Navigating NP Burnout with Cait Donovan
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Show notes:
So much of what we learn as new and seasoned NPs is how to provide the best possible care for others. We dedicate years to learning about and then caring for others… It can be easy to forget to take care of YOU.
This week, I have an episode for you that I think is even MORE important than the clinical knowledge that I share — navigating NP burnout.
Meet Cait Donovan, an International Keynote Speaker, host of “Fried – The Burnout Podcast,” author of the book "The Bouncebackability Factor", and an acupuncturist with a master’s degree in Chinese medicine. Her creative burnout recovery solutions have been featured on podcasts and online magazines such as “Forbes”, “NPR,” and “The New York Post.”
We chat not only about recognizing NP burnout but also about understanding, navigating, and bouncing back stronger than ever.
In this episode, we cover:
How Burnout Impacts Your Brain: Unveiling the neurological aspects of burnout and how it affects our cognitive functions.
The Surprising Factors Causing Burnout: Exploring the unexpected factors that contribute to burnout, both for seasoned professionals and new grads.
The Role of Trauma in Burnout: Recognizing the impact of trauma on burnout and understanding how it influences us.
The Burnout Recovery Process: Providing actionable steps for recovery and discussing how embracing self-compassion can transform your experience as an NP.
I hope this episode can provide a little comfort, knowing that you're not alone, and maybe a little permission to take the best care possible of YOU, not just your patients.
Resources mentioned in this episode:
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WEBVTT1
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but when you are constantly responsible in your own mind
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for intuiting other people's needs, wants, preferences,
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desires, which sometimes we're wrong,
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but that's a whole other subject,
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it's really hard for you to have enough time
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and space left over to intuit those same things
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for yourself.
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Hey there, welcome to the Real World NP Podcast.
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I'm Liz Rohr, family nurse practitioner, educator
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and founder of Real World NP,
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an educational company for nurse practitioners
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in primary care.
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I'm on a mission to equip and guide
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new nurse practitioners so that they can feel confident,
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capable and take the best care of their patients.
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If you're looking for clinical pearls
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and practice tips without the fluff,
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you're in the right place.
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Make sure you subscribe and leave a review
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so you won't miss an episode.
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Plus you'll find links to all the episodes
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with extra goodies over at realworldnp.com slash podcast.
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I just had the absolute pleasure
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of recording an interview with Kate Donovan.
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So Kate Donovan is an international keynote speaker.
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She's the host of Fried the Burnout Podcast,
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author of the book, The Bounce Backability Factor.
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She's an acupuncturist with a master's degree
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in Chinese medicine as well.
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So her creative burnout recovery solutions
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have been featured on podcasts and online magazines
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such as Forbes, NPR and the New York Post.
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So she is just fantastic.
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And I've been through a few burnout experiences myself
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which I speak about on this podcast episode.
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But she has helped me so much with both her podcast,
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her book, there's a free Facebook group.
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You'll learn all about it on this episode.
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But we cover some really unique,
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interesting pieces about burnout.
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I think that the way that she covers it is so unique
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and insightful and in depth
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and really has given me a better picture
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of understanding burnout itself and then how we recover.
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So we covered things about like,
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what are the physiologic changes
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that happen with chronic stress?
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What are some of the risk factors both external
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which are a lot of the ones that we already hear about
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but also what are the internal ones?
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Also talked about where we begin
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if we realize that we're burnt out
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and where do we go from there?
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And also we touch on this concept of burnout prevention
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and what self-care really means
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and is burnout prevention even possible?
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So I really hope you enjoy this episode.
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Without further ado, here is my talk with Kate Donovan.
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I was so thrilled to be asked
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and this is a community that is near and dear to my heart
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so I'm really happy to be here.
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Totally, that's awesome.
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That's so awesome.
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Well, there's so many things
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that we can say about burnout.
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Obviously you have an entire podcast
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you've been doing for years
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and there's still more and more to learn and to do.
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And yeah, so one of the things
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that I see when I talked about off camera
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or off recording was that,
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well actually maybe I'll start with a personal experience.
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So I've had burnout two different times
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and actually the most recent time was in this company.
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And actually it took me by surprise
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because the first time I burnt out
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was I was a clinician as a nurse practitioner
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working in primary care,
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overworked, underpaid, underappreciated
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just all the burnout external risk factors
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which we can touch on a little bit later
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but I was like, oh, clearly I'm burnt out
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because of all of these external factors.
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I'm gonna change my job.
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It's a toxic work environment, all this stuff.
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And then I got burnt out this year
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running the real world NP, which is a job that I love.
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Like I made this job, I made this company
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and it caught me totally by surprise.
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And I just felt like so kind of embarrassed actually.
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So I haven't actually shared this on the podcast yet.
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Maybe I'll record another podcast talking about it
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but I was pretty embarrassed.
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And I think that one thing,
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so I found your podcast.
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That's how I came to meet you
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because I was like struggling.
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I was really struggling
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and I had to take some time away from the podcast.
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Yeah, one of the things that really, really helped me
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initially that I think would be so awesome to talk about
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what happens to our brains under chronic stress.
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Cause I can talk about the symptoms and stuff that I had
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but I'd love to hear from you first
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if you wanna share a little bit about that.
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So this all came about
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when I was doing extra studies into burnout
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and I found this article that said,
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of course it's online.
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It was on just a medium or whatever.
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Your brain shrinks under chronic stress.
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And I was like, oh, here's another journalist
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who doesn't know how to read medical research.
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I was like, oh, here we go.
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So when I see stuff like that,
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my natural go-to is let me actually find these articles
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that this person is referencing
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and figure out what they're actually saying
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because what the heck?
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We can't tell people that their brains are shrinking.
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That's totally irresponsible.
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And then I read the articles and I was like, oh shoot.
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Our brains are shrinking.
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And that threw me down,
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rabbit hole that I never knew I was going to run down
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when I started really looking into burnout
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because it blew my mind.
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And so what was said was that
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what they find with people that have long-term,
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which is the definition of chronic,
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they have chronic stress for extended, extended periods.
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The prefrontal cortex or the front of their brain
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is smaller, especially the left medial
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prefrontal cortex for those that are in the brain sciences.
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And that's still a fairly large area.
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So we're talking about a pretty big zone.
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This is not super specific,
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but that area shrinks and that area is responsible
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for your executive functioning,
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which means your ability to task initiate,
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to make decisions, to connect with other people,
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to self-motivate, to on and on and on.
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These are the functions that we work on with children
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as their brains are developing around preschool
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and kindergarten time.
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This is weight in line,
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inhibit yourself from slapping your neighbor
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when you want their crayon,
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like ask to go to the bathroom,
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repeat instructions that have two, three, four steps,
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et cetera.
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So all of these things that we were supposed to,
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that we developed most likely,
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maybe some of us didn't develop them as well
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because of another reason we'll get to in a bit,
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that we developed as children,
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we lose our ability to react well,
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we lose our ability to read as many mirror neurons.
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So we're having a hard time empathizing with people
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because we can't really connect with how they're feeling
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the way we may have done supernaturally in the past,
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we didn't even realize we were doing it.
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So we have all of these things going on
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and that's just one part.
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Another thing that when I dug in a little bit further
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is that the hippocampus also shrinks.
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The hippocampus is where our memory is stored,
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not all of it,
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we can get into the specifics
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of different kinds of memory, et cetera,
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but suffice it to say that there's some memory
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that gets stored in your hippocampus
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and your hippocampus shrinks
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and then you don't have access to it.
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I had a client once ask me,
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Kate, but am I getting stupid?
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I feel I'm burnt out and I feel stupid.
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Am I getting stupid?
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And I said, well, yeah, a little bit.
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It was like, yeah, it won't last.
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It can come back,
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but you might feel a little dumb right now
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because you don't have access to things
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you think you should know.
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I remember being so excited for someone
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when they said, Kate, Kate,
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I have a new recovery moment,
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like a green, we call them green flag moments, right?
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I have a new recovery moment.
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You know those stupid six digit codes
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that you have to get for your secondary authorization
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of everything you have to sign into now?
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She said, I was able to read it on my phone
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and remember it and put it into my computer
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without looking back at it.
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She said, I used to be able to do that really easily
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and I lost that ability.
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It's been two years since I was able to look
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at that six digit code and just put it in my computer
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and get it right.
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She said, and I was nervous when I clicked enter
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because I like tried not to look, you know?
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I was like, I'm gonna see if I can do this.
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And I clicked enter and it went through.
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So we have the prefrontal cortex shrinking.
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We have the hippocampus shrinking.
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And then we have the amygdala.
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Everybody always says the amygdala.
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Those that are nurses know that there are two, right?
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One on each side.
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I call it Amy G. Dala because I think that that's funnier.
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Amy, instead of shrinking, grows.
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So our amygdala is our fear center, right?
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It's what helps us scan.
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It's the lighthouse that scans for danger
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in our environments.
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It's the thing that exists on a primal level
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to protect us from like evil outside forces.
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We scan, we scan, we scan, we find the danger
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and we create our freeze, fight, flight
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or tend to be friend reaction
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depending on what the situation is, right?
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That part of our brain is bigger,
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which is making us hypervigilant,
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which is making us most likely misinterpreting
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danger signals, looking at safe things
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and interpreting them as dangerous
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because we are unable to process properly the,
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oh my God, this is dangerous.
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And no, no, no, it's not, we're fine.
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Because the no, no, no, it's not, we're fine
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comes from the prefrontal cortex.
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It attaches through the anterior cingulate cortex, right?
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So there's this pathway that's disturbed
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between the prefrontal cortex and the amygdala
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that doesn't allow us to talk ourselves down
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from situations that are not actually harmful.
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So what happens is we end up saying,
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well, this is a toxic workplace
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and sometimes it is and sometimes it's not.
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Sometimes you're seeing stuff that's not there.
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And this is scary because people can gaslight you
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and we don't want people to gaslight you
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because what you're feeling is still real.
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So like how, we can get stuck in this.
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It's a really scary zone where we don't know
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if the things we think are dangerous
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are actually truly dangerous.
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So an example of this, not in the workplace,
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because those are, I think, harder to describe,
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but an example of this is I was walking
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through a path near my house, like a forest path.
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And I was walking along and I went,
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because I looked down and I saw
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what looked like a snake,
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like kind of sticking out of the ground.
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And then my prefrontal cortex went,
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oh no, look, that's just like a root from a tree
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that is pushed out through the ground
260
00:10:29.380 --> 00:10:31.580
and the top of it, the head looks like a snake.
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And I went, oh, okay.
262
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And then I continued on my walk and I thought,
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if I was still burnt out,
264
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I might not have been able to do that.
265
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So I would have gone home and been like,
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oh my God, I was so scared I saw a snake.
267
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And I would have thought that I actually saw a snake,
268
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but I didn't see a snake, I saw a root.
269
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So that was a big, big explanation,
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maybe a little more than you've heard on my podcast
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because I've learned a little bit more.
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And because I know that this, your particular audience
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will understand this a little bit more
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than a lay population.
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Totally.
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And I just like, well, there's two things
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that I found extremely hopeful about that.
278
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Like one, it was just super validating
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because at least for me in this round of burnout,
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which felt different than the first time,
281
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I was like, wow, I just like, I felt dumber.
282
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I was like, I can't remember things.
283
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I love to read and I couldn't even focus.
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I couldn't even focus on a book.
285
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Yep.
286
00:11:19.200 --> 00:11:20.360
That's a common complaint.
287
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And it's like, and I think that,
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and I loved starting with this
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because I think it'll be really validating
290
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for a lot of nurse practitioners
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because like chronic stress kind of comes
292
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with the territory of the job
293
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and like, how are we doing with managing it?
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And like, this also ties into one of the topics
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we talked about, but like,
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there are a lot of people
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who are in these caregiving professions,
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nurses, nurse practitioners,
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who just care so deeply
300
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that they tend to put themselves last
301
00:11:45.400 --> 00:11:47.320
and they're not really attending to themselves
302
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and not taking care of their stress.
303
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I'm like, oh, that's not a big deal.
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Like, I'm fine.
305
00:11:50.000 --> 00:11:50.800
I can handle anything.
306
00:11:51.000 --> 00:11:52.300
I can do anything for a year, right?
307
00:11:52.300 --> 00:11:54.100
They're really tough and resilient too.
308
00:11:55.580 --> 00:11:58.160
And also chronic stress is going to,
309
00:11:58.160 --> 00:11:59.860
like, it's gonna wreak havoc on your brain
310
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regardless of how tenacious you are, right?
311
00:12:02.260 --> 00:12:03.600
Cause I'm also a very tenacious person,
312
00:12:03.620 --> 00:12:05.800
which is why I've gotten burnt out multiple times.
313
00:12:05.960 --> 00:12:07.840
But I think the other piece too
314
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is that this is reversible.
315
00:12:10.100 --> 00:12:10.500
Yeah.
316
00:12:10.520 --> 00:12:12.060
Can you speak a little bit about that?
317
00:12:12.080 --> 00:12:14.340
Like, this is not permanent damage thing.
318
00:12:14.340 --> 00:12:14.700
Right.
319
00:12:14.700 --> 00:12:16.020
It was so terrifying.
320
00:12:16.080 --> 00:12:17.380
And then I was like, oh, no, no, no.
321
00:12:17.380 --> 00:12:18.060
It'll get better.
322
00:12:18.280 --> 00:12:18.720
Yeah.
323
00:12:19.600 --> 00:12:20.920
Which is amazing, right?
324
00:12:21.020 --> 00:12:23.240
We know now how plastic our brains are.
325
00:12:23.760 --> 00:12:24.880
All we have to do,
326
00:12:25.160 --> 00:12:25.900
all we have to do,
327
00:12:26.020 --> 00:12:27.980
that's a really silly thing to say.
328
00:12:29.240 --> 00:12:30.540
The only thing you have to do, darling,
329
00:12:30.660 --> 00:12:32.440
is take four seconds and it will be fixed.
330
00:12:32.560 --> 00:12:33.100
No, it will not.
331
00:12:33.200 --> 00:12:35.180
But what your body needs
332
00:12:35.180 --> 00:12:37.280
in order for your brain to reconnect
333
00:12:37.280 --> 00:12:40.100
and regrow and calm down in the amygdala
334
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is a creation of feelings of safety,
335
00:12:43.940 --> 00:12:46.640
which changing that outside environment
336
00:12:46.640 --> 00:12:49.760
in some cases is really necessary, right?
337
00:12:49.760 --> 00:12:52.220
Sometimes there are so many external factors
338
00:12:52.220 --> 00:12:54.040
that are actually dangerous.
339
00:12:54.080 --> 00:12:54.960
You are being bullied.
340
00:12:55.100 --> 00:12:56.460
Your boss is a narcissist.
