Before I even get started here, I want to stress how important it is to have a choice. After my sexual assault, I was in the ER having some weird symptoms (unrelated, blessedly). I'll never forget waiting for the results of the pregnancy test that night. If I had found out that I was pregnant by my rapist at 17 years old, I absolutely would have made the choice to terminate that pregnancy. If that choice were not legally available, and I was forced to carry the product of my assault to full term, I would have killed myself...while I was pregnant. I was in a very dark place over that entire experience, and at times I was acutely suicidal. If I didn't have a choice to terminate a pregnancy, had that test come back positive, I would have been dead by suicide within weeks.
If you thought I was being brave in sharing the story of my sexual assault, you haven't seen anything yet...To be perfectly honest, this part of my past is quite painful, but in light of recent legislation I feel compelled to share what a multidimensional process it is in making this choice. I'm uncomfortable even getting started. Only those closest to me know that this happened. It impacted relationships, because there were strong feelings about what I should and should not have done within my innermost circle. I've had this used against me during an argument, thrown in my face by one of the closest people to me.
It was 2005. I had just moved to Long Beach from LA, and was living in a house with 2 dudes. I was living paycheck to paycheck. I was dating someone new. I started taking birth control once it was clear I was in a monogamous relationship. I've had migraines my entire life, so I didn't stay on birth control when I wasn't seriously dating someone. Birth control pills can significantly increase migraines and are actually contraindicated in people who get migraines with an aura, a category which I fall into.
I did not work in health care. I had not studied anything health care related. I worked in the film industry. I was a layperson when it came to medications, what makes medications not work as well, and the ins and outs of the different strengths of birth control pills. I was on the lowest estrogen pill to minimize the risk of migraines. I was also taking an antibiotic for something...I don't recall. Bronchitis or a sinus infection...the usual stuff.
Here's where the health care system failed me. I was not informed that certain antibiotics make birth control pills less effective. Nor was I informed that the lower estrogen birth control pills were more likely to fail under these circumstances. The low estrogen pills also made my periods really light, like 2 or 3 days usually. I thought all birth control pills were created equal, and had no reason to believe otherwise. I had been sexually active for 10 years without any mishaps.
I had been dating this guy for 4 months. I'd gained quite a bit of weight, but had recently quit smoking. There's another thing I don't usually disclose...that I used to smoke!! I quit smoking using Wellbutrin, which I was also taking at the time all of this happened. I attributed the weight gain to quitting smoking, and to being in a new relationship where we were going out for nice dinners, and drinking lots of wine. The only clue, retrospectively, is that I started wanting roma tomatoes all the time. Not just any old tomato, roma tomatoes. I would buy them every day after work and eat like 4 or 5 a night.
It was mid October when I missed a period. I took a pregnancy test and the 2 lines appeared instantly. FUCK!!! How could this happen?? I didn't really know this guy that I was dating well enough to co-parent with him. I felt like my body was being invaded. I wanted this situation taken care of ASAP. I made an appointment with my OB.
Here's the ironic part...Planned Parenthood gets a lot of shit about providing abortions. I went to Planned Parenthood for all my annual exams and to fill my birth control prescriptions starting when I was 15 years old. At this point, I was 25 and had pretty good health insurance and an OB in a bourgeois office in Beverly Hills. It was in this fancy office that I planned to have the procedure, AND it was covered by my insurance.
I had been drinking a lot of wine during the early phases of my new and exciting relationship, and I was taking Wellbutrin. Neither of those things bode well for a healthy pregnancy. I scheduled my procedure right after Halloween. I remember handing out candy in my neighborhood, feeling this weird mix of emotions. All these children out Trick-or-Treating, and here I was pregnant and not wanting to be.
I worked with all men at that time in my life, and they were all very supportive. Some shared their own experiences with me. One in particular, and if he's reading this, you know who you are. Shared some very intimate details about his life that paralleled mine. I'm eternally grateful to him for making me feel less alone. I was conflicted. I really cared for the guy I was dating, and I was in kind of a good place professionally...but I didn't have a college degree, and wasn't sure that working in film locations was going to be my career. The biggest internal conflict was that my life was almost, but not quite, an OK situation to have a baby. It took almost 2 weeks before my OB could schedule me in for the procedure. All I wanted was to get it over with and move on with my life.
