Jerome Stone RN knows about stress. As a nurse, he understands the particular stressors of healthcare professionals. But he’s also learned a few things about stress that can help nurses make it through even the most difficult times.
As author of Minding the Bedside and the Minding the Bedside blog, Stone says getting rid of stress isn’t practical or necessary. The way we react to and cope with stress is what gets people into trouble.
Nurses, in particular, know stress is part of their job. “Working as an RN, with others’ health issues in our hands, and the necessity to help alleviate others’ suffering, adds a greater impetus to learn how to deal with stress,” says Stone. “However, we need to develop a way to work with stress in all aspects of our daily lives, whether we’re at work, or with our family, dealing with health issues, or finances.”
Stone says approaching stress in a way that is helpful and healing requires some understanding and a lot of awareness about what’s happening. But it doesn’t take as much time as you would think.
“My interpretation of what causes stress is the key determinant of whether and how I experience stress,” he says. “And to some extent, this interpretation depends on our mislabeling stressors as the actual stress.”
The distinction might seem minor, but it’s critical to how you can begin to change how stress affects you. “Stressors are the triggers in life, in our environment (external and internal), that cause us to experience stress,” says Stone. “They’re the things at work or in life that can elicit a stress response from us. Whereas…stress is a state– it’s what we experience physiologically when a stressor triggers an emotional response in us. And as a state, it’s also changeable and malleable – we can work with it.”
With so much attention focused on stress itself, Stone says it’s easy to confuse stressors with stress. “People constantly try to ‘fix’ what’s ‘out there,’ rather than realizing that it’s how they deal with what’s out there that determines whether and how they experience stress,” he says. “This is so important!”
And while it’s unrealistic to expect to eliminate stress or that you’ll get to a place where it won’t impact you, Stone says nurses can learn tactics to separate the physiology of stress (the churning stomach, the shaky hands–the flight, fight, or flee reactions) from how the mind reacts to those feelings. He refers to it as ‘turning down the volume’ of stress when you feel those stressors ramping up so that you’re not reacting to stress in negative ways.
What can nurses do to actually help themselves when they are in the midst of a chaotic situation? Stone says becoming aware is the first step. “If we are unaware, we get into patterns or habits and we switch to our habitual responses,” he says. “Then our ability to mediate becomes less. It’s a slow process. It starts with awareness and with awareness, we need to find compassion and mercy for ourselves.” Recognize that no one is perfect and give yourself compassion when you feel overwhelmed.
Once you know what your stressors are and how those stressors make you feel, you can look to ways to cope. And Stone, a firm believer in and follower of meditation, says you don’t even have to commit to a time-consuming plan to begin to help yourself. We all have had stress-free moments, so we are hard-wired to have those experiences, says Stone. The key is to increase those stress-free moments.
Because mindfulness brings in awareness of breath, Stone says nurses can begin with just taking one mindful breath. “One single breath, in and out, can alter the physiology just enough to return to the present moment,” he says. And anyone can practice that one breath anywhere–walking down the hall, in the bathroom, before going into a patient’s room, in line for lunch.
“It can feel like one breath won’t make a difference,” he says, “but if you do that 10 or 50 times a day? It adds up. If we do it enough, it is making a difference.” Of course the more you can do that, the better you’ll build a resilience to the stressors of your day.
With taking those mindful breaths, you can also give yourself a needed balance. Choose a simple phrase as a mantra for when you feel overwhelmed. For example, Stone says repeating “I can do this” is a direct reminder that you are facing difficulty right now, that you have the resources to get through it, and that you can focus on the present moment to do so. It’s affirming, and it also helps you disengage the pattern and negative feedback loop of thinking you can’t handle what you’re faced with, he says.
“Find balance in the small things,” says Stone. “Practice balance when you’re eating, when you’re showering, when you’re driving. Bring mindfulness and awareness of your stress response into how you deal with long wait times for customer service, or bad drivers, or cranky kids. The opportunities to find balance are all around us.”
