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When you passed the NCLEX, you proved you were intellectually competent to provide care in the Western, allopathic health care industry. Your nursing interventions are grounded in evidence based on research and optimal outcomes. However, to survive or avoid the trauma of burnout, you need to be grounded in other ways. It is essential that you have or develop the qualities of being emotionally, mentally and spiritually grounded in addition to being educated. This means knowing yourself very well, which means being grounded in your body, heart and  values.

In the midst of chaos do you bring calm, or do you add to the chaos with knee jerk reactions and defensiveness? Do you become overwhelmed and paralyzed? Some qualities of a grounded person are calmness, sensibility, realistic, unpretentious, no- nonsense, present for/in the moment, legitimate and wise. On a scale of 0-10 where do you put yourself in terms of being grounded today?

Regardless of where you are on that spectrum of being grounded, certain situations may trigger you to become ungrounded and less effective in reducing a charge in you and your environment. The following  are 4 trustworthy techniques, which take only a few moments, and will help you to stabilize and enhance your groundedness. They can help to focus your thoughts, body, heart and your energy quickly.

1. In the Vitality phone calls, recently we have been locating and visualizing the 7 energy centers, known as chakras. By grounding yourself energetically, you help yourself and the environment. The root or first chakra, located at the base of your spine, connects you to your body and to Earth which supports you. Try it now: Bring your attention to the base of your spine. (You may be able to sense the energy better if you close your eyes.) You can visualize the energy going from the base of your spine, down your legs, through your feet,  through the crust of the Earth and to the center of the Earth. You could also visualize yourself to be a beautiful tree with your energetic roots in the earth. By grounding yourself, you can energize yourself any time you are waiting. Standing in a line, feel your feet and connect to your own energy, body and Earth. This sure beats grumbling about the length of the line and the wait itself. It also gives your busy mind something positive to focus upon.
2. Put your hand over your heart, mentally focus your attention on your chest region and visualize a person, place or animal who makes you feel love or loved. You can also remember an experience where you felt loved. Close your eyes to enhance the experience. By doing this you are energetically  grounding yourself in your own heart where love resides. Notice what happens for you after this process.
3. Some nurses carry a small stone or special small token in their pocket. When they feel it, it is a reminder to pause, feel their feet on the ground and take a breath and return their awareness to the moment.
4. Some nurses use contemplative, mindfulness and meditation practices as sources of grounding. This is a topic for another blog.

Recently my supervisor said she appreciated my calm on a crazy and hectic day. Well, that is the result of keeping myself grounded with practices that connect me deeply to myself and therefore I am available for others.

Grounding yourself is a process of getting to know yourself deeply. Grounding can start with your mind, body, heart or energy connecting you to your values, issues and intuitions. The more you know and understand your inner life the more empowered you are because you have choice in your responses to your life’s challenges . The integrity that develops with grounding yourself in practices that connect you to your inner life supports your confidence and creates healthy boundaries for yourself in the very demanding industry of health care.

Remember, how you respond in chaotic situations depends upon what you do in the non chaotic times. If you practice being grounded regularly, the tools and techniques will be there for you in the stressful times.

The next Vitality in Progress: Healing and Preventing Burnout

program begins August 27th. You can empower yourself with healthier boundaries, ground yourself with 3 Self-care tools of your choice and enjoy the experience of community with other nurses who are also either preventing or healing from burnout.

Please join us as we explore the 3rd chakra in the next week on our weekly call-in for Nurses.

Please share with us tools, techniques and practices that you use to ground yourself.

Take good care of yourself~~

With love, Padma

I used to crastinate. I did it so much I became a procrastinator!

Procrastination is the act of putting off or delaying what needs to be attended to. Are you avoiding making the assessment and diagnosis? Have you defined your Self care needs and are you procrastinating their implementation? You can apply our beautiful and effective nursing process or caring process to yourself.
So often it works as well for us as it does for our clients/patients.

I’ll bet you don’t waste time with your patients/clients before implementing the interventions that address the given diagnosis.  So, what are your obstacles to implementing your own Self care?

Stop wishing start doing

5 aspects of procrastination can be overcome after they are recognized and accepted. Which one or ones sabotage your best efforts, and where in the process does it or they show up? The italicized slogans may be helpful to place where you can easily see them.

