Is it me or am I just burned out?

[MrsWampthang, BSN, RN]

I have been working in long term acute care for about a year now. In August I went to work for an LTAC that I thought would be better than the one I was working in. I went from having an average of 6-7 patients to having an average of 3-4 patients. Sounds good doesn't it? Orientation was so great, and so informative. I learned more in the week of orientation classes than I had the whole time I was working at my former employer, so I thought I had truly found that the grass WAS greener on the other side.

A little background: at the first LTAC, as I said, the average patient load was 6-7, but occasionally we had 8, which is really too many for an LTAC, even on nights (which is what I worked). If census was too low, we would only have one aid for the entire building (usually about 20 patients). The patients on the regular floor are all considered medsurg patients even if they are on vents or remote tele, with assessments being done once a shift and vital signs being done three times a day. In the special care unit, all patients are on monitors with vital signs and assessments done every four hours. If there was no other ACLS nurses on duty then the charge nurse has to work out of the SCU and therefore not available to help with anything going on on the floor. The patient load in the SCU is 1-3 patients, with little or no help from anyone to turn and help keep patients clean. The aids are expected to do vital signs as well as keep patients cleaned and turned. If there is only one aid like there is on night shift sometimes, they do vitals twice in the shift and are only expected to do half the patients each time. i.e. they do half of the patients vital signs at ten, the nurses are responsible for their own patients if their patients aren't the half that are getting vitals done by the aid. Then at 6am the other half of the patients get their vitals done by the aids and the nurses with the first half of the patients are responsible for the vital signs. i hope that makes sense.

So now for my new job. I was told during orientation that the patient load would be according to the severity of the patient. i.e. if you were assigned a bad patient, you would have no more than one other patient. Enter the real world........the patent load is as I stated above, and it doesn't matter how bad the patients are or how busy. Sounds easy, even if huh? Well, that's what I thought until I actually started being oriented to the floor. All patients are assesed at least twice a shift with vital signs at least twice a shift. Most patients are three times a shift for both because they are either on vents, remote tele or both. Here's the kicker, the techs (aids) aren't necessarily expected to do the vital signs or accuchecks, and some don't do anything more than they half to, spend excessive amounts of time on breaks and take extensive lunch breaks. The nurses meanwhile, are drowning because they are running their butts off passing meds, doing assessments every four hours, sometimes with vital signs, (more often than not), checking the charts everytime a new doctor comes on the floor and does rounds, suctioning patients, changing wound packing and dressings, and on and on. This is on day shift, I understand that is pretty busy on night shift except for the numerous chart checks because of doctor rounds.

My orientation to the floor has been good and bad. For the most part I have had good preceptors. My last day on orientation was supposed to be last week where I was to come in and follow RT and wound care to get familiar with what each of the disciplines do and then Monday was supposed to be my first day on my own. Well, the education person told me all this, but didn't bother telling anyone else. I came in the day I was there to follow RT and WCN and neither one of them knew anything about it. I did follow RT for the first half of the day, then did an admit for the charge nurse, then finished the day following the WCN cause she was had been at a seminar all day so she was doing her wound care late, so consequently I was only able to follow her for two hours. A fact she would have told the educator had she communicated with the WCN. Come Monday, I come in to the charge nurses asking me where I was in my orientation. I told them that that shift was supposed to be my first day on my own, but again, the educator didn't bother communicating this to either charges so the day charge told me to go ahead and let this shift be my last in orientation with a preceptor and that the preceptor would just be my back up, but the preceptor would be helping the charge with some of her things. We were assigned three patients, one of whom we were told kept having low BP issues all night so was going to need close watching all day. When I suggested that my preceptor take the really sick patient and let me have the other two I was told, "no you need to know how busy it can get." The second patient I had was going to go down for radiation so needed to have all her morning meds, assessment, vital signs ect done before they came and got her. The third patient had a K+ that needed treated but because the creatinine was above a certain point I needed to call the doctor to find out if and what she wanted to do about the K+. And this all going down before 9am. On top of all this the first lady was complaining about back pain and the RT came and told me she was asking for pain meds. When I didn't drop what I was doing the RT went to my preceptor and asked her if she would treat the patient's pain, which she did. This was the start of my day, and it got worse as the day went by. Several times, I had to go off and have a short cry because I was so frustrated. When I voiced my concerns about giving me such a hard assignment on my last day of orientation/first day with a full assignment, I was told that I was an RN and should get over it because that's how busy it can get sometimes, and I just have to suck it up, and go on when it is busy. (not in those words, but that was the sentiment). I don't mind being busy and I know there are going to be days that are going to suck, but why throw a new person into the deep end of the pool and end up making them never want to come back? And yes, I expressed that too. I took this job even though I have to drive over an hour to get there and have to leave my house at 5:30 to get there because I thought it was going to be a better place to work. I'm making more per hour and I get weekends off, I get to sleep with my new husband every night so why am I being a baby? I know I don't want to go back to the other place because it would be night shift and at least one weekend a month, and a little less money. I wouldn't work day shift at all there, because it is a worse nightmare than where I currently work.

