burnout

[MistyDawnRN06, BSN, RN]

I've had an exceptionally bad week at work and needed to get this off my chest. . . . Just needed a place to send it so I could let this week go . . . .

I know now how burnout occurs. It occurs with the death of nursing. It occurs when the compassion well has been overturned by those who insist on inflicting both nurses and patients to the moral depravity of never-ending torturous care.

Burnout starts with an oath, taken at the pinnacle of pride and passion when entering a new profession. Burnout starts with caring, which is a quality we hope all health-care workers possess. Burnout starts with hope; hoping that we can make a difference in our patient's lives.

I took an oath on the day of my pinning; my graduation from nursing school. Here is that oath:

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.

I have broken every aspect of that oath in my endeavor to care for my patients. My life is not pure. It is tainted with the misery of the broken that I care fore. I don't practice faithfully. When my patient of six months is asking for death and an end to the monotonous routine of turns, dressing changes and mouth care, my faith fails me. I no longer have the faith that my patient will live a meaningful life.

I have not abstained from the deleterious and mischievous. Many of the therapies prescribed in the never ending ephemera of standing orders and the imperial standards of care, while trying to preserve the hospital's legal standing, bring harm to my patients. I position them in spine twisting angles which limit breathing and stiffen limbs placed on pillows to elevate bottoms and heels and hands. I have bloodied mouths with the routine mouthcare no matter how soft the sponges.

Every drug that I administer is harmful. I promote blood pressure at the cost of digits. I give life-saving antibiotics, yet I rob patients of their kidney function and hearing. Every drug has a cost. . . .

I attempt to maintain and even elevate the standard of my profession through my intelligence, my compassion, and eternal search for knowledge. I interweave therapies with the delicacy of a spider weaving a web. If one part fails, the web falls. I manipulate each organ system with a symphony of drugs in the attempt to create a harmonious whole. And when the physician calls me the mindless bedside attendant, or when the physician states that my tasks are so easy that a monkey could perform them, I smile with inner strength because I know that the physician does not even know how to work the pump to infuse the drug, and does not possess the skill to access a vein for their pharmacopeia's remedies.

I have broken confidence with families. I give reality. I give the grand picture. I comment on quality of life and last wishes. I talk of death with dignity. I broach those subjects which are so taboo to us. I give hope. I give reason. I give honesty. I give my heart and I have given my tears. I cannot uphold an image painted by a patient's service of hope and recovery when experience and statistics tell my heart the truth. I cannot support a physician that states a patient will walk out of my ICU when he is so weak that he cannot lift a finger, and can merely shake his head no to decline care. I can only do what my conscience and my heart guide me to do.

I have limited loyalty for physicians. I cannot bear dishonesty. The physician is no longer the captain of the ship steering the course to recovery. It is my job to question, to demand, and when called for, to take a stand between my physician and my patient when decisions are poorly made or when decisions are against my patient's wishes.

The one portion of my oath which I have steadfastly upheld to the best of my ability is that I have devoted myself to the welfare of those committed to my care. I have cared for my patient and my families more than I have cared for myself. I have become the object of ridicule on behalf of my patients. I have, despite great fear, risked myself professionally to uphold my patient's wishes.

And now, after having lost another fight on my patient's behalf, I feel like the nurse in me has died. The spark that lit my way to healing and the flame that guided my intentions has burned to ashes in the aftermath of flood reaped upon me. I am morally depraved and ethically sullied and I have become an empty shell.

I am no longer a nurse. I am a tender. I tend to the garden of patients with little mind for needs and a conscious drive of simply meeting obligations of care. This is burnout.

Is there a way to re-light the flame of nursing? I think it would take a new oath, one less pure, and one of less responsibility.

[barbyann]

Wow, *wiping tears from my eyes, you have touched me deeply. Please know I hear your cries. I feel it too. The only thing that helps me rise up and out of the pit of nursing despair is when I look at my co-workers and see their kindness and strength. I see people trying to do their best, with what tools they have, and I am inspired to try, try again.

It is my belief that our system of health care is about to hit rock bottom. I will stand and fight in the hopes of something more humane and gentle. I hope to be part of the solution.

PS If you ever decide to turn away form nursing please consider a writing career. Your use of language is powerful.

