Nurses are tired of hearing that they need to practice "self-care." I'm like many nurses-a type A personality trying my best to be a good person and great nurse. Sadly, nursing puts all the weight of perfection on the caregiver's shoulders. I've struggled with perfectionism as long as I can remember, trying for an impossible ideal that leads to burnout. Because of my own experience, I am wary of those who make unrealistic claims about what I can do to make myself better, whether through self-care or other means.
We know we should sleep, eat healthy, exercise, make time for quiet thoughts and laughter. But when I was dealing with perinatal mood disorder, what brought me through wasn't someone telling me to take care of myself. It was a therapist reminding me I didn't have to do it all. I needed to ask for and receive help. I needed friends who cared, community.
The number of current articles touting the self-care message is unsettling. In the April 2021 issue of The Nation's Health, then president of the American Public Health Association Jose Ramon Fernandez-Pena congratulated the public health workforce on the important work they do and reminded members to practice self-care and know their limits, as the work "must start from within." During National Nurses Week last year, an email from the American Nurses Association asserted that since nurses are more likely to be overweight, stressed, and sleep deprived, we should remember to practice self-care.
These recent writings aren't all wrong. A quick search on PubMed for "nurses self-care" produced 22,358 results, including peer-reviewed studies and data derived from large study groups. Unfortunately, the first 20 (and, I assume, the majority) focus on the need for and benefits of self-care in the nursing community, but not on how self-care won't solve the nursing retention issue and is not the only thing nurses need right now.
There's a great TEDx talk by psychologist Travis Heath called "Self-Care to Communities of Care" (http://www.ted.com/talks/travis_heath_self_care_to_communities_of_care) that pushes back against our current structure. When nurses practice real self-care, they come to a place of self-respect, learn to hear their own voice, and recognize when their expressed needs are ignored. True self-care for many has meant walking away from toxic environments. While being a nurse can mean fighting through hard days to provide care for people in greater need than ourselves, when we are completely broken down, we cannot care as well for others. We are now losing nurses of great potential who have found themselves unwilling to sacrifice the hope of providing patients the best care possible.
The fact that nurses are willing to give a great deal for their patients is driven home by the Lost on the Frontline project from Kaiser Health News and the Guardian, which counted 3,607 deaths among U.S. health care workers from COVID-19 during the first year of the pandemic, with nurses (at 32%) the highest percentage.
I know it doesn't have to be this way. While doing disaster relief with a humanitarian organization after the Sichuan earthquake in China, I was pushed to my limits, but the incredible team around me and the mandatory debriefings brought me through. Working in inpatient care in the United States also pushed me to my limits, but there wasn't support when nurse-patient ratios felt unsafe, so I chose my health and walked away. Maybe if the United States had a written reflection requirement built into the licensure process, we'd become more accustomed to sharing our struggles on a regular basis and feel heard by our supervisors. Or if group debriefing sessions were obligatory after code blues, we could come to work our healthiest selves and not feel pushed over the edge by a management that doesn't believe we need help.
Since the start of the pandemic, the nursing community has experienced depression, anxiety, posttraumatic stress disorder, and exhaustion. Good nurses would never tell a postpartum mom, suffering soldier, or anxious patient that it's their fault or that they must go it alone-that's bad nursing care and it hurts. Can we please stop telling ourselves to practice self-care and admit we are the ones who now need help?