PLEASE NOTE:  THIS TRANSCRIPT WAS PARTLY GENERATED USING AI AND WILL CONTAIN ERRORS.

E51 From Emma Orig

[00:00:00] Munir Adam: Welcome back to Primary Care UK. Let's learn together across primary care disciplines. It's Dr Munir Adam here, and today the topic we're going to be covering is about stress and burnout and why so many clinicians are unhappy. You may be listening to this and thinking, oh, yeah, heard it all before, the usual stuff, just be resilient.

[00:00:25] And that is so true that many clinicians find that the general advice out there for recognizing and dealing with burnout just doesn't seem to work. So you're feeling stressed, you're feeling burnt out, you're feeling unhappy, you're fed up with work, things just don't feel right, okay it's burnout, develop resilience, you're going to be fine and everything's going to be okay.

[00:00:42] And that just doesn't happen. And do you know what happens after that? You then start feeling worse because now not only do you feel burnt out, but you start feeling guilty. Not only am I stuck with all of this work and pressure, but now I can't even, you know, seem to follow the strategies to deal with it.

[00:00:57] And now you feel burnt out and like an idiot. Nobody cares, you think. Well, thankfully, there are people out there who care, people who have been researching this to try to understand it better and provide practical advice on how one might do something about it. People like Dr. Laura Laws, who we're fortunate enough to have today, she joins all the way from the west of the USA and talks to Emma, and she's going to be explaining why we need to actually get back to ventral vagal, and quite helpfully will be telling us about the three R's of regulation, reconnection, restoration, and why microdosing, not only will that help you, but through co regulation, it's going to benefit others too.

[00:01:39] You haven't got a clue what I'm talking about, have you? I had no idea either. It's all new stuff and it's beginning to make sense. Well, it's over to Emma from the Primary Care UK team as she interviews her.

[00:01:50] 

Understanding Burnout and Trauma in Healthcare

[00:02:02] Emma: Hi, and welcome to the podcast. It'd be great if you could just sort of introduce yourself, who you are, what you do, where you're from. 

[00:02:09] Lorre: Thank you so much for having me. My name is Dr. Lorre Laws, and I am a nurse scientist and author and a trauma burnout expert coming to you from the West Coast in the United States. States, Idaho, to be exact. 

[00:02:23] Emma: And that's new to the West Coast, isn't it, as I've just, I've just learned you've moved. 

[00:02:27] Lorre: Yes, I'm still unpacking that, uh, but we are here and, um, and I'm grateful for all the technology that brought us together today. 

[00:02:36] Emma: Yeah, we've got there in the end. 

[00:02:37] I really wanted to start by just sort of asking you, burnout and trauma informed care and things like that. It's not something I know a whole heap about, but what got you into this area and interested in this area? Yeah. 

[00:02:48] Lorre: Well, it's been quite a journey, but what really started work in my clinical practice, I'm an integrative nurse coach, and I'm also an integrative nursing professor at a major university. So research is something that is part of my daily role.

[00:03:03] And I was working with nurses before, during, and after the pandemic who were experiencing burnout. And what I found is that they were refractory. to the usual approaches to burnout recovery. You know, the traditional self caring practices that we're all so familiar with, right? And so, being a researcher, I started asking some big questions around that.

[00:03:27] Like, what if it's not burnout? Like, what if it's something more than burnout? And then I started, you know, reviewing the literature, because that's what people, doing research, that's the first place we start, is we deep dive into that evidence base, right? And I found that the concept analysis and all the kind of the theoretical stuff around burnout was from the 1970s.

[00:03:49] The World Health Organization defines burnout as occupational stress that isn't being effectively managed. But what we have in our healthcare systems is not just occupational stress. And so I really started researching, because I started doing some trauma practices with, with the nurses in my care and they were responding.

