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May 9, 2012 - It’s mid-afternoon, and your energy is waning. You’re sleepy and a little cranky, so you pour yourself another cup of coffee to propel you through the rest of your shift. How many cups have you already had? You’re trying not to think about that.

It’s a scene repeated daily in hospitals, clinics and offices all over the United States. Many of us function on less sleep than we really need, so we adopt survival mechanisms to help us.

In fact, a report in the April 27 issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report noted that about one-third of the U.S. workforce gets six or fewer hours of sleep per night. That’s at least one hour less than the National Sleep Foundation’s recommended amount of nightly sleep, which is seven to nine hours.

“We have this idea that we can be a 24-hour society and function well,” said Arlene L. Johnson, Ph.D., RN, a nursing researcher at George Mason University, who has studied sleep and performance in nurses.

“But it’s not true.”

Common signs of inadequate sleep include mood swings and irritability, an increased inability to concentrate, memory problems, weight gain, and of course, feeling drowsy or tired during the day.

“Getting by” on less sleep than you really need isn’t the ideal way to function. For one thing, it could have serious consequences for your patients. You may not be alert enough to deliver the top-notch care that your patients expect from you–or that you expect from yourself. You might even make a mistake.

Chronic sleep restriction affects your critical thinking skills, noted sleep expert Michael Decker, Ph.D., RN, the Byrdine F. Lewis Chair in Nursing and associate professor in nursing, neuroscience and respiratory therapy at Georgia State University.

“As a person suffers reduced sleep, their reflexes become slower and their decision-making skills become reduced,” said Decker, one of only a handful of registered nurses certified by the American Board of Sleep Medicine.

Three studies that provide additional evidence:

• A 2006 study in the American Journal of Critical Care titled “Effects of Critical Care Nurses’ Work Hours on Vigilance and Patient Safety” examined logbooks completed by 502 critical care nurses. Those nurses routinely worked longer shifts than they were supposed to, and that tended to decrease their vigilance and increased the likelihood of making errors. According to the authors, these findings supported recommendations from the Institute of Medicine recommendations to limit nurses’ work hours to 12 consecutive hours during a 24-hour period and reduce or minimize the use of 12-hour shifts.
• A 2003 study in the journal Sleep found that sleep loss and drug use can have similar effects on people. The authors of “Ethanol and Sleep Loss” wrote that sleep loss “was more potent than ethanol in its sedative effects but comparable in effects of psychomotor performance.”
• A 2011 study by Penn State College of Medicine researchers found that a surgeon’s brain has to work harder to learn new tasks when she is sleep-deprived, which could have ramifications if unexpected events occur during surgery. The study was published in the American Journal of Surgery.

But it’s not just your patients who are affected by your lack of sleep. You suffer, too. According to the American Academy of Sleep Medicine, good sleepers have a better quality of life and suffer less depression than people who don’t get enough sleep.

Additionally, people who don’t get enough sleep have a greater tendency toward developing conditions like obesity, high blood pressure, diabetes and metabolic syndrome.

“Most nurses are carers or givers, and we tend to ignore our own body,” Johnson said. “Our body is telling us what we need, and we tend to ignore that, and we try to move forward.”

But, she cautioned, if we want to live longer, healthier lives, we have got to put a higher premium on sleep. “It’s imperative that you take care of yourself now, and one way to take care of yourself is to get a good night’s rest,” she said.

How can you improve both the amount of sleep you’re getting and the quality? For those not working the night shift, experts suggest developing a nightly routine. Try to get to bed a little earlier, and give yourself some time to “wind down” before going to bed, and disconnect yourself from all your electronic devices. And if you need to employ some accessories to help you shut out the world, definitely go that route.

“Whatever it takes,” Johnson said. “If it takes eye covers, if it takes ear plugs, if it takes getting darkening shades for your room.”

