Self-care vital for nurses coping with stress
With new challenges disrupting health care systems around the globe, nurses are facing tremendous pressures. The high stress job typically involves long shifts as well as shift work. During this “International Year of the Nurse,” it may be time to ask, “Who’s taking care of nurses?”
Carolyn Schur, a shiftwork and fatigue specialist, says the emotional and physical toll for those providing health care to coronavirus patients is dangerously high. “In Ontario and Quebec where ICU units are full, almost every nurse will come out with PTSD (post traumatic stress disorder).”
Thankfully, the COVID-19 situation in Saskatchewan is currently not as grave. “We haven’t had an influx of patients,” said Schur. Nurses have taken extra training and are as ready as they can be. “But frankly, some of the nurses don’t have the flow of patients they would normally have because everything has been cleared out for COVID patients.”
Nevertheless, Saskatchewan nurses operate with sufficient challenges on a dayto-day basis. Physical and emotional fatigue are common. Years ago, if a nurse had eight or 10 patients to care for, about two of those were very seriously ill. “Nowadays, if you have eight or 10, they need all your attention all the time. They are very high acuity,” Schur said, and staffing hasn’t changed much.
Fatigue is generated in part by how the system works. The job involves long shifts, night shifts, and a workload that makes taking breaks a real challenge. Nurses get called to pull extra shifts and often feel duty-bound to take them to ensure patient care doesn’t suffer and to protect their colleagues. The vast majority of nurses do shift work and deal with insomnia. “Shiftwork involving nights is where the real problem lies. The body is not designed to sleep in the daytime. The challenge is how do you get good quality and sufficient quantity of sleep in the daytime?” she said.
Schur encourages nurses to advocate on their own behalf. This can begin by guarding their sleep time. They can inform family and friends of their sleep schedule and ask them not to call. They can turn off the phone and set a special ring tone for those who absolutely need to reach them. They can teach others – children, spouse, elderly parents – what a real emergency is and how to respond to it. They can even ask neighbours not to mow their lawns during sleep time.
Nutrition and exercise are big problems for nurses, Schur says. Hospital cafeterias are available during regular 9-to-5 hours, assuming a nurse can get a break. Even if she or he does get a break, it takes precious time off the ward to make the trip to the cafeteria and back. At night, vending machines dispense calories in the form of candies and chips.
Schur encourages nurses to bring portable nutrition with them to work – good protein sources with a little bit of added energy, such as a boiled egg, a banana, nuts, yogurt and small packs of cheese – sustenance that can be accessed once an hour to help nurses keep going. Schur also recommends chocolate milk or orange juice in managed quantities.
If addressing physical needs like nutrition, sleep and exercise is challenging, attending to one’s inner story is more so. Beyond physical care, nurses provide continuous emotional support to patients and their families. “Emotional care is what most nurses regard as their biggest task,” said Schur. Nurses provide reassurance to patients, discuss procedures and ask them what they need. “The energy that takes sucks you dry,” added Schur. When emotional reserves are depleted, they need to be replenished through strategic self-care. If they’re not, physical and mental fatigue may combine to increase the risk of injuries.
When it comes to the well-being of their employees, the health care system is mainly focused on prevention of injuries, Schur says. Back injuries and muscular skeletal injuries are numerous among nurses. “Having a rest break is critical to avoiding these injuries. I teach nurses how to take a break.” But what about emotional injuries?
A different kind of fatigue happens as nurses are exposed to repeated and regular trauma. When sickness, pain and death are near, nurses experience compassion fatigue. Seeing patient recoveries helps, but research has shown that we humans have a negativity bias. This means that negative experiences have a greater psychological impact on us than positive ones. To counter that, nurses need to release a pressure valve by calling a friend to unburden, seeing a counsellor or even having a good cry, to assist their own recoveries.
The public can help support nurses by respecting their sleep schedule during the day. “That’s by far the most important thing you can do,” Schur said. If you know a nurse is doing a lot of overtime for whatever reason – they may need the money, they may be a single parent – send over a meal or a gift certificate to where they can pick up a meal. Volunteer to look after their kids every once in a while. Set up a play date for when a nurse will normally be sending kids to daycare. Pick up extra groceries and save a nurse the trip.
It appears health care systems can do more to protect nurses from various types of fatigue and empower them in self care.