Dear Healthcare Leaders: Self-Care is Not the Answer

[Nurse Writing Nook]

Self-care has become a band-aid to fix a gaping stab wound. And by gaping stab wound, I mean the work environments we are forced to endure every shift as nurses.

The system is broken. We are not broken

So why is self-care thrown out as the answer to our burnout and stress? Because it’s easier to throw a band-aid on it than to get in and fix the internal damage.

We are sad, exhausted, frustrated, and traumatized. To fix this, we are told we need more self-care. It’s up to us to fix ourselves. To fix our trauma. Not only are we expected to give our best to our patients, while being completely stressed out and working short-staffed, we are expected to fix ourselves, too. If we’re too stressed out, we obviously haven’t been caring for ourselves enough, right? That’s what is shoved down our throats at every opportunity. We are made to feel that it’s our fault for being broken. Newsflash: There are not enough bath bombs, spa days, and Netflix binges in the world to fix all the trauma we have suffered.

When are we supposed to find time for all of this self-care anyway?

On our days off, we’re bombarded with texts begging us to come in. Already worked a dozen straight shifts in a row? Doesn’t matter! I never know whether to laugh or cry when my manager sends out texts needing more staff and then adds, “I’ll throw in movie tickets and coffee coupons!” Really? Honestly, it’s a huge slap in the face. Just throwing this crap at the nurses that are literally working themselves to death and all the “thanks for all you do!”s doesn’t help anything. According to these hospital systems, self-care is OK as long as the self-care doesn’t get in the way of us staffing their mismanaged hospital. If our mental health is in despair, we must still go to work. We must work our regular shifts as well as be guilted into working extra.

Don’t get me wrong, I don’t disagree with self-care

I think it’s incredibly important. However, we shouldn’t need as much self-care that’s thrown at us if we didn’t have to endure so much. Also, it doesn’t fit the circumstance. Again, it’s like fixing a major open wound with a band-aid. It’s not appropriate. Leadership within hospitals and healthcare organizations needs to step up and get to the root of the problem, not blame us for not caring for ourselves enough. We all know this isn’t new territory. We’ve been dealing with this forever. The pandemic just added a whole new layer. It added more stress to an already stressful work environment. Instead of helping us, our hospitals told us to take care of ourselves better. We are not OK. We are far beyond needing self-care. We need our trauma acknowledged and addressed, and to stop being blamed for it. This is not our fault.

Fix the horrific staffing ratios to start with ...

Also, support the nurses that build the backbone of your healthcare organization. At the very least, back us up when the patient complains because we didn’t give them their graham crackers right away like they demanded (Stop catering to the patients while kicking us when we’re already down.) And at the other, most critical end of that, back us up when we make a med error or any other kind of mistake that can happen. We are humans. Treat us like humans. It’s like going into a war zone at times with absolutely no support or backup.

We are beyond exhausted

Beyond much hope that things will get better anytime in the near future. The fix to this is not simple. It’s going to take healthcare organizations to look far beyond their bottom dollar. Maybe I’m just too pessimistic and cynical after dealing with it over the years, but I have very little faith in these leaders at this point. Or, maybe I’m just realistic. I hope I’m wrong. Even if it doesn’t happen while I’m still working as a nurse, I hope it’s better for the current nursing students. I want better for them. I want to be able to truthfully tell them it’ll be OK.

FACT: I’d love to be able to speak kindly of our profession, encourage them to become nurses, and really mean it.

I won’t sugarcoat it and I sure as heck won’t tell them to take a bubble bath and put on some slow jazz when they are crying and frustrated.

[SunDazed, BSN, RN]

And add the ANA to that list of organizations sending emails for every type of self-care class delivery method they can think of... webinar anyone? Ack! NOOOOO!

If even the folks at the ANA are buying into the whole self-care is what needs to happen to fix nurses myth... well... we are sunk.

It is like going back to nursing school and being taught everything has a right way to be done and it always will be done that way with a smile. 

