By B.P. Betty, RN

Self-care is an idea that sells a lot of books. It is the idea behind hundreds of workshops and is thrown around corporate medicine as a way to tell staff that if they are feeling sucked dry  and burned out, then it’s their own fault. It’s just one more thing they need to do to be a better nurse, because they aren’t good enough as they are.

Self-care is a difficult concept for people who are willing to empty themselves every day for others. Self-care is an afterthought for those of us who care more about the community than our individual well being. Self-care is just another tagline to make us feel inferior about our limits and capacity to give without breaking.

The tragedy is, nurses and other front line caregivers don’t tell other people how we feel because it is perceived as being weak. We are hopeful that they will notice and assess our pain the way we do for everyone else, but it never comes.

Heal the healer.
Physician heal thy self.
How many times have we heard this? How many times has it actually been encouraged in any of the institutions in which we work. How many times are we asked to work double shifts or overtime or be on call? How many times does “heal thy self” really matter when the unit is understaffed? How many facilities have dismal time off allotments? How many of us have been written up for taking too much time so we can can care for our children or spouses yet never take a day for ourselves without guilt.

Healthcare culture has nothing to do with healthcare. It is all algorithms and surveys and percentages and profit margin’s. It’s making sure our  i’s are dotted and out  t’s are crossed so state surveyors or insurance companies don’t come back and audit our institutions. Nurses are told they are good nurses if their charting is perfect. Few nurses are told they are good nurses when they spend their time in a patient’s room holding a hand or holding a patients hair back while they are vomiting, or spent crying with a patient who knows he is dying.

We are supposed to be patient advocates, not self advocates. However even that advocation for patient “care” is only important when it comes to length of stay, or planning discharges before the admission paperwork is even completed, or the risk for readmissions is measured more for reimbursement than the care of humanity.

Self-care only matters when it affects the bottom line. We put ourselves in harms way every day for strangers while our families suffer and our own health suffers. We keep waiting for someone to care for us. We keep waiting for someone  to look at us with the same type of assessment and empathy we do when we look at our patients. We keep waiting for someone to say, “you look tired”. “When was the last time you had a day off?” “How are your kids?” “You’ve been working a lot, lately. How are  you holding up?”

We keep waiting for someone to assess us, to hold our hands and acknowledge our suffering, yet it never comes. So, we continue to suffer in silence. We continue to believe the lies that unless we are working extra shifts, unless we are charting in triplicate and it’s perfect, unless we are doing pain assessments every 15 minutes, pleasantly agree to an admission while still recovering from a code that’s gone badly, we are bad nurses. We cannot be human. It makes us weak.

There can be no weakness in healthcare. We must be strong for the weak. Without strength there can be no healing for others. So we continue to push ourselves until we crack and break. We continue to down our own handful of pills before we go to our shift. We continue to smoke and drink and isolate. We stop trusting our instincts because we are told that they are wrong.

Our biggest mistake is believing them. We are advocates for so many.

We advocate for the homeless.
We advocate for the addicted.
We advocate for the poor.
We advocate for the uneducated.
Who advocates for us?

We are too tired and too broken to save ourselves. We are bleeding out. We are told to transfuse ourselves, start our own iv, hold pressure and keep moving. We are desperate for someone to save us. We are desperate for someone to acknowledge our pain. We are nurses, we are supposed to not need anything.

Instead of throwing us a life jacket or safety ring, they throw us more pills. They throw us more classes. They throw us bullshit taglines about self-care when we all know it’s a big fucking lie.

They don’t care if we are well. They only care that we are upright and breathing. They don’t care that we are abused daily. Our suffering is inconsequential. Go to a therapist. Go to your doctor.When all those things are supposed to happen on our  one day off between 3 back to back to back 12 hour shifts, who actually has the energy to go? It means we actually have to get out of bed.

When we  don’t even have the energy to  move, how can we be self advocates? Especially when we know the therapist is just going to tell us we need to take another pill or that we  need to take a day off. When that day is requested, we are chastised for not being a team player. We also know that, by taking a day off, our  coworkers are going to be short staffed. (Remember how they tell us we are replaceable? Well they sure as hell don’t replace us on a daily schedule, do they?!) We know at least one or two nurses  that have confessed to feeling the same way; the idea of leaving them stranded gives us enough energy to drag our  broken selves from our bed. We drink our coffee. We take our  pills. We stumble to work wiping the tears from our eyes, hoping the jagged sobs that come in waves on the  commute will get us through one more shift. We hope nobody notices our  swollen eyes but all the same, hope someone does.

We need a nurse, but can’t have one -we are nurses. We are suppose to be infallible and unflappable, so every last ounce of self-care we  could possibly have is funneled into a half a dozen patients who may, or may not,  be worse off than us.