Nurse burnout-symptoms and how to prevent

Hi, everybody, and welcome. Welcome to the Lefora talk show. This is season three, episode four. We are so excited today to have a very esteemed panel that will be joining us. I am your host. My name is Tanya Freedman, and I'm the chief executive officer of Connetics USA international nurse recruitment agency. We help nurses come to the United States and have done that for many years. I'm so excited today to welcome our panel. We have Carla joining us. Hi, Carla. Good evening, everyone. Welcome. We also have Leanne joining us. Hi, Leanne. Wonderful to be here. Thank you. And welcome. And last but not least is Paul, who needs no introduction to the Lefora Forum. Welcome, Paul. Hello. Hi there. So our topic today is health care for nurses, how to manage and prevent burnout. This is a very important topic. Even before the pandemic, there was lots of reports of nurses getting burnt out, both physically, emotionally, spiritually. And now with all of the extra stresses of the pandemic, this has become much more of a hot topic. So very excited to dig deep into this topic today. And before we get started, I just wanted to give a shout out to the Lafora Admin team to Paul, Ms. Jean Louise, Anna, all of the members of the Lefora Admin team who give us this opportunity once a month, every month to do the Lefora talk show where nurses will be able to help nurses. That's really the point here. Burnout is a very real thing, unfortunately. But hopefully today is going to be a show where we're going to have some very positive feedback, a lot hope and inspiration for everybody who's watching. So if you are watching all over the world today, please put into the chat what your name is and where you are watching from. We love to see everybody all over the world put in your name and where you're watching. And we're going to get started. So I'd like each of the panelists maybe to give us just a brief background about yourself and to tell us a little bit about yourself. Let's start with Carla. Hey, everyone. I'm Carla. I am a registered nurse for almost 17 years now. I have a very nursing experience background. I started with medical, surgical and then shifted to Pediatrics. And most of my nursing career is focused on that. I also did LTAC back in Middle East. And when I migrated here, I continued with Pediatrics. And then when Kobe hit, of course, I shifted gears into different practice. I started with infection preventionist, and that is what I'm currently doing still. Yeah. Okay. So lots of different experience in lots of different areas, Carla. And I think that'll be an interesting perspective because right now you're not actually working in bedside nursing, correct? Yes. It's been two years. Yeah. Same school bed. So that would be a really interesting perspective. I'd like to move now to Leanne. I'm not sure if everybody watching knows. But Leanne is pretty famous in the United States. Before she introduces herself, she's probably going to be humble. So I'm just going to tell everybody that Leanne has been featured in Newsweek magazine, Voices of the Century issue on Fox TV News, PBS, BBC, NPR, countless radio and television programs. Her messages of hope inspire people over the world. In August 2018, Lee Anne was inducted into the Speaker Hall of Fame. She's a New York best selling author of 15 Chicken Soup for the Soul books. And this includes Chicken Soup for the Soul, inspiration for nurses. So I thought I would maybe just give you a shout out because I know you're probably going to be humble, but if you want to maybe just give us a little bit of your background. Well, you're very kind. Thank you for that wonderful introduction. Yes, I have been a nurse for a long time. You can tell by my hair color. Well, thank women. I see. I have been every kind of a nurse. I started out in Med surge and then Pediatrics and hospital work, and then I was a school nurse, and then I worked in clinics, and then I worked here and at a hospital where I floated to every Department. So I've had vast experiences in all parts of nursing, which came in really handy when I was able to write the book Chicken Soup for the Nurses Soul, because I knew a little bit about every kind of nursing, which was really a blessing. And it did hit the New York Times bestselling list when it came out in the year 2000. So then we wrote two more additions of Chicken Soup for the Soul Adjust for nurses. And that sort of catapulted me into a speaking career. And I do speak full time and have a program called Selfcare for Healthcare, which was a keynote. And now I've turned it into a year long program. And I give nurses and all health care workers tools to care for their minds, bodies and spirits every day, which was needed before the pandemic. And it is crucially important now. So that's the privilege of what I get to do every day. Absolutely. Well, thank you so much. And it really is an honor to have you on the Lefora talk show. And we can't wait to dig deep into the tools and the philosophies and all the things that you can share with both the nurses on the panel, as well as all the viewers that are watching all over the world. Go ahead and introduce yourself. Hey, guys, to our subscribers in Lefora. I'm one of the Admins of Lefora group, but I'm also a nurse practicing here in the United States as a near nurse moved there in 2017. Prior to that, I was a nurse educator in the Philippines. I've been a nurse for a total of 15 years, currently about to graduate for my doctorate degree this Saturday in doing medicine and also certified FNP. And of course, passionate about nursing education, but also very passionate about family medicine and emergency medicine. During the COVID, I was working as a crisis nurse for state of Texas and state of Chicago. I was logging in 48 to 60 hours a week. And then, of course, I'm going to talk about later what I did to balance out this stress because Kobe was really hard for a lot of nurses that were actually working at the bedside. And that's it. I'm here to share my stories, and hopefully people can learn from it as well. Thank you, Paul. And I think it's going to be a really interesting discussion because all of you are nurses. All of you are looking at this issue of burnout and how to manage it, how to prevent it from different angles, and sharing your experiences. I think it's just going to be so inspirational for everybody who's watching all over the world. So if you have any questions for our panel, please put them into the chat. I'd love to get through as many questions as we can from everybody who's watching all over the world. I see Babakar is watching from Gambia. Welcome. And if you are watching from anywhere in the world, please put into the chat your name and where you are watching from. Okay, so let's get started. Let's talk a little bit about what is nurse