Compassion Satisfaction in Nursing | ETS07

you'll get that little pop up there you're ready. Alright. Hey everyone, it's Sandra Payne here your host of the in the silence podcast sharing stories of nurses from all across this globe. I'm here today with Beth Kavanaugh. She is an registered nurse and knows all too well what nurses are up against not only during this overwhelming era, but always with her over 25 years experience in internal medicine short stay surgery hospice care, she understands firsthand that compassion and health care can sometimes be elusive. In collaboration with Dr. Dominic vishawn, an expert in the science of compassion and MJ Marie Buchon, a counselor with over 40,000 hours of experience. Beth has helped nurses to develop, strengthen and maintain compassion in their career. In her new book, The Power and pain of nursing, it aims to arm both new and seasoned nurses with the tools necessary to care for themselves in the face of one of the most demanding professions in the world. And I think we can all agree with that. Welcome to the show, Beth.

Thanks so much for having me, Sandra. I'm happy to be here. Yeah, it's

an absolute pleasure to sit down with you today and just to have this conversation, and why don't we just kick it off. And you can share with us a little bit more about your story, who you are, where you're coming from, and maybe you know, you can threaten the nursing aspect there too. So,

okay. I'm Beth, I'm in my 50s. I've been a nurse for 25 years, I have three kids, they're a little bit older now. And I've been a nurse for 25 years, it's been a fun, wild, exhausting journey. And, and I've been very, in the last 15 years, I feel like I've tried to lead with my heart, you know, in terms of where I plant myself as a nurse. And so I think it was about 15 years ago that I landed at this beautiful hospice home and I was going to volunteer there. And as soon as I walked into the house, I just knew that I wanted to work there instead. So I applied and got a job. And that kind of shifted everything for me in terms of my professional life and satisfaction. I had never done hospice before as a nurse. I had an experience with my mom when she was on hospice before that. But being a nurse in the profession has been kind of amazing doing hospice care. And I've just kind of done a couple of different things throughout hospice and I am still working at the bedside at an inpatient hospice unit. So

yeah, you know, I worked in palliative care as a as a carried back. Yeah, before I became a nurse, but it's it left an imprint on me and I, you know, have a couple of clients who work in palliative care. And I've had other guests on the show, who have that experience, too. And it does, it definitely is a a unique nursing, right? Being with people in that, in that stage of life. Can you share with us a little bit, you know, what your experience has been doing that work in the hospice, just a little bit more about that.

hospice care is, you know, end of life care. So usually patients have less than six months to live. And as a nurse, we do a lot of pain management, symptom management, anxiety, constipation, delirium, confusion. So there's, there are a lot of symptoms, stuff that we address. And also we do a lot of education, we do a lot of explaining to the family about what's happening, what's to come, what to expect. How to a lot of hospice in the home is, you know, explaining to the family and the caregiver, how to actually take care of the patient. Because most hospice occurs in patients homes, I don't know how it is in Canada, but at least in the USA, that's what we do here. And so families have to take care of them. And it's a huge responsibility. And it's a huge learning curve, because most people aren't trained medical professionals. So we do a lot of education in the inpatient unit. I love working in patient because I actually get to be with my patients for eight hours at a time. And oftentimes I can be there when my patient dies. And I like to be able to sit at the bedside, I like to be with the family in that space. I like to help support patients and their families. This really vulnerable kind of scary time, mostly because they've never done it before. It's a really profound nursing. I just love it so much.

I think there's a real honor in being given that opportunity, right to spend that, that really pivotal time in those people's lives with them and to be able to hold that space. And just to be that, that grounded presence, because you you have done it before. And you you know, although I'm sure every death is unique in its own way. And special in its own way, I'm sure just, you know, it's because of the different family, the different individual, the different circumstances, but tell me, like, you know, when you think back over your career of 25 years of nursing, and I know, you know, just the last chunk has been in the hospice, but there was other experiences before that. How has nursing impacted your life?

My life?

Yeah, no? Where do you know,

I think that's a really good question to ask. Because I think people feel like, a lot of people, you know, you take a job, and you feel like it's very separate from your life life, you got your professional life, and your home life. And it is really nursing seeps into your bones, it seeps into your cells, the events that you witnessed the, the connections you have with a family, the patient, the stress of medication management, taking care of somebody. You know, the job is really intense. So I think it has impacted every part of my life. And I don't think I realized 25 years ago, when I became a nurse, that it was really important just to realize that it was going to affect every part of my life. I mean, boy, I don't even know where to begin. So what was your original question? How did it impact my life? Yes, it did.

Yeah. Yeah. And it does, it seeps in and there's like this, you know, this blanket statement of like, learn how to leave work at work. And I think that that's coming from someone who doesn't have a hot freakin clue what nursing is. Because I've never figured that out. Mind you, I didn't have the tools and the strategies and the practices that I have now. Things maybe, I'm sure would have been better for me had I had, you know, this, this knowledge and experience I have now but but even with it, I'm it's still impacts you right, you're still walking into? I mean, particularly right now, in different aspects of nursing. But, like, where did you see the biggest kind of over? overlap, or the biggest sort of impact? Yeah, in your personal life, being witness to all the different aspects of nursing.

