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Stress and you

Introduction

Image of the sun and a cloud

Nursing staff are brilliant at coping and often have a strong belief that they should be able to cope with anything at all that comes along in their personal or professional domains.

This belief generates a superhuman philosophy that doesn’t make it easy for nursing staff to admit that they are experiencing stress. People who know you well at work or at home may be trying to tell you to slow down or take time out. You might know something needs to change, but feel the pressure to carry on regardless.

Showing signs of stress does not mean you cannot cope. Nursing staff are as human as anyone else and there are limits to the pressures that you can endure. To admit to being stressed does not equal not coping - quite the opposite - knowing and owning your limitations enables you to look for ways of managing stress and coping more effectively.

In this resource we will explore the signs and symptoms, resources and support and to remind ourselves what a healthy workplace should look like and what our employers should be doing to achieve that. 

While many of you might be reading this with a healthy curiosity if, at any time, your thoughts and feelings become a bit much and you need some extra support, you can contact RCN Direct on 0345 772 6100 and arrange to speak with one of our counsellors. 

Signs and symptoms of stress

Image of man falling down hole

Individual responses to stress vary. It is important to understand what is happening on a physiological level when you are feeling stressed. When you are feeling stressed your brain perceives a threat and the fight or flight response is triggered, along with a number of chemical reactions in the body.

This includes the release of adrenalin and in a potentially threatening situation this may save your life. However, living in this state of heightened arousal is not good for you and your body may begin to signal this to you in a number of ways. 

Physical symptoms may include: 

  • a pounding heart  
  • elevated blood pressure 
  • sweaty palms 
  • tightness of chest 
  • aching neck, jaw and back muscles 
  • headache 
  • chest pains 
  • abdominal cramps 
  • nausea 
  • trembling 
  • sleep disturbance and tiredness 
  • susceptibility to minor illness 
  • itching 
  • forgetfulness.
 

You may experience:

  • your mind racing or going blank
  • not being able to ‘switch off'
  • a lack of attention to detail
  • your self-esteem and confidence plummeting
  • disorganised thoughts
  • a diminished sense of meaning in life
  • a lack of control or the need for too much control
  • negative self-statements and negative evaluation
  • difficulty in making decisions
  • a loss of perspective
  • demanding too much of yourself and others.

You may:

  • become withdrawn and not want to socialise
  • increase your alcohol, nicotine or drugs intake
  • change your eating habits
  • become accident prone and careless
  • become impatient, aggressive or compulsive
  • work longer hours – not take breaks, procrastinate with important projects and manage your time poorly
  • no longer have time for leisure activities.

You may feel:

  • irritable
  • angry
  • depressed
  • jealous
  • restless
  • anxious
  • unnecessarily guilty.

You may also experience other feelings such as panic, mood swings and crying easily.

Managing Stress

A man suffering from burnout at his laptop

As mentioned in the introduction, showing signs of stress does not mean that you cannot cope, and some pressure can help you accomplish tasks. Here we are talking about the kind of pressure you may experience for example before a job interview, as it can help you stay focused and may support you to perform at your best. 

As an individual, you need to remain alert to pressure turning into stress and this varies from person to person as we all respond to pressure and stress differently.

If you identify with one or several for most stress responses in the section above, then you need to take steps to alleviate these. It is also important to maintain your wellbeing and self-care to help prevent, physical, emotional and psychological manifestations of stress.

You may find some of the following strategies to be helpful.

  • Consider how you maintain a balance between work and play – do you live to work or work to live?
  • Use leisure time to recharge your batteries, exercise regularly and socialise in person.
  • Maintain a healthy diet, be mindful as some stimulants such as alcohol, caffeine and nicotine can exacerbate stress responses.
  • Plan regular holidays and take them at home if finances are tight.
  • Build and maintain your support networks.

