1. Work-Related Stress and Burnout
Reality Shock

2. Objectives Identify signs of stress, reality shock, and burnout
Describe the impact of stress and burnout on the individual and the rest of the team
Identify resources in place specific to INTEGRIS Health

4. Transitions in Nursing
What are transitions?
Passages/changes from one situation, condition or state to another over time
Types
Developmental
Situational
Health-Illness
Organizational
How many of you have experienced transitions this last year? Would you like to share? What did you do to ease the transition?
Have you heard the saying “when it rains it pours” Transitions may not happen one at a time.

5. Sources of Stress for the New Graduate Nurse
Moving into a new group
Expectations of competence
Ideals vs. Reality
They are the RN
Loss of trusted relationships with classmates
Peer acceptance, ready for the new role, paper vs. patient
“go ask/tell the nurse” is gone, classmates and instructors are gone

6. Coping in nursing school: when I graduate….
No one told me THAT……

7. Reality Shock
“ unsettling and/or jarring experience resulting from wide disparity between what was expected and what the real situation turns out to be.”
Anybody remember one of those moments?

8. Reality Shock and New Graduate Nurses
New graduates often feel a conflict over professional goals or values and the values and goals in place at work.
The work setting goals are often embedded in the culture of the organization.
How many of you would blindly buy a high ticket item? Choosing a new workplace is a complex time consuming undertaking. Exploring the M,V &V as well as life on the floor is what the new grad is doing during orientation.

9. Stages of Reality Shock: Honeymoon Phase
Thrilled with completing school
Excited about finally being a nurse
High energy euphoria.
Wants to become learn everything at once.
Excitement that distorts perceptions
Frequently short lived

10. Preceptor’s Role During the “Honeymoon”
Harness the new nurse’s enthusiasm for learning new skills and routines by helping the new grad stay grounded.
Be realistic without being negative
Assist the new employee integrate into the workplace culture
Where can a new nurse have a voice at INTEGRIS?

11. Shock Phase Experiences frustration and disappointment in new role
Perceives conflicting values between school and work
General negativity about role.
What can you share with someone in this phase? What worked for you?

12. Shock and Rejection Excessive fear and mistrust Physical exhaustion
Feelings of failure
Hypercritical attitude
Physical symptoms
Tend to bond to people with like attitudes
Focus on the positive, exercise, provide positive feedback about a skill done well, encourage participation on a team/workgroup

13. Effects of Stress Stress is assessed on 4 levels: Environmental Social
Physiological
Psychological

14. Ineffective Ways to Cope
Abandon professional goals – will eliminate conflict, but leaves you dissatisfied
Give up professional ideals
Disengage – work for just the paycheck
Leave the profession
We want to keep our employees! It is time consuming, expensive and discouraging when turnover is high. This course is in place to decrease the use of ineffective copings skills by staff.

15. Preceptor’s Role During Shock Phase
Offer support by being a good listener
Offer an objective point of view by: acknowledging negative but emphasizing positives
Encourage new staff to verbalize ideas for improvement
Educate other staff about what to expect in shock phase
We have all been there…
Pacer, staff meetings, community events, smile!

16. Effective Ways to Cope Build a professional identity
Engage in the organization
Communicate effectively
Seek out feedback often
Develop a support network
Identify a mentor
Join ANA/ONA specialty nursing group, take a look at the INSIDE page

17. Emotional Intelligence
Know and manage your own emotions
Motivate your new graduate by setting small achievable goals
Help with organizational skills
Be open to other points of view
Be readily available and open
Not everyone has this, how can we help grow it?

18. Recovery Phase Beginning to re-discover a sense of humor
Decreased physical signs of stress
Increased ability to objectively view work and the environment
Can distinguish between effective and ineffective behaviors
Yay Stay

19. Preceptor Role During Recovery
Continue to emphasize positive
Support the new graduate’s suggestions for improvement
Encourage participation in unit-based council, staff meeting, etc.

20. Unsuccessful Recovery
Job hopping
Limited involvement with co-workers and the organization
Complain but rarely offer suggestions and refuse to help solve problems

21. Resolution Phase Seeing a resolution to previous conflicts
Understands and/or accepts role in both the work environment and workplace culture
Behavior appropriate for situation

22. Differences in expectations
To cope with reality, you must recognize that:
Expectations are often distortions of reality, which can lead to disappointment
To be successful in nursing, you must fit yourself into the work, not fit the work to suit your demands
The way you perceive events on the job will influence how you feel about your work

23. Expectations
Your mental attitude will influence whether your work is a pleasant or unpleasant experience.
Feelings of helplessness and powerlessness cause frustration and job stress.

