Every day, nurses come to work providing care for patients requiring multiple levels of skilled nursing care ranging from basic to complex. Some patients may require vasoactive or vasopressor drugs to reduce or increase a patient’s blood pressure and other devices, such as a ventilator, intra-aortic balloon pump, or continuous renal replacement therapy, just to name a few, in order to preserve a patient’s life. In addition to caring for patients, nurses also have to make sure the patients’ family members understand the different aspects of the patient’s plan of care, such as the medications’ indication, side effects, and expected outcomes, as well as blood tests and diagnostic tests.
On a daily basis, nurses deal with the various level of stress caring for their patients and family members. These stressors could be the workload, time management, difficult patients and/or family members, discharges, admissions, and cardiac or respiratory arrest events. While nurses set goals to provide quality care that leads to better patient outcomes, nurses have the tendency to neglect themselves while working for the welfare of their patients by occasionally taking shorter meal breaks.
The big question is: who cares for nurses so they can continue to provide quality care every day to achieve positive outcomes? I see myself as a guardian angel for nurses whom I work with every day. Driving to work, I talk to God and ask him to help me make a positive difference, whether it is a soft touch of my hands, my soft-spoken voice, or my tight hugs. I believe that nurses should be cared for similarly to the way we take care of our patients and their families. Therefore, I look for a bible verse that would facilitate me making a difference in the lives of others. The bible verse I read is Proverb 3:6, which reads: “In all thy ways acknowledge him, and he shall direct thy paths.” The reason for this particular verse is that I need God’s guidance so I can be a blessing to others. The way I believe that I am a blessing to others is demonstrated by monthly birthday cards and luncheons for coworkers who are born in a particular month as well as greeting cards and gift cards for expecting mothers and fathers or weddings. I also recognize coworkers if they have achieved any type of certification or graduated from college.
Sometimes, I make and bring in desserts and have food delivered for lunch. On our unit, we are a melting pot of people. Every year in August, we celebrate International Culture Day where the staff brings an entrée from their culture and shares a little bit of history and its meaning. Additionally, I show concern about them as a whole and will ask them how they are feeling, what is going on with their children, dogs and/or cats, and their commute to work. The admiration of taking care of nurses and others as extended family members at work gives me great joy and pleasure that leaves my heart full of exhilaration every day.
So many people know of someone touched by brain disease that this month’s designation as Alzheimer’s and Brain Awareness Month is especially relevant.
Dementia and Alzheimer’s, a severe form of dementia, are devastating brain diseases that impact families across the world. As people live longer, the prevalence of brain diseases increases because the risk of developing dementia and similar diseases rises with advancing age.
Your career as a nurse means you can have a direct impact in your personal and professional life on the ravages of this disease. As a nurse, you can learn more about how patients with Alzheimer’s might react in unfamiliar situations (like a health care facility or hospital) so you can offer them even more effective care. You can also learn more about the signs and symptoms to help people who might be concerned about loved ones’ behavior or lapses in their own memory. You can also ease fear by debunking some of the common myths of Alzheimer’s (like that Alzheimer’s is only something elderly people get).
In your personal life, your authority as a nurse can help others in your life who might come to you privately with concerns. You can offer the reassurance and guidance that comes from learning more about brain diseases.
According to the Alzheimer’s Association, these are a few warning signs to notice:
- Memory lapses that disrupt daily life
Lots of people forget where they put the car keys. It’s troublesome if they can’t remember what the keys are for.
- Trouble completing normal tasks
It’s normal to forget how to get to the restaurant you only go to once a year. Getting lost while heading to the regular supermarket should be a red flag.
- Distinct mood changes
Getting a little grouchy at the end of a long day with family is okay. A sharp, noticeable change in normal mood is something to pay attention to.
- Confusion about time and place
In your office, a patient might not remember they are due for a tetanus shot. A patient who can’t tell you why they are in your office is showing warning signs.
As a medical professional, you always focus on prevention, but there is no proven treatment to prevent Alzheimer’s. However, it’s never too late to encourage activities that are good for overall brain health including a healthy diet rich in antioxidants, exercise, social interaction, and remaining interested in many activities whether that’s an interest in a certain historical period, trail walking, kickboxing, building model airplanes, or learning the intricacies of the stock market. Keeping your brain busy is good for your brain health.
