Burnout

I am in the midst of processing. Not the things I intended to work on, but instead an entire catalogue of events I didn't expect would surface when I started this journey.

I have been a nurse since I was 19 years old. If you don't feel like doing the maths, that makes 24 years.

I started thinking about medicine as a profession when I was 14. Initially, it wasn't because I dreamed of healthcare. It was because I wanted to work with abandoned children in Romania. Eventually, I had the opportunity to do exactly that. From there, I moved into postpartum care, caring for newborns and new mothers. That led me into labour and delivery, and years of sacred work in sacred spaces.

I hold two truths to be self evident.

The first is that nursing is a compassionate and beautiful calling. We are invited into some of the most intimate moments of a person's life. Often, we enter as complete strangers. If it is done well, and done right, it can be incredibly rewarding.

The second truth is that nursing is taxing, exhausting, and physically demanding. It is a profession I actively discourage my own children from pursuing. Not because it lacks meaning, but because it is underpaid and because compassion and calling are so often exploited.

There is a persistent implication that because nursing is a calling, you should allow yourself to be emotionally, physically, and mentally drained. That you should tolerate treatment that would be unacceptable in almost any other profession because somehow your commitment to caring should make you endlessly available.

It can be a calling AND I should also be treated professionally and compensated appropriately for the work I do.

This is not the first time in my 24 years that I have felt burned out and completely depleted. It is, however, the worst.

Part of that comes from managerial gaslighting, harassment, and the slow erosion of confidence that happens when concerns are dismissed often enough. The other part comes from the unseen toll of working in a clinic that is chronically understaffed, under-resourced, underpaid, and unsupported.

When I went through nursing school back in 2001, very little was said about mental health for healthcare professionals.

I received some minimal advice about what to do if a patient touched me inappropriately, because this was to be expected and anticipated, and unfortunately more than once I have had to deal with it. However, nobody told me what to do after a patient punched me in the face during a stroke crisis in my first six months as a nurse.

I was taught techniques to avoid being pinned down. Nobody explained what to do when I was unexpectedly grabbed from behind and held against a wall.

None of these events were treated as assaults.

Instead, I was taught the art of compartmentalisation.

Take what happened during your shift, leave it at the hospital door, and move on.

As though experiences somehow stay neatly contained within the walls where they occurred.

I still remember my drive home after losing my first baby during a delivery. I remember the conversation with my mentor on that drive. I remember arriving home feeling utterly broken.

And somehow I learned to shut it all down before walking through the front door.

I would go to bed and then return to work the next day.

I became very good at it.

My first apartment became my sanctuary. I lived alone and protected that space fiercely. Few people were ever invited inside. It was where I recovered, processed, and gathered myself before doing it all again.

Then life evolved.

A husband came along. Children followed. The quiet spaces disappeared.

The opportunities to process difficult things became fewer and farther between.

Over the years, I learned new skills. I learned how to hold space without giving all of my own away. I learned how to support bereaved families without carrying every emotion in the room home with me.

What I never mastered was coming home after thirteen hours of giving everything I had and still having enough left for the people waiting there.

Because nobody rescues you from the next two or three hours.

The moment you walk through the door, your family needs you too.

Children are like eager little adorable leeches. They have waited all day to soak you up the second you arrive home.

One of the great lies of parenthood is being told that the baby years are the hardest.

The teenage years are not for the faint of heart, they are beautiful and life changing, but incredibly draining.

The problem is sometimes the compartments get full, and if you never make the time to unlock the doors and work through it, it just sort of live in you and builds up. 

Two months ago, I started having panic attacks.

If I am being honest, I was probably having smaller ones last year and simply didn't recognise them for what they were.

I found myself unable to walk from the bus stop into the hospital without disappearing into a playlist and a pair of headphones. I needed something to disconnect from reality until the exact second I had to step into the clinic and begin my shift.

In a classic cliché, my first full-scale panic attack felt like a heart attack at the end of my shift. In true nurse fashion, I went home first, tried a hot shower and some Tylenol, when that didn't help I spent the night in the Emergency Department because I genuinely wasn't sure what else it could be.

