“Diabetes is so prevalent in our society, and I feel as though I have a better understanding of my own patients with diabetes,” says Heather Weber, an RN who works in a busy outpatient GI department. She has type 1 diabetes, and she has experienced what it is like working as a nurse with diabetes. “I recently had a GI sickness at work, and as a result, my blood sugar dropped rather quickly after lunch,” she relates. “My coworkers noticed that I was diaphoretic and quickly sat me down, giving me some apple juice to drink. I ended up going home since I was sick with a GI bug, but only once my blood sugar was stable enough to drive. I was grateful for my coworkers’ assistance.”
Since diabetes is such a major problem amongst the population, it only stands to reason that nurses can have diabetes, as well. According to the American Diabetes Association, 30.3 million people in America have diabetes. In addition, 1.25 million adults and children have type 1 diabetes. How can nurses manage their condition? Nurses have a difficult time eating a balanced diet due to skipping meals. They are also on their feet most of the time, putting them at risk for complications of the foot, such as ulcers.
Fortunately, many nurses want to share their experiences to help others navigate the challenge of balancing diabetes and providing excellent patient care. Diabetes educators strive to help all people who have diabetes, and they are an excellent resource for nurses who want to manage their diabetes.
Nurses generally know how to handle their condition. They know diabetes front and back through the job, and they are intelligent professionals who know how to adapt those ideas for themselves.
“I can usually slip away for a few minutes or have a coworker cover for me so that I can test and/or eat a snack,” explains Weber. “When I worked as an ICU nurse doing twelve-hour shifts, I would typically eat snacks to prevent low blood sugars as I did my charting at the nurses’ station.”
Tips like this are invaluable because they are grounded in the actual experience of being a nurse with diabetes.
Fran Damian, MS, RN, NEA-BC, works at Boston Children’s Hospital and is a staff member at Diabetes Training Camp. She has tricks that she uses, as well. “Managing well with diabetes requires good planning and being well prepared with extra supplies all the time,” she says. “I live a healthy lifestyle as much as possible. That includes regular exercise and a well-balanced diet. I feel best when I eat a lot of fruits, vegetables, and lean protein, and I drink a lot of water …. [I] always have glucose tablets on me in case I start feeling low.”
“Our unit was pretty good if we were slammed and did not get lunch,” says Danielle Kreais, MSN, RN, CPNP-PC. She got her diagnosis and learned to cope, all while working a busy OB unit on nights. “The manager ordered lunch meat sandwiches and chips for us. There was another diabetic I worked with and the advice she gave me was to make sure I always had one of those Nature Valley bars in my work bag, in the glove box of my car, and my locker. The peanut butter ones have protein and they are a carb, so it was a great combo if lunch was missed.”
She continues: “She told me for lows to keep those peppermint striped candies [in your pocket] that are soft, and you can chew them. They are enough to bring your sugars up, plus they don’t melt.”
Nurses newly diagnosed with diabetes would do well to carry glucose tablets at all times to prevent low blood sugar. Be sure to tell your manager and your coworkers what’s going on so that they can help you when needed. Snacks and water are essential to good blood sugar control. Don’t forget to use your resources, such as endocrinologists, dieticians, and diabetes educators to plan the right meals and strategies for you to use on the job.
Although tips from nurses can be invaluable, they are nothing like the kind of focused information that can come from a certified diabetes educator (CDE). These are medical professionals who are responsible for teaching all people with diabetes in all situations how to manage their lives and prevent complications.
One such expert is Lucille Hughes, DNP, MSN/Ed, CDE, BC-ADM, FAADE, director of diabetes education at South Nassau Communities Hospital in Oceanside, New York, and treasurer of the American Association of Diabetes Educators. Considering some of the challenges nurses can face when dealing with diabetes on the job, she had tips for some of the most common ones.
Nurses often don’t get the chance to eat during a shift, and this can severely impact blood sugar levels. “When nurses with diabetes find themselves in this situation, planning and being prepared is the best medicine,” says Hughes. “Keeping snacks on hand that are a blend of carbohydrates, protein, and fats can be a tremendous help in these situations.”