[00:04:10] And so I started taking sort of a PTSD angle and then went back into the evidence base and really started looking through that lens and found just a whole plethora of research on, for nurses anyway, it's called nurse specific traumatization. But then you look at what's happening in primary care, you look at what's happening with physicians, you look at what's happening with allied healthcare professionals and we can call it occupational related trauma exposure, much of which this was kind of the kicker because most of us are, well, all of us actually, by virtue of our education and training, we are prepared to manage the trauma exposures that are inherent with our practices, vicarious or secondary traumas, traumas that are resulting from disasters, right?

[00:05:00] We get training on all of what you might classify as Unavoidable trauma exposure, and we're prepared for that, but we're not prepared for, and what is driving nurses, physicians, allied health professionals from the healthcare field in droves is the avoidable trauma exposure, the short staffing, the limited resources. The workplace violence and that could come from those in our care or their families, um, in the form of physical or verbal, or from one another as colleagues in, in terms of gaslighting and bullying and incivilities of, of all sorts, because people under dire stress, people who are being traumatized in their professional roles.

[00:05:47] We lose that sort of, if you look through the lens of polyvagal theory, we start to leave that ventral vagal state where we're regulated and open and able to connect and be heart centered in our practices. And we get sort of first go into this sympathetic, what I call sympathetic overdrive, not just the sympathetic that we manage our daily stressors with, but this is like, you know, sympathetic response on steroids.

[00:06:17] And then we're asked to work under those conditions. In that activated state, we're not designed to have that be a chronic state. It's designed to be like, let's fight the saber toothed tiger and return to safety. And so what we're essentially doing is that I and you, perhaps, and, and many of our, our colleagues, including our primary care physicians who have no lack of exposure, no lack of, Uh, limitations in time and resources and all of that is that our nervous systems are essentially getting hijacked at work.

[00:06:51] Emma: Yeah, I mean, just to sort of put it really clearly, I guess, like, you've mentioned that burnout, and burnout is something we're just hearing a lot of people talk about now, but you've also mentioned PTSD. What's the differences there and how are they overlapping, I guess? 

[00:07:06] Lorre: So the traditional, when you look at the traditional definitions of burnout, they go back to 1970, and they're not trauma informed.

[00:07:16] Right? It's kind of a convenient narrative, outdated, albeit, and somewhat convenient because it shoves the burden and the responsibility on the healthcare worker, right? As though we have some deficit, as though we don't know how to take care of ourselves, as though we are not resilient enough, right? And so when I really started doing the research around that, I'm like, whoa, whoa, whoa, this is 1970s, you know, PTSD was at that time thought to be limited to military combat personnel.

[00:07:46] Yeah, or, or maybe some really violent acts, but the nervous system, the autonomic nervous system, as it turns out, doesn't discern the source of the trauma exposure. It responds to the stimuli, the cues that are not only, not only in our external environments in our, in our practice settings, right? Plenty, plenty there to process. But then also whatever is. When it comes to trauma, which all of us have experienced in some fashion or another, and that trauma gets stored in the body, whatever isn't healed at the time. So recently the world went through a major trauma, right? Yeah. So we can assume that on the planet we have a lot, a lot of almost everybody peoples who have unintegrated trauma that gets stored in the body.

[00:08:38] And so when we get trauma exposures in our professional settings, it activates what's stored within us because the body keeps score. That's a book by Dr. Van Kessel. I'm probably not saying this right. But so what happens is that from the perspective of the autonomic nervous system, from the perspective of the limbic system, from the perspective of the vagus nerve, which those structures innervate everything, right?

[00:09:05] Emma: Yeah. 

[00:09:05] Lorre: So now we're not talking about stress that, well, you know, M, if you would just go have a cup of tea every 15, every four hours, right? Or just take some deep breaths. While important, what I found through my research is that That's why the traditional self caring practices were not effective in the nurses that I had worked with.

[00:09:28] And when I started coaching them through a trauma informed and starting with the autonomic nervous system and the vagus nerve and the limbic system as the foundation. upon which all other self caring practices, then we started getting results. But you could do it hours and hours and hours, and, and millions of us have self caring practices.

