As a nurse, you’re empathetic and compassionate and go out of your way to ensure you provide your patients with the best possible care. But when it comes to looking after yourself, self-care may get prioritized far down the list – or not at all.
Such a mindset may be harmful to you and, ultimately, your patients. Nurses are great patient advocates, but “we do need to start advocating for ourselves because you can’t keep helping everyone. Then you don’t have anything left in your reserves,” said Linda Roney, EdD, RN-BC, FAAN, associate professor, Egan School of Nursing and Health Studies, Fairfield University.
“I think you have to be selfish, which is hard in a selfless profession to balance, but I think that is one of the ways that we can keep ourselves healthy. You have to prioritize yourself,” said Crystal Smith, DNP, RN, NE-BC, director of the medical-surgical unit at Children’s Nebraska.
As healthcare professionals and organizations celebrate Nurses Week with its theme of “Nurses Make the Difference,” now is a perfect time to assess your attention to self-care. In this article, we’ll offer practical strategies to help you care for yourself.
No Perfect Time
When it comes to self-care, “one of the biggest lessons for me is that self-care is not a one-size-fits-all,” said Roney. Nurses need to be aware of their unique needs.
Another awareness is not to wait for the perfect time for self-care. Roney said you can work on “small, incremental changes” for five or ten minutes that can accumulate over a day. You might try “habit stacking”: combining a potentially burdensome task with something enjoyable, notes Roney.
Days Off and “Zen Dens”
Smith meets with her new nurses at Children’s Nebraska in Omaha to discuss a self-care plan. If a nurse is struggling, Smith can consult the nurse’s plan and see the measures that might help that person.
One self-care policy at Children’s Nebraska allows nurses to take a day off if they need to recharge—if “your tank isn’t full enough to come in and give all of yourself that day,” said Smith. There are no negative repercussions should a nurse choose to do so.
Nurses are also encouraged to disconnect completely when they need a break. “It’s very hard to get away from the work when you’re at work,” Smith explained. Nurses are encouraged not to take their work phones on break but to trust that the staff can handle the patients while away.
Another self-care tactic involves “Zen dens.” When the hospital opened a new tower two years ago, these rooms were built into each unit. Zen dens have a lock, a massage chair, essential oil diffusers, books, and low lighting. A nurse can connect a phone to a speaker to play quiet music. “You can go in there and decompress how you need,” said Smith.Â
Smith noted that accessibility of these Zen dens is key. “We as organizations have always had places for people to do that, but never right on the unit. It’s tough to get a nurse or even a doctor to leave the unit where their patients are without any way to communicate with them.”
Added to these measures is a “Thrive” team, a department dedicated to employee wellness, noted Smith. Two members of Thrive are Howie, a golden retriever, and his handler, David. They may, for instance, join the staff for a debriefing after a difficult patient or family situation. Besides Howie and David, Thrive has a team of trained peer supporters and group facilitators available 24/7 for clinical and non-clinical team members.
Howie, the golden retriever, and his handler, David, make their rounds
What’s more, staff are encouraged to go home after a death in the facility. Death in general is very hard, noted Smith, “but I would say especially in pediatrics, it’s usually very traumatic. To expect the nurse who just went through that with a family and a patient to turn around then and take an entirely new patient, the mental load of that is really heavy. And so, to the best of our ability, we try to give them the option to go home.” At the same time, the facility understands that a nurse may want to stay at work instead of going home as a way of coping.
Back to Basics
As a nurse, you also need to take to heart the common-sense advice you probably give to patients about self-care, such as the following:
Sleep and downtime. You may want to spend some downtime on your phone, but be wary of it, noted Roney. “You feel as if you are relaxing and having a positive experience. But all this time is going on, cutting into your sleep/wake cycle.”
Nutrition and hydration. “If you talk to any nurse, most of us would agree we would put our needs after our patient, so there are many times we might miss a lunch break, or we may eat several hours later than we usually do because there might be something going on with our patient and we need to put their needs first,” said Roney. As a solution, “really be intentional and plan on bringing your meals and snacks to work.” Stay hydrated throughout your shift, noted Roney.
Simple measures such as making sure to take your breaks, eat your meals, and use the bathroom regularly while on shift are a start for self-care, according to Sarah K. Wells, MSN, RN, CEN, CNL, clinical practice specialist, practice excellence team, American Association of Critical-Care Nurses (AACN). Next, prioritize quiet times and activities that bring you joy each day.
