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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


Survival Strategies

Updated: Sep 24, 2023

Answer the following question, does kindness and compassion cost us (nurses) nothing? Sawbridge (2015) says the thoughts, feelings and emotional experiences we share with our patients contributes to "emotional labor". Nursing, as described by Menses, is a series of "disgusting, distasteful and frightening tasks". During these encounters there can be a withdrawal from our "emotional bank account" as a survival strategy. If we are exposed too many times to overwhelming, and disheartening emotions and experiences there can be a detachment from our patients and families. How do we fill this emotional bank account back up? Sawbridge (2015) makes an interesting observation, which I have also wondered about, which is that nurses do not get time off when something traumatic happens. Nurses have to deal with the emotions on their own without any help from their employers. No wonder there is detachment and burnout in so many nurses. Kindness and compassion do take a toll on the emotional, social, spiritual and souls of nurses. Survival strategies take over until the nurse is willing to work on the ensuing negativity.

Survival strategies, according to Morgan (2023), are used when we have unmet needs. Survival strategies are the inner critic, traumas, negative self-talk, low self-esteem and a feeling of not being enough. Survival strategies keep us from wholeness and from thriving. Some of those unmet needs are wanting to feel loved, to be accepted, to feel worthy, to be seen and valued and to belong. As nurses we bring our past with us to work. If you were brought up in an environment that was toxic or not supportive then we will continue to feel that way with your patients. But we have to get past those survival strategies to be the best we can be for our patients. An important question to ask is, who did you become to survive your life? (Morgan, 2023). For instance, many children of alcoholics learn to be quiet and not to be seen. As a nurse that does not serve our patients, as we have to be seen and we have to be heard. Remember that you are not your thoughts, and you are not your negative self-talk. Per Morgan (2023) we are taught by society to resolve and meet those unmet needs through external sources. She says, "it's a game changer when you realize you can meet your own unmet needs and that is when healing happens." (Morgan, 2023) When we learn how to meet our own needs, we can pass that onto our patients. Drug use, alcohol use, overeating, gambling, overindulging in material and physical pleasures contribute to survival strategies.

How do we learn to meet our needs internally and stop trying to meet them with external sources? How do we build integrity into our daily practice at work and outside of work? According to Langshur (2021) the first place to start is to remember that underneath every stressful situation is a thought about it. Our first task is to question the validity of the thought. Is it true? Is it real? Is it a negative thought that has caused a negative loop in your brain to surge out of control? For example, you walk into your ) patient's room to introduce yourself at the start of your shift and he (or she) tells you to get out in a less than kind way. As you turn to walk out what thoughts are you thinking? Are you thinking that he, like everyone on the unit, thinks you are a newbie and therefore know nothing? Are you caught in that spiral of "I'm no good" or "I will never be enough, will never know enough". One of my mottos that I take to work with me every day comes from Susan David, "emotions are data, not directives". Maybe the patient just got a diagnosis that he was not expecting. Maybe he found out he has days or weeks or months to live. Would that change your thinking? Langshur (2021) gives a 3-step process to change our thinking:

  1. Notice - what thoughts are spiraling around in your head? Are those thoughts based on reality or your imagination that always goes to the negative?

  2. Shift - how can you shift your perception, thoughts and emotions about the event or experience to that of the patient? How can you change your view of the situation from a negative to a positive? You can also think of a mentor or role model and ask, what would this person think about this situation?

  3. Rewire - take 15 seconds to savor the alternative view. Think of what can be learned from this situation and put that into practice in your mind. This simple practice rewires neural pathways in your brain.

As you practice these steps you will notice situations, events, experiences will not trigger you like they have in the past.

Langshur, E. (2021, May 17). How to make inquiry part of your mindfulness practice. Mindful.

Morgan, C. (2023, February). Love is already yours. Mindful.

Sawbridge, Y. (2016, May). Why might good people deliver bad care?

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