Setting Boundaries

Clare Cable: 04:01

I am Clare Cable, chief executive and nurse director of the Queen's Nursing Institute Scotland. QNIS has been supporting community nursing and midwifery since our inception in 1889. While our work may have changed since then, we continue to support and champion community nursing and midwifery at the heart of enabling health and recovery in every community in Scotland. As caring professionals, we often neglect our own self-care, which when unchecked over time can lead to burnout. These pressures are exacerbated by the current stress of unprecedented demand on our health and care services, and we're seeing the impact on individuals, families, and colleagues.

We can't change the world as individuals, but collectively we can create healthful person-centered workplace cultures. To do that, we need to be present, which requires taking time to check in with ourselves. This series of podcasts seeks to inform and inspire to help you reflect on your own health and consider what you need to stay well in these turbulent times. It's an opportunity to pause and take a few minutes for yourself. Today we're talking about self-care and boundaries, and I am absolutely delighted to have with us Hilda Campbell. And I'm just going to ask you Hilda to say hi. And maybe just tell us a bit about yourself.

Hilda Campbell: 01:58

Thanks, Clare, and thanks for inviting me along today. This is a really important subject because when we're caring for others, it really matters that we also look after ourselves. My professional background is mental health nursing. My academic background is social sciences and my ongoing CPD training, community development, co-production and design, suicide prevention, really anything where I can learn more so that when I'm working with others together we can find better ways to help people suffer less. Many of the challenges that cause distress nowadays aren't clinical in origin, it's life, life causing anxiety, life causing burnout, life causing low mood. And this is especially true when we work in caring professions. We're not immune to the same trials and tribulations as everybody else, but yet we have to smile and the show must go on. And so this opportunity to offer some tips that may remind you that you matter too, I appreciate.

Clare Cable: 03:01

Great, thanks Hilda. And I wonder if you'd just say a bit more about why you feel self-care is so essential for all of those who work in the health and care system.

Hilda Campbell: 03:16

If we think about a plane which is in distress and the oxygen mask come down, we put our own mask on first. Not because we're selfish, but because if we've passed out, we can't help anyone else. And sometimes people think self-care and it's great, I mean going to meditate up a mountain that's marvelous, but it's not something that you can kind of do every day. So it's how to make self-care just part of your life, like brushing your teeth, washing your face because these two are self-care, making sure that you're getting enough water. It's ensuring that your body, mind and emotions are at their peak. We hear about mental load, the amount of things that we have to think about and that can range from, oh, ran out of milk, need to make sure to go to the shop before I go home to Mrs. so-and-so's test results are coming in today.

She's really anxious about it. What can I do to help ease her anxiety? And all points in between. With also an emotional load, now if we're struggling financially, then it might be I can't afford to go to the shops just now. I am worried how Mrs. so-and-so's going to feel because I have compassion, I care because I know the results aren't the results that she was looking for. So we have a mental load and we have an emotional load and just like a physical load, when you're carrying that for a long period of time, you become exhausted.

Self-care doesn't mean we don't have to carry the load because sometimes that's the job that we come into, but it's about, do I have to carry all this load just now? Do I need to carry it this far? Can I ask for help? And self-care gives us that opportunity to pause and think, wait a minute, does it have to be this hard? Because sometimes we're in the midst of it. It just feels like we're stuck in a hamster wheel going round and round and round. Self-care is a way to remind us, whoa, I'm not a machine. I need to look after me too so that I can be there for others.

Clare Cable: 05:21

And I just think that's so important, but it's so easy to lose sight of. It makes absolute sense and yet it's the kind of thing that we preach to others. We look after the others in our team, we tell them how they need to take time and somehow it's really hard to actually do it for me. I wonder if you could maybe share a bit about how you've managed to actually persuade yourself that you need to do it for you whilst you're busy sharing how important it is for others to do that.

Hilda Campbell: 06:07

I think probably one of the most powerful things for me was a few years ago I was fortunate enough to do an eight-week mindfulness based stress reduction course led by a psychiatrist from Gartnavel Hospital. And we had secured funding, it was [inaudible 00:06:24] Scotland who were actually running the course and it was all colleagues from health and social care. And it was quite an intense course because there was a lot of reflection that was there. And the one thing that I took away from that was I became very aware of my respirations. I became very aware of how fast I was breathing. So my resting breath could be 17, 18, 19 resps a minute at rest. And when I did the mindfulness course, I became really aware, wow, I'm virtually panting. No wonder I feel stressed at times. So my mindfulness practice is really focused on how often I breathe per minute and my average breathing rate now is about seven or eight a minute.