I had seriously underestimated the chest pain component of panic. 

It is an experience.

So now I am taking some time to process and untangle things.

Time to work out what comes next.

Part of that work has been recognising something uncomfortable: no amount of personal growth, therapy, resilience, mindfulness, coping strategies, or self-reflection can compensate for a system that is fundamentally broken.

At some point, the problem stops being your ability to cope.

The problem becomes the environment itself.

Returning to a system that will not change, that continues to use people up and spit them out before moving on to the next new nurse, feels less and less like resilience and more and more like self-abandonment.

I don't know what comes next yet. I only know that after spending two decades teaching women to listen to their bodies, trust their instincts, and honour their limits, it might finally be time to take my own advice.

 

Somewhere Slower

A great many things are hanging in the balance these days. Sean and I have invested several years and countless hours to the places we work, and things are changing. Nashville is changing, our kids are growing, and we are no longer the family of three that we were when we moved here 10 years ago. We've doubled to a family of six. Nashville has always felt like a transition point, a staging ground for us to figure out what next. It was a compromise at best, but for both Sean and I it has not felt like a permanent home.

Phases in our marriage are changing too, we are leaving the phase of early marriage, pregnancy, newborn babies, and growing our family. Into maturing kids, school schedules, sports practices, and right around the corner our first three starting puberty one after the other. The past two years have been a refining of our wants and plans by intense fire, a phase that has been harder to weather than any other so far. One of facing the challenges of mental health and wellness for our kids and ourselves, an unexpected baby, followed by an unexpected major home renovation, followed by a foreclosure that we barely made our way out of without losing our home, and all the stress that those things bring on a marriage and a family. None of which we were emotionally or financially prepared for.

We both grew up moving often, and I never thought I would want that for my kids, but here we are looking for what might be next, where might our next home be. When we packed it all up and arrived in Tennessee we were proud that we took the plunge and were not afraid to move on from a place that was not working for both of us. I am eager to be on the other side of this phase and anticipating the start of a new one. In all of it we have landed on the same page with the same desires. Eager to be able to step back and enjoy our kids at the age they are, full of idealistic longings for a culture that values family time, and has the structure to support the raising of kids. Somewhere slower, where we can work to live not just survive.

The short list:

• Socialized Medicine

• Accessibility to travel 

• Good family support

• Free continued education

• Walk-able living (to become a car free family)

• Good free/affordable primary education

• English speaking, as I don't see being able to master a second language to work in health care

Surprisingly there are a few places that fit the bill and one in particular where we can access our current careers in a different setting. I have started the process of applying for my U.K. nursing license in hopes of taking a contract in Cambridge England. Even if it is a two year jaunt that ends in a return to America, we don't think it is one we will regret. It has been easy to feel downtrodden due to the changes coming our way and to the end of this current era, but I am choosing to view it as a release and a launching point pushing us into something that fits better and feels more like home.

