Hey Nurses – Let’s Talk Moral Injury

 

There isn’t a day that goes by I don’t know of something I’d just love to write about.  The shifts in what I like to refer to as my “school shoes and scrubs” at the hospital definitely give me the most material with which to work.  Often, especially lately though, I come home and my mind just goes blank.  Over the past year I haven’t decided if that’s because I’m simply too exhausted after a 12-hour shift, or I’m just getting better at keeping my mouth shut (or in this case, my laptop).

Maybe I worry that what I’d love to get out of my head, off of my heart, or off of my CHEST just might offend someone.  Maybe what I think is just irrelevant or inappropriate – even if it IS true.

Maybe as a Christian I’m worried about offending those who aren’t because I’m supposed to live up to some standard that’s unattainable – one I fail at every single day.

Perhaps I’m even worried about offending other Christians by instead of painting some unrealistic fairytale picture – I tell it like it really is.

Or maybe I just don’t write some of this stuff because sometimes, it’s just too much.  Too much to process.  Too much to think about once I clock out.  Too much to talk about on my days off.  And too much NOT to have a good laugh with my co-workers over because like it or not – they are the only ones who understand and share that same sense of sick medical humor.

Maybe I’ll figure all of this out three-quarters of the way through this blog.  Who knows?

Maybe I’ll type this up while sipping on some plain old black coffee (not the expensive kind), and end up erasing the whole doggone thing for some of the above reasons.  Who knows?

Maybe I’ll publish it, and because nurses typically bottle up all of their moral injury, someone will share this blog and their loved ones will understand them better because I voiced some of it for us.  Who knows?

Maybe someone will be able to relate to me, encourage me or be encouraged by me (I hope the latter).  Who knows?

Maybe I’ll just feel better when I’m done.  Who knows?

Here goes……

I’m an ICU nurse, and I just finished a three-day stretch of 12-hour shifts.  Exhausting shifts.  After one of them, I think I posted on social media something about moral injury being real.

It is.  It’s really, really real.  And today, my first day “off” I can prove it because I had to call my friend and confess how I behaved this morning when I got “bumped” by a perfect stranger.  More about that later.  Maybe.

What do I mean?  How do nurses suffer from moral injury?  Why – I’m so glad you asked!!!

Let me give you a glimpse into just a few scenarios I’ve encountered recently.  Maybe they’ve been over the past 72 hours.  Maybe over the past 12 months.  Maybe over the past 12 years.  Who knows?

Maybe it will make some nurses and physicians laugh.  Yeah – it will definitely do that.  But maybe it will also help family members and friends understand.  I really hope it does that.

I’m 56 years old.  It’s getting harder and harder physically to do this work.  And emotionally, it doesn’t matter if you’re 22 or 62.  It’s just plain hard work.  And it’s hard to share how hard it is with those outside of work because of all of the above reasons……..   You won’t understand us.  You’ll judge us.

It’s hard to take care of addicts and alcoholics who are withdrawing.  They like to fight.  Yes, physically fight.  They are strong.  We often have to call security and hold them down with staff until they get there and restrain them with leather restraints.  Meanwhile, we are very, very often spit on, kicked, punched, threatened – you name it.  We come into contact with bodily fluids that may have diseases we risk becoming infected with.  I’ve personally had my eyes flushed from having hepatitis C blood splashed all over my face, and have been poked twice with dirty hepatitis C dialysis needles.

We get called bitches and whores and “C U Next Tuesdays” and a number of other vulgar names that I would normally not repeat, but in the spirit of full disclosure – I’m hoping and praying this brings some sort of understanding to those who love a nurse somewhere!

We love you, but we’re TIRED WHEN WE GET HOME!!!!!!    And there’s only a few short hours until we go back to the verbal and often even physical abuse we just left!  (Re-read last paragraph if necessary).

Just this weekend (maybe), our nurse technician was purposefully pooped and urinated on.  An hour later she compassionately gave that patient a bath.  An hour after that, the patient was “hocking loogies” (that means spitting phlegm) at us.  The following day, she kicked me.  

Good times!

Reality check – There is nothing glamorous about being a Registered Nurse.

If it weren’t for the young gentleman a few doors down who after coming off life support threw his arms around me and said thank you, I’d have left work even more discouraged than I did.

But, let’s get back to moral injury…….

We’re all about saving lives.  We’re all about fighting disease and living a productive, meaningful life for as long as possible, but…….

