Self-care is a set of meaningful activities that one performs or participates in to refuel and energize the mind, body, and spirit. Irvine1 wrote, "We are ethically obligated to care for ourselves, although as caring professionals, our primary ethical imperative may be to care for others." Irvine1 further added, "This imperative is meaningless, empty if divorced from the imperative to care for oneself."
We aim to explore the imperative of self-care as an ethical obligation for caring professionals, in particular nurses. We will examine the current state of self-care among nurses and the constraints that brought us to the state of ignoring our own self-care. Finally, we will provide some recommendations on the ethical imperative to prioritize self-care.
THE CURRENT GAP IN SELF-CARE PRACTICE IN NURSING
The current COVID 19 pandemic has brought to the forefront of nursing the imperative of prioritizing self-care as a tool to ensure better patient outcomes and prevent burnout or attrition from the profession. The stressors to nurses include long hours, rationing of care, the influx of complex emotional suffering and pain related to caring for sick and dying patients and their families, and the unilateral direction of care, wherein care, compassion, and empathy is given and not received.2-4 How can we hope to care for others if we ourselves are impaired by ill health, burnout, or compassion fatigue?1
The training and education of nurses further compound the gap in the prioritization of self-care practice by the unintentional omission of self-care competencies and courses during the training and education of nurses. For example, a review of course requirements and descriptions of 20 bachelor of science in nursing programs in the United States (by this author) illustrated the widespread omission of training and education in self-care practices. Of the 20 schools researched, only one had a dedicated course on self-care.5 This gap is not by intentional design. It can be inferred that the profession of nursing and other caring professions have focused on improving the science and art of caring for individuals and their families.1
Every program reviewed had numerous courses on the care of the individual and family across the health continuum, but as a society, we must also pay attention to the health and well-being of the individuals that have chosen a career in healthcare. This action will not only protect the growth of these professions by curtailing attrition out of the professions but also help to attract younger generations to the vital disciplines of caring professionals. Many of us know a nurse or physician who has stated that they cannot, in good conscience, persuade their children or loved ones to join their respective profession because of the long hours, emotional stress, and lack of work-life balance that currently accompanies nursing and other caring professions.
From the standpoint of policy, the addition of self-care as the fifth provision of the Code of Ethics for Nurses with Interpretive Statements is a significant step toward acknowledging self-care as a priority.6 Before the 2015 publication, the Code of Ethics for Nurses with Interpretive Statements did not include self-care as a provision.7 The current climate demands that we address and prioritize self-care for nurses on several levels-personally, as a profession, and within healthcare organizations. Steinwedel6 wrote that this provision is profound for both front-line nurses and nurse leaders. Moreover, the current work expectations of nurse leaders, such as long hours and the sacrifice of self, are counterproductive, nonprofessional, and neglectful of professional ethics and duty.7 There is a role for nursing organizations and healthcare policy makers in pushing the agenda of self-care for healthcare forward. The addition of self-care as a provision is a great start that should encourage other government and nongovernment entities to join the efforts. It will take a village to change the current culture.
Although the educational systems and policy makers play a role in the imperative to address self-care for healthcare, organizations also have a stake in this journey. It is well documented that satisfied employees lead to better business outcomes for the organization, and it is also well documented that burnout and compassion fatigue lead to attrition and lower quality outcomes that negatively impact organizations and patients.2-4 If organizations continue to expect nurses and nurse leaders to work in an environment that does not value their health and wellness, then the crisis of nursing shortage will continue to plague the profession and impact healthcare for years.2 This interplay was quite evident in the last 2 years as we dealt and continue to deal with the COVID 19 pandemic. Those of us currently working in hospitals are feeling the very tangible outcomes of the current labor shortage of nurses, and the COVID pandemic has highlighted this and has brought it to the forefront of society.
The nursing profession and healthcare organizations need nurses who are healthy and knowledgeable and are practitioners of the healthcare advice we give our patients.7 A model of care where we role model healthy behaviors is imperative, and research shows that it is critical in influencing the health of patients. For example, Rempel and coauthors stated that physicians who practice healthy behaviors are more confident in counseling patients and are more likely to counsel patients, and patients are more likely to follow their advice.8
PRIORITIZING SELF-CARE
"In 2002, the Joint Commission recommended the development of nurse residency programs" in response to high turnover rates among newly graduated nurses.9 Similarly, the Joint Commission and other policy making authorities in healthcare can create a self-care construct that advocates and even mandates the prioritization of self-care for nurses and other healthcare professionals. The implementation of a residency program has dramatically decreased the turnover rate of new graduate nurses, and such efficacy could be realized in the application of prioritizing self-care models across the continuum of nursing.9
The addition of self-care as a provision in the Code of Ethics for Nurses is a significant step in raising awareness.4 Such awareness may be what nurses need to forge a new way of nursing, where their health and well-being is not only important but also an ethical duty that must be realized to assure optimal outcomes for their patients, families, and society as a whole.5
The imperative to prioritize self-care not only protects the nurse but also allows the nurse to provide holistic care to his/her patients. Self-care is a professional and ethical duty of the nurse, and this responsibility is on the same level as professional development.4 Self-care activities such as coaching, meditation, and exercise should be considered as nurses evolve on the journey of creating a self-care plan that is unique to their individual needs.
Finally, and "equally important, all nurses-from students to bedside and community nurses, to chief nursing officers and members of nursing organizations, to researchers-must take responsibility for their personal and professional growth by developing leadership competency efforts related to healthcare reform."9 In the same regard, all nurses must take personal responsibility in prioritizing their unique self-care practices to refuel themselves to operate at the highest level possible.
THE CLINICAL NURSE SPECIALIST
The clinical nurse specialist, through practicing self-care, partnering with management, and encouraging dialogue with the clinical staff centered around ensuring they are taking time out for themselves and their families, can provide a foundation for a healthy work environment. With the current shortage of nurses predicted to increase, it is imperative that everyone is active in caring for each other and ensuring that both physical and mental health needs are being met. Department goals should include a goal for staff on self-care with measurements for the goal that include regular touch points with management and self-check ins to acknowledge that a time out may be needed to rejuvenate.
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