Stress in Nursing

Introduction

For a long time stress in the nursing profession has raised concerns due to its negative effects on the personal lives of nurses. In many hospitals and care centre nurses are the most susceptible to stress in their workplace due to their highly demanding and delicate tasks that they are expected to execute in their daily activities (Potter & Perry, 2009). Stress among nurses has become one of the most pressing problems among nurses and has created great deal of distress which leads to burnout among many individuals in the nursing profession (Yoder, 2007).

Generally, stress in nursing arises because of many tasks they are required to execute within a short time, this obliges them to work for long hours with no time to rest. Many nurses work for 12 hours shift on a daily basis and they do not have enough time to rest because after work they still have other responsibilities. For instance, many nurses have to carry out their family duties after work, thus making them tired and fatigued. This makes their life to be extremely stressful since they have to balance between family life and work life. In many cases nurses lack sufficient time to spend together with their own families and friends due to workload; they even lack sufficient time to spend with their own children. In some cases this has affected their families because if the nurse is married, most domestic duties are carried out by their spouses and this may lead to dissatisfaction. Unfortunately, in some cases this problem has resulted to breakups of some families as a nurse does not get sufficient time to be with the family. All these issues make the lives of many nurses stressful, and this may lead to adverse effects on their personal health.

As a result of increased cases of stress among nurses at the workplace, nursing profession remains vulnerable to both distress and burnout. This has resulted to the increased rate of turnover among nurses from various hospitals and health care centers as a way of reducing the stress they experience in their workplace (Sullivan & Decker, 2005). Stress has also contributed to depression among nurses which eventually make them engage in activities such as alcohol consumption as a way of reducing stress. In most cases stress in the nursing profession may arise as a result of fatigue due to working at long hours without having enough rest. For instance, the most common shift takes 12hours daily. Also, stress among nurses arises as a result of increased workload in the workplace; nurses are given a lot of tasks to accomplish without having enough time to rest, this subjects them to stress.

In order to handle the problem of stress in the nursing profession, various initiatives have been introduced in various hospitals and healthcare centers aimed at managing stress among nurses in the workplace. This is because stress among nurses does not only endanger their personal lives, but also risk the lives of the patients in hospitals. This is because due to stress nurses can make errors when attending patients and this may risk the life of the patient if not recognized as soon as possible.

A concept of burnout in the nursing profession has created much attention in the nursing literature. Burnout can be described as syndrome that comprise of emotional exhaustion and reduced sense of individual achievement, or a sense of being depleted of energy due to the demands of interacting with various patients, coworkers, families and employees (Pender & Murdaugh, 2006). Some of the measures established to address the issues of burnout comprise of administrative level of the management’s acknowledgement of strive that nursing work has on a person and the need to establish effective measures to assess and modify the entire nursing work environment.

It is imperative to note that in the working environment both emotional and physical components are the main factors in nurses’ experiencing burnout. In many hospitals and health care centers there are abundant strategies to enhance the physical working environment. However, strategies to enhance the emotional environment for the nurses are regularly addressed from the perspective of what management of an organization can do rather than what the person can do.

Emotional aggression and psychological harassment are descriptive of some of the frequently used term, bullying. Intimidation, anger, lateral violence, incivility and oppressed group behaviors are words that can be applied in describing unhealthy bullying that has consistently been a part of the nursing culture. The main reason for this negative behavior is generally tied to the theory of a controlling environment, oppression as well as feeling of no control among nurses in the workplace. These factors combined with other leads to frustrations/ agitation, aggression and anger. Furthermore, this form of violence rises when the stressors that stimulate the behavior go unrecognized or unchecked (Wicks, 2006).

Some examples of the bullying behavior which the nurses experience in their daily work includes non verbal signals like being ignored, being yelled at, gossip, humiliated, sabotage, regularly given undesirable assignments and physical threats. The consequences of these bullying behaviors include escalating feelings of shame and anger. On the other hand, for those individuals being bullied, the responses may have serious consequences on both recruitment and retention activities. As a result of these bullying activities the organization may experience serious financial issues related to sick time, an environment that is prone to many errors and non-productive work time. This is because bullying is extremely stressful for the recipient (Obholzer & Roberts, 1994).

In studying stress in the nursing profession, it is imperative to study the concept of fatigue because it is also one of the factors that cause stress among nurses. Also, fatigue threatens the safety of the patient, and it is described as the need for enough rest or sleep between hours worked. When nurses arrive at the workplace exhausted, they certainly increase the risk for unfavorable events for the patients as well as themselves. This means that if nurses report working without having enough rest or sleep they may risk of patients they serve. Fatigue can be contributed by certain lifestyles such as physical fitness and poor nutrition. For instance, nurses work for long hours and they do not get enough rest because after work they still have their personal responsibilities to accomplish, such as family responsibility (Kjervik & Martinson, 1999). This leads to stress among the nurses and some of them use alcohol as a way of reducing stress.

