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.”

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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.

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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.”

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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.”

Julia Quinn-Szcesuil
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