Well, dear Reader, tonight marks the end of my six-week medical leave of absence from my full-time job, with Monday morning's return to my Nurse Care Manager's desk in approximately 14 hours from the time of this writing. So, what did I accomplish on this leave of absence, you ask? For posterity and my own edification, allow me to enumerate:
Resignation: first and foremost, during this period of time for reflection and self-care I came to the earth-shattering conclusion that I can no longer sustain the pace of my position, and I submitted my letter of resignation. While I return to the fray tomorrow at 9am, I enter only briefly, knowing full well that, come January 18th, my tenure at that position will have come to a timely end. Saying goodbye to beloved and respected colleagues will be difficult, but most challenging will be terminating my relationships with dozens of patients, many with whom I have shared a great deal over seven years. Be that as it may, the decision feels right, and I'm sure I'll process some aspects of it here on Digital Doorway. It's like giving up a part of my identity, both as a person and as a nurse, and the letting go (and grieving) process has already begun.
Hospice: I have applied and been hired for a position as a per diem hospice nurse at a small residential hospice not far from my home. I hope to complete my orientation there quite soon, and begin to pick up shifts as they become available. A goal long postponed.
New opportunity: I have contracted to serve as a Nurse Consultant for Nurse LinkUp, an online nurse networking community for which I previously provided occasional articles. When the site is re-launched, I will be providing original content, recruiting members and advertisers, and using my experience as a nurse to influence the development of the site.
Self-care: acupuncture, a sleep study, psychotherapy, rest, exercise, rejuvenation, solitude, writing, reading----I have had almost as much of these as I wanted (though a few more naps would have been nice......)
Home-care: laundry, organization, an enema for the basement, cleaning, winterizing---good medicine for the nurse with OCD.
Business idea: the development of stress management and burnout prevention workshops for nurses and other healthcare professionals.
Technological upgrade: we did it---we switched to Mac from Windows, and I am reveling in the change! Eat your heart out, Bill Gates!
The importance of decreased stress: the most crucial accomplishment and realization of these six precious weeks has been the need for decreased stress in my life. How else could I have cultivated the needed distance to realize that my stress level was leading me on a path of chronic stress-related illness and dysphoria? Without such a radical decision (with thanks to my wife Mary for pushing me), there may not have been a renewed commitment to self-care, and a realization that working full-time, 9-5, was just not working for me anymore. Not working? Nay, it was not working, and I was not fully living. I was caught in the maelstrom of stress compounded by a workplace wherein there was relentless demand with too few mitigating factors. A release was needed, and six weeks was only a taste of what that release might look like.
Granted, a professional life which is a patchwork of per diem positions, consulting, and self-employment may seem to some to be a self-made purgatory (and perhaps I'll feel similarly in a year or so), but for now, such freedom of movement and broader parameters are just what the doctor....er, I mean the nurse....ordered. Prescription received, and the co-payment? Priceless!
Good-byes: and now the goodbyes begin, and this long-awaited and dreaded separation can get underway. I realize that there is much to grieve, much letting go to do, and sadness and doubt are inevitable. Still, in my heart of hearts, I know that it's for the best, and I consistently remind myself of the line by Michelle Shocked which I have mentioned here before: "The secret of a long life is knowing when it's time to go."
Showing posts with label leave of absence. Show all posts
Showing posts with label leave of absence. Show all posts
Sunday, December 16, 2007
Saturday, November 24, 2007
Attachment, Anticipatory Grief, and Goodbyes
Faced with returning to my full-time job in mid-December following my six-week medical leave-of-absence, it has become painfully apparent to me that my days there are numbered. With the prospect of a job-share having fallen through, I face a slew of choices vis-a-vis my employment status, and the possibilities, while exciting in their potential, also open up tender emotional areas of attachment and anticipatory grief.
Having worked in my current position for seven years, a great deal of my identity as a nurse has revolved around serving low-income, inner-city populations whose vulnerability to disease and psychosocial dysfunction makes them ripe for our services. An endless well of need and dependence, my group of 80 patients have lived in my brain and heart for all of these years, and my emotional closeness with a number of them makes it most difficult to consider leaving my position for new horizons.
