Shownotes Links:
Dr Lorre Laws’ Book – Nursing Our Healer’s Heart: A Recovery Guide for Nurse Trauma & Burnout:
- Dr Sarah Woodhouse on “You’re not Broken” and Dealing with Trauma in Our Modern World Introduction
- Dr. Denise Quinlan: Leadership & Preventing Burnout in the Workplace
- Dr. Tabitha Healey: Mental Health & Burnout in Medicine
- Burnout Recovery for Healthcare Providers with Tammy Guest
YouTube Timestamps (Concise & Highlighting Key Topics):
0:00 – Intro: Why Healthcare Burnout Needs a New Approach
2:43 – Meet Dr. Lorre Laws: Nurse Scientist & Trauma Expert
3:34 – Burnout vs. Trauma: The Science Behind It
7:49 – How Polyvagal Theory Explains Freeze & Fawn Responses
18:26 – Cell Danger Response: What Burnout Does to Mitochondria
32:07 – Why Traditional Self-Care Fails for Healthcare Providers
50:03 – Dr. Laws’ “3 A’s + B” Framework for Healing
1:02:28 – The Future of Healthcare: Nursing 2.0 & System Reform
1:07:08 – Final Thoughts: Practitioner Health = Public Health
Burnout, Trauma & Healing: Dr. Lorre Laws on Healthcare’s Future
Dr Ron Ehrlich [00:00:01] Hi, Dr Ron here and I want to invite you to join our Unstress Health Community. Now like this podcast, it’s independent of industry and focuses on taking a holistic approach. To human health and to the health of the planet, the two are inseparable. There are so many resources available with membership, including regular live Q &A’s on specific topics with special guests, including many with our amazing Unstressed Health Advisory Panel. Now we’ve done hundreds of podcasts all worth listening to with some amazing experts on a wide range of topics. Many are world leaders, but with membership we have our UnstressLab podcast series where we take the best of several guests and carefully curate specific topics for episodes which are jam -packed full of valuable insights. So join the UnstressHealth Community. If you’re watching this on our YouTube channel, click on the link below or just visit unstresshealth .com to see what’s on offer and join now. I look forward to connecting with you. Hello and welcome to Unstress Health. My name is Dr Ron Ehrlich, well today we continue a theme which I think is relevant to absolutely every one of us, whoever comes into contact with a health professional, let alone if you are a health professional, because it is my belief that the epidemic of preventable chronic degenerative diseases, both physical and mental, that we have in our Western world is a reflexion of the health of the practitioners which delivers that. And that says something about the system rather than the individuals themselves. So this is a great conversation today about so many issues which are relevant to us all. My guest is Dr Lorre Laws. Now, Lorre, L -O -R-R-E, Lorre Laws, is a nurse scientist and she’s also a trauma and burnout expert. And we talk about all of those things today, what they mean on a level that I think you will find very interesting. She’s also the author of Nursing Our Healer’s Heart, a recovery guide for trauma and burnout. But as I say, you could substitute the word nurse for you or yourself very easily here. I hope you enjoy this conversation I have with Dr. Lorre Laws. Welcome to the show, Lorre
Dr Lorre Laws [00:02:43] Thank you so very much for having me. What an honour to to come together in such a beautiful virtual way from different parts of the planet.
Dr Ron Ehrlich [00:02:52] Exactly, exactly. Now, listen, you know, burnout is a big topic and we’ve been exploring that theme on the podcast in the last few years. And I have a sort of a hypothesis that the health of the health practitioner is reflected in our global preventable health pandemic that we find ourselves in. So starting with health care professionals is probably a good place to start. And that’s what we’re going to be talking about today. But I’m just interested to know what drove you to explore this, to research, to write about it affecting nursing worldwide.
Dr Lorre Laws [00:03:34] Well, you know, it’s always, you know, when you get to be a woman of my age, there’s there’s a lot of stories, some of them shorter and some of them longer. But the cliff notes to my long story is I started as a very young woman, a teanager cleaning restrooms in a nursing facility, and then got my nurse’s aid credentials at the age of 15 and started facilitating end of life transitions for the residents who were at the end of their lifespan before I was old enough to drive or vote. And so, yeah, so that, you know, my healer’s heart, you know, what I call, you know, the reason that each of us hold deep within for, you know, what matters to us most, including our profession, because really, we’re all healers, parents, health care professionals. You know, it just means that we’re helping another along the path to to their health and well -being. And so that that led me to a career in nursing and went on to start doing it. I did a master’s degree and then and then a doctorate degree. And I became very curious about integrative health, which is which is what my clinical specialty is. And I’m also an integrative nurse coach. And so I started this was prior to the events of 2020, 2021. And I was working with coach coaching nurses, excuse me, who are experiencing burnout. And what I was learning was that they were refractory. A good number of these nurses were refractory to our normal approaches, to self -caring and, you know, mindfulness practises and so forth. And I got very curious around the the the literature and the narrative around burnout. So burnout syndrome was was brought out in in the 1970s, you know, a half of a century ago. And the evidence base has not been materially updated, nor is it trauma informed. So that as a nurse scientist, that gave me some good fodder for some research questions. And so I started really investigating like, what if it’s not just burnout? Like that was that was sort of my overarching research question. It seems to me that in 50 years that I’ve been around, right, from a very young woman to now, shall we say, a very mature woman? That we this hasn’t been materially addressed. And I see it in my colleagues and the physicians and in our home health care professionals and and dentistry and really any helping professional. Right. And so I really started looking and it was my good fortune. I have a background in social behavioural sciences. And I was teaching in in that college when I was doing the research for this book. So it’s a multidisciplinary research project. And so I started looking outside of health care for solutions. And I started looking places like, you know, neurophysiology and, you know, polyvagal theory by Dr. Steven Porges, of course. And then I started looking at relational neuroscience and the work of Ian McGilchrist and Dr. Bonnie Badenoch and among others. And so what I started seeing that and then I did a symptom cluster analysis. Like, let’s let’s do a symptom cluster analysis on the traditional burnout symptoms and then let’s let’s look at the symptoms, the immediate and delayed responses to trauma as framed by SAMHSA. So let’s let’s analyse all of that. And what I found was really shocking, surprising and also gave a little beacon of hope is that in the good number of cases, it’s not just burnout. It’s occupational related traumatization, much of which is avoidable.
