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Stress may be one of the most overlooked issues that nurses and nursing students face. Yet, it is one of the most impactful as it can affect many aspects of work and personal life. Bedside nursing places high levels of emotional and physical demand on healthcare professionals.
Stress can affect the physical and mental health of nurses, which unfortunately can overflow into patient outcomes. It also undermines nursing retention and can hurt a healthcare organization's finances.
Although not all stress is negative, even positive stress can have a negative effect on an individual. Since the mid-1950s, researchers and scientists have recognized that stress is an occupational hazard for nurses. Therefore, learning how to manage stress as a nurse is the key to enjoying a long and healthy career.
During the COVID-19 pandemic, nursing students made the transition to managing classes and clinicals online. Additionally, it became obvious there were pitfalls in the healthcare system that affected patient care and nurses' physical and mental health. These challenges include understaffing, unsafe work conditions, financial losses for the provider, and under-resourced hospitals. As healthcare systems move forward, it is essential to mend these gaps to prevent poor patient outcomes.
Common Stressors in Nursing
A 2011 survey sponsored by the American Nurses Association discovered that combining and integrating person-focused strategies helps manage stress as a nurse at the individual level. Organization-focused strategies eliminated some conditions that helped reduce and prevent job stress.
Some of the common stressors for nurses include working during a nursing shortage. The current shortage is expected to intensify as the last of the baby boomer generation become senior adults. To compound this, nursing schools are struggling to meet the rising demand. Although the U.S. has periodically experienced shortages since the early 1900s, the current magnitude is more significant than ever before.
There are several reasons for the nursing shortage. For instance, as the baby boomer generation ages, it has also led to a large portion of the nursing workforce retiring.
Additional factors that lead to stress on nurses include extremely long shifts as compared to other professions. For example, hospitals have moved to nurses working 12-hour shifts, which gives nurses the option of working four days and having three days off. However, when overtime is required, nurses may be working 16-hour shifts multiple days in one week.
The nursing profession requires many high level nursing skills such as critical thinking, which increases mental strain daily. Working in an under-resourced and understaffed unit increases workplace tension and can lead to higher stress levels.
Nursing is an emotional labor of love. Nurses often must conceal their feelings of frustration, anger, or anxiety while on the job.
These are some of the common stressors that nurses experience daily. During the COVID-19 pandemic, an additional burden is placed on healthcare professionals and nursing students across the country. This only adds to the mental, emotional, and physical stress under which nurses must work.
COVID-19 Is Increasing Burnout and Stress in Nurses
COVID-19 has been responsible for an added burden of stress and burnout in nurses. According to one study from Wuhan, China, the pandemic added a psychological burden to frontline healthcare workers. This has also contributed to the post-pandemic nursing shortage.
The data confirmed past studies that reported negative adverse psychological reactions during the 2003 SARS outbreak. Healthcare workers feared infection, felt stigmatized, and reported reluctance to go to work. Additionally, they experienced anxiety, depression, and high levels of stress.
Not surprisingly, healthcare workers have the highest risk of contracting COVID-19. Thankfully, the infections had a low mortality rate. Experts counted 3,561 deaths of healthcare workers from March 2020 to March 2021; 32% (1,139) were nurses.
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How to Cope and Manage Stress as a Nurse
It is crucial to cope with and manage your stress levels. Fortunately, proven strategies that reduce stress are not complex or complicated. They are simple, consistent practices you can incorporate into your everyday routine.
It's important to remember that stress is a normal part of everyday life. However, chronic stress can increase your risk of heart attack, stroke, and Type 2 diabetes. Using the tips below, you can build a daily routine to help reduce your stress and protect your health, whether you're a working nurse or a nursing student navigating online school.
Maintain a routine to alleviate anxiety.
People are creatures of habit. Developing a routine raises the potential you'll successfully use strategies to promote your health and wellness. Routines keep you organized, structured, and can improve your health. This is especially important during stressful times. Even if you don't typically thrive on a strict routine, it can give you a sense of control, improve your focus, and increase productivity.
