NPs Get Stressed, Too! How They Can Manage It

In recent years, nursing and advanced practice nursing have made great strides in the public’s awareness of their profession.¹Nurse practitioners (NPs) are appearing more often in the media, greater numbers of college students are choosing nursing as a career,^2,3and more patients have an NP as their health care provider.⁴A career in nursing also has become well known for its job security, opportunities for growth, and competitive wages.⁵In addition to these excellent job attributes, the public often views nursing in a favorable light, as evidenced by a consistent number-one ranking in the Gallup poll for most trusted profession and some positives stereotypes, such as the nurse angel or hero.^6,7But at what cost?

Being a health care provider can be physically taxing and emotionally arduous. Physical labor, working with human suffering, long hours, and staffing issues are just a few of the many daily stressors that nurses endure.⁷Some argue that stress has been growing in the profession since the 1980s due to the increased use of technology, rising costs in health care, and a turbulent work environment.⁷In fact, stress is so common that it is believed to be one of the top reasons for turnover.⁸Although the nursing profession is aware of this problem and has been working on strategies to reduce stress, such as lobbying for better nurse—patient ratios,⁹it still remains a high-stress career that can negatively affect health.

These negative effects can manifest in both acute and chronic health problems. In the short term, acute stress can impair memory and cognitive function¹⁰and cause hyperventilation, panic attacks, asthma attacks, diarrhea, constipation, acid reflux, stomach pain, heart palpitations, decreased libido, and more.¹¹Chronic stress has the potential to influence depression, coronary artery disease, and some forms of cancer, possibly epigenetic changes, too.^12,13A breadth of research demonstrates the general negative impact of stress on health and a strong relationship between job satisfaction and mental or psychological problems, burnout, self-esteem, depression, and anxiety.¹⁴Although an individual may not be able to influence the organizational structure that creates and affects stress, he or she can learn self-focused strategies to improve stress. Learning what strategies work best may improve physical and mental well-being.

11 HELPFUL TIPS TO REDUCE STRESS

1.Don’t stress about things that are out of your control. This does more harm than good. If something is causing you significant stress, take a step back and ask yourself, “Is there anything that I can do to improve this situation?” If yes, then do what you can and move forward. If not, then accept what you cannot change and move it out of your mind.¹⁵

2.Find a healthy work—life balance. It seems as though health care workers are competitive by nature and cannot work a normal week. Perhaps this work ethic stems from their intense training,16 but it is unreasonable in the long term and can be dangerous for both patient and provider. Determine what you value in life and prioritize accordingly. Do money or family bring you happiness? Does your family really need all of that extra money while you are spending time away from them to earn it? We cannot get that time back, and research has shown that it is our relationships that bring us our most collective happiness in life.¹⁷By finding a better work—life balance, you may find a sweet spot of decreased stress and increased overall happiness.

3.Ditch the bad attitude. Having a positive attitude reaps a multitude of benefits. Not only are grumps a bummer to be around, but they’re also not doing their health any favors. Here is a small list of the positive benefits of thinking on the bright side and self-encouragement¹⁸:

• Increased life span
• Lower rates of depression
• Lower levels of distress
• Greater resistance to the common cold
• Better psychological and physical well-being
• Better cardiovascular health and reduced risk of death from cardiovascular disease
• Better coping skills during hardships and times of stress

4.Exercise daily. A plethora of research demonstrates the health benefits and reduced stress from exercise.¹⁹While exercising, you produce more endorphins, which boosts your mood. Your physical body benefits, as well. Exercise doesn’t have to be an intense P90X regimen; it can be as simple as going for a brisk walk. Bonding with others during physical activity has the added benefit of improving your psychological well-being.

5.Get enough sleep. Sleep is a necessary human function, and research has shown that people who sleep less than 8 hours per night are more likely to report symptoms of stress.²⁰Try to make your sleep of high quality. This means cutting down on caffeine and other stimulants. You also want to make your room dark, remove blinking lights and any clutter or distractions, and develop a nice relaxing routine to unwind at the end the day. This will help you feel more refreshed the next day.

