Running head: STRESS AND COPING MECHANISMS OF NURSES

Stress and Coping Mechanisms of Nurses

Sheryl Sato
NURS 211: Professionalism in Nursing I
Dr. Paulette Williams
December 6, 2013

STRESS AND COPING MECHANISMS OF NURSES

Stress and Coping Mechanisms of Nurses

Caring for patients can be quite stressful physically, mentally and emotionally for the
nurse. Nurses are particularly at risk from stress-related problems, with high rates of turnover,
absenteeism, and burnout There is also evidence that nurses have higher than normal rates of
physical illness, mortality, and psychiatric admissions (Mark & Smith, 2012, p. 505).
However, employers, as well as nurses, can take steps to reduce and manage workplace stress.
The Physical, Mental and Emotional Stresses in Nursing
The physical pressure of constantly standing and moving patients can cause many aches
and pains on the body. Nurses also work with hazardous materials such as needles and fluids
that increase the chances of contracting a potentially deadly disease. Physical symptoms
experienced by nurses include: a pounding heart, elevated blood pressure, sweaty palms,
tightness of chest, aching neck, jaw and back muscles, headache, chest pains, abdominal cramps,
nausea, trembling, sleep disturbance, tiredness, susceptibility to minor illness, itching, easily
startled and forgetfulness (Peterson, 2010, p.432).
Even a single exposure to acute stress may affect information processing in the
cerebellum- the area of the brain responsible for motor control and movement coordination,
learning, and memory formation. This research raises concerns because a harmful level of stress
can adversely affect the students (nurse) health, coordination in complex tasks, learning
performance, and productivity (Chipas, 2012, p. 49).
Mark and Smith (2012) have noted mental stresses for nurses include the intense
workload (such as accurately calculating medications,) poor resources, conflict with physicians,
discrimination, job insecurity, bullying and client issues. Often times, nurses have to multi-task
their many patients and duties. When mentally stressed out, nurses experience their mind racing

STRESS AND COPING MECHANISMS OF NURSES

or going blank, a lack of attention to detail, reduced self-esteem, disorganized thoughts, a

diminished sense of the meaning of life, a lack of or the need for too much control, negative
thoughts about one self, difficulty making decisions and a loss of perspective.
Because nurses deal with the humane side of healthcare and often form close bonds with
the people they care for, they tend to experience the emotional distress when a patient dies.
Some nurses believed that although the relationships that were developed transcended
professional relationships, it was not professional to go through the emotions of grief even when
the actual experience was in the past. Some nurses did not believe it was appropriate to grieve in
the presence of family of the deceased patients or even colleagues (Gerow, 2010, p. 127). This
is also known as emotional labor. According to Gerow (2010), regardless of culture or specialty,
the dying process and death of patients, especially children, affected nurses on a personal level.
The cost of caring concept is comprised of compassion fatigue, post-traumatic
stress and vicarious traumatization The costs may be minor increases in stress, strain and
weariness or more major in terms of serious threats to the mental health and ongoing capacity to
provide sensitive care (Foureur, 2013, p.115).
What Employers Can Do
By addressing the physical, mental and emotional stresses of nurses, employers can
increase nursing productivity, decrease absences and improve staff morale and relationships at
the work environment. Nurses need programs that both help them develop coping strategies
and prepare them for dying patients as well as resources to help them cope with the experience
once it has happened. Because little is known about the coping habits of nurses facing the death
of a patient, research is needed that examines their coping responses to develop more effective
resources (Peterson, 2010, p. 432).

STRESS AND COPING MECHANISMS OF NURSES

Employers can tackle stress in the workplace by doing a risk assessment via
questionnaires or small group discussions to determine steps necessary to reduce nursing
stressors. Once the results from the assessments have been reviewed, immediate change should
take place. This can include organizational change, new work-shift patterns, etc. Employers
should also provide their nurses a staff support system, stress management training and policies
on managing stress. Examples of good practice include providing readily accessible counseling,
access to locations to exercise, etc.
Coping Mechanisms For Nurses
Nurses, as individuals, can also take steps to alleviate their own stress in positive ways
such as managing their lifestyle, managing their personal work environment, thinking
realistically and optimistically, identifying stressors in their lives, relaxing, exercising, having a
support system, counseling and utilizing medical interventions. Some stress management
activities suggested by The Help Guide include 1.) avoiding unnecessary stress, 2.) altering the
situation, 3.) accepting the things you cannot change 4.) adapting to the stressor and 5.) taking
care of personal needs. (http://www.helpguide.or/mental/stress_management_ relief-coping.)
Avoiding unnecessary stress is comprised of learning how to say no, avoiding people who
produce stress, taking control of the environment, avoiding controversial topics and reducing the
to-do list. Altering the situation, consists of being more assertive in dealing with problems and
managing time better. Accepting the things you cannot change, such as the death of a patient,
places the focus on things that can be controlled, looking at the situation positively and learning
to forgive. Adapting to the stressor involves changing ones own mindset by looking at problems
from a positive perspective instead of demanding perfection. Taking the time to care for ones
personal self should be viewed as a necessity instead of a luxury. Simply getting adequate sleep,