Those steps can also be helpful for nurses who work the night shift and need to block out the daylight and the daytime noises when they’re trying to sleep. It is definitely harder to get enough sleep when you’re a night-shift worker, Decker said.

“They need to protect their sleep in the daytime,” he said. “The rest of the world doesn’t know that you’re a night-shift nurse, so the phone still rings in the daytime, people still show up at the door.”

Plus, you are working against your body’s own circadian rhythms, particularly if your job requires you to work rotating shifts. “It’s very difficult to train your body to stay awake at night, and then two weeks later, expect your body to stay awake in the daytime,” Decker said. “So if nurses have rotating shifts, they’re in a state of chronic sleep restriction.”

Other strategies that can enhance your ability to get the sleep you need include dialing back on the caffeine in the later part of the day and getting some exercise. Exercise has been shown to enhance the slow-wave sleep that’s restorative for your body and brain, Decker said, and you need to get enough of that to be well-rested.

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April 29, 2012 – Patient safety is at the forefront of health care industry concerns, and because of the role of nurses in direct patient care they have ideal experiences for leading the industry in addressing these concerns. Nurses can work in a myriad of patient safety positions, ranging from informatics to risk mitigation to quality improvement.

“The message is consistent: we need to have nurses taking a leadership role in redesigning clinical processes and health care delivery in order to contribute to improvements in patient safety,” asserted Mary Beth Edmond, RN, MBA, senior nurse executive and executive vice president for Juran Health Care, a consulting firm that assists health care providers with improving quality of care while reducing costs. “Because they are working day to day at the bedside, nurses need to be trained as leaders in how to improve processes that result in better patient outcomes.”

In the realm of patient safety, Edmond notes that the typical career opportunities exist in most health care settings: risk management, infection control, patient safety and compliance officers.

“Where I see advances is in nursing informatics,” she said. “Nurses have opportunities to be involved in the design and implementation of technologies and the redesign of nursing processes in order to improve safety and clinical outcomes.”

“There are really a ton of opportunities in this field,” stated Paul Craig, RN, JD, chief human resources and risk officer at University of California San Diego (UCSD) Health System. “Probably 90 percent of the positions are hospital-based, but there are certainly patient safety officers in the ambulatory arena, as well as those who work in either benefit or liability insurance.”

“Ten years ago, nearly all hospital-based risk managers were nurses who had worked their way up the ranks,” he continued. “Mostly they didn’t have advanced degrees, but grew into the position.  Today, people are being more purposeful about going into patient safety as a specialty. An advanced degree isn’t necessarily required, but it is recommended.

Edmond agreed. “One of the changes I’ve seen in the area of patient safety is the hiring and training of specialists. More patient safety officers (PSOs) are being trained in how to lead robust quality improvement changes that will improve customer safety and satisfaction. There is a major opportunity for nurses who want to combine safety and clinical outcomes with process improvements.”

Even so, being a PSO is rarely a nurse’s sole role. Quite often an organization’s chief nursing officer (CNO) or chief medical officer (CMO) also functions as their PSO. Craig doesn’t fault this approach because the PSO must have the ability to influence an organization’s leadership; if the PSO is not a member of the executive suite, then the officer must have the ear of the executives. Edmond hopes that as the importance of the PSO is increasingly acknowledged that it will more often be a position in and of itself.

For nurses interested in pursing a career in patient safety, Edmond recommends that the first thing to do is to become a certified professional in health care quality. Next is to become certified as a PSO.

“There are a number of organizations offering this certification,” she explained. “At Juran we have a five-day training program that covers topics such as how to do a cultural assessment on patient safety, system wide data management, analyzing the reporting of safety measures and root cause and special cause analysis. We require that participants also complete two case studies and they have to evaluate a safety event that happened within their facility. Most important, they have to become teachers. Being a PSO is really about mentoring, teaching and changing behavior.”

“The PSOs who are really doing well are pursuing more robust training in Lean and Six Sigma,” she added. “These improvement methodologies are designed to improve process failures that could lead to a safety event.”

