Confidence and Truthfulness

This blog is the first in a new series,
Nurses on Boards: Building a Healthier America. Wolters Kluwer is a Founding Strategic Partner of the Nurses on Boards Coalition.

Your presence on a board warrants confidence and truthfulness. In our turbulent health care environment, we are faced with old issues and new challenges that require immediate solutions and planning.  In the words of Helen Keller, “optimism is the faith that leads to achievement. Nothing can be done without hope and confidence.” That being said, your role on a board places you in a position of influence. Your ideas, positions, and nursing experiences, provides you with a solid foundation to influence, empowered by confidence and truthfulness.

How can you be confident?

  1. Learn from setbacks, failures, and success.
  2. Become well versed on the topic of discussion.
  3. Be aware of your body language.
  4. Assert views in non-threatening, non-judgmental ways.
  5. Be articulate and concise when making your points.
Your nursing perspective is valuable to inform stakeholders about the realities of the issue, evidence-based information, new research, and stories. What we communicate may have an impact on colleagues, families, communities, or society. The information and perspective you share may be the foundation for an issue that may have political, economic, and social implications both in the short term and long-term.

How can you be truthful?

  1. Convey authenticity through openness, humility, and transparency.
  2. Be diligent in exercising your fiduciary responsibility.
  3. Represent nursing and other disciplines at board meetings.
  4. Communicate in a way as to maintain credibility and build relationships.
  5. When you don’t completely understand an issue, ask for clarification to gain full understanding.
According to Mary Beth Kingston, Executive Vice President and Chief Nursing Officer, Aurora Health Care, Milwaukee Wisconsin, and past AONE Board of Directors, "It is important to do 'due diligence', specific preparation prior to board service by learning about the organization, it's work or product and values.”

Call to Action

As you serve or aspire to be on a board, remember it calls for confidence and truthfulness. We hope our column serves as a reflective tool to strengthen your influence when serving on boards.

American Organization of Nurse Executives. (2015). Nurse executive competencies. Chicago, IL:
Author. Retrieved from
M. Lindell Joseph, PhD, RN, AONE Board of Directors and The University of Iowa College of Nursing
Laurie Benson, BSN, Executive Director, Nurses on Board Coalition
Posted: 5/30/2017 7:14:12 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Leadership

Inspired Nurses Calendar 2017: Through the Stomach to the Heart

Lippincott is partnering with Lippincott Solutions to bring you an inspired nurse’s story every month. These stories are filled with heroic tales created by nurses, for nurses, and were chosen from hundreds of submissions from nurses around the United States. These nurse storytellers are compassionate, informative, and inspiring – we hope you enjoy them!

To kick this off, we are beginning with May’s nurse story, “Through the Stomach to the Heart.” Read the full story below.

Through the Stomach to the Heart
Simone Cheong, Magnet Project Coordinator
West Kendall Baptist Hospital

In a previous role working on an inpatient medical-surgical unit, I had an extraordinary opportunity to make a difference in the life of one patient. We had been caring for a patient who had worked for a cruise line and had become very ill, requiring prolonged hospitalization and medical therapy before being released to return home. He was from India and had no family or friends.

through-the-stomach-to-the-heart.pngThe staff explained that the patient was not eating and was losing weight. His mood was also depressed. The physical ailment included wound healing, and with insufficient nutrients, the body is slowed in its healing process. Although the dieticians tried their best to make accommodations, he was still not eating well, so I took it upon myself to go to a local Indian grocery store and buy some Indian food items. With the physician's permission, I proceeded to cook and provide him with Indian meals and snacks. The patient was thankful and overwhelmed with emotion, and over the course of his hospitalization, he began eating better, improving his nutritional intake along with his mood as well. He was subsequently released after several weeks. 

Over the years, the patient has called back to the nursing unit asking to thank me again and give me updates on his health status. That is what nursing is all about. Going above and beyond to meet the needs of the patient.

Through your strength, courage, and compassion, these stories will help to illustrate just how crucial nursing is to optimal patient care and the art of healing. Help pay it forward and inspire others on just what it means to be a nurse.

