Mark Aitken: Hello, and welcome to the Nurse and Midwife Support podcast: your mental health, it matters. I’m Mark Aitken, your podcast host for today. I’m the stakeholder engagement manager with Nurse and Midwife support, and I’m a registered nurse. My guests today are Sonya and Anne, they both work with Nurse and Midwife Support and are committed to supporting the mental health of nurses, midwives and students. Welcome and hello!
Sonya and Anne: Hi Mark.
MA: Sonya, would you please tell our listeners about yourself.
Sonya: I’m a registered nurse. I did my nursing through the University of New South Wales in 1986, 1985 was (I think) the first time that nursing went through that university. I worked in both hospital and community settings; general nursing, drug and alcohol. I worked as a discharge planner, nurse educator, aged care and disability, Aboriginal health. More recently, and the majority of my nursing, has been in the mental health sector. I’ve also worked in different states in Australia and overseas.
MA: Thanks Sonya, that’s great. A very impressive career history, so thank you. Anne, could you please tell our listeners a bit about yourself.
Anne: Yes Mark, just a little. I’ve always been passionate about the care of mothers and babies. I actually trained as a general nurse in the 70’s, and followed my general nurse training with midwifery at the Royal Women’s Hospital in Carlton (Melbourne). I’ve also worked a lot in emergency nursing and alcohol and drug research. But the women’s (hospital) had given me a thirst for knowledge, the education and experiences provided were an important part of my life. They were the building blocks for my career. My training was hard, it was difficult; quite tiring, quite stressful. Our managers and our educators motivated us and they supported us to take every opportunity. They were ex-army, of course, but absolute leaders in their chosen field of midwifery. They inspired me to be an excellent midwife. I also took the opportunity to work in the emergency department at the Royal Women’s Hospital in Carlton. At this time, there were a significant number of antenatal patients admitted to ED who used illicit substances. IV heroine was the drug of choice at that time. Substance use, for the pregnant woman, brought significant issues. Premature births, mental health issues, social issues, domestic violence; just to name a few. Substance use for antenatal patients was in direct conflict with community perceptions. This actually further complicated premature births and demands for high-dependency neonatal aids in withdrawal and the increased length of stay. Management of the withdrawing neonate was a significant issue, and as a midwife, maintaining personal good health and wellbeing was paramount. The natural progression for me was to combine both areas of nursing with general emergency training and nursing. Further to that, I also became very interested in the field of alcohol and drugs and the burden of disease and the impact it has on society. Managing self-care with good mental health practices was very important.
MA: Thank you Anne, what an interesting career you’ve had and great experience. Thank you for the overview. I just want to give a brief overview of Nurse and Midwife Support; for our listeners who may not know much about the service. Nurse and Midwife Support is the national support service for nurses, midwives and students. It’s an 1800 number; 1800 667 877, and an interactive website at https://www.nmsupport.org.au/ The service is anonymous, confidential and free. You can call us about anything you would like support in relation to; anytime of the night or day. We’re here for you, and we’re here to support you. Sonya, why do you think that Nurse and Midwife Support is important to supporting the mental health of nurses, midwives and students?
S: Nurses experience varying levels of stress in their day to day working life. Stress, over the long term can have an effect on your mental and physical health as well.
S: Our stress levels can vary from staffing levels, to frequent policy changes, to compassion fatigue where we feel varying emotions and pain that our patients and their family members experience. We understand the nurses experience of stress, and how it impacts them. It’s very important to offer support when you’re experiencing stress, and that’s what we offer. We offer emotional and psychological support which can help reduce stress. We offer nurses and midwives the opportunity to express and discuss their feelings, concerns and issues. We’re also there to hear and acknowledge their achievements as well.
MA: Indeed, thank you Sonya you’ve given a great overview of what Nurse and Midwife Support is able to provide for people who contact our service. Anne, why do you think that Nurse and Midwife Support is important in supporting the mental health of nurses, midwifes and students?
Anne: Mark I agree with Sonya, Nurse and Midwife Support is very important in providing mental health support for nurses, midwives and students. Predominantly, studies suggest that nurses, midwives and students of these disciplines can potentially be exposed to high emotional, psychological, cognitive and physical demands which may impact on our mental health. I would say to nurses, midwives and students; if you’re experiencing a mental health issue, there’s a risk it will affect your ability to competently and safely do your work. This could place you and the public at risk of harm.
