Mental health management begins with taking responsibility for your own thoughts and attitudes. Do not allow self-defeating thoughts to dominate your thinking. You may have to remind yourself to stop thinking that you have to be perfect all the time. You may also have to adjust your expectations and become more realistic. Do you always have to be in control? Does everything have to be per- fect? Do you have a difficult time delegating?
Are you constantly frustrated because of the way you perceive situations? If you are answering yes to many of these questions, you may be setting yourself up for failure, resent- ment, low self-esteem, and burnout. Give yourself positive strokes, even if no one else does (Davidhizar, 1994; Posen, 2000; Wolin- ski, 1993).
Realistic Expectations
One of the most common stressors in life is having unrealistic expectations. Expecting family members, coworkers, and your employer to be perfect and meet your every demand on your time schedule is setting your- self up for undue stress.
Reframing
Reframing is looking at a situation from many different ways. When we reframe stressful sit- uations, they often become less stressful or at least more understandable. If we have an extremely heavy workday and we think it is because the nurse manager has it “in for us,”
the day becomes much more stressful than if we realize that, unfortunately, today we are short-staffed but staffing is usually okay most of the time.
Humor
Laughter relieves tension. Humor is a won- derful way to reduce stress both for yourself and your patients. Remember, though, that humor is very individual, and what may be
❖
BOX 10–5
GUIDELINES FOR GOOD NUTRITION
❖
Eat smaller, more frequent meals for energy. Six small meals are more beneficial than three large ones.❖
Eat foods that are high in complex carbohydrates, contain adequate protein, and are low in fat content.Beware of fad diets!
❖
Eat at least five servings of fruits and vegetables daily.❖
Avoid highly processed foods.❖
Avoid caffeine.❖
Use salt and sugar sparingly.❖
Drink plenty of water.❖
Make sure you take enough vita- mins, including C,B, E, beta carotene, and calcium; and miner- als, including copper, manganese, zinc, magnesium, and potassium.Source: Adapted from Bowers, R. (1993). Stress and your health. National Women’s Health Report, 15(3), 6.
funny to you may be hurtful to your patient or coworker.
Social Support
Much research has been done to show that the presence of social support and the quality of relationships can significantly influence how quickly we become ill and how quickly we recover. A sense of belonging and community, an environment in which we can share our feelings without fear of condemnation or ridicule, helps us maintain our well-being.
Having friends with whom to share hopes, dreams, fears, and concerns and to laugh and cry with is paramount to our mental health and stress management. In the work environ- ment, coworkers who are trusted and respect- ed become part of our social support systems (Wolinski, 1993). Box 10–6 lists some addi- tional tips for coping with work stress.
Nurses are professional caregivers. Many years ago, Carl Rogers (1977) said that you cannot care for others until you have taken care of yourself. The word selfishmay bring to mind someone who is greedy, self-centered, and ego- tistical, but to take care of yourself, you have to be creatively selfish.Learn to nurture yourself so that you will be better able to nurture others.
Stress reduction, relaxation techniques, exercise, and good nutrition are all helpful in
keeping energy levels high. However, although they can prepare people to cope with the stresses of a job, they are not solutions to the conflicts that lead to reality shock and burnout. It is more effective to resolve the problem than to treat the symptoms (Lee &
Ashforth, 1993). Box 10–7 lists keys to phys- ical and mental health management.
CONCLUSION
You already know that the work of nursing is not easy and may sometimes be very stressful.
Yet nursing is also a profession filled with much personal and professional satisfaction.
Periodically ask yourself the questions designed to help you assess your stress level and risk for burnout and review the stress management techniques described in this chapter.
There is no one right way to manage stress and avoid burnout. Rather, by managing small segments of each day, you will learn to identify and manage your stress. This chapter contains many reminders to help you de-stress during the day (Box 10–8). You can also help your colleagues do the same. If you find your- self in danger of job burnout during your career, you will have learned how to bring yourself back to a healthy, balanced position.
Unfortunately, we can’t live in a problem- free world, but we can learn how to handle stress. Using the suggestions in this chapter, you will be able to adopt a healthier personal and professional lifestyle.
