Winter Edition 2022

Edition 16 — Our mental health

Welcome to the Winter 2022 edition of the Nurse & Midwife Support newsletter.

Our mission in 2022 is to urge you to look after your health and wellbeing. This edition of our newsletter is devoted entirely to supporting your mental health — and the mental health of everybody in our workforce.
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WARNING
This issue deals with sensitive issues related to mental health. 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.
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Three smiling clinicians in PPE

In this issue
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Mark Aitken: Take your mental health off the backburner
Mark urges healthcare workers to take our own mental health seriously. 

Paul McNamara: Self-Compassion: surviving and thriving in emotionally taxing work environments
Paul McNamara shares resources to help you prioritise self-compassion in your life and professional practice.

Nino Di Pasquale: Managers of nurses and midwives — you can support your employee’s mental health
Experienced mental health nurse and leader Nino Di Pasquale shares why leaders must support employee mental health. 

Claire Hudson McAuley: Befriending vulnerability: Chase away the ‘blahs’
Mental health nurse and therapist Claire Hudson McAuley reflects on how befriending vulnerability could be the first step to securing mental health and wellbeing. 

Kat Evans: My health matters: How I made it my mantra
Early career mental health nurse Kat Evans shares her self-care tips.

Podcast: Mental health with Tessa Moriarty, Georgie Southam and Kat Evans
Mark is joined by special guest co-host Tessa Moriarty, mental health nurse Kat Evans and registered midwife Georgie Southam to discuss how we can support the mental health of nurses and midwives. 
 

Take your mental health off the backburner
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By Mark Aitken, Stakeholder Engagement Manager, Nurse & Midwife Support

Welcome to the Winter 2022 edition of the Nurse & Midwife Support newsletter.

Our mission in 2022 is to urge you to look after your health and wellbeing. This edition of our newsletter is devoted entirely to supporting your mental health — and the mental health of everybody in our workforce.

Young nurse wearing scrubs

Know what mental health means

According to the World Health Organisation, mental health is:

“A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community.”

Remind yourself why your mental health matters

As good as nurses, midwives, and students are at looking after others, we can place our own health on the backburner. It’s time to change that. 

Your mental health matters. It supports you to live your best life — and to be the best clinician. Our codes of conduct require that we maintain our physical and mental health to practise safely and effectively. 
 

Be aware of the factors that may risk your mental health

Working during the pandemic has negatively impacted the mental health of many. You may have experienced exhaustion, burnout, moral distress, anxiety, depression, or post-traumatic stress disorder. 

If you’ve been struggling we want you to know that support is only a phone call away. We’re here on 1800 667 877 — free, confidential, 24/7. 

We know that if mental health conditions are not managed adequately, quality of life may be significantly diminished. Small issues can also deteriorate quickly into big issues without attention. 

The article The psychiatric impact of COVID-19 on healthcare workers in The Australian Journal of General Practice Volume 49, Issue 12, December 2020 confirmed that mental health care workers are vulnerable to developing trauma or stress-related disorders in addition to other mental health conditions during large-scale disease outbreaks such as the COVID-19 pandemic. If not adequately managed the long-term consequences may include chronic psychological conditions. 

The article also highlights that in comparison to the general population, healthcare workers are at higher risk of mental illness including a greater risk of suicide, suicidal ideation, and self-harm behaviours.  The article is a sober reminder that our work can make us vulnerable to mental health issues. Awareness of the risk factors for mental health impairment, the protective factors for our mental health and the availability of support are vital.

The authors offer this advice to managers and those caring for the mental health of nurses and midwives:

“Opportunistic screening for mental health issues among Health Care Workers (HCWs) is especially important during the current pandemic. Various tools and strategies can be used for efficient assessment and treatment of the common mental health issues HCWs are likely to face.”

If you are concerned about your mental health, make an appointment with your GP and request a mental health assessment. You may be eligible for a mental health plan and subsided appointments with a psychologist. 

You can also chat to us about your mental health concerns. Contact Nurse & Midwife Support on 1800 667 877 24/7. We can chat about what you’re going through, offer strategies for change, or just listen if you need to vent. 

Understand the complexities of mental illness

Almost half of us will suffer from a mental illness at some point in our lives. Chances are you or somebody in your life has or will experience a mental illness. 

Mental illness is complex and often comes with stigma and shame. Nurses and midwives with mental illness often worry that they will be undermined as professionals and won’t get the support they need to continue working. As a cohort, we can all work to make our industry a safe place to speak up and make sure our friends, colleagues (and selves!) can get the support we need. 

Author Sarah Krasnostein explores our complex relationship with mental illness in the recent issue of Quarterly Essay: Not Waving, Drowning: Mental illness and vulnerability in Australia. She outlines Australia’s chequered history with mental illness and its management and provides an overview of the complexities of mental illness. Sarah examines the detrimental impact of stigma perpetrated on those with mental illness and how isolating living with mental illness can be-a reason why many don’t seek support until their illness is advanced. The issue is a useful overview for anybody who wants to understand the current state of mental health in Australia. 

