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Self Care~ Sleeping For Success


Your long and short term success  is impacted by your sleep.  Getting adequate sleep is an essential self care activity that optimizes your potential by detoxing your brain and healing body organs and systems such as your heart and blood vessels.  Let’s look at the new information about how and why getting enough sleep influences your body, mind and emotions. With this information about your precious brain, you may no longer believe and behave as if sleep is negotiable.

Physiology of the Glymphatic System 

Your glymphatic system, similar to the body’s lymph system, removes toxins and metabolites from the brain, while you sleepResearchers have observed that noradrenaline a fight-or-flight hormone is released in bursts when brain needs to become alert. Awake, your brain cells are busy processing information which creates waste products. The cells swell and are consequently closer together. And then, while you sleep there is an increase in cerebrospinal fluid (CSF) to your brain. Your brain’s glia cells, part of the glymphatic system, helps control the flow by shrinking the cells in your brain by 60% during sleep, thereby creating more space between the cells. Your CSF can wash through the brain tissue with greater ease,washing away harmful waste proteins  like beta amyloid and tau proteins, and other molecules that build up between brain cells during waking hours. The glymphatic system carries the waste to the brain’s blood stream, which then transports them into the larger circulatory system to be removed through the liver and kidneys. Upon waking beta amyloid concentrations are decreased. Maybe it is no wonder that when we say “let me sleep on it”, we have a clearer mind to work with upon waking.

Effects of Sleep Deprivation on You Physical, Emotional and Mental Abilities


When you don’t get enough sleep your reflexes are slower, you are at risk for high blood pressure, a weakened immune system, diabetes, low sex drive, heart disease, poor balance and weight gain. Here’s a fun fact: Dr. Helene Benveniste and her colleagues at Stony Brook University School of Medicine discovered that side lying is the best position for ridding the body of metabolic waste.



When you are tired, not getting enough sleep, you are emotionally off balance and your decision making becomes poor. You may experience pessimism, anger, sadness, depression and grumpiness. Sleep deprivation does not feel good and you may find yourself eating for emotional reasons because the chemicals that make you hungry are in excess and chemicals for a healthy appetite are at low levels. Remember, sleep deprivation, taken to extreme, is a form of torture.


You may experience a mental fog if you are not getting enough sleep to detoxing your brain.  Lack of sleep affects both your long and short term memories, which shows up as  forgetfulness. Concentration, creativity and problem solving skills are dulled. Your decision making becomes poor. This is when accidents such as med errors and car accidents are likely to happen.


Ignorant about the importance of sleep, and mistakenly  believing that multitasking was something to be proud of, I once was grazed by a car while working 3rd shift-not paying attention to the lights. Another time,  I called the police because I forgot my daughter was at a class. We all got a good laugh later, but at the time, it was not funny. I was exhausted from not sleeping.  I make better food choices and my dietary habits are healthier when I get enough sleep. In fact in 12 step programs,tiredness can be  a trigger for addictive behavior as indicated by the term HALT ( hungry, angry , lonely and tired). So dear sister or brother nurse, I ask you honestly,  “are you getting enough sleep?”

Getting enough sleep, essential to self care is a helpful tool in both a burnout prevention and burnout healing toolbox. And whether or not you sleep alone, healing happens best in a  community who support you in your self care efforts to develop strong habits that maximize your potential. The next Vitality in Progress- Healing and Preventing Burnout for Nurses Program ( VIP program) starts May 6, 2018. Give yourself the gift of a supportive community and personalized mentoring as you develop a keystone practice that supports your happiness and well-being. Good nurses become great nurses when they take great care of themselves.

Sending blessings to you for deep sleep and sweet dreams~~ waking refreshed, ready to start your day with enthusiasm, creativity and ease.