I guess there's a couple of things like, when I so being a nurse, you know, in your family, you're you are then the medical professional in the family. That means, you know, in your personal family, it means in the schools, it means with your you know, family of origin, it means What's your husband's, you know, you're kind of a resource, so it impacts there. I think it has impacted me in terms of kind of my own personal development. And I didn't realize that at the time, but I was always constantly seeking out practices that I could do to help me get back to my center, because I often felt so off. And, you know, Nursing is a mind body spirit profession. You know, it physically it's a really hard exhausting job. And it's, and you really have to just like maintain strength, right? So, exercise, yoga, things like that have always been really important. It's the the mind piece, the intellectual piece. I mean, you're constantly learning there's education. And, and then the emotional piece, I mean, there's so much we witness really terrifying things as a nurse, we witness beauty. We witness you know, so much deep love, you see people heal, you see people die. I mean, we experienced the gamut of what happens out there in the world. And, and it can be really overwhelming on your soul. So, I think emotionally it's been, it's also really sick. It has impacted me significantly. And so keeping in mind, the mind body spirit thing. You know, I do a lot of meditation. I try that that's kind of an inconsistent practice of mine. Sometimes it's five minutes, three times a week, sometimes it's 20 minutes, six times a week. Sometimes it's nothing anytime in the week and Yeah, I I'm sorry, it's kind of a big question. And I don't really, I don't really know how to encapsulate it, I just think that it's really important to remember and know that it impacts, impacts you impacts your mind, body and spirit. And so you need to do practices to return to center in all those areas.

Yeah, yeah. And I think when we get into nursing, I mean, I feel like I had a good, good understanding that it was going to be hard, like, physically, it was going to be hard. Mentally, I mean, we just went through nursing school, we are fully aware of how you know how much knowledge and how much expectation there is. And then that pressure to I mean, we can add that to, to the list of the pieces that really impact us on that spiritual and emotional level, and mental level. But I don't think there is enough emphasis given in nursing school or even in nursing to the emotional impact to the emotional impact of being with people in those experiences. I mean, yeah, the light, the light stuff is great, because I mean, it really is, it's, it reminds us of our humanity reminds us of our shared connection. It's like, it's beautiful, to witness amazing love and connection and being with patients in those in those times. But there's also really, really awful things that we sit through, you know, beautiful in their own way, but at the same time, really, if we're not prepared, really can be damaging to us. And I know there's a part of your book, and we're gonna talk about the book too, for sure. Where you were, you know, saying how you tried to compartmentalize different aspects of the job, trying to push it away. And I think that's what most of us do, because if we don't know how to deal with it, how to deal with it, and it it becomes quite overwhelming, and it can swirl into those, you know, depression and anxiety and worse, and I think we were seeing a lot of that right now, for sure. I've just this, you know, this real affront of like, for years, we've just been pushing it down, we've been hiding from it, we've been dismissing it, avoiding it. And now it's like it just hitting this edge. And it's confronting a lot of people really harshly. And so what has been, you know, you said, the yoga and meditation, what has been some of the other like, most effective strategies for you to help deal with that emotional component, and how it has seeped into your life.

I've done some counseling EMDR, I think it's really helpful. Especially I've done that in just for my personal life events. But I think that for nursing, I think it could be really important that it's an eye movement therapy that helps people process traumatic events that have happened, and I think, you know, on the nursing units, that happens all the time. And I think we don't give it the weight that it deserves. I mean, there were I remember the first couple years of nursing, maybe I had a patient die, or maybe there was some significant event that happened that was really traumatic for me, there's no stopping, there's no pause, there's no hey, go get a drink of water, you know, you've got five other patients to deal with. So it's a very bizarre way to deal with all of these things that we witness on our ships. So other things that I do for the emotional impact are, you know, walks nature, keeping my connections with friends, I think, and my family, my relationships being really important to me, because that feeds me and, and also, I mean, saying no to extra shifts, unless I can really do it and do it with a happy heart and do it, do it where I'm not impacting my family life or that free part of my life. And I think that's a really hard thing to do. As nurses, we're constantly asked to work extra, especially in the last couple of years when, you know, a lot of nurses have jumped ship for obvious reasons. But I just say no, because I will be a really grumpy nurse and nobody wants that.

