Patti.

Patricia

Looking back, I realized I could have died.  They should have held me in the hospital-or at least offered me some kind of resource to help me address my addiction.

But they offered nothing.

The problem with addiction is that it is viewed as a moral deficiency instead of a disease.  If I was diabetic and was diverting insulin and was in DKA, would they have treated me the same way? Absolutely not.

I received no support from the hospital. I lost my position immediately and all health benefits were terminated. Rehabilitation was dependent upon what I could finance. On average, rehab can cost anywhere from $5000-$30,000 per program-and that was more than I was able to pay. I had to turn to my family for help.

The hospital was completely negligent in how they handled my situation, just because they had bought into the stigma.

Jail Time

When I walked out of jail on July 13, 2004, I had a trash bag with my personal effects from when I was arrested. I had no home. The clothes I had on were sagging, because I had dropped 20 pounds in jail. I had no driver’s license and, most devastating, no nursing license.

I had nothing.

But what I did have was a second chance and hope that the best was yet to come. I promised myself in jail that the addiction would end and I would never live another day in regret. I’d go back to school; I’d recover my license.

And that’s what I did.

Before the Board

In March of 2006 I was given the right to practice nursing again, and I will never forget it. It was a battle hard fought.

During my hearing there were over 60 nursing students present, while all the dirty details of my crimes were put forth for public record.  However, if it raised the awareness of just one of those student nurses it was worth my humiliation.  It has taken me years to work through the shame and guilt of what I did and how I ruined a career I loved.

Nursing after a Felony

I gained back my license after lots of documented AA meetings, working with the voluntary state monitoring board for impaired health care professionals, performing random urine screens, working with a sponsor, getting treatment, attending aftercare-doing it all one step at a time.

I currently do not work in a hospital because I’ve been barred from working in any facility that is funded by Medicare (Medicare forbids convicted felons from work). So that narrows down my options significantly.

In May of 2010, I will graduate with a Bachelor’s degree in health administration and policy and will be applying to grad school to pursue a Master’s in public health. I may even focus on policy, because a lot needs to change in the way health care handles nurses’ addictions.

We must abandon the secrecy that hides an epidemic that no one talks about but costs the healthcare profession thousands each year.  We need to stop hiding. If we don’t support our own colleagues, what are we doing to our patients?

Now that’s the real crime.

I spent some time reviewing what the “hot topics” have been.  We certainly have covered a lot of ground–that’s for sure.  We’ve talked about drug addiction, the NCLEX exam, impossible co-workers, and delegation.  We’ve covered making mistakes, insecurities, and being let go after only a few weeks of orientation.  I, myself, have written about goal setting, facing our fears, relieving stress, and being “perfect enough.”

I have a few thoughts after re-reading some of our community’s comments:

1) We’re serious about what we do.

2) We are encouragers.

3) We have a stressful profession.

4) We’re all doing the best we can.

5) Some of us like to swear a little too much.

All said and done, I’d say we’re a pretty amazing group of people.  I count it a privilege to be one of you.

I want to hear from you: What were the highlights of your year of nursing? And what do you look forward to in 2009?

I had been having this weird gunk in my mouth for a few weeks and had no idea what it was. Nor did I want to mention it to anyone because it seemed so bizarre and embarrassing.

So I went to Google. I typed in “white stringy mucous in mouth.” (Too much information, I know, but hang in there with me. I have a point.) Lo and behold, it pulled up all kinds of helpful information from people who also complain of “mouth boogers”–as one man called them. Turns out I’m not going to die from cancer of the mouth or embarrassment. It’s a side effect of the whitening mouth wash I’ve been using.

Still don’t see my point?

It doesn’t matter what may be going on with you, someone else is probably dealing with the same thing. And knowing that can make all the difference for you.

Feeling like you’re alone in something can be debilitating. It can cause worry and stress. It can make you feel powerless or inadequate. Knowing there are others in the same situation or with the same thoughts or problems lifts the load you’ve been carrying by yourself.

That’s the point and the beauty of sites like this one. It builds community for a group of people who otherwise may feel alone.

If you’re living with people who don’t share your anxiety over taking the NCLEX, you can find a hundred people here who feel the same way you do. Girlfriend or boyfriend don’t go to work everyday worried they might kill somebody while on the job? Lots of people here do. Certain you’re the only nurse “in the closet” with a drug problem? Not so.

