What does it mean to practice self-care? What does it look like to care effectively and compassionately for our patients while maintaining our own physical and emotional health? Nurses everywhere know well the delicate struggle for work-life balance that seems just beyond our grasp. Thoughts such as, I should have done/said that one more thing, gone one step further, stayed 10 minutes longer, or What more could I have done? can be constant companions. If we are not careful, these thoughts tip that delicate balance and lead us to choices that send us hurling toward the road to burnout.
SELFISHNESS OR STEWARDSHIP?
Nurses make sacrifices again and again, often at the expense of their own health. Caring for others is a core foundational value in nursing, and we provide compassionate care for those hurting and needing our help, both at work and at home. What do we do when our own “tank” is empty? Where do we look for refreshment? As followers of Christ, we know to turn to him, but what does that look like in daily life and work?
In recent years, nursing associations have incorporated the importance of self-care into models for good nursing practice. Self-care such as good nutrition, sleep health, time with family and friends, exercise, and stress management techniques are considered essential elements to personally incorporate into our regular routines (Help Guide, 2019). To borrow a phrase common to airlines, this is a way to “put on our own oxygen mask before helping others with theirs.” Initially I resisted the term “self-care” due to the focus on “self” and thinking, Isn't this selfish? I had difficulty incorporating caring for myself with a clear conscience.
Frustrated and confused, I asked God for his perspective. I realized that the way I viewed, treated, and spoke to myself was much more negative and harsh than the way I treated my patients, coworkers, or family. I knew God had a better way, and I silently pleaded, God, this would be so much easier if it wasn't me I had to care for! Then this verse came to mind: “...You are not your own; you were bought at a price. Therefore honor God with your bodies” (1 Corinthians 6:19-20, NIV). It struck me: As a believer in Jesus, I am not caring for myself just for me, I am caring for someone who belongs to him, the exalted and most high King! I'm his chosen, special possession, purified as his very own (Titus 2:13-14; 1 Peter 2:9), and in his love he paid the ultimate price of his life to make me his righteous child forever (Romans 3:21-26; 2 Corinthians 5:21; 1 John 3:1). These passages changed my perspective from one of selfishness to one of stewardship.
Theologian A. W. Tozer, in The Knowledge of the Holy (1961), declared that the most important thing about us is our view of God. When my view of God as Creator, King, and Savior shapes my view of myself, it makes all the difference. If someone entrusted you to care for something of value that he made and he owns, would you not want to help take care of it and protect it? The answer depends heavily on your level of regard for that person.
At the core, self-care is not about work-life balance, stress management, nutrition, or exercise. The presence or lack of those things is merely symptomatic. The underlying diagnosis is our disease of a misplaced identity. Peter emphatically states in 1 Peter 5:7, “Cast all your anxiety on him because he cares for you” (NIV). Do we believe we are worth caring for? The answer should be a resounding yes.
Are not two sparrows sold for a penny? Yet not one of them will fall to the ground apart from the will of your Father. And even the very hairs of your head are all numbered. So don't be afraid; you are worth more than many sparrows. (Matthew 10:29-31, NIV)
Again, Jesus affirms our worth, declaring that he is the Good Shepherd who “lays down his life for the sheep” (John 10:11, NIV) in stark contrast to the hired hand who does not own the sheep and cares nothing for the sheep (John 10:12-13).
A PARADIGM SHIFT
When we practice self-care from a stewardship point of view, we are joining in on what God is already doing and has been doing all along! Often, our self-care activities can stem from a heart attitude of resignation mixed with desperation: Well, if I don't take care of number one, no one will! This lie is directly opposed to the truth of God's attentive, sacrificial, and faithful care as our perfect Shepherd described by David in Psalm 23. God is more interested in why we do something rather than the behavior itself. He wants to take us to higher ground, radically changing us from the inside out, beginning with the lies and unbelief in our hearts.
Because of imago Dei, or being made in “the image of God,” our ability to care, love, nourish, and cherish comes from him as he does those things first for us. Knowing this changes our cries of desperation into cries of gratitude!