Yeah, I think that ties to prioritizing your needs and boundaries, which is like always a big aspect of you know what we're talking about him in my groups that I lead and I'm sure every nursing group out there because it really does. There's so many reasons why we say yes, you know, the guilt. The guilt particularly is the biggest part of knowing that you're leaving your coworker short staffed knowing about those patients that are not going to get you know, you know the attention and the care that they deserve and but then there becomes this push and pull between giving there and your family. And it's interesting, you know, in just different things I've read and different people I spoke to how common it is for common it is for us to give everything there and continue to give everything there, even though our personal life and our relationships and our family life are struggling and being neglected. And then there's the guilt of that, right? So I mean, how do we win? How do we win, when this guilt is just this seething kind of curse, in this in this world? You know, I want to go back to what you were sharing about when you were just a new nurse and having these experiences and just, you know, there's no time to talk about, there's no time to feel what is happening, and we weren't trained, we definitely weren't prepared for it. So, I mean, I know I just anytime someone is talking about that, especially in the beginning of nursing, but even later, I mean, those patients still impact you. But in the beginning, it's just it feels so like, I think shock. And I think there's a part of us, that doesn't know how to deal with it. And so then we just like, we have to put this somewhere, right? Because there's five other people that are relying on me, there's like this person saying this, there's this noises, there's alarms, there's the doctors, there's the charts, there's everything, and you're like, holy crap. You know, and it kind of becomes like, I can't deal with that aspect. And I actually have a, this came up the other night, actually, I was just laying there and I remembered this patient, I was I was new, like, maybe in my first two years and and I worked in the neonatal ICU, at a school and, and I came on to shift, and the patient had just died. And so I wasn't there for the death. I wasn't there with the family. But now I'm given this patient as an assignment. And having to deal with all of the after piece. And I, I remember, I was like, I mean, viscerally could feel it in my body, just how I was just like, what what do I do with this? What do I do with this, I'm like, you know, 25 years old. And, and I'm, like, got this, you know, dead baby in my hands. I'm sorry, if that is hard for people to listen to. But that was the reality of it. And now I had to deal with the family and everything. And it's just like, it's, it's interesting from, you know, you know, 15 years later to be thinking back to that, and realize, I never dealt with that. I never looked at it, I tucked it away into a box, and just hoped that it would never show up again. And here it is. 15 years later, as I'm like laying in bed, you know, I haven't even been in the NICU and years, but I'm sure you know, this is not abnormal, is what I'm kind of getting at is that I think I think a lot of nurses go through the same thing, experience something so traumatic, and we just tuck it away, because we're like, I don't know what to do with this, I gotta go on, I have 1212 hours ahead of me I had that day. So I couldn't, you know, I still had other patients as well. And it kind of leads me into the conversation about and we were kind of alluding to this before we hit record today. But the things that we're not taught in nursing, but also the things that are not talked about. And this secondary trauma or secondhand trauma, I think is what you you call it in the book, or vicarious trauma where we are, like we are witness to these things, or we experience these things in nursing that have a huge traumatic impact on us. And we're not given the space or the time or the tools or the resources to deal with it. Tell me what you have learned about this, this trauma and yeah, just kind of like what what your understanding is of it and how you have learned to unpack those boxes that you've tucked away?

Yeah, I mean, I think that it's interesting, because trauma stuff, I mean, that, you know, you holding the baby who died. I mean, that's such a Yeah, that's quite an image. Right. And, and it seeps into ourselves in this way that we have no idea how to process it. And and even smaller events, then that can also be a traumatic event for us. And I think we don't realize that either. But I think really, that's why people I think nurses from the get go should have programs that are available to them with counselors, with EMDR specialist with people who can help do you know Somato emotional release therapy, where you know, you do a kind of a emotional release with your body which also helps release the kind of traumatic event that happened. You know, there's a lot of other things that are just really A basic like diet, exercise time in nature, or therapy, that can help also sufficient sleep, you know, which is hard to do all the all these simple things are actually really hard to do as a nurse. But I think that's why when you enter this profession, you have to kind of enter it armed in a way where you're going to be able, and you're going to know that this shit is going to happen, you're going to deal with some really awful harrowing experiences. And therefore, you need to have an arsenal of a hate using war language, you need to have some really sufficient tools to deal with this throughout your lifetime, because it will impact you emotionally. Like you were saying, Sandra, anxiety, depression, insomnia, that stuff, really, you know that it just kind of comes up over time. So you want to get ahead of it, right? Or at least be able to deal with it. So I think having a team of people that can help you to that is going to be important. I mean, my one of my dreams is that healthcare systems will have really integrated, you know, employee packages that offer things like this to nurses.

Yeah, I'll hold that dream with you. Because, yeah, and I, everybody that's listening, just hold that for a minute, because we deserve it. First of all, and our system is not sustainable if we don't make some changes, to help heal the healers, to help heal the people that are doing the work and holding this massive space for, for all the suffering as well as the good but the suffering in the world. And we can only hold so much, right before it starts to really impact us or we have to leave because we don't see any other option. Yeah, yeah. So you talk about something else in your book. And, you know, it's easy to talk about the really hard things in nursing. And they can sometimes feel like the predominant part, right, the struggle and the suffer, and all of the the heaviness that can come with us. But there is really, there's a lot of really amazing, amazing things that come from the work as a nurse, and I'm you you call it, compassion, satisfaction, I think those are your words. And I was hoping that you could share with us, you know what that means to you. And maybe some of your experiences, like the ones that really jumped out at you as just highlighting that pleasure and reward of doing this healing work as a nurse.

