EDITOR'S NOTE: Heather Stringer is a freelance writer.
For Scott, using time and energy to develop healthy self-care habits seemed difficult when the daily demands of work were so intense — and she’s not alone. One recent study in American Nurse Today found 60% of nurses reported they often have to work through breaks and arrive early and stay late to get the job done, and 82% reported they are at significant levels of health and safety risks as a result of workplace stress.

Other risk factors highlighted in the study included lifting and repositioning heavy objects and prolonged standing.
But evidence suggests failing to take care of themselves before they take care of others can have significant consequences for nurses. A national study published in the Journal of Occupational and Environmental Medicine in October 2017 showed the level of health among nurses was linked to the rate of medical errors.
Toni Scott, MSN, RN, was working as a nurse in a NICU in Illinois when she realized her life was a paradox: She was providing care for others, but not living a healthy lifestyle herself. In response to the stress caused by a demanding job, Scott had stopped exercising, started eating out and drinking alcohol more frequently, and had taken up smoking.
Valuing mental health
In an attempt to identify those at risk, UC San Diego Health recently launched a program that invites its nurses to complete a confidential online depression/suicide risk screening, Davidson said. If the screening reveals moderate or high risk, these respondents receive an encrypted e-mail with an offer for immediate online anonymous counseling.

Counselors then help at-risk employees by providing referrals to mental health treatment. After the first year of piloting this program, which is available on the American Foundation for Suicide Prevention’s website, 44 nurses started receiving counseling.

“This showed us that there are nurses among us who are suffering,” Davidson said. “We can’t assume that they will ask for help or use their insurance to call a doctor, which is why we need to provide a proactive process to identify nurses at risk.”
Rebuilding physical health
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When dietitian Denise Reed, MS, RD, LD, talks to nurses about nutrition, one of her messages is that eating a healthy diet can help decrease the physiological damage caused by stress and working long shifts. This is important because over time, “stress can cause chronic inflammation, which in turn increases the risks of conditions like insulin resistance, obesity and cardiovascular disease,” said Reed, a clinical assistant professor of health sciences at Ashland University in Ohio.
Nurses may have little time to eat, and when rushed, a quick, unhealthy snack from the vending machine or the cafeteria may seem like the only choice. Instead, Reed encourages nurses to pack their own meals with a protein like fresh turkey breast, chicken or beans, a whole grain like pita or flat bread, plus fruits and vegetables. She also urges nurses to avoid sugary drinks and snacks.
“Getting the right vitamins is powerful,” Reed said. “When I work with nurses who make these changes, many of them have more energy and end up losing weight.”
Bernadette Mazurek Melnyk, RN
Judy Davidson, RN
For Scott, the first step in her path to better self-care was taking yoga classes while she was working as a nurse. “The classes taught me how to pause and address how I was feeling,” she said. “When I did that, I realized that all of the things I was doing to make myself feel better were actually feeding the burnout. I started to accept that I needed to take better care of myself.”
She started practicing basic yoga poses at work. If she noticed her back or another part of her body was starting to ache, she would do yoga for a minute or two to engage the muscles in the affected area, and her body started feeling better. As she grew stronger and more confident about taking care of herself, she embraced new challenges like cycling and started to eat more healthily.

She eventually lost 50 pounds, and in 2009, she founded her personal business, Yogatones Health & Wellbeing, which is based in Chicago. Now Scott teaches others what she has learned, and she has a special interest in helping nurses.
When she gives presentations at healthcare organizations about promoting nursing self-care, she reminds nurses to take a moment to check in with themselves at work. Scott demonstrates how to take a five-minute yoga break, one minute for each of five basic poses that can help nurses connect to their breath and body.
The power of good nutrition
“We found more than half of nurses reported they were in relatively poor mental and physical health, and nurses in poor mental and physical health made more errors,” said Bernadette Mazurek Melnyk, PhD, RN, CRNP, lead author of the study and vice president for health promotion at The Ohio State University.

The data also revealed depression was the greatest predictor of medical errors. “The bottom line is that healthcare systems need to pay more attention to nurses’ and other clinicians’ health and well-being," she said. "The level of health among our nation’s caregivers affects the quality of care they can deliver.”
The American Nurses Association also advocated for more self-care by declaring 2017 as the Year of the Healthy Nurse, which it defined as a nurse who actively focuses on creating and maintaining a balance of physical, intellectual, emotional, social, spiritual and professional well-being.

The campaign included webinars and continuing education for organizations and individual nurses who are looking for ideas to improve health and well-being. By being role models and advocates of health, safety and wellness, the nation’s 3.6 million RNs can help improve the health of the nation, according to the ANA.

According to Melnyk, one of the essential elements needed to increase the health of the nation’s nurses is creating a culture in healthcare that facilitates well-being. Leaders at Ohio State hired her as the university’s first chief wellness officer six years ago to focus on building this type of culture among the university’s nearly 40,000 faculty and staff, which included clinicians at six hospitals.

One of her strategies was to launch a program in which about 500 faculty, staff and clinicians worked with her team to develop wellness programs and activities, such as physical activity challenges, healthy food demonstrations and stress reduction seminars. As a result, cardiovascular outcomes, which include blood pressure and cholesterol levels, have improved 7% among the organization’s employees in the last four years, Melnyk said.
While self-care may seem like an afterthought for many nurses, Judy Davidson, DNP, RN, a nurse scientist at UC San Diego Health, has seen the more extreme ramifications of neglecting one’s own needs. “Nurses can experience anxiety and depression because they lack the emotional reserves needed to handle psychological and physical demands,” she said. “In the worst case, this can lead to suicide.”
Toni Scott, MS, RN, CYT, demonstrates basic yoga poses
Toni Scott, RN
We found more than half of nurses reported they were in relatively poor mental and physical health, and nurses in poor mental and physical health made more errors.”
— Bernadette Mazurek Melnyk, RN
Get healthy to give better care
Nurses who take up self-care feel stronger and may even make fewer errors
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By Heather Stringer
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