Guests: Julie Sharrock
Tags: Workplace bullying, harassment, conflict
Soundcloud: Listen to Episode 27
In this episode we talk to Julie Sharrock, an experienced registered nurse and clinical supervisor about the importance of clinical supervision. We explore the benefits and why professional self-care as an essential form of support for nurses and midwives.
Clinical supervision is a formal process that aids supported reflection. It is one tool underutilised by nurses and midwives to provide support. Julie explains how the process helps nurses and midwives to develop their practice through regular time spent in reflective discussion with experienced and knowledgeable colleagues trained in providing clinical supervision — you won’t want to miss Julie drawing a parallel between clinical supervision and the Pensieve in Harry Potter! It’s the first time the wisdom of a Harry Potter character has made it to the Your Health Matters podcast, and we hope it won’t be the last time!
The magic of support matters!
Stakeholder Engagement Manager
Julie Sharrock, RN, Credentialed MHN
CertCritCare, CertPsychNurs, BEd, AdvDip(GestaltTher), MHSc(PsychNurs), PhD Candidate
FACMHN, MACN, MACSA.
Mental Health Nurse Consultant, Clinical Supervisor and Educator
Julie commenced her nursing career in 1977 specialising in general and intensive care nursing for 10 years before beginning Psychiatric Nursing. During her career, Julie spent 38 years in clinical practice, ceasing in January 2017. She has often been asked how she was able to do this type of work for so long, work which focused on human suffering and resilience building. In her words and without doubt, a key component of her survival in health care was good Clinical Supervision. To this day she continues to receive and provide regular Clinical Supervision and is now a clinical supervisor trainer. Julie has contributed to the Framework for Clinical Supervision for Mental Health Nurses in Victoria and led the development of a Joint Position Statement Clinical Supervision for Nurses and Midwives in Australia.
Mark Aitken [0:09] Welcome to the Nurse & Midwife Support podcast: Your Health Matters. I'm Mark Aiken, the podcast host. I'm the Stakeholder Engagement Manager with Nurse & Midwife Support, and I'm a registered nurse. Nurse & Midwife Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free, and you can call us anytime you need support. 1800-667-877, or contact us via the website: nmsupport.org.au.
On this episode of the Your Health Matters podcast, we will discuss clinical supervision and how it can support nurses and midwives to navigate, understand and reflect on the complexities of their work and impact on their health and wellbeing. We will discuss all things related to clinical supervision and its importance to nurses and midwives. I'm delighted to say my guest today is Julie Sharrock, registered nurse and Nurse Consultant Mental Health and Clinical Supervisor. Welcome and hello, Julie!
Julie Sharrock [1:24] Hi Mark, and thanks for having me.
Mark Aitken [1:26] It's our pleasure, Julie. I'm really excited to be talking to you today, because I've got a keen interest in clinical supervision and I want to share all things related to clinical supervision with our listeners. Julie, would you please tell our listeners about yourself and your experience with clinical supervision.
Julie Sharrock [1:46] Mark, I first had an interest in supervision somewhere during my mental health training. I started nursing quite a while ago, in 1977. I did hospital-based training and I worked in general nursing for 10 years, I did a little stint in intensive care, and then always wanted to do mental health nursing. I did my psychiatric nursing training at Royal Park. I was trying to remember the other day, when I first ever heard of clinical supervision. Do you know, I can't remember, but I do remember starting to attend some workshops and education sessions probably in the early 90s around clinical supervision. I guess going back a long way, I've always had a keen interest in nurse welfare.
I remember in my third year...I was reminiscing with one of my dental nursing buddies the other day that I trained in Geelong, and we had this wonderful director of nursing, Marjory Taylor, and for some reason she picked myself and my friend out to go to this seminar workshop in Ballarat, it was at Sovereign Hill, and it was on...well, I don't know what the topic was on. I do remember there was a nurse counsellor from the Royal Children's talking about supporting nurses, and I remember thinking, "What a great idea!" It piqued my interest. I'd love to ask Marjory Taylor what she saw in my friend Suzanne and I, but she's no longer with us, so I can't ask that question. But then I was thinking about this interest in nurse welfare, and when I did my intensive care training, I also did an assignment on 'Stress in Nursing'. So the theme of nurses and nurse welfare permeates my career even though I didn't aim to end up being a clinical supervisor. I didn't even know what it was back then.