With love, Padma



5 Ways to Get Unstuck, Open to Opportunity and Choreograph Your Dance

Now is a great time to begin reflecting upon the past year, the challenges you have risen to, those you avoided and the goals and opportunities calling you in the new year. In the last 20-30 years nurses have been developing new specialties such as nurse coaching, end of life doula services (separate from hospice employment), expert witness services for litigation, in addition to APRN’s hanging out their own shingles. Today there is wonderful business support for and by nurses for those who decide to make the leap for independence. The health care industry is exploding with expanding technologies while the internet and social media are opening new doors beyond the traditional nurse work venues – hospitals, clinics, military, airlines, camps, universities etc. Nurses everywhere bring diverse skill sets, re-purposing them for innovation and improvements that benefit not only nurses, but those we serve. Change is the operative word in the world we live in these days. What are you doing for yourself and those you serve to manifest your creativity and joy?  Are you holding yourself back and if so what habits and thoughts do you engage to keep you stuck? How do you approach the change, if you are to become unstuck?

Whether or not you are considering moving out of the traditional venues of practice, facing your personal obstacles to change is the critical first step. In taking care of your essence and your spirit, your soul is required for making healthy decisions.  If your brain is in a food fog, or a drug fog, if you are not getting enough sleep, if you are angry and unhappy at work more than you’d like to be, if you are not communicating effectively with your colleagues or you have been procrastinating maybe this will be the year you develop your keystone practices so you can show up for yourself and those you love.

5 Ways to Get Unstuck, Open to Opportunity and Choreograph Your Dance

1. Don’t believe everything you think. (The mind thinks all sorts of contradictory thoughts.)

2. Recognize perfectionism as a form of procrastination.

3. Change offers expanded vision and refreshing growth, though it may not be comfortable.

4. Curiosity shifts you from the restricting habits of criticism and judgement.

5. You will bloom in community~ get the support you need from those who believe in you.

I used these 5 steps recently. I was considering going to the National Nurses in Business Association (NNBA) conference. The loud  voices in my head were  saying such things as, “you are too new, you  need to hone your business skills more, you need to get more skilled with social media… etc.” Not believing everything I think, committed to living with my felt experiences of discomfort and moving beyond my comfort zones at work and at home, I realized the fears I felt were from old mindsets and a longing for comfort. With the insightful questions and the support of friends and my business coach, the power of curiosity took me to a new and interesting space. I began to wonder who would be there, how I could move INS forward to reach more nurses, helping them to heal and prevent burnout. The criticisms and judgments, obscurations of fear, shifted. Empowered by curiosity and open to adventure (and the expectation of a visit to the Gulf of Mexico), I booked a flight and a room in sunny St. Petersburg to attend the 2017 NNBA conference. Upon arrival I discovered many gifted, empowered, generous and inspiring nurses. (Generally that is who we are though, right?)  Nurses with established successful  businesses (some 6 figures) guided and educated their colleagues by their sharing tips, strategies and recipes for success.  There was mutual support in developing business ideas and ways to pursue creative solutions to all sorts of health care situations, patient and staff needs.

Whether or not you are interested in becoming an entrepreneur, it is so important to find a community to support you in articulating and manifesting your dreams. A community who with kindness and gentleness challenges your desire for comfort and your habitual thoughts, encouraging you to be and do your best. It is important to spend time with yourself so that you can nourish your creativity and your spirit to find the wisdom that resides within you. Becoming curious whenever you notice yourself judging or criticizing yourself or another will open your own colorful horizons of love, peace as you become increasingly intimate with yourself. Accepting yourself where you are, knowing that you are always doing your best which looks different on different days is a huge step towards moving away from the saddle of procrastination and its harness of perfectionism towards participation in the wild dance of your life.

Sharing is a way of setting up  accountability for yourself. Last year I committed to my community that INS would offer the VIP program (Vitality in Progress program) 4 times and I would write a blog every week. Well, we offered the program 3 times and ran it once. Realizing we need to market more, I have written 43 blogs, made a vlog, hosted 3 guest blogs, wrote a guest blog, hosted 51 Self Care for Vitality phone calls, 2 radio interviews all to market INS so we can serve you. We want to support you in developing your keystone habits, preventing burnout and assisting you in your healing journey if you are experiencing vital exhaustion. Not too bad for just starting out and next year will be even better! The VIP program needs more marketing and you can help us by getting the word out about how much you have gained from the program, which we will add to our testimonial pages.  We will continue to offer content by writing more blogs, providing more VIP programs, more radio shows and we are adding speaking engagements to support you and your colleagues.

