Surviving Another Ho-Hum Day at the Office

By Melanie Sears, RN, MBA​

I knew I was heading into a challenging situation when I arrived to an assignment on my favorite psychiatric unit only to be told that I was being re-directed to work in the Psychiatric Intensive Care Unit (Psych ICU). I gave myself some empathy for my disappointment, reminding myself that I had choice, and could always say “NO.” However, I also knew that my boss’s direction to float to Psych ICU was a demand, not a request, so any NO from me would likely have negative repercussions; I might even be fired.

I decided that until I had a different strategy for meeting my financial and retirement needs, I would comply.

When I got to the Psych ICU, I was assigned a patient, Fred, who had a brain injury. When I walked into Fred’s room, he screamed, “Get out of here! Don’t touch me or I’ll cut off your nose!”

Since Fred was too weak to get out of bed, I felt my nose was probably safe. However, Fred’s arms were bent at the elbow and his hands fisted, and whenever I got near him, Fred let fly a punch. I needed the help of a couple staff people to hold down those fists so I could perform routine nursing care (diaper change, linens change, and repositioning).

During dinner, as I fed Fred, I wondered if it was possible to connect with him. I had an inspiration to sing, and launched into, “I’ve been Working on the Railroad…” Much to my delight, Fred began to sing along with me. I could tell he remembered some of the words, and I felt my heart open toward him.

When it was next time to care for Fred’s physical needs, I again asked a staff person to help me. But, when my face got too close to his unsupervised right hand, he slugged me hard in the mouth. I noticed that my first thoughts were murderous.

Trying to be kind, the nurse who helped me said “I’m sorry that happened to you,” but since I was holding onto some old resentment toward her I felt defended around her. Plus, I needed empathy at that moment, not sympathy.

As I continued to observe my internal state, I noticed that I no longer wanted to kill Fred; now I was mad at the system for keeping him alive so long after his brain injury. I knew that system “experts” had treated him for pneumonia numerous times and had even removed a lung to treat his lung cancer. I felt sorry for Fred, trapped in a damaged mind and voiceless in a system determined to keep him alive, no matter what.

Then I noticed that I felt emotionally hurt. My heart had opened to Fred just a wee bit, which set me up for emotional pain. I wanted to go someplace and cry, but the unit was short staffed and I could not leave.

All animals have a built in mechanism to release trauma. Animals in the wild will often shake and shiver after a traumatic event happens, and humans, too, need to be able to let their feelings out. One way humans release trauma, of course, is to cry and “get emotional.” Yet, Psychiatric nurses do our work in a ‘culture of toughness’ in which we are expected to be calm and stoic in all situations.

As nurses, we learn to view as “heroic” the silent, tearless, suffering of injury and we learn the habit of minimizing and ridiculing the soft human needs for connection, recognition, empathy, and care. Even while we are expected to be kind and empathetic toward our patients, we nurses condemn each other for expressing the need for kindness ourselves. This cruel double standard places us in an impossible situation. How can we be kind and empathic toward others when we ourselves don’t receive the empathy we need?

Back in the Psychiatric ICU the next evening, my lip still swollen from the assault, I was assigned to work with a patient who, earlier that day, had threatened to kill his doctor and Occupational Therapist. My first interaction with him happened right before dinner, when I found him on the floor in the TV room. He said he had fallen when he tried to transfer to his wheel chair. When I told him I could not lift him by myself and would need to call the lift team to get him off the floor, he cussed me out. I noticed that I felt scared, and that my fear was deepened by the recent assault. I concluded that I was storing trauma inside and needed to find some healing.

The next day, I made an appointment with a Nonviolent Communication Trainer to get some empathy. After expressing the full range of my feelings and being heard, the fear I felt dissipated. I reflected on how grateful I am to have found the tools of Nonviolent Communication (NVC) and trainers who know how to make space for my feelings. Because of my exposure to NVC, I understand that my feelings are an alive and fluid part of who I am, and that when I deny my feelings, I deny my aliveness.

With some time for healing, I was also able to think about how I might better meet my needs for financial stability and meaning. I remembered to look forward with optimism to the September, 2010 release of my book Humanizing Health Care: Creating Cultures of Compassion with Nonviolent Communication. The publication of my book will help me to grow my business training health care businesses to create true cultures of care using the principles of Nonviolent Communication. I invite you to buy the book and schedule a training session for your organization so that you, too, can use the tools of Nonviolent Communication to stay healthy, human and whole – even on your most challenging of days.

Melanie Sears, RN, MBA is the author of Humanizing Health Care: Creating Cultures of Compassion With Nonviolent Communication. A Registered Nurse, she has more than 25 years experience working within the health care industry. She is a CNVC Certified Nonviolent Communication trainer, and active member of Northwest Nonviolent Communication in Seattle, Washington.