Our guest, Dr. Lorre Laws, is an author and research scientist who has focused her research on this very problem, and she has learned that “burnout” is an oversimplification. Her research has found that there is job-specific trauma that care professionals experience. 

More importantly, Dr. Laws has ANSWERS!  In her Book, Nursing Our Healer’s Heart, Dr. Laws takes the first chapter to explain her research and methods, but then the rest of the book is a chapter-by-chapter outline of ways that you can train your caregivers to recognize and overcome trauma.

 Since Dr. Laws’ very first job was as a Certified Nursing Assistant (CNA) in a nursing home she was excited for the change to share her approaches with the home care, day services and IDD services communities.  You can learn more about Dr. Laws, her research and her book by visiting DrLorreLaws.com.

You can listen to the episode by clicking on the player below:

Shifting subjects for a moment, Ankota, the produce of Home Care Heroes and Day Services Stars, is now offering a wonderful caregiver recruiting software solution. You can learn more by visiting Ankota.com/Caregiver-Recruiting-Software.  The video below explains what caregiver recruiting software is and what the features are:

Home Care Heroes and Day Service Stars is produced and sponsored by Ankota - If you provide services that enable older or disabled people to continue living at home , Ankota can provide you the software to successfully run your agency. Visit us at https://www.ankota.com. 

Here's a Transcript:

If you want to retain caregivers and direct service workers longer, you should definitely check out this podcast episode with Dr. Lorre Laws. She goes beyond burnout and into caregiver-specific trauma and talks about the coping mechanisms that you can help your caregivers put in place. Enjoy. Welcome to the Home Care Heroes and Day Service Stars podcast. If you provide services to keep older or disabled people living at home, then this podcast is for you. Now, here's your host.

00:29

Ken Acardi. Well, hello and welcome to this installment of the Home Care Heroes and Day Service Stars podcast. I have another wonderful guest today. Her name is Dr.  Lorre Laws and  Lorre is somebody whose work is nonprofit work and she's really about not only helping our caregivers and anybody in the care profession avoiding burnout, but also understanding that sometimes burnout is more than burnout and we're going to learn a lot about that.

00:58

Before we even get into it, Laurie has written a great book that's called, Nursing Our Healer's Heart. And after like one chapter of just kind of explaining where things are going, there's some really good materials in there that can even be used in your inservices as a way of helping your caregivers deal with these type of burnout and traumatic experiences. So with that as an introduction, I think we have a great guest for today. Let me introduce and say hi to Dr. Laurie Laws. How are you today?

01:28

I am so grateful to be here. And I, you know, as you were giving that beautiful introduction, thank you so much. I was reflecting upon my very first job in healthcare was was a caregiver, I was a certified nursing assistant in a skilled nursing facility. And so, so people who are doing, you know, community based direct care provision, y'all are rock stars, like just right off the bat.

01:58

It is such important and meaningful work. Well, thank you for that. And I think we're really on the right track here on a topic that everybody's going to resonate with and learn from. So I guess when I first started speaking to you in preparation for this, I said, oh, I think people would like to learn a lot about caregiver burnout. And then you quickly kind of told me, well, yeah, there's burnout, but then there's even more. So let me just open it there and tell me a little bit about that.

02:26

Well, you know, it's interesting when, you know, for my day job, I'm a researcher. And so I, I, I do a lot of reading of research and trying to figure it, solve problems. Right. That's, that's pretty much what a scientist does. And so one of the things that, that I really noticed in, in looking in, in our healthcare professionals, our helping professionals across all, all segments was that everybody, there's, there's been this like.

02:54

50 years I've been around in this, where there's been this persistent burnout narrative. Like, oh, it's burnout, it's burnout, it's just burnout, you need to do more self-care, you need to... But after 50 years, you have to look and say, are we looking at burnout? You know, is it truly burnout? The definition for which hasn't been updated since 1970, when burnout syndrome was first introduced. So I got really curious about that.