1. Overwhelm I know a nurse who has all the necessary qualifications and experience to set up her own APRN independent practice. She had not done so because she was overwhelmed with all the steps involved in finding a collaborating physician, insurance forms, and an office. When she broke the process into small pieces and tackled them one at a time, the overwhelm began to evaporate. She is now filling out the forms, found a collaborating physician and has found a nurse colleague to cheer her on.

“The person who moves a mountain begins by carrying away small stones.”Confucius

2. Fear What if I fail? What if I succeed? Wired for comfort and predictability, each of us has our own risk tolerance. An attitude of seeing everything as a learning opportunity can be helpful since making change can often mean inviting the unknown and adjusting. You make the best plans and try to avoid or minimize negative outcomes.  You are aware that certain risks persists because you are inviting the new and then move forward.  When you understand your discomfort and what it is like to have healthy ways of managing uncomfortable feelings around change, you are set up for being able to deal with success or failure. After all, it is all about learning right?

It’s always impossible until it is done.

3. Low Self–worth.  If you are not taking good care of yourself, you are not valuing yourself. When you begin caring for your Self, you are valuing yourself, your body, your mind and your emotions.

Your actions speak for you.

4. No accountability   For years I knew I needed  more sleep than I was getting. Initially I was under the delusion that I could catch up on missed sleep and believed that care of my family and showing up for my job was more important. I got up before everyone and went to bed long after everyone else. A couple of years ago, I was in a group of nurses where we were holding each other accountable for our Self care activities. I realized I had been not only lying to myself, but I was setting a poor example for my family, putting my health at risk, and sometimes I was even unsafe on the road. I changed the pattern and am now a much better example of how to provide safe care.
Another great example? A nurse colleague wanted to start running. Knowing she would not do it on her own, she set up a Facebook page inviting all of her friends and colleagues to join with their individual goals, and to report back to the group successes, challenges, failures and insights. She is now running regularly, and has created a loving and supportive community for herself.

Who or what are you waiting for?

5. Old habits. It is possible to change deeply ingrained habits. Some say it takes 21 days to break a habit.  I suggest that it takes at least that long, and maybe even longer, and it is not possible to break a habit until you start.

If not now, when?

The Vitality in Progress: Healing and Preventing Burn out for Nurses  supports nurses moving out of procrastination about Self care with mentoring and an accountability community. It is fully on line 1-2 hours a week. After 90 days with successful completion, s/he has not only changed habits but also earned 39 CNE’s.

 If you are not ready for the VIP program above, maybe you would like to start with joining us on our free weekly Self Care for Vitality phone call.

Nurses week has come and gone. How do you keep alive the celebration of yourself and the beautiful work you do as a member of the health care community? Once again it comes back to your own Self care which means sometimes saying No without feeling guilt or shame. You are a family member and a friend as well as all of the other roles you may have. Remember, saying no to another person is in fact saying yes to your Self.

After the “terrible twos” and/or the rebellions of adolescence, you may have stopped speaking up on your own behalf when it comes to scheduling; especially if you are a people pleaser. Saying No can feel risky if you don’t feel confident in your skills for saying No or, if you worry about what others might think or feel.

When you follow the pathway of your resistance to saying No, or your habit of saying yes, you will probably discover fear. Fear is not a comfortable emotion to feel. It is often irrational, and based in the past. Facing your fears builds your courage muscle. Sit quietly for a few minutes and reflect on the last time you did not say No when you really wanted to. Explore your fear of saying No to see where it takes you. Do you fear that you will lose your job or that someone will not like you?  Are you trying to get someone to like you? Do you want to please the person making the request because they control your schedule? Maybe it feels easier to say yes knowing you will be bullied into a yes. or perhaps you are used to saying, “no one else will do it, so I will”. Are you a martyr? Do you fear being criticized, disliked or punished?

The good news is that saying No can also leave doors open for friendship, connection and confidence. It is something that you can, with practice become adept at. When your No is grounded in your integrity, you are staying true to your Self, your commitments and your values.

Although saying No is not always easy, there are skillful ways that honor you and the other person.

