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It’s OK to Say No to Protect Your Mental Health


At times, the lines between our personal and professional lives can become blurred — especially in nursing. 

When you think of your role as a nurse, terms such as "compassionate and "committed" may come to mind. And while these words capture your identity as a nurse, it's important to define who you are separately from your workplace. 

Setting boundaries at work can be uncomfortable and even scary. For some nurses, the thought of saying no brings up fears of repercussions such as losing your job, harming work relationships, or hindering future roles. While these fears are natural, placing limits for yourself in the workplace is essential to supporting your own needs — both physical and mental.

Start with yourself

Saying no can be difficult when you're always caring for others. But the first step starts with yourself. Acknowledge your worth and recognize that you're not just a nurse — you're a person with abilities and passions who deserves a healthy work-life balance. 

In an episode of the NurseDot Podcast, host Cara Lunsford, RN and Vice President of Community at Relias chatted with guest Katie Duke, MSN, AGACNP-BC, and nurse influencer on how it's OK to say no in the workplace. When creating professional boundaries, start with yourself first, said Duke, who has 20 years of nursing experience, with seven as a board-certified adult and geriatric acute care nurse practitioner. 

"Something I tell people often is you have to create your own definition of what a nurse is," she said. "You have to stop looking for your validation and your identity in your employer or in what your day job or night job is. Because as nurses, we tend to soak up that being a nurse is our whole identity — our whole existence." 

This boundary is exceptionally important because it highlights the significance of other parts of your life. If you don't establish this type of boundary, these areas may feel less valuable when compared to your nursing life. 

For example, let's say you work in the emergency room of the top hospital in the country, but you're also accomplished in another area (e.g., author, painter, or athlete), Duke suggested. If you find yourself comparing your personal and professional identities, you might put more weight on your role in the high-profile hospital. Focusing more on your professional role might make you underrate your personal activities or accomplishments and feel as if they're not worth sharing.

Prioritizing your needs

For some, untying their identity to their workplace can be a tough process to unlearn. However, it's OK to say no — even to set a boundary with yourself. You might say, "I will not allow myself to utilize where I work as the main root of who I am as a person and where my value lies," said Duke. 

Identifying and establishing limits for yourself is a form of self-respect but also self-love because you're prioritizing your own needs and desires. Lunsford highlighted the empowerment and resilience you build with these practices. "Once you have self-love, you are less likely to have people encroach upon or push past your boundaries," she said.

Boundaries and heavy demands

As a nurse, you're responsible for many components of health care while maintaining compassion. Because of these elements, saying no isn't as easy as it sounds. With factors like short staffing, it can seem impossible to say no, especially in high-stress situations.

A study on excessive working and burnout concluded that higher workloads increased burnout symptoms in nurses, resulting in more individuals taking sick leave. In this study, when more nurses took sick leave, it produced larger workloads for the remaining staff, creating a cycle of excessive working and burnout. Scenarios like these are all too familiar in nursing, and enforcing limits can be a means to disrupt this cycle and reduce the risk of burnout. 

A Harvard Business Review article discussed two aspects of boundary setting — hard and soft boundaries. The article defined hard as non-negotiable areas and soft as items you're willing to compromise on. Defining your limits in this way can help you identify and choose what you need the most. 

The nursing profession, while rewarding, comes with many demands. So it's imperative to set realistic professional boundaries. For instance, you may be asked to work overtime or to take on more patients, but you're feeling exhausted or burned out. In situations like these, don't be afraid to say no. Prioritizing your physical and mental health is a realistic boundary.

A matter of safety

In the podcast episode, Lunsford shared a similar perspective, touching on how safety factors in. "There are times where you're asked to do something that's outside your scope," she said. "You're asked to take on a shift that you know you just can't take on. It's not safe for you. It's not safe for your colleagues. It's not safe for your patients." 

Studies have shown that patients are more at risk and nurse safety is compromised when nurses are managing larger workloads. While staffing challenges and conditions like moral injury still need attention, saying no respects your own safety and health needs. 

It's also important to be unapologetic when implementing these boundaries, according to Duke, who has over 15 years of experience in mentoring and advocacy. "You shouldn't start out by saying, 'I'm sorry,'" she said. "If someone asks you to do something that you don't have time to do or that is not your priority at the minute, that deserves a response of saying, 'I'm unable to do that for your right now because I need to focus on the priorities of my responsibilities.' And you leave it at that."

Saying no is a form of self-care

Self-care looks different for everyone. It could involve eating a nutritious meal, taking a brisk walk, or reading a book. 

In a tip sheet, the American Psychiatric Nurses Association states that saying no is also a form of self-care. With most nurses working on the front lines of health care, it's important for them to practice self-care techniques, which include setting professional boundaries. 

Self-care is a method known to improve quality of life. A study on self-care revealed that nurses experienced more fatigue from working long hours in a stressful environment. However, when engaging in self-care, including recognizing their limits, nurses felt happier, healthier, and more confident. 

According to the American Nurses Association's Code of Ethics in Provision 5.2, nurses owe the same duties to themselves as they do to others -- the promotion of personal health, safety, and well-being. By setting personal parameters in the workplace, you're advocating for your own health, comfort, and happiness. 

Setting boundaries is crucial in both your personal and professional lives. However, this practice isn't perfect, and sometimes success isn't immediate. Have patience with yourself as you navigate setting limits in the workplace and remind yourself of all the good you do beyond your role as a nurse. "You are worthy of love and confidence and value, and it has nothing to do with your title or where you work," said Duke.