Bruised but not Broken
Updated: Mar 23
A practical guide to becoming an emotionally resilient veterinary carer
(This piece has been adapted from a talk I gave at BVA Live on June 23rd, 2022 in Birmingham to the veterinary nurses present. Some of the tables are actually screenshots of Powerpoint slides, which is why the links are not working.)
Before we begin, I’d like to invite you to really arrive here with me. Put your bum in the back of your seat and let your back be supported by the back of the chair. Uncross your legs and ankles and root down through the soles of your feet into the earth. Gently let your hands rest on your lap, without clutching anything or making fists.
Keep a soft gaze.
Notice whether you’re holding any tension in your jaw. If so, please release it. Are you unintentionally frowning? Let it go.
Now, take a deep, full breath, bringing it all the way down into your belly. Feel the air go all the way into your lungs, down into the belly and just for a second, holding it there in your belly. Then slowly letting the air come back out of your nose. At the top of your exhale, hold it there for another second before starting your next inhale again. So, we breathe in for a few counts, hold, breathe out, hold, and breathe in again.
Now do this for just another round in your own pace.
Now let your right ear drop to your right shoulder. Make sure the shoulder doesn’t reach up to the ear, but the ear comes to the shoulder. Let it hang there and notice how the side of your neck slowly lengthens. Take another deep breath. Slowly let your chin roll from your right collar bone to your sternum, your left collar bone and notice along the way whether there’s a spot that feels like it just might need a bit more love. A spot where you feel the muscles tighten a bit more or even a tingling sensation radiating to other parts of your body. Let’s find that spot again and not gloss over it. Let’s give it a bit more attention because it won’t go away if we ignore it. Go back there, hold the head still in that position and breathe. Take a deep breath in, hold it, and out. Two more times…
Slowly roll your chin all the way to the left until your left ear reaches your left shoulder. Remember, ear to shoulder and not the other way around. Breathe deeply again…
Use your left hand to gently push your head back to centre, putting it back on top of your neck. Take a deep breath and roll the shoulders back. Give yourself a gentle smile.
You might have recently felt the emotional pain of losing a human loved one, a furry loved one or a patient that you felt particularly strongly about. You might have felt overwhelmed at home or at work, maybe even nearing a burn out… And maybe, just maybe, in the past year, you have investigated changing your job, whether that meant staying within the veterinary industry or completely changing career.
You are not alone.
We work together with people, veterinary surgeons, who are often very theoretically minded, scientifically sound thinking humans. And there’s nothing wrong with that. But when it comes to the emotional and physical care, you, the veterinary nurse, are the star of the show. Or should I say, the Supernova… You have been giving your all, both at work and at home for little pay, a lot of stress, the occasional covering in bodily fluids -and you’re lucky if it’s just blood- and are now collectively burning out.
Why is this? And more importantly, how can we fix this?
It’s been clear for years that the veterinary profession is a stressful one with a lot of drop out, burnout and compassion fatigue. I think every veterinary conference will have a talk about burn out and compassion fatigue and how to battle it. For those of you who are interested, let’s talk numbers.
There are not many recent studies about burnout and compassion fatigue amongst veterinary nurses in general, but specifically since the pandemic happened, but the numbers from before that time were dire enough. You can imagine what they would look like in 2022.
A Royal College of Veterinary Surgeons survey found that 90% people reported stress from their daily job. They felt overwhelmed, overworked, and burnt out. 21% of respondents mentioned they didn’t know how to cope with their stress levels. (The Vet Recruiter)
The most recent paper I found was a dissertation about occupational wellbeing and resilience amongst veterinary nurses and vet techs in Minnesota dating 2021.
The Bureau of Labor Statistics cited the positive growth at 19% for VT/VN job prospects in 2014 to 2024 (Bureau of Labor Statistics, 2016), but that increase is countered by a propensity of VT/VN leaving the field too early, with a relatively short working life of 7–10 years (AVMA Answers, 2006). (Heyder-Kitching, 2021)
The author stated that despite many people wanting to become a vet tech or nurse, not many desired to stick around for much longer than 10 years due to the high amount of stress coming with the job.
