Taking Back Control - The Nervous System and Your Career

Celeste: Welcome to the Nursing and Midwifery Health Program Victoria podcast series where we will be diving into issues that impact the way nurses and midwives navigate today's ever-changing world. I'm Celeste Pinney, a registered midwife and senior clinician at the Nursing and Midwifery Health Program Victoria and host of this podcast series. The Nursing and Midwifery Health Program is a support service which provides care and assistance to nurses, midwives and students by experienced nurses and midwives. NMHPV provides a space where our colleagues can bring with them any sensitive health issues impacting their well-being. The program is voluntary and importantly, it is free to access, confidential and independent. Joining me on the podcast today is Liam Caswell, a registered nurse who helps nurses build their own online business and makes nursing optional. He is also the host of the podcast, which some of you may know, Nursepreneur Academy. Welcome Liam, great to have you here today. 

Liam: Celeste, thank you so much for the invitation. I'm thrilled and I can't wait to dive in.

Celeste: Fantastic. I hope I said ‘Nursepreneur’ accurately. I wasn't quite sure because it's not a word I've heard before. I assume that you sort of, that's, it's an amalgamation word. 

Liam: You did, you got it great. It's an amalgamation. It's a bit of a made up word, obviously mixing nurse and entrepreneur. So we're the Nursepreneur Academy, yes.

Celeste: Fantastic. Okay, great. So you've been in the business of nursing since you began your career in Scotland in 2011. And from what I can see, you've had quite a varied career from working as an ICU nurse to a nurse unit manager, and now running your own coaching practice for nurses. You've certainly had a wide breadth experience in the profession. We would love to hear more about your career.

Liam: Yeah, wow. Well, let's dive in. So as you mentioned, I graduated in 2011. I was actually 19 when I graduated, not because I'm super intelligent or anything like that. I just really knew that I wanted to nurse. I looked after a lot of my relatives and my grandparents as a teenager growing up and worked closely. Well, I would say worked. I went into my mum's work, who was actually the assistant in nursing, and my grandma's a nurse, and I was like really exposed to healthcare at a young age. And having kind of unwell grandparents allowed me, I guess, facilitated me to see that this was a career pathway that I could pursue. So I started at 19. I graduated at 19, much to a lot of my classmates, you know, discontent, because they were like, oh, you don't have enough life experience to be able to be doing this at this age.

And that kind of fuelled me from the get-go to just be like, I'm going to prove you wrong. So little did they know that I had been kind of really supporting in nursing kind of since I was like 13, 14 with family members. So yeah, I started in 2011. I graduated in Scotland and I started my career off actually down just outside London in a place called Reading because I couldn't get a job in Scotland at the time. There's actually no jobs. Can you believe it? Of course, there were vacancies that needed to be filled, but there's no budget, no funding. So I made the move down to the big smoke and it was the best move that I could ever make. I started my career there in the clinical decision unit. So it's kind of like an extension, kind of like an acute medical unit to the emergency department. 

And that was a baptism of fire at 19. I think I got two supernumerary days and then was in charge of like I think I had like nine very acutely unwell patients and we had no graduate years in the UK. We did not do a graduate year, you just got a job so I just had to get on with that and it was like really confronting but one of the best learning experiences of my career. And so I did that for about a year then I moved into intensive care nursing, I was kind of always drawn to the acute care, really wanting to look after people holistically and do it well and I really struggled with that in my first year because I had so many competing priorities and my brain just wanted to like focus in double down and just do the best that I could do. 

So I'd often leave that first year just feeling super deflated that I hadn't done enough. I think everybody listening can probably relate to that regardless of where you start in your career. But I got the opportunity to interview for intensive care. And actually, I cared for an ICU matron's dad. And I did not know she was the ICU matron, which was a little terrifying when she told me after watching me for 12 hours. And she said, maybe you should apply for intensive care. And I was like, oh, that's a great acknowledgement of my work. Thank you. I thought she was going to tell me off for like not washing my hands or something. And so, yeah, so I went to ICU. I did that for a couple of years. 

Then I met my partner. Um he's Australian and uh we needed to make a decision about whether or not we stayed in the UK or came to Australia, and I had always wanted to come across so we made the move in 2014 and I just for a couple years just gave myself permission to explore like, the new place other side of the world I didn't know what nursing would be like here and I kind of dove into agency nursing to the Australian healthcare system. And then my partner got a job down in Canberra. So we moved to Canberra. And Canberra is kind of where I started to pick up my career a bit. And I'd locked down like a permanent job. I'd kind of been enjoying agency life for about two years at that point. And I started to build my career. So I started in intensive care. 

Then I went into advanced life support education and training for about a year, which I absolutely loved. I went into a nurse education. So I was a nurse educator for five inpatient medical units with about 150 staff. And to my care as the educator, which I again, absolutely loved. And then I started to get kind of like, I started to want to do more post grads and more professional development. Now I'm a self classified certificate collector. I love to collect the certificates. Initially to prove, probably to prove those people when I was 19 saying, you can't do this, you don't have enough. But over my career, I've collected lots of certificates on the way to getting to educator. 