Then I did my mental health nursing and worked in mental health until I finished clinical practice in 2017. My area of specialty was mental health nursing in the general hospitals, so consultation liaison, psychiatry, or many other names, Mental Health Nurse Consultant to general nurses. We didn't have midwives, but there's consultants to midwives as well. We work with nurses and midwives, and general hospital staff to look after people with comorbid mental health problems in the general hospital. I was exposed to the challenges that nurses and midwives face in day-to-day work, and started to think about clinical supervision for those folks as well. So then when I finished clinical practice, I already had a very small private practice in clinical supervision. I expanded that and now I also educate people in clinical supervision. I'm part of a training program with Paul Spurr and Clinical Supervision Consultancy. So I provide supervision and I also teach supervision.
Mark Aitken [4:45] Thanks, Julie. What an interesting and rich career you've had, and interest in clinical supervision. Thanks so much for sharing that. You mentioned a nurse buddy. This podcast is part of our newsletter on support for nurses and midwives. We're showcasing, as part of that, friendships in nursing. We're launching our story competition this year, which will be about stories of friendship in nursing. We'll talk more about that later. But have you got a particular friend or buddy who's a nurse, Julie, who has supported you? Would you like to give a shout out to them?
Julie Sharrock [5:26] The person I'm talking about is Suzanne Higgins, who's a Perinatal and Infant Mental Health Nurse. But I just want to give a shout out to my nurse training school, which was School 177 of Geelong Hospital. I can't even pick one out because we still meet up today, regularly at our anniversary time, which is the 7th of February, 1977. We're clicking over on the years, and I just want to give a shout out to them, because we used to support each other all the way through our training and still support each other to this day. I think I might put to them about the idea of writing a story because we have a story to tell.
Mark Aitken [6:06] Absolutely, Julie. Nurses and midwives are great storytellers. And it's a competition, so there'll be a prize for the story that connects mostly with judges. More on that later. Thanks for sharing that, Julie, and the shout out.
Julie, what is clinical supervision? Why is it important to nurses and midwives?
Julie Sharrock [6:30] The way I think about clinical supervision is that it's a structured relationship that's really based on Adult Learning Theory, in particular, reflective learning, which has been around now for centuries, really. It probably dates back to the early scholars of our civilization. But Dewey introduced the idea of reflective learning in a more modern context.
So it's based on reflective learning and adult education, that idea that you have a need to learn, you need to make sense of something. The relationship is based on what we know from communication skills and advanced relationship building. So it's a professional relationship that's got professional development at its core, and really focuses and reflects on the work that we do. So it's a work-related relationship, not a personal relationship, like counselling...but sometimes I guess people do say it feels a little bit like counselling. But the big difference is it's focusing on work-related material.
Mark Aitken [7:37] Thanks Julie, and why is that important?
Julie Sharrock [7:40] Of course, I can't go back through life and not have supervision and see what the impact would have been. I believe that I couldn’t have done the work I did, for as long as I did, without regular clinical supervision. And what's interesting, I guess, [in] the twilight of my career [is] the things that niggle me, memories that still unsettle me sometimes are predominantly before I had supervision. So way back when I worked in ICU, I still have some, you know, memories that I don't like having about that work. I didn't, obviously, have clinical supervision, and we were extraordinarily poorly supported in the intensive care environment with the challenges that we faced.
I like to think that supervision has helped me stay in the work, more importantly than that, in the work, when there's really tough things that you have to think about and process and respond to. Like the suffering, you know, working in the general hospital where people were experiencing life-threatening, life-changing illnesses, or accidents or whatever. Sitting with their suffering and being able to attend to their experience without getting caught up in my own concerns or worries or reactions, or overreactions. It meant that I could be more choiceful in my interventions with the patients, and with my colleagues. I wasn't as reactive. I didn't dwell on, or take the suffering home with me, quite as much. I had a place where I could go and talk about the tough things, and the achievements as well.
Supervision is not only about the tough challenges that [inaudible], the achievements and the things that went well, and then understanding what went well and thinking, "Ah! I can use that again." You get in a similar situation in the future and it comes into your mind, you think "I could try that this time." It allows for a more thoughtful interaction with people.
Mark Aitken [9:54] You make some very good points, Julie. I think that the importance of reflecting on our practice and our experiences is so important. Not only how we may have done things differently, but I really connect with the importance of celebrating a job well done, or celebrating what you've achieved, and how you contributed to the quality care of people that you're caring for. So some really great points.
