Summer/Autumn Edition 2022

Mark Aitken: Your Roadmap to Health
Mark discusses the importance of attending to your health in even the busiest and most difficult of times. 

Geoff*, a Registered Nurse: Not the Only Canary in the COVID-19 Coal Mine: A nurse’s story of post-traumatic stress disorder
Geoff (name changed for privacy) shares his story of developing post-traumatic stress disorder in response to working through the pandemic. 

Tessa Moriarty: Case Notes on Self: The benefits of journaling as self-care
Mental health nurse Tessa Moriarty shares how nurses and midwives are natural writers who can use journaling to improve their health. 

Amy Benn: Your health is important — 7 tips to make it a priority
ICU nurse Amy Benn shares the tips she uses to fortify her health through the gruelling experience of the pandemic.

Podcast: From Survive to Thrive with Sam Eddy 
Sam Eddy joins our podcast to discuss how we can shift gears, refocus on your own health and make intentional changes that assist you to move into thrive mode!
 

By Mark Aitken, Stakeholder Engagement Manager, Nurse & Midwife Support

Our mantra is Your Health Matters. It’s never been more important for you to connect with that idea.

I started writing this in mid-January 2022. I started writing this five times while attempting to reflect the impact of the prolonged and ever-changing COVID-19 climate, the impact of floods, bushfires, and other life challenges, including the distressing events in Ukraine. This is an unusually difficult moment in human history, and our thoughts are with all of you. 

One thing is a constant: nurses and midwives continue to push themselves to meet the needs of others. Many are exhausted or teetering on the brink of burnout with little left to give. Others are experiencing health issues including long COVID, post-traumatic stress disorder, moral distress, anxiety and depression — to list just a few. If working during the pandemic has negatively impacted your health and wellbeing, I’m sorry this has happened to you. Your work should not harm you.

As the COVID-19 pandemic continues to challenge and stress many, I urge you to make your health a priority in 2022. The impact of not doing so may have dire consequences. The cumulative impact of stress, anxiety, dehydration, fatigue, exhaustion, and long work hours may lead to burnout, chronic stress disorders, overwhelm and long-term health issues.

Some nurses and midwives tell me they have remained hopeful and optimistic. They have established health and wellbeing routines and habits that have sustained them and assisted them to thrive while working and living during the pandemic. If this is you we would love to hear what has supported and sustained you while working during these unprecedented times: [email protected]

Take heed: your health REALLY does MATTER! Now is the time to act to manage your health and wellbeing. If not now, when?

If you are a nurse or midwife leader, manager, policy maker, frontline worker or support service, we all have a responsibility to look after ourselves and each other.

Look after yourself — the Code of Conduct requires it

The Codes of Conduct for Nurses and Midwives require nurses and midwives to be responsible for maintaining our own health and wellbeing. The code says: 

Domain: Promote health and wellbeing, Principle 7: Health and wellbeing
Nurses and midwives have a responsibility to maintain their physical and mental health to practise safely and effectively. To promote health for nursing/midwifery practice, nurses/midwives must:

• understand and promote the principles of public health, such as health promotion activities and vaccination
• act to reduce the effect of fatigue and stress on their health, and on their ability to provide safe care
   

Throughout the two years of the pandemic many nurses and midwives have put their health and wellbeing on the back burner as they have worked to meet the needs of others. This is a call to action to make 2022 the year you devote your attention to your own health as much as the health of others. 

The impact of stress and feeling overwhelmed

In Atlas of the Heart social worker and research professor Brene Brown writes about the impact of stress: 

“We feel stressed when we evaluate environmental demand as beyond our ability to cope successfully. This includes elements of unpredictability, uncontrollability, and feeling overloaded.” (p4)

Nurses, midwives and students know the reality of fast paced, unpredictable, stressful work that overloads and fatigues them. Working in the pandemic has stretched us like never before.

Brene Brown reminds us that stress can take its toll:

“Chronic exposure to stress can be detrimental to health. High levels of perceived stress have been shown to correlate with more rapid ageing, decreased immune function, greater inflammatory processes, less sleep, and poorer health outcomes.”(p6)

Atlas of the Heart offers us a roadmap to take control of our health and wellbeing.

The road map includes:

• Biology: Understanding how our feelings and emotions show up in our body and why 
• Biography: Being curious about how our families and communities shape our beliefs about the connection between our feelings, thoughts, and behaviours (biography)
• Behaviours: Examining our go to behaviours and
• Backstory: Recognising the context of what we’re feeling or thinking. What brought this on?

Give us a call on 1800 667 877 and one of our counsellors can help you figure out what your roadmap looks like. 

How is health defined?

According to the World Health Organisation, health is defined as: 

A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.

As you read this you may be scratching your head or rolling your eyes wondering how you make your health and wellbeing a priority during the pandemic when you are in the care and service of others with competing priorities and responsibilities. If you are reading this, chances are you are looking for health support or know someone who is.

Tips to assess and support your health and wellbeing

Ground yourself

Before you read on, take a deep breath and create awareness in the here and now. 

Acknowledge how you feel. 

Give yourself permission to feel however you are feeling. 
It’s OK not to be OK and it’s OK to be OK. Each of us experience stress and pressure differently. If you acknowledge you are not OK, please reach out for support. Nurse & Midwife Support is here to support you 24/7, no matter the issue you need to talk about.

Many nurses and midwives are running on empty — in overdrive with an over-activated sympathetic nervous system. This state is not sustainable. Act now — turn down your flight and fight response through intentional mindfulness and breath work.

Back in Winter 2021, our friends at Evolve Yourself Institute joined our podcast to discuss managing pandemic fatigue. Now, they have shared resources to help you focus on breath and create awareness. They’ve also joined our call to action to focus on your health and wellbeing.

Carving out a moment for you may help you to reflect on and establish your health and wellbeing goals for 2022.

