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Effective Leadership and
Management in Nursing
EIGHTH EDITION
CHAPTER
25
Managing Stress
Learning Outcomes
1. Explain why stress is necessary.
2. Describe the organizational,
interpersonal, and individual factors
that cause stress.
3. Explain the consequences that result
from stress, including burnout and
compassion fatigue.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Learning Outcomes
4. Discuss how individuals can manage
stress.
5. Discuss how managers can help
themselves and their staff manage
stress.
6. Explain how organizations can help
reduce stress in the workplace.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Stress
• Results when two or more incompatible
demands on the body cause a conflict
• Can be positive or negative
• Is essential to sustain life
• In moderate amounts, stress serves as
a stimulus to performance
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Negative Effects of Stress
1.
2.
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Physical
Weight gain/loss
Unexpected hair loss
Heart palpitations
High blood pressure
Emotional
Mood swings
Anxiety
Can lead to depression
Can also lead to unhealthy
coping strategies (i.e. alcohol,
drugs, etc)
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
TYPES OF STRESS
• Eustress—a positive force adding
excitement to provide a sense of wellbeing
• Distress—a negative force caused by
unrelieved tension that threatens
effectiveness
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Nature of Stress
• Handling stress requires balance
• Imbalance occurs when the degree of
stress is greater than the available
coping mechanism
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Nature of Stress
• Stress greater than a person’s coping
mechanisms can lead to physical and
psychological problems
• Lack of stimulating stress can lead to
boredom, apathy, low motivation, and
poor performance
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Organizational Causes of Stress
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Job related factors:
Task overload
Conflicting tasks
Inability to do tasks assigned
Physical environment: ICU with alarms, noise,
light, odor, color
• Manager's behavior
• Organizational norms and expectations in conflict
with individual's needs
• Pressure for efficiency
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Interpersonal Stress Factors
• Strained relationships within the
nursing profession and between nurses
and other professions
– Unrealistic expectations
– Interactions not characterized by open
communication
• Need to fulfill multiple roles
– Family versus professional role conflict
• Working night shift and shift rotation
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Individual Stress Factors
• Rate of life changes
– Marriage, pregnancy, purchasing a new home
• Individual’s interpretation of events (stressful or
positive)
• Role ambiguity: results from unclear expectation
for one’s performance
• Role conflict: result of incompatibility between
the individuals perceptions of the role and its
actual requirements.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Role Ambiguity
• Results from unclear expectations for
one's performance
• Individuals with high tolerance for
ambiguity can deal better with strain
from uncertainty and may cope with
role ambiguity
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Role Conflict
• Two competing roles
– Nurse manager assumes patient care
assignment and needs to attend
leadership meeting
• Conflict between nurses' personal and
professional roles
• Individual role conflict
– Incompatibility between perception of
role and actual requirements
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
STRESS RESPONSE
• Stressor: Defined as anything an
individual perceives as a threat
• Three stages of stress response
- Alarm reaction
- Resistance
- Exhaustion
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Consequences of Stress
• Undue, prolonged anxiety, phobias, or
persistent state of fear
• Depression
• Abrupt changes in mood and behavior
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Consequences of Stress
• Perfectionism
– Unreasonably high standards
• Physical illnesses
– Ulcer, arthritis, colitis, hypertension,
myocardial infarction, migraine
headaches
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Burnout
• Perception that an individual has used
up all available energy to perform the
job and feels that he or she does not
have enough energy to complete the
task
• Combination of physical fatigue,
emotional exhaustion, and cognitive
weariness
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
SYMPTOMS OF BURNOUT
• Nurse managers demonstrate burnout
by:
-
Being workaholics
Experiencing chronic fatigue
Not wanting to go to work
Increasingly taking sick time
Having a negative attitude
Blaming and criticizing others
Engaging in backbiting
Talking behind others’ backs
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Compassion Fatigue
• Secondary traumatic stress experienced
by caregivers
• Affects those caring for others suffering
from physical/emotional pain, with
symptoms similar to burnout
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Managing Stress
Recognize stressors in the environment
Identify and nurture social supports
Keep life in balance
Clarify roles and integrate or tie
together various roles
• Manage time
• Replenish self and relax
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•
•
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
WAYS TO CONTROL STRESS
• Setting of personal and professional
goals
- Value clarification
- Goal setting
- Establishment of priorities
• Stress avoidance and regulation
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Time blocking
Time management
Assertiveness
Feeling pauses
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
WAYS TO CONTROL STRESS
(cont.)
Stress avoidance and regulation (cont.)