STRESS AND COPING MECHANISMS OF NURSES

connecting with supportive people, spending time on hobbies, keeping a sense of humor,
exercising, eating healthy and avoiding alcohol, smoking and drugs are examples of making
healthy lifestyle choices that nurses ought to make. Since each nurse is an individual and views
stress uniquely, this may require experimenting with different strategies to focus on what stress
coping methods best work for them.
Foureur (2013) states mindfulness-based stress reduction (MSBR) is an effective strategy
to achieve stress reduction. Simply put, mindfulness is moment-to-moment awareness. It is
cultivated by purposefully paying attention to things we ordinarily never give a moments
thought to. It is a systematic approach to developing new kinds of control and wisdom in our
lives, based on our inner capacities for relaxation, paying attention, awareness and insight
(Foureur, 2013, p. 115). By following the MBSR daily practice made up of daily meditation,
repertoire of strategies for the mind in the day to day, forming habits of daily mindful practice,
one can increase health, sense of coherence to life and decrease depression, anxiety and stress.
Conclusion
Nursing is a very physically and emotionally demanding profession that may cause
nurses to burn out. To keep stress from developing into burnout, nurses need effective coping
strategies to process their experiences (Peterson, 2010, p. 437). By developing a personal plan
utilizing any or all of the coping mechanisms to help deal with stress more effectively, nurses can
then provide better care for the individual patient, their families as well as themselves.

STRESS AND COPING MECHANISMS OF NURSES

References
Chipas, A., Cordrey, D., Floyd, D., Grubbs, L., Miller, S. & Tyre, B. (2012). Stress: perceptions,
manifestations, and coping mechanisms of student registered nurse anesthetists.
American Association of Nurse Anesthetists Journal Supplement: S49-55. Retrieved
December 5, 2013 from
http://web.ebscohost.com.ezproxy.library.kapiolani.hawaii.edu:8080/ehost/detail?
vid=16&hid=122&sid=92016849-7d06-4890-a1b5d154d07b3c30%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1za
XRl#db=c8h&AN=2011633589
Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the
resilience of nurses and midwives: Pilot of a mindfulness-based program for
increased health, sense of coherence and decreased depression, anxiety
and stress. Contemporary

Nurse: A Journal For The Australian Nursing

Profession, 45(1), 114-125. Retrieved

December 4, 2013 from

http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=39983293dbff-4cef-

a6f1-d2e56f8654bf%40sessionmgr4001&vid=12&hid=4207.

Gerow, L., Conejo, P., Alonzo, A., Davis, N., Rodgers, S., & Domian, E. (2010).
Creating a

Curtain of Protection: Nurses Experiences of Grief Following

Patient Death. Journal Of

Nursing Scholarship, 42(2), 122-129. Retrieved

December 4, 2013 from

http://web.ebscohost.com/ehost/detail?vid=5&sid=39983293-dbff-4cefa6f1-

d2e56f8654bf

%40sessionmgr4001&hid=4207&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZz

STRESS AND COPING MECHANISMS OF NURSES

Y29wZT1zaXRl#db=aph&AN=51126414.
Help Guide 2007b. Stress management: how to reduce, prevent and cope with stress.
Retrieved December 5, 2013 from http://www.helpguide.org/mental/stress_management_
relief-coping.

Mark, G. G., & Smith, A. P. (2012). Occupational stress, job characteristics,

coping, and the

mental health of nurses. British Journal Of Health

Psychology, 17(3), 505-521.

Retrieved December 4, 2013 from

http://web.ebscohost.com/ehost/detail?vid=3&sid=39983293-dbff-4cefa6f1-

d2e56f8654bf

%40sessionmgr4001&hid=4207&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZz
Y29wZT1zaXRl#db=aph&AN=77497628.
Peterson, J., Johnson, M., Halvorsen, B., Apmann, L., Pi-Ching, C., Kershek, S.,
& ... Pincon, D.

(2010). Where do nurses go for help? A qualitative study

of coping with death and

dying. International Journal Of Palliative Nursing,

16(9), 432-438. Retrieved December 4, 2013 from

http://web.ebscohost.com/ehost/detail?vid=7&sid=39983293-dbff-4cefa6f1-

d2e56f8654bf

%40sessionmgr4001&hid=4207&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZz
Y29wZT1zaXRl#db=aph&AN=55099445.