behavioral health

I’m Not Like The Others

Have you ever wondered if you were too old or too overweight or too out of shape or if you were too introverted or had too many learning difficulties or other mental health challenges to to go to nursing school? I’d like to offer my unique perspective. I struggled with many of these questions when I was deciding if I should apply to nursing school and I’ve been thinking about them a lot as I begin my final semester.

Most people are pretty kind. They want to be positive and upbeat. What kind of friend wants to kill your vibe and crush your dreams. So, when you ask for advice, they typically sound like motivational posters. 😝

They reference quotes about doing anything you set your mind to or believing in yourself.

Which is great. 👍🏻 Except I was looking for specifics. 😂 Like super targeted specifics from an advanced Google search with quotation marks and Boolean operators. 👀 Okay. FINE! 😤 I was looking for a real, live introverted, potato-shaped person 🥔 like me, who was over 30 and had ADHD and OCD, but had somehow managed to crack the code, sneak through, and successfully complete nursing school, to give me the play by play of her experience. Apparently, it was a big ask. Maybe because there’s not anyone who meets all the criteria. 🤷🏻‍♀️

Still, while I might be the only one EXACTLY like me, I’m certainly not the only atypical nursing student, nor should I be. Why? Because representation matters.

I want the nonathletic girl who is curious about the way her body works, to feel just as confident asking questions as the girl who worked her butt off to be the one at the top of the pyramid cheering her heart out. I want the single mom of 2, who always wanted to be a nurse, but thinks it’s too late, to know she can still achieve her dream. I want the transgender woman who finds a lump in one of her breasts to feel comfortable making an appointment without fear that no one will take her concerns seriously or that she will be misgendered.

As a larger person, I’ve put off seeking medical treatment numerous times for fear of judgment and discrimination. To be fair, my anxiety does tend to generate some absurd scenarios. 🤔 But occasionally, they’re rooted in reality.

When I was 26, a particularly foul OB/GYN told me there was no need for a biopsy after an abnormal PAP smear. 😰 Apparently, if I would lose at least 30 pounds, female issues usually resolved on their own. 🤨

I have friends and loved ones who are members of the LGBTQ+ community, 🏳️‍🌈 as well as some who have struggled with addiction or some form of mental illness. They also find it difficult to face the stigmas often associated with medical help. Something shouldn’t have to HAPPEN to us for us to care about it, and yet it can be difficult for someone who hasn’t been in your position to understand you or see past a certain characteristic.

Returning to the earlier questions, the short answer is no. Absolutely not. You are NOT too overweight, old, different, or whatever. If you are willing to devote the time, energy, and effort to learning, studying, and challenging yourself, you can definitely succeed in nursing school. 😊

BUT… ☝️

It will be demanding. And I don’t mean in the traditional way that nursing school is demanding. Nursing school is NEVER easy. It doesn’t matter if you were born into a family of medical professionals who groomed you to dual-enroll and start nursing school while in high school or if it is your second of third career and you’re starting after your kids went off to college.

The reality is: It 👏🏻 is 👏🏻 really 👏🏻 tough. It has to be. 💁🏻‍♀️ It is not to prepare you for a clinical experience, an assignment, or an exam. It is to prepare you for the day when you are the only thing standing between your patient and the grave.

It requires a commitment OUTSIDE the classroom and clinical setting of AT LEAST 2-4 hours a day for assignments, studying, skills practice, and NCLEX review questions {that you should be doing as soon as you begin the nursing program. 😵‍💫}

But none of this is usually a surprise to most people. Fortunately, when you start considering nursing school, there are plenty of friends, instructors, and advisors who will give you honest answers about what kind of commitment is expected for a *normal* student. 🤓

UNfortunately, if you fall into one or more of the aforementioned categories that had you second-guessing your decision to apply to nursing school, there are also some not so normal challenges that no one really mentions. 😪 I want to talk about these things, because I think it’s important to have a complete conversation.

No one tells you that you might need to go over a concept 3-4 times more— and in 3-4 different ways, than a traditional student. 📚 Give yourself grace. Try not to be disappointed in yourself or feel like you aren’t doing your best. I won’t lie. It sucks to feel like everyone else just gets things. It sucks to feel like your brain is a mushy, lumpy glob of Jell-o, just living its best life and not helping you with this really hard stuff. But 👏🏻 you 👏🏻 will 👏🏻 get 👏🏻 there. 👏🏻

Don’t focus on everyone else. Just focus on you and lumpy. 🧠 She’s slow, but she’ll get there. If that means you’re watching Every. Single. YouTube video on the topic until you find one that makes it make sense, then so be it. And when you strike gold, SAVE THAT CHANNEL! 😎

