“Performing Under Pressure: Staying Calm While Managing Distress in Others” — Episode 23
Co-host: Marcus—former healthcare security director
Co-host: Natalie—nurse practitioner and clinical team leader
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Hospitals are built for urgency—but working in constant crisis takes a toll. In environments where emotions run high and stakes are life-or-death, healthcare professionals are expected to remain calm, focused, and in control. But how?
In this episode, Marcus (former healthcare security director) and Natalie (nurse practitioner and clinical team leader) dive into the art and science of non-escalation—the proactive skill of staying grounded and professional even as chaos unfolds around you. Drawing from real-world experience and evidence-based strategies, they share actionable tools for maintaining composure, protecting safety, and reducing the ripple effects of stress in clinical environments.
Key takeaways from the conversation include:
Whether you're in direct patient care, part of a support team, or leading others through crisis, this episode offers practical guidance for becoming a stabilizing force in even the most unpredictable situations.
MARCUS: Welcome back to "Confidence in Conflict," the podcast where we explore evidence-based strategies for creating safer healthcare environments. I'm Marcus, a former healthcare security director, and today we're tackling one of the most challenging aspects of healthcare work: maintaining your composure and professionalism when everything around you is chaos.
NATALIE: And I'm Natalie, nurse practitioner and clinical team leader. Marcus, today's topic - non-escalation in high-stress jobs - is something every healthcare worker needs to master. We're talking about tactical tools for staying calm and professional when the stakes are literally life and death.
MARCUS: That's exactly right, Natalie. In healthcare, we don't have the luxury of waiting for ideal conditions to practice conflict prevention. Codes are being called, families are panicking, patients are in crisis, and in the middle of all that chaos, we still need to be able to de-escalate tensions and maintain safety.
NATALIE: And what makes this so challenging is that high stress affects everyone differently. Some people shut down, others become hyperactive, some get angry, and others become scattered. Understanding how stress impacts both you and the people around you is crucial for effective non-escalation.
MARCUS: Let's start with the foundation, Natalie. When we talk about non-escalation in high-stress environments, we're really talking about something that seems contradictory - staying calm when everything is designed to make you stressed. What does that actually look like in practice?
NATALIE: It starts with understanding that non-escalation isn't about eliminating stress - that's impossible in healthcare. It's about managing your response to stress so that you can still think clearly, communicate effectively, and make good decisions even when everything feels urgent and chaotic.
MARCUS: That's such an important distinction. I used to think that staying calm meant not feeling stressed, but that's unrealistic. You can feel the stress and still choose how to respond to it.
NATALIE: Exactly. And in healthcare, stress often comes in waves. One minute you're dealing with a routine patient interaction, and the next minute there's a cardiac arrest three doors down, a combative patient in the hallway, and an angry family member demanding immediate answers. You have to be able to shift gears rapidly.
MARCUS: Let's talk about what makes healthcare environments particularly challenging for non-escalation. Natalie, beyond the obvious life-and-death stakes, what are the unique stressors that healthcare workers face?
NATALIE: Well, there's the time pressure, Marcus. Everything feels urgent, even when it's not. There's also the emotional weight - you're dealing with people's pain, fear, and often their worst days. Plus, there's the unpredictability. You might have a plan for your shift, but emergencies, staffing changes, or equipment failures can derail everything instantly.
MARCUS: And there's what I call the "fishbowl effect" - everyone is watching how you handle things. Patients, families, colleagues, and supervisors. There's constant scrutiny, which adds another layer of pressure to perform perfectly under stress.
NATALIE: That's so true. And in healthcare, mistakes don't just affect you - they can literally impact someone's life. That weight of responsibility can be overwhelming, especially when you're already dealing with multiple competing priorities.
MARCUS: Let's discuss the physiology of stress, because understanding what's happening in your body during high-stress situations is crucial for managing your response. Natalie, what should healthcare workers know about how stress affects their ability to think and communicate?
NATALIE: When you're under high stress, your body goes into what's called fight-or-flight mode. Blood flow shifts away from your prefrontal cortex - the part of your brain responsible for complex thinking and emotional regulation - and toward your more primitive survival systems.
MARCUS: Which means that the exact moments when you most need clear thinking and emotional control are the times when your brain is least equipped to provide them.
NATALIE: Exactly. Your heart rate increases, your breathing becomes shallow, your muscles tense up, and your field of vision narrows. All of these physiological changes affect how you perceive situations and how others perceive you.
