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Combating depression in nurses

Nurses are twice as likely to experience clinical depression than the general population. Why aren’t we talking about it?

The Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) found that 18% of nurses exhibit symptoms of depression, compared to the 9% found in the general public. Nurses are happy to talk about their staff shortages or their back problems, but we almost never see serious discussions about mental health issues.

Minority Nurse suggests that nursing culture exacerbates the depression issue. Nurses take great pride in their survivability and toughness; they often see trials facing new nurses as a proving ground, a way of weeding out those who are not cut out for the job. This leads nurses struggling with depression to bury their feelings and work twice as hard, which will make things worse in the long run.

There’s also the idea that mental health issues are seen as a weakness. Nurses rely on each other to be reliable and trustworthy, and someone who is struggling might be easily dismissed as unreliable. This puts their job at risk, and can affect their relationship with peers. Additionally, the nurse mentality is to put the care of others first; many nurses might not release why their suffering, as they so rarely address their own needs.

If admitting they have a problem or asking for help is often the last thing a nurse wants to do, how do you help them? The process starts with nurse managers. Educating managers about the warning signs of depression, and they in turn train their staff to recognize the condition in themselves and their peers. Coming up with strategies to help depressed nurses that aren’t punitive and making sure their staff have resources available to them can help alleviate the fears associated with mental illness.  Showing the staff that it’s okay to talk about mental illness and that asking for help isn’t a sign of weakness will help change the “tough it out” culture of nursing.

Addressing mental health issues can help improve nurse retention as well. Instead of “weeding out” the weak links, supporting new nurses through a crisis and encouraging them to get help will keep them at their jobs longer, and make them better nurses for the rest of their career.

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Rock Your Health: When you can’t stop working!

What’s up with working all the time? How did that enter our lives?  What happened to weekends off with a Sunday drive in the country? What happened to Sunday morning church followed by a nice meal out? What happened to evenings sitting outside or kids playing till dark? What happened to all that free time computers were supposed to give us?  Oh wait.  Maybe that’s it. It’s the computers fault. Or is it?

If you are wondering why you are so exhausted, look no further than your own choices about how you are living your life. And if the people around you are in the same boat, maybe it is time for a heart to heart.  So what are you willing to do to bring rest and refreshed energy back into your life?  And how committed are you to making that change?

As a wellness coach I know how successful people make changes in their busy lives and having a coach to hold you accountable is often the best step to get you to where you want to be quicker. Contact me if you want a sample session and maybe you will discover what possibilities exist for you. carol@carolebert.com

Dealing with racism in patients

Nurse managers and their staff often face racism in the work place; Minority Nurse reported that almost half of minority nurses said they have experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?

The New England Journal of Medicine published an article last week that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.

The journal lays out five factors to consider when faced with this difficult situation:

  • The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
  • The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
  • Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
  • Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
  • Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.

If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.

For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.

Rock Your Health: 6 Excellent ideas to FIRE UP your work

FFind new initiatives that make your job better and healthier. This is the “fuel for your fire” so keep abreast of new trends and bring people together who have passion for making things happen and hand the reins over to them.

IInvest time connecting with staff. Ask as you shall learn what people want. The best ideas generally come from those around us, but we often don’t ask them for advice. Be the manager that asks!

RRenew your commitment to your role on a daily basis. WHY did you take on the role of manager in the first place? WHAT is in it for you? Write that statement down, hang it where you will see it every day and read it out loud to keep your internal fire burning.

EEnergize yourself daily to keep your mind, body, spirit in balance. This is my number one priority because if I don’t take care of myself, no one else will do it for me. When I stopped working for a boss who controlled my time and my schedule and started working for myself, I make exercise my number one priority above all else, and have held to that commitment for the past 10 years and it is paying off every day. How are you keeping your life balanced despite all the stresses and strains of work and life? And how are you encouraging your staff to do the same thing?

UUndo negative self- talk. This will do you in every time. The minute you tell yourself you don’t have time for something new, you don’t have time! It’s that self-fulfilling prophecy. “Whether you think you can or can’t either way you are right.” – Henry Ford 1863-1947.

