I’m going to ask for your patience as you read this. I’m not going to tell you that my problems are unique, because I’ve been paying attention, and all of us everywhere have been suffering under this pandemic. I’m not going to make a claim that the nurse’s suffering is unique, because what I’m going to write applies to everyone in American healthcare: aides, social workers, doctors, therapists (physical, occupational, speech, respiratory and so many others), PAs, ARNPs, chaplains, phlebotomists, pharmacists, receptionists, patient transporters, medics, and thousands of others. But since I have over 25 years of experience as a registered nurse in the United States, I feel like I’m the person to tell you my story. I’m also going to use some language that some of you may find exaggerated or extreme. That’s fair. Again, I’m not trying to compare my experience to anyone else’s. I’m just going to try express myself in the clearest terms I can.
Here’s something to know about nurses: There are some that follow a career plan, that choose positions with an ultimate goal in mind, and I’m always a little in awe of that kind of purposeful direction. I’m grateful for nurses like that, because they often become great mentors in the science of whatever branch of nursing they’re in. But for a lot of us, our “career path” reflects more of a desire to balance our work with our families and communities. Many nurses are parents, and many more are children of parents, and we often change jobs to seek more stability at home. For example, I spent a big stretch of my career working night shifts, because it was the only shift that allowed me to be home on the days my son was with me (both his mom and I were single parents for much of his childhood) to both see him off to school and when he returned home. Sometimes nurses go into other fields because they’d like weekends off, or a regular schedule. I started doing agency work because until fairly recently Pennsylvania hospitals were allowed to mandate overtime to nurses if there was a staffing shortage for the next shift. Literally, when you showed up for an 8-hour shift (or even just covering someone for four hours), you did not know whether you’d leave 4, 8, 12, or often 16 hours later.
All this to say that like many nurses, I’ve done a lot of different kinds of nursing over my career. Inpatient psychiatric, med/surg hospital, endoscopy, home hospice, ICU, a bit of NICU, geriatric, nursing home, even chart review (Never ER. I don’t like surprises.).
I did not come from a medical family; I’m the only person in my immediate family to go into the field. I had no idea what I was getting into. In nursing school, I was always terrified that I was going to hurt someone, but began to find fields that I thought I could be comfortable in (psychiatric nursing I was especially drawn to). But from the moment I took my first nursing job, I have never felt fully comfortable as a nurse.
I put this down to a lot of factors. That I hadn’t studied hard enough in nursing school was a familiar fallback (my son was born during my first semester of nursing school, and I was trying to balance baths and feedings and naps and play and diapers with school, work, a recently diagnosed depression, an undiagnosed touch of ADD, and a failing marriage). I always looked hard at my faults, always overlooked my strengths. I let the bluster of some bossy nurses (most units had one) convince me that only they were doing it right.
But in April of 2020, I had what everyone usually calls “a breakdown.” My anxiety got so bad that I had to take FMLA for mental health, seeking out a provider with experience in psychiatry that could look at my meds with more experienced eyes (this was in addition to my then and current therapist, a wonderful LCSW who is one of the two best coaches/therapists I’ve ever had). After six weeks I went back to work, and handed in my notice.
(Right here, there is something I desperately need to communicate. I had accumulated enough savings at this point in my life to be able to afford being unemployed for a long stretch. Even twelve years earlier, this would not have been the case: I was deep in debt and living paycheck to paycheck. I was unfathomably lucky to stumble into a relationship where I could stabilize myself enough to catch up. I am fully aware of the enormous privilege that allowed me to be unemployed for months on end and not suffer from food or housing insecurity. It is also my absolute belief that we live in a dysfunctional nation when every citizen is not afforded this opportunity at least once in their lifetime. I’m alive and healthy today directly because of my privilege. It’s a moral travesty that most Americans can’t afford to do this.)
I decided to take “a few weeks off” and then look for a new job. But as the weeks drew on a paralysis seized me. I couldn’t even look at nursing positions. And as time passed from my nursing career, I began to look back and see the common denominator in every nursing job I’d held.
In every position in every healthcare system, every nurse, doctor, aide, etc., every single person who is tasked with providing care to a patient is sooner rather than later given a bigger patient load than they are able to safely handle.
It’s the nature of American healthcare. Even when working for a nonprofit institution – often especially then – I always, always, always felt I was ultimately serving the bottom line. I have never worked anywhere where the call has not been for more and more patients. Everyone talks about quality of care, but it is always second. First, get the numbers up. Never, “Do you need more help?” Always, “Once the numbers are up, we can hire more people.” But that never happens. Nurses retire, quit, go on FMLA or parental leave, and are never replaced, because lower labor costs are the easiest way to help the bottom line. It got to the point where the promises of better staffing actually hurt more coming from managers who seemed to believe it would really happen, and wanted us to be hopeful. It hurt less when it came from administrators you honestly knew didn’t give a shit.
And the effect of all this? In a position that can accurately be called “life and death” with the safety and health of human beings in your hands?
