Can we care for others when our own care is compromised? 

More from Duty of Care  here.

I was facilitating a supervision group recently, and in response to my comment “when we don’t take care of ourselves our care is compromised” – a group member said, “I disagree with you on that, I don’t think it is”.  Although taken aback somewhat by his comment, on reflection, I think it is worth considering further and raises a number of questions and issues in my mind that prompted the topic of this blog.

Most obviously, the first question – is the care we provide as nurses and midwives compromised when we don’t self-care? – something you agree or disagree with? – are you able to care when your own care is compromised?  Is it more a matter of the degree to which our care is compromised when our own is lacking?  Does the type of care we are providing make the difference or the patient-client’s level of acuity to how our care is compromised and should this even be a consideration?  And, how compromised does our own care have to be before our care of others is?

We know a lot about what happens to nurses, midwives and health professionals when they are stretched beyond their means; when the need for care outstrips the people and resources available to provide it.  And we know too – from the last three years particularly – that when the pressure is on, we often put our own needs secondary and invariably we become fatigued, exhausted, unwell and burned out.  We have seen what happens when all these factors are at play – nurses, midwives and healthcare professionals become distressed, disillusioned, and leave their professions and workplaces in droves. Only this morning listening to talk-back radio on the ABC, an Emergency Department Nurse Manager from a hospital in Sydney was speaking about the numbers of nurses they are still losing from their service.

The Toll

Recent evidence highlights the perils of extension of care beyond our limits – evident across and still occurring post pandemic.  Increases in mental health and drug and alcohol issues in our professions demonstrated not just the negative impact of working too hard and caring too much, but also that our capacity and time to self-care was severely compromised.

I know from my own practice and work with health professionals, our patients did not always receive the care they expected; deserved or that we wanted to give them. This in itself sets up both a shared and personal moral dilemma for many. When we can’t give our patients the level of care they need, this makes us feel awful; torn; anxious.  We understand why, and we are part of the scenarios in which the care we provide is sometimes less than optimal.  But this is not what we signed up for when we started.  It is also why our attention to self-care and wellbeing must be a priority.

Earlier this year I was fatigued and burned out. For a while before letting myself acknowledge the poor health I was in, I soldiered on. I kept trying to convince myself – as I dragged the tired, flat and deflated person that was me, out of bed each day – that I could manage; that I would be okay.  I wasn’t. Sound familiar?  My learned stance – I must keep going, was not supporting me.

My context – the impact of work and stress over the last few years had taken its toll. My self-care and wellbeing were compromised and the reality for me was, so was the care I was able to give.   When my close friends, husband and colleagues noticed my fatigue and irritability – that was the hello I needed.

I wasn’t providing direct care to patients but there were times when my frustration and irritability with colleagues (and others), was less than professional. In those instances, I think my care of those I work with (who I also have a duty of care to), was compromised.

Long story short is that I stopped for a decent break, managed my burnout and when I went back to work – did so part-time as an on-going self-care strategy to maintain my wellbeing. That I can do this is a reflection both of my age and financial circumstances. Other colleagues I know do not have the choices and options I do.

It’s a professional and ethical responsibility

As nurses and midwives, self-care is a requirement of our professional standards, and is also inherent in our Code of Ethics.  Standard 3 for Registered Nurses in Australia (2016), make the responsibility for self-care plain and simple – is about our requirement to maintain our capability for practice, and reads as follows:  

RNs, as regulated health professionals, are responsible and accountable for ensuring they are safe, and have the capability for practice. This includes ongoing self-management and responding when there is concern about other health professionals. 

In addition, Standard 8 of the Mental Health Nurses in Australia Standards of Practice (2010) – which applies to Nurses like myself – requires me to practice within the national competency standards and nursing ethical guidelines.  It also requires that I participate in regular reflective practice and clinical supervision – a practice which acts as a wellbeing monitor for self-care.

When I have said to many nurses that we have a professional and ethical responsibility to manage our self-care as part of our capability for practice – I often get a surprised response.  Some forgetting perhaps this Practice Standard – and the agreement we make with our profession each year as we renew our registration, that the onus is on us to take an ethical and professional attitude and the actions required, towards our self-care and wellbeing, and that of our colleagues.  We can’t leave it to chance, our employers or our days off (when we think we’ll have more time), or when we get round to taking some holidays.  No, our self-care and wellbeing are much more important than that and are part of the foundations upon which we practice and commit to doing so.  But a reminder too – that care is a collective (and employer) responsibility. While not forsaking our own needs, we must also watch out for and extend a hand or care to our colleagues, when they are struggling, when we sense their own self-care is slipping. I am grateful my colleagues asked after my wellbeing, and their call on my irritability was the wake-up I needed to take care of myself.

