A speaker at the Oncology Nursing Society Bridge Program discussed how nurses can build their own resilience and proactively protect their mental well-being.
Oncology nurses need to learn to build resilience, explained Lisa Blackburn, MS, APRN-CNS, PMGT-BC, AOCNS, at a recent presentation at the 2021 ONS Bridge.
“I want to tell you that I don't really like the term work-life balance, because I think it's pretty unattainable, especially in this day and age,” Blackburn shared with attendees. “It's a great thing to strive for, but I think it only makes us feel worse when we feel like we're not achieving it.”
She noted that, statistically, resilience has been lacking in the United States health care system. She informed attendees that, sadly, an estimated 300 to 400 doctors commit suicide each year, which is more than double the rate of the general population. Furthermore, greater than 50% of health care workers describe themselves as burnt out.1
“You have to be willing to invest time in your own self-care,” she explained. “You can't be like my generation who used to say, ‘Oh, I give to my family, and my patients and my friends, and at the end of the day, there's just no time left for me. This is part of our responsibility as oncology nurses,’” she said, adding that she also believes institutions should help by providing resources for their nurses to build resilience.
According to the statistics, nurses don’t fare much better. She shared that a recent survey showed that 68% of nurses place their patient’s safety, health, and wellness before themselves, 50% have been bullied in some manner in the workplace, and 25% have been physically assaulted at work by a patient or patient’s family member.
Blackburn emphasized the difference between self-indulgence and self-care. “Self-care requires some effort on your part. And you come away from it having learned something,” she explained. “There's nothing wrong with self-indulgence once in a while. But just know that those practices don't build resilience.”
She advised oncology nurses to constantly take a pulse of their own resilience by checking in on their “resilience vital signs.” She recommended to think about their “heart rate” or passion to reflect on what brings pure joy, what they absolutely live to do and to ask themselves if they are really making time for these activities. In addition, nurses must check on their “respiratory rate” or what helps them to “breathe.” These include activities that nurses find settling and relaxing, and allow them to let go of a lot of the tension in their life.
Finally, nurses should assess their “blood pressure” or the effects of their current resilience practice. Does it work? Or are nurses finding that their resilience is consistently being depleted. This is a sign that a firmer resilience practice is necessary.
Examples of Mindful Practices
Nurses can begin building their resistance by practicing mindfulness. According to Blackburn, it does not require a huge program, or a person whose role is specifically dedicated to this work, for nurses to make grand changes in their mindfulness habits.
One of Blackburn’s biggest pieces of advice is “mindful transitioning.” This involves creating a thoughtful barrier between the end of a work shift and the next phase of the day. Instead of racing through work related thoughts while getting ready for work and mentally planning for the rest of the day at the end of a shift, Blackburn encouraged nurses to try a different solution and create a peaceful boundary:
It's finally the end of your shift. It's been busy as usual and you're tired. The responsibility of your patients, the frequent assessments, phone calls, documentation, all of their treatments, dressing changes medication, it all adds up to a heavy load that can weigh on you like a heavy backpack.
You are more than ready for some rest and relaxation. You know, however, that before you walk out that door, there are a few important ends that have to be tied up. You have to finish your documentation here, report to the oncoming nurse, pass off your phone or pager…
So, at the end of your next workday or shift as you begin to go through your end of shift routine, be mindful that you're laying down the burden of your patients care and responsibility. Remain aware of this as you lay down your phone, your clipboard, and as you give report to the oncoming nurse. Say to yourself, ‘I've completed my patient care. I'm letting go of all my concerns and responsibility.’
As you say this, imagine that you're taking off that heavy backpack. Feel the difference the lightness in your body and mind as you lay down this burden. Remember [that] you are just one member of an entire team of providers who are helping looking after our patients. It's time to let go, rest, and renew.
Now, as you walk away from your unit or clinic, remain mindful that you're leaving the world of work and entering a new space that invites you to be completely present to people and experiences awaiting you. And your feet in your shoes as you walk away.
As you swipe your badge and as you clock out, experience that punch out as your cue that you are finished for the day.
Time to let go. Notice the sensations as the elevator descends, carrying you down in a way. Let the opening of the door to the building be your passageway to another fresh beginning. Be aware of each step. As you walk through the doors to the outside world, feel the fresh air on your face. Notice the feelings of coolness on your skin, the sky, clouds, and trees around you. [You’re] in a whole new experience.
Other mindfulness practices include “positive affirmations” which is when a nurse takes a current negative thought about their upcoming workday and turns it into a positive 1 that is attainable. Nurses then write these thoughts on post-it notes and place them on their lockers or computer screen. They can then share a picture of their note with colleagues.
“Sharing pictures of these [notes] is really key because it makes you realize that you're not the only one that's going through struggles. And that gives you ideas for what other people are thinking,” Blackburn emphasized. She shared 1 post-it note with the following words “for 12 hours, I have the privilege of being the caregiver and advocate for these patients on one of the worst days of their lives.”
Sharing and offering feedback were consistent themes across many of the practices Blackburn described. Whether nurses decide to create “vision boards” (creating a visual collage of their career) or participate in the “play like a child” (making time for a beloved childhood activity) challenge, sharing these practices among colleagues helps remind oncology nurses that they are going through similar experiences, she said.
Her team also regularly practices chair yoga in their facility. Sometimes the patients also participate in the 15-minute yoga sessions. “If you're not used to chair yoga, it's not just for old people. It really gives you extra support so that you can really practice more flexibility and more strength. And the point of it in the hospital was that you're not down on the floor, because we wouldn't want that. But you would be surprised 15 minutes in the middle of an afternoon, what a lift you get from that for the rest of your shift.”
Dealing with Grief
Blackburn emphasized that it is unrealistic to talk about resilience in oncology nursing without discussing grief. “Our work is inextricably linked with death and loss of many different kinds,” she said. “And so I'd be remiss if I didn't give you a couple examples of practices that help build our resilience in terms of grief.”
The first practice that Blackburn described is called “remembrance and renewal.” Her institution has been practicing this since 2016. It’s a self-guided experience that allows staff to come and go as they please in a private space.
The practice involved incorporating remembrance themes such as a private space for grieving, lighting candles, expressive writing, and making hand crafts that are commemorative of the person who has passed. At the same time, themes of renewal are present in the practice. Aroma therapy, guided imagery, relaxation, and thoughts of gratitude accompany the actions of remembrance. Having staff make a gratitude tree with the patients initials with soothing lemon lavender aroma therapy and tea would be a great example of practicing remembrance and renewal.
Blackburn’s other method to deal with group involves spending 20 to 30 minutes journaling about a special patient. It can either be a positive experience or a negative one, it could be their most special patient ever, and that's usually what nurses choose, or it can be a patient that was extremely difficult for them to care for.”
With the nurse’s permission, Blackburn uses these journals develops them into a dramatic reading which is shared across the group. The nurse then reads a special message that the patient has for them. “It's really emotional and really meaningful,” she described.“It really refocuses the way you think about the grief that comes with your nursing practice. I can say that each and every one of the hundreds of patients that have been represented in these readings have had positive significant message messages for their nurses, even if they were the most difficult patient, their nurses cared for.”
Blackburn L. Got resilience? Presented at: Virtual ONS Bridge; Sept 9-16