If you’re like most nurses, the demands of the holiday season plus an already challenging career and family life can really take a toll on your health and well-being. Instead of enjoying a season of joy, some of us may equate it to a season of stress. We get so busy we simply don’t pause to enjoy the festivities, like gift shopping, cookie baking, holiday parties, and visits with friends and family.
As nurses well know, stress can tear down your mind, your body, and your spirit. Of course, stress isn’t always a bad thing, but too much of it can certainly be. That’s why it’s absolutely crucial that you practice self-care during the next several weeks. When you’re more gentle with yourself, you’re able to increase your well-being and to enjoy a calmer entree into the new year.
With stress relief in mind, here’s a look at a multi-pronged strategy that will help you to conquer the chaos and put you in control during the holidays.
Give Yourself Preventative Self-Care
As a nurse you’re aware that diet and fitness are part of a holistic approach to easing your mind and staying healthy. There’s no secret formula to eating healthy, exercising smart, sleeping soundly, and otherwise warding off illness and disease.
Fight the Flu
Start with one obvious tactic: Have you had your flu shot yet? A vaccine can go a long way toward protecting you from minor aches and pains. Or worse, a full-blown case of influenza that keeps you away from the bedside and your patients for two weeks. The worst case scenario, of course, is if you were to become so ill that you had to be hospitalized yourself.
Fit in Fitness
How about making sure to work in a workout everyday to beat stress, boost energy, and burn off extra calories from those holiday cookies? You may have to sneak in exercise if you don’t have 30 minutes in one stretch. Break up your workout into three 10 minute segments—a short walk to work (park at the outer edge of the parking lot), a walk to your car after work, and a strength session using mini-weights while watching TV, perhaps.
Lighten Up Dishes
Comfort food seems to rule when the weather turns chilly, and it’s hard to say “No” when everyone is partaking of once-a-year treats, like eggnog. With some imagination and planning, you can be the diet savior who bring in lighter alternatives that are just as appetizing and festive. Your coworkers will appreciate a featherweight angel food cake with a side of tropical fruit just as much as a calorie-dense pecan pie a la mode. You’ll be glad that you gave a face lift to those heavyweight favorites when you see the scale in January and realized you’ve dodged that all-too-common holiday weight gain.
Lighten Up on Yourself
Taking care of your body is a good thing and it all starts with taking care of your mind. When you practice a gentle attitude towards yourself at meals, when working out, and while you’re at work and at home, you’re taking good care of yourself.
Oftentimes as a nurse, you get so tired that all you want to do is sit down (or lie down) and rest. When you’re mindful about self-care, you’ll be able to discern whether you really need that downtime, or you’re just feeling lazy. If it’s the second case, you can nudge yourself into going for a walk instead, knowing that it will clear your mind and help you feel good again.
The holiday season is a great time to focus on yourself, your health, and your own self-care. Practice prioritizing your health and happiness, and you’re less likely to go back to your old ways. Why not start today?
Raise your hand if you need this season’s first major holiday, Thanksgiving, to give you an extra push to focus on how much you have to be thankful for in your life.
Most nurses do!
But it doesn’t have to be that way. You can experience the cozy feeling of gratitude this November by taking a moment each day for a special time of reflection. The warmth generated from mentally saying thanks will spread to your loved ones, and then to your health care colleagues, patients, and their families.
We’re encouraging you to start your Thanksgiving celebration with this three-step gratitude practice. Even the busiest nurse can fit it in and recoup that investment with greater health and happiness:
Starting today, notice and list three things that you’re grateful for. It doesn’t have to be a major item and it doesn’t have to be new on your list. (If you’re grateful for that first cup of coffee in the morning, go ahead and list that every day.)
Continue noticing and listing for the several days leading up to Thanksgiving. You can get fancy with a special “gratitude journal” or stick to a simple notebook. In a pinch, you can write in the margin of your desk calendar or weekly planner.
