by Paula Manuel Staff Nurse Interest Group

Self Care Self Aware Shiftwork

Night shift is a physical and mental strain that many nurses do not have expert knowledge to manage it. Current times of acuity and complexity means in many cases more workload and a fair number of patients require interventions through the night. This entry will cover what you, as an individual, can manage to optimize your shiftwork reality. Being mindful about what you need will optimize your experience as a shiftworker.

Sleep

The principles for sleep are essential to a shiftworker here are some survival points

  • Know what your natural circadian pattern is for you; are you an early riser–shiftwork may be more challenging for you, ensure you have a nap before first night shift. Studies show individuals who are awake more than 17 hours can be impaired equivalent to having a bloodstream alcohol level of 0.05
  • Wear sunglasses on the way home to minimize light on eyes
  • Invest in a mattress that is comfortable and supportive
  • Leave your smartphone and tablet away from the bed, blue light plays havoc with your brain by disrupting your ability to get to sleep. No TV including live streaming and most assuredly news or day time programming
  • Keep bedtime routine the same for days as for nights
  • Keep bedroom cool, use curtains or blinds that darken the room
  • Use eye mask, ear plugs to protect your sleep time
  • Educate family, spouse, friends that day time sleep you’re not to be disturbed though criteria can be defined i.e. fire, flood, hurricane etc.
  • Aim for 7 hours of sleep during the day and post nights wake up 90 minutes after sleeping to reorient back to days

Nutrition

  • Caffeine needs to be minimal and most assuredly after 0200 h no intake due to effect of disrupting sleep
  • Be prepared take food to work, so those chicken wings from the local diner don’t end up on your hips. Eat complex carbs quinoa, brown rice, pasta.
  • Proteins use chicken, tuna, turkey, beans, soy and round out with vegetables, seeds, dried fruit, healthy oils i.e. olive, avocado, sunflower, a good non-cooking oil flaxseed, walnut etc.
  • Eat a hearty breakfast, have snack foods to pack so your blood sugar will be balanced i.e. trail mix, vegetables, fruit, apples and peanut butter
  • Drink about 750 ml of water during your shift to keep hydrated and you will be less fatigued
  • Eat with someone; social interaction is helpful for coping with nights

Thrive on Nights

  • Exercise on break instead of sleep to minimize fatigue, if you do nap limit to 20 minutes to minimize entering deeper stage of sleep cycle
  • Take activities to keep you awake, knitting, puzzle games, reading material, listen to music
  • Use practices like meditation to relax yourself for sleep both day and night shift
  • Keep a bright light on in the station to perk you up, light is the stimulation you need to stay awake
  • Discuss with your doctor or naturopath the benefits of Melatonin (hormone) and how it helps shift workers
  • Make sure you have social activities with family, friends, and time for yourself. Going to sleep may be the goal but you need human contact too.

Shift Work Disorder

You can experience negative health impacts and if you answer any below as yes; you will need to follow up with your doctor and/or occupational health and safety

  1. I feel drowsy when I’m at work, or in my “off time” during family or social engagements.
  2. I have fallen asleep at work.
  3. I’m not productive at work. I often can’t think quickly or make good decisions while I’m on the job.
  4. I have trouble falling asleep when it’s time to sleep (when my shift ends, or when I am “supposed” to sleep).
  5. I wake up too soon. I cannot sleep seven to nine hours continuously.
  6. My sleep is “broken” and I wake up frequently during the time I should be sleeping.
  7. I feel irritable or moody.
  8. My shift work schedule has created trouble in my personal life (with my partner, family, or friends).
Image result for night shift survival kit
Enjoy and Namaste

Do I giggle?

Giggler is not a word I use to describe myself, when I listen to an individual giggle it strikes as manifesting nervousness. I have a generally calm exterior, indeed I have a gear that can be described as “supercalm”. When my chuckle or laugh occurs it is one that is robust and comes from deep down, indeed when I asked friends, family, and acquaintances about whether I giggle there were more blank stares than not and more emphatic nos.

I am not averse to laughing at myself but I’m not a giggler, when I reflect on my childhood I do not recall much, interesting I recall events when photos are in front of me but truly I’m a forward viewer of life. The past is done and there’s plenty going on in the moments of now. In terms of laughing out loud these few come readily to mind.