03:20

in all the sort of geeky sort of ways that come with my professional role. And when I started examining burnout, I found that it wasn't really a trauma-informed definition. And I started looking at the symptoms between burnout and occupational-related traumatization, which sometimes happens because of the nature of our work. It's very difficult.

03:49

To be a caregiver, it's very difficult to employ those who are giving direct care services. And looking at those symptoms and looking at maybe some of the kind of system-related issues that might be contributing to that. And then what you find is that occupational-related trauma symptoms have substantial overlap with burnout symptoms. And so unless a person...

04:16

is aware of that. You might be bringing a teacup to a forest fire. And so I want to give you the forest fire hose and really being more nuanced in how we look at some of the things that we are observing in our employees that we can help them with and which will of course help them stay employed with us longer, which is everybody wins in those cases.

04:45

Yeah. Okay. Well, thank you for, um, for all that. There's a lot to unpack there. So I'm a little bit thinking, uh, in my own life. So I, you know, I'm running a software company that is helping people that are doing home care or services for, uh, you know, intellectual, developmental disabilities, all these kinds of things. And we do this podcast, which is great as well. But I guess I sometimes find that

05:13

when it's finally Friday and it's like, you know, whatever TGIF and that kind of thing. And, you know, I'm doing the entrepreneur thing. So I'm working late nights and I teach a college course and I get up early in the morning. That like Friday night comes around, which is supposed to be the big night for me to do great things with my wife. And a lot of times I'll fall asleep in front of a movie by like 9 45. And that feels a little bit like burnout. But then, you know, you kind of talked about, you know, these bigger things, which is like

05:42

And I guess you said trauma and occupational trauma and being trauma-informed. So that's something I'd like to dig a little bit deeper into. So I guess, I mean, when I think of some trauma that I've experienced or we've all experienced, I have a disability in my left leg, which might be traumatic. Or we all, not sure if it happened where you were, but there was this thing called COVID that kind of hit all of us a while back. And that had an impact on us. So that sounds like.

06:09

you know, kind of unavoidable trauma and, you know, and maybe just personal trauma. Like, you know, I still, I mean, my dad passed a while back, but, you know, I still get sad about, you know, losing my dad and that kind of thing. So there's that. But then I guess where we're going to go is that, you know, there's really this occupational trauma of being a caregiver, being a direct service worker. You know, again, I'm not sure I'm understanding, but yeah, tell us a little bit more about these types of traumas.

06:37

Yes, well, and the symptoms are so, you know, on Friday night, it's like, well, am I really tired or am I burned out? You know, and so there's the nuance of, yeah, by the end of a long week, you might be tired on a Friday night. That's like, but if it persists into Saturday and Sunday and then you can barely get off the couch to go back to your duties on Monday, we might be talking something a little bit more.

07:05

You know that might be more trauma related than not. And so when you start looking at the helping professions as I have done, you start to see that how a person responds in their occupational role. There's the stress that we all encounter in our professional roles. And there's, you know, we're all pretty skilled at managing the baseline professional stress that comes with the job.

07:33

But then there are things that happen in our jobs that are beyond the stress. And so this might be for a direct care provider going out into a home and they're not being equipped, not being fully trained if you have a patient, say, or a resident who has dementia and is being aggressive.

08:00

or violent, right? Or you get out and you have a patient who is incontinent and there's not enough supplies because, you know, we're rationing supplies to save costs, which is understandable. But then when we look at that through the lens of through a trauma informed lens, how that is impacting the employee, it is bringing further trauma exposure to whatever they've already experienced in their personal life.

08:30

And so we have this, what I call the trifecta of trauma exposure, whatever you and I and everyone else have endured in our lives, we carry that with us. We bring our whole selves to work, as do those in our employ. And then we have the occupational trauma exposure that comes with the job, right? We have to deal with the disasters and pandemics when they show up.

08:59

And we also, we suffer along with those in our care. We bring our whole heart to work with us, right? But that's inherent, that comes with being a caregiver or owning a company that provides those types of services. But so really it's from an employer standpoint, it's looking at, well, am I, or we through our policies, through our practices, are we?