Living well with mental illness

Acknowledging that you may be mentally unwell may make you feel vulnerable and afraid.

Sarah Russell is a former nurse who uses her lived experience to advocate for those living with mental illness. She often reminds us that you can live well with a mental illness and why it’s vital you access support, assessment, and treatment. In 2019 she joined us on the podcast to discuss how she lives well with bipolar disorder. Listen to the episode or check out the blogs she has written for us: 

Discover the benefits of psychological first aid

If you want your organisation to be a leader in supporting the mental health of nurses and midwives, consider implementing psychological first aid training as mandatory education.

The team at Nurse & Midwife Support are all trained in psychological first aid. It helps us to better understand mental illness and support your mental health. It also helps us to recognise when our work is impacting our mental health.

The World Health Organisation recommends the timely provision of psychological first aid for health care workers in need of support.
Psychological first aid is used to help people affected by an emergency, disaster, or traumatic event. It uses support to promote natural recovery by helping people to feel safe and connected to others, calm and hopeful. It gives them access to physical, emotional, and social support, and helps them feel able to help themselves.

In this newsletter a diverse group of nurses and midwives share their wisdom, experience, and passion for supporting the mental health of their colleagues promoting the theme-your mental health matters.

In this issue

Discover resources, tips, strategies to support your mental health

“The way I see it, self-care is about the tasks and strategies we use to avoid burnout. Self-compassion is more … making sure that we are as kind and nurturing to ourselves as we’re expected to be to our patients.”

Paul McNamara, credentialed mental health nurse and blogger with the Meta4RN website shares how self-compassion can support you to thrive in emotionally taxing work environments. In this issue, he has generously shared a presentation he offers on the topic of Self-compassion. Check it out!  

Discover how managers can support the mental health of their staff

Leaders must support employee mental health. So says experienced mental health nurse and leader, Nino Di Pasquale. 

“… the mental health of healthcare workers is a shared responsibility…work to give it the priority status it deserves.”

Read Nino’s important call to action: Managers of nurses and midwives — you can support your employee’s mental health. 

Befriend your vulnerability    

“Caring is a revolutionary act and befriending our own vulnerability by caring for ourselves is the vital first step.”

Mental health nurse and therapist, Claire Hudson McAuley, reflects on what could be the first step to securing your mental health in her article Befriending Vulnerability: Chase away ‘the blahs’.

Self-care tips shared by an early career nurse

“When I’m healthy I can be a better Mum, partner, and nurse. I’m an early career mental health nurse and I have learnt that taking care of my mental health and well-being is vitally important.”

Early career mental health nurse, Kat Evans, shares self-care tips that have supported her mental health in her article My Health Matters: How I made it my mantra.

New podcast episode: Supporting the mental health of nurses and midwives 

Kat Evans is also a guest on the Your Health Matters podcast. She joins registered midwife Georgie Southam and our first special guest co-host Tessa Moriarty to discuss how we can support the mental health of nurses and midwives. Listen to the podcast.

Know the importance of checking in

Regularly check in with yourself and each other by asking these simple questions:

Am I OK?
R U OK?

 

There's more to say after R U OK?

If you are not OK reach out for support. We know that the mental health system is strapped right now, and people in some areas may be finding it difficult to find vacancies with psychologists, GPs, and other mental health services. Thankfully, we’re here no matter what. You don’t need an appointment! Give us a call on 1800 667 877 or email us — free, confidential, 24/7. 

This edition would not have been possible without the generosity of our contributors or credentialed mental health nurse Tessa Moriarty, who helped us craft the issue. Thank you so much for your time, expertise, energy, and honesty. 

Your mental health really does matter!

Mark Aitken RN
Stakeholder Engagement Manager

Self-Compassion: surviving and thriving in emotionally taxing work environments
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By Paul McNamara RN

Paul McNamara shares resources to help you prioritise self-compassion in your life and professional practice. 

This piece originally appeared on Paul’s website and has been republished with permission. Paul is an experienced mental health nurse and fellow of the Australian College of Mental Health Nurses (ACMNH). He has previously joined us on the podcast to discuss suicide and suicidality among healthcare workers. Here, he offers his notes on an annually updated presentation on the importance of self-compassion.

Smiling young nurse in scrubs

Part 1: Introduction

Self-Compassion is defined as “…being empathetic and understanding towards oneself, as you might to a close friend in times of suffering” (Aggar et al, 2022).

I’m using self-compassion as a nuanced but important update to previous presentations and blog posts on the theme of self-care. Why? Because self-compassion is a better fit for nurses, I reckon.  As Mills, Wand & Fraser (2015) say, “…it could be argued that nursing care is synonymous with compassion.” That’s most-often compassion for others, not always each-other or ourselves. eyeroll emoji

The way I see it, self-care is about the tasks and strategies we use to avoid burnout. Self-compassion is more of an attitude or mindset that goes beyond burnout prevention, and shifts towards making sure that we are as kind and nurturing to ourselves as we’re expected to be to our patients.

