The Wounded Healer

April 9, 2015

Trudy is a nurse who works in an in-patient psychiatric facility. During her shift, she was attacked twice from behind by a male professional kick-boxer. He also kicked a pregnant patient and attacked two of the other nurses. Trudy found them on the floor severely injured. When she called security it took them ten minutes to arrive on the scene. They had to come from another building because there was no security in her facility.

 

“I pretended I was ok,” said Trudy, “but I wasn’t. I had horrible nightmares of work. I lost my confidence as a nurse. I experienced panic attacks. They seemed to come from no where at any time.” After filing assault charges on the patient, Trudy sought the help of a therapist who diagnosed her with post-traumatic stress disorder or PTSD. She was out for six weeks trying to deal with her symptoms. When she applied for worker’s compensation, the physician’s assistant who examined her case in the Occupational Health Department, denied it because it wasn’t a physical trauma. She was never examined by a physician. Trudy tried to channel her fears by becoming an advocate for a safe patient environment for nurses and patients, but she was having a hard time convincing anyone that nurses can suffer from PTSD. “The CEO said it was a part of my job. My guess is that 75 percent of our staff on this psych unit have PTSD. We all have witnessed so many assaults, or have been assaulted. Most just pretend they are OK because no one wants to be perceived as being weak.”

 

I read a moving article written by Captain “Sully,” the famous airline pilot who landed his damaged aircraft on the Hudson River saving the lives of everyone on his plane. He writes that for months after this heroic event, he and the rest of the aircraft staff suffered from PTSD. “When the danger was over, what happened hit me hard,” he admits.

 

No one would take Capt. Sully or any of his flight crew out of the river and expect them to go back to flying another plane as if nothing had happened. Yet, in hospitals, nurses are attacked physically and verbally and are then expected to go back to their assignment without a word of reflection or a chance to regroup. In a recent article in the Scientific American, a 2014 survey revealed that almost 80 percent of nurses reported being attacked on the job within the past year. Little is being done to stop the assaults. Nurses feel the pressure to get back to their other patients or the next case without delay because if they don’t, there may not be anyone else who could take their place. If they are physically well enough to work, they cannot leave or they can be charged with abandonment. They are powerless to get relief from duty.

PTSD is an unrecognized problem with nurses. There are two types of the disorder. One is acute, being caused by a specific traumatic incident either on themselves or having witnessed it on another. The other is chronic, from repeated experiences of witnessing traumatic events such as respiratory or cardiac failures or severely injured patients from car accidents. The result plays havoc on their health. PTSD causes social isolation, sleeplessness, flashbacks, depression, panic attacks, hyper vigilance, anger issues, substance abuse, and bullying and even suicide. According to the article in Nation“Unlocking the Secrets of PTSD,” without treatment, it can ruin lives and destroy families. The Harvard Nurses’ Health Study began in 1976 by enrolling 100,000 nurses to study women’s health. Their recent study update showed that nurses with PTSD were at risk for obesity and diabetes.

 

This study reveals that one out of every nine nurses will have PTSD at some point in their life. Symptoms may appear soon after experiencing a traumatic event or they may lurk until something else happens that brings the memory back.

 

While there are systems in place to help veterans, police, firemen, EMT’s and ambulance drivers, it is not recognized in nurses. Part of the problem is that the hospital administration obscures the issue by making it difficult for nurses to report assaults by patients. They refuse to recognize that this could be a problem with their staff. In an article published by the Journal of Emergency nursing “Nothing Changes, Nobody Cares,” ten percent of the nurses said they were blamed by the administration for their own attacks.

The other part of the problem is that the profession of nursing was originally based on a military model, setting a culture enmeshed in nursing that they are expected not to show weakness and “soldier on.” Some do not even understand what they are feeling and while others feel ashamed of their weakness which breaks down the confidence in themselves. They will not go to their Employee Assistance Program counselor at work because they don’t trust that their problems will be kept confidential. They trudge along like good combat soldiers not realizing the consequences repeated traumatic experiences could have on their emotional health.

 

PTSD is a well-recognized problem in the military, police and fire departments, EMT’s and even with ambulance drivers, but that’s where the information stops. Even though nurses are frequently exposed to workplace violence and traumatic events, they are never screened for PTSD. The message is clear. We are failing our nursing healers.

 

The contrast between the treatment that Capt. Sully and his staff received and how our nurses are treated is stark. There are effective systems set up for our soldiers of war but none for our soldiers of caring. I understand the preservation of the right of patients but I also believe the caregiver has rights. I believe we have an obligation to treat nurses with the same respect and treatment as we do our military, police, firemen, EMT’s and ambulance drivers. The difference will be that we have not only rescued the rescuer but ensure that they are mentally healthy when they are caring for our patients.

 

Nurses fatigued from sleeplessness, depression and stress are not safe caregivers. Trudy should not have to pretend she is all right. She should have been moved out of that setting immediately and offered counseling. The patient who committed the assaults should have been identified that he was a threat to others early on. There needs to be a cultural and behavioral change with nurses and with the administration that hires them. It is time raise this issue within our community of nursing and figure out how we can heal from within.

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