Transcript: Preventing Burnout As A New Nurse Practitioner: Interview with a Self-Care Strategist

​Liz Rohr:
Well, hey there, it's Liz Rohr from Real World NP, and you're watching NP Practice Made Simple, the weekly videos to help save you time, frustration, and help you learn faster, so you can take the best care of your patients.

So in this week's video, I did an interview with Diana from Catalyst for Self-Care, where we talk about the role transition, what we wish we knew as new nurse practitioners as it relates to compassion fatigue, burnout, stress. I've talked about this a little bit before in a previous video, but we're just talking about a little bit of a different kind of side to it, as well as talking about boundaries and the things that we can do to get ourselves out of... How to know when we're heading towards burnout or in burnout, and the things that we can do to get out of there, as well as additional resources. So I really hope you enjoy our conversation.

Just I think one thing, if I can impart to you, when I was a new grad, I really was so focused on the clinical medicine and learning as much as I could, as fast as I could. And so, I think new grad me might have overlooked a video like this, but if you can trust me, I would love for you to watch this and soak it all in, because it is important enough that I'm taking an entire week's video to talk about it, instead of another clinical topic, which I know that you also need.

Anyway, coming up is my interview with Diana.
And before we jump in, if you haven't grabbed the Ultimate Resource Guide for the New NP, head over to realworldNP.com/guide. You'll get the resource guide, you'll get these videos sent straight to your inbox every week, with notes from me, patient stories and bonuses I really just don't share anywhere else.

Without further ado, here's my interview with Diana.
Well, thank you so much for being here. Would you like to introduce yourself?

Diana from Catalyst of Self Care:
Yeah. Sure. So, I'm Diana. I'm an NP. I work in Maine. I am a neurology outpatient nurse practitioner, and I work mostly with epilepsy patients, but I also do a lot of headache and general neuro, depending on the day. And then, on the side, I am a burnout educator, a self-care strategist and nurse support.

Liz Rohr:
Oh, I love that. Self-care strategist is so beautiful. It's like, "Give me that." So you have a platform, Catalyst for Self-Care on Instagram. So, tell me a little bit about how that started, how you got into that, and how long you've been doing it for.

Diana from Catalyst of Self Care:
So, February 22nd is my one-year anniversary.

Liz Rohr:
Awesome. Congratulations.

Diana from Catalyst of Self Care:
Thanks. So, it started actually as a blog. So I have selfcarecatalyst.com, was my blog initially, and that was sort of something that I started because I just felt there was a need to talk about burnout and prioritizing clinician wellness and supporting nurses and advanced practice providers who were struggling, because that was pre-COVID, this was December of 2019. Then COVID hit, of course. So of course it was an even more needed.

But at the time, I just looked around and I saw most of the people I went to grad school with were burning out and a lot of people I work with are burning out. So I just thought, "Someone needs to do something." And I looked around and there are some people talking about it, but I just felt we could do a better job.

I learned a lot on my own, because I'm actually a burnout survivor. I had burned out in my first job, back when I was a new NP. So I've spent actually years just cultivating tools, so it would never happen to me again. Mostly out of personal paranoia, that I would have to go through it again. So I had all these tools in my little toolbox. I learned a lot about burnout over the years, so I felt like, "Hey, man, I should share this knowledge."

Liz Rohr:
Totally. So you've been an NP for 10 years, is that right?

Diana from Catalyst of Self Care:
Yes. So, '09, so a little over 10 years.

Liz Rohr:
Cool.

Diana from Catalyst of Self Care:
It's crazy. It goes so fast, it's crazy.

Liz Rohr:
That's so awesome.

Diana from Catalyst of Self Care:
Yeah, I swear.

Liz Rohr:
I love that, because I feel like when I started talking with you, I feel like you just... It's very clear to me you have a huge knowledge base when it comes to burnout, because clearly you have a ton of knowledge and experience in understanding this and learning about it and teaching it.

There's just so many things, and you and I talked before this video, of there's so many things we could talk about, and I just want to give all the things all the time, and I think you feel that way too.

