Recently I was invited to write an article on something I am passionate about for an innovative fairly new nursing magazine called Nursesfyi.  The latest edition just came out, and I am posting the pdf here, graciously provided by Rich Williams, the creator and editor of this magazine.  Rich Williams has been a nurse for 26 years and practices in New South Wales.  With this publication, Rich hopes to bring together nurses from all over the world to share professional information in a novel way–through the Apple Newstand (Geez, you can read it just about ANYWHERE on anything!). I am happy to see this kind of endeavor, as I feel strongly that we need to bring nurses together to support one another. The sharing of ideas globally is one great way to do it!

NursesFYI

Ignore the tap links as they do not work from the pdf file, but it will give you an idea of what can be shared through this venue.  If you have something you’d like to write about that would be of interest to nurses, I am sure Rich would like to hear from you.  For more information about Nursesfyi magazine and to subscribe, please go to http://nursesfyi.com/about-nurses-fyi-magazine

Years ago I had dynamic nursing professor who used to say that nurses are the only professional group who run around in a circle shooting inward at one another instead of shooting outward to protect and support each other.  Her words stuck in my head as I moved along in my career, sometimes working with really wonderful nurses and sometimes not.  Sadly, many people regularly share stories with me, which seem to validate that statement made many years ago.  Current day research, articles, and blogs suggest that nurses aren’t doing a very good job of supporting one another.  Perhaps it is because many feel burdened by the workload, or the lack of resources, or are working in an unhealthy, toxic environment.  Whatever the reason, it has never made sense to me that nurses, who are carers–that is who we are and what we do– could be cruel and/or uncaring to one another.  Yes, we are human; we all have both good and bad days. However, bad days can be made better by kind acts and compassionate caring.  Bad days are made even worse by dispassionate and unkind acts.

I believe that much of our woes in the profession of nursing can be attributed to not being appreciated and supported.  I emphasize this in my work as one of the biggest areas where we can bring about change.  We often do not appreciate ourselves, nor do we seem to know our own importance and the power we have individually and collectively.  We frequently do not appreciate and support one another, and consequently we do not foster a sense of community. This in turn has very negative effects on how we go about our work, and it ultimately affects the quality of care being rendered to people. It is a vicious cycle in that our unhappiness and discontent carries over into our personal lives and ultimately affects every single aspect of our being.

My second book, which explicitly addresses this topic along with other issues related to our professional quality of life and how it dovetails into the way we go about patient care, appears to have struck a chord with many nurses; it is now in over 25 countries and is being translated. Reviewers and readers have heralded it as a must read for every nurse. When I speak and teach on the topics I write about, I see the affirmative nods throughout the room, later validated by the many people who come up to speak with me or contact me by email. I am so glad the work is getting out there and is having such a butterfly effect! It was my goal to inspire nurses to reaffirm their purpose as carers and it is great to see that many are using my work as a guide to help them transform their own practice and their work environments.  Unfortunately, I have also been saddened to find that there are several entrepreneurs clearly using my book as a step-by-step template for their own work and advancement who have chosen not to cite me–not even a mention.  It is quite hurtful, especially given that I dedicated the book to nurses everywhere, (and whether intentional or not, it is unethical–which is perhaps a topic for another time), and it brings me back to the topic of nurses not caring for and supporting each other.

When those who work in health care, or indeed any human service, which includes academia and the government, choose not to support one another, it is a choice that has deleterious effects for everyone.  Of course, it affects those people who aren’t being supported, but it also affects the entire workforce and the people that they are serving.  I think that we need to get back to the basics; we need to recall the why of all of these human services (what is their purpose?) and then we need to start not only talking the darn talk, but walking, working and living the talk. I am emphasizing the word choose here, because we always have a choice in the matter, even when we think we do not.

I absolutely heart nursing.  No, I have not always been happy in all of my work positions during my over 32 year nursing career. In fact, I have been a victim of incivility, bullying,  and even mobbing by other nurse colleagues.  Yet I have always tried to do the right thing, to “do it anyway” (see Kent Keith’s work) because it is what and who I am.  I am a carer.  All of us in nursing are carers.  To choose not to support or appreciate ourselves and one another is absolutely wrong; it goes against our authentic nature.

