Hello, my name is Diana Hecula and my presentation today is Professional Wellness A few housekeeping items. Disclosures, I am a trustee for the California Association of Nurse Anesthesiology or CANNA. I'm also a member of the CANNA Wellness Committee. I'm a member of the ACE CRNA Task Force. I also have certifications in emotional intelligence from the multi-health systems and EQ practitioner certification. And I will not be disclosing any label use of drugs. I've been a certified registered nurse anesthesiologist for 23 plus years. I received my PhD from Walden University with my dissertation specializing in the relationship between certified registered nurse anesthetist, emotional intelligence and burnout. I am an assistant professor at Samuel Merritt University for anesthesia, the doctorate of nursing practice program. I'm also the ADNP projects director at Samuel Merritt University and a part-time clinician at Kaiser Permanente. The course objectives for professional wellness is first to define what wellness is, and then to review the terminology for CRNA and RRNA. And then review some of the nursing statistics, followed by a discussion of the stress and anxiety that is currently occurring for nursing students or residents, and focus on some of the recommendations from our current literature regarding wellness. And then to focus on why personal professional wellness is so important and how you as a registered nurse working perhaps in a critical care environment, why this wellness is important and how you can apply it to your daily lives and increase your knowledge, but also improve your overall well-being. What is wellness? Individuals often think of wellness in terms of physical health, which could be nutrition, exercise, weight management, and healthy blood pressure. But wellness is the equality or state of being in good health. People utilize similar words for wellness like fitness, health, well-being, healthiness, wholeness, shape, and physical condition. Some opposite terms for wellness would be illness, sickness, unhealthiness, disease, disorder, condition, or disability. Basically, wellness is the quality or state of being in good health. And the World Health Organization defines health as complete physical, social, and mental well-being. This is a definition from 1948, but not merely the absence of disease or infirmity. We look back to 2022 in a publication. The Surgeon General defines well-being as a state in which people perceive their lives as going well, including aspects of their physical, emotional, and psychological health, productivity, and economic well-being. So there are various ways to look at wellness and definitions that we will see in our literature. The American Association of Nurse Anesthesiology, or AANA, offers education and resources with the intent to reduce various risk factors, such as substance use disorder, workplace and personal stress, physical and mental disorders, with the intent to improve health and fitness. The AANA defines wellness as a positive state of mind, body, and spirit that reflects a balance of effective adaptation, resilience, and coping mechanisms in personal and professional environments that enhance the quality of life. The bottom line is a well anesthesia professional, whether this is a CRNA, nurse anesthesiologist, or resident, uses healthy, adaptive coping strategies to combat stress, and fatigue, both at work and home. For over 20 years, the anesthesia community has been very integral in addressing wellness and combating stress, because stress can be detrimental to productivity, and an extreme level of stress can manifest into maladaptive behavior, putting all anesthesia providers and their patients at risk. If you do a little Google search and type in CRNA slash rRNA well-being under YouTube, you can find an additional 13 videos that are there for viewing that go over box breathing, stretching, how to cope, um, what wellness is, symptoms of stress, and various interventions, as well as self-assessments. When we look at the terminology, we're going to look at two different groups of individuals. The first is the certified registered nurse anesthesiologist, which can be commonly referred to as CRNA. Sometimes you'll hear certified registered nurse anesthetist, and this is the individual who has completed nurse anesthesia training and is also board certified to practice as a CRNA. Other terms that you'll hear that are commonly referred to is nurse anesthesiologist, and also nurse anesthetist. In comparison, we have the resident registered nurse anesthesiologist, and this is a student or a resident who is currently in training and studying to be a CRNA, and they can commonly be referred to as rRNA, or nurse anesthesia resident, which is referred to as NAR. In some institutions or hospitals, you'll hear the terminology student registered nurse anesthetist or SRNA. Sometimes they'll be referred to as residents. So when you are reviewing videos or maybe the literature, this will help you identify a student from a practicing nurse anesthesiologist. According to a 2022 National Nursing Workforce Study, nursing is the largest healthcare profession in the nation with nearly 5.2 million registered nurses. What's very interesting is when you look at the highest level of nursing education, and again this is from data in 2022, there are a group of nurses who are still diploma degree nurses, and those are about 4.1 percent of the population. 