Karyn Buxman

Catching Up With Karyn

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.

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