"Get Curious" About Self-Care

Amanda Burns has a unique perspective on mental health in the nursing profession. The Pitt Meadows nurse works as a registered nurse and registered psychiatric nurse, as well as a registered clinical counsellor, running a private practice for nurses and first responders.

Burns moved to BC from Ireland when she was five years old with her parents and older siblings. She explains that from an early age she was intrigued by how the brain works and how feelings and emotions can dictate our lives. Her desire to pursue a career in mental health was furthered after she grew up witnessing someone close to her struggle with mental health challenges. These personal experiences led Burns to enrol in a psychiatric nursing program after graduating from high school. After completing her training at age 19, Burns went straight into work at an acute psychiatric nursing unit at Royal Columbian Hospital, where she still works today.

"I was able to administer psycho-active drugs before I was able to legally drink," Burns jokes when reflecting on the beginning of her career in mental health.

In the early years of her career Burns's father was diagnosed with terminal cancer. This led her to continue training and receive her RN designation so that she could work in palliative care. Having established herself both as an RN and RPN, Burns recalls that working in acute psychiatric care and palliative care gave her an initial sense of the links between the health of the body and the health of the psyche.

"I think that's where, early on, I feel like I got it. I understood that we're not cut off from the head up ... or the neck down," she recalls.

Over her career, Burns continued to work in psychiatric nursing while exploring other areas of nursing practice. She has worked in palliative care, medicine, homecare and as a sexual assault examiner. These experiences underpin her approach to mental health, which she describes as a holistic outlook that seeks to tackle not only psychological factors, but also biological and societal influences. This approach is the foundation of Burns' private practice, which she set up a few years ago specifically to support nurses and first responders. She says her decision was made partly out of frustration at the nature of hospital work, where Burns found she was only ever able to help people at the extreme end of the mental health continuum.

"People walk along in that continuum all the time," says Burns, explaining that she was keen to support people with their everyday challenges, not only when they were in crisis.

But it was a meeting a firefighter who was also working as a mental health counsellor for first responders that inspired Burns to apply the same approach to supporting nurses.

"We've got to be more open and informed about our own mental health and the implications and consequences of not tending to ourselves."

 

- Amanda Burns

Burns, who holds a master's degree in counselling psychology, now splits her time between her work as a nurse at Royal Columbian and her private practice, which supports nurses and first responders coping with the mental-health challenges of their roles.

Burns says the findings contained in the recently published UBC School of Nursing survey of BC nurses' psychological health and safety during the pandemic come as no surprise.

"Nurses have been dealing with that [mental injury] consistently, whether it was before COVID or after COVID," she remarks. "The public is more aware right now of all health-care professionals because of COVID but the issues are not new."

Burns notes that COVID-19 has exacerbated existing mental-health stressors that are all too familiar to nurses: workplace violence, shift work, working short, policy limitations and challenging patients. She adds to this list the moral injury that results from "rigid bureaucracies," and the additional harm that arises when organizational barriers prevent nurses from fulfilling their obligations to care for their patients.

Burns also says the public health restrictions preventing family visits to patients and residents make nurses susceptible to the emotional residue of their patients' trauma.

"The psychological health of patients could be supported by family and friends. But now they don't have that. So, the only person they have to meet their physical needs and tend to their psychological safety is their nurse – and you simply can't," she explains. "So we already feel like we're failing.  We are witnessing fear, terror, distress...and that feeling is compounded when we actually can't do anything about it."

Burns warns the most significant impact that COVID-19 may have on nurses' mental health lies in its uncertainty. "We're a tough bunch of people. We can keep pushing through, but everyone needs to know there's an end in sight."

Tackling organization barriers to improved workplace mental health is a long-term goal that requires ongoing commitment. To date, real progress has been made, and BCNU is committed to creating accessible mental health supports for its members.

The union's personal resiliency workshops are designed to help nurses identify things like compassion fatigue and signs of post-traumatic stress disorder in themselves and their colleagues. Many members have found the workshop invaluable.

BCNU's focus on mental health also led to the negotiation of the Canadian National Standard on Psychological Health and Safety in the Workplace during 2015 Nurses' Bargaining Association contract talks. This standard is a set of guidelines that commits health employers to develop a system of positive factors that support psychologically healthy and safe workplaces. Implementation of the standard will take years and much effort from both the union and employers. But, once complete, nurses will be one of the first group of workers who will be able to refer to a normative measure of workplace psychological health.

So, while nurses continue to fight for safer workplaces, Burns poses a vital question: How can nurses help themselves and their colleagues navigate through the extreme stresses of their role, especially when there is no clear indication of when the global pandemic might abate?  

Burns advocates for a response grounded in better self-care. She also makes a passionate call for the evolution of an increasingly compassionate culture within the nursing community. However, she is clear that achieving these goals means challenging beliefs and attitudes that block nurses' ability to meet their own self-care needs and those of their colleagues.

