Nurse Practitioner Stress, Burnout and Compassion Fatigue
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Watch
Show notes:
The transition from RN to NP is TOUGH.
It's exhausting, stressful, but oh so worth it.
We need to be careful, though, because too much stress and not enough strategic prevention can lead to burnout and something called compassion fatigue, which can fizzle out our drive and passion-- and worse, may even lead to leaving the profession altogether.
Prevention and Treatment of Stress, Burnout, and Compassion Fatigue
In this video, I'm covering:
The risk factors, signs and symptoms of stress, burnout, and compassion fatigue (it's not necessarily what you think)
How to know if you're having any of these (or all three)
And what to do about it (prevention AND treatment)
Burnout and Compassion Fatigue Resources:
Take your ProQuol self-assessment here
Read the book To Weep for A Stranger: Compassion Fatigue in Caregiving by Patricia Smith if any of this is resonating with you: (not an affiliate link)
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Hey there, welcome to the Real World NP podcast.
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I'm Liz Rohr, family nurse practitioner, educator, and founder of Real World NP, an educational
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company for nurse practitioners in primary care.
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I'm on a mission to equip and guide new nurse practitioners so that they can feel
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confident, capable, and take the best care of their patients.
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If you're looking for clinical pearls and practice tips without the fluff, you're in
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the right place.
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Make sure you subscribe and leave a review so you won't miss an episode.
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Plus, you'll find links to all the episodes with extra goodies over at realworldnp.com
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slash podcast.
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Hey there, it's Liz Rohr from Real World NP, and you're watching NP Practice Made
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Simple, the weekly videos to help save you time, frustration, and help you learn faster
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so you can take the best care of your patients.
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So today I want to talk to you about stress, burnout, and compassion fatigue.
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If you haven't heard of that before, I'll explain what that's all about.
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But the transition from RN to NP is really stressful, and I'm all about the clinical
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content.
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I love talking about science and medicine and all that, but if I don't talk about
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I'll be pretty remiss because it's a huge adjustment.
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In this video, I'm going to be talking about the common pitfalls that I see, how to identify
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where you're at if you're under kind of like healthy stress versus approaching burnout
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versus experienced compassion fatigue and what that means, and how to prevent it
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in the first place, and then also how to treat it depending on where you're at.
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So a lot of what I'm talking about is based on the work of Patricia Smith.
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She's an author, and she wrote the book To Weep for a Stranger, Compassion Fatigue
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and Caregiving.
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So I definitely recommend that you check out her work in that book if you haven't
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already because it's a short read and it's super powerful.
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So even though her work is primarily focused on caregiving in general, as in caring
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for animals, caring for people, various professions, things like that, a lot of
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the tenets are really applicable to the nurse practitioner role.
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So what are the things that are unique to being a nurse practitioner?
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So a couple of stressful points, and the point here is not to talk about
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not to freak you out, but to kind of just name the experience so that hopefully
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you can recognize it for yourself in your own life and how to manage it.
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So you know what stress is, right?
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But there's a couple of different stressors that are particular to the nurse practitioner
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transition to practice.
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And I'm looking down because I have some notes in front of me.
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But basically, we're set up from the beginning for frustration, which is really
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hard because what happens is when we graduate from school, we have very high
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standards and very big goals and dreams of making a really big impact in the
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world, and we have the capacity to do that.
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However, when we first start, we're kind of starting behind, right, or
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feeling like we're behind, like we don't know enough.
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And we have this high standard of where we want to be, how fast we want to be,
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how much educating we want to do, how much knowledge we want to have.
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And unfortunately, regardless of where you're graduating from, nurse practitioner,
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physician assistant, MD, DO, et cetera, et cetera, we all have on the job
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learning that we have to do.
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So that can just be really stressful just to begin with.
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And this comes along with also with general caregiving is this
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need to prove yourself.
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I find this a lot.
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I found this for myself when I was a brand new grad, working with other
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colleagues and just to myself, feeling like I needed to prove myself to myself,
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you know, that I was worthy of doing this job.