And that's regardless of what I'm doing. So I'm used now to breathing very slowly. If I notice whoa, I'm starting to breathe, then the mindfulness has made me think what's going on, what's happening? Why am I feeling like this? And then I'll take that moment. Another thing that I do is I've got this idea of a battery exercise where one, you flats a pancake, 10, you've got heaps of energy. And every day I'll score myself. Now 10, I don't feel like 10 every day, now I got to do ix, seven, eight, I'm actually quite happy with. If it's at six though, that means it's sliding down. So I will look at, where am I putting my energy, how do I top my energy back up again and where am I wasting my energy? And I think that's one of the things that we can find and work is that we sometimes find ourselves doing things that doesn't make sense.

Our teams maybe find they're doing things that doesn't make sense and creating that space to look at that together and say, "Is there another way that we can do it? What would that be?" Or, "No, there isn't another way we can do it." So is there a way that we can get it done where it doesn't make us feel so bad? But it is a wicked question, how do we show compassion for ourselves while simultaneously showing compassion for others? And our convener of our staff wellbeing group within the Q community, which is open to guests and if anyone wants to come along to that, they're more than welcome.

And that's one of the things that we are exploring is that paradox of we know what it is we need to do, but it's making time to do it. And that's why I think sometimes it's small things, making sure that you're hydrated, making sure that you listen to your body when you need to go to the toilet, making sure that you listen to your mind when you just need to take a moment to pause and to become aware of your body, where your tension is and things that you can do that can help relax it.

Clare Cable: 09:20

Hilda, I'm completely inspired by the fact that you have brought your respiratory rate down from 17, 18 down to six or seven. I just think that is absolutely extraordinary. I have been practicing mindfulness for many years and when I'm meditating, I can bring my respiratory rate right down. But recently I bought one of those smart watches and it's telling me that my average respiratory rate even through sleeping is around 17. So the fact that you have actually made that difference that is sustained through normal life, not just during the periods while you're meditating, that feels really remarkable that you have managed to make that really significant shift.

Hilda Campbell: 10:24

I think that's why it's called mindfulness practice. It was a conscious effort because at times I was having panic attacks through stress. Now I'm in charge of an organization, heading up a team, working with the public, maybe with someone who's very distressed. I didn't have the luxury of having a panic attack. So it was, okay, the show must go on. Where inside it was, the show's not going on at all. So my motivation, I suppose it's built in the oxygen mask. My motivation was so that I could remain calm in what were challenging circumstances. And if people listening to this haven't tried some of the capacity practices, I would highly recommend have a look at them also. There's the finger hold exercise I find is really helpful. That is something that's a kind of first aid for me. So if I'm in a situation where I'm becoming quite, then I'll just do a little subtle finger hold, remember my breathing and before I know I'm back to being calm.

Now the reason why it's called practice is because it does take time and you have to find that motivation. But my motivation is also for my own cardio, because I enjoy chocolate. I'm not exactly somebody that goes hiking. So from my cardio's point of view, I have to think, right, what can I do to keep my lungs and heart in good condition? Yes, I have to be active, but I'm not going to the gym and things, so I need to look at other ways that I can be kind to my ticker and not put it under undue pressure.

Clare Cable: 12:05

No, that's really impressive. And yeah, I'm truly in awe of that one and something it just reminds me to continue that practice. We were working with a wonderful vocal trainer a wee while ago, and you know the phrase practice makes perfect. He did a lovely reframe of that and actually said, "Practice makes habit." And I just think that's a lovely reminder is that these practices are there for us to continue to work at them and then they become habits and it's those self-care habits that we just need to find and keep practicing so that they just become part of our life. As you say like cleaning your teeth, they're just kind of built in to the day.

Hilda Campbell: 13:00

I think actually to remember reading up on learning theory yonks ago, and the analogy maybe is to think about a car. So when you don't know you can't drive a car, you're unconsciously incompetent. And then when you decide you're going to try and drive the car, you then become consciously incompetent because you know you can't drive a car. Then you go through this can drive the car if you're concentrating on what you're doing so you're consciously competent, but once you've been driving for a while, you become unconsciously competent so that you drive the car without even thinking about it. And that's why people drive the car.