Julie, in my blog, 'A difficult year: 2020 and the power of reflection', that's on the Nurse & Midwife Support website, I wrote: 'Clinical supervision is a formal process that aids supported reflection', which you've talked about. 'It is one tool underutilised by nurses and midwives to support and enable reflection. Clinical supervision is a process of professional support and learning in which nurses and midwives are assisted to develop their practice for regular time spent in reflective discussion with experienced and knowledgeable colleagues trained in providing clinical supervision. In 2019, the Australian College of Mental Health Nurses, Australian College of Midwives, Australian College of Nursing released a joint position statement recommending clinical supervision for all nurses and midwives, irrespective of their specific role, area of practice and years of experience.' Julie, could you speak to that joint position statement and the key elements?
Julie Sharrock [11:34] That position statement...I have to say I'm very proud of it. I lead that working party, but I have to acknowledge the wonderful colleagues from all the colleges that I worked with, in developing that. The College of Mental Health Nurses had had our position statement for a while and we were sort of looking at it. We'd done...I have to admit, probably a bit of a half hearted joint position statement with the ACM not because we didn't feel it was important, but we just didn't have the resources at the time. So when I looked at that, I thought, "We really need to think about this and do this better."
So myself and a colleague from the board of the College of Mental Health Nurses, Tom Ryan, (and I was on the board of the Australian College of Mental Health Nurses at the time), put it to the board that we actually invite the Australian College of Midwives as well. So it was, I think, a little bit ambitious, but we managed to do it. I was so pleased. I was able, because I'd semi-retired, to put a lot of work into it. The minds that then came together to think about this were fantastic. I do want to acknowledge those people. They are acknowledged on the inside page of the position statement.
The position statement is available on each of the college's websites, and also a poster that goes with it that you can print off, preferably in a slightly larger format that may be an A3-A2 to and you can put it up in your workplace. It shows the key components of what clinical supervision is, and central to that is the trusting professional alliance. That is the relationship that develops between you and your clinical supervisor; remembering that it also can be done in a group, but developing the same level of trust in a group can sometimes be a bit more of a challenge. But when that happens, it's magic, because you've got a whole group there supporting each other and the wisdom that comes from group supervision is extraordinary. So it can be individual or group. I tend to provide individual, partly because of practicalities. I also think that you need to select your group carefully.
I guess going through the position statement, then what we've got is the trusting professional alliance at the core and then we've got some key components of what leads to effective supervision. I'm not sure, Mark, do you want me to go through those?
Mark Aitken [14:13] I think that'd be really interesting, Julie. This is absolutely fascinating, and I know our listeners will be all ears. So, please!
Julie Sharrock [14:20] One of the important things...and these are no more or less important than each other, I'll just refer to them in the order that I get to them really. But the important thing is that it's conducted regularly, it's private and protected time. So isn't having a chat in the coffee shop. Not that I'm saying chatting in the coffee shop is not a good thing, but it's not a confidential space. You can't talk about client work in a coffee shop. And it's not in a park, although I have to say some people have had to be quite innovative during lockdown and parks were a legitimate way to meet up and talk while they exercised during lockdown. Generally though, you would do it in a private, protected space that's away from interruptions and away from the practice setting enough so that you're not getting pulled out or interrupted, or so forth. That helps create the safe space.
Another important aspect of it is that it's confidential. Confidential within the realms of professional and legal boundaries, because we know there's mandatory reporting and if a supervisee brings up something that I'm a bit concerned about the practice, I'll raise it with them. I have never, at this point in time, had to go and say, "Look, I have to take this somewhere else." But if I was to say that, I would support the supervisee to take it somewhere else, or report on it. So it's not absolute confidentiality, but the important thing is, I don't go talking to the supervisee's boss about what they talk to me about in supervision. That's the really important part, that it's really a confidential space for them to talk about the challenges and their vulnerabilities within their work. That also contributes to the trust.
We need to think about cultural safety, and respecting diversity, and the relationship takes a commitment from both the supervisee and the supervisor. The supervisee has some responsibilities as well as the supervisor. We've got effective communication at the core. Feedback. I mean feedback about how the supervision is going. Evaluating that relationship and where it's going, and how it's progressing is important. We have made it very, very clear within the position statement that it is not provided by your direct line manager. Your direct line manager has a responsibility to provide operational supervision or managerial supervision, or direct line reporting, however, it's called...but it is not clinical supervision.