One of the toughest things nurses face is caring for themselves, and eating for optimal nutrition at work is especially problematic. Filling up on whatever is around can actually zap your energy and lead to longer-term health problems. And a recent study proves the grab-and-go in the break room is challenging for everyone.
A recently published study by the American Society for Nutrition shows that relying on food in the workplace might actually hurt your health. In a time crunch, buying quick take out in the cafeteria, granola bars or candy bars at a vending machine in the hall, or a juice or soda for a pick-me-up can wreak havoc on everything from your blood pressure to your weight.
Even if you resolve to spend nothing on food at work, you aren’t out of the woods. The candy dish that remains filled with tiny pieces of chocolate, the birthday cake for a coworker’s big day, and the party leftovers that appear in the kitchen or break room all add unexpected calories to your daily or weekly total.
The study’s author, Stephen Onufrak noted in his presentation abstract the dietary quality of foods obtained in the average work setting of the study provided less nutrition and a higher ratio of sodium and fats than healthy guidelines recommend.
Even worse, you often aren’t even aware of what you’re eating. A few small cookies barely make a dent in your hunger, but easily pack a lot of fat and calories to your day with little nutritional value. And because nurses work a physically demanding job, eating on the run is pretty common. Sometimes you think it must be better to grab a slice of coffee cake than nothing, and sometimes it is better to do that. But planning ahead and having a yogurt that’s just as fast to eat, string cheese, whole-grain crackers, or a handful of dried fruit and nuts that provides fiber, protein, and a few vitamins to boot is a better choice and provides longer lasting energy.
If it’s the social aspect of workplace eating that appeals to you, just be aware of your intake. Allocate what you are willing to splurge on and what you won’t really miss. Advocate for healthier choices when food is supplied for meetings, lunches, or celebrations. Also be your own cheering section. Take the time to stash your favorite snacks in your bag so you can feel social, but still fuel your body with healthy foods. As with any behavior change, it helps to enlist support. Find a buddy who can help you resist the urge to nosh on whatever is closest at hand.
With healthier eating comes many benefits, but feeling better is one of the biggest benefits of all.
Stress in nursing is most likely attributed to the physical and emotional demands of patients and families, work hours, shift work, interpersonal relationships, and other pressures that are central to the work nurses do. Stress adversely affects the health, safety, and well-being of nurses, patients, and health care organizations alike; therefore, it is essential for nurses to reduce job stress and increase their happiness through their work.
Studies show that loving your job has less to do with your job and more to do with you. That’s right, there are simple ways you can ensure your own happiness at work every single day. Because happiness is the sum of love, optimism, purpose, courage, productivity, health, perspective, humor, and fulfillment, you must manage to achieve. Happiness won’t come to you if you do nothing.
Here are six simple actions you can employ to reduce stress and enhance your happiness.
1. Find out what makes you happy.
When you know the answer, you can add it to your life. If you are not sure, you should start taking detailed notes whenever you feel happy.
2. Create and write down a daily goal of joy each day.
Creating a goal allows you to focus on who you are in the moment, recognize and live your values, and achieve your emotional energy and happiness. Try to create one thing that you can look forward to each day at work, whether it’s seeing a specific coworker or your special lunch break. Whatever it is, the simple act of looking forward to it will increase the happiness you associate with work.
3. Make yourself familiar and comfortable with each of your coworkers and patients.
Studies show that working with unfamiliar coworkers and in different settings negatively impacts you at work. Make sure that you take time to introduce yourself to your coworkers and get to know your patients. Being familiar with your coworkers and patients increases your confidence and happiness at work.
4. Be optimistic.
Research shows that positive people are less likely to become ill. Optimism has been linked to an improved sense of well-being so try to look on the bright side whenever you can.
5. Love yourself and take care of your health.
Caring for yourself must be a priority. Eating well, staying hydrated, and getting enough sleep can make you feel good. And when you feel good, you have the physical and mental energy to work through daily challenges and focus on what’s good about the day. Make time to do the things that make you happy in the moment as well, such as listening to your favorite song during a lunch break.