[00:09:53] But if you're on top of a dysregulated nervous system If one does not feel safe and secure, either in their external world, in their practice role, or in their inner landscape, where an integrated trauma resides, then traditional self caring approaches aren't effective. 

[00:10:11] Here in the U. S., You know, I'm finding that healthcare professionals are feeling quite gaslighted by the terms, just do better self care and a little pat on the head or work on your resilience and let's do, what's happening is we're not getting to the root cause.

[00:10:27] The burnout symptoms are the tip of a much, much bigger Iceberg. And so, it's time to update our, our evidence base around burnout syndrome and, and taking a trauma informed, polyvagal informed approach, and, and I'm assuming that, you know, all of us are somewhat familiar with polyvagal, if not, I can run through super quickly.

Polyvagal Theory and the Innate Care Plan

[00:10:50] Emma: Let's assume we're not. Let's assume we're not familiar with polyvagal. 

[00:10:54] Because I've never heard of it before. 

[00:10:56] Lorre: Okay, beautiful. Well, thank you so much, because it's really foundational. So, Dr. Stephen Porges has done immense research and emerged with a theory, and it's a, it's a, it's a dynamic theory, not a static theory, for those of you who don't know/ those of you scholars out there. Called polyvagal theory and what it does is it provides framework for what these conversations that we're talking about. So we have in our autonomic nervous system and vagus nerve, we have essentially three circuits. 

[00:11:30] We have our ventral vagal circuit. This is when we are regulated in our nervous system. We're relaxed, relatively relaxed. We can manage the stressors of daily living. We're, we're able to connect and communicate as you and I both are right now in a, in a very, Real and heart centered manner. We're curious about the world around us and our our view our point of view is wide We can see the big right and so that's obviously where we all need to be practicing that that is like tick tick tick That's the job description, you know when you look at it through through that world and then when stressors come in Trauma exposures. We are prepared because we have the sympathetic nervous system comes online and all of this is Signaled by the midbrain in a process called the threat detector, which isn't an actual structure But it's how it's the the term that Porges coined to describe like how the midbrain signals to the autonomic nervous system what circuits and hybrids to come online or offline depending on not only external conditions but internal, that integrated trauma, unintegrated trauma.

[00:12:46] So we're in ventral vagal, it's where we should be. 

[00:12:50] But we get to work, and we are short staffed, overworked, not enough resources, we're met with violence, we're met with, uh, gaslighting, you know, in addition, that's all the avoidable trauma exposure, in addition to the unavoidable, which is, comes with the job.

[00:13:09] Right? But we're prepared for that, for the short term, because we have the sympathetic nervous system, which we all know what that does, right? It comes online and you get your TAN hormones going, your cortisol, your adrenaline, your norepinephrine, you're responding. And it's intended, evolutionarily, we're evolutionarily hardwired, that that's a short term stress response.

[00:13:30] And then we return to ventral vagal. Which is where we are to live, and that's where social connection is also available, is in ventral vagal. So we get, so then we get in the sympathetic, and maybe we're an hour into our, into our workday. And then we're in two hours to our workday. And there's no, there's no return to ventral vagal.

[00:13:51] And so we, we move from the, the sympathetic has sort of two zones, let's say. There's the I can zone. And Like, okay, I can do this. I'm busy, but I can get through it. It's, you know, it's a lot, but then over the course of the day, the week, the year, the decades, right? I've been around for 50, 40 years. I'm dating myself, but, you know, it's, it's, you know, it's a stacking effect.

[00:14:15] And then we get into what is the, Not so manageable. I can't part of where you're getting overwhelmed. Right. And so this, this, when we're in this zone where it's what I call sympathetic overdrive, this is like, we can't take a restroom break. I cannot take a sip of water. I cannot take one deep breath, even though I'm breathing anyway, I can't do it.

