Nurses and Depression: An Essay

Nursing and depression are a strange pair of entities that intersect at various points of the compass. Yet the nursing profession continues to walk an uneasy line between comprending depression as a patient symptom and experiencing depression  as a career side effect. Today nursing stands at a pivotal place in history, with academia, the origins of medicine, and progress pulling the threads of nursing theory every which way.

Nursing is a time-honored institution whose origins claims famous feminist icons such as Clara Barton, Margaret Sanger, Mary Breckenridge, and Florence Nightingale. But the feminist mystique itself has oudistanced the treatment and conventional wisdom surrounding depression as a medical concern. Depression, and the treatment of depression, for many people, can be a difficult concept to grasp. Depression is a psychiatric disorder of the mind and psyche which affects persons undergoing medical treatment, but can also originate as a harbinger of other diseases. Depression has almost become a slang term in the pop culture vocabulary used casually to descrive feeling “down”. Yet as a medical denominator, the presence of depression  is serious business.

Depression can be a symptom as well as a diagnosis. Yet the physical side of the medical and nursing fields can often override the psychological of many wellness crises. Conventional wisdom usually trumps academic progress. Commercial pharmaceutical treatment usually beats out long-term alternatives, and little endorsment is given to nontherapeutic analysis. The medical institution as a whole functions mostly to heal the body, and the psycho-analytic milestones in healing don’t keep pace with the limitation of treatment access options for the afflicted. Dabbling in depression doagnosis is seen as specialist referral stuff. Medical professionals are all too familiar with these “rules of the road”.

Both doctors and nurses are more comfortable in general discussing medical symptoms according to a pathology of pure anatomy and disordered functions of the body. This is their clinical training taking over. This is understandable, as many facets of the psychological applications of depression treatment color between the lines of many disciplines. And ad hoc experimentation in the world of treatment for depression is uually not rewarded from a multiple of perspectives.

Too often, physicians skip over depression as a treatable illness and focus on the more concrete diagnoses of the body. In many cultures, psychological illness still carries a stigma from periods of civilization where too little was known about the causes and origins of depression. The onus of depressive symptoms as ‘”madness” still  remains.

Early man used drugs, societal separation, and medicinal forms of witchcraft to “treat” early forms of depression. Later cultures shipped mad people offf to sea, in groups, on a Ship of Fools”., Relying on God to guide their destiny. Sigmund Freud and Carl Jung introduced a standardized form of psychological vocabulary to the medical world, and contemporary man has distinguished himself by pursuing depression in its various guides as a clinical and scientific study for decades.

Today, studies connect depression and everything to sleep deprivation, opiate addiction, anorexia nervosa, Post-Traumatic Stress Disorder, and more. Prevention of depression and observing symptoms of depression, are now a key element of physician treatment advice. The dynamic of career choice has affected medical workers, doctors, and nurses as the practices began to take on occupational definition since the late 1600’s. Medicine  as a discipline has undergone radical reforms from it’s early days. The “physicking’ of another person began to take shape not just as a career for learned man, but as an occupation for educated men and individuals in search of a paying career. While the first doctors of this type were from the most elite classes of scholar and the most wealthy set of people in every culture, religion as  a passport to medical practice admitted religious elders to the treatment of others in more than one tribal civilization around the globe.

Many early teaching institutions centered around the scholastic training of doctors, priests, and teachers. The estimation of a physician was often ruled by his breadth of knowledge of medical studies and material of a religious nature. The indoctrination of a scholar in religion was thought to cement the ethics required to operate a medical practice and found the personal ethos necessary for treatment of other persons, conscious or unconscious. The access to the metaphysical world that many cultures connect with physical wellness allowed this transmutation of disciplines to coexist for many centuries.

The ethics associated with physicianship caused male scholars in the early 1700’s to pledge their scholastic faith in religion, as a going rates of “dues” cementing Christian ethics to the science of treating the bodies of other people. But as Calvinism, the teaching s of Martin Luther, and other religious doctrines took shape, the emergence of a new class of doctor purely to treat the physical malady emerged. The doctor as pure scientists emerged. Marie Curie and her husband were examples of this kind of doctor, who practiced their science without allowing religious culture to dominate their thinking. Doctors were thought of as esteemed members of the community, the equal of all but the highest echelons of the social order. Doctors are respected in every type and section of population where high level of education, practice of any differentiated culture, and necessary acknowledgement of the body of knowledge required and the commitment necessary confers a certain prestige.

