The stress of nursing can take quite a toll on nurses emotionally and psychologically. Learn to recognize the signs, what to do, and when to seek help.
Abbegail Eason, RN, remembers some of the most devastating moments she’s witnessed as a nurse: a teenage girl learning she would never walk again after being shot by a gang member, a mom who gave birth but then died from a cerebral aneurysm just days later, and a baby who was left in a store’s parking lot and ended up dying.
“In these types of situations, it’s almost impossible not to be affected after your shift is over,” says Eason, a holistic coach at Abbegail Eason, LLC.
“Every nurse is susceptible to suffering from emotional distress,” explains Lucia M. Thornton, RN, MSN, AHN-BC, a consultant, educator, and author of Whole Person Caring: An Interprofessional Model for Healing and Wellness. Thornton and other sources we interviewed say that while all nurses can be affected emotionally, those in particular specialties may be more apt to experience this kind of issue. Some of the areas where nurses are especially at risk: emergency departments and trauma, intensive care unit (ICU), hospice, oncology, pediatrics, HIV clinics, homeless medicine, high-risk pregnancy clinics, palliative care, and neonatal intensive care unit (NICU), among many others.
“Anyone who is empathetic and works in a caregiving role—including nurses and certified nursing assistants—are at risk for developing compassion fatigue and increased caregiver stress, which affects emotional health,” explains Karen Whitehead, MS, LMSW, DCC, CCFP, who provides counseling in the greater Atlanta area and at TurningPoint Breast Cancer Rehabilitation. “Nurses who over-identify with patients and blur boundaries, as well as nurses with personal trauma histories, poor social support, isolated working conditions, or a previous history of unmanaged anxiety are at greater risk. Feeling a lack of control about your work environment—including schedule, lack of recognition, or sense of community—can also contribute to caregiver stress.”
“Working in these areas with these types of patients triggers the sympathetic nervous system and keeps the body in fight or flight mode. This heightened stress reaction can, over time, lead to compassion fatigue and ongoing emotional distress,” she adds.
It can also be especially difficult for nurses because they are on the frontline of patient care, says Carl J. Sheperis, PhD, NCC, CCMHC, MAC, ACS, LPC. “Aside from the ongoing stressors of variable schedules, budget cuts, and constant technology changes, nurses are faced with a broad range of emotions experienced by patients,” explains Sheperis, a licensed professional counselor as well as the program dean for the College of Social Sciences at the University of Phoenix. “According to the American Nurses Association 2011 Health and Safety Survey, over 56% of participating nurses had experienced some type of threat or verbal abuse from patients. All of these stressors compound and result in high incidences of compassion fatigue and burnout for nurses.”
Compassion Fatigue, Moral Resilience, and Burnout
Mary Bylone, RN, MSM, CNML, president of Leaders Within, LLC, and a former board member of the American Association of Critical-Care Nurses (AACN) often lectures and writes about the AACN’s healthy work environment standards. Bylone says that while compassion fatigue, moral resilience, and burnout are terms often used interchangeably because they do have a lot of overlap, they also have some differences.
“Burnout is best used to describe a situation in which an individual feels overwhelmed and exhausted. It can be seen when people sacrifice themselves for work or become overwhelmed with the feeling that the work is never done. Compassion fatigue refers to the weariness that develops from caring for individuals when the caregiver feels saddened that they cannot change the situation and give of themselves in the hope of relieving pain or suffering in the patient,” explains Bylone. “Moral resilience refers to the aspect of an individual’s character to rise above situations creating moral distress, such as being asked to provide futile care or care against a patient’s wishes. Resilience comes when the nurse is able to restore and maintain their integrity by challenging or pushing back when asked to do things they do not feel are right. It involves using one’s bold voice to speak up when others would remain silent—to ensure that the morally right thing is done.”
For the past decade, the AACN has addressed all these issues. Its National Teaching Institute recently held a special interactive session during which more than 300 nurses spent an afternoon sharing the types of experiences that would cause these feelings and sharing their solutions with their colleagues as well. “The AACN puts a lot of energy into hope and resilience rather than dwelling on the negative,” says Bylone.
