Stress in vet professionals: How to regain your cool

This is article thirty-one in an RCVS Knowledge series of features on patient safety, clinical human factors, and the principles and associated themes of Quality Improvement (QI).

Martin shifted in his chair as Jen walked into the office. They briefly made eye contact and smiled.

"H, hello there."

"Hi," said Jen.

"I, err, I just wanted to apologise for the other morning … my behaviour in theatre."

"Oh, no need, honestly Martin. It was a…"

"No, it wasn’t good. E, everything was getting on top of me … I don’t know how to deal with it."

Jen was taken aback by his candour, "Oh, I see. I … I was a bit worried about you to be honest. You seemed quite stressed, and you were a bit short with Selina … that business with the checklist."

Martin nodded, so Jen added, "I was a little bit surprised that you left without checking on Lucy afterward too – you’re normally so caring."

"Yeah, that was wrong of me. I was rude to you as well Jennifer, I’m so sorry. I had a chance to reflect on everything on the way back from the airport - there are a few things that have been getting me down recently." Martin looked off into the distance.

"It can be a really hard job. So many things to think about, people to consider, but you’re doing your best – try to go easy on yourself."

"Thank you." He smiled briefly, "I suppose I just want to get it right every time, and when I don’t, well, I just can’t forgive myself. B, but I wondered how you felt about having a chat, the three of us – we could talk about the op? Clear the air, so to speak."

"That sounds a great idea, I’d really like that Martin."

Stress

Workplace stress has obvious implications for the health and wellbeing of staff members, as we explored in the previous blog - it can cause headaches and fatigue for example. But Stress has other effects on members of the veterinary team, many of which have implications for the quality of care that we provide as health care professionals¹. As Jen pointed out in the scenario above, Martin’s stress had contributed to his incivility, and incivility – or poor interpersonal behaviour – can have a dramatic influence on patient safety²: in one study that looked at the performance of anaesthetists in theatre during a crisis, rudeness by the operating surgeon had a marked effect on their ability to manage the situation³. In another study, incivility reduced the ability of intensive care teams to diagnose and perform medical procedures safely².

Stress can also lead to a behaviour called withdrawal⁴, where we become less inclined to chat to our colleagues, and more inclined to keep conversations with members of the public brief and to the point. This increases the likelihood of miscommunication, and all the mistakes that flow from that.

Finally, stress is believed to affect our short term working memory, reducing the number of pieces of information that we can retain in our heads at any one time - this can also have a significant effect on performance at work⁵. For example, it can mean the difference between remembering to turn the oxygen supply back on after repositioning an anaesthetised patient, or not.

Solutions

Clearly, as the consequences of stress risk spiralling out of control, finding effective solutions to prevent it in practice is paramount. Addressing the specific challenges faced by the veterinary team is vital for their well-being and, as we have seen, for the quality of patient care. Fortunately, there are many innovative strategies and practical approaches that can help prevent the build-up of stress in practice, here are some which you might consider:

Team Training

Team training - providing opportunities for teams to train together in practical clinical topics. Good examples of clinical topics which involve the whole team include CPR training and dental training. By fostering effective communication, enhancing collaboration, and promoting a shared understanding of responsibilities, such training not only improves patient care but also reduces the burden on individuals. This collective approach to healthcare instils a sense of support, ultimately alleviating stress and improving overall well-being.

RECOVER CPR training Veterinary Professionals – RECOVER Initiative enhances patient safety in an emergency and provides exceptional practical collaborative training⁶.

Situational Awareness

Situational awareness training is also invaluable in healthcare, as it equips teams with the skills to anticipate and adapt to rapidly changing situations. This enhanced awareness not only improves patient safety but also reduces the stress experienced by healthcare professionals. Confidence in one's ability to handle critical scenarios promotes a sense of control, ultimately fostering a less stressful work environment.

Find out more with our QI Feature Situational awareness: A vital skill to ensure patient safety^7.

Compassion

Developing compassion for both patients and oneself is a powerful tool in reducing stress and burnout among healthcare workers. Evidence demonstrates that when healthcare professionals practice compassionately, they not only enhance patient outcomes but also buffer against the emotional toll of their demanding roles, fostering a more resilient and less stressful healthcare environment.

Watch Dr Stephen Trzeciak, MD, MPH talk about How 40 Seconds of Compassion Could Save a Life^8.

Burden of Perfectionism

Embracing the concept that "good enough is good enough" can alleviate stress among healthcare workers. Understanding that they're often navigating imperfect situations with diligence and professionalism allows them to find solace in their efforts, reducing the burden of perfectionism and fostering a more balanced, less stressful approach to their demanding roles.

