Podcast: The Compassion Revolution with Mary Freer

Episode: 45
Guest: Mary Freer
Duration: 1:03:57
Tags: : Occupational trauma, self-compassion
Soundcloud: Listen to Episode 45

Author and social worker Mary Freer has devoted her career to transforming our understanding of compassion as the CEO and Founder of Compassion Revolution. She joined midwife Celeste Pinney on the Nurse & Midwife Support podcast to discuss the importance of self-compassion and how it can help to carry nurses and midwives through post-traumatic experiences.

“Some of the ways that we can kind of build our self-compassion muscle, as I like to think of it, is we can listen out for a particular voice that we hear. I call it the voice of self-criticism. We have this on speed dial. Everybody listening will be ...some people even give their voice of self-criticism and anger ... everybody knows that we speak to ourselves in a way that we would never, ever speak to anyone else, right? So when we make mistakes, we really quickly can jump into a place of "I can't believe you did that!" Or we'll say things to ourselves like, "Oh, you're so stupid!" which we would never say to anyone else. We've set rules and expectations for ourselves that we wouldn't set for others.

So understanding that there's a particular voice--we'll now start calling this the voice of self-criticism--we then start to say, what might a voice of self-compassion say to me, and we give ourselves an opportunity to start to cultivate a relationship with ourselves that's like we're a dear friend. So we can ask ourselves, what would I say to my bestie right now?” 

Celeste and Mary discuss techniques to practice your self-compassion skills and the power of identifying the activities that nourish you, like listening to music, spending time in nature, or going to the gym. 

“These seem like such small [things], when things are going well, they almost seem silly. But when things are tough, these things that you know about yourself are really helpful.”

What do you know about yourself that can help you through the hard moments? We’d love it if you could let us know. 

Thank you for joining us and sharing your wisdom Mary! 

If you’re struggling and need to talk, Nurse & Midwife Support is here to support you: 1800 667 877 or by email.

About Mary Freer

Mary Freer is a Compassion Revolutionary and the Founder and CEO of Compassion Revolution.

Mary has contributed to Australia’s healthcare system reform in a variety of executive and leadership roles over the past 30 years in both State and National government agencies and not for profit health and social care services.

She has founded social change movements and worked closely with global health improvement leaders, clinicians and administrators in many countries across the world to bring about system improvement.

Mary Freer is a Westpac Foundation Social Change Fellow and the author of Compassion Revolution: Start Now* Use What You Have * Keep Going*.

You can read more about Compassion Revolution and their conference Making Work Beautiful at compassionrevolution.care

Find Mary on Twitter at @FreerMary.

Celeste Pinney [0:02] Welcome to the Nurse & Midwife Support Podcast: Your Health Matters. My name is Celeste Pinney, the podcast co-host today. I'm a Stakeholder Engagement Coordinator with Nurse & Midwife Support, and I'm a registered midwife. Nurse & Midwife Support is the national support service for nurses, midwives and students. It is anonymous, confidential and free. You can call anytime you need support on 1800 667 877, or contact us via the website, nmsupport.org.au.

I would like to begin today by acknowledging the traditional custodians of the land on which each of us are listening on. I pay my respects to First Nations elders, past and present. I extend that respect to Aboriginal and Torres Strait Islander people both contributing and listening today. Sovereignty was never ceded.

Today, we will be discussing Post-Traumatic Stress Disorder in nurses and midwives in the context of compassion and self-compassion. We know from the research that about 15 to 20% of nurses and midwives experience PTSD as a result of workplace stress. Given that's a pretty high percentage of people, we feel it's an important topic to broach. Anyone who has lived with PTSD will know that it's a condition that is very difficult to live with and can be extremely debilitating.

Today, joining me to discuss PTSD and ways in which we can help prevent and support people living with this condition, is Mary Freer. Mary is an author, social worker, compassion revolutionary and the founder and CEO of Compassion Revolution. Mary has contributed to Australia's health care system reform in a variety of executive and leadership roles over the last 30 years in both state and national government agencies, and not for profit health and social care services. She has founded social change movements and worked closely with global health improvement leaders, clinicians and administrators in many countries across the world to bring about system improvement. Mary is a Westpac Foundation Social Change Fellow and the author of 'Compassion Revolution: Start now. Use what you have. Keep going.'

Welcome, Mary.

Mary Freer [2:15] Hello. Thank you for having me.

Celeste Pinney [2:18] Thanks so much for being here, Mary. I'm really excited today that we're having a compassionate conversation.

Mary Freer  [2:25] So am I. My favourite conversation!

Celeste Pinney  [2:28] Yes. Sounds like it! You've created a compassion revolution. Could you tell us what it's all about?

Mary Freer  [2:35] Yeah, I'd love to tell you. I would describe Compassion Revolution as a mighty little organisation, but it has a really big vision. We're all about helping people step into their full compassionate selves. When we talk about compassion at Compassion Revolution, we think of it as muscular. We know that it has a universal quality, and it's powerful enough to change the way we do things. It can shift organisational culture, and it can repair us and revitalise us. That's really important right now for the work that we're all called to do. Compassion Revolution operationalizes itself in a number of ways, and might be useful at the start if I just give you a little bit of an idea about the things we do.

We hold what are called Compassion Labs, and many of your listeners might have joined a Compassion Lab through their health service or organisation. Compassion Labs are small scale, experiential learning opportunities, where we bring people together, either face to face or online. We provide the space for them to learn about the science and the practice of compassion, and how that shows up or doesn't show up in their place of work. We have a lot of attention on self-compassion, and how we can develop a more kind and loving relationship with ourselves.

