This famous adage is accepted as truth by many nurses, and when the feet hit the floor of the unit or workplace, it’s often put into practice by nurses who just can’t—or won’t—see another way.

But there is another way, and the nurturing of our young and/or novice nurses is an essential ingredient of a vibrant, growing, healthy and self-preserving nursing workforce.

1. Reject the old paradigm
The first thing that nurses need to do, individually and collectively, is to categorically reject the old paradigm. It doesn’t matter if you yourself were treated poorly when you first stepped into your scrubs and hit the floor running. It doesn’t matter if you never learned how to properly precept and guide a new nurse. It’s up to you to reject the old ways of doing things, and instead welcome new nurses with open arms and a willing heart. We were all new nurses once, and even if we skipped the frying pan and were thrown directly into the fire (or thrown to the lions, for that matter), we don’t have to perpetuate that practice by turning our back on new nurses out of spite for our own past.

2. If there’s no system, create one
Nurses sometimes complain that there’s no system at their workplaces to accommodate for the time and energy that it entails to take a new nurse under your wing. In some facilities, a nurse who takes on the training of a new nurse receives no extra help or compensation in exchange for these extra duties. Work together as a team and create that system. Perhaps the nurse who has a new nurse in tow is assigned one less patient than everyone else, or maybe two nurses have to be teamed up for a group of patients so that the mentoring nurse can focus on his or her responsibility for a novice nurse who needs guidance. Remember, these new nurses will be your full-blown colleagues as soon as they’re trained, so if you treat them well and train them well, they’ll only be a benefit to your workplace and your work flow.

3. Listen to the new nurses
New nurses sometimes bring enthusiastic ideas for innovation to their new careers. They are full of enthusiasm and fresh perspectives. Some newly minted nurses are former psychologists, marketers, entrepreneurs and businesspeople who have just entered into a new and exciting career. These nurses are, after all, the nursing innovators of the future, so listen to them and realize that they may have as much to teach you as you have to teach them. Their life experience brings something fresh to the table. Don’t overlook their knowledge, expertise and experience, even if it may be in an area outside of nursing. Also remember that some new nurses are simply great thinkers and innovators in their own right, and their insights could be invaluable.

4. Communicate
If you’re mentoring a new nurse, be clear in your communication and expectations. If your workload is intense, make it clear how they can be helpful and the ways in which they might make your work harder. Take breaks, ask your colleagues for help if you’re behind the eight ball, and remember that communicating your needs and frustrations can lead to improved relationships and increased satisfaction for everyone involved.

We all know that it’s common for nurses to develop all sorts of excuses for not practicing self-care due to the many demands of their work. It’s understandable that those of us who care for others so much might oftentimes neglect ourselves, but it’s also possible to provide for ourselves just a little of the TLC that we bestow so readily on our patients.

Some of you out there may laugh and tell me that you simply “can’t afford the time” for such luxuries as self-care, but I would counter that statement by encouraging you to realize that the quality of the care that you deliver can be greatly compromised if you’re not caring for yourself. It’s our responsibility to ourselves—and our patients—to be at our best throughout our shifts. And being at our best also means caring for our own bodies and minds as we go about the business of nursing others.

1. Take a stretch break
If you have a job that requires long hours on your feet (or long hours in a chair), your body can suffer if you don’t give it some well-deserved attention during the course of a long shift. There are many simple but effective stretches that can be employed right in the nurses’ station. Yoga teachers and fitness instructors (as well as yoga DVDs and books) can teach you very simple and helpful stretches that, when practiced for even two minutes every hour or so, can remove stress from your shoulders, neck and back, and bring some relief to your hardworking feet, legs, and arms. (And if you do them in view of other colleagues, some may even want to join you or learn from you. And if any of your colleagues laugh, let them! Laughter relieves stress, strengthens the immune response and oxygenates the brain!)

2. Hydrate and urinate
Hydration is one of the keys to health, and I bet that thousands of nurses become dehydrated during the course of long shifts. We all understand physiology, and we all know that hydration is good for the joints, digestion, kidney health, and any number of physiological functions. We also know that withholding urination can lead to infection, bladder dysfunction and other illnesses and symptoms, so taking the time to drink water (not just drinks heavy with caffeine and sugar!) on a regular basis—and relieving your bladder just as regularly—are great ways to keep your body more fine-tuned during a demanding shift.