And I’m sure you all know a few people who have thrown their hands up and just left the profession all together.
A few weeks ago I spoke to Nynke who was my mentor when I was still working in a veterinary hospital back home in the Netherlands. She quit the profession after 12 years and now coaches veterinary nursing teams to make sure they take better care of themselves in order to be able to take care of others. Her practise is aptly nicknamed The Nurse for the Nurse. On a recent assignment she trained 150 vet nurses from a big chain of surgeries of whom 117 filled in a survey. 16 of them had over ten years of experience and only one of them had over 25 years of experience.
So, only one out of 117 had the tools to cope with the demanding job, or was crazy enough, to stick with the job for 25 years!
Why am I here writing about how challenging your work is? Although I’m sure the job and the stress that comes with it is universal, I have never worked in a UK-based clinic, nor am I a Registered Veterinary Nurse.
Let me tell you a bit about myself.
I should have probably started with this, but my name is Sieske Valk. I’m an ex- veterinary nurse from the Netherlands and have been living in London for over five years.
This is me with my 15.5 year old cat and mental health coach Lewis:
And this is my timeline:
Do you see a pattern?
I started studying to become a veterinary nurse at 16, graduated just before I turned 20 and decided right there and then I didn’t want to stay in the field. I had only worked in two clinics by then, both run by middle aged white men and I just didn’t felt like I belonged. I basically felt like a glorified cleaner. Four years of studying and I was allowed to clean up after them, get bitten by angry cats and get shouted at by emotionally unstable pet owners. I was raised by a strong Indian mother who cannot be told what to do and a nurturing father who showed his children what true equality in a household looks like. I carry those genes and convictions with me.
So… I decided to continue studying and went to the University in Amsterdam where I obtained my Bachelor’s and Master’s degree in Human Geography with a speciality in Environmental Geography and International Development. We’re lucky in the Netherlands that we can both study and work a part-time job at the same time, so I continued to work as a vet nurse, going from doing night and weekend shifts at an Emergency unit within a hospital to a cat-only clinic.
Eventually I graduated from my Master’s, went on to work in the field of Climate Change adaptation which took me to beautiful countries such as Kenya, India and eventually Zanzibar (where I met my now husband and found my purpose in life — they’re not the same thing though!).
The job that took me to Zanzibar, also provided me with a mentor and a coach who were both so supportive in me finding my place in the world. And they were paramount in me getting back on my feet from a near burnout and making sure I would learn to pace myself in the future. At the time I was doing fieldwork during the day, interviewing people about how climate change affected them, writing up the reports, liaising with all stakeholders and organising a conference. At night I was trying to feed the stray cat community of Stonetown, getting lots of them neutered and trying to heal the ones with mange. At the same time, my home situation in the Netherlands was very tricky; I lost three of my own companion animals within one week’s time and I failed to sleep, eat enough and eventually menstruate.
After getting out of this hairy situation, with the help of my mentor and coach, the coach let me write a letter to my future self. A letter that I would read to myself on my 35th birthday, outlining everything I had done until that time, but more importantly, everything I had done in the years up to 35.
It got clear quickly that my purpose in life was to care for animals and their caregivers, but in a different way I had done so far. I’m way too stubborn and independent to work as a veterinary nurse under an employer, so I had to find a way to do care work as a freelancer.
I moved back to Amsterdam, travelled some more and then moved to London with my partner, where I eventually set up my dog walking and medical pet care business. I started to specialise more into the field of palliative and hospice care over the past few years.
I am the first dog walker in the UK using a cargo bike to transport the groups of dogs from their home to the park instead of a van. And if you have difficulties imagining what I just wrote:
I have recently set up Autumn Animals, a holistic End of Life care organisation for London’s elderly and sick companion animal community. We offer in-home veterinary care by registered veterinary nurses, supplementary therapies such as osteopathy and End of Life Doula and pet bereavement support.