24.3 percent have their associate's degree, 51.1 with the baccalaureate degree, 17.9 percent with a master's degree, and then 2.7 with the doctoral degree. And then you can break down that 2.7 to approximately 0.9 percent have a PhD, 1.6 have a DNP or a doctoral of nursing practice, and then 0.2 percent have some sort of other doctoral. And what I really wanted to point out with this slide is that our primary population of nurses, if you look in that baccalaureate arena, and that's 51.1 percent, the nurse anesthesia programs within the United States have currently shifted to a doctoral degree. So I anticipate in the next 10 to 20 years that the 17.9 percent will start decreasing and we'll start seeing an increase in the doctoral degree. When we look at this same workforce study from 2022, it was noted that it's demographically more diverse and representative of the country's actual population than in any previous year when the study was conducted. The RN workforce is approximately 80 percent white or Caucasian. When you compare this to the crna workforce, we have found that the white Caucasian representation is about 85 percent. RNs who are reported being of Hispanic or Latino ethnicity comprised approximately seven percent of the workforce, where the crna population is four percent. 6.3 percent of RNs identify as Black or African American, whereas only three percent of the crna population identify as African American. 2.5 percent of RNs belong to more than one race, and then 0.4 percent are Native American or Alaska Natives. And that's about, when you compare about 0.7 percent for crnas. And then 0.4 percent of the population are Native Hawaiian or other Pacific Islanders, and actually crnas are four percent. So very similar to our registered nurses, although you do see a little shift in diversity with an increase in white or Caucasian numbers for crnas. So when we look at that 2022 National Nursing Workforce Study, it should be noted that approximately 12.1 percent of the nursing population are advanced practice registered nurses or identify as an APRN within their state. And then when you break down those numbers, 1.1 percent are certified registered nurse anesthesiologists, 8.6 are nurse practitioners, 2.0 percent are clinical nurse specialists, and then 0.4 percent are certified nurse midwives. Within the United States, we have approximately 61,000 crnas are members of our national association. And when you look at the representations, approximately 88 percent of all U.S. nurse anesthesiologists and resident nurse anesthesiologists are members of their professional organization, the AANA. So we're going to do a quick recap before we continue on to stress and anxiety here. We reviewed what wellness is and the definition from a variety of different perspectives. We then covered the terminology of crna and rrna. And then we looked at the statistics of registered nurses within the United States and the educational degrees associated with that. And then we reviewed the advanced practice registered nurses and those statistics within the country and then broke it down into the number of crnas, nurse practitioners, nurse midwives, and nurse specialists. What I want for you to take note is that there are approximately 3,000 registered nurses becoming nurse anesthesia residents in accredited programs. And really the take-home message with this slide is that these nurse anesthesia residents face stress and anxiety during their program and that there are both internal and external factors that contribute to stress and anxiety. Basically that nurse anesthesia residents have a variety of worries. First of all, they're moving to a new city or state. For instance, you're currently in a state that doesn't have a nurse anesthesia program, so you need to move to a completely different state which would require also moving to a new city. We have seen a variety of students be quite successful moving from all across the country. We've had several students move from the East Coast all the way to the West Coast, so that's definitely a source of stress. Starting a doctoral program can be very stressful. It is a three-year program that the expectation is for students not to typically work. There are academic pressures regarding weekly examinations and the need to study daily, hourly sometimes. And students worry, are there enough hours in the day to study? I have to maintain a 3.0 or I'm going to be kicked out of school. In a 2023 study by Griffis et al., they ranked classroom education as a major source of stress. As we've shifted from masters to doctoral programs, probably we can attribute the rigor of those programs to play in that major source of stress. Other things are clinical training anxieties. Students are completing approximately 2,500 hours of clinical. Sometimes they have performance anxiety with a fear of failure. Clinical days can oftentimes be 12 hours, and then the expectation is for students to still prep for their patients the next day. So 12 hours in addition to another hour or so prepping for their cases, and then when do they have time to study? There can occur bullying sometimes in the operating room, a hierarchy of power. Every day that students go into clinical is a job interview, and the expectation is to perform. I know from being a clinician, I look at the performance of the students and think, is this a student who I could eventually be on staff with and I want them to perform well. In that 2023 study, Griffis ranked clinical training as the second highest