Tag Archives: emotional labour

Crisis? What Crisis?

I’m a nurse. Every day at work somebody is in crisis.

Every. Single. Day.

People have life threatening injuries and illnesses. People experience suicidal ideation and sometimes act on those thoughts. People experience delirium, dementia and psychosis – they lose touch with reality. People behave in unexpected and challenging ways.

All of these people are in crisis. They are having the worst day(s) of their life.

When you are part of the clinical team trying to help out these people it’s always useful to acknowledge and clarify the nature of the person’s crisis. It’s surprising what the individual’s perception of the crisis is. I’ve met a person who was desperately unwell – ICU unwell – who’s subjective crisis was that the cat was home alone without anyone to feed it. That was the crisis she wanted me to respond to. I’ve met quite a few people who need urgent medical/surgical interventions, but who perceive their biggest crisis as being unable to smoke a cigarette right now. I’ve had the peculiar privilege of spending time with people who have survived suicide attempts, who have experienced a crisis related to abuse, financial problems, relationship breakdown, and loss of job/role/independence/sense-of-self. An existential crisis in mind, body and spirit.

All of these people are in crisis. It is their crisis.

It is important to ascribe ownership. The nurse/midwife/physician/other clinician is not experiencing the crisis; they are responding to the crisis. We (the clinicians) have not been immunised against crises, but we do have the responsibility to do whatever we can to not get overwhelmed by them. Also, truth of the matter is, I’m not sure how long you would last if you responded to every day at work as an adrenaline-filled, too-busy-to-wee, emotional rollercoaster. That be the road to burnout and breakdown, my friend.

So, what do we do?

We use Jedi Mind Tricks, pithy sayings and clinical supervision. That’s what we do.

Clinical Supervision
I’ve written about clinical supervision before (here and here). Despite the name, it’s not about scrutiny. Clinical supervision is about reflecting on clinical practice with a trusted colleague, and asking simple questions of yourself: what did I do?; what were the outcomes?; how did I feel?; what lessons did I learn?.

The idea of clinical supervision is to acquire and refine clinical skills.

Pithy Sayings
A lot of us use and repeat pithy sayings such as the ED adage: “In the event of a cardiac arrest [or any other patient crisis for that matter], the first pulse you should take is your own.”

If you recognise your own anxiety you’re more capable of managing it. Intentional slow breathing is an excellent intervention for this. You can do it while you’re scanning the patient/file/environment.

Breath. Slowly.

It is not a crisis. A crisis is when there’s a fire, storm-surge, tsunami, earthquake or explosion that requires evacuation of staff and patients. If the hospital is not being evacuated it’s not a crisis. It’s just another day at work.


Jedi Mind Tricks
The other thing I like to do when feeling anxious is impersonate a calm person. It’s like a Jedi mind trick. “This not the anxious nurse you’re looking for. This is a calm nurse.”

When impersonating a calm person  I conjure-up a person who was a CNC when I was a student nurse at the Royal Adelaide Hospital. Part of the apprenticeship model of nursing education at the time was to give students experience in RN roles. I had been thrown into the Team Leader role on a day when the neuro ward was especially busy. There were emergency admissions, a stack of post-op patients – two of whom were really unwell, a person dying in the side room, and an inexperienced unqualified overwhelmed drongo (me) coordinating the whole thing. We were in trouble. We needed more nurses and a proper team leader.

I sought-out the CNC – a smart-as-a-whip young woman not much older than me (i was quite youngish 25 years ago). The CNC spent all of about 5 minutes with me prioritising the ward’s workflow:

  • “First things first. No need to shower/clean anyone unless they’re incontinent.” There goes about 50% of the morning’s workload in an instant.
  • “Don’t bother with routine 4-hourly obs unless the person looks unwell. Only the post-op patients and the clinically unwell patients need their obs done.” There goes another 10% of the work.
  • “Let’s get Fiona (the most experienced and skilled nurse on the shift) to look after the two dodgy post-op patients and nobody else.” The biggest concern was instantly taken care of.
  • “Bring all the nurses in here (a cramped nurses station overlooking 2 bays of 6 patients each) and tell them the plan. Make sure they all drink water and coordinate their breaks.” Got it. To look after the patients you need to look after the nurses.
  • “After you’ve told the nurses the plan, tell the patients/visitors who aren’t critically unwell the plan. They’ll understand we’re abnormally busy if we tell them.” Open, honest communication? Who’d have thought?
  • “Slow down your breathing. Use your humour. You’ll be fine. Come and grab me if you need.” My racing thoughts slowed. Panic evaporated.

