I Got 99 Problems, But Self-Care Ain't One!

By Rachel Y. Hill, DNP, FNP-BC, PMHNP-BC, AHN-BC, HWNC-BC

I was on vacation recently, working light, but I had a list of things I wanted to get done.

And somewhere in the middle of it, I felt the tension in my jaw and my neck.

It dawned on me:

What am I doing to myself that has nothing to do with vacationing?

The honest answer was that I was not vacationing.

That was an eye-opener.

I had been telling myself I would do just one more thing, and then I would be free and clear to relax.

Just one more thing.

And then, of course, there was another one more thing behind it.

Anyone who has ever tried to clear the decks before a break knows how that goes.

Then my internet access became limited, and I'll say God has a sense of humor, because the connection shut the whole thing down for me.

I didn't have a choice anymore, and honestly, I'm glad.

This post is about moving self-care off the list of things we are always about to get to.

Just One More Thing

If we sat down and wrote out everything that could go wrong or needed fixing, our lists could easily hit ninety-nine.

Somewhere on that list, most of us would find a line that reads:

Rest.

Eat something real.

Unplug.

Go to my own appointment.

Quietly waiting at the bottom for a day that never comes.

The trap is how reasonable "one more thing" sounds.

It never feels like neglect.

It feels like responsibility.

But a body doesn't read the story we tell ourselves.

Mine reported it in my jaw and my neck.

I also want to be honest about the cost on the other side, because there is one.

When you leave for vacation with a full inbox, there are consequences.

Not every patient and not every administrator will understand that you were in desperate need of a break.

Some won't understand that you deserve to unplug at all.

That can sting.

And it is necessary that you know it anyway:

You do deserve it, and unplugging is not a moral failing.

The Line: Self-Care Ain't One of My Problems

There is a famous song by Jay-Z, "99 Problems," released in 2003, built on a boast: whatever else is going on, one particular problem isn't one of them.

I'm borrowing the swagger of that idea and pointing it somewhere softer.

I may have ninety-nine problems that could be going on. Self-care will not be one of the issues I'm dealing with.

That doesn't mean life gets easy.

It means that no matter what is happening, there is one thing I have already decided I will not neglect, so that it never joins the pile.

Self-Care Is Not a Luxury. It Is the Foundation.

Self-care isn't a luxury added after the work is done.

It is part of how the work gets done.

A nurse who has decided that self-care is simply non-negotiable, not a reward and not a project, is a nurse who brings a steadier nervous system, clearer thinking, and more patience into every room.

The trap is in how we usually think about it.

We treat self-care as one more demand, a chore to fit in, another thing we are failing at.

When it sits on the list as problem number one hundred, it becomes one more reason to feel behind.

The shift is to treat it as the ground we stand on rather than something we stack on top.

Don't Let Self-Care Be the 99th Thing

Here is the part I most want to say out loud.

Don't let self-care become the ninety-ninth item on the list.

And don't let it become one of the problems.

It belongs on the other side of the page, with the solutions.

Sometimes it feels like doing right by yourself has turned into one more thing to do.

Your sleep.

Your leisure.

Your family time.

Your meals.

The basic things we are supposed to enjoy, for goodness' sake, like an afternoon cup of tea.

Somewhere along the way these became tasks to schedule, items to squeeze in, and one more reason to feel behind when we miss them.

That is backwards.

Rest, meals, time with the people we love, and a quiet cup of tea in the afternoon aren't what gets in the way of getting everything done.

They are what makes it possible to get anything done well.

They should be the very thing that we do, not what's left of us when everything else is finished.

If I treat my own care as a problem to solve, I will always be solving it last.

If I treat it as part of the solution, it comes first, and it changes how I handle the other ninety-eight.

Why Self-Care Becomes a Problem for Nurses

Nursing culture is built to put the self last.

The national numbers show the cost.

In the 2024 National Nursing Workforce Study from the National Council of State Boards of Nursing (NCSBN), released in 2025, about 40 percent of RNs and 41 percent of LPN/VNs said they intended to leave the workforce or retire within five years.

Among nurses with intent to leave who weren't retiring, about 41.5 percent named stress and burnout as the root cause, followed by workload, understaffing, and pay.

The survey also found some encouraging news, with emotional exhaustion and workload easing since 2022, but high stress and burnout persist.

When Fatigue Becomes a Patient-Safety Issue

Fatigue has patient-safety costs as well.

In a well-known 2004 study in Health Affairs, Ann Rogers and colleagues had 393 nurses log their hours and sleep for 28 days, covering more than 5,000 shifts.

