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Sharon Weinstein has spent most of her life in nursing, or administrative and consulting health posts that keep her close to that profession. She worked in infusion therapy, writing nine textbooks on the topic, and believed that good health came at the tip of an IV. But over time, the Chicago-based work-life consultant realized that an IV and, more deeply, our personal biology, was not a panacea for ill health.

Genetics affects about 30 per cent of our well being, she estimates. The rest comes from how we act – eating and other daily behaviours. "We can be in control, if we want to," she says in an interview.

That's particularly important for nurses, since so many of them lead out-of-balance lives. It could be ascribed to the nature of shift work in an economic climate where so many nurses – particularly single mothers – have to grab as many hours as they can to keep financially afoot. Those shifts often blend into one another, leading to ridiculously short sleep intervals, and the rigours of the high-pressured job add to the stress. Add in kids and parents to look after in some cases, and it's a recipe for bad health.

But the biggest problem, actually, is their attitude. "The nursing personality is an earth personality," she says, referring to solid, stable people, who are steady and loyal. "They take care of everyone else and everything else before them."

She argues health organizations have to look at what causes stress and create a climate in which nurses aren't working unmanageable back-to-back shifts – and coming in again for another shift after five hours of sleep. Times for rest have to be inserted into the shift. That's critical for nurses but just as importantly it's critical for patients. Fatigued, stressed nurses cannot provide quality care.

When health administrators are disinterested, nurses have to negotiate – for themselves, for other nurses, and for their patients. "We entered nursing to serve others. But as professionals we need to have an expectation of our environment. It should be okay to say, 'this isn't working,' " she observes.

When she started out, it was hard to complain about these issues. If you didn't follow orders, you were insubordinate. But she says it's now part of the modern workplace to discuss how fatigue in nurses can effect patient health – there is evidence to back that idea, and too much is at risk for good employers not to listen.

And the discussion can start – even if it seems contrary to nursing instincts – with yourself: "We negotiate for a healing environment by advancing our own needs." With nursing students, who find it difficult to talk about their needs, she advises them that to take care of their patients they must take care of themselves. "It's okay to say no to a shift to be with your kids or even to just go home and have a warm bath so you are in better shape tomorrow to take care of yourself and your patients," she says.

In her book B is for Balance, which recently had its second edition published, one of the issues she highlights is fatigue, noting it can come physically, mentally, or adrenally, striking in those all important glands. High levels of fatigue affect the ability to think clearly and that includes being able to judge your own level of impairment. Staying awake for 17 hours has the same impact on performance as having a blood alcohol of 0.05 per cent and 21 hours heightens it to 0.1 per cent.

"Fatigue is a reality of nursing. Every day and every shift nurses experience fatigue in mind, body and spirit. And fatigue, over time, takes its toll," she says in the interview, listing depression, diabetes, and high blood pressure as just some of the consequences.

Diet is another concern. With no time to eat, she says nurses "inhale McDonald's at the nursing station." Hydration is increasingly recognized as vital to good health but nurses avoid drinking liquids since that creates a need for bathroom breaks they can't afford the time to take.

That means negotiating not just with your bosses but with yourself. "You are only as good as you are balanced," she says.

She urges nurses to drink plenty of water and take time every day for themselves – ideally 30 minutes, but at worst five minutes to close your eyes and rest. Find time for walks – if you have children, take them along. Don't sleep with your cell phone; the illumination hinders sleep and the alerts or messages are worse. Know when to ask for help. If your schedule is too jammed, consider opting for part-time hours – the monetary consequences may not be as great as the physical consequences of maintaining a too-stressful life.

Life is a balancing act, and balance must not be something you jettison as life becomes too pressured. Instead, make balance a must-do. "We need to take care of ourselves. Too often we put it off for later. But later never comes. I'm saying it's now time for later to come," she declares.

Harvey Schachter is a Battersea, Ont.-based writer specializing in management issues. He writes Monday Morning Manager and management book reviews for the print edition of Report on Business and an online work-life column, Balance. E-mail Harvey Schachter