how to prevent burnout...

Specialties Emergency

Published

So I've been doing this ER thing for some time. I would think that I can hang in there for much longer, as I'm only 41..... my issue lately has been the lack of quality nurses that are being hired. Many with no ER experience, or very little, or just floor experience. I was given a chance and was able to get into an ER, so I feel like it's possible to find a nurse that's a great ER fit. I try and try to find redeeming qualities, but when the majority of those around you make you fearful for those patients or having them help you, I wonder what to do.

There are many who feel this way. Management, of course, doesn't see what we see. I try to mind my own and just do my shift, but of course you care about those patients who have these unfortunate nurses. By unfortunate, I mean those that lack the ability to think ahead quickly, help your team mates, anticipate and find our residents for their needs, or to stop and disagree when there is a concern about a patient.

Examples of nursing mistakes/oversights are: Hanging Bicarb free flow, not on a pump, is one example. Another is a nurse asking how to hang blood (who also happens to work in critical care). Making a patient with 103 temp sit in our lobby, not masked (hello MERS!), not given Ibuprofen or Tylenol - which is part of our triage protocol. I could go on and on, but considering I'm starting the first of three shifts tonight, I better cool my jets. My usual M.O. is to avoid those that really frustrate me, but you have to be able to work together and lean on each other in the ER. I feel like it is one-sided, though, and I definitely do not want their "help" as their is a distrust in their skills. Of course not ALL of my coworkers fall into this category (it's a busy level 1), but it only takes a few rotten apples to ruin the lot.

I do realize my experience allows for me to anticipate certain things in the ER. I do not expect others with less experience to do this, but I expect nurses to be cautious, if not overly cautious, rather than disregard common sense. There's a culture I have noticed in the past 4 years of newer nurses (not necessarily younger, sometimes quite the contrary) not really caring about their coworkers, not helping with their call lights, or walking their patients - or even giving a med when you know your coworker has two septic patients.

I feel like courtesy is something that is ignored or certainly not considered an expectation in nursing school. Maybe this is something that is personally important to me. I'd like to think that people can change when you lead by example, but sadly this is to no avail. I see that many (from charge on down to techs) really don't feel pressure to get their work done, help others, and then sit down to chat. We all like to decompress with a good chat, but with anything, you have to have the right moment.

So, with vacation coming up I've made a vow to work on my perspective. Maybe it's me. Maybe I'm not giving these nurses an opportunity to learn, or see what they don't know. Any suggestions from nurses who have been around for a bit?

Thanks!

btab3

46 Posts

I am a new nurse in the ER and I understand what you are saying. I don't believe it has to do with the nursing education as much as it has to do with the type of person they are. If someone really cares about his patient and his colleagues then those qualities will come with experience and over time. I speak as someone who is unsure about what to do some of the time being a new nurse. I know that when someone quotes me a policy it not as effective as if someone tells me it the. shows me where to find it so that I know that I can do what they are saying. I think it may just be the type of people your ER has hired. As a new nurse in the ER I try extremely hard to help out and be one of the nurses people can learn to eventually count on. This is just my two cents.

MassED, BSN, RN

2,636 Posts

Specializes in ER.

Thanks btab3. I do think it may take time to evolve, especially in a demanding environment. I appreciate those that roll with it and just dig in, like you. I think it takes more of a willingness to let go of control, at times, and just let the chaos guide you. I hope things will change, as we are losing staff left and right. We have 14 open shifts going into summer!! Geeez!!! I appreciate your comments.

ljrn135, ASN

11 Posts

Specializes in ER, Trauma, MICU.

I have only been a nurse for 4 years so iI would consider myself to be a new nurse in many ways, on top of that I have only been in the ED for 10 months. I did not have any ED experience, and on the floor all your allowed to "protocol" are bls and acls "protocols" essentially. I find myself frequently feeling looked down on by those that have been in the ED nursing role for many years because I'm not as efficient or smart as those. This DOESNT build cconfidence or make me want to ask you for any kind of help or advice! With that being said, if you have a newer nurse that doesn't use common sense in the most simple of applications (possibly not even nurse related) that's a problem. I always try to step up and help in any way possible and give it my everything every second I am there and I know that some others do not feel the same way as me. I find that I know MANY more "protocols" now than I did 10 months ago and that I catch irregular/dangerous heart rates faster and that I am getting more efficient in MANY other aspects but that I also have a lot more to learn and more to experience! You may not have been "green" going into the ED but everyone has to start somewhere!

tech1000

210 Posts

I think my ER fosters a really good "teamwork" environment, but if I know a nurse isn't willing to help others, I don't help them much. Those nurses that help me- I go out of my way to help them. I am overly cautious. Three years in, I STILL always make people verify my insulin and go over drips with them and blah blah blah. I am probably overly cautious with helping patients up or making them use a bedside commode. I do think if you notice that others aren't helping and you're a more experienced nurse, try to help the new nurses out, make it known that they can come to you if they are unsure and that no question is a dumb question, and try to get them to understand how important teamwork is. Also, if you see them do something unsafe, tell them. When I was new, an experienced nurse printed off a chart on a pt she took over and came to me and told me that I could have documented something better and explained why. I never forgot that and always think of that.

MassED, BSN, RN

2,636 Posts

Specializes in ER.

Good feedback and suggestions thanks!

