PTSD and the Trauma Nurse: Now What?

Tuesday


Love these Trauma 'Meerkats'
Despite spending 25 years of my life in Emergency Departments, it seems strange to me that I have trouble recalling the horrific injuries and events where I delivered care directly. And that is probably a good thing.

I do remember coming on shift one morning and learning that the night crew worked to save the lives of a mom and her two little boys following their vicious stabbing. The boys died.

I was met with incredulity when I asked ..."So why didn't anybody call us in?"

Part of what makes a good ER Nurse great is to "never letting them see you sweat" and being proud of it. Keeping your cool is extremely important and I totally support that but after witnessing the violent deaths of a 5 year old and 7 year old, I'm thinking that maybe - just maybe - these nurses, techs and docs should have had every effort made to relieve them of having to care for the yeast infection or snotty nose down the hall.

Call me a bleeding heart but I have never forgotten the nurse who came to me that morning, recounting all three stabbing victims arriving simultaneously at 3 am. CPR in progress on the two boys, their Dad pacing the corridors of the ER, the chaos that ensued and then wrapping it all up by reporting off on the other patients that remained in his care.

And no one was called in to relieve the ER staff.

I 'get' that in events such as these, the last thing on the minds of ER nurses is to have someone come in to take care of them. But I guess what I am suggesting here is that it might be a good idea to have a plan in place in the event that your ER staff might need to be cared for. Really. And I doubt you would catch a whole lot of flack from the nurses who are called in to relieve their peers.


...Now What?


Creative Visualization:

Years ago, I read somewhere, something about Creative Visualization.

It takes about as much time as it would to take 5 deep breaths. I've practiced this technique for years and I'm sharing it with you because it really seems to help... especially when you are feeling particularly overwhelmed, negative or angry. You can do it behind a curtain, in a bathroom, in the med room, anywhere.

Close your eyes and "visualize" or imagine the color pink (or purple, or blue ...whatever brings you peace). Breathe the color in through your nose. Visualize the color entering your lungs, exchanging into your cells, travelling down to your fingertips and toes. Now exhale forcefully. Visualize cleansing black soot releasing from your body and coming out of your mouth and nose.

Instant "Attitude Adjustment". I swear.

Meditation:

I attended a conference recently where Dan Harris presented his take on Meditation after experiencing a live "on air" panic attack... This 13 minute video is worth your time.

Meditation? The way I look at it... can't hurt - and might help.

PTSD and the Trauma Nurse

Sunday

Credit: Getty Images
Trauma Nursing was my thing and I was really into it.

Gunshots and stab wounds? Broken bones and collapsed lungs? Bring it on! An adrenaline junkie for sure and proud of it. My life as an ER nurse was entwined in that sort of thing and I had very little time or patience for those who just didn't 'get it'. My friends were ER nurses, techs, docs, RT's, ER clerical staff, cops and firemen. We spoke the same language and I really wasn't interested in developing relationships with 'outsiders'. No need to measure my story-telling with them, nothing could gross them out. I worked hard, partied hard, smoked like a freight train and fastened my seatbelt only after witnessing dental trauma of those who chose not to. I was young and indestructible. And totally desensitized.

My 'cold, hard slap in the face' came when Maureen, my dear childhood friend (after being regaled by my bloodiest and guts-iest stories of the ER) said..."Joanie, what happened to you? You sound like you couldn't give a shit."

Thanks. I needed that.

Ahhhh, and that was why 'normal' people and their trivial complaints pissed me off so much.

So, I gave my head a shake, re-evaluated my trajectory in life and took an opportunity that presented itself in corporate America as a Clinical Educator with a manufacturer of bedside monitoring systems. Nice. I travelled extensively and totally engrossed myself in clinical technology. A healthy change.

When the staff of the various OR's, ER's, and ICU's I visited learned that I had worked in the ER's of Parkland and Baylor, I was frequently encouraged to share 'war stories'.  I choked. Literally. Just couldn't do it.

Then, while on a flight and flipping through a magazine I saw a spread on Trauma Centers. A full page photo of of a Trauma Room - after the trauma - was featured. Inexpicably, my heart pounding, throat tightening, palms clammy - can't breathe. It got hot -  really hot - I turned the fan on above my head for relief. A panic attack? No way. I've been on planes a million times. Closing my eyes, I attempted to calm myself. Slow, deep breaths. Whew. I was OK. Opening the magazine where I had left off... the symptoms returned -with a vengeance.

Post Traumatic Stress Disorder (PTSD) - I had only heard of this disorder when referring to military war survivors. Was I (and so many of my sweet, kind, dedicated nurse-buds) afflicted by it? Who knows? But certainly food-for-thought.

This began my journey into understanding just how witnessing, inflicting and internalizing the pain of so many affected me.

Your 'take-away' here might be to look into PTSD and determine if it affects you or those you love. Treatment for those affected by PTSD? The experts agree that what works for one may not work for others.

Here are some links that you might find helpful on the subject...

PTSD in Emergency Workers
Post Traumatic Stress Disorder
Increased Prevalence in PTSD and Critical Care Nurses
PTSD in Nurses

Namaste.

