Kathy Allan, RN, SEP has left bedside nursing twice – the first time because she was burned out and the second time because she wanted to help other nurses with burnout. Her first detour from nursing, in the late 1980s, took her to Hollywood, where she worked in theater and in films. Her best work, she says, ended up on the cutting room floor. (Kathy also does stand-up comedy and is a member of the Screen Actors Guild.) While in Hollywood, Kathy took a course in Healing Touch and thought it would augment her weekend work as a hospital nurse while also working in theater.
“It was incredible to be able to put my hands on somebody and watch them change and get better,” says Kathy. She ended her theater career. Kathy then worked to get Healing Touch accepted in her hospital and eventually became a Healing Touch instructor. But the environment in hospital nursing turned, and not for the better, in Kathy’s opinion. “With managed care, the ‘business’ aspect of medicine took over. I began to feel there were unethical and unsafe practices going on in hospitals. So I left bedside nursing again, something I had always loved even though it was stressful.”
Not long after, Kathy heard about Peter Levine and Somatic Experiencing®. She knew that was what she needed to study next. She took and completed the SEP training as well as a two-year program with Kathy Kain, PhD, SEP, on using touch for trauma healing, and also took two programs for healing developmental trauma – NeuroAffective Relational Model (NARM) and NeuroAffective Touch (NAT). “But it occurred to me that all of these programs were for psychotherapists who have an hour to spend in a quiet office with a patient who has experienced trauma in the past. Nurses don’t have that luxury and they, and their patients, are being traumatized in the present. That’s when I decided to develop something for nurses, because I’m a nurse first and foremost.”
Nursing has always had a certain level of stress and trauma. The hospital environment, in particular, puts nurses at risk for triggers and traumas of post-traumatic stress – they see people die, they resuscitate patients, they have end-of-life discussions, they try to control debilitating pain, they remove life support. None of this is new; what is new is the added, even extreme, stress for many nurses taking care of patients during the COVID-19 pandemic, with its crushing patient loads, shortages of proper equipment, and often ineffective treatment. In some cases, nurses have been verbally or physically abused by patients or family members. Nurses across many care settings are vulnerable to post-traumatic stress disorder (PTSD). In some settings, the risk may be higher than in others. A study in the Journal of Heart and Lung Transplantation recently found that up to 48% of nurses in a critical care unit meet the criteria for PTSD. And PTSD and burnout lead to a high rate of nurse turnover. Based on region, the rate of nurse turnover in the US varies from 13% to 21%.
A Goal to Transform Nurses and Nursing
When Kathy decided to develop Trauma-Free Nursing, she wanted to develop a comprehensive program to do two things: teach nurses how to recognize and interrupt the felt sense of trauma in themselves and give them tools to address the traumatization of patients, encouraging them to develop new procedures to reduce trauma in patients. The goal is to enrich the individual nurse and transform the way that nursing is practiced.
“The healthcare system is almost inherently traumatizing for patients – multiple specialists, a serious diagnosis, surgery, the insurance process, a hospital stay with in many cases no one to speak for you, a long list of strange medications. We’ve all heard of people being told to ‘mark the right place on your body for surgery.’ Is it any wonder patients feel traumatized and overwhelmed?”
Nurses are also often overwhelmed, in part due to nursing shortages in many areas, a situation Kathy believes to be cost-driven. According to the American Nurses Association, nurses have been an easy target for reduced hours and other cutbacks precisely because they are the largest staff group in a hospital, at almost 40% of operating costs. As of March 2022, California and Massachusetts are the only states with “safe staffing” laws – mandated nurse-to-patient ratios – although 16 other states address nurse staffing in hospitals in various other ways.2 During the COVID-19 pandemic, hospital systems could request a waiver on expected staff-to-patient ratios. This is tantamount to abuse of nurses and patients, says Kathy. “As I was developing Trauma-Free Nursing, I kept thinking, ‘What’s it like for patients to have a burned out and exhausted nurse taking care of them?’”
