Dr. Renee Thompson: Reduce Stress to Reduce Bullying

This post is part of a series of posts on nurse bullying and conflict in the workplace written by Dr. Renee Thompson, DNP, RN, CMSRN. Dr. Thompson is one of the top professional development and anti-bullying thought leaders in nursing.

Have you ever worked with a coworker who is super nice and easy to work with as long as everything is quiet but immediately turns into nurse-zilla when things get hectic?

Barbara is typically friendly and a supportive team player. She’s been a nurse 15 years and recently made the decision to get her MSN. Barbara has three kids, two of whom are in college; she cares for her aging father and is recently divorced. Everyone enjoys working with Barbara, as long as all of her patients are stable and she doesn’t get any admissions. But, her coworkers know to stay away from her any time her patients become difficult or she gets hit with too many admissions and discharges. Why? Because Barbara turns into nurse-zilla!

She’ll stomp about the unit, yelling, throwing her hands in the air, huffing and puffing, and will bulldoze anyone who gets in her way. Even the physicians make comments, “I see Barbara is on the war path again.” Nobody says anything about it, even the manager. They just sigh and say, “Well, that’s just Barbara. She’s so dramatic. She’ll eventually calm down.” So the question is, is Barbara a bully?

I dare any one of us to claim that we’ve never gotten “testy” with a coworker or “stomped about” on our units or departments when we’ve been under stress. We can all be Florence Nightingale when things go well and maybe a softer version of nurse-zilla when they don’t. We are human after all, and when under stress, we don’t always behave.

Stress in the workplace

Let’s face it. Nurses work in one of the most stressful environments in the world. We deal with life and death situations under an umbrella of unpredictability. You never know what you’re going to experience when you walk into work. We all know the “easy” patient who ends up coding on us without warning. Or, as soon as we walk onto our unit, the charge nurse says, “Sorry. But I have an admission waiting for you.” You find yourself curtly saying, “Can I at least take off my jacket and swipe in first?”

Nurses work in stressful environments and our behaviors can be triggered by stressful events. These can be considered short-term stress as they occur within the time frame of our shift. Common triggers that elicit our short-term stress response at work:

  • High census, high patient acuity, short staffing
  • Chronic unresolved system issues
  • Lack of resources to do your job
  • Working with unsupportive coworkers
  • Working for a toxic boss
  • Demanding patients and their family members

However, we all know that nurses don’t leave their personal lives at home when they swipe in. Those problems can also affect behavior and performance in the workplace. When the stress is prolonged, they can be considered long term stressors: strained relationships at home, caring for an aging parent, dealing with addiction, raising a family as a single mom or dad, financial constraints, etc.

Let’s face it. Being a nurse is stressful and so is being a human. When humans are under stress, we sometimes don’t behave nicely to each other.

Understanding stress behaviors

When nurses take their frustrations out on each other, we are tapping into our primitive response. We are essentially displacing our aggression onto to something else (or somebody else), thereby, reducing our internal stress. It’s a survival mechanism designed to protect us. Studies show a direct link between stress and aggressive behaviors.

Results of high stress:

  • We become less cooperative
  • We become myopic and only focus on what we need to do – not others
  • We get short tempered and may lash out at each other (my dad calls it getting “testy”)
  • We are more likely to “bully” others

In Barbara’s case, she already entered into work everyday trying to cope with long-term stressors (caring for her father, raising three children with two in college, going to school, and dealing with a divorce). Although she did well normally, as soon as any minor short-term stressor occurred (meds not available, an admission 45 minutes before the end of her shift, etc.), she turned into a pressure cooker and let out steam on everyone!

How to calm a nurse-zilla

It’s humanly impossible to completely remove stress from our lives and when you think about it, who would want to be completely stress free. None of us would get out of bed! 

When stressed, our brain stimulates our sympathetic nervous system which increases our heart rate, blood pressure and the release of adrenalin and glucocorticoids. These chemicals in our bodies serve a purpose – to keep us alive when faced with danger. However, while releasing these chemicals helps you save patients’ lives in a code situation, they are also released when you get your fourth admission of the day or find out you are working your entire shift with the queen bully.

Stress chemicals, primarily cortisol, can also damage your body if elevated for too long. Leading to chronic toxic stress.

There are many, many proven strategies to reduce the stress response and release of cortisol. The following represents my personal favorites:

1 – Power naps: Humans are actually physiologically programmed to take a nap halfway through their day. Most countries incorporate napping into their workday but in the United States, napping is frowned upon (especially in the workplace).  However, napping for just 20 minutes recharges your battery giving you more energy, decreases your cortisol levels, and reduces stress.

2 – Meditation: Humans have been practicing meditation for centuries as a way to quiet the mind. We know meditation helps to reduce stress yet some people say they are way too stressed to sit quietly and meditate! Quieting your mind for just 10 minutes can provide hours of stress reduction.

3 – Exercise: This is a no-brainer. We know that exercise increases the release of endorphins – feel good chemicals in our brains like dopamine, serotonin, and oxytocin. These chemicals are like stress ninjas who slay stress hormones like Cortisol! Just 20-30 minutes of exercise daily is all you need to release the ninjas! 

4 – Deep breathing exercises: Did you know that it’s physiologically impossible for you to feel anxious while you are deep breathing? This is why many performers do a series of deep breathing exercises before they go on stage. Deep breathing works well before taking an exam too! Just three deep breaths is all you need.

5 – Listening to music: Music tames the beast. That’s because our brains are wired to respond to music. Music makes your life better.

6 – Laughter: When you laugh, like exercise, you release endorphins that act as powerful stress busters! And here’s the good news – your brain doesn’t know if you’re genuinely laughing or faking it. When you laugh, even if you just force yourself to laugh, you release magical stress fighting chemicals.

7 – Eating healthy: We spend 50 percent of our energy digesting our food. But use more energy digesting processed, high fat, and artificially laden unhealthy foods. 

8 – Asking for help: Why is it that we have to be martyrs and do everything ourselves or that by asking for help, we feel we are admitting failure or showing that we are weak? Smart people ask for help to solve problems, get advice on how to handle complex situations, and they delegate appropriately to others.

9 – Positive attitude: Attitude is a choice and so is your reaction to everything that happens to you – good, bad, or ugly. When you make the decision to maintain a positive attitude no matter what happens, your brain looks for a way to make that happen. Traffic jams become an opportunity to listen to an audio CD. Getting pulled to another unit gives you the chance to work with other amazing nurses.

10 – Start a gratitude journal: Many successful humans swear that their lives changed when they started a gratitude journal. Every day, write down three things you are grateful for. Over time, you will feel more grateful, more positive, and less stressed. Start a journal today!

The key here is to recognize that chronic toxic stress may be increasing disruptive behaviors in your department.  Don’t just sit back and complain about it – take action!

Thanks for reading, take care and stay connected!