Cumulative stress is a common experience for people who work in chronically stressful situations. It results from an accumulation of various stress factors such as heavy workload, poor communications, multiple frustrations, coping with situations in which you feel powerless, and the inability to rest or relax. Cumulative stress progresses through three phases:

Early warning symptoms


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Emotional fatigue

Vague anxiety

Mild symptoms

Frequent headaches, colds, and stomach problems

Intensified physical and emotional fatigue

Intensifying depression


More frequent loss of emotional control

Muscle aches

Sleep disturbances

Withdrawal from contact with others

Ingrained symptoms

Elevated blood pressure and cardiac problems

General physical and emotional fatigue

Increased alcohol use

Increased smoking

Intense depression

Intense irritability

Loss of sexual desire

Migraine headaches

Poor appetite

Relationship problems

Skin rashes


Use of nonprescription drugs

(Source: Mitchell J, Bray G. Emergency Services Stress: Guidelines on Preserving the Health and Careers of Emergency Services Personnel. Upper Saddle River, NJ: Prentice Hall; 1990.)

Stress relief/burnout prevention

· Be gentle with yourself

· Remind yourself that you are a catalyst, not a magician. We cannot change anyone else; we can only change how we relate to them.

· Find a hermit spot. Use it daily.

· Give support, encouragement, and praise to peers. Learn to accept it graciously in return.

· Remember that in light of all the pain we see, we are bound to feel helpless at times. Admit this without shame. Caring and being there are sometimes more important than doing.

· Change your routine often, and change your tasks when you can.

· Learn to recognize the difference between complaining that relieves and complaining that reinforces negative stress.

· On the way home, focus on a good thing that happened during the day.

· Be a resource to yourself. Get creative, try new approaches. Be an artist as well as a technician.

· Use supervision or the buddy system regularly as a source of support, assurance, and redirection.

· Avoid shop-talk during breaks and when socializing with colleagues.

· Say “I choose” rather than “I should,” “I ought to,” or “I have to.” Say “I won’t” rather than “I can’t.”

· Aloofness and indifference are far more harmful than admitting an inability to do more.

                  —Gail Noller, MA, LP

Kerstin McSteen is a palliative care clinical nurse specialist at Abbott Northwestern Hospital, Minneapolis, Minnesota, and department editor of The Total Nurse section on