341
00:12:56.500 --> 00:12:58.440
And we know in the medical profession,
342
00:12:58.460 --> 00:12:59.380
there's a lot of that,
343
00:12:59.680 --> 00:13:02.180
more so than in the general population, right?
344
00:13:02.580 --> 00:13:04.700
So yeah, there are these external factors
345
00:13:04.700 --> 00:13:06.080
that may need to be changed,
346
00:13:06.100 --> 00:13:11.040
but internally we also have to learn to find safety.
347
00:13:11.300 --> 00:13:13.100
One of the best ways to do this
348
00:13:13.100 --> 00:13:14.540
that is, listen everybody,
349
00:13:15.020 --> 00:13:16.680
not trying to sell you coaching right now.
350
00:13:16.720 --> 00:13:17.860
This is absolutely free.
351
00:13:18.200 --> 00:13:20.440
This is free all over the interwebs.
352
00:13:21.720 --> 00:13:24.380
Yoga Nidra, which is also known as a body scan,
353
00:13:24.520 --> 00:13:26.620
which is also known as non-sleep deep rest
354
00:13:26.620 --> 00:13:28.500
if you're an Andrew Huberman podcast listener.
355
00:13:29.040 --> 00:13:30.160
I love that by the way.
356
00:13:30.800 --> 00:13:31.780
It's so good.
357
00:13:32.180 --> 00:13:33.020
Anyway, sorry, continue.
358
00:13:33.440 --> 00:13:33.980
It's so good.
359
00:13:34.380 --> 00:13:36.460
Those three things are basically the same.
360
00:13:36.760 --> 00:13:40.000
And what they are doing is encouraging your body,
361
00:13:40.160 --> 00:13:41.160
encouraging your brain
362
00:13:41.160 --> 00:13:43.740
to increase its level of interoceptions.
363
00:13:44.140 --> 00:13:47.880
Interoception is our ability to sense our body's signals,
364
00:13:48.400 --> 00:13:51.680
pain, emotions, hunger, fatigue, thirst,
365
00:13:51.940 --> 00:13:53.060
peeing when you have to pee.
366
00:13:53.240 --> 00:13:56.300
That's our unofficial hashtag for my podcast, right?
367
00:13:56.680 --> 00:13:59.820
The basic systems of your body,
368
00:14:00.340 --> 00:14:02.880
interoception is your ability to connect with them
369
00:14:02.880 --> 00:14:04.200
and know what they're asking you for
370
00:14:04.200 --> 00:14:05.320
and notice what they're doing.
371
00:14:06.580 --> 00:14:09.980
Oftentimes, when we are people that tend to burn out,
372
00:14:09.980 --> 00:14:15.140
we are also people that tend to intuit other people's states
373
00:14:15.620 --> 00:14:19.820
on a regular basis without being asked to necessarily.
374
00:14:21.440 --> 00:14:23.060
But we're good at it by nature.
375
00:14:23.260 --> 00:14:24.840
So we do it all the time.
376
00:14:25.100 --> 00:14:27.780
But when you are constantly responsible in your own mind
377
00:14:27.780 --> 00:14:30.120
for intuiting other people's needs, wants,
378
00:14:30.460 --> 00:14:32.700
preferences, desires, which sometimes we're wrong,
379
00:14:32.720 --> 00:14:34.040
but that's a whole other subject,
380
00:14:34.260 --> 00:14:37.180
it's really hard for you to have enough time
381
00:14:37.180 --> 00:14:39.720
and space left over to intuit those same things
382
00:14:39.720 --> 00:14:40.440
for yourself.
383
00:14:41.000 --> 00:14:45.400
What we do in those states is really basically self-neglect.
384
00:14:45.860 --> 00:14:48.500
We leave ourselves behind so we can figure out
385
00:14:48.500 --> 00:14:50.960
that this patient is thirsty, this patient is in pain,
386
00:14:51.360 --> 00:14:55.740
my children need dinner, whatever the heck happens to be,
387
00:14:55.740 --> 00:14:56.100
anything.
388
00:14:56.860 --> 00:15:00.060
So when we are practicing something like a body scan
389
00:15:00.060 --> 00:15:01.860
or yoga nidra or non-sleep deep rest,
390
00:15:02.020 --> 00:15:05.440
you are laying down or sitting and it is saying,
391
00:15:06.000 --> 00:15:07.440
relax your jaw, relax your forehead,
392
00:15:07.440 --> 00:15:09.840
let your eyes sink, like release your shoulders.
393
00:15:10.320 --> 00:15:14.480
And as you feel literally your physical body shifting,
394
00:15:14.940 --> 00:15:18.000
you are increasing your ability to interocept.
395
00:15:18.380 --> 00:15:21.440
And the more you practice this, the better you get at it,
396
00:15:21.440 --> 00:15:23.580
which means you will start to feel more things
397
00:15:23.580 --> 00:15:26.800
besides your jaw relaxing and your tongue releasing
398
00:15:26.800 --> 00:15:29.000
and your shoulders dropping and your chest opening.
399
00:15:29.960 --> 00:15:30.700
You'll start to say,
400
00:15:30.720 --> 00:15:33.060
oh, I'm feeling a little uncomfortable in this scenario
401
00:15:33.060 --> 00:15:35.060
and I didn't realize it before.
402
00:15:35.100 --> 00:15:36.880
There's a weird dynamic in this relationship
403
00:15:36.880 --> 00:15:40.480
that I don't like, but you can't feel that stuff
404
00:15:40.480 --> 00:15:42.940
if you can't feel your body,
405
00:15:42.960 --> 00:15:44.480
if you can't feel anything else.
406
00:15:44.540 --> 00:15:46.560
It comes in layers, it comes in knowledge
407
00:15:46.560 --> 00:15:49.780
and the base knowledge is knowing when you have to pee.
408
00:15:50.220 --> 00:15:51.960
Nurses and teachers always laugh at this
409
00:15:51.960 --> 00:15:53.260
because we don't have time to pee.
410
00:15:53.580 --> 00:15:54.720
I was gonna say, we have to say that
411
00:15:54.720 --> 00:15:55.700
a couple more times.
412
00:15:56.020 --> 00:15:58.320
Yeah, you don't have time, yes you do.
413
00:15:58.540 --> 00:16:01.180
You have to make time for it.
414
00:16:01.380 --> 00:16:03.320
And I think that the other thing about that
415
00:16:03.320 --> 00:16:06.780
is it's really normalized in the medical profession
416
00:16:06.780 --> 00:16:09.240
and the kind of culture at large,
417
00:16:09.380 --> 00:16:12.300
especially because there are a lot of cis female patients,
418
00:16:12.800 --> 00:16:16.140
sorry, cis female providers and nurses.
419
00:16:16.540 --> 00:16:19.960
So in terms of if you were a socialized female growing up,
420
00:16:20.880 --> 00:16:22.140
it's like, yeah, that's a great thing.
421
00:16:22.200 --> 00:16:23.520
You put everybody else before you
422
00:16:23.520 --> 00:16:25.340
and if you take care of yourself, it's selfish.
423
00:16:25.620 --> 00:16:27.620
And a lot of people don't even know,
424
00:16:27.640 --> 00:16:29.640
does not compute, what does that mean
425
00:16:29.640 --> 00:16:31.100
putting myself first, right?
426
00:16:32.260 --> 00:16:36.100
And yeah, it's just so crucial.
427
00:16:36.100 --> 00:16:37.540
And it's hard for people.
428
00:16:37.940 --> 00:16:39.760
I think we make it bigger than it needs to be.
429
00:16:39.820 --> 00:16:42.480
I'm not asking you to like supply yourself
430
00:16:42.480 --> 00:16:44.400
with diamonds and bubble baths on Fridays.
431
00:16:44.760 --> 00:16:47.000
I'm just asking you to go to the bathroom
432
00:16:47.000 --> 00:16:48.820
when you have to go to the bathroom.
433
00:16:49.500 --> 00:16:52.320
Like I was an acupuncturist.
434
00:16:52.440 --> 00:16:54.860
I had my own practices for 15 years
435
00:16:54.860 --> 00:16:57.800
in Warsaw and in Prague and in New York City.
436
00:16:58.120 --> 00:17:00.320
So I traveled, I was an international acupuncturist.
437
00:17:00.320 --> 00:17:01.940
I was doing all these patients all the time.
438
00:17:02.200 --> 00:17:03.920
I lived inpatient life.
439
00:17:04.760 --> 00:17:07.619
And I would literally go finish an appointment
440
00:17:07.619 --> 00:17:10.380
when I already knew I had to go to the bathroom
441
00:17:10.380 --> 00:17:13.119
instead of literally taking the 60 seconds.
442
00:17:13.180 --> 00:17:15.020
I'm like the fastest peer on the planet.
443
00:17:15.020 --> 00:17:18.599
It's gonna take me 60 seconds to go to the bathroom
444
00:17:18.599 --> 00:17:22.560
and wash my hands thoroughly and get back to my patient
445
00:17:22.560 --> 00:17:25.400
before which I'm gonna wash my hands again anyway
446
00:17:25.400 --> 00:17:26.800
because you wash your hands
447
00:17:26.800 --> 00:17:27.900
when you walk into a patient room
448
00:17:27.900 --> 00:17:29.720
because that's what you do, right?
449
00:17:30.680 --> 00:17:33.800
Like 60 seconds, I wouldn't give myself.
450
00:17:34.500 --> 00:17:36.320
That's like such a great example of like,
451
00:17:36.460 --> 00:17:38.440
it's like a real concrete like, yep,
452
00:17:39.440 --> 00:17:42.440
60 seconds to attend to myself and my needs
453
00:17:43.120 --> 00:17:44.620
before attending to another person
454
00:17:44.620 --> 00:17:46.540
because I mean, I think there's a lot of talk
455
00:17:46.540 --> 00:17:48.080
about filling up your cup first
456
00:17:48.080 --> 00:17:49.660
so that you can serve from a full cup
457
00:17:49.660 --> 00:17:50.600
instead of an empty cup.
458
00:17:51.020 --> 00:17:52.600
But it's like those, like you're saying like,
459
00:17:52.760 --> 00:17:55.020
these are the really small moments of like building on
460
00:17:55.020 --> 00:17:56.220
and building on and building on
461
00:17:56.220 --> 00:17:58.160
of like, what are the habits of self-neglect
462
00:17:58.160 --> 00:17:58.980
that we have?
463
00:18:00.300 --> 00:18:02.500
And amending those because it's like not even,
464
00:18:02.500 --> 00:18:03.840
again, like not being selfish,
465
00:18:03.900 --> 00:18:06.880
we're just talking about like neglect versus care.
466
00:18:07.300 --> 00:18:09.560
And like you can't function, like if you can't do it,
467
00:18:09.600 --> 00:18:11.540
like one of the things that I did for myself
468
00:18:11.540 --> 00:18:12.600
when I got burnt,
469
00:18:12.700 --> 00:18:14.600
before I got burnt out the first time
470
00:18:14.600 --> 00:18:16.380
and in terms of speaking up with boundaries
471
00:18:16.380 --> 00:18:17.440
and having more confidence,
472
00:18:17.540 --> 00:18:18.880
especially as a newer nurse practitioner
473
00:18:18.880 --> 00:18:21.340
because a lot of the listeners of the podcast
474
00:18:21.340 --> 00:18:22.900
are new nurse practitioners is like,
475
00:18:23.080 --> 00:18:25.920
if I can't do it for myself, I'll do it for my patient.
476
00:18:26.140 --> 00:18:28.220
And that was like my proxy way of like,
477
00:18:28.220 --> 00:18:31.360
okay, I don't have the self-esteem and confidence
478
00:18:31.360 --> 00:18:33.260
to make this decision for my own benefit.
479
00:18:33.720 --> 00:18:35.840
However, I care really deeply about my work
480
00:18:35.840 --> 00:18:37.080
and my patients that I take care of.
481
00:18:37.180 --> 00:18:39.100
So like, I'll do that first, right?
482
00:18:39.100 --> 00:18:41.900
And I think that like, that can be a crush for people
483
00:18:42.440 --> 00:18:44.900
is again, like if that feels too foreign for you,
484
00:18:44.920 --> 00:18:46.840
this is gonna help prevent you number one
485
00:18:46.840 --> 00:18:47.660
from burning out.
486
00:18:48.100 --> 00:18:49.760
And also number two tied with that,
487
00:18:49.760 --> 00:18:51.220
if you're really dedicated to your work
488
00:18:51.220 --> 00:18:53.180
and your patients and you can only think about that,
489
00:18:53.340 --> 00:18:55.020
you won't be able to serve them long-term.
490
00:18:55.260 --> 00:18:56.960
And that's one of the first realizations I had
491
00:18:56.960 --> 00:18:57.920
to the first time I burnt out,
492
00:18:57.920 --> 00:19:00.480
I was like, wow, I might lead this profession
493
00:19:00.480 --> 00:19:02.220
if I don't fix something.
494
00:19:02.860 --> 00:19:05.660
Yeah, and I think it's really okay to use that.
495
00:19:06.020 --> 00:19:07.080
Yeah, yeah.
496
00:19:07.340 --> 00:19:10.300
It's okay to, there was an Instagram post going around.
497
00:19:10.440 --> 00:19:11.800
I think this is the third or fourth time
498
00:19:11.800 --> 00:19:13.680
I've seen it go around in the past couple of years.
499
00:19:14.120 --> 00:19:15.740
And somebody said like to a mother,
500
00:19:15.840 --> 00:19:17.560
don't you feel bad for taking time away
501
00:19:17.560 --> 00:19:19.060
from your kids to exercise?
502
00:19:19.100 --> 00:19:21.960
And she said, no, I feel bad when I'm an absolute,
503
00:19:23.680 --> 00:19:25.280
insert word here to my children
504
00:19:25.280 --> 00:19:27.040
because I haven't taken time for myself.
505
00:19:27.040 --> 00:19:27.840
Yeah.
506
00:19:28.040 --> 00:19:29.560
No, that's what I feel bad about.
507
00:19:29.740 --> 00:19:31.360
I feel bad about not showing up
508
00:19:31.360 --> 00:19:34.940
as who I know I can show up as for them
509
00:19:34.940 --> 00:19:38.040
because I didn't take this half hour
510
00:19:38.040 --> 00:19:39.340
to do this other thing.
511
00:19:39.340 --> 00:19:40.740
And I know there's some of you out there
512
00:19:40.740 --> 00:19:42.880
that literally do not have a half hour right now.
513
00:19:43.200 --> 00:19:45.760
So I'm asking you to start with peeing.
514
00:19:46.380 --> 00:19:46.960
I love that.
515
00:19:47.100 --> 00:19:48.840
I love that that was what we're coming down to.
516
00:19:50.020 --> 00:19:54.520
We joke about this on the podcast all the time.
517
00:19:54.600 --> 00:19:55.000
Yeah.
