Hi, I'm Sarah Lavonne and I'm so glad you're here. Here at Bundle Birth, we believe that your life has the potential to make a [music] deep, meaningful impact on the world around you. You, as a nurse, [music] have the ability to add value to every person and patient you touch. We want to [music] inspire you with the resources, education, and stories to support you to live your absolute best life both in and outside of work. But don't expect perfection over here. We're just here to have some conversations about anything birth, work, [music] and life. Trying to add some happy to your hour as we all grow together. [music] Bye nurses for nurses. This is Happy Hour with Bundleber Nurses.

I've been waiting for this guest for now. So, this is the second season. We reached out months and months ago trying to coordinate our schedules because I have read the book Burnout: The Secret to Unlocking the Stress Cycle now three times. I've listened to it twice. I've read it once and I keep coming back to it. And so, we are going to have a super engaging conversation that I'm really excited about today. But, I will just make a plug that we did last season on the pod. We did an episode on burnout and we brought in our mentors and this last mentorship cohort we sort of like brought in a ton of labor and delivery nurses who were struggling with their career and sort of like I don't know if I can keep going. This can be a fix. This can be a community that I can find to support me in my burnout. And so I was thinking about that episode in preparation for this episode and this guest who I'll have her introduce herself in just a second. The epiphany that I had the last episode and the conclusion that I came to, this is all going to play in was that maybe burnout is just a part of the cycle of our jobs. Okay. Yes, I know. I see her face. She's she's like wincing. And now I reread burnout again and I was like, okay, maybe not. Maybe I'm wrong on that one. And so I feel kind of like a jumbled mess about it. And so I'm so excited to have Amelia here to talk about burnout. But really, it's it's bigger than that. And so before we get into that, Amelia, will you just introduce yourself and then we'll have a conversation about this specific to our labor and delivery nurse community. My name is Amelia Nagoski. I uh am the co-author with my twin sister Emily Nagoski of Burnout: The Secret to Unlocking the Stress Cycle, which is a feminist book about stress. Uh my primary training is in music. I'm a classically trained conductor. Emily is an expert in uh human sexuality, actually women's sexuality in particular. And yet uh we discovered at some point along the line that our work actually overlaps surprising amount. Um so when I burnt out of my doctoral program, like to the point that I was hospitalized, I was physically ill. uh due to stress. Um uh she started talking about the things that she wrote about it and I was like, "Oh no, you can't look at it that way because of X and Y and Z." And she's like, "We need to write a book about this." So that's burnout. So then how did you end up writing a book about it? She had already written Come As You Are: The Surprising New Science That Will Transform Your Sex Life, and her publisher wanted her to write another book, and she was like, "Hell no, that was my personal Vietnam. I'm not doing that." I'm like, "What if you didn't have to do it alone?" Interesting. That'll play in, I'm sure. And so, here you are. Well, what I'm grateful for with the book is that I feel like it validated so much of what I've experienced in life, what I've experienced through the various jobs that I've had, but also just experienced in literal life. I want to start with this idea of what is burnout because I think right now, especially in nursing, oh my goodness gracious, we talk about burnout all the time and we are burnt out. There are about a third of nurses are planning on leaving the profession in the next two to five years, you know, and we're talking about we're in like a systemic crisis in nursing. And and yet, especially with this community, I will say that all of you listening, like you're here because you love birth and you love caring for people and you love your job and it's killing a lot of us. And I will say like I'm not at the bedside right now and I feel that collective stress. And so maybe you could just give us what's your definition of burnout? I know there's like the DSM definition, but where are we starting at when we're talking about burnout here? It's important to know that burnout is not um a medical diagnosis. It's not a mental illness. Uh it's studied by the WHO, the World Health Organization, because it's the kind of thing that can be controlled through systemic changes. um uh it was first kind of codified in the early 1970s by research psychologist named Herbert Freudenberger which is fun to say uh and he identified three primary characteristics the decreased sense of accomplishment emotional exhaustion and depersonalization and in the time since then it's been kind of narrowed down that especially women seem to experience burnout as in particular emotional exhaustion how we talk about it in the book is that while wellness is a state of action, right? Wellness is not a single state of being or a single state of mind. Wellness is the freedom to oscillate through all the cycles of being human. And burnout is getting stuck. It occurs because of a disconnect between who you are, what you have to offer, what you're capable of, and what is being demanded of you. And so for nurses in particular, I know you're not a nurse, but you can imagine. Why why would you see that nurses are particularly prone to burnout? It is okay. There's multiple reasons. Number one, it's a female dominated field and uh especially labor and delivery. I will say especially labor and delivery. Yes. Um, and I mean what our book focuses on is the ways that especially women, people who are socialized feminine, um, are treated differently in society. That's just a matter of record. That's just facts. And in general, treated as secondass citizens, treated as though