Nurse on Overdrive

Have you ever felt like you're a nurse on overdrive? Whether it's your professional life, your personal life, or a combination of the two, a nurse's life can sometimes feel out of control. 

Nursing Students and Self Care

Nursing school is a lot like boot camp. The student nurse is pushed to his or her limits, personal resolve is continually tested, students bond in their misery, and the majority come through the other side with new skills and a new career, perhaps a little worse for wear. But are they fully prepared---to care for themselves?

Surviving Stress

These days, it seems that stress is the #1 factor impacting my health and the health of many others that I know. From financial worries to chronic health conditions to the multifaceted and fast-paced aspects of modern life, many of us are suffering from stress on some level or another, and I submit that stress universally impacts the health of millions, both as a cause of disease, as a symptom, and as a 21st century illness or syndrome in and of itself.

Many subsume their stress with alcohol, sugar, caffeine, unnecessary spending, and various forms of addiction and emotional sublimation. We all feel the effects, and we all react in our idiosyncratic way to the vicissitudes of life.

On a personal level, I have lately turned to acupuncture, herbs, supplements, meditation, exercise, and dietary and nutritional changes to assuage the effects of stress. Further challenging myself to pursue optimal health and wellness, I have engaged the counsel of a wellness coach who helps to keep me on track as I navigate some challenging personal times.

All of these changes and approaches have indeed decreased the severity of my Multiple Chemical Sensitivity, improved several aspects of my health, and pointed me further down the road towards optimal wellness. Still, certain chronic conditions continue to rear their heads, and I struggle to make more headway in those areas.

The pace of life frequently seems largely untenable, and we manage our lives as best we can amidst the tumult. We eat well, keep hydrated, exercise, seek leisure and fun, connect with family and friends, pursue creative projects and spiritual renewal---all in the name of balance and wellness.

It's a bumpy road, and all too often we lose sight of our own self care as we focus like a laser beam on our latest to-do list and the unending tasks before us.

Personally, I need to take an enormous breath, sit back, and reassess what's really most important in my life. Failing to do so would simply be an invitation for the stress monster to sink it's teeth deeper. In my commitment to wellness and optimal health, it's ultimately a commitment to creating the healthiest, most satisfying and productive life possible.

Nurses and Stress: A Rant

Thanks to a comment on yesterday's post, I was recommended to read this article on stress and healthcare workers. Brief and to the point, the article elucidates that Canadian "nurses, doctors and lab technicians have the highest levels of stress related to their jobs" of all interviewees, with 45 percent reporting that there work was "quite" or "extremely" stressful.

The International Labor Organization has identified nursing as an industry with relatively high levels of stress and burnout. In identifying the sources of stress in nursing, they elucidate thus:

"The role of nursing is associated with multiple and conflicting demands imposed by nurse supervisors and managers, and by medical and administrative staff. Such a situation appears to lead to work overload and possibly to role conflict. One form of such conflict often mentioned in surveys of nurses relates to the conflict inherent in the instrumental and goal-oriented demands of "getting the patient better" and those related to providing emotional support and relieving patient stress. Role conflict of this kind may be most obvious when dealing with patients who are critically ill and dying. Indeed, one of the areas of nursing that has attracted particular attention has been critical or intensive care nursing. Health care is also a sector which suffers a high rate of violent behaviour (see our pages on violence at work).

"Many studies on stress in nursing have attempted to measure, or have speculated on, the effects of such stress on nurses’ health and well-being. There appears to be general agreement that the experience of work-related stress generally detracts from the quality of nurses’ working lives, increases minor psychiatric morbidity, and may contribute to some forms of physical illness, with particular reference to musculoskeletal problems, stress and depression."

Hmmmm, says the nurse on medical leave of absence.

In South Africa, stress has been identified as the major cause of a nursing shortage in the setting of HIV/AIDS care. The BBC reported earlier this year that stress was harming nurses' sex lives, causing nurses to smoke more, and that stress-related absences from work costs the British National Health Service more than 300 million pounds per year.

