Burned Out or Just The Way It Is?

[StillSearchingRN]

I've been in the nursing field for 4.5 years now, though I find it hard to believe I've made it that long at times. With every nursing job I've had so far, I seem to come across this brick wall that I smack right into and can't seem to get around.

I always start off really enthusiastic, a champion for the cause, Super-Nurse-Meets-Best-Customer-Service-Rep, happy to put in as many hours as needed (within reason, I've never been a total overtime champion, but an hour here or there is fine), and really believing in what I do.

But, over time, in whatever job I've been in (I've always worked in either LTC or Primary Care because I don't want to do floor nursing), the "human condition" (for lack of a better term) wears me down. I get to the point where I start asking myself "Besides the fact that this is the only local industry that pays a living wage, what's the point [of getting putting up with abusive patients, the physical/emotional wear-and-tear on the body, the liability in this lawsuit-happy country, etc]?" and feeling that "No matter what I do/say/how I educate the patient/how much time I invest in the patient, I'm not going to make one iota of difference because it took them YEARS to dig themselves into the hole they've found themselves in".

In turn, other than the regular paycheck, I find that I have very little motivation to keep turning days into weeks, weeks into months at whatever nursing job I'm at. Unfortunately, that has led to some job-hopping, which I'm not proud of (which is another reason why I'm reaching out in an attempt to better understand why I keep reaching this point). Unfortunately, I'm starting to reach this point sooner and sooner with each job. This time, I'm a little more committed because it's a SUPER work environment (for the most part), professional culture (for the most part), great manager, the pay can't be beat in the area, and a much better place to work at than I've come across since entering nursing. However, I'm still struggling.

Thank you for any and all commiseration and/or advice you can offer!

[FolksBtrippin, BSN, RN]

Nursing is a tough field with plenty of jobs and plenty of them are awful. Job hopping in nursing is common for this reason and is not necessarily a personality flaw.

It sounds like you like your current job.

So what's the problem with this one?

Is there something wrong at work or are you ok for now?

If you're good for now, coast it out, don't analyze or criticize yourself for needing to job hop in the past, and enjoy your good fortune.

If not, let's talk about what is wrong.

[StillSearchingRN]

I guess I just struggle with the feeling of futility at times and then also feeling like a heel for, essentially, mentally triaging complicated patients.

For example, being tasked with trying to help the illiterate, quasi-homeless (couch surfing or living out of motel rooms), multiple comorbidity, COPD-but-still-smoking, alcoholic, no-support-system patient that we're tasked with trying to help as an outpatient. The doctors hand them to us nurses and say "help them" after spending their 15 minutes in the room, writing a bunch of scripts that they know the patient can't afford to fill, and happily billing the patient's insurance before going on their merry way.

It's difficult to determine how much said patient just doesn't want to hear what you have to say (after all, no one forced that first drink down their throats, shoved a cigarette in their mouths and forced them to inhale, etc...they made that choice), how much the patient just doesn't understand what you have to say despite your best efforts (due to the effects of their lifestyle, lack of education, and the effects of their multiple health issues on their brain), or how much (and this is what really kills me) they really do want to change but they are SO far down that rabbit hole of health- and self-destruction that they will never be able to climb out.

Now, I can spend my entire DAY x several days trying to help this ONE patient who has had years accumulating all of these issues (mostly self-inflicted) that one person (i.e. ME) is now expected to fix...OR I can help 20+ patients successfully transition from hospital to home, getting them the services that THEY need to return to their previous lives after an acute illness/injury, work with hospice to ensure a comfortable passing for our mutual dying patient, teach the newly-diagnosed diabetic in-office how to care for themselves in the wake of this new diagnosis, and complete multiple follow up phone calls on some of my other patients to make sure that they're still treading water or, even better, improving/thriving in the wake of their chronic illnesses.

I eventually do it all because, well, it's my job, but I can't help feel resentment that others, who may have needed me more, got less of my time or had to wait because of this one case that no one is ever going to REALLY be able to help. And then I feel guilty over feeling that resentment. And, of course, you can't vent at work because all it takes is one bleeding heart who ONLY sees that ONE patient and not your entire workload and then calls you heartless.

[FolksBtrippin, BSN, RN]

On 8/4/2019 at 8:43 PM, StillSearchingRN said:

I guess I just struggle with the feeling of futility at times and then also feeling like a heel for, essentially, mentally triaging complicated patients.

