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Sometimes the Truth is Hard to Swallow

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.

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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?

The Future of Nursing

Nursing is a community service profession. It has been argued that it is more a trade than a profession, which is why there are so many education models to achieve the title of “RN.” For it to continue on a trajectory of ‘professional’ practice, the education standards, role of nurse, his/her contributions to both medicine and the art of nursing must also change. This is becoming a global push and education is emphasized in numerous publications. In the United States, the push has been making ripples since the 1980’s. However, politically, it really came into focus in 2010 with the ACA/Obamacare and healthcare reform. In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched an initiative to re-model the standards of, and change the practice and outlook for nursing.(www.nationalacademies.org)

Part of this reframing is an acknowledgement from the medical community that nurse work does matter. We are not just doctor’s secretaries. We don’t just ‘follow orders’ or are subservient to their role. Nurses are professionals in their own right. They have their own boards, set of ethics, and standards that are not just shadows of the hippocratic oath, but stand both independent on their own merits, and interdependent along with medicine as practiced by physicians.
Because nursing is being seen as a profession with concerns, needs, and patient focused care that are not addressed by the science of medicine but rather the social science that also encompasses our field, the way in which nurses are educated needs to change along with the way society, technology, and medicine is changing. To continue to gain respect and support from physicians, administration and the public, nurses need to have the education to back up their perceived ability to lead.

While nurses have always been on the frontline of care, we have not been included in policy, community boards, or the political realm in which physicians or other scientist have. We continue to fight the ‘mother’ role; we are vital to the health of our communities, but often overlooked.
Up until the past decade, nurses have not been actively sought or actively volunteered to be involved in the transformation of healthcare in this country. We are 3 million strong. We are the largest workforce in the world. Now, more than ever, our voices matter and can, indeed, change the world.

Nurses need to promote our craft and our education both individually and collectively. We need to volunteer on boards and community service organizations that promote health. We have an uphill battle to fight, including the nurse bullying and hierarchy that continues to plague our places of work and even educational institutions. Our education is already vigorous, even the ADN level nurses take more science courses than the general public, or many baccalaureate degrees not based in nursing or medicine. We spend hundreds of hours doing bedside training, hours studying, and must past difficult national licensure to ensure we are educated enough and safe enough to perform complex tasks that can be life altering to those we serve.

Why isnt this enough? It is, and it isn’t. Does having a masters degree increase my ability to care for other humans? I have found many that have BSNs or advanced degrees of any kind are less common sense people than those who have more hands on training. Common sense at the bedside saves lives as much as a knowledge set in theory or policy.  Perhaps the new model of nursing, needs to look at reframing the practice of actual nursing in addition to higher learning. Doctors go to medical school, become interns and then residents before being able to practice on their own. Nurses need to be at the bedside, or treating actual patients in the community before going into roles or continue education to enact policy that affects not just patients but the nurses who treat them. As we all know, theory and and reality are not the same. A controlled environment looks nothing like the real life chaos of saving lives. Being able to think on one’s feet, make immediate adjustments to one’s practice depending on patient status, only comes with experience. All nurses need to have done patient care.

Siloing is already a huge problem not just between hospital units, but between institutions, long term care, community health. There is so much defensiveness, inability to see past the “ but we need it on this form, even though you’ve filled it out on that one” and focus on the minuta because someone in an office who only know policy and theory says it must be done. Our roles have stayed task oriented and fragmented even as our place in the health care system has grown and legitimized as a profession of educated men and women, versus flunky doctors or handmaidens.
Not only do hospitals vie for Joint Commission’s accreditation, but also add  to the mix the magnet status that is also an added feather to an acute care institutions hat. The focus on magnet credentials became a hot topic, also in 2008, along with the focus on increased nurse education, although it credentialed its first hospital in Washington State in 1994. (nursecredentialing.org 2011.)
I doubt the focus on education and magnet requirements is incidental. As more agencies focus on long term outlooks, the more their requirements to achieve goals will become the same.
One goal is to transform nurses into leaders, implement empirical data and have nursing goals based on evidenced based practice (EBP.) The idea to help transform healthcare through nursing is based on the goals set forth by American Nurses Credentialing Center (ANCC). Part of this includes structural empowerment through professional engagement, commitment to teaching and education, commitment to community involvement, and the recognition of nursing in its own right. (nursecredentialing.org 2011.)
As medicine, nursing, community health, and patient engagement continue to evolve, so too, will the needs and roles of who nurses are and what they do  shall also. Nurses will have more power to empower as they gain a larger knowledge base. My only concern is that more people who see nursing as a form of academia versus public service, will become those whom focus in on how goals look in a nice formally written policy or dissertation, and not always the people who are affected by said implementation.

