In Today’s Haelan Nurse Podcast I want to talk to you about how our nervous system gets hijacked in practice. I’d like to share with you today a story about some feedback I received from a nurse who attended one of my educational events. Now, this was a just over 90 minutes of a webinar for continuing education credit that was discussing all of the important topics that we are discussing in this podcast regarding nurse burnout, nurse specific traumatization, and strategies that we can use to insulate ourselves in practice and also to heal and recover from all that we’ve endured.
At the end of this 90-ish minute webinar, the nurses gave me feedback, for which I’m always so very grateful. This particular feedback was in response to a question that I had posed. I asked about the practices that they had learned, the Button Jar practice, the MicroDoses Matters practice, and what the likelihood that they would be implementing those in their daily routine.
And most nurses make an an a concerted effort to do just that.
And many make make the effort, but it eventually falls by the wayside.
And some people simply can’t make the effort. And that was the case in this nurse’s situation. And this is by no means that nurse’s fault. This is a reflection of the state of the vagus nerve and the autonomic nervous system in response to that nurse’s harsh working context and conditions.
So let me give you the verbatim, I’ll read that to you, the feedback that I received and then we’ll unpack it and, and look at through the lens of the polyvagal theory what this means.
“Honestly, I will probably forget these practices (MicroDoses Matter and the Button Jar practice). In the heat of nursing. I’m not stopping to pick up a button. 🤯🥹🆘
For those of you who aren’t familiar with the Button Jar practice, imagine a jar of assorted buttons. Choose one that aligns with the time available to nurture your nervous system. The smallest button = one mindful breath.
In other words, if you can’t pick up a button, that means you can’t take a mindful breath. That’s a serious problem and one that most nurses are unnecessarily burdened with in practice.
That is real and that is true. And that is representative of where the state of nursing is for a good number of nurses. And when I say good number, I mean millions. So let’s take a look at what that means.
Now, in terms of Steven Porges polyvagal theory, we know that the vagus nerve has a ventral aspect (ventral vagus nerve), which is where we are regulated. When it’s online, we’re regulated, we’re cool, we’re calm, we’re connected, we are heart-centered, we’re open and curious and able to provide that patient-centered care that is so vital.
And then we have the dorsal vagus nerve, which is, when it comes online, it’s in response to there being a threat to safety, a danger, or in response to being utterly depleted. When this happens, the autonomic nervous system is literally shutting us down to the level of the mitochondria to conserve energy.
And so here we have the ventral vagal tone and the dorsal vagal tone, and somewhere in between there’s your traditional sympathetic response, the flight, the fight, the fawning, the freezing and so forth that you’ve probably read and heard about.
Well, I know you’ve read about them because you’re all nurses, but maybe not thinking about their application in this context. And so here’s what happens is that we go to work as nurses and there’s a part of a process that’s in our, in our midbrain, kind of in the limbic system region that Stephen Porges calls the Threat Detector 🥸. And its job is what’s called neuroception. And so neuroception is this internal scanning of, of our inner landscape for any cues or signs that we might have a threat to our safety while also scanning our external, looking for any signs of threat to our safety or if there’s an impending danger.
Now, the Threat Detector has one job and one job only. That is to keep us safe. So when we’re at, at work, we’ve talked about in previous episodes that many nurses do not feel safe in their physical environment because they’re not safe. 💯
And the majority of nurses don’t feel safe within themselves in their practice because their Threat Detector is, is seeing all that is happening and then triangulating that with what is stored in within us . . .our repository of unintegrated trauma . . .trauma that’s in varying degrees of healed-ness. And so the Threat Detector, before you can snap your fingers, can make these assessments as to whether or not your inner inner environment feels safe, your external environments feel safe, and the relationship between the two.
Once the level of safety, threat, or danger has been assessed, the Threat Detector signals for either the ventral vagal circuit to come online, the sympathetic nervous system to come online or the dorsal vagal circuit to come online. And it’s not just limited to binary circuits. There’s hybrids composed of every combination of these circuits. We’ll unpack all of that in the future episode. But I call that your circuits, I just named the three circuits, which are ventral, vagal, sympathetic nervous system and dorsal vagal and their hybrids, which would be any of the resulting combinations of those three circuits.
So here’s what happens, even when this is likely what happens to the, the nurse that says, “I’m not stopping to pick up a button, ain’t got no time for nothing”. And that’s real. That is so real. So what happens is that we go to work and as nurses, we’re to provide patient-centered care. We’re supposed to be fully present with our patients, connect with them, facilitate their healing, attend to all the details that are required for their care. That’s, as they say, the nursing school way.
And we get to work.
Our nervous system gets hijacked.
Immediately, our Threat Detector surmises that we’re not safe, we’re understaffed, under resourced. There might be a violent patient. We might have lateral violence or bullying, or we might have oppressive practices by leadership and management. We might be marginalized, we might be disenfranchised. And the list goes on. All of this is picked up by the Threat Detector and that ventral vagal circuit, it goes offline. Why? Because we’re not safe.
So, the threat detector cannot send a signal for us to be fully present with our patients in the way that we would all like to be. So then what happens is our sympathetic nervous system comes online, which it needs to be online. It’s always online to kind of a, a baseline threshold to address the stressors that are inherent with daily living.
