Rooting into our values, community and nervous system, a space to talk about it.

HS:... like I didn't have resources I didn't have hospital beds. I didn't have PPE. I didn't have counseling referrals to give to people in mental health crises. I just felt like I kept saying no. No, I'm sorry. No, I'm sorry, and that was crushing for me because, again, that's not what I'm there to do, and that's not what anybody wants to receive...

LHC: Hey there! Welcome to Let's Make a Health Connection! In this podcast, we introduce, interview, and showcase the many healthcare providers and resources that we feature on our website, localhealthconnect.com. I'm Jennifer Barber, and I'm a licensed clinical social worker in Washington and Oregon, and I'm happy to be part of the local Health Connect provider community. Today, we're talking to Amy Ponteri and Heather Sweeney. Amy is a licensed professional counselor in Oregon and a nationally board-certified art therapist. She has a private practice in southeast Portland, and in addition to her private practice, for the last 16 years, up until this past spring, Amy worked in an emergency department, providing mental health crisis evaluations and interventions during COVID. She was struck with the lack of meaningful acknowledgment and support by the health care system for frontline workers, particularly nurses and aides, who were literally risking their lives to be a safety net for a community in lockdown. She began drawing her colleague's portraits to honor their work, a few of which can be seen on the local Health Connect website. Since leaving the ER, she's collaborated with former ER colleague Heather Sweeney to create a fun and energizing program to support health care workers and turn burnout around. We're going to talk a little more about burnout here in just a moment. I want to introduce Heather Sweeney. Thank you for being here today. Heather has worked as a bedside nurse and is now employed in the post-anesthesia care unit, or PACU. She worked in the ED and ICU for 20 years, including when COVID hit. She has her master's in nursing, and in addition to providing direct care, she has also managed in a variety of settings, including primary care and urgent care clinics. In her words, "the last three years broke me." Heather, that's powerful, sure, and I'd like to turn that over to you because I think there may be more to say about that.

HS: Well, thank you so much for having me. I really appreciate it. Jennifer. The last three years have been really, really hard, and so when Amy came to me to talk about this project, it struck me as something powerful that I needed for myself as well as for all of my peers because, everywhere I looked, nurses were just falling out of the profession. I knew if we were going to continue on, we were going to have to try and save each other and ourselves so that we could continue on.

LHC: Absolutely.

HS: It was just personally and professionally challenging for me to be in the emergency room during this pandemic. I think the only way to move forward is to find ways to connect with other people and address the burnout before it gets to the point where you can't continue.

LHC: So you were a nurse in the emergency department during COVID?

HS: Correct.

LHC: Can you speak a little bit about your own personal experience, if you're comfortable with what that felt like?

HS: Of course. I'd be happy to It was hard. It was really hard. There was so much confusion, chaos, and unknowing, and there were times when we didn't have enough PPE. You'd have to wear the same gown for 10 hours. just wiping your gown down. You weren't able to pause and address the situation. People were like, "You should go in the childcare area because you don't have kids." I have kids. I can't go in there. There was just a lot of back and forth where we were really at a loss and not supporting each other the way we should. Working in emergency medicine is hard enough as it is. When someone's grandmother dies, you're in the code room, coding her. Two minutes later, you have to go into the room next door and blow up a balloon, treat a kid with racemic EPI, and try to entertain a four-year-old while you never get a chance to really deal with the trauma of losing the person in the room next door. Years of emergency medicine have prepared us for how hard this can be, but the pandemic on top of it was just overwhelming.

LHC: Yeah, I hear this over and over in my own practice as I work with medical professionals and do groups with medical professionals. Sometimes it's said I was trained, but I don't know that I was trained for this. This is just something so much bigger, and you'll have done an amazing job. I just want to ask Amy: do you want to speak a little bit about what you would define as burnout and maybe what you've even experienced yourself because, as I understand it, this program that you're creating really touches on that as the theme of connecting with people who are experiencing burnout?

