Burnout - How long do I have?

[KalipsoRed21]

I recently quit a terrible job without a back up plan. It wasn’t the kind of job I could hang on to until something else came up. I’ve been off for a week and it is glorious. There is nothing better than spending time with my husband and child. But I am the breadwinner so I must go back. And to be honest, looking for a job terrifies me. In 13 years I’ve never been able to find something that fits. I’ve found a couple of decent facilities, but I grow so weary of the emotional burned of nursing. I’m tired of being afraid of letting my daughter be near water (because of the 2 year old that drowned), or my heart be in my chest when any kid is playing in a driveway (because of the mother who accidentally killed her baby because she didn’t see her when she was backing up). When I was pregnant I would cry because what if I got cancer a month after the baby was born? Or threw a clot 3 days after she was born? What if my husband has a heart attack?...he was complaining of epigastric pain earlier today, and that 47 year old died the same way. 

See what I mean? My mind does this at least 3-4 days a week. It isn’t just when I have to much time to think, it is just there in the background always now. I can’t watch any TV with sad storylines...I just feel them like they are real. And I’ve seen a lot of real pain....like most nurses. It is better when I am off work for a while, because death isn’t in my face as much when I’m off. Again the reason so much anxiety about having to go back to work.

I am not very religious. I admire those with religion because the religion seems to give them a reason for the senselessness of tragic deaths (the father of 3 that got hit because someone missed a stop sign, the 3 kids and 1 grandparent that died due to a reckless driver...so many more). But I don’t see god in these things. I see a society that is moving to fast to be careful, that is polluting itself to death for profit of a few. No reasonable actions, no community, no way to slow down because bills have to be paid. And really after 13 years in the field, I don’t see the good in what we do. Mostly because we are rushed, so we rush the patients and their families, we all try to give quality, but often the system prevents us from doing so and then we get blamed because no one wants to admit the system is terrible and broken. I wish I had taken a different path, because there is no balance in this career, I’ve been looking for it for 13 years. Even in less emergent care there is still so much pain to see. The 80 year old using her gas stove to keep warm in her home while her son is out trying to pick up some work. She is not safe at home alone but she never worked so she doesn’t get SSI benefits. Her husband never had steady work. The 13 year old at home with cancer, she had been in remission for 4 years but it is back. The family is out of money so they are doing some fund raising. The couple that have kids but no one wants to take care of them, but the kids are discouraging their parents from selling the house to move into assisted living. 

I can say that nursing has brought me such prospective on how good my life has been, and that I appreciate. But my nursing experience has also had this dark cloud effect on how I experience my life now seeing all that I have. I just frequently feel anxious and afraid of losing everything. I wish there was something else I could do to support my family.

[Lunah, MSN, RN]

Honey, it's vicarious trauma. None of us are immune. I have an endless loop of potential horrors in my brain that are a result of prehospital, ER, and Afghanistan experiences, magnified a thousand times over after having my daughter and now doing all those what-ifs related to her. It's part of the reason I stopped working as a trauma educator (that, and peripartum cardiomyopathy (PPCM) that left me with some issues) and I now work at home, where the worst thing I see are sad stories in charts. It helps, a little. I just couldn't see one more dead kid. I probably need to see a counselor at some point and fess up to the VA that I am not as okay as I like to think. Therapy is a great suggestion! I have a lot of coping skills, but my brain likes to pipe up with the "yeah, but what if" stuff, and all my hard-fought perspective and gratitude goes out the window. I don't have any answers, but I totally understand how it feels when you can't unsee what you have seen. 

[JBMmom, MSN, NP]

No advice really, just wishing you all the best with finding out where you fit. In nursing, or in another career, juggling everything can always be a challenge. I would also agree that finding someone to talk with about the fears and anxieties may be helpful for you. Fortunately, you are able to enjoy your time at home with family when you are there. Good luck!