Ok, now here's the real kicker. When I went in the morning of the procedure, my OB discovered that I was not 8 weeks, but 10 weeks pregnant. Those fucking low estrogen pills? Well, my "period" the first month was actually implantation spotting and not really a period. Those fucking antibiotics? They caused my finicky low estrogen birth control to fail. So, technically my first missed period was my second. My OB almost had to reschedule the procedure, which made me feel a suicidal panic. This had to end NOW!!! I was sent home, with some sticks shoved in my cervix in order to dilate it, which was the most excruciatingly painful thing I've ever experienced. I spent all day vomiting from the pain. Then, I went back for the procedure after 8 hours of dilating. The receptionist treated me like trash. I was in a waiting room filled with affluent expectant mothers, because this was a Beverly Hills private practice and not some sketchy Planned Parenthood in the Valley.
I found myself thinking about the what ifs. Around the time I would have had the baby. I pondered what my life would have looked like. I never felt that I made the wrong choice, but it was a sad choice. A choice I never wanted to have to make. A situation where I thought I was doing everything right to prevent this from occurring in the first place. I've used condoms exclusively ever since. Why? Because I know when one of those things fails!
The guy and I broke up after we had been dating for about a year, right around the time I got laid off from my job. That would have been some good times with an infant. I moved to North Carolina, and that same dude lured me back to California with promises of getting back together. We dated a few months and he broke up with me again. Fucker. I decided to go back to school for nursing, made a solid group of friends, and started building my life. Part of my reasoning in choosing to have an abortion was so that I could advance myself academically and professionally. I felt that I had to live up to my end of the bargain, and I did.
The pace of life picked up, and that guy? The one that I had to make a horrible choice with? The one that I dated and broke up and dated and broke up with? He's my husband now. Cue the mind fuck....
When I found out I was pregnant with our son, I was racked with guilt. How was I supposed to know that I'd actually end up marrying the guy who knocked me up right when we started dating? I tortured myself throughout my entire pregnancy. How could I end one pregnancy, and then be so thrilled about the other with the same person? Why did I feel so invaded by my first pregnancy, and so immediately in love with my second? I had a high risk pregnancy and I used my abortion to mentally torment myself...every potential complication had to be my fault. Pregnancy hormones are a bitch. It also wasn't something that's super socially acceptable to talk about, so I suffered alone.
As I reflect back on the whole thing, I did not want to have a child with a man I hardly knew. If he had faded into the anonymous background of all my other ex-boyfriends, I would have been relieved that I wasn't tied to him for the rest of our natural lives. I certainly feel thankful that I never had kids with any of my other exes. *shudders* All of my mental anguish came later, because that guy did not fade into anonymity. In reality, we would not have made it if we had a child in our 20's. I would not have grown into the person that I am today. I was in no way fit to be a mother at that time in my life. My son has the best possible version of me, because I made some hard choices...one of those hard choices was terminating an unwanted pregnancy. Not just unplanned, unwanted. I wanted to have my shit together if I ever decided to have a child, which I did...almost exactly 10 years later.
What are the takeaways from this? We really need to do a better job educating women about pregnancy prevention. I did not realize that my low estrogen pills had a higher potential to fail, and I had NO idea that taking antibiotics would alter the effectiveness of my pills. A perfect storm. It wasn't a choice I ever wanted to make. Had I been better educated about my birth control, this may not have happened in the first place. At the end of the day, the choice was available. If it weren't, I likely would have sought out an illegal procedure.
I'm sharing this really uncomfortable, complex, conflicted part of my life because it is important to know why I made the choice that I did, and how important it was to have that choice available. I also want people to realize that it's not black and white. There were shades of gray in my decision (almost the right guy...almost old enough...). I'm reliving this painful experience because this shit happens, even when you think you're doing all the right things.
