Young and jaded.

  1. 15 Hi all.

    I got my RN license at about this time last year, right after I started working as a GN at a downtown San Antonio ICU. It's a SICU but we see a wide variety of medical/surgical/cardiothoracic patients. We generally have very high patient acuity. Lots of drug abuse, non-compliance in the face of multiple comorbidities, repeat offenders leaving AMA and coming back a day or two later, etc.

    In some ways and on some days, I love working as an ICU nurse. I'm finally able to more or less independently care for the sickest patients that we get. Vented patients, balloon pumps, septic shock pts, CABGs, managing multiple drips, CRRT, RRTs and code blues, I do it all and the rush keeps me going.

    But although I do my best when it comes to particular patients, I feel like I generally just don't care anymore. Without even going into the issue of how hospital administration and doctors' attitudes get me WAY down... patient-wise, I see the same things day after day after day. People who don't want to learn, don't care about their health, don't care that our team snatched them from the jaws of death. And then I read about the pertussis outbreak way over there in California. And then I think about my dad, who has years of untreated HTN and refuses to see a doctor and is probably gonna end up as a STEMI on a balloon pump.

    And then I think, why do I bother? Why am I busting my ass and breaking my back for you, mister 34 year old, 800 pound, 6 cigarette pack a day CABGx5, when you're gonna go to the nearest McDonald's immediately upon discharge and eat 8 big macs? Or you, the violent, intubated 22 year old heroin overdose with seizures and anoxic brain damage, with a history of being intubated following heroin overdose and hemodialysis since the age of 15, whose insane mom is sneaking in opiates behind my back and screaming that the benzos we're giving him for sedation are killing him.

    I feel like I used to care about my patients. Sometimes I still feel like I do. No matter my attitude on any given day, the job always gets done. Some days I go home and I'm proud of my work. I said goodbye to my alert/oriented patients in the morning and wished them well, and I really meant it.

    But then there are the bad days where I go home, have a beer, put my head in my hands. And I feel like an empty human being because I don't care about people anymore, entirely dread having to go back to work tomorrow, and wonder what the point of all this crap is.

    Sorry, I just had to vent. Thanks for reading.
  2. Visit  apocatastasis profile page

    About apocatastasis

    apocatastasis has '4' year(s) of experience and specializes in 'Psychiatry, ICU, ER'. From 'Austin, TX'; 30 Years Old; Joined Feb '08; Posts: 213; Likes: 536.

    19 Comments so far...

  3. Visit  Suethestudent profile page
    11
    Wow... that sounds like a really intense introduction into the world of RN nursing. I hate to say it, but with some of the demographic you are receiving, not caring too much is the best way to go for your sanity. There will be frequent flyers and they will not learn and they will not change. Oh and I may get flamed for that (p.s. don't care), but I speak from bitter experience. As Ron White would say, "You can't fix stupid".
  4. Visit  shoegalRN profile page
    9
    I'm an ER nurse, and I feel you.

    No matter how much I teach, no matter how many frequent flyers come through my ER, no matter how many times they sign out AMA, or leave before being triage (after raising hell for waiting 30 minutes), I sometimes wonder why I do this.

    The GSW's damn near every night, the 21 year old single mother who is in an abusive relationship with the "baby's daddy", who I spent 2 hours with, getting social work involved, getting the SANE nurse involved, getting this woman a safe haven in the battered women's shelter, only to have her LEAVE with the abusive boyfriend who picked her up at the door. Not to mention, the next week she is back by MAST, this time fracture jaw by the abusive boyfriend.

    I wonder sometimes. I really do. All I can do is stay up in prayer and realize it's my job to keep them alive on my shift. Maybe, I may have made a positive impact on somebody's life along the way.
  5. Visit  SandraCVRN profile page
    1
    Big hug to ya. I love to visit San Antonio (grew up in Chicago) but could never work in a big city. Sure we get the occasional frequent flyers but not to the extent you describe. Do you have a smaller facilty you can look into?

    Again, good luck....
    apocatastasis likes this.
  6. Visit  netglow profile page
    4
    apocatastasis, just wanted to give you a
  7. Visit  VivaRN profile page
    25
    I'm not Mother Theresa (now that is a laugh) but when I have a string of what the heck kinda days I like to read this quote. I don't see it as a give until you burn out thing, more that the giving is the gift and what people do with it is what they do. Sometimes it's easy to overlook the many good things we have done because the bad things stand out so much more.

