100 HATS! STRESS MANAGEMENT FOR DD NURSES TABLE OF CONTENTS

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2 100 HATS! STRESS MANAGEMENT FOR DD NURSES TABLE OF CONTENTS INTRODUCTION LOOKING AT STRESS Think About Yourself 1 What is Stress? 2 Signals of Stress 3 Common Triggers of Workplace Stress 4 But I m Not Stressed! 5 A Little Laughter 6 Response to Stress 7 Stress Response 8-9 Are You the Cause of Stress? 10 TIPS FOR MANAGING STRESS The 4 B s of Managing Stress 11 What Else Can You Do? 12 What Do DD Nurses Say? 13 How You Can Help Co-Workers Reduce Stress 14 Stress Busters From DD Nurses How Will You Cope? MANAGE THE TIME, MANAGE THE STRESS What Do You Do All Day? 28 Make a Pie! 29 Study Your Pie Chart Make Your Own CARE Plan to Manage Your Stress 32 Remember When You Were Thinking About Yourself? ACTION PLAN FOR MANAGING STRESS Spot the Positive 35 Keep in Mind 36 My Personal Action Plan 37

3 100 Hats! Do you sometimes feel as if you are wearing so many hats that your head will explode? Nurses everywhere talk about how stressful their jobs can be. They may love the work and enjoy the rewards of the profession but the job requirements can often be overwhelming. There are many easy steps nurses can take to reduce stress on the job. This workbook will give you a chance to take a close look at your work day and figure out how to balance multiple tasks and handle the stress of the job. Try some of the tips - especially those from DD nurses.

4 Looking At Stress by Carl Elbing

5 Think About Yourself You are working in a job that requires you to constantly think about everybody else. Thank goodness there are generous people like you! Now take a few minutes to think about yourself. 1. What is your favorite thing to do at work (besides eat lunch)? 2. What is the task that you like the least? 3. What takes time but is enjoyable? 4. What is a time-sucker and isn t always worth it? 5. At what time of the day do you have the most energy? (Are you a morning person?) 6. At what time of day do you start to fade? (Before coffee? Right after lunch?) 7. What can instantly annoy you at work? 8. What can usually cheer you up at work? Refer to your answers when you get to page 29. 1

6 What is Stress? Circle the definition. A. A mentally or emotionally disruptive or upsetting condition. B. A state of circumstances or difficulty, pressure, or strain. C. Reaction to an external influence capable of affecting physical and mental health. All answers are correct! 2

7 Signals of Stress Stress is a normal reaction to life s daily challenges. Everyone experiences stress at one time or another, and some days are more stressful than others. But too much stress can cause problems. It can affect your mental and physical health and damage relationships with co-workers, friends, and family. Recognize the signals of stress so that you are aware of when stress is managing you, instead of the other way around. Do any of these behaviors describe YOU lately? Snapping at people Voice rising Tapping feet, pencils, fingers Easily irritated Making mistakes Questioning Negative comments and s Fiddling with hair, fussing with papers, etc. Losing patience quickly Talking too much, talking too fast Withdrawing, not talking Yelling Crying Gossiping, complaining Defensiveness Interrupting, cutting people off, jumping to conclusions These are all signs of stress. 3

8 Common Triggers of Workplace Stress Sometimes we don t realize what is causing stress. Below are typical sources of workplace stress. Put a check mark stressors that have occurred in your agency recently. next to Rumors Agency evaluations A change in routine Fast pace Clutter, chaos, confusion Poor health and habits of employees Financial constraints Pressure from leadership Expectations Balancing professional and personal life Not enough hours in the day Difficult co-workers Difficult patients New employees Staff shortages High absenteeism/turnover Do these stressors explain why you may be feeling stressed? 4

9 But I m Not Stressed! Nurses are supposed to be helpers and problem solvers. As a result, they tend to deny that they could possibly be stressed. But stress can show up: Repeated illness Smoking Poor eating habits Alcohol dependence No exercise No appetite Insomnia Sleeping a lot Irritability Spending Depression Anxiety Over half of job-related absenteeism is related to physical ailments that can be caused by stress: ~ Headache ~ Hypertension ~ Chronic pain Recognize that you may be more stressed than you are willing to admit. Stressful experiences can result in health problems that require expert intervention. Don t ever hesitate to consult with supervisors, physicians, or the Human Resource department for advice. 5

