Or did nursing leave me?
Leaving the nursing profession is bittersweet. Hands-on clinical nursing, that is. I haven’t quite jumped ship officially yet. It’s hard to say exactly when, but I think my mind left nursing awhile ago when I came the realization that nursing left me. The profession left me without acknowledgment of work-related stress, specifically post-traumatic stress. First responders and emergency workers often hear the phrase, “It’s just part of the job.”
I’ve heard this phrase countless times throughout my 17-year emergency career, and it’s a dangerous phrase. Not only does it reduce the stress we experience into ineffectual daily work, but it dehumanizes what we really do. Because of this phrase, I have witnessed the damaging effects of not helping nurses through their worse times.
This topic is kind of difficult for me to write about. A few nights ago, my husband and I were discussing my leaving a profession that has offered me so much. It was only when I realized that in just a few months, there will be a day when I walk out and won’t go back. I broke down in tears when I described to him how it feels to leave something that’s been such a big part of my life, my identity, for so long. And yet I feel so strongly that I need to. I want to.
I don’t hate nursing. Actually, I love it. I just need a break from this relationship. After my break — after I fill up my own cup again — I’ll figure out what else I can do for the industry without being directly involved in the very things that drove me out. There’s work to be done.
When I was a kid, people always asked me if I was going to be a nurse like my mom or suggested that I should because “it’s such a great profession for women.” Puke. It’s also a great profession for men. Perhaps with a subtle eye roll and a hint of sarcasm, I often responded, “No, do I have to be a nurse just because my mom is?” The question alone irritated me because I wanted to assert my independence and discover my own identity. Plus, I have just never liked people making assumptions about me or telling me what to do. Even if they were right, I rebelled against their suggestions simply because of their approach. Not saying this is right, but adulthood ultimately taught me this not-so-subtle characteristic about myself that I’m sure drove my parents (and perhaps some teachers) crazy. Still, I was not going to be a nurse.
… I went into nursing. But not because I was told to, and not because my mom is a nurse!
During a retreat for the group of charter nurses who were getting ready to open the brand new Parker Adventist Hospital in Colorado, a facilitator volun-told us all to share our stories about our callings to nursing. She was trying to help us identify our passions, define our purposes, and ignite an altruistic drive to staff the hospital with true Nightingale nurses. There were some tear-jerking, pull-the-heartstring kinds of stories for sure, as well as some benign, yawn-inducing stories too. I, myself, certainly did not have a compelling story that would inspire anyone, but it apparently wasn’t an option to skip this activity. When the so-called talking stick made its way around to me, I had to tell the truth, so I answered (verbatim), “I was actually in college doing my pre-med prerequisites, but I got knocked up and had to change my major.” I think that put a damper on the bleeding heart kumbaya vibe in the room.
Although I don’t have a fascinating, momentous story to begin my nursing journey, I ended up loving so many things about the nursing profession. It has given me scheduling flexibility to accommodate raising kids, provided financially to help me get through single mother years, guaranteed work no matter what the economy was doing, and gave me the opportunity to challenge my mind as far as I was willing to take it. Not to mention timeless relationships, camaraderie built on shared experiences, insight to humanity at its best and worst, endless opportunities to practice new self-awareness, and personal growth. Nursing did all that for me.
Also credited to nursing are chronic back pain, many days of tears, countless wasted zombie days recovering from night shifts, post-traumatic stress (PTS), numbed emotions, hidden coping mechanisms, jaded attitude about healthcare that I’m working my way out of.
And a tenacious desire to effectively help others with these same issues. There’s really no system, and it’s time to develop one.
I know some nurses make it longer than me; and some not as long. Nursing is all I’ve known since 2001 when I graduated from Fort Hays State University — the same college where my mother completed her Master of Science in Nursing (MSN). And up until my resignation from my last per diem ER gig in November 2017, I proudly called myself an ER nurse. Even when I took on different roles in different settings, I still identified as an ER nurse. I probably always will.
ER nursing comes with a certain ego. Unfortunately, it almost has to just to use as a crutch to limp through some shifts. An ER nurse needs a thick skin, wit, intuition, strength, stamina, sharp discernment skills, nerves of steel, assertiveness, comfort with living in the gray, aptitude to predict the unpredictable, quick thinking, strong medical acumen, appetite for adrenaline rushes, resourcefulness to work through gripping realities of death. On top of all that, we must withstand verbal and physical abuse. Every day.
In the beginning, I took pride in all these things.
I eventually grew weary of wearing that ego mask simply for the sake up upholding some unspoken credo that ER nurses must be tough. I was tough for many years. Toughness manifested as rough-and-tumble, strong, confident, unafraid, sometimes aggressive. It sometimes looked like I didn’t care. Thirteen hours of wearing that superpower mask, day in and day out, becomes exhausting. But it’s necessary to cope with the tragedy, pain, sorrow, and trauma — the effects of which seem to get ignored in this specialty.
It takes a special kind of person for each kind of specialty, but I wish that the machinations of helping ER nurses keep their edge, as it were, were more concerned with keeping ER nurses human and helping us cope with the obvious stress we’re exposed to every single day of work. Maybe some of us would stay in the workforce or become better leaders for those just coming into it. Ignored are the patterns that just seem to keep repeating.
