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Introduction Stress affects everyone, yet few people understand what causes
it, how it develops, how it affects their bodies, and how they can be m
Many people view stress as toxic, especially in the workplace. The following was stated: ".. it [stress] is an environmental 'pollutant' that can result in emotional, mental and physical illness from depression to heart attack. For most people, the epicenter of the stress epidemic is the workplace." In a 1995 survey of state nurses associations, which was conducted by the American Nurses Association, it was reported that of all occupational hazards, the one of most concern to nurses was work-related stress. This being the case, as mentioned before, nursing is regarded as a very potentially stressful occupation. The Problem and Some Trends While great progress has been made over the years in the study and treatment of nurses' stress, there is still room for great improvements, both at the institutional/organizational and individual levels. It might also be said that nursing as a profession has increased in its complexity and this has placed nurses at greater risk to experience stress and ill-health. For example, today's hospitals are experiencing severe nursing shortages, hospital administrations are working under the umbrella or "yolk" of smaller budgets, lower reimbursements and institutional "cost containment measures." There are also physical environmental factors including: location, layout, lighting, noise, odor, hazards (e.g., biological, chemical, radiation), that are also potentially stressful. Patients and their families have become increasingly demanding in terms of the care received and, along with the threat of law suits brought against nurses and the hospital for allegedly negligent care, all contribute to the potential stresses nurses face. All these conditions are in addition to the long-standing other potential stressors nurses face, including low pay, insufficient recognition, shift work rotation, conflicts with physicians and other personnel, and location (e.g., ICU, ER, infectious disease, oncology) in the hospital where nurses work. Categorizing Stressors for Nurses Direct Patient Care: Unnecessary prolongation of life Critically ill and unstable patients Dealing with difficult patients Death and dying of special patients Emergency and/or "codes" that occur Inability meeting patient's or patient's family's needs Physical Work Environment: Inadequate work space Inadequate lightening Inadequate training on unity computers and other related technologies Ventilation problems Odor problems Lack of needed supplies Malfunctioning of important equipment Interpersonal Conflict: Communication problems with doctors and nurses Lack of availability of physicians Conflicts between and among staff Disagreements over treatment protocol Lack of respect from physicians Lack of teamwork Lack of needed cooperation Conflicts with personnel in administration Management and Administration Issues: Inadequate staffing Scheduling of shifts Lack of advancement opportunities Inadequate pay incentives, benefits "Floating" in other unfamiliar units Lack of needed time No continuity in patient assignments Breaking in new and/or agency nurses Inadequate Knowledge and Skills: Unfamiliar situations and surroundings Lack of experience and requisite skills Skills needed to deal with cooperative patients Inadequate in-service training and continuing education Unfamiliar situations General lack of knowledge, especially as technology improves and gets newer
Stress-Related Reactions and Outcomes While many outcomes are manifested by nurses when they are experiencing stress, the following are some of the conditions that are usually reported: Marital problems Drug and/or alcohol abuse High blood pressure heart disease Ulcers Chronic back pains Poor appetites Insomnia Feeling tense and anxious Burnout Click here to See The Basics of Stress for more example of stress-related outcomes Stress and Burnout Both stress and burnout are interrelated. In most cases, it has
been said that stress contributes to burnout. However, left unchecked, burnout
can also further exasperate the stress individuals are experiencing. Basically,
burnout involves the long-term changes in motivation for work and in attitudes
to Like stress, burnout is a difficult term to define in a precise manner. Most people agree that burnout is a reaction to a stressful work situation/condition. Although its outcomes may go above and beyond work, burnout begins on the job. It is usually more prevalent in the helping professions, for example professions, such as nursing. Experts in the field (e.g., Maslach and Associates), who have studied burnout a great deal, have focused their definitions of burnout on certain changes in attitudes and behaviors that occur as a result of excessive job stress. To these experts, burnout includes the following: "... the loss of concern for the people with whom one is working... characterized by an emotional exhaustion in which the professional no longer has any positive feelings, sympathy, or respect for clients or patients. A very cynical and dehumanized perception of these people often develops, in which they are labeled in derogatory ways and treated accordingly." Although burnout begins with stress at work, its outcomes are beyond the real space of the workplace. For example, burnout correlates positively with mental illness, alcoholism, marital conflict, insomnia, etc. It must also be said, that burnout is not exclusive to nurses, or even to the helping, health care and service professions. Burnout can affect lawyers, secretaries, sales personnel, teachers, to only mention a few other professional groups. Signs and Symptoms of Burnout: Stereotyping Feeling tired and exhausted daily Rigidity in thinking and resistance to change Sleep disorders High rates of absenteeism Frequent headaches and gastrointestinal disturbances Feelings of failure Guilt