Wednesday, May 22, 2019
Wednesday, January 16, 2019
Nursing, a Cautionary Tale of Burnout: Part 1 The Bullies
I'm going to preface this entire blog by saying that I'm at a very good place in my career. I enjoy what I do, like my coworkers, feel generally well supported by our immediate supervisors, and am well compensated for my time. It was a long road to this place, and there were a lot of pitfalls along the way. I guess, in sharing this, I'm hoping that the takeaway is this: Do not stay in a toxic environment, and there is life after burnout.
I've been reflecting on my nursing career recently. 10 years ago, I started my Associate's Degree program. 10 years later, in the present day, I'm starting my Psych NP clinicals. I've traveled a lot of ground in this last decade, personally, professionally, and academically, so here goes....
Let's start with my first job. This part of my cautionary tale applies to the brand new baby nurses. I started my career in critical care. What should have been a great learning experience occurred in one of the most toxic environments I have ever survived...anywhere. My first preceptor, as a new grad. Constantly rolled her eyes at me, talked down to me, reprimanded me in front of patients and their families, and made me feel stupid for asking questions. One day, she mentioned that she had a headache from "too much wine" the night before. That same day, she hid out, nursing her hangover, and decided to tell my charge nurse that I wasn't a good fit for her. This left me, as a brand new nurse, on a unit where I knew almost no one, without a mentor. It also put a target on my back, because this was an environment where this nasty woman had a lot of clout. If I was on the outs with her, I was on the outs with almost everyone.
Fortunately, there were some really good people who I worked with that circled the wagons, and agreed to help me out. I learned a lot from these ladies, and really owe the foundation of my skills to them and them alone. My previous preceptor? Let's just call her, #1. She did everything she could to make sure that the doctors, other nurses, respiratory therapists, nurses aides, radiology techs...pretty much everyone who would listen, think of me as the village idiot. What happens when you're made to feel like a walking piece of shit? Well, you certainly don't learn very easily...and you don't flourish.
My first day off of my preceptorship. Literally my very first day on my own, I had a patient with an order for a PCA pump (that's patient controlled analgesia). This is not a common occurrence in critical care because most of our patients were too incapacitated to control their own pain medication dosing. Due to the nature of this type of pump, and the risks involved with giving too much IV narcotic medication, setting up this pump required 2 nurses to look at the settings and sign off on it. I asked for help, and no one really knew how to do the initial set up. Our educator happened to be on the unit, so the charge nurse had her help me set it up and act as my co-sign on the dosing. The educator really struggled with helping me set up this pump, and my being new (and the village idiot) I didn't really feel comfortable speaking out. The charge nurse sent 1's BFF...we'll call her #2...into the room to double-check the dosing. I'm glad she did, because the educator had set it up wrong! 2 came back, told me that it was set up wrong, we corrected it and that was the last I heard of it, until it was time for my annual review.
At my review, I was told that I would only be getting a 2% raise, because I had a med error on my record. A med error? I had never been told about a med error! My charge nurse brought up the error in the set up of the PCA. I objected, stating that the educator (let's call her 3) had helped me set it up. My charge nurse responded, "We asked 3 about it, and she denied setting anything up with you." When I objected to her obvious lie, the charge nurse just shrugged and said that she knew...and that there was nothing she could do about it. So, 2 had written me up and just didn't say anything. The charge nurse that day didn't say anything...and 6 months later I first hear about it, as the excuse for giving me a shitty raise. Between the paltry raise and the increase in my benefit cost that year, I was making less than I did the year prior. The money was so shitty, that with the cost of living in Orange County, I had to have a part time per diem gig as a surgical nurse. Most of the nurses I worked with had part time jobs, which is insane if you actually think about how intense it is to be a full time critical care nurse. I started looking for other jobs...
