You walk into the unit not knowing what the day will bring or what assignment you'll get for the next 12 hours. You get report and realize pretty quickly that it's going to be an emotionally difficult day. Your stomach is knots and your mind is racing. You are paired with an intubated patient; a 5 year old with DIPG (a rare and terminal brain tumor) and a 17 year old with metastatic osteosarcoma who is also terminally ill and in the process of making end of life decisions with his family. You take a deep breath because you need a moment. You cannot believe this is your assignment, not after the last shift you had. Not after attempting to save the life of 9 year old who coded as she got to the unit. Not after all the those rounds of compressions and life sustaining efforts that unfortunately did not result in the outcome you wanted. Not after having to sit and console a mother, siblings, aunts and uncles for the passing of their loved one. No, this cannot be. But it is. So you take a deep breath and make the decision to step to the plate and do the work you feel you were put on this earth to do. To care, and heal, and show compassion to the patients and the families that are going through what you know to be the toughest moments in their lives. You finish getting report and walk in to your first patient's room. He's 17 yrs old and you know his days on this earth are numbered. You knock on the door and walk in. He's awake and his mother is standing next to him trying to get him to eat breakfast.
"Hey buddy, my name is Emely and I'm going to be your nurse for today."
If any of this resonants with you as a nurse, please know that my heart is with you. What we do is incredibly difficult work and we must learn how to cope with the trauma we experience on a daily basis. If you are a PICU nurse this blog post is especially for you, but even if you are not in the medical field, this blog is also for you. Learning how to deal with stressful and emotionally difficult situations is important for our mental health. The older I get the more I reflect on how tough life can be. This is inevitable. There will always be curveballs thrown at you, especially when you least expect it. What matters is HOW we manage and respond to those curveballs. Mental health is important no matter what you do for a living and so my hope is that this post will go a long way for anyone who reads it.
So what is vicarious trauma and why is it so important to talk about? According to the Vicarious Trauma Institute, vicarious trauma is the indirect exposure of traumatic information through a first hand account. Vicarious trauma also occurs when you repeatedly bear witness to someone else's trauma. It leads to a psychological response that often causes burnout, anxiety, depression, fatigue, helplessness, intrusive thoughts, hopelessness and irritability. In the pediatric intensive care unit, exposure to the trauma that others experience is a daily occurrence. For me, it was not until 5 years into my nursing career that I actually understood and dug deep into the vicarious trauma I was experiencing. Therapy helped me work through this and I began finding healthy ways to cope. While I've found multiple coping mechanisms, below are my top 4 strategies that I use and that have made the most difference for me.
1. SEEK PROFESSIONAL HELP
As a PICU nurse, you are often seeing children at their very worst and you have to constantly remain calm, even when stressful and unfortunate events occur. You have to fight through your anxieties and worries while educating and consoling family members. Let's also not forget that you have to first and foremost physically take care of that child. Monitor vital signs, titrate drips, communicate with your team, and of course document in a timely fashion (insert nervous laugh here). It is a juggling act where there is very little time to take care of yourself. Drinking, eating, and using the bathroom comes last on your list of priorities for the day. When I first started seeking professional help, I ironically did not seek it because of the stress I was experiencing at work. I was battling with the sudden loss of my brother in law and the COVID 19 pandemic. Through my sessions, the topic of my work came up. I am forever grateful that I sought out help during this time and I have absolutely no shame in saying that I needed it. Unfortunately there is this stigma around therapy and seeking professional help that most people don't even bother with this coping strategy. I was unknowingly experiencing anxiety and burnout at my job. Many days I did not feel like going to work, I felt anxious not knowing what the day would bring and felt physically exhausted. While speaking to friends and family is always a great way to cope with vicarious trauma, a professional can help you better understand what you are going through in a no judgement and safe space, and assist
you in identifying ways to cope.
There are so many resources out there to help you find a therapist that won't cost you an arm and a leg per session. If you have insurance though and want to seek professional help, the button below will lead you to a website that helps you identify a therapist that is in network with your insurance. You can also filter a therapist by location, gender, age, ethnicity, or religion. BetterHelp is also another website that has been recommended to me in seeking professional help.