518
00:19:55.280 --> 00:19:56.460
Well, it's like especially appropriate
519
00:19:56.460 --> 00:19:57.600
for nurse practitioners too.
520
00:19:57.800 --> 00:19:59.160
Nurse practitioners, teachers.
521
00:19:59.420 --> 00:20:01.600
I can't even tell you how many corporate workers
522
00:20:01.600 --> 00:20:03.800
have said, well, no, like I will hold it
523
00:20:03.800 --> 00:20:04.960
until I finish that last email.
524
00:20:05.220 --> 00:20:06.120
It's an email.
525
00:20:06.200 --> 00:20:07.340
It will wait for you.
526
00:20:07.440 --> 00:20:08.060
It'll be there.
527
00:20:08.180 --> 00:20:09.720
It's not going anywhere.
528
00:20:10.220 --> 00:20:12.220
And even if you click send by accident,
529
00:20:12.240 --> 00:20:13.800
you just send another one.
530
00:20:14.100 --> 00:20:17.580
It's not like nothing is going on here.
531
00:20:18.120 --> 00:20:19.300
Just go to the bathroom.
532
00:20:19.420 --> 00:20:22.020
And in my business, we call this foundational self care.
533
00:20:22.620 --> 00:20:24.240
I think a lot of the things
534
00:20:24.240 --> 00:20:27.680
that we are taught on social media about,
535
00:20:28.000 --> 00:20:29.360
self care is not the cure for burnout.
536
00:20:29.820 --> 00:20:31.780
And you only have to do self care for burnout.
537
00:20:31.960 --> 00:20:33.580
Like there's all these things floating around.
538
00:20:34.560 --> 00:20:35.240
And a lot of those feel-
539
00:20:35.240 --> 00:20:36.220
Self care is bubble baths.
540
00:20:36.500 --> 00:20:37.340
Yeah, yeah.
541
00:20:37.500 --> 00:20:38.880
And like set boundaries.
542
00:20:39.340 --> 00:20:41.580
You can't set boundaries if you don't pee
543
00:20:41.580 --> 00:20:42.440
when you have to pee.
544
00:20:43.380 --> 00:20:45.240
Like before we get to the place
545
00:20:45.240 --> 00:20:48.320
where you're able to care for yourself on a larger scale,
546
00:20:48.600 --> 00:20:51.100
you have to be able to do the bare minimum.
547
00:20:51.100 --> 00:20:54.700
So if we're not starting at those silly places,
548
00:20:55.260 --> 00:20:57.760
we're never gonna get to the further places
549
00:20:57.760 --> 00:21:02.000
because you can't set a boundary with,
550
00:21:02.580 --> 00:21:03.580
you know the difference.
551
00:21:03.740 --> 00:21:04.420
Do you have a dog?
552
00:21:05.140 --> 00:21:05.580
Yeah.
553
00:21:06.120 --> 00:21:07.940
So you know when you're walking with your dog
554
00:21:07.940 --> 00:21:10.160
and they're trying to pull you to go to the left
555
00:21:10.160 --> 00:21:12.220
and you don't really wanna go to the left,
556
00:21:12.260 --> 00:21:12.980
but like you could,
557
00:21:13.060 --> 00:21:14.880
but you're trying to get them to go to the right
558
00:21:14.880 --> 00:21:16.280
and they're pulling to the left.
559
00:21:16.760 --> 00:21:18.180
And you have like wiggle room
560
00:21:18.180 --> 00:21:20.000
about what you're gonna do with them.
561
00:21:20.940 --> 00:21:21.740
They know.
562
00:21:23.820 --> 00:21:23.940
Right?
563
00:21:24.300 --> 00:21:25.380
Like if they can feel it,
564
00:21:25.380 --> 00:21:27.860
they'll just keep pulling to the left until you give in.
565
00:21:28.380 --> 00:21:29.940
But when you don't have wiggle room
566
00:21:29.940 --> 00:21:31.420
and you're like, no, we are on a schedule.
567
00:21:31.480 --> 00:21:32.540
We are going to the right.
568
00:21:32.600 --> 00:21:34.280
Like that is not even an option.
569
00:21:34.540 --> 00:21:37.080
They might pull a little bit, but they give up faster.
570
00:21:38.380 --> 00:21:41.480
Same thing with my child who's very spirited.
571
00:21:42.120 --> 00:21:42.260
Right?
572
00:21:42.420 --> 00:21:43.580
And I don't have children,
573
00:21:43.580 --> 00:21:45.480
so I don't use that example, but right.
574
00:21:45.540 --> 00:21:48.380
Children, patients, other doctors, other nurses,
575
00:21:48.380 --> 00:21:50.480
it's like everybody we interact with
576
00:21:50.480 --> 00:21:53.480
can feel when we have that space.
577
00:21:53.860 --> 00:21:56.140
So if you try to set boundaries
578
00:21:56.140 --> 00:22:00.220
before you have enough solidness within you
579
00:22:00.220 --> 00:22:02.160
to be able to set that boundary
580
00:22:02.160 --> 00:22:04.660
and understand on a deep level
581
00:22:04.660 --> 00:22:08.260
that you're really not gonna move it out of the way,
582
00:22:09.140 --> 00:22:10.400
nobody's gonna listen to you.
583
00:22:10.960 --> 00:22:11.160
Yeah.
584
00:22:11.360 --> 00:22:12.840
And I think a lot of people talk about,
585
00:22:13.260 --> 00:22:15.020
I hear it over and over and over again,
586
00:22:15.300 --> 00:22:17.280
new nurse practitioners, because it's terrifying.
587
00:22:17.280 --> 00:22:20.020
It's really scary to be brand new
588
00:22:20.020 --> 00:22:21.700
and have imposter syndrome and be like,
589
00:22:21.800 --> 00:22:23.480
oh, wow, people wanna ask me things,
590
00:22:23.980 --> 00:22:26.340
but and then they say they don't wanna rock the boat.
591
00:22:26.520 --> 00:22:28.120
I hear that all the time.
592
00:22:28.780 --> 00:22:30.300
And yet it's rocking the boat
593
00:22:30.300 --> 00:22:31.940
is just part of being a nurse practitioner,
594
00:22:32.100 --> 00:22:34.040
being part of a clinician, being an adult.
595
00:22:34.580 --> 00:22:34.940
Yeah.
596
00:22:35.760 --> 00:22:38.040
That's called people pleasing is not rocking the boat
597
00:22:38.040 --> 00:22:40.580
and people pleasing is self abandonment and self neglect.
598
00:22:40.940 --> 00:22:43.600
And it sounds nice and it sounds like you're
599
00:22:43.600 --> 00:22:46.720
keeping peace, but it's ultimately neglecting ourselves
600
00:22:46.720 --> 00:22:49.000
and it's also really hard and scary
601
00:22:49.000 --> 00:22:49.960
to break out of that pattern,
602
00:22:50.060 --> 00:22:51.440
like speaking from personal experience.
603
00:22:52.220 --> 00:22:55.240
So what you're like, I just can't overemphasize enough
604
00:22:55.240 --> 00:22:57.260
what you're saying about that foundational piece
605
00:22:57.260 --> 00:22:58.600
is like, that's the entry point.
606
00:22:58.860 --> 00:22:59.120
Yeah.
607
00:22:59.120 --> 00:23:02.120
And so whatever things you can grab onto
608
00:23:02.120 --> 00:23:03.120
to get to that entry point,
609
00:23:03.120 --> 00:23:04.000
if you were in that pattern
610
00:23:04.000 --> 00:23:05.040
of not wanting to rock the boat
611
00:23:05.040 --> 00:23:07.180
or people pleasing or anything like that,
612
00:23:08.000 --> 00:23:10.020
yeah, it's like, it's just a slow and steady process
613
00:23:10.020 --> 00:23:11.780
because especially if you're brand new
614
00:23:11.780 --> 00:23:13.780
or maybe if you're heading towards burnout,
615
00:23:14.140 --> 00:23:16.540
like, yeah, you need to start now
616
00:23:17.060 --> 00:23:20.120
I kind of maybe might segue into our next topic.
617
00:23:20.420 --> 00:23:21.560
One of the topics we talked about,
618
00:23:21.800 --> 00:23:24.120
which is burnout prevention.
619
00:23:27.380 --> 00:23:29.980
There's a lot of talk about,
620
00:23:30.700 --> 00:23:32.040
so there's a lot of talk about,
621
00:23:32.340 --> 00:23:33.660
especially in the healthcare world,
622
00:23:33.920 --> 00:23:35.920
a lot of, and I've seen a trend of this
623
00:23:35.920 --> 00:23:37.320
over the last year or so
624
00:23:37.320 --> 00:23:39.720
that a lot of continuing education programming
625
00:23:39.720 --> 00:23:41.540
or conferences are talking about wellness
626
00:23:42.000 --> 00:23:42.900
because they can see,
627
00:23:42.900 --> 00:23:44.920
they can see that the last three years or so
628
00:23:44.920 --> 00:23:45.880
have been really rough.
629
00:23:45.880 --> 00:23:48.400
I mean, it's been really rough, even for me.
630
00:23:48.480 --> 00:23:50.840
I haven't been in as much clinical practice
631
00:23:50.840 --> 00:23:53.260
as other clinicians who listen to this podcast,
632
00:23:53.380 --> 00:23:57.080
but I don't know, I think there's a lot of talk.
633
00:23:57.240 --> 00:23:59.180
The fallacies of both self care
634
00:23:59.180 --> 00:24:02.740
and about burnout prevention now make my blood boil
635
00:24:02.740 --> 00:24:04.780
because I understand so much more.
636
00:24:05.260 --> 00:24:07.540
But can you talk to us a little bit about,
637
00:24:08.560 --> 00:24:09.740
God, there's so many things I wanna talk about,
638
00:24:09.880 --> 00:24:12.400
but just leading with, can we prevent burnout?
639
00:24:12.960 --> 00:24:14.140
Is burnout prevention real?
640
00:24:14.140 --> 00:24:16.560
What are the things we can do about it versus,
641
00:24:16.680 --> 00:24:18.080
what are the stages of burnout?
642
00:24:18.680 --> 00:24:21.180
I'm just gonna like, can we download as much as we can?
643
00:24:21.340 --> 00:24:23.500
Yeah, we can, and this is a topic
644
00:24:23.500 --> 00:24:26.020
that I am extremely passionate about, as you know.
645
00:24:26.640 --> 00:24:30.520
I don't believe in burnout prevention as a general rule.
646
00:24:31.060 --> 00:24:33.600
When you look at statistics around cancer,
647
00:24:34.260 --> 00:24:37.140
for instance, it is something like 37,
648
00:24:37.160 --> 00:24:39.220
I think it's 37% of cancers
649
00:24:39.220 --> 00:24:41.960
could have been avoided by proper lifestyle,
650
00:24:41.960 --> 00:24:45.000
by different dietary changes, exercise changes, et cetera.
651
00:24:45.400 --> 00:24:49.460
That means 66% of cases, 33 to 66,
652
00:24:49.520 --> 00:24:51.140
I don't remember exactly what the numbers are.
653
00:24:51.860 --> 00:24:54.460
Whatever it is, ignore my math at the most.
654
00:24:54.460 --> 00:24:55.340
Ignore my math.
655
00:24:55.740 --> 00:24:56.020
That's okay.
656
00:24:56.280 --> 00:24:59.000
But I think it was 33 and 67, whatever.
657
00:24:59.140 --> 00:25:01.940
But it's something around 30 and 60, 40 and 60.
658
00:25:02.440 --> 00:25:04.360
That means that all of those other people,
659
00:25:04.700 --> 00:25:06.080
regardless of lifestyle changes,
660
00:25:06.220 --> 00:25:07.280
would have gotten cancer anyway.
661
00:25:08.320 --> 00:25:10.440
So I think sometimes we like to believe
662
00:25:10.440 --> 00:25:12.400
in this magical world where if we take care
663
00:25:12.400 --> 00:25:16.200
of ourselves perfectly, nothing will ever happen.
664
00:25:16.740 --> 00:25:18.260
And that's just not true.
665
00:25:18.580 --> 00:25:20.940
So do I think that there are some cases of burnout
666
00:25:20.940 --> 00:25:22.460
that could have been prevented?
667
00:25:22.820 --> 00:25:23.340
Maybe.
668
00:25:23.760 --> 00:25:26.560
But I know after spending seven years
669
00:25:26.560 --> 00:25:27.700
talking to all of you,
670
00:25:28.880 --> 00:25:31.820
that you didn't notice those things were happening.
671
00:25:32.380 --> 00:25:34.440
And you didn't start paying attention to them
672
00:25:34.440 --> 00:25:37.520
until after they happened, which is totally fine.
673
00:25:37.580 --> 00:25:39.500
I think that there's a lot of shame
674
00:25:39.500 --> 00:25:42.100
being sold to people by saying,
675
00:25:42.600 --> 00:25:44.660
hey, you just get on burnout prevention
676
00:25:44.660 --> 00:25:46.280
and then it won't happen to you.
677
00:25:46.280 --> 00:25:48.660
Why would you start burnout prevention
678
00:25:48.660 --> 00:25:51.560
if you weren't burning out?
679
00:25:51.900 --> 00:25:53.360
And if you're burning out,
680
00:25:53.460 --> 00:25:55.460
the stuff that you're using for burnout prevention
681
00:25:55.460 --> 00:25:57.160
is not going to work.
682
00:25:57.560 --> 00:25:58.600
Because if you're burning out,
683
00:25:58.720 --> 00:26:00.340
your brain is in a different state and you have,
684
00:26:00.340 --> 00:26:03.240
oh, I'm getting real riled up right now, right?
685
00:26:03.320 --> 00:26:04.720
Your brain is in a different state
686
00:26:04.720 --> 00:26:06.060
and you have different needs.
687
00:26:06.140 --> 00:26:08.800
The burnout prevention techniques won't work for you,
688
00:26:08.800 --> 00:26:11.900
in which case then you are doubting yourself,
689
00:26:12.000 --> 00:26:14.080
you're getting self-judgmental, you're feeling guilty,
690
00:26:14.120 --> 00:26:15.860
you're saying, I'm doing all the right things,
691
00:26:15.860 --> 00:26:17.780
but I still feel like crap, why?
692
00:26:18.060 --> 00:26:19.420
This is why.
693
00:26:19.760 --> 00:26:22.140
Because you probably didn't notice fast enough
694
00:26:23.380 --> 00:26:25.500
because your external environment
695
00:26:25.500 --> 00:26:26.880
is adding to your burnout
696
00:26:26.880 --> 00:26:29.740
and your internal environment is adding to your burnout.
697
00:26:30.240 --> 00:26:32.620
And the stuff in your internal environment
698
00:26:32.620 --> 00:26:33.880
that's adding to your burnout
699
00:26:33.880 --> 00:26:36.600
is typically stuff that makes you really bad
700
00:26:36.600 --> 00:26:39.340
at things like interoception that we mentioned before.