I might mention here, Mark, that the term clinical supervision, I know is tricky, but we've used that term because it's nearly 100 years old. We can't find a better name for it at the moment. I like it because it gives you supervision: you oversee your work with a trusted other. In New Zealand, they talk about the bird's eye perspective, where you hover over your work and take a step back from it and look at it from a different perspective with a trusted other. I think if we can get over the difficulties we have with the term clinical supervision, we'll just use it like a lot of other funny terms that we use in health that have a strange meaning. So we've stuck with the term clinical supervision.
The importance of regularity I've mentioned, but it needs to be predictable and consistent. You know, that you get into a way of operating. For example, I have a process where I acknowledge and welcome someone to the space. Then: what have you brought to supervision? Or what would you like to focus on today? Usually the supervisee brings something, and is expected to bring something. But sometimes they come and they go, "You know what? I'm all over the place. I don't know where to start." So that's what you work with. But you have a bit of a structure and John Driscoll talks about 'What? So what? Now what?'
The important thing is it's not just a talk fest. It's about having a goal, or some sort of purpose to the session. Trying to understand what it is that's concerning, or is to be explored. Why that matters, and then, what now? What am I going to do about that now? What are the next steps? Sometimes it's simply to say, "You know what, I understand that better, and that's really helpful. I think that's all I need now. Or there might be some actual steps somebody chooses to take as an outcome of the supervision. It's not a meandering conversation that goes nowhere. I'm not sure if I can use this terminology...it's not a bitch fest either. It is a place to vent a little bit but it's not just whinging. Maybe a whinge fest might be a better way of saying it, it's not a place just to whinge and moan. It's about taking some steps to change the situation or think about the situation differently.
It's important to choose your supervisor because you need to build a relationship. Some organisations do say: "This is your supervisor." I don't agree with that. Sometimes an organisation will say, "These are your choices of supervision, and you choose." That's what I would prefer. I've always chosen my own supervisor and paid for it myself, so that I can have control over who I have supervision with.
The supervisor facilitates the supervisee to monitor themselves and reflect on their practice, be accountable to themselves. When you actually speak to another...one of my supervisees says, "It holds me to account." By saying it out loud to you, I know that I need to follow through. It's a way of firming up a commitment to myself to take some action about something.
It's provided by professionals who have undertaken training. This is where we struggle, because we don't have a lot of training, or good training that runs for long enough available to us, but that's changing. Supervisors need to have their own regular supervision of their supervision, It's an opportunity to talk about the realities and challenges of work, and as I said before, the rewards. To be heard and understood and attended to by another professional is a real pleasure to do, but it's a real gift to the supervisee that helps them feel validated and supported in the work that they do.
We know that through supervision, people develop knowledge and confidence within their practice and it's strengths focused. That doesn't mean we don't challenge. People come and pay for supervision with me, they don't pay to just be validated, they want a little bit of challenging there. As a supervisor, I need to think about where I challenge and where I support, that's important. The supervisor needs to be able to think about the practice skills and have some understanding of what's required in the supervisee's practice. I also can't be an expert in everything, I like to hear the supervisee explain their practice and what the expectations are, in their own words.
Finally, it's supported by an agreement. Now, whether you do a written agreement or a verbal agreement, I don't think it really matters. There's no evidence to say that an agreement in and of itself makes for better supervision. What we do know is that goal-oriented and goal-directed supervision is received very well, and positively received by supervisees. Supported by an agreement that has things in it about how often you're going to meet, what your style is, the things about confidentiality I mentioned earlier. You review them regularly. I tend to try and get the goals and agreement done within the first three sessions, and then review a little way down the track. I have a process where we check out how things are going towards the end of the year, and regularly review how the supervision's going.
So that was a very long answer to your question, Mark.
Mark Aitken [23:15] Julie, wonderful. Comprehensive and detailed, and if any nurse, midwife or student listening was wondering about clinical supervision, they won't be wondering anymore! They've got all the information they need. So thank you very much.
Given all that, Julie, and given the endorsement from those key organizations, peak bodies, really, in nursing and midwifery...Australian College of Mental Health Nurses, Australian College of Midwives, Australian College of Nursing, I know the ANMF endorse clinical supervision...I'm actually perplexed as to why clinical supervision is underutilised by nurses and midwives. How do you think we can support nurses and midwives to access it, or to come on board?