Yeah, I mean, that's why stay, frankly, and I have definitely taken time off nursing over the last 25 years, like I've taken, you know, maybe a nine month break a six month break an eight month break, you know, I think probably three, maybe four different times, where I've thought, okay, hold on, I need to, I need a second to regroup a little bit. And I was lucky enough to be able to take the time off and have come back to it. But as far as compassion satisfaction, so I keep coming back to nursing because it gives me so much meaning and, and I cannot imagine another job out there that would where where I can connect with humans and the way that nursing lets you, I mean, you get let into these patients lives that in their most vulnerable times, it's a really intimate journey to go on their health journey with them. And that's why I keep going back to the bedside. Because when I have taken some time off, I miss it. And I love that kind of connection with people. And Sandra I can tell you do too, because you get to the heart and the depth of things right away, which is super amazing. And so compassion satisfaction is like a real live term out there in the science of compassion. And it is, it is, you know, finding meaning and satisfaction throughout while you're giving being a compassionate caregiver. And I think it's important to know that compassion is resonating with another person's suffering. And then it's responding to that suffering in the way that you're skilled to do. And as a nurse, we have all sorts of you know, things that we can do to respond to a patient suffering, which is the actual compassion component. So compassion is the action piece. And and so I try to and you know, I wrote this book about compassionate nursing because I'm working on it all the time. You know, there it's like it's nothing I have achieved it is just it's part of my work because I know that it gives me so much meaning when I can tap into it. And but it does require like a lot of input handle work and processing that you have to do. So, like I'm thinking about this patient who I took care of who was actively dying. And that means he'll die in probably 15 minutes, I started my shift. It was 7am. And I went into his room, and I noticed he was actively dying. I called the family and no family was able to come and be with him. So I went into the room, I told the CNA and my other nurses that I was gonna go in there for a little bit. So please watch my patients, which was really nice, because you know, that's hard to please watch five of my patients while I sit with my patient. So I really tried to like think, Okay, this is the moment, I'm going to be able to sit with my patient, and I'm gonna make it happen. So pull up a chair, I'm with him. He's actually kind of responsive. I asked him, Are you still in? Are you in pain, and he shook his head, no. And I said, Okay, I'm going to be with you. I just called your family, they know, you're here, they know, you're safe, I'm going to stay with you. And so I just sat with him. And I, you know, put my hand on his arm and just kind of was with him, kind of blessing him silently, knowing that he was exiting. And he took, you know, he was doing his end of life breathing patterns. And, you know, I just whispered to him, you know, I'm here with you, your family, and let's see him, and he died. And, and it's those moments that we have with our patients. I mean, that's a really significant moment to be with somebody when they actually die. But we have so many moments like that in a nursing shift, where you can actually pull up a chair and be with somebody for even a minute, and it makes all the difference in the world. Or, I mean, I, you know, I work with extraordinary nurses, I do think nurses are extraordinary in general. And but, you know, I've witnessed so many nurses just make this amazing connection with a patient in such a short amount of time. And CNAs, actually, to, while they're, while they're turning a patient, or you know, just reminding them that they're safe. So just kind of like lean into these really intimate moments with your patients, and feel it and experience it, and then dwell on it afterwards. That's what the compassion satisfaction is, it's dwelling on those really meaningful moments that will fill your soul up as a nurse, there's so much that depletes you and takes away from you. But this actually fills your well.

I love that. And just listening to you tell that story. I mean, it was just bringing the well of emotion up inside of me, but I think, you know, what you're explaining is just, it is those, those moments that you know, we have so many things to do. But those small moments of just that human connection. That's, that's what matters. That's what matters, right? Like if the it's just what matters. And I think it's what keeps most nurses coming back is those. And I really, I love that idea of you know, instead of ruminating on the heavy stuff, and you know, getting sucked into maybe like complaining or some of that victim mentality of all the different political and, you know, management and all those higher up kind of systemic problems that are trickling down and they're real, I'm not dismissing them, they are, they are real, and they need to be dealt with, but, but it doesn't serve us to spend time in that space where we're just dwelling on that. Because it's because it leads to powerlessness, it leads to hopelessness, it leads to depression. And it leads to us leaving. So if we can, you know, take that time to sit and reflect on those positive experiences, reflect on those human connections. I mean, just as you were talking, my mind was just flooded with all the different over the years, and I'm sure everybody listening to like, you just, you can hear that spark of, you know, two souls, really. And I would I would imagine being in hospice and palliative care, particularly, that you would, you know, almost need to have a spiritual practice of your own. What's your, what's your take on that? Like, I mean, I've worked with a number of nurses and not everyone has a spiritual belief. And I know even in my own story, I didn't have one until I started exploring it six years ago and started digging into different belief systems and really not landing on one in particular, but just landing in a place where I have my own unique understanding of what is you know, the purpose and what is happening and divine intervention and just all of that That aspect and really, it's like our whole human connection but in this in this work like, yeah, what's your take on the spiritual aspect of, of this work but also like the, the importance of it as as a nurse.

Okay, if I if I answer your question, will you kind of give me your kind of spiritual like kind of what you what you kind of figured out after six years and what resonated with you and what kept you kind of? I don't know. Yeah, when you figured out

that a deal, okay, yeah, it's a deal.

Okay. Um, so it is really important to look at your spirituality of care and or philosophy of care. Dominic VASHAUN, has a book that he wrote, it's basically a textbook called how doctors care. And it's all about the science of compassion. It's an amazing book. I have now read all of it, because it's so big, but and it's very sciency. But it is also really practical and useful and funny. Anyway, he talks about the spirituality, care of care, and philosophy of care, and how important it is to really think about how you are operating as a human as a caregiver. And think about this aspect of your life. It's really hard to be in a health care profession where people are living and dying, and they are, you are responsible for them. Without really going, what is this all for? I mean, I mean, it's, I think it's impossible to be in the healthcare profession and not be completely overwhelmed by the significance of our job, and the shit that happens to people randomly. You know, we see the systemic failures, we see misfortune, we see life choices that have brought people to the hospital. So dwelling on your spirituality of care or philosophy of care, and I, you know, he incorporates both of those as options for people who may not see themselves as like religious or believing in God traditionally, but you know, there's got to be some kind of heart centered space that you operate from. Because you are working with humans who are in their most vulnerable times, for the most part. And to well on, like, what feeds you. And I feel like for me, like, I used to be a churchgoer. I was born and raised Catholic, raised my kids Catholic. And then after 17 years of raising my kids Catholic, I decided to not stay in the church anymore, and just kind of jumped ship and see, first of all, see if I got struck by lightning, which I didn't. So that was good. And then, and then it just felt like it really aligned with me, you know, I didn't want to go to church anymore. I totally appreciate it though. My religious Catholic upbringing, and I still have a very strong belief in God. And I have a very strong belief and all sorts of other divine creators out there. And I also have this really amazing belief, well, strong belief that there is something else out there. Part of that's because of what I witnessed when people are dying. But I love actually thinking about my spirituality of care and how it is part of my nursing profession, because there's just, I mean, I feel like every so many moments are just sacred and holy there. And I think that probably adds to my compassion, satisfaction, you know, when I, when I kind of consider this component to how I show up as a nurse,

