Delivering great hospice care, whether in the field or in the office, is stressful. 

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Okay, maybe not breathing into a paper bag stressful, but you get my point. Besides the obvious work-related stress, we also have the responsibilities outside of work that can often create even more stress in our lives.  As a result, hospice employees, like most other Americans, are constantly subject to stress.  Academic and professional studies confirm what we already know - stress breeds more stress, and stress negatively impacts our quality of life and professional excellence.  Stressful situations are simply part of life, and while we can't avoid them, it’s our ability to manage them that then leads to the liberating state of a more joyful life.

Does this liberating state of a more joyful life sound good? Here's how you can get it. 



1.    Clarify Your Expectations

Make a list of exactly what you are responsible for professionally and personally.

Gain clarity of your job requirements.  Stress often arrives when we are responsible for things we can’t control.  As hospice providers, we influence, but not often directly control our patients’ health, care-giver interaction, or work environment; however, we can control the way we interact with each.

Make a list of exactly what you are responsible for professionally and personally.  If you are uncertain professionally, gain clarity from your supervisor.  If you are unsure of your personal responsibilities simply seek wise council and then decide for yourself.  Knowing what you are responsible for is liberating, and is the first step of managing stress effectively.

2.    Create a Second List

Make a list of what is giving you stress with each of these responsibilities.

Once you have a list of your professional and personal responsibilities and requirements, beside each item make a list of what is giving you stress with each of these responsibilities.  Go ahead and also list family members, situations, etc. Being honest about sources of stress is the first step in reducing it.  In doing so, you may find a lot of stress comes from vague expectations and your concern about other peoples’ opinions of how you are doing as a co-worker, spouse, volunteer, friend, or neighbor. 

Next, divide this list into actionable items with tangible responsibilities (i.e. meeting work deadlines, pending decisions that need to be made, etc.) and another list containing concerns you have about other people’s opinions of you.  After all, a lot of your stress is due to wanting people’s approval, which is an insatiable expectation.  Having two distinct lists will allow you the freedom to focus on actionable items first and foremost.

3.    Keep It Simple, Stupid (KISS)

Using the list of actionable items, get up a tad bit earlier each morning and create a very succinct list of very specific things you will accomplish for each of these responsibilities.  For example, four things in the morning, four in the afternoon, and four in the evening.  Period.  Plus, add space for unexpected responsibilities (i.e. your boss needing a report immediately).  As you dig yourself out of the “stress pit” by having a unique daily plan that focuses on accomplishing tangible responsibilities, you will then find yourself accomplishing more subjective responsibilities related to reducing stress related to others’ personal and professional opinions of you.  Yes, you will find yourself finally writing your mom a note, deciding how you will approach your teenager about his excessive use of the gas pedal, etc. Addressing  big and little things that have been stressful helps gain momentum.

In addition, having your own daily “to do” list created by you also allows you to say “No” to interruptions.  It allows the freedom to redirect a lot of interruption to those best positioned to address the issue.  Keep this in mind:  You have a strong back, but you don’t have to carry the burdens of others and the world on it.  Focus each day on your tailored “To Do” list, and redirect people to those who are responsible for things you aren’t responsible for.

4.    Your Refuge

Mentally preparing for your next home visit or other job responsibility is critical to focused effectiveness.

Make your automobile, office desk, and/or home your refuge.  Avoid distractions.  Remember that distractions have a tendency to creep-in.  While in your car, resist the temptation to listen to whatever the radio stations are deciding you should listen to at the moment, decide in advance what you want to listen to and don’t switch from station to station, wait until later to review social media, etc.  Mentally preparing for your next home visit or other job responsibility is critical to focused effectiveness.  If in an office, avoid time-suckers such as co-worker drama, distractions from non-pressing emails, etc. Use earbuds with soothing music or white noise playlists. Even having earbuds in with nothing playing will be a sign to co-workers that you are possibly on the phone or should not be bothered. When at home, there’s always dirty laundry and dishes to be washed so we just have to live with that reality.  Try and get it done and enlist others to help.  Sometimes that’s simply not possible, but it’s a fun thought.  The key is to create places of refuge within your daily environment.  The world will continue rotating on its axis, but it doesn’t need you to spin it.

5.    Create Rest and Create Fun

A great thing to do just before you go to sleep is to write in a journal.