We also deliver what are called Compassion Collaboratives. That's more large scale. That's where a discipline, a group of people, an organisation, or a network, decide that they really want to build and change the culture of their organisation. They want it to be one that is more health-giving to everyone. So we'll work with a larger team of these beautiful humans, and we help them to start action right where they are. I sometimes think of a Compassion Collaborative as like a community of practice, but with an engine.

The other way that we meet the world is through our Annual International Conference. So, we hold a conference once a year. It's a beautiful event. This year, our theme is 'Making Work Beautiful,' so it really fits with this conversation. It's being held in Melbourne on the 24th and 25th of October at Fed Square. I hope we get a chance to come back to that.

Lastly, the way we work is that we also work with organisations, communities, government departments, when they're rolling out a new program of work, or they're, for instance, building a new hospital, bringing something new to life, a new program of work. We bring the design thinking that makes compassion the central focus of the work that they're doing. That's all about building new systems and processes. In many ways, we can be like compassionate provocateurs, and we bring a lot of commitment to beauty and creativity. That's what Compassion Revolution is.

Celeste Pinney  [5:51] Thanks for sharing, that sounds amazing. Sounds like you're creating some incredible social change there and spreading the word about compassion, which I think is really needed in healthcare and beyond. We would love to know a little bit about your self-compassion tips, for those who are working towards creating more compassion in their life. If you could share that with us?

Mary Freer  [6:15] Yeah. You know, the thing that we're just not so good at is applying compassion to ourselves. Before I even talk about self-compassion tips, I think it'd be really good if I just say what I think compassion is, so that we're all thinking about the same thing.

[When] I use that word compassion, I am talking about our quality of being able to notice the distress that we are experiencing, and that other people are experiencing, and to set about alleviating that distress. That's what compassion is. There's a lot of literature and research about compassion. It's quite a field of interest across the world. But essentially, it is about noticing our distress and other people's distress and wanting to alleviate that. What we often think compassion is, is all about everybody else. So we'll think "I'm exhausted, I can't be compassionate." But compassion is also about what is happening for us and getting closer to ourselves, and understanding what we're experiencing.

When we talk about self-compassion, what it's not is, it's not about self-pity. Often people will get trapped by thinking, "If I give myself a lot of compassion, then maybe [it's] just self-pity. It's not about that. Self-pity actually erodes our sense of connection and interdependence. So it's not about self-pity, and it's not the same as self-esteem. It's not about, you know, doing the power pose, or writing ourselves little affirmations, or creating some inaccurate view of what is happening in the world, to talk ourselves into thinking that we can, you know, actually meet the challenges. It's not about self-indulgence.

People will sometimes feel that, "If I practise self-compassion, I'm gonna let myself get away with everything." You know, it's kind of the soft option. "How will I ever get anything done?" people often will say, but self-compassion actually helps us to get things done. It helps us to do things that are really good for us. The voice of self-compassion, when we practise self-compassion ... it's not going to help us on a chilly winter's morning when we wake up at 6am and the alarm goes off, and we're meant to go to the gym ... self-compassion isn't the voice that says, "Roll over, go back to sleep, you deserve all the rest in the world." Self-compassion, actually, is the voice that says, "You know what, this is going to be really, really good for you. And you're almost on a roll. You've done it five days, now keep going." It really is a voice of 'keep going.'

So what is it? What is self-compassion? The person who's probably done the most amount of research around self-compassion is a psychologist, a woman called Kristin Neff. She says there are three elements of self-compassion. It's about self-kindness instead of self-judgement. It's about understanding our common humanity instead of thinking that what we experience, we experience alone. And it's about mindfulness, not over-identification.

Some of the ways that we can kind of build our self-compassion muscle, as I like to think of it, is we can listen out for a particular voice that we hear. I call it the voice of self-criticism. We have this on speed dial. Everybody listening will be ...some people even give their voice of self-criticism and anger ... everybody knows that we speak to ourselves in a way that we would never, ever speak to anyone else, right? So when we make mistakes, we really quickly can jump into a place of "I can't believe you did that!" Or we'll say things to ourselves like, "Oh, you're so stupid!" which we would never say to anyone else. We've set rules and expectations for ourselves that we wouldn't set for others.

So understanding that there's a particular voice--we'll now start calling this the voice of self-criticism--we then start to say, what might a voice of self-compassion say to me, and we give ourselves an opportunity to start to cultivate a relationship with ourselves that's like we're a dear friend. So we can ask ourselves, what would I say to my bestie right now?

We would probably say, when they stuffed things up, we would probably say things like, "Hey, you haven't had enough sleep, you got a lot on your plate at the moment, take a break." Or we'd say, "It's not that bad. I think you're blowing [it] out of proportion. We all know you do great work. This is just a little hiccup." You know, like, there's a whole repertoire of really beautiful and truthful things that we say to people that we care about. Or we say, "I've got you. I'm here for you. Sing out if you need help, or if you get stuck." But with ourselves, there's this expectation that, "Oh my god, I can't fail. If only I was like that particular nurse, she always gets everything done, she goes home looking like she's on top of the world." Because that's what we see, right? So we start to compete with that.