Recognizing the Signs
“Experiencing emotional reactions is human and appropriate,” says Sheperis. “The key is recognizing when the emotional reactions are out of proportion to a situation or when they have a negative impact on you or others around you. Nurses are often good at compartmentalizing emotional reactions, but sometimes the compartments become full, and the emotions spill out.”
Some of the signs that a nurse is experiencing negative effects from emotional overload are: using a greater number of sick days and/or dreading going to work; feeling exhausted; problems sleeping; using drugs or alcohol to sleep; having work-related dreams, nightmares, or intrusive thoughts; being angry a lot either at work or home; yelling at patients or families; changes in mood or behavior at work; crying all the time; feeling angry at supervisors or coworkers; developing fears about the safety of friends or family; feeling less engaged in their personal and/or professional life; the inability to think clearly; headaches; gastrointestinal problems; irregular breathing patterns, feeling devalued, and losing the capacity to care about themselves, their patients, their family members, or really anyone.
This doesn’t even touch on the signs of clinical depression, which nurses may also experience. The point is that if nurses notice vast changes in themselves or in their coworkers, they may need to seek or suggest help.
The first action that nurses can take to keep their emotional health intact is to set boundaries, says Gail Trauco, RN, BSN-OCN, a grief mediator, owner of Front Porch Therapy, and author of Conquering Grief from Your Own Front Porch. Nurses can do small things to make themselves happy. “Be sure you have things that you visually see which create an immediate ‘happy sensation,’” suggests Trauco. “This can be a favorite coffee mug, bright-colored scrubs, flowers on your desk, or even a funny stethoscope cover.”
One of the biggest problems nurses have is that they tend to put everyone else’s care above their own, says Jill Howell, MA, ATR-C, LPC, a board-certified registered art therapist, professional counselor, and author of Color, Draw, Collage: Create Your Way to a Less Stressful Life. While she works at Pocono Psychiatric Associates, Howell worked with many nurses at the Pocono Medical Center. “It’s all about self-care—nurses will, of course, react by saying that they don’t have time,” says Howell. “Please remember what they say on the airplane—put your oxygen mask on first before you try to help others.”
When working with nurses, Howell would check in with them to see how they were dealing with work, give them an opportunity to vent, and make small self-care suggestions. She would also do quick guided meditations with them, teach a relaxation technique, or set up large sheets of mural paper and have them draw out their frustrations.
“I have found that most nurses, while they can care for others continuously, have a very difficult time in caring for themselves,” says Thornton. “Self-compassion is an important and useful practice for nurses to develop.”
“Nurses are givers. We go into the field because we are caretakers,” says Eason. “Many of us feel we are at our best when taking care of others.” She says that it’s important, though, for nurses to understand that they have to take care of themselves first. “Ensure you are getting adequate, quality sleep. You are eating a well-balanced meal. You are getting adequate exercise. You are spending time cultivating a life that is meaningful, rich, and deep outside of work,” says Eason.
After a particularly stressful experience at work, Lisa Radesi, DNP, CNS, RN, academic dean at the School of Nursing, College of Health Professions, University of Phoenix, says that nurses and other staff should have a debriefing session and remember that, despite all of the “bad” that occurs in their jobs, the “good” is the most rewarding part of what they do.
“Nurses should work together to ensure that they are okay after an incident. If a nurse notices a coworker is not doing well, they should talk with the coworker and bring it to the attention of the supervisor or manager,” says Radesi. “Above all, nurses should feel comfortable seeking treatment and communicating about emotional issues they may experience. Keeping this information bottled up can lead to issues and stress that have long-lasting effects. Know that it is not weakness, but strength, to acknowledge emotional disturbances and respond to them accordingly.”
If you see a coworker in distress, you can do something as simple as strike up a conversation with her or him, advises Bylone. “Use open-ended questions to find out how they are doing. Sometimes hearing the other person’s story really puts things into perspective. Let them know you care, and you are there to help, if only to listen. Please do not watch them suffer alone. Left unattended, these feelings only deepen and create lasting impact, often causing them to leave the profession,” she says.
Seeking Professional Help
Let’s face it: there are times when a spa day, time out with friends, or a bubble bath just won’t cut it in alleviating emotional problems. That’s when nurses need to seek professional help.
