The long way around: From Enrolled Nurse to (student) Registered Nurse

Twelve years ago I submitted an application for a double degree in registered nursing and mental health nursing. I planned to up-skill from an Endorsed Enrolled Nurse (EEN) to a Registered Mental Health Nurse. Approximately five minutes before the deadline to change preferences closed, on a whim, I changed my first preference to psychology, not expecting to be offered a place. I was.

Instead of working with people with mental health concerns, I gravitated to the cognitive neuroscience research field, where everything is operationalised and quantified in a precise manner looking for trends across a large number of people. Qualitative research was ridiculed by the academics and individual differences were seen as a hinderance; something to be statistically controlled for so they did not contaminate the data. Emotions were unwelcome and interfered. We were real scientists, with (I am embarrassed to admit) somewhat of a superiority complex. These ideas were drilled into us by senior students and the academics. I had found myself in a very different environment with very different attitudes to where I would have been if I pursued mental health nursing.

Over time my depression began to manifest and lead me to become more and more rigid, while amplifying my perfectionism. I surrounded myself with people and a career that somewhat praised these characteristics. I was very successful for my level, further fuelling these feelings and behaviours.

I constantly had to prove myself worthy – in my undergraduate honours year most people conducted a literature review and survey for their thesis research. I completed a systematic review and learnt electroencephalography (EEG) and programming in Matlab to conduct a lab-based experimental study. You were not given additional marks for difficulty, and only gained additional stress.

I continued with EEG for my PhD, but also added some slightly more human elements and worked in a hospital with stroke patients. The more time I spent with the clinical rather than technical aspects of the project the more I became unhappy with the technical. I did not realise it at the time, but I had become incredibly disconnected from my values and being back in a clinical environment may have triggered a small reconnection.

After leaving the PhD I waited 12 months before applying for entry into a nursing degree. I left because nursing did not feel like the right fit for me and wanted to make sure returning was what I really wanted to do. My suicide attempt occurred during this time.

As a consequence, I begun working with a new psychologist and attended a group program at the same facility my psychologist worked, run by a mental health nurse. I thought I needed a few strategies to improve my self-esteem and then all would be well. I was incredibly wrong.

One day I was struggling with a number of things and after the group program the nurse chatted with me in her office for around an hour. She was busy but worried so made the time for me. She helped with a few practical suggestions but mostly she listened and was present. It was the first time I had not felt judged by someone, even the slightest. She was so kind and compassionate when I had lost the ability to be these things for myself. She hugged me afterwards. I think I will carry that conversation with me forever.

That afternoon was my turning point. She had torn a large hole in the wall I had built around me, not letting most emotions in or out; it started to crumble thereafter. It was tough. I spent a lot of time working on my values, allowing them guide who and what I want to be rather than external driven ideas. At times I felt more vulnerable than I ever had but slowly we got there.

As an EEN I was also overly interested in the technical aspects of care – at the expense of truly connecting with people. Again, I was influenced by the close people in my life, those who thrived on technical skills and eschewed compassion – Army trauma doctors and aviation medics… (you get the picture). I was living their interests and forgot who I was along the way while trying to fit in with them.

I am still very academically minded, however now I have started my nursing degree I feel my learning is because I love learning and want to be the best nurse I can, not to be academically better than everyone else and impress them with my knowledge of pharmacology (yes, that actually happened when I was an EEN) in order to gain approval from those above me.

I have taken a very long way around to up-skill from an EEN to RN, however my achievements and the challenges in that time have facilitated the personal growth I needed to realise how important holistic care is. I am incredibly glad I changed my mind and did not try to become a mental health nurse all those years ago. Mental health nursing was my interest and not those around me; I had the right intentions but I was the wrong person. I am still very much interested in mental health nursing, however which ever field of nursing I choose to specialise in after qualifying, I think I may be the right person doing it for the right reasons this time around.


An exercise in self-compassion

Yesterday I completed a Parkrun double header for New Years Day (that is, two nearby Parkrun events that have been timed so you can complete both, one after the other, totalling 10km of running and/or walking).

I ran and walked about equal amounts of the first course and completely walked the second. This was a far cry from the half marathon I was training for months earlier, with the intention of completing one early this year*. Despite this, I am really proud of the effort I put in, even if I literally slept for half the day afterwards.

The start point of my favourite local Parkrun, minutes before I started my first ever event.

I have been too fatigued to run for months. It crept up on me. Slowly my solo runs tapered down, my times were lengthening, and I was starting to skip Saturday morning Parkrun, where I run with a group of friends and have coffee after (this was also the social highlight of my week).

Despite being physically unable to run, I initially thought I was just becoming lazy, making excuses, and in need of a large dose of motivation. I soon stopped trying and was embarrassed to even walk Parkrun while my friends ran. I gained weight after I stopped exercising and this did not exactly help my confidence either.

When depressed, I avoid many things in my life, including those that I enjoy. I wondered if this were the onset of depression, despite being otherwise asymptomatic.

However, a couple of weeks ago I discovered I have a tumour in my neck (at this stage it is assumed to be benign) that specifically causes severe fatigue and bone and muscle soreness due to its location; the perfect combination to make running nearly impossible. I am seeing a surgeon soon and hopefully it will be surgically removed and the symptoms will abate.

This new evidence that my inability to run is not due to laziness has motivated me to tolerate the fatigue (and fear of others judging me) more than I was and to motivate me to do small amounts of running and more walking again. Compared to my previous ability, my current efforts are minuscule, but based on my current abilities, I think it is a good effort.

Yet when I thought I was being lazy I struggled to motivate myself to exercise despite there only being a motivational barrier.

It is interesting how easy it is to ascribe unwanted personality states and traits to ourselves when we do not have a specific “desirable” or “reasonable” explanation for how we feel, to believe that other’s must feel the same way about us, and for this to send our motivation into a rapid downward spiral.

When I received the tumour diagnosis I think I was able to see the running struggles from a more compassionate lens. I was able to acknowledge that it is okay to struggle to exercise because I am unwell. I will receive treatment and when cured I can resume training. I realised that it was okay to try and do small amounts of exercise, within my current abilities, and it is okay that it is not to the level I was previously capable of, or to simply rest if that is what I need.

I was unable to be this compassionate when I thought there was more of a cognitive/psychological cause. It is frustrating that I would never have these same thoughts towards someone else and would have suggested a more compassionate approach to them, yet could not accept this for myself.

Integrating self-compassion into my life is still somewhat of a work in progress. I had some initial help from an amazing mental health nurse and have been working since with my psychologist. They initially had a difficult job as I was very reluctant and it felt incredibly foreign and uncomfortable for some time. I am much more comfortable with the idea now, and actively working to add more of it to my life. Hopefully I will soon be applying it during motivational slumps too…

If anyone has some resources they have found helpful on self-compassion I would love if you would kindly share. I am starting to find my niche but am always open to learning new techniques and theories.

*I worry this may make me sound like I am a seasoned runner – I am far from that. I tried to make it a habit for around a year but was unable to stick to it regularly. Consistent running became a form of therapy after my suicide attempt and started while I was in hospital last March (why it is so important to me). I am incredibly slow by almost every possible standard. I have a love/hate relationship with running – I hate it most of the time I am running, but love the runners high afterwards, achieving things I never thought I could, as well as the improved fitness and the beautiful locations I am now fit enough to hike or run through that I was not previously able to do.