I guess, maybe to start, what do you wish you knew? If you could talk to your previous self or to new grads now, what do you feel like you want to say to them, or what do you wish that you knew or they knew? Concisely, of course, because it's a huge topic. You don't have to be concise, but I acknowledge that that's a hard question to answer in a short time.

Diana from Catalyst of Self Care:
That's a great question though. Honestly, I think number one, I would just give myself a hug and be like, "Girl, it's going to be okay. It's going to be great. It's hard but-"

Liz Rohr:
Makes me so emotional, I need a hug.

Diana from Catalyst of Self Care:
[inaudible 00:04:56] tell people that I hug myself and just give myself the confidence to enter the force and be like, "You know what? It's okay not to know it all. No one expects you to know it all in the beginning."

I think we all graduate our programs and we think that we need to have everything down pat, and we're going to be awesome at our jobs, we're going to change lives. And that's all true, but it doesn't mean you have to know everything. I don't think any employer expects that of you, but we put that pressure on ourselves.

So I think number one, I would just tell myself to just take a deep breath and say, "You don't have to spend every hour you're not at work reading the things that you're just going to learn on the job anyway." You can read it in a book, but it's better to just learn it as you go.
And just asking questions. I think I would've told myself, Ask the questions, don't feel scared to ask questions. People don't judge you. You're not a dummy. You're not a failure." So I think those are two major ones.

And then, I think definitely looking back for me, having gone through burnout in that first job, I think I'd say, you really need to nurture yourself outside of work and set really healthy boundaries with your job, because I think my lack of... I didn't even know what a boundary was, to be honest. I didn't have any boundaries.

Liz Rohr:
I'm going to say, this is our next topic.

Diana from Catalyst of Self Care:
So I think I would say to myself, "You need to think about where you can set healthy boundaries, so you can then nurture yourself outside of work. Because at the end of the day, we are not a nurse first and foremost. We're a human being that has needs, and we need to nurture those needs in order to stay sane for the long haul." So, there's a lot to be sustainable.

Liz Rohr:
Totally. So, you and I talked about this a bit, but boundaries, I feel like is so important to talk about. You can share whatever you want from personal experience and just stop where you don't want to share, but I know for me, I don't feel like we're taught about boundaries and what that means and how to hold them, how to understand them. I definitely came from a burnt out place. I don't know what you would classify as the line of burnout, but I feel like I was on the verge of leaving the profession myself, before I started this platform.

That's two questions in there, of what are the warning signs? And then, I'd love to talk about boundaries too, but whatever one you want to talk about first.

Diana from Catalyst of Self Care:
Sure. I think it's definitely important to know what to look out for. Because for me, I didn't have any formal education in my nursing or NP programs about burnout. There was nothing about clinician wellness. There was nothing about any of this stuff. I know a lot of programs now do incorporate that into their curriculum, which is amazing, because I really think every program should, but it definitely was not. So I didn't even know. It completely took me by surprise.

I realized what was happening and then I'm like, "What? This has been going on for so long, how did I not see this sooner?" But you just kind of get caught up. And again, you put those pressures on yourself and you fear that people are going to judge you if you say no or you set...

So I think with burnout, it's not just like, "Oh, I'm really tired. Oh, I had a really bad day." We all have bad days. I love my job right now. It's a great job. I love the people I work with. It's definitely not toxic. Do I have bad days? Of course, like we all do. That's not burnout.

Burnout is when the exhaustion is so profound that your traditional methods of bringing the energy back into your body and that traditional rest that would rejuvenate you, doesn't do that. It's feelings of apathy. It's feelings of that emotional numbness, where you feel so much that you actually feel nothing, which I know sounds crazy, but-

Liz Rohr:
No, I think it's so accurate. And I think people who are experiencing that is going to be so resonant.

