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.
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?
Nurse-Specific Symptoms
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.
If you asked nurses or doctors what type of stethoscope they need, most wouldn’t know. Most would pick a type of 3M Littmann stethoscope and call it done. However, many different 3M Littmanns are listed on the site. Which do you need? How can you tell? There are also different manufacturers. Are there some that are better than others?
Marc Leavy, MD, is a primary care physician of 40 years at Lutherville Personal Physicians and the owner of A String of Medical Pearls. He believes that, “Cheap instruments are cheap. A painter will not use a cheap paintbrush. You need a tool that allows you to perform up to your best expectations.” Even with the cheaper types of 3M Littmanns you can get good sound merely from the way they are made.
Does this mean that everyone should own 3M Littmans or that they should have the most expensive type? Not necessarily. Dr. Leavey goes on to state that “if you are just doing blood pressures in a clinic, you can spend that kind of money, but you really don’t need it. You can also drive a Mercedes to the store to get milk, but you don’t need to. There is a world full of people who will take your money, but sometimes there is no net gain.” The question is: How do you make the decision about what you need for the good of your career . . . and your patient?
Which Brand to Choose
It doesn’t have to always be a 3M Littmann. Morton Tavel, MD, Clinical Professor Emeritus of Medicine (Cardiology) at Indiana University School of Medicine and owner of Mortontavel.com has a great deal of experience choosing stethoscopes. “Some of the generic brands can be pretty good. I have tested one or two, and they aren’t bad but they wear out quickly due to substandard materials.”
Some have two air tubes, but the rubber can deteriorate and the diaphragm can go bad. When he has tested the 3M Littmanns against other models, he has found they hold up well, but it doesn’t depend on the stethoscope as much as the practitioner listening to the sounds. He is passionate enough about this to have a complete heart sounds course available on his website.
Dr. Leavy has had different experiences. “I had an off brand, and the chin piece snapped. I’ve never had a 3M Littmann do that. Will the cheap one last? You could use it as throw away.” He notes that the latex tube can develop dry rot and the earpieces don’t fit well. Nurses should weigh whether it will last long enough to justify buying it for the short term.
For newer nurses, having a cheaper one may be preferable until you see what you need from your nursing job. Some of the other companies that produce stethoscopes are American Diagnostic Corporation, Allheart, Prestige, and Welch Allen. The stethoscope has to fit snugly in the ears, be long enough for you, and possibly have both a bell and a diaphragm, depending on specialty.
Choosing a Stethoscope Based on Specialty
The type of stethoscope you need is largely based on the type of nursing you are doing. Mihai Toroiman, BSN, RN, Director of Nursing for Abcor Home Health, Inc, strongly believes in quality scopes for higher acuity patients. “The higher the acuity, the more you want to have an expensive stethoscope. The life of the patient could count on that stethoscope. If the quality is not there and the sounds are not clearly defined, you could jeopardize the life of the patient.” Other nursing units like same day surgery may not need as powerful a stethoscope, but it is another set of eyes for the nurse. Nurse Toroiman states, “It has to be reliable and accurate, function well, and provide confidence that the nurse can definitely diagnosis what they hear.”
Critical care seems to be the area that requires the more advanced stethoscopes. Trauma is another specialty that depends on the stethoscope’s ability to hear fine sounds that may not be obvious with other stethoscopes, even some of the cheaper 3M Littmann types. School nurses, same day surgery, and endoscopy may not need the equipment that runs into the hundreds of dollars, but those who depend on hearing minute sounds–such as cardiology, telemetry, and critical care–certainly require a more advanced stethoscope for the patient’s safety.
Dr. Leavey recommends sane evaluation of stethoscope selection. “In ICU or trauma, when you need to hear things well, then spend the extra money. You can hear better with the more expensive stethoscopes. When you hear a murmur, it is important to diagnose it expertly. When in critical care, you have to bear the expense because it is important to the job. A school nurse who takes blood pressures doesn’t need more expensive stethoscopes because they will refer patients to a facility. You need to appreciate changes in patient. You don’t want to be unsure. You should have that tool for precision.”
Newer nurses are often bewildered by the amount of stethoscopes available on the market, and that is a normal feeling. With the differences in brand and even the differences within a brand, it can make it difficult to know what to buy. When you are in school, opt for a less expensive type that will help you to get to know your basic breath, bowel, and heart sounds. You don’t need the prestige of a 3M Littmann that early in your career.
When you have been on the floor for a while and have seen the types of stethoscopes out there, then it is time to make a decision. Choose a stethoscope that meets your needs and is the safest for your patient. But, as Dr. Tavel states, knowing what you are listening for is far more important than what type of equipment you use. By knowing what a murmur or an extra heart artifact sounds like, study the sounds through the use of classes. See this link for an expert’s view on heart sounds, what they sound like, and how to identify them. Then determine the type of stethoscope you need.