What it’s like in the broader context is an environment of excessive medical errors. Recent studies have estimated errors may account for as many as 251,000 deaths annually in the US, making medical errors the third leading cause of death. Error rates are significantly higher in the U.S. than in other developed countries such as Canada, Australia, New Zealand, Germany, and the UK. At the same time, less than 10 percent of medical errors are reported.3 A study done by Johns Hopkins University says that medical errors surpass the U.S. Centers for Disease Control and Prevention’s (CDC’s) third leading cause of death — respiratory disease, which kills close to 150,000 people per year (pre-COVID).4
“I strongly believe that many of these medical errors would not be happening if nurses were well-rested, well supported, and free of traumatic stress,” says Kathy.
Changing Behavior Can Change the System
Part of Kathy’s program is Healing Our Presence, a module that focuses on how adaptation to early childhood wounding affects the nurse’s ability to be a healing presence for themselves and for others. Additional moral wounding caused by unrelenting professional demands and exploitation is also explored. “Adaptive” behaviors to cope with developmental trauma can result in healthcare professionals exploiting themselves – and leaving themselves open for exploitation by others. Part of the exploitation comes from the healthcare system. “But it helps nobody if we look at it as an ‘us-vs-them’ situation,” says Kathy. “It’s not that nurses are good and the system is bad. We’re all a part of the system and we keep it going. But nurses have to take responsibility for their part. The Stepping Up Our Game module includes the 12 Steps of Healing Care, a spiritual approach to changing our own behavior, which in turn can change the system.”
Kathy likens it to chemical dependency in addicts – and she should know because she spent 20+ years working in locked and open psychiatric units, as well as in chemical dependency units. “Think about the family of the addict, who is consuming everybody's energy. The family can be codependent – they have lost themselves trying to placate the addiction and the addict. The healthy family, when they get into recovery, will take responsibility for their own behavior, and see this codependent behavior. And with the help of a group dynamic, such as with Al-Anon or Co-Dependents Anonymous, they learn to recognize what they're doing, they take responsibility, and they stop doing it. But the first step of the 12 Steps of Healing Care is that we recognize that we work in a field of trauma. It’s important to acknowledge that. When we allow for spiritual help to change ourselves, we can change our behavior in the system. It’s also important to acknowledge that nurses work in an environment where people often are praying for some spiritual power to help nurses, doctors, patients, and family members. It can be powerful.”
Some of the nurses who have attended Kathy’s presentations don’t work in the high-stress ER or ICU. A key takeaway was that once they learned to de-stress themselves, they wanted to volunteer to help their colleagues in the more high-stress units – nurses helping other nurses. Eventually, Kathy would like to offer a program to hospitals. Trauma-Free Nursing also welcomes traumatized physicians who would like to practice trauma-free medical care. “Doctors also are very traumatized,” says Kathy, “especially these last two years during COVID, and too many are leaving the profession.” In fact, the American Medical Association says that about 5,000 physicians quit every two years due to burnout, with an annual cost of $4.6 billion, including lost revenue from vacancies and recruitment expenses.5
Kathy has been an Assistant in the SEP training program for 20 years. Because of her own SE training and what she’s seen in assisting, she knows the power of how our bodies talk to us. “We need to be very curious about what the body is trying to say, even to just ‘hang out with’ the sensations. Once you start doing that, the body says, ‘Ah, somebody noticed.’”
Kathy was one of the panelists for an April 2021 SE Community Conversation on mental health care for medical professionals. To watch the CC: https://www.youtube.com/watch?v=JZoe6IhRXyQ&t=7s
To view all of our past CCs: https://traumahealing.org/conversations/
1. Advisory.com, Why 1 in 4 nurses suffers from PTSD, 05.15.2019
2. Advocating for Safe Staffing, American Nurses Association
3. Your Health Care May Kill You, National Library of Medicine, 2017
4. Study suggests medical errors now third leading cause of death in the U.S., hopkinsmedicine.org, 05.03.2016
5. Each COVID-19 surge poses a risk for healthcare workers: PTSD, reuters.com, 09.05.2021