A routine helps you to cope with change and stress like balancing work and school as a nurse. It takes approximately 21 days to form a new habit or routine. If you set a schedule and stick with it for three weeks, you'll slowly see a reduction in anxiety and burnout.
Eat healthy to boost energy, mental performance, and sleep quality.
There is no denying it — life as a nurse is busy! Yet, there are ways to incorporate eating a healthy diet to support your physical and mental health. For example, refined carbohydrates, sugar, processed foods, and trans fats are all associated with depression. Consider these tips to eating healthy on a busy schedule.
- Make a menu and a shopping list from the menu, so you have everything you need each week.
- Swap canned or frozen vegetables for fresh.
- Eat a nutrient-rich snack when you're busy, so you don't have to cook. Combine nuts, cheese, raw vegetables, dip, and fruit, depending on what you're in the mood for.
- Cook once and freeze the leftovers for an easy healthy meal with no preparation.
- Prepare breakfast the night before so it's "grab and go."
- Drink plenty of water to stay hydrated.
- Pack your own snacks if you get hungry on long shifts.
Good sleep reduces anxiety and depression.
It would be best if you were spending one-third of your life asleep. That's because sleep is essential to your health, especially getting better sleep as a night shift nurse. Research shows that sleep helps you relax, destress, and can reduce your risk of dementia. Symptoms of deprivation include slowed thinking, poor memory, lack of attention or focus, and inefficient decision-making.
Take care of your sleep environment and prebedtime habits to increase having a great night's sleep. Your bedroom should be a place where you sleep (not work).
- Don't watch television or bring work to bed with you.
- Keep your room cool and dark.
- Use room darkening blinds and a sleep mask if needed. This helps your body produce melatonin and fall into a deep sleep.
- Don't eat before bed as it raises your energy level and may make it difficult to stay asleep.
Exercise regularly to lower stress, improve mood, and sleep quality.
Although you are likely walking miles on every shift, exercise outside of work has benefits of its own. Data show that regular exercise has a significant impact on your mental health. In fact, exercise is commonly recommended by therapists treating individuals for eating disorders, stress, anxiety, and depression. Exercise lowers your stress hormones, helps release endorphins, and improves your sleep quality.
Spend time in nature to lower stress hormones.
Spending time outdoors can help reduce your stress and anxiety levels. Research finds that just 20 minutes outside can help lower your stress hormones. If scheduling an outdoor walk seems like just one more thing to add to your list, consider how you might incorporate a walk into your daily errands.
Is there a park between the grocery store and your home where you could take a quick stroll before shopping? Do you get off work during daylight hours and could take a walk before heading to your car? Can you help your elderly neighbor by walking her dog occasionally?
Practice setting healthy boundaries.
Setting boundaries is essential to good mental health. It isn't always easy, but the end result is well worth the effort. For example, you may find that it's necessary to say "no" to one more overtime shift if you are feeling exhausted. While this may feel difficult when the hospital is understaffed, it is essential to effective patient care that you are alert and focused while on duty.
Having a healthy support system is essential to mental health.
A strong social support system in close friends and family has far-reaching benefits. Your network can play an important role during stressful times. On the other hand, isolation can cause more poor lifestyle choices and increase blood pressure. It also promotes a poor ability to cope with stress. Social support can mitigate vulnerabilities and improve resilience to stress.
As a busy nurse, it's essential to maintain your social network. Schedule times to regularly check in with your close friends and family. While digital communication is a quick way to schedule a coffee or phone conversation, it is not a substitute for face-to-face interaction. If you don't currently have a strong support network, consider looking for friends through volunteer opportunities, religious organizations like church or temple, taking a class, or joining a gym.
Connect with a therapist to form healthy coping mechanisms.
Improving your mental health has significant benefits for your physical health and your patients. One strategy is to form a relationship with a mental health specialist or counselor. They can help you identify specific stressors in your life you may have overlooked.
Choose a therapist who is familiar with cognitive behavioral therapy to learn tactics to lower your stress levels. This can help prevent nurse burnout. Burnout can lead to cardiovascular disease, obesity, insomnia, and depression.
Practice mindfulness to combat anxiety.
