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Sometimes the Truth is Hard to Swallow

A Normal Nurse

By B. Betty, RN

Many of us leave acute care hospitals in part because the treatments we are required to administer often prolong suffering, and the suffering  becomes too much to bear.  We do what we can to  prolong life-sometimes simply because a misguided loved one can’t let go or come to terms with their own mortality.

Daily we see and witness grief and pain. When the body fails, there are those left behind who fall apart-raw humanity  left to be gathered and gently pieced back together by a nurse’s competent hands.

I no longer go home with an adrenaline rush from straddling unconscious patients on  moving gurneys, pounding chests with rhythmic abandon, in synchronized thumps with another nurse running next to me desperately squeezing the oxygen bag  that is attached to the breathing tube the doctor just shoved down a dying patient’s throat. We hope this death is one that will not linger. We all know this rarely ends well.  We know futility when we see it. And yet, we proceed.

These moments are followed by calls to weeping families, disease process assessment and clincial discussions with doctors, mind numbing charting in triplicate, and always an incident report for “internal tracking purposes.” There will not be any time for reflection or debriefing, just quiet and brisk efficiency.

So many of us are soul weary from being around humanity at its most vulnerable  We can’t unsee or undo the years of tending to the core of life. All those souls that have passed through our care leave their mark on our psyche.

We are all witness to bad deaths, bad lives, bad choices, bad resuscitations that just prolong suffering and the inevitable. We can’t continue and we can’t stop either, because we  know too much. It affects our view of life and living, of dignity, of dying. It is a constant war.

I know now, why soldiers come home from warzones and land-mine strewn wastelands full of suffering and death, and why they request to go back. There is no “normal” that will be comfortable, again. Being affected by extreme life events most people never see make it impossible to be around “normal” for very long.

Casual conversation is tedious and trite.  Everyday troubles are no longer relatable. The ability to make small talk or smile is strained  and mind numbing at best.  My mind wanders to my patients. The dead ones I tried to save. The ones still alive being held in limbo by machines. Being around “normal” makes me feel like a freak. It makes me anxious and negative. Pessimistic and jaded. I’m overly jumpy, constantly scanning for danger. I’m short tempered and easily annoyed. This mundane routine is too hard to take.

Death and dying. The sacred moments that should not be witnessed by strangers we are privy to them because we are  “Nurse.” Darkness and tears are our normal. Intimate moments of bodily function, fear, illness and the unknown we maneuver with ease. It is both a blessing and a curse to bear witness to other people’s pain. We do it well. It is all we know.

We see suffering every day. The smell of human blood and feces comes home with us more days than not. We break ribs doing CPR, cause bruising  by jamming needles into veins and arteries so we can administer serums with their promises of life and hope. We prep bodies for the morgue, go to lunch with the smell of  plastic body bags still clinging to our nostrils. This is our normal.

Once a nurse, we can never go back. No matter if we want to, or not.

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For All of Us

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Betty B. RN

Human rights violations happen daily, probably hourly, to front line staff and nurses.  “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 patient- 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 would be fired and possibly arrested for assault or intimidation. SO WHY IS THIS ALLOWED ON A DAILY BASIS IN EMERGENCY ROOMS 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 it is 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 for 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 with 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 even worse, 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.  What I can do is refuse further 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, weary, and in need of your own good care.
No. This cancer taking over our professional and spiritual life is not okay.

We are so good at being patient advocates. Why is it so hard for us to advocate for ourselves? We are indoctrinated to believe that giving is selfless. Taking is selfish. Saying yes to ourselves is selfish. It’s hard to say “I’ve had enough.” Why? Why is it easier to say it when it means taking a stand for others? We are we so uncomfortable to do for ourselves what we would advocate for our patients!

So stand for the nurse on the other side of the bed doing compressions with you. Take a stand for the nurse in front of you at the Pyxis machine taking out her hourly morphine dose for the drug seeking patient who is verbally abusing her. Take a stand for that crabby burned out nurse who will never look you in the eye, but is a well full of information, if you just get past her self protective snark. 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 with that mofo.)

There is more to this nursing gig than just taking orders. More than chart checks, calculations, titrations and IV drip double checks and charting in triplicate. There’s more than meetings on your day off about productivity and why you suck because patient satisfaction scores aren’t in the range the CEO you have never seen thinks they should be. There’s more than being shamed for not getting your 19284 administrative tasks done-those same tasks once delegated to ancillary staff so you could do patient care. Now, thanks to “budget cuts,” your patients lives and their properly filed chart are of equal importance. You’re not a robot. You’re not supposed to be a robot.

