I recently had a conversation with a friend who works in the community in the NHS who is visibly exhausted. She is considering taking some time away from work due to extreme fatigue and stress. When I asked her what was stopping her from speaking to her employer or her GP, she said ‘the guilt’. When I explored this further, it turns out that she would be worried about her specialist patient caseload being neglected and not getting the input they require. She is putting their needs before her own. Some might call this honourable and last year may have even come to their front door step to clap and herald her heroism. But, taking a step back just for a second: she’s my friend and I’m worried about her. Ask yourself this: How long can she work in this way? Why should she feel guilty about taking time for herself to be well and return refreshed? What about her health? Why doesn’t she think she’s important? It is my belief that the NHS functions on this mentality. It relies on it. It relies on the will of people to sacrifice themselves beyond recognition so that one day their own health pays the price and they end up using the very system in which they relentlessly worked.
The conversation really struck me (and prompted me to write this blog post) because it’s a notion I have been battling with myself for a number of years, both personally and professionally; what is it within healthcare professionals that makes us put others’ health above and before our own? At first glance, that appears like quite an easy question to answer. One might say: ‘but that’s our job’. We are quite literally ‘health-care’ professionals. But at what cost?
Let’s not say the word ‘resilience’ here. It’s not helpful. In my view, it places shame on hardworking individuals who are trying to figure out why their best efforts in a broken system aren’t enough. Saying ‘you aren’t yet resilient enough’, or ‘it grows with experience’ places the blame and ownership on the individual and suggests it’s something that has not yet been ‘achieved’. Another milestone to reach. Another e-learning to complete. Another classroom session with role play to endure.
We are working in a chronically understaffed, under resourced system, toyed with by politicians in their parliamentary thrones trying to gain votes and public favour. We are living in an ever growing society of hospitals not fit for purpose with rising local populations and expected to continue to provide the same standards and quality of care. The burden of responsibility is laid at our feet and placed on the shoulders of talented and burnout staff. And yet we are asked to do more. To give more. Because it’s us who aren’t resilient enough.
It’s us who aren’t resilient enough yet we watch the news every day about the shortages of staff. It’s us who aren’t resilient enough yet newspaper headlines scream for more NHS funding. It’s us who aren’t resilient enough who showed up and gave our best in a harrowing pandemic. We are resilient. We are not the problem. It’s time we started pushing back and saying that this is not an acceptable way to work rather than continuing to berate ourselves that we are not good enough or able enough to change it. It is not our fault.
We are not heroes. Let’s not glamourize the exhaustion of NHS staff to gloss over the reality of what’s going on. To pacify politicians guilt. We are in Plato’s cave. Branding everything with rainbows and idolising a workforce of thousands that are working tirelessly continues to mask the problem of what is really going on in the shadows.
Let’s not place talented staff on a pedestal and then promptly steal it away when they break and say that they aren’t resilient. We are human beings doing our best in a very challenging situation. These are our careers, our jobs, how we pay our mortgages and rent. How we go on holidays. How we buy our food. We are not here for applause, credit or medals. These are our jobs. Our pride. Our skill. We want to work in a place where stationery is readily accessible. Where office space isn’t a luxury. Where we have easy access to computers and chairs. Where we can have the time to always give a patient a drink or answer that call bell promptly. Where we can break bad news to a grieving family somewhere private and not in a corridor. This is the reality of what we are facing. Let’s change the narrative that broken NHS staff are not resilient enough. Let’s educate our future NHS staff and prepare them. Let’s not show them the shadow. Let’s show them the cave in all its glory and enable them to grow there. We are there with our patients in their darkest and happiest of moments. Our resilience shines through them.
The timeless adage continues to prevail: ‘we have to take care of ourselves so that we can continue to care for others’. I recently watched a series on Netflix called ‘Schitt’s Creek’ and in one of the episodes, the mother of the family likened caring for her family to making sure she has the oxygen mask on first if there is an emergency on a flight ‘well how can I save my children dear if I haven’t saved myself first?’. Whilst the delivery was very very funny, the sentiment nonetheless struck a chord. Are we on an aeroplane, heading into an emergency without first ensuring our own safety? Are we going into a busy hospital environment every day, with no oxygen and expecting to be able to function and perform for those that are receiving our care and treatment? In my view, we are quite literally in a constant state of ‘fight’ because without our oxygen masks, we cannot remain alive (figuratively speaking) or have safe passage and remain in flight to our eventual destination. And nor can we confidently help our patients get their either.
True leadership and care in the NHS exists, I have seen it in the actions of people I am privileged to work with who treat others with respect and grant them permission to rest. When we are tired, we need to learn to rest and not quit. By working with integrity and acting out or values each day we can treat one another with humanity. Through supporting one another and truly caring, we can build each other up. We can push back together. Let's acknowledge how hard the ever-evolving landscape of the NHS actually is. Let's truly care for one another. Show compassion. Admit fatigue. Work with integrity. Say no. Ask why. Gift each other kindness. Say thank you. Ask for help. Avoid toxic positivity. Say when it's tough. Acknowledge difficulty. Accept praise. Understand that self care is not selfish.
‘Self care’ is de rigeur in our current society. Phrases like ‘you are enough’ and ‘be kind’ are branded across t-shirts, pencil cases and mobile phones. They're everywhere. We are bombarded with lyrics and verse from popular culture that tells us: it’s okay not to be okay. But are we paying attention? I don’t profess to have the answer but mine is an alternative and most likely a controversial viewpoint. I’m not seeking a solution but rather a different way to posit the discussion about the teams of people who are crafting their livelihoods, career paths and every day lives in the NHS. Let’s change the narrative.