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Real World, Real Stress

Vol. 8 •Issue 13 • Page 14
Manage with Care

Real World, Real Stress

You don't have to go it alone; make caring for yourself a priority

One of the most frequently requested educational topics by nurses and for nurses is stress management. As society has changed, life has become very stressful for some people. There are many trends that have contributed to the stress, but traditional communication and socialization patterns also have changed. Some people no longer look to others for socialization, but instead visit Internet chat rooms.

For nurses, the HIPAA laws that protect privacy now forbid healthcare professionals from talking to each other about challenging cases. This can contribute to isolation, job stress and disruption of the work/life balance. When asked "What causes your stress," nurses frequently respond with "co-workers, staffing, lack of supplies and resources, or broken systems that one person can't fix." These factors can become overwhelming.

Caring for the Caregiver

Professionally, we have begun to recognize the need to provide self-care and/or "care for the caregiver." It is often difficult to "just say no" to the person who asks a nurse to do one more thing, but often good self-care requires setting boundaries. Recognizing this as an issue, the New York State Nurses Association issued a position statement in 1992 and revised in 2005, titled "Self Care for the Professional Nurse." Included in its recommendations is that nurses need to make caring for themselves a priority.

In a profession taught to care for others, it is often difficult to recognize when caring for ourselves should become a main concern. Stress can manifest itself in many ways — physical symptoms, behavioral changes at work, emotional differences and cognitive changes. Sometimes a circle of life that was once multi-tiered and very full becomes very small, as individuals isolate themselves due to fatigue, anxiety and depression. When work becomes the sole content of that small circle, the issues that present themselves in the workplace can become magnified. Instead of shrugging off a comment or non-verbal gesture, the work issue can be all consuming. For those who have a very large and full circle, it is easier to move on because they are thinking about a social function that evening, or getting together with friends and creating the "work/life balance."

How do you know when to offer help? Sometimes we watch colleagues isolate themselves and choose to do nothing until the problem escalates into angry outbursts or substance abuse. We recently celebrated National Nurses Week, but how do we provide care and self-care all year long?

Stress-Reducing Strategies

First, look for the causative factors of stress or imbalance, which are sometimes easy to correct. Time management has a high correlation to stress. If it seems time is never on your side, try this simple exercise: Keep a log of the day in 15-minute intervals and jot down all activities. Often it's easy to identify where you are losing time and then you can develop solutions to combat the problem. For example, staff nurses frequently lose time at the beginning of a shift as they wait for assignments or report. While experienced nurses can catch up later in the shift, new nurses may find themselves constantly behind, creating more stress at the day goes on.

If getting to work late is stressful, make arrangements to leave home earlier or prepare for work the night before. Managers frequently lose time first thing in the morning by checking voice mail and e-mail, which can take valuable time away from assessing the status of the clinical area. Sometimes an issue that can be easily handled at 8 a.m. escalates into a larger problem by 11 a.m. For those who attend meetings, it is often helpful to schedule them back-to-back to keep on schedule. For example, instead of scheduling 11 a.m., 1 p.m. and 3 p.m. meetings, schedule them at 1, 2 and 3 p.m. This frees valuable chunks of time to get paperwork or projects done, or spend time coaching staff.

Also, delegate whenever possible. Begin by looking at a "things to do list" and identify what can be delegated. Accept that it might not be done perfectly but "good enough." Remember: Delegation requires planning, so if you wait until the last minute, chances are you'll need to do it yourself.

Along with a time log, a mood monitor or log also can help identify stressors that cause a mood shift. Once identified, the cause may seem less serious than originally thought. It also can allow for "proactive thinking" when a similar situation reoccurs.

It is very important nurses make time for themselves. When this concept is mentioned, nurses generally laugh or dismiss the idea. But even 10-15 minutes of personal time can help refresh one's outlook, add perspective or slow down the body's stress response. Simple ways may be to listen to music, exercise or take a short walk.

Finally, making connections with family and friends can provide the support and assistance everyone needs. Building and maintaining good relationships are essential to alleviating stress.

Take Control

"Take control of the things you can and let go of the things you can't."

While that can be a cliché, it's often a helpful reminder. So as you read this, if it's a beautiful June day and the computer system is down and your stress level is up, take a walk outside on your way to the cafeteria. Take back some control by enjoying a little piece of the day.

Sally Ann Corbo is president of Epicare Associates Inc., West Caldwell, NJ, and maintains a private practice as a psychiatric advanced practice nurse.


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