At Thanksgiving Day dinner, say a word or two about your gratitude list. Suggest that everyone at the table share what they’re thankful for, if they’re so inclined. The lull between the meal and dessert is a nice, relaxed time to exchange these types of reflections.
A side bonus: who knows, you may have developed a new routine of taking a couple of moments to note your blessings each day. A habit like that has the potential to see you happily into 2019.
How does seeing and appreciating all that is good in your life increase your well-being?
Research suggests that it trains our brains over time to focus on what’s right and good and plentiful—versus what’s wrong or bad or in short supply. Robert A. Emmons, professor of psychology at UC Davis, is a leading authority on the science of gratitude and how it leads to a healthier, happier life.
In one of his studies, health care practitioners kept a gratitude journal (similar to what’s described here) for two weeks and saw a 28% decrease in perceived stress and a 16% drop in depression. Other studies demonstrated physical health benefits, such as lower blood pressure, from a gratitude practice. For more on Emmons’ work, check out “Gratitude is Good Medicine.”
Wherever you are on your journey towards self-care, as long as you’re taking steps forward, like jotting down three things you appreciate, that’s reason to be thankful!
The term “self-care” is a big umbrella that covers a ton of wellness topics, such as life-balance, stress relief, weight management, fitness, relationships, spirituality, and much more. It’s tough to pinpoint just one life arena you’ll want to make changes to in order to become happier and healthier. But it’s possible and may make your self-care journey easier.
Here’s a tip: Start with sleep.
Why Sleep Is So Important
This is probably the number one area where you can improve your health and well-being. Nurses are notorious for not getting enough sound sleep on a regular basis—odd shifts and rotating schedules don’t help the body to regulate rhythms. Fatigue is one thing but it’s worst when a sleep-deprived nurse actually nods off while at the bedside or on the road after a late shift. Obviously, that’s extremely dangerous—for you, your patients, and everyone near you.
Most American adults don’t meet the guidelines for sufficient sleep (seven to eight hours) and many of us consider it a luxury we can’t afford, or try to “bank” shut-eye by sleeping for 5 hours on work nights and 10 on days off. We like to think that getting along on little sleep is a sign of superhero strength and those who prioritize rest are weaklings. None of those beliefs are accurate. Here’s how you can take care of yourself, in spite of our hyperactive society’s mistaken take on rest and sleep.
The Basics of Sleep Hygiene
Chronic sleep deprivation and sleep disturbances, such as sleep apnea, can be improved by following good sleep hygiene protocols. Try these tips:
Cut out caffeine later on in the day. (That includes certain soft drinks and chocolate, as well as coffee and tea.)
Drink alcohol in moderation, or not at all, because it’s more likely you’ll wake at night after a drink or two.
Another reason to stop smoking cigarettes: nicotine interferes with sound sleep.
Finish your last meal of the day a few hours before bedtime so you’re done digesting.
Don’t do heavy exercise late at night, though gentle stretching or yoga can be a restful entrée to sleep.
Setting the Right Environment for Rest
Digital sights and sounds make it harder to slow down and get ready for bed. Younger nurses, being social media natives, are especially prone to texting, tweeting, Pinteresting, and streaming movies in their bedrooms. Make it a rule to keep your smartphone, iPad, or other devices out of your bed. That way, you won’t be tempted by social media, news, or entertainment right up to the time you turn off the lights. Some nurses even set a digital curfew and power down devices two to three hours before bedtime.
When Your Mind is Too Busy to Turn Off
Some nurses find that the simple act of journaling before bed helps them quiet the worry, anxiety, and fears that may be keeping them awake. Nursing is an emotional occupation and there isn’t always an opportunity to process what happens during the day while on the job. That’s when a notebook and pen by the bed can be a curative. One of the principal researchers in the area of journaling and health is James Pennebaker, a psychology professor at The University of Texas at Austin and author of “Writing to Heal.” His studies have shown that expressive writing (journaling) is a simple and effective way to relieve stress while boosting both mental and physical health.