The first thing I would say is start thinking about the voice that you use. The research tells us, it's not only the words that we use when we speak to ourselves, but it's actually the tone. Just like we know that there's a particular tone of voice that really soothes and comforts others. We know that, because when people are distressed and we work in a clinical space, when our patients are distressed, we know there's a particular way of speaking that is more soothing. Then there's another way of speaking that you could use on the sporting field, which really gees people up, so we know about tone. So think about the tonal quality of how you speak to yourself.

Another tip I would give to people is [to ask] how often do you take a self-compassion break? I think these are really good. Setting aside even if it's just five minutes during each day that you can turn off your devices. You can take a moment to breathe and to regulate yourself coming out of this pandemic. And let's hope we're coming out. But at this stage, I like to say that at this stage of the global pandemic, we're all a little bit dysregulated, right? So our nervous system is [inaudible], and it's likely to be more kind of up-regulated. So it's even more important that we find a time to just put both feet on the floor and just breathe in and breathe out. We don't have to do anything while we're here. The body needs to breathe, and it needs to calm itself. That also helps with our self-compassion. Just like we would say to someone else, take a beat. We're saying to ourselves, take a beat, time is not a bully for five minutes. We can just sit and greet ourselves. That's really important.

Music is really important. Music strengthens our nervous system. It tones the vagal nerve, it up regulates our parasympathetic nervous system. So listening to music that you find enjoyable ... I found during COVID that I started making playlists when things got really stressful. Playlists are a great idea. You can even have your 'Compassion' playlist, or your 'When I'm feeling frazzled' playlist. It might be you put that on on the way home and you decide what the music is. Like, I'm going to be honest here. I had a run of Dolly Parton. Suddenly, I discovered Dolly all over again, and somehow that was really helpful. I don't tell everyone that. So have a bit of a think about that.

Also art, and things that are beautiful. Nature is really important. When was the last time that you got outside and actually enjoyed the natural world. We know that that is really good for our nervous system. All of these things are about self-compassion. Writing is really good. Some people love to write, I sometimes help people write a secret letter. I call them love letters, but write a secret letter to yourself, that is great for you to read on a really bad day. It's like giving yourself the advice, the notes, jotting it down. It doesn't even have to be very long, and you put it away. Then when things are tough, there's this little note of encouragement. Sometimes I will have just a phrase, you know. For a while I had this phrase 'Love is my home.' If things have got scratchy, I could remind myself and I found that really soothing and comforting.

Treating yourself like a friend. Buying yourself flowers, just stopping at the market and getting some flowers or picking flowers out of your garden or anything where you bring the natural world in, things that have fragrance, things that have texture, these are all really good for our nervous system. I know people who send themselves flowers, and write a little note. So they arrive with the note saying ... if I did it for myself, I haven't done this but I could say, "Oh, Mary, you're such an inspiration to me. All the love." I know it's for me, but it's kind of like this reminder.

The other thing that really helps with developing a more compassionate relationship with ourselves is soothing touch. So massage is very good for us. If you're someone who likes having their skin touched in a safe way by someone that you trust, massage can be very good. We know when we get stressed or anxious--and you'll see this with your friends and yourself--we rub our hands together. We might be rubbing our hands, thinking, "I don't know how I'm going to solve this problem." Or, we call it wringing our hands, you know when you're folding one over the other. What we're really doing is we're stroking our own skin to soothe ourselves. That's the body's way of activating the C fibres on the skin, and trying to bring our nervous system into a state of calm.

So: massage, movement. Meditation is a beautiful thing. Joining a singing group, using our voice. Humming, singing, very good for strengthening the vagal nerve as well. Thinking about the food and the water that you drink. Some foods that are highly nutritious and not high in sugar and are high in carbs can really be quite settling for us.

Lastly, I'm going to say we are all so dehydrated. There's research that's told us that clinicians working in emergency departments are often more dehydrated than patients being admitted. We need to think about how much water our body needs. When we get busy and we get stressed and we're not looking after ourselves and not loving ourselves and being compassionate to ourselves, we often aren't drinking enough water.

I know that these things that I've suggested feel like common garden variety ways of expressing compassion. But I really want people to see that is actually what compassion is. Compassion is this sense where we can say to ourselves, "You yourself, as much as anybody in the entire universe, deserve love and affection." Or, "You yourself, as much as anyone in the entire universe, deserve a break, a glass of water."

If we treated the people who work for us the way we treated ourselves, we'd be in big trouble. If we said to someone who started working for us, "I prefer that you don't go to the loo during the day, just hold on until about four because we've got loads to do." That's what I hear people doing to themselves. Or if we said to people, "We don't drink water during the day, because it takes too long to go over to the fountain and get a glass," it would just feel horrendous. But for ourselves, we can often say, "I'll put that off. That's not important. It's just about me, I'll keep going." Loving ourselves is about all those things. So they're my practical tips.

Celeste Pinney  [20:01] Sounds like the small acts of self-care and self-love really add up and can help to build a sense that you're caring for yourself, or you're giving self-compassion to yourself.

Mary Freer  [20:13] Completely, they have a cumulative effect. As we start to care for ourselves, we talk to ourselves differently, we set boundaries that are different. The part of developing self-compassion is that we become more of a boundary ninja. We understand what our boundaries are and instead of saying, "I'm available to everyone all the time," we start protecting the asset. We start caring for ourselves and protecting what we have, because we want to be here for ourselves.