    If there's even one life you saved, and that person went on to see their kids grow up, how many people can say they had a hand like that in another's destiny? ICU can be a hard place where the lows are low, but the highs are high too. Take care and don't forget to let your compassion extend to yourself.

    Alright, here's my cheesy quote:

    People are unreasonable, illogical and self-centered. Love them anyway. If you do good, people will accuse you of selfish, ulterior motives. Do good anyway. If you are successful, you will win false friends and true enemies. Succeed anyway. The good you do today will be forgotten tomorrow. Do good anyway. Honesty and frankness make you vulnerable. Be honest and frank anyway. The biggest person with the biggest ideas can be shot down by the smallest person with the smallest mind. Think big anyway. What you spend years building may be destroyed overnight. Build anyway. People really need help, but may attack if you help them. Help people anyway. Give the world the best you have and you might get kicked in the teeth. Give the world the best you've got anyway.

    -Mother Teresa
    apocatastasis, nickos, sclpn, and 22 others like this.
  8. Visit  systoly profile page
    3
    Sometimes, when all I wanna do is scream "WHY?", I remind myself that I don't have to know all the reasons (I probably wouldn't understand anyway) and I don't have to be the judge. As long as I do the right thing (and that's a big enough task for me) I'll be allright. I stopped measuring my success by how many patients get well and started rewarding myself for being faithfull to the oath, even when no one else seems to care. I cannot fix all ailments, but I can do the right thing to the best of my knowledge and available resources. You have gained tremendous skills in taking exquisite care of your patients. I believe it's time to reward yourself.
  9. Visit  wifeandmomoftwo profile page
    2
    Quote from VivaRN
    I'm not Mother Theresa (now that is a laugh) but when I have a string of what the heck kinda days I like to read this quote. I don't see it as a give until you burn out thing, more that the giving is the gift and what people do with it is what they do. Sometimes it's easy to overlook the many good things we have done because the bad things stand out so much more.

    If there's even one life you saved, and that person went on to see their kids grow up, how many people can say they had a hand like that in another's destiny? ICU can be a hard place where the lows are low, but the highs are high too. Take care and don't forget to let your compassion extend to yourself.

    Alright, here's my cheesy quote:

    People are unreasonable, illogical and self-centered. Love them anyway. If you do good, people will accuse you of selfish, ulterior motives. Do good anyway. If you are successful, you will win false friends and true enemies. Succeed anyway. The good you do today will be forgotten tomorrow. Do good anyway. Honesty and frankness make you vulnerable. Be honest and frank anyway. The biggest person with the biggest ideas can be shot down by the smallest person with the smallest mind. Think big anyway. What you spend years building may be destroyed overnight. Build anyway. People really need help, but may attack if you help them. Help people anyway. Give the world the best you have and you might get kicked in the teeth. Give the world the best you've got anyway.

    -Mother Teresa
    I don't think this is cheesy. I LOVE this. I'm no Mother Teresa either but I do love some of her quotes.
    VivaRN and Doc Lori, R.N. like this.
  10. Visit  sunny d profile page
    3
    I'm just a nursing student, so I know that means I haven't yet been exposed to the type of constant interactions with patients who choose lifestyles that just exacerbate their problems. I can imagine how easy it must be to get burned out by trying to help someone if you expect that they will learn from their mistakes.

    However, I don't think many people learn easily or quickly or maybe ever from the kind of mistakes that cause them to have health problems. The people who are so overweight that they develop type 2 diabetes, the drug addicts, the women who stay with men who physically abuse them, it doesn't surprise me that these people are repeat offenders. I also don't think these people should be considered stupid just because of their behavior, even though their behavior is stupid in that it causes them to harm themselves.

    People who have lifestyles that adversly affects their health are probably most of the people in the United States, at least, and it is just a matter of degree as to how much that lifestyle hurts that person's health. The real sickness as I see it is not the lifestyle, which I interpret as a symptom, but the reasons for that particular lifestyle.

    People who overeat, abuse drugs, or any of those other issues, are suffering, and as humans who are suffering, they are deserving of respect and a caring attitude. I'm not saying that the OP doesn't care, I'm just saying that I think it is possible to care and still not get burned out, but it seems to me that would have to involve believing that many people are not capable of changing their bad habits very easily. I think people can change, but it isn't easy, and lifestyle issues in particular may be the hardest habits to change.

