Dealing with stress in an IVF clinic

The ability to empathise with patients is a quality that is emphasised as a prerequisite for health care professionals. Especially for those at the caring end of the spectrum, in particular nurses and counsellors.

I was just reading a description of the role of the nurse in the fertility clinic setting. I was struck how quickly things have changed in just a few decades. In the early days the role traditionally chaperoned patients, supervised patient investigation and managed clinical data.

The patients in those days, nearly all childless couples would come to the outpatient clinic to consult with the physician. They only had brief dealings to the nurse, who was a kind of auxiliary to the physician.

IVF Patients need a holistic approach

However, the rapid increase in patients seeking fertility treatment from the 1980s led to terrific demands on the time of fertility doctors. It also revealed that these patients necessitated a more holistic approach than could be provided by the medical profession alone. This was because of the nature of the scenario in which they found themselves.

The nursing profession naturally stepped into the breach to provide for these patients’ physical and psychological needs1. Nowadays, nurses working in assisted reproduction technology (ART) need to be multi-skilled, incorporating a multitude of functions and attributes2.

Professional counsellors also found a niche in the world of ART, focussing on the patients’ emotional wellbeing. And the watchword for these professions, both at the forefront of the provision of care to these patients, is empathy.

Empathy is a double-edged sword

This is because people who possess the attribute of empathy are natural emotional resonators. They cannot help but resonate some of the emotion experienced by the patients. This is all well and good when the outcome is joyful, such as a successful pregnancy/birth. However, the road to that outcome is invariably an emotionally rocky one.  And all the while the empathetic health care professionals are resonating the emotional tone provided by the patient.

This is a problem. The stress conferred by a diagnosis of infertility and subsequent treatment has been compared to that of stress experienced by patients who have been diagnosed with cancer3. In other words, there is a lot of negative emotion with which the empathetic health care professionals can resonate.

Stress borne of empathy is in addition to the usual stress that a nurse or other health care employee may experience as part of what might be generically described as a stressful job!

Understanding stress in an IVF clinic

In the clinic setting it is important to understand the nature of stress, including its origins, because it can impact the performance of the team in four ways:

  • The psychological and mental harm caused by stress can adversely affect the delivery of patient care
  • Cause a great deal of distress to the employee concerned
  • Affect an employee’s health
  • Impact on attendance at work and recruitment and retention of staff.

One of the problems with finding means of reducing stress for empathetic health care professionals such as nurses and counsellors is:

  • Their professional training makes them good at spending a great deal of mental, emotional and physical energy on caring for others.
  • Ironically, that does not always translate into them taking the time to think about caring for their own emotional wellbeing.

Reactions to stress fall into four categories:

  1. Physical reactions

These can include the following:

  • Pounding heart
  • Elevated blood pressure
  • Sweaty palms
  • Tightness of chest
  • Aching neck, jaw and back muscles
  • Headache
  • Abdominal cramps & nausea
  • Trembling
  • Sleep disturbance
  • Tiredness
  • Susceptibility to minor illness
  1. Cognitive reactions

People who are stressed may experience:

  • Forgetfulness
  • Inability to relax
  • Lack of attention to detail
  • Self-esteem and confidence plummeting
  • Disorganised thoughts
  • Difficulty in decision-making
  • Loss of perspective
  1. Behavioural reactions

Stress can also cause changes in behavioural patterns such as:

  • Social withdrawal
  • Increase in alcohol, nicotine or drugs intake
  • Change in eating patterns
  • Becoming clumsy and careless
  • Impatience, aggressive or compulsive behaviours
  • Poor time management
  • Lack of time for leisure activities or me time.
  1. Emotional reactions

It is unsurprising that all this has a negative emotional dimension.

Stress increases feelings of:

  • Irritability and anger
  • Depression
  • Anxiety, possibly leading to panic
  • Mood swings, and emotional breakouts, such as crying easily.

Identifying with several or most of these stress responses suggests there is a need for stress alleviation!

So, as an employer, what can be done?

In most countries, employers have a legal duty to assess and manage the risks to your health at work. These include risks to psychological wellbeing as well as physical health. With this in mind it may be useful to consider carrying out a stress risk assessment.

Helpfully, the UK’s Health and Safety Executive (HSE) have established an internationally recognised tool to support employers in carrying out stress risk assessments. These are known as the Management Standards4.

Management standards

The standards cover 6 key areas of work design that are associated with poor health, lower productivity and increased accident and sickness absence rates.

The 6 domains are:

  • Demands – this includes issues such as workload, work patterns and the work environment
  • Control – how much say the person has in the way they do their work
  • Support – this includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues
  • Relationships – this includes promoting positive working to avoid conflict and dealing with unacceptable behaviour
  • Role – whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles
  • Change – how organisational change is managed and communicated in the organisation.

The implementation process for the 6 domains is supported by a downloadable workbook, which provides tips, advice and guidance from people who have gone through the process. It also includes a selection of checklists to allow employers to be sure that each step has been achieved before moving on to the next one.

Employers can address stress in the clinic

Even without undertaking stress risk assessments to remove unnecessary causes of stress, there are several generic actions an employer can undertake to address workplace stress. Here is a pick list of items that may be considered:

  1. Implement a stress policy, which includes guidance on how to manage stress in the

workplace and the process for assessing the causes of workplace stress.

  1. Provide staff support such as counselling, mentoring, coaching, training or supervision.
  2. Offer staff opportunities to improve their own health, such as healthy eating options in canteens and at-work exercise initiatives, gym memberships are usually very popular with staff!
  3. Ensure staff are able to take at work breaks and are not regularly working beyond their scheduled hours.
  4. Improve current consultation and communication mechanisms, particularly around organisational change or changes to shift patterns.

We can’t prevent empathy-rich professionals such as nurses and counsellors from resonating with patients. Since it is part of their essential skill sets in the ART setting, we probably don’t want to. But we can make sure that other areas of work-related stress are reduced to a level that is manageable. Allowing these health care professionals to continue to be as effective as possible, while still feeling good about their roles.

Neil Madden, Editor

The Fertility Hub

References 

  1. S De Lacey. 1999. The nurse’s role in assisted reproduction: visions for the future. Fertility Nurses of Australia Newsletter. August 1999.
  2. H Birch. 2001. The extended role of the nurse: opportunity or threat. 14th International Conference for Nurses and Support Personnel in Reproductive Medicine. Pheonix, Arizona. 2001. Reported in Human Fertility. Volume 4, Issue 3. 2001.
  3. Domar AD, Zuttermeister PC, Friedman R. 1993. The psychological impact of infertility: a comparison with patients with other medical conditions.J Psychosom Obstet Gynaecol.1993; 14(suppl): 45–52.
  4. Health and Safety Executive. 2008. Working together to reduce stress at work – a guide for employees.  https://www.hse.gov.uk/stress/standards/