701
00:26:40.220 --> 00:26:42.740
So if you have a naturally diminished interoception
702
00:26:42.740 --> 00:26:44.100
because of earlier trauma
703
00:26:44.100 --> 00:26:46.720
or because of some sort of learned behavior
704
00:26:46.720 --> 00:26:49.300
in your household or because of a cultural factor,
705
00:26:49.860 --> 00:26:51.860
you're gonna be more likely to burn out
706
00:26:51.860 --> 00:26:52.980
and you're not gonna notice
707
00:26:52.980 --> 00:26:54.460
until it whacks you over the head
708
00:26:54.460 --> 00:26:55.780
and that's not your fault.
709
00:26:56.560 --> 00:26:59.040
And it's okay because you can still recover.
710
00:27:00.320 --> 00:27:00.780
Yeah, definitely.
711
00:27:01.060 --> 00:27:02.740
But yeah, I love that you touched on
712
00:27:02.740 --> 00:27:04.540
this self-blame and shame piece.
713
00:27:04.540 --> 00:27:05.640
Oh, yeah.
714
00:27:06.260 --> 00:27:09.220
Yeah, because I think that I definitely had that,
715
00:27:09.820 --> 00:27:11.820
probably both times, but especially this time
716
00:27:11.820 --> 00:27:14.080
because it caught me by surprise
717
00:27:14.080 --> 00:27:16.420
because it's a job that I love, right?
718
00:27:16.520 --> 00:27:18.520
But then, yeah, so like,
719
00:27:19.060 --> 00:27:20.400
I think one of the things that really,
720
00:27:20.560 --> 00:27:22.400
one of the episodes of yours that I really loved
721
00:27:22.400 --> 00:27:23.520
was an interview with somebody
722
00:27:23.520 --> 00:27:24.620
and I can't remember her name,
723
00:27:24.620 --> 00:27:26.680
but we were talking about the stages of burnout.
724
00:27:27.480 --> 00:27:28.660
And I listened to that episode.
725
00:27:29.180 --> 00:27:30.940
Yeah, and I listened to that episode
726
00:27:30.940 --> 00:27:33.300
and it was basically like stage one
727
00:27:33.300 --> 00:27:36.060
because I'm like, basically when I got burnt out,
728
00:27:36.060 --> 00:27:38.620
when I realized I was burnt out, I was in denial.
729
00:27:38.820 --> 00:27:40.140
And then I got to that place
730
00:27:40.140 --> 00:27:41.860
and then it hit me so hard that I was like,
731
00:27:41.880 --> 00:27:42.900
how did I get here?
732
00:27:43.100 --> 00:27:44.140
How do I get out of it?
733
00:27:44.320 --> 00:27:45.740
This is wild, right?
734
00:27:45.740 --> 00:27:48.020
And I listened to that episode among,
735
00:27:48.240 --> 00:27:50.040
I've listened to like almost your entire podcast,
736
00:27:50.080 --> 00:27:52.660
probably, but this episode in particular
737
00:27:52.660 --> 00:27:53.620
was talking about the stages.
738
00:27:53.700 --> 00:27:58.200
And she said, basically from her perspective
739
00:27:58.200 --> 00:28:00.260
or maybe the data, it's showing that like,
740
00:28:00.420 --> 00:28:02.300
people just, you just don't know you're in burnout
741
00:28:02.300 --> 00:28:03.200
until you get there.
742
00:28:03.440 --> 00:28:06.460
And so the needs that people have are just so different.
743
00:28:06.680 --> 00:28:08.920
And then I think it's just added on to
744
00:28:08.920 --> 00:28:10.860
when there's all of these continuing education
745
00:28:10.860 --> 00:28:13.340
or workplace talks about, you know,
746
00:28:13.400 --> 00:28:15.220
all these things about how to keep yourself well,
747
00:28:15.220 --> 00:28:17.620
but it's like, okay, even if I did those things
748
00:28:17.620 --> 00:28:20.620
and I'm burnt out, like I need different care now.
749
00:28:20.780 --> 00:28:21.300
So I think-
750
00:28:21.300 --> 00:28:23.840
I need different care now is, oh, sorry, is critical.
751
00:28:24.660 --> 00:28:28.620
And I think it's important to grant yourself
752
00:28:28.620 --> 00:28:32.920
some grace around the fact that you didn't recognize it.
753
00:28:33.420 --> 00:28:38.280
If you are taught, especially as someone who was raised
754
00:28:39.040 --> 00:28:42.420
as a cisgendered female throughout their life, right?
755
00:28:42.420 --> 00:28:44.300
If you're raised this way,
756
00:28:45.000 --> 00:28:46.160
you're raised to pay attention
757
00:28:46.160 --> 00:28:47.660
to other people's needs first.
758
00:28:48.380 --> 00:28:51.180
Is it shocking that you don't know
759
00:28:51.180 --> 00:28:52.400
how to tune into yourself?
760
00:28:52.780 --> 00:28:53.380
Yeah.
761
00:28:53.640 --> 00:28:54.480
It's not shocking.
762
00:28:55.040 --> 00:28:56.140
It's not surprising.
763
00:28:56.920 --> 00:28:58.820
How are we supposed to notice things
764
00:28:58.820 --> 00:29:00.120
that we were taught to ignore?
765
00:29:00.400 --> 00:29:04.220
First of all, second of all, things happen slowly
766
00:29:04.220 --> 00:29:07.000
and we make adaptations as we go along.
767
00:29:07.980 --> 00:29:11.120
One of the things that Kristen Holmes mentioned
768
00:29:11.120 --> 00:29:15.620
in our episode was that cognitive decline,
769
00:29:15.820 --> 00:29:17.780
emotional decline and physical decline
770
00:29:17.780 --> 00:29:20.980
usually happen at such a slow rate
771
00:29:21.560 --> 00:29:22.960
that we don't really notice.
772
00:29:23.000 --> 00:29:25.600
So what happens is like your hip starts hurting
773
00:29:25.600 --> 00:29:28.360
a little bit and it's been hurting for a few months
774
00:29:28.360 --> 00:29:29.700
but you don't have time to deal with it.
775
00:29:29.700 --> 00:29:31.000
So you get softer shoes.
776
00:29:31.020 --> 00:29:32.700
You start wearing those like nurse crocs
777
00:29:32.700 --> 00:29:34.760
or like the, you know, you start wearing
778
00:29:34.760 --> 00:29:35.840
like a different set of shoes
779
00:29:35.840 --> 00:29:37.460
and it feels better for a little bit.
780
00:29:37.860 --> 00:29:40.200
Now you've actually started limping a little
781
00:29:40.200 --> 00:29:41.340
but you don't really know
782
00:29:41.340 --> 00:29:42.940
and you're hiking up your other hip
783
00:29:42.940 --> 00:29:45.460
to protect yourself, but you don't really notice.
784
00:29:45.520 --> 00:29:46.580
And then six months later,
785
00:29:46.600 --> 00:29:47.980
now both of your hips are hurting
786
00:29:47.980 --> 00:29:49.180
and you're like, I totally forgot
787
00:29:49.180 --> 00:29:49.940
that my hip was hurting.
788
00:29:50.240 --> 00:29:51.600
Why are both of my hips hurting?
789
00:29:52.520 --> 00:29:54.360
We've all gone through this.
790
00:29:55.640 --> 00:29:57.680
Emotionally, physically, mentally, et cetera.
791
00:29:58.080 --> 00:29:59.620
It happens really slowly.
792
00:29:59.760 --> 00:30:00.980
It builds up over time.
793
00:30:01.280 --> 00:30:02.540
And by the time we get there,
794
00:30:02.560 --> 00:30:04.940
we've made so many adaptations
795
00:30:04.940 --> 00:30:07.340
for all the things that are bothering us
796
00:30:07.340 --> 00:30:10.140
to be able to manage them, to be able to cope
797
00:30:10.140 --> 00:30:13.440
that we were coping until we weren't.
798
00:30:13.560 --> 00:30:15.160
So you also don't notice it
799
00:30:15.160 --> 00:30:17.720
because it's a very slow decline.
800
00:30:18.000 --> 00:30:19.720
Yeah, definitely.
801
00:30:20.000 --> 00:30:22.040
And you become accustomed to whatever it is
802
00:30:22.040 --> 00:30:23.440
you're feeling now, the headaches,
803
00:30:23.920 --> 00:30:25.620
the fatigue, the brain fog,
804
00:30:25.840 --> 00:30:29.380
you become accustomed to it because you're used to it.
805
00:30:29.440 --> 00:30:30.460
So your brain is foggy.
806
00:30:30.520 --> 00:30:32.120
You can't remember those six letter codes.
807
00:30:32.360 --> 00:30:34.460
So you get accustomed to doing only two numbers
808
00:30:34.460 --> 00:30:35.080
at a time.
809
00:30:35.080 --> 00:30:36.500
And you're not thinking about the fact
810
00:30:36.500 --> 00:30:38.020
that your brain is no longer capable
811
00:30:38.020 --> 00:30:39.620
of doing six numbers at a time.
812
00:30:40.320 --> 00:30:42.060
You're just not thinking about it.
813
00:30:42.440 --> 00:30:43.280
Because why would you?
814
00:30:43.280 --> 00:30:44.740
You figured out a workaround.
815
00:30:46.060 --> 00:30:48.080
And nurses know all the workarounds.
816
00:30:50.060 --> 00:30:53.140
And a lot of people, I went through this
817
00:30:53.140 --> 00:30:55.060
and I think a lot of people that listen to the podcast
818
00:30:55.480 --> 00:30:56.620
are in this situation,
819
00:30:56.660 --> 00:30:59.060
but when they work at a federally qualified health center
820
00:31:00.000 --> 00:31:02.720
with grant funded, no insurance, things like that,
821
00:31:02.760 --> 00:31:04.460
and then rural health settings as well,
822
00:31:04.600 --> 00:31:06.820
like you kind of have to make do with what you have
823
00:31:07.460 --> 00:31:08.420
and do your best.
824
00:31:08.800 --> 00:31:11.020
And that in addition to being a new grad,
825
00:31:11.180 --> 00:31:12.740
it's just a lot.
826
00:31:12.740 --> 00:31:14.740
It's a lot of things to take on.
827
00:31:14.880 --> 00:31:15.840
And so it's like,
828
00:31:15.840 --> 00:31:17.520
if you feel like you're drinking from a fire hose,
829
00:31:17.600 --> 00:31:18.300
you feel like you're drowning.
830
00:31:18.440 --> 00:31:19.860
Like a lot of people say when they're new grads
831
00:31:19.860 --> 00:31:21.000
that they feel like they're drowning.
832
00:31:21.420 --> 00:31:23.400
And first of all, I just want to normalize
833
00:31:23.400 --> 00:31:25.160
that you're not alone if you feel that way,
834
00:31:25.160 --> 00:31:28.200
but then also how could you pay attention to other things
835
00:31:28.200 --> 00:31:31.320
when you're just trying to keep your head afloat?
836
00:31:31.400 --> 00:31:33.280
Exactly, so no blame.
837
00:31:34.060 --> 00:31:35.780
Yeah, and I think that's one of the things,
838
00:31:36.160 --> 00:31:38.140
the reason I'm so passionate about this
839
00:31:38.140 --> 00:31:38.880
for so many reasons,
840
00:31:38.920 --> 00:31:40.960
but I think one of the tragedies that I've seen
841
00:31:41.620 --> 00:31:43.840
for this profession of nurse practitioners
842
00:31:43.840 --> 00:31:47.120
is that so many people by the time they,
843
00:31:47.160 --> 00:31:48.880
it takes about three years to be competent,
844
00:31:48.880 --> 00:31:51.060
to feel competent, like, wow, I actually got this.
845
00:31:51.120 --> 00:31:52.100
It's a gradual process.
846
00:31:52.120 --> 00:31:54.440
You get milestones, but then at that three year mark,
847
00:31:54.480 --> 00:31:55.460
so many people are like,
848
00:31:55.500 --> 00:31:57.200
okay, three years is really like a sweet spot
849
00:31:57.200 --> 00:31:58.740
of like, I don't know what I'm doing,
850
00:31:58.920 --> 00:32:00.260
and you can be proud of it.
851
00:32:00.420 --> 00:32:04.040
And yet so many people make it there
852
00:32:04.040 --> 00:32:05.760
and are burnt out, right?
853
00:32:05.760 --> 00:32:07.220
And then they think about leaving the profession
854
00:32:07.220 --> 00:32:09.700
after three years and they just reached competence.
855
00:32:10.020 --> 00:32:11.800
And so that's one of my huge motivating factors
856
00:32:11.800 --> 00:32:13.240
for this whole company.
857
00:32:13.860 --> 00:32:16.260
And so it's just, oh gosh, it's just,
858
00:32:16.260 --> 00:32:17.900
it's just really, it's so hard.
859
00:32:17.900 --> 00:32:19.680
So I just really appreciate you coming on.
860
00:32:19.720 --> 00:32:21.440
I'm beginning emotional thinking about it, but yeah.
861
00:32:21.660 --> 00:32:23.660
I think the thing that's important to know about that
862
00:32:23.660 --> 00:32:25.640
is like you said, you burnt out
863
00:32:25.640 --> 00:32:27.120
and then you left that environment
864
00:32:27.120 --> 00:32:28.800
and then you ended up burning out again,
865
00:32:29.480 --> 00:32:31.460
different set of circumstances, but same result.
866
00:32:31.900 --> 00:32:34.240
And I think the thing that's important for people
867
00:32:34.240 --> 00:32:37.380
to know is that the environment mattered
868
00:32:37.380 --> 00:32:39.880
was definitely a part of the scenario.
869
00:32:40.340 --> 00:32:43.160
And also there's this host of internal things
870
00:32:43.160 --> 00:32:45.260
that also matter, just not blame.
871
00:32:45.760 --> 00:32:49.420
There's just internal stuff that also matters
872
00:32:49.420 --> 00:32:52.040
that you take with you when you leave.
873
00:32:52.800 --> 00:32:52.880
Yeah.
874
00:32:53.100 --> 00:32:54.400
Can we pivot to that?
875
00:32:54.440 --> 00:32:55.580
Can we talk about what the internal
876
00:32:55.580 --> 00:32:56.400
and external factors are?
877
00:32:56.460 --> 00:32:57.780
That really blew my mind.
878
00:32:57.860 --> 00:33:01.100
Cause I think that when, again,
879
00:33:01.220 --> 00:33:02.620
when we talk about in this profession,
880
00:33:02.860 --> 00:33:04.560
everyone's talking about external factors.
881
00:33:05.080 --> 00:33:06.040
But some people don't even know
882
00:33:06.040 --> 00:33:07.040
what the external factors are.
