Optimism Is Not The Opposite Of Realism

“I’ve been smoking for 40 years. Nothing will make me quit, ever. I’m not a quitter. You can’t make me quit!”

The majority of our patients who smoke say they have no interest in quitting. We love them, but they drive us nuts. We know what they need but they won’t do it. Well, they can’t, or believe they can’t, is more like it. But from our perspective, especially those of us who have never smoked ourselves, we see it as a choice they are making. And sometimes it feels like they are doing it just to spite us.

They’re right, though, we can’t make them quit, no matter how much we want to. We want to take away all simple carbs from our diabetics, all sodium from our hypertensives, and the cigarettes from our asthmatics, too, but we can’t. Nor should we want to, that’s not what we’re good for.

All we can do is recommend and hope that telling them will make a difference. We can provide alternatives, help with making changes, and support in self-confidence.

But know what you ARE good for

Research shows that patients listen to us when we’re talking, even if it’s just a throwaway one-liner like “are you ready to quit? No? Okay then, moving on…” Mentioning quitting at the visit is shown to increase quit rates remarkably. So ask if they’re ready to quit at every single visit, but don’t belabor the point. Don’t ram it down their throat; that’s not going to help anything.

It gets tiring asking over and over again, though, doesn’t it? Especially when they get upset at you every time. Sometimes you wish you could just leave it alone, and consider it a lifestyle choice, and let them suffer the consequences. But you can’t, can you? Because you do care, and want the best for them and their health, however paternalistic it may be.

With my most obstinate patients, I make it into a joke. I tell them “okay, you’re going to laugh, but you know I have to ask this every time, like I told you I would… you ready? Okay … Are you ready to quit smoking?” That way, they’re usually laughing with me rather than getting huffy at me for asking yet again.

Then one day, one of your most cantankerous I-will-die-with-a-cigarette-on-my-lips-so-stop-asking patients comes in and says: “hey, I quit smoking!” When you ask why, they say something like “I knew I should,” “you kept asking about it, so I knew it was important,” “I wanted to be healthier,” “I knew it was the right thing to do,” or “I just felt like it.” We don’t care what the reason is anyway, do we? We just wanted them to quit, and when they do we are indeed happy for them and excited for their health.

These moments teach us to be optimistic

Always believe they can change, even when your brain and heart tell you that it’s impossible. Sharing your optimism helps patients be optimistic as well, and optimism breeds self-confidence, which provides fertile ground for change. They can tell when you’re pessimistic, and worse, when you become cynical and jaded and stop caring and stop asking.

Yes, you need to be realistic, too, but optimism and realism are not opposites. You are paid and respected to be realistic, and help them deal with their medical reality. But humanity demands that you do it in ways that have meaning to them.

Realism means not only following their pack-year history and talking to them about risks of heart disease and lung cancer, but also recognizing that change is hard and scary. If you’ve never smoked, you are at a great disadvantage in supporting patients to quit smoking, because you’ll simply never understand. Sure, you can empathize, and you may think you understand, especially if you have worked through other addictions, but even if you’re right, the patient will never believe you.

When I was in school and we were practicing motivational interviewing techniques on each other, about ten minutes into the exercise one of my classmates silenced the entire class by shouting at her partner:


Clearly she was missing the point, but I see many providers using that same argument style simply because they feel so frustrated, like their recommendations never get anywhere with the patients.

Motivational interviewing is not about browbeating them until they change, it’s about meeting them where they are, assessing their motivation and willingness and ability to change, and then supporting that to the best of your ability. It’s about realistically instilling optimism along with the confidence and skills to change.

I make great use of the smoking helpline in Arizona where I work, because many of the counselors are former smokers, and know what it’s like. I don’t, and I admit that to my patients up front. But I also share that I do know the health benefits of quitting and I want what’s best for them, and I’ll support them in any choice, and do my best to take care of them.

It’s what I’m good for.

Do you have a story about the clash between realism and optimism and how you handled it, or about patients who decided to quit? Share it in the comments below!

