However savvy you are in defusing stress between patient and family, you want to be just as smart in caring for yourself. No matter what anxieties people around you have unleashed throughout the day, being concerned about your emotional and physical health after work is paramount in being your best self for andduring work.
You’re likely already familiar with the basics—a good diet, plenty of rest, and lots of activity. Who can argue with the same positive lifestyle choices that experts suggest will help gird you physically and emotionally for any job-related stress? But you also want to be uplifted in other proactive ways so you’re energized to right the family ship for your patients. Whatever conflicts they might provoke, they’ll be easier to tackle if you’ve scheduled routine perks that you’re committed to come hell or high water. If that means taking yoga classes every week or enjoying Starbucks every morning, you want to have something in your quiver just for you.
For instance, Teresa Conte, PhD, CRNP, assistant professor of nursing at the University of Scranton, discovered as early as training that no matter how tight her budget, she could make it through the bad days knowing that she had scheduled a massage in the next few weeks. “Some people might think that it’s a selfish act, but it’s not selfish,” she says. “As nurses we always see ourselves as caregivers. But if you get so bogged down in being a helper that you’re fatigued or even thinking of leaving the profession, what good is that? You’re doing more for your patients by honoring and taking care of yourself.”
Beyond scheduling activities worthy of your time, there are other steps you can take to center yourself personally so you’re prepared professionally. Prior to work, for example, Lorenz preps for the potential challenges ahead by walking and repeating a favorite mantra: “I’m here for the greater good of the patient. Help me become an instrument of healing.”
At the end of the day, however, she retreats to a home where she’s already set boundaries for behavior. Chief among them is the cardinal rule that there can be no yelling or raising voices, especially to solve conflicts. When Lorenz steps in the door, she removes her watch as a ritualistic reminder that she’s off the clock and away from work. Obviously, if she’s had a really, really tough day, some of the stressors, including those involving patient-family dust-ups, come home with her. Even then, Lorenz dispatches them quickly before moving on. “I won’t dwell on anything for more than a few minutes because I don’t want it to affect my home,” she says. “That’s my sanctuary.”
The ancient Chinese philosopher, Confucius, pretty much summed up the goal of a happy professional life when he mused: “Choose a job you love and you will never have to work a day in your life.”
A stellar goal, but what if you’re a modern day nurse searching for your first fulfilling position after graduation? How do you find a job that meets your expectations in a market that’s not always as receptive to new baccalaureate or BSN-trained nurses as it is to seasoned pros? With administrators often focusing their keen eyes on experience in an economy that doesn’t encourage retirement, there’s reason to be concerned. As Deborah Hunt, PhD, RN, associate professor of nursing/course coordinator at the College of New Rochelle and author of The Nurse Professional: Leveraging Your Education for Transition into Practice, notes: “Unfortunately, it’s often the case that hospitals don’t want you if you don’t have experience, but you can’t get experience if no one wants to give it to you.” [et_bloom_inline optin_id=optin_18]
That doesn’t mean all is lost. Landing a position that launches your career is definitely within reach if you’re open to both various settings, willing to expand your skills, and eager to engage in experiences that raise your profile. The good news, at least according to one report, is that the job situation might be improving ever so slightly for nurses in general, but specifically for BSN-trained candidates. In fact, the 2014 annual report of the National Student Nurses Association (NSNA) paints a slightly rosier outlook than any picture since the study’s 2008 launch.
The most recent snapshot, published in the January/February 2015 edition of Dean’s Notes, reflected answers of 8,902 new nurses, most of whom had graduated in spring and summer of 2014. Participants represented students in baccalaureate and accelerated BSN degree programs, along with associate degree programs (ADN) and others.
Among their findings, the authors noted that the majority of all the respondents who answered “yes” to the NSNA question specifically regarding being hired had found work by six months. Also, although hospitals continue to prefer BSN versus ADN-trained nurses—reflecting calls from the 2010 landmark report, The Future of Nursing: Leading Change, Advancing Health for a more educated workforce—the picture may be improving for all graduates. How so? NSNA’s responses suggest a trifecta of reasons: Fewer RNs are remaining in their jobs beyond retirement, fewer hospitals are closing units, and fewer facilities are instituting hiring freezes than previously. Also, employment opportunities have increased, albeit modestly, in all regions of the country with the West and Northeast still lagging behind Central and Southern states.