Dr Ron Ehrlich [00:07:49] Interesting. Yeah. Gosh, you have said so much there that we could unpack. I mean, what a way to start a nursing career and end of life at such a young age. Your interest in integrative health is one that I’ve shared for over 40 years, and we’ve explored many times on this podcast. The story of burnout, you know, I mean, I think I didn’t. Well, I know Christina Maslach was a pioneer, I thought, in the 80s in burnout. But it was kind of a definition that has come to fruition in our modern age. And you’ve mentioned Stephen Porges and Ian McGilchrist, both of which I’m very, very familiar with. I mean, Stephen Porges, Polly Vagel Theory. And this is where the trauma comes in. And we’re going to talk about that in McGilchrist, of course, wrote that wonderful book that I read. I think the Master and His Emissary, the left left and right brain. So we could spend quite a good deal of time talking here, Laurie. Anyway, let’s just start with you mentioned nurse specific traumatization. And, gee, I’m guessing as a young woman in the end of life, you would have thrown yourself in the deep end there. Can you tell us a little bit about it? Because I don’t think that’s a term many people will have heard, but feel intuitively there’s something there.
Dr Lorre Laws [00:09:18] Yes. Well, you know, and it’s so interesting because as I was doing the research for this book and, you know, I’m a nurse scholar, so I teach at a major university in the United States in an integrative focused integrative health focused bachelor of science nursing programme. So that’s that that’s where the population that I work with. And and you start you start looking at all of these factors we discussed. And as I was researching, I was like, well, as a nurse scholar, I need to have this grounded in the right philosophical and theoretical framework, which nobody else outside of academia cares about. But but it but it does matter, you know, for my professional role. And so as I was writing this book, which I decided to bring the research right into the living rooms of the nurses. So I wrote Nursing Our Healer’s Heart, which is a book that in first person coaches nurses who are experiencing burnout or trauma through their process. And as I was doing the research and writing this book, trying to to bring whatever help I could to our community. Dr. Karen Foley at Purdue University published a middle range theory of nurse psychological trauma. And it was as though the Red Sea had parted when I found that in my inbox. And so it was Dr. Karen Foley, who who coined the term nurse specific traumatization. And that ground is what I grounded my research in. And so essentially it is that, you know, we all have, you know, the global the global category of trauma as persons, human beings on this planet. We have all experienced some degree of individual trauma. And that would be, you know, all of the things that we all are very familiar with. And then you look at what we’re exposed to professionally. It’s not just nurses. I just happen to be a nurse scholar, but it’s it relates. And then we look at there’s some unavoidable trauma exposure that we all are that comes with the job. It’s inherent. And so that would be our secondary or vicarious trauma, for example. And then there would be the trauma from disasters. And whether you have gone to medical school or nursing school or any other professional health school, you get some training in how to manage that. Right.
Dr Ron Ehrlich [00:11:41] You would hope. Right.
Dr Lorre Laws [00:11:44] At least you saw one slide on a PowerPoint, maybe. You know, it’s it’s sorely lacking, even even when it is taught. Right. Or and tools to manage the unavoidable trauma exposure. But what’s really driving nurses from the profession and other primary care physicians and health professionals of all disciplines is the avoidable trauma exposure. And you know, nurse specific trauma, physician specific trauma exposure, occupational related trauma. Right. And this would be the things like the workplace violence. Right. Whether it’s from patients, families or the incivilities and lateral violence in the form of bullying and gaslighting. And then we have the insufficient resource trauma. And this is trying to practise with not enough staff, dangerous staffing ratios, not enough resources, perhaps being asked to work an unsafe number of hours or an unsafe number of days in a row. This is all trauma exposure. And then we then we have kind of this historical trauma. You know, like if you think about it, I know you’re familiar with this word, the generational trauma, right, that gets transmitted from one generation to another. Right. It’s integrated, it’s encoded in the DNA. And depending on circumstances, those genes get turned on epigenetics. So that’s no different than the legacies of trauma that we as health providers have also were sort of unknowingly transmitting that integrated trauma. And it’s it’s implicit and not something you can, you know, empirically measure, but it’s there and very powerful at the same time. And then another category of sort of this avoidable trauma exposure is system induced trauma. And this is when the system itself is the source of the trauma. And an example I give of that, it’s just so sad, but it is pervasive worldwide is that the uptick of violence against nurses in their professional roles. I recently spoke at a conference, 200 nurses at a national conference, and I said, how many like you, show of hands, how many like you, like me, have been kicked, hit, had your hair pulled, been spat on, been bruised, been battered, or had bodily excrements thrown on you? Out of 200 nurses, 190, my assistant couldn’t even count the hands up, she had to switch to count the hands that were not up in the audience. And yeah, and so this is and then when the nurse reports this going up the chain of command in policy, right, reporting it to supervisor, doing all the things that you’re supposed to do. The first question that most nurses are met with is what could you have done differently?
