Nurses: The Only Way Through This Pandemic is Radical Self-Care

Healthcare worker burnout was here before COVID-19 came into the picture, now it’s only getting worse. Nurses COVID Article

Nurses: The Only Way Through This Pandemic is Radical Self-Care

Almost two years later, COVID-19 continues to take its toll on every aspect of life. Healthcare workers continue to report feeling exhausted, overwhelmed, and irritable1. Burnout, according to the World Health Organization, can be characterized as "feelings of energy depletion or exhaustion, increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job and reduced professional efficacy". Outside the workplace, life stressors such as fluctuating mandates on public dining and vaccines, and the ongoing debate of mask mandates for children in school continue to add tension to the quagmire of uncertainty.

Even with data that the COVID-19 vaccine continues to be up to 73% effective against the current Delta strain, and greatly reduces severity in symptoms2, the politicization of vaccines, misinformation, and personal misgivings have sown enough doubt that individuals may continue to defer vaccination. On top of that, the CDC has recently warned the public of a potentially harsh flu season this Winter3. The desperately needed decompression of patient volumes in the hospital may not come soon enough.

So what can healthcare workers control? How can they care for themselves amidst fluctuating rules, rampant misinformation, short staffing, and general fatigue?

Let’s Consider Radical Self-Care

It doesn’t mean celery juice detoxes or going on yoga retreats. It can be as simple assessing how you are feeling, and seeing if your needs are being met, in and outside the workplace. It means controlling what one can and accepting what one cannot—like the opinions of others despite logical, emotional, or ethical appeals. It means continually looking at the big picture and making choices that align with quality of life and wellness.

Wellness and self-care encompass eight factors: physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental. Managing all eight of these pieces can seem daunting and like a full time job in itself, but the aim is to find harmony, not perfection. Consider these the foundation and a practical way to make healthy decisions. If you’re not sure where to start, here are some ways to begin the journey of self care.

Organize and protect your headspace

Have a mental health checklist. Ask yourself these questions daily. Unpack with a trusted person—whether it be an empathetic friend, co-worker, or a family member.

  • How do I feel today? 
  • What are my triggers?
  • What is one thing I can do today that makes me happy?
  • What can I say no to today?
  • What can I say yes to today?
  • What are my needs?
  • Have I laughed today?
  • Can I choose good enough, not perfect? 
  • What’s taking up my headspace today?
  • What can I take off my list today that is not a priority?
  • Is it my job to take responsibility for this person’s actions/opinions/decisions?
  • What boundaries can I set?
  • Are my boundaries being violated?

Self-assessment can allow you to decrease the hostilities and increase the practices that bring a sense of well-being. One study involving physician burnout4 reported that focusing on spending quality time with family, friends and significant others along with nurturing spiritual development can be useful against managing burnout symptoms.

Not particularly religious? Developing a life philosophy focused on a positive outlook engaged with fulfilling personal values and a balance with personal and professional life can be just as beneficial to managing burnout.

Let’s talk vagus nerve

Nurses understand that the mind and body are intimately connected. Undergoing acute and chronic stress found in burnout can present itself physiologically through increased heart rate, blood pressure, and an increased risk for platelet aggregation, thrombosis, and ischemia. 

One of the primary levers for managing the parasympathetic and sympathetic responses in the body come from cranial nerve ten, the vagus nerve. The vagal highway innervates through your neck all the way down to the gut.  It affects processes from heart rate, digestion and satiation, to mood and even inflammation in the body5. Here are some known ways to stimulate your vagus nerve and improve your physiological conditioning.

  • Nasal breathing 
  • Cardiovascular exercise
  • Weight lifting
  • Getting sunlight
  • Being in nature
  • Singing/humming
  • Deep, diaphragmatic breathing with longer exhales
  • Getting adequate nutrition (eat some vegetables, please)
  • Cold water to the face/neck
  • Smiling and laughing

If these seem deceptively easy and intuitive to do, it’s because they are. Try to incorporate them as much as possible throughout the day, especially during stressful moments.

Get a side hustle—or consider a career change

At the end of the day, nursing is a job that provides an income. Beyond personal fulfillment and purpose, it has to pay the bills and feed mouths. When the source of your income becomes a huge existential stressor, it can feel overwhelming. 

