From Vet Tech to Registered Nurse & Now Wellness Coach: Mental Health & Self-Care Tips for Health...

Thank you for joining me for another episode of the Nursing Strategies for Success podcast with this week's guest, Riley Koito. Riley is a nurse working in surgical oncology who has pursued additional training as a nurse coach. She is an advocate for mental health and promotes lifestyle changes to guide her clients to feel empowered and take control of their life once again. Having this skill set has helped her to have better communication with her bedside patients and help them feel empowered and advocated for. So let's welcome Riley to the show. Welcome to the Nursing Strategies for Success podcast, brought to you by The Nurse Speak, a show where we rally some of our nation's greatest nurse leaders, educators, experts, and advocates to tackle some of our greatest challenges that the nursing profession faces. My name is Damion Jenkins, and I'm your host for this show. So sit back, relax, and get ready to learn that nurses can do anything. Okay, Riley, thank you so much for joining me on the Nursing Strategies for Success podcast. Why you take a moment and introduce yourself to the listeners? Let them know a little bit about where you started in nursing and where you are today.

So before I was a nurse, I was a vet tech, um, so similar to nursing but obviously with animals. I did that for about 5 years, and the first couple of years were pretty rough. I did work nights, and it did take a toll on my mental health. Um, when I switched to a better, um, schedule for me, I started really taking care of my mental health, um, and my physical health. And I kind of brought that along with me. Um, I ended up switching careers for multiple reasons. I absolutely loved what I was doing with the animals, but the veterinary field is very hard. Um, The suicide rates are higher than most professions, and I just needed to get out of there. So that was a huge thing that really pushed me to go into nursing. So I went through nursing school, and then I worked two part-time jobs initially. I worked in home health with pediatric, um, most of them had cerebral palsy, they had trachs, they had feeding tubes. And then I also did psych. I worked in the psych unit, um, and then where I am currently is surgical oncology. Um, so I take patients who have had major organs removed due to cancer.

Got it.

Wow.

So I just want to back up just a little bit because I'm sure there's some listeners out there that probably clinging on to this little fact that you threw out that many, many of us may not know. Um, correct me if I'm wrong, but you said suicide rates are high? In the veterinarian world?

Yeah, it's one of the professions with the highest suicide rate. Wow.

And what would be the causes of that, do you think? Or maybe you know.

Well, I mean, it's, it's pretty hard, you know, like nursing is, but the pay is a fraction of it. Um, and I worked in the emergency department for a big part of um, you know, my time there. And people would just scream at us. They would call us car salesmen. Um, they just didn't understand what we were going through on a daily basis. And it was, it was not good.

Um, people can be awful, can't they?

Yeah.

Yeah. So I mean, many of us as experienced nurses know that sometimes it's the same thing in nursing. Um, but I could see a big difference between you know, trying to help an animal who cannot communicate in the same way that a person can, having a frightened animal and having a frightened owner, right? The person who owns that animal or, you know, truly believes that that animal is a child of theirs, right? Because many of us do love our pets as if they were our own flesh and blood and that they just don't understand what's going on. And no matter how much we try to explain it to them, they're in denial or they're grieving or they're afraid. And so in such a chaotic situation where we can't really easily determine if what we're doing for the animal is helping or not, as if we can in a human because they don't respond in the same way, I could see how that would create a lot of unrealistic expectations and obviously also, um, just bad behavior from scared owners or family members of those pets. So I can see that's a major issue. And I think another thing people don't realize with that medicine, um, and care is that in animal hospitals, like what you're describing, they're 24 hours, just like regular hospitals. And so you do have night shift workers and day shift workers. And anyone listening who's ever worked a night shift as a nurse, we all know that some of us are designed for night shift and some of us are not. I am one of those that is not designed for night shift. I will shut down If I go more than a week or two doing nights, I've fallen asleep at traffic lights. I have been physically ill. I started losing hair. Night shift is not for me. So I completely understand you on that point. So, you know, crossing over into nursing, so you liked the patient care experience, you liked being able to help folks, you had a wealth of medical knowledge, although it was focused on animals, a lot of it is transferable, right? With vital sign measuring and things like that. It's just different numbers, right? Maybe different—

Yeah.