burnout. I know that this is a term that we hear in the news all the time. Nurses were exhausted before the pandemic where there was a nursing shortage. Now the US government has actually come out and said that the American Hospital Association has said that it is no longer a shortage. It is now an emergency nursing emergency, which means that there is enormous pressure on nurses right now. So let's look at what nursing burnout is. And I think we've got a definition here on the screen, which is it is a widespread phenomenon characterized by reduction in nurses energy that manifests in emotional exhaustion, lack of motivation, feelings of frustration, and may lead to reductions in work efficiency. Paul, can you maybe tell everybody why you think it's so important that we talk about burnout and how to prevent it? Yeah. So I think burnout is very rampant in the nursing community right now. I guess that's not only exclusive for nurses, but also all the health care providers of different professions and different backgrounds. I guess what makes it really extra hard is that our jobs require us to give more than because we're dealing with human lives. So we got to be emotionally connected with our patients. We got to also be physically healthy, mentally healthy, as well as we provide the care. And we want to make sure that we're not committing mistakes as we do those patient care related stuff. So I guess what happens is if you keep doing this constantly for too many hours, or long hours at a time or no recovery in between or not taking care of yourself, I guess health care workers are more likely to experience burnout faster. I think I don't have the data, but I think it happens quite often. What I see right now, like I said yesterday during the teaser, was I'm seeing a lot of new nurses. I've been a nurse for 15 years. I don't think I was probably feeling burnt out, but I think I still have more to give. I'm sad with the fact that new nurses are leaving the bedside faster or sooner than what nurses were 15, 2030 years ago. And that probably contributes I mean, things that contribute to it is not only the workload, but also when I did my DNP classes, we've identified factors that's causing nurses to have burnt out or to get tired or to have lower quality of care. It's one of the factors is the increasing complexity of health care right now. There's so many changes with the guidelines, with the way we do things, with how we increase patient quality and patient satisfaction at the same time. So all these pressures to the nurses, the demand for better care or better outcomes, are probably taking it all emotionally, physically, mentally for nurses as well as the other healthcare providers, Bernard is very real. Yeah, I think that you're 100% correct. I'm sure Leanne and Carla would agree. It's unprecedented. The amount of pressure and stress that nurses are under right now and in the US, they just simply aren't enough nurses. It's a supply and demand issue. So there's a lot of factors that make this topic very important and timely to speak about right now for nurses so that nurses can really look at how to manage their burnout. I know that there are a lot of symptoms that nurses might experience with burnout. And I think we have a slide that you sent us off, some of those symptoms that can be experienced both physically, mentally, and spiritually. Can you talk a little bit about this and some of the feelings or some of the symptoms one might experience? Absolutely. And the reason I think thank you for putting the slide up, because very often people think they are doing better than they really are. We are such benevolent, altruistic people that we give and give, often at our own expenses, and often we think, well, I'm doing okay physically, mentally, and spiritually. But then when I asked people to look at this list and put a little mental check by any of that apply to them. And so I'll just read them so anybody can contemplate in case they can't see the slide or just to give it some thought, any physical changes symptoms of stress and burnout include appetite changes, headache, fatigue, poor sleeping, increased alcohol intake, frequent illnesses, digestive problems, abounding, heart, grinding, teeth, rash, restlessness, foot tapping, finger drumming, nail biting, smoking and mental symptoms of too much stress, forgetfulness, poor concentration, dull senses, lethargy, boredom, low productivity, a negative attitude, anxiety, the Blues, mood swings, anger, bad dreams, irritability, crying spells, nervous, laughter, and a loss of a loving feeling in our lives. And I believe we are mind, body, spirit people. And there are spiritual symptoms of too much stress, feelings of emptiness, loss of meaning, doubt, martyrdom, loss of direction, cynicism, apathy, abandonment, worry, isolation, distrust, a feeling that nobody cares. And when I review this list of symptoms, sometimes with my presentations, the audiences jokingly laugh and say, is there a box for all of the above? Because too often they relate to too many of these symptoms. And sometimes I think until we stop and actually do a self assessment that we don't really realize the toll it's taking on it. That's an interesting thing to talk about, is a self assessment. Can you talk a little bit about that and how somebody would do that? I think just taking time to step back and take a look at your life. We are such a busy, busy society and we are such a busy, demanding profession. And so often we are so busy taking care of other people that we really neglect to take care of ourselves. The same qualities that call us into nursing are the same qualities that allow us to put everybody else first. So I actually ask people to take time out, even if it's 30 minutes. I recommend people to spend 15 minutes a day just in that spiritual mode to meditate or pray or whatever it is you do. But maybe in that reflective time to look at that list of symptoms or sometimes take a day off, sit by a mountain stream or on a park bench, or just give yourself the space mentally, physically and geographically to look at that list of symptoms and do that self assessment and then determine what you need to do and what changes you can make in order to better care for your body, mind and spirit. Yeah, I think you hit the nail right on the head is ready to take the space to be able to do a self assessment. Carla and Paul, if you look at that list and let's put that slide on again and maybe some of the viewers can relate as well. Carla, what are some of the symptoms that you've  seen in yourself that are symptoms of burnout? It might have been on a physical, mental or spiritual level. For me personally, what I have experienced when the pandemic started was definitely there was boredom. And I've always been the type to have a perky attitude. But for some reason at that point in time