Making the Most of a Moral Dilemma

Making the Most of a Moral Dilemma

As a nurse, you’ve likely been caught in the moral distress crosshairs. Your training, instincts, and values are telling you the right thing to do, but you’re anguished because other factions are preventing you from doing it.

Indeed, there are enough grey areas in medicine to cause anxiety for even the most seasoned nurses, particularly those dealing with chronic conditions and end-of-life choices. A physician dismisses your opinions. . .Hospital policy doesn’t permit your suggestions. . .Or you’re at odds with family members over choices. You’re certain the treatment will be suffering without benefit while they hang on to hope.

So, how do you diminish the moral distress that ethical dilemmas trigger? By planning strategically and acting boldly, you can change the dynamic and open the conversation so that you and others aren’t going it alone.

“Silence is extraordinarily harmful when it comes to moral distress,” says Katherine Brown-Saltzman, RN, MA, co-director of the UCLA Health System Ethics Center and an assistant professor at the UCLA School of Nursing. “It creates isolation, which creates a sense that ‘I’m in this alone. No one else understands or appreciates it.’ It also doesn’t allow for the creative potential of coming together and working things through.”

Plan Strategically

Whatever situation is fueling your angst, creating a self-care plan that maximizes your strengths and minimizes potential pitfalls is essential. Since moral distress can trigger physical, emotional, behavioral, and even spiritual responses, recognizing the cues is a no-brainer. But steeling your resolve also involves other proactive steps.

Respect Values—Yours and Others

Being comfortable with your values and those of others is fundamental for navigating any ethical issue. Your moral compass is based largely on a belief system rooted in culture, family, ethnicity, and religion. They set the tone for your responses even though your training and specialty choice influence, too. Caring for patients with chronic illnesses, relentless pain, and/or end-of-life challenges, for instance, can skew your viewpoint. The same holds true for being part of a minority group historically rebuffed by the health care system. “That’s going to profoundly affect your perspective and perhaps even level of advocacy to vulnerable patients,” Brown-Saltzman says.

Whatever influences you, however, being curious about what motivates others matters as well. Understanding someone else’s priorities and goals is crucial in finding common ground. But it also may determine what you do next. Even though your responsibility is to set aside your belief system for a patient, you may need to step away eventually. “We all have the right to our deeply held values, but we can’t force them on other people,” says Donna Casey, BSN, MA, RN, NE-BC, FABC, vice president of patient care services and co-chair of the ethics committee at Christiana Care Health System in Newark, Delaware. “So when we’re asked to do something professionally that goes against our beliefs, it’s our obligation to ask to be removed from the situation.”

Identify Sympathetic Colleagues

Even though the response to any ethical dilemma is personal—not everyone will share your sensitivities—moral distress has to do with the environment, too. Hopefully, you’ve selected a workplace where you’re empowered to speak up because nursing leaders listen. Even if you draw a line in the sand, they’ll honor your values—and the conscience clause protecting your rights.

But you also want trusted colleagues in your corner. With empowerment research showing that two people standing up for something are more likely to stay the course than one person going it alone, there’s reason to lasso a workplace colleague with similar misgivings about an ethical situation. It adds credence to your voice. “There are times,” says Casey, “when you may be off base because you only have partial information. By sharing your concerns with peers, you can validate them.”

Likewise, a mentor not only can help clarify events, but also broaden your skills. For instance, Melissa Batchelor-Murphy, PhD, RN-BC, FNP-BC, assistant professor at Duke University School of Nursing, had little advanced training early in her geriatric nurse practitioner career to be a death and dying expert. But since counseling was part of her job, she not only read copiously about aging patient issues, but also tapped a mentor to model difficult end-of-life discussions. By listening intently, Batchelor-Murphy not only survived an initial rough patch but also sharpened her geriatric communication skills.

Today, she advises other nurses, particularly in high burnout specialties, to do the same. “You need to seek out that mentor and then ask to sit in and watch how it’s done,” she says. “Also notice when someone else isn’t doing it well so you’ll know where you want to be.”

Act Boldly

You may reach a critical juncture whereby you undergo what Alvita K. Nathaniel, PhD, and Margaret A. Burkhardt, PhD, authors of Ethics and Issues in Contemporary Nursing refer to as moral reckoning. That is, something so compelling occurs that you’re finally willing to take a stand, whether that means engaging your supervisor, going up the chain of command, or even blowing the whistle. Even if the situation doesn’t demand dramatic tactics, there are other effective ways to move forward.

