Burnt out and struggling emotionally

  1. As I have mentioned, I do hospice and palliative care. It's been a year. I'm completely burnt emotionally. Hospice I handle much better than palliative care. Palliative care is quite draining as I have most patients who have no resources, are somewhat poor, and mostly dying but trying to live. They depend on me so much. And there is only so much I can do. They call me personally, want me to pretty much make their life or death decisions.....

    It's too much for me. It keeps me up at night worrying about them. I worry I will let them down. And I really don't have a support system. I'm a divorced mother just trying to muddle along. No family except my dad who is wonderful, but it really upsets him to hear I am struggling or to hear about dying people so I don't talk to him. I come home to my 5 year old throw myself into everything but my brain just wants to shut down and my daughter is rather demanding and it's like my emotions don't rest. When she goes to bed I do some chores, and try to unwind. Sometimes I just wish there was someone to take care of me and tell me everything is going to alright and rub my head or something.

    The was basically a pathetic vent. I know, I should be lucky I'm. Of dying of cancer like these people, which I am grateful for, but my brain and heart hurt these days.

    I have went on antidepressants since taking this job and I do kickboxing to let it all out. It's a nice hour where I really just clear my find almost fully. ( almost).

    My patients and families for some reason trust me humongously and it's quite a burden to bear sometimes.

    Thanks for listening whoever got to the end of this
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    About MomRN0913

    Joined: Dec '10; Posts: 1,195; Likes: 1,982
    Specialty: ICU


  3. by   lovinlife11
    Oh mom... I feel your pain, I really do. There is a lot of burnout in hospice for the reasons you described above, there is a lot of "stuff" we deal with. I have been a hospice nurse for 3 years, per diem and triage so I don't have the case management stress. I know the hospice organization I work for has their own support staff to talk with employees who are in your position, is this an option? Maybe talk to a chaplain or another coworker, sometimes it help just to bounce it off another adult who understands our challenges. I wish I had more advice for you, take care of yourself
  4. by   leslie :-D
    i think most of us can relate to what you're feeling.
    while it is much easier said than done, it is ALL about boundaries.
    believe me, i know how easy it is to get emotionally involved, but as you can see, it does burn you out.

    what do you mean they call you "personally"?
    do they call you at home?
    are you continually offering yourself/your services to them, even when they don't ask?
    if so, stop.
    i'm not saying to put up a thick, impervious wall...
    but you do have to find a place somewhere in the middle...
    where your sensitivity will enhance their care but won't eat at you after hours.

    kickboxing is good.
    and so is surrendering all of it to God/universe, when you leave.
    it'll take practice but if you focus on letting it go, it will clear your head and put you in a more peaceful place.

    vent here anytime, as we do understand.

  5. by   MomRN0913
    Thanks so much for the support. I am so completely drained. And at ropes end. Then I find out today they are increasing productivity as of next week. I can't even keep up wih what I have now and work before and after work on the weekends.

    They decided we have more palliative care than hospice and that's equal to home care so we need to be even with them.

    My palliatives are sooooo draining. Constantly with issues because they are on death's door but are still seeking treatment. So many calls, family meetings, issues, doctors not wanting to great them anymore....

    And now they want me to do more. After they tried to get me to stop leaving saying things would get better when they hired more people. We new people started this week and now they are increasing productivity.

    It's a joke. I went to the bathroom and cried at work. I'm crying now.

    I've sacrificed my home life for this job. I can't anymore.

    I love my patients, but they are very draining. They manage to get a hold of my cell when I call them with infor or to make a visit if they don't accept blocked numbers. The office fields some calls and when I am hands deep with a patient, they are texting me with all the issues my patients are calling In a out and I can't handle it in the middle of a visit. It's ridic. I get paid crap and give my heart and soul.

    I'm really trying to learn to set boundaries without compromising patient care because I have no front end support.

    I'm falling apart and want my life back

    Thanks for listening, I really appreciate. I have no one around me who can relate.
  6. by   Spidey's mom
    I'm so sorry you are struggling. It sounds like you need some help. As another poster mentioned, does your employer have an HR dept? Could you talk with the hospice chaplain?

    We don't take calls from the patients. They have to call a number and ask for the hospice nurse on call. It is true that sometimes they get our cell numbers when we have to call while on the road but you have to be consistent and remind them to call the correct way. We don't have a triage nurse per se . . . it is the nurse on call who handles the calls and then goes out to the homes if needed. Of course our census is never over 12.

    There have to be boundaries. Consistently.

    Stand up for yourself in regards to increasing the workload. Don't take any . . . baloney . . from your manager.