We, nurses and patients alike, had a good shift. All the vital stuff was done. It wasn’t a crisis. It was a day at work.

I haven’t seen that CNC (her name is Lee Madden) since 1992, but I think of her every now and then. Whenever I see a crisis unfolding or see/feel anxiety rising, I wonder, “What would a calm person do?” and conjure an image of Lee floating serenely into the space. I channel Lee’s reassuring smile and clear understanding of priorities, and do my best to behave in the way she modelled to an impressionable overwhelmed student nurse.

Crisis? What crisis? I’m impersonating a calm person.



As always, you’re welcome to leave comments below.

Paul McNamara, 5th September 2015
Short URL: meta4RN.com/crisis

Living Close to the Water

August 8th is “Dying To Know Day” – an annual day of action dedicated to bringing to life conversations and community actions around death, dying and bereavement. More info about that here: www.dyingtoknowday.org


The first time I read “Field Notes on Death” by Lea McInerney was two years ago when I stumbled across it via the #DyingToKnowDay hashtag. It is a beautiful, poignant piece of writing, where Lea draws on her experience growing-up Catholic in the 1960s/70s, and later becoming a nurse. I’ve re-read Field Notes on Death four or five times over the last couple of years. I re-read it again this morning. Just as I did every other time, I quietly started crying about three quarters of the way through.

I cry too easily. I have been terribly embarrassed by this on many occasions. It’s not that I don’t think men shouldn’t cry, it’s just that I think I cry too easily. Too easily for my liking anyway.

A couple of things happened recently which make feel slightly less embarrassed.

One was seeing the generous, open display of grief shown by Adelaide Football Club players and staff after the death of the team’s coach. For those not familiar with Australian Rules Football, the players are mostly “blokey blokes”. They are men so manly they make other men question their manliness. They’re fit and fearless. Tonka trucks are nowhere near as tough.

These manly young men wept openly in public. Not embarrassed. Not ashamed. They have never been more inspiring. Never been better role models.

The other thing happened at work. I met a lady who was referred because of postnatal depression. My job involves listening mostly, but I ask questions too, in the hope of gaining an understanding of what support strategies would be most useful. When I asked her whether she had been more tearful than usual, she responded:

Where I grew up we have a saying that translates into English as “lives close to the water”. It refers to people who are sensitive. People who cry easily.
I have always lived close to the water. 

It’s a lovely metaphor. Doesn’t everyone want to live close to the water? That’s where you’ll see some of the most beautiful views.


Trinity Inlet, Cairns

In Closing

Field Notes on Death is a great read. I intend to re-read it and re-share it every year on #DyingToKnowDay. I thoroughly recommend it to anyone, and think nurses and other health professionals who are exposed to end of life care/issues will find it especially useful.

In case you missed the subtle hyperlinks to “Field Notes on Death” above, here is the full URL: https://griffithreview.com/articles/field-notes-on-death/ 



Thanks for reading. As always your comments are welcome below.

Paul McNamara, 8th August 2015
Short URL:  http://meta4RN.com/water


Humanity to Man

The Cairns Post, 29th March 2003:

cairns post column 290303Man’s inhumanity towards man has been getting plenty of coverage lately – it might be time a good time to be reminded of men who demonstrate humanity.

Not quite 10 percent of nurses are male (please don’t call us male nurses – we’re nurses, but happen to be male).

Like our female colleagues, we’re spread across all aspects of health. Blokes nursing in Cairns include Stephen in Intensive Care; Adrian and Denis who work with elderly people; Bill the midwife; Andrew in orthopaedics; Colin who runs a medical ward; Sean who visits new parents and their babies in their homes; Greg and Clif who work with people battling mental health problems; Andy does mostly policy and administrative stuff; Steve and Scott on the local crisis team, and Nick who has spent a fair bit of time nursing out bush and is currently back in town.

There’s plenty of blokes nursing locally not mentioned (sorry fellas), but you get the picture – we pop up everywhere.

So, why nursing? I won’t presume to speak for other nurses of either gender, but I can tell you what I like about the profession – I like being useful.

It’s a peculiar privilege being a nurse. Peculiar because, for all its different guises and specialities, the basic job description is the same – try to be useful to people. It’s a privilege because nursing offers an amazing level of responsibility and intimacy.

It might sound more convincing if it wasn’t coming from a bald bloke with a bit of a beer gut, but nursing is a nurturing profession. The nature of our relationships with patients is therapeutic, but first and foremost it’s a human relationship.