Most registered nurses are familiar with the rights of patients under their care and work hard to alleviate suffering and maintain respect for human dignity. They advocate on behalf of patients, their families, the community, and society as a whole. But many nurses do not know their own legal rights and responsibilities as health care professionals.
Nurses with knowledge of whistle-blower laws, for instance, may be more likely to press administrators to end patient-care abuses or fiscal fraud. Standing up for what’s right is tough in any case, but especially for women and minorities, who make up a majority of the profession. Yet, minority nurses have historically demonstrated heroic activism for community health and social justice, during the civil rights era and the AIDS epidemic, for instance.
Nurses face the same legal issues as many other employees, such as sexual harassment in the workplace. But they also must protect against career-specific liabilities, such as
being accused of violating the nurse practice act or similar regulations.
“There are three major concerns for nurses,” according to Gerard Brogan, RN, lead nursing practice representative at California Nurses Association and National Nurses United. “I travel and talk to nurses across the country and union or not, I hear the same things. The first concern is nurse-to-patient ratio, two is violence in workplace, and three is scope of practice.”
This article, then, will focus on legal issues that are unique to nurses.
Nurse-Patient Ratios
Nurses across the country have expressed overwhelming concerns regarding these roadblocks to patient care and safety: short staffing on overcrowded units, limited ability to take even short breaks due to scheduling gaps, floating nurses without the proper training for certain departments, and so on.
According to Brogan, California is the only state in the country that has nurse-to-patient ratios. “Massachusetts and Arizona have them for the ICU only,” he says. “Nurses are working in understaffed hospitals, which are dangerous for patients and everyone else. We now have two nurse-to-patient bills in Washington. One is a house bill and one is a senate bill. They would require every hospital to adhere to ratios similar to the California bill.”
Brogan says that he often sees on social media the phrase “nurses should not be political.” But he believes that’s a naïve and possibly dangerous position. “Health care employers are heavily involved in politics, so as an organization and profession we have to also be involved in politics ourselves.”
Other aspects of staffing include how hospital plans are created and implemented allowing direct-care nurses to play a role. “The Oregon Hospital Nurse Staffing Law gives power to the hospital staffing committee,” says David Baca, RN, BSN, an emergency room nurse at Asante Rogue Regional Medical Center in Medford, Oregon.
The law is also a legal measure regarding rest-breaks and specialized staffing on specific units and departments. “The phrase ‘A nurse is a nurse is a nurse is a nurse’ is common, but that kind of thought process needs to go away as it becomes clear that appropriate education and training are needed,” says Baca.
The nurses at his hospital also recently won a new contractual right: break-relief nurses on units, when necessary, to allow nurses to schedule earned breaks and meals. Baca estimates that only 30-40% of nurses at his hospital know about the new staffing laws. “A little more education is needed,” including the hospital and individual nurse’s unit. “Standards and practices in the ER should be something we’re aware of. If not, we should be asking: ‘What does the ENA say about staffing and nurse patient ratios?’”
Workplace Violence
“When it comes to workplace violence, nurses have been in the top five forever,” says Baca. According to an U.S. Bureau of Labor Statistics analysis, 52% of all incidents of workplace violence in 2014 involved workers in the health care and social service industry. “The ER is open to everybody. We serve everyone, including the intoxicated or those with mental issues, so nurses are assaulted. It happens on almost a daily basis.”
“A few years ago, we had a huge problem with psychiatric crisis patients. We couldn’t secure them in appropriate rooms for their own safety and ours. They’d either elope or assault. That’s a huge risk, so the hospital invested a million dollars into ER security for the safety of everybody,” says Baca.
“Most assaults in the ER go unreported. If you regularly see colleagues assaulted, it becomes the norm,” warns Baca. “Maybe we need to prosecute more patients who assault nurses, medics on ambulances, or technicians. There’s a very low prosecution rate and almost no legal ramifications for patients who assault. We need to change the workplace culture that accepts violence.”
