09 Dec Is ‘resilience training’ really the answer to quell the record numbers of midwives and nurses leaving the NHS?
There are record numbers of nurses and midwives leaving the NHS and they are stating intolerable stress and pressure as the reasons, according to separate reports by the RCM and RCN.*
The numbers of nurses and midwives at a glance appear to be up because recruitment drives are bearing fruit, showing that around 8,000 more nurses, midwives and nursing associates are now registered to work in the UK compared to 12 months ago. However the numbers joining the profession are not enough to fill the NHS’s leaky bucket. The hole in question created by a massive level of burnout amongst midwives and nurses.
Burnout is characterised by an unbearable amount of pressure placed upon an individual that disengages them from any pleasure, value or meaning from the job. This in itself is deeply problematic when we expect these same people to care and have compassion for those in need. Sufferers may experience fatigue, forgetfulness, anxiety, anger and even depression. A loss of hope and feelings of cynicism and apathy are common early warning signs of burnout.
The ‘pressure’ responsible for burnout can take many forms but commonly stated within the field of maternity care are bullying, workload, lack of resource and lack of managerial support. The most recent RCM WHELM study discovered:
‘66.6% of participants stated they had thought about leaving the profession within the last six months. The two top reasons were: ‘Dissatisfaction with staffing levels at work’ (60%) and ‘Dissatisfaction with the quality of care I was able to provide’ (52%).’**
I have been on midwifery social media forums when the subject of ‘resilience’ comes up and discussion very quickly and understandably becomes inflamed with anger at the implication that ‘resilience’ means ‘manning up’ or finding strength to battle through tough and unacceptable working conditions. Many midwives quite rightly feel that ‘resilience’ is used as yet another stick to beat an already beleaguered work force with. Implying that they are somehow at fault or weak for not being able to cope with often very poor working conditions.
And I agree that any NHS manager who suggests that ‘resilience training’ is what is required to fix the ills of decades of underfunding of the NHS is at best short sighted.
The premise of resilience training is an odd one. In my mind it conjures up a kind of emotional bootcamp where one learns to toughen up their responses to perhaps unsafe workload pressure, uncaring management and maybe even vicarious trauma that is witnessed on a frequent basis.
When really, burnout is a completely reasonable and very human response to very difficult working conditions. The large majority of midwives enter the profession because they want to serve women with compassion, dignity and professional, clinical excellence. However these values are continually eroded by the needs of the institution which too often puts cost, policy and protocal first and ahead of human need.
Resilience isn’t something you can train in it’s something that occurs naturally when we know we can cope. We feel emotionally strong when we are supported by others or exist in a supportive environment. We are able to bounce back from adverse events when we feel others have our best interests at heart.
However there are other internal factors that negatively impact on our ability to feel resilient and can make a tough working situation feel ten times worse. Anxiety undermines our confidence at every turn, adding to feelings of exhaustion and stress. Beliefs that we have no choice or agency in our work situation will also contribute to feelings of hopelessness. Unclear boundaries about what is acceptable and unacceptable to us can leave us vulnerable to exploitative workplace bullies.
Although it is very bad news for families that so many midwives are leaving the profession, for those midwives who have left due to intolerable stress or burnout it was an act of self love and self preservation.
In essence this is how the NHS is being slowly dismantled. Midwife by midwife, nurse by nurse. Many leaving to pursue the private sector where they can enjoy autonomy, free from the constraints of rigid and endless policy and protocol, free to serve families compassionately and on their own terms.
But what of the remaining workforce? What of the large majority of folk who will never be able to afford to engage with private practice?
Will resilience training save them?
No, I don’t believe that it will. If it could then surely it would result in some kind of coup that would over through the managers, politicians and policy makers.
But I do think that if each individual had more awareness of their internal anxiety, stress levels, unhelpful beliefs and fragile boundaries then they could begin to feel stronger, more able to cope. More able to push back against the pressures that cause burnout. This can’t be achieved through resilience training but it can be learnt and it can be practiced.
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