The Problem with Resiliency Training in Health Care
Resiliency:
The capacity to recover quickly from difficulties; toughness
The ability of a substance or object to spring back into shape; elasticity
In the past few years, we as health care providers (HCP) have been called “Heroes,” while simultaneously being told we need to be more resilient in response to the health care crisis we are in. Mental health, Suicide and severe health problems have hit this demographic severely. There is no foreseeable plan as to how this crisis and the crevasse of meeting the needs of patients and health care providers will be resolved. HCP’s have been more than resilient during the pandemic and it’s time we stop putting the burden on the HCPs to be more courageous, more responsive, more tolerant, more “resilient”.
Life is Hard, Put on a Helmet
My first introduction to the term “resiliency skills” in healthcare as a therapist was back in 2006. During that time, I was providing education for first responder interventions with people experiencing a mental health crisis. A colleague who was formerly a military psychologist discussed with me that his former career was helping military personnel who were suffering from severe shock and trauma during war. He was responsible for getting them back into the combat by using “battle mind” resiliency skills. During war, the battle mindset is necessary for survival: “Kill or be killed.”
Health care professionals are not soldiers, we are not at war. We are not here to rescue the disaster of our decaying health care system. Although, at first resiliency seems to be a strength and virtue, it is now being weaponized against HCP so they will take the responsibility for the larger problem of profit over well-being. It does not take into account the trauma, shame, loyalty, guilt and sacrifice of the person asked to be resilient. It is dehumanizing and takes advantage of the dedication, hard work, perseverance and integrity of the person. As HCPs, we are here to assess, treat, diagnose and care for our patients and clients. We are here to provide comfort, respect, compassion and hope. We are not here to prepare for battle.
It is demoralizing and unproductive to tell HCPs that they/we need to do better self-care. Additionally, the economic disparities that exist within this population are not taken into consideration. Due to rising housing, food and childcare costs, which do not align with wages and the working class paraprofessionals (such as nursing aides, phlebotomists, and EMS workers) are forced to live in locations that result in long commutes, which increases their stress before they even show up for work. The emphasis on resiliency ignores the impact of privilege in relation to health and well-being.
In the book; The Burnout Challenge, Researchers Dr. Christina Maslach and Dr. Michael Leiter compare the resilience expectations put upon HCPs to that of a canary bird in a mine. In early mining days, canaries were placed in mines by workers to assess the level of carbon monoxide in the mine. If the canary died, it was too deadly to enter. The authors ask a poignant question: “Do we make the canary stronger to survive the mine?” HCPs that return day to day to a toxic workplace with no solution in place other than putting the oneness on the worker is deadly. Continued exposure to high stress environments and chronic illness and mental illness consistently demonstrates strong correlations between the stressful environment as causational.
When searching websites on resiliency for caregivers, some resiliency suggestions are:
Get adequate sleep- Even if this is your 3rd double shift that you have pulled this week and your child was up all night sick.
Eat a nutritious diet- Never mind the expense and rising cost of food, time and preparation when you are exhausted.
Drink plenty of water- But don’t leave your water bottle at the nurse’s station. Find a way to hydrate in between helping ICU patients or when you get a chance to use the restroom.
Avoid alcohol and stimulants and other drugs – However, do fuel up on caffeine so you can get through a 12 hour night shift.
Exercise- After standing on your feet all day and not getting enough sleep.
Meditate- Make sure you don’t fall asleep from pure exhaustion when doing this.
Download the free meditation app that was part of your employee wellness package- Please use this in your free time or on your break when you are using the restroom getting a drink of water.
Seek help from a therapist- That is, if you can find one that isn’t already booked or has a long wait list. Make sure you find one that can teach you resiliency skills.
Get regular health check-ups and take your medications- Assuming you have a sick leave day you can take, have health insurance, and can afford your medication.
Call the Suicide Prevention Hotline or Crisis Line – Use your resiliency skills to regulate yourself during the long hold times, take some deep breaths.
Get a Hobby- Find one that doesn’t interfere with your work schedule and family. Try one that allows you to multitask the hobby and the above resiliency skills.
Try Cognitive Behavioral Therapy (CBT)
Try Dialectical Behavioral Therapy (DBT)
Try Mindfulness
Pray- A LOT!
Find a Support Group that practices the above resiliency skills, if that doesn’t work, repeat.
HCPs are very adept at searching and utilizing coping and resiliency skills that can be found on the internet. As a psychotherapist who primarily treats HCP, I can attest that they are doing their best at using healthy coping skills and find it’s just not enough to sustain them. Resiliency shaming makes them feel like they need to try harder. Let’s reinforce to HCP that our work is to not give them the “battle mind,” but to do the deep inner work and healing that has come from this crisis. Let us affirm all they/we have experienced.
Suck It Up, Buttercup
Telling HCP that it is our fault for not doing a better job at taking care of ourselves and that we need to be more “resilient” is abusive and is a way of dismissing responsibility from correcting the problems. Resiliency is something that should be built into the system’s structure.