Intentional Self-care

A critical lesson through the pandemic (and still),  has been that we need to self-care and our wellbeing is paramount.  As a Mental Health Nurse and clinical supervisor/facilitator of reflective practice with individuals and groups – the wellbeing of health professionals is one of the primary goals I work with.  Clinical Supervision/Reflective Practice is about care for the carers so they can care for others. The message is simple – Carer wellbeing is paramount.

Intentional self-care are self-care and wellbeing strategies that are purposeful and targeted to a particular aspect of our wellbeing and health. For example, out of necessity – during the pandemic –  like my colleagues, I started undertaking self-care activities such as walking, bike riding and being outdoors, with the intention of it improving and boosting my mental health. Yes, there was a spin off and benefit for my physical and even spiritual wellbeing, but moreover – the primary purpose for undertaking the activity was for my mental wellbeing.

One of my burn out management strategies was sea swimming – specifically to improve my mood and my mental health. The physical wellbeing benefits were an added bonus, but not my goal. I’m please to say it worked – alongside counselling, an extended break, slowing down, eating well, sleeping better – and taking care of all the other parts of my wellbeing that I had let slip – made the difference, and enabled me to return albeit it part-time to the profession I love.

So, what intentional self-care strategies are you undertaking and what element (s) of your wellbeing do they support and maintain? What do you need to add to improve your wellbeing?

A word for our managers and our executive teams

The people that are managing us are struggling too, and sometimes I think we can forget this.  As the leaders of our organisations, they do need to lead by example and participate in a workplace culture that demonstrates its commitment to staff wellbeing and self-care.  And yes, they too need supervision, coaching and practice forums to review and reflect on the impact of their work – because they too have an ethical responsibility for their work capability (as well as ours), and they are also under enormous pressure and are also human – like us.  But I’ve been in organisations where Nurse Leaders and Managers expect a do as I say not as I do culture and wonder why their teams don’t always follow. This is not effective or honest leadership.

Ben Chairella in a recent blog (August 2022) – Why Nurse Leadership Right Now Is More Important Than Ever – speaks to the practice of nursing leaders providing and supporting from the front; demonstrating what they are expecting their staff to emulate and reminding them their nurses and midwives need to feel and be supported. I couldn’t agree more and love Ben’s 3 be’s – be seen, be approachable and be nice.

But what I am asking for here is actually a view back to your manager. A look-see, and a thought about what they are going through and the load they’re carrying alongside yours. I’m not letting them off the hook regarding their responsibilities as managers and leaders, just reminding us that we’re all under pressure and we’re in this together.

Some Self-care Strategies

I finish this blog by sharing a couple of my favourite self-care strategies that I try to use to maintain my wellbeing, because I know they maintain me.

  1. Taking care of yourself throughout your workday, to reduce the stress you need to off-load at the end of it, by unpacking the stress as you go. Take your breaks, so that you don’t break. If lunch has to be short, make it nourish and refresh you. Stay hydrated. Speak up when you need help and don’t wait till the end of the day to take care of yourself.
  2. Our bodies hold the score on how we feel and carry the stress and tension of our day in our muscles, our organs and other parts of it – so pay attention to the headache or backpain you have. Never ignore pain. It is telling us something, stop if only for a moment, pay attention to what is happening in your body and what it is asking you to do.
  3. The Going Home Checklist – was created in the UK, by the National Health Service, and is an awesome way to transition from work – to non-work spaces. It helps us separate and move more freely from one to the other, so that in either space we are who we need to be.
  4. All the parts of who we are, work in unison. Our physical, spiritual, mental, intellectual and emotional, relationship, family and social parts are connected.  When one part of who we are is not well, there is an impact on the other parts of us. The same goes the other way – health in one part of self has a positive impact on the rest of self. Trick is taking care of all parts of self and when one part is not so good, using other parts to have a positive effect.

Last but not least, to rephrase Malcom Fraser’s famous words (1971) – Life isn’t easy sometimes, and neither is self-care.  Sometimes we get it right and we’re at peak performance, but mostly it’s not perfect and we need to review how we go each day.  It is about giving ourselves a pat on the back for good self-care and letting the slips, trips and falls teach us what we can do better.  Personally, I know that when I am taking good care of myself, I am in a better place to care for others. How about you?