134 ❖ Essentials of Nursing Leadership and Management
BOX 10–7
KEYS TO PHYSICAL AND MENTAL HEALTH MANAGEMENT
❖
Deep breathing❖
Posture❖
Rest❖
Relaxation❖
Nutrition❖
Exercise❖
Realistic expectations❖
Reframing❖
Humor❖
Social support BOX 10–6COPING WITH DAILY WORK STRESS
❖
Spend time on outside interests.❖
Increase professional knowledge.❖
Identify problem-solving resources.❖
Identify realistic expectations for your position.❖
Assess the rewards your work can realistically deliver.❖
Develop good communication skills.❖
Join rap sessions with coworkers.❖
Do not exceed your limits—you do not always hove to say yes!❖
Deal with other people’s anger by asking, “Whose problem is this?”❖
Recognize that you can teach other people how to treat you.❖
❖
BOX 10–8
TEN DAILY DE-STRESS REMINDERS
❖
Express yourself! Communicate your feelings and emotions to friends and colleagues to avoid isolation and share perspectives. Sometimes another opin- ion helps you see the situation in a different light.❖
Take time off. Taking breaks, or doing something unrelated to work, will help you feel refreshed as you begin work again.❖
Understand your individual energy patterns. Are you a morning or an afternoon person? Schedule stressful duties during times when you are most energetic.❖
Do one stressful activity at a time.Although this may take advanced planning, avoiding more than one stressful situation at a time will make you feel more in control and satisfied with your accomplishments.
❖
Exercise! Physical exercise builds physi- cal and emotional resilience. Don’tput physical activities on the back burner as you get busy.
❖
Tackle big projects one piece at a time.Having control of one part of a project at a time will help you to avoid feeling overwhelmed and out of control.
❖
Delegate if possible. If you can dele- gate and share in problem solving—do it! Not only will your load be lighter, but others will be able to participate in decision making.
❖
It’s okay to say no. Don’t take on every extra assignment or special project.❖
Be work-smart. Improve your work skills with new technologies and ideas. Take advantage of additional job training.❖
Relax. Find time each day to con- sciously relax and reflect on the posi- tive energies you need to cope with stressful situations more readily.Source: Adapted from Bowers, R. (1993). Stress and your health. National Women’s Health Report, 15(3), 6.
C u r r e n t R e s e a r c h Bernier, D. (1998). A study of coping:
Successful recovery from severe burnout and other reactions to severe work-related stress. Work & Stress, 12(1), 50–65.
In this qualitative study, data were gathered from first-person accounts of pro- fessionals who successfully recovered from burnout. In this study, successful recovery was defined as being in a job situation con- sidered satisfactory by the subject and with the subject having no desire to change jobs. Subjects had to have taken 1 month or more sick leave because of work stress or burnout, had to have solved the related problems within the last 4 years, be human service workers, and be available for inter- views. Twenty subjects were recruited and interviewed from the Province of Quebec in Canada. Grounded theory was selected as the framework. The unstructured inter- views were conducted by the same person and lasted an average of 90 minutes each.
Results of the recovery stages were: (1) A
sequence of stages: (a) admitting the prob- lem, (b) distancing from work, (c) restoring health, (d) questioning values, (e) exploring work possibilities, (f) making a break, making a change; the second aspect of the recovery process (2) was the coping strate- gies: (a) seeking reassurance, (b) under- standing causes, (c) finding support.
This study provides an interesting framework for the general stages and spe- cific coping strategies associated with burnout. Based on what you have learned in this chapter, what recommendations would you make to these participants to deal with burnout before it occurs again?
Additional examples can be found in:
Boey, Kam Weng. (1999). Distressed and stress resistant nurses. Issues in Mental Health Nursing, 20(1), 33–54.
Kalliath, T., O’Driscoll, T., & Gillespie, D. (1998). The relationship between burnout and organizational commitment in two samples of health professionals. Work
& Stress, 12(2), 179–185.
136 ❖ Essentials of Nursing Leadership and Management
C R I T I C A L T H I N K I N G E X E R C I S E
Shawna, the “new kid on the block,’’ has been working from 7 a.m. to 3 p.m. on an infectious disease floor since obtaining her RN license 4 months ago. Most of the staff she works with have been there since the unit opened 5 years ago. On a typical day, the staffing consists of a nurse manager, two RNs, an LPN, and one technician for approximately 40 clients. The majority of the clients are HIV-posi- tive with multisystem failure. Many are severely debilitated and need help with their activities of daily living. Although the staff members encourage family members and loved ones to help, most of them are unavailable because they work during the day. Several days a week, the nursing students from Shawna’s community college program are assigned to the floor.
