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9 tips to combat stress

Even the best nurses feel overwhelmed sometimes. Delegating and prioritising your workload can help – but if you’re still feeling stressed, here are six strategies that may help.

1. Change your inner dialogue

A high workload and unrealistic management expectations can cause pressure – but be aware that negative thinking plays a part too.

‘It’s not just external pressures that create stress but also whether you think that you can cope with the situation,’ explains Professor Stephen Palmer of the Centre for Stress Management.

This can explain why one nurse may feel anxious about carrying out a new procedure or speaking at a management meeting, whereas another may see it as a challenge.

Changing your negative thought processes in reaction to a difficult situation can help prevent stress escalating. Start by not judging yourself harshly when you make a mistake, and avoid worse-case scenario thinking.

Talk to yourself with kindness. ‘In the same way you may support a stressed or underperforming colleague, learning to befriend yourself is a good de-stressing method,’ says Professor Palmer.

2. Pinpoint your triggers

Stress can be cumulative – one minute you’re busy but managing, the next you feel overwhelmed.

‘The more you can pinpoint your stress triggers, the more likely you are to recognise them and find better ways to cope,’ says Heike Guilford, Managing Director of The Coaching Nurse.

‘Think back over times when you felt stressed. What triggered it in the first place? A person? Something you heard that upset you? Where were you when you felt you were losing control?’

Heike suggest keeping a reflective diary of times you felt pressured and how you overcame this.

‘Alternatively, list three things that are causing you stress, then write down what you could do to help. The more you plan ahead and the more solutions you come up with, the better you will feel.’

3. Plan for the unplanned

A recent study by the University of Aberdeen found that while nurses are more stressed when the work was demanding, they were less stressed if they felt in control of their activities.

‘In a fast-paced acute environment, prioritising tasks is crucial for managing workload,’ says Nick Simpson, CEO of nursing agency MSI Group.

‘Prioritisation takes practice, and most nurses know to build their work around permanent fixtures on the schedule, such as breakfast, handover, consultant walk-rounds or the drugs-trolley.’

Once you have identified the highest priority tasks and allocated them time, you can complete other more flexible duties around them, remembering to leave enough time for admin.

Nick says: ‘Many nurses are good at prioritising but make the mistake of not leaving enough time for the unplanned. If a patient’s condition deteriorates rapidly, this will take priority, but other essential duties should never be overlooked, even if they are temporarily postponed.’

4. If you don’t know, ask

It’s often the “unknowables” that add to our stress levels. If you’re unsure of anything at work, ask

‘If you’re an agency nurse, knowing the local policies and procedures, where the supplies are kept, and where to find your line manager, will help you plan your shift better,’ says Nick.

Likewise, if you’re worried about a procedure you’re unfamiliar with, get help and support now. Niggling worries have a habit of feeding stress.

5. Celebrate success

Do you go home and reflect on the things that went badly or the tasks you didn’t complete?

‘You can build confidence, competence and reduce your stress levels simply by noticing and celebrating small achievements each day,’ says Heike.

‘Keep a journal and write down three things that went well. This will also help you build your professional portfolio and tackle new challenges with confidence and competence.

‘When you’re at work, observe the things that are going right. Celebrate others’ successes and you will help create a positive atmosphere where others feel encouraged to do the same.’

6. Change the horror movie

Whether it’s your fear of giving a presentation or facing a colleague you absolutely hate, your mind can be your own worst enemy.

‘You wouldn’t go into the cinema to watch the same terrible movie over and over again. And yet, you may find yourself engrossed in imagining all the terrible things that could happen,’ says Heike.

If this is you, hit the stop button.

Heike says: ‘Change the movie ending so that it all goes well. Research with athletes show that their performance improved significantly just by repeatedly visualizing successful outcomes.’

7. Take a breather

If you find that you can’t think clearly, take a two-minute breather.

‘Taking a step back during your shift to re-evaluate what you’ve achieved and what you still need to do can help put a hectic situation in perspective,’ says Nick.

When we’re stressed, we tend to take shorter, shallower breaths. Going somewhere quiet and taking just five deep breaths will help to clear your head.

8. Change your perspective

Frustrated with the nit-picky colleague picking holes in your project? Upset that decisions have not gone your way?

‘Take a step back,’ advises Heike. ‘Imagine you are looking at this as a complete outsider called in to help resolve the issue. What would they recommend you should do? Make a list of all the things you have control and influence over. Consider all of your options and then make a decision.

‘Writing things down will help you get things out of your brain and onto the paper. Neuroscience shows that this strategy is very effective to help us regroup and find clarity.’

9. Learn to say ‘no’

While prioritising and delegating can help to increase productivity to a point, ultimately, patient safety relies on the ability to say ‘no’.

‘If you don’t feasibly have the time to fulfil your duties to an acceptable standard, let senior staff know so that mechanisms can be put in place to cover the shortfall,’ says Nick.

If pressures at work are affecting your performance, mood or health, speak to your line manager, GP or union representative. Nick says: ‘This is crucial if you feel you are unable to maintain the level of health you need to carry out your professional role as identified in the NMC code.’

You’re only human. Showing signs of stress does not mean you’re failing as a nurse – it’s a warning sign you need to respect your limitations, get some support, and find better coping strategies.

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