Some of the biggest barriers human beings have in dealing with each other are all the assumptions we make. Have you ever been shocked when a neighbor who seemed so pulled together with her beautiful clothes, nicely behaved children, fantastic job, and loving spouse has the most acrimonious divorce? Did you assume her life was perfect because it appeared that way to you?
Nurses, who see all walks of life each and every day, are less apt to assume each person has the life they appear to have. After all, nurses see people in what is often their most vulnerable and often most unhappy times.
But, according to Margaret Erickson, PhD, APRN, CNS, AHN-BC, executive director of the American Holistic Nurses Credentialing Corporation (AHNCC), there is one area where nurses’ assumptions can get in the way of caring for a patient on the level the patient needs.
Making assumptions about self care, she says, can be a problem for patients because self care means something vastly different for each of us. What fuels your soul might not be what makes your colleague happy. What makes you physically, emotionally, and spiritually whole is not going to be the same for your patients.
“I believe people know what they need,” Erickson says. “Our job is to be supportive of that knowledge. Don’t presume what self care looks like to you. Modeling isn’t showing them what to do.”
For some people, a 10-mile run, healthy eating, and getting a solid night’s sleep not only means they are taking care of their bodies, but also nourishing their souls. But for some people, it’s an afternoon of sappy movies or an hour reading People magazine. Are they the same on the health scale? Maybe not. But as a nurse, giving your patient permission to care for themselves in the way they know they need is part of figuring out how they will care for themselves when they leave your care.
The trick, says Erickson, is active listening. Listen without an agenda. Listen without waiting for your turn to speak. Listen without forming any comeback statements. You might be surprised at what you hear. Erickson practices using the Holistic Nursing Theory of Modeling and Role-Modeling (MRM; Erickson, Tomlin, and Swain) which gives guidance on combining both listening to the client’s story and using the art and science of nursing to facilitate the greatest well-being for the client, she says.
Erickson recounts the story of a man who for 15 years had been labeled as difficult and non-compliant. A diabetic, he was not following proper self care and had health complications because of it. Only through careful listening and noticing some nonverbal clues did Erickson find out some stunning information. For instance, the glazed look he got when his nurse talked about fruits and vegetables? When Erickson gently asked about it, he said he lived on a reservation and fruits and vegetables were delivered just once a month. If you were not there in time, you didn’t get any. So he had virtually no access to the fresh produce his care team said he needed.
He also mentioned that he tried hard to comply and use his insulin. But the medication had to be refrigerated and he did not have a refrigerator. For 15 years, no one knew that. No one asked about his living situation, and he didn’t mention it. But no one ever asked about how he took care of himself. They only told him what to do, says Erickson.
“When we are limiting with our world view, we put up a barrier,” she says. “We don’t talk about engagement with clients or colleagues.”
Instead of saying, “I am here to help you feel better,” nurses might consider saying, “How can I help you feel better?” says Erickson. “In order to plan interventions to be most effective, you have to see their world view,” she says. “We tell patients what to do for self care and then we wonder why they don’t participate in their own self care. It’s because it was never their plan.” With more focus on the person and less focus on the tasks at hand, the patient-centered care comes to the front. “Otherwise care becomes a cookie-cutter approach versus care individualized to each unique person,” Erickson says.
So when you find yourself wondering why a patient can’t seem to follow your instructions, seems uncomfortable with a plan of care, or seems puzzled, indifferent, or even resistant, dig a little deeper to find out what they think they need.
“Our goal is to facilitate clients to do self care actions,” says Erickson. “If we don’t plan care and engage the client in that care, harm can be done. Try to remember, ‘It’s not about me, it’s about them.’”
National Disability Independence Day on July 26 honors the signing of the Americans with Disabilities Act (ADA) on July 26, 1990. With the passage of the ADA came opportunities for people with disabilities, including greater access to previously inaccessible public areas and job training skills for employment.
With one in four Americans reporting having a disability, nurses with disabilities exist in the field while providing value in clinics, hospitals, and other areas of work by showcasing the importance of inclusion and diversity, especially in patients with disabilities.