I have practiced nursing in a manner in which "therapeutic use of self" is a frequent technique of connection and teaching, using examples from my own life and struggles with chronic illness and depression as teaching tools and methods of expressing sincere empathy. Such disclosure, as well as my very personalized approach to nursing practice and therapeutic relationships in general, engenders an emotional intimacy that is slightly outside the norm for medical and nursing practice. For this reason, I have become quite invested in the lives and well-being of some of my patients, and I fully realize that this is a potential factor in the eventual development of burnout and compassion fatigue over time. I recently wrote a blog entry about vicarious traumatization, a phenomenon which is more than theory for me. It appears that my patients' trauma and traumatic histories have also begun to trigger my own personal trauma history, further exacerbating my feelings of burnout and compassion fatigue.
With time on my hands during this leave of absence, I have had opportunity to reflect on my relationships with a number of patients, and the notion of saying goodbye and terminating said relationships brings me great pain. As I conjure a mental image of this patient or that patient, I experience a wincing sensation wherein I think, "Oh, no! How will I say goodbye to him/her?" And the thought of each patient of whom I am fond evinces yet another uncomfortable sensation of loss.
This workplace where I have given my all for seven years is like no other I have experienced. United in our mission to serve the poorest, sickest, and most dysfunctional sub-populations, we are also united in a day-to-day feeling of being overwhelmed, of swimming against a steady current of unquenchable need, and of knowing that our collective and individual levels of stress are potentially hazardous. As much as we complain about our patients and their neediness, there must also be an aspect of attachment and addiction to such drama on our parts as well. There must be some secondary gain for us as we slog through the challenges of our days, striving to keep our heads above water in a current which changes directions---and depth---without notice or sympathy for our collective and individual plight. The undercurrent of family and camaraderie under duress keeps us afloat, even on the worst of days.
Within the adjacent inner-city community health center with which we partner to care for our patients---and where our patients receive their primary healthcare---there is a team of doctors with the majority of whom I have developed stellar working relationships. These doctors, all of them very committed to the care of the disenfranchised, poor, and chronically ill, have consistently treated me with a level of respect and professionalism unparalleled in my experience as a nurse. This sentiment is echoed by most of my nurse colleagues, and the learning and teaching which these working relationships engender is priceless. On a first-name basis since the beginning, my opinions and suggestions are taken seriously by these docs, and our discussions are never one-way---rather, there is an exchange of ideas focused on the ultimate goal of improved health and function for our mutual patients, although I frequently do feel that I am left with more responsibility than I can handle. Still, I see that my efforts are recognized and appreciated, and that my opinion is thoroughly and thoughtfully considered. If I am mistaken, it is always pointed out in a gentle and kind way with a goal of teaching and learning which is free from games of power and hierarchy, with few exceptions.
So why leave, you may ask? Why walk away from a situation in which satisfying professional relationships, clinical skill development, and challenging medical and psychosocial situations stimulate my mind, spirit and soul? It is because this level of engagement and deep involvement with extremely needy and often dysfunctional patients over a long period of time has whittled away at my core, slowly but surely damaging my ability to enjoy life outside of my work, causing such levels of stress that my personal quality of life has become diminished. Whether directly related to this job or simply a matter of synchronicity and coexistence , my own constellation of chronic illness, chronic pain, and long-term struggles with major depression are necessitating a change of lifestyle, a ratcheting down of the intensity I experience vis-a-vis my professional life. Perhaps I understand and empathize with my patients so well because of my own chronic illnesses, but because of those personal issues, that empathy, while helpful and useful therapeutically for my patients, is slowly but surely eroding my own ability for healing.
Drawing on my interest in Buddhism, I realize that these sensations and feelings, while sincere and quite real, are a manifestation of attachment. Various attachments arise in relation to possessions, people, relationships, circumstances, and even feelings and sensations. My reluctance to leave my workplace after seven years is, to a large extent, a reflection of a certain level of comfort I have developed, even though that comfort paradoxically coexists with burnout, overwork, and a growing sense of frustration with the intensity of the work and the programmatic dysfunctions of our organization. How to reconcile all of these factors and stay on the same path without incurring further personal damage?
I am at a turning point in my career. There are new avenues of nursing and my professional self which I long to explore, yet slogging away on the front lines of inner-city nursing practice---and the stressors therein---is most likely keeping me from pursuing those new avenues, my energy consistently sapped by the vicissitudes of the ol' 9 to 5.