In the succeeding centuries, academic studies have dominated the world of organized medicine. Then the business world took over mass medicine, and the world now has become a globalized client of large scale medical insurance companies. The patient is not always the client, as doctors usually are the ones that pharmaceutical companies look to for sponsorship of their treatment of new type of medications. It is the nursing profession, and nurses in particular, who deliver the front line of medical care and therapeutic attention to patients. It is the nurses in the medical world who are the ones that patients interact with the most.

But as the nursing career as a lifetime occupation has developed as a paying gig, the culture of acceptance and respect may not have been as evolved. The participation in medical profit for nurses has not followed along with that enjoyed by physicians working half the amount of time per week.  While nurses do the “heavy lifting” of patient care, their compensation is not commensurate with the time spent and sacrifices required of someone who has embarked on a nursing career. Nurses may work unpaid overtime, stay late, and do extra work, but nursing pay generally doesn’t always reflect this contribution. Ensuing generations of nurses will decide if more reform is in order.







Should You Be An E.R. Nurse?

An E. R. is a challenging and high pressure work environment that involves high stress and heavy patient turnover. But nurses coming up through the ranks should seriously appraise whether or not an Emergency Room is the proper career choice for them.
The hiring convention to screen candidates for professional nursing E. R. jobs is to hire from within. Or to hire nurses with commensurate nursing experience from Emergency Room or Urgent Care assignments elsewhere.
The hospital may depend on direct referrals for staffing its Emergency Room. There are some fast-track programs available. The hiring managers from a given hospital or Urgent Care clinic may want to review a student nurse’s transcript if they apply before graduation. If the compensation is particularly desirable, a second interview may be required after references and NCLEX test scores are reviewed.

All E. R. nurses do not operate in a real time work place at the same level. An E. R. can be a daily test of patience, nerves, and professionalism.. The skill sets for an E. R. nurse applicant should be above average in quality and the personality type of the nurse candidate adaptible. But those who can’t function in the fast-paced and demanding hospital or clinic E. R. should face facts about the suitability of their destination job title.
Of all the stressful career choices in the world, an Emergency Room nurse ranks directly behind police officer and firefighter. The Turn-and-burn mentality of many high volume E. R. facilities can wear out the freshness of a newly qualified nurse and age them prematurely.
Some nurses stay in this line of work out of feelings of dedication and trying to make a difference in the world. All too often, such nurses experience stress snd occupational burnout.
Also, the associated risks of depression, addiction, and alcohol and drug abuse for nurses working in the Emergency Room is far higher than the more sedate clinic or the long term care facility nursing pace. The work in an Emergency Room by nature does not absorb nursing errors and the consequences of nursing carelessness can be disastrous.
E. R. employers are not as forgiving of mistakes as normal-pace-type nursing employers might be. Patients in an E. R. setting present a challenge to any nurse lacking in “people skills”. Nurses must often deliver very difficult news to individuals or groups of people already crippled by lack of a family or support system.
Emergency Room nurses put in almost double the performance intensity of clinic desk nurses or long term care med pass nurses. The hours can be brutal and the schedules can make home and family commitments impossible. Physicians will demand near-perfect nursing performance from E. R. nurses at all times. No matter how fatigued or overworked the nurse is, he or she will be required to have a seamlessly professional attitude, critical thinking skills, and alert demeanor.
An E.R. nurse is the Gold standard” if nursing. More than any other kind of nurse, except the Home Health nurse, an Emergency Room nurse is the ambassador for the entire occupational body of nurses worldwide. Patients new to the world of medical care will see more interaction with E. R. nurses than with any other provider personnel.
Student nurses aiming for Emergency Room tenure need to honestly evaluate their skills. Performance in practicals skill development and internships will yield qualified feedback. The unpredictability of the E.R. work environment demands heightened nursing skills, quick thinking, and stamina.
If the feedback a newly qualified nurse gets from their nursing school professors, supervisors and peers falls short of the mark, nurse candidates should rethink applying for work in an Urgent Care setting. Student nurses browsing their career choices should review their strengths and weaknesses when selecting their occupational nursing career environment. Career counselors can answer further questions along these lines.