Despite the increased opportunities for nurses with disabilities in the workforce, they are often confronted with high levels of burnout in the healthcare industry. Having to manage their disabilities while dealing with the fast-paced demands of nursing may make them more vulnerable to burnout or even lead them to leave the nursing profession altogether.
So, what are some ways nurses with disabilities can practice self-care to prevent burnout?
Find Accommodations That Work for You
For nurses with disabilities who work in clinical settings, many of them struggle to obtain accommodations, or are unable to do certain tasks that can lead them to quit or think about leaving their job.
It can be hard to advocate for yourself in this situation. Some workers have invisible disabilities or disabilities that aren’t physically apparent to others. Examples of these disabilities include diabetes, traumatic brain injury, chronic pain, and mental health conditions.
In this case, consider your situation and decide what first steps to take to ensure you get the support you need.
Here are some other ways you can advocate for yourself at work:
Find personal accommodations for yourself. It might be optional to tell a manager or supervisor about accommodations you need. If you find yourself in this situation, discover ways to make your job easier for yourself. Ask a fellow nurse to tag team with you on a client load, or take more breaks to relax if you need to sit down.
Learn how to communicate what you need. If you do need accommodations from your workplace and leaving your job isn’t a reasonable option, talk with your employer about what accommodations you need. It’s likely that they don’t know exactly what you need, so be prepared to ask for specific accommodations that can benefit you. These can look like assistive technologies such as screen reader software or a modified work schedule that is suitable for you.
The ADA requires employers to provide accommodations for employees who ask for them, so feel encouraged to ask for the help you need to do your work effectively.
Discover How to Self-manage a Disability with Coping Skills
There are many coping skills you can use to manage living with a disability. These skills can significantly help on bad days when it can feel like your disability is keeping you from doing the things you want.
“Self-managing” with strategies doesn’t always mean dealing with all of your symptoms by yourself. You can find a friend, family member, or someone with the same disability to be an accountability partner who can guide you through challenges at work.
Try out other coping skills below and see what works for you.
Be Aware of What You Can Control
Those with physical or mental disabilities can be overburdened by emotions or physical pain. It can be easy to slip into a negative spiral of “I can’t do this” and other thoughts that leave us feeling bad about ourselves. However, catastrophizing only leads us to stay stuck and isolated.
You’re not alone in this type of thinking. Adults with disabilities are five times likelier to have mental distress than those without a disability. However, it’s important to note that thoughts about how to care for yourself in the future are valid and show that you care about your health.
Consider taking actionable steps to help you live a more well-balanced life. Do you need any assistive technology at home? Search for what you need to get an idea of assistance available near where you live. If you’re struggling with your mental health, write down what you’re dealing with through journaling or another mindful technique.
Find an Activity You Enjoy
Spending time on a hobby can help us get out of our heads and engage in something we love to do. If you can’t do something you love because of your disability, find an interest you have and create an activity out of it.
For example, hiking in nature can be good for exercise but difficult for people with chronic pain. Painting landscapes, light walking, or photography are other options for people who want to get outside but can’t always do so.
This is also a good way to meet like-minded people who share similar interests. Yoga, gardening, and reading groups are other common groups, so you might find some near you to share and expand your support system.
Takeaway
Practicing self-care doesn’t always involve baths and long naps. While it can be that way for some, advocating for yourself and taking time to enjoy fleeting moments are other ways to take care of ourselves and ensure that we’re living a happy, rewarding life.
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.”
Oftentimes, nurses don’t take care of themselves like they should. While they focus on taking care of others, their self-care falls by the wayside. Especially during COVID-19 and the pandemic, they’ve put everyone else first.
Imani Wilform, MHC-LP, with Empower Your Mind Therapy, took time to answer our questions and give self-care tips on what nurses can do to make sure that they are making time for self-care. Our interview, which follows, has been edited for length and clarity.
Dealing with COVID-19 and the pandemic has been tough on everyone, but especially difficult on frontline workers such as nurses. Why should nurses be sure to practice self-care now?
As much as nurses care for everyone else, it’s crucial to pay attention to your own needs too. By its own true definition, self-care is about taking intentional care yourself: your mind, your body, your environment, and your spirit.