I was like thinking about just negative stuff. And of course, what comes into play is I was also postpartum. So aside from what is happening around, I also had the Blues, the postpartum Blues, to top it off. So it was really a lot on my plate at the time that I'm just thankful that I didn't end up seeking, like, professional help. I'm not saying that you shouldn't, but I really had to sit back and like what Leanne said, you really have to reassess yourself and see where you are at or what's missing or what's happening to yourself before you can actually really function back to how you normally were. Like, do a self check. Yeah. I might suggest if the next step to that, then I think that it's so important that we often forget. So now I took a half a day and I did this assessment. Then I like people to actually take time to figure out what is it you need to better care for your body, mind and spirit. And then I joke that we need to ask as persistently as a toddler asks, because when a toddler figures out what they want, they asked him for it until they get it right. Yes, I want juice until somebody gets the kids. I want us to ask for our juice. First of all, from ourselves. I think we need to give ourselves permission to care. And maybe we need to ask, do you need more time? Do you need more better diet? Do you need more sleep? Do you need better mental health? Do you need more spiritual time? And then figure out what you need to do to change your life and ask the people around you, maybe your family or your coworkers or your community and yourself to then take the next step after the assessment and actually make those requests of yourself and others to implement a better care plan for yourself. Yeah, that's a great way of putting it. A care plan for yourself. Thank you for sharing that. So, Paul, if you look at those symptoms, what are some of the things that you recognize in yourself that you were experiencing that now you look at and can see that the symptoms of burnout. Go ahead. Yeah. I'm glad that Leon is sharing this slide, because I think if I want to sit down and check on this, I probably would be able to check 50 to 60 or probably 70% of these things. But some of the things that stood out for me, definitely there was fatigue. Like I said, at the start of the pandemic, there was a need for crisis nurses to fill up spots for nurses that are getting sick. We have to take like 48 to 60 hours a week. Some nurses are working 72, 96 hours. We're talking about twelve hour shifts, five days, six days, seven days with no brakes in between. So I was definitely having a lot of fatigue, a lot of irritability mood swings. I was having a lot of apathy. I work in the ER, so sometimes it's emotionally draining. So we kind of, like, separate our emotions, keep it in check. And sometimes we're too guarded, like, we don't want to show emotions because there's so many things going on, so many people dying at the same time. We say we cannot be too emotional because otherwise it's just going to stop us from doing what we need to do. But then because of that improper, negative coping, and you keep doing that every day. At the peak of covet, I'm sorry, I work in the ER, but there would be like three or four people that would die in a shift the most. But during COVID, I would see six people die, seven people die. We would intubate back to back. We would run out of crash cards. It was crazy. So it went to a point that I was developing apathy that I felt like there should be some emotional connection with your patients because you are treating them as humans. They're not just an object that you need to do this and that. But because of the apathy, you kind of like lose that connection with someone. You're just going through the routines, the tasks. You're just showing up to work, just to work. So with burnout, it kind of does that to you. You're like a robot responding to like that's what you need to do. But there's no real connection. And at the end of the day, there's no sense of fulfillment or sense of I did something for someone today. I did a difference to someone today. I was able to help them understand and navigate their health care situation, which I normally would do if it wasn't for I was working that much. So partly it was also my fault because I was doing a lot of shifts. But definitely there's a lot of stuff in that checklist that would have told me if I had known that list or if we had given, okay, I'm having a burnout right now, and probably I need to slow down what I'm doing. Yeah. And I think so many nurses. Thank you for sharing that for everybody on the panel, because I think there's so many nurses that are probably looking at this and listening to you right now and thinking the exact same thing and saying, oh, my goodness, yes, I didn't even realize that I was burnt out because it's kind of like that little hamster and the hamster wheel we've got. Here some stats. The majority of Orange experience burn out at some point in their careers. In fact, in 2017, Kronos study found that 63%, nearly two thirds of nurses in hospitals reported experiencing burnout. So if people were experiencing that in 2017, how much more so having lived through and work through a pandemic where the stress has just been. I mean, it's just another level. It's nothing that anyone could ever anticipate or ever expect. So I think, again, just a really important topic that we are covering today. And just to give a voice to those people who might not even realize that they were just kind of going through the motions and experiencing that burnout. Leanne, what would you say is the difference between burnout and compassion fatigue? Well, first of all, what is compassion fatigue and how is that different to burnout? I see compassion fatigue more as the emotional drained when we've just given so much that we're exhausted emotionally. That's my own definition. And I think burnout is mind, body, spirit. Sometimes we pay attention to one and not so much the other. And in compassion fatigue, they pay a lot of attention, thank God, to the mental and the emotional and sometimes even the spiritual well being of the caregiver. And then we don't always pay attention in some aspects of the physical part. And I coined a phrase that I sort of made up, but I suggest that we are not so burned out as we are drained out. I live in Colorado, and we've had horrific wildfires here in the past few years. And when you see the damage from burnout, it's destroyed. And I like to give hope in that perhaps we're not so burned out as we are drained out and we can refill our Wells. I think by giving tools and programs and support for each other that we can build our resiliency again and prevent complete burnout and not be so drained out and refill our Wells. I think that's a great way of putting it. I've never heard that before. Drained out, yeah. But