April 15, 2020

Oncology AP Self-Care in This Pandemic—Really?

By Andy Guinigundo, MSN, RN, CNP, ANP-BC

The setup of the joke goes something like this: “Hey, Andy, what should the oncology AP be doing for self-care during the COVID-19 pandemic?” The punchline would be delivered like this: “Huh? Did we do anything for self-care before the pandemic?” Slow, ironic laugh: “Ha, ha.”

Indeed, there is no shortage of pre-corona metanalyses pointing to rampant provider burnout, with numbers in the 20% to 40% range depending on which measure is being used and which studies one is reading (Bourdeanu et al., 2020; Li, Cheng, & Zhu, 2017; Lindemann et al., 2019; Molina-Praena et al., 2018; Willard-Grace et al., 2019; Zhang et al., 2018). This would suggest that despite the high-quality care that APs deliver (Johnson et al., 2019; Reynolds & McCoy, 2016), we are bad, if not terrible, at self-care. When self-care is inadequate or absent, burnout increases. Burnout can lead to health-care worker turnover, i.e., we quit. We have a higher than usual rate of alcoholism and substance abuse (Alcohol Rehab Guide, 2019). Suicide among health-care workers is higher than the general population too.

Whoa. Dark. Hang with me. We will get to the light.

These ARE dark days, figuratively speaking. As I look out my window at this moment, it’s a beautiful day. I could fool myself for a moment believing this is like any beautiful spring day in Ohio. Lawns are being cut. People are walking dogs. But it’s not, is it? We aren’t going to a movie tonight or eating at a restaurant or watching what should be the final weekend of the NCAA basketball tournament. Each morning I get ready for work as usual (we’re “essential”), and when I walk into my closet to grab clothes for the day, I see my high school senior’s prom dress hanging on the rod in there and my heart is broken all over again. When I arrive at work, I look over labs in the morning. In oncology, we get so accustomed to seeing low blood counts, it doesn’t really phase us much. A couple of weekends ago I worked, and a patient I saw had white blood cell count of zero, yes, 0.0. For the first time, in a long time, I got a shiver down my spine seeing this and was more afraid for our patients’ safety than ever before.

We find ourselves in a peculiar position. Delivery of oncology care services is indeed an “essential” service as defined by society and by government mandates. Most of us office-based clinicians aren’t those front-line ER and ICU personnel we see on the evening news. However, our offices are far from operating like business as usual. Non-treatment, non-urgent visits are being delayed. We are limiting the chemo suite to patients only. We are wearing masks when seeing patients.

Like anyone, I can be pulled down into the darkness of it all. I’ve always been someone who follows hurricanes on the National Hurricane Center’s website wondering, how bad could this get? I now watch the COVID-19 case numbers and the mortality numbers soar and wonder, how bad could this get? I’ve certainly and ashamedly been sucked down the political rabbit hole on social media too many times during this crisis. These are arguments, sometimes with complete strangers, that no one wins.

Finding Balance

Suffice it to say, we all need a healthy balance caring for mind, body, and spirit to survive this pandemic. I posted my quandary in thinking about what to write on social media just to be witty, not actually soliciting ideas. My people came through though and gave me lots of inspiration and ideas anyway. And hey, since we haven’t seen a situation like this for 102 years, anything we can come up with is groundbreaking, right?

Vanessa writes, “What about family time? I have spent more time with my precious children than I have in a super long time. I have (as you) a senior ready to fly and this time with him is feeding my soul. No band practice, no running here or there, just games, laughter, and a bit of distance learning.” She goes on to say, “Also—a good bubble bath is great!”

That is sage advice, even the bubble bath.

Jonlyn chimed in, “For me, I have found some peace in prayer, connection via virtual brunch with friends, FaceTime with parents, finding some way to help someone or some cause, and coloring books (really).” She reminds us all to give ourselves “permission to not be productive and cry, followed by a Netflix binge or other not-so-great indulgence.” At the same time, it’s “important not to beat ourselves up. We are all human and in this together, feeling the same uncomfortable emotions.”

I love this! However, I would caution about falling into the “I deserve this” mentality. I’ve fallen into the “I just worked out, now I can have an extra beer or an extra scoop of ice cream and french fries” trap too many times.

Michelle has been the music teacher for all three of my daughters over the years, and she recommended a more healthy binging in “binge reading, binge solitaire, and binge karaoke (at home of course).” Reading “non-news,” as my friend Jonlyn also stated, is especially helpful. While I am not a big leisure reader, I have found escape and entertainment in audiobooks for years. Additionally, I have found a way to develop “mind” balance at work, too!

Unfortunately, we have seen our patient volume diminish over the past weeks. Our AP group has taken on a project during this time to review and revise our clinical policy and procedure manual. I know, that sounds boring and unglamorous. However, it has been a project that has gone on the backburner a dozen times before but is now getting the attention it deserves. It can be done solo as time allows without a lot of direction.

