Keeping your head above water, lessons from the shop floor

Julie Highfield @DrJulie_H

I’ve been working as a Consultant Clinical Psychologist in critical care for five years now. Part of my role is to work with staff and the system to promote wellbeing and a better employee experience at both an individual and systems level. We know that psychological wellbeing in the workplace is multi-faceted and influenced by individual differences (such as personality and coping style) but also work factors such as job design, colleagues and team attitudes and relationships, management and leadership style, and the ethos of the wider organisation.

I’ve written elsewhere about how to manage the system for a better staff experience[i] , however I have developed some ideas to help individual staff make sense of working in ICU, and these have helped me, and others, to thrive in this environment. I’ve been linking with the ICS to pull together these insights into a series of materials to help their wider members. These will be launched at the State of the Art 2019 this year, and will be available to download from the website.The nature of the ICU lends itself to staff who have high expectations of themselves and are very self-critical. We need to acknowledge that we are only human and there is a limit to the intense emotions we can tolerate. It is important to be compassionate for ourselves- critical care requires us to give out +++, so we need to receive back +++. Sometimes it feels like there is nothing we can do with what our patient faces, but I can assure you from what patients and relatives tell me, sometimes just being alongside them is enough.

Getting off the critical care rollercoaster


In the ICU, staff are required to change gear all of the time. Sometimes we are fast and sometimes we are slow. Sometimes we are on a clinical high and sometimes a clinical low.

I’ve come to refer to this as the critical care rollercoaster. This creates a psychological dysregulation, which I have found staff need to compensate for to keep their stress and emotions on an even keel or “effective rollercoaster riding”: compensating for the highs and lows, and on occasion getting off the rollercoaster. In part, this means ensuring you take your breaks, creating a few minutes to step away from the unit, take a breath and relax (and leaders should enable this), and outside of work allow enough “down time” where you can switch off. Beware the need to keep “on the go” at home.

In addition, creating spaces inside and outside work to process these difficult emotions are important. I use the phrase “detox don’t debrief”, as a way of encouraging emotional processing. We can create formal and informal ways of doing this- from reflective rounds, to chatting over coffee.  In the ICU we practise the art of healthy disconnection- a kind of professional distance without the unhelpful psychological defence of depersonalisation (the slippery slope to burnout). Space to process the tough stuff helps us take that healthy step back.

The ICS will be publishing material in this area soon.  It will be useful in your ICUs.  It’s a hard but rewarding area - let's look out for each other.

Dr Julie Highfield, Consultant Clinical PsychologistBSc, D Clin Psy, C Psychol

[i] Highfield, J. (2019) The Sustainability of Critical Care Staff. Critical Care Nursing.