How to switch off at the end of your shift

Advice and techniques to help you avoid taking work worries and concerns home with you

Advice and techniques to help you avoid taking work worries and concerns home with you

  • Compassionate self-care is even more important – and more challenging – for nurses amid the pressures of the COVID-19 pandemic
  • Tips for using a going home checklist and introducing good end-of-shift habits
  • How to use reflective practice as part of your daily routine to improve well-being and avoid burnout
Picture: iStock

At the end of a shift, some nurses find it difficult to leave worries or concerns about the day behind.

Constantly worrying about or going over what happened that day, or how a patient is faring, is unlikely to make for restful downtime before the next shift.

How to leave work concerns at the door

But caring for and coming into contact with people at their most vulnerable can be emotionally tough, so it is not surprising that nurses sometimes struggle to take their mind off difficult and stressful elements of their day.

A mental health and child nursing student finding this a challenge recently took to Twitter to ask what techniques others use when they leave work.

‘I am placed on an acute mental health ward and adore my job, but that makes it ten times harder to leave it at the door and have some time off,’ she wrote. ‘Any tips on how to switch off when leaving work and avoid burnout?’

Other nurses agreed it can be difficult to leave the job behind as they head home, and offered advice based on what works for them.

‘If you truly care, the job will always come home with you sometimes,’ one said. ‘Up to us to make sense of it and learn from it. Think of empathy as getting in the water with people and not drowning.’

Exercise, meditation, reflection – activities that can help

Some said exercise and meditation helped sooth their mind, and several said a form of reflective practice was helpful.

Clinical supervision was also discussed as an essential way to help nurses protect themselves and their well-being.

Nurses said reminding themselves that there are other members of staff on shift when they leave is also important.

‘It can be helpful to develop end-of-day habits, such as tidying your workspace or making a list of what needs to be done tomorrow’

Faye McGuinness, head of workplace well-being programmes, Mind

One nurse said writing a journal to reflect on her day really helps. ‘I always reflect on the shift, journal what went well and what I can improve, and set three goals for the day after to take your head space away from it. And three things I’m grateful for.’

Exercise can help clear your mind Picture: iStock

This reflective element is highlighted in the Going Home List, originally drawn up by mental health charity Mind and subsequently adapted by many NHS employers for their staff (see box).

It has also been published on Our NHS People, a website focused on health and well-being support for NHS staff, including access to counselling.

The list is a simple, eight-step process for mentally dealing with the issues bought up by shift, and then leaving work behind, which starts with reflecting on your day.

Going home checklist

  • Take a moment to think about today
  • Think about one thing that was difficult. Let it go
  • Consider three things that went well
  • Are you ok? If not, have you told someone? Your colleagues, senior team and occupational health are there to support you
  • Check in on your colleagues before you leave – are they ok?
  • Acknowledge your colleagues’ contribution – have you said ‘thank you’?
  • Now switch your attention to home
  • How are you going to rest and recharge?

Source: NHS Our People

Mental well-being amid the COVID-19 pandemic

Faye McGuinness, head of workplace well-being programmes at Mind, said the end of a shift is a crucial time, especially as nurses continue to deal with the pressures of the COVID-19 pandemic.

‘Looking after your mental well-being is so important at this time,’ she says. ‘Switching off at the end of the day and making the most of your time outside of work is one way to do this. It can be helpful to develop end-of-day habits, such as tidying your workspace or making a list of what needs to be done tomorrow.’

Geoffrey Walker, matron for specialist medicine and ambulatory care at Poole Hospital NHS Foundation Trust, also takes a methodical approach, using a short checklist he has developed over the years for the end of a shift.

‘It is so important to learn to switch off, not only for your physical well-being but your mental health too,’ he says.

‘I do a final check on patients and how they are, a final handover to the nurse taking over from me, and check my notes are completed. Then before I leave I check in with the nurse taking over, ask if they have any questions or concerns and, if so, deal with them there and then.