Many nurses complain about frozen wages, lack of clinical supervision, increasing nurse-patient ratios, and rapidly shrinking benefit packages. While loss of benefits and frozen wages are ubiquitous across the general workforce (unless you're a CEO, member of Congress, movie star, or professional athlete, of course), nurses face other stressors which are singular to their profession. Workers in other professions also naturally face challenges typical to their careers and workplaces, and each of us can truly only speak from our own work experience.

We simply have to face the facts. Americans (and workers in other countries, as well) work too hard, earn too little, have paltry time for vacation and leisure, and are expected to marry their jobs to a degree never before expected in the history of labor. Unions have slowly been dismantled and vilified over the last century (especially here in the US), and healthcare benefits have crumbled, leaving many of us paying higher premiums and copayments for office visits, procedures, and medications. With housing costs and fuel costs through the roof, our paychecks have less buying power than they used to, and those of us in the middle class and working class are left to pick up the crumbs left behind by the 1 percent controlling the wealth.

Are nurses stressed? Of course we are. We earn moderate incomes within a high-stress industry where workloads have exponentially increased and benefits faltered. Retirement seems less than certain, the economy continues its volatile course, and the healthcare industry asks more and more of us without offering any further compensation. Still, I never regret my career choice, and have even encouraged others to walk this path. Nurses are always needed, work is generally easy to find, and when the economy hits bottom, we will still be irreplaceable, since illness never takes a holiday.

So, what's an earnest nurse to do, you ask? Dedicated to my chosen career, I take a few weeks to reassess my options, care for my body and mind, soul and spirit, and plan to reenter the fray with---perhaps---a hopeful and newly-minted outlook and approach. I have been ravaged by the effects of stress and vicarious traumatization, and I now attempt to reconstitute myself during this brief hiatus. I consider myself both lucky and blessed, and pray for my nursing brethren who are unable to afford the luxury of such self-care. May we all be free from suffering.

Snowy Friday and its Denouement

He called on this snowy afternoon to tell me that he didn't feel well. With a history of cardiomyopathy, hypertension, atrial fibrillation, and atrial flutter, I knew "not feeling well" could mean many things. Bearing in mind that this patient had been sent to the ER by his doc directly from the clinic 12 days ago, I also recalled that he left the hospital AMA before a full cardiological workup could be completed. What to do? I suggested calling 911 and was met with a stony silence on the other end. Against my better judgment, I offered a home visit in 30 minutes.

"But that's so far away. What if I die before you get here?" he asked.

"If you think you may die in the next 30 minutes, you'd better call 911 right now!" I responded.

"No. I'll wait." He hung up.

The roads were almost unbearably icy, the snow blowing hard. With schools letting out early and my office closing up shop on this ugly Friday at 3pm, I was heading out on an urgent visit armed with a blood pressure cuff, a stethoscope, and a whole lot of nothing.

He was sitting on the couch looking like death warmed over. Blood pressure: 90/50. Apical heart-rate: 44/minute. Respirations: 24/minute. Skin: pale, dry and warm. Symptoms: chest pain, shortness of breath, headache, dizziness. His ten birds, locked in cages, squawked relentlessly. I turned off the TV to decrease the extraneous noise. I was beginning to regret agreeing to a urgent home visit. Why didn't I just call 911 from the warmth of the office? Super Nurse strikes again.

"Did you take your meds today?"

"Yes. But I was out of my Lisinopril. My cousin was here. She has high blood pressure too. I told her I was out of one of my blood pressure meds. She said we should split her pill. She broke it in half and we each took a half a pill. She said it was for blood pressure, anyway." His face crumpled with exhaustion.

"What pill was it that you took?" I asked calmly, running his other meds through my mind quickly. I prayed for patience.

"I dunno. Some pill. It was white. Ooooh, my chest hurts now."

"Can we call your cousin to find out what she takes?" I ask hopefully.

"I don't know her number."

I dialed 911. The paramedics arrived in 15 minutes. The portable ECG looked initially OK. The patient: ghastly, ashen, short of breath, moaning.

"Thanks for coming out, guys." The paramedics wheeled him out into the blustery late afternoon.

I scrape the ice and snow from my car. The traffic is crawling. The usual five minute ride to the office takes about fifteen minutes. My desk is piled with unfinished notes, charts, the detritus of a day wherein time to sit and organize is a lost cause abandoned at about 10am. Several colleagues still struggle to finish the day and head home before the roads get any worse. Reports of accidents are coming in on the local radio station. Mary's at the Senior Center waiting for me to pick her up.