3. Take a break!
This may seem laughable, but we all need to take a breather, even if it’s just for a few minutes. Have you ever noticed how smokers always seem to find the time to get outside for a smoke break, even if they’re buried with paperwork and patients? They often have a physiological need to smoke (powered by a dependence on nicotine!) and that dependence creates the urge to make smoke breaks happen, no matter what. So, become “dependent” on fresh air, exercise, or time away from the unit. Take your breaks—you need them!

4. Eat well.
This may also seem funny to many of you nurses out there, but sugary snacks and carbo-loading do not a healthy nurse make. Complex carbohydrates, healthy fats, high-quality proteins, and fruits and vegetables should figure prominently in your diet at work. Do you need to take more time to prepare snacks and meals to bring to work? Do it. Are there healthy choices in your facility’s cafeteria? Choose them. (If not, start a movement to change that reality!) Eating well and being well nourished will help your brain and body function better. Your patients deserve a well-fed nurse, not just a frazzled nurse mindlessly buzzing on sugar and caffeine.

5. Partner with Colleagues
Making a pact with other colleagues is a great way to encourage one another to practice good self-care. Make agreements, keep track of one another, and hold one another accountable for self-care during shifts. If several of you want to work together on this, appoint a different person to be “the self-care charge nurse” during different shifts, and allow this person the right to badger you about hydrating, taking breaks, and making other healthy choices during your shift. You can even create contests or prizes as incentives for good self-care.

These are only suggestions, and even if you implement them slowly and over time, you know deep down that taking better care of yourself while working long shifts (or even normal shifts, for that matter!) is better for everyone, including your patients. Nurse, you have to heal yourself first, so start with self-care at work—and outside of work too—and you’ll be happier and healthier for it.

Who—and What—Are Nurse Entrepreneurs?

So, what exactly is nurse entrepreneurship? This term is bandied about a lot these days, but who are the nurse entrepreneurs that everyone seems to be talking about, and what exactly is it that they do?

Nurse entrepreneurs are now working in a large variety of settings. Some nurses have realized that they have skills that can be leveraged within the health care industry, and they are working as consultants, trainers, motivational speakers and teachers. Some nurse entrepreneurs have started their own companies, selling innovative charting programs or speaking to nurses about communication skills or teamwork. Other nurses have joined forces with various professionals, offering continuing education programs or innovations to increase productivity or other measurements of success and profitability within the health care facility.

Nurse Entrepreneurs Who Write

Meanwhile, some nurse entrepreneurs have leveraged their writing and communication skills to carve out niches in blogging, writing, and content creation. The nurse “blogosphere” is teeming with nurses who pour their hearts out to small and large online audiences who enjoy reading the rants, raves and reports of nurses on the front lines who have something to say and know how to say it. And since blogging has become so big almost everywhere (even The New York Times has staff bloggers), some online nursing companies and internet-based health websites have hired nurses to use their expertise to blog about specific areas of interest for various internet audiences.

Speaking of writing, there are nurses who have made names for themselves by authoring books on nursing and health care, and many of these books are available in traditional print format and as downloadable ebooks.

Nurse Coaches

Still other nurses have taken their nursing skills and coupled them with skills in coaching to create an entirely new field. While everyone has heard of life coaching, health and wellness coaching has also been growing by leaps and bounds in the last few years. And since so many health and wellness coaches offer their sage advice without the benefit of a nursing background, some nurses have come to see that many members of the public would rather trust a nurse to coach them through weight loss, fitness, stress reduction and self care. With coaching being, by and large, an unregulated industry (for now), nurses can easily “hang a virtual shingle” and offer coaching services without any training beyond their nursing education, nursing experience and common sense. Nurses are born to coach, and many of the skills utilized by life coaches are skills used by nurses when they are educating clients and patients on the floors of hospitals or during home care visits.

We’re Everywhere

Every day, nurses are creating new niches for nurse entrepreneurship, and there is indeed no limit to what nurses can accomplish outside of the traditional roles that seem to impose limits on nurses’ own identity and professional aspirations.

