“John, I cannot do this anymore,” she said, her voice steady. “I’m going to move out. You have health insurance. Get help for this sexual addiction. You need to make an appointment.”
“Stop playing this bullshit game,” he said.
Lara had thought for sure that he would beg her to stay, but he didn’t. “I’m not going to your family’s holiday party tomorrow,” she said.
He didn’t believe her. The next morning, he loaded the car while Lara finished feeding the kids breakfast. “Just get your suitcase and come on,” he said.
“I’m not going,” she said.
“Get your goddamn suitcase. You know you’re going to go.”
“No, I’m not,” she said.
He looked momentarily surprised, then began to usher the kids out the door. Lara kissed her children good-bye and told them that she had to go to work. As soon as the door shut behind them, Lara burst into tears. She was proud of herself for finally standing up to him, but wondered, still, whether she was giving up too soon.
Why Nurses Crack
After twenty years of working as a cardiac nurse in Washington State, Elena Uhls became so stressed that she sank into a major depression. The combination of the unit director increasing her patient load to twelve at a time, the nurse manager asking her to perform tech duties on top of her own, and patients and techs treating her disrespectfully had broken her spirit to the point where she grew suicidal. “I was crisp,” she said, using nurse slang for “burnt out.” “I felt worthless. I made errors, forgot things.” She considered switching careers, but she couldn’t imagine herself in any other job. “I was so paralyzed. I knew it was possible that I’d accidentally kill somebody if I didn’t take time off. Every day as I drove home, I slowly plotted my death. Depression is painful; suicide felt like the only way out.”
Once she found a helpful doctor and took antidepressants, Uhls recovered her basic mental health, but she isn’t the same nurse she used to be. A traveler, she floats among hospitals, avoiding the workplace where “every day was a nightmare.” She said, “I know in my heart I’m not that loving nurse I once was. If I can make a difference, I try, but what can I do in a few hours? I [used to] try to be their coach, their cheerleader, their educator, whatever it took, but not now. I still care, but not with the same light heart. It’s more businesslike. Maybe it’s better that way.”
We rely on nurses to be our healers, our heroes, to comfort us, to soothe our hurts and salve our psyches. But how often do we pause to wonder who takes care of the nurses?
Nationwide, nurses’ top health and safety concern is the effects of stress and overwork, according to the ANA Nursing World Health and Safety Survey. More nurses are worried about this issue now than in 2001, when the average shift length was shorter and patient loads were lighter. Their second biggest concern is that they will suffer a disabling musculoskeletal injury because of their constant heavy lifting; throughout an eight-hour shift, a nurse lifts an average of approximately 1.8 tons.
Injuries are a major stressor for nurses, who must lift and move patients in addition to working on their feet most of the day. The number of nurses reporting work injuries has increased in the last decade. The ANA found that “Nearly all nurses still indicate that they have worked despite experiencing musculoskeletal pain, including eight in ten who say it is a frequent occurrence.” Other common nurse injuries include needle sticks, strains, sprains, bruises, cuts, head injuries, broken bones, or dislocated joints. A Virginia women’s health nurse added, “Many nurses have bladder issues by age fifty. ‘We don’t pee so you can!’ How’s that for a women’s health nurse motto?”
A number of nurses interviewed for this book reported feeling overworked, overwhelmed, and underappreciated for several reasons. For twelve to fourteen hours at a time, they must demonstrate physical and emotional stamina, alert intelligence, and mental composure, even if they are berated by patients or bullied by doctors and other coworkers. Many healthcare employers don’t engage nurses in decision making, although nurses are at the forefront of patient care. Nurses are under pressure to work quickly and correctly, taking sometimes contradictory orders from professionals who will blame them if something goes wrong. They are stressed because, an Oregon nurse manager said, they are responsible “not only for the patient but also the family, the team of support specialists, hospitalists, physical therapy, occupational therapy, social work, hospice if needed, meals, medications, teaching, spiritual support, keeping the patient clean and comfortable and documenting, documenting, documenting.”
Nurses must constantly face traumas, tragedies, and patients who will die on their watch, no matter what they do. A New York City pediatric ICU nurse recalled, “The other day, one of my coworkers said, ‘I’m taking care of a brain-dead baby today and I just can’t take it.’ When there’s no hope left, that’s when it gets really sad.” Nurses are expected to care for the dying, to save the degenerating, and to minister to all manner of injury. And they are expected to do it without breaking their composure. “Some nurses are exposed to repeated horror on a regular basis, things that a regular Joe couldn’t handle,” said a Virginia NICU nurse. “The worst thing you could ever imagine seeing, we see at work. My hospital doesn’t have anything in place to help. If you can’t deal with it, you leave.”
While doctors and other hospital personnel are also exposed to death and suffering, nurses may be more susceptible to the lasting emotional impact. Nurses spend the most time with patients individually and have a hand in every level of their care. “Nurses are not only ‘first responders,’ but are also ‘sustained responders,’ ” author and clinical nurse specialist Deborah Boyle has observed. “Nurses become part of a mosaic of caring within a family framework that may be fraught with anticipatory loss, tension, disbelief, and physical disfigurement. In the acute care setting they are responsible 24/7 for the patient’s care and the family’s response to the illness trajectory. Often, they cannot leave the situation after bad news is shared or a death has occurred. It is this extended time and the placement of the nurse at the center of the interchange that makes nursing’s role unique.”
Nurses can also become emotionally attached to their patients, some of whom die in front of them. “The patients become part of our family. It’s a whirlwind relationship because you meet someone, and the next thing you know, you’re looking at their naked body and listening to their innermost anxieties. In return, you listen, try to help, and share parts of your own life,” said a Maryland hematology nurse. “If they die, it’s very hard; you have lost someone you became close to very quickly, someone you were cheering to beat the odds. As a nurse, you can’t dwell on your loss. You have other patients who need you. One might think that you would build a tough exterior that doesn’t let the hurt in, but to truly be effective, you can’t. You share your grief with work friends because people at home can’t understand the connection that you share with patients.”
For all of these reasons, nurses are the hospital employees most likely to develop work-related psychological disorders. Eighty-seven percent of surveyed nurses at one university hospital exhibited symptoms of anxiety, depression, PTSD, or what researchers call burnout syndrome. Nurses have relatively high rates of suicide, depression, and anxiety relating to job stress. University of Kentucky researchers found that 35 percent of surveyed nurses are mild to moderately depressed, compared to 12 percent of the general population and 12 percent of emergency medicine residents. Occupational reasons for this depression include not enough time to provide emotional support to patients or to complete their nursing tasks, too much time spent on non-nursing tasks like clerical work, and not enough staff for proper patient care, all of which could be alleviated if hospitals increased nurse staffing.