6. Last but not least, put a smile on your face, act happy, and laugh every day.
Acting happy and keeping a pleasant expression on your face puts your mind in a positive state. Try to let go of negative feelings and learn to forgive because forgiveness will help give you inner peace.
The stress of nursing can take quite a toll on nurses emotionally and psychologically. Learn to recognize the signs, what to do, and when to seek help.
Abbegail Eason, RN, remembers some of the most devastating moments she’s witnessed as a nurse: a teenage girl learning she would never walk again after being shot by a gang member, a mom who gave birth but then died from a cerebral aneurysm just days later, and a baby who was left in a store’s parking lot and ended up dying.
“In these types of situations, it’s almost impossible not to be affected after your shift is over,” says Eason, a holistic coach at Abbegail Eason, LLC.
“Every nurse is susceptible to suffering from emotional distress,” explains Lucia M. Thornton, RN, MSN, AHN-BC, a consultant, educator, and author of Whole Person Caring: An Interprofessional Model for Healing and Wellness. Thornton and other sources we interviewed say that while all nurses can be affected emotionally, those in particular specialties may be more apt to experience this kind of issue. Some of the areas where nurses are especially at risk: emergency departments and trauma, intensive care unit (ICU), hospice, oncology, pediatrics, HIV clinics, homeless medicine, high-risk pregnancy clinics, palliative care, and neonatal intensive care unit (NICU), among many others.
“Anyone who is empathetic and works in a caregiving role—including nurses and certified nursing assistants—are at risk for developing compassion fatigue and increased caregiver stress, which affects emotional health,” explains Karen Whitehead, MS, LMSW, DCC, CCFP, who provides counseling in the greater Atlanta area and at TurningPoint Breast Cancer Rehabilitation. “Nurses who over-identify with patients and blur boundaries, as well as nurses with personal trauma histories, poor social support, isolated working conditions, or a previous history of unmanaged anxiety are at greater risk. Feeling a lack of control about your work environment—including schedule, lack of recognition, or sense of community—can also contribute to caregiver stress.”
“Working in these areas with these types of patients triggers the sympathetic nervous system and keeps the body in fight or flight mode. This heightened stress reaction can, over time, lead to compassion fatigue and ongoing emotional distress,” she adds.
It can also be especially difficult for nurses because they are on the frontline of patient care, says Carl J. Sheperis, PhD, NCC, CCMHC, MAC, ACS, LPC. “Aside from the ongoing stressors of variable schedules, budget cuts, and constant technology changes, nurses are faced with a broad range of emotions experienced by patients,” explains Sheperis, a licensed professional counselor as well as the program dean for the College of Social Sciences at the University of Phoenix. “According to the American Nurses Association 2011 Health and Safety Survey, over 56% of participating nurses had experienced some type of threat or verbal abuse from patients. All of these stressors compound and result in high incidences of compassion fatigue and burnout for nurses.”
Compassion Fatigue, Moral Resilience, and Burnout
Mary Bylone, RN, MSM, CNML, president of Leaders Within, LLC, and a former board member of the American Association of Critical-Care Nurses (AACN) often lectures and writes about the AACN’s healthy work environment standards. Bylone says that while compassion fatigue, moral resilience, and burnout are terms often used interchangeably because they do have a lot of overlap, they also have some differences.
“Burnout is best used to describe a situation in which an individual feels overwhelmed and exhausted. It can be seen when people sacrifice themselves for work or become overwhelmed with the feeling that the work is never done. Compassion fatigue refers to the weariness that develops from caring for individuals when the caregiver feels saddened that they cannot change the situation and give of themselves in the hope of relieving pain or suffering in the patient,” explains Bylone. “Moral resilience refers to the aspect of an individual’s character to rise above situations creating moral distress, such as being asked to provide futile care or care against a patient’s wishes. Resilience comes when the nurse is able to restore and maintain their integrity by challenging or pushing back when asked to do things they do not feel are right. It involves using one’s bold voice to speak up when others would remain silent—to ensure that the morally right thing is done.”
For the past decade, the AACN has addressed all these issues. Its National Teaching Institute recently held a special interactive session during which more than 300 nurses spent an afternoon sharing the types of experiences that would cause these feelings and sharing their solutions with their colleagues as well. “The AACN puts a lot of energy into hope and resilience rather than dwelling on the negative,” says Bylone.