According to poll after poll, nurses are the most trusted professionals in the eyes of the majority of Americans. So, many nurses are capitalizing on that trust and leveraging their skills in order to branch out beyond the narrow confines of what it has meant to be a nurse—up until this time in history.

The day of the nurse entrepreneur has come. And the world seems ready for nurses to finally define for themselves what it means to be a nurse—or a new entrepreneur—in the 21st century.

1) Being an entrepreneur means being your own boss: While this may be a dream come true for some nurses, it may be a living nightmare for others. Entrepreneurship puts you in the driver’s seat, making decisions related to every aspect of your business, including finances, advertising, networking, technology, your work style, your business partners, your collaborators and more. You are in charge, and you are not really answerable to anyone, unless you have business partners or investors. It’s a big responsibility, and you want to be sure that this type of working situation suits your needs, your desires, and your personality.

2) What you want to offer is also important: Nurse entrepreneurs are offering everything from health coaching and life coaching to career development and consulting. Nurses bring a plethora of special talents and skills to any situation, and who you are and what you offer are important aspects of how well your service will meet the needs of potential customers.

The service or skill that you are offering as an entrepreneur and businessperson should have a niche market, a financially viable plan, and a way for you to execute that plan through positive action. Consider how many people are offering what you would like to offer, how stiff the competition is, and whether you have some quality or service to set you apart from others in the field.

3) Outside help may be needed: In the current economic climate, there are certain “givens” of which you may not be aware. First, you will need a website and you will most likely need to engage heavily in the use of “social media” on a regular basis (ie: Twitter, Facebook, etc). You will also need to decide whether you will be operating under the auspices of a sole proprietorship, a Limited Liability Corporation (LLC), an S-Corp, or another form of business entity. There will also be accounting, bookkeeping and tax concerns to consider.

Taking these (and other unmentioned) issues into consideration, you may need to hire out for accounting, bookkeeping, website development, social media, legal advice, business card and logo design, and other common needs of a new private start-up business.

4. Will it make you happy?: When thinking about running your own business—whether it’s full-time or part-time—it’s important to think about whether this type of endeavor will potentially make you happy and more satisfied, or whether it will be an albatross around your neck.

Many entrepreneurs realize early on that entrepreneurship is not really for them and they would rather simply report to work and receive a regular and reliable paycheck. Meanwhile, others thrive on the challenge and the individual initiative that being a successful entrepreneur entails. There is no judgment either way. Find what works for you, and consider these and other issues when thinking about whether to throw your hat into the ring along with so many other nurse entrepreneurs.

1) One reason that many nurses love working in home health is because it allows the nurse to have varying caseloads of patients, with some patients whom they follow regularly over the long term, and some who may be short-term or episodic. The one-on-one aspect of home health is attractive to many nurses, and by entering a patient’s home, the nurse can often have the added benefit of connecting with patient’s spouses, significant others, pets, children, neighbors and friends. Being in a patient’s home can be a true honor, and being welcomed like an ersatz family member can make some of those nurse-patient relationships quite special and memorable.

2) In my own experience as a home health nurse and in speaking with other nurses about their time in home health care, the issue of personal freedom is one that is often discussed. The home health nurse is out on his or her own for the majority of the day, and that ability to be in charge of one’s own schedule and to have a fair amount of solitude during the course of a shift is a positive attribute of this type of work for many nurses.

While the home health nurse is often connected by phone (and sometimes internet via laptop) with his or her supervisors and colleagues, there is still a great deal of time where the nurse can be autonomous and free of the constraints so familiar to those of us who work in a clinic, unit or office. The ability to stop for coffee or a snack, complete clinical notes wherever it’s convenient (like a cafe, library or restaurant), listen to music while driving between patients’ homes, and have time to think without many interruptions (on a good day!) can be some of the priceless benefits of this type of nursing.

3) Aside from personal freedom, professional autonomy is also highly prized by many nurses working in home health. While any actions taken by the nurse are determined and limited by the Home Plan of Care (HPOC) that is signed by the supervising physician, there is often room for a great deal of interpretation of those orders, and some physicians with very positive working relationships with certain home health nurses will allow for that flexibility in their orders.