10 A Little Laughter by Carl Elbing It always helps to maintain a sense of humor! by Carl Elbing 6

11 Response to Stress How do you respond to stress? Your reaction depends on a number of factors. Health Family and Friends Personality Stress Management Training Response to Stress Coping Skills Age and work experience Work Environment Job Security Defensive Style Check out the chart on the next page to see how you respond to stress. 7

12 Stress Response How Do YOU Respond? The way that you respond to stress can depend upon a number of factors. For each category, circle one statement that describes you. Be honest! See the suggestions on the next page. FACTOR COLUMN A COLUMN B COLUMN C PERSONALITY Always easy-going Generally relaxed Easily annoyed COPING SKILLS Know them, use them I try to cope No idea how to cope DEFENSIVE STYLE Tend to walk away There s only so much I can take Easily defensive JOB SECURITY Don t think about it I have work to do Concerned, but trying to stay focused Always on my mind WORK ENVIRONMENT It is what it is I focus on the positive I struggle not to let it bother me Frustrated tend to complain AGE & WORK EXPERIENCE Seen it all nothing surprises me I still can get frustrated Confused and frustrated STRESS MANAGEMENT TRAINING I learn everything I can I need to find out more about how to cope No training probably should FAMILY & FRIENDS SUPPORT Need them and they come through Try not to bother them, but I know they are there Can t really count on anyone HEALTH Taking care of myself Handling my health but not always successful Don t feel healthy 8

13 Stress Response How Do YOU Respond? (continued) Column A: If you circled anything in this column, it appears that you are able to keep your cool. But pay attention to the signals of stress because you might be suppressing them. Address issues as they come along so that they don t build up. Keep looking on the bright side, but use stress management strategies, too! Column B: If you circled anything in this column, it appears that you may try to keep your cool, but it s not always possible. Give some thought to how you might solve some of the problems that are bugging you. If you don t feel that you have the power or the influences to make changes, then concentrate on stress management techniques that will help you stay healthy and calm. (See the Tips section coming up.) Don t hesitate to ask for help if life is getting too stressful. Column C: If you circled anything in this column, it appears that you may express your frustrations loudly maybe even dump stress on those around you. Or maybe you bottle it all up. In the meantime, you may not be feeling healthy, either physically or emotionally. Look around and see if you could be the cause of other people s stress. But also take a look at how you can make small adjustments in your life to ease your stress and live a healthier life. Talk to supervisors, counselors, health care practitioners or a trusted friend and ask how you can handle stress. You ll feel better and so will your co-workers. 9

14 Are You The Cause of Stress? BEHAVIOR NOT ME (and I ll keep it that way) I NEED TO WORK ON THIS (starting now) GUILTY (but I ll stop) Cause drama, or at least stir it up Gossip Complain, negative attitude Unprofessional behavior Inconsiderate about co-worker concerns Casual about getting to work Not a team player no sharing, poor communication Rude by Carl Elbing 10

15 Tips for Managing Stress by Carl Elbing

16 The 4 B s of Managing Stress Here s the BUZZZZZZ. BREATHE BREAK BATTLES BETTER Take a deep breath. Pause. Relax your shoulders. Choose your battles. Don t sweat the small stuff. Battle only if it s truly serious. Be smart about it. Take a break. Excuse yourself. Walk around. Get calm. What will make YOU feel better? Take care of YOURSELF. BREATHE BREAK BREAK BATTLES BATTLES BETTER BETTER 11

17 What Else Can You Do? It s hard to steal a couple of minutes for stress relief. But you are a much better nurse if you take care of yourself. CHECK THE STRESS RELIEVERS THAT YOU WILL TRY TO DO IN THE FUTURE Make time with a patient, just to chat. Get organized by making lists and setting priorities. Sign up for an opportunity to learn something new. Take a quick break to do an errand, even if it s within the agency. Step outside for fresh air, if only for a moment away from smokers. Find time alone to work on paperwork, or just to take a few deep breaths. Share a story with a sympathetic listener. Take a walk around the building (inside or outside), just for the exercise. Pay attention to a task that has been postponed, to get it off your mind. Spend a minute with a co-worker who is a friend, has a good joke, or can cheer people up. Remind yourself that you should be proud of what you do for a living. Put a smile on your face research shows that it actually cheers you up. BREATHE BREAK BREAK BATTLES BATTLES BETTER BETTER 12