I love it. I think it says a lot because it's not that when you say drained out, as you say, there's hope you can be filled up again. And it doesn't mean to say that if that's how you're feeling right now, it's how you're always going to feel right. I think it kind of gives another perspective to it. Okay, so we've got baby. Car is joining us. Pope is saying Hi. Paul Aleen is saying Goodnight. Everyone from a nice and breezy Jamaica sounds like fun. Noreen is from Dubai. Henry is watching from Philippines. Excited to work in North Dakota soon, Henry. So, Henry, be excited. You're going to be joining our clients in North Dakota, and we're going to be talking about another topic. So keep watching, everybody, because we're going to be talking about burnout, but coupled with when you arrive in the United States and you're also experiencing culture shock. So that's coming up in the second half of the show. So if we talk about self care, what actually is selfcare, what does that mean to you, Carla? Self care. For me personally, I need to take care of my own well being so it can come in different aspects, whether it's physically, spiritually, mentally, emotionally. So all of this will come into play. So with what happened to me, I think in some way it was a blessing in this guy that I was on maternity leave when Colby hit. And so I continue that I told my facility that I'm just going to extend my leave. And I am not sure as to when I'll be able to join again. And they were very understanding about it. So always make sure to appoint that you check in with yourself about, like, what Leanne mentioned about what you really need. So that's really tantamount with taking care of yourself more than anything. Okay, yeah, that is true. So we have a slide, which is what are the factors that cause burnout? Carla, what would you say are the factors on the slide that may be caused for you specifically

because your situation is a little different? You weren't doing bad side, but still experiencing burnout. What would you say was the biggest factor for you that was causing you burnout and how you actually were able to care for yourself. So for me, since I transitioned as an infection preventionist for the state of North Dakota, we were actually working long hours during the weekend. So I believe that fits the criteria for me. Working long hours and then the emotional drain and patient deaths. There were tons of debt every day, especially from the long term care facilities. And we would see them dropping like flies, like, every day. We get reports from all the facilities in North Dakota, and you would see the number of deaths. It was just standarding. It was like, wow, I can't believe this is happening. There's so much death that happened, especially the first search before the vaccine rollout even started. There was just a ton. It was like mind blowing.  And I think sometimes when you're in that situation, you kind of cope with it in the moment, but afterwards it hits you what you've actually lived through. And so how would you say that you were able to take care of yourself in this situation? So in that situation, what I did was I made like a body system. This is something that I got from another friend of mine who was working in the hospital. I was like, doing a self check with another friend of mine and asking and asking her, hey, how are you doing? Like, we were doing chats every other day, at least even just for five minutes. So we were asking each other, hey, how did your day go? What made you feel that there's some gratification from what you did from today's work? Okay, so make sure that you at least sleep for at least six to 8 hours instead of 8 hours because they were just working and working during those times. So 6 hours. And then I made sure that I ate healthy food, vegetables, fruits. Of course, protein also has to be there. And since I am Muslim, what also helped me a lot was to connect really with my faith. My faith in Allah really helped me a lot to cope with so much of the menace that COVID made since it hit. So that's a huge deal for me. Yeah, that is very helpful. And if you have faith, then you believe that life happens for you, not to you, because there's a big difference and that kind of gives you that grounding. And Paul, if we put that slide up again, what causes burnout? What are the things that you have experienced and are experiencing that cause burnout? Thank you for the question. For the factors for me, definitely. I think I'd put at the top of the list. It's the high stress working environment, working in the ER and getting all these patients that have emergent issues. Kobe made it extra harder because people are presenting symptoms that are very severe at the same time and we don't have enough resources. Then, of course, there's emotional drain and patient debts that are staggering that were more than what we were used to. There's lack of sleep because shifts are like 12 hours. You don't get off on time and then you have to come in early. So the 12 hours can easily become 14 hours. Working long hours, short staffing issue. It was still a problem was even worse during the pandemic. And of course, they were sicker, sicker patients more complex because now with COVID, you're not only dealing with pneumonia and respiratory conditions, but they can also failing Art and failing kidneys and failing neurologic functions. So if you put all of these together, like I said yesterday, our job was already hard, but the Covid made it like twice thrice harder. So that kind of sped up the burnout. Plus working long hours, of course, is one of the major factors of the burnout. So how have you in the past during Covid and going forward now, taking care of yourself? Yeah. So you know what, I thought about it for a bit at the beginning of Covid when they were deploying a lot of nervous. I was working 48 to 60 hours. My first Covid deployment was in a very high acuity hospital here in Houston, Texas, right in the Med Center. It was a very tough job. I had to quit after the third month, but my contract was only two months. I started for another month and I had to quit after the third month to take a break. I actually took a six week break. And during that break, of course, it has to be safe because it was during the Covid did more outdoorsy stuff like biking and swimming and running and spending time with friends through FaceTime or video family members, stuff that I couldn't do when I was busy working all the time. And it also helped that I worked with my travel buddy, which was also my friend Jovelyn from the Philippines since 2007. So we reconnected. She was from Missouri. I told her to move over to Houston to take on this travel contract with me and we work together. That kind of helps. So when we work together, we kind of like when there's downtime, we could talk and eat together and talk about