Nurses are called upon to care for and show compassion to patients day after day. It is not uncommon for a nurse to have to put aside the painful circumstances of one patient in order to provide cheerful care to the next, often with no time to deal with his or her own emotions in between. All of this giving and all these emotional ups and downs can be draining. As nurses care for others without taking time to care for themselves they often will experience compassion fatigue.

“When a caregiver begins to suffer the symptoms of compassion fatigue, he or she will instinctively know ‘something is wrong,’” noted Patricia Smith, founder of the Compassion Fatigue Awareness Project and a certified compassion fatigue specialist.

“Compassion fatigue can be an insidious thing. You might feel lethargic and like you’ve got nothing left to give. There is no joy in your work anymore,” added Kim Richards, RN, founder, The Self-Care Academy.

The main remedy for compassion fatigue is self-care. This prescription may feel daunting to a nurse who isn’t used to making time for herself, but Richards says nurses need to broaden their view of what it means to care for themselves; it can be simple things like taking a multivitamin or drinking enough water.

“The place to start is to get some rest—just spending some time alone,” said Richards. “Of course exercise is great because it releases endorphins and will increase your energy level. But everybody needs to know what brings them joy. What is it that they love to do, but have put on the back burner in order to meet everyone else’s needs? They need to figure out what reignites their spirit and reconnects them with why they got into nursing in the first place.”

For the deeply fatigued nurse, Smith recommends reducing the demands of life.

“Once the symptoms are labeled ‘compassion fatigue,’ it is imperative that a nurse take some time to restore his or her resources. This includes mental, physical, emotional and spiritual resources. If possible, taking time away from the job of care-giving is the best possible solution,” suggested Smith. “But for many, that option doesn’t exist. Talking with the nursing supervisor might be a way to check out some options that will provide additional time for self-care. Can he or she go part time for a while? Cut back on hours? Job share with a colleague? It is also important for a nurse to check in with family members. Are there chores at home that another family member can help with? Are there funds to bring in a sitter to help with the children?”

For a nurse in the early stages of compassion fatigue, some simple healthy lifestyle choices can go a long way toward staving off fatigue, such as eating well, developing one’s spirituality, or taking some time for quiet reflection during the transitions to and from work.

Richards is developing a website tool that will launch in April called My Self-Care Journey. This low-cost tool will provide nurses with a compassion fatigue assessment that will reveal their strengths and weaknesses in five key areas: emotional, physical, spiritual, choices and relationships. The tool, which is downloadable to a computer or handheld device, then walks users through creating a plan of five commitments they will make to themselves to increase their self-care. Users can receive text or e-mail reminders about their commitments, track their progress and periodically retake the assessment.

Another tip both Richards and Smith recommend is to rally co-workers to fight compassion fatigue together.

“Once there is an awareness of compassion fatigue and how it can devastate the life of a nurse, co-workers will often join forces to be sure they support one another, particularly following any traumatic events,” reflected Smith. “Working together to improve the workplace is one of the best things nurses can do to lower compassion fatigue levels. The higher the compassion satisfaction, which is the satisfaction we derive from the work we do, the lower the compassion fatigue levels.”

“Mid-level managers, especially, need to be supportive if their nurses begin working toward creating a more healthy and sustainable environment,” remarked Richards. “If nurses are happy at work, if they feel connected to their co-workers and patients, they will be great nurses and be willing to go the extra mile. But if they don’t feel that connection they will leave. We became nurses because we care about people and if we don’t feel like we are making a difference, we aren’t going to keep doing it.”

“When self-care practices are in place, nurses will begin to feel energized, positive, and whole. They will feel blessed to be able to offer compassionate care to those in their care. There will be a sense of happiness instead of the isolation, sadness and apathy that compassion fatigue can cause,” Smith concluded.

Read more:

Compassion Fatigue Awareness Project
The Self-Care Academy

Copyright © 2011. AMN Healthcare. All Rights Reserved.

1) Understanding why we want to change
2) having a plan of action, and
3) the courage to do it.

One final question: What is holding us back?

Dr. Nancy Geha is President of Redhawk Mountain Consulting and a motivational speaker and workshop presenter on personal, worksite and community development.  Dr. Nancy Geha www.redhawkmountainconsulting.com.