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.

What Nurses Know

Once you’re a nurse, you walk the halls and sidewalks of life in that foggy place between tragedy and peace. Miracles and failure. You are stuck between the living and the dead.

The dying are glad you’re there. Your efficient normalcy is comforting and safe. The living keep you at arms length, however. Maybe you do the same. The living talk too much and are full of pride and ego. There’s no time or place for either in our work.

You look at us with incredulous suspicion. We look at you warily, as well. We notice your habits or physical signs of ill health like others notice designer shoes and purses. We know what to do when you’re dead. We will comfort your family. We will wash your nude body before zipping you up in cheap plastic. Death is the great equalizer. You may get a fancy casket, but everyone first gets that  same cheap plastic bag.

In response to your question of “what do you do for a living?” I respond “I tend to to the dead and dying.” The small talk sputters to a halt. You laugh nervously. Now you know why I don’t care about the famous people you know, or how much money you make. Your kids scholarship to MIT,  or your latest trips to anywhere don’t affect me. I don’t care about purses or tv shows or the latest trends.

Your jewelry isn’t going with you. Nothing you say to try impress me, will make think better of you.  I’m a nurse. I know what you look like dead.

Signs of a Toxic Work Environment —

You flinch when someone says your name. You only see management when something goes wrong. It’s all about blame versus problem-solving. You have diarrhea before your shift. You have diarrhea  after your shift. You fantasize about ways you can get hurt and file a Worker’s Comp claim so you don’t have to go […]

via Signs of a Toxic Work Environment —

The Descent

By P. Pharm RN

There once was a nurse trapped up to her ankles in quicksand.  Her
manager asked, “How did you get yourself into this predicament?”  The
nurse replied, “I don’t know.  I was helping a patient and before I
knew it, I was caught in this sand.”  The manager rolled her eyes and
said, “Once you’ve figured out how to free yourself, bed 9 needs pain
medicine.” And she walked away.

The nurse looked down at her stuck ankles and started to panic.  She
worried that she might be stuck forever.  Slowly, the sand crept up
her calves.  Hours had past and her manager appeared behind her.  “Why
are you still standing here?” She sharply and callously asked.  The
nurse looked down at her submerged calves and wept.  “I am stuck and I
haven’t been able to free myself.  Can you please help me get out of
this hole?”  The manager looked at her watch and said, “I am late for
a meeting.  Why don’t you call Employee Assistance?  Maybe they can
help you.”  And she walked away.

Slowly the sand began to engulf her legs until her hips were embraced by the sand.
Her manager again made her rounds and saw the nurse
still trying to free herself.  “Did you call the Employee Assistance
hotline?”  The nurse looked down and shrugged.  “They put me
on hold twice.  Eventually the calls went straight to voicemail.  I
did leave a message explaining my troubles.  Can you help me?”  The
manager looked at the clock on the wall and exhaled.  “Have you asked
your co-workers to help you?  You really need to learn how to delegate
tasks to others.” And she walked off.

The nurse spent hours asking other staff to help her but they were all too
busy.  By now, the sand reached her chest and it was becoming hard to
breathe.  The manager asked her why she was still stuck in this hole.
The nurse almost breathless replied, “my feet were caught and you
blamed me.  I sunk further and you walked away.  My legs were fully
submerged as I wept and you mocked me.  Now, I suffocate and you have
the audacity to ask why I still linger in this pit of despair.  “Why
do you discard me so?”  The manager looked down at the nurse and
replied, “Because those who sink cannot be saved.”

The manager walked away as the nurse descended into darkness.

Signs of a Toxic Work Environment

You flinch when someone says your name.

You only see management when something goes wrong.

It’s all about blame versus problem-solving.

You have diarrhea before your shift.

You have diarrhea after your shift.

You fantasize about ways you can get hurt and file a Worker’s Comp claim so you don’t have to go back.

You wonder how you can possibly get through one more shift much less another two or three decades until retirement.

You contemplate increasing your life insurance so your family will have a better nest egg once you’re gone.

You count your sick days like addicts count pills.

You take pills so you can get through your workday.

You think about starting a home lobotomy business and know your coworkers will buy into your MLM plan.

You fantasize about being homeless instead of worrying about being homeless.

You think moving to a Third World country would be a vacation.

You have two or more stress related illnesses.

The idea of talking to people on your days off puts you into a panic.

They tell you you’ll never get another job and you believe them.