I stuff the papers in my bag, close the computer and head out the door. I know what part of my Friday night will consist of: finishing paperwork, making notes for Monday's to-do list, and then blogging about the day as a way to exorcise the stress, and watching the snow drifts grow outside the window.

Monday seems so far away right now. Let's keep it that way, shall we?

Days of Fatigue, Dreams of Succor

defatigable \De*fat"i*ga*ble\, a. [See Defatigate.] Capable of being wearied or tired out.

indefatigable \in-dih-FAT-ih-guh-bul\, adjective:
Incapable of being fatigued; not readily exhausted; untiring; unwearying; not yielding to fatigue.

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For so many workers plying their trade and running in the proverbial race of the rats, fatigue is sadly the name of the game. As the world speeds up and the unrelenting pace leaves us in its dust, one would think that the ranks of the indefatigable must be exponentially decreasing.

When we turn twenty, Neil Young has reminded us for decades now that we must leave Sugar Mountain. The days of luxurious irresponsibility fade away, and the burdens of adulthood begin to work their magic on one's youthful vigor. Debt, work, career, relationships, ageing parents, children, health, one's own inexorable march towards death---the list itself can engender fatigue.

There are always those who seem to retain their youthful glow. Some people appear to find the way to remain energized, vigorous, athletic, pain-free, healthy and whole. What is their secret, we wonder? Is it genes? Diet? Attitude? Luck?

When I talk to friends and colleagues, fatigue is the overarching symptom which seems to embrace us all in these post-modern times. We are tired of working, of cleaning, of driving, of email, of shopping, of moving, of driving, of the media, of the war, of the violence, of the killing. There is just so much to be tired of, it seems. It's no wonder we're exhausted.

But what enlivens us? What drives us to our highest potential and success? What gives us energy and life? These are the places to take our tired minds and bodies, if only we could shake ourselves loose from our individual and collective lethargy long enough to contract those underdeveloped muscles of joy.

Here in New England, the seemingly relentless grip of winter can drive us to the brink of exhaustion. As the thermometer drops below zero this week, the windchill a veritable coup de grace upon our spirits, we bow our heads and grit our teeth, shoulders hunched against the cold. A sunny sky outside the window belies the bone-chilling cold waiting just beyond the panes of glass. It's days like this when hibernation looks so good. Emails from friends vacationing in Maui and Mexico do little to ease the pain. And when one thinks of the homeless, it is unfathomable.

We all need places where we can turn for sustenance, for succor. We all must find those places, be they within or without. We also need to know when the circumstances of our lives are only exacerbating our defatigability. I am walking those edges this week, skirting the abyss, looking for a place to rest my head. May you yourself find your place of rest, your fountain of succor. And if you want to share it with another, there's always enough to go around.

Whirlwind

It's another whirlwind day as I attempt to tie up loose ends and head off on a five-hour trek to be with my Mum for her skin cancer procedure. Yikes. Wet snow falling and many miles to drive....

The calls just keep coming as I try to end the day. No sooner is one progress note or task begun, then the phone rings and another project is born. Overload comes all too soon and all too often. Triage is the name of the game. At times, one feels like a soldier in a foxhole, shouting "Incoming!" as the next salvo shells the office. The walls quake with the impact as waves of unanswered human need and trauma batter the windows.

"Did anyone ever buy life-jackets?" we innocently shout over the din. "Sink or swim, my scurvies!" yells the boss from his perch atop the lookout tower. "There's rough weather ahead! Every nurse for his- or herself!"

At times our practice feels like an unwieldy and hairy beast slaloming with oversized skis over a tundra covered with obstacles, some sticky, some spiny and sharp, others like black holes which suck the life out of the unsuspecting nurse. Rounding a dangerous bend, one occasionally encounters a colleague skewered by his or her own iffy boundaries. "Do I lend a hand or pretend I didn't notice?" is a frequent thought that crosses the mind. Since we're nurses, we generally stop to offer a hand, or at least a pat on the back. Our resident psychologist kneels down alongside the impaled nurse and says, "So how does that make you feel?"

