Nurses are angels.
Nurses are heroes.
Nurses are the most trusted profession.
Sometimes messages about nursing involve an image of nurses that are amazing and often superhuman. They work 12-hour shifts caring for the sick and dying without thanks or a primetime tv show (that’s for the doctors). This image is because nurses do work hard and they do this work is often very difficult circumstances. They chose a profession that relies on the combination of science and compassion to help people through the most difficult moments of their life.
But nurses are not angels and they are not superhuman. They are very human.
There is a lot of discussion about burnout in healthcare these days. Part of that is a greater body of research on burnout that is finally reaching the bedside. The other part of that is in an era of social media, where nurses are finding a voice to talk about it. Under the umbrella of burnout comes compassion fatigue, vicarious trauma, and secondary traumatic stress. One often mentioned but not detailed point in the literature about burnout is how personal trauma increases your risk for burnout, compassion fatigue, etc. In fact, a recent study of 211 students in a BSN program saw a correlation between adverse childhood experiences (A.C.E.) and burnout.
According to the CDC, “Adverse Childhood Experiences (ACEs) is the term used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under the age of 18. “
The research on A.C.E. originated in a Kaiser study of around 17,000 participants. The study found a significant relationship between A.C.E. and health and well being. A.C.E. are organized into three groups, abuse, neglect, and household challenges. The higher the number of A.C.E., the higher the risk for negative outcomes like depression, substance abuse, cancer, and more. A.C.E. increases a person’s chronic stress and may make them more likely to engage in risky behavior. People with a score of six or more tend to die 20 years earlier than those without. As a reminder, having adverse childhood experiences doesn’t mean you will also have all of those negative effects, and some people are quite resilient.
This area of the research is especially interesting to me for multiple reasons, but the primary reason is that when I look at the A.C.E. survey, I have an A.C.E. score of 7. And I did experience some of those lasting impacts (hello teen pregnancy). But I chose a career where I believed I could make a difference and help others because of my adverse childhood experiences. In fact, in nursing school, I was voted the most caring nurse. I see similar reasons in my nursing students too. They often talk about wanting to make a difference.
We know that A.C.E. are not uncommon. So what happens to the nurses with A.C.E. when they care for others? According to that 2018 study, student nurses with higher numbers of A.C.E. had a higher level of burnout and depression. And one thing I tell my students about our most difficult life experiences is that one day you inevitably run into something that brings up those past experiences. It may be your patient reminds of yourself or someone you knew. It may be that your patient is experiencing the same adverse event you did. We are often in a caregiving moment that also brings us face to face with our life experiences. Nurses need to be prepared for how to handle it. In school, we often learn how to use therapeutic conversation skills or lifespan psychology to care for our patient. But there is not enough conversation about how our experience impacts our care or how we manage our emotions through it.
Emotional labor is a key aspect of burnout in new nurses.
So what can you do for yourself?
Learn about A.C.E. See what your score is (there are a few different questionnaires, this is one).
Develop a mindfulness practice. Yoga or meditation.
Get a therapist. Find strategies to help you work through your experiences and develop strategies you can use when you encounter triggers at work.
Have boundaries. Stop working extra or so many days in a row. Stop being the only nurse who will take the abusive patient that reminds you of someone you grew up with.
These events were out of your control, but what you do today is in your control.