Read an Excerpt

Nursing by Heart

Transformational Self-Care for Nurses

John Hunt Publishing Ltd.

What Would It Be Like If ...?

What lies behind us and what lies before us are tiny matters compared to what lies within us. ~ Ralph Waldo Emerson

A revolution in nursing is transforming how nurses practice their profession.

Nurses are some of the hardest-working people I know. We are practical, decisive, and organized with an inherent desire to care for others. The art and science of nursing need to be one, where compassionate care is as prized as the knowledge and skill to deliver expert care. But nurses are exhausted, burnt out and frustrated. Nurses need to know how to care for themselves on a deeper level than what is currently on offer — the usual self-care advice. Self-care is multifaceted, but care of the spirit can't be ignored for true self-care to exist.

The old transactional model wherein nurses followed directions from others, with little of their own input, is being laid to rest — the end of the old paradigm. The old hierarchical structure no longer serves the needs of the health system or recognizes the expertise of nurses as the greatest resource in any hospital. This presents a challenge for some aspects of the nursing profession, as we are encouraged and expected to have a voice, share ideas, and create new models of care; but perhaps we are still constrained by the old and resistant to this new level of responsibility.

An intense focus on nursing in recent times has encouraged transformation of the way we practice nursing. I have had the pleasure and privilege of being part of that change, as both facilitator of a leadership program and trainer of a reflective clinical supervision program, working alongside other wonderfully skilled facilitators who have a vision for nursing wherein all health professionals within teams are empowered to deliver the best possible care. For empowered teams to work, each member must be recognized as having a contribution to make to its health and functioning.

I offer here a perspective that has not been explicitly addressed in this transformational movement but is very much present in all we do as humans. I present practical tools to incorporate into our practice, beginning with cultivation of a relationship with self — acknowledging ourselves as something much more than just physical beings. This allows us to explore who we really are — which is much more than what we perceive — and to build from the strongest foundation possible.

Empowering the self changes how we engage with others. Raising awareness of how we are in the world and of the impact we create fosters new opportunities for behaviors that are self-loving and attract others to want to work with us.

With the health dollar shrinking, our traditional resources are under pressure, and workloads are a constant concern for nurses, but our relationships with others are underdeveloped, and these are our richest resource. I have often heard nurses exclaim that their difficulties in the workplace come from other nurses, not from caring for patients. This situation is not peculiar to nursing, as our relationships with others constantly challenge us to find ways to connect with others to understand each other.

Why is this book so different from others? It acknowledges that each of us embodies the potential to transform self, our practice and our relationships with others by addressing what is at the heart of our profession, seeing ourselves in a fuller sense.

We are energetic beings, and we can manage our energy field through understanding this and learning to be more conscious of how we fundamentally engage with others. We live in a sea of energy — to which we and others contribute — the energy that bathes us on this planet.

Imagine what it would be like to be able to manage our own energy field rather than to be at the mercy of what others project onto us. I invite you to feel the implications for our nursing practice as we envision a future wherein each of us takes responsibility for what we emote or share energetically with others.

I have been nursing for more than thirty years and feel excited to be part of this change. We will all benefit. Patients will experience the best possible care, as we relate to them by honoring their wholeness, not just their physical being. They will be respected as the experts of their care, and they will be cared for by cohesive teams of people who value creativity and collaboration, bringing forth collective knowledge and wisdom. Each of us will bring a unique voice to the delivery of care, and each will be acknowledged for her or his unique contribution. The organizations and institutions that employ us will benefit from a profession driving change that impacts one and all.

This new paradigm differs greatly from what I experienced as a young second-year nursing student in 1984. I was on a three-month placement in the Intensive Care Unit in a large teaching hospital in Adelaide, South Australia. I was rostered on ten consecutive night shifts after a week of day shifts. When I questioned this, I was told this was the usual rostering practice and 'just the way it was.' This acceptance of a practice that was potentially dangerous to both the nurses and the patients in their care puzzled me. I wondered then, and often again over the years, what drove this acceptance. At the time, I braced myself for the long nights ahead and did my best to stay awake on the forty-minute drive home, windows down, eating fruit or sugary foods, willing myself to concentrate on the winding roads climbing the Adelaide Hills. I was so exhausted by the eighth night that I rang the supervisor in tears to say I couldn't come in, sharing honestly the reasons. I was told I must report for duty as rostered unless I was sick and had a doctor's certificate.