Diana from Catalyst of Self Care:
So, it's that exhaustion piece. It's the depersonalization piece where it's like, "I don't feel connected to this job. I don't feel like I'm making a difference." Or you're just like, "I just really don't want to do this anymore." Or, "I can't do this anymore," if it's that extreme. And then, it's just the feelings that you're just not effective in your role and that your role isn't serving any sort of purpose.

And then, there can be physical symptoms; headaches and GI symptoms, anxiety. A lot of burnout symptoms can overlap with depressive symptoms. Sometimes that kind of overlaps.

I think if people really have significant emotional involvement with their symptoms of burnout, it's not a bad thing to talk to somebody and ask for help. So there's definitely physical symptoms, there's definitely emotional symptoms, and people get irritable. If you start to notice that you're drinking more alcohol, or that you're self-medicating with really junky foods, or you're just really snippy with your partner and you just don't feel yourself, these are all red flags.

Liz Rohr:
And in terms of the getting out, and again, feel free to share or not share your experiences, or just whatever you've understood so far, what do you feel like the first steps are for people if they're noticing or they're worried about that burnout? You mentioned boundaries, but what do you feel like if somebody's in that place and they're like, "Oh, gosh, that's where I'm at," what do you feel the first steps are?

Diana from Catalyst of Self Care:
So I think step one is really just... I'm a big believer that every single day we should be checking in with ourselves and auditing where we're at. I highly recommend doing a post-shift reflection every single day. When you get in your car, just asking yourself, "What did I do really well today?" Celebrate those moments. And then, "What didn't go so well and why?" And just, "How am I feeling?" Do a body scan. Is your body tense? Did you eat? Did you drink? Are you low energy? Why are you low energy? Did you not sleep well? All these things. So, I think checking in with yourself is step one, because it's hard to know what to take action on unless you know what the problem is.

So if you know that, "Okay, I'm really low energy, but I really didn't eat today at all. I've had a granola bar in the staff room. I haven't peed at all today, which is probably sign I'm dehydrated," which we've all been there. I've definitely been there. "It's four o'clock, I haven't peed today." Crazy. Need to drink the water. So I think knowing what the problem is allows you to decide what you need help fixing. Again, is it a [inaudible 00:12:00] thing?

And then, what triggers are there? Was it a really difficult patient interaction? Sometimes you had a really hard day because a patient died, or you made a mistake and you freaked out about that. Or you got reprimanded by someone. Or someone was bullying you. Maybe there's a really toxic colleague that you work with. So I think step one is really figuring that piece out.

And then, the whole action piece of that is really... We could talk about that forever, because it's really dependent on what the issue is. If it's a colleague, that's one scenario. If it's your own self-care needs and you're not meeting those, that's a very different scenario. If it's a boundary issue, then that's another scenario. But I think doing that check-in is really important.

Liz Rohr:
Yeah. And how do you feel you learned about boundaries? When did it occur to you, "Oh, boundaries are a thing?" It sounds like a silly question, but it's so true. People talk about boundaries all the time, and I'm still understanding them and getting used to practicing them. So, I guess, how did you come to understand, "I didn't know what a boundary was, and here I am learning about it," and what helped you with that? And I guess, some examples for people, if they're like, "I don't know what boundaries mean."

Diana from Catalyst of Self Care:
Well, there can be boundaries for your home life, for your relationships, for your work life. Boundaries are not just about your work life. Obviously, that's what we're talking about when it comes to burnout. But burnout can be parental burnout. It can be burnout for other reasons, other than your job. So I think boundaries in general are a thing. For me, I realized that I need to set boundaries when... I had already hit the burnout threshold. I was working a million hours. I was never a no person, because it just freaked me out and I felt like it was going to make me look bad. Again, it was all here. It wasn't real.

So a lot of this is mindset, honestly, but it's also confidence. To have the confidence to actually say, "Look, this is what I can and can't do." Around that time, I sort of came to the conclusion that when I'm saying yes to something, I am by nature saying no to something else. And that was a mindset game changer for me, because then I started to think, "Okay, I need to be more intentional with my yes."