our work doesn't matter as much. And of course, labor and delivery is like the quintessential women's work. So it's devalued by the larger scale society when in fact it is the foundation that existence is based on. Um I was a teacher for several years. I burned out of being a teacher too. And teacher burnout is another place. And in general, it's caregivers, people who are expected to sacrifice their time, their lives, their their bodies on the altar of society's convenience. Um, so the fact that it's mostly women who are experiencing this or if there are men who are in it, they also experience the same thing because they are categorized as being womanlike. And that's an even greater disconnect between who they are and how the world perceives them. [snorts] Second, there is the systemic problem of the American health care system. Um this is true in a lot of places around the world but in particularly in the US we have a problematic health care system in which the way that uh billing happens the kind of monopoly of the insurance companies uh the way that medical debt is held over people's heads um the the way that we underpay care providers and overpay the CEOs of insurance companies and the way that medical care is legislated by people who know nothing about medical care. This is another thing that parallels teachers where teaching is legislated by people who know nothing about education whose main experience with teachers is being a student to a teacher and again being a primarily a patient in the medical system does not teach you anything about being a care provider in the medical system. So, um, all of these things result in your existence within a system that does not value your experience, that does not value what you do as highly as it should be. And even more than that, it doesn't recognize how difficult the work you do is, in particular, the emotional labor that you do. Um, emotional labor is often dismissed as something you shouldn't be paid for, but like there's a lot of people who are not willing to do it, so it should be valued more highly. Uh, so in general, that creates a disconnect between who an individual nurse is and what the system demands of that nurse. Mhm. You talk about human giver syndrome in the book that was also just like I I every time I've read it I'm like yep and then I can't of course help but think about our nurses who like it's the epitome of giver job you know and then you add the layer of birth being a lot of time sometimes sick but a lot of times healthy emotional work the experience of birth is spiritual It's emotional. It's physical. And we carry the weight of that every single day and then have to continue to show up to a system that doesn't validate how hard that work actually is. And so, could you speak to that a little bit and especially kind of share with us, give us that overview of human giver syndrome? Yeah. Uh, this comes from a book called Down Girl, the logic of misogyny by a moral philosopher named Kate Man. uh in that book Dr. Man posits a world where there are two kinds of humans. There are human beings who have a moral obl she's a moral philosopher. So she posits a world where there one kind of person the human the human being has a moral obligation to be their humanity to live it to express it to acquire whatever resources are necessary in order to achieve that moral obligation. And on the other side, there are the human givers who have a moral obligation to give their humanity, their time, their lives, their bodies to the human beings. Remembering this is from a book called Down Girl, the logic of misogyny. Which group do you think she's saying the women are? That's right. It's the human givers. No one I've ever talked to has ever doubted that way of describing the world. Um, however, this does not happen just along gender lines. It's not a just a gender dynamic. It's also a power dynamic. So it happens across lines of race and religion and spoken language all the intersections. Um but when in the context of how uh Kate man posits it um the men are stuck being human beings who are not kind of allowed to be givers and the women are stuck as givers not allowed to you know as a moral failing it would be to like request resources of their own. And when you think about these two types of people, our world kind of seems to go, you know what would be great is if everyone could be a human being to live and express their humanity and to acquire resources. If that was the world we lived in, everyone would be taking from everyone else and we would end up with a system that looks a lot like the one we have now. Whereas if we actually pondered a world where everyone was a human giver, everyone looked around at the people around them and felt a moral obligation to give, to care, to provide resources, then no one would burn out because no one would slip through the cracks because everyone would be surrounded by people who cared for them, who were willing to offer support in whatever kind of way is necessary. If the world were full of givers, there would be no burnout. But we don't live in that world. We live in a world where there are givers and beings. And so because of that dynamic, giving instead of being, you know, the answer to world peace becomes a reason that half the population burns out. And we call human giver syndrome. Uh, giving turns into a syndrome because women in particular end up feeling this moral obligation to be constantly at all times pretty and happy and calm and generous and attentive to the needs of others. And they feel like if they fail at any time in their moral obligation to be at all times pretty, happy, calm, generous, and attentive needs of others, then they are failures. And since they're failures, they deserve to be punished. And if there's nobody around to punish them, they'll go ahead and punish themselves. And the final symptom of human giver syndrome is that you believe that these are normal and true ideas. This is just the way the world is. Women give, men can't take care of themselves as well as women can. And this is just the way the world is. This is just normal and true. When in fact, it's a choice we made as a society. the the cure for human giver syndrome would be to change the whole system [laughter]

