Communication and collaboration are central to healthcare, and there are many tools for improving teamwork among medical facility staff members. Medical improv is an increasingly popular experiential strategy that adapts concepts and activities from theater improvisation to improve communication-related skills among healthcare professionals and critical outcomes in organizations.
The Background of Medical Improv
Beth Boynton is a nurse, author, educator, consultant, and medical improv expert. In describing medical improv and its impact, Boynton states, “We’ve known for over 20 years that communication, leadership, and human factors are leading root causes of sentinel events, yet many interventions have been unsuccessful in attempting to ensure best outcomes. Medical improv promotes essential competencies experientially where effective learning needs to occur.”
Boynton continues, “Medical improv provides professional development in competencies associated with emotional intelligence, interprofessional and therapeutic communication, teamwork, and leadership. These competencies, in turn, impact patient safety, patient experience, the health and well-being of the workforce, and even cost-effectiveness.”
Although it uses techniques from theatrical improv, medical improv is not focused on performance.
Boynton clarifies, “By taking the focus off of performance and entertainment and putting it on the learning process and healthcare teams’ goals, staff taking part in medical improv training have the opportunity to practice being together in a safe space outside of their usual stressful clinical environments. In this context, they can build caring, respectful relationships, and even laugh a little together as they learn about themselves and each other.”
“Experiential activities are integrated with other teaching methods (e.g., lectures, discussion, and reading materials) to address skill-building and/or outcome-related topics, “Boynton adds.
“The traditional teaching methods provide intellectual context about the topic and the experiential activity provides fun opportunities to practice skills with peers, reflect on one’s own behavior or habits, and discuss relevance to healthcare goals. The combination is much more effective than either of these teaching methods alone, and experienced medical improv practitioners can tweak activities to meet a variety of goals and objectives.”
“Yes And….”
A central exercise in the theatrical and medical improv worlds is “Yes And.” In this exercise, any idea one participant says is immediately enthusiastically accepted and validated by their partners. Rather than countering an idea with “No, but,” which can derail creative thinking, saying “yes and” allows the person sharing to continue thinking aloud without interruption. This strategy can be directly applied to actual meetings and brainstorming sessions to stimulate creativity and collaboration.
In another exercise known as “Radical Acceptance,” participants enthusiastically respond with “Yes!” no matter what their peers may say.
Boynton shares, “Some of the dynamic magic of this process is that some people will learn to listen better at the same moment that someone else is learning to be more assertive. By listening, we teach each other to speak up, and by speaking up, we teach each other to listen — these exercises provide a structure for that.”
Skill-Building with Medical Improv
Discussing the skills built using medical improv, Boynton points out that the experience of medical improv can improve communication, bolster social development, increase emotional intelligence, and strengthen interprofessional collaboration.
“These experiences can also help to reduce stress, burnout, and bullying behavior and increase patience, empathy, and forgiveness,” Boynton points out. “This can all be accomplished while allowing participants to learn how to take ownership of their experience and learn from their communication-related mistakes.”
Boynton adds, “Through exposure to medical improv, healthcare professionals become more able to learn from diversity, contribute to cultures of safety, and enjoy their work. Participants experience improved relationships and teamwork, less bullying, blaming, and burnout. Just as you can feel the tension in the air between stressed-out professionals in a team, participants experiencing medical improv can feel relief from these persistent and pervasive problems.”
In describing her work with healthcare teams and medical improv, Boynton is keen to clarify that every participant’s experience is different, and all come to this type of work from their own level of emotional development and experience.
Everyone is different in terms of their comfort level and the emotional risk that might be involved in developing emotional intelligence, and communication and relational skills. It requires expert facilitation to create a safe enough environment to ensure the best learning experience for everyone.”
Boynton adds, “It also requires familiarity with a variety of activities and the risk level involved. Workshops must be designed to gradually increase the risk level of activities so that people gain confidence in themselves and their peers, and trust in the facilitators.”
In terms of her approach, Boynton elucidates, “I invite and sometimes nudge folks to step into their stretch zones, and I promise to make their experience as successful as possible. It’s also helpful to explain to participants that medical improv is not about improv comedy or telling jokes, and I reassure them that they’re likely to have the most fun if they don’t try to be funny.”
“I welcome all healthcare professionals to explore medical improv resources while also advising that experiencing it is the best way to understand how it works and why it is such an incredible teaching process.”
