How to Build Resilience and Stay Mindful in Today's Healthcare Climate for Nursing Students and New Nurses

[LynnieVRN, BSN, RN]

Being a nurse today involves an enormous amount of autonomy and adaptability. Not only are we expected to think critically, we are a strategic part of the financial agenda when it comes to cost containment and reimbursement knowledge.  With the "lean mentality" becoming a common theme in healthcare institutions across the nation, nurses have to become familiar with balancing quality care in a budget stricken culture. When it comes to nursing students right now, you may or may not have had all of your clinical rotations satisfied due to Covid 19, leaving you feeling vulnerable without that experience.  As a new nurse, you may have been rushed through orientation and expected to perform autonomously earlier than expected, as the cost to orient new nurses is very costly. Despite these added pressures, I believe nurses need two things to be successful in the current healthcare culture:

1 - Know that change is constant, and to embrace it.

2 - Know that resilience is the key to finding our purpose in nursing and coping with the challenges we face. 

You may be concerned about feeling underprepared in your clinical environment.  Or perhaps you're worried about the stress of the job.  Maybe you're wondering if you'll ever get hired in a new grad program.  It's possible that you're already a new grad and having a challenging time in the real world of nursing. Regardless of how you're feeling at the moment, practicing mindfulness and building your resilience in a number of key areas will help you learn to function better as a nurse. 

Understanding resilience is crucial.  In a nutshell, resilience is knowing how to cope in spite of difficulties.  It involves having emotional strength and an attitude that enables you to deal with challenges. For me it has meant finding meaning in the challenges,  and making the most of the situation. In order to do that, you have to be willing to stay present when the stress rises and know what your triggers are so that you can stop your fight or flight response and reset with focus.  In the following paragraphs I will provide typical challenges new nurses face and how this might look.

Typical Challenges New Students/Nurses Face

Time Management

Even the most organized, calculated nursing care plan can be derailed by emergencies or other pressing issues.  How to stay calm and coordinated as a new nurse who isn't sure how to manage the many tasks at hand may be tough, but these responses may help:

1 - Flexibility

Avoid a rigid plan of care. Embrace change, as it creeps up repeatedly, throughout your shift and is very common. 

2 - Stay calm in the moment

Acknowledge your feelings, label them (anxious, overwhelmed, angry, etc) and remind yourself that it's temporary. Focus on what task is imperative and tell yourself that's your only focus for the moment.

3 - Think priorities

Do what's necessary first, delegate and ask for help from your colleagues.  

Decision Making

Novice nurses are new learners for a up to two years, so don't pressure yourself to know everything. Skill comes with experience, learning standards of care and policy and procedures.  Resilience in this area includes:

1 - Focus on problem solving.

Collaborate and inquire with others (mentors are great).

2 - Learn

Learn from mistakes and set backs.

3 - Observe

Observe tasks that you need to learn and seek out opportunities of growth for. Be a proactive learner.

4 - Debrief

Debrief with a colleague, mentor, charge nurse, instructor, etc. when necessary to overcome barriers to growth/learning.

Communication

Under pressure we tend to regress to our most habituated ways of responding. When emotions are involved, problems arise the moment we personalize an interaction. Avoiding aggression and being passive is key. Tips on assertive communication:

1. Speak for yourself, actively listen to the other person to understand, clarify or ask questions if needed, paraphrase back what you think you're hearing, then close the loop by responding.
2. Goal is to problem solve while being respectful, professional, avoiding assumptions and validating another's perspective.
3. If the other person does not engage in assertive behavior, stay grounded in your intentions and try not to take on the aggression they project onto you.
4. Be open to feedback/advice. Be clear with your objective.  

Mistakes and Errors

Being vulnerable when mistakes and errors occur is important for a growth mindset. We are human, mistakes happen and we shouldn't feel embarrassed or humiliated, rather we should learn from our experiences. Tips:

1. Be accountable if you make an error
2. Understand the lesson learned
3. Research to learn what and why the mistake occurred. 
4. Before any task: Pause for focus. Consider what actions you will take. Concentrate on the steps you will need. Afterwards, check to ensure you followed the steps properly. In a high reliability organization, we call this STAR (Stop, Think, Act, Review).

Techniques for Dealing with Stress

1. Check in with a mentor to ask questions or debrief.
2. STOP (Stop, Take a deep breath, Observe how you feel, Proceed with kindness and compassion for yourself and others).
3. In high stress situations, take 6-8 deep, slow breaths in and out. It changes our physiology and resets our ability to refocus.
4. Stay in the moment (mindfulness).  It encourages focus on what you're doing and prevents anxiety about thinking about multiple things.  
5. Self Care-Essential for reflection and rejuvenation.  Exercise, journal, massage, read, meditate, socialize, pray, hobbies, listen to podcasts, etc.  
6. Support System.  Mentors, friends, colleagues and family.

In Conclusion

Being a nursing student or new nurse is filled with a variety of emotions and learning curves.  Know that it will be challenging and expect that you will be stressed.  Understanding how to cope is a large part of the battle, but also knowing what you drew you to nursing can be a good motivator in being a caregiver.  My objective each shift is to try to make a connection with my patients, and ensuring that I do all that I can to provide them with thoughtful, intelligent, compassionate care.  I deal with the stress of the environment by practicing many of the tips that I've provided.  Balancing mind, body and spirit is essential in providing the best care that I can.  So my advice is to make yourself a priority on your days off and fill yourself with the things that bring you that balance.