The Changing Vision of Nursing

†Today nurses face challenges in the nursing world their predecessors never did. The slightest mistake can end up on YouTube. A crotchety patient might become a vexatious litigant. And worst of all, you could make a career ending mistake.

Newly licensed LVN nurses and RN nurses can safeguard their careers by following the best practices of their facility and the standard operating procedure of conventional nurses.For nurses to stay ethical and keep their noses clean, vigilance and propriety are necessary.

Good manners toward patients is the best practice. But for peers and other staff as well. Managers can appreciate the benefit of a new hire who is a good example. The spectrum of nursing careers can always include a nurse who is polished,perfect, and professional.

The stereotype of s nurse can be from a TV show or from examples people see over time. A paunchy, chain-smoking nurse tapping away at their phone is dividing their attention span before they clock in. The oversexed stereotype nurses who spends most of heir time socializing will often end up the subject of complaints.And nurses given supervisory roles when their performance is substandard will always suggest unfounded favorirism.

Additionally, nurses can look for good ways to stay motivated and meet personal goals. The stability that a career in nursing can offer provides financial security, as well as a few “chicken soup for the soul” experiences.These are often priceless insights into the human condition.

The payoffs of a career in nursing can be concrete and financial in nature or they can be as abstruse as angels dancing on the head of a pin.But each nursing professional needs to decide for themselves where monetary goals stop and vocational goals begin.

Many nurses find their vocation in helping people. Others ate looking for a way to migrate to another career, such as teaching or business. But the toll that care giving occupations take is becoming more difficult to ignore. Statistics on addiction, drug abuse, Petty crime and white-collar crime in the field of nursing is a well kept secret. Nurses often admit to feeding an addiction while on the job. Nurses fight smoking habits made deadly by their sheer casualness masking a dependence. Nurses can have delayed reactions to many of the experiences by they see and encounter PTSD later.

And some nurses worry about if there will be a nursing field in the future. Technical issues are turning the field of medicine into an adjunct of the insurance industry. How much nursing benefit can decades of dialysis provide? How can pacemakers and stints and implants improve the quality of life?

Decisions are being made every day to extend and lengthen life using equipment and materials foreign to the body’s natural makeup. The safety and longevity of many of these methods requires backups of conventional nurses to oversee and treat complex medical conditions.

This type of scientific leap forward will always need development and monitoring by medical professionals. And as long as people age and have health crises, a nurse ( or several hundred thousand) will be needed. Therefore the future of any nursing career is wide open.


When Nurse Training Makes a Difference

Nurse qualification by degree is a choice each nursing student must make. Many nursing curricula organize the classes by degree goal. A bachelor’s nursing degree will set up a nurse candidate for positions of greater prestige and greater longevity. But nurses intent on long term career longevity can groom higher aspirations by achieving higher benchmarks from the outset. Institutions looking to recruit nurses with bachelor’s degrees can expect more fluid patient response’ and more intelligent care plan response.

There has been a significant blurring of the lines between candidates who have achieved an assistant of science in nursing and a bachelor’s degree in nursing. The ability to operate at a higher technical level is what some institutions need. The breakout requirement in the performance capacity is what a health care facility depends on when wards fill up with heavy need patients. These caliber professional performance levels are what hiring managers look for when screening applicants.

Nurses should not put patients into panic mode. A professional attiude is key. They should do everything the can to secure the patient from any feelings of pressure, worry, or discomfort. By charting interactions and vitals, nurses begin to document the case. A care plan for the patient’s outlook is indicated as noted in the charts. For follow up, nurses then can refer back to these notes. Progressively senior nurses should be able to handle multiple patients per shift managing these dynamics.A thorough knowledge of resident care plans encourages the nurse on duty or med nurse to interact with the patient in a beneficial way.

But all too often the hospital wards or long term care floors are filled with anxious and confused patients who have been left to sit or lie down for hours or even days without clarification or proper addressing of certain problems. Patients who feel ignored by their nurses will file complaints and tell visitors their nurses are slacking off. Senior nurse staff should make sure these patients do not feel “lost in the mix”. Inexperienced nurses might be able to miss certain details but peer nurses and managers will notice and hear about patients who have been left by the wayside.