Julie Sharrock [24:04] I guess the reason why we did the position statement was to try and harness some energy towards people receiving supervision, because we're chewing up nurses and midwives faster than we want to, really. You would know that at your organization, that nurses need support. I think clinical supervision is one form of support, but there's many others, even in mental health nursing, it's not taken up to the extent we want. I'm still a little perplexed as to why not, but I also understand it a little bit. There's been a lot written about it as to why people don't take it up. I think, part of it is the name. I think people feel like if you're under supervision, you're somehow not doing your job right, or that you need remedial work, or you've got a problem. [But] if I'm supervising a midwife, I'm not going to teach them how to deliver a breech baby, or whatever it is, that clinical skill. But if that baby dies, I can support the midwife to process that, and look at how they handled it, and to learn for the future.
So it's not about clinical teaching. It's about really looking at the interpersonal aspects of our work and the emotional labor of our work. So I think the name is a problem. I also don't think it's been promoted. I think nurses and midwives are just expected to get on with it. That's what happened in my day, we were expected to get on with it. We weren't supposed to melt down. There was this idea that you had to be professional, that you didn't get upset. Somehow you parked your emotions somewhere, I don't know where! But we know that if we do that, if we suppress what we really feel, it's bad for us. It comes back to bite us, and we do know that.
We've got evidence that the emotional labour, some aspects of the emotional labour of nursing and midwifery, do actually lead to burnout if they're not processed. I think there is this idea of, you know, just get on with it, suck it up, sort of thing. Maybe there's a sense that you have to be able to cope. Maybe also the type of personality that gets drawn to helping professions, perhaps, is not so good at looking after themselves. You might have some thoughts about that, around what you see in your work, about how hard it is sometimes for nurses and midwives to let people know that they need some help.
So there's some of my thoughts. There's probably some more aspects of clinical supervision, as to why it hasn't been taken up. But I think one last reason is it's been misused. The trust has not been established. I know, years ago, there was an expectation that the manager heard about what I did in supervision with the staff. She wanted to know what was discussed. I said, "No way, I'm not going to talk about that." She was very affronted about that. So I think it has been misused. There's been breaches of confidentiality, or people who haven't been trained in supervision, providing supervision that has been harmful. I think that's a sad fact as well.
In terms of how we promoted the position statement, is how we are trying to promote it. We had lots of opportunities that were stymied by good old COVID. But we produced the poster to present at conferences, and we have done and we will continue to do so. It's free to download, we encourage people to download and print it up and pop it up in their workplaces. We also have, in Victoria, the framework for supervision for mental health nurses across the state, which the Office of the Chief Mental Health Nurse has promoted. That aligns very nicely with the position statement. They're complimentary to each other. Nurses and midwives are talking much more about clinical supervision and asking questions about it, about this professional support. So hopefully, we're on a roll.
Mark Aitken [28:22] I don't think there's any stopping you, or the incredible work that clinical supervisors do, Julie. So bring it on, I say, and anything we can do to promote the importance of it, we will be absolutely doing. So we're all in and completely on board. I would encourage any nurse, midwife or student listening to this podcast, to really connect with the importance of clinical supervision. Share this podcast with your friends and colleagues. Indeed, if you'd like to talk about clinical supervision or any other issue you need support for, please contact Nurse & Midwife Support. 1800-667-877, or via the website, nmsupport.org.au. 24/7, Australia wide, anonymous, confidential and free. So thanks, Julie. We'll be shouting this from the rooftops and it's so important for nurses and midwives to connect with this. It's important. Thanks, Julie.
Julie, you're a member of the Australian Clinical Supervision Association that became an incorporated association in July 2014. With a management committee who plays an active role in the direction of the organization, would you please tell our listeners about the Australian Clinical Supervision Association and how nurses and midwives can access the services that it provides.
Julie Sharrock [29:52] The Australian Clinical Supervision Association was set up by a small group of very committed people and I didn't join until a little while later. So I do want to acknowledge Paul Spurr and his colleagues, who set this organization up. Really, it is committed to clinical supervision for all disciplines, not just nurses and midwives. We're trying to encourage cross-discipline sharing of ideas around clinical supervision. We had our first very successful conference in 2018, and we were planning for our second in 2020. Of course, everyone will know what happened to that! We're thinking about next year, we're hoping we'll be able to have our second conference. I have to say it was one of the most energising conferences I've been to.
We also have local member meetings. At the moment, the Victorian local member meetings are not happening because we've got national webinars in lieu of the conference. We've got a series of webinars that people can join. But we'll be resuming those local member meetings later on when there's not such a demand on our time for the webinars, because we know people are busy. You have to be quite selective about what you attend.
