INDIVIDUAL ACTIONS TO ADDRESS AND RECOVER FROM WORK-RELATED STRESS

Strategies to address work-related stress include the following:

• Apply prevention strategies in the workplace
• Employ problem-solving strategies
• Practice assertiveness
• Practice self-care
• Take a break and get help
• Identify and grieve for losses
• Confront denial and cynicism
• Acknowledge one’s limitations
• Establish personal boundaries
  (Blazey, 2016; Mayo Clinic, 2021)

Apply Stress-Prevention Strategies in the Workplace

It is vitally important for healthcare workers to be active in taking good care of themselves while on the job. The following are recommendations to help reduce or prevent stress in the workplace:

• Make a list of work demands/responsibilities, prioritize them, and determine the time needed to complete them.
• Look for opportunities to acquire new skills and participate in continuing education.
• Take breaks and meal times in order to relax and refresh one’s ability to go back to work.
• Get outdoors in the sunlight or take a short walk to improve energy and focus.
• Connect with coworkers, even if it is just a greeting at the beginning and end of one’s shift.
• Pace oneself and monitor for excessive fatigue, irritability, poor focus, or anxiety.
• Take time to breathe slowly before entering a patient room or a work area, since slow breathing is calming and helps the body cope with symptoms of stress.
• Reframe anxiety-provoking statements (e.g., say, “A great many people get sick and recover” instead of “I might get sick and die”).
  (Workplace Strategies for Mental Health, n.d.; Benyon, 2020; NCCN, 2020)

Employ Problem-Solving Strategies

Problem-solving is especially difficult for individuals who are stressed because they are emotionally and physically exhausted. Nonetheless, when individuals employ such strategies, they can help prevent the negative impacts of stress. Four common steps in problem-solving are as follows:

1. Define the problem. Ask, “What work-related area is causing me stress?” If there are several problem areas, prioritize the list and address the one most amenable to solution. The goal is to identify the problem, not the symptoms of the problem.
2. Generate alternative solutions. Consider multiple alternatives. Do not become focused on only one way to solve a problem.
3. Evaluate and select an alternative. Choose an alternative that will solve the problem without causing other problems, will be accepted by the individuals involved, can likely be implemented, and fits within organizational goals and constraints.
4. Implement and follow up on the solution. Establish a process to evaluate and measure the effectiveness of the alternative chosen.
   (ASQ, 2021)

Practice Assertiveness

Many individuals who experience burnout cite working conditions such as inadequate staffing or lack of manager or collegial support. In order to deal with these types of difficult situations, it is important to be able to communicate concerns clearly without becoming angry and accusatory.

If the problem is with staffing, for example, do not start by blaming the manager. Always come prepared with recommendations for helping to defuse the problem (Fry, 2016; Mayo Clinic, 2020). Do not, for example, simply demand that more staff be hired. There may be budgetary constraints or lack of qualified candidates. What actions could the staff take, working as a team, to resolve these issues? How should communication take place?

Make sure not to engage in negativity or complaining about managers or colleagues. Negativity spreads rapidly, may cause people to become aggressive and have hurt feelings, and generally does nothing to help the situation. Consider that it is important to:

• Avoid complaining. It may be tempting to vent frustrations at work, but one’s comments will be spread among colleagues and probably exaggerated. Complaining may also result in receiving some of the blame for current work-related difficulties and lead to a reputation as a complainer. Vent frustrations and concerns to trusted friends or family members outside of the workplace.
• Follow the chain of command. Most, if not all, organizations have a chain of command for expressing concerns and proposing solutions. This usually means starting with one’s immediate supervisor. It is important not to bypass the immediate supervisor and go to the next person in the chain of command unless one has already followed the organization’s policies and procedures for problem resolution. In cases where one may think, “But the supervisor never listens to anything I have to say,” it can be useful to analyze the way one is approaching the supervisor: Do you ask in advance to have a particular topic addressed during a staff meeting, or do you surprise the manager with unexpected complaints? Are you aggressive instead of assertive in your communication (see box below)?
• Promote a healthy work environment. Voice your concerns skillfully to your manager and cooperate with your coworkers on addressing areas for improvement.
• Analyze your communication style. Aim to come across as confident and assertive, not angry and aggressive. Before you walk into a staff meeting, consider constructive ways to contribute. For instance, if staffing issues are on the agenda, begin by making recommendations to deal with current shortages.
  (Fry, 2016; Mayo Clinic, 2020)

It may be challenging to maintain assertiveness. Assertiveness training can help enhance confidence, improve problem-solving skills, and increase one’s ability to improve the workplace environment.