Now, the abuse suffered at the hands of 1 and 2 was ongoing. I overheard them conspiring to stay away from helping me with anything right after morning report one day. They were talking about how they were going to leave me out to dry and laughing about it. I knew that they wanted me to hear this. In the ICU, it really needs to be a team environment. One nurse can't change a soiled patient, or reposition them every 2 hours so they don't get bed sores, or run a code by themselves. I started scheduling myself whenever they weren't working whenever possible. Here's how it worked with healthy co-workers: we would have "turning parties" where we would all team up to help reposition one another's patients. We would discuss the patients that were high risk for coding, so that we all sort of kept one eye on that patient for monitor changes. We would laugh together, offer to break one another. This is how it worked when 1 and 2 weren't on the same schedule as I was. This is how it should have worked all the time. I didn't sleep the nights before I had to work with the unholy duo. I cried on my way to work on those days.
The final straw wasn't the shitty pay, or the bullies, it was a back injury. I had a confused patient trying to get out of bed. I ran into his room, verbally redirected him, and casually picked up his legs to help him lay back down in bed. That's when I felt the pop in my lower back, and searing hot pain shot through my entire left leg just before it went numb. I told my charge nurse, who asked 1 to take my patients from me so I could go to the ER. 1 was working rapid response that day, which the ICU nurses liked doing because you got called to the rapid responses on the other units and didn't have to have a patient assignment. The RRT nurses sometimes got pulled into the unit if there were more admits than nurses, or, as was in this case, if one of the nurses had to leave. 1 just disappeared after she was asked to take over my patients. She disappeared for 45 minutes, while I struggled to take care of my patients in the worst pain I've ever experienced. The charge nurse asked why I was still there almost an hour after my injury. I told her because 1 was nowhere to be found. She tracked 1 down, and 1 heaved sighs, interrupted me, and rolled her eyes through my giving her report. I still have residual pain from this injury, 7 years later.
Right around this time, I was offered another position at a different hospital. It was almost twice my salary at my first job. **Pause for a second here...same job, twice the pay. Both healthcare systems are very successful, both COULD afford to pay their nurses what the second job offered, only the first hospital system simple chooses not to, because they consider the "pride" in working there to be part of your benefits package.**
I was scared to leave, because I was not confident in my skills at all (clearly I was capable, having been offered a job where it is actually really hard to get hired), and I had a few friends that I loved working with. I heard 1 and 2 conspiring to leave me hanging on the day I was either going to put in my 2 weeks notice, or let the new hospital know I was declining the offer. That cemented my decision, and I put in my 2 weeks notice that day. On my very last day, one of the nurses that I had really come to love was charge nurse. She put me on the telemetry desk, since one of the tele techs was out sick. It was a nice gesture, and guaranteed a relaxed day. 2 looked at the other tele tech and said to him, "If you need any help, let me know," she looked right at me and back at him and said, "because you're going to need it." I fired off an email to the department director, and explained the bullying I had experienced at the hands of 1 and 2, and that this was the real reason for my leaving. She showed up, within minutes of my email, and pulled 2 aside. I have no idea what she said to her, but she wouldn't even look at me for the rest of my shift.
I moved on to much better things in my career. The lesson in this story is this: If you're in a toxic environment, leave. End of story. Find something else and leave. If you have your RN license, and you have a least a year of experience, you're marketable almost anywhere. Too many people stay in a toxic environment because they are afraid of change. I was so burned out in my first job, that I looked at the gardners outside and considered making a career change to landscaping. "They work outside...get good exercise..." I can hear myself day dreaming.
I moved on from this job into different hospital systems, different units and different specialties. ALL of those jobs had more positives than negatives. The moves that I made after leaving my first job were calculated decisions that I made to advance my career in various ways. None of those moves were to escape an unbearable situation. Writing this was cathartic for me, because I have carried this trauma and embarrassment with me for years. It feels good to get it out there.
I've become confident and capable through wonderful managers and coworkers who helped me to be the best nurse I could possibly be. I owe all the wonderful things in my career to those people on the way (as well as the nurses who did try to shield me from the bullies in my first job). We need good nurses and can't afford to bully out our new grads or new hires. Those of you who know me are probably surprised that I was so vulnerable to bullies. I was in a position where I was just starting my career, after spending years trying to get to that starting point. I was so terrified of failure that my defenses were down. I had devoted my life to becoming a registered nurse, and literally had no back up plan if something went wrong.