So, I'll keep thinking, reflecting, meditating on it, and embrace these three more weeks of my leave of absence. Returning to work in mid-December, I fully expect at this point to return with my 30-day notice of resignation in hand. Sad, true, difficult, painful, challenging........necessary. And in the immortal words of Michelle Shocked, "the secret of a long life is knowing when it's time to go".
Having worked in my current position for seven years, a great deal of my identity as a nurse has revolved around serving low-income, inner-city populations whose vulnerability to disease and psychosocial dysfunction makes them ripe for our services. An endless well of need and dependence, my group of 80 patients have lived in my brain and heart for all of these years, and my emotional closeness with a number of them makes it most difficult to consider leaving my position for new horizons.
I have practiced nursing in a manner in which "therapeutic use of self" is a frequent technique of connection and teaching, using examples from my own life and struggles with chronic illness and depression as teaching tools and methods of expressing sincere empathy. Such disclosure, as well as my very personalized approach to nursing practice and therapeutic relationships in general, engenders an emotional intimacy that is slightly outside the norm for medical and nursing practice. For this reason, I have become quite invested in the lives and well-being of some of my patients, and I fully realize that this is a potential factor in the eventual development of burnout and compassion fatigue over time. I recently wrote a blog entry about vicarious traumatization, a phenomenon which is more than theory for me. It appears that my patients' trauma and traumatic histories have also begun to trigger my own personal trauma history, further exacerbating my feelings of burnout and compassion fatigue.
With time on my hands during this leave of absence, I have had opportunity to reflect on my relationships with a number of patients, and the notion of saying goodbye and terminating said relationships brings me great pain. As I conjure a mental image of this patient or that patient, I experience a wincing sensation wherein I think, "Oh, no! How will I say goodbye to him/her?" And the thought of each patient of whom I am fond evinces yet another uncomfortable sensation of loss.
This workplace where I have given my all for seven years is like no other I have experienced. United in our mission to serve the poorest, sickest, and most dysfunctional sub-populations, we are also united in a day-to-day feeling of being overwhelmed, of swimming against a steady current of unquenchable need, and of knowing that our collective and individual levels of stress are potentially hazardous. As much as we complain about our patients and their neediness, there must also be an aspect of attachment and addiction to such drama on our parts as well. There must be some secondary gain for us as we slog through the challenges of our days, striving to keep our heads above water in a current which changes directions---and depth---without notice or sympathy for our collective and individual plight. The undercurrent of family and camaraderie under duress keeps us afloat, even on the worst of days.
Within the adjacent inner-city community health center with which we partner to care for our patients---and where our patients receive their primary healthcare---there is a team of doctors with the majority of whom I have developed stellar working relationships. These doctors, all of them very committed to the care of the disenfranchised, poor, and chronically ill, have consistently treated me with a level of respect and professionalism unparalleled in my experience as a nurse. This sentiment is echoed by most of my nurse colleagues, and the learning and teaching which these working relationships engender is priceless. On a first-name basis since the beginning, my opinions and suggestions are taken seriously by these docs, and our discussions are never one-way---rather, there is an exchange of ideas focused on the ultimate goal of improved health and function for our mutual patients, although I frequently do feel that I am left with more responsibility than I can handle. Still, I see that my efforts are recognized and appreciated, and that my opinion is thoroughly and thoughtfully considered. If I am mistaken, it is always pointed out in a gentle and kind way with a goal of teaching and learning which is free from games of power and hierarchy, with few exceptions.
So why leave, you may ask? Why walk away from a situation in which satisfying professional relationships, clinical skill development, and challenging medical and psychosocial situations stimulate my mind, spirit and soul? It is because this level of engagement and deep involvement with extremely needy and often dysfunctional patients over a long period of time has whittled away at my core, slowly but surely damaging my ability to enjoy life outside of my work, causing such levels of stress that my personal quality of life has become diminished. Whether directly related to this job or simply a matter of synchronicity and coexistence , my own constellation of chronic illness, chronic pain, and long-term struggles with major depression are necessitating a change of lifestyle, a ratcheting down of the intensity I experience vis-a-vis my professional life. Perhaps I understand and empathize with my patients so well because of my own chronic illnesses, but because of those personal issues, that empathy, while helpful and useful therapeutically for my patients, is slowly but surely eroding my own ability for healing.