source of stress, which is is fairly significant. So top two didactic and clinical being the second. There can be imposter syndrome. You know, these nurses are experienced. They have been excellent critical care nurses who have perhaps been preceptors or maybe they were charge nurses or maybe they were on the rapid response team where they have great experience but now they're wondering how can I do anesthesia? Do I have what it takes to be an anesthetist? Am I smart enough? Am I good enough? Do I have the skill? Other things is, you know, recognize your strengths and expertise. These students going to nurse anesthesia school is the next step out of critical care. You have the critical thinking skills but there's still that doubt and I will usually say that we are our worst critic and we're definitely ones to doubt our own ability. Other things, there can be a response to, you know, failure which is concerning. Stress and anxiety is time management. We're finding graduates struggle with time management and that's setting in time for their studies, time for clinical, time for self, time for family, time for sleep and oftentimes students struggle with this. Other things can be external stressors which could be maybe they have a family or they have a parent who is ill during the program or maybe they've had a parent who has passed away. I'm seeing more and more students who have families and young children and sometimes those stressors of, you know, am I being a good enough parent or am I being a good enough spouse? And then finally, money is a big stressor. We go from making a great income as a registered nurse to virtually no income. How do I make my car payment or how do I make my house payment? For some people, I've seen them move back in with their parents so that they have grandparents to take care of kids or they don't have to make a house payment. So there's a variety of stress and anxiety for nurse anesthesia residents and these are just a handful of examples. Stress and anxiety has been studied for decades now. This study is from 2012 and it's one of the foundational studies regarding stress perceptions, manifestations, and coping mechanisms for student registered nurse anesthetist. This study found that there is elevated stress in the nurse anesthesia education population. In fact, the population of nurse anesthesia students, they noted the stress to be 7.2 on a Likert scale and this is on a scale from 0 to 10 where 10 is your highest, 0 is no stress. 7.2 is pretty significant. And then 47% of the survey respondents reported having some sort of depression during school, which is half of that population. And then almost one fourth of the respondents had some sort of suicidal ideation, which is concerning for 2012. Okay, so we're going to move ahead about 11 years to a more recent study, which is a preliminary investigation, a pilot study of wellness and suicide prevention for student registered nurse anesthetists. This study by Griffis et al. investigates wellness and causes and prevention of suicide in the sRNA population. They found that their results were pretty conclusive and that sRNA stress levels are elevated. In fact, when you look at that Likert scale where 0 is no stress and 10 is high stress, the mean stress score was 6.7 on the Likert scale compared to that 2012 study where the mean stress score was 7.2. So it's still pretty elevated. The other thing that should be noted with this study is that 80% of the sRNA participants experience both physical and psychological symptoms of stress. So when you look at it, physical symptoms would include like body aches and pains and even tiredness, where some of the psychological symptoms would include agitation, difficulty thinking, and mood swings. So when you really put that in perspective, to have 80% of your participants exhibiting or experiencing physical and psychological stress, this would really inhibit a student's ability to not only perform well in a clinical environment, but also perform well didactic if they're struggling with tiredness or having difficulty thinking. Many of these respondents also reported mental health challenges. Stress can pose barriers to effective learning and overall performance. Something that should be also noted that was stressed within this study is that stress, depression, and suicide do coexist in the anesthesia population. And then another thing that was discussed was that suicide ideation was fairly common in the population at 34.6%. And with intervention, suicide is preventable. So this study was really bringing to light wellness, but also suicide prevention. So we're going to take a little bit bigger, deep dive into the Griffis et al study from 2023. So preliminary investigation pilot study of wellness and suicide prevention for student registered nurse anesthetists, which can be found in the American Association of Nurse Anesthesiologists journal. They identified five sources of stress, and these are the top five. First being classroom training or didactic. The stress of classroom training could also reflect the increased rigor of our didactic components with the incorporation of doctoral degrees. If you're not aware, nurse anesthesia programs have shifted from a master's degree to a doctoral degree. And it's just a little, it's a lot more rigorous than it was before. Another source of stress is clinical training. The requirements are to have approximately 2000 hours of training, but many residents across the country average 