I met Julia Sarazine this past June when I spoke to Rush University nurses in Chicago about my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers. We agreed on the need for nurses to tell their stories.
When I discovered Julia’s background in teaching mindfulness techniques to nurses in order to reduce symptoms of stress (see How PTSD Is Hurting Nursing) I asked if she would share her expertise and experience about how mindfulness can help reduce Burnout syndrome/Post Traumatic Stress Disorder (BOS/PTSD).
I’m honored that Julia agreed.
You’ve said that some experts feel that Burnout syndrome among nurses is a public health crisis. BOS has been affecting nurses for as long as I can remember. Why do you think this problem has been so insidious and tenacious?
Burnout syndrome is now receiving attention as demonstrated by The World Health Organization including it in the Revision of the International Classification of Diseases as an occupational phenomenon.
Levels of burnout are higher in professions that have high risk associated with them, such as a nurse administering medications and treatments that may have a significant impact on someone’s life. Also, nurses are usually the ones that hear and witness the patient and families suffering. In most situations, nurses see people when they are worried about their health, in pain or being treated for a serious illness. Over time, this constant exposure to suffering can take its toll on the ability to maintain our own health and wellness.
Moreover, the demands of the healthcare system continue to increase with technology and integration of electronic medical records. As more patient care is being provided in the outpatient arena, patients are sicker and may require more care than in the past.
You left a hospital nursing position because you had symptoms of BOS, yet a few years later you returned to the same position you left. How did you find the fortitude to do that?
Once a nurse, always a nurse definitely applies to my situation and decision to come back to the nursing profession. I missed working with patients and the sense of accomplishment I received while helping others. It is the same reason I was drawn to the nursing profession in the first place. I know it has been over communicated, but being a nurse is truly a calling, not just a job. It was not an easy decision, but it felt right for me at the time as I changed how I handled stress and suffering. I basically learned to take care of myself with mindfulness at work and how to transition to be fully present at home.
What advice would you give to other nurses who have left nursing?
To leave the nursing profession is a very individual decision. I believe all nurses are caregivers. Where nurses are providing care may change and whom they are providing care to may also change. For example, nurses may be taking care of their children, parents, family, friends or community members. It may look different, such as volunteering for the food depository, listening to a friend discuss her new cancer diagnosis or asking the cashier at the grocery store how they are doing today. Nurses are usually empathetic people and naturally take care of others throughout their lives.
There are terrible statistics about how many new nurse graduates leave the practice after a couple of years because of BOS. Among all the other tools out there to deal with this issue, what does mindfulness contribute?
Mindfulness is not the magical wand that can solve all our problems and prevent burnout. But it is a tool we can use to take care of ourselves so we can take care of others. I think all nursing students should be taught a few mindfulness skills when they begin nursing school. If you can learn just a few simple skills to protect you while witnessing and feeling someone’s suffering, it can help prevent burnout and lower your stress levels.
What is your definition of mindfulness?
The mind naturally wanders from the present moment to the past or future. This is often referred to as autopilot.
- Have you ever commuted to work and not remembered the drive or train ride?
- Have you ever eaten something and not remembered tasting it?
- Have you ever reacted to a situation and later regretted how you handled it?
These are all examples of mindlessness. In contrast, mindfulness focuses on being aware in the present.
There are multiple definitions of mindfulness, but the most commonly quoted is from Jon Kabat-Zinn: “Paying attention on purpose in the present moment, non- judgmentally.”
How did you first learn about mindfulness?
Right after I left nursing, I was struggling with trying to process all of the deaths I witnessed. A friend recommended The Power of Now by Elkhart Tolle. I read it and then began to meditate each morning. I found I was able to focus more and notice moments of joy in simple things such as a warm breeze on my face, a smile from a stranger and the taste from the first sip of coffee in the morning.
I continued to develop my own practice by taking mindfulness courses, attending silent retreats and eventually becoming a mindfulness instructor. Mindfulness is never complete; everyone who practices is always learning and evolving through increased awareness.
How has mindfulness changed you?
Mindfulness allowed me to process all of the suffering I witnessed and absorbed while working at Cook County Hospital as a palliative care nurse practitioner. During one of the mindfulness retreats, the teacher said, “ You don’t have to jump into the deep in of the pool, just dip your toe into the water as far as you can at this time.” This was very helpful for me at the time because I was resistant to processing the deaths for fear I would drown in grief. From this simple instruction, I was able to process each patient’s death by allowing myself to feeling the sadness and grief; then the grief lessened and I was able to wish the patient and family well. I realized I was frozen in time, but the family and friends had moved on with their lives the best they could.
When I returned to my nurse practitioner position five years later, I used mindfulness to keep myself grounded in the moment so I could think critically and also not absorb all of the patient’s and family’s emotion.
Now I use mindfulness all day long to recognize when I am stressed and choose how to respond, enjoy pleasant moments more fully and to accept when I have feelings of sadness or grief while taking care of aging parents.
Please tell us about the success you have had in teaching mindfulness to the nurses at Rush University Medical Center.
It is an amazing experience to be able to share the worst moments in my career and now teach how I processed the grief with mindfulness and continue to use it every day.
At Rush University Medical Center, we completed a study and determined that six months after nurses participated in a four-hour mindfulness and resilience workshop; they had reduced burnout and perceived levels of stress and increased mindfulness skills. We were thrilled with the results discovering that a short four-hour workshop can have an impact six months later.
Please add anything else you think my Blog followers need to know about mindfulness.
Here are some strategies and tips to incorporate into your daily life through informal practice, especially at work, where stress levels can be elevated. Just as a reminder, it is important also to practice informal mindfulness in times of minimal stress since it is easier to focus on being present and will make it more accessible during times of higher stress. Remember, it does not take any more time to be mindful.
Informal Mindfulness Practice:
STOP is a mindful technique that can be used in any situation to slow us down and reconnect with ourselves. It can be used before entering a patient’s room, sending an email, charting, speaking, or entering your home after work. The acronym STOP stands for:
• Stop whatever you are doing to pause for a moment
• Take a deep breath or two
• Observe any specific thoughts, emotions, or body sensations
• Proceed with more awareness
Two Feet, One Breath
This mindful technique can be used in times of stress to ground us and create a little space from the stressful situation being encountered.
With both feet firmly on the ground, while either standing or sitting:
- Focus as much attention as possible on sensations in the sole of the left foot—perhaps pressure or sensations from contact with the sock or shoe.
- Then shift attention to sensations in the sole of the right foot, with as much attention as possible.
- Tune in to your breathing—just feeling the breath as it moves in and out.
- Now, continue whatever you are doing in a more grounded and present manner.
Mindful Hand Washing
Use all the senses to bring awareness to the activity of washing the hands. Feel the temperature of the water and the sensations of the hands rubbing together, the smell of the soap, and the sound of the water running, and notice the bubbles forming from the soap. This awareness can be applied to any routine activity, such as brushing teeth, taking a shower, or typing an email.
On-Line Mindfulness Workshop Opportunity:
TheMindfulness and Resilience 4- Hour Workshop has been shown to decrease stress and burnout symptoms and increase mindfulness skills 6 months after participating.
I am teaching it on Saturday, October 19thfrom 8 am – 12 pm CST.
Sarazine Mindfulness, LLC