In this iteration of an annually-updated presentation aimed mostly, but not exclusively, at new Graduate Registered Nurses I want to put emphasis on self-compassion as a valid and sensible priority. We don’t want new grads to just survive their first year, we want them to learn, enjoy their work, and grow.

Part 2: Prezi

It’s handy to have a way where you can quickly and easily find and share presentations. PowerPoint presentations are so last century. The face-to-face presentation uses this Prezi: prezi.com/view/wsTTDmVzAJOSRpqDXs2I/

Screen capture of prezi slide: Self-compassion

Part 3: References & Further Reading

Note: This must be the 6th or 7th iteration of a theme I’ve been banging-on about for over a decade, so I’m recycling and repurposing a lot of old ideas here. Because of that iterative process the list below is ridiculously and embarrassingly self-referential. Please don’t think of it as self-plagiarism. Think of it as a fresh new remix of a favourite old song. 🙂

Aggar, C., Samios, C., Penman, O., Whiteing, N., Massey, D., Rafferty, R., Bowen, K. & Stephens, A. (2022), The impact of COVID-19 pandemic-related stress experienced by Australian nurses. International Journal of Mental Health Nursing, 31(1). https://doi.org/10.1111/inm.12938

Australian College of Mental Health Nurses [www.acmhn.org], Australian College of Nursing [www.acn.edu.au], and Australian College of Midwives [www.midwives.org.au] (2019) Joint Position Statement: Clinical Supervision for Nurses + Midwives. Released online April 2019, PDF available via each organisation’s website, and here: ClinicalSupervisionJointPositionStatement

Chen, R., Sun, C., Chen, J.‐J., Jen, H.‐J., Kang, X.L., Kao, C.‐C. & Chou, K.‐R. (2020), A Large‐Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID‐19 Pandemic. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12796

Clean Hands. Clear Head. meta4RN.com/head

Clinical Supervision Starter Kit. meta4RN.com/sup

Eales, Sandra. (2018). A focus on psychological safety helps teams thrive. InScope, No. 08., Summer 2018 edition, published by Queensland Nurses and Midwives Union on 13/12/18, pages 58-59. Eales2018

Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks

Employee Assistance Service via QHEPS: https://qheps.health.qld.gov.au/cairns/business-services/people-and-engagement/safety-wellbeing-and-support/getting-help-and-support

Employee Assistance Service
via Benestar (the company that CHHHS contracts out to) benestar.com

Football, Nursing and Clinical Supervision (re validating protected time for reflection and skill rehearsal) meta4RN.com/footy

Hand Hygiene and Mindful Moments (re insitu self-care strategies) meta4RN.com/hygiene

Lai. J, Ma. S, Wang. Y, et al. (23 March 2020) Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open.
jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229

Lalochezia (getting sweary doesn’t necessarily mean getting abusive)  meta4RN.com/lalochezia

Miller, Ian. (circa 2013) Nursing ring theory: Care goes in. Crap goes out. impactEDnurse [blog]. Archived blog post accessed via Wayback Machine: web.archive.org/www.impactednurse.com/?p=5755

Mills, J., Wand, T. & Fraser, J. (2015) On self-compassion and self-care in nursing: selfish or essential for compassionate care? International Journal of Nursing Studies. 52(4).
doi: 10.1016/j.ijnurstu.2014.10.009.

Nurse & Midwife Support nmsupport.org.au , phone 1800 667 877.
Targeted 24/7 confidential support available for nurse, midwives, AINs and students

Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma

Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories)  meta4RN.com/nurturers

Queensland Health. (2009). Clinical Supervision Guidelines for Mental Health Services. PDF

Queensland Health (March 2021) Clinical Supervision Framework for Queensland Nurses and Midwives via QHEPS: https://qheps.health.qld.gov.au/__data/assets/pdf_file/0035/2658734/clinical-supervision-framework.pdf

Q: RUOK? A: Not really. I’m a nurse. meta4RN.com/RUOK

Self-Care: Surviving emotionally taxing work environments meta4RN.com/selfcare

Self Compassion and Post Traumatic Growth amongst Nurses in the Pandemic (Hooray for Grey Hairs!) meta4RN.com/grey

Spector, P., Zhiqing, Z. & Che, X. (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies. Vol 50(1), pp 72-84. www.sciencedirect.com/science/article/pii/S0020748913000357

Surfing the Omicron Wave (Cairns Hospital COVID-19 admission data, 14th December 2021 – 20th February 2022)  meta4RN.com/surfing

That was bloody stressful! What’s next?
meta4RN.com/bloody

QHEPS: Search for “bloody stressful” on QHEPS, or try this link: https://qheps.health.qld.gov.au/__data/assets/pdf_file/0034/2757544/bloody-stressful-staff-brochure.pdf

Zero Tolerance for Zero Tolerance (a reframing of reducing aggression) meta4RN.com/zero

Part 4: Video Presentation

At time of writing, it looks like we are going to have another uptick in COVID-19 presentations. Bugger. I won’t pretend to know how that will affect our local hospital and/or face-to-face and group learning. It will be handy to have a YouTube version of the otherwise interactive face-to-face presentation on hand just in case we revert to crisis-response mode like we did in January/February 2022 [more info about that here and here].