More of Less

At the start of this month the word that kept coming up for me was more.  More of my kids,  more time with Sean, more of the things I find the most joy in.  What is becoming clearer is the way to more is less.
We have always been on top of releasing the clutter and keeping things cleaned out for the most part, but this also mean downsizing the amount of things we bring home or purchase. It has been easier to keep this perspective, even through the holidays for a few reasons. One being that we have been strapped financially so we were very conscious about having a small and meaningful Christmas with our kids and two I do not want to buy anything that we will have to sell or purge before moving, and we will likely take very little with us due to the cost of transporting things over seas. If we really want more of our kids, it means they will need to be surrounded by less and so will we. Less distractions with things to keep them playing with each other and interacting with us instead of their things.
As parents I think we are often told with more kids we need more space. Honestly, often I feel like we need more space, and the definition of more space increased when we moved to the South. Housing down here is much bigger! However, as we have moved and obtained more space, I have realized it did not change the amount of private or even quiet time we were able to find as parents. Our kids often do what I call herding, which means no matter what room Sean or I are in, they collect around us like a little herd. The smaller the room the more they seem to herd! I find myself standing in the middle of 3 medium and 1 tiny human at the bathroom sink more times that I care to count. More space has not really brought more happiness or more peace, instead it has often made both Sean and I feel lonely or sad and worried about our one kid whose room is at the opposite end of the house. As a mom, I have often felt the need to herd my little brood all together when the lights are out and we are at rest. Just this week, after feeling tearful over this very thing and talking it over with Sean we asked Archie if he liked being in his room alone farther away, and he said no, he doesn't like sleeping alone.  He said the rest of the family is all in one hall as a unit, and he is all by himself (cue more motherly tears), so we are moving him up to share some space with his sister and be in the fold with us. Last night as we all went to sleep along the same hall way it felt better, less lonely, right for us at night. We will need less space but likely more boundaries as we are trying to teach the small herd to respect when one of us steps away for a minute of quiet or alone time. I am not sad about the idea of moving into a small English cottage in Cambridgeshire or Bury St. Edwards. Instead as we are looking for more of the things that matter, I am looking forward to more quiet, more together, and less distraction.

 

Making a Change

I took my first trip overseas when I graduated high school. I was lucky enough to see England and France, and it forever changed my plans and perceptions. It immediately made me aware that venturing out was not only possible, but also much easier than I had realized. I returned on my own as soon as I was able and fell in love with the Eastern European way of living. I spent pretty much all my efforts throughout nursing school and after finding ways back to the city and work I fell in love with in Bucharest. I loved walking to work, taking public transportation, eating my meals from the corner market and picking up bread on my way back from the same bakery every day. When I settled back in the states I thought I was only going to be back for a short time to earn enough money to head back to Romania for as long as possible. In my time back I reconnected with my my very first love who I had not spoken to for years and in short order married him and had our first little one Hank. I looked for that same feel of living, hoping urban life would offer the same feel, and at times it does. I love living in cities with public transportation, trains to take, walkable neighborhoods, and good food.While I felt it might be possible to for us to travel the idea of living overseas seemed like a foregone conclusion.
Five years ago I started reading about families that take a gap year, it immediately called back all my longings for adventures, a different way of living, and a different experience for our kids. However, most families taking gap years seemed to either have assets that allowed for them to do so financially, or had careers that made it possible to work from the road. It wasn't until more recently the idea that moving towards a different way of living became something we really agreed and shared the same vision for, and all my old thoughts of how doable travel and living in other countries can be. There is no reason for us not to be a nurse and a paramedic in Cambridge instead of being a nurse and a paramedic in Nashville. Really one just has to start taking the steps to do it. I was only 17 when I took my first trek to England and France on a chaperoned trip with a rather intense southern baptist christian school, it was only 6 months before I made my second excursion by myself and fell fully in love with all the aspects of life in Bucharest, I immediately tried (unsuccessfully) to extend my trip and stay through Christmas, and soon felt I never wanted to leave. Taking the steps and working towards moving to Cambridge feels like answering the call to a part of myself that I had turned away from and in a sense given up on for now, but once pulled back out into the light, all my affection for this part of who I am is as strong as it ever was. All we have to do is take the steps to make the change in where we are to where we want to be.

 