MA: Indeed. I think it’s really important that people know the service is available to support mental health and that they actually access our service early, in relation to health promotion and early intervention. Indeed, that’s where the service is trying to connect with nurses, midwives and students; so that people get the support that they need earlier rather than later. But of course, if people are really struggling with their mental health and need our support, we are here to support people with mental illness as well while they do the work and get the support they need to return their mental health to the place they want it to be. In doing the research for this podcast, I read a lot about mental health and it was really clear that there’s a difference between mental health and mental illness. I read a number of definitions; I particularly like the Headspace definition. Headspace are the national youth mental health foundation who are dedicated to improving the wellbeing of young Australians; their definition is that good mental health is a state of wellbeing where you feel able to:
- Work and study
- Feel connected to others
- Be involved in activities in your community
- Bounce back when changes and challenges come along
I particularly like that phrase, bounce back. I think it resonates with us as a team in supporting the resilience of the people we work with and who we support. Sonya, you’ve worked in mental health nursing for a long time. What do you think are the key elements in this definition for nurses and midwives?
S: Well, it is important to have a sense of satisfaction in your work and study life, as Headspace mentioned. Connection is also an important need, it’s important to meet these needs as a part of wellbeing. If you tend to push them aside, or think you have to overcome them, it’s going to affect your mental and physical health. I think, as nurses and midwives, we’re good at identifying and attending to the needs of others. But, we require a little practice in building up self-care skills. This is what’s going to help us in the long term, to face and deal with challenges and bounce back.
MA: Yes, so it’s historically something that nurses and midwives haven’t been really good at: self-care. In fact, I don’t remember when I started nursing that we were even taught about self-care. It’s not something that many of us… S and
A: No, not at all. It’s very new.
MA: Some of us have learnt it along the way, some people have learnt the hard way when life does serve up a curve ball and they are knocked over by that and then need support to bounce back. I think that’s a really important point.
Anne, you’ve got an incredibly varied and extensive experience in nursing and midwifery, do you think there are specific challenges for nurses and midwives in relation to maintaining mental health in relation to this definition?
A: There are Mark. There are a number of issues that both nurses and midwives and particularly midwives, coming from my perspective, just the usual things like workplace demands, increasing workloads, unknown workloads (for a midwife), roster demands (for everybody, of course), CPD, study obligations. With midwifery, there are changes to models of care. Midwives are also engaging with families, there are community demands for midwives, moving on then to cultural safety and working sensitively with culturally diverse women. Another area I think is very important is the guiding of partners into parenthood. I also see that rural midwives face additional challenges. Especially with remote community practice. Further to that, there are other very important areas in midwifery and it is a midwife managing trauma informed care. Grief and loss in maternity, and post-natal depression. Mental illness among health care professionals is reported as exceptionally high, compared to the national average. The physical and emotional demands of nursing and midwifery can lead to emotional burn out. Burnout is a very important thing for midwives to actually identify.
MA: That’s a good point Anne, and I think the other side of wellbeing is that sometimes nurses and midwives will be tipping towards burnout and the challenges associated with that.
A: Yes, absolutely.
MA: We certainly support a number of callers who are in that space. If you are feeling that you’re burnt out, please feel free to give Nurse and Midwife Support a call for support. Sonya, without giving us names or specific details from talking to nurses, midwives and students on the phones and answering their emails, what are they telling you about their concerns? Regarding their mental health and wellbeing?
S: Anxiety is an issue talked about a lot amongst students, nurses, midwives and grads. As well as what you were referencing before Anne; burnout and compassion fatigue. Some callers have identified that they’ve had anxiety and depressive symptoms in the past, but have managed them well. But due to an increase in stresses; in their personal or professional lives, they have noticed a slow increase in their anxiety levels and a drop in their mood. We discuss those identified symptoms, and what can help manage them. A person can live with a mental illness and still have a balanced life and a satisfying life both personally and within their work, through understanding their illness and understanding how to manage it. Just to also mention that if there’s a health issue; that’s to say, a physical, mental or substance use issue that is impacting on the safety of someone’s practice, then notification to AHPRA voluntary or mandatory is required.
MA: Yes, and we get a number of calls from people who are going through an AHPRA notification. That’s always very challenging for people.
S: It’s very challenging. It takes someone quite by surprise and it’s almost stages of grief; how did this happen? This is my livelihood. We support people through notifications as well.
MA: And some of those callers are concerned that they have a mental health condition and they won’t then be able to work as a nurse or a midwife. Can you give us a bit more prospective on that Sonya?
S: Yes, as I was saying before, you can still work and live a balanced life if it’s well managed and you identify what the symptoms of your illness are and when it’s maybe getting worse. It doesn’t necessarily have to impact your practice.