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I was capable and showing my colleagues that I kind of knew what I was doing.
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And then there's a couple of other things that are particular to the
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transition that are areas to be mindful of.
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One is that there's constant work and it's kind of never ending and that
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you're always working against a deadline.
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So those particular aspects of the job can be add more and more stress.
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And then one other thing that can be either a protective factor or a more
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stressful factor is your relationships at work.
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So with your supervisor, with your colleagues, with the staff that you
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work with on the supports, the supporting staff, medical assistant team,
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nursing team, things like that, your office manager, those kinds of
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relationships can be helpful in terms of protecting you from stress.
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However, if they're not there, that can kind of like add more.
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So just hold that thought.
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So the next thing I want to talk about is burnout.
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So burnout is a gradual process and it's basically coming from not
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having enough support and results in this feeling of like, I'm
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not even making a difference.
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So you're seriously stressed, unable to cope, and you're
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underappreciated and overworked.
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And if that sounds familiar, stick with me, stick with me.
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But yeah, so, so this is definitely the place that it can get to.
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If we don't handle our stress in positive ways and in helpful coping ways.
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Um, so it's just stick with me.
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So compassion fatigue, if you haven't heard of that before, was really
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impactful for me to learn about as a nurse, I used to work as a staff
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nurse in the hospital setting.
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And, uh, basically the definition is that it's secondary trauma from
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working with patients and families.
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Um, uh, so if that sounds a little bit odd, just, just stick with me,
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and I'll, I'll talk about it.
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No symptoms of compassion fatigue might, uh, might come up for you.
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But basically the risk factors for developing this or that you are more
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other director, other directed than you are self-directed, um, and it
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can also bring up a lot of feelings from the past in terms of that
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secondary trauma, trauma doesn't necessarily have to be something,
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um, uh, very unusual or extreme.
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It can just come from the everyday traumas of, of caring for people
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who have a difficult life situations, difficult diagnoses, have chronic
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pain, things like that, anything kind of that is, uh, like a negative
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experience for a patient, we can absorb that.
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And so one of the risk factors as well is that if we have these
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kind of unhealed hurts from the past of when we're dealing with
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patients who have similar experiences or things that remind us of those
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experiences, that can kind of trigger this compassion fatigue
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experience as well.
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So the symptoms of compassion fatigue.
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So I'm going to talk about in a second, how to differentiate the, the
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different kinds, but I want to talk about the symptoms of compassion
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fatigue, just so you can kind of make sure that, uh, you are aware
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of whether or not you're experiencing this.
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So a really common experience is bottling up emotions and stuffing
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them down, um, this kind of impulse to rescue everyone in need or help
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everyone in need other copings, uh, related to compassion fatigue is
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this kind of self isolation and just kind of, uh, drawing
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inwards and only being at home and not necessarily doing things for fun.
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Just kind of like keeping yourself away from the world, um, sadness,
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apathy, excessive complaining.
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And that really comes from this sense of, um, powerlessness, uh,
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lack of interest in self-care practices, nightmares, flashbacks,
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persistent physical ailments, uh, being prone to accidents,
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difficulty concentrating, self-destructive behavior, debt,
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financial problems, all that stuff.
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So if that's sounding, um, a little bit familiar to you, um,
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definitely, definitely, uh, stick with me and we'll talk about it.
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So, so how do we know where we're at?
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So you can probably tell just from listening, if you're
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experiencing any of those things, just kind of regular stress
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versus approaching burnout versus, um, experiencing compassion fatigue.
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You can have all of them, quite honestly, you don't
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have to pick one or the other.
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Um, to figure out where you're at though, um, there's this,
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there's this test called the pro qual, the pro, uh, professional
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quality of life, I believe, which I'm linking to down below
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this video, I definitely recommend you go through it.
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If you're noticing any of these symptoms in yourself, or if you're
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thinking about how to prevent it in the first place and basically
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it's 30 questions, it's really, it's really quick.
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That sounds like a lot, but it's really quick.
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You just kind of give a rating to different statements.
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Um, and it breaks it down by different areas.
