Oxygen

I quite often listen to Radio 2 as I go about my day to day life, it’s on in the car, the kitchen and even the office, I like the mix of music and chat … this week Chris Evans was discussing some rather interesting stuff that really resonated with me.  The section was all about worry and stress and whilst I mostly don’t get too stressed I am a worrier so the conversation was one that I stopped and listened to. Chris and the person he was chatting to (apologies I didn’t catch his name) were talking about how we can cope with stress and worry and the phrase “put your own oxygen mask on before helping others” This was something that I had not heard in this context before and it certainly made me wonder … do we do this in nursing?

Entirely by coincidence last week I ran a series of Twitter Polls through WeNurses asking nurses if they had taken their break that day.  I ran it for 3 days … and here are the results:

Whilst the polls themselves reveal some concerning results the comments made in reply to the polls were perhaps the most interesting part:

 

Not taking a break means that we don’t get to rest, eat or drink.   Hydration amongst doctors and nurses on call (El-Shakawry 2016) is a study that looked at the scale and impact of dehydration on doctors and nurses.  The study found  ”Thirty-six percent of participants were dehydrated at the start of the shift and 45% were dehydrated at the end of their shift” and “Single number and five-letter Sternberg short-term memory tests were significantly impaired in dehydrated participants” This doesn’t even take into account hunger or tiredness … and what about the long term effects on mental health and wellbeing and morale? Not taking a break is a serious problem in nursing and you might argue one that affects the care we deliver, yet from the comments not having a break seems so … well … normal … and .. acceptable!

I wonder if we were to view our breaks as oxygen masks would we think differently about the importance of them? I am not being flippant here, I honestly think that we need to take this approach.  We have to take care of ourselves before we can take care of others – how can we make important care decisions if we are have not rested, eaten or drunk throughout the course of our shift?

break

At this point I feel I must confess that I have often been on a clinical shift where I have not taken a break and recently I have been reflecting of why this has happened.  Sometimes the shift has been very busy and there just doesn’t seem to have been time for me to step off the floor .. so given the now established fact that breaks are akin to oxygen masks would I do this differently? Yes I think I will – no matter how busy the shift working tired, hungry and thirsty is counter productive and we need to recognise this.  If I were on a plane and attended to someone else’s oxygen mask before my own I would soon be on the floor gasping for air and we would both be in trouble ! By taking a break this means I can return to my work refreshed and able to care more effectively.

Although taking breaks whilst on duty takes a change in individual mindset I also think that we have to support colleagues to take breaks to … ask them if they have had a break, do that urgent thing for them whilst they go off the floor, reassure them that you will care for that really unwell person and tell them that in order to care effectively they must take care of themselves.  We also need to address organisational culture – is it normal in your work environment that people take breaks? How can we make this a good thing to do? How can we check that people have had a break? How can we support people to take breaks?

The choice is simple – we can either care until we drop, leading to unwell nurses and poor care … or we can take a break and breathe in the oxygen that enables us to provide the very best of care.

oxygen2

The problem with resilience

I think that’s it’s time to open up the debate on the term resilience – I have a problem with resilience, I know its en-vogue currently for nurses to be resilient, and in theory I get why, but in reality I am not so sure.

How about we start this with a definition …. The internet says resilience is:

Screenshot 2017-07-03 11.06.03

 

I think this is where my problem with resilience starts – recovering quickly, bouncing back and toughness are concepts I find hard to reconcile as a nurse.  Here’s the rub .. I don’t think that I am resilient.  When things upset me I often take them to heart, I can find it hard to recover quickly and spring back and I am not sure that I need to.  I feel what I need are good support networks and self-care so that I can reflect and grow from experiences.  When something adverse happens, I don’t want to be resilient, I want to be human, but I want someone to ask me if I am OK … in the same way that I would ask them.

I recall a particularly tough day whilst working as a care home manager a good few years ago now.  I felt really ill, I had a really bad head cold, I had been in work since 5 am, I was dealing with a number of incidents and short staffing.  I had a phone conversation with my manager during which I asked if it was ok if I left early as I wasn’t feeling 100% and had been at work since very early … she told me I had to be more resilient.  I got off the phone and sat and cried.  Whilst I was crying at my desk another of my managers walked in – he asked, “are you ok?” Of course, I wasn’t but he sat and listened. We brainstormed a few things to help with the staffing and the incidents and he told me to go home and rest.  The first manager epitomised everything I hate about the term resilience and the second show cased everything that is right about supporting one another.

woman-1006102_1920Having had a few discussions on Twitter about resilience I can understand that it’s not the term itself but perhaps how we apply it.  With this in mind it is only fair to look at resilience in the context of health (and not just an internet, black and white – definition) Murray (2014) states:

Resilience can be defined as ‘the ability of an individual to cope with and adapt positively to adverse circumstances’. Resilience has been identified as comprising a serious of personality traits such as optimism, self-efficacy and hardiness which enable an individual to cope with increased adversity. Increasingly, resilience is viewed as the combination of internal and external factors, a dynamic process which develops over time and one which can be learned” 

I agree that we need this! I agree that as nurses we need to be able to cope with increased adversity and yes I love that resilience could be a combination of self-care (internal factors) and support (external factors) I do take exception to the word “hardiness” here but let’s set that aside as the definition within the context of health sounds pretty utopian to me and perhaps what we should all be aiming for. To me though this description is not resilience as I have seen it.

This leads me to think that resilience is the wrong word, I think that it does what we are trying to achieve in nursing a huge disservice.  This isn’t about toughness or bounce-back-ability this is about support and self-care. It’s about what we do to take care of ourselves and what our colleagues and organisations do to take care of us.

So what is the way forward? How do we equip the nursing profession with the skills to cope with adversity? I don’t think that anyone has or ever will become more resilient by a colleague telling them that they need to be resilient! The term resilience, when used like this, seems rather like telling the profession to “man up”! This is not healthy or productive.

I rather like what the police are doing…. Have you heard of Oscar Kilo? There is a great link here that explains all > https://oscarkilo.org.uk/about/ The Oscar Kilo website states

 “We need to get the message to our staff that “it’s ok not to be ok””

Oscar Kilo doesn’t talk about resilience it talks about health and wellbeing.  It acknowledges that policing is tough and that people are affected by the things they see and the role they have but it focusses on support, health and wellbeing.

Screenshot 2017-07-03 12.06.36I guess at the heart of this is that I feel that the term “resilience” is a spoiled fruit.  I can see that there are good intentions by encouraging nursing and nurses to be resilient but I don’t think that this term can be used as its synonymous with hardiness, bouncing back, being tough and manning up … and do you know what … it is ok not to be ok!  I think that we should acknowledge that nursing is tough and learn and grow form this, support ourselves and each other … ask that question to yourself and to colleagues … are you ok today?

 ok