Boynton concludes, “I see healthcare leaders, managers, and positive change agents as perfectly positioned to learn about the process and integrate activities into their staff meetings. With a commitment to learning how to teach these simple yet profoundly effective skills, this is an affordable and time-efficient intervention that any earnest leader can use for the benefit of all.”
On the job, nurses are compassionate and focused during stressful work conditions. However, this kind of work can drain nurses’ emotional energy to care for themselves and put them at risk for burnout and compassion fatigue, according to an article by the Holistic Nursing Practice. During times like these, it’s easy to forget about creative pursuits, like art.
Engaging in art can actually make us happier and calmer. At the University of New Mexico (UNM) Hospital, nurses at work participated in the UNM’s Arts-In-Medicine program to practice creative activities such as poetry reading and creating paper flowers and gift cards for positive wellbeing. As a result, more nurses felt relaxed, peaceful, and ready to complete their assignments.
Although we can’t always make paper flowers at work, engaging in art can significantly release negative emotions and feel more centered.
How Creating Art Helps Mental Health
Art is a great way to decrease stress. Studies have shown that engaging in art decreases cortisol and leads to better memory, resilience, and self-esteem. Other benefits of art-making include healing from trauma and expressing creativity on a deeper level, which can decrease anxiety and depression.
Many people from different fields, including nurses, have found art to be a way to cope with difficult times and use it as a relaxation method. Art that involves different uses of the senses also helps with emotional regulation.
In UNM’s arts-in-medicine program, hospital nurses who participated in art workshops like clay making, guided art walks, and other immersive experiences “learned to relax” and had greater self-awareness by paying attention to the shapes, colors, sounds, and textures of what they were making.
What Types of Art to Do
When we think of art, we might imagine painting a large canvas and getting intimidated in the process. However, art can also mean buying an adult coloring book with some markers or taking pictures of nature scenes on your phone. Our practice can be whatever we feel comfortable doing.
Painting isn’t the only form of art; other types of art we can explore include:
Doodling, coloring, or scribbling
Writing or journaling
Sculpting (e.g., clay making)
Scrapbooking
Needlework crafts
Jewelry making
Dancing
Photography
It’s better to make the practice as low-stress as possible so that you’ll continue with it over time. If you find it hard to start an activity, think about what type of creative pursuit you’ve always wanted to try. Is it making an art college online or designing a vision board using magazine clippings?
Remember, you don’t have to frame your art when you’re done creating it. This can be for your eyes only.
You can also buy a drawing prompt book to give you ideas for your creation. For those who want to try painting, you can find paint-by-number kits at your local craft store or online at mass-market retailers.
Using Art as a Tool for Self-care
Some art exercises are based on art therapy, which can help release lingering stress. Using art is also a unique way to get in touch with how you’re feeling. For example, drawing whatever comes to mind without making the lines look nice can help deal with perfectionism or a lack of control in life.
It’s important to note that if you want to try activities similar to art therapy, it’s best to find a certified art therapist to support you as you experience challenging emotions.
Many forms of art use therapeutic ways of relaxing, so consider the following art therapy-based ideas to help you become more expressive:
Use colors that calm you. What are some colors that calm you? Finding tones that help soothe you can be an easy way to feel more at peace.
Make a collage related to a quote you like. Maybe you have a quote you’d like to remember more when feeling anxious. Recreate aspects of the quote visually and turn the words into your inspiration. To create your collage, use stickers, newspaper clippings, paint, or other design elements to make the college stand out.
Or, collage your joy. If the last idea sounds too hard, consider what brings you joy (your pet, family, plants, etc). Then, find aspects of those things for gratitude the next time you feel lost.
Create a happiness jar. A jar is filled with moments of happiness, memories, or motivation for the future. This could be a good idea if gratitude doesn’t come easy. All you need is a jar, some scraps of paper, and a pen or pencil to write down your moments of joy.
Draw a place where you feel safe. Draw or paint a safe, peaceful, real, or imaginative place. Consider doing this practice and discussing how it felt with a trusted professional, such as a therapist.
When we’re busy in our careers, it’s easy to forget that we deserve to have fun and let loose once in a while. Picking up a brush or coloring pencil can be a great way to feel like a child again and discover our creativity.