Make your health and wellbeing a priority in 2022

Make an I will statement:

I will make my health and wellbeing a priority in 2022.

I will make time for me.

Assess your health and wellbeing

You assess those you care for every shift. Take a moment to assess your health and wellbeing.

On a scale of 0–10 — you know this type of scale! — rate your health and wellbeing, where zero is excellent health and wellbeing and ten is extremely poor health and wellbeing.

Now, reflect on that rating. What can you do about it? If you rated your health and wellbeing as good, keep doing whatever you are doing — it is obviously working for you. If you’ve been doing anything particular to tend to your health, drop me an email! I’d love to hear what works for you. 

Make a plan to improve

If you’ve realised your health and wellbeing needs some attention, here are some strategies that may help. 

• Make an appointment to see your GP or preferred health practitioner. You may be eligible for a funded health plan-discuss this with your doctor.
• Complete a health and wellbeing survey and your own self care plan. By completing the survey, you will have an opportunity to take the time to reflect on your current state of health and wellbeing through the development of a self-care plan. You will then be able to decide whether you intend to improve any aspects of your current state of health and wellbeing. This may include a list of up to three specific health-related activities. 
• Check out our wellness plan for some ideas.
• Make daily choices that benefit your health. Check out Amy Benn’s ideas to help you prioritise your health. 
• Start a journal. Regular journaling enables time to reflect and write down thoughts and feelings, set goals and evaluate our health and wellbeing. Check out Tessa Moriarty’s Case Notes on Self in this issue to help you get started. 
• Share your experience, emotions and feelings. Tell your story — to a therapist, friend, colleague, or even stranger. Talking about your experiences and how you feel is a useful way to make sense what has happened.
• Contact us on 1800 667 877 — we are always happy to discuss your health and wellbeing and provide guidance on how you can make it a priority.

Tell your story

Many nurses and midwives tell me how important it is to share their story — their truth — of how working and living in the pandemic has affected them. They want to be free to tell an unsanitised version of their experience. They say that it is vital to share ‘their truth’, and that it is heard, validated, and acknowledged. 

Indeed, for many it is an important part of recovery. Talk to a trusted colleague, supportive family member or friend. Tell them that you need to share your story. Pick someone who you know is a good listener and has your back. Not those who may shut you down, who cope differently or whose own burnout makes them aloof, remote and dismissive. 

Sometimes we need to share our story beyond our immediate confidantes. Writing can be a fantastic outlet for that. Writing can be cathartic and help us to make sense of our experiences. In this issue, we share the writings of George, a nurse who has developed post-traumatic stress disorder as a response to his experiences living and working as an aged-care nurse through the COVID-19 pandemic. We thank George for sharing his experiences with us and encourage you to consider writing down any experiences you might be struggling to process. 

Read George’s story: Not the Only Canary in the COVID-19 Coalmine 

Celebrate your story 

Sometimes, stories are a celebration, even if they include painful or complicated memories. We’re running a competition to celebrate your stories of nursing and midwifery friendships. We’d love to hear from you. 

Most nurses and midwives have at least one special nurse/midwife friend and confidant who gets them. The friendships we make with our colleagues offer great support throughout our careers. They’re with us to celebrate the highs and commiserate the lows. We share similar work experiences and challenges, so other nurses or midwives can understand what we are going through. 

Tell us about your special nursing and midwifery friendships and you could win AU$1000 towards the professional development opportunity of your choice. We know how busy everybody has been over the summer months, so we’ve extended the deadline to March 31st 2022! 

Find out more about the competition

Focus on your professional self-care

For most of us, this is a rough time to be a nurse or midwife. We encourage you to seek additional support to protect your personal health as you navigate this extremely difficult time for our profession. 

In Episode 27 of the Your Health Matters podcast we spoke to Julie Sharrock, Mental Health Nurse Consultant, Clinical Supervisor and Educator about the benefits of clinical supervision and professional self-care. We think now is a good time to revisit this important episode — have a listen! 

In the podcast Julie discussed the impact of emotional labour:

"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.” 

Julie maintains that clinical supervision is providing service to self as a therapeutic tool — a vital component of self-care. She urges us to be aware of the impact of the emotional labour of our work and how if unchecked it is a risk factor for burnout.

Julie reminds us:

“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.”

It is not surprising that two years into the pandemic, nurses and midwives report being fatigued and exhausted. Fatigue is recognised by WorkSafe Victoria as a risk factor to health and safety. It places people at risk of injury and health issues. If you are an employee or manager and don’t already focus on preventing employee fatigue, now is the time to make it a priority. Make fatigue management part of your health and safety plan. 

Employers and employees have a responsibility to prevent fatigue and exhaustion in workers:

“It is normal to feel tired or drowsy after prolonged physical, mental or emotional effort at work. Fatigue, however, is an acute and/or ongoing state that leads to physical, mental or emotional exhaustion and prevents people from functioning safely. Working long hours, with intense mental or physical effort, or during some or all the natural time for sleep, can cause fatigue. All of these have obvious implications for workplace and public safety. Fatigue can also have long-term effects on health.” — Work-Related Fatigue: A Guide for Employers, Worksafe

If you’re feeling burnout or fatigue, it’s important to take it seriously. Get in touch with us to discuss strategies to prioritise your health and wellbeing into this future. 

On this episode of our podcast: Burnout prevention

There are steps you can take to prevent burnout even in the toughest situations. 

On episode 30 of the Your Health Matters podcast, we are once again joined by Sam Eddy, Mental Health First Aider, experienced workplace trainer, coach and educator. We talk to Sam about his latest offering: From SURVIVE to THRIVE, a 12-week self-paced online course focusing on burnout prevention and recovery. 

Listen to the episode 

Hope is key

I’m ending this newsletter introduction with a message of HOPE. Let’s face it — we could all use a large dose of hope right now.