None of us are going to arrive at the end of our lives in great health, safely, unharmed, and in the best shape we’ve ever been in.  Death is a part of life.  And there just comes a time when we’ve got to think about someone other than ourselves…….

Sometimes we have to LET our loved ones die, because SOMETIMES, it’s selfish of US to keep them alive.

We have to trust the physicians, the diagnosis, the prognosis, GOD, and we must honor our loved ones wishes.  And you’ve got. to. trust. your. nurse.

For the love of Pete (Pete’s my Dad)……     Please trust your nurse.

Do you know what’s really, really hard?  Taking care of the same patient for months and months and months and months.  And the patient is soooooo sweet.   They are in continuous pain, yet manage to blow you kisses when they can’t talk.  Wounds on their backside the size of a baseball – and literally ROTTING…….  Hour after hour we turn, we dress, we clean, we medicate, we clean again, we turn again.  We travel for tests.  We go without breakfast.  We go without lunch.  We go without peeing.  And then after 10 hours, the family member comes in and says something like, “Well, it doesn’t look to me like you put any Vaseline on Mama’s lips today!  I’d like to talk to your charge nurse!”

Can I get a witness?

You know what else is really hard?  When your loved one, who trusted you to make the right decisions regarding end-of-life care, is forced to remain alive and tortured because you refuse to believe an educated physician’s diagnosis and instead, demand that your loved one not receive any sort of pain medication because you want them to be fully awake so that you can visit with them for ten minutes.  Or when you refuse to look at their wounds – the ones that cause excruciating pain when they are being turned by the nurses.   Or when you hire someone you met on line, and pay them under the table to sit in the room to monitor whether or not the nurse is doing their job.

It’s also difficult to say goodbye to our patients – especially the ones who shouldn’t be dying, but should be going on to dental hygiene school in their 20’s.  But instead, they are dying of brain tumors and other cancers……     And to be the one who has to answer “yes” when they ask if they are really going to die.  Have you ever had to do that?  It sucks.  (Sorry – There IS no other word to describe it.)

Dear God, I hate cancer with every cell in my body.  Every.  single.  Cell.

Zipping body bags and waiting for transport to come and take them away on a metal stretcher.  The same patient you and all of your friends spent weeks caring for, hoping for some improvement, getting to know their family members, their family dynamics, and even how many creams and sugars each of them took in their coffee….

And then being told by a well-meaning loved one that “You’re so lucky that you only have to work three days a week!”  Or being told you’re “rich” when your employing hospital doesn’t even provide you when a retirement package or decent health care coverage.

Another reality check – Nurses aren’t rich.  But we DO know what matters most to people at the end of their lives.  (And it’s not “stuff.”)

So yeah…..   We’ve got sick senses of humors.  We can discuss the consistency of poop and eat lunch at the same time.

We like long drives with loud music.  Or no music.

We like to leave our phones on silence.

We cry really hard, and we laugh even harder.

We are better at making fun of ourselves (and each other) than anyone else.

And yes, we only work three days a week – and we need at least one to recover, so please don’t make plans for us on that day.

We don’t always want company.

We love silence.

We need alone time.

And we’ll wake up tomorrow and we’ll do it all over again.

Because we’re nurses.

So as I come to a close on this here blog post…..     I just got a text from Carrie, the friend I called to confess my ugliness to when I got “bumped” this morning…..

I’ll just give you HALF the story.   I was in my office (at my 2nd job), and went down to use a large public bathroom that has about  – I don’t know, maybe 15 or so stalls?  I am fairly certain I was the only one in it.  A young teenage girl came in and sat in the stall right next to me and started yelling at me because she didn’t like the smell of my poop.

Ummmm, sorry???   No.

Having had poop slung at my nurse tech this weekend………….    And having had to inhale the ICU smells that are unique to every ICU for the past three days……….    Well, let’s just say I schooled that young lady on what public bathrooms are for, and that neither she nor her poop were exempt from the smell of YUCK……

And then I drove home.

At first, I thought, “It’s not my fault.  I’m morally injured.”  But then, I promptly called my friend Carrie and confessed (and yes, laughed).

There.  Confessed twice.

I hope this makes somebody somewhere laugh.  I hope it makes someone who knows a nurse un-offended when they don’t feel like stopping by on their way home from work.  I also hope I don’t regret this blog.  But, who knows?

Time for lunch.