Burnout after 8 months in ICU

[nursing8889]

I recently began a job in the ICU, with a background of a year and a half experience as a med/surg nurse. I've been in this position for 8 months, only on my own for 3 months, and I'm already EXHAUSTED. I've never been the type to want something "easier." When I initially started in the ICU, I did my orientation on the day shift and was SO excited. I would be the first one to arrive at codes, so eager to be a part of it because it gave me the biggest adrenaline rush. Anytime I heard a procedure would be happening on the unit, I would be there waiting to watch. I had millions of questions, I wanted to know EVERYTHING, wanted to help everyone and hop from nurse to nurse to learn from them about their unique patient cases. I wanted to take care of the sickest patients, and admired my preceptors so much for being such incredible nurses who could handle these very ill patients who required so much attention. I've been on my own for 3 months on night shift, and I have completely changed, and I'm not sure why. I dread going into work to the point where I cry before my shifts and really need to drag myself to go. I hope, before going in, that I have more stable patients. My brain feels so tired of constantly being paranoid, double/triple/quadruple checking, constantly thinking of what could go wrong. I'm no longer as excited about codes, and there are rarely any procedures on nights to watch. I worked days on med/surg, and I feel exhausted from switching to night shift, but I know I'm not ready to go to days in the ICU because I fear I will drown. Sometimes I feel like I was so much more sharp when I was on med/surg, and that my critical thinking skills were better as a floor nurse. I'm so tired of taking care of patients who most of the time don't make it. It's exhausting to put in so much effort and work into keeping someone alive, just to watch them not make it. You see these patients come in and families that hold on so long that they end up with trach/peg and no quality of life, laying there with no response. It's painful to watch so many people constantly die, and we go on with our days as if it's normal. I wish I could be naive again and feel that "miracles" could happen, like my patients families do, but instead I sit there and wonder why they still hold on. I envy my friends who chose different career paths, who still believe in these miracles, and don't have this jaded thought process. I hate that I'm becoming cold and emotionless to death, it makes me fear that when someone dear to me passes, It might not even effect me.

In my ICU, it feels like everyones competing to prove that they're the smartest nurse (not with me, as I'm new and don't know ANYTHING yet, but with each other). I feel so incompetent and useless, where on my other floor I felt so confident and successful, and was the one people would go to for questions. I realize that it takes a long time to even feel remotely comfortable in the ICU, but I hate going into work constantly feeling like a failure. I keep thinking about how much nicer it would be to work in a clinic and have normal hours, with patients who are stable.

Is the ICU just not for me?

[NurseCard, ADN]

I wouldn't necessarily say that it's not for you. You sound like a great nurse and

someone who could definitely shine in the ICU. Lord knows the world needs

plenty of good ICU nurses, right?

I'm thinking of a few things though, that are maybe causing you to feel like

you do. First of all, just adjusting to night shift alone, can cause all sorts

of issues. Nurses come on here all the time complaining of being more

depressed since starting night shift. It's not an easy adjustment! Night

shift is not for everyone.

From what you've written... I suspect that the hard reality of working

the ICU is getting you down. Spending 12 hours with critically ill

patients who may not make it and in fact, often do NOT make it.

Sounds like you may have had a rosy idea of what working ICU was

like; lots of adrenaline, codes, constant excitement... then got

into it and realized what it really was, a hard 12 hours of taking

care of horribly sick people who often do not make it. In

med surge, you likely had so many more people who came in

sick, got better, and went home. Not so in ICU, huh?

No wonder you are feeling like you are. I'm not trying to put

words in your mouth, thoughts in your head... I'm just going

by what you have written.

[Been there,done that, ASN, RN]

The honeymoon is over in ICU. You are most certainly NOT incompetent and useless, you are in the process of learning a new specialty. Don't compare yourself to nurses that have been there for years.

"I dread going into work to the point where I cry before my shifts and really need to drag myself to go."

Trust me on this, life is too short to feel that way. Stop banging your head against the wall, start thinking about another place to use your skills.

Peace to you.

[Cat365]

Ok several thoughts. Some people don't adjust to night shift. It can cause stress, sleep disorders, and depression. I love it, but I've been a night owl since childhood.

Second it takes over a year to be comfortable in a new specialty a lot of times.

Third I don't work ICU. I don't see myself doing so. I spent one day during clinicals following in ICU. My hats off to ICU nurses because I spent a good portion of that day thinking "Someone needs to let that guy die." I was tired, depressed, and convinced that ICU was not for me by the end of the day. If it's that way for you there's nothing wrong with that. Find a new unit; maybe a step down unit? Or ER? That's the direction I went.

