Burnout is a problem in many professions – and particularly in nursing. For National Nurses Week this year, the focus is on promoting good health for nurses themselves. Within Public Health – Seattle & King County, this fits squarely with many efforts to help people overcome the impacts of burnout and “secondary trauma” (which comes with providing intensive, compassionate care to vulnerable populations).

At the core of this work is resilience – the capacity to recover from adversity.

Anneleen Severynen, a Public Health Nurse with Health Care for the Homeless Network, is one of the department’s champions for understanding the impacts of trauma and building resilience. Severynen has been with PHSKC for five years, and she has a 25-year career with a number of public health agencies, with a special focus working with homeless populations.

We asked her to explain how working with traumatized clients impacts nurses.

Public Health Nurses are focused on the needs of their clients, who come from highly vulnerable circumstances – often lower income, sometimes homeless, and having experienced abuse. They may have immigrated under very difficult circumstances. With such needs, why should nurses also be focusing on their own personal health?

It’s hard to help someone if you are completely draining yourself. A trauma informed approach really requires that you be present for your clients, and if you are not taking care of yourself, that’s much harder to do.

Public Health Nurses are now much more aware of how ACES (adverse childhood experiences) impact a person’s health from childhood to adulthood. Along with the research on ACES here is a growing body of research about “secondary trauma” – this is the trauma that comes from witnessing someone else’s trauma.

Most of us have experienced some kind of trauma in our lives, and hearing stories about trauma can also be a trigger for us to remember our own. Secondary trauma does really cause physical health problems and can actually make people sick. We can prevent this by strengthening our resilience. I like to think of resilience as the “capacity to bend without breaking”.

What are some of the main challenges that Public Health Nurses face?

We are really getting to know the clients. We are in their homes. We are spending time hearing their stories and their challenges. And all of this work puts us at risk for secondary trauma, simply by hearing the stories of hardship and trauma. At the same time, we also get joy and hope from hearing the resiliency that people have.

Really, some of the exhaustion comes from not having enough resources to be able to help people. That is really hard. We are seeing the human consequences of systemic issues and results of policies that have worsened health inequities. For example, seeing people struggle with homelessness and hunger, or self-medicating untreated mental illness with drugs. We are witnesses to health inequities playing out and it is heart breaking. Public Health Nurses are advocates in this climate.

And with nurses, what I see is that we put other people first. It’s hard for us to put ourselves first. The more I do this work, especially through the Health Care for the Homeless Network, I see the nurses who remain hopeful – and they find a way to be present in their own lives, whether it’s through breathing or mindfulness or a walk in the park or laughter.  And finding a way to not be hard on yourself. Because it’s easy to think you’re not doing enough for your patients.

You’ve been offering trainings around what it means to be “trauma informed” and how to build resilience. What are some of the tips to best deal with the stresses at work?

Again, try not to be hard on yourself. I hear nurses even be hard on themselves for not doing self-care right! Mindfulness is a key element in resilience, partly because it can help stop the stress response. It brings back the prefrontal cortex, our thinking brain. Being able to be present is what we want in our lives.  To be able to go home and not be burned out.

Here are some techniques I like.

• For those of us struggling with self-criticism, picture a friend in your mind telling you to stop the negative talk and remind you how good you are.
• Also, it’s ok to rest.  We have to pace ourselves.
• Even if you can just think of one thing to be grateful for each day, that can raise dopamine and serotonin levels and make a difference in how you feel.
• Getting some exercise is crucial.  It combats depression, prevents health problems and can make us feel much more present in our lives. This doesn’t have to be going to crossfit or boot camp! Get a brisk walk or something you enjoy – the key is trying to break a sweat every day.
• There are tons of great mindfulness apps on phones that can lead you through a body scan, some deep breathing exercises. Or you can simply set a phone alarm four times a day and spend 60 seconds taking slow deep breaths.

During or after the trainings, what are you hearing from the nurses?

People talk about how they love the clients and the work, but not having solutions for their clients – not having housing or whatever people need – makes it hard to go home and enjoy their life.

People consistently say they don’t have time for exercise or play. So we look for ideas, like you can walk fast to the bus, or schedule walking meetings.  Make it work within your life.  Get a workout buddy or walking buddy.

I try to use humor to get the point across. Like, how many of us are binge watching Netflix to avoid feeling?

Has learning about resilience, trauma and self-care made a difference for you?

Totally. Because I have to remind myself daily, “You can stop now.”  I have to remind myself, “You can’t fix everything.” There’s always something else to work on.

I stop and make myself take breaths. I can’t meditate at all. But I can say three things I’m grateful for — and studies show that makes a real difference, if you can commit to it every day.  It shifts my attention and takes me out of “fight or flight.”  I feel less overwhelmed, and I have more attention when I get home and play with my kids.

In honor of National Nurses Week, King County Executive Dow Constantine issued the Proclamation below:

(Originally published on 5/9/2017)