18 What Do DD Nurses Say? Here is what DD Nurses do to handle the stress of a very demanding job: I understand that some people are just plain ornery and I should not take it personally. I make sure that I m not the cranky one. My attitude sets the tone. I have set up a system for keeping my paperwork organized. Now I don t feel / frantic when I need to find something. I have two people at work who will listen to me, provide support, and maintain confidentiality. I do the same for them. I understand that sometimes disagreements are just healthy debates, not serious conflict so I relax and try to learn something. I accept the fact that interruptions, changes, and unforeseen events are normal in DD nursing, so I go with the flow instead of getting upset. I have taken a close look at my personal habits so that the job does not ruin my health. I understand that some co-workers and managers see things differently than me, so I try to see their point of view and choose my battles. I have a space that I can go to when I need to get away and calm down. If I am feeling depressed, I ask a counselor for help. I don t try to handle it alone. If I m enjoying my day I try to cheer up other people who may be feeling stressed. BREATHE~ BREAK ~ BATTLES ~ BETTER 13

19 How You Can Help Co-Workers Reduce Stress If a friend or co-worker is feeling stressed, you can help. ` Try to take them to a quiet place. ` Be calm don t make it worse. ` Reassure. ` Ask what is causing the stress. ` Listen more than you talk. ` Listen for what is really causing the stress. ` Don t start out giving advice. ` Try to use gentle humor. ` Focus on the problem. ` Figure out ONE small thing that might help. ` Remind them of how valuable they are. ` ` Follow up later. 14

20 Stress-Busters From DD Nurses There is one person at work who drives me nuts. Then one day I realized that she was in control of how I felt about my day. I no longer let her drive me anywhere. For a long time I kept saying that I was fine and wasn t stressed. Then I developed health problems that my doctor attributed to the stress of my job. I still love my work, but I recognize that it s demanding, and now I take much better care of myself. When it s all getting to me, I go to a training program. It gives me a much-needed boost, I learn something new, and my consumers definitely benefit. More suggestions 15

21 More Stress-Busters From DD Nurses To forget what s going on in my personal life, I spend time with the patients under my care. I know that I have a million things to do and I have a lot on my mind but I went into this field because I care about people. So I sit with my people and talk to them. It may be just for a minute. But it s a minute that makes me feel a lot less stressed. When you are around people who are coping every day with multiple health issues, you really have to develop life-enhancing activities outside of work. Keep going for more suggestions! 16

22 More Stress-Busters From DD Nurses I remember that the people around me take cues from my behavior. I remain calm instead of freaking out. My calm reaction is contagious. I try not to AWFUL-ize. That s awful! I ll never finish this! I m such an idiot! It s hopeless! I can t do this! Instead I say positive things to myself: Relax things happen. Just solve the problem. I can figure this out. This, too, shall pass. Keep going for more suggestions! 17

23 More Stress-Busters From DD Nurses When I get stressed out, I make mistakes. Then I get more stressed out so I make more mistakes! Now I make sure that I am calm and relaxed when I do my job. Why get caught up in the stressmistake cycle? If I feel stressed during the day, I take a quick break and start over. I expect so much of myself. And everyone around me expects so much of me! I am working on establishing reasonable expectations. I keep telling myself and everyone else that I m not superhuman, I m doing the best I can under challenging circumstances and I appreciate their support when some problems are especially difficult. Keep going for more suggestions! 18

24 More Stress-Busters From DD Nurses Sometimes the agency wants to handle a clinical situation differently than I would handle it. That s when I rely on my go-to person, my Nursing Supervisor. She listens to my opinion and explains the agency perspective. I selected her as my go-to because she has the authority to intervene if it seems appropriate. I suggest picking your own go-to person right now in case you need them in the future. Keep going for more suggestions! 19