To see all 2016-2017 stories or to share an inspiring story of your own about being a nurse, or how you were inspired by another, and enter to win prizes, visit Be sure to check our blog every month for a new inspired nurse’s story.
Posted: 5/26/2017 11:28:47 AM by Cara Deming | with 0 comments

Categories: Inspiration

Systemic Vascular Resistance and Pulmonary Vascular Resistance: What’s the Difference?

In a previous blog post, we discussed preload and afterload. You may recall, preload is the amount of ventricular stretch at the end of diastole. Afterload is the pressure the myocardial muscle must overcome to push blood out of the heart during systole. The left ventricle ejects blood through the aortic valve against the high pressure of the systemic circulation, also known as systemic vascular resistance (SVR).1 The right ventricle ejects blood through the pulmonic valve against the low pressure of the pulmonary circulation, or pulmonary vascular resistance (PVR).1

Let’s dig a little deeper into these concepts.

Systemic vascular resistance (SVR)*

Systemic vascular resistance (SVR) reflects changes in the arterioles2, which can affect emptying of the left ventricle. For example, if the blood vessels tighten or constrict, SVR increases, resulting in diminished ventricular compliance, reduced stroke volume and ultimately a drop in cardiac output.1 The heart must work harder against an elevated SVR to push the blood forward, increasing myocardial oxygen demand. If blood vessels dilate or relax, SVR decreases, reducing the amount of left ventricular force needed to open the aortic valve. This may result in more efficient pumping action of the left ventricle and an increased cardiac output.2 Understanding SVR will help the bedside clinician treat a patient’s hemodynamic instability. If the SVR is elevated, a vasodilator such as nitroglycerine or nitroprusside may be used to treat hypertension. Diuretics may be added if preload is high. If the SVR is diminished, a vasoconstrictor such as norepinephrine, dopamine, vasopressin or neosynephrine may be used to treat hypotension. Fluids may be administered if preload is low.

SVR is calculated by subtracting the right atrial pressure (RAP) or central venous pressure (CVP) from the mean arterial pressure (MAP), divided by the cardiac output and multiplied by 80. Normal SVR is 700 to 1,500 dynes/seconds/cm-5.

Here’s an example:
If a patient's MAP is 68 mmHg, his CVP is 12 mmHg, and his cardiac output is 4.3 L/minute, his SVR would be 1,042 dynes/sec/cm-5.
Conditions that can increase SVR include1,2:
  • Hypothermia
  • Hypovolemia
  • Cardiogenic shock
  • Stress response
  • Syndromes of low cardiac output
Conditions that can decrease SVR include1,2:
  • Anaphylactic and neurogenic shock
  • Anemia
  • Cirrhosis
  • Vasodilation

Pulmonary vascular resistance (PVR)*

Pulmonary vascular resistance (PVR) is similar to SVR except it refers to the arteries that supply blood to the lungs. If the pressure in the pulmonary vasculature is high, the right ventricle must work harder to move the blood forward past the pulmonic valve. Over time, this may cause dilation of the right ventricle, and require additional volume to meet the preload needs of the left ventricle.1
PVR can be calculated by subtracting the left atrial pressure from the mean pulmonary artery pressure (PAP), divided by the cardiac output (CO) and multiplied by 80. To obtain the left atrial pressure, a pulmonary artery catheter (PAC) is needed to perform a pulmonary artery occlusion pressure (PAOP), also known as pulmonary artery wedge pressure (PAWP). Normal PVR is 100 – 200 dynes/sec/cm-5.

Here’s an example:
If a patient's mean PAP is 16 mmHg, his PAOP is 6 mmHg, and his cardiac output is 4.1 L/minute, his PVR would be 195 dynes/sec/cm-5.
Factors that increase PVR include1:
  • Vasoconstricting drugs
  • Hypoxemia
  • Acidemia
  • Hypercapnia (high partial pressure of arterial carbon dioxide [PaCO2])
  • Atelectasis
 Factors that decrease PVR include1:
  • Vasodilating drugs
  • Alkalemia
  • Hypocapnia (low PaCO2)
  • Strenuous exercise
The accuracy of SVR and PVR depends on the direct pressure measurements and indirect cardiac outputs from a pulmonary artery catheter which are subject to error. However, SVR can provide critical information when differentiating various types of shock and PVR is useful when diagnosing the severity of pulmonary hypertension.3 Understanding these parameters will help the bedside clinician better manage medications and hemodynamic instability.
*You may also see systemic vascular resistance index (SVRI) or peripheral vascular resistance index (PVRI) reported; these measurements are calculated by substituting cardiac index (CI) for CO in the equations.