stuff, but definitely six months into the pandemic, I took another contract that lasted for five months. But I already know that when I'm off, I wanted to have time in an open space, like in a park, maintaining safe distance. But definitely I like to work out like three to five times a week. So gym is part of it. It was just hard because you have to wear the mask, but you got to do it. So that's why when they said they're rolling out the vaccine, that was the first one to get it, because I just want to live a normal life. I can work out without a mask, but it still took a while to do that. I definitely like running and biking and just going out and descent, because that makes me feel, like alive, because work can sometimes make you feel like you're just going through the motions. And that's kind of like worsens the burnout and feeling drained. But whenever I'm off, I like to separate myself from work. So anything that makes me remember work, I don't think about that that much. I'll have to worry about that later. If they tell me, hey, you need to do this education online. You missed it. I'll take care of it. After work, when I'm off, I want to be separate from work, so I'm on my side. Lots of good tips there. Carla was eating right, speaking to her friends, Paul being outside, exercising, and also speaking to your friends because we're social beings at the end of the day. So I think that's really an important piece of it. Carly, you mentioned your faith. Can you tell everybody how you got started in healthcare? Because I think this will be interesting for people to hear about how you got started. And maybe you can also just add to that, like, what are the different kinds of self care? Because I think Paul and Carl have touched on some of those, but I think there's probably more that you can share with us. So you're wanting to know how I got involved with self care for health care. Yes. A little bit of your history. I know you had some we got some pictures from Vietnam. Oh, well, that goes away back for sure. Okay. Briefly, at the end of the Vietnam War, in 75, I agreed to go to Vietnam and escort six babies back to their pre assigned adoptive homes. I was a volunteer for Friends of Children in Vietnam. And. Oh, I didn't know you had all of those. Yes. And so when I got there, present Fort at. Okay, Operation Babylift, because bombs were dropping. And when I said I'd go, but they were dropping when I got there. So instead of bringing out six babies, they said, you'll help us bring out 300. I was only there for five days, but I went into the two storey building and that one photo is all the babies laying. There were 100 babies laying all over the floors of this building. And on day five, we took them to the airport. And that's me and a Volkswagen van was just 22 on the first leg of the journey to the airport, where we had a C 141 cargo jet. And they made Bassetts out of cardboard boxes. And we placed two to three babies in a cardboard box. There were nine of us to take care of 100 baby. I imagine I say that's the worst shift ever, but it was driveful, work, bring the babies to freedom and to families. And the best amazing part of the story, that's part of it all is my husband and I had applied for adoption of a son through this organization, and we expected to be assigned a child in probably two or three years. But when I was there, they said because of Operation Baby Lift, you can go into the next room and choose one. And I went into that room of 100 babies and a little nine month old boy took one look at me prowled into my arms, my heart, my family. I didn't have to choose him. Unbelievable. I came home and was quite happy being a nurse and a wife and a mom and working at the clinic and at the hospital. And then finally I wrote the book about Operation Baby Lift. And that's when healthcare organization started calling me. I was on a national nursing board, and they asked me to speak on lessons I learned from Operation Babylift. And that's when I wrote a book and a speech and built a career around balancing life in your war zones. Because what I learned from that is in order to cope in the war zones of our lives today, we have to be strong physically, mentally, and spiritually. And I never guessed the world would care. I got so busy, I quit my day job, hospital started wanting more and more. So I turned my keynote, as I mentioned, into this year long program. And that's how I got started. As unbelievable as it is, I know that is some story. It really is. What an experience and what a journey that led from that experience. So what advice would you give to nurses who are experiencing burnout, emotional, physical exhaustion, have lived through the pandemic and now are looking at ways to reduce burnout, to take care of themselves? What are some of your best advice and tips in that regard? Well, first of all, I'd like to say to them, please don't quit. We need you desperately. And I understand why. Paul, I am in awe when you tell me everything that you did and all that you witnessed day after day. I am in awe. And, Carla, with your job, with the state, I can't even imagine the pressures and all of that. I've never experienced anything like that. I mean, I was in Vietnam for five days with all those babies. And you did this for months and months and months. So God bless you and thank you both. First of all, the thing I like to say, and this is not exactly the answer to your question, but I hope nurses don't quit, do as Paul did, take a break. And you're so wise to have done that, Paul, because I've met lots of travelers and they just go from the next to the next to the next because it's good money and I got to make all I can and I got to have those loans and they don't take the self care breaks. And the way that Carla said that she found a friend to walk the journey with her and she kept into her face. And so I would suggest that everybody step back, take a look at your life, do that self assessment, and honestly make a list. Paul knows what he needs. He's like me. I need nature. I need outdoors. I need space. Some people don't. They want crowds, whatever. But do that assessment and then literally make a list of what you need. But please consider body, mind and spirit, not just one or the other. I always joke it's one thing, you get a stress ball and lower your HDL. That's great. But we need to take care of body, mind and the spirit as well. So I would suggest they look at that, review the symptoms, make their list, and then make a commitment and take a break if you need from health care. But the good thing about our profession, I'll make this plug always is that the good news is we don't have to all work in the ER like Paul did. You work in any setting in Pediatrics, geriatrics, home care, intensive care, schools, there's jobs. And if you're tired of the recipient care, there's quality. And