883
00:33:07.120 --> 00:33:08.620
But yeah, I actually talked about this
884
00:33:08.620 --> 00:33:09.660
with my nurse practitioner friend
885
00:33:09.660 --> 00:33:11.420
who's been an NP for about 11 years.
886
00:33:11.440 --> 00:33:13.440
And she's like, oh, I never heard of internal factors.
887
00:33:13.820 --> 00:33:15.040
I made them up.
888
00:33:16.260 --> 00:33:17.320
Did you actually make them up?
889
00:33:18.420 --> 00:33:20.200
Oh, well, amazing.
890
00:33:20.580 --> 00:33:21.220
Go for it.
891
00:33:21.340 --> 00:33:21.880
Yeah, sure then.
892
00:33:22.060 --> 00:33:25.060
There's a little tiny piece of research on it
893
00:33:25.060 --> 00:33:26.940
in the biggest researchers on burnout,
894
00:33:27.180 --> 00:33:28.760
Christina Moslock, Michael Leder, et cetera.
895
00:33:29.060 --> 00:33:30.840
They wrote a book called Job Burnout
896
00:33:30.840 --> 00:33:32.980
and they've written numerous articles
897
00:33:32.980 --> 00:33:34.200
since before I was even born.
898
00:33:34.520 --> 00:33:36.980
So a lot of the information that I use
899
00:33:36.980 --> 00:33:38.160
stems from them.
900
00:33:38.460 --> 00:33:41.240
Plus for the external factors,
901
00:33:41.800 --> 00:33:45.400
they name six that they see regularly on a regular basis.
902
00:33:45.580 --> 00:33:46.920
And those six, if I can remember them
903
00:33:46.920 --> 00:33:48.700
all off the top of my head are workload,
904
00:33:49.020 --> 00:33:50.580
which high every nurse ever.
905
00:33:51.380 --> 00:33:52.260
Lack of autonomy.
906
00:33:53.020 --> 00:33:55.080
Oh yes, 100%.
907
00:33:55.080 --> 00:33:55.480
Yeah, right?
908
00:33:55.480 --> 00:33:56.560
That's a big one.
909
00:33:56.660 --> 00:33:58.520
Lack of praise and recognition.
910
00:33:59.040 --> 00:33:59.920
Oh my God, yes.
911
00:34:01.500 --> 00:34:02.560
Lack of community,
912
00:34:03.120 --> 00:34:05.900
which can be up and down depending on where you're at.
913
00:34:05.900 --> 00:34:07.540
Because I know some nurses that are like,
914
00:34:07.600 --> 00:34:08.780
I would die without my other nurses.
915
00:34:08.840 --> 00:34:10.080
Like they are my family.
916
00:34:11.560 --> 00:34:13.000
Oh, values mismatch.
917
00:34:13.199 --> 00:34:15.380
So now we're into the moral injury conversation.
918
00:34:15.760 --> 00:34:17.020
Oh God, yeah.
919
00:34:17.460 --> 00:34:17.840
Yep.
920
00:34:19.219 --> 00:34:22.100
And I only give this talk five times a month.
921
00:34:24.480 --> 00:34:25.000
What was I gonna say?
922
00:34:25.020 --> 00:34:26.420
I still have a healing burnout brain
923
00:34:26.420 --> 00:34:28.540
so I'm not really gonna help you that much
924
00:34:28.540 --> 00:34:29.159
on that burn.
925
00:34:29.179 --> 00:34:29.980
Workload, autonomy, recognition.
926
00:34:29.980 --> 00:34:33.300
It's like overworked, underpaid, not appreciated.
927
00:34:33.980 --> 00:34:35.900
Oh, lack of fairness is the sixth one.
928
00:34:36.239 --> 00:34:37.179
Oh, right.
929
00:34:37.300 --> 00:34:38.219
Lack of fairness.
930
00:34:39.179 --> 00:34:41.120
The thing that I find problematic
931
00:34:41.120 --> 00:34:43.960
with those external factors is that we're not talking
932
00:34:43.960 --> 00:34:46.420
about how the internal factors can influence them.
933
00:34:47.400 --> 00:34:48.580
Say that again, say that one more time.
934
00:34:48.940 --> 00:34:50.260
What we're not speaking about
935
00:34:50.260 --> 00:34:51.880
when we talk about internal factors
936
00:34:51.880 --> 00:34:53.560
is how the external factors
937
00:34:53.560 --> 00:34:55.699
can influence the internal factors.
938
00:34:55.800 --> 00:34:59.260
So if you are someone who has a history of trauma,
939
00:34:59.460 --> 00:35:00.620
a lack of interoception
940
00:35:00.620 --> 00:35:02.420
and you are more keyed into the negative
941
00:35:02.420 --> 00:35:03.480
than the average person,
942
00:35:03.740 --> 00:35:06.400
you are going to perceive more things as not fair
943
00:35:06.400 --> 00:35:08.740
and you're not going to be able to take in praise
944
00:35:08.740 --> 00:35:09.340
when it's given.
945
00:35:09.900 --> 00:35:11.820
So there will be a lack of recognition and praise.
946
00:35:11.820 --> 00:35:12.800
Double whammy, yes.
947
00:35:13.080 --> 00:35:14.400
But not because it's not there
948
00:35:14.400 --> 00:35:15.900
but because you can't take it in.
949
00:35:16.020 --> 00:35:18.720
I wanna like overemphasize that
950
00:35:18.720 --> 00:35:20.720
for our nurse practitioner friends
951
00:35:20.720 --> 00:35:22.640
because I hear that all the time.
952
00:35:22.660 --> 00:35:24.500
I think it comes so in that package
953
00:35:24.500 --> 00:35:26.220
of like, I put myself last,
954
00:35:26.400 --> 00:35:29.000
I put everyone first and no one appreciates it.
955
00:35:29.240 --> 00:35:31.500
And then I can't receive it even when it's coming in
956
00:35:31.500 --> 00:35:33.040
because it's hard.
957
00:35:33.160 --> 00:35:35.200
And that's a muscle I've had to work on too.
958
00:35:35.200 --> 00:35:37.200
But that's one of the-
959
00:35:37.700 --> 00:35:38.420
Usually trauma-based.
960
00:35:39.960 --> 00:35:40.760
Yeah, yeah.
961
00:35:40.960 --> 00:35:42.860
I mean, one of the things that I talk about on Instagram,
962
00:35:42.900 --> 00:35:44.640
I haven't been as active with the last couple of months
963
00:35:44.640 --> 00:35:45.900
but we talk about wins.
964
00:35:46.200 --> 00:35:47.580
And I know a lot of other business owners
965
00:35:47.580 --> 00:35:48.420
talk about that too
966
00:35:48.420 --> 00:35:49.700
but I think it's just so important
967
00:35:50.540 --> 00:35:52.300
because it's, yeah, it's hard to,
968
00:35:52.340 --> 00:35:55.100
it's important to celebrate ourselves also
969
00:35:55.580 --> 00:35:57.020
what is going well.
970
00:35:57.360 --> 00:36:00.460
And sometimes it's about listening to a patient say,
971
00:36:00.720 --> 00:36:02.300
oh my God, thank you so much
972
00:36:02.300 --> 00:36:04.560
and taking three seconds,
973
00:36:05.500 --> 00:36:07.300
I literally mean three,
974
00:36:07.620 --> 00:36:13.770
to inhale, give yourself a moment to recognize it
975
00:36:13.770 --> 00:36:14.790
before you walk out of the room.
976
00:36:16.490 --> 00:36:17.130
Absolutely.
977
00:36:17.830 --> 00:36:18.450
Take it in.
978
00:36:19.210 --> 00:36:22.230
But that's really hard for those of us that were taught
979
00:36:22.230 --> 00:36:25.290
through trauma and other developmental
980
00:36:25.290 --> 00:36:27.670
and parental issues
981
00:36:27.670 --> 00:36:30.790
that we weren't deserving of people's attention
982
00:36:30.790 --> 00:36:33.590
and gratitude and that our job was to serve
983
00:36:33.590 --> 00:36:35.270
so we don't get that part
984
00:36:35.270 --> 00:36:39.230
whose mothers were treated in a certain way in the home
985
00:36:39.230 --> 00:36:41.890
saying, well, that's your job, deal with it.
986
00:36:42.590 --> 00:36:44.990
The mental load that we're supposed to carry,
987
00:36:45.070 --> 00:36:45.710
all of those things.
988
00:36:45.810 --> 00:36:48.370
So it can be hard to take in that gratitude
989
00:36:48.370 --> 00:36:49.910
and it is, like you said,
990
00:36:50.070 --> 00:36:51.510
a muscle that you have to work.
991
00:36:51.930 --> 00:36:53.810
It's not something that comes naturally
992
00:36:53.810 --> 00:36:55.250
to most of us that burn out.
993
00:36:56.050 --> 00:36:57.630
So lack of praise and recognition
994
00:36:57.630 --> 00:37:00.170
sometimes really does exist in a big way
995
00:37:00.170 --> 00:37:03.630
and also it exists more in populations
996
00:37:03.630 --> 00:37:06.110
that have a hard time accepting praise and recognition.
997
00:37:07.510 --> 00:37:08.030
Absolutely.
998
00:37:10.250 --> 00:37:13.030
So most of the internal factors
999
00:37:13.030 --> 00:37:15.010
are in some way, shape or form
1000
00:37:15.010 --> 00:37:16.730
based on brain development.
1001
00:37:17.390 --> 00:37:20.170
They are coping mechanisms that we created
1002
00:37:20.170 --> 00:37:21.870
in response to trauma
1003
00:37:21.870 --> 00:37:23.290
or the way that our brain developed.
1004
00:37:23.390 --> 00:37:26.370
A lot of people go undiagnosed ADHD,
1005
00:37:26.710 --> 00:37:28.510
undiagnosed autism, et cetera,
1006
00:37:28.510 --> 00:37:30.510
especially women, right?
1007
00:37:30.890 --> 00:37:34.910
So we have a lot of these developmental shifts
1008
00:37:34.910 --> 00:37:38.210
that we go through that are not recognized
1009
00:37:38.210 --> 00:37:41.410
and so we create ways to get around them.
1010
00:37:41.590 --> 00:37:42.930
We create perfectionism.
1011
00:37:43.090 --> 00:37:44.450
We create people pleasing.
1012
00:37:45.110 --> 00:37:48.210
We create an inability to accept recognition.
1013
00:37:48.370 --> 00:37:49.910
We create low self-esteem.
1014
00:37:51.070 --> 00:37:53.330
We create a separation from other people.
1015
00:37:54.110 --> 00:37:55.730
We create what's known as,
1016
00:37:55.730 --> 00:37:57.270
in Gabor Maté's book,
1017
00:37:57.550 --> 00:37:59.890
as super autonomous self-sufficiency, right?
1018
00:37:59.890 --> 00:38:01.670
We create hyper-independence.
1019
00:38:01.970 --> 00:38:05.430
That is such a big thing in this field.
1020
00:38:05.590 --> 00:38:06.770
So huge. Huge.
1021
00:38:07.170 --> 00:38:09.150
Especially like, oh, and the overachieving too
1022
00:38:09.150 --> 00:38:10.750
tends to go with the perfectionism.
1023
00:38:10.910 --> 00:38:12.170
It's like a package deal. Exactly.
1024
00:38:12.850 --> 00:38:13.970
Beginning also from experience.
1025
00:38:14.470 --> 00:38:17.230
Right, so we create all of these modes of being
1026
00:38:17.230 --> 00:38:19.950
that we carry with us throughout our lifetimes
1027
00:38:19.950 --> 00:38:22.670
and then people tell us all of a sudden
1028
00:38:22.670 --> 00:38:24.690
when we're 40 to stop being perfectionists
1029
00:38:24.690 --> 00:38:25.790
and we're like, wait, what?
1030
00:38:27.870 --> 00:38:29.470
And sometimes people don't even recognize it.
1031
00:38:29.530 --> 00:38:31.610
I think perfectionism may be easier,
1032
00:38:31.830 --> 00:38:33.590
but then people pleasing, for example,
1033
00:38:33.810 --> 00:38:35.450
I think people can just not like,
1034
00:38:35.490 --> 00:38:36.890
oh, that's the problem.
1035
00:38:37.310 --> 00:38:39.570
They just haven't had it modeled another way.
1036
00:38:40.350 --> 00:38:40.930
Right, exactly.
1037
00:38:41.130 --> 00:38:43.530
And the other thing about these elements,
1038
00:38:43.630 --> 00:38:45.210
these coping mechanisms, these shifts,
1039
00:38:45.670 --> 00:38:48.990
is that they worked for the majority of your life.
1040
00:38:49.090 --> 00:38:49.110
Yes.
1041
00:38:49.850 --> 00:38:51.850
Yeah, and also that reminds me to say
1042
00:38:51.850 --> 00:38:53.170
there's no judgment.
1043
00:38:53.290 --> 00:38:54.530
You always say that on your podcast,
1044
00:38:54.530 --> 00:38:56.730
but this is very transparent of me,
1045
00:38:56.930 --> 00:38:59.150
but even my own therapist is just like,
1046
00:38:59.410 --> 00:39:01.470
your coping skills kept you safe,
1047
00:39:02.140 --> 00:39:04.330
and that's not a problem.
1048
00:39:04.790 --> 00:39:05.470
That's what they're for, to help you cope.
1049
00:39:05.610 --> 00:39:08.010
And it's not working for you anymore,
1050
00:39:08.350 --> 00:39:10.070
so let's choose something different.
1051
00:39:11.410 --> 00:39:14.670
Or let's find out, my method with clients
1052
00:39:14.670 --> 00:39:17.690
is let's find out where it's still really useful
1053
00:39:17.690 --> 00:39:20.410
so that we can exploit it in that area
1054
00:39:21.100 --> 00:39:23.070
and then start relying on different measures
1055
00:39:23.070 --> 00:39:25.470
in places where it's not useful anymore.
1056
00:39:26.070 --> 00:39:27.510
So if you're a perfectionist
1057
00:39:27.510 --> 00:39:29.470
and you're a nurse anesthesiologist,
1058
00:39:30.690 --> 00:39:32.510
like I kind of want you to really pay attention
1059
00:39:32.510 --> 00:39:33.310
to those numbers.
1060
00:39:33.710 --> 00:39:35.350
Yes, that's, yeah.
1061
00:39:35.570 --> 00:39:38.230
Please do that if I'm on your table.
1062
00:39:39.070 --> 00:39:42.390
But if the dishwasher isn't stacked perfectly,
1063
00:39:42.990 --> 00:39:45.010
like make it okay to just run it twice,
1064
00:39:45.010 --> 00:39:46.330
if you have to.
1065
00:39:47.070 --> 00:39:50.710
Where can we actually use it
1066
00:39:50.710 --> 00:39:53.030
because it's a power that we have.
