Keeping Burnout at Bay 

Keeping Burnout at Bay 

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.

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At the same time, NPs deliver more of the care patients receive in the U.S., according to a study published in September in The BMJ. From 2013 to 2019, the researchers found the proportion of all traditional healthcare visits

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 Strain 

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. 

COVID Makes it Worse 

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. 

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?”

Treating Burnout, Trauma, and Grief with Dance

Treating Burnout, Trauma, and Grief with Dance

Tara Rynders, RN, MFA, BSN, BA, admits she hasnt had the easiest life. From when she was a child, though, she would heal from it through dance. In fact, she wanted to be a professional dancer before she thought about being a nurse.

My earliest memory is of holding a neighborhood performance in my backyard—and its a lifeline that Ive held on to through all of lifes highs and lows,” Rynders explains.

So Rynders graduated high school and headed to Hollywood. But she soon realized that the business was more focused on outward appearance rather than the inward healing dance provided.

After my time in Hollywood, I realized that I wanted to be able to offer both emotional and physical healing. Nursing allowed me the entry point into that space. Its a profession that offers flexibility to keep connected to my lifeline—dancing,” she says.

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Trauma Hits Home 

Rynders came to embrace dance and bring it into the world of nursing after her tough times. She cared for her mother until she passed. Rynders says that losing her mother made her entire world fall apart. At the time, she was working as a nurse but decided to reach out again to what had always helped—dance. So, she cut down her nursing hours

to earn a masters degree in dance.

Her sister became ill during that time and went into a coma for months. Rynders took off a semester and went to live with her in rehab until she was transferred from California to Colorado, where Rynders was living.

In my sisters hospital room, my dance and nursing worlds began to collide,” recalls Rynders. Every night, I would dance to Miley Cyruss ‘Party in the USA.’ And I discovered that although my sister couldnt speak, she could laugh. That became my goal—to make her laugh.”

When Rynders returned to school, she created an immersive theater performance called You & Me that was connected to her experience as her sisters caretaker and her work as a charge nurse in the ER.

The show You & Me traveled nationally and internationally to more than five countries.

What I realized when I cared for my sister was the gift that comes from having one-on-one intimate moments with another human being—to bathe her, feed her, and help be her voice,” says Rynders. During the day, I would hold the suffering and loss with my sister, and at night we would hold the joy as I danced. It felt like I had both my joy and my grief coupled together in all that I did.”

One more scary experience brought Rynders to where she is today. When her twins were six months old, she learned she was pregnant again. But this time, it was an ectopic pregnancy.

When I arrived at the hospital, things moved quickly. I remember the ER tech rolling me on the bed with too much force to start my IV; the ER physician and his caring face took extra time to see and listen to me. I remember feeling his compassion for my situation. I remember being transferred to a room when my fallopian tube burst and my abdomen began to distend with blood,” says Rynders.

They called a code yellow—the code they call before a code blue when your heart stops. My room was full of people,” she says. I passed out, but I could still hear everything being said. I felt my nurse grab my hand. She leaned into my ear and said, I am here, and you will be okay.’ I remember thanking her for remembering me because I was so scared and couldnt speak.”

This experience caused Rynders to have an epiphany.  “I realized that nurses are everything to their patients–their voices, their advocates, their support, their healing hands. I experienced this firsthand as a patient and realized how many opportunities I was missing as a nurse to connect and see my patients authentically. I became passionate about this in my practice as a nurse and began researching authentic connection in nursing,” she says. Everything pointed to one thing: our nurses are tired, overworked, and our healthcare systems are not set up for them to thrive and successfully care for patients.”

Rynders decided she was going to change that.

Bringing Dance to the Nurses

Pre-COVID, Rynders says that nursing leadership was downplaying nurses burnout. And in 2017, nurses werent ready to talk about it openly.

But the CNO and CEO where she worked approved her creating a two-hour immersive theater experience at the hospital to raise awareness of compassion fatigue and burnout. She created the performance with artists Jadd Tank and Lia Bonfilio and worked with playwright Edith Weiss.

The 2-hour performance took place in the hospital and was open to the general public. The nurses, doctors, and other healthcare personnel testimonials were breathtaking. Most along the lines of Thank you for giving us a language to understand the unrelenting grief and trauma we have been carrying with us,’” says Rynders.