[00:14:38] Right. Because we are, so overwhelmed. And then we all know the impact of chronic stress. We all know the impact of oxidative stress on the mitochondria, which is responsible for a whole sequela of chronic conditions. And then if it persists alright, so we've, we've gone from ventral vagal to sympathetic I can, to sympathetic overdrive I can't.

[00:15:07] It's too much. I'm getting overwhelmed. And then what will happen is that threat detector process in the midbrain will signal to the dorsal aspect of the vagus nerve to shut us down because the mitochondria cannot produce enough energy. This is a physiological, cellular, subcellular issue that we're talking about.

[00:15:32] And so if you, like me and the thousands that I have worked with, find yourself can barely drag yourself into work each day, you're so exhausted, your heart is willing, your body is not so willing, your mind knows it needs to go. Or if you're on the weekend and the best you can do is, you know, you have a whole list of things that, things you want to do, but like, I just need to order takeout and, and watch Netflix or, so it's not a laziness thing.

[00:16:02] It's not a character deficit. It's not a personality flaw. It is a physiological condition that results as the inordinate amount of avoidable trauma exposure that each and every one of us has. And so when we start looking at burnout through this lens of polyvagal theory, you start going, Oh, Oh my, I think we're talking about a much more significant issue.

[00:16:30] And it's not.

[00:16:34] It's a trauma exposure and taking a completely different approach to occupational or professional well being, which is, which is of course my research and a book I've written on this topic and an academy. I have a healing academy for this nonprofit organization. Like I'm all in because now I can't unsee it.

[00:16:54] Yeah. 

[00:16:55] Emma: So you've meant, you did mention before, we talked about that, about the dressing the root, the root cause, and like you've alluded to a couple of times now, it's not just a matter of meditating or like, you know, have a relax, have a day off, it's how do we manage this then? What is the solution? I'm hoping you've got one.

The Innate Care Plan

[00:17:10] Emma: Well, 

[00:17:11] Lorre: yes, I do. You know, because because of the nature of my day job as a university professor and a researcher, where I kind of sit on that spectrum as I'm a conceptual framer. I frame things, and so I came up with a, developed based on the evidence, a four step process called the innate care plan. Each of us has a whole lived history of trauma exposures, and we don't have to know what those are for one another, we just have to acknowledge that those exist.

[00:17:44] And so the innate care plan process starts with three steps. Three A's. So I'm going to give the global, kind of the global framework, and then I'm going to leave you with a practice that can be done on the busiest of days. So you have something to take into work tomorrow, today, this moment. But in the, in the big scheme, what we have are the three A's.

[00:18:05] And the three A's are first becoming aware. Which we are doing right now being aware that there's it's not just burnout the vast majority of cases and then being aware of your autonomic nervous system your vagus nerve being aware of how your body is operating below the level of consciousness this is all midbrain and below.

[00:18:27] But you can see evidence, just like we do for our patients, right? We are always assessing in our patients for those signs, so being aware of ourself, of what our, how our nervous system is responding. Okay, that's the first A. 

[00:18:40] The second A is to attend, attend to the nervous system, because if we start with our self nurturing and nourishing. I do not use the word self care in my work. It's nurturing it. But if we learn the language of our autonomic nervous system and our vagus nerve and we learned how to navigate it effectively, and this is what my, what my book, Nursing- Our Healer's Heart is all about, where there's a hundred practices in there plus what, you know, so it's a, it's written in the first person, like we're having a cup of tea together, just like you and I are chatting and I would guide you through some practices, right?

[00:19:18] And so. Knowing that there's a hundred plus practices depending upon where you are in the three circuits, the ventral vagal, the sympathetic and the dorsal vagal. So for example, you mentioned meditation. Well, if people are in sympathetic overdrive, it is not available. To their nervous system. It's like asking a firefighter who is fighting a, a, a fire to go into the middle of the burning structure and sit and do a meditation. It's not available. We're in sympathetic. So that's the second A, 

[00:19:50] The third A is alignment. Mm-Hmm. . And this is where we start to align the inner and outer worlds based upon nervous system health, making sure that. If our conditions externally are not safe, if we're getting a lot of trauma exposure, then knowing that we need to insulate our nervous system so that we aren't as profoundly affected.