[Covidnursedropout]

This resonates with me so much.  I've been on a mental health vacation for a month.  Now I don't want to go back.  One night when I couldn't sleep I was browsing the different message boards on this site and came across a post from new grads who were upset because hospitals were refusing to hire nurses who didn't have hospital experience during the pandemic.  I was speechless.  I've been an RN for 14 years and I cannot even put into words the *** that I witnessed as a covid nurse during the pandemic.  Cannot put it into words.  I was lucky to make it out with my life.  4,000+ healthcare workers died working on the frontlines.  Some died from Covid, others committed suicide.  The government screwed up enough, can you imagine the backlash the very second they put a new nurse into that situation and "something happens"?  Like catching covid and dying or making a mistake and losing their license?  The hospitals weren't hiring new grads because they knew the conditions we were working in were beyond unsafe.  Beyond unsafe.  And the death toll from Covid is proof of it.  Now that the pandemic is over, we're taking a break and that's all some hospitals have is new grads.  If a new grad has a question they go to the charge nurse, who is also a new grad and also doesn't know, etc.  This is a field where time is of the essence and situations like this are already sending new grads running to the hills.  And things are nowhere near as bad now as they were 3 months ago.  Not even close.

"The transition from student to qualified nurse is a complex phenomenon (Pimmer et al., 2019) and various studies have highlighted how hard the first year of work is for new graduates, who may feel exposed and anxious or uncertain about their ability to do the right thing, struggle to adapt to a high workload, and experience stress as a result of their own and the team's expectations of them (Dyess and Sherman, 2009; Pimmer et al., 2019). In this respect, it is important to recognize that those final-year nursing students who stepped up to the challenge of early deployment have missed out not only on the study-to-work transition but also on the last two months of their clinical placement, in which they would have gained experience in more specialist services or high-complexity settings. These students have had to work in chaotic conditions, in a health system that has never seen such high rates of patient mortality and where treatment protocols were constantly being updated, all this in addition to the strict infection control measures, the long shifts and physical fatigue, the fear of becoming infected, the feeling of being unprepared for working in the middle of a pandemic, the lack of personal protective equipment, the pressure to provide care, and isolation from their family (some students moved to alternative accommodation so as to avoid exposing their families to risk of infection).

There are several reports detailing the negative effects that previous virus outbreaks have had on the mental health of health professionals, especially nurses. For example, studies conducted during the epidemics caused by SARS in 2003, influenza A (H1N1) in 2013, MERS-CoV in 2015 and even Ebola in 2018 have all documented negative psychological effects for nurses. Feelings of loneliness, anxiety, depression, fear, sleep disturbances and post-traumatic stress have been described, as well as other somatic symptom disorders in both the short and long term (Sun et al., 2020). There are also reports of a greater psychological impact on nursing students than on other healthcare students (Wong et al., 2004). It should be noted, however, that in addition to the well-documented negative effects and post-traumatic stress associated with caring for patients during a virus outbreak, evidence from a qualitative study suggests that working during the SARS epidemic in 2003 was also experienced by nursing students as an affirmation of their professional identity and as an opportunity for self-growth (Heung et al., 2005)."

[Covidnursedropout]

For example, you have one patient after another code, and the CNO who hasn't set foot on the covid unit in at least 3 weeks finally makes an appearance.  And before they even ask how you are doing they ask why the lunch trays of the 2 patients who aren't intubated (yet) are still sitting in the hallway.  Well genius, probably for the same reason you actually left your office to grace us with your presence.  You can't do CPR and pass lunch trays at the same time.  

[Covidnursedropout]

I knew it was time to run when I was the only nurse in the hospital that knew how to transcutaneously pace a patient who was in a 3rd degree heart block and hypotensive.  I had to guide the nurse taking care of the patient and I had 3 critically ill patients of my own.  Hell no!  Covid's about over, I'm out!