MARCUS: And other people can sense that stress in your body language, your voice, and your energy. If you're projecting high stress, it tends to increase stress in everyone around you, which can escalate conflicts even when that's not your intention.
NATALIE: That's why learning to manage your physiological stress response is so important. It's not just about your own well-being - it's about your ability to be effective in high-pressure situations.
MARCUS: Let's talk about preparation strategies. Natalie, what can healthcare workers do before their shift even starts to set themselves up for successful non-escalation during stressful situations?
NATALIE: Mental preparation is huge, Marcus. Before I start my shift, I take a few minutes to center myself. I review what I know about my patient assignments, I think through potential challenges, and I remind myself of my key non-escalation strategies.
MARCUS: That preparation time is like warming up before exercise. You're getting your mind ready for the challenges you're likely to face rather than just reacting to whatever happens.
NATALIE: I also do a quick physical check-in. Am I well-rested? Have I eaten recently? Am I hydrated? Those basic physical needs have a huge impact on your stress tolerance and your ability to manage difficult situations effectively.
MARCUS: And there's something to be said for visualization. Mentally rehearsing how you want to handle challenging situations can actually improve your performance when those situations arise.
NATALIE: Absolutely. I might think through how I want to approach a patient who was difficult during the previous shift, or how I'll explain a complex procedure to an anxious family. Having that mental rehearsal makes me more confident and less reactive.
MARCUS: Let's discuss in-the-moment strategies. When you're in the middle of a high-stress situation and you can feel tensions rising, what are the immediate tools you can use to prevent escalation?
NATALIE: The first thing is breathing, Marcus. It sounds simple, but when stress hits, our breathing becomes shallow and rapid, which actually increases anxiety and reduces clear thinking. Taking deliberate, slow breaths activates your parasympathetic nervous system and helps restore some calm.
MARCUS: And it's not just about feeling calmer - controlled breathing actually changes how your voice sounds. When you're breathing shallowly, your voice gets higher and tighter, which can sound stressed or defensive to others.
NATALIE: Right. And breathing techniques can be done discreetly. You don't need to excuse yourself or make it obvious. You can practice controlled breathing while walking to a patient's room or while washing your hands.
MARCUS: What about body language? How does managing your physical presence help with non-escalation in high-stress situations?
NATALIE: Your body language needs to project calm confidence even when you don't feel calm inside. I focus on keeping my shoulders relaxed, my movements deliberate rather than rushed, and my facial expression appropriate to the situation.
MARCUS: And positioning matters too. In high-stress situations, people's personal space needs often change. Someone who might normally be comfortable with close interaction might feel threatened when they're already stressed.
NATALIE: That's such a good point. I pay attention to how people are positioning themselves and adjust accordingly. If someone seems to need more space, I give it to them. If they seem to need reassurance through closer presence, I might sit down next to them.
MARCUS: Let's talk about communication strategies specifically for high-stress environments. Natalie, how does effective communication change when everyone's stress levels are elevated?
NATALIE: Everything needs to be slower and more deliberate, Marcus. When people are stressed, they process information differently. I speak more slowly, use simpler language, and check for understanding more frequently.
MARCUS: And repetition becomes more important. In normal situations, saying something once might be enough, but when people are stressed or overwhelmed, they might need to hear important information multiple times.
NATALIE: Absolutely. And I've learned to be much more explicit about what I'm doing and why. In a calm situation, I might just start taking vital signs. But in a high-stress situation, I'll explain: "I'm going to check your blood pressure now to make sure everything is stable."
MARCUS: That narration helps people feel more in control and less anxious about what's happening to them or around them.
NATALIE: Let's discuss something that's particularly challenging - managing multiple high-stress interactions simultaneously. Marcus, in healthcare, you're rarely dealing with just one stressed person at a time.
MARCUS: That's one of the most difficult aspects of healthcare non-escalation. You might have an anxious patient, worried family members, and stressed colleagues all in the same space, each feeding off the others' emotions.
NATALIE: I've learned to think of myself as an emotional thermostat in those situations. I try to bring the overall temperature down by maintaining my own calm and addressing the most urgent emotional needs first.
MARCUS: And sometimes you have to make triage decisions about which interactions need immediate attention and which can wait. Not every stressed person needs to be addressed simultaneously.
NATALIE: That's so important. I might say to one family member, "I can see you have questions, and I want to answer them. Let me finish checking on your father, and then I'll come talk with you in just a few minutes."
