Ok so I'm a nurse with 2.5 years of experience. I've worked in Cardiac Tele with 9 patients on drips (in a 36-bed floor), and currently I'm working in a Med-Surge unit with up to 6 patients (in a 28-bed floor). I work nights.
Lately, I've been getting burned out
on the med-surge units because
1) We just had 2 experienced nurses on my shift move to SICU (for various reasons) in January.
2) We have 2 more nurses moving to day shift by the end of April because (one is getting sick from the stress of school and working nights, and the other is having trouble balancing school and working nights in general)
3) I am having trouble managing my time since our documenting process involves meticulous "clicking" in our new documentation system (we transferred from MediTECH to a new system that does not have the "F5" function).
4) I can't educate and teach my patients and their families as effectively as I can.
5) I can't get to my patients when they call me (my rule of thumb is to get to their room in <2 min if my PCA can't get to them first; I did a research for my hospital before and this method helped reduce falls).
6) We are short-staffed, and as of 2013 our unit is no longer hiring Agency or Travel nurses since it's too expensive to pay for them. (We had a net loss last year because of hiring out-of-hospital nurses to try and meet the demands of the floor)
Here are traits on what I'm really good at from what my patients and co-workers, and even educators and Managers of other units, say about me:
1) I am very compassionate.
2) Very good at teaching about pathology and explaining why the MD chose this type of treatment.
3) I am a team-player.
4) The educators are impressed of my eagerness to learn (I am PALS, ACLS, BLS certified, and I recently got my 12-lead EKG certification --- I'm not that good yet at 12-lead since I don't get the opportunity to practice it on a med-surge floor; I also don't have anyone to critique my assessment of a 12-lead strip since no one on the med-surge floor knows it besides me)
5) My manager has given me assignments here and there to educate my co-workers on various new policies or Evidenced Based Practices.
1) Time management - for some reason, documentation is always my downfall. I have clocked myself that it takes at least 25 min, to do 1 patient's start-of-shift assessment; 15 minutes if the patient is a walkie-talkie, independent patient who does not call for anything (this is rare). That's because our new Electronic Health Record (EHR) documentation does not have the ability to "pull up" information that has not changed from the last assessment. At the end of shift, we "close" our Notes with the Education we gave to our patients, which takes about 2 min. to "click" and type in what we did during the shift. I usually have 6 patients: so that's 2.5 hours on documentation itself, which includes the Education part. Remember, there's NO way we can "pull up" or copy the information from that last assessment; we have to "click" our way through.
I've been thinking since January that if I just skip most of my documentation except for the start-of-shift documentation (eg: head-to-toe assessment) and just place Nurse's Notes on things that are not normal, I should be able to cut down on my documentation. I don't have to open my Notes and chart q2 hours if my patient had nothing happening. I spoke with my Manager who spoke with Administration, and they said there is no consensus that charting ONCE for the entire shift is no different that charting q2 hours with no changes to the patient's condition. In other words, if I only chart ONCE (mystart-of-shift documentation) I "should" be legally covered if I am audited in the future... right?
When I look at my co-workers' documentation, there's a handful of errors, some RN's skip all-together the Education piece and some RN's don't document that an MD was called, for example, chest pain. They clock-out on time, but it's not best practice.
So Management has already warned me twice for the Overtime I'm doing (that was within 6 months). And the third one will cause Administrative discipline (whatever that means).
I am burnt out. And since January, I've been getting sick and not sleeping well (I usually work out 4-5 days a week and play sports; now I just sit at home sleeping most of the day). I still give my patients the best care I can do while trying to keep up with what is expected of the RNs when we document interventions, or input what the MD's ordered, etc. But I am extremely unhappy since I get reprimanded for doing:
a) What my patients expect of me.
b) What the State expects of me with my documentation.
Our HCAHPS have plummeted to 79 (we average 88) this past first quarter. And the surveys have said that the RNs on my floor have not met their needs in Education nor controlled their pain nor have made their stay comfortable. I am striving to turn this around, but it's impossible to meet the demands of the new documentation system and still be expected to be a "nurse" to my patients.
My coworkers sometimes ask me, "Why in the world did you want to work as a nurse? You know too much! (They say this colloquially as friends, not as a derision) "
Some of the MD's who know how I treat my patients and are pleased with my work ask me: "So tell me again, why are you working as a nurse?"
My patients who approve of my care to them even ask me, "So are you going to be a doctor some day? Are you still in school?"
I answer all of them the same: "I love what I do, I love being at bedside, I love being a nurse."
So my dilemma: I don't want to leave our unit because I'll get reprimanded/fired for putting in too much Overtime. I also don't want to make our unit more under-staffed than it already is.
But I am increasingly unhappy because:
1) I can't take care of my patients the way I want to if I'm too worried sick
of clocking-out on time.
2) I can't put to use the critical thinking I have in my brain to good use.
3) I find myself hating that the nursing profession has turned more into a money-making field (no matter how you slice the cake, nursing is different from 30 years ago).
Our ICU RN's usually have a 2:1, max 3:1, nurse to patient ratio. I like a moderate dose of adrenaline --- I want to know how to do Open Heart patients on drips. I want to get better at doing Codes. I don't care about giving blood products as long as I don't have to juggle 6 patients with it (who call for pain meds, going to the bathroom, feeding them, turning them, suctioning, cleaning, calling MD's for events, etc). I don't mind doing Total Care patients (turning, cleaning, fixing vents, etc) since I "enjoy" getting to know my patients inside and out.
I know floor nursing is different from ICU, so I'm willing to take a chance so I can be enjoy nursing and still not be bogged down by time-management constraints.
So should I stay on the Med-Surge unit until we get more staff to cover? Or is it ok for me to switch to ICU?