all the other areas that we can serve in. And we desperately are needed. Nurses, US Labor Department says we will be 1.1 million nurses short by 2030. So please take care of yourself so you can hang in there and continue to serve well, I think a lot of good advice and a really just an incredible, awesome account of nurses and what everybody has lived through and how important it is to take care of yourself because it is such an important job. And I think nurses really just have such a unique quality about them. And there's something special about nurses who just have so much compassion and empathy. And that's why you got into this profession. And as Leon said, there are ways to take care of yourself and help navigate through this difficult time. I'd like to talk a little bit more about culture shock and how you need to take care of yourself and how they can be burned out when you come to the United States, because a lot of the viewers that are watching right now are either just newly arrived in the United States, or they might be arriving in the United States soon. And as an immigrant myself, I know that both Carla and Paula also came to the United States. As immigrants. We know that coming to the United States can be difficult at the best of times. There's a lot of challenge. There's culture shock, which is a very common phenomenon. And if you couple all of that with the pandemic, what nurses have gone through in the last few of the last two years, the shortage of nurses in America, patients getting older, getting sicker, the silver tsunami, there's a lot of compounding factors here. But for nurses coming from overseas who have worked really hard to come to the United States, I think it's also important just to talk a little bit about what they can expect and what advice and tools and methodologies we can suggest to help them through that transition as they enter the country who is still hopefully moving out of the pandemic but still in this phase. So I'd like to put up a slide about the kinds of feelings that you can experience with culture shock when you first arrive in the country. And Carla, can you maybe talk a little bit about your experience? And did you experience some of these emotions when you first arrived here? Helplessness, stress, surprise, fear, indignation, lost homesickness, confusion and rejection. So as I'm looking at the slide, I would have to say that with my experience, it was homesickness, loss and homesickness because I did not actually originally plan to work in North Dakota. I asked to be assigned in a different state, which is much closer to where my immediate family is. But for some reason, I landed here. So that was also one disappointing fact that happened to me. And then aside from that, was helplessness because I did not know anybody here. None of my friends knew anybody in North Dakota. So that's another factor that helped me feel that helpless. And then I guess the stress, because when I came here, I did not immediately start with orientating in the facility. I had to wait nine days. It had to do with my license endorsement. So, yeah, I was just by myself in the apartment without any friends. So the only people that were helping me were from the staffing agency who came here before me. So they were helping me out, pick up some stuff, move some of the furniture that I bought. And then when they go home, I'm all by myself. So one thing that I made sure that I had was the Internet connection. That was the most important thing for me because food, I can just probably go to McDonald's, and if it's fast food, it's still food. So I was always online with my parents and other members of my family. So to make sure that I don't get crazy because I'm just by myself in a two bedroom apartment, and it was a bit huge for me. And then one thing that of course, shocked me here is everything has a price. Everything has a price there. And coming from me because I work in the Middle East, so I was only paying for maybe when I go out for the taxi, the cab fare, and my cellular line, that was the only thing that I was paying for. But here, everything has a price tag. So that one was one thing that I missed. I said, was this really the right choice that I actually migrated here? I know this has been my childhood dream. From what I can remember. We had like autographs. And I would always say there I want to be a nurse. What is your ambition to be a nurse, to be a nurse. And then that was like my culminating point. Did I make the right choice to be here because I'm all by myself? It's not like it's my first time abroad, but just thinking of those people who had no previous experience working outside of the country, it will be much more for them because they would really feel that burden, that feeling of loss and loneliness, especially if they don't know anybody around. So that will be a huge deciding factor of how they're going to cope. And hopefully they will be able to just like I did, they will get through it definitely like we all did. But at the same time, as I said, coming to the United States at the best of times can be stressful and you experience culture shock and a lot of those feelings, and that's where it's still being at the tail end, hopefully of the pandemic. But all the repercussions that have come from that self care is vitally important for new arrivals. Paul, if we look at some of those feelings and some of those emotions, did you experience some of those things as well when you came here? Definitely for me, there was a lot of stress and of course, loss and homesickness and confusion like what Carla shared earlier. I was one of those nurses who never worked outside the home country, Philippines, prior to coming over here. For all 30 years of my life, I was in the Philippines working with Filipinos. And then, of course, you moved to the United States. It's a melting pot of culture. And now you're immersed with what, 5678 more than ten different cultures at the same time. It was hard to adapt. At the beginning. I would not lie in my first three months, I wanted to go home. I was like, I'm down here. I gave it a try. I like it. But I think I'm more comfortable being at home. And there was a lot of homesickness that I had to call my mom every day. And there was a lot of anxiety. Like, what if I get sick? I do not know anyone. The problem with me, I don't have family members in the United States. I'm a first generation immigrant. My friends are all spread out. I was assigned in South Texas, and I have friends from San Francisco, from New York. It's not like I can go to them all the time because I still have to work to earn my money. So definitely there was a lot of communication barriers as well. I mean, it was hard to express yourself. Sometimes I try to say something, but instead of me saying it in English, I'd say it in Filipino. And my patients are like, hold