Self-Awareness: A Critical Nursing Shortage

Written by on September 28, 2012 in Insight - No comments

A nurse’s workday is full of people in need:  patients and their family members struggling to understand and cope with their medical conditions, co-workers requiring assistance, demanding physicians and administrators.  Then, at home they are often still helping others:  children, spouses and partners, elderly relatives, friends, volunteer work—the demands and requests may seem never-ending.

Most nurses are drawn to their professions by a desire or need to care for others—and many are more likely to think that taking time for self-examination or self-care is highly self-indulgent.  As a result, nurses are often less apt than the general population to pay attention to who they are, what they like, value and fear, what they need and why they do what they do.  Nurses who lack this “self-awareness” are often:

  • Overwhelmed with responsibilities at work and at home—because they never say “no.”
  • Resentful that they are overworked and overtired—because they don’t believe it’s right to request time to recharge or request that their organizations provide resources to help them.
  • Willing to accept punitive or negative feedback—because of their own unrealistic and unachievable expectations for   themselves.

Developing and using a healthy sense of self-awareness is a necessary first step toward being able to not only take better care of themselves, but also to becoming more resilient, setting healthy boundaries at home and work, engaging in healthier behaviors—and, ultimately, becoming a better nurse and caregiver.

A Practical Guide to Self-Awareness

Some people have an intuitive knowledge of their feelings.  But, for most, raising self-awareness takes a conscious effort.   Paying attention to one’s “inner dialog” is critical to becoming more aware of one’s needs and recognizing that individual approaches taken often only rationalize and justify less than healthy ways of thinking and acting.

In coaching nurses who are feeling overwhelmed or burned out, we ask them if they:

  • Know which emotions they are feeling and why?  Example:  “I’m feeling disappointed and uncomfortable with the way that surgeon is communicating with me.”
  • Realize the links between their feelings and what they think, do and say?  Example:  “I asked to be transferred because the nurses on this unit are critical and I end up feeling inadequate when I work with them.”
  • Recognize how their feelings affect their performance?  Example:  “I’m so upset that I need to take a few minutes to calm down before I start filling medication orders.”
  • Have a guiding awareness of their values and goals?  Example:  “My patient’s safety is more important to me than what Dr. X will say when I wake him up when he’s on call.”
  • Know the things they want others to know about them?  Example:  “I take care of my elderly mother.  I take responsibility for what I do.  I love camping and hiking!”
  • Know the things that they want and need?  Example:  “I’m sad about losing that patient.  I need to take a walk outside and come to terms with my feelings of grief. “
  • Draw appropriate boundaries with others?  Example:  “No, I can’t help out with the class trip next week.  I’ve been looking forward to seeing a dear friend.”

It’s important, when working toward greater self-awareness, to recognize that nobody makes anyone feel anything when they’re truly self-aware—we choose how we feel.  In the end, we’re better caregivers when we take care of our own needs.

Translating Self-Awareness Into Self-Care

 After becoming more aware of one’s feelings, it’s time to put that knowledge to work in daily life.  In making choices in terms of how to react to situations and how to balance work and life responsibilities, we coach nurses to do the following:

 Manage emotions:  Things will still happen that will leave feelings of anger, frustration or unhappiness.  However, the impact of those emotions—the degree they’re felt and for how long—can be a choice, not a foregone conclusion.  For example, getting yelled at is never pleasant, but it doesn’t have to be devastating.  Below are some techniques we couch our nurses to explore.