I wonder if it's, you know, sometimes takes for those of us that don't have a spiritual belief in my own life. And so I wonder if this would resonate with others, but it took you know, I experienced death of friends and family members as a younger, like, as a younger child, I guess, and a younger adult, but it didn't really hit me, in a way until I was older. And even, you know, in nursing, it didn't, it didn't seem to confront me, but for some reason, a death of somebody I didn't even know, hit me. And I don't I don't have a rhyme or reason for it, other than it was just time and, and it hit me in a way because I was witnessing all these other people who knew the same person like you know, I when I said I knew him, but I'd never met him. And so all of these people also knew him and we're grieving and we're, you know, turning to God and we're turning to their, their belief systems for support and for faith and for understanding and I felt very lost. I was I felt very lost and it kind of confronted me as far as like just feeling like I had gap, a gap in, in my capacity to fully be a human being. And, and I felt like I was missing something that just witnessing all these other people have this strong faith in this community in this connection. And I was like, Where do I fit in that, and it was just this, it was this aha for me and, and then a spiral. Because it was like, I didn't know where to go with that either. And I just, you know, I just happen to talk about it with somebody who is supportive. And sometimes that I think, is just the spark that gets the ball rolling, and I just started exploring different things. You know, I wouldn't say I've landed in a certain space as far as like a religion, I don't believe. I mean, I think religion can thread into spirituality, but I don't, I think they're separate spirituality, I feel, in my own journey, is a belief in something else in something bigger in something other than just us. And I, I also find that having that belief, whether it's, you know, in God or the universe, or you know, a source energy, or our highest self, or you know, pixies I don't like I don't, it doesn't matter what you believe, as long as you believe that there is something else out there, not greater than us, but that is working with us. And that, that sparks me when I'm feeling loss, when I'm feeling scared when I'm feeling hopeless, when I'm feeling betrayed, when I'm feeling left out, or all those harsh human experiences that we all go through to some degree, having that understanding that there's something else out there there is there is a path being laid out, it may not make sense. But there there lands this capacity to trust. And I talked about this with my clients not not necessarily that that way, but of like not having a faith and it creates this or not having a trust and, and a belief, it creates this tension because you think you're the only one, you're like I'm it if I don't figure this out, if I don't do all the things that I need to do, like how's it all gonna, there's a lot of pressure in that. And that tension is like paddling upstream, right against the current, it's like tense and rigid, and just just frenetic and just a panic sense. And that's that trauma response happening in your body because we're constantly feeling this, like, need to fight against it. And whereas I found when I, when I really started leaning into a belief, and it's taken years to you know, even I just had something happen in my life that kind of threw me back and, and I've just, that's where I've been leaning. And I've found it's so supportive, because it's like turning that boat around, where I can just, it's not that I'm not taking action, it's not that I'm not active in my life. But there's this trust, and so it's like, a release a freedom. And, and I think, don't, we all want that. Don't we all want a little bit of freedom, and just like to let go of that tension that we're holding. So I mean, that's, that's where I've landed. And, you know, I don't have a belief in a certain aspect. When I go out at night, and I look at the stars, I talked to the stars, sometimes I look for signs I, I asked for things. And then I noticed them show up, not always in the package I want but they do, they do show up. And I just think it's like it becomes a practice of leaning into that trust and faith and there is a real, like, you can just sit back, when when you have that, that you're not, it's not all on your shoulders. So, you know, it kind of wants to lead me into the conversation. And I want to talk more about your book, but we're gonna get there in a second. But there isn't, there's a chapter in your book and just for everyone that is going to buy it after they listened to us. It kind of goes 30 days. And so you have these practices for for 30 days that you can go through and I really liked that that layout because I mean, you know, full well, nurses are busy and it's hard to incorporate these different practices and exercises. So you know, one a day or one every couple of days, it just makes it really reasonable and doable, and they're so specific to nursing. So just super helpful. But one of them talks about confronting our own death. And I want to dig into this particularly, you know, you see a lot of death in the work that you do. And I think when I reflect on the last two years, and the amount of fear that has unfolded and kind of like billowed up for people, it's been, it's been confronting our, our own mortality. And you have this practice that you share in the book. So I want I wanted to give you some space to share a little bit about that, and maybe even share the practice with with the listeners.

