Taking Care of Yourself First
One of the most important parts of being an effective caregiver is giving care to yourself, first and foremost. By nurturing yourself, you can approach families from a place that is centered and healthy. This in turn lets you lead by example, which can inspire families to strive for balance, self-nurturing, and health in their own journeys.
Acknowledge your own feelings of sorrow. When you form meaningful relationships with the babies and families in your care, witnessing their difficulties and sorrows can be sad for you too. Even discharges can bring mixed feelings of happiness and sorrow. But if you try to dampen your grief, you’ll also dampen your ability to feel joy, satisfaction, and accomplishment. Additionally, you’ll find it more difficult to tolerate grief in the parents you deal with. Psychosocial rounds can be helpful, wherein staff get together to discuss challenging situations and provide support to each other. Also seek other emotional, physical, creative, or meaningful outlets away from the NICU so you can process your experiences and tensions.
Face your own past losses. Since your work encompasses loss and sorrow, it may dredge up unresolved grief from your past. It is important for you to acknowledge all of your past losses, big and small, and give yourself permission to process your emotions and thoughts about these experiences in a safe and private place. Some of your emotions may seem unacceptable to you, but if you have them, you are entitled to them. You might try talking to others, writing, exercise, meditation, creating art, joining support groups, or getting professional counseling. If you can free yourself from the past, you can deal more effectively with the present.
Get your emotional needs met outside the NICU, so that you can become close to parents because they need it, not because you need it. This also frees you to be able to truly support and encourage parents. If your emotional bank account is full, you can make meaningful withdrawals without draining yourself or your own family.
Find ways to add energy and health to your life. Good nutrition and exercise feed your body and spirit, and can help you weather the demands of your job. Lighten your life by finding the humor or absurdity in things, especially those things that annoy you. Leave your job at work. Trust that the families and babies are in the kind and capable hands of your peers—even if your peers do things differently from you. You do important work, but to do your best, you must take time way to recharge yourself.
Allow yourself to cry, if you feel so moved . For many people, crying can be a valuable coping tool. If this is true for you, once you accept its value, it will feel less embarrassing. Still, if your culture or the unit culture frowns upon any emotional displays, you will feel pressure to stifle your tears. The trick is to try to find the appropriate balance for you and the families you work with. For instance, be careful not to express your emotions in ways that put parents in a position where they feel they have to take care of you. Shedding some soft tears in front of parents may be appropriate and appreciated whereas sobbing is not. If you feel you are losing control, excuse yourself, with reassurances that you’ll return soon. Find ways to calm down or a place away from the NICU to shed your tears (such as the chapel, where no one would think twice about it.)
Start an open relationship with each parent, as if the slate is wiped clean. Do what you need for yourself so you don’t shut down because the last parent was difficult, or even if your first impression is poor. Give parents the benefit of the doubt and let yourself be emotionally available.
Find a healthy balance in your relationships with parents. Get close to families, but also set limits and boundaries. Don’t take on their problems. You can care about them without taking care of things for them. Find a balance between involvement and detachment. Involvement can allow you to be empathetic and supportive; detachment can protect you from others’ emotional intensity. Remember that both extremes—caring too deeply or not caring much at all—when chronic, are ineffective and unprofessional. Caring too deeply and becoming enmeshed can lead to burnout and clinical depression. Not caring and remaining aloof leads to numbness and detachment. A supportive and professional relationship with families includes a balance between the two extremes. Balance also includes showing your humanness and honoring your unique, heartfelt style of supporting parents.
Maintain your own emotional balance. If you are sensitive and empathetic, it is normal for you to be affected by the profound emotions expressed by parents. However, you need to be able to empathize without taking on the intensity of others’ feelings. When parents are having a hard time and you’re starting to feel overwhelmed or over-involved, affirm your boundaries by reminding yourself that you are most helpful when you consider that their pain is natural and belongs to them. Repeat this mantra to yourself: “This is their baby and their journey. I help them by walking with them, not for them.” Refer parents to specific support people or organizations and trust them to find their own solutions in their own time. Talk with coworkers and others about your feelings—you are likely to discover that you are not alone, and that others have found ways to keep from becoming emotionally submerged.