Drawing on my interest in Buddhism, I realize that these sensations and feelings, while sincere and quite real, are a manifestation of attachment. Various attachments arise in relation to possessions, people, relationships, circumstances, and even feelings and sensations. My reluctance to leave my workplace after seven years is, to a large extent, a reflection of a certain level of comfort I have developed, even though that comfort paradoxically coexists with burnout, overwork, and a growing sense of frustration with the intensity of the work and the programmatic dysfunctions of our organization. How to reconcile all of these factors and stay on the same path without incurring further personal damage?
I am at a turning point in my career. There are new avenues of nursing and my professional self which I long to explore, yet slogging away on the front lines of inner-city nursing practice---and the stressors therein---is most likely keeping me from pursuing those new avenues, my energy consistently sapped by the vicissitudes of the ol' 9 to 5.
So, I'll keep thinking, reflecting, meditating on it, and embrace these three more weeks of my leave of absence. Returning to work in mid-December, I fully expect at this point to return with my 30-day notice of resignation in hand. Sad, true, difficult, painful, challenging........necessary. And in the immortal words of Michelle Shocked, "the secret of a long life is knowing when it's time to go".
Tuesday, November 20, 2007
Back to the Drawing Board, Wherein the Heart and Mind Discuss the Future
Back to the subject of my (currently non-existent) work-life, although the job-share position was ostensibly approved by the powers that be, the nurse practitioner with whom I was planning to share said job has accepted another position. Thus, the job-share is now defunct, and a vast blank drawing board appears on my horizon. Yikes.
So, when faced with a blank drawing board, what does one do? At first, nothing. The blank space is kind of nice, isn't it? See how the light reflects? Notice how that blank space is one upon which any number of potential futures can be projected? Why don't we enjoy it for a while?
But then the Mind in all its glory jumps in, grabs some (thankfully erasable) markers, and goes to town.
"So," the Mind says. "We have Option 1: return to full-time job as planned, and decide to stick it out for another 6-12 months. See all of the gains and stress reduction from the leave of absence erased in a matter of weeks. Hmmm. Maybe not such a good choice." The Mind looks puzzled.
"Well, then," says the Mind. "Option 2 seems better: return to work for the required 30 days, close up shop, say our goodbyes, terminate with patients and colleagues, and skedaddle asap, no looking back. Not a bad scenario, if I do say so myself." Some skeptical interest is perceived.
"Or how about Option 3, perhaps?" asks the Mind hopefully. "Offer to work per diem for old employer after fulfilling 30-days of full-time work in order to fulfill leave-of-absence obligations. String together several other per diem positions---one of which is quite close to home, actually---and have a renewed sense of professional invigoration? Let "The Mrs." carry the health insurance benefits, and take this golden opportunity to cut loose from the 40-hour grind! Work when you want to---some weeks will be extra heavy, others can be quite light. What freedom! What a concept!" The mind smiles.
Then the Heart steps up to the plate, chiming in. "Oh, God! All of those patients with whom we have cultivated intimate working relationships for seven years! How would we say goodbye? How would we terminate? What would it do to them? To my colleagues? To the workplace? How can I handle so many goodbyes?" The Heart wrings its hands.
The Mind rests a reassuring hand on the Heart's virtual shoulder. "Look here, cousin. Don't get so worked up. People leave jobs all the time, even ones in which long-term therapeutic relationships have been nurtured." The mind smiles reassuringly as the Heart looks dubious.
"We all have to say goodbye and move on at some point," the Mind continues. "Patients know that clinicians come and go. It's part of the process. Perhaps your leave-taking will cause some of them to become more self-sufficient, more empowered. Just imagine the relief you would experience when you released yourself from the responsibility you feel for those eighty people and their well-being!"
The Mind and the Heart sit in silence for a while.
"Y'know," says the Heart. I need some time to consider these scenarios. It's just too much to process today."
"I understand," says the Mind. "Change is always hard. Take your time, enjoy the rest of your leave-of-absence, and know that this is all happening for good reasons. Remember that drawing board? We can leave it blank for a while."
"Thanks," says the Heart. "I can only take in so much change at one time. It was enough to accept a six-week leave-of-absence. Let's clean the basement, then we can make dinner and watch a movie."
"It's a deal," says the Mind. "We'll put the drawing board in the corner for now. Let's tackle that basement."
So, when faced with a blank drawing board, what does one do? At first, nothing. The blank space is kind of nice, isn't it? See how the light reflects? Notice how that blank space is one upon which any number of potential futures can be projected? Why don't we enjoy it for a while?