In Atlas of the Heart, Brene Brown reminds us: 

“We need hope like we need air. Hope is a function of struggle. We develop hope not during the easy or uncomfortable times, but through adversity and discomfort.” p100

Brown argues we experience hope when:

1. We have the ability to set realistic goals: I know where I want to go.
2. We are able to figure out how to achieve these goals, including the ability to stay flexible and develop alternative pathways: I know how to get there, I’m persistent, and I tolerate disappointment and try new paths again and again.
3. We have agency — we believe in ourselves: I can do this. 

Think about how you can use these principles to help yourself find hope even when your situation feels overwhelming.

I hope that 2022 is a year that you find the time and energy to focus on your health and wellbeing and YOU make it a priority to look after YOU and thrive.

Our promise at Nurse & Midwife Support is that we will support you to do it!

Your Health REALLY does Matter!

Mark Aitken RN
Stakeholder Engagement Manager 
Nurse & Midwife Support

By Geoff, a Registered Nurse 

Many healthcare workers are dealing with PTSD and other mental health problems as a result of the pandemic. An Australian nurse shares their experience as an aged care worker in facilities dealing with outbreak and how they came to realise the trauma was affecting them more than they ever expected. 

This piece was written in 2021 before the outbreak of OMICRON.

WARNING: This piece deals with sensitive issues including trauma related to working through the pandemic. This is a complex and sensitive area and may be triggering for some, difficult for others and result in strong emotions. If this topic raises issues for you, now may not be the right time for you to read it. Give us a call on Nurse & Midwife Support on 1800 667 877 if you would like to talk about what you are feeling. 

Names have been changed to protect the author's privacy

Well into the 20th century, coal miners brought canaries into coal mines as an early-warning signal for danger from toxic gases.

COVID-19 has had a significant detrimental impact on the health of nurses and midwives. I’m telling my story as part of making sense of what has happened to me and the significant health impact working as a frontline nurse in the COVID-19 pandemic has had on me. I am not the only canary in the COVID-19 coal mine of this pandemic.

Why don’t we talk about this more?

I am curious as to why I am one of the few nurses singing about the COVID-19 impact our health. This is not unusual when it comes to mental health issues. Those affected often do not go public about their mental health issues. Some do not even admit it to themselves. Stigma, shame and fear are some of the reasons nurses and midwives remain silent about what COVID-19 has done to their health.

Stigma, I suspect, is only one reason nurses and midwives remain silent. Stigma is a stain or blemish as perceived by others and by the one affected. A blemish that — although based on ignorance — leads to negative attitudes and concerns about performance capacities and potential impact on personal and career progression or opportunities. These — usually unfounded — fears exist within us even in relation to those closest to us such as family. The fear is then multiplied when it comes to our work environment where reputation and competence are critical.

Those not working in health may be surprised that even some health managers and Human Resource departments still struggle to manage this area well enough. Therefore, many staff lack the confidence to approach their employer when they need to and should. 

Concerns about the effectiveness of Employee Assistance Programs (EAP) have been discussed in the literature for some time. So much, in fact, that the Productivity Commission Inquiry Report 2020 recommended that minimum standards be developed and for the evaluation of the efficacy of these programs.  
But that’s a scholarly article. This is a personal account — a brief description of one nurse’s journey into a diagnosis of Post-Traumatic Stress Disorder, secondary to trauma associated with working in up to 40 Residential Aged Care Facilities (RACF) that had COVID-19 outbreaks from March to mid-November 2020. During this period approximately 176 residents died because of COVID-19 in circumstances that I could never have imagined. I am back at work in December 2021 and the Omicron COVID-19 variant is impacting us and the residents I care for.

My story

I am 63 and have been working in health care since I was 18. I have worked as an orderly, nurses’ aid, Registered Nurse, ANUM, NUM, Operations Manager and Director. For the last nine years I have worked as a Clinical Nurse Consultant for a public health community-based service. The objective being to provide for RACF clients an alternative to having to go to an emergency department or possibly be admitted to hospital. This program offers an alternative to potentially longer inpatient stays. 

If you had asked me at the start of 2020 that I might be diagnosed with PTSD, I would have thought you were joking. I have never experienced the workload, stress, number of deaths and trauma in my long career.

Here are some factors that I believe led to the development of PTSD. 

Inside an RACF during an outbreak

For those who have not worked on the COVID-19 frontline and were not exposed to what it was like working within RACF’s during an outbreak, let me try and offer you a Readers Digest of some of the issues we encountered and found traumatic over an extended period — many continue to be experienced today.

The following things happen when a RACF has an outbreak.

• Most if not, all visiting services that normally support the residents stop attending. Including GPs, Locums, Physio & Speech therapists, Dental, Wound Consultants, Pathology services, Leisure therapists, etc.
• In one recent example cleaners stopped going and the contractor cancelled the contract.
• Some staff are unable to attend as they are quarantined as close contacts.
• Other staff don’t attend as they are frightened of contracting the virus themselves and or their families don’t want them to attend.
• Air-conditioning units can be turned off for fear of increasing transmission within a facility. 
• All leisure activities cease.
• All communal activities cease, including dining.
• All visitation from family and friends ceases.
• Residents who are dependent on visitors to help them eat and drink or to ease behavioural issues lose access to this support.
• Water jugs are replaced with water bottles and Styrofoam cups. Residents found these often difficult to use and increased the risk of dehydration.
• Residents were asked to remain in their rooms 24 hours a day, windows & doors closed.
• Residents often lost access to outdoor areas and sunshine.
• Staff caring for residents were replaced by agency staff not familiar with the residents, the facility or each other. As a result, no matter how hard they tried — and they did do their best — they could not provide the same standard of care as provided by the regular staff.
• The replacement staff had to work in full PPE. This meant residents — many with cognitive impairment — found it hard to recognise and or hear the staff due to masks and face shields. They lost the benefit of the simple joy of touch due to the need for staff to wear gloves.

