Stress is toxic for nurses! It is often characterized by negatively toned emotions such as anxiety, anger and guilt. As a nurse, you know all about stress, or you think you do. You certainly know about the pressure of being responsible for your patients’ welfare, for life-sustaining care, for life-and-death decisions, and for errors.

You are even very familiar with the headaches that come with a tough shift and the anxiety and scattered focus that is apparent when the unit or department is short staffed. And now, with all the discussion and review about team building, you feel that stress level rising again!

            Can nurses actually be stress free in the team building process? At this moment you probably think, “impossible!” But as you practice a few of the stress reducing strategies listed below, you will discover that a great deal of stress can be prevented.

As you begin, remember that lowering your stress level takes practice and when you experience stress, you have not failed in the process. As you practice, you will make progress and every reduction of stress is a success.

What else can we do? We can learn to take care of our team members and ourselves. We can work at recognizing stress and we can practice the strategies to prevent burnout.

Research done by  Katherine Lawler and Loren Schmied on stress-resilient people, those who do not succumb to stress-related-diseases, consistently identify the characteristics of: commitment to work, acceptance of challenge, and a sense of control. They also found that a sense of commitment and challenge and a sense of personal control “buffer the effects of stress on illness.” 

[Lawler, Katherine and Schmied, Loren, “A Prospective Study of Womens 
                Health: the Effects of Stress, Hardiness, Locus of Control, Type A Behavior  
                And Physiological Reactivity,” Womens Health  1992; 19(1): 27-41. 

Benjamin Peterman looked at the way nurses survived extremely demanding situations and identified two groups. Nurses who responded with “I” statements took ownership of a situation, held realistic expectations, prioritized workloads and practiced self-care techniques. Nurses who responded with “they” statements blamed others, felt powerless to make change and felt out of control.

He also identified several skills designed to build hardiness. They focus on taking control and embracing a change and certainly the team building concept is one of change. He emphasizes that the skills listed are “life skills.”

They will not be mastered in one or two days. But every time you appraise a situation understand the thoughts and feelings it created, and imagine how you can think differently in the future, then you will build resilience to stress. 

Strategies to Build Hardiness and Reduce Stress

·        Learn to recognize the stress signals.  

 Building resilience to stress begins with understanding your own stress signals. Is it an inability to concentrate, self-criticism, or forgetfulness? Learn to recognize these thoughts, emotions, behaviors, and physical signs that signal stress.  

·        Learn to appraise the situation.  

When you recognize one or more stress signals, evaluate the situation:  

What demands are you experiencing? 

Where are the demands coming from, inside or outside yourself? 

What thoughts are occurring? 

What negative feelings are you experiencing?                       

·        Realize that demanding situations are complex.  

Discipline yourself to identify the source of demands, and describe the full range of controlling factors and the emotions you experienced. A demanding situation in a team building effort could be identification of a conflict between or among team members.  

·        Viewing the demand.  

Remember, as you appraise the situation, the demand is not causing you the stress, you view of the demand is! Something in your view of this situation is threatening to you; you may anticipate harm or loss.

 This could be what triggers the negatively toned emotions of stress, anxiety, fear, guilt, anger and frustration. Situations that arise at work may threaten your view of yourself as a nurse, colleague, or team member.  

·        Determine what is the most demanding of you.  

For most nurses, it is the personal demands and expectations we have of ourselves that create the most pressure. The bad news is that changing ourselves is one of the hardest tasks se will ever master! And the good news is that the personal change is the most possible of options open to us.

 Changing various team members may be beyond our control. But changing our expectations, goals, and self-confidence is always within our control.  

·        Define “how we are,” and “how we wish to be.”  

            Nurses often tend to be assertive, competitive, and resourceful. They also can be dedicated and maybe a little too idealistic. These can be considered traits of hardiness and can define “how we are.” They can also make the same nurse vulnerable to stress when they find themselves in an imperfect work setting of limited time, limited resources and uncertain professional roles.

Further exploring those traits can make the nurse so committed to taking responsibility that they often take responsibility for things they cannot control, and then feel as if they have failed. So, “how do we wish to be?”

 When nurses feel threatened, they “wish” to have the coping skills to survive the situation. Effective coping starts with your awareness of what causes stress and your belief that you can eliminate or reduce it. They are several questions that you can ask when you face a difficult situation:  

Is my concern based on reality and is there truly a reasonable chance that it will occur? 

