Leadership and Mentoring

Making the workplace healthier, one self-aware nurse at a time

From the disruptive physician throwing instruments or treating nurses with contempt to coworkers or nurse managers “eating their young,” some people and behaviors in healthcare organizations threaten not only job satisfaction but patient safety. How do you react to bullying by doctors or coworkers? Do you say something while the behavior occurs? Report it to a manager or supervisor? Complain about it to another nurse, family member, or friend? Are you hurt by the behavior, or does it make you mad?

If you’ve reported a disrespectful behavior or spoken directly to the person showing you disrespect, you’re part of a small but steadily growing minority of nurses. Of more than 6,500 nurses and nurse managers surveyed in the 2010 American Association of Critical-Care Nurses’ (ACCN) Silent Treatment study, 85% said they’d experienced disrespect from colleagues that caused one or more problems:

  • Forty-six percent said it undercut respect for their professional opinion.
  • Nineteen percent said it made them unable to get others to listen.
  • Twenty percent said it was making them seriously consider leaving their job or profession.

Of the 85% who’d experienced disrespect, 49% said they spoke to their manager about the person whose behavior had the greatest negative impact. However, just 24% spoke directly to the person who demonstrated the disrespect and shared their full concerns (compared to just 10% in the 2005 AACN Silence Kills study).

What makes some nurses speak up when they encounter disrespectful or abusive behavior, when so many of their peers are willing to suffer in silence? Many nurses cite fear of termination or retaliation as their reason for not speaking up—even if they work for organizations with no history of taking such actions against nurses who’ve made legitimate complaints, and that have systems in place for intervening if an objectionable behavior continues or gets worse.

However, if your employer lacks zero tolerance for disruptive behavior or turns a blind eye to retaliative behavior, fear of termination could be genuine. Nonetheless, some nurses refuse to work under such conditions.

More than anything, nurses whose primary sense of identity comes from their self-perception as caregivers may be unwilling to stand up for themselves for fear of losing their jobs. In many cases, fears associated with job loss are more emotional than financial. Recognizing this can be the first step toward regaining perspective and understanding what you can do to be more effective in addressing a wide range of issues in your work and personal life.


Self-awareness: A critical nursing shortage

A nurse’s workday is full of people in need: patients in pain or nearing death, and family members struggling to understand and cope with their loved ones’ conditions. Most nurses are drawn to the profession by a desire or need to care for others, and many are more likely to think that taking time for self-examination or self-care is highly self-indulgent.

As a result, many nurses are less apt than the general population to pay attention to who they are, what they like, what they value, what they fear, what they need, and why they do what they do. Nurses who lack this self-awareness commonly are:

  • overwhelmed with work and home responsibilities because they never say “no”
  • resentful that they’re overworked and overtired because they don’t believe it’s right to request time to recharge or request their organizations provide resources to help them
  • willing to accept punitive or negative feedback because they define themselves more by whatever they’ve just done wrong than by all the things they do right
  • unaware of the true reasons they’re so miserable and ready to blame others.

Developing and using a healthy sense of self-awareness is a necessary first step toward being able not only to take better care of yourself but also to become more resilient, set healthy boundaries at home and work, engage in healthier behaviors and, ultimately, become a better nurse and caregiver.

A practical guide to self-awareness

Some people have an intuitive knowledge of their feelings. For most of us, however, raising self-awareness takes a conscious effort. Paying attention to your “inner dialogue” is critical to becoming more aware of your needs and recognizing the individual approaches most of us take to rationalize and justify our less-than-healthy ways of thinking and acting. Methods that can help raise self-awareness include keeping a journal, talking with a counselor or mentor, asking for feedback from a trusted friend or family member, practicing mindfulness meditation, and taking time for personal reflection.

As you reflect, do you:

  • know which emotions you are feeling and why? Example: “I’m feeling disappointed and uncomfortable with the way that surgeon is communicating with me.”
  • realize the links between your feelings and what you think, do, and say? Example: “I asked to be transferred because the nurses on this unit are critical and make me feel inadequate when I work with them.”
  • recognize how your feelings affect your performance? Example: “I’m so upset that I need to take a few minutes to calm down before I start filling medication orders.”
  • have a guiding awareness of your values and goals? Example: “My patient’s safety is more important to me than what Dr. X thinks when I interrupt his dinner.”
  • know the things you want others to know about you? Example: “I care about others. I work hard. I love Zumba dancing!”
  • know the things you want and need? Example: “I’m tired and hungry. I need to take a break and get something to eat.”
  • draw appropriate boundaries with others? Example: “No, I’m not available to help with the school bake sale this weekend. I have a date with myself to go shopping and buy a good book to read.”