    The psychological reasons why people have lifestyles that hurt them need to be considered as much as the more obvious physical wounds. I believe everyone is doing the best that they can to survive and be happy, and that isn't always easy for many people, so they self-medicate with food or drugs or alcohol, and hope society won't bash them in some more as they try to get their act together and function in the world.

    To the OP, I know you posted here to vent, and so I also believe that if you didn't care you wouldn't be feeling burnt out. I think you probably know that these people are suffering psychologicaly as well as physically. I hope you can come to find a way to nurse these people without feeling so bad yourself, and maybe that means working in a different area. I wonder how much the problems you mentioned with hospital administration and doctors are affecting your overall attitude; it must be very difficult to do your already difficult job if you don't feel valued or respected. For what it's worth, I respect you for doing the kind of job you describe, and I'm sure most patients respect you for that too, whether or not they are capable of showing it when you see them. I hope you things work out for you.
    apocatastasis, TREC96, and MInurse.st like this.
  11. Visit  AWanderingMinstral profile page
    0
    In brief, I understand the O.P.'s feelings. I think all of us do. My suggestion is to try a different specialty. Maybe a pediatric ED? You won't be rehydrating 7 y.o. drunks... Or, how about public health? Having served in the Peace Corps, I really feel that you will feel like you're making a difference when working abroad (CDC, Doctors Without Borders, WHO, etc.). Good luck and chin up!
  12. Visit  highlandlass1592 profile page
    14
    Quote from apocatastasis
    Hi all.

    I got my RN license at about this time last year, right after I started working as a GN at a downtown San Antonio ICU. It's a SICU but we see a wide variety of medical/surgical/cardiothoracic patients. We generally have very high patient acuity. Lots of drug abuse, non-compliance in the face of multiple comorbidities, repeat offenders leaving AMA and coming back a day or two later, etc.

    In some ways and on some days, I love working as an ICU nurse. I'm finally able to more or less independently care for the sickest patients that we get. Vented patients, balloon pumps, septic shock pts, CABGs, managing multiple drips, CRRT, RRTs and code blues, I do it all and the rush keeps me going.

    But although I do my best when it comes to particular patients, I feel like I generally just don't care anymore. Without even going into the issue of how hospital administration and doctors' attitudes get me WAY down... patient-wise, I see the same things day after day after day. People who don't want to learn, don't care about their health, don't care that our team snatched them from the jaws of death. And then I read about the pertussis outbreak way over there in California. And then I think about my dad, who has years of untreated HTN and refuses to see a doctor and is probably gonna end up as a STEMI on a balloon pump.

    And then I think, why do I bother? Why am I busting my ass and breaking my back for you, mister 34 year old, 800 pound, 6 cigarette pack a day CABGx5, when you're gonna go to the nearest McDonald's immediately upon discharge and eat 8 big macs? Or you, the violent, intubated 22 year old heroin overdose with seizures and anoxic brain damage, with a history of being intubated following heroin overdose and hemodialysis since the age of 15, whose insane mom is sneaking in opiates behind my back and screaming that the benzos we're giving him for sedation are killing him.

    I feel like I used to care about my patients. Sometimes I still feel like I do. No matter my attitude on any given day, the job always gets done. Some days I go home and I'm proud of my work. I said goodbye to my alert/oriented patients in the morning and wished them well, and I really meant it.

    But then there are the bad days where I go home, have a beer, put my head in my hands. And I feel like an empty human being because I don't care about people anymore, entirely dread having to go back to work tomorrow, and wonder what the point of all this crap is.

    Sorry, I just had to vent. Thanks for reading.
    I've walked your walk, still do. I totally understand. It's a difficult situation to be in, we give so much to our patients, work so hard to help them live to find it all get thrown out the window. We get emotionally involved with their families, see them at their good and worst, try our hardest to impact their lives. ECMO, IABP, dialysis, multiple pressors, working like a dog to keep them alive for one more shift, not even taking time for a bathroom break of our own. Why, what's it all for?

