Nuts: How We Treat Nurses

May is National Mental Health Month. May is National Nurses Month. The World Health Organization declared 2020 the Year of the Nurse and Midwife. This year, instead of having the typical weeklong recognition of nurses the second week of May (Florence Nightingale’s birthday being May 12th), the American Nurses Association declared the entire month nurses month.

Week one focuses on self care: “Nurse self-care is more vital than ever now as we face the COVID-19 pandemic and its accompanying stress, isolation, and anxiety.” They include links to daily self-care tips on rest/sleeping, nutrition, and exercise—and a way to sign up for a daily “hope-filled message.” Relaxation techniques. “Mindfulness while wearing an N95 Mask.” Building resilience. Safety at work with a focus on anti-bullying efforts. Obviously, these resources and webpages were designed before the COVID-19 pandemic struck our country and frontline nurses, physicians, and emergency personnel could not access sufficient N95 masks and other personal protective equipment–to be mindful and resilient in.

Self-care is important but insufficient. Access to high quality, low-barrier, affordable, confidential, and non-stigmatizing mental health treatment for nurses is an absolute requirement under any circumstances. But especially now when what we are asking our nurses to do—and all nurses, not just ICU and emergency department nurses-—is emotionally taxing and traumatic at unprecedented levels. And now, during a time of a public mental health and substance use disorder crisis, as the American Public Health Association has declared. And states that continue to have antiquated and punitive state licensing laws for nurses and other healthcare providers, requiring providers to reveal any and all mental health treatment, those state laws need to be changed so that they aren’t an additional barrier to to mental health treatment. (see: “Why don’t doctors seek mental health treatment? They’ll be punished for it” Kayla Behbahani and Amber Thompson, Washington Post, May 11, 2020)

Recommended training resources:

Northwest Center for Public Health Practice has a three-module free, self-paced online training on disaster response, including “Stressful effects of disasters on workers.”

Johns Hopkins Bloomberg School of Public Health has an excellent six-hour interactive online training program “Psychological first aid.”

Homeless Vets

I have known and worked with way too many homeless veterans of various U.S. wars. But the one I remember best is a Vietnam veteran I call Jake. He became a patient of mine in the mid-1980s when I ran a clinic for the homeless in my hometown of Richmond, Virginia. I wrote about him in a chapter titled “Homeless Ghosts” from my 2016 medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net. Even though our system of care for homeless veterans has improved since the 1980s, homelessness, post-traumatic stress disorder (PTSD), and suicide remain prevalent at alarming rates for our veterans. Below, I include the VA suicide prevention hotline, followed by an excerpt of my story of Jake.

*Where to Call for Help:
The Department of Veterans Affairs maintains a hotline for veterans in crisis that operates 24 hours a day. Call 1-800-273-8255 and press 1. Online, visit, or send a text message to 838255.*

“Since I was seeing Jake regularly for wound care, over the next several months I got to know him better. He wasn’t talkative, but began offering more information, at least about his current life. There was something about the daily ritual of foot care and wound cleaning that nudged him to talk. I learned to modulate my questions with his moods, knowing when to gently probe and when to back off, when to be silent as he brooded. It was like falling into step beside him.

Jake told me about his pet crow named Blackie, how smart Blackie was, and what a good companion because she listened and didn’t talk back. “She had a hurt wing when I found her but she let me splint it. Healed up crooked but she’s real strong.” Insomnia and nightmares plagued him, so he stayed up most nights reading paperback novels by flashlight. Mysteries were his favorite as long as they didn’t involve much killing. He didn’t like sleeping outside because it reminded him of the war, so he stayed in his car, or in a vacant garage he’d found near the Hollywood cemetery on the edge of the river. He liked the quiet of the cemetery and was able to sleep better there. The ceiling of the garage had old glow-in-the-dark stars and he could see his way around at night by their light. Jake had been homeless off and on ever since he was discharged from the U.S. Army ten years ago: “I tried going home but it didn’t work out.” I didn’t press for details. His face closed down as he said it. Jake had a classic case of the recently named Post Traumatic Stress Disorder—PTSD. It had older names, including battle fatigue and shell shock. During the Civil War it had been called nostalgia or homesickness.

I knew about PTSD, but only in an abstract, clinical sense. At the time, I didn’t realize I would develop it myself. I wish I had known then what I know now about PTSD, how it festers and flares inside while leaving no visible scars. Maybe I could have done more to help Jake. Maybe I could have seen that his PTSD was more destructive than his leg wound.

What I would never know first hand was what it was like to be a chronically homeless war veteran. The media people liked to focus on this segment of the homeless population, the long-term disabled homeless, the large number of Vietnam vets who were on the streets. After the Vietnam War was finally over, people in the U.S. wanted to forget about it, but the presence of homeless vets on the streets wouldn’t allow them to.” pp. 89-91