Feeling stuck

[GSDlvrRN, MSN]

Hello,

I wasn't sure where to post this so I started here. I have been an RN, hold a BSN, and I work in a correctional facility. I have been here at the jail for a year and I have become very depressed. I feel burned out. I can average 50 intakes a night at the adult facility, with managing our outpatient housing unit, and responding to medical emergencies in the units. I sometimes pass meds to 300 people between 9 pm and 11:30 pm. I feel mentally exhausted and unmotivated sometimes and have started cutting corners just to get things done. I also work at the juvenile facility. I am very burned out on the kids trying to hang themselves, the cutters, the frequent flyers, the long sentencing and increasing number of juveniles committing crimes qualifying them for adult punishment. Sometimes I go home and my soul is shook. I don't feel like I am helping them sometimes, especially with the psych patients. They never get better, they just learn to manage.

At other times I feel like a million bucks in this job. I can be the only medical professional in the building sometimes and my skills and knowledge save people and get them the help they need. I have seen a lot of acute emergencies I never saw in the hospital or LTC. Law enforcement trusts me and relies on me a lot when patients are sick or injured, and sometimes I am the first medical professional the inmates have seen in years when they come in to intake. I have had to think on my feet in ways I never thought I would have to and my assessment skills, delegation skills and confidence have greatly improved, considering my rough start to my career. All of this makes me feel appreciated and happy.

But I feel stuck right now. I dream of moving on to a hospital but I am afraid my past will hold me back. I am also afraid I have lost knowledge or that people won't trust me because I have been out of the hospital for awhile. I resigned from my first job in a med/surg RN residency program because my manager made damaging accusations. I gave a patient medications crushed with pudding because the doctor ordered NPO except medications, and I even called him and asked if it was okay and he said yes. My manager said I was unsafe. I don't want to get into too much because it still hurts to think about, but it was a constant battle between what my manager said I should do and what the doctor ordered. She often said I was wrong, even though I had orders for certain things.

I went from that job after four months to a LTC, finished my BSN 9 months later and came to corrections. Maybe I am just in a rut, maybe I am unsure what I want. But I feel stuck. I feel like I am not qualified to work in a hospital, I feel less than a nurse sometimes because I don't work in a hospital, but other times I am really proud of what I do and NEVER want to deal with bed alarms, families screaming at me, management not supporting me when I tell a family member I will not bring them a hamburger from the dining room, the nurse bullying, CMS, and other things I dislike about hospitals. I also dream of going back to school to be a nurse practitioner and work in a private practice. But other times the thought of leaving my current job is scary. I feel more safe in my job and most inmates respect me more than my residents and their families ever did. I couldn't ever set boundaries with families and patients that cussed me out because my manager had "the customer is always right" attitude.

Maybe I should try to get a job in the hospital part time to see if I can get back into it. Maybe if I sell myself well in a cover letter and on my resume I can get back in. Maybe this is a stage I am going through or I am putting myself down. Sometimes I think that I can't work in the hospital because of my first job experience, or that the hospital is not for me. I feel like I don't have any direction right now. Does anyone have any input?

[TheMoonisMyLantern, ADN, LPN, RN]

You sound totally confused. Have you considered some counseling to help you figure out what you want to do? Just remember the hospital is not the end all be all for nursing.

[GSDlvrRN, MSN]

I have a counselor and I see her regularly but I am seeking input from members on this site. What have others on here done when feeling confused in their career?

[NightNerd, MSN, RN]

It sounds like you are very proud of the work you do but are either falling short in self-care or are burnt out on the environment. I have enormous respect for what you do, because you're right: working with inmates and patch patients can feel very helpless, like you can't help them move forward in life. It's understandable that you may feel you need a change of pace.

I agree with the above poster that some cater counseling or talking to a nursing mentor might help you decide your next steps. It couldn't hurt to apply to some PRN hospital jobs and do a share day to see if you'd like to try something new.