[JKL33]

Your post really expresses the heart of wonderful nurse, I think. I don't think most lay people (and some nurses, too) have any concept of what it means to care for the critically ill and dying day after day. Your quest for knowledge and for doing your absolute best for these patients is another stressor (albeit something about which you can feel good).

I don't want to discount your concerns at all, but at the same time realize that what you've been through in the past 8 months is a metamorphosis of sorts; you are currently in the midst of it. Your statements about being so eager to learn everything and see everything remind me of myself - - but what comes next is you go through the part where you start to reconcile your eager and hopeful nurse-self with reality. It's the beginning of learning that there's so much more to caring for critically ill people than tests and procedures and intensive medical management and sometimes things that are rather heroic. To some extent, your feelings are a crisis of hard questions and not-so-exciting realizations: You've learned so much about what to do in x, y, z scenario - but what happens when A-Z don't work and the patient, the family (and you, the nurse) are left with...what feels like nothing? It's where you learn that there is more to nursing. Much more.

Also, you are going through a very real information overload. That will ease with time and experience - pretty soon you won't have to think so hard about some of the things you do now - - it'll just happen. But in the meantime, in addition to everything else, you feel a little off-kilter since you don't quite feel like you have your subject matter well in hand just yet. That's okay - you are conscientious and concerned about your duties and ask questions/get help appropriately. You strike me as someone who doesn't feel good merely being "competent" - - I get that, too, but know that you have years of learning to look forward to because of your drive for excellence. It will not serve you well to be hard on yourself with regard to this. Or, should I say, you will just invite angst unnecessarily.

You're the only one who knows how you do or don't identify with our comments here, but if you personally see any truth here, I would encourage you to hang in there, give yourself a mental/emotional break. Slow down and take things as they come and back out just a tad to see the big picture. Let yourself grow naturally (you can do this without lowering your standards for patient care, by the way). Don't be afraid to reach out to someone in real life who can provide an outlet for you and give you encouragement. Practice affirming "self-talk" and take care of yourself! Relax and do what you enjoy when you're not at work.

Best wishes ~

ETA: I'd like to agree with the poster above me. As an ED nurse you may eventually find that's a viable place for you - but it may be too early to make a decision about ICU...

[Rocknurse, MSN, APRN, NP]

It's hard for those who have never worked in the ICU to fully understand what goes on in there, and you're now being exposed to its full reality. What you're experiencing is normal but you need some perspective. You're doing amazing and you just need to realize that. Even if patients don't make it, the work you're doing is worthwhile and important. You're providing care to people in the last days of their lives, and at the same time learning and gaining experience in what most people view as the most difficult specialty. I have been where you are. I worked for many years in the ICU and suffered burnout, mainly because I was going through a divorce and a painful period in my personal life, so I left and went to informatics, but my god I miss it. I felt part of something when I was there. Now I just go to work...same thing every day.

I am actually working towards an acute NP degree so I have been doing clinicals in the ICU and have actually just gotten a per diem job in the ICU also. I want to be excited by it again and enter it with fresh eyes. I will probably go back because honestly it's the only thing that really excites me, despite the difficulty, the stress and the pressure. One day you'll look back at this and see it in a different light. Even though it's hard, try to see it as an incredible opportunity. Have a plan, and don't forget to look after yourself. Maybe take a little ETO and have a break. I promise that being an ICU nurse will reward you in ways you can't see yet, not least by enabling you to have a really awesome resume that will pay you back in dividends in the future. Keep your chin up.

[bellini]

Your post really expresses the heart of wonderful nurse, I think. I don't think most lay people (and some nurses, too) have any concept of what it means to care for the critically ill and dying day after day. Your quest for knowledge and for doing your absolute best for these patients is another stressor (albeit something about which you can feel good).

I don't want to discount your concerns at all, but at the same time realize that what you've been through in the past 8 months is a metamorphosis of sorts; you are currently in the midst of it. Your statements about being so eager to learn everything and see everything remind me of myself - - but what comes next is you go through the part where you start to reconcile your eager and hopeful nurse-self with reality. It's the beginning of learning that there's so much more to caring for critically ill people than tests and procedures and intensive medical management and sometimes things that are rather heroic. To some extent, your feelings are a crisis of hard questions and not-so-exciting realizations: You've learned so much about what to do in x, y, z scenario - but what happens when A-Z don't work and the patient, the family (and you, the nurse) are left with...what feels like nothing? It's where you learn that there is more to nursing. Much more.

