BEFORE BECOMING a nurse, I worked as a paramedic and was known among colleagues as "the girl who could lift." Weighing barely 110 lbs. (50 kg) myself, I often lifted my share of patients weighing up to 400 lbs. (181 kg), plus the weight of the stretcher and equipment.  Whether extricating patients or returning them home from healthcare facilities, my partner and I faced situations that challenged our resourcefulness and our muscles.

I could have taken exception to the term girl and the assumption that "girls" can't lift, but I wore my nickname proudly, exercised to keep my legs and back strong, and assessed situations critically to avoid harm. I was never injured during my years on the road as a paramedic.

From paramedic to nurse
Eventually, I went back to school to become an RN. When people asked me where I wanted to work, I had one answer—the ED. My passion for helping people in harm's way made the transition from community paramedicine to hospital ED nursing a natural fit.

I loved my new position. Emergency nursing was fascinating, challenging, rewarding, and life-changing.  As I progressed from timid novice to expert nurse, protocols became automatic. I learned by observing and taking direction from the best nurses and physicians.

In time, I became "the nurse who could lift." Because I was older than many of my coworkers, keeping my symbolic superhero cape became my new goal. I thought I could do anything.

A strong dose of reality

As patient advocates, nurses are adept at doing without to give patients the best care possible. We've all gone without breaks, without meals, without visiting a bathroom for too many hours. We've become habituated to working without the appropriate help, and the supernurse cape emerges. We convince ourselves that we can do the work of at least five people and have the strength of a bodybuilder. I had to learn the hard way that this superhero attitude isn't realistic.

One day I noticed that a confused older patient had maneuvered herself to the bottom of the ED stretcher and was about to dive off the end. She wasn't my patient; I just happened to see her as I walked toward the nurses' station and glanced through a partially open curtain. I shouted for help while I twisted and leaped backward, determined to get to the patient before she fell.

The patient was much larger than I was and pulling her safely to the top of the stretcher by myself seemed challenging but possible.  Without waiting for assistance, I lowered the bed, tilted it back with the foot pedals, and inched the patient into the center of the stretcher. I was able to use the sheet to pull her back into a safe position. By then, her nurse had arrived and taken over her care.

I didn't realize until days later that the twist and lift had injured my back. The hospital said they couldn't consider the injury work-related because I didn't report it immediately. Lesson learned: Take the time to complete an injury form no matter how minor the damage seems.

Donning your supernurse cape and lifting without help can do more harm to your body than you may realize. That's where habituation, acceptance of working alone and turning a blind eye to the dangers of our actions can hurt. Sometimes we unexpectedly encounter our limits.

It takes only one situation, one lift, one inner certainty of infallibility, for life to change. The advice has always been to wait for help when lifting or moving more weight than one person can handle, but sometimes I chose not to wait, convincing myself that my patient's needs outweighed my own.

Know your limits

I still remember the surgeon walking me down the hallway and saying, "You need to think about doing something else. Your body can't take any more of this." This meant no more abusing my body, no more lifting, no more supernurse.

I now offer this advice to all nurses: Please remember to take care of yourself. We quickly dismiss our limitations and needs because we desire to deliver the best patient care possible. Providing care expertly and from the heart makes us good nurses, but those who make a habit of putting themselves last can cause irreparable and long-lasting harm to themselves.

Still lifting

I'm no longer a direct caregiver but still "a nurse who can lift." I can lift spirits by encouraging and guiding early career nurses. I can enlighten; as nurses transition into other aspects of their professions through embracing higher education choices, I can share what I've learned. I can lift colleagues by thanking them for the excellent care they provide.

Most importantly, I've become an advocate for nurses who, in their struggle to help others, somehow neglect to help themselves.

Take my advice if you've seen yourself in this story, whatever your duties or career phase. Being a good nurse doesn't mean sacrificing yourself or your health to take good care of your patients. You can still be "the nurse who can lift" while being smart and considering the long-term outcomes of your actions. Living with the consequences of an occupational injury doesn't have to be the cost of caring. Take care of yourself.

------- Jones, S. (2017, May). The nurse who could lift. Nursing2017, 47(5), 42-44. doi: 10.1097/01.NURSE.0000515505.18087.ab
 

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As people consider starting a CISM team, there are some guidelines you might review to assist you in moving forward. These were first developed by Jeff Mitchell and placed in the Second Edition of the Group Crisis Intervention Workbook. I have added some of my thoughts and experiences along the way for your consideration. These steps are outlined in sequence, but you can proceed in the fashion that works for your community. If all these guidelines are addressed, you should be able to function well as a CISM team. 
 

Why do you think your agency/community needs a CISM team? What kind of events have or are happening that are affecting the personnel you hope to serve? Based upon these identified needs, a rationale for the team's existence should both pragmatically and theoretically emerge.
 

Step Two: Write the team's Mission and Goals. 
Clearly state the purpose of the team and the constituency to be served by the team. Are you going to be a team that serves the general community, First Responders, or just your agency? Are you going to be an in-house peer team or external and independent? 

Clearly state that you are adopting the ICISF models of intervention for your team. (There are many models of crisis intervention; the ICISF model is recognized as the most widespread around the world and the best-established model).

Clearly state that all information shared during any intervention by team members will be held confidential.

Step Three: Determine how the team will be legally constituted. 
Are you within an existing organization? You will need to get approval from the leadership of the organization. You must get buy-in for the uses of the team and the confidentiality of information shared during interventions.

Are you going to be a group of volunteers? You will need to set standards for being able to join the team. This usually means that all members have had the ICISF training in Group and Individual Crisis Intervention as a minimum standard. It is helpful to have written expectations of team members, so they understand their responsibilities.

How are you going to operate? It is important to write procedures for the team's functioning.

How will you "market your team" to those you wish to serve?

Are you going to become a Limited License Corporation? Some teams chose to become a corporation (see legal advice below). This may help in obtaining grants or opening a bank account.

Are you going to apply to become a non-profit corporation? Some teams chose to become a non-profit, allowing them to accept charitable donations.

Step Four: Obtain legal counsel to operationally define issues such as malpractice, standards of care, confidentiality, "good Samaritan" practices, necessary liability insurance coverage, etc.

You will no doubt run up against situations that the above article does not cover. Please contact the ICISF or the author for assistance when you hit the road bumps. We want to be helpful.

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