Those who work in the healthcare industry are well aware of its constantly changing landscape. Healthcare institutions are challenged to balance the provision of safe care with the allocation of essential resources. Changes in healthcare are aimed at increasing the efficiency and safety of care through best practices. Nurses, as the primary caregivers, are charged with implementing many new change initiatives into their daily practice. Institutions are poised to recognize that a constantly changing practice environment is extremely stressful and the effects on staff vary; therefore, institutions have begun to implement a more bottom up versus top down approach to change.

This approach engages nurses in active decision making to achieve best practice, and can have a tenfold return for patients, nurses, and healthcare organizations as a whole. Yet, continuous change over time creates symptoms of fatigue, and burnout, which can compound already existing stressors, cripple a unit team members’ commitment, and ultimately affect the quality of care. The nurse’s ability to adjust to change must be self-realized. Nurses have to make conscious decisions to become activists in the care they provide. To combat change fatigue, nurses must learn new C.A.R.E. strategies.

The nature of caring

What does it mean for nurses to care in today’s healthcare environment? If you ask nurses what “care” means to them, the response will largely depend on the nurse’s experience, personal resilience or coping, and the healthcare environment in which he or she practices. Nurses feel strongly about their commitment to care and their responsibility as providers. They seek to do no harm, and to practice primary prevention and advocacy to promote healing and wellness for those who trust in their care. As a nurse who has worked in nearly every capacity in a career spanning the last 30 years, I can tell you that these are not just words.

Nurses have had to adjust or navigate multiple changes in healthcare over time, particularly as they are burdened to do more with fewer resources. For example, as a nurse you might have skipped lunches or stayed late to do “one more thing” for the patient, or help the next shift. This is noble, yet can add to stress overtime.

As nurses, we teach patients and families to care for themselves in order to live well. It’s time we take our own advice. Here are some essential self C.A.R.E. strategies to adopt and share.

Courage

Courage to care for yourself and each other is the first step of self-care. Most nurses are a courageous lot, but we tend to put ourselves last. We need to speak up as we would for our patients. Here are some additional strategies:

• Take your well-deserved break and be sure to cover someone else’s. Nourishment and rest is needed for you to be at your best for yourself, and your patients.
• Collaborate with your coworkers when implementing new practice changes on the unit. Commit to each other for support with simple and complex needs.
• Have the courage to create a transparent and respectful environment that addresses new changes on your unit. Support your coworkers, or be a unit representative to address practice concerns and share in the processes to establish best practices.
• Have the courage to just say“no” when you need to, and “no” to the guilt too.

Attitude

Attitude matters. Help other nurses who may be having difficulty adjusting to changes or a new graduate who is overwhelmed. Your attitude about nursing and practice goes a long way in the eyes of a new nurse. Think. Who would you want them to become as experienced, caring nurses of the future? It’s tragic when talented, caring nurses of any experience level shut down, throw their hands up, and announce,“I don’t care.” This is not what a nurse plans, but it happens. Try to reach out and help other nurses to realize their value. If you anticipate a problem with a nurse being overwhelmed with an assignment, reach out to coworkers for help.

If a change might not be perceived as beneficial to patients, speak up and communicate your concerns to nursing leadership in a positive way. Then offer alternative solutions when possible.

Reenergize

Reenergize and give back to yourself. Your physical and emotional well-being is your most valuable asset. You can’t keep going to an empty well and expect to stay healthy. Whatever healthy actions you think you’d like to try, do it! Some nurses like to let loose and listen to loud music, while others like to read or just have quiet time. Adopt the mantra, “If you care for yourself, you can care for others.” ­­­In addition, work to gain support from nursing leadership to achieve an optimal work-life balance. Some organizations have adopted self-scheduling, which can help staff meet the needs of their families and themselves.

Educate

Educate yourself and share your experience with others. The best way nurses can keep their valuable know-how is to share their expertise. Nurses can gain a better understanding of healthcare and why changes occur when they actively engage in new learning opportunities. Try one or more of the following:

• Start a journal club that meets together to review relevant literature that is of interest or could benefit practice on your unit.
• Attend a conference with coworkers.
• Take a class.

Engaging in your own professional development can serve to support your commitment to nursing throughout your career.

Think about adopting other positive, productive strategies that you can use to adjust to change. When addressing practice changes, ask clarifying questions to avoid misperceptions. Keep in mind that healthcare organizations want to hear from you and incorporate your valued expertise. Many organizations have implemented shared governance, which encourages collaboration to guide expert decision making for the safe delivery of care.

Nursing needs a strong workforce to help steer change in the right directions. We have to be gentle lions and support each other at the different stages of our careers. This way, you’ll be able to smile and know that when the wind is blowing again and things are changing, you will be well prepared.

Selected references

Bowers B. Managing change by empowering staff. Nurs Times. 2011;107(32-33):19-21.

Cohen S. Recruitment and retention: how to get them and how to keep them. Nurs Manage.2013;44(4):11-14.

Dubois C, Bentein K, Mansour JB, et al. Why some employees adopt or resist reorganization of work practices in health care: associations between perceived loss of resources, burnout, and attitudes to change. Int J Environ Res Public Health. 2014;11(1):187-201.

Grossman SC.The New Leadership Challenge.4th ed. Philadelphia: FADavis; 2013.

Gurchiek K. Survey: Many Organizations Unprepared for Aging Workforce. January 13, 2015. shrm.org/hrdisciplines/staffingmanagement/articles/pages/hr-aging-workforce.aspx

Huber DL. Leadership and Nursing Care Management.4th ed. Maryland Heights, MO: Saunders Elsevier; 2010.

Institute of Medicine.The Future of Nursing: Leading Change, Advancing Health. October 10, 2010. iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Kravitz K, McCallister-Black R, Grant M, et al. Self-care strategies for nurses: A psycho-educational intervention for stress reduction and the prevention of burnout. ScienceDirect.2010;23(3):130-8.

Mercado L. Strategies for nurse retention: a high nurse turnover rate is an expensive problem for any healthcare facility. October 9, 2012. http://nursing.advanceweb.com/Features/Articles/Strategies-for-Nurse-Retention.aspx

Short L. Commitment is vital to drive change. Nurs Times. 2013;109(47):33.

Trossman S. Healthy and safe: facilities take a pathway to excellence. Am Nurse. March 1, 2015. theamericannurse.org/index.php/2015/03/01/healthy-and-safe-facilities-take-a-pathway-to-excellence/

Mariana Szumilas is a Nurse leader at Yale New Haven Hospital in New Haven, Connecticut.