It was always my intention that if I earned any money from the sales of my second book, I would donate a portion to a charity that supports nurses.  The royalty check came in April and I sent in my first donation–25 % of all my royalties from the book are going to Nurses House, an organization that is dedicated to helping nurses in need.  As an aside, authors whose work is handled through a publishing house typically earn approximately 10 % from hard copy book sales and 5 % from e-books–its not all that much money (and they set the pricing too).  My proceeds will likely not ever cover all the associated costs from doing the work I do (which my hubby calls extracurricular activities), but hell, I am “doing it anyway!” People sometimes ask me why I work so hard.  Why I don’t really give a hoot if it costs me out of pocket to get the work done.  I am asked all the time why I do not charge a set speaking fee when I undoubtedly could command high(er) honorariums. Why I cannot, will not, “go along to get along” when it has without a doubt cost me dearly on occasion.  Well, the reason is simple.  I care; I am a sensitive old soul who has a passion for caring. And I do it all because, as I have said in other places, “We (nurses) are engaged in the most important work there is—for what could be more important than assisting people to actualize their potentials to live well and die well?” (Todaro-Franceschi, 2013, p. 195).

It really is more than time for nurses to support nurses; for us to appreciate and value each other for our talents, skills and service.  Our work is about serving others and in order to do that we have to take good care of ourselves and each other first.  It is time for us to ‘fix’ us–no one else is going to do it.

If you’d like to join me to support Nurses House you can go to:
http://www.nurseshouse.org/documents/DolphinSummer2014.pdf

If my words are resonating with you and you want to help fix us,  in my work I offer much food for thought along with ways to help address individual and collective compassion fatigue, burnout, moral distress, and death overload, along with a shot in the arm about butterfly power, advocacy, and assertiveness… all so that we–nurses–can keep loving what we do. The book is available at Amazon, B & N and other bookstores. as well as through the publisher.  Or you can grab a copy from one of the many libraries that have it  (including  hospital libraries).  If you find my work helpful, please pass it along to enhance the butterfly effect and if you do use my work as a template, could you please cite me? (I would appreciate the mention, and Nurses House will surely get more donations from book sales if people give credit where due).

Wishing you peace, love and light.

Below is a link to an article I wrote on bullying and incivility in nursing and applying the ART model published in New Jersey Nurse. 

If we want to make things better, we have to work together… Do you belong to your State Nurse’s Association?  There is power in numbers.

http://nursingald.com/uploads/publication/pdf/1035/New_Jersey_7_14.pdf

Burnout is a serious syndrome that is unfortunately affecting many carers today.  I equate burnout with a person who appears almost “heartless,” a person who no longer seems to care–about anything.  People who are burned out are detached, disconnected, disengaged, and dispassionate–they have lost their sense of purpose and are losing their moments.  In a way, burnout is a widespread disenchantment with one’s work.

When we are enchanted, we are enamored with something—we value it as something worthwhile. We are more apt to be engaged, interested, and motivated because we like whatever it is we are doing.  Conversely, when we are disenchanted, we are more likely to be disinterested and unmotivated. We are emotionally empty—heart empty—and suffer with a generalized apathy. It is a form of suffering that transforms our very being into an almost non-being kind of existence. It is when we become routinely robotic.

Of all the professions, nursing is the one that has been most studied in relation to the phenomenon of burnout. Why is that the case? Well, there are many things that I think stack the deck in our favor for developing burnout, including the way nurses are educated (a topic I rant often enough about but it would take too much space and time here). There is also the fact that it is still a predominantly female profession, and lastly, there are the oh, so many, not so nice things that contribute to an unhealthy work environment (such as inadequate staffing, lack of resources,  poor management, and relational problems, ie. bullying, incivility and sometimes even mobbing).

