Caregivers' stress can lead to burnout

'We have to save ourselves,' expert advises

Employee health practitioners who spend hours each day identifying and solving workers' stress-induced problems may tend to overlook their own pent-up stress until the consequences have become too severe to ignore, warns an international consultant on self-care for caregivers.

"Nurses have the need to be liked, but we can burn ourselves up trying," says Mary Warzecha, BS, RN, president of Dynamic Performance in Merrimack, NH. "We get so engrossed in trying to be liked and pleasing other people that we can come down with terminal illnesses. It's only then that we become charged with the responsibility of saving ourselves, but we have to save ourselves before we can save the rest of the world."

Unfortunately, most caregivers don't know how to save themselves, but Warzecha maintains that the answer is "learning how to say no after a lifetime of saying yes."

Occupational health nurses often take on responsibilities way beyond the scope of their jobs, and then take home built-up stressors instead of learning how to discharge them safely, she adds. (See chart listing common employee stress reactions to change, p. 81.)

The first line of defense against job stress involves clear communication and careful consideration of new responsibilities one is asked to assume, Warzecha advises.

"When you are asked if you will take on an additional burden or responsibility, get a very clear definition of what that is," she says. "Most nurses jump immediately and say, 'Oh sure, certainly, I can do that.' Sure, you can do that, but you will burn yourself out in the process."

First, she explains, ask the supervisor or administrator to define precisely what you are being asked to do. Then, repeat exactly what you heard to be sure you have understood it correctly and completely. Next, take some time to decide if the request truly is feasible.

"If it seems too big of a chunk to take on, then go back to the person and say, 'I find that in order for me to take on a project of this magnitude, I am going to have to decrease the number of open hours in the clinic,' or pull back in another area, whatever it might be, at least temporarily until the new project is completed," she suggests.

Make time for self

If you've taken on too much, how do you know when stress is pushing you over the edge? Warzecha says warning signs include: becoming short-tempered at work or at home, fatigue, irritability, unhappiness with life, depression, pain in the shoulders and neck, low backaches, high blood pressure, inability to sleep, or the desire to sleep too much.

If one or more of those symptoms is present, or to help prevent them from developing in the first place, the next line of defense involves "centering" and making time for self.

Warzecha defines centering as "finding that quiet place within oneself where you are focusing on the here and now with no concern for the future or the past."

She ties in centering with a simple technique called "anchoring," in which one touches the thumb and forefinger together on each hand. This can be accompanied by deep cleansing breaths and the use of certain relaxation triggers, such as soft music, pleasant scents, the tinkling of chimes or bells, or even a symbolic object such as a smooth stone held in the hand. Visualization or guided imagery also is effective and can even be done during a short work break.

Nurses tend to be "big worry warts," Warzecha says. She humorously suggests confining all one's worrying to a particular day and time, such as, "'I'll worry from three to five p.m. on Thursday,'" but the absurdity points out that "99% of what we worry about never happens."

No good comes from worrying, she adds. The key is detachment -- acknowledging you no longer have to control or take care of everyone's problems.

"It's a process of releasing and letting go," Warzecha explains. "Do your job and let it go. Things are going to work out for the highest good. You have to relinquish and trust. Efforting is when we fuss and fret, when we work and we worry -- that's what nurses do best. Then there's effortless effort: We do the work, we believe that we have done the very best, and we let it go."

She suggests that caregivers focus on the people they've helped instead of those they could not help, and on what they've accomplished instead of what they could not accomplish.

Take stress-reducing mini-breaks

To help develop this more stress-free attitude, which Warzecha says actually will make one more productive, she suggests three categories of stress-reducing self-care activities:

* Take four to six two- to five-minute mini-breaks per day, which can be just sitting quietly listening to one's breathing, massaging the face, rubbing the feet, or even looking out the window (or at the wall) in one's office and daydreaming.

* At least once a day, take a five- to 30-minute self-care break to play with pets, take a bubble bath, write in a journal, thumb through a catalog or look through a picture book of favorite places (which can be done at work), or exercise. The latter can be just walking or doing non-stressful physical activity such as t'ai chi or yoga.

* For two hours or more once a week, go to a movie, have a picnic, fly a kite, get a massage, take an exercise class, "do anything that gets you outside with nature," take a self-development course, go to a flea market, sing in a choir, or bowl in a league. The list of these kinds of activities is endless, she says.

In addition, she recommends other self-care measures such as buying flowers for oneself or hiring a home-cleaning service, even if it's only once a month. Performing random acts of kindness also is helpful.

"You feel great about yourself when you acknowledge and validate others. Merely saying thank you, smiling openly and directly into someone's eyes, taking a friend out to get her hair done, telling a stranger you like his tie, volunteering in a soup kitchen, and acknowledging the kindness of others are different from the kind of giving nurses are used to. It's very therapeutic for nurses to give when they don't have to, when it's totally unexpected and not required because it's their job," she explains.

Caregivers need to consider what their friends are like. Are they positive and fun to be around, or are they negative, energy-draining people who constantly complain and add to your stress?

Time management according to life's true priorities also is an important skill for caregivers to learn. Having quality time for romance and family can become impossible if one is consumed with work all the time. "I went to the cemetery last week, and I could not find one gravestone that read 'Susie Smith, RN, BS, MSN, CCM, COHN-S,'" Warzecha jokes. "But the point is to prioritize. What's really important? Is [work] your world, or is your world your family and what you are as a person? Don't give away so much to others that there is nothing left for the family." *