Part 5: End Notes

Thanks for visiting.

As always, feedback is welcomed via the comments section.

About Paul McNamara

Paul McNamara

Paul McNamara has been a nurse since 1988, a mental health nurse since 1993, a credentialed mental health nurse since 2006, and a fellow of ACMHN since 2008. He works as a consultation liaison CNC at Cairns Hospital. Paul also tinkers online quite a bit; he has a social media portfolio built around the homophone “meta4RN”, which can be read as either “metaphor RN” or “meta for RN”.  

Managers of nurses and midwives — you can support your employee’s mental health
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By Nino Di Pasquale RN 

Experienced mental health nurse and leader Nino Di Pasquale shares why leaders must support employee mental health.

Midwifery manager and her staff

Nursing/midwifery are caring professions. Naturally, we see the mental health of nurses and midwives as important — but mental health is complex and the competing priorities for nurse/midwife leaders and managers means it doesn’t always get the attention it requires. At this moment in history, it’s more important than ever that we recognise that the mental health of healthcare workers is a shared responsibility and work to give it the priority status it deserves. 

My story: 30 years in nursing and mental health

I’ve been a nurse and mental health nurse for nearly 30 years. I care about the mental health of all.

I know many nurses who have struggled with their mental health and that support, compassion and kindness can be a gateway to a conversation that can change a life.

My mental health nursing career started in a Melbourne Western Metropolitan Adult Acute Psychiatric Unit as a graduate nurse.

I’m now the Director of Nursing – Mental Health for Barwon Health in the beautiful city by the bay — Geelong. I’ve been a clinician, manager, and nurse educator in a variety of mental health services and teams in addition to periodically working as an academic. 

Early in my career, I became aware that the mental health and wellbeing of our workforce must be a priority for health services, managers, and employees. This became especially clear in my early career as a mental health crisis assessment and treatment (CATT) clinician and manager, treating and caring for fellow nurses and healthcare professionals from a range of clinical settings and disciplines. Being a nurse or midwife doesn’t prevent us from being human and experiencing mental health distress and illness. 

During my career, the tragedy of nurses’ suicide has touched me. Sadly, I’ve attended funerals of my nursing colleagues. The tragedy and suffering at the time is unbearable. You’re left feeling loss and guilt as you witness the suffering of those closest to those who have died in such tragic circumstances. On several occasions, I have supported the mental health treatment and admission of colleagues, peers and those who have reported to me.

Caring for the carers — a shared responsibility

The mental health of the nursing/midwifery workforce should be a priority for nurse/midwife leaders, boards, and managers. Given nursing/midwifery are caring professions it is vital that nursing/midwifery managers ensure the mental health of employees is cared for.

Learned experience — managers can do more to prevent mental illness

Learnings and reflections over my career have highlighted there is more managers can do to prevent mental illness in our colleagues and promote mental health and wellbeing in our workplaces.

As a nursing leader I would much rather invest my efforts in mental health promotion than reacting and responding to mental health distress, crisis, and loss that mental illness can often lead to.

Mental illness: The facts

Mental illness is more prevalent than many people realise. The 2007 ABS National Survey of Mental Health and Wellbeing showed that around 45% of Australians aged between 16 and 85 will experience a mental illness at some point in their life, while one in five Australian adults will experience a mental illness in any given year. The ABS conducted a new survey in 2020–21, with the results to be released soon. Given the unique stresses of the global pandemic, it seems possible that number might now be even higher. 

Our work can put us at higher risk of developing mental illness

Being a nurse/midwife requires us to rely on the therapeutic use of self. We invest ourselves not only in the complex clinical tasks that we undertake, but the emotional labour of our work.

This investment can make us vulnerable to empathy fatigue and vicarious trauma. A 2017 study by Joyce Yan Lee showed that there are “high levels of undiagnosed PTSD in Mental Health Nurses”. Australian health professionals are also at a higher risk of suicide than the general population.  
 

Barriers — what stops us from accessing support

One of the major barriers for people seeking support regarding mental health is stigma. It plays a part in how we care for others and ourselves.

These negative attitudes may extend to how nurses or midwives treat a fellow nurse/midwife with a mental illness.

Ross and Goldner examined stigma and discrimination towards nurses experiencing mental illness. They found that nurses who suffered from mental illness often felt that they were targets for ‘horizontal violence’ — that is demeaning, contemptuous and shunning reactions from supervisors and colleagues. Nurses' negative judgements towards nurses with mental illness may also contribute to the development of self-directed stigma as well. Shame and negative self-image makes it much more difficult to reach out for help. 

Focussing on the mental health of employees is good governance

Boards, leaders, and managers are recognising the importance of staff health and wellbeing. Our employees are our greatest asset. Prioritising the health and wellbeing of employees makes good business sense.

