By Tracey Boyd
Stress in the OR always has been present, but today’s healthcare environment brings with it changes required to keep pace with healthcare reform, said Carla Thorson, MSN, APRN, ACNS-BC, CNOR, CNS-CP, content manager for clinical nurse leadership of the Association of Operating Room Nurses.
“There is constant pressure to perform cases faster and in a more cost-effective manner while meeting all the added documentation requirements,” she said.
Marty Higgins, MS, RN, NE-BC, director of surgical services at The Medical Center of Plano (Texas), agreed. “The OR nurse is responsible for patient care, monitoring sterility and trouble-shooting countless pieces of equipment used in numerous services,” she said. “Familiarity decreases stress.“
Higgins added some hospitals offer programs that allow new graduates the opportunity to work in the OR. Higgins said nurses new to the surgical setting experience the highest level of stress.
“The new nurse is learning procedures, equipment, time management and critical thinking in a fast-moving environment,” she said. “OR nurses can circulate complex cases with ease when they are experienced with the procedure and confident in their ability to anticipate the surgeon’s needs. I think high stress occurs when the OR [nurses are] not confident in their skills or when they are not familiar with the surgeon’s routine.”
Lourdes Lorenz, MSN-IH, RN, AHN-BC, NEA-BC, board member and president-elect of the American Holistic Nurses Association, said research shows younger, more inexperienced nurses feel much more stress than more experienced nurses.
“In recent years,” she said, “research demonstrated events creating higher stress levels are related to the pressure to work quickly.”
All three nurses agree the results of this stress are less than optimal. Burnout is the result that most quickly comes to mind. But there’s a difference between burnout and stress, Lorenz said.
“Nurses who experience stress can still imagine that if they just get everything under control, they will feel better,” she said. “Burnout is a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress.”
Lorenz said another major difference between stress and burnout is people usually are aware of being under a lot of stress, but they don’t notice burnout as readily when it happens.
“Burnout reduces your productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical and resentful,” she said. “Eventually, you may feel like you have nothing more to give. Nurses experiencing burnout often don’t see any hope of positive change in their situations.”
In addition, if a nurse is stressed, it can have ancillary effects on the entire department, spurring increased conflict among staff because of greater demands on performance and outcomes, Thorson said. Patient care might suffer as well.
“There may be lost days at work and an increased likelihood for errors related to fatigue and distraction,” she said.
There are ways to combat and alleviate the stress perioperative nurses experience. The AORN offers tool kits including guidelines for managers and staff, Thorson said.
“The Just Culture Tool Kit is especially effective to strengthen team communication and create a high reliability environment,” she said. “With good communications and effective leadership, the OR [nurse] has an outlet to stress. Many hospitals also have programs for the management team to better deal with the increased stress and the constant change that’s occurring.”
Lorenz said the AHNA also offers programs and webinars that focus on self-care and stress resilience to help nurses who are feeling overwhelmed.
“One of the core values of holistic nursing is self-care,” she said. “Our chapters offer self-care workshops for local nurses. The AHNA’s website also offers stress-reduction exercises for diaphragmatic breathing, progressive muscle relaxation, autogenic training, guided imagery, mindful meditation, etc.”
Most hospitals also offer employee-assistance programs to help staff members manage life’s difficulties.
“These programs offer assistance to all employees anonymously and usually free of charge,” Higgins said. “Sometimes something as simple as a long weekend or an occasional day off in the middle of the week is a great stress reducer.”
As stressful as working in a surgical setting may be, Higgins said it remains a great place to hone nursing skills.
“Even with the stress, the OR is still one of the best places I know of for nurses to work,” she said. “No two days are the same, and you are constantly learning and growing.”
Tracey Boyd is a staff writer.