After raising awareness about burnout, Rynders co-created, with Dr. Clare Hammoor, a six-week grief and trauma workshop series. The nurses connected with it so much that they began having monthly meetings post-workshop, which continued until COVID.

At the height of COVID, my CEO asked me if I would come off the floor and focus on caring for our nurses as they cared for our COVID patients. This told me he also saw that our staff would need ongoing support,” says Rynders. The position was temporary, though; she would eventually work as a clinical nurse educator at another health care system.

Today, Rynders is also an advanced grief recovery specialist and a RESTORE (Resiliency and Equity Support and Training for Organizational Renewal) peer responder who is on call for health care personnel when they need immediate support.

I help teach resilience, equity, and anti-racism courses for our entire system. I do this alongside my position as executive director of The Clinic Performance. I see both of these roles mutually honoring each other as I bring my whole self into all my experiences,” she says. We dance in the hospital at our meetings, and having a pulse on nursing in the hospital setting is vital to creating workshops that tend to our nurses—meeting them where they are emotionally.”

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Tara Rynders in her dance workshop

Dance Workshops

Rynders workshops touched many people and were so effective that Kaiser Permanente asked her to bring them to nurses across California. These six eight-hour workshops with up to 600 nurses began in April and will run through September.

Our workshops are now titled (Re)Brilliancy, a play on the word resiliency. I was tired of hearing everyone tell us to be more resilient during the pandemic. Nurses are some of the most resilient humans I know. We need resilient systems that reflect the brilliant and resilient humans we already are. (Re)Brilliancy workshops help us reflect on and honor the brilliant and resilient humans we already are,” says Rynders.

Until they experience the workshops, nurses often dont even realize that their stories or experiences have continued to both of them.

Rynders knows that her workshops are keeping nurses from leaving the profession. I have seen firsthand nurses ready to leave—completely burned out and done with the profession. [Theyve] attended our workshops on an ongoing basis and have a rekindled joy and fervor for caring for themselves and their patients,” she says.

But more needs to be done.

Nurses go into this field to make a difference in the lives of others. At some point, we begin sacrificing ourselves to do this. We dont have to sacrifice our mental well-being. These workshops help us disentangle our worth and identity as caregivers from being directly related to how much we can sacrifice our well-being. Our workshops help remind us what we love, what we are passionate about, and what we need to feel seen, heard, and cared for,” says Rynders. If healthcare systems want to retain their nurses, they need to start thinking creatively and bringing in non-traditional and innovative ways to care for their teams. Wellness must be embedded as a cornerstone that everything else builds upon.”

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Preventing Nurse Burnout, Beginning with Hospital Leadership

Preventing Nurse Burnout, Beginning with Hospital Leadership

Nurses—especially in the last year during the pandemic—have been experiencing burnout. Often, articles focus on what they can do to make themselves feel better. But what can their workplaces do?

Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Wolters Kluwer, Health Learning, Research & Practice, a Critical Care Nurse Practitioner at Penn Medicine Chester County Hospital, and a Clinical Adjunct Faculty member at Drexel University. She’s also authored and presented on many clinical and professional topics including a recently published eBook, COVID-19: Transforming the Nursing Workforce in the New Paradigm of Care.

She took time to answer our questions about what hospital leadership can do to prevent nurse burnout.

From a hospital leadership standpoint, what are some of the steps they can take to help prevent nurses from burning out?

Health care systems need to recognize that their most valuable commodity is their workforce. For years, health care systems have focused on patient well-being, but now many of those institutions are beginning to see the importance of focusing on workforce well-being too. Hospitals need to provide a safe environment for their workers, recognizing when they’re exhausted, burnt out and/or experiencing moral distress on the job. Safe environments should include the assurance of personal as well as patient safety and having adequate personal protective equipment, clinical decision support resources, and adequate staff to appropriately care for patients.

Staffing needs must be based on clinical acuity and severity of illness, not just on the number of patients. And having an agile workforce that can work in a variety of units as well as be shifted to other units when and where they are needed the most, is also a new essential, thanks to COVID. What we want, and need, are multispecialty nurses who can work across multiple units, not just single-specialty nurses working only with one patient population. Cross-training and upskilling staff to care for patients in a variety of units with a variety of care needs brings flexibility and efficacy to the workforce so managers will not need to overwork staff and can provide necessary time off.

