Stress Management and Role Transition for Nursing Students - Report Example

Stress, Stress Management and Role Transition for Nursing This paper will examine the general field in psychology related to stress, and provide a working definition of this generalized stress. Some sense of the identification of stress symptoms and the strategies to deal with such stress will be considered. It will then focus in on the specific stresses experienced by Licensed Practical Nurse (LPN) to Bachelor of Science Degree Nurses (BSN) or Registered Nurse (RN) to BSN nurses as they transition between student and working life. In this area, recommendations will be made regarding both institutional and personal responses to such stress, and mechanisms which may serve to alleviate such stress. Keywords: stress; transition; nursing; stress management Introduction In popular culture and in popular perceptions of medicine, stress has become an important factor in explaining numerous ailments and health problems among the general public. It is presumed, often, that stress is the result of external factors beyond the control of the individual that produce the responses of stress. Medically, it has further, however, been argued that stress is more a result of the mediation of the individual – or a personal response to outside, independent events – that cause this condition to be noted. Stressed people believe that the pressures facing them are greater than their ability to cope (Lazarus & Folkman, 1984). Thus interventions should be directed toward the interaction between the individual and the external environment if stress is to be managed effectively. The nature of the individual’s thought determines responses to stress. External events may be viewed from a negative and insecure perspective, or from a positive, receptive point of departure. Overall attitudes will determine how individual stress can be managed (APA website, 2012). In the case of nurses completing their education and moving into the world of employment in health facilities, stress is associated with transition. The role adaptation required for newly graduated nurses is significant and rapid, and causes these people to be confronted by a “broad range and scope of physical, intellectual, emotional, developmental and sociocultural changes” (Duchscher, 2008, p. 1). This is clearly a cause of stress in their lives, and anxiety, insecurity, feelings of inadequacy and instability may result (ibid.). This paper will seek to clarify the causes and symptoms of stress on a general level, in the first section, “Definitions, Causes and Results of Stress” and thereafter explore the nature of stress management. Specific stress experiences of Nurses in the transition phase from education to work will be examined in the section “Stress in the Transition from LPN to BSN or RN to BSN” and then stress management will be explored, at first generally, and then specifically for these nurses. In the consideration of stress management for nurses, both individual and institutional changes will be proposed in order to aid individuals in coping with stress. A Conclusion section will provide final comment and discussion. Definitions, Causes and Results of Stress The American Institute of Stress (AIS) provides a useful working definition of stress, suitable to the purposes of this paper. In short, stress is defined as a subjective feeling, in response to perceptions of external events, which causes anxiety (AIS, 2012, website). This can be supplemented by the comments made in a report published by the European Union sub-committee on workplace health, in 2007. It is suggested that stress is experienced when people feel that the demands made on them cannot be met by the resources they have available to them. The report cites “lack of control over work, unsuitable demands …, and lack of support from colleagues and management” as major causes of stress in the workplace (EU Reports, 2007). This definition adds to the focus in this paper on the situation of nurses leaving educational institutions and entering into work. It is essential that stress be dealt with, particularly in the workplace. In the European Union, 22% of work related health problems were reported as stress (EU Reports, 2007). It is likely that similar statistics could be derived from most Western societies. Importantly, the prevalence of stress in the workplace has numerous effects. People do become ill, physically, and unhappy due to stress. Stress also affects the productivity and effectiveness of workplaces – both businesses and institutions. In 2002, the cost of work-related stress in the European Union was estimated at €20 Billion (ibid.). The results of stress for the organization can be widespread: absenteeism; staff turnover; poor time-keeping; reduced productivity; increased costs and other negative effects. On the personal level, people may react badly emotionally both at work and at home. People may struggle to concentrate and make decisions, or struggle to learn. They may begin to behave destructively, and use drugs or alcohol to attempt to cope. And they could become physically ill, as mentioned, with symptoms such as hypertension, heart problems and weakened immunity. In the health industry, the effects of this phenomenon could certainly have very serious consequences. It is thus very clear that strategies and mechanisms to assist people to cope with stress are essential – not least of these, newly graduated nurses. What is Stress Management? Some consensus can be found in theories surrounding the techniques with which individuals can learn to cope with stress. Generally, these strategies and techniques can be applied to all people and be broadly termed “stress management”. Most theorists and practitioners would agree that stress is not the same for everybody – and that each person may find each situation differently challenging and respond to that situation differently. Furthermore, stress is not always negative: it does have some positive consequences and is necessary to effective human functioning, if it is not overwhelming. It is also acknowledged that very specific techniques to cope with stress are necessary for each individual – there is no real universal method to manage all kinds of stress for everybody. In addition the symptoms of stress may be unrecognizable, and even absent in individuals. In its initial stages, stress symptoms can be hidden by medication, or not acknowledged by the individual (APA, 2012, website). This management of stress should be tailored to individuals and specific situations, and cannot be addressed from a single perspective, with the presumption that only one set of universal treatments will work. Stress in the Transition from LPN to BSN or RN to BSN As referred to in the Introduction of this paper, nurses making the transition from a purely academic and learning way of life, at educational institutions, to the world of work and learning, face stress and may feel anxiety, insecurity, inadequacy and instability as a result. In North America 33-61% of new nurses reported that they would change the place of employment or leave nursing within their first year of professional practice (Various writers cited in