Circus Skills… CPN Life.

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Oh my word by anyone’s standards 2016 has been difficult for me in so many ways with family illness then subsequent bereavement with one of those family members, our ongoing infertility issues, a cancer scare and a change of job with pressures which have left me questioning my own capabilities daily. I feel like I have spent months walking a tight rope with my own mental well being. I have written recently about how I have felt here

I’m a mental health nurse, not a circus acrobat, so walking an emotional tight rope has felt dangerous. I have stumbled and nearly fallen on so many occasions, arms outstretched with a wobble and a dance the one we all do until just at the last moment we correct out footing and just about manage to prevent the fall. My colleagues and I are all mental health professionals; nurses, psychiatrists, psychologists and social workers to name but a few and whilst we are acutely aware our own well being and that of each other what we aren’t overly good at is being kind to ourselves and looking after our own well being, we are for each other but rely on coffee and a couple of custard creams so sustain ourselves. Turns out that is not enough.

I have long since considered myself a resilient person, I’m a survivor. I thrive on having a full and busy life yet lately I have felt completely overwhelmed. By everything. The realities of my community psychiatric nurse job are such that in the manner of Stretch Armstrong (If you are too young I don’t want to know lol just google it!) I am pulled in all directions each day and whilst by mid morning on a Saturday the slower pace of the weekend helps me return to shape, I also know that by Monday morning I will be stretched again with the risk each Monday that this will be the week whereby a weekend is not enough to get the ‘normal’ me back.

A typical day starts with my daughter slipping out of bed in a stealth like manner and ambushing me as I am trying to slip out of the front door unnoticed whilst her and my husband still sleep, her ambush often involves a hair brush and bobbles and sometimes even includes an ipad thrust in front of my eyes with an elaborate hairstyle tutorial  from youtube indicating this as her requirement for that day. We agree to settle on a super high ponytail or a plait then I rush out acutely aware that those five minutes can add twenty minutes on to my journey with traffic and that something as simple as this can set the tone for my day.

I listen to the radio as I drive to work and try to remind myself that it is only a job, that I have experienced far greater stress than this and still come back smiling. The thing is though this isn’t just a job, it is people’s lives. Sometimes it is life and death.

I want to be the best nurse I am capable of being, I want to walk a journey along side people then wave them off as they step into wellness. I live for the small moments, I don’t need praise that’s not why I do this, its not why any of us do it (as an aside we certainly don’t do it for the salary either since we could be an assistant manager in the local budget supermarket for more money than I earn as a band 6 nurse!), but I live for the moments when someone who hasn’t been out in years grins from ear to ear as they tell me they went to the shop at the end of their road and bought a pint of milk. I live for the moments when a person shares with me that most days this week they have felt 4/10 rather than their usual 2/10 because they have used some of the strategies we talked through the previous time we met.

I hear myself sigh as I return to the office after my first home visit of the day to a pile of telephone messages knowing that I still have another four service users to visit and a meeting on the ward as a woman on my caseload is due to be discharged home from hospital. I look at the list of telephone messages and prioritise who I need to ring back first wondering if I can risk taking a slurp of coffee that a kind colleague has popped in front of me as wait for the first person to answer. I don’t even know which colleague made my coffee but I’m guessing my face held a facial expression which shared that I needed caffeine and quickly.

My first call is to someone I have nursed and worked with for months needing extra support, I can hear the desperation in his voice but one glance at my diary shows I literally can’t fit in a visit, I offer to visit one my way home at 5pm and hear myself telling him it is no problem. I know that the telephone messages, all of them, three from a social worker will simply stack up, likely double in number by the end of the day but since I am unlikely to have time to empty my bladder I decide I will try to return that call later in the afternoon with a hopeful thought that someone may ring and cancel.

I came into nursing for the cliche reason so many of us give ‘because I wanted to make a difference’ except some days I wonder whether the difference I make is a positive one or where am part of a system which does the best its capable of but sometimes that just isn’t enough. Often I am left feeling that I am not enough.

As a CPN I am in a privileged position to be able to get to know individuals well and walk their journey of recovery along side them celebrating their victories and helping to pick them up on the tough days. I am also acutely aware though that we are told that we are a community treatment team not a community mental health team which means I am supposed to visit people to deliver planned, focused treatment yet sometimes the people I nurse just need someone to off load to and someone to offer support whilst monitoring their mental state. That’s not evidence based however, not quantitative enough to capture the outcome. As a multidisciplinary body of clinicians in mental health we have created our own directory of phrases which ‘allow’ us to absolve ourselves of the guilt for a service which doesn’t afford us the opportunity to afford the positive change we all set out to make. Outcome measure tools may provide tools for the board room but they don’t capture the narrative of the personal relationship and how that can aid a person’s own recovery journey.

Services are so stretched that our language has evolved so we talk about ‘signposting to the third sector’ rather than saying ‘doesn’t meet the threshold for secondary mental health services’, we talk about life and death more than we talk about living with distress.