And then of course, I thought I needed more certificates to be able to get to NUM and to build my career. Little did I know you don't actually need them, but we can maybe talk about that a bit later. So I did a dual master's whilst working full time, which was a little crazy, but I loved it. And I studied international public health and a master's in health leadership and management. And that kind of allowed me, gave me the permission to then feel like I was ready to apply for nursing leadership roles. So I did an ANUM role. Yeah, no, I did a NUM role, backfill. And then I got a kind of permanent NUM role after that. And throughout this time I had lots of highs and lows you know, it wasn't all plain sailing there was lots of you know, challenges moving to Australia learning a new healthcare system, you know medication terms are different here and infection control practices varied a little bit and just settling just being there you know the guy with the funny Scottish accent was just a bit confronting, I guess, when you start in a new place, a new world, when you were so familiar with what the NHS looked like.  

But that allowed me to kind of give myself permission to just almost break the rules a little bit and be opportunistic because I was new. So I would just kind of put myself out there and ask for what I wanted. And I got a lot of rejections, a lot of knockbacks. I applied for lots of roles that I didn't get. And of course, you only ever hear people's Instagram, you know, highlight reel. But I got lots of kind of those knockbacks and I experienced some really interesting toxic nursing cultures across, you know, across the globe in the UK, in the NHS and also in Australia. And so I hit a point where I kind of, I experienced some bullying from a nurse who we were both going for the same job and she ended up getting it. And I just experienced this like, I don't know, I kind of had never really been criticised as a nurse and then this criticism just kind of like came down on me from this individual once they got the job, and it was so jarring for me because I was like, I'm such a people pleaser, like I'm such a, I used to be such a people pleaser and conformist and you know, you tell me to jump, I'll be like how high, very much that type of individual in the system. Of course, I like to break the rules and be a little rebellious because I always had ideas and I was innovative, but always within the confines of what I could do and my scope.  

But this seemed to rub this individual up the wrong way. So we kind of butted heads. And that was the point where I started to question everything. And I started to go, is this what I really want from my career? And it triggered for me a lot of childhood traumas and experiences having been bullied as an LGBTQIA kid. So kind of like, just to go deep there and to get into that. But that was like the connection point for me. In the moment. I didn't see that. But I was just like, why am I all of a sudden really disliking my career? It's been great up until this point. I've been so driven, so ambitious. I had a vision, I had a goal, I had a purpose. And then I felt like I'd given this person permission to just wipe it out from underneath my feet. And in doing so, like I had to give myself permission to just take a break and I had been building and studying and doing all these things there's multiple layers and I just said yeah I'm gonna take a break so I went, I was lucky enough through the university to get a scholarship to go to Fiji. 

Sounds lovely, but I was actually there working. But I was there on a scholarship through my master's to work with the UN, WHO, organisations like that, also studying international public health. That was a real eye-opener, a really great kind of like resetting of my nervous system but also of my kind of like professional career where I wanted to go and what I thought that would look like and also experiencing a health system that is, and it was so underserved and really very basic helped me see that like what I was going through wasn't really that big of a deal. But it still impacted me, but I needed to kind of like come back and level up. So I came back. I did take a nurse unit manager job in another area that I applied for, but I was very cautious about coming back in. 

And from there I started to think about, okay, what can I do with my career? And that's when I hired a career coach and kind of the rest is history. And I started to unpack the whole, what if I could do something beyond bedside? So that's my kind of like 12 year career in a synopsis. And today, obviously now I've been building my nurse trainer academy, my business at first started as a nurse career coaching business um, since about 2021 um so we're kind of like three four years into it now. I've helped over 500, probably more now nurses kind of directly in my coaching services and we've had over 100 000 nurses listen to the podcast globally and I’m really really proud of that creating a space where nurses can, you know, really buckle down and explore themselves and get the support that they deserve to be able to thrive in nursing, not just survive. And this is my life's work. As soon as I landed on coaching, I was like, oh, I've been doing this my whole career. I was that nurse in the system that would help other people see how amazing they were. And so now I get to do that for a living and I absolutely love it.

Celeste: Wow, that's amazing. Thanks for sharing your story so openly and vulnerably about your experiences. I know it's a lot to talk about an entire career in just a few minutes, but it's really great to hear what you know and the journey that you've been on that you've turned your experiences into something really positive where you've been able to help other people. Thank you. 

Liam: Yeah, yeah, it's a lot to talk about in a couple of minutes for sure. 

Celeste: Can you tell us a little bit more about your coaching practice and specifically what you're doing with nurses and midwives?

Liam: Yeah, so when I first started out, you know, I was like, who the hell am I to coach anybody? I didn't really even know what that was. And to me, it was kind of like a bit made up, to be honest. And I hired a career coach myself. And at the time, I couldn't find a nursing career coach. And this was pre, you know, Nursing Midwifery Health Program, all of the amazing services that exist now. And so I was thinking to myself, okay, like, what do I do? Where do I go? And will a non-clinical career coach understand me? And so I found, like I did my research and I found a career coach in Canberra at the time. I just kind of like really loved the vibe, hopped on a call and then booked coaching with them. 