Awareness is the first step. How often do you say yes and then realize that you did not want to say yes? For some saying yes is a habit. Remember, you always have choices.

Embrace your priorities and set boundaries that reflect them, honor yourself and others. To not abide by your priorities and values is not only disingenuous, but harmful to both you and the other person. After all, caring for your Self makes it possible for you to genuinely care for others.

What are your priorities?
Reflect upon this question and perhaps you can list them.

Empower yourself by taking the time you need to make the choice. This can mean saying, “let me get back to you after I have checked my calendar”, or “I need some time to consider this”. Your ability to say this improves and reflects your self esteem.

Express your gratitude for the offer.  Without making excuses- just stating the facts, you can say “no”. “Thank you for asking, but that is not possible at this time.” Remember that the part that comes after the “but” is the part that will stay with the person. … And the “Thank you” softens the message. Depending upon the situation, you may choose the order of what you will say first.

Offer a suggestion. When you can, help the requester to meet their need, if it is a genuine possibility. “I’m not available for this but maybe you can contact…” This shows your consideration of the other person’s situation.

Deepen your relationship, when it is appropriate through your No. Sometimes the other person, (my children come to mind) becomes relentless in the request, as if you can be worn down into a yes. At that point, you might want to say, “I am not going to change my mind. Please stop asking me.” However, then there is often an opportunity to ask them what they are feeling since you are not going to meet the request. This can be a time for a deepening of the relationship as you show your caring about the impact of your statement on the person. Whatever they say, this is not a time for you to feel guilty. You are giving them the opportunity to express their feelings, thoughts and concerns. Your listening is a gift.

As you develop your No muscle, deepening your relationship with your Self, you build your courage and become empowered to align yourself with your priorities and values. Go for it! The world is waiting for you to show up in your fullness! Please share with us your challenges and the ways you say No that empowers you and also cares for the other person.

Each week there is an opportunity to practice tuning into your Self.
Self care strengthens your self esteem and competence.

Today’s health care institutions need creative and innovative solutions.
Nurses need to think creatively, to experiment, to take risks, and to innovate.

You are creative because you are human. Humans are infinitely creative. Throughout history in groups and as individuals we have invented tools, developed ways of survival, produced beautiful pieces of art, literature, theatre, music and dance. We celebrate concepts with theories and ritual. We study the cosmos to discover how and where we fit “into the scheme of things”. We design health initiatives and at the same time we create weapons to kill.  Innovation, discovery and creativity are forms of Self care or self preservation, motivated by different states of awareness that are experienced as feelings.

Making time to tune into your inner self, to feel, to notice, to breathe, to heal and to feel comfortable in your own skin is a way of supporting your creativity. Tuning in to deal with fears and anxieties in new situations is also a way to support your creativity. Your creativity is one of the keys to your wellbeing. When you are exhausted, driven by external demands that come from the outside- by the employer, family or friends, or inner demands in the forms of perfectionism or pride in “doing it all without help”,  your mind gets dull, you cannot solve simple problems, you may over eat or abuse some other substance. Small issues become magnified and out of proportion. Your ability to creatively address situations decreases.

Laura jumps out of bed, checks her email, gets ready for work, drinking a cup of coffee as she prepares for her work day. Since she no longer takes time to prepare her lunch or dinner, which her husband now brings home from fast food places she ended up in the ER with stress induced hypertension. She started to cry while describing her latest hamster wheel of working 92 hours in a 7 day stretch. She also bemoaned the loss of her creativity.

That was the note that began our discussion of her journey towards meeting her needs. Based upon her schedule, what she can and is willing to do at this time, she created a Self care plan that starts with 5 minutes of meditation 5 days a week and time on her treadmill before checking her email. Never having meditated, she was fearful that she would not be able to sit still for 5 minutes and worried about her mind that “never stops”. The first session “went by so fast, and it was so good”. Then she used her treadmill. I instructed her to download the Insight Timer app  that she can use in the future. Laura said, “I always said ‘charity begins at home’, as she pointed to herself. Starting Self care may initially be challenging, however when you respond to the call, new ways of seeing situations appear, and you create ways of responding to challenges and opportunities. Additionally a new sense of wellbeing and hope can arise, which I heard in Laura’s voice.