Thanks for listening...hopefully this blog will inspire you to move away from a toxic unit, or know that you aren't alone if you've been a victim of bullying. For any new nurses reading this, know that you deserve better than to be eaten alive. It's not like that everywhere, I promise!
I've been reflecting on my nursing career recently. 10 years ago, I started my Associate's Degree program. 10 years later, in the present day, I'm starting my Psych NP clinicals. I've traveled a lot of ground in this last decade, personally, professionally, and academically, so here goes....
Let's start with my first job. This part of my cautionary tale applies to the brand new baby nurses. I started my career in critical care. What should have been a great learning experience occurred in one of the most toxic environments I have ever survived...anywhere. My first preceptor, as a new grad. Constantly rolled her eyes at me, talked down to me, reprimanded me in front of patients and their families, and made me feel stupid for asking questions. One day, she mentioned that she had a headache from "too much wine" the night before. That same day, she hid out, nursing her hangover, and decided to tell my charge nurse that I wasn't a good fit for her. This left me, as a brand new nurse, on a unit where I knew almost no one, without a mentor. It also put a target on my back, because this was an environment where this nasty woman had a lot of clout. If I was on the outs with her, I was on the outs with almost everyone.
Fortunately, there were some really good people who I worked with that circled the wagons, and agreed to help me out. I learned a lot from these ladies, and really owe the foundation of my skills to them and them alone. My previous preceptor? Let's just call her, #1. She did everything she could to make sure that the doctors, other nurses, respiratory therapists, nurses aides, radiology techs...pretty much everyone who would listen, think of me as the village idiot. What happens when you're made to feel like a walking piece of shit? Well, you certainly don't learn very easily...and you don't flourish.
My first day off of my preceptorship. Literally my very first day on my own, I had a patient with an order for a PCA pump (that's patient controlled analgesia). This is not a common occurrence in critical care because most of our patients were too incapacitated to control their own pain medication dosing. Due to the nature of this type of pump, and the risks involved with giving too much IV narcotic medication, setting up this pump required 2 nurses to look at the settings and sign off on it. I asked for help, and no one really knew how to do the initial set up. Our educator happened to be on the unit, so the charge nurse had her help me set it up and act as my co-sign on the dosing. The educator really struggled with helping me set up this pump, and my being new (and the village idiot) I didn't really feel comfortable speaking out. The charge nurse sent 1's BFF...we'll call her #2...into the room to double-check the dosing. I'm glad she did, because the educator had set it up wrong! 2 came back, told me that it was set up wrong, we corrected it and that was the last I heard of it, until it was time for my annual review.
At my review, I was told that I would only be getting a 2% raise, because I had a med error on my record. A med error? I had never been told about a med error! My charge nurse brought up the error in the set up of the PCA. I objected, stating that the educator (let's call her 3) had helped me set it up. My charge nurse responded, "We asked 3 about it, and she denied setting anything up with you." When I objected to her obvious lie, the charge nurse just shrugged and said that she knew...and that there was nothing she could do about it. So, 2 had written me up and just didn't say anything. The charge nurse that day didn't say anything...and 6 months later I first hear about it, as the excuse for giving me a shitty raise. Between the paltry raise and the increase in my benefit cost that year, I was making less than I did the year prior. The money was so shitty, that with the cost of living in Orange County, I had to have a part time per diem gig as a surgical nurse. Most of the nurses I worked with had part time jobs, which is insane if you actually think about how intense it is to be a full time critical care nurse. I started looking for other jobs...
Now, the abuse suffered at the hands of 1 and 2 was ongoing. I overheard them conspiring to stay away from helping me with anything right after morning report one day. They were talking about how they were going to leave me out to dry and laughing about it. I knew that they wanted me to hear this. In the ICU, it really needs to be a team environment. One nurse can't change a soiled patient, or reposition them every 2 hours so they don't get bed sores, or run a code by themselves. I started scheduling myself whenever they weren't working whenever possible. Here's how it worked with healthy co-workers: we would have "turning parties" where we would all team up to help reposition one another's patients. We would discuss the patients that were high risk for coding, so that we all sort of kept one eye on that patient for monitor changes. We would laugh together, offer to break one another. This is how it worked when 1 and 2 weren't on the same schedule as I was. This is how it should have worked all the time. I didn't sleep the nights before I had to work with the unholy duo. I cried on my way to work on those days.