The home health nurse often has many choices to make within his or her scope of practice in the home, and while there are no other “clinical eyes and ears” on hand to examine a patient and offer advice or feedback, some home health nurses find this to be a particularly satisfying professional and clinical challenge.

Not For Everyone

While many nurses simply love home health, other nurses might find the solitude, the driving, and the increased autonomy either unnerving or unsatisfying. Home health is a very particular specialty, and like all nursing specialties, it’s not for everyone.

If you’re thinking about trying home health on for size, consider contacting a local agency and shadowing a home health nurse for a few shifts. You will probably know fairly quickly whether this type of nursing is for you, and whether or not it would be a good “fit” for your particular personality and nursing skills.

1) Ask for help: If you feel like you may be experiencing burnout as a nurse, it’s important to ask for help in the appropriate places.

Your employer may have an Employee Assistance Program (EAP), which is a confidential program providing short-term counseling for employees, usually at a separate agency that provides such services. In EAP, the nurse experiencing symptoms of burnout can seek the help of a counselor who can guide the nurse in identifying the core issues, activating support systems, and identifying strategies for recovery and self-care.

Your immediate supervisor may be a person to whom you can turn, but this depends on your relationship and the supervisor’s style of leadership. This can be a double-edged sword, so be thoughtful in this regard.

You can also seek psychotherapy or counseling apart from EAP or work-related programs or providers. Career coaches and counselors can also be helpful at times like these.

2. Take a leave of absence: Sometimes a leave of absence (LOA) is the only way to gain some perspective when you’re feeling burnt out. It can be possible to take unpaid leave and seek temporary employment elsewhere, or you may be in the position to use savings or other income to support you financially during your LOA. You may be eligible for unpaid leave under the Family and Medical Leave Act, but this may necessitate a note to your employer from a psychotherapist or doctor who is treating you.

3. Ask for decreased responsibilities: If you are not in a position to take a leave of absence and must continue working, there are sometimes ways to decrease your responsibilities or otherwise ease your workload. You might also be able to “job share” with someone willing to work half of your hours for a period of time, or you may be able to, for example, leave bedside care and switch to managerial or clerical tasks temporarily.

4. Practice flawless self-care: Whether you can take a LOA or not, virtually flawless self-care is essential in the face of burnout. This may include seeking out psychotherapy, coaching, your employer’s EAP, or taking care of yourself in other ways. Daily exercise, and a diet free of processed foods, sugar, caffeine and other foods that may increase stress and decrease immune function can be very useful. Good hydration, thoughtful use of dietary supplements, and attention to sleep hygiene are also crucial. You may also want to focus on time with family, your hobbies, travel, leisure time, as well as anything that brings you peace of mind, joy and a sense of well-being.

Burnout is not fun, and you are not the only one who can suffer. Your patients, colleagues, friends and family also notice when you’re not at your best, so do your best to prevent burnout from occurring. You can also be aware of the need to put yourself in a healthy position to recover from it quickly when you realize that burnout has indeed reared its ugly head in your nursing career.

So, what does a toxic healthcare-related workplace look or feel like? Let’s examine some clues.

1) A toxic workplace uses authoritarian control to “keep employees in line“. Edicts come down from the upper echelons of power, and workers have no input in decision-making.

2) Toxic workplaces breed unhappy workers who internalize the oppression that they feel from their superiors, and this internalized oppression manifests in back-biting, bullying, the formation of cliques, and poor communication between employees, committees, and various groups within the organization.

3) When toxicity is rampant, the consumers who utilize such a facility may actually sense that something is wrong. Care may be poor, employee attitudes may reflect a lack of caring or concern, and there is a feeling that the organization lacks a “human” touch. Outcomes may also be compromised.

4) High turnover is a symptom of a toxic workplace, and employees who stay often feel like they are aboard a sinking ship.

5) Toxic workplaces feel bad to those who operate within them. These types of organizations breed unhappy workers, authoritarian and dictatorial leaders, and very poor cohesion and morale.