Our Dirty Little Secret: Lateral Violence

Friday

I wish I could give credit to this artist...
Two years ago, I retired from bedside nursing. My initial anxieties of "what next.?", were soon relieved by sleeping late every day, volunteerism, crafting and oil painting. Ahhhh, Nirvana. A two-year nursing honeymoon period, for sure.

Last week, in an effort to maintain licensure, I attended the American Association of Critical Care Nurses' National Teaching Institute (AACN-NTI) where over 8,000 Critical Care Nurses converged on New Orleans, La.

I chose this conference because I could knock out over 20 CE's in 4 days. 

Coming to terms with recognizing my interests no longer lay in "Advance Concepts in Ventilator Management" or "Cardiomyopathies: Understanding the Complexities of Diverse Diagnosis", I chose to attend classes on topics that are rarely discussed outside of nursing circles... "Workplace Violence: Do You Have A Plan?", "Impact of Moral Distress on Perceptions of Work Environment and Patients Safety", " Bullying: An Unhealthy Intrusion in the Work Environment", "Silence: A Never Event" were just a few.

And I grieved. 

I grieved for the thousands of nurses broken by workplace violence, bullying, lateral (aka Horizontal) violence and workplace violence delivered at the hands of patients. 

I grieved for my oppressed and subjugated peers. I know it sounds bad - really bad - and for so many, it really is - but it's time to talk about it and delve into why it occurs so frequently in a profession that is consistently ranked as the most honest and ethical by the public.

In my twenties, a manager taught me a valuable life lesson ..."Don't come to me with a problem unless you have a solution." So I'm writing about 'our dirty little secret'. Not to 'slam' nurses - but to share what I have learned, if only to begin the uncomfortable conversation and possibly support those who are experiencing the phenomenon and to prevent future pain to those who are on the frontlines of healthcare delivery. 

Incidentally, ER Nurses are subject to this form of violence at a much higher rate than any other specialty.
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25 years ago, Meissner coined the expression... "Nurses Eat Their Young". I disagree. In my experience, many of my peers have a less discriminatory palate and will "eat" anything that has let their guard down (ie: the nurse who has been on their feet for the past 12 hours and too tired to fight) .

I was 50 years old. An ER nurse for 25 years, it was the lateral violence I experienced at the hands of several young ER nurses that helped cement my decision to leave ER Nursing permanently and try my hand in the ICU. Usually, it was non-verbal, eye-rolling and sarcasm during patient-report at the end of my shift that really got to me. Giving "report" became dreaded. Miffed, badgering and nit-picking nurses who would get their egos massaged by trying to prove just how much more knowlegeable they were. It wasn't just one nasty nurse or one isolated incident. It was repeated several times a week. And it got old.

Wisdom told me that the confrontational report had very little to do with me. It had everything to do with them and their perception of themselves and their personal power. But I was getting to old for this shit and recognized that staying in the ER was not a healthy personal choice for me any longer. I transferred to ICU full-time.

Lateral Violence: Definition.

A consistent pattern of behavior designed to control, diminish or devalue a peer (or group) which creates a risk to health or safety (Farrell, 2005).

Some specific examples are:
  • Overt. Name calling, bickering, fault finding, criticism, intimidation, gossip, shouting, blaming, put-downs, raised eye brows
  • Covert. Unfair assignments, refusing to help someone, ignoring, making faces behind someone's back, refusing to only work with certain people or not work with others, whining, sabotage, exclusion, fabrication.  See more at: Break the Spell and End Lateral Violence
My experience was minimal compared to many, and I admittedly did not have the skill set (nor the inclination) that was necessary to deal with the problem. I was fortunate enough to have an 'out'. 

Several years earlier, our hospital offered a 6-week program in ICU Nursing. Although I loved being an ER Nurse, I knew the frenetic pace and physical requirements of the job could possibly be impacted as I aged. Attending those classes and gaining some part-time work in ICU nursing was one of my best career decisions made. My personal ICU nurse-nurse experience was by and large, welcoming, supportive and nurturing. It worked for me. 

But for those of you who can't bear the thought of leaving the specialty of where you work, I have a few suggestions...
  • Consider creating (or joining) a multidisciplinary departmental committee on Healthy Work Practices.
  • Develop a departmental"Safe" word or phrase when you are feeling oppressed or bullied by someone ("Peace").
  • Develop a departmental "Safe" word or phrase when you recognize someone is failing to complete job requirements or slacking (ie: "Dude")
  • Develop or tweak the current "Code of Conduct"
  • Violations in Code of Conduct should include clearly defined disciplinary actions
  • Prepare now for an 'out'. 
Now, take a long, hard look in the mirror. Could you be the problem? Maybe it's time to reflect and regroup.

My own, personal 'Year-of-the-bitch" was 1995. It wasn't pretty. And then I gave myself an attitude adjustment. Why was I such a bitch? Just like the experts say... I was feeling oppressed. powerless and silenced. Simple as that. Fortunately, I (hopefully) made amends to those nurses I may have hurt.If not, I am truly sorry. 


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In an effort to promote healthy work practices, I plan on writing about the ways I have learned that we, as nurses can care for ourselves. 

Who knew?

Some of this info I gleaned from the NTI - some I just made up. I hope it helps. I look forward to hearing from you and your experiences in this area as I have learned that "getting your cards on the table" is generally a good place to start when the topic causes discomfort.

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