Today, we are much clearer about the complexities Selye described because of the large body of research in psychoneuroimmunology, which studies the interactions between consciousness (psycho), brain and spinal cord (neuro), and immunology.1


From prehistoric times A stress response causes specific biological changes, such as increased heart rate, bronchodilation, horripilation (goose bumps), increased blood pressure, increased sweat production, decreased immune response, decreased insulin and increased blood glucose.1


All these physiological changes are the result


of sympathetic stimulation designed to let us fight or run from the saber-toothed tiger of prehistoric times. Today, however, we do not have many saber-toothed tigers to run from — although psychosocial stressors are with us constantly. The volume of research in this area is growing rapidly, and it is safe to conclude that immune modulations caused by psychosocial stressors or interventions directly affect health outcomes.1 Long-term stress falls into three categories: challenges that have


a limited scope and some end point, long-term stresses that have an unlimited or infinite scope, and remote stresses stemming from untoward experiences in childhood or early adult life with unresolved consequences. Chronic stressors suppress both cellular and humoral immunity.2 Chronic stress acts on the hypothalamus and then on the pituitary


gland, ending in a cascade that causes fluid retention, increases blood glucose, promotes lipogenesis in the face and trunk, and may be part of metabolic syndrome and obesity.1


Selye called the


conditions resulting from chronic stress “diseases of adaptation,” physiological consequences of stressors that do not go away.1


The toll on nurses In the 2011 American Nurses Association survey of health and safety in nursing, 74% of nurses said acute and chronic effects of stress and overwork was at the top of their list of the three most frequently occurring health and safety concerns.3


An AMN


Healthcare survey of more than 3,400 practicing nurses of all ages found that 90% reported satisfaction with their career choice of nursing. However, there was less satisfaction reported with their current job as a nurse; only 73% stated they were satisfied with their current position, and 51% reported concern that their jobs were affecting their health. Nurses that reported the highest satisfaction with their jobs were in management and education.4 A recent publication reports that nurses experience high levels


of workplace stress with negative effects on both individual nurses and the organizations that employ them.5


2016 • Visit us at NURSE.com 25


Job difficulty and stress from job demands were the reasons


given most frequently by surveyed RNs leaving the profession of nursing. For new RNs, lack of time to complete assignments and do the assignment well were the reported concerns expressed most often.6


What can leadership do? For healthcare systems with Magnet status or those starting on the Magnet journey, attention to nurse workplace stress is important. A criterion to be demonstrated is evidence of organizational efforts to address caregiver stress.7


Additionally, a variety of studies have


shown a relationship between nurse job satisfaction and positive patient outcomes, so there are quality of care and potentially reim- bursement reasons for focusing on the nurse work experience and initiating efforts to improve it and reduce stress.8, 9


Organizations


with higher nurse job satisfaction and, ultimately, a less stressful patient care environment have focused on several specific areas. These include structural empowerment of the nurse workforce that has been found to lead to increased individual nurse satisfaction.9 As might be expected, an inverse re-


lationship is found between nurse stress and job satisfaction with higher rates of absenteeism, in- attention to patient care and higher staff turnover rates.10


It


is also interesting to note that in various settings, the level of stress may be differ- ent among dif- ferent nursing departments. Some studies


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