Untoward reactions can come from feeling unsure or inadequate about how to act, the situation (feeling overcome or impotent), or the distressed person (distress invades the health care professional).
Emotional involvement and empathy are the main causes of stress and burnout among nurses. If nurses become too involved with others' distress, they overload themselves emotionally and become ineffective (Johnston and Swanson 2004). If nurses avoid the distress of others by ignoring or belittling it, they are left with the feeling of not giving the attention and support that is expected. Some nurses feel helpless about how to be therapeutic with distressed persons. Others feel annoyed or irritated that clients or colleagues cannot solve their own problems. Thoughts about their own inadequacies, or judgments about the appropriateness of others' behavior, prevent nurses from acting in the best interests of the distressed person (Carroll and Arneson 2003).
Four common events that can cause burnout are: loss of control, change, sense of threat, and unrealized expectations. When nurses face distressed clients, these are the issues. Remember that it is not the situation itself that causes problems, but our reaction to it. The teaching of communication skills implies that if we say the right thing, clients or colleagues will have an unpleasant experience. ...
for another person's distress, to remain nonjudgmental so that they can convey appropriate compassion for the situation at hand, and to be clearheaded enough to act responsibly on behalf of the other person (Johnston and Swanson 2004).
The literature abounds with documentation of the stressors nurses experience. Johnston and Swanson (2004) cite four main events responsible for workplace stress and conflict: multiple levels of authority, heterogeneity of personnel, work interdependence, and specialization. All four criteria apply to the nursing profession. As a nurse, an employee navigates several organizational structures to ensure client well-being: the nursing hierarchy; the medical hierarchy; and the agency's bureaucracy. To survive this organizational maze, a nurse needs effective interpersonal communication techniques and efficient management skills (Koller and Bertel 2006).
Not only do nurses require a sound knowledge in their own area of expertise but, in order to be effective in helping clients, they need to know the role and functions of other health care professionals, how to communicate clearly with other members of the health care team, and how to coordinate work efforts of all these disciplines. The changing exposure to different personnel demands that a nurse quickly sizes up how to relate to colleagues effectively, adding one more stress to an already complex working environment (Koller and Bertel 2006). One of the most frequently cited sources of stress in nursing is the excessive workload demand, giving nurses the feeling that they are always in a hurry, as if in a race with time. These factors are overlaid by nurses' day-to-day encounters with distressing and anxiety-provoking situations, as well as insufficient resources in these times of health