In the wait

I haven’t written in weeks. Often I process anything big I am trying to wrap my heart and mind around through journaling or writing it all out, editing, and thinking it through, making a little space and time to set it in front of myself. I didn’t write much from 2017 to 2019 because we were in the middle of what felt like one of the hardest seasons we have gone through, and each time I felt we were beginning to crest the wave, another thing would crash down. It felt too big to process, too much to take in, too much to pen down on paper. I kept setting things aside and saving them to go through when we reached the other side. Now here we are, this is not the other side. Everyone is feeling the hard and trying to keep up with all the individual layers that are unique to each person. I think like most people I was eager to end 2019 even as Sean and I were both going through corporate takeovers in our careers that left us feeling incredibly uncertain about our future as a family and our job security moving forward. All we could do is wait. Wait to see how our jobs were going to land, wait to see if our efforts to exit foreclosure and keep our home would work out, wait to see if our toddler that I was spending nights fretting over was going to catch up developmentally. Waiting is not my strongest skill, but it is now something I have had to practice ad nauseam. Here are the things that are hard for me. I have been overly careful not to mention them because it feels like whining, when everyone is having a hard time and some are having a much more tragic and intense time than me. However, I can’t seem to move through what is feeling hard when I won’t acknowledge it. Before a pandemic hit the world one of the things that was keeping me going is the decisions we’ve made for our family moving forward. I was able to pour my efforts into our plans for relocating our family in Summer 2021. I have been applying for my UK RN license, working through the logistics of what it take to move a family of 6 to another country with little but suitcases and bins that we will check on a plane. I’ve been studying for exams, looking at housing, and it has been the plan that has kept me sane in the midst of everything else that has been falling away. I had planned on documenting this process step by step starting with how we came to this decision and what the nuts of and bolts of this process are. I was scheduled for my first part of a 2 part exam on March 23rd, when all the test centers closed the process of working towards this goal sort of ground to a halt. Of all the tings I have grieved in missing friends, worrying over missing therapy appointments for Frankie’s speech, our kids missing school, the halt of our plans to move have been the hardest for me. Possibly, because like everyone else, this part of the wait is something I wish I could just escape from. Right now so many parts of our life are on pause, and there is nothing but time to help move things forward. MIght as well start going through the pile of things I set to the side…

 

Checklist for Change

In January 2.5 long years of disconnect, intense emotional and financial stress and exhaustion came to a head. It wasn’t the foreclosure looming over our home, or the baby turned toddler that unexpectedly roughed up the edges of our marriage, the final straw was medical bills from a broken wrist in May from a fateful fall off the monkey bars at recess. In short, something that could have and should have been covered by the insurance policy we pay thousands of dollars for was going to cost more than I could wrap my head around; it was going to bleed over into another calendar year and continue to cost more out of pocket because of the lovely thing known as a deductible. I found myself pressuring orthopedists to make quicker decisions in December that were not able to be made because sometimes you just have to wait for bones to grow before you can decide what needs to be done with them. In a rare moment of clarity I expressed to Sean that I no longer wanted to do this. By this I meant work 4 jobs between two parents to make ends meet when one thing like a broken arm can take it all away. I meant I no longer wanted to work so much to support our kids that we didn’t get to see them or each other. I hate not having time to enjoy raising and watching them grow. For the first time in what felt like a long time, we both agreed, neither of us wanted to stay where we are, and both of us are aligned in our desire to make a change. We made a list, said list can be seen in an earlier post, “somewhere slower.” In the process of making a list I revisited a truth I have known and had to relearn many times, the first step in making something happen is simply to make the decision you are going to make a change. So many times I get stunted or stalled in the logic, but the truth is moving to another country is just a more complex algorithm of choosing to move to another state or even a new house. Once the decision is made, you just have to make a list of what needs to be done. For us that looked like figuring out how to work in another country as medical professionals including licensure, requirements, and researching the differences in roles. I am forever grateful to have found continental nurse in England as they have been holding my hand through the process of getting my UK nursing license. The second step was figuring out the type of visa that best suits our situation and needs. There are many reasons I feel lucky to be married to Sean, the newest one, his Commonwealth citizenship and the fact that I can ride his coattails into an ancestry visa since his sweet grandmother is from Scotland. Third, telling out children, let me just acknowledge the response was luke warm to frigid depending on the child, and the most excited one is really only in it because she is hoping for a pet bunny once we settle.