Can I do anything to prevent the harm or conflict that I anticipate? 

Can I do anything to lessen the effect or cause of the conflict? 

What strategies can I use to prevent the harm, loss or conflict to reduce its effect on me? 

[ Peterman Benjamin, “Analyzing Job Demands and Coping Techniques,” Nurse Manager 1995; 26 (2): 51-53. 

Chronic Stress: the Killer 

          The most insidious kind of stress is chronic stress. When a patient codes and your adrenaline goes sky high, you know you are under stress! You recognize the threat and go into action to meet the emergency. Chronic stress is something else. The source may be hard to identify. Feelings of anxiety and tension have no clear beginning or end. You don’t relax and recharge.

            Chronic unresolved stress could result in burnout, long recognized as a major problem in nursing. When nurses in team building situations face this type of stress there are tools to be examined that can possibly change your inside world. Changing your thought patterns and inside world can aim at creating positive thoughts.

These positive thoughts generate positive feelings of challenge rather than negatives feelings of threat that can lead to burnout. The value of positive thinking is an age-old truth. This is not to say that it is easy. It takes a lot of awareness, determination and practice. Tools to assist in changing your inside  world could include:  

·        Avoiding toxic thinking  

Negative thoughts and negative feelings can poison your outlook and your ability to act. Some of the more common types of toxic thinking could include the following: 

Mislabeling : You assign an incorrect, negative meaning to an event, activity or even a person. Instead of healthy relaxation, you label your noon break “procrastination” and feel guilty about leaving the work on the unit. Another example would be labeling a new nurse “the green one.”

Automatic Thinking: You assume motives or expectations in others. “They expect me to take all the weekend call.” Or another example might be, “Do they think I am a magician?” Communication is the answer here and prevents automatic thinking. It’s OK to ask what is expected. Then you can discuss priorities, resources or standards.

Polarized Thinking: You think in terms of black or white. It has to be “all or nothing.” When you make a mistake, you think “I can’t do anything right.” This kind of thinking destroys your achievements, are seldom true and make you feel terrible.  

Pessimism : This concept include seeing situations from a negative viewpoint. You assume that things are bad and don’t admit the possibility of a beneficial outcome.

Catastrophizing: Making the worst of the situation. You imagine the worst case scenario, then feel the same stress as if this imagined outcome was real.

Blaming : Fixing blame is easier than fixing the problem, so you shift the responsibility instead of fixing the problem.

Perfectionism : When you expect perfectionism from yourself and others, you are confusing your ideals with reality. No human being can be perfect in an imperfect setting!

Victimization: You feel that you have been singled out by others for bad consequences. Others have let you down, they don’t appreciate you, and have left you holding the bag.

·        Positive Focusing  

Even in the worst situation imaginable, there will be something positive to focus on. If you can’t find it, rely on a fellow nurse or colleague to find it. High achievers are usually good at finding benefits when others see disaster.

·        Managing Emotions  

Toxic thoughts generate toxic emotions. It is possible to learn to regulate the negativity toned emotions of stress, guilt, anger, frustration and anxiety. In some cases, negative stress emotions are justified, and it is appropriate to feel and act on them.

In other cases these feelings are based on unrealistic expectations or lack of information. For nurses, often the two most commonly felt emotions are guilt and anger. Unresolved, continuing guilt or anger is your route to burnout.

·        Positive Self Talk

 We all carry on internal conversations that can be an important source of energy and support or a debilitating burden. When you say to yourself, “I can’t do it,” you tend to create negative emotions, such as guilt.

Negative self-talk can be one of the principle contributors of stress and is largely a habit! Positive self-talk and its use as a power booster can increase your sense of control during internal conversations. Words can often create feelings of power or helplessness. Make your self-talk an empowering habit.  

·        Build Realistic Expectations

Unrealistic expectations of yourself and others is a high source of stress that you create for yourself. Put your goals, beliefs, and viewpoints to the test. Are they realistic? If they are not, why hold on to attitudes that pull you down? Get into the habit of giving yourself frequent reality checks.  

