Burnout vs. Stress vs. Not cut out for nursing

[Susan9608]

I'm brand new to the forums, and I'm sure there are dozens of threads on nurse burnout. I hope y'all don't mind one more.

Lately, I've been feeling rather burned out. I've been a nurse for 5 years, and I'm already on my third job. I started out in general pediatrics, but after 2 years (and a 6 week leave of absence to calm my nerves) I switched over to NICU nursing. I lasted a year in the NICU before coming over to my current job in the PICU. I've been there for a year and a half now, and I'm feeling the familiar stirrings of burnout creeping back on me.

I take care of a lot of chronically ill children. My hospital doesn't have a step down ICU and our floor nurses don't take things like home vents or drips or anything like that, so my unit ends up with lots of patients that aren't technically ICU status.

Lately, I've found my empathy and compassion for these chronic families to be sorely tried. I've started feeling stirrings of resentment towards them for keeping these vegetative children alive at all costs, thus depriving someone else of that space in the ICU (we've been diverting people to other hospitals on and off for months), and thus forcing me to care for their child, who often has MRSA or is very heavy and incontinent. I find myself more prone to making jokes with my coworkers about pulling the plugs, and I just feel overcome with distaste about going to work in the morning.

I don't volunteer for the sicker, more critically ill children, though, because I have this unrelenting anxiety that I am not competent enough to care for them. I'm terrified of making a serious error or of discovering a problem that I don't know how to handle. There are only 2 doctors in my unit whom I feel comfortable working with; around all the others, I end up feeling stupid and worthless and useless. I feel less knowledgeable and competent around all of my coworkers, even people who have only been out of nursing school for 6 months.

I find it difficult to go to sleep the night before I have to work. When I'm at home, I find it difficult to get motivated to even get out of bed to do anything because I'm so worn out and anxious about work. I live for my days off.

I'm tired of being called on all my days off and being asked to come in and work. I'm tired of the never-ending outside of work requirements - the classes and certifications and staff meetings and crap like that. I'm tired of enduring the condescending attitudes of the doctors. I'm tired of working for 14 hours a day, having to beg to be relieved for lunch, and hardly ever getting to use the bathroom.

This all came to a head for me last Friday, because I made a serious med error. I had not slept much the night before, overslept in the morning and didn't get to eat breakfast, and by 1:30 in the afternoon, I still had not been able to go eat lunch. I repeatedly called my charge nurse to ask her to relieve me for lunch, and she kept promising that she was coming, but she never did.

I was caring for a chronic child and a child on an oscillator. I couldn't walk away even long enough to pee, much less eat. I had to wait for her to come over.

My chronic child had a bunch of meds due at 1400, along with an I&O cath. I figured I'd hurry up and get all that stuff out of the way so that when my charge nurse finally did come over, I'd be ready to go to lunch. I've taken care of this child almost every day I've worked since September, so I knew (or so I thought) her care backwards and forwards. I figured that I could cath her blindfolded, if I had to.

So I got her meds out, scanned them with our computerized med administration system, and drew them all up. But I still ended up making a rather large error, simply because I was hungry and in a hurry and got careless. Fortunately for me, the kid is okay, but it really shook me.

And now I wonder - do I have any business at all being a nurse? Surely this kind of anxiety and hostility and resentment isn't normal or good, right? Am I just burned out? Or under too much stress? Or should I really consider another career path?

I'm just so tired of taking care of other people - it seems like I have to take care of *everyone* in my life, and I"m sick and tired of worrying all the time about whether or not I'm going to make a mistake that's going to kill someone.

I need a break, but I don't know how to get one. I have to work, no so much for money, but for insurance purposes. A vacation might help in the short term, but not in the long run. I can't keep changing jobs, but something's got to give.

I think I'd like to talk to a counselor who specializes in health care professionals and burn out. I just have no idea how to go about finding one. If anyone has any ideas, please let me know. I live in Dallas, TX, if that helps.

I also think I need some medication for anxiety. I've tried many of the anti-depressants that also claim to treat generalized anxiety disorder, and they don't do jack for my anxiety. What else is there besides Xanax? Is Buspar still around?

I so appreciate the opportunity to vent ... no one in my family really understands the kind of stress and pressure I'm under. They don't "get" my job, and they hate hearing about it, because they're always afraid I'll tell them something gross. I'm so glad I stumbled across this forum.

[Susan9608]

Thanks for all the replies; I appreciate the time everyone took to read my really long post. :)

It feels so good to finally vent about all of this to people who get what I'm talking about. My family wants to be supportive, I know they do, but they can't stand hearing about my job. They are afraid that I'll either tell them something disgusting or that I'll depress them with the details. So I keep a lot bottled up inside.

