Managing Workplace Stress in Nursing

The nursing profession is a physically and emotionally demanding job with high role expectations and challenging working conditions, that place nurses at the risk of stress-related illnesses and burnouts. According to Olds & Clarke (2010), work-related stress is not only damaging to a person’s mental health but also their physical health and levels of productivity. In nursing, the high job demands coupled with lots of responsibilities and little authority have been identified as some of the primary causes of occupational stress. Nonetheless, despite the challenges, nurses continue to deliver high-quality patient care an element that can be attributed to their resilience even in the face of adversity. 

Workplace Factors that can Affect the mental Health of Nurses

Stress in the workplace is usually defined as a negative emotive and physical response that occurs when the demands of the job surpass the abilities, resources, or individual needs (Khamisa, Oldenburg & Peltzer, 2015). Similarly, job stress is also defined as an interaction between work environment and the nurse characteristics, where extra job requirements and pressure weigh down on the individual performing the job. Essentially, several factors relating to the individual, organizational, and external factors play a vital role in workplace stress and burnouts in nurses.

Factors relating to individual

At the individual level, work demands necessitate the physical abilities and effort of the individual to undertake massive workloads characterized by extended working hours, changing schedules, exposure to hazardous substances, heavy lifting, and risks to personal safety. Due to their nature of their job, nurses are often characterized by longer working hours to meet the demands of quality patient care. This is an issue that has attracted much attention in the recent past, with several studies pointing to several negative consequences attributed to fatigue that comes with the extra work load. Apart from long work hours, nurses are also exposed to shift work. According to Caruso (2014), scientific evidence supports the importance of adequate sleep as a biological need, something that is not available for nurses. Nursing staff operate round the clock with demanding schedules, often leading to irregular sleeping time, which is not in harmony with the circadian rhythms. Caruso further notes that this misalignment leads to more arousals during sleep, poorer sleep quality, and shorter sleep duration, which have the ability to affect the health of the nurse negatively. Further studies show that sleep deprivation impairs the individual performance, slows down capacity to concentrate and remember. In addition, lack of adequate sleep is associated with irritability, bad moods, and inability to cope with the demands of the workplace. Overall, sleep deprivation leads to decline in neurocognitive performance leading to increased rates of fatigue-related injuries and medical errors. At the end of the day, workers have to put up with fatigue, sleepiness, and the stress that comes up with demanding work schedules.

Organizational Factors

Alongside individual factors, studies show that organizational and management characteristics influence the nurses to stress experiences in their workplace. The relationship between nurses and nurse managers is particularly important when understanding stress and burnout within the workplace. For instance, Sarafis, Rousaki & Tsounis (2016) note that conflicts between management and nurse staff and getting little to no support from the supervisors or charge nurse may lead to stress. Similarly, uncertainty concerning treatment and lack of adequate information from the physicians also has the ability to weigh down on the nurse. Adding to this, sometimes nursing workplace is inhibited by certain discrimination acts from colleagues and other professionals, which have the ability to affect the individual self-esteem or confidence levels when handling patients. 

External Factors

In relation to workplace stress, lack of family support or conflicts has been known to escalate nurses’ stress at the workplace. According to Jennings (2008), the family has a direct relationship with work exhaustion in several ways. For instance, lack of family support at home is more likely to leave individuals feeling worried and distracted at the workplace. Other times, work schedules often deprive nurses of adequate time to be with family and participate in their children’s’ growth; something that triggers feelings of guilt and affects the individual psychologically. Conversely, nurses with spouses who are not understanding and accommodative of their working schedule are likely to have family-work conflict. Ostensibly, while studies show that it is highly unlikely for nurses to bring personal stress to work when it is combined with workplace stress it can be devastating to the health of the individual. 

Developing Resilience

The nature of nursing job involves caring for patients, comforting bereaved families and offering support during challenging times among others. Similarly, nurses experience additional pressure in part due to taking care of an aging population who come with complex social, physical, and health needs. Unfortunately, all these are likely to cause interpersonal challenges such as detachment from the workplace, lack of compassion and empathy for patients and families, as well as interrupted communication (Koinis, Giannou & Drantaki, 2015). Furthermore, cost implications are also associated with a burdened healthcare system, which might negatively affect patients and the overall health organization. Nonetheless, amidst all these challenges nurses must continue to deliver high-quality care retain resilience and professionalism in the face of these adversities. 