We want to be here for our dog, we want to be here for our family, we want to be here for our patients, our clients, our colleagues. We want to be here for the planet. We really have to take care of ourselves, and we can't just, every time someone asks, we say, "Yes." That means that we're saying no to something else. All of these things accumulate, we start to think about ourselves differently. That's what I've found.

Celeste Pinney  [21:14] Yeah. I like that you've helped to define what self-compassion is, because I think we do maybe hear the term bandied around, but we're not really sure specifically what it means and your examples and practical strategies have helped to give more clarity to that.

I'm also curious because we know that people who are in distress who may be suffering from something like PTSD can have quite a strong inner critic, or may feel that they're not doing well enough in their life, or they may feel that they should be better, or they may feel guilty or negative thinking like that. How easy do you think it is to implement these things when someone is in distress? Or is it just about starting, like you said, with five minutes a day of setting aside some time to practise that self-compassion.

Mary Freer  [22:06] I think there's a couple of things here, actually. I would say to people, you never know what's coming. My friend in the United States is a wonderful teacher around compassion and boundaries. Her name is Shannon Weber and she's written a great book called 'Show Up Hard.' But one of the things that she teaches is build a resiliency landscape. Predict the things that you need weekly, the things that you need to happen in your life monthly to look after yourself. Maybe quarterly, or maybe they're just once a year, and then understand "What do I need when I'm in distress?"

I'll talk a little bit about this, I think this is really helpful to us. Because when we're in the midst of distress, it's more difficult for us to understand what it is that we really need. But if we've done a little bit of work beforehand, then we can rely on that practised wisdom, right, that we already know enough about ourselves and we've had some forethought.

For everyone listening, I would say: what are the things that are really important to you on a weekly basis when it comes to taking care of yourself? People might have things on that list, like, 'I go to the gym.' Maybe I go to the gym once a week, twice a week. Or I like to walk, or I like to catch up with a particular friend on a Saturday morning, we always have a great laugh, or I always love to be reading a novel. That's something any week, if you dropped in, I have a book by my bed and I like to read it. I love to listen to a podcast, whatever it is, that happens regularly. Understand what those things are.

Then there are things, we only maybe do them once a month. In that little area, you might say, a massage. Going and having a massage, going and swimming in a public pool, visiting the ocean and having a morning swim, inviting a group of my dearest friends around to my house for a barbecue or whatever it is that you do. And then like what are the things that are spread out over the year and it might be three times a year I like to have a mini vacation. I may not even go anywhere, but I just do something really nice at home, or I go stay at a caravan park by the beach. Or I have a little bit more resources, so there's an Airbnb that I go to or I visit. But there's these things that I do a few times a year and they're really important to me. Each year it's really important that I take my leave or I visit my family or whatever it is.

Then we work out: in times when things are really tough, what really helps? When I did this, it's like, when everything hits the fan, it's really important for me to remember to drink lots of water. Because I know from years and years of experience, that I will stop drinking as much fluid and that exacerbates a sense of distress or nervousness. I also often will become more attracted to sugar. One of my strategies is to cut sugar in times of distress. Don't have it. It'll only make things worse. And the other is, I will find it a little more difficult to go to sleep. This is what I know about myself. So when I'm going through stressful times, I have an evening shower.

These seem like such small [things], when things are going well, they almost seem silly. But when things are tough, these things that you know about yourself are really helpful. I'll always remember to have breakfast when I'm stressed. This may not mean anything to anyone else, you'll have your own. I will often not exercise when things get really busy, because I'll tell myself I'm too busy to go for a walk. But I actually know that going out into nature and walking is really, really good for me.

I have these ... there's probably about five or six things. I have them, I know where to find them. So it's like, "Oh yeah, I love to listen to that music! I will have an evening shower. Cut out the caffeine, stay away from the sugar and make yourself drink more water, you will get through this next little period so much better. Maybe there are two people I know [who are] great to call at times like that. 

I would say develop that ahead of time. But if you are going through a really tough time and you haven't developed that, then you're right, we have this really critical self-talk that happens. We see ourselves not the way other people see us, and we judge ourselves really harshly. So then it's like, "What can I do that I really, really enjoy?" And I'm gonna give myself permission to do it. Is it floating at the pool? Is it drinking a berry smoothie and turning all the devices off? Is it sleeping in on a Saturday? What are a few little things I can do that are just like, 'I'm cutting myself some slack.' That can be really important as well.

Celeste Pinney  [27:50] Wow, it's such a great concept, and I hadn't really thought of it. But I love thinking about how you can proactively put a plan in place, because we know that in all of our lives, there will be hard times. It's thinking ahead about 'what are the things that I really need?' that I can put in place now. So that when I am in a really distressing time, I've almost, like you said, built the muscle or I've practised that, so it's easier to implement.

Mary Freer  [28:16] Exactly, that's exactly right. We don't even have to think of the really distressing time as post-traumatic stress. Some of us will get to that place. Not all of us will. For others, it'll just be that there's another COVID outbreak, and I am having to work in a really stressful situation, or that we suddenly lose a few more members of staff, and we've got agency staff coming in. That's always tricky, because I'm bringing people up to speed on all of these things. Or it could be anything, someone in my family might get very sick [for example]. You know, there's a million things and so when the rubber band is being pulled more than feels comfortable, what are these things [to implement]? Then we start to prioritise them.

