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FLOURISH! Meaningful steps to increase personal resilience and be your best self - even during a pandemic

This is an extraordinarily challenging time to be a nurse. The COVID-19 pandemic is stretching many of us to the limit and beyond, as we work overtime to treat anxious, frustrated patients while trying to come to grips with rapidly changing guidelines, supply shortages and the awareness that our own families are also at risk.

Worse, during a crisis like this, the stress doesn’t end when we clock out. Going home to scrounge up some dinner from nearly bare shelves while panicky talking heads on the TV warn of the latest case counts does nothing to improve your state of mind. It’s a recipe for overwhelm, exhaustion and burnout.

NEW GRAD BURNOUT

The hard truth is that even before the COVID-19 crisis became a pandemic, many nurses were already dangerously close to burnout. This is nothing new for our profession, and it’s a problem that starts early. 

I have vivid memories of my first nursing job as a new graduate, sitting in the conference room to take change-of-shift reports from nurses just coming off the night shift. A few managed to crack a smile, but others were dreary and red-eyed, complaining about heavy patient loads, inadequate staffing and having to finish work for other nurses. 

Even in my first week, colleagues asked, “Why on earth did you go into nursing? This is a thankless job.” By the end of my residency, I was already so burned out by the stress and negativity that I jumped at a chance to join the staff of a physician group. 

Although that was years ago, many new grads today could tell similar stories.

A PROFESSION IN CRISIS

In October 2019, the National Academy of Medicine (NAM) released a widely anticipated report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Wellbeing, a culmination of two years of research.

The report cites research suggesting that more than half of all clinicians — including nurses and physicians across the United States — experience symptoms of professional burnout, depression and suicidality. This is a bona fide public health epidemic that is adversely affecting the quality and safety of U.S. healthcare.

For nurses, burnout manifests as emotional exhaustion; feelings of ineffectiveness and cynicism; no longer finding work meaningful; and a tendency to view patients, students and colleagues as objects rather than human beings. Burnout reduces job satisfaction; contributes to medical errors and poorer patient satisfaction; and increases rates of alcohol and drug abuse, self-harm and suicide. It’s a serious danger to your physical and mental health. 

RISK FACTORS AT HOME AND AT WORK

The NAM report affirms something nurses already know: that burnout can have both personal and workplace causes. Personal risk factors include not practicing self-care or healthy lifestyle behaviors.

Workplace risk factors can include poor staffing, schedules that cut into personal time, inadequate leadership support, IT challenges, spending less time with patients, a negative or toxic work environment and a lack of connection and trust with coworkers. 

As a nurse, you may have little control over your unit’s staffing and schedules, but there are measures you can take to bolster your personal wellbeing and be your best self.

What does it mean to be your best self? Martin Seligman, Ph.D., founder of the Positive Psychology Center at the University of Pennsylvania School of Arts and Sciences, identifies three distinct states of human functioning:

1. Flourishing describes people who maintain an “optimal level of functioning,” characterized by goodness, generativity, growth, joy, hope and resilience. 
2. Languishing describes those who are showing up day to day, watching the clock and collecting their paychecks, but who ultimately feel like something is missing in their lives. 
3. Dysfunction describes a negative condition characterized by depression, anxiety and loneliness.

P-R-O-P-E-L

How does one reach the ideal “flourishing” state?

Thomas Muha, Ph.D., has defined a  framework with the acronym “PROPEL,” which stands for Passion, Relationships, Optimism, Proactive response, Energy and Legacy. Muha has developed an evidence-based program designed to improve clinicians’ wellbeing and increase resilience by focusing on each of these factors.

► Passion is your source of inspiration and motivation. Having a passion for your work empowers you to perform at the highest level and helps to protect you from burnout. 

However, Muha distinguishes between harmonious passion (where you choose to engage in an activity of your own accord and in harmony with your core values) and obsessive passion (where you perform a task solely for the sake of an external reward or recognition). While harmonious passion increases your resilience, an obsession with perfectionism and external goals leads to conflicts, frustration and negative emotions.

► Relationships at work, with your family and in your community foster wellbeing. Individuals who attain the highest levels of success in life typically also have large circles of friends, coworkers and others, providing abundant support. Maintaining relationships is especially important during rough times like the COVID-19 pandemic. These bonds help us to remember that there’s still life beyond the current crisis and provide mutual support in periods of isolation and stress.

► Optimism is a learned way of thinking that leads to a mindset of hope and growth. While everyone has some negative thoughts, research has demonstrated that individuals who can maintain a 3:1 ratio of positive to negative thoughts are more courageous and less prone to defensiveness, anger and hostility. Optimistic people are also more empathetic, better able to understand and appreciate the challenges and successes of others, and tend to perform better in their personal and professional lives.

► Proactive response to challenges is the opposite of being reactive. It’s about playing to your strengths: looking for opportunities to apply your strongest attributes and perform at your best. Doing this empowers you to remain optimistic and resilient when facing challenges. According to Susan B. Sorenson, Ph.D., of the University of Pennsylvania School of Social Policy & Practice, people who use their strengths at work are six times more likely to be engaged in their jobs and have lower turnover, higher productivity and greater patient satisfaction. satisfaction.  Learning to be proactive takes practice.

Author and workplace wellbeing coach Michelle McQuaid, MAPP, suggests developing a routine to let you practice your strengths for 10 minutes a day, reinforced by a small reward. Exercises like this are also very useful during a crisis because they can help you regain a sense of control over your situation. Nothing drags down your spirits like feeling powerless.

► Energy — physical, mental and emotional — is vital for nurses. We are not like the Energizer Bunny; to ward off stress and burnout, we need time to rest and recharge. Neuroscience studies have shown that a healthy diet, exercise, adequate sleep, mindfulness, meditation and expressing gratitude can all help to measurably decrease stress, increase your resilience and enhance your emotional and physical wellbeing. 

For many nurses, this may seem like a tall order, especially when healthy snacks are in short supply. However, even if you can’t make your shift any shorter or less hectic (or make your grocery store restock any quicker), you can take the edge off by learning to step back from constantly running and doing. Take a beat and just be in the moment. 

An easy exercise you can try is to make a point of pausing upon entering a patient’s room or going into a meeting, focusing on the feeling of your two feet on the floor and taking a long breath before proceeding.

► Legacy is about the impact you have on those around you. Focusing on empowering others to bring purpose and meaning to the workplace and bring out the best in each other is a great way to ignite your passion and embrace your values.

DON'T JUST SURVIVE — THRIVE!

There’s no avoiding stress, but not everyone suffers adverse effects from challenging situations. With the proper mindset, stress can actually bring about positive change. In her book The Upside of Stress, author Kelly McGonigal, Ph.D., points out, paradoxically, that “common effects of stress include strengths, growth and resilience.” 

By making a commitment to yourself and incorporating the above tips and tools, you can transform tough times into opportunities to flourish in your personal and professional lives. The benefits will last long after the present crisis has faded into historical memory.

Sue Trace, RN, BSN, COCC, ACC, is a professional life/career coach. Certified by the PROPEL Institute, she works with organizations to foster positive workplace culture and improving nursing/staff engagement, retention and patient satisfaction. www.tracecoaching.com

Jasmin Mora is a Los Angeles-based Illustrator who contributes frequently to Working Nurse. Reach her at www.jasminmora.com