6) If you work in a toxic workplace, you may dread going to work. You may experience poor treatment from many coworkers, and there may be a feeling that your workplace is “unsafe”, emotionally and otherwise. You may fear for your job while also wishing to lose it. In this type of environment, you may feel that you walk a knife’s edge between just getting your job and being reprimanded at every turn. There may be unfair demands made upon you and your colleagues, and there is likely little real recourse for you if you want to file a complaint with your superiors. Mediation and other forms of assistance for employees are non-existent or dysfunctional if they exist at all.

This list is by no means exhaustive, but it belies the ways in which toxic workplaces can impact individuals, groups of employees, as well as the organization at large and the people whom it serves. If you think that you work in a toxic workplace, it may be time to consider finding a new employer or working towards helping your workplace become a healthier, more functional organization.

So, what might be some signs that you’re burning out as a nurse? Let’s explore the possibilities.

1) You dread coming to work

Once upon a time, you loved nursing. Perhaps it was your first professional career, or maybe it was a second—or third—career. Whatever your reasoning for taking the plunge, nursing gave you something, and you gave back. Nursing became part of your identity and self-concept, and your pride in being a nurse was palpable and strong.

Now, you dread coming to work. You don’t want to relate to coworkers. Patients are a burden, and the daily tasks of your work are deadening to you.

You may simply be working in a toxic workplace. But if not, it may be your relationship to your work itself that has become toxic.

2) You are regularly experiencing “compassion fatigue”

Compassion for the suffering of our patients is part and parcel of nurseing, and if you asked any layperson what the attributes of a good nurse are, compassion would no doubt be in the top three.

When you begin experiencing compassion fatigue, your patients seem less like people and more like disease processes and problems. You begin to see them as objects rather than real human beings, and their complaints or problems grate on your nerves like nails on a chalkboard. When compassion fatigue has set in, you find it more and more difficult to feel true empathy for your patients, and the distance that separates you from them grows to a cavernous divide.

3) You commit more errors

If you’re burning out or burnt out, you might find yourself making more errors in your nursing work. Med errors, documentation mistakes, poor documentation and lack of attention to detail are also common. The burnt out nurse loses his or her desire and ability to perform at the level of quality for which they were trained, and their skills and job performance may become lackadaisical. You may even find yourself called into your supervisor’s office or written up for multiple errors.

4) Your relationships suffer

In the face of burnout, your personal and professional relationships may suffer.

At home, you feel terrible about work, think about it too much, dread going in to work, and you snap at your family and friends. You have less fun, you dwell on thoughts of work, and you lose your ability to “let go” of work when you’re not there. No matter how much you hate work, you can’t stop thinking about it.

At work, you have less patience with colleagues, you may feel more critical, and you may even voice your criticisms and unhappiness more readily. Colleagues may notice your change in attitude, and some may even try to talk to you about it.

What to Do?

There are many things that you can do about burnout. If a leave of absence is not possible, an Employee Assistance Program (EAP) at your workplace may be useful, or you can see a private psychotherapist or counselor. You can also talk to sympathetic colleagues or supervisors, and you might even consider requesting a transfer to another unit where there is less stress and a change of scenery. Sometimes a long-needed vacation may do the trick, but not for serious burnout.

The most important thing is to recognize that you’re burning out, and then seek help to nip it in the bud before it impacts your health and the safety and health of the patients for whom you provide care.

Remember: you can only care well for others if you care well for yourself.

While exercise, nutrition, hydration and leisure are important aspects of self care, sleep is a form of self care in which many nurses may find themselves significantly deficient.

Shift Change

There are always nurses who must work overnight shifts, and it is these nurses who are most likely to suffer from sleep deprivation and other sleep-related issues. Staying awake throughout the night is a challenge, and nurses who work such shifts know all too well the problems with concentration and mental acuity that these odd hours can cause. Additionally, many nurses have families and other responsibilities, and “catching up” on sleep during off hours can be a formidable challenge.

The Ravages of Sleep Deprivation

Sleep deprivation can cause any number of symptoms, including fatigue, daytime sleepiness, diminished cognitive function,irritability, memory lapses, poor mental concentration, depression and malaise.