“Meal planning is the secret to living with diabetes and being a healthy person,” Hughes continues. “Investing in a good lunch bag (or two) will allow you to plan and pack all the essentials to eating and snacking healthy. Being unprepared and finding yourself at the mercy of a vending machine is not a good situation to be in. It is very unlikely you are going to find a ‘healthy’ lunch or snack option.”
In addition to poor nutrition, nurses also face significant impact to their feet, and this can cause foot related complications for nurses who have diabetes. “First and foremost, investing in a good pair of comfortable shoes is essential for anyone who spends most of their day on their feet,” says Hughes. “Calluses and skin evulsions due to rubbing of a shoe on a toe, heel, or ankle area can be dangerous and yet avoidable.”
Here are six tips that Hughes has on how to find shoes that fit and how to determine if they are a healthy choice:
- When trying on a shoe in the store, make sure it feels comfortable. If it isn’t comfortable, don’t buy it.
- Many think that new shoes require a bit of breaking in and you must endure the associated pain. This is not true. If new shoes start to hurt, immediately remove them and don’t use them again.
- Don’t think that the only shoes you can wear as a nurse with diabetes are unfashionable ones. There are many options for shoes that fit, so do your due diligence and find shoes that will protect your feet.
- In addition to finding the right shoes, foot inspection is vital in protecting your feet. Check them every day. Use a mirror to see the bottoms and sides of your feet. If you notice any redness, cuts, or blisters, see your podiatrist immediately. Take care of small changes immediately before they expand into something unmanageable.
- Podiatrist. Yearly, no exceptions. More often if necessary.
- Finally, any time you see a medical professional, ask them if they will take a look at your feet at your office visit. This could be your primary care doctor, your endocrinologist, or any other specialist you may see—within reason, of course. Many dentists would have trouble with this request. Seriously, though, any professional who looks at your feet could possibly see a problem early enough to stop it. Use these resources.
Nurses spend so much time taking care of others that the self is often forgotten and ignored. Unfortunately, this is unhealthy for any nurse, but particularly troublesome for a nurse with diabetes. Yet, these challenges are not insurmountable, although they may take a little work. Planning your diets and meals are key to ensuring that you will have food on hand for sudden lows. Meal planning can also help you keep your high blood sugar under control. For your feet, planning is again essential. You must find shoes that are comfortable—no questions asked.
Following these steps, nurses with diabetes should be able to function well as nurses—and many are! If you find yourself troubled by mixing diabetes and nursing, let your doctor know. They may be able to refer you to any number of professionals who can help. The most important item, though, is to catch things early and always plan how to confront any challenges.
Kyana Brathwaite, founder and CEO of KB CALS- Caring Advocacy & Liaison Services, worked as a critical care nurse when she hurt her shoulder during a patient transfer.
“Our patient population is getting heavier [and] it is not always realistic to pull colleagues from different areas/departments to help. My true issue was not with the injury—although unfortunate, they do happen—my issue was with how my particular situation was handled after the injury by both management and the entity I worked for,” she explains.
For these reasons, the pain of her injury and the lack of support by management, Brathwaite chose not to stay at the bedside. Would she have stayed had circumstances been different?“Prior to the injury, I was considering staying at the bedside for at least five more years to give me time to plan the direction in which I wanted to take my nursing career.”Although she did plan to continue her career eventually, she would have given solid years to suffering bedside nursing specialties.
In fact, many nurses run from the bedside as soon as possible because conditions are so deplorable. They look for jobs in advanced practice, teaching, and other non-bedside related areas of nursing, while the number of nurses taking care of the most critical patients continues to dwindle.
Here are four reasons nurses leave the bedside and some ideas as to how to make them stay.
1. New Grad Education
New grads can go into a bedside job and not know exactly what they are in for. In nursing school, clinicals usually don’t go beyond two to three patients per student so they are not exactly exposed to the real-life rigors and stresses that come with the life of a bedside life—and cultural shock is a very real phenomenon.
“Nursing students are constantly told by faculty, peers, mentors, and experienced nurses what bedside nursing is ‘really like,’ says Greg Eagerton, DNP, RN, an associate professor at the University of Alabama at Birmingham School of Nursing. “However, it is like the first time we ride the bike by ourselves…The same is true for new nurses; their hands are held throughout their training and then the day comes when they are ‘alone’ and it’s a little frightening. They now have the sole responsibility for their patient’s care, their patient’s life—and that can be daunting. It’s also the reason we always encourage team support from their mentors, their more experienced peers, and from all members of the health care team, including physicians, therapists, support staff, etc.”