I guess I just needed to vent here, I'm not sure what to do at this time, except just continue to work at the second place, even though I dread going in, and when I'm there, I count the minutes until I can go home again. I'm getting tired of being exhausted by the time I get home, and I'm getting tired of getting off late because the day was so busy. Sorry this is so long. Just needing an ear, thanks.

Pam

[bargainhound, RN]

I would leave and find another job better suited to you.

What I mean is that this job is too much for any human being.

[texas_lvn]

WOW, take a deep breath. It sounds like you had a rough day. , but know we are hear to listen *read* (to) you. Give it some time. everything will turn out ok. Good luck and keep us posted. :monkeydance:

[jjjoy, LPN]

When I suggested that my preceptor take the really sick patient and let me have the other two I was told, "no you need to know how busy it can get."

Can anyone explain this logic to me? It would make sense if it were the last day of an extended preceptorship but that's not the case here. How are you supposed to learn better by being overwhelmed by what you're not prepared for? This mentality is pervasive throughout the nursing community. I'd imagine much of it comes from nurses who hate it as much as the next person but after getting the brush off themselves in regard concerns about the ridiculous expectations put on them, they pass it on to the new nurses.

[MrsWampthang, BSN, RN]

Thanks for the replies. The last two days I worked were a little better and were my first official days on my own. I had three fairly simple patients so it wasn't too bad. Even though I will only have 3-4 patients I know it is going to be busy, because the nurses are expected to do all thier own V/S (which I don't disagree with), but they also have to do dressing changes that don't include wound vacs and we're told that if we don't chart it off on the wound MAR then we will get wrote up. (which I do disagree with). The charting has to do with Wound care's ability to charge for the dressing change. My feeling is that if they are going to charge for the dressing change, then they should do it, if nursing is going to change the dressing, then it should be a different or less charge. On top of doing everything else for my patient, I don't have time to take a half hour to do an extensive dressing packing one to two times a shift. I never did agree with that. I don't think I would mind doing as much for my patients if I could count on my techs to be available to keep the patients cleaned and turned, but there are a couple that are just useless, and spend their time on their cell phone or holding up a wall. Its so frustrating when I am running my butt off!!!! Oh well, I guess I'm getting too old to work that hard and have an hour drive on either end of the 12 hour shift. I am so sore and exhausted when I get home that I could just collapse. I'll get used to it though. Thanks for letting me vent.:wink2:

Pam

[csiln]

How would you like to have just graduated? If its difficult for an experienced nurse, I don't see how the nursing shortage is going to be helped when nurses that have been at a facitlity awhile treat nurses (experienced or new) with a sink or swim mentality. Again and again, I ask why? What do nurses gain by not going all out to see that new nurses succeed?

Hope it works for you. I hated hurting and legs cramping all night and I only had a 15 min. drive to work! You must be exhausted!

[tridil2000, MSN, RN]

I have been working in long term acute care for about a year now. In August I went to work for an LTAC that I thought would be better than the one I was working in. I went from having an average of 6-7 patients to having an average of 3-4 patients. Sounds good doesn't it? Orientation was so great, and so informative. I learned more in the week of orientation classes than I had the whole time I was working at my former employer, so I thought I had truly found that the grass WAS greener on the other side.

A little background: at the first LTAC, as I said, the average patient load was 6-7, but occasionally we had 8, which is really too many for an LTAC, even on nights (which is what I worked). If census was too low, we would only have one aid for the entire building (usually about 20 patients). The patients on the regular floor are all considered medsurg patients even if they are on vents or remote tele, with assessments being done once a shift and vital signs being done three times a day. In the special care unit, all patients are on monitors with vital signs and assessments done every four hours. If there was no other ACLS nurses on duty then the charge nurse has to work out of the SCU and therefore not available to help with anything going on on the floor. The patient load in the SCU is 1-3 patients, with little or no help from anyone to turn and help keep patients clean. The aids are expected to do vital signs as well as keep patients cleaned and turned. If there is only one aid like there is on night shift sometimes, they do vitals twice in the shift and are only expected to do half the patients each time. i.e. they do half of the patients vital signs at ten, the nurses are responsible for their own patients if their patients aren't the half that are getting vitals done by the aid. Then at 6am the other half of the patients get their vitals done by the aids and the nurses with the first half of the patients are responsible for the vital signs. i hope that makes sense.