As you work toward greater self-awareness, recognize that nobody makes you feel anything when you’re truly self-aware. You choose how you feel. In the end, you’re a better caregiver when you take care of your own needs.

Translating self-awareness into self-care

Once you become aware of what you’re feeling and have a better understanding of why, it’s time to put that knowledge to work in your daily life. You have choices in how you react to situations and how you balance your work and life responsibilities.

Manage your emotions

Things will still happen that will leave you feeling angry, frustrated, or unhappy—but you have a choice over how you’ll allow those emotions to affect you and for how long. For example, getting yelled at is never pleasant, but it doesn’t have to derail you. (See How to manage your emotions by clicking the PDF icon above.)

Choose yourself

For many caregivers, putting themselves first doesn’t come naturally. Putting off exercise, sleep, and fun is so ingrained that many nurses have to formally add these things to their daily to-do lists—and give them the same weight as work or family responsibilities. (That’s why it’s called work/life balance.) Here are some ways to put yourself first:

  • Keep a journal. Keep a notebook by your bedside and spend a few minutes each night writing down every positive experience you’ve had that day and things you’d like to do tomorrow.
  • Exercise. Commit to getting regular exercise. The more fun you make it, the more likely you are to do it.
  • Sleep. Identify your sleep patterns and needs, and strive to optimize them. Getting adequate sleep is critical to your emotional and physical health.
  • Stretch and meditate. These activities have been shown to reduce stress and increase energy.
  • Indulge yourself. Find affordable ways to treat yourself, from bubble baths and ice cream cones to picnics or grocery-store flowers.
  • Connect with friends. Engaging in regular activities, such as book club meetings, is a great way to stay in touch with friends without having to coordinate schedules each time.
  • Disconnect technology. If you’re not on call, turn off your cell phone and computer while you’re having dinner or visiting friends.

Other avenues to explore

Everyone experiences the journey to self-awareness and self-care differently. If you’re struggling, there
are many avenues to explore. The first might include your organization’s Employee Assistance Program (EAP), if one is available to you. EAPs typically provide a range of wellness services at the individual and organizational level, including:

  • health and wellness coaching
  • life coaching and assertiveness training
  • personal counseling
  • work/life balance coaching
  • peer coaching. (See Case study: From self-awareness to self-care by clicking the PDF icon above.)

If your organization doesn’t offer an EAP, there may be affordable counseling services in your community. In most cases, your employee health insurance provides coverage for these services. Sometimes a session or two is all that’s needed to gain insight about what’s going on in your life and develop a plan to align your behaviors and attitudes with the nursing career you want to have and the life you’d like to lead.

Other resources to consider include clergy or spiritual advisors, hospital chaplains, self-help courses and books, mindfulness meditation courses, and local support groups (or form one yourself with other nurses and health professionals). There’s more support out there than you may be aware of. Committing to taking better care of yourself is an important part of achieving greater self-awareness.

Selected references

Maxfield D, Grenny J, Lavandero R, Groah L. The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough to Save Lives. Vital­-Smarts, Association of periOperative Registered Nurses, & American Association of Critical-Care Nurses; 2010. www.silenttreatment study.com/. Accessed June 6, 2012.

Maxfield D, Grenny J, McMillan R, Patterson K, Switzer A. Silence Kills: The Seven Crucial Conversations in Healthcare. VitalSmarts & American Association of Critical-Care Nurses; 2008. www.vitalsmarts.com/userfiles/pdfs/silencekillsdetails.pdf. Accessed June 6, 2012.

Rick Gessler is manager of employment/employee relations-human resources at Altru Health System in Grand Forks, North Dakota. Liz Ferron is senior Employee Assistance Program (EAP) consultant at Midwest EAP Solutions in Minneapolis, Minnesota.

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