8 Tips for Nurses New to Limit-Setting
"I'm too stressed to take another patient right now."
"I'm sorry, I'm not available to work overtime today. I have plans with my family."
"Please don't interrupt me unless it is urgent. I'm trying to administer medications safely."
It is part of being assertive and hard work for many of us, myself included. The desire to help, fix and problem-solve is part of our nursing make-up and saying "No" or "I can't" or even "I don't want to..." may feel risky. Worries about necessary care not getting done are complicated by individual emotional factors such as the need for belonging; fears about being judged; or worries that we are not good, not good enough or not as good as someone else.
There may be organizational expectations or even subtle ones from peers that add to the pressure a nurse feels to say "Yes" even when she or he knows it is not healthy. A unit that is chronically understaffed or a colleague who has a long history of working extra shifts reflect old ways of doing business while the focus on nurses taking care of themselves is a more recent trend.
Setting limits is essential for safe care, healthy workplaces and rewarding careers. This list of tips will help nurses practice the skill while creating a foundation of self- and other-respect.
- Be in tuned to how you feel. Are you stressed? Tired? In pain? All of these may be common and present, and what constitutes too much stress, fatigue or pain is an individual and personal decision that will vary over the course of a shift, lifetime and among us. If you watch the "Interruption Awareness" video, a group of nurses and students helped me create, you will see some valuable teaching moments of what stress looks like and the "Overload" activity is a fun way to develop your awareness about how you are feeling!
- Honor what you are feeling. You are the only one who can really gauge it. Just as we are taught not to tell patients "don't worry" or "don't be anxious," it is much better to validate. A simple internal acknowledgement such as: "Hmmm, I'm feeling sad (or frustrated or worried, etc.) is an important step in understanding and managing your feelings.
- Use ownership language. The above examples show ownership and I-statements can be helpful. Keep in mind that you need not apologize for your feelings or explain them although this is a judgement call. Apologizing for not being available is different than apologizing for feeling fatigued or stressed. Offering a little more information such as the number of overtime hours you've already worked or what plans you have with your family may be appropriate and honoring your role as a team player and part of the larger organization.
- Let the silence be. This has been really challenging for me to learn and yet in this space of silence there is opportunity for others to help. It is also a place where compromise and co-creative problem-solving can occur. If setting limits is new for you, you might surprise others who are used to your willingness to fix, help and problem-solve.
- Try trusting the village. There are toxic teams and workplaces out there, and I would never insist on this tip. However, often times there are others who are willing to help and may need a few moments to think about it. By setting your limit and letting it hang "out there" you may be surprised by who steps up to the plate. And if no one does, you'll have more information about the culture in your team and the toll it might be taking on you.
- Consider compromise. Compromise can be a healthy process providing it isn't a chronic pattern and doesn't interfere with solving underlying problems or lead to working unsafely. Offering to work additional hours from time to time may be part of a work expectation, and, let's face it, sometimes staffing crunches or excessively busy times will happen. And in reality sometimes you'll be able to help and sometimes you won't. There may be some colleagues at different times who help more than others. If patterns emerge that place unfair burdens on other staff, there is a leadership imperative to address these situations case by case. This is true whether it is organizational i.e. staffing, or individual i.e. a colleague who never covers extra hours.
- Accept some anxiety during and after the process. There is often a perceived emotional risk in saying "No," and during the silence you may feel your heart racing. Just note it and take a deep, slow breath. You may also feel insecurities arise after someone has honored your limit or you've reached a compromise with others. This may be a rich opportunity for you to learn more about what motivates you to help others. Do whatever works for you to manage stress. Take a deep breath, go for a jog or journal about your experience. It's new emotional territory, and very normal to be a little anxious. If you find yourself excessively anxious, get some help from a counselor or talk to a trusted friend. It is good to get to know and take care of yourself!
- Validate the limits of others before negotiating a compromise or challenging someone else's limit, and be careful not to judge. A nurse who never works overtime may have family obligations; a reasonable accommodation for a disability; transportation issues or a lack of understanding of job expectations, or be unwilling to meet them. These present opportunities for dialogue that lead to better understandings of the nurse's limits as well as organizational expectations. Either or both may be reasonable or not, and lead to positive change or not.
In my case, nurses who can set healthy limits and respect the limits set by others will be role modeling respectful communication, and contribute positively to their workplace culture and the delivery of safe care.
*This article originally appeared on ConfidentVoices.com.