If you were to stop just saying and actually say, "Walk through the process of starting your car." It would be, eh, eh, ah, because we do it intuitively, and I think that's what we have to get to the self-care is that we don't realize we're not doing it. We then realize we're not doing it, but we're not very good at doing it. We then do it if we really think about it, but if we do it enough where we're really thinking about it then it's true, it becomes a routine and that routine becomes a habit and then it just becomes instinctive where you don't think about it anymore. It's like now brushing your teeth, you just do it without thinking about it.

Clare Cable: 14:15

That's really helpful and I think it would be good to maybe move that onto the next thing that connects us nicely into the idea of boundaries. So sometimes people talk about work life balance, but it suggests that we've got a finite amount of energy and we need to split it. But I suppose for me the idea of boundaries is just a bit more comfortable. How do we create those boundaries between our work selves, our private lives, our our family lives, and ensure that at the heart of all of that we are still looking after our needs and that we're not just splitting ourselves between the many demands on our time and energy? And I know boundaries is something that you've done a lot of thinking about and a lot of writing about, and I wonder if you'd be kind enough to share some of what you've learned about setting boundaries.

Hilda Campbell: 15:21

Yeah, you're right. And the trouble is if we don't set boundaries at the beginning, it actually becomes really difficult to then put them in place. So if you imagine you've written a job description to the world, I am a doormat, I will never say no, I will work all those extra hours. No, I don't want paid for it neither I do. Yes, of course I'll watch the kids at the weekend. I was going to do something, but it doesn't matter, your time's more important. If we have been this kind person who always wants to help others, who finds it really difficult to say no, then actually can be quite difficult when we decide, no, no, I'm not watching the kids in the weekend. I'm going to do something for me at the weekend. Because what we can get is a pushback and this is one of the things that can confuse us.

So it's I'm a nice person thinking about others, so why is it when I decide to think about me, people call me selfish? Because if we've created this job description for ourselves for our life, people have became used to, well, that's who you are. So one of the things when we're starting to reestablish boundaries is that if we feel this is our personal life, but it can also apply in our work life, if we feel maybe, whoa, there's no boundaries here, anything goes. I need to pull this back in a little bit, then it's who are my decisions going to affect? And let me create some time to sit down with them and explain, this is how I feel and I appreciate this is how you feel, but somewhere in here I'm losing myself and I need to take back some time from me as well as still doing X, Y, and Z.

And I think one of the challenges since lockdown and especially as well with all the various things that are happening, strikes et cetera, is that more is being expected of people in the work. People are dealing with emails when they're not at work, when they're on holiday. And if they're not doing that, they're thinking about it. Was speaking to someone in social work recently and they were saying that when they're standing doing the dishes, they're replaying their day decisions that have been made. Did I do the right thing? Did I leave that report? Did I do X, Y, and Z? And the same thing happens to the nursing workforce. When we are feeling under pressure because we'll get so many demands on is sometimes it can be hard to trust your own judgment. So another reason why boundaries are really important is because if we don't set them, it increases our chances of burnout.

So sharing with others why we're creating these boundaries, recognizing they're not barricades. So boundaries are there to keep our energy in, not to keep other people out. And sometimes what can happen is that, and that's why people get confused. If your job is discretion is I'm a nice person and then all of a sudden it's like, "I don't believe I keep having to do this." And people are like, "Whoa, where did that come from?" Because it's like a pressure cooker that has been building up and up and up. So again, part of self-care is recognizing to yourselves, how am I feeling just now? And that might even be rehearsing a conversation before you have it with a real person, writing down what you think, writing down what you feel. And in a workplace there's compassion circles, there are various ways that people can create that couple of minutes where we just listen to each other without interruption, without judgment where things can just be released.

And that also is important that there's a manager in that circle that they don't feel, oh, I need to take all this on. Because one of the challenges when you're a manager is that sometimes people forget that you're human too. A lot of courses is now, if you're feeling under pressure or stress, you go and tell your manager. When managers go on training courses, this is what you need to do for your workforce around training for managers around their wellbeing. And we spent 10 minutes convincing them that they were there for them and not the staff. It's like get it right for you, you get it right for your team because they were so unused to the idea of, oh, you care about me, I matter. It's yes, you matter too. So there are also boundaries depending on the roles that we have in our team.