MARCUS: Setting those brief timeframes helps people feel acknowledged without requiring you to split your attention ineffectively.
NATALIE: Let's talk about something really challenging - performing non-escalation when you're being personally attacked or blamed. Marcus, how do you stay professional when someone is directing their stress and anger directly at you?
MARCUS: This is where understanding that the anger usually isn't really about you becomes crucial. When people are in crisis, they often direct their emotions at whoever is available, rather than at the person who caused the problem.
NATALIE: It helps me to remember that hurt people hurt people. When someone is lashing out at me, they're usually in pain or fear, and I just happen to be the most available target.
MARCUS: That doesn't mean you have to accept abuse, but it does help you not take it personally, which allows you to respond more effectively rather than just defending yourself.
NATALIE: I use what I call the "emotional shield" technique. I visualize the anger or blame as something that's bouncing off me rather than penetrating. It helps me stay focused on problem-solving rather than getting defensive.
MARCUS: And sometimes you need to acknowledge the emotion while redirecting the focus. "I can see you're really frustrated, and I want to help. Let's figure out what we can do to address your concerns."
NATALIE: That validation plus redirection approach works so well. You're not dismissing their feelings, but you're channeling them toward something productive.
MARCUS: Let's discuss team dynamics in high-stress situations. Natalie, how does non-escalation change when you're working as part of a healthcare team under pressure?
NATALIE: Team communication becomes absolutely critical, Marcus. When everyone is stressed, miscommunication happens more easily, and small misunderstandings can quickly escalate into conflicts that affect patient care.
MARCUS: And you have to be aware of how your stress might be affecting your colleagues, just like you're aware of how it affects patients and families.
NATALIE: I've learned to be more explicit in my communication with colleagues during high-stress situations. Instead of assuming they know what I need or what I'm thinking, I state it clearly: "I'm going to need help with the patient in room 3 in about ten minutes."
MARCUS: And checking in with team members becomes important. A quick "How are you doing?" or "What do you need?" can prevent stress from building to the point where someone snaps.
NATALIE: Also, supporting each other's non-escalation efforts. If I see a colleague dealing with a difficult situation, I might offer to step in, or I might help by addressing other family members or patients so they can focus on the immediate crisis.
MARCUS: That team approach to non-escalation is so much more effective than trying to handle everything individually.
NATALIE: Let's talk about something specific to healthcare - dealing with emergencies while maintaining non-escalation with non-emergency patients and families. Marcus, how do you balance urgent medical needs with the emotional needs of people who aren't in immediate medical danger?
MARCUS: This is one of the most challenging scenarios in healthcare. You have a legitimate emergency that requires immediate attention, but you also have other patients and families who don't understand why they're suddenly being ignored.
NATALIE: I've learned to do quick explanations when possible. "I need to step away right now because we have a medical emergency, but I'll be back to check on you in about twenty minutes." It's not perfect, but it helps people understand that they haven't been forgotten.
MARCUS: And enlisting other team members to provide updates and reassurance while you're dealing with the emergency can help maintain those other relationships.
NATALIE: The key is not just disappearing without explanation. Even a brief acknowledgment helps people feel less abandoned during what might already be a stressful time for them.
MARCUS: Let's discuss error management in high-stress situations. Natalie, mistakes happen more frequently when everyone is under pressure. How do you handle errors in a way that doesn't escalate conflicts?
NATALIE: Quick acknowledgment and immediate action plans are crucial, Marcus. If I make a mistake or if something goes wrong, I address it directly rather than hoping no one will notice or trying to cover it up.
MARCUS: And taking responsibility without being defensive helps maintain trust even when things go wrong.
NATALIE: I might say something like, "I realize I told you the doctor would be here by 3:00, and it's now 3:30. I apologize for the delay and for not updating you sooner. Let me find out exactly when she'll be available and get you a realistic timeframe."
MARCUS: That approach shows accountability and immediate action, which often prevents people from escalating their frustration into anger.
NATALIE: And being proactive about potential problems helps too. If I can see that we're running behind or that something might not go as planned, I try to give people a heads-up rather than waiting until they ask.
MARCUS: Let's talk about cultural considerations in high-stress non-escalation. Different cultures have different norms around emotional expression, authority, and family involvement in medical decisions.