Moments of Gratitude
Practicing gratitude can also help with self-care. In talking to an experienced nurse who was struggling, Smith told her, “You guys have to remember that the tiniest things you do make the biggest difference.”
Smith says, “Sometimes we must find and center ourselves around those tiny moments of gratitude. It’s easy to leave work and feel like your entire day was terrible. But really, you probably did many good things throughout the day.”
Burnout can steal the enthusiasm, satisfaction, and joy that prompted you to become an NP. It can rob you of the joy of caring and potentially deprive your patients of the care they need.
As a nation, the U.S. can ill afford to have NPs burn out. A national survey of U.S. adults conducted by the American Association of Nurse Practitioners (AANP) in April 2023 found that more than 40% of respondents have experienced a “longer than reasonable” wait for healthcare. In a press release, 26% of those surveyed reported waiting more than two months to gain access to a healthcare provider. NPs, notes the AANP, can help fill that void.
delivered by NPs and physician assistants (PAs) increased from 14.0% to 25.6%.
We’ll look at some factors that cause burnout and ways to prevent it from diminishing your enthusiasm or leaving practice entirely.
First, let’s take a brief look at the signs of burnout.
Signs of StrainÂ
Burnout is characterized by emotional, physical, and mental exhaustion, notes April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, immediate past president of the AANP. A practitioner can feel less valued and lose interest in their work.
You may have trouble sleeping, experience tension and stress, and potentially have prolonged feelings of depression, according to Sunny G. Hallowell, PhD, APRN, PPCNP-BC, associate professor, pediatric nurse practitioner, M. Louise Fitzpatrick College of Nursing, Villanova University.Â
COVID Makes it WorseÂ
While blaming the pandemic for NP burnout would be easy, burnout was a phenomenon before COVID. “What happened during the pandemic is the phenomenon of burnout, which has been consistently well documented in the healthcare literature for decades before COVID. Those events were exacerbated by the pandemic,” according to Hallowell. “It was already there. It just got so much worse.”
One data point of burnout before the pandemic comes from a study conducted in early 2018, which examined advanced practice registered nurses, including NPs and PAs. It found that 59% of respondents experienced or formerly experienced burnout. The pandemic “really blew everything up,” says Kapu, the study’s lead author, published in the Journal of the American Association of Nurse Practitioners.Â
Forces of Stress
Besides the pandemic, unhealthy work environments can lead to burnout. In those environments, notes Kapu, staff shortages continue to take a toll, overtime may be needed, and there needs to be more opportunity for professional growth, development, or change.
Furthermore, the back-and-forth involving full practice authority for NPs may also cause stress. During the pandemic, various states provided temporary waivers allowing full practice authority for NPs. Since then, some states have reverted to reduced or restricted practice laws. This sends a “mixed message,” notes Hallowell, breeding mistrust, uncertainty, and confusion.
“In states that have moved to full practice authority, we’ve seen an increase in the workforce; NPs enjoy working there,” says Kapu. “We’ve seen those states move up in terms of overall healthcare outcomes. The top five states in the U.S. in terms of healthcare outcomes are all states where nurse practitioners can practice to what they’ve been educated and trained to do.”
NPs might also suffer from stress in dealing with inexperienced healthcare colleagues. “The distribution of healthcare delivery has shifted in such a way that we have a lot of inexperienced folks at the frontline now,” Hallowell notes.
“We need to create a structure to onboard and train and bring these new workers into the work environment, help them develop confidence in their skills, make sure that they’re competent in what they’re doing,” notes Kapu .” We’ve done this as nurse practitioners for years. We have onboarding, orientation, and training programs, and we support them through that so that they feel competent and integrated into the team. They have a supportive environment where they can reach out and ask questions as needed.”
Self-care is Key
When it comes to preventing burnout, tactics involve self-care, notes Hallowell. They include:
Rest.
Asking for help. Hopefully, you can call on experienced colleagues who can provide emotional support to offset the stress, demands, and mental load of patient care.
Requesting training. If you are doing something unfamiliar, ask for education.
Exercise.
Good nutrition.
Having interests outside the profession.
Socializing with friends and family
Mindfulness.