We often have the privilege of being with people at very important stages of their lives, and we get the opportunity to show that nurses can be professional, skilled and caring.

I’m sure it’s not unique to nursing, and it’s certainly not unique to nurses who are male, but let’s not forget that there are daily demonstrations of man’s humanity towards man.

Final Notes

Back in 2003 a journalist from The Cairns Post invited me to submit an article for the My Say column (a daily feature presenting the views of a cross-section of the community). The article’s reference to man’s inhumanity to man is in the context of current events at the time – it was published during the second week of the war in Iraq.

As I was identified as an employee of a local hospital, at the time of publication the content of the article had to be approved by the hospital’s media department. The media department approved the article without changes to content.

In 2003 I should have used the phrase “man’s humanity towards mankind” instead of “man’s humanity towards man”. Sorry. I was tempted to correct it in this 2014 version, but decided it was more authentic to leave the original unaltered.

Anyway, I stumbled across the very-low-resolution JPG version of the article today and thought it might be worth reprising. Man’s inhumanity towards mankind is still dominating the mainstream media. This is a tiny, inadequate bit of counter-balance.

As always, your feedback is welcome in the comments section below.

Paul McNamara, 26th October 2014

Short URL:  meta4RN.com/men

McNamara, Paul (2003). Humanity to man. The Cairns Post, 29 Mar 2003, pg 19.


Nurturing the Nurturers

Lately I’ve been thinking a lot about how we nurture those who nurture: nurses and midwives especially. It’s a subject that has popped-up in a couple of journal articles, on social media (including my recent blog), and in conversations at work.

Before we think about nurturing nurses, let’s think about miners.

Believe it or not, the mining industry with its big burly blokey image has some valuable lessons in nurturing for us namby-pamby health industry types.

Pit Head Baths + Pit Head Time

Back about 100 years ago Welsh coal miners said to their bosses, “We work hard in your mines all day. We get sweaty and covered head to toe with coal dust from your coal mines. Then we go home and use our time, our bath, our laundry to get cleaned up. It’s a mess of your making, shouldn’t the daily cleanup be your expense?”

Then, as now, the mining industry bosses threw their collective hands in the air and said, “No! We can’t afford to do that! Your excessive demands will send us broke!”

So the miners went on strike.

And stayed on strike until, eventually, the mining companies installed pit head baths so miners could get cleaned-up and changed in the boss’s time, using the boss’s resources. It’s called “Pit Head Time”: it’s enshrined in award conditions for miners and pit head baths are just part of the infrastructure of mines.

Todd and Brandt clocking-off.

Todd and Brandt clocking-off.

Remember the Beaconsfield miners emerging clean and shiny after a fortnight underground? They clocked-off AFTER getting cleaned and changed. The infrastructure is in place – somewhere between the working part of the mine and the clocking-on/off area is a shower and change room – the pit head baths. The miners clock-off by moving their tag from the red “underground”  section of the board to the “safe” green area of the board. That’s how pit head time works – you clock-off after you’ve cleaned-up.

"Care for the Caretaker" generously shared by Kath Evans via Twitter: https://twitter.com/KathEvans2

“Care for the Caretaker” generously shared by Kath Evans via Twitter: https://twitter.com/KathEvans2

So what?

Nurses don’t usually get covered in coal dust.

Nurses do emotional labour.

Nurses get covered head to toe in the emotional experiences of people who are, very often, having the worst, most traumatic, day(s) in their life.

Shouldn’t nurses get cleaned-up on the boss’s time too?

Clinical Supervision

Clinical Supervision is the name given to the process of cleaning-up after doing emotional labour.

Clinical Supervision is a slightly clumsy name for it, because the word “supervision” implies scrutiny. Nurses are a bit thingy about scrutiny. Nursing was born in the church and raised by the military – it has shameful history of bombastic, bullying, bellowing scrutiny. Nursing and feminism (ie: the gender equality movement) have fought hard to overcome the worst of some very bad power imbalances. That’s why it’s understandable that some nurses are cautious about volunteering for something called “Clinical Supervision” without understanding it fully.

Clinical Supervision does go by some nom de plumes: “Supported Reflective Practice” and “Guided Reflective Practice” being the most common alternatives I’ve come across. Whatever the nomenclature, they each generally attend to the same task – assisting and supporting the clinician to reflect on their work, with the intent of keeping them and their practice safe.

ProctorCSBrigid Proctor is considered one of the rock stars of Clinical Supervision, mostly because she had the capacity to simply articulate the primary functions of Clinical Supervision.