Craig points out that a variety of graduate degrees can benefit a patient safety officer, including a law degree, a master’s in public health, a master’s of health administration or a master’s in health law.

“For people who aren’t in a position to pursue an advanced degree, there are probably about half a dozen nationally recognized certificates, largely self-study with some course work,” he mentioned.

“Ultimately, my goal is to make patient safety ‘invisible,” Craig concluded. “We are always striving to make it easier to do the right thing and harder to do the wrong thing. When we have the right system in place, it will be easy to keep patients safe.”

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By Holly Mosier, health expert and author of Stress Less, Weigh Less

March 6, 2012 – In part two of our health series, I gave you my key eating tips to keep your weight down and energy up. Now it’s time to revamp the way you’re exercising. Study after study has found that exercise is the closest thing we have to the fountain of youth, but it need not take up a lot of time.

As with my eating plan, if it is difficult or time consuming, I won’t do it.  I researched the best and most efficient ways to exercise because I get bored, and I don’t have hours to spend at the gym.

Let me give you the key guidelines that work for just about everyone (don’t forget to consult a doctor before beginning any kind of exercise regime):

1.  Exercise every day for 45 minutes to one hour (even at work).

There’s just no way around this. If you want to lose weight and keep it off, and keep your energy high, you have to exercise 45 minutes to an hour per day, with maybe one day off a week. But you don’t have to have killer workouts every day. Not at all. You just need to move every day.

You can split this up during the day. Studies confirm that three 10-minute exercise sessions throughout the day are just as effective as a solid 30 minutes.

Getting your daily exercise might be easier than you think because all movement throughout the day counts! Constant moving throughout your nursing shifts adds up. Try wearing a pedometer to work; you might be surprised at how many miles you log without giving it any thought. 

2.  Do both cardio and resistance training.

The greater your muscle mass, the higher your metabolism. Resistance training builds muscle, boosting metabolism, and prevents the muscle atrophy that occurs with age. Cardio burns a lot of calories and strengthens your heart and lungs. For complete fitness, you need to do both. 

Author Holly Mosier says that 45-60 minutes of daily exercise is vital to maintaining weight loss and fitness, and some of the walking nurses do at work can count.

Resistance training can include lifting weights, but that’s not your only option. Anything that uses your body weight will do. Push-ups are a classic example. Yoga and Pilates are also examples. I particularly like yoga–not only is it a terrific all-over-body toner, it is a premier stress reducer. To save time, I do one of my 10-Minute Yoga sequences every other day, rather than trying to attend those 90-minute classes when I am just too busy. (I talk more about my 10-Minute Yoga sequences here.)

3.  Use interval training.

The key to reducing the time you work out, while still getting better results, is interval training.  Interval training is where you exercise at a moderate pace punctuated with short bursts of high-intensity effort. 

For example, if you are walking for your cardio exercise that day, you’d walk at a moderate pace for 3 or 4 minutes, and then pick up the pace to a fast walk or light jog for a minute. Then you return to the moderate pace and let your heart rate slowly come back down. You keep repeating this pattern, alternating between moderate- and high-intensity effort for the duration of your cardio session.  

Using interval training is what allowed me to reduce my old 45-minute cardio sessions down to 30-minute sessions with much better results.

About the Author:

Holly Mosier is a healthy-lifestyle expert and author of Stress Less, Weigh Less, as well as a lawyer, business owner, mother and wife.

See all four articles in this special health series on NurseZone:

Part 1: Reduce Your Stress

Part 2: Revamp the Way You’re Eating

Part 3: Revamp the Way You’re Exercising 

Part 4: Easy, Healthy Recipes (Five Ingredients or Less!)

© 2011. AMN Healthcare, Inc. All Rights Reserved.