AP: Yeah, absolutely. Burnout is a really big umbrella term. I think that it encompasses a lot of different things, but particularly during this time of COVID, it's a term in itself that’s been pushed to the surface. I think a lot of people recognize it now. Specifically, burnout refers to more demand than capacity. so the continual and cumulative need outstrips the resources. So, like Heather was speaking to, that's always been a part of emergency medicine, but during COVID, that was just pushed to the brink. "Burnout" refers to institutional and systemic stress. So within burnout, there's also what's called "compassion fatigue," which is when caregivers are repeatedly exposed to the stress of caregiving or to another person's trauma. whereas burnout is more about the system. so much like the emergency department not having enough PPE or constantly telling us to do things differently. Today, we're doing it this way. Nope, that's not the case, you know. Today, we're doing it this way. That is about burnout. There's also that, and I'll just mention it. One other piece of this that I think is gaining some traction. It really was a new term for me in all the time spent doing this, which is "moral injury." "Moral injury" is a term that speaks to when your sense of right and wrong is challenged. We enter this world as moral beings, especially those in the helping professions or as caregivers. We really want to do the right thing and help people, but when we can't do that or when systems are actually working against us doing that, we have to make a choice: stay true to ourselves and our conscience, or go with the system. we're injured. That is what's called moral injury, or even not having enough PPE.

LHC: Right, there was such a fear, as providers, of not only catching it ourselves but also taking it home to our families. You know bedside nurses had to worry about catching it and giving it to other patients, right?

AP: That goes against everything you know anyone is there to do. They're there to help heal and to consider passing on an illness that no one understands or knows how to treat. It's terrifying.

LHC: Yeah, absolutely. I just want to ask this question; maybe we can expand a little more, and whoever wants to speak to it may do so. either your own personal experience or what you've seen in your co-workers. What does it look like when a healthcare professional is burning out?

AP: I think it can take so many different forms. You can imagine feeling powerless if you're there to help and there's never an end to the demand. At the far end of that, you might even feel like you’re harming other people. in terms of, like, if I pass on this COVID, you might be harming other people. It's very similar to Sunday dreads. I say Sunday with a Monday work start in mind, but you know that dread you might feel thinking about going to work the next day or while driving to work—just feeling like you're going to be put in a position where you really can't affect things the way you want to? or positively, I'll just say this: There came a point during COVID when everything was so stacked that I think it started to affect me, and I felt like I was just standing there saying no to everyone. like I didn't have resources. I didn't have hospital beds. I didn't have PPE. I didn't have counseling referrals to give to people in mental health crises. I just felt like I kept saying, "No, no, I'm sorry." No, I'm sorry, and that was crushing for me because, again, that's not what I'm there to do. That's not what anybody wants to receive.

LHC: Heather I wonder if you might speak a little bit about what you would see around you that might have said, "Oh wow, there is burnout going on all around me." I mean, perhaps, an increase in substance abuse, alcohol consumption, insomnia, and the like.

HS: Burnout, in my opinion, was when I was completely empty. My bucket was empty. I didn't feel like I had anything left to give to my children, to my marriage, or to my patients, and that's when I decided to leave the emergency room and go to the PACU, which is a retirement job. It's not a place you go where you feel like you are. I love emergency medicine, and if I could stay there and sustain it, I would go back in a heartbeat, but for my own mental health, I needed to step away, and when I did step away, that's when I realized that was my burnout moment. I wasn't giving my patients what I wanted. I would go home at the end of the day and be like, "I should have and could have done this." There just weren't enough nurses. There wasn't enough time. There weren't enough resources. I couldn't do these things that I wanted to do to give my patients what I felt was the right thing to do. So where I'm at in the pacu, I'm able to do that, and that's really revitalized my love of nursing and knowing that I can give great care. then it's also given me an opportunity in my personal life to step back and look. and now that I'm divorced, I've realized I deserve different things in my relationship. I'm able to be way more present for my children, and I'm rebuilding myself as a person, which is really hard to do when you're just giving constantly and not feeling like you're getting anything in return other than angry patients that you can't meet their demands or their needs. I feel like the term "quiet quitting" has really come around recently, and I think a lot of people are quietly quitting their professions as healthcare providers because we've all been stretched so thin that we don't have anything left to give. So I didn't want to quietly quit. So I switched roles so I could still feel like I could do what I wanted. I have seen tremendous burnout among my colleagues in the ICU and ER. Like you said, there are tremendous vices that people turn to. substance abuse. There are a lot of unhealthy behaviors that people are just denying because if they think about all of the trauma they're dealing with, they'll snap. You can't go back, just like Amy was saying. You get those Monday morning dreads, and you get that pit in your stomach, and it's like, "I don't know if I can do it and go back." That's why talking with Amy about this project of finding ways to give people tools to rebuild so that they have tools and ways to find their center again, even if it's just for a couple minutes, was so exciting. Find a touchstone that reminds you of why you started doing what you're doing.