[Covidnursedropout]

I responded to a code and upon arrival the patient was in pulseless vtach, nobody was doing CPR, they were standing around looking at the zohl.  When I asked what was going on they said "we are pressing the shock button but nothing is happening."  I pushed them out of the way and showed them the red button with the lightning bolt, the charge button, you have to press that before you press the "shock" button.  Think about all that time that was wasted, nurses standing around looking at the zohl.  Wow.

[Covidnursedropout]

If I ever get sick I'll be damned if you admit me to the hospital.  I'll make myself a DNR and die at home with dignity.  Thanks anyways.

[Covidnursedropout]

You want my opinion?  There's too many people getting into the profession for money.  From the corporations down to the housekeepers.  Working in healthcare "pays better".  New grads are cheaper than experienced nurses and the hospitals have to make up for all of the crisis pay they spent on travelers.  At least now if a new grad gets covid and dies or makes a mistake and loses their license, nobody can blame it on the hospital for hiring a new grad during a pandemic.  It's driving the people who got into it for the right reason out.  I wouldn't let most hospitals look after my garden let alone a family member.

[Covidnursedropout]

I like reading articles about the mental health impact the healthcare profession has on all healthcare professionals.  Not just nurses.  Doctors, techs, CNA's, right on down the line.  Did you know if a doctor sought treatment for depression that it would be grounds for the board of medicine to yank their license?  I seriously never knew that until I did my research.  Poor doctors are going through the same emotions we are but are expected to "suck it up".  I know we are expected to suck it up too but at least we have the option of seeing a therapist or getting a prescription to soften the blow.  They don't even have that option.  I bet the substance abuse rate amongst healthcare workers right now is astounding.  And for lord's sake please change the curriculum in nursing school and start teaching them stuff that will actually be beneficial after they graduate.  90% of nursing school is spent teaching care plans and nursing diagnoses.  And how many hours per shift do you spend formulating care plans and nursing diagnoses in real life?  Probably 0-1%.  They are worthless.  Teach the students how to use the damn zohl.  Teach them how to transcutaneously pace.  Teach them why you need to do an ekg before giving nitro for chest pain.  The "if you didn't chart it, you didn't do it" mentality has done nothing but created some of the laziest nurses I have ever met.  They think it's acceptable to chart something instead of doing it.  Other nurses see what they are doing and that they are getting away with it, so they start doing it too.  Patients are dying a result.  From CLABSI, CAUTI, pressure sores, VAP, and the list goes on.  Want to know the only real way to avoid a lawsuit in nursing?  See to it that your patient leaves the hospital in better shape than they came in.  Charting is not going to heal your patient, help your patient, prevent nosocomial infection, etc.  You're not going to save everybody obviously but if you pay attention you will notice that nurses who spend more time in the room than in front of the computer have better patient outcomes.

https://www.Google.com/amp/s/amp.usatoday.com/amp/4875096001

[Covidnursedropout]

Want to hear a true story?  A patient was admitted with AMS due to hepatic encaphalopathy.  His history included NASH and he was on lactulose prior to be admitted to the hospital.  He went unresponsive on the floor and was transferred to ICU.  We did an ammonia level, it was 4 times higher than what it was in the ER.  Every dose of lactulose was charted "not given, patient refused" by the nurses.  He wasn't responsive so I couldn't ask him why he was refusing his lactulose, I simply put an NGT in and gave the lactulose.  I also put a foley in to monitor urine output.  When he started to come around, we pulled the NG.  He never refused his lactulose for any nurse in the ICU, not even once.  The amount of diarrhea he had after receiving a dose was enough that we put an FMS, but he never refused a single dose.  Sounds suspicious.  He was better and was sent back to the floor, same thing.  Unresponsive.  We checked his ammonia level and it was critically high again.  Once again the nurses are charting that he refused his lactulose.  No he didn't.  I can guarantee you he didn't.  The nurses on the floor weren't giving it because they didn't want to have to clean him up, so they are charting he refused it.  Again.  Back to ICU he went, a nurse noticed that his urine was blood tinged and started a CBI.  There was no doctor's order for a CBI, but we were running it anyways.  The patient started spiking a fever so I called the doctor.  The doctor looked at the urine and said "the blood in that foley, that's a UTI, we need to stop the cbi and get cultures and start antibiotics.  I told the next shift that the CBI is gone and we drew cultures and started antibiotics.  The nurse said to me "did you put a note in saying that he gave you verbal orders to discontinue the CBI?  I said, "No, I didn't.  Because the order for the CBI order was never put in.  I'm not going to say "order received to discontinue CBI" when there was never an order for one in the first place.  An incompetent nurse had been taking care of him and when he saw blood in the urine instead of getting a culture he started a CBI.  He was on CBI for 3 days instead of antibiotics.  So now he's septic and on levophed.  He died a few days later.  His family could easily have a lawsuit.  Read it a few times, the floor nurses charted the patient was refusing medication.  Not once did it happen in ICU.  They did it because they didn't want to clean him up.  And if this case did go to court, and the floor nurse stated he refused it, they will call me to the stand, and I will say he never refused it, not once, in the ICU.  