Please join us in sharing your challenges from this past year and how you met them. Count us as part of your community support. Inspire yourself as you inspire us by stepping up to share with us your dreams and goals for the next year.


 Vitality in Progress: Healing and Preventing Burnout for Nurses the 9 week program that supports nurses in developing their own personalized keystone practices of Self care.  With successful completion, you receive 39 ANCC approved CNE’s in addition to meeting wonderful peers and receiving bi-weekly mentoring! Check us out, as the next series starts in January 2018 and there is an early bird discount.

In the meantime, if you want to see what we are like, join our  Free Virtual Connecting Weekly Call-in for Nurses  

 Self Care for Vitality             Phone 712-775-8968                Pin 177444
There is a guided relaxation, followed by a short time for silence in community and optional sharing. We present tips and strategies for Self care on a variety of topics such as:
Setting boundaries, balance, healing, self love, vulnerability, and other topics as they arise.
You can join in with a share or just listen in.           
Wednesdays 6:30-7:00 pm EST


Have a beautiful week in reflection, contemplation, getting unstuck, opening to opportunity, visualizing your goals and successes for the coming year choreographing your own dance!

With love, Padma

Compassion Satisfaction ≠ Vital Exhaustion , Burnout or Compassion Fatigue

Let’s clear up any confusion about the terms we have been using in the last 3 weeks. You explored Vital exhaustion–  you were encouraged to see what comes up for you in terms of your experience. Then you addressed measuring your experiences of compassion satisfaction, compassion fatigue, burnout, and Vital exhaustion to receive an objective reflection of what you might be experiencing, undoing any shackles of shame, fear and denial to move into the solution. The experience of healing or preventing these states is very empowering.


In the 1970’s Herbert Freudenberger coined the term burnout, based on his observations of the drug addicts he worked with- sitting with blank looks, staring at cigarettes until they burned out. In that same decade, psychotherapists began using the term describing their own overstressed condition where there is “Total and incapacitating exhaustion; inability to go on”.  In addition to signs of exhaustion, the person with burnout exhibits an increasingly negative attitude toward his or her job, low self-esteem, and personal devaluation. There is a conflict between what needs to be done and what can be done, so the work environment is part of the equation.

Compassion Fatigue

Compassion fatigue, also called “vicarious traumatization” or secondary traumatization (Figley, 1995) is the emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. Michael K. Kearney et al. have considered compassion fatigue to be similar to PTSD posttraumatic stress disorder except that it applies to those emotionally affected by the trauma of another (eg, client or family member) rather than by one’s own trauma. Compassion fatigue can occur due to exposure to one case of trauma and/or there can be a cumulative effect. When Mother Teresa mandated that her nuns take a year off every 4-5 years to allow time to heal from the effects of their caregiving work, she demonstrated understanding compassion fatigue.


Compassion fatigue and burnout are not the same. They both occur over time, and can co-exist and produce very similar symptoms. An important factor that distinguishes them is that a person experiencing compassion fatigue does not loose their ability to empathize and desire to help whereas those experiencing burnout become cynical, inefficient in their job roles and loose their ability to empathize. The American Institute of Stress succinctly distinguishes between the terms.”Burnout is the cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma-related.”

Dr. Rachel Remen, nuances our understanding with, “We burn out not because we don’t care but because we don’t grieve. We burn out because we’ve allowed our hearts to become so filled with loss that we have no room left to care.” Here I would suggest that she is actually referring to compassion fatigue within a burnout context.  If your workplace does not recognize the value of affording staff time and space  to decrease some of the stress,  burnout and compassion fatigue become greater risks. Left unmitigated Vital exhaustion can ensue.