Burns says the close bond between nurses has the power to help colleagues through dark times. However, she notes that the stigma surrounding mental health, and some people's behaviour when confronted by it, can prevent those in need from seeking help before they hit a crisis point.

"Nobody likes the words 'prejudice' or 'discrimination,' but we have to have real conversations [about this issue]," she argues. "There's still misinformation about what depression and anxiety is and how it shows up – it's not a personal weakness," she stresses.

A common concern among nurses, according to Burns, involves the fear of being seen as a "weak link." To avoid the judgment of colleagues, many nurses believe that they should simply "suck it up" when it comes to dealing with mental illness. Burns explains why this attitude is flawed:

"If you've had a 12-hour shift and you don't go to the bathroom once, you come home and instantly you know you have to tend to that. You're not going 'oh gee, my bladder should suck it up.' You understand that it's a physiological reality and you respond to your body's needs accordingly," she explains. "Unfortunately, with mental health, we do prioritize other people and we do judge ourselves and each other rather than just taking those few little minutes to tend to the physiology of the body and let that whole system settle down."

This fear of judgment is often unintentionally generated by the attitudes of colleagues.

"You'll always take five minutes to tend to that [full bladder], or to eat, but if you want to take five minutes to go for a walk, people look at you like you're insane."

While acknowledging that nurses need to vent their frustrations, Burns explains how this can serve to discourage open discussion around mental health:

"We hear comments like, 'oh that grumpy person,' or, 'that nurse, she's got issues.' We hear that, even if we mean it lightly. I am not saying that we have to constantly watch what we're saying but we have to really be careful about the words we're choosing. Absolutely, nurses blow off steam. We absolutely love dark humour. But we have to be careful about the terminology we're using," she warns. "Unfortunately, when nursing pressures and nursing shortages are there...you end up getting mad at the nurse rather than the organization. That's scary. The work itself is already taxing but we can't forget to care for each other."

"When we attune into ourselves, we can attune into other people."

- Amanda Burns

There is no question Burns is passionate in her call for nurses to display compassion towards each other and to facilitate safe discussion around mental health, but her overriding message is for individual nurses to take charge of their own self-care. This begins with simply noticing what's going on with mind and body. 

"What I really want to advocate for is nurses to be way more attuned. Notice what's going on so that you can get to it sooner and be much more proactive. I always tell people, 'just get curious.' Check in, and not just when things are bad.

"What's been going on in my thoughts lately? What's going on with the emotions? Are they serving me? And again, tuning into the body. Am I eating more? Am I eating less? Am I drinking enough fluid? How am I sleeping? How are my relationships? Am I able to feel connected? Am I socializing? Am I able to be present with the people in my life that I love? Am I able to be present in my hobbies and my activities? Am I just going through the motions?

"And, when we attune into ourselves, we can attune into other people. Are you noticing a colleague is more irritable, maybe calling in sick more, maybe showing up to work sick, maybe taking too much overtime and working constantly, maybe they are quieter?

Burns says she always makes time for self-care despite her own busy life.

"I love spending time with friends and family, I love walking with my dog, I like binge-watching shows," she says. "I don't need to come to any grand conclusions, I just need to give myself five minutes to breathe. They say emotions exist for only 90 seconds. But we keep that emotional content going by either denying it or attaching assumptions about what that emotion is. So, I just sit with things and I notice how my body is responding and what it's telling me."

As someone who experiences the challenges of point-of-care nursing every day, and who is a counsellor supporting nurses suffering from the demands of their role, Burns offers a unique perspective on how to handle the pressure the profession places on nurses' mental health. She calls on nurses to be honest with themselves and others, and to have real conversations about mental health.

That honesty also means the onus of improving mental health within the profession falls not just on employers, but on nurses and the nursing community too, she says.  It's a message born out of compassion for colleagues and a passion for the profession.

Attitudes about mental health are improving. Yet Burns says she still meets nurses who have significant fear about the nursing college learning they are going for counselling or having mental health issues. "There's a big fear of punishment. But I always tell them that the college identifies psychological fitness as a standard of practice – so it's not attending to mental health issues that's the problem," she explains. "Self-care, both physical and mental, is just simply good practice for our personal and our professional lives."

Despite these challenges, Burns is whole-heartedly optimistic about nurses' growing appetite for conversations around mental health.

"I'm unapologetically encouraged and hopeful that nursing culture can make huge, positive shifts moving forward," she says. "The most courageous thing we can is to be willing to be vulnerable. I think the time is now. I think COVID has thrown it right in our faces. As a society, and definitely as a professional group, we've got to start doing that. We've got to be more open and informed about our own mental health and the implications and consequences of not tending to ourselves." •

UPDATE (Winter 2020)

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