Sometimes the Truth is Hard to Swallow


B. Betty, RN

Full blown panic attacks by proxy of other people’s experiences can invoke PTSD, making it difficult to be a good nurse, a good friend, a good parent, a good wife, or good anything.

I think the chronic ringing in my ears is really the electric humming of my nerves. I’ve become so used to the white noise of my internal high pitches that when they do occasionally stop ringing, the silence is like a hole I fall into giving me vertigo. Like a transformer on a hot summer day, I bet I could shimmer and crackle in the right kind of light.

If I don’t text or call, if I make excuses for missing events or lunches, if I, god forbid, run into you and seem fidgety, distracted, sound curt or you notice me visually scan the room for an exit, if I can’t look you in the eye, it’s because I am anxious. I am ashamed of my anxiety. I am also super pissed at my goddamn anxiety. I am now more anxious knowing you know I’m anxious.

I am full to the brim of too much feeling, too much noise, too much stimuli, too much small talk, too much over-analyzing, too much nuance, too much double entendre, too much public posturing, too much shallow bullshit.

I have often been told, “Smile more.” I used to feel ashamed of my face and vowed to smile more and concentrate on looking “nicer.” I used to concentrate so hard on my face, I would forget what was being said and just stare blankly, awkwardly, appearing aloof, bitchy or stupid. It made me anxious. To avoid this anxiety, I now avoid circumstances where I need to look or be pleasant.

If I don’t look you in the eye, you can’t tell me to smile. I am not smiling because it’s all I can do not to flee. Sometimes it’s too much energy to scan areas for exits, to think up new creative reasons why I need to leave early, or why I didn’t show up. I’m anxious when I show up. I’m anxious when I don’t.

It comes and goes, these feelings of being too big for my skin, feeling too big for any given occupied space. Like a balloon over expanding and sucking all the air of a room, squealing in protest, I bouncing off surfaces until popping with a bang so violent, we all cringe involuntarily.

It has gotten exponentially better since I left the cult of healthcare where I was told that I’m am sole savior during my shift, solely responsible, and whole incompetent while other people’s lives are one hundred percent in my hands. If they survive, I’m lucky to keep my job. If they code, I either didn’t follow protocol or didn’t use my nursing judgement, or both. I’m also worth less than my training or paycheck and a quarter century of my best years. I was worth nothing but a 401k contribution. I was told I was lucky to be there, not worthy because my anxiety won’t let me do anything but attempt countless acts of proving that what I do and who I am have meaning.

I realize these days that I’ve always been anxious. I’ve always absorbed the emotions left behind in empty rooms. I could tell you if the last people there fought or cried. I chain smoked for something to do with my hands. If I took long sighing drags in a defiant stance with half lidded eyes, if I looked like a bad ass, people left me alone. I spent my teens and twenties battling bulimia. (That’s a lie. I didn’t battle it. I made it my life.) My nails have always been bloody nubs.

Since I have been old enough to drive,I have spent most of my days hidden behind causes greater than myself. I’ve rallied, protested, marched for those who were invisible or targeted because it was the only way I could in some convoluted way, fight for myself. Don’t tell me to smile while others are being oppressed. Don’t tell to smile when I am, in reality, my own fiercest oppressor.

Anger is the elixir of bravery for the chronically anxious. It is served by enabling bartenders who free pour the mixed sweet and bitter drinks of misconduct that invoke angry righteous indignation. Give me a double shot, on the rocks. Put it on my tab. Knowing full well I willingly linger until last call, paying no mind that the hang-over of anxiety and isolation is always payment for the liquid courage it takes to fight for others with the dark secret hope that maybe someday, an anxious stranger does the same for the times when even one small empty room has too much space filled with other people’s emotions.

There will be no peopling tomorrow. Once the kids are in school, I look forward to silence, goats, chickens and dogs. I need a deep breath. I need to inhale life that requires nothing from me but small bites of food taken eagerly from my outstretched hand. Where all that’ matters is my quiet presence of being without the human requirement of having to justify the use of communal oxygen.

