By Nanci Harris, BSc Nursing
The notion of self-care is no longer an exotic or optional practice for healthcare workers. However, the way in which it is effectively incorporated into the life of a nurse working in a mental health setting is not routine by any means. Given my experience as a nurse for over a quarter century in the addiction treatment field, I have reflected on what it means to effectively integrate self-care into practice. In the “caring professions,” burnout is becoming more and more common. This unfortunate outcome may be intensified, given that individuals seeking help for addiction or other healthcare services are presenting with very complex problems. Therefore, self-care becomes imperative to ensure there isn’t a “cost of caring” for those providing the care.
For 15 years I worked at a women’s addiction treatment program and it was there the issue of self-care for staff became apparent. In particular, a counsellor who was working with women with identified trauma histories began experiencing unusual fatigue and a feeling of disconnection with some of her clients, canceling appointments and not sleeping. These symptoms are now recognized as possible manifestations of “vicarious traumatization.”
Vicarious trauma, sometimes also called compassion fatigue, can occur to individuals who care for others who are suffering or in distress. Being exposed to others who have experienced trauma — listening to their stories, bearing witness to the pain and fear, and working with them — can create vicarious trauma in counsellors and nurses.
It is my belief that nurses, and particularly those who work in addiction treatment, are at risk of experiencing vicarious trauma by the very nature of the people we are caring for on a daily basis. In the 25 years I’ve worked in this area I’ve seen the “typical client” change dramatically. In the 1980s and early 1990s, individuals seeking treatment for addiction were dependent mainly on alcohol, prescription drugs and cocaine. Clients usually had some family support, often some form of employment, and rarely disclosed a concurrent mental health issue. Now, the majority of individuals seeking addiction treatment is dependent on multiple substances, including highly addictive opiates, and also has histories of trauma — be it emotional, physical and/or sexual. In the past, these were not always recognized as underlying issues associated with the addiction and were certainly not addressed in treatment. But now, it is becoming the rule rather than the exception that clients being admitted for addiction treatment also present with a co-occurring mental health issue and require more complex care. This places more demands on the nurses and staff, who may begin to experience ongoing fatigue, stress and possible burnout as a result.
What makes self-care even more important is that most nurses experience the stresses of long shifts, overtime and the effects of shift rotation; all of which can be physically taxing and tough on family life and friendships. Given the emotional and physical demands of the job, nurses can sometimes internalize their feelings in order to stay in control and make tough decisions in a short period of time. At times, nurses can go from one emotionally and physically demanding situation to another, and may have little opportunity to process their experiences and decompress. It is these conditions that can contribute to burnout and compassion fatigue.
Nurses by their very nature are people drawn to help others, provide empathy and put others ahead of themselves. They must be mindful of the impact these increased demands have placed on them as primary care providers. Employers need to demonstrate recognition of this impact by providing education, support and opportunities for staff to debrief. They must ensure staff receive the training they need to offer care appropriately and to recognize when someone may be on the verge of burnout leading to blurred boundaries, unhealthy coping strategies and even depression and anxiety.
To avoid the pitfalls noted, it’s important for individuals in the caring professions to consider the following strategies for self-care:
- Get enough sleep — sleep deprivation is our worst enemy
- Maintain a good exercise and nutrition plan — these are the best tools for managing stress
- Engage in mindfulness meditation — it isn’t hard and it works!
- Talk it out with someone you trust – either a friend or colleague who understands, or a professional counsellor
- Leave work at work — that means ensuring you are supported by your supervisor to receive regular supervision and have in place boundaries between your work and personal life
- Keep your learning current so you have the right tools to do your job and know your limits
- Know when to say no — this is hard for women in general, and even harder for nurses who don’t want to let anyone down
Being committed to ensuring that you incorporate at least some of the above list into your personal commitment to health greatly increases the likelihood you won’t end up drained and disheartened to the point you believe you can’t do the work anymore. Addiction nurses are a special group of care providers and their contribution to someone’s recovery is, I believe, a fundamental component of their journey. But, it is nearly impossible to teach wellness to someone else if you don’t practice it yourself.
As someone who has often been identified as a “human doing” versus a “human being,” I know all too well the risks of over-extending. I wouldn’t stay working as a nurse in this field if I didn’t love what I do and have the chance to be a part of people’s journey back to good health and positive well-being. For me, the work is a privilege and keeps me grounded in what are the priorities in my life. To manage my choice to work in this area, I stay mindful of what is considered good self-care. That doesn’t mean I’m always successful at practicing self-care, but I’m a believer that being informed in what I can do gives me the tools I need to stay healthy and remain a good nurse.