Madnursie

3 Posts

I've been in the ED for almost 2 years now. I got chewed up and spit out at one of the facilities in our group. I had to look up stuff on my own because some felt that a question was stupid, or they wanted to "toughen" me up. Now, I've watched those same people leave a brand new to our ED charge nurse with practically no staff saying the same thing. I think sometimes that we forget that people need to learn. I don't work in a Level 1 - though one day I will - but it seems to me it is about the people themselves. I still feel like a noob, but now I'm a CEN, I handle my workload, and one of my precepting nurses prefers for me to be charge because I handle flow better.

We grow up! I swear! Try for patience. And ENJOY your vacation.

Luvagarden

2 Posts

Specializes in ER.

I happen to agree with your concerns. However, there are a lot of seasoned nurses who do look down on new nurses. The whole problem with nursing is in attitudes. If you are a new nurse entering the ER don't come with "I know it all" attitude. After 25 years doing ER I still don't know it all. I looked up a med the other night. Even though I had given the med under a different name. The nurse there was familiar and told me the name it was under but I said can you show me? Even though she might have breathed deep and rolled her eyes she showed me. Could she have done it nicer? Well yes but no matter how she behaved I got the information. I thanked her. I really don't care how I get the info and although other nurses my feel like you are stupid at the end of the day that shows a strong nurse. Because allowing someone to tell you and not reassuring yourself with the info is a sign of weakness. You practice on a license and are responsible. I walked into a room and stood there amazed at what I saw. This time two new nurses were trying to insert an NG tube. Oh that poor patient. I offered a hand to help and used this as an opportunity to educate. But I lost respect for them because instead of seeking the knowledge they lacked they were torturing a pt. then after me showing them they came to me later demanding I help them. I could go on with so many stories but I think it all comes back to YOUR attitude. Whether you are new in nursing or just burned out everyday in the ER is a learning experience. Find a doctor that you respect and ask why.... I have gained a lot of knowledge this way. And really at the end of the day education is always good to have and give. In me asking the information all the nurse can say about me is she is a safe nurse and I would trust her with me or my family member. It shows I am not a know it all and I am willing to get help or look for the answer. NOT just assume. I have encountered new nurses who have an attitude like "I am stupid" but when I find them not being able to accomplish a task I step in and help without an attitude because at the end of they day they need to know how to do it and they could potentially be caring for you or your family. I just excuse there "attitude" and remember Jesus saying, "forgive them for they know not what they do". Again ATTITUDE!!!!!!

midinphx, BSN

854 Posts

Specializes in ED. ICU, PICU, infection prevention, aeromedical e.

It's not just in the ER. It's everywhere in nursing. I'm 46 and been doing ER and ICU nursing for 18 years. I remember when I started and finally had a tiny foothold of confidence in the ER how I looked at the older nurses. I thought they were so slow and that I could run circles around them. Well, physically I could run faster BUT I discounted some of their knowledge. I judged them to be passed their prime and that I had a future when they were just doing time. I did finally learn my lesson, I'm glad to say it didn't take too long. I learned to appreciate 65 yr old Ruth who had the patience with older people that I lacked. Ruth also could jump to the heart of a problem and fix it while I was still trying to get the patient undressed!

Now I'm on the other side. I'm glad that I remember how the young nurse in me felt, it gives me some patience with these newer folks. I get just as frustrated, but finding out what is going on I their heads help me make connections with them. I think that the power of chitchat and personal caring with our coworkers can really help. It's a struggle for me because I'm introverted, but I have learn how to develop better teamwork all around.

I hope you can reenergize on your vacation. Thank you for making the focus of your concern on safe patient care!

Anna Flaxis, BSN, RN

1 Article; 2,816 Posts

I've only been around the ER long enough to feel like I've finally moved out of novice stage- that awkward stage where you feel like a total fraud and wonder when someone's going to call your bluff- to the stage where I feel competent. Not an expert by any means, but competent, and much more confident in my own clinical judgment.

When I started in the ER, I was so green! I was a good nurse, and a rock star on my old inpatient unit, but in the ER, I was a babe in the woods. Although I never made any mistakes that I am aware of (with the exception of one time giving insulin SQ instead of IV- habit from my days on the floor), and was able to swim in the sink or swim environment I had thrown myself into, I will never forget the patience and kindness shown to me by the veterans.

Enjoy your vacation!

Ron Oswald

5 Posts

Conflict with co-workers is only one of many factors that can contribute to burnout. Some of the stresses that can push us to the brink are difficult to recognize. The best advice that I ever received, regarding burnout, was that mental fatigue should be treated with physical exertion(but not in the workplace). I wonder if physical fitness gets the attention it deserves, as a mental health tonic. Second piece of useful advice might be that we cannot control the other person but we can control how we react to them.

Specializes in Aged Care.

I am not an ER nurse but I read these posts with interest. I feel too many nurses get to this place of what they call burnout or just get sick and tired of the sick and tired. I used to cycle through this kind of thing in my work too, so moved from place to place trying to find some external circumstances that would reduce the emotional charge of my internal dilemmas. The only thing that has worked for me has been spending time working on myself and who I'm telling myself I am. So I suggest three things.

First get yourself a copy of the Compassion exercise from The Compassion Exercise

Do this exercise on each person you may have issues with and feel the "personal sense of peace" it gives you.

Second, download a fantastic publication called 10 Actions You Can Do to Start Taking Back Your Life. Simple effective exercises that will calm you down and give you more energy at the same time. Get it from: TEN ACTIONS YOU CAN DO TODAY and feel how you can totally change your perspective in a very short time.

Thirdly get a copy of the book Living Deliberately by Harry Palmer and read it. This book describes how your beliefs are creating your life as it is and what you can do to change that. You can download free from eLiving Deliberately or buy hard copy from Books & Publications It will change your life.

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