It's not just about like, "No, no, no, I'm not going to do that." It's about, "Okay, if I say yes to this extra shift, or covering this person, or what have you, then I don't get to put the kids to bed. Does this mean my relationship with my husband suffers? I don't have time to exercise, and that's really important for my mental health."

So once I decided that piece, that helped me a lot. And then, when I left that job, so I did end up leaving for a couple reasons. That was part of it, but we also wanted to move here, which is where we're from. In my new job, on day one, I was in the mirror like, "You are just going to make sure you set boundaries. You're going to be good at this. You have to be your own self advocate." It was this serious heart-to-heart with myself, "You have to always advocate for yourself." And so, that's what I've done since day one at this job. I think the boundaries, it's important to do it, the earlier the better, because then you set up that expectation from the get-go.

Honestly, this comes into play all the time. Literally, a couple weeks ago, I had to set a boundary at my job. I won't tell you the whole story, but basically, an attending I work with is going out because she needs a surgery, and she has very challenging patients that require a lot of energy, and I have to cover her while she's gone. So they're like, "Okay, we need you to cover so-and-so," which is fine. But I was like, "Okay, I know that that's going to be a lot on me. I'm going to be probably crying in my office." So I went to my supervising physician in the management, and I said, "Look, I'm happy to do this, but I need these urgent slots for when urgent things come up. I need admin time. I need these things while she's gone." And they were like, "Okay." Totally reasonable. And now I'm like, "Okay, this is great. Now, I'm helping her. I'm not going to be overwhelmed. I feel good about this. Everybody's happy."

It's just about self advocating and knowing what's going to work for you and what's not.

Liz Rohr:
Yeah. And I think that one of the things I see so commonly is that, in terms of how to describe a boundary, it's kind of like what you need and what you want, compared to what other people... This is the most common scenario I see, is what other people need and want versus what you need and want. And there's so much of the time, with caregivers, there's a lot of people pleasing that happens.

And I think that that's potentially an intro point, of where are you overgiving, where are you overdoing it. Because when are you abandoning yourself and your own needs for somebody else, that is not sustainable. And I think it's really hard for people to have that confidence and sense of self and self-esteem and all this. And it gets into a lot of deeper stuff, like you were talking about, because you need to feel solid in yourself to ask for the things that you want, especially if it's going to "disappoint" somebody.

Because a lot of the times we assume, "Oh, this is going to be so hard for them." And it's like, "No, who are you choosing here? You're choosing yourself." Which is sustainable. Again, if you can't do it for yourself, do it for your patients. Because if you can't can't do it for yourself and you're going to get burnt out, then you can't do it for the patients.

Because this is the common scenario I think that I see from a lot of new grads, where I try to help them see that for themselves. It's really hard and people are not really ready to do that.

I mentioned, when we were chatting before, there's a book called Codependent No More, which sounds really odd, talking about codependency and people pleasing, but it's actually really a lot more comprehensive than just the typical thing that you're thinking about with codependent...

Intermittent relationships, for example, where it's kind of this paradigm of wrapping yourself around somebody else. And it's based on a person who is struggling with alcohol use herself, and her family's alcohol use.

And regardless of that, it's actually really applicable to caregivers and to burnout. So I do recommend that book for people to consider reading, especially if they're having a hard time with their... Like, "I'm not sure what boundaries are. I don't know what this means," and they're really involved with people pleasing too, because I think it's really well-intentioned, and I think it's the way that we're brought up, especially for cis women and feminine people, but it's ultimately detrimental to ourselves.

Diana from Catalyst of Self Care:
That's true. I think most people view boundaries as a wall. You're putting up this boundary. It's like this. But I honestly think that it reinforces relationships. I think, again, like you said, if you are putting yourself first, you're only better able to do the things that you do best, caring for your patients, things like that.

If we don't do those things, then the apathy creeps in. I read a quote just the other day. It was a primary care provider who was sitting with a patient and she started to cry. And he was thinking, "How much time is this going to take? Is this going to get me behind?" And he was just going through the motions and feeling very robotic and putting his hands like, "Ugh, I'm running behind. This is kind of a time stuck."