The bedside nurses focus on the people, not the process. As the two begin to merge as a seamless all encompassing profession, may they meet in the middle and understand the needs both in the trenches, and in the boardrooms.

 

Despair

B. Betty, RN

Even with a support system, the darkness of despair is solitary. You may hear your voice being called, but it’s from behind locked doors without doorknobs  in rooms that lets in no light. Support, when you’re in a fetal position, is only support when you aren’t mandated to get up to receive it.

I have a friend currently intubated in the ICU for a suicide attempt.  She is a healer, stricken by the endless despair that we all bear witness to daily. She was either found just in time, or a few hours too soon,-the viewpoint dependent on how often one has fumbled for knob-less doors in frantic efforts to shut out the nameless voices who call out their own needs. “Don’t leave me. I need you. We can’t go on without you. Come back! Come back!” The words are prayed in a frantic eulogy, a chant of faith and superstition by people who have no realization these are the same needs that have deadbolted the door to the dark room, to begin with.

She and I have had long discussions of how the system breaks the healers. How we have become empty from our giving. We have cried in the telling of our stories-spoken in tear filled whispers, long jagged silences that crucify us as we grip each other’s hands.  We drip our anguish onto our fingers, mingled tears of grief in a kind of blood sister bond of understanding. Our tears have kept vigil for each others broken spirits. Our tears have salted our dreams. Our tears have been the nourishment of our friendship.

Another friend, also a healer, once said, “The strong are the ones who fall the hardest. The weak simply complain.” The institutional rhetorical response to the few who dare ask for help to keep going is always, “stop complaining-everyone else can do it.” and “Suck it up, buttercup, you signed up for this.” This kind of on going  shaming can only be ended by deciding to finally walk away. In some cases, permanently. Those who have been chased by that darkness don’t judge it. They know it is always on the horizon.

I suffered from excrutiating altitude sickness that included vomiting, vertigo, headache, numbness, tingling, dry cough and hallucinations when I hiked Mount Whitney in the Sierra Nevadas of California for my 40th birthday. At at 14,505 ft elevation, it is the highest peak of the lower 48 states.

It was hard. There was a snow pack unusual for that time of year.  I was slow. I fell many times. I should have turned around, but I didn’t. It was a stupid, dangerous decision that could have ended up as a medical emergency of cerebral or pulmonary edema which, at its worst, causes death. I had summit fever which is much like being in the throes of despair. No amount of logic or any kind of reasonable voice can talk you out of either. I was going to do it even if it killed me.

Sometimes looking death in the face is seductive. Sometimes you must see her face to not be afraid of her call. Sometimes she’s the only voice that can be heard. She knows us each by name.

Eight of us began training a year before our ascent. Three dropped out before we could even apply for permits. Two of us in our party made it to the top. Three in our party turned back. The three that turned back said “we will conquer this damn mountain next time.” They haven’t won permit rights again. They’ve stopped trying.

Mountains, like despair, cannot be conquered. They are instead given reverence, as both will indiscriminately take you down without caring how strong or weak you think you or those around you are. You can only summit mountains and despair with fortitude and grace. You will remember standing with your face in the wind, breathless with weariness, fearful that your pride in that moment will jinx your descent back down to where you started. You will tremble, buckling at times to your knees with a deep appreciation of making it. You will remember those who helped you along the way and understand that they may not reach the top.

My tears fall heavily. They are solitary tears, falling this time  onto my own flaccid, open palmed hands. I watch them slowly make their way down my fingers, to fall away and be absorbed by the smooth cotton case on my pillow.

I’ve taken to bed as the horizon’s darkness is spreading. The room’s light is changing in the growing shadows. I can still see the doorway in the lingering light. I’m trying to keep it open for my friend. I’m trying to memorize its shape and place in the room. I am hoping of all the voices I may soon hear calling, one of them will be hers.

Trauma

B. Betty, RN

I haven’t worked in Trauma for over five years. I’ve been out of acute-care nursing for 15 months. Today, while sitting at a cafe that is wrapped on three sides with glass windows and situated on a busy intersection, I saw a man stick his arm out of a car window.  The hair on his arm glinted copper in the afternoon sun. I couldn’t see his face in the glare between the window and the late July sunlight shimmering between us. He point that arm and held it horizontally in my direction.

I flinched. I told my kids calmly but firmly to move their chairs away from the window immediately. When asked why, while noisily scraping wooden chair legs against well polished linoleum, (they know “that voice,”) I said, “there’s a man with a gun at the stop light. It’s pointed at the restaurant.”

They turned to look as I scanned the room for a quick, safe exit, or where we could shelter in place. My 16 year old said, “Mom, there’s no gun. He’s holding a cigarette.” They laughed and did that “mom is crazy” eye roll all teens do when they think adults are being stupid or over protective.

