Trauma Informed Leadership Development in nurses on the front line.
Nurses on the front line. Nurses standing in their truth, in a picket line, on strike.
Nurses finding their voice. Not being able to speak is a universal experience of Soldiers returning from war. Not being able to speak is a manifestation of being in a life threatening situation.
Many references have been made to a War experience, with nurses being on the front line the early stages of the pandemic. Stories of what was happening in China, and then NYC, began spreading throughout the United States. Stories very similar to soldiers’ experiences in a war zone. At that time, nurses did what they had to do, what they were trained and educated to do. But one of the things we have learned from our war veterans, including but also different from PTSD, is Moral Injury. Healing from Moral Injury is now considered, along with PTSD, essential for soldiers returning home from war.
Moral injury has been defined by many within nursing and medicine as what is really happening to the decline in well being, not so much burn out. Although it seems burn out is still a very popular term, maybe because it is easier to talk about than moral injury. I heard of moral injury for the first time a decade ago, reading Jonathan Shay’s book, “Achilles in Vietnam: Combat Trauma and the Undoing of Character”. Shay wrote this book in 1994, fourteen years after PTSD became a formal mental disorder, coining moral injury to refer to the “unfolding of character” that war can inflict on good soldiers. “Moral injury is an affliction of conscience, identity, and meaning because of harm we cause, witness, or experience from others”. Critical and imaginative interpretations of the ancient accounts of battle, described in Homer’s “Iliad and Odyssey”, are deepening our understanding of the effects of warfare on the individual. As he shared soldiers’ horrific stories, fighting on the front lines in Vietnam, he shared the stories of soldiers being commanded to wipe out villages, women, children, older men, and killing young boys and little girls who were most likely carrying bombs and IEDs on their little bodies, which would detonate as soon as the soldiers came close. They had to kill to protect their comrades. In doing so, they acted in ways that completely dishonored their most valued beliefs in what was right and what was wrong. Non-negotiables.
But it was not until returning home that the isolation, guilt, shame, feeling out of sync and not fitting in, that the symptoms of PTSD and Moral Injury were manifested. Symptoms of alcohol abuse, drug abuse, anger, domestic violence, not being able to hold a job, stay in a marriage and care for children.
Not being in community has led to the diseases of dispair – alcoholism and suicide.
Nurses are experiencing these same manifestations as the pandemic is winding down. Violence is escalating, in the workplace, in the home, in the schools, in hospitals and healthcare organizations. Healthcare organizations are experiencing people who do not have coping skills. These people are in the systems receiving and needing care, and these people are working in these systems, providing care.
How do we create safety in a community of clinical nurses? Because it is in a community where trauma is healed. Healing from trauma does not happen in isolation. With nurses who are striking as an option to leaving the profession, they are striking standing in a picket line, demanding safe care of their patients, which can not happen without nurses feeling safe. Community can be a safe place, a place of refuge. Healing from collective trauma will co-create safe spaces of coherent clinical leaders on the front line. Spaces where the WE is Medicine. When one heals we all heal.
Trauma informed leadership development in nurses on the front line includes trauma sensitive interventions for integrating personal, collective, and ancestral trauma. Trauma healing is the missing piece in the implementation of “Trauma Informed” practices and policies. Nurses are caring for people who are living in violence, as well as living in violence themselves. Consider this recent heartbreaking tragedy.
The help we know of as help is not helping.
How do we create a new model for healthcare, a new way of being and a new way of doing from our being? Our bodies want to heal, our systems made of human souls and bodies want to heal. How do we let go of the system we know? Consider dissolving the box. Rather than thinking outside of the box, dissolve the box.
Nurses are finding their voice, healing from trauma, and transforming healthcare. This requires time, time for attunement and slowing down to connect, to create space for a nurse’s intuition. Compassion is a felt sense, a nervous system shift, where miracles occur, and it is always energizing, never fatiguing.