As to job targets, hospital medical-surgical (med-surg) units don’t hold the same first-stop sway for most job-seeking new nurses as in years past. But that’s not to say you can’t land work on a unit. In fact, the majority of NSNA’s 2014 study respondents who found employment found it on a med-surg floor. But they’ve also found graduate-friendly first jobs in other hospital specialty areas, albeit on a smaller scale.
In fact, whether or not you see them as your cup of tea, other less-traditional settings—free standing surgery, urgent care, renal dialysis centers, or even those community health clinics—are a viable path into the profession. “Hopefully you’ll find a facility where you will be challenged to keep your skills sharp and learn new things,” says Keith Carlson, RN, BSN, NC-BC, CEO of Nurse Keith Coaching. “There are limits to what you can learn and experience in such venues, but when that’s the work available, I say, ‘Go for it.’ It can be a good place to start for a few years—or you might love it and want to stay.”
Carlson, for instance, ignored friends who warned him that doing anything less than launching his career with a hospital med-surg stint would be professional suicide. Instead, he chose to work in an inner city community health center, a fortuitous move since he’s never been unemployed in the ensuing 19 years. Carlson has fashioned a career in the home health field that merges his role as chief nursing officer/director of nursing for an Albuquerque-based home health agency with additional roles as a health care career coach, nurse podcaster, writer, and blogger. “Nurses entering the profession might have to be a little creative,” he says. “There are plenty of different places. You just have to think outside the box.”
Enhance Your Skills
Indeed, even if you’ve opened your mind to new options, things may not click immediately. That gives you wide berth, however, to pursue activities that flesh out your resume and improve your position. For starters, it’s never a waste of time to bone up on skills germane to your specialty goal. In fact, earning an additional certificate can be relatively quick and easy, based on what you’ve already mastered in nursing school. If you’re interested in a coronary care unit, for instance, taking advanced EKG and biotelemetry training could be a game-changer. “It just shows your dedication and how serious you are with the field,” says Hunt, whose students have demonstrated their willingness to learn new concepts and keep up the basics, even if that means giving flu shots until better things come along.
If you’re energized for a larger educational leap, you’re certainly not alone since a “bright ray of sunshine,” say the NSNA study authors, is the continual shift among new graduates toward earning advanced degrees. (“It bodes well for the discipline.”) In fact, only 9% of those answering the question about returning to school said they wouldn’t be doing so. Of those who responded “yes,” 62% were currently enrolled or planned to enroll in a program by next year with degrees ranging from BSNs to PhDs in their sights.
Even if you’re not ready to delve head long into a new degree program, there are other options, including a hospital residency, for positioning yourself. In fact, a key recommendation of the 2010 Future of Nursing report is to increase the number of new nurses participating in these six-month-to-a-year post-baccalaureate programs. They’re designed specifically to elevate the training and educational levels of a clinical setting’s nurse workforce by offering BSN-graduate—yet novice—nurses the mentoring and continuing education tools necessary to bolster their confidence and skills.
More importantly, a residency can open employment doors, especially if the organization has shaped you into the type of nurse it wants. You might have to win a competitive application process, but if you shine during the transitional training, you may also have the inside track. “Nursing school prepares you to be a generalist,” says Hunt, “but a residency provides a kind of bridge or transition program for additional clinical training and experience. It helps people become more independent over time.”
Volunteer With Enthusiasm
As old as the concept may seem, volunteering is still a good way to energize a resume. Whether you commit time and talent to an organization, agency, or hospital department, you never know whom you’ll meet or what skills you’ll be able to expand. The experience may round out the picture a potential employer has of you. “You want to demonstrate that you’re a go-getter, a contributor, and a team member,” says Carlson. “Anything you can do to exhibit those qualities will help you stand out.”
