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In these times of trouble, what comforts you?


Nurses know all about stress already and problems with recruitment and retention are increasing the pressure – so, George Coxon asks, how can burnout be avoided?

We’ve recently had stress awareness month. Well, how about that? I can hear people say, ‘We are well aware of stress, thank you very much, since we are living with it every day.’

So at the risk of being antagonistic, and perhaps stating the [expletive] obvious, here are some thoughts to stir the pot and shake the stress awareness tree.

So much is written on stress and much of it is obvious in theory; we all know the logic of good habits and the value of self care.

But burnout – what is the physiology of this, and how can we truly stay confident, proud, smiling, in control and strong amid the almighty volume of work and life-related stress?

I’ve been exchanging some really positive and useful views and top tips on burnout prevention with some extremely inspiring ‘lived experience’ social care nurses across the UK – most particularly north of the border (more on our cross-border, like-minded alliance and learning network another time).

A survival guide or toolkit to manage stress levels and reduce burnout risk is surely worth sharing.

Here are some personal thoughts on a stepped approach for a person-centred survival guide to prevent burnout:

Step one: Know your yellow and red flags. What are your triggers, past history and exposure to pressured situations? What are the high impact moments of stress, distress and upset you have experienced, from life stage changes to loss and bereavement? How have you coped with them – what helped and what worked?

Step two: The value of talk. Having someone to offload with – either a friend, family member or colleague – can be brilliant, as can an objective, skilled listener. The key is to choose a trusted person who can apply the Rogerian principles of being non-judgemental, able to resist giving lots of advice, and happy to make the time while demonstrating positivity and warmth.

Step three: Taking control. Fundamental to stress reaction and response is acknowledging the importance of gaining or regaining control. It might be that there are some situations where we can’t control what we are dealing with; if this is so, then finding places and things we can control is crucial. Organising the pens in your pen cup, for example – perhaps a little too facetious, but hopefully you get my meaning.

Step four: Internal dialogue and its influence on behaviour. From my past experience as a CBT (cognitive behavioural therapy) trainer when working as a mental health senior nurse, I’ve learnt the need to have some well-constructed and easily accessible answers to the following questions to resort to at times of peril or feeling overwhelmed:

  • Where does my security come from?
  • What, where and who are the things, places or people I love?
  • Why I’m a good person (have lots of examples of these).
  • What or who energises, inspires and excites me?

Considering the huge pressure placed on nurses, the unrest about pay and conditions and the major problems with recruitment and retention, it’s no wonder burnout and stress exposure is taking its toll on us all. For example, the news story here is about nurse shortages in care homes – my area of special interest – but it’s really reflective of nurse shortages across the spectrum of the profession.

So to avoid blowing a personal or professional fuse or gasket, engage in positive self-talk, adopt a no-blame philosophy about system imperfections, and avoid too much doom and gloom.

My four steps might – and I emphasis might – offer something to muse on. I’m genuinely hopeful that sharing these ideas will at the very least generate more or better top tips from others – I’d be thrilled if they did.

George Coxon is a mental health nurse and care home director