What I mean is... did nursing school prepare you for the brutal reality of nursing work? The politics, the work load, the crazy orders from doctors that didn't make sense but couldn't be questioned, the day shift-night shift divide that is easy to blame for things not getting done, the lack of breaks-meal-bathroom-etc, running all shift just to just try to give the meds and basics, no aides to give baths-feed 1:1s-basic cares, and the managers who are never there to help, the administrators who can not properly operationalize a major change to prevent complete chaos! 

My whole community is in crisis - not enough places for the homeless, houseless, impoverished elderly, mentally ill, or addicts to live here. So they don't discharge safely and they come back over and over. It is not the fault of the patients, the whole system to support basic dignity is missing. As long as the community is in crisis the hospital will be too. 

[CeciBean, ASN, RN]

I'm retired now (thank all the gods and goddesses!) but all that toxicity COMES FROM ABOVE and filters down. There is one word you need, and that word is NO. When I worked PRN I used it a LOT, especially at one hospital. I am a past master at it.

The other thing to do is examine the entire system. Why do we need a BS in Health Care Administration, of all things? Those people are about as useful as a screen door in a submarine unless you reform the whole curriculum, and I have thoughts about that which I could write a whole article about if someone would like to hear it. Degrees in Health Care Administration should start with a Master's and should be restricted to people with a health care background and experience, plus a bachelor's in a health science field. 

Stepping off my soapbox, for now anyway.

[cherylrenee]

5 hours ago, SunDazed said:

And add the ANA to that list of organizations sending emails for every type of self-care class delivery method they can think of... webinar anyone? Ack! NOOOOO!

If even the folks at the ANA are buying into the whole self-care is what needs to happen to fix nurses myth... well... we are sunk.

It is like going back to nursing school and being taught everything has a right way to be done and it always will be done that way with a smile. 

What I mean is... did nursing school prepare you for the brutal reality of nursing work? The politics, the work load, the crazy orders from doctors that didn't make sense but couldn't be questioned, the day shift-night shift divide that is easy to blame for things not getting done, the lack of breaks-meal-bathroom-etc, running all shift just to just try to give the meds and basics, no aides to give baths-feed 1:1s-basic cares, and the managers who are never there to help, the administrators who can not properly operationalize a major change to prevent complete chaos! 

My whole community is in crisis - not enough places for the homeless, houseless, impoverished elderly, mentally ill, or addicts to live here. So they don't discharge safely and they come back over and over. It is not the fault of the patients, the whole system to support basic dignity is missing. As long as the community is in crisis the hospital will be too. 

You make a very good point. Our entire healthcare system and our social support system (or the lack thereof) is in crisis. We have so many changes that need to happen. It is larger than just a nursing issue.  Advocate for nurses, educate patients, engage in grass roots lobbying, and vote! I see change in the future.

[kbrn2002, ADN, RN]

17 hours ago, cherylrenee said:

You make a very good point. Our entire healthcare system and our social support system (or the lack thereof) is in crisis. We have so many changes that need to happen. It is larger than just a nursing issue.  Advocate for nurses, educate patients, engage in grass roots lobbying, and vote! I see change in the future.

You are not wrong. We live within a broken system, health care is only one component of that.  Mental health funding is minimal, addiction treatment is not readily available in many areas or if it is available there's a long wait list to receive treatment even for those with insurance that will pay for an adequate course of treatment which very few do. So called affordable housing is out of reach for many unemployed as well as underemployed while truly affordable housing is almost impossible to find. Government programs to help with housing have wait lists of literally years. Housing for those with mental illness is severely under the amount needed after budget cuts that caused many group homes for those living with mental illness to close. 

A lot of our current crisis can be traced to budget cuts made in the 1980's and then carried forward and made worse in subsequent decades. Now that the fall out from those budget cuts has reached crisis level some politicians are acting like this shouldn't have been the expected outcome and are crying from the rooftops "we have to fix this" while others are just as adamantly voting down any legislature that might actually help.

