What is moral injury (burnout) like…

This is graphic, it is pain and hurt coming out, Read at your own peril

It was Wednesday when my boss called me to his office for a little “chat.”  Lisa had come up with another list of complaints (she was getting quite good at these since I think she spent more time watching me than she did her job. This weeks’ fun included being 10 mins late from lunch one day and the fact that she felt I wasn’t dressed for work (my attire bothered her) and again I went to lunch and on a break with a friend.  Signed another form to just get the verbal warning over with.

I was never spot on time back from lunch and seemed to be the only care manager in the building held to the 30-minute standard.  You are “just too important” to not have in the clinic I was told, even though I was rarely allowed to do anything by Lisa because (I never did find out why) she did things the way she did. I was stuck…

Rewind to 18 months earlier.  I was happy and respected.  I had launched a brand-new position with a program that had never had a nurse before. It was a challenge, but the staff I worked with was top-notch and capable. This was a position that was first a challenge of educating the social workers what a Nurse case manager did; and the patients, oh the patients. I think Wade and his wife that I found while doing outreach on the Jordan River.  There was 8 inches of snow on the ground.  Wade his wife and their 2 dogs were living in a pup-tent (couldn’t resist).  They were cold and dirty and struggling with trying to find housing.  Those 2 Pitties were so cute, they were so adorable.  In early December I managed to get them housed on December 23.  They had a warm-house that was all their own for a change and a fresh start.  Wade was like any vet, he had a lot of issues with adjustment after the military.  He was a challenge and a good guy. I used to help them get dog food, even though I wasn’t supposed to, but the pups needed food to match the love they got from Wade and his girlfriend.  I had a purpose and felt like I made a daily difference.

Working with the homeless is a tough job, but we were people first and worked very independent of each other, so my interactions were very much patient related, not politics.  Not dealing with a system that treats their staff like objects with very little care for their well-being. After 3 years doing what I was told was a great job, I was outright offered a position as a team leader. I was excited, I was recognized, and then I met Lisa, fucking Lisa, with all her lists and extra tasks that I wasn’t to do unless she was on leave.  Then I was slammed with tasks that I had no fucking clue.  I worked hard in that position, but it never mattered.  Lisa had decided she didn’t like me because I beat her friend out of the job I took. I was slacking and stopped caring about myself or my life.

I used to come in late because I would literally sit in the parking lot trying to force myself to come in.  I had arranged to have my service dog with me, and even that was in contention.  Ranger was a great dog and very mild temperament, yet it pissed her off.  Then the boss that hired me left, and we got a new one…

At first, I thought this would be ok as this person was nice, but apparently the old boss had done a lot to cool Lisa’s bullshit.  Well that filter was gone and now not only was shit raining down on me for every little thing, but I was also rapidly losing the respect that I had gained.  Literally to keep this woman out of my shit had to sit in my office constantly. I carried 3 forms of communication if I left the office but that was not good enough (she didn’t want to have to call me because god forbid phones or whatever) anything else took too long.  Ranger went faithfully with me, but my absenteeism began to increase because it was getting tough to do the work and focus.  I was ignored where I had been praised not a year earlier.  I had been written up twice, once formally and still felt that the only reason anyone in this clinic kept me around was that Lisa needed an RN to supervise her license.

I was demoted from team lead to whatever it was under the auspices that the team social worker needed “leadership time” to help her get promoted.  So, she would be the team lead and fuck me.  No help on promotion for me now, “average” annual evaluations, sub-par review. I mean the review was just short of commending me for walking and breathing. No constructive criticism, no help. No matter what I did was wrong, and I felt more and more abused. Moral and Morale injury.

I was sitting on the edge of my bed one morning trying to think of ways to kill myself; I had decided on a gun.  I didn’t want to hurt my big beautiful boys by doing the car in the garage thing. Ranger recognized it and fought me until I realized I was fucked up.  We cuddled, and in many ways, my existence to write these thoughts for you is courtesy of a dog I lost about 18 months later to cancer.

Moral injury, once I had the target on my back, I became an easy target, and it stuck with me. Management stopped believing what I had to say and for 6 weeks I literally had to email my boss (who was gone) at the end of the day. All this in Grad School doing what I hope was making a difference in my life (it did). I had to make that difference with little or no help from management.  In fact, at many points, resistance.

So, what’s my point?  Simple, the interactions we have with other staff members as peers or managers impacts you in a big way.  How many people who knew me during this time frame know that Ranger stopped not one, but 2 attempts on my life?  Veterans tell you it’s the demons.  This was not the demons, this was a nurse with an attitude and her corruption of the system.  That corruption has happened twice in the weirdest of ways. Management takes a blind eye. Why do organizations not watch for this and deal with it when it is reported.  Well mostly its bottom line.

I am not asking for pity, but I am trying to help others who may have lost the way or are fighting the moral injury.  When you feel like you are struggling in a job to maintain your integrity, that is a terrible sign.  When you have co-workers that gossip about you, harass you, bully you, that is a sign.  When you lose any support of management because you try to push back, very bad.  In the end, you must repair that damage to be functional.  It took me 6 months and a position change to feel like I can go to work again.  I won’t lie, I still watch my back.  I am still not convinced that my old boss didn’t tell my new boss or other NP’s about my “misbehavior.” (I overheard that he had a conversation with a new collegue) Trust me I hear the gossip, it is demoralizing.

I made it, but how many healthcare workers don’t?

If you are having negative interactions with someone to burn them out, you are the lowest form of human garbage. We have enough moral injury in healthcare without your help.

Well, home to the couch destroying hell hounds.  The podcast is coming later today.