Running head: STRESS REDUCTION

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Reducing Stress to Avoid Nursing Burnout
Ashley A. Dean
University of Louisiana at Lafayette

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Stress

Stress is our body’s reaction to a stimulus that triggers our primal “fight or flight” response. This response causes a hormonal dump of adrenaline and cortisol into the bloodstream that enables our bodies to react quickly to perceived danger. These hormones cause us to become more aware of our surroundings and able to make quick decisions and movements. This “acute-stress” reaction is a good thing but continued or chronic stress over long periods of time can cause detrimental effects to your body as the body never returns to homeostasis. Chronic high levels of cortisol and other corticoids can cause a decline of your immune system, making you more susceptible to illnesses. Additionally, they increase your body’s resistance to adrenaline that is also at higher levels under chronic stress (Bryant). If we do not reduce stress then there is a very great danger of becoming burned out. First described in the 1970s by the American psychologist
Herbert Freudenberger as the consequences of severe stress and high ideals experienced by people working in “helping” professions (Informed Health Online. (2013). Burnout is a special kind of job related chronic stress that results in a state of physical, emotional and mental exhaustion where you derive little or no enjoyment in your career and begin to doubt your competence. The increased levels of stress and burnout among nurses significantly affect the efficiency and productivity of nurses leading to low quality care, lowered job satisfaction, increased nurses’ turnover rates, and increased health care costs on the part of patients (Saini,
Kaur & Das, 2011).

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Reducing Stress to Avoid Nursing Burnout

I achieved my goal of working in a Surgical and Cardiovascular Intensive Care Unit, but did not anticipate the high patient acuity and the level of stress that I would subjected to on a daily basis. As a former paramedic/fire fighter I thought I was well equipped for the rigors and stress of an ICU, but over the years they are beginning to take a toll on me. I have noticed that I am not enjoying working or life as much. I took the Burnout Self-Test on Mind Tools website and was dismayed to discover that I am at a severe risk of burnout (Appendix A). As I approach my 50th birthday, the findings of a Danish 15-year study of 12,000 female nurses found that nurses who reported their work environment had excessively high pressures had double the risk for ischemic heart disease and was significant was among the younger nurses (Allesoe, Hundrup,
Thomsen, & Osler, 2010) was alarming to me. The increased levels of stress and burnout among nurses significantly affect the efficiency and productivity of nurses leading to low quality care, lowered job satisfaction, increased nurses’ turnover rates, and increased health care costs on the part of patients.
My goal is to reduce my stress level to avoid job burnout, so that I may continue being an effective, productive nurse and contented person. To achieve that goal I used the Plan-Do-Check-Act

(PDCA) cycle to develop a plan of action, implement the plan for improvement, collect data to evaluate the plan, and determine the plan’s effectiveness or need for modification (Neuhauser,
Myhre, & Alemi, 2004).
(P) Plan
In preparation to create my stress reduction plan, I researched stress reduction techniques and strategies on the internet. Through my searches I found several pertinent articles. Using these as a guide, I selected 3 techniques to focus on in my stress reduction plan: exercise, journaling and being more assertive in the workplace. My plan is to actively exercise for 45 minutes 3 times a week; keep a journal where every day before going to sleep I will write down my feelings

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about the previous day, my successes at being more assertive at work and how my exercise plan is working; and to start being more assertive at work by delegating tasks and declining additional tasks or responsibilities.
(D) Do
I began my stress reduction plan on Thursday January 16, 2014 and ended data collection on Friday February 22, 2014. I collected and recorded daily data on the 3 stress reduction techniques that I selected. I created a spreadsheet for each technique to collect the daily data.
Below reflects the data collected.
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Week 1 o Exercised 2 days for a total of 80 minutes; o Wrote in my journal 3 out of 3 days; o Delegated tasks to Clinical Assistant every shift.

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Week 2 o Exercised 3 days for a total of 130 minutes; o Wrote in my journal 6 out of 7 days; o Delegated tasks to Clinical Assistant every shift and declined to work overtime shift.

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Week 3 o Exercised 2 days for a total of 110 minutes; o Wrote in journal all 7 days; o Did not delegate any tasks because I was in training and not working on the floor.

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Week 4 o Exercised 4 days for a total of 220 minutes; o Wrote in journal 5 out of 7 days; o Did not delegate any tasks as I had a 1:1 patient assignment.

