MANAGING TIME AND STRESS 1 There is an old saying that : time is money. In health care, time affects both money and quality 2 1
The Present Yesterday is History Tomorrow s a Mystery But Today is a Gift That s Why They Call it.the. Present 3 For every hour you are in class, you should study at least two hours 4 2
DEFINITION: Time management is defined: as the accomplishment of specified activities during the time available. It is the process of managing the things an individual does with his or her time block. In reality, time management is selfmanagement. 5 The goal of time management is the efficient use of time resources in order to be effective in achieving goals. Principles of analysis and planning need to be used. This may be difficult because time management is personal, cultural, and a matter of individual style and circumstances. 6 3
Time management has been linked to success and the achievement of goals. The perception of being successful is linked to the perception of how time is spent.?? 7 Awareness and analysis of goals and objectives is a beginning step. Goals and objectives may be: short (1 week to 3 months), medium (3 months to 1year), or long -term (1 to 5 years). Objectives should be specific, measurable, achievable, realistic, and defined in terms of time. 8 4
With the same 60 seconds in every minute, nurses need to find ways to stretch the time available to meet the needs that arise. Time pressures are a key source of stress and an area in which nurses have the most to gain by learning management techniques. "Time controls and limits how we use our other resources. Thus, it is often referred to as our most valuable resource" 9 For all of us there are 24hours in a day and 168hours in a week. In that time, certain activities are conducted by necessity and to fulfill commitments and goals. Typical activities include personal time (to eat, sleep, get dressed; and do personal maintenance), job or work time, free time, and time for personal growth, leisure, and family. When competing demands create a time conflict, time management becomes important. 10 5
The Time Management Process: Improved ability to manage time can come from the following : Examining attitudes toward time. Analyzing time wasting behaviors. Developing better time management skills 11 Time management habits are embedded in personal preferences, childhood experiences, and cultural influences that may be unconscious or rarely consciously examined. For example, individuals have personal work and management styles that may be based in gender, culture, or personal preferences. One example is the monochromic/ polychromic continuum (Innovations International, 2004). 12 6
Analyzing and Managing Time Time management is like any general management endeavor. It involves the skills of planning, organizing, implementing, and controlling. The time management process is continuous and ongoing and involves a cycle of analyzing, planning, reanalyzing, and replanning with the following eight steps: 13 Replanning with the following eight steps: 1. Analysis of current time use with time logs 2. Analysis of time logs to identify time problems, causes, and solutions 3. Self-assessment 4. Setting goals and establishing priorities 5. Developing action plans that define tasks, resource needs, and time frames 14 7
6.Implementing action plans via planning guides, schedules, and to-do lists 7. Developing techniques and solutions to improve time management problems 8. Follow-up and reanalysis 15 The first step in getting started with planning, prioritizing, and organizing is to analyze how time is currently being spent by keeping a time log. This is a running account of what was actually done include things as you do them, such as open mail, chat with coworkers, or make coffee. 16 8
This log can be analyzed by day, week, month, or year, depending on the circumstances. For example, if the focus is on a work shift, it might be most useful to analyze by the hour for a week. If the focus is on implementing a new project, an overview may be by the month for a year. 17 Activity log for the beginning of an RN shift. 18 9
TIME WASTERS There are two general categories of time wasters: (1) external ones, such as phone calls and drop-in visitors, and (2) internal, or self-generated, ones: 1. Lack of self-discipline, 2. failure to delegate, 3. procrastination, 4. indecision, 5. personal disorganization The goal of TM is to control the cause of wasting time by strategies such as deferring a task when there is something more important to do, diminishing the time spent on the task, or eliminating selected parts of the task. 19 Procrastination may occur because of any of the followings: 1. You are not really committed to doing the job. 2. You are afraid of the job. 3. You do not place a high-enough priority on the activity. 20 10
Perfectionism is the need to. do. everything exactly right-to be perfect. It can lead to procrastination over the fear of making a mistake. The antidote to perfectionism is to set acceptable and realistic standards far goal achievement. 21 Prioritization is a key aspect of time management. After analysis af personal characteristics, attitudes, and behaviors that may black time management effectiveness comes setting goals and establishing priorities. One way to approach this is to analyze what needs to be done immediately and what can wait. Goals and activities can fall into one of the following four categories:.. Next slide 22 11
Goals and activities can fall into one of the following four categories: 1. Important and urgent 2. Important but not urgent 3. Not important but urgent 4. Not important and not urgent 23 TASK QUADRANT Important and urgent 1 Important but not urgent 2 Not important but urgent 3 Not important and not urgent 4 24 12