Mindfulness is a state in which you attend to the present. This means you don't judge your thoughts or feelings as good or bad; you let your thoughts pass through you and focus on being present. It also infers that you are aware of your current surroundings and do not practice daydreaming.
Being mindful of the present can help combat depression and anxiety. These feelings are often rooted in concern over what might happen. Mindfulness practices include meditation, yoga, and body recognition. These are self-care for nurse practices that you can learn and use at nearly any time to help reduce stress, such as at work, on the drive home, or while taking care of family obligations.
Prioritizing self-care improves emotional health.
Self-care is not the same as self-indulgence. Instead, self-care means caring for yourself in a way that promotes health and wellness. This includes self-care products for nurses, strategies to improve your nutrition and diet, seeking medical care when needed, and building healthy lifestyle choices into your daily routine. You will experience the benefits of lowered stress and anxiety, greater energy, and a better outlook on life.
Self-care strategies include many of the tips on this list, such as:
- Staying connected to friends and family
- Eating a healthy diet
- Spending time outdoors
- Setting healthy boundaries
Connecting with loved ones relieves stress.
Being around loved ones releases a powerful hormone in your body called oxytocin, which aids in relaxation. Historically, scientists have found the hormone is released during childbirth, breastfeeding, and sex. But we now know that most forms of social bonding or positive physical contact can also trigger the release. Activities like petting an animal, moving in sync with a group, like at a concert, or even eating together can also trigger the release of oxytocin.
During one human couple study, researchers administered oxytocin intranasally before a conflict discussion. They found couples using oxytocin had more positive communication and lower levels of the stress hormone cortisol. Another study found that individuals who perceived support through hugging experienced reduced stress and less severe signs of illness. This is why it is essential to maintain relationships while in nursing school or at work.
Spending time with your pet can improve your mood.
Science has discovered the unconditional love of a pet can help reduce stress and improve heart health. Interactions help reduce levels of cortisol, blood pressure, and loneliness.
Pets can also boost your mood and increase feelings of support. Studies have also found that spending time with a pet can help release oxytocin, including petting your dog. If you don't have a pet at home, consider volunteering at a local shelter to get your doggie therapy.
Breathing techniques regulate your nervous system.
Deep breathing helps your body relax and lowers your stress level. This is because deep breathing triggers your brain to send messages to lower your heart rate and blood pressure. Using deep breathing is a good way to help reduce stress in the moments when you are in a tense situation since it helps to regulate your nervous system.
Daily inspiratory muscle training also helps lower blood pressure and improves endothelial function and oxidative stress. Daily training may also help improve your response to deep-breathing strategies when you are under stress.
Journal regularly to help with emotional regulation.
Talking about problems has been a source of stress relief for centuries. Writing and journaling is another way of releasing emotional stress and gaining a better perspective over a situation. Journaling is a strategy where you keep a record of your thoughts, feelings, and insights on paper or a computer.
It may initially feel like work, but the benefits include:
- Reducing anxiety and stress
- Creating greater awareness of the situation
- Regulating emotions
- Speeding physical healing
It is important to find a technique that works for your lifestyle. For example, "morning pages" is a strategy for writing your thoughts first thing in the morning. This technique may be great to practice on your days off or if you work a night shift.
A gratitude journal trains your brain to prioritize things for which you are grateful. Another form of journaling is a prayer journal where you write your prayers and the concerns you want to share. Others find relief by writing letters in their journal as if they are talking to their friend about what's happening in their life. However you choose to use a journal, it's easily some of the best 10 minutes you'll spend relieving stress.
Laughter has healing benefits.
Reader's Digest had it right for many years: Laughter really is the best medicine. Laughter can lower your stress hormone levels, distract you from stress and negative emotions, give you perspective, and help you connect with others. As you laugh, you take in more oxygen, which helps your muscles relax. Laughter supports your immune system, lowers your blood pressure, and raises endorphins.
During a busy day, you can listen to a funny podcast on the drive to or from work, follow a funny social media account, or watch a comedy routine on YouTube. Think about hosting a game night with friends and family or watch a funny movie after work. By seeking out and finding humor, you can change your attitude, change your stress level, and even change your life.
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