A few years ago I committed to “walking the talk” that I gave my patients and caregivers about Self care. After working 60 hours a week and getting paid for 37.5, for years, I began a regular routine for Self care, setting a good example for my daughters and husband. It is from this practice that Integral Nursing Solutions, PLLC has evolved~ supporting my passion for empowering others to take good care of themselves so that they can continue to shine their beautiful lights in the world with innovation, creativity and ease.

How do you protect and celebrate your creativity? What does your creativity at work look like? Are you happy with your nursing career? Are you comfortable taking risks, trying the new and sharing your innovations? You can look forward to receiving later in the week a video on creativity, and at least one article that is stimulating and short.

August 27, 2017 we will begin the next Vitality in Progress: Healing and Preventing Burnout for Nurses creating and supporting individualized Self care plans for nurses.

In the meantime, give yourself a dedicated 1/2 hour weekly for Self care.
Please join us

Have a beautiful week, filled with creativity and clarity.

With love, Padma

Water, beautiful , clear, fresh water— a wonderful source of a health for you at work, for our friends and neighbors far and near and for our Beloved Earth.  April 29,  2017 was  the date of the People’s Climate March in Washington DC and one of the hottest days in April on record in our capital.  There were signs everywhere. Small cardboard signs, billboards, electric signs and people with microphones reminding everyone to, “Stay hydrated”. Staying hydrated with clean water is essential for our patients, for ourselves and for our dear Earth.  As nurses, part of caring for our patients is caring for the environment. Protecting Earth’s water, Earth’s circulatory system, is essential for all life on this precious planet. Staying hydrated with clean water is an aspect of your own good self care and healthy habits at work and elsewhere.

Nella Pineda-Marcon of the NYSNA spoke to 100’s of people at the People’s Climate March on Washington this past week. Sharing wisdom and compassion from her nursing experience she reminded us of how changes in Earth’s climate are impacting people and their health care  in the US and around the world. As nurses we have always taken care of people when they are challenged by disease, and assisted those living in war torn areas. Today the most vulnerable people everywhere are feeling the impacts of climate change first and hardest. Climate change effects mental health as well as physical health. The higher and more intense winds and storms with flooding, extremes of heat and cold makes growing food and survival even more challenging. For the poorest, there is nowhere to move to. Nurses make a difference when we speak up with scientific evidence to support our wisdom and understanding. The the current political trends towards austerities based in the lack of awareness that we all share only one planet make for fewer resources to help the vulnerable get back on their feet, and our jobs harder. We are proud of our nurse colleagues who are proactive in caring for themselves and others as you continue to advocate for healthy environments, healthy life styles and equitable health care for all .

Speaking up for water today let’s look at some facts to support you in caring for yourself, your patients and your planet Earth.

Up to 60% of the human adult body is water, the brain and heart are composed of 73% water, and the lungs are about 83% water.

About 71 percent of the Earth’s surface is water-covered, and the oceans hold about 96.5 percent of all Earth’s water. Water also exists in the air as water vapor, in rivers and lakes, in icecaps and glaciers, in the ground as soil moisture and in aquifers, and even in you and your dog.

Staying hydrated on your busy shift is as important as keeping Earth’s hydration in balance. 

1. The time you spend drinking water is a pause that can reset your mental clarity and give you a moment to rethink what has been going on.
2. Your body needs water and by keeping your fluids balanced, so your body can continue doing its job­–transporting nutrients, digesting, regulating temperature, removing toxins, etc.
3. Drinking water helps you to focus, think and concentrate thereby improving alertness. Dehydration causes shrinkage of brain tissue. So when you haven’t been drinking enough water, your brain has to work a lot harder to perform at the same level.
4. Drinking water aids digestion and can be helpful in preventing constipation.
5. Bringing your own water saves you money rather than drinking whatever is in the vending machine.
6. You can flavor your water with lemon, crushed basil, an herbal tea bag, crushed fruit, or even a few drops of a fruit concentrate.
7. Flushing out toxins through sweat, urination and feces you fight infections, prevent UTI’s and other ailments.
8. You can prevent lightheadedness and headaches caused by dehydration.
9. When you drink water before a meal, it becomes a natural appetite suppressant if you are trying to lose weight.
10. Staying hydrated protects your joints and cartilage by keeping them lubricated- so you can move with greater ease.