—patients that you put the stethoscope on. Maybe slightly different techniques, but for the most part it's pretty similar. So why nursing instead of some other kind of healthcare field?

Um, I think I like the nursing because I wanted to be the one working directly with the patients. Got it. I, I liked what I was doing, you know, I was basically a nurse with animals and I just liked that patient care. I originally wanted to be a vet, but I was like, I don't want to be I don't want to do their job. I liked working directly with my patients.

Got it, perfect. And no better place than nursing to do that. Um, and no matter what specialty you're in or what the patient really needs, nursing is still the foundation of the care that they're receiving. So that's amazing. Awesome. And I thank you for joining us in the nursing profession. All right, so let's get to it. Um, so you transitioned to nursing. How long have you been in nursing now? You mentioned where you've been, but I don't, I don't remember if you said how long for folks.

Yeah, it's been a little over 2 years.

Okay, and in 2 years you've already done several different things. And that's what I always loved about nursing is I could get a variety of experiences in a very short period of time, where at the fundamental of my profession and what I'm doing is the same despite the population in which I'm serving or the specialty that I'm working within. Um, I get to really stretch my skill set as a nurse, but always stay true to the foundation of what my role is. And that's really one of the reasons why I've loved the nursing profession so much these years. All right, so let's talk about it. Um, what's the problem, right? What is the issue or challenge that you've identified within the nursing profession, um, that you want to address on today's show?

Yeah, so I actually have two, um, both related to mental health. Um, I wanted to discuss the burnout, um, in mental health of healthcare professionals as well as the mental health of our patients, especially the ones who are with us for months at a time.

And see, that's interesting that you bring that up because I don't think many people who have come on the show just yet out of 3 seasons I've been doing this have really addressed the mental health of our patients. Now, of course, you know, psych nurses and people when we deal with individuals with mental illness, we tend to look at them at a very clinical, like, mindset. Like, we look at them clinically, but we don't always take into consideration the impact of our environment or the workflows that we create or the requirements to meet both regulatory requirements and to meet the needs of the individual to keep them safe and healthy. Sometimes it's hard for us to remember that they're humans and that they have needs, and that if they're always treated like a diaper change or a medication pass or wound treatment, then they might start to feel depressed or hopeless or helpless or angry, right? And they may start to suffer from mental illness that's caused directly by us. And has nothing to do with their physical circumstance, but has everything to do with how they may be treated and also the environment that we're creating working with them. So I would love to explore more of that, um, but let's start with burnout because we know this is an ongoing issue. It's been an issue for a long, long time. There's many reasons why burnout happens. So if you could pick 3 of the top reasons why you think burnout happens for caregivers, let's address those 3 and talk about some strategies for that before we move into the patient component?

Yeah, I mean, obviously being understaffed is a huge one. Um, just constant go, go, go. You don't get to sit down and chart. Your body is tired, your mind is tired. Um, that is a huge one. Yeah. Um, I would say lack of sleep. You know, the turnover time that we have, I don't think people understand. I'm gone 14 hours a day. Yeah. I have to come home, take care of my animals, feed myself, shower, and I go straight to sleep. And I, you know, it's a lot. Yeah.

No time for housekeeping, laundry, family time, you know, studying, yoga, any of those things that might provide you with a sense of recharge, recuperation, with the exception of throwing nutrients into your face, drinking as much water as you can stand before going to sleep, and then, of course, getting as much sleep as you can. Yeah, it's just in a 12-hour day, 12-hour shift, which always turns into at least 13 or 14 hours, it's very difficult if you're doing more than a couple of those in a week to ever feel like you're catching up. I've been there. I've done that. So what do you do with specifically that, right? How can you, in addition to getting enough sleep, What else can you do that might be realistic for individuals working that type of schedule?