which we laugh because like looking especially at where we're at right now I'm like oh boy we have quite the battle in front of us when you're saying all of this I'm picturing particularly labor and delivery nurses on the floor who are natural givers myself included I people ask me why I became a nurse and I'm like because I want to help people that's an easy on. Yeah. Which is true. The vast majority of people regardless of gender Mhm. little toddlers, boys, girls, whatever gender they turn out to be, want to help. It is in the socialization that the separation of genders becomes dumb. Yeah. Well, and I'm like that alone, you're talking about the cure for burnout is that we all become human givers. And like then it's beautiful to be on that side of things in many ways. Yeah. And yet the reality is that at least for me, I'll speak for myself that often times what that means is I get walked on. And often times I imagine these nurses and what I hear all the time and what I've experienced myself is that they're a part of a system that is a taker. And so then what how that manifests is you give give give and you feel like you're getting nothing in response and there's no compassion. There's no care for you as the caregiver to be well. And so therefore, no wonder, you know, it's like it all it it entirely makes sense. And yet it's a beautiful thing to be a caregiver. And so how does one in this system show up and keep going? There are two specific pretty concrete strategies that I can give you for overcoming this human giver syndrome and turn being a giver into something actually healthy for you. Uh the first one uh comes as a metaphor. Uh, and I'm going to use the story from Hunger Games to illustrate it. Remember the Hunger Games? Kenneth Everdine is a is an archer and a hunter. She lives in this future dystopia. There's the capital who every year have this Hunger Games where they reap two children from all of these um sort of far-flung uh districts. And Katniss volunteers as tribute to go into the Hunger Games to be like punished as this terrible horrible dystopian thing. Uh, and she's got to go in and fight to the death other children for this in this arena. So, she's about to go into the arena and her mentor says to her, "Katniss, when you're in there, remember who the real enemy is." So, she's in the arena. She's fighting for her life. She doesn't know who she can trust. And here comes this guy and he's she's got her arrow. She's got her her bow pulled and she's about to shoot him. Like, she doesn't know if she can trust him, if he's on her side, if if he's there to kill her. Uh, and he says, "Cadness, remember who the real enemy is." And she points her arrow from him. She points it up at the arena itself. That the way we end this feeling of constant competition for these artificially constructed uh uh illusion of scarcity. how we get rid of the idea that you know money is limited. We invented money. It's not limited. We can do whatever we want with it. Right? This artificially constructed scarcity is created by a larger scale system. And instead of fighting each other and falling for this lie that comes from this larger scale system, the thing we do instead is to point our eye our arrows where it belongs at the system itself. Um, it's complicated and hard to do in the moment when you're feeling like I need these resources. I need this time, I need this care, I need this money, I need whatever. Uh, and and the people directly around you also need it. And you're like, but scarcity and it you have to remember that's fiction. We could have these resources if only someone chose not to give the CEOs seven figure bonuses. That's thing number one is remember who the real enemy is and turn toward each other with kindness and compassion and understand where the um artificially created scarcity is coming from. Thing number two is to remember that humans are a herd animal. We're we're a communal species. 90% chimp, 10% bee, says Jonathan height. When you feel that feeling of like I I need to conform. I need You watch HGTV and suddenly you're like, "Oh my god, I need a white kitchen." Not because you're gullible, not because you're petty or um uh what's the word? Vain or anything shallow. No, no, no. It's because we are a herd species. And when you are running from the lion in the herd, the safest place in the herd is the middle. And deep down our nervous systems know that the safest place in the herd is the middle. And in order to belong, you need to do the things that your community signals to you will make you belong. Um uh only if you are not if you're not someone who conforms to a very narrow socially constructed ideal, you are not in the middle of the herd. If you are not white, you are not in the middle of the herd. If you don't speak English as a first language in the United States, you're not in the middle of the herd. Uh if you're not educated in a certain way, if you're not rich, you're not in the middle of the herd. And that's almost all of us are left literally on the fringes uh and put at more risk in society. And this makes our nervous systems tell us that we're not safe. And it is actually physically true that we are not safe unless we conform because we have constructed this system where only rich white heterosexual cis thin able-bodied English-speaking men are allowed to be safe. And if you diverge from that in any way, your life is going to be literally more difficult, literally at greater risk. And the less you conform to that socially constructed ideal, the harder it's going to be. So instead of making your nervous system feel like it has to conform to this like largecale vast uber culture, uh the thing to do is to surround yourself with we call in the book the bubble of love. It's a it's a group of people who care about your well-being as much as you care about theirs. And they remind you that you are in the middle of this herd. You don't have to belong to that bigger herd out there. you