Caring, a mutual and collective experience of Nurses

I sit at my computer. With some hesitation, I begin. Trying not to hold my breath and all-the-while typing as fast as my fingers will carry the excitement and tension I start to feel in this moment, I stop to steady myself. Behind the document in which I type on my screen is the website for the Nurse and Midwife Support service. Having viewed the site earlier in the evening and now just finishing reading a beautiful piece called “Field Notes on Death”, I hover. On the verge of disquieting emotion and at the edge of something unknown yet strangely familiar, I take a deep breath, trust myself and keep typing. Then, through the tears that suddenly begin to fall, I realise I feel like I have come to a place of belonging, a place of welcome. In the words I read of another nurse’s story and in the one I am about to tell, there is a recognizable uncertainty, alongside the desire to find knowing.

The yearning to tell “my story” has always been inside me. Like others who have come to nursing in similar ways, as children, death an integral and familiar part of life. Of how we were bought up, what we grew up in and the ways in which we were challenged and taught, to live. Through my own culture as a child, growing up Maori in New Zealand, with our traditions around dying and death, I learned early, the importance of process and the art of caring. Add to that, a catholic religion and being born into a family of nurses. I was destined for the career I have had, am still having, still loving. My childhood and my life in New Zealand, however, is a long way from me now. Forty years into this country, children, marriages, a grand-child, and a stellar nursing career have taken me far from the place that I was born. From the place I first learned to care. But my roots, the cultural rituals and my family background, have carried me through time, my life and my career. As these words flow from my heart, my head and somewhere in-between, out onto this page, I write with relief and joy in the possibility there is somewhere to share my story. Somewhere, that a lived experience as a mental health nurse may be valued and find its way to the eyes, the minds and maybe even the hearts of other nurses, like me.

Like any group of professionals there is a bond between those of the same discipline. Sometimes, it matters not that we may specialise in different areas of that discipline, because there is a common ground. A connection; a link, that brings us together. It’s part of the “thing” and the motivation that brought us to nursing, in the first place. For me and for many of the nurses I have worked with, it’s the satisfaction that caring for others brings. It’s sharing in the journey of those who come, or are brought to us, albeit sometimes against their will, for help. It’s about working with families and communities in the struggle to manage so much with so little. It’s also in holding and managing the strain and fatigue of a long shift, a long week, a long year, a pandemic. It’s about the burden and disappointment that caring sometimes brings. It’s also the failures to care, in the right way, with the right resources, at the right time. Sometimes it’s less about what we do, and more about what we don’t do. And always, there must be learning, both from what we do well and from the times we fail. These are the challenges and the joys of nursing. This is what we share as nurses. Our bond, our connections, no matter where we specialise.

This year, that we all have come through - not just a state of emergency, a national crisis and an international pandemic, has been testimony to the work and spirit of so many human beings. That this is also the international year of the nurse, where not just our communities, but our world has needed us we have stood up, stepped forward and got on with the job of doing what we do best. Caring for others.

In February this year (just before our first Victorian lock-down), I stood in-front of a room full of lung cancer nurses at the Convention Centre in Melbourne and for a moment, I thought I was in the wrong place. I had been invited by a conference organiser to talk about the importance of de-briefing and clinical supervision in nursing. Having spent much of my time as a nurse debriefing, supervising and mentoring others, I love any opportunity to talk about these practices. They give us time to reflect on what we do. To heal and recover from the trauma and the negative impacts, our work and the context in which it occurs sometimes brings.

But, back to the Convention Centre. As a way of managing my anxiety in that moment, I took a deep breath. Understandably, I was a little nervous at the prospect of having nothing in common with this group of amazing specialist nurses. However, casting my eyes round the room and seeing the faces of those looking intently at me, I saw something familiar. I took another breath, looked at my audience once more, and then I knew. What I was looking at, looking into, were the faces of compassion. I was looking into the face of nursing. It didn’t matter that our careers had taken us on different paths. We had something in common and I had just connected with it. A mutual and collective experience of caring.

In my last few years in senior mental health nursing roles, I had a favourite way of introducing myself. Whenever speaking to a new group of colleagues, nursing students, graduates or professionals at forums or conferences I started with an introduction that came from my heart. I said “I am a mental health nurse. I have been a mental health nurse all my life, and the older I get, the more I love who I am as a professional. The more I love being a mental health nurse."

Truth is, I love what mental health nursing has allowed me to do. What it has enabled me to learn and the ways in which I have been constantly challenged to grow. With the passing of time and the richness of many different experiences I have been privileged to be part of, I arrive now at a place; this place and inside this story, where I am truly proud of the work I have done.

Be it with the consumers I have had the opportunities to care for and learn from, or the professionals and others with whom I have worked and supported, or the organisations and teams I have been a part of or led. These people and this nursing work, has given me so much more than a fortnightly wage, a roof over my head and the life I have been so fortunate to have.