Recognizing the Signs
“Experiencing emotional reactions is human and appropriate,” says Sheperis. “The key is recognizing when the emotional reactions are out of proportion to a situation or when they have a negative impact on you or others around you. Nurses are often good at compartmentalizing emotional reactions, but sometimes the compartments become full, and the emotions spill out.”
Some of the signs that a nurse is experiencing negative effects from emotional overload are: using a greater number of sick days and/or dreading going to work; feeling exhausted; problems sleeping; using drugs or alcohol to sleep; having work-related dreams, nightmares, or intrusive thoughts; being angry a lot either at work or home; yelling at patients or families; changes in mood or behavior at work; crying all the time; feeling angry at supervisors or coworkers; developing fears about the safety of friends or family; feeling less engaged in their personal and/or professional life; the inability to think clearly; headaches; gastrointestinal problems; irregular breathing patterns, feeling devalued, and losing the capacity to care about themselves, their patients, their family members, or really anyone.
This doesn’t even touch on the signs of clinical depression, which nurses may also experience. The point is that if nurses notice vast changes in themselves or in their coworkers, they may need to seek or suggest help.
The first action that nurses can take to keep their emotional health intact is to set boundaries, says Gail Trauco, RN, BSN-OCN, a grief mediator, owner of Front Porch Therapy, and author of Conquering Grief from Your Own Front Porch. Nurses can do small things to make themselves happy. “Be sure you have things that you visually see which create an immediate ‘happy sensation,’” suggests Trauco. “This can be a favorite coffee mug, bright-colored scrubs, flowers on your desk, or even a funny stethoscope cover.”
One of the biggest problems nurses have is that they tend to put everyone else’s care above their own, says Jill Howell, MA, ATR-C, LPC, a board-certified registered art therapist, professional counselor, and author of Color, Draw, Collage: Create Your Way to a Less Stressful Life. While she works at Pocono Psychiatric Associates, Howell worked with many nurses at the Pocono Medical Center. “It’s all about self-care—nurses will, of course, react by saying that they don’t have time,” says Howell. “Please remember what they say on the airplane—put your oxygen mask on first before you try to help others.”
When working with nurses, Howell would check in with them to see how they were dealing with work, give them an opportunity to vent, and make small self-care suggestions. She would also do quick guided meditations with them, teach a relaxation technique, or set up large sheets of mural paper and have them draw out their frustrations.
“I have found that most nurses, while they can care for others continuously, have a very difficult time in caring for themselves,” says Thornton. “Self-compassion is an important and useful practice for nurses to develop.”
“Nurses are givers. We go into the field because we are caretakers,” says Eason. “Many of us feel we are at our best when taking care of others.” She says that it’s important, though, for nurses to understand that they have to take care of themselves first. “Ensure you are getting adequate, quality sleep. You are eating a well-balanced meal. You are getting adequate exercise. You are spending time cultivating a life that is meaningful, rich, and deep outside of work,” says Eason.
After a particularly stressful experience at work, Lisa Radesi, DNP, CNS, RN, academic dean at the School of Nursing, College of Health Professions, University of Phoenix, says that nurses and other staff should have a debriefing session and remember that, despite all of the “bad” that occurs in their jobs, the “good” is the most rewarding part of what they do.
“Nurses should work together to ensure that they are okay after an incident. If a nurse notices a coworker is not doing well, they should talk with the coworker and bring it to the attention of the supervisor or manager,” says Radesi. “Above all, nurses should feel comfortable seeking treatment and communicating about emotional issues they may experience. Keeping this information bottled up can lead to issues and stress that have long-lasting effects. Know that it is not weakness, but strength, to acknowledge emotional disturbances and respond to them accordingly.”
If you see a coworker in distress, you can do something as simple as strike up a conversation with her or him, advises Bylone. “Use open-ended questions to find out how they are doing. Sometimes hearing the other person’s story really puts things into perspective. Let them know you care, and you are there to help, if only to listen. Please do not watch them suffer alone. Left unattended, these feelings only deepen and create lasting impact, often causing them to leave the profession,” she says.