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New York Taxi Driver School Of Stress Relief

Brakes screech and you are thrown against the side door as the cabbie zooms over into the next lane, missing that candy apple red Audi’s shiny bumper by mere inches. You thank God the taxi at least has working seat belts. The cabbie enthusiastically lets out a colorful stream of invectives as another car cuts him off, then immediately quiets, eyes darting rapidly, searching for the next quarter-second opening between vehicles to get you to your conference in Manhattan in record time.

Big Apple cabbies make snap judgments under heavy stress hundreds of times per day, just like we nurse practitioners do, and mistakes can cause injury or even death. They don’t have time to weigh their options; they are too busy making the decisions and moving forward. And they absolutely can’t let their sympathetic nervous system fight-or-flight response overwhelm them, as they have to remain clear-headed at all times to continue making decisions, just like us.

So how can those of us in high-stress occupations avoid being overwhelmed by our own constant stress responses to non-life-threatening situations?

Respond Right For Your Stress Type

First, know your stress response type. If you haven’t already, check out this article on recognizing your own stress response: Are You Making This Mistake And Missing Out On Near-Instantaneous Stress Relief? In short, we humans respond in physical, psychological and spiritual dimensions with either a GO, STOP or FREEZE. Your responses may vary by situation, but you probably tend toward a specific type, and knowing your type is crucial to responding effectively.

ALL Response Types: Breathe First

The instant you recognize you are in fight or flight mode, immediately inhale a deep slow breath in through your nose, and just as slowly exhale it out through your mouth. Recognize that you are feeling activated, and simply allow the feeling to exist. Next, go to your response type below:

GO Responders: Pause, Decide, Act

If you are a GO responder, you engage with the stressful situation and act immediately, regardless of whether action is the best idea. Your fight-or-flight response leans heavily to the mental dimension. You are too busy taking action to notice the physical symptoms as intensely as other responders do, and disengagement is not even on your radar. Start noticing how irritable, angry, moody or jumpy you get when your sympathetic nervous system fires.

How to handle your GO stress response:

  • Pause after you take your deep breath. Recognize that you need to think before you act, as going with your “gut” may result in an overreaction or the wrong action.

  • Decide consciously how you want to respond to the situation.

  • Act on your decision.

STOP Responders: Pause, Engage, Act

If you are a STOP responder, you disengage and withdraw from the stressful situation and avoid direct action, even when engagement with immediate action is the best idea. Your fight or flight response leans heavily to the spiritual dimension. You have a tendency to become depressed and/or anxious when stressed, and may even feel bitter or cynical when stressed for long periods.

How to handle your STOP stress response:

  • Pause after you take your deep breath. Recognize that you need to engage and be fully present before you act, as going with your “gut” may result in avoidance or failing to take necessary action.

  • Engage with the situation. Don’t shy away from it; be present. Think about your options and decide how you want to respond.

  • Act on your decision.

FREEZE Responders: Reboot, Re-engage, Act

If you are a FREEZE responder, your body reacts to acute stress by becoming paralyzed. At the same time, your brain goes into overdrive, hyper-engaged with the situation, but overwhelmed and unable to come to a decision or act. Of the stress response types, your fight or flight response leans most heavily to the physical dimension, and you feel the physical symptoms of acute stress more intensely than other response types.

How to handle your FREEZE stress response:

  • Reboot after you take your deep breath. Recognize that you need to distract yourself from the push-pull of the “freeze” before you can act appropriately. To do so, pinch your cuticle firmly, and pay 100% attention to the sensation of the pinch. Block everything else out. This will pull you back into the present moment, instead of feeling overwhelmed by the stressful situation.

  • Re-engage with the situation once you can deal with it more objectively, and decide how you want to respond.

  • Act on your decision.

Which stress response type are you? Try the above steps for dealing with your fight or flight responses for the next 7 days, and let me know how you do in the comments below.

Take Care Of You,


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Are You Making This Mistake And Missing Out On Near-Instantaneous Stress Relief?

