Stoggles Spotlight: Alice Benjamin

*This interview has been edited for clarity and length.

Max/Rahul: How did you get into nursing? What was that pivotal moment where you decided you want to be a nurse?

Alice: Well, nursing— although I love, love, love nursing and I couldn't think of doing anything else, I didn't always set out to be a nurse. I thought I wanted to be an accountant.

My dad was retired military, from the Navy—and these sailors would develop bad habits of smoking, right; high blood pressure, high risk for heart attack, stroke, those types of things. That's what happened to my dad. We had health care insurance; but even with having access to health care, it doesn't always mean you have access to quality health care. Long story short, my dad died of a massive heart attack in the ER because he wasn't properly monitored. And because it wasn't properly monitored, interventions and things couldn't be done.

Those things played a role into some of the things that happened. And so because I was able to identify that at such a young age before becoming a nurse, I said, “I'm going to be the best cardiac nurse in the world. And I am going to help other patients and family members take the best care of themselves so they don't find themselves in situations like this.

So I set out on this work, and it's been my life's mission since. I've been a nurse since 1997 and have always worked in the hospital in critical care, ICU, telemetry, everything cardiac. I did a lot of community service in cardiac. I've spoken at churches and schools, at different businesses, banks, and different health fairs on the radio and television, championing heart health.

My last position in that specialty was as the cardiac clinical nurse specialist at Cedars Sinai Medical Center - practicing as a nurse and teaching all incoming nurses. But there was still a little piece of me that was not fully complete. I didn't have the power, the privilege of prescription, I didn't have the ability to prescribe. So I went back to school and got my post-masters as a family nurse practitioner. I thought, ‘Aha, I'll get on the preventative side of it, working family practice, and help people before the heart attacks.” I entered into that world, but something from the critical care excitement/high-risk thing was tugging on me. So I ended up working in what I currently do as a family nurse practitioner in the emergency room. I never wanted to work in the emergency room because my dad died in the emergency room. I felt like it was too personal. But then full circle, I thought, “No, this is probably where I'm supposed to be." Gather all that experience, do all of that work and end up in the place where I can really make a difference that I felt the prior health care providers didn't do for my dad. Now I get to help someone else. So that's what I do now.

Max/Rahul: Yeah, that’s amazing. Thank you for sharing. We've heard a lot about these feelings of burnout and compassion fatigue that are prevalent in the healthcare industry, especially throughout the pandemic, just wanting to hear what your feelings are about that.

Alice: The stakes are high in health care, especially if you work in the hospital. In the emergency room, people are coming in after the fact; you’re responding and being reactive to something that's already happened. The patients that come in, they're afraid, they're in pain, they're sad. There's so many emotions that are involved there. And we, as nurses, and other health care providers, kind of get the brunt of that. I know you're sad, and you're scared, and you're not feeling well, and because of that, you're snappy, you're yelling, you're fussy, you're all of these things; you don't necessarily mean it towards me, but because of how you feel, I just happen to be there to catch that. We have the patients and the families, and how they're responding in their crisis. We have the stress of managing very sick people. It’s no longer that we're just treating heart disease, or we're just treating diabetes; we're treating heart disease, diabetes, on top of cancer. People are living longer, living with chronic illnesses, and they don't necessarily get sick by the textbook. A lot of critical thinking has to go on in the workspace. So even though that may not be physical work, it's mental work that really can make you tired.

Also, being short staffed. Because of the urgency of things that are going on, we got to work quickly, we got to move fast. Time is tissue, that's what they say. We have to rush and we don’t always have the right/enough resources, whether that’s people or supplies or even specialties.

I’ve seen the dynamic between those smaller places and hospitals that have more resources. I'm not going to say they're less stressed, but at least you know there’s a neurologist that’s going to come and fix this pretty quickly. Whereas a small community hospital, if a patient has a head bleed, we’ve got to call USC Keck. It's going to take two hours for them to get there and you know in your mind and your heart, the patient’s just bleeding in their brain for two hours while we're waiting. It’s that distress we feel when we can’t do the things that we know need to be done.

Then you take things like COVID, which obviously turned everything up 1000 notches with patient demand, patient resources, patient everything. Even though we are healthcare providers, we're still consumers. Just as much as the public fears certain things, we naturally fear those things too. We get sick too, our family gets sick too. But no one ever seems to look at us and say “Oh, you guys get sick too, you guys need to be off.” We would tell people to go home; I’d say “Stay home, don't go anywhere yet.” But we were expected to hurry up, get sick, then it was “When can you come back, when can you come back?” There wasn't that same compassion for us. So that contributed to these high levels of stress, burnout, and mental health challenges.

