Strategies for fostering resilience as veterinary care providers

While my time since veterinary school spans far beyond 1 year, I feel compelled to write about my experience since I graduated 13 years ago and offer some important advice to the more recently graduated veterinarians.

If you told me at graduation that I would be engaged in a “split-personality” veterinary career divided between small animal emergency and critical care and health and well-being advocacy, I would have thought you were joking. Prior to obtaining my DVM degree, I thought I was destined for a life in companion animal practice, working in the Edmonton suburb that I grew up in. But life has taken a much different turn for me, which has led me down an extraordinary path into academia, specialty private practice, the speaking circuit, and even yoga and meditation teacher training. I love the work that I do and believe that my path has been intentional as it allows me to deliver many important messages regarding veterinary wellness.

That said, my path has not been easy and has been fraught with episodes of burnout, experiences with compassion fatigue, and struggles to manage my mental health and well-being. It is because of these events that I chose to leave jobs in veterinary medicine that I otherwise loved and at times felt unable to do the work that I am so passionate about. It is due to these same difficulties that I know of veterinarian and technician colleagues and friends who have left the profession or even taken their own life; feeling inadequate to continue working in veterinary practice, but not being able to name (or tame) the underlying cause.

It is for this reason that I have become passionate about sharing my story, experiences, knowledge, and advice when it comes to maintaining (and preferably thriving) rather than just surviving a career in veterinary medicine.

I’m often asked the question…what allows a person to stay resilient within this profession, bouncing back from setbacks and not letting failure or disappointment drain her or his resolve? I have come to believe and recommend that veterinary care providers adhere to 5 “S-words” when it comes to fostering resilience within our profession because difficult clients, unanticipated outcomes, challenging cases, and co-worker conflict are not going away.

1. Self-care — Self-care means doing something just for yourself and not for anyone else. While this might seem selfish and unimportant, experts suggest that it is unethical for care providers not to tend to self-care (1). We’ve all had days when we didn’t get enough sleep the night before, skipped breakfast, forgot to drink water, and avoided taking breaks just to get through the day. Unfortunately, not tending to self-care ultimately harms the clients and animals we are caring for because we end up making mistakes or experiencing compassion fatigue, which is a physical, emotional, and spiritual inability to care for others. Self-care has been shown to allow physicians to continue to care for their patients compassionately and safely (2). So, how can veterinary care providers tend to self-care? By setting self-care goals that align with the 8 wellness dimensions (i.e., physical, emotional, spiritual, social, intellectual, occupational, financial, and environmental wellness). Veterinary care providers can take a holistic approach to their wellness, allowing an overall sense of mental and physical health and wellbeing (3). For example, self-care can be as simple as scheduling a massage each month (physical wellness), seeing a mental health provider once monthly (emotional wellness), writing in a gratitude journal each day (spiritual wellness), scheduling an outing with a friend each week (social wellness), signing up for a new class once a year (intellectual wellness), attending an annual workshop to learn a new veterinary technique (occupational wellness), meeting with a financial planner once a year (financial wellness), or clearing clutter from the home and workplace (environmental wellness). No matter what resonates with an individual regarding what constitutes self-care, it is important to make time for it regularly. Self-care is truly a necessity (not a luxury) in the work that we do as veterinary care providers.

2. Saying no — Most of us struggle with saying no to others because we want to help, appear eager, remain a team player, and avoid disappointing our colleagues, family members, and friends. However, as Steve Jobs said, “it is only by saying no to others that we can say yes to ourselves.” When people ask me how to make time for self-care, I urge them to consider offloading something from their calendar to free up time. So, the next time you are asked to join a committee, coach your child’s sports team, or organize a work function, consider your other obligations and priorities, as well as the time commitment involved. If it is not a resounding “absolutely!” that you want to commit to the new request, then consider passing on the opportunity. Saying no is not easy, but there are some strategies that can help: be brief, be honest, be respectful, and, if possible, say no in person. That way the desire to help and thankfulness for being asked are passed along non-verbally, rather than the receiver assuming that you are disinterested or do not care. As difficult as saying no is, it is essential to fostering resilience and making time for self-care.

