7 Tips to Handle Pre-Shift Anxiety (Podcast)

Caller Question: My wife who is an ICU nurse cries before going to work. She cried every night before going to work the past 4 weeks at her new job. She’s been a nurse for 4 years and she says she loves being a nurse, but if she did, why is she crying before every shift? 

Nurse Alice: I have been that nurse who cries before, after and probably during the shift. I think we’ve all been there. You don’t have to necessarily be a new grad for this to happen. This can happen whether you’re a new nurse or a seasoned professional. You might try to cope with these anxious feelings and thoughts before and after shift. So it isn’t uncommon for nurses to deal with what they call “pre” or “post-shift anxiety.” In this situation, it sounds like the caller’s wife might be experiencing some pre-shift anxiety. Obviously I’m not diagnosing her because I haven’t talked to her, but I feel like I know her. I feel like I’ve been there. 

Many nurses have been there. When we have these feelings of pre-shift anxiety, it’s generally because there are some types of fear of rejection, anxiety, your concern that you might make a mistake, you don’t feel supported in your environment, or you just dislike the specialty you work in. Many things are going on through your mind and you’re second guessing your identity as a nurse, maybe even your career choice or you might even become resentful with work. 

>>Listen to this episode on the Ask Nurse Alice podcast

What is Pre-Shift Anxiety?

Pre-shift anxiety is an emotion that’s characterized by intense, excessive, persistent worry, fear, dread or just uneasiness about everyday situations. Now that's not to minimize the work that nurses do because these “everyday” situations are not really everyday situations. We just went through a pandemic. What is everyday about that? If anything, it's just intensified the workplace. We've been more short-staffed and had a lack of resources. So we've been asked to do a lot more with a lot less. Then you factor in just being a human, our own fears, concerns, obligations and responsibilities outside of work.

There's a honeymoon phase when you start the job. You’re excited with new shoes & scrubs, looking cute and feeling good. You’re a nurse, boom! But that honeymoon wears off quickly and reality slaps you in the face. It’s the real deal and there’s horror that kicks in with actually working as a real nurse, especially in certain environments. Let’s take the ICU and ER for example, it can be traumatizing. 

I was at work a week and a half ago and I cried in the middle of the day. I was in a new location on a new assignment, just overwhelmed with work. I didn’t get much of an orientation and had to beg for a unit tour to get to know where things are. It felt like there was no camaraderie. Everyone was pissed because they were short-staffed already and I just didn’t want to be there. I feel like tears are words that you’re at a loss for. It’s a form of expression and I was full of anxiety and ended up crying in the break room. People will cry before work, during work, and after work and all of this is related to anxiety. 

How to Handle Pre-Shift Anxiety: 7 Tips

Tip 1: Create a Calming Routine

This is an important step because how you start your day impacts the rest of the day. Your mood and energy level will help define how you perceive a stressful situation. You can intentionally elevate your mood before work by doing things such as listening to calming music, mediating, praying or taking nice deep breaths. You can even give yourself positive affirmations: “I am smart. I am a great nurse. I am a loving person. I am intelligent. I am caring.”

Tip 2: Calm Your Mind

This goes hand in hand with creating a calming routine, but you can do this before, during or after your shift. Whenever you’re approaching a stressful situation, it’s important to keep your mind calm. You have a greater chance of conquering the situation when your mind is calm. You can’t always escape the unit when you’re there because you’re at work, but sometimes taking a moment to do some breathing techniques is an easy and effective way to calm your nervous system. So when you are anxious before your shift, try regulating your stress hormone by taking three big shallow breaths before your shift. If something bad happens during your shift and you’re able to take a quick break, go somewhere like the supply room or bathroom and calm your mind with some deep breaths. 

Tip 3: Take Care of Yourself at Work

It’s important to take care of yourself while you’re working. If you don’t, no one will. There is no one coming to rescue you. You have to rescue yourself. You have to be your best cheerleader. Starting your shift with a calm mind helps start your shift well, but don’t neglect your mental health while you’re actually working. That is very, very important. If you need a reminder of how to care for yourself physically, emotionally and mentally while you take care of others, think of the acronym PEELS: pray, eat, exercise, laugh and sleep. 

Tip 4: After Your Shift, Exit With a Coworker

One of the best things about exiting your shift with a coworker is that no one else better understands your stress and anxiety than a fellow colleague, someone who’s in the trenches with you. From one nurse to another, you guys can leave together and maybe talk or share some of your experiences from the shift. Of course you should always be mindful of HIPAA, but it’s an opportunity to debrief and get some emotions off your chest. That can be healing, especially with people that can relate to what you’re experiencing, what you’re seeing or how you’re feeling. 

Tip 5: Create a Calming Environment to Come Home to

You’ve been in the war all day at work and the last thing you want to come home to is chaos, because that only builds your stress and anxiety. You want to come home from a stressful shift to a nice relaxing environment. And leave work at work. This typically takes some planning, because if you don’t have anyone to help you, you have to do it yourself. But try to come home to a clutter free area in your house where you can relax after a long shift. If you have someone at home who can help with this, even better! You can ask your family, your partner, or even a housekeeper, to tidy up your house before you come home, because you deserve that. 

Tip 6: Find a Therapist or Someone to Talk to

I’m very much a proponent of therapy. I have a therapist that I talk to, sometimes more frequently than others. There have been times where I’ve talk to them three times a week, and others where I’ve gone three months without talking, but it’s something I have on standby. It’s important to talk about your feelings to get that anxiety out, and make sure we’re doing it in a healthy way. 

Tip 7: Find a Fulfilling Community Outside of Work

Working long hours in a stressful situation can leave you emotionally and physically exhausted. It may feel like it’s difficult to connect with people outside of work, especially when you’re tired from a full day. But who gets you better than another nurse who’s experienced the exact same thing? You swap stories, you can cry together, laugh together and get mad together. You can connect with people at the gym, your church, maybe the grocery store. So you should check out your community, but Nurse.org is here for you too. We are trying to plan more events and find ways in which we can release stress and anxiety, meet other nurses and build a fellowship, or a fulfilling community outside of work.  

So for those of you who are listening who might be raising their hand thinking this is me. I have pre-shift, during-shift and post-shift anxiety. I cry before I go to work. I feel sick before I go to work. I cry in the break room. I don’t feel like I belong in this nursing world. I feel like an outsider. You are not alone, and there are steps you can take to get a handle on these feelings.