This taught me that as a nurse I wasn't valued and that the needs of others were always to come first. There was no understanding that my welfare was related to the care I could provide for patients. I believe this rostering system was a part of nursing training, designed to produce nurses who followed directions. Parallels with the military were evident. I remember thinking what a strange system I worked in, given that nurses were the backbone of hospitals. We were trained to have diverse skills and to expertly care for very ill patients, yet we were treated like naughty school children. This seemed to create a culture of blame, as, when people believe they are without influence, they can direct the energy of frustration and resentment towards each other. I am sure that we can all recall an experience of this, and perhaps, driven by frustration, we have originated such behavior.

I am curious to know how this hospital-based training continues to impact us today.

How much impact does this have on how we support new nurses entering the profession?

How can we contribute to empowering nurses to value themselves and others, and what influence can we have on our profession by embedding new ways of nursing practice?

A year after completing my training, I decided I wasn't cut out for general nursing. I enjoyed the diversity of the experience and making a difference in the lives of patients, but I felt suffocated by the oppressive culture. I was attracted to Mental Health Nursing, believing it offered a different experience wherein diversity was accepted and nurses were encouraged to have a viewpoint, as there was less certainty in this specialty area. My belief turned out to be somewhat true and somewhat false. There was, indeed, a greater acceptance of diversity, and nurses were more encouraged to express their views, but those views could be judgmental, reflecting the unresolved aspects of each of us — saying more about the person expressing the view than about the patient.

I became more interested in how I could help the patient without imposing my own bias and unresolved issues. I seemed to find my niche, and I stayed in Mental Health for more than twenty years, training in one of the original psychiatric institutions in Sydney, Australia then working for six years in an acute admission unit in the inner city and, later, caring for mentally ill patients in jail.

Within healthcare settings, there is growing interest in working with the principles of collaboration and engagement, fostering well-functioning teams in which each member accesses her own knowledge and brings it together with that of others, in respect and consideration, to create team empowerment. The challenge I see for nurses is in fostering a strong belief in self — the confidence to find, and express from, a space of liberation, breaking free of the limitations of the old paradigm, building internal resources and creating a new box of tools to draw upon in the practice of nursing.

Teaching nurses the importance of caring holistically for the self is foundational; and giving care to patients from a space of fullness rather than depletion is essential for the profession. Increasingly scarce resources in healthcare is a real issue, but we have a wealth of resources in human potential. Can you imagine what nursing will be like when each of us taps into our own potential, finding the creativity and innovation within?

Pondering the changes I have seen and experienced during my thirty years of nursing, I am truly amazed. I didn't imagine I would be working in management or education, as I was reserved by nature and didn't believe I had much to offer. I decided to stop allowing this to be an impediment to sharing my gifts and decided to stop hiding away, waiting to be perfect and instead have a go. This has helped me assist others to discover their unique gifts, as not feeling ready is a common experience. This difficulty is something I have acknowledged and continue to heal in myself, and I can nurture and offer a genuineness, an authenticity, in relating to others.

Genuineness or authenticity is much more than this, but this is a great starting point, taking our true selves wherever we go, not creating different masks according to the people we are with, trying to fit into a box others have created for us. Believing that we need many different masks to effectively relate to different people is an illusion cultivated by not believing we are enough; so we cover, distort and build layers over our core essences. We can remove these veils we have created, freeing ourselves from illusion, finding the truth of who we really are.

What if there were nothing wrong with any of us, nothing that needed fixing, rather it is simply a choice to remove the veils of illusion that cover our inner radiance?

Fixing others or feeling responsible for others becomes redundant, as there is nothing wrong with any of us, nothing that needs fixing in the way we may believe.

How can we assist others to see, discovering their radiant essence?

By expressing from the heart, courageously daring to be vulnerable, sharing what we believe in, what we value, and not judging others for their choices.

