Nurse Stress Factors: Identification and Management

What is Stress? Nurse and Midwife Support defines stress as “a state of mental or emotional strain or tension resulting from adverse or demanding circumstances. It is your body’s way of responding to any kind of demand or threat”. Stress can range from a major physical crisis like a heart attack, to minor symptoms like tiredness and irregular sleep patterns. Recognising stress is the first step towards learning how to cope. Stress is not an easy emotion to define as we all experience and handle stress differently. It can be referred to as an emotional, mental and physical response which nurses experience when placed in demanding circumstances.

The stress of nursing has been regarded as an occupational hazard since the mid-1950s. In the 1960s, Menzies Institute of Technology identified four sources of anxiety among nurses: patient care, decision making, taking responsibility and change. This has been regarded as stress-filled based upon the physical labour, human suffering, long work hours, staffing and interpersonal relationships that are central to the work nurses do. Due to the increasing use of technology, continuing rises in health care costs, and turbulence within the work environment, work stress is increasing leaving nurses feeling overwhelmed on a daily basis.

Recent WorkCover NSW statistics indicate stress is among the most common workplace hazards for nurses, including manual handling injuries, physical injuries from acts of aggression or violence and the consequences of chemical exposures and pandemics.

Nurses confront a range of occupational health and safety (OHS) risks in their roles when providing care and comfort to the sick and aged. There are many causes and types of stress nurses experience. As researched by The National Institute for Occupational Safety and Health (NIOSH), the most common factors causing stress are:

  1. Work overload – can lead to lower levels of nurse engagement, increase in errors, effect the quality of care, cause visible stress and exhaustion, and increases nurse sick days.
  2. Time pressure – strict deadlines may reduce the quality of care each patient receives. This increases pressure to perform all responsibilities, and decreases the levels of reliability, responsiveness and assurance.
  3. Lack of social support – lack of support due to conflicts with co-workers, managers and patient’s family members can lead to the decrease in satisfaction.
  4. Exposure to infectious diseases – there are many infectious diseases and toxic substances nurses are exposed to, placing them at high risk. It can cause anxiety as it constantly plays on nurses mind, especially now due to Covid-19.
  5. Needlestick injuries – Accidental exposure to blood-borne pathogens are one of the major hazards for nurses and the general public. This could cause human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV).
  6. Exposure to work-related violence or threats –nurses are at high risk for facing episodes of violence. This includes patients who verbally abuse, make threats, and sexually harass nurses.
  7. Sleep deprivation – working in health care facilities is not the normal 9-5pm job. Nurses are confronted with various working hours, and working conditions such as understaffing.
  8. Role ambiguity and conflict – refers to the lack of clarity concerning the nurse roles and responsibilities, such as a situation that is complicated, vague, but also highly demanding.
  9. Understaffing – the increased of job demands as a result of staffing shortages, places pressure onto nurses, especially because they work long hours. The decrease in support, increase in responsibility, is even more stressful especially when making decisions and implementing changes.
  10. Lack of career development options – Research illustrates one in six nurses have contemplated leaving their nursing profession.
  11. Dealing with difficult or deathly ill patients – nurses may feel a sense of grief and loss when caring for a dying patient, while supporting the family at the same time. This may present emotional challenges. Caregiving itself is quite emotionally draining, and some nurses may find it difficult to not carry their emotions home.

The way an individual manages stress varies. Some nurses thrive under pressure, while some nurses feel overwhelmed and drained. If pressure becomes excessive, it can cause physical and mental health effects. When a nurse does not identify the stress, it may decrease their professional performance and patient care. Therefore, it is important nurses improve their self-awareness, by understanding their triggers for unhealthy stress, and stress management techniques:

Physical Stress – signs of physical stress may include muscular tension, aches and pains, nausea, bloating, headaches, feeling light-headed or dizzy, increase in heart rate, chest tightness and pain.

Behavioural Stress – can lead to changes in eating habits such as eating more or less, change in sleeping patterns (sleeping too much or too little), distancing yourself from others, procrastinating and/or neglecting responsibilities, and increase use of alcohol, cigarettes, or drugs to relax.

Emotional stress – refers to feeling lonely, isolated, overwhelmed, irritable, angry, anxiety, depressed and experiencing regular changes in mood.

Cognitive stress – include the inability to concentrate, struggling to remember small things you usually would, decrease in judgement, and experiencing negative feelings, racing thoughts, and constant worry.

When stress is ongoing for a long period of time, it is identified as Chronic Stress. This type of stress is detrimental to one’s health, and can lead to serious issues. This includes the increase risk of heart disease, heart attack, stroke, ageing quicker, and mental health problems such as mood disorders, panic attacks and depression.

However, there are solutions for nurses to help them relax and experience lower levels of stress:

  • Talk About It – enlisting the help of a mentor offers a reliable go-to person who can listen and guide at overwhelming times.
  • Exercise Regularly and Eat Healthy – produce endorphins which improves ability to sleep, uplift a person’s mood and decrease feelings of stress
  • Keep Things in Perspective, Prioritise. Don’t be too hard on yourself.
  • Set Realistic Goals – taking on only how much work and responsibility one nurse can handle helps to reduce feelings of being overwhelmed and burnt out.
  • Find a Hobby – takes your mind off stress as you focus on something you enjoy. Have fun, think positive and enjoy new experiences.
  • Practice Relaxation Techniques – breathing deeply reduces stress as it helps bring oxygen to the brain, stimulating the parasympathetic nervous system.
  • Seek Help – it is okay to seek professional help. Remember, nurses are caring for others, but it is also important to care for yourself.

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Nursing will always be a stressful profession, and is why it is important for nurses to know how to balance work commitments and personal life. The stress levels for nurses working in aged care facilities in Australia, are much higher than those in hospitals. It is alarming work overload, nurse shortages and high turnover rates are the major workplace issues, and raises concerns for the psychological well‑being of nurses. Promoting the use of effective coping strategies and maintaining supportive social relationships will be beneficial in decreasing workplace stress.

However, if coping strategies and techniques are failing to relieve feelings of being overworked, anxious or over-stressed, extra help should be sought out before long term stress and health problems ensue. There are a number of allied health services covered by Medicare. Your GP may be able to refer you to a health professional for sessions rebatable under Medicare.

  • Local Community Health Centre – Contact your local community health centre
  • Alcohol & Drug Information Service (ADIS) –24 hr advice 1800 422 599
  • Beyond Blue – is a not-for-profit organisation working to address issues associated with depression, anxiety and related substance misuse disorders in Australia.

For nurses to provide quality care, it is important their mental health is not suffering. Nurses should practice staying in touch with their own feelings and emotions, and recognise stress and the effect it has on their life to help maintain a long and healthy career.

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