The Healing Power of Art

The Healing Power of Art

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.the-healing-power-of-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.

Making Self-care a Priority

Making Self-care a Priority

As a nurse, youre 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.making-self-care-a-priority

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 dont 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 Childrens 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, well 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 Childrens Nebraska in Omaha to discuss a self-care plan. If a nurse is struggling, Smith can consult the nurses plan and see the measures that might help that person.

One self-care policy at Childrens Nebraska allows nurses to take a day off if they need to recharge—if your tank isnt 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. Its very hard to get away from the work when youre 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.

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Howie, the golden retriever, and his handler, David, make their rounds

Whats 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, its 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. Its easy to leave work and feel like your entire day was terrible. But really, you probably did many good things throughout the day.”

How Health Systems Are Using Technology to Combat Burnout, Improve Nurse Retention

How Health Systems Are Using Technology to Combat Burnout, Improve Nurse Retention

Nurse burnout continues to hinder the healthcare system across care settings. Hospital margins are thinning, and allocating resources to nurse retention and engagement is imperative to offset the cost of losing nurses. The average cost of turnover for one bedside RN is $52,350 – which can add up to expenses between $6.6M-$10.5M, according to a recent retention and staffing report stating each percent change in RN turnover will cost/save the average hospital an additional $380,600/year.” In skilled nursing facilities, regulated staffing levels will likely impact quality care scores and reimbursements in the future. Staffing and reducing turnover are top of mind for healthcare leaders everywhere, even more so as they continue to look ahead to 2024.using-technology-to-combat-burnout-improve-nurse-retention

Overcoming Nurse Burnout

While the industry challenge of nurse burnout is clear, the right approach to ease nursesburden is harder to decipher. Staffing leaders must balance competing priorities, such as investing in expensive agency labor versus racking up internal hours and offering nurses more flexibility to choose the best shifts while ensuring every shift is filled.

Three themes are among the top strategies to address nurse burnout: improving communication, increasing flexibility, and supplementing staff.

1. Improving Communication Between Nurses and Managers

Many organizations need help in traditional staffing workflows, tediously tracking multiple spreadsheets or using one-by-one phone calls or text messages to make scheduling adjustments and fill last-minute openings. This approach is not just time-consuming; it’s disruptive, siloed, and does not take advantage of widely accepted and expected technology.

With healthcare workforce software to deploy one-to-many communications, nurse leaders can post shifts, set rules for shift selection, and relay scheduling needs quickly – for example, by implementing a first-come, first-served open shift approach or shift bidding based on seniority or other factors. This respects nursestime and frees up time for nurse leaders to focus on their teams growth and development, supporting operations, and improving patient care.

2. Giving Nurses More Flexibility

More shifts are not the answer to nurse burnout – but more scheduling options could be. With real-time scheduling available at their fingertips, nurses have the necessary flexibility. More choice empowers them to select schedule changes that best fit their work-life balance. It gives nurses the freedom to trade shifts or take on open shifts and makes them feel like they have control over their schedule, motivating them to do their best work.

Greater scheduling flexibility can reduce the likelihood of no-shows or call-outs and reengage nurses in their work, preventing turnover. Meanwhile, nurse leaders can ensure these individual choices are made with commitment rules in mind by defining scheduling rules that make their staffing software work with their teams unique needs.

3. Supplementing Staff with Agency Nurses

For some healthcare leaders, agency staff can be an expensive response to reducing burnout and attrition. However, it could be the more affordable option in the long run. Compared to the cost of losing a nurse and the time it takes to hire a new nurse, the investment in supplemental agency staff could greatly outweigh the costs of staff turnover. If managed well, agency staff becomes an extension of the team – used as needed, but not the immediate response to every open shift.

At the core of all these decisions is data and using available technology. Schedulers must have confidence in who is doing what, when its happening, and where its taking place. Clear, at-a-glance staffing data differentiates between taking a one-size-fits-all approach and making appropriate staffing adjustments based on an organizations most significant contributors to burnout and resignations.
Accessible staffing data revenue objectives and organizational goals empower healthcare leaders to take a holistic approach. They can weigh their options and resources from a united front and choose investments to target specific challenges while understanding the impact this may have on another aspect of the organization.

Smarter Planning Leads to Reduced Stress, Higher Satisfaction

While there are many options to address nurse burnout, one thing is clear: better staffing management is necessary. In fact, 57% of nurses planning to leave the workforce would reconsider returning to their position if their workplace implemented a more flexible approach to scheduling and shift management.