In three month’s time I’m going to be 36 and I achieved what I set out to do in that letter to myself. This did not come easy, but with a lot of stumbling, the occasional fall, getting back up and taking deep breaths, support from my loved ones and my vast network of kick-ass women that support and help me.
I’m not here to tell you how to change your workplace or fight for the support you need from your employer. Everyone’s workplace situation is different, and I don’t have the expertise to tell you how to diplomatically tackle that issue. Although, if you are interested, I can really recommend checking out the Organise Platform, a network that’ll help you unionise anonymously if you feel your employer is not pulling their weight.
I’m here to share with you a few of the little things you can do to be the best caregiver for yourself, so you can be the best caregiver for others and feel empowered and energised enough to demand what you need.
For those of you who remember what it’s like to fly, you’ll remember flight attendants telling you to put on your own oxygen mask first, before helping your child or the person next to you on a crashing airplane. So, let’s get cracking!
I remember Nynke, my old mentor, telling a group of vet nurses a story back then about when the GP told her to exercise more. She told the GP she already had a physically challenging job, running around in the clinic, lifting heavy dogs up and down a stair, getting her steps in. The GP told her that’s not the same. Exercise is not just getting your steps in, it’s a way of moving your body in an intentional, healthier, more balanced, way. It’ll release endorphins, more so than when lugging a 25 pound heavy dog up the stairs.
I now agree, but how do you fit in your daily or even weekly exercise when you’re already too pooped to cook for yourself at night?
The same goes for me, I cycle about 20 miles per day with live cargo and walk two hours with two groups of dogs, lifting the dogs in and out of the cargo box at almost every stop when doing pick-ups and drop-offs. I always thought I got enough exercise, yet I felt like an old lady with sciatica and sore feet. Because I was also still teaching yoga some evenings, I didn’t have the energy or inspiration to practise it myself.
Eventually, during lockdown (shocker!) I started doing a daily yoga session with Adrienne on Youtube in the morning (which is free!) and am currently in love with the Peloton app, which costs less than £13 per month. I practise yoga every morning at home, because I’m too lazy and stingy to get my butt into a studio.
Just ten to twenty minutes in the morning before my shower sets me up for the day, by loosening up the muscles, fascia and by connecting my breath with movement. Also, nowadays I don’t have the attention span to practise for 60 or 75 minutes, and I get bored easily when people start talking about chakras, so this particular exercise app works really well for me. I practise in the morning because I know that, despite my best intentions, my body and mind are just too tired when I get back home from work. And when on a morning I feel particularly tired or am on my period and need to take it slow, I practise a restorative yoga that allows me to actively rest while stretching the body and breathing deeply.
Here are some other physical wellbeing things I practise to set myself up for the day or week:
As you can see, there’s lots of little things I’ve incorporated into my routine that many people often neglect, such as drinking enough water, being in bed on time or even taking time to eat breakfast. I must say that these tricks didn’t appear to me overnight. It has been years and years of working towards feeling great most days and I still sometimes wake up tired.
Over the years I’ve noticed that I just don’t function well if I don’t sleep enough, or if I’m dehydrated, or rush out of my bed and into work. I know it’s not everyone’s cup of tea, but I’ve chosen to take two hours between rising and leaving for work, to really make sure I set myself up well for the day. It’s probably not feasible for people who have small children who need caring for, but for the rest of you: why save breakfast in bed for your birthday?! Most people agree with me that the first few hours of the day are the hours you have the most and best kind of energy. Why spend it on anything or anyone else than yourself?
My cat grounds me and helps me to slow down, so I make sure to make time for him. I call him my little Japanese Zen Garden (you know, the ones with pebbles the monks rake elaborate figures in) because it is super comforting and soothing to brush him. I even use my (now his) Mason Pearson hairbrush on him, because he enjoys it so much (and let’s be honest, he does look like he’s only 5 with that amazing coat!)
In addition, my husband and I always take time at the end of the calendar year to sit down and look at our planning for the next year. What are major events coming up, such as birthdays in the family, weddings we need to travel to. When are we taking breaks to see family? And when will we take time for the two of us. Instead of planning a break when we feel like we really need to get away, we make sure to plan breaks and fun activities on a regular basis, before anything else is planned in. We prioritise planning leisure over planning work. This also makes sure that leisure has been planned and set in the schedule before it gets too difficult to take time off because your to-do lists are ever expanding.
