Storytelling is powerful. Do I even have to tell you this? You know this, from marketing to movies, to songs to any media we interact with, storytelling is the most powerful tool humans use to communicate ideas. And now, companies like Google are using data as a way to tell a story.
Storytelling in healthcare has been limited in some ways. Medical shows and movies are often focused on physicians. You have the occasional appearance of other professionals, like with Nurse Jackie, but doctors are the story most of the time.
With this narrow view, those of us in health care find our stories overlooked and unaccounted for. Nurses, for example, are often voted the most trusted profession in America, but often find that the public understands very little about our work. Sometimes, our own colleagues understand very little about our work. The same goes for some other unaccounted for professionals, like Occupational Therapists.
With the rise of social media and new platforms for storytelling, you find that a lot of people traditionally left out of storytelling are finding a platform to share their stories. The questions for health care professionals is what story are we telling and who are we telling it to? What stories do we want to tell?
This is our opportunity to tell our stories about the real work of caregiving. Beyond the role of angel, beyond the role of extra in the scene just following doctors’ orders, we can talk about our experiences in our own voices. What story are you going to tell?
In a couple of months, I am going to be able to share with you how I am working with storytelling and I can’t wait. Stay tuned!
In 2017, I was burned out. From cancer nursing, from busy fast-paced hospitals with constant change, from caring for my children, from graduate school… from everything. I wanted a break. But I still had responsibilities and I couldn’t just leave them all to run away to Europe. I wasn’t a travel nurse and I wasn’t young and just out of college taking a gap year. So I devised a plan to take a leave of absence from nursing.
This video was pretty specific to my unique situation and opportunities, but let me know if you did anything similar or have any advice for other situations!
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.
When I graduated from nursing school in 2004, I applied and interviewed for only one job. I wanted to work in pediatric oncology. In my interview, the manager asked me how I would deal with death. I replied that everyone deserves compassionate care through all stages of life, even at the end of life, and that it should be provided by people who really care. I wanted to be able to provide that kind of compassionate care.
I got the job and started a new graduate training program that lasted 13 weeks. We learned a lot about cancer, chemotherapy, managing side effects, and the psychosocial aspects of cancer care. But even from the beginning, some conversations and lessons were lacking or absent.
I remember getting a letter mailed to me at home from my preceptor introducing herself to me. It was a thoughtful way to be welcomed onto the unit. I learned a lot from my preceptor, who was very experienced. But there were a few things I learned over the years that I wish would have been included in my new grad orientation program.
Making a Mistake Does Not Make You a Bad Nurse
Everyone makes mistakes. Everyone. Let’s say that again. EVERYONE MAKES MISTAKES. Even the perfect nurse on your unit. Obviously, none of us want to and none of want our mistakes to harm patients. But the ways in which a hospital achieves that is to create and design systems that prevent mistakes. Every time we introduce something new into a system, there’s a chance for mistakes. New drug? People could make mistakes when they are still learning it. New equipment? People might program it wrong, clean it wrong, etc. But also, new people. New nurses, new doctors, a new chance for miscommunication.
I remember making my first mistake on the night shift. It was with medication. We used to store all of the similar types of syringes in the same pyxis drawer. Even if they were different doses and had different patient names on them. So when my patient was upset and wanted medication in a hurry, I grabbed the wrong syringe. Luckily, I was the right dose. This was before barcode administration. But I felt like a bad nurse. I failed the basic rights of med administration.
But I wasn’t a BAD nurse. I was a human nurse. I was dealing with my emotions, a panicky kid, another nurse telling me to hurry, and a poorly designed system.
Perfectionism is Not Necessarily a Good Thing
Maladaptive Perfectionism is a term to describe the perfectionism that has been observed in nurses from internal or external pressures. Following along with the idea that making a mistake makes you a bad nurse, is this idea that is often pushed in nursing school and throughout the profession. Some of it is internal and some of it is external messaging.
When I joined my first nursing council, we had a portion of the meeting here we examined errors, without knowing who made the error and discussed the next course of action. We were supposed to be operating under a just culture frame work. But despite that, there were always inevitable conversations that nurses would have where they said how could they do that and I would never…As a recovering perfectionist, I was right there with them, reinforcing the same ideas that we needed to be perfect 100% of the time and internalizing the message. But the outcome of that messaging was only a creeping doubt that I was not a good nurse because I was not perfect. We needed to hear the message that we were not perfect and could not expect to be, which was why we needed better systems.
Compassion Fatigue is Inevitable
In nursing school, my classmates voted me the Most Compassionate Nurse. I am sure it was based on an occasion in our first semester where a classmates patient yelled at me and I ended up eating my lunch with them and talking about their frustrations. I was a highly idealistic, compassionate new nurse committed to making a difference. What I didn’t know at the time, was that the research shows is that I was at high risk for burnout and fatigue. I also had my own life experiences, that included past unresolved trauma, that made me at risk for poor coping. How many of us go into nursing to make a difference because of past experiences? Have we fully come to terms with those experiences?
New nurses under thirty who are highly idealistic are at higher risk for dealing with the burnout spectrum. I wish I would have known that what I loved about nursing, the compassion satisfaction I get from caring for others, had a cost. That all of the kids I would care for with cancer who would not survive would take a toll. And I wish I would have been taught strategies to manage and deal with it.
A lot of what we do to prepare nurses is about the science and art of caring for others. But not enough of it is about the science and art of caring for ourselves in order to sustain the care we provide for others. What are some things you wish you would have known as a new nurse in order to sustain your career as a caregiver? Leave a comment below!
This one is for the caregivers. The parents, grandparents, children, spouses and other family members caring for loved ones. The partners, friends, foster parents and families of choice. The home health aides, nurses, social workers, occupational therapists and other professional caregivers. The emergency workers, international aid workers, and community outreach workers. You. The ones who are caring for someone who needs help.
Caregivers are doing the work in a variety of circumstances and for a variety of reasons. But ultimately those reasons boil down to caring, whether you’re getting paid or are doing it just because you see a need and want to help. And there are a lot of you out there. According to Caregiving and AARP in 2009, there were 16.8 million families caring for a child with special needs. According to the Bureau of Labor Statistics, 41.3 million Americans are giving unpaid care to elderly people. There are almost 3 million registered nurses in the US.
Some of you are working 12-hour shifts, some of you are working nights, and some of you are spending 30 unpaid hours a week providing for a child’s special needs. All of that work can put a strain on families or lead to burnout in caregivers.
What’s burnout? According to WebMD, burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude — from positive and caring to negative and unconcerned. The strain on family caregivers is influenced by a combination of stressors, resources (or lack of), and perceptions about their roles. These factors can lead caregivers to feel exhausted, overwhelmed and isolated. And caregivers typically don’t want to burden their loved one, which often causes them to internalize their feelings. The combinations of strain and internalized emotions can lead to health problems of their own in caregivers.
According to the Self-Healing Through Reflection Workbook, professional caregivers experience burnout as job stress that accumulates over time as physical, emotional, and mental exhaustion (Bush & Boyle). This experience is affected by workload, resources, personal coping skills, leadership and workplace support. The previously mentioned workbook is an excellent resource for nurses.
Withdrawal from patients, friends and family
Loss of interest in activities previously enjoyed
Feeling blue, irritable, hopeless, and helpless
Feeling “numb” or apathetic
Changes in appetite, weight, or both
Changes in sleep patterns
Getting sick more often
Feelings of wanting to hurt yourself or the person for whom you are caring