Although this is true, new grads often express intense dislike of their new role as a bedside nurse, and they immediately want to move to another branch of the profession. Is it that the nurse is not prepared or that the job is simply too difficult? It certainly sounds like management is trying to accommodate new nurses, but a quick search of internet nurse boards will reveal new nurses in despair. Perhaps more intensive job shadowing will allow new grads to see what bedside nurses do. Perhaps more realistic teaching would also go a long way toward helping them. Whatever the answer, new grads are a special population that needs attention—though it already gets quite a bit—to keep them safe and happy at the bedside.
2. Staffing Ratios
Another issue that chases nurses from the bedside is poor staffing ratios. It can be overwhelming for one nurse to have eight to ten patients to themselves. Not only is it unsafe, it is also stressful, and many nurses would rather find a new job than to put their licenses and their mental health on the line like that. For this reason, staffing ratios are important to consider when examining the loss of bedside nurses.
“I do not feel staffing ratios is the main driving factor,” argues Ken Shanahan, MSN, RN, CCRN-K, clinical nursing director at Tufts Medical Center. “One of the main reasons I feel this way is because the only state with staffing ratios is California and yet they have the most nurse strikes. These strikes are actually increasing dramatically and are something we will need to address as a profession. The work environment is the most important factor and number of nurses or ratios is only a component of the working environment. There are many other components that we are not hitting the mark on that would help create a healthy work environment.”
Although a large portion of nurses would disagree with Shanahan’s opinion on the importance of staffing ratios, he does have a point: they are not all that is involved here. Getting the floors better staffed is only one part of the puzzle, but addressing pressing issues such as horizontal violence is needed, too. Everyone knows about staffing ratios, but few realize they are only one prop to hold up a very large house meant to keep nurses at the bedside.
3. Compassion Fatigue and Burnout
Compassion fatigue and burnout are the psychological components that keep nurses from staying at the bedside. The two are closely related but are not the same. Burnout, in short, is frustration with the situation and is typified by anger. Compassion fatigue is an exhaustion of the ability to extend oneself emotionally anymore and is typified by depression. Please note, these are very simple definitions and they are not exhaustive. Both of these conditions can occur together, and neither is pleasant. Nurses have had their lives broken over these issues, and no one wants to go through that. How, then, do we solve this problem?
“Burnout and compassion fatigue are concerns for direct care providers in all professions,” explains Eagerton. He suggests the following measures to help support staff:
- Leaders should be visible and approachable.
- Work schedules should allow adequate time off between shifts.
- Adequate breaks should be provided during the work shift so that staff have down time.
- Schedule time for staff to have discussions about what stressors they are experiencing that may lead to burnout and fatigue.
- Create opportunities for staff to be involved in activities that allow them to do things that are not direct patient care but have meaning to them, such as committee membership, attending professional conferences, and so on.
- Have resources available for nursing staff in addition to their managers to discuss their stressors, such as chaplains, mental health professionals, and counselors.
- Have dedicated space(s) on or near the units where they work where they can have some quiet time or time to eat their meal or have their break without interruption.
With these ideas in place, nurses can have a better shot at overcoming compassion fatigue and burnout. When these are not a factor or are a mitigated factor, the more a nurse can feel happier staying at the bedside.
Nursing is definitely a contact sport, as stories like Brathwaite’s prove. Transferring patients is getting more and more difficult with increased body weights. In addition, various specialties are more susceptible to transfer related injury. For instance, operating room nurses are at great risk because they must move patients who are unconscious and essentially dead weight. However, that doesn’t make your typical bedside nurse any less at risk. Moving and lifting are just as much a part of the job, and mechanical equipment is usually not available to help.
“There is only one of you, [and] there will always be more patients,” says Nick Angelis, CRNA, MSN, author of How to Succeed in Anesthesia School (And RN, PA, or Med School) and cofounder of BEHAVE Wellness.“If no one is available to perform a task safely with you, don’t do it. Hospitals always push putting the patients first, but you’re a danger to patients if you give and give until your weekly schedule must also include time for massage and chiropractor appointments. Flu vaccines, unsafe equipment, dangerous staff ratios, risk of physical harm from unruly patients because hospital security resembles nursing home patients—these all require putting yourself first.”