Dr Ron Ehrlich [00:15:01] Oh, yeah, right.
Dr Lorre Laws [00:15:03] So now we have a traumatised nurse who is battered in some degree, and now the system, instead of having compassion and offering resources and supports and taking accountability for whatever system issues that could be addressed to prevent, we do sort of this blame the victim gaslighting sort of narrative. And it’s these types of issues that are driving nurses and a good number of health care professionals from the profession. But the narrative surrounding these conversations is still rooted in that 50 -year -old burnout, which places also if you look at the World Health Organisation’s definition of burnout, it is occupational stress that is not being effectively managed. More blame the victim, more gaslighting. So we have these social structures that are not trauma -informed, that are from times long ago, right, that are embedded in our systems, in our policies, and health care has gotten much more complicated than, you know, than it was. So we have some cognitive dissonance at the bare minimum that needs to be addressed.
Dr Ron Ehrlich [00:16:30] But what you are describing is we really need to take a step back even further and look at global health. And when we say there is an epidemic of preventable, chronic degenerative diseases, both physical and mental, and the key word there is preventable, and then we look at the cold face of the people that are being asked to manage that, and that’s all they can do, manage it, they’re managing chronic disease, that is a soul -destroying, traumatic experience on a day -to -day basis that we’ve come to accept as normal. And I often say, and I’ve often said on this programme, that if we wanted to make sense of our health care system or our environment or any of these issues, if we preface the word with two words, business model, then we make sense of it, but that doesn’t help the health of the individual, society, or the environment. But people having to deal with this on a day -to -day basis is exactly the trauma that you’re talking about.
Dr Lorre Laws [00:17:42] Well, yes, and it goes a little bit deeper than that, in that if you start looking at the work of Dr. Robert Naviaux and cell danger response theory, so you’re familiar with that as well.
Dr Ron Ehrlich [00:17:56] I am.
Dr Lorre Laws [00:17:57] Right, right, so we’re just getting out all of our geek flags today and flying them back. So when you start really looking at this…
Dr Ron Ehrlich [00:18:06] Just remind our listener, just because I’m familiar with it, let’s just stop there for a moment, because what Robert Naviaux talks about, and we’ve explored this on several podcasts as well, with mast cell activation, all of that problem, but let’s just go, Robert Naviaux 101, what his message is.
Dr Lorre Laws [00:18:26] Well, and I’ll say his message as pertains to my work, because he has a very grand message and it’s complex, but as pertains to the topic that we are discussing today, is that it looks at the stressors, right, of chronic conditions and the healing process, and how that affects particularly the mitochondria, which is the powerhouse of every cell in our body. And what happens, and it just so happens, that trauma exposure, psychological trauma, is one of those major stressors to the mitochondria, and then we partner that with polyvagal theory, right, and then it gets really exciting, but we’ll stick with one.
Dr Ron Ehrlich [00:19:11] We’ll get onto that as well.
Dr Lorre Laws [00:19:13] We will get onto that. And so what we have is that the mitochondria become stressed, and then they become rigid, and as they become rigid and they start moving into what’s known as mitochondrial dysfunction, then they cannot produce the energy that is needed for the organism under the best of circumstances, the organism being each of us, right, all of us as human beings, so we are subjected to this, and it can lead to a whole host of mitochondrial dysfunction -related chronic conditions. And so then we look at the healthcare provider who has an inordinate amount of trauma exposure, and so it complicates. So now what we have are the patients and clients, those in our care are coming to us on what might be a traumatic circumstance or situation that they’re navigating in their lives, and then they’re being met by healthcare providers who have had the same individual trauma exposures, and then this whole layer of unavoidable trauma exposure that comes with our jobs, right, comes with our profession. We suffer along with those in our care, and then there’s this whole other, you know, avoidable trauma exposure. And so if you think about that through the lens of the mitochondria that are trying to produce the energy that is required to not only just be a human, but to be a health provider, right, with the unavoidable trauma, and then be a health provider with the, you know, the other layer, the avoidable, the unavoidable, it’s just, I call it the trauma trifecta, and this is blowing out, for lack of a better word, the mitochondria. So for healthcare providers who are out there, nurses, physicians, dentistry folks, allied health professionals, if you are struggling to get off the couch on your days off, and maybe the best you can, I have been here, the best I can do is, no, I can’t go for the hike and the picnic in the woods, because I just, my mind is willing, but my body just can’t. And I can grab the remote control in one hand, and I can get my phone in the other for some takeout, and just, you know, kind of be in this sort of, what Porges would call the freeze state, you know, it’s this exhaustion that’s not just, I’m not just tired from work. Not the tired, I’ve had a busy work week, and I don’t feel up to it. This is the bone -weary fatigue and exhaustion of I can’t, and that is not a character flaw or a personality deficit. It is literally a function of the mitochondria, not being able to produce the energy that is needed for the prolonged trauma exposure and traumatization. So that’s kind of like how his work meets mine.
Dr Ron Ehrlich [00:22:26] Well, that’s a great, great 101 of Robert Navariaux’s work, and you’ve mentioned Stephen Porges and the polyvagal theory, and I think it might be worth also just, let’s talk about that, because so often when people do face a trauma, you know, abuse, a physical attack, it’s often said, well, why didn’t you run away? The fact that you didn’t run away condoned what will happen to you. You know, again, another form of gaslighting. Can we just talk about polyvagal theory so people understand? Because I think this is relevant to how we approach the rest of your work. Tell us about polyvagal.
