Anxiety Origins and My Last Full-Time Job

e3d0f15470243e3f766e7b5a4c1fad1fAussa Lorens posted a piece on anxiety on her blog today and it really got me thinking about the reality of my own anxiety and where it all came from. If you don’t know her, she works in a psych hospital.

I have anxiety disorder and there are times when my heart is racing and pounding in my throat and I can’t breathe. It can be overwhelming, especially when trying to work. I haven’t always had anxiety disorder. It just sort of sneaked up on me, but I think I have determined when.

The last place I was employed as an RN (in a free-standing psych hospital for six months) had me working nights in admissions alone with an open-door walk-in policy. Many nights it was me and 10-20 psychotic patients and their half dozen family members each. (Did I mention alone?) Many potential patients and/or their family members/friends were intoxicated on drugs or alcohol. The noise level was deafening.

While attempting to manage these people and all of the questions, needs for blankets, food, drink, etc…I was inputting their data into a computer (with my back to the door), screening calls and faxes from local hospitals for potential admissions, taking cold calls from people needing services or counselling, interviewing and performing assessments, inspecting and processing their belongings (you know, running the magic wand over them and collecting their guns and knives and things they might hurt somebody or themselves with, confiscating contraband), reviewing their meds with them, calling doctors for orders, processing patients out to ERs who were too sick to be admitted, printing out forms, calling insurance companies for pre-certs, admitting and walking patients to the wards to give report. Calm-during-stress-300x264All the while, I am attempting to remain the calm anchor in this sea of chaos and provide comfort and care to those in crisis. After all, I had worked forensics, ER, and CCU. Calm was my middle name. I had once worked a detox facility where a man walked in put a gun in my face and demanded his wife…so I thought I could handle this.

My begging for a health services tech for months had fallen on deaf ears. Again, I was alone in the admissions unit at night. I tried very often to get the nursing supervisor to send me assistance but, of course, she never had anyone she could send. On my last night there, I had 16 patients and their family members. I had done everything possible to make them comfortable, but one girl was screaming at the door to be let out, while her family waited on the director to come in (from her bed at home) to admit her involuntarily.

I had just turned around a patient who arrived via ambulance from the local ER whom I had been told had a “little head wound”, but who appeared on a stretcher comatose, with eighteen stitches down the side of his shaved head, and unequal pupils. The girl at the door screaming had tried to convince the ambulance attendants to take her with them. Once they were gone, her screaming became louder, and she started banging on the walls with a chair.

I thought I had screened everybody well at the door, but a man, obviously tired of the disruption and noise, pulled a gun from his sock and started shooting at the ceiling. We had no security department, and the guy gave up the gun willingly. Thank goodness no one was injured. When the director arrived, I handed her the keys and left. I never went back. There are reasons why it was the last place I worked. Anxiety or real fear…your call?

What makes you anxious?

Have you ever had a panic attack?

Do you understand why most healthcare workers feel the system is broken?

28 thoughts on “Anxiety Origins and My Last Full-Time Job

  1. So… is it really a panic attack if it’s a completely justified and sane reaction? This sounds like a nightmare, and the saddest part is that it probably hasn’t changed.

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    1. That’s the saddest part. I know it hasn’t changed. In fact, each day corporations expect healthcare workers to do more with less. I guess the sweating, heart pounding, can’t breathe, “get me outta here” is real anxiety, but sometimes it is justified anxiety. Either way. A good dose of Ativan seems to work to control symptoms. The problem now is that I get these symptoms over otherwise trivial stressors. Like when I go to the grocery store and it is crowded and I can’t find something I need. Pathetic.

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  2. Sounds like it’d be anxiety and fear. Can’t blame you for not going back after all of that. I’ve had panic attacks before, which usually stem from extended periods of stress. Basically, a lot was put on my shoulders and it felt like everything I did was wrong. Didn’t matter how I got done or how successful I was because there was always something to blame me for. I think the day I had my first panic attack in the parking lot was after I was put on a project and called into an office 15 minutes later to get yelled at for the project being behind schedule. This was the same day I caught wind that all of my attempts to get a transfer or promotion were going to get blocked for some reason. Well, I knew the reason, but I can’t go into details here. I really felt like I was expendable at this job and I think it ruined office work for me. I still get a little anxious whenever I pass the exit I took to get to the job.

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    1. I understand. I actually did quite well at this job when I first accepted it, but your boss can make a huge difference in how you perceive your own performance. My previous boos was a calm, cool, collected guy who let me decide how many patients to allow in at any one given time and taking up to ten was doable. Then came a boss lady who pushed the limits and opened admissions criteria to just about anyone. If you turned away a patient, you got to spend an hour in her office every morning explaining why. Even citing corporate policy didn’t appease her, she was all about raising the numbers. Being given the opportunity to perform well and being commended for good performance make a huge impact on a person’s ability to function in any setting.

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      1. We would have patients in overflow sleeping on the floor in the treatment units waiting on a room and she would want me to hold admissions in the admission unit lounging in chairs or lying on the floor for hours until morning when others were discharged. Sometimes my admissions unit would have a dozen patients sleeping on the floor while all of this other chaos was going on. How therapeutic is that?

