This past year has challenged nurses like never before, from grueling shifts due to COVID-19 outbreaks in communities, to the mounting volume of heartbreaking cases that have left them physically exhausted and emotionally drained. Nursing was already demanding before the pandemic, but now nurses are grappling with an inordinate amount of stress and struggling to cope.

With levels of exhaustion, anxiety and depression growing among frontline medical workers, “I think many of us realized very quickly into the pandemic that sleep alone wasn’t restoring us or resolving our fatigue,” says Dr. Saundra Dalton-Smith, an internal medicine physician and rest expert who works with healthcare professionals to prevent burnout.

Though sleep is critical, it’s just a fraction of the rest you need to feel refreshed and rejuvenated every day, she says.

“Physical rest has two components: passive and active,” says Dr. Dalton-Smith. “Sleeping and napping are passive types of physical rest, but they make up just a small part of the whole picture. That’s why you can get seven or eight hours of sleep at night and still wake up feeling tired.”

So, what other kinds of rest could you be missing out on? In her book, “Sacred Rest: Recover Your Life, Renew Your Energy, Restore Your Sanity,” Dalton-Smith explores seven types of rest nurses need to thrive under the extreme pressures of caring for patients during a pandemic. Read on for more of our conversation with her.‍

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Keener: Why is rest so important, especially for nurses working long hours and exhausting shifts during the pandemic?‍

Dalton-Smith: Nurses know that there is a compassion component to their job, but many of them are dealing with issues right now that they aren’t necessarily trained for, especially those who are the only support system for critically ill patients who are unable to have family members at their bedside. It’s important for nurses to realize just how much of themselves they have poured into their jobs over the past year and how much of the different areas of their lives have been used and expended into the care of others. It’s important to restore those places so they don't run out. Many nurses right now are experiencing functional burnout, which means they are going to work every day, doing their jobs and staying on top of their quotas and criteria, but they're burned out. They have lost the joy of their profession, and they no longer see the deeper purpose behind why they do what they do. That’s not how it should be. Healthcare is a hard job, but it shouldn't become a cross you have to bear.‍

Keener: Tell us about the seven types of rest we all need.‍

Dalton-Smith: Active physical rest includes restorative activities we do to help improve circulation, lymphatic drainage and muscle flexibility. Mental rest is clearing out your cerebral space and getting your brain to quiet down and to focus. Emotional rest is allowing ourselves to be authentic and vulnerable about sharing what we are experiencing. Spiritual rest depends on your own spiritual beliefs, but it’s basically that feeling of peace you get when you understand that you’re part of something bigger, when you feel interconnected with humanity or feel like you belong and are accepted. We experience social rest when we are around life-giving people. Sensory rest deals with our senses and managing the sensory overload our lifestyles include. Finally, creative rest is allowing ourselves to appreciate beauty in whatever form that is. Maybe it’s natural beauty, like mountains, ocean, trees and flowers, or man-made beauty, such as artwork, dance or music.‍

Keener: For nurses working in a hectic environment and then going home to a busy household, how can they incorporate these different kinds of rest into their day without having to carve out even more time for them?‍

Dalton-Smith: You can’t always go on vacation when your job gets hard. You have to learn how to live a restorative, well-rested life in the middle of your busy days. Nurses often carry a lot of stress in their shoulders, neck and upper back area, so I recommend doing shoulder shrugs while walking down the hall from one room to the next. This stretches and relaxes the muscles in your upper body, and it’s active physical rest.\

When you get a break—especially during tough shifts when you’re masked up all day—get some creative rest by stepping outside for a few minutes. Breathe in the fresh air, feel the sun on your skin and allow yourself to appreciate that time out in nature, even if you’re just listening to the birds or looking at the trees and flowers in the parking lot.‍

Keener: What difference can these types of rest make to your mental and emotional health and your ability to perform better under pressure?‍

Dalton-Smith: They build up your personal resilience. Resilience acts very similar to a muscle. Not only does it increase under stress—which nurses and healthcare workers have plenty of— but resilience grows as you experience stress followed by periods of rest and recovery. It's during that time of rest and recovery that your resilience gets strengthened, just like a muscle does. When you start incorporating more of these restful activities into your day and become more intentional about getting the rest you need, the first thing you’ll notice is you don’t feel so tired all the time. That’s because your fatigue wasn’t really about sleep at all.

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Wondering what types of rest you may be lacking the most? Take Dr. Dalton-Smith’s rest quiz to uncover your rest deficits and how to fix them.

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