1. Breitenbach, J. (2010). Putting an end to perfusion confusion. Nursing Made Incredibly Easy!. 5(3): 50 60
2. Gowda, C. (2008). Don’t be puzzled by cardiovascular concepts. Nursing Made Incredibly Easy!. 6(4): 27-30.
3. Silvestry, F. (2015). Pulmonary artery catheterization: interpretation of hemodynamic values and waveforms in adults. Uptodate. Retrieved on April, 17, 2017 from
Myrna B. Schnur, RN, MSN 



Posted: 5/25/2017 10:11:09 AM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Diseases & Conditions

National Conference for Nurse Practitioners (NCNP): Spring 2017

Last month, I had the pleasure of attending the National Conference for Nurse Practitioners at the Gaylord Opryland Resort & Convention Center in Nashville, Ten. The interest and enthusiasm were palpable at this sold-out show! From the opening session, where attendees were welcomed with live music, to the exhibit hall, where vendors updated us on the latest products and we enjoyed meals with our colleagues, this was the best NCNP yet!

Gaylord-Opryland.jpg  NCNP-Spring-2017-welcome.jpg  WK-in-the-exhibit-hall.jpg

From the Experts

At the conference this year, I was happy to see several sessions related to women’s health, which is my advanced practice area. I learned so much from these experts, as well as those who presented in the acute care and primary care sessions. Here are some things I learned:

“Virtually all cervical cancers are associated with persistent infection with high-risk HPV types.”
Update on Cervical Cancer Screening: Appropriate Use of Pap and HPV Testing
Nancy Berman, MSN, ANP-BC, NCMP, FAANP
“One treatment modality that improves survival in patients with COPD? Oxygen.”
Acute Care: COPD Across the Scale
“Primary care providers see 80% of patients with skin conditions. We need to know when it’s NOT acne.”
Acneiform-Pediatrics to Adults
Margaret Bobonich, DNP, DCNP, FNP-C, FAANP
“Sepsis is a medical emergency. First step in treatment is VOLUME -- 30mL/kg of crystalloid fluid within the first 3 hours.”
Acute Care: Understanding Sepsis
Sophia Chu Rodgers, ACNP, FNP, FAANP, FCCM
“Nearly 6% of deaths globally are attributable to alcohol (80K in U.S.)”
Alcoholism and Liver Disease,
Christopher Chang, MD, PhD
“Unlike vasomotor symptoms, vaginal atrophy can be progressive and is unlikely to resolve on its own.”
Comprehensive Menopause Management: An Update on Current Strategies
Nancy Berman, MSN, ANP-BC, NCMP, FAANP
“Maternal risk depends on complexity of primary cardiac lesion and if residual lesions or other clinical sequelae exist.”
Making Sense of Heart Disease in Pregnancy
Kismet Rasmusson, DNP, FNP-BC, FAHA, CHFN
“Switching between anticoagulants should be based on the pharmacokinetic profile of each anticoagulant, appropriate laboratory assessment of patient’s coagulation status, and the patient’s renal function.”
Acute Care: Understanding Direct Oral Anticoagulants
John Togami, PharmD, PhC
This is just a sampling of the takeaways I left with. What did you learn? What would you like to learn? Leave us a comment, and we’ll pass it along to the NCNP Planning Panel.

It’s very exciting that we are now able to bring this conference to nurse practitioners twice each year! Come see us in Las Vegas in October 2017!