1067
00:39:53.570 --> 00:39:55.430
People-pleasing as a nurse practitioner,
1068
00:39:56.350 --> 00:39:57.310
thank God you do that,
1069
00:39:57.310 --> 00:39:58.750
because you know how many patients you have
1070
00:39:58.750 --> 00:40:00.910
would never ask for a GD thing,
1071
00:40:01.570 --> 00:40:03.330
but you can feel into them
1072
00:40:03.330 --> 00:40:04.970
because you have that superpower,
1073
00:40:05.330 --> 00:40:07.150
and you notice when they're thirsty
1074
00:40:07.150 --> 00:40:08.830
and they're not asking for anything,
1075
00:40:09.050 --> 00:40:12.230
but you know they need something and you provide it.
1076
00:40:12.870 --> 00:40:15.310
While that's unhealthy for you to do
1077
00:40:15.310 --> 00:40:18.070
to the people in the grocery store,
1078
00:40:18.750 --> 00:40:21.150
you can do it for some of your patients,
1079
00:40:21.210 --> 00:40:23.010
maybe not all of them all the time,
1080
00:40:23.810 --> 00:40:27.150
but you can choose to use this skill that you've honed.
1081
00:40:27.270 --> 00:40:29.070
I think one of the biggest misnomers
1082
00:40:29.070 --> 00:40:31.370
is that we're trying to say
1083
00:40:31.370 --> 00:40:33.790
that everything that you've created was a mistake.
1084
00:40:33.970 --> 00:40:35.470
It wasn't like your therapist said.
1085
00:40:35.470 --> 00:40:37.290
You created these things and they protected you
1086
00:40:37.290 --> 00:40:38.150
and they worked.
1087
00:40:38.830 --> 00:40:40.710
Perfectionism worked really well for me.
1088
00:40:40.970 --> 00:40:42.590
I got perfect grades all throughout school.
1089
00:40:42.690 --> 00:40:44.630
I graduated near the top of my class in high school.
1090
00:40:44.670 --> 00:40:46.110
I got a scholarship to college.
1091
00:40:46.490 --> 00:40:47.630
It worked.
1092
00:40:48.730 --> 00:40:51.010
Why wouldn't I continue something that worked?
1093
00:40:51.070 --> 00:40:52.270
That's just normal.
1094
00:40:52.890 --> 00:40:54.770
So you're just normal.
1095
00:40:55.370 --> 00:40:57.910
You're just doing the things that you learned worked.
1096
00:40:57.970 --> 00:41:00.210
You tried them out when you were probably four.
1097
00:41:00.710 --> 00:41:02.090
You got attention for it.
1098
00:41:02.110 --> 00:41:03.210
You got what you needed.
1099
00:41:03.670 --> 00:41:05.110
So you continued.
1100
00:41:05.470 --> 00:41:07.310
Okay, that's fine.
1101
00:41:07.990 --> 00:41:10.110
But now as an adult,
1102
00:41:10.650 --> 00:41:13.530
some of these things are a little bit wonky
1103
00:41:13.530 --> 00:41:14.970
in some areas of your life.
1104
00:41:15.610 --> 00:41:18.490
I remember once when I was going through my like
1105
00:41:18.490 --> 00:41:20.170
unwinding my own people pleasing,
1106
00:41:20.530 --> 00:41:23.250
I found myself in someone else's kitchen
1107
00:41:23.250 --> 00:41:25.670
filling up a glass of water for a guest
1108
00:41:25.670 --> 00:41:26.730
that was at their house
1109
00:41:26.730 --> 00:41:28.510
because I noticed that their water was empty.
1110
00:41:29.190 --> 00:41:30.910
I'm like, I'm not the hostess here.
1111
00:41:31.270 --> 00:41:32.570
Go, Katie, sit down.
1112
00:41:34.690 --> 00:41:36.290
Like, what are you doing?
1113
00:41:37.250 --> 00:41:38.090
That's so funny.
1114
00:41:38.310 --> 00:41:40.190
First of all, you're taking away
1115
00:41:40.190 --> 00:41:41.930
that other person's autonomy.
1116
00:41:42.150 --> 00:41:42.630
Yeah.
1117
00:41:42.990 --> 00:41:43.750
You are deciding.
1118
00:41:43.750 --> 00:41:44.550
I know you're not gonna.
1119
00:41:45.150 --> 00:41:45.810
Yeah, go ahead.
1120
00:41:46.510 --> 00:41:46.750
Right?
1121
00:41:47.090 --> 00:41:48.810
I'm taking away their autonomy, their independence,
1122
00:41:48.810 --> 00:41:50.230
and I'm assuming they don't have a voice
1123
00:41:50.990 --> 00:41:52.930
because most of the time when I need something,
1124
00:41:52.930 --> 00:41:53.850
I don't have a voice.
1125
00:41:54.230 --> 00:41:55.750
So I become the voice for other people
1126
00:41:55.750 --> 00:41:57.710
instead of becoming the voice for myself.
1127
00:41:58.290 --> 00:42:00.590
But that's not actually helping them get a voice.
1128
00:42:01.030 --> 00:42:01.370
Yeah.
1129
00:42:01.950 --> 00:42:02.270
Yeah.
1130
00:42:02.330 --> 00:42:02.730
Right?
1131
00:42:03.250 --> 00:42:04.710
It seems like it's helpful,
1132
00:42:04.710 --> 00:42:06.490
but it's actually ultimately not helpful.
1133
00:42:06.770 --> 00:42:08.130
It's ultimately not helpful.
1134
00:42:08.390 --> 00:42:10.910
And while I'm doing that, guess who I'm neglecting?
1135
00:42:11.810 --> 00:42:13.050
I don't know if I need water.
1136
00:42:13.050 --> 00:42:14.590
I just know that you need water.
1137
00:42:15.330 --> 00:42:16.470
So I'm neglecting myself.
1138
00:42:16.610 --> 00:42:18.130
I'm taking over your powers.
1139
00:42:18.170 --> 00:42:19.470
I'm not empowering you.
1140
00:42:19.810 --> 00:42:20.910
Yeah, absolutely.
1141
00:42:22.030 --> 00:42:22.230
Right?
1142
00:42:22.230 --> 00:42:23.970
And I'm being rude to the hostess.
1143
00:42:24.090 --> 00:42:24.490
Yeah.
1144
00:42:24.990 --> 00:42:26.090
All at the same time,
1145
00:42:26.270 --> 00:42:28.070
because I'm trying to be a good person
1146
00:42:28.070 --> 00:42:29.230
and people please.
1147
00:42:30.110 --> 00:42:30.230
Fair quote.
1148
00:42:30.230 --> 00:42:31.650
That's a scenario where I learned to.
1149
00:42:31.770 --> 00:42:32.450
Yeah, right?
1150
00:42:33.250 --> 00:42:35.410
That's where I learned to pull it out
1151
00:42:35.410 --> 00:42:36.830
and say, well, I don't need to do that
1152
00:42:36.830 --> 00:42:37.610
in this environment.
1153
00:42:38.230 --> 00:42:40.230
I was living in Prague
1154
00:42:40.230 --> 00:42:42.150
when I was going through the majority of my recovery.
1155
00:42:42.150 --> 00:42:44.950
And as an English and a Czech speaker,
1156
00:42:45.430 --> 00:42:49.850
I would, and in Prague is massively touristic.
1157
00:42:50.450 --> 00:42:50.570
Right?
1158
00:42:50.650 --> 00:42:52.290
There's tourists all over Prague,
1159
00:42:52.730 --> 00:42:53.910
every day, all day.
1160
00:42:54.630 --> 00:42:56.050
It's unreal.
1161
00:42:57.070 --> 00:42:59.750
But I would hear people speaking English on the tram
1162
00:42:59.750 --> 00:43:00.750
and looking at a map.
1163
00:43:01.510 --> 00:43:03.450
And I would be offering them help
1164
00:43:03.450 --> 00:43:05.670
before they even asked for it,
1165
00:43:05.670 --> 00:43:07.770
which sometimes was super appreciated
1166
00:43:07.770 --> 00:43:10.070
and sometimes was like totally unnecessary.
1167
00:43:10.070 --> 00:43:13.130
I wasn't waiting until they sounded confused,
1168
00:43:13.290 --> 00:43:15.070
but when you're spending so much time
1169
00:43:15.070 --> 00:43:17.170
tuning into other people's conversations
1170
00:43:17.170 --> 00:43:18.630
and guess what you're doing?
1171
00:43:19.510 --> 00:43:21.550
You can't pay attention to yourself
1172
00:43:21.550 --> 00:43:23.190
and to them at the same time.
1173
00:43:23.490 --> 00:43:27.670
I'm helping people to get to Karlovy Most,
1174
00:43:27.890 --> 00:43:29.010
to Charles Bridge,
1175
00:43:29.570 --> 00:43:33.310
instead of getting myself to work in a mental state
1176
00:43:33.310 --> 00:43:35.130
that's gonna be good for the 15 patients
1177
00:43:35.130 --> 00:43:36.290
I'm gonna see today.
1178
00:43:37.390 --> 00:43:38.590
What the heck?
1179
00:43:41.530 --> 00:43:44.350
But that patient in room three
1180
00:43:44.350 --> 00:43:47.510
that never asks you for water and then doesn't pee
1181
00:43:48.070 --> 00:43:49.790
because they're dehydrated,
1182
00:43:50.370 --> 00:43:52.050
remembering about them,
1183
00:43:52.330 --> 00:43:54.070
might literally save their lives.
1184
00:43:55.110 --> 00:43:56.930
So it's, you know, like.
1185
00:43:57.690 --> 00:43:57.770
Yeah.
1186
00:43:58.890 --> 00:44:00.410
None of these things. Yeah, there's a lot of nuance.
1187
00:44:00.410 --> 00:44:01.610
There's a lot of nuance.
1188
00:44:01.730 --> 00:44:04.090
None of these things are either bad or good,
1189
00:44:04.790 --> 00:44:06.130
unless they're bad or good for you
1190
00:44:06.130 --> 00:44:07.890
in a particular moment.
1191
00:44:07.890 --> 00:44:10.050
Mm-hmm, definitely.
1192
00:44:10.490 --> 00:44:12.750
So again, gentleness with yourself, no self-blame.
1193
00:44:13.530 --> 00:44:16.210
You created patterns that worked, so you repeat them.
1194
00:44:16.410 --> 00:44:17.310
Okay, you're human.
1195
00:44:18.030 --> 00:44:18.570
That's okay.
1196
00:44:19.270 --> 00:44:21.250
Well, I feel like it's a really nice segue
1197
00:44:21.250 --> 00:44:25.850
into the burnout recovery process.
1198
00:44:27.490 --> 00:44:29.610
There's obviously so much to say about that,
1199
00:44:29.610 --> 00:44:32.750
but I think that for my experience,
1200
00:44:33.650 --> 00:44:35.450
I, again, was in, just as an,
1201
00:44:35.450 --> 00:44:37.810
and I just share this to hopefully normalize it
1202
00:44:37.810 --> 00:44:41.190
for other people, it just like really snuck up on me
1203
00:44:41.190 --> 00:44:42.570
where I was just like, I knew I was stressed,
1204
00:44:42.570 --> 00:44:44.570
but I'm like, oh, I'm tenacious, I can handle this.
1205
00:44:44.910 --> 00:44:46.370
I have a really high capacity.
1206
00:44:46.510 --> 00:44:48.490
And then it just like dropped me basically.
1207
00:44:49.370 --> 00:44:51.410
And I just, I kind of panicked because I was like,
1208
00:44:51.410 --> 00:44:54.330
well, this is my job, this is my livelihood,
1209
00:44:54.470 --> 00:44:55.930
this is my income, like all this stuff.
1210
00:44:56.150 --> 00:44:57.350
And I was like, I don't know what to do.
1211
00:44:57.390 --> 00:45:01.350
And I just remember like some divine insight was like,
1212
00:45:01.350 --> 00:45:02.630
oh, there's a podcast named Fry
1213
00:45:02.630 --> 00:45:03.990
that I heard about several years ago.
1214
00:45:03.990 --> 00:45:06.350
And I was like, oh yeah, I never did check that out.
1215
00:45:06.530 --> 00:45:08.030
And then I started listening to stuff.
1216
00:45:09.270 --> 00:45:11.610
But yeah, I just, I basically was like, yeah.
1217
00:45:11.990 --> 00:45:13.670
I was like, how did I get here?
1218
00:45:14.030 --> 00:45:16.270
How do I get back as fast as possible?
1219
00:45:16.530 --> 00:45:19.130
I'm gonna take like a couple of weeks off.
1220
00:45:20.650 --> 00:45:22.210
Which I know you have some opinions on.
1221
00:45:22.510 --> 00:45:23.810
This is like, so the FAQ,
1222
00:45:23.910 --> 00:45:26.550
the frequently asked question along a lot of burnout people
1223
00:45:27.270 --> 00:45:30.850
is how do I make the most out of my recovery?
1224
00:45:30.950 --> 00:45:32.430
I have about three weeks off
1225
00:45:32.430 --> 00:45:34.550
because I literally asked myself that same question.
1226
00:45:34.610 --> 00:45:36.390
I didn't have a limit on like the three weeks
1227
00:45:36.390 --> 00:45:37.890
because again, I work for myself.
1228
00:45:37.930 --> 00:45:39.350
So it's like a little bit more flexible,
1229
00:45:39.350 --> 00:45:41.790
but I was like, I gotta work at this.
1230
00:45:43.370 --> 00:45:46.430
Which is ridiculous to say now that I've been through it.
1231
00:45:46.570 --> 00:45:47.110
Is it though?
1232
00:45:47.430 --> 00:45:50.290
It's not, it's not because it's really demonstrative
1233
00:45:50.290 --> 00:45:52.830
of like where we come from when we're in burnout
1234
00:45:52.830 --> 00:45:56.090
of like, we just wanna get over this as quick as possible
1235
00:45:56.090 --> 00:45:56.710
and get back to myself.
1236
00:45:56.710 --> 00:45:57.790
And I'm still impatient.
1237
00:45:58.290 --> 00:46:00.250
And it's been several months.
1238
00:46:00.430 --> 00:46:01.570
It's been, I don't even know.
1239
00:46:01.570 --> 00:46:02.850
It's been some, I don't know.
1240
00:46:02.970 --> 00:46:06.550
It's at least six months or so about.
1241
00:46:06.990 --> 00:46:08.710
And I'm like, well, when is it coming back?
1242
00:46:08.970 --> 00:46:11.270
I'm gonna do a three month hiatus from the podcast.
1243
00:46:11.290 --> 00:46:12.110
I'm gonna come back.
1244
00:46:12.350 --> 00:46:14.810
I'm like, okay, well, I love doing podcasts.
1245
00:46:14.870 --> 00:46:16.950
So I'm doing it, but I'm still not 100%, right?
1246
00:46:17.130 --> 00:46:17.530
So I guess like-
1247
00:46:17.530 --> 00:46:19.910
And you won't be probably for another six to 12 months.
