The Basics! (As Told By Healthcare Workers)
The Basics of Boundaries is written with the private healthcare practitioner in mind, but really these bullet points can be applied to anyone. Are you a Psychiatric Nurse Practitioner or a therapist or a doctor? Are you a receptionist or the office manager? How about a CNA? Whatever your role, you probably care deeply about the people around you, and when you care, it is tempting to take work home with you – figuratively and literally – but you need to avoid this at all costs. Work, however much you may love it, is work. If anything can suck the joy out of a passion, making it your profession will absolutely do it. But it doesn’t have to.
Maybe you dread going into work, and when you arrive you are short tempered, irritable and unhappy. Do not be fooled, you are not as good an actor as you think. Your patients, customers and coworkers 100% notice. Worse, maybe your distraction causes mistakes. Maybe you go so far as to drive off someone from your office. If you are in healthcare, maybe your actions cause you to provide subpar patient care.
Why is this happening? Simply put: Because You Need a Break.
Inevitably, I have The Talk with all of my clients. The I-need-boundaries-talk, or I-need-different-boundaries. Personally, I love having this talk! It means someone is taking some of their power back, and when it comes to a professional life – particularly one in service to others – this is a huge moment! It Is great for providers, great for their staff and great for their patients, too.
Some people are ready and committed to making changes right away; some people are more tentative, a little apprehensive. Some of my clients make one or two changes and things are great. Some are constantly adjusting.
What I have to get across to all of them at some point is that they are an ASSETT. It absolutely matters if you have a specialized degree. It also matters if you have a skillset that someone else does not. It matters if you are doing a job that someone else needs you to do. You are an ASSETT. We spend so much time being told to be (and trying to be) humble, that it can be difficult at times to wrap our heads around that one word, but say out loud it to yourself. I am a resource. I am an asset. I am an important part of my team. I have a skill that someone requires. I have an education that someone else does not. I am needed.
Once you start to feel comfortable with this, then you can start to feel confident enough to establish boundaries around your professional life. Here are the universal points my clients have emphasized in the past.
I am a resource. I am an asset. I am an important part of my team. I have a skill that someone requires. I have an education that someone else does not. I am needed.
Do NOT be Afraid of Consequences!
Oh boy, this is a hard one – consequences can look like a million things, and most of them are deeply intimidating. If you work for someone, maybe it is the fear of retaliation or reputation. If you work for yourself, maybe it is the fear of patient pushback. Maybe you are afraid of what your coworkers will say about you, or how they will perceive you. Especially in healthcare you could be called a bad provider, someone who does not sacrifice their whole being to the good of the patient. If you have traditionally operated pro bono and find that you aren’t paying your bills, maybe a policy to collect payments will result in the label “greedy”.
Consequences are real and they will happen, but here is the funny thing: everyone settles down after the initial shock and your new boundaries soon become the new normal. Simply, “just how things are”.
Do NOT Work Your Days Off
If you are in practice for yourself, for example, turn off your work phone at 5 pm on Friday and leave it off until 9 am Monday. Your life outside of the office should not be lived in a silent panic. When your bestie calls you on a Saturday morning you should not be afraid to look at your phone. If you are in a constant state of arousal, you are going to burn out!
On the flip side, if you are someone’s boss, do not expect your employees to reply on their time away. Do you want good customer service? Do you want accurate work? Do you want a healthy team dynamic? Then let people go to their safe, restful place. Home.
DO Engage in Community
When I say community, this does not mean social media – sure, enjoy a Facebook group for therapists and use this to find out where the meetings are happening and who is accepting patients right now. Scroll through and check in with far-flung family while you wait in the car. But social media is a cesspool of comparison and judgement that will trick you into thinking you are “supposed” to be doing something else, living a different way or establishing a different style. You will lose your own message when you compare. Social media will tear you down. It is a fake world. Limit your time there.
Your community should be in person (or Virtual, depending). That could be a professional group where you gather with 50 other nurses once a month to vent, laugh and blow off steam. It could be a collection of loud friends or your small family at home each night; it could be your religious community; your hobbyist collective; a poker crew or gamer team. Whatever it is, engage whole heartedly and lean on them! As long as you are finding relief and support in a way that is effective for you as an individual person, then you are engaging in your community.
DO Let Patients Engage in Their Care
This may sound like a no-brainer to some or like heresy to others, but it is trickier than first glance. What I mean by this is that patients need to do their own work, and sometimes they are going to fight it, refuse it, are unmotivated, or even may blame you for failures. Maybe you know they need to see an eating disorder specialist; you can provide the referral and provide extensive motivational support, but ultimately they must set up the appointment.
I have a history of addiction. I failed many times to get sober. I blamed my healthcare personnel more often than I accepted it as my own responsibility. In fact, I blamed a lot of people and a lot of things (never myself), and I stayed in active addiction for a long time. So I can strongly attest that no good ever came of someone else (provider, parent, friend) picking up the load and carrying it for another (patient, child, addict). No one get sober that way.
Patients HAVE to do their work – whether it is post op care, substance abuse, PTSD recovery, ADHD management – healthcare providers are there to help people get a hold of their bootstraps, but only the patient can pull themselves up. We all need help, we also all need responsibility. Balance that out. It is okay to tell a patient no.
DO be Consistent
I have talked about Consistency in other posts, but I will reiterate it here. If you set down rules and boundaries, they really need to be the same for all people. And if you have to establish one particular guide for one particular person, then be sure that you maintain that all the time. Otherwise you will confuse people, you will create loopholes, grounds for pushback, and your chances of failure are much higher.
I like knowing that what I see is what I get. Most people find it comforting to know what to expect. If you are not consistent then your area full of surprises and in healthcare setting, surprises are stressful.
You will get pushback to boundaries. Do NOT fold. DO be compassionate.
You are a hugely important figure to someone’s life. If you are a therapist, doctor or other professional, then someone came to you for help. You and your opinion matter so much. So understand that if you start to implement boundaries, this can been deeply frightening to your patient. Have compassion for that. Talk to them about what these changes may mean to them and their individual care and walk them through what this will look like for them.
If the pushback is coming from an employer, have sympathy for their stress, chances are that they are not sure what to do in your absence. They relied on you, maybe more than they should have. If the pushback is from a coworker, then maybe realize that they are jealous. You are establishing new rules where they are not. There are a lot of reasons that people react poorly to boundaries, but it is rarely about their boundary itself and has more towith their relationship with you.
Do not give in; hold your ground. Be kind to those around you. Everyone will settle in to the new normal soon enough.
Boundaries are hard, so bear in mind some of this basic advice and build up from here. If anyone has already experienced any of these basics, please reach out. I would love to get people’s stories and experiences out there – burnout, boundaries and the experience of it looks different for people from all different walks, so the more who are willing to share, the better.
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