As nurses and midwives, we are often featured in glossy advertisements and TV shows as the ‘face of caring’ — yet we live and work in settings where it can be highly stressful or toxic to care, and ironically, we may feel uncared for by these systems. Sometimes we might feel voiceless, powerless, disrespected, or unsupported.
I will argue that in this context, caring is a revolutionary act, and that befriending our own vulnerability by caring for ourselves is the vital first step.
Even though just over 10% of nurses are men, we are overwhelmingly treated as a female profession — and continue to attract outdated sexist attitudes. A devalued-because-we-care profession, we are not ever supposed to be frustrated or angry. Instead, we are expected to be ‘nice’, ‘compliant’, and ‘submissive’. If we complain, we may be replaceable.
This is reinforced by the poor optics of the actions of:
- a state government that took legal action to stop NSW nurses and midwives, who are exhausted by the fray, from striking
- a state government that asks more and more of Victorian nurses and midwives by ramping up elective surgery while the pandemic continues to detrimentally impact many of us
- a federal government that hasn’t publicly recognised the impact on aged care nurses of working in an underfunded broken system that led to neglect of residents.
We watch on with bleary eyes. COVID-19 has laid bare stories of being forced to work on COVID wards, or work in areas for which we aren’t expert due to staff shortages. We are told we must ‘live with’ the virus, do double shifts, have leave cancelled, or work in systems that aren’t great for clients or ourselves.
There is bullying, fear and oppression in many settings, and often nurses and midwives are afraid to risk their jobs to speak out about what is really happening. In some settings inadequate Personal Protective Equipment (PPE) reinforces the perception that the safety of nurses and midwives doesn’t matter.
Tragically, in my practice as a therapist I have witnessed nurses and midwives confide that they feel silenced, powerless, disregarded, and burned out. Many are not sure how long they can stay in the role. Many are looking for new jobs. Nurses and midwives are suffering severe stress and anxiety, struggling with addictions, self-harm, even suicidal thoughts.
It’s not just the bullying, lack of respect, lack of commonwealth Mental Health Nurse Incentive Program (MHNIP) or Better Access funding, poor and inequitable pay or conditions, or the savage cuts to Primary Health Networks (PHN) or National Disability Insurance Scheme (NDIS) funding for nurses and midwives in the community. Systemic problems and stresses existed before COVID-19. But many of us believe that COVID-19 allowed the federal government to quietly push through brutal cuts to services and welfare for the most vulnerable, jacking up the level of demand and stress in the system.
No wonder so many of us suffer exhaustion, burnout, moral bruising, or injury within our professions. We are carrying increased safety risk, workload and stress, risk of addictions and health issues, and decreased opportunity to care for clients properly. Given the magnitude of issues facing us, we need a lifeline.
Trauma-informed approaches are the lifeline for this moment. We can start by allowing ourselves to acknowledge that things aren’t easy, but stress and trauma can be healed. What! How? By “befriending” our vulnerability.
This starts with understanding the body. Learning how to take care of a nervous system that is by now either exhausted or revved up — or both.
Humans have built-in systems to cope with stress or powerlessness. Stress initially puts us into sympathetic nervous system (SNS) arousal, the fight or flight part of the nervous system. This fast SNS state affects us mentally by making us crave quick certainty, answers, demand favourable outcomes, or seek more structure or predictability. We may become more ‘black and white’ in our thinking, more idealising, or more reactive, irritable, harsh, or critical toward ourselves or others. Facial muscles tighten and we smile less. Sometimes it’s hard to sit still or to relax with family or friends.
Prolonged stress affects the body and shifts the focus of the brain. Over time the brain becomes more oriented to look for sources of threat and it becomes more difficult to dampen embodied sensations of stress. We begin to doom-scroll on devices. At the same time, stress hormones like cortisol and noradrenaline flood the body, so it’s harder to get restful sleep and recover. Mental and emotional exhaustion set in, but we fight it at first.
Over time we may become riveted by stress and become ‘stress junkies’ as we compulsively doom-scroll or watch the nightly news. Images, sounds, and sensations that are ‘stress adjacent’ can amplify our physiological stress responses, leading to imbalance in our allostatic load. Blood pressure goes up. Self-care goes down. Gut and appetite changes. We develop an apple shape as we eat more sugar. Prolonged stress may damage our immune system or gut. As the brain orients us more toward threat, we lose the pleasure of ordinary life. This eventually leads us toward the second biological adaptation, Dorsal Vagal (DV) collapse, commonly known as depression, low mood, anhedonia or ‘the blahs’.
This slow low energy state is meant to help us rest and recover from the huge energy drain of the ‘fight or flight’ SNS state. However, if we are in DV for too long, it starts to impact our mood, clarity of decisions, our resilience, and our hope for the future. Life becomes a burden or a grind.
Luckily, we can recover from either state by befriending our vulnerability.
Befriending is when we learn to witness ourselves as a friend and attend to whatever is happening in the body without labels or judgements. There is a spaciousness in befriending that builds hopefulness, resilience, and trust in our own humanity and capacity to repair and heal.
How? Simply put, when you are stressed or going too fast, practice things which will slow you down and make you kinder and more compassionate towards yourself.
Exhale fully from the belly, give yourself soothing circular temple rubs, use large muscles though yoga or exercise, practice long sighs or exhales, try massage, float, or walk in water at the pool or beach. Ask your inner critic to ‘please wait in the waiting room’ while you have some time without their commentary. Imagine talking with a friend who is calm, accepting, and supportive.
Practice an ‘inner half smile’ with yourself. Notice how sweet you are. Do at least 10 minutes of guided Mindfulness practice every day. Switch off screens and stop doom-scrolling. Eat a Mediterranean diet. You should notice stress levels decreasing in as little as two weeks.
Alternatively, if you have low mood, lack motivation, or ‘the blahs’, the antidote is to increase mobilisation. This stimulates the vagus nerve which is connected to ears and all major organs. Sing, hum or make a ‘voooooo’ sound. You can dance if you want to. Lengthen the spine just a centimetre or two for a few minutes. Inhale deeply until your belly rises equally with your chest. Stand or straighten the spine if you are slumped. Do some yoga stretches. Go for a slightly longer walk each day. Watch a kind-hearted comedy show — or join a community group. Avoid alcohol. Find what gives you meaning and purpose every day. Try ‘nature bathing’, and anything new or novel that you haven’t done before. Grow a tomato plant if that’s new.
Once you start to feel better, you may notice that others too are struggling. Share the love. Share your new-found wisdom in a supervision or social group that supports all that you are. Teach others that stress and trauma can be healed.
By befriending your own vulnerability, caring becomes a revolutionary act, an act of defiant courage and healing that will gradually change the world.
Navigating your mental health and workplace issues can be stressful. If you’d like to chat about it, reach out to Nurse & Midwife Support — free, confidential, 24/7. Give us a call on 1800 667 877 or by email.