Whilst pressure is good for us and can help us complete a task or reach a goal – too much pressure can lead to stress, which can have a negative impact on our wellbeing, ability to cope, our own safety, patient safety and life in general.
Stress is not an illness, but it can make you ill if you experience too much of it, especially over a prolonged period. Stress can affect your mood, your body, your behaviour and your relationships.
Although nursing is rewarding, inspirational and can be deeply satisfying, we also must recognise that it’s emotional, hard work, carries great responsibility, and is sometimes delivered in a system that is far from perfect.
It can be difficult to avoid stressful situations in nursing, but there are a number of things you can do to minimise and reduce the impact of stress.
Take a look at the Pressure/Performance Chart below to gauge the level of pressure you are under at the moment.
While you may have done your best to mitigate stressors in your life, inevitably a stressful situation will occasionally arise.
Stressors – the causes of stress – are either short term (acute) or long term (chronic). Our primal fight-or-flight response is a reaction to an immediate threat or acute stressor. Chemical changes in the brain prepare the body either to run away or defend itself.
With long-term stressors, the pressures are ongoing and continuous, and the fight-or-flight urge becomes suppressed.
The working environment can generate both acute and chronic stressors, particularly for a newly registered nurse, but it is more likely to be a source of chronic stressors.
An example might be a procedure you have not undertaken very often that goes wrong – taking blood, for example. You make a mess of it and feel terrible as a result. Those feelings manifest themselves as uneasiness or apprehension, particularly when you’re placed in a similar situation again.
Events in your personal life can contribute to the build-up of stress. Money worries, a sick child, the washing machine flooding the kitchen – each of these may be manageable on its own, but in combination with pressure at work can push you over the edge. Think of it in terms of “demands” and “resources” at either end of a see-saw.
When the demands are heavier than the resources available to alleviate stress, the balance tips the wrong way.
Physical effects include:
• faster breathing
• faster heartbeat
• dry mouth
• tense muscles
• tiredness/disturbed sleep
• a need to use the toilet more often/nausea
• increased sickness absence – stress affects the immune system.
Stress can also induce changes in behaviour, including:
• restlessness
• overeating/undereating
• increased caffeine/alcohol intake/smoking
• inability to relax
• snapping at others/aggressive behaviours
• double-checking everything.
There are psychological effects of stress too, such as:
• feeling overwhelmed
• loss of confidence in your ability
• irrational thoughts
• irritability/moodiness
• lack of motivation
• feeling low or depressed.
There are many more symptoms, but clearly none of the above is conducive to calm, measured, effective nursing care.
Resilience is your ability to rebound quickly from a stressful or negative experience. It is a skill which enables you to recover from difficult and challenging situations. Building and improving resilience takes time and commitment. Adopting strategies, including those shared in this chapter, will assist in doing so.
Please understand that resilience does not replace the need for self-care and self-compassion. The three work in partnership – each dependent upon the other.
Imagine you are walking up a rocky mountain in unsuitable shoes and so keep slipping and falling. Resilience is putting on a pair of walking boots so that you can manage the climb better. However, it doesn’t alter the fact that the path is rocky and sometimes dangerous.
Stress affects people differently – what might cause stress in one person may not affect another. Considerations such as skills, experience, age or disability may all affect whether someone can cope. Poor coping strategies can lead to other behaviours that are harmful to health, such as skipping meals, drinking too much caffeine or alcohol, or smoking.
To help you understand what might cause you stress, take some time to reflect and understand:
- how you practise
- the things you are good at and what might need improvement
- how you react to different situations (good and bad)
- how you behave if you are unsure of something or doing something for the first time
- how you work and interact with your colleagues
- how the behaviour of others (good or bad) impacts on you.
If you (or others who know you well) notice you are displaying signs of stress, it’s important for your health and wellbeing that you do something about it. For instance:
- recognise when stress is becoming a problem
- think about where you can make changes
- build supportive and trusted relationships
- ensure you are eating healthily and at appropriate times
- be aware of changes in your smoking and/or drinking habits
- take gentle exercise on a regular basis
- take time out for yourself, away from distractions
- get some restful sleep
- be kind to yourself.
Maintaining a healthy weight is a key part of looking after your body and a balanced diet is central to achieving that. The Nursing You wellbeing app enables nurses to reflect on how they make decisions at work and identify goals to help achieve and maintain a healthier weight. Email nursingyou@c3health.org to get access to the app.