Seeking Professional Help
Let’s face it: there are times when a spa day, time out with friends, or a bubble bath just won’t cut it in alleviating emotional problems. That’s when nurses need to seek professional help.
“If you are experiencing distressing symptoms over an extended period of time, it’s a good idea to check in with a professional therapist or counselor,” says Whitehead. “Whether it is distress from work or something related to your life outside of work, connecting with a professional can help you be a more effective caregiver and build your own resilience to mitigate the effects of your chosen population at work.”
If you need professional help, first see if your workplace has a program for staff members. If not, Sheperis says that the National Board for Certified Counselors has a directory of board-certified counselors across the United States (visit nbcc.org for more info). PsychologyToday.com also has a therapist directory that includes profiles of providers who can help.
There’s no shame in seeking help to get better. Sheperis says, though, that all nurses should do whatever they can to prevent their emotional stress from getting to this level. “Most people only seek professional help after something in their life had caused significant distress. While it is important to seek help if you are reaching a level of burnout or compassion fatigue, it is much better to take proactive steps and to work with a counselor to build resilience prior to hitting an emotional wall,” he says.
Sheperis also suggests that nurses focus on wellness practices at the onset of their careers. “It is easy to become engrained in a high-pressure system and to become emotionally overwhelmed if you don’t have a set of wellness practices in place.”
March is National Nutrition Month and offers up a good time to think of tweaking your diet.
Nurses are especially prone to falling into an eating-on-the-run trap. With long shifts that barely offer time to sit, nurses rarely have the luxury of taking the time to eat a relaxing meal when they are on the job. No one recommends eating quickly, but, let’s face it, most nurses have to eat quickly or they won’t eat at all.
During National Nutrition Month, the Academy of Nutrition and Dietetics helps people focus on making nutritious choices. Knowing that nurses have short bursts of time in which to get the most nutrition possible, they have to plan ahead to map out what is the best eating plan for them. Leaving it all to chance means fast food that might be higher in fat and salt and lower in things like fiber.
What makes sense for nurses? Figure out what and how you eat throughout the day and try to find foods that can fit that pattern but that offer a nutrition boost. Do you make a coffee run and add in a danish or a roll? Is lunch whatever is left in the vending machine and that you can eat in the few minutes you have?
Packing your food at home and bringing it with you is an easy option. Once you get into the habit of prepping your food at home (beware – it can feel like a chore until you get into a groove) you’ll have an instant fallback of food you like to eat, that gives you energy, and that provides you with the most nutrition possible.
Salads are an excellent way to pack in vegetables, fruits, and some great protein, but they take a lot of time to eat. You can keep the focus on the nutrition a salad provides and bring other foods that are healthy but take less time to eat. One of the easiest ways to pack in all those veggies and fruits is with a smoothie. Throw all the ingredients into a blender, add some protein powder or high-protein Greek yogurt, and you have an easy-to-digest and quick-to-eat option.
Lots of granola bars in the supermarket offer wholesome ingredients without extra sugar or added binders. With pure ingredients like nuts, seeds, and dried fruit, these bars are easy to tuck into a bag, don’t take a lot of time to eat, and offer energy-boosting nutrition. You can also make your own trail mix to bring. Customize it to include the ingredients you like and you’ll get an even more pure (and less sugary) small meal. Pair it with a yogurt drink, a hard boiled egg, or a few slices of rolled deli meat and you’ll feel more energized for a longer time.
If you think it will fit into your day, pack smaller portions, but eat more frequently. A small bowl of brown rice or quinoa, lentils, beans, or chicken, and some finely chopped veggies takes less time to eat than a bagel with cream cheese and offers a powerhouse of hunger-fighting fiber, protein, and nutrients.
And one of the best ways to keep yourself energized is to stay hydrated. Instead of fueling with caffeine all day, add in some other beverages. Try to swap out soda with flavored seltzers (add in some juice if you need more flavor) or throw a couple of fruit-flavored herbal tea bags into your water bottle with a little lemon. Being even slightly dehydrated quickly saps your energy and makes your body work harder at everything.
With a few small changes, you can give your body the energy and nutrition to have a more productive day and better overall health.