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In these stressful times, be good to yourself  by Penelope Chase Psychiatric Consultation Liaison The year is not 1994, and it’s not “Change Management” in the Medical Center. But if you remember those days, you might be sensing—what did Yogi Berra call it?—“deja vu all over again.”   If you weren’t at MUSC in 1994, you may feel a vague uneasiness in the air or you may feel just plain tired, over-worked, and under-appreciated. Perhaps you wonder if you’ll be a “survivor” on this MUSC “island” of newness and the resulting tension which some of us are feeling these days.   It’s not just you. There really aren’t as many people doing the job as yesterday and the day or year before. And the work they did? Well, let’s just say you’re doing things that weren’t spelled out in your original job descriptions or didn’t yet exist when you signed on. Remember the phrase, “and other duties?” Remember that our new Medical Center Values include being adaptive to change? Well, here we are.   These days we really are doing more with less, and, for most of us, that creates stress. Plus, the new interns and residents are here, and learning the ropes, needing help and asking questions which take time to answer. The change to being a state authority also brings with it uncertainty of how things will affect and play out for us as individuals.   It is useful, however, to remember the long term goal of coming through difficult times in a stronger position for having accepted the challenge and stayed the course—if that is what we have chosen to do.    As good for us in the long run as this may be, we don’t know what to expect in the short term, so we are uncertain how to prepare or to respond. And uncertainty naturally creates anxiety and stress for most of us.   For some of us worry, stress, anxiety, and even panic or terror march in lock-step with overtime, (how can I say “no” and leave more work for my peers?—what about “my” patients?) sleepless nights (or days, if you’re a night worker), upset stomach (thank heaven for Pepcid), irritability or short tempers, headaches, back aches, and other stress-related illness. These can translate into difficulties with concentration or decision-making, medication errors, a nasty attitude, reduced job performance, and other situations that could prove dangerous to you, your patients, and your co-workers. Your family or friends may not find you much fun to be around, either.   A search through The Catalyst catacombs found a useful reference when it comes to the stress management conundrum. It worked in 1994, and luckily it’s still there to help take the rough edges off these stressful days.    The advice then—and now—is that everybody is stressed in one way or another. Instead of trying to avoid stress, the better choice is to face it head on and learn to manage it in a healthy manner—before it leads to serious physical or mental problems such as high blood pressure, heart attack, stroke, ulcers, depression, substance abuse, etc.   Some people under stress—especially men—deny they’re stressed. After all, “I’m strong or tough. I can take it.” Left unchecked, denial of being stressed can be a severe health hazard, not to mention being a hazard to our patients. The cure really isn’t all that bad: Maintain good nutrition and eating habits, get enough sleep, make time to exercise regularly and spend time with family and friends, re-create spiritually, and don’t forget to play.   Unmanaged stress can lead to burnout. That’s a word popularized in the 60s that we haven’t heard much about lately. But maybe, like other things “retro,” it’s time to bring it out of the closet again and see if it fits. With burnout, we become less effective in our judgment and our work. Job burnout can also lead to domestic violence, child and spouse abuse, depression, anxiety, and, in extreme cases, suicide. Burnout is another result of under-managed stress.   Here are 20 ways to handle or manage stress. They’re not a prescription for hard-to-swallow medicine. They’re more like a permission to be good to yourself. Consider the following time-honored strategies for managing stress: Exercise, especially aerobic. Balance your work and personal life. Develop and use a sense of humor. Be empathetic and forgiving (to yourself and others). Be positive and optimistic, and use prayer and positive self-talk. Learn and practice flexibility, especially with the people you love. Accept and adapt to whatever you cannot change. Develop friendships with a diversity of people. Recognize and accept the limits of your circumstances. Learn to relax and take short breaks. Slow down. Establish routines to help manage your time. Learn to plan and establish your values and priorities. Keep a journal or notebook of your feelings. Get a therapeutic massage at a health club. Spend time alone and outdoors, in nature. Take or make time to do things you enjoy doing. Take classes that help people to make healthy lifestyle changes. Re-prioritize your spending habits and allocation of your money. Skip watching TV news for a week. Don’t be afraid to seek professional counseling. You’re not crazy. Some stress in our daily lives is inevitable, even beneficial. “Good” stress (eustress) gives us the energy and motivation to get those things done, which help us survive difficult or potentially disastrous situations. Try looking at stress, change, and uncertainty as opportunities to grow or learn new skills, including coping and survival skills.  The Catalyst will feature a series of articles in upcoming issues on how to survive in this era of tight budgets, reduced staffing, sicker patients, and dwindling resources: “doing more with less.” The author, Psychiatric Consultation Liaison Nurse Penelope Chase, MSN, M.Ed., R.N., coaches people on ways to cope with both natural and man-made disasters.