2. FIND YOUR JOY
Through my therapy sessions I was able to brainstorm some of the things that make me feel good and bring me joy. For some this could be a night out with friends, spending time outside or in nature, reading, or cooking a homemade meal. For me, movement and exercise has always brought me joy. Excerise, known to release the "feel good" hormones called endorphins, always boosts my energy and mood. There is also an endless amount of evidence on how exercise reduces stress hormones in your body. I've noticed that when I'm not consistent with my workouts, I'm more sluggish with low energy, crabby, and require naps during the day. I've been incorporating workouts/movement prior to my 12 hour shifts for the last 6 months and it has made such a difference in my mood and in how I show up at work. When I have hard days at work, I still show up for myself in the gym the next day. Even if my heart feels heavy or I just physically do not feel like moving. Being consistent has taught me to show up even when I don't want to and I've made it a part of my lifestyle. I can honestly say I have yet to regret a workout! On my days off, I hit the punching bag and get an incredible release of stress with kickboxing sessions and strength training. It has recently been my favorite sweat session and seriously... if you haven't tried punching a bag...you're missing out on some bad ass fun. If you're in the Fresno, CA area I highly recommend trying IronBirdFit. My trainer and friend Sam owns this gym and incorporates a holistic approach to fitness and wellness.
3. Take time off
Back in September of last year I had two patients that passed away on my time in the same week. One of those patient's death was unexpected, barbaric, and traumatic. The other was a patient whose parents decided to withdraw care and so it was a more controlled and peaceful death. Both incredibly heavy to process and both brought tears to my eyes. To this day, I do not forget the cries and faces of those parents, the look of despair and pleading eyes asking me to bring their child back to life. It is still difficult to even fathom that it is part of my job to bring that child to their mother or father's arms so they can hold them one last time as they take their last breath. Nothing really prepares you for these experiences and despite having patients pass away on my watch before, I still never feel prepared. Trust me when I tell you that seeing death happen right in front of your eyes can be one of the most humbling experiences you can have. It undoubtedly grounds me, puts life into perspective and reminds me of the reality of our mortality. Without getting too philosophical here, let me just say that the debrief that often occurs with the medical team involved in a patient's death, whether expected or unexpected, is never enough time to truly process what you have just experienced. Typically during a debrief, anyone involved in the patient's end of life care can talk about what they feel went wrong, what went right, what we could have done differently, and any other feelings you may be having at the time. Usually we also have a moment of silence to acknowledge the life that has passed. In my experience these meetings have never been more than 30 minutes long. For me, this is not nearly enough time to process the events that just occurred. Depending on how I feel, I will often take some time off to give myself the space I need to reflect and decompress on these experiences. I encourage you to do the same. What we do as medical professionals requires so much of us... mentally, physically,
and emotionally. It is never safe to go back to work if your mind and your heart are not in the right place. Give yourself grace. It is OK to not be OK. Acknowledging this has been me such a game changer for me. I tap in and spend some time with my feelings and the cues my body gives me. Some days I feel a tightness in my stomach, while other days I notice I'm not sleeping well...constantly wondering how the family is doing grieving their loss. For a while, my vicarious trauma has made me even question whether or not I want to ever be a mother one day. It has taken me years to hone in on these cues and acknowledge when I'm not "OK" and it is still a work in progress. Listening to my body's cues though helps me better understand when it is time to press that RESET button and take a step back from my work environment. As a travel nurse, you don't get paid time off. Basically...no work, no pay. You also don't get that tax free stipend for the day. While it is not ideal for me to lose a day of pay, I recognize that I have to take care of myself in order for me to show up and properly take care of others. Listen to your body and take that time off when you need it! Trust me when I tell you that the unit or the company will still run without you for the day!
4. Practice Gratitude
"We should not focus on the shadow in the corner and be so foolish as to miss the fact the shadow exists only because the room is illuminated. There is light all around, there is much to be grateful for in this seemingly dark world..." - Brendan Burchard
The simple practice of gratitude has helped me shift my mindset, especially on my most difficult days. I've learned that the tragedies, heartaches, and traumas I experience as a PICU nurse have made me look at life in a different perspective. When you repeatedly see young children not able to experience the pleasure of food, feel the ocean breeze, or see the natural wonders of this world, you start to not take those simple things for granted. Everyday when I wake up in the morning, I thank God and the universe for another day I get to live my life. I acknowledge and rejoice in my fortune and my health. I am grateful for the lungs that allow me to breathe, the bed and warm sheets I just slept in, the sun that shines on my face as I walk my dog. The random stranger at the coffee shop who asks me how my day is going. Guys, we live in a crazy world that can feel like hell sometimes but there is beauty literally in every corner. You don't have to go far to find it. Don't lose sight of this. No matter your situation, stressors, or worries... find two minutes in your day and acknowledge what you are grateful for. This simple practice can really go a long way.
Let us be more conscious of how we show up for ourselves. Let us not be ashamed or embarrassed to seek help when we need it. My goal with this blog is still the same it has been from when I started it back in 2021.... to help a fellow nurse in any way that she/he may need it. Sending every single person reading this all the love, health, and healing energy in 2023.