Practically speaking, this shift isn't easy. It requires walking in faith by God's grace because we sometimes cannot “see” or “feel” the fullness of God's care. I am discovering that grateful reverence is the key to this treasure. As I asked God to open my eyes to his care for me, he led me to first thank him out loud for the truth of his Word that he always cares, loves, and provides for me and those around me, even when I cannot see it. This opened the floodgates of my heart in a new way, and I saw God through new eyes.
When God renews your view of yourself, a renewed view of others follows. I began to see others as God does. When looking at my patients, especially those who are more challenging, I find myself increasingly remembering that God made them, graciously cares for them, and loves them. This helps me to interact and respond more positively, not as concerned with their fifth request to use the bathroom, their biting remarks about having to wait, or that I've answered the same question for the tenth time as they're coming out from anesthesia. Instead of remaining irritated that preoperative instructions were not followed, God is helping me to view this as an opportunity to extend his grace and patience and overlook the offense (Proverbs 19:11). By so doing, I've discovered a renewed, God-given energy. There's no denying that patients and their families can be demanding, but God increasingly works in us to will and to act in order to fulfill his good purpose (Philippians 2:13). As I've aligned my heart with his, he extends a bit more energy and ability to care.
PRACTICING SELF-CARE AS STEWARDSHIP
My work in outpatient surgery can be very fast-paced; there are times when I have difficulty keeping up with the timely demands. Earlier in my career, I refused medicine or supplements that may have helped me handle the stressful environment and demanding hours. My refusal stemmed equally from pride in thinking I could handle it myself, shame that I couldn't and therefore mustn't have enough faith, or that God would be disappointed in me. Can you relate?
The solution has been simple and yet humbling as Jesus spoke to my heart: “Remember your identity. Taking a vitamin or nutritional supplement doesn't change how I look at you. Just take it and thank me for it!” This was a game-changer as I took a posture of humility and thanked God, the giver of every good gift, for providing something natural and safe to help me have better tolerance for stress. The results have been dramatic. By knocking my pride aside, admitting my weakness, and giving my body what it needs, my stress threshold is not only greatly increased during busy days at work, but I make better and more focused choices in prioritizing time at home as well, leading to a much better work–life balance.
For me, self-care begins and ends with worship and gratitude (see Sidebar: Self-Care for Nurses). When I choose to remember and meditate on the beauty of Scripture regarding how much I am cared for and loved unconditionally, without having to earn a thing or prove a point, this stirs a desire to freely care for others and myself out of a grateful heart. Instead of feeling guilty for taking extra time for self-care physically via nutrition, exercise, rest, or setting boundaries where necessary, I thank God for these options. What a wonderful heart recalibration that brings an awareness of the One who “...richly provides us with everything for our enjoyment” (1 Timothy 6:17, NIV) into my daily activities through gratitude!
When your identity is secure in Christ, it changes everything. It's not as big of a deal to ask for help or admit weakness. Managing your image and what people think of you doesn't matter as much. One begins to realize it is not the end of the world to get pushback from setting a boundary and saying no. I am not advocating laziness, but I am advocating the examination of heart motives and the why behind the decisions. Are you picking up that extra shift out of feeling you have something to prove to your family, coworkers, or yourself, or because you genuinely have the time and energy to do so? Jesus speaks in Luke 14:28-30 about the importance of counting the cost, in particular before becoming a disciple, but the underlying principle is wise advice.
Jesus had to work, eat, rest, attend social events, and relate with various people and situations just like we do. He lived in perfect dependence on his Father through prayer and continual communion with him, knowing full well his divine identity and divine mission. May we gaze at his perfection rather than striving to be better, humbly thanking him for doing what we cannot do, for dying in our place, and for enabling us to live for him in the resurrection power he provides. May we be like David, proclaiming, “For with you is the fountain of life; in your light we see light” (Psalm 36:9, NIV).