Have realistic expectations for your work with families. Do not expect yourself to make a significantly positive impact on every family you work with. For you, some families will be easier, more rewarding, or a better fit than others, and that’s okay. Also, remember the ripple effect—that by helping just one family, you’ve made a difference that stretches to many other lives, the way a drop of water makes ripples that fan out.
Have realistic expectations for your work with babies. Remember that you do not have the power to know all the answers. No one is perfect, and everyone makes some errors in judgment and mistakes in care. If you had a crystal ball that told you the information you needed and every correct move to make, you’d use it, because you want the best for your patients. But since you don’t have a crystal ball, you cannot expect yourself to always have the answers or to never err. Some babies’ conditions are so complicated or bewildering, and some babies are born only to die or to be significantly impaired, in spite of your best efforts. While letting yourself off the hook can be difficult, if you learn from your experiences, then your trials and errors are not in vain. Also learn from the babies and families you work with. While you have much to teach them, recognize that they have much to teach you too.
Understand the emotional aspects of parenting a baby in the NICU—and beyond. Part of taking care of yourself is making sure you have the knowledge and skills to do what you need to do every day in your dealings with struggling and distraught parents. If you don’t understand the dynamics or don’t have the skills to interact effectively and supportively with parents, you’ll continually feel inadequate, drained, and demoralized—the recipe for burn out. Having resources you can rely on—including informational materials, specially trained consultants, and supportive colleagues—can boost your competence and replenish your emotional reserve. Push for developmentally supportive care for babies and their parents in your NICU or practice, as this integral part of relationship-based care and philosophy will make your job easier and more rewarding.
Push for developmentally supportive care for caregivers in your NICU or practice. Ask your hospital or clinic to improve your unit by funding efforts to support staff by providing the time and resources to attend in-services, seminars, and conferences that deal with relationship-based (or family-centered) care and the emotional aspects of parenting in the NICU and beyond. Advocate for the establishment of psychosocial rounds and perinatal mortality rounds, which should be facilitated by an outside professional who is knowledgeable about the emotional aspects of perinatal crisis and adjustment and tuned into the needs of families and staff. (See www.theschwartzcenter.org/rounds.asp) Rounds can be a place where you and your colleagues can share your experiences, gather insight and ideas for ways of working with parents, talk openly, and alleviate some of the stress of being with sick babies and their grieving families. Also recognize that some staff members have a natural gift for working with dying babies and their families, and they should be considered important resources to all of us.
Know when it’s time to move on. If you are feeling burned out, exhausted, depressed, depleted, overwhelmed, or waning interest in the welfare of others, take heed. You may be ready for a significant leave of absence or moving on to new challenges. It can be hard to quit. You may resist this move because of finances, guilt, or feelings of inadequacy. But there is no shame in acknowledging that this job is no longer right for you. You have changed and grown, given and given. Perhaps it’s time to seek another path, one that doesn’t involve the aspects of your job that you can no longer tolerate. Listen to your needs. Find ways to continue to use your signature strengths. Do what makes you happy, not what makes you miserable.
Being an effective caregiver doesn’t involve changing the world. Just plant seeds of hope and encouragement. In other words, don’t try to “fix” or erase others’ difficulties or emotional pain. You may have the answers for your own life, but don’t insist that those will work well for others. People need to live at their own pace, in their own way. As a caregiver, planting seeds means being a good listener and encouraging each person to find their own path. For instance, by giving a teen mother extra nurturing, you have planted seeds of encouragement that can germinate when the time is right in that girl’s life. By showing faith in a mother who has little confidence, listening to a dad talk about his childhood, or encouraging befuddled parents to read their babies’ cues, you have planted seeds of comfort and assurance that they can draw strength from. If you need closure, it may help you to follow up with families. NICU reunions, follow-up clinics, annual memorial services, communication with other practitioners can provide this opportunity. Whether you seek follow-up or not, trust that you do make a difference simply by planting seeds of hope and encouragement.