Before I go further, I’d like to say a few words about things you “should” do. In the case of exercising, I often hear: “I should do more yoga”, or “I should do Pilates for a stronger core”. I’d say to hell with “should”! The only exercise that works is the exercise you actually do. If you can’t be bothered to practise yoga or Pilates, it’s may just not be for you! Life’s too short to do anything you don’t feel like doing, just because you think you “should” do it. Find something, in this case an exercise, you enjoy doing and are able to stick with. It’s the stories we tell ourselves that get in the way of actually living our best lives. But more on that later…
I understand that some of the practises I mentioned might not be feasibly for someone with kids or canines so let’s just take time to think about what would be the one small (physical wellbeing) thing you would like to incorporate in your day-to-day life that would create quality of life. It could be the way you commute, what or how you eat, picking up exercising again, whatever… What would nourish your soul and your body and also explain why. What are you craving? What would improve your living quality? Take a minute or two to write them down…
Alright, back to centre again. Here are a few more suggestions of little actions you can take that would help you physically (and sometimes also mentally) in your day-to-day life. Obviously, this list is not exhaustive, but just some things that sprung to mind when I thought about little things that can change your life.
Now how can we make sure we’re actually going to implement these small changes into our lives? It’s easy to talk about this now in this exciting set up, but how about when we get back home and the children, dogs, partners and employers are screaming for our attention?
We get an accountability partner involved.
Someone you know and who can check in with you regularly to ask whether you’d done the deed or flaked. And then without judgement be asked what the reason was if you didn’t manage to take care of yourself. Just text a person (after we’re done here please, not now.) who can be that accountability partner for you and say: I want to make sure I do XYZ every week or day and I need you to hold me accountable!
We’ve already touched upon some mental wellbeing aspects, as I’m sure you are aware that physical and mental health are connected. The way we feel in our head is shown outwardly by how we hold our body.
We all know a dog with the tail between the legs and is showing destructive behaviour is an anxious or bored canine; humans show similar symptoms. We tend to hunch over, hold tension in our neck, jaw and shoulders and self-medicate or sometimes even self-destruct when we are off balance mentally.
One of the things I used to do when I was going through my near burn-out in my twenties was going around in circles in my head about all the things I still needed to do or the things that weren’t happening as they should. This would often happen at night when I should have been sleeping, resulting in a lack of sleep, making me more tired and less productive during the day, creating a vicious cycle. Recognise this?
Later on when I was about 33 and when going through an emotional breakdown due to overworking, my hormonal system was very off balance, causing severe PMS and wondering almost monthly why my partner was still with me if I was clearly not the smartest, most beautiful and kindest person he knew… Sounds silly right?! Not when you’re in the middle of it!
I was lucky enough to have a partner that was patient, brought me a cup of tea and offered a shoulder to cry on… he also kept a mental note on when my period was supposed to start. I had good friends that talked me through these periods (pun intended) as well.
But eventually, when it seemed like I was crying every four weeks and just feeling like I couldn’t cope with the amount of work I was getting, I knew I had to get professional help. My partner also felt like he needed to walk on eggshells one week per month, and I hated that I made him feel that way.
We had decided to get married and before we would say I do, I wanted to make sure I didn’t sabotage the relationship, just because of my own mental instability. So, I reached out to the GP who sent me to an NHS mental health care provider who helped me to find my balance in work and personal life. It turned out I had the tools to find that balance, I just needed to unlock the shed to get to them.
Nowadays I notice my mental wellbeing is starting to slide when I almost compulsively start checking whether I have locked a door (remember the part of me being a dog walker? I lock a lot of doors per day!) or switched off an appliance, because my brain does not mindfully register small actions anymore.
