Box of chocolates with some scatters around it on table
Health06 ตุลาคม, 2563

Chocolates and tissues: Overcoming faculty and student stress in nursing school

By: Lenore Cortez, MSN, RNC
I have been a certified psychiatric mental health nurse for 16 years. If anyone had asked me where I thought I would end up in my nursing career I never would have said in this specialty. I certainly never thought I would end up teaching. I guess it is true when people talk about suddenly finding their niche, because that is what happened to me.

In 2008 I decided to go back to school for my Master’s in Nursing. I went to an online university and completed an RN-MSN program. My thought was that I was “doing this for myself.” You see, I like education. I thrive at being a student. Now here I am as a faculty member for a big university system in Texas, teaching both online and in the classroom. I love teaching. I tell my students that I sometimes feel like I am learning just as much from them as they are from me. I also tell each new cohort that I always have chocolates and tissues in my office.

Understanding the stress of nursing school

Even though I became a registered nurse back in 2004, what I jokingly call my nursing school PTSD is still fresh in my mind. I remember walking out of the classroom after the first exam I took and thinking, “What the heck was that?” I had no idea if I had passed or failed. As an educator, I have had many conversations with my students about testing with NCLEX style questions. I include practice test questions in my lectures to help them better understand the material we have covered, while also getting a better grip on how to read those pesky questions. We talk a lot about how to answer this style of question as it is a huge source of stress and anxiety for our students.

In addition to test anxiety, nursing students are under an inordinate amount of pressure to perform clinical skills, apply critical thinking and endure a huge workload. As educators how can we assist our students seeing their way through feeling overwhelmed, exhausted, and wondering why they ever thought going to nursing school was a good idea?

I make a point of being available to my students. I give them my cell phone number. I tell them to email, call, or text at any time. I give parameters for how late I will answer a call but tell them they can always leave a message and I will call them back. I began my faculty career strictly teaching online courses. I had a wonderful mentor. I am used to checking my e-mail before I go to bed each night. I truly care about my students. I have never had a student take advantage of my generosity. In actuality, I have had many students thank me for being available to them. I understand the nursing student’s need for support.

Why chocolates and tissues?

Let me be honest, I have a HUGE sweet tooth. Chocolates usually make me feel better when I am having a rough day. I extend that same solution to my co-workers and students. I have a nice seating area in my office that I have told students they can use if they need a quiet place to get away from everything for a bit or if they need to vent about their frustrations. Of course, with covid-19 there are new social distancing requirements in place. I cannot even count how many times I have people “drop by” for a chocolate and to ask for advice about this or that. This goes for faculty and students.

I have my “regulars” who stop by weekly to check in with me. I have the “occasionals” who stop by only to ask a question about an exam or an assignment. I have the “co-workers” who stop by to troubleshoot an idea for a lesson plan or lecture. And, once in a while I have someone from outside my department stop by for chocolate because they heard I have them in my office.

The tissues usually come out with the students who have requested a short meeting which ultimately turns into an hour or more discussion in which they share their anxieties and begin to cry. I am a psych nurse, and they know they can talk to me. I have a good rapport with the director of our campus counseling center, and I have referred certain students to make appointments to really get to the core of their anxiety. I have even had a few students ask if I provide therapy. While I am flattered that they feel comfortable talking with me I always tell them I cannot be their therapist but am always happy to listen and refer as needed.

Pandemic-related stress

The current pandemic has added an additional level of stress to all that we do both professionally and personally. Students left for spring break and then were told that all courses would be going online for the remainder of the semester. Faculty were given an extra week between spring break and resuming the semester to transition their courses to the Blackboard format we use for online learning. For faculty such as myself, this was extra work but not the end of the world. For faculty who are not comfortable with Blackboard or who have never taught online before this was like being thrown into the deep end of the pool when you don’t know how to swim. My university has been wonderfully supportive by frequently providing positive feedback and support so that everyone could move forward smoothly. As we begin the fall semester, we have a mix of online and face-to-face courses, with many social distancing and safety practices in place. While most students are happy to be back on campus with their peers, there is still a feeling that we are on tenuous ground. We understand that things can change very quickly if we start to see a spike in covid-19 cases on campus.

My mental health nursing course is a first-semester course taught in a flipped classroom style. I am passionate about the subject matter so it felt like I couldn’t teach everything I wanted to when the semester was shortened by a week and switched to online learning. I had to look at my syllabus and determine what topics needed to be kept, what topics could be reduced, and how to turn a flipped classroom into a totally online format, while still meeting my course objectives. I also had to consider the students’ stress levels and how I could reach them virtually. I changed my assignments and made sure that I had really clear instructions. I also scheduled weekly Collaborate sessions as a way to touch base with my students.

What I found surprising was that only a small core group of students regularly attended the weekly Collaborate sessions. Was it just me who needed to see that my students were doing okay in the midst of social distancing? One week I had no one attend, so I canceled the next week’s session, making myself available for any student who wanted to meet individually. My last session was a course review prior to the final exam.

I discovered that the students who were having a really rough time reached out to me and asked for extra help. They e-mailed, texted and called me. I scheduled individual Collaborate sessions with them to do exam reviews, clarify assignment instructions even further and offer what support I could as they missed their on-campus routines. These were the students who stated that they preferred face-to-face classes. They were the ones who felt more motivated by being with their peers. Many of these students needed help with time management as they reported not changing out of their pajamas for several days or feeling a lack of drive to get schoolwork completed. If I didn’t hear from these particular students, I made sure I e-mailed them with a short “check-in” to ask how they were doing. I did this with my second and fourth semester students as well, as I already knew that some of them have underlying anxiety even in pre-pandemic times.

