From this Iraq war nurse to all of you COVID-19 war nurses: I see you.

I see your utter exhaustion from long days and extra shifts.

I see your despair that the stream of casualties seems endless.

I see your anger at having to shoulder so many of the brutal consequences from others’ choices and decisions.

I see your hearts and souls breaking at the senseless, preventable death, suffering, and trauma.

I see your frustration when barriers and resource limitations prevent you from providing the level of care you believe everyone deserves.

I see your courage when your own lives are at risk as you do your work, and your deep sadness at how so many leaders and members of your own communities who hail you as heroes don’t seem to care enough to take meaningful action.

I see your devotion to your patients and to your teammates.

I see your impulse to stay in the chaos, understanding that in some ways, it’s the moments of quiet that are more unbearable.

And I know that while I can relate to much of what you’re experiencing, I will never have a full understanding of your world—none of us who aren’t on the front lines could possibly fully understand. But if my own experience in war and in the 17 years since can provide any value to you, I hope it’s through two pieces of advice.

Get therapy

Get therapy—as soon as you can and for as long as you need. Find the right therapist for you. Try a dozen different ones if you have to. The right fit matters.

What you’re experiencing is not what you signed up for in becoming a nurse. What you are doing is incredibly hard, and you are worthy and deserving of help. I know a lot of tough, smart, capable military nurses who, convinced they’d merely “done their jobs,” proceeded to white-knuckle their way through their careers and lives for years after coming home from war.

Some never even realized that’s what they were doing. Many of them eventually sought professional help, and not a single one has said to me “I’m so glad I waited 2, 5, 8 years before getting help (3 years for me); those extra years of suffering, anger, and sadness were totally worth it.” No. We lament the time, relationships, and opportunities we lost trying to “suck it up and move on.”

The kindest, most generous and helpful thing you can do for both your current and future self is to get professional support now.

Unfortunately, access to these services can be challenging, so get on providers’ waitlists, check-out online/remote therapy options, and take advantage of services and support offered by your employer, for example, through an employee assistance program.

It can feel frustrating and defeating to finally being ready to seek help, only to discover that the first six numbers you call have a recorded message saying, “My practice is currently full.” Keep looking for options and pushing through access barriers until you get what you need. It’s worth it. You’re worth it.

Step back when you need to

Stay in the fight only as long as you can continue to hold compassion for yourself and for those around you and only as long as you can continue to do your best in the moment.

Notice that I wrote best in the moment, not your best ever. Consider what best looks like right now, given the many constraints of your world (such as fatigue and resource limitations). When you reach the point where you can no longer do this current, realistic
best, step back.

Stepping back when you are feeling most needed may seem weak or cowardly. It’s not. It is perhaps the bravest, most important action you can take.

Your future self will be able to reconcile all of the times you fell short while doing the best you could and holding fast to your values. You’ll be in a position to withhold judgment about what you think you could have done better and to instead have empathy for the version of you who did the best you were capable of in the moment and under seemingly impossible circumstances.

Future you will struggle mightily, however, if out of frustration, anger, or exhaustion, you take actions that don’t align with your values. I cannot adequately convey to you the immense comfort it brings me to know that for all of my imperfections, I did the best I was capable of in the moment, whether treating Americans, Allies, enemy combatants, or civilians. It has been my greatest solace to know that my fear and anger didn’t steer me to a place of apathy or worse, to taking actions not aligned with my values.

I was fortunate that my deployment ended after 7 months. I don’t know how anyone could expect to hold that space indefinitely. We are human, and our minds and hearts can only take so much before they put forth defense mechanisms that may not align with who we
know ourselves to be.

No one else can know when you’ve hit your limit. No one else is going to pull you back. You have to be the one to speak up and step back. You have to define what stepping back looks like for you. A week off? A month? Six months? A shift to a different job or role? Some combination thereof? You’re the one who has to live the rest of your life with the decisions you make and the actions you take. As I have seen in military peers, regret is a powerful punisher and a robber of futures.

I don’t believe you’ll regret doing the best you can while you can and then stepping back to save yourself. Becoming another casualty of this war—physically or mentally, today or in the years ahead—doesn’t serve you. It also doesn‘t serve the patients you care for, the people who love you, or our nursing profession that is going to so desperately need your experience and leadership going forward.

The path ahead

I see you. Not only now, but years from now. I’ve observed the different paths that post-war futures can take, and I want yours to be one of healing, post-traumatic growth, and possibility.

I know this path is possible through even the darkest, harshest experiences. I’ve walked it, as have many of my military nurse friends. We continue to walk it to advocate for ourselves and to seek the support we need—the help we are worthy of receiving. It is my fervent hope that you will join us on this path. I will be honored to walk alongside you.

Karen Steinbock served as a Navy Nurse with Bravo Surgical Company at Camp Fallujah, Iraq, in 2004. She provides coaching support for women transitioning from military to civilian careers and for nurses who are seeking to excel in their current jobs and/or are exploring what’s next. Connect with Steinbock on LinkedIn (linkedin.com/in/karensteinbock/).

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