But then the Mind in all its glory jumps in, grabs some (thankfully erasable) markers, and goes to town.
"So," the Mind says. "We have Option 1: return to full-time job as planned, and decide to stick it out for another 6-12 months. See all of the gains and stress reduction from the leave of absence erased in a matter of weeks. Hmmm. Maybe not such a good choice." The Mind looks puzzled.
"Well, then," says the Mind. "Option 2 seems better: return to work for the required 30 days, close up shop, say our goodbyes, terminate with patients and colleagues, and skedaddle asap, no looking back. Not a bad scenario, if I do say so myself." Some skeptical interest is perceived.
"Or how about Option 3, perhaps?" asks the Mind hopefully. "Offer to work per diem for old employer after fulfilling 30-days of full-time work in order to fulfill leave-of-absence obligations. String together several other per diem positions---one of which is quite close to home, actually---and have a renewed sense of professional invigoration? Let "The Mrs." carry the health insurance benefits, and take this golden opportunity to cut loose from the 40-hour grind! Work when you want to---some weeks will be extra heavy, others can be quite light. What freedom! What a concept!" The mind smiles.
Then the Heart steps up to the plate, chiming in. "Oh, God! All of those patients with whom we have cultivated intimate working relationships for seven years! How would we say goodbye? How would we terminate? What would it do to them? To my colleagues? To the workplace? How can I handle so many goodbyes?" The Heart wrings its hands.
The Mind rests a reassuring hand on the Heart's virtual shoulder. "Look here, cousin. Don't get so worked up. People leave jobs all the time, even ones in which long-term therapeutic relationships have been nurtured." The mind smiles reassuringly as the Heart looks dubious.
"We all have to say goodbye and move on at some point," the Mind continues. "Patients know that clinicians come and go. It's part of the process. Perhaps your leave-taking will cause some of them to become more self-sufficient, more empowered. Just imagine the relief you would experience when you released yourself from the responsibility you feel for those eighty people and their well-being!"
The Mind and the Heart sit in silence for a while.
"Y'know," says the Heart. I need some time to consider these scenarios. It's just too much to process today."
"I understand," says the Mind. "Change is always hard. Take your time, enjoy the rest of your leave-of-absence, and know that this is all happening for good reasons. Remember that drawing board? We can leave it blank for a while."
"Thanks," says the Heart. "I can only take in so much change at one time. It was enough to accept a six-week leave-of-absence. Let's clean the basement, then we can make dinner and watch a movie."
"It's a deal," says the Mind. "We'll put the drawing board in the corner for now. Let's tackle that basement."
Sunday, November 18, 2007
Injured Soul? You're On Your Own
Recently, an anonymous commenter on Digital Doorway responded to a post I wrote about nurses and stress. He or she wrote the following:
"One major reason why nurses are stressed is because hospitals are understaffed. Management has been able to get away with this understaffing because they don't have to pay for workload-related chronic stress injuries.
"This is discrimination against psychologically injured workers who succumb to excessive WORKLOAD by getting depression or other chronic stress diseases.
"The hard-working employee who sustains a mental injury due to overwork is left without compensation which means they usually then go through a downward spiral of bankruptcy, loss of home, loss of pension and all the further stress that goes along with poverty.
"No wonder we have a health care worker crisis!"
The commenter makes some salient points. Taking my circumstance into consideration, seven years of working with trauma survivors and giving my all to the care of vulnerable individuals has led me to make a decision to take six weeks of unpaid leave in order to collect myself and heal. Why, within this society, are individuals serving the poor, ill and traumatized left to their own devices when it comes to recovering from providing such a public service? Why must burned out teachers and nurses take unpaid leave and use up their personal savings at a time when their service has exacted a psycho-emotional toll on their health?
Now, to draw an apt comparison, if a professional baseball player experienced undue stress and psychological trauma from the vigors of the season's play, would he need to eschew his multi-million dollar salary in order to take a six-week leave to clear his head and regain balance? Would he be forced to use his savings to pay his bills and care for his family while he recuperates? Would some portion of his astronomical salary be withheld? That baseball player, handsomely compensated for his work (which, in my mind, bestows precious little benefit on humanity), will have little difficulty making ends meet while he rests and recuperates.