In 2006, due to increased concerns for patients and staff safety, American Nurses Association (ANA) published two policies related to fatigue. The first statement said that all registered nurses granted the responsibility providing health care to patients should not work when fatigued. The second statement said that the employer had a responsibility of enhancing healthy nursing hours; this meant that the employer had a role in ensuring that all nurses were not overworking. These policies were aimed at enhancing service delivery to patients by nurses. Also, these policies were aimed at improving the working conditions and welfare of nurses in the workplace. Furthermore, these policies encouraged employers and nurses to assess current practices and establish effective measure to ensure safety of the patients and nurses.

Fatigue is also entangled with the concept of vigilance. Even when nurses are well rested, they cannot logically be expected to remain vigilant for an extended amount of time like the ordinary 12 hours shifts that many nurses work. Vigilance can be defined as a state maintaining watchful attention of psychological readiness to act, as well as possessing ability to detect and react to danger. Vigilance has consistently been described as the real essence of nursing work in hospitals and healthcare centers. Although this condition of high alert can be perceived as a good way of describing nursing work, it may instead be compared to the condition or state of alarm described in the stress reaction. It is imperative for all nurses charged with the responsibility of providing care to patients not only to recognize, but also try to act on cues for patients.

Basically, expectations that all nurses should remain on high vigilance without emotional support and breaks can possibly lead to compassion fatigue, burnout or even bullying. Currently, in work and life environment many nurses are always stressed beyond their own ability to cope; that is, manifesting excess responses that are unique to the individual based on the culture, values, education, experiences, beliefs and family of a person. These responses can range from headaches, appetite changes, fatigue, gastrointestinal disturbances, memory disturbances, anger, changes in sleep, impaired judgment and reasoning as well as increased isolation.

In reality, vicious circle get created in a situation where stressors from sources regarded as a threat initiate the stress response without overriding periods of balance and restoration; hence, fatigue arises and manifests in various forms. Stress is stress, regardless of the source, neurochemical or physical response occurs and cascades into the numerous human reaction facets. The coping skills of an individual are extremely vital in handling the perceived threat. This is imperative because if stress among nurses is not well managed, then the lives of patients might be at risk since nurses will not be unable to provide proper healthcare for all patients. Therefore, it is imperative for the management of hospitals and healthcare centers to establish effective mechanisms that can help in addressing the issues of fatigue which contributes to stress among nurses. This can be done by ensuring that nurses do not overwork by giving them a lot of tasks to execute within a short duration of time or working for long hours without enough rest.

Coping skills

In order to address the issues of stress in the nursing profession, nursing literature provides various activities perceived as possible solutions for stress management. These include breathwork which activates the relaxation, response/parasympathetic, provision of friendly physical environment; this means safe workplace and environment with no excess noise or light. Others include Nutrition breaks, stretch break, massage, guided imagery, progressive muscle relaxation among others.

Furthermore, management of hospitals and healthcare centers are also required to limit hours worked, limit staffing ratios, provide social and emotional support to nurses especially on situations related to death, trauma and high risk outcomes. They are expected to provide education related to improved communication skills between co-workers and healthcare team members. This will enhance the relationship between nurses and other members of staff in organizations and in turn enhance the performance of all nurses in terms of flexibility and provision of high quality services to all patients.

Moreover, they are required to develop and implement policies that eliminate workplace autonomy of nursing practice, bullying, violence, job enrichment, incivility, reflective practice and leadership training. These policies can play a fundamental role motivating all nurses on their daily operations and create mutual relationship between them, patients and the management. In achieving this, it requires commitment from the management, nurses as well as other stakeholders; every party must play its part to ensure success. This is because the health of patients, as well as nurses, will be at risk if effective measure of managing stress will not be implemented.

In conclusion, it is clear that stress in the nursing profession arise as a result of nurses being overworked, working for long hours, denied a chance to have enough rest as well as lacking time to spend with their families. Therefore, the management of hospitals and healthcare centers should establish effective mechanisms to address the issues of stress among nurses. This is because stress endangers the lives of patients as well as the health of nurses. This is because nurses like other staff in different organizations are not able to execute their tasks efficiently if they are fatigued or stressed.

In order to eliminate stress in the nursing profession, it is crucial to improve the working conditions. This can be accomplished by regulating the working hours for nurses to ensure that they are not working for long hours, get enough time to rest and an ample time to be with their families. This will act as a motivating factor to all nurses, and in turn, they will improve their performance in the provision of healthcare to all patients.

Additionally, the management of hospitals and healthcare centers must ensure that there are enough nurses in their organization to assure that nurses are not overworked. The management should also ensure that there is equity in assigning duties and responsibilities among nurses. This ensures effectiveness and efficiency in the provision of healthcare services to all patients and brings satisfaction to all nurses.