are protected and uh held and valued in your little bubble of love. Uh these are people who will when you have not had any sleep for 3 days, they will lock you in your bedroom and stand guard at your door to make sure nobody interrupts so that you can get the sleep you need. Does that make sense? Mhm. So, the two cures for human giver syndrome, remember who the real enemy is, not the other people in the arena with you, and the bubble of love, which I think a lot of times when we're talking about burnout, when we're talking about emotional exhaustion, we're told like take a bath and do some self-care and, you know, because it's meditate. It's our job as individuals to make sure that we aren't overly stressed because wouldn't that be so much easier for the CEOs if they didn't have to, you know, provide care or create a community where care is exchanged in equal amounts. Yeah, that would be so much easier if you could just like tell somebody, "Go get a pedicure and that's your job and now your stress is managed." Yeah, that would be so nice for them. So then if it's caused by a broken system, what responsibility lies within you as the individual versus the system? And then at what point does becoming a caregiver become self- eraser?

The things that we can do as individuals to manage stress like we haven't talked about completing the stress response cycle but as nurses you all probably know about you know the fight orflight response and how it's a cascade of you know electrochemical signals that affect every system in the body. Uh, and that most of the time like this evolved in the environment of evolutionary adapt to save us from like saber-tooth tigers and we could fight or flee and using up all the energy and all the neurotransmitters and all the new electricity that changes all those systems. Using that up by actually fighting, actually fleeing returns us to our baseline. um we do not have access to that most of the time these days because the things that cause us stress cannot be dismantled with uh fighting or fleeing like I know kids are very stressful right they're they make our lives full of so much joy but when your four-year-old has not put on their shoes and you've been telling them for 15 minutes sweetie go get your shoes on we have to leave in five minutes sweetie you need your shoes on go get right now. Okay, you have one shoe on. Where is your other shoe? Why are you in the TV room when we have to leave right now? Where is your And the thing that's going to handle that situation is not fighting or fleeing. Please do not leave your child by the side of the road. Society needs you to keep track of that, right? This is that's not how you cure that. So, what you do is you set the feeling of stress aside. You put it in a little box in the back of your mind and you breathe deeply and you stay patient and you are as loving as you can in that moment. That is a healthy and good thing to do. However, because you had that stress response, just because you ignored it doesn't mean it went away, right? it still exists in your body and it needs to be addressed in a separate process from the process you used to deal with the thing that caused initiated that stress response. So doing things that complete the stress response cycle independent of the experience of stress is one of the things we can do to make sure that our capacity to experience stressful things stays at a baseline. That means we can tolerate how much we are experiencing. Mhm. Uh which means that longer term we can stay in the system and work to create the change that will mean the next generation doesn't have to fight like we did which is difficult because of human giver syndrome. You feel like the things that will complete the stress response cycle are like physical activity and a good night's sleep and creative self-expression and uh yeah, your imagination and a big old laugh and a big old cry and all of those things. Women in particular are told you're not allowed to have that. Those things aren't okay. You need to be baking cookies for Becky's birthday party. You need to be showing up the church with the casserole for the whatever. Um, we are not told that we're allowed to do whatever it takes to take the resources and the time to do the basic things that will remind our bodies that the world is a safe place. So, doing the things that remind our bodies that the world is a safe place uh is the number one thing we can do to keep our bodies remembering that our nervous systems do not have to be vigilant all the time and that we can and have access to return to a state of safety. And what I'm hearing is the difference is instead of saying,"Well, you're burnt out. It's your problem. Go meditate and go for a walk." Instead, it's saying I am a part of something bigger than this moment that is creating an environment that isn't supporting my wellness that is testing um my internal resources day in and day out and maybe doesn't provide an opportunity for or an environment that supports my recovery. And so I'm going to take my recovery into my own hands and say in order to sustain for out of like love for myself and recognizing that I'm probably a human giver more often than not and therefore because I'm a human giver in order to keep sustaining this environment and my life and my relationships and wellness which is the oscillation between the two that I the freedom to oscillate and I'm thinking like from a nervous system standpoint too like your ability to move between fight and flight right and then rest and digest your recovery in the middle the the font in in polyagal theory it's the three poly bagel states yeah yep and so therefore my agency that I have as a part of a greater system that isn't likely going to support that is to do those things and prioritize those needs that my body physiologically has. Sleep being the number one thing. Um, sleep is the thing that we hear the most. People feel guilty for sleeping because they can't construe it in a way that will mean that they're doing it to help someone else, which is what gets them through other things. Um, of course, when you