Affirm Your Role

Whatever the setting, your perspective as a nurse is uniquely important given the intimate time you likely spend with patients and families. You may have a view about someone’s suffering, beliefs, and family positions that other providers haven’t heard and need to know. Unfortunately, that doesn’t necessarily buy leverage. In fact, physicians don’t always appreciate the moral burden nurses experience.

There are ways to let others know your value, however. Being respectfully inquisitive of other viewpoints even as you use your listening and questioning skills to determine the rationale behind a medical decision can create inroads. “Many times nurses blame physicians for what they perceive as lacking the moral courage to refuse the aggressive care a family is demanding,” says Casey. “But they’re not our adversaries. We’re all in this together.”

Still, the linchpin in getting your voice heard is to know your ethical responsibilities and refer to them liberally. The American Nurses Association’s Code of Ethics for Nurses, for instance, not only outlines what you can and can’t do, but also yields a framework for discussion and ammunition for making your case. By being able to say “I have an obligation as a nurse to raise and explore this issue with you,” your opinion and advocacy gain new weight. As Mary K. Walton, MSN, MBE, RN, director of patient and family-centered care and nurse ethicist at the Hospital of the University of Pennsylvania, notes:If we can anchor our questions and concerns in the framework of our obligations as nurses, we’ll have a guide to help mitigate distress and/or clarify when we need to hold fast to our professional code and speak up.”

Engage Early

Whatever you do to advocate for your patient, bringing everyone to the table for an ethical discussion is critical. You may involve other resources—chaplains, social workers, and palliative or hospice care specialists — separately at times for their unique perspectives. But you’ll likely need the structure of an ethics consult to sort out those value-laden uncertainties tied to end-of-life or other high stakes care. Such a meeting facilitates common ground by encouraging patients and their surrogates to express their goals—and providers equal time to reframe them into feasible objectives and care.

“Reasonable people can disagree on important matters,” Walton says. “So you want to understand before you try to convince others that your perspective is the correct one.”

To achieve your objectives, you need patience, curiosity, and what Walton refers to as “cultural humility” and “exquisite communication skills” to uncover what’s relevant to others. It’s critical to ask, listen, and reflect so you know how someone else views the situation or sees what you’re not seeing. Whatever the give-and-take, ensuring that everyone has a realistic, coherent picture of the situation—and is comfortable with the next steps—can break the isolation for you and others. “If you engage in an ethical dialogue right from the beginning by inviting everyone to the table,” says Brown-Saltzman, “you have the potential for greater understanding. That paves the way for reduced moral distress.”

Encourage Family Participation

Since family members are important players, obviously you want their input to build consensus and avoid any unsettling surprises. But sometimes you need to go even further than keeping relatives informed by specifically asking for their participation.

For instance, citing her research about end–stage dementia and eating, Batchelor-Murphy suggests that teaching family members supportive hand feeding as an alternative to tube feeding not only gives family members a role, but also affirms that the health care team is in sync with their quality end-of-life goals. “Sometimes when we have these conversations the only thing families hear is that we’re taking something away from the patient,” she says. “But as soon as we tell them what we can’t do, we also need to say, ‘Let’s talk about how we’re going to take care of your family member.’”

Final Thoughts

With new technologies recasting the diagnostic and treatment landscape in every which way, health care providers have more effective tools now than ever to help patients. But they also have to grapple with the fine line ethics of when to use them. Since the same options that improve and lengthen life may also prolong discomfort and extend dying, there are ample ethical challenges for everyone. And even if you’re not on the high stakes care front line, you may experience other conflicts.

Whatever the source, you have a vested interest in being proactive since moral distress may eventually hurt your ability to provide quality care and shorten your professional longevity. But by boosting your skills, you’re protecting yourself and even changing the dynamic with colleagues. More importantly, you may also stiffen your resolve for helping patients and families make very difficult ethical choices. “We sometimes need to help families understand that life is a limited circumstance,” says Casey. “Medicine has done some wonderful things, but we can’t cure the fact that we’re all going to die.”

How to Curb Emotional Eating

How to Curb Emotional Eating

When work stresses you to the max, what’s your intuitive response? Do you scour the break room for party leftovers or boost your emotions in healthy-conscious ways?

