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Hospitals Attempt to Help Nurses Cope with High Levels of On-The-Job Stress

Michelle Faust

Emily Roth sits in a café after a long weekend shift. The 27-year old obstetrics nurse eats a sandwich and gushes about her 15-month old daughter. Her smile puffs her cheeks up, lifting her brown rectangular-framed glasses away from her face.

Roth has been a nurse for three years and she loves her job, but she hasn’t always felt that way. "I was going home pretty stressed out on a regular basis. I would go home and cry to my husband sometimes," she said.

Three months ago, she moved from a position where she’d been working with oncology patients. “(I saw) patients who were around my age with cancer, and dying, and taking that home and seeing my life and not being able to make their lives better...was taking its toll on me,” Roth explained that stress was part of her motivation to switch jobs.

Roth isn’t alone. A 2012 study produced by the Robert Wood Johnson Foundation found that in a sample of 25 hundred nurses in North Carolina, close to 20 percent of them reported depressive symptoms--around double the rate of the general population. But Critics say the sample size isn't large enough to assume this is the case across the country and the profession.

Carole Farley-Toombs doesn't believe nurses are at greater risk for depression than the population as a whole. She’s the Associate Director of Nursing Practice for Strong Behavioral Health at the University of Rochester Medical Center. She likens them to police, firefighters, and emergency responders who all care for people in extreme situations. “And by nature then, yes, that exposes them more to the potential for traumatic situations,” said Farley-Toombs.

Cindy Amalfi has been a nurse in a number of units. Over 30 years, she's watched the extreme on-the-job stress cause burn out in many of her colleagues.  “Sadness, death and dying, and then combine all that with long working hours, often times rotating shifts, working night shifts, and also sleep deprivation, can all add to enhancing that trauma.”

An approach used at URMC can be found in many hospitals. After a traumatic incident or in the most stressful units of the hospital - like Emergency and Intensive Care - they hold debriefing sessions.

Farley-Toombs explains how they work:

“The debriefing session is to back people up. Each person telling what they saw and what they experienced in that process. And you begin to put together the whole picture and as people begin to be able to talk about it, it decreases the stress reaction, because you're cognitively now putting words to your feelings.”

Credit Michelle Faust

Nurses who spoke to me said this is helpful. And Amalfi sees hospitals doing more to support staff now than when she began her career.

Hospital administrators say they've got to do what it takes to keep good nurses on the job. Along with the debriefing sessions, there's counseling through the Employee Assistance Program, chaplain services, and other programs that encourage what they call "self-care."

Clinical Assistant Professor of Nursing at the College at Brockport, Jennifer Chesebro makes sure her students know the risks. Without a positive outlet, she’s seen people cope in unhealthy ways.

“I think there’s always been sort of a pride among health care professionals, like “I can deal with all of this. I can handle all of this and still keep moving.” Some people can, but for the majority of people I think it does take its toll. They start turning to things that aren’t so healthy, like drugs and alcohol, depression can be a huge issue,” Chesebro said in a simulated clinical setting, used as a classroom.

New York State Nurses Association offers a program that helps nurses address problems with substance abuse without losing their licenses-through support from other professionals.

Chesebro believes community support also plays a role in combating stress, even before bad habits develop, “I worked with great people who said, "Hey, why don't you pull back a little bit." And I tried to do that for them too. That was really important, that comradery and sense of you can't do this by yourself you really need to reach out for other people.”

Chesebro teaches her students to ask for help with on-the-job stress, just as easily as they seek out advice on nursing techniques.

Most nurses interviewed for this story told me that they focus on the best parts of the job.

Dealing with death can take an emotional strain on a nurse, but as a hospice nurse for Visiting Nurse Services, Marcia Chiappone sees it every day. For her, the job gives a sense of satisfaction that she’s able to comfort people when they need it most.

“You gotta look at the silver lining because you’re helping them not suffer until the day they die. You’re helping them live comfortably until the day they die,” said Chiappone.

This is the fourth installment in a nurses' health series. Here are links to the other stories in the series:

Nurses Have Higher Rates of Workplace Injury Than Construction Workers

Nurses Unions Propose Solution to Nurse Injuries, Improved Patient Safety

1 in 10 Nurses Assaulted by Patients

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