Research shows the impact mental health and wellbeing can have on physical health, happiness, and productivity. According to one Australian study, on average, every full-time employee with untreated depression costs an organisation $9,665 per year. It also found that implementing early intervention programs could result in a five-fold return on investment, thanks to increased employee productivity. 

Creating a safe and healthy workplace makes good business sense

Organisations that offer staff a safe and healthy workplace report:

  • less absenteeism
  • slower staff turnover
  • greater loyalty 
  • a better return on their training investment
  • better performance thanks to lower stress levels and good morale.

According to research, safe and healthy workplace also means less:

  • breaches of health and safety laws and associated litigation and fines
  • discrimination claims (which are time consuming and costly) and
  • industrial disputes.

Legal, safety – reasons why managers must focus on the mental health of employees

While mental health promotion is clearly a moral imperative, it is also a legal obligation. Organisations and leaders are required to take appropriate steps to eliminate and minimise health and safety risks in the workplace.

An employer or manager is obliged to: 

  • identify possible workplace practices, actions or incidents which may cause, or contribute to, the mental illness of workers 
  • take actions to eliminate or minimise these risks. Your occupational health and safety (OHS) obligations extend to any workers with mental illness.

How we can promote mental health in the workplace

The Australian Human Rights Commission published Workers with Mental Illness: A practical guide for managers to help people provide ethical and reasonable support for workers struggling with mental health concerns. 

Strategies for leaders to create a safe and healthy workplace

The report recommends the adoption of workplace-wide initiatives that can promote good mental health, including:

  • have staff health and wellbeing policies and procedures 
  • offer flexible working arrangements 
  • provide mentoring and peer support 
  • provide access to counselling services and/or specialist support groups 
  • mental health awareness raising through education and training 
  • ensure safe and healthy work conditions.

Tips for supporting colleagues

The report also provides advice for how to provide interpersonal support between colleagues. 

  • ask the employee if they wish to privately talk about their mental health concern
  • listen without judgement and offer support
  • negotiate reasonable adjustments in the workplace 
  • obtain advice and assistance from external support services (without disclosing personal information) or
  • talk with treating practitioners (with the approval of the worker)

Mental health education for managers

As a manager, you may grapple with how to talk about mental illness with your employee. For managers who want to develop their skills in providing mental health support, training programs are available. Applied Suicide Intervention Skills Training (ASIST) ASIST and Mental Health first Aid (MHFA) are education programs specifically designed to assist employees and leaders to recognise and respond to mental health issues. 

Mental Health First Aid (MHFA)

MHFA is a universal training program available in 23 countries. It teaches people to help a person with a mental health issue, experiencing an escalation of an existing mental health problem or in a mental health crisis.

A study of over 15,728 nursing students who received MHFA revealed that participants experienced positive effects on intentions to provide MHFA and confidence in helping a peer, improvements in MHFA knowledge and a reduction in stigma. Similar results and evaluations have indicated that general confidence in helping to recognise and support mental health deterioration and reduce stigma improves for people who have participated in MHFA training. I can bear witness that at Barwon Health staff in the acute hospital and mental health programs completed this program and we have seen positive outcomes.

Applied Suicide Intervention Skills Training (ASIST) 

ASIST is a two-day interactive workshop in suicide first-aid. More than 80,000 people in Australia have attended ASIST, which is available in all states and territories.
ASIST teaches participants to recognise when someone may be at risk of suicide and work with them to create a plan that will support their immediate safety. Although ASIST is widely used by healthcare providers, participants don’t need any formal training to attend the workshop—ASIST can be learned and used by anyone.
ASIST supports employees to apply a suicide intervention model. It helps caregivers to recognize when someone may be at risk of suicide. It then explores how to connect with them in ways that understand and clarify that risk, increase immediate safety, and link them with further help.
 

Commit to making a difference — for everyone

Compassion, kindness, knowledge, and a commitment to focus on mental health are essential for managers committed to making a difference to the mental health of their employees.

It can be troubling dealing with mental health concerns, whether they are your own or someone else’s. If you are a nurse, midwife or student experiencing emotional and mental health upheaval, seek help! Talk to family, friends, your manager, the Employee Assistance Program or Nurse & Midwife Support — you can give them a call on 1800 667 877 or email them.

The mental health of our nursing workforce is everyone’s business.

Befriending Vulnerability: Chase away ‘the blahs’
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By Claire Hudson McAuley RN

Mental health nurse and therapist Claire Hudson McAuley reflects on how befriending vulnerability could be the first step to securing mental health and wellbeing. 

Nurse in mask with smiling eyes

Note: The views expressed in this piece are the author’s own. Nurse & Midwife Support understands members of our cohort hold a diversity of opinions and that we can draw strength from sharing and reflecting upon our different experiences and perspectives.

Understanding the cost of caring

As nurses and midwives, we are often featured in glossy advertisements and TV shows as the ‘face of caring’ — yet we live and work in settings where it can be highly stressful or toxic to care, and ironically, we may feel uncared for by these systems. Sometimes we might feel voiceless, powerless, disrespected, or unsupported.

