The Cost of Caring
By Dr Kate Owen
Clinical Psychologist & Family Therapist
"What do you want to be when you grow up?"
We all go into the helping profession for different reasons.Can you remember yours?
Your journey into nursing may have stemmed from a desire to help others, because someone in your family was in the field, perhaps you had a medical experience in your own life and you wanted to pay it forward by helping others, or one of one million other reasons why you chose nursing.
For some of you nursing was a childhood dream. For others, a decision soon after leaving school. And for others, a later in life career change.
Whatever your reasons, and whenever you started on your nursing journey, can you remember what it felt like when you first decided to become a nurse? Did you feel excited, passionate, a bit anxious?
It is important to revisit your hopes and dreams and reasons "why" you entered this field in the first place. Because over time with the demands of the job these values and ideals can fade. It is not to say that the underlying passion and drive is no longer there, it just now takes a back seat to other more immediate demands and pressures.
Hopes vs Reality
At what point did your hopes for becoming a nurse start to blend with the reality of what this important profession actually encounters and experiences on a daily basis? Or did you have a realistic view of what this job entails?
Do you feel fulfilled and grateful that your job matches your hopes and expectations of what you wanted to achieve and experience in your career?Ê Do you feel grief and sadness that what you do each day doesn't fit with what you had imagined? Do you feel resentful or frustrated in your job?
And for people outside of nursing and the helping profession, can they really appreciate what you experience in your everyday work? Can they appreciate the joy you feel when you have a great shift, save a life, made someone feel more comfortable, and achieved your goals for the day? Equally, can they appreciate the burden you carry when patients share tragic stories, you witness stressful patient experiences, see colleagues struggling, and navigate working in an often dysfunctional health system?
The Cost of Caring
When you first sign up for your nursing program, nobody ever says "This is such a rewarding career and you will get lots out of nursing, but there's also a risk you will become affected by this job.Ê You will experience great satisfaction, but you will also witness and experience stress which will affect your wellbeing and your relationship with others and life".
There are many factors that contribute to stress and burnout in the workplace. Excessive work load without much down time, an often chaotic and high pressured work environment, lack of autonomy and control in some situations, little recognition and feeling under-valued, being uncertain as to what is expected of you, when leadership is missing or chaotic or critical, workplace conflict, and personal characteristics of perfectionism and wanting to control outcomesÉto name just a few.
One other important factor that contributes to nursing stress is the effect of being exposed to traumatic experiences directly and witnessing traumatic experiences in the workplace. And what may be experienced as stressful by one nurse, may not be experienced the same by another.
Signs and Symptoms
It is important to inform nursing staff that there is a continuum of workplace stress ranging from helpful stress to acute stress to chronic stress to compassion fatigue (burnout) to vicarious trauma.
Let's look at the more severe and complex end of the continuum and understand the difference between compassion fatigue (also known as burnout) and vicarious trauma.
Compassion fatigue is a state of physical, emotional and psychological exhaustion after extended periods in highly emotionally demanding situations. Some signs of compassion fatigue include:
- Feeling stressed
- Low mood
- Cynical or pessimistic attitude towards work and life
- Feeling suspicious about situations or people's intentions
- Seeking comfort or escapism from excessive food, alcohol or drugs
- Inability to make decisions and procrastination
- Somatic complaints (headaches, upset stomach) on a regular basis
- Feelings of reduced accomplishment at work
Vicarious trauma is the cumulative impact on you as a worker when you empathically engage with people's trauma stories and traumatic experiences, and the stress of wanting to help your patient who is suffering.Some signs of vicarious trauma include:
- Intrusive thoughts and images of the trauma of someone you are caring for
- Feeling hypervigilant and jumpy
- Feeling numb or a loss of empathy
- Constantly irritable and frustrated
- Fear and anxiety
- Poor sleep and nightmares
- Boundaries becoming blurred Ð such as taking on too much work or going beyond your work role
- Dreading going to work and/or difficulty leaving work
- Not enjoying life like you used too
What's the Antidote?
The first step is awareness and education. This can be an easy step to take given the increasing amount of knowledge and discussion happening in the helping profession field right now.
