Nursing Stressful......Says Who?

burn out · Jan 10, 2007

nursing is stressful but not distressful...if it becomes distressful it is time to get out.

hellerd2003, RN · Jan 10, 2007

My stress level really varies. I'm an RN with barely 1 year experience working on a MICU unit. On "good" days, my stress level overall is a 3 to 7. Even if we have a "road trip" to CT scan or a major procedure . . . on a "good" day, you feel like you've accomplished something and that reduces your stress level overall. I like learning new things and discovering results that can "fix" my patients! If I have a day that is a 1-2, I usually stress thinking that I should be doing more. I like days when it's a 3-7. :-)

As I think back . . . the majority of days that are a "10" on the stress scale are these types of days:

1. patient received from ED that is crashing. Placing lines, running max pressors, pt. skin tone purple, family asking you to do "everything" to keep them alive.

2. patient from surgery-- coding for 1 hour in surgery and delivered to ICU while in code. Further code two hours. No support from charge nurse, who leaves at her regular time while you stay 3 hours late. Educate family after they arrive regarding the patient's temp (33.7), and the fact that they've been coding for 3 hours with poor brain oxygenation. Family asks, "what would you do?" and know that although you would cease rescusitation, you can't say that. Place the decision back on the grieving daughter and granddaughter-- the only family in town. Receive DNR/ DNI orders, and stop efforts. Stay 3 hours post-shift completing paperwork, punch out, and spend 1/2 hour comforting the family, who THANK you for your failed efforts. Cry the whole way home.

3. (this is my last day's work assignment, so it's long-- part of therapy, I guess) Patient on BiPaP. patient has been on BiPap for three days. You've made a bond with the family. They and the patient trust you. Patient does not want to be intubated, because with pt's poor lung function, hx of emphysema and COPD, she will be a difficult wean off the vent-- if not impossible due a completely lost lung. Patient's ABG's are failing. On your last day, you and the pulmonologist explain to pt. that the only option for life is intubation. Pt's family is split-- half want intubation, half want what the patient wants. The patient wants to not be intubated. You walk into the room to deliver lunch to the husband (the patient cannot eat due to poor O2 sats off the mask). The husband is sobbing into his handkerchief because his wife is attempting to write out funeral plans for her own demise. Later, as he is nearly leaving the hospital, you page him back because the pt. is desat'ing, with dusky skin and a confused stare. Stat ABG's come back unchanged since morning. The patient continues to refuse intubation, and is still A/O. You leave shift, with it unknown how this patient will do. When informing the husband that you won't be back, he starts to cry, stating "but you know her so well". The husband further explains that the night nurse wouldn't let him rub his dying wive's back, because when he did that, she would desat. Know that when he rubs his wife's back during the day, sure she desats, but she comes up higher than without a back rub due to relief of discomfort. Know that that contact may be the only husband-wife contact they have in a long time, if not forever. Vow to make sure he can rub her back as much as he wants, whenever he wants. Lecture the night nurse. Tell her that if she kept *your* husband from rubbing *your* back that you'd come back to haunt her. Leave unknowing what will happen to your sweet patient and loving husband. Have your charge nurse tell you you did a great job today, despite feeling inadequate to remove the pain. Cry the whole way home.

What helps me on "10" days is using the drive home as a "transition" to normal life. I do what I need to do to achieve "normal" on the drive. Blast loud music, cry, hit the steering wheel . . . whatever. Sometimes I'll stop and "shop" (I.E., walk around a store aimlessly) until I can go home clean-slated. I used to work in psych, so I know that I can't come home until I'm relatively balanced-- I need to keep "home" and "work" separated. I have a wonderful husband who, when I worked as a psych case manager pre-nursing, was trained to give me 30 minutes of non-demand time once I walk through the door. He continues to give me that time as an RN. He also will listen and sometimes just let me have an hour-long bath alone as soon as I arrive home, where I can redirect my mind. Those are all things that help me through my "10" days.

interleukin · Jan 11, 2007

of course, bsndec06, you may reprint any of my thoughts.