Another thing no one talks about is how much more physically painful and demanding this may be for you if you’re an older and/or larger person. 😑 You will ask yourself, “What is happening? Why does this hurt? Am I dying?” No. You’re not dying. It only feels like it. You will survive this. But you will have muscle aches in places you didn’t even know you had muscles. 🤯 There will be days when you get home and you can barely move. It will be incredibly humbling when an elderly neighbor who wears a Life Alert pendant 🚨 asks if you need assistance as you crawl out of your car like a sloth with 2 broken legs. 🦥 Just smile your best smile and assure him you’re fine. 👍🏻 With any luck, he won’t call the police to perform a welfare check. 🤦🏻‍♀️ Stay hydrated, soak joints in Epsom salts, use your heating pad as necessary, and take some ibuprofen {as directed, your liver will thank you. 🙏🏻}

People joke about the ‘introvert hangover.’ But it’s a legitimate thing. To help during busy clinical days, take your breaks in your car, at the library, or somewhere else you can decompress alone, if you’re allowed. Alternatively, bring your earbuds and zone out or study in the cafeteria. It helps recharge your introvert batteries a bit before you go back to the floor. 😉

There’s also a mental and emotional aspect to patient care. No one mentions {maybe they don’t realize} how re-traumatizing it can be, as a survivor of rape and/or abuse, to encounter patients who have been raped or abused— or patients who are *perpetrators* of such acts. 🥴 Yes, they deserve your empathy, compassion, and respect, too. 🥺 Take a couple extra minutes to gather yourself if you need it. 😮‍💨

Finally, there’s the impact nursing school can have on your personal relationships with those around you. If you’re lucky, you will be surrounded by wonderful friends and family who want you to be successful. But even the most supportive people can grow weary from the commitment and their role in your pursuit. It’s really easy to *say* “I’ll support you while you go through this.” But not everyone is mentally or emotionally prepared for what that offer truly entails. Some start nursing school in what they feel is a happy marriage and graduate while going through a divorce due to the intense pressure and stress on tiny fractures that may have already been developing. Others develop stronger connections *because* of {or in spite of} it. As you mature, grow, and learn more about yourself, you might even find you aren’t the person you were before. Which makes it difficult to maintain the same relationships— romantic or platonic.

I don’t know that anything or anyone can prepare you for the level of self discovery you’ll experience in nursing school. It can be frightening and sometimes even a bit lonely. But it’s also incredibly cathartic.

The bottom line is, when you feel yourself starting to panic because you’re not like the perfect picture in your mind of what a nursing student or a nurse should be, STAHP!

You don’t need to fit into a perfect little box to be a great nurse. Patients don’t fit into prefect little boxes and they don’t need need caregivers who do either. They need caregivers who have compassion and empathy. They need caregivers who are human and imperfect, just like they are. They don’t need an idealized personification of what some antiquated source decided a nurse should be. They need YOU! And don’t you dare let anyone tell you otherwise. ❤️‍🩹💖💗

Failure to Communicate

I’m sorry. But I’m just gonna say it. Mental and behavioral health in our society is a dumpster fire. 🔥 It is a travesty of human dignity and anyone who tries to argue otherwise is lying out of their lying liar hole and I hope their pants literally catch on fire. 👖🔥 #NotSorry 😒

As a nurse, I want to be able to help people by providing the best care and resources. That’s going to mean, in part, asking difficult questions. Unfortunately, there are a lot of misconceptions and misinterpretations in healthcare and mental health. So, what if patients don’t completely answer my questions? 😲 More importantly, what if they only *think* they know what I mean?

What if I told you that the majority of us only have a very superficial understanding of mental health and self injurious tendencies? 😳 With so much stigma and fear surrounding mental health, is that really such a surprise?

Let’s discuss.

Self injury or self-harm sounds pretty self explanatory. 🤷🏻‍♀️ It refers to the deliberate act of inflicting pain and damage to one’s own body. This is most commonly associated with cutting, 🔪 burning, 🔥 scratching, 🪒 one’s body or other form of external injury. 😢 At least, those are the manifestations with which we’re most familiar.

