Are some people not meant for acute care?

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Hi all, I recently switched from acute care after 5 years to outpatient PACU. It's less stressful although I am nervous giving so many narcotics. It's a bit routine and I don't get to do IVs (only remove), draw blood, foleys, IV pumps, wounds, etc. I emailed my former manager about coming back per diem. So far I haven't heard back but I heard she's out on family leave. All the patients, nurses, and doctors I worked with complimented me on how I did my job, as did my boss, but my boss and close friends commented that the job seemed to stress me out too easily.

I never freaked out in front of patients, but sometimes in break room or nurse's station I would talk about being overwhelmed, wanting to cry, wanting to quit... I know, not professional. Maybe to do with bipolar disorder and anxiety. But it never affected my job performance, just my own mental health. For this reason I'm not sure if my boss will take me back and if I should apply per diem at another hospital (lots of hospitals hiring.) I still have bad dreams about my hospital days... last night about a time a patient needed a second IV for antibiotics because other IV used for bicarb drip. My floor was so understaffed, no one free to help. I tried to help but missed 3 times, pt's nurse couldn't do it and we had to pause the bicarb for 30 mins =( This was 4 years ago. Why does it still come into my mind?? Are these dreams and my coworkers' feedback a sign I shouldn't ever do acute care again? They all want me to come back. Does anyone think they personally aren't mentally fit for acute care? Not as in can't do the job, just that it affects you too negatively? Thanks

SilverBells, BSN

1,021 Posts

Specializes in Rehab/Nurse Manager. Has 8 years experience.

From what it sounds like, your performance was up to standards in the past if you were getting compliments on your job before.  It also seems as if maybe your current position isn't as fulfilling or interesting as you would like? If that's the case, maybe you do want to consider PRN if they would allow you to and if coworkers are interested in having you come back.  I also think that it's not that uncommon for us to remember the moments we were most stressed out or we didn't do the best we would have liked. 

With that said, I do think that acute care can be too much for some people.  I know that for myself, I found hospital clinicals during nursing school to be stressful, so I've mostly avoided those types of positions during my career.  I also wonder if PRN is the right option if you find acute care stressful and aren't doing it on a daily basis? I think I would actually find PRN more stressful than full or even part time because I wouldn't be used to doing those types of skills on a daily basis.  For me, I become stressed out when asked to perform a skill I haven't done in a while.  You may be different, though, so I would think about what stresses you out about acute care before going back. 

Good luck whichever you decide to do! ?

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 10 years experience.
47 minutes ago, SilverBells said:

From what it sounds like, your performance was up to standards in the past if you were getting compliments on your job before.  It also seems as if maybe your current position isn't as fulfilling or interesting as you would like? If that's the case, maybe you do want to consider PRN if they would allow you to and if coworkers are interested in having you come back.  I also think that it's not that uncommon for us to remember the moments we were most stressed out or we didn't do the best we would have liked. 

With that said, I do think that acute care can be too much for some people.  I know that for myself, I found hospital clinicals during nursing school to be stressful, so I've mostly avoided those types of positions during my career.  I also wonder if PRN is the right option if you find acute care stressful and aren't doing it on a daily basis? I think I would actually find PRN more stressful than full or even part time because I wouldn't be used to doing those types of skills on a daily basis.  For me, I become stressed out when asked to perform a skill I haven't done in a while.  You may be different, though, so I would think about what stresses you out about acute care before going back. 

Good luck whichever you decide to do! ?

That's true! Right now I work almost exclusively PACU and I'm terrified when I have to go to pre-op once in forever and do EKGs and IVs. Luckily most outpatient patient IVs aren't as hard as the hospital, and if looks to hard call anesthesia! I hope my foundation will still be there when the time comes. And that I don't put the EKG leads in the wrong place and make it looks like pt has a STEMI LOL. I agree maybe doing skills only PRN will be even more anxiety provoking.

I wanted to do mostly pre-op due to the hours and keeping up some skills and not giving meds, but turns out I'm PACU. Like you I will stick with what I have for now, be grateful for a job, not complain, and keep an eye out for the "perfect" job. It takes experience to know what we really want to do. Outpatient surgery is busy but I never feel like I can't breathe like I did at the hospital. Thanks for your advice! 

TheMoonisMyLantern, ADN, LPN, RN

1 Article; 922 Posts

Specializes in Mental health, substance abuse, geriatrics, PCU. Has 16 years experience.

No doubt you were competent as a nurse in acute care, but there is a lot more to nursing than what goes on in the hospital. The experience you got in acute care will serve you well wherever you go, but if the stress was burdensome to you and you still have nightmares about it, why go back per diem? Is it that you miss the hospital or is it that nursing has an unofficial hierarchy where nurses in the hospital are at the top? So what if you're not putting in IV's and foleys all the time, there's a lot more to nursing than that.

Before you go back per diem really reflect on whether the stress you experienced is worth it. 

Jedrnurse, BSN, RN

2,776 Posts

Specializes in school nurse. Has 31 years experience.

Your title sums it up.

Not everyone is built to do everything and that includes acute care nursing. The field is wide enough that most people can find their niche, and it's often not the area they started in...

JBMmom, MSN, NP

4 Articles; 2,350 Posts

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 11 years experience.

The beauty about nursing is that there are so many environments and all of them need competent nurses in order to run. Patients in every area of care rely upon the nurses and there's no reason that all nurses have to want to work in acute care. I think almost everyone is capable of working in acute care but capable isn't all you want. You want a nurse that finds the environment to be the right fit and that's encompasses the patient population, the job responsibilities and the flow of the work. Nothing wrong with deciding that acute care isn't for you!

Has 11 years experience.