According to the American Nurses Association, about 50% of nurses experience these symptoms: burnout, mental health exhaustion, depersonalization, and reduced productivity. I didn't feel like I was achieving or like I was being of help; I felt like I was always failing. There are so many people and so many things that need to be done. I'm only one person, I couldn't get them all done, so I would feel stress and that would lead to anxiety. There are times we don't get breaks or lunches, we don't even get to go drink a glass of water. Like, I just need two minutes to make my son's dental appointment. I can't even do that, because the call light’s ringing and this person coming into admission, oh, code blue, oh, there's a code stroke over here. And it's just all of those things can lead to stress and burnout.

Then also moral distress. We will see people who are very, very sick. Especially during the pandemic. We had them on ventilators and we were doing everything that we could, but the outcome of the progress was so poor. Of course, we're going to do everything that we can, but when you see that over and over again, and being exposed to so much illness and death, it takes a toll on you, it makes you really sad inside. If you've had any experience with death in the past, you know that it can remind you of your own certain experiences. A lot of people have died during the pandemic; almost all health care providers had a personal friend or family die. So you're still hurting from that and then you're seeing people in front of you, and you hurt for them too because they look like your grandma, they look like your neighbor, they remind you of so and so. It's just sad.

Max/Rahul: Thanks so much for sharing those experiences. From a hospital's perspective, how are they supporting you with resources to help you cope? How do you guys as a community and as a team lean on each other to really help each other cope? And being a mentor for other younger nurses, how do you help and encourage them?

Alice: Yeah, that is a great question. I actually have some statistics that I wanted to share with you from nurse.org, I’m Chief Nursing Officer there. They’re the largest online platform for nurses. They did a 2022 State of Nursing report where they spoke to about 2100-2200 nurses, and they talked about burnout, and how it's contributing to people wanting to leave the profession. The people who suffered the most depression, most anxiety, and had higher levels of jobs’ dissatisfaction were nurses. And all these were the newer nurses, people with two or less years of experience.

So as someone who has more experience, when I've been around nurses who I know, I would take the time to just to check in on them. I’d ask them “Hey, you okay? know this is a lot. What can I help you with what's going on? I know that's a really hard assignment for you. Let me help you.” I would offer to help walk them through it. I think having that mentorship and support was important, because then you don't feel like you're alone. If you feel like you're alone— it felt like we were in over our head. People were really struggling. So I could do that, personally, when I was there. Now what will happen on an everyday basis, I think it was often dependent on the team that you had working.

During the pandemic the newer junior nurses were thrusted into charge nurse roles and were asked to take very sick patients— pre-COVID level, they wouldn't have taken this type of patient yet because it's too early, they’re still new grads. So what hospitals have done to help is they have employee assistance programs. These are programs where we can go and get confidential counseling or help. They provide resources and referrals; for example, I'm working longer hours because of COVID. Well, let's help you with some childcare, let's see what we can do for you.

There were some hospitals that had support groups, but I'm not really sure how those were operationalized. Because once your shift was over, you were ready to go. You're not hanging out for a support group meeting or anything like that. So there were a lot of people who ran to Facebook groups, just other online social media groups to vent on their stuff. Or we would have IG lives; myself and some other nurses would get on there to talk about what was going on. And we would engage with the audience so people could kind of debrief.

Some hospitals also had crisis workers or mental health workers actually onsite at the hospital to help nurses during the day-to-day because some nurses, especially during the height of the pandemic, would just breakdown, mid-shift, couldn’t do anything.

They also tried to create mindfulness programs where you could go in the break room and listen to things like waterfalls and try to create an ambiance where we could somewhat feel like we were getting away. And then provided us tips with things we could do, like meditation exercises, and when you're away from work, be away from work, things like that. And although they said this was available to us, I don't know that it was really available to us: the mental health days. Because they were so short-staffed, and we needed to be at work. It was hard to get a day off from work, because even when you had COVID, there was all that confusion around when you get go back to work.

So those were things that the hospital said that they would help us with. But I think a lot of nurses just leaned on each other in the world of social media. We have hard days, we want to vent about things too. But the minute we complain, it's like, oh my gosh, you're ungrateful. What kind of nurse are you? What do you mean, this patient got on your nerves? Oh, yeah, patients get on our nerves, too. But we're not allowed to say that.

