[HillaryC]

I'm five months into my nursing career, and I'm finding myself very discouraged about nursing and worrying that maybe I'm not cut out for it. I'm working in a Surgical IMCU at a large medical center, and I'm considering trying to switch to SICU in a month or so.

What worries me is that lately I have been finding myself getting very irritable at work and have even started complaining that I hate my job. I think part of the problem is I have a very hard time taking breaks when things are busy (which is always), so I end up going nonstop from about 7am to 2 or 3 pm, when things start to slow down a bit (i.e., I've finished assessments, 10 and 12 meds, and all the new orders from am rounds). I realize that going 7 or 8 hours straight with no break for a drink of water or a snack is probably part of the problem, but I have a really hard time stopping to take a 30 minute lunch break when there's all this work to be done, even though most of it can probably wait. I'm worried that I'm going to burn out really quickly (I already dread going to work and have bad days about 90% of the time).

What really scares me is that people say the unit I'm on is relatively easy, compared to other units on the hospital. I'm probably crazy to consider SICU, since I can't even handle the unit I'm on, but it seems like SICU would at least offer more variety and intellectual challenge compared to the our SIMC population, which is largely chronic vent weans post-CABG. I'm also getting really tired of patients with it enough to use their call bells, and love the thought of having a patient on propofol (I know; I'm a horrible person).

Am I doomed? Maybe I'm just not cut out for bedside nursing. Intellectually, I really enjoy critical care nursing, but in practice, I get so irritated. What should I do?

[lavenderli]

I know what you're going through. Sometimes, I hate to do bedside nursing as well. Anyway, it's part of nursing, how can we avoid doing it!!

[Moonepie]

I'm sort of in the same situation. I work in a medical, surgical, trauma, neuro ICU which is always always busy. I rarely ever get lunch on time. I usually start work at 7:30am and get lunch by 3-4pm. I hate to go to lunch when all this work has to be done. I can't relax knowing that all this stuff is just piling up. I go to lunch after most of the major stuff has been done. That way, I can relax and enjoy my break. It seems like everything ordered in the ICU is STAT. It all has to be done now. The intensivist will come around and ask "has this or that been done yet." And so, you feel like you have to get it all done before you can step away. I don't know what it is; maybe I have poor time management. It just seems like the work never ends. I'll look around and see some of the nurses sitting around or talking and I'm thinking "What the heck am I doing wrong? How come I never get to do that?" Is there some ICU secret that I'm not aware of? hehe! Is it like this everywhere or is it just me? I do give some meds early or little late. Like, if there are meds due at 12 and 2, I'll give them all at 1pm..things like that; but I still feel like I'm always running around with my head cut off. Those of you who are great at time management, please give us some words of wisdom. I would very much appreciate it.

[Tweety]

It takes a while to get your groove. But I understand, seems like I'm the last one done. I go in a 7pm and sometimes the nurses coming in at 11pm are done by midnight before me. It can be discouraging.

But the one thing I insist up is taking care of myself. I'd rather stay late than skip a meal or a drink of water. Often I eat while charting but I insist on eating and drinking. Kind of like when there's a will there's a way. Fortunately working night shift it's a bit easier in the wee hours to find time to sit and eat, even if it is while I'm charting.

Good luck. Don't burn yourself our. New nurses are like that, don't be one of them.

[RedBait]

First of all, don't give up this soon. It takes every bit of a year to be a free standing citizen in a new unit when first out of school...maybe more. The learning curve is very steep, the bedside is different than the classroom (I'm sure you know that well) and today's nursing programs are very thin on bedside hours. (I had more than 3200 bedside hours when I was graduated in 1976.) It is a tough job to learn the realities of bedside care and develop organizational skills at the same time.

That said, you will learn them. Just give it a little more time.

I have worked ICU for more than 22 years, and the only time I ever could count on a real lunch break was on units that build it in to the shift. We report off to a nurse, designated at the time of patient assignments, and leave the floor for an hour. Even on the night shift, we close the break room door. At the end of the hour...switch.

