Manage Stress, Avoid Burnout

Providing workplace renewal opportunities for nurses

Stress among nurses is caused not only by the demands of clinical care, but also the continual outlay of compassion required to meet the emotional needs of patients and families. In a fast-paced clinical setting, however, nurses are not typically afforded the necessary respite for reflection and renewal. Respite provides nurses with an opportunity to reflect on stressful experiences and prepare themselves for subsequent patient and family relationships. Respite periods also allow nurses time to regain clinical focus necessary for a safe patient
care environment. Senior nursing leaders have an obligation to understand and support the needs of nurses and encourage use of resources to mitigate stress.

In 2010, The Joint Commission Journal on Quality and Patient Safety published Caring for our own: deploying a system wide second victim rapid response, which supports the need for a private location away from the care environment for nurses to relieve their stress and renew themselves after stressful events. The private location gives nurses time to alleviate stress and prepare for re-engagement in safe patient care.

One of the coauthors of this article (Rich) recognized the need for this type of environment and advocated for the creation of a Center for Nursing Renewal. This Center would house a quiet space for mental and physical relaxation, promote wellness, and offer stress management modalities.

This article describes how the center became a reality at the Hospital of the University of Pennsylvania (HUP).

Start up

More than 500 respondents participated in a preimplementation survey, validating a substantial interest in stress-relieving modalities. The top five areas of interest were massage chairs, yoga, Pilates®, Zumba® and weight-loss programs. There were several requests for self-help sessions on financial planning and stress management. The survey also identified best hours of operation and the need for multiple short 30-minute classes at key times of the day.

Members of the Nursing Recognition Committee and Shared Governance at HUP formed a committee of nurse representatives, including clinical nurses and nurse managers, to create the Center for Nursing Renewal. They began by networking with other hospitals to learn of similar initiatives. Members of the committee visited a neighboring healthcare facility that had implemented a “Healing Room” for nurses and met with the facility’s leadership team. The nurses returned inspired and ready to begin the development of the Center.


The committee secured funding through a proposal to the chief operating officer and chief financial officer for minor construction to build the Center. The Center also received many donations from family members of clinical nurses and vendors, including framed photographs, guided imagery videos, and furniture. As plans for the Center unfolded, the committee decided to expand access to all hospital employees.

Creating a soothing environment

The committee worked with HUP’s facilities department to determine how best to create a functional soothing environment. The end result is a welcoming space that includes a computer café, meeting room, large open space for yoga and other training classes, relaxation room with three massage chairs, meditation room with one massage chair, lending library, and refreshment room.

The relaxation and meditation rooms have low lighting, battery operated candles, and televisions that continuously play a guided imagery video accompanied by soothing music. The computer café provides nurses with an area away from the nursing units where they can work on shared governance and committee projects and check work and personal e-mail. The lending library is lined with book cases filled with books of various topics, ranging from clinical to leisure reading; hospital employees donated many of the books. The refreshment room provides staff with a remote location to take a break, eat lunch, or enjoy a cup of complimentary coffee or tea.

Grand opening

The Center was unveiled with an open house hosted by Rich. Senior leaders, the board of trustees, and all nursing and hospital employees were invited. The committee also sparked additional interest by holding a “Biggest Loser” competition. This was an opportunity for employees to motivate each other to engage in healthy eating habits and participate in exercise programs. The competition included weigh-ins and weekly healthy eating tips that were given to the team captains for them to distribute to team members. The 48 teams, totaling 240 participants, generated more than $1,200 in donations. The funds were donated to the winning team’s charity of choice: The Ovarian Cancer Research Fund.

Positive outcomes

About 60 guests visit the Center for Nursing Renewal each day. It’s open Monday through Friday, from 7am to 9pm. Access is also available outside those hours, including weekends and holidays, by contacting on-duty nursing coordinators. The busiest time is between 11am and 1pm.

The most popular services are the massage chairs and guided imagery. The Center also offers salsa dancing for nondancers, Hip Hop Abs®, mindfulness classes, and nutrition lectures. The Center currently hosts Weight Watchers at Work® programs, yoga, and Zumba classes. All classes, with the exception of Weight Watchers, are provided at no charge and are led by volunteer instructors.

To evaluate the outcomes and obtain ongoing feedback, guests are asked to complete a survey at the beginning and end of each visit. The guests rate their overall stress on a scale of 1 to 5 (1 = no stress and 5 = overwhelming stress). Results have shown a 42% reduction in self-rated stress levels among the guests after visiting the Center. Since the Center’s opening in 2011, there have been more than 17,000 visits. Many nurses report visiting regularly as a method to decrease stress. Over the same time period, HUP’s RN satisfaction survey results have demonstrated positive changes. Nurses report increased job enjoyment and fewer have expressed plans to leave direct patient care.

Looking to the future

Support from senior nursing leaders creates a positive environment for cultural change. Future work includes guidelines to help leaders recognize nurses’ need for time away from patient care and a structured coverage plan during the respite period.

Nurses experience stress every day whether it is related to care giving or ethical issues. They also struggle to balance workplace stress along with personal and family responsibilities. Resources such as HUP’s Center for Nursing Renewal can improve nurses’ physical and mental well-being, ultimately improving safety and quality of care.

Jean Romano is clinical director for nursing operations and Victoria Rich is chief nurse executive at the Hospital of the University of Pennsylvania in Philadelphia.

Selected references

NIOSH—National Institute for Occupational Safety and Health. Stress at work. Centers for Disease Control and Prevention; NIOSH Workplace Safety and Health Topic. Available at http://www.cdc.gov/niosh/topics/stress/. Accessed August 12, 2013.

Scott SD, Hirschinger LE, Cox KR et al. Caring for our own: Deploying a system-wide second victim rapid response team. Jt Comm J Qual Patient Saf. 2010;36(5):233-40.

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