Burnout is said to be the result of cumulative frustration with one’s workplace environment, and for nurses, many of the things that contribute to our frustration are relational in nature. They have to do with whom we work, how we interact and communicate with each other, and whether we are respected and valued for what it is we do. Since a lot of the things nurses do may not be acknowledged or valued, many nurses who began their careers as very compassionate, competent carers, over time seem to value less the caring aspects of their own work. It is then that the technical skills and the lab values might become more important than the human-to-human connection. I think of this as disenchantment in action.  This is when the science (of nursing and indeed any caring profession) is likely to become more important than the art, for caring is indeed an art. As a result, the science becomes more visible, while the art is discernibly less visible and in some cases seems to disappear altogether. When that occurs, with it comes burnout.

It would seem that burnout is a kind of defense mechanism similar to pulling your hand away from something hot. Shut the switch, pull the plug, become numb, and protect yourself. The difference and the irony is that in flicking the shutoff switch, we actually hurt ourselves as well as others. Carers are meant to care-it is who we are and what we do. When we no longer enjoy our work we are no longer being authentic to our own nature. We lose ourselves.

There are a great many signs and symptoms that may manifest when one is suffering from burnout-the cardinal sign is said to be physical and emotional exhaustion. I especially like nurse Melanie Chenevert’s list, which includes whining and bitching, among other appropriately labeled things; however, all jokes aside, burnout is serious stuff.  The one thing that I think is a sure sign of burnout is when you really hate getting up and going to work. At that point you are in genuine trouble, and, unfortunately, so are your coworkers, your patients, and your loved ones. That is because unhappiness and apathy become part of a negative feedback loop–an unfavorable butterfly effect.

Researchers continue to report that a great many nurses and other carers are burning out. And we all know that burnt out, unhappy people are less likely to do their work well. But there are things we can do to get back the joy in our lives and in our work (see the ART model for a simple three step guide www.qualitycaring.org).  It is more than time for us to tend to our own wounds; we need to do it for the sake of us–carers, and for those who are trusting us to care.

As an aside, for me much of this is about energy and transformation (and butterflies), a topic you can read a great deal about on my other, much more philosophical website: www.energy-enigma.com (based on my doctoral research in the 1990s–the published book is still floating around). Essentially it is about how we actualize our potentials as human beings.

*Parts excerpted from my book on compassion fatigue and burnout in nursing, first published in late 2012 by Springer.*

During several recent keynotes at events where nurses and other health care professionals were in attendance, I introduced my idea of “flutterbying,” and the response was so overwhelmingly positive, I am utterly convinced that the concept of  “flutterbying”  has real merit.  So please feel free to use the term to promote positive change.

I often say (and write) that “compassion provokes purposeful action.” When we care about other people (or I might add, other living things), when we feel love for them, it compels us to do things right-to follow the Golden Rule-to do unto others as we would have them do unto us. When we are able to put ourselves in another person’s place-whether good or bad, happy or sad, we acknowledge their humanness and our inextricable connectedness.

For many years I have used physicist David Bohm’s words at the end of my email signature: “To see that everybody not merely depends on everybody, but actually everybody is everybody in a deeper sense.” His words resonated with the findings of my philosophic work into the enigma of energy. It is all essentially one. The notions of butterfly effect, and what physicists Briggs and Peat refer to as butterfly power, combined with ideas of love and compassion congeal to form an ethic of care that takes us beyond ourselves to acknowledge the larger whole. That everything we do is not just reflected in the whole-it is the whole.

As I sat here working on an upcoming keynote, I remembered someone in the audience coming up to me after I presented my opening talk on Reawakening the Passion for Caring at the Barnabas Hospice and Palliative Care conference in New Jersey. She said that I needed to take my talk to the Tea Party and her comment got me thinking. My talk that day wasn’t just applicable to those working in nursing, medicine, social work, psychology, chaplaincy, and education. It was also applicable to every other human endeavor that contributes to the whole-and that of course includes the politicians. We all need to be cognizant of how our actions transform the one; we must continually remind ourselves.