Yeah, I think having your routine set on the days that you work. I think self-care is a huge one. When you're at work, taking your breaks is so important. It's important for your mental health. It's important for your physical health. Yes. And it's important for the whole unit. Yes. I think meal prepping is a great one on your days off. You know, prep for a couple days so that you have healthy food to eat when you're working. You're not crashing from all the donuts. And I know my unit has a giant candy drawer. I don't know if other units—

Of course, of course we all have candy drawers. At least in— at least the DON or the administrator or the manager, somebody has a candy drawer somewhere, right? Right. Or my favorite, chicken fingers and french fries from the cafeteria. If you're fortunate enough to have a cafeteria in the facility you work, that would be my go-to when I'm stressed out and hungry, right? And we know that that's not healthy, right? Something else that I would like to just add on to that is, if possible, group your shifts together. That way you have more time off in a row, right? So what helped me manage that busy schedule is I You know, for me, it's like if I show up to work, I'm gonna do 110 all the time. And I find that those folks who appreciate that dedication and devotion to doing a great job is also gonna work with you to create the schedule that works best for you so that when you are there, they can depend on you 100%, right? So I would show up, I would do my job, often help other people, be a team player, a superstar, all that good stuff. And I would be able to get my 3 days in a row. I would, yeah, 3 days in a row and my 4 days off.

I think everyone's a little bit different with how their schedule works because I prefer 2 in a row and I spread it out. So I just always do 2 in a row.

I still do 3 a week in between. That's, that's beautiful. That would also work for me as well if I worked in a facility that was just like, no, we can't do 3 in a row. Um, then I wouldn't want 2 in a row. I would do the same thing.

Yeah, yeah, cool. Um, and then I think another huge one with self-care— I know a lot of nurses are gonna laugh at this— but limiting your caffeine.

Oh, for sure, absolutely, that's a no-brainer.

But you know, so many people are just like, I need my caffeine, I, I need this to like function.

And I get that people also need cigarettes when they're addicted to them, right? Yeah. So it's an addiction. And if you always approach it from that mindset— the beautiful thing about nursing is we can always default to science, right? When we're a little ambiguous or we feel like subjectivity kind of clouds our judgment, we can always go back to the science. And there's already enough evidence that shows caffeine is highly addictive. It is a stimulant that winds up causing anxiety. Right? It winds up causing dehydration, which can also further add to your anxiety and feeling exhausted and so on and so forth. It curbs your appetite, which actually is not good for you when you need energy to stay functioning, right? Because then you wind up going most of your shift without eating, and then next thing you know, you're gorging. So there's a lot of things that caffeine can do that's not necessarily great. So limiting it or cutting it out altogether is also something that could be helpful.

And I think if you're going to drink it, I've read that it's best to wait at least an hour after waking up because it does mess with your cortisol levels. Correct. You want to start your day with just pouring stress hormones into your body, right?

Um, yeah, have a nice peaceful slow wake up, right? Yeah. And I, I personally have never been the person to get up and go. I like to take my time. I like to wake up and stare at the ceiling for like 20 minutes and kind of do a gratitude, you know, uh, thought process and maybe just like stare at my husband a little bit longer and just, you know, be thankful that I have that moment. Sit on the toilet as much as people don't like to talk about bathroom habits, sit on the toilet for like 15 minutes and just do deep breathing and prepare myself for the day. Right. And then when I'm out of the house and all the way to work, which has been several hours, usually 2 or 2 and a half hours after I wake up, then I have my coffee. And I have one, and I'm good for the day. Right? Great. I think that's a really great tip because a lot of people do overindulge in caffeine, and then they wind up having a lot of anxiety, and they don't handle stress really well, and they wind up yelling at each other. And I'm like, wait a minute, I thought the caffeine was supposed to help you perform better. It's not. It's making it worse.

Yeah, awesome.

Great. So self-care is super important. Um, now let's talk about the patients, right? Let's talk about the patient perspective and their mental health and how we can impact that.

Yeah. Um, so patients, you know, they, they can be frustrated because they don't have their independence. They have to call us to use the bathroom, have water, have food. Like do anything. And if the call lights are going off nonstop, I can understand why they're so frustrated. Um, some of them are scared, some of them have like this trauma with just being in the hospital, right? Um, and they don't have their autonomy. They could be painful, they could be nauseous, they can be grieving. I work on an oncology unit, that's a huge one. Um, I think active listening is the best thing that we can do for our patients, and that includes turning towards them. Like, when I walk into a room and I'm meeting my patient for the first time, you know, I'll log in really quick. It takes a minute for the computer to do its thing. And while it's doing that thing, I will turn to my patient and I will look them in the eyes and talk to them. And I ask them how they're doing. You know, I show that I care about them. I'm not just talking to them while I'm staring at a computer screen. Right. Um, and I think acknowledging them if they're telling you something deep, and opening up to you, acknowledge them. Tell them, I hear you say this. That makes sense because blank, blank, you must be feeling— and list a couple of emotions that you can see in them. Right. Let them know that, like, you care about them. Yeah. They're validating them, right?