LHC: Heather I'm so glad that you had the option to get out of the emergency department and use your skills, your passion, and your heart in a different environment. I think that there are some people that are thinking, or sometimes it happens that, you know, I just need to get out. I need to do something different, but they don't always have that within their career. within their skill set. within their education to be able to move and still use those. I'm so happy for you that you had the opportunity to do that.

HS:I feel blessed to have a lot of co-workers who have left to go run food trucks or something else that is not in the industry, and I completely understand why some days it feels like I want to go sell hammers at Home Depot, but I know finding a way to sort of take a step right or left but not leave the industry is the key. I feel really lucky that I have that opportunity, and I think people should look at that so that you don't completely get to the point of breaking and moving on and not staying in healthcare.

LHC: I think you just spoke to that so well, Heather, in so many different ways. I think one of the most important points is that we're not talking about the actual setting. Heather, you were talking about going from, you know, the code directly next door to, you know, treat an allergic reaction. By the end of your 12-hour shift, you have made so many pivots that you can even go back to 8 a.m.

HS: It's like a world away, and so there is just not time, space, or the culture to actually stop and reflect on what you have been holding and moving through the day working with, let alone to notice your own emotion or your own body. I mean, there were times when I would go 12 hours and realize I hadn't even gone to the bathroom once. So you even pause and think, "Oh my gosh, I'm getting pretty stressed," and then you go home and you can't really talk about it with your family or your loved ones. There's just not a place that supports it. The other thing is sort of a byproduct of there not being a place to support it. It is the point at which you begin to believe that it is you. If I'm really struggling with this or if I'm stressed out, I won't hear anyone else talking about it, but I might hear someone else talking about it. venting right? I might hear them venting about the patient in 24 hours or, you know, venting about the lack of PPE, but I don't hear them grieving. I don't hear them talking about being afraid. So you begin to think that it's you. that you're not cut out for this, or that you know you must be extra sensitive, or that you just don't have what it takes to do this. which just creates more stuffing and more denial. I'm definitely not going to talk about this, and that's when it starts to come out sideways. drinking too much or not talking about it. not feeling and not giving yourself space in other areas of your life, right? Isolating myself from life, yeah, Amy I feel like talking about the culture is a really big deal. I have seen a slight shift recently as burnout has become a more popular topic of conversation. Quitting, using these words, or simply seeing our peers leave departments means that we are finally beginning to have those conversations about how we are going to heal our healers so that we can all continue on. The more I talk about the project that you and I are working on with my peers, everybody's like, "Please let's." I need this. You're not alone. We all feel that way, so finding that connection so that you don't feel alone is essential. Feeling like you don't have to wear your armor all the time because we are expert stuffers is unacceptable or culturally inappropriate.

AP: You know that armor is important so that you can go from the code to taking care of somebody who has a kidney stone. But you also need to let that armor down at some point so that you aren't constantly just not feeling it.

LHC: yeah. So we're definitely going to talk about this program, and I'll leave it up to you how you want to segue into it. I just know that there are a couple of more questions, and maybe those questions will be answered as we begin to talk about the program that you're creating. I would really like to talk and make sure that we address, like, when a person recognizes the signs of burnout, what they can do to address it, and then also be able to talk a bit about the role of connecting with others.

