My son recently said to me, "I heard you had a bad time at work the other day." I responded, "I hate my job. I can't take it anymore, and I have to get out of there."

I have just spent 19 of the last 24 hours on the couch. I was flipping through my journals when I came across Thom Schwarz's Viewpoint. Thank you!! Maybe I'm not the only one who is losing it.

A colleague told me that the source of my stress is that I want the best for my patients. In today's health care, that's apparently an unreasonable expectation. I'm tired of cutting corners. I'm tired of trying to support frantic, grieving families while the physicians hide from them. I'm tired of dealing with bed coordinators who shuffle patients around like merchandise and who think that the provision of a mere bed constitutes patient care.

Name withheld by request

Youngstown, OH

I have often thought I might have posttraumatic stress disorder (PTSD) related to both personal and professional caregiving. I left hospital nursing in December 2004 after more than 18 years in critical care, medical-surgical nursing, oncology, and end-of-life care. For two of those years I was a manager and supervisor; during the last four years I also cared for my dying sister and father. These are my signs of possible PTSD: I could name, diagnose, and see every patient I've cared for whose condition unexpectedly deteriorated, who coded or had a poor outcome, for two years afterward. I had hallucinations of hearing the telephone ring and the staffing coordinator telling me to work in the ICU. Four months after the deaths of my sister and father, I began to cry at home before a shift. I wept for them and for all the patients who had died on my unit that year.

During my years in hospitals, I gave my all to patients and fellow caregivers. I knew there were compromises we had to make to get through the shift, but I felt my work was of immense value. Now, I couldn't ever work in a hospital again because I have lost trust in the system. In my eyes, the discrepancy between the value of the nurse and the lack of support is irreconcilable.

June Butkas, MSN, RN

Bloomfield, NY

I think Thom Schwarz has missed the point in saying that PTSD is driving nurses from the profession. Nurses always have dealt with trauma-whether caused by natural disaster, war, plague, accident, or fire-and with people in physical, emotional, or spiritual crisis. Today's nurses are not leaving because of trauma but because of overwork, mandatory overtime, and unsupportive management. Nurses are people who want to help and who need decent working conditions to do the job they are trained to do, and do it well.

Jean Cabelus, RN

Revere, MA

Some of my patients who are veterans developed PTSD by simply being medics in noncombat areas. I'm sure I would have developed PTSD if I worked in medical-surgical nursing. I find psychiatric nursing easier to take. Still, I had to move from job to job in order to avoid burnout. I remember having to resign from a hospital in New York City after I was the one who found a dead body hanging in a closet. Also, I left New York because I witnessed the terrorist attacks of September 11, 2001.

Another important factor in burnout-nursing errors-is mentioned from time to time in AJN. We were terrorized in nursing school about the vital importance of accuracy and good judgment in order to avoid killing patients. Nurses usually take this responsibility seriously. Things sometimes go wrong, or a dying patient can't be saved, and we are more unforgiving of ourselves than even the harshest Nursing 101 instructor. What seems like burnout may actually be nurses' inability to accept their own fallibility.

Charles Kaiman, MSN, RN, NP

Albuquerque, NM

The highlight of my career was in a cardiothoracic ICU. As the assistant head RN on the night shift, I witnessed and participated in many attempts to maintain life. I am haunted by these disasters. I never received any counseling, nor was there any thought that anyone on my staff might need it. It never occurred to me that the "cutting edge" I was so proud to be working on would, in the end, cut me so deeply.

When I accepted a position as a nurse manager in a different area, I became aware of the stress I had accepted as normal. I continued to experience stress and came to understand that I was burned out and would have to leave the profession.

I have found a position in a private program that trains medical assistants, nursing assistants, and nursing technicians. I am a wounded healer. That's not a melodramatic statement; it's simply a realization that I was a clinically practicing nurse-and now I'm not.

Joanne McDonough, RN

New York, NY

When I became a nurse in 1986, I found other RNs unsupportive. I believe this was because of their burnout and PTSD.

I burned out while at the University of Minnesota, working in their float pool. There was only one person to help thousands of RNs deal with nursing issues. I was glad to have found her. She was helpful and encouraging and was instrumental in my finding a job that I could tolerate.

After all these years I have finally found a job in which the nurses I work with are supportive; we share our horror stories, which helps us to heal.

Rebekah Lorence, RN

Minneapolis, MN

Many years ago, after working in the ED for three years, I decided I could not return because I did not want to see any more children die. Now, 20 years later, I work in a trauma-neurosurgical ICU.

Last year we had two very sad cases. The first was a 22-year-old man who shot himself in the head after his girlfriend broke up with him. Shortly thereafter, we admitted a 16-year-old who hanged himself on Mother's Day. We don't receive any formal debriefing on our unit, although it is "available." Several months after these incidents, I found myself in the clinical manager's office, in tears, talking about what had happened and how it affected me.

I'm now working part time on the unit and part time in nursing education. But I find myself wondering: do I want to stay at the bedside or not? How many more young lives can I see pass before my eyes? How many more parents can I try to comfort? How many more dysfunctional families can I deal with? In a patient population in which crisis abounds, how much more do I have to give?

Betty Cole, RN, CNRN

Beaverton, OR

I can relate to the fact that Thom Schwarz's memories seem so fresh in his mind. After I switched to the surgical unit, I realized that for more than 20 years I hadn't gone more than three weeks without witnessing death or horrific trauma. I doubt there are really any bulletproof nurses. I am sensitive to my coworkers and try to check in with them when I think they need to talk. It will take more than that but it's a good place to start.

Amy Timony, RN, RNC, CCRN

Bend, OR

I was a trauma ICU nurse for three years, and I loved almost every minute of it-up until the last few months, that is. I loved the adrenaline rush we got from tending to fresh trauma and the satisfaction of saving someone so close to death. But as any nurse knows, there's not always a happy ending. I became so stressed out and depressed that I actually contemplated suicide. I am so glad to know that I wasn't alone.

Health care professionals too often suffer in silence. I hope that nurses will speak out more often and that resources will be made available to help us cope.

Barbara Coulter, RN

Chattanooga, TN

While taking a research class for my master's degree, I attempted to study nurses' grief resolution and the length of their employment. A literature search gave me very few results, and I had to choose another topic. But when I approached the administration about the possibility of conducting an in-house study, I met not only very little interest but also a great deal of denial that nurses, other than oncology nurses, faced this problem.

I have 35 years of experience as an RN. I love bedside nursing, but I'm unsure how much longer I will be able to survive in it. PTSD is related not just to patient care but also to pressure by administrators to reach unrealistic goals in budgeting, documentation, and patient satisfaction. Nursing can't be cut into little blocks of time, with five minutes allotted for dealing with a crying husband. For me, PTSD is more often the result of not being able to care for a patient fully than it is about losing one.

Name withheld by request

Mahwah, NJ