All of this happened from day one and often lasted for weeks to months. In some instances, visitation rights stopped or were severely limited for more than 10 months. 

Death by isolation

As you might imagine, if you did this to any population — let alone a frail elderly population with multiple pre-existing comorbidities — those affected quickly became depressed. Residents were isolated in their rooms with little social interaction except for fleeting visits from staff, many of whom they didn’t know or recognise due to PPE. Many residents simply went to bed and stayed there. As a result, they declined further in mood, functionally, cognitively, behaviourally and ate and drank less. My residents lost weight, became malnourished and dehydrated. Many of these residents were not COVID-19 positive and died from lack of care. Their deaths were not recorded as being due to COVID-19. 

Their death is because of ‘Sis’ — what we called COVID Isolation Syndrome, or CIS. CIS is still not adequately recognised and certainly not compensated for. 

Some of the things that happened after the initial stages of the pandemic varied but some stayed the same.

Our team’s role

When an outbreak was detected at a facility, the Department of Human Services were notified. They contacted my health service for support. We immediately attended to undertake a situational analysis and attempted to support the facility managers, staff, and residents.

On day one, it was rare for any of the COVID-19 positive residents to be seriously unwell. But some residents were. The difference was that neither GPs nor Locum doctors would attend. As a result, only our service was available to attend. We assessed the residents and managed medical issues and provided care and support.

As you might imagine, this was a monumental task. Our initial team of six Nurse Consultants, a Nurse Practitioner, a Registrar and a part time Geriatrician quickly expanded to a team of approximately 40. This included runners, additional registered nurses, clerical and medical support. Medical support went from being available only Monday to Friday day duty to AM and PM shifts seven days a week at the peak. 

Typically, COVID-19 positive residents declined progressively over a seven-day period and then succumbed to the illness between day seven and ten. Those that survived beyond day 12 left us with a growing degree of confidence that they would recover.  

In too many cases we were unable to offer the most seriously affected much more than comfort or Palliative Care. Over 10 months 176 residents died in facilities we supported through outbreaks. 

Sadly, these residents died isolated from family. Being cared for by staff that were often not known to them. This occurred in the absence of even the comfort of touch of another’s hand because of the need for us to work in PPE.

Witnessing the grief of distant families

For family, it was just as hard for the same reasons. 

Family would receive calls advising them that their mother or father was COVID-19 positive, then daily calls advising them of either a gradual or sudden decline. They usually hadn't seen them for months. Then, over the phone, they are told the one they love has either already died or is believed to be terminal.

I made many of those calls. 

In some instances, families didn’t want to come in for fear of the infection. On other occasions the residents didn’t want family to come for the same reason. On other occasions, I had to advocate for the next of kin to be allowed to attend because their parent or partner was dying.

The most memorable of these conversations was with the daughter of a man I will call Jack. I found Jack one evening when I went to work in a RACF. I was told by staff they were concerned about him. When I eyeballed Jack from the door of his room I knew he was sick. He appeared very distressed, and I immediately became concerned that Jack was terminal. The relieving staff were unsure of his Advanced Care Directive (ACD) status. On this occasion I had the benefit of having a Geriatrician with me.

While I repositioned Jack and applied O2, my colleague contacted his daughter. The outcome of reviewing the ACD and discussion with the daughter was that Jack was not for transfer to hospital and that his goals of care was to focus on comfort.

As a result, I then gave Jack 2.5mg of both morphine and midazolam. The O2, repositioning and SC medication quickly settled Jack to the point that we were able to have a conversation in brief sentences within the limitations of his respiratory function. I became aware that his wife had died some time ago. He was close to his daughter and grandchildren. Because visitors were not allowed — even before his facility had the outbreak — Jack had not seen his daughter in months.

I got his daughter on my mobile and had a brief chat about how we had been able to get Jack more comfortable. I then held the phone for Jack in one hand, and the mask away from his face enough so he could both hear and talk to his daughter. 

I remember the conversation, trying to hide my tears from Jack. I cried through much of it. It will remain a private conversation except for one component. 

Jack’s daughter said near the end, “I love you Daddy."

Jack replied, “You haven’t called me Daddy in a long time.”

“I know Daddy. I’m sorry."

This was only one of many calls I made to family of those dying in my care. When I returned the next morning, I was advised Jack died comfortably that night.

Frustrations and anxieties over workplace policies

I believe my frustration with workplace policies and practices contributed to the development of PTSD. An example is that I felt I needed to instigate an Intelligent Disobedience clause from my employment contract. 

Early in 2020, we were advised that the policy regarding PPE when testing a suspected COVID resident had changed. We were now only to wear a small plastic apron and standard surgical mask, not full PPE. 

At that time there had been media reports about concern over adequate access to PPE. In the absence of open and frank discussions, my personal belief was that this policy was more about supply than science.

I said I could not comply with this policy directive and intended to continue to wear full PPE and would encourage my colleagues to do the same. Not to do so put us at risk — myself, my next patient, my colleagues, the organisation, and my family. As a result, we hid PPE to ensure adequate supply and continued to wear full PPE.

About 8 weeks later the policy was quietly changed.

We were provided with N95 masks early on, though we did not initially have access to mask fitting. RACF staff were not. I raised this as a matter of concern as I worried that we would lose relieving staff to COVID isolation if they became infected. This fear became a reality. We did in fact lose even more facility staff to quarantine before they were eventually provided with N95 masks. 

I was eventually tested for mask fitting two weeks after we closed our last outbreak facility in mid-November 2020. I was advised that none of the masks I had available to me during the previous 10 months had been a safe fit. Bit late.