MA: Yes, and I think it’s really good to reinforce that point.
MA: Because a lot of people think that that will be the loss of their career, if they get that notification or they have a mental illness. But if they get the right support, and they get it early, then they can actually keep working as a registered nurse or midwife. Really important point. Thanks Sonya. Anne, do you think there are specific mental health concerns for midwives?
A: I do Mark. Further to what Sonya has indicated with nurses, midwives and students, the mental health of midwives is of course something that I’m very interested in. Midwives actually need to be aware of different things; they need to be aware not only of their own anxieties but they also need to be aware of the women’s anxiety during pregnancy. This can be a difficult role, for the midwife, as women can quite often mask their anxiety and stress during pregnancy. Midwives actually have a lot of listening to do; they spend a lot of time supporting mothers, mothers to be and their families. At this time; women are more likely to divulge sensitive information to a midwife (the midwife that they know). Midwives need to provide facts and information in a way that will facilitate a better understanding of support and options available to them. As midwives, we also need to nurture ourselves and each other to ensure that we’re not stressed. If we experience stress, we need to have strategies in place to help us manage. This self-care allows us to be truly present in one of the most intimate experiences of a woman’s life. Having a peer-support group allows us to debrief after a critical incident. It also allows us to celebrate that truly brilliant day. The caring nature of our profession and our busy lives may mean that we put other people’s health ahead of our own. Workplace stresses and demands increase our risk of developing health issues; mental health issues. We need to take care of ourselves in a holistic way. This makes our health better and in turn equips us to look after our patients much better.
MA: Indeed, and I really like that point you made about celebrating that brilliant day. I think we need to do more of that in nursing and midwifery; to give people feedback throughout their shifts so that we are involved and supporting each other as a team. Because we cannot do this work without being a part of a team, so I think that’s really important, that we give people that feedback. Let’s put that out there, celebrate those brilliant days. And sometimes celebrate those not so brilliant days, but the days that just go well. Ok thank you. Sonya, we also support students. Sometimes when I talk to people about Nurse and Midwife Support they don’t actually know that, but we do. We really want students to connect with the fact that we’re here to support them. So, Sonya, what needs do students have in relation to maintaining their mental health that may be a bit different to nurses and midwives.
S: Well, from speaking with students, they are experiencing the stress of studying, working to support themselves, they’re also facing the challenges of a new career. Sometimes we can be very hard on ourselves and self-care is a really important skill to have; to develop and build up over time. Anxiety is often talked about as well. It’s natural when you feel overwhelmed with all of these stresses and feelings that you experience some anxiety symptoms. One of the self-care strategies is mindfulness and deep breathing exercises. That can help the panic or anxiety moment to pass. It can ground you. It calms the central nervous system down. On placements, you know, you’re experiencing new skills and time management and managing those anxiety moments is very important. Compassion, for oneself, is also important as it does help reduce stress. Especially if you’re feeling insecure about the future. I just wanted to say, don’t forget to use your campus counselors. University counselors can help you with problems coping with your study and uni-life.
MA: Indeed, and I think that’s great advice Sonya. Also, I would say to students; talk to your friends as well as the people that you’re studying with. Chances are, they’re having similar issues and it’s really supportive and validating to hear that you’re not alone in these situations.
S: It makes a big difference, knowing that you’re not alone.
MA: It does indeed, thank you. Anne, if a student phoned Nurse and Midwife Support, seeking our support for study pressures and related anxieties, how would you assist them?
A: Exam time can be quite daunting. Reviewing your lecture notes, completing practice exams, all of those sorts of things can be quite stressful. I think as a student, we need to actually plan, because we have huge workloads. Being ready to tackle your exams from the start of semester, that can be a way of preventing cramming and the stress that comes with it. On our website; https://www.nmsupport.org.au/ there are a range of exam tips that are very simple things that we’ve often heard before, that sometimes we need to revisit. They’re strategies and simple things like being positive, doing a bit of study everyday rather than cramming…
-MA & S laugh-
…organizing your notes, working at a study plan that works for you, being a part of a study group is important, planning your exam day. And when those exam days come; having your brain food, taking breaks, getting some sunshine, all of those sorts of things and those tips are actually very valuable and you can find them on our website.
MA: That’s great Anne, I laughed when you mentioned cramming because I think all of us could potentially relate to that.
MA: So, you know, we have all of the great advice but what we sometimes do ourselves can be quite different. And I think that’s really important for people to connect with; that if you don’t stick to the script around what you should be doing that it is ok.