Kimberlee says, “My yoga studio is streaming live yoga classes, which is a good way to de-stress.” Indeed, there are plenty of these “body” opportunities. My daughter’s old ballet studio is offering free online classes from beginner to advanced. Although we are social distancing, we have all been encouraged to exercise. The president of our practice held a walking challenge last week. He challenged us to walk at least a mile, as a workout, not walking around the office, to a max of 3 miles counted per day. The office with the most miles per FTE won lunch courtesy of the president. I also joined a 30-day exercise challenge with my National Ski Patrol buddies. 30 minutes of activity per day is definitely possible in order to achieve that “body” balance. 30 minutes is only 2% of a 24-hour day!

From a spirituality standpoint, Melinda simply states, “Scripture has been helping me big time.” As I write this, in the Christian calendar, this week, Holy Week, is the ‘granddaddy of them all,’ starting with Palm Sunday and culminating with the holiest Christian feast day of Easter. For me, this Holy Week will be different than any in my life. Virtual services and lots of self-reflection will hopefully take place. Joni agrees and recommends, “Gratitude, prayer/reflection/meditation, family time, journaling, acts of kindness for others.” However, you do not have to be religious to balance your spirituality. The saying is, “There’s an app for that.” There are plenty of technological solutions to help with spirituality, including religious podcasts and non-religious meditation podcasts. There are great guided meditation apps out there. In fact, if your day is full of work and evening full of home-schooling and other obligations, podcasts and apps work great during your commute. Although, I wouldn’t recommend a relaxation podcast while driving.

Final Thoughts

I hope this provides some springboard to your own balancing of mind, body, and spirit through this pandemic. Who knows, maybe some of this self-care business will stick even after our lives return to more normal so we can avoid some of the pitfalls mentioned earlier.

A few last points I’d like to make. If you have a significant other, spouse, children, or others in your house, self-care needs to be balanced with them. Don’t let self-care become selfish-care. Being in the house isn’t the same as being present. You could even plan a couple-care activity like a walk together or a shared meditation session. I believe that good self-care should be planned carefully. APs are brilliant multi-taskers. If we put forth the effort to balance work life, home life, and self-care, we will reap the benefits.

References

Alcohol Rehab Guide. (2019). Alcoholism and medical professionals. Retrieved from https://www.alcoholrehabguide.org/resources/alcoholism-and-medical-professionals/

Bourdeanu, L., Zhou, Q., DeSamper, M., Pericak, K. A., & Pericak, A. (2020). Burnout, workplace factors, and intent to leave among hematology/oncology nurse practitioners. Journal of the Advanced Practitioner in Oncology, 11(2), 141–148. https://doi.org/10.6004/jadpro.2020.11.2.2

Johnson, D., Ouenes, O., Letson, D., de Belen, E., Kubal, T., Czarnecki, C.,…Peabody, J. (2019). A direct comparison of the clinical practice patterns of advanced practice providers and doctors. American Journal of Medicine, 132(11), e778–e785. https://doi.org/10.1016/j.amjmed.2019.05.004

Li, H., Cheng, B., & Zhu, X. (2017). Quantification of burnout in emergency nurses: A systematic review and meta-analysis. International Emergency Nursing, 39, 46–54. https://doi.org/10.1016/j.ienj.2017.12.005

Lindemann, F., Rozsnyai, Z., Zumbrunn, B., Laukenmann, J., Kronenberg, R., & Streit, S. (2019). Assessing the mental wellbeing of next generation general practitioners: A cross-sectional survey. BJGP Open, 3(4), bjgpopen19X101671. https://doi.org/10.3399/bjgpopen19X101671

Molina-Praena, J., Ramirez-Baena, L., Gómez-Urquiza, J. L., Cañadas, G. R., De la Fuente, E. I., & Cañadas-De la Fuente, G. A. (2018). Levels of burnout and risk factors in medical area nurses: A meta-analytic study. International Journal of Environmental Research and Public Health, 15(12), 2800. https://doi.org/10.3390/ijerph15122800

Reynolds, R., & McCoy, K. (2016). The role of advanced practice providers in interdisciplinary oncology care in the united states. Chinese Clinical Oncology, 5(3), 44. https://doi.org/10.21037/cco.2016.05.01

Willard-Grace, R., Knox, M., Huang, B., Hammer, H., Kivlahan, C., & Grumbach, K. (2019). Burnout and health care workforce turnover. Annals of Family Medicine, 17(1), 36–41. https://doi.org/10.1370/afm.2338

Zhang, Y. Y., Wen‐Li Han, W. L., Qin, W., Yin, H. X., Zhang, C. F., Kong, C., & Wang, W. Y. (2018). Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta‐analysis. Journal of Nursing Management, 26(7), 810–819. https://doi.org/10.1111/jonm.12589

Related:

APs Helping APs Prioritize Self-Care in the Clinic, at Home, and on the Front Lines of the COVID-19 Pandemic (April 9)

Read more from the APSHO Advance: Special COVID-19 Series