Five o'clock sounds, the boss's bird-clock sings its sweet song, and a "Yabba-Dabba-Doo!" bursts from his lungs. Oftentimes, it seems that no one even notices that 5:00 has come and gone. Some evenings, I leave around five and several colleagues are still at their desks, distractedly saying goodnight as I exit. Next morning, they're all in the same positions when I arrive at 9. Where do they keep those sleeping bags, anyway?

Nervous System Reconstitution

Those of us who work with people with HIV and other immune disorders understand the concept of "immune reconstitution", when the patient's treatment of the virus eventually begins to restore the immune system. There are positive and negative aspects of this process, but the overall returning of immune function is a good thing in the end.

Just as immune systems must reconstitute, so do nervous systems, especially the nervous systems of stressed nurses whose lives seem to have gotten the better of them. Sometimes Nervous System Reconstitution entails taking time off to relax, be at home, and practice good basic self-care. Sometimes it means increasing exercise, sweating out the toxins and stress, working tired muscles into shape. At other times, food and drink is the answer, vital elements from nature literally feeding the cells, nourishing the tissues. Drinking water is important for cleansing cortisol, a stress hormone, from the body, and exercise also helps in this regard.

The prudent nurse or healthcare professional will decide to do what it takes to nurture the nurturer, prevent stress-based illness, and bring balance to the mind, body and soul. Many other modalities of Nervous System Reconstitution are there for the taking: friendship; creative pursuits; enjoyment of the arts; sports; taking care of one's responsibilities at home; pets; cleaning and organizing to decrease the stress of disorganization; time with children (or not!); meditation and other spiritual practices; yoga; massage; cooking; the pursuit of hobbies; gardening; the list is endless.

How can we as healthcare professionals, burnt out and crisp around the edges, hope to foster and encourage healthy living in our patients when we are walking on the edge of personal oblivion? How can we be so disingenuous as to expect our patients to follow our advice when our poor example is written in the lines of stress on our faces, in our hollow and fatigued eyes sunken with lost sleep and overwork, our short tempers, our obvious burn-out?

I have had a patient with a diagnosed thought disorder look at me and say, "You look really tired." I've had other patients look concerned and ask, "Did you eat lunch today?" Whether the patient is mentally ill or physically ill, our stress is perceived, and although we think that the world at work will fall apart without us, we eventually learn that the clock at work travels from 9 to 5 (or 3 to 11, or 11 to 7) whether we're there or not, and our well-meaning colleagues are entirely capable of covering for us when we're gone. We can make ourselves indispensable in the big picture, but that little picture yearns for a time out, and if we don't give it its due, it will come back to haunt us with a vengeance, bringing illness and unhappiness along for the ride.

Healthcare providers are notorious for being bad patients, often eschewing timely self-care because "there's not enough time". How many nurses are overdue for mammograms, dental cleanings, PAP smears, prostate exams? How many doctors ignore symptoms for which they would advise patients to seek attention? How often do we go to work sick, coughing on our patients because the office would never survive without us? When will we learn? When will we get it?

I'm guilty. I'm as bad as the rest. Luckily I have a spouse who can spot my stress in a heartbeat, who can see the signs, read the tea leaves, and threaten divorce if I don't call in sick. She will cajole and coerce, determined to convince me that caring for myself is also an act of caring for others, allowing myself to reconstitute and return, refreshed and available to begin again, providing better quality care because I have cared for my own needs. How many colds has she helped me to avoid? How many moments of spiritual torture have I side-stepped by simply taking a few days to myself? To calculate the value of self-care would need a calculator not yet invented, with circuitry which recognizes inner peace, balance, and a body and mind at ease.

For now my inner calculator will need to suffice, that barometer in my mind which tells me when I am walking a fine line between health and illness. Keeping that barometer in check should be a prime focus, a measure of contentment and balance. If I lose sight of that marker, if I let myself go to that edge too often, the consequences are just not worth the paltry rewards. No one loves a martyr, and I'll stake my future on the fact that my health will take me anywhere I want to go, but its demise will take me to only one place---an early grave---and I'm in no hurry to arrive at that final destination.

Here's to health.