It really does come down to this: Nurses need to learn how to put themselves first. If you can’t lift that 300-pound patient, then don’t even try, no matter how much it needs to be done. Similarly, hospitals need to make allowances for nurse injuries. Providing mechanical lifts, better security, and education about safety could go a long way towards protecting nurses and keeping them at the bedside.
In the end, the question of keeping nurses at the bedside is definitely multifactorial—and controversial. Patients have been cared for all this time with the methods we’ve been using, so why change? The reason to change is that the nursing shortage is real, and it isn’t what you think. It isn’t a lack of trained nurses. It is a lack of trained nurses willing to work. If we can make the bedside more appealing to these nurses who have run for cover, perhaps the nursing shortage wouldn’t really exist at all.
We all sat around in my living room, friends in the fight against those nursing school teachers who seemed hell-bent on making our lives miserable. There were about ten of us crammed into my small living room for this Saturday study group, and I was the de facto leader. I didn’t need to be there. I didn’t need much more than to glance through the notes to get good grades, but I wanted to help these on-the-bubble students pass. I taught what I knew. Everyone wanted to study with me because, well, test scores speak for themselves in nursing school.
Yes, I was one of those, and I always have been. Give me a book, and I can ace a test. It isn’t really genius. It’s just that I know how to take a test. Of course, I was immensely proud of my 4.0. I didn’t lord it over people, but I did feel rather smug I guess, rather superior. I felt this meant the nursing world was my oyster. I was cocky that I would breeze through orientation, but I certainly didn’t feel I knew it all. I also didn’t put my fellow students down. In fact, I enjoyed helping them, fighting the good fight to get them to pass.
One day, my teacher said something that made the bottom drop out of my stomach: “The best nurses are usually those in the middle of the pack. Those who score high tend to not do so well.”
Was she talking to me? She said it to the class, but was she talking to me?
Maybe I was paranoid, but it turns out that there was a kernel of truth in what she said.
When I interviewed out of nursing school, no one cared that I graduated at the top of my class, although I told them repeatedly. They were more interested in how I would handle a crisis and what sort of person I was and whether or not I would fit in with this culture. Despite my obvious hubris, I am actually someone who can work well with others, can care for patients, and can be a part of the team. The only thing is that my work in school didn’t matter a damn to them.
What really opened my eyes was orientation. I was lost. Everything I had learned was so much chaff. It came into play from time to time, but it really and truly did not matter.
I remember the first time I had four patients. It was a juggling act. The fact that I knew all the bones of the hand by heart was completely irrelevant. I needed to look at vital signs and know what they meant. I needed to know when to pass meds and when to chart. Most importantly, I needed to know when I didn’t know something, and I needed to ask for help.
Fortunately, questions have never been a problem for me, and I was able to become a safe nurse because of that. This 4.0 student spent more time with her preceptor or charge nurse than she did with her patients in the first year of nursing.
And still, all that book learning I had was merely peripheral. Sometimes, it came into play. I would know obscure things about electrolyte imbalances, for instance. I was also considered one of the go-to nurses with problems in my later years.
But my knowledge is not what makes me a good nurse.
I found that my personal sense of patient safety was the most important. My ability to handle more and more stress became the calling card of my practice. My life was about looking at a situation and making a decision. Do I call a doctor about this, or do I have the means to fix it myself? Do I delegate this responsibility, or do I do it myself? Should I ask for help, or do I know enough?
My mentors—my preceptor, my manager, the various charge nurses, and the more experienced nurses—made me into a nurse. It wasn’t that huge book I lugged around for so many years. It takes a village to raise a nurse. Not a textbook.
These are skills that are not measured by GPA. These are skills that I have but don’t come as easily to me as multiple-choice questions. The point is that if you are a 2.5 student, don’t worry. Your ability to pass tests and get good grades has nothing to do with real world nursing. Trust me. I’ve been there. I am a good nurse. I worked hard to become one, but it didn’t have anything to do with what I did in school. It was about a fabulous preceptor, a supportive group of experienced nurses, and hard work on my part.
