EMS self-care for supervisors: Manage stress and avoid burnout
Who's looking out for the supervisor?
By Wendy Lund, BScN, MSc; and Robbie MacCue, MBA, FP-C
COVID-19 is a global health crisis that has impacted every single person, and while first responders and their leaders are arguably some of the most skilled professionals equipped to handle a crisis, they are also on the cusp of longer-term crises; vicarious trauma, compassion fatigue and burnout. [At the end of this article, download a 3-part guide to help supervisors and providers practice self-stewardship to manage stress]
This is the cost of caring, but what about the cost of leading? While ensuring the health and safety of staff is nothing new, doing so in a pandemic is. Behind every caregiver donning and doffing PPE in this global health crisis is a supervisor, chief or captain who is charged with the care and concerns of both those they lead, and also addressing staffing issues, budget demands and securing life-protecting PPE while ensuring compliance with emerging policies.
Enough pre-pandemic evidence exists to suggest that the work of being a first responder can threaten one's mental health, but less is known with respect to the wellbeing of those who lead in EMS services. Supervisors are not immune to the cost of caring and are arguably more vulnerable given the burden associated with leading.
Statistics on the rates of PTSD include:
- It is estimated up to 35% of law enforcement and first responders had symptoms of PTSD, compared to 20% of the general population
- According to Mealer et al., 25% of critical care nurses and 33% of emergency nurses had PTSD symptoms
Crisis has a way of impacting how people receive and perceive the world; often narrowing attention to the immediate threat and how we position ourselves to react to it. Supervisors may be most impacted by the educational gap in EMS that addresses training and sustaining the resilient mind. Supervisors are naturally concerned about their human capital, but who is watching over theirs?
We need to equip all first responders with this knowledge, and especially our leadership team who are often the first responder to the first responders themselves.
It behooves leadership to recognize the knowledge gaps that exist and to provide adequate training so that supervisors themselves aren’t left managing everyone’s mental wellbeing without a framework of understanding on how to prevent it and manage it when it begins to show up on shift.
Clinical mistakes and patient safety events often result from staff who are just preoccupied or working with a high degree of presenteeism or burnout.
The fact that we haven’t addressed the mental health of middle managers likely originates from long standing beliefs that “you knew what you were getting into.” Stigma related to mental illness can appear in insidious ways (e.g., not providing training on an issue that costs organizations thousands of dollars every year to psychological injuries or cultures that don’t support psychological safety).
When you hear the term self-care, what comes to mind? A beer with your buddies (thinking pre-pandemic here), lounging on a beach or a weekend away at the cottage? While these are most definitely methods, the concept of self-care can be more than just relaxing. Self-care also includes holding ourselves responsible and accountable for actively participating in mental health hygiene practices.
The following self activities are all built on qualities of mindfulness and resilience. In order to be reflective, to be kind to yourself and to rest in appreciation for your own qualities, strengths and wellbeing, one must become present to this moment. Each of the following self-care practices promote not only a sense of wellbeing in individuals, but ultimately contributes to organizational resilience and promotion of wellbeing to others by example.
Encourage supervisors to practice and share the following self-stewardship practices to manage stress and avoid burnout – and to share them with their front-line providers. [Download the guide to distribute to your team]
"Without reflection, we go blindly on our way, creating more unintended consequences, and failing to achieve anything useful.” — Margaret J. Wheatly
Consider carving out time once or twice a month to write about recent events in your personal/professional world and examine what you have to say about what happened and how it impacted you. We cannot change what we don’t acknowledge. Writing reflections deepen insight and wisdom, and provide a record of your experience, an opportunity to examine your thoughts and find important cues to triggers of stress/resistance and peace/joy.
Questions to reflect on may include:
- How did this experience make me feel at the time and after?
- Looking back on it, what parts of me or the experience would I keep the same (and why?)
- If I had the chance, what would I do differently (take your own inventory, not others)
- What have I learned about myself, my organization and the world as a result of this experience?
- Despite the difficulty, what remains? What can I be grateful about having been through this experience?
Perhaps you became a supervisor because of an internal drive to lead. Maybe you have this voice that pushes you to be better, do better and lead better. There are times this inner voice hasn’t been so kind to you. We all have an inner critic. But, let’s face it, we likely wouldn’t be friends with this voice if we had the option. A little further down the hallway of our minds lives the friendly self and we would all benefit from getting to know what that version of ourselves has to say more often.
From a biological and psychological point of view, the problem with the self critic is that it can trip the on switch to our stress response and challenge our mental wellbeing. On the other hand, self-compassion has been associated with lower levels of anxiety, depression and body dissatisfaction.
There is nobody on the planet better positioned to be aware of what we can be grateful for than those in EMS. EMS providers have seen people and situations at their worst, and it can be hard to not let the situations we see influence our state of mind or not think tragic end-of-life situations are inevitable. In dealing with repetitive trauma situations, remember to be grateful for your own able-bodied life.
Gratitude is the “state of affirming the goodness or good things in one’s life, accompanied by a recognition that the sources of this goodness lie at least partially outside the self, such as with the good intentions of another person,” write Cregg and Cheavens in a “Journal of Happiness Studies” article.
Similar to self-compassion, self-gratitude is turning towards what it is about you that you can be grateful for, “gratefully reminiscing about the qualities of strength, integrity and flexibility (as examples) that you bring to your role as supervisor as an example.”
Practicing self-gratitude can foster self-acceptance and improve self-esteem. Those who practice gratitude cultivate the awareness and appreciation for what is good in their lives (extrinsic) and in doing so, they believe themselves to be more worthy of receiving what is good, which enhances self-acceptance.
Self-care is about taking care of oneself in a way that promotes wellbeing and effectively processes what is challenging in life. It’s not about ignoring what has happened in your professional life, or ignoring what needs to be done.
As supervisors of first responders in a pandemic, we need to recognize these signs in ourselves and others, and to be intentional about scheduling time to reflect and recharge.
Being proactive about your own wellbeing, mental health, and wellness will help you and others around you throughout your career.