You're validating them in that moment, which is so important. That's what most of us want anyway, is to, one, be heard and to be validated. Right. So great, right?

And you don't have to agree with them to do this. They could be saying something that you completely disagree with, but I think as long as you're acknowledging them, validating them, um, that their feelings are, you know, telling them their feelings are valid, that's fine. And then don't use the word 'but' before you say your part.

Say 'and.' And good, that's so helpful. Um, that, you know, that really goes into higher level thinking, that emotional intelligence that many great nurses and nurse leaders develop over time. So I think it's really amazing that you are developing that. Um, it's super important and it gets you really far with your patients and even your colleagues, right? If you have, um, emotional intelligence understanding and you demonstrate high levels of emotional intelligence, it's very easy to win or settle debates. It's very easy to resolve conflict. It's very easy to minimize misunderstandings. It's just— it makes communication so much better when you have that emotional intelligence. So awesome.

Yeah. Another important thing that I feel very strongly about with patients, and it's something that I'm still working on, But setting boundaries and talking to them ahead of time, making agreements with them so that there's not expectations on either side that are not met. I think communication, you know, so important. So important. Yeah.

It's the number one thing that breaks down relationships. It's the number one thing that causes mistakes. It's the number one thing that causes resentment and disgruntlement and jealousy and all the other things that exist in the world that create conflict. It's breakdowns in communication. Yeah. And I think you made a really good point about not allowing misunderstandings to take place by promising people things that you can't deliver on, not setting those unrealistic expectations, and being more open and transparent about what the plan is. And just for me, it was always just going back and updating the patient as soon as the development happened, as soon as I got more information. About their appointment time or what the results were or what the doctor said or what they— what we could expect for their treatment and just update them little by little, keeping them informed, they trusted me and they would be a little bit more forgiving with me if I didn't get there as fast as they would have liked me to.

And I'm pretty transparent with my patients about that too. If, if we're super short-staffed and they're asking me for a shower, I'm like Look, I will do the best that I can. If we do a shower, it won't be till afternoon because that's, that's usually when we have the time for it. But correct, I, I tell them I have to prioritize my med passes, I have other patients, but I will do the best that I can for you.

And that is really the perfect scripted answer. And I want every nurse who doesn't know how to say this to take those words and use them. Please do not tell your patients, I can't do that today because we don't have enough nursing or nursing assistants. We cannot say that to the patients. First of all, the patient does not care. Secondly, it's not the patient's fault. And thirdly, that's always going to be a situation, right? We're always going to be down a nurse or a CNA because people get sick, people have vacation, we have to cover the unit sometimes. You know, people are leaving jobs because they can make a crazy amount of money for agency for a short period of time, and so they flee and leave us hanging, which happens. You know, I've done agency too. There's a lot of pros and cons with both being a direct hire or being agency. Um, but yeah, don't say that you're short-staffed to a patient or a family member because they don't care. And all they're going to do is report to, um, the news and other people and, you know, social media, is that they don't have enough staff there, that they must be cheap. That's exactly what they're gonna say, and that's not always the case. Yeah, yeah, awesome. So it sounds like you are wrapping your head around mental health, which comes from a standpoint of taking care of yourself, right? So we talked about taking care of yourself on a physical level so that way it improves your mental health. And then also some work-related tips to keep people functioning. We talked about grouping us, you know, grouping your days on if you can, trying to negotiate with leadership about the shifts that work best for you, whether you're a night shift or a day shift person, or if you don't mind swinging, we'll take you, right? Honestly, leadership in any facility organization will take you on whatever shift works for you because we do need all shifts covered. If you're flexible to rotate, great. Maybe you want to rotate for a very short period of time and then be on a set schedule for a while. That's something you can negotiate with your organization or your direct supervisor. But yeah, meal prepping. One another big thing that, um, we may not have mentioned directly, and that's making sure you're drinking enough on your shifts as well, right? We did talk about meal prepping, but one of the biggest challenges is, as nurses, we know you need a, a lot more water than most of us think in order to stay hydrated. Um, and are you ever allowed to carry around a water bottle while you're working? And nope. No, right? Most facilities will say you're not allowed to have a water bottle, you can't drink at the nurse's station, you can't keep one on your computer on wheels or your workstations. Because it's an infection control issue. So let's address that real quick. What's one thing, the easy thing, that you could do to make sure you're getting enough hydration if that's the kind of work environment you, you're working in?

