Disillusioned, Depression, or Both?

[Kim O'Therapy, BSN, RN]

Good Afternoon Everyone,

Those of you that know me realize that I have been participating here since nursing school. I graduated May 2009 and have been working in oncology. I worked in oncology as a nurse assistance and student extern before I graduated. After graduation, I started off in a Stem Cell Transfusion unit and loved it; however, I soon realized the acuity was too much for me. I resigned (in good standing) and started anew at another hospital on a generalized oncology/hematology unit. I've enjoyed it and my skill set has grown enormously. Please let me start off by saying that the end-of-life aspect of my job does not effect me nearly as much as the other points I will be making. I am becoming depressed. I am assuming it is because reality is setting in and I'm doubting my decision to go into nursing.

First let me say that there are a few patients out there that keep me in this job because they appreciate the job I do for them; however, the negative is starting to get to me too.

I am tired of staff being cut, leaving the nurses with not only more patients per nurse, but higher acuity patients, no nursing assistant, no unit clerk, and sharing our charge nurse with two other units. I had a pt have a reaction to a transfusion and luckily I was able to handle it on my own, because no one else was around. Unfortunately, I had to leave the pt alone to pull meds and call the doctor; which I know is a big no-no. To top it off, scheduled vital signs and glucose levels were not done because the reaction set me behind and they had sent our nurse asst home when we "dropped" to ten patients (five per nurse).

I am tired of monthly meetings where we are told we need to improve our "customer ratings", the "ratings" determine our raises, while they cut staff and call bells cannot be answered in a realistic time frame. (E.g., the transfusion reaction). And, of course, the nurses are left to make the circus work. When asked an opinion and I professionally and courteously reply with the reality of the situation, we are told "to just call me to help out". Yeah, the DON, OA, Unit Manager, and Unit Director come running from their meetings when you call for help (inject sarcasm here).

I am tired of one of the charge nurses making comments like, "If you make friends, more people will help you." I am a friendly person, I don't hang out alot after work, so I do not know what she means by this. I have noticed her being slower to help out some people, including myself?

I am tired of managment telling me to document precisely because "everything falls back onto the nurse", but precise charting seems to be a luxury lately.

I am so very tired of getting flack from families about wanting information from the doctor, but the doc has yet to come see them.

I am tired of docs making certain patients DNR, but leaving me to tell the family (we have a medical futility law that allows physicians to make a pt DRN, with or without the pt permission).

I am tired of calling security because people don't know how to behave when they visit loved ones, or having to speak to families about their out-of-hand children destroying the family lounge.

I am tired of finally getting myself organized and safely performing care, to only get another email regarding more paperwork we are required to squeeze in to our daily responsibilities.

I am trying to decide if I should keep doing what I'm doing. Is my license worth the occassional smile from a patient, or the feeling of satisfaction I get when I explain something to a patient or family member that "no one else would help me understand"?

I knew nursing would not be a cake walk, but I did not think I would burn out so quickly. Thanks for any advice you may have.

[SlightlyMental_RN]

First of all, ((hugs)). Secondly, I loved oncology, too, but even if the end-of-life stuff doesn't bother you, it does add to your overall emotional stress. My honest opinion is that maybe you should take your career in a different direction, to a unit that doesn't burn you out. Perhaps investigate outpatient chemo? Or perhaps a dialysis unit? I truly think you need to move on, as this unit is going to drain every bit of your energy and joy-of-living and nursing right out of you.

[perfectbluebuildings, BSN, RN]

It sounds like the place you work is unhealthy and unsafe, on many levels. I wouldn't say all of nursing is like this, although you do hear stories like this more often than in the past. If it is feasible for you, I would start quietly looking around at other job opportunities. I don't think it's nursing that you are fed up with, as you mention you enjoy the patient care aspect of it. I think it's the place that you are working, and the fact that you don't have the support that you need in situations like the transfusion reaction or patients' families behavior. I think once you start looking and see that there are other opportunities and jobs out there, you will start to feel a little better. Please take care.

[fungez]

You work in a bad place. I think it's as simple as that.

If you have a good rapport with any of your oncologists see if he has any office jobs available. I've worked office and it's a much nicer environment.

If you can't take the pay cut then is there a nonprofit hospital you could work at? In my experience the nonprofits, especially the Catholic ones, tend to be better places to work.

Good luck. Unfortunately this is reality. I tell people not to go into nursing, and it really saddens me to have to say that.

