging as we try to compete without fully understanding ourselves or the people we are working alongside.

Early warning system
It might be a quite a while before we actually begin to feel the effects of stress on our wellbeing, but being able to detect early on that things might need be attended to is worth considering in protecting ourselves from what can be a hugely damaging
experience.

An individual's response to stress will be very varied but it is worth considering things to look for. Table 1 identifies the many ways in which we might respond to stress.
Hopefully, you are not experiencing all of the above at the same time but it is worth giving yourself a check-up every now and then, particularly in relation to emotional responses to events around us. It might be an external event or a seemingly trivial event that becomes the tipping point to crying, shouting, or generally overreacting to a situation. If you find yourself in this position it is time to check out where you are at and what is causing you stress.

[[Table 1 Care]]

Managing stress
Lifestyle
Maintaining a balance between work and play is worth reiterating - do you work to live or live to work? Do you sacrifice weekends and holidays for your job? We all need leisure time to switch off and to recharge our batteries, so plan trips away and relaxing activities. Join up with some friends and/or colleagues to have a weekend away or plan a trip with your family.

Exercise regularly, go for a brisk walk at lunchtime or after work, go swimming, or join an exercise class.
Eat well, regularly and resist the temptation to skip meals.
Keep alcohol and nicotine intake at a moderate level.
Keep in contact with your friends and maintain/build your social support networks. Explore new hobbies or rekindle past interests.

Be creative! Enrol in an art class, textile class, or a pottery class. Creative/expressive activities that absorb you are really a great way of channelling stress.2

Keep a diary/journal of how you respond to life around you as this can help you identify the main sources of stress, how you respond to stress and whether your response is a sign of it all "getting a bit too much!"

Learn to say "no", "not now" and delegate - are you really the only one who can do that particular task?
Learn to identify your own needs and be self-confident in stating what they are. This can be particularly challenging at work when you might be stating those needs to an employer BUT if you don't, what are the possible consequences?
Techniques to help you with this might be to write a letter to that person first to rehearse what you want to say, or write an imaginary dialogue between you and the other person.

Be aware of unhelpful thinking when stressed - ie, reading other people's motives, raising expectations of ourselves, mind-reading and repeating "must do", "should do", etc.
Again, writing these down and responding to them as a critical but supportive friend can help get a sense of perspective on those automatic thoughts and feelings.3

Turn this unhelpful thinking into constructive self-talk and stop putting yourself down. Be your own best friend and give yourself a pat on the back for all the things you have achieved, rather than giving yourself a hard time over what you might not have done. If you have survived more stressful times than this one, what gave you the capacity to cope then? What is different this time? Build your own resources to improve your resilience so that you continue to learn and manage the situation.

Relaxation
There is no doubt that relaxation is a key way to manage stress.4 However, it is important to remember that what might be relaxing for one person might not be for another so, again, an individual response is what is needed. For some people it might be a aromatherapy massage with soothing music, for others it might a pony trek in the open countryside, a writing class, reading group, meditation, a facial, manicure, yoga or hypnotherapy - the list goes on.

What it should be is 'time out' from your usual routine time for yourself and all the stimuli that usually surround you.
Find someone to talk to about how you are feeling and responding to the issues. Many nurses may find this really difficult as we are often the one our friends come to talk about their issues. Allowing ourselves to cry is also a good outlet. Bottling it all up is not helpful and a good cry can be the key to releasing pent up sorrow and frustration that might be fuelling unhelpful thinking and loss of perspective.

Conclusion
It is important to be aware of how you might protect yourself from chronic stress and its damaging effects. A solution could be finding time to discover or reinvent the artist, musician or performer within you. Remember to be kind to yourself - and that way you won't push yourself so hard.

References

  1. Royal College of Nursing (RCN). Managing your stress: A guide for nurses. London: RCN; 2005.
  2. Malchiodi C. The Soul's Palette: Drawing on Art's transformative powers for health and wellbeing. London, Shambhala Publications; 2002.
  3. Bolton G, Field V, Thompson K. Writing Routes A Resource Handbook of Therapeutic Writing. London: Jessica Kingsley Publications; 2011.
  4. Mimura C, Griffiths P. The effectiveness of current approaches to workplace stress management in the nursing profession: an evidence based literature review. Occupational and Environmental Medicine 2003;60:10-15.