“We need to make sure that we recognize the signs and symptoms and then determine what will be our change,” says Kapu. “Do we need to work in a better environment? Can we help contribute to making our work environment better? What are we doing in terms of self-care?”
Addressing the exhaustion that can lead to burnout is similar to exercising a muscle, notes Kapu. “You work a muscle to a critical mass and then recover. That’s how it gets stronger. It’s the same thing with stress,” she notes, where some stress is good, but it may get to a point where you have to take time away.
“We have to give ourselves time to recover, to refuel, to constantly check in and say, Am I taking care of myself so I can bring my very best self to my patients?”
There has been a greater focus on creating healthy work environments in recent years, and nurses deserve kindness, too. Regardless of your nursing position, remember that kindness is still in style.
If you are a nursing student, new graduate nurse, educator, or chief nursing officer, remember that the foundation of nursing is rooted in caring. I don’t know what has happened to nursing over time, but we must return to caring basics as a nursing profession. Emotional intelligence and empathy can go a long way in nursing.
Research shows that kindness and helping others can decrease stress and benefit our mental health. Demonstrating kindness has been shown to reduce cortisol levels, increase self-esteem, compassion, and empathy and improve your mood.
Being kind to ourselves and caring for ourselves as nurses should be a priority.
Here are some self-care activities you can implement to be kind to yourself and others.
SleepÂ
Sleep is truly underrated. It is crucial to get your rest and relaxation.
Healthy Eating
It’s not easy sometimes, but try to look for healthy eating options as much as possible. I know nurses love all things caffeine. However, reducing caffeine can be helpful.
MassageÂ
Massage can be highly relaxing and stress-reducing. Some nursing positions can be physically demanding, so try a nice massage. Some insurance will cover this as well.
ExerciseÂ
Even if you are not a big workout type, you can at least go for regular walks. Walking outside and being in nature is also relaxing.
MusicÂ
Research shows that listening to 30 minutes of music a week can reduce stress and have physiological benefits such as reduced blood pressure.
AromatherapyÂ
Aromatherapy has also been proven to reduce stress. Even having different lotions, such as lavender, can instantly reduce stress.
Deep Breathing/StretchingÂ
These are easy to do and can only take a few minutes but have powerful positive effects.
Healthcare providers must prioritize putting their health first. Remember to take time off regularly. No job is worth your mental or physical health. It is time we start normalizing taking time off regularly in the healthcare industry. If you are in leadership, please encourage the staff to take time off. When the team feels happy and relaxed, they can be more productive.
Be kind to yourself so that you can have more kindness for others.
Nursing for me is about making a difference — and every day I’m making a difference in the lives of the people I care for. Take a Monday earlier this month. A patient of mine living with cerebral palsy was struggling to complete her therapeutic exercises. Her mother, clearly frustrated, feared her daughter wasn’t making sufficient progress. Dedicated and caring, the mother also worried that she wasn’t doing enough to help her daughter improve and succeed.
But this young woman was improving — slowly, surely, in ways imperceptible to the untrained eye. “Your daughter can now open both of her hands; all of our hard work is clearly paying off,” I explained, as the mother’s face transformed from hopeless to full of hope. “Your daughter just wants to be independent,” I continued, “and she obviously gets this spirit from you.”
Independence – as much as making a difference – is becoming a bigger focus for me in my career. The freedom to control my schedule. The freedom to control my income. The freedom to care for my three children. The freedom to care for me.
Until recently, I didn’t really have that choice.
For too long nurses have been treated like afterthoughts. We’re burned out and stressed out – from Covid, from our home lives, from feeling like our needs are always considered last. And this not only impacts our ability to perform, it threatens the effectiveness of the entire healthcare systems we’re so passionately committed to supporting. Yet, the working conditions and rigid schedules have not changed with the world around us.
Over my six-year career in nursing, I’ve witnessed both the indifference and abuse that has become too common in our industry. As a result, our community is suffering. Less than half of the 12,000 nurses recently polled by the American Nurses Association (ANA), for instance, believe that their employers care about them – a mere 19 percent for nurses 35 and under. More than 50 percent of all nurses are also thinking about leaving nursing; a figure that rises to 63 percent for nurses under 35. The latter numbers particularly worry me; with so many of my younger brothers and sisters ready to give up on nursing – and a national nursing shortage only expected to get worse – the future of the profession I love has never felt grimmer.