Jane Treat is a nationally known storyteller and workshop leader specializing in life transitions.  Jane Treat www.janetreat.com.

Dr. Geha and Ms. Treat are currently writing a forthcoming book on Women in Midlife.

Wishing you a wonderful Valentine’s Day feeling all through the year!

As a licensed professional healthcare provider, do you feel any responsibility for ensuring you consistently offer the best of yourself to create the optimal healing environment? Given your role, how do you define “the best of yourself“?

• Is it knowledge of disease and subsequent care planning?
• Is it clinical proficiency?
• Is it completing daily “tasks”?
• Is it spending time and money on installing technology?
• Is it leading your team to do their best?
• Is it purchasing equipment, machines and gadgets to help you get back to the top of the list and repeat?

It’s all of this and more. Certainly, no one would argue that these questions, as well as a long, complex list of others, are not important to consider when defining the “best of yourself” as a professional healthcare provider. But in this New Year, we have an opportunity to do things a little differently, don’t we?

I ask you to reflect upon the energy source or the “vehicle” which will deliver the “best of yourself”. You need go no further than the mirror. YOU provide the strength, the influence and the initiative to create the sometimes overwhelming challenge of providing optimal care, no matter what your job title may be.

We all contribute. Just as your car, your golf cart or any other vehicle needs “re-fueling”, so do you. No vehicle would last very long or get very far without fizzling out, performing poorly, eventually coming to a complete halt.

While the analogy of a vehicle may be crude, it paints a clear picture for the necessity to “re-fuel” to offer the “best of yourself”.Yet, over the past year, I have spoken to hundreds of nurses who tell me they don’t have the time to “stop by the gas station”. Really?

What happens to everything around you when YOU run out of gas?

OK, let’s commit to do things differently this year… and YES, you do have time to re-fuel by learning to apply practical self-care practices to your life.

Could I dare go so far as to imply that self-care is mandatory for professional healthcare providers? Hmmm…

Look at the questions again; is there any reference to caring, compassion or the “softer side” of nursing that is sorely lacking for some providers?

Wait! Was that left out?

As Kathy Douglas, MHA, RN recently stated so eloquently in her article titled, “When Caring Stops, Staffing Doesn’t Really Matter”, published in Nursing Economic$, November-December 2010, Vol. 28 / No.6:

“Individual care providers must take responsibility for their own well-being and make choices that promote self-care. What caregivers do, think, and how they behave can very much impact the work they are doing, and that work can and does impact the bottom line.”

Click here to view entire article.

Caring International Science Research is repeatedly showing that in order to create the optimal healing environment, the caregiver MUST sincerely feel care and compassion. The presence of care and compassion is an essential part that cannot be overlooked.

So how do you keep burning brightly without burning out?

Start by truly understanding the value that you play in your own life. Is self-care self ish? When you don’t embody a healthy self-care practice, who suffers? Your family, your patients, your colleagues, and ultimately YOU. You are the pillar, the source and the first element of creating your own caring environment full of purpose, joy and wellness… it begins with you and the degree to which you nurture, love (yes, love) and honor yourself.

If you want to see real change and quantum improvement in your life, start practicing consistent, sustainable self-care.

So, deep breathe…make 2011 THE year you get healthy in mind, body and spirit!

Increase your happiness, resilience and ability to remember the past without regret, face the future without fear and focus on the present with gratitude!

Find out more about Profound Care and how we can help!
Visit:  www.profoundcare.com

For me self care has not been easy to come by. I grew up in a very hard working immigrant family, where money was tight, and self-care was more of a luxury than anything else. At the age of 7, I was already helping take care of my sister, because my mother worked two jobs. I myself, then grew up having at least two jobs, sometimes 3, even in my nursing career.

self-care was more of a luxury

I was 23 years old before I realized that I was “worth” taking of myself. I met a wonderful and very generous person who taught me to believe in myself, because others saw something in me that I didn’t. I learned to let go of the feeling of guilt, and truly began to embrace the concept of self-care. Since then, self-care has taken on so many different wonderful meanings to me. Self-care initially in my career meant taking the personal time to pursue advanced degrees, first a BSN, then a MSN in Nursing Administration. Later on in my career, it meant advancing my education and professional growth for “fun” earning 5 different certifications, in Wound, Ostomy, & Continence Care, as a Nursing Professional Development Specialist, and most recently as a Nurse Executive. None of these were required, but in my quest for self-improvement and self-actualization, they truly became a part of caring for me.