Fairy Tales

Bedpan Betty, RN

This started as a writing prompt where each stanza is doubled and the next and the next. Once I got started it was hard to stop. I kept wondering if this was about that which we call love. Is this about giving and getting lost in it? Is this about nursing and we end up terrorized by the shackles of our limitations? Is it in the eye of our lover, our patients, our administrators, or ourselves? Who have we chained ourselves to so willingly? What happened to our dreams of love and hope and happy endings? Have we snuffed out hope? You tell us, our sister castle queens. How does one survive as the tragic hero?

Fairy Tales


I do

But sometimes I don’t want

To care or think or cry or scream or even

Look you in the eye. I want to sleep and cover my head with the blankets. Pillow cool and smooth

Beneath my cheek. Lights out. The only sound my breath as my mind rages and screams out loud. How is this all silent? The war inside my head? How can you not hear my anguish? Why do you not force open my eyelids and stare into the windows of my soul

Until you understand and have absorbed me? Why must I take to my bed to wrestle my demons alone? Are you not the one to slay them for me? Or at least stand by my side on the battlefield? Where is your horse? The white one? Have you forgotten how to ride? I thought you were the one to save me from the tower. The one in which I was alone waiting. Now the tower is my refuge not my prison. That lonely bed still lonely but once full of expectation and fantasy and hope. Bedding now crumpled and stale

and smelling of sleep. You were the one. You are the one. But we have both lost our way. Looking to the other to save us. You have put away your sword. You have forgotten your purpose. I have lost hope in salvation. I thought this dragon was yours to conquer but I was mistaken. It is my beast and my beast alone. Were you ever able to kill it? I still wonder. But I have drawn my own weapon. Unleashed my fury. The beast within a strong match for the one trying to consume me. I will survive the flames. I will singe to be sure. But the fire will serve to cleanse not just destroy. Watch and learn. You too must wake up. Wake up! I am no longer the passive princess you longed to save. I waited long enough. I wanted to be saved. Saved by you. I thought I wasn’t pretty enough or smart enough or dumb enough for you to want to save me. But now I see you were never planning on saving me to begin with. Why? Why? Why? You promised you would. You vowed you would. It was our sacrament. This

dragon has not become as complacent as you. It lies in the corner and sleeps like I want to. But I can hear it breathing. It watches me on occasion with one yellow eye. Its chains clink as it moves. But those chains are an illusion to pacify us. They are not as strong as they look. With one quick movement this dragon shall be upon me. It will try to consume me with its fire and its teeth. And I still fear it. I do. I watch it daily but although it sleeps it knows as I do, that it is only time. Only time before it rises again and sends me to my tower. Alone. Again and always alone. When? The waiting is worse than the knowing. Shall I just go there before it chases me? You seem to not notice its sulfurous presence. You do not notice its chain mail of scales. What can I do? I wring my hands as you roll your eyes. I check the stable daily. Wondering what happened to your beautiful white horse? I notice your scabbard carelessly thrown aside. Its contents rusted. You think this war is over. You do not hear the battle drums. I do. I hear them. It is not just the blood pounding in my ears. It is the enemy and you are the one who is sleeping and I am the one who is tired. Where is the key? The key to my tower? I shall sweep up the cobwebs that have taken residence there. I want to run up the stairs-won’t you lock me in again? You have saved me once but is that enough? You think the battle is won. You think the beast is tamed. Your eyes are closed while mine have been washed clean with tears. You find me ungrateful. Spoiled even. You filled me with great expectation yet become angry when I lament over what was promised and what was given. You read me these bedtime stories! You fed me with the golden spoon so why is it my fault when I am confused by the truth? Why am I irrational when I want what you told me I could have? Don’t tell me not to cry or gnash my teeth while you throw the bones of the beast in my direction. Don’t imply I wasn’t worth it. Don’t be angry that I prefer the silence and protection of my tower to the silence and complacency of your heart. While you sleep I pick the scales from your hair. While I watch the corner and catch the gleam of that one yellow eye. My crown is gathering dust. Lying askew next to your rusty weapons. My glass slippers have cracked-its shards have cut my feet. I stand before you bleeding yet you find me insolent and demanding. I wander into the hall and gaze up at the window which once held both my soul and my dreams. Where is our happy ending?


Bedpan Betty, RN

When do we get to stop listening to people telling us it’s going to be alright?

When will they stop telling us to keep smiling and to remember our blessings or to be grateful.