I know what it’s like to be undervalued in the workplace. I’ve been told by nursing agencies to wait in the cold if my patients are running late. Then when they finally do arrive, I’ve been expected to wash their clothes – even though I’m a nurse, not a housekeeper. I’ve been berated by patients for “moving too slowly” and battled with administrators for adequate PPE safety gear during the height of the pandemic. I’ve been made to feel like a number – a body – by nursing agencies just focused on profits and disrespected by patients and family members aggressively insistent I could just “do more.”
But more must be done to consider our needs, too – both by the nursing industry and the community of nurses to whom we all belong. What we seek is to be seen, valued, and supported in ways that matter. To be listened to if we are struggling during a hard shift. To hear “thank you” instead of being ignored. To give us tools and resources to take care of our mental health because after the past two years, we need it.
I experienced this kind of support unexpectedly when I found connectRN, a new platform that matches nurses with health care facilities that need our services. The ability to work when I want, where I want has given me the independence I was seeking, and an opportunity to step away if I need to recharge. As a mother, this flexibility is more important than ever. I can take on shifts that work with my child-care needs, eliminating the stress that usually occurs when making money and being a Mom collide. This should become an industry standard, rather than a perk from a digital start-up.
One of the things I value most about connectRN is that they are nurse-first and care as much about our community as the shifts they post. When I joined the platform, I was given access to The Beat, a private community of nurses who also work with connectRN. It is a safe space to chat with your peers about the things only nurses can truly understand – without the fear of reprisal or retribution. We share stories about hard shifts, give each other support to keep going, and often find “work buddies” in the places we work often. As debates rage around the role of nursing unions, hospitals and agencies must understand that a united nursing community is a better nursing community – better equipped, better prepared, and far better focused on the needs of our patients. With my life far more than just nursing – kids (both teens and a toddler), my extended family, a bit of me time – I feel lucky to be part of this community
For me, personally, The Beat proved particularly helpful when dealing with mental health concerns. At the height of Covid, the community offered telehealth therapy sessions through a partnership to use at our discretion. To be honest, I never considered I might need this kind of help — no one had ever asked me. But the death of a colleague — a young mother who passed away shortly after giving birth — hit me harder than I’d initially expected. I needed help to process how I was feeling and I took advantage of the offer. To have that support – for free – made me feel worthy and valued.
Over the past two years, I’ve been struck by a newfound respect for nurses as the Covid crisis continues unabated. Patients and families recognize our role at the frontlines of the pandemic and understand the risks taken daily to help their loved ones survive. What’s needed now is a parallel boost in understanding and appreciation from the hospitals and nursing agencies that power our profession. Because fairer pay, added flexibility, stress reduction, and self-care won’t just improve the lives of nurses, they’ll help ensure the positive patient outcomes we all desire. As nurses, we intuitively understand the necessity of these demands; it’s time for staffing agencies and health facilities to embrace this mindset with equally open hearts and minds.
All my life I have rarely been sick, in fact there have only been two times that I can recall. So, about three months ago when I started feeling bad, it was out of the ordinary. I did not have any obvious symptoms, such as nausea, vomiting, headache, runny nose etc. I just had a lack of energy and no appetite. During this time it made me realize that “I would rather have great health, more than any material thing”; not that I do not like nice things or places. As children, many of us dreamed of growing up and having lots of money, big houses, cars and anything else that money could buy. We were only focused on the “material” things. There were never any thoughts about our physical or mental health.
I would rather have excellent health, than all of the money in the world. If you are sick and cannot get around, what good is having money and things, if you cannot enjoy it? Some people may say that they would use their money to hire the best doctors, but that is no guarantee that you will have good health. I often think of our patients that we are taking care of in the hospitals and clinics, they are relying on us to give them the best possible care to make them feel better. During this time, they become dependent on the healthcare staff and this may be hard for many that are used to having control of their own lives. Before you make an assumption that the patient is “difficult” or “hostile”, remember that these are people that were working, taking care of themselves and families and making their own decisions. We need to include them in all aspects of their care, instead of dictating what will be done. Although we may have our daily assignment planned, discuss with the patient the Plan of Care and let them have some input on the order of some things, to give them that feeling of control. We still have to stay on task, but we need to make them feel like adults and not like children being told what to do. Some people may think that this will interrupt your normal day, but imagine if it were you laying in that bed, how would you want to feel?
