Skills for newly qualified nurses 2: identifying and managing stress

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.

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.