I will argue that in this context, caring is a revolutionary act, and that befriending our own vulnerability by caring for ourselves is the vital first step. 

Even though just over 10% of nurses are men, we are overwhelmingly treated as a female profession — and continue to attract outdated sexist attitudes. A devalued-because-we-care profession, we are not ever supposed to be frustrated or angry. Instead, we are expected to be ‘nice’, ‘compliant’, and ‘submissive’. If we complain, we may be replaceable. 

This is reinforced by the poor optics of the actions of:

  • a state government that took legal action to stop NSW nurses and midwives, who are exhausted by the fray, from striking
  • a state government that asks more and more of Victorian nurses and midwives by ramping up elective surgery while the pandemic continues to detrimentally impact many of us
  • a federal government that hasn’t publicly recognised the impact on aged care nurses of working in an underfunded broken system that led to neglect of residents.

We watch on with bleary eyes. COVID-19 has laid bare stories of being forced to work on COVID wards, or work in areas for which we aren’t expert due to staff shortages. We are told we must ‘live with’ the virus, do double shifts, have leave cancelled, or work in systems that aren’t great for clients or ourselves.

There is bullying, fear and oppression in many settings, and often nurses and midwives are afraid to risk their jobs to speak out about what is really happening. In some settings inadequate Personal Protective Equipment (PPE) reinforces the perception that the safety of nurses and midwives doesn’t matter.

Tragically, in my practice as a therapist I have witnessed nurses and midwives confide that they feel silenced, powerless, disregarded, and burned out. Many are not sure how long they can stay in the role. Many are looking for new jobs. Nurses and midwives are suffering severe stress and anxiety, struggling with addictions, self-harm, even suicidal thoughts.

It’s not just the bullying, lack of respect, lack of commonwealth Mental Health Nurse Incentive Program (MHNIP) or Better Access funding, poor and inequitable pay or conditions, or the savage cuts to Primary Health Networks (PHN) or National Disability Insurance Scheme (NDIS) funding for nurses and midwives in the community. Systemic problems and stresses existed before COVID-19.  But many of us believe that COVID-19 allowed the federal government to quietly push through brutal cuts to services and welfare for the most vulnerable, jacking up the level of demand and stress in the system.  

Befriending your vulnerability

No wonder so many of us suffer exhaustion, burnout, moral bruising, or injury within our professions. We are carrying increased safety risk, workload and stress, risk of addictions and health issues, and decreased opportunity to care for clients properly. Given the magnitude of issues facing us, we need a lifeline. 

Trauma-informed approaches are the lifeline for this moment. We can start by allowing ourselves to acknowledge that things aren’t easy, but stress and trauma can be healed. What! How? By “befriending” our vulnerability. 

This starts with understanding the body. Learning how to take care of a nervous system that is by now either exhausted or revved up — or both.

Humans have built-in systems to cope with stress or powerlessness. Stress initially puts us into sympathetic nervous system (SNS) arousal, the fight or flight part of the nervous system.  This fast SNS state affects us mentally by making us crave quick certainty, answers, demand favourable outcomes, or seek more structure or predictability. We may become more ‘black and white’ in our thinking, more idealising, or more reactive, irritable, harsh, or critical toward ourselves or others.  Facial muscles tighten and we smile less. Sometimes it’s hard to sit still or to relax with family or friends.

Create awareness of the impact of chronic stress

Prolonged stress affects the body and shifts the focus of the brain. Over time the brain becomes more oriented to look for sources of threat and it becomes more difficult to dampen embodied sensations of stress. We begin to doom-scroll on devices. At the same time, stress hormones like cortisol and noradrenaline flood the body, so it’s harder to get restful sleep and recover.  Mental and emotional exhaustion set in, but we fight it at first. 

Over time we may become riveted by stress and become ‘stress junkies’ as we compulsively doom-scroll or watch the nightly news. Images, sounds, and sensations that are ‘stress adjacent’ can amplify our physiological stress responses, leading to imbalance in our allostatic load. Blood pressure goes up. Self-care goes down. Gut and appetite changes. We develop an apple shape as we eat more sugar. Prolonged stress may damage our immune system or gut. As the brain orients us more toward threat, we lose the pleasure of ordinary life. This eventually leads us toward the second biological adaptation, Dorsal Vagal (DV) collapse, commonly known as depression, low mood, anhedonia or ‘the blahs’.

This slow low energy state is meant to help us rest and recover from the huge energy drain of the ‘fight or flight’ SNS state. However, if we are in DV for too long, it starts to impact our mood, clarity of decisions, our resilience, and our hope for the future. Life becomes a burden or a grind.

Luckily, we can recover from either state by befriending our vulnerability.

Befriending is when we learn to witness ourselves as a friend and attend to whatever is happening in the body without labels or judgements. There is a spaciousness in befriending that builds hopefulness, resilience, and trust in our own humanity and capacity to repair and heal.
 

Slowing down

How? Simply put, when you are stressed or going too fast, practice things which will slow you down and make you kinder and more compassionate towards yourself.