Posted: 5/23/2017 10:11:13 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Continuing Education

ASHPE Awards 2017: Wolters Kluwer wins big!

ashpe-award_2017.bmpWolters Kluwer continues to shine in the American Society of Healthcare Publication Editors (ASHPE) awards! In 2016, Wolters Kluwer won 24 times, and this year, we exceeded that amount and won 27 awards across 20 categories.

We are particularly excited to announce that Lippincott won three awards this year. NursingCenter is a proud part of Wolters Kluwer’s Lippincott journal portfolio. The award-winning nursing journals from Wolters Kluwer are listed below. For the full list of award-winners, please visit ASHPE’s website.

Posted: 5/17/2017 1:35:22 PM by Cara Deming | with 0 comments

Categories: Inspiration

Focus on faith and nursing

Gspiritual.jpget in touch with your spirituality while earning CE credits. If you are a faith community nurse, or want to learn more about how spiritualty and faith can play into your nursing career, our Focus On: Faith Community Nursing has been recently updated with new continuing education activities.
This includes one updated CECollection and 38 individual CE activities under the specialty, Faith Community Nursing:

CE-badge.pngFaith Community Nursing
Earn 7.5 contact hours for $19.99!

 CE-badge-(1).pngSpecialty: Faith Community Nursing
Earn contact hours with 38 CE activities!

It also includes authoritative, stand-alone nursing articles on faith community nursing, spiritualty, and clinical topics, like trauma-informed care, autism, diabetes, and more.

How does faith and spiritualty affect your practice?

Posted: 5/15/2017 10:06:46 AM by Cara Deming | with 1 comments

Categories: Continuing Education

If only I had said something…

empty-bench.pngI walk into the room and look at the figure of a 20-year-old college student lying in the bed after a deliberate overdose, intubated and on a ventilator, the steady rhythm of the machine making her chest rise and fall and the steady beeping of the heart monitor somewhat reassuring that my patient was still alive. The parents sitting by her bedside with tears streaming down their faces. The mother speaks to me, “If only I had said something. I thought it was only stress of being in college and having to take final exams; if only I had said something…”.

If only I had said something…these are words none of us wants to say or hear, but too often this is exactly what happens. Frankly, I’ve heard those words too many times in my professional practice. How many times have you wondered if someone you know has a mental health disorder? Maybe, you wonder if you have a disorder? When we look at the statistics, the impact of mental health issues —which is defined as any mental, behavioral, or emotional disorder, excluding developmental and substance use disorders — is sobering. Mental health issues affect 21.2% of adult females and 24.3% of adult males, per the National Institute of Mental Health (NIMH, 2016).  None of us are immune to being touched by someone who has a mental health disorder. From generalized anxiety disorder, panic disorder, post-traumatic stress disorder, bipolar disorder, major depressive disorder, and so on, we have all known someone or taken care of someone who has a mental health issue. Perhaps the greatest issue we face is being able to recognize when someone needs professional help or when we need professional help.

Although we, as health care professionals, recognize that managing mental health disorders is as important as managing any other disorder, the stigma in the community that mental health issues are a sign of weakness or that the person can snap out of it, still exist. We must take an active role in educating the community on when a person may have a mental health issue and not just feeling anxious or feeling down about something that happened in their life. People who entertain risky behaviors, such as prescription drug misuse, exercise extremes, compulsive buying, and risky sex may have an underlying mental illness (

The theme of Nurses Week is Nursing: The Balance of Mind, Body, and Spirit and mental health is certainly a part of that initiative. May is also Mental Health Month. The National Institute of Mental Health (NIMH) is leading the initiative on mental health awareness and management by outlining objectives to define mechanisms of complex behaviors, recognizing those who have mental health issues, and when intervention is necessary, and striving for mental health illness prevention.