Our Creator knows better than we do how to care for us. Lean into him when you go to work. Will you thank him and praise him for the way he loves and cares for you, your patients, and your coworkers? Will you thank him for your secure identity and value in him and ask for help in seeing yourself and others the way he does? Blackaby and colleagues (2008) suggested asking God how you can join him in what he has already been doing in your workplace or home and what that would look like. Ask God to show you if his to-do list differs from what you think you have to do. The answers will be different for everyone. Our God is a personal God, delighting that we inquire of him and are willing to be led by his Spirit as he illuminates by his Word our unique paths.
Self-Care for Nurses
Self-care for nurses is developing into an increasingly important concept. An extensive Health Risk Appraisal was coordinated by the American Nurses Association (ANA) from October 2013 to October 2016 (ANA, 2021). Major findings indicate that nurses have higher levels of stress, are often overweight, and generally sleep less than the average American. In addition, shift work demands disturb nurses' health. Workplace violence and musculoskeletal injuries are among the risks found in nursing (ANA, n.d.). In fact, 68% of nurses surveyed stated that they put health, wellness, and safety of their patients ahead of themselves.
The ANA established the Healthy Nurse, Healthy Nation (HNHN) Grand Challenge in 2017 as a national movement to improve the health of approximately 4 million registered nurses (RNs) in the United States (ANA, 2017). Partnering with schools of nursing, state boards of nursing, and healthcare organizations, the HNHN Challenge currently has 520 organizations and 117,000 RN members. If nurses and nursing students have improved health, wellness, and safety, they can work more effectively as educators, advocates, and role models. To join the Healthy Nation Challenge, go to hnhn.org or text healthynurse to 52-886. Once registered, participants are asked to complete a short survey before obtaining access to a myriad of self-care activities. The options are grouped into five areas: rest, nutrition, physical activity, quality of life, and safety.
Another resource is posted for nurses on the ANA website. An e-book entitled: Self-Care and You, advertised as a detailed guide with six self-care pathways to guide one's lifelong journey in self-care, is available for purchase (Richards, Sheen, & Mazzer, 2014). The pathways discuss compassion fatigue, burnout, nutrition, exercise, rest, mental self-care, mindfulness meditation, stress self-talk, stress yoga, and Tai Chi practice. This e-book is accessible through https://www.nursingworld.org/nurses-books/self-care-and-you-caring-for-the-caregiver/
Christian nurses may find the steps listed in “Faith-driven Self-care” helpful. These steps include 1) spending time with God; 2) bringing self-care into prayer time; 3) surrendering to God's will and timing; and 4) making small steps of obedience and big leaps of faith (My Life Nurse, 2019). A Nurses Christian Fellowship blog post (McKinnon, 2018) dedicated to the topic of self-care is titled “Do You Care for Yourself?” Important information gleaned from this blog post includes identifying that Jesus knew how vital self-care and rest were. In Mark 6:30-31, Jesus told his disciples to rest after they performed exhaustive mission work. Jesus took time to be in silent prayer away from the crowds. There is concern that life stressors can act to cause spiritual disconnection in people who may turn away from God, resulting in greater stress. McKinnon (2018) suggests adhering to the “Three P's”: find your passion, your purpose, and a person to bless. This moves the focus from oneself and one's problems. God's Word, music, prayer, readings, and time alone with God move one toward peace. Further, avoid overcommitment and learn to say “no” to too many requests, which can cut into self-care time. Colossians 3:23 (NIV) states, “Whatever you do, work at it with all your heart, as working for the Lord, not for human masters.”
The following “Prayer for Self-Care” found in a Nurses Christian Fellowship blog post is a fitting way to start or end a nurse's day:
Dear Lord, help me. Show me how to care for myself so that I can be strengthened to care for others. Forgive me for the times I have neglected my time with you. Give me wisdom to balance my life according to your will. Where I am weak, please make me strong. Where I am hurting, please heal me. When I am fearful, please release the fear. I pray for sound mind, purity of heart, and peace. I pray you teach me how to rest when my mind races. Show me how to live a balanced life and remove all distractions that come my way. I only want to walk through the doors you open, Lord. Thank you for forgiving me and loving me just as I am. Amen. (McKinnon, 2018, para. 9)
—Mary Helming, PhD, RN, FNP-BC, AHN-BC, JCN Contributing Editor