Not graduating at the top of your class? You may just be the best nurse yet. If you are someone who can manage your time well, you will make a good nurse. If you are someone who can stare down a stressful situation and make decisions, you will be a good nurse.
Most importantly, if you can and will ask questions when you don’t know the answers—and accept that you know very few of the answers—you will be well on your way to becoming a fantastic nurse. If you just eked by in nursing school, don’t let it bother you. Take it from someone who has been there: It doesn’t matter at all.
She didn’t know her words would haunt me for years to come. It was a night like any other night. I stood at the bedside of a relatively stable patient, and I was dutifully giving him his meds. The floor was quiet, patients and nurses preparing for the night shift a few hours away.
Like a fire klaxon, a voice cut through the relative peace of the hospital floor. “My husband is dying! My husband is dying!”
Instinctively, I dropped the medicines and darted out of the room. In the middle of the hall, a middle-aged woman ran toward me, screaming about her husband in the room across the hall. “He’s dying,” she yelled into my face.
Mouth dry, heart pounding, I pushed past her and entered the patient’s room. Of course, he was unconscious, blue, and not breathing. I started CPR, but the craziness was not over.
I wasn’t exactly a new nurse. I had been through a few codes, and they all went rather smoothly. I never experienced the stomach-churning nausea of having a family member witness their loved one dying.
The patient wasn’t mine, but I knew about him. He had recently had coronary artery bypass grafting surgery and was due to be transferred to the ICU any minute because his heart rate and rhythm were abnormal. His doctor was on the floor, writing the paperwork for the transfer.
Others had heard the wife call out in anguish, and everyone came running, including the doctor. He burst into the room, shouting, “I need an intubation kit! Get me an intubation kit!”
I could hear the rumble of the crash cart coming down the hall, but it hadn’t quite reached the room yet. The doctor continued to yell at me, to point, to spit. His hands shook, but I had been here before. I yelled back, “Hold on a second! It’s coming!”
I realized then that the doctor was more afraid than I was. The cart arrived, the patient continued to code, and the doctor got his intubation equipment. Although we managed to get a sustainable rhythm on the patient, he soon died in the ICU.
Of all the codes I experienced over my years as a nurse, this one sticks out as the most horrible. When codes start, nurses become the ultimate professionals. No one runs. No one yells. Everyone works as a team.
As a relatively new nurse, I never experienced the terror that “normal” people experience when someone starts to die. For me, I knew how to handle it. A patient going south deserves my close care, but the emotion is usually not high during care involving advanced cardiovascular life support. Afterward, I would cry and shake, but not when I needed my faculties about me to do everything I could to save a life.
This code was different. In fact, I can live it over and over in my mind, and I still feel as scared now as I did then. The wife and the doctor were breaking the rules. They didn’t know how to deal with death, and I don’t really blame them. I just know their actions scarred me deeply.
Trauma is a real problem in nursing, and situations like these can cause a nurse to relive moments that didn’t go well. This is especially true of new nurses. New nurses make mistakes, and they haven’t developed the ability to be the calm professional yet. This means that the trauma of extraordinary events can stay with them forever.
I never dreamed that I would face a family member who was screaming that her husband was dying. I can only imagine the torment she was going through, the heartbreak of knowing that her loved one was slipping away before her eyes. She reached out for the only help she could.
And that help was me.
Her terror has stayed with me all of these years. In that moment, I became her. I empathized with her, as any good nurse will do. I felt her sorrow, and despite our best efforts, we couldn’t save her husband. I find myself imagining how she felt when he actually passed away.
I will admit that this situation scared me, and I have dwelt on it more than I should. Nurses, especially new nurses, have to develop a sense of detachment from the patient and family. But what about the human side of the equation? Too much distance leads to too little caring.
I am happy to say that I took part in codes after this one, and I did the best job I could. In fact, I was praised for my work in situations where a life was on the line. But I never forgot the distraught woman in the hallway, or the surreal feeling of dread that her words—”He’s dying!”—caused in me.
It remains a trauma that has impacted my life forever. Nurses need to realize that they experience traumas, too, and that it is okay to talk about them. It is okay to be afraid. It is okay to reflect on the situation and examine the emotions the trauma awakens. Without this reflection, the emotions become buried. Ignored emotions manifest as substance abuse, out-of-control feelings, and hatred of the job.