09:25

robustly supporting our caregivers in ways that we're not visiting that avoidables kind of system related trauma exposure, which is often, you know, maybe not lack of training or perhaps a caseload that isn't as optimal as it could be, or it could be not having enough supplies or having your caregivers experience violence. I know once I was in a

09:54

in a home health situation and I went out to the home to provide my direct care services. And I was met by three dogs that were aggressively doing a very good job of defending the property. And I did not feel, I mean, even now I'm getting a little bit of goosebumps as I think about, and I needed to care for the person inside.

10:23

inside of this residence. And the adult son would not do anything about the dogs, just like told me to come in as they were like nipping and like I'm seeing all of the aggressive signs in dogs. And so, you know, that was a trauma exposure for me because I needed to go in there and to take care of my person. And it wasn't safe for me in that particular moment to do so.

10:53

you know, go to my car, call my office, reschedule for another time. The person didn't get the care they needed that day because of the unwillingness to make the environment safe. So that would be like an example of something that a caregiver might encounter out there. And we just sort of, you know, don't think of that necessarily as a trauma exposure, but that person's nervous system, and not to get too geeky, but the way that the physiology responds to that.

11:22

is that it is a flight or flight situation. And so we wanna minimize those exposures as best we can. And for those who have been affected in these ways, having a culture of support and transparency and then having the right tools to help your staff know how to do their self care for...

11:47

in these kind of trauma related ways is different than just traditional self-caring practices. Okay, got it. Well, yeah, I think you struck a lot of things that people will really connect with in that situation. So first of all, there's a company they're now called Activated Insight, and they, most of the audience here probably knows them as Home Care Pulse. So Home Care Pulse has, you know, they really the way they started was they

12:14

they started doing a survey of home care agencies and they got thousands of home care agencies and a lot of people look at this, they wait for next year's statistics and they get to benchmark themselves against other companies and things like this. And in here, like one of the big statistics that's shared every year is turnover and caregiving. And I, you know,

12:39

I've read different reports. I can't remember the most recent numbers, but it's over like two, right around two thirds of the caregiver workforce turns over every year. And secondly, of those that are turning over more than half of them, something in the 50, maybe 58% is what I tend to remember. They actually leave within the first 90 days. So I think that, like when you say, hey, you're putting people in,

13:08

you know, fight or flight situations, you know, that's maybe what's happening is a lot of them are like, you know, I didn't sign up for this, right? They sign up to be a caregiver and you've talked about some tough things, you know, like the dogs barking or, you know, and some of our home care clients aren't the most friendly people, right? I mean, they don't love us and embrace us. You know, a lot of times we picture, you know, just this great, you know, this caregiver and the...

13:35

and the person that they're helping, having this loving and supporting relationship, but sometimes it's not like that. And also, I mean, you go through some training and then there's the first time there's an accident, there's an incontinent situation, or there's, I think a lot of times these caregivers feel very alone and they're like, I don't know how to deal with this. And it's not like they can go down the hall and get the more...

14:04

senior person to help them because they're just alone in the house. And they, you know, if they feel like they have to figure this out on their own, I think they're like, you know, Hey, that, that other kind of job, you know, might be more attractive. So, so I guess that I could definitely see that these are, you know, traumatic and, you know, just like you think back to the situation with the dogs and that's something that, you know, just pops immediately to mind. Um, yeah, I think these are, you know, much more traumatic than me being tired on Friday afternoon and falling asleep after I.

14:32

have a slice of pizza and turn on the latest thing on Netflix. So that's great. Okay. Well, I guess, I mean, you know, every time we get together on, you know, Home Care Heroes and Day Service Stars, we're hoping that there can be, you know, something that the person, you know, investing their time and listening to this can take away, right? And so, you know, so what are things like, how are some ways that these owners, these people who are

14:58

directors of personnel or kind of leading and hiring and overseeing the work of these caregivers, what can they do to help them through this and maybe hopefully retain them longer? Yeah, and this is a phenomenon that's occurring across healthcare in all disciplines that we're faced with similar challenges. And really it comes to two things. It comes to some education.