sleep well, you are doing it for other people because if you are sleepd deprived, you're not going to be good at your job. You're not going to be a good parent. You're not going to be a safe driver if you are sleepd deprived. So, by all means, get some sleep. We need you to. Otherwise, you're hazard to society. [clears throat] Get some sleep. Um, if you only want to change one thing to make your life more enjoyable and to help manage stress better, let that one thing be getting more and better sleep. But a major barrier to that is the feeling that you don't deserve it, that you're that you're that you're wasting your time. That sleep is selfish. So, the thing that's going to I mean, we all know that physical activity is good for us, right? We all know that sleep is good for us. We all know that connection and creative self-expression are good for us. But we also have human giver syndrome feeling like if we accept those resources, the time it takes to do those things, then we're moral failures and deserve punishment. So because we have that blockade, the thing that really makes that work is the bubble of love. Is the people who will remind you you deserve the time it takes to go get a good night's sleep. You deserve the time it takes to go for the run. I know when you get back from a run, you feel like the weight of the world is lifted off your shoulders. Go for a run. I will watch the kids. I will make dinner. Go for your run. I I got this end. Go take care of yourself. As you're saying this, I'm picturing and I don't know that I would have I definitely would have called it out as far as like who's my community, but as you're saying that I I'm having an aha for my own personal recovery is I think one of the ways that I've been able to manage and sustain and keep going in bundle birth for the last really hard couple of years is my sister who also works with me and she is so supportive for my needs. And I am human giver syndrome. Like it's I will be fine. I'll keep going. I'll take it on. I'll just work harder. I'll like I'll self-sacrifice it. Like I I have like a I have the syndrome. And what I've learned over having and being being through various stressful scenarios and like ongoing stress all the time is that I she's given me permission to learn my body and learn my own stress when I'm at my max to go Sarah you need to do. And she doesn't even have to say it now because I know that I have permission and she will be nothing but supportive when I'm like I got to go walk. And that's typically become like I I have to get outside. I need to do bilateral stimulation through exercising and metabolizing all those stress hormones and let my brain go and remove myself from my environment and get some fresh air and sunlight and be by myself in many times, but also she'll come with me where I'm like, "Let's go for a walk. You need to walk." Yep. I need to walk. Like we have a system now. And it's been lifechanging to also be given the permission that I can step away from my computer. I can step away from the quote unquote work. Like we frame it as the work now. But if I didn't have her supporting me in that, if I didn't have her like encouraging me and for me now to know so deeply like in my entire soul that that's acceptable, that that is praised, that that is supported. Mhm. I would be sitting at my computer continuing to grind myself into nothing. Yeah, that's exactly the answer. You did it. Five stars. [laughter] Well, and I'm still here, right? Like when in theory I should have given up many many years ago. Going back to fight and flight, when I think about our nervous systems being turned on into fight and flight in our environments and like the moment you start to remove yourself or and and sort of pull back, it's easy to get really pissed off at the system and the brokenness of it all. And I have to acknowledge that I believe that there are the best human beings imaginable in this system. And so it actually takes me back to our move learning retreat. So we just got back from Mexico and we had five days together with our Bundleberg nurses community and the theme was live colorfully the creative art of nursing centering the patient experience for better outcomes. So, it was like this three-fold thing, but really the sneaky goal of mine was to create an environment for recovery and to talk about the fact that we are a part of this system that we're all pissed off at many times or you just become apathetic. To me, it's like I see one of two things. It's like I'm furious and I hate it and I have to leave it, which I hear all the time or I've become apathetic and I can't care anymore. And you oscillate between the two, which it's honestly one of them is fight and one of them is freeze andor fawn. And so when we think about functioning in that system, how do we get through and turn the arrow at the ceiling versus blame each other? Now I get to ch talk about chapter two, which I am so psyched about because I almost never get to talk about chapter two. Chapter two is about the monitor. Uh the monitor is the name we give to a brain process that's actually referred to as the discrepancy reducing increasing feedback loop. It's a it's a brain process that monitors what your goal is, how much effort you're putting toward that goal, and how much progress that effort is creating. So goal, effort, progress. So for example, let's say you're going to drive to the mall. That's your goal. I'm going to get to the mall. Uh and everywhere in America that we've talked to anybody, it takes like 20 minutes to get to the mall, just about everywhere. and you're like, "Okay, I'm leaving my house. It's going to take me 20 minutes to get to the mall." But you get to the to the main road and the light is just green. And after that, you sail through another green light and another green light and oh my god, there's no traffic. Where is everyone? And it takes you like 12 minutes to get to the mall. You put in not much effort to make all of the progress and achieve your goal. That makes your monitor very, very happy, right? But if you leave your house and you're like, "Take me 