Laurie Barkin, RN, MS has worked as a staff nurse, head nurse, nurse manager, instructor, and psych liaison nurse.
Her book, The Comfort Garden: Tales from the Trauma Unit, won the American Journal of Nursing Book of the Year Award and a Nautilus Award for excellence in writing.
In this guest blog post, Laurie shares personal insights into caregiver stress and the role of institutional support from her years of working with trauma survivors. You can find out more about Laurie on her website.
“How can those of us who bear witness to trauma make sense of the violence inequity, injustice, and waste of human potential that confronts us daily? What should we do with the feelings we feel?
I needed to talk about how awful it is to come face to face with evil in the world. I asked for what I needed. That was hard enough. Did I violate a taboo by asking?…Other trauma programs incorporate time each week for staff to talk about such things. Why can’t we?”
– adapted from The Comfort Garden: Tales from the Trauma Unit
Too many front-line healthcare clinicians are struggling with burn-out, compassion fatigue, and moral distress at work. Contributing factors include high patient acuity, fear of making medical errors, unrelenting exposure to human pain and suffering, and inadequate staff resources.
When front-line staff are stressed, the entire system is negatively impacted. The solution is a combination of “self-care” and institutional support.
I came to this conclusion after attending a psychological trauma conference in the late 90s where I heard the phrases “vicarious traumatization” and “secondary traumatic stress” for the first time. Back then, I had been working as a psych nurse consultant on the trauma unit of a large hospital for a few years.
Many symptoms described by presenters resonated with me: nightmares and intrusive images related to my patients’ stories, palpitations, shortness of breath, excessive worry for my children’s safety, and emotional fatigue, to name a few.
I knew I wasn’t the only one. Each week, all of us on the psychiatric consult service were hearing horrific stories of abuse and neglect. Several of us had requested support groups for staff. Each time we did, our administrator politely turned us down and made the same suggestion:
“Do it on your own time.”
At the conference I learned that the antidotes to caregiver stress were staff support groups and a commitment to good self-care practices. In speaking with other trauma professionals, I learned that many trauma programs provided time each week for staff to process and reflect. These practitioners were incredulous that our program—affiliated with a major teaching hospital—did not.
Months later, after listening to a particularly vicious story from a survivor of sexual violence, I requested time in our staff meeting to talk about it. Again, I was turned down.
That’s when I decided that, because my mental health was worth protecting, I had to resign my position.
The Caregiving Personality
Since then, I’ve been writing about the experience of bearing witness to others’ pain and suffering. One of the questions I’ve considered is this: Is caregiver stress solely attributable to the work itself or do aspects of the caregiver personality play a role?
Most people who decide to pursue caregiving careers are naturally empathic. From where does this wellspring of empathy originate?
In my decades as a psych nurse, I’ve spoken to many nurses (and other healthcare clinicians) about why they chose their professions.
Many grew up in families that provided fertile ground for caregiving experiences. In families battered by addictions and trauma or stressed by disability and illness, these future caregivers often assumed responsibility for younger siblings, grandparents, parents, or themselves when adults were unavailable. In this way, they learned to be responsible caretakers, sensitive clinicians, conflict managers, and family administrators.
Because of the skills honed in our families, we are good at what we do. However, if the emotional pain of the family crucible still lives within us, i.e. our feelings remain “unresolved,” we may be especially prone to caregiver stress.
The Institutional Role
So, in addition to self-care practices such as yoga, meditation, journaling, exercising, maintaining adequate sleep and good nutrition, etc., I’m all for people pursuing individual psychotherapy as another tool in one’s self-care practice.
But since the antidote to caregiver stress is both personal and institutional, hospital administrators and executives also have an important role to play in decreasing job stress among clinical staff.
In addition to limiting mandatory overtime, creating a safe environment, paying competitive salaries, and improving general work conditions, they could, for example, provide on-site childcare and banking services, host farmers’ markets on campus, champion support groups, and sponsor staff wellness centers.
Additionally, they could offer regular staff retreats, on-site mini-massages, and an on-call confidential counseling service for work-related issues, to name a few.
Nurses and physicians who value caring want to provide excellent care for their patients. Actual caring—as opposed to performing tasks associated with caring—requires time and emotional labor. When clinicians are bolstered by self-care practices and supported by administrative practices, they are energized by their work, not burned out by it.
Actual caring requires time and emotional labor. When clinicians are bolstered by self-care practices and supported by administrative practices, they are energized by their work, not burned out by it. Click To Tweet
Here are my questions to you:
Do you have a regular self-care practice at home and at work? If so, what does this include? If not, what prevents you from doing so?
How does your workplace support your work as a caregiver?