With data and a smart workforce management solution, staffing leaders can make thoughtful, more informed choices that fluctuate seamlessly with day-to-day, real-time scheduling needs. Nurses can impact their schedule and sign up for shifts that give them the best work-life balance through technology customized for their practice. Managers can refocus their time to make strategic staffing decisions. And ultimately, patients get high-quality, uninterrupted care.

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Keeping Burnout at Bay 

Keeping Burnout at Bay 

Burnout can steal the enthusiasm, satisfaction, and joy that prompted you to become an NP. It can rob you of the joy of caring and potentially deprive your patients of the care they need.

As a nation, the U.S. can ill afford to have NPs burn out. A national survey of U.S. adults conducted by the American Association of Nurse Practitioners (AANP) in April 2023 found that more than 40% of respondents have experienced a “longer than reasonable” wait for healthcare. In a press release, 26% of those surveyed reported waiting more than two months to gain access to a healthcare provider. NPs, notes the AANP, can help fill that void.

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

delivered by NPs and physician assistants (PAs) increased from 14.0% to 25.6%.

We’ll look at some factors that cause burnout and ways to prevent it from diminishing your enthusiasm or leaving practice entirely.

First, let’s take a brief look at the signs of burnout.

Signs of Strain 

Burnout is characterized by emotional, physical, and mental exhaustion, notes April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, immediate past president of the AANP. A practitioner can feel less valued and lose interest in their work.

You may have trouble sleeping, experience tension and stress, and potentially have prolonged feelings of depression, according to Sunny G. Hallowell, PhD, APRN, PPCNP-BC, associate professor, pediatric nurse practitioner, M. Louise Fitzpatrick College of Nursing, Villanova University. 

COVID Makes it Worse 

While blaming the pandemic for NP burnout would be easy, burnout was a phenomenon before COVID. “What happened during the pandemic is the phenomenon of burnout, which has been consistently well documented in the healthcare literature for decades before COVID. Those events were exacerbated by the pandemic,” according to Hallowell. “It was already there. It just got so much worse.”

One data point of burnout before the pandemic comes from a study conducted in early 2018, which examined advanced practice registered nurses, including NPs and PAs. It found that 59% of respondents experienced or formerly experienced burnout. The pandemic “really blew everything up,” says Kapu, the study’s lead author, published in the Journal of the American Association of Nurse Practitioners. 

Forces of Stress

Besides the pandemic, unhealthy work environments can lead to burnout. In those environments, notes Kapu, staff shortages continue to take a toll, overtime may be needed, and there needs to be more opportunity for professional growth, development, or change.

Furthermore, the back-and-forth involving full practice authority for NPs may also cause stress. During the pandemic, various states provided temporary waivers allowing full practice authority for NPs. Since then, some states have reverted to reduced or restricted practice laws. This sends a “mixed message,” notes Hallowell, breeding mistrust, uncertainty, and confusion.

“In states that have moved to full practice authority, we’ve seen an increase in the workforce; NPs enjoy working there,” says Kapu. “We’ve seen those states move up in terms of overall healthcare outcomes. The top five states in the U.S. in terms of healthcare outcomes are all states where nurse practitioners can practice to what they’ve been educated and trained to do.”

NPs might also suffer from stress in dealing with inexperienced healthcare colleagues. “The distribution of healthcare delivery has shifted in such a way that we have a lot of inexperienced folks at the frontline now,” Hallowell notes.

“We need to create a structure to onboard and train and bring these new workers into the work environment, help them develop confidence in their skills, make sure that they’re competent in what they’re doing,” notes Kapu .” We’ve done this as nurse practitioners for years. We have onboarding, orientation, and training programs, and we support them through that so that they feel competent and integrated into the team. They have a supportive environment where they can reach out and ask questions as needed.”

Self-care is Key

When it comes to preventing burnout, tactics involve self-care, notes Hallowell. They include:

  • Rest.
  • Asking for help. Hopefully, you can call on experienced colleagues who can provide emotional support to offset the stress, demands, and mental load of patient care.
  • Requesting training. If you are doing something unfamiliar, ask for education.
  • Exercise.
  • Good nutrition.
  • Having interests outside the profession.
  • Socializing with friends and family
  • Mindfulness.

“We need to make sure that we recognize the signs and symptoms and then determine what will be our change,” says Kapu. “Do we need to work in a better environment? Can we help contribute to making our work environment better? What are we doing in terms of self-care?”

Addressing the exhaustion that can lead to burnout is similar to exercising a muscle, notes Kapu. “You work a muscle to a critical mass and then recover. That’s how it gets stronger. It’s the same thing with stress,” she notes, where some stress is good, but it may get to a point where you have to take time away.