In 2014, California enacted a trailblazing law to reduce workplace violence incidents in health care facilities. “Every hospital has to develop a comprehensive workplace violence program to protect the safety of patients and employees,” Brogan explains. “We’re not just interested in working on the welfare of nurses in California or nurses in the union. Our efforts are for nurses across the nation.”
Then there’s the more common, less intense form of violence: bullying…
Brittney Wilson, BSN, RN, a social media influencer also known as The Nerdy Nurse, started blogging as a response to the stress of nurse-on-nurse bullying as a newly graduated floor nurse.
“What I learned from my experience with lateral violence is that in a right-to-work state it is very difficult to make a stand for yourself,” Wilson explains. “I did learn that in order to build a strong case for yourself you should keep notes including dates/times/names of incidences. You should also report incidences as soon as they occur. But if your hospital does not have a union, it is pretty much your word against another employee.”
In Wilson’s case, the nurses who witnessed the bullying weren’t her allies, and neither was management. “My employer didn’t support me and believe me enough to address the work environment, pursuing the issue just made things more difficult for me and lead to me being forced to take a different position and a pay cut until I ultimately left the organization,” she adds.
Though nurses have a right to be treated with dignity, respect, and civility, they sometimes must fight just for an environment that isn’t downright hostile. Wilson advises nurses in that situation to “find new employment and an organization that will support and value them. We are living in an economy where there are more jobs than there are nurses. If you aren’t being treated respectfully, you owe it to yourself to remove yourself from a damaging situation.” That’s just what Wilson did, parlaying her newly accrued digital skills into a well-paying and satisfying career in nurse informatics and technology product development.
It goes without saying, but nurses must themselves also avoid those types of uncivil, hostile, bullying, or intimidating behaviors that show disrespect for patients or colleagues. Otherwise, they put themselves at risk of censure for trampling the rights of others.
Scope of Practice
“There are fifty states and 50 different nurse practice acts,” says Brogan. “Hospitals don’t really educate employees on the legal scope of practice. I’ve been educating nurses for 20 years and find that hospitals see nurses as a unit of labor, not as a professional.”
In today’s fiscally-focused health care landscape, there is always a concern that the scope of professional nursing practice is at risk from understaffing, de-skilling, and other encroachment, warns Brogan.
“The hospital industry is trying to expand the scope of nurse’s aides and medical assistants. Nurses are professionals with independent judgment,” he says. “If they are given too many patients to care for, as is often the case in non-unionized hospitals, they have to take them or they can be fired.”
All nurses need to remain current, competent, and within their scope of practice, or risk losing their license—and their career. Protect yourself by taking continuing education courses in nursing (online or in-class) or enrolling in an advanced degree program. If further formal education is problematic, you can learn informally through a professional nursing association, either for your particular minority group or one in your specific area of
practice.
Rachel Seidelman, RN, a direct care nurse at Providence Health & Services in Portland, Oregon, has been a nurse for eight years and continually updates her understanding of the law. She knows her state nurse practice act rules and reviews them regularly to ensure she protects her practice and her license. “The biggest thing that’s helped guide me comes through my union; there’s a branch for practice. I know state and federal law and the overlap. I make sure I know who I can delegate to, because it’s all on me if a colleague messes up under my umbrella.”
“How I was precepted really helped me as a young nurse without much work experience,” Seidelman says. “Part of the onboarding process is to ensure they understand the wage scale, the contract and their rights within it, and a lot of other things, too. I’m a preceptor now and will never stop because I learn so much from doing it.”
One example of how Seidelman expands her knowledge of issues related to nursing practice concerns the opioid epidemic. After reading a series about it in the state’s major newspaper, she wondered what her response should be as an off-duty nurse encountering a stranger overdosing. Should she carry the opioid antidote naloxone as a precaution? “That question led me to the Oregon Nurses Association, my employer, and discussions with pharmacists and mentors.” She couldn’t obtain the antidote without a prescription, but new laws enacted in 47 states make it more freely available. The surgeon general recently urged opioid users, concerned family members, and professionals to keep it on hand.
