Is Nursing All About Stress?

Jerome Stone RN

PART ONE: IS NURSING ALL ABOUT STRESS?

As nurses, we know the meaning of stress. In fact, we may know its meaning more intimately than most of our peers who work in other professions. This is partially because we've seen the devastating effects that chronic stress has on the bodies of our patients. It's also because nursing is reported to be one of the most stressful professions. Why is it that when we enter into discussions on how to decrease stress in nursing, we usually point to changing things external to ourselves and that when we try to change how we deal with stress, we usually end up stressing out about that too?

I think that asking the question, "Is Nursing All About Stress?" is preposterous, don't you? Because, nursing isn't all about stress, right? It's about caring, compassion, kindness, clinical expertise, critical thinking and many more wonderful qualities embodied by thousands of nurses.

Why then does it seem that so many articles having to do with the nursing profession tend to segue into the challenging aspects of the profession, inevitably leading to a discussion about burnout and fatigue? In fact, these days there's so much written on the subject of burnout that you'd think that there's an epidemic happening in our profession. Is there?

The sources of this epidemic are varied but in general, the "all-inclusive" reason comes down to stress; stress due to workload, stress due to working nights, stress due to short staffing, the list goes on interminably. But, what's at the heart of this stress?

Many nurses will describe their work environment as "stressful." Does that mean that the environment is full of stress, or that the people who work there are all stressed? Let's look at definitions to make sure that we're talking about the same thing here.

DEFINITIONS

Many people use the word stress to describe both the external factors that are the cause of stress, as well as the physical experience of stress. Let's get on the same page here.

Definition of stress - (partially from Merriam Webster online, and partially my own definition) is a state resulting from a stressor; especially - one of bodily or mental tension resulting from factors that tend to alter an existent equilibrium OR: a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances.

I think that the inclusion of the word equilibrium is very important. THAT is what we're working for with stress management, maintaining our equilibrium.
Let's remember the word "state;" it's key to learning how to decrease our experience of stress. If stress is just a state, then it's something that can be changed.
So, stress is the physiology that we experience when we're stressed, it's the "juice" that can get us going when something stresses us out. And it's what we're going to learn how to work with to decrease its impact on our lives.

Definition of stressor - (from Wikipedia) A stressor is a chemical or biological agent, environmental condition, external stimulus or an event that causes stress to an organism. AND: (My insertion here) In some cases, a stressor can also be an internal stimulus; an example of this would be chronic pain or illness.

So, stressors are the things in life, in our environment or internally, that cause us to experience stress.
I make the distinction because a lot of people will say things like, "There's so much stress at work..." when in fact, it's the stressors at work that are the triggers for us to experience stress.
I also make the distinction between stressor and stress because it's by learning what we can change, I.e., the stress that we experience in response to stressors, that we can manage it.

Stress management - (My definition) The ability to manage your body and mind, your internal environment, so that even while stressors may be present you're able to maintain internal and external integrity in a way that benefits not only yourself but those around you as well.

FEELINGS AND EMOTIONS

There are two more definitions that we need to include. Often times, these two terms are mixed up and confused with one another. *NOTE: I've even found differing definitions listed on the web, so for the purpose of this discussion, let's use the following ones.

The first term is emotions. Emotions are the physiology, the "juice," that we experience in our body and how our body interprets the input from the outer world, including how we interpret stressors. In many cases, our emotions determine how we experience stress.

Feelings, on the other hand, are how our mind interprets our emotions. We experience a rapid heart rate, or fast breathing, and "feel" (mentally and psychologically interpret these emotions) as excitement or anger. Or we experience a slowing or dampening of our senses and feel sadness or depression. We'll talk about this later, but it's often our feelings about something that cause us to perpetuate the stress in our body.

So, stress is the emotional component of our experience, and feelings are our interpretation of our emotions.

STATS ON STRESS

I'm all about facts. A facts-geek and researcher at heart, I love to hear about what other researchers have discovered about human nature and the mind-body interface. So, let's look at a few facts that can inform us about how prevalent stress is in the nursing population.

According to many reports, stress is the number one reason for nurse burnout. In fact, because of stress at work, 17% of all newly licensed nurses leave their first job within the first year, and up to 33% leave by the end of the second year. This costs an average teaching hospital up to $6.4M per year!

How about some stats on what stresses nurses out the most?

You probably have your own experience of stress at work, so what I'm about to share with you may not be a huge surprise...or it may. Let's take a look at the "top 10" stressors experienced by nurses and see how many of them are familiar in your work world[ii] [iii]:

Conflict with physicians.
Bullying.
Problems with peers.
Dealing with death and dying patients.
Problems with supervisors.
Discrimination.
Heavy workload.
Lack of balanced meals/mealtime at work.
Lack of rewards/poor reward system.
Physical stress of lifting and caring for heavy-care patients.
...oh, I only said 10 right? That's enough; we could probably come up with a dozen more, but that's not the point of this article. The point of this article is for you to learn how to deal with stress so it doesn't keep your health and wellness. So...