The second step is consciously making the decision to care for yourself and taking action. This is the harder step. Often helping professionals give so much to others but spare little time, energy and commitment to nurturing themselves and seeing themselves as a priority.
Why is that?Ê Where does that come from?
One reason might be the propensity for helping professionals to self-sacrifice. Often a pattern in their life that is also present in their career. Another reason is stigma around mental health and acknowledging that they are struggling. Even with social movements like "R U OK?", our society continues to view those with mental health concerns as "them" not "us". Or perhaps it is the workplace culture. Are colleagues praised for working double shifts? Are those who prioritise work over life rewarded with acknowledgement?
Whatever the reason, let me repeatÉ.the second step is consciously making the decision to care for yourself and taking action.
The third step is cultivating a culture of care It is important not to blame yourself if you are feeling burnt out, or to judge colleagues who are struggling. Nurses are doing the best that they can in a highly stressful industry. Just as war veterans are finally being recognised for the suffering they endure from being exposed to war trauma, so too is it time for society to acknowledge nurses for their ongoing exposure to trauma in the health field. Although the traumatic experiences are very different, the impact on the brain, body, and relationships is the same.
My Gift To You
During the Australian wide lockdown phase in mid 2020, I felt inspired to create a free online program to educate professionals on burnout and vicarious trauma, with lots of practical strategies to create a "wellness buffer" to sustain them in their practice.
Although originally created for counsellors and mental health practitioners, feedback from many participants in the program suggests that the self-paced program can benefit anyone in the helping profession.
So sign up today. It's totally free. My gift to say "Thank you" for all your hard work.
If I can positively impact one health professional and they go on to help 100 patients, the impact on society has the potential to be large.Ê Isn't that why we do what we do?
Keep Calm Cards
There's two things that I have learnt in 20+ years in the mental health field nobody cares more about your wellbeing than you, and effective policies and processes at work aren't always going to buffer against the effects of workplace stress.
So I encourage you to take charge of your own wellbeing in order to sustain you in your chosen career of nursing. I encourage you to put on your "oxygen mask" first before assisting others. And what I know from experience, training, and mentoring others, is that reading about wellbeing and talking about wellbeing is not enough. Action is needed.
So for those wanting practical, simple, and effective strategies to combat against stress, worry and anxiety, then my Keep Calm Cards is an excellent resource to help regulate your central nervous system and help you think clearly at times of stress.
Keep Calm Cards link
Here is a video explaining what The Keep Calm Cards are, how to use them, why they work, and how to use them for yourself and when supporting others with anxiety.
Click to watch video from Dr Kate Owen.
Keep Calm Cards: What they are and how to use them.
Nurse & Midwife Support is available 24/7 nationwide to nurses, midwives, students and anyone concerned about the welfare of a nurse or a midwife. Call them on 1800 667 877 or email . The service is anonymous, confidential and free. For more information go to: www.nmsupport.org.au
Being a helping professional involves giving your energy to others, and then coming home and giving more energy to the ones that you love.Ê Make sure that you are also bringing energy back to your physical, emotional and psychological self in the form of self-care, nurture and wellbeing.Ê Buffer against the "cost of caring" so that you can remember the reasons that you became a nurse in the first place, and live aligned with your helping values.
Bio for Kate
My mantra is helping people find calm, clarity, and connection. Being a Clinical Psychologist and Family Therapist gifts me the appreciation of you as an individual as well as your relationships and context; whether that is family, friends, work or community connections. Variety is what sustains me in my practice, and so you will find me doing a mixture of all things that I love: supporting clients and families in my clinic, mentoring and supervising other health professionals to strengthen their clinical practice, teaching and guiding whole health teams, running workshops around Australia, and teaching the next generation of Family Therapists in my training company at The QLD Institute of Family Therapy.
Connect with me in whichever forum best suits you:
- @drkateowen for Instagram, Facebook, LinkedIn
- Dr Kate Owen YouTube channel
- @qldfamilytherapy for Facebook
- QLD Family Therapy YouTube channel