Otherwise, we're human and we fall back into lots of bad habits. We're not going to judge ourselves for that, or beat ourselves up about it. Like even if we do [give in to the bad habits], it's like, "Yeah, I see what you're doing there. Put the chocolate bar down Mary, let's have a berry smoothie. We're not gonna be cruel to ourselves. We're just going to love ourselves through it. But we've done a bit of work that can help. It's like a little safety plan for ourselves.

Celeste Pinney [29:43] Yeah, I love that.

Mary Freer [29:43] This will really help, you know?

Celeste Pinney [29:48] I think it's good and pragmatic. I think it'll really help our listeners have a better understanding about how they might be able to give that care plan to themselves. We've talked quite a bit about self-compassion, what we can do for ourselves when we're in distress or if we are suffering from PTSD. I'd love to turn now more to a little bit about the way we relate to other people, particularly in the workplace. Because we know that the way we communicate and relate to others is important to our wellbeing. So I'm just curious to hear from you what you know about how the way we communicate with each other has an impact on our emotional and mental health, and wellbeing?

Mary Freer  [30:42] Yeah, it so does, it so does. We know from the research that if we experience incivility at work, rude behaviour, shaming, blaming, any of those things ... if we experience them, or if we witness other people experiencing that sort of behaviour, then it has an immediate impact on us. 

There's a researcher out of Israel called Amir Erez, and colleagues like Christine Porath have done some really interesting research around what happens in clinical simulations when teams ... what they've done is they did a piece of research where they put nurses and doctors into two different teams. They had, I think it was three nurses and a doctor and then a simulated infant. I think it was an 11 month old infant, I can't remember ... no, it was much younger, actually was a 30 day old infant.

In both of the groups, they knew that they were being observed by someone. In one of the groups, the control group, the observer would save them at the beginning of their simulation. Now, if they correctly diagnosed the 30 day old infant [with] necrotizing enterocolitis, if they made a correct diagnosis, they would start a correct treatment. You know, you would want to get moving on this. They knew they were being observed, they would hear the observer on the other side of the mirror in the control group say something really benign like, "I'm observing you now, please commence the simulation when you're ready," and then interrupt them partway through to say, "I am continuing to observe you." So really a very benign kind of communication. 

But in the other group, the observer was really rude and dismissive and would say things at the beginning of the simulation. He said something like, "I'm new to your health system, but from what I've seen so far, I'm really glad I'm not sick. Because I wouldn't trust you." Then they started the simulation, and then he would interrupt them, tell them off, and ridicule them. [He'd] say, "You work so poorly as a team. None of you would be employed in my hospital." You had this group of people that were witnessing each other and experiencing for themselves this really rude behaviour.

The difference that it made in terms of clinical outcomes was really frightening. Because they felt that it accounted for over 50% of the errors, that people in a control group doing that simulated study where they had experienced rude behaviour, were much more likely to make incorrect diagnosis, to ask for incorrect medication, to give incorrect medication from what the doctor had requested. They didn't share as much information about their thinking and how they were reasoning around the diagnosis. Things just weren't happening.

In the other group, it's not that everything was perfect. But you didn't have this series of things that were going wrong. What it tells us is when we're at work, and we're experiencing this rude behaviour, or people make dismissive comments, put us down, or to speak to us or our colleagues rudely, the frontal cortex kind of goes offline. We often call this amygdala hijack, but we do not think as clearly, as rationally, we don't have such high order thinking. We can't make these strong executive decisions when we're experiencing this poor behaviour. That's why when we get really stressed when we get upset, we will often forget things. So if anyone has ever, you know, experienced a shock, you find it hard to recall your phone number, or you're like, "Where did I put my key?" Suddenly, I'm losing everything, I'm not able to think straight, or you might need someone else to help you make decisions if you've just received some really hard news.

Same thing is happening for us at work, we're not able to think really clearly. If we want people to be creative, innovative, practice in a way at the top of their licence, practice in a way that is safe, that is caring, that is kind, then the way we speak to each other has a huge impact on that. This was really shocking for me to learn a few years ago when Professor Erez did this research and I read it, because it was my wake up call. Bad behaviour at work ... I had always thought it was just really bad for workers. Like, this is really stressful, it's really bad for their health, no one should be treated like this. Then I started to realise this is really bad for patients. This actually costs lives. 

More and more I speak to health administrators and clinicians and I say to them, creating the best possible culture in your hospital, in your workplace, not only has a protective quality for the people who work there, who are really important to us, but it's actually a clinical safety issue. It's going to keep some people alive, it's going to reduce our risk of error. It's super, super important. So I say to people, be mindful of the way you speak. We all have really crappy days, and [when] you say things [and] think afterwards, "Why did I put it like that?" It was just so snippy. Walk it back, create a culture where you can pick up the phone and call someone and say, "I was so snippy in that meeting, and I just want to apologise. That wasn't the best version of me."

Yeah, that is so appreciated. People are like, 'she actually knew that she was a bit rude and cranky.' We'll give each other a bit of slack. It's not about always having to be perfect. But it's about understanding what is our wake, what happens after we leave the room. What's the impact that we have on people?

Celeste Pinney  [37:38] Yeah, I think it's a very telling story you've told there, in relation to that study. I think unsupportive work environments do have a huge impact on people. We know that from the people who call us, and we know that from the research that positive relationships and supportive work environments obviously has a huge impact on not only nurses and midwives, but also patients, which is really important to think about.

Mary Freer  [38:07] Yeah, totally.

Celeste Pinney [38:12] I guess in light of that, I'm curious to know from your perspective, how can managers, leaders, teams, and individuals create a safer and more compassionate environment to help prevent PTSD and things like emotional distress in general?

