“I resigned my staff nurse position today,” my young colleague confessed, “after only 7 months. I loved taking care of patients and families, but just couldn’t take it anymore – the other nurses complaining, but never speaking out, the rude behavior and put downs, and the nurse manager who made bad decisions and supported the wrong people – will it be like this in my next job? I feel like such a failure.” I have heard this story at least three times over the past year and I am only an N of 1. Recent studies have documented the alarming percentage of nurses who are leaving their jobs or leaving the profession climbing to 17.2 % in 2016 and costing hospitals an average of $5.2M – $8.1M annually. ¹ Reasons cited by nurses for leaving include poor management, and stressful work conditions, including inadequate staffing, verbal abuse, and work-life balance issues. ^{2, 3} While employing organizations are deciding how to tackle this problem, you need stress relief now to get you through the day. First, let’s revisit the concept stress, then consider a few simple and creative strategies that you can use to get the elephant out of your workday ---- STRESS!

Stress Revisited

Hans Selye, a Canadian physician, conceptualized the “stress response” and conducted research on how it worked after observing patients’ responses to the stress of hospitalization. ⁴ “Stressors” are those factors experienced or perceived by individuals as causing harm or distress. “Experienced” or “perceived” is an important distinction since the stressor can be real and direct like a contracting a virus or being robbed at gunpoint or the stressor could be the result of how we view a situation; a putdown for one nurse can be devastating and for another a minor blip in the course of a day’s work.  The apathy of her colleagues, rude behavior, put downs, and the passivity of the nurse manager were my colleague’s perceived “stressors.” Stress, on the other hand, is the individual’s reaction or the body’s response to real and perceived threats whether that reaction is manifested physically or mentally. In this case, my young colleague’s reaction was to let the stressors overwhelm her to the point of leaving – remember fight or flight? She could have tried to “change her perceptions,”  “change her reactions,” “change her behavior or get help,” instead the stress led to resignation.  Depending on the severity of the stress, individuals and organizations always have a measure of control in managing “stressors.”  Instead of merely reacting, striving to develop a deep awareness of how you can plan, craft, and control your responses to difficult situations can be the first step to stress inoculation. 
 

Stress Inoculation

                You get to choose how to “vaccinate” your stress. Choose “ingredients” based on your preferences, style, and time – some take no time, others take a commitment of 20 minutes to half an hour per day. Try one strategy per week to find what is right for you. Continue with those you believe are helping you to respond effectively instead of reacting haphazardly and then move on to more structured and serious stress management modalities. Below is a simple formula to begin stress reduction. It’s your choice!   

• Move -- Twenty minutes a day of running, walking, cycling, etc., will help to dissipate the effects of stress. Regular exercise improves cardiovascular function, produces endorphins in the brain that result in improved mood, strengthens muscles, and improves tone.  If you are not inclined to run, sign up for yoga or Pilates.  These meditative exercise forms stretch and tone your body and improve your posture and flexibility which can become a metaphor for how you respond in stressful situations. Regularly moving the body increases body awareness during stressful interactions.  So, if you experience bullying or other negative interpersonal encounters on the job, use your body’s signals to respond – stand taller, face your nemesis or – if you are too rattled – leave the scene, it is your absolute right to remove yourself from such situations.  Better yet, dance!
• Rehearse difficult conversations in the privacy of your car – you could even let loose, scream, use profanity – no one will hear you but you, and hearing how you respond or “talk back” can be helpful in changing your verbal responses during stressful situations. Just be cautious; if someone in the next car notices your solitary conversations, just smile, fiddle with the radio and pretend you’re singing. Rehearsals should help your responses become more rational, more focused, less defensive and more “I” oriented. Read up on developing calm, assertive responses or join an assertiveness training group. In time you will be surprised when the assertive responses that you rehearsed become natural and automatic during difficult situations.
• Laugh – Humor provides release and helps put things in perspective.  Most importantly, laugh at yourself even at your best efforts.  At the urging of my internist, I hired a personal trainer and worked out 2 days a week for 2 years – the result, I spent $3,000 dollars and lost three pounds but I was “toned.” I am still laughing at the result. Get a small group of like-minded nurse colleagues together and watch funny SNL’s vignettes or YouTube videos. My SNL favorites are from the 1980’s particularly Jane Curtin attending assertiveness training class or Roseann Roseanna Danna reporting the news.  Humor heals and humor shared is even more healing.
• Reframe difficult situations, that is, change the meaning, the emotional tone, or your viewpoint of a difficult situation and place it in another frame.  Remember when Huckleberry Finn, a Mark Twain ⁵ character,  had to whitewash the fence – it was work he did not want to do but he “reframed” and pretended to be having such great fun that all his friends begged to help and he finished in record time. How would you reframe a heavier than usual patient assignment or having to work on a holiday?  It is possible to change what we think or how we view any situation.  Conjure up at least 3 positive or at least, neutral interpretations of the next difficulty you encounter.  Flexing perspective is liberating.
• Imagine – Your imagination can save you from revealing negativity, disapproval or even fear.  Use fantasy to get yourself through difficult situations. For example, when attending that meeting you dread with all of those difficult colleagues gathered in one place, imagine that you are all different animals in a zoo. Imagine the sounds they would make when things got tough or how they might gallop or slither from the room. You will get a pleasant look on your face when you are fantasizing and group members will think that you are relaxed and have it together.  The rule is to keep your fantasy private.
• Sing in the privacy of your car or the shower. Sing uplifting and inspirational songs that emphasize self-empowerment. Or download the following songs on your phone and sing along or listen on your break. Music reorganizes the brain and the messages sung are uniquely remembered. Here is a selection of empowering songs to get your started. If you are of my vintage, Sinatra’s, “I Did It My Way,” or “I Gotta Be Me,” or a few pop favorites, “Let it Go,” or “Brave,” or “Fight Song.”  It you are hip, there is Des’ree’s “You Gotta Be,” and if you are inclined to country music, one of my favorites is Bobby Bare’s, “Drop Kick Me Jesus thru the Goalpost of Life.” In Bobby’s words, “If you have the will, God has the toe.” Make your own song selections and share.

So there is it, a simple formula that will get your started to managing every day stress:
  If your health is at risk or your situation is dire, consult a health professional.  Take care of yourself!
 

References:

1.  2016 National Healthcare Retention & RN Staffing Report Published by: NSI Nursing Solutions, Inc. www.nsinursingsolutions.com.  Accessed 4/30/2017

2. Flinkman M, Ulpukka I, Salantera  S, International Scholarly Research Notices. August 20, 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762080/  Accessed 4/30/2017.

3. Robert Wood Johnson Foundation. The RN Work Project, September 1, 2009. http://www.rwjf.org/en/library/research/2009/09/the-rn-work-project.html.  Accessed 4/30/2017

4. Selye H. The Stress of Life. New York: Mc Graw Hill, 1956.

5. Twain, M. Adventures of Huckleberry Finn. Costa Mesa, California: Saddleback Educational Publishing, 1999,2011

Gloria F. Donnelly, Ph.D., RN, FAAN, FCPP
Professor and Dean Emerita
College of Nursing and Health Professions
Drexel University
Editor in Chief, Holistic Nursing Practice