If you have a problem or concern that you are having trouble finding support for, post a topic. We may not have all the right answers (though I think all the smartest nurses read RealityRN.com), but I think you will find that you’re not alone in your issues.

So go ahead, post a topic. See if I’m right.

Unfortunately, nurses, who pour themselves into caring for others, are notorious for self-neglect. There’s no one around to make sure you make “you” a priority.

It’s a conundrum—you know you ought to take better care of yourself, but you don’t. Maybe you’re too tired to care. Maybe you don’t know where to start.

If you’re one of the many nurses languishing in this predicament, a fellow RN, Brenda McLaughlin, wants to hear from you. Alongside her advisor Dr. Sirois, from the University of Windsor, Department of Psychology, McLaughlin has developed a nurse self-care survey at http://uwindsor.ca/nurses_health_beh.

RealityRN recently spoke with McLaughlin and Sirois about their research, and how it will benefit nurses across the globe:

RealityRN: What led you to conduct the study?

McLaughlin: I’ve always been interested in health and making my body work better. When I got into nursing, I found many nurses would complain about leg problems and back problems, yet they wouldn’t exercise. I would see nurses using poor ergonomics and again complain. I’d see nurses going out for cigarette breaks and drinking coke and eating chips for breakfast. I thought, As nurses, we know better. When I sat back and looked at my own behaviors, I realized I do similar things. For instance, I procrastinate with exercise and don’t eat healthy all the time.

What are the results of poor self-care?

McL: Obesity, stiffness, poor balance, high stress levels, type 2 diabetes, and irregular menstrual cycles, among others. Because of this, nurses often call in sick more frequently and experience less job satisfaction.

If these are the results, why don’t nurses make self-care a priority?

Dr. Sirois: Procrastination is probably the biggest factor. Through my research, I’ve found that when people are under a great deal of stress they tend to not look after themselves very well. The higher the stress level, the poorer the self-care– even when you know better. Stress wreaks havoc on your ability to look after or care for yourself–the way that you know you need to.

I also think that nurses fall into a “role” of looking after others, but the job requirement doesn’t say you should look after yourself. By focusing on others’ health, nurses have blind-spots when it comes to caring for themselves.

How do you hope your research will benefit nurses?

McL: We hope to detangle the issues around why it’s so easy to look after others’ health but not ourselves. We also hope to provide insight on how nurses can take responsibility for their health.

We’re also finding that nurses who fill out the survey become more self-aware of their self-care. In the survey we ask, “Did this survey bring attention to an area you need to improve on?” And about 50 percent of the group said yes.

Dr. S: You might be fooling yourself, thinking you’re on top of your health. Through the survey, you may discover areas where you’re not doing as well as you thought.

That awareness in itself can actually provide good motivation to think of better ways to take care of yourself.
To fill out the survey go to: http://uwindsor.ca/nurses_health_beh.

“I thought I was immune,” says Patricia Holloran, RN.

But she was wrong. A recovering drug addict, Holloran has become a strong advocate for other nurses facing the same struggle.

Most nurses think they will never fall into addiction, but, according to Holloran, even as healthcare professionals, nurses are vulnerable.

Look around your unit: You may be surprised to find out that out of the 10 nurses you work with, one may be struggling with or recovering from an addiction. And such addiction not only leads to personal devastation but also to impaired patient care.

Maybe you’re the one trapped in the addiction. Maybe you see a friend or co-worker going down that path. Holloran offers honest insight into the nature of nurse addiction and the road to recovery:

RealityRN: Is there a higher rate of addiction among nurses compared to the general population?

Pat Holloran: Nurses fall into the same range as the general population—about 10 percent. The difference is the ready availability of benzodiazepines and opiates, such as Morphone, Dilaudid, and any form of oxycodone. So nurses don’t have to go through great lengths to get the drugs. They’re sitting right in front of them.

Are certain nurses more prone to addiction than others?

No one can predict who will become an addict.

But many nurses become addicts at the time in their lives when their children are teenagers and their parents are elderly, and, for women, when menopause strikes. Often, dependence occurs in adult life after 11-17 years of service – there is an increased risk of physical injury and emotional pain and fatigue. This may prompt the use of benzodiazepines or alcohol.

Nurses who work off shifts may begin to abuse medications that induce sleep.