I remember the half-dozen times I sat in my car after a shift, literally crying over the stress of what I’d been through, needing to get the tears out so I could see well enough to drive home. Running into a bathroom for just thirty seconds once a shift, most shifts, because that’s the only place you could go to just catch your breath between patients. The agony of tearing yourself away from a patient who needed a little more time, a little more attention, a few more words, because you were being pulled to other people who equally needed help. Most shifts knowing that you only had the time to provide the most basic care to each person on your patient assignment, not having the time to research the chart, provide the education, reassure the patient, reassure the family. Working in a whirlwind of other caregivers at all levels who were just as stressed and just as busy as you.
The time off, for me, was the worst. Looking back on a previous shift wondering whose pain was not relieved because I couldn’t try everything in my arsenal, just throwing medication at it and hoping for the best (Do you know that simply sitting with a patient and talking with them is the best adjunct to helping a pain medication take effect? I learned that in hospice. I often didn’t have time to do that in hospice, when my next patient was 15 miles away. Who had time to do that at the bedside in the hospital? How do you explain to your second of six patients in your assignment that they had to wait in pain because that’s what you were doing?). Looking back, I obsessed over what I’d missed, what I might have done if I’d had more time. Or thought about tomorrow. Would my next shift be the one where it finally all came crashing down? Would tomorrow be the day I killed someone because of something I overlooked? What if I missed something – and the nurse’s job is supposed to be the patient’s last line of defense – because I couldn’t take the time to do a thorough textbook assessment, the way I’d been taught in nursing school? I was literally losing sleep over worrying about my work. Nightmares were frequent, and keep me awake afterward (even now, I still have them).
We nurses are not angels. We are not superheroes. We are ordinary people, just as strong as anyone else. Not everyone handles that kind of stress well. It can bring out the worst in some nurses, just as it can bring out the worst in human beings of all professions. All of us nurses have worked dysfunctional units, with nurses who are mean, petty, bitter, judgmental, nurses who resent new hires and jealously guard their turf.
It certainly didn’t always bring out the best in me. Right now, someone I worked with is reading this, thinking, “I remember him. He was an asshole.” You’re right, and I apologize. I often didn’t handle it well, and I’m sorry. I was often hesitant to reach out because I felt insecure in my own assignment. All I can tell you is I remember, too. I’m wiser now, and a better teammate, and if I could go back and correct my mistakes, I would. But none of us are at our best under that kind of pressure. I was doing the best I could at the time. Just like you.
On my “sabbatical,” discussing this in therapy, I began to realize how abnormal it was to be under that kind of stress for a solid 25 years. I’d always assumed the fault was mine, that if I were a smarter nurse, or had thicker skin, or weren’t so sensitive, I could handle it better. Because everywhere I looked around me, I saw nurses who were coping just fine. I seemed to be the only person who felt that way.
And I’d realized my mistake, the lesson I seem to need to learn over and over again in my life. Maybe, a lot of those other nurses were hiding their pain and insecurities as intently as I was. Maybe not all of that bravado I saw was real. Maybe the apparent callousness I’d run into was a defense mechanism hiding deeper pain. Maybe, because I was in the trenches and didn’t feel safe enough to risk looking vulnerable, I failed to see vulnerability in others. I’m thinking now of what they tell people in AA: “Never compare your insides to someone else’s outsides.” Maybe this all wasn’t normal.
I don’t remember if it was me or my therapist that originally brought up the term “PTSD,” but I do remember pushing back on it right away. PTSD was for soldiers, brave people who had literally been through war. PTSD was for victims of domestic violence, and to claim their term would be to dismiss them. Wouldn’t it? But the more I talked, and the more I let myself remember, the more I saw the symptoms matching up. And then, in another context, a friend of mine said something that snapped me into focus. They told me that there need not be an intent to abuse for a person to be abused. Abuse is real, and it does not matter if there is malice behind it or not.
Everything cleared, including my inability to get back into nursing. I suffer from PTSD. And the American healthcare system was my abuser. Here’s where I began to connect the dots, over 25 years, three states, and most kinds of institutions:
- I remember sitting in countless staff meetings having an administrator happily commend us for admissions being up, clearly clueless this meant we were working harder and being stretched thinner as a staff (for the same pay). What caregiver in their right mind would celebrate that?
- I remember sitting in a staff meeting and a manager tell us that the one thing the hospital couldn’t afford was a nurse standing around with nothing to do. And I remember thinking, “You’re more afraid of a nurse catching her breath between onslaughts than of a patient not receiving proper care because there isn’t enough staff.”
- I remember my first job out of nursing school working inpatient pediatric psych, and after six months being made evening charge nurse. I remember the stress of our busiest times, when seemingly no admission was refused, and we were given more children than we literally had beds for, and since every floor in the hospital was also overburdened and understaffed, there was no one to turn to. I remember being called on the carpet by the day manager for letting the stress get to me. After being threatened with the loss of my job, she told me to come up with a plan for delegating help. Except there was no one else to delegate to, since about two thirds of the hospital’s staff left the building when my shift began. I couldn’t think of a thing, but I knew I’d lose my job if I said that. So I made up a fictitious resource plan, which she accepted, and never checked back with me again. I remember thinking to myself, “This isn’t about actually solving the problem. This is about her being able to say she dealt with the problem.” Remember, I had been a nurse for less than a year.