Mary Freer [38:30] I think organisations need to think really carefully and with a lot of intent and commitment around the sort of culture that they are creating and want to create where they work. Our workplace needs to be psychologically safe for us. It needs to be like that, because that's the sort of work place where people are innovative and creative as well as, that's the sort of workplace where we deliver better care that is safer, and works for everyone. It's good for us in a whole range of ways. 

I think I'm really heartened when I see organisations inviting Compassion Revolution in to help them actually have more structured ways of learning about compassion and care. So that's one way. Seeing more people adopt, you know, things like Schwartz Rounds, where they're bringing people together to actually talk about the implications of their work, their emotional responses to their work. Finding ways to have fun at work. Work shouldn't be something that we need to have a couple of days off to recover from. Right, this idea that we've created work environments that [make us feel that] 'I could handle five days but after that I need to sleep for a day, just so I can recover.' This is crazy. This isn't going to be the future of work, there is going to be a global shift around the way we structure work. 

I think already, we're seeing in many countries a move to the four day working week, that's going to put a lot of pressure on employers here in Australia, because that's also something I think that will come for us. People are wanting more autonomy at work, create workplaces where your people can make decisions within safe boundaries, where they can bring their wisdom, their clinical expertise, their knowledge, their knowledge, the intuitive knowledge as well, to the fore and can offer those solutions. 

For people that are working in these organisations, you can sometimes feel like, 'it's all very well for you to say all those things, but how do we actually change what's happening for us in our ward or in our department?' Then I think, don't underestimate how contagious compassion, kindness and care are, it really does have a ripple effect. Start small with others. Think about what are some of the small things that we could do at work that would make a real difference. 

I was talking a minute ago about how we can all have bad days where we behave badly. And I was saying we can walk it back and apologise. Well, it kind of works in the reverse as well. I've just remembered this, and it's a sweet story. During the height of the pandemic, when so many of us were just stretched beyond what we thought was possible, I had a conversation with an executive in a large public hospital in Australia. He said that there were these weekly, or might've even been twice weekly, COVID meetings, they had to go to. They're very strategic and there were so many things that were happening. They're just making these decisions on the fly. 

Anyway, he went to this meeting, and he just lost it. He got really cranky. He felt that a particular thing hadn't happened and he was really pissed about it. He looked back and thought he didn't behave particularly well, as he was walking to his car. But the beautiful thing was, as soon as he got back to his office, someone else in that room who didn't know him really well--but knew him, had been observing him for a while--rang him and said ... I'll just make up a name now, I'll call him Phil, I don't even remember his name. But [they] said, "Phil, are you okay? I just noticed in the meeting this morning, you were pretty grumpy, or scratchy, (or whatever term he used, I don't know what the term was.) But I just wanted to check in, how are you travelling? It seems so unlike you." 

This guy said it moved him to tears. Because it was not only like that, 'I feel bad about the way I behaved and better make amends.' It was like, 'people actually care about me. We're more than the worst thing we've done at work, we're more than the time we lose our cool.' Think about that in terms of the people that you work with. Because all we can see are people's actions, we can never see their intentions. 

We always judge people on actions. We see what they're doing, and we make up a little story about what we think that is. I think the story this guy shared [showed that] there can also be some love and care. The other alternative would be as soon as the man leaves people go, "What about the way he behaved? Who does he think he is?" But instead it was like, 'let's check that he's okay.' I think we could do more of that for each other as well in general.

Celeste Pinney [44:08] That's great. I think you never know what's going on for someone. Someone, on the outside, may appear to have it all together, but we don't know people's histories and backgrounds. We will have colleagues who are suffering from PTSD. I think everyone has a part to play, like you said, in bringing more compassionate communication to the workplace. I think we can all start with ourselves and think about ... maybe some reflective practice around how we speaking to others with our tone and even just doing little check-ins with our colleagues. "How are you? How are you feeling? Are you okay after that?" can go a really long, long way. I'm sure we've all experienced that at work if someone asks us how we are after a difficult event, it can be the one thing that can actually help us leave without taking a whole lot of distress home with us.

Mary Freer  [45:00] That's so true, isn't it? I hear those stories as well. They're the things that will stand out for people. They'll be so surprised that someone took the time to ask how they were, to give them some feedback, to even like, I'm making a cup of tea and I make two. And I say, "Here, do you want one?" Quickly make another one. These things really, they go so far, and we can all do that now. We can think about when was the last time that someone did something really kind, and the impact that it had on us. 

You're right, just because we know that there is this percentage of nurses who experience PTSD, does it mean that we know who they are? Some people are going to be more open about that, and other people are going to experience that and suffer in a lot of silence. There's a lot of shame that is attached for us when we're not travelling well. We may never know what people are experiencing, and never know they're actually finding it really difficult. The kinder we can be to people with this sense of 'I have no idea what could be happening for you, so I'm just going to err on the side of generosity.' 

But that doesn't mean we get walked all over. It doesn't mean we let people get away with bad behaviour forever. But it just means we have a little bit of leniency where we can check in and say, "Are you okay? Everything all right, you're travelling okay? I noticed you really jumped at that comment in the meeting? Is this going to create more work for you? Or what is it that's really worrying you?" People start to tell us things, we start to learn things about our colleagues.

