Finding Motivation in a Hopeless Area?

[mingK]

Hi everyone. I started a job as an RN on a med/surg floor a few weeks ago and I already feel burned out. Yes, I have had some wonderful patient experiences and have met some really great people. However, the hospital I work at gets a lot of nursing home patients and many of the patients are confused, incontinent, and FULL CODES!!

I have been swung at, pinched, and yelled at multiple times already and the number of beds I've had to change and patients I've had to clean up is a lot! Especially given that I have only had a few weeks on the unit.

We have some patients who are full codes (at the insistence of their families) although they have no quality of life left (I'm talking feeding tubes, incontinence, extreme morbid obesity and end stages of dementia). I just feel so un-motivated sometimes when I care for these patients. I do give them good care, I am not neglectful, and I try to talk to them as if they know who I am but it's so frustrating, I have to double up my efforts to care for them and by the end of the day I am exhausted. Not to mention my back I know is going to get injured because of these patients.

Any advice? I'm here for at least 6 months before I can move so any words of wisdom, advice, would be greatly appreciated :-).

[nursie_nursie_415]

Um, I'm not sure what type of patient population you were expecting to care for in med/surg. The majority of my patients are confused, incontinent, full codes & from nursing homes & I work in med/tele where the patients tend to be older & sicker. Now, the more surgical floors tend to have younger patients (better candidates for surgery) who are less confused & continent... is that your ideal patient population? Even those patients have their own issues (high fall risk r/t needing help with toileting, always on the call light, pain management, higher nurse-to-patient ratio, higher patient turnover, etc).

Med/surg nursing is rough, especially during the first year or so when you are still acclimating to everything new - it is probably the roughest type of inpatient nursing, which is why employers have a high regard for med/surg experience & most flat-out require at least a year or two of it. Savor every experience you can - sounds like you have lots to learn & that is definitely a good thing to help your grow in your career.

When I was a new grad, I excused myself from the floor MANY times so I could have a good cry. It's such a lonely & frustrating time, especially because I never reached out to anyone for support. I burned-out early on & hit rock bottom before I finally got the hang of things & switched to a shift that better matched my pace & style of nursing. Never would I have imagined being in med/tele for almost 5 years now! The original plan was to do 2 years then move on, but with hospitals being so reluctant to hire even experienced nurses, here I am still, caring for my confused, morbidly obese, tubes-in-every-hole, full code, total care nursing home patients :)

I do want to say something about taking care of your back - I seriously injured my sciatic nerve due to repeatedly stressing it & was out of work for a while. TAKE CARE OF YOUR BACK - can't tell you how many older nurses I no longer work with because their back injuries were past the point of fixability. I DO NOT LIFT patients anymore, with the exception of the tiny old ladies who are all skin & bones (even then 2 staff is still the standard). If I absolutely have to lift/turn/position a patient, you better believe I come full force with enough staff to do so safely. If it can't be done safely, I chart that not enough staff was available at the time to provide safe patient care & wait until enough staff is present to do the task SAFELY. My facility has a "no lift" policy so we do have equipment available to assist with safe patient mobility, & although it is not a perfect solution 100% of the time, it does help.

My advice to you is to just take your time so you don't make mistakes, try your best to focus on the priority tasks, stay organized & BREATHE. There is so much to do in so little time for so many patients (med/tele here is 1:4 ratio) & it is impossible to do it alone so learn which staff you can rely on & help them so that they can help you, too. Every staff has their strengths so learn from them what you can. Being *new* is extremely difficult on so many levels but you won't be *new* forever. Watch the more experienced nurses who find enjoyment in their job while managing to get out on time - you will see that they stay professional, focused, organized, cluster activities, take their time, are team players & delegate appropriately.

You will also notice that the ones who are always stressed-out & appear scattered are the ones who talk/complain too much, are poorly organized, cannot focus on their patients, talk more than they listen, complain more than they work - did I mention that they talk & complain too much?

All that said, I will admit that I know exactly what kind of shift I will have just by looking around at who I am working with that day. Floor nursing is a full-on TEAM effort, even though right now it feels like you're in your own hell. Keep your head up & treat each patient as if they were your very own family member regardless of what "quality of life" means to you - thinking that way helps me to give the best care I can even in the worst of situations. Nursing is not about the nurses; it's about the patient & sometimes the patient is really the family who makes decisions for them.

If you find yourself compromising your care because the workload is just too much, be diligent in finding another job because if the stress is not manageable you WILL make mistakes & that is no bueno. GOOD LUCK.

[libran1984, ASN, RN]

imo, get out of med-surg and go to ER....

much more ambulatory population.

more consistent security to control the unruly.

forget measuring I&O's.

Rarely to never spend a full 12 hours with the same patient.

Get out on time all the time.

Lots of overtime and Critical bonus (in my and other surrounding EDs) pay.

I know I have to respect Med-surg nurses b/c I couldn't do it. I'd be burned out. Bless you and your co-workers for even trying it.

[Orca, ADN, ASN, RN]

Had to chuckle at this phrase:

...tubes-in-every-hole...

Thanks for the laugh.

[BluegrassRN]

You have no control over other people's decisions regarding their lives or their family members' lives. You don't have to agree with those decisions to provide care. You can provide education when appropriate, of course, but it sounds to me like you need to learn to let a lot of things go.

That's like fretting over poor, starving children in Africa. Do you stay up crying every night over how terrible the disparity of distribution of resources is in this world? It's truly horrible and unfair, and I'm sure you agree. But I'm also sure you don't lose too much sleep over it. Maybe you try to not waste gas and water, maybe you donate now and then to an organization which fights poverty and famine, or provides education to children who would otherwise receive none. You do what you can, and you let the rest go. It's the same with nursing. You do what you can, and you let the rest go. You can't bear the weight of the world on your shoulders, and you can't bear the weight of other peoples' decisions, good or bad, on your shoulders or your heart either.

For your back: regular yoga and pilates.