As nurses, we must speak up when we suspect someone may have a mental health issue and encourage that person to seek professional help.  We must have the courage to speak up even if that person is our colleague, in our family, or even ourselves.  No more should we hear, “If I had only said something…”.
Chief Nurse
Health Learning, Research & Practice
Wolters Kluwer

Posted: 5/12/2017 8:06:27 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Inspiration

Are You Soaring Spiritually?

bird-soaring.jpgSpirituality is a vague concept for many nurses—especially when our primary focus is implementing physical, scientific interventions. As holistic caregivers, we believe nursing care should be for body, mind, and spirit. Our personal spirituality, however, is easy to ignore. Some of us don’t think about our spirituality until we are turned upside down by a life crisis. But over time, even without crisis, if we don’t care for our spirits we will suffer consequences.
Paying attention to personal spirituality is especially important for nurses. Researchers and spiritual care experts have found that offering good spiritual care requires the nurse to attend to his or her own spirituality (makes sense, right?) (Baldacchino, 2011; Taylor, 2009; 2011). Furthermore, we regularly experience spiritual distress in our work, which leads to weariness, depression, compassion fatigue, and burnout. Moreover, being spiritually healthy – soaring spiritually – feels better than spiritual malnourishment. In fact, it feels great!
What is spiritual health? Our spirit is the core of our being, a characteristic of all humanity. While our spirit is accessed through our mind, spiritual health is more than mental health. Spirituality involves the ultimate search for meaning and understanding of the sacred or transcendent. It expresses a universal human capacity to transcend ourselves and connect with God, other people, and the world around us. It is through spirituality that we find self-fulfillment, peace, and meaning in life and suffering (Lepherd, 2015). A frequently used assessment of spiritual health is the Spiritual Well-Being Scale (SWBS), a general indicator of perceived well-being and spiritual quality of life, with subscales that assess Religious Well-Being (one's relationship with God or “higher power”), and Existential Well-Being (one's sense of life purpose and life satisfaction) (Bufford, Paloutzian, & Ellison, 1991).
What helps nurses’ spirituality? Recently, researchers in Iran found a positive correlation between nurses’ clinical competence and spiritual health, and professional ethics and spiritual health (Tabriz, Orooji, Bikverdi, & Taghiabad, 2017). A U.S. chaplaincy department conducted a randomized controlled study of a spiritual retreat for nurses. Nurses who did the spiritual retreat scored higher at 1 and 6 months on the SWBS and Daily Spiritual Experience Scale than nurses with no retreat (Bay, Ivy, & Terry, 2010). The ancient text of Proverbs in the Tanach (Hebrew Bible) and Christian Holy Bible speak about what makes for spiritual health (kind words, trustworthy words, humility, relationship with God, clean heart), versus a crushed, broken, or weighed down spirit (i.e., Psalm 51; Proverbs 15:4, 16:19-24, 17:22, 18:14, 29:23). Wise king Solomon wrote, “Keep your heart, for from it flow the springs of life” (Proverbs 4:23, ESV).
How are you caring for your spirit? Do you engage in spiritual renewal? A renewal experience is doing something you enjoy like a walk in nature or a hobby. I find renewal exercising with friends and playing the piano. For nurses of faith, attending a gathering in your worship tradition can be (should be!) a renewal experience.
Meet regularly with friends who will listen to and support you. Two months ago, I reluctantly joined a small group from my church to share time, meals, and service projects. I expected this to be work. To my surprise, even though I can’t attend regularly, the group is renewing me. This week, a young man shared his struggles with me, and I shared mine. He texted me today saying he was praying for me, and that “your absence is felt and we cherish when you are able to attend.” I felt spiritually connected, that someone of like mind cares for me. That is spiritual renewal in the struggle of life.
Below are ideas for spiritual self-care. As we think about balancing body, mind, and spirit during this year’s 2017 National Nurses Week, take time to care for your spirit.

Ideas to Help Your Spirit Soar

  1. Daily quiet time with personal reflection or meditation on spiritual readings.
  2. Read enlightening materials—spiritual readings (i.e., Bible) or devotional books.
  3. Plan for times of rest and take your mind off work, off problems, and relax (Sabbath). Consider a one-day or longer “guided spiritual retreat” at a retreat center near you.
  4. Attend gatherings of your faith tradition.
  5. Spend time in prayer, talking with the Mystery many call God.
  6. Join a “share group” of people with whom you have a common interest.
  7. Do special things you enjoygo to a greenhouse, art gallery, antique mall, camping or on a picnic, take in a movie with a friend. Be creative!
  8. Engage in regular physical exercise (walk/run alone or with a friend; join an exercise group).
  9. Conduct a spiritual self-assessment; heighten awareness of your spirituality (Beckman, Boxley-Harges, Bruick-Sorge, & Salmon, 2007).
  10. Engage in spiritual direction with a spiritual director or companion consistent with your beliefs (