And through that process, that coach who was non-clinical and knew nothing about nursing was able to help me see that like, my whole career had been coaching and that in fact, there's a huge gap and a space for this for nurses to be supported. And so that kind of started it off. So I started out coaching nurses on, you know, CV cover letter selection criteria and interview preparation. And at the very start, of course, I didn't know what the hell I was doing. I thought I would just like, you know, put up an Instagram page, build a website and, you know, the crowds would come, which did not happen. 

And so I very quickly learned that I had to learn how to market and sell and all of the things. So a lot of my nursing skills came in handy with that right, because as nurses we don't know it but we market and we sell every day to our patients for them to get out of bed you know to move to eat their meals all of the things we do is kind of marketing and sales really, but I started off in that space and I got my first client from connecting at a party in Canberra, we went to like a friend's barbecue and somebody said oh, Liam's doing this thing and I was so embarrassed and then all of a sudden she's like I want to work with you like, cool let's do it so that's where it started um, and then I just saw more and more of a gap like I would see nurses in the system go for jobs and they were amazing but they would always fall short because they were underselling themselves. 

They didn't know how to communicate how great they are on paper. And they didn't know how to sell themselves at the interview stage because of fear. I was like, no, I need to help people like that. Because that was me. I went for so many interviews that I didn't get. And of course, no one talks about them. But there were so many where I got knocked back. And I just, through repetition, learned the art of how to sell my skill set during interviews. And so I started offering that and I started getting people that wanted promotions, people that wanted to get from like a clinical nurse specialist into NUM or maybe they wanted to get into the grad program, and then I noticed that there was a gap with grads and grads were like desperately trying to get their graduate programs, they wanted their dream role, they had worked so hard to get to this point where they finished their degree and yet some of them are like, not even getting considered, and they had great GPAs, had you know great potential but because they didn't know how to do their applications and their interviews they were falling flat, so I created like a coaching group container where I took them through applying interviewing and landing their dream graduate nursing role and that's where I helped most of those across Australia. 

And nurses in the UK take that program and in New Zealand also. And what people often don't recognize is like, I didn't go out and get like any more skills to be able to do that. I just leveraged what I'd learned as a nurse. Having been a nurse applying for jobs and being an educator and a manager sitting on panels, I just packaged up what I already knew and offered that to people and people needed it and we got great results. So that's what I started off with. And then as my business progressed, built and grew and I started to have business success and you know I was like cracked making six figures online as a nurse entrepreneur and then I quit my nursing job people started paying attention. I mean, like, how did you build your business? They started asking me, how can I do this? I'm a nurse. Is this possible for me too? And at the time, the imposter syndrome was too much for me to handle. So I just stuck with the career coaching. I was like, yeah, that's great. I did a couple of podcast episodes on that. And I chose not to pursue it. 

And I actually realized this week that I had this like, the idea of the Nursepreneur Academy since 2022 because I found something where I had it documented but I haven't actioned it until the last 12 months where I launched it, so you know that's sometimes just how long it takes for these ideas to come to fruition and to build belief and to like really build my own self-confidence and being able to deliver that but now like, I couldn't imagine not doing it so fast forward to today I help nurses package up their skills nurses and midwives by the way package up their skills knowledge experiences everything that they've learned personally and professionally to build a business that makes nursing optional, so build a business online that allows them to leverage everything that they have they don't have to go out and get any more certifications to be able to build a business where if they choose to they can make nursing optional now. 

It's not because I'm anti-nursing and anti-midwifery it's because I think where we're headed with nursing a modern nursing and midwifery career. It is where we have a beautiful mix of bedside, non-bedside roles and leveraging the amazing world of the creator economy online where people literally make money online for doing whatever they're doing across all different niches, specialties, regardless if you're a nurse or a non-nurse. And I think that nurses, we should be in that space and we should be leveraging that. And there's no reason why we can't. 

So currently I have about 20 nurses across Australia that I'm working with and we're building their knowledge expertise based businesses to be able to chip away at the nursing career and just keep their foot in, but also serve people in a different way where they can control the narrative, they can control their experiences, they can control their income and they can make more money if they want to or they can just have more freedom, and the thing that I love the most about it is we get to still have the same impact that we became nurses to have but we get to do it from the comfort of our own homes or a coffee shop or wherever you want to work leveraging the skills that nursing has paid you to learn

Celeste: Oh, wow. It sounds incredible. Really innovative and so amazing that you're offering that to the profession where, you know, I know a lot of people who come to our service can feel stuck in their careers. They feel they want to change. They're not sure what direction to go in. They might have been in a role for a really long time, perhaps 10, 20 years, 30 years, sometimes even less, and it's just not working for them anymore. And this I haven't heard of anything like this before so the fact that you're opening doors for people and leading them into something that like you said is more creative for them, something that they have more control over the direction of their career, and they're not necessarily having to work in a hospital if that's not what's good for their well-being or they just don't enjoy it.