Intentional breathing

Exhale fully from the belly, give yourself soothing circular temple rubs, use large muscles though yoga or exercise, practice long sighs or exhales, try massage, float, or walk in water at the pool or beach. Ask your inner critic to ‘please wait in the waiting room’ while you have some time without their commentary. Imagine talking with a friend who is calm, accepting, and supportive.

Mindful living

Practice an ‘inner half smile’ with yourself. Notice how sweet you are. Do at least 10 minutes of guided Mindfulness practice every day. Switch off screens and stop doom-scrolling. Eat a Mediterranean diet. You should notice stress levels decreasing in as little as two weeks.

Mobilise

Alternatively, if you have low mood, lack motivation, or ‘the blahs’, the antidote is to increase mobilisation. This stimulates the vagus nerve which is connected to ears and all major organs. Sing, hum or make a ‘voooooo’ sound. You can dance if you want to. Lengthen the spine just a centimetre or two for a few minutes. Inhale deeply until your belly rises equally with your chest. Stand or straighten the spine if you are slumped. Do some yoga stretches. Go for a slightly longer walk each day. Watch a kind-hearted comedy show — or join a community group. Avoid alcohol. Find what gives you meaning and purpose every day. Try ‘nature bathing’, and anything new or novel that you haven’t done before. Grow a tomato plant if that’s new.

Share the benefits of intentional wellbeing

Once you start to feel better, you may notice that others too are struggling. Share the love. Share your new-found wisdom in a supervision or social group that supports all that you are. Teach others that stress and trauma can be healed.

By befriending your own vulnerability, caring becomes a revolutionary act, an act of defiant courage and healing that will gradually change the world. 
 

Seek support

Navigating your mental health and workplace issues can be stressful. If you’d like to chat about it, reach out to Nurse & Midwife Support — free, confidential, 24/7. Give us a call on 1800 667 877 or by email.

My health matters: How I made it my mantra
Body

By Kat Evans RN

Early career mental health nurse Kat Evans shares her self-care tips.

Young family enjoying a park together

When I’m healthy I can be a better Mum, partner, and nurse. I’m an early career mental health nurse and I have learned that taking care of my mental health and well-being is vitally important. 

As a student — and again as a mental health graduate nurse — I was told that self-care is important. I hope you have been told this too! 
 

Understand how you can care for yourself

Self-care means something different to each of us. I encourage you to explore what is best for you. 

Start by asking yourself questions such as:

  • What brings you joy?
  • What helps you to de-stress? 
  • Do you have an established self-care routine?

I spent most of my first two years of nursing playing around with these ideas and trying lots of ways to keep myself on track with a self-care routine.

Here’s what I learned.

1. Balance family life with study and work

I had a child in what I expected to be my final year of my nursing studies, as a result I extended my study from 3 years to 5 years. The experience forced me to grow up and take stock of what mattered to me. It kept my career as a focus for me and my family. We had to work together so that I could manage the demands of both my family and my career.

Having a child was difficult. I was stuck studying at home during a pandemic with a toddler who just wanted cuddles. The guilt was real, and I made up for lost time as best I could. 

My partner was amazing. He’d take our child to the park to give me space to get on with my study. He would return with bakery treats and coffee and — often times — a sleeping child. Together, we were able to create the time and space I needed to reach our goal of finishing my studies. 

2. Work out a study routine that suits you

As a mental health graduate nurse, I’ve been encouraged to take on post-graduate studies. This has been a mammoth task.  In the beginning I struggled with time management. It took me awhile to establish a study routine that worked for me.

I learned that setting whole days aside worked for me and helped me to prevent my studies from interfering with my family life. 

I would pack up and head to the library to have uninterrupted study days. Sometimes, I’d only study for a few hours after work, but mostly I tried to allocate a couple of days to study before an assignment was due. I love going to the library on the weekend, taking over a conference room and bringing in every relevant book to reference. 

This helped to keep me present and prioritise my family when at home, rather than be distracted by study.

3. Carve out family time outdoors

We tried to get out of the house whenever we could, so we didn’t have to think about cleaning! We are committed to giving our child happy memories of adventures and outings. 

Recently, we moved to a new area and missed our social connections.  Since we didn’t have friends nearby to enjoy picnics with as we did in our previous home, we sought out new family programs and got involved. Often we just checked out different playgrounds in the area. We met a lot of new people that way.

4. Eat well 

Eating healthy food is one of my main self-care priorities— but I don’t always stick to healthy eating! I have been known to get home from an evening shift and crack open a pack of chocolate biscuits and eat the pack before going to sleep! Hey, I’m only human!

Thankfully, for me, the joy of cooking a wholesome and nutritious meal far outweighs the guilt of those biscuits! I discovered cooking delicious bulk meals when time allowed ensured we had something good to eat, which supports our emotional and physical well-being. 

When I do eat those biscuits, I’m going to enjoy them, rather than waste time feeling guilty! 

