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Living with Mental Illness as a Nurse – Opening the dialogue

By | Health, Nursing | One Comment

Nurses are so amazingly compassionate and kind to the sick.  The mental strength and fortitude required to nurse other human beings through the very worst times of their lives is almost unbelievable to comprehend. This is why nurses do not become mentally ill.

Let me tell you another one…..April Fools.mhbubble

Mental Illness has nothing to do with weakness.  It has to do with neurotransmitters, trauma, and other unfortunate factors.  Yet, nurses very often find fault with the mentally ill, and feel like mental illness is a result of weakness of morals, character or will; laziness; malingering; or the lack of discipline or self-control. In essence, as a group we blame the ill for their illness. But we are not blaming the smoker for their lung cancer (though we shouldn’t do that either), we are blaming the infant for their Acute Myelocytic Leukemia. We are blaming patients who did nothing to cause their illness, or increase their risk factors for the symptoms associated with it. We are blaming chemo patients for vomiting. This is a widespread issue in nursing, and when I searched for studies I didn’t have to look far at all.

If there is anything worse than being a patient in psychiatric crisis in a purely medical environment, it might be working as a nurse in a medical environment while living with mental illness.  Especially in an environment where mental illness is considered unimportant, and where the resources for those afflicted with mental illness are so strained that the nurses feel helpless to do anything to relieve the suffering of their patients. 

Before I made the transition to cardiology, I was an ER nurse.  I loved my ER, and would go back in a second if they could offer the salary and benefits package I have now.  However, I would be lying if I said the emergency department was not stressful because of constantly hearing the disparaging remarks made about the acutely mentally ill.  This was not only from my fellow ER staff members. The stereotypes and misinformation were dispensed liberally (and loudly) by EMS, other patients, physicians, cab drivers, housekeepers, pizza delivery men, and the families of the patients themselves.  So, everyone.

And I would also be lying if I said I never uttered a disparaging word about a psych patient.

mhprobEvery ER has their ‘regular’ psychiatric patients. Many of them are the vulnerable homeless, and chronically mentally ill.  Some are the schizophrenic patient who feels better, stops taking his medication, and becomes acutely psychotic.  Some are depressed and have made multiple suicidal gestures or statements. Some are manic and have poor insight and judgement.  All of these people can have one thing in common.  No resources.  We are unable to find appropriate psychiatric beds in any area facility for them, and board them in the ER for days at a time, which is probably one of the worst places in the world for them.  It is full of busy nurses, techs, and doctors taking care of too many people, and some who may literally die any second. Therapeutic communication can go out the window at such times, no matter how caring and kind the staff member is.  It is easy for nurses to feel like the psychotic patient is less acute than the patient in V-Fib, because they are.

Once the psychiatric patient is contained in a safe environment, has completed diagnostic testing, and is waiting for a bed, (which may or may not ever come) there is little for the nurse to do for them except dispense medication and keep the patient from disturbing others.   Sometimes it is a matter of getting a facility to accept a ‘self pay’ patient, and sometimes beds are simply not available at any price. The interminable wait in an uncertain environment often exacerbates the patient’s symptoms. And staff are injured, messes are made, and feelings are hurt.

But we are talking about nurses. 

I know many nurses who suffer from one mental illness or another.  Naturally, you would never know unless you are told about it.  The nurse may be suffering from crippling depression or anxiety, while hearing her coworkers talking about the psych patient who is ‘faking’ suicidal ideation, or psychosis. It makes a nurse want to stay completely silent about their own illness, because not only do they see the stigma attached to mental illness, they have FELT it.

As we all know, I am lousy at staying silent.

When the symptoms of my illness became unmanageable, I hesitated to seek treatment because I knew how my peers would react if they knew. I would be another one of the ‘crazies’ to them, and to my former mhagorself. And I let it go for far too long, and became more ill because of it.