  7. by   sunflower918
    I only have my own experience with family members and palliative care/hospice to go on but know that you have prayers/positive thoughts coming your way. It's incredibly difficult to be a caregiver.
    Take care of yourself in whatever way that you can; I feel for you ((((hugs)))). Things will get better!
  8. by   CJ9330
    Bless your heart... I can certainly relate to it all being too overwhelming... & to the tears. I have been a hospice CM for a little over a year now; did oncall for a year prior to that. I can't take your pain nor your exhaution away, I can only share a few things that I try to do to minimize my stress level.
    1) I totally agree with Spidey's mom - set boundries. Each & every time they call your cell, tell them that they must call the office number. If I'm at home - I do not answer those phone calls; I have even let it go to voicemail, then call the oncall nurse & ask them to call the patient back. I love my patients dearly, I am not being cold hearted - but I must also take care of myself if I am going to continue doing this job that I love.
    2) If my patients ask me questions concerning resources, etc. - I tell them I'm very sorry, but that is not my area of expertise & that I will have a social worker, chaplain, etc. call them. It takes at least a little pressure off of me by not having to play all roles.
    3) When I sense that a patient/family is wanting me to help them make a decision, I look them in the eye & tell them, gently/kindly/tenderly that these are decisions only they can make; I can give them all the info, but they need to take time to consider it after I leave & make the best decision they can for themselves.
    4) Just lately I am learning that after I leave a particularly difficult situation, I will pull over in a parking lot somewhere & take just a few minutes to say a little prayer, & then ask myself if I am taking on roles that are not mine, if I am feeling unjustified guilt, and if I am attempting to relieve a type of suffering that I am incapable of doing. I remind myself to lay that problem in God's/Universes hands & listen to some soothing music on the way to the next home. I also do this in between back-to-back phone calls. It helps... it really does.
    5) In the evenings, if I have not 'let go' of a specific situation from that day, I have a notebook that I write about it in; usually after writing a few minutes, the truth of the situation - and my part in it, will come to me. It helps me 'let go'.
    6) And occasionally.... I'll go to our really awesome Chaplain's office, have a short meltdown, tell her 'thank you!' & then go wash my face & go on to the next visit!
    7) My lunch time - even if it's only 30 minutes or so, is spent away from work with a comforting book; right now I'm reading the Jan Karon, Mitford series.
    AND - Please, please, please don't forget to remember that we cannot relieve all suffering of all patients/families.... but the services we provide are relieving a whole lot of suffering, from a whole lot of people.
    Keep sharing with other hospice nurses.... we understand, we really do! This is a really tough job we have chosen, find ways to take care of you!
  9. by   DavidKarl
    Is this 'palliative' care more aptly what would be 'hospice' care, if the patients qualified for Medicare or another program that paid for hospice, but don't, so therefore are on Medicaid, or etc? If yes, I can imagine the nightmare caseload you have, since every state is broke. Wonder what'll happen next year with Obamacare, in your line of work?
  10. by   RNnbakes
    I second the post on setting boundaries.
  11. by   anotherone
    Have only worked in inpatient med surg but what helped me when I was feeling awfully drained and burnt out was decreasing ot .We get comfort measure pts only and they/their families can be very draining/emotionally and physically needy. Not that I don't understand nut it drains on the giver too! so i can only imagine what someone who does this exclusively full time goes through! Now, if pts were calling me at home that would definitely make me or anyone else burnt out!!! You are essentially never free from your job! Do you have any interest in another type of nursing job? It is so annoying and draining to have your off time consumed with thoughts of work, coworkers and pts.Then on my off time I go on a nursing message board, watch The Doctors or NY ER!
  12. by   elprup
    Hugs..everything will be alright.
  13. by   WunMsJayLPNtoRN
    And somehow, this turned political...^^^^^^

    OP, you have been given some great advice. Prayer, setting boundaries, seeking counsel, or (if all else fails) finding a new field. I hope you soon find peace in both your work and home life, or at the very least some effective coping mechanisms. You are in my prayers.
  14. by   MomRN0913
    Grammy, that was great advice. And compassion. And that notebook idea is great. Because I am sick of waking up at 4am with something left over bothering me, whether it be about an order I received or a patients condition......

    I am not religious which probably doesn't help me in this field......although I find myself praying a lot these days. The chaplain I work with is nice, but ummmm, but not someone I would confidein. I confide in the MSW's. it's just too much. Not only havei been emotionally trapped the thought of more paperwork and visits is making it worse.

    I was an ICU nurse for 5 years. Then I went out of bedside because as a single mother with not much help, I couldn't do shift work anymore. My ex took her some days but neither of us could do anything about the early mornings or late nights. I eventually came back after taking some jobs that weren't for me to do hospice. However, I do mostly palliative home are which I didn't want to do, I was told it would be only a little palliative. Well, it's mostly palliative and I get the worst of the worst cases, unfortunately.

    I took a big pay cut for a work life balance. I have all work and no life now and now they want me to more work.

    I am waiting on a position for way too long for a work from home job. I am just waiting for them to start rehiring for almost 4 months now. I'm feeling hopeless. I would go back to the hospital but now my daughter is in kindergarten and there is no one to get her to and from school.

    This stinks. I love what I do but not full time. Per diem I could handle. Not case managing, just making visits.

    I'm sad my work/ life plan went down the drain. When we had our daughter I was going to work 2 nights a week in the ICU per diem. Brought in good money, was there for our daughter, had his health insurance. Did it for a few months then he decided to leave me for his affair partner when our daughter was 6 months old, so there went those plans!

    It is what it is. But I've spent 5 years trying to balance a nursing career with single motherhood of a young child and can't seem to figure it out.