In your work environment, it helps to advocate for resources like better staffing or salaries and basic needs for breaks or vacation. In the end, organizations must realize that stress isn’t good for nurses or for patient safety. Stressed nurses are more forgetful, more prone to mistakes, less likely to have the resources to work to their full capacity, and much more likely to quit.
Nurses can begin to help themselves as they learn to respond to stressors in a new way. “People say they don’t have that much time to devote to this, but everyone showers, brushes their teeth, sits in the car,” says Stone. “Every one of these is a minute where you can sit. Then celebrate each time we do it.”
Think about the last time you visited a hospital or doctor’s office. Chances are, it was the nurse who offered support, comfort, or answered your questions. Nurses handle a lot of responsibility every day. Unfortunately, shouldering that responsibility is stressful. Research has found that 38.4% of registered nurses over the age of 30 experience burnout and feelings of frustration, anger, and irritation. For registered nurses under the age of 30, the percentage rises to 43.6%.
It’s evident that nurses are feeling the pressures of providing the best care possible for their patients. So, as we honor our nurses during National Nurses Week, May 6-12, it’s important to remember that the greatest gift you can give yourself while you care for others is to take the time to care for yourself. An important step in self-care is controlling stress.
When you feel stress working overtime on your well-being, here are five ways to control the dangers of stress before it controls you.
1. Get organized.
In an environment dictated by the need to react, nurses have to deal with many interruptions, many of which can’t be helped. “However, there are many interruptions that are not so important,” Catherine Bynes says. “Interruptions like long non-work related chats with other staff members, checking non-work email, or other non-essential tasks can get you off track quickly.” Taking as little as fifteen minutes before your shift begins makes a big difference in examining the day.
2. Be physically fit.
Let’s be honest; Are nurses really short on exercise? However, working on your feet all day does require some relief. “We bring in a massage therapist for students and staff every few weeks where they can receive a 15-minute neck and upper back massage,” says Julie Aiken, CEO of Ameritech College of Healthcare. She added that faculty and staff could participate in weekly yoga sessions, daily group walks, and both students and staff are encouraged to use essential oils to help with stress relief.
3. Get some quality sleep.
At this very moment, a resounding “hah” is rippling through the throngs of nursing students. Quality sleep? Not in this world. But the need for restful sleep has a profound effect on your health and work performance. Experts suggest creating a nightly routine that prepares your body for relaxation and rest. Don’t load up on snacks or caffeine, and make sure your bedroom is dark, quiet, and cool. If stressful thoughts keep you up at night, the American Nurses Association says to keep a notebook by your bed. If anxiety is keeping you awake, write those feelings down and let them go until morning.
4. Improve communication skills.
Poor listening or communication skills leads to misunderstandings and mistakes, which almost always results in chaos and stressful situations. Studies show that, yes, you do have time to concentrate your attention on a physician’s or coworker’s instructions or a patient’s concerns.
Good communication improves the quality of care provided to patients. “The best expertise training and continuing education of nurses in matters relating to the proper technique of communications will enable them to respond adequately and humanely to the expectations of patients,” Dr. Lambrini Kourkouta, and Ioanna V. Papathanasiou, RN, MSc, PhD, conclude in a study published by the National Institutes of Health. By reducing the risks of mishaps caused by miscommunication, nurses can experience increased levels of satisfaction in their work.
5. Keep things in perspective.
It’s been a bad day. Not a bad life, or a bad world, or even a bad career choice. When bad things happen, it’s tempting to allow those feelings to take over your entire day—but, don’t.
People depend on you for your knowledge, abilities, patience, and empathy. So when those feelings of discouragement settle in, it’s time to divert them. In a profession that requires constant caring for others, leadership expert Dan Rockwell says to let someone care for you for a change. “Hang with positive people or schedule time to do more of what you love.”
Every health care facility relies on its nursing staff to keep the doors open, so while today may have been rough, or the lessons from the latest mistake may be painful, you are providing a service that keeps the health care process moving.