[Katie82, RN]

What you are saying is an echo of what I told myself many times during the early years of my nursing career. Sounds like you may be working in a LTC or geriatric floor. I urge you to consider the good you do as well as your frustrations with not being able to deliver "the perfect world". You do make a difference every day in the lives of your patients, even though there are not enough pats on the back to make you feel good. My burn-out cooled down a lot when I left acute care and began working in Public Health and Care Management. Now, 26 years out of school, I find that I do have the power to make a difference in people's lives despite the barriers placed by the government and medical establishments. I have touched a lot of lives over the years, and despite the fact that I have not always been appropriatly appreciated, I know this to be true. I am proud of the job I have done, and thank God I did not allow the hospital floor to be the sum of my existence. Move on - there are many paths available to you in nursing.

[tencat]

It sounds like it's time for you to move on, maybe to another kind of nursing. Burn out happens for a variety of reasons, but when we care more for others and don't take care of ourselves, that is one path to burn out. I've burned out on another career, and I learned that I have to control what I can, pick the battles worth fighting, and let the rest go. I have to take care of me, and I have to do whatever I need to do to keep myself healthy mentally and physically. If that means turning off my phone when not at work, taking vacation time without pay, etc. I will. Take care of you first.

[coffee4metech]

When a client stops you at the door to say thank you and gives you a smile ...thats what keeps me going to work everyday . Knowing that people do noticed that I work hard for them and try to provide the best care possible recognition ,and appreciation is GOLDEN !!!!

To relax and put myself first which rarely happens I lock myself in the bathroom and paint my nails I know it sounds odd but its the only place in the house the has a lock on the door and is quiet !!!!

[Lucky0220]

What a beautiful and touching post!:heartbeat I am a brand new nurse, but it's a second career (was a teacher prior to going back to school), and right after I graduated, I got a job in the ICU. It was so way over my head, even though I did really well in school. Great grades do not mean a thing when you hit the floor! I worried about every single thing I did. I saw nurses doing things that made me cringe. I left after 2 months to go to med/surg and while the patient load is pretty large, at least I understand most of the pathology of what is going on with my patients. You sound like an awesome nurse...and your writing is beautiful. It's refreshing to read a post by someone who can spell!!! :bowingpur

[Spring08]

WOW!!!! I'm a new nurse with less then 1 yr experience and boy do I feel what you are saying already....U should publish this post beautifully written......

[PostOpPrincess, BSN, RN]

An excellent message. When you feel this way, time to step away and find a temporary path that leads you to see happiness. Truly, there are paths in nursing that are positive all the way around. Having spent time in the ICU and being in charge frequently, I knew it was time to take a break when I no longer saw patients as people, but as numbers in a bed. I knew if patient A died, I could have a bed for patient B who was waiting intubated in the ER. I was actually thinking how inconvenient that patient A wasn't dying fast enough and I needed that bed YESTERDAY!

Geez.

So I worked in Education for awhile until I got my humanity back. It worked. Then I went to NICU and got to see some really happy (some sad, but different than when older people died) things. Now I am in PACU where I still get to take care of patients, but send them away to the other parts of the hospital or to their home. Love it--no bonding, no nothing, and most go home quite healthy.

Take a break.

And Good luck. Gifted people like yourself are very hard to replace.

[florianslove]

I absolutely loved your post. It is so so true. You seem like a nurse I would trust my parents or my child with. Please take some time off if you are able, or take a break and do something else until you feel better. This is a profession that needs people like you. I NEED people like you. As a Unit Manager I wish every nurse I worked with felt the way you do. Fortunately, most do and really put their patient's needs above their own ego bruising by MD's who often don't know what they're talking about.

Beautiful post, it really should be published.

Best of Luck,

Roxann:bowingpur:bow:

[locolorenzo22, BSN, RN]

It's time to explore another avenue....but does your employer offer employee counseling? You may benefit from some face to face conversations....

[MistyDawnRN06, BSN, RN]

Thanks all!

I had a particularly bad week and writing is my outlet. Sometimes that writing needs an outlet other than my computer, so I offer it up to others. Writing helps me re-charge and let go and put things in perspective. Once I've let it go, I find the strength to do the internal re-phrase of the situation that I need.

I went through an emotional intelligence series at work and while it was helpful, it also brings up more of the work that I have to do internally to achieve longevity in this field.

Sometimes I catch a lot of flack when I try to fight the good fight at work. I'm still a relatively young nurse and am still learning my way through the bureaucratic and political mine fields that are hospitals. It's not always easy.

Anyway, thank you all for the kindness and the reassurances. If I was able to move some of you, I am grateful. Thank you for listening, and thank you for caring. We all need a boost at times . . .

[MistyDawnRN06, BSN, RN]

As suggested, this post has been submitted for the article writing contest. Thanks to all!