And it's interesting, there's different schools of thought. So some people feel that if you're in a senior role that you should be able to tell your team when you're feeling stressed, that's one school of thought. Another school of thought and I have to admit this is the one that I adhere to, but I'm not saying that's the right one, I'm just saying it's mine, is that if I'm feeling stressed, I may say to the team, "It's a lot going on just now, give me a minute to think about that." But I wouldn't actually show them how distressed I was because if we are going through a challenging time, they need to be able to know there's somebody there who's a common influence. However, and that's why I value yourself Clare, is because I'm very fortunate to have peers that if I really feel, that I've got colleagues that I can phone and say, "I really need to offload." Because we do.

And sometimes what people think is it means that, well, if I can't let my team know, I can't let anyone know. Other people feel comfortable sharing with the team and that's fine. I'm not making a value judgment as it's what works for you, just saying for me. So setting boundaries initially, maintaining boundaries, and bringing boundaries back under control is really important for our wellbeing. And guilt can get in the road of setting boundaries because we can feel guilty or no, If I don't do that over time or I don't go out today, this is going to happen. And I think one of the things when we're thinking about boundaries, maybe we need to think about as well as self-care is self responsibility. We're not responsible for everything and that's really important. We're only responsible for the little bit that's our responsibility. And sometimes we take on more responsibility than we should, and that too can become a boundary issue.

Clare Cable: 21:26

Absolutely. And I know it's something if I look back, I've done significantly that somehow we take on all sorts of things that are way beyond our control or we take on others' responses to what's going on. And at one level that feels like the kind thing to do, but at another level when you actually stop and think about it, it makes me a very powerful person if I think I'm in control of all of this and I'm not. I can only do what I can do and what I'm asked to do is to be who I am, one conversation at a time and just show up but not take on everybody else's problems. And I think that's when we find that we're not sleeping because we're turning things over and over and actually creating those boundaries that say, I can do what I can do and I need to be there, but I can't take this on because our heads would never stop.

I was interested what you were saying, Hilda, about finding others. There is something about having finding your tribe that if you are a team leader or in a senior position that it may not be appropriate to let what you are carrying spill out or there is a boundary there about what's appropriate to share and not with the wider team, but having somebody or a group of friends or a group of peers who have your back so that you know you have a safe space that you have somewhere where you can offload, somewhere where you are held and supported is really important. And I think for some of us, as you've said, sometimes that's outside of the workplace through professional networks and there are more and more spaces that we can find.

But to prioritize the time to actually give yourself that safe space to decompress, whether it's an action learning set or whatever it is for each of us to find that safe space is really important because all of us need a space where we can be ourselves and share something and even just get in touch with how it feels to be me right now and just to reflect on the extent of what we're carrying. So I would also encourage those listening that if you're not sure where your safe space is, to maybe think about finding it because we all need that space to decompress somewhere where we know we can be honest about how things are.

Hilda Campbell: 24:31

It’s also being honest with your team because what you don't want is making people who are on your team feel inadequate so you appear really cool, calm, and collected and they're not is actually a saying, I'm fortunate, I've got a peer support network, so today isn't about me, today's about the team. We all get stressed. I have things I do to help me manage my stress. My role here today is what can I do to help you manage the stress the team's going through? Because I think it's important that because that's why sometimes it can be difficult to ask for help because we fear we're going to be judged, but we all need help sometimes, we all need to offload sometimes and that's okay.

Clare Cable: 25:13

Absolutely. And I think there's something about role modeling, isn't it? That we are all human and to see our team leaders, our managers actually acknowledging the fact that they have asked for help from elsewhere, that feels important to make it okay. Hilda, I wanted to move on to maybe some practical boundaries, things like our physical self-care, having breaks, finishing late, not taking holidays, these sorts of things that were mea culpa, I've done it.

Hilda Campbell: 25:49

This is where within organizations and teams there needs to be cultural shifts and that's easier said than done. Because if you've only got one person who's turned up that day, but you have got a dial load for three people, then there is the risk that you're going to be on till 9 o'clock at night that you are going to skip your breaks. And A&E with triage, that's another form of boundaries. And the same is within, if we're working in communities, it's looking up, if we only have so many resources, where are we going to direct those resources today that's going to make the most impact? Because one person cannot, yes, you can have days when you're busy but not all the time. So if people choose to come in five, 10 minutes early because that helps them prep for the day, that's fine.