2500 hours. I know the students at my program tend to average about 3000 hours of clinical training. Decreased time for family and friends is another source of stress. They feel isolated when they're in that first year of their program, studying the didactic component. Oftentimes, even when they're in the clinical arena, they're just in the clinical arena and spending 12 hours within the hospital and not feeling like they have enough time for family and friends. In addition, there is a oftentimes a decreased time for self. When you're studying, you oftentimes reduce the amount of hours that you can participate in exercise or sleeping or, you know, mental health activities. So many students feel that they have a decreased time for themselves. And then finally, the change in professional status, you go from being kind of top tier critical care nurse who maybe was a preceptor, or a charge nurse, or even a rapid response provider within the facility. And now you are a student and you're back to learning. And sometimes there's days that are very humbling when you are a student. So these are the top five sources of stress for nurse anesthesia residents, which comes from the Griffis et al. 2023 resource. I've only reviewed a few studies in today's lecture. But the take home message is that there is definitely stress and anxiety in our nurse anesthesia residents. And what I really want to focus on are the recommendations for wellness. And first and foremost, is just that student registered nurse anesthesiologists and educators need to identify when stress is overwhelming, before it manifests into unhealthy symptoms, depression, suicide, we can prevent suicide. And we have seen that in our community. And it's devastating. There is a recommendation for the ANA through their wellness initiative to consider programs, activities and national efforts to promote physical and mental health. And then it also should be noted that one of our accrediting bodies, the Council on Accreditation of Nurse Anesthesia Education Program, requires nurse anesthesia programs to teach about wellness, and teach about substance use disorder that it is, it can be an issue. And then also to encourage students to use the ANA wellness resources and to increase involvement. There are programs within the ANA that residents, resident roundtable, which are actually held by residents where it's a safe place for there to be peer conversation. Other thing is really encouraging faculty to check on the students periodically, regarding their wellness. I know at my program, part of our quarterly check ins is not only to look at how our students are doing didactically, but also clinically, and then also how their mental health is going. We've really taken that very serious. And usually when I'm holding didactic classes, I try and do a wellness minute or a mindful minute, let's do a quick meditation. Let's kind of just reflect on our wellness. Another recommendation is to allow students time off, so that they can see their healthcare professionals as needed. And then also to improve access and support those wellness activities. I know upcoming in our program, we're going to have a luncheon and we're including a yoga time, and not just for the students, but also for the educators. And then really is to create a safe and stigma free environment so that we can discuss mental health, and some of the mental health concerns, and not be fearful or have shame in regards to the conversation about mental health. It needs to be talked about. Much of the discussion today has been surrounding registered nurse anesthetist. But there is evidence that healthcare providers have high rates of depression, anxiety, addiction, and suicide. And I think we're really noticing this and we've kind of created a stigma free environment that we're more aware of wellness. And this wellness is something that we need to focus on individually. And it should be noted that depression and anxiety and addiction are inversely correlated with clinical wellness. There can be adverse patient outcomes and workforce attrition. Clinical burnout is is more prevalent. And it is associated with lower patient satisfaction, for clinical outcomes, and then also higher healthcare costs. So when we look at professional wellness, it's important for all healthcare providers. We focus on healthcare improvement, and many of you might be participating in various quality improvement projects. So this may not be new knowledge to you. But I just want to do a little kind of a little history in healthcare improvement. So the Institute for Healthcare Improvement started their triple aim back in 2007. And the triple aim focus was to improve patient experience, improve outcomes for patients, and then also lower cost. And then this triple aim shifted to a quadruple aim, which started including the clinician well-being. So we started seeing institutions and hospitals really incorporating clinician well-being as part of the healthcare improvement, quality improvement idea. And that was in 2014. And we've now seen a quintuple aim, which is where they've included health equity as a fifth dimension. And the goal, again, is for better health and improved economy. And again, you will see this quality improvement projects within your hospital to include clinician well-being and health equity. The bottom line is that professional wellness and improving wellness for healthcare providers is crucial. So, wellness starts with you, you, and I should say