It’s been a year since my blog post went viral and I have faced some rather scathing remarks from people online and offline for my blog post, which was just advocating for nurses to care for our mental health, and for my refusal to take it down. Yes.. I could have taken it down but I continue to receive emails from nurses who have found comfort in that post. Who have found validation that yes, nursing is this hard and yes, people break down, and no, the need to take a day for your mental health does not make you a bad nurse.

First, I just want to reiterate that I am non-binary and do not use “she” or “he” or “they” pronouns. My name is Jo. When you tell me I am a horrible person, please go through the effort to not misgender me while doing so.

Excuse me while I double down.

Frequently nurses are required to go above and beyond. While going above and beyond should be something reserved for doing weekly.. monthly, at the most, once a shift… recent changes at my place of employment now require nurses to go above and beyond multiple times a shift. Indeed, going above and beyond is now the daily order of things and this is becoming incredibly stressful. Nurses have spoken up and I believe we will find resolve to these changes and I hope we come out of this better and stronger and more united.

Last night, I went above and beyond.  I took a patient load that most nurses on my floor could not have handled. I notified the charge I would need her to be at my side and she was. How busy was I? The Up – Move pedometer stopped registering my steps and recorded a 3 hour cardio work out. I gave blood. I checked vitals. I assessed and reassessed and reassessed and at the end of my 12 hour shift, there are 4 human beings looking better than they did 12 hours before.

I did so much critical thinking that I started to critically think through this post and that is the last thing we need.

I didn’t do it alone. I had the intern on the floor for the first 5 hours of the shift, working side by side with me, reminding him of protocols and giving suggestions on what we could do. My fellow nurses checked in on me frequently and gave prns. They were also at their max patient load. The aides checked in and did walks, did some of my frequent vitals. I had a lot of help. We all went above and beyond.

My first near break came at 1 AM. That’s when a new grad who has known me for years told me “you need to eat, I can tell.” She was right. I ate. I once more believed in the validity and importance of life and kept on truckin’.

Things got better. Through hard work, my patients all stabilized. I got my charting done. I actually took a break off of the floor. It was amazing.

And then … something horrible happened.

At 5 AM, I ran out of fucks to give.

I remember it clearly. I was priming tubing to give a bolus. And as I watched the fluid roll down the tubing (always satisfying when it doesn’t bubble), I saw the ghost of my last fuck fade away.

I don’t remember who it was who first told me about the importance of rationing your fucks, but as a nurse, this knowledge, this ability, is so important. You must ration the number of fucks you give throughout the course of a 12 hour shift so that if someone falls apart at 6:55, you have a fuck. If you see a wreck on the way home and your feet and back are screaming, YOU NEED THAT FUCK…

And lo, I had no more fucks.

That is how, at 5 AM, I ended up talking to a new grad who has probably never uttered the word “fuck” about the importance of rationing fucks. I used the last dried up wisp of the last fuck in my arsenal to tell her.. do better. Ration. Mete them out appropriately.

Fucks allow you to go above and beyond. Fucks allow you to listen to complaints that you can’t fix but you need it to look like you have TRIED.

Fucks allow you to realize you are running low on fuel and need to regroup so that you can keep being an awesome nurse.

So I dug deep. I found one last, shriveled fuck down in my soul. The fuck that happens when someone gets a hard on at three in the morning and the other person is like… well… okay, why not? It wasn’t an enthusiastic fuck, but it got me where I needed to go. I pushed through the rest of the morning and here I sit, waiting for my melatonin to kick in, once again, begging nurses to care for one another.

I was so busy last night. I am so tired this morning. My patient load was not unsafe for me because I have been on my floor for a long time and I had good support. An energetic charge nurse. Helpful co-workers. AWESOME CNAS (you live and die by your CNA and so do your patients).

I did well last night because other nurses & staff looked out for me. Everyone knew I had made a sacrifice in order for the team to work efficiently and everyone helped out as they could. I have a stack of thank you notes to write out to people who really did so much to get us through the night.

On multiple occasions last night, others also offered to cover me so I could take a break. They made sure I took a break, when my own inclination was to skip it. That break was what gave me the last fuck I needed to get through the end.

A year after an impassioned, exhausted blog post about the need for nurses to practice better self-care, I am happy to say that thanks to my co-workers (and yes, even my manager), I am better at caring for myself as a nurse. I am better at scheduling my shifts so I do not get overtired and I am a better person for it.

I have learned to ration my fucks. I really hope, if you are a nurse, and you are going to work tonight, you stop and think about how many fucks you have to give and realize you’ll need to parcel them out. You might need to borrow a fuck from someone else.

If you truly have no fucks to give.. tonight might be the night you take that mental health break, and that is still okay. You are not a bad nurse for taking care of your own mental health. Nurses should not fall on the pointed tips of our nursing pins to be martyrs for the cause. Take care of you, take care of each other. Be careful with your fucks, for they are precious. This will make you a better nurse, and even a better person.

Good night.