Max/Rahul: That's really interesting. And it ties into our next question, actually, which was about whether you and your peers felt comfortable seeking support for your mental health. Were there any barriers or obstacles or any stigma around doing so?

Alice: I think there was a lot of stigma. People didn't necessarily want to go to their employers for help because you always felt like it was going to go on your employee record. Even though it's the Employee Assistance Program and they're not supposed to tell, it’s still at work. It was the potential for being discovered in some sense, especially if, heaven forbid, the counselor you're speaking to isn't as honorable and quiet as you'd like them to be. They could slip up and accidentally say something to your manager. So people felt more comfortable seeking care on their own. A lot of people did online therapy, BetterHelp is one of them. That's actually one that I've used. I know there are several other ones as well. But I felt like I needed to talk to an objective third party who who could listen to me objectively, because they're not necessarily in the hospital to know exactly what's going on.

They didn't know me from a can of paint so I could just come and not feel judged. I just needed someone who could just listen and offer me tools, resources, suggestions, that maybe I hadn't heard from someone before.

And I really couldn't absorb or benefit from those things in the hospital. Because I was still at the hospital. I needed to be home, in my comfortable environment, somewhere I can destress, not having to worry about a call bell ringing. So a lot of us used online therapy, and we use our professional nursing groups in kind of our tribes. Nurses are a large community, but there are definitely niches and tribes of nurses. So we lean on each other a lot.

Max/Rahul: That's amazing. Everything that you had to do and the way that you guys bonded together as a community to help resolve some of those issues, because there weren’t necessarily adequate resources and there was some fear and stigma around potentially seeking the resources offered to you.

So my next question would be what steps do you think can be taken by the hospitals or the community, or really anyone to improve mental health for healthcare professionals going forward?

Alice: To improve mental health? Well, one of the things that I think needs to happen, but I don't know that hospitals can institute this, but I really think it's important that health care providers have an out, a place that they can go on a regular basis, to express themselves or to talk. Like therapy, like BetterHelp, you know.

I can imagine that, depending on people's responsibilities or how much they make, not everyone may be able to afford those type of services. So I think that hospitals should actually pay for therapy for their staff. During the pandemic, there were some hospitals that paid for six months of therapy with some other things. But a lot of that stuff is over. It's done. I think that having that type of resource should be for all employees in hospitals; doesn’t matter if you're full time, part time, per diem, work day shift/night shift. I think that type of resource should be available to all health care workers.

That's one thing from the employer. Now as far as like community, what can community do? You know, I'm a firm believer of leading by example. So not even just with health care workers. But I think even in the general community, all together, the United States, the world, we all got a whole bunch of mental health issues going on. All of us have different types of stressors. But I think we should be leading by example, by having more community events that are outwardly displaying that it's okay to talk about mental health. Let's have an event together. Let's do these exercises.

Let's engage in an activity, not just something like talking, but let's engage the senses. The exercise, the movement, the music, the sound, because not everybody gets access to actually do that. Maybe they don't have the resources, time, or the money to do those things. Or they don't know where to go to do that. Or they feel corny doing it by themselves. So if we could do that in a group and show them hey, it's okay. I'm doing it. You're doing it. We're all doing funky, weird yoga poses, but we're doing it together. So we're all weird together today. It's okay. So I think community events would be would be really great. Hospitals have tried to do something like that, but nurses don't want to do stuff with their hospitals on their off time. I'm gonna be honest, we’d rather do it with a community. People want to go to stuff like that, because we want the community there. The Surgeon General just released a statement that one out of two US citizens has experienced and is suffering from loneliness. We need community. When we're all going through the stressors and depression and anxiety, we think we're alone. We think we’re the only one feeling what we're feeling. And the truth is we're not. We're all feeling it, we're all in this room together, feeling lonely, by ourselves. So to change the mindset, we actually have to engage the mind, the body, and all of these things. Whatever you have to do to be internally and mindfully healthy. Whatever you want to call that. Let's do that.

But I think you have to lead by example. Sometimes people feel kind of weird talking about mental health, especially if they’re the only one in the room. So we need to create a safe place with an activity where people can feel like they can go there with no judgement, experience something new, make new friends and feel better about themselves.

Max/Rahul: Thanks so much for your time, and for sharing all your great stories and experiences.

Alice: I'm glad to meet you guys, this has been great. I think you guys have a great product. And it was really good for you to ask, “What do you know, what do you guys need, what's going on?” Because sometimes people don't take the time to hear that, they just give you what they think you need without really listening to the person that needs the help.