My good friend Nic mentioned that she notices she is off balance when she’s ordering food in more than twice per week. She’s an amazing cook and really loves to cook for herself and others, so noticing that she can’t be bothered to do something she really enjoys, means something is off and she needs to see her therapist to check in what is going on in her life that throws her off.
Every one’s Life Balance is personal. It’s a dance between throwing in enough self-care to keep yourself thriving yet being productive enough at work and having enough energy and inspiration to enjoy leisure time.
Right. Let’s talk a bit about self-care. I cringe when I hear that word because the wellness industry has grabbed the term and doused it with bath bombs, scented candles, and £200 face creams.
For me self-care is the stuff you do on a daily basis that makes sure you are thriving, not just living and getting by. The physical stuff we talked about before, but also the mental and emotional steps you take. Just like brushing your teeth twice a day, self-care for me is about daily hygiene to make sure body and mind are working well. I’d like to call them non-negotiables. Not as catchy as self-care, but less of a self-indulgent waft around it.
Here are my mental non-negotiables:
These are just a few things I practise to make sure I stay sane mentally. I don’t always stick to them and get thrown off balance occasionally, but I then know where it went wrong and get back on track. I know that I need to block out a weekend if I‘ve been very social for a couple of weekends in a row. I need to forego my penchant for cleanliness if I have been working on the weekend. Or I need to communicate with my partner that I will be very busy in the coming week, so he needs to scrub the loo and make sure we’re all fed on time in the evening.
It’s also important to ask ourselves the following:
What stories do we tell ourselves?
Society throws a lot of wants and needs at us, that we soak up like a sponge and try to adhere to.
We need to be: - the best partner and parent - carer for an ageing parent - and a sex god or goddess - we need to be zero-waste eco-warriors who cook from scratch to protect our children and animals from whatever - a good neighbour - perpetual students - and all-round furry friend caregivers - we need to have great skin that looks like glass - have a 30-step make-up routine to look like we’re not wearing make-up - have a size 2 waste but a bum like Kim Kardashian - we need to be nice, but assertive, smart, and funny - and on top of all of that, we need to “not look so damn tired”.
To add to the stories we tell ourselves about what we need to be, we can also ask ourselves:
What are my limiting beliefs?
If it’s accessible to you I want you to stand up — if you’re not able to stand on your feet, stay seated but make sure your back is supported.
1. Lift your right hand if you have pushed through to help out a family member, friend or colleague, even when you didn’t want to, had no energy for it or didn’t have the time.
2. Lift your right foot when you’ve used the words “lazy” when sleeping in a bit longer or “naughty” when eating something your body craves.
3. Now lift your left hand when you feel like you need to do something in return when somebody does something for you in kindness, like it’s a transaction.
4. And lift your left leg when there’s something in the back of your head you really REALLY want to do (such as a course, a workshop or hobby or change career) but you stop yourself, because there’s no time, energy, or money for it, or your team needs you, so you keep on going with what you’re doing, foregoing your own wishes.
It’s difficult to support yourself with these limiting beliefs, isn’t it??
What I’m trying to say is that it’s ever so important to take care of yourself first, no matter what other people say, think or how they perceive you OR how you think they might perceive you.
It’s worth thinking about what your limiting beliefs are and where they come from. If you’re finding it difficult to take steps to work through them, take care of yourself and to practise mental hygiene, go and talk to a therapist. There is nothing wrong with talking things through with a professional to help yourself. You don’t even have to go into a physical practise anymore to see a therapist. If therapy is not your thing or not feasible financially, there’s always the online or physical support peer to peer support groups or NHS mental health care via your GP. But do know, that:
If you are in severe mental distress, nothing beats seeing a therapist as soon as possible.
The emotional baggage
Let’s get down to the nitty gritty, the emotional rollercoaster we often find ourselves in when we lose someone we love, a patient we’re particularly invested in or just get too overwhelmed by life. As veterinary nurses we face severe illness and death on a day to day basis, more than let’s say, an accountant. It ain’t all puppies and kittens folks!
