Feeling like I'm not making a difference

[Wrestler133, BSN, MSN, RN]

I've been an RN for about three years now and worked as an aide prior to that for a year during nursing school in the surgery department at a local county hospital.

After passing the boards I was hired directly onto the PACU floor at my workplace and would float to the preop area occasionally when needed. I worked here for about 9 months because I felt I was not learning much as far as the disease process and most patients were stable after surgery and any complications that occurred the more experienced nurses would jump in and didn't get much experience there either. I liked the job for the most part but felt I needed more exposure to sicker patients to really 'learn'.

I left that job for a float position at a nearby hospital and eventually cross trained in the ICUs. I would float to every tele, ICU and do ICU/Tele holds in the ER as well. Eventually took a permanent position in the Surgical ICU and learned a ton! It was very interesting work but slowly I just felt nothing I do really makes a difference in people's lives ..

Recently I took a job on tele floor at a hospital 5 minutes from my house and love having extra time to sleep and come home before it's dark. I left my previous ICU job because of the hostile work environment and management that seemed to micromanaged everything you could think of. My current manager said if I ever want to leave to the ICU at my current place I'd be welcome to do so after 6 months if any positions open, but I'm not so sure I want to do that anymore either. Each day seems like it's the same problems with patients; chronic conditions that aren't taken care of properly, drug seekers, people with multi organ failure from poor choices etc and family members that treat you as a servant, the endless charting that seems to have more and more 'assessments' added each month and management that puts staff last on a priority list for anything but blames then for any mishap. I don't feel like I'm making a difference at all in anyone's life, basically feel like a glorified waiter that helps prolong death.

I'm sure this isn't the only thread like this here and feel like I need to vent a bit. I try to enjoy my time off but often think if I did everything correctly at work or missed charting something and get a dreaded call into the management office. I'm thinking maybe a change of specialty but I don't know where I could go with my experience and have only been at my current hospital since March so trying to leave so soon would look bad. I've even thought about changing careers altogether but it would be difficult with a wife and child now in my life and the need to help provide.

Has anyone else felt like this? Any tips on things I can work on to maybe ease the stress? Any specialties that truly feel rewarding? I feel like I'm in a hole and can't get out.

[caliotter3]

Have felt like this most of the time. Dealt with it by changing my expectations. Now look at the job as a job with tasks to be accomplished during the time allotted. I ask myself how much of my job did I get done (was everything done for the patient that good nursing practice calls for?), and how well did I get it done (was my patient or their family reasonably pleased with my efforts?) I do not ever look for validation from the employer. They walk over me, mostly in terms of my wages and other day to day things. If the patient improves, or I get a thank you, or acknowledgement, well, then, that is nice. But I do not ever look for those things. When a person has unrealistic expectations, and looking to make a difference really is unrealistic, they are bound to be disappointed. I have taken myself out of the disappointment game. It helps with my mental health.

[Ra3liana]

I heard you and I'm in the same boat... I work in an oncology/med-surg unit.. most of my patients have cancer and nothing I ever done can seem to make a difference. Some of my patients just want the nurse to spend more time to comfort them but we are always short-staffed working like a robot. I don't feel proud about being a nurse anymore.

[Workitinurfava, BSN, RN]

Do yourself a favor and stop job hopping. If you keep this up, you will regret it and look back at places that you could have stayed at. You are going through some changes and with the wife and baby, your mind is busy. Just accept that sometimes you can only do your best and the left is up to others. Right now may not be the best time to quit nursing to join the circus. You have bills that need to be paid. When you wake up say, I have bills that need to be paid but I hope that I can make a difference, however if I don't I will know that I tried my best. It may take more time for you to figure out what job is best for you but in the meantime don't job hop too much where you live, to the point that when you do finally figure out what you want, it is not an option (due to you working at so many places, now many places won't take you back because they see you as the easter bunny with all of your hopping). The other thing is are you doing all of this to feel like you are good enough or can handle something you really don't like. Try to find peace in what is right for you, even if it may not be looked at by you or others as a high level position.

[ruby_jane, BSN, RN]

You'll probably find a lot of us agree with you. I hated the ICU for exactly the same reasons you verbalize - we were busily rearranging the deck chairs on the Titanic for a lot of folks.

Two things: first, my favorite college professor (before nursing school) told me not to work in nonprofit; to get my masters degree and serve on as many boards as I wanted to in my spare time. In retrospect, that's great advice. If you're not making "a difference" but you are making bank - realize it. Find something else that serves the charitable purpose you seek. If you seek to continue to "make a difference" in nursing, I predict you'll burn out.

Second- I'd remain for a year wherever you are, but you might find your excellent critical care skills to be valuable in the ambulatory setting as well. I love school nursing. I don't "make a difference" every day but there are days I do and it feels great.

[Davey Do]

5 hours ago, ruby_jane said:

we were busily rearranging the deck chairs on the Titanic for a lot of folks.

And we folks really appreciated your effort spent at rearranging those deck chairs before we took the big dive, ruby_jane.