Celeste Pinney  [47:05] Yeah, it's great food for thought. Thanks, Mary. I'd like to touch now a little bit on the concept of 'compassion fatigue,' which some of our listeners may have heard of, because we know there are a lot of nurses and midwives who are burnt out, who are really overwhelmed, who are giving a lot, and who may feel like they're running on empty. I'd love to hear your thoughts about this, because I know in your book 'Compassion Revolution,' you say you don't agree with that term compassion fatigue. Would you be willing to explain?

Mary Freer [47:35] Yeah, I'd love to. I think compassion is often misunderstood as the cause of burnout and fatigue. So we created this term, which is called 'compassion fatigue.' But I actually think that compassion fatigue is a misnomer. I find it misleading and unhelpful. It's not that I don't think people experience fatigue and exhaustion. I think coupling the word compassion and fatigue together has led us down the wrong path. I'm going to help you understand why I feel quite strongly about that. 

When I ask people in the workforce who are experiencing burnout, exhaustion, or are finding it really hard to keep showing up and caring the way that they really want to, or the way they did when they started out their career ... I always say, "What are the things that are causing this to happen for you?" People will say things that are really practical. We can pull together a list and they'll say, "Well, these are some of the things that contribute: there's never any fresh food at work. I can never get refreshments during my break when I'm on night shift. People were really rude, they're so dismissive. That drives me crazy. The hours that I'm working at the moment are just so long. The hours on my roster, they feel like they're killing me," or "I'm experiencing sexism or racism or homophobia at work," will come up, or "I feel unsafe at work. I feel unsafe physically or psychologically." Or they'll tell me that they feel unsupported, "My boss or my organisation just really don't support me to do the work that I really want to do." 

They'll talk about microaggressions at work, "These are the things I deal with." Other times people talk about, "You want to try working with these electronic medical records, they're Nutsville!" They'll say there's unrelenting demand. "It doesn't matter how hard I work, I go home, and I feel like I haven't really hit the mark." Or they'll talk about having this sick feeling of dread just thinking about going back to work, being forced to do things that they feel are not in a patient's best interest. 

They're the things I hear, but I never hear people say it's all the compassion that I have to give, it's wearing me out. It's never showing up and being compassionate, or creating a compassionate environment, or compassionately caring for ourselves that causes the exhaustion. So I like to separate the two. I call it what it is. Sometimes I will call it exposure to incivility, or burnout, or exhaustion, or the outcome of a psychologically unsafe environment, or a moral injury. Then we've named it for what it is, rather than calling it compassion fatigue. 

But I totally agree with what that term refers to. This is how I have interpreted what people mean when they use that term, that sense of 'I decided to become a nurse or midwife because this is the work that I want to do I. I want to be part of somebody's journey of healing, of improving their health and living the best healthiest life, or creating a family,' or whatever it is. You want to deliver great care to your patients, you want to form these beautiful relationships where your patients trust you and will come to you for advice and follow instruction, and you can also learn from them. When they are so exhausted or worn down that they can't do those things, it's like, 'this isn't why I went into this career. I feel so much distance between the me who started out and the me now.' 

That, I think, is the feeling of fatigue. I hope that's useful. It's not that I don't think people are experiencing it, I just don't like the coupling of the words compassion fatigue.

Celeste Pinney [52:03] Yeah, I understand what you're saying. I think of it like this: let's say in an ideal world, there wasn't the pressures of staffing issues or time. You could just be with your patients, have your breaks, not feel tired, not work long hours and not be working hours that are not conducive to your lifestyle. Then maybe the ability to feel like you can give compassion without feeling tired would be different. So you're saying it's not compassion fatigue, but it's fatigue due to other things that are happening in the workplace.

Mary Freer [52:38] Yeah, and I think compassion is actually the antidote. I think when you feel like that, when you couple the two words compassion and fatigue together, it almost implies [that] when I'm like this, compassion is the enemy. That's the thing I can't do, but actually, that's the thing that will really help.

Celeste Pinney [53:04] Starting with self compassion, as well, I imagine would be quite an important piece of that.

Mary Freer [53:08] Really important. Okay, the fatigue is there, the exhaustion is there, the burnout, but whatever it is that you're experiencing, compassion is actually your friend right now. That's the thing that is going to help you get through this. Noticing the distress that you're experiencing, and applying compassionate action, care, love, interest towards yourself, and to the people that you work with. Like understanding yes, yes, this is what is happening right now. And right now, what we've got is the fact that we are going to care about each other. Between now and where we have to be, we're going to care about each other. 

We're not going to pretend that there isn't a stress here. I'm never about fake joy, or 'let's pretend that this is only temporary.' I hear that a lot, people saying, "Oh, we're just going through this phase. It's only temporary." Well, I think we all know by now that it's pretty long-lasting temporary, the conditions that we're working under, right? We don't have to pretend it's all going to be over in a minute, because we don't actually have any evidence to support that. 

But what we're going to do is we're going to work our way through this in a way that really honours these values that are important to us. And one of them is compassion. We're going to be more compassionate towards ourselves. We're going to start to practise it with our colleagues. Sometimes people will say to me, "What's the use of me regulating my nervous system, practising this mindful breathing, stopping and putting my feet on the floor? It's not going to change the way the organisation is." That might be absolutely true, but it's gonna save your life. You're gonna get through this, you're going to be a different person, if you can regulate yourself, calm yourself, and care for yourself.

When we are calmer and can think clearly, we make much better revolutionaries, advocates, rebels, whatever it is. Wherever you need to activate the change, you're in a much better position to do that when you're clear and level headed. That's the place I want people to be in.