Staying hydrated on your busy shift is as important as keeping Earth’s circulatory system in balance.

Drinking a glass of water before you start your day and as you end your day is a great way to connect to your gratitude. Remembering that water comes not only from pipes and bottles, but from streams, lakes and reservoirs awakens us to our connection to our essential nature and to others.

Another easy to tune into this awareness is when you join our
Free Virtual Connecting Weekly Call-in for Nurses
Wednesdays 6:30-7:00 pm EST
Phone 712-432-3066
Pin 177444
There is a short guided relaxation, followed by a short time for silence
in community and optional sharing.

Water makes up about two thirds of who we are, and influences 100 percent of the processes in our body.     Doug Casa, PhD.

The feeling of belong is yours and it is inside of you. It makes a difference in your happiness.  Love and belonging follow the basic physiological and safety needs in Maslow’s hierarchy of needs. Working collaboratively, on interdepartmental teams or interdisciplinary groups can be painful and consequently stressful if you’re feeling like you are on the outside. Do you wonder, “Do I really belong here?” How often do you feel like you are not a part of the team, or not a part of the culture of where you work? have you hidden your wisdom and light by not participating with enthusiasm because you were feeling disconnected? Here are 3 steps to explore your sense of belonging. This process can be a useful guide to decrease the stress of feeling on the outside.

1. Awareness– Using your mind and intuition, tune in to the voice within yourself to check your physical, emotional and mental experiences for your truth. Does your stomach get tight thinking about the meeting/group/gathering? Do your shoulders tense; maybe on the days that you meet you don’t sleep well. Your symptoms are unique messages for you. They can be gifts. If you choose to understand them, you can  move to a deeper understanding of yourself and your situation. What is your body saying to you? Perhaps you are feeling listened to, but not heard, tolerated and not appreciated, or just plain excluded. What makes the symptoms pass?
2. Acceptance– Being in acceptance means that you are no longer wishing things to be different. You recognize your situation as it is and you contemplate your role in it. If you feel on the outside, is it because you are new, and need to give yourself some more time? Or is it because you have not been welcomed and don’t feel accepted or included? Are you being bullied? Is feeling on the outside an old habit and this is an opportunity to work through it? Do you need to understand the culture of the group more deeply? Recently I found myself working with a group who had been working together for a long time. I was replacing a nurse co worker who had retired. When I realized that the nurses were experiencing resentment for some recent managerial decisions and were missing their friend I had clarity about my situation. I can not change their situation. They have to grieve and adjust.  With this understanding I choose to feel a part of rather than on the outside. My happiness is again, an inside job.
3. Action– Based upon your assessment and acceptance of the situation as it is, you now have options for action. Perhaps you are keeping yourself on the outside because you don’t really want to be there.  Suppose you discover you need to find another place to work where there are people who have values similar to yours. Will you give yourself permission to reduce the stress and take the action of making a change? Do you need to find for yourself common ground with members of the group or team? This might mean reaching out to individuals to create for yourself a sense of belonging. If feeling on the periphery is a habit, then you need to answer the question, “Do I want to change this habit?”  The Vitality in Progress: Healing and Preventing Burnout for Nurses can help you make habit changes like this.  For example, the networking group I joined  was very welcoming and friendly, nonetheless, I felt on the outside. An old habit- discomfort with being new changed when I discovered that  in creating opportunities to get to know them as individuals, my inside experience changed.

The others did not change but my experience of belonging changed by working with the 3 above steps which empowered me to reach out and address the need to feel a sense of belonging. Belonging is an inside job that comes with your honest appraisal of your situation and making choices that support your need to feel like you are a member of, a part of, and belonging to the group.  When you work with the above 3 steps, you move your focus from outside of yourself to inside. You are enhancing your relationship to yourself, making choices from inside, rather than outside and you are empowering yourself. Bottom line if you don’t belong in that group, you do belong to yourself, and you will find a group, community, others you do belong with. Such is sometimes the process of finding your peeps.

Please share with us any tips or strategies that you use to create the experience and feeling of belonging at work or elsewhere.