Truth is, if you’re using food as a crutch for healing stress, you’re like other Americans whose appetites go into overdrive when they’re uptight. In fact, eating is such a common response that 40% of people, according to estimates, consume more than normal when they’re anxious; 73% say it’s all about increasing snacks.

As a nurse, you already know that emotional or overeating is never a cure-all for what ails you. It can lead to multiple health problems, torpedo your self-esteem, and mask other issues.

“Overeating is a coping mechanism that suppresses stress rather than dealing with it head on, says Amy Gorin, MS, RDN, owner of and contributing blogger to “Fortunately, you can retrain your behaviors to deal with it in a healthier way.”

So, how do you chart a nutritious course from stress eater to stress non-eater? By understanding your eating triggers and then building a new plan for dealing with them!

All in the Body

Scientists are still plotting the intricate relationship between appetite and emotional well-being. Yet evidence thus far suggests that when you overeat under stress, you’re likely responding to both physiological and psychological signals.

How much can be attributed to your head? It appears a substantial amount since your brain triggers a complicated chemical cascade dictating events. That includes directing your appetite to stay quiet, come alive, or even crave those highly refined, fatty, sugary, or salty foods that are comfort.

Obviously, structures play roles. Studies have shown, for instance, that the hypothalamus-pituitary-adrenal (HPA) axis, which governs the stress response, is overactive in some people and could influence their hunger perception and drive to eat. Yet to get the ball rolling, your brain signals your adrenal glands to pump out adrenalin and cortisol, neurotransmitters that help energize you for the fight plus govern your appetite. Adrenalin temporarily suppresses your hunger while cortisol eventually reboots it and may be partially responsible for cravings. What’s driving that train? Studies suggest high cortisol levels along with elevated insulin and ghrelin, the hunger hormone, increase your desire for fatty, sugary, and/or salted foods.

Programming Counts

So if everyone undergoes the same biochemical chain of events, why do some people gravitate to food, especially fatty and sugary options, while others keep their distance? For starters, individual appetites and coping mechanisms are simply wired differently. Since stress is an emotional response to internal or external threats, it’s logical that your psychological profile and personal traits come into play. Food may have greater meaning for you than for others because it’s been a Band-Aid, a prize, or a family ritual. You revert because it is comfort!

“People who overeat under stress get a higher sense of reward from food than people who don’t overeat,” says Joey Gochnour, BS, BS, MEd, RDN, LD, NASM-CPT, a registered dietitian, nutritionist, and certified personal trainer for RecSports at the University of Texas at Austin. “It’s as much habit as it is biological. And even if they weren’t raised with the habit, they’ve discovered that a particular food makes them happy and so they want to go to that happy place. It gives them a sense of euphoria.’” Adds Charmaine C. Jones, MS, RDN, LDN, the founder and CEO of Food Jonezi: “Stress can cause you to revert to what’s felt good in the past. Why is it often food? Because it’s flavorful and effortless.”

Even if you’re not getting such cues, you still may be driven to certain foods because they really do give you a positive jolt. That’s in part because they signal the body to release chemicals that participate in elevating your spirit. Eating influences endorphins, the brain’s “feel good” chemicals. When you ingest something you like, they flood the zone, so to speak. Your body may crave high fat or sugary foods because they signal other pleasure-causing chemicals. “If you crave carbs when your mood is low,” says Jones, “your brain may be asking for a serotonin boost.”

So if you’ve been hardwired to reach for your favorite comfort food how do you change that dynamic? By replacing old habits with new ones you boost your overall well-being, which supports a healthier stress response. With a balanced diet, a healthy food milieu, and a better attitude toward your options, you’ll no longer have to wing it in an emotional eating pinch!

Think Dietary Balance

When it comes to relieving stress you don’t have to sweat the small stuff. A diet reflecting the major food group infuses your body with the macro- and micronutrients necessary to support your physical health and mental well-being. In fact, by focusing on wholesome eating patterns, you’ll likely score big on the individual nutrient front. “We’re really working with nutritional density,” says Charlotte Hammond, MS, RD, LDN, RYT, Chicago-based registered dietitian. “We’re trying to get as much bang for our buck as possible.”

She suggests five foundational “mood foods”—eggs, fish, beans, leafy greens, and nuts/figs—that keep the body running smoothly and have a calming effect. Besides checking blood pressure and glucose, they supply nutrients—e.g., vitamin A plus folate and other B complex vitamins—known to boost serotonin. They’re also linked to dopamine and its precursor tyrosine, which promote pleasurable moods and feelings.

