Top 6 tips for avoiding burnout

by Scrubs Contributor • October 17, 2013 Wellness Tips, Your Health

BananaStock | ThinkStock

Whether you’re a nurse, student, or parent, we all face the same challenge: time. In a profession that revolves around caring for others, it’s not unusual for us to neglect ourselves. It’s a dangerous and slippery slope to go down.
We get swept up in countless responsibilities, obligations and assignments, often forgetting that our tank is running on empty. It’s important to stop, take a breath and recharge. Life is not a sprint…it’s a marathon. Avoid burnout by taking a few moments to take care of yourself:
1. Fuel up. Limited time? Not a problem. Smoothies are a great way to get essential vitamins and minerals on the go. Healthy snacks like baby carrots, peanuts, cheese sticks, apples, oranges and yogurt require no preparation time and can be taken anywhere. Three meals a day are ideal, but when that isn’t possible, be sure to continually snack on healthy foods throughout the day.
2. Get some ZZZs. There is no substitute for sleep (sorry!). Most medical errors are made during the last hours of the shift. Don’t feel guilty for taking a little extra time to recharge. You’re doing a favor not just for yourself, but your patients and loved ones as well. In situations where sleep gets skimpy, power naps of less than 30 minutes have been shown to improve alertness, restore wakefulness and increase productivity.
3. Unwind. Get your mind off of work. Disconnect. Unplug. People unwind in different ways–what’s your niche? Explore what works for you. Yoga, hiking, art, working out and music are just a few avenues. Even if it’s just for a few minutes before bed, let your brain rest so you can dominate at full force later.
4. Process. Whether it’s delivering bad news to family members or witnessing a patient’s condition crumble, nursing is emotionally taxing. Talk to a friend, family member, coworker, someone. If a long conversation isn’t possible, journal. Utilize the notepad feature on a smartphone, carry a pocket sized memo pad, or incorporate journaling into your bedtime routine. It’s important to process heavy emotions so they don’t weigh you down later.
5. Flex Time. Lifting weights isn’t the challenge…finding time to is. If you have a one-hour lunch break, spend the first half working out. Multitask on the bikes or treadmill. Make gym time a fun event and go with friends. If getting to the gym is difficult, find a YouTube workout video you can do at home. Exercise is a great way to rejuvenate your body and blow off steam.
6. TLC. Everyone needs some tender love and care. Juggling an active work, family and social life gets tricky. One way to balance it? Never eat alone. We all have to eat…might as well eat with company! Another great way to keep in touch with loved ones is to utilize transportation time to catch up on the phone (hands-free, of course) or send emails (if taking public transportation). With technology it’s even possible to hang out without having to leave your house (i.e. Skype, Google Hangout or Facetime).
It’s impossible to continue helping others when our batteries are near empty. Don’t feel guilty. You’ve got to help yourself before you help anyone else…and helping yourself may be the biggest favor you can do for someone else!
Sources:
Rogers AE, Hwang WT, Scott LD, et al. “Hospital staff nurse work hours and patient safety.” Health Affairs. 2004 July;23(4):202–12
Dhand, Rajiv; Sohal, Harjyot (2007). “Good sleep, bad sleep! The role of daytime naps in healthy adults.” Current Opinion in Internal Medicine 6: 9
National Institute of Mental Health, “Power Nap Prevents Burnout; Morning Sleep Perfects a Skill.”
Divya Kulshreshtha is a nursing student at Columbia University. She has a double bachelor’s degree in biology and psychology from the University of Maryland. She was inspired to pursue a career in nursing after her father was hospitalized, and has since done volunteer medical work in Kenya. In the future, she hopes to work with underserved populations and be involved with international health.