An administrator who I loved told me at the age of 22 that I had a Messiah Complex.

Forty years later I have realized that the most I or anyone else can ever be is a strong link in a chain.

[Forest2]

Sounds like nursing to me. Most of the time I just try to think of what task requires being done next and keep moving on the best I can. Bedside nursing today does not fulfill me like it used to. I keep hoping that someone will hire me for a good position that I will enjoy more and not want to leave. Hasn't happened yet. But, like I said I am hopeful.

Being elbow deep in someone else's feces doesn't put me in my happy place.

[Davey Do]

13 minutes ago, Forest2 said:

Being elbow deep in someone else's feces doesn't put me in my happy place.

And yet it does me, Forest, because I am making a difference, providing comfort and care to another human being.

Some of us are happy just being pooper scoopers.

[FolksBtrippin, BSN, RN]

I feel that I make a difference at my current job, but I am not in a hospital and I develop long term relationships with my patients. I think that helps. Yet even in this setting there are many people that I can't help, some that seem to slip through the cracks, and there are a few who I believe are so inappropriate for our program that they are actually a little worse off because of the treatment they get from us. I'm in mental health.

But there is the guy who spent his whole life gesticulating to himself and talking to voices to the point where he would get thrown out of public places, no one could stand to be around him. I built trust with him and got him to agree to a long acting injectible antipsychotic and now he is working on his GED and has been welcomed back into his mother's home. I feel very good about that, and it's okay with me that this patient is like a 1 in 30 or so that I have been able to help to this extent.

I celebrate small movements toward goals and keep my goals reasonable and time limited.

For example, I once had a severely intellectually and psychiatrically disabled patient who wanted to learn how to handle money. He called every coin a "quarter". After a month of working with him he could correctly identify pennies, but he still called every other coin a quarter. I celebrated that. Never mind that he would never get to a place where he could handle his own money, he felt good about himself for making progress, and sometimes that's what life is about. It's not necessarily about getting the pot of gold but enjoying the rainbow.

I hope this is helpful. I am on the other side of the nursing spectrum here, but my point is that if you are getting jaded, find some way to make a small difference in a way that you can, that means something to you personally. Or help the patient identify a goal that matters to him or her instead of thinking about meeting an objective. Try flipping the tables and just asking your patient what they want to get out of their hospital stay. Where do they want to go next? What would they do if they were in perfect health? Questions like these might give you insight into behaviors or conditions that you find frustrating.

[AngelKissed857, BSN, RN]

A very wise nurse once said to me-actually says at least once a month- "you can't save them all". It sounds flippant, but it's not, not at all. I work with ESRD patients. Literally, my entire caseload of patients are dying, A precious few will get transplants, but most will die within a few years, usually of heart disease. They know this, they know they are immunologically fragile, they know they need to eat enough protein but watch their phosphorus and calcium levels, take their binders at meals, eat plenty of fruits and veggies and watch their potassium, etc. They know they need to take their Epogen injections on time, get their Venofer, they know they need to and they know why, and what the potential consequences are when they don't. And some of them just don't do it. They know, but they don't do it.

Sometimes the hardest part of my day is to remain my patient's advocate for the choices they make, when my brain is screaming "This choice is likely to kill you!". Or the patient who gets calciphylaxis and nothing can help with the pain, nothing slows it down, their whole world becomes the pain and I can't tell them it's going to be ok or it's going to get better or easier. Because I will not ever lie to my patients.

Even as I hate what choices they are making I still need to be their champion, educate them, but accept their agency and be the one who safeguards their right to choose.

I also know I make a difference. There are days I have to be reminded of this. I have a patient who I told to put it out there on social media that a transplant would be a life-saving gift. There are now over a dozen people being tested to give a kidney. I made a difference for that patient. That's enough for me, except for the days when it's not,

You're a nurse, no one ever said it was going to be easy. I admire you for doing mental health, it's a specialty we desperately need more nurse to choose, I promise you DO make a difference, to someone, every day you show up.

[Kooky Korky, BSN, RN]

I guess I never really wondered if I made a difference. I went to work. Some jobs I loved, some I really didn't care for. I supported my family and did what I could for my patients.

I remember a few patients with fondness, most I do not recall at all. Kind of sad and amazing, now that I really think about it.

Life can be beautiful, it is also filled with much pain. Try to find something that makes you happy. Perhaps that will be something outside of work. and don't job hop if you can help it.

You do make a difference just by showing up to give care every day.

How do you define "making a difference"? What do you think it will take for you to feel successful at that.

[Alex Egan, LPN, EMT-B]

I first experienced this when I was an EMT. As I moved into nursing I continued to find this. Nursing at heart is about making a difference. Nursing in practice isn’t.

When good old Flo N went to the Crimean War. The woman she took and the things she did made a difference, but to the day to day nurse it probably felt a lot like cleaning up, feeding people, and changing bandages.

The big picture changed but day to day it was drudgery and death. I imagine lots of this woman went him feeling as if they didn’t save a single life, even though the statistics show they did.