Did you ever have that one nurse mentor or clinical instructor who seemed to be able to do things quickly without ever seeming to tire? They always seemed to have endless energy to do a long list of tasks in a short period of time一all of which seemed impossible to do as a nursing student. Unfortunately, even though they were scarily efficient, a lot of times their lightning fast pace also came with a level of harshness or poor communication skills. Many instructors struggled with their own significant health concerns that could have been linked to overwork.
It’s possible that some nursing instructors came from a generation when nurses were treated as “just a nurse” and had to work much harder to prove their worth as a valued member of the patient care team. The work culture has made some progressive strides in dismantling inappropriate patriarchal culture, where doctors are no longer treating nurses like expendable servants. The historical culture of working non-stop to prevent physician tantrums and mistreatment has been so ingrained into some nurses that they can’t leave the overworking culture behind them. Things aren’t as bad as they used to be, but there is still room to radically reform nursing culture with the goal of efficiently delivering safe patient care without sacrificing nurses’ mental health and well-being in the process..
Why Nurses Resist Taking Breaks
There are numerous reasons why nurses commonly don’t take their breaks, including the old-school workaholic mentality, providing a sense of higher status or invincibility. Studies have repeatedly shown that nurses perform better when they take breaks, but the cultural push to overwork is strong.
Which one of these lines have you said to yourself or others?
”If I just do this one more thing... I’ll be caught up…”
(Spoiler: This can go on for perpetuity, as there is always “one more thing…”)
”I don’t have time. There’s too much to do, and we are understaffed, so I’ll just keep going.”
”I’m on a roll. It’ll get it done faster if I just keep going.”
”It’s easier for me to just do it, instead of explaining to someone else what needs to be done.”
”I’m not hungry, I’m fine.”
”I love taking care of this patient, so I’ll just work a little bit longer.”
”I made a mistake and got behind, which was my fault 一 so I need to work extra hours to make up for my mistake.”
(The mistake may have happened because we were too tired and haven’t taken a break)
“People will think I am slacking if I take a break, and I want to pull my own weight.”
Why Perfectionism Needs to Take a Long Walk Off of a Short Pier
We can talk all day long about the importance of taking breaks, how it is safer and healthier for everyone,but the cultural pressures nurses face in addition to a strong work ethic一makes taking a break difficult. Instead, nurses can take “pseudo” breaks while continuing to work. It is not ideal, of course. If you can take a break, by all means take that break! But pseudo breaks lasting about 15 seconds are better than no breaks at all, so here are a few ideas to get you started. If you don’t have even 10-15 seconds to take a “pseudo” break, that is a gentle signal that a break is needed now more than ever.
3 Types of “Pseudo” Breaks to Do in 15 Seconds or Less
Box Breathing: Box breathing is a technique that Navy Seals use to help calm their nervous systems so they can think as clearly as possible under enormous amounts of stress. This is a form of deep breathing where you take one slow inhale, holding it at the top for a few seconds, then followed by a slow exhale, and holding it for a few seconds at the bottom. This stimulates your vagus nerve, which turns on the parasympathetic nervous system that provides a calming sensation. I can always tell when it’s working because my shoulders immediately drop after holding my breath for even a few seconds.
Caution: some people get dizzy the first few times they try different kinds of deep breathing, especially ones that involve holding your breath. Go slowly and only do one or two breaths at a time. Stop if you feel dizzy or discomfort.
Times when you can do box breathing while working:
After you take a sip of water
Every time you go to the supply closet
Before you administer medication
Riding the elevator
Texting your Mom/friend etc.
Waiting for your coffee to be brewed
Compassionate breathing: Dr Kristin Neff, a renowned psychologist who studies the effects of self-compassion, teaches many different types of compassionate breathing that include internally saying mantras while breathing in and out. One that is easy to use is called “Breathing with Equanimity” or “Self-compassion for Caregivers.” As you breathe in, you say to yourself, “I am breathing in for me,” and as you breathe out you say, “I am breathing out for you.” You can even shorten it to “In for me, out for you.” You don’t have to do any special kind of breathing, but it helps to mindfully pay attention to both the in and out breath.
These breathing techniques can be incredibly helpful, especially when working with an upset patient. These are great tools for a “pseudo” break because it’s possible to still pay attention to patients, while taking a moment to ground yourself in the moment.
Cultivating kindness and grace toward yourself: Dr. Neff posts regular tips for self-compassion on her Facebook page. She teaches that one way to cultivate kindness toward yourself is by “Speaking (and thinking!) kindly about yourself.” Often we are hard on ourselves without even realizing it. But if we pay attention to our thoughts and catch ourselves saying something negative, we can take a moment to rephrase our concern in a more productive light. This saves time and energy, and keeps us moving in the right direction.
So instead of saying “I can’t believe I overslept and missed my bus. That was so stupid of me!” you can say something like “Ugh, I’m so bummed I missed my bus. This really sucks. I must have been really tired. I should let my boss know that I am on my way, and try to get some extra sleep tonight so hopefully this won’t happen again. Even though I overslept, I am still a good nurse and care about my patients. I just made a mistake, like all people do from time to time.” In Dr. Neff’s recent Facebook post, she also includes the following five tips for cultivating kindness toward ourselves:
Spend time doing things you truly enjoy
Forgive yourself for your mistakes
Strive to avoid judgments and assumptions
Take care of your mind and body
Cultivate acceptions (even for your flaws)
Fortunately, these three kinds of “pseudo” breaks can be done quickly without anyone noticing, while also having a positive effect on our mood and energy levels. Of course, taking a full break from working is the preferred method of taking a break. But if you are in a pinch, be sure to try a 15 second “pseudo” break and write in the comments about how it worked for you!
ANA Nurse Fatigue Position Statement 2014 https://www.nursingworld.org/~49de63/globalassets/practiceandpolicy/health-and-safety/nurse-fatigue-position-statement-final.pdf
Healthline Box Breathing https://www.healthline.com/health/box-breathing
Cleveland Clinic Box Breathing https://health.clevelandclinic.org/box-breathing-benefits/
Compassionate breathing https://self-compassion.org/category/exercises/
Dr. Neff video on breathing with equanimity https://www.youtube.com/watch?v=jJ9wGfwE-YE
Dr. Neff Facebook posting about cultivating kindness toward ourselves
Susannah Marshall, BSN, RN-BC, CCM has been a Registered Nurse for 8 years, and is board certified in both case management and psychiatric nursing. Prior to becoming an RN, she worked for 10 years with children in social service settings, where she became passionate about patient advocacy and de-stigmatizing mental healthcare needs. When she isn’t practicing Argentine tango or west/east coast swing dancing, she loves to play with her baby nephew and write children’s stories.