On two occasions I also came across facilities where fire doors were blocked by furniture as a means of ensuring staff and or wandering residents didn't move from what was considered an infected area to a clean one.

Uncertainty about executing decisions we might not support

Patients were moved out of facilities after an outbreak occurred, but these were not our decisions unless it was purely on medical needs. Our concern related then and now to being unable to predict when, why or who would be decanted from an outbreak facility. Over 2020, whole facilities were closed, the positive patients moved out or the negative patients, or some or all or wandering residents were moved. 

On two occasions, I witnessed the separation of married couples who both had dementia. They were separated for reasons they did not understand or remember — but they did know that their partner was not with them and would beg me to help. Our concern and frustration were and is that we never new who, why or when residents would be decanted.

More recently we have observed, in our opinion, that patients became infected because patients are not decanted in a logical or in a timely fashion.

Taking it home

At home, we carried our concerns with us. Worried that we could take the virus with us into the sanctity of our homes and family. A colleague from an RACF did just that. She and her two young children developed mild illness but her husband ended up in ICU intubated. He survived but is still recovering a year later.

My son is autistic. He has low support needs,  and I am very proud of him. Like me, COVID-19 took its toll on him. He is an insulin-dependent diabetic, as am I. He was concerned I would bring the virus home or contract it myself. 

He would say, “Dad you are 63, insulin-dependent and have idiopathic cirrhosis of the liver. You are at high risk of being very sick if you get COVID-19.” 

I'd returned fire with, “I know, but I'm far more likely to contract it at a supermarket, on the way home than at work.”

Developing PTSD

My service worked in Covid outbreak facilities every day for 10 months until the end of the third wave. The detail above is only a glimpse of the kind of issues that contributed to the kind of sustained stress that my team worked under.

There are many factors that led to me developing PTSD. Some were situational, others related to inadequate communication or recognition of what we were dealing with. Some were the result of policy and resources that lagged the rapid pace of the pandemic.

Like most nurses and midwives, when we are in the ‘eye of the storm’, we keep going. A job needs to be done and we do it. We forget to pause and reflect on the negative impact our work is having on our health and wellbeing. I wish I had stopped sooner and acknowledged that I needed a break.

My employer did offer support, but I think that we all underestimated the toll that this experience would take.

Recognising the symptoms

I have learned that nurses are not particularly good at recognising and responding to signs of emotional or mental exhaustion in their colleagues. I was witnessed crying on two occasions while assisting with media reporting and again during three zoom-based psychologist-led group debriefing sessions. Yet I wasn’t approached privately to see if I was OK.

While in the thick of the COVID-19 aged-care impact, I thought I was OK. I was doing my job. When things slowed down, I began to struggle. I experienced poor sleep, increasing agitation, anger and frustration. I lost interest in life. I questioned everything that I did or didn't do and experienced unpredictable and uncontrollable tearfulness. Progressively, I noticed physical symptoms, signs I wasn’t well. These included frequent hypoglycaemic episodes, intermittent tremor, and loss of appetite. I began to have reoccurring dreams, mostly of that call with Jack.

The crisis came when I weighed myself and realised I had lost 16kg in 5 weeks.

Seeking help

I was unsure what to do regarding work but knew I needed support. I informed my manager what was going on and that I was seeing my GP, a psychiatrist, and a psychologist. I then went on four weeks’ annual leave and returned to work on a gradual basis over an eight-week period until I was able to resume full duties.

During this time, I reached out to many colleagues. I was concerned that there was a hidden tsunami of stress, anxiety, depression, and PTSD impacting nurses.

Awareness of your health and wellbeing is the first step towards seeking support and getting help.

This was illustrated to me because of a conversation and email from a colleague who had resigned from the service. I rang to check on them, to tell them my situation and let them know that I was concerned others may be feeling the same. The person typically empathised, said they were OK and offered me support.

The next day my wife found me sitting on the couch in tears. She approached me concerned. I reassured her I was OK. In fact, I was weirdly pleased as my colleague had just sent me a text along the lines of: Thanks for the call and the honestly, I lied, I'm not OK!  I am seeing my GP and will see a psychologist. I’m taking a break from work.

Giving ourselves permission to seek help

This is part of the reason I’m writing my story. If you are a nurse, midwife, student or other worker who has been impacted by COVID-19, reach out for support. If my story resonates with you. If it gives you a voice, I hope you now have permission to speak out and seek help.

My call-to-action is: we must all do more to support those who are struggling. If you notice the person in a meeting next to you doesn’t seem themselves, or the clinician you are working with doesn’t seem OK, pause to take them aside, check in and offer support.

Nurse & Midwife Support is the national 24/7 support service for nurses, midwives and students and anyone concerned about our welfare: 1800 667 877.

I acknowledge the many nurses and health workers who have died from COVID-19 in the course of their work. No doubt they would wish that every person suffering has the support they need.

I honour Gillian Dempsey, the first Victorian nurse to die from COVID-19. I hope her loved ones and colleagues have the support they need.

Like me, you may still be working on the COVID-19 frontline as this virus continues to challenge us.

I urge you to look after yourself and your colleagues and seek support when you need it.

Reach out

Navigating your response to the pandemic 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.

By Tessa Moriarty RN 

Mental health nurse Tessa Moriarty shares how nurses and midwives are natural writers who can use journaling to improve their health. 

During the last lockdown, I gave myself a 30-day journal writing challenge. Initially to see if it would improve my writing skills, but also to see if journaling as a self-care strategy would have a positive effect on my wellbeing. 