Duchscher, 2008, p.2). It appears that one of the primary reasons for this finding is that nurses graduating from their courses have very different perceptions about what nursing is from what they experience in health care facilities (Duchscher, 2008). These people experience role change and performance stress. They are often morally distressed, discouraged and disillusioned, and find the new environment “prescriptive, intellectually oppressive and cognitively restrictive” (Kramer, 1966, Crowe, 1994 cited in Duchscher, 2008, p.2). Certainly, this perception is not universal, and the possible interventions are also not universal: the experience of nurses making this transition is influenced by the individual’s perceptions, expectation and history, as well as the situation she/he may find themselves in. Nonetheless, many nurses in the study by Duchscher (2008, p. 4) reported that they experienced “overwhelming, and at times physically and psychologically debilitating, levels of stress”. The stress experienced in this phase was emotional, physical and sociocultural and developmental. Not only, therefore, are nurses in this situation faced with the “normal” stresses of hard work, or long hours, they also struggle to find their new roles, cope with new responsibilities, and find their places in the hierarchies of health facilities. Management of Stress General Many sources exist to advise the public on stress management techniques, from self-help books to websites. Perhaps the most generic list of stress management techniques is advised by the APA, on their website, and could be applied as a general guide to dealing with personal stress. This is briefly explored below. An important starting point is the need for individuals’ to learn about themselves: what their stress signals are, and how their bodies and minds respond to stress. This includes being able to clearly identify the sources of their stress. Thereafter, it is advised that physically and mentally healthy activities should be developed to counter stress – for example meditation and mild exercise. Healthy eating and sleeping regimens are further suggested, and regular periods of relaxation are important. Support from family, friends, colleagues, and health professionals is additionally an option (APA, 2012, website). Thus on a personal level, at least some guidelines can be found to enable the individual to begin to cope with stress. LPN to BSN or RN to BSN In the case of nurses in the midst of transition of their roles, it may be necessary to consider both the personal mechanisms noted above, as well as institutional strategies to assist in this widespread experience of stress. On a personal level, a major adjustment for nurses is in their lifestyles. They have new time constraints, new financial pressures, new personal social pressures, and even new emotional contexts in which they have to operate. In terms of their personal stress management, highly effective time management strategies may be an essential step. In addition, the real effort to create balance is required. This will be aided by effective time management, but it will not be simple to find leisure or relaxation time in the programs of most nurses who are starting out. It is essential that some time be found, though, during which the individual can spend time on a personal interest, a friendship or a family relationship, preferred exercise, or even meditation. In finding personal coping mechanisms it is essential that the individual maintains a positive behavioral coping strategy rather than a negative one. The use of alcohol or medication should not be the strategy. Positive, reaffirming internal communication may be a solution, where the nurse recount perhaps a period of work, and notes the events in which she/he did succeed, acknowledges those and in fact continues to reaffirm her/his abilities based on such experiences rather than the less successful ones. One of the real dangers of restricted time, and the sudden and extreme changes which nurses do experience in this transition, is that eating and sleeping patterns are disturbed. It is advisable that such individuals take care to eat regularly and well, rather than irregularly eating low-nutrient, high-energy foods. Sleep patterns can also be influenced by learning effective relaxation techniques, so that the tension of work does not prevent sleep and rest. In the context of newly working nurses, there is the need, though, for institutions and their practices to be reviewed as well. There is evidence to suggest that some movement is occurring toward more effective workplace orientation and transition processes being adopted in health care facilities (Duchscher, 2008). But often, the nurse is “thrown in the deep end” in the words of one participant in a study (Duchscher, 2008, p. 7). It has been suggested that new graduates should be placed in stable clinical settings, be gradually exposed to the more advanced situations in health care, be given regular and supportive feedback, and even enter into mentorship relationships with more experienced colleagues in the first year of their professional lives (ibid, p. 9). This means that on both the level of the individual, and on the level of institutions – both educational and operational – the newly graduated nurse must be considered to be exposed to high levels of stress. Thus cooperation between the institutions and individuals in finding coping mechanisms to allay this stress is essential. Conclusion It is true that stress cannot be completely eradicated from human lives – there are some positive results from healthy stress, and a sense that individual motivation can be enhanced by stress. Nonetheless, situations in which stress is excessive and widespread, and in fact debilitates the individuals and harms the institution, should directly be addressed. In the case of newly graduated nurses, the possibilities for change by institutions to mediate the levels of stress experienced in this transition phase must be considered seriously. On a personal level, nurses should become aware of the stress they are exposed to, and find ways to ensure that their own stress is managed by positive means. Ideally, these combined strategies will yield positive results and reduce the epidemic of highly stressed new medical professionals. References American Psychiatric Association website (2012) APA Help Centre: Six Myths About Stress available at http://www.apa.org/topics/stress/index.aspx and accessed February 13, 2012 American Institute of Stress (2012) Definition of Stress available at www.stress.org and accessed February 15, 2012 Duchscher, J.B. (2008) Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses. Journal of Advanced Nursing doi: 10.111/j.1365-2468,2008.04989.x European Union Sub-Committee (2007) Report on Work-Related Stress In the European Union Stuttgart: EU Publications, and available at www.eu.gov with search term “health reports” Lazarus, R.S. & Folkman, S. (1984) Stress Appraisal and Coping. New York: Springer Writer Unknown (2011) Silent Signals You’re Stressed in Prevention Magazine available at http://www.foxnews.com/health/2011/12/22/silent-signals-youre-stressed/ and accessed February 15, 2012 Read More