Your heart beats a rapid staccato in your chest, your muscles clench tightly, you breath rapidly and shallowly, your mouth turns into the Sahara, and the butterflies dance with wild abandon in your stomach. You raise your clammy palm to the door to push it and enter the room, steeling yourself for the worst, knowing this is going to be the patient visit from hell…

But… did you even realize how stressed you were? Or did your stress response creep up on you unnoticed, and advance unmanaged? Did you at least take a deep breath when you realized how on edge you were? No? Let’s talk for a bit…

As a nurse practitioner and human being, you intimately know the sympathetic nervous system cascade that overtakes you in times of acute stress. The precisely orchestrated hormonal and physiological avalanche that helps you flee from the proverbial saber tooth tiger are as easily activated these days with a non life-threatening stressor such as a difficult patient or fear of a bad patient outcome, rather than something truly life threatening.

However, stress isn’t always so straightforward, and doesn’t even always look like stress. Do you recognize your own stress response, and what it looks like in YOU?

Failing To Recognize Your Own Stress Response Is Ignoring A “Restore-All” That Could Offer You Near-Instantaneous Stress Relief

Recognizing stress and your own stress response is the first and most important step in lessening its effects. I’m going to say that again. Recognizing stress and your own stress response is the first and most important step in lessening its effects.

We all know that we are stressed, and that we are facing many different stressors. We often don’t recognize our own stress response, though, and don’t respond until it is too late. We push through it, or take meds for it, or ignore it, or simply don’t even realize it exists. So what exactly is the stress response?

Stress Responses Fall Into 3 Main Categories: GO, STOP and FREEZE

Do you feel angry or agitated when you are stressed? Are you mobilized to action, unable to sit still, irritated, and maybe even prone to lash out? You are a GO responder.

Do you back away from stressors? Withdraw into yourself? Stop talking about it, distance yourself and try to avoid it as best as you can? You are a STOP responder.

Do you freeze in place, unable to take conscious action, either toward or away from stressors? Do you feel overwhelmed or paralyzed by indecision at key moments, even though your brain is nattering away furiously at you that you must do something, anything? You are a FREEZE responder.

Take a moment now and think about your responses to different stressful situations. Which response type do you experience the most? How does it effect your actions and how you handle stressors?

Stress Responses Include 3 Dimensions: Physical, Mental and Spiritual

Physical responses include sensations as eclectic and far-reaching as heartburn, unexplained energy, lethargy, headache, abdominal pain, “butterflies” in your stomach, muscle tension and hyperventilation, including to the point of asthma and panic attacks.

Mental responses include psychological and emotional states such as agitation, frustration, decreased ability to handle intellectual and social tasks, moodiness, rigidity, anger, depression, shutting down, pulling away and spacing out.

Spiritual responses highlight how we see ourselves in the world, and include disengagement, apathy, anger at the world, angst, moral indecision, invalidation as a person and self-awareness.

How do you respond to stressors? Take a minute now and characterize your own responses to stressors in the physical, mental and spiritual dimensions.

Why Do You Respond to Stress The Way You Do?

Genetics play a major role in stress responses, firmly guided by life experiences. Stress responses are definitely a case of both/and with respect to the nature/nurture debate.

How others react to your stress responses plays an additional pivotal role. For example, anger is frowned upon in our society, especially when expressed by women, so individuals with natural anger reactions learn to dampen their external expression of anger and turn it inward.

Can You Change The Way You Respond To Stress?

Kind of. While the physiologic and hormonal cascade of stress response and how your brain interprets it is outside of your control, recognizing and engaging with your stress response lowers its impact on you markedly. Additionally, when you start taking healthy actions based on the responses, such as deep breathing, you begin training yourself how to respond in the future, affecting the “life experience” side of the response for the better.

Can You “Fix” Your Stress Response?

That’s a fair question, but a tricky one. You don’t want to “fix” your stress response, meaning get rid of it completely, because some stress is positive, and we require some stress to make healthy decisions and move forward as human beings. This is especially true of us nurse practitioners, who make decisions affecting others’ health and lives many times per day.

You can decrease the strength of the negative aspects of your stress response by implementing nonspecific recommendations like exercising, fostering healthy social connections, eating right, sleeping enough, relaxing, meditating, cultivating a sense of humor and otherwise taking care of yourself, but these don’t address the specific concerns with YOUR stress response.