Those that work in the ER and other high-acuity areas are susceptible because of the high stress environment. Also vulnerable are high academic achievers with advanced degrees who are accomplished in their fields. They hold demanding jobs, they are respected by colleagues and loved by patients, and they hold themselves to high expectations.

Usage is solitary, not social. Often there’s a family history of chemical dependence and the initial use is not for “kicks”. Nurses don’t use street crime as a way of obtaining drugs.

How do nurses become addicts?

Most nurses become addicts because of chronic pain (for instance, from a back injury) and/or emotional pain. In these cases, pain control medication often is prescribed.

Because they feel that they have to work regardless of the pain (in fact, the profession enables this by rewarding nurses who work sick), nurses begin to abuse the narcotics. Over time, they become physically dependent and some develop addiction without even realizing it.

What follows is self-medication, and, sometimes, diversion of the narcotics on the job.

Why do nurses self-medicate?

It’s called Pharmacological Optimism or excessive faith in drugs. We witness the power of drugs in our day-to-day environment. We see our patients’ misery and how a drug relieves the anguish. Our Pavlovian response is to reach for a pill or a shot to relieve our own pain and suffering. We rationalize that this is the right thing to do for ourselves. After all, it is what we are taught; it is what we see; it is what we do.

It usually occurs without any thought to the risks –and without exploring healthier coping mechanisms.

Does self-medicating lead to diverting?

Sometimes. Nurses who divert usually don’t start out by consciously diverting for their own use. It’s usually by accident at first. During the course of a busy day, nurses continuously put things in their pockets: tape, syringes, alcohol pads, and occasionally a medication that the patient refused to take, or the waste of a med that was used in an emergency situation.

The nurse truly intends to waste the med, but finds it in her pocket when he/she returns home. Eventually, this med becomes “available” when he/she has fought with the spouse, is fatigued by work, is in pain from an injury, or the kids are out of control. The meds provide immediate relief for whatever pain the nurse is experiencing—and life seems so much more manageable.

What are common signs of denial?

Rationalization is what keeps the denial alive. Nurses who find themselves with drugs say, “The next time will be the last time.” or “The drug was going to be ruined anyways.” Nurse addicts truly believe this. They are good nurses who would never consider harming a patient’s well being.

They rationalize that they are in control and can stop whenever they want. In fact, they usually aren’t even aware that they are rationalizing.

What does rationalizing do?

Rationalizing eases the mind and calms down any fear that what they are doing is wrong. My sponsor said it in a way that I understood for the first time: “It had more control over you than you had over it.” I did not understand it until then. I thought I was in control.

How do you break through the denial?

Breaking through the denial usually has to come in the form of an intervention. An intervention should never be done alone and never done without a professional who is schooled in addiction and addictive behaviors. Addiction by its very nature is a suicidal risk.

The fear and shame a nurse experiences when confronted is so strong that many nurses, including myself, have their first thought ever of suicide. Sadly, there have been nurses who went through with it, and those who have come very close.

Where is the hope?

Nurses need to remember that addiction is a disease. When I was just starting my treatment program, I was so confused. I absolutely did not know why I could not stop. I had been able to control so many other things in my life—like quitting smoking. I was a good person. But this addiction grabbed hold of me in a powerful way.

I began to learn about the pleasure-reward system, which teaches us how to survive on the instinctual level. I was taught that addiction biologically hijacks this brain system into a controlling, dominant, and vigorous force that prevails over reason and intellect. It was then that I knew I was sick and not “bad”. Being in healthcare, this rang true to me; it was something I could understand.

A friend once said, “The attitude held toward addiction interferes with the very spirit of nursing.”

When an addict finds and embraces recovery, the denial breaks – and the healing begins. They begin to have choices in their lives. The addiction isn’t driving the bus anymore. Recovery is a lifelong process. They’ll eventually be able to say, “My addiction is not my responsibility, but my recovery is.”

But it’s not that simple. According to Dr. Linda Barile, APRN, and advocate for nurses who are addicts, we need to stop blaming them and instead support them through recovery.

Here is Barile’s insight on how to help a nurse who is an addict:

RealityRN: How have hospitals historically dealt with nurse addiction?

Linda Barile: Through denial and punitive measures, unfortunately, addiction is not seen as a disease, even by many in the medical community.

Often no action was taken. When it was, we’d put them on nights; hide the problem–because we thought the addiction was due to stress. And if we could relieve the stress, then the addiction would just go away. While stress may have been the reason a person started abusing a drug, it’s no longer the reason they are addicted.