The website is the Australian Clinical Supervision Association, it's currently being revamped, so be patient with that. But there are some wonderful resources on the Australian Clinical Supervision website around things like agreements, how to find a supervisor. There's a small but growing database of clinical supervisors. We're getting quite a number of nurses and midwives trained as supervisors, and they're putting their shingle, so to speak, up there. You'll see their profile, and be able to contact them if you're interested in your own private supervision. For people like me, at the end of the career, it's a really nice way of staying in touch with the profession and giving back to the profession. So I'll encourage older, more experienced nurses who are perhaps coming to their twilight years, that don't want to work full time but want to give back a little bit to the nursing and midwifery professions that they might like to consider becoming a clinical supervisor. So that's something to think about as well.
Mark Aitken [32:17] Thanks, Julie. Great information. You spoke a bit earlier, posing the question that I agree with, as to why it is nurses and midwives don't reach out for support sooner rather than later, and clinical supervision as an important form of support. I think part of that, Julie, is that we haven't come from a culture, or having created a culture, where professional self care is ingrained in us, and is part of our toolbox as professionals. I know, Julie, you wrote a chapter, which I love, on professional self-care in Mental Health in Nursing, fifth edition. So I'll ask you to speak a bit about that, please. What is professional self-care, and what are the important elements?
Julie Sharrock [33:11] This was a great chapter to write. It was a new chapter in, as you say, the fifth edition and Kim Foster, one of the editors asked me to write this, and Kim has been involved in one of the podcasts. She's a guru, if you like, on resilience and so forth. I was very honored to write this chapter. What I was saying earlier about my interest in nurse and midwife welfare culminated in thinking about this chapter.
We wanted to think about it from a holistic perspective, so we went through some of the challenges around nursing and midwifery practice. We talked about how, even though we might be carrying out physical tasks in the care of patients, we also use ourselves in our work. Mental health nursing talks about that therapeutic use of self, how we use ourselves and our own personality in developing our relationships and rapport with our patients, their kin, and our colleagues but particularly our patients and their kin. So how we use ourselves in our work. When we do that it takes a personal toll on us, of course, but it's also very rewarding. Self-awareness and reflection is very, very important in terms of maintaining ourselves as a therapeutic instrument.
I guess from a clinical supervision [perspective] it’s like maintenance of myself as a therapeutic tool. I can't claim that idea, it was a mental health nursing student I heard present at a conference years and years ago. He said, “You service your equipment as a general nurse, or as a nurse, things like your thermometers or your blood pressure machines.” To her, clinical supervision was actually providing service to herself as a therapeutic tool. I think that is a really important component of self-care.
In the process of working in the helping professions, there's a concept of emotional labour. I'm not sure if that's been addressed in any of the podcasts. But I want to shout out to Frankie. Frankie won the midwife story, and she gave a lovely example of the emotional work involved in midwifery. It's a great podcast, and I encourage people to look at that. But emotional labor was first thought of in the context of air hostesses, back in the day when they were called hostesses. It was that work, where air hostesses needed to put on the smiling face of ‘Welcome!’ so that their customers felt cared for. Hochschild looked at this and was intrigued about what was required to make this happen. You can imagine the air hostess giving a hand to the businessman whose hand luggage is way overweight, or oversized, trying to put it into the overhead compartment. Feeling like she wants to throttle the businessman, but smiling and saying, “I’ll help you with that, sir. Let me help you. There, that’s okay. Take your seat, please.” That requires emotional labor. It requires work to put that face of caring on.
There's two concepts in emotional labor. One is that it's really actively creating an emotional response to a person, so they feel cared for, or in the service of caring, which takes a lot of work. That sort of emotional labor has been associated more closely with burnout. Whereas there's the other sort of emotional work where you really feel and connect with your patients, which is exhausting, sometimes, but also the joy of the work. It does bring that joy. Some person, I can't remember the author, called it ‘emotion-full work’. Regardless though, the emotional labor of nursing and midwifery needs to be acknowledged, and as I say, have a listen to Frankie's podcast and her story because she describes some of those challenges beautifully in her story.
Now unmanaged, that can lead to stress and burnout, compassion fatigue, and so forth and so on. Supervision is one way of processing emotional labor, but so is peer support collegiate chats. When I lived in the nurses’ home, we’d come back and we’d just chat about our day. That's where going out for a coffee with your mates or the pub after work or whatever, and connecting with your nursing and midwifery colleagues using the language of our work is so beneficial.