[00:20:17] And so this alignment, I just kind of for, for brevity, it's sort of the inner outer world correspondence.

[00:20:25] And then we get to the B. So it's three A's plus B. So we just talked about the three A's. The B is for balance. And This is the eight domains of wellness and self care that we all are so familiar with.

[00:20:39] We all have licenses that say we know how to take care of people, and so this gaslighting thing of you need to do better at self care. So, you know, your relational, your physical, your mental, your emotional health, financial health, relationship health, environment, making sure you're in a safe environment that doesn't have, uh, toxins of water you drink, you know, all of the normal things that we think about.

[00:21:03] So you notice in this innate care plan, which is designed to leverage within each of us, our innate capacity for healing, because as we all know, the body is always working towards homeostasis, whether, whether we ask it to or not. Right? And so we're leveraging that, so we're starting, the three A's are starting internally with that autonomic nervous system, vagus nerve system.

[00:21:27] Then we take that to the external in the balance, that's what the alignment step is kind of bringing that through into our traditional self caring, so now our self caring practices are being practiced upon a regulated nervous system. And then what does that lead to? What's the outcome? The outcome are three R's.

[00:21:49] The first R is that we get regulated in our nervous system. We get back to what's called ventral vagal tone, which is where that ventral vagal circuit is online and sympathetic is available to us to meet the stressors of daily living. All right, so first thing is we get back in regulation, and then we can practice from, from that place.

[00:22:13] And then the second R is reconnection, reconnection within ourselves and without, because when we're not in ventral vagal, when we go into that sympathetic, the sympathetic overdrive, the dorsal vagal, we lose the ability to make meaningful connections within and with others. Because, because we're literally in survival mode.

[00:22:35] We're not sitting down to have a cup of tea when we're running from the saber tooth type, right? Yeah. And so that's how we can be in a room of loved ones and still feel utterly alone, is because we have this sense of disconnection or dissociation within us. So we, so we bring harmony and wholeness within.

[00:22:55] And so the three R's again are regulation in our nervous system, reconnection. And the last R is restoration of our healer's heart, which is our why for everything that matters to us most, including our practice and bringing us back. So that's, that's kind of the global, that's global framework. And depending upon, That's what my work is about, my book and my academy, so you can learn how to navigate and learn how to assess where am I in my nervous system, what practices are helping me, how am I going to insulate myself, I have to go in tomorrow and it's going to be, whoo, it's going to be a doozy a day, how can I partner with the ancient wisdom, a hundred million years plus, I can't even count how old the autonomic nervous system is.

Action: Take Steps in Microdosis Matters Practice

[00:23:49] Lorre: So, if we have time left, I can walk you through what I call the microdosis matter practice. So we have something that people can put in their pocket and take with them. 

[00:23:58] Emma: Yeah, I think that would be really, really good. 

[00:24:00] Lorre: Okay, so the microdosis matters practice can be done in under 30 seconds. Sounds good.

[00:24:06] It's going to take, it's going to take me longer than 30 seconds to explain it, but you'll see. Um, and, and the idea is, is that we need to deprogram our conventionally held notions of self care. That means I need to take an hour, I need a spa day, I need to, you know, take a hike in nature. All of those are important.

[00:24:29] Yes. Yes. Yes. However, they're not available during our busy work days. And so it's super important to our autonomic nervous system to that threat detector that we micro dose it throughout the day with these 30 second micro doses to send signals of safety. in to the threat detector so that it can help us get back to ventral vagal if we're in that sympathetic overdrive where, where the vast majority of people are in sympathetic overdrive, I'm overwhelmed.