That's the kind of things that you see with burnout, which obviously the patients suffer. You're more likely to make mistakes. So I think it reinforces relationships within teams, but also with the provider-patient relationship and with yourself. I think when you advocate for yourself, it makes you feel really good. I think it helps you build confidence by doing those hard things and saying, "You know what? I am worthy of this."

Liz Rohr:
Absolutely. I think it's so tricky, because for me, at least when I work with new grads or when I'm in community with them and I see stuff like that happening, it just feels like a monstrous issue. It feels like a big thing, because it's not simple, it's not really a quick fix kind of thing, but I think that there are pathways in. There are self-reflective practices. There's a way to reach out. People can educate themselves.

I mentioned that book, and then there's another book I mentioned in another video that I made about... To Weep for a Stranger, and it talks about compassion, fatigue in caregiving as it relates to animals and people and all that stuff.

Do you have other resources that you particularly love for people to start on that journey of the self-reflection and the confidence and the boundary learning and that kind of stuff?

Diana from Catalyst of Self Care:
There's a lot of really great books for just mindset and things like that. For habits, Atomic Habits is a really good book

Liz Rohr:
It's on my list. I haven't read it yet, but that sounds amazing.

Diana from Catalyst of Self Care:
It's really good.

And Start with Why, which is the Simon Sinek book. [inaudible 00:21:23] without knowing your purpose, your values, why. The why is really important.

Just for beautiful poetry, there's Heart Talk, which I'm sure you've looked at by Cleo Wade.

Liz Rohr:
I have not, no. It's poetry?

Diana from Catalyst of Self Care:
Yes. But it's very much about self and self-love and all of those things. It's very empowering.

There's a daily meditation book, which is lovely, Journey to the Heart. I actually have a whole book list on my Instagram page.

Liz Rohr:
Oh, good.

Diana from Catalyst of Self Care:
So if it's something you're interested in, just click on the link in the bio. It's there.

There's a lot of great books out there. There's a great book. I don't know, you might have read this, The Burnout: Closing the Stress Cycle, I think is what it's called. It's by two sisters. It's a very feminist perspective, but it's really great.

Liz Rohr:
That's awesome. I'm going to look at this list. I'm excited.

Diana from Catalyst of Self Care:
Good. It's a really good book.

And then, this is written by an attending, and it's targeted towards physicians, but I think it's actually a really powerful book. A lot about mindfulness in medicine. It's called Attending. And it's by, the last name's Epstein, but I can't remember the first, Ronald, I think. That's a really great book. I'm a science nerd, so it has a lot about the brain and-

Liz Rohr:
Totally. That's awesome.

Diana from Catalyst of Self Care:
It's the benefits of mindfulness and things like that.

Liz Rohr:
Definitely. I can hear my people in my head when I make all this stuff, and especially thinking back to my own experience, I think that as a new grad I was so overwhelmed and I wanted to read about all the things all the time. And I was like, "I don't have time for all of that stuff."

And so, this is not a clinical video. We are clinicians and we love the science, but I hope that it lands for someone that's watching this, how important this is, that we're taking this time to talk about this stuff, because it is in fact impossible. You don't have to do it the way that we're advising you to do it, you can choose to ignore it and just read medicine all day long, all day, every day, but we do not recommend that. You have the choice to see it for yourself or prevention. I think sometimes new grads and nurse practitioners and caregivers in general are really good about caring for others and not really about themselves. So, if you can just trust us as experienced clinicians.

Diana from Catalyst of Self Care:
Pray for health first. I think people feel guilty. It's all about the guilt or feeling you're not worthy. But ultimately, again, you're living as your highest self when you are nurturing yourself. You have more energy, you're going to be more on your game. Your patients are going to be far happier. Your partner's going to be far happier. I know when I was burnt out, I was irritable and no fun to be around. I think doing those things and exercising, all these things are so important.