“We have to give ourselves time to recover, to refuel, to constantly check in and say, Am I taking care of myself so I can bring my very best self to my patients?”

Lions, Gazelles, and Nurses – The Herd Mentality at Work

Lions, Gazelles, and Nurses – The Herd Mentality at Work

Nursing has a hierarchy of power and experience like any other profession; it also has a hierarchy that sometimes feels akin to the laws of survival on the savanna or in the jungle – the herd mentality at work.

Have you ever observed that the less experienced and more vulnerable nurses frequently get left on the outside, often falling prey to bullies and “predators”? This is the herd mentality at its worst, and many novice nurses are taken down by bullies and power-hungry colleagues who eat them alive when they’re demonstrating the slightest weakness.

Protection and Predation

Out on the African savanna, herds of gazelles keep watch for lions, one of their most fierce predators; the culling of the pack is a natural phenomenon, and lions need to eat just like anyone else. However, some naturalists notice that the sicker, older gazelles are left outside the herd, vulnerable to predation and outside of the safety of the circle. Young gazelles are naturally kept on the inside, their parents and elders protecting them and keeping them close, with the innate understanding that they are the carriers of the gene pool which need to survive into adulthood so that the species can thrive in the future.

In the healthcare environment, we often see a herd mentality; in this scenario, the experienced nurses make up the bones of the innermost circle of safety, and survival of the fittest is frequently the name of the game. But what about the newer nurses? Where are they in the hierarchy?

A Med/Surg Herd

Let’s consider a large Med/Surg unit where we find a mix of older, highly experienced nurses, some nurses two to five years into their careers, and several fresh-faced novice nurses in their first year.

Now let’s imagine a bully in the mix; she’s a nurse with 25 years of experience, a toxic personality, and a stranglehold on the unit culture. The administration is afraid of her, the nurse manager turns a blind eye to her egregious behavior, and most nurses keep their heads down and hope she doesn’t pick on or single them out.

The older, more experienced nurses may be relatively safe from the bully; they’ve known her a while, put up with her toxicity, humor her, or perhaps ignore her as much as they can to not call attention to themselves. Their silence is essentially complicity, and some may play into the bullying and tacitly empower her aberrant behavior. A bully can sometimes be a younger nurse who bullies older nurses, too; this power dynamic can work in both generational directions.

The New Nurse: Falling Prey to the Lion

Meanwhile, the newer nurses are fresh blood for the bully/lion/predator; they are unsure of themselves, need to ask questions, and are vulnerable to being singled out and stalked by the bully and her minions.

If the members of the nursing herd try to stay out of the bully’s way – or support her in being the bully – what does that mean for the newer nurses? It generally means they are kept outside the circle of protection and safety, left to fend for themselves against the nurse predator.

If you think of the nurses on the unit as a herd, the young are left outside to fend for themselves. The elders are primarily held in the center, cushioned against the attacks of the predator/bully; however, an elder nurse can also be deemed weak by the “herd” and thus ostracized to the fringes.

The calculus of this situation is untenable and unhealthy, with certain nurses receiving the short end of the stick; vulnerable novice nurses need nurturing and support, not the feeling of being thrown to the lion(s).

Extending the Circle of Safety

To counteract a situation that lends itself to the burnout and attrition of newer nurses (as well as those seasoned nurses who are vulnerable to bullies), the circle of safety needs to extend its protection to everyone. Rather than leaving more vulnerable colleagues to be picked off the edge by predators and bullies, the circle closes around those needing its reassuring sanctuary, whether older, younger, or somewhere in between.

Dr. Renee Thompson, one of the world’s foremost experts on nurse bullying and incivility in the healthcare workplace, has documented and communicated the subtleties and vicissitudes of this scourge through books, blog posts, articles, podcasts, keynote speeches, videos, social media, and the powerful work of the faculty of her Healthy Workforce Institute. As Dr. Thompson informs us, we must learn to speak up in the face of bullying and to protect those members of our team who are susceptible to a form of professional predation that sends many a nurse running for the exit, often leaving the profession altogether.

We must reject the adage that nurses eat our young; we can create and embrace a new paradigm where nurses nurture and empower their young instead.

This isn’t rocket science, but we nurses need to learn the skills that will help us to bully-proof ourselves, speak up in the face of bullying, end nurse predation, and enclose our colleagues in a circle of safety that keeps the lions on the outside and the vulnerable protected from harm.

We can make different choices, and it’s our daily decision regarding our path. I implore you to extend the circle of safety, protect the vulnerable, and bring a sense of community, safety, and symbiotic togetherness to your corner of the nursing world.

Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.

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