“In this day and age, it’s important to protect our own license and also protect our patients and colleagues. I advise fellow nurses to ask good questions, be curious, find answers, and then tell others,” says Seidelman.
Advocating for Your Patients, Community, and Profession
Nurses have long participated in the political process and sought to shape health care legislation that supports nurses as well as benefiting patients and communities.
Martese Chism, RN, a Chicago nurse, is inspired by the example of her great-grandmother, Birdia Keglar, a civil rights activist in the 1960s. “She marched in Selma with Rev. Martin Luther King Jr. and lost her life because of it. Dr. King, in his speech, said he would like to have a long life, but that wish didn’t stop him from protesting,” she says.
Chism explains that her first college degree was in accounting, but she discovered “my calling is advocating for patients,” so she went back to school to become a nurse. “We’re supposed to advocate for our patients… I believe my fiduciary duty is to my patients, not the hospital. I advocate for my patients, but in the back of my mind, I worried about job security. I was single and didn’t have a family to support, but if I had, I wouldn’t have been so vocal without my union,” she explains.
One matter that Chism has spoken out about is the closure of public hospitals and other health care facilities in minority communities. “When elderly patients with no insurance need skilled nursing care our hands are tied [because of the closures] so now our uninsured patients have nowhere to go,” she says.
Some of Chism’s patients were retired public employees who aren’t eligible for Medicaid or Medicare. “They’re now turning 70 or 80 and they have no insurance. That’s why I’m fighting for Medicare for all,” she says. “As nurses, we’re supposed to advocate for our patients, but I don’t feel like I can without union protection. If I do, I’m branded a troublemaker. I’ve been speaking out in public for a long time and I could never get a promotion. If it wasn’t for the support of my patients, and union, I wouldn’t have lasted this long on the job.”
According to The Code of Ethics for Nurses (2001), nurses do have the right to advocate for themselves and their patients, and to do so without fear of retribution. Each state’s nurse practice act varies, but Chism was outraged when Illinois tried to remove “advocacy” from its nurse act. “They tried to say that your duty is to your employer, but our union fought to stop that. We don’t know about the future, though, especially with the recent [Supreme Court] Janus decision. The union movement might be weakened even more.”
Finding an Attorney to Explain Your Rights or Represent You
Even though you do your best to learn the laws related to nursing, you can’t always avert legal trouble. There may be a claim of professional negligence, say, and then you’d need to retain a qualified attorney in your area to defend you.
“Generally, look for an employment lawyer, they will understand the federal and local laws on wages, overtime, discrimination,” says Jeffrey M. Edelson, JD, attorney at Markowitz Herbold in Portland, Oregon. “They’re often divided by union and non-union. The tradeoff with collective bargaining is that an agreement could be in conflict with state law.”
If facing disciplinary action with the nurse licensing board, you may require an attorney who specializes in licensure protection.
Or your case may call for an attorney with experience in an entirely different area of practice. “For example, in the case of the Utah nurse [Alex Wubbels refused to draw blood from an unconscious patient], you’d need a criminal lawyer,” he explains. Or, if you work at a state hospital and are fired for expressing an opinion or acting on a matter of conscious, “you may need a constitutional lawyer in that you may have additional first amendment rights, versus if you’d worked at a private clinic,” Edelson adds.
A common way to find an employment lawyer is to checking profiles in listings such as “Best Lawyers in American,” he suggests. Or use your personal network of nurse colleagues, friends, or family to find an attorney. “Call your family lawyer, the one who does wills, and ask ‘do you know an employment lawyer?’” You’ll likely be referred to an appropriate attorney. Plus, “you’ll get that lawyer’s ear because you’ve been referred,” says Edelson, and they’ll each want to protect their professional relationship. Ask about their experience with your type of legal trouble or concern. Then inquire about fee structure. Some will charge for an initial consultation, while others won’t, and most work on a retainer basis, though some will take a case on a contingency basis.