Tina, the nurse manager, does not participate in any direct client care, say- ing that she is “too busy at the desk.’’ Laverne, the other RN, says the unit depresses her and that she has requested a transfer to pediatrics. Lynn, the LPN, wants to “give meds’’ because she is “sick of the clients’ constant whining,’’ and Sheila, the technician, is “just plain exhausted.’’ Lately, Shawna has noticed that the other staff members seem to avoid the nursing students and reply to their questions with terse, short answers. Shawna is feeling alone and overwhelmed and goes home at night worrying about the clients, who need more care and attention. She is afraid to ask Tina for more help because she doesn’t want to be seen as incompetent or a complainer. When she confided in Lynn about her con- cerns, Lynn replied, “Get real—no one here cares about the clients or us. All they care about is the bottom line! Why did a smart girl like you choose nursing in the first place?’’
1. What is happening on this unit in leadership terms?
2. Identify the major problems and the factors that contributed to these problems.
3. What factors might have contributed to the behaviors exhibited by Tina, Lynn, and Sheila?
4. How would you feel if you were Shawna?
5. Is there anything Shawna can do for herself, for the clients, and for the staff members?
S T U D Y Q U E S T I O N S
1. Discuss the characteristics of healthcare organizations that may lead to burnout among nurses. Which of these have you observed in your clinical rotations?
How could they be eliminated?
2. How can a new graduate adequately prepare for reality shock? Whose respon- sibility is it to prevent reality shock?
3. What qualities would you look for in a mentor? What qualities would you demonstrate as a mentee? Can you identify someone you know who might become a mentor to you?
4. What are the signs of stress, reality shock, and burnout? How are they related?
5. How can you help colleagues deal with their stress?
6. Identify the physical and psychological signs and symptoms you exhibit during stress. What sources of stress are most likely to affect you? How do you deal with these signs and symptoms?
7. Develop a plan to manage stress on a long-term basis.
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138 ❖ Essentials of Nursing Leadership and Management
139
The Workplace
O U T L I N E Workplace Safety Threats to Safety Reducing Risk Violence
Sexual Harassment Latex Allergies Needlestick Injuries Back Injuries
Impaired Workers
Reporting Questionable Practices Enhancing the Quality of Work Life Social Environment
Professional Growth and Innovation Cultural Diversity
Physical Environment Conclusion
O B J E C T I V E S
After reading this chapter, the student should be able to:
• Recognize threats to safety in the workplace.
• Identify agencies responsible for overseeing workplace safety.
• Describe methods of dealing with violence in the workplace.
• Recognize situations that may reflect sexual harassment.
• Make suggestions for improving the physical and social environment.
C H A P T E R 1 1
❖
❖
❖
Almost half our waking hours are spent in the workplace. For this rea- son alone, the quality of the work- place environment is a major concern.
Yet it is neglected to a surprising extent in many healthcare organizations. It is neglected by administrators, who would never allow peeling paint or poorly maintained equipment but leave their staff, their most costly and valuable resource, unmaintained and unre- freshed. The “do more with less’’ thinking that has predominated in many organizations places considerable pressure on staff and man- agement alike (Chisholm, 1992). Improvement of the workplace environment is more difficult to accomplish under these circumstances, but it is more important than ever.
Occupational hazards for healthcare work- ers are an enormous health and economic problem. According to Linda Rosenstock, MD, MPH, director of the National Institute for Occupational Health and Safety (NIOSH), every day in the United States, 9000 health- care workers sustain a disabling injuring on the job (Slattery, 1998, p. 12)
Much of the responsibility for enhancing the workplace environment rests with upper- level management people, who have the authority and resources to encourage organi- zation-wide growth and change. However, nurses have begun to take more responsibility for identification of and problem solving for workplace issues. The first international con- ference, Caring for Those Who Care: Occupa- tional Hazards to Health Care Workers, was held in 1998. Some of the most prevalent threats identified at the conference were latex allergy, back injury, violence, needlestick injury, and pollution. These issues, as well as sexual harassment, impaired workers, enhancement of the quality of work life, and diversity, are the focus of this chapter.