Our original pre pandemic timeline included allowing for the one unified request from our older three kids to finish out the school year. We have this year a grade 6, grade 4, and grade 2 school aged children as well as a toddler. As elementary school in our area ends at grade 4, it felt like a reasonable request and the process of acquiring my license is lengthy anyways. This was the plan before COVID 19. I started by opening a request with the Nursing and Midwifery Counsel and started begging the Tennessee board of nursing to communicate with them. This sometimes meant spending hours on the phone or sitting in the office refusing to leave until I was seen, but in the end it was all worked out and I scheduled to take the first half of my exam in March. Due to what we all now just lovingly call Corona Virus, my first exam was cancelled and rescheduled 4 times, but I finally took and passed my CBT exam in May. The last hurdle in being employable in the UK is to fly to England and take my OSCE exam. Currently, it feels like the world has changed a million ways since last January when we decided to start this process, in many ways it has only made me more prepared to go. My biggest concerns and fears have been around our children adjusting to a new place, new culture, and smaller more intimate spaces as homes are smaller there and they will for a time, only know each other. When we went into lock down it was like a mock trial run. I was relieved to watch them all lean in to each other. That is not to say there has not been sibling fights and high tensions, but I have watched them all band together, I know they can do this.

I am no longer sure when we will leave. Taking the OSCE will require me to fly in to the UK and quarantine 14 days before the exam, absorbing the cost of that trip as well as the cost of the exam is another hurdle we are trying to clear. I no longer feel we have to wait for school because our kids are not physically in school, but I do not want to break our work to our kids either. We are in the wait, and that is okay for right now. We have started to tick the boxes on our checklist for change.

 

Stepping Stones

I haven’t been able to think about what is next after this exam, nothing else can be done until this step is completed. Like many families right now, none of this looks like I wish it did. In my dreams I would have all of us here, taking a family adventure through Scotland and showing the kids around all my favourite places while finding new family favourites for us to return to after moving. Instead I am taking strange photos wishing I could show Archie the double decker bus he keeps talking about and knowing they would love the northern shore here. Sean has always wanted to visit Scotland and see his family here and hike around Scotland. Instead I am traveling solo and he is taking his vacation to hold down the fort at home with 4 kids, 2 who are just starting back to school and one toddler who is home all the time. I can tell you the one who is really doing the hard things is not me! I missed Archie’s first day back at school and will be missing Elsie’s last soccer games, Halloween, and Frankie’s 3rd birthday. While this feels exciting and like progress, it also feels very sad. I miss my kids and my husband. I have not been away from my kids this long ever and I haven’t been away from Sean this long since our long distance dating days. The last solo trip I took (other than trips to Canada when we were dating) was to Romania when I was 22. So it has been a bit since I navigated changing planes and trains (vastly easier when you don’t have a toddler in an ergo strapped to you). The stress of trying to remain COVID 19 free while traveling added some extra stressors to this venture and while wearing a mask for 21 hours on planes and trains was not my best life, I am grateful to have arrived here. Every glimpse of Scotland I’ve seen has felt like a privilege, so has the full night of sleep and the quiet day of studying. So whats next? When I complete quarantine here I will take the train to Northamptom England and take my nursing exam (also known as the OSCE) the next morning. Then the next day the train back to London for my morning flight home.

Partially due to COVID 19 and partially due to the massive process it is to move a family of 6 to another country, everything has been happening in agonizingly slow stages. I have had to re-frame it many times to avoid feeling frustrated. The next biggest step is securing my nursing license. The first half of testing I was able to take in the states, the second half has to be taken at a testing center in England. Originally I had planned to fly here for a week, take my test, and maybe explore a little as well as look at housing and neighborhoods in Cambridge. Then COVID 19 caused border shut downs, testing centers were closed, and it felt really uncertain when it would be a possibility to schedule things. Testing centers opened again in October and I was cleared for a November 3rd exam. Instead of a 1 week adventure, a two week quarantine was necessary before testing. I find myself in the incredibly lucky position of knowing a sweet friend in St. Andrews Scotland who offered me a room in her house for two weeks. I wish I was out exploring Scotland, I have always wanted to visit, instead I find myself studying training videos and watching the weather out the window. Here’s to completing next steps and hopping to the next stone.