The final straw wasn't the shitty pay, or the bullies, it was a back injury. I had a confused patient trying to get out of bed. I ran into his room, verbally redirected him, and casually picked up his legs to help him lay back down in bed. That's when I felt the pop in my lower back, and searing hot pain shot through my entire left leg just before it went numb. I told my charge nurse, who asked 1 to take my patients from me so I could go to the ER. 1 was working rapid response that day, which the ICU nurses liked doing because you got called to the rapid responses on the other units and didn't have to have a patient assignment. The RRT nurses sometimes got pulled into the unit if there were more admits than nurses, or, as was in this case, if one of the nurses had to leave. 1 just disappeared after she was asked to take over my patients. She disappeared for 45 minutes, while I struggled to take care of my patients in the worst pain I've ever experienced. The charge nurse asked why I was still there almost an hour after my injury. I told her because 1 was nowhere to be found. She tracked 1 down, and 1 heaved sighs, interrupted me, and rolled her eyes through my giving her report. I still have residual pain from this injury, 7 years later.
Right around this time, I was offered another position at a different hospital. It was almost twice my salary at my first job. **Pause for a second here...same job, twice the pay. Both healthcare systems are very successful, both COULD afford to pay their nurses what the second job offered, only the first hospital system simple chooses not to, because they consider the "pride" in working there to be part of your benefits package.**
I was scared to leave, because I was not confident in my skills at all (clearly I was capable, having been offered a job where it is actually really hard to get hired), and I had a few friends that I loved working with. I heard 1 and 2 conspiring to leave me hanging on the day I was either going to put in my 2 weeks notice, or let the new hospital know I was declining the offer. That cemented my decision, and I put in my 2 weeks notice that day. On my very last day, one of the nurses that I had really come to love was charge nurse. She put me on the telemetry desk, since one of the tele techs was out sick. It was a nice gesture, and guaranteed a relaxed day. 2 looked at the other tele tech and said to him, "If you need any help, let me know," she looked right at me and back at him and said, "because you're going to need it." I fired off an email to the department director, and explained the bullying I had experienced at the hands of 1 and 2, and that this was the real reason for my leaving. She showed up, within minutes of my email, and pulled 2 aside. I have no idea what she said to her, but she wouldn't even look at me for the rest of my shift.
I moved on to much better things in my career. The lesson in this story is this: If you're in a toxic environment, leave. End of story. Find something else and leave. If you have your RN license, and you have a least a year of experience, you're marketable almost anywhere. Too many people stay in a toxic environment because they are afraid of change. I was so burned out in my first job, that I looked at the gardners outside and considered making a career change to landscaping. "They work outside...get good exercise..." I can hear myself day dreaming.
I moved on from this job into different hospital systems, different units and different specialties. ALL of those jobs had more positives than negatives. The moves that I made after leaving my first job were calculated decisions that I made to advance my career in various ways. None of those moves were to escape an unbearable situation. Writing this was cathartic for me, because I have carried this trauma and embarrassment with me for years. It feels good to get it out there.
I've become confident and capable through wonderful managers and coworkers who helped me to be the best nurse I could possibly be. I owe all the wonderful things in my career to those people on the way (as well as the nurses who did try to shield me from the bullies in my first job). We need good nurses and can't afford to bully out our new grads or new hires. Those of you who know me are probably surprised that I was so vulnerable to bullies. I was in a position where I was just starting my career, after spending years trying to get to that starting point. I was so terrified of failure that my defenses were down. I had devoted my life to becoming a registered nurse, and literally had no back up plan if something went wrong.
Thanks for listening...hopefully this blog will inspire you to move away from a toxic unit, or know that you aren't alone if you've been a victim of bullying. For any new nurses reading this, know that you deserve better than to be eaten alive. It's not like that everywhere, I promise!
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