Okay. Um, yeah, one thing I wanted to mention about our previous conversation that we were having about spirituality of care if that's okay, is, I believe that you are building community in what you're doing right now. You know, it's like your own little version of a spiritual community. And, and I do also think that it's important to think about agnostics and atheists and like you said, I mean, you can find, you know, in nature, and maybe that's your driver, or maybe I encourage listeners to, when they're on a shift, kind of lean into like, the energetic back out and just kind of look at the energetic component of what's happening in your day. See, if you can get into some kind of flow, see if you can be open to, you know, wisdom that might just pop into your head. Dominant question in his book, how doctors carry talks about how, how doctors, you know, will say, I don't know where that came from, but I gave the patient this response this answer, and it really resonated with them, you know, just see how many times that kind of thing shows up on your shift and that, you know, so it doesn't have to be like a God centered thing, it can just be openness to something else? Yeah, um, let's see. Okay, so the death exercise, I, um, I think it's important. I mean, we are confronted with our mortality every time we show up on our ships, for the most part. And I think it's a really jarring experience for most humans, right. I mean, most of us, that's the last thing we're thinking about is our death. And so to have maybe a patient who's so sick, maybe stage three, stage four cancer confronting their own mortality, I think it's really important practice as a nurse CNA to really contemplate your own imminent death. And by imminent, I mean, it's going to happen eventually, right? Guaranteed, except for Elvis. So really, you know, if you want to the practice that I talked about in the book is thinking of your life, maybe find a quiet place in your house where you can lie down, and, you know, do maybe a body scan, so go from head to toe, just kind of thinking about each part of your physical body, and how it served you over your lifetime, in whatever arena, whatever you're, you are really just, you know, from head to toe, and, and I love that practice, because that gives you so much appreciation for you know, what's happening in this physical body of ours. And, and, you know, I think a lot of gratitude and just positivity in general shows up, and then process your death, meaning, you know, if I had 10 years left to live, if I knew I was gonna die in 10 years, what would I want that to look like? Who would I want at my bedside? What is important to me when I'm dying? Do I want religious leader to come and give me an anointing? You know, will my sister be there who I've been in a fight with for the last two weeks? You know, just really kind of process that moment, the moment of your death. And then and then take it a shorter time span five years from now. But I was dying five years from now, who would I want at my deathbed, what's important to me? And then have it come closer to you a year from now? And I, you know, I think when it gets really closer, then think about in addition to Who do I want at my bedside, what do I want my death to look like? What's important to me? Consider, what do I want to do for the next year? What's important to me? I think that really helps you kind of lean into like your professional stuff. You know, what's important to me with my job? What's important to me with my family, my relationships, Is there anywhere I want to go? I just think those this activity just really helps you kind of clarify like a laser what's important in your life, and then continue with the exercise whatever. I was gonna die 30 days from now, what if I was gonna die tomorrow. And I just love the process of it because it really, maybe it'll bring up your relationship with your sister. And maybe I want to kind of hone in on that everybody usually wants to call their mother. Or maybe I want to go to Hawaii and buy a ticket to Hawaii. Or maybe I want to, like, you know, go run around the country in a VW bus for a year. You know, I just think whatever it brings up is good, because it's going to tap into our hearts desires, which I think often gets lost just in, you know, the way that we're living anyway, in this culture. So I think it can really impact you. The other layer of this as a healthcare professional, is that you can show up for your patients in a different way, right? The ones who are confronting their own mortality. You, you're so much more empathic to somebody when they have maybe six months left to live, you know, they're going through this exercise in real time. That's so intense. And to really think, God, what is going on in their head? What would they want? Yes, I'm gonna bring them water. Yes, I should ask them if they want ice cream right now, you know, I think it makes you just a better nurse. Because because you are also like, oh, shit, like, I just did this the other day. And I would definitely want some ice cream right now, if I was going to die in six months, you know, you just got to go the extra mile for people.

Yeah, it's, it's making me think of you maybe have read this book, too. It's the top 10 Regrets of the Death, death, death and dying dead and dying. And written by a palliative nurse. And it's an exercise that I introduced in the end of my program. And it's inviting everyone to write a letter to them their present day self, from their 100 year old self. And it's allowing us an opportunity to, again reveal, like some of that desire and of what's important to us. Because we do get lost in the world, we get lost in the hustle and the busyness and the expectations and the pressures and everything and we lose sight of, you know, our dreams, and what really is important to us. And it can really kind of bring it back and recenter us as we move forward. Is that like, is this aligned with what I want my life to look like. And that's ultimately, you know, everything I teach is about alignment of your life, like pulling all these fragmented pieces is pulling them back. And when we can find that, you know, that's maybe the ultimate state of like nirvana or whatever. But maybe we don't achieve that in this life. But, but that's kind of the, my, my intention. And my goal is just to look at all the different aspects. And are they aligned? Are they aligned with what's important? I think those kinds of practices and exercises are really helpful for us to figure that out. Because I think we forget, we forget, and we get lost and sucked into the vortex of, you know, our culture and society. And, and no shame. Yeah, yeah. But yeah, I haven't It happens to all of us. Right. And, and but then when we can do these practices, and remind ourselves, then it just helps us moving forward, you're, you're absolutely right, it it does make you it makes you a more present and more willing to go the extra mile as a nurse, it makes you more present with your family, it makes you more present with yourself and your your whole entire life. So, you know, I would invite people to visit that practice, or the one that I was mentioning, and just, you know, on like, a regular basis just to really, really pull yourself back in and like what what what are the, you know, where is my life right now? Like, am I aligned with what it is that I want? And what I think is important, and maybe it is maybe it isn't? And if it isn't? Again, it's not a shame thing. It's okay, what could I do differently? It's an opportunity to make change. Yeah,

yeah. Are you going to talk about what your groups are? Because they sound amazing.

