Why 'self care' is not enough for healthcare workers

"It's time to get another job darling".

My husband had found me sobbing on the floor after enduring the most traumatic several months of my career, in a job that I loved and had thought I would never leave.

To cut a long story short, a change in management had left me working with children who had significant histories of neglect, and physical, sexual and emotional abuse:

• in a fractured team,
• without clinical supervision, and
• isolated in very challenging work.

At the same time, my wonderful, external supervisor of eight years had had to stop work suddenly due to illness.

With all of my work-related supports gone, I was left working:

• with vulnerable children, who were significantly at risk,
• within a number of toxic systems, and
• without adequate support, governance or supervision over a period of many months.

The result?

Mashed me inside a toxic systems mess.

All the self care in the world does not correct inadequate healthcare management.

Self care is often presented as a solution when people are exhausted, overworked, and struggling to cope.

This can look like suggestions to do less:

• "Take time off work"
• "Drink less alcohol"
• "Drink less coffee"
• "Eat less sugar"

Or suggestions to do more:

• "Get more sleep / exercise"
• "Improve your diet"
• "Meditate / be creative / go to yoga"
• "Spend more time with your friends and family"
• "Go to therapy"
• "Go to EAP" (aka: Employee Assistance Program: counselling sessions paid for by most workplaces).

I tried variations of the above.

Unsurprisingly, they did not solve the systemic challenges that culminated in a lack of support and governance in my workplace.

Why can self care be problematic in healthcare?

Whilst it is important for everyone to look after themselves, the push for self care alone is problematic as it lodges the problem in the individual, rather than addressing the social and systemic causes of distress.

These are structural, cultural and political issues.

The very notion of self care is problematic, as it individualises a problem that is the result of overloaded and toxic systems. Individuals not coping is a normal response to extreme pressure over a long period of time.

Workers in helping roles struggle to put themselves first.

I think it's important to note that anyone who is struggling to cope is going to find it difficult to add extra tasks to their list.

We can all write the perfect list of all the things that we know we should do, but when we have no energy to do anything, the whole concept of self care becomes moot.

After all, it takes effort to enact tasks of care for ourselves

Although the notion of self care was borne out of the radical feminism of Audre Lorde, the core message appears to have been diluted into a ubiquitous, and at times, dismissive individualistic focus.

Further, the push for self care often comes from less altruistic purposes:

• There can be a certain condescension which suggests a preciousness, and an air of not coping that whiffs of blame.
• The commodification of self care sells the idea that we can buy our way out of a hard time, rather than pushing back on the structural supports that are required.

This attitude makes the solution transactional, rather than relational.

What can we do instead of limply suggesting self care?

Cultural and systemic change in healthcare are essential, and whilst that is an overwhelming thought, together it is possible.

The answer lies in building ethical communities of care, accountability, belonging and support: in collective care.

Together we can push forward to empower ourselves and make small, everyday actions to hold the policy makers and politicians accountable to make systemic and cultural change in healthcare.