In some offices, the summer is a slow period. As the weather heats up, people take vacations, Friday dress codes get ever more casual, and the stress level goes down.
Not in hospitals. Patients get sick year round and nurses don't get a respite from stress, as I was reminded when two recent studies caught my eye.
A Finnish study published in the Journal of Clinical Psychiatry found that nurses working in the most crowded units are twice as likely to take sick time for depression as nurses working in units with "optimal" numbers of patients.
Reuters reports the findings don't prove overcrowding causes depression, but does show a link between chronic stress and its detrimental effect on nurses' mental health. The study has limitations—it didn't look at management or the financial health of the institutions, for example—but it is more evidence of what we already know.
I also read a piece in last month's New York Times' "Well" blog, which noted a 15-year study of Danish nurses that found those who were stressed out had double the risk of heart attack. The same article mentions a British study that found people who regularly work more than 10 hours a day had a 60% higher risk of heart disease than those who work seven hours.
Think back over the last few weeks about the number of 10-hours plus shifts we've pulled. Does it count if we checked e-mail while watching TV? Would you have felt more relaxed if you gave your entire attention to the Modern Family repeat instead of your typing?
Milliken, Clements, and Tillman wrote in a 2007 Nursing Economic$ article that to prevent burnout, organizations need to employ a nurse-centered stress management program AND an executive system support. Too often, stress reduction programs fail because they aren't relevant for bedside nurses or because bedside nurses do not receive support for such programs from leadership. The following strategies were found by this study and others to be effective:
1. Stress reduction classes: Offer live classes and computer-based sessions about self-care stress reduction techniques. Be sure to tailor the sessions so they make sense for busy staff nurses. For example, a session filled only with strategies that aren't applicable to the nurse environment won't be as helpful as one that includes easy to implement techniques such as deep breathing that can be performed during a quick meal break. Encourage nurses to participate by raffling off gift certificates for massages.
2. Create a space for relaxation: Social support has been shown to reduce the effects of stress, and senior leadership can help foster opportunities for nurses to interact by providing a place for them to meet. The break room can be more than a place to scarf a quick sandwich and managers should encourage staff to take breaks together when possible to build a sense of community.
3. Mentor and buddy programs: Having someone to vent to and engage in joint problem-solving can mitigate the effects of stress. Encouraging mentor and buddy programs also boosts nurse engagement and helps in long-term retention and professional development.
4. Recognition and reward: Although often considered a short-term boost, simple recognition and reward activities lift nurses' spirits and go a long way to making a bad day into a good one.
5. Manager involvement: Building a supportive and healthy work environment reduces the stress nurses feel. Managers can provide positive feedback and support through stressful situations. They can use opportunities such as unit staff meetings to solve problems and share stress reduction techniques.
6. Training and education: Offer continuing education and frequent training because nurses who feel competent in their jobs are less anxious. Support and praise nurses who attend non-mandatory educational events, achieve specialty certification, and other forms of professional development.
7. Counseling: Employee assistance programs can provide assistance specifically to prevent nurse burnout. Request your EAP start offering group classes and promote these heavily to encourage nurses to attend.