we, are part of the 5.2 million registered nurses in our current workforce. It should be noted that many nurse anesthesia programs are moving to a holistic admissions process. And what does holistic mean? It means we're reviewing both traditional and non-traditional measures in the admissions process. So, we are looking at your grades, but we're also looking at your clinical experience. Some programs are looking at your volunteer experience, some of your leadership. I know in the admissions process, there are programs that are looking at one's emotional intelligence. Sometimes it's sitting there and having an interview and really watching the individual's body language and really identifying how put together the individuals are. So again, many programs are looking at the holistic admissions process and not just looking at traditional, but are also looking at non-traditional measures. So, when I talk about wellness, if you are a well provider, that wellness oftentimes exudes in your dress, the glow in your face, maybe the smile, your body language. There's a variety of different things, and we're going to talk about that within our slides that are upcoming. We are all unique, and each one of us has a different vision of their healthiest self. But bottom line is we can look at improving your personal professional wellness by looking at five of these areas, because they impact your overall health. The first is your surroundings or environmental wellness, for instance. This could be you making your home safer, having a CO2 alarm or a fire alarm, reducing allergies, staying safe during hot weather, guarding against cold weather, maintaining safe air quality and water safety, and awareness of toxins in your home. When we look at your disease defense or disease prevention, this is guarding yourself against germs, protecting your body's bacteria, and keeping current with your vaccinations. This can also include prevention of mosquito-borne illnesses and even tick bites. Emotional, physical, and social wellness are going to be the areas that we will focus more on in the upcoming slides. The emotional wellness checklist, this comes from the National Institutes of Health, and it focuses on several areas. Those areas include building resilience, reducing stress, increasing sleep quality, being more mindful, and strengthening social connections. Nurse anesthesia students struggle with many of these areas during their doctoral education, and the goal today is just to share that knowledge with you so you can start working on these areas to build emotional wellness prior to matriculating into a nurse anesthesia program. To build resilience, and resilience is the ability to withstand or recover from difficulties quickly. I'm sure you can look in your workplace and identify individuals who seem very resilient, and then others, not so much. Emotional wellness includes being able to be self-aware, and this is the ability to identify your feelings and to regulate those feelings. And this is an aspect of emotional intelligence. It should be noted that individuals with higher emotional intelligence tend to be happier and are less affected by their emotions. So, you want to build resilience. What are some of the things that you can do is develop healthy physical habits, and that could just be walking, getting out and exercising, walk around the block, play with your dogs, get some of those happy hormones. Schedule time for yourself every day. I try and schedule in when I'm going to go for a walk or schedule in time with my spouse. Another thing that you can do is to reframe your problems and look at them as opportunities for growth. Another way to build resilience is to practice gratitude or a dose of vitamin G. Something each evening before I go to bed, I try and think of three things that I'm grateful for. Oftentimes, it can be my family. It can be that I have such a fantastic profession, and that I get to take care of patients. I feel very lucky to do the work that I do. Another way to build resilience is to work on breathing, and there's various breathing exercises. There are box breathing, various breathing exercises that you can find either in like the Calm app or Headspace, and what you'll notice is that this breathing can help modulate acute stress. Now, we all feel stress from time to time, and it should be noted that a moderate amount of stress allows individuals to be kind of in that optimal growth and learning zone. If you don't have enough stress, you can be bored, whereas you have too much stress and that can cause exhaustion or anxiety or panic and eventually lead to a breakdown and or burnout, so some ways that you can manage your stress. I talked about breathing exercises. Other things, meditation. Meditation includes breathing. Exercise regularly. Show compassion for yourself. Remember that we're still human. We are usually our worst critic, and that it's usually not as bad as what you perceive it to be. Practice staying in the moment. A big thing that I really have been working on personally is getting enough sleep. I try to tell my nurse anesthesia residents, you know, seven to nine hours of sleep is that optimal window for some individuals, and then set priorities. Be able to set a schedule, and then also build a social network. Individuals that you can reach out to who you can share that you've had a rough day or you can share some of your emotions. As I mentioned, when you're in clinical for 9,000 plus hours or you're traveling