Is Nursing All About Stress?

Whereas, I can appreciate your article.. the bottom line is nurses are CONSTANTLY bombarded with stressors from all angles.Nursing brings a unique level of anxiety. The solutions you propose will not lessen that anxiety. Nobody's got time for that.The only thing that will lessen a nurse's anxiety is manageable nurse -patient ratios, respect from hospital administration, respect from doctors, respect from the almighty corporations that work us like dogs to boost their bottom dollar.

Hey BTDT (short for Been There Done That - hope that's okay?) -I'd like to engage in some friendly and collegial dialogue here. Whatever I have to share is open for discussion, critique, or modification. And I do hope that you'll reply with your thoughts about what I have to share. With that in mind....I completely appreciate what you're sharing in terms of the work environment being full of stressors. I've been an RN for over 33 years, and have spent - literally - tens of thousands of hours at the bedside, working within the stress-inducing environments of bedside care. AND...I've suffered due to the relentless pressures that are exerted on nurses.Two responses; first off, I'm not implying that we need to "just learn how to deal with it," in terms of only working with our stress response without advocating for change. Far from it. We owe it to ourselves and our profession to fight the good fight and demand safe/sane nurse-patient ratios, respect from our peers, and pay equity/parity. So, I'm completely with you on these points.Second; because our environment, whether work, home, or...traffic, is bound to stress us, even under the best circumstances, we need to and can work with our most immediate locus of control which is...our mind and our physiology. What I'm sharing and - to a certain extent - espousing, isn't theoretical; it's practical, it's doable and it works. Whereas you wrote that, "The solutions that you propose will not lessen that anxiety," TONS of research has been done showing that the solutions that I'll propose in the next two parts of this series do exactly that. For almost all of us, anxiety or stress, is a physiological state, not a trait. As such, states can be mediated through a number of methods/means. And these means do positively impact stress reactivity and do reduce the perceived stress that we experience. I've been there and done that; I've allowed myself to drown in stress and have come damn near close to the edge of its precipice. In terms of "Nobody's got time for that" I want to request that we all ponder the alternative; if we don't take time to learn how to deal with stress and anxiety, what else is there? A life full of stress? The inevitable list of diseases and disorders associated with chronic stress in nursing? A never-ending battle of fatigue and burnout while tilting at windmills of external stressors? How better prepared can we be as we engage in culture change than to have our own act together, having managed our stress-reactivity. How much more effective will we be when one of the "corporations" who are working "...us like dogs.." comes to the bargaining table if we can address them without the burden of physiological and mental stress? And here's the real cool thing; changing how we respond to stressors and their impact on us doesn't take a lot of time. Really? Yes.....And that...is what I'll share in the next article (great segue eh?)Please respond, comment, and help to continue this incredibly important discussion.Take care,Jerome Stone

Quote from Been there,done thatWhereas, I can appreciate your article.. the bottom line is nurses are CONSTANTLY bombarded with stressors from all angles.Nursing brings a unique level of anxiety. The solutions you propose will not lessen that anxiety. Nobody's got time for that.The only thing that will lessen a nurse's anxiety is manageable nurse -patient ratios, respect from hospital administration, respect from doctors, respect from the almighty corporations that work us like dogs to boost their bottom dollar.

Hello NICUGUY (great name!) Thanks for the comment. Also, thanks for the quote by Charles Swindoll:"Life is 10% what happens to you and 90% of how you react to it." - Charles SwindollI hadn't read that one before; seems spot on in terms of what is being discussed here. And thanks for your insights on the use of physical activity as a way to defuse the impact that stress can have on our body and mind. Hockey? What a great (and intense?) way to blow off a lot of energy! NICU, L&D and Lactation; great clinical arenas. And so wonderful to see a "guy" in an arena that, for many years, was mostly women. Take care, Jerome

My 2 cents. Stress (often) occurs because of a conflict (sheesh, sounds Freudian, but that's not where it came from, to the extent that I am aware of it . . . just digging myself in deeper.)For example, I like having a job and I think that I need to do this, this, and that to keep the one I have. It's so anxiety provoking to be out of a job and to have to look for a new one and to try to make ends meet, so I'd like to keep this one. But, this policy or that law and that co-worker or this patient and the lack of appropriate resources are making it extremely difficult if not impossible to do this, this, and that, all the time, every time, and to follow this policy or that law etc etc. When is someone going to write me up, when am I going to get dinged in my performance review, when is someone going to layoff people and maybe I won't be in that someone's good graces.It is not possible to control any of these things or to control anyone's perception. Anyone given a lot of responsibility that is measurable, such as nurses but not only nurses, but without authentic and significant input into legislating and executing policies, law, and compensation, is going to live with unreasonable stress.The fact is there is a lot of unreasonableness in nursing and many other occupations/professions/positions where a person is being measured all the time (and many of the metrics are sick and subjective) and has little or no authentic and significant input/authority over the metrics and appraisal and compensation.Given the realities, a person has to make a dignified peace, whatever that looks like to them, or suffer blindly and perpetrate that suffering on others. Blindness is ugly. If the article offers tools to help people make a dignified peace for themselves, great. The tools and people using them have to acknowledge the realities, both positive and negative, in order to be used successfully.

