Nurses and the OCD Trap

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“The beatings will continue until morale improves.

The sadistic madness of this statement is obvious, yet in a more subtle form, it’s mainstream thinking in nursing. So desperate to enforce our ideals of perfection, we’re often brutal towards each other. We even “eat our young.” We need to stop beating ourselves up, stop beating on each other. We can’t make real progress by relying on punishment and fear. We need to learn more effective ways to work. Beatings will never get us there. They never do.

As for OCD, it’s ironic how often nurses claim this label, even in jest. Obsessive Compulsive Disorder is a devastating anxiety disorder involving “intrusive and unwanted thoughts” and/or “repetitive behaviors… that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly… aimed at preventing or reducing anxiety or distress… [but] not connected in any realistic way with what they are designed to neutralize or prevent, or are clearly excessive.” (DSM DR p129) Rigidly applied rules and behaviors to avoid anxiety and prevent getting in trouble: doesn’t that sound like mainstream nursing? Yet unrealistic or excessive… we can do better than that, surely. We deserve better.

Some nurses embrace “my OCD,” others see it as a benign bad habit or a cute joke, but few see the problem: OCD addresses anxiety in ways that replace performance with a disability. “OCD” is a trap, not a solution. It’s a distraction, not a guide. It’s a problem, not a solution. Few nurses experience real OCD, of course, yet many nurses vaguely embrace it as a model for quality assurance. Why in the world would anyone do such a thing? The further you go down this path, the less functional you get. It’s a disease, after all, a set of dysfunctional ways to ease anxiety. We nurses can do far better. We deserve success, not pointless suffering.

“Reduce anxiety,” that sounds nice, doesn’t it? Health care work is extremely tough. Emotionally draining, life and death, suffering everywhere you look, liability, violence: it’s no wonder we have such a hard time coping with it all. It’s no wonder we cling to imperfect solutions to feel secure. Sailors of old were extremely superstitious, working as they did under even worse conditions: bad food, isolation, brutally hard and dangerous work. Total catastrophe was common and expected: blue skies one day, all hands drowned the next. Such extreme stress and powerlessness lead to extreme ways of coping: that’s human nature. Nurses don’t have it so bad as those old sailors, but many of us still cling to defensive strategies that serve us poorly.

Yet we can also adapt: learn smarter, healthier ways to cope. Adaptability is the single most human strength when we choose it. We nurses can cling to “OCD” and other dysfunctional habits and traditions, or we can choose to do better. Take my advice: forget about “OCD” and perfection. Move forward instead. Perfection is a myth: progress is reality. 


This post is a follow-up to Nurses have A Perfection Problem. Do You?.

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