But you're right, it's not a one size fits all. It's not about the action that you're taking. It's just about doing something and trying different things and seeing what works for you. Some people thrive on AM routines and having a very specific... They meditate, they do this. Other people hate meditation because they feel like their mind's too busy and what have you. I personally think they could train their mind to simmer, which is probably a good thing.

Liz Rohr:
Totally.

Diana from Catalyst of Self Care:
Other people really like nighttime brain dumps right before bed, or meditation at night because it helps them transition to sleep. There's all these things. But once you get into it and you see the difference makes, I think it speaks for itself, honestly.

Liz Rohr:
I think two entry points, like you said, I just go back to... I hear so many people are not willing to do it for themselves, and so, do it for the patients then. Do it for your future ability to care for patients. If we don't have the confidence and the inner worthiness, we're not willing to do the things anyway. And so, sometimes it's helpful to just, like you said, take action, do something. And then, if you're willing to commit to the action, then hopefully the inner work will catch up, if that makes sense.

I'm just being real honest. I speak from experience here, of I came from this place of not having any of that stuff and putting myself last place for years. I'm not perfect at it still. I don't think there is perfection in general.

Diana from Catalyst of Self Care:
No, there's never a finish line. Definitely not. I'm a big, big, big believer. It really starts with self. I think, yes, it's fine to say, "I'm going to do this for my patients," but if you feel like you don't have that sense of self, I think that inner work really should be also happening on the side. Well, you do it for your patient, but I think it's really important to dig deep as to where that's coming from. Even in the winter program that I'm doing now with my mentees, the whole first module is all self, and we go deep. It's really, really powerful. Things come up that are like, "Oh, my gosh. This explains so much."

But then, it makes it a lot easier to then take action, because then you're like, "Okay, now, I have the confidence. Now, I do feel I'm worthy. Now, I can set boundaries," because of that.

Liz Rohr:
Absolutely.

That's a beautiful segue. So, how can people learn more from you and get to work with you?

Diana from Catalyst of Self Care:
So, I'm on Instagram predominantly. I have a Facebook page, but I'm not really on there. You can go on there though. But Instagram is where all my content gets posted.

Liz Rohr:
It's @catalystforselfcare, right?

Diana from Catalyst of Self Care:
Yeah, @catalystforselfcare. I do have the blog, which has some stuff on it too, that's selfcarecatalyst.com. Right now, winter mentorship is going strong. There'll be another round in the spring. The wait list is always open. Last time we kind of filled up off the wait list, so if someone out there in the world wants to talk more about it, I highly suggest you hop on, so you don't miss out. My doors are always open, as you know. I love chatting with people. I love this community so much.

Liz Rohr:
That's awesome. And so, just to clarify, you do one-on-one mentoring with a cohort of people for a couple of months at a time, or you have a program, or...

Diana from Catalyst of Self Care:
So it's called The Rising to Resilience Mentorship Program. Right now, we have four nurses of all different... We have an ER nurse. We have all these people, kind of different specialties. We do 12 weeks one-on-one. You get a guidebook, it's like 130 pages, so we have a lot of content. We have a lot of various exercises, a lot of prompts. There's other bonus materials like TED Talks and fun stuff that... Because, again, I love that stuff, video on neuroplasticity. So, we do a lot of that stuff and then there's just ongoing support. I hold them accountable, I check in on them, and we have fun. Honestly, it's been really, really fun.

But there's a bunch of free stuff too, on my page. There's a whole mini-training on boundary setting and how to have meaningful conversations. There's a free training on morning routines. There's a whole thing on sleep. A confidence accelerator program, which is like a self-guided minicourse that people can do, which gets into the whole limiting beliefs and imposter syndrome, comparison syndrome, which is probably the worst place to be, Instagram, for that.

But there's lots of resources and I really try to post something every day that's an actionable tool for people to have in their little toolbox, so they can go into work feeling joy and not feeling crummy.

Liz Rohr:
Awesome.

Well, thank you so very much for talking with me. I know this is going to be so helpful for so many people, so thank you so much.