[00:25:02] I feel like I can't do it all, or they're in the shutdown place. I'm at work, I'm doing my best, but it's presenteeism. I'm here, but I can't be wholly here because my body can't make enough energy. 

[00:25:13] Yeah, so the micro doses practice goes like this. The first thing you do is you find a safe space. Alright, so any place, it could be a, uh, an empty, uh, clinician room, I call it my potty practice, it can be the restroom, it can go to the loo, uh, you can go, um, to the conference room, to your car, to a stairwell, take a ride to, in the elevator, any place you could just get away for 30 seconds so that your nervous system, that threat detector, that midbrain process, can get a signal of safety, like, okay, I'm safe, I'm safe.

[00:25:45] And sometimes that can even happen when you're in a meeting. You know, you can, if you can't physically leave, you can, in your mind's eye, put a bubble around yourself. Okay, I am safe. Here's a bubble of blue or golden light. I am safe. I'm in this, you know, having a really difficult conversation or the person is being aggressive towards me.

[00:26:03] All right, so you can't leave. So whatever you, however you can, ideally physically, but if you cannot, I call it bubble up. And get yourself in, in a bubble of safety. So that's step one. 

[00:26:15] And then step two is to ground and center. Now your feet are always on your ball. Yeah. So you can always just feel your feet on the ground below. Put your attention there. Um, you can also use your hands like right now, just if you just think about your hands, you know, they're there. Just feel the energy in your hands. Okay. Thanks. You don't have to look at them, but you still know they're there, right? Yeah. So see how that's dropping you into your body.

[00:26:43] Put your attention into your feet. Feel the feet, feel your feet, put them flat on the ground, feel the soles of your feet. You're not looking at them, but yet you know they're there. Notice how that's dropping you into the body. So, again, can be done in a difficult encounter or in a meeting or ideally if you can break away for 30 seconds.

[00:27:05] So, safe space, ground and center. And then the next one is called signaling safety. We need to signal safety. Overt signal of safety to the threat detector. And so the most available thing for all of us is maybe some 4 7 8 or 4 5 4 breathing, right? If you're really ramped in your nervous system, a little bit of jumping or twisting or shaking to discharge some of that energy because as mammals, that's what we're supposed to do, just like the dogs do and the cats do, right?

[00:27:43] And so a lot of times I start with just one big Deep mindful breath. You know? So let's do one together. Inhale 1, 2, 3, 4, hold 2, 3, 4, exhale 2, 3, 4. You can do that. 

[00:27:58] Emma: You do immediately feel better, don't you, when you do that, even with a hand thing, you do feel yourself just, you 

[00:28:06] Lorre: down regulate a bit. Yeah, because when we do that deep breath, it sends a little bit of stimulus to the ventral aspect of our vagus nerve.

[00:28:16] It helps to bring us back into that, um, and so that could also be done in a meeting. That could also be done during a difficult encounter with a colleague or a patient, right? It's about microdosing. So we have to review the Microdosis Matters Safe Space. physical or in your mind's eye, ground and center.

[00:28:38] Two quick things. I always have a grounding stone in my pocket that, that for me, that works well. But if, if I don't, then I know where to find my feet and I know where to find my hands. The third step is signaling safety, that deep breath, a couple of rounds. And then the last thing to do this with me is put both of your hands over your heart to receive and connect to the love that you are and the love that is here for you. 

[00:29:07] Every waking moment of every day, connect to your healer's heart, your why, for what you're doing, and for all that matters most to you. And just notice how having your hands over your heart. Also, it's like I just, I just went down like three notches.

[00:29:28] Yeah. So, all of these things I have done in meetings, I have done, I, I, I teach students at the university and sometimes some, some big challenges come up or, uh, when I'm in a clinical setting, um, even bigger challenges come up and, and you can even do this sort of in the background just to make sure because if we're regulated.