10 things that’ll surely happen five minutes before the end of a shift

by Sean Dent • October 16, 2013 Featured Articles, Fun & Humor, Lists and Ideas

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Any nurse who’s been on the job for more than a couple of months knows all about “the witching hour.” You either hear about it, or you get the slap-in-face personal experience. It’s that time on your shift when things are more likely to be, well, bad. It’s that time on your shift when things are going to go wrong, no matter what you do.
This is notoriously the last leg of your shift. You can slice or dice it any way you like, but roughly 60 minutes (or less) prior to the so-called end of your shift, the “Code Brown hits the fan” (if you know what I mean).
You do your best to get all your ducks in a row, but it never fails. The witching hour always seems to toy with you. Here are 10 things that are sure to happen during the witching hour:
1. Your patient just had the worst Code Brown of your career: Get out the mop.
2. Your “stable” patient becomes not-so stable.
3. You realize there were tasks and/or orders you missed from the beginning of your shift.
4. Somebody just entered in two pages of new orders on your patient.
5. A Code Blue is called on your patient or unit.
6. A new admission just showed up–without a report–and there is another one on the way.
7. The unit secretary’s shift just ended…and the phone is ringing off the hook.
8. There was a massive power outage – and now you’re bagging your mechanically ventilated patient.
9. The EMR just went down – and you have charting to finish.
10. Your patient’s one and only IV access just blew and you have to give blood products.
I mean, you’re human, right? We all like getting out on time, don’t we? It just seems that the forces of the universe don’t usually allow nurses to get out on time. Am I the only one who thinks the universe has a sick sense of humor?

Teaming up to serve the underserved

Nursing partnership benefits urban residents.

By Carrie Stetler

​Cindy Sickora, DNP, RN, makes sure that every weekday, the Rutgers School of Nursing’s health care van is there to help the people who need it. Its patients, mostly from Newark, New Jersey, USA, are elderly residents in buildings without elevators, gunshot victims in need of follow-up care, and children booked for vaccines in a city with one of the lowest vaccination rates in the United States.   Many are public housing residents with no health insurance or primary care doctor. Although the traveling clinic treats more than 1,500 patients a year, the city’s need for affordable, accessible health care is overwhelming.    Sickora, an associate professor at Rutgers School of Nursing, part of the former University of Medicine and Dentistry of New Jersey, was searching for a way to reach more people. She found it when she met Suzanne Willard, PhD, RN, APNC, FAAN. Both are members of the Honor Society of Nursing, Sigma Theta Tau International (STTI).   Willard had opened FOCUS Wellness Center last year on the other side of Newark. The wellness center is part of the Rutgers College of Nursing, which was founded at the university in 1955. By joining forces, Willard and Sickora hope to accomplish a shared mission: transforming urban health care.   The pair began working together as Rutgers was preparing to integrate with most of the schools, centers, and institutes that made up the former University of Medicine and Dentistry of New Jersey. Their new partnership allows the facilities to share resources and serve patients far better than they could on their own. For instance, the center has a social worker on staff for patients with mental health needs. The mobile clinic, which has no social worker, can now refer patients to the center.     “We have the potential to help a whole lot of people,” says Sickora, who directs the School of Nursing’s community health program. “Our mobile clinic can make inroads in educating people to use FOCUS, which could be a health care hub, especially for areas of the city we don’t cover.”     Nurses have a reputation for cutting through red tape and getting things done, says Willard, associate dean of Rutgers College of Nursing’s advanced practice program. “There is a solidarity among nurses.”   The center’s first patient was a referral from Sickora. The mobile clinic staff, which couldn’t provide gynecological exams at the time, sent her to FOCUS. “Cindy said, ‘I’ve got someone who’s had problems accessing services, and your center would be perfect,’” Willard recalls. Days after the visit, mobile care nurses checked in on her at home to make sure her symptoms had subsided.    Newark has one of the most underserved populations for basic health care in the United States. Many residents lack reliable transportation and must take multiple buses to see a primary care doctor, if they have one at all. Some wait days, even weeks, for appointments. Others are prescribed expensive medication they can’t afford.   Studies show that nurse-managed care can be just as effective as physician-administered care, according to Willard and Sickora. Nurse-managed care is especially successful at providing treatment continuity—as well as a personal touch—at a much lower cost. “Our approach is more holistic,” Willard says. “Nurses look at patients and think of their overall ability to improve health outcomes; that’s how we’re wired. We ask, ‘What do I need to do to help them take care of themselves when they leave?’ We want to keep them out of the emergency room.”   The FOCUS Wellness Center, funded with federal and local grants, is designed to meet the multifaceted needs of patients who are often grappling with mental health issues and neighborhoods filled with violence. These issues aggravate conditions such as diabetes, hypertension, and asthma that are common throughout inner cities.   Willard recalls one patient who said her father had been murdered when she was 7. “I thought, ‘How can you just treat the physical symptoms with a patient whose father was killed in front of her when she was that young?’ We have a lot of case histories like that,” Willard says.   The nursing school’s mobile clinic is part of a larger network, based on a pioneering health care model, in which residents work closely with nurses, Sickora says. The nerve center of the program is Rutgers’ Jordan and Harris Community Health Center, headquartered at the Hyatt Court public housing complex in Newark. It’s staffed by two nurses who make house calls to shut-ins and serve as liaisons between patients and outside health care providers.   Community health workers in Sickora’s program are trained to pinpoint residents in need, schedule appointments, and coordinate follow-up care. “They knock on doors. They’ll say, ‘We need to make sure the babies get their measles vaccine.’ They’re the reason we’re able to see so many patients,” Sickora says.   She and her staff, which includes nursing students, have worked hard to form relationships with residents, many of whom rely on them to treat chronic conditions.    During a recent physical exam, Andrew Jackson was diagnosed with high blood pressure. Since his Medicaid was cut off last year, he’s made weekly visits for checkups and advice. “They tell me to go slow on the salt,” says Jackson, 42.   No other mobile health care program in the nation, according to Sickora, uses the community health worker model, which she believes can be a valuable source of data for researchers. Two nurse scientists are already involved in evaluating programs.    Says Sickora, “We’re really asking the question: Can we change health care for underserved populations?” RNL   Video   Published 9/19/2013, Vol. 39, No. 3