I have noticed that nurses can start with either burnout or compassion fatigue. If left untreated  Vital exhaustion can happen.  Subsequently they may leave the profession which is a loss. If they stay in the profession, they are unhappy colleagues creating difficult work relationships and climates.

Moving into Healing and Engagement 

Nurses and other practitioners in the human services fields are at great risk of burnout, compassion fatigue and Vital exhaustion in part due to the high-stress work environments, and the emotional demands of our jobs.   With information, intention, and support you can assess your self-care practices, compassion satisfaction, compassion fatigue, burnout, and Vital exhaustion.  Then, using our beloved nursing process, you can empower yourself with interventions that nourish your well-being and compassion satisfaction. We know that a supportive work climate positively impacts compassion satisfaction because it encourages relationships, mutual learning, and self-care (Harr, 2013) and thereby empowers the staff. Maybe you will want to share your discoveries, thereby empowering not
only yourself but others.

Maybe you’d like to join our   Self Care for Vitality a free Virtual Connecting Weekly Call-in for Nurses.  There is a short guided relaxation, followed by a short time for silence in community and optional sharing.

Wednesdays 6:30-7:00 pm EST   Phone 712-432-3066     Pin 177444


Increasing Your Compassion Satisfaction

Last week I suggested we would compare Vital exhaustion, compassion fatigue and burnout. Now, I think it might be better to do the measurements first, so you can get into the solution and then come back to discussion.  Compassion satisfaction is a sweet and happy place to be. Some of us live in that space a lot and for others it is fleeting. It is that sense of fulfillment and well-being. It is the positive feeling you experience as a result of knowing you did a good job. You have the sense that you make a difference in your work setting. You enjoy knowing you have a positive impact in the lives of those you care for. In fact, your compassion satisfaction may motivate you to continue your work.

On the other hand, you intuitively know if you are experiencing burnout, compassion fatigue, Vital exhaustion and compassion satisfaction.  However, in our evidence-based world, you can measure your experience and your risk for these states which can be very useful to corroborate your felt sense.

So, why, how and what do we measure? Everything changes including compassion satisfaction. Many nurses become paralyzed by fear, shame and denial, tolerating experiences of burnout, compassion fatigue and Vital exhaustion for very long periods. This discomfort is stressful and impacts others- colleagues and those we care for. Having an objective reflection of your experience can help reduce shame and confusion and help with moving into the solution rather than staying in the problem.

For some nurses burnout starts in nursing school. When was your first experience of one of these states and what did you do about it? Are you now happy at work? The sooner you identify an unhappy situation, which might mean measuring your professional satisfaction, the sooner you can mitigate it.

My first experience was 2 years into my first job and my responses were typical- changing jobs (geographical solution) and getting more education. Those changes did not give me tools to heal or prevent the burnout, compassion fatigue and Vital exhaustion experiences which would come and go several times in my 40-year career. Now I have tools to prevent burnout and I use them because it makes a big difference in my happiness. Regardless of your position or status in the nursing world, measuring your professional satisfaction is informative, helpful and a form of self-care.

The PROQOL (Professional quality of life)  measures Compassion Satisfaction and Compassion Fatigue, Burnout, Secondary Traumatic Stress, Vicarious Tramatization, and Vicarious Transformation. “Professional quality of life is the quality you feel in relation to your work as a helper. Both the positive and negative aspects of doing your work influence your professional quality of life. Understanding the positive and negative aspects of helping those who experience trauma and suffering can improve your ability to help them and your ability to keep your own balance.”

We use the PROQOL as a measure in the Vitality In Progress: Healing and Preventing Burnout for Nurses prior to the program in the middle and again at the end as a measure for participants to track their progress.

It is free and is available to individuals and organizations.

Another measure that could be used is The Maslach Burnout Inventory (MBI) which addresses three general scales:

  • Emotional Exhaustion measures feelings of being emotionally overextended and exhausted by one’s work.
  • Depersonalization measures an unfeeling and impersonal response toward recipients of one’s service, care treatment, or instruction.
  • Personal Accomplishment measures feelings of competence and successful achievement in one’s work.

