Because of the challenges I’ve faced on the job, I’m aware of just how bad things can get in the hospital, and resilient enough to be able to act when the worst happens. Nurses are at the patient’s bedside to take action if something goes very wrong very quickly. But that need for an immediate and correct response also creates fear. Will I know how to react? What if I make a mistake and hurt a patient by doing either too much or too little? Seeing a patient sitting in bed, eyes wide, neck muscles standing out like gills while they struggle to breathe, we all want to do the right thing. The messages of inadequacy that begin in nursing school give us even less confidence about the clinical choices we make.
As a new nurse I had a patient bleed out and die in seconds in front of my eyes and I reacted in all the right ways: I called the code, did CPR. This sudden and unexpected death (the patient was set to be discharged later that day) generated the same kind of physical fear that breathlessness can, but also left me worried that I had screwed up. Could I have somehow prevented her death? The thought haunted me for months afterwards, but she’d had a primary artery burst, probably because a piece of tumor broke free of her lung. There wasn’t anything anyone could have done to save her life.
No one told me that, though. My unit manager asked, wasn’t I glad it happened in the hospital rather than in the patient’s home. The charge nurse, noting I was no longer carrying a full load, gave me an admission right away. Other nurses said I handled myself well, but no one sat me down and said it wasn’t my fault the patient died.
It’s not our way, as nurses or physicians, to speak up about our own pain and worries, or to acknowledge the pain of others. There’s an emphasis on being tough. I’ve heard nurses confess to feeling such stress about work that they vomit on their way to the hospital. A really horrible day has led nurses to uncork a bottle of wine or crack open a beer, and drink into the night. Many of us swear too much and make horribly callous jokes. A nurse may begin a shift with a murmured, “You never know what to expect…” and then grit her teeth and get to work. All of these methods of coping with stress will get a nurse through his day, but they’re all ways of avoiding difficult feelings rather than owning up to them. I know, because I dealt with my fear on the job in many of these ways.
Then I decided to take swimming lessons and the fear I had submerged on the hospital floor came to the surface as I struggled, breathless, through my strokes. The swimming lessons ended up being a great controlled fear experience because they made me scared, but why? Really, what’s frightening about swimming lessons? If I’d been rock climbing, skydiving, swimming with sharks, it would be obvious why I was afraid.
Swimming taught me that fear, like breathing, can be managed, but it also showed me that fear, like compassion, is inseparable from being a good nurse.
Nursing is a job, but a unique profession because we stand with our patients on the edge between well and unwell, stable and dangerously unstable. “Do one thing every day that scares you,” Eleanor Roosevelt said famously. I would respond to this maxim by saying, “I do: I go to work as a nurse.”