When added to the mix, whole grains, fruits, and other selected foods expand the universe of wholesome carbohydrate and other sources to feed your energy and cravings with nutrient staying power. “You have a lot of control and options with the food groups,” says Torey Armul, MS, RDN, CSSD, national spokesman for the Academy of Nutrition and Dietetics. “That variety is important because we want people to have an array of flavors and enjoy what they eat.”

Build a Healthy Milieu

Since eating nutritiously is especially important when you’re anxious, you want to put a structure in place that facilitates your choices. “It’s not just about anticipating those moments of stress, but also about building an environment around you with food that encourages and supports your goals,” explains Armul. That not only means creating an eating plan that meets your nutrient and energy expectations, but also structuring a food schedule that keeps healthy sources flowing.

Even though you may have little control over snack and lunch breaks, start the day with breakfast so you’re not playing catch up. “If you don’t eat a good breakfast it sabotages the rest of the day,” says Angel C. Planells, MS, RDN, the owner of ACP Nutrition in Seattle. “By lunchtime, you’re famished and by dinnertime you don’t even care anymore. You’re just going to eat what’s appealing.”

Make Peace with Stress, Food

Since your health status is dependent on what you eat and what you eat is often governed by stress, tackling underlying issues that might ruffle your feathers needs to be a priority. Achieving your health goals or even negotiating smart food decisions can be difficult without the attention. “People make short-term choices when they’re highly stressed and long-term choices when they’re less so,” Hammond says. “That’s the crux of sticking with a plan. When you’re not stressed you make healthier selections.”

In fact, dietitians often focus on an individual’s internal wherewithal rather than diets and other cues to coax them into developing a better relationship with mind, body, and food. For instance, among the 10 principles Evelyn Tribole, MS, RD, and Elyse Resch MS, RDN, outline in their book, Intuitive Eating, “honor your hunger” and “make peace with food” are key. By feeding your body when it’s ready and not depriving yourself of your options, you can stave off the cravings.

You also make wiser choices, say other dietitians, by tracking your mood triggers—those events that set off the overeating—while being mindful of your food behaviors. When hunger strikes, for instance, knowing that the pangs are physical and not emotional can help you control your eating habits. Also, by savoring each bite you cue your body to digest leisurely until you’re really full.

“You don’t have to be a master at it,” Jones says, “but once you recognize your stressors, you can control how you respond to them. That can be empowering.”

The Bottom Line

A balanced diet of nutritionally laden foods has sweeping advantages for your physical and mental health, including how you respond to stress. But you also need to incorporate other stress relievers: Walk. Meditate. Call a friend. Whatever you choose, by redirecting your responses, you won’t reach for that donut or party leftover. You’ll opt for nutritious and other intuitive strategies including new comfort foods!

“Many people say ‘I have a problem with food because I love it,’” says Hammond. “My response is, “That’s not a problem. That’s our solution. We just need you to love great healthy food.’”

The Nurse Recruiter and You

The Nurse Recruiter and You

When Brittany Castaneda-Thibault, BSN, RN, first started her job search she made sure that the first thing she mentioned in her resume and cover letter was her externship at the Mayo Clinic in Rochester, Minnesota. She wanted recruiters and hiring managers alike to recognize that she had experience, albeit for one summer, in surgical nursing.

Castaneda-Thibault’s strategy worked. Before she even graduated from her University of Texas-Austin nursing program, she had snared a job as a cardiac surgical nurse at Baylor Scott & White Health in Round Rock, Texas.

“Yes, grades are important, especially if you want to go back to school,” says Castaneda-Thibault. “But you need to show everyone who’s reading your resume that you’re familiar with patient-centered care because you’ve worked in it. You have experience.” 

Indeed, in terms of getting noticed by a recruiter, what you do outside the classroom may be just as important as what you achieve inside. Granted, you’ll have to demonstrate that you know your academic and clinical stuff to be considered a quality candidate and potentially valued member of the nursing staff. But hiring professionals have their eagle eyes focused on a mix of factors. They want to see a well-rounded individual who’s not only prepared, but also professional and passionate.

As Ellen Lorenz, nursing talent acquisitions specialist for the North Shore Long Island Jewish Health System, says: “It’s not that they just went to school. It’s that they did other things as well. They made the most of their time as students.”