A nurse knew to the facility might miss important cues. Sometimes this can be too late. Hidden bruises, unusual lesions, draining ulcers, and stiff or numb extremities must be noted. Is the color worsening? Is the affected area becoming larger? A nurse should watch the way a patient walks around or gets up from the bed, transfer to the wheelchair or toileting apparatus.

The physician must be notified and the Change of Condition filed in the patient’s medical chart. Nurses need to keep a weather eye on patients who may hide their symptoms. Patients who fear their treatment due to pain or physical discomfort will take their bead from nurses. If the nurse comes off as too busy or distracted they may drop or suppress medications, palm them, even mix them up. This is fraud. Nurse cannot depend on patients to put them straight. Hyper-adrenalyzed patients can collect the medications and trade or sell them on the street.

Sufficiently trained nurses will watch their patients consume all ordered narcotics and medications and closely observe their effects. A professional nurse does not leave unconsumed medications at the bedside or anywhere near a patient without witnessing their intake. For example, a patient consuming multiple painkillers should display drowsiness and lethargy. Trained nurses should take away patient’s own medication. Patients undergoing narcotic and other pathologies of medical care will lose track of what personal medications they may take, confusing displayed symptoms.

On the job training and experience will progressively groom a nurse to deal with such patients.. Sometimes another nurse may be more effective for caretaking goals. Patients may hide problems and nurses can only tell by examination and assessment what is going wrong. progressively trained nurses should be able to observe changes in hygiene, outlook, and mental condition. Perfectly normal patients sitting in a room all day can turn manic after induction of medications and excitement.

Nurses who are properly trained can skip over important details in haste. So when re-checking patient conditions and vital statistics over time nurses can catch a problem with a patient or even a machine. Nurses can pick upon failure in machines or other technical problems only with usage experience on patients and issuing of improper results. If a nurse is trained to assess both the patient condition and the readings, they may simply report inadequate readings.

The patient then has inappropriate and inaccurate readings reported to the physician and to their chart. This can really impact negatively the care plan for that patient. Nurses assigned to different patients in the same room cannot pick up the slack. They sometimes may switch working machines for technically unproductive machines without the nurse’ knowledge. The timing of dealing with these machines may be more than the nurses can handle.

Therefore a properly trained nurse is required for patient care because they can determine the difference between a technically accurate vitals reading from an erroneous one. But only highly trained nurses capable of independent thought processes and independent decision making can achieve these top notes of nurse duty performance. Otherwise patients suffer in silence. And supervisors wonder why their feedback card ratings are declining.

Later, when the nurses determine a problem with the machine, they will need to retake those readings and then commit them to the patent’s chart. This can make a window of doubt into the patient’s care because these missing readings are not present in the records. This prevents a physician from following the path of a treatment plan or set of medications results. The pathology of this error may be lost but it has a negative impact on a patient.

But how will they know? This is just one of many problems that occur during a busy shift and may not even be detected until the next shift when nurses begin their vitals readings on rounds. This can be hours into the next shift, creating problems for every patient’s care plan. The regression backwards over time affects different patients in varying ways. For every patient struggling with mood disorders, over-medication, untreated pain, burgeoning infections, and multiple organ failure, the gap in sloppy nursing allows a documentation blindness.

Nurses at the desk will discuss various cases and verbally update each other with observations. This patient is sick. That one is still coughing. This one isn’t sleeping so well. That one is not walking straight. This way nurse bounce the patient symptoms off each other, reporting and seeing what other nurses think at the same time. Without such communications, there is a temptation to ignore the problem or conceal it. A more professional nurse grooms her co-workers to recognise a problem and deal with it.

The other detriment of such practices is to the entire nursing ward or health care facility. Healthcare systems and HMO businesses are the most stringently planned budgets in the world today. The patient stay in the hospital becomes longer because problems in the care plan need to be changed and the patient stay extended. These costs can add up and change the health care approach of an entire facility. These are the far reaching consequences of poorly trained nurses.

Where Have All the Good Nurses Gone?

Those familiar with the nursing landscape and the patient options universe have been noticing a talent vacuum for some time. Has the general quality of nursing fallen off? Where have all the good nurses gone? Hospital policy and budget cuts, public mental health policy and supervisory practices combine to eradicate the best and most talented nurses out the door.