If it's becoming an hour, an hour and a half early, that's not fine. And what happens as well is when we see somebody else, it's a little bit modeling, when we see someone else doing that and we're in a structure where it's all about promotion as well, then it's, oh, we need to come in at that time. We need to work through our breaks. So by having regular start and stop times, regular breaks, we're more efficient so actually we get more done. Sounds counterintuitive so you have more breaks and you're more effective, but it actually, well, it's true. Having time and team meetings so at the beginning of the day when there's a team briefing going on, take a couple of minutes to do a breathing exercise. Just take a couple of minutes to be in the moment or if that doesn't appeal to the team, share what's attune that gets you going in the morning to make you feel energized.

So boundaries are also about how do we create the boundaries to ensure that our energy's protected, our energy's maintained and our energy's supported? And that is things like, I know maybe this is the nurse in me, I'm toilet obsessed, but the amount of times, not so much when I went to work in the community, but when I worked in the wards, the amount of times I ended up with cystitis because I just couldn't get to the toilet. You're heading towards the toilet, somebody needs you. You're heading towards the toilet, somebody else needs you. Now it can be the same for people who may have done a lot of online consultations, you need to go, but it's, no, I'll go after this meeting. That's not good for our body at all. So there are things as human beings, we have rights. Even a 20-minute break a day, we have rights.

So it's putting those boundaries in place. How much administration time do I require? How much administration time do I have? Is there any negotiation on how much of this I have to do? There's also some things where I understand that people can be very much on call all the time on their mobile. So it's maybe someone they don't have an appointment with that day, but the person's been encouraged to, "No, you can contact me anytime." These also are things which at an organizational level need to be looked at because it's about managing the expectation of the public. Now I know that may sound like a contradiction in terms when there's a lot of consultations about what else people are looking for from services and I get that, but when services are overstretched, I've been led by the voice of the lived experience for more than three decades.

People are realistic. When people sit down so there's also boundaries with your clients, which is if you do need to contact me, this is our appointment time and you may be have space in your diary, here's when else I may be available, but I'm sorry I can't immediately get back to you because I'm with other people just the same as if I was with you, you wouldn't like me to take a phone call from somebody else. So there's also those professional boundaries when we're working with people. And again, it comes into the guilt because we want to be helpful, but we're not giving our total attention to what we're doing just now when we're being distracted by the other things that we need to do. So looking after our physical body, by listening to our body signals and curving out a space to do that. Also, curving out a space for our thinking time, which is an administration or a reflection on practice, et cetera, et cetera.

Where do I have that? And then use your practice and taking the time to actually look at where's my working day, how has that mapped out, are there things that I can do that actually can help me regain that sense of balance is something only we as individuals can do. But one of the things that I do is that I will only check my emails at certain times. I wouldn't be distracted by them coming in all the time. And I very rarely use the phone. And if I do use a phone, it's a prearranged call because you waste a lot of time, the person's not there, you phone back and so on. So it's find the boundaries that work for you.

Clare Cable: 31:05

Absolutely. And I think in this online world it's been so difficult. So often teams meetings start at on the hour or on the half hour and people assume they have your time up until the hour, the half hour. And you can wind up just going from one set of screens to the next. And as you say, there isn't time to get up and go to the toilet to stand up, to move about, to stretch your legs, your spine between meetings.

Microsoft Teams has now got a new function that says, start meetings on the five past or finish them at the five two just to give yourself to take that chance and give yourself that space to get out of a chair, to stand up, to stretch, to have a comfort break, to get another drink. And it's just so easy not to do that, to come off one meeting and think, oh, I've got 10 minutes until the next meeting and wind up in your emails and still not getting up and standing and stretching and having a drink and just to introduce that practice makes habit in terms of standing up even. I know that I can go for crazy periods of time without standing and just continue to remind myself to stand up is so important.

Hilda Campbell: 32:30

The other thing as well as for people that do a lot of screen time is to actually let your eyes just focus on infinity because the eye strain that you can have, because sometimes we don't blink as much as we should when we're staring at a screen and then we find it's, oh, the world just went all bloody. Where in point of fact what we have is eye strain and just for a few minutes looking up and just letting our eyes focus on infinity, blinking a few times is also another thing that's really important. And these are simple things to do.

