Survival Mode Isn’t Sustainability

-By Coshema Carvan, RN

Burnout for me didn’t happen all at once, it accumulated silently, shift by shift. After every 12-hour shift, my body felt as though it needed days to recover. As a new nurse, I experienced intense emotional overwhelm, often breaking down in isolated spaces like the bathroom, gathering the courage to step back out and continue supporting and stabilizing others. At the time, I didn’t have the language to explain what was happening in my body. It took four and a half years for me to understand that what I was experiencing wasn’t weakness, it was an overactive nervous system living in constant survival mode.

In nursing school, we are never taught how to care for our nervous systems. I deeply believe this education should be foundational in every nursing curriculum. And if it cannot come from professors, then it must come from preceptors, mentors, and senior nurses, woven into the plan for building sustainable, supported professionals. Nurses are taught how to endure, how to push through, how to survive, but rarely how to regulate, restore, or truly recover. We rely on survival mode as fuel, not realizing the cost it extracts over time.

At one point, I wondered, what if they were never taught either? What if the nurses guiding us were only shown how to withstand the pressure, not how to heal from it?

This realization is why I am here. To educate new graduate nurses on something I desperately wish I had known at the beginning of my career: chronic burnout is often a nervous system response, not a personal failure. When the body remains in a prolonged fight-or-flight state, burnout is inevitable. Eventually, the very system that pushed you forward will be the reason you’re searching for a way out.

Before I understood this, I sought help from doctors, only to be repeatedly referred to therapy or offered central nervous system, depressant medications, which I declined. It made me question how many nurses are silently medicating nervous system overload without ever being taught how to regulate the source of it. I used to believe something was wrong with me, that I simply couldn’t endure the stress the way others could. It took time to see the truth: it wasn’t me. It was the environment.

Leaving bedside nursing wasn’t a failure, it was an act of survival and self-honoring. It marked the beginning of a healing and uplifting path, one where education, regulation, and compassion come first.

When a stressor or perceived threat is introduced to the nervous system, it typically responds by shifting into either a hyper- arousal state (fight or flight) or a hypo- arousal state (shutdown). In my case, my nervous system went straight into hyper- arousal.

This response wasn’t accidental, it was the result of prolonged exposure to unsafe working conditions. I was caring for multiple high-acuity patients while facilities I worked in consistently refused to hire adequate staff for safe patient ratios. Overtime was often denied to nurses willing to help lighten the workload and improve safety. My shifts frequently extended beyond 13 hours on my feet, requiring me to prioritize endless nursing tasks, charge duties, constant delegation, and at times, there were not even enough staff members to delegate to. On top of my role as a nurse, I was often expected to function as a technician, cleaner, and secretary.

Over time, living in constant hyper-arousal led to multi-system exhaustion, affecting nearly every part of my body.

Neurological and emotional effects:Emotional instability became increasingly noticeable. I experienced mood swings, brain fog, anxiety, depression, irritability, and a low tolerance for stress. I withdrew socially and felt deeply isolated, as though no one truly understood what I was experiencing. I also began to have PTSD-like symptoms, including flashbacks and heightened distress the day before returning to work.

Cardiovascular effects:I developed panic attacks, heart palpitations, lightheadedness, dizziness, and episodes of diaphoresis—clear signs that my body was operating in a constant state of alarm.

Musculoskeletal effects:I experienced persistent muscle fatigue from being in constant motion, bending, lifting, turning, and twisting. My body felt as though it was carrying an invisible, heavy coat, weighing me down at all times.

Gastrointestinal effects:Chronic stress manifested physically through stomach cramps and ulcers, nausea, vomiting, diarrhea, and excessive thirst.

• This was not a failure of resilience. It was the predictable outcome of a nervous system pushed beyond its capacity for regulation.

I left bedside nursing because my body was asking for safety, regulation, and restoration, not endurance. My departure was not an ending; it was a reclamation. Leaving was an act of self-trust that allowed me to step out of survival mode and onto a healing and educational path rooted in nervous system awareness.

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