Beat nursing stress and stay calm and collected

Nurse Leader Insider, May 18, 2017

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Stress management tips for your students (and yourself)

Stress is not only the No. 1 health problem in America; it's one of the major problems facing your staff, resulting in poor job satisfaction and increased turnover. Some stress will always come with the nursing territory, but as a manager, you can play a pivotal role in helping your nurses manage the daily stress that comes with a taxing work environment.

"It's important that if you're going to be teaching nursing students effective strategies to manage stress, you have to model those things," says Maria Shirey, RN, MS, MBA, CNAA, BC, FACHE, PhD(c), adjunct faculty member at the University of Southern Indiana in Evansville.

Thus, as you attempt to teach your nurses the importance of limiting stress, make sure you embrace stress-relieving tips yourself, says Shirey. "You can't tell someone not to smoke when you smoke yourself," she adds.

Recent research strongly advocates stress management in healthcare. A Nursing Economic$ article notes that "the healthcare work environment as a source of overwork and stress has been implicated in the nursing shortage ... Because stress-related illness contributes to rising healthcare costs and disability, creating a healthy work environment is a priority for maintaining an adequate nurse work force." Read more about this research.

If stress relief isn't a priority, consider that research has found work-related stress can detract from the quality of nurses' work lives, increase psychiatric morbidity, and contribute to forms of physical illness, such as depression. Read more about nurse work-related stress.

Grissel Hernandez, MPH, BSN, RN, director of clinical education at AtlantiCare Regional Medical Center in Pomona, NJ, says exemplifying stress-reducing strategies is the key to helping nurses keep their cool. "We basically represent the model of how we want them to be around patients, families, and other colleagues," says Hernandez. "Sometimes our frustration gets spilled over into how we present ourselves ... but new nurses are very impressionable and will imitate everything we do as something that is acceptable or not acceptable."

Take a deep breath, count to 10, and read on

Stress is defined by the Gale Encyclopedia of Medicine as "the body's normal response to anything that disturbs its natural physical, emotional, or mental balance," and stress reduction "refers to various strategies that counteract this response and produce a sense of relaxation and tranquility." There are some straightforward and effective strategies that can make a big difference in the stress levels your nurses experience and the stress you fight as a manager.

"The first thing is to acknowledge that we're stressed out and to be compassionate to that knowledge without feeling guilty," Hernandez says. "Don't feel like you're 'less than' because you're not going through it stress-free. All of us are stressed out at one moment or another."

Once you acknowledge and accept the stress, you must realize that while some stressors are unavoidable, you can choose how you react to tension.

"We can't avoid stress from some areas, like The Joint Commission [formerly JCAHO], but what we have control over is how we choose to respond to it," Hernandez says. "The biggest problem we have is that we walk around with a grudge and don't learn to speak to other people."

This, says Hernandez, leads to another proven strategy to improve communication and avoid unnecessary stress: Avoid e-mail conversations when you can simply pick up the phone. "I've learned the hard way that when you've gone back and forth with e-mail too many times, it's time to pick up the phone. Things get lost in translation," she says.

Additionally, teach yourself and your nurses to engage in self-reflective practice, says Shirey. "Teach students to step back from a situation and rise from the here and now. They have to be able to put themselves in a different place where they can think clearly. It has to be a deliberate process," she says, adding that you should not be swayed by others who may view self-reflection as too soft a skill.

"This whole notion of building reflective practice, building self-awareness, and being able to focus on self are things that we aren't taught and aren't reinforced," Shirey says. "They're sometimes denigrated because they're seen as soft skills, but we work in a professional setting where we're constantly thinking of hard data and outcomes. In truth, it takes some of this softness to produce this hardness, if you will."

Cost-avoidance: Making an argument

Conducting a pilot study in stress management may be the perfect way to assess the anxiety levels of nurses across your organization, but getting administrative buy-in for such a venture requires some convincing with numbers and dollar figures, says Shirey.

"You must present it from the standpoint of piloting a program that can impact a desired outcome that the organization wants," she says. "If the organization wants to retain nurses and has data that the staff is reporting high levels of stress, the role of the educator can be to present a proposal for educational intervention with a pilot study."

That cost-avoidance argument can be consistent with the organization's strategic plan and goals, says Shirey. "If the pilot study works, it's a precedent for a learning activity that can be expanded more broadly and more thoroughly documented," she adds.

Calming classroom exercises

To help new graduate nurses get a grasp on their fears and manage their stress, Hernandez has created several activities.

One of the exercises she has created revolves around art therapy. She asks new graduates what their biggest fear is regarding the nursing world, then has them draw that fear. As their pictures begin to illustrate the various stresses they have over becoming a nurse—for example, harming a patient or not passing the NCLEX—Hernandez helps them to take those fears and use them as drivers toward success.

"I tell them it's okay for them to have those fears, but there is a fine line between being frozen by fear, not learning from it, and basically shying away from being a nurse versus taking that fear, acknowledging it's there, and using it as a motivation to make sure you know what you're doing."

Additionally, Hernandez hands out "STOP Meditation" cards to her new graduates for them to have on hand and reference during stressful moments. "It's one-minute meditation," she says. STOP stands for:

  • Slowing down
  • Taking three deep breaths
  • Observing your mind and body (e.g., "Am I hungry?")
  • Proceed with your day

"You should STOP for two or three minutes every hour of the workday," says Hernandez. "Give yourself permission."

And sometimes camaraderie can do wonders for relieving the stress load of new nurses. Teach your new graduates to stay in contact with friends and former classmates, who can provide support and serve as great resources for relaxation and rejuvenation. Read about other stress relieving tips for nurses.


    Bruno, L. (1999). "Stress reduction." Encyclopedia of Medicine issue 20010406. (2008). "Look to NURSES to relieve your stress." Available at

    Shirey, M. (2006). "Stress and coping in nurse managers: Two decades of research." Nursing Economic$ 24 (4): 203-211. Available at;col1

    International Labour Organization. (2000.) "SafeWork:Work-related stress in nursing." Available at

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