Well, I talked about it. Throughout all the episodes, I definitely will share at the end, but I want you to tell us a little bit more about the book and how people can find the book, what they can expect from the book, where they can find you and, and, and everything that you do. Yeah. Alright.

You, I have a website. It's Beth kavanaugh.com. And that's where I have. I have two books, one in some light at the end, which is a hospice caregiver guide, basically, and I have this new book, The Power and pain of nursing, which is C It's tiny. It's a really easy read for busy busy nurses. It It's a 30 day guide to self care practices to protect and replenish compassion. And you can get the book on Amazon, of course, and all other places that sell books, you can get the ebook version as well. On my website, I also have a blog for basically anybody who's taken care of somebody who's a hospice patient. So it's written to, you know, kind of for, for lay people, but I think it's really helpful for nurses as well, because it gives people kind of the words to explain to their patients, you know, what's happening and the life or what to expect? Yeah, so that's how you can find me.

And is there anything, you know, I gotta scrap that question. Is there if you could leave us with one, you know, nugget, one last juicy nugget of like, your, maybe your top tips for self care. I don't even like that word, self care, but it's become so watered down over time. And I talked about I've talked about this in the past about, like, almost the shame aspect that's attached to it. And like, right, like, if we're not doing enough for ourselves, but that being said, it's what everyone understands. So like self care tips, or, you know, just how we can care for ourselves. But what I hang on, I'm scrapped that whole thing. I'm gonna say it again. All right, welcome. I know where you're going. Okay, so you got some time to think about it. Okay. All right. This is the bloopers reel. Anyway, your screen keeps freezing, too. I got it. That's okay. All right. So if you could leave us with, like, the advice that you would give to a younger version of yourself. So you know, 25 years in nursing, you've learned a lot, you've witnessed a lot, you've experienced a lot, and you've grown a lot in that time. And knowing what you know, now knowing what you've been through, you know, kind of like that exercise, we were just talking about the 100 year old self to your present day, but like what would your today's version self say to your 25 years ago self that's just getting into this profession, what would be some of your advice and guidance to her?

Okay, I can think of maybe three things. There is this program over at the University of Virginia that has the nursing school, and they have a bunch of self care practices and programs there, there's like a compassionate Institute there. It's really beautiful program, beautiful people that run it. And they had this one video seminar that talked about the system, and the system of health care, and how damaging it can be two nurses. And so really important to know that we work in a system that has job demands, and inadequate staffing ratios and technology, snack foods and administrative responsibilities that we shouldn't necessarily have. And, and, and, and it's a hard system that we work in. So there are some systemic things that do have to change for your nursing profession to be better. And then there's self care stuff that we can do to make our profession better, and to make you be a better nurse, and to make you feel better about the work that you're doing, and to make you a more compassionate human and nurse. And, and these two, shall coexist, right? That so I think changing the system is actually a really important piece of this, I think if you can get involved in some way to make some effective change, and it can be really small, but be a voice out there for how to improve your unit or your system. I also think that you know, self care. I'm going to say self compassion. Self Compassion is a really, really important piece, do do a little bit of research. Kristin Neff is a PhD and she's like the queen of self compassion. Um, she has so many resources on how to incorporate self compassion and what it looks like. And I think nurses we can be really, really hard on ourselves about everything. And when we are not self compassionate, we become more judgmental, and we cannot give compassion to other people. So really like the first place I used to start is right here. Um, and being self compassionate means you would talk to yourself as you would talk to a friend that you dearly love. Now, I'm surprised at how critical I can be of myself, like I, you know, I can call myself all sorts of names all the time, I really have to work at being kinder to myself. But it does play out in a really expansive way, if you can actually incorporate this into your life. So I'm just going to leave you with those two things, work on self compassion, know that changing the system is going to be equally important.

