Posted March 24, 2017

Self-Care Should be a Priority for Nurses: Q&A with a Nurse Leader

By Erin Shipley, RN, MSN

Erin Shipley, RN, MSN, is a Studer Group coach with more than ten years of leadership experience. She has a passion for collaborating with care providers to improve the patient experience, increase quality, move results, and hardwire standards across departments.

Recently, we sat down with her to discuss the importance of self-care for nurses, as well as challenges to and strategies for making it a priority.

For more resources related to nurse self-care, check out our Nurses Week 2017 resource page.

In your experience, what are the greatest challenges for nurses related to self-care?

Nurses are naturally givers – they are always thinking of others first. So just the concept of making their own self-care a priority is foreign to them. I would say, in terms of challenges, one of the biggest is inconsistency in leadership and the team that they work with. That uncertainty creates additional stress because nurses don’t know if they will be supported or have the backup that they need if they get tied up with a patient. Because of concern for their patients, nurses may not take the time for themselves that they need. There are the breaks they don’t take; the lunches they don’t eat; and the sleep that they lose at night. And it all comes back to that sense of ownership that nurses have for their patients. If they’re sick, they might not call in because they want to make sure their patients are well cared for and that they aren’t leaving their team short-handed. But often that comes at the price of their own self-care.

How can nurses find the time to commit to self-care?

Clustering care is something that we talk about in nursing school, but there are a lot of nurses that still really struggle with that. Things like Hourly Rounding®, Bedside Shift ReportSM, and Nurse Leader Rounding -- that’s the bundle that keeps you successful. Rich Bluni has a great metaphor about the mailbox: You observe your neighbor go out to his mailbox and get a piece of mail and go back inside. Then he goes back out to his mailbox and gets a magazine and comes back inside. Then he walks back out to get a bill and goes back inside. If you saw that, you’d think, “What in the world is he doing?” But that’s often how we care for patients – because we don’t cluster. We go in the room and say, “I’m here for you right now. What can I get for you?” If a patient asks for a blanket, a nurse will run out and go get it, and then come back in the room and they might ask for a glass of water. So, nurses are constantly running back and forth, which in turn, means that they are always running to catch up. That’s not proactive. But by using the eight behaviors of Hourly Rounding®, nurses can more proactively address patient needs so they aren’t running back and forth, which saves time that could potentially be used for a bathroom break or a quick snack or any number of self-care activities.

What are some examples of self-care that nurses can easily incorporate into their busy schedules?

I think finding a quiet moment in the day for caregivers can be difficult. How many times do they eat lunch while doing a task as opposed to taking 20 minutes to truly eat lunch? I’ve led nursing departments; I know how we love for our break rooms to have boards with pillar goals, patient experience results, and educational posters. You can’t even go to the bathroom without seeing a Joint Commission checklist on the wall. To take a moment for themselves, nurses must find a place where they can escape. Most hospitals have a walking path, garden, chapel, or some peaceful place where nurses can get away for a few minutes. On my lunch break (it was 30 minutes), I would walk around the hospital three times. And when I came back, I was so much better for my patients because I had gotten a little fresh air. It was truly a moment to refresh so I could come back and provide the best possible care.

How do you see nurses supporting each other as they are being asked to do more and more each shift?

When a call light goes off, any nurse that is available and hears it go off, should be ready to go in and help that patient. It is vital to get nurses out of this siloed mentality, so that they understand that they are all responsible for every patient on a unit. That is the number one thing nurses can do to support each other. Don’t walk past a call light. If you hear a patient calling for assistance, you have a duty to to respond to this patient’s needs as if they were your own. It makes things so much better for patient outcomes, certainly, but also for the nursing team. If I am tied up, I want to know that someone else will take care of my patient, so I don’t have to be constantly worried. If one of my fellow nurses answers a call light when she is right there, that might afford me a few extra minutes in my day so that I can take a short break or eat my lunch or run to the bathroom.

Also, it’s important to remember to celebrate the “wins”. In huddles, start with a positive story or report. And don’t skip the little things like celebrating each other’s birthdays or personal milestones.

How can nurse leaders help ensure their nurses are taking care of themselves?

When we round with direct reports, we say, “What questions do you have for me?”, but the flip side of that question is, “What are you struggling with? How can I, as your leader, help you?” Be aware of how many shifts nurses are working and if they are exhibiting any symptoms of burnout. As a nurse, my maximum is five shifts in a row before I recognize that my care is not as good on the sixth shift. It is important for leaders to recognize the subtle signs of burnout that nurses have – crankiness, call-ins, frumpy uniforms, a slide in their documentation. Those are all indications that as a leader, I need to be more assertive, thank my nurse for volunteering to take on another shift, but let him or her know that I can’t accept the offer. We don’t do that often because leaders are trying to run a unit. If that nurse isn’t on the floor, then I am responsible for that care. It’s also important that if leaders see those signs of burnout that they try to understand why it’s happening. Is it because my unit is not adequately staffed? Is it because I have newer nurses that are still learning? Is it because of high turnover? There’s a responsibility for leaders to think through that and act. I’m the CEO of my unit, and I need to be accountable to my nurses to make sure that they have what they need to be successful.

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