I have been sitting on this post.
I wrote this post recently, but was not planning on sharing it. I was not sure how I felt about sharing my personal story on the blog. There is a lot of stigma related to mental health in the healthcare community (and world) and while I am pretty open about my own nursing journey, I was not confident yet that I was ready to put my mental health story out in the great, wide world of the interwebs.
However yesterday there were some comments made on the New Thing Nurse social media that reminded me why it is so important to share our stories. There is an expectation that nurses need to have a "thick skin" to be successful in medicine, or it might not be the career for you. That people with anxiety or depression or other mental health diagnoses cannot be strong, capable & amazing nurses.
I THINK THAT IS CRAZY.
Nurses don't need thicker skins. They need better support. They need better coping strategies & stress management techniques. They need better work conditions. They need to know that their job is hard, that what they're feeling is normal, and that it is OK to admit if you're struggling and to talk about it.
Nurses, like all humans, have mental health. We should be concerned about their mental and emotional wellness. Nurses have to take care of themselves, so that they can take care of others.
Now, let me tell you a story.
Let’s start with a story, my story.
I was born a baby ER nurse in 2011, and it seems like only five minutes ago.
I remember being a newly-minted nurse, hyperventilating on my way to those first night shifts. I had finished nursing school in an accelerated 16-month, master’s-entry program. It was disorganized. It went by way too fast. I did not feel prepared to save lives.
During nursing school, I was anxious.
I was nervous about classes and tests. I was terrified during my first weeks of clinicals. The first time I went to take vital signs on a patient, I went with my classmate to record a blood pressure, heart rate, SAO2 and respiratory rate. We divided and conquered the tasks, and I almost passed out while trying to put on the patient’s blood pressure cuff. I am sure that the poor patient thought we were completely inept, but she was kind enough not to tell me to buzz off during the encounter.
Most people would say that some academic anxiety is normal. Sure. It probably is, but I have always been a nervous person. My anxiety was magnified by a million in nursing school. Because everyone kept telling me that it would get better, I shook off the fact that I cried constantly when I was alone and stress ate like it was going out of style. I once showed up at my classmate’s house and just ate a whole cheesecake. That isn’t normal.
Then I started my first job.
I was working nights, like everyone does when they start out, and was SO excited about being in the ER. It was my dream, and I was working in a great department with a very supportive staff. Yet I was barely sleeping. I was still stress eating, and sometimes I liked stayed in bed for days at a time when I was not working. When out with a crowd, I was usually fine, but I was frequently tearful at home. My then boyfriend, now husband, dealt with extreme mood swings and many crazy, sleepless days/nights. I thought it was all because I was working night shift, so I made excuses and soldiered on.
I moved to California and worked as a traveler, then as a staff nurse at several ERs. I continued to work nights. I had a terrible time sleeping, continued to be anxious and tearful when home alone and had many days where I could not get out of bed. I blamed everything and everyone for my continued anxiety and down moods. There was no way that I had a problem. It was always situational, at least that is what I continued to tell myself.
Then one day about three years ago, I was at home, an anxious, hot mess.
I was working 4-6 shifts a week at two jobs that I was juggling while trying to pay off my student loans. There had been a string of really brutal patient cases that had made me sad to the core of my being. I had not worked for several days yet at home that day, I was jumpy and crying. My husband was away on a business trip. I started looking for something to blame my mood on, but I could not think of anything - I had stopped working nights. I had gotten married. I had an amazing community of family and friends. I had a job that I loved.
So, I did what any good nurse does. I got a consult.
I found a therapist. She changed my life.
Through a lot of talking, time, exercise, mindfulness work, self-care and medicine (YES – I take medicine for my mental health), I have come to realize and accept that I have problems with depression and anxiety. For most of you reading this, you probably could have told me that years ago just by reading my story. That would have been great! But when you are on a journey of mental health self-assessment, it usually takes a lot of time to come to accept help and realize the deeper causes of your problems.
But I work in healthcare, so why didn’t I figure this out sooner?
Nurses and other healthcare workers historically HATE talking about their own mental health. We will diagnose and treat others ‘til the cows come home, but we will not discuss our own feelings for a million dollars. ER nurses may be some of the worst. We are so cowboy and pride ourselves on our ability to see the saddest, grossest, most traumatic cases and just keep going. That’s why we like to binge eat/drink/exercise/Netflix/craft. Call it what you want, but a lot of that is coping mechanisms in the extreme. I mean, have you ever seen any stress eating like a night shift pot luck? Think about it.
Things are changing.
The healthcare community is starting to talk more and more about the relationship between our work and our mental health. There are many organizations and foundations working to advocate for increased awareness of healthcare workers’ mental health needs (see below). Self-care and stress management is becoming more a part of the conversation, in addition to the need to combat compassion fatigue and burnout. This is a positive evolution for nurses and other healthcare providers everywhere. The world is starting to take note of the toll that our work is taking on us.
What else can we do?
I personally have made stress management and self-care a part of all of my education for both nursing students and veteran nurses. While awareness is the first step, we have to actively engage in self-care to protect ourselves from the negative effects of the stress of our jobs. Humans are incredibly resilient, and nurses are super stars in the resiliency game. However even super stars can burn out. We have to take the steps to not just continue to make nurse mental health a part of the conversation, but also to actively work to making self-care, mindfulness and stress management a part of our daily nursing and personal practice.
So, am I all better?
My anxiety and depression are going to be my forever friends. Sometimes they hang out with me, while other times they go on vacation. I have to continuously work on the things that keep me mentally well so that I do not backslide into the depths of Depression Town. I see my therapist regularly. I take my medicine. I (try to) eat well, sleep enough and exercise. I have started to try to meditate and stretch more. I surround myself with positive humans. I travel. I read. I stay engaged with my professional and personal community. I continue to do work that I love – ER nursing, ENA volunteering & of course, New Thing Nurse. However, I am human, and I do not always succeed. I love donuts and cookies. I do not like to work out in the cold. I sometimes get too affected by things outside of my control (i.e. politics, family, donuts). But I do my best and most of the time, I feel like a fulfilled and happy person.
Also, I am, and continue to be, a strong and awesome nurse.
Having my own struggles with depression and anxiety have never made me a weak or bad nurse. On the contrary, I feel that I am a better nurse and advocate for both my patients and colleagues because of it. Additionally I have lead a successful ER nursing career, started a business to support the nursing community, lectured at the local, state and international level, and supported nurses and nursing students all along the way. My mental health challenges have never stopped me from being successful or effective in any role. I just have had to work harder and overcome more to achieve my goals.
Final Thoughts.
If you have read all of this, I commend you and thank you for sharing in my story. I want to make nurses everywhere realize that if you are feeling anything on the spectrum of anxious, self-doubting, irritable or sad, YOU ARE SO NOT ALONE. I have been there. I will be there again. There are so many more of us out there than you think. There are lots of other nurses talking about their own mental health journey on social media. Check them out! Let’s not keep how we are feeling a secret anymore.
Let’s keep the conversation going about our nurse mental health.
Let’s talk about it.
- Sarah @ New Thing Nurse
Want to read more about Nurse Mental Health & Wellness?
American Nurses Association - Healthy Nurse, Healthy Nation Campaign
Elizabeth Scala - Nursing from Within Blog
Nurse.org - Nurse Wellness: Not an Oxymoron
The Code Green Campaign - A First Responder Mental Health Advocacy Group
