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A call came from the emergency department. Three admissions are on their way. Three! We're already understaffed. how are we going to handle three? (Heart starts pounding.) What if one of them crashes? (Chest tightens.) I'm going to be here all night! Who'll watch the kids in the morning while Bill goes on his job interview? He can't miss that interview! (Vague nausea.) There's the call bell from 8B. Oh please, not again!
Nurses have always dealt with stressful wallops - losing patients, aching backs, extended hours. But suddenly they have menacing low blows to dodge, like hospital closings and layoffs.
Telling It Like It Is
Barbara Crane, BCRN, charge nurse at St. Catherine of Siena Medical Center, Smithtown, NY, is president of the National Foundation of Nurses and a board member of the American Nurses Association.
"I don't think there's a nurse in the country who hasn't been affected, or doesn't know someone affected, by the economy," Crane said.
"Everyone's scrambling to stay on their feet. Suddenly RNs who thought they would be retiring can't go anywhere. Pensions are in jeopardy. Responsibilities are changing. Skills are increasing with computerization, excessive recordkeeping. The patient population is changing - people aren't coming to the hospital until they're at death's door.
"Such stresses can only lead to poor patient outcomes," Crane summarized.
Professional Stress Buster
Vicki Lachman, PhD, MBE, APRN, a clinical associate professor at Drexel University, Philadelphia, whose doctoral dissertation prompted her to write "Stress Management: A Manual for Nurses," offers insights on stress in this economically challenged environment. She applies her research daily, teaching graduate nursing students practical ways to use cognitive behavior strategies for de-stressing.
"An HR person just told me his nurse recruiter is working on the floor. She doesn't need to recruit because no one's budging," Lachman explained. "RNs figure, 'I have a job; I'm staying put.' That in itself creates new stress. What if they don't like their job?
"And what if your spouse loses a job? People need food, clothing, shelter and security. If security is threatened it's hard to support and care for others. If you're the only source of income, and you make a med error, that could send you over the edge."
Stress-related burnout, Lachman said, is a dangerous situation. "When I hear a nurse say: 'It's his own fault. If he'd watched his cholesterol he wouldn't be back with a second heart attack,' I think, whoa! When you're burned out, you don't like yourself and you don't like your patients."
Useful Strategies
What can an RN do to keep from falling prey to an overload of stressors? Plenty! Lachman offers some relevant coping strategies:
- Reframe - Change your perceptions. "Instead of thinking, 'Oh no, three patients,' reframe the thought to, 'Wow, three admissions! That's job security!" While you can't always change what happens, you can change how you react.
- Avoid catastrophizing. Don't invent problems that may never occur. In our opening scenario, the RN took three admissions and turned them into her husband missing an interview. She was crossing imaginary bridges. "I have a sign over my desk," Lachman said. "It says: 'When you change the way you look at things, the things you look at change.'"
- Avoid personalizing. "Don't think everything people say or do is a reaction to you. It's not," Lachman said. "If a patient screams at you, it's because he's stressed, or scared or feeling discomfort. It's not about you."
- Catch stress early. You've got to look for signs of stress and cut it off at the pass. Lachman's example: You forget to call your sister; that's a 3 on the stress meter. You miss your turnpike exit; that's a 7. You lock your keys into your car; that's a 10. When you forget the call to your sister, that's the time to examine your stress levels and take proactive steps. Don't ever get to level 10.
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