If you find yourself meandering from the present too much, you can always refocus to the present pre-ritual activity. It’s another sip of coffee, another pedal on your bike, or intently listening to your colleague’s recollection of their latest vacation.

The Art of Breathing … on Shift

It is non-stop on shift. It feels impossible to fit in a moment to go to the bathroom or take a sip of water. Staff interrupt you while you’re in Room 3 with a patient you’ve placed on BiPAP, “We have an incoming patient with CPR in progress in five minutes,” the nurse says before adding, “Room 4’s family really wants to talk with you again.” And as you power-walk to prepare for the incoming ambulance and tell Room 4 you will be delayed, thoughts interrupt you: “I’m worried about Room 3; if BiPAP doesn’t turn her around, I’ll have to intubate her.” and, “I hope I make it out on time to tuck my kid into bed tonight.”

You may have heard of “mindful breathing” or “tactical breathing,” which is associated with a decrease in acute stress, anxiety, and mental illnesses—and on the flip side, even improving performance.^7-10 But when do we have a moment to—figuratively and literally—just breathe? After patient contact, the 15-20 seconds we take to use alcohol-based sanitizer and/or wash our hands is an opportune time to “habit stack.”^11,12 As James Clear describes in his book, “Atomic Habits,” by linking a new behavior (mindful breathing) to an existing habit (hand washing) you use less cognitive energy and are more likely to successfully adopt this practice.

While there are multiple techniques for mindful breathing, the general concepts include: Focusing on the present process of breathing, and breathing in through your nose and out through your mouth.

To give an example, “box breathing” starts with exhaling for four seconds, inhaling for four seconds, holding the breath for four seconds, and exhaling again for four seconds. As a plus, the breathing technique can even be helpful to coach an anxious patient, a patient in pain, and your patient who doesn’t know how to use a metered-dose inhaler!

During and After Shift: Expressing Gratitude

It may sound counterintuitive to say “thank you” during or after difficult shifts. You may be ruminating on the unsuccessful resuscitation of a cardiac arrest in a young mother, all the notes to be done, or the dread of possibly missing something on the patients you signed out or discharged. However, expressing genuine gratitude for yourself and others is powerful for your mental and physical well-being.^13-15 Even the thought of gratitude can positively influence mental wellness.¹⁵