My current journey of self-care is much more personal. This year I was incredibly blessed to be able to go on two different Medical Mission trips, one to Uganda, Africa and the other to Port-Au-Prince, Haiti. I have never felt so at peace, happy, and truly fulfilled in my role as a nurse and as human being than when I was on both of these missions. It is truly amazing how you can find that a part of allowing for self-care, is allowing your spirit to just be what it wants to be.

self-care is allowing your spirit to just be

Lastly, I am now encouraging and teaching my mother to embrace self-care. Her upbringing also led her to believe that self-care was “selfish” and only for the privileged. We have embraced self-care by traveling to Las Vegas first, and most recently with our entire family to Cancun, Mexico. She and I have also found great pleasure in caring for ourselves by reading inspirational/religious books, and growing in our faith. I am planning to surprise her with a trip to attend a special church service for her birthday next year. What a better way to care for myself than to embrace my faith, renew my spirit, and focus on what matters most in life!

Direct Approaches

Indirect Approaches

“It is not the end of the physical body that should worry us. Rather, our concern must be to live while we are alive-to release our inner selves from the spiritual death that comes with living behind a façade designed to conform to external definitions of who and what we are.”

Elisabeth Kubler Ross

Gator, 1995 - 2010

Fall is my favorite season. Here in Colorado, we have had an unusually hot summer and having intentionally moved from the searing deserts of Arizona to the Rocky Mountains, I was reminded why. I am invigorated by the typical daily (sometimes hourly!) weather changes of Colorado and I long for the transition to fall. The crisp freshness of cool nights and early mornings causes me to pause, reflect and breathe in life. I start to anticipate my first fall hike, a bike ride without 50 SPF and eventually a downhill powder run on my newly waxed skis. The lush flowers that used to grace my deck and patio are now withered and spent. I can relate…our 15 year old dog, Gator, was peacefully euthanized in our home yesterday.

Gator was a 90 pound Chesapeake Bay Retriever who never allowed his brothers, very friendly and effusively social, but forgetful of the “Retriever” part of being a Golden Retriever, to define his existence nor his life purpose…to swim and retrieve his tennis ball. It was his job, his mission and heaven help anyone or any animal that got in the line of his laser like focus. Gator was also supremely loyal to my husband and me even up until the moment he passed painlessly and effortlessly with the assistance of a Veterinary angel.

While I could write a book on lessons learned from each of my dogs, and the gut wrenching heartbreak of loss, I will take a clue from Gator and write about the power of focusing on “the ball”, living in the moment, releasing the gift of our inner selves and removing the façade of external definition. Through the twists and turns of my life, finally I am able to face the fear of sinking and do what comes naturally…swim! I have been blessed to mostly swim in a collaborative school of other likeminded “fish”, yet the occasional encounter with the deceptive allure of mermaid fish may have briefly taken my focus off the ball. No problem! That instance was erased with another throw of the ball chucker!

As Gator perfected the snowplow with abandon and would leap without fear into sometimes frozen water, breaking the ice with his powerful momentum, determination, and fueled by passion, I too have found my biggest successes occur after just “going for it”, without worrying how I am defined by others. His life was big, focused, joyous, uninhibited yet sometimes messy and just plain crappy. We always knew how he felt and he asked for what he wanted. Gator never stopped to wonder how he must have looked to his brothers, the “born to please” Golden brothers, Sammy and Valentino who are notoriously seeking approval and attention. While treasured, they are beautiful followers and even as Gator slowed and lagged behind, they understood that Gator set the tone for every walk to the park, every encounter with other dogs, and would correct every errant way of his much younger brothers.

Even as his massive body wore out, his mind and his deteriorating eyesight was still focused on the ball. He did not know that he could not run after the ball without suffering the later consequences of pain…he just ran! He did not know that a younger, more agile dog would catch his ball…he ran like he was one with the ball! He simply wanted to carry the ball and stayed the course of his passion!  Yes, others (specifically little yappy dogs) may not have approved of his assertiveness, but so what? He was the master of his destiny.

