Archive for August, 2011

Distress Call

August 16th, 2011 | General Nursing | 2 Comments

A few months ago, I started feeling odd.  I would lay awake at night, staring at the ceiling.  I always felt a little ill.  Soon, anxiety kicked in, and I was wondering if I needed to go to the doctor to seek some help for a possible mental health issue.

Then I realized one day going into work that nothing was wrong with me.  It was where I was employed!  I was employed in a high-stress PICU, the kind where things go south often, and ethical and moral dilemmas run rampant.  I wasn’t entirely sure if it was the patients that were the root of my problem, or the actual environment itself, but I felt it in my gut that things were amiss.

Soon, the anxiety I was experiencing pre- and post-shift started to get to me.  My emotions were out of whack, I lashed out at my fiancé (more often than I’d like to admit), and my sleep deprivation reached a new low.  I found myself thinking about my patients, or the other patients I encountered in my workplace, and I was wondering how they were, what was being done for them.  I needed to get out.

Transition theory shows that there actually IS a time when a new nurse feels overwhelmed, and experiences a range of emotions as they adjust and grow into their new role.  These feelings eventually subside as the new nurse finds their “groove” on the unit, and feels more comfortable as a nurse and as a member of the team.  As a leader for Nursing The Future, I’ve learned a lot about what this theory means, and how the stages impact new nurses during their transition into practice.  During my eight months in the PICU, I could feel myself transitioning through the first two stages. I felt myself becoming more and more comfortable providing care to patients, and handling my workload, but there was this other evil lurking over me: the feeling that what we were doing there was wrong… that what I was doing was wrong.   I felt guilty and distressed over doing the necessary (albeit traumatizing) things we did to those patients (medically paralyzing, sedating & sedating, supporting quantity over quality of life), and I found it incredibly difficult to come to work.  I even considered calling in “sick” a few times to avoid that sick-to-my-stomach feeling I got whenever I stepped foot in that unit (however, I never did, because I didn’t want to become another ‘statistic’).

If you look up “Moral Distress” on any search engine, you will immediately be sent to a ton of pages regarding Nurses and Ethical/Moral distress in the workplace.   I read a lot about it in University, even wrote a couple of papers regarding the subject, but it was so far removed from my mind that I had a hard time coming to the realization that it was EXACTLY what I was experiencing.  Unfortunately, it took me awhile to realize it, and I left my job just eight months after starting as a new nurse.  I took up a new position in the Orthopedic OR, and the move has revived my love of nursing, and has greatly improved my outlook on life.  I’m happy to report that I’m not as angry, emotional and anxious as I was just a few weeks ago (and my fiancé is thankful for that!).

For more information on Moral Distress, check out the Canadian Nurses Association’s) , and the American Association of Critical Care Nurses’  handouts on how to recognize moral distress, what causes it, and how to handle the situation in yourself or your peers.

If I have learned one thing from this experience, it’s that moral distress is a difficult thing to go through, that new graduates are particularly vulnerable to the effects of morally challenging practice and that you shouldn’t go through it alone.  Dr. Duchscher speaks about being ‘cautious’ when placing new nursing graduates in highly acute environments (e.g., ER, ICU) for this very reason – as ‘new’ practitioners, we are trying to figure out what it MEANS to practice nursing, the ‘weight’ of taking ultimate responsibility for practice decisions that we previously shared with our educators or senior mentors, and to deal with how it ‘feels’ when the quality of our practice is challenged by situations like family dynamics, staff shortages, work overload, imbalance in our lives, or just morally difficult practice decisions that we are now ‘responsible’ for. When you are just starting out, all of this weighs heavily on what Dr. Duchscher identifies as a ‘developing’ sense of professional identity.  I did not reach out to my peers or my family, primarily because I wasn’t sure what was happening to me, so I wasn’t sure I should talk about it.  So….be careful about where you START your nursing practice and if you do find yourself feeling anxious, reach out and talk to someone.  You might be surprised to find out that you are not the only one in the same predicament and that there IS a reason for these feelings that goes beyond ‘normal’ transition stress.

Jenna Parsonage