Time Management Strategies Two fundamental strategies universally recommended are: Analyzing the workday Prioritizing the workload. In nursing, care needs and work assignments can fluctuate daily, making organizing the workday quite a challenge. 25 Some general strategies can be identified. Their use depends an the individual situation, available resources, and safety considerations, as follows: -Take control of your calendar by analysis and prioritization. - Minimize time spent in the office in nonproductive behavior or away from client care. -Tame the telephone through effective clerical support. - Simplify documentation using technology. - Plan ahead. - Save time for others. 26 13
. RNs often have a sense of being overwhelmed by the rapid-fire needs and wants of patients, families, coworkers, and bosses until they impose analysis, prioritization, organization, and delegation on the chaos. some tips as follows next slide. 27 Some time management tips and strategies are as follows (p.11) Continually analyze and examine how time is spent. What can be dropped or delegated? Keep a time log, calendar, or other scheduling device. Develop a specific statement of major goals: short-term, intermediate, and long-term.focus on goal attainment. Focus on getting yourself started and keeping yourself motivated. Keep daily to-do lists and continually reprioritize them. 28 14
The practice and improvement of time management habits can increase successful goal achievement and reduce stress. 29 STRESS MANAGEMENT Nurses are healers they focus on activities related to caring in the diagnosis and treatment of human responses to health and illness phenomena. 30 15
Definitions Stress is one concept that links and examines the effects of behavior on health. Stress is defined as "a physical, mental, psychological, or spiritual response to a stressor A stressor is defined as an experience in a person-environment relationship that is evaluated by a person as taxing or exceeding resources and threatening the sense of well-being 31 Stress has been seen as a stimulus, a response, or a transaction that is either internal or external. It is important to recognize that stress is subjective and a person's level of eustress, stress, or distress is an interaction within an individual in the entirety of his or her environment. 32 16
A person's perception of his or her stress level is in large part a reflection on his or her perception about being equipped to handle it A stressful event today may be viewed differently a month from now 33 34 17
Sources of Stress in Nursing Stress is associated with the work of nursing. Individual nurses may experience internal tension, conflict, or stress, occupational or job stress derives from the jobs and organizations that employ nurses. Stress in nursing is an occupational and managerial concern individual nurses' health, job satisfaction, absenteeism, and turnover, along with client welfare, are thought to be affected by high levels of work related stress. 35 Individual Sources of Stress: Sources of stress that arise from the individual nurse can be either internal or external in origin. For example, the individual nurse may bring to work internal personal emotional conflicts or the need to balance work and family roles. Similar to intrapersonal conflict and tensions in women's careers, the pressure to balance multiple roles in life may create an internal tension that is manifested by personal stress 36 18
Stress on the individual nurse from an external source maybe derived from the characteristics of an individual's personality. For example, the individual's personality may not fit in or match a given work situation This is an external stress source in that the external work situation impinges on the individual. 37 Potential outcomes or consequences of the sources of stress that arise from the individual nurse include hardiness. Hardiness is a personality characteristic composed of commitment, control, and challenge. This outcome of withstanding high job stress is a variable that may reduce or buffer burnout. Buffering occurs because the higher the personal hardiness, the lower the burnout 38 19
Burnout has been described as a syndrome of emotional exhaustion, negative attitudes, and cynicism toward clients that afflicts individuals in the helping professions. 39 Burnout is a condition that develops from continuous job-related stress, but not all nurses under stress develop burnout. Mediation or stress-resistance resources include hardiness and the use of social resources A person's self-esteem may be the most important personal factor predicting burnout potential. 40 20
Apathy, alienation, job dissatisfaction, and depersonalization of clients are associated with burnout. In the new graduate the movement from school to active practice can create an incongruence or conflict in the values and behaviors of the two subcultures in nursing, termed "reality shock. Reality shock can create feelings of helplessness, powerlessness, frustration, and dissatisfaction. 41 This crisis of role transformation may be resolved by: - adopting organizational values, - returning to school, - limiting personal involvement or commitment, - becoming burned out, - hopping among jobs, - abandoning nursing, - or becoming bicultural and working with the best of both worlds. 42 21
Many nurses complain about needing more time. They are stressed and frustrated. At any point in time nurses juggle work and other roles such as student, partner, parent, child, or friend. As work places are restructured for efficiency and employ fewer people, personal work-role stress rises. Effective time management is needed. 43 Organizational Sources of Stress nurses experience stress that comes from the nature of nursing and the organizations that typically employ nurses. Sources of stress that arise from the job or occupational environment relate either to the intrinsic nature of the work or to a specific work environment. The intrinsic nature of nursing's work is recognized as stressful. This includes bedside nursing care delivery to ill or hospitalized clients 44 22