I lost a close sibling the month before I started journaling. There was no shortage of personal material to write about. Not that I intended to use it for the sole purpose of working through my grief, but as it turned out, it was a vehicle for processing my loss. I also used it to reflect on the challenges and demands of my work, and as a springboard for initiating professional writing, poetry, and non-fictional pieces I was working on. I also discovered that writing regularly in my journal improved my writing skills. Moreover, over the weeks and months, I noticed the positive impact on my wellbeing. Through regular written reflection I came to a greater understanding of personal and professional issues. It gave me insights into some of the issues that lay beneath my frustrations with others, and I was able to find resolution with some of the problems I took to the page. This in turn helped me feel more at ease. 

Carry forward four months and journal writing has become part of my daily routine — now an intentional self-care strategy. The first thing I do most work mornings. With coffee in hand, after waking, I head straight to my desk and use the freshness-of-mind at the beginning of a day to write. Sometimes I start with leftover thinking or work experiences from the day before, or I return to a previous entry or piece I have been working on. Other mornings I have nothing to start with outside the day, date, my mood or the weather I see through the window above my desk — so that’s where I begin. 

On the odd occasion, my whole being is bursting to get to the keyboard from the moment of open eye. It’s as if an energy outside myself has entered the ideas space in my brain and my hands and takes over. These mornings, I let my fingers do the talking as they race to keep up with the words pouring through me. Whichever way I start on the page, it is a practice that generally sets me up for a good day, giving me a sense of achievement and quiet mindfulness. Journaling nurtures and develops my creativity through written expression and I carry this energy into the rest of the day. It’s also like morning exercise for my brain and soul and without exception, it makes me happy. And that’s got to be good for my wellbeing!

Nurses and midwives as skilled writers

As nurses and midwives, we are trained to write about the health and wellbeing of our patients. Our case notes cover their daily status, treatment progress and recovery. Whether in a hospital or community-based setting our nursing case note documentations cover the gamut of our interactions and care. And, whether in a direct clinical role or that of a manager, academic or in the business of policy or service development, nurses and midwives are skilful and experienced writers. 

Also, because we are trained to observe with an acute eye for the subtle changes in a patient’s presentation (and we have highly developed attunement and assessment skills) we are good at picking up the nuances and variations in their mood, behaviour, responses to treatment, vital signs, and subtle changes to their physical, emotional, and mental states. Add to that our accumulated and intuitive knowledge of caring and we’re in a good position from which to write on what we know, hear, what we see, and what we intuitively know is going on for those in our care. 

Journaling gives nurses and midwives the opportunity to use the skills they’ve developed through the practice of daily patient case note writing as reflective tools to observe and process their own worlds. To come to a greater understanding of self in the workplace and the world and to use written reflection as a form of self-care and to improve wellbeing. 

Why we should journal

The work we do as nurses and midwives and the contexts in which we work are diverse and rewarding but challenging — especially in the last few years. We know all too well the mental health cost of our work. We also know and understand the importance of debriefing, professional reflection and clinical supervision and how they help us process, make meaning of and gain insight into our work practices and what goes on in the workplace. Importantly too, we have come to see and value the need for self-care as a way to maintain our health and wellbeing and to prevent workplace fatigue and burnout. The use of journaling is one such way that nurses and midwives can practice the self-care. 

Journaling in nursing and midwifery 

In a study to determine the effect of journaling on the degree of compassion fatigue, burnout, and trauma/compassion fatigue in registered nurses it was found that over time, journaling not only had a positive effect on the ability of nurses to handle stress but also improved their compassion satisfaction and decreased burnout, trauma and compassion fatigue. 

Secondary outcomes of the study demonstrated that regular journaling increased nurses’ awareness and expression of their feelings. Themes that emerged from the journaling process were 1) that it allowed nurses to unleash their innermost thoughts, 2) that it helped nurses articulate and understand their feelings more concretely and 3) that it helped nurses make more reasonable decisions.

Nurses in the study said that journaling:  

• “allowed me to unleash my inner thoughts, to use the journaling experience as a valve to release pressure”
• “helped me have a place to pour out thoughts or to rant by writing rather than getting the urge to do it out aloud when it is not always appropriate” 
• “has given me knowledge and tools to express my inner experiences”
• “made me more in touch with myself and created an awareness which helped me take care of myself and therefore better care for others”. 

And a last offering from a nurse in the study that captures the process and use of journaling: “when I feel stressed, I use free-flow writing to get my ideas down. It really helps get things on paper. After I finish writing and reread it, it helps me understand what I have been feeling, and makes it easier to deal with”.

How to journal — guidelines and tips

Whilst I have titled this piece case notes on self, the journal entries we may make as nurses and midwives don’t have to be in written form. There are as many ways of keeping a journal as there are types. A Nurse Art Therapist I once supervised drew diagrams, figures and pictures with coloured pens, pencils, and crayons into a bound scrapbook. This was the medium that she used in her work with clients, so it was natural for her to use this method for her own reflective process. 

Many people use gratitude journals, with the focus on regular expression and development of thankfulness, wonder at the small and the cultivation of humility and gratefulness. Other people use journaling in dot points or bullet journaling as it is described. 

I have used the dot point listing for prioritising and planning at different times through my journal. This form of journaling can be a great way to get things out quickly onto the page, in short form without too much detail. The dot points or lists can then be used to refer back to and/or developed further at another time. 

Some people love journaling apps. There are a multitude available — some free, others at a cost and many available through health organisations. For those who prefer the ease and accessibility of smartphones, the app journals may be preferable. 

The message is: each to their own. There is no one ‘right’ type or way to journal. There are many mediums and it is worth finding a method and approach that works for you. I would say, however, that I do think it is a worthwhile and effective self-care strategy. Not the only self-care strategy in my toolbox, but now as a declared Nurse-Writer, I use it also to hone and practice my writing skills and maintain my wellbeing.