on, just say like, oh, I'm sorry, I thought I was talking to you in English, but it was hard. So it was a struggle at the beginning. Lots of stuff that you have to go through. Like, I was established in the Philippines, and then here I felt like, oh, I have to start at the very beginning. I had to leave all my stuff in the Philippines. Now I have to buy this again, buy more quotes, buy more furniture. This and that. Get to know your community, because you're not only getting yourself assimilated with work, but also your community. Where's the nearest bank? Where's the police? The first time that I was ever in a car accident, I lived with a Filipino family for a bit, and I had to call them, like, okay, I just got into an accident. What do I do? Do I call 911? Do I step out of the car and ask them for the insurance? I don't know what to do. How do they do it here? I know what to do if I was back at home, but I don't know so many stuff here. You feel locked. Exactly. Should I just go back to the home country where I feel comfortable or stay here and learn? So I chose to stay here and learn because I felt like I had more opportunity for growth and I wanted to learn more about different races. I love to travel. I love to travel because I love to learn new things about places that I visit, about the people that I visited, about food that they eat, and the culture. So in order for me to learn more about people, I have to assimilate and put myself in the middle and really understand different races, different beliefs, and different attitudes. And I learned from my patients as well. That's something that I've never experienced before. But thanks for letting me know. Eventually it got better. It's only hard at the beginning, but it gets better. And that's where you can see this is well documented. That culture shock. It looks kind of like a dip. You start off with the honeymoon period. You arrive in the United States, worked so hard to get here, came here for greener pastures, and you have that honeymoon period, and then all of those feelings come into play with a lot of change and a lot of stress, and you have what we call the dip, but it does, over time, get better and you do start to adapt. So that's the hope. And I really want to thank Carla and Paul for sharing your story, because I think that this will be so inspirational for so many nurses who are arriving in the United States now or have just arrived in the United States and experiencing culture shock, where they're coming from a post pandemic world where they have been depleted and drained, as Leon said, and then they're coming into this environment, which is a whole other compounding layer of burnout and stress that can occur. Leanne, in your experience, what would you say to a nurse who is newly arrived in the United States might have been burnt out from the experience over the last two years in the pandemic and now going through culture shock, what are some of the strategies that you would suggest? Talk to Paul. Good one. Not like you really did. I'm born and raised the United States. I'm an Iowa farm girl. So all that you're telling me about is foreign. Forgive the punish, but I guess I would say exactly the things that they talked about. And I know I sound like a broken record, but when you come here also to remember to take really good care of yourself and know that we are social beings and to reach out to that community and to form new communities. And like Carla said, to find a friend that walked the journey with her so that you can reach out and have people that can support you. And it must be really hard to ask even for that, to step out with that confidence, to tap into the resources. And maybe another thing is to ask about all the resources we do have here in the United States. There are so many wonderful things that are for free, that don't include welfare necessarily, but just so many resources we have with libraries and lending services and churches and communities and events and trails in cities, and to ask the locals and see how you can be connected to find the resources that you need to care for yourself. So great advice. And I think at the end of the day, a lot of that is about connection and knowing that it will get better and having the courage to persevere because the pandemic is going to pass, the culture shock is going to pass. These things do pass, and it's really being grateful also in the moment for the blessings of that the pandemic is hopefully coming to an end for those nurses who arrived in the country that you are now here and living your American dream. And I think that's a great place for us to actually finish off. I really wanted to thank the panel today for joining us. And for everybody who is watching from all over the world, I think this is such an important topic. Nurse burnout, as we said in the beginning, is a buzzword. We hear it in the news every single day. But there is enormous pain and suffering that comes from nurse burnout. And as Dianne said, I think it was a great way of putting it is that it is draining. But the good news with that is that there are tools and strategies that can help you to fill yourself up. It's kind of like that being on the airplane, give yourself oxygen, because when you give yourself oxygen, then you're able to give those around you oxygen. So just to sum up and establish strong interpersonal skills, I know that everybody on the panel has spoken about that setting boundaries between work and personal life, invest in proper sleep, pay attention to self care practices, lots of tips and pointers that everybody on the panel has shared and turned to therapy or other employees' programs as well. A lot of employees have that as a resource. As the an said, there's a lot of resources that might be available for nurses that are going to be coming and living and work in the United States. So to finish off, I thought if everybody just wants to give one final piece of advice for nurses who are going through burnout and want to take care of themselves, let's start with Carla. So for me, I think just to add more like what Leanne said there, if you go to the CDC website, if you really feel like you're experiencing this burnout, reach out. I know there's this stigma that's keeping us or preventing us from doing that. And like what you just mentioned, the employee assistance program. I think most of the employers have that because I know with a facility that I used to work for, they have that. So use that exhaust your resources. First, reach out to someone in the know, reach out to your supervisor, your nurse manager, someone who can really help you out. And like I said, if you go to the CDC website, they have a disaster distress hotline. If you're really feeling so emotionally overwhelmed, you can actually text. I'm not sure if that's a text message or call, but if you go to the