[Cat365]

You are not less of a nurse because you do not work in a hospital. However, if you decide on a hospital you might try ER. I imagine that your skills and quick thinking might transfer well. Also, at least in my ER, there are very few bed alarms. :)

[GSDlvrRN, MSN]

It sounds like you are very proud of the work you do but are either falling short in self-care or are burnt out on the environment. I have enormous respect for what you do, because you're right: working with inmates and patch patients can feel very helpless, like you can't help them move forward in life. It's understandable that you may feel you need a change of pace.

I agree with the above poster that some cater counseling or talking to a nursing mentor might help you decide your next steps. It couldn't hurt to apply to some PRN hospital jobs and do a share day to see if you'd like to try something new.

I have a counselor like an LMFT, but not a nursing mentor. That is why I came here! My counselor helps to guide me and she relates to me sometimes about burnout. I do sometimes fall short in self care. I have worked 6 out of the last 7 nights and I just go home and sleep, eat and get up again for work. I sometimes feel like I don't have energy to do things that help like walking my dogs or taking them swimming.

One thing I learned about myself when I worked LTC was I like to see people get better. I loved to see my rehab patients be able to walk/eat again, and to see them go home to their wonderful lives. I also loved the chronic wounds that would eventually heal after revising the care plan multiple times. It was very rewarding and I felt closure. I DO NOT get that here. These kids/adults stabilize on psych meds, get cleared by mental health, get released on parole/probation, can't afford their meds/do not pick them up and they come right back around to intake for battery/drug abuse/home invasions/violation of parole because they can't make their court dates and anything else. I have worked consistently with the juveniles this schedule and I am being moved to adult intake next schedule so it might help to have change.

[Nurse Beth, MSN]

One thing I learned about myself when I worked LTC was I like to see people get better. I loved to see my rehab patients be able to walk/eat again, and to see them go home to their wonderful lives. I also loved the chronic wounds that would eventually heal after revising the care plan multiple times. It was very rewarding and I felt closure.

Was there a reason you left LTC? Rehab or LTAC sounds like a possibility for you.

Maybe Home Health once you gain more experience. There are dissatisfactions with every role but maybe if your core likes are met, in the right setting for you, you'll have more resilience. Best wishes.

[GSDlvrRN, MSN]

I left because I became interested in corrections and accepted a full time job at the jail. I would go back to a rehab job though!

[ChryssyD]

First of all, hats off to you. Corrections is always tough, but I would never work the juvenile facility because those kids are completely off the chain--impulsive, obnoxious, hyperactive, hypersexual, always doing completely crazy stuff just to get a rise out of people. Ugh.

I worked night shift at a prison for several years, but that isn't the same as a jail. We don't get intakes in the middle of the night. But I sympathize with the ridiculous volume of work in corrections, especially the meds--I didn't mind passing the meds but pulling them was awful--I got bad tendonitis in both thumbs from popping hundreds of pills out of bubble packs every night; over a year has passed since my last day in corrections and my thumbs still aren't right.

To me, it mostly sounds like your facility is woefully understaffed; unfortunately there isn't much you can do about that. As far as the rewards you get out of corrections nursing, there are several: you have autonomy, endless variety--everything from psychosis to stabbings, plenty of opportunity to learn as well as teach, and the added interest of working within a fascinating parallel society. You can learn an awful lot about human nature from being around criminals--and not all of it is bad, oddly enough; some of it is incredibly inspiring. They can and do change, and it's an amazing (if rare) thing when it happens.

You would probably feel most at home in ER, but your corrections skills will transfer well to almost any med-surg type area. You are versatile, you can think on your feet, you can handle high volume and emergencies, and you obviously have great organizational skills. Whatever you decide to do, I'm sure you'll be successful.

And, by the way, there are people who look down on corrections nursing, because they just don't know what it's really like. Believe me, you're every bit as good as any hospital nurse. If you choose to move on, be sure to highlight your skills and be prepared with a couple of stories that showcase your amazing abilities. Best wishes.