Be Prepared

Your recruiter will be measuring you against other applicants, so it’s important to be savvy in how you present yourself. You want to pull together all of the resources that could propel you into the job of your dreams—or at least one that’s a satisfying start to a nursing career. That means not only highlighting your achievements, but also demonstrating your knowledge of the institution’s strengths. Since every interview is a two-way conversation, the recruiter likely will expect you to have your fair share of questions. (Now is the time to bone up on the organization’s website.)

Castaneda-Thibault, for example, not only took advantage of her program’s leadership class to master everything she could about the job hunting process, but she also tapped the websites of each organization that granted an interview to learn more about the mission, surgical specialties, and even nursing models. “All of the questions that I couldn’t find answers for I wrote down and asked during the interview,” she says. “It was helpful in helping me look very interested in the hospital and what they did.”

When the spotlight shifts to you, your goal is to make everything you’ve done relevant to the job. Hopefully, your resume is a well-organized mix of academic achievements and other activities. How important is your GPA? It’s as relevant to your job search as a potential employer makes it. If your record puts you at the top of the class, highlight it. In fact, some organizations will be delighted to court you because they want the highest achievers.

Yet more often than not, recruiters are targeting the bigger educational picture in evaluating scholastic success. They’re interested in the content of your classes, the focus of your clinicals, and even the experience you gained from a practicum, externship, or volunteer or part-time job.

At Washington, DC-based Children’s National Health System, for instance, the emphasis is always on a broader evaluation than just one’s GPA. “We’re looking at the whole person, and your academic record is certainly not the whole person,” says Jill Board, MS, BSN, RN, a nurse recruiter, noting that whatever applicants did through their high school or college years involving children—teaching dance, babysitting a family, or even volunteering for a youth group—are profile-raising. “It jumps out at us if we see that you weren’t building a resume just to build a resume, but you really enjoy working with children. That’s important.”

Likewise, although Castaneda-Thibault’s GPA hovered at 3.5-3.6 during nursing school, she didn’t think it was her strongest suit. So she highlighted the points—her leadership roles, volunteer activities, and part-time work in addition to the externship—that demonstrated she was both well-rounded and prepared. She also kept her eye on the ball by applying only for those specialties—surgery, pediatrics, or critical care—that she really wanted. Admittedly, by targeting areas that are normally difficult for first-year grads, Castaneda-Thibault had fewer calls than her colleagues. Yet by parlaying her experience, particularly her Mayo Clinic training, she made a positive enough impression on managers to achieve her ultimate goal.

Be Professional

When it comes to putting your best foot forward, remember that etiquette counts. No matter how high your GPA is, it won’t matter if you don’t combine your academic achievements with common and business sense. “I can’t say enough about how you only have a few minutes to make a good impression,” says Lorenz. “It’s very important that you look put together—that you present a professional package.”

But it’s more than just dressing the part, even though what you wear signals that you’re either a serious candidate or not up to the task. (Bring out the suit!) Recruiters are attuned to factors you might overlook. The tone of your e-mail, the sound of your voicemail, and the way you behave during an interview, for instance, all resonate.

It’s fine to be a “happy warrior” or “hot babe” to your e-mail friends, but during your job search, you need to have a grown-up e-mail address. Likewise, your voicemail’s snappy intro—“Yo, the phone is here but I’m not. Leave your info.”—may fit you to a T personally, but when recruiters call, they want to hear: “You have reached Jo(e). I’m sorry I’m not here to take your call, but please leave a number and I will get back to you as soon as I return.”

As to interviews, at the top of the red flag and pet peeve list for many hiring pros are candidates who arrive late and don’t apologize for their tardiness. So whether you’re scheduled to talk on the phone or meet in person, be on time and on guard. It’s not only important to deftly navigate the formal interview, but don’t drop your defenses if you’re asked to shadow on the unit since you’re being evaluated there too!

For instance, as the market leader for Milwaukee, WI-based Medical Staffing Network & Allied Health Group, Susie Clementi has one goal in mind: Establishing a rapport with her nursing applicants so she knows more about them than their five-year plans. The downside, however, is that sometimes candidates get too comfortable. “They drop the professional façade to reveal who they actually are,” Clementi says. “That might not have been enough to lose the job, but it could be enough to lose the opportunity to interview further for it.”