-
Inner shouting
Anchoring
Sorting
Thought stopping
Compartmentalization
Environmental changes
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
WAYS TO CONTROL STRESS
(cont.)
• Practice of good health habits through:
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Humor
Centering
Nutrition
Exercise
Sleep
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
WAYS TO CONTROL STRESS
(cont.)
• Relaxation techniques
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Abdominal breathing
Massage
Progressive relaxation
Biofeedback
Autogenic training: self-hypnosis
Meditation
Visualization and mental imagery
Poetry
Music, Baths
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
WAYS TO CONTROL STRESS
(cont.)
• Enhancement of self-esteem
- Support groups
- Protection from workplace violence
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
TIME MANAGEMENT
•
Personal time management
1) Start by being proactive and accepting
responsibility for one’s actions and attitudes.
2) Begin with the end in mind.
3) Put first things first.
4) Think win-win.
5) Seek first to understand, then to be
understood.
6) Synergize.
7) Give priority to a balanced program for selfrenewal.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
MAXIMIZE MANAGERIAL TIME
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Inventory activities
Set goals
Plan strategies
Plan schedule
Say “No”
Use transition time
Accelerate learning
Improve reading
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
MAXIMIZE MANAGERIAL TIME
(cont.)
• Improve memory by:
- Verbal techniques (e.g., repeating,
clarifying, summarizing)
- Physical techniques (e.g., note taking,
filing, follow-up memos)
- Mental techniques (e.g., focusing,
linking, imaging, locating, chunking)
- Mnemonics (e.g., rhymes, formulas)
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
MAXIMIZE MANAGERIAL TIME
(cont.)
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Engage in critical thinking.
Streamline paperwork.
Use computers for time management.
Use telephone calls.
Schedule office visits.
Control visit time.
Use meetings effectively.
Delegate.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
FIVE RIGHTS OF DELEGATION
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Right
Right
Right
Right
Right
task
circumstance
person
direction/communication
feedback
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
CONDITIONS THAT FACILITATE
DELEGATION
• Understanding the concept of delegation
• Having a positive attitude toward people
• Overcoming feelings of loss of prestige
through delegation
• Developing a positive atmosphere for staff
• Clarifying policies, goals, and objectives
• Using job descriptions to help determine
which assignments can be delegated
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
CONDITIONS THAT FACILITATE
DELEGATION (cont.)
• Checking on how well the delegated
responsibilities were performed
• Ensuring that staff know whether or not
they are meeting their responsibilities
• Assessing the results of delegation
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
RESPONSIBILITY,
AUTHORITY, AND
ACCOUNTABILITY
• Responsibility denotes obligation.
• Authority is the power to make final
decisions and give commands.
• Accountability refers to liability.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
CULTURAL CONSIDERATIONS
FOR DELEGATION
• Interpersonal space
• Past, present, and future orientations
• Context of speech, dialect, kinesics, use
of touch, and volume of speech
• Social organization
• Biopsychosocial differences
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
REASONS FOR
UNDERDELEGATING
• Leaders and managers think they can
do the job more quickly themselves.
• Leaders and managers are afraid that
the staff will not keep them informed.
• Leaders and managers may like to do
the work and think they will get the
work done better.
• Some leaders and managers are afraid
of losing power and prestige.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
REASONS FOR NOT ACCEPTING
DELEGATION ASSIGNMENTS
• Staff have their reasons for not
accepting delegation.
- Some depend on the leader or manager
and find it easier to ask the boss.
- Some lack self-confidence and fear
failure or criticism.
- Guidelines, standards, and control may
be lacking.
- Some staff are already overworked.
- Some staff may procrastinate.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
REASONS FOR PROCRASTINATION
• Emotional reasons
- May fill time with trivia to escape
overwhelming task
- Can use as an excuse for poor work
- Play victim of circumstances to gain
sympathy
• Nonemotional reasons
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Lack of goals
Goals without deadlines
Unrealistic time estimates
Overcommitment to other duties
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
TECHNIQUES TO STOP
PROCRASTINATION
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Plan
Organize
Staff
Direct
Control
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Questions Managers Ask
• Is stress from role ambiguity or
conflict?
• Can conflict or ambiguity be reduced?
• What is the manager's leadership style?
• Do barriers interfere with goal
attainment?
• Do staff have feelings of low selfworth?
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Questions Managers Ask
• Is additional training or education
needed?
• Would reinforcing positive behaviors be
helpful?
• What other sources of support help the
individual?
• Is an EAP with counseling available?
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Organizational Stress Reduction
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Matching job with applicant
Skills training
Employee assistance programs (EAPs)
Communication and social support
Reducing stress of shift work
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan