Burnout vs. Stress vs. Not cut out for nursing

  1. 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.
  2. Visit Susan9608 profile page

    About Susan9608

    Joined: Apr '07; Posts: 211; Likes: 316
    RN

    16 Comments

  3. by   kstec
    I do not know what RN burnout consists of but I do know what LPN burnout is. It seems no matter what you do it isn't good enough. You of course can never work enough (days off) or long enough (over8-12 hour days). They never leave you alone on your days off. What I don't get is in nursing school they stressed to take care of yourself first, but how can you when you can never get away from work physically or mentally to do it. When you can't give to yourself and family how can you give to others, or if you give to your patients to much you have nothing left for yourself or family. Where is that happy medium? Well my opinion of your e-mail is to get away from floor work. Go to cardiac cath lab, mammography, radiation oncology, gi lab, or some type of support department. If that is not something you want than get out of the hospital all together. I don't think that having three jobs in five years is alot considering it takes some nurses a while to find their niche. Also as far as anxiety, have you tried Lexapro? I have type A personality with anxiety and it seems to work wonderful for me. No weird side effects either. Also does your hospital have EAP (employee assistance program)? If they do, try and go and talk to someone. I've only been an LPN for 8 months and can see how nurses get burnt out, especially RN's, the liability is astronomical. I occasionally think about getting my RN, but with it comes more responsibility and liability, and I don't know if I want that. Working as a LPN is enough stress for me. I wish you the best of luck in whatever choice you make, but it definitely sounds like you need to do something and fast.
    Last edit by kstec on Apr 8, '07 : Reason: wrong wording
  4. by   Florence NightinFAIL
    Hi,

    About calling you on your times off (maybe alot of the stress and anxiety is due to working too much and not getting enough time off/rest which is really bad for your health and sanity). Why don't you get caller ID phone and not answer anyone calling from the hospital? Then you can always make up excuses that you were out, sleeping, guests over, etc.

    Are you forced to answer calls from the hospital?
  5. by   anne74
    You need to leave that environment before you quit nursing altogether. I started out in a similar environment - lost 17 lbs in 6 months from never getting to eat lunch and stress. Cried before every shift. Woke up in the middle of the night. Unsupportive co-workers, etc. So I transferred to a different unit and my life has changed.

    I, too, wondered if I was cut out for nursing - if I had stayed on that floor, I would have convinced myself I had no business being a nurse. But now that I'm in a good environment - (I ALWAYS eat lunch, work day shift except call, great coworkers, supporitve mgmt,etc) I'm thriving as a nurse.

    It's not you, it's your environment. Get out soon before nursing is ruined for you forever. You'll be amazed at how the anxiety is just gone from your life. Why are you letting this job rule your life? Is this job worth your health and sanity? There are too many other nursing jobs out there that won't ruin your life - it doesn't make sense to stay there.
  6. by   lossforimagination
    I think you're depressed and burned out and need to do something else. Try another aspect of nursing...home health or adults, ER or anything. Even try agency so you can go to different facilites and can stay out of the unit politics.

    Also, definately...DO NOT ANSWER YOUR PHONE! Screen all of your calls and don't pick up or return any calls you don't want to deal with. I let my answering machine get all of my calls and I do not give a rat's ass what anyone thinks. DO NOT worry about it, to hell with the unit. YOU HAVE TO TAKE CARE OF YOURSELF FIRST IF YOU WANT TO CONTINUE TO BE USEFUL TO ANYONE. Right now, you need to take very very good care of yourself.
  7. by   GingerSue
    Hi Susan
    First of all, do you have to work when they ask you?
    They may need help, but you need your days off.
    Sometimes it's difficult to say that to them when they ask, so you come up with various reasonable responses that indicate - "no, can't come in today."
    And don't feel guilty.
    Maybe get call display so that you can screen your calls.
    Working 14 hours a day is kind of long - can that be changed?
    As for bathroom breaks - can you take them when you need them? How can that be changed?
    Lunch breaks - yes, you need your lunch break, and your other breaks too.

    Okay, now you've made a med error - and from this you will, of course, learn and probably be even more careful

    Maybe medication will help you re: the anxiety.
    And counselling can be helpful to, but you might have to go to several to see determine the one that is right for you - you need the right "fit"
    Changing jobs can be done, if that's really what you want to do.
    There are other fields of nursing that might be less stressful.
    Maybe things can be improved where you are.
    Give yourself some time, you'll sort through this.

    {as I think more about your request for counselling, do you want someone for face-to-face, or would you consider online counselling? I will send you the name of someone who offers online service, there are many, and you can check this person by googling too, his email is easily found}
    Last edit by GingerSue on Apr 8, '07 : Reason: online counselling
  8. by   Halinja
    There are other areas of nursing! Have you thought of working community health, or psych? Community health is all about prevention and amelioration, rather than with heroic health measures. It has a different pace. There are many different roles in community nursing, from environmental (checking out the health levels of restaurants), checking on young teen mothers to see if they're feeling overwhelmed, visiting bed bound patients, not to provide medical care but to assess if their needs are being met, if they have heat, water, etc.