Dr Lorre Laws [00:23:10] Yeah, it’s really, it’s foundational truly to my work, and really we need to be teaching this in medical schools and nursing programmes, and I’m a nurse scholar and educator, and I have combed the curriculum worldwide, a number of curricula, and they are just, it’s just not being taught, you know? And so I kind of use like, you know, a stop signal here, and in the United States, a stoplight. We have the green light for go, the yellow light for caution, and then the red light for stop, right? And I think that’s pretty universal. So Dr. Stephen Porges, in his work, he looks at the midbrain and the vagus nerve, which innervates just darn near a whole lot of stuff. I don’t want to say everything, but it goes all the way down to our intestines, you know, from the lower brain there, and then looks at what happens with the autonomic nervous system under certain conditions, all right? So green light conditions. Green light conditions would be ventral vagal tone, which means that we are relatively relaxed, as you and I are right now. We are curious. We’re able to socially engage with one another. We feel safe because we are safe, and we can, if you and I were in our practises right now, we would be able to offer patient -centred, heart -centred care, and in a manner that is very authentic and genuine, right? Now, we all agree that’s what we want in all of our healthcare providers, right? We want to be seen and heard and understood and felt and supported. And so ideally, we would be in this green light, ventral vagal, and then our sympathetic nervous system, which kind of comes online to help us manage stress, it’s a short -term response. It’s not intended to be a chronic response, stress response. And if we have a really challenging situation, a patient’s health is changing quickly, or we experience some bullying by a colleague, we kind of ramp up a little bit to manage the stress, and then we are intended to go back into that green light ventral vagal, all right? That’s ventral vagal tone, green light, that’s where we all want to be. That’s where we are in what Porges just calls ‘our window of tolerance’, right? We’re in our window of tolerance, meaning we can manage the stressors and still be grounded, centred, socially engaged, and heartfelt and curious. And we can see the big picture. We can look as you and I are talking about broad topics and we’re able to switch conversations and be very open -minded. But then what happens is that whether it’s stress in one’s personal life or in professional life, and that stress goes from the regular kind of day -to -day living or kind of these blasts of short -term acute stress, right? Like, oh, maybe we have a rapid response for a patient, right? Or maybe my patient passed away and I’m helping with the family. And those are some kind of bigger stressors that could even be construed as trauma exposures. But they’re still manageable. They’re taking us sort of to the top of the I can manage this zone, right? But again, intended and designed, evolutionarily speaking, to be short -term responses. But that’s not what we have in healthcare. We have chronic stress. We have chronic, much of which is avoidable, trauma exposure and traumatization. And so that takes that sympathetic kind of flight or fight response, right? You’re either running towards the sabre -toothed tiger or you’re running away from the sabre -toothed tiger, right? This is the autonomic nervous system and it’s primal and it’s kept us alive over the millennia, right? And so sometimes a person, if they have an encounter at work with a difficult patient or a colleague, they might lean into that maybe with a little bit of anger, a little bit of rage. They might be moving towards the stimuli, right? And then other people might move away from the stimuli, the conflict, and in more of a fear, worry, doubt, anxiety sort of way. But both of those are legitimate responses to a trauma exposure or what Porges calls when our threat detector, pardon me, in the midbrain, which isn’t really a structure but a process, when the threat detector detects that there is a threat to our danger, to our safety, whether that’s in the external environment or even our internal environment, right? That we go into this trauma response as flight or flight. And then if we have unintegrated trauma, which is another word of saying unhealed trauma that’s kind of been stored in our body from days gone by, traumatic experiences that weren’t completely healed because of a number of factors, well, then those can come up and those are also deemed as unsafe or can be. And so we have this, not only is it what is happening in our external environment, but what’s happening in our inner landscape as well, can kind of turn on these green light, yellow light dimmer switches. So again, the green light is a ventral vagal tone where we’re open and grounded and centred. And then the yellow light is sort of this sympathetic. Like, okay, we got a big stressor here. Let’s get some all hands on deck. We need to meet this, right? But then if that trauma exposure or if that stress persists beyond what is manageable by the autonomic nervous system, then we get into the red light, which is kind of the danger signal and for good reason. And this is when that threat detector is saying, the danger is so great. The threat to our safety is so great. Or the mitochondria cannot keep up with energy production, right? It’s looking at cell danger response and kind of bringing these two together. And it’s saying, we’re going to shut you down because we need to conserve, the body needs to conserve energy. Red light means shut down and kind of go into this freeze response or like where you’re there at work and you’re present, but not fully present. Sometimes presenteeism is confused with this sort of freeze response. And then there’s variations, one of which many people have heard of is the fawning. So if you can’t move towards the stimulus, right? You can’t fight the sabre -toothed tiger or whatever that represents in your workplace, right? And you’re not in a position where you can flee because we can’t abandon our patients, right? We can’t do that. So we can’t fight and we can’t flee. Then oftentimes we fawn, which means we just say, oh yes, I’ll do that. Yes, I will. Oh sure, whatever you need. We just sort of say and do whatever needs to be done because we don’t have any other choice. And many of our colleagues, many of our colleagues are operating in some degree of what I call sympathetic overdrive. Like they’re sitting right at the border of yellow and red, right? And it’s like, I can’t get off the hamster wheel. I can’t take a restroom break. I can’t have a sip of water. I cannot eat any food. And that is real because of a lot of our short resources and lack of staffing. So that is real. I’m not minimising that. And it is also a trauma response.