HCP are well aware and many do their best to incorporate resiliency skills and do ask for support. Yet, when they are given one more patient on their already bursting case load, told they cannot refuse a shift or call in sick, asked to work double shifts and then punished because they get sick or make mistakes at work, how are they going to manage resiliency? HCPs feel ashamed and guilty for not being able to be “resilient.” HCPs often experience perfectionism and have been conditioned to believe that something is wrong with them if they can’t tolerate the workload. It is “their fault.”
In 2020-2021, many psychotherapists had a booming business as a result of HCPs doing their best to be “resilient.” I can safely say for myself and many of my colleagues that we would love to be able to work our way out of a job as a result of caring for and helping the personal growth of HCPs, rather than profit from the devastation it has caused them. We must stop telling HCPs that resiliency is the antidote or prevention of burn-out. Burn-out is the result of the refusal of the healthcare system to acknowledge and meet the needs of HCPs. Burn out literally means there is nothing more to give, there is nothing left, no ability to “spring back into shape.”
Speaking of Heroes
Another term we need to let go of when referring to HCPs is “hero.” Hero = sacrifice. Heroes do not set out to be heroes, they become heroes after great tragedy and when faced with extreme circumstances. Heroes are often left to manage their own pain and suffering without care from others. These wounded healers often have been in role of caregiver most of their lives, often providing for their family early in life, while their own receiving of care is pushed aside. Referring to HCPs as heroes, although they most certainly are, is another way of dismissing that they became heroes out of necessity, integrity, grit and abandonment by the systemic “Gods” of healthcare. The Gods of healthcare—administrators, CEOs, and legislators—are well aware that HCP’s are loyal, dedicated and won’t abandon their colleagues to take a break for themselves. They will do chart notes until 3 a.m. and then return to work the next morning berating themselves for forgetting a patient’s name. I’ve been asked, “How can I walk away from a dying baby or a grieving mother? How can I not care if a patient doesn’t get their anti-seizure medication?” The answer is you cannot. The Gods of healthcare are aware of this and have unethically used this to their advantage. I hear stories from HCP clients in private practice who have requested long overdue increase in reimbursements from insurance companies, only to be shamed by the insurance company telling them, “If we give you a raise then we have to raise the rates on the insured.” Ultimately this shames the provider back into submission, while still raising the rates of the insured.
We have a new generation of HCPs that will be graduating and entering the workforce soon. If we want them to be resilient, then let’s give them what they need to be able to do that, so they can have longevity and provide the care they dream of giving. Let’s collectively demand that we not create anymore heroes, but more humans. Humans that are honored, respected and given what they need to be effective at their work. If not done correctly, resilience training reinforces the idea that the healthcare professional is once again on their own to care for themselves instead of providing more nurturing and care for these gentle souls.
Stop enabling the system, stop taking one for the team. We can do better, but we must demand better. By no means am I saying violate your ethics of abandoning patient care. Instead, stop believing that it’s your fault for not being resilient enough. Don’t allow yourself to believe that you aren’t enough or that there isn’t enough. Stop blaming yourself, thinking there is something wrong with you because you can’t tolerate it anymore. Sometimes, we do have to care less, so we don’t become careless.
There is enough money, supplies, workers, medicine etc. to do better but it won’t come from wishful thinking and resiliency training. We can no longer accept the excuses given to us to protect corporate stakeholders, Big Pharma, politicians, and insurance companies. Especially those insurance companies that outsource to foreign countries so they don’t have to pay a decent living wage in the US to their employees or provide adequate reimbursement rates for HCPs. Stop tolerating insurance companies that refuse payment or treatment with a “what-are-you-going- to-do-about-it” smugness. Corporate Medical CEOs and scholars in their ivory towers promoting and writing about resilience are not in the bowels of healthcare day to day. HCPs are and always have been resilient and do strive to be their best and to care of themselves as best they can. Resilience is recognizing when you can no longer “spring back” or bend, and instead say ENOUGH! Stop believing the myth that we need to tolerate more. What we need is what we give. Care, compassion, concern, respect, integrity, and advocacy.
Here to Help
As a psychotherapist in Lake Oswego, Oregon who specializes in treating HCP, I can attest that HCP are doing their best at using healthy coping skills and find it’s just not enough to sustain them. Resiliency shaming makes HCPs feel like they just need to try harder. I reinforce to HCP clients that our work is to not give them the “battle mind” of coping skills, but to do the deep inner work and healing that has come from this crisis we are experiencing and to affirm all they have experienced. I offer an online Authentic Healers Group, where we explore the concept of “Wounded Healer’ advocacy, and learn very effective tools for healing. In this space of non-judgmental, confidential support and understanding, HCPs learn how to regain their identity and practice as the Authentic Healer in a non -resilient system that creates burn-out.