  • Saskatchewan trip I was walking along a muddy path with a friend when my feet slid and onto my butt I slid and daresay slithered. My friend was bursting trying not to laugh and when it was deemed nothing was damaged except my muddy butt (right through to my underwear) the laughter burst forth and forth and even now we can easily capture the vignette of my decorously slow mo slide to muddiness.
  • When my nephew #1 was playing with coloured rings, I placed them on my head then tilted it to have them fall off, laugh with a toddler it’s a true workout
  • #2 nephew on a winter day we played at the park, running through the snow I chased him, caught him and twriled him in the air then swooped him into a snowbank. Laughter burst from both of us and time truly stood still–it was a moment.
  • Golfing one of my passions on this occasion I hit the ball off a tree, the ball careened into a bunker ran out onto the green and stopped inches from the hole. I doubled over chortling as I explained that’s just how I saw the shot being executed in my mind.

It is a great connection to yourself to really laugh, indeed experience and feel any emotion that has you move your life and choices forward. Laughing provides a small pause in the grand continuum of time I’ll close with the words of Norman Vincent Peale

The way to happiness; keep your heart free from hate, your mind free from worry, live simply, expect little, give much, scatter sunshine, forget self, and think of others.

Namaste

Peale, Norman Vincent Power of Positive Thinking, clergyman & author

Three years ago I keyboarded an entry as my nephew headed to Northern Ontario to embark on his nursing studies. My Auntie status embraced his entry into this most demanding of academic studies and the acquisition of numerous cognitive, tactile, and sentinel skills.

During my vacation I coordinated our schedules and with this nephew we spent the day on a golf course, a pursuit for the individuals who enjoy the outdoors and the chasing of a wee ball into a hole in so many strokes. (google Robin Williams and golf to learn more on the game). We spoke on a range of topics as he related his experiences as a Personal Support Worker at his local hospital; observing the RNs on the team and he has a plan to optimize his chances of spending his pre-grad in the Emergency department.

He pointed out that he had considered my advice to be in medicine for some time then specialize, but he is forging his own path. As I listened to his vignettes of experiences it was evident he is linking his knowledge, skills, and judgment. The poignant moment when the team called a Code Pink and he recognize the agonized scream of a grieving mother. He recognized the effect this event had on the team, that the manager acknowledged the team’s grief, and that the nurses processed the event individually and as a unit.

My vacation has been a recharge time to rest, recreate, golf, spend time with friends, to have alone time and enjoy the quiet of a summer evening. Make time for yourself and invite those who lift you up and pursue some fun, though it’s hard to imagine not everyone enjoys a round of golf. Namaste.

Nursing Week 2019

Welcome back and what’s new?

Well the wellness journey continues and I am grateful for my boss who has been supportive and truly is one of my top 3 bosses.

As I reflect on what I consider to be a good boss the word trust comes to the fore. Trust is a word used a lot and I wonder if anyone considers how complex trust is; it’s a behaviour, an outcome, a process within an employee and supervisor relationship.

The transformational leadership framework has establishing trust as a core process, without it the sustained changes needed in heart, mind, and soul will be a challenge. As you navigate this term trust you have to ensure a shared understanding exists about the term; what does it mean, how is it built, how is it broken, and how can it be rebuilt. So trust is not a destination you will find it is an issue, action, and it’s about growth of one’s emotional intelligence.

Now trust (Reina, 2017) can be seen as a capacity for trust and there are 3 C’s that contribute to making a complex term more concrete, practical, and sustainable.

Capability is to acknowledge people’s abilities and skills. As a leader you will allow people to make decisions, include others in the decision-making by seeking input, and this builds succession planning as people learn skills and want to apply them (Reina, 2017).

Character is integral to trust, (Reina, 2017) and when you can trust you can manage expectations, others will behave according to “the rules”. The team to be effective means they do what they say they will do, this mutual reliability includes boundaries, consistency, delegate prn and appropriately. Say no if you can’t do it, renegotiate the task and remain true to the relationship–honesty, faith, reliable.

Communication you need information, we all need truth, disclosure of truth, to admit our mistakes, to exchange constructive feedback, to maintain confidentiality and to to speak with good purpose (Reina, 2017)

We all know good teams from bad teams and unless you prefer uncertainty, inconsistency, turf wars, conflict, silos, workarounds, and hidden agendas to name a few. Consider how trust can provide you with a team that is accountable, adaptable, effective and efficient, happy, innovative and comprised of high performers to name a few attributes.

Final thought

  • Be impeccable with your word
  • Don’t take anything personally
  • Don’t make assumptions
  • Always do your best

These are great life values and I’ve tried to live to them since I read The Four Agreements and fit right into trust.

