While it’s completely normal to feel stressed, chronic or excessive stress can be a significant problem. It's important to recognise these signs or feelings and how to overcome them. It's helpful to learn how to manage stress caused by work. If you often experience feelings of stress, you might be at risk of developing a mental health problem like depression or anxiety.

What is stress?

Have you ever found yourself in a situation where your to-do list seems endless, deadlines are fast approaching and you find yourself saying ‘Eek! I feel stressed!’? But what is stress really, and how does it affect us?

Stress is primarily a physical response. When stressed, the body thinks it is under attack and switches to ‘fight or flight’ mode, releasing a complex mix of hormones and chemicals such as adrenaline, cortisol and norepinephrine to prepare the body for physical action.

Stress affects different people in different ways. Below is a list of some of the common signs. Some of these things will not apply to you. You may have other signs of stress that we have not listed.Stress-signs.PNG

Almost anything that affects your daily life, work or relationships can cause stress. Even seemingly small issues can cause stress if they go on for a long time. Some people are more affected by stress than others. It can depend on factors such as your personality, upbringing, your work and home life.

Situations or events that seem positive can cause stress, such as having a baby or getting married. If you feel stressed in these situations you may struggle to understand why. You may not feel that you can talk to anyone about your feelings or struggle with guilt. But feeling stressed in these situations is very common.

Below are some examples of things than can cause stress.


There isn’t a set process for where you should start, or what you should do, everyone is different. You may need to try different things until you find what works for you.you may wish to try some of the suggestions below:

  • Create a stress diary: You could write down when you feel stressed, include what happens just before or after you feel stressed. It could also help you to identify things which can make you unwell. These things are known as ‘triggers.’ Identifying your triggers can help you to have more control over your stress levels.
  • Plan your time: If you plan your time this can make you feel more in control of things. Some examples are write lists of what you need to do, prioritise the most important tasks, share tasks with others if you can, don't put things off, and set yourself steps and goals for complicated tasks.
  • Try practicing mindfulness: This practice is about focusing on the here and now. It might help you to find calmness and clarity to respond to stressful situations. See our pages on mindfulness and join a free class today to learn more.
Make lifestyle changes
  • Look after your physical health: Exercise and eating well can relieve stress. There are lots of ways to exercise, you could try cycling, walking, running or going to the gym. Eating a healthy balanced diet is good for your mental and physical health.Our page on nutrition and physical exercise have more details.
  • Get enough sleep: If you’re dealing with stress you may struggle to sleep well. If you don’t get enough sleep this can cause problems such as poor concentration and low mood. Long term sleep issues can lead to mental health problems such as anxiety and depression. Visit our managing sleep page for some tips.
  • Manage your money: Money can cause many different issues such as poverty, debt and relationship problems. Making a budget sheet could help. This will help you work out what you can afford to pay. Visit our financial wellbeing page.
  • Get practical advice: You may be able to take steps to change the cause of your stress. There are lots of places you can get practical advice on different issues. An advice service may be a good place to start. They may be able to support you to solve an issue. 

Use the list below to see how many signs you notice in yourself
  • Energy - You feel like you have less energy than before. No matter what you do, you don't find things get better.
  • Sleep - Struggling to fall asleep, or stay asleep. Feeling like you never feel refreshed when you wake up.
  • Eating - Your appetite has diminished, you are losing weight. Or you are eating to feel better, putting on weight.
  • Dress - You can't be bothered to dress properly and don't care to look at yourself in the mirror.
  • Irritation - You find yourself getting angered easily. You can be snappy and frustrated, more than usual.
  • Down - You feel sad, with a strange hollow feeling. You might be tearful at times without knowing why.
  • Anxious - You are more nervous about doing things than usual. You find yourself avoiding anything slightly stressful.
  • Negative - You find yourself having negative and critical thoughts about yourself. You are also not as hopeful as before.
  • Talking - You don't feel like talking to others, and at times avoid people at work or at home.

If you notice some of these in yourself, please take the time to have a conversation with someone.

