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 How many of you have experienced transitions this last year? Would you like to share? What did you do to ease the transition? Have you heard the saying “when it rains it pours” Transitions may not happen one at a time.

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 Peer acceptance, ready for the new role, paper vs. patient “go ask/tell the nurse” is gone, classmates and instructors are gone

Coping in nursing school: when I graduate…. No one told me THAT……

Reality Shock “ unsettling and/or jarring experience resulting from wide disparity between what was expected and what the real situation turns out to be.” Anybody remember one of those moments?

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. How many of you would blindly buy a high ticket item? Choosing a new workplace is a complex time consuming undertaking. Exploring the M,V &V as well as life on the floor is what the new grad is doing during orientation.

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 negative Assist the new employee integrate into the workplace culture Where can a new nurse have a voice at INTEGRIS?

Shock Phase Experiences frustration and disappointment in new role Perceives conflicting values between school and work General negativity about role. What can you share with someone in this phase? What worked for you?

Shock and Rejection Excessive fear and mistrust Physical exhaustion Feelings of failure Hypercritical attitude Physical symptoms Tend to bond to people with like attitudes Focus on the positive, exercise, provide positive feedback about a skill done well, encourage participation on a team/workgroup

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 ideals Disengage – work for just the paycheck Leave the profession We want to keep our employees! It is time consuming, expensive and discouraging when turnover is high. This course is in place to decrease the use of ineffective copings skills by staff.

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 We have all been there… Pacer, staff meetings, community events, smile!

Effective Ways to Cope Build a professional identity Engage in the organization Communicate effectively Seek out feedback often Develop a support network Identify a mentor Join ANA/ONA specialty nursing group, take a look at the INSIDE page

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 Not everyone has this, how can we help grow it?

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 Yay Stay

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 conflicts Understands 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 Wellness program

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 Stephen Covey

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. Ineffective communication

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 conflict Changing 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 Comfortable Act or respond rather than react

How to Handle Conflict Know your limits and boundaries: What actions/promises are you authorized and willing to take? What can you tolerate? 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 positive Be direct, but non confrontational Have access to facts Be aware of body language, tone of voice, eye contact Use appropriate timing Let the person know that you share the same goal.

Remember that usually there are rarely absolute rights and wrongs Don’t judge Don’t accept fighting as acceptable; excuse yourself if the other person cannot gain control of themselves Work on not letting others push your buttons