Burnout or Boredom?

[NurseLil13]

I have been an RN for 3 years, and working in Private duty via a small agency for 2 years. I left the hospital because I hate the politics and the lack of freedom in my schedule. 

My pediatric patient now is pretty complex, but balanced at this time. They have to have an RN during daylight hours for TPN. I have been commended many time by the pt's mom for "going above and beyond" by keeping up with organizing and restocking the supplies they receive through insurance, basic cleaning of patient's room and bathroom (nothing extensive, just enough to do my job, ex: wiping counter I mix TPN on or washing the oral syringes I use for meds), or picking up a few extra hours so that mom and dad can have a date night every once and a while. 

The issue is, I feel like a glorified babysitter.

I have been with the pt since they came home from a LTC facility. Yes, I feel close to the pt's family. Sometimes, even as though I have crossed the professional line a few times in regards to purchasing things for my patient as Christmas or Birthday gifts (ADA bath equipment not covered by insurance, bedding that will fit their hospital bed, special scales). 

A few months ago, I discovered that my pay and benefits were wayyy less than other agencies in my area. So I applied for another position and got a call for an interview. I let my patient's mom know that I was interviewing for another job, as she had 2 agencies in the home and I figured that that would give both agencies time to potentially find a new nurse. The mom freaked out on my agency, my then manager basically went into a frenzy, acting completely shocked, even though I told her my feelings 6 months ago. Then the manager claimed they couldn't find a nurse, using guilt to keep me. 

Eventually, my agency basically only gave me enough of a raise to cover insurance through the marketplace, and only one additional PTO day, no where near what I was asking for. I told them I thought it would be okay for a few years or until I have another baby. 

Now, my patient still remains balanced. My schedule is all over the place, being sent home early one day, being asked to stay late several times a month, flip flopping hours. It's even effecting my private life, as I've recently moved, creating a 45 minute commute to my patient's home. My spouse is definitely not happy with the schedule changes either, as it sometimes leaves them or my mother in law watching my daughter for long periods of time. 

Do you think this is burn out or boredom, as there have been no significant changes? Should I stop doing kind things for the family, like reordering supplies or buying useful gifts? Should I just grin and bear it, tell my spouse to suck it up? Or are these just signals that it's time to leave? 

[Kitiger, RN]

You say there have been no significant changes . . . except for your schedule and the fact that you have now a 45 minute commute, and childcare is now a big problem. Isn't that significant?

Are you saying your schedule used to be regular, and now it's all over the place? Your spouse was happy before, and is unhappy now?

Did you move before or after you contemplated switching agencies?

Are you currently working for one client only through your current agency? And do you have another agency lined up - one that has cases that you would be comfortable taking?

You say you've gone above & beyond, by "keeping up with organizing and restocking the supplies they receive through insurance, basic cleaning of patient's room and bathroom (nothing extensive, just enough to do my job, ex: wiping counter I mix TPN on or washing the oral syringes I use for meds". I would say that these things are a regular part of your job. Even picking up a few extra hours now & then is OK. (This is always through your agency, and not as private pay, right?)

However, when you are "purchasing things for my patient as Christmas or Birthday gifts (ADA bath equipment not covered by insurance, bedding that will fit their hospital bed, special scales)", then you have gone past that professional line. It may be that the family reacted so strongly because they didn't want to lose these extra perks.

If the schedule changes came after you indicated that you might leave, that's a red flag. I would want to have something else lined up.

For what it's worth, I consider it risky to work for only one client. When you need time off, it throws a wrench in the client's schedule. And if they decide they don't want you anymore - or your client is hospitalized, or they move - suddenly you have no hours at all. Not good.

[NurseLil13]

Kitiger,RN: When I say significant changes, I'm meaning with the patient themselves, not with my personal situation. It has definitely changed.

I have spoken to the manager in the past about potentially picking up other cases and my requests were either ignored or denied. Which I thought was strange to begin with. Like I pick up the extra hours with the case, as the agency has asked. I rarely call off. I haven't even taken a vacation since maternity leave 2 weeks into this case (not that I have more than 3 days of PTO, maximum), and they won't even entertain the idea of me floating? This way of operating has went on since I picked up this case years ago. As for the cleaning and stuff, I'm the only nurse this patient has that does those things. The others won't even let mom know if they're low on diapers or meds, much less a pharmacy or supplier.

This was my first private duty case, so I didn't know what to expect. I have definitely learned lessons (like the gifts thing), buy I guess it's biting me in the butt now. Did I put in/do too much in the beginning? 

[kbrn2002, ADN, RN]

Despite your obvious connection with and devotion to this patient you are definitely being taken advantage of here.  As much as I hate to say it you allowed this to happen when you made your employer aware you had other options that paid more and offered better benefits but then didn't leave when your employer refused to exceed or even match that offer to get you to stay. 

