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