15:28

and my book lays it all out. You could have six weeks of an in-service or weekly support or training. But I think really onboarding your employees and preparing them for what they might see because not every family system is healthy. There could be drugs or alcohol use. There could be animals. There could be hoarder situations. I mean, I've seen them all in my own.

15:57

practice and it affects the employee in ways that they aren't really as, you know, think of someone who's been in your employee for maybe two weeks. They're not going to transparently share their vulnerability. They're not going to volunteer that they felt unsafe. They may not even have the words for it if they don't understand how trauma works, which many people do not in the body.

16:25

they may not even be able to articulate what they need. And so I think as employers, the single most important thing that we can do, and I'm an employer myself, so I'm having to walk and talk and all of my stuff at the same time, is really educating people a little bit about the difference between stress and burnout and trauma and how that kind of lands in the body.

16:53

and making it a culture of compassion, where we know it's hard out there, we know everybody's had their own situations in their personal life, and those might get touched on and kind of activated by what you experience out in the community. And so here, like I have a, for example, there's a microdoses matters practice. And this is something that I would on day one start

17:21

start with my new hires, I would have this be a part of every staff meeting, you know, everything. And the microdoses matters practice is something that you do throughout the day in 30 seconds or less, right? Because a lot of people have this perception that self-care means I need to take a half a day off and go to the spa or go out for a hike that takes three out, you know. And so,

17:48

It's not the nervous system in these kind of challenging work contexts. It needs nurturance, little micro doses of nurturance and signals of safety throughout the day to help that employee stay regulated and feeling safe. And so the micro doses matters practice goes something like this.

18:11

I would say to my employees, find a place where you can, where you feel safe for 30 seconds. A lot of times for my home health nurses, that's in their car in between their, you know, before or after, or in the restroom when you're taking a natural restroom break, right? So find those little moments where you can have 30 seconds where you're in a kind of safe private environment so that you can attend to yourself, right? So the first step is safe place. The next one is grounding, ground.

18:41

I always, I'm gonna hold it up. I mean, for the listeners I have, I always have a little grounding stone of some sort that I carry in my pocket for just this purpose. But if that's not your thing, you always have your feet and they're always on the ground so you can connect to the earth. So however you bring your energy and kind of reconnect into your body and to the earth, that is a signal of safety to your nervous system. And the next thing that you can do to actually signal safety,

19:10

is maybe take a couple of deep breaths, like those big, like big, deep count to four, inhale, hold to the count of four, and then exhale to the count of four. And what that does is that if you're, you know, if we think about it evolutionary, when you're running from the saber-toothed tiger, you're not deep breathing, right? You're in flight or flight because you're, the caveman is either fighting the saber-toothed tiger or it's running away from it.

19:36

Right? And so similarly, you're not breathing deeply. So when you take those deep cleansing breaths and it's helpful to exhale using kind of a ha sound, like, you know, I can't, my mic will cut me out, or to exhale like you're blowing through a straw. What that does is it stimulates a part of our vagus nerve that helps us remember that we're safe, even though we're feeling like maybe we're not. Right?

20:01

And then the last thing, so let's recap. The first three steps is safe place, ground and center. And then the third one is signal safety to your autonomic nervous system, which what we talk. And then the fourth step is placing both of your hands over your heart. That's your healer's heart is the fourth step. And that is, I mean, I'm gonna invite all y'all to just do that right now and just notice.

20:32

notice how that brings your energy into a more calming configuration. And then you remember a lot of camera but I yeah, I you know, I'm grounded. I'm at home, I feel safe, I'm going to do my breath, can put my hands over my heart.

20:53

I mean, it does immediately feel different. It's incredible. Yeah, I guess I would say in most cases that caregivers have that experience of moments of solace. So they'll have some time when they're alone. And hopefully, they don't have to go out to the car. If they're not facilities-based, they'll be in the home. But they could find that private time, and they could do something like this. And yeah, so that's.

