THE SELF-CARING NURSE

Strategies For Avoiding Compassion Fatigue and Burnout

James D. and Linda S. Henry

We interviewed 29 nurses in various specialties and locations for our book, The Soul of the Caring Nurse. Our intention was to capture their fascinating stories and provide a wide array of strategies for the caring of self, colleagues and patients. A number of common themes surfaced, such as:

· Many interviewees maintained that most nurses enter the profession because of an innate desire to care.

· A number of nurses expressed the belief that they were called to the profession, reflecting the words of Florence Nightingale, “Nursing is most truly said to be a high calling, an honorable calling.”

· Self-caring begets caring. Some nurses enter the profession with a desire to care for others that stems from their own experiences of needing to be cared for. That, in turn, can result in unhealthy caring behaviors. In this respect, self-caring contributes to healing and minimizes burnout and compassion fatigue, especially when admiration from patients and others is not forthcoming.

Hospice nurse Christine Hall describes herself as a wounded healer who in her 40’s decided to enter nursing a number of years after having lost both of her parents in a car accident. “Their loss became a pivotal point in my life where all of a sudden, I felt very alone and I was forced to move into a kind of unformed, fogginess in order to discover who I truly was as a person.” Today she finds tremendous power and healing in hospice work. She especially cares for herself by applying her artistic interests and talents to this specialty.

“I have created an artistic symbol system of painting animals that represent some of my patients,” she says with a smile. “These pictures remind me of something I learned from them that I needed to know. For example, one patient taught me how important it is to use our personal creativity because you can control it, much more so than controlling destructive impulses. In this troubled and broken world, most of us are attempting to gain some kind of control over our lives. I captured this lesson in the art form by painting a raccoon. This patient was a creature of the night with dexterous hands, an artist himself. He was 29 years old.”

Build upon your strengths

Chris testifies to a strategy that stands foremost in caring for yourself. It involves more clearly identifying and building upon your non-clinical strengths. To do this, take advantage of the career services available through your organization, a community college or on the Internet. A number of positive, fun assessment instruments are available to assist you in identifying passionate skills and strengths. Use a search engine like www.google.com in the Internet and type in the words “transferable skills.” A number of resources are available, many from online college career centers. In addition, a free version of the Myers-Briggs Type Indicator® is available at www.humanmetrics.com to help you identify your personal strengths. It’s called The Jung Typology Test. When you have identified your four-letter code, read a chapter about yourself in a book by Paul Tieger and Barbara Barron-Tieger entitled Do What You Are, which relates your profile to work/career strengths.

Practice positive intentionality

Colleen Person, a nurse and Vice President of Creative Health Care Management (CHCM), encourages us to live with intentionality. “Quantum science teaches us that energy flows in the direction to which we pay attention,” she reminds us. Her workshops on Reigniting the Spirit of Caring focus on being intentional in caring for self, colleagues, patients and their families. She challenges people to replace the three “B’s” as they are called at CHCM - bickering, backbiting and blaming - with the three “C’s” or choosing, caring and collaborating.

Nursing professor Jean Watson, a pioneer in research on the nature and processes of caring, invites nurses to practice intentionality by:

• honoring nursing as the spiritual, spirit-filled practice that it is;

• using whatever presents itself, including the dark and difficult times, as lessons for growth and

• at the end of the day, offering gratitude for all.

Focus upon possibilities, not problems

This strategy closely relates to living with intentionality. In their book, The Art of Possibility, Rosamund and Benjamin Zander claim our perceptions of reality are invented. We enter the world hard-wired with certain assumptions based upon centuries of human experience. Upon arrival and during the first few years of life, our mental “processors” are soft-wired with data from parents and significant others, assumptions about life and how it should be lived. But if it is all invented, rather than expending energy upon negativity and problems, the Zanders’ suggest we may as well create a second universe of innovation and possibility. Two basic questions are given to help us make a paradigm shift: “What assumptions am I making, that I’m not aware I’m making, that gives me what I see?” and “

What might I now invent, that I haven’t yet invented, that would give me other choices?” Those who continually challenge perceptions and assumptions and embrace potential are more likely to be resilient through times of change and burnout.