[Hannahbanana, BSN, MSN]

What's a zohl? Do you mean a Zoll (tradename) defibrillator?

 

OMG. What an awful thing to see. Well at least somebody learned something that day. Maybe.

 

 

 

---

A little knowledge is a dangerous thing / Drink deep, or taste not the Pierian Spring / There shallow draughts intoxicate the brain /And drinking largely sobers us again. ~ A. Pope

[subee, MSN, CRNA]

2 hours ago, Covidnursedropout said:

Want to hear a true story?  A patient was admitted with AMS due to hepatic encaphalopathy.  His history included NASH and he was on lactulose prior to be admitted to the hospital.  He went unresponsive on the floor and was transferred to ICU.  We did an ammonia level, it was 4 times higher than what it was in the ER.  Every dose of lactulose was charted "not given, patient refused" by the nurses.  He wasn't responsive so I couldn't ask him why he was refusing his lactulose, I simply put an NGT in and gave the lactulose.  I also put a foley in to monitor urine output.  When he started to come around, we pulled the NG.  He never refused his lactulose for any nurse in the ICU, not even once.  The amount of diarrhea he had after receiving a dose was enough that we put an FMS, but he never refused a single dose.  Sounds suspicious.  He was better and was sent back to the floor, same thing.  Unresponsive.  We checked his ammonia level and it was critically high again.  Once again the nurses are charting that he refused his lactulose.  No he didn't.  I can guarantee you he didn't.  The nurses on the floor weren't giving it because they didn't want to have to clean him up, so they are charting he refused it.  Again.  Back to ICU he went, a nurse noticed that his urine was blood tinged and started a CBI.  There was no doctor's order for a CBI, but we were running it anyways.  The patient started spiking a fever so I called the doctor.  The doctor looked at the urine and said "the blood in that foley, that's a UTI, we need to stop the cbi and get cultures and start antibiotics.  I told the next shift that the CBI is gone and we drew cultures and started antibiotics.  The nurse said to me "did you put a note in saying that he gave you verbal orders to discontinue the CBI?  I said, "No, I didn't.  Because the order for the CBI order was never put in.  I'm not going to say "order received to discontinue CBI" when there was never an order for one in the first place.  An incompetent nurse had been taking care of him and when he saw blood in the urine instead of getting a culture he started a CBI.  He was on CBI for 3 days instead of antibiotics.  So now he's septic and on levophed.  He died a few days later.  His family could easily have a lawsuit.  Read it a few times, the floor nurses charted the patient was refusing medication.  Not once did it happen in ICU.  They did it because they didn't want to clean him up.  And if this case did go to court, and the floor nurse stated he refused it, they will call me to the stand, and I will say he never refused it, not once, in the ICU.  

Is the nurse who started the CBI, sans antibiotics, under discipline?  Not only took unsanctioned action but then did it wrong.  This is a blatant error.  Plantiff's lawyer would be very reassured of a win.