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.
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.
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 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.
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.
In 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