Engage in community and a support system

In recent years, we Americans seem to be increasingly isolated from one another. This impression is more than subjective: it is borne out by the data. For instance, in his 2000 book, Bowling Alone, sociologist Robert Putnam presented extensive data showing the ways in which we Americans have become increasingly disconnected from family, friends, neighbors, colleagues and our democratic structures.

To fill this need for community building in the healing professions, Rachel Naomi Remen, MD, created a program called Finding Meaning in Medicine, establishing support groups for healthcare workers. A free (you must register first) Resource Guide Starter Kit is available at www.meaninginmedicine.org. A free support group facilitator’s guide for nurses is also available by contacting us at jlhenry@aol.com.

Anchor yourself in the present moment

Throughout history, philosophers have struggled attempting to understand and describe time. They probed whether time has a beginning, whether it has an objective feature or is only a product of subjective experience. Generally, before the 19^th century, there was little or no perception of linear time. All time was viewed as circular, as in the seasons of nature. Linear time came about because of our attempts to measure it, which today causes many of us to become fixated on watch time.

Based upon research, we know that one of the key dynamics of caring relates to being present to oneself and others. In this sense, time serves as a way to evaluate whether one is truly being present. Time seems to speed up when we are truly caring; an hour seems like ten minutes when we are engaged. On the other hand, when we remain detached and don’t seem to care about a person or activity, time seems to drag. Think of a person you dislike, who is dull or an argumentative know-it-all; in the presence of this person, ten minutes may seem like an hour.

Critical care nurse Lisa Wayman learned the importance of living in the present when the roof caved in on her. Her 11-year-old son, Joe, was diagnosed with a brain stem tumor and passed away within 18 months. As difficult as that period in her life was, Lisa believes that she learned a great deal from the experience. Joe’s life and death became a gift to both Lisa and her patients because it helped her move through a transformation process from appearing as a cold, uncaring clinician separating herself emotionally from her patients to becoming a much more human person of compassion. She states, “It was a journey through the dark night of the soul that I would not like to repeat, but it caused my growth to speed up. With Joe, I initially thought that the only good outcome would be his return to health. But I learned to let go and not try to control the outcome of an event. That was very difficult because I am the oldest child of the family and I always wanted to be in charge. As an ICU nurse, I knew what needed to be done and I did it. But I simply could do nothing to make my son live. So, I have learned to live in the present.”

Create a Self-Care Plan

Beyond some of the basics mentioned above, a wide array of strategies for self-care may be addressed, depending upon individual situations and needs. Some guidelines follow.

Pick a Goal That Turns You On

Build on strengths. Cultivate excitement. Starve problems and feed solutions. Goals that enrich your life are usually more successful--and are certainly a lot more fun--than goals that deprive you of something.

Check Out Your Available Resources

Start with your own personal resources. Were you an athlete in high school? If so, maybe you can reconnect with some of the habits and practices that kept you in shape back then. Do you love to cook? Maybe you would enjoy developing some nutritious natural-food recipes.

Design Freedom Into Your Goal

"I will allow myself to take work breaks to do yoga whenever I feel like it. I will go to bed early in order to give myself some quiet time in the morning before breakfast."

It is natural and normal for those in the helping professions to sometimes experience compassion fatigue. When you feel this coming on, begin by doing one thing for yourself during the day or the next weekend. You can begin climbing the mountain toward more fully becoming a self-caring person who cares for others by taking that first step.

Jim and Linda Henry are authors of The Soul of the Caring Nurse, Stories and Strategies For Revitalizing Professional Passion (American Nurses Association, www.nursesbooks.org, March 2004). They conduct workshops across the country on topics similar to this for individual and organizational enhancement and can be reached at jlhenry@aol.com