However, I have run out of space, so I will defer the answer to the question “how do you deal with specific reaction types” until the next blog post.

Do you recognize your stress response category, and how you respond in the 3 main dimensions? How does it affect you and your workday and your stress level? Share your story in the comments below.

Take Care Of You,


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How To Stop Being So Cynical: Try These 7 Simple Steps

Do you want to feel happier and more satisfied at work? Do you want to be less cynical, but are too jaded to censor the sarcastic remarks before they slip out? Do you want to have an attitude you can be proud of, but don’t want to live in a mental version of a Disney castle like the “Be Positive!” folks seem to want you to?

You’re in the right place. In this article I share specific actions to take to rekindle your idealism and quiet down your inner cynic. If you haven’t read my previous post on idealism yet, check it out before you continue reading: Have You Acknowledged The Death Of Your Idealism?

Did you read the above article yet? If not, I can wait. I’ll be right here when you get back.

Okay, now that you’ve acknowledged that your idealism is in bad shape, and spent time grieving it, it’s time to take concrete steps toward rekindling it.

Step 1: Recognize Your Inner Cynic

For many nurse practitioners, “jaded” is our default state of being. We have been hurt too many times, tried too hard, failed too often, and cynicism starts to come naturally to us. It becomes such a constant companion that we forget that our cynicism isn’t natural at all.

Your cynicism is a highly targeted protection mechanism. It prevents you from being hurt by horrific sights and sounds, heart-wrenching emotional decisions, death, failure and the worst of human conditions. You work in health care, after all, and often it’s not a pretty sight. However, when your cynical armor becomes so rigid that you can no longer engage with your idealism, it’s time to figure out how to remove the armor and move more lightly.

Action Step #1: When you have a negative, cynical thought, notice it. Then let it go.

Step 2: Challenge Your Inner Cynic

When your inner cynic is telling you how appalling things are, notice and acknowledge the thoughts, then challenge them. For example, if you think “every single patient is a drug seeker today! I hate this!” look at your schedule and recognize which patients were NOT “drug seekers.” It’s amazing how our brain can ignore seeing a kiddo for an ear infection not 60 minutes ago, and still have thoughts like the above.

Remember how wonderful your patients are sometimes, and how interesting and amazing. Think about how your inner cynic is exaggerates how negative your situation is.

Action Step #2: When you have a cynical thought, challenge it by comparing it with objective reality. Then let it go.

Step 3: Evaluate Your News Consumption

News media don’t get paid to report what is happening. They get paid to convince people to consume their version of the news. Because our brains pay closer attention to the negative than the positive, reporters focus on negative events to get people to watch their media channel.

That is why the news is filled with bombings, threats, brokenness, anger and sadness. Yes, news channels report on happy and positive events as well, but the negative topics easily dominate, as they garner more viewers.

You may feel it is important to stay current with the news, and that’s okay. But do you really need to check your news feed on Twitter and Facebook 34 times today, and then watch the six o’clock news on television, too?

Action Step #3: Decrease or eliminate how often you consume television and social media news. Decide how often is appropriate for you, and don’t check it any more than that.

Step 4: Examine Your Social Network

When are you the most negative? Who is the most negative around you? What is the tone of the groups you follow on social media? Who is the most negative/positive of your coworkers?

Have you ever noticed that if you complain to one person, you get constructive help, and if you complain to another you get entangled in a battle of one-downmanship?

Action Step #4: Examine your social network at your job, in your free time and on social media. Change how you interact with negative people and groups so they don’t affect you as much, or remove them from your life.

Step 5: Focus On The Positive

Yes, straight-up optimism has immense value in declawing cynicism, even if you are just “faking it until you make it.” You did it with new procedures when you first started nursing, so I know you can do it for optimism!

We work in an inherently chaotic environment with rapidly-changing situations. It’s what we signed up for in joining the US healthcare industry, and there will always be frustrating times.