25 More Stress-Busters From DD Nurses My doctor recommended a stress-buster called guided imagery. I call it going to the beach in my mind. For a few quiet moments I imagine my favorite picnic spot, or hugging my new grandchild, or working on my hobby. These brief thoughts relax me immediately. If I have more time, I picture all of the details right down to the grains of sand and I feel a lot better. Some days start out smoothly and suddenly get bumpy. Other days start out with a problem and then go downhill from there. I keep telling myself YOU CAN T DO IT ALL. This is a job that requires that you go with the flow, make adjustments, and do your best. But always remember that it s a JOB, not your LIFE. Keep going for more suggestions! 20

26 More Stress-Busters From DD Nurses I hate to ask for help. After all, I m the one everyone relies on. I am responsible and full of good advice. But when stress started to affect my health, I asked for advice. First I talked to a co-worker I trust. She connected me with a counselor who has helped me figure out how to change some things in my life. I was resistant at first, but it s wonderful to be able to have a safe place to dump my thoughts. Don t hesitate to seek some guidance. After all, you are not an expert in everything! Nurses have such an independent streak. They need to know that it is okay to ask for help if they are stressed. 21

27 How Will You Cope? Nurses who work with individuals with developmental disabilities indicate that stressors come from many different directions on the job. STRESSOR: MEDICATION VARIANCE How do you respond to investigations and reports of medication variance especially when there is an adverse event? Here s how DD nurses say that they cope. Circle what you will do. Know the policies. Follow procedures to the letter. Concentrate on improving systems, instead of blaming personnel. Don t get defensive. Fix the problem. Be prepared to talk to caregivers as a calm professional. Review procedures with staff, to prevent problems in the future. REMEMBER: Concentrate on fixing the immediate problem to reduce your stress. Later you can address procedures and prevention. 22

28 STRESSOR: LACK OF RESOURCES How do you respond to limited resources such as equipment or supplies, especially when your individuals with DD need them? Here s how DD nurses say that they cope. Circle what you will do. Remember that attention to individuals is worth it s weight in gold. Communicate with co-workers about needs sometimes they have creative solutions. Gather support if advocacy is necessary. Make sure you are still doing your best under the circumstances. Accept that insurance or funding sources may deny requests. You can t fight every battle. REMEMBER: You can t fix everything. 23

29 STRESSOR: COMMUNICATION How do you communicate with providers such as physicians, pharmacists, and day programs? Here s how DD nurses say that they cope. Circle what you will do. Provide clear, organized information. Explain how to communicate with your patients. Use a system to track all communication. Don t assume the disability is understood. Educate. Make it clear you will advocate. REMEMBER: Keep communication person-centered and make sure all stakeholders are included in the conversation. 24

30 STRESSOR: SHARING INFORMATION How do you handle limited communication within your agency, across different settings and disciplines? Here s how DD nurses say that they cope. Circle what you will do. Seriously analyze the problems, don t just complain. Demonstrate your personal systems that work. Address miscommunications immediately to prevent future problems Improve personal communication skills how do you talk to people? Work with co-workers to improve efficiency. Develop reliable contacts within the agency. REMEMBER: It doesn t help to complain about poor communication. Study the problem and come up with solutions. 25

31 STRESSOR: CHANGE! How do you handle changes in the way services are provided to individuals with developmental disabilities? Here s how DD nurses say that they cope. Circle what you will do. Ignore rumors and gossip why get stressed if it s not true? Recognize that it s easier to cope with change if you know the facts. Keep saying: that was then this is now instead of I hate change. Pay attention so that you are wellinformed and can plan ahead. Keep reassuring individuals with DD. Accept that transitions are often a bumpy road help to smooth it out. REMEMBER: Don t waste time stressing about why the change is happening concentrate on how you can adjust. 26

32 STRESSOR: END OF LIFE How do you handle the loss of a patient? Here s how DD nurses say that they cope. Circle what you will do. Know about the phases of grief. Do all you can do, even if it s not everything you would like to do. Accept that you, your co-workers, and consumers may be grieving although they may not show it. Learn about the elements of a good death. Talk to friends, co-workers, and counselors for support. REMEMBER: Nurses who work with individuals with developmental disabilities have the unique opportunity to get to know their patients over a long period of time. Grieving is natural. Don t hesitate to ask for help through the grieving process. 27