As we celebrate National Nurses Week, let’s develop healthy habits that will sustain us long after the celebration is over. By developing strong organizational and communicative habits, and maintaining physical and mental toughness, we can reduce the strains of stress while contributing a healthy dose of excellence to our profession.
I had never received the backhanded compliment of “oh, she has such a pretty face” until recently. That was a compliment reserved for fat women. I did not consider myself fat at all. I would describe myself as overweight, but never fat. If I could still purchase clothing out of regular department stores, I did not believe myself to be obese. Even when I was hospitalized last year and the doctor’s notes said “…obese, 47yrs old female,” it did not truly register. However, once my vanity was attacked it hit home.
Sometimes, I see myself in the mirror and wonder how did it get to be this way. I am 5’4″. I weigh 210 lbs and am a Registered Nurse! Euphemisms like “thick,”” full-figured,” and ” healthy” only mask what I know to be the truth. This body that I live in is well on its way to diabetes and hypertension. Thankfully, in this moment I do not have any of those diseases, but it is just a matter of when, not if.
Being overweight has affected my self-esteem, my sense of self-worth, my self-love. It feels like a self-inflicted punishment. When I think back to when I was slim and feeling good, it almost brings me to tears. I start asking myself how did I let it get this out of hand? Why didn’t I just get up from the table? Stop eating at fast food restaurants? Continue to exercise? I am not a fat person who does not know how I got fat. I know exactly what I did, which I think makes it all the worse.
There are times I find it difficult to teach my patients about health and wellness. I wonder if they are looking at me and finding me a hypocrite. Or are they realizing that I, too, understand how hard it is to walk that path.
The heavier I became, the more crap I accepted from the men I dated. I no longer felt I that should be respected or loved entirely. Glad that they were in my life was enough. Trust me, when you do not love you, no one else does either. I stayed with a man who told me that he did not usually date “big girls.” So, I sat wondering, should I feel special that you chose me? I found myself always trying to overcompensate for not being thin, for not being his ideal of beauty. I was showing him that my love was not worth it because it did not come in a perfect size 4, 6, or 8. I was depleted walking out of that one.
So now at this juncture, I am ready to lose the weight. I mean do what is necessary to get to where I feel comfortable in my skin. This is not simply about my vanity, but about my life, my health, and self-love. So, I am inviting you on this journey with me. Come along.
“ Once you know yourself, in this living stillness, there is nothing in this world that is greater than you”
One of the elements of discovery is “stillness”… I am sure you are thinking, ” What does that really mean? As healthcare professional, how can I incorporate STILLNESS into my life when I have been trained to move and move fast because it is the difference between life and death?”
Guess what, IT IS POSSIBLE! Let’s break this down a little bit more.
Many people see the word “stillness” and automatically think it means to have no movement which is true to a certain point, but from the perspective of discovery, “stillness” is the state of being or being one with yourself. Not thinking about the kids, what you have to cook for dinner, the bills you need to pay, but can’t… the job you dread, the co-worker or friend that gets on your nerves, etc. I mean you DO NOT think about any of that, just simply BE!! In the state of being is where we really and truly get to “know thyself” and not what everyone else tells us about ourselves. In stillness we allow the voice of the holy spirit, which is our GPS navigation system, to guide us through the streets called life. In stillness we learn to quiet the mind and not allow anything that is going on around us affect us. So when you are in a state of stillness, it doesn’t mean that things are not going on around you, it means that they are not going on within you. Let me make it a little clearer for you, you can be at work on a 35 bed med-surg unit with 10 physicians and 3 respiratory therapist on the unit, family all over the place, a supervisor who is screaming at staff, and a co-worker who scrolling through her social media timelines chilling while you have 10 outstanding task and not let ANY, I mean ANY of it affect you internally. The key is to create an intention of stillness which can be achieved by having some intentionality about how you are carrying yourself in a given moment and focus on what is within your control.