I suffer from Panic Disorder with Agoraphobia.  My previous diagnosis was Generalized Anxiety Disorder.  When my son was killed, the trauma exacerbated my illness.  For years I went to work, my home, and the grocery store.  Any change in my routine has been almost unbearable.  A transfer from one department to another is debilitating for months.  Nowhere is safe, except my very few ‘safe’ places.  From being a very social person, I became a recluse.  I am barely able to answer the phone at times, because it represents someone coming into my ‘safe place’.mgskull

Slowly but surely, I am ‘Feeling the Fear and Doing it Anyway’.  I repeatedly expose myself to other places, so I can process it.  I have to.  Show Me Your Stethoscope is forcing me to go ‘on the road’.  To conferences, rallies, and mission trips.  However, I am one of the lucky ones. My family is mostly understanding.  My most debilitating problem was caused by trauma that I may eventually be able to process. It won’t make my anxiety go away, but I may be able to lessen it.  Agoraphobia is not considered curable.  But many people will suffer forever with their particular illness, and do well only as long as their medication is working. They can’t do what I am doing.  Their illness is caused by a chemical imbalance.

The most judgemental people I have encountered have been fellow nurses. I have been told to muscle through my illness, get a grip, just calm down, think about something else, get off those drugs before you become addicted, and that if I just got out and exercised more, I would feel better. I have actually been encouraged to withdraw abruptly from my medications without the advice of my physician, by a fellow nurse. Nevermind that the SSNRI I take has a reputation as the hardest medication in its class to withdraw from; Or that I would be unable to go to work or interact with anything but my pillow if I stopped taking it.

Nurses, please keep the facts in mind.  Mental illness can be just as serious as physical illness. Nurses who take antidepressants are not unfit for duty – they are used to return them to baseline.  No matter how you personally feel about mental illness, the research has been done.  Just as we believe that smoking causes lung cancer based on the data, we need to be clear that mental illness is not a result of laziness, lack of drive, or weak character.  More importantly, those suffering from mental illness deserve your compassion, and your competent, non judgmental care. Also, keep in mind that it could in fact happen to you.

 

Love,

 

Janie

 

 

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Narcan – Judgey McJudgeyPants.

By | Dead, Health, Healthcare Policy | 7 Comments

Narcan is being sold over the counter with education in many places now.  You can hear the screams of the self-righteous and uninformed from a million miles away.  I am going to assume that any person who reads this and is completely scandalized by my attempt to educate about narcan is simply uninformed and requires tutoring.  Because I don’t want to assume that you think ‘Those Damn Junkies Ought To Die’

Well, then.narcan

As a former ER Nurse, I love me some narcan.  It can turn an essentially dead person into a swinging, puking whirlwind of life in a moment.  Heroin overdose? Have 0.4 mg of This Party is OVER! And hopefully you got it fast enough that we have saved your brain.  So you can live to go to rehab someday.  This is because all people are precious, and I want all of them to live for as long as they can.  I am a grieving parent, myself (pedestrian accident) so I am firmly wired into the community who have lost their children due to drug overdose.  I wish there had been a vial of Narcan sitting there when my friends found their kids down.  Seriously.

Narcan does need to be sold with education, especially because of the half-life.  We all know they can obtund again in 20-30 minutes.  Or an hour.  They still have to come to the hospital, and they need to know that.  However, we cannot control that.  We can only give them this one precious second chance at life.  Yes, there are side effects associated with Narcan, but none of them are as serious as dead in 3 minutes.  We can usually fix the other ones.narcan2

And now we are giving it to the police as well! This is wonderful! The police usually get to scenes much faster than the ambulance, and they can inject it and save that person, who may go on to change lives for the better someday.  Maybe they will speak at your kids school about the dangers of drugs, and convince your kid to never try heroin WHEN it is offered to them. Because it will be offered to them.  And if you think it won’t, come visit me and I will take you to an extremely affluent area of St Louis where kids are dying in record numbers from heroin overdoses.  Good kids.  Smart kids.

And if you think that this will not save anyone, Let me direct you to this Time Magazine article about a 2013 study, and the use of Narcan in the community since 1996.