Baldacchino, D. R. (2011). Teaching on spiritual care: The perceived impact on qualified nurses. Nurse Education in Practice, 11(1), 47–53. doi: 10.1016/j.nepr.2010.06.008
Bay, P. S., Ivy, S. S., & Terry, C. L. (2010). The effect of spiritual retreat on nurses’ spirituality: A randomized controlled study. Holistic Nursing Practice, 24(3), 125-133.
Beckman, S., Boxley-Harges, S., Bruick-Sorge, C., & Salmon, B. (2007). Five strategies that heighten nurses’ awareness of spirituality to impact client care. Holistic Nursing Practice, 21(3), 135-139.
Bufford, R. K., Paloutzian, R. F., & Ellison, C. W. (1991). Norms for the Spiritual Well-Being Scale. Journal of Psychology and Theology, 19(1), 56-70.
Lepherd, L. (2015). Spirituality: Everyone has it, but what is it? International Journal of Nursing Practice, 21(5), 566–574. doi: 10.1111/ijn.12285
Tabriz, E. R.., Orooji, A. Bikverdi, M. & Taghiabadl, B. A. (2017). Investigation of clinical competence and its relationship with professional ethics and spiritual health in nurses.   Health, Spirituality and Medical Ethics, 4(1), 2-9.
Taylor, E. J. (2009). What do I say? Talking with patients about spirituality. West Conshohocken, PA: Templeton.
Taylor, E. J. (2011). Spiritual care: Evangelism at the bedside? Journal of Christian Nursing, 28(4), 194-202. doi: 10.1097/CNJ.0b013e31822b494d
Kathy Schoonover-Shoffner, PhD, RN
National Director, Nurses Christian Fellowship USA
Editor-in-Chief, Journal of Christian Nursing
Posted: 5/11/2017 7:56:52 AM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Inspiration

Protect yourself so you can continue to protect others

How often have you given your patients advice on preventive health care and screenings and heard that nagging, guilty little voice in your head saying, “Don’t be a hypocrite, don’t forget about you”? Part of our job as nurses is to teach our patients about preventive health care and recommended screenings to maximize their health, longevity, and quality of life. While we know the importance of these health care services, however, we don’t always translate that into practice for ourselves.

Nurses may not follow recommended preventive and screening practices for a multitude of reasons. Shift work, long hours, limited paid time off, and an unpredictable schedule make it difficult to schedule appointments. As caregivers to the core, the needs and activities of our children, spouses, and parents become our focus during our non-working hours, and our own health care needs tend to take a backseat. But, in order to take care of our patients, as well as our families, we must make our own health a priority. A sick nurse can’t take care of anyone.

schedule.pngSo, what exactly do you need to do? To start with, schedule a check-up with your practitioner. Your practitioner will perform a physical examination, provide counseling, and perform or order screening tests and preventive services based on your age, gender, and risk factors. Your practitioner may include the following during your check-up, based on the recommendations by the U.S. Preventive Task Force:
  • Screen for alcohol misuse, intimate partner violence, depression, or high blood pressure
  • Order a serum blood test to screen for human immunodeficiency virus or hepatitis C virus
  • Order a serum lipid blood test to screen for hyperlipidemia
  • Order a dual-energy X-ray absorptiometry scan to screen for osteoporosis
  • Order or perform cancer screenings at the appropriate intervals, including breast cancer, cervical cancer, and colorectal cancer screenings
  • Order or perform any additional targeted screenings based on your history, the presence of risk factors, and physical examination findings
In addition to the health care screenings, preventive measures can stop certain diseases from occurring in the first place. The Centers for Disease Control and Prevention recommends the following vaccines for all health care workers: vaccine.png
  • Hepatitis B series
  • Influenza (annually)
  • Measles, Mumps, & Rubella
  • Varicella
  • Tetanus, Diphtheria, & Pertussis
  • Meningococcal

Some of these vaccines may be required at your facility, so they may be given free-of-charge during work hours, which saves you the time and inconvenience of scheduling a separate appointment. If they’re not, ask your practitioner about them at your check-up. It’s important to protect yourself so you can continue to care for others.