Liam: Yeah, yeah. And I think as nurses, we are so good at underselling and undervaluing what we have to bring to the table. We're the most trusted profession globally. And that will convey into whatever you do, whether it's bedside or non-bedside. And I have nurses with 20, 30 years experience coming to me saying, but what would I do online? And the thing is like we're not nursing or being a midwife online right, like we're not nursing people, we're nursing them in a different sense but we're not leveraging the nursing skills online like we're not doing telehealth, we're leveraging the skills and knowledge and experience that you've gained to be able to help people in different ways. 

You know we have nurses that are, we have one nurse that's a return to practice nurse and she had been a nurse for like 10 years and she took a break and then she's come back, did her grad and she just went, I just want to help businesses, small businesses and service-based businesses build systems into their business to be able to scale and grow. Like those are skills that she has just from life that she's able to monetize online. We have other nurses that are burnout coaches. I know a nurse that's a finance coach. She loves all things money. So she teaches nurses how to manage their money, right? So it's not like we're sitting there and having to leverage, like if you've been a cardiac nurse, you have to talk about cardiac. I mean, that would be great, right? Like why not become the cardiac education nurse online and teach other nurses or other health professionals? 

To be able to leverage that skill set online and make money that you could make, you know, beyond the bedside and the capped income that we can experience in healthcare. So there's so many different things we can do. And often what it takes is just someone to reflect back to a nurse and a midwife to say, actually, have you looked at how much you've achieved? Like there's every nurse, I believe, every nurse and midwife has a six figure business idea for sure.

Celeste: Wow, that's pretty phenomenal to think about, isn't it? And I know you mentioned that one of the nurses you have worked with is working as a burnout recovery nurse. And I'm aware that you yourself have had experiences of burnout where when you worked in the hospital system, and I'm sure you talk to lots of nurses and midwives and hear stories about burnout or people just struggling with shift work and the demands of the profession. What do you see as the main reasons for burnout in nurses and midwives?

Liam: That's such a good question. Look from my experience personally and I mean, I've been in calls with hundreds of nurses as well you know, and that have been inquiring about my services or just I used to just do calls for the sick calls to get to know people and see how I could best help them um, I think what it comes down to is a combination of compounding chronic stress that is not helped or attended to or noticed in the system. and the collective cumulative micro and macro traumas that we see every single day. And I think that the marrying up of those two things alongside the pressures, the stress on the system, between the flags and we're doing okay. And this is the New South Wales health reference, but I'd like to steal it. 

I think every state territory has their own version of this, but we're coasting along at the start and we're in this between the flags zone. And as we experience more stress and chronic stress and traumas, micro and macro traumas in our day-to-day careers, those stressors and traumas, they compound and they take us out of that beautiful safety between the flag zones and they put us into a state of dysregulation. And what happens, I believe, and just based on the evidence and the literature around stress and trauma and burnout, is that as we continue to experience those traumas and those stressors, we then stay in like a dysregulated state. So imagine if your patient was chronically tachycardic. What would we be doing with that patient? We'd be wanting to get them back down into safety, back down into homeostasis. And the reality is, many of us as nurses and midwives, we are chronically dysregulated. We are in a state of tachycardia and we're not coming out of there. 

And we don't give ourselves permission to regulate, and the system doesn't facilitate that either. So what happens is we continue to just go like 110, 115, 120, 130, and we just continue until we crash in a heap. And we become like, you know, what I call team bradycardia. We drop from like a team tachy or chronically dysregulated state into a state where we are kind of very hypo, very...you know, lethargic, burnt out, maybe even depressed. And then we kind of like cycle through that. I think once you see it like that, you go, oh, it makes total sense. Like that was my trajectory. And every nurse that I teach, I always start with this because this is, by labelling it and acknowledging it, allows us to claim some power over it and see that we actually have some agency over what we can do when it comes to managing burnout. Because I, for a very long time, blamed the system, blamed anybody that I could potentially blame, the ADON, the DON, the CEO, my peers, my colleagues, anybody that phoned in. I was always thinking about how is everybody else's reason as to why I was so stressed. 

But I failed to acknowledge that there was so many moments every single day that I could manage and regulate my nervous system. And I think that that's where as nurses and midwives, we have a kind of duty of care to ourselves, but it's so hard. It's so hard when we're in it. And it's easy for me to say now, having been at it for a while, that it's so easy for me to see from the outside looking in. But when you're in it and you're, you know chronically surrounded by people that are chronically stressed and, and traumatized it's so difficult to pull yourself out of that because it almost becomes a collective norm and so I think that in order to tackle burnout for nurses midwives we have to start with Uni’s and organizations like seriously prioritizing teaching nurses about their own nervous system and how that works, and how to manage their minds so that they can take back agency and really manage their nervous system on and off shift because without a regulated nervous system like we're already off to a bad start. It doesn't matter what else you do. 

It doesn't matter if you throw us pizza parties or you give us clinical supervision. It doesn't matter if the nurses regulate. I think that the first national standard should be recognizing and responding to a deteriorating nurses and midwives nervous system. Because without regulated nurses and midwives, you don't have safe care.

