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Dealing with Difficult Patients: The importance of self-care

By Joan Monchak Lorenz, MSN, RN, PMHCNS-BC

Nursing is known as the caring profession. Nurses are known as caring individuals. Caring and anticipating needs are strengths of those in nursing. They are our best assets, and the assets most recognized by others.

But our greatest assets can also be our worst liabilities. In other words, caring has two sides to it: Caring for others is noble and fulfilling, but caring too much, or using up all of our energy caring without caring for ourselves, can leave us tired and drained.

In order to take care of challenging patients, we need to make time to take care of ourselves. Nurses who do not take care of their own health needs are often the ones most likely to have problems caring for challenging patients. We need to face up to the reality that spending our work life caring for others is a heavy burden, and we must take some time to recharge, and refill our cupboards. We need to address the emotional toll our work takes on us.

Rethinking stress

Stress can be emotional, physical, or spiritual. The first step in handling stress is to make sure that we understand how we cope with stress.

As nurses, we can make the assumption that our personal life and our work life cause us stress. There is really no need to make a list of our stressors—this might cause us more stress. But it’s safe to assume that we have stress. We have all developed methods to handle our stress: Sometimes we develop adaptive ways and other times we use maladaptive methods. Start by listing some coping methods and separating them into those that help and those that hinder you. Then do more of what helps, and systematically eliminate or change those that hinder.

Sometimes the way we look at things causes us increased stress. Here are some ways of thinking that add to stress. Do any of these ring true for you?

Extreme thinking: Sometimes we see things with no middle ground or no gray. It is all black and white, all or nothing, good or bad.

Overgeneralizing/blowing things out of proportion: Everything is a crisis. “No one here knows what he or she is doing.” “I never get a good assignment.”

Mind reading/fortune-telling: You predict the future in a negative way: “This is going to be another rotten day.”

Jumping to conclusions without enough evidence or guessing about what other people are thinking about us: “They don’t know what it is like to work on the floor. This is just one more thing they thought up to make our days difficult.”

Personalizing: Jumping to a conclusion that something is directly connected to you: “Everyone knows I’ve been off work because I can’t cope.”

One way to reduce your stress is to change the way you look at things. Try these alternatives and see how they work for you:

Change extreme thinking into reality thinking. Look for the gray between the black and white.
Stop overgeneralizing and recognize that what is happening now is only what is happening now. Nothing lasts forever. Look for times when good things happen to you, such as when you do get a good assignment.

Stop mind reading. Ask for clarification and details. Check out the facts. What does the policy say? What does the procedure mandate?

Gather your data before making a conclusion. We all know we need to make a comprehensive patient assessment before a diagnosis can be made. Use the same principles when coming to a conclusion (diagnosis) about a situation that has caused you discomfort.

Come to grips with the reality that the world doesn’t revolve around you. Yes, sorry to say, most of the time other people are so concerned about themselves that they don’t even think about how their actions might affect you.

Change stress into relief

In her article “Break the cycle of stress with PBR3,” Becky Graner, MS, RN, IAC, shares a simple tool that aids in stress relief. PBR3 stands for pause, breathe, relax, reflect, rewrite. Let’s see how it works. Adhere to the process in the following table the next time you are in a stressful situation at work, or just before going in to take care of a patient who presents a challenge to you.

Pause: Simply stop thinking. You can continue doing something such as walking down the hall, washing your hands, or another activity that has become automatic for you. Simply stop your thoughts.

Breathe: Stop the chatter in your mind by paying attention to your breathing. Just focus on your breaths and count, say a prayer, or repeat an affirmation to yourself. Don’t try to control your breath. And don’t hold your breath.

Relax: Simply taking a pause and a few breaths, particularly diaphragmatic breathing, takes you out of a reactive state and into a more relaxed state. When you are relaxed, your thinking will clear.

Reflect: Debrief yourself. What was going on that led up to the situation that bothered you? If you felt angry, what was the feeling behind the anger? Was your response out of proportion to the situation? Were you thinking the worst?

Rewrite: Check yourself to find out where you may have been taking things too personally, making assumptions, or doing some of the other automatic thinking processes that cause more stress than not. Rethink or rewrite these into more realistic assumptions. Using humor, empathy, or compassion may soothe you.

Reference
Graner, B. “Break the cycle of stress with PBR3.” American Nurse Today, (2)5:56–57.

 

The dangers of compassion fatigue

Nurses are the frontline of patient care, making them the most susceptible to compassion fatigue, a state of mental exhaustion caused by caring for patients and their family through times of distress. It’s important that nurse managers are aware of the risks, identify the signs in their staff, and provide guidance to nurses that need it. While the increase in stress and unhappiness caused by compassion fatigue are evident, some of the other consequences are less obvious:

Increased medical risk: Compassion fatigue can lead to an increase in medical errors due to a lack of communication or inability to react. Nurses suffering fatigue can become unsympathetic, self-centered, and preoccupied, to the detriment of a patient’s care. To read more about this connection and how to counter it, check out Reduce Nurse Stress and Reduce Medical Error from HealthLeaders Media.