Nurses Week is the perfect time to renew our commitment to take better care of ourselves by practicing preventative care measures and making those screening appointments. Be well!

Vicki Cantor, RN, BSN, MA
Clinical Editor
Health Learning, Research & Practice
Wolters Kluwer

Posted: 5/10/2017 7:17:08 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration

Stress: The Elephant in Your Career

stress.png“I resigned my staff nurse position today,” my young colleague confessed, “after only 7 months. I loved taking care of patients and families, but just couldn’t take it anymore – the other nurses complaining, but never speaking out, the rude behavior and put downs, and the nurse manager who made bad decisions and supported the wrong people – will it be like this in my next job? I feel like such a failure.” I have heard this story at least three times over the past year and I am only an N of 1. Recent studies have documented the alarming percentage of nurses who are leaving their jobs or leaving the profession climbing to 17.2 % in 2016 and costing hospitals an average of $5.2M – $8.1M annually. 1 Reasons cited by nurses for leaving include poor management, and stressful work conditions, including inadequate staffing, verbal abuse, and work-life balance issues. 2, 3 While employing organizations are deciding how to tackle this problem, you need stress relief now to get you through the day. First, let’s revisit the concept stress, then consider a few simple and creative strategies that you can use to get the elephant out of your workday ---- STRESS!

Stress Revisited

Hans Selye, a Canadian physician, conceptualized the “stress response” and conducted research on how it worked after observing patients’ responses to the stress of hospitalization. 4 “Stressors” are those factors experienced or perceived by individuals as causing harm or distress. “Experienced” or “perceived” is an important distinction since the stressor can be real and direct like a contracting a virus or being robbed at gunpoint or the stressor could be the result of how we view a situation; a putdown for one nurse can be devastating and for another a minor blip in the course of a day’s work.  The apathy of her colleagues, rude behavior, put downs, and the passivity of the nurse manager were my colleague’s perceived “stressors.” Stress, on the other hand, is the individual’s reaction or the body’s response to real and perceived threats whether that reaction is manifested physically or mentally. In this case, my young colleague’s reaction was to let the stressors overwhelm her to the point of leaving – remember fight or flight? She could have tried to “change her perceptions,”  “change her reactions,” “change her behavior or get help,” instead the stress led to resignation.  Depending on the severity of the stress, individuals and organizations always have a measure of control in managing “stressors.”  Instead of merely reacting, striving to develop a deep awareness of how you can plan, craft, and control your responses to difficult situations can be the first step to stress inoculation. 

