Self-Care: Knowing Your Needs & Setting Boundaries

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Doctor Neha: Welcome, everybody. Today, I have a special guest, Kim. Welcome. Kim.

Kim: Thank you.

Doctor Neha: I’m really glad to have you here because not only are you someone I found to be really insightful—Kim’s a nurse—but you also are a leader. So you understand teams and workplace environments. You’ve been giving me some of your own personal examples to help me in my upcoming books, the power handbook for women, as well as self-care in healthcare. So full disclosure, I’ve known Kim for about six weeks. She was a brave soul who agreed to come on and ask a question so that all of you could learn. So Kim, what have you been thinking about?

Kim: So we’ve been talking about self-care and communication. My question is, how do I communicate or deal with toxic people at work by preserving myself and physical balance, with all the changes in health care. It’s rampant everywhere. People are burnt out. They’re scared. They’re mean. They’re withdrawn. And if I’m trying to balance myself, how do I deal with the toxic person in my environment?

Doctor Neha: That’s a great question because I think you’re speaking of it in healthcare, but I’m pretty sure it’s happening in every industry. Technology has disrupted a lot of industries that are trying to find their way. The pace of our lives is moving faster and faster. And I think what you’re really speaking to is how do I handle an environment where people are coming more from fear than love? Is that right?

Kim: Yes.

Doctor Neha: So have you seen a change over time? Like was there a time when it felt different than this?

Kim: There was. The organization I work at is large, but it always had a family feel. Over the years, like every other healthcare, it’s become more of a business than a people-serving place. And that’s needed to survive. But because we’ve had rampant change, and I would say change fatigue, everybody’s uncertain. So instead of pulling together, people are being siloed and they’re fragile. From my standpoint, I used to be very good at stepping in and mentoring people, molding them and bringing them through a situation. But it affects me as much as them. And to get over that, how do I protect myself? And we’ve talked about that through all your classes with self-healing. But when you get into an environment and someone just brings you down immediately—and you’re trying to heal, what do you do?

Doctor Neha: All right. So I think of creating healing organizations as a me-we-world approach. Most people have single vision, which is me. What do I want? What’s my promotion? What’s my career path? What do I need to do? What’s my job? Roles and responsibilities. Me, me, me, me, me. That’s the natural default in human nature. Now, that’s not the case in health care. We are about we, we, we, we, we—how can I serve you, you, you, you? We get our self-worth from serving our patients and serving others. So in a weird way, it is me, but it’s an indirect me. Does that make sense?

Kim: Yes it does.

Doctor Neha: So what you’ve done is…you’ve also been in leadership, yes?

Kim: Yes, I’ve been an executive director for a while.

Doctor Neha: So you know the roles: there is a time when you are about me, and there is a time when it has to be about we, and there’s a time when it has to be about the world. But a leader actually has to navigate all three at the same time. So I wonder on a me level for you, what’s been changing lately? So you spoke of change in the world. And you spoke of change in the we. But there’s a me level. So tell me what’s been changing for you.

Kim: I think it’s the first time I’ve ever identified that I’ve had anxiety and stress. It was impacting me. As a healthcare worker, you ride that stress curve and you’re on the top. And then when you do that slippery slow down, I didn’t know how to handle it. So I had my first anxiety attack and I’m always supposed to be the strong one, the one taking care of others. So it was a perfect storm of a physical ailment, a family issue, and the uncertainty at work. And I was like, I can’t deal with this. But you have to; you have to move forward because people are leaning on you. So that was my change.

Doctor Neha: Well, that was me-we-world right there. It was a physical element for you, change in the family, and work all coming down at once. So this is how a large proportion of the world is feeling chaos right now. And what you’re saying is when this many things change at once, how do we stay grounded? How do I stay grounded in myself? And then you’re saying, when I am grounded in myself, because you’ve learned these tools, what do I do in the presence of other people who are chaotic? Is that what you’re saying?

Kim: Correct. That’s what I’m saying.

Doctor Neha: All right. The first thing is you have to know where you end and somebody else begins. As healthcare workers because we’re helping people in physical crisis, emotional crisis, end of life—all these experiences with that where we can really feel empathy, sympathy, caring, love for these people and what they’re going through—our hearts bleed to help them. But sometimes we lose the boundary, knowing where I end and they begin. And sometimes we take on responsibility that isn’t ours.

What I mean by that is if you came to me, Kim, and said, “Now this is what’s going on for me, and don’t you think it’s awful?” Now I have choices in how I can interact with you. If you’re speaking about leadership, for example, I could jump on the bandwagon with you and say, “Oh yeah, let me tell you what they did to me. I have a choice—do I want to get into the drama triangle of gossip and create more toxicity with you? That’s a choice I have.

Now, once you’ve learned about yourself, you get to say, “Huh, I want to stay connected to this other person. They’re going through something really difficult.” So drop down to listening for your emotions, such as, “Kim. That sounds awful. It really sounds like it’s been hard. You’ve been feeling anxious. You even for the first time really felt a panic attack. Gosh, that is awful.” Then I would do this because I know where I end and you begin. Instead of saying, “Have you tried this? Have you done this? Have you checked this person out? Have you done this?” I would say this one sentence: “How can I best support you?”

Kim: Yeah. That’s a powerful sentence.

Doctor Neha: Now, it’s not my responsibility. It is your job to tell me how I can support you. And then my job, instead of working really hard—asking “What about this? Did you try this?” which is medicine where we’re giving everybody the assessment or the plan…we’re doing all these things because we’re the ones who are supposed to know. And when you have your own physical ailment and you need to start funneling your time and energy into taking care of you, you may not have the capacity to solve everybody else’s problems.