Intimidation still a problem in health care workplace

Survey reveals patients also victims.

​Recently released survey results from the Institute for Safe Medication Practices (ISMP) show that bullying, intimidation, and other types of disrespectful behavior remain a problem in the health care workplace and continue to erode professional communication, essential to patient safety and quality.   Ten years ago, ISMP conducted a national survey regarding intimidation that indicated disrespectful behaviors were not isolated events. Between July and August 2013, ISMP conducted a similar survey to determine how things have changed in the last decade. The 2013 survey included 4,884 respondents—more than double the number of 2003 participants. Most were nurses (68 percent) or pharmacists (14 percent), but more than 200 physicians and almost 100 quality- and risk-management staff also participated in the survey. Seventy percent had more than 10 years of experience. Following are some highlights of the findings.   The most frequent disrespectful behaviors reported are: Negative comments about colleagues (reported by 73 percent at least once, by 20 percent often) Reluctance or refusal to answer questions or return calls (77 percent at least once, 13 percent often) Condescending language or demeaning comments (68 percent at least once, 15 percent often) Impatience with questions or hanging up the phone (69 percent at least once, 10 percent often) Reluctance to follow safety practices or work collaboratively (66 percent at least once, 13 percent often) Although physical abuse (7 percent); throwing objects (18 percent); insults due to race, religion, or appearance (24 percent); and shaming or humiliation (46 percent) were not encountered frequently by most respondents, nearly a quarter reported that those behaviors were among the top three encountered during the past year.   Who is involved or affected? In both 2003 and 2013, respondents reported that physicians and other prescribers engaged in disrespectful behavior most often; more than half of 2013 respondents said physicians and other prescribers had often (6 percent) or at some time during the year (51 percent) yelled, cursed, or issued verbal threats. However, they also made it clear that it is not just physicians—in many cases, encounters with other health care professionals were nearly as frequent.   Repeated occurrences of disrespectful behavior did not arise from a single individual—36 percent reported that three to five individuals were involved in incidents. The survey also showed that gender of the individual affected has little impact; only minor differences were reported in the frequency with which men and women encountered disrespectful behaviors.   Impact on safety Almost half of the 2013 respondents said their past experiences with intimidation altered the way they handle questions about medication orders. At least once during the year, 33 percent of respondents had concerns but assumed an order was correct rather than interact with an intimidating prescriber. More than one-third asked another professional to talk to a disrespectful prescriber about an order. Eleven percent reported a medication error that occurred primarily due to intimidation. It also appears that 2013 respondents were less satisfied than 2003 respondents with organizational efforts to address the problem. While 70 percent of respondents in 2003 reported that their organization would support them if they reported disrespectful behavior, just 52 percent of the 2013 respondents felt this way.   The results of ISMP’s surveys expose health care’s continued tolerance of disrespectful behavior in the workplace and reveal that little progress has been made in the last decade to eradicate intimidation and bullying. The institute plans to issue recommendations on how health care professionals and organizations can address disrespectful behavior in a future issue of the ISMP Medication Safety Alert! newsletter. RNL   2013 survey findings 2003 survey findings   Published 10/10/2013, Vol. 39, No. 4