I race out of the office again after a glance at my diary reminds me just how far I have to drive to get to my next visit, some days I wonder why I bother bringing lunch to work. Preparing it is a ritual each evening but the sense of achievement when my days runs smoothly enough that I actually get to eat it is phenomenal. Most days I grab something laden with calories that is able to be eaten whilst driving.

When I get to the next house having driven nearly 40 minutes through roadworks traffic there is no answer at the door, I feel worried as it is not like that person not to be in but also I experience a sense of thankfulness that I have a short period of time whereby I can respond to those other telephone messages and just catch my breath. I ring safeguarding first about something disclosed in a visit a couple of days ago which has prayed on my mind, when it woke me at 4am I realised I really did need to go with my gut and report it. I explain to safeguarding that the only opportunity I had to ring was whilst I was driving and ask with a pitiful tone in my voice if they are able to write up the conversation, they oblige and I thank them very genuinely but what I hear come out of my voice is more like a gushing Oscars speech as I am so relieved.

I ring my husband and let him know I have agreed to see someone at 5pm and that I won’t be home to see our daughter so can he get her ready and fed before taking her to Brownies. He understands that this is the nature of my job and he understands I care, he understands that the clinicians who stood out when I was so poorly were the ones who went the extra mile but still I am aware this is happening most weeks. I know that sometimes although he never says it he must get cross, sometimes when I don’t get to spend more than a few minutes with my daughter before bed then I get cross.

I see the other people I have in my diary for this afternoon and attend the meeting on the ward, my woman is now not being discharged until next week which leaves me a spare hour on Friday where I had set aside time to visit her at home post discharge. Maybe I will catch up a little on paperwork?

When someone on my caseload overdoses and ends up in A&E I take the angry feedback about lack of services from her partner because I know he is just worried, they have young children and his only wish in the world is for the mother of his children to be alive. I take it without mentioning the phone calls I made after our last session to try and add to their package of care, the emails I have sent to try and support their benefit application. I do care but I am representative of a broken system, I am austerity personified.

When I return to the office I flop into the chair exhausted and trying to reflect and process the stories entrusted to me today, to order with in my mind to ensure as I document the interactions I do so for the correct people. I still have a couple to write up when I realise my kidney’s are actually hurting; it was early morning since I had the opportunity to go to the toilet.

A quick glance at my emails reminds me that I have mandatory training outstanding and a child protection report to write as well as a newly requested Mental Health Act section 2 report due within five working days as the hearing has already been scheduled. I don’t know where to start, I feel my own heart rate booming in my chest faster and faster. My life as a CPN is so far removed from the recovery focused role I dreamed of, often I feel more like a trouble shooter. I am in fact a circus act, when I am not juggling I am walking a tight rope of stress. I wake up in the early hours of the morning hoping the person I fitted a visit in at 5pm has managed to fight their suicidal urges for another night and wondering if I will ever catch up with my documentation? How is it even possible that at 4am my brain is racing yet by mid afternoon my cognition’s feels so slowed down I can barely recall my own name?!?!?!

I haven’t exercised in months and I have gained a colossal amount of weight from grabbing a couple of biscuits or a bar of chocolate on the run. I hear myself snap at my husband when I have only been in the house five minutes and I am mentally ticking off a symptoms checklist for stress in my head, I know I am stressed, most of my colleagues are stressed but having been unwell with severe depression in the past I always worry that this will be the time my stress becomes illness. I wonder whether I will recognise the difference between relapse and stress? A dear colleague and friend realised that I am concerned about this and offered reassurance that I am not unwell but offered some advice to take a breath and allow myself some time just to be. I have not missed sense of irony  the tight rope between illness and wellness I walk whilst supporting others experiencing mental illness. No one can pour from an empty cup so I owe it to all those on my case load to look after my own well being as well as owing it to myself.

The juxtaposition is that I love nursing but I hate my job some days, I don’t want to burn out, I don’t want to lose compassion, I don’t want to worry about targets before I worry about tears. I have written previously about my ongoing issues with secondary infertility and when we attended the clinic recently the consultant we saw confirmed my suspicions that stress could be a major factor in our difficulties to conceive. I find myself now resenting work for this not even knowing if it is the reason when actually what I resent is much more than just this. I need to get some balance back but feel so overwhelmed that I don’t even know where to start. I share skills every day on how to challenge negative thought processes and coping strategies for when things get difficult, maybe it is time I took my own advice.

So it is Sunday evening and my muscles are already aching in preparation for resuming my role as a human Stretch Armstrong tomorrow… will this be the week that over stretches me for good? I hope not.

 

NB. Please note that whilst fully based in reality all cases discussed in this blog post are fictional and do not depict anyone currently or historically on my caseload. This blog does give an accurate description of an average day at work for me. 

 

 

 

 

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