and/or blame Isolation and withdrawal High resistance to going to work each day Postponing patient care/client contact Suspicion and paranoia Excessive use of drugs Negativism Frequent clock-watching Avoiding discussion of work with colleagues at work Stress Management Strategies Any serious attempt to reduce or control the stress of police officers will have to take into consideration both the organizational and individual factors, both of which are inextricably linked to each other. In the case of organizational factors, which are usually the most difficult to address, it requires serious effort on the administrators and other high ranking officials to make the workplace more conducive for nurses to work. In short, both the structure and the functioning of the work and work-related environments will have to be changed and/or modified in ways that will reduce the stress nurses currently experience. Some examples of organizational changes include: Enhancing the hospital's image; Better allocation of financial and other resources A written plan for administrators to identify and reduce organizational stress Instituting or upgrading nurse's programs Upgrading and providing Critical Incident Counseling Commanding important follow-up and sustained support after critical incidents matching nurses' capabilities with the needs of their jobs by conducting "person-job-fit-analyses" Some examples of individual changes include: In the case of individual factors, which in some respects are more easily changed and/or modifiable, police officers will have to be educated about stress, what to expect, what to do when they are experiencing stress and their resources (e.g., Employment Assistance Programs or EAP, counseling office, etc.) provided by the police administration. It is very important that these "resources" be both sensitive to the needs of the affected police officers and, at the same time, all contacts must be held confidentially. From an individual's perspective it has been said that stress-related problems can be prevented in basically two ways: a) by eliminating the source(s) of the stress and (2) by learning how to deal with stressful conditions before they lead to problems (e.g., depression, anger, marital problems, suicide, etc.). The most fundamental component of any stress management training, whether it be directed by EAP or any other legitimate source, is the general awareness officers have about stress. This is in keeping with Dr. Livingston's basic I.R.M. Approach to Stress Management. Simply put, I refers to identifying the sources of stress or stressors; R refers to recognizing when you are experiencing stress (i.e., its signals); and M refers to managing stress using selected strategies. When individuals are unaware of the nature of threats to their well-being, they are less able to escape, avoid, or directly confront them. Thus, in order to successfully cope with stress on an individual or organizational level, nurses need to be made aware of the nature of job stress and its consequences." Some Selected Stress Management Strategies to Practice: Try to achieve good personal physical health Try to achieve good personal mental health Become aware of the stress myths you are following Try communicating any pain and/or emotional suffering to a "supportive" other Become aware of what are your stressors Become aware of how you are reacting to stress Try monitoring yourself as to how you are reacting to stressors and stress Adjust your expectancies to yourself and to others so that they are practical and real Try to objectively evaluate your attitudes Seek professional help when needed Seek temporary or permanent changes of shift or assignment Use your time off wisely Make time to laugh and have some fun with those you like Dream when you can Try visualizing places that are relaxing for you Try being cooperative versus confrontive Try increasing your physical activity Make a list and prioritize items on the list Say "NO" to extra demands placed on you Learn to control your anger Learn to relax Get organized Talk rationally to yourself Try to have a social life where your are stimulated by interacting with friends Manage your time effectively and efficiently Reduce the time urgency associated with things as bets as you can Watch and reduce your destructive habits (e.g., poor eating, exercising, sleeping, etc.) Try finding quite each day so that you can reflect and relax Try to achieve good personal physical health Try to achieve good personal mental health Become aware of the stress myths you are following Try communicating any pain and/or emotional suffering to a "supportive" other Become aware of what are your stressors Become aware of how you are reacting to stress Try monitoring yourself as to how you are reacting to stressors and stress Adjust your expectancies to yourself and to others so that they are practical and real Try to objectively evaluate your attitudes Seek professional help when needed Click here to See The Basics of Stress for more examples of stress management strategies.
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effective in managing their stress. Basically, stress is the body's way of
coping with emotional and physical change and a very necessary part of our
modern-day survival response. Numerous stress-related illnesses and diseases, as
well as personal behaviors (e.g., the frequent use of tranquilizing drugs like
Valium), underscore the need to manage stress more effectively. While many people know of stress,
few fully understand its nature. As a positive force, stress gives us the push
we need to achieve our most coveted goals. However, when stress is unrelenting
and out of control, it is a villain that causes unhappiness, sickness, and even
death. Nowhere is stress the greatest than in the helping professions, e.g.,
nursing. In fact, some
have referred to the helping professions, such as nursing, as possibly one of the most
increasingly stressful occupations or professions.
