HONOLULU - "I have been a nurse in the health care industry since 1988," said Maj. Julie Cowles, Tripler Army Medical Center's Labor and Delivery officer in charge. "There are events that I can see as clearly now as the day that they happened; my first nurse delivery and the tears of joy and the wonderment on the faces of a multitude of young men and women as they hold their child for the first time." Cowles was speaking to staff members during the Army Nurse Corps Anniversary on Feb. 2, 2018, at Tripler Army Medical Center.

Other memories as a nurse Cowles mentioned were of heartache and pain; shifts that would never end; issues she had no idea how to fix; moments of fear as she performed lifesaving interventions; and frustration with things she could not change.

"No, after 30 years, I am not the shiny new nurse I once was," explained Cowles.

Due to the stressful nature of the work, nurses must be resilient which is defined as the ability to return to a state of normalcy or to "bounce back" from adversity or trauma and remain focused and optimistic about the future.

"For Army nurses this quality is essential," Cowles said. "It is well known, that those with higher levels of resilience are less likely to develop stress disorders and more likely to remain in the profession as healthy nurses, therefore (resilience is) a very important aspect to Army nursing."

Through the years, Cowles found herself in many stressful situations where she thought she would not make it as a nurse. She thought she was not good enough, not smart enough, or strong enough; the list goes on.

What kept Cowles in the nursing field for the last 30 years was learning the six principles that follow:

1. Connectedness and support - That person or people to buffer against the negative effects of stress. For some, this is a friend at work, a family member, a spouse.

"I have a few of these people in my life, and you can't have too many," said Cowles. "My spouse has been there for every one of the last 30 years. When I am hurting he is there to hold me when I cry, he makes me laugh when I take myself too seriously, or from time to time he has given me the soft motivational push that I need."

2. Intentionality -- Identify your mission, your philosophy, and your goals.

"Write them down, revisit them," explained Cowles. "Realize what is important to you and stay focused on that during the difficult times. Find your true North!"

3. Self-efficacy -- Believe that you can succeed. Experiencing mastery of new learning increases your motivation to take on new challenges.
"This is not quick or easy, it takes time and dedication," Cowles explained. "Mentoring is crucial for this area. Find your mentor, you need one, and then use them. If you are an experienced nurse, be a mentor!"

4. Self-regulation -- Learn how to switch from the sympathetic (reactive) to parasympathetic (calm, rational).

"We all switch to a state of sympathetic dominance when challenged or threatened," said Cowles. "It is critical when we need to respond with urgency. However, the inability to be able to bring yourself back down leads to burnout. Learn to take a breath and stop the racing when it is no longer needed."

5. Positivity -- Perceptions, attitudes, and expectations.

"A positive attitude will increase your feelings of energy, help you cope with adversity, and feel more optimistic about life," Cowles explained. "You cannot control anyone else's perception or attitude, but you can control yours. Look at the positive side!"

6. Self-care -- Sleep, healthy eating, regular exercise, hobbies, pampering.

"This one is so important the Army developed a whole program, the Performance Triad, to address it," explained Cowles.

"So no I am not the nurse I used to be," she said. "I am now an Army nurse, and I am in the fight!"