First year down, now what?

[wannabeinwanaka]

My first year of nursing (second career, I'm 43 yo) has been so hard. I work 3.5 hours away from my home; I pack up and leave my husband and house every 3.5 days to work 3 days in a row. I work in a rural, Critical Access hospital with about 25 beds (med/surg/tele, peds, OB, swing) and after a year, I am finally not as scared as I was when I started. Resources are slim, we are all stretched thin, wear too many hats and I think sometimes give unsafe, or at least, unsatisfactory care. I have learned ALOT - the right things to do and sometimes the way NOT to do something. I often just had to tell myself, "be thankful you have a job." Every month, I would write an update to send to family and friends. Here is the last installment. See what you think - and please, help me sort out what I should do next...because I can't keep doing what I'm doing...

Helping hands full of "things" rather than comfort

As I stand at the foot of the bed, my patient is looking up at me. Tears are in his eyes as he faces the prospect of a foot amputation due to an infection and an out of control wound (the consequences of diabetes), and I am holding "things" in my hands, unable to use my hands to comfort him.

I had rushed in, in order to pick up, check on, and take care of things - pressure mounting to transfer him elsewhere and to take a new admit and to start an IV immediately on an urgent outpatient, and to return the elderly man to the nursing home - his concerns incompletely addressed because of confusion on his part and hurriedness on ours.

Overloaded again. One reason for which is a broken system that determines staffing by measuring acuity of illness rather than measuring the complexities of the patient's needs throughout and to the end of his hospital stay. My patients are suffering because of it. Death is not imminent for some but life is pounding on their doors with choices and difficulties. I feel pressed to help so that life does not crush them into early death. But I can't, not right now. The pressure is greater to get on to the next "thing": here comes an outpatient with urgent needs, here comes a new admit accompanied by the ER nurse who is anxious to give report in the hall - now - because she must get back, here comes the ambulance to transport my patient, there goes a call light down the hall - someone needs help and we have no aide again today.

I gave my notice a few days ago. Today reminds me that it was the right thing to do. This kind of nursing doesn't feel right for me. But now I need help finding the next right thing to do. I believe that nursing is about caring for patients, often by doing things for them. Yet, I also think it is about being with them, sometimes more than doing for them. Look, see my full hands? Today, I put those things down. I held my patient, prayed with my patient, cared for and cried with my patient. This is the better thing. What kind of nurse will I be? What kind of nursing can I do that will encourage the better thing while properly prioritizing the patient above the task?

As I begin the search for the next right thing to do, I appreciate your prayers and ideas. I started nursing late in life and I am feeling a bit too old to waste time trying out different types of nursing in order to find what suits me best. I want to find my niche and get on with the best thing - hands empty and open.

[crazycat0311, BSN, RN]

what about hospice nursing?

[wannabeinwanaka]

Definitely on my short list. I'd like to continue some type of acute care PRN as well to keep enhancing skills...

[SCnurse2010]

Hospice was also my first thought. Maybe oncology? Wherever you end up, let God use you and guide you. Every moment has a choice in it. Sometimes what's expected of us goes against what we feel is "right". Let God help and do what He guides you to do, just like you did when said "forget the other stuff, this guy needs me". If it's not the right fit, that doesn't mean it isn't where you are supposed to be at that time, even if you aren't there long. Impact people along the way! Good luck in the next phase!

[wannabeinwanaka]

Thanks, I've thought about oncology as well. As for the stress of "other stuff," I really struggled the other day because all the other stuff was dumped on my plate and not stuff I could delegate - so I felt like I was in a dangerous place for the other patient I couldn't get to and for myself professionally. What do you do with that?

Also, I understand "impact people along the way" however I struggle to feel competent for a while so I don't feel I am doing much impacting. Then, to change again so soon, I feel I'm too discombobulated for too long. So, I guess I'm saying that I need a little more stability - which is why I want to find a right fit sooner.

You all are helping me think this stuff through - Thanks!!

[jjjoy, LPN]

You express the dilemma facing many bedside nurses very well. Thank you for sharing and best wishes as you look for alternatives.