Position Statement

Self Care

Since nurses are a professional group most likely to report high levels of workplace stress, this position declares the importance of nurses caring for self in order to be effective providers of patient care and provides recommendations for addressing “negative” workplace stress.

Position

It is therefore the position of the New York State Nurses Association that:

  1. The profession of nursing has multiple sources of stressors regardless of workplace setting.
  2. Responsibility for reduction of workplace stress should be shared between the nurse and management, but it begins with self-awareness by the nurse.
  3. There is a relationship between nurses’ ability to care for self and their ability to provide effective patient care.

Background

Stress is a condition of tension experienced by individuals when they are subjected to extraordinary physical and psychological demands. (Anderson & Pulich, 2001) This complex phenomenon can be either positive or negative, depending upon the individual’s perception. A gap between an individual’s perception of the demands being made upon them and their perception of their capability to meet those demands results in a stress response. (McVicar, 2003)

Stress in the workplace today is a key problem for many organizations, and the workplace for nurses provides a multiplicity of sources of stress. Some of the identified stressors are unrealistic workload due to inadequate staffing and excessive paperwork; fluctuating schedules associated with changing shifts; mandatory overtime; floating without appropriate orientation; moral and ethical dilemmas, and interpersonal conflict with physician colleagues; and role conflict. Additionally, the care of patients and families experiencing progressive illness, death and bereavement can increase nurses’ awareness of their own losses and vulnerabilities and heighten their fear of death, thereby raising anxiety and stress levels (Sherman, 2004).

Consequences of untreated cumulative stress can result in: somatic complaints such as changes in eating habits, gastrointestinal distress, headache, fatigue, and sleep disorders; change in work habits such as tardiness, absenteeism; mental and emotional difficulties such as memory disturbances, anger, self doubt, isolation, impaired judgment and reasoning, and burn out; and accidents. Recent laboratory studies showed a correlation between mental stress and higher rates of adverse ischemic events (Shep, et al, 2002). Long term effects of ineffective stress management can result in post-traumatic stress disorder (Oster & Doyle, 2000) In addition to the negative consequences of stress upon the nurse, when nurses fail to care for themselves in the face of loss and grief, the care they provide may be compromised.

Although workplace stress can not be eliminated, the negative stressors can be reduced when nurses make caring for themselves a priority. Most nurses are not taught the importance of self care to the delivery of quality patient care as part of their basic nursing education. Self care can be viewed as a form of insulation against stress. It is the self-initiated behavior that people choose to incorporate to promote good health and general well-being (Sherman, 2004).

As suggested, self care begins with each individual. Rather than the tendency to look for external solutions to problems, Wright invites nurses to pay attention to inner thoughts and feelings and actions (Sherman, 2004). In order to remain healthy, nurses must exercise personal power, which Martin defines as “the ability to control one’s actions and personal and professional life” (Sherman, 2004).

Recommendations

The New York State Nurses Association recommends:

  1. Encouraging basic nursing education programs to build principles of self-care into their curricula.
  2. Supporting utilization of personal stress management strategies such as relaxation, meditation, exercise, group therapy, guided imagery, massage and humor.
  3. Advocating for work environments that are healing and nurturing for staff and patients, through: improved communication, collaboration, empowerment, and accountability; and use of debriefing and support groups.
  4. Encouraging further research to determine the relationship between nurses who practice self care and the benefits to the patients for whom they care.
  5. Utilizing contractual and administrative supports to decrease workplace stress related to mandatory overtime, floating and unexpected shift rotation.

Approved by the NYSNA Board of Directors March 19, 1992; reviewed and revised by the Expanded Council on Nursing Practice on July 22, 2005; approved by the NYSNA Board of Directors August 30, 2005.

References

Anderson, P., & Pulich, M. (2001). Managing workplace stress in a dynamic environment. Health Care Manager, 19(3), 1-10.

McVicar, A. (2003). Workplace stress in nursing: a literature review. Journal of Advanced Nursing, 44(6), 633-642.

Oster, N. S., & Doyle, C. J. (2000). Critical incident stress and challenges for the emergency workplace. Emergency Medicine Clinics of North America, 18(2), 339-350.

Shepp, D. S., McMahon, R. P., Becker, L. et al. (2002). Mental stress induced ischemia and all-cause mortality in patients with coronary artery disease. Circulation, 1780-1784.

Sherman, D. W. (2004). Nurses’ stress & burnout. American Journal of Nursing, 104(5), 48-55.

For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.