HS: This is so important when we're addressing the culture. Like we brought up, we're addressing watching each other burnout and how we can keep each other from doing that. So there's not one approach to beginning to address burnout. It's a bit like saying, "You know, how do you begin to address depression or PTSD?" It's sort of multifaceted, but there are things to do to begin to look at in the short term, which essentially means anything that's good for your body is going to be good to begin to address burnout. Self-care is frequently described as a night of indulgence. like taking a bubble bath, doing your nails, or making a spa appointment. That is an event, but what we really need to shift to in this culture is thinking about this as a practice. a discipline that's not something that you come to when you're just in a crisis or you're really feeling it, but something that you touch on daily. everything from eating well, sleeping well, and being mindful of the substances that you're using. moving your body. I'd sometimes get to the end of a shift and realize I hadn't peed in 12 hours. then that's a cue, like, "Well, I'm definitely not going to leave here and go eat a bunch of junk food and have a few drinks." I need to care for my body. I need to recalibrate it, so that's a short-term piece, just really taking care of our physical being. Then there are longer-term pieces that reconnect us to why we got into this in the first place. burnout compassion, fatigue. moral injury. Heather, you were saying that your tank is empty. You feel like you have nothing to give, and that disconnects us from why we're even doing this. So, returning to why we got into this in the first place and what actually brings me joy about it, is it talking to the patient? Is it establishing a connection? Maybe I was able to find a referral. Maybe I was able to have a conversation where something was understood. Those are real pieces that can happen and are within my agency. The other piece is just noticing our own nervous system, right? Like when we're running from thing to thing, we don't have time to pee, and oftentimes that doesn't even get noticed. We know we've been busy, but we're actually paying attention to what's going on for me. Oh my gosh, I'm so tired, or wow, I've just been running all day and then not letting that go at the end but really paying attention to what we've just been through. You know the toll that it has taken. Going back to our values, we are so attuned to our nervous systems. taking care of our bodies as a discipline.

LHC: great. What about the role of connecting with others? It seems like this is a really big piece.

AP: You know, one of the things that was or was not fascinating to me—I guess what I'd say was more disappointing during COVID—was how we were all having this collective experience. There was not enough space to talk about it. So again, venting was happening, but we weren't talking about what was happening to ourselves. then you know the system would say, "We really see your sacrifices if you're struggling; here's the call map." Here's EAP. But weren't those the factors that kept it with the individual? If you are struggling, it's easy to think, "Well, I don't hear anyone else talking about struggling, so I must be the only one." "Go!" they exclaimed. Go do it on your phone or go talk to someone one-on-one. That kept it isolated, right? which keeps it stigmatized. which keeps it down and does not normalize this part—that caregiving as a profession is really hard work—we, as caring, conscientious people, are going to feel the effects of that, so connecting with other people around us is critical for healing. I mean, if you think about trauma work and healing, it isn't done in isolation. It's done through connection. when we can make use of the resources, energy, and support that others bring to the table. so connecting. So connecting is key, and that's definitely something that Heather and I are planning to incorporate into our program, which is about really connecting in a common space. making sure that it is normalized and that there is a space to talk about it, as opposed to it just being one-on-one.

LHC: So let's dive into that a little bit. Tell everybody what it is that you are in the process of creating, or is this already created and being utilized at this point? We are in the process of creating it. Okay, tell us about it.

HS: yes. so it is called "rooted." "Rooted" refers to the place of rooting in your values, rooting in your community, and rooting in your nervous system. It is going to be a sequential workshop series, where people can either attend online or we’ll have an in-person component. It is a place for people to come and both get information and learn how to tap into their nervous systems to see what's going on. How do I reconnect with what I'm passionate about while also receiving and providing support to peers and colleagues who are going through and experiencing the same things?

LHC: Is this specifically for medical professionals in hospital settings, or is this in the community? Talk about how people might find this program and know that it is for them.