in the car from different clinical sites, there can be some isolation that is involved. When you're in an operating room with only your clinical preceptor, and there might be some times where you're the only one in the operating room, there's some isolation that can definitely occur with that. So, how do I get better quality sleep? Let me tell you, there are many high-performing individuals that sacrifice sleep, but research has shown that sleep affects both your mental and physical health. Your brain is meant to recharge during your sleep and repair your injuries, and that the requirements for optimal sleep are individualized. They're going to be different for everybody. As I mentioned, five to seven hours, sometimes it's five to eight hours. Typically, adults between the age of 18 and 64 are seven to nine hours. Other things that can help your sleep is to exercise daily, but maybe not too close to bedtime. Try and go to bed at the same time every night. Wake up at the same time every day. Sleep in a quiet and dark place. I tend to work a lot at night still, and I really try and create an environment that's quiet and dark. Limit your electronic use, especially that one hour before bedtime. There's too much stimulation. In fact, that hour before bedtime, try and relax, whether it's drinking a cup of cannabinope or taking a bath or maybe meditating. Try and reduce your alcohol intake. Limit your naps, although I am the queen of a 20-minute nap. Avoid heavy meals before bedtime. And then try and reduce caffeine intake closer to bedtime so you don't have that stimulant. We talked about mindfulness, and the concept of mindfulness is to be completely aware of something. And it is a mental state in which an individual focuses on the present moment. Oftentimes, there's deep breathing exercises that are occurring during this mindfulness. During this moment, you want to calmly acknowledge and accept your feelings, thoughts, and sensations. You want to be aware of your body and do a mental scan to make yourself more aware of how different body parts feel. I know when I get more stress, I tend to feel that stress in my back and my neck area. So when I start having those feelings, I need to take a step back and go, okay, I must be feeling stress because my body is telling me that I'm having stress. Becoming more mindful requires a commitment and practice. Ways to do this is through meditation or yoga. Find mindfulness resources online. Something that I've seen students use is, again, the Calm app, Headspace. There's a variety of Android and iOS phone apps. And then also part of being more mindful is practicing, like, mindful eating and being more aware when you're full. Sometimes I'm a stress eater. Sometimes I like the salty chips. And I try to be mindful, like, why am I doing this? It should be noted that mindfulness and spiritual wellness is unique to each individual. So ways to increase your activity. It is recommended that adults get at least 150 minutes of moderate physical activity weekly. And this could be 20 to 30 minutes a day. So how do you make that happen? Right now when you're practicing registered nurse, you know, maybe take the stairs instead of riding on the elevator, set an alarm every hour as a reminder to move around, especially if you're standing just in one place doing patient care or sitting. Physical activity can improve your health, mood, and energy levels. Take a walk on your lunch break. I like to usually eat and then go take a stroll around the hospital. If you're on the computer, perhaps walk on a treadmill while you're utilizing the computer. Schedule your favorite physical activity. Literally put it in your calendar so that you're like, hold yourself accountable that, okay, I'm supposed to exercise from 2 p.m. to 3 p.m., whatever that is. Get moving with others and make it a shared routine. My husband and I, we tend to go out for evening walks. We've been including our, I guess, they're young adults now. And various wellness activities and have made this more of a family time to build healthy relationships. And then we're also developing habits that will last throughout our lifetime. So ways to eat a healthier diet. And this is always easier said than done. But try and eat a variety of foods. And that can be vegetables, fruits, whole grains, beans, nuts, seeds. If you're not a meat eater, you know, focus on your whole grains and beans. Drink plenty of water. Water is amazing for your body. Reduce your sugar intake so you don't have those crashes. Get more fiber in your diet. Try and limit snacking. Watch out for foods that are high in salt. Sometimes I see students, they'll actually share healthy food recipes with each other. Or, you know, start sharing with your friends and family. So another part of this is to build healthy and supportive relationships. Healthy relationships can impact your mental and physical well-being. So share your feelings honestly with individuals. And it's okay to ask for help. It's okay to say I'm not okay. Listen to others without judgment or blame. Try and be caring and empathetic. It is okay to disagree with others respectfully. Try and protect yourself from violent or abusive individuals. Sometimes you need to set boundaries with others. And then learn the differences between healthy and unhealthy and abusive ways of relating to others. We're going to start wrapping up our lecture today. And take home message. We're very aware that healthcare providers are stressed. In