Disclosures: Roche reports a consultant role with BTG Specialty Pharmaceuticals.
December 17, 2021
4 min read

Cultivating the calm with the chaos: Self-care should be priority for APPs

Disclosures: Roche reports a consultant role with BTG Specialty Pharmaceuticals.
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Exhaustion. Fear. Burnout. Uncertainty. Stress. Trauma. Grief.

How do these words resonate with you?

A routine for mindfulness and gratitude.

Over the past 21 months, we all have experienced some tough emotions. The ongoing COVID-19 pandemic in combination with social injustices and civil unrest has created infinite challenges.

Hematology/oncology APPs are experiencing the weight of these challenges, not only in the heart of the work that we do, but also in our personal lives. On a daily basis, we participate in critical conversations as we witness patients and families in their most vulnerable states. In one shift we may experience a myriad of emotions, from joy and laughter in the inhale to fear and despair in the exhale. It is in these moments that we learn the power, strength and endurance of the human spirit.

Breanne Roche, DNP, RN, CPNP, CPHON
Breanne Roche

Most of us have heard of the saying, “You cannot take care of others unless you take care of yourself,” but how often do we follow this advice? The impact of the pandemic on health care workers is enormous. Research shows health care workers may have increased anxiety, depression, insomnia and distress. Taking care of ourselves and incorporating self-care into our daily routine needs to become a priority. The foundation of self-care is acknowledging and identifying what you need in order to show up as your wholehearted self.

So how do we continue to provide empathetic and high-quality care to our patients and families when our own compassion tank is running on empty?

Building momentum with gratitude

In a world filled with social injustices, political divide and economic instability, life may feel overwhelming and chaotic. The universal law of impermanence is a constant reminder of life’s unpredictable course.

Caring for patients with blood disorders and cancer reminds me to celebrate the small victories of life, whether it is a patient with prolonged pancytopenia who finally has a neutrophil count, or the child on hospice who wants one more ride on her tricycle while her patient-controlled analgesia pump is tucked in her backpack. To the hem/onc APP, these are monumental triumphs because they are a gentle reminder that beauty and tragedy often intersect in our line of duty. Often these small victories are overlooked in our personal lives, but learning to recognize and celebrate these moments is a form of self-care. It is through life’s ordinary moments, which may seem insignificant at the time, that we can cultivate gratitude and grace. One way to create your own gratitude practice is by writing down three things you are grateful for each day.

Developing mindfulness, self-compassion

Do you ever feel like you are on cruise control — going through the motions without pausing or reflecting on the moment because your “to-do” list seems endless?

During these times, it is important to welcome mindfulness and self-compassion. Mindfulness invites awareness to the present moment in a nonjudgmental manner. Ellen Langer, PhD, a professor in the psychology department at Harvard University who is known as the “mother of mindfulness,” describes mindfulness as “the process of actively noticing new things.” This may sound counterintuitive, although it is intentional. The more we stop and notice what is transpiring around us in a nonreactive way, the more we welcome the present moment unfolding.

For APPs, it can be difficult to make ourselves a priority because our profession demands putting the needs of others before our own. We chose this profession because caring for others is part of our nature; therefore, if we prioritize our needs first we may feel guilty or selfish. When feeling this way, try acknowledging your emotions without judgement and give yourself permission to feel them. Take a breath right now (inhale deeply and let out a huge sigh as you exhale) and think how often you encounter a situation and are too quick to react. When a difference of opinion arises, it becomes familiar to respond immediately with our own biases. Instead of this reactive reflex, try inviting curiosity by listening with the intent to understand a new perspective.

Incorporating intention and mindfulness into our responses and current lived experience is an important component of self-care. Developing and practicing self-compassion can help us cope during turbulent times by responding to suffering in a supportive and comforting manner. Building awareness in a difficult situation by being present allows our body to process reality and “feel out” the feelings, which leads to mindfulness. When we welcome self-awareness into our experience, it can help regulate our emotions, which can increase our wellbeing, resilience and compassion.

Find some grace for yourself when you feel drowned in self-criticism and treat yourself with the same kindness you would treat others. Challenge your mind to be present in the moment and feel all the feelings as you lean into discomfort with self-compassion. Establishing a routine of mindfulness and gratitude allows emotional expression to flow freely and fill up our compassion tank.

Self-care is contextual, it is not a linear path, so buckle up and follow the mindfulness and gratitude detour signs along the way to cultivate the calm within the chaos.

Healio collaborated with Association of Pediatric Hematology/Oncology Nurses on the submission of this column.


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Self-compassion, Dr. Kristin Neff. https://self-compassion.org/. Accessed Nov. 30, 2021.
Sinclair S, et al. Appl Psychol Health Well Being. 2017;doi:10.1111/aphw.12086

For more information:

Breanne Roche, DNP, RN, CPNP, CPHON, is a pediatric hematology/oncology nurse practitioner at Rainbow Babies & Children’s Hospital in Cleveland. She can be reached at breanne.roche@uhhospitals.org.