Burn out? Part 2

What does it feel like to understand that one is operating under the influence of irrational fear? My personal experience is the almost predictable. I do not always experience anxiety/fear. Understand that I think that calling something like this an 'anxiety' issue is a bit of an understatement.

Anxiety

1.	distress or uneasiness of mind caused by fear of danger or misfortune: He felt anxiety about the possible loss of his job.

2.	earnest but tense desire; eagerness: He had a keen anxiety to succeed in his work.

3.	Psychiatry. a state of apprehension and psychic tension occurring in some forms of mental disorder.

Fear

1.	a distressing emotion aroused by impending danger, evil, pain, etc., whether the threat is real or imagined; the feeling or condition of being afraid.

2.	a specific instance of or propensity for such a feeling: an abnormal fear of heights.

3.	concern or anxiety; solicitude: a fear for someone's safety.

4.	reverential awe, esp. toward God.

5.	that which causes a feeling of being afraid; that of which a person is afraid: Cancer is a common fear.

We have a winner

Terror

1.	intense, sharp, overmastering fear: to be frantic with terror.

2.	an instance or cause of intense fear or anxiety; quality of causing terror: to be a terror to evildoers.

This is the one I feel. FEEL. The sensation is an escalating one. It starts with a simple "I'm too tired to go to work*yawn*. Progresses to "damn am I gonna vomit, do I have a fever? Where is the thermometer?". This progresses to an iff then situation, if I happen to think that i can get away with a sick call. as in if I have not pulled it off in a while I'll cal in. explain I am ill and stay home. This sis starting to get complex. I literally have to voices in my mind when this is going down. the alternate path is: wake up its time for work "man I need this money." "you aren't sick you know it, your just wussing out, your stomach is fine you don't have a fever that's why you don't grab a thermometer." "Stop! Put the damn phone down its gonna be fine just walk through the door and start your day you'll be fine." ( If I manage to push through and make it to work) " Bout damn time no just go in here and get through the first half hour." (If I pick up the phone) "God damn it Jason. *Amanda's voice: damn it Jason* Said in that tone of voice that conveys the ultimate disappointment. It's a tone of voice that I do not think any wife would ever have to create. Its a tone of voice that has it's own personal emotional response. I hear her say that and my hear skips a beat my breath gets short and my eyes find my feet, or what ever obstacle lies between. I feel a faint flush of adrenaline as the desire to get away sets in.

Sometimes I do not pick up the phone. Sometimes I get in the car and I drive. Sometimes I drive to the hospital and stay in the car and consider the terror that keeps the engine running. I think "what could go wrong, its fine you do well once you get in there" and I also think "get the fuck out of here. You can't do this. this it too much. Jason Leave!"

If I go in I am shaky for about 20 minutes which is fine. The morning is the quietest time. People are still asleep trying to push through the fog of traffic (see war) and bring themselves from there reverie and into the here and now. I am not so out of place to anyone else that might observe a guy that looks/feels slightly out of place. After this odd period of time I meet my patients and I forget that I ever felt that way. I push into and through the obstacles of functioning properly as a nurse and get the job done. I receive complements I connect spiritually and importantly as an advocate for the ill. I crack jokes I receive respect from Doctors. I trend information and function with the critical thinking developed after 8 years of nursing.

Other times I drive around the parking lot for about an hour maybe longer I realize that I can't do it or that I won't be able to force my body to respond to the logical side of my mind and I call in and create whatever story I think will fly. understand that I have gone through about a dozen different scenarios concerning half a dozen different excuses and have sorted through which of them would be the best in response to who it is I need to speak to. The response is fight or flight in the creation of these excuses I am able to appease both. I fight to make the stories fit to facilitate the flight. I often find a way to not go into work and the relief is nothing compared to the disgust. It's like being mugged. My money for that day has just been stolen by the trader that operated my body.

I have done this for years. I have lost jobs I have been denied employment, I have damn near reached bankruptcy. I need to set an appointment this week.