20 minutes to get to the mall. Here I go. And you get to the first light and it's red and then the person in front of you doesn't go and you're like, "Oh, you didn't go. You stupid jerk." It's frustrating, right? This is where frustration comes from is the fact that you put in more effort, made less progress, and did not achieve your goal. And this increases over time as things get more and more frust. You hit every red light and then oh my god, there's an accident. And now the police are there and you're not going anywhere for like at least an hour. And now you want to bang your head on the steering wheel and cry because this is the most miserable thing ever. At some point, your monitor changes its assessment of your goal from achievable to unachievable and it switches you from a state of rage to despair, which yes, in the poly vagal theory are sympathetic and dorsal. Um they're the opposite ends of the spectrum. And there is a thing that in the book we called it foop. it. It's this state of oscillation between rage and despair, between sympathetic and dorsal, where you're thinking, I can't believe this thing. It's so terrible and I give up. It'll never be anything because it's so awful and why can't they see that I'm just trying here? This oscillation between rage and despair. We call it the foop. Um because there was no name for it. So the thing to do in that case is to deal with your monitor itself to change the goal, change the effort you're making. And either one of those is going to change your a monitor's perception of the progress. So if you set out to change the system to basically climb Mount Everest, if you think, "Okay, I'll have that done next week." next week you're going to be throwing rocks at people out of rage and then taking long hot baths out of despair. But if you instead understand that your assessment of this goal is this is going to be the biggest thing I have ever done and it's going to take 20 years then your monitor knows this is going to be so much effort and the progress is going to be so slow. uh and then your monitor won't get as frustrated and won't shift you into these, you know, protective states of sympathetic and dorsal. I It reminds me of our story that we share about the starfish. I don't know if you've ever heard that that story of the grandfather on the beach. I've now people listening to this, I'm like just bear with it because you've heard it 600 times, but it's so important to to us. Great. So, let me tell you this little story that's very important to us. You'll see a starfish on anything bundle birth, our ab everything because of this story. and I think it relates, but I would love your take on it. So, the story goes that there's a grandfather and grandson. They're walking on the beach and they come around this bend and they come across this beach covered in starfish, like piled high, thousands and thousands of starfish. They're stepping around them and the little boy reaches down, grabs a starfish, and throws it back in the water. And the grandfather goes, "That's cute. Look at you." But like, dude, look at the beach. We're covered in starfish. What difference do you think you can make? And the little boy reaches down, grabs another starfish, throws it back in the water, and says it matters for that one. And so, as I've been talking about the system now for the entire lifeline of bundle birth, that's like the whole reason why we exist is like helping change the game. We say change the game. That's our slogan for physiologic birth. Like this is the point. I think what when I was reading about the monitor, I'm like, it's the starfish to me that like you take this like the whole system must change and it must be different and I'm going to change it to let's create a measurable goal that is much smaller and much more tangible that we can focus on and really celebrate, which is the one patient you can throw back in the water. It's the one moment that you're being given to throw the, you know, to throw the starfish or to make a difference or to contribute to the change. Yeah. The way we talk about it in the book is uh standing on the shore trying to move the beach, one bucket at a time. And it feels so fruitless, so hopeless. I'm never going to make this change. But you look to your left, there's a whole line of people with buckets. Look to your right, there's a whole line. We're all working for each other. And more important, as you're getting exhausted, you look behind you and there's a whole line of other people waiting to take over for you so you can take a break. Now, in the system that exists, sometimes there isn't a whole line of people behind you. Hospitals are chronically understaffed and people have to schedule their vacations around each other because there isn't enough there isn't a deep enough bench um within an actual limited closed hospital system. But in the larger society there is a whole line of people who would offer help. It might not be I can take your shift on Tuesday but it might be I can watch your kids for a couple of hours on Tuesday. Um yeah. So the like throw one patient back in the water is a hilarious when I think about it literally and b yes a very important aspect of like I I did it I did something I achieved a goal and that's something and yes in the book we have like a a list and a whole like way of coming up with new goals that are soon certain specific concrete positive and personal like there's a whole way of like how do I construct a goal that's going to make me feel like I achieved something so that I don't feel so frustrated all the Um, and also part of the research that went into this understanding of how the monitor works and how frustration works. Uh, at the end of the study where they they intentionally frustrate people to find out what happens when people are frustrated. When the person is frustrated at the end of the study, uh, the the research condition was that the the goal they were trying to achieve was actually impossible. They made an impossible task and then measured how people responded to trying to achieve an impossible goal. And they found that