If you are able to take steps to improve your personal work environment, you may wish to consider some of the advice below:

  • Take time to regularly review and plan – consider your time management skills.
  • Plan regular breaks – 30 minutes not working increases your effectiveness later on.
  • Negotiate and if possible delegate – use "let me get back to you", "no" and "not now", especially when you sense that others are offloading their work onto you.
  • Learn to recognise your needs and be assertive in stating them – do not feel pressured into overtime that you know you cannot do or do not want to do.
  • If the adjustments you are making are not working then make use of one to ones, appraisals and clinical supervision to address your current situation.
  • Career advice may be useful if you are stressed and frustrated with your career development. It can help you gain greater awareness of your career values, interests and needs. The RCN's Careers service may be able to help you.

If your work environment is part of the problem, please read our section on work related stress.

  • When stressed be mindful of ‘unhelpful thinking habits’ for example, ‘I must be perfect, I must never make a mistake’ – find ways of thinking more realistically ‘I am doing the best that I can in difficult circumstances’.
  • Avoid mind reading, jumping to conclusions, black and white thinking, catastrophising. Likewise avoid generalisation, for example, ‘this always happens to me’, ask yourself ‘where’s the evidence, what are the facts?’
  • Challenge the pressure you put on yourself by turning musts, ought’s and shoulds into likes and preferences. So instead of, "I must complete this task today" think: "I’d like to complete...today and I will do what I can". Also, learn to identify what you can and can’t control and acknowledge what can’t be avoided.
  • Use constructive self-talk and avoid putting yourself down.
  • It is important to acknowledge your achievements.
  • Maintain a sense of proportion and remember that you have managed to get through difficulties before.
  • Think about what helped you through a previous difficulty – how did you do that? It may give you some clues and instil hope that there is a way forward.
  • Remember too that you are not superhuman!
  • Take time out to reflect and to be as objective as you can. 
  • Identify your main sources of stress – try anticipating stressful periods and plan accordingly.
  • Assess how effective your current coping strategies are – are there any different strategies that can be applied, discussing these with people you trust can be helpful.
  • Ask: "What is in and what is out of my control?" and if you are able to influence this. If you cannot influence, ask yourself: "How can I start to accept this?"
  • Make use of the NHS Live Well website and other such online resources.
  • The RCN resource, Healthy You guide includes helpful videos and a self-assessment worksheet. 
  • Our Counselling service also has a range of helpful links to a range of interactive tools and advice. 
 

Struggling with stress?

Image of lightning strike

If you find that you are struggling and you are experiencing physical and emotional health problems, then the responses here may help you reduce and manage your stresses.

Learning to relax is key to managing the stress response – relaxation tells your brain that the threat has diminished and the ‘flight or fight’ response can be switched off.

Do things that you enjoy doing which have a relaxing effect on you, for example, listen to a particular piece of music, a long soak in the bath, a hobby – plan to treat yourself with more of these simple pleasures which may have been cancelled from your normal routine.

Many relaxation CDs, apps and internet downloads are available which can, when used regularly, have a significant impact on helping you to relax.

Relaxation techniques can then be transferred wherever you are, when you feel yourself becoming tense. You may be immediately drawn to a form of relaxation that works for you or you may need to try out different ones.

Relaxation can also have a positive effect on your heart rate, blood pressure, sleep disturbance and anxiety; it may be helpful in managing a variety of health conditions.

Exercise is another key to managing the stress response. Exercise will burn up the excess adrenaline and release endorphins – the feel good hormones.

  • If you are used to exercising and this area of your life has been squeezed out, make time for this again
  • If you are not used to exercising, start small with what you enjoy. Perhaps try regular walks, swims, a gentle work out in the gym or a class.
  • Creative outlets can be welcome distractions from the stresses of the day and be particularly helpful if you are unable to exercise.

You can also see our 'Healthy workplace, healthy you' pages for further information and our Counselling service for additional resources.

Talk about how you are feeling with supportive friends, family and colleagues as this will help you offload and gain a fresh perspective.

  • Crying to express the hurt, allowing yourself to feel angry and expressing this in a safe way can be extremely therapeutic.
  • If there isn’t someone you feel you can turn to then access counselling to talk to a therapist in a confidential setting.
  • If you are not a talker or feel quite isolated write your feelings down in the form of a diary, letters to remain un-posted or try drawing/painting to express your feelings.