How to get started 

Here are my tips, based on the how-to literature I’ve read and my own experiences: 

Starting out: 

• Take one word at a time, one entry at a time. 
• Make an appointment with yourself, put it in your diary, and show up. Close the door behind you. Let others know not to disturb you throughout your ‘appointment’. 
• Start small. Begin with the date and the weather if that helps to get you going. 
• Yes, it can be like a diary to begin with. You are making the rules. Your rule might be there are no rules at all. 
• Ten minutes at a time might be enough to start with and build it up as you progress. As with most new things, if you’re new to journaling it will take time to develop your skills, but it is important to show up to the page and give yourself permission to be there. 
• It will get easier, you will get better at it, but unless you commit (even after writing only a few words some days), you can’t give yourself a chance to make it work.

Frequency and timing: 

• Journal as often as you can, but start small. Five minutes three times a week for the first month might be how you start. Your sessions can expand as you build your skill, enthusiasm, and commitment. 
• Choose a convenient time. I like mornings, but I don’t have to leave the house at 6 am for a morning shift. It might be at your lunch break or the finish of your shift. It might be better in the evening as part of your wind down. The key is regularity. It doesn’t have to be daily, but the more you journal, the more you’ll journal. 

Volume: 

• Write as little or as much as you like. If 5 minutes is all you have, see what comes out in that time. Trust that you will know when you’ve written enough or expressed what you need to. 

Most importantly: Remember who this is for. 

• Write for yourself. This is your journal. Your place to express and understand what you are going through. You don’t have to write for anyone else, so feel free to express it like it really is, and don’t let grammar and spelling slow you down. 
• In your reread (if that’s what you choose to do), you can edit and add anything you wish. Let your fingers speak what is in your head and heart. If you choose to share any of what you put down on the page, you are in control of that. This is your Case Note, nobody else’s.

Through a commitment to the practice of journaling on a regular basis, nurses and midwives as natural writers can employ this effective self-care strategy to decrease personal and professional stress, improve their understanding of self, develop, and nurture their expressive creativity and improve their wellbeing. 

If you uncover something in your journaling that you’d like to discuss further, Nurse & Midwife Support is always there. Call them a call on 1800 667 877 or reach out by email.

By Amy Benn RN

ICU nurse Amy Benn shares the tips she uses to fortify her health through the gruelling experience of the pandemic.

Following a treacherous 2020, we never would have believed 2021 would be tougher and more challenging for nurses and midwives — but for many, tougher it has been! Now, nurses and midwives have once again been required to dig deep and step up to fresh challenges of 2022. As always, nurses and midwives have continued to care for patients, residents, clients, communities, and families. For this and being the exceptional person, you are we thank you.

If you are still working — thank you. 

You provide help to people who need it. When people are sick and come flooding through the unit door you are there. After every challenge thrown at you: from wearing PPE until you are dehydrated and with pressure marks on your face, to the anxiety that you may bring Covid-19 home to your family. You have navigated staffing issues and extended your work hours including increased workload and acuity. Be proud, that you extended yourself beyond what our teachers at university ever said you would have to do. That you came through 2021 is an achievement. That you’re persevering through 2022 is phenomenal. 

If you have adjusted your role, thank you. 

If you have changed your role because of the pandemic — well done. 

If you have managed to work from home, elsewhere, moved departments or simply adjusted your hours — well done. 

In a time of high pressure and great uncertainty, making strong and difficult moves to take care of yourself and your family is essential.

As an ICU nurse, I have adapted my role and work environment. I have worked in four Intensive Care Units across three hospitals and many clinical areas prior to being vaccinated. I have worried about my health, the wellbeing of my colleagues and constantly evaluated the risks to my health, and my loved ones. 

I have also made many adjustments, like learning to maintain self-care and relationships while I live alone and adapting to working from home in a different job. My colleagues and I lost the ability to support one another in person when, with a few hours’ notice, we were all sent home with our headsets and laptops to triage and take calls from the COVID-19 response phone line. The way many will work into the foreseeable future remains uncertain.

If you are kind, thank you. 

Competing demands have come from every angle. Executives faced pressures to keep things afloat. These pressures and demands flowed down to managers to implement. They were dispersed on to the educators and frontline staff. The tsunami of high acuity patients flooding through the door placed greater pressure on everyone. At times this has caused great friction in the workplace. Snide remarks and comments when doing your best, cut deep. When I was working with constant change, and not knowing anyone on shift, those that showed me where to go and what to do were appreciated beyond measure. The acts of kindness, sense of humour and comradery under stress has made me so proud and happy to do what I do best. 

If you have been kind to your colleagues, if you extended yourself and your leadership, if you have managed to keep the ward running — thank you. 

Who knows when or if this pandemic will ever end? 

Will we ever see a ‘normal’? What does that ‘normal’ look like? Change is inevitable. Looking back at history over the decades, I can see many, many changes and challenges which our profession has endured and overcome. However, we need to except that our current situation and the demands may continue. 

If you feel exhausted, unfortunately you are the only one who can put yourself back together at the end of the day — even if I wish I could do it for you! 

What I can do is share some health and wellbeing tips that I have found useful.

Nurses and midwives do not ever wake up, turn over a leaf and feel “healthy.” However, tiny little tweaks, small consistent acts will add up over time to create habits for a healthier, happier experience. 

Here are my suggestions to fortify yourself. 

1. Limit your exposure to negative information when not at work.

Be conscious of what information, media and social media you consume. 

We are constantly exposed to media. It is available 24/7 on our phones, on the radio, on billboards and our TVs. There’s actually a word for our tendency to continue absorbing news media beyond the point where it is helpful for us: doomscrolling, the act of spending an excessive amount of screen time devoted to the absorption of negative news. It’s something most people have found themselves doing through the pandemic, and it’s not helping us at all.  

It takes effort and planning to reduce the amount of information, news, and media we consume.

One idea to minimise your exposure to harmful media is to have a plan for your commute. It may be a favourite soothing playlist, a podcast or audiobook. Choose something that makes you smile, laugh and makes your heart sing. 