If caught diverting, most nurses were punished. You were sent before the State Board of Examiners for Nurses and you would have your license suspended for prolonged periods of time or taken away. Nobody wants to employ an addicted nurse, so they took away the nurse’s job—without seeing them through recovery.

Why are addicted nurses treated so harshly?

There is a mistaken belief that someone can stop using if they really want to. And in cases where nurses suspect or know something is wrong, they don’t know what to do. They’re not sure if they should confront their coworker, but they would feel like a traitor who could cause the nurse to lose his/her job, if they let someone know.

When a nurse is discovered to be an addict, other nurses struggle with bitterness and anger about having been manipulated. They’re not ready to jump to an addict’s rescue.

There is also the “family secret” mentality. It’s important to keep the image of the “healthy, happy, functioning” facility/unit/staff intact. Many institutions like to pretend addiction doesn’t happen in their establishment. But this cycle of enabling puts patients in jeopardy–and the addicted nurse becomes increasingly ill.

How should addiction be dealt with?

First, nurses need to become educated about addiction as an illness, an actual brain disease that causes people, even nurses, to act outside their normal moral behavior.

It is essential to document any incidents they are concerned about, followed by notifying their direct supervisor. An individual nurse should never confront another nurse alone. If a nurse comes to work intoxicated or high on some drug, call your supervisor or head nurse and seek the help of an addiction professional. But don’t confront the nurse yourself. On many occasions, they’ll argue with you, deny it, or get angry.

When a nurse is confronted, don’t send that person home alone. Legally and ethically, you can’t let someone who is under the influence of a drug get into a car and potentially harm someone. That person needs to be escorted home or, if indicated, to an appropriate medical facility for care.

During the intervention, the addicted nurse also needs to be guided through how and where they can get help—and not judged but supported through the process of recovery.

Where can nurses find help?

In many states, like Connecticut where I am an APRN, there are non-punitive alternatives to a disciplinary system (which typically are initiated by the Department of Public Health). Connecticut’s program is called HAVEN (Healthcare Assistance Intervention Education Network). Through programs like this, nurses can anonymously self-refer, and if they meet the criteria, their monitoring is done in a confidential manner. When the nurse successfully completes the contract, his/her license is clean and unrestricted.

In many states, there is also a peer support group called Nurses for Nurses, which is anonymous and confidential and provides a place where nurses can discuss the specific issues facing nurses with substance abuse. And at the very least, nurses can get involved in a 12-step recovery group, like AA or NA. AA and NA are welcoming and knowledgeable about addiction–and don’t cost a penny.

It’s crucial that help be sought to assist the nurse on the road to recovery, which is multifaceted: biological, psychological, social, and spiritual.

I wish that were the truth. I’m a nurse, and I certainly never thought I was vulnerable.

Not all nurses will develop the disease of addiction. But for many nurses, addiction is real. Substance abuse in the nursing population is believed to parallel or be slightly higher than that in the general population: approximately 10%. And it very often begins with a legal prescription for a legitimate medical problem. That’s how it started for me, anyway.

A Migraine of Problems
When Stadol first came on the market (1991), it was not considered or marketed as a controlled substance, so I wasn’t concerned about my Stadol nasal spray prescription for the migraines I suffer. Two years after using Stadol as prescribed, I had major abdominal surgery. Three weeks following that surgery, I found out my abdominal wounds weren’t healing and my incision opened in four separate areas, exposing my abdominal wall.

The next two years were very difficult. In order to encourage healing of these deep wounds, I had to “heal by granulation.” I had to keep the wounds irritated, cleaning them with medicated soaps and rough gauze 2-3 times a day. My doctor prescribed Stadol nasal spray for my dressing changes; it still hurt, but the Stadol made it more tolerable.

No one knew Stadol was addictive and should be treated as a controlled substance. Stadol was usually ordered for short term pain relief in recovery rooms of hospitals, so it was considered perfect for my dressing changes. I wasn’t getting high on it. The drug just made the pain go away.

As I healed, I continued using Stadol for the dressing changes as prescribed; I’m not exactly sure when the physical pain actually ended and my fear of being in the pain began to drive my continued use.