However, if the wheels start to fall off, you may need help. That's where services like yours are so important. I guess that's what I knew back there in my third year of nursing, when I heard this counsellor talk about the nursing counselling role that she was in. That we needed, we need to have that service. It was during my ICU course I first reached out to a counsellor for support. I learned something very painful about myself: I didn't quit things. I was taught once you start, you don't stop. And I'd started this ICU course, and it nearly did me in. I didn't quit it, I probably should have. But I didn't quit; but realizing that I could quit if I wanted to helped me get through to the end of it. I'm ever so grateful for that counselling support I received.
It is hard to reach out. I think one of the things that I also have talked about in the chapter but also in supervision training, is at some stage it's really important to consider what on earth brought you to nursing or midwifery. Some people say, “Oh, I just fell into it.” Yeah, well I’ll say, “Yeah, but it didn't keep you in it.” Usually this stuff from our family of origin...you know...I was a nurse long before I was a nurse. I had an interest in looking after others. I understand that from my family of origin, which I won't bore you with, but it's important to reflect on. There's a supervision book by Hawkins and Shohet that talks about that part of clinical supervision is about why we become helpers, what maintains us in the work, and what our vulnerabilities in the work are. If you're someone who is a compulsive helper, you need to keep an eye on that, because you might give yourself away in the service of the work. I think they're the sorts of things to reflect on, not only in supervision, but with your buddies. Then, in the chapter we talk about all the different sorts of things in holistic self-care, that are important. As I said to you, I can talk about clinical supervision while I’m underwater, with a mouth full of marbles. So tell me if you want me to go into the self-care strategies.
Mark Aitken [40:47] Julie, I’m a captive audience as I know our listeners will be. I’m just loving your passion and your expertise. Please feel free to share that.
Julie Sharrock [41:01] Okay. Don’t give me too much encouragement, Mark! In the chapter, we talk about different aspects, and I won’t go into them in detail. But I’ll just mention what they are, and certainly on your website you address a number of these issues.
There’s work/life balance, which is very important. There’s some great podcasts I’ve listened to where people have talked about how they make some sort of delineation between their work day and their home day. I used to ride a bicycle to and from work, and I loved it. I used to have a little reminder that...I used to ride past the MCG, and I’d say to myself, “If I’m not taking in the world outside, and I’ve got to the MCG and all I’ve thought about is what I’m going to do at work, then stop it! Get out of yourself and breathe in the Yarra river, breathe in the MCG and the Melbourne skyscape.” On the way, if I got to the doggie park and was still thinking about work, I’d say, “Hang on a minute. What are you doing? Look at the dogs. Look at the happy owners. Look at everybody. Take in the world.” It was my way of starting to put a marker between home and work, and a lot of people I talk to do that sort of thing. That work/life balance is really important. That’s just one example.
Sleep, rest, exercise and diet; we’re our own worst enemies when it comes to that. And working shift work! It’s very, very difficult to manage that. But there’s some great literature and suggestions for nurses and midwives about how to manage that. Meaning-making is a psychological strategy that I think is important. If I couldn’t make sense and give meaning to my work, I don’t believe I would have lasted as long as I have.
Having compassion for myself. Recognising myself as a frail human being, a flawed human being, and being compassionate about that has been a very important component, for me, of self-care.
We’ve got a section there on spiritual care, and I don’t necessarily mean religion, but religion is an important part of self-care for some people. But spiritual care is a little bit about meaning-making, what purpose I have in my life. I’m not religious, but I believe in people. I love contributing and supporting people. That gives my life meaning, and it’s my energy. But then balancing that with other things. The other thing that nurtures my spirit is [inaudible]. Finding things that help bring meaning to your life and work is important as well.
I wanted to comment about why nurses don’t self-care. Paul Spurr quotes that ‘we were born in the convent, and raised in the military’. The idea that both religious orders and the military have strong influences on our culture in nursing and I wonder whether that, because there’s this idea of it being a ‘vocation’ and a ‘calling’, that you somehow have to put your needs last. If you’re the sort of person who looks after everybody else and you’ve been a compulsive helper since day dot, then you’re going to be really vulnerable to not ask for help when you need it, because you’re supposed to be able to cope and everybody else is more important. But I just thought I’d mention that lovely quote, thanks Paul Spurr.
Mind/body practices, they’re certainly becoming more important. There’s many, many mind/body practices such as yoga, tai chi, meditation, massage. I’m a big fan of massage too, where I go and have my therapeutic massage, but also give myself a place to relax.