“If you are experiencing distressing symptoms over an extended period of time, it’s a good idea to check in with a professional therapist or counselor,” says Whitehead. “Whether it is distress from work or something related to your life outside of work, connecting with a professional can help you be a more effective caregiver and build your own resilience to mitigate the effects of your chosen population at work.”
If you need professional help, first see if your workplace has a program for staff members. If not, Sheperis says that the National Board for Certified Counselors has a directory of board-certified counselors across the United States (visit nbcc.org for more info). PsychologyToday.com also has a therapist directory that includes profiles of providers who can help.
There’s no shame in seeking help to get better. Sheperis says, though, that all nurses should do whatever they can to prevent their emotional stress from getting to this level. “Most people only seek professional help after something in their life had caused significant distress. While it is important to seek help if you are reaching a level of burnout or compassion fatigue, it is much better to take proactive steps and to work with a counselor to build resilience prior to hitting an emotional wall,” he says.
Sheperis also suggests that nurses focus on wellness practices at the onset of their careers. “It is easy to become engrained in a high-pressure system and to become emotionally overwhelmed if you don’t have a set of wellness practices in place.”
Working overnight shifts is a big change for many nurses, but it’s also extremely common. With the 24-hour demands of the bustling, modern health care system, there’s a good chance you’ll have to work the night shift at some point in your career, especially when you’re starting out. But don’t fret! There are many ways to ensure that the transition from day to night goes as smoothly as possible.
All nurses need to be on their A-game with technical medical skills and emotional resilience no matter what time of day they’re working. Night shift nurses have to shoulder even more burdens because they often work mostly or entirely alone for their shift. While there’s no one “right” way to adapt to the night shift, there are several common mistakes that you’ll want to avoid to build good habits.
Common Mistakes to Avoid When Switching to the Night Shift
Going against your circadian rhythm is no small task. However, resorting to quick fixes will only make your shifts more difficult in the long run. Avoid these five common mistakes and you’ll adapt to the swing of a night shift quickly.
1. Not getting enough rest before starting a shift.
As a nurse, it’s important to always be sharp on the job. The staff at Gurwin Jewish Nursing and Rehabilitation Center emphasize that not getting enough rest is the number one mistake that new night shift workers make, and it’s one of the most dangerous. Since shifts are often upwards of eight hours long, there’s no safe way to “power through” on too little sleep. This goes for both on-shift work and driving when sleep-deprived.
How to Avoid It:
- Install blackout curtains where you sleep and get a fan or white noise generator.
- Turn off your phone, get a “Do Not Disturb” sign, and inform loved ones of your schedule.
- Staying up for a few hours to relax and take care of yourself may be easier for some nurses than going straight to bed at the end of a shift. You’ll figure out what works for you with time, so don’t be afraid to experiment.
- Take proper care of your legs and feet while on your shift, so you won’t be troubled by pain or soreness when you’re trying to sleep.
- Light soothing candles and practice stretches to relax yourself before bed.
2. Leaning on sugary foods, alcohol, or caffeine instead of proper nutrition.
It can be tempting to snack on chocolate or chug coffee to keep yourself going through your night shift. Keep in mind that, if consumed in excess, coffee can lead to jitters at first, followed by a crash. You’ll be far better off if you instead focus on getting more sleep.
How to Avoid It:
- Plan and pack your meals ahead of time to avoid relying on vending machines.
- Schedule your heavy meals so they won’t interfere with sleep.
3. Letting your personal life fall into disorder.
Sometimes it’s hard to keep your personal life in order while working the night shift. Errands, social gatherings, and childcare all battle for your attention when you’re not at work. This reduces your ability to get good sleep and, in turn, to focus at work.
How to Avoid It:
- Yoga and meditation help you relax and leave work behind so you can be present when you’re engaging with family or friends.
- Establish a schedule for sleep, chores, and activities. This will reduce the stress of missing out on things.
- Plan gatherings ahead of time with friends and family to ensure you can make it to fun gatherings.
4. Not asking for help or feeling like you have to “do it all.”
Yes, there are fewer resources available overnight at the hospital. This can lead to superhero-esque thinking, where you refuse or even genuinely forget to ask for help. Being honest about needing a hand is better than dropping the ball because you’re juggling while tired.
How to Avoid It:
- Get to know the others who work nights so you can trade favors.
- Get to know the resources available to you during your shift.