Working on changing the inside world is challenging, but let’s also look at changing the outside   world. Listed below are a few tools to assist in that process: 

·        Build Collegial Support  

 Nurses are a vital resource for each other in stress management. Together, nurses can create a culture that reduces stress and empowers each individual to create positive change in the profession.

As a group, especially those in a team building situation, it is important to encourage each other to think positively, to use empowering language, and to take charge through creative problem solving. Another example would be to incorporate stress management discussions in meeting to share techniques, ventilate intense feelings and support creative change.

·        Create Problem Solving Opportunities  

Creativity is a talent that each one of us possesses, especially as nurses! Creativity helps make change a positive adventure, because your imagination and desires are shaping events rather than allowing events to shape you. It takes the right attitude and environment to get your creative juices flowing. To harness these problem solving talents and put them to work, the following sequence may be helpful:

·        Describe the problem objectively, then try and define and dissect it. 

·        Generate ideas, being as free and objective as possible. 

·        Select the best and promising ideas then refine as necessary. 

·        Take a risk implementing ideas and make a game plan. 

·        Evaluate an action plan, monitor your progress and revise as necessary.       

·        Create adventures and opportunities  

            The adventures in nursing are finding opportunities in the changes sweeping health care. While some nurses may view cost cutting and staff reductions as a threat, others turn limitations into advantages. Look for ideas everywhere. How about a think tank or center for innovation within the nursing department? 

·        Learn to Manage Your Time  

 As you build your positive thinking skills and adopt the attitudes of an adventurer, one of the most basic skills that you will need is time management. Time is a critical resource in every situation. Poor use of time can limit you, no matter how skillful, positive, or creative that you are. To increase control over you time, the following suggestions may be useful:  

·        Make “to-do” lists. 

·        Prioritize tasks. Be realistic, accept that not everything will get done today.  

·        Plan to do the tasks that you dislike when your energy is high.  

·        Schedule enjoyable tasks when your energy is low.  

·        Delegate everything possible, Accept that others will not do it your way, but

     tasks will get done and it will give others a chance to learn. 

·        Recharge your batteries  

            Build relaxation and recreation into every day. Relaxation for nurses is not a luxury, it is a necessity. Rest, pleasure, and joy can heal and revitalize. Creating positive emotions for yourself is also a chronic stress buffer. Remember that recreation is purposeful, energy building time that is well spent. If you feel guilty about treating yourself well, your guilt will cancel the positive effect. 

Reward Yourself 

          There is often a belief that chronic stress is a necessary part of nursing, and that enduring it is like wearing a badge of courage. This is false thinking! Many nurses promote the value of stress themselves by saying “we’re always under enormous stress, which proves that we are really working hard and that we care.”

          There is great value in being an adventurer and in challenge, especially when it produces increased performance. But there is no value in stress. The culture that expects or rewards stress is doing its members a disservice.

                Feeling good about yourself and your work is the real purpose of stress management and dealing with chronic stress. One of the most important things to remember is that stress is not  a necessary part of the job, you are entitled to enjoy your job.

You will reduce stress and increase your joy in nursing if you consider the following; don’t expect the ideal from a situation that is not ideal. At the end of every day, think of one thing that made it better for a colleague or a patient and tell yourself that you did a good job and reward yourself!  

Framework for Continuous Renewal 

·        Celebrate the small successes that you are achieving. 

·        Research what you are doing to generate those successes. 

·        Continue to focus on what your goals and objectives are. 

·        Help all parties (colleagues, bosses, and family members) to understand the benefits of reaching your goals and objectives. 

·        Continue to search for what you could be doing differently or better to move closer to your goals and objectives.  

Conclusion 

          A change in mind-set is needed to create the workplace in the new millenium and the key is to think in terms of future tense. Effective teams are swiftly becoming the keys to this change in mind-set and future vision. Collaborative and effective teams are a fundamental change in the organizational structure and require a new way of thinking for the change in mind-set.

         Teams must not be afraid of failure. They must earn the trust of the organization and each other through hard work, results, and productivity. Much will be asked of staff members in the new workplace and the effective use  teams will make a difference.

          Through teamwork, collaboration and open communication, nurses can manage the changes that are occurring and arrive at the better patient outcomes There may be many set backs along the way that hinder growth in all directions. But, periodic reassessment and checkpoints along the way will put each individual on a course correction.