After your employer realized you weren't going to leave despite having a much better offer they decided that jerking you around would now be OK since you are likely to put up with it after you proved you were willing to put up with lower pay and fewer benefits already. 

As much as you enjoy this patient and family I think it's time for you to move on. Take that better offer if it's still on the table, or go out and get a better offer again. Not only for your professional growth but also because if you are unwilling to sever ties with this patient despite having an obviously better compensation option and you are now seeing negative impact on your home life you are too close, too personally involved.  

This time put in your notice, and mean it.  Don't get guilted into keeping this position just because of your connection with the patient and family. Even in the unlikely event your employer decides you are serious and matches another offer it's probably in your best interest to make a change anyway. 

[Kitiger, RN]

1 hour ago, NurseLil13 said:

Kitiger,RN: When I say significant changes, I'm meaning with the patient themselves, not with my personal situation. It has definitely changed.

I have spoken to the manager in the past about potentially picking up other cases and my requests were either ignored or denied. Which I thought was strange to begin with. Like I pick up the extra hours with the case, as the agency has asked. I rarely call off. I haven't even taken a vacation since maternity leave 2 weeks into this case (not that I have more than 3 days of PTO, maximum), and they won't even entertain the idea of me floating? This way of operating has went on since I picked up this case years ago. As for the cleaning and stuff, I'm the only nurse this patient has that does those things. The others won't even let mom know if they're low on diapers or meds, much less a pharmacy or supplier.

This was my first private duty case, so I didn't know what to expect. I have definitely learned lessons (like the gifts thing), buy I guess it's biting me in the butt now. Did I put in/do too much in the beginning? 

Some cases are hard to fill, and the agency will try to keep the current nurse on the case, even when there are other clients who need nursing. I experienced that in one home. The mother was becoming more and more distant, but when I asked her if there was a problem, she denied any problems. The agency also denied any problems. When I asked to orient in other homes, the agency insisted that they had no open positions - not even for a fill-in nurse. However, after the mother abruptly took me off the case, suddenly the agency had several clients who were understaffed. One client had been understaffed for over a year (!) yet the agency had told me that they had no openings.

They just wanted to keep me on this one, hard-to-fill case.

As for the basic cleaning, the other nurses should be doing this, too. It's usually best to have one nurse (or parent) responsible for ordering, but anyone can do inventory, and everyone should should be keeping things organized, restocking shelves, notifying the parents when stocks are low, etc.. Whoever is on duty when supplies come in should put them away.

By letting you do it all, the agency doesn't have to push the other nurses to do their job.

I agree with kbrn; your problem isn't so much how you started out, it's the fact that you didn't leave when the agency refused to match the compensation that your potential new job was offering you. I would go ahead and interview for the new job, while telling them that I would have to give my 2 week's notice. If they offer you the job, take it . ?

It is not your responsibility to make sure that your client has a nurse. That belongs to the agency, along with all the money they make off you. Of course they don't want you to leave, but - since they won't pay you enough to stay - you can go ahead and leave.

[NurseLil13]

1 hour ago, Kitiger said:

Some cases are hard to fill, and the agency will try to keep the current nurse on the case, even when there are other clients who need nursing. I experienced that in one home. The mother was becoming more and more distant, but when I asked her if there was a problem, she denied any problems. The agency also denied any problems. When I asked to orient in other homes, the agency insisted that they had no open positions - not even for a fill-in nurse. However, after the mother abruptly took me off the case, suddenly the agency had several clients who were understaffed. One client had been understaffed for over a year (!) yet the agency had told me that they had no openings.

They just wanted to keep me on this one, hard-to-fill case.

As for the basic cleaning, the other nurses should be doing this, too. It's usually best to have one nurse (or parent) responsible for ordering, but anyone can do inventory, and everyone should should be keeping things organized, restocking shelves, notifying the parents when stocks are low, etc.. Whoever is on duty when supplies come in should put them away.

By letting you do it all, the agency doesn't have to push the other nurses to do their job.

I agree with kbrn; your problem isn't so much how you started out, it's the fact that you didn't leave when the agency refused to match the compensation that your potential new job was offering you. I would go ahead and interview for the new job, while telling them that I would have to give my 2 week's notice. If they offer you the job, take it . ?

It is not your responsibility to make sure that your client has a nurse. That belongs to the agency, along with all the money they make off you. Of course they don't want you to leave, but - since they won't pay you enough to stay - you can go ahead and leave.

Thanks so much for your feedback! I appreciate your words, as I have felt that way for a while, but felt alone, as many do when working in home health, thinking that no one understood. The guilt is definitely real! 

