Today’s Nursing Crisis: A Laughing Matter?

Did you hear the one about…?  According to a recent study, one of every three U.S. nurses surveyed under age 30 plans to leave their jobs within the next year. One in five nurses plans to leave the profession within five years because of unsatisfactory working conditions. According to the Bureau of Labor Statistics, 450,000 additional registered nurses will be needed to fill the present demand.  Experts worry about the year 2020, when the registered nurse shortage is projected to reach 500,000 positions, coinciding with the increasing needs of healthcare in an aging U.S. population.
It is obvious that the state of health care today is no joke.  But it may be a laughing matter, if one understands the premise that humor oftentimes is generated by painful circumstances.  There is nothing funny about unlimited resources, job security or a physician who responds quickly and cheerfully to a nurse’s request. The things that make nurses laugh tend to be the very things that drive nurses crazy.

Whether it’s a picky patient, a cranky coworker, or a demanding doctor, nurses frequently have no control over the stressors that arise in their work setting. They do, however, have a choice in how they respond to those pressures.  No single tactic will be appropriate for every situation, so a healthy nurse needs to have a variety of strategies. Numerous means of coping with stress in a healthy manner are available, and one of those ways is with humor.

There are three primary roles of humor in the healthcare setting: psychological, social, and communication. 

Psychological.   As nurses become more anxious and their focus becomes narrower, they become less creative and are more easily upset. Stress may not come from the event, itself, as much as from the nurse’s perception of that event. Humor provides a perceptual flexibility that can increase one’s sense of control. Learning techniques such as catastrophizing the event, where one takes the situation at hand and looks for the absurdity by asking, “How could this be worse?” may help the nurse put the event into its proper perspective.

Social.  As Victor Borge, a well-known comedian, said so eloquently, “Laughter is the shortest distance between two people.” When two or more can share in amusement, there is a commonality experienced among them, thus creating a bond. Some types of shared humor, such as self-effacing humor, reveal one’s own flaws, ‘humanness’ and vulnerability. This ‘revelation’ creates an environment where the listener feels that it’s safe to share, helping to develop rapport and establish or strengthen relationships. For that moment, the humor helps to diminish the perceived hierarchy, such as nurse/patient, doctor/nurse, or teacher/student while all involved participate in the fun.

Communication.  Sometimes a joke is just a joke.  But often, true words are spoken in jest. It may be helpful for the nurse to know that frequently people will present a serious concern in the guise of a joke. A patient may joke about an embarrassing or frightening situation. If her nurse responds in the manner that she had hoped, she has achieved her desired outcome. However, if the nurse doesn’t recognize the serious nature of her comment, then she has the ability to “save face” with the rationale that she was “only joking.” The skill for nurses is in learning to listen beyond the laughter, whether the person addressing them is a peer, patient, family member, or doctor.

 Physiological effect.  In addition to the functions of humor, the physiological effect of humor is identified as a benefit.  Most nurses have experienced at least one negative physiological effect of stress: Muscle tension, cold hands, headaches, gastrointestinal disturbances, among others. While researchers have spent years identifying the negative effects of stress on body systems, they are now looking at the therapeutic effects of humor and laughter on the human body.  These include decreased muscle tension, deeper respirations, and positive increases in the immune system.

As nurses practice to improve their abilities to use and appreciate humor, they also enhance their skills.  “Humor appreciation involves responding to humor produced by others or being a good audience. On the other hand, humor production involves thinking of things on your own to amuse yourself or others,” says Michelle Newman, PhD. When using humor as a coping mechanism, one cannot always count on being able to find an external locus of amusement.  “Of the two, humor production is the more portable skill,” says Newman and adds, “From the standpoint of coping, it seems to me to be less important whether you can amuse other people than whether you can amuse yourself.”  The implication for nurses is that while they may gain benefits from humor when enjoying it passively, there are even more benefits in being active participants by producing a humorous state of mind for themselves. 