As time would tell, I became numb. Even cold. These are common traits in ER nurses that go unrecognized or unacknowledged because they help nurses cope. Why would healthcare corporations want to put time or energy into helping nurses with these issues when being numb and cold is probably what helps them tolerate going back to work? Cogs in the machine. Until 2016, my signs and symptoms of PTS went unidentified, even by me. I’m pissed off that PTS in nurses continues to be ignored. Meredith Mealer of University of Colorado Health has performed studies on ICU nurses who experience PTS, with findings that indicate nurses’ PTS is comparable to that of post Iraq War veterans. Shouldn’t this research be some indication that we need to offer nurses more resources to manage and cope with daily stresses of the workplace, as well as post-career?
I burnt out. It’s partly because of PTS, but I didn’t realize it was even happening to me until it was too late. Excuses, pride, and ego got in my way. Even now, as I sit here recalling events over the years that continue to distress me so much, my keyboard feels the gravity of the tears that fall. At the time these events occurred, the ER nurse ego trained me to shake it off and laugh, lose the humanity. The mask looked like resilience.
How good is resilience anyway? No doubt, I think resilience is necessary — when identified correctly and done right. I read this opinion editorial article on KevinMD about how the sound of laughter in ER staff is actually the sound of resilience in the ER. While I agree with this concept on so many levels, there’s also something much deeper that we’re ignoring — the fact that sometimes we become too resilient. We allow things (all things) to bounce off of us so easily so that we become impenetrable. Resilience, or bouncing back, if not done in a healthy way, has the potential to turn into disdain or, worse, apathy. At this point, it may look like resilience on the outside and even be identified as such, hence we praise people for being so resilient, coach them to carry on, and certainly don’t bother asking if they need any help because, well, why would they? They’re so resilient! But it may actually be that we’re turning parts of our own humanity off (or not letting others experience our humanity) in order to cope, fit the stigma, or to avoid penetrating our own feelings. Unfortunately, this stoicism can get mislabeled or misidentified as resilience. Stoicism goes ignored because it looks like what we want resilience to look like, sometimes to the point that we begin to neglect self-care, let alone meaningful care of others. Stoicism is not resilience.
Because I was so ‘resilient’ for so long, I never recognized my PTS for the monster it is. If I hadn’t been so damn stoic, I would have been viewed as weak. At least that’s what I thought. I wouldn’t have been a good ER nurse. At least that’s what I thought. It’s time to start talking about it more.
I know not everyone shares my experiences or opinions. But I also know I’m not alone. The result is the industry losing seasoned nurses that have a lot of knowledge and experience to contribute still. With the ever-looming-but-kind-of-improving nursing shortage, new nurses are entering the profession and would benefit from veteran nurses. Instead, we are not only overlooked, but expected to return with altruistic hearts and smiling faces, like any good Nightingale nurse would promise.
Moving out of the ER helped, but not enough. My attitude carries over into my views of the bureaucratic role in healthcare, governmental regulations, unbalanced priorities that do not focus on humanity, and misdirection in incentivizing healthcare workers.
Once upon a time, I wrote a book. I recognize that it’s not the most eloquently written book, but it was an outlet to help me manage the emotions I was having as 2012 came to a close. At the time, I was directing my energy into writing letters to state representatives, senators, county commissioners, and even President Obama. I was going to change the world. My husband asked me facetiously one day, “Why don’t you just write a book?” I said, “Okay, I will.” (Because he offered this suggestion facetiously, not seriously, I was able to push through my normal suggestion-rebellion and consider it more seriously.) There are some typos and areas that could be articulated better, but it was my first big expression of work-related stresses, yet I still hadn’t recognized it as PTS. The title alone gives away my attitude at the time, which was exhausting me more and more each day. Anger is so much more draining than compassion. If you’re interested in reading more of my personal nursing experiences, my book, Yes, I Know You’re Dying (by Leigh Abilland, my pseudonym), is available only in electronic version for your reading devices. Honestly, I haven’t even read it all the way through because the therapeutic catharsis of publishing it was all I really needed.
I waited quite a few years to attend graduate school. I wasn’t sure what I wanted to do when I grew up, but I always had a nagging feeling it wouldn’t be direct patient care. Over the years, it became evident that my desire for building human capital superseded any delusions my mother had for me to be a nurse practitioner, just like her. What was she thinking? She’s been encouraging me for years to go get my MSN. (We know how I respond to suggestions. Also, I had announced to the world I would never be a nurse like my mom to begin with; I couldn’t continue this trend of eating crow.) Much to my mother’s chagrin, I sought out an advanced degree that would help me learn more about building people to their fullest potentials through leadership strategies. Master of Business Administration degrees (MBAs) tend to focus on numbers, which is exactly what has exhausted and dispirited me. I chose instead a Master of Science in Organizational Leadership. Organizations like it because building human capital builds their bottom lines. I like it because it recognizes humanity for what it is and focuses on people, not numbers.
What to do now? I’m only leaving nursing for a little while. I’m not sure in what capacity I’ll return, but I know it won’t be clinical. When I decompress from the accumulated stress and re-focus my energies, I want to come back into nursing as an educator or perhaps a leadership consultant who focuses on heading these disasters off at the pass instead of reacting to the results of burnout, turnover, and nurses who permanently leave the profession.
Bittersweet indeed. I am beyond ecstatic to be starting this new journey with my husband and his company West38Moto, delving into a fantastic motorcycle community, and getting involved in meaningful work through motorcycling. It’s a sweet thing to be partnering with my husband, but I’m bitter about some of the reasons why it’s so easy for me to leave nursing to do it.
Nursing, it’s goodbye for now, but don’t think you’ve gotten rid of me forever.