Nurses Under Stress: Top Ways to Cope

Let’s face it; nursing can be a stressful profession. The life-and-death decisions, the hours, the families, the workloads—they all contribute to nursing stress. 

“Stress is going to be part of everyone’s life in health care,” said Kiki Orski, MBA, RN, founder and president of Peak Performance Consulting in New York. “We have a stressful profession.”

“There are myriad reasons that practicing as a nurse is stressful,” added Cynda Hylton Rushton, PhD, RN, FAAN, at Johns Hopkins University in Baltimore and ethics column editor for AACN Advanced Critical Care, published by the American Association of Critical-Care Nurses. “Nurses experience multiple competing demands on their time, attention and specialized skills.”

Holly Carpenter, BSN, RN, senior policy advisor for nursing practice and innovation at the American Nurses Association (ANA), explained, “Nurse stress can come from many different things,” including work environments, suboptimal staffing, workplace violence, work-life imbalance, long shifts and overtime, heavy lifting, and new technologies. 

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Nurses Under Stress

ANA’s latest health risk appraisal found 82 percent of responding nurses reported a significant level of workplace stress. It was identified as the top work environment health and safety risk. 

A 2016 study involving nurses at a Midwestern hospital, led by Timothy R. Jordan, MEd, PhD, professor of public health at the University of Toledo in Ohio, found 92 percent of nurses reporting moderate to very-high levels of stress. 

“Over time, the body, mind and spirit can be overwhelmed with the intensity and chronicity of stress that leads to poor health, relational and job performance outcomes,” Rushton said. 

Nurses under long-term, chronic stress can experience blood sugar imbalance, insomnia, weight gain, suppressed immune system, gastrointestinal problems, blood vessel damage, and heart disease, Jordan said. 

“In terms of the impact of long-term stress on the profession of nursing, it certainly leads to decreased patient-centeredness, compassion fatigue, increased burnout and leaving the profession,” Jordan added.

The Healthy Way to Combat Nurse Stress

Johnson’s research showed nurses under stress commonly used unhealthy methods of coping, with 70 percent saying they consumed more junk food and 63 percent reporting they ate more food when faced with workplace stress. Sixty-nine percent did not exercise regularly, and 22 percent were binge drinkers. 

There are healthier ways of coping, but Jordan cautioned that coping techniques and skills come from genetics and learned behavior via observation, mainly from parents. 

“If our coping skills are unhealthy to begin with, let’s say lashing out at others, it is very difficult to change unhealthy coping skills and replace them with healthy coping skills once we are adults and enter nursing,” Jordan said. “Difficult but not impossible.”

Healthy coping skills begin with self-care, Carpenter said. 

“First, we have to believe that our own well-being matters; that it isn't a selfish or self-centered act to steward our personal resources in a way that allows us to serve others and remain whole,” said Rushton, while reminding readers that the ANA Code of Ethics says, "the nurse has the same duties to self as to others."

Self-care recommendations from Carpenter and Jordan include: 

• Get adequate sleep, at least 7 hours per night. “Without adequate sleep, our entire world begins to collapse,” Jordan said.  
• Eat healthy and nutritious meals. 
• Develop a good work-life balance; dedicate time to relaxation and doing things you enjoy. 
• Foster adequate social support. “One of the absolute best coping skills is sharing your stress and burdens with intimate friends and loved ones via conversation,” Jordan said. 
• Emotionally debrief. Find “a way to center one’s thoughts, calm down, and seek proper perspective when dealing with a stressful issue,” Jordan said. “People do a lot of different things to accomplish this including prayer, meditation, positive self-talk, yoga, and connecting or sharing with other nurses, such as a nursing mentor.”
• Take breaks while at work. 

Rushton encouraged nurses to learn to recognize stress signals. That mindfulness, she explained, “gives us the chance to create a pause to choose how we want to respond.” 

On the job, Orski called communication key to reducing a nurse’s stress level. 

She recommends meeting patients early in the shift to start developing a relationship; putting people first; developing relationships with peers; and honing time management and organizational skills. She also recommends talking with leaders monthly.

Employers also should help reduce nurses’ stress, Carpenter said, by “supporting a safe workplace with optimal staffing,” and not tolerating violence. Employers also can support wellness, with restoration rooms or a wellness center. 

The American Nurses Association named 2017 The Year of the Healthy Nurse and in May launched the Healthy Nurse, Healthy Nation Grand Challenge to improve the country’s health by enhancing nurses’ health in five domains: activity, rest, nutrition, quality of life and safety. On the site, nurses can assess their health, access resources, participate in health challenges, find support from fellow nurses, and more.

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