Be Passionate

No matter how polished and impressive your resume, you’ll need to show recruiters more than academic qualifications for the job. From your cover letter to your interview, you want to demonstrate that you’re truly engaged in the specialty, are excited about the position, and have decided that this is the place you want to be. That’s not to say that you’re not open to possibilities. Even recruiters understand that you may have liked so many aspects of nursing school that you’re unsure about your career path, but don’t appear so anxious that you’re seemingly throwing darts at a board.

“If you come across like you’re willing to take anything because you just want a job, you’re not the kind of candidate we’re really looking for,” explains Lorenz. “We want people who are excited and passionate in what they’ll be doing. It’s not about taking any job. It’s about taking the right job . . .and having the right candidate for the job.”

Board agrees, noting that a cover letter is the first opportunity to cement your commitment in the mind of a recruiter. You do it by producing a letter that’s not just generic in its appeal but refers specifically to the job at hand and qualifications or interests you have for it. “I often tell people I’m only half joking when I say, ‘If you can make me cry, you probably will get an interview,’” she says. “Nursing is hard work and we want to see if someone is committed and feels that this is really what they’re meant to do.”

Case in point: Board recalls giving one aspiring applicant a second look after the woman called and asked what she could have done differently to land an interview. When Board suggested that she needed to offer more than just “the dry basics” in her resume and cover letter to gain a foothold, the caller mentioned how her experience as the mother of a sick child had inspired her.

Granted, that kind of information may not be appropriate for every position—you have to be measured in how you use any personal narrative. Yet as a former manager who had hired parents of children treated at her institution, Board saw the story as ripe for an effective cover letter since it showed her commitment to pediatric care. When the caller resubmitted the application and letter with reference to her story, Board was happy to schedule an interview. She won the job!

Final Thoughts

Searching for a nursing job can definitely create stress. Finding the right position takes time, energy, and emotion. But by knowing what recruiters might have on their agendas, you not only can reduce the levels, but also increase your profile as a standout candidate.

6 Ways to Defuse a Tense Patient Situation

6 Ways to Defuse a Tense Patient Situation

When a traumatic or otherwise medical turn-of-events forces patients and their families to deal with serious, sometimes even life-and-death situations, it doesn’t always bring out the best in people. Yet as a nurse, there are many things you can do to de-stress an otherwise stressful situation. Taken together, these six small steps can yield significant results in calming everyone’s frazzled nerves.

1. Don’t Poke the Bear.

Remember that if you’re injured you can’t care for anyone, so be aware of your own actions and don’t aggravate someone who’s already aggravated. Although you may end up calling security if a person is escalating and you need assistance, oftentimes you can defuse the situation by just listening and being kind. Nodding your head and letting an otherwise frazzled individual rant and rave may not be a cure-all, but it could lower the room temperature. As Holly Carpenter, BSN, RN, policy associate in nursing practice and work environment for the American Nurses Association, notes:  “If you’re just reflective and empathetic, people will sometimes calm down. By taking the wind out of their sails, you’re helping them de-escalate. Often they just want to be heard.” 

2. Be Aware of Differing Family Dynamics.

Some relatives are by nature boisterous so just because you hear screeching doesn’t necessarily mean there’s a fight afoot. Teasing and sarcasm may just be the way they communicate. Likewise, one culture’s method of dealing with family and family issues may not be your method. So be aware of your internal biases and draw on the cultural competencies you learned in nursing school to ensure that you’re not the one making everyone’s stressors worse.

3. Speak Up.

Don’t take the situation personally, but also don’t be afraid to ask for another assignment if you’re tapped out by the drama. When it gets so heady that you don’t even want to enter the room, it’s reasonable to say to your manager, “You know, I’ve had this patient three days in a row and I just can’t be as good with him (or her) as I’d like to be. Is there anyone else who could try it for a few days?” By doing so, “you’re taking care of your own stress while ensuring that the patient doesn’t feel the fallout,” says Leslie G. Oleck, MSN, PMHCNS-BC, LMFT, a psychiatric clinical nurse specialist and a graduate instructor at the Indiana University School of Nursing.

4. Impose Visitor Policies.

Although it’s tempting to be the nice nurse who lets one more visitor into the room or gives everyone an extra 15 minutes, enforcing quiet hours is a good strategy for keeping troublemakers at bay. Rules push curfews on people who may be causing anxiety for the patient and you. Also, you want to know who really belongs to the immediate family, especially if you’re working on a restricted floor such as the ICU. For HIPAA and other reasons, it’s important, albeit sometimes difficult, to identify who’s who in the mix. When you do, you sideline those extra people who maybe visiting too often and asking too many questions much to the chagrin of an already upset family.