- I remember going into a hospital as an agency nurse, and seeing copies of a book called Who Moved My Cheese? lying around the break room. The book was about a cartoon mouse who had a meltdown because his cheese was in a different place. The book suggested that if only the mouse were to change his perspective, he’d find everything was really OK. Another nurse told me all the staff had been required to read this and attend training on it. Apparently, the hospital was equating its staff with fable mice, and the crushing patient loads as something the staff could overcome by somehow being more positive. I remember how neatly this absolved the hospital of all responsibility.
- I remember sitting in two full days of Zoom training earlier this year learning Outward Mindset. Before any terms had been defined, the trainer asked us what might be a good balance between an “inward” and an “outward” mindset. I thought, 50/50, thinking you needed a certain amount of self-awareness and self-care to fully engage with the outside world. I was told that was wrong, that we always needed to be looking outward. It became clear that the solution to every problem presented in Outward Mindset was for the employee to adapt to what they were being told, not to demand change. I started to think it was Who Moved My Cheese? all over again, but it was much worse than that. In one featured video, a woman talked about being publicly belittled by her male manager, her knowledge and authority being picked apart by him in every meeting. And using her Outward Mindset training, she learned how to consider the position of her abuser and learn how she could adapt to his way of thinking. I remember thinking that I believed she was suffering in a toxic environment that upper management needed to address, but that this training had gaslighted her into thinking that she was responsible. I remember thinking, “Every woman in this Zoom meeting has had this experience, and can clearly see what’s really happening here.” I came back to this video later when the instructor asked each of us to say “something we’ll take with us from this training.” My hands were shaking under my desk because I’m an introvert who avoids confrontation, but I felt like I owed it to the others in the meeting to spend some privilege by speaking up. I remember saying I thought it showed how the training could be weaponized by management to keep those without privilege from calling for justice at the workplace. I remember being told that’s not what the training was meant to do. I remember being never so certain in my life that that was exactly what the training was supposed to do, and why it had such appeal to the white male manager who brought it to the system.
* * * * *
No wonder I was terrified to go back to my abuser. I engaged a career counselor who ultimately proved helpful, but for the first few weeks couldn’t seem to look past my nursing license, and kept suggesting other jobs in nursing (including teaching – god, can you imagine anything worse than a burned-out nurse guiding new people into the profession?). It wasn’t until I interrupted a suggestion with “I will literally kill myself if I have to go back to being a nurse. I am dead serious,” that she finally took the hint. I ended up taking a job as a contract tracer (from home) with the state Department of Health. It ended up being a poor fit for other reasons, but it led me to where I am now.
Today I work for two nursing agencies. With one, I gave vaccinations in pharmacies (COVID, flu, shingles, and others) in a local supermarket chain. With the other agency, I have recently taken a contract to work weekdays giving monoclonal antibody injections to COVID patients at a clinic about 40 minutes from home. Neither job gives me a great base pay for my years of experience in nursing. Neither job is challenging in any technical way; in fact either can also be done by a pharmacist or a medic. But I’m happy. It’s exactly what I need right now. I give shots to people as they come in, and I go home at the end of the day. I can’t even think of a way to take my work home with me. Because I can only deal with one patient at a time, I can give my full attention to the person in front of me. These days, I’m a superlative teammate. I’m more aware of myself and my colleagues than I ever was before.
I tell people that this work is my way of “easing myself back into nursing,” but that’s just something I say to avoid questions of why I’m not jumping back onto what I call “the hamster wheel” again. In truth, these jobs may evaporate as quickly as they appeared. (Or, they may not – I have a feeling the way Americans are treating this pandemic that it’s about to become endemic, a new reality, as will other viruses climate change is sure to bring our way). I don’t know what I’ll be doing five years from now, and I have a feeling it probably won’t be in nursing. But for now, if you really want to know what I’m doing… I’m healing.
I hope the nurse who feels terribly alone right now reads this and understands that no matter what he thinks, his pain is not in any sense “normal” or “part of the job,” but a terrible, terrible injustice. I hope the nurse who has battled through this and found her place of meaning in the system reads this and looks out for the other nurses in her life that need to be taken aside and asked two or three times, “How are you really doing?” I hope others of you who read this can take something to help you (teachers, especially – I’ve been hearing you cry out, and sense familiar echoes in your pain). I’d like to leave you all with one, final, “I remember:”
- I remember giving flu shots in a local supermarket pharmacy just weeks ago. An elderly woman came in from a local nursing home, brought in by her son, who was sitting in the waiting room outside of earshot. She looked stricken, and she whispered to me in tears that she was heartbroken in her facility, and simply wanted to die, that she’d been on this earth long enough. And there was nothing I could do but take off my gloves and hold her hand and say, “I’m so sorry you’re in such pain right now.” And sit there in silence with her for five minutes because it was a slow time of day and there were no others to be kept waiting. But I remember thinking, “I feel more like a real nurse right now than I think I’ve felt in years.”