Dr Ron Ehrlich [00:32:07] It’s so interesting to hear you put that and put it in this way because so many people would have heard many times about the parasympathetic rest and digest, the sympathetic fight or flight. But this is what distinguishes polyvagal theory is that it acknowledges this freeze response or fawn response. I love that. And from a practitioner perspective, it goes such a long way to explain why the prescription pad provides the perfect solution to people’s health issues. And such a quick and simple solution. And yet at the same time, we have such high burnout rates in healthcare. And juxtaposing those two with the polyvagal theory and putting the prescription pad in the middle of all of that, it goes a long way to explain why we have a $1 .5 trillion pharmaceutical industry put in this polyvagal theory response to healthcare trauma.
Dr Lorre Laws [00:33:15] So here’s the thing that I find so curious about that is that oftentimes, even though I’m an integrative health nursing professor, so I fully acknowledge that that is my clinical specialty. And also that includes the prescription pad but is not limited to the prescription pad. But oftentimes, and I’m over here in the US, so while we do have different healthcare systems, we do share a common denominator is that none of us have enough time or money to care for our patients in the way that we need to. Because trauma healing, as you know, is a slower process of unwinding the nervous system and rewiring the limbic system. And all of these things cannot be done in a 12 to 15 minute patient encounter. And so oftentimes, the prescription pad is the bandaid. The bandaid. And yes, there’s utility and yes, there is symptom relief but then a good number of people stop there and they don’t get to the root healing where we can really start getting into the chronic illness, the chronic disease, the chronic condition of the mitochondria and how they can be supported so that they can produce the energy that we need for all of our physiological functions, right? And so the prescription pad has merit but a lot of people think that that’s the end all be all and I just will come back next month for my next prescription and the chronic health conditions persist and the anxiety and the sleep challenges and the list goes on and on. And so it’s taking this trauma -informed approach to self -caring and understanding how each and every one of us has been through some sort of a trauma and most of us, many, many, many.
Dr Ron Ehrlich [00:35:21] Hi, Dr Ron here and I want to invite you to join our Unstress Health community. Now like this podcast, it’s independent of industry and focuses on taking a holistic approach. To human health and to the health of the planet, the two are inseparable. There are so many resources available with membership including regular live Q &As on specific topics with special guests including many with our amazing Unstress Health advisory panel. Now we’ve done hundreds of podcasts all worth listening to with some amazing experts on a wide range of topics. Many are world leaders but with membership we have our unstressed lab podcast series where we take the best of several guests and carefully curate specific topics for episodes which are jam -packed full of valuable insights. So join the unstress health community. If you’re watching this on our YouTube channel click on the link below or just visit unstresshealth.com to see what’s on offer and join now. I look forward to connecting with you. But this is where and this is why I was so looking forward to talking to you Lorre because it is my belief that if we can improve practitioner health the flow on effects to our patients and public health will be huge which leads to my next question is how does nursing our healing hearts let’s start being a little positive here because there are solutions to these issues. Tell us about nursing our healers heart.
Dr Lorre Laws [00:37:05] Well this is the book that I wrote and based on my I did five years of research across four disciplines and I self -funded this research so that I could get it right into the living rooms of the people who needed it the most because for those of you who aren’t in the research of healthcare it takes about 17 years from the time you do your first study until it’s translated into practise and is accessible to everyone. Well we don’t have 17 years and within the next decade we’re going to have half the number of nurses that we need worldwide. So it’s like okay well I don’t have 17 years and the nurses don’t have 17 years so I wrote the book and part of what I do for my professional roles I’m a conceptual framer which means I come up with clinical frameworks that emerge from the evidence base that can be useful in guiding patient care. And so this is something that I do for a living and so looking at all of these challenges that we talked about today is like well how can we address this it’s not just burnout it’s likely occupational related traumatization and how can we frame this in a way that not only will be helpful but also as an integrative health clinician how can I leverage each person’s innate capacity for healing for within each of us resides that capacity. And so how can we tap into that and really help people with the healing process and importantly for the clinicians still in practise how can they insulate how can they learn to insulate their nervous system from all of the trauma exposure whether it’s avoidable or unavoidable doesn’t matter our physiology doesn’t care the autonomic nervous system doesn’t care if it’s a sabre -toothed tiger or a code at work that went with a sad outcome right but from the perspective of our autonomic nervous system our vagus nerve and our mitochondria don’t care about those higher concepts right so how can we get in here and really affect healing which in my work healing is a repatterning in any one or more dimension of a person’s body mind essence and I use body mind essence instead of body mind spirit because we have to capture also the ancestral trauma right and that’s being transmitted and the cultural trauma and the social trauma and you know so I use body mind essence as the broadest most inclusive term that I can and so that was sort of my question writing the book is like how can I translate this evidence or the research that I have done into a way that really meets the reader where they are in their health in their nervous system in their trauma response and offer framework and so what I discovered is that most people most of the self -care things are externals you know I’ve got to and they’re all important I’ve got to eat right I’ve got to exercise I need to be hydrated I need to have sleep and I say to that yes yes yes and yes and then I need to go for hikes and I need to be in nature and I need to spend quality time with loved ones and I say yes yes and yes but that’s not where we start we start we have to shore up the foundation we start with the most primal and important system which is our autonomic nervous system and our vagus nerve because if you’re doing all of those things all of those absolutely wonderful and correct things on a dysregulated nervous system this is what I found with the nurses once we address the trauma once they got supported in trauma healing as the foundation upon which all of those important self -caring practises are our practise then we got somewhere then healing oh I got goosebumps even as I’m just kind of recalling it’s so powerful that shift when you know when healing happens and that’s why I’m in the game you know it’s like that’s what is the fuel for my healer’s heart is to be a part of that process so we start with the nervous system and so the framework the framework that I brought forward is very simple it’s got a little formula because you know how health professionals we love our acronyms we love our easy to remember things and so here is the framework it’s three A’s