Celeste: Just so well said, everything you've just talked about. And I think part of the issue is a lack of awareness and education and people don't always know when they're burnt out or it takes until they're quite at a severe level of burnout for them to become aware. It may not be until they're very symptomatic and they start questioning what's going on. So I think if we can start at the beginning, like when we're studying or when we're in our graduate year and talk about, okay, how do we best care for ourselves? How do we make sure that we're always being aware of our wellbeing so that we can hopefully avoid or there's less likely of a chance that we're going to become burnt out? 

Liam: Yeah. I think burnout is, I think even if we taught that, I think we'd still experience burnout, but we'd have less of it. And I think the awareness piece of everybody just understanding what that is because I think there's so many misconceptions around burnout, like you know burnout is because I've worked too hard or like all of the narratives that we all have about burnout like the WHO's definition comes back to chronic stress, and it actually comes back to occupational stress and overwhelm right in the system, and it's like well we can learn how to manage that and the best thing that I think we could do is equip nurs,es and midwives with the tools and the awareness to be able to go, oh I am dysregulated when I'm dysregulated my amygdala brain is running the show, I need to make sure that for my safety and for my patient's safety, I find an opportunity to regulate and that should be facilitated in the workplace. 

And that doesn't need to take like 30 minutes, right? Like the more we learn how to go from a dysregulated state into a regulated state, the quicker that muscle becomes, like the faster that neural pathway fires. So it's just something that needs to be a learned behavior. And so many of us already do it and we don't even know that we're doing it.

Celeste: And from what you've learned in working with nurses and midwives, it sounds like you know, you have a good understanding of the nervous system and how people can better regulate themselves. Could you share with us some strategies that people could use to help support themselves to both prevent and recover from burnout?

Liam: Yeah, yeah. Oh, look, there's so many things, right? But I like to start with what we do every single day, like breath and breath work, like you access your breath all the time subconsciously. Breathing is one of the best ways to regulate your nervous system in the moment. So just increasing your inhalation and your exhalation is enough to send signals that you're regulating, right? The other thing that people often overlook as well is washing your hands. When you're washing your hands, it's actually been proven in the literature that that is kind of very cathartic and very healing and very safe. We always want to come to the things that make us feel safe and connected back to our safety or regulating. So I like to teach people that when you're washing your hands, try and give yourself a moment of like being very in the moment and present with yourself and wash your hands for the allotted time as per the IPC guidelines and see that as a moment to check in with yourself. 

Another good moment to check in with yourself and to regulate is when you're checking and assessing your patient. We've got time when we're assessing people and you're waiting for the blood pressure machine to go to stop and to think about yourself and think about where would I put myself on this chart right now? Would I put myself in team tachycardia or am I in team bradycardia where I'm really low and lethargic and I'm like so burnt out and I don't want to be here today? Where would you plot yourself? The awareness is gold because then you have information and data to do something about it. So there are like three things that every nurse/midwife could be doing every day. 

And it really is about thinking about what makes you feel the most safe. Everybody's flavor of safety and nervous system safety is different but what I've learned is that most nurses don't actually even know what safe feels like because most of us have been running on adrenaline overworking people pleasing. They don't teach you this in undergraduate training because there's that you know, performance you know, you've got to show up, you've got to deliver, you've got to perform to get your job like all of the things and then the traumas and the stressors, it all just compounds over time. 

So often when nurses come to me in the career space they would like they'd get amazing jobs in non-clinical roles and they'd really struggle with them and they struggled because they were so used to the new normal, like that was their new baseline and it was so confronting to them, and it was the same for me when I took my first office job. I was like I don't know if I can do this but the reality was it was my nervous system settling into what is actually normal for most people, and as nurses we like it's not that we glamorize it, that's the wrong words, butit's just that it's just become so normal to be so dysregulated that when we're in a role where it's safe and you can be regulated, it's so jarring for us. So it's about allowing that, accepting that and building tolerance within, it sounds crazy to say, but building tolerance to be safe as a nurse at work.

Celeste: It's fascinating, isn't it, that people may be familiar with this feeling of being stressed out, that when they're not feeling stressed, maybe it's a little uncomfortable for them, at least initially. Yeah. There's some really good simple strategies there. And I think, like you said, we don't have to necessarily do any kind of elaborate wellbeing tactics like meditating for an hour a day or thrashing it out of the gym or doing Tai Chi classes. But it's those small kind of mindfulness moments where it just helps to bring us back to the present moment, helps us to say that we're safe, that we're not in danger. And that if we can do that, if we can do that consistently throughout the day, that helps to bring the nervous system back online a bit, maybe out of the tachycardic or the bradycardic states.

Like you said, I like those phrases that you've created there. And when we do that, we're interrupting the stress cycle. So the more we interrupt that stress cycle, the less the stress compounds, the less likely you are to burn out. Very, very interesting. Well, it's good for nurses and midwives to think about, and it's something that we offer at our service, you know, a lot about self-care and developing a plan for well how can we help you to reduce stress even in just a small capacity because even those little micro ways of reducing stress add up. 