Also, you are going through a very real information overload. That will ease with time and experience - pretty soon you won't have to think so hard about some of the things you do now - - it'll just happen. But in the meantime, in addition to everything else, you feel a little off-kilter since you don't quite feel like you have your subject matter well in hand just yet. That's okay - you are conscientious and concerned about your duties and ask questions/get help appropriately. You strike me as someone who doesn't feel good merely being "competent" - - I get that, too, but know that you have years of learning to look forward to because of your drive for excellence. It will not serve you well to be hard on yourself with regard to this. Or, should I say, you will just invite angst unnecessarily.

You're the only one who knows how you do or don't identify with our comments here, but if you personally see any truth here, I would encourage you to hang in there, give yourself a mental/emotional break. Slow down and take things as they come and back out just a tad to see the big picture. Let yourself grow naturally (you can do this without lowering your standards for patient care, by the way). Don't be afraid to reach out to someone in real life who can provide an outlet for you and give you encouragement. Practice affirming "self-talk" and take care of yourself! Relax and do what you enjoy when you're not at work.

Best wishes ~

ETA: I'd like to agree with the poster above me. As an ED nurse you may eventually find that's a viable place for you - but it may be too early to make a decision about ICU...

What a wonderfully kind and thoughtful response!

[RNperdiem, RN]

I will echo a previous poster who mentioned that you seem to have very high expectations for yourself. This will serve you well in the long run. But, as my preceptor once told me, "you got to learn to crawl before you can walk". This is humbling but true.

Give yourself some room to not know everything, ask for help and realize it takes time, experience and work to gain in skill.

You may never get that feeling of newness and miracles back, but you can gain confidence and satisfaction.

[Castiela]

I was the same way when I first started ICU. I wanted to do all the codes, procedures etc. Hur downside of the was that I missed focussing on the fundamentals of ICU care and when I was on my own, I missed a few things - not major, but it made me paranoid and made me double down and learn to focus in my patient right now and not the "exciting" things happening with other patients.

A certain level of paranoia is good. I find when I get too confident, I almost immediately learn there is more to the diagnosis/ procedure that I was unaware and learn something completely new. We should be always double checking and triple checking ourselves and our work because our mistakes can be more serious given how sick the patient is.

I know I personally can't do more than three night shifts in a row, and more than two sends me into a brain fog. I do not know how people do full night shift lines. Maybe you will feel more Sharpif you go back to days?

I was told when I first started ICU that approximately 90% of the patients who enter ICU will not make it, it's not a reflection of your skills as a nurse to keep them alive - they are just that sick. I still struggle with taking it personally when a patient becomes sicker on my shift, I wonder what I did wrong or if I missed something, but it's honestly their body just no longer being able to cope with the sickness.

I think it's a cultural belief that we should be able to do miracles with their loved ones when their sick, but the unfortunate truth is that everyone dies eventually and we aren't miracle workers. We do the best we can, but we aren't Gods. we just can't fix everything. Being nurse, we have a more realistic viewpoint if a patient might make it or not because we have the training and experience and the knowledge that many family members do not. Compound that with the guilt many families seem to have about past relationships and the culture that medicine can do everything including fry an egg, it's no wonder they hang on.

I've been fortunate and the ICUs that I have worked have had fantastic team members who help each other and are there for each other. I've never met a competitive nurse trying to prove she's the best. Maybe it's not that ICU isnt for you but this particular ward isn't.

Do you have access to counselling through work or employee assistance? do you debrief at work dyer bad codes/ bad deaths? I find these resources helpful just to work through what happened and what your feelings are. If you can access them, I highly recommend you utilize them.

Best of luck

[nursing8889]

Thank you so much to all of you wonderful posters for your incredibly kind words. You really helped me realize that I am not alone in feeling this way. Although I have so much to learn, I feel more at ease knowing that it's okay to not know everything right now, and that the knowledge will come with time and experience. I do feel a little bit crushed now that I know the reality of the ICU and that unfortunately, not everyone can be saved. But I feel lucky to be able to try and help my patients during their last moments. I will continue to stick it out, knowing that these experiences are vital for growth.

[WestCoastSunRN, MSN, CNS]

So many thoughtful responses here. I think there is not an ICU nurse alive that hasn't struggled with the darkness in our work. It is hard hard work. If you're not a nightshift person by nature, doing nights is very hard. Look to try to move to days when you can. And pay close, nurturing attention to your life outside of work. Spend time with friends and family, do your hobbies/sports/interests --- keep yourself filled up. And do remember there are other ICUs and critical care areas --- such as the ER (as others have mentioned).

[Dranger]

Most people don't stay in the ICU forever, I was over it after a few years.....