Furthermore, as an individual appreciated and respected far above the nurses, social workers, factory workers and teachers who are truly a part of the backbone of the society, the athlete in question will have no fear of income loss as a result of his temporary disability. In fact, a guest appearance on Oprah or a Newsweek expose on the psychological stresses of professional sports would most likely be in order. Our athlete suffers in ways which may actually enhance his career.
On the other hand, take a burned-out nurse like myself and consider my options. While I may have the Family Medical Leave Act to allow me up to 12 weeks unpaid time off, short-term disability insurance does not allow for disability for mental health or substance abuse. In fact, many long-term disability insurance policies also exclude a mental health benefit. Parity for those suffering from mental health-related injury are basically left out in the cold.
The conundrum is thus: if I injured my hand at work caring for a patient, workers' compensation would be a no-brainer. But if I injure my soul at work? I'm on my own.
"One major reason why nurses are stressed is because hospitals are understaffed. Management has been able to get away with this understaffing because they don't have to pay for workload-related chronic stress injuries.
"This is discrimination against psychologically injured workers who succumb to excessive WORKLOAD by getting depression or other chronic stress diseases.
"The hard-working employee who sustains a mental injury due to overwork is left without compensation which means they usually then go through a downward spiral of bankruptcy, loss of home, loss of pension and all the further stress that goes along with poverty.
"No wonder we have a health care worker crisis!"
The commenter makes some salient points. Taking my circumstance into consideration, seven years of working with trauma survivors and giving my all to the care of vulnerable individuals has led me to make a decision to take six weeks of unpaid leave in order to collect myself and heal. Why, within this society, are individuals serving the poor, ill and traumatized left to their own devices when it comes to recovering from providing such a public service? Why must burned out teachers and nurses take unpaid leave and use up their personal savings at a time when their service has exacted a psycho-emotional toll on their health?
Now, to draw an apt comparison, if a professional baseball player experienced undue stress and psychological trauma from the vigors of the season's play, would he need to eschew his multi-million dollar salary in order to take a six-week leave to clear his head and regain balance? Would he be forced to use his savings to pay his bills and care for his family while he recuperates? Would some portion of his astronomical salary be withheld? That baseball player, handsomely compensated for his work (which, in my mind, bestows precious little benefit on humanity), will have little difficulty making ends meet while he rests and recuperates.
Furthermore, as an individual appreciated and respected far above the nurses, social workers, factory workers and teachers who are truly a part of the backbone of the society, the athlete in question will have no fear of income loss as a result of his temporary disability. In fact, a guest appearance on Oprah or a Newsweek expose on the psychological stresses of professional sports would most likely be in order. Our athlete suffers in ways which may actually enhance his career.
On the other hand, take a burned-out nurse like myself and consider my options. While I may have the Family Medical Leave Act to allow me up to 12 weeks unpaid time off, short-term disability insurance does not allow for disability for mental health or substance abuse. In fact, many long-term disability insurance policies also exclude a mental health benefit. Parity for those suffering from mental health-related injury are basically left out in the cold.
The conundrum is thus: if I injured my hand at work caring for a patient, workers' compensation would be a no-brainer. But if I injure my soul at work? I'm on my own.
Saturday, November 17, 2007
Job-Share Ahoy!
Well, well, well. It looks like my workplace has conditionally approved a job-share for myself and a Nurse Practitioner colleague following the end of my medical leave of absence. Suddenly, the future looks a whole light brighter.
What does this new reality mean for the earnest nurse who is ever-so-steadily recovering and recuperating from acute burnout, vicarious traumatization, and compassion fatigue? The true meaning of this new reality is multifaceted. Initially, it means that I will no longer carry the emotional, psychological, and clinical weight of some 80 patients on my own shoulders. Instead of a caseload of 80 for which I am solely responsible, I will share a caseload of patients with a very competent Nurse Practitioner of whom I am exceedingly fond. I will be in the office three days per week, and she will be in the office the other two days. With our excellent rapport, open communication, and superb documentation, we will bear this load together, neither of us slogging through the dreaded five-day week. We will meet for lunch once a month to discuss cases, talk by phone, communicate by email, and otherwise work as a well-oiled clinical nurse-machine, free of the burnout born of the forty-hour week.