DIFFERENTIATING BETWEEN ASSERTIVENESS AND AGGRESSION

Assertive	Aggressive
(MSCIL, 2017)
Stating opinions while being respectful of others	Attacking or ignoring others’ opinions
Speaking in a calm tone of voice and actively listening to the opinions and concerns of others	Interrupting and talking over others, often in loud, even shouting ways
Making good eye contact	Frowning and staring at others in an attempt to make them uncomfortable and/or intimidate them
Having a relaxed posture and respecting others’ personal space	Displaying a rigid posture, crossing the arms, and invading the personal space of others
Remaining calm	Shouting and losing one’s temper
Listening respectfully to what others have to say	Ignoring others or discounting what others say
Adopting a problem-solving approach so that all parties involved in conflict or problem resolution come to an agreement that benefits, as much as possible, everyone involved	Wanting to “win”; seeing only one’s own point of view and wanting to achieve it without caring if others are hurt in the process; not looking at the whole picture to benefit everyone

Practice Self-Care

Self-care means caring for oneself. When people who are burned out finally stop what they are doing and get help, they are beginning to nurture themselves. Self-care is a conscious awareness of personal needs, with the focus on taking responsibility for oneself.

Ultimately, such self-nurturance is a measure of maturity. It means taking care of one’s own basic needs for survival, safety and security, belonging and affection, respect and self-respect, and self-actualization. Practically speaking, self-care means creating a healthy lifestyle, finding a good work-life balance, and engaging in self-actualizing activities. Strategies include:

• Making a life beyond work by engaging in nonwork activities and developing interpersonal relationships outside of the workplace
• Maintaining a healthy diet and participating in regular exercise (e.g., biking or walking to work if possible)
• Avoiding alcohol, drugs, and excessive amounts of caffeine
• Getting an adequate amount of sleep
• Keeping up connections with friends and family, since meaningful interactions with loved ones is important for well-being
• Asking for help from a support network of friends, families, and colleagues in order to problem-solve together
• Evaluating other career options
• Seeking out services from a mental health professional when needed
  (Blazey, 2016; Mayo Clinic, 2021; APA, 2018; Cleveland Clinic, 2021)

Take a Break and Ask for Help

Stressed individuals may find that they have used up their emotional and physical reserves. When people acknowledge they are stressed, they need to take a break and get help. It is important that healthcare professionals realize that taking care of themselves is the most important step for them to continue to care for others.

It is normal to feel anxious when needing help from a supervisor or colleague, because one may fear receiving unwanted advice, shaming, or rejection. All relationships benefit when people admit they are struggling and express their needs. This allows others to do the same. It is important for healthcare professionals to acknowledge when they are hurting and to return support and caring to colleagues as well as patients (Blazey, 2016; Mayo Clinic, 2021).

Identify and Grieve for Loss

As burned-out individuals scrutinize each part of their story, it is not unusual to find that one or more of the pieces is a jagged, unhealed, unresolved loss. That loss may be their reputation, a cherished loved one, a prized possession, their health, an opportunity, or some other treasured thing.

When unresolved bereavement is a factor in burnout, it is important to engage in what some call grief work. This is an emotional process through which bereaved individuals re-experience their loss, loosen the ties to it, and gradually adjust to life without the cherished person, item, or situation. To facilitate the grieving process, individuals set aside a time to grieve during which they allow themselves to re-experience the loss. At the end of the allotted time, they “close the book,” dry their tears, and return to activities of daily living. They do this repeatedly and over time. Such grief work facilitates a separation from what has been lost (Joyful Heart Foundation, 2018; Sheppard, 2016).

Confront Denial and Cynicism

When individuals are in positions of high stress and overwhelming anxiety, they may not realize just how stressed they have become. They may insist they can “handle it,” whatever “it” may be. Over time, they become distraught, distrustful, and skeptical of the goodwill of others. They may attempt to protect themselves with a defense of cynicism and denial. This does not work because denial is a lie they tell themselves.

When people confront the truth and admit their exhaustion, cynicism, and vulnerability, they open the door to health and healing. In fact, truth does set people free. As soon as they accept themselves just as they are, honestly admitting their frailty, failures, and fatigue, they are relieved of the burden of being perfect and are able to replace denial, cynicism, and fear with acceptance, joy, and hope (Blazey, 2016; Mayo Clinic, 2021).

Acknowledge Limitations

Often, individuals who are burned out have been trying to be “super-beings.” They have been strong and accommodating, worked diligently, and persevered no matter what was asked of them. Things are different now. When people reach the end-stage of burnout, they must admit that they are not super-beings; they are human beings and have limits. These limits may be different from other people, but they are real for that individual. As with denial, when people admit they are less than perfect, they are wonderfully liberated. In the future, they will be better equipped to heed the signs and symptoms of emotional and physical exhaustion (Blazey, 2016; Mayo Clinic, 2021).

Establish Personal Boundaries

Setting personal boundaries means knowing who you are, where you begin and where you end, and when to say, “This is my responsibility and that is yours.” Typically, healthcare professionals are empathetic, understanding, and nurturing. When individuals fail to maintain personal boundaries, they may exercise inappropriate control over others and become unwittingly codependent (Blazey, 2016; Mayo Clinic, 2021; NCSNB, 2018).