[Simply Complicated]

I agree with everyone else. Sounds like the place you work has some major problems. It is getting bad in the hospitals, some are worse than others though. I've been doing this for 5 years, and am honestly feeling the same way quite often. I'm trying now to decide if I want to try to get a job in an ER, or switch to psych.

Try and keep your head up, and start looking around. You may find something you do like. Good luck to you!!

[CaLLaCoDe, BSN, RN]

My last place of work was oncology and it was almost as crazy as yours. One time we were short patients so the unit secretary and the aide were sent home. I got an admit who was very confused and could not be left alone to his own devices. Pulling this yanking that, voiding on the floor. The charge nurse was not convinced that we needed a sitter for this patient. So I suffered the inability to attend to my other patients and played sitter most of the shift. I so dislike cuts in staff that end up jeopardizing our licenses. What is it with charge nurses who never see the need for a sitter?

[Kim O'Therapy, BSN, RN]

:redbeathe Thanks for your responses. I have a question. Maybe it is just a matter of getting more experience under my belt, but, how come other nurses seem to handle these issues effortlessly? They complain and discuss "getting out of here"; however, they seem to sail through the guff. Your comments have made my day, thank you. I am starting to work on my OCN (more marketable), and put out applications.

KOT

[anonymurse]

Could it be that you're simply tired of having pts die on you?

[SoundofMusic]

Wow, I could have written your post. I think this is EXACTLY why I'm leaving my unit. The short staffing, the attitude of the admin and mgrs that we should just do the work and not complain about everything they continue to pile up on us, not to mention now, as you said, working some shifts w/o techs and w/o secretaries now, increasing the duties of the charge so they are not available to us. We nurses in these hospitals are essentially on our own a lot now ... and it's just so stressful I can't stand it anymore. Just add all of that short staffing to the expectation that we continue to have excellent customer service ratings, and I wonder if someone at the "top" isn't just smoking something -- I mean, are they nuts, honestly?? Meanwhile, our unit seems to create jobs for higher ranked nurses that essentially takes them out of staffing ...they keep doing this, while increasing our ratios! We "donkeys" just continue to pull the weight while the coffee drinking nurses sit in their offices and generate reports or what have you. It just disgusts me.

I'm in grad school to obtain a degree that will get me away from the hospital nursing, and I'm taking a slower paced job at a rehab hospital. It might not be "sexy," but I will be preserving my sanity and my health. I have to hang in here for the long run for my family, and the unit i'm on will surely kill me off. I hate to leave the other ones behind, but I've done my time and it's time to go -- I say find another situation which will be less stressful, if only for a break so you can restore your soul again. . . . I'm right here with you.

[msn10]

First off Kim, I am sorry you are going thru all of that. It does sound depressing, but I will say you have a gift for writing. I don't want to start a firestorm, but I wish there was someway you could replicate that post on a non-nurse blog/website. It encompasses so much of why nurses are feeling so overwhelmed and frustrated but you wrote it without (too much) sarcasm. Wonder if any nurse administrators really understand what they are asking? Good way to start another nursing shortage.

[Bella RN, BSN, MSN]

Maybe you can take a vacation soon and decide which direction you want to go in. :nurse:I worked oncology for years and the end of life care did burn me out. :crying2:And seeing young patients be taken so quickly by this dreadful disease cancer, and I also; like you had to step away and care for the patient while the patient was having a reaction to the chemo. As I read your post it brought me back to the days when I felt just like you. Management not appreciative of your efforts and your own unit not really being appreciative. I know how that feels.

I had to step away from oncology all together and took some time off to regroup and figure which direction I wanted to go in. Perhaps you may want to try that. Listen to your heart and what area of nursing you think you may enjoy:nurse:

Quick question: What state allows an MD to write a DNR order without getting the family or patient involved. I believe I read that from your first post. I have never heard of that.

[Ruby Vee, BSN]

:redbeathe thanks for your responses. i have a question. maybe it is just a matter of getting more experience under my belt, but, how come other nurses seem to handle these issues effortlessly? they complain and discuss "getting out of here"; however, they seem to sail through the guff. your comments have made my day, thank you. i am starting to work on my ocn (more marketable), and put out applications.

kot

more experience will help enormously. the experienced nurse can walk into a room, take a quick look at the patient and have assessed mental status, oxygenation, circulation, pain status and how "safe" they are to ignore while you deal with the train wreck down the hall.

that said, some nurses are conscientious and some aren't. the ones that aren't seem to have the most time to shop on ebay, read allnurses.com and socialize with their friends.