All nurses understand stress to some degree, and how it affects individual patients at any given moment. However, do you understand its impact on you and your career?
The picture that emerges when we look at the research is sobering, maybe even alarming. Not only do nurses experience pervasive job stress that contributes to overall health problems and concerns (Roberts, Grubb, & Grosch, 2012), but nurses also have disproportionately high rates of illness, stress-related disease, and mortality (Roberts et al., 2012, Fronteira, & Ferrinho, 2011). What do we do about this? “The sad reality is nurses ‘accept’ health problems that come from the physical and emotional demands of the profession, and … often do not care for themselves” (Letvak, 2014). Clearly too many of us, either do not sufficiently understand the impact of stress on our lives, or we do not have the right skills to counteract it, or both. I know that I personally always looked at stress as something that happens to others, never really taking the time to notice its effect on me.
The American Psychological Association (2015) reports that “stress remains a barrier that prevents people from living well and reaching their health and lifestyle goals.” They also report that despite the fact that only 18% of American adults reported stress levels that were lower than the prior year, a mere 20% of US adults participate in any type of stress management or stress reduction.
Nurses are not immune to this barrier. Cuneo (2011) reports that work-related stress contributes to nursing burnout. Other studies show that PTSD and burnout syndrome are prevalent in the nursing population (Mealer, Burnham, Goode, Rothbaum, & Moss, 2009). PTSD within the nursing community is also called “compassion fatigue,” referring to the secondary traumatic stress that nurses can develop from the various traumatic patient experiences they endure (Figley, 1995). As high as 86% of nurses are reported to exhibit symptoms of burnout syndrome (Roberts et al., 2012, Mealer et al., 2009), and 22-33% of critical care and ER nurses have been found to exhibit symptoms of PTSD (Mealer et al., 2009 & Dominguez-Gomez & Ruthledge, 2009). Med/Surg nurses may think they are immune to PTSD, but they are not; Mealer reports that 14% have it (Mealer et. al., 2007).
The problem goes beyond nurses themselves. Nursing burnout and PTSD adversely affect nursing turnover, staff absenteeism, employee morale, the financial bottom line, and thus ultimately, patient care (Portnoy, 2011).
While we nurses may possess a cognitive understanding of stress and even burnout, the data clearly shows that there is an opportunity for the entire nursing experience to improve, given better control of symptoms, and even prevention of PTSD/compassion fatigue and nursing burnout. Nowadays there are ways to do that. However, it is vitally important to grasp that recovery from compassion fatigue involves the development of positive self-care strategies (Lombardo & Eyre, 2011). Indeed, improving self-care is essential to creating overall wellness (Portnoy, 2011). It is time to stop focusing exclusively on others, and realize that we serve our patients best only when we give enough attention to our own basic needs.
As nurses, we need to start the conversation. It’s up to us to discuss and seek ways to process and release the stress of our jobs, so that it does not get stored as trauma. It is a strong tendency of many nurses neglect their own needs as they care for others; we need to band together as a profession and demand self-care for one another with as much passion and concern as we show for patient care!
– American Psychological Association, (2015). Stress in America: Paying with our health (ReleaseFebruary 4, 2015).Washington, DC: Author.
Cuneo, C., Cooper, C., Drew, C., Naoum-Heffernan, C., Sherman, T., Walz, K., Weinberg, J., (2011). The effect of Reiki on work-related stress of the registered nurse. Journal Holistic Nursing, Mar;29(1), 33-43. doi:10.1177/0898010110377294
Dominguez-Gomez, E. & Ruthledge D. (2009). Prevalence of secondary traumatic stress among emergency nurses. Journal of Emergence Nursing, 33(3), 199-205. doi:10.1016/j.jen.2008.05.003
Figley, C. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. NY: Brunner/Mazel.
Fronteira, I. & Ferrinho, P. (2011). Do nurses have a different physical health profile? A systematic review of experimental and observational studies on nurses’ physical health. Journal of Clinical Nursing, 20(17-18), 2404-2424. doi:10.111/j.1365-2702.2011.03721.x
Letvak, S., (2014). Overview and summary: Healthy nurses: perspectives on caring for ourselves. The Online Journal of Issues in Nursing, 19(3), Overview and Summary. doi:10.3912/OJIN.Vol19No03ManOS
Lombardo, B. & Eyre, C. (2011). Compassion fatigue: a nurse’s primer. The Online Journal of Issues in Nursing (OJIN). 16(1), Manuscript 3. doi:10.3912/OJIN.Vol16No01Man03
Mealer, M., Burnham, E., Goode, C., Rothbaum, B., & Moss, M. (2009). The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety, 26(12): 1118-1126. doi:10.1002/da.20631
Mealer, M., Jones, J., Newman, J., McFann, K., Rothbaum, B., & Moss, M. (2012). The presence of resilience is associated with a healthier psychological profile in ICU nurses: Results of a national survey. International Journal of Nursing Studies, 49(3), 292-299. doi:10.1016/j.ijnurstu.2011.09.015
Mealer, M., Shelton, A., Berg, B., Rothbaum, B., & Moss, M. (2007). Increased prevalence of psot-traumatic stress disorder symptoms in critical care nurses. American Journal of Respiratory and Critical Care Medicine, (175): 693-697.
Portnoy, D. (2011). Burnout and compassion fatigue: Watch for the signs. Journal of the Catholic Health Association of the United States-Health Progress, 2011(July-Aug), 47-50.
Roberts, R., Grubb, P., & Grosch, J. (2012). Alleviating Job stress in nurses, NIOSH: Workplace Safety and Health. Retrieved from http://www.medscape.com/viewarticle/765974