‘Once you are both satisfied, then say goodbye and leave. This final act should reassure you that there are no issues before you leave and therefore you are able to switch off in the knowledge that you completed your care spell.’

Make your handover clear and check in with the nurse taking over before you leave Picture: iStock

While the checklist is relatively simple, Mr Walker has found it gives him peace of mind when he leaves work.

‘This does not take a lot of time, but by being methodical and focused you will feel satisfied and reassured that you have done everything before you leave. We all have anxieties, especially at the beginning of our careers.’

Build reflective practice into every working day

University of Leeds nursing lecturer Philip Esterhuizen suggests that building reflective practice into the end of every shift can help nurses reduce the risk of emotional burnout.

Avoiding emotional burnout is a major issue for nurses. Levels of burnout in UK nurses are high and burnout is linked to nurses wanting to leave the profession, research suggests.

‘When going home is about clearing the computer off the kitchen table, it is even more difficult to switch off’

Clare Cable, Queen’s Nursing institute Scotland chief executive and nurse director

In a 2013 European nursing survey of 23,000 nurses, 42% of UK nurses who responded reported burnout. The UK figure was the highest for all ten countries surveyed, with the European average at 28%.

Dr Esterhuizen says using reflective practice daily doesn’t have to be time-consuming. ‘It can just mean developing the habit of taking a few minutes when you are reliving part of your shift on the way home, walking to your car or catching the bus, and using a simple approach, such as the Gibbs model to provide structure.’

How to structure reflective practice

The Gibbs reflective cycle is one of the best known and simplest ways to structure reflective practice.

It provides six simple steps to work through, starting with describing the situation to yourself, followed by thinking about the emotions and feelings the situation prompted, and then what went well and not so well.

Dr Esterhuizen says: ‘It allows you to make sense of the experience, before considering what you learned and you could have done differently. The final step is to consider an ‘action plan’ of how you would approach a similar situation differently in the future. This model is easy to memorise and can offer a framework to think things through.’

He says it is particularly important amid the pressures brought by COVID-19 that nurses use a structure that offers a degree of objectification. ‘Otherwise, there is a chance that reflections could become self-defeating and destructive, especially when things have not gone as well as planned.’

The Gibbs model: a reflective cycle

The Gibbs model, developed by Graham Gibbs in 1988

Nurses can use the Gibbs model when reflecting informally and formally.

It can help you consider what you did well, even during difficult experiences, and what you would wish to do differently in the future.

The model has six stages:

Describe the experience Think about the feelings and thoughts prompted by the experience

Evaluate the experience, both good and bad

Analyse to make sense of the situation

Conclude What you learned and what you could have done differently

Consider an action plan for how you would deal with similar situations in the future, or general changes you might find appropriate

Source: University of Edinburgh: Guide to the Gibbs reflective cycle

Resources for well-being

Queen’s Nursing Institute Scotland (QNIS) chief executive and nurse director Clare Cable says nurses have described to her many different ways of turning off from work and recharging, from sea swimming to meditation, mindfulness and dog walking.

However, she adds, many nurses who are now working from home are finding it more difficult than ever to leave work behind at the end of the day.

‘When going home is about clearing the computer off the kitchen table, it is even more difficult to switch off,’ Professor Cable says.

Recognising the challenges that many nurses are facing in terms of their physical and mental health, the QNIS has published a series of tools, videos and links to well-being practices on its website.

Compassionate self-care: be kind to yourself

‘For me, the focus is about taking a few moments to reconnect with yourself at the end of the working day, and bring a lens of compassion to yourself,’ Professor Cable says.

‘As nurses, what tends to happen when we reflect back on a day is we think about the things we feel uncomfortable about, maybe the things we weren’t able to do as well as we had hoped or situations we could have handled better.’

But nurses need to treat themselves more kindly, and look after their well-being to protect themselves from burnout and chronic fatigue, Professor Cable says.

‘We should tune into a kinder internal voice, listen to the kind of narrative that our best friend would say to us about the day,’ she says.

‘Acknowledge it has been a hard day, but bring that compassionate voice and be kind to ourselves.’