plus B so three A’s and a B leads to little arrow right side arrow to the three R’s right so that’s the big that’s sort of the thing that’s the big takeaway that is like okay what are okay so what are the three A’s the B and the three R’s what are those all right so quickly I’ll just cliff notes but the first day is awareness all right and you and I are helping people with that today now they’re becoming aware of what polyvagal theory is they’re becoming aware of the cell danger response theory and how this is affected but more than that it’s an internal awareness of starting to tune in to your inner landscape because we are so outwardly focused and thinking that the solution comes from somewhere outside but healing is always and this is a universal it always is within and can be found without but always always within so we start there and become aware of how our body is responding to stress through the lens of polyvagal theory where am I in my nervous system response right now am I green light yellow light or red light because that is the driver of what self -caring practises so if you ask someone who is in sympathetic overdrive to go sit in meditation it is physiologically not available to them right I mean it just isn’t and so we start there so the first A is awareness the second A is attending and then attending to our nervous system attending to our vagus nerve and what it’s telling us right and so in my book I offer case studies and over a hundred practises and kind of an assessment matrix so people can really start to I say learn the language of their nervous system first and then how to navigate it right so that’s so that’s we’re still in the foundation of our of our house here so learning how to what practises work when you’re in that free state different practises than when you’re in on the hamster wheel of sympathetic overdrive right and being able to align that and then the third A is the alignment and this is where we start to look at the relationship between our inner and outer worlds and this is is something that that a lot of people especially in the heat of a very busy and demanding healthcare practise it sort of gets obliterated by the system right and we’re all just trying we’re doing the best we can and we’re cracking on the best that we can but we lose this we lose this sense of connectedness into what our inner landscape is telling us that we need our beliefs our morals our values what our healer’s heart yearns for like all of those softer kind of right hemispheric ways of being in the world we all are kind of left shifted to use McGilchrist’s term into to a lot of left brain doing and analysing and so on and so forth and so this is kind of my language in a similar way of bringing more coherence in between or correspondence in our inner and outer worlds and a lot of times what we find is what’s happening in our outer world is kind of pointing is like a mirror pointing us inward to where some healing shifts can be made so those are the three A’s which is awareness attending and alignment that’s the foundation now we put on the B which is balance which is the external self -cares that we all know to do that we’ve talked about all of the wellness domains your physical your mental your emotional health your relational health your financial health living your dreams your purpose your values all of the things that we think of in terms of wellness that we all know but if we start there and we don’t take care of the three A’s underneath that’s why people aren’t progressing is because a lot of times they’re not within their window of tolerance they may be dysregulated in their nervous system or they might be reaching for a self -care strategy that doesn’t align with where they are in that green light yellow light red light sort of looking at it and so if we start with the three A’s and then we add all the things we already know how to do and we’ve aligned them to where we are then that leads us to the outcomes which is the three R’s which is first and foremost and of the most importance is regulation we become regulated in our nervous system that is probably one of the biggest this is a big claim I’m going to make but it’s truly I think from my research from what I’ve learned that’s one of the biggest drivers of health is nervous system regulation because it affects nearly every cell of our body certainly every system right and so first and foremost we have regulation and then we have another outcome is reconnection because we have now reconnected within ourselves we have connected within we’ve become aware we’ve reconnected with our body and in a very primal way and we are able to care for it in a more effective way in our mental health and in our relational health and so we become more connected within ourselves which means we’re also now more connected with others because when you’re in the yellow and red light of Porges’s theory when you’re in that sympathetic overdrive when we’re in that freeze response with that fawning response physiologically it is social relationships are not very available to us and that is McGilchrist’s work is that’s how you can be in a room of your dearest loved ones and still feel utterly alone right because if you’re in a dysregulated nervous system state you can’t socially engage and receive that you know that window is closed very narrowly not much is getting through and so that’s where when we start really looking at at how to and I don’t use the word self -care in my work because a lot of people feel gaslit by it but I say nurture and nourish ourselves in these ways then we become regulated in our nervous system we get reconnection within and with others and then importantly also really important is we restore our healer’s heart you know because we have nurtured ourselves and we have reconnected with our why for what matters most in our life we’ve we’re able to reconnect that to our why for being in our chosen career roles and so that’s sort of the that’s sort of the big three A’s of B get you those three R’s and you want the three R’s we all want those three R’s
Dr Ron Ehrlich [00:50:03] and the third R is restore
Dr Lorre Laws [00:50:05] restore yeah not only a body mind essence but restoring your healer’s heart so we’re not fixing anything we are unwinding to our innate and sovereign ways of being healthy in body mind essence you know
Dr Ron Ehrlich [00:50:23] I love that I love what you the way you’ve laid that out and it’s so interesting it’s actually music to my ears because having been a holistic health practitioner integrative health practitioner for 40 years I was very focused on on reducing the stressors identifying them and building up recovery by focusing on pillars of health but as I’ve moved into this area of burnout and mental health in health practitioners and for not just practitioners but people I realise that the mental fitness is the key your mind can either be your best friend or your worst enemy and that’s where we really need to start because that allows us to make decisions about balance and awareness you know it’s really a nice structure and I love the way you’ve taken cell danger response and polyvagal theory and Ian McGilchrist in packaged it all up like that it’s a really really nicely put so the concept of your repository reveal I’m just you’ve just described that I guess in many ways