As if all We need to do is make a list of everything that’s good and suddenly like magic or medicine there is no pain.

When will it be all right that it’s not all right!

When do We get to hear the door slam because someone is coming versus the door slam because someone is leaving?

When do We get to cry without having to apologize or explain?

When do We get to be loved and not left?

When can we stop doing and just be?

When can We stop listening and finally be heard?

When can We cry and not be shamed or shushed or told to go inside and “get it together”?

When can We stop helping and ourselves be helped?

When can We cry and be held and told, “Yes, it’s not all right. It is shit. I feel it too. Do you want someone to cry with you?”

When can we stop crying alone?

When is it okay to not be whole?

When will our scars no longer need to be hidden?

When will our trauma be seen as a chapter but not our whole story?

When will our suffering be embraced as universal instead of a singular moment in which we are alone?

When will it be alright to not be alright?

When can we breathe in our imperfections and know we can still exhale?

When do the nurses get to be nursed?

What Nursing Shortage?

Bedpan Betty, RN

Nurses are exposed to life threatening infectious diseases. They are exposed to and are victims of violence. They do not get the tools they need to do their jobs.

The culture is of martyrdom and shaming/bullying. It’s physically and emotionally demanding. There is little “leadership” support as healthcare is now a hospitality industry vs a healing modality.

It is retaliatory when nurses take a stand against the grain of doing what’s right vs enabling bad behavior and habits in leue of patient satisfaction survey scores. It is adversarial and unit-centric. It is based on pointing out “errors” instead of celebrating cooperation and patient advocacy, however that looks to patients. It is rigid policy and process based vs working with and for the patient as an individual.

It is not based on whole healing but rather symptom management. It has become consumer driven, which makes us either salespeople or whores. We are no longer helping people or communities. We have become commodities and it is soul crushing.

The art of medicine has been replaced by algorithms and profit margins. 24 percent of us have PTSD and compassion fatigue. Even more are medicated with anti depressants just to do the job.

There’s not a shortage of nurses. We are 30 million strong in the US alone. Because of the toxic work environment, they’re either walking away, killing themselves, or dead inside. As long as the healers continue to be broken, none of us will be healed.

Sign My Cast

B. Betty, RN

Sign my cast.

The one that encases my heart.

The one that makes straight my jagged bones.

My limbs once crushed by the pain of us

now taped tightly at sharp angles.

Angles that once cut my soul like shards,

Now blunted with plaster,

Smoothed by strangers hands.

“All Better?” she smiles.

“Be gentle. This will hurt for awhile.

You will be stronger after you rest.

Bones grow harder once they have been broken.”

She washes her hands

of the dust that now

settles into my marrow.

The particles encase me.

I am hardened.

The warmth makes me sweat.

My exoskeleton, now

my superpower,


my  pale underbelly

once so easily


Like a priest with incense

I give you first rites to all of me.

Use the permanent marker.

Write carefully

so as not to smear

your name.

Reflections on Burnout; It’s Personal.

B. Betty, RN

The past experiences that have formed my own nursing practice and view of the world are ones of bullying, power struggles and dehumanization . My parents were authoritarian, only interested in me behaving. Any of my personal experiences outside of their presence was of little interest unless it could potentially reflect badly on them through my behavior or perceived rebellion. To them, if I had troubles, it was because I  brought it on myself by behaving “badly,”  or  it was irrelevant and I was over reacting. I was told when I was 14, “if you ever get pregnant or end up in jail, don’t call home.”

I have older sisters who were out of the house before I was 12.  They were busy raising babies in states I had never been to. I was basically an only child in a town that didn’t like foreign or different. I was both.

When I was 11, We moved to a rough  cowboy oilfield boom town on the lip of eastern Montana where the mountains  bleed into the Dakota plains. My father owned a farm dealership business selling combines and 100, 000 dollar tractors to the local farmers and ranchers. My mother is European so we spent almost all our summers in Germany coming home with suitcases of hand me down clothes, bags of coffee and candies and cheeses in packages with foreign lettering. This made our family suspect. We were outsider thought to be ‘rich’ since my dad owned a business.

I was tormented mercilessly by classmates whose family roots dug generations deep into local soil. I was physically struck in school, on the bus, and in any dark corner or hallway that didn’t have an adult watching-or even sometimes when there was. I was considered a liberal European communist. I was a big mouth in a small town where girls and women should still be seen and not heard. I was called terrible names, many of which  I didn’t know the meaning of until years later, which brought more waves of stinging shame even into my adult years.

I had no one to stand up for me. My seemingly thick skin and strong pride was just a ploy to hide the humiliation of being publically broken. I became a strong victims advocate because of this experience and I still jump in to stop mean behavior before I think of the ramifications it might have for me. I cannot stand seeing other people or animals hurt, abandoned or neglected in part because of my temperament, but also because of my experience of chronically feeling alone, afraid, and in the dark.

I have been told on numerous occasions that I connect well with the ‘difficult’ patients, the homeless, the mentally ill. Mostly this is because they are disenfranchised, misunderstood, and largely neglected by society. I feel their pain and want to be the light I wish I had had.

I am 47 years old, hitting menopause and midlife.  I’m mad as hell. Gloria Steinem said, “the truth will set you free, but first it will piss you off.” I don’t feel free yet, I’m still in the rage phase. I am burned out.

Nursing has become about maintaining a fiscal responsibility vs a human responsibility.  We are being bullied by our institutions, our managers, and our human resource departments to maintain their profit margins. Any push back is seen as trouble making, histrionic behavior; we are to ‘heal ourselves,’ instead of having our institutions keep us safe, protect our mental health or defend us when we are being abused. It is always the nurse’s fault, there is no other story.

I feel that my profession has divorced me against my will. I am sad, I have newly diagnosed ADD, compassion fatigue and PTSD, No one cares. Burnout is real and like being called dirty names you don’t know the meaning of, shameful in ways that can’t be verbalized because I didn’t know such feelings existed or even had words to be described. Once again, I have no choice but to hold my head up even though I feel like I want to be in the fetal position. It is the only way to remain standing.

I hope with increased awareness, nurse bullying, like schoolyard bullying, becomes a zero tolerance sport. I hope that Press Ganey surveys die a terrible death and there is once again a balance between care and cure, people and profit. I hope that I can someday feel passion about this profession instead of just sadness and rage. I hope that I can give the same kind of self care to myself that I have given to others over the past 24 years of my career.

I’m angry that I haven’t gotten the same consideration from other healers or even family that I have given to strangers in my twenty plus years of nursing. In all my dark days of childhood and adulthood, whenever I was my weakest or most exhausted, I have had to always stand alone.

I’m tired of being the one to intervene for the weak and neglected. I feel weak and neglected. Where is the me I’ve been for everyone else? Since I was the only one saving worms from the concrete after the rain, or bringing home stray dogs or even stray people I shouldn’t expect anyone to rescue me. I’m the rescuer. It doesn’t occur to anyone that the carers need as much care as they give.

I am tired. Tired of the world demanding more. Tired that there will always be victims. Tired of hoping there will be less need for things to be saved. Worms, dogs, people. Me.

My fears are that the current political and social model in this country are wrecking our fragile goodness. There is no sense of a greater good outside of profit or one’s personal wants in the moment. People care even less than they did before. I felt that the lack of care by others  is what propelled me forward. Now it is what is pushing me to my knees without any energy or hope of standing again.

My fear is my fear of people being selfish and driven by material wealth vs the common good is actually accurate. I fear that all my life my wanting to be helpful is as insignificant as I now feel. I always wanted to be a nurse. I don’t any more, My self identity as “nurse” is gone. My fear is, that it now makes me nothing.

This has all impacted my practice. In the beginning, it made me an eager, ‘above and beyond” nurse.  I got above average evaluations. I worked extra shifts. I took on extra  licensing certifications. As an oncology nurse I went to patients funerals on my days off, put up educational boards for  nurses, organized certifications for our unit. I was “super nurse.” Until I became human.

When compassion fatigue started affecting me, management could have cared less. All they wanted was robot nurse. Someone who did what they were told and wasn’t a problem and represented them well. So once again, as long as I behaved and gave what was wanted, all was well. Once I started having needs, I was no longer in good graces and the intimidation and bullying started,  At 47, I am done having to prove my worth to people or systems that have standards that are unattainable.