Now use the list below to see how many signs you notice in others
  • Energy - They are not managing workload as before. Perhaps sighing frequenetly, appearing to be overwhelmed.
  • Sleep - They look like they have just woken up, yawning frequently. They look exhausted even in the morning.
  • Eating - They have lost or put on weight. This is coupled with another item on the list.
  • Dress - They are looking far more casual than usual. They wear the same clothes several days in a row.
  • Irritation - They appear to be getting frustrated easily, complaining more than usual and argumentative with patients and colleagues.
  • Down - They look sad; are more tearful than usual and avoid discussions.
  • Anxious - Your colleague seems to be avoiding things. They don't take on new challenges and even avoid answering phone calls.
  • Negative - They are derogatory about things, dismissing ideas and changes; they were not like this before.
  • Talking - They don't talk to you as much. They give you short answers. They just don't seem themselves.

If you notice these in a colleague, please take time and ask them how they're doing.

If you feel stressed by a certain problem at work, you might not be alone in this. Anyone can experience some of these common stressful situations in the workplace. The important thing is understanding how to manage them.

  • Ask your manager for help. Discuss your workload with your manager. Try setting realistic targets and talk about how you can solve the issues you're having.
  • Try to balance your time. You might be doing too much at once. If you don't give each task your full attention, it can take longer. Try to claim your time back if you ever need to work extra hours to get something done.
  • Reward yourself for achievements. Rather than only focusing on work that needs to be done next, reward yourself for tasks you’ve completed. Your reward could be taking a break to read, do a puzzle, chat with co-workers or spend time outside.
  • Be realistic. You don't have to be perfect all the time. You might find that you're being more critical of your own work than you need to be. Work within your limitations and try to be kind to yourself.
Resources to help you

Source: www.nhsemployers.org

Moral injury is a term which refers to the psychological experience of when an individual engages in, fails to prevent, or witnesses acts which conflict with their personal values, moral/ethical code or belief system. Often recognised in the military field, there has been widespread attention in recent years to experiences of moral injury amongst health and social care workers, which has been in particular highlighted by systemic issues faced during the Covid-19 pandemic by healthcare staff.

Some examples of situations where moral injury may occur in healthcare settings could include the following:

  • A patient dying despite a staff member desperately doing everything possible to save their life

  • Informing patients who are very mentally or physically unwell of long service waiting times

  • Struggling to arrange adequate care provision for unwell patients due to lack of resources in the healthcare system

A British Medical Assocation (BMA) survey of nearly 2,000 doctors found that nearly half (48.4%) of doctors had not heard of the term “moral injury”, however upon learning of this definition, 51.1% reported that it resonated with their experience of work.

How do I know if I am experiencing moral injury?
  • Feelings of guilt, despair, anger, shame, disappointment, regret
  • Anxiety and/depression
  • Engaging in self-criticism
  • Self-blaming behaviours
  • Replaying events over and over in your mind
  • Difficulties sleeping
  • Crying/tearful episodes
  • Changes in social interactions with others (e.g. withdrawal/isolation)
  • Increased substance abuse (drinking, drugs, medication)

This short video clip discusses the effects of moral injury (although moral injury is not a clinical diagnosis, it can lead to anxiety, depression or significant mental health difficulties if not supported).

Although there is no official treatment protocol or specific intervention for managing the psychological impact of moral injury, some evidence-based techniques may aid to reduce distress associated with moral injury:

  • Seek support: It has been well-recognised that social support acts as a buffer for psychological distress  (Taylor, 2014). Use the support networks around you as a means of sharing your feelings and unburdening. If you feel concerned about being judged by some of what you share in relation to your work, you could contact the Samaritans, speak to your GP or even contact a designated support line for individuals in your line of work. For example, nurses can use Nurse Lifeline. Speaking to others who are from a line of work similar to your own can help to reduce feelings of isolation.

Talk to one of our wellbeing practitioners for a confidential conversaion either call 0300 123 1705 or email keepingwell.nwl@nhs.net.