The wealth gap is larger than it's ever been and it just keeps getting worse. The rich keep getting richer while the poor keep getting poorer.  What used to be lower middle class has now slid down to poverty while the true middle class continues to shrink.

As long as the wealthy continue to hold all the election funding power and have the ability to put financial pressure on the elected officials who are by the way supposed to represent all their constituents, not just the rich ones I sure don't see any changes coming. All the politicians that say "something needs to done" rarely if ever results in something actually being done.  Then come the next election cycle the wealthy throw their money and power behind the opposition whose platform calls for more budget cuts to social services while throwing more tax cuts to the rich and the representatives who call for a more balanced distribution of government funding are not elected. 

News flash, Regan's "trickle down economics" didn't work in the '80's and no matter how the wealthy rebrand it it isn't working now.

[brandy1017, ASN, RN]

On 6/4/2022 at 12:16 PM, klone said:

Here's a solution - when you're not working, ignore the texts and phone calls. You're the only one who cares about protecting your down time. Management is just trying to fill the staffing holes. Why did you volunteer to work a dozen straight shifts in a row?

Agree, but the new nurses who haven't learned the system are easy to guilt trip into picking up extra shifts.  There is so much manipulation in nursing.  Also some places it isn't even voluntary, but mandatory above and beyond your scheduled shifts management trying to fill the holes. Well in the old days, they didn't rely on just in time staffing.  They had an actual float pool that was there to fill in for sick calls and vacations.  Now they want to put all the stress on the few poor remaining nurses they have left because apparently it's cheaper than hiring enough in the first place like they used to do.  In response I recommend saying no if you don't want to work extra and if you are being forced, then it is time for a new job. 

The new yes manager demanded our cell phone so she could text us and I refused to give her one.  She had my landline and work email.  I'm glad I stood my ground because soon after she started coming after the older nurses harassing us and trying to get rid of us even during covid.  She sent a text for the need for a meeting to discuss her "concerns" with another coworker while she was on vacation.  I can only imagine the type of passive aggressive power trip she got out of ruining her vacation.  Then the day of the meeting she was yelling at her and gave her a write up one step away from termination over a minor issue and this person had not had any disciplinary warning before. 

Next she came at me, but since she didn't have my phone she sent an email and since I knew what to expect, I demanded clarification of what concern she was talking about as I wasn't aware of any problem.  Again it was something stupid and ridiculous and I explained the situation but still she insisted on a meeting.  I emailed her that I was aware that she was targeting the older nurses and she said interesting comment ... and then cc the Director and CNO and tried to play down the meeting but at the end mentioned discipline may occur depending on the facts determined so I insisted on a union rep.  I had to sit in front of a computer with a one way camera with two HR people watching me lest I roll my eyes and interrogate me over what I had already told her. 

Basically a patient had a nose bleed that I couldn't stop that needed to be packed and the house Dr wasn't trained, there was no ENT on call and the ER had to come and do it.  She claimed I wasn't professional for not saying my name when I called the ER.  That was the only thing she could complain about me.  So yes seriously grasping at straws to try to drive out the older nurses.  In the end, I was told it was a counseling, not a write up. Whatever!  Totally ridiculous.  To top it off we were in her tiny closet of an office and she didn't bother to wear a mask and this was before vaccines. 

Then covid spiked and she was running around telling other older nurses how much she valued them and needed them.  She did!  Ironic as she had previously told all the new grads she hired that she was going to get rid of the older nurses.  I can only imagine how they felt as new nurses!  What a mess! 

Now almost all of us are long gone.  The first nurse she targeted has a much better job at a clinic and is happy!  There is only one senior nurse left on days and a couple older nurses on nights and the rest are new grads and travelers.  The manager left shortly after I did.  I feel sorry for her next staff.  I wish them well.  I hope she gives up on her desire to target older, experienced nurses for everyone's sake and for patient safety and continuity of care and the mentoring and support of the next generation of nurses.  

