NurseWeek: Looking out for No.1

Looking out for No.1
Nurses extol the virtues of self-care – in personal and professional life

By Cathryn Domrose
January 8, 2001
Photos: Photodisc

Although some studies of nurses’ health show they are slightly more health conscious than the general population, many nurses say they are too busy working and caring for families to practice healthy habits.


	You've read the article. Now tell us what you think. Related sites Short Relaxation Techniques Relaxation Techniques How to practice better stress management Managing stress Stress or stress-related illnesses probably will be the No.1 public health problem of the 21st century, predicts JoAnne Herman, Ph.D., RN, an associate professor of nursing at the University of South Carolina. If this is true, nurses could end up filling the hospital beds they now manage. Although studies on stress and health are relatively new, many are finding links between stress and illnesses such as hypertension, diabetes and coronary artery disease. "About 80 percent of diseases have a stress component to them," said Herman, a certified stress management educator who frequently conducts seminars for nurses. She recommends dealing with stress in one of three ways: First, if possible, avoid the things that cause stress, she said, although this often is difficult at work. Second, if you can’t avoid the cause of stress, try changing your perception of it. For example, Herman said, if the way a co-worker treats patients makes you angry, instead of thinking, "That person interacts horribly with the patients," tell yourself, "That person doesn’t have the skills needed to interact with other people. I’m really glad I have those skills." You can’t change the person, but you can change your reaction, she said. Finally, if you can’t avoid stress or change your perception of it, take a break and try a relaxation technique, such as a breathing, or a meditation exercise to get yourself back in balance, Herman said. You can build up your resistance to stress by eating well, getting enough sleep, exercising and doing things you enjoy, such as listening to a beautiful piece of music or daydreaming, she said. "Or just take a minute to go outside and lie on the grass and look at the stars." ~ Cathryn Domrose

Just after the holidays last year, nurses in the operating room at Houston’s Texas Orthopedic Hospital had reached a breaking point. They were snapping at each other, criticizing each other, driving each other crazy.

The nurses diagnosed themselves with a case of classic burnout. To salvage their "extended family," Kathleen Nastally, RN, said, they decided to meet with a family therapist.

In those meetings – away from the hospital – nine nurses talked about relaxation techniques, aromatherapy, holistic medicine and stress management. They learned to deal with anger and how to communicate with each other. They found hobbies or interests outside of work. They began trying to eat right, get enough sleep, exercise. They learned to say no. They learned to find time in their schedules to do things they enjoyed.

"Nurses tend to take on everybody else’s problems," Nastally said. "But in the process, we forget to take care of ourselves."

That paradox, common among working women in general, seems especially true of nurses. Although some studies of nurses’ health show they are slightly more health conscious than the general population, many nurses say they are too busy working and caring for families to practice healthy habits. Instead, they grab meals at fast-food restaurants or from vending machines. They lie awake, worrying about work or get up early to take care of the children. They collapse in front of the television when they have free time. As a result, they have little resistance to dealing with stress at work or at home.

Greater workloads, shorter hospital stays and sicker patients have recently put even more stress on nurses and other hospital workers, said JoAnne Herman, Ph.D., RN, an associate professor of nursing at the University of South Carolina, College of Nursing. Herman, a certified stress management educator, offers stress-reduction classes for nurses. Although nurses cannot always manage to control stress at work, she said, they can increase their tolerance for it by taking care of themselves.

Nurses who do care for themselves are amazed at the results. They talk about achieving balance, about rounding out their lives.

"It’s made me a calmer, saner person," said Ted Bush, RN, who works with AIDS patients in the University of California, San Francisco’s Positive Health Program at San Francisco General Hospital Medical Center. Bush recharges himself by meditating and working in his garden in Oakland. By taking a few moments to breathe, to let go, Bush finds he is better able to care for his patients.

Instead of snapping at each other, the nurses in Nastally’s group now support each other – reminding each other to eat right and stay on their exercise routines.