[lpn90425]

I was the only nurse on a case for 5 years. My hours were Monday-Friday 8-4p, but the family had 16 hours a day x7. Slowly, they started asking more and more from me. Could I cover Saturday, cover Sunday, could stay until 7p, could I came at 6a. I stupidly said yes at first to everything at first so they got used to taking advantage of me. Their requests came hours before the shifts, the changes were never planned out ahead of time. One day I put my foot down because I moved out of state and had an hour commute on top of everything and started to say no to the changing hours and extra days and I was the bad guy. 

After I said no to changing or taking extra hours, they started cancelling shifts and sending me home early. I cared for their child for 5 years and they were spiteful that I wanted a life outside of their house nor could they be understanding that I lived an hour away and didn't want to wake up at 430 to be at their house at 6 for absolutely no reason on a whim. When I realized they were clearly taking advantage of me it was time to leave. 

I've never bought any kind of supply or gift for any patient I've ever cared for. On the above case, the previous nurse bought tons of clothes for the patient, tons. I always received comments from both the parents and school staff almost implying that I should too "x really looks like they need a new sports bra, the old nurse used to buy them for her all the time. Old navy has cute ones" Not happening. I didn't receive a raise in home care ever, barely making ends meet, and the parents both make six figures a year... Nope. I'm not the parent.

And on top of the schedule issues, after 5 years of nothing but Gtube feeds and diaper changing most days I found myself wanting to put my head through the wall from boredom. I had to change it up for a bit with a non private duty job. When I got out I realized how underpaid I truly was and got a new job paying $11 more an hour. 

The agency and family will guilt trip you to stay, if you reached a point that you're asking the internet if you should stay or not it's probably time to leave. The case likely burned you out from boredom and being taken advantage of. 

[NurseLil13]

5 hours ago, lpn90425 said:

I was the only nurse on a case for 5 years. My hours were Monday-Friday 8-4p, but the family had 16 hours a day x7. Slowly, they started asking more and more from me. Could I cover Saturday, cover Sunday, could stay until 7p, could I came at 6a. I stupidly said yes at first to everything at first so they got used to taking advantage of me. Their requests came hours before the shifts, the changes were never planned out ahead of time. One day I put my foot down because I moved out of state and had an hour commute on top of everything and started to say no to the changing hours and extra days and I was the bad guy. 

After I said no to changing or taking extra hours, they started cancelling shifts and sending me home early. I cared for their child for 5 years and they were spiteful that I wanted a life outside of their house nor could they be understanding that I lived an hour away and didn't want to wake up at 430 to be at their house at 6 for absolutely no reason on a whim. When I realized they were clearly taking advantage of me it was time to leave. 

I've never bought any kind of supply or gift for any patient I've ever cared for. On the above case, the previous nurse bought tons of clothes for the patient, tons. I always received comments from both the parents and school staff almost implying that I should too "x really looks like they need a new sports bra, the old nurse used to buy them for her all the time. Old navy has cute ones" Not happening. I didn't receive a raise in home care ever, barely making ends meet, and the parents both make six figures a year... Nope. I'm not the parent.

And on top of the schedule issues, after 5 years of nothing but Gtube feeds and diaper changing most days I found myself wanting to put my head through the wall from boredom. I had to change it up for a bit with a non private duty job. When I got out I realized how underpaid I truly was and got a new job paying $11 more an hour. 

The agency and family will guilt trip you to stay, if you reached a point that you're asking the internet if you should stay or not it's probably time to leave. The case likely burned you out from boredom and being taken advantage of. 

Exactly! This is exactly how I'm feeling. Night shift began purchasing holiday gifts, so me being naive and new, thought that was the norm. Clearly not. This particular set of parents is understanding, especially since I just obtained my BSN, it's just the agency. I've only been with this patient almost 2 years, but I'm still bored. I feel like there's no growth. I feel like I'm getting paid pennies to be a yes man when I can't even afford to go to the doctor due to lack of insurance... as a BSN, RN! 

Thank you so much for the feedback. I really appreciate that I'm not alone in feeling like this. 

[caliotter3]

I did not read the other replies first. You are facing retaliation from the client and an insulting attitude from the agency. It is time to leave this case and this agency. Pursue employment with another agency. Get a better agency, a better case, better pay, better benefits. Your health will benefit from a successful change.

[C.Love, MSN, NP]

Time to move on. You're barely using your RN skills. If you don't like the hospital, how about trying home health nursing where you see a variety of patients while learning and using your skills.

[StudentRN56, BSN, RN]

On 6/3/2021 at 5:28 AM, lpn90425 said:

 

And on top of the schedule issues, after 5 years of nothing but Gtube feeds and diaper changing most days I found myself wanting to put my head through the wall from boredom. I had to change it up for a bit with a non private duty job. When I got out I realized how underpaid I truly was and got a new job paying $11 more an hour. 

 

What type of nursing are you doing now? Just curious. I was doing private duty nursing for peds as well and just got hired to be a school nurse starting in the fall and I'm excited for the new challenge!