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.
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.
Every 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 self. 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’.
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.
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