Burn Out!! **Long**

[nursenotamaid]

Most people face burn out at least once in the course of their career and it's killing me now!

I've been working ICU for about a decade now and I am turning into a crispy critter. I travel nursed for a while, I changed ICU specialties and have now done Burn ICU, CCU, CTICU, Trauma ICU, Neuro ICU, Transplant ICU, SICU and MICU. I've changed hospitals and cities, I've always made sure to work in large, university teaching settings so there are new therapies, new residents rotating through... but after a while it seems like its always the same sh**, different day.

The ICU I work in now I ended up signing onto after being there as a traveler because the unit really focused in on patient care without the fluffy stuff that gets under my skin... You did what you needed to do for the patient, they had limited visitation hours that made me feel like I could do my work, they didn't mind that I had some tattoos as long as I worked hard and was a good nurse, they supported the nurses with plenty of help and great staffing. There were no uniforms or stepford wife scripting that so many other hospitals have all implemented that really cook my goose.

Then, after being there for 6 months, they got a new CEO and a new unit manager. They have cut down the staffing and now we are always running short, they changed the tattoo policy and the uniforms - but their uniforms are such that my tattoos show *through* the uniforms -- so I have to work 3 layers of shirts just to be at work, so I'm constantly overheating. They did away with our visitation policy and now families run the ICU. If they complain about anything - we have to give them gift cards. "Do anything you can to make them leave happy!" -- regardless of if what we are doing is right, safe for the patient or an important part of being able to do our jobs. The politics are off the hook, with promotions going to friends of friends and demotions based off of personality conflicts... The hospital has now made it mandatory to speak to our patients about "room service" that we offer in the ICU (ie - nursing and dietary staff) and have even dictated how we must stand and posture ourselves when interacting with patients and families. They even have managers and administrators doing 'sneak-attacks' on the unit to monitor us and see who is not following the script, the speech, who might be wearing the right color uniform, but not in the right cut... Surprise phone-calls to your ICU bedside to see how you are speaking.... AGRHRRHRHR

The reality is - this stuff seems to happen just about anywhere. I'm not really sure that leaving the unit is going to make a difference because it really does seem like this is just the new trend of hospitals - the Hilton Hotel model of care. I love taking care of my patients, and I'm GOOD at it - I'm a great ICU nurse and I have a lot of experience that I can bring to the table, but that doesn't matter anymore to hospitals. I LOVE my coworkers, I hate the system.

What do I do!? I'm already finishing my BSN (done in 4 months) so I can go onto grad school.... Do I try to change specialties?? and to WHAT? I'd even be willing to pick up a per diem job somewhere if the full-time job I changed to didn't pay as well as much current job...

I need ideas, suggestions - whatever - what did you guys do when you got so burned out, you drive home in tears? That you dread going to work?

[gcupid]

Well I guess I experienced burn out at 6 months.... Is that even possible?

[Dixielee, BSN, RN]

When I got burned out in ICU, I went into home health. It was new to me, and I ended up doing it for 5 years. I loved the independence, the appreciative patients, and the autonomy (although the paperwork was awful). Nursing offers so many options! It sounds like your hospital admin has gone off the deep end, and it may be time to move on! Good luck, you may just need a change of scenery!

I had always done ED as a second or primary job as well, so it was easy to get back into hospital nursing when I was ready. The quick turnover of patients and the constant change keeps ED fresh, even though I sometimes want to scream!! That is the nature of any job though!!

[BostonTerrierLover, BSN, RN]

:yawn:ICU, Try a dose of ER, it changed my life. I always thought I would be a Unit Nurse too, but ER got into my bloodstream, and just might be the "shot in the arm" you need.

Never be afraid to try something new, I was BORED TO DEATH on the units, and thought I had come alive in ER. Judge for yourself! You have nothing to lose.