Health care systems need to recognize when a member of their workforce is experiencing burnout and moral distress by having leadership and those trained in recognizing emotional distress available and on the unit to assess for it. Social workers and mental health workers are excellent resources to utilize for this kind of assessment. Taking the time to debrief and discuss what went right and what could have gone better in emergencies is a great opportunity to decompress after stressful situations. Many hospitals have instituted a moment of silence after a death where everyone in the room stops to acknowledge the life that was just lost.

Employee assistance programs (EAP) are good, but only if they can be easily accessed by those who need them. Too often EAP programs are difficult to find on the health care system website, and once they are found, the paperwork and or searching for an available care provider is incredibly challenging. EAP programs need to be made readily accessible and usable.

What should they do first?

 The most important first step is to recognize that there is a problem with burnout. If staff are quitting, retiring early, or are becoming less engaged, there is a real problem. Be present! The leaders within the organization must be up on the units to experience what is going on firsthand. You need to find out if staff able to take breaks and leave the unit to have a meal. Are they able to sit down or are they constantly moving and up on their feet? Are they working as a team or as individuals? Health care is a team activity. It takes an interdisciplinary approach to provide the highest quality care and facilitate the best outcomes. If patient outcomes are not where they need to be, the first place to look is at your caregivers to see if they are exhausted, burned out, or experiencing moral distress.

 What action steps should leaders recommend that nurses take? How can they get this information to them?

The question should not be what steps leaders should recommend to nurses to combat burnout, but how can health care organizations facilitate workforce well-being and prevent burnout? It is the obligation of leaders to assess the situation, make a plan, implement it, and then evaluate if the plan and interventions are working.

Start meeting with the staff, watch and listen to what they have to say, and start implementing these 10 steps:

  1. Assess if the staff are burned out or experiencing moral distress.
  2. Make employee assistance programs easy to access and utilize.
  3. Adequately staff the patient care units with the right staff for the right patient populations.
  4. Cross-train the workforce so they are more agile and can go when and where they are needed.
  5. Provide adequate support systems, unit coordinators, unlicensed assistive personnel, and transporters.
  6. Make sure the workforce takes their breaks and mealtimes.
  7. Offer healthy food. Get a cart and take healthy options to the unit if the staff is too busy to get to the cafeteria at mealtime.
  8. Give the staff time to debrief and collect themselves after a challenging situation.
  9. Decrease documentation burden and make sure nurses have input on what is added to required documentation in the electronic health record.
  10. Offer continuing professional development activities and career ladders to meet the staff’s professional needs.

Remember, nurses have family and financial concerns; offer care alternatives and financial counseling if and when it’s needed.

If nurses are already experiencing burnout, what should hospital leaders do? How can they help? And how can they let nurses know that their jobs aren’t in jeopardy if they need to take time off for their mental health because of burnout?  

Take the time to see, hear, and experience what nurses are experiencing. You can’t do that from an office, so get up on the patient care units and look around. If the workforce doesn’t feel valued by the organization, they will leave, and there will be fewer caregivers left to care for the patients. Develop a “care without judgement model,” meaning that to whomever is in need of care—a patient, a nurse, or another employee—care will be delivered, without judgment. No one’s job should be at risk if they need to take time to step away and focus on self-care. You cannot be a good clinician unless you care for yourself first. Again, make it easy to access employee assistance and mental and physical health resources.

What should hospital leaders absolutely *not do when trying to prevent their nurses from burning out? What are the biggest mistakes they can make?

The biggest mistake health care leaders make is not recognizing that the health care workers are the most important commodity within their organization. Patient outcomes are optimized only if the staff feels valued, have adequate resources, are properly trained, and feel safe in their work environment—both physically and emotionally. Everyone on the health care team needs time to be able to take a moment to step away and recharge.

During COVID-19, what have been the biggest challenges that nurses are facing in terms of burnout? Is there anything that hospital leadership can do to help?

The biggest challenges have been fear and uncertainty. Fear that we initially didn’t know enough about the COVID-19 virus, and we might bring it home to our families or become infected ourselves, and fear that the death we experienced day after day wouldn’t stop. And uncertainty that we wouldn’t be strong enough to keep delivering care to our patients as we fought this seemingly unending pandemic. Yet we did. We looked fear and uncertainty in the face and said—”we will not be daunted!” That’s who we are—we are nurses, and our passion is to care for those in need.

