It's not the load that breaks us down; it's the way we carry it. - Lena Horne

Everyone has had the experience. You are in an airplane and the flight attendant is giving the welcome speech, along with the initial safety tips. You are told that, if there is a problem and the oxygen masks release, you are to put on YOUR mask before you assist anyone else: your children (what!), your seatmates, anyone.

Why is that? Because you are of no help to anyone else if you have not first taken care of yourself first. As healthcare professionals we have seen-or have personally experienced-caretakers who have used up their reserve and, try, as they may, cannot emerge from the state of tired, burnout.

Resilience. What exactly is this human condition, usually stress induced, that weighs us down? And can we, as healthcare professionals (and caretakers), find ways to stay resilient? I will attempt to answer the "what." My colleague, and student of resilience, Ellen Fink-Samnick, will help us find the "how."

Several years ago, when Ellen was writing one of her articles on this topic, we went back and forth, trying to pin down exactly what "resilience" was. It was an interesting, sometimes funny, exercise and even the email banter made me feel resilient! Recently, I came across a quote from John Reich, a social psychologist at Arizona State University, which cites resilience so well:

At the heart of human adaptation is resilience, the ability to create a positive world for ourselves, often in the face of stressful life experiences, and the ability to resist being overtaken by negative experiences when they seem to be overwhelming.

Who wakes up in the morning wanting the negative experiences in their lives to overwhelm them? My sense is most of you rise to an opposite mantra, such as, I want to be in total control of everything today! This is especially true for those in case management.

We strive to maintain control as we intervene, prioritize plus coordinate care, and then advocate for the needs of so very many patients, clients, members, consumers and so on. This control is tested time and again, indiscriminately at work and home. As members of professional disciplines where we are viewed as natural caregivers, we face an occupational hazard of caring for others before and often instead of ourselves (Fink-Samnick, 2007). Clearly, John Reich knew something of the case manager's world, for we are in a constant juggling act to create a positive world for ourselves while resisting that tide of being overtaken by the needs and negative experiences surrounding us.

When the term, resilience, hit the mainstream in 2008, I was shocked at the dearth of definitions geared to those in the healthcare workforce. The majority of framings I identified were related to the patients and/or specific populations. It was clear the health and human service professionals, especially case managers, deserved a unique definition (of resilience) to ground a comprehensive model providing step-by-step direction. There had to be strategies for managing the ever-changing realities and dynamics invading both professional practice and personal lives. The Professional Resilience Paradigm (Fink-Samnick, 2009) was born.

Why Revisit Professional Resilience Now?

As I scan our current industry, it is evident the world has tossed a whole new gamut of daunting realities at society, with case managers on the front lines.

Licensure Portability

Licensed professionals across disciplines face the trials and tribulations of intervening appropriately with our mobile society across state lines. At the time of this writing, there are efforts to advance the Nurse Licensure Compact beyond the current 24 states. Yet the Telehealth community, serving as the needed catalyst to move licensure portability forward, is exerting a strong force (see this month's Legal and Regulatory column).

Social Innovation Stressors, Plus a New Generation of Ethical Dilemma

Keeping pace with innovation, organizational policies, patient concerns and regulatory adherence requires moving at warp speed plus. Some suggest the wonder of technology, and all assorted mobile devices, has contributed to decreased conversation and in essence, less connection and more isolation (Ostrow, 2012)."Organizations are trying to be aggressive to maximize time, effort, and energy to achieve not only their business goals, but in some instances, meaningful use and to capitalize on those dollars as quickly as they can" (McNickel, 2012).

Along with these stressors, the promise of social innovation and technology has yielded a new generation of ethical dilemma as professionals and providers work to as align the implications of practice across cyberspace. Ethics has transitioned from What everyone does while nobody watches, to What everyone does while EVERYBODY WATCHES 24/7 (Fink-Samnick to Grobman, 2011).

New and Emerging Care Coordination Models

Increased integrated behavioral health models abound, yielding new and exciting opportunities for case managers. However, the models also highlight society's growing presence of acute psychopathology amid biophysical symptoms. This level of acuity is present through a barrage of daily media stories related to violent crimes and incidents.

Unemployment and the Economy

The unemployment rate may be down, 8.3% at the time of this writing (Bureau of Labor Statistics, 2012). However, the ripple effect of tougher times continues for many. This extends beyond patients, to the professionals. Most know someone forced to leave his or her home, separated from family, and/or experience a change in life circumstances due to the economy's influence. Nobody is immune, it would seem.

The Reality of Our Lifetimes

We are the sandwich generation coping with aging parents amid raising children, more than 20 million in fact (MSNBC, 2012). Recent numbers show by 2030, 18% of the population will be over age 65. This has profound implications for those who will have to manage their care needs and wrestle daily with feeling they have bitten off more than they can chew (Serafini, 2012).