  • Get the feelings out of your head: In addition to seeking social support, there are various means of expressing the range of emotions you might be experiencing. Some people find writing a helpful aid, others prefer to draw, paint, dance or sing as a way to ventilate their feelings. If you’d like to better understand and work through the feelings so that they’re less impactful, you can speak to a trained mental health professional. Cognitive-Behavioural Therapy or Counselling therapies in particular can be accessed through a local Talking Therapies service which our hub can arrange.
  • Compassion-focused approaches: Be kind to yourself during this time. Try and recognise that you are doing the best you can in a difficult system. Self-compassion can take many forms including giving yourself permission to connect with a hobby you’ve been avoiding, reaching out to a friend you haven’t see for a long time, or even allowing yourself a long-needed rest break for even five minutes.
  • Keep up with your basic needs: The importance of regularly eating healthily, engaging in physical activity and getting a good night’s sleep should not be underestimated for maintaining good physical and mental wellness.

What is burnout?

Burnout is a state of physical and emotional exhaustion. It can occur when you experience long-term stress in your job, or when you have worked in a physically or emotionally draining role for a long time.

The NHS Staff Survey 2021 results indicate that NHS staff are experiencing high levels of burnout. Research by The King's Fund shows that NHS staff are 50 per cent more likely to experience chronic stress, a known contributor to burnout. Factors such as staff shortages, high workload, and pressures to maintain high quality patient care all contribute to burnout in NHS staff. According to the British Medical Journal (BMJ), burnout significantly impacts the retention of our highly valued NHS workforce, with more staff thinking about leaving the NHS.

Whilst burnout is a type of stress with overlaps in symptoms, the main difference is that stress is associated with a feeling of ’too much’, whereas burnout relates to a feeling of ’not enough’.  

Physical signs and symptoms of burnout
  • Feeling tired and drained most of the time.
  • Lowered immunity, frequent illnesses.
  • Frequent headaches or muscle pain.
  • Change in appetite or sleep habits.
Emotional signs and symptoms of burnout
  • Sense of failure and self-doubt.
  • Feeling helpless, trapped, and defeated.
  • Detachment, feeling alone in the world.
  • Loss of motivation. Increasingly cynical and negative outlook.
  • Decreased satisfaction and sense of accomplishment.
Behavioral signs and symptoms of burnout
  • Withdrawing from responsibilities.
  • Isolating from others.
  • Procrastinating, taking longer to get things done.
  • Using food, drugs, or alcohol to cope.
  • Taking frustrations out on others.
  • Skipping work or coming in late and leaving early.

Burnout isn’t something which goes away on its own. Rather, it can worsen unless you address the underlying issues causing it. If you ignore the signs of burnout, it could cause further harm to your physical and mental health in the future.

If you're feeling any of these common signs, or notice these signs in others. Please feel free to talk to us, we can help support. Call 0300 123 1705 or email keepingwell.nwl@nhs.net.

Reference: helpguide.org

Burnout may be the result of unrelenting stress, but it isn’t the same as too much stress. Stress, by and large, involves too much: too many pressures that demand too much of you physically and mentally. However, stressed people can still imagine that if they can just get everything under control, they’ll feel better.

Burnout, on the other hand, is about not enough. Being burned out means feeling empty and mentally exhausted, devoid of motivation, and beyond caring. People experiencing burnout often don’t see any hope of positive change in their situations. If excessive stress feels like you're drowning in responsibilities, burnout is a sense of being all dried up. And while you’re usually aware of being under a lot of stress, you don’t always notice burnout when it happens.

Stress vs Burnout
Stress Burnout
Characterised by over-engagement
Characterised by disengagement
Emotions are overreactive
Emotions are blunted
Produces urgency and hyperactivity
Produces helplessness and hopelessness
Loss of energy
Loss of motivation, ideals, and hope
Leads to anxiety disorders
Leads to detachment and depression
Primary damage is physical
Primary damage is emotional
May kill you prematurely
May make life seem not worth living


NHS Employers have produced guidance intending to support leaders in the NHS, including health and wellbeing leads and managers, who all play an important role in beating staff burnout.