Health care systems need to invest in workforce well-being, retaining the talent they have and recruiting new nurses to take the place of those who have left the profession. Care begins with those in our family. In health care, the workforce is our extended family.

Anything else?

The vaccine is a game-changer for nurses. The more shots in arms, the lower the number of patients we will see fighting for their lives because of COVID-19. Let’s trust in the science and use the evidence to educate people about COVID-19 and how to prevent it.

And finally, nurses need to invest in their own well-being so they can invest in caring for others.

9 Tips for Nurses to Stay Positive and Prevent Burnout

9 Tips for Nurses to Stay Positive and Prevent Burnout

Nurses work as superheroes every day, and the high-performance demands of this profession can lead to side effects such as exhaustion, anxiety, and constant stress. However, as leaders in health care, nurses can choose the way they approach their roles and thrive.

Below are nine strategies that can help nurses manage stress and stay positive all year long.

1.     Make Self-Care a Priority

Nurses are inclined to focus on the needs of others. However, the American Nurses Association explains, “Self-care is imperative to personal health and professional growth, serving as sustenance to continue to care for others.” Nurses should make a point to squeeze in at least one self-care activity that makes them happy every day, such as drinking a hot cup of tea or taking a bubble bath.

2.     Spend Time With Positive People

When work life feels hopeless, nurses can benefit from reaching out to others to gain some positive energy. Increasing social contact and venting to a good listener are great ways to relieve stress and calm anxious nerves. Sharing work concerns, problems, or thoughts with loved ones can also help build trust and strengthen these relationships.

3.     Set Aside Relaxation Time

Practicing daily relaxation techniques, such as prayer, meditation, yoga, or deep breathing, can help nurses achieve a state of restfulness. However, it takes daily practice to reap the full benefits. Getting into a habit of engaging in regular relaxation time can lead to improvements in overall health and happiness. These beginner-friendly guided meditations only take five minutes a day.

4.     Begin the Day With Positive Self-Talk

Daily positive affirmations, also known as self-talk, can have a significant influence on how we react to our environment, jobs, and other people. Making a habit of this can help increase self-esteem and reduce feelings of anxiety and depression. For instance, write a positive affirmation and keep it handy at work to refer to when starting to feel overwhelmed.

5.     Keep a Consistent Exercise Routine

Regular exercise is an excellent way to manage nursing stress and work burnout. As the Centers for Disease Control and Prevention points out, at least 30 minutes of daily physical activity helps to improve mental health, cognitive function, and quality of sleep, as well as decreases depression and the risk of many cardiac diseases.

6.     Just Say No to Extra Shifts

Nurses are often eager to assist when someone asks for help. However, working longer hours and agreeing to take on more shifts than necessary can lead to burnout and even compromise patients’ safety. On the other hand, saying no to extra work means saying yes to more meaningful things in life. This could mean more quality time with family, outdoor nature hikes, or starting a new hobby. Plus, when we achieve a better work-life balance, we become more effective as nurses.

7.     Take a Break from Social Media and News

When away from work, set a time each day to completely disconnect from social media, technical gadgets, and the news. Aim to also turn off cell phones, put away the laptop, and stop checking email. Instead, try spending some time outdoors, breathing in fresh air while doing something physically active and enjoyable.

8.     Aim for 8 Hours of Sleep

Getting enough sleep every day is paramount—particularly for nurses. An article from health.gov discusses several benefits of sleep. This includes an elevated mood, reduced feelings of stress, improved cognitive function, and better maintenance of a healthy weight. Therefore, it’s important to make time for a few calming activities to help unwind after a stressful day.

9.     Start a Gratitude Journal

Writing about what we’re thankful for can encourage feelings of optimism and boost overall  well-being. Gratitude journaling works by adjusting our focus, and changing how we perceive situations over time. This type of writing allows us to see more of the world around us, deepening our appreciation for the things and experiences we have.

Conclusion

Stress and overwhelm are an inevitable part of every nurse’s life. However, developing healthy habits and coping strategies can help reduce feelings of burnout and boost resilience. Try to implement a few of these actionable steps every week to maintain a better work-life balance and improve overall health.