Read more with Good Enough is Good Enough: Let Go of Perfectionism to Get Things Done^9.

Sense-making

The ability to make sense of complex healthcare situations is invaluable for reducing stress in healthcare workers. Sense-making allows professionals to navigate uncertainty and cope with challenging scenarios more effectively. When healthcare workers can construct a coherent narrative from chaotic situations, it empowers them to make informed decisions, ultimately diminishing stress levels and enhancing overall well-being.

Read more with Sensemaking: A New & Necessary Competency for Managers^10.

Schwartz Rounds

Schwartz Rounds, a structured forum for healthcare workers to discuss the emotional and social challenges of their work, hold immense value in reducing stress. These sessions provide a safe space for professionals to share experiences and feelings, fostering empathy and solidarity among teams. By acknowledging and addressing the emotional toll of healthcare, Schwartz Rounds help mitigate stress and enhance overall well-being in the workplace.

Delve deeper by watching What are Schwartz Rounds? from The Point of Care Foundation and access our free QI Boxset: Schwartz Rounds in practice^11,12.

Vulnerability

Embracing vulnerability in healthcare is essential for reducing stress among healthcare workers. When professionals allow themselves to be open about their challenges and limitations, it promotes a culture of support and empathy. However, the risk lies in tightly associating our professional identity with our personal worth, which can intensify stress when faced with difficult situations or setbacks. Balancing vulnerability and professional identity are crucial for overall well-being in healthcare.

Listen to Brené Brown, research Professor at the University of Houston, discuss The power of vulnerability^13.

Community

Fostering a genuine sense of community in the workplace is invaluable for reducing stress among healthcare workers. When individuals feel they are part of something bigger—a cohesive team with shared goals and values—it provides emotional support, reduces isolation, and enhances resilience. This strong sense of belonging promotes overall well-being and helps healthcare professionals navigate the challenging demands of their roles with greater ease.

Find out more about Rekindling a Sense of Community at Work^14.

Back to the team

Martin did find time in his diary to sit down with Jen and Selina a week later. He was honest with them about the struggles he’d had recently balancing a busy home with a demanding role.

"I realise that the stress I’ve been feeling lately doesn’t define me, and that has been a source of great comfort. But I also recognise the impact that my outburst had on you guys and for that I’m really sorry."

Over a long cup of tea they discussed the stress that they all felt from time to time at work. Having shared their worries they found that the conversation naturally moved to possible solutions – small improvements they could make to help things run more smoothly day to day. At the end of the meeting Martin felt relieved that he’d found the courage to be a little vulnerable. Feeling stressed he was realising, was a warning sign, and a nudge to be kind to himself, but also to look for ways to improve the way the clinic ran.

In the demanding world of veterinary care, the importance of addressing stress cannot be overstated. By implementing strategies such as the ones discussed we can mitigate the impact of stress on teams. Recognising our vulnerabilities and embracing a holistic approach to well-being is crucial in ensuring a healthier, more sustainable future for the veterinary profession.

Checklist - What you can do next

• Evidence suggests that incivility can increase errors and have a knock-on domino effect that impacts the whole team. Listen to Laura Playforth and Pam Mosedale as they discuss incivility and it's impact on patient care and outcomes. Delve deeper by accessing Civility Saves Lives, a website run by health care professionals aiming to raise awareness of the power of civility in medicine.
• Read our QI Feature 'Team culture in veterinary practice: Why it's essential for success' to understand the relationship between organisational culture and improving aspects of work, be it clinical standards, practice profit or team wellbeing.
• Learn about the tools available to help create a learning culture in practice where the whole team feels empowered to speak up in a safe environment with our free to access QI Boxset Series 6 'Learning from everything - Significant Event Audits and root cause analysis'.  The QI Boxset is available in bite sized episodes to help you learn about Quality Improvement in a way that suits you best.
• Read our previous QI Feature 'What do patient safety and buckets have in common? An introduction to non-technical skills' to learn how developing non-technical skills allow teams to work to their strengths.
• The Institute of Healthcare Improvement (IHI) have developed the Joy in Work framework to help make improvements in how we feel and work. Listen to the experiences of Angie Rayner and Mark Moreton in using this framework in 'What matters to you? An antidote to burnout' to gain a comprehensive understanding of what lies beneath our combined commitment to the best possible care.
• Visit the Vetlife website, an independent charity that provides free support to anyone in the UK veterinary professionals community who has emotional, health or financial problems.