I acknowledge that I am lucky to be able to either 1) afford to pay a pro-rated increased rate for my health insurance as a part-time employee or, 2) take part in my wife's health plan under the auspices of her place of employment. With health insurance being one of the major factors for many workers staying in jobs which they dislike or cause them undue stress, I realize that I am privileged in having choices vis-a-vis my healthcare and insurance.
As far as generating income, I also realize how lucky I am that, as a registered nurse, the ability to earn money on a per diem basis is one which makes the nurse a hot commodity in the current job market. With two per diem positions already in my employment portfolio---one with a visiting nurse agency and the other at a urban community health center) this part-time nurse can choose to earn extra money one week and slouch around the house the next. What better burn-out prevention could there be?
Taking a leave of absence was a leap of faith which was initiated by my wife (with only a mild threat of divorce) and embraced whole-heartedly by me when I realized that there was no other way for me to regain my emotional balance. With chronic illnesses slowly overtaking my previous state of relative good health, we both acknowledged that something had to give (and I had already "given at the office", so to speak).
Now, as the layers of stress begin to unravel after two weeks' leave, I now face the next four weeks of leave with a desire for further healing and recuperation. With part-time employment and brighter prospects at work, perhaps my life is truly turning around.
What does this new reality mean for the earnest nurse who is ever-so-steadily recovering and recuperating from acute burnout, vicarious traumatization, and compassion fatigue? The true meaning of this new reality is multifaceted. Initially, it means that I will no longer carry the emotional, psychological, and clinical weight of some 80 patients on my own shoulders. Instead of a caseload of 80 for which I am solely responsible, I will share a caseload of patients with a very competent Nurse Practitioner of whom I am exceedingly fond. I will be in the office three days per week, and she will be in the office the other two days. With our excellent rapport, open communication, and superb documentation, we will bear this load together, neither of us slogging through the dreaded five-day week. We will meet for lunch once a month to discuss cases, talk by phone, communicate by email, and otherwise work as a well-oiled clinical nurse-machine, free of the burnout born of the forty-hour week.
I acknowledge that I am lucky to be able to either 1) afford to pay a pro-rated increased rate for my health insurance as a part-time employee or, 2) take part in my wife's health plan under the auspices of her place of employment. With health insurance being one of the major factors for many workers staying in jobs which they dislike or cause them undue stress, I realize that I am privileged in having choices vis-a-vis my healthcare and insurance.
As far as generating income, I also realize how lucky I am that, as a registered nurse, the ability to earn money on a per diem basis is one which makes the nurse a hot commodity in the current job market. With two per diem positions already in my employment portfolio---one with a visiting nurse agency and the other at a urban community health center) this part-time nurse can choose to earn extra money one week and slouch around the house the next. What better burn-out prevention could there be?
Taking a leave of absence was a leap of faith which was initiated by my wife (with only a mild threat of divorce) and embraced whole-heartedly by me when I realized that there was no other way for me to regain my emotional balance. With chronic illnesses slowly overtaking my previous state of relative good health, we both acknowledged that something had to give (and I had already "given at the office", so to speak).
Now, as the layers of stress begin to unravel after two weeks' leave, I now face the next four weeks of leave with a desire for further healing and recuperation. With part-time employment and brighter prospects at work, perhaps my life is truly turning around.
Monday, November 12, 2007
Leave of Absence and Its (Dis)Contents
Being on a leave of absence presents a series of challenges, most of which I would deem "problems of luxury", yet their problematic quality is still worthy of my attention. And it is these challenges which occupy my mind most vividly from day to day.
First and foremost, during this time of rejuvenation and mental/emotional recovery, I am faced with the question of whether or not to return to my full-time job. Being on a medical leave of absence, I am required by law to return to work for at least 30 calendar days following my leave, yet the future beyond those thirty days is wholly uncertain, professionally speaking. My job---and all of its vicissitudes and benefits---is doubtless waiting for me to return in just under a month, and my desire to embrace that 40-hour challenge once again is waning daily.
So, the questions remain. What would it mean to leave my workplace, my work family, the comfort of the familiar? How would it impact my career, my personal life, my clinical development, my future as a nurse? How much should I worry about my patients and how my leave-taking will effect them? How much of my patients' experience is my responsibility? Haven't I given them enough for seven long years?
If I do indeed decide to leave my position, it begs the question of how I will move forward, earn a living, and piece together a sane, healthy work life, unencumbered by the burnout with which I have lived for far too long. Luckily, Mary is poised to have benefits early in 2008, ostensibly freeing me from the oh-so-American shackles of sticking with a job solely for the health insurance.
