Title : Shift strong: A proactive stress-physiology framework for early identification of nurse distress
Abstract:
Background: Nurses operate within high-acuity, emotionally demanding environments where chronic stress is often normalized and unaddressed until impairment is visible. Traditional burnout interventions focus on late-stage symptoms, leaving a gap in early recognition. The original Stress Continuum model was developed by the U.S. military (Combat Operational Stress Control) to help service members identify stress states before they escalated. This model has since been adapted for other responder communities, including search and rescue. However, it has not yet been widely translated into the context of day-to-day bedside nursing.
Purpose: This presentation introduces the Shift Strong Stress Physiology Framework and the Stress Continuum Triage Scale for Nurses, a clinically intuitive tool that maps military- and SAR- derived stress concepts into nursing language, physiology, and workflow. The aim is to provide nurses with a rapid, ESI-inspired method to self-assess stress at the start of a shift and intervene before symptoms progress.
Methods/Approach: Grounded in the military Stress Continuum, responder psychology, and trauma-informed performance science, the Shift Strong Framework integrates three components: Hall, Laura Abstract Submission for Nursing World Conference The Stress Continuum Triage Scale for Nurses, which categorizes stress into color zones using physiologic markers, cognitive functioning, and behavioral cues tailored to clinical practice; The “Shift Start Stress Scan,” a 60-second self-triage tool mirroring the familiar urgency- based structure of the Emergency Severity Index; and Zone-specific micro-interventions, including grounding techniques, tactical breathing, nutrition timing, and cognitive reset strategies supported by performance physiology. These tools were piloted informally among participants of the Shift Strong Collective, a 12- week resilience and self-care program for nurses. Qualitative feedback was collected through written reflections and group discussions.
Results/Insights: Participants reported that the Stress Continuum Triage Scale provided a shared, non- stigmatizing language for discussing stress, improved their ability to catch early physiologic warning signs, and increased confidence in adjusting their mindset before entering high- intensity environments. Nurses highlighted that the Shift Start Stress Scan felt familiar, practical, and “as routine as checking vital signs,” making early stress identification more accessible.
Conclusion: The Stress Continuum Triage Scale for Nurses and Shift Start Stress Scan offer a novel, rapid, and clinically aligned approach to proactive stress recognition. By drawing from military and responder-health models, these tools have the potential to enhance nurse readiness, psychological safety, and long-term wellbeing. Future evaluation will explore measurable impacts on burnout indicators, resilience, and workplace culture.