Nurses who worked shifts of 12.5 hours or longer were about three times as likely to report making an error as those on shorter shifts.

The errors were self-reported, but about half involved medications.

Being tired isn't a personal weakness. It is a patient-safety issue.

This is also the same imbalance behind compassion fatigue, a term connected to researcher Charles Figley, which describes the cumulative cost of caring for people in pain without enough replenishment.

What the Research Suggests About Self-Care

The evidence for individual practices is encouraging but modest, and I want to be honest about that.

A 2020 systematic review and meta-analysis in the Journal of Advanced Nursing by Suleiman-Martos and colleagues examined 17 studies including 632 nurses.

It found that mindfulness training was associated with less emotional exhaustion and depersonalization and a greater sense of personal accomplishment compared with control groups.

The authors called for more randomized trials.

In other words, the early picture is promising, not proven.

The research on connection is stronger, and you can read more in my post on why love heals.

People with stronger social relationships have notably better odds of survival, and isolation carries real risk.

Part of self-care is simply staying close to the people who keep us human.

A Necessary Caution: Self-Care Cannot Fix a Broken System

Here is where I want to be careful, and where this post could easily go wrong.

Self-care is not the answer to a broken system, and a nurse who is burned out is not simply failing at bubble baths.

In 2022, then U.S. Surgeon General Vivek Murthy issued an advisory on health worker burnout.

Its central message was that burnout comes mainly from systemic causes, such as workplace culture, administrative burden, policy, and staffing, and not from individual shortcomings.

It called for a whole-of-society response, including a reduction of administrative burden, more time with patients and colleagues, and removing barriers to mental health care for health workers.

So I hold two truths at once.

Employers and systems have a responsibility to make care sustainable, and we should keep asking for it.

And while we do, we can refuse to abandon ourselves.

Saying "self-care isn't one of my problems" is not a claim that one nurse can fix burnout alone.

It is a decision to stop being part of the problem to ourselves.

What Living This Looks Like

It looks like deciding in advance, not in the moment.

The decision isn't "I'll rest when I get time."

It is "this is already handled."

It looks like small, repeatable, almost boring things:

• Eating a real meal, sitting down, instead of whatever is closest to the charting station.
• Making time for afternoon tea, or whatever your version of a quiet pause is, without apologizing for it.
• Protecting family time and leisure as appointments that don't get bumped.
• Protecting sleep as seriously as you would protect a patient's.
• Taking the full break, even when the culture rewards skipping it.
• Keeping your own appointments, including the ones with a therapist, a doctor, or a dentist.
• Staying connected to the people who fill you up.
• Truly unplugging when you are off, without keeping half an eye on the inbox.
• Saying no without writing an essay to justify it.
• Letting someone care for you when they offer. Receiving is part of self-care, too.

And it looks like noticing when the old habit creeps in.

The pull to put yourself last is strong, and professionals are often the best at building a case for why the rules don't apply to them.

Catching it is the practice.

None of this is perfect.

Some weeks the ninety-nine will win.

The measure isn't a flawless record.

It is whether you keep returning to the decision.

Until the Cows Come Home

If I can still fall into the misty pits of self-neglect, after all the years and all the teaching, and then catch myself, then anyone can.

That is why I will preach this message until the cows come home, or until we come home to ourselves, whichever comes first.

A Few Questions to Sit With

• If you wrote out your list of ninety-nine problems right now, where would your own care appear on it? Near the top, near the bottom, or not at all?
• What is the one form of self-care you would refuse to let slide, even in your hardest week?
• Where are you building a case for why the rules don't apply to you?
• What do you need from your workplace or team to make self-care realistic, and who could you ask?
• Who in your life would notice if you stopped taking care of yourself, and have you let them help?

--Dr. Rachel

A Note on Sources

• National Council of State Boards of Nursing (NCSBN) & National Forum of State Nursing Workforce Centers. 2024 National Nursing Workforce Study, released April 2025. Summary via NCSBN news release.
• Rogers, A. E., Hwang, W.-T., Scott, L. D., et al. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs. Summary via Relias Media; errors were self-reported by 393 nurses across 5,317 shifts.
• Suleiman-Martos, N., et al. (2020). The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis. Journal of Advanced Nursing, 76(5), 1124–1140. Numerical effect sizes should be checked against the full paper before quoting.
• U.S. Surgeon General's Advisory on Addressing Health Worker Burnout (2022). Vivek Murthy, MD, MBA. Summary via the Association of American Essential Hospitals.
• Figley, C. R. (1995). Compassion fatigue as the cost of caring, as described in the nursing literature. See also The Law of Receiving.
• Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLOS Medicine.