I distinctly know I saw a flash of metal. I got the same adrenaline rush I used to get when my patients were active gang members or on watch by border patrol, sheriff, or federal agents. I felt that same wariness and heightened awareness that comes with the threat of immediate danger. My ears were ringing which is my sign of impending chaos. In that glint of metal and sunlight coupled with an aggressive movement from an idling car, I instantly saw my gunshot patients. I smelled fresh blood and death.

I saw the faces of gang bangers and drug addicts. Prostitutes and border hoppers. Young boys and old men, shot by uniformed officers  in pickups as they attempt to jump or tunnel the border fence. Sullen wanna be’s and hardened gang members alike caught in the cross fire of affiliations or initiations that are rites of passage to the dark and gritty streets.

Drug deals gone bad, robbery, retaliation, love triangles-they’ve all played out and ended with boys and men assigned to me in the sorrow lined hallways of the inner city hospital where I worked.

I saw boys my own children’s ages crying for their mothers as I pulled rolls of blood covered gauze from their abdomens before methodically pushing medicated clean gauze back in. I heard nurses and doctors yelling in the chaotic dance of CODE BLUE with desperate attempts at sustainable CPR. I heard machines warning of flat lines that indicate the cessation of life. I heard the wails of family members as i unhooked lifeless bodies from the machines that failed to save them. I felt the helplessness of my inability to do anything to change it.

I was wrong. It was a cigarette. It’s been four hours since I thought we were going to die. My kids are at home watching crime shows on TV. My husband is washing the car. I can still smell their wounds.

For All of Us

For all of us.

Human rights violations happen daily to nurses and front line staff. “Suck it up, buttercup- you signed up for it.” That’s the general consensus.

We signed up to give. We didn’t sign up to be sucked dry and abused by the same system that is supposed to help the community. Am I not also part of the community I give to daily? Apparently not when I’m in scrubs.

If I kicked a coworker or spit on them or threw poop, pee, blood, or vomit, called them bitches and whores, backed them into a corner, threatened and said “give me what I want or I’ll slam your effing face into the wall!!” I’m pretty sure I’d get fired and possibly arrested for assault or intimidation. SO WHY IS THIS ALLOWED ON A DAILY BASIS IN ERS AND HOSPITAL FLOORS IN EVERY FREAKING HOSPITAL IN THIS COUNTRY?! The last guy who threaten to punch me in the face? I took my glasses off and said “do it. I need a workers comp vacation.” I meant it, too. How the fuck do I get out of this hell hole without losing a body part or my sanity?

That was the beginning of the break of willfully standing in harms way and thinking its NORMAL or ACCEPTABLE to be abused. You can only be bent so far until you are broken. There is an alternative option to being a victim or volunteer. It’s not suicide-although that can look pretty damn viable when it’s easier to wash off the c-diff than the hopelessness

Walk.away. If all we know is abuse, then anything else is easy. I guarantee you, you will never regret not fearing for your sanity, your safety, or your soul, again. I don’t know how long it will take me to stop cringing when I hear my name called by management. I still assess a room the minute I enter it to scan for danger zones and safe escapes. I am working on my eye contact w other humans on my days off. I have fewer heart racing 3 am wake ups in a sweaty oh shit I forgot to do 3 of those 394759667 million tasks i was told to do or fear for my job panic. I don’t cry every day from exhaustion or dread of another shift exercising my complete futility in a system that makes caregivers simply givers…or the sheer scariness of feeling nothing at all.

We save the world-who saves us? No one. That’s the most soul wrenching painful realization. Who will give everything to save ME, like I do to save others? Who will lose sleep if I don’t make it? No one. They’ll only notice if I miss my shift.

Except my kids. My husband. My widowed mother. My sisters. But no one I have handed my blood sweat and tears, my best youthful years, my back, my spirit, my naivety, my life spark, my love of humanity, my need to make a difference-not one of those mother fuckers will stop and assess my pain and make a plan of care to save me. Not.fucking.one.

Am I really contemplating increasing my life insurance so my husband can have a better nest egg before I off myself w a bottle full of prescription meds that I have received as consolation prizes for leaving the best parts of me in the wrong places? I want to die because I’ve given too much of me away!?

I can’t unsee or unfeel or unknow all I have witnessed in this profession. I can not have back the pieces of my heart I have willingly given to my patients. (Nor do I want them back-those were freely given, not taken.) What I can do is refuse abuse of my battered heart. My aching feet. My weary head. My sorry soul.

Part of nursing is saying no. No you can’t eat cake with a blood sugar of 500. No you cannot have sex in your bed with your boyfriend in a semi private room in the hospital. No you can’t lay in bed for days after surgery. No you can’t get up to go to the bathroom after you’ve had a heart catheterization and are at risk for popping in artery and bleeding out.