With me so far? Awesome. But hang on, it actually goes much deeper than that. Keep reading.👇🏻

Self-harm can also be internal or emotional. ❤️‍🩹 There are numerous behaviors that pose significant short-term risks or long-term, potentially permanent or even deadly consequences. Yet many of us do not associate them with self-harm. 🤔 This is a huge problem. 😱

Incredibly vulnerable people who are engaging in some of the most destructive behavior, when asked if they are having thoughts of, or currently acting on impulses of harming themselves, will say, “No.” 😨

This is not because they’re being intentionally vague or disingenuous. But because they’ve never known self-harm to be anything except cutting or other visible damage. (Thanks for the super broad perspective, networks who brought us the defibrillator shock to treat asystole and ultra realistic physicians who never need to consult any other specialists before performing virtually any procedure. 🙄)

So, what are some of these lesser known harmful actions I mention? I’m glad you asked. 🙃

You’ve probably known someone who has exhibited some of these behaviors. You just didn’t know it at the time.

Have you ever known a young girl or woman, maybe in college, high school, or even middle school, with a reputation for sleeping with a lot of people? What about a guy who had a reputation for drinking so much that he transformed into a completely different person and/or made himself physically ill? Ever known someone who drove really recklessly, weaving in and out of traffic, 25, 35, 40 miles, or more over the speed limit, particularly when they were upset? Maybe you were always amazed they never had an accident… or maybe you remember the day they weren’t so lucky. 😔 How about someone who punched trees or banged their head against walls?

Some of the most risky behaviors that we tend to NOT associate with self-harm include participating in unsafe sex, 🛌 consuming toxic amounts of drugs 💉 or alcohol, 🍻 extremes in eating, such as starving one’s self 🦴 or binge eating 🤢 {with or without inducing vomiting or abusing laxatives/diuretics to purge}, compulsive hair pulling 💇🏻or skin picking, 🤏🏻 punching, kicking, or head butting trees, walls, or other objects,💥🥊 and even unreasonably excessive exercise.🚴

Studies have shown that around 15% of teens and as many as 35% of college students have inflicted self-harming behaviors. Of those, about 1 in 3 are known to ALSO cut themselves. About 30% who participate in bingeing behavior {with or without purging} also cut themselves or practice another form of self-harm behavior.

My point? These things are a lot more common than most of us realize. 🥺

Still, if you’ve never felt or acted on these kinds of urges, you may be wondering why someone would engage in such behavior. Is it an attempt to die by suicide, a cry for help, attention seeking, or a form of manipulation? 🤨 The short answer is D.) None of the Above.

While accidents can certainly happen, self-harm, in and of itself, is not a suicide attempt. Individuals who engage in these behaviors typically do not express any desire to end their lives. And although these individuals may desperately NEED or WANT help, they usually won’t ask or tell anyone what they’re going through. They may be ashamed or afraid. They may believe they are a lost cause, beyond the point of being helped or that they’ll be burdening someone.

And as for attention seeking or manipulation…🤨🤦🏻‍♀️ *sprays with spray bottle*🚿 No. Just no. 🙎🏻‍♀️

They usually do everything in their power to HIDE these feelings and behaviors, even from the people who mean the most to them. Perhaps… 🤔 I don’t know… because people ask questions like, “Is this attention seeking behavior or manipulation?” 🤷🏻‍♀️

For an individual who has experienced trauma or is struggling with a deep internal conflict, self-harm meets a need. For many, the physical pain inflicted by self-injurious behavior serves as a temporary distraction or numbs emotional pain they’re experiencing. For some it is a form of punishment in response to intense feelings of shame or guilt. Others explain that they are numb to emotions and resort to self-harm in an effort to feel SOMETHING, even pain, fear, and self-loathing. 😞

This often leads to a vicious, self-destructive cycle. For instance, an individual may be experiencing anxiety and feel the only way to cope is through the short-lived physical connection to another human being, albeit a stranger from the internet. The encounter provides temporary distraction, comfort, and relief. However, after the instant gratification dissipates, there are immense feelings of shame, disgust, and guilt. Subsequently, to cope with these new uncomfortable feelings, the individual may turn to cutting or burning themselves to temporarily escape or manifest their self-loathing.

In essence, maladaptive behaviors are the only way they know to express, change, or suppress negative or overpowering emotions. Individuals who engage in self-harm may be unable to effectively verbalize and process emotions, leading them to use their bodies for expression.

These individuals also have a propensity to exhibit body dissatisfaction or dysmorphia, low self image or self-esteem, feelings of worthlessness and emptiness, impulsiveness, and cognitive distortions or self-criticism.

To help this vulnerable population, we have to stop stigmatizing and recognize and address underlying causes such as depression, impulsiveness, low self-esteem, abuse, poverty, homelessness, and family dysfunction and conflict. Then we can collaborate with these individuals to develop healthier coping strategies and a network of support and empathy.

But before we can ever get there, we have to take the time to make sure people understand exactly what we’re asking when we ask about self-harm. Because some of the deepest scars aren’t visible.