Portal de Periódicos da CAPES

Learning to Just Say No

2017; Elsevier BV; Volume: 18; Issue: 5 Linguagem: Inglês

10.1016/j.carage.2017.04.003

2377-066X

Karl Steinberg,

Nursing Education, Practice, and Leadership

I spent much of February and March attending (and sometimes presenting at) a variety of professional meetings, starting with the Idaho Health Care Association, then the American Academy of Hospice & Palliative Medicine’s annual meeting, then the Coalition for Compassionate Care of California, followed by the AMDA – the Society for Post-Acute and Long-Term Care Medicine Annual Conference, and finally the California Association of Health Facilities legislative conference. I was in Boise, Orlando, Phoenix, Sacramento, Phoenix, Sacramento, and then back to Sacramento for a last-minute meeting with legislative staff on an advance directive-related bill. While on the road, I continued to check faxes and take calls on my patients. During the few days I was home between meetings, I had to hustle to catch up with my patient care and administrative duties, and then — all too soon — to start packing the suitcase again. Thankfully, I don’t plan to go anywhere farther than Los Angeles in the next month or two, and I am enjoying sleeping in my own bed. Most of the time I don’t really mind traveling. Yes, there are frustrations: flights get delayed, babies cry and kids kick the seat back, sometimes my carry-on has to be gate-checked, the water pressure and temperature in the hotel shower are inconsistent, and too much food beckons (especially sweets). I hope for a business center with a working fax machine so that I can complete the occasional death certificate, and getting enough exercise can be a challenge. But I enjoy seeing different places, catching up with old friends and meeting new people, and sharing experiences and perspective with others who do the same kind of work I do. It feels collaborative and meaningful most of the time. As always, I enjoyed seeing old and new friends at the Society meeting in Phoenix, and I want to thank those of you who took the time to give me feedback about Caring. Although I invariably leave the Society’s meeting feeling warm, fuzzy, and energized, I am also often exhausted! I had 3 consecutive days of 6:30 a.m. meetings (a couple of which I had to lead), a 3½-hour policy intensive to moderate, then a House of Delegates lunch, followed by another 3½-hour wound seminar where I co-presented. Then I ran the Public Policy Committee meeting, did the plenary session on policy, ran our Caring Editorial Advisory Board meeting, and attended the House of Delegates meeting. And, of course, there was our California Association of Long Term Care Medicine (CALTCM) state chapter reception, plus thanking the exhibitors for attending our meeting and supporting the Society. “To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit oneself to too many projects, to want to help everyone in everything is to succumb to violence. More than that, it is cooperation in violence.” — Thomas Merton I’m not listing all this stuff to break my arm patting myself on the back, but rather I intend it as a cautionary tale, and maybe a lesson for the future. I’ve been to a few leadership workshops over the years, and among the things I’ve taken away from them is that leaders show up, and leaders say yes when asked to take on a commitment. That has generally been my philosophy: Just say yes. I suspect many of our readers are in the same boat, but this is also how we wind up overextended and burned out. I serve on so many boards and committees, with their constant conference calls, that I sometimes start to lose track of them. I enjoy participating, and that’s why I keep just saying yes — but there are only so many hours in the day. My workdays are quite variable, and that variation is part of what keeps me somewhat sane and grounded. I may spend the morning seeing patients with my dogs in a couple of nursing homes and an assisted living facility, lead a quality assurance performance improvement meeting at lunch, make a house call in the afternoon, and then review a couple of articles for Caring before spending an hour or two in my role as an expert reading a legal case or preparing the slides for my remote learning session for Case Western Reserve University’s graduate school of biomedical engineering (the class is on the U.S. health care “system”). The next day, I may have a hospice team meeting, sit in on couple of conference calls, work on an upcoming presentation, see patients all afternoon at a nursing home, including an interdisciplinary team meeting with a resident and family to discuss changes in goals of care, then head down for a dinner meeting at the San Diego County Medical Society. If I am lucky, I can sneak in an hour running on the treadmill. Every day is different, but every day feels like I am doing something meaningful and at least in some measure helpful to others. Barbara Resnick’s column on resilience (pg. 8) mostly relates to the patients we look after, but resilience is very important in health care providers, too. After all, there are numerous stressors associated with the medical field, and in working within the post-acute and long-term care space in particular. Not only do we have increasingly ill, high-acuity skilled nursing home residents, but we also have more serious mental illness and behavioral health challenges in our facilities, and we continue to provide care for the dying. Unhappy and unrealistic patients and families can bring a lot of unwelcome drama, in addition to threats of legal or regulatory action. All these factors contribute to day-to-day stress. Physician and caregiver burnout is a very real entity. Many of us know colleagues who have taken their own lives due to the stress. How do we stay balanced and mindful and grateful? How do we “float above the fray,” as an elderly patient once recommended to me on an especially challenging day? There are no definitive answers to these questions, but a few strategies can help. Being connected to others is a big one — the presence of supportive family and friends outside our professional circles is vital. We also have colleagues and coworkers who deal with the same trials and tribulations we do, and peer support is essential. Sharing with our brethren the difficulties we all experience is very therapeutic, which is one reason why it’s so important to get together and share war stories at our annual meeting and our state chapter meetings. Getting good, consistent, restful sleep is another way to help keep us in a good place — although as a person who takes calls around the clock for my patients, I admit that sometimes after getting a really inappropriate 2 a.m. call (“Doctor! The patient’s mean platelet volume is 14!”), I sometimes have a hard time getting back to sleep. Physical exercise definitely helps, and can be a way to work off some of those frustrations. Taking 15 minutes to take a brisk walk can really be an attitude-adjuster. Even just stepping out into the sunshine and admiring the beauty and fragrance of a flower for a moment can help turn a day around. And finally, I find that sometimes when I am having a hard day, it’s helpful to take a few moments, a few deep breaths, and maybe make a short gratitude list. Even in a stressful moment, I can be thankful for the things that are so easy to take for granted — my home, my family, my dogs, a cool ocean breeze, and even my smartphone! Some of you may be aware that I ran for vice president at the Society’s annual meeting, and I lost the election. (This was the first election I can recall losing in almost 60 years of life, and an excellent lesson in humility!) I was disappointed but also somewhat relieved. My colleague and opponent, Arif Nazir, MD, CMD, worked very hard for the victory; he earned it and totally deserved it. Dr. Nazir will be an outstanding and innovative leader of our organization. After the election, many colleagues hugged me and asked, “Are you OK?” and I assured them I was. Interestingly, I got more hugs after the election than I can ever remember getting at a meeting. (Note to self: If you want hugs, run for something and lose.) When I told my loved ones about losing, the response was basically, “Sorry you lost, but another commitment was the last thing you needed. Enjoy the extra time you’ll have to do other things!” Words of wisdom. Now I just have to make sure the “other things” don’t push me in the direction of burnout, because sometimes even if you say yes, the universe says no for you. In the meantime, I am going to try to ease back a bit on the number of commitments I sign up for. It’s taken a long time, but I am slowly learning to do with professional commitments what Nancy Reagan suggested we do with recreational drugs: “Just Say No!” Dr. Steinberg, editor in chief of Caring for the Ages, is a multi-facility and hospice medical director, as well as chair of the Society’s Public Policy Committee. The views he expresses are his own and not necessarily those of the Society or any other entity. He may be reached at [email protected] and he can be followed on Twitter