21:22

I think that's really, really powerful. I mean, you know, I can't say that I've officially done meditation, but every once in a while, you know, like I just like see some video or something that says, you know, Hey, if you, you know, just try just, you know, sit there, you know, lie peacefully and just, you know, take an in-breath count to eight, take an out-breath count to eight. And when I do it, which is very rarely, unfortunately, I do feel amazing after doing it. So, so that's great. It's a great self care technique.

21:51

Yeah, and it's something that, you know, it's not a one and done, you know, because while we're in our professional roles, you know, that stress exposure is still there even if it's kind of a lull time, right, if it's quiet time. And so as many times throughout the days, this can be done. And it can be done, I mean, you can do it in 10 seconds. You know, if you're in a difficult situation.

22:20

Let's just say that you're training an employee who has had one of these more challenging, maybe potentially trauma exposure type of events that they're navigating. Even while they're in the heat of the moment, they can put an imaginary bubble around them so that they feel safety, right? Visualize a bubble of safety around you. Notice your feet on the ground while you're even in this difficult situation.

22:50

Take a deep breath while you are navigating this challenging situation. And I'm wearing a necklace, which may not be, but a lot of times I'll just like fiddle with my necklace. Or if I can't get my hand to my heart, if that's not appropriate, I might just tuck my hair behind my ear, or I might adjust my glasses. Just some sort of gesture to the nervous system that you're safe. This is a hard situation, not a dangerous one.

23:19

and kind of untangling the language, the internal language that is happening. And so as many times as that can be done throughout the day, whether it's in a relatively quiet, calm time, or if it's in a particularly challenging time, what that's doing is building nervous system resilience. Right? And that really is how we prevent burnout. And that's really how we can...

23:44

start to retain our employees and have, you know, optimized workforce wellbeing is starting with the most primal system that innervates every part of our body, starting there at root cause and then working our way out. And that's how we can really address, you know, the burnout and the turnover challenges that are facing all of us.

24:13

We talked about this culture of compassion. I think that home care agencies and disability service providers would say that that's what they're all about. We're all about having this culture of compassion. And they're saying that in the context of caring for the older or disabled folks that they're doing it. And they're not maybe kind of expanding that to their own folks and the trauma they've achieved. So again, maybe a slow study here,

24:42

I definitely understand that there's some education and that, you know, like just having heard in this podcast about, you know, something I could do to hit your four points of, you know, I'm in a safe place, I've grounded myself and, you know, I'm doing something that signals safety to my nervous system and I have my hands over my heart and this kind of thing. I mean, that's really powerful right away. But, you know, are there parts as well that could be either...

25:13

I guess from the home care agency perspective, were they just kind of training them in these self-care techniques? Or are there some other things that they should do that are a little bit more, when they do do an in-service and there's like a number of caregivers together, they're doing like an event in the community and things like that. Are there things that they could do that, help address some of the, those traumatic situations that, that caregivers have experienced? Like what might you recommend there?

25:39

Yeah, and that's my nonprofit offers just those sorts of programs. And so really, what it is, is it's sort of a structured in-service. The first thing, we can't solve, address a problem wholly, unless the people with whom we are trying to address it have the basic knowledge, right? So there's the education piece. And this can be integrated into the onboarding process.

26:09

into the training process and then continuing that kind of that education piece throughout the in-services and you know in each organization is different how they support their employees but integrating it's not just a one and done but you know we call it we call it in academia we call it embed it and then thread it all right so you embed it you embed kind of the education piece around like you know self-care let's do trauma-informed self-care.

26:39

Because everyone on the planet, every single human being has experienced some form of trauma. And it is in varying degrees of healedness, right? So embedding, like let's take trauma-informed self-care and then weave it. So that's the embedding and then thread it through the rest of how you support your employees.

27:04

And, you know, we don't have time in sadly to go through a lot of the practices, but in the book, I have over 100 practices that can be used. And what the grander, the grander framework for this work, it's called the innate care plan, where each employee would start to then to learn the language of their nervous system and how to navigate it professionally to keep them professionally well.

