Newly qualified nurses may find it hard to deal with stress. This article, part 2 in a three-part series on skills for newly qualified nurses, outlines how to recognise and manage stress

Abstract

Stress is all too familiar to student nurses and does not come to an end upon registration. In starting their career as a registered professional, newly qualified nurses will likely feel under pressure as they grapple with the reality of caring for patients – and doing so autonomously. There are various ways to deal with stress, but its symptoms must first be recognised. This article examines stress in the workplace, and how to identify and manage it as a newly qualified nurse.

Citation: Cathala X, Moorley C (2020) Skills for newly qualified nurses 2: identifying and managing stress. Nursing Times [online]; 116: 15/10/2020.

Authors: Xabi Cathala is lecturer, School of Health and Social Care/Institute of Vocational Learning; Calvin Moorley is associate professor for nursing research and diversity in care, School of Health and Social Care/Adult Nursing & Midwifery Studies; both at London South Bank University.

Introduction

Inadequate preparation for clinical placements, knowledge and skills demands, and conflicts between professional beliefs and the reality of hospital situations are some of the causes of stress experienced by student nurses (Admi et al, 2018). Researchers have also reported stressors such as ineffective communication, feeling a sense of inadequacy and being ignored (Rafati et al, 2017; Jamshidi et al, 2016; Sun et al, 2016). This pressure continues after registration, when nurses’ stressors can include workload, long hours, being accountable for their practice (Cathala and Moorley, 2020), and the overall work environment. Nursing has been reported as having a high prevalence of stress and burnout (Woodhead et al, 2016), which can lead to:

  • Adverse health issues such as exhaustion and fatigue;
  • Incapacity;
  • Being unfit for practice;
  • Personal repercussions, for example on family life.

This article examines stress in the workplace, and how to recognise and manage it as a newly qualified nurse (NQN).

What is stress?

It is important to understand that there are two types of stress:

  • Eustress – good stress;
  • Distress – bad stress (Seaward, 2017).

One view is that all stress is good for you, but it is the level of exposure and the ability to deal with it that turns it to distress (Dhabhar, 2014). Good stress helps the individual to prepare and cope with distress (Le Fevre et al, 2003). In nursing, we are hearing about stress more and more often; although it is usually related to work, it can also be linked to personal issues.

Stress is complex: it involves psychological conditions with physical manifestations. Numerous definitions in the literature highlight a lack of consensus; one reason for this may be because stress is related to both psychological and physical aspects of health. It is often defined as an emotional or physical pressure resulting in significant changes in a person’s mental, physical, physiological and social life (Fink, 2017). At times, stress can be useful and harmless but, once it becomes unmanageable, it becomes harmful, resulting in negative changes and effects on the individual and their performance. As such, it is important to recognise stress manifestations and the symptoms of stress to be able to manage it.

“Talking about a stressful situation may reveal people who have had similar experiences and can share support mechanisms”

Recognising stress

Most people are under stress, but everyone reacts to stress differently: under the same stress, some people will manage it well while others may not. This highlights the importance of recognising stress symptoms and manifestations. Table 1 shows some of the areas affected by stress, along with the manifestations and symptoms of it; the list is not exhaustive – the possible symptoms and manifestations are nearly endless.

Table 1. Stress areas and their manifestations/symptoms

Stress area  Manifestation/symptom
Emotional
  • Overwhelmed
  • Irritable
  • Anxious
  • Lack of self-esteem
Mental
  • Racing thoughts
  • Constant worrying
  • Difficulty concentrating
  • Difficulty making decisions
Physical
  • Headache
  • Muscle tension
  • Dizziness
  • Sleeping problems
  • Feeling tired
  • Change in eating habits
Behaviour
  • Drinking or smoking more
  • Snapping at people
  • Avoiding issues or people
  • Absence from work

NQNs may experience pressure that can be more difficult for them to manage compared with a senior or experienced nurse (Monaghan, 2015). Warning signs of stress to which attention should be paid include:

  • Being unable to work properly;
  • Making frequent mistakes;
  • Having a lack of patience;
  • Being unable to manage a situation that is usually easy to deal with.

