Overcoming Decision Fatigue to Reduce Nurse Stress

**CareerSmart Learning**

Several statistics estimate that people make an average of 35,000 decisions every day (Hoomans, 2015). It's that incredible number of decisions in a day that makes the theory of "decision fatigue" all the more reasonable (Tierney, 2011). Decision fatigue is the idea that people are only capable of making a certain number of decisions in a day. In healthcare, making decisions is a constant battle because when medication time begins, a patient's call bell dings, then a bed alarm sounds, and then a code is called.

Creating routines is meant to reduce the number of decisions made in a day. For some people, the act of making coffee right after waking up is a routine; they automatically walk to the kitchen and can sometimes have a cup of coffee in their hands before they're conscious of making their first decision. Routines are meant to reduce decisions, and thereby reduce stress, by taking the guesswork out of the day. While healthcare professionals cannot take the guesswork out of their work day, there are still many decisions left in the day that can be reduced.

Before work

Making the pre-work routine streamlined can have a tremendous impact on the rest of the day. Start by having an outfit picked out ahead of time and ready to go (if wearing scrubs, you're already ahead). Plan your route for must-do chores along the way, and don't hesitate to delegate some of those chores to other family members.

During work

Have your snacks and meals planned out. Bringing a lunch from home means that all food decisions have been made for the day, and no time from breaks needs to be dedicated to procuring food. If eating out or at the cafeteria, go in with a plan - know what you'll be ordering before you even get there. This removes the common problem of wandering around the cafeteria to browse all options. The time spent making decisions like where to eat and what to eat can easily add up. Routinizing breaks will make them more enjoyable; instead of spending time and energy deciding between pizza and salad, you can simply grab your lunch, head to your spot, and enjoy a few minutes to yourself.

After work

Create a routine for the commute home to decompress from the day; this can range from taking a few deep breaths before driving home to internally turn off from work, to meditating on the subway, or listening to music that brings you joy. Another routine option is to take a shower once home to wash away the pressures of the day (this is also a great infection prevention strategy if working in a hospital unit). After work is the best time to begin making decisions for the following day; prepare tomorrow's lunch, outfit, and other items needed for the day.

Healthcare professionals make plenty of decisions in a day without even noting it, constantly triaging and prioritizing patients and their needs. Decision fatigue is often most notable when getting home and being unable to even decide what to have for dinner. When decision fatigue hits after work, having an easy dinner on standby will ease end-of-day decision making.

People often create routines and don't realize it; when the dinner plates are cleaned, the cookies come out. It boils down to creating routines that make life easier and less stressful. We cannot control the patients we get in a day and the types of decisions we have to make for their care on a given day, but we make a lot of other decisions that we do have control over, including the amount of stress and fatigue we allow those decisions to cause.

References

Baer, D. (2014). Always Wear the Same Suit: Obama's Presidential Productivity Secrets. Fast Company. Retrieved from Always Wear The Same Suit: Obama's Presidential Productivity Secrets

Hoomans, J. (2015). 35,000 Decisions: The Great Choices of Strategic Leaders. Leading Edge Journal. Retrieved from 35, Decisions: The Great Choices of Strategic Leaders

Tierney, J. (2011). Do You Suffer From Decision Fatigue? The New York Times Magazine. Retrieved from Do You Suffer From Decision Fatigue? - The New York Times

Akay1717 · Nov 12, 2017

Thanks for this article. It's nice to know I'm not crazy when I feel fatigued with decision making! Great tips.

sharonstoutshaffer · Dec 1, 2017

The tips offered in this article are effective and can be adopted by new graduates to focus their energy on the learning required of transition into practice. I want to offer a few additional suggestions:

Before work: Create your day by setting an intention that is meaningful for you. For example, intend that you will be grateful for the experiences you will have; intend that you will have a very positive day; intend to learn as much as possible and offer one positive comment to your preceptor or intend to ask more questions. Setting intention for the day is a powerful way to create the experiences you will have that day.

During work: Take leadership in organizing your learning experiences for the day. Make sure you take a few minutes with your preceptor to plan your day. Let your preceptor know what you believe you need and then set an overall schedule for the day. During the first two weeks, it is particularly important for you to seek help from your preceptor in learning what are the best tools/ methods you can adopt to organize your day. Also, be sure to plan in some break and coaching time.

After work: Practice a few minutes of structured self-reflection. This is one routine that will have a major impact on helping you to develop your confidence and understanding. It will deepen your personal knowing related to all of the new experiences you have. Just try this for 5 minutes each evening. Pick a time (right after getting home, before bed, before TV, etc). Go to your journal or computer and write down the most important things you learned that day; ask yourself why these are important. Set one intention for the next time you will be at work.

These practices do not take much time, but they will change your life. How will you structure your time?

nikegirl09 · Mar 3, 2018

The tips offered in this article are effective and can be adopted by new graduates to focus their energy on the learning required of transition into practice. I want to offer a few additional suggestions:
Before work: Create your day by setting an intention that is meaningful for you. For example, intend that you will be grateful for the experiences you will have; intend that you will have a very positive day; intend to learn as much as possible and offer one positive comment to your preceptor or intend to ask more questions. Setting intention for the day is a powerful way to create the experiences you will have that day.
During work: Take leadership in organizing your learning experiences for the day. Make sure you take a few minutes with your preceptor to plan your day. Let your preceptor know what you believe you need and then set an overall schedule for the day. During the first two weeks, it is particularly important for you to seek help from your preceptor in learning what are the best tools/ methods you can adopt to organize your day. Also, be sure to plan in some break and coaching time.
After work: Practice a few minutes of structured self-reflection. This is one routine that will have a major impact on helping you to develop your confidence and understanding. It will deepen your personal knowing related to all of the new experiences you have. Just try this for 5 minutes each evening. Pick a time (right after getting home, before bed, before TV, etc). Go to your journal or computer and write down the most important things you learned that day; ask yourself why these are important. Set one intention for the next time you will be at work.
These practices do not take much time, but they will change your life. How will you structure your time?

I like these addditional suggestions! I already do the ones in the article.

**CareerSmart Learning** · Mar 5, 2018

What great additional tips you each have added and thank you for the comments on this topic! It's so important to combat this issue since it can have a domino effect on our patient outcomes and personal outcomes.

Overcoming Decision Fatigue to Reduce Nurse Stress

Before work

During work

After work

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