Burn out? part 1

I wrote these installments years ago and am a little shocked at the tonality that I see through out the posts.  But i believe that it is beneficial to share the reality of the experiences.  I just hope to be some bit of support to other worn down Nurses.  Even in your darkest moments you aren't alone. 

Ergophobia: An abnormal and persistent fear of work. Sufferers of ergophobia experience undue anxiety about the workplace environment even though they realize their fear is irrational. Their fear may actually be a combination of fears, such fear of failing at assigned tasks, fear of speaking before groups at work, or fear of socializing with co-workers.

I am a pretty social guy, I can relate to people of all walks of life and have no qualms regarding race, creed, religion, sex, age.
I'd like to take a moment here to focus on the fact that people with anxiety disorders KNOW that the fear is irrational. A good analogy would be to imagine that you are in the operating room undergoing a routine surgery only to find that the drugs used to put you out did not stop pain but did stop you from moving. You would sit there and understand that if you could just move a limb, a digit, change your breathing, shed a tear, that everything would be ok. Someone would notice.

This is how I have felt many times. Over the last 8 years I have found various reasons and methods for leaving jobs just to get away from the feeling of nausea and vomiting associated with waking up and knowing I am going into the work place. I can trace this. Vividly. I know that I have a knack for allowing this type of understanding to lay dormant. One can assume that such a thing is dormant, but for me I think that the emotions transmuted into rage. One can assume that during the surgical process wherein on can feel pain but not move that one would feel the red heat of rage inter the scene just behind fear and before helplessness. 

In school, and by this I mean the odd hybrid of education that I underwent to become both a high school grad and graduated vocational nurse in time for the summer of 2000, I spent two academic years dealing with the anxiety of puberty, relationships with the opposite sex, and crazy ass parents on top of and in addition to the craziness of a 17/18 year old boy trying to make old/sick people believe that I was capable of healing listening and preventing further injury to them while they were in the hospital. 

Add to that the fact that while I was convincing myself and my patients and my instructors that I was able to become and function as a nurse, I had other nurses and Doctors to deal with as well. Doctors. Let that sink in.

 From the moment a child is born the profession of Doctor is amongst the top desires of parents for their children. Doctors reputedly make for a fine catch on the day time tv. Doctors are authority, they are ranked just above cops and just below the President in the mind of a child. So there I was... Dealing with all the normal bullshit that (some) kids deal with and trying like hell not to get on the radar. I did not want to kill any one. I did not want to be the catalyst of causation for some sort of catastrophic event.

I never spoke to people about what it was to go to school at that age. Most people would hear that there was once a group of 13 kids that were allowed to attend nursing school while in high school and would think, "damn that's lucky... Wish they had that when I as a kid..." Those types of comments or even observations do not allow for the open hearted complaints and undersides of the experience. some things have been hammered out by now. the relationships with the opposite sex. Never speak to my parental units again, and yeah Doctors are fallible.

My first job out of school was through the hospital network that provided my education. They allowed me to work in a confinement center at the resilient (see tender) age of 18. I was an LVN not in a hospital. I liked that concept I figured less I could make go wrong. I was wrong. The management at the medical unit I worked at decided that I was capable of handling a facility that contained over 500 inmates on my own over night on the weekends. So it was a bit of a kick in their ass when I had to respond to a complaint of chest pain and had not clue what I was supposed to do or how to do it. But more importantly it rocked my little world too. That wasn't supposed to happen I was the medicine man the guy that passed out tablets and capsules. Not the guy that saved potential heart attack victims. I was sure that I had done something wrong. that I didn't know enough to do the full work that the position required and that I was at fault. These many years later i see that I did not really have the fault there, that I was used and the management staff had absolutely no grasp on what was needed to safely run the facility. So first job lasted around 8 months.

I am more than a little frustrated.

 I just read over the Texas Nurses association's list of 100 great nurses for North Texas.  This is an interesting and well respected method of nurses recognizing nurses.  The problem I have with that is that I am not capable of being recognized by the Texas Nurses Association because I am a Licensed Vocational Nurse.