The saying goes that necessity is the mother of invention; you don’t need to reinvent the wheel, but maybe creating new job opportunities that do not focus around in-hospital work can alleviate stress and create more financial flexibility. Some examples of creative side hustles I’ve seen from nurses are:

  • Crafting (Etsy)
  • Social media influencing
  • Health writing
  • Dog breeding
  • Nurse legal consulting
  • BLS/ACLS instructing
  • Post-op Lymphatic massage
  • Piercing business
  • Concierge nursing
  • Event staffing nursing
  • Event planning
  • Tutoring NCLEX/CCRN/CEN
  • Travel nursing
  • Remote working
  • Working for insurance companies

Maybe another gig would stretch you beyond capacity and instant success isn’t guaranteed overnight—the last and viable option is to always switch to a new career, or slide into another area of nursing that suits your needs for pace, acuity and hours. 

To a profession full of individuals who get paid to take care of people’s needs all day, I’ll say this—nurses, you have full authority to consider your emotional, physical, and financial needs just as important as everyone else’s, and to discover for yourself how to achieve balance between them.

Resources

Burn-out an "occupational phenomenon": International Classification of Diseases

Dimensions of wellness: Change your habits, change your life

The impact of stress on body function: A review

How You Can Repair Your Vagus Nerves

References

1Year One COVID-19 Impact Assessment Survey

2Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study

3CDC director warns the U.S. is at risk of a severe flu season this year

4Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies

5Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders

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mlee71113

About mlee71113

Specializes in ICU, ER.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

Burnout in healthcare is a form of stress disorder.  It's not terribly different from PTSD. 

 

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Specializes in Med-Surg.
On 10/28/2021 at 10:06 AM, toomuchbaloney said:

Burnout in healthcare is a form of stress disorder.  It's not terribly different from PTSD. 

I have a friend that is on social security disability for PTSD caused by nursing.  He's been was a nurse for 40 years.  It is a thing.

I wonder if the newer Gen Z is going to have this problem.  Their tolerance for this seems to be quite low, which is a good thing.  I was reading an article today about Gen Z and one of them texting their boss "I'm not in a good place mentally today and am not coming in".

Mental health and self-care should be a thing.  I've called off for "mental health days" (but my generation isn't so bold and we make up a diagnosis and call in sick) but I've also worked myself to near burnout.

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Specializes in ICU, ER.
On 10/29/2021 at 7:40 AM, Tweety said:

I have a friend that is on social security disability for PTSD caused by nursing.  He's been was a nurse for 40 years.  It is a thing.

I wonder if the newer Gen Z is going to have this problem.  Their tolerance for this seems to be quite low, which is a good thing.  I was reading an article today about Gen Z and one of them texting their boss "I'm not in a good place mentally today and am not coming in".

Mental health and self-care should be a thing.  I've called off for "mental health days" (but my generation isn't so bold and we make up a diagnosis and call in sick) but I've also worked myself to near burnout.

I am a millennial and it is still a struggle to shrug off the apathy for self-care from the generation past. I feel like I grew up believing that productivity equals self worth and that it's no pain, no gain. There are a lot of mental mantras I see repeated in my coworkers that denotes the lack of agency and ability to say no to something that feels wrong for the mind and body. I've seen coworkers work themselves to the bone in an exhausted and anxious state and complain about it (rightfully so), but do not make any choices that might improve their condition. I'm not trying to place blame, but there does need to be an intentional choice to speak up, say no, take the vacation, get the therapy, ask for help, etc. I hope your friend is getting the rest that they need. ? We are all just fragile, squishy humans like the patients we take care of.

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1 hour ago, mlee71113 said:

I am a millennial and it is still a struggle to shrug off the apathy for self-care from the generation past. I feel like I grew up believing that productivity equals self worth and that it's no pain, no gain. There are a lot of mental mantras I see repeated in my coworkers that denotes the lack of agency and ability to say no to something that feels wrong for the mind and body.

I was raised doing hard work even as a child, adolescent and young adult. I think work ethic is very valuable, both working diligently and doing one's best. I'm not one whose tendency would be to shirk responsibilities in favor of self-care and would usually do the responsibility and incorporate self care as able.

The part where things get dicey is the failure to discern the differences that come into play when someone is doing hard work and someone else takes advantage of it, comes to expect it and regards it as the only measure of value of that human being.