But this story doesn’t just belong to me. It belongs to the people with mental illness that I have been privileged to work with. The people who have taught we what I could not learn from a text-book or at university. It belongs to those who have challenged how I have cared for them. The many who stretched my understanding of what recovery means, from their perspective not mine. Those who have made me think about the how dehumanising and objectifying nursing language can be. Those who inspired me to stop the cruel talk that happened in the nurses station and the handover room. Those who made me see them, and who they were, beyond their illness. People first, with lives, not unlike mine and so much more than a diagnosis. These are the people who are part of my story. I am grateful and lucky to have been a small part of theirs. I also take my hat off to the consumer consultants and advocates I have worked with who have pushed me (and my colleagues) to take up what we need to learn from them. Those who have helped me understand what Valerie Billingham (1998) meant when she said, “nothing about me, without me”. Not just in our models of care, but also in how we plan, design, implement and evaluate our mental health systems, programs and services. To the people who have taught me that we need to listen to, value, learn from and use the wisdom of those with lived experience.

My story also includes the colleagues (so many of them nurses), with whom I have worked. Wise Nurse Educators I had in the 70’s. Whom I modelled much of my early nursing behaviour on. What they taught me and the passion for what they believed, lives on in my nursing bones. From Carl Rogers to Hildegard Peplau, I learned empathic understanding, unconditional positive regard and the dimensions of person centred care. I have come through hospital-based training (much like a lived-experience form of nursing education) and made my way eventually to postgraduate studies at RMIT. I spent several years at the creative edge of community-based mental health care at the time of de-institutionalisation. Working in multi-disciplinary teams I learned the value of disciplinary differences and the need for shared understanding, language and goals. I trained in several forms of psychotherapy; finally settling with the humanistic, phenomenological, relational and dialogic tenets of Gestalt Therapy. I ran my own counselling practice and endured the necessary pain and growth of many years in my own psychotherapy. My career has taken me across the scope of primary, private and tertiary mental health sector services and settings. I have worked in clinical, education and nursing leadership and management roles. I have learned from some of the best. Not always those in charge of in-patient units or teams, departments or government services. But the everyday mental health nurses working in emergency departments, high dependency units, crisis assessment and mobile support teams, community residential services, continuing care teams, drug and alcohol programmes, disability services those working with people who are homeless. The ones whom I have worked with, who take their time to sit and talk with a consumer who is troubled or agitated, over, reaching for a prn. The ones who ask a consumer how they are feeling as they seek to understand, over assuming they already know. The nurses who still come up hurting when a patient they nursed and cared about and for, dies. It’s the ones who step back and take a breath to steady themselves and consider the context, before responding to a patient who yells. It’s these nurses who are part of my story. These nurses who have taught me the teacher, so much.

Now-days I am no longer a clinician at the front line of care, working in a hospital, a clinic, home-visiting or trying to engage with those who sleep rough. I am (as a colleague recently described me to another), the clinician’s clinician. The nurse supporting nurses. I learned long ago, the need for and healing power of reflective practices. I’ve had the same clinical supervisor myself for twenty five years. And yes, she is a mental health nurse, who has guided, mentored, taught, supported and challenged me along the path of my career.

So now, like my clinical supervisor, this is where much (but not all) of the focus of my care as a nurse, is now. Caring for the carers. Providing safe spaces in which to talk, debrief, reflect on and unravel the ins and outs of the job. Giving nurses support. Helping them to understand more of who they are and who they want to be. Guiding them to manage their loads, while maintaining their self-care. Stretching them to learn from their consumers and colleagues to improve what they do. Ultimately for those in their care, but also for themselves. In the twilight of my nursing career, this is one way I give back to the profession that has given so much to me. In closing this story, I finish with a deep and heartfelt honouring of, farewell and thanks to the hundreds of nurses worldwide, who in their efforts to treat those who caught coronavirus, got it themselves and died. All in the line of duty. Doing what we all do and love – caring for others.

By Tessa Moriarty

Credentialed Mental Health Nurse Consultant

Tessa Moriarty is a credentialed Mental Health Nurse Consultant with over 30 years experience across public, private and primary health care, mental health and drug and alcohol settings. She has worked in a variety of senior leadership and executive roles and is an experienced group facilitator, clinical supervisor and psychotherapist. Much of Tessa’s work in recent years has focused on supporting those working in clinical settings – providing individual and group clinical supervision and reflective practice. She also works as a mental health nurse consultant for Primary Health Networks and always tries to bring a humanistic approach to the clinical governance and service review projects she undertakes.

Tessa writes professionally as part of the roles and consultancy work that she does. More recently, she has turned to more creative writing and calls herself a lived experience writer. She believes in the healing capacity of writing for both those who write and read the written word.