24. Warning Signs of Stress
Apathy
Anxiety
Irritability
Reacting in the extreme
Smoking/drinking
Eating “comfort foods”
Tardiness or absenteeism
Chronic ailments or repeated bouts of illness
Relationship problems
exhaustion

25. Burnout The ultimate end of job related stress
Often attributed to the nurse’s inability to deliver what is perceived as ideal care.

26. Stages of Burnout High expectation and idealism
Early job dissatisfaction; pessimism
Withdrawal and isolation
Irreversible detachment and loss of interest

27. Beating Burnout A-B-C’s of Stress management
Awareness – be honest when signs appear
Belief – help new graduates develop confidence in their abilities
Commitment – be committed to helping the new graduate recognize and reduce stress
Don’t forget your own stress!

28. Physical Health Management
Get plenty of sleep
Take breaks
Practice relaxation techniques: deep breaths, stretching
Exercise
Eat healthy
Wellness program

29. Mental Health Management
Realize that new nurses own their thoughts, attitudes, and values
Set realistic expectations
Laugh
Provide social support

30. Traditional View of Conflict
Conflict is BAD
It’s adversarial
It’s a Win – Lose proposition: if I win, you have to lose and if you win I have lost
Stephen Covey

31. Typical Self-Talk about Conflict
There is nothing that I can do about it.”
“I wish it will all disappear when I wake up tomorrow”
“He’s always been this way and as long as I have to deal with him nothing will change.”
“It would feel so good to kick her ***.”

32. Why Do people Fall Into the Conflict Mode?
They’re just ‘doing their job”
This method has always worked for them in the past.
They don’t think they are difficult ( and they can prove it!!!!)
They don’t have the skills to resolve or handle conflict.
Ineffective communication

33. What’s Really Behind Conflict
Fear
Differences in values and beliefs
Differences over facts
Differing view of the priorities
Differences over methods
Competition for resources
Competition for power
Simple misunderstanding (poor communication)

34. Conflicts in Nursing
Conflicts that can occur are often rooted in trying to balance institutional interests, “client” interests, and personal interests of the individuals involved. Some complicating factors are:
-Distribution of costs and benefits. Those who benefit
from resolution may not be the same people who pay the costs
-Perceptions of problems. People tend to blame others for causing the problem
-Speed of the action. Some will want change to take place more quickly than others

35. What are your options? Do Nothing Walk Away/Turn the “Other Cheek”
Change Your Attitude
Change Your Behavior to resolve the conflict
Changing their behavior is NOT an option!

36. Dealing with Difficulty
Remember that the only one you can change is you;
you can become the “skilled” person
Become Confident, remain Calm, be Comfortable
Act or respond rather than react

37. How to Handle Conflict
Know your limits and boundaries: What actions/promises are you authorized and willing to take?
What can you tolerate?
What pushes the “difficult’ person’s button? Realize that once it’s been pushed, conflict management skills are likely to be ineffective.

38. Diffusing Anger Stay clam yourself ( breath!!!)
Create emotional distance: ask yourself if there is any value in what they other person is saying
Listen for information and ignore the emotion

39. Prepare an Effective Response
“Time out!. I hear what you are saying, but you need to slow down.”
“ Give me a chance to respond. This is what I hear you saying.”
I need to interrupt you to let you know that yelling is distracting, and makes it hard for me to listen to your information,’

40. Remember You can’t change them; you can only change yourself.
Change the environment. If certain settings usually trigger responses, change the scene. Meet for lunch or in a non-threatening setting.
Show you understand; summarize and ask questions.

41. The single best anger diffusing technique:
Apologize!
……..even if you are not sure you did what the other person thinks you did, it can diffuse the situation.
When emotions aren’t high, you can approach that person to work on a solution.

42. Practice Good communication Skills
Be positive
Be direct, but non confrontational
Have access to facts
Be aware of body language, tone of voice, eye contact
Use appropriate timing
Let the person know that you share the same goal.

43. Remember that usually there are rarely absolute rights and wrongs
Don’t judge
Don’t accept fighting as acceptable; excuse yourself if the other person cannot gain control of themselves
Work on not letting others push your buttons