When he landed his first nursing job in 2013, Jesse M.L. Kennedy, BSN, RN, had just been elected president of the NSNA. With an associate nursing degree in hand, he set his sights on a critical care float position at Eugene, Oregon’s Sacred Heart Peace Health at River Bend, where he now works as a BSN-trained, critical care super pool nurse.
To corral his initial position, however, Kennedy used both his resume and interviews to highlight a variety of plusses in his life. Among them, he pointed out how his student volunteer and other nursing leadership experiences with state, national, and international organizations had already provided immense learning and other opportunities that could be tied directly to a job. For instance, Kennedy founded NSNA’s National Day of Service as well as coordinated two international nursing brigades to Thailand. Since then, he’s not only added his BSN degree to an otherwise stellar resume, but other achievements as well. In addition to his role as a director-at-large for the American Nurses Association board, for instance, he’s the founder of Nurse Connect, a group committed to fostering camaraderie among nurses including mentoring for recent graduates.
Not surprisingly, Kennedy’s advice to other new nurses is to volunteer, join, and lead. By parlaying the resources and professional development opportunities available through ANA’s constituent and state organizations, for instance, he fashioned his own leadership and teamwork styles plus boardroom skills. But as someone who worked in the family construction business until following his heart into nursing, Kennedy encourages new colleagues to rely on all of their life events during the interview.
“Everything you’ve done has made you what you are. Every job you’ve held has provided unique skills,” he says. “Your struggles have made you stronger and your successes have shaped your understanding of the world. Be sure that you utilize all of those experiences.”
If you are a nurse you’ve likely experienced stress now and again. Long hours, sicker patients, staffing issues, and other specifics tied to the job can torpedo the joy of doing it. But what happens when families of your patients add their own unique dynamics to the mix? Your stress levels likely surge even higher!
Most relatives want the best for their loved ones, but uncertainties of all shapes and sizes can provoke tension even in the most loving families. And people who let past disputes, present rivalries, or even personal demons overshadow the problem at hand can quickly disrupt the flow of quality care, not to mention cause angst for nurses.
The unfortunate reality is that you may not have time to process what’s occurring, even though doing so can be a safety valve for your own mental health. As Teresa Conte, PhD, CRNP, assistant professor of nursing at the University of Scranton, notes: “There’s always a patient in the next room to think of so you never get to pause and deal with it. So you’ll either start crying in the car or you’ll push it off and push it off without realizing the small effects it’s having on you until you yell at the dog or get really annoyed when your child spills the milk.”
A Proactive Pact
As a nursing professional, you’ve likely found ways to center yourself after an untoward event or other encounter. Perhaps you talk with your colleagues or even debrief as a unit. Yet taking steps at the first simmering signs of tension or an issue can go a long way in helping you advocate for your patients and their families. By establishing rapport, setting boundaries, and knowing your limits, you can calm agitated nerves—both theirs and yours!
Establish Rapport
Even though you’ll likely have an admitting diagnosis and impressions from colleagues during report, you probably won’t get a true sense of what’s going on with the patient and family until your first assessment. That’s why it’s important to establish common ground when you enter the room: Acknowledge the players, explain what you’re doing, and ask for any questions or concerns. From that point forward, your goal is to keep people in the loop by delivering information in ways that either empower or soothe. Also, always remember that being a patient or the family of the patient is a difficult place to be under any circumstances.
“What nurses do best is to educate patients and families,” says Leslie G. Oleck, MSN, PMHCNS-BC, LMFT, a psychiatric clinical nurse specialist and a graduate instructor at the Indiana University School of Nursing. “When people feel like they have a better understanding of what’s going on, they’re able to cope better. They don’t get short with each other or the patient as frequently—and the patient doesn’t get short with them.”
For instance, although obstetrics is usually a happy specialty for Lexi Dunn, MSN, APRN, CNM, a midwife and doctoral candidate at Emory University School of Nursing, sometimes she has to deal with the inevitable tension that arises when expectant parents have to make tough medical choices. Whatever the issue, the fact that events can turn on a dime can be a “shocker for people,” she says. “There’s high emotion and a lot of tension because of the nature of the situation.”