Be proactive and choose the notifications you want on your phone. Reduce or eliminate alerts that come from social media. Consider replacing notifications with others that are beneficial to you — for example, breathing and meditation apps. I have Headspace and the Waking Up app. I don’t have time to stop and breathe with my eyes closed, but I do have 40 seconds to listen to the ‘moment’ on the Waking Up app, which makes me feel a lot more centred through the day. Even keeping your phone on airplane mode or do not disturb for the first hour of your day can make a difference. 

2. Brighten up your day on your plate.

For years I thought that because I had coleslaw for dinner with five different vegetables that I was meeting the recommended vegetable servings a day. Boy, was I wrong! The actual serve relates to the quantity of vegetables, so having ½ cup of cooked vegetables, or one cup of salad is considered a serve. 

Some tips for getting more vegetables in during your busy schedule:

• Snack on veggie sticks on the way home from work. 
• Always include vegetables for lunch and dinner, even if the recipe does not have any.
  • I make a side of greens with onion, garlic and olive oil.
  • Adapt your recipes for added veggies. For example, grated zucchini is a nutritious but virtually undetectable addition to many common recipes, such as bolognaise, chile con carne, stir fry, or curry. 
  • Add some frozen packet vegetables in with your meal/for lunch/dinner. 
• Pick up pre-made salad mixes from the supermarket for easy meals.
• Snack on fruit between meals. 
• Include a piece of fruit for breakfast or dessert.

3. Prioritize sleep, rest, and your sleep-wake cycle.

Taking the time to get clothing and meals organised for the next day can set you up for a good start to the day and give you some time to seek out a little Vitamin D in the morning. Getting sunlight first thing in the morning may benefit your sleep. Sitting outside, going out to the bin, or just checking on the garden in the morning can work wonders. 

Dimming lights or only using lamps in the evenings, turning off devices, TVs, and technology for 30-60 minutes before bed and resting and relaxing can also be beneficial.

4. Write down your thoughts. 

If things are bothering you, or you cannot sleep, put pen to paper. Even recounting the boring events of the day and getting them out of your head, and onto a page can help to empty your mind and process the day. If writing is hard consider recording your thoughts on the voice memo app.

You may like to start with this journaling activity spending 3 minutes on each topic:

• Today I did… 
• Tomorrow I plan to…
• The moments that made me happy or grateful today are…

Tessa Moriarty wrote an article on journaling for this edition of the newsletter, check it out!  

5. Hydrate before you caffeinate.

Before you fill up your cup with your favourite brew, fill it up with water and enjoy it. Savour the fact it is hydrating you and supporting your health. Drink as much water as you can and as often as able. Avoid those dehydrated headaches and sluggishness by keeping up your water intake through the day. Drinking fluid earlier in the day and tapering off in the evening can mean you are less likely to get up during the night. 

6. Tiny little tweaks add up. 

As Nurse and Midwife Support remind us — Your Health Matters. Do less, cancel things from your schedule that are non-essential and do not bring you joy. Cancel all the ‘stuff’ that you do not actually need or want to do. Focus on quality time, give yourself the gift of experiences and remove clutter from your life.

Be kind to yourself and others. Pat yourself on the back for what you achieved in 2021 and make 2022 a year that serves you and your wellbeing. 

7. Reach out

If you need support I recommend contacting Nurse & Midwife Support on 1800 667 877. They’re here to listen, whatever it is that you need to say. 

By NMS Podcast 

In this episode we discuss burnout prevention with Mental Health First Aider Sam Eddy.

Listen to Episode 31

Podcast details

Episode: 31
Guest: Sam Eddy
Duration: 44:39
Tags: Burnout, fatigue, mental health
Soundcloud: Listen to Episode 31
 

Introduction 

Have you started 2022 feeling you are in survival mode? Was your longed-for leave cancelled? Are you working too many hours? Are you — like many — sapped of energy, depleted, and running on empty? Do you feel cooked? 

You are not alone. Unfortunately, this is exactly how many nurses and midwives feel.

This podcast may help you to shift gears, refocus on your own health and make intentional changes to move into thrive mode!

Two years into this brutal pandemic, many nurses and midwives are exhausted, fatigued and wondering how much they have left in their energy tank. We are concerned about the impact on the health of nurses and midwives. We’ve recorded this podcast to offer you support, health tips and hope.

Two years ago, we spoke to Sam Eddy, Mental Health First Aider, experienced workplace coach and educator on Episode 15 of the podcast. We discussed stress management in times of crisis. That was in the early months of the pandemic and now feels like a lifetime ago.

Given the popularity of the episode we asked Sam back to offer his support and tell us about his new training program From Survive to Thrive, a 12-week program developed with Mental Health Nurse Sarah. This is a self-paced online study program filled with emerging scientific concepts to empower you with the knowledge and skills to move beyond merely surviving and into thriving in your career, home life and for your mental and physical health.

GIVEAWAY

Do you think you could benefit from learning how to go from Survive to Thrive? We have teamed up with Sam to offer two people the chance to win access to the 12-week course. Find out how to enter on our Facebook or Instagram. Entries close 28 March 2022, 8:59am. 

Terms and conditions

We discuss the importance of listening to your body and mind and taking affirmative action to provide refocus and attention to your health and wellbeing because YOUR HEALTH MATTERS!

We often hear from nurses and midwives that they feel drained and don’t know how to refuel. The tips in this podcast aim to assist you to top your energy levels, refocus your health, establish boundaries that support your wellbeing and work towards thriving in 2022.

We hope this podcast supports you to take a moment to reconnect with your health and wellbeing and make it a priority. If you’d like to talk, take a minute to reach out for support — give Nurse & Midwife Support a call on 1800 667 877.

Your health REALLY does matter!

Mark Aitken RN

Listen to the Episode