Preventing Burnout with Natural Remedies

Preventing Burnout with Natural Remedies

Nurses in the United States are facing unprecedented hardships that increase the risk that they will experience burnout. Health care workers, especially nurses, often experience high levels of stress due to the long hours they put in and the sheer number of patients that they interact with.

Avoiding burnout is necessary for a long career in nursing and it is important that nurses do their research when it comes to methods for preventing burnout. While there is a pharmaceutical answer in the use of antidepressants, this method merely treats the symptoms that can lead to burnout. For many nurses, the answer lies in a more natural path that will give them the tools they need to combat burnout holistically.

Building Resiliency

Health care workers have been shown to be particularly susceptible to experiencing burnout due to the fact that they are expected to perform patient care with consistent and constant empathy and patience. This can lead to emotional exhaustion which, coupled with the physical exhaustion that comes with working in the medical field, eventually morphs into what we know as burnout. Naturally, the stresses of this line of work can lead to fatigue that impacts motivation in the workplace and a misplaced sense of failure.

One of the best tools available to nurses in the fight against burnout is the development and strengthening of resiliency skills. When nurses possess a solid foundation of resiliency skills they are better equipped to bounce back from a particularly intense shift more easily and are able to maintain their ability to work effectively. Taking breaks during shifts, scheduling time to hang out with coworkers outside of work, and learning how to say no to taking extra shifts if they need breaks are all ways to increase resiliency.

The prevalence of burnout and resiliency’s effectiveness in combating it has led to the development of nurse resilience programs designed to arm nurses with the proper tools before they begin their careers. Through cognitive-behavioral training, stress inoculation therapy, and various other methods, nurse resilience programs are effective in preparing nurses for what lies ahead of them in their career and can be invaluable in the fight against burnout.

Taking Care of Mental Health

Another natural proven method for nurses avoiding burnout is simply taking care of their own mental health and well-being. While it might seem like obvious advice, for those working in high-stress environments like health care can find it far too easy to forget to take care of themselves. Self-care is vital for nurses who want to dodge burnout, and even something as simple as keeping a journal to acknowledge positive things that happen in life can be enough to stymie burnout.

Many nurses suffering from burnout experience feelings of inadequacy, low self-worth, and depression. It is important that nurses recognize that these feelings, while they can be intense, do not represent the reality of the situation and do not reflect their actual performance or capabilities either at work or life in general. Quieting that negative inner-voice is an effective way for nurses experiencing burnout to boost their self-esteem and sense of self-worth.

Learning how to practice mindfulness meditation is another excellent natural way to look after one’s own mental health in even the most stressful of situations. Mindfulness meditation has a whole host of benefits from helping to increase attention and concentration to improving practitioners’ heart rates and blood pressure, all of which can help to manage stress and fight off burnout. While there are plenty of books on the subject, there are also a multitude of free resources available online that are secular, simple, and can get a struggling nurse on the right track.

Looking Towards Nature

Should building resiliency skills and working on maintaining good mental health fail to do the trick, spending time in the great outdoors has also been proven to help prevent occupational burnout. Engaging in physical exercise outdoors helps to reduce fatigue and improve overall cognitive function and can result in a marked reduction in tension, depression, and anger. While nurses do indeed have wildly busy schedules, making an effort to set aside time for themselves in the outdoors can yield incredibly positive results for them.

If a nurse finds themselves unable to break away from the concrete jungle, there are still ways in which stress can be reduced naturally without going outside. Taking the time to unplug from technology frequently can reduce stress and allow for moments of silent self-reflection untainted by the constant and looming force of the internet and social media.

Finally, nurses that are looking for a way to combat burnout but are wary of getting a pharmaceutical prescription to manage its symptoms can always turn to mother nature. Cannabidiol, or CBD, is a compound found in cannabis that has no deleterious or psychoactive effects and is becoming a popular stress-reduction tool for many. While the science regarding CBD is still in its infancy, there is a huge amount of anecdotal evidence that points to the compound being an effective treatment for stress and a host of other symptoms and disorders.

At the end of the day, nurses and health care practitioners are some of the most important people in a functioning society. It is vital that they receive all possible help when fighting against burnout, whether that comes in the form of resilience training, mindfulness practices, or spending time with mother nature.

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