Work-Related Stress and Burnout

Reality Shock

Objectives

Identify signs of stress, reality shock, and burnout

Describe the impact of stress and burnout on the individual and the rest of the team

Identify resources in place specific to INTEGRIS Health

Transitions in Nursing

What are transitions?Passages/changes from one situation, condition or state to another over time

Types Developmental Situational Health-Illness Organizational

Sources of Stress for the New Graduate Nurse

Moving into a new group Expectations of

competence Ideals vs. Reality They are the RN Loss of trusted

relationships with classmates

Reality Shock

“ unsettling and/or jarring experience resulting from wide disparity between what was expected and what the real situation turns out to be.”

Reality Shock and New Graduate Nurses

New graduates often feel a conflict over professional goals or values and the values and goals in place at work.

The work setting goals are often embedded in the culture of the organization.

Stages of Reality Shock: Honeymoon Phase

Thrilled with completing school

Excited about finally being a nurse

High energy euphoria. Wants to become learn

everything at once. Excitement that distorts

perceptions Frequently short lived

Preceptor’s Role During the “Honeymoon”

Harness the new nurse’s enthusiasm for learning new skills and routines by helping the new grad stay grounded.

Be realistic without being negativeAssist the new employee integrate into

the workplace culture

Shock Phase

Experiences frustration and disappointment in new role

Perceives conflicting values between school and work

General negativity about role.

Shock and Rejection

Excessive fear and mistrust

Physical exhaustion Feelings of failure Hypercritical attitude Physical symptoms Tend to bond to

people with like attitudes

Effects of Stress

Stress is assessed on 4 levels:

Environmental Social Physiological Psychological

Ineffective Ways to Cope

Abandon professional goals – will eliminate conflict, but leaves you dissatisfied

Give up professional idealsDisengage – work for just the paycheckLeave the profession

Preceptor’s Role During Shock Phase

Offer support by being a good listener Offer an objective point of view by:

acknowledging negative but emphasizing positives

Encourage new staff to verbalize ideas for improvement

Educate other staff about what to expect in shock phase

Effective Ways to Cope

Build a professional identityEngage in the organizationCommunicate effectivelySeek out feedback oftenDevelop a support networkIdentify a mentor

Emotional Intelligence

Know and manage your own emotions

Motivate your new graduate by setting small achievable goals

Help with organizational skills

Be open to other points of view

Be readily available and open

Recovery Phase

Beginning to re-discover a sense of humor

Decreased physical signs of stress

Increased ability to objectively view work and the environment

Can distinguish between effective and ineffective behaviors

Preceptor Role During Recovery

Continue to emphasize positive

Support the new graduate’s suggestions for improvement

Encourage participation in unit-based council, staff meeting, etc.

Unsuccessful Recovery

Job hopping Limited involvement

with co-workers and the organization

Complain but rarely offer suggestions and refuse to help solve problems

Resolution Phase

Seeing a resolution to previous conflictsUnderstands and/or accepts role in both

the work environment and workplace culture

Behavior appropriate for situation

Differences in expectations

To cope with reality, you must recognize that: Expectations are often distortions of reality,

which can lead to disappointment To be successful in nursing, you must fit

yourself into the work, not fit the work to suit your demands

The way you perceive events on the job will influence how you feel about your work

Expectations

Your mental attitude will influence whether your work is a pleasant or unpleasant experience.

Feelings of helplessness and powerlessness cause frustration and job stress.

Warning Signs of Stress

Apathy Anxiety Irritability Reacting in the extreme Smoking/drinking Eating “comfort foods” Tardiness or

absenteeism Chronic ailments or

repeated bouts of illness Relationship problems exhaustion

Burnout

The ultimate end of job related stress

Often attributed to the nurse’s inability to deliver what is perceived as ideal care.

Stages of Burnout

High expectation and idealism

Early job dissatisfaction; pessimism

Withdrawal and isolation

Irreversible detachment and loss of interest

Beating Burnout

A-B-C’s of Stress management Awareness – be honest when signs appear Belief – help new graduates develop

confidence in their abilities Commitment – be committed to helping the

new graduate recognize and reduce stress Don’t forget your own stress!

Physical Health Management

Get plenty of sleep Take breaks Practice relaxation

techniques: deep breaths, stretching

Exercise Eat healthy

Mental Health Management

Realize that new nurses own their thoughts, attitudes, and values

Set realistic expectations

Laugh Provide social

support

Traditional View of Conflict

Conflict is BAD

It’s adversarial

It’s a Win – Lose proposition: if I win, you have to lose and if you win I have lost

Typical Self-Talk about Conflict

There is nothing that I can do about it.”

“I wish it will all disappear when I wake up tomorrow”

“He’s always been this way and as long as I have to deal with him nothing will change.”

“It would feel so good to kick her ***.”

Why Do people Fall Into the Conflict Mode?

They’re just ‘doing their job”This method has always worked for them

in the past.They don’t think they are difficult ( and

they can prove it!!!!)They don’t have the skills to resolve or

handle conflict.

What’s Really Behind Conflict

Fear Differences in values and beliefs Differences over facts Differing view of the priorities Differences over methods Competition for resources Competition for power Simple misunderstanding (poor communication)

Conflicts in Nursing

Conflicts that can occur are often rooted in trying to balance institutional interests, “client” interests, and personal interests of the individuals involved. Some complicating factors are:

-Distribution of costs and benefits. Those who benefit

from resolution may not be the same people who pay the costs

-Perceptions of problems. People tend to blame others for causing the problem

-Speed of the action. Some will want change to take place more quickly than others

What are your options?

Do Nothing Walk Away/Turn the “Other Cheek” Change Your Attitude Change Your Behavior to resolve the

conflictChanging their behavior is NOT an

option!

Dealing with Difficulty

Remember that the only one you can change is you;

you can become the “skilled” person Become Confident, remain Calm, be

ComfortableAct or respond rather than react

How to Handle Conflict

1. Know your limits and boundaries: What actions/promises are you authorized and willing to take?

2. What can you tolerate?

3. What pushes the “difficult’ person’s button? Realize that once it’s been pushed, conflict management skills are likely to be ineffective.

Diffusing Anger

Stay clam yourself

( breath!!!) Create emotional

distance: ask yourself if there is any value in what they other person is saying

Listen for information and ignore the emotion

Prepare an Effective Response

“Time out!. I hear what you are saying, but you need to slow down.”

“ Give me a chance to respond. This is what I hear you saying.”

I need to interrupt you to let you know that yelling is distracting, and makes it hard for me to listen to your information,’

Remember

You can’t change them; you can only change yourself.

Change the environment. If certain settings usually trigger responses, change the scene. Meet for lunch or in a non-threatening setting.

Show you understand; summarize and ask questions.

The single best anger diffusing technique:

Apologize!

……..even if you are not sure you did what the other person thinks you did, it can diffuse the situation.

When emotions aren’t high, you can approach that person to work on a solution.

Practice Good communication Skills

Be positiveBe direct, but non confrontationalHave access to factsBe aware of body language, tone of

voice, eye contactUse appropriate timingLet the person know that you share the

same goal.

Remember that usually there are rarely absolute rights and wrongs

Don’t judgeDon’t accept fighting as acceptable;

excuse yourself if the other person cannot gain control of themselves

Work on not letting others push your buttons