PPlan, Plan, Plan. Create daily, weekly, monthly, 3-monthly, 6- monthly or a full 12 months in advance. Without a plan, you are lost. Trust me, whenever I have a plan I feel better and have success, when my plan runs out and I haven’t created another one, I “feel” lost.   Select which time frame works for you and get your team creating a masterpiece that will keep the flame burning.

So keep the flame alive, and don’t give up! As author Napoleon Hill said: Quitters Never Win and Winners Never Quit!

Rock Your Health: Ten questions to ask when you are looking for the right coach for you

Are you stuck and don’t know how to move forward with an issue that is bugging you but you never seem to finally do anything about it? This is where having a coach can be a real asset, helps you break thru barriers and gets you into action. But how do you find the right coach for you? Here are some questions to ask your potential coach to help you sort it all out.

  1. What are your qualifications that make you an effective wellness coach?
  2. Where did you receive your coach training?
  3. How long have you been coaching?
  4. What makes you different from other coaches?
  5. How do you decide whether you can help me?
  6. What strategies do you use when you coach someone?
  7. Can I interview you by phone before I decide to hire you?
  8. Do you provide a complimentary coaching session before I sign up?
  9. What happens during a coaching session?
  10. What does a coaching package look like and how much does it cost?

Want to ask me these questions to find out what kind of coach I am? Contact me at carol@carolebert.com.

Take Five: How renewal rooms revive stressed out nurses

With long shifts, hard work, and close contact with the sick and the dying, it’s unsurprising that many nurses are burnt out. One study found that nearly one-third of oncology nurses exhibit emotional exhaustion and 50% report levels of emotional distress. Despite the fact they might be hurting, nurses are often expected to “tough it out,” hiding their stress from the eyes of others.

Compassion fatigue is a huge issue for us all in bedside nursing, and we as leaders need to look into and address that,” says Jacklynn Lesniak, RN, MS, BSN, senior vice president of patient care services and chief nursing officer at Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center in Zion, IL.

In response, CTCA Midwestern created several “nurse renewal rooms,” with one in each inpatient tower, surgical department, and outpatient care area. The rooms were designed by Jillianne Shriver, RN, BSN, HN-BC who studied relaxation techniques and holistic nursing for three months for the project.

Only one nurse is allowed in the room at a time, giving them much needed private time away from the eyes of patients and coworkers. Each room is laden with relaxation material and décor: aromatherapy and meditation material, a yoga mat, a sand garden, books for reading and journaling, and music therapy.  When a nurse feels he or she needs to step back, they inform their charge nurse that they need to use the room. Then they hand over their communications devices and go into the renewal room for a couple minutes to decompress.

“I decided that I really wanted somewhere for the nurses to take that time to renew, rejuvenate, and recharge,” Shriver says. “To step out of whatever situation they may be in, whether that be a stressful or busy day, and have five to 15 minutes to themselves to be able to focus, ground themselves, take a deep breath, and then step back into practice.”

Not only did the renewal rooms work, they worked well. CTCA Midwestern reported that the first renewal room was used 422 times in the first three months and 96% of nurses said they felt better after using it. Which is pretty impressive when you consider the first renewal room was just a supply area with a massage chair and some relaxing decorations.

To read more in-depth about nurse renewal rooms, check out the original article at HealthLeaders.com.

Rock Your Health: 7 Secrets to Being a Healthy Nurse

So what does it mean to be a healthy nurse?  I am one and am proud of it!  But I latched on to the concept of Wellness early-on.  Right out of nurse’s training I spent 3 years as a Navy Nurse caring for Vietnam casualties and really got a wake-up call about war and how it is not a good thing!  But I learned a lot, grew up a lot, but then entered civilian life again doing the nursing thing at the bedside.  That may have been the turning point for me because I felt the problems I was treating could have been prevented, and it all seemed senseless to me.

So I became a school nurse, got hooked on teaching kids how to stay healthy, and made the shift from treating problems to helping people prevent them. Much more rewarding for me and thus was dubbed “Nurse Wellness.”