I've actually been on lexapro. :) Well, I started taking lexapro in Jan. when I had some martial problems. I was on it for about 6 weeks, and it worked okay for depression, but it had some side effects I didn't care for. So I quit taking it. After my medication error, though, I went home and the first thing I did was take one again.

I've noticed that I don't feel as trapped or stuck when I'm taking the lexapro (obviously that's the depression part being helped) but it hasn't done much about my anxiety level. I still feel really anxious about my job. I had a hard time falling asleep last night, knowing I had to come to work today. That's why I'm wondering about Buspar. I know my physician (whom I adore) wouldn't be opposed to giving me something like Xanax in the short term, but that's not a long term solution, even if she'd be willing to prescribe long term.

I am looking into counseling, both career and personal. We do have an EAP program. I think I used all my benefits during my marital problems earlier this year, but I do have good health insurance, so I should be able to cover counseling on my own.

My husband has been wonderful, which is surprising to me. I kind of expected him to take a hard line and say something like, "Well you have to work." But he didn't. He was totally supportive and said if I really want to quit, then I should and find something else I want to do. Or he said I could work part time or whatever I want to do. His attitude has also helped me feel less trapped, especially since he said he will pay for insurance if I want to quit.

I don't feel like quitting is the answer; I feel like that would be running away rather than dealing with the problem. And I also think that if I change jobs, I'll be okay for awhile but eventually these issues would come back. I don't know if it's nursing, really, or if it's me. Maybe I'm the problem. Or maybe the way nursing in general is the problem.

Most people I know and talk to have the same problems with their jobs that I have with mine ... long hours, no breaks, called in on their days off. It seems that if you work in a hospital, then that's what happens, at least in my area. I do NOT ever answer my phone on my days off, but they still call, and then I feel guilty for not going in. But I don't feel as bad as I would if I did go in.

I like working with kids, and there are a lot of things I like about my unit. I talked to a couple of my co-workers today about my burnout with the chronic, long-term patients, and most of them said that they have periods where they feel the same way, where they are just sick of caring for a particular patient. So maybe I need an assignment change.

I just need to do something so that I feel competent and not so anxious all the time. People keep telling me that one mistake isn't worth ripping myself up over, but I can't help it. The anxiety is just overwheming, and I think that's my biggest problem. Now I just have to figure out how to deal with it.

I do feel so much better than I did when I wrote my first post, so that's a step in the right direction. Thanks so much for all the advice and thoughts; it's greatly appreciated.

[SmilingBluEyes]

Please, get some professional help on a couple of fronts:

Medical/physical checkup and eval to see if you need medications or other intervention by a doctor or PA/NP. There are a lot of meds for depression and anxiety, and doses need titration often, for best effect. Your regimen may not be the right one for you.

Counseling for the burn-out sx you feel. Find a good therapist who can help you sort out the issues going on and help you make sense of these things

Your situation is very concerning and you have valid worries. Please, take care of yourself, get the professional intervention you need and if possible, take a short vacation to unwind and relax a bit. Then, evaluate if indeed this job is even worth all the pain, anxiety, worry, physical s/s you are feeling. I suspect the answer may be "no". But you alone can decide that----I just urge you get professional help in finding the answers and seeking emotional, physical and mental wellness.

I wish you all the best. I am so sorry for all you are going through right now.

[Susan9608]

Thanks again for all the replies; I appreciate the effort everyone has put into reading my posts.

As I have said, I'm looking into getting counseling. I also have a follow up appointment with my physician on the 24th to talk about Lexapro and other anti-depressant options. So I'm trying to get the professional help.

But as I've also said, no one in my life wants to hear about my job, so I guess I'm also looking for a sympathetic audience where I can vent about the more unpleasant aspects of my job and my reactions to them.

Thanks for all the advice; I do indeed appreciate it.

[dcnballmom, ASN, RN]

stress and burnout - thats nothing new where i work - i am an LPN in a LTC where i am responsible for 5 nursing assistants and 38 residents on 2 wings - i do all the assessments - documentations - notifications of physicians about lab results and any other patient related problems - along with deal with the family members, call the kitchen for meal replacements, monitor weights, and just about anything else - and that doesnt include doing MDS work so the coordinator can put it in the computer - and also doesnt include the 3 pages of reports that i have to fill out before end of an 8 hour shift that turns into 10 quite easily - looking for a new position you bet i am - but until then i just keep on keepin on and hoping for the best

[jjjoy, LPN]

Effexor is another antidep that is also supposed to help with anxiety.

Glad you found a place to vent and be heard and understood. Hope you find some peace for yourself. It sounds like you're taking steps to figure out what changes you need to take care of yourself - good for you! Keep on keeping on!