My trauma is just one example. Almost every nurse has a story of when she or he was scared and traumatized. Talk about it. Don’t pretend to be so strong that you don’t need to ask for help.
I wish I could have saved that man. I wish I could have wrapped that wife up in my arms and made it easier for her. I couldn’t, but it will stay with me forever as the trauma in my career that haunts me, because I couldn’t hide behind the façade of the calm professional.
I am the calm professional, but I am human, too.
Tears build behind your eyes. Your mind plays over and over how much you want to turn and run, but you can’t. No matter what, you have to keep going because you are strong and people are relying on you. How can you endure it, though, when one part of you wants to scream and one part of you wants to break down and sob? You can do neither, and instead, you hold yourself as taut as a wire over the Grand Canyon.
You are in the elevator on your way up to your unit. Your shift hasn’t started yet, but these feelings are already invading your mind, spreading like tree roots into concrete. It will be worse once you are there, but nurses don’t crack. Nurses don’t break down. They get used to it. Except you can’t get used to it. It is killing you.
You are a nurse with clinical depression, and no one knows—not even you.
Depression is an epidemic in nursing, but no one will talk about it. According to the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), nurses experience clinical depression at twice the rate of the general public. Depression affects 9% of everyday citizens, but 18% of nurses experience symptoms of depression.
If this is such a common occurrence, why don’t nurses talk about it? They are afraid that they will not be trusted with patients and they will not be part of the team. Some of them cannot accept that they need care when they have always been in the caring role. Unfortunately, many nurses just don’t know they have it.
Causes of Nurse Depression
Since depression is so common in nursing, what is causing these men and women to feel this way? The fact that it is ignored is almost inconsequential when you consider the fact that the causes are also ignored. If the causes of this epidemic are not addressed, more nurses will become depressed, patients may be put in danger, and the profession could wind up losing yet another nurse to the stresses of the job.
“Medicine is a profession that doesn’t give much thought to mental illness,” says John M. Grohol, PsyD, the founder, CEO, and editor-in-chief of PsychCentral.com. “It is not within their realm of treatment.” Since medicine is concerned with what it can see, touch, and heal, mental health concerns are often shunted to the side. Nurses not only dismiss the idea of depression in their profession, but they also do it to themselves. This only causes the feelings to multiply.
It also doesn’t help that nursing culture is ruthless by nature.
“Depression is like a cardiac disease: you don’t know you have it. You don’t realize the subtleties,” says Louise Weadock, MPH, RN, the founder and president/CEO of ACCESS Healthcare Services. “Leaders need to create a culture that lifts nurses up. It shouldn’t be a culture in which only the strong survive. Nurses should not be proud of eating their young. Some managers brag, ‘If you can make it on my floor, you can make it anywhere.’”
The culture of survival leads nurses to feeling like they are always under tension—and this can cause anxiety, stress, and depression. Some nurses seem to take great pride in the amount of horrors they have endured, but for those who struggle with depression, living up to this standard and living in the culture only makes them feel like failures.
What are the evidence-based predisposing characteristics of depression, besides culture and neglect? The INQRI study found that certain factors, such as body mass index, job satisfaction, and mental well-being, can lead to clinical depression in nurses.
Furthermore, family problems can exacerbate the stresses a nurse feels, and often nurses feel out of control. They can’t control their shift, their patient load, or even if a patient lives or dies. Helplessness is a feeling that pervades the depressed nurse. When all of these causative factors are coupled with the disruptive cycle of shift work, can depression be far behind?
What does clinical depression look like in nurses? All nurses have covered mental health in their schooling and some work on mental health units. It is safe to say that most nurses know the general symptoms of depression, but it is far more subtle than what they were taught. In nurses, the symptoms are nearly buried under a continuously thwarted attempt to hide their feelings.