CDC website and type in Kobe, you will find that there is a disaster distress hotline. You can make use of that. Or if you know anyone else who might make use of that so you can provide them that number. And like I said, always do a self check, just even for five minutes. Just take a break, stop, appreciate like what is around you, always feel grateful of what you have and acknowledge yourself and put like Pat on the back, say that yourself, that you did a good job for today. So just be in that moment, be in the present moment and acknowledge everyone that who has helped you made the journey and try to always have that positive mindset. I believe that it will really make you go waste beyond what you can imagine as long as you maintain a positive mindset. Yeah, I think you're so right, Carla. And when you speak about gratitude, I love Oprah, and Oprah always talks about a gratitude Journal. In fact, for those nurses who come through connetics, we give them a gratitude Journal when they arrive. And I think that that's really so important. It's how you perceive things, and having a positive attitude really changes your mindset from that. What does it say? You can have either a mindset of fear or love, and it shifts you from fear to love if you're grateful. Paul, what would you say is your final words of advice to anyone who's experiencing burnout and how to care for themselves? Yeah, I think we've all said lots of really great things that are really important for self care, but I want to remind our nurses that we're human beings.

We have need. Earlier we talked about going into therapy, and I'm working with my therapist right now. I didn't think I needed therapy until I was in the middle of the pandemic and all these crazy things were happening, and it's affecting me and causing me a lot of burnout, too. But I would want to share what my therapist said, which I shared yesterday as well, that I keep in mind because sometimes we like to give and give. But like what Leanne shared earlier, you cannot run dry. You have to replenish yourself, too. Being selfish. It's not bad. We have a negative connotation of being selfish. You have to remember you have a need. You have to focus sometimes on yourself and actually take a step back and see where you're at and see what actually brings you your purpose back in your life, your happiness back in your life. Sometimes the world can be so busy with our jobs, with our family, with our responsibilities, but we cannot live our lives with those things just controlling our lives. We have to make sure that we're living our lives with a purpose. So take that day off. Spend about two to 4 hours doing things that make you happy. It could be something like physical activity, yoga, meditation, a prayer, connecting with your friends, singing, dancing, sitting in the park and smelling the air, going to the beach and just listening to the water, listening to songs. But find those things that will bring your purpose back in your life. And then tomorrow, the following day, you'll feel like you're refreshed and you rejuvenate your spirit back. But Leon has made a good point about we're not only trying to care for our body and mind, but we're also a spiritual being. And that means connecting with other people, connecting with our souls, with the one being that gives us life. So find your purpose and make sure that you're pursuing, pursuing your happiness and caring for yourself, bothin physical, social, emotional, mental, and spiritual.  So I guess those are really important. I love it, Paul, because if you don't feed your mind and strengthen your body, you really can't find that meaning and that purpose, because you're just too depleted, you're too exhausted. And I also love the fact that you are very courageous in talking about getting help, because I think sometimes there's a stigma that getting help is a weakness. In fact, it's a strength, I think, because that's where if you're getting help, you're actually taking control of your own life. I think just the fact that you are speaking about that will give a lot of hope and inspiration to people who might be feeling lost and not sure where to go. Final words, Leanne. Well, gosh. Those are hard acts to follow. The two of them just summed up my entire self care for health care program. I guess I can sum it up almost in a sentence. I would encourage everyone to care for themselves as lovingly and as attentively as you do a patient or someone you love the most in the world. I love that, Lian. We would never deny anybody else food, drink, and we deny ourselves. So care for yourself as lovingly as you do a patient or someone you love. And remember, Nurses Week is always May 16 to 13 here in the United States. But the American Nurses Association has made entire month of May Nurses Month. So go celebrate yourself and be grateful for all that you have, as they said, but really celebrate and love being a nurse and find your joy and your passion in it again. And thank you for giving so selflessly. Well, thank you. Thank you to everybody on the panel and thank you to everybody who's watching. You can see on the screen some of the and books that you can purchase as well. And there's a QR code on the bottom of that. And I think the message really being that there is hope, there is a lot of positivity and a lot of ways for nurses to care for themselves. But I think loving yourself as you would somebody as the answer, as you would love your patience as well as somebody that you love, I think really just says it all and it's a great place to end off. So thank you, everybody, for joining us. This has been such an interesting topic. I hope that it has been inspirational. And I want to thank the Lefora admin team again for giving us this opportunity. Lefora is all about nurses helping nurses. And I hope that that's what the last hour has been before everybody leaves. Just one thing. We have some upcoming shows just to remind everybody. So we have on Friday on our onwards and upwards and show on the connetics USA Channel, we have our immigration Q and A, and we have our legal immigration panel on the 13th. We have life as a nurse in Nevada. What it's like to live and work in Nevada. On the 20th we have our iOS bonus class. On the 27th. The NCLEX bonus class in June. The QA immigration panel again on the third the next Lefora talk show is going to be very interesting topic. What are the clinical differences that we might expect overseas and working in the United States? And then on our onwards and upwards show on the 10th, we have our clients showcase one of the most prestigious hospitals in the United States, Cedars Sinai and international nurses. So with that said, thank you to the panel. Thank you to the for our admin team and we look forward to seeing you again next month. Thank you, everybody. Thanks. Thank you. Have a good night. Bye.