Whether it’s taking an outside walk during a break, driving, or wherever and whenever, stretching your muscles and taking deep breaths.  Find something lovely to admire and think about.  Such mental breaks are vital to reducing stress.  Plan for sleep.  Go to bed at a set time and don’t allow the TV or social media to creep in once you are in the bed.  Instead, read something uplifting and funny before going to sleep.  A great thing to do just before you go to sleep is to write in a journal.  It’s not a diary of your day, but a paragraph or two that is topical, such as advice I’d give my 10-year old self, describing a life event, a description about what made a favorite uncle so grand, etc.  The key is for it to be reflective and fun.  Doodle.  Do not use the journal to vent frustrations.  Sometimes use it to describe a life event in the past.  You will find your narrative of such events puts things in a positive light that at the time were stressful.  All of this helps with perspective and realizing a larger context to your life.  Allow for fun. 

As Kurt Vonnegut wrote, “Sing in the shower. Dance to the radio. Tell stories. Write a poem to a friend, even a lousy poem. Do it as well as you possibly can. You will get an enormous reward.  You will have created something.”

6.    Avoid Suckers and Don’t be a Sucker to Others

Negativity breeds negativity.

We all know them, the folks who are negative, petty, critical, and sometimes just plain mean.  Sometimes we are forced to be with them (co-workers, family, neighbors, etc.), sometimes we choose to be with them (friends), and sometimes we choose to have them with us (characters on some TV shows). 

Remove yourself from such people and situations that suck energy and add stress to you, as much as possible.  Their negative way of thinking becomes your way of thinking.  In contrast, think on uplifting things, and listen to podcasts of encouraging people.  This takes effort, but don’t allow negative people to wedge themselves into your life.  Consider such people as “loan sharks” of energy - often providing interesting gossip, and sarcasm. That is fun in the short-run, but quickly can become your world view as their negativity becomes part of your approach to things, as well.  In sum, negativity breeds negativity.  Misery doesn’t love company, it loves miserable company, and miserable people want you to wallow in misery with them.  Being miserable is incredibly stressful and draining.  Refuse to be part of that. Run!

7.    Do Unto Others…

Say “Yes” to delightful contributions of your time and talent, but “No” to on-going responsibilities.

Volunteer and bless.  Yes, your work has elements of volunteerism and ministry, but find something you love doing as a way to serve others outside of work.  Stress diminishes as we take our eyes off ourselves and onto helping others.  The key here is to do things you love doing but not making a job out of it.  For example, if you love gardening, simply show-up somewhere with your tools on a Saturday and garden, but do not let it become an ongoing responsibility.  Say “Yes” to delightful contributions of your time and talent, but “No” to on-going responsibilities.  Only commit to ongoing responsibilities once you are confident such activities are significant, you want to do them, and have a clear exit plan if it adds stress down the road.  You already have a full-time job and important family-related responsibilities – don’t create another “job” as you volunteer.  Simply decide today the number of non work-related responsibilities you will perform and stick to that number.  A good rule of thumb is you will volunteer and/or be a member of no more than two entities at a time.  Saying “no” to all others or replacing one is absolutely liberating.



The Takeaway - Your patients need you at your best!

Stress diminishes our legacy.  Gaining the ability to manage stress is just the beginning.

Stress is a reality of life, and our role models in our professional and personal lives often carried stress as a badge of honor.  While stress is simply part of our culture and we usually don’t have great role models for how to best manage it, we do not have to let it control us.  When left unmanaged, stress not only diminishes our effectiveness, but also reduces our quality of life and kills initiative.  The reason is simple.  The prefrontal cortex is where we sort the relative importance of things.  When we are stressed, studies show our ability to put responsibilities in a hierarchy is diminished, so every responsibility begins having equal importance.  Stress builds to the point of being overwhelming.  This doesn’t have to apply to you!

You are reading this article so you are obviously a responsible adult having multitudes of responsibilities.  You are investing yourself in your professional career in the hospice industry and also investing yourself in your personal life.  You are an adult, with adult responsibilities but faced with infinite responsibilities and expectations.  If you allow stress to control you, it becomes part of who you are, which becomes debilitating to the point of ineffectiveness in all you are hoping to maximize.  Stress diminishes our legacy.  Gaining the ability to manage stress is just the beginning.  As you dig out of the pit of stress and begin gaining control over it (i.e. managing the process), you will be able to focus on proactive self-leadership. 

Your patients need you at your best!  Those you love need you at your best.  You, need you at your best.  Let’s get started in reducing stress, today! 


Dr. J. Hall C. Thorp

Kurt Vonnegut* from A Man Without a Country, (2005)