    The community health nurse is important, but it is a totally different feel. Its usually 40 hours, days, out of doors often.

    Just one idea. (I'll leave the psych one alone)
  9. by   extraordinary067
    what is it that you like about nursing? the nursing profession is very diverse so i would suggest exploring other options w/in the field. it sounds like the picu is not the place for you for many reasons. good luck.
  10. by   Myxel67
    Susan, you have all the symptoms of severe depression. Perhaps the Lexapro someone mentioned will help. Wellbutrin also might help, but you need to see your doctor about the depression because it won't go away by itself. I know all of this from personal experience. I've been a nurse for almost 14 years, and I tended to stay in one area for about 3 years. I finally found my niche as a diabetes educator--I've been doing this for 4 years now (after 3 years in tele, 3 1/2 years in Respiratory/HIV, and 3 years in critical care).

    Once you overcome the depression and anxiety, you will be able to find where you fit in.
  11. by   jthewood
    Hey Susan9608, I couldn't help but notice the the underlying desperation in your post. You sound as if you're trapped in this job. Maybe you should take some time off and then look for a position that doesn't include working with kids. According to your post, you've been working with children for 5 years and your stress has done nothing but increase. There may be a recurring theme there... If you've only been in the field for 5 years, you can probably look back and remember why you started in the first place. It may be time to re-start your career as a nurse; take a new certification, try a new direction, whatever....just shake things up a little. That's the great thing about nursing as a profession.
    I don't mean to be judgemental, but it also sounds like your workplace has your number (if you know what I mean). You should never have to stand for being called in every weekend and not getting breaks to eat, etc. YOU need to take control of that situation using HR resources, managers, etc. Even your charge nurse answers to somebody.
    One final thing, if the job changes help, you might also think about trying some stress reduction techniques before medication. Sleep and exercise can give miraculous results when applied to a stressful situation. You might also find that if the job situation improves, it may lead to more regular eating habits and that can help a lot with stress.
    I, for one, hope you don't leave nursing. It sounds like you attempted to take on a lot by diving right into pediatric nursing at the beginning of your career, a task I wouldn't have tried. You have my respect for that and I hope you hang in there and turn the things you can control around.
  12. by   GingerSue
    take control as the above have mentioned

    one place to start is in what you say to yourself and
    about your work situation and patients or family:

    [quote] 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[quote]

    - try to change the above quote

    - don't make jokes about pulling the plugs (did you ever hear of Susan Nelles {you don't want to be accused of murdering children if anything does happen at the hands of someone else}):

    "March 12, 1981, began as a routine Thursday at Toronto's Hospital for Sick Children, a century-old institution known throughout the world for its year in, year out success in the care of young patients. But events that day were to trigger a real-life horror story for the parents of dozens of infants being treated at the hospital. They also were to cause a skilled and experienced nurse to be suddenly arrested and wrongfully accused of the horrendous crime of killing four sick babies in her care."

    - try to find your empathy and compassion

    - deal with the resentment that you feel (if it is resentment about the work hours and lack of breaks then don't displace it onto the patient or their family)

    - try to rethink "depriving" and "forcing"

    I sincerely do hope that you sort through all these issues
    and find the answers the work for you.
    Maybe you don't like working with these particular kinds of patients.
    There are numerous other settings where you can find satisfaction.
    Last edit by GingerSue on Apr 9, '07 : Reason: additional quote about Susan Nelles - accused and later found not guilty
  13. by   santhony44
    Quote from anne74
    You need to leave that environment before you quit nursing altogether. I started out in a similar environment - lost 17 lbs in 6 months from never getting to eat lunch and stress. Cried before every shift. Woke up in the middle of the night. Unsupportive co-workers, etc. So I transferred to a different unit and my life has changed.

    I, too, wondered if I was cut out for nursing - if I had stayed on that floor, I would have convinced myself I had no business being a nurse. But now that I'm in a good environment - (I ALWAYS eat lunch, work day shift except call, great coworkers, supporitve mgmt,etc) I'm thriving as a nurse.

    It's not you, it's your environment. Get out soon before nursing is ruined for you forever. You'll be amazed at how the anxiety is just gone from your life. Why are you letting this job rule your life? Is this job worth your health and sanity? There are too many other nursing jobs out there that won't ruin your life - it doesn't make sense to stay there.
    :yeahthat:

    I agree completely. Been there, done that, for sure.

    As others have said, there are lots of avenues open for nurses. Think about what you might like and give something else a try.

    There is nothing wrong with changing jobs occasionally. It's easiest to stay with the same facility but a different area, but going elsewhere is OK too.

    And, as others have also said, don't answer the darned phone!!
  14. by   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. <sigh> 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.

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