A Quick Way to Talk Stress-Level on the Job

Phyllis Quinlan, PhD, RN, NPD-BC
Nursing Coach

In her early career as an emergency room nurse, if someone had asked Nursing Coach Phyllis Quinlan, PhD, RN, NPD-BC, to talk about her stress level, she would have politely said, “If I had time to talk about stress, I wouldn’t be stressed!”

Unfortunately, this “suck it up, buttercup” mentality regarding stress wasn’t working for nurses before Covid and it’s definitely not working now, Quinlan acknowledges. “This business of being in denial of our own humanness and capacity to manage stress at high levels for prolonged periods is causing people to reconsider their choice of profession. In the most severe cases of stress clinicians are using isolation as a coping mechanism, which can lead them to consider self-harm.”

When Quinlan works with nurses to heal from stress-induced injuries, she teaches them two important lessons, and one quick trick to self-identify stress level.

Lesson # 1: Understand the Stress Curve

Stress can be measured on a bell curve that is directly related to performance level, which she breaks down by color.

• Green: This is when you are at your most relaxed—on those days when you can hang out in your pajamas and your biggest worry is what to binge watch and order in. Performance in the green stress zone is pretty low.
• Yellow: In this zone, stress is elevated, and performance is elevated equally, like on a day when the OR schedule is on track, you are on your game and performing through your day like a champ.
• Orange: This is when the stress tipping point hits at the top of the curve, stress level exceeds performance level, and fatigue and exhaustion set in. Maybe you have a tough case that runs long, maybe you have a sick family member at home, whatever the reason, your stress is hampering your ability to perform.
• Red: This is the stress danger zone where too much stress most undermines performance and causes burnout, anxiety, and depression.

Quinlan notes two main causes for dipping into the stress red zone—either an intense stress experience such as a personal or professional death, or, more often, a prolonged stress incident when a nurse is forced to perform at a high level beyond what is healthy. In either situation, the physiologic workings of your brain and body that thrive with moderate stress are completely depleted.

“Nurses often teeter in the orange zone given the natural stresses and fast pace of our work, and this means we are at higher risk for slipping into the red,” Quinlan explains.

#2: Know the 4 Different Stress Injuries

Quinlan teaches nurses seeking peer support for stress-induced illness that stress injuries come in four common forms:

• Trauma injury–due to a horrific or gruesome experience.
• Loss injury–due to extreme grief.
• Moral injury–due to being prevented from following your moral instinct.
• Fatigue injury– due to the accumulation of stress from all sources over time without sufficient rest and recovery.

Identifying these different types of stress-induced injury creates a pathway for healing by acknowledging the source of the stress internally, or more helpfully with peer support.

Quick Trick to Talk Stress on the Job: Say Your Stress Color

Once a nurse knows how to gauge their level of stress, they can start self-correcting when they feel they reach their stress tipping point. They can also express to co-workers or leaders who understand the stress curve what color they are at, she explains.

For example, say a good leader is rounding and checking in with staff, she might ask a nurse, “What is your color today?” and that nurse might say, “I’m in the orange.” This would raise the leader’s concern level to talk to the nurse in that moment about stress relief or round back and keep tabs on the nurse to advise support steps if needed.

This one trick for nurses to think and talk about stress demonstrates the kind of work that needs to be done more to incorporate mental health strategies into busy workplace settings like the OR, Quinlan suggests. “This approach is part of a culture change to embrace the idea that the empathy and compassion we offer patients and families is exactly what we need to offer each other, without making people feel guilty or embarrassed for speaking up about it.”