AP: So, any health care professional is fine? It could be an inpatient or outpatient hospital setting for folks who are in health care, anyone from a nurse's aide to a physician or unit secretary. People are subjected to the system, the trauma, and the demands. You know, everyone is welcome to participate, and we're going to be offering continuing education credits for folks who want or need them, but even without continuing education, our hope is that it is a place of connection and renewal, that it's actually not just like going to a training but that it's fun and that it's energizing.

LHC: So, Heather Maybe you can speak a little more when Amy says "sequential." Are we talking about once a month or once a season? What does that schedule look like?

HS: We're still determining how frequently this is going to need to occur and continue. You've got to give people time to sort of reflect on what they're learning at each moment. I feel like weekly would be way too often. Because everyone is so time-crunched these days, monthly is probably more appropriate. But we're still going to sort of feel that out and see what people really need and try to be flexible and adjust accordingly because everyone is in different places in terms of where they are and what they can give. or that they're willing to even take a mirror and look inside to see where they're at and where they need to go. I really don't think that we can say that this is cookie-cutter for everybody, and so that's why my gut says once a month. Perhaps once every three weeks, but we're still working on that, and this could be done virtually or in person. So either both of those things happen at the same time, or perhaps a virtual cohort is followed by an in-person cohort.

AP: Correct, specific cohorts. one online and one in person. We wanted to have a flexible approach because, as Heather just mentioned, people are in different places, and we knew that there would be people who wanted to come in person and those who would prefer to stay at home.

LHC: I was going to ask, "How might people get a hold of you?" Where is this going to happen? It appears that we are a little early, and perhaps once this begins, we will have you come back with all of that information.

HS: That sounds awesome. Yes, I believe we intend to launch something.

LHC: I'm not sure if you've figured this out yet, but is this going to be in the spring? going to cost someone.

AP: Yeah, there will be a fee. But hopefully a lot of folks in health care systems, particularly when they're earning continuing education credits, have education funds through their organizations that can be utilized. Our hope is that folks can make use of that, and that's actually something that came up, that a lot of folks don't even realize that they have those funds available to them, and if they do, a lot of folks don't utilize them for themselves, so, actually, using their education dollars to do something fun and energizing would be their own way of caring for themselves and investing in themselves. I think one thing I just want to say that comes up for me as we talk about this program is that Heather and I both really recognize that there are huge systemic issues that create and perpetuate burnout, and you know, part of the stigma around burnout is that a person doesn't have the chops and that they just need to work harder so they can meet the demands. So by creating this program, we are by no means saying people need to work harder so they can go back into their systems. What we recognize is that systems move at a glacial pace in terms of People are burning out left and right, and it's about providing support for themselves as a person so they can be in the system if that's where they choose to be and can evaluate the impact on them. If there are ways to adapt to endure and persevere, or, as Heather suggested, go run a food truck where their values can be aligned, they should do so. So it's definitely not about working harder. It's about noticing how you're working.

LHC: yes. Yes, thank you so much for going through everything that you've gone through, seeing the need, and beginning to create this thing to address this need. I'm excited for you. Thank you so much for coming on today, and let's just plan our launch for the spring, or maybe after your first few groups, we'll have you come back and tell us a little bit about how it's going.

HS: That would be fantastic, right? We would love that.

LHC: Thank you so much. Thank you so much. Heather

HS: Thank you so much, Jennifer.

LHC: Thanks again for listening to "Let's Make a Health Connection." Find us online at localhealthconnect.com as well as on Facebook, Instagram, and Twitter. Links and show notes for this interview are available on our podcast page. These interviews are really fun, and I hope you made a health connection today. We'll talk again later. Let's make a health connection for 2022. All rights reserved. This is the exclusive property of MBS Therapy LLC, a Washington-based company. Local Health Connect is inclusive and does not endorse any political or religious group. Thank you again for listening, and we'll see you next time on localhealthconnect.com.

By Jennifer Barber, LICSW 1-30-2023