If we don’t practice self-care, we can become burned out, resentful, angry, and may even start feeling depressed. This also lowers your immune system and can make you feel tired and low. If you’re not feeling your best, how can you manage caring for others?
What are some things that nurses can do to be sure to remember self-care and to fit it into their busy days?
While the occasional self-indulgence like a spa day or getaway can be a great way to express some gratitude to yourself and all you accomplish, self-care is about more than an occasional treat. An intentionally cultivated daily self-care routine can make a huge difference in our lives and allow us to be balanced & more restored.
Today, ask yourself:
How do I typically take care of myself day to day?
Do I take time to regularly assess and address my needs?
How is that impacting both my mental and physical health?
I really want you to think about how (or if) you set aside time each day to take care of yourself. Do you have time to sit back and assess your needs? Do you listen to your body when it tells you that you need a break? When you’re mentally strained, do you have a routine that helps you rest and rejuvenate?
Is there anything they can do at work on a break or at home?
There are a lot of little things that are self-care, but aren’t exciting or Instagram-able. You can do these quickly:
Write down your to do list for the week to stop the constant nagging in your head.
Set a time to be done with screens before bed.
Make a meal plan that gets you excited to eat 3 meals a day.
Take a look at your calendar: are you overbooked, need a fun outing to look forward to, need to make a doctor’s appointment?
Call a friend to catch up.
Spend time outside.
What are absolute must-dos regarding self-care?
Assess your true needs: when we’re talking about daily self-care we’re talking mainly about wellness (mental & physical). For a week, keep a log of your physical and mental expressions of stress or strain. Are you tired? Do you have frequent headaches? Look at what comes up for you and come up with small, incremental steps to take action. Maybe you have constant headaches because you’re dehydrated. Start carrying a water bottle, set some reminders on your phone to actually drink from it.
Take a critical look at your routine: What is taking up your time on a daily basis? Often times we fall so behind on creating an actual daily routine that serves us that we end up playing perpetual catch up. Finding the right way to balance what you need day to day will help ease stress and keep you feeling more balanced and in control.
Prioritize rest: if you have to put it in your schedule or “to do” list to make sure you get time to rest and recharge then do it. Maybe it’s yoga, reading, taking a bath. Rest and rejuvenation should be a priority in your daily routine. Set aside small chunks of time each day where you stop the machine, ignore “productivity” and let yourself rest.
What would you say to a nurse who says s/he doesn’t have time for self-care because too much is going on?
Self-care can be something quick and small to help yourself with your own mental and physical well-being. As a nurse, it’s important to remember that you are just as important as your patients and family. Others rely on you, so rely on yourself too. Even if it’s a quick walk around the block during lunchtime or outsourcing personal to-dos to another family member—such as creating a shopping list or picking up a birthday gift for someone—try to take some time for yourself. Also remember that self-care shouldn’t create more pressure. If it’s too much to take time every day, start with setting aside some time once a month to check in with yourself.
Well it has been a while since my last post, due to the “busyness” of life. Often times we let the things in our life take so much of our time, that we forget about taking care of ourselves. As nurses we are focused on taking care of others: our patients, our family, our friends, and sometimes even strangers. We have heard of the saying “Take care of yourself, so you can be there for others,” but how many of us actually practice this? This really hit home after hearing about the unexpected death of two colleagues over the past month. They both devoted so much time to their job and neglected to relax and take care of themselves.
Credit: Leslie McRae-Matthews
We have our plates so full with other people’s issues, cares, and needs, yet there is no room on the plate for us. There has to be a balance between work and relaxation. This is not new information for us—we just need to apply it to our lives. Many of us advise our patients about taking time to relax, meditating, and thinking about things they enjoy to decrease stress. These are some of the same principles that we can use.
When you start noticing that you are feeling anxious, moody, or depressed, these are signs that it is time to step back to refocus, recover, and renew. Many people relax by traveling, but you do not have to spend a lot of money to relax. Engage in simple activities, such as drawing, photography, taking a walk to enjoy nature, riding on a swing, or going for a swim. These activities are not an escape from reality or stepping into a “fantasy world,” but they will help you take your mind off of work or other issues, so that you can refocus. Take care of yourself and find that balance.