Celeste Pinney [55:35] Yes, that's so great to hear you expand on that. I hope that shed some light for people who may be feeling like they've had or have compassion fatigue. Thank you for expanding on that, Mary. I'd love to lastly talk a little bit about Post-Traumatic Growth, which some of our listeners may have heard of, some may have not. I'd like for you, if you can let us know what that is, and what the experience might be like, what that experience may be like for people who have had a traumatic experience or had PTSD. Then they've come out of it, and that has actually been something that might have helped them grow and flourish in some way.

Mary Freer [55:49] My pleasure. Earlier I alluded to our international conference, Making Work Beautiful. That is on in October, and one of our keynote speakers is a woman called Selma Quist Møller from Copenhagen, and her area of interest is all around Post-Traumatic Growth. That's someone I think that we will all be able to learn from. I had a conversation with her just recently and recorded a little podcast. It's really interesting, this whole area of Post-Traumatic Growth. Often what we think is that we survive in spite of the trauma that happens to us. We need to get through it and get to the other side, right, now I've survived it. But actually, these moments of distress and moments of trauma in our lives, while we don't welcome them and we wish that we could all have a much smoother ride, none of us are really going to make it from the beginning to the end without experiencing these moments of great distress, or different moments of trauma, and they inform who we can become. We can use those experiences as moments to discover more about ourselves and to flourish.

You'll often see where we have people who are activists, and this is true in the healthcare field as well, where we have really great patient advocates or clinicians who are wonderful advocates for improving wellbeing in the workplace, often it is because they have had a profound experience that has been really negative or traumatic. Or there's been a loss of someone or they've had something that has impacted [them] in some profound way. Even as I'm speaking, I can think of people who have written a number of books and come out of it with this great advice for us. 

So what's that about? That's about, we decide that these moments of distress and trauma can also be moments where along the way, we're going to come out the other end better than we went in. I think about that, in terms of the experience that many of us have had of the global pandemic. We're not going to survive in spite of it and hope that we can return to 2019. Right? That's not success, coming through all of that turmoil, and arriving safely at the place that we started at. That feels like a great big... I don't want to go there. What looks like success to me is that you can go through all of that, and learn enough about yourself and about the system that you can actually change it. 

That's why these moments of distress are like openings or portals. They say to us, "Right: now, what could be different? How could your life be different? How could you use the experience that you've had, that might have a profound impact on others? What did you discover about yourself that changes the whole relationship that you have with yourself?" That's a time of flourishing, because what we discover is that we come to the other end of whatever that trauma or distress is, and we look at ourselves and we look around at our life, and when you say, "Wow. If that hadn't happened, I might never have got to this place."

For all of us, there are moments in our life where we look back, and it's like, 'Wow, it wasn't just in spite of it, I actually used it as fuel, to be able to create something that is so much bigger.' People can do that in very small ways and in big ways. It doesn't mean that right in the middle of it, when things are really tough, is the moment for us to go, 'How can I use this for good? How can I use this for good?' I mean, in some ways, we let it work on us. But it's not to say that we are damaged, because that's the other narrative about things like Post-Traumatic Stress, we have these experiences and when we come out, we're never going to be better than we started out. Somehow, there's going to be a little dent in our armour, or we're going to be damaged in some way. I stand in opposition of that. My experience throughout life tells me that.

So many people that I know who have experienced profound loss, profound grief and profound trauma, now are just such beautiful advocates for another way of living and being in the world. It's like, wow, is that the possibility? It's a pathway, I think, for growth. If people are getting the right therapeutic assistance, counselling, or support, during times of trauma, it will be navigating towards that. How might you really flourish? Which is why it's like, keep going, keep going. There's something on the other side of this. That's the advice I always give myself.

Celeste Pinney [61:45] It sounds like, from what you’ve said, it can be a great teacher and it can really help us learn and discover more about ourselves, and I imagine, help us at some point (you’d hope) to become more compassionate towards ourselves and others, which we know the world really needs.

Mary Freer [62:00] Well, if you made a little list of five people who are well-known in the world who you associate with these ideas of compassion, kindness, social justice, and advocacy, you wouldn’t have to look very deep to discover that there were moments of profound loss or trauma, and somehow they had galvanised that. We see that. You would see that as well, all the time, the amazing things that human beings are capable of doing when they go through times that are really difficult. We keep going.

Celeste Pinney [62:39] Yeah, and I think that’s a great message of hope for our listeners who may be concerned about PTSD, who may have experienced or may be experiencing PTSD, that there is the possibility for growth with the right support, because we know for people who are in the midst of something like PTSD they often need a big team of support around them. What I’d suggest for anyone who is concerned about Post-Traumatic Stress Disorder is to call our service, Nurse & Midwife Support, at any time on 1800-667-877 and/or contact us via the website, at nmsupport.org.au.

But we’ve come to the end of our time together today, Mary. I want to thank you so much for being here. It’s been really a riveting conversation and you’re such a passionate speaker. I think you’ve brought so much to this really important topic. So thanks for being here and sharing your time with us.

Mary Freer [63:39] It’s been my absolute pleasure, Celeste. And thank you for the work that you do. It’s so, so important. We all need to know that there are safe places that we can call and reach out to when times feel difficult. So much gratitude for the work that you do.

Celeste Pinney [64:01] Thanks so much, Mary. Take care.