As a nurse, you provide an incredible service for your patients. However, while caring for others, it’s too easy to forget to care for yourself. If you’re in that situation, it’s time to make a change. You may be more susceptible to health issues than others, so you must prioritize your wellness, which you can do during your off-time and at work. Here is some advice for why your health is so important and how to stay active and eat right during your busy life.
Why Wellness And Nursing Must Go Hand-In-Hand
Although most nurses spend a lot of time moving from place to place, it’s still a sad fact that obesity is more common in the nursing field than many may think. The reasons are numerous.
While nursing is rewarding, it can also be stressful, as you have to ensure that your job is performed correctly, or the patients may have complications. Nursing burnout is a very real thing. Working in stressful environments can cause chronic stress, which can disrupt your hormonal cycle and lead to overeating. Nursing also requires long hours, which can reduce the chances of getting enough sleep at night, and a lack of sleep can affect your metabolism.
The obesity epidemic is often more dangerous for African Americans. Studies show that African American women have the highest rates of obesity when compared to other groups in the U.S. That’s bad because people who are overweight are also more likely to suffer from different physical ailments, including high blood pressure and potential blood clots.
There’s also an anxiety component to consider. Worrying that you’re doing what’s right one hundred percent of the time can be very stressful, and an unhealthy diet can compound those issues. Staying healthy, exercising, and being kind and helpful to others can help you stay level and mentally stable during a high-pressure job.
Exercise When You Can
When you have a busy schedule, you need to fit in some form of exercise whenever possible. Luckily, there are ways to squeeze in fitness throughout the day, starting in the morning. If you’re crunched for time and cannot go to the gym, but you have a garage at home, try doing a short workout there.
You can maximize your garage workouts by doing quick exercises that require little to no equipment. Various programs include 15-minute core workouts, push-up variations and routines, and many beginner exercises that use no equipment. Another idea is to invest in a recumbent or upright stationary bike and put it in the garage. Then, you can work out while reviewing work and job reports to prepare for the day.
Making small adjustments in your routine when you’re at work and at home can help you perform many exercises, including ways to get more cardio. Park further away in the parking lot, take the stairs instead of the elevator, do calf raises, and stand instead of sitting whenever possible, and you’ll likely notice great results over time.
There are also opportunities to exercise if you work the night shift. Like in the day, you can count your steps and walk more during your shift or practice push-ups or sit-ups during lunch. It can be hard to stick to your workout regime when you’re alone, so get your other nurses involved by having a group workout or yoga routine at some point during the night after the patient’s needs are met. You’ll be more likely to follow your exercise regime if you do it with others.
Nutrition Is Key
As a nurse constantly on the go, stopping for a healthy meal is likely challenging. Instead, you may be tempted to get a quick treat from the vending machine or fast food so you can eat and go. However, while food like that may temporarily fill you, many of those items include trans fats, which can make you feel sluggish and are also bad for your overall physical health..
What you need is a plan. You must have your fruits, vegetables, whole grains, beans, fish, and berries whenever possible. In addition to being the building blocks of a healthy body, many of these food groups can also give you energy to help you stay alert and active when you get to work.
Most people need a proper routine to fit this food into their lives, so start one. Think about what you want to eat, then go to the grocery store and pack your lunch for work each day—that way, you know that you have healthy food that you can turn to throughout your shift. That way, you know that you have healthy food that you can turn to throughout your shift. It would help if you also packed your lunch with healthy snacks that you can fit in your pocket. A bag of almonds will be tasty while giving you a boost of energy. Granola bars and roasted chickpeas will do the same.
As you likely tell your patients, it’s also vital that you drink enough water throughout the day. At least 8-12 cups. Bring a reusable water bottle with you or keep it at the nurse’s station so you can be reminded to drink, stay healthy, and avoid dehydration.
Conclusion
As a minority nurse trying to make a difference in your patient’s lives, you must take care of yourself in your off-time to stay strong throughout the day. Finding ways to stay active and eat right will make a big difference.
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.
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 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?”
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.
Sleep
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.
Massage
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.
Exercise
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.
Music
Research shows that listening to 30 minutes of music a week can reduce stress and have physiological benefits such as reduced blood pressure.
Aromatherapy
Aromatherapy has also been proven to reduce stress. Even having different lotions, such as lavender, can instantly reduce stress.
Deep Breathing/Stretching
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.