Building resilience, and Kim Foster can talk about, probably underwater with a mouth full of marbles as well. Resilience training is actually showing promise. Kim talks about that, I think, in her podcast she did for you a while back. That is showing promise. So it’s not something you’re born with, you can develop resilient practices as well.
There’s other aspects in the chapter we talk about, about having a growth mindset. Always being interested in learning, if you’re an early graduate, looking at those graduate support programs, ongoing professional development, clinical supervision and reflective practices that we’ve talked about. Sorting yourself out during career transitions; and I know there’s been a podcast around career transitions, that I think is a very good reflection on when we make these changes and the challenges they bring, but also the rewards.
But having said all this, there’s a lot of onus on the nurse or midwife. I want to stress that burnout and resilience are concepts that are not just from within the nurse or midwife. We have a responsibility to look after ourselves but our work environments also have a responsibility as well. Resilience and burnout are in relation to the work context. Burnout is not a failing of the nurse or midwife. It’s a syndrome that develops when there’s a mismatch between the demands of the work, the supports (or not) in the workplace and the demands and stresses, interpersonally for that nurse or midwife. Organisations can no longer relinquish responsibility for creative supportive and safe environments for their nurses and midwives. I really believe that very, very strongly. And I’ll do a little shout out to Ged Kearney, who is the MP for…! I’ve forgotten! It’s got a new name. Sorry, Ged!
Mark Aitken [47:25] The federal MP in Victoria.
Julie Sharrock [47:28] Yeah, for Baxter, she is a nurse. She’s still a nurse, even though she’s not practicing. She’s very, very supportive and keen to make sure that nurses and midwives, and all healthcare professions are supported in the work that we do. She’s been a very supportive advocate of clinical supervision during her time. So thanks, Ged.
I guess they’re the main components of the chapter. Thank you again for promoting the book, we’re very proud of the book and the chapter. I think you’ve got the details of how people can access that and also, let your library know to add it to their collection as well.
Mark Aitken [48:15] Great points, Julie. I reckon at the end of this podcast, people listening are going to rush out and order that book based on that wonderful overview and those really important elements that you’ve outlined. Thanks, Julie. We’ll put a link to where you can access that book from, as part of this podcast. I’ve just come up with an idea, Julie. I’m full of bright ideas, as people may know! What we will do as part of this story competition, where you honour and write about your story about a nursing or midwifery friendship, we will make this book part of the prize for it.
Julie Sharrock [49:02] Great idea.
Mark Aitken [49:08] So make sure you get those entries in. You’ll get information around how to enter as part of this newsletter, on support for nurses and midwives. We’ll get those copies out to you once we announce the winners. Thanks very much, Julie. Wow, I reckon we could talk all day about this really important issue of clinical supervision, but unfortunately we’ve come to the end of the podcast. Julie, do you have any final words of wisdom or reflections that you’d like to share with our listeners?
Julie Sharrock [49:41] Well, I don’t know if you’ve got any Harry Potter fans out there listening, but I just want to share the wisdom of Harry Potter...I love it. Apologies to those who don’t. I want to acknowledge my colleague Naomi Riley, who likens clinical supervision to the Pensieve. Those who know Harry Potter know that Dumbledore would put his thoughts into the Pensieve and study them. This is a direct quote from Harry Potter...and Dumbledore was explaining this to Harry. He says, ‘“It is called a Pensieve,” said Dumbledore. “I sometimes find, and I’m sure you know the feeling, that I simply have too many thoughts and feeling crammed into my mind. At these times, I use the Pensieve. One simply siphons the excess thoughts from one’s mind, pours them into the basin, and examines them at one’s leisure. It becomes easier to spot patterns and links, you understand, when they are in this form.”’ So...the wisdom of Harry Potter, huh?
Mark Aitken [50:52] Julie, who knew? If anybody had’ve said we’re going to be talking about Harry Potter on this podcast, I would’ve said, “Uh, I don’t see the link, or how…” But I’m all for it, and you’ve just shown us that. So thank you very much, Julie, I know we’ll have Harry Potter fans out there, as am I, and clearly, as are you. Thanks once again, Julie, for sharing your wisdom, knowledge, expertise, you’ve been a great and generous guest. I know our listeners will benefit from this podcast and your wisdom. Please remember, everyone, that you can contact Nurse & Midwife Support 24/7, no matter where you are in Australia, 1800-667-877, or via the website, nmsupport.org.au. You can speak to a nurse or a midwife about any issue you need support for, including questions around clinical supervision. Look after yourselves, and each other. Your Health Matters. I’ll speak to you next time.