For example, being tasked with trying to help the illiterate, quasi-homeless (couch surfing or living out of motel rooms), multiple comorbidity, COPD-but-still-smoking, alcoholic, no-support-system patient that we're tasked with trying to help as an outpatient. The doctors hand them to us nurses and say "help them" after spending their 15 minutes in the room, writing a bunch of scripts that they know the patient can't afford to fill, and happily billing the patient's insurance before going on their merry way.

It's difficult to determine how much said patient just doesn't want to hear what you have to say (after all, no one forced that first drink down their throats, shoved a cigarette in their mouths and forced them to inhale, etc...they made that choice), how much the patient just doesn't understand what you have to say despite your best efforts (due to the effects of their lifestyle, lack of education, and the effects of their multiple health issues on their brain), or how much (and this is what really kills me) they really do want to change but they are SO far down that rabbit hole of health- and self-destruction that they will never be able to climb out.

Now, I can spend my entire DAY x several days trying to help this ONE patient who has had years accumulating all of these issues (mostly self-inflicted) that one person (i.e. ME) is now expected to fix...OR I can help 20+ patients successfully transition from hospital to home, getting them the services that THEY need to return to their previous lives after an acute illness/injury, work with hospice to ensure a comfortable passing for our mutual dying patient, teach the newly-diagnosed diabetic in-office how to care for themselves in the wake of this new diagnosis, and complete multiple follow up phone calls on some of my other patients to make sure that they're still treading water or, even better, improving/thriving in the wake of their chronic illnesses.

I eventually do it all because, well, it's my job, but I can't help feel resentment that others, who may have needed me more, got less of my time or had to wait because of this one case that no one is ever going to REALLY be able to help. And then I feel guilty over feeling that resentment. And, of course, you can't vent at work because all it takes is one bleeding heart who ONLY sees that ONE patient and not your entire workload and then calls you heartless.

Okay, I see.

You get frustrated by the self destructive types, and that's understandable. These folks are not responding to your interventions. It sounds like you are good at and enjoy educating your patients, but these folks have significant barriers to education. You feel like they need more than you can give them and they eat up your time and energy for naught.

I think you're right. These are my patients. I work on an ACT team and we exclusively deal with people like this who have failed at many other less intense forms of treatment. We do help them. But we go out to their homes, transport them to appointments and social services and do all kinds of stuff that you can't do as a clinic nurse.

You don't need to quit, you just need to learn how to handle these patients, and how you handle them is to refer them to a service that can help them.

Most of them will need some type of case management. There are different ways of getting case management for your patient that will depend on what the main problem is.

For mental health issues, find out what your local community treatment agencies are for mental health and call to make a referral.

For heroin I would start with a methadone clinic. If a person admits they are using to you, they are close enough to wanting to stop that a referral is worthwhile.

Under ACA, hospitals are required to create community based programs for chronic illnesses such as diabetes, heart failure and COPD. If you can't find good resources through the hospital, call the insurance company and ask for case management through them. If your patient has been hospitalized many times they often qualify for case management through the insurance company.

[StillSearchingRN]

On 8/5/2019 at 5:50 AM, FolksBtrippin said:

Okay, I see.

You get frustrated by the self destructive types, and that's understandable. These folks are not responding to your interventions. It sounds like you are good at and enjoy educating your patients, but these folks have significant barriers to education. You feel like they need more than you can give them and they eat up your time and energy for naught.

I think you're right. These are my patients. I work on an ACT team and we exclusively deal with people like this who have failed at many other less intense forms of treatment. We do help them. But we go out to their homes, transport them to appointments and social services and do all kinds of stuff that you can't do as a clinic nurse.

You don't need to quit, you just need to learn how to handle these patients, and how you handle them is to refer them to a service that can help them.

Most of them will need some type of case management. There are different ways of getting case management for your patient that will depend on what the main problem is.

For mental health issues, find out what your local community treatment agencies are for mental health and call to make a referral.

For heroin I would start with a methadone clinic. If a person admits they are using to you, they are close enough to wanting to stop that a referral is worthwhile.

Under ACA, hospitals are required to create community based programs for chronic illnesses such as diabetes, heart failure and COPD. If you can't find good resources through the hospital, call the insurance company and ask for case management through them. If your patient has been hospitalized many times they often qualify for case management through the insurance company.