The Formative Function of Clinical Supervision (learning) attends to developing skills, abilities and understandings through reflecting on clinical practice. We don’t know what we don’t know; sometimes it is only through reflecting on our work with a trusted colleague that we get a glimpse of some of our blind spots.

The Normative Function of Clinical Supervision (accountability) is concerned with maintaining the effectiveness and safety of the clinician. Sometimes we need a trusted colleague to prompt us to revisit clinical practice guidelines, policies, procedures and legislation as a way to make sure we’re working within expected norms in everyday practice.

The Restorative Function of Clinical Supervision (support) addresses the inevitable emotional response to the privilege, the frustrations, the joys, and the stresses of working in a caring, nurturing role. Sometimes it is only through discussing our work with a trusted colleague that we recognise the emotional effects of our work, and learn how to manage our reflex responses.

It is the restorative function of clinical supervision that I value the most. By (metaphorically) cleaning-up the dust and grime I get covered in doing emotional labour, I feel that I am being nurtured, sustained. By being nurtured in the workplace not only do I avoid spending my entire wage at Dan Murphy’s bottle shop as a maladaptive coping strategy, but it also equips me with the capacity to nurture others.

http://www.psychologyboard.gov.au/documents/default.aspx?record=WD12%2F7465&dbid=AP&chksum=wn1dw%2FoJV9PLEAY7hO5kJw%3D%3DIn some workplaces (mine included) there have been attempts made to make Clinical Supervision part of the infrastructure, just like the showers and change rooms the Beaconsfield miners used. If you’re interested in an example of what the infrastructure for assisting clean-up after emotional labour looks like, take a look at the Queensland Health (2009) Clinical Supervision Guidelines for Mental Health Services [PDF].

I know that many of my Nurse and Midwife colleagues don’t have this infrastructure available to them, and I can’t understand why. If it’s good enough for miners to have pit head baths and pit head time, surely it’s good enough for Nurses and Midwives to have Clinical Supervision.

Shouldn’t we be nurturing the nurturers?

Paul McNamara, 15th January 2013

That Was Bloody Stressful! What’s Next?

It was 1998 when the decision was made to use comic sans and screen beans in this staff resource... the idea was to make a heavy subject accessible. Please don't judge me.

It was 1998 when the decision was made to use comic sans and screen beans in this staff resource… the idea was to make a heavy subject accessible. Please don’t judge me.

Gather around children, Uncle Paul has a story to tell…

No! Don’t run away! It’ll be quick, I promise!

Back in the late 1990s I was working as a Nurse Educator in Community Health – it was good to get back in touch with general nursing after a few years in mental health. One of the things that popped-up at the time was that some staff (both clinical and non-clinical) were getting pretty stressed-out at work, usually because of work-related stuff. My boss at the time was keen to tap-into my background in mental health to see if it was something we could address as an organisation.

Some of the nurses, indigenous health workers, admin officers and cleaners I chatted to at the time made it clear that they didn’t want to show their vulnerabilities to clients, colleagues or management for fear of being thought of as weak or unable to cope. Staff asked for information and support that could be accessed discretely, without it being necessary to disclose anything to anyone at work.

One nurse put it succinctly: “This place is bloody stressful. There’s no avoiding it. We know we’ll cop stress, we just don’t know what to do about it; about what comes next.”

That’s how the staff resource, That Was Bloody Stressful! What’s Next? was born. Since 1998 it has been on the workplace intranet. We told people how to find it, “Just search for ‘bloody stressful’ on QHEPS”, and asked that they pass the tip on to workmates. It has sometimes been used with general hospital patients too – feedback is that some patients find it validating to know that staff can relate, in part at least, to their experience of having a stress reaction after a traumatic event.

Over recent years information about the organisation’s employee assistance program has become much more visible and easy to access on the intranet; so much so that a dinky, amateurish, screen-bean & comic-sans laden little PDF with 10-year-old references probably isn’t really necessary anymore. Nevertheless, we made the decision a couple of months ago to keep it available because each month a dozen people or more search the organisation’s intranet using these key words: bloody stressful.

Here is what they find: BloodyStressful

Perhaps you’re wondering why, in 2013, I have decided to liberate this shabby-looking resource from the intranet to share with the internet. Well, nurses experiencing secondary traumatisation popped up as a topic in a Twitterchat last month, in a Google+ community a week ago, and again on Twitter this morning.

Nurses do emotional labour. Maybe we should pool our thoughts and resources about how best to manage the effects of this.

Paul McNamara, 4th January 2013