What is the impact of burnout?
  • Employee wellbeingBurnout can negatively impact both mental and physical health, and often results in presenteeism and absenteeism. Organisations have a moral and legal obligation to look after the wellbeing of their staff.
  • Financial cost to the organisationThe cost of absenteeism and presenteeism can be detrimental to organisations. Although we are slowly moving out of the height of the pandemic, the long-term negative effects of issues such as long COVID and patient waiting-list backlogs are likely to remain.
  • Patient careHow staff are feeling can impact on the quality of care provided to patients. Staff who have constant exposure to traumatic events associated with caring responsibilities, can often experience compassion fatigue.

Stress may be unavoidable, but burnout is preventable. Now is the time to pause and change direction by learning how you can help yourself overcome burnout and feel healthy and positive again. Dealing with burnout requires the “Three R” approach:

  • Recognise - Watch for the warning signs of burnout
  • ​​​​Reverse - Undo the damage by seeking support and managing stress.​​​​​​
  • Resilience - Build your resilience to stress by taking care of your physical and emotional health.

Following these steps may help you reduce burnout from getting the best of you and regain your energy, focus, and sense of wellbeing:

  • Turn to other people: Reach out to those closest to you, such as your partner, family, and friends. Opening up won't make you a burden to others. Be more sociable with your coworkers. Developing friendships with people you work with can help buffer you from job burnout. Limit your contact with negative people. Hanging out with negative-minded people who do nothing but complain will only drag down your mood and outlook. 
  • Reframe how you look at your life and work: Try to find some value in your work. Focus on aspects of the job that you do enjoy, even if it’s just chatting with your coworkers at lunch. Find balance in your life. If you hate your job, look for meaning and satisfaction elsewhere in your life: in your family, friends, hobbies. 
  • Take time off: If burnout seems inevitable, try to take a complete break from work. Use the time away to recharge your batteries and pursue other methods of recovery.
  • Reevaluate your priorities: Set boundaries. Don’t overextend yourself. Learn how to say “no” to requests on your time. Take a daily break from technology. Set a time each day when you completely disconnect. Put away your laptop, turn off your phone, and stop checking email or social media. Set aside relaxation time. Relaxation techniques such as mindfulness (we have a weekly group!) yoga, meditation, and deep breathing activate the body’s relaxation response, a state of restfulness that is the opposite of the stress response.
  • Practice good sleep habits: Feeling tired can exacerbate burnout by causing you to think irrationally. Keep your cool in stressful situations by getting a good night’s sleep.
  • Eat a balanced diet: Eating a healthy diet filled with omega-3 fatty acids can be a natural antidepressant. Adding foods rich in omega-3s like flaxseed oil, walnuts, and fish may help give your mood a boost.
  • Make exercise a priority: Not only is exercise good for our physical health, but it can also give us an emotional boost. Stretched for time? You don’t need to spend hours at the gym to reap these benefits. Mini-workouts and short walks are convenient ways to make exercise a daily habit.
  • Reduce smoking and alcohol: Smoking when you're feeling stressed may seem calming, but nicotine is a powerful stimulant, leading to higher, not lower, levels of anxiety. Alcohol temporarily reduces worry, but too much can cause anxiety as it wears off. For tips to help you cut down visit our drug, alcohol and tobacco support page.

Reference: Healthline and helpguide.org

Compassion fatigue

Compassion fatigue refers to the “emotional cost of caring for others or their emotional pain”, whereby the individual struggles emotionally, physically and psychologically from helping others as a response to prolonged stress or trauma.

It is often commonly confused with burnout however it is not the same; compassion fatigue arises from dealing with individuals who are in psychological distress or have been psychologically traumatised. Learn more about compassion fatigue.

Support for work stress and burnout

Join our six-week online burnout group for staff experiencing work related stress. 

Take a self-assessment questionnaire

If you are unsure about needing further support, you might want to complete the self-assessment questionnaires on low mood to find out more about your symptoms.

We recognise that our healthcare colleagues in North West London are from a variety of culturally-diverse backgrounds, with many cultures having unique and specific information on mental health disorders. 

We have linked some free trauma psychoeducation resources translated into a number of languages for our colleagues. 

Talk to us

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