Managing stress

Stress is more likely to be experienced at the beginning of a nurse’s professional life but can occur any time in their career – therefore, it is important to learn how to manage it. Box 1 outlines some strategies and tips that can help with stress management.

Outside of work you can:

  • Contact your GP, who should be able to propose other solutions;
  • Self-refer to a psychologist or seek counselling.

You may develop your own strategies, such as:

  • Practising mindfulness, meditation or yoga;
  • Taking up a leisure activity, such as rambling or cooking;
  • Eating healthily.

Box 1. Stress management strategies

  • Listen to yourself – this is key. If you, your colleagues, family or those in your network identify behaviour changes or emotions that indicate stress manifestation or symptoms you should look at ways to manage it.
  • Listen to others – this can help, as can sharing your experience with those in your network. Speak with your manager – they can develop an action plan to support you and reduce the pressure you are under. Speaking to your manager and occupational health team can be considered a form of escalation in regard to your workload if this is a contributing factor to your stress. As an NQN, you should escalate any workload concerns to those directly responsible for work allocation and schedule
  • Talk with colleagues – talk with your team about the issue you are experiencing; this way, your colleagues will be able to support you during practice. You can also seek help from occupational health, which can give you advice and help your manager develop a plan for you. It may also be beneficial to talk to other NQNs and share your experience
  • Take your breaks on time
  • Get enough sleep – recognise when you have not had adequate sleep and need a ‘duvet day’
  • Contact your GP – they should be able to propose other solutions
  • Self-refer to a psychologist or seek counselling
  • Practise mindfulness, meditation or yoga
  • Take up a leisure activity, such as rambling or cooking
  • Eat healthily

NQN = newly qualified nurse.

Ensuring a good work-life balance is important for good physical and mental health, and can contribute to managing stress. For those who experience stress, doing nothing and not talking about it can be the worst course of action; talking about the situation may reveal people who have had similar experiences and can share support mechanisms.

Conclusion

Every day, nurses deal with patients’ lives and there is no margin for error. This places nurses, and NQNs in particular, under pressure and stress. Often, acknowledging stress is seen as a weakness but, doing so, means a person is strong enough to speak up and find solutions to manage it.

Key points

  • Stress comes in two forms and can be either beneficial or harmful
  • Stress is a psychological state that can have physical symptoms
  • Everyone reacts differently to stress but, to manage it successfully, its symptoms and manifestations must be recognised
  • Symptoms may include irritability, difficulty sleeping, worrying and increased smoking or drinking
  • Talking openly about stress can contribute to it being managed successfully
References

Admi H et al (2018) Nursing students’ stress and satisfaction in clinical practice along different stages: a cross-sectional study. Nurse Education Today; 68: 86-92.

Cathala X, Moorley C (2020) Skills for newly qualified nurses 1: understanding and managing accountability. Nursing Times [online]; 116: 15/10/2020.

Dhabhar FS (2014) Effects of stress on immune function: the good, the bad, and the beautiful. Immunologic Research; 58: 2-3, 193-210.

Fink G (2017) Stress: concepts, definition and history. Neuroscience and Biobehavioral Psychology; doi.org/10.1016/B978-0-12-809324-5.02208-2.

Jamshidi N et al (2016) The challenges of nursing students in the clinical learning environment: a qualitative study. The Scientific World Journal; 2016: 1846178. doi: 10.1155/2016/1846178.

Le Fevre M et al (2003) Eustress, distress, and interpretation in occupational stress. Journal of Managerial Psychology; 18: 7, 726-744.

Monaghan T (2015) A critical analysis of the literature and theoretical perspectives on theory–practice gap amongst newly qualified nurses within the United Kingdom. Nurse Education Today; 35: 8, e1-e7.

Rafati F et al (2017) Iranian nursing students’ experience of stressors in their first clinical experience. Journal of Professional Nursing; 33: 3, 250-257.

Seaward BL (2017) Essentials of Managing Stress. Jones & Bartlett Learning.

Sun L et al (2016) The impact of professional identity on role stress in nursing students: a cross-sectional study. International Journal of Nursing Studies; 63: 1-8.

Woodhead EL et al (2016) Stress, social support, and burnout among long-term care nursing staff. Journal of Applied Gerontology; 35: 1, 84-105.