Sometimes saying no is saying yes. Yes you deserve better. yes you are worthy. Yes you can live. Just as surgeons pull out tumors and dying tissue, so must we stop allowing the cancerous culture of a predatory system from metastasizing. No you don’t have to take it. No you aren’t weak for saying you are hurt.
No. It is not okay.

We are so good at being patient advocates. Why is it so hard for us to advocate for ourselves? We are in doctrinated to believe that giving is selfless and taking is selfish, saying yes to ourself is selfish. It’s hard to say “I’ve had enough.” It’s easier to say it when it means taking a stand for others. So stand for the nurse on the other side of the bed helping you. Take a stand for the nurse in front of you at the Pyxis machine. Take a stand for that mother friend and all-around good person that resides within you. You are worthy. You are an excellent nurse. You deserve better. Bend but don’t be broken. Be the nurse you need. For you. For your family. For that patient in the bed who isn’t trying to bash your head in. (Security can deal w that other mofo.)
There is more to this nursing then just taking orders and chart checks and calculation titrations and IV drip double checks and charting in triplicate. You’re not a robot. You’re not supposed to be a robot. Bend but don’t be broken.

Do not let them tell you this is all there is. Thieves, addicts and patients lie. So do hospital administrators. Say no so you can say yes. You matter. You are not replaceable. You are needed and loved. You deserve to be the nurse you set out to be.

Care vs Cure

 

B. Betty, RN

A past patient of mine and I had altering ideas about his ideal state of health. He was an older gentleman in his 60’s but appeared much older because of his smoking, drinking and decades of self-neglect.  He was a wheel chair bound frequent flier back in the hospital for a second toe amputation with possible foot involvement  secondary to his uncontrolled type II diabetes, vascular disease and 100 pack year x 40 years smoking history. He was angry. He was angry that he was on a sugar-free and low carbohydrate diabetic diet, angry that he was getting another amputation because “the damn doctors screwed up my foot.” Angry that he was no longer allowed to go outside to smoke because of the hospital’s no smoking policy. Angry that he was ordered dressing changes three times a day to his legs and foot  that caused him discomfort. He was chronically short of breath and oxygen dependent. His blood sugars were baseline high 200’s, and he was completely non-compliant. He was abusive to staff-a total PITA (pain in the ass). For some reason, he was my favorite patient. He was a challenge. His chronic crabbiness reminded me of my dad.

He was a personal lesson for me about being in the moment, being non-judgmental, allowing others their own story. He was a reminder about  how to be present without being controlling and  honoring other people’s truths. He pushed my buttons. He yelled and was mean just to watch the nurses jump and get flustered. I smiled and gave it right back to him. He respected me (sort of) for not kowtowing to his roar. I discussed the WHYs of no smoking, food choices, diabetes, amputation, smoking  effects on vascularity and  all their roles in both the diabetic ulcers and the need for amputation.

He knew all this in an intellectual way but his heart wasn’t in it. I gently (in my blunt way) told him that if he continued down this road, he was going to die from complications from his bad habits. He stopped being snarly for a few moments and teared up. He cleared his throat and said, “Yea, so? I have nothing left to live for since my wife died. My kids hate me. They blame me for her dying. She’s didn’t want to keeping going to the doctor so I didn’t make her. The kids won’t talk to me, so who the F*ck cares?”

That was it. That was the defining moment for both of us. He was busy fighting us so as not to have to feel his own grief. We were too busy trying to get him to comply and labelling him a difficult patient that we all forgot why he was there, or humanity behind the disease.

Healthcare is completely ‘goal’ and “outcome” based.  Because reimbursements are dictated by the Joint Commission’s set of standards and goals, we have lost sight of the complicated humans in our beds. Humans cannot be algorithm-ed into compliance. There is not a holy grail of health, no matter how nicely we try to tie it up in bows or threaten monetary punishment to institutions. We have made institutional goal attainment the ONLY outcome allowed.

Not every patient wants to be wholly well. Not every patient is whole enough to achieve such an outcome, to begin with. One’s health journey is just as spiritual as it is physical. Our spiritual pain can cause our bodily disorders, more likely thus than the other way around. Until we adjust our own sights  we will not get our patients to see the facts or truths of healing “our way.” We must be in tune, unrushed. We need to  truly understand perception, social conditions, environment.  We must SEE our patients in all their glorious, messy, complicated, unscientific impracticality if we are to be any help to them at all.

Sometimes we will simply be the face of kindness that becomes the seed for wellness. Sometimes we will be the hand that guides them forward. Sometimes we will be one more person to whom they lash out. Never the less, our goals for their health cannot be pushed or forced, no matter how much our institutions will try to do so. We can assess, we can recommend, we can evaluate. We will never be able to strong arm humanity to do our will, whether it’s ‘best’ for them or not. Sometimes, the most therapeutic option is to listen and validate. We touch lives by touching souls.

 

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