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Week 5 o Exercised 2 days for a total of 100 minutes; o Wrote in journal all 7 days; o Asked for meeting with unit manager to discuss staffing changes that affected me adversely and delegated tasks on all shifts to Clinical
Assistant.

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Week 6 o Exercised 3 days for a total of 200 minutes; o Wrote in journal 5 out of 5 days; o Decline overtime assignments twice and did not delegate tasks to Clinical
Assistant as I had a 1:1 patient assignment.
(C) Check

After collecting data for 6 weeks I created a histogram reflecting the number of days and the minutes I exercised, which can be found in Table 1. I met my goal of exercising 3 times a week only twice during the 6 weeks, but the average time spent exercising each week was above my goal of 135 minutes at 140 minutes a week; I wrote in my journal 34 out of 37 days or 92% of the days; and I delegated tasks or declined extra shifts on 10 out of 18 shifts worked for 55.5% of the shifts. It should be noted that there were 2 weeks of shifts (6 shifts) where my patient assignment was 1:1 and there were no tasks delegated. An additional week I was in training and did not work on the floor. At the end of the 6 weeks I took the same Burnout Self-Test, although my score of 45 indicates that I am still at risk for suffering job burnout, my new score was lower than the original 57. I also felt better physically and mentally at the end of the 6 weeks, was less irritated with tedious tasks and had better sleep cycles according to my FitBit Force tracking device with fewer than 5 minutes of restless or interrupted sleep per sleep cycle.
(A) Act
Recovering from chronic stress or Burnout Syndrome is a long and ongoing process.
According to Mind Tools website, burnout occurs when passionate, committed people become deeply disillusioned with a job or career from which they have previously derived much of their identity and meaning. While I did have limited success in decreasing my risk for burnout over the 6 week period, long term success is the ultimate goal. Focusing on rediscovering my passion for nursing is a priority, for that is a very important determinant in avoiding work related chronic

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stress and burnout. I will continue with the stress reduction techniques I started and will eventually add more such as socializing with people not associated with work. As part of this project I built a Kaoru Ishikawa “Fish Bone” diagram to look at what I perceived as my work stressors. Upon completion I realized that a large portion of these stressors are outside my control. Mosby’s Medical Dictionary states that “causes of burnout peculiar to the nursing profession often include stressful, even dangerous, work environments; lack of support; lack of respectful relationships within the health care team; low pay scales compared with physicians' salaries; shift changes and long work hours; understaffing of hospitals; pressure from the responsibility of providing continuous high levels of care over long periods; and frustration and disillusionment resulting from the difference between job realities and job expectations (Mosby,
2009).” Therefore, I took a huge step during the final week of this project and accepted a position in a day surgery center. While it is not the ICU, it will allow me to focus on myself and my family. After accepting and notifying my current employer, I felt as though a huge weight had been lifted off of me. I’m excited to learn a new nursing role and expand upon my current knowledge. STRESS REDUCTION

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References

Allesoe, K., Hundrup, Y. A., Thomsen, J. F., & Osler, M. (2010). Psychosocial work environment and risk of ischaemic heart disease in women: the Danish Nurse Cohort Study.
Occupational and Environmental Medicine, 67(5), 318-322.
Bryant, C. (n.d.). Discovery Health. Discovery Fit and Health. http://health.howstuffworks.com/wellness/stress-management/physical-effects-ofstress2.htm Burnout Self-Test. (1996-2014). - Stress Management Training from MindTools.com. http://www.mindtools.com/pages/article/newTCS_08.htm Informed Health Online. (2013). What is burnout syndrome? http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050545/ Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.
Neuhauser, D., Myhre, S., & Alemi, F. (2004). Personal Continuous Quality Improvement Work
Book. 7th ed. pp. 1-34. Retrieved from http://www.a4hi.org/docs/Neuhauser_personal_improvement_project_workbook.pdf Saini, R., Kaur, S., & Das, K. (2011). Assessment of stress and burnout among intensive care nurses at a tertiary care hospital. Journal of Mental Health and Human Behaviour, 16(1),
43-48.

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Appendices

Appendix A

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Appendix B

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Figures

Figure 1

Minutes Exercised
90
80
70
60
50 40
40
30
20
10
0

85

60
40

45 45

40

45

60

45
30

35

60 60

60

40
30
20

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Figure 2

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