Nurses and other surgery center staff could benefit from stress reduction techniques, especially as the COVID-19 pandemic drags on.

“Prior to COVID, [many] nurses experienced burnout. Now, we add COVID onto it, with all of the stressors that go on with what we’re experiencing — the guilt and fear,” says Cathy Alvarez, MA, RN, CNML, HNB-BC, PCCN, nursing professional development specialist at Yale New Haven Hospital.

The pandemic has disrupted some ways healthcare workers previously found stress relief, such as connecting with co-workers and spending time with family, have been disrupted by the pandemic. Physical distancing is the current normal while healthcare professionals try to prevent spreading the virus to family and each other.

Alvarez and others who focus on reducing nursing stress offer these suggestions for how surgery centers and individual healthcare professionals can reduce stress and prevent burnout:

Build a support network. As surgery center staff continue to deal with the uncertainty pandemic, a good first step is to build a support network among employees.

“We’re doing compassion circles or caring circles, a virtual platform where nurses can come to a safe environment, with a facilitator, and start discussion,” Alvarez explains. “This allows them to talk about experiences they have gone through and pick up with others who may have gone through similar things, but could not acknowledge how they were feeling.”

Healthcare professionals may experience trauma that is difficult to process in that moment. Alvarez says these sessions help nurses unpack what they are experiencing and lighten their stress load.

Try meditation, calming activities. Every healthcare worker should make a conscious effort to help themselves through meditation, exercise, prayer, or yoga to stay mindful.

A study of compassion fatigue among nurses revealed those who practiced short breathing and meditation exercises experienced better outcomes and reported feeling more relaxed and well.1

The American Holistic Nurses Association provides a one-page, downloadable instructional sheet on centering for resilience.2 The paper focuses on alleviating emotional distress, including using centering. This is a process of closing the eyes or finding a soft gaze to keep attention within and to focus on breathing. Centering can start the process of meditation and reflection.

“As we deal with COVID, where do we build our resilience?” asks Deborah McElligott, DNP, AHN-BC, HWNC-BC, CDE, a nurse practitioner at the Center for Wellness and Integrative Medicine at Northwell Health in Roslyn, NY. “Until we start to do it, we won’t see any benefits.”

Nurses might find it challenging to carve out time for meditation and mindfulness activities because of all their competing priorities. “If you have kids to get off to school in the morning, then you might not take time to meditate for an hour,” McElligott says. “We’re all on this journey toward wellness, and it’s not like a perfect routine.”

If someone does not know how to start meditation or a wellness activity, McElligott suggests carving out just five minutes in the morning as a good start. Some may take 15 minutes during a mid-morning break to go on a relaxing walk. Others may use their lunch hour to walk outside or engage in other regular wellness activities.

While each individual needs to find his or her own motivation to make wellness activities part of their daily routine, employers can facilitate and encourage.

“Motivation comes from the person, but it works when the work environment supports it,” McElligott says. “They need to take a break somewhere during the day ... many nurses say, ‘I will work through lunch because I want to get out on time.”

Promote peer support. There is plenty surgery center leaders and staff can do to lift each other, says Jin Jun, PhD, RN, an assistant professor at The Ohio State University College of Nursing. Management style is especially important.

“The frontline managers, nurse managers, their direct supervisors really make a difference in terms of nurses’ job satisfaction and turnover,” Jun says. “Managers should be empowered, especially in surgical centers, which are not really big.”

Surgery center leaders can create a space that promotes teamwork. It needs to be a safe space for employees to come together, whether it is in physical or virtual space. It could be a group chat where employees feel safe to share their thoughts and feelings.

“The idea of safety has to be there however it’s carried out,” Jun explains. “There are creative ways of reallocating resources and having the space. If we don’t have the money [for creating space for staff], then just having the [teamwork] culture helps.”

Peer support also can help staff with forming healthy habits and goals. McElligott was involved in a project in which nurses were focused on creating healthy food habits. When they came into work in the morning, they were assigned a peer partner.

“They were responsible for making sure their peer partner got lunch that day, and their peer partner was responsible for them to get lunch,” McElligott says. “When someone is responsible for making sure you take lunch, that person will say at 1:30 p.m., ‘You haven’t had lunch yet, so I’ll relieve you. Go take a break.’”

Give staff wellness resources. “We need to take integrated approaches to wellness and give staff options to be well,” Alvarez says.

Resources could include virtual activities or videos on demand. Surgery centers can give employees links to wellness information and affordable tools. Surgery centers might even invite a yoga or meditation instructor to teach a quick course on meditation or mindfulness and relaxing exercises.

Surgeons could benefit from wellness resources, says Bala Subramaniam, MD, MPH, FASA, associate professor of anesthesiology at Harvard. “When surgeons arrive in the morning, you might think they’d be relaxed and ready to go,” Subramaniam says. “But we found that at 7 a.m., they are so stressed out that half of them have moderate stress levels.”

A solution is to invite surgeons to a workshop on meditation. After attending a workshop, surgeons may use what they learned and take a few minutes for themselves each morning. That could help surgeons make it through the entire day with less stress.

Surgery center leaders could use a tool to see where employees are in efforts to stay healthy. For example, the Integrative Health and Wellness Assessment tool is a 36-question, self-reporting tool that helps people assess their healthy behaviors. It can be used as part of nurse coaching.3 “What I like about the tool is it makes people think a lot more about wellness than just what they’re eating and how they’re moving,” McElligott says. “It looks at ‘Do I have a connection to something greater than myself?’”

REFERENCES

  1. American Holistic Nurses Association. Holistic approaches to mental health.
  2. American Holistic Nurses Association. Self-care and resilience.
  3. McElligott D, Turnier J. Integrative health and wellness assessment tool. Crit Care Nurs Clin North Am 2020;32:439-450.