However, focusing on the positive catalyzes your return to idealism by crowding out energy for negative thoughts and feelings via a positive feedback loop mechanism.

Action Step #5: At the end of every day, write down 3 positive things that happened.

Step 6: Cultivate Your Curiosity

Go outside and play.

Spend time with children.

Engage in flow activities.

Lose track of time.

Jump in puddles.

Go for a walk.

Practice mindfulness.

Spend time in nature.

Be loving to yourself and others.

Enjoy art, music or theater that moves you.

Action Step #6: Do something playful and fun for five minutes every day.

Step 7: Practice Not-So-Random Acts Of Gratitude

Gratitude powerfully neutralizes cynicism, and cultivating an attitude of gratitude takes you a long way toward being present with your idealism. We have so many opportunities for gratitude in our profession, but they are so often overwhelmed by the crushing responsibility and stresses of being a nurse practitioner.

We make a difference in other peoples’ lives every day through our profession. Take advantage of this and recognize the phenomenal work you are doing in the world.

Action Step #7: At the end of every workday, make a list of three things you are grateful for.

Do you have any other ideas for ousting cynicism? Are you struggling with feeling jaded? Share your story in the comments below!

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Have You Acknowledged The Death Of Your Idealism?

5-year-old with pigtails: “I want to be an astronaut!”

Society: “Aww, that’s so sweet. You can be whatever you want to be!”


15-year-old with metallic blue highlights: “I want to be an astronaut!”

Society: “That’s nice. Maybe if you study hard in all the right subjects it might be possible, but you’d better have a backup plan. How about you stop dying your hair weird colors and think about being a secretary instead?”


25-year-old with a ponytail: “I want to be an astronaut!”

Society: “Get real. Only kids think about stupid stuff like that. Get a job, a mortgage, a car payment, and contribute to society like you’re supposed to.”


We nurse practitioners tend to be helpers and organizers. We had ginormous idealistic dreams when we were younger, wanting to help the entire world and all the people around us. However, as we grew up society and people around us firmly told us to put that idealism away, so we did. 

Slogging through the reality of nursing and medicine in today’s health care environment tends to squash that idealism even further. The squashing happens so subtly and slowly that we don’t even notice it happening until its decay is advanced, leaving us feeling drained, stressed, burned out and unhappy.

We do get to help people as nurse practitioners, but not like we thought we would when we were kids, or even when we were nursing students. We start to feel cynical and jaded and even trapped within “the system,” trying our damnedest to make a difference but feeling powerless because we often are simply not allowed to do so due to constraints by society, insurance companies, patients and administrators.

So what can you do?

Acknowledge The Death Of Your Idealism

We rarely engage in this kind of thing in US culture, as we love actions and “fixing” things. However, you have to admit the problem exists and give yourself time to process and grieve before you can fix it.

I realized my idealism was dead a couple years ago. I started to feel cynical, jaded and sarcastic. I started judging my self, patients and coworkers harshly, as well as random people around me. I felt excruciatingly frustrated with what I perceived as my inability to truly make a difference in my patients’ lives, even though I was working my tail off every single day. I was burning out and losing hope. I went through a many-months-long process to acknowledge and then rekindle my hope and idealism, and I hope to help you get there, too. Yes, you can have your spark back.

The first step in acknowledging the death of your idealism is to grieve your loss. We are trained as adults to see realism as correct, and idealism as foolish. However, when we lose contact with our idealism, a large chunk of our physical, mental and spiritual energy leave with it. This rapidly results in lack of meaning and purpose in work and life.

For example, remember what you expected your role/identity would be as a nurse practitioner would be back when you were a student? It turned out to be much different than what society, patients and clinics want you to be, didn’t it. The loss inherent in that rift hurts, and deserves to be acknowledged.

You don’t have to do anything fancy to acknowledge it. Just sit down in a quiet place for a few minutes and remember and imagine what it was like to be an idealistic student or new nurse, and how excited you were at the time.

Have a conversation with or write a letter to your younger self, expressing your grief at the loss of your innocence and idealism. Or think about it as vividly as you can, and allow yourself to experience the loss of your idealism fully.

