Nurses know that it is important to care for patients as a whole- physically, mentally, and spiritually. They know the toll that depression can take on one’s health. Because of this, nurses go above and beyond for our patients and that includes patients with psychiatric needs. Nurses make sure their patients have all the referrals, medications, appointments, and access to resources to ensure patients have the best chance of recovery. They advocate for and encourage them to get the help they need.
Nurses see a lot of trauma on a daily basis and there is a cumulative effect of the compounding stress. Poor coping skills are perpetuated because of time constraints, the never-ending cycle of patients, and nurses’ experiences are labeled as just “part of the job.” When stressful events and the emotional impact they have on are not processed, they begin to fester and gain more control. Because of this, burnout, anxiety, depression, addiction, and PTSD are common amongst the nurses; but instead of seeking help, the nurse motto is:
“I’m fine.”
Why do nurses reject their own mental health needs?
- It is ingrained in nurses from the very beginning.
New nurses learn right away that in order to keep up with the demands of the job they have to be on their game 100% of the time. The job involves split-second decisions that can have life or death consequences for patients. When a patient dies or has a close call, nurses do not have the luxury to grieve and process in the moment because they have other sick patients to attend to and as soon as a bed is empty, they will get another one.
- Nurse’s compassion works against them
Since the job demands so much of the nurse, they sacrifice their own basic needs to ensure their patients needs are met. At work nurses skip meals, rarely hydrate, and cannot remember when they last used the restroom. Selflessly ignoring their own needs becomes the foundation of every decision made at work. Oftentimes, that foundation extends to their personal life as it becomes harder to switch mentalities back and forth. Nurses continue to ignore their needs. When a person does not take care of themselves that can lead to depression, anxiety, alcoholism, drug abuse, and unhealthy relationships.
- Unhealthy sense of responsibility
Not only do nurses have high levels of compassion, they also have high levels of responsibility. When people’s lives are at stake, responsibility is a key requirement. But just as compassion can start working against the nurse, so can responsibility. Whenever something goes wrong, even if it was impossible to prevent, nurses feel guilty. They replay the scenario in their heads over and over again asking, “What did I miss?”and “What could I have done differently?”
- Nursing Guilt Theory
Every nurse experiences “Nursing Guilt.” It is found in new and experienced nurses alike.
It happens when nurses are so busy just trying to keep their head above water that they don’t get to spend time with their patients. When they are so bogged down by tasks that some become late or have to be passed on to the next shift. When they have a deteriorating patient and haven’t stepped foot in other patients’ rooms for 5 hours. When all they are doing is passing nonstop meds and feel more like a drug dealer than the nurse they trained to be. When they forgot to get their patient something simple they promised them hours ago. When nurses have done a million things that shift, but at the end feel like they did nothing. When they know they have so much more to give as a nurse, but the assignment they were dealt did not allow it.
That feeling is Nursing Guilt. Not only do nurses have Nursing Guilt, but what do they do about it? NURSE it! They foster it. It dwells in their minds and spoils the joy they take in their work. It frustrates nurses and perpetuates the lie that they are not good enough.
- Nurses have a battlefield mentality
Even if a nurse has not been deployed to a war zone, they develop a battlefield mentality. They have a team. They fight together, have victories together, and lose together. Nurses have common language and experiences to be able to understand the full impact of what they experience and carry each other through to the end of the shift.
There are stories of wounded soldiers pushing through recovery so they can redeploy to their unit again. It seems unfathomable when all while they were at war they just wanted was to be home with their family, but nurses are the same way. Nurses go to work sick because they feel guilty when they call off work. They know what it is like to work short-staffed and the additional pressures that puts on an already stressful job.
- Refusal to be Vulnerable
If nurses miss something, their patient can die. Distraction can cause things to be missed. Nurses refuse to be the reason harm comes to a patient. Whether something is going on at home or there was a rough situation at work, nurses box it up, push it aside, and soldier on. It’s not that they do not have feelings. On the contrary, nurses are the most compassionate and empathetic people to do the work they do. A nurse will cry as they hold a dying patient’s hand and comfort their grieving family members, but compose themselves as they walk out of that room and smile walking into the next room. If the nurse is emotionally vulnerable past the threshold of that dying patient’s room, it is a distraction and therefore a weakness.
These Reasons Create A Duality
There is a mentality amongst nurses that what they know, believe, and teach about mental health cannot apply to them. They fight to remove the stigma of mental health amongst the community, but perpetuate the stigma amongst themselves. Nurses praise others for making their health a priority while refusing to let their own guard down.
This inconsistency between beliefs and behaviors is called Cognitive Dissonance. What applies to everyone else does not apply to them. To some extent, that rings true. There is a job to be done and the nature of the job requires nurses to be fully present at all times. However, nurses are human and the impact of stress and trauma on mental health is universal.
A nurse grappling with a traumatic situation interprets vulnerability as weakness. Nurses hold themselves to a higher emotional standard than even fellow nurses do. All nurses know the toll it takes to walk out of a dying patient’s room, flip a switch, and carry on as if they do not have any other priorities but the next patient they see. Compartmentalized boxes pile up and become a heavy weight on the soul. Nurses selflessly carry that burden, but there comes a breaking point where the manageable sacrifice turns into martyrdom.
Ways to Fight Mental Health Stigma in Nursing
- Permit yourself and fellow nurses to be vulnerable
One way to help prevent the progression to martyrdom is to give permission for nurses to be vulnerable. Allow them to pause after a patient’s death, near death, or violent event. Give them time to breathe and release negative energy instead of forcing it to stay pent up inside. A 5, 10, even 15 minute break is possible in the busiest of hospital settings.
- Talk about it
When a difficult behavioral patient is rude to a nurse, nurses have no problems venting to co-workers in the medication room. Take the same approach with all situations. Sit down in the charge office or breakroom and talk to a co-worker about it. Debriefing can be an effective processing tool to prevent the buildup of ignored emotions from presenting themselves as symptoms of post-traumatic stress. It can be as simple or as detailed you are comfortable. Nurses need to know that they are not alone and what they are feeling is perfectly normal after being involved in or seeing what they have seen.
- Step up and be a role model
Be the nurse that breaks unhealthy workplace patterns. Workplace environment does not become healthier on its own. It takes a catalyst and fuel. You cannot control other people’s actions, but you can influence them over time.
- Start with yourself. Prioritize your mental health by taking a break after key incidents and debrief if possible. Allow yourself to be vulnerable and ask for help when needed.
- Encourage your co-workers to take a break. Ask them when the last time they had water or if they had an opportunity to take their lunch break yet.
- Offer help to ease your co-workers load. When you see they are busy, ask them how you can help. Pass medications for them or take their patient to the restroom so it allows them to get other things done.
- After a patient event, offer to cover their patients while they take a break. Even if they are getting an admission, you can take a report and make sure the room is ready.
Over time, your co-workers will recognize the changes to the way you practice nursing and how those changes are not only benefiting you, but them as well. When nurses see the benefit of change, they are more likely to adopt those changes. If you train new nurses, instill these positive practices with them. Over time the work environment will evolve to have a more positive culture.
Fixing ingrained patterns within the nursing profession that perpetuate an unhealthy perspective on the mental health of nurses is not going to happen over night. It is a long, but necessary process to improve the quality of life for nurses.
When nurses accept that they are just as worthy of love, compassion, and care as their patients, the healing will be able to begin.