instead of letting people leave feeling like I didn't I didn't do the thing they asked me to do. It was I I couldn't do it. They told them, "Hey, just FYI, that goal was impossible. You couldn't have achieved it. It was the game was rigged." Like and even just that, as you said, validation at the beginning of the thing that the book is validating, even just the just knowing, oh, the game is rigged. Just that is enough to tell your nervous system, oh, not a failure, not an outcast, not on the fringes. In fact, I belong right in the middle of this herd because I, like everybody else, nobody else could do it. I couldn't do it. Turns out I'm safe after all. Mhm. What about the people that don't want to fight and don't care and are just saying no can't do it. That's completely and perfectly understandable because uh there is among this research about frustration. There's a thing called learned helplessness. Um which maybe you studied in like psychology class in undergrad or somewhere. Um and like how they studied learned helplessness was they put a a a rat in a bucket of water and see how long it swims until it gives up and dis and discovers that it can't swim anymore. There's no land to be achieved. So when that happens, a rat just extends all their limbs and floats on the surface conserving energy. They basically go into dorsal conserving all their energy so that they can survive to whenever. So when that happens, they can click measure the time it took for the rat to learn that. And they compared two groups of rats. One group of rats was just the regular rats who live in their little cages and they get their little food. And then they took the other group of rats and they stressed them out just a little bit. They didn't like torture these rats. They just like maybe tilted their cages. They made their bedding wet. Just a little uncomfortable, just a little stressed. And when you're just a little stressed all the time, the amount of time you spend swimming, looking for land before your body just gives up and floats is much, much shorter. And eventually you're going to Okay, now I have to switch to another study about puppies. And it feels sad because it's puppies, but it's fine. And these dogs are fine. Um, if they [laughter] if they put a puppy in a box and it's a very cute little puppy in a very safe box, very well cared for, but the uh the bottom of the box is electrified and uh it makes them go, it doesn't hurt. It's just uncomfortable and they're like, "Oh, no. I don't want this. I want to go away." And they they try to escape and they discover that they can't escape. And eventually the dog will just lay down and not try anymore. And in the various stages of the research, they open a door and let the dog out and see how long does it take before the dog figures out how to get out. Um, but if they teach this dog well enough, you can't escape, you can't escape, you can't escape, you can't escape, then eventually they remove the door and the dog doesn't even try. That's learned helplessness. And it's not cognitive learning. It's your nervous system learning I can't escape. And uh when you are raised in a society where your sex, your the color of your skin, the texture of your hair, the size and shape of your body tells you that you're not included, that you're not safe, that you don't have access to medical care, to food. You learn over time, a little bit every day, oh, I can't get out of this. I can't escape. I am helpless. And that is the person's nervous system deep down understanding. And hey, does this sound like clinical depression? It sure as heck does. I feel confident that there's a link between learned helplessness and clinical depression. That is my opinion. I don't know of any research that actually makes this conclusion. But as a person who has had very severe depression, that's what it feels like to me. So when a person has given up and just says, "No, I I can't I don't have the bandwidth for this. I don't have the resources. I can't be of help to anyone because I can barely even keep myself safe. That they have to do that. That's protection. That's their sense of safety. Would it be great if they could experience what it's like to escape that box? And you know what? Those researchers did not leave those puppies in the corner getting lightly buzzed with electricity. They did not do that. They grabbed the puppies by the scruff nug. Come on, pup. and they pull them on over. Look, here's the door, babes. This is You can get out this way. It would be great if somebody would come and, you know, put their arm around the person who feels like they just have nothing to offer and guide them into a place where they see, oh, I'm safe here. I can contribute here. That would be awesome. And I think that's the solution to that. But it's nobody's job to tell that person, you have a moral obligation to give more. Um, but it would be an act of giving and the kind of community care that would end up being the cure for all burnout for everyone ever if they had a giver around them who would introduce them. Show them you can get out, you can escape, you're safe or at least you have access to safety. Oh my god, if we could show everybody that they have access to safety, the world would be so much better. Yeah, totally. All of this is honestly giving me hope. That sounds crazy, but like as I was prepping for this for I I mean Yeah. I mean like that's how I felt reading the book. But I even like this conversation. I'm like okay because I I mean I have been in a season of like oscillating and trying to like tread water and not feel like I have to just fully give up. And I have been on both ends of the spectrum of like I'm going to fight so hard and then I just want to float on top of the water and not care or, you know, lay on the zing of the stress and just be like I I'm here forever. And Oh, yeah. And uh not for nothing, the there's a sex difference in how long the rats swim when they're stressed. The difference between a rat who is stressed and not stressed is is a big difference. But the difference between male rats when they're stressed, they give up