The moment you admit to yourself how idealistic you aren’t, you connect with the fact that your idealism isn’t dead, just dormant.

Before you start trying to rekindle your idealism, though, give yourself time to sit with the acknowledgement. Some people can acknowledge something and immediately “own” the knowing of it, but most of us take some time to fully understand it. Go at your own pace.

Once you successfully internalize the knowledge of your dormant idealism, you are ready to start rekindling that idealism. I will discuss exactly that in my next blog post, to help you take the next step toward stress relief and healing burnout.

Take Care of You,




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Do You Use All Twelve Seconds Of Your Lunch Break Effectively?

You peer blurrily at the stupid tiny clock in the corner of your computer screen, watching the last few seconds of your lunch “break” slip away. You continue charting frantically, trying to finish as much as you can before you get bombarded with the workload of your afternoon patients.

You rub your eyes, but the grittiness won’t go away. You know it’s because you have been staring at the screen too long, and that you shouldn’t chart through lunch, but what can you do? You don’t want to be charting at 9pm either, so working through lunch seems like the lesser evil.

You wolf down some food in 60 seconds flat with one hand as you click madly away with your mouse using the other hand, sighing as you are called to go see your first afternoon patient.

Sound frustratingly familiar? Desperate to find a better way? Do you wish you could actually feel rested after lunch and still get more done?

Enter the two-minute power-walk

Your body and mind require time to rest and recharge. Nurse practitioners usually have “little to no” opportunity to relax, even during our “long” break for lunch. However, honoring your need for rest results in increased productivity, creativity, problem-solving social engagement and decreased errors.

Take a two-minute walk outside the building as your first action the instant you are free of patient responsibilities. Your body and brain will thank you.

Walking briefly outside during lunch offers many benefits, such as:

More Creativity

Studies show up to a 60% increase in creativity after a hike, and a short walk outside offers a powerful creativity-booster in the middle of your workday. When you are mentally exhausted, you can’t think of as many creative solutions for your patients’ issues, so you taking a short walk can be the difference between “no solution” and “hey, I know what we can do” for your patients.

Less Errors

Longer work without adequate breaks leads to increased numbers and severity of errors in the clinic just as it does for nurses in the hospital. You simply don’t work at your best when your brain can’t rest. You can reset this timer at least to some degree by getting outside and moving around, even if it’s only for two minutes.

Better Problem Solving

Changing your environment results in clearer thinking and improved problem solving. Yes, you can get these benefits in just a couple of minutes. The key is to get your mind off of the “same old same old” train tracks and onto a fresh set of tracks where you may come up with different solutions to the problems you are trying to solve.

Less Pain

When you chart through lunch, you tend to hunch over your shoulders, scrunch your eyebrows together and stare at the screen even longer than usual because you’re trying to reach a certain goal.

This results in increased stiffness and pain in your neck, wrists, shoulders and back, as well as the “stale” mental feeling that we all know and hate to feel when we have been working too long.

Get up, get out, move around, and you will be less prone to injuries and more able to work effectively.

Increased Productivity

Short rest breaks such as a two-minute walk will increase your productivity, which is why I recommend the power walk as the first thing you do during your lunch time. If you don’t do it right away, there is always “just one more thing” that you absolutely have to do before you can take your walk, and suddenly you run out of time and you are seeing patients again.

After the break, you are more productive thanks to the increased creativity, clearer thinking and the movement inertia you gain through the walking. Despite the loss of charting time to the break, you will get more done, and more effectively.

Increased Social And Emotional Engagement

Many of us nurse practitioners stare at our screen throughout our lunch, ignoring those around us. Taking a walk opens up our energy to connecting with our coworkers in meaningful ways. Positive social and emotional engagement in our workplace leads to increased happiness, job satisfaction, and morale.

So get up and go for a walk the moment your lunch break starts. Even if you end up charting through the rest of your lunch, the walk will help you be more energized, creative and productive, and prevent mental and physical exhaustion.

Try incorporating this two-minute power walk into your daily routine for the next three days. How did you do? Did it help? Let me know in the comments below!

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