[00:29:47] If we are regulated in our nervous system, then that, by proxy, because we're mammals, those around us are going to co regulate. It's going to help them heal, because we co regulate as mammals. in groups. But if everybody's dysregulated, which is kind of what we have now, it's not burnout. We have people who are not regulated in their nervous systems and they don't have the language or the tools or the practices to really support them and bring them back in to regulation where those other self caring practices that we all know to do are then so effective.

[00:30:31] But if you're trying to do all of that on a dysregulated nervous system, well, this is why we're in the kind of situation that we're in. 

[00:30:39] Emma: I've had a bit of a few months of it, and I have described to many people recently, I feel like I'm like spinning plates on a hamster wheel while I'm trying to, you know, and just the things that you're describing, I suppose it's like actually just sort of Getting yourself from that, stopping that for even just a moment and just bringing it back down. Isn't and you know, I think perhaps if I'd have done that a bit more I might be in a better place I suppose. 

[00:31:04] But and I think so many people probably relate to that, that you just sometimes get on this hamster wheel spinning plates and you just feel like you can't stop all, you know, cause even They're even the smallest amount of time.

[00:31:15] You know, you're like, I don't have time. I don't have time. I don't have time. But then sometimes like, well, you need to actually do need to make the time, don't you? Because this is what's going to keep you going. 

Implementation simplified

[00:31:22] Lorre: Well, let me address the time thing, because one of the things that is really important is that we, um, I call it minding the transition gaps.

[00:31:30] This is where you fit it in. We have natural transitions. throughout our day. Every time I walk through a door, I tap it with my elbow and just do a 10 second as I'm walking through the door. When I sit down to chart, I do a micro dose. When I am going from the supply room into the next room, I'm, you know, before I enter, before every encounter I have, I do a quick 10 second micro dose.

[00:31:56] I mean, it doesn't have to be a thing. So look in your day when I'm putting on my seatbelt. before I take my first bite, as I'm taking a sip of my tea, right? It's, it's a perspective shift. So it doesn't have to take any more time. We are breathing anyway. 

[00:32:15] Emma: Yeah. 

[00:32:15] Lorre: Yeah. At their minimum, right. At bare minimum.

[00:32:20] And the, in the most

[00:32:25] Emma: Yeah. 

[00:32:25] Lorre: We're still breathing, so shift that perspective, and it's just a, it's kind of a retraining to prioritize our nervous system health, which translates to improved health and well being in every, every sector. Right? Yeah. And then, we, our nervous system is availed for those in our care to co regulate because the reason they're in their care, chances are they are in some sort of a sympathetic or sympathetic overdrive or a dorsal collapse.

[00:32:54] They need our regulated nervous system. We need our regulated nervous system. And this is where the important conversations, you know, it's like we all know that our health systems need to be fixed. Yeah. They're broken. We all, this is not, this, I've been around over 40 years, I'm not waiting for the healthcare system anymore.

[00:33:13] Emma: Yeah, because that would be ideal, wouldn't it, if they fixed that, but like you say, it's not going to happen. Well, it's not probably going to happen. 

[00:33:19] Lorre: It's not going to happen, right, and in the meanwhile, people, people are thinking that they're burned out and they're trying to do all the right self care things and they're, and they're, they're not improving and so they're leaving their roles or they're leaving the profession because they don't know what else to do, which is, which is legitimate Because it's survival.

[00:33:37] We are not evolutionarily built to withstand this degree of trauma exposure on a chronic level. It is physiologically not possible. And we've kind of hit that wall, um, in healthcare systems worldwide. I've studied all the, all the major ones and everybody's sort of in the same boat. So I think this is where our work is, but it starts with us.

[00:34:03] It starts with each and every one of us reclaiming our professional well being in the ways that I've described. And then we can, we can come together working from our healing scars instead of our gaping wounds to then work on the, on the organizational and system level changes that need to happen, you know, and that's, that, you know, social change system change takes decades.

