The authors of this week’s blog are Prof Gemma Stacey (@GemmaStacey10) (Director of Academy, Florence Nightingale Foundation [@FNightingaleF]) and Bethan Davies (Co-Founder, The Bravest Path [@BravestPath]).

Gemma: As a Mental Health Nurse and Director of Academy at the Florence Nightingale Foundation (FNF) I have become increasingly concerned about the impact of the pandemic on preceptorship programmes which have inevitably been disrupted or abandoned in order to respond to clinical demands and redeployment of the workforce. Through the provision of our Nightingale Frontline support service (Bond et al 2022), I and our facilitators, have heard stories from our newly registered workforces which bear witness to the sense of fear, overwhelm and conflict they have experienced. The reality shock described by Kramer in 1974 is no longer adequately representative of the suffering described by our early career nurses in the past two years.

You may argue that our perception is subjective and only represents the experience of a minority. However, the results of a survey we undertook in collaboration with Unison and Nursing Times received responses from over 5000 student, early career and established nurses. The consensus was the current context for transitioning to practice was more challenging than ever and early career nurses had been left to “sink or swim” (Mitchelle 2022). The consequence of this on their health and wellbeing was stark and emphasised the urgent need to act now as a remedial effort to show our early career workforce a positive way forward. We knew this would need a different kind of conversation. Traditional messages around transition to practice encompassing a process of “armouring up” and desensitisation to the emotional impact of our practice were unhelpful and ethically misplaced. The evidence to underpin different kind of conversation came from the research of Brene Brown which was brought to life by Bethan Davies, co-founder of The Bravest Path, a courage building consultancy.

Bethan: The opportunity to partner with FNF to provide this groundbreaking support to nurses and midwives is one that carries unique personal significance for my family and I. Both my children are alive today only because of the quick and decisive actions of nurses, and it was a midwife who helped me find the courage to have the VBAC at home I so dearly wanted.  A community that cares so deeply and held us so tenderly when we most needed support, it’s almost impossible to put into words the impact they had when we were at our most fragile. We wanted to help them provide that support for themselves.

At The Bravest Path we work with organisations to create psychologically safe cultures in which individual contributors and teams feel empowered to bring more of their authentic selves to their work without fear of blame, shame or judgement. A key part of this work is self-compassion, defined by Dr Kristen Neff as “mindful, loving, presence” and comprised of three key elements – self-kindness, common humanity (knowing we are not alone in our struggles) and mindfulness.

In a career where you assume so much responsibility for the lives of others and the clinical standards of performance are so high, I wonder how many of you reading this would still count yourselves as your greatest critic, creating internal expectations for yourself that are ultimately unachievable. How often do you convince yourself that you must always have the answers and that to ask for help will only lead others to view you as less than capable? This can be particularly acute when starting a new role, as you are eager to demonstrate your competence and worth to your new colleagues. As human beings, we are wired for connection and belonging; our desire to be accepted by our colleagues is strong. However, our secretive inner critic tells us we must exude perfection or risk rejection and is often the very thing that stops us bringing the best of ourselves to our roles.

It’s one thing to talk of self-compassion, and another entirely to practice it. We might try and convince ourselves that we don’t deserve it or worry it will make us complacent. Particularly in healthcare it can be all too easy to fall into a contest of comparison with the patients in your care, and ask “Who am I to be thinking of my own self-care right now?” Situations at work when we need it the most, are often when we have very little opportunity to focus on anything other than the job at hand. In these webinars we are providing a practical toolkit alongside the theory and giving a live demonstration of how to apply that can be accommodated during a busy shift. Instead of acting out our feelings by moving against or moving away from others, we have the opportunity to sit in the moment with acceptance, noticing times of struggle without judging ourselves and talking to ourselves in the way we would do to a dear friend. When we give ourselves permission to be imperfect, rather than wear armour that we think protects us, it allows others to do the same. The courage to be vulnerable to say I don’t know, to ask for help or to challenge may ultimately result in better patient care and outcomes, as well as decreased anxiety and fear for nurses and midwives through shedding the weight of our own unrealistic expectations.

Strapping on a full suit of perfectionism as armour at the start of every shift can be exhausting, and as it becomes the norm, it is not so easy to remember to take it off each time we step back into our personal lives. We have designed these webinars to help newly registered nurses and midwives acknowledge themselves as doing the very best they can, in the most challenging of circumstances and recognise the need for self-care as a priority. Because when they can practice self-compassion, it not only benefits themselves but those in their care, and those they love.”

Both: In partnership, we are delivering webinars which can be accessed by all newly registered nurses and midwives in England. There is space for 17,000 people to attend and everyone is welcome. Our first webinar has already taken place and we were humbled by the willingness of our audience of early career nurses and midwives to lean in to vulnerability and critically explore the self protection strategies they were relying on as opposed to the self-compassion that they deserved. The theory in the webinar was illuminated by the story of Joshua Hammond who is an early career nurse himself and a role model to all who have previously viewed vulnerability as a weakness. He story demonstrates his courage in asking for help, listening to the feedback and committing to self compassion.

We encourage all newly registered nurses and midwives in England to attend and call upon their leaders to give permission and time to enable this. For the dates and booking details please visit Cultivating courage and compassion for ourselves and others – a webinar for newly registered nurses and midwives – Florence Nightingale Foundation (florence-nightingale-foundation.org.uk)

References

Kenny, A., Dickson-Swift, V., McKenna, L., Charette, M., Rush, K. L., Stacey, G., Darvill, A., Leigh, J., Burton, R., & Phillips, C. (2021). Interventions to support graduate nurse transition to practice and associated outcomes: A systematic review. Nurse Education Today, 100, [104860]. https://doi.org/10.1016/j.nedt.2021.104860

Kramer, M. (1974) Reality shock: Why nurses leave nursing. American Journal of Nursing, 75, 891. doi:10.1097/00000446-197505000-00041    .

Mitchell, G. (2022) Exclusive survey reveals too many newly registered nurses lacking good support. Nursing Times Vol 118 Issue 2 (8-11)

Neff, K. (2011) Self Compassion: The Proven Powe of Being Kind to Yourself. Yellow Kite