27:31

Right? I mean, this is like, it's a win for the person for whom is receiving care, it's for the employee and it's for the organization. So it's a win, win, win. And then, and so using that innate care plan, which has three A's that we've kind of touched on today, which is awareness of your nervous system, which we've done here today. And then there's how do you attend to your nervous system, which we did one practice here today. And then the third A is alignment. How do we?

28:00

How do I align what is happening within me to my outer world, right? When I'm at work, how does this translate? Now that I'm feeling regulated and safe in my nervous system, now I can translate that into what I'm doing in my professional role. And then of course, the B part of this care plan formula is balance, which is all the traditional self-caring wellness things that we all know to do, get enough rest, eat right, exercise.

28:28

be in healthy thriving relationships, financial health, you know, all the normal, all of the usual suspects show up there. But if we start with the external self-care in the traditional sense, and you're trying to do that on top of a nervous system that isn't regulated, it won't be effective. And that's why the traditional approaches to burnout over 50 years have not been wholly successful. So I would say trauma-informed self-care.

28:57

And then that will lead to the outcome is that your employees will be regulated in their nervous system, which translates to better care, better everything. Right. And then there's a sense of internal reconnection within and now because we're regulated, we can connect better with those in our care and with one another as colleagues. And then there's the important one, which is the name of my book, which is our healer's heart.

29:26

our healer's heart gets restored because during these trauma exposures, it feels like it's getting broken. And so we wanna keep the caregivers why for coming to this profession, to our organization. We wanna nurture their healer's heart so they wanna stay and continue to do the good work that they're doing and to do it for us.

29:52

So that's kind of the grander framework that could be integrated into an organization's onboarding and training and ongoing support of their employees. And I got goosebumps as I'm saying it because I've seen this. I've seen how this works in other contexts and properly done. It has tremendous, tremendous positive benefits.

30:21

Wow, incredible. So I guess I made some things up a few major things I've heard and I know there's certainly an incredible amount of turnover in caregiving. And I know that anybody listening is like, holy cow, you know, if I could incorporate some of this, and I could make my caregivers enjoy their jobs more, stay more refer their friends, and feel nurtured in our company compared to our competitors, these are going to be big wins for this. And then a big thing I heard is that

30:49

I think you said there's over like a hundred practices in the book. So they could go out to wherever they buy their books, like Amazon or on their Kindle, or they get downloaded on Audible or whatever they do. But they could go and they could get nursing our healer's heart. And yeah, look for that. And I think I'm going to read it myself, just to make myself more balanced and those types of things and see what I could do.

31:17

to help our employees. We have different stress, just kind of in our world, I won't delve into that. But then also, so if they wanted to get in touch with you further, Dr.  Lorre Laws, is there a way that they could get in touch with Dr.  Lorre Laws? They certainly can. And my website is that same name. So it's DrLorreLaws.com.

31:46

You can just google my name and and it'll pop right up.  If you can't remember the URL i am on social media with the same handle @DrLorreLaws so however i am everywhere and i am here in service this is my darma and i'm a spiritual person is so this i consider this to be my light work in my service i'm not only to my profession but to to all helping professionals so.

32:14

Just know that I am here and I can consult and guide and support however anyone is needing those services. Love that. Okay, so just to clarify one thing really quick. So, LORRE is spelled L-O-R-R-E. Yes. So it's Dr. LORRE Laws. So that would be D-R for doctor, L-O-R-R-E for LORRE and then L-A-W-S, so DrLorreLaws.com.

32:43

And the book again is called, Nursing Our Healer's Heart. And it's available anywhere on the planet that books are sold, I'm sure. Yep. And with that, I think we will say thank you. And, uh, and we'll wrap it up for today on Home Care Heroes and Day Service Stars. Thank you so much, Dr. Laws. Thank you for having me. All right. Have a great day, everybody. Thanks again.

Thanks for joining us today on the Home Care Heroes and Day Service Stars podcast produced by Ankota.

33:13

You can listen to back episodes by visiting https://www.ankota.com/home-care-heroes-podcast. That's the number 4, then the words homecareheroes.com.