It may very well be your bipolar anxiety, and if it is.....it is what it is. Unless you are going to medicate it down (which often sucks) you have to learn to work through it or around it. I would NOT leave PACU but you could do PRN on the floor, however it probably would increase anxiety. Think about why you are going back. Is it just because your friends want you to? 

Sometimes you just keep on going with the "grass is greener" logic. Which it usually is not. 

You are sort of selling me on PACU. I hate IV's! LOL 

Has 11 years experience.

I swear working the floor gives you some weird case of PTSD and codependency. LOL. Every time you leave you want to go back. Or think you want to. No matter how miserable you were when you left. It's like having kids, I swear. You have that second and third one totally forgetting what the first one was like. Selective amnesia. ? 

If you really are not meant for acute care you will make this mistake a handful of times before you finally convince yourself NOT TO GO BACK. 

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 10 years experience.
On 2/5/2021 at 6:01 AM, Curious1alwys said:

It may very well be your bipolar anxiety, and if it is.....it is what it is. Unless you are going to medicate it down (which often sucks) you have to learn to work through it or around it. I would NOT leave PACU but you could do PRN on the floor, however it probably would increase anxiety. Think about why you are going back. Is it just because your friends want you to? 

Sometimes you just keep on going with the "grass is greener" logic. Which it usually is not. 

You are sort of selling me on PACU. I hate IV's! LOL 

LOL PACU is pretty great! When you do a whole day of recovering endoscopy/colonoscopy patients it's a little boring/routine, but luckily other days I get to do ortho, urology, OB/GYN, etc. If you apply for PACU I would ask what type of surgeries they do, if you would float between pre-op and PACU. Some days are busy trying to get people in and out to have enough beds, but overall so much less stress than the floor! Give it a shot! 

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 10 years experience.
On 2/5/2021 at 6:04 AM, Curious1alwys said:

I swear working the floor gives you some weird case of PTSD and codependency. LOL. Every time you leave you want to go back. Or think you want to. No matter how miserable you were when you left. It's like having kids, I swear. You have that second and third one totally forgetting what the first one was like. Selective amnesia. ? 

If you really are not meant for acute care you will make this mistake a handful of times before you finally convince yourself NOT TO GO BACK. 

Yes! This is exactly what I'm experiencing. I think it's because the floor is so extreme. Some days it's amazing! You catch something early that could have been fatal, take care of wonderful people, see people progress and finally go home, see strength, resiliency and experience gratitude from patients, and feel grateful to have met them/cared for them. You help people in their most vulnerable times. Have a day when you're so on top of it, time management is great, all your skills are sharp. Even help people have a peaceful death and comfort their families.

But other days are SO horrible. Overwhelmed, behind, getting yelled at and attacked, patients out of control, afraid they'll fall, short staffed, not enough Ativan in the world to control your etoh patients, sad stories, traumatic deaths, making mistakes, feel like you missed things, ANXIETY. For me there was no real middle ground. I think we miss the intensity and the feeling of doing good, but when we go back we remember the horrible parts. An unhealthy relationship LOL

SmilingBluEyes

20,964 Posts

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 26 years experience.

You are right; not everyone is suited to acute care. Fortunately for all of us, nursing has a lot more to offer. Don't kick yourself, just move on and find what makes you happier.

Hang in there.

Specializes in Critical Care.
On 2/1/2021 at 3:49 PM, LibraNurse27 said:

 

I never freaked out in front of patients, but sometimes in break room or nurse's station I would talk about being overwhelmed, wanting to cry, wanting to quit... I know, not professional. Maybe to do with bipolar disorder and anxiety. But it never affected my job performance, just my own mental health. For this reason I'm not sure if my boss will take me back and if I should apply per diem at another hospital (lots of hospitals hiring.) I still have bad dreams about my hospital days... last night about a time a patient needed a second IV for antibiotics because other IV used for bicarb drip. My floor was so understaffed, no one free to help. I tried to help but missed 3 times, pt's nurse couldn't do it and we had to pause the bicarb for 30 mins =( This was 4 years ago. Why does it still come into my mind?? Are these dreams and my coworkers' feedback a sign I shouldn't ever do acute care again? They all want me to come back. Does anyone think they personally aren't mentally fit for acute care? Not as in can't do the job, just that it affects you too negatively? Thanks

I would advise you to stay where you are for now and not go back to acute care.   You may feel bored now by the routine and lack of stress, but I would argue that is better for both your mental and physical health than being stressed out and overwhelmed. 

I would say the majority of nurses in acute care are stressed out from the poor working conditions and deliberate understaffing that has been going on for years!  Many may deny it because they can't admit they don't like nursing or feel it is a sign of weakness.  Many are so emotionally invested in being a nurse they will proclaim how much they love it even though they will admit they are stressed, anxious, can't get a break or lunch. 

Your emotional outbursts and nightmares from lack of resources mirrors my struggles, especially the last year.  I lived with nightmares and felt dread 24 hours before my next shift started!  I had similar situations where patients were left without IV access for the night as admin got rid of the IV team to save money.  I totally understand that fear of what will I do if a patient needs an IV and I can't get it.  Looking back, it really pisses me off because it was not my fault, nor was it yours.  It was the fault of greedy mgmt that refused to provide adequate resources!

I finally put myself first, listened to my mind and body and quit.  I should have done it sooner.  There is no way in hell I would ever go back!  The nightmares have stopped, and I feel so much better.  The stress is gone and no amount of money would get me to go back.  It is like heaven not being subjected to endless alarms.  That is the best thing, but even now the sound of the phone really gets to me.

I implore you to listen to your body and put yourself first.  More research is coming out about how harmful stress is to one's health.  I felt if I didn't quit, the job would kill me thru a stroke.