“I’m too tired to work overtime safely.”
“I’m sorry I’m not available to work this week-end. I have plans with my family.”
“I’m feeling overwhelmed with my workload. Can you give the admission to someone else or help me in some other way?”
Setting healthy limits about what we can and can not or will and will not do is key for healthy individuals, teams, and organizations as well as providing safe care! As such, it is a skill that every nurse should practice! However, setting limits is hard work for many of us, myself included. The desire to help, fix, and problem-solve is part of our nursing make-up and saying “No” or “I can’t” or even “I don’t want to…” may feel risky. Worries about necessary care not getting done are complicated by individual emotional factors such as the need for belonging, fears about being judged, or worries that we are not good, not good enough or not as good as someone else. And that’s not all, because any of these factors may be respected or not respected within the cultures of our teams and organizations. OY!
Nevertheless, setting limits is important and I’ve created this list of tips that nurses can use to practice them while creating a foundation of self-and other-respect.
7 Tips Nurses Can Use to Set Healthy Limits
- Be in tuned to how you feel. Are you stressed? Tired? In pain? All of these may be common and present and what constitutes too much stress, fatigue, or pain is an individual and personal decision and will vary over the course of a shift, lifetime and among us. If you watch the “Interruption Awareness” youtube a group of nurses and students helped me create you will see some valuable teaching moments of what stress looks like and the “Overload” activity is a fun way to develop your awareness about how you are feeling in a fun way!
- Honor what you are feeling. You are the only one who can really gauge it. Just as we are taught not to tell patients, ‘don’t worry’ or ‘ don’t be anxious’ it is much better to validate. A simple internal acknowledgment such as; Hmmmm, I’m feeling sad, ( or frustrated, or worried etc) is an important step in understanding and managing your feelings.
- Use ownership language. The above examples show ownership and I-statements can be helpful. Keep in mind that you need not apologize for your feelings or explain them although this is a judgement call. Apologizing for not being available is different from apologizing for feeling fatigued or stressed. Offering a little more information such as the number of overtime hours you’ve already worked or what plans you have with your family may be appropriate and honoring of your role as a team member and part of the larger organization.
- Let the silence be. This has been really challenging for me to learn and yet in this space of silence there is opportunity for others to help. It is also a place where compromise and co-creative problem-solving can occur. If setting limits is new for you, you might surprise others who are used to your willingness to fix, help, and problem-solve.
- Try trusting the village. I know that there are toxic teams and workplaces out there and would never insist on this tip. However, often times there are others who are willing to help and may need a few moments to think about it. By setting your limit and letting it hang ‘out there’ you may be surprised by who steps up to the plate. And if no one does, you’ll have more information about the culture in your team and the toll it might be taking on you.
- Consider compromise. Compromise can be a healthy process provided it isn’t a chronic pattern and doesn’t interfere with solving underlying problems or lead to working unsafely. Offering to work additional hours from time to time may be part of a work expectation and let’s face it, sometimes staffing crunches or excessively busy times will happen. And in reality sometimes you’ll be able to help and sometimes you won’t. And there may be some colleagues at different times who can help more than others. If patterns present that place unfair burdens on other staff there is a leadership imperative to address these situations case by case. This is true whether it is organizational i.e. staffing or individual i.e. a colleague who never covers extra hours. (The story in the “Magic of Limit-Setting” linked below provides an example of how a nurse and nurse manager arrived at a safe compromise.)
- Accept some anxiety during and after the process. There is often a perceived emotional risk in saying “No” etc. and during the silence you may feel your heart racing. Just note it and take a deep slow breath. You may also feel insecurities arise after someone has honored your limit or you’ve reached a compromise with others. This may be a rich opportunity for you to learn more about what motivates you to help others. Do what ever works for you to manage stress. Take a deep breath, go for a jog, or journal about your experience are some ideas. It’s new emotional territory and very normal to be a little anxious. If you find yourself excessively anxious, get some help from a counselor talk with a trusted friend. It is good to get to know and take care of yourself!
I hope these are helpful suggestions. As you practice this skill, you’ll be developing your assertiveness and will find the work helpful in important areas such as managing conflict, delegating tasks, and speaking up in groups. If you have additional tips or ideas to improve on these, I’d love to hear them! Here are a couple of related articles:
Lorie Brown, a well-known nurse attorney writes, No is a Complete Sentence. (Lorie has a different perspective on compromise and equally valid, IMHO!)
An older article by myself called, “The Magic of Limit-Setting” that includes a story about a nurse who said “No”.