Some nurses have shown themselves to be highly creative. One nurse carried a marker to decorate disposable gloves and masks on isolation carts.  A critical care nurse took a couple of adhesive EKG patches, attached them to the bottom of her shoes and “tap danced” her stress away during her break.  At a medical-surgical nurses station, whenever someone would shout “Massage Train!” everyone on hand would line up, put their hands gently on the shoulders of the person in front of them and soothingly massage. Before disbanding, they would switch directions of the line so the person on the end wouldn’t be left out. The whole procedure lasted only a minute or two, but everyone proceeded to their next task with a big smile.

Unfortunately, there is no “one size fits all” list of fun things for nurses to do. Because everyone’s sense of humor is unique, the techniques used to create humor must be highly individualized. The methods need not be flamboyant to be effective. For example, some nurses might be comfortable wearing a small decorative pin with an amusing picture or statement on it, particularly at seasonal times. Colorful clothing with festive accents might be an option if dress codes do not forbid. Some nurses are subtle, wearing Looney Tunes socks or Mickey Mouse jewelry while others walk the halls wearing a red sponge nose or carrying a rubber chicken! Posting cartoons and illustrations can brighten up any nursing unit.  Sharing jokes, stories, or embarrassing moments are other ways to generate laughter.  Humor baskets, carts and humor rooms are means of creating a more humorous environment.

Nurse researcher Vera Robinson once said that a sign of a profession’s maturity is its ability to laugh at itself. The profession of nursing is surely mature enough to be able to laugh at itself, and yet many nurses still refrain from using the skill of humor on the grounds that it is not “professional.”  Humor is not the equivalent of “goofing off.”  Indeed, it is important for nurses to maintain high standards and high expectations on their units and to take their work seriously. It is also important for nurses to be able to take themselves lightly. Sad is the nurse who cannot learn to separate the two– and that is no joke.

Mirth Managment: Kudos to Cosmoflex

Kudos to Cosmoflex, Inc. in Hannibal, MO and to the ingenuity of Operations Manager, Max Nicholson and Safety Committee Member, Mike Allen.  The task: A 3-year safety certification required by OSHA for all 50 employees at the plant.  The creative solution: A rodeo with a forklift—No bull!

Over the course of 2 days, all four shifts at Cosmoflex (a subsidiary company of Goodyear Tire and Rubber Co.) participated in a certification process like none before.  Outside the plant, a course involving all the necessary skills for using a forklift was laid out and put into place.  Exercises included a ‘Loaded Figure 8’, the ‘Stack and Back’, the ‘Ram and Jam’ and removing a basketball from a pylon and dropping into a basket.  The safety committee judged the employees individually and as teams on knowledge, accuracy, speed, and safety.  During the competition, everyone enjoyed an outdoor barbeque, drinks and music.

The initial goal was simply to complete certification for all employees.  When asked if there were any unexpected benefits, Nicholson and Allen agreed that they hadn’t anticipated the amount of strategizing and teamwork they observed.  “You can’t force teamwork,” said Allen.  “We saw great communication and tons of enthusiasm.  People were hooting and hollering, and lots of laughing.” He added, “This really perked up everyone’s attitude, and in a small plant—attitudes are contagious.”

This year’s winner, Brad Pemberton (with an individual time of 6 minutes and 36 seconds), won a gift certificate for Lula Belle’s—a popular local restaurant/bed and breakfast.  Team winners enjoyed a pizza dinner at the plant.

Was there a downside?  Nicholson said, “Just that the employees didn’t want to return to their posts—they enjoyed watching their coworkers compete.”  Even though the certification is good for 3 years, Cosmoflex plans to repeat the event because of the overwhelmingly positive feedback.

When Humor is Part of The Corporate Culture

I had the chance to sit around the table with the most fun bunch of people recently. They weren’t humorists or comediennes—but they were funny as all get out—kind of like Seinfeld meets healthcare. And they love their work.

Moe Green, founder of Classic Care Pharmacy started his business 10 years ago with a handful of people. Today he has over 120 employees and services 125 long term care facilities. The corporate culture is fun, and his staff and his customers are raving fans.