NATALIE: That's so important, Marcus. What looks like appropriate emotional expression in one culture might seem excessive or concerning in another. And stress can make those cultural differences more pronounced.
MARCUS: And family dynamics can become more intense under stress. In some cultures, the entire extended family might be involved in medical decisions, which can create complex communication challenges during emergencies.
NATALIE: I've learned to ask directly when I'm not sure about cultural preferences. "I want to make sure I'm communicating in a way that works for your family. Who should I be talking to about your father's care?"
MARCUS: That shows respect for their cultural norms while also helping you navigate the communication more effectively.
NATALIE: Let's discuss something that's particularly relevant in emergency departments - dealing with people who are under the influence of substances while maintaining non-escalation in high-stress situations.
MARCUS: This adds another layer of complexity because intoxication affects people's perception, judgment, and emotional regulation, often in unpredictable ways.
NATALIE: I've learned to adjust my communication style significantly. I speak more slowly, use simpler language, and avoid complex explanations. I also give them more time to process information.
MARCUS: And you have to be prepared for their emotional state to change rapidly. Someone might be calm one moment and agitated the next, with little warning.
NATALIE: Consistency becomes really important. I try to use the same phrases and approach each time I interact with them, because their short-term memory might be affected.
MARCUS: And safety considerations change too. You need to position yourself more carefully and be ready to call for help more quickly if the situation starts to deteriorate.
NATALIE: Let's talk about mental health crises in high-stress environments. Marcus, how does non-escalation change when someone is experiencing psychiatric symptoms while everything else around them is chaotic?
MARCUS: Mental health crises require extra patience and modified approaches, especially in already high-stress environments where there's less time and space for lengthy de-escalation.
NATALIE: I've learned to enter their reality rather than trying to correct their perceptions, at least initially. If someone is paranoid about the medical equipment, saying "Don't worry, it's safe" doesn't help. But saying "That equipment must look scary. Let me explain what each thing does" acknowledges their experience.
MARCUS: And sometimes you need to simplify the environment as much as possible. Too much stimulation can worsen psychiatric symptoms and make de-escalation much more difficult.
NATALIE: I might ask family members to step out temporarily, turn down lights if possible, or speak more quietly - anything to reduce the sensory overload that might be contributing to their distress.
MARCUS: Let's discuss self-care in the context of high-stress non-escalation. Natalie, this work is emotionally and physically demanding. How do you maintain your capacity to handle these situations effectively?
NATALIE: Recovery time is crucial, Marcus. After a particularly intense situation, I try to take even just a few minutes to decompress before moving on to the next patient. Sometimes that's just stepping outside for fresh air or sitting quietly for a moment.
MARCUS: And recognizing your limits is important. If you're too stressed or depleted to handle a situation effectively, it's better to ask for help than to push through and potentially make things worse.
NATALIE: I also debrief with colleagues when possible. Talking through what happened, what worked, and what might have been done differently helps me learn and also helps me process the emotional impact.
MARCUS: And maintaining perspective helps. Reminding yourself that most situations, even very stressful ones, do get resolved. The acute crisis will pass.
NATALIE: Let's talk about something practical - creating quick stress-relief techniques that you can use during your shift. Marcus, what are some things healthcare workers can do in the moment to reset their stress levels?
MARCUS: The 4-7-8 breathing technique is one I use frequently. Breathe in for 4 counts, hold for 7, exhale for 8. It activates your parasympathetic nervous system and can be done anywhere.
NATALIE: I use what I call "grounding" techniques. I'll notice 5 things I can see, 4 things I can touch, 3 things I can hear, 2 things I can smell, and 1 thing I can taste. It brings me back to the present moment and out of stress-driven thinking.
MARCUS: Progressive muscle relaxation can be done quickly too. Tense and then release different muscle groups - your shoulders, your jaw, your hands. It helps release physical tension that builds up during stress.
NATALIE: And positive self-talk matters. Instead of "This is terrible" or "I can't handle this," I try to use phrases like "This is challenging, but I have tools to deal with it" or "This feeling will pass."
MARCUS: Hydration and blood sugar also affect stress tolerance more than people realize. Keeping a water bottle nearby and having healthy snacks available can help maintain your resilience during long, stressful shifts.
NATALIE: Let's discuss learning from high-stress situations. Marcus, how can healthcare workers use these challenging experiences to improve their non-escalation skills?
MARCUS: Reflection is key, but it needs to be structured rather than just ruminating on what went wrong. I ask myself specific questions: What was the first sign that stress was building? What technique worked best? What would I do differently next time?