Dr Lorre Laws [00:51:30] well so here’s you know and this is drawing from Porges again and also The Body Keeps Score of Bessel Van Der Kolk I think is his last name and forgive me if I’ve misattributed I or said his name incorrectly yes the body keeps score so what we know what we know about trauma is that and I’m going to draw from Badenoch’s work here also Bonnie Badenoch is that if we don’t have the people that we perceive that we need before during and after a traumatic event it is unlikely that we will fully integrate that event fully heal that event right so what doesn’t get integrated I in my work call unhealed bits of wisdom because they get stored in the body until such time that conditions are favourable for healing not forever but until such time that healing is possible and so where where do we store as humans where do we store trauma in our body that doesn’t get addressed at the time we we store it in in our skin our muscles our fascia and our neuroplexes right those are the those are the top the top four and and so that that sort of gets gets stored there and I call that the repository right and so sometimes let’s say you and I right now Ron we had a we had a an emergent event that we needed to respond to right now and you and I have 40 years of experience in completely different ways right of our lives and we both had to respond to this emergency right now and you might respond in a way that is very different you might be the one who’s running towards the stimuli I might be the one who’s running away from the stimuli like in terms of like getting a little anxious getting a little more inward you might be a little more outward and so why is that why is that two why is it that two people would respond so differently as trained health care professionals to to the same emergency well that has largely to do with what is stored in our body in that repository so when your brain scans in what is happening in the event it also is scanning what is stored in your body right and triangulating that to inform the response all before we can blink an eye and and similarly in my body what’s stored in my repository is also getting scanned and it’s informing by what Porges calls the threat detector right this 24 seven surveillance system that is has one job and that’s to keep us safe right and so all of all of this is happening very quickly and so it really depends upon what what our lived experiences and how how well those have integrated from a trauma perspective and and what’s in the repository now when conditions are very favourable and this is what I found with my nurses that I was working with who were refractory to every manner of burnout healing approaches and but when we started when we started working here and we worked on you know focusing on a sense of safety and the three a’s and the b and getting connected with those three r’s and sort of this unwinding of the nervous system and what we found is that these unhealed bits of wisdom or the unintegrated trauma would start to emerge now it just does a kind of disclosure they’re not always comfortable and they’re not always convenient but we keep in we keep in mind that that conditions are favourable for healing and so we lean in we lean into the healing opportunity and really really helping to integrate the trauma as it emerges right and so that’s when it started shifting that’s when I started getting the the well it wasn’t me but when those that I was facilitating that’s when they started really like wow I had no idea and it sort of changed the whole self -caring approach to making it too trauma -informed let’s make this burnout narrative trauma -informed you know it’s outdated it doesn’t reflect what is happening
Dr Ron Ehrlich [00:56:12] yes amazing you know and the way I it’s so interesting again I love this conversation Lorre I knew I would you know I I have got into integrative health through chronic musculoskeletal pain issues and and at a real aha moment came to me when a mentor of mine Dr Janet Travell many many years ago 30 over years ago said muscles have memory and that memory can last a lifetime so if you had a trauma literally a physical trauma as a five or a 10 year old and you’ve been suffering chronic musculoskeletal pain for 30 or 40 years that may be the triggering event that caused that musculoskeletal problem and yet so rarely in chronic pain management is that concept explored or understood and again people become gaslit by saying look we’ve taken all the x -rays and we’ve taken the MRIs and there’s nothing wrong you’re perfectly fine and here we are talking not just about well you said skin and muscle have hold the memory and that is absolutely true but the unresolved psychological traumas that we experience which are very personal and individual to two people you know what one is a trauma to one person is not a trauma to another but I know you also talk about your innate care plan framework and I’m guessing this would be a good time to maybe discuss that
Dr Lorre Laws [00:57:44] well you know we already did well no that’s the three A’s plus the B takes us to the three R’s but thank you because I failed to mention that I actually the framework has a name yeah the innate care plan which would be yours and it draws upon that innate capacity for healing but just as a side note you’d literally in the musculoskeletal that was me my I was that I was that child and to this day I’m you know I’ll share that I’m 63 and I had a whole host I had hip dysplasia that was not diagnosed until I was nine months it wasn’t screened for at the time and into spica casts and leg braces and corrective shoes and all of the things and then knee surgeries later and then knee replacements later so it’s been this whole sequela and to this day I am still releasing the trauma from the hips from when I was an infant and had been misdiagnosed over and over and over and over again and many people with chronic conditions because we are not assessing we’re assessing the for very large scale PTSD sometimes some of our assessment tools capture the big stuff I had in my life experience and you know I’m open about this in my book it’s not about me but sometimes it’s helpful to share from your personal experience that I have had such a substantial trauma history in my life that my limbic system got injured like quantifiably on an MRI you can you know like this became a thing we were all really curious about right and and yet I was never diagnosed with PTSD because because the types of traumas and we certainly are not we are not in any form assessing for unintegrated trauma which is what I’m pounding The drums for my scientific communities is like, we need to look here with Navariaux Danger Response Theory. And so we have, we have just such an opportunity before us to really shift the paradigm around what, around chronic conditions, around self -care and what that looks like and how we can make it more effective to make sure that we’re starting with our autonomic nervous system and vagus nerve and, and also these occupational challenges of burnout and occupational related trauma. And so through, through all of the hardship and it’s, you know, kind of, you know, it’s not a lot of fun to talk about and do research around trauma. Let me tell you, I have lived this personally and professionally. It’s a heavy, it’s a heavy topic. And yet through, you know, through the dark clouds always is the sun and brighter skies. And this is an opportunity for us as global clinicians and scientists and health professionals to really start embodying this approach and leading the way for the system changes that need to be had, because, you know, the systems aren’t going to fix themselves. We’ve been around, I’ve been around 50 years, it’s, you know, but we can be the change and through us becoming as healthy and as resilient in the types of ways that we have been talking about today, then we can care, as you said, better for our patients and we can show them the way, you know, through their chronic conditions by making sure that we are addressing that unintegrated trauma and taking this different approach to where we’re starting there. And then let’s see where the prescription pad and the other kind of traditional interventions need, where they need to be instead of starting at the traditional interventions and kind of forgetting about all of the things that we’ve talked about today. You know, we’ve got to back up our bus a little bit and take take this really trauma -informed approach to health and wellness.