5. Get Further Training.

You likely have a psychiatric or mental health class under your belt from nursing school, so you should be able to pick up the relevant clues or dynamics about a family in distress. It’s never a waste of time, however, to enroll in any class that your employer offers to sharpen your communication skills or deepen your ability to recognize, negotiate, and resolve conflicts. Whatever the crisis, you want the best possible tools for anticipating, preventing and, if necessary, responding. That means filling out any incident reports so that your colleagues too have a heads-up to avoid a recurrence on later shifts. Also, brush up on the advice from your professional association and other relevant agencies.

6. Give it a Break.

Rather than eating lunch with your colleagues, take advantage of the fitness facilities your health center offers during that hour. That way you’re not bringing your patient-family concerns to the table. Also, while daily breaks are essential, time off from work is a must. “Nurses often feel guilty about taking vacations because they’re leaving everybody behind,” Oleck says. “But getting away for a few days or a week can help recharge your batteries so that you can come back and be the best patient caregiver ever.”

4 Ways to Keep Your Diet in Check

4 Ways to Keep Your Diet in Check

What’s the best way to take on stress at home and work? By following these four tips, you’re ready to take on the day while maintaining a healthy diet.

1. Anticipate the Possible.

You may have little control over your day, but even if you can’t dictate events, you can game plan for them by arriving early and prioritizing tasks so you’re not overwhelmed no matter how work unfolds. Be ready with quick action steps if someone or something throws you off kilter. (For starters, take a deep breath!) As to food, dietitians recommend eating every two to four hours. Although it may be difficult to plan lunch and snack breaks amidst all the fires you’re putting out, you need to adhere to something reasonable so you’re not starved for blood sugar. For a quick pick-me-up, stash a protein bar in your pocket to munch in a pinch. “You don’t want to starve yourself since that’s when your willpower breaks down,” says Torey Armul, MS, RDN, CSSD, national spokesman for the Chicago-based Academy of Nutrition and Dietetics. “That’s what leads to stress eating.”

2. Keep it Homemade.

Packing your own lunch and snacks is the easiest way to control what you eat because you also control the ingredients. By prepping at home, you’re not only able to select nutritious options, but also avoid the extra salt, butter, and trans fats that make purchased foods so tasty. Also, think color! With a mix of items on your plate you ensure an array of nutrients. If you still frequent the cafeteria, scan your options before diving in, especially on a stressful day. “If you go with your gut you’re more likely to choose fattier foods,” says Angel C. Planells, MS, RDN, the owner of ACP Nutrition in Seattle. “That’s not a problem if it’s one time, but if it becomes a habit, it will ultimately take its toll.”

3. Rev Your Engine With Carbs.

Since carbohydrates influence the dopamine-seratonin ratio in your brain the last thing you want to do is to restrict your daily intake of those quality foods that supply them. Doing so only depletes your energy and the very neurotransmitters that help you feel good. To keep those levels optimal, however, you should devote at least 45% of your diet (65% if you’re more active) to those healthy carbohydrates abundantly available in whole grains, green vegetables, fruits, dairy, and even some pastas and breads, says Joey Gochnour, BS, BS, MEd, RDN, LD, NASM-CPT, a registered dietitian, nutritionist, and certified personal trainer for RecSports at the University of Texas at Austin. (Just keep the high sugars at a minimum.) What’s more, make sure you spread them throughout the day so that you’re not craving by the end of it.

4. Drink, Drink, and Drink.

Although you need a balanced diet to stay mentally and physically on top of your game, you also need water. Your body simply can’t function effectively if you’re not hydrating it. In fact, being dehydrated, nutritionists suggest, is a number one stress trigger. For starters, by denying your body the fluid it needs you’re facilitating the increase of cortisol. Conversely, a steady intake of water not only controls the hormone, but in doing so also helps keep blood sugar consistent, which steadies the appetite. Although 64 ounces a day is recommended, your body may need more, depending on the demands of your life. So think of eight eight-ounce glasses of water—with no sugar or artificial sweeteners added—as a daily starting point. “It will change your life,” says Charlotte Hammond, MS, RD, LDN, RYT, a Chicago-based registered dietitian. “It’s a win-win for energy and stress.”

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