This opening which I have created for myself is truly an opening---a portal of opportunity---through which I can walk, run, saunter, stumble, or fall. The mode of entry through said portal still remains to be seen, but the desired outcome is, in the final analysis, sanity.
First and foremost, during this time of rejuvenation and mental/emotional recovery, I am faced with the question of whether or not to return to my full-time job. Being on a medical leave of absence, I am required by law to return to work for at least 30 calendar days following my leave, yet the future beyond those thirty days is wholly uncertain, professionally speaking. My job---and all of its vicissitudes and benefits---is doubtless waiting for me to return in just under a month, and my desire to embrace that 40-hour challenge once again is waning daily.
So, the questions remain. What would it mean to leave my workplace, my work family, the comfort of the familiar? How would it impact my career, my personal life, my clinical development, my future as a nurse? How much should I worry about my patients and how my leave-taking will effect them? How much of my patients' experience is my responsibility? Haven't I given them enough for seven long years?
If I do indeed decide to leave my position, it begs the question of how I will move forward, earn a living, and piece together a sane, healthy work life, unencumbered by the burnout with which I have lived for far too long. Luckily, Mary is poised to have benefits early in 2008, ostensibly freeing me from the oh-so-American shackles of sticking with a job solely for the health insurance.
This opening which I have created for myself is truly an opening---a portal of opportunity---through which I can walk, run, saunter, stumble, or fall. The mode of entry through said portal still remains to be seen, but the desired outcome is, in the final analysis, sanity.
Saturday, November 03, 2007
Postcard from Texas
We are presently here in Temple, Texas, checking in on Mary's mother who is in ICU following carotid artery bypass surgery. Tonight, I will do the midnight to 6am shift (most of which will be spent sleeping in the recliner behind the curtain by the window) so that she can have her needs met if she wakes in the middle of the night. (There's nothing more miserable than having a nasogastric tube down your throat and nobody around to feed you ice chips when you're parched.)
Overall, though, this "caregiving visit" is a relative breeze: time by the hotel pool, writing emails and blog posts on the hotel computer, chatting with my father-in-law and the nurses as we sit in the room passing the hours, or wandering this strange Texan town. Plus, it's 80 degrees and sunny all day.
Beginning a leave of absence from nursing and being in such a hospital/medical environment could very well set off my stress buttons, but my role here is so minimal---so "nurse lite", if you will---that it is a pleasure to be of service. My skills are helpful in identifying when, for instance, Mary's mom's oxygen saturation is getting low and she needs the cannula back on, or perhaps to listen to the doctor and translate some of the medicalese for her dad. Energy output and stress? Almost zero. Value? High.
Anyway, nurses serve a purpose in families, and my "nurseness" certainly does come in handy at times like these. As long as my boundaries are clear and self-care remains of primary concern, no harm done and all is well.
So, dear Reader, remember the end of Daylight Savings Time tonight, set those clocks back, gain that hour of precious beauty sleep, and enjoy your Sunday, wherever you fare.
From deep in the heart of Texas,
A Nurse at Rest
Overall, though, this "caregiving visit" is a relative breeze: time by the hotel pool, writing emails and blog posts on the hotel computer, chatting with my father-in-law and the nurses as we sit in the room passing the hours, or wandering this strange Texan town. Plus, it's 80 degrees and sunny all day.
Beginning a leave of absence from nursing and being in such a hospital/medical environment could very well set off my stress buttons, but my role here is so minimal---so "nurse lite", if you will---that it is a pleasure to be of service. My skills are helpful in identifying when, for instance, Mary's mom's oxygen saturation is getting low and she needs the cannula back on, or perhaps to listen to the doctor and translate some of the medicalese for her dad. Energy output and stress? Almost zero. Value? High.
Anyway, nurses serve a purpose in families, and my "nurseness" certainly does come in handy at times like these. As long as my boundaries are clear and self-care remains of primary concern, no harm done and all is well.
So, dear Reader, remember the end of Daylight Savings Time tonight, set those clocks back, gain that hour of precious beauty sleep, and enjoy your Sunday, wherever you fare.
From deep in the heart of Texas,
A Nurse at Rest
Subscribe to:
Posts (Atom)