Dr Ron Ehrlich [01:02:28] So this is probably a good time to say, what does nursing 2 .0 look like? What does it entail?
Dr Lorre Laws [01:02:35] Well, that is what, you know, and it could be health 2 .0, it could be physician 2 .0 or 3 .0, wherever we are.
Dr Ron Ehrlich [01:02:42] I think I think we could I think we could agree that something’s not working well. And if the evidence is anything to go by, it’s working really badly. And we need to change something for the sake of not just public health, practitioner health, but the whole community. Well, let’s talk about nursing slash practitioners slash health 2 .0. I mean, you’ve outlined plenty for us to think about.
Dr Lorre Laws [01:03:14] Well, this is kind of my call, my global call to my colleagues in health systems around the world, because what we know, we know what we’re doing. And this is I’m quoting Dr. Don Berwick, who is co -founder of the Institute for Health Care Quality Improvement, the IHI. And so in his work, which is well published and so grateful for, he said, you know, he’s right. And where it comes to health care quality is that we have very, very good people working in very poorly designed systems. And this is this is part of that system induced trauma we talked about earlier. So when I talk about nursing or health 2 .0, it’s time for us to rethink this through the lens of all of the topics we’ve talked about today. And so nursing 2 .0 is is the professional, the nurse safety and professional well -being addition. Start with keeping our personnel, our health personnel safe in their roles and adequately resourced and safely staff ratios with their patients to provider, patients to nurse. You know, I, I, I can’t do a 12 minute office visit. It takes me 12 minutes to say good morning and, and really, really connect with the person in a way that I, that they can be seen and, and, and cared for, which is why they’re there. That’s what they want. And that’s what we want as health providers. Right. And so if we, we, we kind of turn this paradigm, yes, patient care, patient safety, patient outcomes. Yes, yes, all important. But again, let’s back our bus up. Let’s take a look over here. And making sure that the providers and the nurses and the allied health professionals are safe in their nervous system so that they’re in that green light, ventral vagal tone. This is the single most important thing because that’s where the fewest amount of medical errors are made. Why? Because we have the capacity, the physiological capacity to see the big picture, to make the discernments, the clinical judgements, right. And not in a way that is rushed and hasty. And I don’t even have time to use the restroom and you want me to make what diagnosis, right. That’s a whole different way of arriving at a diagnosis than being fully present with your, with the person, the patient, the client in your care. And, and right. So, so starting with the safety, we need the nervous systems of the people who are working in the health systems need to be safe. They need to feel safe. They need to be safe. And from that then comes the professional wellbeing, because now when the nervous system is regulated, we’re not in that flight or flight yellow zone. We’re not in that sympathetic overdrive going into the freeze, fawning red zone, right. We want, we want everyone to be in the green zone. That’s where the patients need us to be because they’re coming into our care in the yellow and red zones. So we can’t have, we need somebody’s got to be in the green zone and we’re the providers. So we need to, we need to hold that ventral vagal tone because our patients and our colleagues, we are all, whether we’re conscious of it or not, we are co -regulating with one another, right. So if you have a dysregulated health professional who’s caring for a patient who is also dysregulated in their nervous system, like we need to rethink that. So that’s nursing 2 .0.
Dr Ron Ehrlich [01:07:08] Laurie, what a note for us to finish on and what a message for us to leave. And I want to thank you not only for today and sharing your knowledge and wisdom, but for all of the wonderful work you are clearly doing and articulate so beautifully and clearly. Thank you so much for joining us today.
Dr Lorre Laws [01:07:25] Oh, it was my pleasure. And I’d happily come back and visit you anytime. Thank you for having me.
Dr Ron Ehrlich [01:07:30] Wow. Well, as I said, you know, so much there, Dr. Robert Navariaux and cell danger theory and mitochondria. Here we are revisiting the importance of mitochondrial function. And we’ve talked about this in terms of our circadian rhythm and in terms of getting out in the sun and exposing ourselves to the sun and the earth, but here we are looking at it from a different perspective. We’re also touching there on the polyvagal theory of Professor Stephen Porges, P -O -R -G -E -S and polyvagal theory and and the work of Ian McGilchrist as well, who looks at left and right brain activity and how that shapes our history and our future. Look, there are there’s so much in that episode. The links I would recommend you visit Dr. Lorre Laws, that’s L -O -R -R -E, Lorre Laws, all one word, drlorrelaws.com great information there. And of course, her book, Nursing Our Healer’s Heart, a Recovery Guide for Nurse Trauma and Burnout. And I suspect that would be of relevance to any health practitioner or individual, for that matter, who is suffering from burnout and may not have recognised the importance of trauma in that whole experience. I hope this finds you well. Until next time, this is Dr. Ron Erlich. Be well. Feeling stressed, overwhelmed? It’s time to unstress your life. Join the Unstress Health community and transform stress into strength. Build mental fitness from self -sabotage to self -mastery. And together, let’s not just survive, but thrive. Expert led courses, curated podcasts, like -minded community and support and much more. Visit unstresshealth.com today. This podcast provides general information and discussion about medicine, health and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.