Dunn admits that while disagreeing with the parents about their choices can make her feel sad or even helpless, she stays focused on her mission—to educate and empower them so they’re comfortable with the decision. “Most of the time when you have conflict it’s because there’s so much going on that people miss important information,” she says. “So I want to reassure them that I’m here for them, that I want to know what’s bothering them, and that I’m giving them all of the perspectives to come to an agreement.”
Set Boundaries
Even though illness can bring out the worst behavior, you likely don’t want to wait for an unruly family member to erupt before taking action. Outlining your rules at the first sign of a problem not only tells people what’s acceptable and what won’t be tolerated, but it also may keep security at bay.
For instance, when the wife of a heart transplant recipient made it clear that his adult children couldn’t see their father, Christy Hogue, BSN, RN, CCRN, was equally frank. As the supervisor and day shift charge nurse in the cardiovascular intensive care unit at the Medical City Dallas Hospital in Texas, she not only let it be known that she’d do whatever was best for her patient, but they’d have to either put their differences aside or stay away if they couldn’t be civil. “We’re not counselors or the police,” she says. “As nurses, we’re just trying to do the best for the patient. Sometimes we need to set acceptable boundaries with families so we can provide that quiet, healing environment.”
Know Your Limits
As a caregiver, solving every issue that’s sucking the energy out of the room might be an appealing notion. Yet it’s not your job to deal with the bigger, entrenched problems haunting a family—even if circumstances have pulled you into the drama. Resisting whatever urge you have to fix what you likely can’t fix helps you stay focused, even though you might have to leave your ego aside to do so.
For instance, when one mother’s abusive behavior toward her child’s pediatric oncology nurses started affecting unit morale, Conte’s administrative colleagues arranged for volunteers to sit with the boy multiple times a day. They were concerned that the woman’s off-putting antics were not only stressing the nurses, but also jeopardizing his care. Giving her multiple breaks admittedly didn’t change her personality, but it allowed the nurses to work without fear of entering the room. “People have issues that are not going away just because a loved one is sick,” Conte says. “If anything, that compounds the situation. We may wonder why they can’t get it together, but it’s their reality. You can’t change it.”
But you can be effective in redirecting the course of events by putting your ego aside and being mindful of your words and delivery.
For instance, when a combative father went Papa Bear ballistic on an emergency room nurse trying to test his 18-year-old daughter for brain function, Lourdes Lorenz, DHA(c), MSN-IH, RN, NEA-BC, AHN-BC, swooped in immediately. The founding CEO of International Integrative Health Institute in Ashville, North Carolina, was rightly concerned about protecting her then-hospital colleague. She also knew that she needed to clear up the man’s confusion about the prognosis. Even though the girl was non-responsive after aspirating from a roofie-laced drink, her father misread a cardiologist’s assurances that her heart was stable as a sign that she was getting better.
Lorenz immediately legitimized the dad’s concerns by suggesting that anybody in his position could be similarly confused. But she also provided the parents with a full picture of what was occurring before circling back to the doctors to make sure that they’d be better at coordinating their messaging in the future. “Before you can control the situation you need to be very mindful of what you’re thinking and let your ego out of it,” Lorenz says. “If you don’t do that it can become a bigger conflict.”
Final Thoughts: Safety First
Whatever you do to keep everyone on an emotional even keel, it always comes back to safety. Your institution likely has protocols in place to deal with progressively difficult or challenging situations.
Calling security is clearly a front-and-center option if people are threatening or nasty. But it may not come to that if you can move family members to a quiet place for a heart-to-heart with a social worker, chaplain, or yourself. Beyond an actual face-to-face meeting, however, instituting a behavioral or visitation contract further cements the fact that you mean business about someone’s menacing attitudes or verbal abuse.
You may be fortunate in that you won’t need to put your rules in writing. Then again, putting them to paper may be the best way to clip the wings of potential troublemakers and give you much needed stress relief. “Sometimes when you lay it out for people,” says Conte, “it kind of jars them into realizing, ‘Oh my gosh, I need to make some changes.’”