More of us have or know of families with children returning home to live due to the economy. A majority are faced with enormous debt plus employment challenges (Fairbank, 2011). We deal with illness, diagnosis, and loss of peers and family members, not to mention devoted family pets. We struggle with the impact of the rash of natural disasters and violent crimes on our communities and our lives. This latest generation of military who have valiantly served, face their own unique trials and tribulations, as do their families, and all involved professionals.

Balance Amid Chaos

The current times mandate a heightened urgency for all healthcare industry professionals to renew their commitment to achieve balance amid occupational stressors and life challenges, while fostering professional values and career sustainability. This is accomplished by a series of defined building blocks and individualized strategies (Fink-Samnick, 2009). Therein lies the essence and definition of Professional Resilience.

Review, individualize, and then engage in these 14 pragmatic strategies to strengthen your resolve. Whether this is your initial exposure or a return visit to Professional Resilience develop one practical means to apply each strategy:

1. Value, do not devalue, your Professional Self. You are in a team meeting with a colleague of a higher position. In communicating a point, you say, "I know I am just the case manager, but" ... STOP! Instead try, "As the case manager I bring a unique perspective to this process. Let me share how this impacts this situation." A little self-advocacy goes a long way to demonstrate and educate others about your expertise.

2. Present with a presence. If you think you are burned out, you are. Consider how you present to anyone you interface with. It may be seen in how you dress, the tone of your speech, or how you engage with consumers. If you are sensing apathy, or even a lack of interest in being at work, so do others.

3. Have positive contacts with colleagues and peers. Know who motivates versus depletes you. How many times do you avoid a certain interaction with someone who drains you of any positive emotion? Although we do not always have control over the duration and frequency of those interactions, being mindful of them enhances our ability to see how they impact our energy and focus.

4. Achieve validation. Identify and name your goals and aspirations. Then, go to that next level by engaging in dialogues with those who will empower you to achieve them. If you do not have someone who you trust to be able to engage in these dialogues, make it a priority to develop a relationship for this purpose. It may be a mentor, partner, or peer, but clearly someone you respect.

5. Use the power of professional networking. Engage with professional associations, plus use professional networking websites and groups to keep from falling behind new trends. Both have unique power to expand your horizons, plus your opportunities. In these times of so much innovation, every day is a new decade; so keep up or get left behind!

6. Stop saying you cannot take a break. How many times last week did you say, I cannot afford to take lunch or a break? The truth is you cannot afford not to. Even the briefest break helps to re-energize and reframe a situation.

7. Use creative visualization. In 30 seconds, you can imagine yourself in a better place, whether the comfort of your favorite space in your home or lying at the beach. Your mood and energy level will benefit.

8. Take control and shift activities. Focusing too long and hard on a specific activity is draining. We can become enmeshed in what we are working on and can lose objectivity. It is the same premise as forgetting what you want to say. The more you think about it at that point in time, the more anxiety you develop and the less likely you are to remember. Then you say, ENOUGH and move on. Then suddenly, out of nowhere, clarity happens! Give yourself that permission to walk away and shift gears.

9. Laugh at least once a day! Along with releasing those endorphins, laughter reduces stress and promotes a sense of camaraderie among the staff. The ability to share the more humorous experiences in the workplace goes a long way to engage even the most distant colleagues. It also makes for a happier work environment.

10. Stop to take that long deep breath. We use the same muscles to be tense as to calmly breathe. Still a valuable perspective!

11. Develop a grounding list. Keep accessible this three to five-item list of individualized actions to ground you. A favorite song, picture, aroma, or phone call to someone who provides unconditional support are ways to restore one's foundation of inner strength.

12. Exercise. Release those endorphins to boost your spirit! Whether a 5-minute sprint up the steps or a scheduled activity, we all know the merits of a healthy physical self.

13. Release frustration with a silent meow. Primal screams are effective but tough in the workplace! Ever watched a kitten attempt to meow? They tense their body, open their mouth as if the fiercest of felines, and let loose! Afterward, a sense of calm emanates from them. TRY IT!

14. Revision honestly and regularly. If you still have not begun your revisioning journey, you must (Fink-Samnick, 2006, 2008). For those unfamiliar with this concept, or perhaps for those who need reminding, the revisioning tool provides a template; to

* revise previously defined life's goals and priorities,

* define an individualized schedule,

* identify realistic obstacles to the schedule's implementation, and

* progress with a plan to reflect your current perspective.

(Fink-Samnick, 2009)

Accountability for Professional Resilience

There will always be a steady flow of new realities and circumstances to challenge the reserve of our ardent health and human services workforce. Whether these present in personal and/or professional realms, one's accountability for maintaining that underlying reserve is critical. The Professional Resilience Paradigm serves as an essential resource to fuel this process. It is the one constant each of us can control amid so much that is unpredictable and uncontrollable.

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