NATALIE: And celebrating successes is just as important as analyzing failures. When a high-stress situation goes well, take time to understand what you did right so you can replicate it.
MARCUS: Keeping a brief journal can be helpful too. Writing down challenging situations and how you handled them helps you notice patterns and track your improvement over time.
NATALIE: And seeking feedback from colleagues who witnessed the interaction can provide valuable insights you might miss when you're focused on managing the stress yourself.
MARCUS: Let's talk about organizational support for non-escalation in high-stress environments. What can healthcare institutions do to better support their staff in these situations?
NATALIE: Training is obviously important, but ongoing support is even more crucial. Regular debriefing sessions, access to mental health resources, and policies that prioritize staff well-being all make a difference.
MARCUS: And staffing levels matter enormously. When units are understaffed, every situation becomes more stressful, which makes effective non-escalation much more difficult.
NATALIE: Clear protocols for when to call for help are important too. Staff need to know that asking for assistance with difficult situations is supported, not seen as a weakness.
MARCUS: And leadership modeling matters. When supervisors and managers demonstrate calm, professional responses under pressure, it sets the tone for the entire unit.
NATALIE: Let's address something that many healthcare workers struggle with - perfectionism in high-stress situations. Marcus, how do you maintain realistic expectations for yourself when the stakes are high?
MARCUS: Perfectionism can actually increase stress and make non-escalation more difficult. The goal isn't to handle every situation perfectly - it's to handle it safely and effectively given the circumstances.
NATALIE: I remind myself that doing my best in the moment is enough. I might not have handled something exactly as I would have liked, but if everyone stayed safe and the situation was resolved, that's a success.
MARCUS: And learning from mistakes without being self-critical is crucial. Mistakes are information, not character flaws.
NATALIE: It helps to remember that patients and families usually aren't expeting perfection either. They want to feel cared for and safe, not to see flawless performance.
MARCUS: As we start to wrap up, let's give our listeners some concrete strategies they can implement immediately. Natalie, what are the most important tools someone can start using right away to improve their non-escalation skills in high-stress situations?
NATALIE: First, practice controlled breathing before, during, and after stressful interactions. Second, slow down your speech and movements when you feel stress rising. Third, acknowledge emotions - both yours and others' - before trying to solve problems.
MARCUS: I'd add: prepare mentally for your shift by thinking through potential challenges. Use grounding techniques to stay present during crisis situations. And remember that your calm energy can influence everyone around you positively.
NATALIE: And don't try to implement everything at once. Pick one or two techniques and practice them consistently until they become automatic, then add more tools to your toolkit.
MARCUS: For listeners who want to develop these skills further, what would you recommend?
NATALIE: Look for de-escalation training opportunities in your organization. Practice with colleagues through role-playing. And pay attention to healthcare workers who seem to handle stress well - learn from their approaches.
MARCUS: And remember that these skills transfer to your personal life too. Learning to manage stress and communicate effectively under pressure benefits all your relationships, not just your work interactions.
NATALIE: Before we close, I want to emphasize something important: working in high-stress healthcare
MARCUS: And every small improvement in how you handle stress makes a difference - not just for you, but for your patients, their families, and your colleagues. You have more influence over the emotional climate around you than you might realize.
NATALIE: Remember that non-escalation in high-stress situations is both an art and a science. It requires practice, patience with yourself, and a commitment to continuous learning and improvement.
MARCUS: For our listeners, we encourage you to start implementing these strategies gradually. Pick one technique that resonated with you today and try it during your next shift. Notice what happens when you focus on your breathing, slow down your movements, or take a moment to acknowledge emotions before jumping into problem-solving.
NATALIE: And be patient with yourself as you develop these skills. Managing stress and preventing escalation in healthcare environments is some of the most challenging interpersonal work there is. You're not expected to master it overnight.
MARCUS: Thanks for joining us for today's episode of "Confidence in Conflict." If you enjoyed this episode, don’t forget to follow, rate, and leave a review on your favorite podcast platform.
NATALIE: Until next time, remember - your ability to stay calm and professional under pressure doesn't just make you a better healthcare worker. It makes you a source of stability and safety for everyone around you during their most vulnerable moments.
MARCUS: Take care of yourselves out there, and remember that every day you choose to respond with calm professionalism instead of reacting with stress, you're making healthcare a safer place for everyone.