A & S: Yes.
MA: Just get back on it as quickly as you can, or call us to get some support. There are many tips for maintaining and improving mental health. When I did the research for the podcast I connected with many of those tips. Many of you will know many of those tips and be implementing those into your life and work. I particularly like the 10 tips from the Mental Health Foundation of the UK. You can find it at http://uk.mentalhealth.org/ if you wanted to have a look for yourself. Those tips are, and I’ll list them here:
- Talk about your feelings
- Be active
- Eat well
- Drink alcohol sensibly
- Stay connected
- Ask for help
- Take a break
- Do something you’re good at
- Accept who you are
- Care for others …which nurses and midwives wouldn’t have any problem with. Caring for others.
-S & A laughs-
MA: It’s how much we care for ourselves, that is sometimes the issue. Sonya, what are your thoughts on these tips?
S: Well, talking about your feelings. It’s very important to talk to someone you trust, that can have great benefits. It helps you validate and acknowledge what you’re experiencing. Sometimes that can help clarify what you are worried about and what the options and solutions that are available to you are. Being active; activity releases endorphins and serotonin, so that improves your mood and helps reduce stress. The other tip mentioned is eating well; eating is important to your mental health as well as your physical health. Having a diet that has more whole foods and less high sugar levels reduces the effects of feeling tired and the ups and downs of your energy. As nurses, we have to probably plan more with our food and shift working.
MA: I agree, like those glycemic spikes.
S: Yes, exactly. The other tip was drinking alcohol sensibly. Occasional light drinking is perfectly healthy for most people, however with too much alcohol damage can occur. Stay connected, with family and friends. It builds good mental health, and is a protective factor against anxiety and depression. Asking for help was the other tip, I sometimes think that those of us that work in the health profession don’t seek help and have shame around mental health symptoms. We think, it shouldn’t happen to us. How did it creep up on us?
MA: That’s a really big point.
S: We don’t actually see that we’re struggling. We are a part of the general population; and in Australia almost one in five people experience symptoms of mental health disorders. Taking a break; I see this not just as a holiday but it can be just a mindfulness break or a breathing exercise break.
MA: Oh ok, that’s a good way of looking at it!
S: Because breaks help us reconnect with ourselves.
MA: Yes, to refresh.
S: Doing a good act, helping others…
MA: Which we’re good at.
A: Yes, we are good at that, and also doing things that you’re good at. How good do you feel when you accomplish an activity you enjoy? I think accepting who you are was one of the tips, really important for reducing stress and anxiety. Accepting who you are is self-compassion, this is where we treat ourselves the same way as we treat a friend. We wouldn’t be judgmental to someone going through a hard time; we would be supportive of them and have empathy. It’s about being kind to yourself when confronted with personal failings, and not judging and criticizing yourself. And like I said, taking care of others we are pretty good at, but through acts of kindness it has a benefit for your mental health as well and gives you a sense of belonging. So, they’re all very good tips.
MA: Thanks Sonya for expanding on those, I think that was really valuable. We’ve come to the end of the podcast, it’s amazing how time flies. We’ve talked about mental health and Nurse and Midwife Support and some of the issues for nurses, midwives and students in relation to mental health. We’ve also introduced 10 tips for supporting mental health, and what advice would you give to a nurse o midwife who is listening as a first step to accessing support for concerns about mental health. Sonya, what advice would you give?
S: If you do have concerns about your mental health, do talk to someone. Whether it’s talking to your GP or even checking out resources like Beyond Blue, Black Dog Institute or Phoenix Australia Center for Posttraumatic Mental Health. Know, most importantly, know that you are not alone. And there is help there.
MA: That’s vital. Thank you. Anne, what advice would you give?
A: I would say Mark that it is ok to ask for help. There is telephone support for nurses, midwives and students. There’s email support, there are a number of services, of course there is Nurse and Midwife Support. We have newsletters, I would actually say that as midwives we’re focused on supporting mothers, babies and their families. Sharing the most wonderful human experience, so now it’s actually time to care for you and Nurse and Midwife Support is there to help you.
MA: Thanks Anne, great advice. Thank you, Sonya and Anne, your insights have been invaluable and I appreciate your wisdom and sharing with our listeners. You can find out more at nmsupport.org.au or call us anytime, 1800 667 877. We’re here, if you need support. If you found this podcast useful; please share it with other nurses, midwives and students. Your mental health matters. Look after yourself, and each other. We’ll see you next time.
S & A: Thank you.