The numbers of nurses available at any given time ebb and flow; those of us who have been around for awhile, have seen the gluts and the derths, and seen hospital administrations foolishly respond as though the current situation would never change. The numbers and types of ancillary professions ebb and flow right along with us (nurses), since when times are good, lots of help abounds and the ancillaries spring up like mushrooms. When times are lean, the ancillaries go first, and we are expected to do our work and pick up the tasks left undone by the exodus of those ancillary folk.
We're used to that, though. The roots of nursing have always been in being all things to the patient - seeing the patient as a whole person, and seeing ourselves as compleat care givers. We must be competent in a wide variety of skill sets and knowledge bases. While most professionals are allowed to specialize, we must be generalists in a field that has expanded beyond the scope anyone could have imagined 100 years ago and to a degree of skill that is spectacularly unrealistic.
Being a nurse at the bedside today is a lot like being the victim of domestic violence. The expectations to please a system that can't be satisfied, and to endure being abused physically and emotionally. No, we're not being struck by our charge nurses or administrators (although, we often *are* injured physically by our confused or violent patients), but we are being worked to the point of exhaustion, and the emotional stress is very real.
Emotional pain is something we as healthcare professionals recognize and are sympathetic to in our patients and their families, but rarely do we acknowledge or appreciate in ourselves, or look for ways to help each other. In hospice, one of the things we have recognized is that dealing with death and dying is very stressful for the staff - we try to help each other by providing opportunties for staff support. We include memorial services, the availablity of the team chaplain for the staff to have one on one time with, as well as team activities to allow folks to process what they are going through.
Sometimes folks who have endured physical pain will diminish emotional pain, thinking, I guess, that they shouldn't whine about not having their needs and wants met - they should be grateful for their health. That's bullshit! Physical pain comes and goes - it's not a good thing to be sure - but when it's over, it's over! People who are ill or injured suffer more from the anticipation of further pain or grief over loss of function and the like, far more than their actual injury or illness. They often don't recognize that their suffering is actually emotional. It's great when someone faces death and learns from that situation - but that's something we all can do, having been ill doesn't make anyone saintly or special. I'm not minimizing the profound nature of being injured or ill at all, just putting it in perspective. The learning is the thing - something that is available to everyone.
Having been on both sides of some pretty profound caregiving and being cared for, I'll take being the sick one any day!
Being the caregiver is hard work, and emotionally draining - it's not whining to acknowledge being exhausted and battered! We've found in hospice that physical pain is something that can be managed pretty easily when you know how. Emotional pain, on the other hand, is not so easy and is far more challenging to deal with. Emotional pain, I believe is truly at the heart of religious thought and experience. It's also created a field of science that is still learning and stuggling with how to help.
I also believe that many healthcare workers are stuggling with Post Traumatic Stress Disorder. I haven't seen this in the literature, but the more I hear nurses talk and the experiences that they are going through, it struck me that the symptoms are very similar. It makes sense to me, anyway - think of what we see all day every day! There are shifts in the ER or Critical Care Unit that are very much like seeing a train wreck. People who have been exposed to that level of visual assault can have life long emotional damage. The trauma of getting our hands in it, hearing people beg you to help them, fighting with the natural instinct to run the other way, all the while triaging in your head what to do next, and delegating to others what they need to do, all the while doing what needs to be done can be a major overload.
Some nurses respond by shutting off their feelings, going somewhere else emotionally. This can do long term harm to them, and is certainly not good for the patient. On the other hand, how much emotional availability and reaching out should really be expected by our patients? We're not their therapist, we're not their spiritual advisor, we're not their family - compassion is vital, but what are the boundaries to that?
All nurses want to show our patients that we care - but we really are not trained for, nor should we be expected to be all things to our patients. Yet, we allow ourselves to be guilted into doing it all. Historically that's been our role, and afterall, if we don't do it, it won't get done!
I talked with a nurse a few days ago who is very much burned out - I encouraged her to leave the bedside. Her response was to look at me incredulously - "Don't you know there is a nursing shortage, Cheryl?!?"
My response was to ask her why she felt responsible for that. She had allowed herself to feel whipped into submission - she had to continue on, because she knows she is a good nurse, and she feels she must do her part.
I went through a long haul of that feeling - trapped by circumstances, family responsibilities, and the misguided belief that I had to keep the world spinning on its axis. I was lucky - a wonderful spiritual teacher helped me resign from keeping the earth spinning. Her point to me was, that if I didn't flat out, unabashidly, passionately, beyond a shadow of a doubt, LOVE what I was doing for a living - I could QUIT!
That idea struck me like a ton of bricks! I cried just hearing it!
I also felt liberated - and while I did not walk into the hospital the next day to resign, I felt that I had the right to. I took lots less guff, and I began to look for alternatives.
Amazingly, I found the ideal alternative - a computer firm looking for a clinical person to help with their healthcare product. I knew next to nothing about computers, but I jumped in with both feet, figuring if I fell on my face, I could always go back to the hospital. It was great! I had figured that travelling, office hours, even wearing civies would be things I just couldn't do. I was wrong - I could figure all those things out, my family could make adjustments, I could learn new things and contribute in a different way.
Even when I'm not working at the bedside, I know that I'm contributing to the welfare of patients. In a very real way, I am extending my reach by leaving the bedside and doing other things. I worked on the design of a nursing care planning module for the computer firm, bringing my desire to make life easier for the nurse to the project. Seeing the final product in action was amazing! Having a nurse on the floor recognize that "a nurse must have put this feature in here" was a terrific pat on the back.
Nursing, for me, has become the adventure that I had thought it would be when I was a girl reading Cherry Ames books - the route I've taken, though, has been very different.
I've popped in and out of the bedside role over the years, but at this point, I doubt I'll go back. I like working on process improvement and quality - trying to extend my reach still. Keeping my hand in being in hospice by going on visits once a month or so, and working with field staff.
My son will be graduating from high school soon, so maybe I'll go back to school to study Industrial Pyschology or Law. Since I know retirement will be far, far away, maybe taking my knowledge and experience to a new level would be good. I can see a glimmer of working with public policy in the future - work that wouldn't be easy, would certainly be frustrating, but with patience and persistance might extend my reach further still.
For me, the point still is creating those healthy boundaries, honoring myself by not allowing abuse - staying clear in my communication with people. Working from my inner stregth, not from fear. I still have work to do on that, but I have a picture in my mind of how that looks, and I'm getting closer.