Clare Cable:: 33:02

And back to breathing, I read a little while ago about there is a phenomenon called email apnea where you're actually not breathing. And I thought that's crazy and then I observed myself and there are times when I'll read an email, I'm trying to compose what I should respond and I'm breath holding and just to be really thoughtful about our, back to the respiratory rate, are we hyperventilating or are we breathe holding? Just to be thoughtful and to ground ourselves again by taking a minute just to slow down and take a few deep breaths, crocodile breathing or circular, whatever your breath pattern is or so many smart watches will encourage you to just pause for a minute and breathe. But to actually do that from time to time I've found helpful. But I just wanted to spend a few minutes, Hilda, if I might, just thinking about what happens when it all goes wrong.

We know what we should do, but there are times when it all gets on top of us and we don't and I've just wondered if you'd just tell us a bit about your experience, what's burnout and how do we know when we're getting close to it and how do we intervene? Because I just think the pace over the last three years has been relentless and it's really hard, just as you were saying earlier, we're short-staffed. The amount of unmet need is, if anything, getting more extreme. When we've sense that we're getting to that place, I wonder if you'd just say a bit about your experience with that.

Hilda Campbell: 34:55

Humans are inherently compassionate. So you only have to see when there's a tragedy happens in somewhere in the world. Even when people are struggling themselves, they'll do what they can to help others. So it is in their nature to be compassionate towards others. When we work in a caring profession, every day we are exposed to the suffering of others. That's our job to trying to alleviate that suffering. And because we're inherently compassionate, then every day we are being exposed to the suffering of others. And if we are not looking after ourselves and it's day in, day out, story doesn't seem to be getting any better. Our reticular activating system, which is a filter that we look at the world through, it's just telling us it's bad and it's going to get worse then it's a bit like a ball that started off as being pretty resilient.

So when you hit it, it bounced, but it's now been hit so many times the ear has been knocked out of it and it can't bounce back. And it can be very subtle because it can creep up on you without you realizing it. Not caring anymore is one defense mechanism because it hurts when you care. So not caring, and that's an anathema to people in the caring professions because we care. We see someone suffering, we want to help, but that if we are not looking after ourselves can make us suffer over time. So one way to get around that is we tighten our professional boundaries, we become very clinical, we become, it's about the gangrene. It's not about the person who has gangrene, it's about treating the wound because I can treat the wound. I just think about the wound, I can get through today because I've got 15 other visits that I have to do that also are challenging.

But I start to think about the financial problems this person has, the fallout they've had with their family, et cetera, et cetera, et cetera, et cetera, I will feel overwhelmed so I'm just going to focus on this bit, but a little bit of us dies because deep down inside we know this isn't why I come in the job. I didn't come in the job just to treat a wound. I came in the job to do something, to reduce suffering in people, to promote wellbeing. So when we experience compassion fatigue, one of the things that can happen is that we start to doubt ourselves, why am I doing this? I'm not a good person, I don't care anymore. Our sleep can be disrupted, our eating habits can go out the window, our patience and tolerance with our family because it goes back to the mental and emotional load. So I remember doing some work with nurses once, and I got this myself. They come in for work and someone asks, "What's for dinner?" And it's like lighting a touch paper. I’m tired. I don't want to make another decision.

Clare Cable: 37:52

Yes, absolutely.

Hilda Campbell: 37:54

Or the weekend's coming and it's, "Oh, it's really nice, the weather, what are we going to do?" I don't know what we're going to do today. I'm fed up making decisions. So being irritable and then eventually burn out is where we actually maybe can no longer work. We are now having to go off sick ourselves. The impact that has on our confidence, our guilt, because all of a sudden it's, oh no, I know what everybody else is going through, now I'm not in work. And we're caught in this vicious circle.

So it's important that we're mindful of our feelings and a lot of that is also about the teams that you're in. I'm doing some work just now with someone actually creating a burnout survival guide because they themselves experienced burnout. And what they said really was a breaking straw for them was different environments. So one, each team had the same pressures, but one team's another part that waddled. One team where barbecues are a lot more common, would have team things that they did like maybe go to a barbecue or do something that they shared together. Whereas the other team was very robotic, very mechanistic.

Clare Cable: 39:05

Okay, so something about that team culture was really supportive.

Hilda Campbell: 39:09

Definitely, because the other thing in a team culture where there's collective care, which is something I'm really passionate about because as well as looking after ourselves is how do we look after each other is you recognize a colleague start to struggle and proactively find ways to have a safe space to have a conversation with them about. Because we all know when people say is everything okay? Yeah, it's fine because we don't want to admit it's not because then we might need to do something about it.

