It’s not uncommon as a nurse to bring stress from regular life to work, especially to the first part of a shift. Stress from home, piled on top of an abnormally busy assignment, can cause stress for anyone. To have a patient become critical on top of it all has the potential to push a nurse into full blown fight or flight mode. In my profession when it rains, it seems to pour every time. We all jump in to help in hopes we all survive with patients thriving by the end of the shift.
I am sure this is similar to other professions. Whether you are pouring over someone’s coffee order or rushing to solve a problem, stress can hit us in a variety of ways. In my experience, the fight or flight mode doesn’t just apply to life threatening events. As a photographer, capturing the first kiss at the end of a wedding ceremony can put me in the heightened state. Flying over the Rockies after a trip to the west causes enough turbulence to send my heart rate through the roof. Being busy and assuming I won’t get everything done in time can cause trigger this response as well.
Let’s be clear. Stress is normal. When we are healthy, we learn to cope with the stress. We must keep our stress level at manageable because the fight or flight situations do come. Once higher stress occurs, endured and survived we need to be able to return to our normal stress level, our baseline. For example, as a nurse our stress should resolve when the shift ends, the patient gets better, or the situation comes to an end. Once it ends, we can move into a recovery mode. Our heart rates begin to normalize, we realize we haven’t gone to the bathroom or eaten for longer than normal, and we start to process the stress experience.
Pictures help me understand concepts so I drew two to show normal stress and recovery verses abnormal stress and recovery. The first picture is normal life. This person has a baseline which might adjust over time. I have found my baseline has adjusted as I get older because of “adulting”, higher stress jobs and adding family to my responsibilities. As this person goes through life, he or she has experiences which can cause some stress or extended stress which cause that fight or flight mode. Once this person goes through these experiences, resiliency is used to return to baseline.
In the second picture we see the person’s original baseline, and stress experiences. After each experience he or she does not return to normal baseline. A new baseline is created until it becomes as high as other stress experiences previously were. This person ultimately lives at a higher level of stress. It will take less and less for the fight or flight mode to hit. Because the normal stress level is constantly elevated, this person has less opportunity for stress management during high stress experiences and recovery after.
We need resiliency practices. Our mental and physical health are not meant to be at an elevated level all the time. Sure, we have seasons where we are at a higher level, but we must reduce our stress after these seasons so we will be in a better place when the next stress hits.
Here is an an example from a few weeks ago from my work. I witnessed a nurse arrive for her shift and be given a busy assignment. A critical patient admission was added. This nurse began showing signs of low resiliency. These signs included being quick to be angry, tearful, unable to be asked questions without snapping back and making statements about the injustice of the situation without seeing everyone was equally as busy. The shift was rough and we all have them. Not knowing what home life was like I just assumed it was the situation of the day. I hoped the situation would resolve.
The next shift I worked with this nurse the signs of low resiliency returned. There was no critical patient, a less busy assignment and no foreseeable reason for tears. When I was finally able to talk with the nurse I learned her home life is overwhelming. I knew that helping this nurse recover in better ways after long shifts would allow for greater longevity during this nurse’ career. Although the unit’s nurse mentor may not be able to change this nurse’s home life, I encouraged providing more unit education around critical patients, stress management and mental health support in hopes of helping this nurse.
We need to be able to return to baseline after stress because stress will occur again. Developing skills and habits to return to baseline are essential and can start now. We can’t avoid stress and some of us may even run towards it. Life without stress wouldn’t promote growth or courage. Stress, however, should not be allowed to rule our lives. We have the power to return to our normal level of stress and live courageously and with resilience. It takes practice, time and effort.
In the next few weeks we will dive into some practices to help us return to baseline after we make it through stress.
-ST
Stephanie Trowbridge 