Protecting ourselves from burnout

In preparing to write this piece on burnout and how we can protect ourselves as nurses and midwives, I note an article burnout in Midwifery, an Occupational Hazard (Williams, 2018). Williams brings to our attention a point made by a former psychologist Peter Charleston, that midwives and nurses (my addition of nurses), are at risk of burnout because we are altruistic and poor at self-care.

Furthermore, a common element to our lack of self-care is our low self-worth. I tend to agree with these points but add, that in the context of this year’s pandemic with increased expectations on nurses and midwives, the risk of burnout is even greater and is something about which we should all be concerned. As we have been asked to do more, we have stepped forward and taken it all on. Perhaps that is our altruism at work, but it has been fed by increased community expectation that we respond.

So why do we stop short on ourselves? Perhaps, some of us missed out on early lessons from parents and others. Not just on self-care, but on the inherent messages below that, about self-value and self-worth. What we learned instead was others and their needs are more important than us and ours. But, does this explain it all? Is our altruism, poor self-care and low self-worth the only reasons we are at risk of burnout? While these points may be central, I think there is more.

As nurses and midwives we are highly attuned observers and listeners. Taking in the stories of our patients and consumers is integral to effective identification, assessment and management of need. In my own work and that which I see in many colleagues, is just how easy it is to take in the pain and suffering of others. We do this in part as a way of understanding those we care for. It’s also how we empathize and when undertaken as a therapeutic skill we develop an awareness and mastery of the process in which this occurs.

But, this way of taking in, also happens outside of our awareness. Throughout our working day during the range of interactions not just with patients, but their families and visitors, colleagues and the many people that come and go from the workplace. In the Nurses Station, during handover, in meetings, in the medication room, while we are home-visiting and even during meal breaks in the staff room. People around us are projecting an array of emotions, and experiences onto us. Some of it we need, some of it we do not. Without attention to these processes, an awareness of what is happening and action to combat and offload the stories, experiences and projections of others that do not serve us, we are easily weighed down.

This is often why we naturally feel tired at the end of a work-day. But it is also what can organise us to feel overwhelmed and exhausted. These projected emotions, stories and events can accumulate over time and if left unchecked and unmanaged can lead to the outcome of burnout.

The tiredness after a shift or a long day, week or month, becomes an on-going and enduring feeling of physical and emotional exhaustion and fatigue, unchanged by a good night’s sleep, a restful weekend or a longer break. This is accompanied by indifference and apathy to those in our care and eventually an anxiety and dread for the work itself. It can also be an insidious process, that creeps up on us. That others will often recognise long before we do. We may sense there is something not quite right, but we continue on regardless. Not saying anything and perhaps even too tired or ashamed to reach out for help. I have seen it in many professionals I have worked with (over the years), and though not an experience of my own, I am no stranger to my own fatigue and exhaustion.

So, what to do? How can we protect ourselves? How to counteract the negative impact of our work, particularly in these current circumstances? My first suggestion builds on my earlier points about what we take in as nurses and midwives and requires us to see and understand ourselves in context. For this view I look to a seminal piece on Field Theory (Lewin, 1942) and the Principle of Organisation.

That is, who we are, what we feel, think and do in part is organised by the situations and relationships in which we work and live. We take in from our environments (and those within them) aspects and elements of those people, places and events into ourselves. This is a natural, interactive and necessary process. It is also the way (s) in which we define and know ourselves to be. So, as nurses and midwives this is happening to us throughout our working day and as I mentioned previously, some of it is useful, some of it, not.

To explain further. When I am working in a reflective practice or clinical supervision session with a health professional, I will invariably ask how they are. When I hear, “I am tired”, “ I feel overwhelmed”, “I feel frustrated”, “I am exhausted” or “I’m not coping”, I will go on to ask what they think is organising them to feel that way. From that point, I then focus on seeking to understand what is happening around and outside of that person to organise their tiredness or feeling overwhelmed or like they are not coping. Is it in the role they are being asked to perform, a particular task (s) within that role, a patient or consumer interaction (s), a discussion or conflict with a colleague, an event that happened on the shift or perhaps it is something to do with the requirements and culture of the organisation. That they are interacting with and is organising what is going on for them and how they are feeling right now? I do not dismiss how this person manages internally what comes in from the outside (and there is likely to be a conversation about this), but I make a point to contextualise their experience.

Through this process we come to understand more about the environment (or context) in which the person’s current feelings and experiences occur. And, there are always new learnings. I might also offer a rephrase of their initial feeling. Taking it from “I feel overwhelmed” to “the work is overwhelming”. Inherent in the dialogue is also an aim to place some of the feeling and experiences outside the self (sometimes where it originated and often, where it belongs). I always invite the person to verbalise and transfer the shift, from “I am ...” to “the work is ...” This movement, can lighten the emotional intensity and internal weight of the experience and can be a useful and constructive way of offloading the negative impact of the work.

My conversation now comes to the importance of self-awareness as a protection against burnout. Self-awareness is critical in nursing and midwifery. The simple fact that we are in caring relationships with those who are both vulnerable and in need warrants a high degree of knowledge about self. Self-awareness enables us to know and mark the boundaries in those caring relationships. It also assists us to know our strengths and weaknesses, to understand our triggers and when and what we need, to restore the energy daily work can take from us. There is much to know about self and a great deal more to understand about the dynamics of how we effect and are affected by the work we do. Self-awareness is an important tool to protect us against the development of burnout. When we are aware of how and what within our work distresses us, we can use our awareness to do something about that and not let it accumulate.

There’s no one right way or method for developing and/or increasing our self-awareness. There are many. Several methods that I have utilised (and still do) as a recipient and a provider, are those which come under banner of reflective practice. Intentional forums, sessions and meetings (in groups or one-to-one), that aim to increase self-awareness, provide opportunities for learning and spaces to offload the negative impact of the work. These processes are also occasions to mark and celebrate our workplace achievements and these opportunities must not be over-looked. Whether through clinical debrief, clinical supervision, or the learning and growth that takes places within coaching or mentoring – they are all instruments through which we can develop and increase our self-awareness. This in turn acts as a protection against the development of burnout.

Our service provides free and confidential support 24/7, to nurses, midwives and students Australia wide. If you would like to speak to someone call 1800 667 877, or you can request support via email.

You may like to listen to our podcast about burnout with Athol Hann, where her shares his own experience of burnout, how he worked through it and what he is doing now to help other nurses and midwives.

You can also read some of our articles that look at staying healthy promoting your wellbeing:

• Burnout
• Sleep
• Mindfulness

If you would like to know a bit more about the service before getting in contact — take a look through accessing support.

Tessa is a Mental Health Nurse Consultant with over 30 years experience across public, private and primary health care, mental health and drug and alcohol services. She has generously shared her extensive experience and wisdom supporting nurses who have or are experiencing burnout. Tessa raises the importance of self-awareness and clinical supervision as protective factors against burnout.