Hey there bbyRN - Eloquent! "a person has to make a dignified peace, whatever that looks like to them, or suffer blindly and perpetrate that suffering on others. Blindness is ugly" I couldn't have said it better myself...glad that you did!! You contributed perfectly to this discussion and took it to a "bigger picture" level; thanks for your insights. Take care, Jerome

I work at a place where Management decides to make changes that affect my job without letting me know. Then all of a sudden when there is a problem, I am expected to clean up the mess that was created due to them not knowing what I do on my job or how I have been handling things which now has been totally turned upside down. Or all of a sudden get a call wanting to know where reports are that should have been sent a month ago, to which I had no idea they were needed due to the Physicians not informing me they were needed after they had seen the patient. Having a Physician that calls the Secretary to given her instructions to give me regarding procedures to start on a patient while he is on his way to the clinic. Yes all this can cause stress! Being responsible without knowing what is going on. That is the culture and has always been at the place I work. I called and spoke to the Nurse I replaced and she said it changed about 10 years ago. Has went downhill since then. I wish I had known would have left before I have to worry about jeopardizing my Nursing License.

Hello she57 - Ugh! The scene/situation that you've described is so prevalent in nursing isn't it? Very frustrating, sometimes even maddening. So, what do you do in these kind of situations? In terms of jeopardizing your license; what have you done to protect yourself? Do you file occurrence or incident reports when things happen that aren't your fault but are due to policies? Have you voiced your concerns and offered solutions? Sometimes it's so easy to get caught up in the whirlwind of the system that we forget that there are things that we can do to, if not solve the problem, at least address it and cover our own....license! What causes us to get caught up in the whirlwind is our habit of stress-reactivity; we get so bound up because of the sheer numbers of stressors, that we forget that there are alternatives. That's why I wrote this series; because while we may not be able to change what's going on *out there*, we can change our own inner landscape. Yah!!Take care,Jerome Stone

Quote from nicuguyWhile I do agree that better nurse-patient ratios and your other suggestions have merit, I wholeheartedly disagree that those are really the answers. As nurses and human being, we can't always control the external environment as much as we try, but we can control our internal reaction to such situations. As the OP also discussed internal locus of control is paramount in working through situations where external stressors are high and ability to control the external situation is low."Life is 10% what happens to you and 90% of how you react to it." - Charles SwindollLet's also examine my reality having worked in 10+ hospitals in multiple states. The majority of the nurses I have worked have either lost or choose not to use their ability to control themselves to help decrease the effect of the stressful situation. There are certainly those who just need a little time off to unwind, but so many people don't actually have real outlets today. Me? I play ice hockey AT least once a week which realistically takes two hours of my time but has innumerable benefits for my physical, emotional, and spiritual state. More people would benefit from having a physical outlet when working in a job such as nursing that does have many uncontrollable stressors on many sides (patients, physicians, administration, insurance, etc).My argument in total is that the onus in on the individual to consider what their reaction to stress is and understand how to control that reaction rather than focusing on the stressor itself which often is truly out of their control. Though I'm almost certain I just paraphrased what Jerome Stone said.

Hi eroc - Thanks for getting engaged in this discussion. You wrote that, Stress depends on how you let it happen and is self-inflicted from an emotional standpoint.

Quote from Jerome Stone RNHi eroc - Thanks for getting engaged in this discussion. You wrote that, My experience is that the emotion may not be self-inflicted, i.e., that an emotional response may be the involuntary physiological response to a stressor/trigger. What can be self-inflicted, and what we can work with, is the habitual tendency to create more trauma/drama around our perceptions and interpretations of those emotional/physiological responses. And many times even the "self-infliction" of our habitual ways of doing things is completely unconscious! That's why beginning to work with our mind is such a powerful tool in learning to change our stress-reactivity.Thanks for contributing to the discussion. Take care,Jerome Stone