3. Setting boundaries — While physicians would not consider giving out their personal cell number or answering e-mails to patients on the weekend, veterinary care providers seem unable to prevent their work from creeping into their personal life. Over time, these actions can lead to resentment, frustration, and burnout. It is important to set limits in accordance with what you will and will not tolerate at work when it comes to client behavior (e.g., contacting you out of hours), co-worker conduct (e.g., treating team members with respect), and even the work that you choose to do (e.g., whether to perform declaw procedures). Feelings of discomfort or resentment are clues that a person’s boundary has been crossed. Very often, a person might also feel a loss of energy, knot in the stomach, or urge to cry. If these feelings come up, notice what it is about the situation, interaction, or expectation that is bothering you. Usually it is a sense of being taken advantage of or not feeling appreciated that causes resentment. When a boundary has been crossed or a boundary needs to be expressed, it is important to be direct and assertive in your communication, so that others know explicitly what your expectations are. Then stick to the boundary so that there is no confusion as to when or to whom it applies.

4. Sleep hygiene — The benefits of sleep are numerous and not just related to the restorative effects on the physical body. Sleep is required to refresh the mind, process what has been learned during the day, manage emotional experiences, and consolidate memories. The detrimental consequences of not getting enough sleep are also becoming more well-known and can include metabolic disturbances (e.g., diabetes, weight gain) and mental health concerns (e.g., depression). Recently, a link between Alzheimer’s disease and lack of sleep has also been found, suggesting that sleep is required to rid the body of waste products that have a degenerative effect on the brain (4). Insomnia affects up to 1/3 of adults at some point in their life and is typically due to worry and anxiety. However, there are many other things that can disrupt sleep including noise, interruptions, room temperature, humidity, lighting, diet, naps late in the day, lack of exercise, reduced exposure to outdoor light, negative self-talk, absent bedtime routine, or inadequate relaxation techniques. Physical stress (e.g., full bladder, poor mattress) or disruptions in circadian rhythm (e.g., shift work), can also inhibit sleep, as can alcohol or caffeine intake and use of electronics. Some pointers to help improve sleep hygiene, which is the ability to fall asleep (and stay asleep) for the recommended 7 to 9 hours per night, include the following: release daytime stress by relaxing throughout the day (e.g., stretching), make lists during the day to avoid trying to remember things in bed, avoid negative self-talk regarding sleep (e.g., “I never sleep well after a stressful shift”), allow 30 minutes to unwind before bedtime, exercise for 30 minutes each day, keep light out of the bedroom, turn off electronics (e.g., TV, cell phone) at least 1 hour before bedtime, get up and go to bed at the same time every day, use the bed only for sleep or intimacy, and avoid alcohol 2 hours before bedtime and caffeine 6 hours before bedtime.

5. Sitting still — As veterinary care providers, we spend most of our days rushing through appointments (often on autopilot), attempting to multitask (not that it’s truly possible), and reacting to things that happen to us (e.g., a co-worker makes a rude remark and we shoot back with a snide comment). Making time in the day to sit in stillness during meditation is a tremendously effective way to practice mindfulness. Mindfulness is living in the present moment (e.g., not worrying about upcoming appointments or thinking about previous clients) and remaining calm when faced with difficult situations. Neuroscience research shows that practicing mindfulness regularly can enhance the brain’s gray matter within the prefrontal cortex, which is responsible for holding attention, making decisions, moderating behavior, and solving problems. Mindfulness also shrinks the amygdala, which identifies physical threats and emotional triggers (5). Research in the medical field demonstrates that mindfulness training helps nurses cope more effectively with stress by improving their ability to think clearly and remain focused and calm during stressful situations. Mindfulness training also assists medical students, physicians, and nurses by promoting self-awareness and self-care, while reducing risk of professional burnout (5). Meditation is easy to do and involves sitting in a comfortable, upright position (back straight, crown of the head towards the ceiling), closing the eyes (if comfortable), and focusing attention on the senses. This can be the smells or sounds in the room, as well as sensations in the body. For many people, the sensation of breathing is a good anchor for the mind and counting each breath can allow focusing attention. It is completely normal (and expected) that the mind will wander. The key is to notice when it has and gently bring the attention back to the breath, body, or senses. Sitting in meditation for 5 minutes in the morning or even a few moments during a busy day can allow the mind and body to refresh and an emotional buffer to form between the triggers and responses that are a part of every day. If you are interested in learning more about mindfulness or trying out meditation, try downloading an application for your phone such as Headspace, Aware, or Calm.