Risk averse nursing workplaces are becoming harder and harder to find, thanks to Social Security’s failure to keep mentally ill populations locked appropriately in pace. Mentally ill patients now take up regular population beds, a violation of nursing care in ethics if not in deed. Because these are not actually critical care patients, i. e. no amount of direct nursing care can restore mental logic or activities. Many new nurses (and old ones) do not have concentrations and/or documentation and licensing for strictly psychiatric patients, even if patient organization loads and assignments offer them these patients!

Consider: if a nurse applied for a position of equivalent nursing station in a psychiatric ward they would not be accepted because they did not have the credentials or experience. These patients would formerly have been residents of hospital wards more suited to round the clock care specific to this kind of patient need. And ward backups could otherwise have absorbed the extra patient care load.

But burnout of regular nursing staff and nursing shortages are behind this new gap in patient care. Why, as one old pro asks, should they wear themselves out simply because the State wants to save a few bucks on medical costs? They don’t get paid more for severely heavier care demand patients. But according to the present model of overstuffed wards, they are expected to do the work!

This “Lost Generation” of nurses will pass on thankless extra work, thank you very much. Generally speaking, more experienced nurses in older conventional labor models could be counted on to fulfill more complex nursing tasks to more demanding and more complex critical care patients, such as dementia, Alzheimer’s, or even Huntington’s Disease cases. But many experienced nurses looking to retirement do not feel the same push to fulfill additional case work per patient for no additional compensation.

More experienced nurses are simply not to be depended upon anymore to “pick up the slack” because newer grads want the easier cases and managerial staff can’t be troubled to properly supervise them. The charge nurses assign them to heavier load patients. Nurses are likely to pass on extra shifts or extra duty and extended hours, because they will simply get dealt the harder tasking. Nurses are likely to call in sick and take the personal time owing than spend the day chasing a thankless care load.

Many new nurses are “new grads”, shining with brand new diplomas but heartily lacking on practical nursing experience. New grads, as they are being termed are simply not experienced enough to care for mentally ill patients. These patients can be a significant drain on ward care time, because they need nurturing and coaxing to eat, take medications, and need more intensive body nursing than an ambulatory patient. And ambulatory and non-mental patient populations are deleteriously affected. Patients who “behave see the “problem children” get all the attention.

How taxing is the average mentally ill patient on a regular care ward tasking? Take for example the fictional case of “Robert Fickle,” an aging dementia victim undergoing unilateral amputation of the right leg. His care requires negative ionization chamber care and round the clock nursing care of a (1:1) one to one ratio assigned directly to him. But there is no rest for those on the same ward as Robert Fickle.

Fickle has transformed a quiet and orderly ward into a chaotic and noisome irritant. Bawling incessantly, he wears down every nurse and supervisor. Encouraged by the attention he receives, Robert continues to yell and scream if he does not get the attention of every person who passes into his field of vision, and yells abuse at other patients or staff if they do not instantly hurry to his side. The social worker licensed to carry out medical activities for Robert Fickle is only employed onsite from nine a.m. to five p.m.

Robert has abandoned all attempts at coping and spends all night yelling at nurses and passersby in the ward. Robert refuse to wear his hearing aid and can be heard all the way down the hall on a nightly basis, haranguing nurses for hours about fictional missed appointments he must get to (at five o’clock in the morning). There is no way to shut the noise out and other patients suffer to no avail.

Robert’s constant verbalizations wear out the nurses, who must complete the charts and medicine dosages of other patients while this noise is going on. It is very distracting and nurses feel put upon to keep their performance error free in this environment. The new admissions to the ward are accompanied by family and visitors, who are struck with amazement at this spectacle while their loved ones are taken into “restful” hospital care.

Sickle’s “condition” rule the ward. He refuses to stay in bed and insists on sitting in the doorway of his room, heckling patients and hospital staff, employees and visitors alike as they walk by, with imperious screams and abusive catcalls. Hospital policy limits what nurses can do or say to limit this nuisance. Numerous complaints from other patients go on “deaf ears”.

So, where are all the good nurses? Looking for alternate employment, or counting their days until retirement. And considering that any of us might be the next “Robert Sickle”, that is food for thought indeed.

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