You can also see our Healthy You guidance which includes a self assessment tool and helpful resources.

You are approaching burn out when you have reached exhaustion and:

  • can no longer motivate yourself
  • feel depressed, unhappy or even suicidal
  • the pressures seem so overwhelming that your performance, mood and health are suffering significantly
  • you are unable to maintain the level of health you need to carry out your professional role as identified in the Nursing and Midwifery Council’s Code.

If you are approaching burn out you should seek medical support as detailed in this section.

Medical Support

Visit your GP and/or access occupational health support if available – this is not an admission of weakness, it can be a courageous first step towards a relaxed and energised level.

A prescribed break from work will give you some time out to recover and, whilst there are many ways that can make it easier for you to reduce and manage stress as outlined in the previous paragraphs, there are times when medical interventions are helpful.

Medication can control symptoms enough to enable you to put into practice some of the methods already outlined.

You can also see our Sickness guidance.

Counselling

  • Counselling is often helpful as a way of giving yourself a regular space to reflect on what is happening emotionally, mentally and physically, and to have support for any changes you want to make.
  • You may have feelings and thoughts that seem out of control that you need help with, which may be frightening and may be a new experience for you, so there will be the opportunity to explore and understand these. 
  • There may be new coping strategies to learn which a counsellor can help you with, such as relaxation, assertion, time management and thinking skills. 
  • You may decide to see a counsellor as an individual or you may wish to join a group. You can ask your GP about counselling or your employer may provide access to a counsellor through occupational health, an in-house service or an Employee Assistance Provider (EAP).
  • You may choose to access help privately. Professional regulating will help you to search for therapists locally. You can try: The British Association for Counselling and Psychotherapy (BACP); UK Council for Psychotherapy (UKCP); British Association for Behavioural & Cognitive Psychotherapies (BABCP) and The British Psychological Society (BPS).  
  • The RCN also provides a Counselling service.

Work related stress

There are a variety of ways to manage pressures at work, and it is important to remember that not all the responsibility for reducing workplace stress rests on you.

Under legislation, all employers have an overarching legal duty to ensure - so far as is reasonably practicable - the health, safety, and welfare of all their employees when they are at work, no matter what their role is within the organisation.  

There is a clear distinction between pressure, which can create a ‘buzz’ and be motivating and work-related stress. Work-related stress is the adverse reaction people have to excessive pressures or other types of demand placed on them and is a major cause of occupational ill health potentially leading to severe physical and psychological conditions.  It can also lead to human error, increased sickness absence, increases in accidents, high staff turnover and poor retention, all of which will add further pressures to the existing workforce and could affect patient care. It is therefore essential that employers adhere to their legal duties and take all reasonable steps to prevent work-related stress from occurring. 

Your manager should be your first port of call, but it is not always easy to identify and articulate your concerns and needs. You may find the HSE's Stress Management Standards Indicator Tool a useful way of thinking about the factors that are contributing to your stress or a stressful culture in your team. The RCN’s Nursing Workforce Standards also refer to the health, safety and wellbeing of staff setting out steps employers should take to support the nursing workforce in safe, healthy environments.

If you feel you have a significant concern that needs to be raised more formally, see our guidance on health and safety and how to raise concerns. If you need more support to take the issue forward, contact our advice team. 

How the RCN can help you

Man and woman talking in therapy session

Your employer has a duty to ensure your health and safety at work and that includes the psychological wellbeing of employees. If you have concerns about stress, you must raise these with your manager as soon as possible, preferably in writing and ask for remedial action to be taken such as a risk assessment of stress.

It may be that other workplace situations such as bullying and harassment, discrimination or violence at work will cause a great deal of stress. Visit our main stress page and advice guides for our range of resources and support you can receive from the RCN. 

If you require any help and workplace support, please contact us.

Further reading

Check out our LibGuide which has a wide range of information and is maintained by our fantastic library team.

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