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      2. All of the local facilities are this bad. Seriously. Homeless people use them as shelters. People with real needs don’t get the proper attention. You will pay $30-$40 thousand for a twenty-eight day stay in a private facility and most often insurance won’t pay for more than three days. Fourteen tops.

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  3. Anyone would’ve been anxious in that situation. Terrified even. How horrible they had you working alone in such an at-risk environment like that. I hope after you left they wised up and improved things for the next person. Very, very scary.

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    1. From what I heard after I left, things didn’t improve much, at least not initially. They gave the next admissions nurse a tech, but it was someone pulled from the unit every night and a different tech each night, so the nurse would need to spend time explaining all that she needed assistance with every night to someone new. Now they have four admissions staff,one MSW, one nurse and two techs,..but they have started taking involuntary admits direct from the city and county police forces, so I am certain the workload has increased, as well. Shameful.

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  4. How horrible! You made the right decision to walk away after such a terrifying incident…that is unbelievable.
    Several years ago, when my mother was very sick, I had a panic/anxiety attack and it was a frightening experience. I truly thought I was going to die. She got better and the attacks went away on there own. I feel for people who experience something like that on a regular basis.

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    1. I think having a child or parent sick is cause for panic. Mine started with this incident and I wish it would go away, but attacks strike me for such little matters now…the symptoms. I work on the wellness side of the illness-wellness spectrum now and it is not so bad, but I don’t pick up assignments often.

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  5. I believe I have panic attacks when I realize all I’ve got on my plate and wonder how it will all get done in time. 😦 Yes, your life was a little scary back then…I would have gotten out too!

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  6. I think I had my first (and only) panic attack this past March … the day the movers were coming. I had been in overdrive in packing for about 6-7 weeks, and that morning I didn’t feel ready. The movers were several hours out, and my wife was living for work … and my heart was racing and breathing labored. Because I had never felt anything like this before, I wondered if a heart attack was on the way. I think I slowed down while trying to maintain (but I can’t recall).

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    1. It is a creepy thing. Glad to know it wasn’t a heart attack, but that’s what it feels like. Can’t breathe, crushing chest pain, palpitations. I had one at night that was so bad I drove to the hospital. Of course they thought I was crazy saying I was having a heart attack and driving to the ER. They told me to take a seat. I told them if they didn’t take me back right away I was going to dial 911 and step outside and come back in on a stretcher. They took me right back and I was throwing some disrhythmia on the monitor. Nothing serious. Ativan calmed me down in minutes and it all went away. That has only happened once. Sheeze…it is so very real!

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  7. The situation at you last job sounds unbearable. Most of us wouldn’t be able to handle it.

    I had panic attacks for a year when my dad was dying from lung cancer. The strange thing was, I was in the Philippines; my parents were in the US. I figure my attacks started about the day he was diagnosed, but my parents didn’t tell me he was sick for the first 2 or 3 months. The attacks stayed with me until the day he died. I know how you feel. It becomes a physical thing, almost beyond your control–although I did find some relaxation techniques that helped.

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    1. Sorry about your dad. That must have been stranger still to be so far away and trying to endure. I have even tried the sensory deprivation chamber once. Ha! It was spooky in there. Yoga would probably help.

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  8. Some facilities clearly should not be allowed to operate. It’s effectively malpractice if not criminal on the part of every doc involved, every manager, every regulator involved. My suggestion, if at all possible, is not to work on such a doomed, sinking ship. No good comes of it, only suffering. One Nurse cannot save it or anyone on it. She can only flee, or sink with it.

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  9. If I’d read this before your last post I would have understood your interest in the topic more, SK. I have such a huge respect and appreciation for nurses – and the lovely macabre sense of humor so many of them have (I’m drawn like a magnet!) My mother is a retired RN who worked in a psych ward, a burn sanitarium (after hearing her descriptions, even in my smoking days I NEVER smoked in bed – or even in the bedroom!), in private terminal care, geriatrics and hospice. Those who do the job well are a blessing to those they minister to. You’re SO right abut the difference a boss can make in any situation – what a loser that last one was! Now I’m going to go back an reread your post and repeat to myself: “I only THOUGHT I have a stressful job!” Nothing like a different point of reference to get a new perspective!

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    1. My early retirement was, in part, based on my experience here and the last place–a pediatric extended care facility–I worked for eight years. New grads were coming with no critical thinking skills and old hats were either jaded or came from countries that did not maintain similar standards. There was always an expectation to cut corners…which always led to poor quality. I refused to lower my standards and could not get management to maintain any reasonable quality. It got severe toward the end. Two years after I quit, the facility was closed due to allegations of abuse/fraud/neglect. Maybe I could have made a difference (yeah right) or maybe it was just a good thing I got out when I did. I spent as much time giving depositions and speaking with law enforcement as I did working. No regrets for getting out. I do health screenings part time now, on the wellness side of the spectrum and I am happy to be out of the illness side. 😀

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