Top 10 nursing lessons you’ve learned from your mentors

by Scrubs • October 3, 2013 Career, Featured Articles, Inspiration and Stories

Every single nurse experiences a learning curve, and that transition from nursing student to practicing nurse can be a doozy! That’s why you need someone who will be there with a pat on the back when you’re feeling rotten…and who can give it to you straight when you’re messing up.
A great mentor can be a huge asset for any nurse, so we asked our Facebook fans for the best nursing tip they’ve ever learned from their mentors. Read on for their inspiring and very smart answers, then share your own tips in the comments below!
Top 10 nursing lessons you’ve learned from your mentors
1. Always, ALWAYS treat your patient as you would want your family treated. Try not to judge—just be compassionate. Judgment is for God, care is for nurses.
—Trayce RN
2. Value your healthcare assistants. If you treat them well, they will go to the end of the world for you.
—Laura Ellison
3. If it wasn’t documented, it wasn’t done!
—Jill Nesta
4. Remember to LISTEN even when the patient isn’t talking. And like what you do. If you love it—you have found a passion like no other! Be observant and treat your peers with kindness and respect. Being a nurse isn’t a job; it’s a way of life—never forget why you go hungry for hours. Always go home with the knowledge that you did your best and GAVE all you had to give. We will all grow old and need a nurse someday; be the one that people never forget.
—Janann Phillips
5. Trust your gut, especially if the patient tells you that something isn’t okay…even if the monitors show otherwise.
—Vera Lynn Stricker-Heckrotte
6. Never miss the chance to hold your patient’s hand and sit and talk awhile.
—Victoria Lewit
7. Walk into every room with confidence, even if the president is the patient.
—Erin Lynn McDermott Jones
8. A sign at my first job: “The day you stop learning is the day you stop nursing.” Kept that saying in my mind ever since then.
—Roberto Reynaga Rodriguez
9. Stay an hour ahead of yourself because you never know what can happen!
—Cecily Cruz
10. Don’t think “I just have to get through this shift!” Think “What can I do in these 12 hours that will make a difference?!”
—Tori Jordan Houston
What’s the best advice your nursing mentor has ever given you?