So now for my new job. I was told during orientation that the patient load would be according to the severity of the patient. i.e. if you were assigned a bad patient, you would have no more than one other patient. Enter the real world........the patent load is as I stated above, and it doesn't matter how bad the patients are or how busy. Sounds easy, even if huh? Well, that's what I thought until I actually started being oriented to the floor. All patients are assesed at least twice a shift with vital signs at least twice a shift. Most patients are three times a shift for both because they are either on vents, remote tele or both. Here's the kicker, the techs (aids) aren't necessarily expected to do the vital signs or accuchecks, and some don't do anything more than they half to, spend excessive amounts of time on breaks and take extensive lunch breaks. The nurses meanwhile, are drowning because they are running their butts off passing meds, doing assessments every four hours, sometimes with vital signs, (more often than not), checking the charts everytime a new doctor comes on the floor and does rounds, suctioning patients, changing wound packing and dressings, and on and on. This is on day shift, I understand that is pretty busy on night shift except for the numerous chart checks because of doctor rounds.

My orientation to the floor has been good and bad. For the most part I have had good preceptors. My last day on orientation was supposed to be last week where I was to come in and follow RT and wound care to get familiar with what each of the disciplines do and then Monday was supposed to be my first day on my own. Well, the education person told me all this, but didn't bother telling anyone else. I came in the day I was there to follow RT and WCN and neither one of them knew anything about it. I did follow RT for the first half of the day, then did an admit for the charge nurse, then finished the day following the WCN cause she was had been at a seminar all day so she was doing her wound care late, so consequently I was only able to follow her for two hours. A fact she would have told the educator had she communicated with the WCN. Come Monday, I come in to the charge nurses asking me where I was in my orientation. I told them that that shift was supposed to be my first day on my own, but again, the educator didn't bother communicating this to either charges so the day charge told me to go ahead and let this shift be my last in orientation with a preceptor and that the preceptor would just be my back up, but the preceptor would be helping the charge with some of her things. We were assigned three patients, one of whom we were told kept having low BP issues all night so was going to need close watching all day. When I suggested that my preceptor take the really sick patient and let me have the other two I was told, "no you need to know how busy it can get." The second patient I had was going to go down for radiation so needed to have all her morning meds, assessment, vital signs ect done before they came and got her. The third patient had a K+ that needed treated but because the creatinine was above a certain point I needed to call the doctor to find out if and what she wanted to do about the K+. And this all going down before 9am. On top of all this the first lady was complaining about back pain and the RT came and told me she was asking for pain meds. When I didn't drop what I was doing the RT went to my preceptor and asked her if she would treat the patient's pain, which she did. This was the start of my day, and it got worse as the day went by. Several times, I had to go off and have a short cry because I was so frustrated. When I voiced my concerns about giving me such a hard assignment on my last day of orientation/first day with a full assignment, I was told that I was an RN and should get over it because that's how busy it can get sometimes, and I just have to suck it up, and go on when it is busy. (not in those words, but that was the sentiment). I don't mind being busy and I know there are going to be days that are going to suck, but why throw a new person into the deep end of the pool and end up making them never want to come back? And yes, I expressed that too. I took this job even though I have to drive over an hour to get there and have to leave my house at 5:30 to get there because I thought it was going to be a better place to work. I'm making more per hour and I get weekends off, I get to sleep with my new husband every night so why am I being a baby? I know I don't want to go back to the other place because it would be night shift and at least one weekend a month, and a little less money. I wouldn't work day shift at all there, because it is a worse nightmare than where I currently work.

I guess I just needed to vent here, I'm not sure what to do at this time, except just continue to work at the second place, even though I dread going in, and when I'm there, I count the minutes until I can go home again. I'm getting tired of being exhausted by the time I get home, and I'm getting tired of getting off late because the day was so busy. Sorry this is so long. Just needing an ear, thanks.

Pam

pam- about this sink or swim mentalility, i too used to think it was horrific. however, afer many years, it becomes one of the only real ways you can see who can truly survive on a unit. i know i may get some flames for this. after an average orientation, you're put on your own. we (experienced) nurses KNOW you're going to struggle. we ALL struggle. how you handle it speaks volumes. you can, and should stay calm. admit that you found your morning a crazy start, but you prioritized and focused to get a b and c accomplished. your coping skills are being assessed, whether you know it or not....and whether those nurses know it or not.

see, what it gets crazy, we all get flustered and overwhelmed. even after years and years of experience. the difference btwn new nurses and older ones is how to deal with it.

KNOW right off the bat, each day will be stressful. know some things are just out of your control. decide on your plan of attack and exude confidence. if asked, say, i'm doing pt a first, before anything else. i will get to pt b in a few minutes.

if placing a call out to a dr.... tell the charge nurse and secretary. tell them to page you when they return. continue to do something. know that within an hour, you will get most tasks done.

when the unit is crazy, we all like to work with people who don't panic and keep their cool. more gets done and everyone benefits. wouldn't you want to work with those kind of nurses! :)

do make a mental list about what really concerns you and address it with the nm. complaining to your peers accomplishes NOTHING and just puts you in a negative light. make suggestions to the nm.

you could job hop all your life, but before you do, examine your ability to cope too. maybe in the end, you will have to say good bye anyway.

good luck