6.Limit alcohol, caffeine, and any other stimulants. Many people unwind at night with alcohol, but this can have counterproductive effects. Not only can alcohol negatively impact your health, it

can also interfere with your sleep. As for too much caffeine throughout the day, this can lead to nervousness, anxiety, agitation, panic attacks, sleep interference, and less sleep.²²Be aware of all your sources of caffeine, such as coffee, tea, chocolate, cocoa, and energy bars and drinks.

7.Eat a healthier, more well-balanced diet. Have foods that will leave you full longer and won’t lead to crashes. Get in the habit of eating meals that include lean proteins, complex carbs, and plenty of fiber, and aim for phytonutrients as well (eg, fruits, vegetables, herbs, spices, legumes, nuts). Further, try to stop eating a few hours before going to bed so that digestion does not interfere with sleep. Also avoid alcohol, caffeine, and spicy, greasy, sugary, and acidic foods to reduce the risk of acid reflux.²³This can interfere with your sleep and may lead to daytime fatigue and increase your risk of restless leg syndrome.²³

8.Become more mindful. Research from Carnegie Mellon University has shown that as little as 25 minutes of mindfulness for 3 consecutive days can alleviate psychological stress.²⁴Mindfulness is a “state of active, open attention on the present...you observe your thoughts and feelings from a distance without judging them good or bad. Instead of letting your life pass you by, mindfulness means living in the moment and wakening to experience.”²⁵There is a common belief that modern habits, such as constantly checking e-mail, apps, and phones, has led to “continuous partial attention.”²⁶By becoming more mindful, we can potentially lessen stress, foster more compassion, and reduce pain and medical errorrs.²⁶Here are 9 one-minute exercises from PsychCentral that you can try²⁷:

• Yawn and stretch for 10 seconds every hour. As you yawn, say “Ahh,” and as you stretch, pay attention to how your muscles feel. This should bring you into the present.
• Hug someone tight and take 3 breaths together.
• Close your eyes and mindfully stroke your hand.
• Close your eyes and pay attention to all of the tiny details of what you are eating. Slowly savor the fragrance, taste, warmth, and texture.
• Clench your fists and breathe into your hand.
• Do mindful breathing for 1 minute. Close your eyes and focus only on your breathing. Pay attention to the air flowing in and out. Place your hand on your stomach and feel your abdomen gently rise and fall with each breath.
• Practice loving kindness meditation. This is like sending good thoughts or a prayer to someone, but to yourself. Think of something positive, such as “May I be filled with peace.”
• Start your day off with a positive aspiration. For example, “I will be kind. I will be patient.”
• STOP²⁷:Stand up and breathe. Feel your connection to the earth.Tune in to your body. Lower your gaze so you can scan your body and notice physical sensations or emotions. Discharge anything unpleasant on your out breath. Try to notice anything pleasant and let it fill you up on the in breath.Observe. Take in your surroundings. Notice something in your environment that is pleasant and be grateful for it and its beauty.Possibility. Ask yourself what is possible or what is new or a forward step.

9.Learn what triggers your anxiety. One of the best ways to learn about triggers is to journal. The correlations may not be obvious at first, but they may become more evident after reviewing a personal journal of stress levels and associated activities or events. Additionally, the process of journaling is reflective, and this activity alone can also help reduce stress levels.²⁸

10.Become a grateful person. This isn’t just about having a good attitude, it’s about developing a true sense of gratitude in your life. Sure, people can think of tons of reasons to feel stressed and angry, but at the expense of overlooking everything else around them that is not only working well, but almost remarkably perfect. Recent research from the University of California, Davis shows that practicing gratitude can lower blood pressure, improve immune function, and facilitate more efficient sleep.²⁹

11.Take pleasure in simple daily enjoyable activities. These activities release endorphins in the body that can make you feel good and reduce stress and pain. Taking a small moment to enjoy a scented candle, listen to your favorite music, get a massage, laugh, and cuddle has the ability to reduce stress and improve quality of life.

Sara Marlow, MSN, RN, PHN,FNP-C, is a licensed and board-certified family nurse practitioner, public health nurse, and adjunct assistant professor of health policy. She was the spring 2015health policy fellow at the American Association of Nurse Practitioners’ government affairs office in Washington, DC, and is the current co-chair of the Health Policy and Practice Committee of the California Association for Nurse Practitioners.