Nothing other people do is because of you. It is because of themselves. All people live in their own dream, in their own mind; they are in a completely different world from the one we live in. When we take something personally, we make the assumption that they know what is in our world, and we try to impose our world on their world.” – Ruiz Don Miguel

Namaste

As a Registered Nurse with many years of experience my time as an individual with a long-term progressive illness had been relatively short–a mere decade.

At first the condition was more of an annoyance, but my physical decline in the previous five years correlated with increased dosages of necessary medications and side effects that impacted my well being.

Living with constant pain, compensating continuously for increased movements, fatigue, and countering the effects with exercise, body therapies, and energy healing. My life was about carrying on and coping with an altered dynamic health status. As one physician observed, you are extremely high functioning. Translation I worked full time in a demanding managerial role, mentored and led RNs and RPNs and influenced Allied Health team members.

The emotional toll evolved into the characteristics of depressive qualities, crying jags were not uncommon. When the offer came to be evaluated for an innovative surgical option I readily agreed.

Two years from initial assessment to receiving a date for surgery was a mixture of anticipation and concern. I mean this was a procedure to alter my brain function, to drill into my cranium and place electrodes and a computer with power source. Twenty years in development it still had the elements of new territory, it was comforting to be told I had a good brain. So my view was that even if a few neurons were lost in the process I would still be okay.

Such an undertaking is not done alone, my family, friends, colleagues, team, and the health care team at the academic tertiary hospital were all instrumental in my successful recovery from the surgeries. The unexpected outcome was severe sciatica that affected all aspects of my life.

Pain unrelenting, all consuming, agonizing, frightening, debilitating it affected me physically, emotionally, cognitively, and a significant frustration that I was not being listened to, even when I researched and defined the working diagnosis.

My family physician, truly a gem, who invested the time to carefully consider what options were possible referred me to a pain management clinic. There a physician was intrigued by the surgical option for my condition and how well I had responded other than the life altering pain in my “ass”.

What’s the status now? Injections into the lumbar region of the back to cool off the nerve that had been firing out of control, secondary to the stimulation by something and here I am 10 months later gaining more control of my body, pain has minimized, my outlook improved, and the desire to move the body. Let me rediscover the athlete within and prepare for the 2019 golf season. Stay tuned.

via Joy in work – pictorial 

To lead change  means you have given great thought to what the goal is for the team, indeed the alignment of the goal with the mission, vision, and values is significant.  The alignment with the team members is not always cut and dried, the process is dynamic and the experience can be exhilarating to frustrating, rewarding to having doubt.

A formal or informal leadership role the ability to recruit followers, engage and sustain their interest one needs multiple approaches, resiliency, optimism, flexibility, desire to learn and Emotional Quotient can be components in the toolbox.

The team I lead has employees who vary in motivation, self awareness, and possess variable critical thinking skills. and mixed with that are the elements of collective agreement content, legislation, standards of practice, and the organizational mission, vision, and values. The path to change a culture is not for the faint hearted, it requires vision, stamina, resilience, building trust, continuously build and sustain connections, scan the environment, respond not react, and foster mentoring behaviours.

The pillars of leadership (Stein, 2017)  that you can cultivate include authenticity, coaching, insight, and innovation.

Authenticity the real you is what needs to be shown in a consistent and credible way.  You need to be viewed by others as fair, consistent, demonstrate integrity and transparency, there is also another feature humility.  Leaders with authenticity are role models, inspire others to be fair and moral and you respect them; these are leaders who you esteem and are confident about.

Coaching is the ability to mentor and collaborate with team members; as a leader is not an enforcer that is the manager aspect of my job.  The coach walks around the unit, connects with team members, has one on one meetings and key is to act on concerns, needs, support team members and align actions that staff want to be on the team.

Insight is to truly understand what the team/organization is about, the core mission and values and know how to communicate those elements in a form that inspires staff, patients, and families.  Do you know your higher purpose?  I know that first and foremost I am a healer.  Whatever role is placed within my influence my core being is to heal others.

Innovation is to harness the energy of creativity, to learn how to take risks, to encourage autonomy, to provide ongoing opportunities to gain knowledge, and mistakes or failures are opportunities to learn from not punish individuals.

Are leaders born–no; there are intrinsic personality traits that can provide advantages, the true measures are mentoring, encouragement, opportunities, clarity of what is to be done, and mix in some resiliency, confidence, and you are really on your way.  Informal or formal roles there are ample opportunities to develop leadership skills and there is certainly room for our world to encourage authenticity, moral courage, and can do attitude.  Namaste

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