What I have learned and “know for sure” (as Oprah would put it) is that there are some core principles that if you adhere to them, all will be well.   Why people don’t is still a mystery to me, but once you get in the groove of these things, it becomes fun, with a huge payoff – like you might live to 100+.  And right now as a Boomer myself, that sounds mighty nice.

So here is my magic formula for staying HEALTHY.

H – Happy Attitude.

E – Exercise Daily.

A – Abundance of Antioxidants.

L – Low Glycemic Foods.

T – Take Time for Yourself.

H – Help Others.

Y – Young at Heart.

Rock Your Health: Finally – An Easy Way to Get Moving!

Why are we so resistant to exercise?  The CDC says 80% of the US population doesn’t get the recommended amount of exercise for health.  So which group are you in – the 80% or the 20%?  Are these some of your excuses when it comes to exercise?

  • I tried it before and I always stop after a few weeks
  • I don’t feel better right away and in fact, I hurt all over
  • I don’t see the benefits soon enough so why even start again
  • I don’t have the time
  • I’m too tired at the end of the day
  • I’m too busy to fit it in
  • I don’t need to exercise because I am on my feet all day
  • I’ve gotten this far without exercising so why start now
  • I’m too old to start exercising and I might hurt myself
  • I have a health condition and can’t exercise
  • I’m too lazy

Well guess what.  I fall prey to many of those excuses as well, but at one point in my life I realized a huge benefit from regular exercise and I’ve never stopped since.  Yes, exercise became my tool to MANAGE STRESS.  Now that I use exercise as my stress management prescription, I’m much more motivated and have received huge benefits that continue to keep me coming back for more.

  • I get to burn off all the pent up energy that can turn on my body and create pain
  • Moving my body immediately changes my attitude from negative to positive
  • I get to be around other great women who want to feel better which inspires me
  • I feel better being with others
  • I’ve gained many new close friends to share feelings and reduce the anxieties of life
  • We get to laugh a lot because our instructor is so fun and pumps us up
  • My endorphins also get pumped up and I “feel” what others call a “runner’s high”
  • I forget about all the day’s irritations and just focus on my body’s movements.
  • I get really creative when exercising and come up with cool new ideas for my work
  • If I feel any depression at the beginning it all dissipates while I’m working out
  • I feel a great sense of accomplishment at the end and feel relaxed and calm
  • I sleep better

And oh yes – people ask me how I stay so fit and think I am younger than my age.  Now that is the best self-esteem booster of all!

So what are you waiting for?  Stop thinking of exercise as a chore, or torture or a waste of time.  Start thinking of it as a way to reduce stress (who doesn’t experience this daily) and you don’t have to take any drugs either.

JAMA: Nurses key to surviving surgery

A study published in The Journal of the American Medical Association has found that surgery patients in hospitals with better nursing environments receive better care without drastically increasing costs. Researchers found the 30-day mortality rate for postoperative patients was 4.8% at hospitals with more than 1.5 nurses per bed (NPB), while facilities with less than one NPB had a 30-day mortality rate of 5.8%.

“It wasn’t just the number of nurses that made the difference. Magnet status hospitals recognized for having excellent nursing programs and cultures do better,” study author Linda Aiken, PhD, RN, said in a press release.  

While there’ve been numerous studies showing the benefits of a bigger nursing staff, the cost of hiring new staff has been an impediment for many facilities. Despite this, better staffed hospitals actually paid less ($163) overall per patient than understaffed hospitals.

When nurses get sick, a culture of toughing it out can put patients at risk

A woman comes to the hospital lobby asking to visit a friend who has recently had surgery. The visitor is coughing heavily and appears to be sick. Do you let her in to see her friend? Most hospitals would say no; a well-meaning but sick friend or relative could have a devastating effect on an immunocompromised patient.

Meanwhile, a nurse arrives for his shift with the exact same cough as the sick visitor. Do you let him go to work, potentially treating the exact same immunocompromised patients you’re trying to protect?

According to a study published this July by The Journal of the American Medical Association, the answer is yes. [more]