At a recent workshop I gave to Nurses, “numbing out” was a common thread. It happens to all of us. Remember the Columbine school shooting in Littleton, Colorado in 1999? We stopped in our tracks, praying for the children, staff and families. Gun violence has become all too common that it unfortunately doesn’t create the same level of alarm for Americans, consider the shooting at UCLA last week. Nurses detect cardiac monitor alarms, fetal monitors, apnea alarms, dialysis beeps, wound vacs, bed alarms, IV pumps, vent alarms and of course Code Blue, Red, Gray, Silver, Pink and Orange alarms. Nurses exposed to beeping alarms develop alarm fatigue by detecting which alarm responds to what notification and tuning out sounds.
Just like gun violence and beeping alarms become tolerable, Nurses numb out to all the suffering we bear witness to. For some of us, it is our way of controlling our emotions or emotional attachments to our patients. We worry if we feel everything so deeply, we wont be able to contain it.
When the patient gets a terminal diagnosis, we take it in cognitively, but only so much. It’s way too much pain for me to hold it in my heart to contemplate that he will be dying and leaving his wife and three children. Is it such a crime to not want to feel such anguish?
When your patient asks if he’s going to die, you wimp out by saying “Of course not”, meanwhile he knows you are lying and so do you. He dies without having had the opportunity to talk about his feelings about dying because we just didn’t have it in us.
We become numb because we are expected to be super human. We medicate one patient febrile with rigors receiving amphotericin, triple antibiotics and blood products while weaning patients from ventilators, manage sepsis, help diagnosis and treat strokes and heart attacks while explaining 20 minutes of discharge teaching in the 5 minutes you have to spare. When we numb out to the demands of work, we lose our barometer of when to advocate for our patients.
When July comes around and the resident is on his third attempt at an epidural or central line, the numbed out Nurse doesn’t notice. When the physician tells you the patient is drug seeking but refuses to order a psych consult and appeases the patient with the Dilaudid regimen she requested, the numb Nurse carries it out. She is too detached to care and advocating for the patient in this case would require resistance from the patient and the Doctor and that would require too much energy.
Another Nurse might refuse the order, obtain a pain/palliative care team consult or psychiatric consult and be willing to take a stand instead of contributing to the ever growing problem of narcotic dependence in our country. She will likely leave work exhausted and frustrated with a 50/50 chance of having made an impact.
We have a hard job and our shifts are filled with non-nursing tasks, dealing with broken equipment, moving beds and rebooting computers. When we recognize we are maxed out, we can recharge and return a little thawed out. When we let our armor fall off, we can allow ourselves to feel again and let that serve to advocate for our patients.