Brief breaks for the bathroom, or just to take a deep breath...use the smokers on the unit as your models, don't they always manage to get away, you get away, too.

[begalli]

I can only describe how it is on my unit. Fortunately, we have the staff to cover breaks keeping within the max ratio in the state of CA of 1 nurse to 2 patients. We take turns being the "float" nurse for the unit. There can be anywhere from 1-3 floats depending on the census.

Float nurses do not have an assignment except for the rooms that they cover for breaks, to help out in emergency or code situations, and to just help out the nurses they're assigned to with general things like baths, turning, etc. The float nurse is in the count and is usually a mentor type of person who has experience and can help out with problem solving with the newer or less experienced nurses (the way the floats are assigned make for a good match with the less experienced nurses).

When my breaks are covered (or when I'm a float), the RN covering is looking after ONLY my patients so I'm able to delegate things while I'm away such as doing blood sugars, gases, suctioning, etc.

I know I've said this before, but we take all of our breaks that are afforded us by law, we're practically forced to take our breaks. Rarely do we miss a break, I mean rarely! And if we do, we are paid for the 30 minute unpaid break and a report is filled out (don't remember what kind of report, that's how rarely). I think my hospital (or at least my unit) takes the law seriously (probably because of the union).

The float asks each RN (not more than 3-4 nurses beside themself) what time they'd like to go and coordinate all breaks making sure everyone gets all of their time before the end of shift. For a 12 hour shift, that's 3-15 minute paid breaks and a 30 minute unpaid lunch/dinner break; 8 hour shift is 2-15 minute breaks and a 30 minute lunch/dinner break.

When I first started out, I felt really frazzled. I felt so behind all the time. It took time for me to utilize my resources...like my float. It's hard to learn to delegate and what can be delegated and to who. It took me a good year at least to feel comfortable being kicked out of my room to take my breaks!

I've been known to tell docs that I really genuinely wish I could get everything done at once, but I just can't. Usually that disarms them and they realize where I'm coming from. With our docs, if you don't get defensive, they're cool.

It really makes me sad that nurses everywhere don't get those so important rest periods, even if for only 10 minutes. Sometimes, I think, one gets so bogged down, they really need to just step away or a mistake will happen. I find this especially when I'm orienting new grads or new nurses to the unit - I have to literally tell them to GO, I can do the gas, or GO, I can turn your patient, or GO, that can wait 15 minutes!

With this great experience, I don't think I would work anywhere that doesn't encourage an RN to get out and regroup.

[begalli]

Originally Posted by HillaryC

What should I do?

Force yourself to take a break and hang in there. It will get better. Maybe the SICU would suit you better?

...and love the thought of having a patient on propofol (I know; I'm a horrible person).

p.s. I must be a horrible person as well...I love it when my assignment is a very sick patient on lots of drips and some awesome technological piece of equipment and PROPOFOL!

[apaisRN]

Everyone likes their patients intubated and sedated! At least they like it better than alert patients who sit on the call bell.

My unit is pretty good about meals and breaks - it's a MICU/CICU with lots of failure-to-weans, so not as crazy busy as SICU or a mixed unit. We cover each other and the charge nurse checks in to make sure everyone got lunch. Our union is going to arbitration with the managemene, so hopefully we'll eventually have the breaks and coverage Begalli described.

[GAgirl]

I think there are nurses better suited to work in areas where the patients are sedated, and there are others better suited for floor nursing. It may be that you haven't found your niche yet. MAKE TIME for a break. You are one person and you can only do what you can do. It will all still be there after lunch. If I'm having an unusually rough day, I escape outside for 5 or 10 minutes, just to take a deep breath and get off the floor.

[moonchild20002000]

You have recieved some excellent advice from the other posters.

Is there a way you can eat a small high protien snack while you are charting?
Try to take your breaks, A short time away from pt. care can make a difference.
I also think you need to give yourself more time...it takes a year to feel comfortable.

I have been a nurse for 31 years . In the early days I had a hard time taking my breaks...too much to do.You learn after a while how to pace yourself.
Good luck!