Other resources for finding local attorneys: your professional nursing organization or union, the American Association of Nurse Attorneys (TAANA), and the State Bar Association.
In addition, you may want to purchase malpractice insurance (including license defense coverage) in advance of any need. Some professional nursing associations even offer a discounted rate, making it a prudent and affordable option.
Very soon it will be Halloween, the start of a holiday season that researchers warn adds an average of eight pounds — if you’re not careful about sweets and snacks.
Ouch!
Nurses have a lot of practice saying “no” to treats at work – boxes of candy from grateful families to trays of pastries from coworkers. Temptations abound, but they become especially intense during the next two months of the year.
Of course, we love getting together with teammates to mark Halloween, Thanksgiving, Hanukkah, Kwanzaa, Christmas, Solstice, or the New Year. Plus, we’ll continue to toast other happy occasions: birthdays, anniversaries, weddings, graduations, and job promotions.
So what’s the problem? Some surveys show that nurses are more likely to be overweight than the general population. Could the reason be extreme workplace stress and long shift hours? Or maybe it’s because the nurse population is aging, which correlates to a higher BMI.
You may not be able to do anything about events at work or your own slowing metabolism. But you can control your own actions, which will help you keep on the nutritional straight and narrow.
Here are a few ideas that have worked for other nurses:
First try to become aware of any emotional basis for your cravings for sweets and treats. It’ll then be easier to make behavioral changes, which will go a long way toward keeping you at your healthiest weight.
Decide beforehand on your “food rules” for this season, and then don’t deviate from them. For instance, you may decide to bring low-calorie snacks to events so that you’re not so tempted by sugary, fatty, or salty offerings. A cup of cubed cantaloupe is sweet (only 7 grams of natural sugar), while cut vegetables with Greek yogurt dip and air-popped popcorn with chili spices are savory.
Devise a healthy-eating phrase to repeat silently to yourself when you’re most tempted. Here are a few mantras to try this Halloween, and if some prove helpful, to keep handy all year long.
“My stress level is through the roof, but chocolate is not the solution.”
“Sugar is not the best antidote for fatigue from 12-hour shifts.”
“I can accept the good wishes, but resist the treats from families and staff.”
“I deserve better than sugary goodies when I work a night shift.”
“Sweets can not change my not-so-sweet feelings of anger at work.”
In addition, try to cut out sweets in other areas of your life, too. The American Heart Association says to limit added sugar to 6 teaspoons for women and 9 for men. That’s a tall order when you consider that the American average is 22 to 30 teaspoons a day.
You have to be a good detective because sugar hides where you least expect it, like in coffee drinks. Compare a Starbucks’ Grande Vanilla Latte vs. plain coffee with a packet of sugar. The difference is a whopping 32 grams of sugar!
Of course, plain black coffee would be best, but that would probably be too big a shock to the system for a coffee drinker with a sweet tooth.
It’s better to make small and sustainable changes, such as eating and not drinking your snacks and meals. Fruit smoothies, for instance, enjoy a “health halo” but can pack on the pounds because they’re high-calorie, high-sugar, and apparently innocuous.
Sometimes it doesn’t pay to fight the inevitable, like candy on Halloween, though you can sidestep some of the danger. So, don’t go hog wild but instead enjoy a fun-sized piece of candy (80 calories for most bars), and you won’t do too much damage.
It goes without saying, but don’t be the health saboteur who brings bags of candy to work. Your fellow nurses and other staff members won’t appreciate it.
At home, buy your least favorite candy for trick-or-treaters – and fewer bags than you think you’ll need to prevent leftovers. If you want to avoid temptation altogether, give out mini-toys or stickers instead of sugary treats. In a pinch, just reach into your wallet or piggy bank for some quarters and dimes. The youngest goblins appreciate even pennies!
It’s not easy to limit treats around Halloween, but remember, you’re taking good care of yourself, and setting a good example for your patients.