Perhaps we need a word that will not only denote the subtle influences that can make or break our world (the butterfly effects) but one that could serve to remind us of the purposeful acts that we need to strive to do as we go about our day-to-day living and working. Something that represents and reminds us of the meaning and purpose in our lives and work. Something that gets at our individual and collective butterfly power.

The word that came to mind is of course related to butterflies: FLUTTERBYING. The term “flutterbye” is noted to be a childish way of saying butterfly-but we all know that children are very smart little people! Butterflies flutter and float, right? Since butterflies do flutter by, the word “flutterbye” doesn’t seem to be very childish to me. I think with the ‘ing’ it nicely denotes purposeful action and I plan on using it. My definition of flutterbying (for the time being, anyway) is: enhancing and transforming the quality of living-dying for all—through mindful awareness of our butterfly power and its effects.

Life is a gift, and an enormous responsibility. Every single thing we do transforms the one and our mindful awareness of this should provoke all of us to do whatever it is that we do, well; to meaningfully, purposefully and passionately participate in our wholeness-oneness…we can strive to do it with our flutterbying.

I am pleased to share that on October 24th, 2013 I will be the speaker for the annual Ann Baran Lecture of Trinitas Regional Medical Center in Elizabeth New Jersey. The title of my talk will be: “Compassion Fatigue and Burnout in Nursing: The Heart of the Matter.” For more info, please call Danielle Anderson, 908 994-5345.

I am very pleased to share that I was invited to be the opening speaker with a talk on “Reawakening the Passion for Caring” at the Barnabas Health Hospice and Palliative Care Center annual conference in West Orange, NJ on October 4th 2013. For more information: http://www.barnabashealth.org/hospitals/hospice/acrobat/End-of-Life-Conf-Bro-13.pdf

Many say that compassion fatigue is a consequence of caring for those who are suffering and that nurses and other professionals engaged in health care are likely to develop it at some point or another.  My experience with John Doe (in the digital story on my home page) is an example of how swiftly and easily compassion fatigue can evolve.  Knowing what we do (or think we do!) today, might those feelings of compassion fatigue been prevented if I had not been assigned to care for John over the course of several days?  I am not sure.

I do think that if I had been practicing mindful awareness as I went to work, I would have been able to pick up cues that compassion fatigue was developing; I would have been able to tend to myself and perhaps through journaling or meditation, averted the incident where I fell apart all together. In any case, I know that the way my charge nurse acknowledged my feelings and actually showed me (and my co-workers) through her actions, compassionate caring and understanding, helped me to deal with it and to heal.  Had she not acknowledged my suffering, I would have suffered more and over time my wounds might have festered-resulting in more fatigue and perhaps eventual burnout.

Good leadership is vitally important to organizational wellness and professional quality of life and it hinges on compassionate caring.  When a leader acts with compassion it is transformational in that it enhances the well-being of the people who work in the organization, as well as the quality of the work they do.  Conversely, when a leader does not acknowledge the humanness of staff and their potential suffering, wounds are allowed (and sometimes actually encouraged) to fester.  Staff will feel undervalued and without a doubt it will manifest in various negative ways such as, lateness, absenteeism, poor morale, incivility, decreased productivity, and in the case of patient care, well, overall quality of care will unquestionably be affected.

I am a big fan of the organizational behavior scholar Peter Frost whose work emphasized the importance of compassion in organizations and how bringing the importance of compassion into awareness and changing organizational culture can yield amazing results.  One of his books, Toxic Emotions at Work provides insight as to how leaders can handle toxicity in the workplace and also how some leaders promote toxicity in the workplace.  I cite him often.

Ultimately, in order to avert or heal from compassion fatigue and/or burnout, the first step is to acknowledge there is a problem, thus, being mindfully aware of how we are going about our work is important for us individually and collectively. When compassionate leaders acknowledge that suffering exists in every workplace and that we are all human, they foster a community of caring that is palpable. In nursing that equates with quality caring for all.