You wonder if prison has a better work life balance.

I Cut Myself.

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By P. Pharm, RN

It didn’t take much to set me off into that rapid, swirling decline of drowning despair.  I had been heading in that direction for years.  The nosedive began when I watched my best friend among others being bullied, shamed, and pushed to the breaking point by management.  The hospital’s administration had molded its culture into a self-serving business model that took a no-prisoners approach to leading its employees.

The nursing staff existed for the sole purpose of providing optimal patient satisfaction with the final product of maximum reimbursement.  The cost being too high for the emotional, spiritual, and physical livelihood of its employees.  There was no 99 percent one could give.  You either operated at 110 percent or a 0 percent failure rate.  I believed that I was supposed to be a perfect nurse.  Any mistakes meant total failure and shame which sent me into a depression.  This was reinforced by my superiors through threats of written warnings which took away the only annual bonus offered.  If a mistake was made, everyone knew about it and it was placed in our permanent record.  That mistake followed you wherever you went.

I watched a nurse make a medication error which resulted in no harm to the patient.  She took the policy enforced path of self-reporting the error to the physician and her superiors.  She was counselled, written up, bonus taken away, threatened with possible termination, and shamed.

I witnessed another nurse openly voice her burnout to management which resulted in multiple future write-ups and a strong suggestion that she find work elsewhere.  She slowly emotionally deteriorated under the pressure.  The manipulative tactics used were geniusly executed.  I was horrified over how sly and calloused leaders in the medical profession actually are, as they dress up in the costume of healthcare servitude.

A fellow nurse admitted to me she was on 8 prescription medications just to function. Another one said she has never been on as many antidepressants in her life as the present. Another was diagnosed with Colitis.  Another Crohn’s disease.  Fibromyalgia.  Cancer. Obesity.  Depression.  Drug addiction.  This list goes on.  We were all battling something. Yet, it was barely talked about.

The quantity and frequency of my panic attacks grew and grew.  I couldn’t control the suffocating feeling that overwhelmed me during my shifts.  The patients may have been stable but I constantly convinced myself they were about to code or I was on the edge of making some catastrophic mistake.  This feeling took over and there was no way to conquer it.  And this monster kept growing bigger and its behavior more unpredictable and out of control.

I heard the term “self-care” thrown around by administrators.  Honestly, I tried “self-care” but the true self-care came when I chose to leave this toxic establishment.  Massages and meditation can only go so far and probably only temporarily band aid a small fraction of the true problem.

While others outwardly voiced their displeasure, I was imploding on the inside.  My health declined and I found myself withdrawing from people and life.  I slept more with no change in the overwhelming fatigue I couldn’t beat.  I fought more with my husband and I wondered if we would make it.  I couldn’t stand being around my children yet I missed them terribly.  I was dying in every way.  I contemplated not existing anymore.  I couldn’t stand my job and couldn’t stand the person I saw in the mirror.

One day, I just started cutting.  I watched the blood run down the shower drain.  I was shocked that it didn’t hurt.  It actually felt good.  Bringing the evidence of my internal pain to the outside was a release.  Until, I felt the stupidity of it all.  Why was I hurting myself over a job?  Why was I allowing myself to be a victim?  Why was I allowing in all this pain and misery?  And, possible infection?  What the heck was I thinking?

I called in sick for my next few shifts.  I saw a counselor and a psychiatrist.  Amazingly enough, they said they had many nurse-patients with the same symptoms as myself.  My symptoms were finally validated.  I was diagnosed with anxiety and depression.  I was placed on a leave of absence and I gave myself permission to emotionally and physically heal.  It didn’t take long to feel a renewing of my soul and body.

Most of this article is about the mentioned evil healthcare machine and I paint myself as its victim.  But, I place much blame on myself for not taking a risk sooner and leaving.  I let fear dictate my future.  I was scared every job was the same.  I feared I couldn’t measure up to anyone’s expectation of who I was or what I should be capable of.  I put too much emphasis on a paycheck instead of my own sanity and well-being.  I was stuck in a self-dug trench full of lies I had believed for way too long.  No longer.

It took me less than a week to find a new job.  One that wasn’t oppressive or abusive.  They really do exist.  Nursing with respect and dignity for the professional is not some made up fairy tale told by nursing schools for recruitment purposes.  So, know that if you feel your situation is similar to my story,  I want you to know you are not alone.  Many have been there and recovery is out there.

Please don’t let a job, a person, or a situation destroy you.  Your feelings are real and deserve to be validated.

Self Care

 

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.

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