In terms of long-term effects, sleep deprivation can increase the risk of developing obesity, depression, diabetes, hypertension, fibromyalgia, and increased levels of stress hormones.

What Can This Mean for Nurses?

Sleep-deprived nurses can be more likely to make medication errors, feel irritable and out of sorts, and find their work more challenging and tiring. Mental and physical fatigue can be very dangerous for a nurse’s health as well as his or her ability to be effective and safe at work.

Regulating Sleep

Improved sleep hygiene is often the first intervention that is recommended for those having sleep-related challenges. Sleep hygiene includes regular hours for sleep, specific practices prior to sleep (ie: avoiding alcohol, caffeine, and disturbing or stimulating images or entertainment), as well as other behavioral adaptations that can assist an individual to experience more ease in terms of getting to sleep and staying asleep.

For those who work the overnight shift, practicing good sleep hygiene can seem almost impossible, especially if these nurses also sometimes work the day shift as well.

To Whom Can You Turn?

Nutritionists, sleep specialists, and other medical providers can assist you in regulating your sleep, and this is most crucial if you frequently work nights. There are nutritional supplements and medications that can be helpful, as well as sleep hygiene practices that may be useful in resetting your rhythms when your shifts move from day to night and back again. Other nurses and colleagues who work these shifts can also be sources of support, but be cautious about the overuse of caffeine and other stimulants, since these substances can only add to your sleep challenges.

However you measure it, sleep quantity and quality are important, so do your best to ascertain what your challenges are and come up with an action plan to address them. Sleep is good for your nursing practice, your patients, and your overall health and longevity!

In a stressful and results-oriented environment, nurses and other clinicians can become quite task-oriented to the point of being focused solely on their own disciplines goals. This focus can be a great motivator, but it can also lead to a sense that we are all walking around wearing blinders that literally blind us from truy seeing the inherent value of the other professionals in our midst and how we might cooperate rather than simply coexist.

1. Who’s Who: Other clinicians and their cohorts can sometimes feel like alien armies that we barely know and only infrequently cross paths with. Going out of your way to connect personally with other clinicians from different specialties and disciplines can foster positive relationships and recognition of mutual value. In a large facility, it’s not always possible to know everyone by name, but having contacts in most disciplinary areas gives the nurse an “in” that can sometimes come in handy, especially when a patient needs extra care or special attention. Making time to stop by other clinicians’ offices or work areas, learn about their roles and generate a sense of camaraderie can be helpful on many levels.

2. Cross-discipline communication: It’s one thing to acknowledge that another discipline is presently going about the tasks assigned to them (be they P.T., radiology, phlebotomy or case management, for just a few examples), but it’s another thing to actually create an environment of interdisciplinary communication.

A great deal of clinical benefit can be gleaned from off-hand and casual communication that occurs between disciplines “on the fly”, but a great deal more can often be communicated when time is made for interdisciplinary meetings. It can be easy to barely skim the notes written by P.T. or case management, but when a conversation is held and findings are communicated clearly and verbally, that direct contact between clinicians can foster more understanding and cooperation, as well as understanding of mutual—and differing—clinical goals and objectives.

3. Convince Your Colleagues: Your nursing colleagues may not share your view that other disciplines warrant your collective attention, and it may take some convincing to bring your colleagues on board. If you’re a manager, supervisor or charge nurse, it is your prerogative to enforce interdisciplinary meetings, but such enforced cooperation is only fully successful if the supervisors of each team create an atmosphere of trust and professional respect.

For instance, a nursing supervisor and a case management supervisor might hold a meeting for the nurses and case managers from a particular unit, allowing members to get to know one another, share mutually held work-related clinical interests and concerns, and identify areas needing clarification. If supervisors or team leaders can lead by example, interdisciplinary sharing and cooperation can be significantly improved.

4. Minds Function Best When Open: It’s really all about an open mind, a willingness to engage in open communication, and a desire for cross-discipline cooperation. Being willing to engage with other professionals and truly understand their methods, goals and struggles can do worlds of good for your clinical practice and theirs. Engage and interact sincerely and openly with your interdisciplinary colleagues, and observe how cooperation, solidarity and mutual success can result.