fact, there are high rates of depression, anxiety, addiction, and suicide among healthcare providers. There is an inverse relationship or an inverse correlation between clinical wellness and adverse patient outcomes, in addition to costly workforce attrition. You know, the current workforce right now has already experienced burnout. And nurse anesthesiology and anesthesia in general is not immune to burnout. What we also know is that graduate nursing students face a variety of internal and external factors that contribute to stress and anxiety. Nurse anesthesia school is demanding. There is a didactic component. There is a clinical component. There is a project component. And it lasts, school lasts for three years. Many registered nurse anesthetists have personal challenges and external demands while they're in school. We have found that time management, balancing life, dealing with high stress levels, being overwhelmed are real thoughts. And that there are individuals who have really thought about quitting their program that is difficult. What we want from a professional standpoint is for individuals to be well. And that is an evidence, as evidenced by the American Association of Nurse Anesthesiology definition of wellness. And that definition, again, is a positive state of the mind, body, and spirit that reflects a balance of effective adaptation, resilience, and coping mechanisms in personal and professional environments that enhance the quality of life. So take care of yourself. We went over a variety of things that you can do to care for yourself. And if you can do that now while you're a registered nurse preparing to apply for nurse anesthesia school, it's going to make you that much better of a candidate who is applying for school. So I'd like to wrap up with some frequently asked questions. I have been a mentor for over 20 years for a variety of registered nurses. In fact, it's a joy to mentor a registered nurse who comes to me and says, I want to be a nurse anesthetist. And I tell them, these are the things that you need to do. And then it's a joy to watch them, one, get into school, two, complete school, three, pass their boards, and then four, it's an even bigger joy to be able to work with those individuals. And I've had that opportunity on a few occasions. But many registered nurses want to know what can I do to be a better applicant? And that is the whole premise of the ACE CRNA program. We're trying to provide information to applicants and registered nurses how to improve, to teach you about our association, about a variety of topics in anesthesia, the various programs within the state, and how to improve your professional wellness, which is our lecture today. So I would say really first and foremost is to be more self-aware, to have that self-awareness of your strengths and your weaknesses. And then to be self-aware and reflect, do I have resilience? Am I that resilient individual? And if you're not, what do I need to build resilience? What do I need to do to reduce stress? Am I one who handles stress well? Do I get quality sleep? How many hours a day am I actually getting of sleep? Or do I burn the candle at both ends? Which is not always a healthy thing to do if you want to provide good patient care. Other things, there are classes that one could take. There's things you can improve on your emotional intelligence. You can take a variety of classes regarding that. You can take a public speaking, how to improve your speaking ability. Focus on your body language and how you present yourself. Sometimes it's, you know, how you walk into a room, what you're wearing, if you're smiling, if you're standing up straight, those are things that are identified, you know, during an interview, again, I had mentioned it earlier. Your wellness reflects in who you are and how you interview. When I was preparing for nurse anesthesia school over 25 years ago, I wish someone would have helped me and prepare me to say, Diana, this is what you need to do to help manage your stress, this is what you need to build resiliency. I recommend taking, you know, this class in emotional intelligence or taking a speaking class, how to speak better. Other things is, you know, having a growth mindset and being able to really identify and improve on who you are. Other things that you can do to improve your wellness, you know, just reflect on, do I have, you know, a healthy lifestyle? Do I eat well? Do I include physical activity? I think I mentioned it should be 20 to 30 minutes a day, which some of us do that and some of us do not. There are a variety of books, self-help books. One book that I would definitely speak to is Atomic Habits. I've really learned a lot from that book. Any of the Simon Sinek, who talks about leadership, we're looking for quality candidates who not only are smart and have a good clinical background, but again, we're looking for candidates holistically and looking at those nontraditional. So, we're looking at the individual and sometimes their life experiences and what they can bring to our academic institution that might be different than what we normally see. So, I hope you've enjoyed this lecture today. These are a couple pages of references. Again, I could spend all day long talking about wellness, but here's a couple variety of different resources that I have mentioned during the lecture today.

Professional Wellness

Nursing

Mental Health

CRNAs

Stress Management

Resilience

Burnout

Mindfulness

Wellness Initiatives