My favorite Collaborate session was one in which we all introduced our pets to one another. Course questions had already been answered when my cat jumped up onto my desk. I introduced him and then it was like a chain reaction. I mean, who doesn’t enjoy meeting a pet? One student had just gotten a puppy and everyone “oohed” and “aahed” at how cute he was. In those minutes, the airwaves between us didn’t matter. We were socializing and laughing. It felt great to be with my students at the moment.

My co-workers were not forgotten in my efforts to connect with people during the spring semester. We had frequent emails and phone calls. One of my co-worker friends is our college’s Instructional Designer. She and I had a Collaborate coffee break one day. It was great to see her smiling face and just have a regular conversation once again. I helped a few of my friends get their exams loaded into Blackboard as I am so used to doing it that it doesn’t take me long to complete the task, yet for them, it seemed overwhelming. I also was contacted by the director of our university counseling center and asked if I would like to do some sort of webinar for our campus. I lead a faculty/staff relaxation webinar. Is there something you have done or could do to help others through these tough times? Do you have a stress-reducing idea you would like to share in the comments below?

Stress-reducing tips

When I have students come to me in a panic because they are feeling overwhelmed, I try to offer some stress-reducing tips that are easy to use. I found that in the last eight weeks of the spring semester I was needing to use some of those tips myself. I am going to share some of those tips with you so that you can suggest them to your students and co-workers.

Tip 1: Everyone gets stressed. Remember that none of us is above getting stressed from time to time. I have a PowerPoint slide in my first mental health lecture that contains just a horizontal line with the question, “What is this?” I always stump my students. They look at me like I have two heads and say, “A line?” I tell them it is the fine line between good and poor mental health. Then I remind them that anyone can be on either side of that line given one tipping circumstance. Right now, that tipping point could be the sense of isolation many people are feeling. I tell them it is okay to ask for help and give them the contact information for the university counseling center.

Tip 2: Belly breathing. Begin by lying down or sitting comfortably. Put one hand on your chest and one hand on your stomach. Imagine your stomach is a bellows. Take a long breath in through your nose and feel that breath going all the way down into your belly. Think of the way an infant breathes with their tummy doing the work. Try to keep your chest as still as possible. As you inhale pay attention to expanding your stomach. Slowly exhale the air out through your mouth as you concentrate on retracting your stomach. Repeat this for five to 10 minutes a day. This exercise can be done anytime you are feeling stressed. It gets easier the more you practice. Performing belly breaths has been shown to lower blood pressure, decrease stress, decrease blood glucose levels, and improve lung strength (Elkaim, n.d.).

Tip 3: Grounding. When a person is anxious, they often begin to concentrate on the somatic symptoms they are experiencing such as: feeling light-headed, having a rapid heartbeat, having a headache, having a stomach ache, and a feeling of impending doom. As they concentrate on these symptoms the symptoms increase in what I refer to as the “snowball effect.” One thing that I have found helps is to tell the anxious person to concentrate on the feeling of the ground beneath their feet. This may sound rather strange but what it does is makes the person switch their thoughts to something solid. Their focus switches to their senses instead of the anxious self-talk going on in their heads.

An extension of this grounding technique is called 5-4-3-2-1. This anxiety reducer involves having the person look around their environment and name 5 things they can see, 4 things they can physically feel, 3 things they can hear, 2 things they can smell, and 1 thing they can taste (Mayo Clinic Health System, 2020). Again, this brings their focus to the present and the actual world around them, instead of the anxiety.

Tip 4: Schedule relaxation time. Do you feel overwhelmed and as if there is not enough time in the day? Schedule relaxation into your calendar. Make yourself a priority. Most people I know use a calendar on their phone or laptop. I encourage my students to put some “me” time into their schedules as they will actually be more likely to take that time if they see it written on their calendar. I tell them to do something they enjoy - take that nap, read that book, take their dog for a walk, or go for a run. Remember, the time you put into relaxing will give you the benefit of being more productive with the rest of your scheduled activities for that day.

Tip 5: Get some fresh air and sunshine. Take this tip from someone who lived in New England all her life until three years ago. During Autumn and Winter, the days get long and dark. My moods would dip during the winter months. I had to take Vitamin D supplements just to get my levels into a more normal range. It turns out I was not able to get the amount of sunshine my body needed. Lack of an adequate amount of Vitamin D can result in depression. After moving to Texas and settling in for a few months I stopped taking the Vitamin D. I loved the sunny weather and spent as much time outside as possible. When I found a new PCP, I asked to have my Vitamin D level checked. For the first time in years, it was within normal limits simply because I was getting natural vitamin D from the sun. I no longer have mood dips in the winter because it is pretty much sunny all the time in Texas. Even my husband noticed the improvement in my moods, and he loves to share this story with our family and friends who still live in New England.

I encourage my students and co-workers to take breaks and feel the sunshine on their faces. It is amazing how good it feels!

The takeaway

We all feel stressed from time to time, probably much more during this current year than at any time in the recent past. There are simple steps we can take to reduce that stress. We can share these tips with our students and other faculty members. I find that helping others also helps me feel good.

Do you have any mental health topics you would like to learn more about? Do you have stress-reduction tips that have worked for you that you would like to share? Please join me next month for another edition of “Chocolates and Tissues.”

Ready for part 2? Read Chocolates and tissues: Beginning to eliminate the stigma of mental illness now.

Lenore Cortez, MSN, RNC
Expert Insights Contributor for Wolters Kluwer, Nursing Education
  1. Elkaim, Y., (n.d.). How to belly breathe like a pro. Making Fit and Simple Healthy Again.
  2. Mayo Clinic Health System. (2020). 5-4-3-2-1: Countdown to make anxiety blast off.
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