1248
00:46:20.890 --> 00:46:22.170
Yeah, can we just let that sink in
1249
00:46:22.170 --> 00:46:24.110
for a second for people that like-
1250
00:46:24.110 --> 00:46:27.430
12 to 18 months is the average recovery time
1251
00:46:28.090 --> 00:46:28.810
with support.
1252
00:46:29.470 --> 00:46:31.010
It doesn't have to be my support.
1253
00:46:31.010 --> 00:46:33.350
It can be support of another nurse practitioner,
1254
00:46:33.530 --> 00:46:35.410
of a doctor, of a functional medicine practitioner,
1255
00:46:35.530 --> 00:46:37.030
of an acupuncturist, of a reiki master,
1256
00:46:37.130 --> 00:46:41.550
of a therapist, of a, I don't care who the support is,
1257
00:46:42.730 --> 00:46:44.570
without support, we're looking at a three
1258
00:46:44.570 --> 00:46:46.850
to five year range to recover from burnout.
1259
00:46:47.010 --> 00:46:48.470
And when I say recover from burnout,
1260
00:46:48.930 --> 00:46:50.750
what I mean is to get your brain back
1261
00:46:50.750 --> 00:46:52.010
to a fully functioning state
1262
00:46:52.010 --> 00:46:55.030
and for you emotionally to not be afraid of burnout
1263
00:46:55.030 --> 00:46:57.030
because you are so aware of what's going on
1264
00:46:57.030 --> 00:46:58.090
in your own world now
1265
00:46:58.090 --> 00:47:00.270
that if you feel yourself going in that direction,
1266
00:47:00.270 --> 00:47:02.170
you feel really confident in your tools
1267
00:47:02.170 --> 00:47:03.710
to be able to pull it back.
1268
00:47:04.430 --> 00:47:04.750
So to me-
1269
00:47:04.750 --> 00:47:05.870
Not that it's never gonna come back,
1270
00:47:06.090 --> 00:47:08.210
just that like you can recognize that, right?
1271
00:47:08.250 --> 00:47:09.070
Because I think that's another stigma piece too.
1272
00:47:09.070 --> 00:47:10.410
This is when burnout prevention is okay.
1273
00:47:10.730 --> 00:47:11.130
Yeah.
1274
00:47:11.930 --> 00:47:13.670
This is where I'm okay with it.
1275
00:47:14.050 --> 00:47:15.690
Yeah, and also like I just, I loved,
1276
00:47:16.030 --> 00:47:17.970
and so maybe multiple episodes you talked about
1277
00:47:17.970 --> 00:47:22.010
how it's not a one and done thing.
1278
00:47:22.230 --> 00:47:25.050
Like I thought the first time I burnt out,
1279
00:47:25.110 --> 00:47:27.590
I was like, oh, I recognize it, I fixed it,
1280
00:47:27.590 --> 00:47:28.650
I changed my job, it's fine.
1281
00:47:28.890 --> 00:47:30.030
And then this time I was like,
1282
00:47:30.030 --> 00:47:31.850
I think that was another layer of shame is like,
1283
00:47:31.910 --> 00:47:34.610
I've been through this before, like what's wrong with me?
1284
00:47:35.190 --> 00:47:37.450
But I think that it was really normalizing for me
1285
00:47:37.450 --> 00:47:39.530
to hear that like, if you've had burnout before,
1286
00:47:39.890 --> 00:47:41.370
it's likely you can do it again.
1287
00:47:41.390 --> 00:47:43.110
Like, I don't know what the data is on that,
1288
00:47:43.770 --> 00:47:46.750
but it's not a malfunction of you.
1289
00:47:46.870 --> 00:47:49.470
It's just, oh, okay, I'm noticing how quickly,
1290
00:47:49.630 --> 00:47:51.590
like I'm noticing quicker I'm getting into burnout
1291
00:47:51.590 --> 00:47:53.950
and I have better tools to get me out of it quicker.
1292
00:47:54.050 --> 00:47:55.890
It's not gonna take 18 months next time.
1293
00:47:55.930 --> 00:47:56.730
Hopefully, I don't know.
1294
00:47:56.730 --> 00:47:57.830
That's what I'm taking from it.
1295
00:47:57.950 --> 00:47:59.810
Exactly, yes, but then that's exactly true.
1296
00:47:59.810 --> 00:48:03.390
It takes less time, you notice it faster, you react faster.
1297
00:48:04.350 --> 00:48:06.030
But those of us that have a tendency to burnout
1298
00:48:06.030 --> 00:48:09.150
have a tendency to burnout because of a myriad of factors.
1299
00:48:09.490 --> 00:48:12.730
So epidemiologists would call this a web of causation.
1300
00:48:13.870 --> 00:48:15.790
Each one of us has a web of causation.
1301
00:48:15.930 --> 00:48:17.570
There's internal factors, there's external factors,
1302
00:48:17.610 --> 00:48:19.430
there's cultural factors, there's health factors,
1303
00:48:20.230 --> 00:48:21.850
there's all these things.
1304
00:48:23.070 --> 00:48:26.190
And so sometimes you're gonna deal with a wheel,
1305
00:48:26.450 --> 00:48:28.330
you know, one strand of that web
1306
00:48:28.330 --> 00:48:29.550
and it's gonna feel really good,
1307
00:48:29.550 --> 00:48:31.150
but there's still six more strands
1308
00:48:31.750 --> 00:48:34.310
that you haven't gotten to and that's not your fault
1309
00:48:34.310 --> 00:48:36.670
because you can only do so much at one time.
1310
00:48:37.030 --> 00:48:38.890
But I think going back to this question
1311
00:48:38.890 --> 00:48:40.730
of how do I optimize burnout recovery?
1312
00:48:42.090 --> 00:48:44.470
The idea that you have to optimize it
1313
00:48:44.470 --> 00:48:46.610
is the first thing that you need to address.
1314
00:48:47.990 --> 00:48:50.290
If you have to optimize everything in your life,
1315
00:48:50.290 --> 00:48:51.070
that's problematic.
1316
00:48:51.770 --> 00:48:53.510
Like we're not actually designed
1317
00:48:53.510 --> 00:48:55.290
to optimize everything all the time.
1318
00:48:55.670 --> 00:48:58.510
So we are not going to optimize your burnout recovery.
1319
00:48:58.510 --> 00:48:59.690
We're gonna start breathing.
1320
00:49:01.410 --> 00:49:05.170
We have to start with foundational self care
1321
00:49:05.170 --> 00:49:06.030
and interoception.
1322
00:49:07.010 --> 00:49:08.790
If these skills do not get built,
1323
00:49:09.350 --> 00:49:12.010
you will not be able to do the further skills.
1324
00:49:12.450 --> 00:49:14.790
And they are what take the longest
1325
00:49:14.790 --> 00:49:18.290
because you likely, at some point of your development,
1326
00:49:18.410 --> 00:49:20.050
whether from nature or nurture,
1327
00:49:20.950 --> 00:49:22.410
at some point of your development,
1328
00:49:22.750 --> 00:49:24.950
didn't develop this as well as some other people
1329
00:49:25.690 --> 00:49:28.530
and you need to actively work on it as an adult
1330
00:49:28.530 --> 00:49:31.550
in order to be able to start to meet your own needs.
1331
00:49:31.870 --> 00:49:33.190
It's just that simple.
1332
00:49:34.670 --> 00:49:36.930
That is where we begin, no matter what.
1333
00:49:37.350 --> 00:49:39.390
People are like, build boundaries to keep yourself safe.
1334
00:49:39.510 --> 00:49:42.550
I'm like, whoa, hold on, we'll get there.
1335
00:49:43.250 --> 00:49:44.170
Take it easy.
1336
00:49:44.430 --> 00:49:45.690
Yeah, we'll get there.
1337
00:49:46.170 --> 00:49:48.290
But let's figure out what you actually need boundaries
1338
00:49:48.290 --> 00:49:50.830
around and you can't know that unless you know yourself.
1339
00:49:51.130 --> 00:49:52.430
You can't know that.
1340
00:49:52.430 --> 00:49:55.110
You make things up and then you fight with people
1341
00:49:55.110 --> 00:49:56.910
and your boundaries feel like electric fences
1342
00:49:56.910 --> 00:49:58.770
because you don't know how to actually
1343
00:49:58.770 --> 00:50:00.090
structure them properly.
1344
00:50:00.770 --> 00:50:01.970
Most boundaries have gates in them.
1345
00:50:02.850 --> 00:50:04.350
A lot of them are flexible.
1346
00:50:04.870 --> 00:50:06.570
Boundaries also include your ability
1347
00:50:06.570 --> 00:50:08.390
to ask for help and let people in.
1348
00:50:08.410 --> 00:50:10.230
It's not just about keeping people out.
1349
00:50:11.250 --> 00:50:13.070
We're so confused about boundaries
1350
00:50:13.070 --> 00:50:15.230
because we don't know where we are.
1351
00:50:15.630 --> 00:50:15.970
Yeah.
1352
00:50:16.370 --> 00:50:17.670
Are you standing in your own garden
1353
00:50:17.670 --> 00:50:19.090
with a fence around you that has a gate?
1354
00:50:19.750 --> 00:50:21.350
Are you locked in a basement somewhere?
1355
00:50:22.870 --> 00:50:24.050
Where are you?
1356
00:50:24.090 --> 00:50:25.370
You don't know where you are.
1357
00:50:25.410 --> 00:50:27.250
We have to start there.
1358
00:50:28.450 --> 00:50:31.130
Spend time with yourself, with your body,
1359
00:50:31.230 --> 00:50:32.230
with your sensations.
1360
00:50:33.090 --> 00:50:35.450
Some sort of somatic practice.
1361
00:50:36.530 --> 00:50:37.690
There's a million options.
1362
00:50:38.510 --> 00:50:40.210
This is very popular right now.
1363
00:50:41.430 --> 00:50:43.790
Go find a weirdo on the internet that can help you.
1364
00:50:44.050 --> 00:50:45.590
I say that with so much love.
1365
00:50:46.690 --> 00:50:48.490
I am one of those weirdos, right?
1366
00:50:48.970 --> 00:50:50.610
I mean, I was doing acupuncture.
1367
00:50:50.610 --> 00:50:52.570
I started acupuncture school at 19.
1368
00:50:52.670 --> 00:50:53.390
That's weird.
1369
00:50:54.570 --> 00:50:57.670
That's an abnormal time to get into something like that.
1370
00:50:58.570 --> 00:51:01.010
So I say weirdo with so much love.
1371
00:51:02.310 --> 00:51:03.510
Start with that.
1372
00:51:03.610 --> 00:51:05.710
Foundational self-care, interoception.
1373
00:51:06.250 --> 00:51:07.970
If you grant yourself that gift,
1374
00:51:08.630 --> 00:51:11.430
every single step you take after it will become easier.
1375
00:51:11.830 --> 00:51:12.490
Every single step.
1376
00:51:13.470 --> 00:51:13.990
Absolutely.
1377
00:51:14.410 --> 00:51:15.970
Well, I wanna be mindful of our time.
1378
00:51:16.830 --> 00:51:17.850
I guess one,
1379
00:51:19.470 --> 00:51:22.410
well, like I have to say, well, okay.
1380
00:51:22.570 --> 00:51:23.610
Either I can shout you out
1381
00:51:23.610 --> 00:51:25.870
or you can share with the things that I'll just share
1382
00:51:25.870 --> 00:51:26.750
and then you can add anything.
1383
00:51:27.370 --> 00:51:30.490
So one, just like one little pearl I wanted to add
1384
00:51:30.490 --> 00:51:31.970
was about resentment.
1385
00:51:33.390 --> 00:51:35.790
So like one of the mind blowing things about,
1386
00:51:35.890 --> 00:51:37.650
again, I just like love your work so much,
1387
00:51:37.670 --> 00:51:39.310
but like you talk about resentment
1388
00:51:39.310 --> 00:51:41.610
and resentment is a really helpful clue
1389
00:51:41.610 --> 00:51:43.070
to where you need a boundary.
1390
00:51:43.470 --> 00:51:45.630
And so one of the practices you recommend
1391
00:51:45.630 --> 00:51:46.810
is keeping a resentment journal.
1392
00:51:46.810 --> 00:51:47.970
I'm still working on mine,
1393
00:51:49.250 --> 00:51:51.750
but that's another piece I think is a starter piece
1394
00:51:51.750 --> 00:51:53.550
that I found just so fascinating.
1395
00:51:54.190 --> 00:51:55.390
And why is it a starter piece?
1396
00:51:55.810 --> 00:51:56.710
What does it help you do?
1397
00:51:57.030 --> 00:51:58.810
It like tunes into, yeah,
1398
00:51:58.870 --> 00:52:00.930
like it tunes into like what I want and I need
1399
00:52:00.930 --> 00:52:02.410
and how I feel totally.
1400
00:52:02.570 --> 00:52:03.890
So I feel like it's really complimentary.
1401
00:52:04.370 --> 00:52:06.390
And then I think the other pieces too
1402
00:52:06.390 --> 00:52:07.570
is I'd really like,
1403
00:52:07.710 --> 00:52:09.410
I cannot recommend enough your podcast.
1404
00:52:09.590 --> 00:52:12.150
It is just like the most valuable resource
1405
00:52:12.150 --> 00:52:14.350
and it's free, like that's amazing.
1406
00:52:14.610 --> 00:52:15.910
So many great things on there
1407
00:52:15.910 --> 00:52:18.010
and it's so searchable by podcast of topic
1408
00:52:18.010 --> 00:52:19.570
because there's different levels of like,
1409
00:52:19.570 --> 00:52:20.710
if I'm just starting out with burnout
1410
00:52:20.710 --> 00:52:22.650
or if I'm in recovery or all this stuff.
1411
00:52:22.830 --> 00:52:23.450
And like that's what I,
1412
00:52:23.850 --> 00:52:25.170
like the ones I listened to at the beginning
1413
00:52:25.170 --> 00:52:26.930
are very different than ones I listen to now.
1414
00:52:27.350 --> 00:52:30.050
And then you're also a coach and you help people.
1415
00:52:30.090 --> 00:52:33.470
And I actually have my therapist and a coach already,
1416
00:52:33.470 --> 00:52:35.290
which is the only reason why I haven't worked with you,
1417
00:52:35.290 --> 00:52:36.930
but I would totally work with you
1418
00:52:36.930 --> 00:52:38.650
if I weren't working with both of them.
1419
00:52:39.330 --> 00:52:41.090
But yeah, and I've read your book.
1420
00:52:41.130 --> 00:52:42.010
I'm clearly obsessed.
1421
00:52:43.050 --> 00:52:45.170
So those are just some hashtag obsessed.