- Ensure that your roommates or family are sharing the load with you at home.
- Choose sleep over chores when possible at home. Others can help you with chores, but they can’t sleep for you!
5. Missing out on workplace bonding, training, or resources due to night shifts.
It’s easy to feel forgotten when working the night shift. Try not to miss out on opportunities for bonding, continuing education, or extra support because of your schedule. It can be hard to make time or schedule changes for these opportunities, but they’re integral to your career development down the line.
How to Avoid It:
- Check announcement boards and learn about opportunities available at your workplace.
- Make it known to your boss and coworkers that you’re interested in additional training, support, resources or team bonding even if you work the night shift.
- Ask if there are online resources available for any opportunities that you simply cannot attend.
Your job as a nurse is important. Don’t let working the night shift get in the way of providing the best care possible to your patients and yourself. Getting enough sleep is integral to your job performance and personal health, but that’s not always enough. You also need to make sure you’re practicing good self-care and focusing on your health along the way. With these great tips, you’ll adapt to the night shift in no time!
March is National Nutrition Month and offers up a good time to think of tweaking your diet.
Nurses are especially prone to falling into an eating-on-the-run trap. With long shifts that barely offer time to sit, nurses rarely have the luxury of taking the time to eat a relaxing meal when they are on the job. No one recommends eating quickly, but, let’s face it, most nurses have to eat quickly or they won’t eat at all.
During National Nutrition Month, the Academy of Nutrition and Dietetics helps people focus on making nutritious choices. Knowing that nurses have short bursts of time in which to get the most nutrition possible, they have to plan ahead to map out what is the best eating plan for them. Leaving it all to chance means fast food that might be higher in fat and salt and lower in things like fiber.
What makes sense for nurses? Figure out what and how you eat throughout the day and try to find foods that can fit that pattern but that offer a nutrition boost. Do you make a coffee run and add in a danish or a roll? Is lunch whatever is left in the vending machine and that you can eat in the few minutes you have?
Packing your food at home and bringing it with you is an easy option. Once you get into the habit of prepping your food at home (beware – it can feel like a chore until you get into a groove) you’ll have an instant fallback of food you like to eat, that gives you energy, and that provides you with the most nutrition possible.
Salads are an excellent way to pack in vegetables, fruits, and some great protein, but they take a lot of time to eat. You can keep the focus on the nutrition a salad provides and bring other foods that are healthy but take less time to eat. One of the easiest ways to pack in all those veggies and fruits is with a smoothie. Throw all the ingredients into a blender, add some protein powder or high-protein Greek yogurt, and you have an easy-to-digest and quick-to-eat option.
Lots of granola bars in the supermarket offer wholesome ingredients without extra sugar or added binders. With pure ingredients like nuts, seeds, and dried fruit, these bars are easy to tuck into a bag, don’t take a lot of time to eat, and offer energy-boosting nutrition. You can also make your own trail mix to bring. Customize it to include the ingredients you like and you’ll get an even more pure (and less sugary) small meal. Pair it with a yogurt drink, a hard boiled egg, or a few slices of rolled deli meat and you’ll feel more energized for a longer time.
If you think it will fit into your day, pack smaller portions, but eat more frequently. A small bowl of brown rice or quinoa, lentils, beans, or chicken, and some finely chopped veggies takes less time to eat than a bagel with cream cheese and offers a powerhouse of hunger-fighting fiber, protein, and nutrients.
And one of the best ways to keep yourself energized is to stay hydrated. Instead of fueling with caffeine all day, add in some other beverages. Try to swap out soda with flavored seltzers (add in some juice if you need more flavor) or throw a couple of fruit-flavored herbal tea bags into your water bottle with a little lemon. Being even slightly dehydrated quickly saps your energy and makes your body work harder at everything.
With a few small changes, you can give your body the energy and nutrition to have a more productive day and better overall health.
I’m orienting as a charge nurse at a clinic. A middle-aged gay man (well, late middle age), surrounded by young women. Something odd happened that I want to share. My clinical partner, a charge nurse with 35 years of experience, pulled me into a room. “I’m going to tell you something awkward. Some of the nurses have said they feel uncomfortable when you touch them on the shoulder.”