:redbeatheBoston

[NO50FRANNY]

I'm with Boston. I work with quite a few ICU nurses who described exactly how you are feeling now prior to coming to ED. They are an amazing asset to the department, we love them and they LOVE ED. I don't think you would find too many airs and graces being monitored by the higher ups in ED, the environment is too chaotic. We "don't have time for that crap" if you will, no Hilton standards that's for sure. I know our ICU nurses really enjoy the imperfection/craziness and tell me they find the nursing politics far less punitive. I worked in haematology and bone marrow transplant for almost 10 years and was burnt out after five. I found myself too attached to my patients, but after so long it was so easy. I was on autopilot and it felt nice to be the person who was the most experienced, knowledgeable or senior but had always wanted to work in Emergency and took the leap.

I have honestly never looked back and wish I had the guts to make the change sooner. I love the autonomy, respect from doctors and teamwork I've never experienced in any other area. I work with heroes and I love them all (even the ones that annoy me). I love the immediate effect we have on our patients, the brain game of diagnosis and the diversity. I have never ever heard any nurse in emergency say "same s, different day" because it never is! Tonight, in 15 minutes we had an imminent delivery, CPR in progress, GCS 10 with blown pupil and high mechanism MVA all at once- everyone just pulls together. I know facilities differ though and great unit culture has to start with upper management, if they are good, it usually filters down. Don't get me wrong, suckful days are common but I can truly say, I love my job. Just for the record, dreads and tattoos are encouraged

[HouTx, BSN, MSN, EdD]

I agree, Home Care may be a good option for the OP... I know several ICU nurses who made the switch and love it.

The OP is right... this 'customer service' movement is here to stay because reimbursement is affected by the providers' HCAHPS score. Higher customer satisfaction = more reimbursement & lower satisfaction = cuts in reimbursement. I think the Feds (as usual) are off their rockers on this. There is already a small but growing amount of evidence that there really isn't any positive correlation between satisfaction & quality... in fact, in some instances, striving for higher satisfaction will drive down quality outcomes. But for now, it is the flavor of the month (decade?) and we all have to live with it.

As an member of the 'ICU Tribe' myself, I know how frustrating it is to have to work around families at the bedside. But there is quite a bit of nursing research that indicates this is a beneficial practice - for patients, families and nurses. Families tend to visit less often because they know that they can come in any time and stay as long as they want. Patients' anxiety is lessened with loved ones' in close proximity. It provides the nurse an opportunity to do in-depth teaching with the family so that they have a more accurate understanding of what is happening - which in turn helps guide them to better decisions. For instance, if they actually see how much physical labor is involved to get granny into the chair, they will probably be more open to realistic discharge planning preparations. Some studies have even found that family members who witnessed resuscitation efforts were more accepting of negative outcomes. So it's probably best just to steer into this particular skid and use it to our advantage.

[Anna Flaxis, BSN, RN]

I got out of the hospital altogether, into an on-call position. I love it. It would be perfect for the person continuing their education!

[mlykateRN]

OMG!!!!! When I read your post, I thought I was talking! I said the exact same words for about two years before I decided that I was an ICU nurse and not a hand maid to family! I finally got so fed up with the uniforms, pillows, drinks, meal cards, scripting, making the family happy and who cares about the patient atmosphere that I had to get OUT!!!!! I applied for jobs everywhere.....for anyting but ICU nursing! (For those new grads out there, its no easier to find a job with 10+ years experience....keep on trying!) I finally found a job working at a really great hospital for a cardiology practice. I am doing nuclear stresses and it is great!!!!!!!! I still get to use my skills if I need them and my ICU knowledge base has really helped me excell at this job!!!

SO.....maybe my advice is not the best but, I say get out!!!!! Find something you love to do! If the job you find eventually doesn't challenge you enough, the ICU will still be there with out a doubt!

[xoemmylouox, ASN, RN]

So much of healthcare anymore is patient satisfaction. It dictates everything we do anymore... Now if only management could understand that you need staff to do all of those things to make patients happy..

[dirtyhippiegirl, BSN, RN]

What about flight/transport nursing? Pros: Sick or really sick patients, pretty much no contact with the public, little in-house bickering.

cons: It's dangerous. (You want to do fixed wing or ambulance - and I'm a pilot, myself.) Shifts aren't regular. Pretty hard to get a job in this area.