regarding hellerd2003's message, save for extraordinary circumstances no nurse should be leaving three hours late. sure, sometimes it is impossible to leave on time. but, going home on time should always be your goal.

it's a 24-hour operation. don't forget it and don't be afraid to remind the others. just be sure to let them know what you could not safely get done.

if possible, do not schedule non-stat tests which will interfere with your shift change or breaks. be sure docs do not put in stat tests that are not needed "stat". and, question the need for tests. especially if the results will not change the course of therapy. we spend billions on such useless tests.

you know how many things you must accomplish. do not let a family talk your shift away. for it is you who have allowed them to talk it away, not them. prioritize. adapt you situation to the time you have.

of course, nursing's middle name is, "surpirse!". expect them and try to get work done in preparation for them.

crashing patients are easier than a family which needs guidance and explanation regarding a complex medical/social/ethical scenario.

remember, it is also the doctor's job to provide explanations. know that most of whatever you explain to the family will then be reiterated by the doc. and the family will, often, want it repeated again and again. they are stressed out and may not hear lots of what you say. especially if you use medical phraseology.

develop the ability to focus on what's important for the family and state it plainly. you may become involved regardless. but know that other personnel are capable of taking over and you have responsibilities to your loved one, and yourself.

so.................go home!

family situations are often complex. try to distill down the facts, if possible.

"what would john want in this situation?" and, "you honor and love him by carrying out his wishes," are never out of place.

again, i don't want to over simplify this enormously critical part of our jobs. if handled badly, it can explode in your face. when handled well, you feel like you're one with some magnificient compassionate universe. it's like a drug.

the technical stuff will become second nature. memorize the clinical algorithms, watch for changes, and err on the side of safety.

still, you're not the doctor. let him/her shoulder their responsibilities.

go home! you're not paid anywhere near what you should considering the burden of your responsibilities.

so, keep your perspective. nursing's a job...an important one...unlike most others...but its' still a job.

P_RN, ADN, RN · Jan 11, 2007

Is Nursing Stressful? Yes-siree-you-betcha.

Life is stressful too. What makes the difference in stress and distress is how you manage it.

thinkin' about it · Dec 17, 2008

In my opinion, it's beyond stressful. Far, far, far beyond. You can be completely innocent and still get sued. You can bend over backwards for someone and still have a complaint made about you. You can go to school for years and years, be at the top of your class, and do ongoing education, and still be belittled because you aren't an MD. Nurses get blamed for so many things we have no control over, like how quickly food gets delivered from the kitchen, or how well housekeeping cleans the room, or how old the building is, or what someone's diagnosis means. When the doctor tells the patient (or family) something they don't want to hear, they then leave the room. You're there for oh, about 12-13 hours, in which the blame gets placed squarely on your shoulders. Although it's no excuse for being outright rude or overly demanding, many, many people you will encounter as a nurse are under extreme stress. So are you, but they are allowed to show it. There will be times when people say things to you, or in a way, that in most other jobs, you'd never put up with it. But nurses are often expected to be punching bags for others. It's often a physically and emotionally draining job.

And there's no room for error. There aren't many jobs where a mistake can literally kill someone. But some of those jobs, for example, air traffic control, are insulated from the emotional stress of dealing directly with the people the job serves. They work in an office-type setting due to the concentration required and must work only a few hours and then are mandated to take a break (and no, I'm not saying their job is easy). Contrast that with nursing, where you may go 12 or more hours without a break and have constant interruptions, enormous lists of tasks to complete, family member after family member after rude doctor making demands (and then there's the paperwork). You may not have a risk of killing as many people at once, but it's still life or death.

Sorry, I had reservations about posting this, because I know that it sounds negative, but I wanted to tell you the truth as I see it. I answered the question at hand. Ask what's good about nursing, and there are some answers to that, too.

DalilaRodriguez · May 15, 2012

Can someone help me on my senior project!!! ASAP!!! Any ideas? My topic is about stress factors that nurses face and I don't know what product to do? Can you guys help me on any product ideas???!!! I'm a senior in high school and this is my senior project. Please help