 

 

[PsychRN67]

I agree as well. I’ve been in nursing for over 30yrs and I used to think the systemic problems like staffing wouldn’t last forever-surely they would “iron out” over time. Nope. Not at all. Here I stand today & it’s the same stressful and dangerous issues as when I started in 1988. I don’t do extra shifts unless I really want to. I’ll come in early only if it’s for a close colleague who needs to leave early & I feel good about being there for her, and I usually get the same in return when I need it. I’ll stay late for a nurse who has trouble getting in for whatever reason if it’s not chronic. Everyone is human. On the way in & during the shift I’m constantly devising & updating how I’m going to inject goodness, quality, and positivity into my environment with all my “people skills” and great organizational abilities. I work 32 hrs so I don’t feel I’m overworking. Self-care doesn’t prevent burn out when internal practices r/t business impede nursing care & the nurses who desperately want to provide the best skilled care possible. Sorry to say, I take care of myself to the best of my ability & it has never helped issues within the hospital setting where I’ve worked my entire adult life. 

[SunDazed, BSN, RN]

On 6/9/2022 at 7:49 AM, kbrn2002 said:

You are not wrong. We live within a broken system, health care is only one component of that.  Mental health funding is minimal, addiction treatment is not readily available in many areas or if it is available there's a long wait list to receive treatment even for those with insurance that will pay for an adequate course of treatment which very few do. So called affordable housing is out of reach for many unemployed as well as underemployed while truly affordable housing is almost impossible to find. Government programs to help with housing have wait lists of literally years. Housing for those with mental illness is severely under the amount needed after budget cuts that caused many group homes for those living with mental illness to close. 

A lot of our current crisis can be traced to budget cuts made in the 1980's and then carried forward and made worse in subsequent decades. Now that the fall out from those budget cuts has reached crisis level some politicians are acting like this shouldn't have been the expected outcome and are crying from the rooftops "we have to fix this" while others are just as adamantly voting down any legislature that might actually help.

The wealth gap is larger than it's ever been and it just keeps getting worse. The rich keep getting richer while the poor keep getting poorer.  What used to be lower middle class has now slid down to poverty while the true middle class continues to shrink.

As long as the wealthy continue to hold all the election funding power and have the ability to put financial pressure on the elected officials who are by the way supposed to represent all their constituents, not just the rich ones I sure don't see any changes coming. All the politicians that say "something needs to done" rarely if ever results in something actually being done.  Then come the next election cycle the wealthy throw their money and power behind the opposition whose platform calls for more budget cuts to social services while throwing more tax cuts to the rich and the representatives who call for a more balanced distribution of government funding are not elected. 

News flash, Regan's "trickle down economics" didn't work in the '80's and no matter how the wealthy rebrand it it isn't working now.

Word.

Truth. 

Still have to advocate for change!

[Nurse Beth, MSN]

My sister (also a nurse) just worked 8 days straight and most of them turned into 16 hr shifts. I hate to see her get caught up in the working because we're so short-staffed cycle.

At least she splurged and bought a nice Johnny Was dress.

[HiddenAngels]

On 6/3/2022 at 1:30 PM, Nurse Writing Nook said:

Also, support the nurses that build the backbone of your healthcare organization. At the very least, back us up when the patient complains because we didn’t give them their graham crackers right away like they demanded (Stop catering to the patients while kicking us when we’re already down.)

We are beyond exhausted

Wonderful sound off!! I love it!! 
 

this point must be reiterated!  Acknowledging Patients Rights and completely ignoring or downplaying Nurses rights is disgusting and unacceptable. We are dealing with a completely different patient population than from 10-20 years ago!

On 6/4/2022 at 1:16 PM, klone said:

Here's a solution - when you're not working, ignore the texts and phone calls. You're the only one who cares about protecting your down time. Management is just trying to fill the staffing holes. Why did you volunteer to work a dozen straight shifts in a row?

And this! Took me a while but I’m here. I Am Responsible for my well being!