Guy Winch, PhD, a licensed psychologist and TED speaker, describes the different nuances in sadness and depression on the Squeaky Wheel blog at PsychologyToday.com:
“Sadness is usually triggered by a difficult, hurtful, challenging, or disappointing event, experience, or situation. … [but] when that something changes, when our emotional hurt fades, when we’ve adjusted or gotten over the loss or disappointment, our sadness remits. … Depression is an abnormal emotional state, a mental illness that affects our thinking, emotions, perceptions, and behaviors in pervasive and chronic ways. … Depression does not necessarily require a difficult event or situation, a loss, or a change of circumstance as a trigger. In fact, it often occurs in the absence of any such triggers.”
Nurses often feel this way as well, but other factors and symptoms appear. “Nurses deal with depression by doing more, keep moving, not standing still, not putting their feelings into words,” says Michael Brustein, PsyD. “They power through it.”
Blake LeVine, MSW, founder of BipolarOnline.com, also makes this point about nurse culture and the medical status quo in general: “There is more detachment in medical professionals who are depressed. It is normal to be slightly detached. When a nurse is depressed, they can also become more detached with their family. They are used to being detached, but they can’t bring it home and cry over people [who] are sick. Depressed nurses may cry more over a patient who died. They may get very emotional. Something they used to deal with in the past can get more difficult for them.”
Of course, this need for detachment and getting past the pain can lead to self-medicating. Usually, that takes the form of alcohol or opiates—both downers that can make depression worse.
“All studies show that those with substance abuse problems have depression or anxiety,” states Nikki Martinez, PsyD, LCPC, a verified mental health counselor on BetterHelp.com. “Prescription drug problems are often present, and that becomes their drug of choice. Just take a pill, and the pain is gone. When a nurse is having a bad day, they can’t wait to come home and have a glass of wine.”
In addition to various negative coping mechanisms, nurses exhibit many other symptoms that are obvious to those looking in on the situation. Weadock explains them this way: “Nurses can experience difficulty concentrating, are slow to respond in a crisis, are accident-prone, and have a limited ability to perform mental tasks, such as care mapping, calculating doses, or intervals required for biometric interpretations. They are reclusive with poor interpersonal skills, struggle with time management, and have lower total productivity outcomes than nondepressed workers. They often have a ‘short-fuse,’ leading to explosive outbursts toward patient, family, or coworkers.”
Stigma against Mental Illness
Nurses are usually willing to talk about the problems in the profession, such as short staffing, poor ratios, and lack of managerial support. However, what they are not willing to talk about is depression and mental illness in their ranks. It is arguably nursing’s best kept secret. Eighteen percent of nurses are suffering from some form of clinical depression—and no one will talk about their experiences with it, what to do about it, or what causes it. What is behind this stigma?
Grohol breaks down the problem by focusing on the two parts of stigma: prejudice and discrimination. “There is a great deal of misinformation and misunderstanding of what depression is,” he explains. “Many in the medical profession hold antiquated beliefs about mental illness, such as the condition was brought upon the self. Nurses are taught not to complain about it, and this is why they don’t talk about it.”
Then, nurses must deal with discrimination when they are found out. “Discrimination comes about when people with mental illness see nurses talking about those who have other medical issues, and don’t want things said about them,” Grohol continues. “Nurses would assign a person a label and boil down their personality to one word, and that is insulting and discriminatory.”
A primal aspect comes into this discrimination, as well. Nurses, for lack of a better reference, are a “band of brothers.” If you suspect the nurse beside you can’t handle the pressures, then you tend not to trust them.
Weadock has experienced this. “I don’t think nurse leadership or the workforce sees depressed nurses. When they perceive some sort of injury, then they throw the nurse out of the wolf pack. When you backslide into your disorder, that’s when people don’t know whether to trust you.”
The stigma has become so bad that many depressed nurses fear for their jobs. “Nurses know that admitting a mental health problem puts their job at risk,” says LeVine. “People are scared to admit it. That’s when mistakes happen. Get treated. Nurses feel they have to hide it to protect their jobs, but a nurse that seeks help for depression ends up a better and stronger nurse. Those who seek help have more longevity in their career.”
Psychologically, the prospect of losing everything rewarding about nursing is scary, and LeVine cites that as a reason for keeping quiet. “The hard part of admitting to depression is that nursing is a good paying job and losing it is hard. You are on a big team as a nurse. When you can’t do that anymore, you lose that sense of team. It is hard to give that up. Therapy means you can work on that and possibly avoid leaving the profession.”