As mentioned before, I don’t work as a veterinary nurse anymore, but I have chosen to run a palliative and hospice care business and function as the in-house End of Life Doula for the pet parents. This means I support people through some of the most difficult stages in their life; periods of time during which they go through their own emotional rollercoaster of often unresolved emotional issues from the past.
Pets are not just furry housemates; they are children, confidants, the only remaining link to deceased parents or partners, or proxy children after failed pregnancies.
I’m not a therapist or veterinarian, so my superpowers to help these people are my listening skills and my ability to hold people in Unconditional Positive Regard. A difficult Doula term that boils down to this:
I believe every person has the inherent ability to solve their own problems and dilemmas.
I am there to listen to and witness them going through the process of loss and support them throughout by asking the right open ended questions, sitting with them in stillness or offering respite care for their animals so they can take a breather.
This is not always an easy thing to do. As a natural carer, I want to make things better. I want to take worries away, heal animals, say the right things, and solve problems, especially the ones we think are very easily solvable. But these are not sustainable solutions for the client or for me.
Let’s think about the tough emotional situations you as nurses get yourselves in, the ones that really punch you in the gut and leave you feeling empty at the end of the day: the loss or impending loss of a patient you were particularly fond of. Physically, you and the veterinary team have done everything you could to save the animal or support it through old age, but the client is still having a tough time deciding to euthanise or the decision to euthanise is taken from them through circumstances. We are creatures that sympathise and empathise, but these are not always the most helpful of emotions for the client or ourselves.
Sympathy (I feel sad/bad for you) shows itself when you’re feeling sorry for someone; we take on a feeling that wasn’t organically ours when we sympathise.
When showing Empathy (I feel how this feels for you) we are taking one step back from Sympathy: We’re putting ourselves in the other person’s shoes and thinking we’re meeting them where they’re at but actually projecting our own perceived experience onto them.
These two, whilst coming from a good place, are draining emotions.
Compassion however (I honour how this feels for you) moves beyond empathy. You’ll be learning how someone feels by becoming a neutral ally and witness. When showing compassion we make no assumptions, give adequate safe and boundless space to explore these feelings for themselves.
When adopting Compassion, we’ll become a more neutral observer or witness; sure, we still feel other (sometimes volatile) emotions when coming home, but we have trained our mental and physical muscles to cope with it and bring us back to centre quickly.
However, if you do feel like a particular case keeps on popping up in your head, making you feel unstable or keeps you up at night, you should talk to a confidant, whether that’s within your surgery or an external therapist. Remember those neck rolls we did before? That spot that needed a bit more of a stretch? It doesn’t go away by just ignoring it, it needs love and attention for it to start smoothing out. The same goes for niggling cases.
Another thing that’s important to do is have rituals. I’m not talking religious rituals, although if that’s your thang, go for it.
But I’m talking things you practice regularly in a certain way. Rituals are not only a great way to honour a passing, but also to start or close other events. For instance, I have rituals of saying goodnight to my loved ones and goodbye when I leave the house. But another ritual is how I say goodbye to a patient — a few words I say to them quietly whilst they’re still alive or after they’ve passed away, and emptying my bag of tears at home, away from the client.
Here are a few things I practise to be the most emotionally resilient carer and human being:
So, what do you need to become emotionally resilient? Is there anything that you need to ask for at home or at your work that would make you feel more stable? Take a minute to think about this and write down what you can do to feel more balanced emotionally. Perhaps even try doing this exercise with another person where you both take 30 seconds to explain your needs and wishes; try to listen fully to the person and not think about what you’re going to say next or judge. It’s just 30 seconds.
I want to end this piece with one final message. We all have a choice: A choice to live and thrive or a choice to get by. We’ve chosen this profession for a certain reason. Think about what this reason is and whether it’s being satisfied.
If yes, then that’s fantastic, go forth, inspire, and support your peers.
If not, stop to think what the reason is. Can you make circumstances better for you or is it a lost cause? There’s no shame in quitting or doing a 180 when you’ve tried to make matters better. But do remember, the one thing that is a constant, no matter which job you’re in, is you. So, start working on approaching your life in a way that works best for you and start flexing those resilience muscles!