Hello, and welcome to episode 26 of The Nurse Trauma Healing Podcast. I’m Dr. Lorre Laws, your host, and today we’ll be discussing some startling survey results where violent work conditions, burnout and trauma symptoms are concerned.
Recently, I had the good fortune to have my research featured by the National League of Nurses. After self-funding five years of research across four disciplines, I presented a snapshot of that work in my presentation titled What if it’s not (just) burnout? Trauma-informed resilience strategies for nurses.
For those of you who have never submitted a proposal to speak at a national conference, let me tell you that it’s quite a process! 🤯 Each conference has their own system, which means you first registered into yet another portal. Then, you submit all the particulars like the title, learning objectives, a rigorously developed outline, make explicit all the teaching methods and resources that will be used . . .and the list goes on from there!
Once you submit the proposal, it’s the “hurry up and wait” game, which takes several months. All submissions are blind peer-reviewed. Most proposals are rejected. Only the best, most relevant presentations are selected. Letters of acceptance are sent out several months before the event and then the planning process begins!
There’s all the usual travel logistics to navigate, along with preparing the presentation itself. And when it comes to presentations, I don’t hold back! I’ve been a university-level educator for over a decade and have learned that “death by powerpoint” isn’t the presentation style for which I am striving! 😅
The last thing I want to do for my students or my colleagues who are attending a high-level national conference, is to bore them with a sea of banal powerpoint slides that result in an hour of mind-numbing hour of bullet points. I had to get creative and learn how to share the evidence in a way that tells the story, one that we can all feel, regarding the state of nurse-specific trauma science and prevention-healing strategies. My goal was to create a presentation that compelled my beloved colleagues to FEEL what they were learning. To connect it to their experience, their healer’s heart.
And it worked!
During the 50-minute presentation, there was such a sense of connection, camaraderie, and community. Those in attendance laughed, cried, applauded, and shared their experiences. I and over two hundred of my colleagues gathered to have real-talk about the gaslighting and outdated burnout narrative. It’s not “just” occupational stress that is not being effectively managed. What’s really happening is that the stress is really trauma exposure, much of which is avoidable and secondary to the system and organizational inadequacies.
We talked about the gaslighting definition of burnout, as described by The World Health Organization (WHO), as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”
Is it just me, or are we detecting a blame-the-victim narrative here?! 🤯🤯🤯
First of all, what nurses are experiencing, in addition to chronic workplace stress, is substantial trauma exposure secondary to health system and organization shortcomings. The dangerous staffing ratios, the lack of resources, the often physically violent patients or families, the bullying, gaslighting, hazing, and other workplace incivilities – these are all forms of avoidable nurse specific traumatization.
And then we get the avoidable system-induced trauma. Like when we follow the chain of command and policies to report that we’ve been physically assaulted at work and are further gaslighted and traumatized by the blame-the-victim questioning from our leaders that almost always ask, “what could you have done differently to prevent being assaulted?”.
ARE. YOU. FOR. REAL.😡😠😲
Does this sound like “workplace stress that is not being effectively managed” to you?
It’s trauma exposure that often results in nurse-specific traumatization, which cannot be wholly prevented, addressed, or healed by traditional self-care approaches.
Let’s unpack this WHO burnout definition a step further, adding a trauma-informed perspective to each burnout dimension:
WHO Burnout Dimension #1
Burnout is classified by energy depletion or exhaustion.
Trauma-Informed Dimension #1
Physical, verbal, cognitive, emotional, relational, or existential prolonged stress and trauma exposures that, when left unsupported or unhealed, lead to mitochondrial rigidity and dysfunction whereby the mitochondria are unable to produce enough energy to sustain person working in these conditions resulting in energy depletion or exhaustion.
You see, nurse-specific traumatization is an energy problem, right down to the level of the mitochondria.
WHO Burnout Dimension #2
increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job.
Trauma-Informed Dimension #2
Prolonged stress and trauma exposures are detected by the mid-brain’s “threat detector” which signals to the autonomic nervous system to activate the fight, fight, fawn, or freeze responses that result in rightfully distancing oneself from one’s job, negative world views, absenteeism, presenteeism, and a host of other behavioral adaptations designed to keep a person safe when in unsafe conditions.
WHO Burnout Dimension #3
Reduced professional efficacy.
Trauma-Informed Dimension #3
Professional efficacy is optimized when individuals are safe, regulated in their nervous system, and thriving in their Window of Tolerance in ventral vagal tone. Employers who do not provide safe, sufficiently staffed and resourced units that are free from workplace violence (including verbal, gaslighting, extortion, bullying, and other incivilities) promote reduced professional efficacy, burnout, and occupation-related traumatization.
Non-Trauma-Informed Burnout Definitions Mean No Insurance Coverage for Treatment
To add insult to WHO’s gaslighting burnout definitions are considered an “occupational phenomenon” and not a medical condition in the International Classification of Diseases (ICD-11).
“Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
Oh, so are you saying that people have one body at work and another body in other areas of life?
How convenient.
And utterly reductionistic.
So let me get this straight.
WHO blamed the victim for the system and organizational shortcomings that result in prolonged stress and often avoidable trauma exposures.
WHO infers that nurses and other professionals are not whole persons who are inseparable from the systems and contexts in which they live and work.
WHO infers that there is an “off switch” within each person that can be applied to stress and traumatization responses depending upon whether we are at work or in another context. That our bodies are actually machines that can discern between “occupational context” and “other areas of life” in the physiological responses to stress and traumatization that often occur below the level of consciousness.
AND THEN WHO EXCLUDES BURNOUT FROM THE ICD-11.
So, even if a person seeks medical attention for the devastating and often debilitating symptoms that emerge in the wake of nurse-specific traumatization, that is frequently misattributed to “just burnout”, that their insurance company (likely) won’t pay for this care?!!
A whopping 86% of nurses report having little to no resources to help them with trauma exposures or trauma healing.
A whopping 91% of nurses report one or more PTSD symptoms.
A whopping (almost) 25% of nurses meet the diagnostic criteria for PTSD.
And we are being gaslighted by outdated positions and science that inform policies like the WHO’s definition of burnout and its exclusion from the ICD-11.
It’s time to update the “burnout is an occupational phenomenon” and call it what it is.
Nurse-specific traumatization.
Which requires an entirely different approach to preventing, addressing, and healing. That’s why I’m here. To shine a massive spotlight on what the science is really saying and how nurses can embrace pathways to healing and insulate themselves from the impact of the broken healthcare system.
If you or someone you know has been affected by nurse-specific traumatization, please seek support immediately. I and my team are standing by to support nurses. Please take this five-question nurse trauma assessment or schedule a personal call with me to explore the best healing options for you.
Until next time, thank you for all that you are and do.
I see you.
I feel you.
I hear you.
And I am here for you.
From my healer’s heart to yours,
Dr. Lorre 💕