Developing Emotional Resilience

The importance of developing resilience in nurses is widely recognized. There is also a growing recognition that enhancing emotional resilience has the ability to help achieve this aim. According to Grant & Kinman (2014), emotional resilience is a multi-faceted and complex element that reflects on the capacity of an individual to bounce back in the face of life’s challenges. Several studies have examined the ability of emotional resilience to help professionals to adapt positively to workplace stress, manage emotional demands, and nurture effective coping mechanisms as a way to improve professional growth and wellbeing. Ordinarily, to understand how nurses can develop resilience, we consider four competencies that can be adopted, which include reflective ability, social confidence, emotional intelligence, and social support. By developing the reflective ability, the focus is usually on the development of personal strengths and weaknesses to nurture several competencies associated with increased self-awareness, improved coping mechanisms, and problem-solving skills. Research shows that individuals who can reflect on the practice were more resilient and reported high levels of psychological wellbeing. Emotional intelligence focuses on the ability of the nurse to motivate and persist even when faced with frustrations, control impulse, regulate moods, and refrain from distress. As Grant & Kinman note, there are two sides to emotional intelligence; interpersonal, which helps individuals relate empathically and confidently to others, and intra-personal, which helps individual gain insight into their emotional state and regulate moods. Social confidence, on the other hand, boosts assertiveness, effective communication, and boosts conflict resolution skills. More specifically, developing social confidence skills will help nurses to endure hostile work environments, effectively manage conflicts, as well as enhance working relationships. Lastly, social support is one of the most important mechanisms, which helps professional nurses build resilience by fostering social connectedness and empathy. In essence, social confidence comes from colleagues and in return helps professionals to cope with stress and work burnouts.

Role of Leaders and Managers 

There has been a great emphasize about the role of healthcare leaders and managers in leading by example to promote medical staff wellbeing and the need to be fully equipped with training and skills to recognize the needs of those under them, identify risks, and provide support services when necessary. Nurse Managers and leaders have an obligation towards the nurse staff that includes diplomacy, honesty, being approachable and accessible, and be able to make effective decisions. According to Brennan (2017), there has been a close relationship between social support from leaders and managers and staff wellbeing. Research shows that a close-knit relationship between these two helps in reducing exhaustion and enhances work satisfaction and positivity. Further studies also show that working with a good team, with high-levels of support from supervisors reduces levels of emotional exhaustion, which has been strongly linked to work-related stress. Along with that, nurse leaders and managers have the ability to adjust workloads and working schedules to ensure nurses get breaks and well-deserved rest. Involving nurse leaders in stress management provides a systematic way to deal with workplace stress by addressing organizational stressors through preventive interventions, teamwork, career counseling, and medical treatment among others. 

Substantial scientific evidence supports that several factors at the workplace have the ability to trigger work burnouts and lead to accelerated stress levels sometimes affecting the mental health and the ability of the nurse to deliver quality patient care. Nurses, as well as their leaders, have a responsibility to enhance self-resilience as a way of reducing these risks. As it is, stress is often triggered by the inability of the individual nurse to handle the primary triggers of stress. By enhancing emotional resilience, nurses become empowered and can easily manage work-related stress and know how to manage burnouts. Similarly, leaders play a significant role in establishing policies and systems that reduce fatigue by influencing work schedules, workloads, and ensuring nurse safety among others. In essence, workplace stress is unavoidable, but knowing how to handle and develop self-resilience is one way to manage the situation.

References

Brennan, E. J. (2017). Towards resilience and wellbeing in nurses. British Journal of Nursing, 26(1), pp. 43-47.

Caruso, C. C. (2014). Negative Impacts of Shiftwork and Long Work Hours. Rehabilitation Nursing, 39(1), pp. 16-25.

Grant, L., & Kinman, G. (2014). Emotional Resilience in the Helping Professions and how it can be Enhanced. Health and Social Care Education, 3(1), pp. 23-34.

Jennings, B. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. [Place of Publication not identified]. Agency for Healthcare Research and Quality.

Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work Related Stress, Burnout, Job Satisfaction and General Health of Nurses. International Journal of Environmental Research and Public Health, 12(1), pp. 652-666.

Koinis, A., Giannou, V., Drantaki, V., Angelaina, S., Stratou, E., & Saridi, M. (2015). The Impact of Healthcare Workers Job Environment on Their Mental-emotional Health. Coping Strategies: The Case of a Local General Hospital. Health Psychology Research, 3(1984), pp. 12-17.

Olds, D. M., & Clarke, S. P. (2010). The effect of work hours on adverse events and errors in health care. Journal of Safety Research, 41(2), pp. 153-162.

Sarafis, P., Rousaki, E., Tsounis, A., Malliarou, M., Lahana, L., Bamidis, P., Niakas, D., … Papastavrou, E. (2016). The impact of occupational stress on nurses’ caring behaviors and their health related quality of life. Bmc Nursing, 15(56), pp. 1-9.

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