An LVN is a Licensed Vocational Nurse which is a nurse that is licensed by the state to provide routine patient care. Some states use the term LPN or Licensed Practical Nurse rather than LVN. An LVN can work in a hospital, long-term care facility, convalescent home, doctor’s office or surgical center, providing many of the same services also performed by Registered Nurses (RNs).

The LVN, however, must be supervised by RNs or doctors, and cannot do everything an RN does. In some states, an LVN never starts an intravenous line (IV), while in others, they may be able to obtain IV certification to perform this procedure. In areas where they do not start IVs, most LVNs can take blood or administer injections. The LVN may have to do a lot of the clean up in hospital settings. Preparing rooms for new patients, bathing patients, or cleaning up a patient who has vomited are typical LVN jobs. These jobs are important, yet some LVNs feel that their supervisors abuse their authority by assigning them the dirtiest jobs.

I received my education over a decade ago through the John Peter Smith Institute for Health Career Development. I was pretty sure I was bound for bigger and better things at that time. Alas I find myself in the same position all these years later.  I am at the point in my career now where I have to wonder if I am experiencing the limitations of my licensure or simple and commonplace disrespect.   

I love teaching hospitals.  Early in my career I was fortunate to hire on to Brackenridge in the heart of Austin, Texas.  It was there I was first exposed to the concept of Nurse Magnet Status.

The Magnet Recognition Program® recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Consumers rely on Magnet designation as the ultimate credential for high quality nursing. Developed by the American Nurses Credentialing Center (ANCC), Magnet is the leading source of successful nursing practices and strategies worldwide.

 At the time it was the only hospital in the state.  I loved every one of the nurses I worked with and enjoyed the fast paced on the go vibe that the Tele/IMCU department offered.  I was the first LVN hired into the position in over 15 years. 

I stayed with Brack for a year or so then Moved back home to my DFW stomping grounds.  I was fortunate enough to find EXACTLY one hospital that employed LVN's.  I began my work with the Methodist Healthcare System on the Surgical telemetry floor.  Even here there were only a few LVN's in house.  I was fortunate to find an open minded Unit Manager.  At present an LVN that is searching for a position in an acute care setting will be sorely disappointed.  Go ahead and try it out yourself.  Go to any national job search website and look for an LVN position in an acute care setting like a major trauma center type hospital and you too will be disappointed.

So then where does an LVN find a home in the grand scheme of healthcare?  Long term care, such as nursing homes and rehab centers.  Long Term Acute Care facilities, Correctional health, and occasionally psychiatric nursing.  We are tasked with continuing the level of care that these patients receive within the major hospital systems.  I mean imagine this:  Your loved one has experienced a major decline in health and you are forced to confront the fact that your particular person is not going to be a candidate for a 6 week rehab and the discharge to a home environment.  Neither is your loved one just slightly infirmed.  Your loved one is not a suitable candidate for a nursing home.  You are then very likely to see your loved one in what is called an LTACH.

LTACH's specialize in Long Term Acute Care services, while a traditional hospital offers many general services such as emergency rooms, maternity wards, and other services. 
The second difference is that LTACH's may offer better care for patients that fit their specialization. The LTACH can focus very high standards on just a relatively small list of ailments, where the traditional hospital is more "spread-out" across a wide range of medical specialties. This is not to say that you cannot receive good acute care in a traditional hospital; its just that the Long Term Acute Care Hospital is set up to specialize in that care.

It is frustrating to realize that one's entire career is undervalued, it is hurtful that entities such as The Texas Nurses Association do not provide a methodology for recognizing the LVN's whom shoulder the brunt of the non acute care workforce.  I would argue that my nursing interventions are no less important.  My licensure does not restrict my ability to be a stalwart Patient advocate.  Not having the letters R and N after my name does not prevent me from offering true understanding empathy and in some cases respite to families in need. 

Is this really acceptable behavior?