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One is, um, first of all, your satisfaction when it comes
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to your caregiving role, um, how much do you actually
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enjoy the work that you're doing?
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Number two is, um, how burnt out are you, if you're burnt out.
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And then number three is a scale about compassion fatigue.
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And it's kind of mild, moderate, and severe.
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And you can kind of identify where you're at in each of those
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categories to kind of make your plan kind of going forward.
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So, so how do we, how do we prevent this or treat these situations?
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So number one is self-awareness.
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And so if you are taking that test or you're thinking about your
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symptoms and you're just mindful of that and mindful of the risk factors
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of, again, like other directed instead of being self-directed, um, not having
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the support at your workplace with your colleagues and, um, having too much
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work and, uh, kind of always feeling behind like that kind of stuff.
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Uh, the other one is boundaries.
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And I'm going to explain kind of each of these as some
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suggestions to use relationships, like I just said, and then
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some strong coping skills.
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So there's foundations of self-care and I put all of those
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things in the self-care category.
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One of the things that I get really frustrated with is that when it comes
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to self-care, a lot of the discussion is about, um, the basic stuff, right?
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When this is all important.
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So we'll start here, but, um, eating three meals a day, uh, eating
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vegetables, uh, not drinking alcohol excessively, caffeine excessively,
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um, smoking exercise, making sure that you're getting enough
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exercise, getting enough sleep, limiting your kind of, uh, traumatic
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experiences.
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And I know there's, um, it's hard, especially right now, not to kind
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of be glued to the news and social media, um, but kind of just being
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mindful of, of what that does for you and what the limits are there.
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You know, um, so, so aside from those self-care practices, those are
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that, that's what kind of frustrates me sometimes because it makes it seem
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really simple and it's just those things, but it's actually more than that.
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Um, so one thing that you're probably going to be resistant to, if
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you're anything like me is, um, feeling like you want to take care of
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everybody else before yourself.
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So putting others first, and I know you've heard it a thousand million
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times about putting your oxygen mask on first, like on the airplanes.
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It's really true.
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And I would really encourage you to make a commitment to that, even
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if you're feeling resistant, because that is the key to it in a lot of ways.
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Because if we don't take care of ourselves, we can't continue to
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care for others and we can't really continue to be in our spectitioner.
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It's a, it's a really strong recipe for stress burnout and
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compassion fatigue, um, and boundaries.
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So a couple of different there, I could talk forever about boundaries.
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And this is something that I'm working on as well.
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And by the way, all of these topics I'm sharing because I've
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experienced all of them and I struggle with self-care actually before
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I get into boundaries, um, one of the pitfalls I want to bring up
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is I love pearls and pitfalls pitfalls of this whole, um, treatment, prevention
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and treatment is making sure that you're, um, doing it consistently,
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like identifying authentic self-care practices that you can do consistently.
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Um, and that you keep going even when you feel good, because most people,
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myself included will do self-care practices until they're feeling like,
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oh, I don't need to do this anymore.
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Like I feel fine.
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And then it's a, it's kind of like a slippery slope back into that place
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of either burnout, stress or compassion fatigue, things like that.
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So boundaries, um, one particular one that is important for a nurse
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practitioner transition to practice is having conversations with your
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supervisor, um, your colleagues and your support staff.
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And I feel like, again, I could go on and on about boundaries and
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this is something I'm developing in as well, but I think one of the main
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things that I see is that new nurse practitioners are willing to take any
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jobs and willing to do anything they have to do on the job to keep that job
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despite its effect on themselves.
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And I definitely put a stake in the ground that you are worth it to have
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a good job with good support, um, with somebody who really cares about you
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an employer that really cares.
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So anyway, I could talk forever, but identifying for yourself,
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Hey, am I overwhelmed?
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Am I overworked?
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Is this too much?
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Is this too soon?
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Again, keeping in mind that like desire to prove yourself that, and
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I'm saying that because that's how I felt too.
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And this is like a common theme of like, it's okay.
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If it's too much, like you, it's not normal to take on 20 patients
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after two weeks of orientation, right?
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Um, a day in the clinic setting.