The Drug Becomes Master
My abdominal healing took two years. During that time, Stadol slowly gained control of my life. Scientific research has found that actual chemical changes occur in the pleasure/reward area of the brain with repeated use of narcotics. This area is also responsible for human survival instincts. Pretty soon my brain was telling me: “Eat, sleep, take Stadol, drink water, take Stadol, hit the washroom, take Stadol.” I believed I truly needed it to survive.

You don’t really notice when the transition happens. However, when you haven’t taken the drug, you experience withdrawal symptoms, such as itching, diarrhea, intense muscle cramps, sweating, anxiety, or as in my case, shakes and nausea. Then you take the drug, and the pain goes away. After all, we’re taught, that’s what it’s there for, right? Nurses see instant relief—both physical and emotional–in their patients’ when pain medication is given.

Diversion Begins
When I was working in Labor and Delivery, the dose of Stadol required for our patients was half of what was available in the vial. This meant that we would have partial vials of Stadol leftover. As we rushed to clean up after a delivery, the vial(s) would end up in our pockets–and often the process of properly discarding them was overlooked.

One day after arriving home and having a headache, I found my nasal spray was empty. I had a vial of injectable Stadol in my pocket, and I wondered, If I put this in a nasal spray bottle, will it work? It didn’t. Because I’m diabetic I had syringes, and without thinking I injected myself intravenously; like many nurses, I was skilled in starting IVs.

During this time, I didn’t/couldn’t see anything wrong with taking the leftover vials from the hospital. I rationalized that I would have tossed them out otherwise, and it saved me a trip to the pharmacy.

One thing led to another. Eventually I was taking full vials home and injecting Stadol on a daily basis. When I was medicating a patient, I would often take out two bottles: one for them, and one for me. And as I later learned in treatment, my usage increased as my tolerance increased; soon I needed more and more.

Eye Opening Intervention
Desperate, I began to use a coworker’s code for the Pyxis system. The pharmacy started asking questions when they realized my coworker was signing out a lot of medication– even when she wasn’t on duty and sometimes for patients no longer at the hospital but still in the system. Because of me, she was fully investigated; I can’t imagine how horrible that must have been for her. My drug use caused me to act and function outside my “normal” moral behavior: typical addict behavior.

Around this time I finally realized that I was really sick, that I had become addicted to Stadol. But where could I go? Who was going to help me? I felt an overwhelming amount of shame, guilt, and humiliation: I’m a nurse, I should know better. I’m supposed to be helping people.

Once I realized what was going on, I firmly believe the healthier part of my brain started making mistakes on purpose so I would get caught. During their investigation, state drug control agents installed surveillance cameras over each of the three Pyxis systems on our floor. Once they had enough evidence, I was confronted. I was physically ill when I saw the still shots from the video cameras. The day I was confronted was the worst and best day of my life; I no longer had to hide my illness, and I could stop lying, especially to myself.

I wasn’t thrown in prison. They didn’t take away my son. I wasn’t fired. But I did have to go before the State Board of Examiners for Nursing and my nursing license was disciplined. My probation lasted four-years, which certainly wasn’t a cake walk. During the first year I didn’t have access to narcotics, which required co-workers to medicate my patients. And during all four years, both my nurse manager and therapist had to submit monthly reports regarding my ability to practice safely. I also had to submit to weekly and then twice monthly urine drug screens and attend support group meetings.

Alternative to Discipline
Each state has its own disciplinary practices, often governed by the Department of Public Health or other licensing body. This type of disciplinary process is public and punitive. Can you imagine having heart disease and being punished in a public forum? There are only about four states that do not have an alternative-to-discipline program. I wish that an alternative-to-discipline program had been instilled in my state at the time of my intervention; that’s why I’ve been fighting for it publicly ever since.

An alternative-to-discipline program recognizes that drug addiction is a disease and an occupational hazard for nurses. It provides them an avenue for getting help while maintaining their integrity, dignity, and job status after rehabilitation.

You can self-refer yourself, or a facility or coworker can refer you. There are mechanisms within the program to address those referrals and get nurses out of practice and into treatment and recovery without impacting their confidentiality or their ability to practice safely once they are proven fit to work. It functions within a case management system; therefore, trained addiction specialists conduct all monitoring. The process begins immediately, without the Department of Public Health’s involvement.

And Now?
I’m not a bad person, and I wasn’t then. I used a drug prescribed to me that was unknown to be addictive. But it turned into a disease. Without knowing it, I was putting other people in jeopardy—mainly because I was afraid of what would happen if I looked for help.