Kelley Johnson looked like any other nurse as she stepped onto the stage of the Miss America pageant. Wearing a dark blue set of scrubs, a stethoscope draped around her neck, and her beautiful hair pulled back away from her face, she looked like any other nurse you may meet in your facility.
It took a great deal of courage to do a monologue for her talent portion. After all, how do you illustrate the talents that it takes to be a nurse? Kelley took a deep breath, steadied herself, and launched into a touching story about an Alzheimer’s patient who moved her. Nurses knew what she meant to convey with that story. All of them have had similar experiences.
What was not expected was the backlash that started a movement with Kelley at the center.
Kelley was born in Fort Collins, CO in 1993. Even as a young child, she knew she wanted to go into a helping profession. “I always wanted to take care of people when I was little, but was unsure in what capacity I would practice as an adult.”
Like most potential nurses, Kelley did her homework and found nursing was her calling. “I loved shadowing nurses and doctors in junior high school. After science and anatomy courses in high school I completed my CNA course. I knew that nursing was for me as I headed into college.”
College proved an exciting and rewarding experience for Kelley. She attended Colorado Mesa University from 2010 to 2012, graduating with a BSN as the valedictorian of her class. Despite her stunning good looks, Kelley has found that she was never discriminated against because of her 6’1” frame, her long blonde hair, or her participation in pageants.
“No, I have not [been treated differently because of my looks]. I have never felt like my patients or their families didn’t take me seriously, either.”
As a student and a new grad, Kelley probably never thought that she would be the center of controversy, a rallying point for nurses, or a potential ambassador of the profession. She states, “I did not anticipate this incredible reaction. I am thankful that the amazing and experienced nurses of America are receiving a newfound recognition that they deserve.” The recognition they are now receiving is a result of her courage in expressing her talent, and the backlash from a popular talk television show.
By now, everyone knows that the commentators on The View poked fun at Kelley’s heartfelt presentation. Although they were criticizing pageants in general, they referred to Kelley’s scrubs as a “nurse costume” and the stethoscope around her neck as a “doctor’s stethoscope.” The reaction of nurses around the country was immediate and outraged. The comments made by these talking heads degraded the contributions nurses have to the medical system and showed a marked lack of understanding about the profession as a whole.
Kelley never realized she would be in the center of such an intense media storm. Perhaps it is the deplorable depiction of nurses in the media. Kelley feels differently, though. “There are both positive and negative portrayals of nurses in the media. I don’t believe that media had an effect on the backlash from the View. I believe, as they said themselves, it was a lack of understanding.”
Unfortunately, this lack of understanding about nurses is far too common. The public simply does not know what nurses do, and the comments by the ladies on The View only exemplified the relative knowledge of most of the public. Although The View tried desperately to backpedal on what was said, even going so far as having a nurses’ day on the show, the apologies rang hollow to most nurses. Kelley, however, kept a positive outlook and would rather focus on the issues in nursing than the media storm.
Nursing has many issues, and like most who work in the trenches, Kelley has opinions on how to deal with the major problems. For instance, short staffing is a problem everywhere. She offers this advice, “I think it’s important to continue to have recruiting efforts through nursing schools and student associations.” Recruiting is definitely needed to help with the profession’s major problem of short staffing. Engaging potential nurses through schools, such as high school and college, could help make an impact on this issue.
Another problem in nursing is the crushing loans that are required to pursue a degree. Kelley has come under some fire because the Miss America pageant will pay her student loans, but she agrees it is a problem. Her solution is both practical and simple. “I believe in nursing incentive programs provided by hospitals for continued education. I also believe that student loans are an issue for most professions, not just nursing. We need legislation to decrease costs across the board for students and make loans more affordable and accessible.” Loans are a countrywide problem, but nursing is hard hit. Incentive programs seem like the best solution, but loans are a problem that needs to be addressed in nursing immediately.
Despite the backlash of The View and the problems nursing has, Kelley remains dedicated to pursing her career in nursing, including going on to get her MSN. “[I want to pursue] nurse anesthesia. I love math and pharmacology, and I want to increase my scope of practice in those fields within nursing specifically.” For someone with so many strengths, she is sure to excel in this program as she has in so many other aspects of her life.
While being a contestant on Miss America would be stressful for most people, all nurses know that the most stressful part of being a nurse is handling a code. Kelley sums up her feelings this way: “Being in a code is definitely more stressful. Being in the Miss America competition was exciting and rewarding, but it was not stressful for me.” Most nurses would likely agree.