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By Holly Mosier, health expert and author of Stress Less, Weigh Less

March 12, 2012 – Over the last three articles in our health series, we went through my three-part plan:  first, reduce stress to put an end to out-of-control appetite and cravings.  Next, revamp the way you’re eating, so you’re not only satiated, your blood sugar levels are steady and your energy is high.  Then, revamp your exercise to make it quick and wickedly effective. 

But without fast and easy recipes, you might find yourself tempted to head for the fast-food drive-through after completing a tough, 12-hour shift! 

Let’s remedy that. 

As with my eating and exercise, if a recipe is difficult or time consuming, I won’t do it.  I will never consistently stick to any eating program that requires me to eat out of a box, or follow detailed recipes and use ingredients my family and I aren’t used to.  Simple is my mantra. All of my recipes use five ingredients or less (excluding salt, pepper and cooking spray); plus they are family-friendly and filling.

Here, I’ll share one of my breakfast, lunch and dinner recipes so you can test how fast, easy and filling healthy eating can be. You can find more recipes on my website and in my book.

Breakfast:  Holly’s Cottage Cheese Berry Delight

(Approximately 250 calories)

Holly’s Cottage Cheese Berry Delight

Ingredients:

1 cup low-fat cottage cheese
sweetener (like Splenda)
1/2 cup fresh berries
cinnamon

Measure 1 cup of low-fat cottage cheese into a bowl. Add approximately ½ cup of berries of your choice, such as strawberries or blueberries. Sprinkle Splenda and cinnamon over the top and serve.  I particularly like this recipe because you can take it to work, and it includes cinnamon (which helps keep blood sugar levels steady). 

Lunch:  Holly’s Terrific Tuna Sandwich

(Approximately 490 calories)

Ingredients:

• 1 can tuna packed in water
• 1 tbsp reduced-fat canola mayonnaise
• 1 medium apple
• lemon juice, to taste
• 2 slices whole-grain bread
• garlic salt, to taste

Drain the water from a can of tuna; empty the tuna into a small bowl. Finely chop half of a medium-sized apple and stir into the tuna. Add 1 level tablespoon of canola mayonnaise (the reduced-fat versions taste great and save calories), plus lemon juice and garlic salt to taste. Use 2 slices of whole-grain bread. This tastes best if you toast the bread. To cut the calories, use only 1 slice of bread and eat open-faced, or stuff into half a pita.

Dinner:  Holly’s Cheesy Chicken

(Makes 2 servings, approximately 425 calories each)

Holly’s Cheesy Chicken

Ingredients:

• 2 boneless, skinless chicken breasts
• 2 Tbsp bread crumbs
• 2 slices Swiss or provolone cheese
• splash of wine
• 1/2 cup cream of chicken soup or cream of mushroom soup

This entrée is quick, easy, and delicious. I serve it to dinner guests. Preheat the oven to 375°F. Spray a baking dish with cooking spray. Place boneless, skinless chicken breasts in the baking dish. Place 1 slice of Swiss or provolone cheese on top of each chicken breast. (Reduced-fat Swiss cheese works well and cuts about 30 calories per slice.) Spoon ¼ cup of either cream of chicken soup or cream of mushroom soup over each breast. Sprinkle 1 level tablespoon of bread crumbs over each chicken breast, then pour a splash of wine over the top of each. I use about an ounce per breast and have used both red and white wine. Bake for approximately 1 hour, or until done. Delectable!

About the Author:

Holly Mosier is a healthy-lifestyle expert and author of Stress Less, Weigh Less, as well as a lawyer, business owner, mother and wife.

See all four articles in this special health series on NurseZone:

Part 1: Reduce Your Stress

Part 2: Revamp the Way You’re Eating

Part 3: Revamp the Way You’re Exercising 

Part 4: Easy, Healthy Recipes (Five Ingredients or Less!)

Great paying travel nursing jobs available now!
Design your ideal travel job today.

© 2012. AMN Healthcare, Inc. All Rights Reserved. 

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