So we always have some sort of sympathetic tone happening in terms of our nervous system response to external stimuli. So what happens though is that we get to work and, and the avoidable nurse specific traumatization on top of the unavoidable on top of the individual traumas that we’ve all endured that are integrated and healed to varying degrees.
Remember that trifecta of trauma?. Well, that trifecta (individual + avoidable + unavoidable nurse-specific traumatization) is so much that it constitutes a threat to our safety. In turn, the Threat Detector signals for the sympathetic nervous system to go into overdrive. We move from what is manageable, normal sympathetic tone in our day, to unmanageable. We’re built for short term stress.
Like we’re running from the saber tooth tiger. 🐯
What the human body is not equipped for is prolonged extortionate stress and repeated Trifecta of Trauma exposures. 🚫
Our physiology cannot meet these excessive demands. The “I’m going to work for five years understaffed, chronically understaffed, under-resourced and expect to stay healthy and well” isn’t sustainable. Nursing is demanding enough without the system overworking and understaffing us.
So what happens in prolonged stress or trauma exposure is that we move from manageable sympathetic tone to unmanageable sympathetic overdrive. If the excessive stress and the threats to our safety (real and/or perceived) persist, the Threat Detector signals for dorsal vagal freeze or shut down. Why? Because our mitochondria, literally our mitochondria, get depleted to the point where, where they cannot produce the energy that is required to physiologically manage all of the stress and trauma exposure that that nurses experience.
This is how nurses nervous systems get highjacked at work. 💯
This is why nurses are leaving the profession en mass. 🙌🏼
Nurses have been overworked to the point that the mitochondria can’t support the sustained stress and trauma exposure. 🆘🆘🆘
When the Threat Detector signals for dorsal vagal circuit to come online, it’s to conserve energy, to kind of shut us down. And this is when we start feeling numb and detached. We start to feel like we can’t manage . . .because our mitochondria literally can’t keep up with the excessive energy demands.
Nurses should and must be able to practice in a safe work environment that has sufficient resources so that we can be in our ventral vagal tone – calm, cool, collected and connected. But what happens is, is anything but, and then we get into this sort of this positive feedback loop, much like this nurse who, in the heat of nursing, just can’t stop to pick up a button (take one mindful breath) because they’re stretched so thin and so overworked.
They’re temporarily stuck in sympathetic overdrive. 😶
And so under-resourced that that nervous system is sending messages that you cannot even stop. Not even for 30 seconds to support the nervous system. We do not have one second to take a deep mindful breath. Why? Because all around, nearly everything that is being detected by the Threat Detector is recognized as a threat to our safety . . .especially the avoidable nurse specific traumatization that we’ve been talking about.
Surely we have a lot of trauma exposure that’s unavoidable, inherent with the profession of nursing. And most of us are very well equipped to manage that degree of additional trauma exposure. But when you throw on the rest of this, our Threat Detector’s like, “whoa, whoa, there’s 0% chance that this human can be in ventral vagal tone”, which is where we are supposed to be in our practices . . . to be safe and thriving.
And so the goal of my work is to provide some education and some practices and resources so that it does take a little bit of effort.
But the, there’s no longer a choice, right? We, we know, we know the system isn’t gonna fix itself. It’s not in the system’s best interest to fix itself. 💸 It’s not in the system’s best interest, in terms of corporate profits and shareholder returns, for us to be sufficiently staffed and resources resourced.
And so until we reach that tipping point where we can paradigm shift into Nursing 2.0, The Nurse Safety and Professional Wellbeing Edition, until then we all must learn how to insulate ourselves.
Because we must take the time to pick up a button, to pick up one button.
And by picking up a button that is one conscious breath, that could lead to every hour doing a 3-second practice. This is mission critical because we must interrupt the sympathetic overdrive positive feedback loop. We must interrupt and then support that hijacked nervous system, the Threat Detector which in turn downregulates the sympathetic overdrive, the dorsal vagal shut down.
How do we do this? It’s all about interrupting that mobius loop, that positive feedback loop with micro doses of nervous system nurturance that will signal safety to the Threat Detector. It’s imperative, for the sake of our health, that we interrupt the sympathetic overdrive loop from which corporate interests are profiting🛑. At the expense of our safety, health, and professional wellbeing.
This is how we begin.
Because healing always begins within, always.
And then it translates externally.
And so that is really the point of healing is the point of impact for the most profound healing is not trying to fix everything on the externals, but looking at how we can help our Threat Detector understand that we are safe, we are indeed safe.
But we can only do this if we engage of micro doses of safe behaviors. Like a mindful breath. Like giving ourselves a bear hug in the supply room. Small, miniscule gestures to the Threat Detector matter. Immensely.
Here are some small steps that you can take today.
If you’re curious to learn more, please consider ordering my book, Nursing Our Healer’s Heart, which is available wherever books are sold.
Take one minute, literally one minute, to see what your nurse burnout indicator is.
I hope this podcast has been helpful to you. I have so many resources for you on my website at https://drlorrelaws.com/
From the bottom of my healer’s heart to yours, thank you so much for your engagement, for your time, and most importantly for all that you are and do.
From my healer’s heart to yours and until next time,
Namaste 💕