While having lunch with two of the team (Judy and Girish) they told me they hate to miss even a day of work. “There’s something going on everyday, and most of the time it’s fun!” they said. Apparently the rest of the staff agrees with them. The camaraderie and team spirit is palpable when you walk in the office.

As far as retention goes, people who come on board tend to stay on board. “We don’t brag too loudly to others about how good we have it here,” teased a couple of gals following my after-dinner entertainment. “We don’t want a bunch of other people vying for our jobs!”

From chatting with Moe, two keys to Classic Care’s success became obvious. First, he’s a firm believer in empowering his people. “When issues come up, I let them make decisions. There’s rarely an issue that is life or death.” Engaging his employees in company matters helps them to feel ownership. Once a month he holds a “State of The Union” address where he collects all 125 people and gives them updates on what’s going on and gets their feedback. And all of the executive team have an open door policy.

Second, fun is part of the corporate culture and it begins with the interview process. Moe is looking to hire for attitude and if the interviewee isn’t comfortable with the joking and teasing that goes on with the interview committee, then it’s made clear that this is part of the culture. If he or she feels uncomfortable, then perhaps they would be better off working elsewhere—the company isn’t going to change its culture just because someone doesn’t want to play along. Throughout the year, employees spend time together at potlucks, bar-b-ques, sports and just hanging out. They are an extended family.

The weekly executive meetings usually include gales of laughter. “Sometimes staff will come over and close our door because we’re laughing so loud,” Moe admitted.

What’s the result of all this? It comes as no surprise that Classic Care Pharmacy Ottawa was just named one of The Top 10 Employers in the National Capital Region (based on engagement, leadership and over-all employee satisfaction). This award was not just for healthcare but for businesses across the province. And Classic Care continues to grow at an astounding rate: 30% in the last 10 months!

When humor is part of the corporate culture, businesses can enjoy tremendous financial success—but that’s not all. George Burns once said, “Do something you love and you’ll never have to work a day in your life.” It seems that Classic Care employees will never have to “work” again—and with clients as fun as Classic Care, neither will I!

Improv Your Customer Service

My youngest son, Adam, is a student at Second City, the school of improve in Chicago, the springboard for so many of the Saturday Night Live cast. Finally people who can appreciate what his high school teachers could not—his comedic genius! (How many trips to the principal’s office for entertaining his classmates?)

Recently I asked him how he was applying his lessons at Second City to other areas of his life (hoping that my tuition dollars were getting the most bang for the yuck, so to speak). I was pleasantly taken aback by the wisdom he has acquired. He works evenings waiting tables (as many starving artists do) at a local restaurant/jazz club: Andy’s Jazz Club. (For those of you living or visiting Chicago, definitely check this place out—great food and great music [and amazing waiters—at least on certain nights…]).

He explained that the two most important rules of Improv are 1) Never say no. Whatever the situation, say yes—take whatever situation you’re given (especially the unexpected) and go from there—run with it.

2) Make the rest of the ensemble look good. It’s not about yourself—it’s about the others on your team.

So… how does that apply to waiting tables??? Adam explained to me that every seat, every patron is a “scene” and whatever request is made, the answer is always yes. (Oh, that all the waiters and waitresses in my past could have said “yes,” rather than—“we can’t substitute,” “it’s not our policy,” “you’re not my table” and other statements sure to ruin one’s appetite!)

Secondly, being a very funny guy, his tendency in the past was to entertain those at his tables—not a bad thing.  But what he’s realized is that there’s always at least one person in every group that enjoys being funny, too. Thus rule #2: Make the other person look good. Adam loves being funny, but now his goal is to make someone at his table appear funnier than him. “When I’m funny, I get good tips. But when I make the other guy look even funnier, I get great tips.”

Wow! The answer to almost all customer service challenges wrapped up in the first two rules of Improv!

Say yes to the customer’s request and run with it—make it work using creativity, imagination, humor and whatever it takes.

It’s about the other people, not us. Making our customers, patients, coworkers, bosses, spouses, family members, friends, classmates—whomever!—look good.  As my mom always said, “what goes around comes around.”

Way to go, Adam. Go to the head of the class.