Work environments and organizations that employ nurses also generate stress for nurses. For example, the role of the nurse can be a source of stress and strain Organizations can and do generate multiple and conflicting demands on nurses, resulting in a job experience that generates numerous stressful situations. Energy and coping resources are devoted to the task of adapting and mastering the stress of role pressures and competing role expectations. 45 Specific work environments also generate s tress in nursing. Specific characteristics present in health care organizations create stress. For example, - the physical and technical environment, (ICU Syndrome) - patterns of interpersonal relationships, - professional bureaucratic- role conflict, - multiple expectations, - management, - leadership style, 46 23
- communication patterns, - staffing and workload, - negative client outcomes, - relationships with physicians, - lack of participation in policy decisions, - and inadequate knowledge and skills for role functions each can be a source of stress 47 Structural, procedural, and contextual factors cause stress and conflict stress interrelates with other organizational variables, such as: - organizational climate, - group cohesion, - job satisfaction, - turnover, - productivity, - conflict, - change, - organizational restructuring. Job strain has increased in many nursing environments because of increased workload and higher acuity 48 24
Coping and Adaptation Stressors are demands or threatening experiences either from an individual's internal or external environment that create disequilibrium. Restoration and balance are sought as a result of stressors. Excessive occupational stress can lead to the undesirable outcome of burnout. 49 Burnout in nurses undermines the nurse's helping relationship. Therefore it is counterproductive for organizations to allow occupational stress to flourish without checks and balances. A preferable outcome goal is for nurses to function as self-dependent innovators who operate within realistic expectations and exercise control within a stressful work environment 50 25
An individual's coping ability is the major variable modulating stress and its outcome. Coping strategies are key elements of nurses' stress reactions. The coping process is composed of the perception of stress, conditions and situational factors affecting cognitive appraisal, assessment of coping mechanisms, and the selection of a coping strategy 51 Nurses need to learn to manage or cope effectively with daily work stressors by evaluating and moderating response patterns. For example, attitudes and skills, habits or typical approaches to problems, and specific actions for stress management all can be used to intervene between stress and the outcome. Effective coping actions reduce emotional distress, resolve or diminish problems, and maintain or enhance the sense of self. 52 26
There have been various recommendations for nurses for coping with and managing stress. For example, the development of an internal warning system to alert the individual to stress and provide a choice of responses has been recommended. 53 Nurses need to test the subjective and objective boundaries of stress and be willing to look after their own best interests. This may be a competing value to the concept of altruistic, unselfish service to others. However, guilt may be used by organizations to induce nurses to respond in ways that primarily serve the interests of the institution 54 27
Stress management techniques range from those focused on the individual to those focused on the organization. Some coping strategies used by nurse executives include spending time on non work-related interests, using a personal support network, being active in the larger professional arena, 55 identifying resources for problem solving, manifesting somatic symptoms, walking away from situations to gain perspective, considering resigning, rigid adherence to rules, complying, and participating in dysfunctional competition Humor in communication can also be used as a mechanism for coping with stress and thereby enhancing morale and productivity. 56 28
A comprehensive stress management plan may be needed for organizations. It begins with a baseline stress assessment to determine the levels and types of occupational stress. Interactions of departments and availability of support systems can be analyzed in relationship to nursing stress levels. Educational programs can be developed around universal stress and coping themes, such as work overload, time management, decision making, prioritization skills, and change management. Assessments of nurses' perception of their workload may help target changes where the most impact will be felt. 57 Other methods of personal or organizational strategies for coping with stress include : - physical activity; - nutritional control; - environmental control; - psychological strategies to improve attitudes, - self-esteem, and self-mastery; - and interpersonal strategies related to social support. 58 29
Exercise, sports, hobbies, meditation, relaxation, and spiritual exercises are advocated. Balancing an increase in personal control with coping with what is beyond control is a key strategy. Monitoring the effects of caffeine, nicotine, and sleep/rest are advocated to increase coping. Intervention techniques can be focused on filtering, buffering, and adapting to stress. 59 30