And I'm aware that you used to work with graduates perhaps more so than you do now, but I would be curious to hear from your experience; what did you see or what did you see as the main issues that they faced in their lives as early career nurses and midwives and given that it is kind of quite a unique, vulnerable time when people tend to experience more feelings of low self-esteem and self-doubt. 

Liam: Yeah, yeah, totally, yeah. I mean, imposter syndrome, low self-confidence, the feeling of being unprepared, like that deep-rooted feeling of not being ready, that was a real fear for the grads.  And because a lot of them that I coached and supported didn't feel like they'd had enough exposure to acute clinical experiences. So some of them were in their third year and they had pretty much done no clinical placements in an acute area. And, you know, they were going up against other grads that were applying for, you know, EDs and ICUs, and they wanted those programs, but they didn't have the experience. 

So I think there's a lot of areas that could be improved with the grad process. And having not gone through a grad year, I don't know whether grad years are good or bad. I didn't go through one, so I can't really talk about it. But I know that I just had to level up and do it. I'm not saying it was the right way to do it. But with our grads, it was the under confidence and the feeling of not being ready to hit the ground running in this deep sense of imposter syndrome. And then when they started, it was the lack of support unfortunately and it was this very hands-off approach to well, you're a grad, like you should know how to do this, like you're registered now and you know a lot of that stuff would happen in the first few weeks and that's really disheartening or they wouldn't get their supernumerary periods you know honoured so they'd be thrown at the deep end because the staffing was bad um, and just lots of situations like that that I feel like should be ironed out. I mean, it's in an ideal world.

Grads should have that protected time, but I know how it works. Having been a nursing manager, things change and you have to do what you have to do. But I think overall, the lack of support, even for those that landed very good grad programs, a lot of the grads were very surprised that they might only see their grad coordinator like once every three months and like that to me is not a grad program, that's like you know you've got a job with an education visit once a quarter and so I think there's a lot of work to be done in that space, like you either do it and you do it really well and you prioritize that because they are the future workforce, and honestly the upcoming nurses, like nurses you know kids come into nursing nowadays they could go and be a youtuber right, because it's a really really hard career and the kids that are growing up now I'm like oh, they see the opportunities that exist online, and they could have a whole career doing whatever they want online and be able to monetize that and then you know nursing's got this kind of reputation where speak to anyone and they'll say, oh well you're under supported you're underpaid you're overworked, that we really have to tidy up that narrative to attract people that are going to want to do it and stay in it. 

And a lot of the grads get to a point where like even six months in, they're questioning whether this is for them. And I just feel like that lack of support could be, I mean, if you're working in the grad space, you've got to be super passionate about graduate nurses and supporting them. And in my experience clinically, I just never found that to be true. That could have just been my experience. But I just feel like we need to, like, not mollycoddle them, but like they really, really need to be supported because I think having worked in the university sector as well, they are coming out undercooked and they're underprepared. And that is not sustainable for the workforce. And I've even got grads that are building businesses now because they're like, this is not what I want. I'm like, yeah, sure, let's do it. 

But on the flip side you know, not to just talk all the negative, like I've had grads that I worked with that absolutely loved the programs and they had great support. Of course you're going to hear about the bad ones, so that's what I would say if you're a grad listening you're always going to hear about the bad, people never talk about the good uh and so you'll hear bad more than you hear good, but I had grads that really enjoyed their program and went on and thrived um, but a big part of that as well is acknowledging it's a huge transition period, and your nervous system is going to be deeply dysregulated and that's normal. 

It's normal in that period of time to feel like an imposter, to feel stress, to feel anxiety. That is all very normal and it's about how you manage your thoughts your stories that you tell yourself about yourself that will dictate your experience of it so you still have power to make even a bad experience better by the stories that you tell yourself and how you manage yourself through them.

Celeste: They certainly do need more TLC than they're getting, that's for sure. And I think it's just so important that if possible, grads reach out for support, you know, come to our service. Maybe they come and see you or they find an educator or, you know, another nurse or midwife that they feel safe with, and they feel that they can connect with like a mentor. But I do think there needs to be more preparation for the grad year. And, you know, you just hit the ground running and you don't really realise often how challenging it can be. So really drawing on the self-care tools just to help yourself get through it. Because once you're through that year, it tends to not, maybe not for everyone, but it tends to start getting a little bit easier. But that first year certainly can be very challenging.

Liam: Yeah. And it's so interesting, isn't it? Because, you know, as nurses we get taught all these amazing clinical skills and we go in-depth pathophysiology and we do all these complex medication calculations and these simulations and OSCES. But nowhere does anybody stop and teach us how to manage your own self-talk. Like how to manage stress. And, you know, maybe I just was like very unlucky that I never learned that as a human, you know, never mind a nurse. But I think that's most people. And so you just got to beg, like, the question is like, why are we not teaching that at University? Why are we not equipping people with these, what we'd call like softer skills, right? 

But especially when as nurses and midwives, we're not dealing with regulated people. We're dealing with very stressed, dysregulated patients. So I always think like two dysregulated brains, they just don't work, right? Like two dysregulated, very stressed people, they don't work well together, right? Because they've both got their amygdala firing. And so I'm just like, oh, it's so important to talk about it all the time, but to be regulated so that we can then hold space and critically think for our patients. And I think that teaching needs to start at university and it needs to be in services in the hospital, it needs to be a yearly competency: can you demonstrate your ability to manage your brain? It sounds ridiculous but most of us don't have the tools to be able to do that. 

