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A National Nurses Week Q&A with Rebecca Freeman, PhD, RN, PMP

Rebecca Freeman is the chief nursing officer, Office of the National Coordinator for Health Information Technology and a a member of the HIMSS Nursing Informatics Committee (2015 – 2017) .

Q. The theme of National Nurses Week is “Balancing the Mind, Body and Spirit.” That’s becoming a challenge for many nurses, with compassion fatigue, moral distress, and burnout among the maladies becoming more common among nurses. Given the pressure nurses are under, why is mind, body and spirit balance important?

A. I think that to provide the best care for patients, we have to be the very best version of ourselves. Not only do we need to stay abreast of the latest clinical and practice knowledge, but we have to be physically, mentally, and spiritually healthy – and that last part means many things to many people. Patients deserve our full attention and it is difficult to provide optimal care if one of those three aspects of “self” is hurting.

For example, a bedside nurse with a back injury is severely limited in the optimal physical care of her patient. The handicap of an injured mind (i.e., maybe you’re distracted that day) or spirit (i.e., there is something happening with you internally that doesn’t allow you to be centered) is no less impactful on your care of the patient. The healthier we are as people – as nurses – the better care we can provide.

Q. The connection between mind and body is important is virtually every occupation — does nursing have a spiritual aspect to the work? If so, explain.

A. I believe there are two sides to the spirituality of nursing.

Outward-Facing

The first is outward-facing and follows the patient’s lead. There is a meme that has made its way around the internet, addressing the fact that every kind of person is cared for by nurses. Some patients are intensely spiritual and others are not – a key part of caring for the patient is understanding where they exist on that spectrum and participating with them in that aspect of their care, if they wish for you to do so – this has nothing to do with your personal approach to spirituality.

Inward-Facing

The inward-facing part addresses how you deal with an incredible amount of stress as a nurse. Sometimes that stress is administrative or organizational and sometimes it is related to loss, patient-family dynamics, or any other number of factors.

I worked as an ER nurse and your shift could turn on a dime…you might be losing a patient in one room, dealing with a family situation in the next, and have a third scenario come rolling in that supersedes the others. If you don’t have some form of anchor, an outlet, a spiritual/mental grounding point – the work of nursing can make it difficult to maintain a healthy balance of body, mind, and spirit. 

Q. Why is mindfulness important to a nurse’s work? How can it be fostered in the workplace? 

A. I would like to refer everyone to a blog post by my friend Teri Pipe, PhD, RN, who wrote about becoming a mindful leader.

Mindfulness is important because, as Teri points out, “Becoming more mindful and in the moment provides us with the skills of authentic presence and compassion” and optimal care comes from being fully present and compassionate.

Certainly, mindfulness can be fostered in the workplace as part of a structured program, if you have a leader or organization focused on these things. If you don’t, though, the good news is that you can do it yourself!

Again focusing on Teri’s blog, she offers six simple steps towards mindfulness, and they are all self-driven…you don’t need to have someone lead you through the process – you just have to take responsibility for approaching your day in a different way, with a different perspective that will allow you to be more fully present. A few minutes with Google and YouTube will provide incredible information about how to work to become more mindful in your work space.

Q. Are the qualities associated with emotional intelligence – self-awareness, self-management, social awareness and relationship management — fostered in most health care settings? How can they be better fostered and encouraged?

A. I don’t believe the qualities associated with emotional intelligence are actively fostered in many healthcare settings. That is at least true of many of the hospital settings in which I’ve worked. I suspect there may be other care settings that provide more focus on relationships, but I cannot speak from experience in those areas.

Nurses are very task-oriented because, frequently, the accomplishment of tasks is how they are measured in terms of performance. However, the lack of focus on emotional intelligence is unfortunate.

I firmly believe that teamwork and relationships are the key drivers of success. If you want to attract top-notch staff to your unit, the staff members have to build relationships with each other and work as a team. If you want the best possible outcomes for your patient, you will achieve those by assembling a care team built on trust and communication. Those types of relationships are easier to build and maintain when the team members have a sense of emotional intelligence, either naturally or through organizational training.

Nurses understand that every patient is different and each relationship requires a different approach…
  • How do they like to learn?
  • How do they want to receive information?
  • How do they want you to interact with their family?
  • How do they want to define their care goals?

Using your emotional intelligence to assess the patient may not result in observations that are recorded, but this work is as critical as the physical assessment, and it happens almost unconsciously for experienced nurses. If you don’t build a solid relationship with your teammates and patients, using your emotional intelligence, you may check the boxes on your proverbial “to do” list, but your outcomes can suffer.

Q. What do you think is key to nurses finding joy in their work?

A. I will tell you this – I love getting out of bed every morning to come to work! I have almost always loved my work, regardless of the job. My primary key to finding joy in work is to find the right fit in terms of environment – and that fit will vary based on each individual nurse. 

Personally, I am a stereotypical Generation X employee and, to that end, the most important aspect of a job for me is the leader I will be reporting to. I love a strong, hands-off leader who sets a clear direction and doesn’t micromanage the way I do my work. If I find myself in a position where that is not the case, I will look for a new job. 

The “hands-off, minimal guidance” type of employment doesn’t work for everyone! Each employee must determine which aspects of work (e.g., schedule, location, duties, leadership, benefits, etc.) are most important, then seek that type of organization.

If you find yourself in a job where there is friction and your work is not joyful, do a self-assessment.

  • Is there something happening internally with your mind/body/spirit health?
  • Is the problem external at your organization?
  • Is it is a short-term issue or something more pervasive? 

Once you figure out the source of your discontent, you have to be really honest with yourself (back to the emotional intelligence component of self-awareness) about how much responsibility you bear for making the situation better. Some of the frustrating aspects of bedside nursing don’t change when you move to a new organization…so how do you enact more mindfulness and “quiet” those aspects, to allow you to be more present?  As you learn to navigate those pain points, especially if you stay in place, I bet your level of joy at work will start to increase.

Q. Do nurse informaticists have different pressures than the average nurse? How so?

A. I think every nurse in every care environment experiences pressure in a different way. As an ER nurse, I would have told you that our version of pressure is more fantastic than any other unit?

Then I saw a busy ICU…and a crazy-busy ambulatory clinic…and a med-surg floor where the patient ratios were crazy…and I realized that my pressure in the ER is different, but no more or less stressful than for nurses on other units.

This is true for informatics nurses – especially during a GoLive, upgrade, downtime, etc. Good informatics nurses understand that a downtime, malfunctioning interface, or botched aspect of a GoLive...can be just as dangerous as a medication error or a packed census. I personally feel like every “flip of the switch” for a GoLive feels just like a trauma rolling through the door – you’re suddenly hyper-alert and begin the rapid-fire triage process of figuring out what is working, what isn’t, and what needs attention first. So the pressure is different but I don’t believe it is more or less significant…if a health IT system isn’t running optimally, patients and staff are at risk.

Celebrate #NationalNursesWeek  #Nurses4HIT.

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National Nurses Week