I have only known Gator for 6 of his 15 years and admit to being very intimidated by his “eye lock” on me when I invaded his space and married his Dad. After all, Valentino was a new puppy and I had only had a miniature daschund before then! In the years since, big Gator became a mama’s boy and I was smitten with the combination of his sense of enormous power, protectiveness and self control, yet childlike sweetness as he would cry like a baby when I walked in the door after trips away. Often, no words were needed to communicate. If you are a dog lover, you know the bond. It is unyielding trust. In the last few months, at 5am when I awoke to see him staring at me to help him navigate steps to go outside, he knew, without a doubt, that he would be cared for with compassion, gentleness and honor reflective of his gifts to us.

With the last hydrotherapy session, (a treadmill in a water tank!) it was painfully obvious the thrill was gone…we chose to let him swim with assistance in the big pool and even though he carried the ball in his mouth, he was struggling.  He was asking us to let him go. Swimming with a “just in case” Speedo diaper was not his idea of dignity, nor ours, and he was, for once in his life, terrified of sinking.

If you are not a pet lover, you are probably wondering why all the effort. If you are, you already understand. A life of focus on a purposeful ball, swimming freely and living fully is a worthy life. His memory lays buried within my heart.

Jump in.
Swim.
Keep your eye on the ball.
Release your gifts.
Define your own life.

We’re surrounded by tools designed to enable connection. Everyone seems to be plugged in, frequently 24/7, yet many people feel less connected than ever.

“The human connection is an important thing. 
It teaches me something, and is fulfilling in that respect.” ⁱ

Healthcare professionals were recently asked what creates a healing experience for staff. The key result of the research, 5 Dimensions of Self-Caring that Heal Healthcare: The foundation for an experience management strategy; is the need to shift from primarily caring for others first to caring for self first. One important ingredient of self-caring is connection.

“Healing in medicine is about relationship.
It is not about fixing something.” ⁱⁱ

Connect in all 5 dimensions of self-caring

We have experiences every moment of the day. To create meaningful connections start by identifying the moments, the experiences, when you feel connected and those times when you feel disconnected. As you become more aware of the attributes of connection that you value, you can then begin to make adjustments, create practices, which foster connection.

“I am a healer because of the way I connect with people
and how I care about people.” ⁱⁱⁱ

The respondents in the research study identified 5 dimensions of self-caring. These dimensions can guide your assessment and to help you create new practices that nurture connection.

Personal practices at home
Explore what creates connection during your time away from work. It could be gardening, reading and sharing thoughts on meaningful books or meditation. Resources abound to support you in personal practices at home. When viewed through the lens of self-caring even cleaning can be a meaningful practice.

“You need to be compassionate and connected enough to care.” ^iv

Personal practices at work
Experiment and bring some of those practices into the rhythm of the workplace. Talk with others about your passion for creating meaningful connections. Join with peers and engage in a few practices everyone wants to make part of their day. Consider starting the day with a common intention and focused breathing. Commit to a daily 20 minute walk in fresh air. While these ideas are not new, engaging in them with the intention of self-caring brings a new energy to what could otherwise be a lame pot luck or a short lived exercise program.

“You can have a healing person-to-person experience
without a beautiful building, it’s about spirit.” ^v

Interactions with others
Connect with others through the power of language. Language guides behavior. Language that fosters connection suggests, rather than commands; supports rather than pushes; encourages growth and development rather than demanding obedience. Pause before speaking and set an intention to speak in ways that encourage connection.

“You could not be all that you are without
the other person being all that they are.” ^vi

Clinical and business processes
Integrate connection into processes by making connection a key factor in assessing what works. For example, consider what a shift change process would be like when the primary goal for all is to connect. Does your current process foster connection with peers and connection with patients? What would need to be adjusted to result in greater connection? How would everyone, patients, family and staff, feel as a result?