Um, I guess taking your breaks and chugging water. Um, my unit, we have a cabinet.

You're allowed to put your water bottles in the cabinet?

Yeah, we have a cabinet in our nurse's station. And that is where we can have them.

Great. And I think every facility should have something like that where the nursing staff can have their designated reusable water bottles that they bring from home with their label, hopefully labeled, or if, if not labeled, at least identifiably different from the rest, right? You shouldn't have the same company logo one and then you're not knowing whose is who because that could be a risk to each person. Not necessarily to the patients, but each other. Um, and we should be able to have that. I think that's a great idea. And if we have any leaders listening to this, which we always have a lot of leaders listening to the show, please arrange that for your staff. Have a water cooler in the pantry that your staff can drink from a cone perhaps and dump it in the trash or something like that. For me, we, we weren't even allowed to have like a cabinet on the unit we could only keep stuff in the break room. So I would set an alarm every hour on my phone and it would buzz and I would go into the break room and drink at least 4 to 5 big gulps of water. So for every hour, so just like you have to program yourself to do that hourly rounding, or if you're in the ICU, that Q15-minute assessment, same way you prioritize your patient care, you also have to prioritize your own. Um, and so, you know, will you miss 1 or 2 alarms in a day? Absolutely. There's going to be times you're going to miss your alarm, but you get into a habit of doing it, then you build it into a routine, and then you avoid some of the crazy things that I dealt with, like UTIs and kidney stones. I've had the stones too. I'm holding my urine all day long, right? Not drinking. Yeah. So that happens because you're not being adequately hydrated. One of the best interventions to prevent UTIs is adequate hydration. That's amazing, right? And then actually being able to pee once and being able to let your urine out when it starts to accumulate in the bladder. Correct. Yeah. Awesome. All right, so if people wanted to connect with you to speak more about your journey, maybe learn some more, uh, tips on mental health and wellness and self-care, um, you mentioned offline. I don't think you mentioned for the for the group listening yet that you do some coaching, right? Yeah, great. So how can people find you if they wanted to connect with you to inquire more about coaching services that you offer?

Yeah, so I do have a website, um, it's rileyreneewellnesscoaching.com. So R-Y-L-I-E and then R-E-N-E-E wellnesscoaching.com. Um, my Instagram is @riley_renee_, um, so they can find me at either place. Um, I do coaching, I do one-on-one. I'm going to be starting workshops soon talking about how to build a healthy routine. Um, and I would love to do more workshops towards things like, um, you know, mental health related. Um, I'm very open to that. So if anybody is interested, please reach out. Awesome, great.

And I'll have all of the ways that people can connect with you in the show notes of this episode. And, uh, Riley, one more thing. As an ADON currently in my role, you know, we are having issues with bringing new folks in who are having a hard time adjusting because of a short staffing situation, right, that many facilities are having. They feel like there's a combination of things that make them not want to stay. One of the things is, is that they're met with already frustrated individuals who might be short-tempered and may not want to take the time to show them extra things or nurture them in the way that they feel like they should be nurtured because they're new to the facility. And many experienced nurses will come in thinking, hey, I'm here to help you, right? So I just need you to show me the bare minimum. Once you show me the bare minimum, I'm good to go. But some of them feel like they're not even getting that. Or the other thing is that they're on the— they're on a unit with another nurse, and then suddenly there's a short shortage, someone calls out, and then we have to pull one of the nurses to go to a different floor, and now they're kind of by themselves, right? So I look— I work in a long-term care subacute facility, so we know the acuity is a lot different. We would never have one nurse on a hospital unit by themselves, but sometimes in long-term care that happens for like 33, 36 patients, right? What would you say to those individuals who are suffering from the negative mindset in that moment, like letting the anxiety of the situation overcome them possibly even behaving unprofessionally because of their anxiety or frustration. Speaking on mental health, what could they do in that moment to perhaps set themselves up for success or perhaps even handle the situation more professionally? Just off the top of your head, I'm interested in hearing your thoughts.

