"Lead by example," and "Actions speak louder than words," are two sayings that imply authentic leadership. Yes, they may be cliché sayings, but there is a ring of truth to them, especially when it comes to healthcare workplace wellness and dealing with nurse stress and burnout.
Nurse leaders are certainly not immune from stress. For example, in a qualitative study published February 2017 in The Journal of Nursing Administration, 20 nurse executives shared their experiences with stress caused by moral distress in the workplace.
The nurse executives often cited issues in nursing such as staff salaries and compensation, financial constraints, hiring limits, increased nurse-to-patient ratios to drive productivity, counterproductive relationships, and authoritative improprieties as contributing factors to moral distress.
"From the leader's perspective, with so much focus on finance and outcomes and all these mergers and acquisitions, you [become] worried about job security," says Adele A. Webb, PhD, RN, FNAP, FAAN, Assistant Dean, External Relations & Partnerships at Capella University. "There's a lot of things that are contributing to raising the stress level in the workplace. So, [how can we protect] ourselves [from stress] and then protect the people that are important to us and work with us?"
Self-care actions speak louder than words
"About wellness or self-care, I think the most important message is that [nurse leaders] need to model the behavior that you want your staff to adopt," says Webb.
Webb shares an example of a time when, as a nurse leader, she may have unknowingly sent the wrong message to her staff.
"On Sundays, I would sit and send a ton of emails because I had time. But my staff came [to me] and said, "We feel like we have to respond. You're taking away our day off," Webb recalls. "I was putting so much pressure on them to respond to these emails that didn't need an immediate response. It was just that I had time."
Webb took the feedback to heart and stopped sending Sunday emails, so the staff didn't feel like they needed to be checking their email and responding on their day off.
"I encourage leaders to be self-aware and look at your own behavior," she says. "Is this what you want for your staff? And if it isn't the behavior you want for your staff, then you need to find a way to adopt the behavior that you think is going to help them because it's going to help you, too."
In a recent interview with HealthLeaders, Webb shared some specific ways nurse leaders can quickly bring down their stress levels in minutes without even leaving the building.
6 stress busters
1. 4-7-8 Breathing Technique
"Sometimes we say, 'I know I should exercise, but I have to drive to the gym. I have to pay the fee. I don't have the shoes," Webb says of reasons many people don't participate in stress relief habits like exercise.
But, as she points out, breathing is free, and "you're already breathing."
This technique has been promoted by integrative medicine physician Andrew Weil, MD, to combat anxiety and aid with relaxation.
Webb describes the method as inhaling the breath for four seconds, holding it for seven seconds, and then exhaling for eight seconds.
"You can repeat [this technique] as many times as you need, but you need to do it at least three times," she says.
2. Belly Breathing
Not everyone finds 4-7-8 breathing comfortable.
"With 4-7-8 breathing, some people get dizzy, so the belly breathing is an option to do the same thing in a way that's less constrictive," Webb says.
To perform belly breathing, put one hand on your chest and one hand on your stomach. Breathe slowly through your nose as your stomach expands.
"Feel your stomach go down as you breathe," Webb says. "That helps you concentrate because your hands are involved. Now you're concentrating, not just through your breathing, but also with touch."
Some may bristle at the thought of meditation, but as Webb points out, the practice doesn't have to be a spiritual exercise.
"It's really just concentrating [on something]," she says. "Many hospitals now have quiet rooms. They'll have a picture on the wall, and you can just focus on the picture."
In 2013, a room like the one Webb describes was created at Cancer Treatment Centers of America (CTCA) Chicago in Zion, Illinois. During the first three months it was open, the room was used by nurses over 422 times, and 96% of nurses surveyed said their anxiety levels decreased after they left the room.
Webb says intentionally humming a song can help leaders' shift stressful thoughts out of their minds.
"When you're humming, you're not really thinking about anything else. It's a really good thing to do if you're walking down the hall. It just clears your mind," she says. And she encourages picking a song that has a connection to joy.
Studies have found that physical activity in general, and dance in particular, can lower stress and anxiety.
"If you see a nurse having a hard day, twirl them around," Webb suggests. "Have a little dance party or tap out a rhythm at the nurses' station. Before you know it, everybody's doing it."
Studies have found that yoga has benefits specific to nurses including reports of higher self-care and less emotional exhaustion and depersonalization compared to control groups that did not take part in yoga.
"If you have an office, you can get into one of these poses," Webb says.
When it comes to self-care, stress management, and wellness, Webb says it’s time to push pride aside for the good of nurses and patients.
"So many people say, 'I can [deal with stress]. I'm tough. I can push through,'" she says. "But we're hurting ourselves [because it] is trickling down to your family and trickling down to your staff. [And nurses] trickle it down to their patients. It's really our opportunity to recognize that our wellness is important, to respect ourselves enough to take a minute, and to model that for our staff."
Editor's note: This story has been updated to reflect Cancer Treatment Centers of America (CTCA) Chicago's most recent name. The previous version of the story listed the organization's prior name Cancer Treatment Centers of America at Midwest Regional Medical Center.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.