A main cause of stress is feeling out of control, Herman said. Hospital administrators can help relieve some stress on nurses by allowing them control whenever possible, said Debra Mills, MSN, assistant teaching professor at Brigham Young University in Salt Lake City. Nurses may feel they have more control if they think those they work for are listening to them and showing appreciation, she said. But in the end, Mills said, nurses have to decide to take care of themselves.

Nurses who have made that decision offer these suggestions:

Fit in fitness
Nastally, a mother of two daughters, had stopped going to the gym. She hadn’t a moment to spare between work, picking up her children, taking them to karate lessons and home for dinner. Desperate for exercise, she started a kickboxing class at her girls’ karate school. She found herself wrapped up in the sport, taking out the days’ frustrations by kicking and punching bags. She earned a black belt. She’s gone from three push-ups a session to 40. Now, she teaches cardiofitness kickboxing while her husband picks up the girls and fixes dinner.

Kickboxing lets her exercise without sacrificing family time, she said. The girls watch her and say, "Hey, mom’s doing it, too."

Set limits
About six years ago, Sharon Lee, MSBA, RN, a nurse supervisor, was "spiraling out of control." Lee, vice president for nursing and patient care services at Boise, Idaho’s St. Luke’s Regional Medical Center, was tense and irritable at work and felt that everyone around her was, too. She couldn’t do much about her co-workers, she said, but she could do something about herself. Among other things, she stopped taking appointments before 8 a.m. so that she’d have time to visit the gym.

She was surprised by the reaction of her co-workers. Instead of resenting her decision to work less, they began to follow her example. They told her, "You gave us permission" to set limits that allowed them to care for themselves, she said.

Make time for yourself
Nastally suggests nurses surround themselves with "things that make you happy – clip meditations up in your locker, aromatherapy in your car, relaxation tapes to and from work."

When Mills has students she thinks are under pressure, she sometimes assigns them to go to a movie.

Bush grants himself quick retreats by lighting incense at shrines in his garden and concentrating on a person who has died – sometimes a patient, sometimes a relative or friend – letting the memories nurture him.

Don’t beat yourself up
Taking care of yourself, like taking care of others, is work, Herman said. "You have to practice." You can’t expect to be perfect, either.

Nastally, who once drank two six-packs of Coca-Cola a day, now is happy when she keeps it to four cans. Lee still gets by on five or six hours sleep, although she knows she should be getting at least seven. Both said it’s easy to fall back into old, bad habits – eating junk food or skipping exercise – but they keep trying.

"This is not something that you do once and it’s going to solve your problems," Lee said.

Feed your soul
Some nurses hike in the mountains, go on retreats, make dollhouses or quilts. After years of immersion in a science-based career, Hopkins Stanley, MS, RN, was thrilled to find a hobby that let him explore his artistic side. Stanley, a clinical nurse specialist for San Francisco General’s Positive Health Program, started glassblowing about 1½ years ago.

Stanley has converted the basement of his San Francisco home into a small glassworks. He creates vases, goblets, holiday ornaments. Glassblowing requires his complete concentration, Stanley said. He can’t think about work or anything else when he is transforming a glob of molten glass into a work of art.

Ask yourself why
About 10 years ago, Bush was working 10- and 12-hour shifts in the operating room of a large Manhattan hospital. Although exhausted, he thought he liked the excitement and fast pace. But after he began working weekends caring for people with AIDS, he realized how much he enjoyed building relationships with patients.

"A whole new set of goals happened," he said. He moved to San Francisco to work on an AIDS research project. While visiting a patient in a Zen Buddhist hospice center, he was introduced to meditation, which now helps him in everything from dealing with work tension to sleeping.

In rethinking his career, Bush believes he opened a path to taking care of himself as well as his patients. Instead of being burned out at 51, he feels the opposite, he said. "I’m looking forward to how I could be a nurse in retirement."