How this emergency room nurse got diagnosed with PTSD [PODCAST]

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“Over a period of about two years, our city experienced a very large influx of seniors. One nearby town grew by over five thousand people. This, in turn, created a surge of patients coming to the hospital. As most were older, they often had multiple medical conditions. They would almost always require more complex care. The whole system became overloaded because, once again, no one had thought to make extra resources available.

In the emergency department, this translated into a genuine crisis. Though the actual number of patients we saw in a day stayed about the same, what did change was the type of patients we were seeing. More patients came in that were not mobile. Thus, many required stretchers. Until this time, having patients in the hallway was a rarity. Now, it became the norm. Our normal workload in the monitored area had been three or four patients per nurse. Suddenly, it was not unusual to have six to eight patients per nurse.”

“T. C. Randall” is an emergency room nurse and author of The View From The Wrong Side Of The Day: A Story About Nursing, PTSD And Other Shenanigans.

He shares his story and discusses his KevinMD article, “An emergency room nurse diagnosed with PTSD.”

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have T. C. Randall. He’s a nurse and the author of the book The View from the Wrong Side of the Day: A Story About Nursing, PTSD and Other Shenanigans. He’s a KevinMD contributor and contributed this article recently, “An emergency room nurse diagnosed with PTSD,” and we’re going to certainly get into the book and that article. First off, welcome, T. C.

T. C. Randall: Thank you. Thank you for inviting me.

Kevin Pho: Before we get into that, tell me a little bit about your story and your journey to where you are today.

T. C. Randall: So I graduated from nursing school back in 2006. It was the second career for me, and I went pretty much right into the emergency department. I worked for two years as a student in the emergency department, and when I graduated, I worked there as a medical nurse for about eight months before doing my specialty training. Then I worked in another emergency department for 11 years, 12 years, until two years ago, which is when I was diagnosed with post-traumatic stress.

Kevin Pho: Now, was this in a large urban area or a smaller community?

T. C. Randall: It’s sort of in between, actually. The area where I live now is what we call a hub hospital, so all the smaller communities around funnel to us, and then we send them on to other areas. There’s a level 1 trauma center just south of us, so we’re considered a regional trauma center.

Kevin Pho: So you share your story in your book, and I think it’s a tremendously important topic, but it’s something that’s certainly not emphasized, both in medicine and in nursing. Can you share some of the events that led up to you writing that book?

T. C. Randall: I think really the most important thing about it was that I felt that a lot of things that happened to me along the way didn’t have to happen the way that they did. Some of that was my own fault, or, you know, not placing blame, but just saying that there are things that we as nurses and doctors could do differently. But also, there are a lot of systemic inefficiencies that worked to sort of compound those problems and to make working in health care very difficult and very challenging from a mental health perspective.

I think for me, I’d been having difficulty for about a year before I went off, and I had no idea what was wrong with me. I found that I was getting angry all the time at work, to the point where I was feeling actual rage at times towards people coming in, and things like that. And then I’d go home and the opposite would happen: I’d be sad and crying all the time. And then the nightmares started. I started having nightmares about work at least once a night, but I didn’t have a name to put to it. And when I talk about things that I could have done differently, I didn’t talk about it to anyone, right? I just stuffed it down and kept going, and things just got worse and worse.

And then things came to a head on January 15, 2018, when I had a very difficult day involving four very intense resuscitations; two of them involved children. And I came in the next day and had a panic attack outside, and I had never even experienced anything like that before. It was like having somebody sitting on my chest.

Kevin Pho: And what kind of support services did your hospital or medical institution offer at the time?

T. C. Randall: Nothing. It wasn’t even really talked about as a problem in the health care profession. When I went off, I’m sure there was help available, but I didn’t know what it was, and there was no sort of clear-cut path to that. And also, dealing with our local Workers’ Compensation Board, they’d never dealt with anything like this, so it was very difficult to sort of get them on board.

And I think one of the things that really struck me, and one of the reasons I wrote the book, was that when you’re going through a mental health problem, especially one as sort of acute as mine was at the time, having to go through a difficult process to get help when you’re not feeling 100 percent and you’re not thinking clearly was a very, very difficult process. There were days when I would just curl up into a ball on the floor.

Kevin Pho: One of the analogies that you wrote in this book, and that’s part of the excerpt that I ran, was like a frog being slowly boiled in water. Did a lot of your colleagues feel similarly?

T. C. Randall: Oh, definitely. I think since the book has come out, a lot of my colleagues have approached me, and some of them have even expressed that they had a lot of difficulty reading the book because it was so close to their own experiences. We went through a period where basically everybody left, and I think we reached sort of a tipping point where the amount of senior staff leaving just sort of compounded the problem. It became sort of a vicious cycle, where the more senior staff that left, the more pressure was put on the senior staff that remained.

So in our monitored area in the emergency department, I went from a four-to-one patient ratio to, some days, an eight-to-one, right? It doubled. We’d have patients in the hallways, we’d have patients off to one side, we’d have patients in our little quiet room area, and you’d be looking after all these people, and you’re also trying to mentor the new people coming in. And of course, every time we get a new patient coming in the door, if you have a choice between sending it to the new person who’s got, like, a month in or the guy who’s got 12 years in, who’s getting the new patient, right? So it just compounds the problem. And so for every senior staff member that burned out, that got shifted on to the next one in line.

Kevin Pho: And I could only imagine now, with the pandemic, these frontline health care workers are even pushed more to the brink, and you hear stories about nurses with not enough personal protective equipment. I think that’s certainly part of the exacerbation of the burnout that you’re talking about.