I’ve been clean for ten years, and I continue to hold an active nursing license which has been unencumbered since 2001. My son is 14, knows his mom is in recovery, advocates for other nurses, and provides tremendous support. I went back to school and earned a DARC (Drug/Alcohol Recovery Counselor) degree in 2005.

I am very active in the recovering nurse community and am an advocate for all recovering individuals. I have helped co-author legislation for an alternative-to-discipline program for Connecticut nurses in the past; now that Connecticut has passed a law allowing such a program, I am involved in its development. I am also an active member of Nurses for Nurses–Connecticut’s peer support group for nurses.

Nurses suffering from addiction are no different from anyone else suffering with a chronic and progressive disease. Addiction doesn’t discriminate or care what you have or what your status is in society. They say it’s an equal opportunity disease.

So, if you find yourself or a friend in this situation, find out if your state has an alternative-to-discipline program – and use it. Also locate the nurse support groups available. Remember: You don’t have to do this alone. It doesn’t matter if you’re taking pills or injecting; addiction is addiction, and you need freedom from it.

All nurses work extremely hard to become a nurse, but what’s most important: your license or your life? The opportunity for a better life is there. Take it.

One moment, Kayla thought she was depressed and that medication would help. Another moment, she thought her husband was the problem and that she should quit her marriage.

But Kayla wasn’t depressed. She suffered from something that affects many professional caregivers.

In recent years, Mary Jo Barrett, author and social worker from the Center for Contextual Change, in Elmhurst, IL, has helped many nurses deal with compassion fatigue. Read on as Mary Jo describes what it is, how it affects a nurse at work and home, and some simple solutions to fight it:

What is at the root of compassion fatigue?
Compassion fatigue is the physical, emotional, spiritual, and intellectual exhaustion a caregiver experiences.

And the symptoms?
They vary from person to person. When you’re intellectually depleted, you feel stupid, incompetent, and judgmental. You start comparing yourself to other professionals; you might decide you’re better or worse than them. There’s a lot of self-judgment. You start believing your work isn’t meaningful or won’t really help.

Physically, it’s easy to have a breakdown. Nurses eat mindlessly and gain weight. They might struggle with addiction to caffeine, alcohol, or drugs. They’re trying to medicate; they’re trying to soothe.

For those of faith, some might even have a spiritual crisis. They stop believing, lose sight of the role of faith in healing, and become bitter.

How does compassion fatigue spill over into other aspects of a nurse’s life?
“Shutting down” carries over into the home life.

The energy you use as a nurse is the exact same energy you use to be a mother, partner, or child. At the end of the day, you might not have the emotional energy to listen to your partner or kids. You might bring the numbing feeling home, or you might act hypervigilant and overprotect your kids from every little thing.

Nurses also see the world through the eyes of the illness or disease they specialize in. For example, neonatal nurses—mostly younger women—are neurotically anxious about having babies. When a nurse is pregnant, they talk to the doctor about everything that could go wrong, even though they’re nurses. Some are even afraid of getting pregnant.

How do you counter and heal compassion fatigue?
Nurses need to understand the consumption, conservation, and replacement of energy.  They need to be mindful. When you’re mindless, you’re consuming energy instead of replenishing it.

What are some things nurses can mindfully do?
They should mindfully eat. Nurses wonder why they have no energy; the problem is that they load up on white sugar, white flour, and caffeine. Instead of eating doughnuts or downing Diet Coke, nurses should include lots of protein in their diets.

They can also mindfully relax. Attend to your breathing by practicing meditation. Listen to music, which is neurologically proven to change your mood. Keep flowers at your station and use aromatherapy. Also exercise 30 minutes every day. It may mean 10 minutes, 3 times a day. Another simple thing is to sit in a chair that supports your neck and back.

Take breaks. You don’t have to take an hour—take a few minutes. If a patient dies, instead of moving mindlessly on to the next patient, take two minutes and let it affect you. If you have a terrible disagreement with a doctor or administrator, take three minutes and think about something you really love about your job.

What about nurses who say there’s not enough time to do all this?
I understand their viewpoint, but that’s the compassion fatigue talking. Everybody has time; you have to prioritize.

You’re not as efficient when you’re exhausted. The more compassion fatigue you have now, the more you’ll have later—it feeds on itself.  By the same token, energy creates more energy. Replenishment re-feeds itself.