On that note, this is your invitation to join us:

Sending you lots of love,
Padma

The parallels between the nursing profession and bees begin with the need to understand both through the lens of holism, as I discovered when I became a beekeeper last year. Both are mostly female, hard working and essential to the well-being of large groups of people. Nursing is the nation’s largest health care profession with more than 3.6 million registered nurses practicing nationwide. Most health care services involve some form of care by nurses. Honey bees are responsible for 80 percent of the pollination of about one-third of the human diet . Many of the tastiest flowering crops we enjoy, apples, nuts, avocados, soybeans, asparagus, broccoli, celery, squash and cucumbers are pollinated by honey bees as are citrus fruit, peaches, kiwi, cherries, blueberries, cranberries, strawberries, cantaloupe and other melons.

Bees are considered super organisms. The colony of bees is the organism and the bees within the colony have prescribed roles they evolve through as they age. Eventually, all the worker bees, which are all female become foragers, going out to collect water, nectar, and pollen to make honey and to feed the hive. Bees have been dying in large numbers causing colony collapse which is affecting our food chain. Colony collapse seems to be related to the bees’ compromised immune systems resulting from the use of the carcinogenic and neurotoxic chemicals neonicotinoids and glyphosate, which people spray on crops.  Subsequently, the bees have become more susceptible to viral and bacterial infections.  When enough individual bees become sick from infections the colony becomes vulnerable to attack by beetles and/or moths and the colony dies. So beekeepers care for the hive by watching for signs of disease in individual bees, doing their best to keep the bees strong and healthy and trying to treat the causes of the symptoms.

Coming back to nursing, the profession might also be considered a superorganism, made up of many subspecialties which depend upon the evolution of professional nurses. All nurses graduate, take the NCLEX and go through Brenner’s prescribed stages as they develop professionally. Nurses start off focusing on the skills and techniques and after mastery, they begin to practice the art of nursing. In the current health care climate, it is essential for each nurse to learn ways to stay healthy and strong, setting boundaries that honor themselves, employers and patients. When nurses don’t care for themselves like bees, their survival is at risk. They can develop burnout, compassion fatigue, and Vital exhaustion.

Today the profession depends upon supporting nurses’ vitality and keeping up our numbers. If you don’t practice Self care, if the educators and leaders of the profession, like the bee keepers, do not make concerted efforts to provide support and education in the prevention of unhealthy and unsafe situations, the profession is weakened and becomes at risk of losing its prominent role in designing and delivering optimal health care. Over the years other health care workers have nibbled away at the edges of nursing roles because we did not care for our boundaries and the profession as a whole. To mention a few, social workers, physical therapists and med techs now perform what were once nursing duties and tasks. Today there are health care navigators and coaches who are not nurses providing similar services but without a nursing focus on holism and a deep theoretical background to support their work.

Since Florence Nightingale, nurses have provided care  “focusing on wellness and the interrelationship of humans, events and the environment” p 51 CarlaMariano Holistic Nursing 5th edition. Using the nursing process you do your best to prevent untoward situations. You look at the spiritual, emotional, mental, physical, environmental, and economic aspects of situations and create with your client a plan of care that addresses the well-being of all. No other group of professionals has such a varied, holistic and comprehensive vision. Just as the honeybee has the glorious job of pollinating flowers, creating beauty in the process of sustaining our planet, you have a powerful role to play in the emerging global healthcare paradigm, creating a sustainable future for
all.  Like the honey bee sustaining the web of life, you have an integral role in improving human health, improving the system in which you work and making a difference in the world by sharing your wisdom developed from evidence-based care, supported by theory, self-reflection and devotion to optimal outcomes. You pollinate by sharing authenticly at work with your colleagues, other professionals, your clients and in your personal life by providing healing energy, wisdom, theory, clinical expertise, and laughter.

2 ways to let us support your Self care.

1. Join our   Self Care for Vitality, 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

2. Sign up for the next Vitality in Progress: Healing and Preventing Burnout for Nurses which begins May 7, 2017. For more information contact Padma 828-620-0521

Have a great week and we look forward to hearing from you about how you care for yourself, your colleagues and the nursing profession- all forms of caring for pollinators, the sustainers of the web of life.

With love, Padma