As nurses, we tend to be very good problem solvers and are trained to make decisions quickly and constantly in the delivery of patient care. This makes giving advice very much second nature to us. The busyness of most wards has allowed limited time for or encouragement of reflection on our professional practice. This reluctance to reflect on our practice is what impedes us, as we are very skilled at task completion but not so skilled at valuing our knowledge and informing other health professionals what we do. However, we can raise awareness of who we are as nurses only from reflection on our practice and thus discover new and innovative ways of caring for self and others.

An example of how to begin to do this is to reflect with intent and commitment at the end of a shift, acknowledging what went well and what could be improved. This honest retrospection strengthens our ability to reflect in the moment next time, giving us something new to draw on. This process, practiced consistently, develops skills for being more fully present in each moment.

One way we can learn to empower self and others is to discern when giving advice is desirable and when there is an opportunity for others to find their own way. Asking questions that assist self-exploration offers others a development tool. When I have missed an opportunity and have given advice to another rather than asking some enabling questions, I know I have disempowered that person, holding her in a limiting belief that she could not find a way forward. I may have done this because I was busy and giving the answer is quicker, or I may enjoy feeling important as the bearer of knowledge.

What does this bring up for you?

What if each of us knows what is best for self and that we can best assist others not by giving advice but by asking questions, enabling them to access the knowing within?

All skills can be learnt and enhanced when we see value in their application. Several years ago, new to my role as a Nursing Unit Manager, I believed that solving the team's problems was my responsibility. In retrospect, I see that in dispensing quick answers I felt validated as a new manager, reasoning that if I knew the answers, I was deserving of the role. Nonetheless, I felt conflicted in this role I had created — being the holder of knowledge — as I was so busy assisting the nurses I managed I often needed to stay late to understand and complete the paperwork from my new role. 'Needing to be needed' is a powerful driver for many of us, and this pattern disempowers others because we create dependency. If others no longer need us to solve their problems, how can we have our need satisfied? I felt a weight lift when I came to understand this and began instead to practice the art of questioning to enable others to make their own decisions by encouraging and allowing, recognizing their potential and most importantly healing this pattern within myself.

I learnt how to better assist the team to acknowledge their strengths and to develop weaker areas by asking enabling questions when I was presented with the day-to-day issues of the ward. I knew that many of the team knew how to address the various issues, but some lacked the confidence to enact their ideas, or some were just being lazy thinkers. Some felt surprised that they actually did know how to move forward; however, some were occasionally frustrated, as they had been accustomed to coming to me for answers and were then being asked for their own ideas.

It was also frustrating for me, as working in a more enabling way initially took longer as I needed to stop and consider how to do this. We can all get caught up in the busyness of the day and forget to be future focused. The rewards were evident down the track, as some of the team would come to me to discuss their ideas that would then be taken back to the team for a trial. The team were more engaged in decisions and knew they would be listened to. A breakthrough came one day when a young nurse came to see me and said: 'I know you are going to ask me what I would like to do about this, so I have an idea.' I felt heartened as this seemed the beginning for this nurse to try a new way, and I watched her flourish over the years, learning the value of enabling questions and using them in her own practice.

Imagine what it would be like if enabling others were embraced in teams across our hospitals?

The health dollar is stretched to breaking point, and adequate funding, although important, is only a part of the solution. We need to understand that we are each a part of the solution if we embrace all of our gifts and take responsibility for what is within our level of influence by accessing and putting to practical use much more of who we really are.

To all who can hear by listening with their hearts and feeling the ancient wisdom encouraging us to step forward, to take action, know that we are not buffeted by the winds of fate but are instead able to create whatever life we choose. We can learn to feel on all levels of our being, creating deeper levels of maturity and authenticity that inspire others as we respond rather than react to life.

How would you like to learn a way to fully engage with how you feel and to transform not only your nursing practice but your life?

Can you sense the strength and possibility in that for yourself and all in your sphere of influence?

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Excerpted from Nursing by Heart by Julie Skinner. Copyright © 2014 Julie Skinner. Excerpted by permission of John Hunt Publishing Ltd..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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