You could have knocked me over with a feather. I honestly didn’t remember ever touching anyone and said as much. However, later that same day I actually caught myself just as I was about to touch a coworker on the shoulder and say, “Thanks for helping me with that patient.” So I had touched someone….without their permission, without thinking about it. I really had to rethink my behavior toward the opposite sex in the current climate.
Women are finding their power. Things that might have slipped by in the past are no longer going to get a pass. Frankly, I think it was a long (centuries) time coming. I hope it continues. I know it will. I’m excited to live in a time where women’s rights and female empowerment is in ascendancy.
I guess I just thought that being gay somehow made me immune from charges of sexual harassment (from women at least). This is just not the case. Harassment is in the eye of the beholder. If someone is uncomfortable with something, he or she has a right to their feelings, even if, from the other side, he/she/we may feel that nothing was done wrong (or at least intended). It’s hard to grasp, but important. Harassment is whatever someone says it is.
I admit, my feelings were hurt. I did not intend to make a coworker uncomfortable. My being gay or straight has no bearing on the issue of someone else’s feelings. I won’t argue that I didn’t mean to. I won’t say that I’m a hugger, or come from an affectionate family. Whatever my reasons for touching someone without their permission are not pertinent. All I can do is identify the behavior that caused the problem and fix it going forward.
Some might argue that the pendulum of women’s rights has swung too far. Anyone can say they feel harassed about anything. Any innocent touch, a pat on the back, is harassment and it’s just too crazy. That’s not the way to look at it. The #MeToo movement did not happen in a vacuum. It takes place in the context of an entire human history of women being treated as property and all that entails. There was a time when gay-bashing was, if not a national past-time, at least a frequent diversion, and I’ve been the victim of it several times. Gay rights didn’t happen in a vacuum, either. The broken body of Mathew Sheppard brings to mind exactly why we are fighting. Now, women are fighting.
What I’m saying is that I understand that women have a right to be seen and heard, respected, and not touched in the workplace. They have a right to pick and choose how they will be interacted with and what is appropriate. They fought for that right and continue to do so.
I’m glad that someone thought enough about me to point out something I could improve upon in my work life. I’ll keep an open mind, and my hands to myself in the future.
It might seem ironic that the kickoff of the National Sleep Foundation’s Sleep Awareness Week starts with an hour less of precious shut eye.
While Daylight Savings Time has most of us springing our clocks ahead one hour early in the morning of Sunday, March 11, it also means we are losing that extra hour of snoozing.
But paying attention to your forty winks is nothing to slack off on. Nurses, traditional whirlwinds chameleons thanks to long shifts, nighttime hours, family and school obligations, and just plain stress, are typically fairly sleep deprived. Known to fit amazing amounts of tasks into one day, nurses often accomplish these things while shorting their bodies of necessary sleep.
Here are four reasons to pay more attention to your sleep.
1. Your Work Performance
According to the American Sleep Association, lack of dreamtime contributes to big problems on and off the job. You know you’ll feel sleepier during the day, and that’s a problem for nurses when they are working. Given the fast pace of the job and the critical thinking necessary to dose medications or provide care, chronic sleepiness will impact your patient care negatively.
2. Your Health
Not getting enough slumber can also lead to potential health problems. A body that is sleep deprived gets the hormones that regulate appetite mixed up. Not only are you awake extra hours, but you are hungrier during those hours as your body tries to stay alert. If you aren’t careful, this can quickly lead to weight gain and associated problems like high cholesterol or high blood pressure. Lack of sleep can even trigger an improper processing of glucose and can make you more prone to developing Type 2 diabetes.
3. Your Mood
Sleepiness can easily turn to crankiness as your body craves needed rest. Sleep gives you the extra cushion against the things in the world that irritate you. When you haven’t had enough good rest, your mood takes a nosedive and everyone around you notices it. You might be more short-tempered with your friends and loved ones, but it can also impact your attitude with your patients and with your colleagues.
4. Your Quality of Life
As a nurse, you work hard for everyone else’s well being. You spend your days taking care of other people and other needs, often while neglecting what you need. Not getting enough sleep is a sure-fire way to put a wrench into your forward momentum and finding a balance that is sustainable.
The next time you find yourself skimping yet again on crawling into bed, think of how often you tell your patients they need rest to heal and rest to recover. Treat yourself the same way and see if it makes a difference in your life.