[00:34:28] Right. So we need something that's actionable today that we can, we can do so we can get out of survival mode in practice and, and return to kind of what, what Stephen Porges calls our window of tolerance, where we want to practice for our window of tolerance, meaning that we're mostly in ventral vagal with some sympathetic, that sympathetic I can.

[00:34:51] You know, as we manage go through the stressors of daily living and our practices and staying in that window of tolerance is probably the single most important thing each of us can do. And so I'm hoping that the framework, the innate care plan framework, the big picture, um, gives, gives a place to go starting with our nervous system.

[00:35:15] And then working out to self care and then the micro doses matters, which can be done actually can do it in four seconds. Truly. Yeah, once you get the hang of it. So I'm like, those will be some tools. 

[00:35:28] Emma: Yeah, it sounds like building the habit of doing it is probably a big part of it as well. Like, like you used to do when you go through a door, you do that and like building it into the moments in your day and then it becomes just a habit that you do when you need it.

[00:35:41] Um, so people, if this is really resonating with people, which I'm sure it probably is, especially from like the, the burnout, crossover, PTSD, all of this and thinking, yeah, I do need to perhaps, you know, address this, you know, do you have like, people can find your book, you have resources. Where can we find that?

[00:35:58] I 

Take home messages

[00:35:58] Lorre: do. Yes. Thank you. I have a book, uh, it's called Nursing Our Healer's Heart, and you can find it wherever books are sold. And the first chapter is, uh, the introduction is nursing specific and, and as is the book. The last chapter, but everything in between is what we've talked about. It's really, it's really the playbook of what we can do.

[00:36:21] And then on my website, I have a self assessment. I have, um, we have town halls and masterclasses. We have an academy for people who want to be facilitated in their healing because really we're intended to co heal and co regulate. So all of that can be found on my website at drLorrelaws. com that's D R L O R R E L A W S dot com.

[00:36:47] Emma: Perfect. And I suppose if you had a final sort of key message, take home message for clinicians, what would you, what would you end on? 

[00:36:56] Lorre: I would end on: really challenge the burnout narrative. Challenge that. Challenge even how perhaps you perceive it. Because it's, it's not just burnout, we, the, the health, especially since, uh, since the pandemic and, uh, people did not have really a chance to even process or integrate.

[00:37:17] So even if we take just that one thing, uh, let alone all of the trauma exposures that each and every one of us have experienced over a lifetime. So starting with that autonomic nervous system, the most primal system that innervates everything in the body, it just makes good sense to start there. And then build your self care on top of that with the goal of being regulated and thriving in your window of tolerance.

[00:37:43] Reclaim your professional well being. It's yours for the taking. It's not the system. Only you can let the system make you feel bad. It's within our power, it's just a shift, it's an awareness shift, it's a micro doses matters practice and I've helped thousands of people and it's amazing, it's amazing what can happen where you can go from, I think I chose the wrong profession, I think I've made a terrible mistake, which I know millions are second guessing, to okay, well this is hard sometimes but I know what to do.

[00:38:22] Emma: Yeah. 

[00:38:22] Lorre: And I'm staying healthy despite, despite the challenges in, in our unit, our organization or in, in our healthcare delivery system at large. 

[00:38:33] Emma: Yeah. Yeah, absolutely. And I think that's the position that so many people are finding themselves in, isn't it? Where they go, well, I love the job and I got into this for a reason, but then also it's... I'm struggling because of everything, of those things we can't control. So if there's something that helps with that, and I always say to people I coach or mentor about being, having that sort of self protective element of doing things that sort of help you carry on being a clinician, that's important because what we don't want is people to leave really.

[00:39:02] Well, thank you so much for speaking with me, it's been really interesting, we'll put all the links to the things you mentioned in the description, so thank you very much. 

[00:39:11] Lorre: Oh, thank you for having me and from my healer's heart to yours, thank you for all that you are and all that you do, you are so seen, valued and appreciated.

[00:39:21] Thank you, alright, bye bye.