Sick people do not deserve to die because you disagree with their choices, Judgey McJudgeyPants.   

 

Love,

 

Janie

 

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Nursing Frustration Nation – CNA Edition

By | Advocacy, Health, Healthcare Policy | 7 Comments

Ok, friends…..I am going to rant a little.  Just a teeny tiny bit about a healthcare policy issue that is completely eating me alive.

I wish it was not an election year.  #NJGovNot4LTC

You know that I am completely incensed about Chris Christie’s Veto of the LTC safe staffing bill in NJ.  I even went so far as to write a layperson-friendly blog about what this would mean to families and patients in LTC in NJ.

New Jersey Governor Chris Christie addresses the annual  Conservative Political Action Conference (CPAC) at National Harbor, Maryland, outside Washington, DC on February 26, 2015.    AFP PHOTO/NICHOLAS KAMM        (Photo credit should read NICHOLAS KAMM/AFP/Getty Images)

And I can get no traction on it. NONE.  Because of the debates, the mudslinging, and the freaking super bowl.

I keep thinking about New Jersey’s terrible LTC facility rating, and all of the elderly people who would benefit by the bill being passed.. And Governor Chris Christie vetoed this bill.  He is rich and will never have to spend time in a nursing home.  He will be able to afford care at home.  What about the middle class elderly? What about the grandparents in New Jersey for god’s sake?

According to Nursing Home Report Cards, New Jersey gets a D rating in number of direct care staff.  CNA’s.  CNA’s do most of the front-line work in LTC facilities, and the staffing in NJ is terrible.

How can this man be ok with warehousing the elderly in squalor? With too few direct care staff, the elderly will sometimes be forced to soil themselves before someone can get them to the toilet.  The patients who have had strokes and need help will wait for their meals, hungry and watching other patients eat while ‘waiting their turn’ to be fed.  Bedsores, infections, falls, wounds….I could go on forever.  Why are we allowing this to happen? Hip Fractures KILL the elderly.  We need adequate staffing!

Why did Chris Christie do this to the elderly in New Jersey? It is absolutely shameful.  

Does he not understand the implications of what he has done? Has he completely failed the elderly by not doing any research or asking any experts? Is his golf buddy a LTC Facility owner? This makes absolutely no sense.  These were not lavish staffing ratios.

How can we allow this to go on in other states? What are you going to do to help our frail elderly?

This breaks my heart. Please help get the word out.

Love,

 

Janie

 

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Governor Christie – A Veto – and Why you should care about it – Updated

By | Advocacy, Health, Healthcare Policy, Uncategorized | 2 Comments

donald-trump-unloads-on-chris-christie-with-multipronged-attackLet us remember THIS if this gentleman is chosen as a Vice Presidential candidate.  How the heck could a nurse even consider supporting this person on a ballot?

There was some legislation pending in New Jersey last week that would have set ratios for CNA:Patient ratios in long term care facilities.

Vetoed by Governor Chris Christie.

New Jersey Governor Chris Christie addresses the annual Conservative Political Action Conference (CPAC) at National Harbor, Maryland, outside Washington, DC on February 26, 2015. AFP PHOTO/NICHOLAS KAMM (Photo credit should read NICHOLAS KAMM/AFP/Getty Images)

This guy does not care about caregivers and he does not care about seniors.

Sweet, why should we care about it?

A law mandating staffing levels in NJ is exactly what was needed based on their track record.

Staffing Levels will ultimately be mandated by the states, not the federal government.  But we are going to need to get guys like this away from our staffing legislation.

This is the wording:

  1. a.  Notwithstanding any other staffing requirements as may be established by law, every nursing home as defined in section 2 of P.L.1976, c.120 (C.30:13-2) or licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall maintain the following minimum certified 1[nursing assistant-to-resident] nurse aide-to-resident1 ratios:

(1)  one certified 1[nursing assistant] nurse aide1 to every 1[six] eight1 residents for the day shift;

(2)  one certified 1[nursing assistant] nurse aide1 to every 1[nine] 101 residents for the evening shift; and

(3)  one certified 1[nursing assistant] nurse aide1 to every 1[14] 161 residents for the night shift.