References

1. Michie, S. (2002) Causes and management of stress at work. Occupational and Environmental Medicine, 59 (1), pp. 67-72. http://dx.doi.org/10.1136/oem.59.1.67
2. Riskin, A. et al. (2015) The impact of rudeness on medical team performance: A randomized trial. Pediatrics, 136 (3), pp, 487–495. https://doi.org/10.1542/peds.2015-1385
3. Katz, D. et al. (2019) Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Quality & Safety, 28 (9), pp. 750–757. http://dx.doi.org/10.1136/bmjqs-2019-009598
4. Welp, A., Meier, L.L. and Manser, T. (2014) Emotional exhaustion and workload predict clinician-rated and objective patient safety. Frontiers in Psychology, 5. https://doi.org/10.3389/fpsyg.2014.01573
5. Sliwinski, M.J. et al. (2006) Intraindividual coupling of daily stress and cognition. Psychology and Aging, 21 (3), pp. 545–557. https://doi.org/10.1037/0882-7974.21.3.545
6. Why certify? [RECOVER][Online]. Available from:https://recoverinitiative.org/veterinary-professionals/
7. Silver-MacMahon, H. (2022) Situational awareness: A vital skill to ensure patient safety [RCVS Knowledge] [Online]. Available from: https://knowledge.rcvs.org.uk/about-us/news-and-events/features/situational-awareness/
8. Trzeciak, S. (2018) How 40 seconds of compassion could save a life. YouTube [Online Video]. Available from: https://www.youtube.com/watch?v=elW69hyPUuI&t=5s
9. Good enough is good enough: Let go of perfectionism to get things done [Effectiviology] [Online]. Available from: https://effectiviology.com/good-enough-is-good-enough-letting-go-of-perfectionism-to-get-things-done/
10. Calvert, D. (2023) Sensemaking: A new & necessary competency for managers [People First Productivity Solutions] [Online]. Available from: https://blog.peoplefirstps.com/connect2lead/sensemaking-a-new-necessary-competency-for-managers#:~:text=The%20solution%20is%20sensemaking%2C%20a,info%20glut%2C%20and%20data%20smog

11. The Point of Care Foundation (2013) What are Schwartz Rounds? YouTube [Online Video]. Available from: https://www.youtube.com/watch?v=Ug7TQ6gyKiY

12. Mosedale, P. and Martin, A. (2023) QI Boxset: Schwartz Rounds in practice [RCVS Knowledge] [Online Video]. Available from: https://learn.rcvsknowledge.org/mod/page/view.php?id=3013

13. Brown, B. (2011) The power of vulnerability. YouTube [Online Video]. Available from: https://www.youtube.com/watch?v=iCvmsMzlF7o
14. Porath, C. and Sublett, C.P. (2022) Rekindling a sense of community at work [Harvard Business Review] [Online]. Available from: https://hbr.org/2022/08/rekindling-a-sense-of-community-at-work
15. Compassionate and inclusive leadership [The King’s Fund] [Online]. Available from: https://www.kingsfund.org.uk/topics/organisational-culture/compassionate-inclusive [Accessed 3 November 2023]

About the authors

Mark Turner BVSc MRes MRCVS

Mark graduated from the University of Liverpool in 1996 and in 2017 completed a Masters degree at the RVC investigating patient safety culture in the UK veterinary professions.

The research project investigated contemporary knowledge of patient safety behaviours in practice including significant event reporting and auditing.

He has an interest in the application of patient safety as a tool for improving staff engagement and success. He has written for Vet Times, Companion magazine and appeared as a guest blogger for the BVA/RCVS Vet Futures project.

Laura Playforth BVM&S MRCVS

Laura qualified from the University of Edinburgh in 1999. After working in a variety of small animal practices in Yorkshire for eight years, she moved into Emergency and Critical Care, holding a variety of roles at Vets Now, the most recent being Professional Standards Director. In 2022 she began a new role as IVC Evidensia's Group Quality Improvement Director.

Today, Laura is responsible for driving a culture of continually improving care delivery for the benefit of patients, owners and the veterinary teams across 19 countries. She has extensive experience in supporting teams in developing and utilising clinical benchmarking, checklists, guidelines, significant event reporting and communities of practice in order to deliver high quality tailored care across the company's network.

Laura has an MSc in advancing healthcare practice with the Open University, which aims to develop skills in evidence-based practice, policy development and innovation to facilitate sustainable improvements in care quality. She has a particular interest in improvement culture and how this increases team wellbeing and role satisfaction as well as exceptional care. She hopes to bring a fresh and open mind to the QIAB, drawing on more than 15 years of experience of clinical leadership and large scale quality-centric strategy.

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