Now, let’s talk about solutions. So going forward, what are some things that both nurses and medical institutions can do to prevent PTSD in our current health care workforce?

T. C. Randall: Well, actually, there’s a whole chapter on that in the book, right at the end, where I say, “OK, these are all the problems that I’ve had. Now, these are some of the things I see.”

I think one of the big ones is, and I know your system in the States is different than ours, but certainly there’s a similarity in that when it comes to managing health care, we tend to staff and budget for the best-case scenario, right? So we tend to underbudget, we tend to understaff, and as a result, we put more pressure on the people that are in there. We need to stop doing that. We need to start planning for the worst-case scenario. Not only is it beneficial to the staff, but it also can save us money, because we’re spending a huge amount of money in health care on just trying to keep up: overtime, sick time, retraining.

There’s a nursing shortage going on right now, and I’m a highly trained emergency nurse who’s been sitting at home for two years, and the amount of time and energy that they put into training me has been lost as well. So now they’re having to pay that money to somebody else to train them. And so I think that’s a really big thing that we need to work on, and we need to start looking at how we can better staff and manage that.

I also think there need to be very clear-cut and defined strategies for people, so people aren’t going in blind like I did, where it’s, “Here’s where you can find help, here’s the paperwork you need to fill out, here’s who you can talk to.” And that needs to be readily available. I think we need screening tools that are readily available, and we need to let people know what the next steps are. We need to educate health care staff about what to watch out for and how to approach one another. If I see somebody struggling, do I just ignore it, or do I approach them and go, “You know, I noticed you’ve been having some problems lately. Do you want to talk about it?”

Certainly, from our perspective as health care workers, I think that we need to start talking about it. We need to start admitting that it’s a problem, and not looking at that as a failure or weakness. I think we have a big tendency as health care workers to stuff things down, right, and not, “Oh, no, everything’s fine, I’m doing great,” and just continue on. We tend to think of ourselves as being there for the patients and the patients only, so our own feelings get sort of shoved to the side. And I don’t think that we as health care professionals can look after people effectively when we’re doing that, because then problems do develop and nobody knows about it, right? We tend to keep silent, and when we do come forward, people tend to sort of back off and shy away.

Kevin Pho: And I think a lot of what you say can be applied to the medical profession as well. The burnout rate in physicians is 50 percent, and you talk about the cost of retraining. For every physician that leaves, the cost is $100,000 to train another one, and physician burnout specifically costs the health care system over $4 billion a year just because of that turnover.

And especially with what you said about how we have to take care of ourselves first, because if we can’t take care of ourselves, how can we be expected to take care of patients? So I think that there are a lot of similarities between what you’re talking about in the nursing profession and what’s happening to physicians.

So if you had a new nurse coming into the field, and you talked about this a little bit in your last answer, but expand on that, what kind of advice can you give to the new nurse that’s now entering the profession?

T. C. Randall: Well, there are a lot of things. First off, I think that new nurses or new doctors or anybody coming into a medical profession, in a lot of ways, are our greatest resource, because they’re not entrenched yet, right? They’re not stuck in the systems, so they can look at things with a fresh perspective, like, “Oh, hey, this is a problem.” They can come up with innovative solutions that we haven’t thought of.

I know when I was a nurse working in the emergency department, I tended to rely on the students a lot, because they’re coming in with the latest knowledge and the latest ideas. There were things that, you know, we never do in the emergency department, and sometimes they’d come up and I’d be like, “Well, I don’t know how to do that. I’ve never done that in 14 years.” And they’d be, “Oh, no, I know. We did this last week, right, in class.” So listening to them and listening to their knowledge, I think, and encouraging them to come forward with that knowledge and say, especially around mental health, “Hey, why don’t we change this? Why don’t we fix this?”

But I also think that, again, we need to encourage them to talk to people. I do workshops with students, and as I said, it’s been sort of slow going. A lot of places don’t necessarily want to hear what I have to say. But I did one at my own college, where I graduated from, and the students there took that message and just sort of ran with it. For the rest of the day, the instructors at the college were having to talk to students individually, because all of a sudden, every one of them wanted to share their story at the same time.

So I think we work in a profession that is rife with things that are going to have an effect on us, right? We see some pretty horrible things, or we watch people go through the process of dying. We see all these things that really weigh us down, and we need to start acknowledging that and saying, “Hey, you know, I’ve had a really bad day,” or “Hey, I did this,” or “This happened,” and not worrying about how that makes us look.

Kevin Pho: I think one of the things that you said earlier was kind of normalizing it, so it’s less of a stigma, and I think that’s fantastic advice. So thank you so much for sharing your story. Now, let me ask you, what’s your take-home message? What’s the one thing that you want my audience to come away with?

T. C. Randall: I think that we need to open up a conversation on both sides, both from our side as the health care professionals and from the side of management. How can we make this better? How can we make it so that we’re not losing people all over the place? And certainly, how can we, I just want to make sure that this doesn’t happen to other people, right? That was a big reason I wrote the book, to get this out there and say, “Hey, you know, my story does not need to be everybody’s story.” So I think that’s the takeaway message.

Kevin Pho: Well, thank you very much for sharing. It’s tremendously powerful. T. C. Randall is a nurse, and he is the author of The View from the Wrong Side of the Day: A Story About Nursing, PTSD and Other Shenanigans. Thank you so much for joining us on the show.

T. C. Randall: Thank you.

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