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So thinking about what is working for you, what's not working for you,
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just having that dialogue with your supervisor, um, and just kind of
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asserting where your boundaries are and what's appropriate and what's not.
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And reaching out if you're not sure if what you're doing is appropriate.
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Um, taking breaks when you need them, listening to yourself.
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So like, I know a lot of people work through lunch because
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they don't want to bring work home, but like, that's fine.
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Like whatever you want to do, but just keeping in mind, does that work for you?
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Is this contributing to your stress and your feelings of burnout or
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your feelings of compassion fatigue, right?
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Um, a couple other things, uh, just in terms of prevention and treatment,
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one of the things is identifying the things that let you up at work.
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Like what, what exactly are you excited about and trying to
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minimize the things that you're not excited about.
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So, um, for me, I don't super love writing notes.
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So I have a lot of quick texts.
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I do my best to get them done as quickly as possible so that I can spend
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more time talking with patients.
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Easier said than done, right?
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If you're brand new, but, um, or you're on the newer side, but yeah,
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just kind of like making an inventory of what are the things that are kind
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of going to fill up your cup so that you can continue to, to give,
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because this is a giving profession.
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Um, kind of two to three other things.
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Um, one is prioritizing non-work activities.
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So I am prone to being workaholic and myself personally, and I love what I do.
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So it's really hard not to get sucked into always working or always caregiving
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because when I'm not working, I'm taking care of my family.
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So, um, making a concerted effort, again, not falling into that pitfall.
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Like I love what I do for work so that I don't ever do that.
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Maybe you're not in that place.
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Maybe you're kind of feeling like I wish I could work less and I
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just have too much on my plate, but making a concerted effort to identify
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what are the things you actually like to do outside of your work and
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caregiving and doing those things.
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And if you're having a hard time connecting, one of the tips that
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Patricia Smith mentioned in her book was thinking about what you like to
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do as a kid, what you used to like to do, and kind of using that as
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an inspiration to reconnect with that and excuse my construction outside.
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Um, and then the last thing I think I'll wrap up here is examining your
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why, and so this, I'm not going to talk a lot about, I definitely
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recommend checking out the book, um, that I mentioned, To Weep
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for a Stranger, if you haven't already, um, because it gets a
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little bit more into this, but I think that that is one of the keys
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in terms of this self-care, um, consistent, like filling up your
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cup so that you can continue.
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It's like, basically that's the paradigm of caregiving, right?
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You fill up your cup, you empty it out, you fill it back up,
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you empty it out, right?
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Um, and sometimes we have, uh, um, unhealed hurts from the past
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that have led us into the position that we're in and it doesn't
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necessarily truly joyfully light us up inside.
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It's just kind of like where we found ourselves.
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So that's really important is just examining deeply the why you're doing
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it, why you're in this profession in the first place to make sure that
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it's a healthy, sustainable, happy experience because you deserve joy.
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You deserve to have, um, an excellent, um, life and
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career and all that stuff.
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So, um, yeah, if you're kind of feeling like that's maybe
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bringing some stuff up for you, definitely consider reading that
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book and also getting support.
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You know, if you're, if you're in this place, especially if you have a
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high score and that pro qual, definitely getting support either
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from your colleagues, supervisor, therapist, friends, family, things like that.
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So, so yeah, so that's it for me, but, uh, let me know.
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I would love to know from you if you, uh, what are the things that you
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like to do that fill up your cup again, um, in that cycle of kind
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of fill up and empty of caregiving.
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Um, I love hearing about that.
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If it's makeup artistry or clay figures or whatever it is that excites you.
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Um, and if you liked this video, hit like and subscribe and share
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with your NP friends so together we can reach as many new nurse practitioners
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as possible to help make their first years a little bit easier.
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Thank you so much for watching.
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Hang in there and I'll see you soon.
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That's our episode for today.
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Thank you so much for listening.
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Make sure you subscribe, leave a review and tell all your NP
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friends so together we can help as many nurse practitioners as possible.
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Give the best care to their patients.
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Take care and talk soon.
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