I honestly don’t know if  I want to be part of this profession anymore. When bullying from the inside from the top to the bottom is norm, standing up for patients or other nurses is both career and soul suicide. I will not survive another crisis of self. Not everyone or everything  can be saved. Maybe that’s the lesson. Maybe the only way to be saved is to walk away.

The Dark Path

B. Betty, RN

We go in whole. Wholehearted, with a sound mind, eager to save. Eager to help, we can lose ourselves and our essence on this dimly lit trail of fairy tales and disillusionment. The trail into the woods we are told, is where our goodness is.  It is the path that will save us.

As we trip through the somber paths over-run with branches, disoriented by elongated shadows, the goodness is peeled off with deep, ragged scratches. Our pristine white jackets become rumpled and stained with blood and tears. We are dirty and for the first time, truly lost. We cry in fear and pain, but no one hears.  We learned to save the lives of others, yet here we are with the inability to perform life-saving support on ourselves. Can we make it through the dangerous forest without being deceived or eaten by the wolves?

The picnic basket is still full. Perhaps we can make it to the warm, safe cabin that is within the circle of moonlight on the other side of the forest. We remember the welcoming light shining from the windows. The trail is getting rocky. Narrower. The tree branches grasp and tear at our jackets with corpses fingers. The clouds scorn the moon as they snuff out her light.  The birds have ceased to call our name. The wind mocks us with her hissing whispers.  We are in the dark. We are alone.

There are no call lights here. No crash carts, no oxygen masks. No algorithms for care. No life-saving serums.  No transfers to ICU. There is no one to cry for in our own time of need. We must save ourselves. The hungry wolf’s hot breath is the only heat we feel.
“Didn’t your mother warn you?” he asks.
“No, We were only told, ‘Physician, heal thyself.’”
“There is no healing in the dark, Doctor.” says the wolf. “Only feeding.”


What It Takes to Lead

Not all managers are leaders, but they should be. Many leaders don’t manage and that means there are corporations and public entities everywhere that are struggling with the grey area between administering formal operational needs which allow entities to function, inspire creative employees to be independent and innovative change agents.
In nursing, or healthcare in general, there seems to be more managers than leaders. Healthcare is highly regulated, needs to be extra cautious, analyze risk, and do all it can to “do no harm.” Because of the hierarchical culture, need for policy and procedure to protect the public as well as its staff, those who prefer to manage, who are task and goal oriented, enjoy a position of power. They tend to be attracted to the hierarchical roles of management in healthcare.

Leaders can be found on every floor and staff position in healthcare settings. They may not have formal titles, but you can spot them even without a badge that says “leader”. These staff are change agents. They enjoy their work. They are people oriented and service driven. They engage others with their goals for empowerment and bettering the system, the process, or simply the unit they work on.

Managers dictate rules already made by powers greater than their staff. They do not require input, only compliance.
Leaders invite feedback, group input, interpersonal relationships. Leaders care about people. Managers care about process and algorithmic outcomes. They may be inspirational leaders while still juggling the rigors of planning, implementing, analyzing, assessing both processes and people. It takes a special person to do so, one more inspired to work with and for their subordinates and patients, vs someone who goes into management to delegate the workload because they have the power to do so. Delegation is a tool. The skill to delegate and negotiate tasks can take time. It usually feels uncomfortable to new managers that are true leaders. Those that delegate heavily
prior to management usually have less inspiring leadership skills than leaders who become managers because they want to help the work of the “people.” The reason many leaders become managers is to care for the employees in new and different ways. Many times delegating more work to those same people feels counter intuitive. There is a standard of delegation to help with this skill set. It includes:
The five rights of delegation
Right Task
Right Circumstance
Right Person
Right Direction/Comminication
Right Supervision/evaluation
When considering delegation, the above “rights” can help to organize the tasks and people needed to complete them.

There are many different leadership styles. Authoritative-leader and subordinate, no room for discussion, strong control, Democratic-goals discusses by group, cooperative between leader and subordinates, Laissez Faire-not involved, lack of real personal leadership, Situational-dependent on situation or need,places value on accomplishment and relationship, charismatic-an emotional tie exists between leader and followers and a strong sense of commitment and loyalty, transactional-leadership is a traditional manager/staff model. Uses incentive and reward as a way to get staff to do extra or means of control, transformational-emphasizes importance of interpersonal relationships serves as a role model, inspires change, encourages growth, caring leadership- an extension of transformational as it believes managing is about people not manipulation, quantum-creative, flexible, encouraging, servant leadership-serve first by helping the helpers and those they serve.