Decreased retention: The increased stress and potential trauma associated with compassion fatigue can drive new nurses away from the field. The American Association of Colleges of Nurse reports that 13% of newly licensed RNs work in a different career within a year of receiving their license, and 37% said they were ready to change careers. Many reported that the significant, ongoing emotional stress was a factor in their dissatisfaction.

For more information on combating nurse fatigue, check out the Health and Wellness section of the Strategies for Nurse Managers Reading Room:

Don’t underestimate damage caused by burned out nurses

Preventing nurse fatigue
Beat nursing stress and stay calm and collected

Study: Nurse fatigue on the rise

A new survey indicates that fatigue affects 85 percent of nurses, and more than half of nurses have experienced burnout.

The study, conducted by Kronos Incorporated, surveyed 257 nurses currently working in U.S. hospitals. Nearly all of the respondents (98%) said their work is physically and mentally demanding, and 63 percent reported that their work caused nurse burnout. 44 percent worried that their patient care would suffer because of their exhaustion, and 41 percent considered changing hospitals in the past year because of their burnout.

Nurse fatigue has a number of causes, and can occur during any shift. An excess of fatigue without proper coping mechanism can cause burnout, an exhaustion that can cause your staff feel alienated from their work and cause diminished performance.

The best way to counter burnout in your staff is to create programs that encourage self-care and raise awareness about the symptoms of nurse fatigue. For more tips about coping with burnout, check out the following articles from the Strategies for Nurse Managers’ Reading Room:

Preventing nurse fatigue
Take Five: How renewal rooms revive stressed out nurses
Don’t underestimate damage caused by burned out nurses
Stop requiring nurses to work overtime

Educating staff about compassion fatigue

While many nurses know about compassion fatigue, they might not know exactly what it is, why it happens, or how to identify it in themselves. In a recent blog post, Jennifer Lelwica Buttaccio tackled some of the most common myths associated with compassion fatigue.

Not me!
One of the most common misconceptions about compassion fatigue is that your compassion is a limited resource, and if you can still feel compassion for a patient, it must not pertain to you. More likely, you will experience symptoms in other aspects of your life, such as physical or mental exhaustion, dreading going to work, worrying and dwelling on possible errors, or becoming easily frustrated with coworkers. So even if you feel empathetic while you’re with a patient, you could still be suffering from compassion fatigue.

Work harder! Nurses tend to throw themselves into their job head-first, but that approach can be detrimental when dealing with compassion fatigue; your instinct to work harder to overcome challenges at work will not help you here. It’s important to maintain a work-life balance, and compassion fatigue is often caused by overwork and neglecting yourself.

Patients first! Nurses take great pride in the care they give to their patients, but it should not come at the cost of caring for yourself. The best way to provide consistent and outstanding patient care is to take care of yourself first, by taking time for yourself, away from alarms, patients, and colleagues. Make sure that both you and your staff take their breaks and use their time off.

Check out the articles below for more information about compassion fatigue and solutions to your health and wellness problems.
Preventing nurse fatigue
Take Five: How renewal rooms revive stressed out nurses
Worker Wellness: Fatigue and Burnout

How evidence-based practice can improve nurse satisfaction

If a nurse is unsatisfied with their career or feeling burnt out on nursing, taking an evidence-based approach can help them rediscover their passion for nursing. Robert Hess Jr., PhD, RN, FAAN and co-author of HCPro’s Shared Governance book, recently wrote a piece about EBP and nursing careers; here are some ways to apply EBP in your career:

  • Update your practices. Nursing is changing all of the time! If you feel like you’re stuck doing the same thing every day for years, you’re probably not using the most up-to-date practices. Nurse scientists and researchers are studying and updating practices for nurse specialties all of the time, and these changes can benefit patients and nurses alike. Try joining your specialty group’s professional organizations, attend professional events, and subscribe to specialty journals to keep abreast of the latest practices in nursing. Changing up your routine and increasing your engagement can bring the excitement back to your career!
  • Use EBP in your career. Evidence-based research is not just conducted on healthcare practices. There is organizational research that provides indicators for when nurses should consider a career change, such as switching roles, going back to school, or even leaving their current job. Burnout has been measured for decades, and evaluating your own signs of job fatigue can be instructive for potential career decisions. Nursing has a plethora of opportunities outside of the hospital bedroom, and feeling burnout could be your signal to explore them.
  • Evaluate your environment. Research has found the workplace satisfaction can correlate with career satisfaction. Observe your colleagues; do they seem happy? Do they participate in work group activities, both at work and outside of work? Having coworkers that are satisfied with their jobs has a positive impact on your own satisfaction, and if you’re feeling career fatigue, sometimes your coworkers can fuel your enthusiasm.

For more tips about career satisfaction and burnout, check out these articles from the Strategies for Nurse Managers’ Reading Room:

Delegation prevents nurse manager burnout

RN satisfaction survey promotes positive change


How nurse executives can help tired nurses

Tips for recommitting to nursing in the new year

The new year is often a time for retrospection and reflection, especially when it comes to your career. If you’re starting to feel burnt out on nursing but not quite ready for a career change, here is some advice to freshen things up in the new year.