  • Communicate concerns clearly and quickly.  Example:  “I feel hurt and angry with how Dr. X communicated with me today.  I’m going to let her know how I experienced her communication and get it off my chest.  Hopefully, it will make a difference the next time we work together.”
  • Refuse to dwell on negative thoughts or emotions.  Example:  “I resent being talked to that way but hanging onto this resentment makes me feel awful.  Is there anything I can do to change the situation?  I will choose to invest my mental energy in other places and think about more uplifting things.”
  • Avoid negative behaviors.  Example:  “I’d like to tell everybody what a jerk Dr. X is but that only adds to the gossip mill and keeps me thinking about it longer than I have to.  I’m going to mention it to my nurse manager in case it happens again and then let go of it.”
  • Admit to mistakes.  Everyone makes mistakes, sometimes small, sometimes catastrophic.  Agonizing over mistakes doesn’t erase them—looking for short- and long-term solutions can.  Example: “What can I do right now to improve the situation?  What could I have done differently?  How can I avoid making the same mistake again?”
  • Accept and act on valid feedback.  While nobody has the right to yell at others, a doctor, supervisor or co-worker may occasionally point out a performance area that needs improvement.  If it’s valid, own up to it, apologize if necessary and commit to improving whatever skill or behavior is deficient.  Unless the mistake is life threatening, nobody will expect changes to occur overnight.  They’ll be looking for progress, not perfection.

 Self-advocate:  For many caregivers, putting themselves first doesn’t come naturally.  Putting off exercise, sleep and fun is so ingrained that many nurses have to formally add exercise, sleep and fun to their daily to-do lists—and give them the same weight as work or family responsibilities (that’s why it’s called work/life balance).  Our recommendations are:

  • Journal:  Keep a notebook at the bedside and spend a few minutes each night writing down every positive experience from that day and then things to do tomorrow.
  • Exercise:  Commit to regular exercise—the more fun it is, the more appealing it will be.
  • Sleep:  Identify sleep patterns and needs and strive to optimize them.  Getting adequate sleep is critical to emotional and physical health.
  • Stretch and meditate:   Both are proven to reduce stress and increase energy.
  • Indulge in indulgence:  Find affordable treats and luxuries —from bubble baths and ice cream cones to picnics or grocery store flowers.
  • Connect with friends:  Regular events like book clubs are a great way stay in touch without having to coordinate schedules each time.
  • Disconnect technology:  When not on call, turn off cell phones and computers while having dinner, visiting with friends—or just relaxing.

Case Study:  From Self-Awareness to Self-Care

A middle-aged nurse contacted us because, a year after ending her marriage to a mentally ill spouse, she was depressed, exhausted and frustrated that she wasn’t getting the help with chores she felt she needed from her adolescent kids at home.

In discussing her kid’s non-responsiveness, she realized that her guilt over staying in the marriage as long as she had now made her reluctant to hold her kids accountable for meeting her perfectly reasonable demands.   In discussing her exhaustion, it became clear she was working too many hours and then spending her free time meeting the needs of everyone else in her life except herself.

With that new awareness, she began insisting that her kids shoulder their fair share of household chores.  She also began building a network of exercise buddies and a schedule for working out that was both fun and got her to work feeling more energized, confident and happy.

In just two weeks, this nurse had discovered a variety of small ways to make a dramatic improvement in her outlook and life.

Other Avenues to Explore

Everyone experiences the journey to self-awareness and self-care differently.  For those who are struggling, there are many avenues to explore.  The first might include an Employee Assistance Program (EAP), if one is available, for counseling, coaching and other resources.

Aside from an EAP, there may be affordable counseling services in the community.  In most cases, employee health insurance provides coverage for these services.  A session or two may be all that is needed to provide some insight about what is going on in one’s life and to create a plan for aligning behaviors and attitudes with a more rewarding nursing career and life.

Other resources to consider include:

  • Clergy or spiritual advisors
  • Hospital chaplains
  • Self-help courses and books
  • Mindfulness meditation courses
  • Local support groups (especially ones with other nurses and health professionals)

There is more support out there than most are aware of.   Committing to taking better care of oneself is an important part of achieving greater self-awareness.

Liz Ferron is a senior Employee Assistance Program (EAP) consultant and manager of clinical services at Midwest EAP Solutions in Minneapolis, Minnesota. . For more information, visit


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