    I've found this helps me: it's for that one patient who, when all is said and down, actually makes it through it all and comes back and says to you "thank you for saving my life. my wife (husband, parents, etc) told me all you did for me and how hard you worked to keep me alive." that thrill you get when you see that person walk thru the door, that person the doc said would never live let alone walk again...and see all your hard work pay off. If I wasn't there, that might not have happened....that patient may not have made it. I MADE A DIFFERENCE IN ONE PERSON'S LIFE. And for those patients who won't make it, I make sure to advocate that their last time on this earth will be as comfortable as I can make it, making sure that NO ONE on MY shift will die alone...I'll find the time to stop and hold someone's hand as they pass from this life into the next. The time to tell them it's ok, I'm here for them as they leave this earth. And as they leave, knowing I did all I could for them....that is some small way I hope I've impacted their life in a good way.

    I've just learned over the years you have to take the victories where you can and stock them up...keep them in that special place in your heart you take out when it seems like nothing is going right, nothing you do matters.

    Let me share an experience that happened a few years ago: I was working in a neuro surg ICU as a travel nurse. Had a patient who was a Jehovah's witness, who ended up infarcting her spinal cord due to blood loss and the resulting low BP's. The doc was angry that the patient wouldn't accept blood and started to berate her. I pulled him off and told him he couldn't do that, she understood the risks and it was against her religious beliefs to take blood and he needed to respect that. He stormed off. I ended up spending a lot of time that night, time I didn't really have, comforting her. She was facing a life of lower extremity paralysis. She was scared, anxious..you name it. I told her to rest, I'd be with her all night and would see that she was taken care of. Well, my shift ended and I was off for a few days after that. She was discharged to a different level of care and I went on to my next patients.

    About 4 months later, I was shopping at a local mall one day when I heard someone holler "nurse! Nurse!" I turned around and there was my patient from that night. She was in a wheelchair, barreling across the food court to get to me. She said to me something I've kept in that precious place in my heart: "You made a difference in my life that night. I was scared, lonely and worried for what my life would turn out to be. And that night, you talked with me till I went to sleep. And every time I woke up, you were there...making sure I was ok. I felt truly safe with you caring for me, knowing you'd be there to see that I was fine. You helped me more than you can ever know." At this point, I was crying like a baby and she was too. This precious woman, who had been through hell on earth remembered me. And she stopped enough to share that with me. I gave her a huge hug and wished her well as she continued her recovery and literally floated out of that mall. I will never forget that woman and I came to realize that doing what I did...trying to be the best nurse I could be influenced people in ways I may never be able to measure or initially know about.

    On those dark nights, when it seems nothing can go right....I remember that patient. And find the strength to go on. Hang in there, everything you do affects your patients even if it seems like it doesn't. You may be planting the seed that will cause them to make positive changes. Hugs to you.
  13. Visit  newrn05 profile page
    2
    I can totally understand. I have been a nurse for 5 years. I work med/surg, tele, stepdown. I have seen a lot of the same issues and drama's. Had one the other night. I kept saying to my self why bother.


    Remeber this: You will make a difference to someone almost every day. You may not see the effects or be told. Your patience, understanding, caring touch will matter to someone. It might not be a patient but a family memeber or a teenager in the hallway who you didnt know was watching.

    Sometimes I have to remember the lil things to get by.
    apocatastasis and SandraCVRN like this.
  14. Visit  CareteamRN70 profile page
    6
    Still a student myself (only for 3 more months God willing), but as a tech (cna) working in a neuro/behavior unit I had more then enough experience with patients that didn't seem to want to "get with the program". Without being able to lose my ability to care and see the patient as a unique person, I was able to go on autopilot. I saw my patients still as people and treated them as such but my mind would go analytical and see them as broken machines..I could still offer care but shield myself from the worst of the sights, sounds, smells by doing this. I have been told by instructors this is a uniquely male ability to deal with the stressors of patient care and that it can be good or bad depending on how much I let the patient slip from my view as a unique individual.
    "My" other probloem I joke about is I am trying to get comfortable with patient education when i really am probably the last person to do so on some subjects...I am overweight...I have no idea what happened to that 180 lb marine I was back in the day...I think I have a parasitic twin that grew and added another 90 lbs. I still smoke, but am down to half a pack a day. The only areas I feel comfortable with are substance abuse (aside from smokes) becuase i don't really drink or do narcotics. I feel guilty about my weight at times and now see losing it just isnt for my own health but to set some example for those I educate (Hard to tell a patient to cut down on the fatty foods when it looks like Ive been breast fed by a pork chop).


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