But it's creating that culture of sharing, learning together, being strong together, being vulnerable together, and recognizing that they're not exclusive because we feel vulnerable sometimes doesn't mean that we don't still have a lot of strengths within us, it's just that's part of being human. But there's a really good professional quality of life scale, which you can download from the internet. Doesn't replace professional advice so if someone really does feel they're struggling, they're advised to go and speak to a professional. But the ProQOL is a really helpful tool to actually look at, am I starting to show any signs of compassion fatigue? And it gives you key pointers to consider of areas that you might want to give attention to.

Clare Cable: 40:23

Thank you. And we'll put that in the show notes. It just reminds me of that lovely Charlie Mackesy image that in pandemic was so important for folk. The boy says to the horse, "What's the bravest thing you've ever said?" And the horse responds, "Help." And it is sometimes just recognizing that when we find ourselves at that point where we're not sleeping, that we're being anxious. All those signs that you so beautifully described, Hilda, just to have the courage to ask for help. So I'm mindful of time, Hilda, I could speak to you all day because I love listening to you, but I wonder if we could draw our conversation to a close, whether you have a couple of top tips for nurses and midwives who are carrying on day by day at the moment in the face of extraordinary pressure. What would your top tips for self-care be just now?

Hilda Campbell: 41:34

I would say one is become aware of getting a voice. So actually become aware of the story you're telling yourself about the situation you're in. And ask yourself, does the story inspire you? Does how you talk to yourself, is it kind? Could you speak to a child that you loved in that way? And if you find actually you're being very self-critical, very down in yourself, and it won't be easy at first, let's change the story. Find a kinder inner voice that reminds you how amazing an individual you are. Because sometimes, especially just now with everything that's happening, sometimes it can be an identity crisis almost, who am I as a nurse? What do people think of me as a nurse?

Think of yourself as a person, a person who caress and wants to make a difference in the world. But there's no point building a kind fairer world for everybody else if you don't make space for yourself in that too. There's heaps of tips on our website about reprogramming that activate system, getting back your oompf if you've lost it, setting boundaries. But the key things are just to remember, be kind and tell yourself, "I matter too." Because once you start believing that all the other things fall into place and you do matter.

Clare Cable: 42:54

Thank you Hilda. That's just such an important thing to hold onto and a beautiful place to end. Hilda, thank you so much for being with us. Thank you for your wisdom. Thank you for all that you're doing through COPE Scotland. It's making such a big difference to so many in Scotland and beyond. We'll end today's episode with Queen's nurse Gill Dennes, who's a practice nurse in Fife on the types of boundaries she sets for herself, which you too can perhaps incorporate into your working day.

Gill Dennes: 43:28

I'm Gill and I work as an advanced nurse practitioner in a busy, semi rural general practice. Every day is full on but rewarding and I feel inspired by constant learning and challenging myself. But thanks to the Queen's Nurse program, I understand the importance of self-care practices to prevent burnout, but also to enable me to live well and continue to love my work. So what does that mean for me? Timekeeping is essential. It shows I respect my patients who have set aside their time for consultation, but I also respect the value of my own time, starting and finishing on time, running my clinics within the allotted appointment times, offering follow up when needed and getting a proper lunch break are key aspects. Feeling connected with colleagues as well as my patients and of my community means taking time to inquire and listen about people's concerns.

I try to get a lunchtime walk with my nurse colleague. It's always a pleasure and we come back revitalized. I practice yoga and meditation and will often take my yoga mat to work for some lunchtime stretches on wet days. We'll sit quietly for a few minutes of mindful meditation. There are phone apps or online short meditations you can use, or just closing eyes and focusing on the body breathing sensations and letting go can give welcome relief from just being in my head. I firmly believe that compassion for ourselves and others is something we best access through connecting with our hearts. If I'm having a difficult day, I put my hand over my heart and allow myself to feel soothed. It's amazing the physical and emotional ease of that. I try to cycle to work and listen to the birds and feel the sun on my face. I try to eat healthily most of the time, but don't beat myself up about enjoying cakes when they're available. And when I do these things consistently, I feel I can completely focus on my patients and show them the compassion they deserve.

Clare Cable: 45:32

Thank you for listening. All the things that we've talked about are in the show notes, links to things that Hilda has spoken about, links to COPE Scotland. So do please connect in with the resources that are there and please take care of yourself. And for now, goodbye.