Celeste: It's an important life skill too, isn't it right? In your working career but also in your personal life, how it impacts your relationships, how you take care of yourself. 

Liam: Yeah, like coaching is a multi-billion dollar industry because, like the government in Australia has invested in services like NMHP, because it's deeply needed. And so it just begs the question, there's just a gap and we've got to fill it. And we are filling it, but it should be like a top priority for the workforce.

Celeste: I'm moving just a little bit away now from graduates in terms of nurses and midwives at other stages of their career. I mean, you've obviously worked with people over the whole span of their career. What have you seen as other particularly difficult times in a person's career? Like would it be as they're transitioning to retirement? Is it mid-career? You know, after sort of maybe 20 years, people are feeling a little stagnant? Like what have you seen?

Liam: Yeah, look, I've worked with people, like you said, across the spectrum. I think the mid-career point where maybe people, well, I mean, we call it mid-career, but like it's probably like five years. People are really questioning where they're going and where they're headed, especially if they've kind of like niched and specialized very early. Because we're all kind of fed this story right, like find a specialty, like deep dive and build your career. But for example when I went to ICU and I niched down that's like five years in, and I'm going well I've only got like three roles that I can kind of go to from here um on the on the traditional path so it was very foreign for somebody to leave the intensive care like I did I went and bloody worked in acute medical. 

Like why would you do that, and that was the response right so I think at that stage mid-career or like early mid-career people are questioning where they go and what they do because they see that maybe the traditional path is not one that they want to potentially follow or they just can't see themselves in the positions ahead of them. I think when people hit what I call rock top, so they hit the point where they've landed their dream role and then they look around and they go, but I don't want the next role and I don't want the next role and I don't want the roles to the left or the right. So where do I go from here? And there seems to be no pathway. 

That was me when I hit NUM. I looked at my ADON and I thought, I don't know that I want that. And I looked at the don and I was like, I definitely don't want that. And ironically, I'd always wanted to be that position. I think because I wanted to have influence and wanted to change the system so strongly. But when I saw what they actually had to do, I was like, I want to spend my days doing that. So I was then like, oh, I'm going to go and get these two masters and they're going to solve the problem. And I see a lot of people doing that. That's why I joke about being a certificate collector because I think many of us believe that, that if we just get more certificates, we'll have more opportunities. I didn't find that to be true. I got two masters in two kind of different areas and they didn't really open any other doors.

 They just were expensive bits of paper that took some time and distracted me for a while. Not saying that they're bad to do, but I just think that you can be opportunistic. And I think we, again, at that level, when you hit rock top and you're maybe, you know, 8, 10, 15 years in, you actually, and most times you don't need more certificates. You just need to reapply what you've learned in different areas in different ways. So that's what I would help people do. And then I helped people that were at the retirement stage. And often they wanted to like finally crack the code on a position. So they wanted to like, I had a midwife in Perth that wanted to get her like CNS. 

You know, she'd been working for years and she'd put in the hard yards and she'd applied multiple times. And she kept getting knocked back. Excellent clinician. And so we just worked on her kind of self-marketing skills, her CV, her cover letter, her selection criteria in her interview. And then she got that position that she could retire in. And that was like her career highlight for her.  So I think across the career, and then I think the more that you climb the ladder, the harder it gets. I don't know I just feel like you just get a little bit more stuck and you get very comfortable with the money and the income and the safety or the perceived safety of it um, and the security of it and arguably you know the higher you get in the system, probably the more you have to offer the market when it comes to like through a nursepreneur lens, as a consultant, as a coach, as a mentor, as a guide, as a facilitator. 

So if there's people listening that are thinking, I can't, it's about giving yourself permission to stop and reflect and see how much you have done. And often if we are struggling with our career and our trajectory it's because our monkey mind or amygdala is running the show because we're burnt out and dysregulated so we just need a bit of space and time to regulate nervous system safety and then when we start bringing back our prefrontal cortex online, and we have a bit of safety we can start to see and acknowledge and recognize what we've actually achieved and start to look at different opportunities. I think often the job hopping is a symptom, I did this, of believing that the grass is greener and that another job's going to solve the problem. But I always say this, new job, same brain, same nervous system. 

So it's all well and good. In some jobs, some people go and they absolutely thrive. And they're like, Liam, shut up. You don't know what you're talking about. And I live for that. That's great. But 9 times out of 10, 3, 6 months in, you're feeling the same way. Because your nervous system, your body, your mind, it's all adapted. And we have to do a lot of unlearning, which is hard, and deconditioning to be able to then see what actually could be. And that's the process that I went through. That's the process I take people through. And it's confronting and it's challenging. And that's why most people don't want to do it.

Celeste: So for nurses and midwives who are feeling stuck, who are unsure what direction they want to take, would you say the first step is finding that space and time to kind of regulate, have a little bit of a break from the chronic stress, recalibrate so that they can actually think a little more clearly, become more in touch with what they really want for themselves?

Liam: Yeah, yeah, absolutely. And I think that there's so much to be said in services like, you know, what you guys provide because co-regulation is so essential to creating nervous system safety. So just by reaching out and having a conversation with the Nursing Midwifery Health Program or you know, a mentor a guide a coach whoever, a valued peer, that is like step one of allowing yourself to start to co-regulate and you're kind of almost like borrowing other people's um safety and regulated state, because typically they're in a state where they're like there to provide feedback and support to you and you're maybe not there and that's fine. And so first step one is co-regulation. 

And that's why when we try to do it ourselves, you might have success, but nine times out of 10, you're going to fall back in a heap. So for nurses I think we find it really difficult to ask for help because we're so used to giving help um and I talk about us being in giving debt and we spend our whole life um you know, I don't have children but I imagine a lot of my clients have children and they you know, give at home and give professionally and so when we think of that even if you were to like plot that on like a fluid balance chart if you thought about how negative or positive your giving debt is, you know, we just are so chronically in a negative balance in terms of giving back to ourselves. 

So co-regulation is the first step and it's super easy and simple. And then from there, it would be about, really for me, I would be teaching people to look at their thinking and the stories they tell themselves about themselves and about their careers and the relationship that they have with themselves in their career. And then we'd start to rewrite some of their stories because that's what we forget is that our brain is so amazing. We are incredible neuroplastic beings and that is what makes us so special and unique. And we often forget that we can rewrite the stories that we have about ourselves. 

Just because you've thought “I can't do something” a million times doesn't mean we can't rewrite that story, right? We might just need to rewrite that story like a million and one times. And that's a very dramatic example, but often we've just bought into a belief that we can't because we've heard it, we've learned it, we've seen it from someone else, and it's not actually factually true. And so starting to, I call it like clean out your mind, tidy up your mind, tidy up the stories you tell yourself, that's going to create some space for you to start to see what's possible. Like if we go from like negative to neutral, that's a win. But often I think we want to go from negative to super positive. It's too much of a jump in our nervous system. That does not feel safe for our nervous system.  

So we can just incrementally co-regulate, start tidying up our brain, indulge and engage in some nervous system safety practices. Like I mentioned a few earlier but like for me I love music so if I’m feeling off music's on. Um I love going to see you know theatre and shows, I love watching other people perform. I don't know it just gives me like so much happiness to see other people thrive so I go and watch a show you know or I go out for a walk and I just like, don't do what I'm supposed to be doing um, or I connect with a friend or I go to a coffee shop and have a solo date with myself or listen to a podcast or like, it doesn't have to be hard or big or expensive, it can be so simple and then from there once you've created that safety you're gonna start bringing your prefrontal cortex online which is essential for building belief and building capacity and also for seeing what's possible, right, like when we have our amygdala running the show and running our mind and our body, we're just we're so locked into that I can't see what's possible. 

And I remember that so deeply like from my burnout. I burned out three times and it makes so much sense when people say like yeah sure I can't do that, when people comment on something on Instagram and I'm trying to say you can do x y and z and they're like no you can't. To me I don't think that's negative, I’m like oh, like your system is absolutely blocked off to any opportunity because where you are right now is not safe, so how could it even perceive that you could be somewhere else? So the whole process right but it's doable and so many of us do it, so many of us are doing it without even knowing um but getting support is absolutely essential.

Celeste: It's great to hear some of your own personal experiences of what you do to help yourself feel better. And I think, you know, so we can talk to people about what are some non-addictive, pleasurable, enjoyable activities that you can engage in that are simple and easy, like listening to music, going for a walk, preferably not doing something like a Netflix binge, but it's something that's just where, you know, you feel nice and light and easy and that can be enough sometimes just to bring us back into a bit more of a regulated state.  So I think that's a really good place to start.

Well, we've come to the end of our time together today, Liam, and thank you so much for sharing. So much food for thought and a very enlightening conversation. And I feel like our listeners will really appreciate what you've offered today in terms of your experience and insight. 

Liam: Thank you so much. It's been a pleasure. I hope there was some value in there. And yeah, it's an absolute joy and pleasure and I love what I do. So the more people that I can help, the better.

Celeste: Fantastic. And if people would like to find out more about you, where can they go? Did you want to share with us your website? 

Liam: Absolutely. I'm actually on Instagram at Nursepreneur Academy underscore. So the link, I think, will be with Celeste in the show notes. I'll make sure that that's there. But yeah, you can find me on Instagram at Nursepreneur Academy and the podcast is the same, Nursepreneur Academy. You'll find me on other platforms as well, but I kind of play most on Instagram at this point in time because I'm trying to regulate my own nervous system and not be on three million different platforms. 

Celeste: Okay, well, we'll pop that in the show notes so people can access it. And thanks again, Liam. Awesome. Thank you so much. 

Liam: Pleasure. 

Celeste: For any nurse or midwife who might need support after today's podcast, you can contact our service on 9415 7551. Thank you for listening.