It was a very reasonable amount of staffing for CNA’s.  CNA’s are the backbone of LTC, and overworked, underpaid, and constantly put in situations dangerous to their well-being because of poor staffing ratios.  When you have a CNA taking care of 15 people on days, it is completely impossible to get everyone up, toileted, fed, and cared for.  With these numbers as the minimum staffing, care in New Jersey would improve dramatically.  And it NEEDS to improve because NJ Nursing Homes are ranked 43/50 in the US.

chrisAnd Governor Christie said NO.

You know, Governor…. Seniors VOTE.  Nurses VOTE.  CNA’s VOTE.  These CNA’s are in a union, and while that might not fit with your political views, vetoing that bill was a completely ridiculous thing to do.

You just told NJ Residents that it was OK for their Mothers, Fathers, Grandparents, and THEMSELVES to be neglected in understaffed LTC facilities.  

Seriously? And you offered no explanation.  Do you have a conflict of interest we need to know about? It is OK with you that NJ residents are warehoused in understaffed, dangerous facilities during their golden years?dignity

This is outrageous.  It is dangerous.  It will be deadly for some LTC residents in New Jersey.  It will cause debilitating physical injuries in direct caregivers who just tried to take care of their patients.

Absolutely Not. We will not stand for this.

Love,

Janie

Copy and paste this text into twitter.  Tweet everyone, and keep doing it.  Bring awareness of this problem to your circle.

This is the tweet:

NJ Gov declared that Seniors are not a priority by veto power
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Hi, Judgey McJudgeyPants. Let’s Talk about Second Victim Syndrome

By | Advocacy, Health, Nursing, Workplace Safety | 7 Comments

As a nurse, my largest fear has always been a fatal medication error. Like the nurse in this article who accidently killed a baby.  And then died for it. After she was blackballed and fired.

You too?

I have known nurses who have made a fatal or near fatal medication error.  Have you? What did you do? Did you ostracize that nurse and tell them how wrong they were? Did you think that saying that would make them feel worse, as you deemed was appropriate?distraught-nurse-5361035

Of course you didn’t.  For God’s sake you comforted them, and hugged them.  You may have participated in the Root Cause Analysis.  You told them we would figure out what we could have done differently.

You did not call them names.  

So why, dear reader do you think it is ok to abuse a fellow nurse on social media who made an honest, albeit tragic mistake? A mistake they will never, ever get over.  

A mistake that has transformed the vibrant, caring, competent nurse they were into a shriveled up ball of self-doubt, grief, and humiliation.  A nurse who killed a human.  BY ACCIDENT.  

Now, there are some really awful nurses who have killed patients on purpose, like this real gem of a nurse from Italy.

However, a fatal medication error is something that requires a policy change, almost always. In this case, the hospital is changing their policy about color coding on dangerous medications.

And some nurses have decided to put on their Judgey McJudgeypants. Do you not even realize that your opinion on this subject was drilled into you in nursing school? You were instructed to blame your coworkers for mistakes. Because you were instructed to blame yourself for your mistakes. 

error

I have news for you, pal.  That could be you.  By this time tomorrow.

Of course we must be extremely careful and follow all policies when giving medications.  That is a given.  And then things happen.  Someone interrupts you, an emergency happens, you have to go to the bathroom.  Something.  And you take your eye off the ball for one second and it happens. And maybe you live through it, and maybe you don’t.  It will most likely depend on how the powers-that-be treat you after you kill someone’s grandmother.

How does blaming other nurses and talking about them as if they were baby-killers promote unity among healthcare professionals? Do you think you are immune? 

Think again, Nurse.

Think again.  

 

Love,

Janie

#NursesUnite

#ShowMeYourStethoscope

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