One of the most prominent reasons for nurses to keep quiet about their mental health is the stigma associated with an “unhealthy” caregiver. Martinez describes it this way: “Nurses feel they need to be perfect and healthy at all times. It is just not possible when they are doing so much for someone else. Mental health professionals realize that this is a huge problem. Openly talking about it is the only way to break the cycle, but no one talks about it. When they do talk about it, it takes away stigma and shame.”
For these reasons and more, many nurses are living with depression in silence—afraid for their jobs, afraid that they are weak, and ignoring their own health in favor of others. In addition to education, treatment for nurses specifically is important for recovery and retention.
Self-Care and Treatment for Nurses
Nearly all experts agree that education is the primary method to get nurses treated for depression. This means educating management on what to look for, and for nurses to know the symptoms to recognize the condition in themselves and others. Sometimes coworkers can see symptoms far better than a manager can. If the stigma is reduced with education and support, those nurses can get the help they need from a team effort.
Weadock suggests that this reform starts with the manager. “A manager should say, ‘I’m going to put you on the bench and help you get better.’ Assignments should be given out just a dose at a time, because you don’t want to ruin the reputation of a good nurse. The nurse can’t help it when they are feeling depressed. Management needs to lift the RN up by promoting them to other suitable, supportive work environments, and to make reasonable accommodations for nurses whose cyclic phase of depression is negatively affecting their work performance.”
After management has identified a struggling nurse, that nurse should be introduced to treatment and encouraged to keep attending. Many nurses terminate their therapy because they think they don’t need it, they don’t feel they should be sick, or they are afraid someone will think they are weak.
“Seek medical treatment with a professional that understands depression,” LeVine suggests. “Find a therapist who understands a nurse’s career and life. Openly assess your situation. Do you need to take a break? If it is all too much, it is okay to do something else. It is better to admit that you are struggling and seek help. It’s like trying to fit a round peg into a square hole.”
What can nurses do when they are in therapy and still working? According to Martinez, it all comes down to self-care. “Nurses often don’t have good self-care. It can be as simple as starting the day off right, instead of waking at the last minute and rushing around. Start off slowly: have some coffee, do meditation or yoga. Do things at the end of the day, too. Have rules with your family that the first half hour after work is for you when you come home.”
Alejandro Chaoul, PhD, is an assistant professor in the integrative medicine program at the University of Texas MD Anderson Cancer Center. Working for a hospital, he often instructs nurses in how to better handle the stresses of their jobs.
“The motivation for nurses is that they feel like they shouldn’t focus on self, but they can focus on how their own mental health can help patients,” Chaoul explains. “We don’t need an excuse to take care of ourselves. It is an important part of being, not just a nurse. We have forgotten this. Showing how busy we are is the way to go. If you tell someone you are happy, it is almost like a sin.”
Nurses are practical, though. Self-care, therapy, and meditation are great ideas, but how is a depressed nurse supposed to handle the rigors of their fluctuating mood while actually working on the floor? One helpful technique is known as grounding. Grounding can be done anywhere, anytime, cannot usually be seen, and can last as long as you need it.
Lisa Najavits, PhD, describes grounding in her book, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, as follows: “Grounding is a set of simple strategies to detach from emotional pain (for example, drug cravings, self-harm impulses, anger, sadness). Distraction works by focusing outward on the external world—rather than inward toward the self.”
Najavits breaks it down into three categories: physical, mental, and soothing. A physical grounding exercise would comprise breathing in and out, thinking a soothing word on every exhale. A mental grounding exercise would include describing an everyday procedure, such as passing meds, in as much detail as possible. Finally, soothing grounding might be picturing your loved ones—or actually looking at a picture of them. For each type, there are many types of grounding, and these techniques can be learned through therapy.
Although the reasons for nurse depression are multi-factorial, part of the problem is the stigma. With education and a decrease in the antiquated notions of mental health, these nurses could get help. Registered nurses are leaving the profession in droves. Some of those defections are due to injury, but a large part is likely due to undiagnosed or unacknowledged depression. If nurses hope to keep the profession vital and solve such problems as short staffing and poor ratios, they need more nurses to stay working as nurses. Helping, instead of ostracizing, nurses with depression is exactly what nurses need to help solve other problems that they face.