lowering your “stress bucket” for nurses
In my twenties I felt like I had deep, boundless bundles of patience and ease as a nurse. I worked full time and also went to grad school to become a Clinical Nurse Specialist, with the goal of serving my fellow nurses.
At work, I got scared but not overwhelmed when a patient tried to bite me and screamed “how do you sleep at night Sarah, doing this to people?” while I tried to remove his PICC line with Police presence. I juggled giving hugs to a grieving spouse of a terminally ill patient while inserting another NGT to give his love some relief.
At home, I wrote term papers, racked up clinical hours, and ran to catch trains to the City for class.
In short, I handled the emotional ups and downs of being a bedside nurse, like we’re all expected to do.
At my “farewell potluck” from the hospital I started at, about 2 years after becoming an RN.
At this time I felt like I was doing “fine” and handling all the stressors of being a nurse well.
But then, sometime in my 30’s, after serving patients for over a decade and becoming a mom, my sh*t began to wear-out.
I couldn’t sleep the night before each shift.
I felt anxiety and dread as I walked up to the hospital in the morning.
I came home irritable and snapped at my kids who were being, well, kids.
I felt like a ticking time bomb of pressure. That at any moment I might explode if I had to deal with one more violent patient, one more traffic jam on the Bay Area freeways, one more tantrum from my kid.
Was this a nervous breakdown? I wasn’t certain, but it sure felt like it.
This was my body telling me that my nervous system was overwhelmed. My Stress Bucket* had long ago filled up and was not just spilling over the sides, but spouting straight up like a geyser.
We can envision that each of us has a bucket inside that fills with the stressors of modern living. The fullness of your stress bucket depends upon your stress tolerance and number of events perceived to be stressful.
Our buckets become full to bursting with:
Day after day heavy assignments without any breathing room
Long emails that haven’t been checked, but the unit manager keeps saying everyone needs to read them during their shift
Mandatory online training assignments. Is it just me or does the list of modules get longer every year?!
Traffic
The doom and gloom on the news
The kids’ needs and demands for attention (which they rightly deserve but we just gave all our patience away at work)
Our partner might not participate in household chores or kids’ schedules
An aging parent wants to get her haircut and you schedule those appointments, too
The list goes on and honestly makes me a little sweaty just typing these out.
When too many stressors pile-up inside your bucket you begin to feel pressure, anxiety, overwhelm and exhaustion. This is your nervous system telling you it doesn’t have a chance to rest and soothe itself, so you become irritable as a result.
what stressors would you add to your own bucket?
The stress bucket works like this:
Stressors are like clouds above your bucket, and rain down into the bucket causing the water (stress) level to rise
You can lower the level of water by opening spouts at the bottom of the bucket and relieve pressure
The spouts open by using healthy coping strategies that activate the parasympathetic nervous system (PNS): meditation, deep breathing, exercise, social connection, body scans etc
Unhealthy coping mechanisms temporarily lower the water level, but usually act as a new hose that fill the water level back up: substance use, mindless scrolling, bottling up emotions etc
We each of us have a different shape and size bucket based on a few factors:
Innate wiring. Some people are born as more highly sensitive and take on many of life’s stressors that other people wouldn’t recognize as stressful, sad, emotional etc. (me, raising my hand)
How we grew up. Our nervous systems are wired in the first few years of life and depending on the volatility or scariness of our environment, our nervous system may become chronically activated leading to a hyper-vigilant state. When this happens, people are more easily triggered into the fight-flight state. If you were raised in a more calm and predictable environment, your nervous system is more likely regulated, and not as quickly triggered into fight-flight.
Your current stress load and responsibilities. Do you have demanding patients at work and then come home to the needs of children or parents or relationships?
There was probably a period in your life where your bucket felt deep and wide. You felt like if a traumatic event happened at work, you could quickly move through it, and on to the next thing.
But, over time, if your bucket isn’t periodically emptied of all the triggering events, you will start to feel the consequences of anxiety, overwhelm, irritability, reactiveness, and/or insomnia (among others).
If you don’t incorporate a practice to open the spouts and relieve the pressure in the bucket, you will start to spout off little puffs of pressure. Like a tea kettle right before it totally blows its top.
You will release a little steam in the form of a one-time yelling at your kids, drinking a glass of wine, or feeling a lack of compassion for the patients at work.
You will feel slight relief from each of these little spouts, but it's not enough to totally feel better and let out all the pressure and stress from your bucket.
If you feel less like a tea-kettle and more like a volcano about to erupt, your nervous system is frayed and needs soothing and relief.
So, how do you cope?
The very first step in emptying your stress bucket, and thus healing and bringing back more peace and patience into your life, is to spend at least 5-7 minutes a day in stillness. In quiet, without any demands or distractions.
You can absolutely find 5 minutes each morning (or evening if you work the night shift). I used to get to work a little early and sit in my car for 5-10 minutes to do a guided breathing exercise.
Maybe you take 5 minutes each morning on your days off before you start doing, and just be. Be still. You can meditate, stretch, or read in quiet, but I recommend you start with a deep breathing exercise.
Sit or lie down in a comfortable position. NOTICE what you hear, the feeling of the chair or floor underneath you, and what you smell. Notice the feel of the air on your skin.
Now, place a hand on your stomach and breathe in through your nose into your stomach (not your chest) for a count of 4.
Hold for a count of 7
Exhale through your mouth for a count of 8
Repeat this 4 times, then up to 8 times as you become more familiar with the practice
Then sit for another minute or two in silence, with regular breath.
It doesn’t matter how fast or slow you count, but aim for a slower, rhythmic pace.
If thoughts come into your head, that’s fine, you're normal! Do not judge yourself for having a thought, just let the thought come and go.
Ok, how do you feel? I became more calm just thinking about this breathing practice.
If you’d like some guidance you can find this 4-7-8 breathing exercise and many others on apps like Insight Timer, Calm and Headspace.
Doing this breathing exercise will activate your PNS.
This is our favorite system! Since we nurses often run around busy all day, we need to balance that grind with the calming and soothing PNS. It's in this state that you release the water from your stress bucket so you don’t overflow into the zone where health problems develop.
activate your PNS by focusing on small sensations, like your fingertips brushing against one another or your palm
Here are a few other ways you can activate the PNS, thus reducing your levels of stress:
Visualize yourself in a calm, relaxing situation: your favorite beach spot or mountain hike
Focus on one of the 5 senses: what you hear, touch, see, taste, smell
Muscle relaxation: tense all the muscles in your body, then relax and notice the difference in your muscle tension
Connect: seek out a dear friend who you feel calm around
Do something just for yourself, that you love
One thing that nurses and other healthcare providers experience is squishing down emotions and stressors quickly at work due to the nature of the fast-paced environment, and need for quick critical thinking. But this “squishing” is not helpful in the long-term. You can activate your PNS in short, 10 second bursts throughout your shift to lessen the overall burden in your bucket:
rub 2 fingers together very lightly, feeling the individual ridges on your fingertips (patients will never know if you’re doing this)
slow deep breaths wherever you are: in the patient’s room, med room, linen room, anywhere. Do box breathing: inhale through your nose for a count of 4, hold for a count of 4, exhale through the mouth for a count of 4, hold for a count of 4…for a few rounds
There are many ways to release stress from your bucket. The main thing is to pick one and start today. You have given amazing care to others for years, now it’s your turn to give amazing care to yourself.
*The stress bucket model was originally developed by Professor Alison Brabban and Dr Douglas Turkington, 2002