Yeah, one thing that I use when I'm really stressed out or when I was brand new and I was struggling, it was super busy, we were understaffed. I would, you know, whenever I went into the bathroom, I would take some deep breaths. Like, take the deep breaths while you're charting, while you're in the restroom, even at the bedside. Deep breaths help just relax your body, take you out of that, um, you know, super stressful state, and that can make you think more clearly, speak more clearly. You're going to be a little bit more professional. Mm-hmm. Um, and one of the things that I wanted to touch on with the healthcare, uh, professionals and the burnout, mm-hmm, building a culture that creates teamwork, mm-hmm, empathy. Um, you know, obviously communication is a huge part of that. And I think on my unit, people have done a great job with taking on teaching new people. Like, we just have that culture that I have not seen anywhere else, right? Um, I just, I think it's so important that you take the time to teach people and have a sense of humor. Like, yeah, treat your, your co-workers with respect. Um, give everybody the benefit of the doubt as much as you can and just be there for one another. And understand that everybody is doing their best, and not everybody's best is going to be the same.

Perfect. I love that, and that is so true. And, you know, just to piggyback on that, you know, I, I never understood why people would complain so much about being short-staffed, but the minute we bring a new person into the unit, they treat them not nicely. I'm like, so, so I'm confused. Either you like being short-staffed or you don't like it and you want to do something differently to change that. And you're right, the only way we can truly change that is to really pour ourselves into welcoming those individuals, teaching them everything we know, being supportive for them when they need help, being— sometimes going above our own ability to stretch ourselves to show up for them so they feel supported, so that when you need that support, they will also do the same. You know, we're going to be much more likely to help each other and stick around for team members who help and support one another versus feeling like you're running your own show every time you show up to work and it's you against everyone else, right? Because you and I both have been on both sides of that spectrum, and it's always more pleasant when you work in a place where people help each other versus everyone do their own thing. Yes, right. One thing I ask everyone— one thing I ask everyone in orientation or when I'm teaching them or when I'm working with them is I ask them, you have two choices, you can only choose one. Which one is it? You work alone or you work with people that make your job harder. What would you choose? And 100% of people will say, I'd rather work alone. So that speaks volumes about not wanting to put up with bad behavior, people who are not teamwork-oriented, people who don't support one another, people who don't build some form of camaraderie, have, you know, at least a basis level of We're here to do this work, and we're going to do everything we can together to get it done. Once it's done, then we can, you know, gripe, complain, you know, look for another job, whatever the case may be. But while we're there, we need to band together and get the work done to the best of our ability. So awesome. Yeah, perfect. Well, thank you so much, Riley, for being on the Nursing Strategies for Success podcast. Everything that we shared here I know is going to be so helpful. For new nurses, experienced nurses, and everyone in between. Sometimes it's just good to hear it again, you know, even though a lot of these strategies are foundational. But it's so amazing, we know how important they are, but many of us don't do them on a regular basis. And so that's where the magic happens, is that consistency. So thank you so much again, and, uh, hopefully I'll be out on the West Coast and maybe we can meet up. And I look forward to seeing you grow in your career. Take care.

Thank you. Thank you so much. My pleasure.

Bye-bye. Bye. And that concludes episode 5 of season 3 of the Nursing Strategies for Success podcast with this week's guest, Riley Coitoe. All of the ways to connect with Riley will be in the show notes of this episode, and we hope that everything that we shared with you will help you to better manage your mental health and the mental health of those whom you care for. If you have any questions about anything covered in this episode, feel free to visit thenursespeak.com/contact and get in touch with me. I would love to have a conversation with you. So until next episode, take care, be well, and remember that nurses can do anything.