The symptoms of stress and anxiety are almost identical, the difference being the presence of a specific trigger. Stress is typically tied to a specific situation, once that situation resolves, so does your stress. Whilst anxiety can occur as a reaction to stress, it can also happen without an obvious trigger.
If you try to implement strategies to reduce stress levels with no effect, then you must access additional support to get a better understanding of your situation in order to prevent your wellbeing from deteriorating, and to avoid compassion fatigue and burn-out.
Your employer has a legal duty to protect its workers from stress at work by carrying out a suitable and sufficient work-related stress risk assessment, and acting on its findings. This involves identifying the significant factors that can lead to work related stress and taking reasonable steps to reduce those stress factors, as far as practical. In addition, your employer may offer an employee assistance, a wellbeing programme and/or an occupational health service to support you.
Recognising how stress affects you is the first step towards dealing with it, and asking for advice is the second step. RCN Member Support Services offer free, confidential advice, representation and support. Services include counselling, career advice, welfare rights and guidance, peer support and immigration advice. The team work closely with regional offices and legal services to ensure that RCN members are fully supported. For further information visit: rcn.org.uk/mss or contact our advice team.
Your accountability – please refer to 1.5 and 1.6 of NMC (2018) Future Nurse: Standards of Proficiency for Registered Nurses. Available at: nmc.org.uk/globalassets/sitedocuments/educationstandards/future-nurse-proficiencies.pdf
Make the most of your preceptor or senior nurse
If you feel unsure about something or need a bit more advice or guidance, talk to your preceptor or senior nurse. They can help you reflect on your experiences so far and identify where you might need some extra support – deflecting nervousness and anxiety before stress develops. Remember, you’re not expected to know everything immediately, so don’t be afraid to ask other colleagues questions too.
Recognise areas for improvement
A more formal process of professional support is clinical supervision. This can help nurses reflect on their practice and identify areas for improvement. It also provides an opportunity to develop expertise, find new ways of learning, and to gain professional support, which may be especially important for new registrants who work alone.
Learn from others
Professional networking is another useful tool that can help newly registered (and established) nurses to share and learn from their experiences, and develop insight and new ways of working.
The RCN’s professional forums cover all nursing specialties. As a member you can join for free. They offer great capacity for support and learning from more experienced colleagues. Read more about the forums at: rcn.org.uk/forums
Self-reflect
Take time to think about your practice and your day. What has gone well, what hasn’t, and what have you learned from the situation? Think about what you could have done differently – would this have improved the care you have given? Or how you looked after yourself? You may prefer to use Rolfe et al’s (2001) What? So what? Now what? reflective model.
Mindfulness
If you’re feeling stressed, you could try some mindfulness techniques, paying attention to the present moment, your own thoughts and feelings, and the world around you.
For more information and to view mindfulness based videos for nursing staff, visit: rcn.org.uk/healthy-you/time-and-space
Some people also find complimentary therapies, such as massage, reflexology or aromatherapy, are good for relieving stress.
Sleep
Sleep is the cornerstone of good physical and mental health. You can find lots of helpful information about how to improve your sleep pattern at: nhs.uk/live-well/sleep-and-tiredness/
how-to-get-to-sleep and nhs.uk/live-well/sleep-and-tiredness
Or you could try these NHS-recommended apps: Pzizz and Sleepio.
Try this at work
Try to organise your day differently or better – there’s a saying: “Failing to plan means planning to fail”.
• Prioritise – and delegate where appropriate.
• Take breaks.
• Say no – this is not always easy, but worth considering if possible.
• Plan a holiday.
• Raise concerns about your working environment with your RCN workplace rep.
For further information on what your employer should do to promote a healthy workplace see: rcn.org.uk/healthyworkplace
Outside of work
• Exercise more.
• Eat a healthy diet.
• Communicate – talk to someone you trust about the causes of your stress or anxiety.
• Socialise with friends and family.
• Pamper yourself occasionally – you really do deserve it.
• Make time for you – find an hour or two each week to do something you enjoy.
“Humour is recognised as a great stress buster. It distracts you and gets your brain working in a different way. So watch a favourite comedy programme, go to a comedy club, try a comedy podcast on the way home from work, or share a joke with friends or colleagues.”