Finding Calm Amid Crisis: Stress Reduction on the Job

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By Jennifer Larson, contributor

June 17, 2011 - Halfway through a 12-hour shift you realize that your neck and shoulders ache with tension. Your mouth is dry, and you feel like you might snap at the next person who barks an order at you.

You approach a patient’s room and reach down to grasp the door handle. But instead of just stepping right into the room, you stop. You take a long, deep breath, letting the air surge into your belly before you slowly release the breath. You take another deep breath and exhale. Some of the stress you’ve been carrying around begins to seep out of your body with each breath.

That simple exercise can help you recalibrate your stress level by making you stop and slow down. It’s an exercise advocated by Pamela Ressler, BSN, RN, founder of Stress Resources in Concord, Mass., as an easy way to help you feel a little more controlled in the midst of chaotic times on the job.

Ressler calls it “finding the calm within the crisis.”

“We often think that we don’t have time to take care of ourselves,” Ressler said. “[But] if we deplete ourselves totally, there won’t be any caregiving that we’ll be able to give.”

And easy-to-implement steps may be the key to effective stress management.

In a September 2007 article in the journal Nursing Economics, authors Tammi Milliken, Ph.D., Paul Clements, Ph.D., APRN,  and Harry Tillman, Ph.D., MSN, RN, noted that today’s work environment causes more stress than ever. Many hospital nursing staffs are stretched very thin, caring for patients who are sicker than in the past. Additionally, the nursing workforce is aging, and many must cope with the effects of the job’s wear and tear on their bodies.

“There is a significant need to provide realistic stress-reduction approaches that are immediately usable and promote a decrease in burnout,” they wrote.

And they went on to call for health care organizations to “address some of the variables that lead to nurse attrition or they will find themselves confronted with the dire consequences related to patient care delivery and meeting national patient safety goals.”

In effect, it’s good for nurses, patients and everyone around them to find ways to help nurses (and other caregivers) better manage their stress levels.

Leaders at Kent State University’s College of Nursing believe dealing with stress is so important that they launched a pilot program called “Care for the Caregiver” last fall to help their accelerated program students learn stress-reduction strategies. The college partnered with the Urban Zen Foundation, founded by fashion designer Donna Karan, so students could get hands-on experience with alternative healing modalities such as yoga and reiki.

Assistant professor Barbara Drew noted that the program focuses on mind-body techniques so that nurses can attend to their own needs as necessary.

“When you’re in the midst of patient care activities and things are happening at a fairly rapid pace, you need to be able to become fairly facile with being able to take…even a minute to do some mindful breathing and manage your anxiety so that you can then respond to the patients, be present with the patients and be responsive to the patients’ needs,” she said.

Diana Grove, RN, teaches a course on mindfulness-based stress reduction (MBSR) for the integrative medicine department for UW Health in Wisconsin. A number of hospital staffers, including nurses, have taken her class and learned to be more present in the moment.

“Often, we feel like we’re just being run by life, so this is a huge shift into realizing that when we’re present, we have choices and time slows down,” she said. “You feel clearer. Your thinking is clearer.”

Ressler agreed that learning mindfulness is extremely helpful. She encourages people to think of a stop sign and use a mnemonic for STOP: Stop for a few minutes, Take a few deep breaths, Observe where your mind is, and Perceive (and move on).

Ressler also recommends these other easily-implemented stress-reducing opportunities:

• Toothbrush time: If you use an electric toothbrush that beeps after one or two minutes, use that alarm to give yourself the time to breathe and focus.

• Take a break alone. At least once a week, take your lunch break alone. Separate yourself from your colleagues, and regroup by yourself for a few quiet minutes.

• If you like to meditate, find the chapel at work or another quiet place to spend your break.

• Use the time spent driving or riding home from work as a transition time. You could listen to a guided meditation CD or do some other type of mindfulness meditation on your own.

Grove recommends a technique she calls the three-point body scan. Take a few moments to focus on your feet. Then do the same with your jaw, taking a few moments to relax it. Finally, notice your breathing. Take a deep full breath in, then let it out. This can all be done in a minute or two.

“It can be done anywhere,” Grove said.

Family nurse practitioner Nancy Onyett, FNP-C, leader of Pyramid Preventative Medicine in Scottsdale, Ariz., suggests that nurses also make the effort to identify the specific stressors in their lives.

Then, they can take steps to address them, keeping in mind what has and hasn’t worked in the past, she noted. They may want to alter their diet and exercise level, as well, with the guidance of their own health care practitioner.


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