Nursing in stressful work environments

By Gale Lyman Posted on March 27, 2021June 24, 2021 Category :

Stress Management

Health care needs to change. It’s time to improve work environments for nurses and ultimately improve the patient experience. A systems approach to reduce burnout and unnecessary systems challenges can result in greater well-being, engagement, safety, and career satisfaction.

Stressed Healthcare in the U.S.

What do you think – is U.S. healthcare perfect just the way it is? I don’t think so! Neither does the Massachusetts Health and Hospital Association (MHA). In an easy to read bullet format, a the newly released Caring for the Caregiver Task Force Report presents challenges and recommendations regarding workplace violence and worker injury, workplace culture, workplace wellness, caregiver preparation, lack of available job applicants, and staffing shortages. All of these challenges negatively impact not only healthcare staff, but also patient care.

In my research about stress and nursing, I’ve read about all of the challenges cited before. None of them are new to me, and if you work in healthcare, they won’t be new to you either. The difference, for me, is that this is the first report I’ve read that compiles all of these challenges in one place. Frankly, I was overwhelmed, and began to wonder how any of us healthcare workers make it through the day.

I don’t want to overwhelm you, my reader, but I do want to bring to your attention that reducing the stress of working in healthcare is not only a personal issue, but also a systems issue. I want you to feel supported by knowing that others see the problems and want to improve the healthcare system. I hope you will accept that you are likely stressed, and something needs to give, even though a common response of healthcare professionals is to accept all the challenges thrown at them as “all in a days work.” I want you to care for your self by managing your personal stress and become an advocate for a healthier safer healthcare system for all workers and patients. Don’t worry – I’ll help!

Stressful Challenges

If you work in healthcare, do you acknowledge or ignore the stressful challenges of your work? The number and nature of challenges varies among organizations, and sometimes among departments within the same organization. One of the accomplishments of the MHA task force is to name, in one document, the many challenges interfering in doing what we entered healthcare for in the first place – to compassionately care for patients.

Here are some of the challenges they identified in “Caring for the Caregiver Task Force Report.” I invite you to read through this list of challenges addressed by the task force as if it’s a check list. Check how many you experience in your work setting. How many do you think you might check? One, five, ten, or more?

Challenges to safety from workplace violence and workplace injury

Organizations that discourage or make it challenging to report violence or injury
Inaccuracy of systemic data collection about workplace violence
Lack of support for staff affected by violence or injury
Lack of training for staff in violence prevention
Lack of effective injury prevention in the workplace
Insufficient specialty beds for patients with mental health, forensic, or substance abuse issues

Challenges to engagement in positive work environments

Rapid changes with information technology
A trend of high turnover among younger generations
Different generations of staff have different skill sets, communication styles and motivations.
A shift from smaller to larger organizations, created by mergers and consolidations
Varying levels of contentment and discontent within an organization, often related to leadership within micro-cultures
Compassion fatigue

Challenges to well-being, including physical, emotional, mental, financial and social health

Disruptive financial, technological, political, and workforce challenges
Overall, a decreased well-being of staff members
Increased rates of burnout
Ineffective wellness programs
Reactive stress management approaches, rather than proactive mitigation of stressors
Insufficient opportunities for growth and development
Lack of respect and supervisory support

Challenges to a healthcare workforce

Shortages of job applicants, depending on location and specialty
Not enough effort given to staff retention resulting in high turnover rates
Negative perceptions of some care settings, such as home care and long-term nursing care
Reimbursement rates in many settings too low to compensate staff sufficiently
Sense of isolation specifically among home care staff
Shortages of mental health staff
Lack of safe and effective staffing measures

How many of these challenges do you experience in your workplace?

How many did you check? 50%, 75%, 100%? With that information you are ready to

Acknowledge and accept your own stress levels
Care for yourself with stress management interventions
Advocate for what needs to change in your work setting

Solutions for a systems approach to resilience

Thankfully, this task force’s report does more than identify problems, which most of us are quite capable of doing. In each of the four focus areas, both recommendations for the future as well as specific recommendations during the Covid-19 pandemic are offered. In addition to recommendations, there is an extensive list of resources for each of the focus areas and for the Covid-19 pandemic. Additionally, the MHA has created a website to which additional curated resources will be added.

What nurses and patients can do

The health care system needs to improve work environments for nurses and ultimately the patient experience. Reducing clinical caregiver stress and increasing resilience will take a systems approach. Best practices improve work environments for nurses by reducing burnout and unnecessary challenges, resulting in greater well-being, engagement, safety, and career satisfaction. And those accomplishments will result in better patient care and patient satisfaction.

What can we do to be sure the challenges of either working in healthcare or being a patient in healthcare are resolved? Changing the healthcare system not only begins at the top of the administrative ladder, but it also begins with front line transformational leaders on the bottom rungs of the administrative healthcare ladder. Two places to start are by raising awareness to both challenges and solutions, and by advocating for change in whatever circles of influence you have. Each healthcare leader, department, site, facility, and organization must choose to act – and you can encourage them to do so.

Alert your employer to the Caring for the Caregiver Task Force Report.
Discuss issues you see in your workplace with healthcare administrators.
Bring hope to your unit director, team leader, or C-suite that change is possible and that resources to create change, such as this task force report, are available.
If you don’t work in healthcare, you are likely a patient consumer. Ask your provider if they know about this report, and what positive changes they plan to support their staff.

What will I be doing? In upcoming newsletters and on TLC’s Facebook page, I’ll continue to offer information about how you can join healthcare advocacy organizations and how you can support legislation that solves challenges in ways you know to be effective. Until effective system changes take place and stress on healthcare providers is greatly reduced, I’ll be here to help you with stress.

Together we can raise awareness of the challenges and advocate for healthcare change!

In peace, Gale