Stress Inoculation

                You get to choose how to “vaccinate” your stress. Choose “ingredients” based on your preferences, style, and time – some take no time, others take a commitment of 20 minutes to half an hour per day. Try one strategy per week to find what is right for you. Continue with those you believe are helping you to respond effectively instead of reacting haphazardly and then move on to more structured and serious stress management modalities. Below is a simple formula to begin stress reduction. It’s your choice!   
  • walking_biking.pngMove -- Twenty minutes a day of running, walking, cycling, etc., will help to dissipate the effects of stress. Regular exercise improves cardiovascular function, produces endorphins in the brain that result in improved mood, strengthens muscles, and improves tone.  If you are not inclined to run, sign up for yoga or Pilates.  These meditative exercise forms stretch and tone your body and improve your posture and flexibility which can become a metaphor for how you respond in stressful situations. Regularly moving the body increases body awareness during stressful interactions.  So, if you experience bullying or other negative interpersonal encounters on the job, use your body’s signals to respond – stand taller, face your nemesis or – if you are too rattled – leave the scene, it is your absolute right to remove yourself from such situations.  Better yet, dance!
  • Rehearse difficult conversations in the privacy of your car – you could even let loose, scream, use profanity – no one will hear you but you, and hearing how you respond or “talk back” can be helpful in changing your verbal responses during stressful situations. Just be cautious; if someone in the next car notices your solitary conversations, just smile, fiddle with the radio and pretend you’re singing. Rehearsals should help your responses become more rational, more focused, less defensive and more “I” oriented. Read up on developing calm, assertive responses or join an assertiveness training group. In time you will be surprised when the assertive responses that you rehearsed become natural and automatic during difficult situations.
  • Laugh – Humor provides release and helps put things in perspective.  Most importantly, laugh at yourself even at your best efforts.  At the urging of my internist, I hired a personal trainer and worked out 2 days a week for 2 years – the result, I spent $3,000 dollars and lost three pounds but I was “toned.” I am still laughing at the result. Get a small group of like-minded nurse colleagues together and watch funny SNL’s vignettes or YouTube videos. My SNL favorites are from the 1980’s particularly Jane Curtin attending assertiveness training class or Roseann Roseanna Danna reporting the news.  Humor heals and humor shared is even more healing.
  • Reframe difficult situations, that is, change the meaning, the emotional tone, or your viewpoint of a difficult situation and place it in another frame.  Remember when Huckleberry Finn, a Mark Twain 5 character,  had to whitewash the fence – it was work he did not want to do but he “reframed” and pretended to be having such great fun that all his friends begged to help and he finished in record time. How would you reframe a heavier than usual patient assignment or having to work on a holiday?  It is possible to change what we think or how we view any situation.  Conjure up at least 3 positive or at least, neutral interpretations of the next difficulty you encounter.  Flexing perspective is liberating.
  • Imagine – Your imagination can save you from revealing negativity, disapproval or even fear.  Use fantasy to get yourself through difficult situations. For example, when attending that meeting you dread with all of those difficult colleagues gathered in one place, imagine that you are all different animals in a zoo. Imagine the sounds they would make when things got tough or how they might gallop or slither from the room. You will get a pleasant look on your face when you are fantasizing and group members will think that you are relaxed and have it together.  The rule is to keep your fantasy private.
  • Sing in the privacy of your car or the shower. Sing uplifting and inspirational songs that emphasize self-empowerment. Or download the following songs on your phone and sing along or listen on your break. Music reorganizes the brain and the messages sung are uniquely remembered. Here is a selection of empowering songs to get your started. If you are of my vintage, Sinatra’s, “I Did It My Way,” or “I Gotta Be Me,” or a few pop favorites, “Let it Go,” or “Brave,” or “Fight Song.”  It you are hip, there is Des’ree’s “You Gotta Be,” and if you are inclined to country music, one of my favorites is Bobby Bare’s, “Drop Kick Me Jesus thru the Goalpost of Life.” In Bobby’s words, “If you have the will, God has the toe.” Make your own song selections and share.
So there is it, a simple formula that will get your started to managing every day stress:
Move + Rehearse + Laugh + Reframe + Imagine + Sing
If your health is at risk or your situation is dire, consult a health professional.  Take care of yourself!
  1.  2016 National Healthcare Retention & RN Staffing Report Published by: NSI Nursing Solutions, Inc.  Accessed 4/30/2017
  2. Flinkman M, Ulpukka I, Salantera  S, International Scholarly Research Notices. August 20, 2013.  Accessed 4/30/2017.
  3. Robert Wood Johnson Foundation. The RN Work Project, September 1, 2009.  Accessed 4/30/2017
  4. Selye H. The Stress of Life. New York: Mc Graw Hill, 1956.
  5. Twain, M. Adventures of Huckleberry Finn. Costa Mesa, California: Saddleback Educational Publishing, 1999,2011

Gloria F. Donnelly, Ph.D., RN, FAAN, FCPP
Professor and Dean Emerita
College of Nursing and Health Professions
Drexel University

Editor in Chief, Holistic Nursing Practice

Posted: 5/9/2017 6:46:20 AM by Lisa Bonsall, MSN, RN, CRNP | with 3 comments

Categories: Inspiration

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