The Nursing Team - Health and Wellbeing: Stress and Burnout
“Stress is a condition or feeling experienced when a person perceives that their demands exceed the personal and social resources the individual is able to mobilize”. In short, it’s what we feel when we think we have lost control of events. The key concept here, is that it is an emotional and physical response to a thought process, and that other factors influence how we respond to demands placed upon us.
I’m sure we all know the symptoms, but it is worth taking a moment to reflect on some of the common features:
- Difficulty getting to sleep or difficulty waking up in the morning;
- Constant fatigue;
- Aches and pains for no apparent reason;
- Poor appetite;
- Social withdrawal;
- Loss of interest in activities;
- Increased anxiety and irritability;
- “Flying off the handle”;
- Palpitations and raised blood pressure;
Here is a great little video by a Canadian doctor. It highlights the problems and brings out some of the key concepts in stress management. "The Single Most Important Thing You Can Do for Stress"
Please take some time to watch the video, reflect on it and then watch it again!
The key points are that you can change your thinking style and how you react to the situations you find yourself in. But you might need to learn techniques to do this and new skills to break away from patterns of established thinking and behaviour.
Remember, if you can’t change the situation (too many patients, too much paperwork, not enough time etc.) then you can change how you respond to it.
Here are some resources for stress management:
- How to be Happy is a video link you might find interesting. This video looks at some resilience and stress management tips. Website: https://www.youtube.com/watch?v=sycZZrYvCNw
- Mind Tools is an interesting site that has lots of useful material. A lot is open access and contains material on stress management, project management, communication skills etc. You can find these in the toolkit section on the website. Website: https://www.mindtools.com/
Ok, it’s time to get more serious now. If the constant stress of work and life is leaving you feeling disillusioned, helpless and worn out then you may be suffering from burnout.
Burnout is a state of emotional, mental and physical exhaustion caused by excessive demands and prolonged stress. It leaves you feeling increasingly helpless, hopeless, cynical and resentful. Life loses its meaning and you may feel you have nothing left to give. On the BMA website is a link to a questionnaire to rate your risk of burnout Are you in danger of burn out?
Here are some common signs that you might be experiencing burnout:
- Exhaustion mental, physical or emotional, or all three;
- Neglecting your needs no time or energy for anything else other than work;
- Lack of motivation don’t feel enthusiastic about anything anymore;
- Frustration, cynicism or other negative emotions these become overwhelming;
- Slipping job performance tasks building up, complaints increasing;
- Interpersonal problems at home and at work more conflicts, withdraw from colleagues and isolate yourself;
- Not taking care of yourself develop unhealthy coping strategies drinking more alcohol, eating too much, junk food, smoking more, having affairs, self-medication;
- Being pre-occupied with work, even when not at work;
- Generally decreased satisfaction in everything you do;
- Health problems digestive issues, heart disease, depression;
- Depersonalisation lose contact with yourself, no longer see yourself as valuable and lose track of personal needs. Your view of life narrows to the present time and life turns to a series of mechanical functions or tasks that are not to be enjoyed but just completed.
Stages of Burnout
There are several different models but the stages are similar:
High energy, good satisfaction from trying to solve problems and make changes, you find the job interesting most of the time
Fuel starting to run low
- Gradual onset of frustration, tiredness and loss of interest. Distancing yourself from colleagues and patients, become more cynical
- Denial of emerging problems blame increasing problems on time pressure and all the work you have to do
- More mistakes
- Physical symptoms increase fatigue, sleep disturbances
- Escape activities such as drinking or eating too much, smoking, buying things
Towards a crisis
- Symptoms and dissatisfaction with the job dominate all areas of life
- Wanting to be alone, rejecting help, lots of anger and inability to relax
- You start thinking of extreme measures to escape - moving, resigning, divorce or even suicide
- Energy is very depleted and symptoms get worse
Causes of Burnout
There are many causes of burnout, in many cases it stems from your job but can result from any situation where you feel overworked and undervalued. This may be a combination of work and home life. Other factors also contribute to risk of burnout, including lifestyle and personality traits.
Work related causes
- Feeling like you have little or no control over your work
- Lack of recognition or rewards for good work
- Unclear or overly demanding job expectations
- Doing work that is monotonous or unchallenging
- Working in a chaotic or high-pressure environment
- Working too much, without time for relaxing or socialising
- Being expected to be too much to too many people
- Taking on too many responsibilities without help from others
- Not getting enough sleep
- Lack of close or supportive relationships
- Perfectionist tendencies, nothing is ever good enough
- Pessimistic view of yourself and the world
- The need to be in control, reluctance to delegate
- High achieving type A personality
There are lots of tips, books, websites out there with plenty of advice. Most involve some of the following and spending some time reflecting on how you can avoid burnout is never wasted, even if after reading the above you don’t feel it applies to you.
- Give yourself planned time for a relaxing ritual. This might be doing gentle stretches, meditating, writing a journal, reading, listening to music etc. The key is to do it mindfully, with your whole attention.
- Eat healthily, exercise and get enough sleep
- Set boundaries
- Take a daily break from technology, "disconnect from an overly connected world"
- Do something creative and chose activities that have nothing to do with work or achievement
- Learn how to manage stress you may need help with this
Recovering from burnout
If it’s too late, and after reading this it is clear to you that you need help, then you need to take your burnout very seriously. You can’t push through burnout and serious harm may come to you and your family if you do.
SLOW DOWN. You need to force yourself to slow down or take a break. Give yourself time to rest, reflect and heal.
GET SUPPORT. You need help. Share your true feelings, stop trying to deny the situation and talk to another person. Consider seeing your GP and perhaps book a double appointment, or contacting the RCN Counselling Service on 0345 772 6100
RE-EVALUATE. Burnout is a sign that something isn’t working in your life. Your task is to find out what and put it right. You may need help to do this.
TAKE TIME OFF. If burnout seems inevitable then you might need to take a complete break from work. This often seems impossible as we tend to put our responsibilities before our health. This of course is part of the problem! Take a holiday, ask for leave of absence, take a sabbatical or you might need to take sick leave. Unless you take a break you will not be able to find the solutions.
We worry what others will think if we “confess” to having problems and of course if we do we may have to speak to a colleague who knows us professionally as well as being their patient. However, it is really important to put those fears and inhibitions to one side and trust the professional judgements and decisions of others. The strong person is the one who recognises the problems and decides to take action positively to get a better life.
Ref: The Stress of Medicine - David Rainham
Useful Links and Publications
Help Guide - www.helpguide.org
QNI Support - Talk To Us – The Queen's Nursing Institute (qni.org.uk) The QNI offers a Listening Service, TalkToUs, to offer emotional support by phone to registered nurses working in the community.