You can't be a nurse without knowing that stress is a major problem in our profession. There are numerous articles about the effects of stress on nurses, including posttraumatic stress disorder (PTSD) in new nurses and how difficult it is to recruit and retain specialty nurses due to the stress of their roles.

Strangely enough, in a recent report of the most stressful jobs, nursing didn't even make the top 10, whereas studies do suggest that high-stakes decision making is responsible for the most stressful jobs. Police officers, firefighters, and airline pilots did make the top 10. If you ask most nurses, they would probably disagree with this report; 70.5% of nurses cite the acute and chronic effects of stress and overwork among their top three health and safety concerns, and 75.8% report that unsafe working conditions do, in fact, interfere with their ability to deliver quality care.

Stress and the damage done

A review of the literature and studies on stress confirms that stress can cause, or be a contributing factor in, a variety of problems, including, but not limited to, high BP, heart disease, asthma, obesity, diabetes, headaches, backaches, depression, anxiety, PTSD, substance use disorder, insomnia, anger issues, gastrointestinal illnesses, decreased immune response, accelerated aging, and even premature death. Additionally, stress reduces decision-making capacity and can lead nurses to make poor decisions, thus compromising patient care. Poor decision-making capacity can also lead to an increased risk of work-related injuries.

Frequently cited reasons for stress in nursing include high-stakes decisions, long hours, the inability to take breaks, alternative schedules, and poor work-life balance. Now that reimbursement is being tied to patient satisfaction scores, there's increased pressure on hospitals to operate more like hotels, further increasing stress on nurses to perform. Additionally, The Joint Commission requires more documentation of nursing interventions to meet national safety guidelines. This takes additional time in an already busy schedule, shrinking the amount of time a nurse has to perform his or her work and further increasing stress levels.

Stress can contribute to nurses leaving their jobs and the nursing profession. It can cost up to $93,000 to recruit, hire, and orient a new RN; it benefits the healthcare organization to reduce nurses' stress levels and increase their workplace satisfaction. Hospitals have tried to help combat stress with wellness programs, including teaching meditation, increasing exercise programs for their personnel, offering positive thinking seminars, and implementing gratitude programs, yet the stress continues to increase.

Have you laughed today?

If you're a nurse experiencing stress overload, I highly recommend finding solutions that work for you. You must take care of yourself first and foremost. Think of being on an airplane during the standard safety speech. They tell you if the oxygen mask drops, place it on yourself first and then assist others because if you don't take care of yourself, you can't take care of anyone else.

Besides exercise, other helpful ways of managing stress include making sure you're eating a well-balanced diet on a regular basis, drinking enough water, getting enough rest and sleep, balancing your life with activities that make you happy, decreasing unhealthy coping mechanisms such as smoking and alcohol, speaking with colleagues and supervisors, and talking with therapists. Most hospitals have an employee-assistance program that will often allow up to five visits a year to a psychologist to learn healthy coping mechanisms. Support groups can also be helpful.

After you have a handle on your own stress, what can you do to help your colleagues who are stressed out? If you notice that a coworker is showing signs of severe stress, you can offer to answer his or her call lights and maybe assist with some tasks such as toileting a patient. Offer to bounce ideas off of each other to prioritize care and make tasks easier, or just lend an ear for support. Charge nurses can rotate patient assignments for difficult patients. Notify management about any problems that are causing excessive stress in the workplace. Remember, managers can't make changes to help reduce stress if they don't know what the problems are.

There's one tool, however, that we seem to forget-laughter. It can lessen stress, provide relaxation, and decrease depression. And there's one thing that we can usually still laugh at without much criticism-ourselves. Do you ever get the feeling that we need to bring back laughter? I truly believe that the ability to laugh at yourself actually increases your self-esteem and happiness. There's a reason why older nurses are known for their sense of humor; we know how to address our stress.

Laughter: The best medicine

So you're having a horrible shift, nothing has gone right, you have all high-acuity patients, and at least 5 hours more work than can be accomplished in a shift. You finally get 3 minutes to go to the bathroom and scarf down a quick snack. What's there to laugh at? I remember that my grandmother taught me to get through something difficult by making a game out of it (at the time, for me, it was third grade and fractions). So my last few years taking care of patients, I started looking at the games we play as nurses. See how many of these games you recognize.

* Scavenger hunt. This game is most frequently played by night nurses; however, any shift can play. Central supply hasn't refilled a product you need for patient care. You can't reach central supply for whatever reason. What do you do? Start scavenging the other hospital supply rooms, patient rooms, and so on until you find the necessary supplies. Night-shift charge nurses make the best scavenger hunters. You can't beat them! This is because they play this game often for several hours a night while central supply is closed.

* Hot potato patient. This is most frequently played with more difficult patients who've been in the hospital for longer than a week. The difficulty can be due to acuity or temperament. Suddenly, none of the nurses believe in continuity of care; they'll do anything to avoid taking this patient. During assignments, the charge nurse finds him- or herself with a wide variety of assignment changes after shift change to accommodate the multiple issues of taking care of certain patients. New admissions often fall into the hot potato patient mold. And nurses who were seemingly caught up are suddenly too buried in work for even the simplest of patients.

* Not it (a variation on tag, you're it). The call light system in older hospitals often makes it difficult to see which call light is going off unless you're sitting next to the system. So, the one nurse working near the system will call out the room number of the patient who's calling his or her nurse. That nurse, of course, is likely in a patient room. All of the nurses who are actually at the desk will start calling out "not it!" Usually, this game results in the charge nurse answering the patient's light.

* Hide and go seek. This one is a variation of hot potato patient. The nurse who plays this game usually has a very demanding patient that he or she is seeking to avoid. Suddenly, this nurse spends the entire time being impossible to find. You swear the nurse is nowhere on the unit, but he or she is generally in an easier patient room, finding any reason to stay in there.

These are a few of the games we play as nurses. The next time you find yourself frustrated, see if you can identify the game. I guarantee that it will bring a smile to your face and reduce your stress level at least a little. These games do increase the stress of our workplace by being huge timewasters. But the first step to reducing that frustration, and therefore decreasing your stress, is to recognize them. Then, if you find these timewasters are a problem on your unit, it's time to address them.

I recommend sharing these with your unit during a staff meeting. You can even do a study in which checkmarks are used under each game per 1-week shift. Each nurse records how many times he or she found him- or herself playing one of these games to identify how much of a problem they are and what solutions need to be found. Reducing these games increases time management, decreases general frustration on the unit, and lessens stress. But until they're solved, sometimes you just need a bit of laughter as stress relief.

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