Now that we have what stillness means from the perspective of discovery out of the way, I can hear you saying “ Nicole I don’t have time for that”, I have to take care of my family, walk the dogs, manage all the household chores, manage the financial accounts, and I am sure that the list could go on and on but guess what you CAN practice stillness through all of this (I am not telling you what anyone told me but what I know)!! And to be honest if you want to live a life purposefully as a healthcare professional according to Gods’ will then it is a non-negotiable.
So let me share 4 tips that helped me to begin my practice of stillness and make the practice of stillness a ritual in my life.
1. Deep Breath- Yep simply deep breath! I hear you saying “and what is that going to help”? When we take deep breaths it induces the parasympathetic system and slows down your heart rate, which leads to a state of relaxation (use this one when you have trouble going on all around you so that it is not going on in you). 2. Schedule Time to Be- Look lets keep it real we all live busy life’s that pull us in 50 directions and many us live by a Google calendar which tells where to be and when. Well guess what place your “Be Time” on there too. It has been proven that anything we do for 21 days becomes a habit. 3. Get off Social Media- Yep I said it!! Get off Facebook, Instagram, Snapchat, etc. stalking pages and looking at fairytale lives that often don’t exist and practice just “ Being” (I was once guilty of this one, LOL). With the hours we spend on these sites weekly, we can really get to “know thyself” and find our purpose as a healthcare professional. 4. Find a Location that brings you Serenity- Know I know I said the state of being can happen when trouble is all around you which means we can have stillness anywhere but to get to a place where we can do this, we can get practice by doing it in areas where we find peace. So that may be by the water, outdoors with the birds chirping, a certain room in your home, etc. Practicing stillness in a location that brings you peace prepares you to be able to do it anywhere.
These tips are the very tip of the iceberg for practicing stillness because stillness goes much deeper but I wanted to start with building a foundation for you to build upon.
Remember in Psalms 46:10 we were told to “ Be still and know that I am god”.
Being a nurse is hard. And stressful. Depending on where you work your daily stress level can escalate from 0 to 10 in a matter of seconds when a critical situation arises. Even worse, the average nurse’s stress level can fluctuate greatly over the course of a shift frying ones’ nerves by the time it’s time to punch the clock and go home.
What’s the best way for a nurse to manage daily on-the-job stressors? By using stress relieving methods on a regular basis. There are many ways to ease tension when stressed.
Here are 8 ways to combat stress:
Take a deep breath. Deep breathing does more than giving the brain a boost of oxygen. Stopping to take a deep breath when times get rough has been shown to reduce cortisol levels, which in turn can lead to reduced stress and anxiety.
Listen to music.Music has a soothing effect people and can prove beneficial when tension runs high.
Exercise. Exercise releases endorphins, which instantly makes you feel better. Imagine punching out your stress on a punching bag or running your best mile. Trust me, after you’re done exercising you’ll feel much better.
Cuddle with your pet. Dogs and cats are good cuddle buddies and can help you feel more at ease when times get tough.
Hug somebody! Have you ever hugged someone while you were feeling tense? If you’re like most people, you immediately feel a release during the act. That is stress leaving your body!
Get a massage. Getting a massage from someone can relieve physical tension in your muscles. Another added benefit from a massage is human touch. Think of the human touch of a massage the same way you would of receiving a hug.
Write. Writing when stressed can help release stress-related symptoms. Have you ever heard of someone writing a letter and then burning it to “let it go?” Writing allows you to say whatever it is you need to say about what is bothering you. You don’t have to burn it when you’re done because the act of writing is actually a release within itself.
Go out with friends. Surrounding yourself with people you love and trust is good for your mental health. Aside from being able to speak to someone about what is bothering you, you could probably use a fun night out.
In addition to working as a RN, Nachole Johnson is a freelance copywriter and an author with her first book, You’re a Nurse and Want to Start Your Own Business? The Complete Guide, available on Amazon. Visit her ReNursing blog at www.renursing.com for more ideas on how to reinvent your career.
