What My Favorite Book Taught Me About Surviving a Bad Day

Jun 01, 2019

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By Andrea Useem

I discovered two wonderful things in my 40s that many people discover decades earlier: critical care nursing and "The Lord of the Rings." They are very different, I know — one is a career while the other is an epic fantasy story.

But "The Lord of the Rings" has taught me a vital skill I did not learn in nursing school or preceptorship or even CCRN prep-class: how to survive a bad day in the ICU.

When I started as a new-grad bedside nurse three years ago, the "bad days" usually involved feeling overwhelmed: I struggled to keep up with the flood of orders on a crashing new admission. It still took me forever to find anything in the supply closet. And an hour after my shift was over, I would be charting in a corner, with the night shift nurses asking why I was still there.

Those days made me feel demoralized. I wondered how I could ever do this job — how anyone could do this job — given the physical, mental, emotional, intellectual and spiritual stamina required.

When I would get in my car at the end of the day, completely wrung out, I would press "play" on my audio edition of "The Lord of the Rings" and lose myself in a world of elves and snowcapped mountains while I drove home.

If you haven't read "The Lord of the Rings," allow me to summarize it: There's a hobbit named Frodo, he has an important job to do, and completing that job leads to a series of very, very bad days.

For obvious reasons, I began to identify with Frodo and how he survived a difficult — even seemingly impossible — journey toward his goal.

Early Days

In those early days as a new-grad ICU nurse, I admired Frodo for putting one foot in front of the other. I often thought of a moment near the beginning of his journey, when he starts to realize how truly difficult it will be. He is standing on top of a jagged hill with his friend Sam. The sun is setting and they are gazing ahead, far away, to the terrifying mountains where they must go to finish their job. At this point, Frodo is already hungry, tired and afraid. The path ahead of him is bleak and uncertain. But still he faces the future, with his friend Sam at his side. And he chooses to keep moving forward.

This image inspired me because, as a new nurse, I too was just realizing how much I had to learn. As I slowly gained competence in the basics of ICU nursing, I started to see that next level of knowledge and knowhow.

Yes, it's great to successfully draw an ABG on a hypotensive patient, but how about successfully interpreting the results that come back from the lab? And I might know it is normal for my patient with delirium tremens to be hallucinating, but how do I find the patience to cope with his relentless attempts to climb out of bed?

In these early days, I discovered something precious that came to me by chance: a work friend. Karin Kutscher is a fellow career-changer and recent grad who started on our unit at the same time as I did. From the get-go we compared notes, encouraged one another and texted each other tips and tricks we had learned the hard way.

After a long shift, we would stand by our cars until it got dark, talking through the challenges and reminding each other that we shared the same goal: to become a competent ICU nurse. And some days we even let ourselves imagine a goal that seemed so distant as to be impossible: to become expert ICU nurses, who might someday have knowledge to share with others.

When I go out of my way to help others, I just feel better about my job. Because so much of what I love about critical care nursing is the teamwork, knowing that we have each other’s backs no matter what.

Andrea Useem

Today: Working for Others

Gradually I began to feel at home on the job. Karin and I studied together and earned our CCRNs. More often than not, I completed my charting before the end of the shift. But just when I felt good, when I would pat myself on the back for finally knowing how to find the Blood Bank without getting lost, I would come in to work and be smacked in the face with another bad day.

I learned that there are an endless variety of bad days. Though I was now less consumed by an internal fear of failure, I became more bothered by the external issues I now had time to notice. I felt humiliated by the medical resident who patronized and condescended to the nurses. I felt frustrated by problems left unsolved by a previous shift. And on the days when our unit was bursting at the seams, I questioned how we could possibly deliver high-quality care to every patient.

That's when I discovered a strategy that almost always makes me feel better: helping a fellow nurse. I know how grateful I am when someone swoops in to start that IV or check a blood sugar. Not only are they recognizing my distress, but they are wordlessly stepping in where I need them most.

When I go out of my way to help others, I just feel better about my job. Because so much of what I love about critical care nursing is the teamwork, knowing that we have each other's backs no matter what.

Now that I am entering my fourth year of nursing, I think I have a good set of strategies for coping with bad days. I make time to meditate in the morning before arriving at work. I use part of my lunch break to pray in the chapel. I try to speak up when I think something larger needs to change.

But I know that no matter how many strategies I use, there will always be bad days. These days force me to dig deep and ask: "Do I really want to be an ICU nurse?" I feel grateful that my answer so far has always been yes.

At the end of "The Lord of the Rings," when Frodo is in the most dire circumstances, his friend Aragorn prepares for one last heroic effort. At that moment, Aragorn turns to his companions and says: "A day may come when the courage of men fails, when we forsake our friends and break all bonds of fellowship, but it is not this day."

I put a picture with that quote on my locker in the breakroom. And on those days when all hell is breaking loose in our unit, I say quietly to myself: "Not this day." No matter what, we will be there for each other.

Andrea Useem is a critical care nurse at Virginia Hospital Center in Arlington, co-chair of the hospital's Ethics Committee and part-time instructor for George Washington University School of Nursing's accelerated BSN program. Useem and fellow nurses Anna Rodriguez and Magally Rolen were panelists for an NTI 2019 session, "Support for Practice: How to Survive a Bad Day."