And, here are just a few physical symptoms experienced by those who are stressed. There may be a chance that you've experienced one or two (or more?!) of the following:

Fatigue - 51%
Irritability - 50%
Feeling nervous - 45%
Lack of energy - 45%
Headache - 44%
Feeling as though you could cry - 35%
Upset stomach - 34%
Muscle tension - 30%
Change in appetite - 23%
Teeth grinding - 17%
Change in sex drive - 15%
Feeling dizzy - 13%

I'm sure that you could have told me many of these facts without relying on official statistics. Still, it's interesting (and alarming) to find out just how many nurses worldwide experience stress to the point where it affects their work quality and endangers their patients.

Now that we know what we're talking about, let's talk about what we usually do to deal with stress and what's at the heart of why we experience it (as well as how to relieve it)

HOW WE MIGHT DEAL WITH STRESS:

How do you normally deal with stress? There are many ways that we can deal with stress, both "positive" as well as "negative." However you deal with it, you're not going to hear any judgment from me. I've done IT both ways, positively and negatively. Besides learning how to deal with stress, there were many times in my past when I went out for (too many!) drinks after a nasty shift at work. I've also had my fill of acting out in ways that, looking back on them, probably hurt others as much as I hurt myself. Fortunately, I'm too old for that now and...I've got different skills.

What are some of the ways that we think that we control stress in our lives? Again, this isn't about judgment or right or wrong. Nothing that you think about while reading this article is going to leave this room.

Try to control our environment. Right? We can try to control all of the stressors in our lives, but does that work? Not really; there is an endless number of stressors available to test our patience. We could spend our entire lives trying to control our environment. It simply doesn't work.
Thinking that we can be happy and find relief from stress, we buy ourselves lots of new toys or gifts. This probably isn't going to work because eventually, the "toy" will break, or we'll get bored, and then we're stressed again.
We spend our time finding activities to keep ourselves distracted and find new "stress relievers" every day. Some of them are great, like spending time with our family or friends, yoga, exercise, or reading. Others, like impulse eating, consuming too much alcohol and arguing with our loved ones aren't as good.
We can think of meditation as a way to "bliss out" and shut the world out, trying to keep our mind free from thoughts - good luck! - and ending up just as stressed about our meditation as we were about the other stressors in our lives. We'll talk more about this later.
And I'm sure that there are more that we could mention.

THE EMOTIONAL COMPONENTS OF STRESS:

Remember when we defined stress and stressors, and emotions and feelings? Let's look a bit at the cycles of emotions and the responses that we usually have in trying to deal with them.

Sometimes, when I'm getting ready to present to an audience of new people, I'll experience a rapid heart rate, maybe sweat, feel a little "buzz" in my nervous system. There's no problem with this though; up to that point, it's all good. I've just got some physiology (emotions) bubbling away. BUT, when I take that emotion, interpret it as a "bad" feeling, and then start creating thoughts and ideas about it, that's where the slippery slope starts.

See, up to the part where we just experience the emotions, and maybe even after we've labeled them, we actually haven't gotten into any trouble. The trouble starts when, due to our habits of stress reactivity, we begin elaborating on what we're feeling and start labeling it "good," "bad," "pleasant," or "unpleasant." And where does that trouble start? In the mind.

THE STRESS-FREE "YOU":

Let me ask you a question:

Have any of you ever had a time in your life when you weren't stressed? Of course you have.

Well, let me ask you a really silly question; I'm sure you'll get this one right:

Was it you who wasn't stressed during these times or was it someone else?

You, right. So, what's the difference between that "you" and the "you" who gets stressed?

We all have the potential to not be stressed. The only difference between "who" we are when we are stressed and who we are when we're not is...what? Well, in one case we're reacting to a stressor, and in the other, we're not. Hmmmm...

So, how do you stay with the less-stressed you and not get caught up in the "stressed you?"

Here's something to keep in mind...literally:

That which is stress-free already resides within you; your process isn't about "becoming" less stressed, it's about recognizing the aspect of yourself that already is... stress-free, and reconnecting with that state of mind, or "state of being" repeatedly, until it becomes a habit. <-- THAT is a very important point, so keep it in mind.

What do I mean here?

Essentially it's this; if you can be stress-free some of the time, chances are, you can be stress-free most of the time. You're already wired to be stress-free right? I mean, if you weren't you wouldn't be able to experience that state of body and mind. So you've already got it within yourself. ÃŸ THAT is also a very important point, so keep it in mind.

Just take a moment to think about a time when things were going well and you weren't feeling any stress. Think about times, maybe even now, when you've been happy and you weren't worried. This "you" is the same you who's reading this article. Remember to connect with this aspect of yourself as much as you can.

Three things that you can do right now to begin to work with your stress reactivity:

You already know things that stress you out. Now, begin to "grade" them; what is it in your work and home environment that pushes you the most?
Where in your body do you experience stress? What are your emotional cues that you're experiencing stress? Begin tuning in to the more subtle expressions of stress in your body. Begin to develop an "early warning" system that you can use to warn yourself before you're actually "feeling" stressed.
Is there anything that you're doing now to deal with stress that works well? Is there anything that you're doing now that helps you to short-circuit your normal stress reactivity?

In the next article, we'll begin to look at why we get stressed; what the sequence of thinking is that gets you into stress, and the way that you can start to circumvent your normal way of reacting. Until then, be well and enjoy each precious moment of stress-free life. And...share with others; what's your biggest stressor? Where in your body do you feel the stress? How do you deal with stress?