“We have LEANed humanity out of healthcare.” ^vii

Business model
Examine what type of business model supports you to be in an optimal state of well-being and feel connected. If you’re working in an emergency room yet feel more connected spending time with patients and their families, you may enjoy being part of a long term care residence. If you gravitate to complimentary therapies yet work in a strict allopathic environment, perhaps working at a holistic clinic would be a path to connect with your soul. How and where you work should and will change over time.

“Being there for each other is most important. 
That’s the biggest piece that is missing for
people in a healthcare environment and it gets
translated to the patient.” ^viii

Commit to connect

We all have choices in our experiences, both what we enter into and how we show up “being” in the moment. New ways of “being” evolve by creating practices that support the connection we desire. We’re empowered when we consciously evaluate what we do and how we do it. Commit to connect. As each person engages in self-caring practices with the intention to connect, the result is more connection for all. That shift transforms organizations, and may even spark to transform the healthcare system as a whole.

5 Dimensions of Self-Caring that Heal Healthcare: The foundation for an experience management strategy research study is available at: www.experienceinmotion.net

Workshop: Get CEUs and create a strategy that focuses on all 5 dimensions of self-caring. Institute of Noetic Sciences, Sept. 8 – 10. Click here for details.

Please share your comments on our blog!

ⁱ Tina Frontera, RN, Health Care Trends and Innovation Leader/Speaker/Consultant

ⁱⁱ Ruth Stanley, OSB, PharmD, MA, FASHP Holistic Services, Central Minnesota Heart Center

ⁱⁱⁱ Dawn Bazarko, MPH, RN, Sr. Vice President Center for Nursing Advancement at United Health Group

^iv Dr. Abraham Verjovsky, M.D.

^v Cindy Bultena, RN, VP of Patient Experience at Woodwinds Hospital

^vi Ruth Stanley, OSB, PharmD, MA, FASHP Holistic Services, Central Minnesota Heart Center

^vii Dr. Tim Culbert, Medical Director of Integrative Medicine at Children’s Hospital in Minneapolis, Minnesota

^viii Sue Penque, RN, MSN, Chief Nursing Officer North Memorial

We all talk about self care a lot: “I need to lose weight… I need to get to the gym… I need to take care of myself!” Instead of just talking about it, or worse, feeling bad about it, I have found a much more positive and practical approach. That is to live with more intention.

What exactly do I mean by living with intention? It means remembering we are in choice, not always about what happens, but how we deal with what happens. It means choosing to be present to your partner, your finances, or what you put into your mouth. It means staying mindful of what your highest joy is and making decisions based on that joy.

It means choosing to ask for what you want.

Asking for what you want is such a simple, but difficult concept; We often don’t feel like we deserve to ask for what we want, we may not feel like we will ever get it, and many times we don’t even know what it is that we want to ask for! Here are my top five ways to help you ask for what you want to live more intentionally:

Vision.
It’s important to have a clear picture of what you want. Instead of your normal “to do” list, write down an intention as if it is already happening. Write it in the present tense such as I am feeling…  I am doing…  I am enjoying…  Then you can write down specific action steps you need to bring this affirmation to life. You can also create a vision board with appealing pictures, words, or phrases that represent your intention and display it someplace you can see every day so you can remember to ask for what you want.

Remember your core values.
Your core values are the non negotiable attributes in your life that you need to feel fulfilled. Are you living them? Do your actions, choices, or overall lifestyle reflect your core values? If you have not identified your core values, or it has been a while since you reviewed them, revisit them so that you can ask for what you want.

Enlist support.
We all can use a little help from our friends and family in asking for what we want. Be sure to communicate with them to let them know you are practicing asking for what you want to live more intentionally. You can partner up with a friend to support each other, or hire a coach or mentor to help you stay accountable to ask for what you want.

Get grounded.
Do something everyday that gets you grounded, centered, and focused on what is most important to you. My 30 Days to Grace program is a perfect 30 minute practice to help you do this. You can also choose to do any part of it, deep breathing, meditation, yoga, prayer, journaling, even for 5 minutes. We all need this time now, more than ever to be able to get and stay clear to ask for what we need.

Let go of the outcome.
Remember the power of the intention is in the asking for what you want, not the outcome of asking for what you want. So let go of the fact you may or may not get it. You could get something even bigger and better! The important thing is that you asked.