  • Reflect on your past: Sometimes the best way to go forward is to look back. What drew you to nursing in the first place? Why was a career in nursing right for you? Think about the positive experiences you’ve had as a nurse that reaffirmed your career goals. Treat your next shift like it’s your first day; what excites you? What makes you nervous? Sometimes asking these questions can reinvigorate how you approach your work.
  • Connect (and disconnect): If you’re feeling down about your job, sometimes the best solution is to ask for help. Reach out to your peers and develop a support system to help yourself and others. If you think there’s something that could make you happier at work, talk to your managers about it; sometimes a small change can have a profound effect.

    It’s also important to let go sometimes. Being a caregiver, interacting with patients at some of the worst times in their lives can negatively impact your outlook and make your job even more difficult. Try to focus on the good you’ve done for patients and don’t take it personally when a patient struggles or suffers.

  • Commit to the new: Even though it doesn’t always feel like it, taking on new challenges can be a great way to energize your career. Seek out new experiences and opportunities; take the frustrations of the day and channel it toward learning a new skill or pursuing additional training options. Reflecting on your weaknesses can be difficult at first, but identifying them and working towards improvement can be satisfying and build you confidence.

    Another great way to embrace the new is working with nursing students or new nurses. They bring energy and enthusiasm to the job, and becoming a preceptor or informal mentor can be a great way to grow your own enthusiasm while furthering your career.

For more articles about avoiding burnout and developing your career, check out the Health & Wellness section of the Strategies for Nurse Managers Reading Room!

Rock Your Health: Are your joints starting to act up?

As the Nurse of Wellness that I am, my belief is that I am unstoppable and will live forever. Can you relate? But the mechanics of my body have a different story to tell. Over-use syndrome of doing too much, in too much of a hurry, and not honoring the fact that my body might need to slow down a bit to move safely and not get hurt  took its toll on my knee.

Yes, I was on crutches with a swollen left knee from just squatting down briefly.  Go figure! But I have learned from this experience. YES – ONCE AGAIN – another learning experience!!

  • I had to ask for help, even when it pains me to do so
  • I had to do less and the world didn’t end because I’m not scurrying about
  • I had more time than I thought and could catch up on reading and making calls to reconnect with others – you know; all that old-fashioned stuff we don’t always seem to have time to do.
  • I became more efficient with my movements because I had to rest my knee more often instead of being in perpetual motion
  • I received visitors who brought me great food and great conversation
  • I discovered how valuable friends are who will rally around me when I am down and out
  • And finally, I learned that my joints need more respect as I age so I don’t injure myself needlessly.

So as I healed with ice, elevation, powerful anti-oxidants, essential oils, relaxation, ibuprofen and crutch-walking, I realized we are all on this journey of aging so I hope you give your “joints” a chance to serve you to the best of their ability. Respect them and they will carry you through.

Be well on your journey!  Would love to hear your story about how nursing can be tough on your joints!  Email me at carol@carolebert.com

Rock Your Health: Cleaning Up Your Act

As we enter the Spring Season, I feel the need to clean up my act.  Everything now feels better – more light at the end of the day, waking up to a light sky, chirping birds, walking outside again without slipping on the ice or worrying about walking in the dark, seeing sprouts of greenery and color once again.

That good feeling and renewed energy even compelled me to clean up one shelf in my office and now I not only feel better and more organized, but the empty places on the shelf makes me feel like I can even breathe easier.  Interesting how these simple things have powerful rewards.

So what can you clean up that will provide you with more relief and less stress?

Need support with cleaning up your act?  Email me at carol@carolebert.com and I’ll give you a complimentary laser coaching session.

Rock Your Health: How nurse managers can remove the roadblocks of life

As a nurse manager or nurse leader, you probably have many unfilled dreams. What is standing in the way of you realizing those dreams? Think about whether this roadblock is a true obstacle or a false belief about yourself. Break it down into small components so you can chip away at it a little bit at a time. You can’t move a large boulder, but you can chisel off small rocks, until you have the strength to push it aside.

Write down one roadblock standing in the way of what you want in life. [more]

Save yourself: Tips for protecting your valuable time

First, a couple of brief items:

Better Meetings, Better Outcomes: You can download the PDF I promised a few days ago, “What am I doing here? Tips for being accountable in meetings,” here.

Nursing Survey Ends 5/27: Our 2015 nursing survey is still open if you want to share your thoughts and (not incidentally) participate in our drawing for Team-Building Handbook: Improving Nurse-to-Nurse Relationships. Here’s the link: https://www.surveymonkey.com/s/hcpronurses2015

Next, my confession.

I’ll admit it, I peeked—I couldn’t resist the temptation to look at the results of our ongoing 2015 nursing survey to find out the biggest issues facing nurses today.

Would you be surprised if I mentioned that time (not enough of it) is as common a concern today as it was in the 2013 survey? To relieve some of your pain, I’ll share some great tips from Sharon Cox, [more]