Are patients at risk when you work too long?

by Laurie

in The Comfort Garden: Tales from the Trauma Unit

Since publishing The Comfort Garden in 2011, I’ve had the opportunity to speak to groups of nurses and other healthcare professionals about compassion fatigue, vicarious trauma, and self-care. Looking out upon my audience, I notice much head nodding and sometimes dramatic aha! moments when I describe the signs and symptoms of the first two topics. However, the phrase “self-care,” uttered only in the last third of my talk, elicits an immediate eye-roll response from nurses, followed by an audible exhalation of withering disapproval—as if it’s OK to experience nightmares, shortness of breath, emotional and physical exhaustion but definitely NOT OK to do something about it.

In a recent post on Jonathan Turley’s blog, guest blogger Charlton Stanley recounts the story of Elizabeth Jasper, a 38- year-old nurse and mother of two young children, who was killed after allegedly falling asleep at the wheel on her way home from work where she had been asked to stay beyond her 12-hour shift. In his piece, Worked to Death: Fatigue and the Health Profession, the Dirty Little Secret, Mr. Stanley describes how his wife, also a dedicated nurse, was often summoned to work on her days off for “emergencies” and frequently worked 16-hour shifts only to return to duty 8 hours later. Eventually, his wife developed idiopathic cardiomyopathy which forced her retirement. To the bafflement of her cardiologists, during her forced time away from work, her heart recovered enough to allow daily functioning. In other words, he says, her work was killing her.

Mr. Stanley devotes much of his post to the problem of inadequate sleep and society’s denial of the importance of this despite a body of research such as the Whitehall II Study that correlates decreased sleep with a “doubling of risk from all causes.”

This made me recall something I heard at a recent psychological trauma conference—that childhood trauma disrupts normal sleep cycles such that children cannot reach the stage of sleep that refreshes and renews the body. One wonders if many chronic sleep disruptions are holdovers from childhood trauma as depicted in Kaiser’s ACE (Adverse Childhood Events) study which correlates the onset of chronic illness in adulthood with a history of childhood sexual abuse, emotional abuse, neglect, parental substance abuse, and/or a history of growing up with a relative who committed suicide, was incarcerated, or was mentally ill.

When I ask the eye-rollers in my audiences what they associate with “self-care,” they invariably say, “self-centeredness,” “self-indulgence,” and “selfishness.”

(Sigh.) Fellow nurses and other caregivers: If this is what “self-care” means to you, you may be placing your patients at risk for harm due to medication errors, neglect, and inattention. By working too hard and too long, you may also be placing yourself in danger.

The next time I address a group of nurses, I plan to talk about “self-compassion.” I have a feeling that when I do, instead of rolling, the eyes will tear up. If so—if the tears indicate we have moved beyond judgment and cynicism—we just may be able to have a heart to heart about taking good care of ourselves in order to take good care of our patients.

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