Yeah, and it's like pick your pick your mountain. And where I land with that is like, for many of us, the system feels like, impossible. And the system feels like no one's listening, we have tried, no one cares, they don't care about us. That's a lot of the conversation. And it's like, if we keep feeding that, that's what we're gonna see. Right? So if we keep saying those things, and we keep having that kind of mindset about it, yeah, it's not going to change. So what it's what it will take, though, is for people to step into roles to have a different mindset and a different attitude about it and work towards and taking those positions that can impact change. But that's not for everybody. I'm pretty sure that's not for everybody. But what is for everybody, if you're open to receiving it is what you're talking about these self compassion, self care, self acceptance, self love, all of the selfs, is focusing on yourself. Yeah, and, you know, the boundaries that we talked about before, and saying no, and all those things they come into when we deal and we work on ourselves. And I like to say, you know, when when we focus and start here, the ripple spreads, because it will, it'll impact your family, it'll impact a, you know, your own work environment, it'll impact the culture of nursing. And that's where we can see you are impacting systemic change, even without, you know, taking on a role in a leadership position where you're, you know, doing administrative type of like policies and change it like, those kinds of things are important. But when we do the self work, it impacts the culture as well. So we can't downplay that every single one of us if we want to take a responsibility in this, not just in nursing and in healthcare, but in our own lives, is to say I can I have a percent of control in this, right? Like, I'm not powerless, whether it's 1%, or 50%, or whatever you see, even 1% is enough to get you to say, I can do something different here. Like, I'm not powerless, I have some control. So I think those are amazing pieces to leave it at is like the this is not hopeless. And I mean, you probably are witnessing this too. But there is a shift happening right now, there is a significant shift happening. And it's going to call on us to rise into these places to be a part of the change that we have been desperately wanting to see, and how much more equipped we are to rise to that challenge. If we are, you know, starting now, like getting into ourselves, and, and learning these practices that you lay out in your book. And there's, you know, Kristin Neff is just an amazing resource to bring up, I'll make sure I put that in the show notes. And yeah, and you know, there's so many tools, and we could talk forever about them all, because there's so many things. Because you asked, I'll just share, like, my, my group is a, it's, it's for women nurses, I call it nurse RX, and we meet it's a group program. So we have an opportunity to connect to share our stories and to learn different practices to explore different exercises and things together, where we can share our experiences with them and share parts of ourselves. And it's really and then as well, there's a coaching aspect because I'm a coach. And so coaching is somewhat different than counseling in a sense of, it's very action focused. So it's, you know, we talk a lot to and I've taken a lot of training and that around trauma, embodiment practices, I do a technique called aroma freedom, which is similar to EMDR as far as the benefits and you know, just all of those pieces that we've already talked about, but it's it's it's about digging in and then taking action because if we talk about it, it's great. It's great, but if we don't, number one, access our body, none of that talking goes anywhere. And and number two, if we don't take any action, we're just continuing to talk about it. So we have to do things different. And yeah, and the group just it's a really, it's I always disagree I was magical, because it really is to see women, particularly nurses too, because we, you know, it sounds like you have a pretty solid workspace, but there's a lot that are not. And there is a lot of really toxic workspaces that people are in. And so it doesn't feel safe, right, it doesn't feel safe to share your story or to drop your guard and talk about how you're feeling, or how this is impacting you. And so, my, my biggest intention is to create that safe space for nurses so that they can, they can drop their armor, they can drop all their arsenal, because it is like a freakin war out there. And, but they can drop it in the safe space. And when we can drop it, we can truly heal if we can't fully feel safe, we can't fully heal. So, and particularly a lot of this, you know, the trauma that we just kind of brushed over because really, it's a huge topic. But it's, uh, you know, we can't truly heal from that and find a place of ease in ourselves if we if we can't feel safe. And, unfortunately, in the culture that nursing is right now, there is not a lot of that safe feeling. So yeah, I don't want to leave it on that because that doesn't feel very inspiring, but tell us like, just you know, before we close, one last amazing nugget from you, putting you on the spot, okay, and go. Okay,

so um, it was this was like, probably in 2016, I was taking care of a patient, and I'm going to tell a little story who is actively dying. And, and he was he had terminal alginate agitation, he was restless, pulling in his gown pulling at, you know, the bed covers, trying to get out of bed. And his wife and daughter were at the bedside, kind of trying to keep them in the bed. And they were like, super agitated. Also, you know, they were kind of feeding each other. The son in law was sitting in the corner of the room terrified. And it was a pretty distressing scene. My doctor and I had been working together trying to get this gentleman's agitation under control. So after titrating, his held all his morphine. You know, after a couple hours, he finally started to settle. And the family finally started to settle and they could sit in the chairs. And then the patient started exhibiting what's called Cheyne Stokes, respirations, and a life respiration. So I knew it was going to happen. Soon, they asked to talk to the doctor, the doctor went into the room. And he came back to the nurse's station about 10 minutes later. And he was really ghostly white, and he goes, the patient has died while I was in there. And I said, Oh, okay. And he goes, I've never been with one of my patients when they died. And I was like, what? And then I didn't say anything else. But there was all sorts of things going on in my head, which was, wait, I'm taking orders from you, like, wait a second, like, how does how is this even working. But I share the story, because as I processed it, I thought, Oh, my God, we have such a powerful role at the bedside in any job that we do. You know, the physicians have an amazing amount of knowledge. But we have such a different kind of knowledge, because we are witnessing our patients, we see what they don't see. And we see what the family is don't see, our role is critical to advocating for our patients and being an activist really, for our patients. So now, I never lead a phone conversation with the doctor, you know, I'm sorry to bother you. Because we carry so much weight in how they're going to respond with their orders or whatever it is. Our point of view are the reason we're at the bedside is just as significant. So I just I think it's really important to remember the power in our role as a nurse.

Yeah, yeah. And that is an amazing place to leave it an amazing place to really remember the critical role that we play in our patients care and in their lives. And not to downplay it or let anyone tell you differently. Yeah. Love it. Thank you so much for being here and sharing with us. I'll make sure that I put the link to your website so people can get your book and and follow along with you reading the blog if they choose. It has been an absolute delight having you here.

Yeah, I know. It's been fun. I really like love this. I don't think I've been with somebody who's so aligned. So thank you for inviting me and I feel honored to share space with you and and you really do cultivate a beautiful space. So thank you

even in my cage. Oh,

I love it like I don't know it feels safe it does

wonderful Awesome Thank you

Thanks Sandra Have a good day