Maslach and her colleague, Michael Leiter, defined the antithesis of burnout as engagement. Engagement is characterized by energy, involvement, and efficacy, the opposites of exhaustion, cynicism, and inefficacy.

Where are you on the continuums of compassion satisfaction, compassion fatigue, burnout, Vital exhaustion, engagement? Have you taken the PROQOL? It is free. Will you consider it? If you have taken it recently, what do your scores tell you? Do they match your felt experience of your professional life?  When was the last time you did an inventory of the beautiful ways that you care for yourself? Even that measurement could be useful to increasing your compassion satisfaction. A few tweaks to your current habits could make a big difference in the joy and happiness you experience in your life.

Maybe you’d like to join our   Self Care for Vitality – a free Virtual Connecting Weekly Call-in for Nurses.  There is a short guided relaxation, followed by a short time for silence in community and optional sharing.

Wednesdays 6:30-7:00 pm EST   Phone 712-432-3066    Pin 177444We are looking forward to your answers and comments to the above questions~~

With love, Padma



Healing, Authenticity and the Paradox of Boundaries

Boundaries are elusive, energetic, practical, conceptual and permeable. Understanding your boundaries is essential to compassionate, healthy relationships with your Self, your family, your friends, and your employers. Living an authentic life means knowing your limits — your boundaries around what is okay/not okay — and making it clear to yourself and others.

Boundaries maintain your integrity. But setting boundaries isn’t just about saying “no” or carving out time for self care (although it is about those things). What about your actual, physical space? The fact is, each living being is an electromagnetic energy field (invisible to all but a few highly sensitive folks). That energy extends beyond our bodies, commingling with the energy fields of others. In other words — we are all connected.

Your boundaries will change depending on who you’re with, how you’re  feeling, what you eat, how much time you have, and what’s going on in your electromagnetic space.  Your fields — internal and external, personal and professional — swirl together with those of your peers like one of those colored moving sand art toys.

So essentially, boundaries aren’t just “yes or no,” or “set it and forget it.” They’re permeable, ever-changing, and largely conceptual. Legal and professional boundaries provide protection for health, well being and healing.

Nurse Practice Acts of each state basically agree:
“Patients can expect a nurse to act in their best interests and to respect their dignity. This means that a nurse abstains from attaining personal gain at the patient’s expense and refrains from jeopardizing the therapeutic-patient relationship. In order to maintain that trust and practice in a manner consistent with professional standards, nurses need to be knowledgeable regarding professional boundaries and work to establish and maintain those boundaries.” The nurse’s interior influences what happens in the care recipient, and vice versa —  so nurturing healthy boundaries is both  ethical and professional. Preventing burnout, is elemental to the process of protecting the sacred bond that exists between nurses and those they care for. It is also important for healthy employee/employer relationships.

How you practice Self care, and how you care for your mind and heart, has a direct influence on your consciousness.
It’s the first and most important piece in creating authentic connection — to your Self and to others. The trick is to simultaneously recognize and honor your boundaries and your interconnectedness. Celebrate your uniqueness as an individual and your connection with others. Imagine a big sound echoing off a mountain. Although we may no longer hear the sound, it rises up and continues to reverberate in time and space. Just because you can’t see something (like the electricity that turns on the light, or the electromagnetic fields connecting you to every other living thing) doesn’t mean it’s not there. Such is the illusive nature of boundaries, and the value of understanding our connectedness as humans, as caregivers and care recipients.

A recent participant in the VIP program spoke of signing off on letters with “Take care… Give care.” Good Self care makes it possible to both give and receive, recognizing the paradox and fluidity of boundaries, and the ethical imperative of preventing burnout by setting healthy personal and professional boundaries.

What are your experiences of your boundaries being crossed, maintained, and permeable? How do you experience your electromagnetic field?  What do you think about the idea that preventing burnout is an ethical issue?

Let me know.

Take care of yourself…

With love,


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