33 Manage the Time Manage the Stress by Carl Elbing

34 What Do You Do All Day? Check off your responsibilities at work, then go to the next page. Consumer and caregiver education Staffing and scheduling Training direct care staff Monitoring direct care staff Communication with providers and specialists Medication management Coordination of patient care Resolving conflicts Ordering supplies and equipment Documentation Committee membership Hands-on nursing care Coaching employees (advising, explaining) Performance appraisals Meetings with family members Developing Care Plans Phone calls Housekeeping Professional development Triage and delegation Forms and paperwork Now go to the next page 28

35 Make a Pie! Using the circle below, make a pie chart that shows the amount of time that you spend on each of the tasks listed on the previous page. Add anything else that you do. For example, if you feel that you spend about half your day coordinating patient care, fill in half of the circle and label it coordinating care. This is just an ESTIMATE. Don t worry about exact percentages of time. Try to give a general picture of how your time is spent during the week or month. Feel free to color in your pie chart! 29

36 Study Your Pie Chart Your pie chart describes a general picture of your work day. But you know that the work day can change in the blink of an eye: A visiting family member urgently needs to talk to you. A patient seems unusually agitated. A co-worker bursts into tears in the middle of the shift. A provider has not returned your calls. Study your pie chart and answer the questions below: 1. What surprised you when you worked on your pie chart? 2. What takes up most of your time? 3. What can suddenly change the entire day? Continued on the next page 30

37 Study Your Pie Chart (continued) 4. What would you like to spend more time on? 5. Which slices of the pie give you the most stress? 6. How can you change the distribution of tasks to reduce your stress? 7. What can you delegate? 8. What can you train someone else to do? 9. Who can help you? HOW CAN YOU PRIORITIZE? See the next page for a CARE plan! 31

38 Make Your Own CARE Plan to Manage Your Stress DO FIRST Examples in your work life: ritical Tasks that must get done immediately DO SECOND Examples in your work life: dvance Tasks that move one more step towards completion DO THIRD Examples in your work life: enew Tasks that need attention, need to be finished DO FOURTH Examples in your work life: xpected Tasks that are not urgent but need to get done eventually. 32

39 Action Plan For Managing Stress by Carl Elbing

40 Remember When You Were Thinking About Yourself on Page 1 of This Stress Management Workbook? FOR EACH QUESTION, THINK OF HOW YOU CAN MANAGE WHAT GIVES YOU STRESS. 1. What did you say was your favorite thing to do at work (besides eat lunch)? How can you do this more often during the day? 2. What did you say is the task that you like the least? How can you change the way this task is handled in order to reduce your stress? 3. What did you say is the task that takes time but is enjoyable? How can you make sure it is part of your day when you need it the most? 4. What did you say is a time-sucker and isn t always worth it? How can you change this so that you can reduce the time involved?. Continued 33

41 Remember When You Were Thinking About Yourself? (continued) 5. What did you say was the time of the day when you have the most energy? What can you do to boost your energy at other times of the day without damaging your health or your reputation! 6. What did you say was the time of day that you start to fade? What can you do during that time of the day that doesn t require high levels of energy? 7. What did you say can instantly annoy you at work? How can you manage your day so that you can get your work done without the emotional distraction? 8. What can usually cheer you up at work? How can you make sure that you often experience cheer during the work day? 34

42 Spot the Positive! Whenever I m feeling overwhelmed, I look around and spot the positive. Sometimes you may feel as if everyone around you has a negative attitude. You, too, may have fallen into the pattern of complaining. Sometimes it can be hard to remember that the work can be rewarding and satisfying. LOOK AROUND and list 5 things you experienced this week that were uplifting and positive Keep these in mind when you need to spot the positive. 35

43 Keep in Mind Confide in a trusted friend. Choose your battles. LET IT GO Talk to a supervisor. Talk to the source of the problem. Know causes of stress. Slow down, take a breath. WATCH FOR SIGNALS Be aware of signals of stress. Take care of yourself. Concentrate on solutions, not blame. Remember the positive. SOLVE THE PROBLEM Focus on patient care. Come up with realistic suggestions. 36

44 My Personal Action Plan Starting RIGHT NOW I will do the following to reduce my stress: