Uncertainty in healthcare.

As nurses, you are confronted with a unique brand of uncertainty in the work you do.

You devote your life to the caring of others, yet you are never promised a guarantee on how things will turn out.

The patients you work with sometimes get worse or even die.

From time to time, you are placed in the position of making important decisions, despite uncertainty. This can be truly unsettling.

In this post, I want to share with you some of my thoughts and practical strategies for managing uncertainty.

This approach is something I use on myself and with the clients, I work with. I hope you find it helpful.

Acknowledge that certainty is an illusion we create and not an obligation of the universe.

Uncertainty creates discomfort AND pleasure.

We can spend a lot of time trying to feel in control of our world, but unfortunately, the natural state of things is to be unpredictable and chaotic.

The more we try and feel in control of something that is uncontrollable, the deeper the problem becomes.

Acknowledging uncertainty means things might feel uncomfortable from time to time.

These feelings are part of the spectrum of emotion that living a full life involves; the joy life brings is inextricably linked to that uncertainty.

For example, the patient that suddenly pulled through after you were doubtful about your treatment probably creates an enormous sense of elation, joy and pride.

I was shocked at how happy I was last week one evening when my wife had ordered takeaway for dinner as a surprise.

It literally made my day. This may be trivial, but it was something I hadn’t predicted, which made it all the more special.

So, I am suggesting we reframe how we view uncertainty.

If we view uncertainty as akin to ‘unpredictable’, then we can also start to appreciate how the things that positively take us by surprise are also part of the fabric of that same system.

Is life worth living in uncertainty in order to experience the good stuff that is generated from surprises?

Reminding ourselves that all human beings are subject to this little arrangement of the universe can be helpful, too.

Try connecting with this through a statement such as “It’s not just me, everyone’s life is uncertain, just in different ways”.

Managing uncertainty: distance yourself from control. Befriend acceptance.

Many people will tell you in a time of uncertainty to “focus on the things in your control”.

I don’t think this is bad advice. I just think it needs unpacking and reformulating a little.

If “lack of control” is at the route of the anxiety, dread and despair we are experiencing, it may be a preoccupation with, and rigid desire to control the world that creates such feelings.

Therefore, focusing more on things that you can control can perpetuate this “agenda of control”. And often one of the targets of this control agenda is our inner world: our emotions.

When things get difficult and uncertain, trying to control our own anxiety and pain can have an unintended effect – it can become worse, and can result in a conclusion that “I can’t even control how I feel”.

On goes the attempt to control. On goes the mental turmoil.

Research clearly demonstrates that the more we try and control how we feel by suppressing or avoiding painful emotions, the worse we feel.

This is because it can blunt our feelings in general, and/or lead to a rebound effect. Trying to suppress anxiety can lead to a fear of anxiety.

That basically means MORE anxiety. Ouch.

The alternative is to allow your feelings to be present; honour the anxiety and make space for it.

Remind yourself as in point 1 that this is the natural state of the universe – unpredictable.

Allow yourself to be okay with that.

It can be helpful to generate self-talk that conveys acceptance of the situation and of the emotion you are feeling.

For example, “I acknowledge I can’t know the outcome, and it’s okay to feel unsettled by this.”

Turn your attention inward to your body and locate the feelings rather than running from them.

Speak to the part of you that feels anxious about whatever situation it is. Empathise with yourself and avoid running from your feelings.

I discuss the concept of “opening the front door to emotions” in another article.

Confront the worst-case scenario and remind yourself of your inner resources.

As your mind tries to worry and catastrophise, it shrouds your access to the memory bank of numerous situations in which you managed just fine with difficult situations.

If your mind is worrying, as well as the acceptance self-talk above, it can also be helpful to remind ourselves that we are competent enough to deal with pretty much anything that shows up.

You would have faced many situations before in which you drew on your own resources or recruited other people to help you get through something.

You are an extremely high functioning individual who has got through med school.

You absolutely can get through anything.

To add to this, here’s something counterintuitive: spend some dedicated time actually imagining the worst-case scenario in your mind and allow yourself to feel whatever feeling that generates.

Ask yourself, “why does that matter so much to me?” or “what does this say about me?”

At the route of this exploration, you will find some of your values.

When we worry about things, whilst it may seem like we are confronting the worst-case scenario, actually what tends to be happening is that worry is functioning to avoid confronting this possibility or trying to control the uncontrollable in some way.

If we confront the feelings that the actual worst-case would create, we open up new possibilities. You deal with the pain head-on and stop trying to control it.

I recently did this by imagining what it would be like to not be able to get back to the UK to see my dad.

He’s had several strokes and is now having major heart surgery.

He may well die or have another serious stroke soon.

He hasn’t met my son yet due to COVID and I don’t know when we’ll be able to go back. There is a LOT of uncertainty.

Even writing this I can feel sadness showing up, but I allow myself to be gentle with that feeling, allow it to be there, and tell myself “worrying will not help me prepare – I will be able to deal with this if it happens”.

If there’s something you are currently worried about, I would invite you to confront what’s underneath the worry and refocus yourself on ways you would cope.

Get it out of your head too – write down exactly what you would do and put those worries to bed.

You owe it to yourself so you can focus on life in the here-and-now. There are people around you who need you now, not in some future place your mind tries to take you.

Focus on the choice, not the uncertainty.

Choice is the close cousin to control. Whereas control often gets rigidly applied to the situation at hand, the choice has the promise of being more versatile, giving you lots of options.

There are many things you can choose in life that don’t necessarily require control.

You can choose which personal qualities you want to bring to a difficult situation.

You can choose whether or not you stay in a relationship.

You can choose whether or not you make contact with your friends during a COVID lockdown.

You can choose how you want to treat yourself on an ongoing basis.

Choice is limitless.

Each passing moment of your conscious existence has the possibility of a new choice embedded within it.

Yes, you can choose to try and control things in each moment, but control is merely one choice.

Ask yourself each day, “what choices do I have today?”

Ask yourself, “what do I choose to stand for in this difficult time?”

Even focusing on the little choices you have, such as what breakfast cereal you eat, or which direction you take to get into work, can help snap out of the trance of control and make us realise the freedom we have.

Embrace our own mortality. Practice gratitude.

The emotional pain of uncertainty is inherently created from a focus on the future.

Am I going to pass this exam?

Will this person write me a reference?

Is this patient going to get better?

Finding ways to bring us back to the here-and-now can help deal with this problem when things are out of our control.

There is a good reason why Buddhists and the ancient Greeks believe in spending time considering our own death.

Death is a teacher; if we reflect on our own impermanence and the certainty of our death, it can be a powerful way to focus on how we want to live right now, today, instead of what is out of our hands and lays ahead in the future.

If you acknowledge even from time to time that you will one day no longer exist, it helps to bring us back to savouring and being grateful for the little things we do have now.

So, I invite you to consider this now: If you knew tomorrow were your last day on Earth, what would this make you feel grateful for now? What would you savour?

Are you a nurse whose uncertainty holds you back from achieving your goals?

Get in touch now for a free, no-obligation coaching session to work on a plan to start implementing some strategies.