much faster. Female rats when they're stressed, they don't give up nearly as fast. Yep. And then to our detriment, probably. Yeah. Somebody needs to show us land. Yeah. Yeah. I'm listening to this and I'm like, "Okay, that's what we do." And honestly, it's like it's making me emotional because I've struggled with my purpose in bundle birth and like does anyone care and like where is everyone and what are we even doing and yet everything you're describing is exactly what we do for people through mentorship through Emer Learning Retreat through this new live colorfully class which now we're making all of that content available online for people to access and come and learn and have hope be shown that there is hope and then given tools to recover and be a part of the system. One of the one of my ahas through our move learning retreat was we heal people and people heal the system. And I got to the stage and I and I read that and and it like sunk in for me so deeply in my frustration of just like what the heck am I doing and why the heck is it even worth it? I'm not sure. Is the door open? I see a crack, but like I don't actually believe that the doors open anymore. Yet, this is why the main point of the book is the cure for burnout is not self-care. It can never be self-care. Because self-care is standing in the middle of the river trying to resist the flow all by yourself. The cure for burnout is all of us caring for each other. Because when we all stand together in the river, we can hold each other up and that's the way we shift the way the river is flowing. Thank you for being here. Thank you for sharing your expertise, your perspective, and just honestly, it's so fun for me to talk to people outside of the nursing world because one of my favorite things to do for our community is take this like non- nursey contenty stuff and go, "Wait, but it really applies." And I just I mean, I can't say anymore how much this applies. If you haven't bought their book, um I will link it down below. You have to have it. I decided yesterday I was like, this is the type of book that you get you give someone as they're like going into their first career. Um no matter if you're burnt out or not, it's like it's not even preventing burnout in my brain. It's like how to survive the world basically should be the title of this book. The the title burnout was actually given to us by the first editor and I didn't like it. I was like, "No, it's not really about burnout. It's it's a feminist book about st." But um the the title rang so meaningfully to a lot of people that obviously and it was published in 2019 and we didn't expect it to stay as relevant as it is for as long more now probably. Yeah. Um but we have spent the past seven years trying to make it more and more accessible. So there's a book and then there's the audio book for people who don't have time to read a you know 80,000word book with 28 pages of references. Uh, and then we got feedback that like, you know, I'd love to have all this know what to do, but like I don't have time for that. I don't need all those receipts. I don't need all those references and I don't need to know about the studies. Just tell me how to fix it right now. For them, we published a workbook. So, if you don't need receipts, there's a workbook. Uh, and then to make it even more accessible, we did an audio version of the workbook. We will link all of that down below. Thank you again for being here and sharing yourself with us and giving us this hour of your time. Everyone, you can find everything in the show notes down below. Go get yourself a book, a workbook, an audio book, something to recover and keep going. I know I just mentioned it, but if you are looking for hope, if you are looking for community, that is exactly what we do here at Bundle Birth, particularly the hope part, please join us at our live colorfully class. It's like it feels like it's literally a response to this book without I knowing that it was a response to this book to offer that hope to offer that community to offer that validation of how you're feeling and then some really tangible tools to be in the system making a difference helping your and resetting your monitor to a place where you actually feel like you've arrived at the mall. And then especially if you're looking for community, that's really where our our Bundleberg nurses group mentorship program comes in where you know that you're not alone. That if you are struggling to find those people who are ready to cheer you on, who know what you're going through, where you can process and learn and be safe to just like remind yourself that you're safe. That is exactly what our bundle nurses mentorship program is for. And so I know it's not open right now, but it will be open in the future. And then I will drop the weight list link down below. Add yourself to the weight list and then we will let you know when it opens up next. We'll let you know about the next upcoming cohort. And just know that like the entire point of us here is to support you to provide that community. If you haven't been to physiologic birth, physiologic birth is also hope for systems change. It's giving you the tools in your hands to throw the starfish back in the water and feel so confident that you are making a difference in the system. and the culture because really if I think about what needs to happen in our profession in nursing of specifically obstetrics, it's going back to that physiologic approach. And so that's another way that you can be a part of the systems change while doing your part and really protecting yourself along the way. We're here for you. We're cheering you on always. Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps both of us if you subscribe, rate, leave a raving review, and share this episode with a friend. If you want more from us, head to bundleburst nurses.com, subscribe to our email list, or follow us on Instagram. Now, it's your turn to take what you learned today, apply it to your life, and remember that we heal people who heal the system, and that we need each other. We'll see you next time. [music]