As I have progressed in my career as a nurse I discovered a passion. Stress management. Stress management touches all aspects of our lives with increasing urgency. As we move forward each day we are expected to manage more, accept more, think more, and accommodate more. For more what do you ask? For more of everything. In our home lives we are expected to be Pinterest parents, cooks, home makers, and community leaders. At work we are expected to carry more patients, give ever increasing levels of customer service, contribute to shared governance, chart with legal precision, and still have compassion left for our patients. On Facebook we are expected to offer comfort to friends, get excited about petitions, try to get the best deals and sale prices on goods, and make sure we are sending back gifts in frivolous online games.
While one can say, "Well just stop doing X, Y, Z and you will be fine" have you ever stopped to ask yourself "Do I even know how to recognize that there is too much on my plate?"
Nursing and Stress Management
Prior to the birth of my first child, and while completing my undergraduate requirements, I started brewing a plan of stress management tailored for acute care hospital nurses. I chose this population because, well, I was one of those nurses. I knew the limitations, expectations, and resources available. I also knew the anxiety and stress that could come with it.
As I began formulating my plan I started asking questions of co-workers such as:
"Would you go to a group therapy session of all nurses?"
"Would you consider one-on-one counseling if it were available once or twice a month?"
"Would you want debriefing time after a traumatic patient event?"
Many of the responses were dismissive, uninterested, and withdrawn. I was surprised by this because I often found discussion to be a therapeutic route for myself, so I wondered "Where is the disconnect happening?"
I didn't realize it until I was hospitalized for a weekend during my first trimester of my second pregnancy for suicidal ideation.
From the Bed of the Depressed
In November of 2012 I went into my OB-GYN in tears. We had discussed Zoloft as a possibility for post-partum depression, which I had read can be much worse with two children. I knew I had PPD with my first, and was worried it would be worse this time around, so I wanted to be prepared. My tears and discussion of thoughts of swallowing Tide laundry pods because I was so miserable with morning sickness scared my practitioner and settled me in for three days in the High Risk Perinatal ward.
For three days I felt what others have felt when admitted for anything mentally related. I felt pitied, tip-toed around, and brushed off. Even though I had been cleared of all suicidal tendencies within hours of being admitted, I was still treated differently. During this time I was dehydrated from vomiting, anxious, and miserable. Most of these ailments were related to my morning sickness, which is notoriously bad.
When I was discharged that Sunday, I went home with a prescription of Zoloft. For two weeks I convalesced at my in-laws battling to find passion for my daughter again and to gain some reprieve from my nausea and anxiety. Thankfully, after getting to 100mg/day I was finally coming around. I found myself engaging with my daughter again, feeling less anxious, and feeling the ability to participate in my life again.
Shortly after my discharge I started therapy sessions with a psychologist who specialized in women's health issues and Eye Movement Desensitization Reprocessing (EMDR) therapies. EMDR is a treatment used primarily in Post-Traumatic Stress Disorder (PTSD) patients, but also has benefits for depression and anxiety. In a nutshell EMDR teaches you how to reprocess memories so that they no longer haunt or hold you back. I was skeptical of this approach, however after my first session I was a believer. The process of EMDR helped guide me down pathways I had never seen before in processing my anxiety.
Currently I have completed several sessions of EMDR, which has reduced anxiety over past circumstances, helped me develop new coping mechanisms, and is helping me wean off my Zoloft completely prior to delivery of my second child in May. So how does this all affect my perceptions of stress management in nursing?
Stress and Nursing
Stigma
Mental health fears
Weakness
Vulnerability
Incompetence
After I was first prescribed Zoloft I was open with everyone about it, because it was helping tremendously. It felt amazing to feel like myself again, to be able to move, function, and love my life again. So when people asked about my pregnancy I would admit it was rough and that I was on Zoloft, but doing well. I was met with basically the same reaction from nearly everyone. Moderate discomfort.
For comparison, when you tell someone you are on a new medication for any chronic or acute disease most people will show enthusiasm for you. Often praising the wonders of medication, telling you how glad they are that you are feeling better, or agreeing that maybe they should look into this option for themselves. This is not true of medications for mental wellness. The idea that you might be imbalanced somehow outweighs that you are working hard to manage both on a pharmaceutical and therapeutic level. While I was never swayed to silence my story by this reaction, it did make me understand why nurses are reluctant to seek stress-management options.
No nurse wants the stigma of weakness, vulnerability, or incompetence tagged to their credentials. We often think of being blamed first for drug diversion if we are on Xanax or Zoloft. We fear lawsuits if something goes wrong with a patient because we have been in therapy for depression. For me I had seen first-hand, from the bed, how those diagnosed with mental ailments were treated, and I understood all too well why most nurses I talked to cringed at even the thought of therapeutic conversations about work.
As my therapy, pregnancy, and time on Zoloft have come to end I have learned a valuable lesson, despite stigma, stress can be addressed without creating labels on the nurses participating. Getting to the root of stress related problems can help prevent occurrences of depression and pharmaceutical intervention; it just has to be presented in the preventative health arena.
My Commitment
From here on forward I am committed to bridging the gap between prevention and mental health awareness. I am committed to finding a way to let nurses recognize areas of stress and reduce them without being afraid of being labeled. My commitment starts with my own openness about my struggles and revelations, available here, in this story.