In my childhood/adolescence the work was dirty and physical; generally involved long hours when not in school. Doesn't sound great, but the difference was that it was work being done within the family small business, our sole source of income. It was just us and we were all doing our part. I had everything I needed and a small share of the things I wanted too. We were loved and provided for and treated very well. We were told to do our best, yes, but were never under a blanket command to just do more. Nursing doesn't really hold a candle to the type and amount of work I had done before I even reached adulthood as far as hard work, but the off-kilter premises under which nursing work is done makes nursing 1000x worse in my opinion.

I can sacrifice a lot and do a lot of hard work when things are even-handed. What people are rejecting is the idea that one group/class of people must work very hard and additionally must carry a lot of the emotional weight of a thing, while others meddle and restrict and criticize and blame and PROFIT.

I guess my rambling and reminiscing boils down to the idea that at heart I'm not really one to shirk responsibility in favor of "self care" very often, and I don't think that fact becomes problematic until involved in an emotionally off-kilter situation (like nursing). It took me a long time to porifice all of this out and understand it and ultimately decide that I will not work under these specific conditions.

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Specializes in ICU, ER.
1 hour ago, JKL33 said:

I can sacrifice a lot and do a lot of hard work when things are even-handed. What people are rejecting is the idea that one group/class of people must work very hard and additionally must carry a lot of the emotional weight of a thing, while others meddle and restrict and criticize and blame and PROFIT.

I guess my rambling and reminiscing boils down to the idea that at heart I'm not really one to shirk responsibility in favor of "self care" very often, and I don't think that fact becomes problematic until involved in an emotionally off-kilter situation (like nursing). It took me a long time to porifice all of this out and understand it and ultimately decide that I will not work under these specific conditions.

I think the struggle you highlighted was that you personally have a strong work ethic and a high tolerance for adapting under a number of difficult/challenging circumstances, but that this characteristic may be taken advantage of by the current healthcare system and it's machinations.

I often felt like working and hustling in a busy ER was rewarding, gritty, and really fun but the parts that grated on me the most were the constant push for faster turnover, higher volumes, and eventually unsafe conditions. I worked in a safety net/county hospital where even if the entire state was on diversion, we would still get patients pouring in. This is in part is a resource problem and a public health issue. There were no stretchers on many occasions, and definitely not enough nurses. I would get multiple ICU patients (vents/drips), along with patients in the hallways, along with the messy, high-needs step-down patients (obviously this state doesn't have a union with crystalized nurse-patient ratios). It's literally impossible to give the sort of quality care that all these patients need as a single human being. You do your best, but it's not always going to be the best for them. It becomes even more demoralizing when upper management (and the C-suite) of the hospital doesn't give extra working hands or doesn't incentivize high pay rates if you work more/longer. The most common jokes are that they throw pizza parties at us or tell us that we are heroes. Even from a labor/business standpoint, it's pretty clear that we just needs more hands (bodies) to do the work. I'm sure I am only scratching the surface of how complex this issue can be, but I felt landlocked by the options of how to move forward, especially when I started feeling physically and emotionally burdened for prolonged periods of time.

It sounds like you did the hard work of wrestling with what you valued vs what you could tolerate. Thank you for sharing your experience. I think there are many others stuck in a similar predicament.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
2 hours ago, JKL33 said:

I can sacrifice a lot and do a lot of hard work when things are even-handed. What people are rejecting is the idea that one group/class of people must work very hard and additionally must carry a lot of the emotional weight of a thing, while others meddle and restrict and criticize and blame and PROFIT.

I think you did a good job of putting words around a complex form of oppression that has long operated in a system that REQUIRES the specific professional skill set of a registered nurse, the target of the oppression.  The origins were most certainly misogynistic but it's become much more than that since Nixon. 

1 hour ago, mlee71113 said:

I worked in a safety net/county hospital where even if the entire state was on diversion, we would still get patients pouring in. This is in part is a resource problem and a public health issue. 

This is the business model for American healthcare.  American political leadership has been starving public health for decades.  At the same time, an increasingly profit driven health system persistently suppressed the wages, benefits and staffing of the nurse driven positions. 

In all inpatient settings (acute/rehab/snf) it is the patient's need for 24 hour nursing observation, assessment and care that has them in facility.  All other care is episodic and can be obtained in an outpatient setting, right? Study after study has reflected improved patient outcomes with increased nursing contact during inpatient care, yet, the capitalist model for our health payment and delivery system seeks to minimize those hours for cost control and pursuit of profit. This is not a sustainable national approach to the health of We the People.  IMV

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