Discussion

How do we find the courage to reassess our stressful interactions? As caregivers we may struggle with the idea that we might need care ourselves. If I admit a struggle maybe I am not as good a nurse as the one who just keeps going. I have had nurses tell me, “but everyone else seems to be doing so well,” and the admission that they are not makes them feel weak in their practice. But of course, we need to use our courage when considering our emotional response to patient situations. In particular, those situations where we find ourselves at a loss for what to do are an easy time to give in to fear.

One red flag for me is when I find myself retelling the story of what happened again and again. As I hear myself repeat the words, I now have trained myself to say, “What is it about that situation that makes me need to repeat it? What am I struggling with in this instance?” Retraining our inner calculations is not easy. I may dismiss my own red flag. “It’s because I was tired that day,” or, “the family was so overwhelming, that’s all that it was.” But burnout does not happen suddenly. It happens slowly, over time, as we let distress seep into our practice and rob us of the passion that made us choose to be a nurse in the first place.

We hear about the importance of self-care but don’t always hear how to practice it in anything but general terms. Get a good night’s sleep; exercise regularly; eat right. These are all things we are supposed to do anyway. What else does self-care look like as a nurse? Does it extend to our self within a group or unit?

Most of us practice within a larger group, which is essentially a larger self. How do we ensure self-care extended beyond self? It means care of the others we work with. So what does that look like? It involves many of the skills we use as nurses: good assessment and reassessment. What do we see? What questions do we ask?

Here are a few practical, brave suggestions for self-care of our individual selves and group selves:

Take the time to debrief, especially after unusual and complicated situations. For example, an unexpected code, a mismatch between treatment and expectations, or barriers in providing the best care.

Write down your feelings about the situation. As a unit adopting a practice of self-care of the unit, notice the coworker who may be struggling and ask ourselves, “Is this the appropriate reaction/is it the reaction I expect to see in others?” It would be okay — and not a betrayal of trust — to let the supervisor know that you or others are having a difficult time coping with a recent situation.

Can we formally debrief as a unit? Who sets that up and what does it look like? Advocating for ourselves and each other, not just for our patients and families.

Brene Brown, PhD, MSW, is a research professor at the University of Houston who studies courage, vulnerability, shame, and empathy. A quote from her explains what courage looks like, “Asking for what you need. Speaking your truth. Owning your story. Setting boundaries. Reaching out for support.”1

Nurses by definition are care givers. We give care away. Sometimes it seems that in the process we may fail to save some of that care for ourselves. The flip side of courage is vulnerability. What happens if I use my courage to reassess my care of a patient and listen to my inner voice? Doing so makes me vulnerable but yet opens me up to support. What if I used my courage to acknowledge my work distress and to ask for support? How much healthier of a nurse might I become? How much better of a nurse might I become for my practice and for my patients?


Ann Brady is a symptom management care coordinator at a cancer center in Pasadena, California.


Reference

1. Brown B. The Call to Courage [videotape]. Los Gatos, CA: Netflix; April 2019.