So it’s about boundaries. But before you have boundaries, before you can share your boundaries with somebody else, you have to know what they are yourself. When you’ve spent decades as a nurse, as a leader, focusing outward on other people…I’m wondering if the last six weeks on burnout and self care has been eye-opening and your physical illness has been eye-opening in the realm of you having to focus on yourself. Like you have no choice in the matter.

Kim: It has been. Like we discussed, this was difficult to open up about. As you know, when you’re that type a strong leader, you take care of everything and just let it go. You know, health care workers do that all the time.

Doctor Neha: So I want you to say what you just said and say, “I put myself last.”

Kim: I put myself last and didn’t let my needs come through to anybody else. I let everybody else come to me.

Doctor Neha: And your body said, “Enough!”

Kim: It said, “Enough!” And it was a wakeup call for me. I said, “I can’t do this anymore.” I can’t be everything for everybody in all realms. And what I ended up doing was disconnecting. And that was one of the things I said in the beginning of our sessions that I let my anxiety gets so strong that, to deal with it, I disconnected from everybody, which is not healing either. So these sessions have really opened me up. Like get your elevator out of your head and bring it down to your heart—you’ve got to connect. But connect in a way that it doesn’t harm me or drain me. If I’m still healing, I have to set those boundaries.

Doctor Neha: So it’s about choosing whom the “right others” are for you to be around at this point in your life. So we can come from creativity and our heart or when things are chaotic, sometimes people go to a reactive space. When they do that, there are multiple ways that they show up. They can try to please other people if things are worrying them and they want to avoid conflict. They can go into pleasing other people. Or they can separate themselves from other people by becoming a little bit arrogant or distant. Another way they can do it is by removing themselves physically and emotionally from situations. And sometimes you need to do that when you’re heading into the level of anxiety where you may be like imploding or having a panic attack. That is when you do need to disconnect and disconnecting is useful and helpful.

All of these strategies are useful and helpful until they are overused. When you disconnect and now you feel lonely, alone and depressed—I’m not saying that you were feeling those things; I’m saying that’s usually what happens when you disconnect for any finite period of time—and it’s for an extended period of time, then you’ve used too much of a strategy. Even if it’s a strength in the moment, it becomes a weakness. So what you’re doing is renegotiating and finding your way back because the truth is you can’t heal like burnout, self-care, physical traumas, emotional traumas alone. We heal in community. We are humans. And we are programmed in our DNA to need each other. We care about connection and belonging and we heal in community, not in isolation.

Brené Brown speaks about this: knowing who you are, choosing to open up to and making sure that that is the right community. I gave a TEDx talk on this called “The community cure.” And it’s about picking and making sure you surround yourself with the “right others.” And it tells you biologically how we influence one another by literally being in the same room, being in the office next to somebody else, how it has that much effect on us. And we discount it.

So tell me what your takeaways are. How was this for you? Did this make any sense? You have any new a-ha’s you can use?

Kim: I’m learning to set boundaries as I’m going back into a community. I’m trying to reconnect. I have to get a little more stress back in my life because I’ve really gone off that curve—and stress living is part of me, critical care, leadership type A, you kind of thrive on that.

Doctor Neha: Who thrives on it?

Kim: I thrive on it. I need to bring it back. I am starting to connect with people in reaching out to them and telling them what I’ve been going through because up to this point it’s been very private. Our self-care um, group on Thursdays is a great support group. But I’ve also reached out to a few select friends and a coworker. They’re safe people for me; it’s not somebody I’m going to worry about if they judge me or not. Obviously, I’m not going to go into a meeting and say, “Hey guys, I’m having panic attacks, anxiety attacks.” I really have to find your community, find what your boundaries are and how to have conversations with them to get what I need and how to move on. That it’s about me, not them, but me. As a leader, you are expected no matter what the time is to put on a good face and help your team. I mean, I as the leader, I feel the pressure.

I am told by my superiors, you know, get your team engaged. And I need to say, well, how about me? How can I get my team engaged or the frontline staff engaged if I feel uncertain, if I feel the fear for the future, if it is impacting me?

Doctor Neha: So what you say is, “I want to get my team engaged and the support I need in order to do that is…” So it’s your responsibility to get really clear about the same question we asked earlier: How can I best support you? So your job with your leadership is to tell them the answer for you. I guess this is not going to be as private anymore as it has always been. What I will tell you about that is you’re going to share your experience to empower other people to know that it’s okay to say what they need then if they’re experiencing something like this as well. This is actually about you stepping into your personal power, owning what’s true for you and saying, “This is my experience, and I’m going to get better at boundaries.”

So thank you so much for doing this and being with us. It’s been an honor to talk to you. Thanks for all the help you’re going to give other people.

Kim: Thank you, Doctor Neha. I really hope empowers other people to step forward and get out of their comfort zone and say, “I need to support myself.”

Doctor Neha: Thank you.

Awareness Prescription for Self-Care and Boundaries

1. When others offload their problems to you,

   1. Listen for the emotions beneath their words.

   2. Affirm the emotions you’re hearing.

   3. Restrain yourself from attempting to fix their problem.

   4. Instead ask, “How can I best support you?”

2. When the tables are turned and you need support,

   1. Ask yourself: “How could others best support me?”

   2. Communicate your needs to safe and supportive family, friends and coworkers.