1422
00:52:45.650 --> 00:52:47.090
So those are just a couple of things
1423
00:52:47.090 --> 00:52:48.330
that I wanted to share with people,
1424
00:52:48.330 --> 00:52:49.230
but are there other things
1425
00:52:49.230 --> 00:52:50.290
that you wanna share with people,
1426
00:52:50.390 --> 00:52:52.370
like a last pearl of practice
1427
00:52:52.370 --> 00:52:54.670
or kind of like last thought or resource
1428
00:52:54.670 --> 00:52:56.450
or anything like that to share with people?
1429
00:52:56.990 --> 00:52:59.230
The resentment piece is really, really important.
1430
00:52:59.510 --> 00:53:01.430
Tuning into an emotion in that way
1431
00:53:01.430 --> 00:53:03.250
helps build your interoception, right?
1432
00:53:03.250 --> 00:53:04.590
Helps you reconnect with yourself
1433
00:53:04.590 --> 00:53:06.150
in a way that you've probably never
1434
00:53:06.150 --> 00:53:08.210
allowed yourself before because anger and resentment
1435
00:53:08.210 --> 00:53:10.470
and those are bad emotions, right?
1436
00:53:10.710 --> 00:53:13.170
But this is a permission to explore something,
1437
00:53:13.190 --> 00:53:14.690
which I think is really important.
1438
00:53:14.690 --> 00:53:17.310
The resentment journal is my favorite tool
1439
00:53:17.310 --> 00:53:21.130
that I've ever created and the podcast
1440
00:53:21.130 --> 00:53:22.870
is my favorite resource that I've ever created.
1441
00:53:22.910 --> 00:53:25.190
I love the book, but the podcast is a different,
1442
00:53:25.290 --> 00:53:26.630
I think just like a different level.
1443
00:53:27.070 --> 00:53:28.530
I think the only thing that I would add
1444
00:53:28.530 --> 00:53:31.050
is that the biggest part of my business
1445
00:53:31.050 --> 00:53:32.450
is not even coaching.
1446
00:53:32.590 --> 00:53:34.470
The biggest part of my business is speaking.
1447
00:53:35.610 --> 00:53:37.110
So I can come into your hospitals.
1448
00:53:37.370 --> 00:53:39.830
I can come to your offices.
1449
00:53:40.070 --> 00:53:41.590
I can go all of those places.
1450
00:53:41.670 --> 00:53:43.070
I travel all over the country,
1451
00:53:43.070 --> 00:53:44.390
sometimes all over the world
1452
00:53:45.170 --> 00:53:48.670
to teach the basics of what burnout really is
1453
00:53:48.670 --> 00:53:50.910
because even as nurse practitioners
1454
00:53:50.910 --> 00:53:52.890
who have a lot of knowledge, even as therapists,
1455
00:53:52.990 --> 00:53:55.850
people don't really know what's happening.
1456
00:53:56.350 --> 00:53:57.930
And of course, the things that I teach now
1457
00:53:57.930 --> 00:53:59.330
might be different in five years
1458
00:53:59.330 --> 00:54:01.570
because science and research and we learn and that's okay.
1459
00:54:02.270 --> 00:54:04.070
But having this basic understanding
1460
00:54:04.070 --> 00:54:06.650
and allowing us to remove some of this shame,
1461
00:54:06.790 --> 00:54:10.110
blame, guilt and judgment allows us to then start
1462
00:54:10.110 --> 00:54:11.830
to actually create those culture shifts
1463
00:54:11.830 --> 00:54:14.710
that we need as teams to make a real difference.
1464
00:54:15.210 --> 00:54:18.950
So this is the work that I do the most of the time.
1465
00:54:19.650 --> 00:54:22.590
Definitely, and I can't stress enough
1466
00:54:22.590 --> 00:54:23.970
in all the work that I've done
1467
00:54:23.970 --> 00:54:25.590
with burnout recovery and equity work,
1468
00:54:26.150 --> 00:54:27.350
all of it comes,
1469
00:54:28.390 --> 00:54:30.130
it's so important to start with the individual.
1470
00:54:30.310 --> 00:54:31.950
Any sort of large movement
1471
00:54:31.950 --> 00:54:34.670
is done on an individual level first
1472
00:54:34.670 --> 00:54:36.390
and then community is individuals
1473
00:54:36.390 --> 00:54:38.490
who have done the work, right?
1474
00:54:38.490 --> 00:54:40.730
You can't really start top down in terms of like,
1475
00:54:40.730 --> 00:54:43.570
end burnout culture just by saying we're going to, right?
1476
00:54:43.690 --> 00:54:45.690
No, that's not how that works, it's individual people.
1477
00:54:46.510 --> 00:54:47.850
Well, and that's important.
1478
00:54:48.510 --> 00:54:49.750
And I know we're short on time,
1479
00:54:49.770 --> 00:54:51.330
but there's so many important things to say.
1480
00:54:52.270 --> 00:54:55.130
This idea that the culture needs to shift
1481
00:54:55.130 --> 00:54:57.050
is an important one and I agree with it.
1482
00:54:57.370 --> 00:54:59.510
And this culture starts in medical school
1483
00:54:59.510 --> 00:55:00.570
and in nursing school.
1484
00:55:01.070 --> 00:55:04.030
It's as early as that where you are really like,
1485
00:55:04.290 --> 00:55:05.570
you're being weeded out,
1486
00:55:05.950 --> 00:55:07.710
that's a known thing that happens,
1487
00:55:08.130 --> 00:55:11.090
you're being bullied, that's a known thing that happens.
1488
00:55:11.750 --> 00:55:14.270
So that starts really early
1489
00:55:14.270 --> 00:55:16.370
and those things do need to shift.
1490
00:55:16.710 --> 00:55:18.170
So I don't want to say
1491
00:55:18.170 --> 00:55:20.330
that the culture pieces don't need to change
1492
00:55:20.330 --> 00:55:22.010
and I want to recognize
1493
00:55:22.450 --> 00:55:25.770
that if I am a person who came into the world,
1494
00:55:25.990 --> 00:55:28.370
I don't know whether my developmental changes
1495
00:55:28.370 --> 00:55:30.350
were mostly nature or mostly nurture.
1496
00:55:30.530 --> 00:55:32.870
I know that nature had some effect
1497
00:55:32.870 --> 00:55:35.010
and I know that nurture had plenty of effect.
1498
00:55:35.030 --> 00:55:36.890
I didn't admit that for a very long time,
1499
00:55:36.890 --> 00:55:41.110
but I took the ACEs score and I was a little surprised.
1500
00:55:41.970 --> 00:55:45.170
If I understand that I'm bringing my whole self
1501
00:55:45.170 --> 00:55:48.570
to a situation and even if the situation is ideal,
1502
00:55:48.650 --> 00:55:51.290
I'm going to be bringing pieces of myself
1503
00:55:51.290 --> 00:55:54.650
that make it more difficult for myself and for others.
1504
00:55:55.290 --> 00:55:58.050
Part of my process was assuming always
1505
00:55:58.050 --> 00:55:59.610
that I wasn't good enough for anything,
1506
00:55:59.970 --> 00:56:01.650
which meant that I was always looking for ways
1507
00:56:01.650 --> 00:56:03.110
that other people weren't good enough too.
1508
00:56:03.190 --> 00:56:05.130
You want to talk about judgmental?
1509
00:56:05.130 --> 00:56:10.650
Whoa, I was Miss Judgerton, Missy McJudgerton was my name.
1510
00:56:10.870 --> 00:56:13.830
I had moral superiority, real, real high.
1511
00:56:14.850 --> 00:56:16.370
Righteousness through the ceiling.
1512
00:56:16.950 --> 00:56:20.710
Not proud of that, but was very true for me
1513
00:56:20.710 --> 00:56:22.190
and it was how I kept to myself,
1514
00:56:22.330 --> 00:56:23.610
I thought at the time safe.
1515
00:56:25.310 --> 00:56:27.290
But if I'm bringing that to an environment
1516
00:56:27.830 --> 00:56:30.290
that has been improved, I'm still bringing that.
1517
00:56:30.830 --> 00:56:31.790
So we talk about this
1518
00:56:31.790 --> 00:56:33.170
when I'm talking with people one-on-one,
1519
00:56:33.230 --> 00:56:34.390
I say, well, what are the ingredients
1520
00:56:34.390 --> 00:56:36.590
you want to bring to the communal energetic soup?
1521
00:56:37.370 --> 00:56:38.850
If you want to improve the ingredients
1522
00:56:38.850 --> 00:56:39.450
that you're bringing,
1523
00:56:39.550 --> 00:56:41.190
that's where the internal work comes in
1524
00:56:41.190 --> 00:56:43.510
and if all of us do a little bit of internal work,
1525
00:56:43.610 --> 00:56:46.770
the flavor of the communal soup gets better exponentially.
1526
00:56:47.390 --> 00:56:49.170
We can't all be showing up with bitterness.
1527
00:56:49.870 --> 00:56:50.930
It doesn't work well.
1528
00:56:51.690 --> 00:56:52.750
Nobody likes it.
1529
00:56:53.010 --> 00:56:55.490
But often we are not even realizing it.
1530
00:56:55.670 --> 00:56:57.270
And this is not, again, to blame people.
1531
00:56:57.790 --> 00:56:58.970
There's no blame in this.
1532
00:56:59.450 --> 00:57:00.630
But we do, like you said,
1533
00:57:00.810 --> 00:57:03.010
we do need to start on this individual level
1534
00:57:03.010 --> 00:57:05.210
unwinding some of these internal processes
1535
00:57:05.210 --> 00:57:08.870
that we've gained, again, nature versus nurture,
1536
00:57:09.930 --> 00:57:11.710
do the best we can with what we've got
1537
00:57:11.710 --> 00:57:14.250
so that the ingredients that we're presenting to the world
1538
00:57:14.250 --> 00:57:15.590
are as good as they can be.
1539
00:57:16.090 --> 00:57:18.890
In that way, we can make that cultural shift
1540
00:57:18.890 --> 00:57:20.050
actually stick.
1541
00:57:20.470 --> 00:57:24.850
So we need policies and we need attention
1542
00:57:24.850 --> 00:57:27.230
and we need all of those things.
1543
00:57:27.270 --> 00:57:30.690
But we also need to be able to use those policies
1544
00:57:30.690 --> 00:57:32.530
and not think that we're a better person
1545
00:57:32.530 --> 00:57:35.790
if we ignore the like no triple shift policy.
1546
00:57:37.090 --> 00:57:38.910
Like you can't be better than everybody else
1547
00:57:38.910 --> 00:57:39.930
for working a triple shift
1548
00:57:39.930 --> 00:57:42.330
if the policy is double shift only.
1549
00:57:42.890 --> 00:57:45.870
And that's not something that anybody else can do for you.
1550
00:57:46.550 --> 00:57:48.590
That's something that you have to decide for yourself.
1551
00:57:49.550 --> 00:57:50.930
Yeah, you show up so differently
1552
00:57:50.930 --> 00:57:54.130
when you've changed internally or grown.
1553
00:57:54.510 --> 00:57:56.450
Yeah, so that both pieces are necessary
1554
00:57:57.330 --> 00:58:00.570
and don't wait for the external things
1555
00:58:00.570 --> 00:58:01.570
to shift for you.
1556
00:58:01.570 --> 00:58:03.870
Do your stuff because the more of us
1557
00:58:03.870 --> 00:58:04.930
that are doing this stuff,
1558
00:58:05.110 --> 00:58:07.210
the more of us are showing up to environments
1559
00:58:07.210 --> 00:58:09.510
and then not accepting them naturally anymore
1560
00:58:09.510 --> 00:58:12.270
because we're like, no, no, no, no,
1561
00:58:12.270 --> 00:58:13.230
none of this, sir.
1562
00:58:13.650 --> 00:58:15.490
Yeah, totally, I love that.
1563
00:58:15.590 --> 00:58:17.390
I think that's probably the end.
1564
00:58:18.030 --> 00:58:20.110
Oh, thank you so much, this is so fun.
1565
00:58:20.190 --> 00:58:22.110
I could talk to you for hours.
1566
00:58:22.430 --> 00:58:24.250
So thank you so, so, so much.
1567
00:58:24.550 --> 00:58:27.210
And yeah, we'll share all the links
1568
00:58:27.210 --> 00:58:30.750
and we didn't touch a ton on the ACE questionnaire
1569
00:58:30.750 --> 00:58:33.370
but I'll, adverse childhood events questionnaire,
1570
00:58:33.690 --> 00:58:34.890
I'll link to that below as well.
1571
00:58:35.750 --> 00:58:37.550
And yeah, just thank you so much.
1572
00:58:37.550 --> 00:58:37.990
You're welcome.
1573
00:58:38.190 --> 00:58:39.750
You can feel free to share that paper.
1574
00:58:40.410 --> 00:58:42.750
Yeah, feel free to share that.
1575
00:58:43.770 --> 00:58:45.770
The easiest place to find me is the podcast,
1576
00:58:45.990 --> 00:58:47.050
Fried the Burnout Podcast.
1577
00:58:47.330 --> 00:58:48.970
It's everywhere that you listen to podcasts
1578
00:58:48.970 --> 00:58:51.010
and that will guide you to all the other things
1579
00:58:51.010 --> 00:58:51.730
where I am.
1580
00:58:51.770 --> 00:58:53.770
So that's, I think like the easiest entry point
1581
00:58:53.770 --> 00:58:55.370
for people. Totally, awesome.
1582
00:58:55.530 --> 00:58:56.490
Well, thank you so much.
1583
00:58:56.490 --> 00:58:57.830
Thank you so much. I really appreciate it.
1584
00:59:16.550 --> 00:59:18.350
That's our episode for today.
1585
00:59:18.350 --> 00:59:20.270
Thank you so much for listening.
1586
00:59:20.590 --> 00:59:22.970
Make sure you subscribe, leave a review
1587
00:59:22.970 --> 00:59:24.890
and tell all your NP friends
1588
00:59:24.890 --> 00:59:27.810
so together we can help as many nurse practitioners
1589
00:59:27.810 --> 00:59:30.590
as possible give the best care to their patients.
1590
00:59:31.010 --> 00:59:32.490
If you haven't gotten your copy
1591
00:59:32.490 --> 00:59:35.130
of the ultimate resource guide for the new NP,
1592
00:59:35.430 --> 00:59:38.610
head over to realworldnp.com slash guide.
1593
00:59:38.930 --> 00:59:40.870
You'll get these episodes sent straight
1594
00:59:40.870 --> 00:59:43.690
to your inbox every week with notes from me,
1595
00:59:43.970 --> 00:59:45.730
patient stories and extra bonuses
1596
00:59:45.730 --> 00:59:47.850
I really just don't share anywhere else.
1597
00:59:47.850 --> 00:59:49.810
Thank you so much again for listening.
1598
00:59:49.970 --> 00:59:51.210
Take care and talk soon.
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