5. Manage your alcohol consumption

When I was a student, I always thought that I’d be drinking wine by the bottle nightly once I reached professional status and had some of my free time back. Happily, I found the opposite to be the case! 

When I started working, I prepared myself and signed up for a wine subscription. My partner also wanted to reduce his sugar intake, so whisky mixes were out the window! Unexpectedly, the bottles piled up. 

I realised that when I got home from work I was tired. Alcohol was not what my body and soul needed. So, I just didn’t drink — not to say that I’m completely sober. I simply chose the mood. If I knocked off work and felt like beer, I’d usually only drink 1 or 2. 

As a nurse I’m aware of the importance of drinking in moderation. The health benefits of mindful alcohol consumption are well known.

6. Embrace fun activities

An important part of my self-care, especially in terms of my mental health, was to not put any extra pressure on myself. If I got home and the kitchen bench was covered in the day’s activities, we would have a picnic dinner in the lounge room. Things like that help keep life lighter and more fun.

Laundry was something that became therapeutic to me! It is an escape to the outdoors and a satisfying task to complete. We use cloth nappies at home, so it was important to keep on top of this. I do at least one load of washing every day and enjoy the monotonous task of pegging and unpegging. Sometimes this is my daily stretching — a good multitask!

7. Schedule quality time with others

Date nights became important. Our version was date days, as my partner was full time stay at home parent and our child takes a long time to warm to strangers. We had day care for one day a week, so we made sure we would go out for breakfast or lunch or just sit together in the calm of a childfree environment and reconnect.

8. Find an exercise that you want to keep up

I tried going to the gym for a few mornings in the early stages of the year. I got up early and gave it a red-hot go, but it didn’t satisfy me. I’m not that kind of morning person and it was really helpful to recognise that. 

I love yoga but finding a class that fits in with my shifts and with the constant lock downs was hard. I let that go for the first year. When I found that my old yoga instructor offered online recorded classes I started again and now do yoga almost every night once the little one is in bed.

I also have a yoga app and stretching app. Every night I do one or two activities, to shake off the day.

9. Discover a self-care routine that works for you

I’m enjoying discovering and exploring my self-care and what is best for my well-being. I regularly remind myself that my health matters and encourage you to adopt this mantra.

Discover what works for you, what fits with your life and what you enjoy — these key elements are my recipe for improved health. 
If you need a helping hand to sort out your self-care routine Nurse & Midwife Support are happy to chat to you and help you to develop your plan. Give them a call on 1800 667 877 or email them. 

Podcast: Mental Health with Tessa Moriarty, Georgie Southam and Kat Evans
Body

In this episode of the podcast we discuss the complex mental health needs of busy nurses and midwives. 

Podcast cover: Smiling health professional

Listen to Episode 32

Podcast Details

Episode: 32
Guests: Special guest co-host Tessa Moriarty, Georgie Southam and Kat Evans
Duration: 54:42
Tags: mental health
Soundcloud: Listen to Episode 32

Introduction

The mental health of nurses, midwives and students is vitally important. In this episode of the podcast we welcome our first ever co-host Tessa Moriarty and discuss insights and experiences on mental health for working nurses and midwives with Registered Midwife Georgie Southam and Registered Nurse Kat Evans.

We discuss the unique challenges and factors that impact workers in the healthcare industry. Working on the frontline during the ongoing pandemic has led to prolonged levels of unhealthy stress, anxiety, depression, burnout, and post-traumatic stress disorder in our workforce. Our guests share tips and tricks to improve your mental health and access support. 

We urge you to remind yourself every day that your health matters as much as the health of those you care for. We hope you know how important your mental health is. If you ever need to chat Nurse & Midwife Support are here for you. Give us a call on 1800 667 877 — free, confidential, 24/7. 

About our guests

Special guest co-host Tessa Moriarty

Photograph of Tessa Moriarty

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

Tessa has previously joined us on the podcast in Episode 25, Workplace bullying and harassment — personal stories and help-seeking. Tessa was also one of the winners of our first story competition for her piece Caring, a mutual and collective experience of nurses. She joined the podcast to discuss her winning story in Episode 22

Georgie Southam

Photo of Georgie Southam

Georgie Southam is a Registered Midwife with over ten years’ experience. Her enthusiasm for midwifery grew after she had her own child and as a mature age student, she went back to university to undertake Bachelor’s degree at Australian Catholic University. Georgie has worked in the clinical setting across both private and public sectors in areas of labour and birth, postnatal care, high risk antenatal care, special care nursery and antenatal education. She has been preceptor to junior staff and students and enjoys working collaboratively within a team environment.
Her passion is working with families from all cultural backgrounds and vulnerabilities. She strives to facilitate positive experiences helping families feel safe and empowered in their journey into parenthood. Georgie feels blessed to have found a career she is so passionate about and looks forward to where it may take her in the years to come.

Kat Evans

Photo of Kat Evans

Born and raised in regional Victoria, with an extensive background in hospitality, Kat Evans is a mature-aged early career mental health nurse with a passion for caring for colleagues, carers, her family and self.

Listen to the podcast or read the transcript

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