Effective leadership must be genuine and heartfelt. One must manage tasks but lead people. People can manage themselves, in fact they must for there to be proactive qualitative change and growth. People are inspired when their strengths are allowed to flourish and their weakness are not under a microscope. Leading people allows the (micro) management of their daily lives to fall away so that time and task can be spent on giving employees tools to do their best, the space and trust to have innovative ideas that can in turn be used for a greater good for others.

Humans are pack animals. We are social, especially in a healthcare setting. Leaders must be able to manage in healthcare in a fluid nature as situations change quickly. In times of crisis, authoritative styles are needed and appreciated (codes, transfers to higher level of care, escalating violence from families or patients.) Other times, a democratic model works best.(We need a resource nurse. What times are you the most
busy and when could you need the
most help?) Transformational leadership is the highest level of leadership/management style
as it encourages and inspires employees to engage in their work, make personal connection, and want to thrive.

It takes a tenacious person to lead in healthcare. The
ones that value the personhood of their staff, their work, who trusts their employees, listens to needs, provides resources and tools, acts as a resource vs micromanaging or shaming, has the ability to change as the need presents, and can share their humanity with their staff-those are the qualities of a manager that is also a leader. Someone who values the people who make up the organization, manages up, surrounds themselves with strong, supportive, intelligent people who share the same values. That is my ideal manager, and one I have not had in many years. This is why nurse burn out rates are high, and we will continue to lose nurses at an alarming speed.  Managers who lead. Healthcare needs them.

Birds of a Feather

B Betty, RN

We were once starry eyed nurses, convinced we would change the world. We would be the helpmates and Saviors we knew the world needed and wanted. We end up  broken like those we were trying to save. The people who come into institutions whole and leave broken are different than the patients who come in broken and leave whole.

Nurses, doctors, technicians- we stand daily at the abyss of death only to use our knowledge and magic to bring patients back from that perceived darkness. We pat each other on the back, cheer our own fabricated sense of Divinity. We are Demi gods. We are told we are, too. We believe every word of it.

Tear stained faces turned up to us in supplication. “What would we do without you? You’re an angel! I prayed for help and here you are….”  The drunkenness of re-starting hearts when there is no life, inject potions that hold the secrets to life –they are what allows us to fly. But only for so long. Even gods can’t fly forever.

When our wings falter, the shock of it almost throws us off course. We realize how tired we are, that we have been flying far too long. When gods fall, they are problematic. When gods need to rest their wings, pluck old feathers, molt and renew like earth bound chickens, they are never allowed to fly again. Their wings are clipped, cut jagged with rusty shears. The wings are clipped in such a way that their hideousness and inability for flight are visible  for all to witness. Like a naked chicken who has lost all feathers, the shame is all consuming, No one remembers that new feathers will soon grow when allowed time and rest. Until then, there shall be no golden eggs from a featherless bird. Without eggs or feathers or flight, no bird is useful. Except maybe in soup.

So the featherless Demi gods are banished with their broken and bleeding wings. They leave behind a trail of fallen feathers, a trail of down that could be gathered, if only the source wasn’t a pariah. There are many broken winged Demi gods but they wander alone, through the grey fog of burnout, the wastelands and smoke filled barren hills of compassion fatigue, all the while dragging their broken and mangled wings behind them.

Shame.  Separation. Banishment. It is what happens when gods are no longer able to give life at all costs, when they admit they are more human than diety. These fallen? They are the birds who fall from the sky out of nowhere. The ones who careen into windshields or plate glass windows, leaving faint images of open wings upon the glass.

They die instantly, broken wings and broken body crumpled, lifeless in a pool of blood. They are swarmed by ants until a human with compassion gently picks her up, examines with curiosity her crushed, limp form. They may brush off the ants, wrap her in a shroud of plastic and newspaper. If she’s lucky, she’ll get a proper burial, but most likely will end up wrapped with disgust and dropped  unceremoniously into the trash with a thud.

“Stupid bird! Why didn’t you see where you were going?”
Why? Why indeed?

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