11 great tips for nurses dealing with stressful work relationships

by Scrubs Editor • September 15, 2013 Blog Carnival, Coworkers

The French novelist Alphonse Karr once said, “The more things change, the more they stay the same.” And while the nursing profession has evolved and changed over time, many of the same issues–such as bullying, jealousy, and how to build stronger work relationships–remain for nurses today.
Worried about work relationships or have workplace drama on the brain? Luckily, you have the advice of those who have gone before you to help guide you through your journey. Nursesontheedge.com, in collaboration with the Scrubs Blog Carnival, recently featured a fantastic roundup of wisdom especially for nurses thinking about work relationships. Check it out below:

Nurses Eat Their Young

An awesome recent article by Candy Treft, The Gypsy Nurse, inspired me as she wrote about the age-old saying, “nurses eat their young.” This is one phrase and idea which has been around for years. I love how she used a recent experience and was able to correlate the idea of “supporting their young” instead of destroying them. We as nurses need to be empowered to stand up for ourselves and others, as discussed by Lorie Brown, The Empowered Nurse, who also hits this subject head on in her post about nurses eating their young!

So What’s a Nurse to Do?

So how do we as nurses who want to make a difference start to change the atmosphere?  Elizabeth at Living Sublime Wellness speaks openly and candidly about her experience as a nurse and discusses that Love-Hate Relationship between nurses. Elizabeth, like so many of us, has grown tired of the atmosphere and is out to be a agent of change in the nursing industry! Elizabeth not only discusses the issue but also shares the Benefits of Building Relationships with your nurse peers.

Social Media

The recent boom in social media has brought the subject of nurse relationships to the forefront. More and more nurses are speaking out about the issue. No longer is this subject hidden or swept under the rug. Erica MacDonald, from Self-Employed Nurse,  speaks of how new nurses can build a support system and connect with others through social media. I have found personal support and developed great relationships through this avenue.

Diversity Issues

Building relationships with other nurses also means building relationships with people who are different that you are. No one is the same. Even within the same culture, you will find people don’t have the same views or ideals. Instead of embracing differences, some people put up walls and don’t allow communication to transpire. This is not acceptable. Joyce Fiodembo discusses How To Relate To The Nurse who is different than yourself in her International Support Nurse blog.

Find That Mentor

One thing that is very important is to find someone who you can talk with and receive SOUND wisdom from. A mentor is key to connect with, especially in the beginning of each career move. Brittney, the Nerdy Nurse, discusses how important it is to Find That Nurse Mentor! If you are a seasoned nurse, YOU could possibly be the mentor for a nurse and make a difference in their life!

Bridging the Relationship Gap

We KNOW there are issues. We KNOW these issues need to be addressed and improved upon. Communication and relationship challenges not going to go away overnight. We need a paradigm shift where nurses are empowered to stand up for themselves and for others. Understanding your value as a person is a place to start. In this guest post by Lisa, at The Gypsy Nurse, Lisa takes a look at her own experience and discusses Going Beyond simple communication camaraderie.

Keith Carlson with Digital Doorway discusses cooperation and communication in his post about Nurses and Relationships. I just loved that post! It reminded me about personal accountability. Each nurse should evaluate their role related to how they contribute. What is the underlying issue with the difficult nurse? Is it work or home related stress? What role do we play as the nurses who desire to promote a better work environment?

I loved the writing from Adrienne at Nurseables as she illustrates communication styles in story form. Nurse Snow and her Seven Patients is a really neat way to learn about difference communications styles.

A few years ago I received a book titled “Aspire” by Kevin Hall. It was a small book where Mr. Hall did an in-depth word study on several words I had never heard before. One of those words was Genshai. Genshai means to never communicate with someone in a way to make the other person feel small, including yourself. I immediately felt the need to share this concept with the nursing world, and so I wrote Creating a Genshai Nursing Culture. I realized when I wrote it there was some idealism, and not everyone would embrace the concept. The concept hit home to me though, and I’ve tried to employ this concept every since.

Nursing relationships can and should be nurtured. We are not expected to be best friends with everyone we work with. We don’t even have to like everyone we work with. If every nurse would begin to take an honest look at how they perceive others or are perceived in the workplace and then take ownership of those findings, make changes where needed, and embrace others without judgment…we may start seeing the positive changes needed related to nurse-relationships.