I have decided that I am going to enjoy life, spend more time taking care of myself and creating experiences with my daughter. I have been privileged to accomplish a lot of things in my life: writing my first children’s book, starting a home-based travel business, building my photography portfolio, traveling domestically and internationally; all while being a mom and nurse. We spend a lot of time taking care of others; but we must start taking care of ourselves; otherwise we will not be here for others.
So, the fatigue and loss of appetite that I was having was due to my Vitamin D level being critically low. I am currently working remotely, so eight hours of my day is spent inside on the computer. When I get off work, I wait until the sun goes down to go on my evening walk; therefore I was getting minimal to no sun. I am happy that this is a condition that can be easily corrected by diet, taking nutritional supplements and spending a few minutes sunbathing (in moderation). The benefits of sunlight is that Vitamin D is produced when your skin is exposed to the sun and it is one of the many vitamins our bodies need to stay healthy, relieve stress and increase energy.
I realized that work will be there; so I have made it a point to sit outside on my breaks and lunch. I am glad to say that I am feeling a lot better now. Never take your health for granted. You only have one life and you need to make sure to maintain your health. Take care of yourself, mind, body and spirit. The six best doctors in the world: sunlight, exercise, rest, diet, self-confidence and friends. Maintain them in all stages of life and enjoy a healthy life.  Remember Health is Wealth!!
If you’re a nursing student, this time of year generally brings a schedule full of midterm exams and projects. Many students say this time of year is the toughest for studying. The weather is still chilly, and everyone’s ready for something, anything, than what they have to get done.
Being a nursing student is stressful and pretty busy in general. You’ve got a lot of work to do, a limited amount of time, and haven’t shaken off the winter hibernation mode yet. If that sounds familiar, here are a few ideas to help you power through this tough time.
Block It Out
The news is full of upsetting events. Coronavirus. Politics. Climate change. Influenza. If you have a fear or an anxiety, there’s probably something about it in the news. You’ve got work to do and world events are overly distracting—but you also can’t just pretend it’s not happening. Set aside specific times to check in with daily events. Don’t scroll through on your phone every hour. Resist the urge to check the news on TV when you’re making dinner or eating with friends. Being in control over the way you consume the information will make it less distracting and leave you time to focus.
Find Your Study Sweet Spot
You might find studying in the library is not the best location for you. Maybe you prefer studying in the gym with the rest of your gym buddies or your team. Maybe a coffee shop is for you or a lounge in your school’s campus center. Or maybe your best study spot is a comfy corner in an academic building. Wherever you can focus on your work and get the most done is the place for you to go during midterms. Find that place and set yourself up with snacks, a water bottle or some coffee, and get your work cranked out.
Time to Relax Isn’t Wasted Time
Endless studying is actually going to work against you. Your brain needs to take breaks to help it process what you are learning and what you are trying to get done. The key is to plan it into your day. A couple of hours of cramming deserve to be followed by a short walk with a friend or some time listening to your favorite podcast or watching funny cat videos. Plan a dinner in which your only company isn’t just a textbook. Connect with your family, friends, or pets. Take time to eat. Watch a movie. You’ll actually give your brain a much needed rest so it, and you, can perform best.
Pay Attention to Self-Care
You probably are going to skimp on sleep during midterms. There’s a lot to get done and only so many hours in the day. But try to keep as much to a schedule as you can. Fit in short naps during the day if you’re really dragging—they will refresh you. In this time of flu and colds, be sure to wash your hands frequently with soap and water—even when you feel like you’re washing your hands all the time. Stay hydrated with lots of liquids (water is always best) or even fruits and veggies like watermelon and cucumbers. Get outside when you can because sunshine and fresh air are refreshing to tired bodies.
Get Help
If you feel overwhelmed by the academics or the life overload, get help. Tutors, student success centers, study groups, or even reliable online help can give you a better understanding of work that you’re having difficulty with. Many schools offer counseling centers where trained therapists can help you manage the stress and anxiety many nursing students feel during midterms (or at any other time as well). The help is out there and taking advantage of it can help you through this tough spot.
Remember, midterms will be over soon enough and you’ll be on to the next great challenge that nursing school brings. This is part of the road to a career that will be rewarding to you and will make a huge impact on humanity. Good luck—you’ve got this!