Thank you for the helpful suggestions. I'm definitely leaning toward using the insurance's case managers as a helpful tool! Unfortunately, we're in a very rural, socioeconomically-depressed area if you're not a tourist (as in good luck if you don't have your own car or know someone who can reliably drive you around because there is VERY limited public transit and, then, only if you meet specific qualifications). We have several chronic illness programs, but again...good luck getting to them if you don't have your own transportation. Our mental health resources consist of one hospital-network acute inpatient hospital program and, if under 18, several group-homes/"homes for troubled youth". And the average person can barely afford the VERY LIMITED "affordable" housing around here so good luck to anyone unemployed/has a history of a hard life. We do have one old motor inn that was turned into so-called "temporary" housing, but most people have nowhere else to go and just...stay. It's not cheap, either, per month all things considered!

[BSN-to-MSN, ADN, BSN, RN]

Hi, I'm sorry that you are struggling so much.

Have you tried dissociating yourself from the patient's problems? It helps to look at those problems as THEIRS instead of OURS. Look, the bottom line here is nurses will always have patients. Taking on their problems and trying to solve them is your job as RN, and you are not their friend or relative. Sure, there are patients in miserable conditions, the types that self destruct, frequent flyers, etc. Pick the most important problem at the time, and help them, don't get invested personally.

Hope this helps.

[javadown2, BSN]

Or....just get out. Take a break, go flip some burgers or work at a hotel. You won't be stressed at work, but will be stressed with paying the bills.

Nursing is hard, and I'm going on 5 years like you, it doesn't get easier. Many seem to accelerate and move onto ICU careers or find their niche. If your young enough, move onto something that makes you happy.

[dennis8, ADN, BSN, CNA, RN]

Hello OP! As a poster above has stated, I think dissociating yourself from your patients' issues can help a bit in toning down the mental stress you get from these type of patients. I worked in a med-surge/tele unit for 2 years and some months and I agree that treating these patients was more difficult than the others. I have since moved on to hospital case management and I get to see the other side of the situation with these frequent fliers. It is a bit disheartening to hear the insurance case manager on the other line telling me "I knew Mr. Doe was going to be back there again." But I guess it's just a reality check that no matter how much good we try to do for our patients, there will always be the minority that chooses to keep down their path. You can lead a horse to water but you can't make it drink! I do as much as I can for my case load when I'm on the clock and I go home every time with a clear conscience knowing I did my best.

[ruby_jane, BSN, RN]

Google Motivational Interviewing. That may help address the issue of why, say , someone with COPD continues to smoke.

Also you absolutely, positively cannot care more than the patient. And it's hard. What else do you absolutely love to do? Can you do it in your spare time? Because I realize that my job is just a job. As a school nurse, I get to leave at 4 PM whether I love the job or not!

[Mary Harrell]

Hi. In nursing there is a way one wants to provide care and identify themself. A nurses identity is a big deal. When a nurse sees that she is not 100% what she or he thinks that identity looks like something happens. Faced with this identity crisis one has one of three choices and each comes with its own consequences.

1. You can think...well it is pretty normal not to live up to the perfect standard. Result: Self acceptance and a measure of contentment along with the ability to soldier on.

2. You can think...this is terrible and being this nurse is not good, but yeah, it might be a little normal, but I am not happy about it. Result: a measure of self loathing and a bitter spirit that continuous on for a while.

3. You can think...this expectation for me to nurse like this is unacceptable and terrible. Any nurse who accepts being a nurse under these conditions is a terrible nurse and she should not be a nurse! Result: Burnout.

All the advice in the world does not change this basic psychology.

Sincerely,

Mary

Nurse for 40 years.

[StillSearchingRN]

Thank you all for your understanding! The suggestions have been great, too, but it's the camaraderie and understanding that really reached home and touched me!

[Imustbedreaming]

On 8/6/2019 at 7:37 PM, Mary Harrell said:

Hi. In nursing there is a way one wants to provide care and identify themself. A nurses identity is a big deal. When a nurse sees that she is not 100% what she or he thinks that identity looks like something happens. Faced with this identity crisis one has one of three choices and each comes with its own consequences.

1. You can think...well it is pretty normal not to live up to the perfect standard. Result: Self acceptance and a measure of contentment along with the ability to soldier on.

2. You can think...this is terrible and being this nurse is not good, but yeah, it might be a little normal, but I am not happy about it. Result: a measure of self loathing and a bitter spirit that continuous on for a while.

3. You can think...this expectation for me to nurse like this is unacceptable and terrible. Any nurse who accepts being a nurse under these conditions is a terrible nurse and she should not be a nurse! Result: Burnout.

All the advice in the world does not change this basic psychology.

Sincerely,

Mary

Nurse for 40 years.

Let's agree to disagree.....